Archive for August, 2010

Paying People to Prevent STDs

August 30th, 2010 | 1 Comment | Source: BurrillReport

Paying people to avoid sexually transmitted diseases effectively reduces their spread, according to a proof-of-concept study carried out by scientists at UC Berkeley, the Development Research Group at the World Bank and the Ifakara Health Institute in Tanzania.

The study involved young adults in southwestern Tanzania. Subjects were randomly assigned to a high-payment group, a low-payment group and no-payment control group. Participants in the high payment group received $20 every 4 months–up to $60–if they tested negative for STDs. Those in the low-payment group received half that amount.

Participants in all groups received individual counseling and could attend monthly group counseling sessions as well. Any participant that tested positive for an STD received free care for the condition.

By the end of the year, 9% of participants in the high-payment group had tested positive for an STD. That was significantly better than the 12% rate seen in both the control group and the low-payment group. The cash reward had the same impact in men and women. It had a more pronounced effect in people with lower incomes.

“For many of our study participants, $60 represented about one-fourth of their reported annual income, so it was a significant incentive,” says Will Dow, a study author and a health economist at Berkeley. “The question we tested is whether the cash reward was enough of an incentive to reduce risky behavior. The fact that disease prevalence decreased suggests the incentives worked.”

Participants were tested for chlamydia, gonorrhea and syphilis. HIV/AIDS status was not tested, but the same sexual behaviors that increase the risk of the STDs increase the risk of HIV.



Condom Maker Sold for a Boatload

August 27th, 2010 | No Comments | Source: Wall Street Journal

UK-based consumer-products giant Reckitt Benckiser Group has entered the bedroom by acquiring SSL International, the maker of Durex, for $3.9 billion. Durex is the world’s best-selling condom brand.

Before purchasing the condom-maker, Reckitt had accumulated a ménage of decidedly unsexy products including d-Con mousetraps, Clearasil acne cream, Veet hair remover, Mucinex decongestant, Lysol disinfectants and Harpic toilet-bowl cleaner.

In marketing Durex, SSL had recently moved from a “safe sex” message to “better sex.”  It introduced a line of lubricants and began selling vibrators in supermarkets and pharmacies. It also entered emerging markets like India and China. Durex sales rose nearly 5% last year, to $410 million.

In addition to condoms, the SSL deal allows Reckitt to market Scholl bunion pads outside the US (Merck has rights in the US), where they can enhance Reckitt’s already profitable line of OTC health care products including Gaviscon heartburn elixir and Strepsils cough drops. Even before the deal, health and personal care had been Reckitt’s largest market, accounting for about 40% of its $9.3 billion in sales.

In this market, shoppers will pay a premium for trusted brands, according to Julian Hardwick, a Royal Bank of Scotland analyst. “If you’ve got a sore throat, runny nose or splitting headache,” she explained to the Wall Street Journal, “You want something to sort that out for you. You really don’t care how much you pay for it.”

Reckitt’s offer of £11.71 per share was 45% above SSL’s average share price over the last 6 months. SSL shares traded below £5.50 just 9 months ago, suggesting the acquisition might have come a bit late for Reckitt.

The deal was prompted by pressure from consumer-goods colossus Procter & Gamble, which had been gaining market share vs. Reckitt in several categories in Western Europe over the last year.


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Can Recurring Nightmares be Treated?

August 25th, 2010 | No Comments | Source: Wall Street Journal

In Victorian times, dreams were believed to represent repressed sexual desires or random brain activity. Now scientists believe they reflect an attempt by the unconscious mind to process and store emotion-laced events from the day.

“We take our problems to sleep and work through them during the night,” Rosalind Cartwright, a neuroscience professor at Rush University Medical Center told the Wall Street Journal.

According to Cartwright, during dreams the mind juxtaposes unprocessed emotions encountered during waking hours with older, related memories. “That’s why dreams look so peculiar. You have old memories and new memories Scotch-plaided into each other,” she added. “They are emotional connections rather than logical ones.”

If this theory is true, it may be possible for people to direct their own dreams. For example, people who experience recurring nightmares might learn to substitute happier endings or eliminate them altogether.

