Impending Penury in usa
NEW YORK -In a time when income gap is widening and the USA is being crushed by the continuing subprime mortgage crisis, another impending disaster is likely to hit USA in no time, so beware.The calculus of living paycheck to paycheck in America is getting harder. What used to last four days might last half that long now. Pay the gas bill, but skip breakfast. Eat less for lunch so the kids can have a healthy dinner.
The wealthiest 1% of Americans earned 21.2% of all income in 2005, according to new data from the Internal Revenue Service. The bottom 50% earned 12.8% of all income. The wealthiest Americans' share of national income has hit a postwar record, surpassing the highs reached in the 1990s bull market, and highlighting the divergence of economic fortunes blamed for fueling anxiety among American workers. Behind the Numbers: Scholars attribute rising inequality to several factors, including technological change that favors those with more skills, and globalization and advances in communications that enlarge the rewards available to "superstar" performers whether in business, sports or entertainment.
Across the nation, Americans are increasingly unable to stretch their dollars to the next payday as they juggle higher rent, food and energy bills. It's starting to affect middle-income working families as well as the poor, and has reached the point of affecting day-to-day calculations of merchants like Wal-Mart Stores Inc., 7-Eleven Inc. and Family Dollar Stores Inc. Food pantries, which distribute foodstuffs to the needy, are reporting severe shortages and reduced government funding at the very time that they are seeing a surge of new people seeking their help.
While economists debate whether the country is headed for a recession, some say the financial stress is already the worst since the last downturn at the start of this decade. From Family Dollar to Wal-Mart, merchants have adjusted their product mix and pricing accordingly. Sales data show a marked and more prolonged drop in spending in the days before shoppers get their paychecks, when they buy only the barest essentials before splurging around payday.
"It's pretty pronounced," said Kiley Rawlins, a spokeswoman at Family Dollar. "It seems like to us, customers are running out of food products, paper towels sooner in the month."Wal-Mart, the world's largest retailer, said the imbalance in spending before and after payday in July was the biggest it has ever seen, though the drop-off wasn't as steep in August. And 7-Eleven says its grocery sales have jumped 12-13 percent over the past year, compared with only slight increases for non-necessities like gloves and toys.
Shoppers can't afford to load up at the supermarket and are going to the most convenient places to buy emergency food items like milk and eggs. "It even costs more to get the basics like soap and laundry detergent," said Michelle Grassia, who lives with her husband and three teenage children in the Bedford-Stuyvesant section of Brooklyn, N.Y.Her husband's check from his job at a grocery store used to last four days.
"Now, it lasts only two," she said.To make up the difference, Grassia buys one gallon of milk a week instead of three. She sometimes skips breakfast and lunch to make sure there's enough food for her children. She cooks with a hot plate because gas is too expensive. And she depends more than ever on the bags of free vegetables and powdered milk from a local food pantry. Grassia's story is neither new nor unique.
With the fastest-rising food and energy prices since the 1980s, low-income consumers are stretching their budgets by eating cheap foods like peanut butter and pasta.Industry analysts and some economists fear the strain will get worse as people are hit with higher home heating bills this winter and mortgage rates go up.
It's bad enough already for 85-year-old Dominica Hoffman. She gets $1,400 a month in pension and Social Security from her days in the garment industry. After paying $500 in rent on an apartment in Pennsauken, N.J., and shelling out money for food, gas and other expenses, she's broke by the end of the month. She's had to cut fruits and vegetables from her grocery order — and that's even with financial help from her children.
"Everything is up," she said.Many consumers, particularly those making less than $30,000 a year, are cutting spending on nutritious food like milk and vegetables, and analysts fear they're further skimping on basic medical care and other critical services. Coupon-clipping just isn't enough."The reality of hunger is right here," said the Rev. Melony Samuels, director of The BedStuy Campaign against Hunger, a church-affiliated food pantry in Brooklyn.
The pantry scrambled to feed 5,000 new families over the past 12 months, up almost 70 percent from 3,000 the year before."I am shocked to see such numbers," Samuels said, "and I am really concerned that this is just the beginning of what we are going to see." In the past three months, Samuels has seen more clients in higher-paying jobs — the $35,000 range — line up for food.The Regional Food Bank of Northeastern New York, which covers 23 counties in New York State, cited a 30 percent rise in visitors in the first nine months of this year, compared with 2006.
Maureen Schnellmann, senior director of food and nutrition programs at the American Red Cross Food Pantry in Boston, reported a 30 percent increase from January through August over last year.Until a few months ago, Dellria Seales, a home care assistant, was just getting by living with her daughter, a hairdresser, and two grandchildren in a one-bedroom apartment for $750 a month. But a knee injury in January forced her to quit her job, leaving her at the mercy of Samuels' pantry because most of her daughter's $1,200 a month income goes to rent, energy and food costs.
"I need it. Without it, we wouldn't survive," Seales said as she picked up carrots and bananas.John Vogel, a professor at Dartmouth College's Tuck School of Business, worries that the squeeze will lead to a less nutritious diet and inadequate medical or child care. In the meantime, rising costs show no signs of abating.Gas prices hit a record nationwide average of $3.23 per gallon in late May before receding a little, though prices are expected to soar again later this year. Food costs have increased 4.5 percent over the past 12 months, partly because of higher fuel costs.
Egg prices were 44 percent higher, while milk was up 21.3 percent over the past 12 months to nearly $4 a gallon, according to the Bureau of Labor Statistics. The average family of four is spending anywhere from $7 to $10 extra a week — $40 more a month — on groceries alone, compared to a year ago, according to retail consultant Burt Flickinger III.
And while overall wage growth is a solid 4.1 percent over the past 12 months, economists say the increases are mostly for the top earners.Retailers started noticing the strain in late spring and early summer as they were monitoring the spending around the paycheck cycle. Wal-Mart and Family Dollar key on the first week of the month, when government checks like Social Security and public assistance generally hit consumers' mailboxes.7-Eleven, whose customers are more diverse, looks at paycheck cycles in specific markets dominated by a major employer, such as General Motors in Detroit, to discern trends in shopping.
To economize, shoppers are going for less expensive food."They're buying more peanut butter and pasta. And they're going for hamburger meat," Flickinger, the retail consultant, said. "They're trying to outsmart the store by looking for deep discounts at the end of the month." He said the last time he saw this was 2000-2001, when the dot-com bubble burst and the economy went into a recession after massive layoffs.For now, low-price retailers are readjusting their merchandising and pricing.
Wal-Mart is becoming more aggressive on discounting. It announced Thursday it is expanding price cuts to 15,000 items, ranging from Motts apple juice and Progresso soups to women's fleece tops, heading into the holidays. Family Dollar, whose food offerings were limited to candy and snacks until two years ago, has expanded its mix of groceries like fruit cups, cereal and such refrigerated items as milk and ice cream while cutting back on shoes.
This summer the chain began accepting food stamps. Food pantries are also getting creative. Samuels said her church, Full Gospel Tabernacle of Faith, just started offering free cooking classes to teach clients who are diabetic or have other health conditions how to prepare vegetables like squash. It's also offering free exercise classes. "We are trying to make them health conscious," Samuels said. "It's not right to give them just anything. Our mantra is eat well and live well."
Saturday, November 10, 2007
Cure Insomnia
Surprising advice for insomniacs — sleep less
Changing your behavior, rather than medication, may be the first step to a better night’s sleep. And surprisingly, for chronic insomnia, the best treatment may be to cut back on the time you spend trying to sleep.
People with insomnia often find that spending less time in bed promotes more restful sleep and helps make the bedroom a welcome sight instead of a torture chamber. As you learn to fall asleep quickly and sleep soundly, the time in bed is slowly extended until you obtain a full night’s sleep.
Some sleep experts suggest starting with five or six hours at first, or whatever amount of time you typically sleep at night. Setting a rigid early morning waking time often works best. If the alarm is set for 7 a.m., a five-hour restriction means that no matter how sleepy you are, you must stay awake until 2 a.m. Once you are sleeping well during the allotted five hours, you can add another 15 or 30 minutes, then repeat the process until you’re getting a healthy amount of sleep.
ReconditioningIn the 1970s, a Northwestern University professor developed a technique to recondition people with insomnia to associate the bedroom with sleep. These are the rules:
Use the bed only for sleeping or sex.
Go to bed only when you’re sleepy. If you’re unable to sleep, get up and move to another room. Stay up until you are sleepy; then return to bed. If sleep does not follow quickly, repeat.
During the reconditioning process, get up at the same time every day and do not nap.
The idea is to train your body to associate your bed with sleep instead of sleeplessness and frustration.
Relaxation techniques
For some people with insomnia, a racing or worried mind is the enemy of sleep. In others, physical tension is to blame. Fortunately, there are ways to release physical tension and relax more effectively. Relaxation techniques that can quiet a racing mind include meditation, breathing exercises, and progressively tensing and relaxing your muscles starting with your feet and working your way up your body — a technique known as progressive muscle relaxation.
In biofeedback, people use equipment that monitors and makes them aware of involuntary body states (such as muscle tension or hand temperature). Immediate feedback helps people see how various thoughts or relaxation maneuvers affect tension, enabling them to learn how to gain voluntary control over the process.
Biofeedback is usually done under professional supervision. Other relaxation techniques — such as progressive muscle relaxation or meditation — can be learned in behavior therapy sessions or from books, tapes, or classes.
Progressive muscle relaxation
Looking for a drug-free method to help you relax, free your mind of worries, and fall asleep? Progressive muscle relaxation is a tried and true technique for achieving both physical and mental relaxation.
• Lie down on your back in a comfortable position. Put a pillow under your head if you like, or place one under your knees to relax your back. Rest your arms, with palms up, slightly apart from your body. Feel your shoulders relax.
• Take several slow, deep breaths through your nose. Exhale with a long sigh to release tension.
• Begin to focus on your feet and ankles. Are they painful or tense? Tighten the muscles briefly to feel the sensation. Let your feet sink into the floor or the bed. Feel them getting heavy and becoming totally relaxed. Let them drop from your consciousness.
• Slowly move your attention through different parts of your body: your calves, thighs, lower back, hips, and pelvic area; your middle back, abdomen, upper back, shoulders, arms, and hands; your neck, jaw, tongue, forehead, and scalp. Feel your body relax and your lungs gently expand and contract. Relax any spots that are still tense. Breathe softly. • If thoughts distract you, gently ignore them and return your attention to your breathing. Your worries and thoughts will be there when you are ready to acknowledge them.
Changing your behavior, rather than medication, may be the first step to a better night’s sleep. And surprisingly, for chronic insomnia, the best treatment may be to cut back on the time you spend trying to sleep.
People with insomnia often find that spending less time in bed promotes more restful sleep and helps make the bedroom a welcome sight instead of a torture chamber. As you learn to fall asleep quickly and sleep soundly, the time in bed is slowly extended until you obtain a full night’s sleep.
Some sleep experts suggest starting with five or six hours at first, or whatever amount of time you typically sleep at night. Setting a rigid early morning waking time often works best. If the alarm is set for 7 a.m., a five-hour restriction means that no matter how sleepy you are, you must stay awake until 2 a.m. Once you are sleeping well during the allotted five hours, you can add another 15 or 30 minutes, then repeat the process until you’re getting a healthy amount of sleep.
ReconditioningIn the 1970s, a Northwestern University professor developed a technique to recondition people with insomnia to associate the bedroom with sleep. These are the rules:
Use the bed only for sleeping or sex.
Go to bed only when you’re sleepy. If you’re unable to sleep, get up and move to another room. Stay up until you are sleepy; then return to bed. If sleep does not follow quickly, repeat.
During the reconditioning process, get up at the same time every day and do not nap.
The idea is to train your body to associate your bed with sleep instead of sleeplessness and frustration.
Relaxation techniques
For some people with insomnia, a racing or worried mind is the enemy of sleep. In others, physical tension is to blame. Fortunately, there are ways to release physical tension and relax more effectively. Relaxation techniques that can quiet a racing mind include meditation, breathing exercises, and progressively tensing and relaxing your muscles starting with your feet and working your way up your body — a technique known as progressive muscle relaxation.
In biofeedback, people use equipment that monitors and makes them aware of involuntary body states (such as muscle tension or hand temperature). Immediate feedback helps people see how various thoughts or relaxation maneuvers affect tension, enabling them to learn how to gain voluntary control over the process.
Biofeedback is usually done under professional supervision. Other relaxation techniques — such as progressive muscle relaxation or meditation — can be learned in behavior therapy sessions or from books, tapes, or classes.
Progressive muscle relaxation
Looking for a drug-free method to help you relax, free your mind of worries, and fall asleep? Progressive muscle relaxation is a tried and true technique for achieving both physical and mental relaxation.
• Lie down on your back in a comfortable position. Put a pillow under your head if you like, or place one under your knees to relax your back. Rest your arms, with palms up, slightly apart from your body. Feel your shoulders relax.
• Take several slow, deep breaths through your nose. Exhale with a long sigh to release tension.
• Begin to focus on your feet and ankles. Are they painful or tense? Tighten the muscles briefly to feel the sensation. Let your feet sink into the floor or the bed. Feel them getting heavy and becoming totally relaxed. Let them drop from your consciousness.
• Slowly move your attention through different parts of your body: your calves, thighs, lower back, hips, and pelvic area; your middle back, abdomen, upper back, shoulders, arms, and hands; your neck, jaw, tongue, forehead, and scalp. Feel your body relax and your lungs gently expand and contract. Relax any spots that are still tense. Breathe softly. • If thoughts distract you, gently ignore them and return your attention to your breathing. Your worries and thoughts will be there when you are ready to acknowledge them.
Friday, November 9, 2007
Chips to Track Students
RFID Chips in School Uniforms Track Students
How about tracking chips in kids' school clothing so that school officials can know their whereabouts during the school day?
Oh, it's happening. Ten students in a secondary school in the UK are being tracked through RFID implants in their school uniforms in a pilot program. The kids attend Hungerhill School for ages 11-16 in Edenthorpe, England.
Add the RFID chips to increased video surveillance and fingerprinting of kids, and this is a heavily tracked generation—for safety's sake.
That extra peace of mind for adults comes with a heavy loss of privacy for kids.
