A federal panel advised the FDA last week that menthol cigarettes are more harmful to the public health than regular cigarettes. However, it did not recommend or endorse any actions the FDA should take to act on the advice.

According to the panel, menthol cigarettes drive-up cigarette smoking rates among youth and African-Americans because its minty taste attracts people to try cigarettes and makes it harder for them to quit. In addition, its mild anesthetic properties mask the harsh taste of cigarettes. That sensation might otherwise deter some from the habit before they get hooked. The report also cites evidence that consumers believe (incorrectly) that menthol provides some health protection or medicinal benefit.

“Removal of menthol cigarettes from the marketplace would benefit public health in the United States,” the panel’s report concludes.

The panel’s official name is the Tobacco Products Scientific Advisory Committee. Its report will likely trigger a lengthy test of the FDA’s ability to promulgate and enforce restrictions on cigarettes, nicotine and menthol. The FDA will review the report and other information before deciding what to do. It has no obligation to do anything.

Reaction to the report was mixed. Some saw it as a necessary first step toward an outright ban on menthol. Others were disappointed that the advisory group shied away from recommending steps the FDA might take to deal with the problem it identified. (more…)

Based on their experience during countless schleps to the market, moms know that kids pick cereals whose boxes have cartoon characters on them. Previous research by Yale scientists explained the phenomenon: kids say that the stuff poured from such boxes tastes better than the same stuff when poured from a cartoon-less box. The same thing happens when kids pick graham crackers, carrots and gummy fruit snacks.

Pictures of Shrek, Dora the Explorer, Scooby Doo and their kin make just about anything taste yummier, it seems.

Can this observation be leveraged to encourage kids to select healthier foods? Yes, it turns out. But the story isn’t as straightforward as you’d think.

To study the impact of licensed media spokescharacters and other nutrition cues on kids’ taste assessment of food products, scientists at the University of Pennsylvania fed cereal from a box that had been labeled either “Sugar Bits” or “Healthy Bits” to 80 kids. Half the boxes in each “brand category” were adorned with cute cartoon penguins, while the other half were not. The kids were between 4 and 6 years old.

The scientists then asked the kids to rate the taste of the cereals on a 1 to 5 smiley face scale. Surprisingly, kids loved the Healthy Bits, which scored 4.5 regardless of whether the penguin was present or not. However, the penguins had a marked impact on kids’ taste preferences for Sugar Bits. For this brand, the taste score sans penguins was below 3, whereas it was over 4 if the cereal was delivered from a box featuring the friendly penguins.

Lead author Matthew Lapierre didn’t know for sure why this happened. “One of the explanations we’ve been working with is that kids grow up with this negative association with sugar,” he reasoned in an interview.

To support his hypothesis, Lapierre noted that many cereal brands have replaced the word “sugar” with other words that imply a somewhat healthier message. Sugar Smacks are now called  Honey Smacks, for example. Sugar Crisps are now sold as Golden Crisps.

If Lapierre is right, then these healthier messages have been internalized by kids to the point that they have negative perceptions of the word ‘sugar’ in the faux brand created by his group. (more…)

Other than a prolonged tantrum perhaps, nothing upsets the normal give-and-take between parent and child more than a child who is running a fever. Mild temperature elevations are usually a benign, physiologic response to a mild viral infection. Yet many well-meaning parents give their kids medicine for no other reason than to keep the temperature down. As if treating the fever was the same thing as treating the virus.

Now, a task force from the American Academy of Pediatrics has advised physicians and parents that a fever, in and of itself, should not be a cause for concern, and that parents should not bother  treating low-grade fevers in kids unless they are demonstrably uncomfortable because of the fever.

In short, parents should try to keep kids comfortable rather than reducing their temperature to a pre-determined number.
 
The viruses that cause most fevers typically last just a few days and cause no harm. And although febrile seizures do occur, the group says anti-fever medicine don’t necessarily prevent them.

“There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications,” the report stated. In fact, fever is one mechanism by which the body fights viral infections. It slows growth and reproduction of the germs that typically cause fever and enhances neutrophil and T-lymphocyte production, for example.

According to the report, nearly half of all parents believe (incorrectly) that a temperature less than 100.4 degrees constitutes a fever, and nearly 25% would give antipyretics to their children for temperatures less than 100. And nearly 85% of parents would awaken a sleeping child if it was time to administer a dose of anti-fever medicine.

That’s unwise. “If they’re sleeping, let them sleep,” Henry Farrar, an emergency room pediatrician and report co-author said in an interview. (more…)

Cancer patients usually don’t die from the effects of their primary tumor. Metastatic lesions in other organs like the liver and brain usually do them in. Clinicians would thus love to know, if they could, which cancers are going to spread, and when.

Remarkably, Y. Peng Loh of the NIH and colleagues appear to have made progress in this regard. They claim to have identified a biomarker that predicts which tumors will metastasize in the next 2 years, with accuracy rates approaching 90%…at least in the rare cancers they studied.
 
The marker is a protein, CPE-delta N. It is normally involved in the intracellular response to insulin and other hormones. Loh’s group didn’t actually measure CPE-delta N levels in tumor cells per se. Instead they measured levels of the particular RNA (ribonucleic acid) molecule that codes for CPE-delta N.

The scientists showed that when intracellular levels of CPE delta-N RNA within cancers was at least twice that found in surrounding tissue, the tumors were likely to metastasize within two years. Tumors that had levels below this threshold were unlikely to metastasize. Using this simple cut-point, Loh’s group accurately predicted metastatic events more than 90% of the time, and predicted the absence of metastasis 76% of the time.

