Archive for August, 2009

Check Your Neck

August 21st, 2009 | No Comments | Source: NY Times

Many believe that healthy people should examine themselves regularly or submit to cancer screening because early detection saves lives.

nowweregettinsomewhere 200x300 Check Your NeckThat’s likely true for women, who should begin cervical cancer (Pap) screening by the age of 21, and for adults 50 years or older, who should get colonoscopy.

And it’s probably true for women at least 40 years old, for whom many suggest it’s wise to get mammograms annually to screen for breast cancer.

But that’s about it, at least according to today’s best evidence.

Which brings us to a well-meaning but ultimately dangerous PR campaign by the Light of Life Foundation to raise awareness about thyroid cancer.

“Confidence kills. Thyroid cancer doesn’t care how healthy you are,” read ads in People magazine, Sports Illustrated and elsewhere.  “Ask your doctor to check your neck.”

Thyroid cancer kills about 1,600 Americans per year. In other words, it’s responsible for about 0.3% of all cancer deaths in this country.

And there’s not a shred of evidence that routine neck exams cut the risk of death from thyroid cancer, according to Barnett Kramer, an associate director for disease prevention at NIH.

Most thyroid cancers grow slowly and are curable surgically no matter when they’re found, and the remaining ones are so aggressive that early detection doesn’t’ improve outcomes anyway, according to Kramer. 

A routine thyroid screening program would trigger thousands of unnecessary ultrasounds and needle biopsies not to mention thyroidectomies that risk damaging the vocal cords.

And there’s no guarantee that cursory palpations of the gland by busy PCPs would detect more than a small percentage of the tumors anyway.

Healthy people should consult with their physicians about cancer screening. And they should contact their physicians if new symptoms develop or if their health status changes in any way.

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A Bridge over the Valley of Death

August 20th, 2009 | No Comments | Source: BurrillReport

The National Cancer Institute has funded cutting-edge research for years, but now it’s engaged in some innovation on the financial side of things, and the initiative might just help the venerable institution improve the ROI on its own investments.

igotanidea 300x199 A Bridge over the Valley of DeathThe NCI’s idea is to set aside funds that help emerging companies forge the “valley of death,” a term describing the period after their SBIR funding is exhausted and before they are ready to raise funds from an increasingly penurious VC community. 

According to BurrillReport, then acting NIH Director Elias Zerhouni hatched the idea upon realizing that $650 million invested by NIH in the Small Business Innovative Research program was not yielding adequate returns in the form of newly commercialized drugs and devices.

Zerhouni charged the NCI’s Michael Weingarten and Andy Kurtz to remedy matters, and they came up with the concept of the Bridge Awards.

“A lot of projects die on the vine when they exhaust the usual funding through the SBIR program. The idea with the Bridge Awards was to provide additional funding for the most promising projects,” Kurtz explained to Burrill.

The NCI recently issued its first round of Bridge Award grants and is now reviewing a second round. The 3-year grants top-out at $3 million.

Bridge Award applicants must match NCI funds on a dollar-for-dollar basis via external funding mechanisms. The Award provides non-dilutive capital and a measure of independence for the  companies while helping the NCI to validate the commercial potential of the company’s product.

“It’s money that buys you some runway or buys you time to a next milestone where you can get traditional venture capital,” Ernst & Young’s Glen Giovannetti explained.

“With NIH, there’s a process by which you have to qualify, so there is a scientific review and validation that comes from that.”

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Red Bull So Yesterday

August 19th, 2009 | No Comments | Source: NY Times

How is it that a vile-tasting drink that costs 20 times more per ounce than a Pepsi can generate $700 million in revenues in just its fourth year of sales?

newjolt Red Bull So YesterdayBecause it contains caffeine. A lot of caffeine.

The so-called “energy shots” are now ubiquitous at convenience stores, especially those located near college campuses or at truck stops.

Students, truckers, construction workers and others need their caffeine after all, and why bother sipping a cup of Joe or being seen with a hopelessly passé 16 oz. canned energy drink when you can slam down a 2-oz. jolt in one gulp? 

“It helps me stay up all night when I have work to do,” University of Maryland sophomore Matt Sporre told the New York Times.

