Bay State public health officials have discovered that the cardiac catheterization programs at Boston’s vaunted Massachusetts General Hospital and Worcester’s St. Vincent Hospital had unexpectedly high death rates in 2007.

In fact 43 of 1,543 patients undergoing the procedure at the General died and a ridiculous 16 of 112 patients died at St. Vincent.

That was significantly higher than state norms after accounting for severity of illness.

Hospital officials at both facilities attributed the high mortality rates to aggressive treatment strategies involving seriously ill patients, often at the request of family or referring physicians.

Which is better than leaving the old meat cleaver inside the body but it sure sounds like a quality problem in any case.

“Some of these patients are very difficult and quite ill,” St. Vincent’s CMO Octavio Diaz told the Boston Globe.  “Sometimes it’s very difficult to say no to those patients and their families.”

But he and Michael Fifer, director of the General’s cath lab promised to give it the old college try. They’re mandating a second opinion from a cardiologist before green-lighting caths on critically ill patients.

Conveniently, at the time of the announcement Paul Dreyer, the state’s director of healthcare safety and quality already had data in hand for 2008 and the death rates had settled down at both facilities so he saw no need to suspend the programs.

Which is good for everyone because that’s a story that would have gone national in a heartbeat.

So there’ll be a few extra inspections, an outside expert will fly in for a look before catching a Sox game and the shuttle home, maybe some extra documentation here and there and that’ll be the extent of it.

The millions of postmenopausal women who use multivitamins in the belief they prevent cancer, cardiovascular disease and premature mortality can forget about it, according to Marian Neuhouser and colleagues at Seattle’s Fred Hutchinson Cancer Research Center.

They don’t do any such thing.

To reach this conclusion, the scientists examined data from 161,808 participants in Women’s Health Initiative, an observational trial that enrolled women between 1993 and 1998 and tracked them through 2005.

The findings appear in the Archives of Internal Medicine.

Nearly 42% of women in the study took multivitamins.

During the observation period, there were 9,865 deaths, 8,751 cardiovascular events and 9,619 cases of bladder, breast, colon, endometrial, kidney, lung, ovarian or stomach cancer.

The multivitamin poppers tended to be more physically active, more likely to consume alcohol, more likely to be white and less likely to smoke than nonvitamin poppers.

After controlling for these factors, the scientists observed no difference in disease outcomes between the 2 groups.

“Multivitamin use does not confer meaningful benefit or harm in relation to cancer or cardiovascular disease risk in postmenopausal women,” they concluded.

It’s still possible that vitamins and other nutrients obtained from whole foods do impact survival, however.

Earlier this month physicians at a clinic in Udine, Italy withdrew nutritional support from Eluana Englaro, a 38 year-old woman that had been in an irreversible coma for 17 years. She died 3 days later.

Sad though it may be, such an event isn’t particularly newsworthy in most of Europe, but it was huge in Italy.

Pro-choice and pro-life protestors came to blows outside the clinic.

TV programming was interrupted to report the woman’s demise.

And at the time Ms. Englaro passed away, parliament was haggling over a bill to keep her alive.

“Eluana has been killed,” declared a member of Silvio Berlusconi’s ruling coalition.

After trying for 9 years, the woman’s father had secured a ruling from the nation’s highest appeals court that his daughter had a right to die because she had stated a preference not to be kept alive by artificial means before her auto accident.

The Vatican saw the ruling as licensing euthanasia, and since the women had been receiving care at a church-run facility, she had to be transferred.

And Berlusconi himself stepped into the fray. The prime minister, who thinks noblesse oblige is an Italian expression, directed his cabinet to issue a decree forcing the woman’s physicians to keep her alive.

Forget the political process and the polls showing most Italians favored the woman’s right to die. All that had to happen was for President Giorgio Napolitano to sign the decree and it was done.

But he didn’t.

