El Pollo Loco, a chain of 418 grilled-chicken restaurants based in the Southwest, is engaged in an ugly cock fight with industry giant Kentucky Fried Chicken.

Last month, KFC launched a grilled-chicken product amid great fanfare. It was the largest new-product launch in the history of the bespectacled Colonel’s storied franchise, and a lightning strike to the grill of El Pollo Loco.

It didn’t buckle the contender’s knees. In fact, El Pollo Loco’s CEO Steve Carley unleashed a furious counterattack including TV commercials challenging KFC to a taste test.

He even set up a toll-free number that the Colonel could to call to arrange a showdown.

Yum Brands’ KFC, which has 11,000 outlets world-wide, claims it wasn’t ruffled by the challenge.

“We’re certainly more focused on Kentucky grilled chicken than on any advertising or online efforts of competitors,” KFC spokesman Rick Maynard told the Wall Street Journal.

Maybe so, but when a flood of calls came in to the hot line from people claiming to prefer KFC’s entry, El Pollo Loco’s handlers determined by tracing the caller IDs that some of the calls originated from HQ over at KFC.

“We’ve been grilling our employees to see if anyone’s done any undercover dialing,” Maynard said.

For El Pollo Loco though, this was a chance to make some serious gravy. It posted follow-up videos on YouTube outing KFC’s purported sham calls and claiming it had gotten under the Colonel’s oven-baked skin.

The spat has now escalated to the grandest stage of all, as king-maker Oprah Winfrey--who in the last year alone got the other Big O elected president and quadrupled the value of Twitter—announced that viewers could download coupons from her Web site for a freebie at KFC.

Once again, El Pollo Loco was ready. The coupons, it turned out, were good through mid-May, excepting Mother’s Day.

The contender posted yet another video on YouTube.

“What does KFC have against Moms?” it asked, while offering to honor KFC’s coupons on the holy day.

Responding to a flood of stories regarding unseemly relationships between researchers and the private sector, the venerable Institute of Medicine has released a report that declares it’s time for the medical community to clean up its act.

“Such conflicts present the risk of undue influence on professional judgments and may jeopardize the integrity of scientific investigations, the objectivity of medical education, the quality of patient care, and the public’s trust in medicine,” the report said.

The report’s notable recommendations include:

Professional societies, academic medical centers, and medical journals should implement conflict-of-interest policies that require financial disclosures between their staff and Big Industry.

Practice guideline-writing groups should exclude participants that have conflicts of interest.

Insurance companies should avoid promulgating policies based on guidelines that could be perceived as having conflict of interest problems.

Scientists should not undertake human trials if they are tied financially to the outcome of the research.

Teaching hospitals should proscribe staff from engaging in industry-controlled presentations, accepting gifts and claiming they wrote ghost-written manuscripts.

The IOM panel that prepared the report was chaired by Bernard Lo, director of medical ethics at UCSF.

“We do not say that if you disclose, problems will go away,” Lo told MedPageToday. “(But) there are certain types of relationships that are longstanding that doctors should not engage in anymore.”

The Pharmaceutical Research and Manufacturers of America responded that Big Pharma is already “careful to ensure that relationships with healthcare professionals and students are ethical and appropriate.”

And a device maker advocacy group said her groups’ code of ethics already covers the bases.

“We feel that physicians and industry interaction is important,” said Wanda Moebius, VP for policy communications at AdvaMed. “It helps improve communication, drives innovation and improves patient care.”

Fast-food chains and vending machines offer more healthful food items than ever these days, and sales are up. Sales of burgers, fries and assorted junk food, that is.

Gavan Fitzsimons may have figured out why. The Duke professor and his team concluded that simply seeing a salad on the menu empowers some consumers to select less healthy foods.

The scientists dubbed the phenomenon, “vicarious goal fulfillment.”

It seems that people can convince themselves a nutrition goal has been achieved by taking some small action, like considering a salad, without actually ordering it.
 
Fitzsimons’ team used a pre-test to identify people with particularly high levels of self-control regarding food choices. On the pre-test, they had consistently avoided French fries, the least healthy item on a test menu.