A small group of people who practice “lucid dreaming” believe this is indeed possible. According to these people, recurring nightmares are caused when people wake up from the frightening experiences, thereby interrupting the normal process of emotional reconciliation that takes place during dreaming. Without the reconciliation, the dream is left to repeat itself.

“Your brain seems to think that it’s helping you to prepare, but you don’t allow yourself to finish it so it becomes a broken record,” Shelby Freedman Harris, a Behavioral Sleep Medicine expert at Montefiore Medical Center explained to the Journal.

Harris runs a program that tries to help folks either rewrite or delete the script of recurring dreams using a technique known as Image Rehearsal Therapy. In implementing the technique, dreamers recreate the nightmare with better endings or more palatable story-lines (substituting dolphins for sharks, for example), and rehearse the new script several times per day. 

While far from 100% effective, many of Harris’ patients are able to dream the revised script, while others stop having the nightmare completely.



Docs Push Back Against Performance Reports

August 24th, 2010 | No Comments | Source: Wall Street Journal

Private health insurance companies have long since required patients to pay higher out-of-pocket fees when they see physicians who are not in the insurers’ contracted physicians network. In a more recent development, they have begun to rank physicians according to quality and cost parameters and offer enrollees lower out-of-pocket charges if they see physicians who fare better on these parameters.

In such programs for example, a doctor shown to order fewer imaging tests that are of questionable value would rank in a higher category.

Physicians have always objected to these practices. A March article in the New England Journal of Medicine brought the issue to a boil by showing that these tiered rating systems misclassified 22% of all doctors.

The study prompted provider organizations to release a letter protesting the payer’s practices. “Physicians’ reputations are being unfairly tarnished using unscientific methodologies and calculations,” the letter claimed.

“There are serious flaws in health insurers’ programs to try to rate individual physicians,” AMA President Cecil Wilson added in an interview with the Wall Street Journal.

The provider organizations implored payers to reevaluate their ranking programs.

Payers’ reactions to the letter were lukewarm. For example, Cigna told the Journal that its doctor-rating program already addressed issues raised in the study by focusing on physician groups rather than individuals. Besides that, “Some physicians do provide higher-quality or more-efficient care, and it makes sense to provide modest incentives for choosing that care,” said Dick Salmon, the company’s VP for network quality.

A spokesperson for WellPoint responded it has “taken a thorough, thoughtful approach in introducing measures of physician quality and cost effectiveness” and that the effort is “collaborative with the physician community.”


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Egg Producers No Strangers to Trouble

August 23rd, 2010 | No Comments | Source: Washington Post

Last week, 2 Iowa-based egg producers recalled more than half a billion eggs after federal investigators traced a recent salmonella outbreak to their production facilities. The outbreak began in May. So far, it has not been linked to any deaths.

The two companies are Wright County Egg, which recalled 380 million eggs that had been distributed across the nation, and Hillandale Farms, which recalled 170 million eggs that had been distributed to 14 states in the West and Midwest. According to the Washington Post, the companies use some of the same suppliers of feed and young chickens, a fact that may help investigators trace the source of the outbreak.

Hinda Mitchell, a spokesperson for Wright County Egg told the Post that her company “recognizes the significant consumer concern about the potential incidence of Salmonella Enteritidis…we continue to work cooperatively with FDA after our voluntary recall. This is consistent with our commitment to egg safety.”

It turns out that the Iowa-based DeCoster family owns or has close ties with both egg producers.

For what it’s worth, the Post reported yesterday that the family has a long history of run-ins with federal officials. In 1996 for example, another DeCoster-owned egg farm was dunned $3.6 million for health and safety violations after inspectors found employees handling dead chickens and manure with their bare hands.

Then, in 2001, Iowa’s Supreme Court cited the family as a “repeat violator” of its environmental laws, singling-out violations involving DeCoster’s hog-farms. Later that year, the family settled a complaint that company supervisors subjected 11 female workers to a “sexually hostile work environment,” including assault and rape.

What is more, in 2002 and again in 2008, OSHA cited the family for several violations that resulted in the exposure of workers to dangerous conditions.