Do you agree with David Clouter, a parent and founder of the children's advocacy group Leave Them Kids Alone, who says taking all these precautions has the effect of treating kids like criminals? Or
do you agree with the parents who have OKed the pilot program who do not find it egregiously intrusive?
One possible side effect:
Uniform sales may pick up as kids try to procure extra non-RFID-tagged clothing. "So now it's easy to cut class; just ask someone to carry your shirt around the building while you're elsewhere."
Unexpected Risk with OCP
23
Oral contraceptives may increase risk of atherosclerosis
"The link of taking birth control pills and for some women, high blood pressure and blood clots is known." However, " a recent study from AHA ( American Heart Association ) meeting shows that...healthy women, who had previously taken the pill, had an unexpected increase in artery causing plaque," which "is a key factor in heart disease."
"Long-term use of oral contraceptives" may "increase the chances of having artery buildups that can raise the risk of heart disease," according to the findings. Researchers in Belgium "studied about 1,300 healthy women ages 35 to 55 taking part in a long-running observational study." Approximately "81 % had taken oral contraceptives for more than a year at some point in their lives." When "[u]ltrasound exams were done of arteries in their necks and legs to look for...plaque,"
The researchers found "a 20 to 30 % increased prevalence of plaque for every 10 years of oral contraceptive use."
"Many of the women in the study used pills with higher doses of estrogen than are used today."
"A woman who smokes or has a strong family history of heart disease...may want to avoid oral contraception," because these factors increase the "risk of blood clots." However, this risk is eliminated once they cease taking the pill.
Vivisimo Velocity search platform
National Library of Medicine adds web search tool.
"Visitors to the National Library of Medicine's website should have their medical questions answered more quickly and with less fuss, thanks to the recent deployment of the Vivisimo Velocity search platform."
The world's largest biomedical library is National Library of Medicine ," and is using the search tool to allow patrons to have "a consistent frame of reference for each query, and enable them to navigate through its different supported collections, including Medline Plus and Online Exhibits."
The tool has allowed them to accomplish their "objective to provide a search experience that mirrors the quality that NLM users have come to expect." Now NLM brings this search to site visitors so [that] they can quickly find the most pertinent health information."
Better Hope for Healthcare:IT
Futurist predicts IT may offer solutions to increasing healthcare demands.
Speaking "Monday night before a group of healthcare leaders," Goldsmith's presentation "focused on how the health system would cope with the 'mismatch' between the demand for healthcare services, and the dwindling supply of professionals, technicians, and managers in the field."
In a recent article, he equated the increased demand and declining supply to a tsunami, and predicted that "eICU, remote monitoring, and Eliza [are] three types of technology that can help fill the gap."
Biomarker of Breast Cancer- new
Discovery of possible breast cancer biomarker.
" A molecule that may be more accurate in predicting breast cancer than existing biological markers was identified by researchers at the University of Cincinnati."
This was published last month online in the International Journal of Cancer.
Investigators examined "178 breast tumors," and found that there is "a molecule, osteopontin-c, that is absent from the normal breast, and appears to more accurately predict breast cancer metastasis."
Arresting Atherosclerosis
Crestor Now for Blocked Arteries.
" Crestor won U.S. approval for use of its cholesterol treatment, Crestor (rosuvastatin calcium), against artery-blocking fat deposits that cause strokes and heart attacks."
"Crestor is said to be the first cholesterol medicine to win FDA clearance to be marketed as effective against...atherosclerosis."
"Atherosclerosis is a progressive disease and the main cause of heart disease, the world's biggest killer."
FDA spokesman Christopher Kelly said that Crestor "was approved as a therapy to slow the progression of" the disease.
Vaccine for Blood Pressure !!!
Study shows blood pressure vaccine could be promising.
"A vaccine underway was seen to control morning blood pressure better than the daily medications an early-phase trial presented at the American Heart Association meeting."
The vaccine works by starting an "immune response by binding angiotensin II to a virus-like particle."
In the 72-patient trial, the vaccine "improved daytime systolic blood pressure better than placebo." In addition, when levels of the drug were measured in participants, its "half-life was 123 days, suggesting that the agent could be given three times a year."
Most strokes and myocardial infarcts occur in the morning when blood pressure rises naturally with arousal from sleep." However, "medications are at their lowest concentrations before patients take their morning pills."
Tuesday, November 6, 2007
Scary Article about USA: Beware
Impending Penury in usa
NEW YORK -
In a time when income gap is widening and the USA is being crushed by the continuing subprime mortgage crisis, another impending disaster is likely to hit USA in no time, so beware.
The calculus of living paycheck to paycheck in America is getting harder. What used to last four days might last half that long now. Pay the gas bill, but skip breakfast. Eat less for lunch so the kids can have a healthy dinner.
Across the nation, Americans are increasingly unable to stretch their dollars to the next payday as they juggle higher rent, food and energy bills. It's starting to affect middle-income working families as well as the poor, and has reached the point of affecting day-to-day calculations of merchants like Wal-Mart Stores Inc., 7-Eleven Inc. and Family Dollar Stores Inc.
Food pantries, which distribute foodstuffs to the needy, are reporting severe shortages and reduced government funding at the very time that they are seeing a surge of new people seeking their help.
While economists debate whether the country is headed for a recession, some say the financial stress is already the worst since the last downturn at the start of this decade.
From Family Dollar to Wal-Mart, merchants have adjusted their product mix and pricing accordingly. Sales data show a marked and more prolonged drop in spending in the days before shoppers get their paychecks, when they buy only the barest essentials before splurging around payday.
"It's pretty pronounced," said Kiley Rawlins, a spokeswoman at Family Dollar. "It seems like to us, customers are running out of food products, paper towels sooner in the month."
Wal-Mart, the world's largest retailer, said the imbalance in spending before and after payday in July was the biggest it has ever seen, though the drop-off wasn't as steep in August.
And 7-Eleven says its grocery sales have jumped 12-13 percent over the past year, compared with only slight increases for non-necessities like gloves and toys. Shoppers can't afford to load up at the supermarket and are going to the most convenient places to buy emergency food items like milk and eggs.
"It even costs more to get the basics like soap and laundry detergent," said Michelle Grassia, who lives with her husband and three teenage children in the Bedford-Stuyvesant section of Brooklyn, N.Y.
Her husband's check from his job at a grocery store used to last four days. "Now, it lasts only two," she said.
To make up the difference, Grassia buys one gallon of milk a week instead of three. She sometimes skips breakfast and lunch to make sure there's enough food for her children. She cooks with a hot plate because gas is too expensive. And she depends more than ever on the bags of free vegetables and powdered milk from a local food pantry.
Grassia's story is neither new nor unique. With the fastest-rising food and energy prices since the 1980s, low-income consumers are stretching their budgets by eating cheap foods like peanut butter and pasta.
Industry analysts and some economists fear the strain will get worse as people are hit with higher home heating bills this winter and mortgage rates go up.
It's bad enough already for 85-year-old Dominica Hoffman.
She gets $1,400 a month in pension and Social Security from her days in the garment industry. After paying $500 in rent on an apartment in Pennsauken, N.J., and shelling out money for food, gas and other expenses, she's broke by the end of the month. She's had to cut fruits and vegetables from her grocery order — and that's even with financial help from her children.
"Everything is up," she said.
Many consumers, particularly those making less than $30,000 a year, are cutting spending on nutritious food like milk and vegetables, and analysts fear they're further skimping on basic medical care and other critical services.
Coupon-clipping just isn't enough.
"The reality of hunger is right here," said the Rev. Melony Samuels, director of The BedStuy Campaign against Hunger, a church-affiliated food pantry in Brooklyn.
The pantry scrambled to feed 5,000 new families over the past 12 months, up almost 70 percent from 3,000 the year before.
"I am shocked to see such numbers," Samuels said, "and I am really concerned that this is just the beginning of what we are going to see."
In the past three months, Samuels has seen more clients in higher-paying jobs — the $35,000 range — line up for food.
The Regional Food Bank of Northeastern New York, which covers 23 counties in New York State, cited a 30 percent rise in visitors in the first nine months of this year, compared with 2006.
Maureen Schnellmann, senior director of food and nutrition programs at the American Red Cross Food Pantry in Boston, reported a 30 percent increase from January through August over last year.
Until a few months ago, Dellria Seales, a home care assistant, was just getting by living with her daughter, a hairdresser, and two grandchildren in a one-bedroom apartment for $750 a month. But a knee injury in January forced her to quit her job, leaving her at the mercy of Samuels' pantry because most of her daughter's $1,200 a month income goes to rent, energy and food costs.
"I need it. Without it, we wouldn't survive," Seales said as she picked up carrots and bananas.
John Vogel, a professor at Dartmouth College's Tuck School of Business, worries that the squeeze will lead to a less nutritious diet and inadequate medical or child care.
In the meantime, rising costs show no signs of abating.
Gas prices hit a record nationwide average of $3.23 per gallon in late May before receding a little, though prices are expected to soar again later this year. Food costs have increased 4.5 percent over the past 12 months, partly because of higher fuel costs. Egg prices were 44 percent higher, while milk was up 21.3 percent over the past 12 months to nearly $4 a gallon, according to the Bureau of Labor Statistics.
The average family of four is spending anywhere from $7 to $10 extra a week — $40 more a month — on groceries alone, compared to a year ago, according to retail consultant Burt Flickinger III.
And while overall wage growth is a solid 4.1 percent over the past 12 months, economists say the increases are mostly for the top earners.
Retailers started noticing the strain in late spring and early summer as they were monitoring the spending around the paycheck cycle.
Wal-Mart and Family Dollar key on the first week of the month, when government checks like Social Security and public assistance generally hit consumers' mailboxes.
7-Eleven, whose customers are more diverse, looks at paycheck cycles in specific markets dominated by a major employer, such as General Motors in Detroit, to discern trends in shopping.
To economize, shoppers are going for less expensive food.
"They're buying more peanut butter and pasta. And they're going for hamburger meat," Flickinger, the retail consultant, said. "They're trying to outsmart the store by looking for deep discounts at the end of the month."
He said the last time he saw this was 2000-2001, when the dot-com bubble burst and the economy went into a recession after massive layoffs.
For now, low-price retailers are readjusting their merchandising and pricing.
Wal-Mart is becoming more aggressive on discounting. It announced Thursday it is expanding price cuts to 15,000 items, ranging from Motts apple juice and Progresso soups to women's fleece tops, heading into the holidays.
Family Dollar, whose food offerings were limited to candy and snacks until two years ago, has expanded its mix of groceries like fruit cups, cereal and such refrigerated items as milk and ice cream while cutting back on shoes. This summer the chain began accepting food stamps.
Food pantries are also getting creative. Samuels said her church, Full Gospel Tabernacle of Faith, just started offering free cooking classes to teach clients who are diabetic or have other health conditions how to prepare vegetables like squash. It's also offering free exercise classes.
"We are trying to make them health conscious," Samuels said. "It's not right to give them just anything. Our mantra is eat well and live well."
IQ Boost from Breast Milk
Study indicates babies with specific gene allele may receive IQ boost from breast milk.
"Breast-fed children with one common variation of" a gene that influences "the metabolism of long-chain polyunsaturated fatty acids" averaged "seven points higher on IQ tests than children nourished on formula or cow's milk."
However, "children with another, less common variation did not benefit from breast-feeding at all," according to a study published in the Proceedings of the National Academy of Sciences .
Researchers at London's King's College "looked at more than 1,000 children in New Zealand who were born in 1972," and 2,200 British children who were born between the years 1994 and 1995, Nature (11/6, Kaplan) adds. After testing the participants' IQs "at ages 7, 9, 11, and 13," the team used a DNA test "to look at a specific spot in their FADS2 genes, to see which version or 'allele' of the gene they carried."
Breast-fed babies more likely to have higher HDL levels, lower BMI.
"Breast-fed babies are less likely than bottle-fed infants to have certain cardiovascular disease (CVD) risk factors in adulthood," according to research presented at the AHA annual meeting. Researchers looked at "two generations of participants in the Framingham Heart Study." Lead author Dr. Nisha I. Parikh, a cardiovascular fellow at the Beth Israel Deaconess Medical Center in Boston, said, "Having been breast-fed in infancy is associated with a lower average body-mass index (BMI) and a higher average HDL...level in adulthood, even after accounting for personal and maternal demographic and CVD risk factors that could influence the results." WebMD (11/6, Laino) also covers the story.
Blood Pressure in Winter
Study suggests colder weather may affect blood pressure levels.
"Hypertension is harder to control in colder weather," according to findings presented at the American Heart Association's (AHA) annual meeting. The "study drew on a vast database," which included the "storehouse of 1.8 billion vital statistics records" of patients "cared for at 15 Veterans Affairs (VA) hospitals located" across the nation.
After analyzing 443,632 veterans, with a mean age of 66, researchers, led by Ross D. Fletcher, M.D., chief of staff at the VA Medical Center in Washington, D.C., discovered that "[b]lood pressure was nearly 8% less likely to return to normal in the winter than in the summer.
"People usually gain weight in the winter and lose weight in the summer. People tend to exercise more in the summer and less in the winter."
"The bottom line is that regardless of whether you're in Anchorage, Alaska, or San Juan, Puerto Rico, there is a difference in high blood pressure returning to normal in the winter compared to the summer,".
"Hypertension is harder to control in colder weather," according to findings presented at the American Heart Association's (AHA) annual meeting. The "study drew on a vast database," which included the "storehouse of 1.8 billion vital statistics records" of patients "cared for at 15 Veterans Affairs (VA) hospitals located" across the nation.
After analyzing 443,632 veterans, with a mean age of 66, researchers, led by Ross D. Fletcher, M.D., chief of staff at the VA Medical Center in Washington, D.C., discovered that "[b]lood pressure was nearly 8% less likely to return to normal in the winter than in the summer.
"People usually gain weight in the winter and lose weight in the summer. People tend to exercise more in the summer and less in the winter."
"The bottom line is that regardless of whether you're in Anchorage, Alaska, or San Juan, Puerto Rico, there is a difference in high blood pressure returning to normal in the winter compared to the summer,".
Monday, November 5, 2007
Rise at Medical School
Medical school enrollment increases, underscoring need for more residency positions.
"Enrollment is increasing sharply at medical schools across the country, a trend that's expected to help the nation combat a worsening shortage of physicians." However, "it's also focusing attention on the need to expand the other half of the physician pipeline: residency programs."