Energy shots cost $3-4 per 2-oz. plastic bottle. At that price, a large bottle of Coke would run $40, a price-point that would humble even Starbucks.

In the face of the explosion, sales of first-generation energy drinks like Red Bull have lost their luster. 

So Red Bull has recently introduced its own shot, as has venerable Coca-Cola. Dr Pepper Snapple will soon have an entry and a raft of smaller companies have flooded the shelves as well.

oldschool Red Bull So YesterdayNone of them has managed to steal much thunder from the industry leader however.

Living Essentials, a Detroit-based outfit, still controls 80% of the market with something called 5-Hour Energy.

But why not do something about that awful taste?  “Five-Hour Energy’s not supposed to taste fantastic,” said Joseph Sperber, a spokesperson for Living Essentials.

“This is supposed to be a functional product, not something for flavor or refreshment.”

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Mass Hysteria or Toxic Exposure?

August 18th, 2009 | No Comments | Source: NY Times

Tian Lihua had just clocked in for work at a textile mill outside Jilin when she became nauseated, then dizzy. Moments later she passed out. In the next few days 1,200 of her co-workers developed medical issues ranging from seizures to shortness of breath and transient paralysis.

spoiledrotten 300x225 Mass Hysteria or Toxic Exposure?“When I came to, I could hear the doctors talking,” she told the New York Times last month. “They said I had a reaction to unknown substances.”

Tian and her colleagues believe those “unknown substances” had wafted downwind from the Jilin Connell Chemical Plant which makes aniline, a notoriously toxic chemical used to produce rubber, dyes,  polyurethane and herbicides.

Local hospitals began seeing befallen workers immediately after the plant opened this spring. On a bad day, so many workers showed up that the hospital was forced to put 2 in each bed.

The State Administration of Work Safety initially stated on its Web site that the cause was a “chemical leak,” but hours later the statement was pulled down.

Now, local health officials as well as those dispatched from Beijing contend the entire event is due to mass hysteria….psychological reactions on a massive scale to a presumed chemical exposure.

The officials have admonished the workers to “get a hold of their emotions” and get back to work, say afflicted individuals and their loved ones.

 “How could a psychological illness cause so much pain and misery?” asked 29 year-old Zhang Fusheng, who appeared to a Times reporter to be short of breath despite being hooked up to an oxygen mask. “My only wish is to get better so I can go back to work and take care of my family.”

The Ministry of Health in Beijing refused to release details of its investigation, but local officials insist they found no evidence of a toxic exposure.

The plant is partially owned by local government officials. Its president is Song Zhiping, who is also a representative to China’s legislative body, the National People’s Congress.

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File Sharing Software Exposes Data

August 17th, 2009 | No Comments | Source: Washington Post

Government personnel using popular online file-sharing software have inadvertently caused sensitive government and personal data to be released.

yourmoneyoryourstimulus 200x300 File Sharing Software Exposes DataThe information includes lists of people with HIV, FBI photos of a Mafia hit man, the names of people in the federal witness protection program and the safe-house location for Laura Bush, according to testimony provided last week to the House Oversight and Government Reform Committee.

The leaks occur when people download so-called “peer-to-peer” software to share music or other files. Many of these software products expose the contents of their computers’ databases to remote users, the experts explained.

“The administration should initiate a national campaign to educate consumers about the dangers involved with file-sharing software,” Towns understated to the Washington Post.

Expert testimony was provided by Robert Boback, the chief executive of Tiversa, a company that scans Internet-based music- and file-sharing networks for sensitive data. Boback told the committee that foreign governments are exploiting peer-to-peer software to spy on the US government.

“Other countries know how to access this information and they are accessing this information,” he warned.

The list of HIV infected people also included their Social Security numbers, according to Boback. 

“This is unbelievably sensitive medical data,” Deborah Peel told the Post. The founder of Patient Privacy Rights added, “It has people’s names on it from mental-health treatment programs, drug studies. These files have everything needed for identity theft, the most prominent and frightening consumer issue with electronic systems.”

Another expert witness, Lime Group chairman Mark Gorton said his company’s P2P software renders such piracy extremely difficult, but there are hundreds of P2P software providers out there.

“Most creators of P2P applications are not based in the United States, and may not even be corporations,” Gorton said.