Of course none of this is directly relevant to the salmonella outbreak…



FDA Panel Cuts Avandia Some Slack

August 20th, 2010 | 1 Comment | Source: Wall Street Journal

An FDA advisory panel has voted to allow ongoing sales of the diabetes drug Avandia despite the fact that Glaxo’s former blockbuster poses a “significant safety” concern by increasing the risk of cardiovascular events.

The FDA is not required to follow the recommendations of its panels, although it usually does.

Nearly one-third of the 33-member panel voted to ban Avandia. Most panelists who voted to keep the drug on the market called for increased restrictions on its use, and said it should be used only as a second- or third-line drug for the treatment of diabetes.

For example, David Oakes, a statistics professor at the University of Rochester, told the Wall Street Journal that his vote for continued sales of Avandia should not be construed a “vote of confidence,” but rather that he was concerned about the quality of studies which link Avandia to heart attack risk.

Janet Woodcock, who heads-up the FDA’s drug division, said her agency will decide on the matter within the next few weeks.

Avandia sales have plummeted since a 2007 article in the New England Journal of Medicine reported a 43% bump in heart attack risk with the drug. Q1, 2010 world-wide sales of Avandia were reported to be $245 million, off 10% year-over-year.

The FDA panel also concluded that Avandia posed a greater heart attack risk than Actos, a rival drug made by Takeda. Both drugs were approved in 1999 for blood-glucose control in patients with Type 2 diabetes.

In the wake of the panel’s announcement, Glaxo’s Chief Medical Officer Ellen Strahlman defended the safety record of Avandia. She said the drug would remain on the market pending the FDA’s decision.


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Lobbyists Impact Comparative Effectiveness Research

August 19th, 2010 | No Comments | Source: Washington Post

The Affordable Care Act has catapulted the US Preventive Services Task Force from an obscure agency which produced unenforceable guidelines about screening and preventive services into one whose recommendations directly impact reimbursement.

The health reform law requires insurers to pay in full for services receiving an A or B recommendation from the Task Force. The flip-side is that insurers may not have to pay at all for services that are not recommended by the Task Force. As a result, the Task Force’ new best friends include lobbyists and disease advocates who want their priorities — things like screening for Alzheimer’s disease, HIV and diabetes or HIV — to get covered.

The American Diabetes Association, for example, is advocating that insurers be required to cover a broader population than current Task Force recommendations suggest. Current recommendations are that only patients with high blood pressure should be screened.

The HIV Medicine Association has made a similar argument to the Task Force. It claims that a key reason why 20% of people infected with HIV are unaware of that fact is because most insurers don’t cover the costs of testing.

“If you want to be evidence-based, lobbying doesn’t fit,” Ned Calonge, the chairman of the Task Force told the Washington Post. “My charge to members would be to stay true to the methods and the evidence.”

The Task Force, by the way, is the same one that caused a stir before the 2008 presidential election when it recommended that women should start receiving screening mammograms at the age of 50, rather than 40. That move was eventually trumped by an amendment to the Affordable Care Act which required insurers to cover mammograms for women in their 40s.


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How Dead is the Gulf of Mexico?

August 17th, 2010 | No Comments | Source: Washington Post

In the 4 months since the Deepwater Horizon blew up and oil began spilling into the Gulf of Mexico, scientists have been trying to understand the magnitude of the gusher’s ecological impact.

The gusher has been plugged thankfully, although there is no consensus on how much damage has been done. Some believe the gulf has largely avoided an ecological disaster. Others say that the spill has pushed already damaged ecosystems to the brink.

Take those ghastly pictures of oiled birds, for example. Officials say they’ve found only 1,200 of them, a fraction of the 35,000 that were discovered after the Exxon Valdez disaster. Of course, officials only count the birds they find. Some scientists believe the number is much higher.

“It’s an instinctive response: They’re hiding from predators while they recover,” Kerry St. Pé, told the Washington Post. St. Pe, who oversees a marsh protection program, added “They plan to recover, and they don’t. They just die.”