"Though medical school enrollment is on the rise, increasing the number of residency positions is arguably more difficult." This is due mainly to the fact that "programs in most states depend largely on funding from the federal government through Medicare, and that funding has remained static for the past few years."
For instance, state funding in Texas in recent years has allowed the number of residency positions to increase, but this increase is likely to be offset by the influx of physicians to the state "because of new limits in medical malpractice lawsuits that make it more appealing for physicians to practice" there.
The ultimate outcome would be less IMG in USA.
Robots to be Dr.'s Secretary
Robots may help reduce hospital errors.
"One of the major players in the burgeoning $40 billion health information technology industry is...McKesson Technology Solutions, which manufactures and sells robots" used in hospitals.
McKesson's "products streamline communication between doctors and patients, build digitized medical records and eliminate pharmaceutical mistakes often caused when pharmacists can't read the...handwriting of physicians."
One of the company's robots, called Fillmore, "lives in a room full of hooks laden with thousands of tiny bar-coded medication bags. On command, it zips down a rail and pulls medicines off, dropping them into an envelope and sending them by computerized pushcart to a nurse's station."
Doctor's "Travesty."
Few physicians trained in military medical ethics, study indicates.
"Too few American medical students receive adequate instruction about military medical ethics and a physician's ethical duties under the Geneva Conventions," according to findings published in the latest issue of the International Journal of Health Services.
Harvard Medical School researchers "surveyed students at 8 medical schools across the United States, and found that 94 percent had received less than one hour of instruction about military medical ethics."
Notably, just "37 percent of medical students could correctly identify that the Geneva Conventions apply irrespective of whether war had formally been declared."
Almost 34 percent "didn't know that the Geneva Conventions state that physicians should 'treat the sickest first, regardless of nationality,
'" while "37 percent didn't know that the Geneva Conventions prohibit ever threatening or demeaning prisoners, or depriving them of food or water for any length of time." Lead author Dr. J. Wesley Boyd called this knowledge gap "a travesty."
Serious Risk to US Economy
The economy might be edging toward a recession in the wake of mortgage-related credit woes plaguing the financial markets, bankers and analysts said on Monday.
"I think that the risk of a recession is greater than people realize," James Dunne, CEO of S & P, said at the Reuters Finance Summit in New York.
With home prices dropping, more people about to lose their homes due to unaffordable mortgages and sharply higher oil prices, the economy could be on the brink of slowing down, they said.
"I think there is a serious risk to the economy," Howard Lutnick, CEO of Cantor Fitzgerald, told the summit.
The Fed may have to take more aggressive action and drop the benchmark fed funds rate in an effort to prevent a Japanese-style economic stagnation, which eventually evolved into a deflationary recession.
"We're moving into a recession, and over time -- the length of which is difficult to predict -- there is going to be a lot more credit problems," he said.
Preliminary data released by the U.S. government last week showed that the GDP grew by 3.9 % in the third quarter, compared with 3.8 percent in the previous quarter and 0.6 percent in the first three months of this year.
Last week the Fed announced at the end of a two-day meeting of its policy-setting Federal Open Market Committee that it was reducing its federal funds rate a quarter percentage point to 4.5 percent, citing its expectation that "economic expansion will likely slow in the near term" because of the housing sector's problems.
The Fed noted that growth was "solid" in the third quarter and said it thought financial-market strains were easing, but still opted for some insurance to add stimulus.
When asked where the U.S. economy is headed over the next year or so, John Duffy, chairman and CEO of Keefe, Bruyette & Woods, said at the summit: "In the toilet."
With the recent data and Fed moves, Wall Street firms believe the Fed will be forced to reduce interest rates on loans to banks to 3 %, or even as low as 1 %, at least over the next year.
Duffy said Fed action alone will not cure what ails the U.S. economy and financial institutions, which are experiencing a liquidity squeeze in the markets for credit and other financial products.
"I don't think they (the Fed) have a silver bullet,' he told Reuters.
FDA approves leukemia drug, Tasigna.
Tasigna (nilotinib), "[a] second-line drug [used] to treat a life-threatening form of leukemia, has won federal approval." The drug is now approved "to treat chronic and accelerated phase Philadelphia chromosome-positive, chronic myeloid leukemia (CML)."
CML is "among the most common forms of leukemia," and there are around 4,500 cases each year in the U.S. In addition, some patients "have become resistant to or cannot tolerate a standard therapy for CML, Gleevec (imatinib mesylate)."
Unlike current therapies, Tasigna works by targeting "a protein that is produced only by cells that have an abnormal chromosome in people with Philadelphia chromosome-positive CML," according to the drug's manufacturer, Novartis. This "protein is a key cause of the over-production of the white blood cells that characterizes this form of CML."
According to Novartis, the drug should "be available in the U.S. within days."
Reversing Severe Bone Loss
Study suggests walking may reverse severe bone loss in prostate cancer patients.
"Brisk walking may reverse the severe bone loss associated with a common prostate cancer therapy, curbing the risk of fractures and osteoporosis," according to a study presented at a meeting in Los Angeles.
Investigators followed "70 men with localized prostate cancer undergoing radiation therapy with or without androgen deprivation therapy (ADT)."
They discovered that "brisk walking led to a 0.49 percent gain in bone mass in just eight to 10 weeks," while those "who didn't exercise lost 2.21 percent of their bone mass" during the study.
"Men treated with ADT while getting radiation for localized disease lose bone at a rate of up to 13 percent a year." However, according to the study's lead researcher, Dr. Jennifer Wenzel of Johns Hopkins University, these "men are not routinely advised to exercise in order to preserve bone mass and prevent the risk of fractures."
Glitches Of Newborn Screening
Healthcare professionals recognize newborn screening process has glitches.
"The recent adoption of widespread screening of newborns for congenital health problems is saving thousands of lives every year, identifying potentially deadly conditions in time to begin treatment."
However, "healthcare professionals [now] recognize that success has highlighted glitches in the system."
This practice "has meant more potential for erroneous test results and misdiagnoses, causing needless angst for parents."
"Doctors and hospital officials...are often ill-informed about the diseases that are screened for and how they are treated." In addition, parents often "get little follow-up" once diagnoses are confirmed.
"To improve the screening process, health providers and government officials are starting to expand beyond the push for more screening to also address shortcomings in the entire system."
For instance, "the American College of Medical Genetics' website offers a series of...ACT Sheets, which walk...[physicians] through what to do when a baby screens positive for a rare condition."
Furthermore, confirming diagnoses has become paramount. Some "medical centers that conduct 'second-tier' tests to check results are getting inquiries from around the country about expanding the use of such tests before informing pediatricians or parents."
Medicoegal Hurdles & Ethics
Physicians less likely to accept responsibility for errors if liability threats loom.
"The 21st century doctor is supposed to be all about transparency, but legal liability, that seemingly eternal bugbear, continues to weigh on the profession."
Recently, there has been much discussion about the benefits of physicians admitting their errors and apologizing to patients. Patients feel validated, and typically accept much smaller settlements as part of the process.
Currently, Massachusetts is considering legislation which states that "if a doctor apologizes to a patient and admits making a mistake, the statements couldn't be used in court."
Other states have already adopted similar legislation. However, "not everybody's on board, especially the lawyers," notes the Journal.
They argue that physicians "should be held responsible" if they "cause harm." While many advocate "full disclosure," Massachusetts physicians maintain that "if the threat of liability remains," most healthcare providers will not admit to errors.
"The 21st century doctor is supposed to be all about transparency, but legal liability, that seemingly eternal bugbear, continues to weigh on the profession."
Recently, there has been much discussion about the benefits of physicians admitting their errors and apologizing to patients. Patients feel validated, and typically accept much smaller settlements as part of the process.
Currently, Massachusetts is considering legislation which states that "if a doctor apologizes to a patient and admits making a mistake, the statements couldn't be used in court."
Other states have already adopted similar legislation. However, "not everybody's on board, especially the lawyers," notes the Journal.
They argue that physicians "should be held responsible" if they "cause harm." While many advocate "full disclosure," Massachusetts physicians maintain that "if the threat of liability remains," most healthcare providers will not admit to errors.
Cure for E. Bullosa??
Researchers discover promising treatment for epidermolysis bullosa.
Epidermolysis bullosa (EB) is "a rare genetic disorder caused by lack of a protein, [collagen VII], that is needed to keep skin attached to the body."
The disease "affects about 20 of one million babies born, but the most severe form, recessive dystrophic EB,...occurs in about two out of one million births."
Until recently, there was no known treatment for EB. However, on October 19, a physician "transplanted bone marrow and cord blood cells from" a healthy donor to an EB patient in hopes that "the healthy cells will move into...[the patient's] skin and correct the genetic defect."
Researcher Jakub Tolar of the Blood and Marrow Transplantation program at the University of Minnesota performed the procedure. Last year, he "found that three of 13 mice infused with cells from the marrow of healthy mice didn't die." Prior to that, "researcher Angela Christiano, of Columbia University," had "identified the gene for dystrophic EB."
This recent operation was the first ever performed on a human with EB. "If the treatment works, even partially, doctors say they may be able to try it on...[another patient] in about six months."
Epidermolysis bullosa (EB) is "a rare genetic disorder caused by lack of a protein, [collagen VII], that is needed to keep skin attached to the body."
The disease "affects about 20 of one million babies born, but the most severe form, recessive dystrophic EB,...occurs in about two out of one million births."
Until recently, there was no known treatment for EB. However, on October 19, a physician "transplanted bone marrow and cord blood cells from" a healthy donor to an EB patient in hopes that "the healthy cells will move into...[the patient's] skin and correct the genetic defect."
Researcher Jakub Tolar of the Blood and Marrow Transplantation program at the University of Minnesota performed the procedure. Last year, he "found that three of 13 mice infused with cells from the marrow of healthy mice didn't die." Prior to that, "researcher Angela Christiano, of Columbia University," had "identified the gene for dystrophic EB."
This recent operation was the first ever performed on a human with EB. "If the treatment works, even partially, doctors say they may be able to try it on...[another patient] in about six months."
Origin of Fibromyalgia
Fibromyalgia may originate from neuron mismatch, study suggests.
"Fibromyalgia might have its origin in a mismatch between input from motor and sensory neurons," according to a study published in the November issue of Rheumatology.
Dr. McCabe, Ph.D., of the University of Bath, and colleagues, analyzed "29 fibromyalgia patients and 14 healthy volunteers. Participants performed a series of upper and lower limb movements that were either congruent or incongruent." They found "that 26 of 29 fibromyalgia patients reported sensing a transient increase in pain, change in temperature, or heaviness in the hidden limb.
The sensations mimicked what occurs during a fibromyalgia flare up.
However, only 50 percent of the volunteers felt the same sensations. The researchers concluded, "We have shown that by confusing the motor and sensory systems, we can exacerbate the symptoms felt by people diagnosed with the condition."
These findings correspond to previous studies which suggest that fibromyalgia symptoms "may be perpetuated, or even triggered, by this sensory-motor conflict."
"Fibromyalgia might have its origin in a mismatch between input from motor and sensory neurons," according to a study published in the November issue of Rheumatology.
Dr. McCabe, Ph.D., of the University of Bath, and colleagues, analyzed "29 fibromyalgia patients and 14 healthy volunteers. Participants performed a series of upper and lower limb movements that were either congruent or incongruent." They found "that 26 of 29 fibromyalgia patients reported sensing a transient increase in pain, change in temperature, or heaviness in the hidden limb.
The sensations mimicked what occurs during a fibromyalgia flare up.
However, only 50 percent of the volunteers felt the same sensations. The researchers concluded, "We have shown that by confusing the motor and sensory systems, we can exacerbate the symptoms felt by people diagnosed with the condition."
These findings correspond to previous studies which suggest that fibromyalgia symptoms "may be perpetuated, or even triggered, by this sensory-motor conflict."
Silence of Apoplexy
"Silent" strokes may be prevalent among elderly, study indicates.
"'Silent' strokes and other unrecognized brain abnormalities -- including benign brain tumors and aneurysms -- are common among older people," according to findings published in the Nov. 1 issue of the New England Journal of Medicine.
Dutch researchers performed brain imaging "on 2,000 people participating in an ongoing study...designed to explore the effect of aging on the brain. The average age of the study participants was 63." MRI "revealed that seven percent of the participants showed evidence of a previous unrecognized, asymptomatic stroke."
In addition, "1.6 percent had benign brain tumors, and nearly two percent had aneurysms." The researchers were unable to determine "[t]he clinical relevance of these incidental brain findings." However, study author Aad van der Lugt, M.D., stated, "We know that there is a relationship between asymptomatic stroke and symptomatic stroke and dementia. ...
We now need strategies to prevent these consequences." One lesson from these findings, according to stroke specialist Claudette Brooks, M.D., of West Virginia University School of Medicine, is that patients should always inform their physicians of "any symptoms that might indicate a stroke,...even if the symptom goes away."
"The researchers had expected to find some people with undiagnosed infarcts, because blood vessel changes are common in older adults." According to Dr. van der Lugt, "we were very surprised to find such a high frequency of other findings such as aneurysm and meningiomas, as previous studies reported much lower frequencies."
The study's conclusions "may have implications for patients in the future: As more of these abnormalities are spotted with more sophisticated equipment during routine medical tests," some physicians "may urge patients to have surgery or other treatment as a precaution."
Alternatively, "some patients may push" their physicians to repair "the potential problem." According to the researchers, study "participants were mostly white, middle class and healthy; whether the same brain abnormalities would be found in other groups of people isn't known."
"'Silent' strokes and other unrecognized brain abnormalities -- including benign brain tumors and aneurysms -- are common among older people," according to findings published in the Nov. 1 issue of the New England Journal of Medicine.
Dutch researchers performed brain imaging "on 2,000 people participating in an ongoing study...designed to explore the effect of aging on the brain. The average age of the study participants was 63." MRI "revealed that seven percent of the participants showed evidence of a previous unrecognized, asymptomatic stroke."
In addition, "1.6 percent had benign brain tumors, and nearly two percent had aneurysms." The researchers were unable to determine "[t]he clinical relevance of these incidental brain findings." However, study author Aad van der Lugt, M.D., stated, "We know that there is a relationship between asymptomatic stroke and symptomatic stroke and dementia. ...
