Wall Street Journal

Those Pesky Tension Headaches

April 12th, 2011 | 6 Comments | Source: Wall Street Journal

Tension headaches are a nearly universal affliction. They are characterized by dull, non-pulsatile discomfort on both sides of the temples and forehead. They typically last for 30-60 minutes, but they can go on for days. Tension headaches affect at least 40% of adults in any given year. Nearly 80% of adults have experienced at least one during the course of their lifetimes.

It’s amazing therefore, that scientists don’t yet understand what causes them.

httpv://www.youtube.com/watch?v=SuL7z6zzhYc

Triggers
To be sure, scientists and those who’ve experienced tension headaches know when they tend to occur and what things trigger them.

Tension headaches occur most commonly in the early morning and late afternoon. The morning variety is often triggered by lack of sleep, awkward sleeping positions, hangovers and caffeine withdrawal.

Afternoon tension headaches are triggered by poor posture or airborne irritants in the office, eyestrain from looking at a computer screen all day, teeth grinding, and plain-old everyday stress (see YouTube video, above). The hypoglycemia associated with missed lunches is another culprit, as is excessive caffeine intake.

But What Causes Them?
This is what scientists don’t yet understand. For years, the prevailing theory was that muscle tension, especially in the neck and shoulders, caused tension headaches. That theory has been disproven by studies in which tools that measure muscle contractions revealed no correlation between muscle tension and headaches.

Today, the prevailing belief is that the tension-type headache is caused by abnormalities in parts of the brain that perceive pain. These poorly understood abnormalities render the brain hypersensitive to the inputs it receives (similar mechanisms are also thought to be involved in fibromyalgia, a disorder characterized by diffuse bodily sensations of pain).

Treatment
Typically, tension headaches sufferers just “bear with them” until they subside, or use OTC pain killers like aspirin, acetaminophen and ibuprofen for quick relief. These drugs usually work, but taking them more than 10 days per month can precipitate so-called “rebound” or “medication-overuse” headaches, which feel like the tension headaches they’re supposed to treat. (more…)

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Long-Term use of Nicotine Replacement Products

April 5th, 2011 | 1 Comment | Source: Wall Street Journal

Nicotine replacement therapy makes it easier to quit smoking by providing a therapeutically safe fix of the chemical that makes cigarettes addictive in the first place. In the 25+ years since nicotine-laced patches, gum and lozenges became available, they have amassed a remarkable safety record. In fact thousands of people—and perhaps many more than that–have used NRT products for decades with few or no untoward effects (other than a notably thinned-out wallet). 

As a result, the FDA may soon relax the warning label verbiage affixed to NRT products. Currently, the FDA recommends that such products should be used for no longer than 12-weeks. The recommendation under consideration is that NRTs can be used for prolonged periods—perhaps indefinitely.

“There really doesn’t appear to be any great harm” with the use of NRT over long periods of time, said K. Michael Cummings, chair of the department of health behavior at the Roswell Park Cancer Institute in an interview. “You’re better off chewing gum or wearing a patch than smoking.”

Public health advocates like Cummings have petitioned the FDA for years to relax its recommendations. They received a boost from a 2009 law which empowered the FDA for the first time to regulate tobacco products. A provision in the law tasks the agency to consider relaxing the warning labels on NRT products.

Labels on NRT products advise users to taper-off on their consumption of the products over a 12-week period. These recommendations have stood since the FDA first approved nicotine gum in 1984. They were established to be consistent with the duration of NRT product utilization during clinical trials that were designed to test their efficacy, rather than scientific data regarding health risks associated with long-term NRT use.

There is no evidence that nicotine is carcinogenic in its own right, at least in humans. It may however increase cardiovascular risk because it causes mild tachycardia and mild elevations in blood pressure. (more…)

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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…)

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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…)

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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…)

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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…)

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Personalized Medicine for the Treatment of Alcoholism

March 16th, 2011 | 1 Comment | Source: Am. J. Psychiatry, Wall Street Journal

Genetic factors predispose people to alcoholism. That’s why the children of alcoholics are four times more likely to develop drinking problems, and the sons of alcoholic fathers are at even greater risk. And that’s why kids who are born to alcoholic parents and then raised by non-drinking parents have the same risk for alcoholism as if they had been raised by their biologic parents.

This is not to say that one, or even a handful of genes are responsible for the disease. The number is clearly far higher than that. Genes that predispose to alcoholism affect diverse physiological functions ranging from those involved with alcohol metabolism to those governing the behavioral response to rewards and pleasure. Some genes linked primarily to depression have even been linked to alcoholism.

The explanation for this multi-gene etiology is that diverse social and environmental factors can interact with genetically programmed mechanisms in complex ways, all of which end-up precipitating the syndrome.

Gene Links to Alcoholism: A Sampler
The “Asian Flush” genes are perhaps the best understood in this regard. Fully one third of all people of East Asian descent are 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. This “Asian Flush” syndrome is often associated with nausea, headache and tachycardia, distasteful symptoms which act collectively to deter people from drinking alcohol. The result: very few affected individuals become alcoholics.

A separate, colloquially named “tipsy gene” makes affected individuals feel completely bombed after just a drink or two. As many as 20% of the US population has the tipsy gene. It too seems to protect people from becoming alcoholics.

