In the 15 years since cell phones first appeared on the scene, they have spread with astonishing speed and revolutionized communications on a global scale. But right around the time the Motorola Flip-phone was the rage, reports surfaced that cell phone use might be associated with brain cancer.

Since then, the majority of research on the subject has refuted this claim, as has the most recent publication on the matter by Isabelle Deltour of the Danish Cancer Society in Copenhagen, and her colleagues.

Deltour’s group looked at registry data from 4 Scandinavian countries between 1974 an 2003, a period encompassing the birth and growth of the technology.

They found that the incidence of the 2 major forms of brain cancer either remained stable, decreased, or continued the same slow rise that had been observed in the pre-cell phone era.

These findings are “consistent with mobile phone use having no observable effect on brain tumor incidence in this period,” they wrote in the Dec. 16 issue of the Journal of the National Cancer Institute.

The registry contained 59,984 glioma and meningioma cases had been diagnosed in people between the ages of 20 and 79 during the study period.

The incidence of glioma increased in men by 0.5% annually and in women by 0.2% annually during the study.

The incidence of meningioma increased 0.8% per year in men, on average.  In women, the incidence of meningioma rose by 2.9% per year from 1974 to 1987 (when cell phones began hitting the market), then dropped by 2.1% per year between 1987 and 1991, and then began rising again at a rate of 3.8%.

Most of that recent increase in meningioma incidence occurred in women who were at least 60 years old when they were diagnosed–an age group not likely to have been heavy cell-phone users back then.

The scientists could not exclude the possibility that very heavy cell-phone use could pose risks, or that a positive association may be present for very rare brain tumors.

In the last 3 decades, Americans have reaped enormous health benefits by smoking less, but have lost ground due to weight gain and obesity, and their negative impacts on health. Ever wonder how these competing trends interact with each other?

Susan Stewart of Harvard University and colleagues tried to answer this question by forecasting life expectancy for a nationally representative 18-year-old assuming that recent trends in smoking and weight gain continued for the next decade or so.

The scientists estimated cigarette smoking trends over the last 30 years using data from the National Health Interview Survey, and BMI data from the National Health and Nutrition Examination Survey.

It turned out that the negative effects of increasing body mass index swamped the positive effects of cigarette smoking declines.

Specifically, continued declines in cigarette smoking would increase the life expectancy of an 18-year-old by 0.31 year by the year 2020. However, continued escalations in BMI would cut life expectancy by 1.02 years over the same period of time, with an overall net loss in life expectancy 0.71 years.

The scientists did mention that other factors such as better nutrition and education are likely to generate a very modest increase in life expectancy despite the impact of obesity, at least through 2020.

But at some point, the authors concluded, a failure to address continued increases in obesity could erode the steady gains made in health over the last century.

It’s “a bit of a wake-up call,” senior author Allison Rosen told the Los Angeles Times. “We have attributed so many of our health problems to smoking, and we’re getting health improvements from declines in smoking. But changes in the rates of obesity are starting to outweigh the declines in smoking.”

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

Health and Human Services Secretary Kathleen Sebelius announced last week that she had ordered a complete review of the Feds’ ability to respond to emerging public health threats, bioterrorism and the like.

The news was prompted by the uneven performance of the government’s  swine flu vaccination program, which began delivering serious quantities of the jab right around the time the second wave of the outbreak began to subside.

“We’ll look for new technologies that will let us quickly produce countermeasures that are more dependable and more robust,” Sebelius told the AMA’s Third National Congress on Health System Readiness.

“Not just for flu and infectious diseases, but for all the public health threats we face.”

“Today, we face a wider range of public health threats than ever before in our history,” Sebelius told the crowd. “It could be anthrax delivered in an envelope. It could be a dirty bomb in a subway car. It could be a new strain of flu.”

“The countermeasure that saves the day during a quick-hitting public health emergency can take years to discover, develop, manufacture and distribute,” Sebelius continued. “We’ve often failed to make the kind of long-term investments in countermeasures that we need to stay safe.”

Referring to the H1N1 vaccine, which was produced far more slowly than officials predicted, Sebelius said “we were fighting (it) with vaccine technology from the 1950s…there was nothing we could do if vaccine grew slowly in eggs.

