News Brief: Contraceptive Used in Africa May Double Risk of H.I.V.

Parsa Shahbodaghi

The use of a popular hormonal contraceptive was found to have increased the rate of HIV infection in African populations. According to a recent study by the Lancet, the intravenous use of a hormone over a three month period was found to double the risk of women contracting HIV. Similarly, when HIV positive women used this method their male partners were twice as likely to contract the virus.

Though there is uncertainty with any scientific endeavor, this study looked at 3800 heterosexual couples where one member was already infected with the disease. Researchers were therefore able to monitor viral transmission and provide evidence for a causal link between contraceptive use and infection.

The implications of this work are enormous. Injectable contraceptives are popular in Africa, because a woman is able to control the timing of birth without having to travel or see a doctor. The contraceptives have also helped hundreds of thousands of women avoid the infections, injuries, and death associated with childbirth. On the other hand, increasing HIV incidence is an enormous price to pay. The WHO will be re-evaluating to see whether the costs of using this method of conception outweigh the benefits.

Reference: Belluck, Pam. "Contraceptive Used in Africa May Double Risk of H.I.V." The New York Times. Web. http://www.nytimes.com/2011/10/04/health/04hiv.html?_r=1. Oct 3 2011.

News Brief: Beta Blockers "May Stop Breast Cancer Spreading"

Ariel Lefland

The American Cancer Society estimates that in 2011 there have been about 230,480 new cases of invasive breast cancer in women, 57,650 cases of carcinoma in situ will be found and about 39,520 women have died from breast cancer. Breast cancer is the most common cause of cancer in women and the second leading cause of cancer death in women. Ninety percent of the deaths from breast cancer are specifically due to the malignant character of the disease, which causes it to spread to other parts of the body Although the statistics show that due to better treatments and earlier detection of tumors more women are surviving breast cancer, cancer experts are looking into a new type of therapy that may cut the risk of breast cancer spreading, hopefully cutting the number of deaths it causes.
Early work on beta blockers found that women taking beta blockers had a seventy-one percent reduced risk for cancer-related death. Studies have highlighted the potential of beta blockers to stop noradrenergic receptors, preventing cells from moving to other parts of the body. The chance for cancer to spread in eight hundred female patients who have used these beat blockers commonly used as blood pressure drugs has already decreased fifty percent. The Cancer Research UK backed study to be reported next year will study a sample of thirty thousand patients. This research, investigators remark, has huge potential to save lives.

Reference: "Beta Blockers 'May Stop Breast Cancer Spreading'." BBC Health News. http://www.bbc.co.uk/news/health-15117324. Sep 30 2011.

News Brief: The Temptations of Chocolate

Alex Sakers

Pass me the chocolate!

A short review of recent epidemiological research on the effects of chocolate on health has suggested that chocolate may actually be good for us. Specifically, a handful of observational studies found a correlation between increased chocolate consumption and better cardiometabolic health - ie. greater chocolate consumption correlated with lower rates of cardiovascular disease, stroke, heart attack, and diabetes. These results are consistent with the historical observation that cultures that consume more chocolate per capita have lower rates of these diseases compared to those that consume less chocolate per capita.
These results though promising and encouraging, especially in light of the fact that nearly many “comfort” foods are detrimental to our health, but they must be taken with a grain of salt. The studies performed used non-randomized groups and were observational. To verify their results, truly randomized and well controlled studies must be performed. Until then, keep eating your chocolate.

Reference: Mackenbach, Joseph P. "Editorial: The Temptations of Chocolate." BMJ 2011; 343:d5883. Sep 20 2011.

News Brief: Remark on HPV Could Ripple for Years

Marie J Murphy

During last week’s debate for republican presidential candidate, Michelle Bachmann was quoted questioning the safety of the recently produced vaccine that protects against cervical cancer. The vaccine safeguards against the acquisition of HPV, the cancer inducing sexually transmitted infection. Bachmann announced that the vaccine is dangerous, although semi-recanting after being attacked by opposing medical experts. Dr. Wharton, a deputy director at the CDC, exclaimed that the rates of immunization are not meeting goals, especially with the high levels of transmission, and that Bachmann’s statement will do little to help the cause. Opinions of politicians, regardless of their validity, have a large impact on public opinion and can be very damaging to public health efforts, especially when they lack of factual basis involve highly controversial topics. In the case of the HPV vaccine, there is already a low uptake of the regimen because of social stigma and its identification as “the sex” vaccine. Since it is administered around the ages of early puberty, many parents will not approve it for their children for fear that it encourages sexual acts. Misconceptions about the vaccine continue to drive its lack of application in the general population. Despite its effectiveness, misunderstanding of the purpose of the vaccine hinders the widespread application.According to Dr. Deborah Saslow, the director for breast and gynecological cancer at the American Cancer Society, the vaccines are “93 to 100 percent effective at preventing infection with HPV Type 16 and Type 18” (Grady). As of this year, more than 35 million doses of the two cervical cancer vaccines have been disseminated in the United States, with projections likely to drop because of continued political involvement in the debate, which can not be afforded.

Reference: Grady, Denise. "Remark on HPV Could Ripple for Years." The New York Times. Web. <http://www.nytimes.com/2011/09/20/health/20hpv.html?pagewanted=2&_r=1&adxnnl=1&ref=health&adxnnlx=1317510083-qoeoaOKqm1gV3qGKs4VAxg> Sep 19 2011.

News Brief: Parents Fear Health Care Law Could Derail Autism Coverage

Lucia Joseph

The annual cost of caring for a child with autism, a medical and educational endeavor including physical and occupational therapy as well as behavioral analysis, can run upwards of $50,000. Many families rely on state mandates (present in 26 states around the country) which force health insurers to pay for autism services as a way to continue treatment for their children. Insurance companies claim that state laws mandating autism coverage boost premiums for all persons insured, but for families saving tens of thousands of dollars a year on otherwise unsustainable costs, the 1 to 3% hikes are worth it.
Unfortunately, these mandates are at risk of disappearing due to the 2010 federal overhaul healthcare law which gave federal government the right to designate what “benefits” will be offered by health insurers to individuals and small businesses. In other words, while in the past “[autism] mandates have been a way for states to be doing something on a major issue without money coming out of the state treasury,” after the overhaul bill comes into effect states will have to pay for anything they mandate which is not present on the list of federal benefits. It’s unclear how the government will determine its list of benefits, or whether the Department of Health and Human Services will play a role, so for now, families caring for autistic children just have to wait and see.