We now need strategies to prevent these consequences." One lesson from these findings, according to stroke specialist Claudette Brooks, M.D., of West Virginia University School of Medicine, is that patients should always inform their physicians of "any symptoms that might indicate a stroke,...even if the symptom goes away."
"The researchers had expected to find some people with undiagnosed infarcts, because blood vessel changes are common in older adults." According to Dr. van der Lugt, "we were very surprised to find such a high frequency of other findings such as aneurysm and meningiomas, as previous studies reported much lower frequencies."
The study's conclusions "may have implications for patients in the future: As more of these abnormalities are spotted with more sophisticated equipment during routine medical tests," some physicians "may urge patients to have surgery or other treatment as a precaution."
Alternatively, "some patients may push" their physicians to repair "the potential problem." According to the researchers, study "participants were mostly white, middle class and healthy; whether the same brain abnormalities would be found in other groups of people isn't known."
Perils in US Healthcare
Americans frustrated with healthcare system, according to New York Times.
"Americans are increasingly frustrated about the subpar performance of this country's fragmented healthcare system, and with good reason."
A recent survey by the Commonwealth Fund found that thirty-three percent of "American respondents felt their system is so dysfunctional that it needs to be rebuilt completely -- the highest rate in any country surveyed."
Respondents from all socio-economic backgrounds gave the system low scores. The investigators "interviewed some 12,000 adults in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States."
They found that many Americans went without healthcare because of costs, and just 50 percent "of the American adults were able to see a doctor the same day that they became sick or the day after, a worse showing than in all the other countries except Canada."
The Times concludes that the survey results "underscore the need to ensure that all Americans have quick access to a primary care doctor, and the need for universal health coverage."
"Americans are increasingly frustrated about the subpar performance of this country's fragmented healthcare system, and with good reason."
A recent survey by the Commonwealth Fund found that thirty-three percent of "American respondents felt their system is so dysfunctional that it needs to be rebuilt completely -- the highest rate in any country surveyed."
Respondents from all socio-economic backgrounds gave the system low scores. The investigators "interviewed some 12,000 adults in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States."
They found that many Americans went without healthcare because of costs, and just 50 percent "of the American adults were able to see a doctor the same day that they became sick or the day after, a worse showing than in all the other countries except Canada."
The Times concludes that the survey results "underscore the need to ensure that all Americans have quick access to a primary care doctor, and the need for universal health coverage."
Attacking Virus to Cure Cancer
Study indicates cancer could be treated by attacking viruses which cause it.
"U.S. researchers have shown that some cancers can be successfully treated by targeting the viruses that cause them," according to a study published in the journal PloS One.
Investigators "at the Albert Einstein College of Medicine of Yeshiva University in New York used radioimmunotherapy, in which radioisotopes are piggybacked onto antibodies," and then injected the molecules "into the body." Once there, "the antibodies target a specific protein, and destroy the cell to which the protein is attached."
"This novel approach is important to note because nearly 20 percent of human cancers worldwide are caused by preexisting virus infections," including "liver cancer (caused by hepatitis B and C viruses), cervical cancer (caused by human papillomaviruses), and certain lymphomas (caused by the Epstein-Barr virus)."
This "study has shown in principle that radioimmunotherapy can help" to treat "cancers caused by viruses," and to prevent cancer.
"U.S. researchers have shown that some cancers can be successfully treated by targeting the viruses that cause them," according to a study published in the journal PloS One.
Investigators "at the Albert Einstein College of Medicine of Yeshiva University in New York used radioimmunotherapy, in which radioisotopes are piggybacked onto antibodies," and then injected the molecules "into the body." Once there, "the antibodies target a specific protein, and destroy the cell to which the protein is attached."
"This novel approach is important to note because nearly 20 percent of human cancers worldwide are caused by preexisting virus infections," including "liver cancer (caused by hepatitis B and C viruses), cervical cancer (caused by human papillomaviruses), and certain lymphomas (caused by the Epstein-Barr virus)."
This "study has shown in principle that radioimmunotherapy can help" to treat "cancers caused by viruses," and to prevent cancer.
Fat People and Cancer Connection
Obesity is second only to smoking as leading cause of cancer, study finds.
"Researchers say [that] obesity is causing more and more cases of cancer. ...
According to the CDC [Centers for Disease Control and Prevention], 127 million Americans are overweight or obese. That's two out of three people."
"The results of a landmark study on the causes of cancer" indicate that "what we eat [and] how much we weigh matter much more than experts first thought."
The publication, by the American Institute for Cancer Research and the World Cancer Research Fund, involved a "compilation of 7,000 other studies," and found "a connection between obesity and six types of common cancers."
The study "involved nine independent teams of scientists from around the world, hundreds of peer reviewers, and 21 international experts who analyzed" thousands of large-scale studies.
The study, which took five years to develop, indicates that "[e]xcess body fat increases the risk of cancer of the colon, kidney, pancreas, esophagus, and uterus as well as postmenopausal breast cancer."
The study also suggests that people should "forget eating bacon, sausage, and lunchmeat," because there is no "completely safe" amount.
"Every 1.7 ounces of processed meat consumed a day increases the risk of colorectal cancer by 21 percent," according to the study. The especially significant risk associated with processed meets may be due to the presence of carcinogens in "smoked meat, and the nitrates and excess salt in processed meats," according to Cancer Institute nutritionist Karen Collins.
The study author Dr. Walter J. Willett, a professor at the Harvard School of Public Health, and 20 co-authors, compiled the 517-page report, entitled Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective.
Their analysis of the studies found that "[e]xcess body fat influences the body's hormones, and these changes can make it more likely for cells to undergo the kind of abnormal growth that leads to cancer."
In short, "[t]he risk from excess weight begins at birth." Therefore, obese girls who begin menstruation earlier in life "will have more menstrual cycles. This extended exposure to estrogen is associated with increased risk for premenopausal breast cancer." The researchers stressed the fact that "[n]ot smoking is the most important thing one can do to reduce the risk of cancer."
"[o]besity is on course to overtake tobacco as the leading risk factor for cancer in America, according to [the] report." In fact, Dr. Willett "predicted that over the next decade 'obesity will become the number one risk factor for cancer,' as obesity increases and the number of smokers decreases."
He added that this "finding was a call to action for clinicians, who he said should begin counseling patients about the danger of excess weight with 'the first few pounds gained or first few extra inches of abdominal girth,'" rather than current practice, where clinicians may wait "until patients need to lose 30 pounds or more," to encourage them to lose weight.
W. Philip T. James, M.D., Dr.Sc., chairman of the London-based International Obesity Task Force, and a panel member, insists that "the panel went to great lengths to ensure that their findings were based solely on scientific evidence,".
"To this end, researchers working on the project reviewed every published study on weight and cancer to come up with the 7,000 studies on which they base their conclusions and recommendations."
"This is not a report from a select group of people who have their own biases. It has been done in a three-tier system to make sure it is as rigorous and up to date and savagely analyzed as any group could do."
"Researchers say [that] obesity is causing more and more cases of cancer. ...
According to the CDC [Centers for Disease Control and Prevention], 127 million Americans are overweight or obese. That's two out of three people."
"The results of a landmark study on the causes of cancer" indicate that "what we eat [and] how much we weigh matter much more than experts first thought."
The publication, by the American Institute for Cancer Research and the World Cancer Research Fund, involved a "compilation of 7,000 other studies," and found "a connection between obesity and six types of common cancers."
The study "involved nine independent teams of scientists from around the world, hundreds of peer reviewers, and 21 international experts who analyzed" thousands of large-scale studies.
The study, which took five years to develop, indicates that "[e]xcess body fat increases the risk of cancer of the colon, kidney, pancreas, esophagus, and uterus as well as postmenopausal breast cancer."
The study also suggests that people should "forget eating bacon, sausage, and lunchmeat," because there is no "completely safe" amount.
"Every 1.7 ounces of processed meat consumed a day increases the risk of colorectal cancer by 21 percent," according to the study. The especially significant risk associated with processed meets may be due to the presence of carcinogens in "smoked meat, and the nitrates and excess salt in processed meats," according to Cancer Institute nutritionist Karen Collins.
The study author Dr. Walter J. Willett, a professor at the Harvard School of Public Health, and 20 co-authors, compiled the 517-page report, entitled Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective.
Their analysis of the studies found that "[e]xcess body fat influences the body's hormones, and these changes can make it more likely for cells to undergo the kind of abnormal growth that leads to cancer."
In short, "[t]he risk from excess weight begins at birth." Therefore, obese girls who begin menstruation earlier in life "will have more menstrual cycles. This extended exposure to estrogen is associated with increased risk for premenopausal breast cancer." The researchers stressed the fact that "[n]ot smoking is the most important thing one can do to reduce the risk of cancer."
"[o]besity is on course to overtake tobacco as the leading risk factor for cancer in America, according to [the] report." In fact, Dr. Willett "predicted that over the next decade 'obesity will become the number one risk factor for cancer,' as obesity increases and the number of smokers decreases."
He added that this "finding was a call to action for clinicians, who he said should begin counseling patients about the danger of excess weight with 'the first few pounds gained or first few extra inches of abdominal girth,'" rather than current practice, where clinicians may wait "until patients need to lose 30 pounds or more," to encourage them to lose weight.
W. Philip T. James, M.D., Dr.Sc., chairman of the London-based International Obesity Task Force, and a panel member, insists that "the panel went to great lengths to ensure that their findings were based solely on scientific evidence,".
"To this end, researchers working on the project reviewed every published study on weight and cancer to come up with the 7,000 studies on which they base their conclusions and recommendations."
"This is not a report from a select group of people who have their own biases. It has been done in a three-tier system to make sure it is as rigorous and up to date and savagely analyzed as any group could do."
Credibility Issue for HDL...
Higher serum HDL cholesterol has been a therapeutic goal ever since the strong inverse association between HDL levels and the risk of coronary heart disease was first observed.1 Nearly two decades ago, the discovery that persons in Japan had extremely high levels of HDL cholesterol because of a genetic deficiency involving the cholesteryl ester transfer protein (CETP) led to the concept that pharmacologic inhibition of CETP could raise HDL cholesterol levels. When this theory proved to be true in humans, it led to great anticipation that CETP inhibition would permit the ultimate test of the "HDL hypothesis" as to whether raising HDL cholesterol levels would reduce the risk of cardiovascular disease.
This hope suffered a severe blow with the surprise announcement in December 2006 that a large phase 3 clinical trial of the leading CETP inhibitor, torcetrapib, had been terminated because of increased mortality in the active treatment group, as compared with the placebo group. This announcement was followed by a presentation of imaging trials showing that torcetrapib had no effect on the progression of atherosclerosis.2,3 Since then, the biomedical community has been anxiously awaiting detailed information on the trial in the hope of achieving a better understanding of the adverse outcomes. In the issue of the Journal, Barter et al. discuss the results of the torcetrapib trial, called the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events (ILLUMINATE),4 and the results are, well, illuminating.
In the study, more than 15,000 patients at high risk for cardiovascular disease were treated with atorvastatin during a run-in period to reach a target goal for low-density lipoprotein (LDL) cholesterol of less than 100 mg per deciliter. Then patients who met the target were randomly assigned to receive either 60 mg of torcetrapib plus atorvastatin or placebo plus atorvastatin. At the time the trial was terminated, the median follow-up period was only 550 days.
Despite the very favorable lipid changes in the torcetrapib group (an increase in HDL cholesterol of 72.1% and a decrease in LDL cholesterol of 24.9%), the rate of major cardiovascular events was increased by 25% and that of death from cardiovascular causes by 40%. Furthermore, death from noncardiovascular causes was increased by a factor of two. Torcetrapib was also associated with an increase in blood pressure and aldosterone levels and changes in electrolytes consistent with mineralocorticoid excess. These effects of torcetrapib are molecule-specific and are not related to the mechanism of CETP inhibition. Other CETP inhibitors do not elevate blood pressure in CETP-expressing species, including humans.
The ILLUMINATE trial raises several questions that are vitally important for cardiovascular medicine: Was the increase in adverse events and mortality caused by CETP inhibition, off-target effects of torcetrapib, or both? Might a "clean" CETP inhibitor reduce cardiovascular events without increasing noncardiovascular adverse events? What implications does this trial have for the broader issue of HDL cholesterol as a therapeutic target?
It is indeed possible that the increased rate of cardiovascular events and death associated with torcetrapib could be due either to CETP inhibition itself or to off-target effects of the drug — or to some combination of the two factors (Figure 1). Despite the effects of torcetrapib in raising HDL cholesterol levels, there has been concern that CETP inhibition could impair reverse cholesterol transport, the process by which peripheral cholesterol is transported back to the liver for excretion. The transfer of cholesteryl esters from HDL to lipoproteins containing apolipoprotein B is probably the major route in humans by which HDL cholesterol is returned to the liver, completing the pathway of reverse cholesterol transport.
Although this pathway is difficult to measure in humans, in a study by Brousseau et al.,5 torcetrapib therapy was associated with a decreased turnover of HDL and no change in the fecal excretion of sterols. In mice, which do not have CETP, introduction of CETP expression actually promoted reverse cholesterol transport from macrophages despite a reduction in HDL levels.6 On the other hand, in mice that do not have effective uptake of LDL cholesterol by the liver, the expression of CETP had the reverse effect, which implies that there could be a potential benefit of CETP inhibition in this setting.
Furthermore, HDL obtained from patients receiving has been shown to promote cholesterol efflux from macrophages through the ABCG1 pathway.7 It is tantalizing that in the ILLUMINATE study, a greater increase in HDL cholesterol levels in torcetrapib-treated patients was associated with fewer major cardiovascular events; it will be important to confirm this observation in the atherosclerosis imaging trials of torcetrapib.
Potential Mechanisms of Adverse Outcomes Associated with Torcetrapib.
Treatment with torcetrapib has both mechanism-based and off-target effects that may have contributed to an increased rate of adverse cardiovascular and noncardiovascular outcomes. The drug inhibits cholesteryl ester transfer protein (CETP), blocking the transfer of cholesteryl esters to lipoproteins containing apolipoprotein B (ApoB), such as low-density lipoprotein (LDL), resulting in increased levels of high-density lipoprotein (HDL) cholesterol and enlarged HDL particles. Although HDL cholesterol can be taken up directly by the liver through the HDL scavenger receptor, class B, type I (SR-BI), inhibition of CETP may reduce the rate of return of HDL cholesterol to the liver, thus impairing reverse cholesterol transport and increasing cardiovascular risk.