We could make deals with foreign vaccine producers ahead of time, but we (then) wouldn’t have as much control as if they were based in the US.”

Sebelius did point to some progress in this regard. She mentioned a new facility in Holly Springs, N.C. that can produce flu vaccine from cells in lieu of eggs, for example. That facility is being run by Novartis, which received nearly $400 million in seed funding from the Feds.

This post first appeared on HCPLive.com/Psychiatry.

Women that have been diagnosed with cancer or multiple sclerosis are 6 times more likely to be separated or divorced than their male counterparts, according to a study in Cancer.

To reach this conclusion, Marc Chamberlain and colleagues enrolled 515 patients at 3 medical centers beginning in 2001, and followed them for 5 years.

During the study period, 11.6% of the patients either divorced or separated, a rate similar to that found in the general population.

However, the rate was 20.8% when the woman was the patient and just 2.9% when the patient was male.

The scientists also detected correlations between age and length of marriage, and the risk of divorce or separation. Older woman, it turned out, were more likely to experience a break-up, although longer marriages tended to remain intact.

Regardless of gender, divorced or separated patients were found to have an increased reliance on antidepressants, less frequent participation in clinical trials, more frequent hospitalizations, and failure to complete radiation therapy.

“Female gender was the strongest predictor of separation or divorce in each of the patient groups we studied,” Chamberlain–a professor of neurology and neurosurgery at the University of Washington School of Medicine–told Newswise.

The authors speculated that men were more likely to leave a sick spouse because they were less willing or able to commit to being a caregiver, while women were more able to assume the task of maintaining home and family.

“We recommend that providers be sensitive to early suggestions of marital discord in couples affected by a serious medical illness, especially when the woman is the affected spouse and it occurs early in the marriage. Early identification and psychosocial intervention might reduce the frequency of divorce and separation, and improve quality of life and quality of care,” concluded the authors.

Most people have assumed that direct-to-consumer advertising has helped drive up the cost of drugs, but there really hadn’t been much proof of that. Until now, that is.

The proof comes in the form of a study published in the Archives of Internal Medicine.

In the study, Michael Law of the University of British Columbia and others looked at US sales of Plavix, the $4 billion clot-busting blockbuster co-marketed by BMS and Sanofi-Aventis for the prevention of recurrent heart attacks and strokes, and thrombotic complications following stent placement.

Plavix was introduced to the US market in 1998. DTC advertising for the drug began 3 years later, and exceeded $350 million dollars over the next 4 years.

Law’s group queried pharmacy data from 27 Medicaid programs from 1999 through 2005 to analyze changes in Plavix prescription volume, the cost per unit dispensed, and total pharmacy expenditures before and after DTC advertising was introduced.

The scientists detected no change in the preexisting trend in the number of Plavix prescriptions written after DTC advertising was introduced.

They did, however, detect a sudden, sustained increase in cost per unit of the drug, of $0.40 per unit dispensed which coincided with the introduction of DTC advertising.

This resulted in an incremental cost of $40.58 per 1000 Medicaid enrollees per quarter, or an additional $207 million in total pharmacy expenditures.

“The key issue is whether advertising to consumers, which has risen 330% in the last 10 years in the US, contributes to the significant cost increases in publicly funded health insurance programs such as Medicaid,” Stephen Soumerai told BurrillReport.

A meta-analysis performed by Italian scientists has shown that reducing salt intake by half in Westernized countries can reduce strokes by 23%, which amounts to about 1.25 million deaths, and reduce cardiovascular disease by 17% which amounts to nearly 3 million additional deaths per year.

Americans consume about 10 grams (or 2 teaspoons) of salt per day.

The  World Health Organization recommends that dietary salt intake should be half that. The US Department of Agriculture recommends just under 6 grams per day.

To reach their astounding conclusions, Pasquale Strazzullo and colleagues at the University of Naples pooled data from 13 prospective studies published between 1966 and 2008. The analysis covered 177,000 subjects who sustained more than 11,000 strokes or cardiovascular events.

The extra power of the meta-analysis proved decisive in reaching the positive conclusions, since only 9 showed a direct positive link between sodium intake and the adverse events (of which only 4 reached statistical significance). Three  actually showed a non-significant inverse relationship.