The team then asked subjects to select a food item from one of 2 pictorial menus. One menu offered up strictly junk: fries, chicken nuggets, and a baked potato with the fixins. The other menu had the same 3 items and a side salad.
 
Subjects shown the latter menu rarely chose the salad and went for the fries—the least healthy menu option—more frequently than those shown the salad-less menu.

The fascinating work appears in the Journal of Consumer Research.

“The presence of a salad on the menu has a liberating effect on people who value healthy choices,” Fitzsimons explained to BurrillReport.

“Simply seeing, and perhaps briefly considering, the healthy option fulfills their need to make healthy choices, freeing (them) to give in to temptation and make an unhealthy choice.”
 
The team concluded that schools and other establishments that are serious about promoting healthy behaviors better start deleting junk food from the menu altogether.

Last week, a Senate committee began fast tracking its version of a bill to regulate tobacco.

The bill’s sponsors, California Democrat Henry Waxman and Massachusetts Democrat Edward Kennedy say they’ve got a filibuster-proof majority that supports it, and the Big O, who has been known to take a drag or 2, said he intends to sign it.

The legislation would permit the FDA to regulate the manufacturing and marketing of tobacco, a product used by 20% of Americans, killing a third of them.

“If this happens, and if the FDA uses its powers, it will be an enormous public health achievement,” said Matthew Meyers, president of the Campaign for Tobacco-Free Kids.

The regulation will force the $89 billion tobacco industry to disclose the ingredients in its cancer-producers, and would allow the FDA to ban the most deadly chemicals contained in or produced by smoking cigarettes.

The bill will enable the FDA to cut nicotine levels in the smokes, perhaps to a point where the nasty leaf isn’t addictive, and require tobacco producers to increase warning label size from 30% to 50% of the carton package. 

Tobacco producers would also be prohibited from using terms like “light,” “mild,” and “low” unless they could prove the product was less harmful than the regular stuff. 

Remarkably, Altria supports the bill. It believes FDA approval will help it sell new products that are less deadly. The tobacco giant recently acquired US Smokeless Tobacco and is introducing a new line of, get this, spit-free smokeless tobacco products.

North Carolina Republican Richard Burr has vowed to fight the bill on behalf of his state’s stakeholders, RJ Reynolds and Lorillard. His alternative promotes reduced-risk tobacco products, which sounds like an oxymoron to us.

In Q1, 2009 alone, Altria spent $4.29 million to state its case regarding the bill, according to federal lobbying records. RJ Reynolds chipped in $1.59 million in the same period, and Lorillard paid $850,000.

The Campaign for Tobacco-Free Kids scraped together $157,000 and some coupons for free meals at KFC to lobby for its position.

The Agency for Healthcare Research and Quality is reporting an 18% increase in hospitalization rates for eating disorders between 1999 and 2006, and that’s not the whole story.

Although women between the ages of 19 and 30 are still the most commonly affected group, hospitalization rates are growing faster in demographic categories not usually considered to be at risk.

In particular, hospitalizations for children younger than 12 grew 119% over the same period, while admissions among males rose 37%. Hospitalizations for people between the ages of 45 and 55 grew 48%.

“Many people in my field are seeing younger and younger people appearing more severely ill, and we’re seeing more atypical patients,” David Rosen told AMedNews. Rosen is a professor of pediatrics and psychiatry at the University of Michigan.

The study, based on data from the Healthcare Cost and Utilization Project, revealed there were 28,155 hospitalizations for eating disorders in 2006.

The incidence of more serious diagnoses also increased during the study period. Patients discharged with cardiac dysrhythmias jumped from 650 to 1,462, for example. The number of patients that sustained acute renal or liver failure increased from 99 to 216.

Mortality remained stable at 0.6%.

Some believe the trend may be explained by improved awareness and diagnostic acumen, but others worry it may be collateral damage from the effort to stem the obesity epidemic.

“BMI testing or weighing of kids may wind up triggering something even worse,” warned Edward Tyson, medical director of Austin’s Cedar Springs Eating Disorder Treatment Center.

“I have a lot of patients who start out wanting to get healthy, but they don’t keep things in balance with exercise and food. Eating disorders are all about being out of balance.”