Reference: Galewitz, Phil. "Parents Fear Health Law Could Derail Autism Coverage." Kaiser Health News. Web. http://www.kaiserhealthnews.org/Stories/2011/September/24/autism-health-insurance-benefits.aspx . Sep 24 2011

News Brief: Glowing Cats Shed Light on AIDS

Alex Sakers

Fluorescent cats are lending a (glowing) paw in the fight against AIDS. These cats have been genetically engineered to express two genes, one for green fluorescent protein (GFP) - that causes them to glow, and an antiviral gene from a rhesus monkey. Of course, the antiviral gene is the one of interest - the GFP gene was only included to allow researchers to visually determine if cats had successfully received both genes as they were transferred together. The monkey antiviral gene codes for a protein called a restriction factor that is particularly good at fighting the feline aids virus called FIV which is analogous to HIV in humans. Native restriction factors in both felines and humans are useless against FIV and HIV respectively making the monkey version particularly useful in fighting the infection in infected individuals. So far, cultured cells from the glowing cats have been shown to be resistant to FIV. The team now plans to expose cats to the FIV virus to see if they are protected by the monkey restriction factor, hoping that this may someday aid in fighting HIV.

References: "Glowing Cats Shed Light on AIDS" BBC. Web. http://www.bbc.co.uk/news/science-environment-14882008. Sep 12 2011.

News Brief: UN Meeting for Non-Communicable Diseases

Joshua Dower

This past week, the UN held a high level meeting to discuss NCD. This stands for Non-Communicable Diseases, which include heart disease, cancer, and other illnesses that cannot be transferred from one person to another. The entire world is waiting to hear about the outcomes of this meeting because NCD is currently not a focus of medical research and economic support. This group of diseases represents the number one killer in the world and the World Health Organization predicts the number of deaths caused by NCD in developing countries will increase over the next ten years. Although many predict that NCD will remain a problem in society even after the meeting, many organizations are happy to see that the creation of the NCD alliance will increase public awareness of the diseases. Organizations involved include Unicef and UN habitat, and they hope to model programs that fight NCD after similar programs developed to fight HIV/AIDS that came as a result of a similar meeting ten years ago.

To fully eradicate NCD, many different countries must commit to researching and educating about these diseases. There are already eleven global organizations devoted to this cause, but this is not enough to reach every affected group of people. In the current global economic environment and with the population growing, it will be incredibly difficult to change NCD’s wide impact. However, this important meeting will hopefully kick-start many global initiatives that will eventually lead to saving people’s lives.

References: Koehlmoos, Tracey Perez. "UN Meeting for Non-Communicable Diseases". British Medical Journal. Web. http://www.bmj.com.ezproxy.library.tufts.edu/content/343/bmj.d5762.full. Sep 13 2011.

News Brief: More Kids Accidentally Poisoned by Prescription Drugs

Ariel Lefland

Despite the efforts of childproof caps that seal medication bottles, researchers believe that the increased presence of drugs in homes with small children has led to an increase of poisonings in children. A recent study published in the Journal of Pediatrics examining data from the American Association of Poison Control Centers reported that emergency-department use for all pharmaceutical exposures increased 30% between 2001 and 2008. Randall Bond, an author of the study, stated that “there are more medications in households with small children.” As obesity rates increase, adults start taking medications for diabetes and blood pressure at younger age. Furthermore, older kids and teens are also taking more pills for diabetes and ADHD, allowing increased opportunities for small kids to get their hands on prescription drugs. Investigators pointed out three drug categories that most often cause accidental poisonings in children: opioid painkillers, sedative-hypnotics and sleep aids, and cardiovascular medications. Drugs may not only be easier for children to access but may also be more potent, which also contributes to the problem. Families must now take extra care to keep pills in places where young children cannot get to them. Researchers suggest that the best poison prevention would come not just from families taking extra caution but from better packaging methods that would make it more difficult for young children to get into medicine bottles and “pill minders”.

Reference: Hobson, Katherine. "More Kids Accidentally Poisoned by Prescription Drugs" Wall Street Journal. Web. http://blogs.wsj.com/health/2011/09/16/more-kids-accidentally-poisoned-by-prescription-drugs/. Sep 21 2001.

News Brief: Portrait of an Ostracized Autism Theorist

Emily Clark

A timely piece addresses the life behind that scientist who, with one research project, initiated a cascade of controversy about whether there was a vaccine-autism link. While the medical establishment has repeatedly discredited Andrew Wakefield’s scientific integrity, revoked his medical license and retracted the original 1998 article from the Lancet, he continues to hold a curious position of power. Journalist Susan Dominus visits Wakefield in his adopted state of Texas and witnesses the way he holds sway over families impacted by autism. It is an interesting transformation that she describes from a man who once was a respected physician and researcher to one who is seen in the media as a fraudulent, slippery and unethical appropriator of science for profit, yet who sees himself as a martyr. The image she paints is one of a man devoted to his theories like a preacher is devoted to his beliefs, and who dismisses scientific scrutiny in favor of faith. Wakefield is widely blamed for the current decline in vaccine rates and for scaring parents away from immunizations without adequate evidence. It is easy to see how he’s been able to hold this position in the eyes of someone who has seen autism develop in a child. He presents an absolute certainty and trust in the idea that “parents know best”. This is something they often don’t feel like they get from visits to doctors. As one mother professed, “I think that validation is all that parents want - just that someone is taking the symptoms that we report and looking at them to see what we can do about it.” The incidence of autism in children is creeping up nationwide, and without a definitive treatment or any evidence about what parents can do to protect their children, the fact that Wakefield is able to defend his theories just enough to convince parents that he is onto something has huge implications.