What about coastal marshes, whose oil-stained shores made regular appearances on the evening news? “The marsh grasses, the canes, the mangrove are dying,” Robert Barham, secretary of the state’s Department of Wildlife and Fisheries told the Post. “There’s visible evidence that the ecosystem is changed.”

But the National Audubon Society’s Paul Kemp disagreed. According to him, the impact of the spill was small by comparison to the marsh’s existing problems.

“We have a patient that’s dying of cancer, and now they have a sunburn, too,” Kemp said. “What will kill coastal Louisiana is not this oil spill.” (It’s) what was killing it before this oil spill,” he explained, citing erosion and river-control projects.

There is also disagreement about the presence of “plumes” of dissolved or submerged oil offshore. Some scientists claim to have found underwater oil many miles from the gusher.  But an official at the National Oceanic and Atmospheric Administration said his agency found significant submerged oil only within 6 miles of the well.

“Right now,” John Valentine, a gulf researcher told the Post, “we should be more impressed by what we don’t know than what we do know.”



Genes and Longevity

August 16th, 2010 | No Comments | Source: NY Times, Science

Boston University scientists claim to have identified a small set of genetic variants that predicts extreme longevity.

The scientists, Paola Sebastiani and Thomas Perls, examined the DNA of 1,055 centenarians living in New England. They isolated 150 gene variants that were common in this population. They subsequently examined a separate sample of centenarians and found that 77% of them had many of the same genetic variants.

The centenarians in the original cohort had as many disease-associated gene variants as shorter-lived people, so the scientists reasoned that the genes they identified must protect against disease.

This conclusion is at odds with current thinking about extreme longevity which is predicated on the assumption that long life is caused by the absence of disease-causing gene variants, rather than the presence of protective genes.

To find the protective genes, the scientists implemented a genome-wide association study, a technique that has so far failed to meet expectations that it would unlock genetic secrets behind common conditions like diabetes and Alzheimer’s disease.

Some scientists questioned the findings of the BU group. Kari Stefansson, a geneticist who works for Decode Gentics told the New York Times for example, that he was “amazed at how many loci of genome-wide significance have been found in a modest sample size.”

Stefansson’s company has also studied extreme longevity. Apparently, none of the BU group’s 150 genetic variants showed up in the population studied by Decode Genetics.

There are roughly 80,000 centenarians in the US right now. Roughly 15 % of the general population has some or many of the 150 genetic variants found in the BU study. Most of them fail to reach a ripe old age because of accidents or an unhealthy lifestyle.

Their report appears in Thursday’s issue of Science.



Cancer Death Rates Continue to Decline

August 13th, 2010 | No Comments | Source: BurrillReport

Continuing a trend that began more than 2 decades ago, the death rate from cancer in the US dropped 1.3% year-over-year in 2010. It now stands at about 178 people per 100,000 per year.

The news is contained in a report prepared by epidemiologists at the American Cancer Society and published in CA: A Cancer Journal for Clinicians. The scientists estimate there will be about 1,530,000 new cancer cases in the US in 2010 (790,000 in men and 40,000 in women), and 569,000 deaths due to cancer (299,000 in men and 270,000 in women) in the US in 2010.

According to the report, cancer death rates have dropped applause21% in men, and 12% in women since 1991. The report attributes the fall-off to fewer people smoking, improved treatment, and better screening.

In men, cancers of the prostate, lung, and colon will be the cause of 52% of all newly diagnosed cancers this year. Prostate cancer alone will cause 28% of these, and 90% of these cases will be discovered at local or regional stages, for which the five-year survival rate is nearly 100%.

In males who are less than 40 years of age, leukemia is the most common fatal cancer. In older men, lung cancer becomes the leading killer.
For women, cancers of the lung, breast and colon account for 52% of newly diagnosed cancer cases. Breast cancer alone will cause of 28% of all new cancers in women this year.

Leukemia is the leading cause of cancer death among women less than 20 years old. Breast cancer ranks first for those between the ages of 20 and 59. After that, lung cancer becomes the leading cause of cancer death.

Lung cancer surpassed breast cancer as the leading cause of cancer death in women in 1987. It will be responsible for 26% of all cancer deaths in women this year.



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