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Disease Prevention is no Cure

August 14th, 2009 | No Comments | Source: Wall Street Journal

Seems like just about the only thing folks inside the Beltway can agree on these days is that the US government ought to invest in disease prevention. It’s cheaper to keep people healthy than to treat them after they become sick, right?

igotanidea 300x199 Disease Prevention is no CureWell, maybe.

The Wall Street Journal is reporting that some government-led prevention efforts have worked, while others have been costly failures.

The WSJ cites a study on the matter appearing in last year’s NEJM for example, which reviewed 279 prevention-oriented government initiatives and found a mixed bag.

The NEJM authors cite a program to increase colonoscopy rates in men in their early 60s as one that saved lives and money, but pan another that screened people for diabetes in addition to high blood pressure. That one wound up costing $590,000 for every healthy year of life added.

Meanwhile according to the WSJ, Medicare has conducted 7 pilots of disease management programs in the last decade, and not one of them showed cost savings or improvements in health status.

The largest such study was the Medicare Health Support program, which began in 2005 and covered 200,000 patients. In that study, participants with diabetes and CHF were assigned to companies that were supposed to help them improve their health while reducing medical costs.

Nurses from these companies contacted patients relentlessly to assure treatment plans were implemented. They shipped educational materials and shepherded patients to health promotion classes.

The initiative had no impact on hospitalization rates, readmission rates, ER visits or mortality, nor did it cut Medicare payments by an amount equal to the costs of the services themselves, which amounted to between $67-118 per month.

Disease management programs like these are “not going to cut costs,” Louise Russell, a professor at Rutgers University told the Wall Street Journal. “We already do a lot more prevention than other countries (and)…we are not healthier.”

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Hawthorne Effect Found to be Bogus

August 13th, 2009 | No Comments | Source: Economist

In 1924, the National Research Council dispatched 2 engineers to study the effects of shop-floor lighting on productivity at the Hawthorne Plant, a telephone-parts factory near Chicago.

hawthornefactoryworkers 300x199 Hawthorne Effect Found to be BogusTheir observations led to an unexpected, but soon-to-be widely accepted principle of management science. The “Hawthorne Effect” posits that being observed, whether by a scientist or a supervisor, changes peoples’ behavior.

The phenomenon was derived from the engineers’ accounts of their experiments, in which they observed that the output of workers on an assembly line increased when lighting was raised in the factory, but also when it was lowered.

The worker’s behavior improved, it appeared, when they realized they were being watched.

Many had questioned the validity of those conclusions, and the original data was thought to have been lost.

Recently however, University of Chicago economists Steven Levitt and John List discovered the data and decided to reanalyze them using new econometric techniques.

The pair concluded that worker productivity at the Hawthorne plant did not change in response to lighting alterations at the plant, and that the engineers’ incorrect interpretation resulted from an epiphenomenon they had not accounted for.

The engineers, it turns out, always adjusted plant lighting on Sundays, when the plant was closed. Monday’s worker output was indeed greater than Saturday’s, but that was true even for weeks in which no adjustment was made to the lighting on Sundays.

Levitt and List concluded that workers just worked harder on Mondays.

Similarly, the engineers had noted that plant output fell after their experiment ended, which supported their conclusion. But they ceased experimentation during the summer. The economists found that similar summer drop-offs occurred in the years before and after the engineers ran their trials.

It does get hot in Chicago in the summer, after all.

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Who will get Arthritis in 20 Years?

August 12th, 2009 | No Comments | Source: Economist, Osteoarthritis and Cartilege

Several conditions associated with aging, such as atherosclerotic blockages of the arteries and cataracts can be treated nowadays, but for osteoarthritis, a condition that affects millions in this country alone, little can be done save the administration of anti-inflammatory agents and pain relievers.

knee 300x126 Who will get Arthritis in 20 Years?Osteoarthritis of the knees can be particularly unfortunate since afflicted individuals typically cut down their physical activity in response, and this can exacerbate or cause other health conditions like diabetes. 

A cure does not appear imminent, but a new technique developed by Lior Shamir and colleagues at the NIH might just be able to predict who will get the condition 20 years prior to symptom onset.

This would be good since people found to be at risk could be encouraged to lose weight, exercise properly, and alter their diet to ward off the onset of the painful condition.