In addition, the change in HDL composition could conceivably impair immune function associated with HDL, thus increasing noncardiovascular risks such as infection and cancer. On the other hand, the molecule torcetrapib clearly has the off-target effects of elevating levels of aldosterone and blood pressure, changes that probably contributed to the increased cardiovascular risk. The potential that torcetrapib has off-target effects that contributed to an increased risk of noncardiovascular events is possible but speculative.
Finally, CETP inhibition has the potentially beneficial effects of increasing cholesterol efflux from macrophages mediated by ATP-binding cassette transporter G1 (ABCG1) (which could increase the rate of physiologically relevant reverse cholesterol transport from macrophages) and of increasing the uptake of LDL cholesterol by the liver (which reduces LDL cholesterol levels), effects that could be important for CETP inhibitors that do not have the off-target effects of torcetrapib.
The "off-target" effects of torcetrapib probably contributed in important ways to the increased rate of cardiovascular events and death in this trial. Indeed, aldosterone, through activation of the mineralocorticoid receptor, not only elevates blood pressure but has direct vascular effects, including impaired endothelial function, increased inflammation, and increased vascular smooth-muscle migration.8 Death from cardiovascular events was higher in patients with greater changes in serum electrolytes, consistent with the hypothesis that this mechanism played a causal role.
It is much harder to explain the increased rate of death from noncardiovascular causes by either CETP inhibition or off-target effects of torcetrapib (Figure 1). The doubling in the rate of death from noncardiovascular events in patients receiving torcetrapib, as compared with those receiving placebo, was largely due to more deaths from cancer (24 to 14) and infection (9 to 0). Could CETP inhibition have led to the excess noncardiovascular mortality, or are the off-target effects of the drug to be blamed? In many ways, this question is one of the most important ones raised by the ILLUMINATE study.
It appears that HDL evolved as a component of the innate immune system and that its composition is critically important to its function. For example, HDL binds endotoxin and protects mice from endotoxin-induced death. In addition, in primates HDL serves as a synergistic platform for the assembly of a complex consisting of apolipoprotein L-I and haptoglobin-related protein that has the unique ability to lyse a species of trypanosome.9 Studies of the human HDL proteome have identified a large number of HDL-associated proteins that are involved in innate immunity, complement regulation, and inflammation.10 CETP inhibition increases the size and alters the lipid and protein composition of HDL particles. Could these changes in composition alter the immune or inflammatory function of HDL in such a way as to increase the risk of death from cancer or infection? Alternatively, off-target effects of torcetrapib could potentially account for the excessive rate of death from noncardiovascular causes through an unknown mechanism.
It is still possible that a CETP inhibitor without the off-target effects of torcetrapib could be viable as a therapy for cardiovascular disease. Mechanistic studies of torcetrapib's effects on the function of HDL cholesterol and the renin–angiotensin–aldosterone system and the investigation of a wide array of candidate genes to search for association with adverse outcomes in the ILLUMINATE study should be performed, along with a systematic study of outcomes in persons with homozygous CETP deficiency. It is possible that CETP inhibition might be better suited to certain subgroups of patients, such as those with impaired clearance of LDL cholesterol or low levels of HDL cholesterol at baseline. In any case, it is premature to announce the death of CETP inhibitors on the basis of the torcetrapib experience alone.
The results of the ILLUMINATE trial have led some observers to question the entire concept of targeting HDL cholesterol therapeutically. However, torcetrapib therapy is just one mechanism for raising levels of HDL cholesterol — and with a flawed molecule to boot. There remains substantial reason for cautious optimism regarding the therapeutic targeting of the metabolism of HDL and reverse cholesterol transport.1 Liver-X–receptor agonists promote reverse cholesterol transport and reduce atherosclerosis in animal models. Endothelial lipase inhibition is an approach that may raise HDL cholesterol levels through a mechanism that promotes reverse cholesterol transport and improves the function of HDL cholesterol.
Apolipoprotein A-I mimetic peptides have been shown to improve HDL function and reduce atherosclerosis in animals. Up-regulation of apolipoprotein A-I transcription remains in many ways the "holy grail" of HDL-based therapies. New validated targets are certainly still needed in the HDL therapeutics arena and will probably come in part from genetic studies in humans with defined phenotypes.
In any event, the ILLUMINATE trial will undoubtedly stand as a watershed event in the field of HDL-targeted therapies. It may ultimately be seen as the study that brought about the rejection of the "HDL hypothesis." At a minimum, it will have been responsible for shifting the focus from HDL concentration to HDL function and raising the bar for approval of new HDL-targeted therapies. Despite the light that the ILLUMINATE study has shed onto part of the HDL journey, many poorly lit paths remain to be explored.
This hope suffered a severe blow with the surprise announcement in December 2006 that a large phase 3 clinical trial of the leading CETP inhibitor, torcetrapib, had been terminated because of increased mortality in the active treatment group, as compared with the placebo group. This announcement was followed by a presentation of imaging trials showing that torcetrapib had no effect on the progression of atherosclerosis.2,3 Since then, the biomedical community has been anxiously awaiting detailed information on the trial in the hope of achieving a better understanding of the adverse outcomes. In the issue of the Journal, Barter et al. discuss the results of the torcetrapib trial, called the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events (ILLUMINATE),4 and the results are, well, illuminating.
In the study, more than 15,000 patients at high risk for cardiovascular disease were treated with atorvastatin during a run-in period to reach a target goal for low-density lipoprotein (LDL) cholesterol of less than 100 mg per deciliter. Then patients who met the target were randomly assigned to receive either 60 mg of torcetrapib plus atorvastatin or placebo plus atorvastatin. At the time the trial was terminated, the median follow-up period was only 550 days.
Despite the very favorable lipid changes in the torcetrapib group (an increase in HDL cholesterol of 72.1% and a decrease in LDL cholesterol of 24.9%), the rate of major cardiovascular events was increased by 25% and that of death from cardiovascular causes by 40%. Furthermore, death from noncardiovascular causes was increased by a factor of two. Torcetrapib was also associated with an increase in blood pressure and aldosterone levels and changes in electrolytes consistent with mineralocorticoid excess. These effects of torcetrapib are molecule-specific and are not related to the mechanism of CETP inhibition. Other CETP inhibitors do not elevate blood pressure in CETP-expressing species, including humans.
The ILLUMINATE trial raises several questions that are vitally important for cardiovascular medicine: Was the increase in adverse events and mortality caused by CETP inhibition, off-target effects of torcetrapib, or both? Might a "clean" CETP inhibitor reduce cardiovascular events without increasing noncardiovascular adverse events? What implications does this trial have for the broader issue of HDL cholesterol as a therapeutic target?
It is indeed possible that the increased rate of cardiovascular events and death associated with torcetrapib could be due either to CETP inhibition itself or to off-target effects of the drug — or to some combination of the two factors (Figure 1). Despite the effects of torcetrapib in raising HDL cholesterol levels, there has been concern that CETP inhibition could impair reverse cholesterol transport, the process by which peripheral cholesterol is transported back to the liver for excretion. The transfer of cholesteryl esters from HDL to lipoproteins containing apolipoprotein B is probably the major route in humans by which HDL cholesterol is returned to the liver, completing the pathway of reverse cholesterol transport.
Although this pathway is difficult to measure in humans, in a study by Brousseau et al.,5 torcetrapib therapy was associated with a decreased turnover of HDL and no change in the fecal excretion of sterols. In mice, which do not have CETP, introduction of CETP expression actually promoted reverse cholesterol transport from macrophages despite a reduction in HDL levels.6 On the other hand, in mice that do not have effective uptake of LDL cholesterol by the liver, the expression of CETP had the reverse effect, which implies that there could be a potential benefit of CETP inhibition in this setting.
Furthermore, HDL obtained from patients receiving has been shown to promote cholesterol efflux from macrophages through the ABCG1 pathway.7 It is tantalizing that in the ILLUMINATE study, a greater increase in HDL cholesterol levels in torcetrapib-treated patients was associated with fewer major cardiovascular events; it will be important to confirm this observation in the atherosclerosis imaging trials of torcetrapib.
Potential Mechanisms of Adverse Outcomes Associated with Torcetrapib.
Treatment with torcetrapib has both mechanism-based and off-target effects that may have contributed to an increased rate of adverse cardiovascular and noncardiovascular outcomes. The drug inhibits cholesteryl ester transfer protein (CETP), blocking the transfer of cholesteryl esters to lipoproteins containing apolipoprotein B (ApoB), such as low-density lipoprotein (LDL), resulting in increased levels of high-density lipoprotein (HDL) cholesterol and enlarged HDL particles. Although HDL cholesterol can be taken up directly by the liver through the HDL scavenger receptor, class B, type I (SR-BI), inhibition of CETP may reduce the rate of return of HDL cholesterol to the liver, thus impairing reverse cholesterol transport and increasing cardiovascular risk.
In addition, the change in HDL composition could conceivably impair immune function associated with HDL, thus increasing noncardiovascular risks such as infection and cancer. On the other hand, the molecule torcetrapib clearly has the off-target effects of elevating levels of aldosterone and blood pressure, changes that probably contributed to the increased cardiovascular risk. The potential that torcetrapib has off-target effects that contributed to an increased risk of noncardiovascular events is possible but speculative.
Finally, CETP inhibition has the potentially beneficial effects of increasing cholesterol efflux from macrophages mediated by ATP-binding cassette transporter G1 (ABCG1) (which could increase the rate of physiologically relevant reverse cholesterol transport from macrophages) and of increasing the uptake of LDL cholesterol by the liver (which reduces LDL cholesterol levels), effects that could be important for CETP inhibitors that do not have the off-target effects of torcetrapib.
The "off-target" effects of torcetrapib probably contributed in important ways to the increased rate of cardiovascular events and death in this trial. Indeed, aldosterone, through activation of the mineralocorticoid receptor, not only elevates blood pressure but has direct vascular effects, including impaired endothelial function, increased inflammation, and increased vascular smooth-muscle migration.8 Death from cardiovascular events was higher in patients with greater changes in serum electrolytes, consistent with the hypothesis that this mechanism played a causal role.
It is much harder to explain the increased rate of death from noncardiovascular causes by either CETP inhibition or off-target effects of torcetrapib (Figure 1). The doubling in the rate of death from noncardiovascular events in patients receiving torcetrapib, as compared with those receiving placebo, was largely due to more deaths from cancer (24 to 14) and infection (9 to 0). Could CETP inhibition have led to the excess noncardiovascular mortality, or are the off-target effects of the drug to be blamed? In many ways, this question is one of the most important ones raised by the ILLUMINATE study.
It appears that HDL evolved as a component of the innate immune system and that its composition is critically important to its function. For example, HDL binds endotoxin and protects mice from endotoxin-induced death. In addition, in primates HDL serves as a synergistic platform for the assembly of a complex consisting of apolipoprotein L-I and haptoglobin-related protein that has the unique ability to lyse a species of trypanosome.9 Studies of the human HDL proteome have identified a large number of HDL-associated proteins that are involved in innate immunity, complement regulation, and inflammation.10 CETP inhibition increases the size and alters the lipid and protein composition of HDL particles. Could these changes in composition alter the immune or inflammatory function of HDL in such a way as to increase the risk of death from cancer or infection? Alternatively, off-target effects of torcetrapib could potentially account for the excessive rate of death from noncardiovascular causes through an unknown mechanism.
It is still possible that a CETP inhibitor without the off-target effects of torcetrapib could be viable as a therapy for cardiovascular disease. Mechanistic studies of torcetrapib's effects on the function of HDL cholesterol and the renin–angiotensin–aldosterone system and the investigation of a wide array of candidate genes to search for association with adverse outcomes in the ILLUMINATE study should be performed, along with a systematic study of outcomes in persons with homozygous CETP deficiency. It is possible that CETP inhibition might be better suited to certain subgroups of patients, such as those with impaired clearance of LDL cholesterol or low levels of HDL cholesterol at baseline. In any case, it is premature to announce the death of CETP inhibitors on the basis of the torcetrapib experience alone.
The results of the ILLUMINATE trial have led some observers to question the entire concept of targeting HDL cholesterol therapeutically. However, torcetrapib therapy is just one mechanism for raising levels of HDL cholesterol — and with a flawed molecule to boot. There remains substantial reason for cautious optimism regarding the therapeutic targeting of the metabolism of HDL and reverse cholesterol transport.1 Liver-X–receptor agonists promote reverse cholesterol transport and reduce atherosclerosis in animal models. Endothelial lipase inhibition is an approach that may raise HDL cholesterol levels through a mechanism that promotes reverse cholesterol transport and improves the function of HDL cholesterol.
Apolipoprotein A-I mimetic peptides have been shown to improve HDL function and reduce atherosclerosis in animals. Up-regulation of apolipoprotein A-I transcription remains in many ways the "holy grail" of HDL-based therapies. New validated targets are certainly still needed in the HDL therapeutics arena and will probably come in part from genetic studies in humans with defined phenotypes.
In any event, the ILLUMINATE trial will undoubtedly stand as a watershed event in the field of HDL-targeted therapies. It may ultimately be seen as the study that brought about the rejection of the "HDL hypothesis." At a minimum, it will have been responsible for shifting the focus from HDL concentration to HDL function and raising the bar for approval of new HDL-targeted therapies. Despite the light that the ILLUMINATE study has shed onto part of the HDL journey, many poorly lit paths remain to be explored.
Statins Now for Heart Failure ??
Statins represent one of the most important pharmacologic advances in the prevention of cardiovascular disease in decades. Since the publication of the Scandinavian Simvastatin Survival Study in 1994,1 several trials have demonstrated important benefits of statins in patients with established coronary disease. These findings have resulted in strong recommendations for the use of statins in clinical-practice guidelines.2 Statins are one of the few classes of drugs that are embedded in clinical-performance measures for coronary artery disease, which indicates that clinicians should be considered remiss if they do not prescribe these agents for all their eligible patients.3
In the context of the strong evidence base and recommendations supporting the use of statins for secondary prevention of cardiovascular disease, in this issue of the Journal Kjekshus et al.4 report on a study assessing the efficacy of 10 mg of rosuvastatin daily in patients with heart failure and left ventricular systolic dysfunction attributed to coronary artery disease.
