Archive for February, 2009

Mass General in the Doghouse

February 27th, 2009 | No Comments | Source: Boston Globe

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.

isthatamisprintIn 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.

allisforgivenConveniently, 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.



Bag the Multivitamins

February 27th, 2009 | No Comments | Source: Archives Int. Medicine, Wall Street Journal

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.

moneyspentonvitaminsThey 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.

lifesavers“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.



The Right to Die in Italy

February 27th, 2009 | No Comments | Source: Economist

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.

thatwasalongtimeagoSad 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.



Google-IBM Deal on PHR: Smoke, no Fire

February 26th, 2009 | No Comments | Source: Wall Street Journal

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.

msftLast 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.

bigblueBut 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.

thegooglesDespite 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.



Khan a Free Man

February 26th, 2009 | No Comments | Source: NY Times

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.

sophisticatediranianbombHe’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.”

eviliranianrocket“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.



Gene Link to Thyroid Cancer

February 26th, 2009 | 1 Comment | Source: Nature, NY Times

decodegeneticsReykjavik-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.

thyroidgenesahead1mileCompared 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 War on Roquefort Cheese

February 25th, 2009 | No Comments | Source: Wall Street Journal

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.

goodwitharugulaThe 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.



Meth Costs a Fortune These Days

February 25th, 2009 | No Comments | Source: NY Times

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.

One'sInvestmentinMethGovernment 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.

she'sgonnablow!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.



Popularity Genes

February 25th, 2009 | No Comments | Source: Medical News Today

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.



That’s a Lot of Diabetes

February 24th, 2009 | No Comments | Source: BurrillReport, Diabetes Care

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.

easiertoloseweightAll 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.



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