Reference: Dominus, Susan. “The Crash and Burn of an Autism Guru” New York Times. Web. http://www.nytimes.com/2011/04/24/magazine/mag-24Autism-t.html?pagewanted=1&_r=1&ref=global-home. Apr 20 2011.

News Briefs: FDA Approves Non-Surgical Aneurism Treatment

David Gennert

The FDA has given “Premarket Approval” to the Pipeline Embolism Device, manufactured by ev3 of Menlo Park, California, for the treatment of brain aneurisms without the necessity of open surgery.

Aneurisms are bulges that develop in blood vessels due to blood pressure pushing against a weakened portion of a vessel. Aneurisms in the brain are particularly common, with one of the more frequent locations being at the base of the brain in the internal carotid artery, which is the one of the main blood suppliers of the brain. If left untreated, aneurism can bulge enough to impinge upon surrounding brain tissue, causing neurological symptoms, or they can rupture, causing a life-threatening hemorrhage.

The device is a metal mesh tube that is inserted through a blood vessel in a patient’s leg into the carotid artery near the site of the aneurism. Once in place, the device is expanded against the neck of the aneurism, which limits blood flow to the aneurism. This lack of blood flow causes blood left in the aneurism to clot and the aneurism to shrink over time, both of which help reduce the risk of a ruptured aneurism. Past methods of treating brain aneurisms mostly included surgical procedures, which had the potential of causing serious complications, such as damaging surrounding brain tissue, disease recurrence, and stroke.

According to the clinical studies, 70% of aneurisms treated remained blocked by the device without significant narrowing of the artery at that location after one year following the insertion procedure.

The device has been approved in Europe and has been on the market outside the US since July of 2009. According to the parent company of ev3, Covidien, it will become available at existing clinical sites in the US shortly.



References:
Petrochko, Cole. “FDA Okays Aneurysm Device.” Medpage Today. 10 April 2011. 15 April 2011.
Zacks Equity Research. “Covidien's Pipeline Device Cleared.” Zacks Investment Research. 7 April 2011. 15 April 2011.
Roberts, Scott. “Device Approved to Treat Brain Aneurysm.” Bloomberg Business Week. 14 April 2011. 16 April 2011.

News Briefs: Drug-Resistant Bacteria in Supermarkets

Emily Clark

A study published today in the journal Clinical Infectious Diseases raises cause for some alarm about the state of food safety and agriculture in the US. 47% of the meat and poultry samples that researchers tested from supermarkets contained Staphylococcus aureus bacteria, and more than half of these were resistant to at least three classes of antibiotic. Staph bacteria can cause skin infections and food poisoning, and pose a danger if meat is not cooked properly or if there is cross-contamination in the kitchen. However the exact risk that this finding poses to consumers is not fully clear yet. These bacteria aren't one of the three drug-resistant organisms that the government looks for in retail supplies of meat, and so researchers suggest that it probably should be better tracked. The FDA is the branch of authority responsible for making sure that US consumers are safe from dangerous food products. Still another concern raised is that the widespread use of antibiotics in livestock ends up causing antibiotic resistance in humans, and there is evidence that the source of these bacteria were from the animals themselves. Therefore in the long run, this may be a question not just of food quality standards but also of agricultural practices more generally.

Reference: Barclay, Eliza. “1 in 4 Supermarket Meat Samples Tainted with Drug-Resistant Bacteria.” Shots: NPR’s Health Blog. Web. http://www.npr.org/blogs/health/2011/04/15/135435291/1-in-4-supermarket-meat-samples-tainted-with-drug-resistant-bacteria. Apr 15 2011. 

News Briefs: April 10

American under Medicaid Unable to Access Adequate Healthcare

Alex Sakers

Under Obama’s health care bill, Medicaid plays a vital part in providing health insurance, and thus access to healthcare for many uninsured Americans. Medicaid aims to reimburse doctors, dentists, hospitals, and other healthcare providers enough to ensure that its recipients have the same access to care as the general population. However, as payment rates have been cut in many states, many with Medicaid are finding it hard or impossible to find doctors and specialists to accept their insurance. For example, Kim Hardy, an OB-GYN in Lafayette, LA reported that Medicaid pays $1,000 for the same level of prenatal care that private insurance pays $2,400. The increasing disparity in reimbursement between Medicaid and private insurance has been driven by the need to control the Medicaid budget while accommodating the surge of people now insured under this program; it is expected that the number of people covered under Medicaid will surge from 56 million to 76 million in the next 10 years. Already, over 20 states have cut payments to healthcare providers by 15-20%. With each cut, it becomes harder for Medicaid enrollees to find specialists to provide the care they need. For example, Nicole Dardeau described her Medicaid card as “a useless piece of plastic” after being unable to find an orthopedic surgeon to treat three herniated disks in her neck that keep her from being able to work. Stories like hers are far too common; sadly Medicaid simply does not afford the same level of healthcare to its enrollees as private insurance.

Reference: Pear, Robert. (2011, April 1). Cuts Leave Patients With Medicaid Cards, but No Specialist to See. The New York Times. Retrieved April 10, 2011 from http://www.nytimes.com/2011/04/02/health/policy/02medicaid.html?_r=1&ref=health.

Image: Available here.

Middle School Students Showing Early Symptoms of Cardiovascular Damage


Eriene-Heidi Sidhom

In a study conducted as part of the Project Health Schools in Michigan, children as young as 10 years of age were exhibiting symptoms of cardiovascular damage. In a first study, with 1,104 students, 16% of students had low HDL cholesterol levels and a second study with 1,276 students showed children with poor cardiovascular fitness. Additionally, these findings correlated with other risk factors: a low HDL cholesterol level correlated with higher BMI and well as at least two additional symptoms of metabolic syndrome (high LDL and triglycerides, elevated blood pressure or abdominal obesity). Project Healthy Schools is a school-based intervention program that is affiliated with the University of Michigan and focuses on educating children on diet, exercise and healthy lifestyle choices.

Reference: Neale, Todd. (2011, April 03). ACC: CVD Risk Seen in Middle School. MedPage Today. Retrieved April 10, 2011 from http://www.medpagetoday.com/MeetingCoverage/ACC/25691.