Fallout from the tragedy is that Berlusconi and Napolitano won’t be sipping cappuccinos by the Spanish Steps any time soon, and parliament is making progress on a bill enabling people to draw up living wills.

That’s not something 21 year-olds are prone to do but it’s a start.

There aren’t many areas where Google is behind Microsoft but Personal Health Records might be one of them. Then again, the gap may be closing.

Last October, MSFT partnered with Cleveland Clinic and together, they enrolled several hundred of the Clinic’s most intrepid chronic disease patients into a pilot.

The patients are using multiple home monitoring devices to upload data to their Healthvault PHRs.

These heavily leaden HealthVaults are to be shared with Clinic physicians who presumably will have time to peruse all that data and know what to do next.

So when Google announced a PHR deal with IBM last week, people thought surely the 2 tech titans would have also roped in the boys up at Mayo or some place like that in response to MSFT’s deal with the Clinic.

But no, they haven’t gotten that far yet. Basically, IBM’s got software that lets patients upload data from their home monitoring devices into Google Health, so long as the devices comply with Continua Health Alliance standards.

That’s it from 2 companies whose CEOs have been carrying the Big O’s gym bags since Iowa?

Come to think of it, only a few hundred thousand people use Google Health and HealthVault combined, according to Parks Associates. A hundred times that still watch TVs running Rabbit Ears.

Despite that Sameer Samat, director of Google Health said he’s “pretty happy with progress so far” according to the Wall Street Journal. 

Then he got real. “We have had a lot of people who…rave, and probably more people who say it is a great start and here is what we want to see” feature-wise.

Days before the Big O’s special envoy Richard Holbrooke was scheduled to visit Islamabad, a Pakistani court released Abdul Qadeer Khan from house arrest.

He’d been living that way since 2004 after confessing to being top dog in the world’s largest nuclear black market.

Khan’s not going to be invited to many cocktail partys in the West, which reviles him as the man who sold nuclear technology to Iran, Libya and North Korea. But Pakistanis revere the man. After all, he built their bomb. 

The Pakistani press had been skewering President Asif Ali Zardari for cozying up to the US, so most viewed Khan’s release as politically motivated.

Fans and paparazzi mobbed the visibly elated Khan as he strode forth, not the least bit contrite and feigning disinterest in what the West might think about his release.

“Are they happy with our God? Are they happy with our prophet? Are they happy with our leaders? Never, so why should we bother what they say about us?” he told the New York Times.

Many Washington officials think Khan can reactivate his nuclear network, since it was never completely dismantled.

Why just awhile ago, computers seized from that network were found to contain 3 different designs for a nuclear bomb including one from China and 2 from Pakistan’s own nuclear blueprints.

“He’s still a proliferation threat,” State Department Robert Wood told the Times. “We’re very troubled by this.”

“The key question,” a Bush administration official said last year, “is whether he gave (those) designs to the Iranians.”

Of the 3 pirated designs, one was particularly compact and efficient; the sort that could be delivered by a Shahab-3 missile anywhere Iran aimed it within a 2,000 mile radius.

Reykjavik-based Decode Genetics, which is a lot better at personal genomics than selecting investment advisors, is back in the news now that its scientists have determined that 57% of all thyroid cancer is attributable to 2 genetic variations.

Julius Gudmundsson and colleagues report in Nature Genetics that the variants are simple base-pair substitutions occurring in genes residing near those controlling thyroid gland development, one on Chromosome 9 and the other on Chromosome 14.

Compared with those having neither variant, “the risk associated with these variants was almost six-fold, which is quite extraordinary,” Erich Sturgis, a head and neck surgeon at Houston’s MD Anderson Cancer told the New York Times.

Each year in the US, about 35,000 cases of thyroid cancer are diagnosed. Treatment generally includes surgical resection of the gland followed by lifelong thyroid replacement. It’s quite effective and only 1,500 people die from thyroid cancer each year.