Shamir’s group digitized 200 x-rays that were taken in the 1980s for a project designed to document human aging. All radiographs had been read as normal at the time.

Since the images were obtained, many of these people developed osteoarthritis of the knees.

The researchers sorted the original x-rays into 2 groups: one group included “normal” pictures from the people that eventually developed osteoarthritis while the other had pictures from people that did not.

The researchers then looked for subtle structural alterations of the bone and cartilage in both groups of x-rays.

From the inter-group differences they detected, they built a computer algorithm designed to predict which individuals would eventually develop osteoarthritis and which would not.

Their algorithm proved to be accurate 72% of the time, an astonishing finding considering that the x-rays had originally been read as normal and that they were obtained 20 years before symptom onset.

The write-up is in Osteoarthritis and Cartilage.

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Doctor Ratings Stir Controversy

August 11th, 2009 | No Comments | Source: Washington Post

In the old days, patients could do little when physicians kept them waiting, blew-off their questions or seemed incompetent. A tale of woe over the phone to friends or family, or if things got really bad, a complaint to the state medical board was all they could muster.

scientificratingsystem 144x300 Doctor Ratings Stir ControversyThe Internet has changed that. In the last 5 years, several dozen Web sites have cropped up where patients can post reviews of their physicians, and the chatter on such sites has been louder than the birds at Bodega Bay.

“The worst doctor I have ever encountered in my life,” ranted one consumer. “Impolite, unengaged and unfocused,” chirped another. “Long wait, rude staff, never sent me a follow-up on my tests.”

The most popular physician rating sites, according to the Washington Post, are RateMDs.com, DrScore, Yelp, and Vitals.com.

They support themselves via ad revenues from Google and they’ve become a force.

RateMDs.com for example, has ratings on more than 200,000 physicians and attracts a million unique visitors per month, not to mention the wrath of physicians.

“The people least capable of judging quality of care are patients,” argued Washington DC internist Nancy Falk. “They don’t know what we know.” 

“Doctors aren’t like dishwashers or trash compactors or minivans,” agreed orthopedic surgeon Peter Lavine. The sites, he told the Washiington Post, “attract patients who have an axe to grind.” 

Meanwhile, ethicist Arthur Caplan worries the sites don’t focus on care outcomes, which he insists is the most important consideration.

“One person’s brusque is another’s direct,” Caplan told the Post. “Many doctors who score well on ambiance are not good doctors… (I’ve seen) doctors who were well beyond the border of malpractice who kept going because patients loved them.”

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Schizophrenia Genetics: Complex

August 10th, 2009 | 1 Comment | Source: BurrillReport, Nature

A multinational group of scientists has concluded that about a third of the genetic underpinnings of schizophrenia are caused by the interactions of many thousand common genetic variants. While each variant may be harmless on its own, the combined impact vastly increases the risk of both schizophrenia and bipolar disorder.

thyroidgenesahead1mile 300x225 Schizophrenia Genetics: ComplexThe results imply that the genetic basis of the 2 common psychoses  are more complex than had been thought, and that the conditions can develop not just from a rare, devastating genetic variant, but from dozens or hundreds of common ones.

The write-up is in Nature.
 
“This is an enormous first for our field,” co-author Patrick Sullivan told BurrillReport. “We now have the outline of the puzzle, we just need to… see how (the pieces) fit together,” added the professor of psychiatry at the UNC School of Medicine.
 
Although scientists have long recognized that schizophrenia has a genetic basis, it’s only recently that they’ve started pinpointing offending genetic loci.
 
To reach their conclusions, Sullivan and colleagues isolated 30,000 genetic variants that occurred more frequently in 3,000 people having schizophrenia than in a control group without the condition. The team confirmed the differences in 2 other populations of schizophrenic patients and 2 groups with bipolar disorder.

The genetic link between schizophrenia and bipolar disorder had not previously been recognized.
 
“While our study finds a surprising number of genetic effects, we expect that future work will assemble them into meaningful pathways that will teach us about the biology of schizophrenia and bipolar disorder,” senior author Pamela Sklar told Burrill.
 
The scientists also found that a particular HLA haplotype increased the risk for both psychoses. Since HLA proteins are involved in the immune response to infections, they speculated that an infectious agent might be an etiologic factor.

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