Studies featuring longer periods of follow-up appeared to strengthen the relationship between salt intake and stroke, although this was not the case for cardiovascular events.

The findings were not impacted by age, sex, and hypertension status.

In an accompanying editorial, Lawrence Appel of Johns Hopkins hailed the study as a “useful and welcome addition” to the confusing literature on the subject.

“At a minimum, Strazzullo and colleagues’ analyses should dispel any residual belief that salt reduction might be harmful (a canard resulting from misinterpretation of studies, often with flawed analyses),” Appel wrote.

Appel probably had in mind long-standing efforts by the food industry to oppose tougher public health policies on dietary salt intake, which have been largely successful because the above-mentioned studies had muddied the waters so completely.

The write-up is in the British Medical Journal.

In the 15 years since communications expert John Gray penned the book, Men are From Mars, Women are from Venus, the concept that the 2 sexes are wired differently has become entrenched in popular culture.

And there’s plenty of evidence to support his observations.

Most recently, a team from Poland used functional magnetic resonance imaging (fMRI) to assess gender differences in brain activity in response to images  designed to evoke various emotional reactions.

Lo and behold, they found plenty!

Andrzej Urbanik and colleagues from Jagiellonian University Hospital in Krakow demonstrated the differences in 40 volunteers, and presented their findings at the recently completed meetings of the Radiological Society of North America.

When the scientists showed women a sequence of negative images, fMRI records showed widespread activity in the left thalamus, an area known to relay sensory information to other parts of the brain that process pain and pleasure.

When the same negative images were shown to men, the fMRI revealed that the left insula lit up like a pinball machine. This region helps control involuntary activities like breathing, heart rate and digestion, and is involved in the so-called “fight or flight response.”

As for the positive images, the fMRI results in women revealed strong activity in areas of the brain associated with memory, while in men strong activity was found in areas associated with visual processing.

In an interview with the BBC, Urbanik postulated that “when confronted with dangerous situations, men are more likely than women to take action.”

As for the differential responses to the positive images, Urbanik suggested the differences imply that women tend to analyze them in a broader social context and associate them with particular memories.

An image of a smiling toddler for example, seems more likely to evoke memories of one’s own child in Venusians than in Martians.

Young adults may be putting themselves at increased risk of unplanned pregnancies and sexually transmitted diseases (STDs) during the upcoming holiday period, according to new independent research conducted by YouGov and published on the Web site of UK-based Marie Stopes International.

Nearly half (48%) of respondents aged 18-34 stated that they drink more alcohol during the holidays than at other times of the year, and 27% admitted having unprotected sex because they were too drunk to remember to use contraception.

In response, Marie Stopes has launched a ‘Wrap it Up’ campaign that urges men and women to carry condoms and practice safe sex during the holidays.

Marie Stopes’ UK centers are also offering an emergency contraceptive pill  (which can be taken up to 3 days after unprotected sex to terminate unwanted pregnancies) at the reduced price of £10 until January 31st 2010 or while stocks last.

The research also showed that of the 18-34 year olds questioned:

- 19% had sex with someone they just met due to the influence of alcohol at a holiday party,
- 45% had sex under the influence of alcohol with someone that they wouldn’t have, had they been sober,
- 41% had sex that they regretted the morning after.

“The combination of alcohol and the festive party spirit may reduce inhibitions, and lead men and women to make decisions about their sexual behavior that they may not have made if sober,” said Lindsay Davey, Sexual Health Nurse at Marie Stopes. “In January and February last year Marie Stopes’  UK centers saw greater numbers of women seeking abortion services than at any other time of the year.”

Add Selective Androgen Receptor Modulators, or SARMs to the list of substances used by athletes to enhance competitive performance.

SARMs have not yet been approved for any indication by any regulatory agency in the world. Nevertheless, scientists at the German Sport University in Cologne have shown there already is an Internet-based black market for the substances, which are believed to provide benefits similar to anabolic steroids with fewer side effects.

Many drug companies are developing SARMs for the treatment of osteoporosis, benign prostatic hyperplasia, and appetite loss associated with cancer.
 
