Archive for March, 2011

A New Way to Allocate Donor Kidneys?

March 31st, 2011 | 2 Comments | Source: Medical News Today, NY Times

Younger, healthier patients would be more likely than older, sicker ones to get the best kidneys if a new proposal by UNOS, the US’ organ transplant network is accepted. The proposal would supersede an existing first-come, first-served policy. It is designed to match-up the life expectancies of patients with the expected functional life of donated organs.

According to the proposal by the United Network for Organ Sharing, recipients and donor organs will be graded. The top 20% of patients and kidneys—based on age and health—will be placed in separate pools such that patients with the longest life expectancies will receive the best kidneys. The other 80% will be assigned to a separate a pool from which UNOS will match recipients and donors such that the age difference between the two is no greater than 15 years. For example, a 60 year-old person could only receive a kidney from donors who are between the ages of 45 and 75.

“Right now, if you’re 77 years old and you’re offered an 18-year-old’s kidney, you get it,” Richard Formica, a member of the UNOS  panel that penned the new proposal said in an interview. “You’ll die with that kidney still functioning…a 30-year-old could have gotten that kidney and lived with it to see his kids graduate college.”

The new proposal would affect the 90,000 or so people that are currently on waiting lists for donor kidneys. In 2009, 10,442 kidney transplants were performed using organs from deceased individuals. An additional 6,387 procedures involved live donors who typically specify the recipient. Nearly 5,000 people die while waiting for a kidney transplant.

Many transplant surgeons and medical ethicists support the proposal. Arthur Caplan, a leading bioethicist at the University of Pennsylvania reflected this sentiment as follows: “If it’s a choice between saving grandpa or granddaughter, I think you save granddaughter first.” (more…)



Supreme Court Hands Vaccine Makers a Big Win

March 30th, 2011 | 1 Comment | Source: Reuters, Wall Street Journal

Vaccine makers won a big victory last week when the Supreme Court ruled by a 6-2 margin that US law effectively protects them from product-liability suits based on claims of poor vaccine design.

The plaintiffs in the case were the parents of Hanna Bruesewitz, who in 1992 received a diphtheria, tetanus and pertussis (DPT) vaccine and subsequently developed a seizure disorder and multiple neurological problems.

The vaccine was made by Wyeth, which was later acquired by Pfizer. Bruesewitz will require expensive medical care for the remainder of her life.

Wyeth had denied that its DPT vaccine caused Bruesewitz’ injuries and warned that an adverse ruling by the Court would presage a flood of similar lawsuits that could threaten the supply chain for childhood vaccines. The Justice Department had supported Wyeth’s position on the matter.

In its ruling, the Supreme Court upheld a decision made by the Court of Federal Claims. In the former case, the Federal Claims court rejected the Bruesewitz’ attempt to receive compensation for medical costs associated with the care of their child. In that ruling, the court argued the parents did not prove that Wyeth’s vaccine caused their child’s injuries.

(The Federal Claims Court, a.k.a. the “vaccine court, was created by the National Childhood Vaccine Injury Act of 1986. Its adjudicates vaccine-injury claims and oversees an associated national compensation program. The vaccine court has awarded nearly $2 billion for vaccine injury claims in 2,500 cases since its inception. Its funds are derived from a tax on vaccines. The Vaccine Injury Act also protects vaccine makers from certain kinds of claims.)

In writing for the majority, Supreme Court Justice Antonin Scalia said the Vaccine Injury Act “pre-empts all design-defect claims against vaccine manufacturers brought by plaintiffs who seek compensation for injury or death caused by vaccine side effects.” (more…)



Self-Injury Videos on YouTube

March 29th, 2011 | No Comments | Source: LA Times, MedPageToday, Pediatrics

Millions of people watch YouTube videos depicting teens injuring and cutting themselves, according to a new study. The authors conclude that the videos may serve to legitimize the behaviors as acceptable, even normal.

To assess the scope and accessibility of self-injury videos on the Internet, Stephen Lewis of the University of Guelph, and colleagues searched YouTube for keywords like “self-harm,” and “self-injury.”

