The Great Recession may have done something that countless public health campaigns and the billions of dollars spent to fund them could not: reduce our nation’s appallingly high teen birth rate.

According to CDC data released last month, the birth rate among girls between the ages of 15 and 19 dropped to an all-time low of 39.1 per 1,000 in 2009, the first full year of the worldwide economic recession. That was 6% lower than the previous year and the lowest rate since the government started tracking the statistic 70 years ago.

The trend among teens was consistent with drops in virtually all age groups, with the overall birth rates reaching a historic low of 13.5 per 1,000 females in 2009, down 4% from 2008. The drop was seen in teens in all races and ethnic groups. Among Hispanic teens, the birth rate in 2009 fell a full 10% to a still ridiculously high rate of 70.1 per 1,000 females. In African-American teens, the rate fell to 59.0.

Many scientists said it was too soon to conclude that the recession was responsible for the precipitous drop. Relevant data, like that referable to contraceptive use is still being collected for 2009. But even if there were a spike in such responsible behavior, the question remains why would that have happened? After all, the educational programs designed to promote contraceptive use have been around for years.

At a minimum, the recession is likely to be an epiphenomenon, a large contextual issue that drives more obvious relations between cause and effect. Would-be teenage moms “see parents who have lost jobs or houses. They’re very aware of how tough it is now, and I think that causes teens to be more cautious,” Sarah Brown, chief executive of the National Campaign to Prevent Teen and Unplanned Pregnancy told the Wall Street Journal. (more…)

Although cocaine use has declined steadily since its peak in the early 1980s, public health officials estimate that about 7 million Americans used the drug at least once last year. Many of these folks are addicted to the drug, and its intense, short-lived euphoric effects mean the addiction is terribly difficult to overcome.

Addiction specialists believe existing treatment paradigms for cocaine addiction can be enhanced by a vaccine that prevents the drug from crossing the blood-brain barrier, thus blunting its euphoric effects. Scientists have worked hard to develop such a vaccine, but have had limited success so far. 

About a year ago for example, Thomas Kosten and colleagues at Baylor reported partial success in a human trial of a cocaine vaccine. In that trial, 38% of subjects who received all 5 shots in the vaccine series achieved sufficient antibody levels to blunt the effects of the drug. In that subset, 53% of the subjects stopped using cocaine, meaning that overall, the vaccine worked about 20% of the time.

Unfortunately, some subjects began snorting massive amounts of the drug in an effort to overcome the vaccine’s effects. Some people managed to amass 10 times more of the drug in their systems than was present before the trial began. Cocaine levels like that can kill people. In addition, the cocaine antibodies, when they developed at all, remained in the bloodstream of subjects for only 8-10 weeks; it takes longer than that to assure the behavioral aspects of the addiction are overcome.

What’s New?
Last week, Martin Hicks, Ronald Crystal and colleagues at Cornell reported that they had developed an alternative vaccine and that it was quite effective…in mice.

The Cornell team attached a chemical congener of cocaine onto a specially prepared version of an adenovirus, the virus responsible for many common colds. The latter vector was chosen to assure that the body’s immune system would recognize the newly created molecule as foreign and create antibodies against it. The trick of course, was to assure that the antibodies so created would recognize “pure” cocaine after it was ingested, and prevent it from crossing the blood brain barrier. (more…)

Two years ago, Congress passed a law which tasked the FDA to regulate tobacco products. The legislation required the agency to ban cigarettes flavored with candy, fruit or spices because they might prompt younger people to start smoking. But the law punted a decision on the thornier issue of whether to ban menthol flavored cigarettes–which account for 30% of domestic cigarette sales–to the FDA.

To help the FDA decide this matter, Congress established Tobacco Products Scientific Advisory Committee. The committee’s final report on menthol cigarettes is due by the end of March. It could recommend an outright ban on the sale of menthol cigarettes, or that certain restrictions be placed on advertising these brands. Or it could recommend that the FDA take no action whatsoever.

Sometime after that, FDA will make a final call on the matter. Its decision will have a huge impact on Lorillard, the nation’s third largest cigarette manufacturer, since nearly 90% of its revenues are derived from the sale of Newport, a menthol-flavored cigarette.

Menthol is a naturally-occurring chemical that comes from mint plants. Manufacturers have added it to cigarettes for nearly a century, presumably because its local anesthetic effects and cooling sensations mask the harsh taste of cigarette smoke. The effect seems to attract young smokers in particular. A 2009 government study has shown for example, that nearly half of all smokers between the ages of 12 and 17 use menthol-flavored cigarettes.

Menthol cigarettes are also the overwhelming choice of African-American smokers. Government studies have shown that as many as 80% of African-American smokers prefer these brands, particularly Salem, Kool and Newport. Cigarette manufacturers have directed marketing campaigns for menthol cigarettes toward African-Americans for decades (see above picture). (more…)

Sixteen percent of eighth-graders reported using an illicit drug in the past year, an increase of 1.5% over the previous year, a recent national survey has found. The rise has been stoked by steady increases in marijuana use, which also increased among tenth and twelfth graders.