The Decode breakthroughs are thus not going to trigger interest in population-wide screening programs, but the information would be useful in the assessment of people at high risk, such as those with a positive family history of the disease. 

Gudmundsson’s group reached its conclusions by performing a genome-wide association study involving 192 positive cases and a large control group.

They showed that people having both genetic variants had low levels of thyroid-stimulating hormone, which is produced normally by the pituitary gland.

TSH helps thyroid cells mature, so the authors postulate that chronically low TSH levels might impede their differentiation and thus increase the risk of malignant transformation.

If this theory proves correct, TSH supplementation might reduce the risk of developing thyroid cancer in affected individuals.

The tiny village of Roquefort-sur-Soulzon, nestled at the base of a limestone promontory overlooking a valley not far from Montpellier, has become ground zero in a nasty spat precipitated by George W. Bush days before he packed up and headed for a spider hole in Crawford.

The pristine valley is honeycombed with cravasses and caves that provide a completely unique environment in which ewe’s milk can be fermented just so to become Roquefort cheese, a blue-veined delicacy that some say is lovely with a spot of rye toast and a full-bodied red.

On January 13, US Trade Representative Susan Schwab announced the Bush administration had leveled a 300% duty on Roquefort cheese, essentially nixing the entire US market.

She said it was in retaliation for the EU ban on imports of hormone-containing US beef.

She added that the administration targeted other scrumdiddly items like French truffles, Italian sparkling water and “fatty livers of ducks and geese,” which last time we checked was foie gras.

But only poor Roquefort got nailed with a duty so steep it might as well be a ban, according to the Washington Post.

“This measure is completely out of proportion,” Robert Glandières told the Post. He’s a sheep farmer and heads of the Regional Federation of Ewe Raisers’ Unions.

“It’s a…provocation.”

Maybe so, but the Roquefort Economy is probably going to be just fine. The US had imported only 450 tons of the stuff per year, or 3% of the amount produced.

Besides, the Big O’s in town now. He knows that Roquefort tastes great on an arugula salad.

In a first-of-its-kind effort to assess total social costs of methamphetamine abuse, the RAND corporation pegged 2005 costs at $23.4 billion, which puts it in the same league as heroin.

Government surveys indicate that about 1% of the US population at least 12 years of age uses the drug at least once in a given year. That’s much higher than heroin and fully half that of cocaine. 

 About 400,000 of these are addicted to the drug, and more and more smoke it rather than swallowing or snorting it. Smoking offers a faster, more intense high and it’s more likely to foster addiction.

Meth abuse used to be a problem for Hawaii and the rural West and South, but it’s been catching on in the East and Midwest. 

RAND scientists estimated methamphetamine directly caused 900 deaths in 2005, and that social costs associated with this premature mortality were $4 billion.

The scientists then added $4.2 billion for costs associated with crime, $900 million in foster care costs secondary to parents’ addiction, nearly $700 million in productivity losses, $550 million for rehab costs and $350 million in health care costs.

They threw in $60 million for morbidity and mortality associated with exploding meth labs and toxic waste clean-up, and then  added $12.6 billion in estimated costs for things like the burden imposed by addicts on friends, families and children that don’t end up in foster care.

The calculation can be found here.

Christakis and Fowler are at it again!

Two months ago they caused a stir by publishing research in BMJ which seemed to show that happiness is contagious, a conclusion that some chalked up to an inexcusably naïve failure to recognize the effects of epiphenomena in social networks.

Now these crowd pleasers have put a piece in PNAS which concludes that a person’s popularity is genetically determined. 

Or as Christakis, a medical sociologist at Harvard told Medical News Today, “We were able to show that our particular location in vast social networks has a genetic basis.”

“In fact, the beautiful and complicated pattern of human connection depends on our genes to a significant measure,” he waxed.

Does this guy think he’s Ram Dass or what?

To reach this data-mining epiphany, Christakis and Fowler characterized the social networks of 1,110 identical and non-identical teen-aged twins from the National Longitudinal Study of Adolescent Health.