In the run-up to the Summer Olympics, Chinese officials pressed mines and factories near Beijing to shutter or move elsewhere in an effort to assure the event would be held under blue skies.

Now, as China rushes to invest nearly $600 billion of stimulus money and shake off a rare economic slowdown caused by the Great Economic Crisis, its skies seem destined to turn smoggy once again. 

The Ministry of Environmental Protection has begun fast tracking hoards of industrial projects, almost completely trampling environmental reviews in the process.

In one 3-day period late last year for example, it green lighted 93 new projects worth $38 billion.

“This is the moment to decide whether we want to keep the old growth model or change it,” Ma Jun told the New York Times. “This new round of development might generate more pollution for the future,” understated the director of China’s Institute of Public and Environmental Affairs.

China’s brief industrial slump actually helped the country close in on environmental targets it had set years ago. Data from the second half of last year showed that China was on target to increase energy efficiency by 20% and to cut water and air pollution by 10% compared with 2005 levels

Meanwhile, the central government’s environmental movement, such as it is, remains plagued by bureaucracy, conflicts of interest and worse.

Take the strange case of Pan Yue. Pan had been the number 2 guy in China’s environment ministry and was by far the most outspoken green supporter within the Communist Party. For years he had led a rare public campaign against polluters and supported rigorous environmental inspections.

This angered provincial officials, state-owned companies and his current boss who eventually sidelined him, shook down his top aides and harassed his wife, according to people who confided in secrecy with the Times.

For the record, Pan chalked up his lower profile to an illness, and records show he had indeed been hospitalized for a time.

It’s not the first time Chinese party officials have wound up in the hospital after falling out of favor.

Women who took valproate during pregnancy had children with lower IQ scores than those who used a different antiseizure medication, according to scientists at Emory University.

Valproate, available generically or under the brand name Depakote, is the second-most-popular drug for the treatment of epilepsy.

Earlier studies had shown it to cause developmental delays and malformations in the offspring of pregnant women.

To reach these conclusions, Kimford Meador and colleagues recruited 303 pregnant women that took drugs to control epilepsy from 25 medical centers in the US and the UK between 1999 and 2004.

They performed cognitive assessments on 258 2- and 3-year-olds born to these mothers, 53 of which had taken valproate.

They found that kids whose moms had taken valproate while pregnant had a mean IQ of 92. Kids that had been exposed to lamotrigine, phenytoin and carbamazepine in utero had mean IQs of 101, 99 and 98, respectively.

Overall, there was a strong correlation between the IQs of kids and their mothers, but this relation was not present in the offspring of mothers taking valproate.

The write-up appears in the New England Journal of Medicine.

Valproate is also widely prescribed for migraines, pain and psychiatric disorders although people taking the drug for these indications were not enrolled in the study.

The study authors warned against using valproate as first-line therapy for seizure control in women of childbearing age.

“If I (use another drug) and the patient has a breakthrough seizures, I can switch the patient to valproate,” said Meador reasoned for the New York Times. But “If I put the patient on valproate as a first choice and the baby has cognitive impairment or a malformation, I can’t repair that.”

US drug sales will fall 1-2% in 2009, according to IMS Health, a record drop. The market research firm expects growth to rebound in the following years, but that overall compound annual growth over the next 5 years will be flat.

The problem, according to IMS, has been inopportune pharmaceutical cost shifts to patients who are being hammered by the Great Economic Crisis, as well as patent expirations for several blockbusters in the upcoming years.

Global sales are not immune to these developments. IMS now predicts that worldwide sales will rise only 2.5- 3.5% this year, which is 2 percentage points less than it forecast before the Feds played Russian Roulette with Lehman Brothers and the chamber turned out to be loaded.

The new forecast translates to about $750 billion in 2009 revenues for Big Pharma.

In October, IMS had pegged that number at a cool $820 billion. 

“To the now-familiar factors impeding market growth such as patent expirations, a slowdown in innovative product launches, and hurdles imposed by payers on market access and acceptance, we can now overlay the economic downturn,” said Murray Aitken, a senior VP at IMS.