According to results from the 2010 Monitoring the Future Survey (MTF), the percent of eighth, tenth and twelfth graders who reported smoking the herb daily last year were 1.2%, 3.3% and 6.1%, respectively. That represented an across-the-board increase from 2009 figures, which were 1.0%, 2.8% and 5.2%, respectively.

The increases were associated with declining perceptions that smoking marijuana regularly is harmful. Among 10th graders surveyed in 2010 for example, 57.2% felt this practice was harmful. In 2009, 59.5% of 10th graders felt this way. In a related trend, the percentage of eighth graders that disapproved of smoking marijuana dropped significantly in 2010.

“These high rates of marijuana use during the teen and pre-teen years, when the brain continues to develop, place our young people at particular risk,” said Nora Volkow, the Director of the National Institute on Drug Abuse in a press release. “Not only does marijuana affect learning, judgment, and motor skills, but research tells us that about 1 in 6 people who start using it as adolescents become addicted.”

Remarkably, more 12th-graders now smoke pot than cigarettes, the survey showed. Last year, 21.4% of high school seniors had used marijuana in the last month, compared with 19.2% that had smoked cigarettes. (more…)

Plenty of folks get a bit red in the face this time of the year. The cheeks of those who live in northern climes may take on a certain glow when they walk the dog or take out the garbage on a brisk, windy night. The same appearance bedevils folks in warmer climes should they forget to apply sunblock before settling beside the pool.

An altogether different group includes fully one third of all people of East Asian descent, who have been born with a genetic deficiency that causes their cheeks, and often their necks, arms and trunk to turn sunburn-red after consuming even small amounts of alcohol (see picture).

The condition is known colloquially as “Asian Flush” or “Asian Glow.” It is often associated with nausea, headache and tachycardia, and is caused by an inherited deficiency of aldehyde dehydrogenase 2 (ALDH2), one of 2 key enzymes involved in the metabolism of alcohol.

Unfortunately, Asian Flush isn’t as benign as once thought. Scientists have determined in recent years that ALDH2 deficiency is a risk factor for esophageal cancer, which happens to be one of the deadliest cancers humans can get.

Philip Brooks and colleagues at the National Institute on Alcohol Abuse and Alcoholism published a seminal article on this association in 2009. In it, the scientists explained that the first of those 2 key enzymes transforms alcohol into acetaldehyde, a vasodilator in the short term and a carcinogen in the long term. The second enzyme, ALDH2, converts that toxin into acetate, a harmless chemical.

People who lack ALDH2 experience a build-up of acetaldehyde in the body after they consume alcohol. The short-term effect of the build-up is the Asian Flush.

But that’s not what prompted Brooks to write that article. “People with this ALDH2 deficiency have a really high risk of getting esophageal cancer when they drink alcohol,” he explained to the LA Times. “Anyone who drinks is at risk, but the more you drink, the more your risk goes up. And when you’re ALDH2-deficient, your risk goes up much more dramatically.” (more…)

Last year was another lackluster one for the drug and biotech industries, as the FDA seemed to ratchet-up its scrutiny of trial data and set the bar higher on requirements for drug efficacy. Overall, the regulatory agency approved 24 new drugs in 2010, which was slightly down from the 26 it approved in 2009 and dead-even with the 24 it approved in 2008. Only 17 were approved by the FDA in 2007

Two of the newly approved drugs appear to have a shot at becoming blockbusters: these are Gilenya, which is Novartis’ pill for multiple sclerosis, and Provenge, Dendreon’s injectable treatment for advanced prostate cancer. A pair of much-anticipated obesity drugs, Arena Pharmaceuticals’ lorcaserin and Vivus’ Qnexa were rejected by the FDA, as were many others. Perhaps the biggest news however, focused on the FDA’s handling of safety issues surrounding drugs it had approved in previous years. Here’s a summary of some winners and losers:

Newly Approved Drugs
Multiple Sclerosis-Patients with multiple sclerosis did have a good deal to cheer about last year. In addition to Gilenya, the FDA approved Ampyra (Acorda Therapeutics) to improve gait disturbances in MS patients.

Advanced Prostate Cancer-Dendreon finally won FDA approval for its cancer-fighting vaccine, Provenge. The regulatory agency had previously rejected the drug and required that additional trials be performed, despite early clinical trials which were generally positive.

Stroke Prevention-Drug makers have been vying for years to replace warfarin, the widely used anticoagulant that has been available for more than half a century. After receiving approval for its drug, Pradaxa to prevent stroke in patients with cardiac arrhythmias, Boehringer Ingelheim now has a head start in this highly lucrative field.

Emergency Contraception-HRA Pharma’s drug ella, was approved by the FDA last summer. It blocks pregnancy up to five days after sexual intercourse, a full-day longer than other drugs on the market. The drug is now marketed in the US by Watson Pharmaceuticals.