They measured popularity by the number of times an individual was named as a friend and the likelihood those friends knew each other.

Does this work for everybody?

Whatever, the scientists observed a higher concordance among the networks of identical twins than their non-identical counterparts.

They also concluded that whether a person was central to, or at the periphery of her social network was genetically determined, which inspired them to raise Charles Darwin from the dead, all in the same article.

Maybe it’s good to be on the periphery of a social group, they mused, like when there’s Ebola virus floating around. Then again, those hub-of-the-network types have access to more information like which Starbucks still has Christmas Blend in stock.
 
Please people.

Nearly 13% percent of US adults at least 20 years old have diabetes and 40% of them don’t know it, according to a study in Diabetes Care.

And another 30% have pre-diabetes, a condition characterized by mildly abnormal blood sugars and a risk profile not all that much better than the full blown syndrome.

All these numbers are higher than previously thought.

To reach these conclusions, a scientific team lead by the NIDDK’s Catherine Cowie performed a history and physical exam, and then a fasting and 2-h oral glucose tolerance test on a sample of 7,267 people from the National Health and Nutrition Examination Survey. The year was 2005-2006.

The team subsequently compared these values with similar data from 1988 and 1994.

 “We’re facing a diabetes epidemic that shows no signs of abating, judging from the number of individuals with pre-diabetes,” Cowie told BurrillReport.
 
Diabetes is the leading cause of amputations, blindness and renal failure in adults, and a prominent cause of cardiac disease and stroke. Pre-diabetes bumps one’s risk of stroke and cardiac disease not to mention developing type 2 diabetes.
 
The elderly and minorities have been hit particularly hard by the epidemic. Nearly a third of US citizens who are at least 65 years old have diabetes. And the incidence of the scourge in both blacks and Mexican-Americans is 70-80% higher than in whites.

Men and women were affected equally. Frighteningly, 16% of youth aged 12-19 years have pre-diabetes.
 
“These findings have grave implications for our health care system, which is already struggling to provide care for millions of diabetes patients,” Griffin Rodgers, the NIDDK director told Burrill.

Young, stupid and naïve was the way Alex Rodriguez described his behavior during his tenure with the Texas Rangers between 2001 and 2003.

The latest A-Bomb from A-Rod was that he used performance enhancing drugs during that particularly prolific part of his career…after adamantly denying this for years.

So now Rodriguez becomes the poster-boy for Major League Baseball’s juicing era; he’s by far the most famous player to admit using performance enhancing substances.

Other players like Mark McGwire, Sammy “Captain Cork” Sosa, Barry Bonds and The Rocket are also widely believed to have juiced, and like A-Rod’s, their denials have become required viewing for YouTubers.

“When I arrived at Texas in 2001, I felt an enormous amount of pressure,” Rodriguez told ESPN reporter Peter Gammons. “I felt like I had all the weight of the world on top of me and I needed to perform, and perform at a high level every day.”

“Back then it was a different culture. I wanted to prove I was worth being one of the greatest players of all time. I did take a banned substance, and for that I am very sorry and deeply regretful.”

According to the New York Times, Rodriguez said he didn’t know what he took and emphasized he’s been clean since joining the Yankees before the 2004 season. His positive test dates to 2003, his last with the Rangers.

In keeping with terms of the collective bargaining agreement between MLB and the player’s union, testing that year was carried out randomly, was associated with no penalties, and the results were to be kept secret.

All that changed in April, 2004 when the Feds, in hot pursuit of perjury charges against Barry Bonds in the BALCO case, seized the positive urine specimens from 2003. One of those cups contained A-Rods’ urine, which was reportedly glowing in the dark.

Last week the Feds unsealed 200 pages of evidence against Barry Bonds.

They plan to use it in March when the former San Francisco Giants slugger stands trial on charges he perjured himself before a grand jury in the 2003 BALCO case by claiming he never knowingly used steroids.