They found that the top 100 most frequently viewed videos were watched more than 2.3 million times. Ninety-five percent of the viewers were female. Their average age was 25, although Lewis’ group suspects their actual average age was lower, since some YouTube viewers provide restricted content only to older viewers.

Typically, the videos contained graphic images of cutting, embedding and burning. Many of the videos contained statements of despair or images of sad or crying people. About 42% of the videos neither encouraged nor discouraged self-injury. An additional 26% denounced the behavior, while 23% gave a mixed message and 7% actually encouraged people to perform the depicted behavior.

Most of the videos contained no warnings or viewing restrictions. Viewers tended to rate these videos highly (an average score of 4.61 out of 5). Self-harm videos were identified as “favorites” over 12,000 times. (more…)


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Rare Form of Dwarfism Protects against Cancer, Diabetes

March 28th, 2011 | No Comments | Source: Science Translational Med., Wall Street Journal

People affected by a rare, inherited form of dwarfism virtually never get diabetes or cancer, scientists have reported. Their findings may someday open up new ways to treat or prevent both conditions.

The scientists are Jaime Guevara-Aguirre, an Ecuadorean physician, and Valter Longo, a cell biologist from USC. They collaborated to study a cohort of about 100 Ecuadoreans that had Laron syndrome, an extremely rare condition caused by a gene mutation that prevents their bodies from responding properly to growth hormone.

Guevara-Aguirre had been following the cohort for more than 2 decades. He and Longo reviewed his notes and found exactly one nonfatal case of cancer and zero cases of diabetes. By comparison, the scientists’ review of 1,600 relatives, who also resided in Ecuador, revealed that 5% of them developed diabetes and 17% developed cancer. These incidence rates matched those found in the general population.

The absence of diabetes was particularly remarkable since the Laron cohort had higher obesity rates than their non-affected relatives, and obesity is a risk factor for the disease.

To figure out why Laron dwarfs almost never got diabetes or cancer, the scientists performed genetic analyses on samples of their blood and saliva. They found that family members with the condition had lower levels of IGF-1 (insulin-like growth factor 1), a chemical that plays a central role in growth during childhood. Laron patients also had lower blood insulin levels and increased sensitivity to insulin. (more…)



A New Way to Treat Panic Attacks

March 25th, 2011 | 3 Comments | Source: J. Psychiatric Res., Wall Street Journal

Panic attacks are characterized by a racing heart, copious sweating, rapid breathing and feelings of impending doom and loss of control. Approximately 15% of adults have experienced a panic attack. A stressful event like a final exam or a big presentation typically precipitates the episode.

A minority of affected people, perhaps as many as 2% of adults, have full-blown panic disorder, which is characterized by frequent attacks, often in the absence of an obvious trigger, and by behaviors designed to avoid situations that might precipitate an attack. In extreme cases, affected individuals shut-out social interactions altogether to avoid the possibility that they might have a panic attack.

Physicians tend to reserve drugs like SSRIs (newer antidepressants) and sedatives to prevent recurrent panic attacks, but the drugs seem to work in no more than two-thirds of affected individuals, at best. As an alternative, many clinicians use cognitive-behavioral therapy to treat the symptoms of panic attacks. In this approach, individuals learn to control and live with that horrible sense of doom during an attack. When behavioral therapy works, people gain confidence that the unpleasant sensations are temporary and not overly harmful.

What’s New
For decades, a cornerstone of the behavioral approach to panic disorder has involved breathing deeply, usually into a paper bag. This exercise is thought to help people calm down by focusing on something benign, non-threatening and controllable.

Now, a pair of studies by Alicia Meuret and colleagues at SMU suggests that the exact opposite approach to breathing, one that involves taking slow, shallow breaths, may be better.