News Briefs: May 4, 2010

Survey Reveals Increased Chocolate Consumption among the Depressed
Priya Larson

A new study supports the notion that clinically depressed people eat more chocolate than those who are not clinically depressed. The conclusions were based on a survey that assigned individuals with a score on the Center for Epidemiologic Studies Depression Scale, where a score above 15 indicated clinical depression. Participants were also asked to report how often they consumed chocolate. On average, individuals with depression consumed 8.4 servings of chocolate per month, and individuals with scores above 21, or probable major depression, consumed 11.8 servings. People who screened negative for depression consumed only 5.4 servings per month.

Because the study is based on survey results and not a controlled experiment, the study’s authors could assume no causal relationship between depression and chocolate consumption. However, the association between depression scores and consumption was statistically significant for both genders. The authors suggested several reasons for this association, including motives to self-medicate using chocolate, chocolate cravings for non-depression-related reasons, and other physiological factors that could instigate cravings or depression.

Reference: Bankhead, Charles. (2010, April 26). Depression and Chocolate: Self-Medication or Perpetuation. MedPage Today. Retrieved May 1, 2010 from http://www.medpagetoday.com/Psychiatry/Depression/19765.

Image: Available here.


Auditory Processing Disorder can Lead to Decreased Academic Performance
Yang (Karen) Chen

A disorder known as auditory processing disorder (APD) is recently getting some overdue attention, thanks to talk-show host Rosie O’Donnell and her 10-year-old son, Blake, who has APD. Symptoms of auditory processing disorder include trouble paying attention and following directions, low academic performance, behavior problems and poor reading and vocabulary. It is a poorly understood syndrome that interferes with the brain’s ability to recognize and interpret sounds. Gail Chermak, an expert on speech and hearing sciences at Washington State University, says it’s been estimated that 2 to 5 percent of children have the disorder and likely that many cases have gone undiagnosed or misdiagnosed.

Children with APD can hear perfectly well but have trouble distinguishing between sounds. Words such as “tangerine” and “tambourine,” “bed” and “dead,” may sound the same. They often have trouble filtering out other sounds. For example, the teacher’s voice, a chair scraping the floor and crinkling paper are all heard at the same sound level. Blake’s brain struggled to retain the words he heard, leading to a limited vocabulary and trouble with reading and spelling. Abstract language, metaphors like “cover third base,” even “knock-knock” jokes, were confusing and frustrating. Lois Kam Heymann, the speech pathologist and auditory therapist, suggests that the solution is often a comprehensive approach, at school and at home. Dampening unwanted noise can be accomplished by placing strips of felt or tennis balls on the legs of chairs and desks. Parents can work to simplify language and avoid metaphors and abstract references.

APD disorder can affect a child’s world, as it cuts them off from society and interactions with others. O’Donnell emphasizes it is most important to diagnose the disorder early on in order to treat it.

Reference: Parker-Pope, Tara. (2010, April 26). Little-Known Disorder Can Take a Toll on Learning. The New York Times. Retrieved April 29, 2010 from http://well.blogs.nytimes.com/2010/04/26/little-known-disorder-can-take-a-toll-on-learning/?ref=health.

Addition to Chemotherapy Helps Survival Rate of Pancreatic Cancer
Virginia Saurman

Data from a small phase I clinical trial shows that pancreatic cancer patients given an insulin growth factor (IGF) inhibitor combined with chemotherapy resulted in durable responses beyond one year. According to Rachna Schoff, MD of M.D. Anderson Cancer Center of Houston, this data shows that “for a subset of patients, IGF-1 receptor is integral to pancreatic cancer.” IGF type 1 receptor (IGF-1R) initiates signaling pathways involved in the pathogenesis and pathophysiology of pancreatic and other cancers: MEK/Erk and PI-3Kinase/Akt. MK-0646 is a human antibody against IGF-R1 that leads to the receptor’s internalization and subsequent degradation. Preclinical studies have shown that IGF-1R signaling increases the efficiency of chemotherapeutic drug. For this study, of the six patients who had partial responses, the shortest that was 14 weeks. The remaining five patients had response durations of 32 to more than 59 weeks.

Reference: Bankhead, Charles. (2010, April 26). AACR: Durable Responses Seen In Pancreatic Cancer. MedPage Today. Retrieved May 1, 2010 from http://www.medpagetoday.com/HematologyOncology/OtherCancers/19758

Eriene-Heidi Sidhom is the 2009-2010 News and Analysis Editor.

News Briefs: April 26, 2010

Psychedelics Offering a Cure?
Eriene-Heidi Sidhom

Like many Americans, Dr. Clark Martin, a clinical psychologist, suffered through depression. Dr. Martin fell into depression after chemotherapy for kidney cancer and none of the traditional methods were helping him recover until, at the age of 65, he had his first psychedelic experience as part of an experiment at Johns Hopkins University, involving psilocybin, an ingredient in mushrooms. He claims this six-hour experience helped him overcome depression and entirely transformed his personal relationships. Similar studies, using psychedelics, have yielded encouraging results, but review boards have set up strict guidelines to avoid there being an exaggerated perception about the drugs’ risks and benefits. However, despite positive results from multiple studies there is still limited public money granted for research, although nonprofit groups like the Heffter Research Institute have supported research efforts.

Reference: Tierney, John (2010, April 11). Hallucinogens Have Doctors Tuning in Again. The New York Times. Retrieved April 25, 2010 from http://www.nytimes.com/2010/04/12/science/12psychedelics.html?ref=health.

A Decline in Death from Childbirth
Adam Snider

Due to factors including lower pregnancy rates, higher income which correlates to better nutrition and healthcare, better education, and an increased prevalence of hospitals staffed with skilled workers has lead to a worldwide decrease in maternal mortality rates. Improvements made in India and China stand out as major contributors to this important improvement in public health. In other regions, AIDS is a dominant factor in maternal mortality rates. These findings contradict the dominant view that maternal mortality rates cannot be combated. However, many advocates of women's health resisted the publishing of this data, fearing that the news would reduce public support for their cause. This opinion was contested by other medical professionals. The interviewed Dr. Horton argued that public knowledge of this information demonstrates that public support and donation is having a positive effect.