The documents tie the all-time home run king to 4 positive tests. They also include doping calendars and transcripts of a secretly-taped conversation in which Greg Anderson, Bonds’ longtime trainer and confidant says he injected Bonds with the juice.

Anderson has racked up more than a year behind bars for contempt by famously refusing to testify before that very same grand jury. His obstinance may yet invalidate some parts of the Fed’s case.

Three of the 4 positive tests date to 2000-2001 and were performed at the Bay Area Laboratory Co-operative. The fourth, a specimen collected by MLB in 2003 showed the designer steroid THG, a synthetic testosterone and clomid, a female fertility drug.

That specimen had come up clean using MLB-sanctioned tests, but it was seized by the Feds a year later and handed over to the UCLA Olympic Analytical Lab which found the goods. 

The tape-recorded conversation took place in 2003. It involved Steve Hoskins, a former Bonds business manager, and Anderson. Transcripts reveal Anderson saying he injected Bonds with designer steroids that weren’t detectable at the time.

Hoskins and Bonds had been childhood friends that reconnected when Bonds returned to the Bay area to play Left for the Giants in 1993. They had a spat in 2003 and next thing you know, Hoskins was wearing a wire for the Feds.

In sworn testimony before the BALCO grand jury, Bonds admitted using “the clear” and “the cream,” but claimed he did not know they were laced with performance enhancing substances.

Two days after federal officials discovered that Peanut Corporation of America knowingly shipped salmonella-laced products 12 times in the last 2 years, they launched a criminal investigation.

Soon there followed a public lynching on Capitol Hill and a liquidation filing under Chapter 7 of Virginia’s bankruptcy laws.

That was fast.

The salmonella outbreak has sickened 637 people in 43 states and killed at least 8. Nearly 2,000 products have been recalled.

“A criminal investigation has been initiated through (the FDA’s) office of criminal investigation. (It has) to work through the Department of Justice to develop a case and prosecute, if that’s what it comes to,” Stephen Sundlof told the Washington Post.

Sundlof is director of the Center for Food Safety and Applied Nutrition at the FDA.

The investigation might or might not trigger felony charges against PCA and its management team, according to Michael Taylor, a one-time food safety official at the FDA now at George Washington University.

“Under the food safety law, if you ship an adulterated food in interstate commerce, that violates one of the so-called prohibited acts and can be prosecuted criminally,” Taylor told the Post.

“Food can be considered adulterated if it is produced under unsanitary conditions.”

According to Taylor, the penalties for relevant misdemeanors top out at a fine of $1,000 plus a year in prison per offence. For felonies, the maximum punishment is a $10,000 fine and 5 years in jail.

No one knows yet whether it’s possible to file separate claims for each tainted lot, or how the bankruptcy filing will affect progression of the criminal investigation.

“The penalties are relatively light,” Taylor said. “If the facts are…as…reported, you have a company that was knowingly and recklessly shipping products from a facility known to be contaminated with salmonella,” he told the Post.

“The question is whether the criminal remedies in the Food and Drug Act are sufficient, given the severity of the harm.”

Looks like we know the answer to that.

The director of China’s central leading group on rural work has outlined an approach to manage growing unrest precipitated by a sharp economic downturn that has left 26 million migrant workers jobless.

“If mass incidents happen,” said Chen Xiwen “all officials must go to the front line and try to persuade people face-to-face. They cannot…push police to the front lines. The police cannot be deployed unless there are truly unfortunate situations where people are beating, attacking, robbing or burning.”

And officials should punish the instigators, learn from the conflict and figure out how to improve what they do, he added.

In that order, we assume.

Right now 15% of China’s 130 million migrant workers are unemployed and 6 million more will enter the pool this year, according to the Ministry of Agriculture.

