Archive for September, 2010

Tricked-Out Medical Bracelets

September 30th, 2010 | No Comments | Source: Wall Street Journal

Many emergency physicians and first responders suggest that people who have medical conditions that would not be obvious to providers in the event they couldn’t communicate should enroll in some form of medical-identification program.

This advice covers tens of millions of Americans who have diabetes, heart disease, serious food and drug allergies, and who take anticoagulants like Coumadin, among other conditions.

People who decide to heed the advice may be surprised to find the medical bracelet industry has made remarkable advancements of late. Those simple, silver ID bracelets containing a few engraved words saying “allergic to penicillin” have largely been replaced by a family of high-tech gadgets that can alert emergency medical providers about nearly all aspects of one’s medical history, including things like their full medication list, prior EKGs and so forth.

Perhaps the most well-known bracelet provider is MedicAlert, which markets engraved bracelets that include one’s member number and toll-free access to a medical hot line. The service costs about $30 per year. 

Kaiser Permanente offers some enrollees a  flash drive containing encrypted health information that is derived from its electronic health record.

MedInfoChip markets software that lets people create a medical record and download it to a thumb drive. American Medical ID offers a similar device that comes in the form of an engraved pendant.

For people who object to the bracelets on aesthetic grounds, there’s the Invisible Bracelet. Members of this program can affix cards to their driver’s license, carry a key fob or wear a sticker on their bike helmet. All these devices display a member ID and links to a secure web site that houses personal health records. 

Even jewelry companies have gotten into the act by providing “smart” bracelets, necklaces and pendants that mimic real bling. Tiffany sells a gold bracelet for $2,250, for example. Rich people get sick too, after all.



Lithium: It’s Not Just for Mania Any More!

September 29th, 2010 | No Comments | Source: NY Times, Washington Post

This June, the US Department of Defense proclaimed that those woefully parched mountains in Afghanistan contained a $900 billion trove of mineral deposits including copper, gold, iron and lithium. Of the four minerals, lithium was the one that sent Pentagon officials into a swoon. Some even claimed that as a result of the discovery, the impoverished nation could become “the Saudi Arabia of lithium.”

The mood-stabilizing properties of lithium have been known for a century. Physicians have used lithium for nearly that long to treat and prevent episodes of mania in people with bipolar disorder, for example. The popular soft drink 7-Up included lithium citrate as a “mood-booster” for 20 years after it was first commercialized in 1929.

Of course the mood stabilizing properties of lithium isn’t what has those Pentagon types excited. They’re pumped because lithium has become the can’t-do-without ingredient in the batteries that power smartphones, computers and other electronic devices. Lithium is also expected to become the prime source of battery power for hybrid-electric vehicles.

No one knows how much lithium exists in the Earth’s crust, and with demand for lithium batteries exploding, people worry the demand for lithium might outstrip supply. There is no shortage of the mineral today, but this worry has caused lithium prices to double since 2003.

Not all lithium deposits are equally easy to mine, by the way. Chile and Argentina currently supply half the world’s lithium, because deposits there can be mined inexpensively by drilling below the surface of dried-up lake beds and exposing lithium-laced saltwater beneath. From there, it’s a simple matter to evaporate the water and what’s left is lithium.

There are vast lithium deposits in Nevada as well, but they are mixed into clay. Extracting lithium from clay involves complex chemical reactions and heating the mix to 1,000 degrees. Lithium miners in Australia have to drill through granite, a still more expensive process.

No one knows yet how to extract the lithium from those forlorn mountains in Afghanistan. But so long as demand for the stuff remains high, the most important withdrawal plan for Afghanistan may have more to do with getting lithium out of the ground than getting troops out of the country.


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Aging and Muscle Loss

September 28th, 2010 | No Comments | Source: NY Times

We know that people tend to lose muscle mass as they age. We know that sedentary lifestyles, hormonal changes, oxidative damage and infiltration of fat into muscles are common causes of the phenomenon.

But few of us know that age-related loss of muscle can be a profound cause of disability. The condition affects nearly 10% of people over the age of 60, and it has been estimated to account for at least $18.5 billion per year in direct medical costs.

A growing understanding of the economic costs of age-related muscle wasting has sparked renewed interest in the matter by scientists, pharmaceutical and food companies, and of course, by all those aging baby boomers.

Drug companies are searching for compounds other than the notoriously dangerous anabolic steroids that can build muscle or delay age-related muscle loss. Food conglomerates like Danone and Nestlé are looking for nutritional products that have the same effect.