“There is a clear correlation between demand for medicines and key macroeconomic variables such as GDP, consumer spending and government expenditures. The pharmaceutical industry is not recession-proof.”

Despite the near term hit to global pharmaceutical sales, IMS predicts that the global compound annual growth rate for pharmaceutical sales will run between 3-6% through 2013.

Countries in which patients largely pay out-of pocket for drugs, such as China and Brazil will impact these figures negatively.

Despite this, IMS expects that China will rise from its current position as the world’s sixth-largest pharmaceutical market to 3rd place by 2011.

Law enforcement officials have begun a determined effort to expand DNA databases by obtaining specimens from citizens that have been arrested or detained for crimes but not yet convicted.

The FBI’s DNA database currently includes 6.7 million profiles.

It had been growing by 80,000 entries per year, but the new initiative will increase this annual growth rate 15-fold, to 1.2 million per year by 2012.

Cops say genetic surveillance solves crimes more accurately than other physical evidence. “I’ve watched women go from mug-book to mug-book looking for the man who raped her,” Denver DA Mitch Morrissey told the New York Times. “It saves lives.”

DNA evidence has also exonerated at least 200 wrongfully convicted people.

Courts typically support compulsory DNA collection from convicts on grounds they are not entitled to full privacy rights, but the new initiatives appear to trample those precedents.

Currently, minors in 35 states must provide DNA samples if convicted, and in some states they must submit specimens upon arrest. In 16 states, authorities can obtain samples from certain people after being found guilty of a misdemeanor.

Some believe the new initiatives threaten Fourth Amendment privacy rights. “The Constitution prohibits…indiscriminate taking of DNA for things like writing an insufficient funds check, shoplifting, drug convictions,” ACLU lawyer Michael Risher told the Times.

In the UK, which has fewer privacy protections than here, authorities have DNA samples for 4.5 million of its 61 million citizens including children as young as 10. About 20% of them have no criminal record.

Rock Harmon, a former prosecutor for Alameda County, Calif., told the Times there was no cause for concern. “If you haven’t done anything wrong, you have nothing to fear,” he said.

Hospitalized Medicare beneficiaries are far less likely to be seen in house by their PCP than they were 10 years ago, according to Gulshan Sharma and his team at the University of Texas medical Branch of Galveston.

The findings raise concern about continuity of care as various payment reforms and the hospitalist movement change longstanding routines.

The scientists reported that in 1996, 51% of hospitalized Medicare patients were seen by at least one physician that had seen them as an outpatient in the preceding year.

In 2006, that number had dropped to 40%.

To reach these conclusions, the scientists utilized a retrospective cohort trial design involving 3,020,770 hospital admissions from over a 2 year period, representing a 5% national sample of Medicare beneficiaries.

The write-up is in JAMA.

Using multivariable, multilevel models, the scientists ascribed about a third of the lost continuity to the hospitalist movement. Medicare payment formulas discourage PCPs from visiting their hospitalized patients when hospitalists are on the case.

Patients admitted on weekends, or who lived in large metropolitan areas or in New England experienced greater losses in contact with their outpatient physicians during the study period.

For its study, Sharma’s team posited that continuity of care included 3 dimensions: continuity in information, continuity in management, and continuity in the patient-physician relationship.
 
The team recommends further study to determine whether the reduced continuity of care has detrimental effects on patient outcomes, and that interventions be developed which would mitigate any such untoward effects.

The Bill & Melinda Gates Foundation’s Grand Challenges Explorations program announced last week that it awarded $100,000 grants to each of 81 scientific teams that had submitted unconventional, almost whacky-sounding ideas to improve health in developing countries.

Many wondered whether the program’s second round could generate the same creative idea-flow that characterized its first round, in which 104 scientists were funded last October including one fellow who plans to recruit mosquitoes into an air force of flying syringes that deliver vaccines rather than diseases.

It turned out to be no problem.

The program funded scientists from 17 countries whose ideas focused primarily on infectious disease treatment and prevention.

“Grand Challenges Explorations is our way to help inspire the bold ideas that could one day help transform global health,” said Tachi Yamada, president of the Foundation’s Global Health Program.