In Limbo
Stroke Prevention-The FDA asked AstraZeneca for more information from a generally positive study of the anticoagulant, Brilinta assuring a longer glide path to market for Boehringer’s entry into this space (see above). (more…)

Later this year, federal regulators will begin reviewing requests by private health insurers who wish to raise premiums by 10% or more, year-over-year. The move represents an expansion of federal regulatory power since until now, the review of such proposals has been carried out exclusively by the states.

The new federal guidelines will take effect on July 1, and were called for by provisions in the Affordable Care Act. The guidelines specify methods by which the feds will determine whether the proposal is reasonable. These will include the percentage of premiums spent on direct medical care and whether the rates include higher premiums for some, but not all enrollees with similar health risks.

The new regulations should help Democrats respond to the lambasting they received last fall by the GOP and consumer advocates after several private insurance companies jacked their premiums by 20% or more. At the time, the companies claimed the increases were driven by soaring medical costs as well as certain provisions in the Affordable Care Act, the health reform law that was enacted last March.

In particular, private insurers pointed to provisions in the law which require them to provide more comprehensive benefits to certain populations. They also claimed that rate increases were justified in response to the increasing trend by young and healthy people to forego health insurance, a trend that obligates insurers to raise rates for everyone else.

Spokespeople for private insurers also accuse the Obama administration of demonizing the health insurance industry for political gain. “Without a doubt, this is a political process, not a technical process,” Karen Ignagni, president of America’s Health Insurance Plans has said. (more…)

Last week, Nintendo became the latest consumer electronics maker to warn that kids shouldn’t use their three-dimensional image-based gaming devices, because they may have a negative impact on development of the human visual system.

The warning came just a month before the company’s much anticipated release of the 3DS, which is just such a device that features a 3.5 inch screen which can create 3-D images without the need for special glasses. The 3DS is Nintendo’s most anticipated new product since it released the iconic Wii gaming device in 2006.

Sony’s PlayStation3, a similar product that requires glasses to create the 3-D effect, already carries a similar warning, as do 3-D TV sets made by Sony, Samsung and Panasonic.

Nintendo’s warning applies to kids that are 6 years old or younger. The Japanese company advised parents to block access to the game machine’s 3-D mode for these kids, while adding that it was OK for them to use the 3DS in 2-D mode.

The Nintendo 3DS is one of the first devices of any sort to project a 3-D image without the need for specialized glasses, which can be quite expensive in their own right. Many analysts believe this breakthrough will accelerate the adoption of home-based 3-D entertainment, a process that has been disappointingly slow to date. (more…)

Although Facebook has long-since been woven into the fabric of modern life, it continues to pose ethical challenges for government officials and professionals in many fields. How much personal information should they share with others? Are their traditional codes of conduct robust enough to cover the behaviors associated with the use of Facebook and other social media outlets?

Physicians, nurses and other health professionals know they must never disclose confidential health information concerning their patients on Facebook or anywhere else. Beyond this, new media outlets create countless situations in which “acceptable” behavior for government officials and professionals remains unclear.

To their credit, some professional societies including the AMA have recently issued guidelines for acceptable behavior on social media outlets. Surprisingly however, scientists have published few studies describing professionals’ actual use of such sites.

Recognizing this gap, Ghassan Moubarak and colleagues at Hopital Lariboisiere in Paris designed a questionnaire to study the way young physicians use Facebook. Moubarak’s group mailed the survey to 405 residents and fellows at Rouen University Hospital. Nearly half of them responded, including 160 residents and 42 fellows. The mean age of respondents was 29.

Seventy-three percent of the survey respondents reported having a Facebook profile. Nearly a quarter of them, 24%, said they visited the site several times per day, and an additional 28% reported visiting it once per day.

Ninety-nine of the respondents who had a Facebook profile used their real name on it. Over 90% of the respondents also displayed their birthdates and a headshot, although only 59% listed their current university and 55% listed their current position. Sixty-one percent of the respondents had modified privacy settings on the site, and 85% said they would never accept friend requests from patients. The remaining 15% said they would decide about friend requests from patients “on an individual basis.” None of the respondents said they would automatically accept a friend request from a patient. (more…)

People know it’s important to avoid excessive weight gain as they get older, and that exercise is a key to success in this regard. But until recently, scientists had published surprisingly few studies purporting to quantify the impact of habitual exercise on weight gain over the long haul.

Arlene Hankinson and her colleagues at Northwestern set out to do just that. Using data from a prospective follow-up study, Hankinson’s group showed that men who were able to maintain high activity levels over an extended period gained 6 fewer pounds, and 5 fewer centimeters of waist circumference than those in the lowest activity group. Women in the highest activity group gained 13 fewer pounds and nearly 7 centimeters less around their waists.

To reach these conclusions, the scientists examined data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which is a 20-year longitudinal study that began in 1985. CARDIA included complete historical data for 3,554 men and women from Chicago, Birmingham, Minneapolis and Oakland. Enrollees were 18 to 30 years old at study onset. 

During each follow-up visit, CARDIA enrollees completed questionnaires regarding their activities and exercise habits. Each activity had been assigned a numerical score ranging from 108-288 by the scientists. Activity scores were summed for each individual to yield a total score. (more…)