The study, called the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA), was a randomized, placebo-controlled trial involving patients who were at least 60 years of age (mean, 73 years) who were receiving high rates of evidence-based therapy for left ventricular systolic dysfunction, including angiotensin-converting–enzyme inhibitors or angiotensin-receptor blockers and beta-blockers.
As compared with placebo, treatment with rosuvastatin resulted in no significant difference in the primary composite outcome of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, even though the drug was associated with substantial reductions in levels of low-density lipoprotein (LDL) cholesterol and high-sensitivity C-reactive protein.
Patients in the rosuvastatin group had significantly fewer hospitalizations for cardiovascular causes, including heart failure; rates of adverse drug events did not differ between the two study groups. Rosuvastatin therapy had no effect on the health status of patients, as assessed on the basis of New York Heart Association class and the McMaster Overall Treatment Evaluation questionnaire, which were designated as tertiary outcomes.
Results aside, one might ask whether a study of a statin for secondary prevention in this population was warranted. Although the numbers of patients with systolic heart failure who have been enrolled in previous secondary-prevention trials have been inadequate to generate robust evidence, observational studies have suggested benefits of statin therapy on morbidity and mortality in this population.5 Statins also have a favorable effect on surrogate end points (e.g., endothelial function), which in theory would be beneficial for patients with heart failure.
Given these facts, it might be tempting to assume that patients with ischemic left ventricular systolic dysfunction would accrue benefits from statins similar to those identified in previous trials. However, there are several reasons to resist this temptation. First, the limitations of assumptions based on observational data6 and surrogates7 are well documented.
Furthermore, the need to understand specifically the balance of risks and benefits of drug therapy in patients with heart failure is magnified by particular characteristics of this population. Although patients with ischemic left ventricular systolic dysfunction have high rates of adverse outcomes, their risk of ischemic cardiovascular events — outcomes that statins seem most likely to prevent — may occur less frequently than in other patients with coronary disease.
Moreover, heart failure disproportionately affects older persons, who often have a substantial risk of coexisting illnesses, a factor that raises questions about the applicability of evidence from clinical trials involving younger patients with a single, dominant clinical problem.8 Finally, typical regimens for this population involve multiple drugs, both because of the burden of coexisting illnesses and the number of drugs used to treat heart failure.9 The addition of a new drug to an already complex regimen increases not only the cost but also the risk of adverse drug interactions. When coupled with a theoretical concern about possible adverse drug effects from statins specific to patients with heart failure,10 such factors amplify the need to understand the safety and efficacy of this therapy.
How, then, can the clinical findings of the CORONA study be reconciled with the existing randomized trials of statins in patients with established coronary artery disease? First, statins as a class may not be efficacious in patients with ischemic left ventricular systolic dysfunction who are already receiving evidence-based therapy for heart failure. An attenuated effect of statins could reflect the distribution of the causes of outcomes in this population.
For example, among patients in the CORONA study, rates of nonfatal myocardial infarction were about one quarter of the rates reported in patients in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) study,11 a statin trial that enrolled patients whose mean age was about 75 years and who had a mean follow-up of about 38 months (as compared with 32.8 months in the CORONA study). It is also important to point out that the confidence intervals around the primary end point in the CORONA study are consistent with as much as a 17% relative reduction in risk or an absolute risk reduction of approximately 2%.
An absolute benefit of this magnitude would be clinically significant and is similar to that identified in PROSPER. Second, it is possible that even though rosuvastatin lowered levels of LDL cholesterol and high-sensitivity C-reactive protein, the drug does not share the same benefits regarding important health outcomes with other statins. Although several statins have proven clinical efficacy, supporting the assumption of a class effect, experience with cerivastatin has shown that such assumptions can lead us astray.
It is reassuring that in the CORONA study, patients in the rosuvastatin group had fewer hospitalizations for cardiovascular causes and no greater risk of adverse events than did those in the placebo group. Finally, statins may have less incremental benefit in a population of older patients who are at higher risk for competing events, which could reduce the likelihood of ascertaining a benefit for specific cardiovascular outcomes. Although only a minority of deaths in the CORONA study were designated as having noncardiovascular causes, deaths that did not have a clear cause were presumed to be cardiovascular in nature, potentially limiting the quantification of the magnitude of competing risks.
Future trials may shed light on some of these unresolved questions. The Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) (ClinicalTrials.gov number, NCT00239681 [ClinicalTrials.gov] ) trial12 should provide additional perspective on the general effect of rosuvastatin on important health outcomes in patients without established cardiovascular disease.
The results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca Heart Failure Study (GISSI-HF) (ClinicalTrials.gov number, NCT00336336 [ClinicalTrials.gov] ),13 a randomized trial in which patients with heart failure are receiving either rosuvastatin or placebo, will complement the findings of the CORONA study. The GISSI-HF study is also enrolling patients with nonischemic cardiomyopathies and those with preserved left ventricular systolic function, both important subgroups of the population with heart failure who were not evaluated in the CORONA study.
The results of the CORONA study highlight issues that are central to the conduct of trials involving patients with heart failure. When important questions are raised about the benefits and risks of a therapy that is well established in other populations, it may still be essential to establish treatment effects in the population with heart failure.
Admittedly, enrolling subjects in trials that challenge well-established treatment paradigms may be difficult despite equipoise on an intellectual level. Second, trials simply must focus more attention on including patients who are representative of those seen in clinical practice. In enrolling older patients, the CORONA study made important strides, although the proportion of women who were enrolled (less than 25%) was no higher than that in previous heart failure trials.
Finally, because health status (including symptom burden and quality of life) provides a patient-centered understanding of the effect of any treatment, it should be included as an outcome in all studies of heart failure. Ideally, health status outcomes would not be consigned to tertiary status and would be assessed with valid, reliable, and clinically sensitive instruments designed specifically for use in populations with heart failure.14 Trials enrolling more representative populations and assessing a broader range of outcomes are instrumental to informed decision making.15
Meanwhile, enough uncertainty exists about the mechanisms underlying the primary results of the CORONA study that clinicians should continue to prescribe statins for patients with ischemic heart failure and left ventricular systolic dysfunction. Until further evidence accumulates, we cannot tell to what extent the CORONA study reflects the limitations of the use of statins for patients with heart failure, the problems associated with a particular drug, or the intrinsic challenges of treating older patients with complex coexisting illnesses.
In the context of the strong evidence base and recommendations supporting the use of statins for secondary prevention of cardiovascular disease, in this issue of the Journal Kjekshus et al.4 report on a study assessing the efficacy of 10 mg of rosuvastatin daily in patients with heart failure and left ventricular systolic dysfunction attributed to coronary artery disease.
The study, called the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA), was a randomized, placebo-controlled trial involving patients who were at least 60 years of age (mean, 73 years) who were receiving high rates of evidence-based therapy for left ventricular systolic dysfunction, including angiotensin-converting–enzyme inhibitors or angiotensin-receptor blockers and beta-blockers.
As compared with placebo, treatment with rosuvastatin resulted in no significant difference in the primary composite outcome of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, even though the drug was associated with substantial reductions in levels of low-density lipoprotein (LDL) cholesterol and high-sensitivity C-reactive protein.
Patients in the rosuvastatin group had significantly fewer hospitalizations for cardiovascular causes, including heart failure; rates of adverse drug events did not differ between the two study groups. Rosuvastatin therapy had no effect on the health status of patients, as assessed on the basis of New York Heart Association class and the McMaster Overall Treatment Evaluation questionnaire, which were designated as tertiary outcomes.
Results aside, one might ask whether a study of a statin for secondary prevention in this population was warranted. Although the numbers of patients with systolic heart failure who have been enrolled in previous secondary-prevention trials have been inadequate to generate robust evidence, observational studies have suggested benefits of statin therapy on morbidity and mortality in this population.5 Statins also have a favorable effect on surrogate end points (e.g., endothelial function), which in theory would be beneficial for patients with heart failure.
Given these facts, it might be tempting to assume that patients with ischemic left ventricular systolic dysfunction would accrue benefits from statins similar to those identified in previous trials. However, there are several reasons to resist this temptation. First, the limitations of assumptions based on observational data6 and surrogates7 are well documented.
Furthermore, the need to understand specifically the balance of risks and benefits of drug therapy in patients with heart failure is magnified by particular characteristics of this population. Although patients with ischemic left ventricular systolic dysfunction have high rates of adverse outcomes, their risk of ischemic cardiovascular events — outcomes that statins seem most likely to prevent — may occur less frequently than in other patients with coronary disease.
Moreover, heart failure disproportionately affects older persons, who often have a substantial risk of coexisting illnesses, a factor that raises questions about the applicability of evidence from clinical trials involving younger patients with a single, dominant clinical problem.8 Finally, typical regimens for this population involve multiple drugs, both because of the burden of coexisting illnesses and the number of drugs used to treat heart failure.9 The addition of a new drug to an already complex regimen increases not only the cost but also the risk of adverse drug interactions. When coupled with a theoretical concern about possible adverse drug effects from statins specific to patients with heart failure,10 such factors amplify the need to understand the safety and efficacy of this therapy.
How, then, can the clinical findings of the CORONA study be reconciled with the existing randomized trials of statins in patients with established coronary artery disease? First, statins as a class may not be efficacious in patients with ischemic left ventricular systolic dysfunction who are already receiving evidence-based therapy for heart failure. An attenuated effect of statins could reflect the distribution of the causes of outcomes in this population.
For example, among patients in the CORONA study, rates of nonfatal myocardial infarction were about one quarter of the rates reported in patients in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) study,11 a statin trial that enrolled patients whose mean age was about 75 years and who had a mean follow-up of about 38 months (as compared with 32.8 months in the CORONA study). It is also important to point out that the confidence intervals around the primary end point in the CORONA study are consistent with as much as a 17% relative reduction in risk or an absolute risk reduction of approximately 2%.
An absolute benefit of this magnitude would be clinically significant and is similar to that identified in PROSPER. Second, it is possible that even though rosuvastatin lowered levels of LDL cholesterol and high-sensitivity C-reactive protein, the drug does not share the same benefits regarding important health outcomes with other statins. Although several statins have proven clinical efficacy, supporting the assumption of a class effect, experience with cerivastatin has shown that such assumptions can lead us astray.
It is reassuring that in the CORONA study, patients in the rosuvastatin group had fewer hospitalizations for cardiovascular causes and no greater risk of adverse events than did those in the placebo group. Finally, statins may have less incremental benefit in a population of older patients who are at higher risk for competing events, which could reduce the likelihood of ascertaining a benefit for specific cardiovascular outcomes. Although only a minority of deaths in the CORONA study were designated as having noncardiovascular causes, deaths that did not have a clear cause were presumed to be cardiovascular in nature, potentially limiting the quantification of the magnitude of competing risks.
Future trials may shed light on some of these unresolved questions. The Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) (ClinicalTrials.gov number, NCT00239681 [ClinicalTrials.gov] ) trial12 should provide additional perspective on the general effect of rosuvastatin on important health outcomes in patients without established cardiovascular disease.
The results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca Heart Failure Study (GISSI-HF) (ClinicalTrials.gov number, NCT00336336 [ClinicalTrials.gov] ),13 a randomized trial in which patients with heart failure are receiving either rosuvastatin or placebo, will complement the findings of the CORONA study. The GISSI-HF study is also enrolling patients with nonischemic cardiomyopathies and those with preserved left ventricular systolic function, both important subgroups of the population with heart failure who were not evaluated in the CORONA study.
The results of the CORONA study highlight issues that are central to the conduct of trials involving patients with heart failure. When important questions are raised about the benefits and risks of a therapy that is well established in other populations, it may still be essential to establish treatment effects in the population with heart failure.
Admittedly, enrolling subjects in trials that challenge well-established treatment paradigms may be difficult despite equipoise on an intellectual level. Second, trials simply must focus more attention on including patients who are representative of those seen in clinical practice. In enrolling older patients, the CORONA study made important strides, although the proportion of women who were enrolled (less than 25%) was no higher than that in previous heart failure trials.
Finally, because health status (including symptom burden and quality of life) provides a patient-centered understanding of the effect of any treatment, it should be included as an outcome in all studies of heart failure. Ideally, health status outcomes would not be consigned to tertiary status and would be assessed with valid, reliable, and clinically sensitive instruments designed specifically for use in populations with heart failure.14 Trials enrolling more representative populations and assessing a broader range of outcomes are instrumental to informed decision making.15
Meanwhile, enough uncertainty exists about the mechanisms underlying the primary results of the CORONA study that clinicians should continue to prescribe statins for patients with ischemic heart failure and left ventricular systolic dysfunction. Until further evidence accumulates, we cannot tell to what extent the CORONA study reflects the limitations of the use of statins for patients with heart failure, the problems associated with a particular drug, or the intrinsic challenges of treating older patients with complex coexisting illnesses.
Continued loan deferment for Medical Residents
"The federal Department of Education has granted a plea from organized medicine to extend the deferment eligibility that allows graduate physicians to delay paying back student loans until after the completion of residencies."
The medical student representative on the AMA's board of trustees, called the extension "a temporary fix."
He continued, "We are committed to working with Congress and the Department of Education on a long-term solution for continued loan deferment eligibility for medical residents,"
He also reiterated AMA's warning that "making it harder for residents to pay back their high debt can deter young physicians from going into primary care medicine, or practicing in underserved areas."
The medical student representative on the AMA's board of trustees, called the extension "a temporary fix."
He continued, "We are committed to working with Congress and the Department of Education on a long-term solution for continued loan deferment eligibility for medical residents,"
He also reiterated AMA's warning that "making it harder for residents to pay back their high debt can deter young physicians from going into primary care medicine, or practicing in underserved areas."
Living Longer and Looking Younger
Low-calorie diet could extend life, study indicates.
"Cutting back drastically on daily calorie intake can lead to longer life, at least in rats," according to a study published in the October issue of Journals of Gerontology Series A: Biological Sciences and Medical Sciences.
Researchers at the University at Buffalo found that "[a] lifelong 40 percent calorie-restricted diet reduced the rats' amount of visceral fat, which expresses inflammatory factors -- proteins that, in humans, cause chronic disease and an age-related decline in physical performance and vitality."