Using mass spectroscopy, Mario Thevis and colleagues recently demonstrated the presence of Andarine, a potent SARM in containers labeled as green tea extract and face moisturizer that were purchased over the Internet for $100.

Their write-up appears in Drug Testing and Analysis.

“This product with considerable anabolic properties is readily available without sufficient research on its undesirable effects,” Thevis told BurrillReport. “This is especially significant where uncontrolled dosing is applied and drug impurities with unknown effects are present in considerable amounts as observed in the studied material.”

Thevis presented his findings at the Conference of Parties to the International Convention against Doping in Sport, which was held in Paris 2 months ago.

In 2008, the World Anti-Doping Agency (WADA) prohibited the use of SARMs in sports. WADA President John Fahey said at the time that in order to rid sport of doping, government agencies must adopt laws and regulations to combat the trafficking and supply of illegal substances.

People thought Columbus was nuts when he set off to find a shorter route to China, so let’s try not to snicker at the scientists who’ve announced plans to develop healthy ice cream.

Ingolf Gruen, a professor of food chemistry at the University of Missouri-Columbia, proposes to add fiber, antioxidants and probiotics to the real thing.

Gruen and his fellow ice cream professors chose these additives because they are known to contribute to good health and because consumers are familiar with them.

The Ice Cream Professor doesn’t anticipate that his concoction can match the seductive flavor or texture of the real stuff, however. 

What he’s after instead is consumers saying, “Oh it’s not as good as the full-fat heavy ice cream, but because it is good for me, and it still tastes good, I will purchase it,” Gruen explained.

“Our major challenges are texture, flavor and psychological acceptance,” Gruen continued.

“The nutrients we add often have bitter tastes and affect the texture of ice cream that we have to mask.”

Luckily for some ice cream fans, “flavors like chocolate are easier to work with because the flavor is so strong that it can overcome other flavors from the nutrients,” Gruen added.

The Ice Cream Professor has decided to include enough fiber to account for 10-15% of the recommended daily allowance, despite the gritty texture it will impart. “We want to make sure if you consume it there is a significant contribution to health benefits from these ingredients,” Gruen reasoned.

Gruen plans to have a prototype ready by spring. We know some denizens of Murray Hill that would be willing to give it a try.

Lincoln University, a historically black college located west of Philadelphia, requires that overweight students take a fitness course if they want to graduate, and that’s not sitting well with a number of students.

The rule was enacted 4 years ago. It requires that students get their body mass index checked, and those found to be obese—a BMI of 30 or higher—must take a class called “Fitness for Life,” which meets three hours per week.

The course involves physical activities including walking and weight training as well as information on nutrition and stress management.

James DeBoy, chairman of the Lincoln’s department of health said the school had become concerned about high rates of obesity and diabetes in the African-American community.

“We’re in the midst of an obesity epidemic,” he told MSNBC. “We have an obligation to address this head on.”

Protests bean last week when seniors—who are the first class affected by the new rule—began realizing they were running out of chances to meet the requirement.

Senior Tiana Lawson wrote in the student newspaper that she “didn’t come to Lincoln to be told that my weight is not in an acceptable range. I came here to get an education.” Lawson added that she has no problem with the general concept so long everyone must take the class.

As of this fall, about 80 seniors — 16% of the class — had neither had their BMI tested nor taken the class. At least some of them are expected to be cleared because they are not obese, officials said.

————–

UPDATE: After this post was written and scheduled for publication on Pizaazz, faculty at Lincoln decided to nix the idea of a required “fat course.” So obese students at Lincoln can now graduate without taking the class. 

In lieu of the requirement, the school will “suggest” to certain students that they enroll in a “Fitness for Life” class.

In the last decade, ultra endurance sports like triathlons and cycling marathons have grown in popularity. The granddaddy of these extreme sports is the Western States 100-Mile Endurance Run, which courses through the Western States Trail in Northern California. The first running was held way back in 1976.

Recently, scientists from the Virginia Commonwealth University and the Department of Veterans Affairs Northern California decided to have a look at the 3,500 people who have entered this event over the years.

They found dramatic trends in the demographics and results of the participants.

For example, the average age of race starters was 41 back in 1986, but between 2000 and 2007 the average age had risen to 45-47.