Reference: Grady, Denise. (2010, April 13). Maternal Deaths Decline Sharply Across the Globe. The New York Times. Retrieved April 25, 2010 from http://www.nytimes.com/2010/04/14/health/14births.html.

Sources to Aid Donor Identification
Namratha Rao

Donor identification for patients suffering from conditions of poor cell development such as immune system diseases primarily needs allergenic hematopoietic stem cell transplantation (HSCT). In order to widen the pool of donors, four primary sources are suggested: blood or bone marrow of adult unrelated donors, of mismatched relatives, the umbilical cord stem cells and a combination of various donor sources. There is hope that the body’s own somatic cells can act as a source of stem cells.

Reference: JAMA. 2010;303(14):1421-1422

Study Shows that Robots can Aid Stroke Patients
Kanupriya Tewari

A randomized trial has recently shown that rehabilitation assisted through the use of robots actually results in some improvements in motor function and quality for patients who suffer from chronic disability following a stroke. The New England Journal of Medicine’s researchers reported online that significant progress has been observed in basic motor function and time taken to complete everyday tasks for the robot-assisted group at only 36 weeks, as compared with usual care. Albert Lo, MD, PhD, of the Providence Veterans Affairs Medical Center in Rhode Island, and his colleagues have cited that these findings "provide evidence of potential long-term benefits of rehabilitation and challenge the widely held clinical belief that gains in motor function are not possible for long-term stroke survivors.” Results demonstrated that compared with usual care, robot-assisted therapy was superior on one of the secondary endpoints, the Stroke Impact Scale, which measures quality of life and social participation. Certain criticisms have come up, however, such as that it might have been difficult to observe between-group differences because of the effects of certain patient characteristics, like depression. Nonetheless, "the potential for robotic therapy after stroke remains enormous," Steven Cramer, MD, of the University of California Irvine, wrote, noting that “robots never get tired, can design training regimens in reproducible ways, reduce the need for human oversight, can measure performance during therapy, and can provide simultaneous cognitive training by interfacing with computers.”

Reference: Neale, Todd. (2010, April 16). Robots May Aid Stroke Recovery. MedPage Today. Retrieved April 25, 2010 from http://www.medpagetoday.com/Cardiology/Strokes/19592.

News Briefs: April 13, 2010

Dealing with Smoking at Home
Paulina Zheng

As evidence continues to demonstrate that any level of exposure to cigarette smoke may result in future health problems in children, public health advocates are confronted with the challenge of limiting such exposure. Public spaces have become largely smoke-free as of late and experts must now focus on the home. Since children spend most of their time at home and remain considerably more susceptible to both the influence and effects of smoking, experts are justified in their change of attention. However, difficulties remain in regulating the effects of so-called, “passive smoking” in such environments. Even after active smoking has stopped, children remain exposed to the heavy metals and carcinogens that may remain on furniture, carpets, and clothing. The tobacco advisory group of the Royal College of Physicians in England’s report suggests that children can be indirectly protected by encouraging adults to not smoke through various strategies. Direct attempts to protect children – by banning smoking in homes with children, for example – remain woefully impractical. Such measures would be difficult to implement and enforce, regardless of public support. As such, it is suggested that further discussion is required in order to decide the best possible way to protect society’s most vulnerable members.

Reference: BMJ 2010;340:c1680
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How Much Exercise is Necessary to Lose Weight?
Kristin Bradley

In a recent study published in The Journal of the American Medical Association, Harvard researchers investigated the long-standing question of how much exercise is needed for middle aged women to prevent age-related weight gain. Over 34,000 women were followed for fifteen years, and the results show that both the starting weight of the individual and the level and amount of physical activity they engaged in per day affected weight gain. Women within the normal weight bracket who got an average of hour of moderate exercise or a half hour of vigorous exercise per day were able to avoid weight gain, whereas women who weighed more to begin with or received less than the equivalent of an hour of moderate exercise per day tended to gain more weight.

Reference: Rabin, Roni Caryn. (2010, March 31). How Much Exercise Prevents Weight Gain? The New York Times. Retrieved April 13, 2010 from http://www.nytimes.com/2010/04/06/health/06regi.html.

Understanding the Correlation between Socioeconomic Status and Health Outcomes
Alex Sakers
Many studies reveal a correlation between socioeconomic status and potential health outcomes and potential health risk behaviors (smoking, alcohol consumption, certain dietary patterns, etc...); with those of a lower socioeconomic status more likely to have poorer outcomes and engage in more risk behaviors. A recent study by Stringhini et al attempted to determine whether the socioeconomic differences in health outcomes can be attributed to socioeconomic differences in health risk behaviors. Although the study found a strong correlation between health outcomes and health risk behaviors, it found that socioeconomic differences in health outcomes cannot be explained solely with socioeconomic differences in health risk behaviors. Thus simply trying to reduce the amount of health risk behaviors in which people of low socioeconomic status engage will not necessarily result in better health outcomes. There are social and economic determinants of health that together with health risk behaviors determine health outcomes. Thus the study found that it is important not to view socioeconomic differences in health outcomes as a function of socioeconomic differences in health risk behaviors. There are more pieces to the puzzle that anyone wishing to change this trend must sort out.

Reference: JAMA. 2010;303(12):1199-1200

Diabetics at Greater Risk, Post Cancer Surgery
Sangita Keshavan

According to a recent study, the mortality risk of cancer surgery increases significantly if a person has pre-existing diabetes. Hsin-Chieh “Jessica” Yeh, PhD, conducted a study at John Hopkins that suggested that the likeliness of death is significantly higher (51-85%) if there is a preexisting condition of diabetes and that nonsurgical options may be preferable cancer treatment options for diabetics. Patients who have diabetes are more at-risk for infection. Furthermore, after surgery, a diabetic is more likely to have a heart attack.
Yeh stressed that it is important for diabetics to continue to manage and to pay attention to that condition, despite the cancer diagnosis. She said that some patients neglect to control their diabetes after cancer detection because cancer seems much more threatening. Ultimately, cancer diagnosis can come with more and different risks if a person is diabetic, and thus the patient should be aware of other treatments where their risk may be lowered.