Meuret’s group tested a ginned-up version of “slower, shallower breaths” in which patients adjusted their breathing to correspond with a series of tones produced by an audiotape, and checked their physiological responses with a gadget called a capnometer. (more…)



Cancer Scare for Coke, Pepsi Drinkers

March 24th, 2011 | 4 Comments | Source: Huffington Post

Most people know that sugary cola drinks have no nutritional benefits, promote weight gain, obesity and diabetes, and contain caffeine, a mildly addictive stimulant. Some people know these drinks contain phosphoric acid, which promotes tooth decay and bone loss, especially in females. But until last week, almost nobody knew that the artificial brown “caramel” coloring that gives cola drinks their familiar appearance contains carcinogens.

How can something as apparently benign as caramel coloring contain cancer-causing agents? Isn’t caramel coloring derived from caramel, that simple homemade treat created by melting sugar in a saucepan?

It turns out that there are several ways to create caramel coloring. The one used to create the caramel coloring found in Coca-Cola, Pepsi, and other foods involves chemical processes that include ammonia. This particular process produces so-called Caramel IV and a pair of byproducts, 2-methylimidazole and 4 methylimidazole, which have been shown to cause cancer of the liver, lung and thyroid, as well as leukemia in laboratory animals.

The disquieting news came in the form of a regulatory petition filed by the Center for Science in the Public Interest, which also called for the FDA to ban these substances from food and drinks that are consumed by US consumers. 

The petition cited studies from the National Toxicology Program which provided “clear evidence” that both substances are animal carcinogens. It also cited studies by scientists at UC Davis, which found the chemicals in several popular cola brands.

“Carcinogenic colorings have no place in the food supply, especially considering that their only function is a cosmetic one,” CSPI executive director Michael Jacobson said in a press release. “The FDA should act quickly to revoke its approval of caramel colorings made with ammonia.” (more…)


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Social Network Theory and Physician Prescribing Behavior

March 23rd, 2011 | 1 Comment | Source: MIT Technology Rev., WSJ Health Blog

Several years ago, scientists led by Harvard’s Nicholas Christakis showed how happiness and obesity can spread through social networks. The team showed for example, that when certain people gained weight, the chances increased that others in their social network would also gain weight. Similar analyses have mapped-out the impact of social networks on influenza outbreaks and cigarette smoking.

Now, Christakis has teamed-up with Larry Miller to create MedNetworks, a company that uses the same network mapping methods to identify physicians that most strongly influence their colleagues when it comes to prescribing drugs. If their work proves successful, they will surely find plenty of drug makers who will pay for their insights.

The Boston-based start-up relies on medical claims data for its mapping studies. It claims to be able to track growth in the popularity of a new drug within professional circles. It has identified physicians within these circles that appear to influence the prescribing behavior of others, in that after they begin prescribing a newly released drug, colleagues within three degrees of separation from them begin doing the same. “We’ve shown that we can predict adoption of pharmaceuticals among doctors,” Miller said in an interview.

To support its claims, MedNetworks cites a case study on the launch of Merck’s diabetes drug Januvia in the Raleigh-Durham area. In this example, prescribers that had Januvia adopters within one degree of separation in their social network were twice as likely to prescribe the drug as those who did not have Januvia adopters in their network.

As another example, MedNetworks reports that when a generic replacement drug for Pfizer’s blockbuster Lipitor became available, prescribers discontinued Lipitor “in clusters…and social network influence accounted for about 40% of the decline.” (more…)


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Approval Process for Medical Devices is Faulted in Study

March 22nd, 2011 | 1 Comment | Source: LA Times, NY Times

More than 70% of all medical devices that have been recalled by the FDA for safety concerns were not subjected to rigorous clinical testing before the agency approved them, according to a new study.

The study authors were Diana Zuckerman and Paul Brown from the National Research Center for Women and Families, a consumer group, and Steven Nissen, a cardiologist at Cleveland Clinic.

The authors reported that overall, the FDA recalled 113 medical devices between 2005 and 2009. Of these, 21 had been approved on the basis of rigorous clinical trial data. Eighty others had been approved under a less stringent, expedited approval process known as 510K, in which a device maker needs only to show that its new product is substantially similar to one already on the market. An additional 8 devices were exempt from FDA regulations, and 4 more were either counterfeit or classified as “other.”