Among the compelling projects, Boitumelo Semete at the Council for Scientific and Industrial Research in South Africa will attempt to develop “sticky” nanoparticles that attach to tuberculosis-infected cells and slowly release anti-TB drugs.

Eric Lam at Rutgers will try to develop a tomato laced with antiviral drugs.

Thomas Baker at Penn State will try to infect malaria-carrying mosquitoes with a fungus that essentially gives them a head cold which, hopefully, suppresses their sense of smell and hence their ability to find human prey.

The winners were selected from more than 3,000 applicants.

The grantees are based at universities, research institutes, nonprofit organizations, and private companies in Africa, Asia, Australia, Europe, Latin America, and North America.

Applications for the next round of Grand Challenges Explorations are being accepted through May 28, 2009.

Routine preventive measures for kidney stones might someday include consumption of diet soda, especially the fruit-flavored ones, if the findings of a team led by Brian Eisner withstand further scrutiny.

The UCSF-based scientists proposed that surprising possibility at the recently concluded meetings of the American Urological Association.

Using ion chromatography, Eisner and colleagues measured the amount alkalis such as citrate and malate in 15 diet soda products. These 2 chemicals increase urine alkalinity and so create a milieu that inhibits formation and growth of kidney stones.

Diet Sunkist Orange and Diet 7-Up had the highest alkali content according to Eisner, and fruit-flavored concoctions in general contained much more of the good stuff than colas.

“It’s not clear how all of these products got their alkali,” Eisner told MedPageToday. “The drinks with the highest alkali in our study presumably got it from the orange or lemon-lime juices that were added to them.”

Diet Sunkist Orange had a total of 10.49 meq/L total alkali, mostly as the citrate. Diet 7-Up took second with 9.79 meq/L, all from the citrate.

The top 10 finishers were all fruit-flavored (orange, lemon-lime, etc.). Diet Squirt was tenth at 3.93 meq/L total alkali, an amount that was more than twice as high as the top-scoring cola-like beverage, which for the record was Diet Mug Root Beer, at 1.72 meq/L.

Eisner’s group limited its investigation to diet drinks because, according to Eisner, “we wanted to be able to recommend something that was healthier for our patients.

We didn’t feel as comfortable recommending something with a lot of sugar or calories in it.”

AUA spokesperson Anthony Smith said the study “suggests that people with stone disease who do not drink soda may benefit from moderate consumption.”

Aware of recent studies which showed that paying people to lose weight and quit smoking actually works, CIGNA and Merck have decided to launch a program that pays CIGNA beneficiaries to improve their diabetes control.

And if they happen to take Merck’s oral anti-diabetes medications during that effort, so much the better.

According to terms of the deal, CIGNA will review hemoglobin A1C results for enrollees who take oral hypoglycemic agents and if at the end of the year the values have improved, Merck will offer discounts on its entries in this field, Januvia and Janumet.

CIGNA will also review claims data for people taking the 2 drugs to determine whether they’re using them as prescribed by their physicians.

If they are, Merck will increase its discounts to CIGNA for these drugs even more.

CIGNA would then supposedly pass the savings along to its beneficiaries. 

“Merck (is) the first major pharmaceutical company to offer discounts on its oral anti-diabetic products, supporting CIGNA’s efforts to reduce A1C levels for individuals with diabetes, regardless of what medication they may be taking,” said Eric Elliott, president of CIGNA Pharmacy Management.

Januvia was approved by the FDA in 2006. Janumet made the grade in 2007. Annual sales for the two are in the $1.5 billion range, and some experts predict that number will triple in the next few years making these drugs world leaders in the growing market for oral antidiabetic therapy.

Come to think of it, why wouldn’t Merck throw tuppence at a program that hooks patients on its high-end drugs for the rest of their lives?

West Penn Allegheny Health System claims it’s losing its shirt because its larger rival, the University of Pittsburgh Medical Center has colluded with Highmark, the area’s leading private insurer to drive it out of business.

So it filed suit in federal court against both of ‘em.

West Penn’s accusations cite numerous activities since 2002 that ensured Highmark’s dominance while guaranteeing juicy payouts for UPMC.