Interestingly, the predictive accuracy of the new test surpassed that generated by routine “staging” procedures for cancers of the liver and the other rare tumors that served as the foci of these experiments (pheochromocytoma and paraganglioma). Routine staging typically accounts for primary tumor size, spread to local lymph nodes, and the presence of far-flung metastases.

“Testing for CPE-delta N, if combined with existing diagnostic methods, offers the possibility of more accurately estimating the chances that a cancer will spread,” said Alan Guttmacher, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which funded the study. “Conceivably, a patient’s CPE-delta N levels could be a key guide in individualizing their cancer care to improve outcome.” (more…)

Several studies have confirmed the link between excessive intake of sugary drinks and obesity, especially in kids and teenagers. Other studies have shown that steep taxes on cigarettes can cut smoking rates. So it’s plausible that a steep tax on sugary drinks could cut their consumption as well.

A dozen states have followed this logic; they already impose taxes on sugar-laced drinks. But how big an impact can we expect from a national tax on such beverages?

Not that much, according to a new study by Eric Finkelstein and colleagues at Duke. What is more, the impact would end-up being localized to middle-class Americans, leaving the rich and poor relatively untouched.

To reach these conclusions, Finkelstein’s group looked at the association between beverage prices, energy intake, and body weight using a multivariate regression model. Their data set was derived from the 2006 Nielsen Homescan panel, in which a nationally-representative sample of US households  uploaded their store-bought food and beverage purchases into a database every week for one year.
 
The scientists found that a 20% and 40% tax on all sugary drinks would reduce calorie intake by a bunion-sized 7 and 12 calories per day, respectively. This would result in an average weight loss of 0.7 and 1.2 pounds per person per year, respectively. Interestingly however, nearly all of this impact accrued to those in the middle-income tax bracket.

The scientists also calculated that the 40% tax would generate about $2.5 billion per year in tax revenue, and that the lion’s share of this money would come from high-income households. They suggested that extending the tax to restaurants and vending machines would increase the take, but only modestly.

“Although small, given the rising trend in obesity rates, especially among youth, any strategy that shows even modest weight loss should be considered,” Finkelstein commented.

But Susan Neely, president of the American Beverage Association didn’t think much of the idea. “Taxes are not going to teach our children how to have a healthy lifestyle,” she has said.

Regardless, public support for a soda tax would be weak, at best. Last April, a survey conducted by NPR and Thomson Reuters revealed that 51% of Americans were moderately or strongly opposed to such a tax. Only about a third liked the idea. Responses were not affected by income or age, although party affiliation did: 70% of Republicans were against the sugar tax, whereas only about 55% of Democrats were against the idea.

Finkelstein’s write-up appears in the Archives of Internal Medicine.

The Federal Trade Comission has charged POM Wonderful, makers of several drinks containing pomegranate juice and a host of supposedly healthful dietary supplements, with making “false and unsubstantiated claims that their products will prevent or treat heart disease, prostate cancer, and erectile dysfunction.”

The FTC’s deceptive advertising complaint came a few months after the Food and Drug Administration warned POM Wonderful about the same thing.
 
Both regulatory agencies cited claims like “30 Percent Decrease In Arterial Plaque,” “Super Health Powers” and, “Promotes Healthy Blood Vessels” in their complaints.

The ads in question appeared in Parade, Fitness, the New York Times, and Prevention magazines, on bus stops and billboards, on tags attached to the product, and on Internet sites like pomtruth.com, pomwonderful.com, and pompills.com.

“The available scientific information does not prove that POM Juice or POMx effectively treats or prevents these illnesses,” David Vladeck, the director of the FTC’s Bureau of Consumer Protection told NPR.

For example, Vladeck explained, POM says its products are 40% as effective as Viagra. The FTC complaint indicates that the study referred to in making this claim actually showed the juice was no more effective than a placebo.

In its response to the FDA, POM Wonderful said its claims were valid and backed by scientific research. The FTC is “wasting taxpayer resources to persecute the pomegranate,” the company said. It added that the product research it conducted was “unprecedented among food and beverage companies” and that the FTC was “acting beyond its jurisdiction, exceeding its authority, and creating a new regulatory scheme that attempts to treat our juice as a drug, which it is not.”

A hearing on the FTC complaint will take place 8 months from now.

Naltrexone, a drug usually reserved for the treatment of alcohol and drug addiction, has been found to reduce the urge to steal in kleptomaniacs, according to Jon Grant and colleagues at the University of Minnesota.

Kleptomania is a rare disorder characterized by recurrent stealing. Until now, there had been no empirically validated treatments for the condition.

The scientists lured 25 kleptomaniacs to participate in an 8-week, randomized, double-blind, placebo-controlled trial of the opioid antagonist.

Subjects had spent at least an hour per week stealing things prior to enrollment.

Many had tried to control their impulses by wearing tight-fitting clothes, carrying a small purse or shopping with friends with little success.

Every 2 weeks, participants were assessed using the Yale Brown Obsessive Compulsive Scale Modified for Kleptomania and associated tools for the assessment of depression, anxiety and psychosocial functioning.

Subjects receiving naltrexone were found to have greater reductions in K-YBOCS scores, stealing urges and stealing behavior than placebo-treated subjects. 

Remarkably, nearly 2/3 of the treatment group stopped stealing altogether.

The drug “gets rid of that rush and desire (to steal)” Grant told Reuters. “These people were really troubled by their behavior.”

“Based on the fact that (kleptomania) clinically presents like an addiction, our thought was, why shouldn’t we use a medication that was approved by the FDA for addiction, to see if it can help with shoplifting?’” he told NPR.

The write-up appears in the Journal of Biological Psychiatry.

The shoplifting pill is marketed as Revia by Duramed and as Depade by Mallinckrodt.