In addition, many more women now compete in the race. From 1986 to 1988, between 10-12% of the competitors were female. Since 2001 however, that percentage has nearly doubled to 20-22% of the competitors.

The scientists attribute this to the fact that more women in their 40s and up, and more men in their 50s and up have signed up for the race, while fewer men who were less than 50 have entered.

And these older runners have delivered. Every year since the inception of the event, the average age of the top 5 finishers has gone up. Initially this number was in the early 30s, but now it is in the late 30s. This phenomenon is mostly attributable to changes in finish times for women, which the scientists say have improved by 37 minutes per decade since 1980.

This means that the finish time difference between the top men and women has been cut by 4% per decade, to a margin of 14% in 2007.

The study appears in Medicine & Science in Sports & Exercise.

Until Friday, the UN-sponsored climate conference in Copenhagen had been a rather dull affair, characterized as it was by the bickering of mid-level dignitaries and the usual menagerie of activists and hangers-on outside the convention center.

But on Friday, there was significant news.

An ad-hoc UN working group released a document that will likely serve as a starting point for negotiations when the big boys roll into town later this week.

The document proposes a deal in which industrial nations cut carbon-based emissions between 25 and 45% compared with 1990 levels by 2020, and major developing countries like China and India cut theirs over the same period by 15 to 30%.

In addition, all countries would reduce emissions by 50 to 95% by 2050.

The document skated over details like how much money rich countries would fork over to poor ones to help them cope with global warming, or what levels of global temperature increases would be deemed “tolerable.”

Still, it was a start.

Aside from survival of the planet as we know it, the economies of every nation on Earth could depend on the outcome of this agreement. Rifts have developed between developed and emerging economies and between the world’s 2 major carbon emitters, China and the US.

The 2 superpowers disagree about their obligations to fix the mess, and warily eye each other in advance of the battle for supremacy in Green technology, which seems certain to drive national economic success for the rest of the century, much as information technology has driven US economic success since the 1970s.

Costa Rican delegate Ricardo Ulate, described the skirmishes for the Washington Post  as “a game where a new economic hegemony is being developed.”

That may be, but what he’s seen so far is just the undercard.

The main event begins later this week, at which point heads of government from 60 countries will have arrived in Copenhagen.

“We’re getting into the big leagues,” said Carlos Manuel Rodriguez, vice president for global policy at Conservation International. “The heavyweights are coming.”

Drugs used to reverse anemia in cancer and kidney failure patients are largely ineffective and markedly increase the risk of blood clots, according to a study by scientists at Columbia University Medical Center.

To reach this conclusion, Dawn Hershman and colleagues studied use of the so-called erythropoiesis stimulating agents (ESAs) in more than 50,000 patients that had been diagnosed with cancer.

In these patients, ESAs did not reduce blood transfusion requirements caused by chemotherapy, but they did jack up the risk of deep venous thrombosis and pulmonary embolism.

Hershman’s study population included patients that were at least 65 years of age and had been diagnosed with cancers of the breast, colon and lung. ESAs are used frequently in such patients as adjuncts to chemotherapy.

Survival was not impacted by the ESAs.

The number of patients receiving ESAs jumped 10-fold from 1991 through 2002. By that time, nearly half of all cancer patients were receiving them.

“This analysis confirms the association between ESAs and venous thromboembolism, which was observed in previous meta-analysis,” Hershman told BurillReport. “This data is from community practice – real-life clinical settings – where you see things that wouldn’t necessarily show-up in a short-term, 12-week study.”

Leading ESAs include Amgen’s Aranesp and Epogen, and Johnson & Johnson’s Procrit. Sales of these drugs topped $10 billion in 2006 in the US alone.

The meta-analysis mentioned above prompted the FDA to issue a black-box warning regarding the potential for tumor promotion, venous thromboembolism and decreased survival with ESAs. The warning suggested that ESAs should be used only for specific tumors and only when hemoglobin levels dropped below certain levels.

The write-up appears in the Journal of the National Cancer Institute.

For the second time this year, a clinical trial has shown that the cholesterol-lowering drug Zetia does not prevent heart disease.  