“West Penn is running out of options,” Jan Jennings commented to the Pittsburgh Post Gazette. The CEO of American Healthcare Solutions added, “you don’t sue UPMC and Highmark, with the deep reserves of cash they both have, unless you’re desperate.”

UPMC released a statement saying it “unequivocally denies the allegations,” and that the filing is an attempt by West Penn Allegheny “to divert attention from (its) operating and financial difficulties.”

Last year, WPA took a $73 million write down caused by an overestimation of revenues derived from patient care. A month ago, the system reported operating losses of $9.1 million and a Q4 2008 net loss of $5.6 million.

Highmark officials announced they were “surprised and disappointed” by the lawsuit, while citing their recent$125 million loan to West Penn and multiple grants they provided to “strengthen (West Penn’s) administrative and information systems.”

West Penn claims the 2 organizations have “engaged in mutual back-scratching designed to preserve Highmark’s monopoly in health insurance and to permit UPMC to build a monopoly in sophisticated … health care in this region,” according to David McClenahan, its board chairman.

“I can’t judge the arguments. I just know these kinds of cases in general are very hard to prove,” Jennings opined.

The National Security Agency has been intercepting email messages and phone calls of American citizens in violation of the already broad legal limits imposed by Congress last year, according to government intelligence officials.

These officials indicate there has been significant and systemic, although possibly inadvertent “overcollection” of domestic communications involving people living in the US.

Last week the Justice Department acknowledged to the New York Times that, as part of a routine review of NSA operations, it “detected issues that raised concerns.”

Justice Department officials then “took comprehensive steps to correct the situation and bring the program into compliance” with the law and court orders, according to the statement.

The violations apparently began last July when Congress modified the law regarding government wiretapping powers on terrorism and spying suspects. The new spying framework apparently created implementation challenges and errors resulted.

The original law represented a triumph for the Bush administration, 3 years after his warrantless wiretapping program was outed in 2005.

After much wrangling in Congress, the original law permitted the NSA to collect, without court-approved warrants, gobs of international phone and email traffic as it passed across US telecom gateways, so long as the targets  were “reasonably believed” to be outside the US.

The modification was designed to assure the law wasn’t extended to US citizens but either something got lost in translation or NSA staffers ran into operational glitches making it difficult to distinguish domestic from international communications, or both.

The result was that the agency was targeting US citizens and domestic communications without warrants.

No one seems to know the scope of the problem, or if they do, no one’s talking.

It is not clear whether the NSA actively listened to conversations or read email from Americans, or whether it simply obtained access to them.

In the brains of patients with Alzheimer’s disease, A-beta proteins stick together to form plaques that are at least associated with, and may actually precipitate the clinical syndrome.

A-beta proteins are formed when enzymes known as secretases digest a larger protein known as amyloid precursor protein.

Knowing this, drug designers have tried to find something that inhibits the secretases, but so far the search has been fruitless.

Malcolm Leissring and a team at Mayo Clinic, Florida have taken a different approach. They searched for compounds that hasten the destruction A-beta proteins, and they may have hit paydirt.

In a report published in PLoS ONE, the scientists used in vitro procedures to isolate 2 chemicals that stimulate insulin-degrading enzyme or IDE, which chews up A-beta proteins faster than Owen and Jen’s white Lab Marley could dismantle a sofa.

Almost immediately after the chemicals were added to IDE, more than 99 percent of the A-beta was destroyed.
 
“This study describes the first examples of synthetic small-molecule activators of IDE, showing that activation of this enzyme is achievable,” Leissring told BurrillReport.

“If it is possible to generate drugs for human use that stimulate the activity of IDE, these agents might offer therapeutic benefit for treating and preventing Alzheimer’s disease.”
 
IDE is shaped like a clamshell that opens and shuts, like Pac-Man.

When IDE is open, A-beta fits snugly inside. The protease then closes like a Venus-fly trap and digests the A-beta.

IDE’s primary role is to digest excess insulin in the body, so small molecule activators like the ones uncovered by Leissring’s group might prove to be useful in managing diabetes one day as well.

The compounds are years away from human testing.