China’s ranks of migrant workers have exploded in the past 20 years, as farmers are increasingly forced to rely on supplemental income, which can account for up to 60% of their total take.

“There is a saying in the countryside that to feed the mouth depends on farming but pocket money comes from outside,” Xu Yong told the Washington Post.

But “that road is blocked this year,” said the director of the Center for Chinese Rural Studies at Central China Normal University.

So at a recent conference with the state-owned press, Chen offered more than just crisis management tips. He urged local officials to solve land disputes, resettlement issues and environmental problems for example, lest they spawn demonstrations.

So will the protests increase? Xu couldn’t say for sure. “During the Spring Festival, most migrant workers went home and had a rest,” he said.

“After this, they will hunt for jobs. If they can’t find any jobs but stay in the cities, it will be easy to generate conflict and instability.”

“April and May will be the most serious time,” Xu said.

Female physicians implement evidence-based guidelines for drug utilization in heart failure more often than their male counterparts, according to Magnus Baumhäkel and colleagues at the University Hospital of Saarland.

Meanwhile, female heart failure patients are less likely than male patients to receive guideline-recommended drugs, the scientists reported in European Journal of Heart Failure.

To reach these conclusions, the scientists carried out a cross-sectional, observational study of 1,857 New York Heart Association Class II heart failure patients who were treated in eastern Germany from March through November, 2006.

Just over 52% of the participants were male and 63% received care from male physicians.

Female participants were a bit older—their mean age was 70 while the men clocked in at 66.

The scientists found that 80% of heart failure patients received either an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB). Nearly 4% received both. Only 70% of the patients were receiving beta-blockers, a third recommended drug for heart failure.

But the key was that use of “ACE-inhibitors or ARBs was significantly higher in male compared with female patients, and recommended doses also tended to be higher in males,” wrote the scientists.

Men also tended to get higher doses of beta-blockers, consistent with trial findings showing that higher doses of all these drugs are more effective.

Even so, only half the participants got “sufficient doses of ACE-inhibitors and only every fourth patient [was treated] with the recommended dose of a beta-blocker,” they wrote.

All in all, the researchers were left to conclude somewhat gallingly that a “female patient was likely to receive the worst medical treatment from a male physician, whereas male patients were best treated by a female physician.”

For young children, a family history of frequent, sun-splashed vacations is associated with more nevi, and nevi counts are a reliable indicator of lifetime skin cancer risk.

In fact for kids under the age of 7 each waterside vacation bumps the small nevi count by 5%, according to Lori Crane and colleagues at the University of Colorado.

In 2005, Crane and colleagues examined 681 children that were born in 1998 and lived continuously in Colorado. They also interviewed parents each year between 2003 and 2005 regarding vacations, sun exposure, and the use of sun block and hats.

The scientists classified vacations as waterside or not after asking about recreational activities like boating, surfing and water skiing.

They also accounted for climate and time of the year when vacations took place. Hawaii vacations counted as waterside no matter when they took place for example, but coastal North Carolina getaways counted as waterside only during summer.

No word on whether demerits were given to sun seekers venturing to Boston, by the way. 

Their findings appear in Cancer Epidemiology, Biomarkers and Prevention.

“Parents should be aware of the effect that vacations may have on their children’s risk for developing melanoma as adults and they should be cautious about selection of vacation locations,” wrote the scientists.

Interestingly, use of sunscreens and hats did not impact risk of developing small nevi, nor did eye color. And neither vacation length nor total estimated UV exposure predicted nevus counts; it was just the number of vacations.

Crane’s team suggested a threshold phenomenon could explain these observations. According to this hypothesis, radiation necessary to trigger nevus formation is obtained early during the vacation and additional exposure has no impact.

Boys were found to be at greater risk for sun-driven nevi development. They accumulated19% more by age 7 than girls. And Hispanic ethnicity reduced the risk of nevi by 35% versus Caucasians.

The presence of facial freckles and a positive sunburn history were also associated with more nevi.