Many normal people abhor something about their physical appearance–a beauty mark, their nose, flabby thighs or whatever. In a few people however, the issue becomes an all-consuming, irrational obsession that prevents them from focusing on work or school or even leaving their homes. The obsession can lead to drug abuse or attempted suicide.

The latter instance, which is believed to affect tens of thousands of Americans, is known as body dysmorphic disorder (BDD), a syndrome that has been recognized for more than 100 years but that only recently made it into DSM-V, the diagnostic manual for psychiatrists.

Unlike eating disorders which disproportionately affect women, BDD is nearly as prevalent in men as in women. In one form of BDD affecting guys (muscular dysmorphic disorder), people who are totally jacked from compulsive weight training actually think they look puny and weak.

According to Katharine Phillips, a professor of psychiatry at Brown Medical School and a BDD expert, many individuals trace the problem to emotional trauma in childhood like being teased about their looks, parental neglect or abuse. Most people overcome this without developing BDD, especially if other factors in their lives lift self-esteem.

There may be a genetic component as well: about 20% of BDD patients have an affected parent, sibling or child.

Both cognitive behavioral therapy and serotonin-enhancing drugs (SSRIs) appear to be effective treatments for BDD. In the former, counselors help patients reorder their self-perceptions and expose their “defect” to others. SSRIs help 50-75% of affected individuals, although positive effects aren’t usually seen for months after drug therapy is initiated.

Cosmetic treatments do not work. They can modify one “defect,” but the affected individual often develops another.

Cancer is always in the news. Yet although nearly half of all US cancer patients die of their disease or related complications, no one seemed to know whether news reports reflected this reality.

Jessica Fishman and colleagues at the University of Pennsylvania decided to look into the matter by reviewing the content of cancer news stories in 8 high-circulation newspapers and 5 popular magazines.

The scientists identified 2,228 cancer-related articles appearing between 2005 and 2007, and focused on a randomly selected sample of 436 of them. They found that in general, the stories were overly optimistic about survival, more likely to focus on aggressive treatments and rarely covered negative things like death, treatment failure and adverse events. Almost none of the stories covered end-of-life issues.
 
In particular, 140 stories focused on people who survived or were cured of the disease, while 33 focused on people who were dying or had died of cancer. Just 57 articles mentioned that aggressive cancer treatments can fail. A majority of articles (249) discussed aggressive treatment exclusively, but only 57 reported that such treatments can fail to extend life or cure the disease, or that some cancers are incurable. Just 131 mentioned adverse events associated with treatment, and a grand total of 2 articles focused on palliative or hospice care exclusively.

“These portrayals of cancer care in the news media may give patients an inappropriately optimistic view of cancer treatment, outcomes, and prognosis,” the authors write in the Archives of Internal Medicine.

“For many patients with cancer, it is important to know about palliative and hospice care because this information can help them make decisions that realistically reflect their prognosis and the risks and potential benefits of treatment.”

Congress is pressuring private companies to cease doing business with Iran, but the  effort has encountered the same problems US sanctions have ran into for 30 years  — reluctance in the European Union to play ball and a bevy of shady, Middle Eastern front companies that can maneuver around any prohibitions.

Both chambers of Congress have passed bills that would sanction companies supplying gasoline to Iran, as well as the insurance and shipping companies that support such trade, in an effort to deter the Islamic republic from developing the bomb.

The US would like to stop sending Iran 130,000 barrels a day of gasoline that the oil-rich nation imports because it can’t refine the stuff.

Several companies including Caterpillar, Huntsman and Siemens have announced they will stop doing business with Iran.

But Catherine Margaret Ashton, the EU’s representative for foreign affairs and security policy, has written to Secretary of State Hillary Rodham Clinton opposing the congressional sanctions.

Those bills “envisage the extraterritorial application of US legislation and would be contrary to the EU-US understanding of 1998, under which it was agreed that such sanctions would not be applied to the EU in the light of the EU’s commitment to work with the US to counter the threat that Iran poses to international security,” she wrote.

Meanwhile, oil industry sources told the Washington Post that that Iranian front companies are securing gasoline from the United Arab Emirates, and that companies based in Iraq were doing the same thing.

In Iran, gasoline is heavily subsidized, costing drivers just 38 cents per gallon, although the government has cut quotas recently, and seems to be stockpiling gasoline. Best guesses put the nation’s gasoline supply on hand at about 1 month’s worth.

Amid an unfolding nationwide outbreak of salmonella that has been linked to salami made with tainted black and red pepper,  officials from the Food and Drug Administration met recently with spice industry representatives to figure out how to prevent future outbreaks. 

People agree that spices need to be treated with either irradiation, steam heating or fumigation with ethylene oxide to rid them of bacteria. But the FDA cannot currently require such action.

Last year, the House overwhelmingly approved legislation that would require domestic spice producers to take these steps and spice importers to assure the safety of foreign supplies, but the bill is stalled in the Senate.