For commercial enterprises like these to succeed, of course, the condition needs to be clearly defined. Call it creating a disease if you wish, but “if you are trying to sell drugs, you want to have a very clear criterion for diagnosing the problem and for endpoints to treat it,” UCSF’s Thomas Lang explained to the New York Times.

Lang and other scientists have settled on the term “sarcopenia” to describe the condition. Some prefer to think of the matter simply: sarcopenia is to muscle what osteoporosis is to bone. However, some studies have shown that strength, as manifested by gripping force, or muscular function, as measured by, say, walking speed, are better predictors of future problems for the elderly.

Meanwhile, experts agree that for now, exercise, especially resistance (weight) training is the best way to restore or maintain muscle mass. Adequate nutrition, particularly Vitamin D and perhaps protein intake, may also help. See you at the gym!



Melanoma Drug Shows Promise

September 27th, 2010 | No Comments | Source: BurrillReport

Plexxikon announced last week that its experimental drug shrank melanoma tumors in a whopping 81% of the patients who received it.

Scientists suggested that the positive results from this early-stage trial might represent a breakthrough in the treatment of a notoriously recalcitrant malignancy, even though the drug’s beneficial results were not permanent. The cancers began growing again in every patient but two after the course of treatment ended.

“Metastatic melanoma is a challenging disease to treat. There have been no significant therapeutic advances in the past 20 years,” Paul Chapman, senior author of the study told BurrillReport.

“We learned that half of melanomas are addicted to a mutated gene called BRAF; this new drug inhibits BRAF and shuts off these tumors,” added Chapman, who is an attending physician at the Melanoma and Sarcoma Service at Memorial Sloan-Kettering.

The BRAF mutation occurs in 40-60% of people with melanoma.

Berkeley-based Plexxikon’s experimental drug is called PLX4032. It appeared to shrink metastatic lesions in multiple locations including liver, bone and the small bowel.

Plexxikon has co-developed the drug with Roche under a license and collaboration agreement. Roche also plans to market a gene-based diagnostic tool that can identify melanoma patients who carry the genetic peculiarity that renders their cancers receptive to PLX4032.

Plexxikon has begun mid- and late-stage studies of its drug simultaneously in an effort to find out as quickly as possible whether it can improve survival in patients with melanoma.



FDA May Approve Cymbalta for Low Back Pain

September 23rd, 2010 | No Comments | Source: Wall Street Journal

Last week, an FDA advisory panel narrowly supported a proposal by Eli Lilly & Co. to approve its blockbuster antidepressant Cymbalta for the treatment of chronic lower back pain.

Cymbalta has already been approved to treat fibromyalgia, anxiety and diabetic nerve pain. The drug is Lilly’s top-seller, having rung-up more than $3 billion in sales last year.

Before the vote, the committee reviewed FDA data showing that 2/3 of Cymbalta prescriptions written last year were for off-label uses, including headaches, musculoskeletal pain and non-diabetic nerve pain.

Regarding Lilly’s current proposal, 8 of the 14 members on the FDA’s anesthetic and life support drugs advisory committee voted “yes” in response to a question whether the FDA should green-light Cymbalta for the treatment of pain in a “broader population” than that which it has already approved.

The panel clarified that the FDA should approve Cymbalta for lower back pain but not for pain associated with osteoarthritis of the knee. In support of its decision, the panel noted that 2 out of 3 Lilly-funded studies of people with low back pain showed that Cymbalta provided significant pain relief over a 3-month period. In the case of osteoarthritis, only one out of two studies showed the drug reduced pain.

The FDA is not required to follow recommendations of its advisory committees, but it usually does.

Cymbalta carries a black-box warning from the FDA regarding the risk of suicide in children, adolescents and young adults. There are also warnings about liver damage, bleeding and adverse effects on blood pressure.


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Long-Term Effects of Multiple Concussions

September 21st, 2010 | 9 Comments | Source: Wall Street Journal

A small study has linked multiple blows to the head, sustained during athletic competition, to a degenerative brain condition similar to Lou Gehrig’s disease.

In the study, Bob Cantu, a neurosurgeon at Boston University Medical Center and colleagues examined brain and spinal cord tissue from a dozen former athletes that had died. Three of them had been diagnosed with ALS before their deaths.

Each athlete had sustained multiple concussions. One of them had at least 10 concussions. The subjects were found to have protein deposits known as tau and TDP-43 in their brains and spinal cords. These proteins have previously been found in the brains, but not the spinal cords of patients with ALS.