Reference: Phend, Crystal. (2010, March 29). Diabetes May Elevate Risk of Cancer. MedPage Today. Retrieved April 13, 2010 from http://www.medpagetoday.com/Endocrinology/Diabetes/19264.

Eriene-Heidi Sidhom is the 2009-2010 News and Analysis Editor.

News Briefs: April 6, 2010

Do the Hazards of Sunbed Use Merit Legislation?
David Gennert

Recently, the use of indoor tanning booths has come under intense scrutiny from researchers and governmental groups, including an FDA advisory committee in late March that recommended that minors be banned from using the devices. The committee cited a “growing body of literature” suggesting a link between indoor tanning and skin cancer risk. The situation is especially worrisome in the UK, where a recent survey puts the prevalence of tanning bed use among those under 18 higher than the prevalence in the United States and other European countries.
A major problem is the misuse of tanning devices through the lack of compliance with regulations regarding device operating specifications and information given to consumers. The British Medical Journal article cites studies in Europe that show the UV intensity for many tanning facilities was over the recommended limit, and 71% of sunbed facilities in Ireland did not know the type of UV light used. It is also cited findings in Britain that described that many users of tanning facilities were not given information about potential harms, and substantial numbers have used tanning beds at home or in unsupervised facilities.

One possibility to help decrease this misuse of tanning facilities is to instigate a voluntary code of practice for operators of tanning facilities, but the article cites a study in Australia that described the number of facilities that disregarded regulations regarding age restrictions (more than half of facilities), skin type of users allowed to tan (90% of facilities ignored the code), and eye protection (14% gave inadequate or no eye protection).
With European nations starting a trend to ban access to those under 18– France and Scotland have banned it to this age group and the EU has passed regulations limiting access to those under 18– it seems important to also include the enforcement of any regulations as a priority as well.

Reference: BMJ 2010;340:c990.
Image: Available here.

The Importance of Informed Consent
Priya Larson

Improving patient-centered care is an under-publicized aspect of health care reform, but Dr. Harlan Krumholz of Yale University School of Medicine calls for a standardized method of informing patients about treatment options, risks, and benefits. Informed consent is the term for the process of providing patients with detailed information about treatment so that they can choose to agree to undergo medical procedures. Krumholz advocates for the use of a standardized informed consent document that could be tailored to individual patients’ situations. The document would have space for background information and risks for their health condition, the procedure suggested, and other available treatments. The form would also educate patients on the frequency that their doctor performs the procedure, and the exact cost associated with it.

Krumholz believes that increasing the quality of informed consent would lend more legitimacy to clinics and hospitals that claim to focus on patient-centered care. A standardized informed consent procedure would help to ensure that all patients know exactly what undergoing a medical procedure entails. Studies show that such forms would improve the consent process and lessen patient anxiety. However, an increase in knowledge could also cause patients to become more nervous about the procedure, but this is not a proven effect of the informed consent process. Krumholz also points out that a standardized form might decrease the personalization of care, contrary to the original goal of the whole initiative. In the grand scheme, however, the form should improve patient-doctor trust and communication, thus improving patient-centered care.

Reference: JAMA. 2010;303(12):1190-1191.

Ensuring Primum Non Nocere
Virginia Saurman

Physicians, whether as researchers or clinicians, must do no harm to their patients. However, the case of GlaxoSmithKline’s (GSK) inappropriate conduct surrounding its company-sponsored clinical trial of Avandia (rosiglitazone) is a clear example of corporate motives outweighing scientific and ethical standards, thus potentially putting patients at risk.

The US Senate Committee on Finance investigated GlaxoSmithKline and Avandia and found that GSK exerted an unacceptable amount of influence over the RECORD (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes) drug trial. This behavior included attempting to undermine the authority and responsibilities of the study’s steering committee, rushing publication of an unscheduled interim analysis to suppress findings that suggested Avandia increased cardiovascular (CV) risk, and having employees highly involved with the statistical analysis and the production of the manuscript. After reviewing over 250,000 pages of documents from GSK, the FDA, universities, and others, and conducting interviews for 2 years, the US Senate Committee on Finance concluded that GSK knew of the potential cardiac risks associated with Avandia years before other studies suggested this. However, GSK did not air their concerns to the FDA and patients—instead executives focused on obscuring findings that showed Avandia may increase CV risk while at the same time attempting to downplay findings that a competitor drug Actos (pioglitazone) might reduce CV risk.

Given the implications of GSK’s data collection methods and their resultant behavior in the RECORD trial, perhaps all editors of journals should require that academic researchers have “full-access to all trial data, and that all industry-sponsored trials include independent statistical analysis and assurance.” This would, in theory, prevent repeats of GSK’s actions, and maintain that physicians must do no harm.

Reference: JAMA. 2010;303(12):1196-1198.

Eriene-Heidi Sidhom is the 2009-2010 News and Analysis Editor.

News Briefs: March 28, 2010

Even Earlier Intervention Necessary to Curb Obesity
Eriene-Heidi Sidhom

Despite an increased push to raise awareness of obesity in schools and to educate about a healthy and nutritious lifestyle, recent studies show that interventions as early as kindergarten may still be too late. In fact important events in a baby’s early years, even while still in the mother’s womb, may predispose a child to obesity that is difficult to alter by the time the child enters kindergarten. For example, babies whose mothers smoked during pregnancy are at a higher risk of being obese as well as babies who sleep less than 12 hours. Forms of early intervention have included encouraging women to lose weight before pregnancy and breastfeeding their children. As Dr Leann L. Birch has stated, ““The idea that a big baby is a healthy baby, and a crying baby is probably a hungry baby who should be fed, are things we really need to rethink.”

Reference: Rabin, Roni Caryn. (2010, March 22). Baby Fat May Not Be So Cute After All. The New York Times. Retrieved March 28, 2010 from http://www.nytimes.com/2010/03/23/health/23obese.html?ref=health.