The outbreak of salmonella-tainted salami has been linked to 249 illnesses in 44 states. There have been no deaths.

Although salmonella is more commonly associated with poultry, meat and vegetables, the bacterium can survive in dried spices for years. And since spices have a long shelf-life, it becomes difficult for health officials to link diseases to particular spices.

With the exception of garlic, onions and red chili peppers, most spices consumed in the US are imported from countries like Brazil, China, Egypt, Grenada, India, Indonesia, Morocco, Spain, Sri Lanka, Turkey and Vietnam, developing nations where pollution and water problems create contamination hazards.

About half the nation’s spices are irradiated, but these end up being sold to industrial customers. Retail spice companies don’t irradiate spices because federal law requires that this be disclosed on the label. The industry believes consumers won’t buy such products.

“If the labeling issue would go away, there would be a high interest (in) irradiation,” said Steve Markus, director of food safety and commercial products at Sterigenics, the nation’s largest food irradiation company.

Anger management programs are a popular antidote these days for immature celebrities, road ragers, obstreperous airline passengers, and foul-mouthed employees.

But the programs, which range from pricey private sessions with therapists to anonymous group sessions on a conference line, may or may not work. Few studies have been designed to find that out.

There are no licensing requirements for trainers and no regulatory oversight of the programs, and there have been notorious failures—those Columbine kids attended one before shooting up their school in 1999, for example. 

The problem is made worse by the fact that clinicians often can’t determine whether a pattern of angry outbursts signifies mental illness or a simple behavioral issue. This means that some people who need psychiatric help don’t get it. 

Psychiatrists typically recommend a psychiatric exam for people with repetitive outbursts, because anger often accompanies common psychiatric disorders.

The closest thing to a psychiatric diagnosis for isolated anger is Intermittent Explosive Disorder, which is defined as recurrent episodes of aggression against people or property that is out of proportion to any provocation. Scientists estimate that 5% of Americans (mostly men) fit these criteria.

“These people are hot heads, and the people around them are walking on egg shells. They don’t know when they are going to blow up next,” University of Chicago psychiatrist Emil Coccaro told the Wall Street Journal.

While some people with IED respond antidepressants, most psychologists believe that individual talk therapy is the way to go for treating the condition. 

For their part, anger-management trainers think psychiatrists over-diagnose the condition. 

“I don’t want everybody who calls up for anger management to be assumed to have a mental illness,” Ian Shaffer told the Journal. Shaffer is chief medical officer for MHN, which runs employee-assistance programs including anger management. MHN claims that ¾ of the employees whose jobs were on the line when they began the program were in good standing upon its completion.

Lately, the Food and Drug Administration has been receiving increased numbers of reports describing  problems with insulin pumps, those small devices used by diabetics to deliver insulin without the need for injections.

The FDA noted that various hardware and software issues have resulted in 18 device recalls during the last 5 years.

“Device problems…exist across manufacturers,” the agency noted. 

In response, FDA has convened an advisory panel to recommend actions to “minimize risks associated with the devices in these recall situations,” according to its Web site.

Insulin pumps are typically used by patients with Type I diabetes, in which the pancreas produces little or no insulin. Type 1 diabetics rely on exogenous insulin for survival.

According to the FDA, the number of people in the US who used insulin pumps increased from 130,000 in 2002 to 375,000 in 2007.

The FDA requires pump makers to report problems and potential problems associated with the devices. The agency received 17,000 such reports in the 3-year period ending September 30, 2009. Such reports don’t necessarily mean the pump caused a problem but usually merit further investigation. Patients can misuse a properly functioning pump, for example.

Roughly 12,000 reports to the FDA were associated with a patient injury (which typically involved gyrating blood glucose levels). Deaths occurred 310 times.

In these instances, the FDA said information provided by pump makers “was typically incomplete.” In 225 of these reports, the manufacturer listed the device problem as “unknown.” In many of these cases, the device wasn’t returned to the manufacturer for follow-up investigation.

In 41 reports involving a patient death, the circumstances included diabetic coma and other problems typically associated with severe abnormalities in blood-sugar levels, which suggests possible device malfunctioning.

Everyone knows that people react differently to pain: the initial jab of Novocain at a dentist’s office causes excruciating discomfort for some, while others barely seem to mind. But is that because some people truly feel more pain than others in a given circumstance (such as an injection) or because some people can just suck it up better?

A new study by Frank Reimann and colleagues at Cambridge Institute for Medical Research suggests the former may be true, even though it doesn’t completely rule-out the whimp factor.

Reimann’s group reported in the Proceedings of the National Academy of Sciences that variations in the SCN9A gene were associated with changes in the perception of pain.

To reach this conclusion, they studied kids with a rare condition characterized by an inability to detect pain. These kids can pass knives through their arms and walk across hot coals without a flinch. Reimann’s group found this extremely maladaptive condition was associated with a nonfunctioning SCN9A gene.