They noted that "[t]his is the first study to report that caloric restriction reduced production in visceral fat of the inflammatory cytokine IL-6, and enhanced performance on overall physical function assessments."
While most humans could not maintain such a strict diet (1,200 calories per day for women, and 1,500 for men), they could manage an eight-percent reduction in caloric intake, the researchers said.
"Cutting back drastically on daily calorie intake can lead to longer life, at least in rats," according to a study published in the October issue of Journals of Gerontology Series A: Biological Sciences and Medical Sciences.
Researchers at the University at Buffalo found that "[a] lifelong 40 percent calorie-restricted diet reduced the rats' amount of visceral fat, which expresses inflammatory factors -- proteins that, in humans, cause chronic disease and an age-related decline in physical performance and vitality."
They noted that "[t]his is the first study to report that caloric restriction reduced production in visceral fat of the inflammatory cytokine IL-6, and enhanced performance on overall physical function assessments."
While most humans could not maintain such a strict diet (1,200 calories per day for women, and 1,500 for men), they could manage an eight-percent reduction in caloric intake, the researchers said.
Breakthrough in Morphine Tolerance
Study suggests eliminating peroxynitrite may prevent morphine tolerance.
"Blocking a substance called peroxynitrite, a potent oxidant that's formed when patients take morphine, can prevent the development of tolerance to the pain-relieving effects of the narcotic," according to findings published in the November issue of the Journal of Clinical Investigation.
Researchers at Saint Louis University of Medicine repeatedly dosed animals with morphine, and found that this "caused peroxynitrite to develop in the spinal cord, resulting in inflammation and damage to proteins and DNA in that area."
"[m]orphine and other opiate narcotics are the most powerful treatments for acute and chronic pain. However, their pain-killing effectiveness decreases quickly and significantly with repeated doses."
When the researchers eliminated peroxynitrite, "either by causing it to decompose once it formed, or by blocking it from forming in the first place," they discovered that this "prevented morphine tolerance."
They concluded, "We believe these findings represent a major breakthrough in understanding how tolerance to the pain-relieving action of morphine and other opiate medications develops -- and how it can be prevented from happening in the first place."
"Blocking a substance called peroxynitrite, a potent oxidant that's formed when patients take morphine, can prevent the development of tolerance to the pain-relieving effects of the narcotic," according to findings published in the November issue of the Journal of Clinical Investigation.
Researchers at Saint Louis University of Medicine repeatedly dosed animals with morphine, and found that this "caused peroxynitrite to develop in the spinal cord, resulting in inflammation and damage to proteins and DNA in that area."
"[m]orphine and other opiate narcotics are the most powerful treatments for acute and chronic pain. However, their pain-killing effectiveness decreases quickly and significantly with repeated doses."
When the researchers eliminated peroxynitrite, "either by causing it to decompose once it formed, or by blocking it from forming in the first place," they discovered that this "prevented morphine tolerance."
They concluded, "We believe these findings represent a major breakthrough in understanding how tolerance to the pain-relieving action of morphine and other opiate medications develops -- and how it can be prevented from happening in the first place."
Check out this New Online Physician Database
Zagat, Wellpoint to launch online physician database.
"Today, thanks to greater mobility (yours and the doctors'), rare is the lifelong doctor-patient relationship." In addition, some physicians have closed their practices, so it takes some effort to locate a new physician. Help is available from various sources, such as the AMA's DoctorFinder.
Another source of help might be a website which rates physicians, such as the one being launched by Zagat Survey and Wellpoint, the Chicago Tribune (11/4, Deardorff) added in separate article. The site will "allow consumers to rank doctors on a 30-point scale, just as diners rate restaurants." Advocates of this idea say that "doctor-rating sites promote much-needed transparency and are a natural part of the consumer-driven healthcare movement."
However, "several states and the American Medical Association have raised concerns about ratings programs run by health insurers, and the accuracy of the information on the sites." According to Rita Schwab, a professional in medical credentialing, such sites "may provide patients with some valuable information not easily obtained elsewhere, but all the information provided on these sites is subject to serious reliability issues."
Zagat's "online service, which will be available only to WellPoint clients, is hardly the first effort to make doctor information more widely available."
Other sites, such as RateMDs.com and Healthgrades.com, have also attempted to provide information on physicians. "Each of these sources is useful, but taken together, available doctor information is, well, pretty weak medicine."
Currently, no one site provides a combination of "qualitative and quantitative data, including information about outcomes, legal actions, education, specialties, feedback from other patients, costs, relevant comparisons, and other tips that rise above the scuttlebutt level."
"The medical and legal establishments have not been hurrying to solve, or even acknowledge, this problem." For instance, "Medicare has resisted making its claims database -- the largest collection of such information in the country -- available to raters." The Times pointed out that overall, such sites are getting better at providing need data, and "the Zagat/Wellpoint announcement is another small step toward making your choice of doctors as informed as your choice of burgers."
"Today, thanks to greater mobility (yours and the doctors'), rare is the lifelong doctor-patient relationship." In addition, some physicians have closed their practices, so it takes some effort to locate a new physician. Help is available from various sources, such as the AMA's DoctorFinder.
Another source of help might be a website which rates physicians, such as the one being launched by Zagat Survey and Wellpoint, the Chicago Tribune (11/4, Deardorff) added in separate article. The site will "allow consumers to rank doctors on a 30-point scale, just as diners rate restaurants." Advocates of this idea say that "doctor-rating sites promote much-needed transparency and are a natural part of the consumer-driven healthcare movement."
However, "several states and the American Medical Association have raised concerns about ratings programs run by health insurers, and the accuracy of the information on the sites." According to Rita Schwab, a professional in medical credentialing, such sites "may provide patients with some valuable information not easily obtained elsewhere, but all the information provided on these sites is subject to serious reliability issues."
Zagat's "online service, which will be available only to WellPoint clients, is hardly the first effort to make doctor information more widely available."
Other sites, such as RateMDs.com and Healthgrades.com, have also attempted to provide information on physicians. "Each of these sources is useful, but taken together, available doctor information is, well, pretty weak medicine."
Currently, no one site provides a combination of "qualitative and quantitative data, including information about outcomes, legal actions, education, specialties, feedback from other patients, costs, relevant comparisons, and other tips that rise above the scuttlebutt level."
"The medical and legal establishments have not been hurrying to solve, or even acknowledge, this problem." For instance, "Medicare has resisted making its claims database -- the largest collection of such information in the country -- available to raters." The Times pointed out that overall, such sites are getting better at providing need data, and "the Zagat/Wellpoint announcement is another small step toward making your choice of doctors as informed as your choice of burgers."
Price of the Pricing
Bristol-Myers Squib, AstraZeneca ordered to pay $13.6 million in drug pricing suit.
A "federal judge has ordered drug companies AstraZeneca and Bristol-Myers Squib to pay a combined $13.6 million in a Massachusetts case that alleged they inflating the so-called 'average wholesale price' of expensive, and sometimes life-saving, drugs."
In her opinion, U.S. District Court Judge Patti Saris wrote that both companies "caused 'real injuries to the insurers and the patients who were paying grossly inflated prices for critically important, often life-sustaining drugs.'"
She "said she decided to double the damages because the conduct was willful on the part of the companies." AstraZeneca did not respond to an AP inquiry, but "Bristol-Myers Squib said its pricing was fair," and indicated that the company plans to appeal.
A "federal judge has ordered drug companies AstraZeneca and Bristol-Myers Squib to pay a combined $13.6 million in a Massachusetts case that alleged they inflating the so-called 'average wholesale price' of expensive, and sometimes life-saving, drugs."
In her opinion, U.S. District Court Judge Patti Saris wrote that both companies "caused 'real injuries to the insurers and the patients who were paying grossly inflated prices for critically important, often life-sustaining drugs.'"
She "said she decided to double the damages because the conduct was willful on the part of the companies." AstraZeneca did not respond to an AP inquiry, but "Bristol-Myers Squib said its pricing was fair," and indicated that the company plans to appeal.
Look at this Plavix Rival
Prasugrel outperforms Plavix in study, but has higher risk of bleeding.
"An experimental anticlotting drug from Eli Lilly reduced heart attacks in patients with heart disease by 24 percent compared with Plavix (clopidogrel bisulfate), the current standard treatment," according to study results to be published in the Nov. 15 issue of the New England Journal of Medicine. However, the new treatment, prasugrel, "also increased the risk of severe bleeding compared with Plavix, and quadrupled the risk of fatal bleeding, though the risk was still relatively small."
Plavix and prasugrel "work in the same way, by preventing platelets in the blood from forming clots. But prasugrel is more potent," study results indicate.If the FDA approves the drug, it could be on the market by the end of 2008."
"A three-year study into the new medication found that patients already at a high risk of bleeding could be harmed by taking" it. In addition, the drug's bleeding risk could be fatal in some trial participants, "typically...individuals with a history of strokes, and the elderly."
Dr. Elliott M. Antman, a professor of medicine at Harvard Medical School and colleagues, "randomly chose 13,608 patients at 707 sites in 30 countries," who were given "prasugrel (60 milligrams as a one-time 'loading' dose, followed by a 10-milligram maintenance dose) or Plavix (300 milligrams initially, followed by a daily 75-milligram maintenance dose) for up to 15 months following angioplasty and stenting to open blocked arteries."
During the study, "[o]nly 9.9 percent of participants taking prasugrel died from cardiovascular causes, compared with 12.1 percent of patients taking Plavix, a 19 percent reduction."
Additionally, "Prasugrel was...associated with a lower incidence of stent thrombosis, revascularization and heart attack." However, "the incidence of major bleeding was significantly higher with prasugrel -- 2.4 percent vs. 1.8 percent of patients on Plavix."
Patients like those who experienced bleeding problems during the trial would make up roughly "20 percent of the total population." Dr. Antman pointed out, "For the remaining 80 percent of the patients, which I would say represented eight of 10 patients undergoing stenting, the drug works very well."
Furthermore, among diabetics, who are considered a group at high risk of bleeding complications, "there was no excess bleeding, and a 30 percent reduction in [myocardial infarctions] compared with" Plavix. Roughly "99 percent of patients had percutaneous interventions at the time of [trial] randomization, 94 percent of them with at least one coronary stent, and 47 percent with a drug-eluting stent."
"Several leading cardiologists said they believe the results are strong enough for Lilly to gain...[FDA] approval to market the drug, in part because the overall benefit in the study favored prasugrel over Plavix, the current standard of care." Prasurgel "is intended to treat patients on the verge of a heart attack, and it marks" Eli Lilly's first attempt "to break into the blockbuster heart-drug arena."
Some physicians are optimistic about the drug's future," with many saying that "on balance, the new drug comes out ahead, and offers great promise as a more potent alternative to Plavix, which costs $4 a day and does not work for some patients." Dr. Steven Nissen, of the Cleveland Clinic, who is also "a frequent government adviser," added, "I'm encouraged by the results," and expects that "prasugrel should win Food and Drug Administration approval because it so dramatically cuts non-fatal heart attacks."
"Doctors can sort out who might benefit most from prasugrel, such as diabetics, and who might face too much bleeding risk to use it, like the elderly, people who previously had strokes and those with kidney problems."
"Blood clots have become a major concern among patients given drug-coated stents, because the coating seems to promote clot formation. Some doctors now recommend those patients take Plavix indefinitely." Should prasugrel gain FDA approval, physicians could prescribe it as frequently as Plavix, if not more often.
"An experimental anticlotting drug from Eli Lilly reduced heart attacks in patients with heart disease by 24 percent compared with Plavix (clopidogrel bisulfate), the current standard treatment," according to study results to be published in the Nov. 15 issue of the New England Journal of Medicine. However, the new treatment, prasugrel, "also increased the risk of severe bleeding compared with Plavix, and quadrupled the risk of fatal bleeding, though the risk was still relatively small."
Plavix and prasugrel "work in the same way, by preventing platelets in the blood from forming clots. But prasugrel is more potent," study results indicate.If the FDA approves the drug, it could be on the market by the end of 2008."
"A three-year study into the new medication found that patients already at a high risk of bleeding could be harmed by taking" it. In addition, the drug's bleeding risk could be fatal in some trial participants, "typically...individuals with a history of strokes, and the elderly."
Dr. Elliott M. Antman, a professor of medicine at Harvard Medical School and colleagues, "randomly chose 13,608 patients at 707 sites in 30 countries," who were given "prasugrel (60 milligrams as a one-time 'loading' dose, followed by a 10-milligram maintenance dose) or Plavix (300 milligrams initially, followed by a daily 75-milligram maintenance dose) for up to 15 months following angioplasty and stenting to open blocked arteries."
During the study, "[o]nly 9.9 percent of participants taking prasugrel died from cardiovascular causes, compared with 12.1 percent of patients taking Plavix, a 19 percent reduction."
Additionally, "Prasugrel was...associated with a lower incidence of stent thrombosis, revascularization and heart attack." However, "the incidence of major bleeding was significantly higher with prasugrel -- 2.4 percent vs. 1.8 percent of patients on Plavix."
Patients like those who experienced bleeding problems during the trial would make up roughly "20 percent of the total population." Dr. Antman pointed out, "For the remaining 80 percent of the patients, which I would say represented eight of 10 patients undergoing stenting, the drug works very well."
Furthermore, among diabetics, who are considered a group at high risk of bleeding complications, "there was no excess bleeding, and a 30 percent reduction in [myocardial infarctions] compared with" Plavix. Roughly "99 percent of patients had percutaneous interventions at the time of [trial] randomization, 94 percent of them with at least one coronary stent, and 47 percent with a drug-eluting stent."
"Several leading cardiologists said they believe the results are strong enough for Lilly to gain...[FDA] approval to market the drug, in part because the overall benefit in the study favored prasugrel over Plavix, the current standard of care." Prasurgel "is intended to treat patients on the verge of a heart attack, and it marks" Eli Lilly's first attempt "to break into the blockbuster heart-drug arena."
Some physicians are optimistic about the drug's future," with many saying that "on balance, the new drug comes out ahead, and offers great promise as a more potent alternative to Plavix, which costs $4 a day and does not work for some patients." Dr. Steven Nissen, of the Cleveland Clinic, who is also "a frequent government adviser," added, "I'm encouraged by the results," and expects that "prasugrel should win Food and Drug Administration approval because it so dramatically cuts non-fatal heart attacks."