Image: Available here.

Nutrition: Rise in Soda Price linked to Better Health
Namratha Rao

A recent study shows that an increase in the price of soda can lead to better health in young adults. High prices decrease soda consumption resulting in the decrease in calorie intake and weight. For example, the study showed that every 10% increase in the price of a two-liter bottle of soda let to 7% fewer calories consumed from soda as well as a drop in weight of over two pounds. However, not everyone is on board with these new taxes. Maureen L. Storey, senior vice president for science policy at the American Beverage Association, said “Taxes do not make people healthier. Making smart education decisions about diet and exercise do.”

Reference: Rabin, Roni Caryne (2010, March 15). Nutrition: Rise in Soda Price Linked to Better Health. The New York Times. Retrieved March 28, 2010 from http://www.nytimes.com/2010/03/16/health/research/16nutr.html?ref=research.

Rising Prevalence of Multidrug-Resistance Tuberculosis
Kanupriya Tewari

A report released by the World Health Organization this week states that “the percentage of tuberculosis cases around the world resistant to two standard drugs remains low - about 4 percent - but is three to six times as high in the vast area that once encompassed the Soviet Union”. The WHO report is based on information from 114 countries. Statistics demonstrate that in the Russian Arctic city of Murmansk, 28 percent of new TB cases in 2008 were "multidrug-resistant" (MDR) and that in the Central Asian nations of Kazakhstan and Tajikistan, the rates of MDR-TB were 25 and 17 percent, respectively. "We knew that it was serious, but we are reporting increasing levels that we thought were not possible before," said Mario C. Raviglione, director of the WHO Stop TB Department. However, a point to be noted is that because testing for TB drug resistance is not uniformly carried out and is not even done in some countries it cannot be substantiated whether the problem is getting worse or better.

This increase in MDR-TB may be due to factors like the collapse of the Soviet Union which caused a definite decline in the quality of TB treatment. Also, many patients were treated with limited drugs, which may have lead to the development of resistant strains (MDR-TB), which has caused the rates in Eastern Europe and Central Asia to be much higher than other regions of the world. However, nearly half of all MDR-TB cases occur in China and India because those countries have so many overall TB cases.

What is of most immediate concern at the moment is that about 5 % of MDR-TB cases worldwide are "extensively drug resistant," which means they are resistant to two alternative drugs. Added to this, the WHO estimates that to adequately treat MDR-TB in the 27 most-affected countries by 2015 will require about $3 billion per year; a feat which is extremely challenging.

Reference: Brown, David. (2010, March 20). Drug-resistant tuberculosis poses global risk, World Health Organization says. The Washington Post. Retrieved March 28, 2010 from http://www.washingtonpost.com/wp-dyn/content/article/2010/03/19/AR2010031902064.html.

Massachusetts leads the nation in flu vaccines
Yang (Karen) Chen

In a recently released state report, Massachusetts has been named the #1 state in the nation for vaccinating its residents against seasonal flu and H1N1. John Auerbach, commissioner of the Massachusetts Department of Public Health, says that the mobilization against swine flu in the state was a successful one. This is evident by the fact that 36% of residents were vaccinated for swine flu, compared to the 21% nationally, about 2 million doses of the H1N1 vaccine were administered in Massachusetts. In addition, 57% of Massachusetts residents received seasonal flu vaccinations, as compared to the 37% national rate. While H1N1 was declared a pandemic, it did not cause nearly the amount of deaths that was feared. In Massachusetts, 32 deaths were confirmed due to swine flu, and all except 5 of the cases involved underlying medical conditions. The state was prepared with years of pandemic planning, and local health departments, school systems, and hospitals sent out public health messages through brochures, online forums, Twitter feeds, and 30-second videos in movie theaters. Auerbach says that “the chances of coming down with H1N1 are diminishing in Massachusetts.” A third of population already had H1N1, and another third has been vaccinated. Public health specialists hope this will provide “herd immunity,” as there are not enough people sick with or susceptible to H1N1 for it to easily spread.


Reference: Cooney, Elizabeth. (2010, March 21). Mass. tops nation in flu shots, report says. The Boston Globe. Retrieved March 23, 2010 from http://www.boston.com/news/health/ blog/2010/03/mass_tops_natio.html.

Study on Subjective Memory Loss Reveals Link to Depression
Soumil Mhaskar

A recent clinical review was published at that University College London that investigated the link between subjective memory and cognitive impairments. The study revealed many important findings that may overturn many long held beliefs by the medical community. The first recommendation by the study is that doctors should take subjective memory problems seriously and not disregard the memory loss as a characteristic of the “worried well.” Also, subjective memory problems have been linked to depression, old age, females, and a low education. An interesting finding within the study was that depression is more of an indicator of dementia rather than subjective memory loss. It was commonly believed that subjective memory loss was an early symptom of dementia but now it seems that depression is a risk factor for dementia. Therefore, the overall conclusion of the study is that general practitioners need to expand on the diagnostic tests that are employed to diagnose dementia and not overly rely on subjective memory loss.

Reference: BMJ 2010;340:c1425

Eriene-Heidi Sidhom is the 2009-2010 News and Analysis Editor.

News Briefs: March 22, 2010

Set Back in Diabetes Treatment
Paulina Zheng

The fight against heart disease in diabetics has taken a disheartening stumble, according to new studies. Although diabetic patients suffer from a plethora of other medical ailments as a result of their bodies’ resistance to insulin, they remain most vulnerable to heart disease. The high blood sugar levels, associated with Type 2 diabetes, contribute to increased risk of heart disease. However, the control of these blood sugar levels had little to no effect in these individuals, leading to a change in the search. Researchers chose to examine other risk factors – including cholesterol levels, weight, and high blood pressure – that exist in these patients. As such, researchers’ studies focused on the effects of low blood pressure as well as cholesterol and triglyceride levels on the prevention of heart disease. These studies also failed to demonstrate a significant impact on the manifestation of heart disease in diabetic patients. This suggests that researchers must again look elsewhere in their battle against heart disease. In the meantime, doctors must re-evaluate their recommendations to patients. “Lower,” as Dr. David Nathan of the diabetes center at Massachusetts General Hospital said, “is not necessarily better.”