Devices approved using the 510K approval process included mechanical ventilators, insulin infusion pumps, artificial hips and knees, and external cardiac defibrillators. The more rigorous process is typically reserved for life-supporting devices like implanted cardiac defibrillators. In the latter process, device makers must sponsor trials designed to prove their products are safe and effective.

Last summer, the FDA announced it was implementing some steps to “strengthen” the 510K process, but it deferred on a complete overhau pending the release of a report on the matter by the Institute of Medicine. The report is due later this year. (more…)


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Dietary Fiber and Mortality

March 21st, 2011 | No Comments | Source: Archives Int. Medicine, LA Times, USNews, Wall Street Journal

Scientists have proven that dietary fiber lowers the risk of coronary artery disease, diabetes and certain cancers. Surprisingly however, they had yet to show that fiber could impact overall mortality. Now apparently, they have done just that. 

A research team led by Yikyung Park of the National Cancer Institute has published a study showing that high fiber intake is indeed associated with longer survival.

To reach these conclusions, Park’s group looked at data from nearly 400,000 men and women between the ages of 50 and 71 using the AARP Diet and Health Study. They assessed dietary fiber intake with a questionnaire that had been administered at the beginning of the 9-year study. They excluded people with diabetes, heart disease and most cancers, as well as those who reported extremely high daily fiber intake.

After controlling for smoking, exercise and body weight, the researchers showed that dietary fiber intake was associated with a reduced risk of death in both sexes.

Specifically, people in the highest quintile for fiber consumption (29.4 grams per day for men and 25.8 grams for women) were 22% less likely to die from all causes than those in the lowest quintile (12.6 grams per day for men and 10.8 for women). Women were 34-59%, and men were 24-56%  less likely to die from heart, respiratory and infectious diseases, in particular. Fiber consumption was associated with a lower risk of dying from cancer in men (who are prone to get cancers thought to be reduced by dietary fiber intake) but not in women.

Interestingly, the type of fiber consumed made a huge difference in this study. Participants who consumed fiber from grains, like oatmeal, brown rice and cornmeal experienced all the benefits. In this study at least, fiber derived from vegetables, fruits and beans did not reduce mortality. (more…)



Platelet-Rich Plasma Therapy: Much Ado about Nothing?

March 18th, 2011 | 6 Comments | Source: Commentary

Platelet-rich plasma (PRP) therapy became a hot topic among professional and recreational athletes after some studies suggested it could hasten wound healing and several high-profile athletes reported using it as they rehabbed from various injuries.  But recently, the news hasn’t been quite so good. For those not in the know, let’s do a quick review of the subject.

PRP therapy involves extracting and centrifuging a person’s blood to create a concentrated broth of growth factors and white cells, and then then injecting the stew directly into injured tissue. The growth factors supposedly promote healing.

PRP therapy has been used for numerous conditions including tennis elbow and pulls, sprains and strains of dozens of different muscles, tendons and whatnot.

The treatment became buzzworthy after animal studies showed that it fostered collagen and new blood vessel formation in the tendons of animals that had been surgically injured by scientists.

The buzz grew after reports surfaced that Tiger Woods used PRP therapy to treat a sore knee, NFL player Chris Canty used it for a hamstring injury, and itinerant MLB pitcher Cliff Lee used it for an abdominal strain. After these high-profile athletes claimed to be satisfied with the results, recreational athletes began demanding PRP therapy for themselves, even though it cost $1,000 per shot and isn’t covered by most insurance plans.

Alas, recent scientific studies of PRP therapy should dampen that enthusiasm, at least a bit. It just doesn’t seem to work in humans with overuse injuries and strains, according to these studies.

This month for example, S. de Jonge and colleagues at Erasmus University (Rotterdam) published one-year follow-up data on their placebo-controlled trial of PRP therapy for Achilles tendinopathy. Their original report showed no benefits at 6 months, and the extended follow-up showed the same thing (no benefit). de Jonge’s group concluded there is “no evidence for the use of platelet-rich plasma” therapy in this particular condition. (more…)



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