The fact that similar proteins were found, but in a different distribution from “classic” ALS suggests that the neurodegenerative disorder associated with multiple head trauma is similar to, but distinct from the classic disease.

Repetitive head injuries include both full-blown concussions and less severe blows to the head, said Robert Stern, in an interview with the Wall Street Journal. The study co-author added that “concussions are really the tip of the iceberg.”

This doesn’t mean children shouldn’t participate in contact sports, cautioned Gerard Gioia, chief of pediatric neuropsychology at Children’s National Medical Center. “The benefits of kids’ activities in sports, in recreation, in physical exercise far outweigh the risks,” Gioia told the Journal. “But that doesn’t mean we ignore the risk.”

Previous studies have suggested that repetitive head trauma increases the risk of other degenerative brain disorders including Parkinson’s disease (think about Muhammad Ali) and Alzheimer’s disease.

The write-up appears in the Journal of Neuropathology and Experimental Neurology,


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FDA Approves Emergency Contraceptive Drug

September 20th, 2010 | No Comments | Source: Wall Street Journal

The FDA has approved ella, generically known as ulipristal, to prevent pregnancy up to 5 days following intercourse. That’s 2 days longer than Plan B, the emergency contraceptive currently on the market.

ella was developed by Paris-based HRA Pharma. It has been available in Europe since last year. It will be available in the US later this year, by prescription only. Watson Pharmaceuticals will distribute ella in the US.

The FDA green-lighted ella after reviewing the results of 2 studies. In the first, women who took the drug between 48 and 120 hours after sex experienced a 2.2% pregnancy rate, as compared to a rate of 5.5% among those who hadn’t taken ella. In the second study, women who took the drug within 72 hours after intercourse had a 1.9% pregnancy rate, as compared with an expected rate of 5.6%.

Plan B has been approved for the prevention of pregnancy up to 72 hours following intercourse. It is available without a prescription for women who are at least 17 years old. Younger teens must have a prescription for Plan B.

The FDA’s review of ella rekindled an old debate concerning the effects of emergency contraceptives. Antiabortion advocates argue that they can end pregnancies, not just prevent them.

“The bottom-line concern is that it’s a drug that causes an abortion,” Jeanne Monahan, director of the Family Research Council’s Center for Human Dignity told the Wall Street Journal.

However, the FDA-approved labeling for ella indicates the drug is an emergency contraceptive: it’s use is to prevent pregnancy. The drug works either by inhibiting or delaying ovulation, or by altering the lining of the uterus to hinder implantation of the fertilized egg.

“It’s used to prevent ovulation,” a Watson spokesman told the Journal. “It’s not an abortion drug.”



Obesity Rates Surge Forward

September 17th, 2010 | No Comments | Source: BurrillReport

Recently, the CDC reported that between 2007 and 2009, the number of states with at least a 30% prevalence of obesity tripled from three to nine. As recently as 2000, no state reported having as many as 30% of its population that were obese.

Overall, 72 million American adults, representing 26.7% of the adult population, are obese. That’s up 1% since 2007, according to the CDC, which also calculated the annual medical costs of obesity to be nearly $147 billion.

The CDC report is based on data from the Behavioral Risk Factor Surveillance System, which contains self-reported data that is used by the states to assess progress toward the goals of Healthy People 2010. In the BRFSS 400,000 phone survey respondents are queried each year about their height and weight. From these data, scientists calculate body mass index. An adult with a BMI > 30 is considered to be obese.

BRFSS data are known to underestimate obesity prevalence, since respondents tend to claim they are taller than they actually are, and since women tend to claim they weigh less than they really do.

“We need intensive, comprehensive and ongoing efforts to address obesity,” CDC director Thomas Frieden told BurrillReport. “If we don’t, more people will get sick and die from obesity-related conditions such as heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of death.”

The new data reveals that the highest prevalence of obesity, 36.8%, is present among non-Hispanic blacks. In non-Hispanic black women, the rate is 41.9%. The data also show that obesity is more prevalent in the South and Midwest than in other regions of the country.

Colorado is the only state that had a prevalence of obesity less than 20%.



Entrepreneurship, Philanthropy and American Capitalism

September 16th, 2010 | No Comments | Source: Commentary

Last month, 40 US billionaires including Bill Gates and Warren Buffett agreed to donate at least half their fortunes to worthwhile causes. Their actions reflect a keen sense of social responsibility and are consistent with a tradition first established by Andrew Carnegie, John Rockefeller and other successful entrepreneurs of the past 2 centuries. 