Reference: Kolota, Gina. (2010, March 14). Diabetes Heart Treatments May Cause Harm. The New York Times. Retrived March 22, 2010 from http://www.nytimes.com/2010/03/15/health/research/15heart.html?ref=health.

Doctors Foregoing Their Practices for Drug Companies
Hoai Le

As more and more universities are establishing conflict-of-interest restrictions preventing their academic physicians from being employed by drug companies, there is a growing trend to hire community doctors to speak at promotional talks. Last year, Cephalon, GlaxoSmithKline, Lilly, and Merck spent tens of millions of dollars to pay doctors for promotional speaking. Some of the highest paid doctors, such Tara Dall, MD, earn $45,000 in just three months of speaking. Critics, however, argue that the talks are biased and may add to increasing healthcare costs by promoting the use of more expensive drugs. Proponents, on the other hand, say that the talks help deliver the latest medical findings. Drug companies have no other choice but to rely on private practitioners because of growing university bans. After all, they claim, physicians often learn best from their colleagues, not sales representatives. Critics, nonetheless, believe physicians can get information on new drugs through many other sources besides dinner talks. Doctors are "clearly being used" for a reason. There are also unintended consequences to these promotions, including doctors leaving their primary occupations rather than forego their secondary job as a speaker for drug companies. In January, Lawrence DuBuske, MD, one of GlaxoSmithKline's top-paid speakers, chose to leave his position at a Harvard training hospital rather than quit his job with GSK, which paid him $99,000 during the second quarter of last year. After all is said and done, one thing we can all agree on is that with possible cuts in Medicare reimbursements happening in the near future, it is difficult to pass up such a tempting source of income.

Reference: Fauber, John. (2010, March 13). On the Stump: When Academics Are Out of the Picture. MedPage Today. Retrieved March 22, 2010 from http://www.medpagetoday.com/PublicHealthPolicy/Ethics/18989.

Questioning the Implications of and FDA Approved Treatment
Eriene-Heidi Sidhom

Currently, there is a discrepancy between the implication of a newly approved treatment and the actual guidelines for a approval and rejection. To the public, an approval implies that this new treatment is more effective over older treatments. However, new drug approval is actually only based on efficacy over randomized clinical trials (RCTs) in comparison with a placebo. Therefore, it does not determine efficacy relative to current treatments and raises questions about the clinical significance of these new treatments. This can result in patients receiving these new treatments, due to effective marketing, but also receiving the high costs associated with them as well as the higher risk for a poor outcome. To close this gap between the public perception and the actual guidelines for approval, two solutions have been proposed: First, Alexander and Stafford recommend that the FDA "incorporate the principles of comparative effectiveness research throughout the process of approval and regulation." This will reduce needs for comparative effectiveness research later on. However, companies may choose to compare their products to a second or third-line drug or simply state that there is little known about the comparative efficacy of the treatment. The second solution, recommended by the European Medicine Agency (EMA), suggests that trials are conducted with both active-comparator and placebo control groups. The EMA then makes decisions based not only on the efficacy of new treatments but makes a holistic decision, including risks and benefits of the new drug. Regardless of the route taken, it is necessary that the FDA reevaluate its approval guidelines.

Reference: JAMA. 2010;303(10):979-980.

Eriene-Heidi Sidhom is the 2009-2010 News and Analysis Editor.

News Briefs: March 14, 2010

Cost-Effectiveness of Mandatory EKG Screening for Athletes

Priya Larson

Seemingly healthy athletes with undetected heart conditions are at risk for cardiac failure while performing rigorous activity. According to recent studies, electrocardiogram screening can prevent sudden cardiac death of athletes in a cost-effective manner. In Italy, competitive athletes have been required to undergo EKG screening, and a 2006 JAMA study found that the number of cardiac deaths in athletes ages 14-35 decreased by 89 percent with screening. Essentially, EKG screening makes the rate of cardiac death equal between athlete and non-athlete groups.

Currently, the American Heart Association does not give any recommendation for EKG screening, and one argument against such a recommendation is the high expense associated with the number of preventable deaths. However, a 2010 study published in The Annals of Internal Medicine electronically simulated the cost per number of cardiac deaths prevented. The results? Screening all athletes is cheaper per athlete in terms of deaths prevented, and it saves more life-years per 1,000 athletes than the regular physical examination.

Reference: Bakalar, Nicholas. (2010, March 1). Screening May Save Athletes. The New York Times. Retrieved March 14, 2010 from http://www.nytimes.com/2010/03/02/health/02heart.html?ref=health.

Image: EKG of a 26-year-old man. Available here.

News Briefs: March 7, 2010

Cracking Down on Front-of-Packaging
Soumil Mhaskar

Companies within the food industry are always developing new methods to improve marketing. With this has come the advent of front – of – package claims that proclaim that the products provide “ten essential vitamins and minerals.” Recently, the Food and Drug Administration has embarked on a mission to crackdown on misleading front-of-package labels that have been ubiquitous in food marketing.

The issue with food label advertising began in 1906 when the Pure Food and Drug Act prohibited food labels that were “false and misleading.” In 1969, President Richard Nixon sought ways to end hunger and malnutrition and as a result, the FDA permitted food packages to state “contains 7 essential nutrients.” Furthermore, in the Dietary Supplement Health and Education Act along with the FDA Modernization Act were passed in 1994 and 1997 respectively. Both of these acts ushered the proliferation of nutrient-content, health, and structure/function claims on food labels.

Recently, there has been increasing concern regarding the validity of the food labels. The FDA is increasing efforts to examine the issue of front-of-packaging labeling, making sure that they help consumers make the appropriate and healthy choice. Moreover, more public health officials are pushing towards regulating the labels based on national standards. Some are even contending that by banning front-of-package labels, it would encourage the public to make healthy and nutritious choices in selecting foods.

Reference: JAMA. 2010;303(8):771-772.
Imaage: Food Pyramid. Available here.