The first trial appeared last January. That trial compared Vytorin—a blockbuster drug that combines  the active ingredient in Zetia with a generic cholesterol-buster known as simvastatin—against simvastatin alone in patients with a genetic condition causing them to have very high levels of LDL (bad) cholesterol and premature cardiovascular disease.

In that trial, Vytorin reduced LDL cholesterol levels much more than simvastatin alone but surprisingly, atherosclerotic plaques actually grew faster in the coronary arteries of the patients taking Vytorin.

The news was greeted with a precipitous fall in prescription volume for both Zetia and Vytorin.

The second study was published last week in the New England Journal of Medicine. This study compared Zetia to Niaspan, a drug that raises blood levels of HDL (good) cholesterol.

In the second study, Allen Taylor of the Walter Reed Army Medical Center and colleagues enrolled 363 people with coronary artery disease that had been taking statins for many years. 

Taylor’s group found that Niaspan shrank carotid artery plaques by 2%, but Zetia had no such effect, even though it effectively reduced cholesterol levels (as it did in the first trial). In addition, patients who received Niaspan sustained 2 heart attacks or heart-related deaths during the study, while 9 patients receiving Zetia suffered that outcome, a significant difference.

Zetia “should be better for the arteries and it wasn’t,” Taylor told reporters covering last month’s American Heart Association meetings. “The drug wasn’t operating as you would expect.”

Officials at Merck, which co-markets Vytorin, said the study wasn’t large enough to draw firm conclusions and that larger trials of a similar nature are underway. Stay tuned.

This week, the Senate will bicker over health reform, EHR vendors will continue their anxious wait for government agencies to release Meaningful Use criteria on which their financial viability depends, people  will continue arguing whether middle-aged women should get mammograms, and world leaders from 100 countries will convene in Copenhagen to hammer out a new agreement that prevents or at least slows down global warming.

There’s not much doubt which issue will have the most impact on the health of US citizens, at least those who are around 50-100 years from now.

In 1997, the global family of nations released a document known as the Kyoto protocol. Its goal was to reduce worldwide greenhouse gas emissions to levels 5.2% below those produced in 1990 by year-end, 2012.

Since then, 187 countries have signed the document, including China, Russia, India and every country in Europe. But Uncle Sam, the source of nearly one-third of the world’s carbon emissions, never did. 

In the absence of leadership from the world’s biggest offender, global carbon-dioxide emissions rose 33% since the treaty was signed.

That’s despite the ready availability of cheap, low-carbon technologies which can be deployed in both developed and developing nations. Electricity can be produced by wind and solar plants, hydropower and nuclear fission, and cars and trucks can run on electricity and biofuels.

Views on the matter of climate change are as divergent as can be. Some are convinced that life on the planet hangs in the balance: we must reach an accord in Copenhagen and make it stick in major offending countries like the US…or else. Others think the global warming is unrelated to human activity and is likely to self-correct in a century or two.

Nobody really knows whether global warming is man-made or how bad it will get, so it’s no wonder that it’s been hard to persuade people to spend money on a fix. It’s the mother of all externalities.

Yet as The Economist points out, this uncertainty is precisely why man needs to tackle global warming, now. If we knew that temperatures would rise by just a few degrees in the next century, then the argument to let things go would seem somewhat reasonable.

But the Intergovernmental Panel on Climate Change (IPCC), which was organized by the UN to develop evidence-based consensus on the matter, and which used every shred of evidence it could find, could do no better than give a range. It concluded that if things are left as they are, by the end of this century the average temperature on planet Earth will rise somewhere between 2-11ºF.

No sane person can argue that temperature elevations near the top end of this estimate would be anything less than catastrophic. More than a billion people would be displaced by coastal flooding, and at least that many would be severely affected by associated climate change.

But there’s some good news. Assuming humans approach the problem smartly (as discussed for example, here), the costs of averting that kind of catastrophe are not nearly as great as many think…about 1% of the world’s global economic output for the next several years.

On average, US homeowners spend about that percentage of their income insuring their homes. Heck, just last year, the world spent 5% of total global output bailing out the banking system.

The technology to control global warming is here. Global warming is a problem with unknown but potentially catastrophic consequences that can be averted with no worse than mild economic consequences. How could we not do this?