The scientists reasoned that polymorphism at the SCN9A locus could cause differing pain thresholds, and tested their hypothesis by examining DNA from 578 people with osteoarthritis. They found that folks having a common variant of the SCN9A gene had lower pain self-assessment scores than those having a rarer form of the gene.

The scientists reproduced their findings in people with back pain, pancreatitis and phantom limb pain.

The SCN9A gene it turns out, codes for a membrane-bound protein on pain sensory nerve cells. The protein is involved with triggering those cells, which then relay a pain message to the brain. Apparently, the version of the protein created by the rare SCN9A decreases firing thresholds in the cells so they are more likely to relay bad news.

The Senate Finance Committee is investigating patient deaths and allegations of substandard treatment at the Select Medical Corporation, a for-profit company that operates 89 long-term care facilities, making it the largest organization of its kind in the nation.

Long term care hospitals treat about 200,000 seriously ill patients per year, although they rarely employ full-time physicians. The facilities are defined solely by their length of stay, although they also tend to be smaller than acute care hospitals and do not have emergency rooms.

In a letter sent to Robert Ortenzio, the CEO of Select , the committee’s top two senators, Montana Democrat Max Baucus and Iowa Republican Charles E. Grassley demanded that his company provide records concerning staffing levels and turnover, and patient monitoring and the quality of care at its facilities.

The letter is not a subpoena, but companies typically respond voluntarily to things like this.

A New York Times article prompted the investigation. The article described poor treatment and several deaths at long-term care hospitals, including one owned by Select in which a dying patient’s heart alarm rang for 77 minutes before nurses showed up.

Former employees of Select told the Times that Select’s hospitals are understaffed, and that the company tries to keep patients for exactly 25 days since the most profit can be obtained by patients who stay for this duration, according to government reimbursement rules. 

Select spokesperson Carolyn Curnand said her company would cooperate with the Senate investigation. She said the Times article was misleading and inaccurate and that her company had a record for providing high quality care. She denied that Select discharged or held patients for financial purposes.

The Ortenzio family has made $400 million since starting Select 14 years ago.

Coffee drinkers are less likely to be hospitalized for heart rhythm disturbances, according to scientists who presented at an American Heart Association conference last month.

The findings might seem counterintuitive for people that experience palpitations after drinking coffee, especially if they believe palpitations are associated with heart rhythm disturbances (they are, but the association is weak, especially in young, healthy people).
 
Nevertheless Arthur Klatsky and colleagues from the Kaiser Permanente Division of Research reached this conclusion by following 130,054 people. Those who reported drinking four or more cups of Joe per day had an 18% reduction in the risk of hospitalization for arrhythmias. People who reported consuming one to three cups per day had a 7% lower risk.
 
Previous studies showing the opposite result—that caffeine can produce arrhythmias—were based on much higher levels of caffeine intake, Klatsky said. He also cited the findings of a Danish study showing that heavy and light coffee drinkers experienced the same risk of atrial fibrillation, a common major disturbance of cardiac rhythm.
 
 “Coffee drinking is related to lower risk of hospitalization for rhythm problems, but the association does not prove cause and effect,” Klasky told BurrillReport. It is possible, for example, that other characteristics of coffee drinkers, like their dietary habits or how much they exercise, could be driving the apparent association.

As a result, it’s certainly not possible to advise people to drink coffee in order to prevent heart rhythm disturbances. Still, Klatsky felt his findings might reassure people who drink moderate amounts of coffee: their habit isn’t going to trigger a major rhythm disturbance.

The Food and Drug Administration and the National Institutes of Health have announced they will collaborate to hasten development and commercialization of biomedical breakthroughs,  an effort that might eventually reduce R & D costs for developers and speed new therapies to the bedside.

The project will utilize the NIH’s expertise in supporting biomedical innovation and the FDA’s 100+ year experience in the regulation of drugs, biologics and medical devices.
 
 “We’ve all been following the remarkable advances in biomedical sciences led by the NIH with great enthusiasm for years,” says HHS Secretary Kathleen Sebelius.

“However, much more can be done to speed the progress from new scientific discoveries to treatments for patients. Collaboration between NIH and FDA, including support for regulatory science, will go a long way towards fostering access to the safest and most effective therapies for the American people.”
 
The two agencies, both belonging to HHS, plan to establish a Leadership Council that will oversee collaborative work on public health issues, assure that regulatory matters are factored into biomedical research planning and assure that cutting-edge science becomes part of routine regulatory review processes. The agencies will also pony-up about $6.8 million during the next 3 years to support research on the effects of regulation on biomedical innovation.
 
“The FDA plays an essential and unique role in how therapies are evaluated. We are the bridge between biomedical research discoveries and new medical products,” FDA commissioner Margaret Hamburg told BurrillReport.

“We are working in collaboration with the best minds and research institutions available, so that we can better develop and utilize new tools, standards and approaches needed to properly assess the safety, effectiveness and quality of products currently in development or already on the market.”