In the broadest sense, these behaviors can be seen as part of a virtuous cycle of American capitalism, in which our uniquely entrepreneurial culture creates both wealth and the philanthropic mechanisms by which that wealth can be recycled.

Some suggest that this cycle is the defining characteristic of American capitalism. In fact many conservatives and supporters of private enterprise believe this is single most important mechanism by which our economy differs from socialist economies, in which government takes responsibility for recycling wealth, and the economies of developing nations, in which the fortunes of those in control are almost never recycled.

These are the same people that believe low tax rates, small government, and light-handed regulatory strategies are the proper elixir for long-term economic growth.

The problem with this approach, according to Washington Post columnist Steven Pearlstein, is that it ignores other mechanisms that serve to buffer the economic inequalities that inevitably result from the US brand of capitalism. Pearlstein cites unions, “which ensured a fair distribution of corporate profits,” as well as antitrust laws which prevent large companies “from snuffing out entrepreneurial competition,” for example. He also mentions “tax-supported schools, playgrounds and hospitals that were good enough to be used by rich and poor alike.”

Pearlstein contends that regardless of which party has governed our country in the past 2 decades, the American political system has progressively savaged these other buffers to a point where economic inequalities in the US are greater than they have been in the last century. CBO data from 2007 show for example, that the richest 20% of US households amassed 52% of the country’s after-tax income. The top 1% earned a whopping 17% of such income. In the 2 decades before 2007, “the average after-tax, inflation-adjusted income of households in the middle of the ladder increased 25%; for the top 1 percent, it rose 281 percent,” Pearlstein wrote.

As these inequalities increase, poor people find it increasingly difficult to improve their economic position. In fact, a recent study by Isabel Sawhill and Ron Haskins of the Brookings Institution showed that while US citizens born into the middle class remain quite mobile economically, those born into wealth and poverty tend to stay there throughout their lives. Shockingly, US citizens nowadays enjoy less economic mobility their counterparts in France, Germany and Canada, at least according to some measures.

“The idea that equality of opportunity is a distinctly American strength is a myth,” concluded Sawhill and Haskins.

The endemic problem of economic “stickiness” was easier to swallow when the US economy was growing robustly, creating jobs and income opportunities for much of our population, but the Great Recession of 2008-2010 has changed that. It has imperiled the most fundamental American dream: that with hard work and some old fashioned ingenuity, people, or at least their children, might be able to improve their standing in society. 

No one argues that Gates, Buffett and their wealthy contemporaries did a marvelous thing last month. Their generosity will help millions of people. But as Pearlstein says, “it will take much more to revive the virtuous cycle by which wealth begets opportunity which in turn begets more wealth. Whether at an individual company or in the country at large, it is the feeling that we are all in it together that creates the basis for a truly vibrant economy and just society. Trickle-down alone won’t cut it.”



A Weighty Problem for Expecting Moms

September 14th, 2010 | No Comments | Source: Wall Street Journal

A study published in Lancet has provided convincing evidence that moms who gain a lot of weight during pregnancy give birth to heavier babies. The finding is important since high birth-weight newborns have a greater risk of becoming obese adults.

To reach these conclusions, Harvard’s David Ludwig and colleagues looked at the birth records of over one million full-term babies born in New Jersey and Michigan during a 15-year period ending in 2003. To eliminate genetic effects, the scientists only studied women that had given birth more than once.

Ludwig’s group found that the more weight women gained during pregnancy, the higher was their risk of giving birth to a high birth-weight baby (defined as 8 pounds, 13 ounces). Those who packed-on more than 52 pounds were more than twice as likely to have a high birth-weight baby as those who gained between 18-22 pounds. The latter amount is within a recommended range of pregnancy-related weight gain for overweight women.

The scientists also found that if a woman gained twice as much weight during one pregnancy as compared with another, that baby weighed about half a pound more at birth than its sibling.

Excessive weight gain during pregnancy is also dangerous for the mothers themselves: it increases the risk of gestational diabetes, the need for a Cesarean section, and pre-eclampsia, a potentially serious condition involving high blood pressure and seizures.

In addition to their increased risk for obesity in adulthood, high birth-weight newborns may also be at higher risk for allergies, asthma and cancer.

Managing weight gain “is an absolutely critical part of preconception care and prenatal care,” William Callaghan, the CDC’s chief of maternal and infant health told the Wall Street Journal.



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