By contrast, a gene variant for the DRD2 dopamine receptor in the brain causes people to feel downright euphoric after drinking, probably because it alters the way the brain’s reward circuits respond to alcohol. Some (but not all) studies have shown this gene variant to be present in a disproportionate number of alcoholics, drug addicts and cigarette smokers. (more…)

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Feds to Regulate Rocket Fuel Levels in Tap Water

March 11th, 2011 | 2 Comments | Source: MSNBC, Wall Street Journal

After nearly a decade of inaction, the US government is finally going to set safety standards for perchlorate in the nation’s water supply.

Perchlorate is a rocket fuel additive that causes thyroid abnormalities in newborns and children. Even tiny amounts of perchlorate can impair thyroid hormone production, especially in utero and in newborns. The resulting metabolic abnormalities can lead to irreversible loss of IQ and increased perceptual and behavioral problems.

Nearly all the perchlorate found in drinking water is the result of lax disposal methods at chemical plants, rocket test sites and military installations. Government estimates say that 16 million Americans are exposed to unsafe levels of the chemical. Independent scientists using state and federal data suggest the number is twice that.

White House and Pentagon officials, primarily in the Bush administration, had pressured the Environmental Protection Agency for years to refrain from establishing safe, allowable levels of the chemical in tap water, presumably because the cost of a national cleanup would cost several hundred million dollars.

But under new management (the Obama Administration), the EPA has announced it will establish standards for the toxic compound sometime during the next 2 years.

“As improved standards are developed and put in place, clean water technology innovators have an opportunity to create cutting edge solutions that will strengthen health protections and spark economic growth,” EPA administrator Lisa Jackson said in a press release.

As far back as 2002, an EPA risk assessment determined that safe levels of perchlorate in drinking water should be set at 1 part per billion. After 6 years of complete non-action on the matter, the Bush administration decided not to regulate the chemical. Instead, it established an “advisory guideline” that perchlorate concentrations should not exceed 15 parts per billion. (more…)

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Fighting Cancer with Cancer

March 4th, 2011 | 1 Comment | Source: Cancer Research, Wall Street Journal

The pathophysiology of cancer involves uncontrolled cellular proliferation–that we know–but the process doesn’t go on forever. After reaching a certain size, tumors do stop growing. This phenomenon is probably driven by growth-inhibiting chemicals that are released by tumor cells themselves.

Scientists are now trying to harness this phenomenon using a decidedly counterintuitive strategy: introducing cancer cells into the bodies of mammals–including humans–that are already afflicted with cancer. The strategy amounts to fighting cancer with cancer. Remarkably, early results from studies of the technique have been positive.

The technique was developed by Barry Smith and colleagues at the Rogosin Institute, an independent treatment and research center in New York. Smith’s group creates pea-sized beads of mouse kidney cancer cells that are encapsulated in a growth-restricting shell.

Initially, the beads contain about 150,000 cancer cells. During an incubation period however, all but 1% of those cells die, according to Smith. The remaining ones secrete proteins or peptides that inhibit tumor growth. Some of the chemicals promote cell death directly; others impair a cell’s ability to stimulate new blood vessel formation which is  needed for cellular survival.

“They reach a stable state in which there is cell division and cell death,” Smith said in an interview. “They are producing inhibitory factors that regulate their growth.”

Once the encapsulated concoction is “mature” in this way, Smith’s group  implants the beads into the abdominal cavities of cancer patients.

In a pair of studies released last week in Cancer Research, Smith’s group reported that their treatment reduced tumor size in laboratory mice, dogs and cats. Many cancer-stricken animals survived longer than expected. (more…)

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Should the US Destroy its Cache of Smallpox Virus?

February 17th, 2011 | No Comments | Source: Wall Street Journal

Smallpox killed between 300–500 million people during the 20th century. As recently as 1967, 15 million people were infected and 2 million died from smallpox. Amazingly however, a massive, global vaccine-based effort to eradicate the disease was declared a complete success in 1979. That feat stands among the greatest achievements in the history of medicine. In fact to this day, smallpox remains the only human disease to have been completely eliminated from the face of the earth.

End of story, right?

Well, not exactly. Today, officials believe that the only samples of the virus in existence are stored in refrigerators at the CDC and in a Russian government lab in Siberia. At these tightly guarded facilities, scientists use the specimens to develop treatments which would be used in the event that very bad people somehow found a way to release the virus into a world containing billions of unvaccinated people.

For this to happen, bioterrorists would have to secure unsanctioned samples of the virus (none of which are known to exist), steal it from the above-mentioned facilities, or genetically engineer it (a task believed to be extremely difficult using current technology, since the virus’ genome is long and complex). It’s also possible that the above-mentioned facilities could release the virus accidentally.

The probability that any of these events will happen is exceedingly small, so public officials have debated for decades whether the known, remaining samples of smallpox virus should be destroyed.

The debate now appears headed for a resolution. Representatives of 34 countries including the US and Russia are meeting to decide the matter. The group will make recommendations to a governing body, the World Health Assembly, in March. The Assembly plans to decide the matter in May. (more…)

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