"Doctors can sort out who might benefit most from prasugrel, such as diabetics, and who might face too much bleeding risk to use it, like the elderly, people who previously had strokes and those with kidney problems."
"Blood clots have become a major concern among patients given drug-coated stents, because the coating seems to promote clot formation. Some doctors now recommend those patients take Plavix indefinitely." Should prasugrel gain FDA approval, physicians could prescribe it as frequently as Plavix, if not more often.
Whole-Grain to Lower Heart Failure Risk
Eating whole-grain breakfast cereals may be associated with a lower risk of heart failure for men
Men who consume a higher amount of whole-grain breakfast cereals may have a reduced risk of heart failure, according to a report in the Oct. 22 issue of Archives of Internal Medicine.
Archives of Internal Medicine is one of the Journal of the American Medical Association (JAMA)/Archives journals.
Men who consume a higher amount of whole-grain breakfast cereals may have a reduced risk of heart failure, according to a report in the Oct. 22 issue of Archives of Internal Medicine.
Archives of Internal Medicine is one of the Journal of the American Medical Association (JAMA)/Archives journals.
Free CME resource at click of a mouse
AMA's new online CME portal offers programs for primary care physicians
Primary care physicians now have a free continuing medical education (CME) resource available online at the click of a mouse.
The AMA recently launched AMAprimarycare.org—a portal that offers Web-based CME programs in several therapeutic areas that can be completed at your own convenience. It includes a broad range of certified educational programs on three clinical topics: depression, Parkinson's disease and type 2 diabetes. These programs were developed with independent education grants from Eli Lilly, Teva Neuroscience, and Takeda Pharmaceuticals, respectively.
Each tract provides practical, evidence-based information to stimulate physician learning on the diagnosis, management and treatment of these illnesses and strategies to help improve patient outcomes.
The programs include video webcasts with clinical exchanges between primary care physicians and key medical specialty leaders, and slide presentations with audiocasts developed under the direction of expert advisory boards specific to each therapeutic area.
The AMA will continue to add new programs relevant to primary care physicians. Make sure to bookmark the Web site and check back for new programs.
Primary care physicians now have a free continuing medical education (CME) resource available online at the click of a mouse.
The AMA recently launched AMAprimarycare.org—a portal that offers Web-based CME programs in several therapeutic areas that can be completed at your own convenience. It includes a broad range of certified educational programs on three clinical topics: depression, Parkinson's disease and type 2 diabetes. These programs were developed with independent education grants from Eli Lilly, Teva Neuroscience, and Takeda Pharmaceuticals, respectively.
Each tract provides practical, evidence-based information to stimulate physician learning on the diagnosis, management and treatment of these illnesses and strategies to help improve patient outcomes.
The programs include video webcasts with clinical exchanges between primary care physicians and key medical specialty leaders, and slide presentations with audiocasts developed under the direction of expert advisory boards specific to each therapeutic area.
The AMA will continue to add new programs relevant to primary care physicians. Make sure to bookmark the Web site and check back for new programs.
Educate pts with U Tube
Use YouTube videos to educate patients
Armed with data showing that 71 percent of U.S. adults have used the Web to research health information, Medem has announced a new service that enables doctors to embed YouTube-hosted videos into their iHealth practice Web sites.
The videos can be used to educate patients, explain treatment plans or procedures and introduce their practices to new patients.
More than 70,000 U.S. physicians currently have iHealth practice Web sites, including many members of the AMA. Founded by the AMA and several national medical specialty societies, Medem offers a suite of Web-based services to engage patients in better managing their health
Armed with data showing that 71 percent of U.S. adults have used the Web to research health information, Medem has announced a new service that enables doctors to embed YouTube-hosted videos into their iHealth practice Web sites.
The videos can be used to educate patients, explain treatment plans or procedures and introduce their practices to new patients.
More than 70,000 U.S. physicians currently have iHealth practice Web sites, including many members of the AMA. Founded by the AMA and several national medical specialty societies, Medem offers a suite of Web-based services to engage patients in better managing their health
Stress:
One-Third Live With Extreme Stress
One-third of Americans are living with extreme stress and nearly half of Americans (48 percent) believe that their stress has increased over the past five years, according to a survey released by the American Psychological Association. The national survey also found that stress is taking a toll on people — contributing to health problems, poor relationships and lost productivity at work. Money and work are the leading causes of stress for 75 percent of Americans, a dramatic increase over the 59 percent reporting the same sources of stress in 2006. Fifty-one percent of Americans blame "the housing crisis" as a leading cause of st! ress, citing high rent or mortgage costs as sources of this stress.
Twenty-eight percent of Americans said they are managing their stress extremely well. But 77 percent of those polled reported physical symptoms, while 73 percent said they suffered psychological symptoms related to stress in the last month. Physical symptoms of stress include:
fatigue (51 percent);
headache (44 percent);
upset stomach (34 percent);
muscle tension (30 percent);
change in appetite (23 percent),
teeth grinding (17 percent);
change in sex drive (15 percent); and
feeling dizzy (13 percent).
Psychological symptoms of stress include:
experiencing irritability or anger (50 percent);
feeling nervous (45 percent);
lack of energy (45 percent); and
feeling as though you could cry (35 percent).
In addition, almost half (48 percent) of Americans report lying awake at night due to stress.
Four in 10 Americans (43 percent) said they overeat or eat unhealthy foods to manage stress, while one-third (36 percent) skipped a meal in the last month because of stress. Those who drink (39 percent) or smoke cigarettes (19 percent) were also more likely to engage in these unhealthy behaviors during periods of high stress. Significant numbers of Americans report watching television for more than two hours a day (43 percent) and playing video games or surfing the Internet (39 percent).
Healthy behaviors used to manage stress included:
listening to music (54 percent);
reading (52 percent);
exercising or walking (50 percent);
spending time with family and friends (40 percent); and
praying (34 percent).
Richard Swenson, MD:
"Stress is such a common term that we might tend to trivialize it, assuming it’s a convenient fiction for the weak who do not wish to do their best. Such an attitude would be a mistake. Stress is real, it is increasing and it can be highly pathogenic.
While a life of no-stress is fatal and a life of low-stress is boring, a life of hyperstress is toxic to health, relationships and faith. God has created us enormously adaptable. Once we exceed our limits, however, the adaptability mechanism breaks down. Dysfunction results. The modern stress epidemic is not a single-point source problem, meaning we need to be vigilant in many directions.
What to do? Own the problem; keep it objective; do self-diagnostics (everybody’s different); be intentional (passivity doesn’t work); apply therapeutics (among hundreds to choose from) and let God be God. Also, stress reduction is often as importan! t as stress management."
One-third of Americans are living with extreme stress and nearly half of Americans (48 percent) believe that their stress has increased over the past five years, according to a survey released by the American Psychological Association. The national survey also found that stress is taking a toll on people — contributing to health problems, poor relationships and lost productivity at work. Money and work are the leading causes of stress for 75 percent of Americans, a dramatic increase over the 59 percent reporting the same sources of stress in 2006. Fifty-one percent of Americans blame "the housing crisis" as a leading cause of st! ress, citing high rent or mortgage costs as sources of this stress.
Twenty-eight percent of Americans said they are managing their stress extremely well. But 77 percent of those polled reported physical symptoms, while 73 percent said they suffered psychological symptoms related to stress in the last month. Physical symptoms of stress include:
fatigue (51 percent);
headache (44 percent);
upset stomach (34 percent);
muscle tension (30 percent);
change in appetite (23 percent),
teeth grinding (17 percent);
change in sex drive (15 percent); and
feeling dizzy (13 percent).
Psychological symptoms of stress include:
experiencing irritability or anger (50 percent);
feeling nervous (45 percent);
lack of energy (45 percent); and
feeling as though you could cry (35 percent).
In addition, almost half (48 percent) of Americans report lying awake at night due to stress.
Four in 10 Americans (43 percent) said they overeat or eat unhealthy foods to manage stress, while one-third (36 percent) skipped a meal in the last month because of stress. Those who drink (39 percent) or smoke cigarettes (19 percent) were also more likely to engage in these unhealthy behaviors during periods of high stress. Significant numbers of Americans report watching television for more than two hours a day (43 percent) and playing video games or surfing the Internet (39 percent).
Healthy behaviors used to manage stress included:
listening to music (54 percent);
reading (52 percent);
exercising or walking (50 percent);
spending time with family and friends (40 percent); and
praying (34 percent).
Richard Swenson, MD:
"Stress is such a common term that we might tend to trivialize it, assuming it’s a convenient fiction for the weak who do not wish to do their best. Such an attitude would be a mistake. Stress is real, it is increasing and it can be highly pathogenic.
While a life of no-stress is fatal and a life of low-stress is boring, a life of hyperstress is toxic to health, relationships and faith. God has created us enormously adaptable. Once we exceed our limits, however, the adaptability mechanism breaks down. Dysfunction results. The modern stress epidemic is not a single-point source problem, meaning we need to be vigilant in many directions.
What to do? Own the problem; keep it objective; do self-diagnostics (everybody’s different); be intentional (passivity doesn’t work); apply therapeutics (among hundreds to choose from) and let God be God. Also, stress reduction is often as importan! t as stress management."
Older Docs: what are they doing?
Older Docs Phasing Out Their Practice
48% of physicians between 50 and 65 years of age are planning to reduce or end their clinical practice in the next 1 to 3 years. The findings also suggest that many older physicians believe that their younger counterparts do not have the work ethic they do. The survey, which was conducted by Merritt Hawkins & Associates, a Texas-based physician search and consulting firm, suggests that many older physicians are simply unhappy with the changes that have taken place in medicine over the years.
"When Baby Boom doctors entered medicine they had control over how they practiced and the fee they charged. But the ! rules changed on them in mid-stream and now many are looking for a ticket out," Mark Smith, executive vice president of Merritt Hawkins & Associates, said in a statement.
For those physicians not leaving clinical practice, many said they would make changes to reduce the amount of patients they treat. For instance, 12 percent said they would begin working part-time, 8 percent said they planned to stop taking new patients or markedly reduce their patient load, and 4 percent expressed a desire to work on a temporary basis. When asked about the work ethic of physicians entering practice today, 68 percent of the respondents said that these younger doctors are not as dedicated or as hard working as physicians who entered practice 20 to 30 years ago.
Fifty-seven percent of older physicians said they would not recommend medicine as a career to their own children. Similarly, 44 percent said they would not select medicine as career if they were starting out today. "The most ominous finding is that about one half of physicians surveyed plan to either abandon patient care in the next 1 to 3 years, or significantly reduce the number of patients they see," Smith said. "The U.S. already is facing a widespread shortage of physicians. Should older, 'workhorse' physicians choose to opt out of patient care, access to medical services will be further restricted."
Director of CMDA Campus & Community Ministries Al Weir, MD:
"Most doctors work very long hours under time urgent, life and death decision-making pressure. So, it is not a surprise that many of them wish to reduce those pressures after 20-30 years of practice. At CMDA we are seeing the same phenomena, but we find that many Christian doctors choose this time in their lives to redirect their efforts such that their lives are more focused on God’s kingdom.
We have now developed and are running an 18 month distant learning course called Completing Your Call, to help doctors in such a position find God’s will for the next season of their lives.
Rather than retiring, these doctors are looking at 'restructuring' their lives toward ministry in areas such as: healthcare for the poor, overseas missions, more deliberate mentoring of younger Christian doctors, developing CMDA ministry within their home city, speaking out on vital rights of conscience and ethical! issues, continuing practice in a more Christ honoring way and living with a greater focus on the relationships within their own families. The 50-65 year range is a time for change for many doctors.
If you are at that point in your life and wish to change in a way that will glorify Christ, please contact us. We would love to walk with you down such a road."
48% of physicians between 50 and 65 years of age are planning to reduce or end their clinical practice in the next 1 to 3 years. The findings also suggest that many older physicians believe that their younger counterparts do not have the work ethic they do. The survey, which was conducted by Merritt Hawkins & Associates, a Texas-based physician search and consulting firm, suggests that many older physicians are simply unhappy with the changes that have taken place in medicine over the years.
"When Baby Boom doctors entered medicine they had control over how they practiced and the fee they charged. But the ! rules changed on them in mid-stream and now many are looking for a ticket out," Mark Smith, executive vice president of Merritt Hawkins & Associates, said in a statement.
For those physicians not leaving clinical practice, many said they would make changes to reduce the amount of patients they treat. For instance, 12 percent said they would begin working part-time, 8 percent said they planned to stop taking new patients or markedly reduce their patient load, and 4 percent expressed a desire to work on a temporary basis. When asked about the work ethic of physicians entering practice today, 68 percent of the respondents said that these younger doctors are not as dedicated or as hard working as physicians who entered practice 20 to 30 years ago.
Fifty-seven percent of older physicians said they would not recommend medicine as a career to their own children. Similarly, 44 percent said they would not select medicine as career if they were starting out today. "The most ominous finding is that about one half of physicians surveyed plan to either abandon patient care in the next 1 to 3 years, or significantly reduce the number of patients they see," Smith said. "The U.S. already is facing a widespread shortage of physicians. Should older, 'workhorse' physicians choose to opt out of patient care, access to medical services will be further restricted."
Director of CMDA Campus & Community Ministries Al Weir, MD:
"Most doctors work very long hours under time urgent, life and death decision-making pressure. So, it is not a surprise that many of them wish to reduce those pressures after 20-30 years of practice. At CMDA we are seeing the same phenomena, but we find that many Christian doctors choose this time in their lives to redirect their efforts such that their lives are more focused on God’s kingdom.
We have now developed and are running an 18 month distant learning course called Completing Your Call, to help doctors in such a position find God’s will for the next season of their lives.
Rather than retiring, these doctors are looking at 'restructuring' their lives toward ministry in areas such as: healthcare for the poor, overseas missions, more deliberate mentoring of younger Christian doctors, developing CMDA ministry within their home city, speaking out on vital rights of conscience and ethical! issues, continuing practice in a more Christ honoring way and living with a greater focus on the relationships within their own families. The 50-65 year range is a time for change for many doctors.
If you are at that point in your life and wish to change in a way that will glorify Christ, please contact us. We would love to walk with you down such a road."
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