Tuesday, March 30, 2010

Broken Femur Despite Fosamax


Q. I have been on Fosamax for approximately eight years and have NEVER been told it should not be taken so long. I am 62 years old and have always worked out to stay healthy and strong.

I fell last year and broke my femur, close to the hip! This concerns me, since I had hoped the osteoporosis medicine would prevent broken bones and I fear that it has contributed instead.

I also have a friend who is 55 and ended up with a broken jaw after a dental procedure. She broke her tibia this winter and also has been taking Fosamax. Please share this information.

A. We're sorry to learn of your traumatic experience. Drugs like Actonel, Boniva and Fosamax increase bone density, but long-term use may alter the quality of bone.

At a recent meeting of the American Academy of Orthopaedic Surgeons, researchers presented data suggesting that after four or five years of treatment some bone may lose structural integrity and become brittle. The FDA is reviewing data to determine whether these drugs contribute to atypical femur fractures.

We are sending you our Guide to Osteoporosis so that you and your doctor can discuss other options for building bone strength.

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Sunday, March 28, 2010

New drug for menstrual cramps shows promise in early clinical trial

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Painful menstrual cramps could be treated more effectively by a new drug now in clinical trials. Credit: iStock

"We hope that the drug will provide a more effective treatment option for millions of women worldwide with this painful condition," said Andrzej R. Batt, "Dysmenorrhea not only diminishes the quality of life for millions of women, but also has a hidden, society-wide economic cost that involves an enormous number of days lost from work and school. Batt is with Vantia Ltd, a pharmaceutical company in the United Kingdom, which is developing and testing the drug.

Batt pointed out that dysmenorrhea affects between 45 and 90 percent of women of child-bearing age, In addition to pain in the abdomen and back, symptoms may include nausea, vomiting, sweating, and dizziness. Existing treatments for the condition include pain-relievers, anti-inflammatory drugs, and that stop menstruation. However,these treatments are ineffective in almost one-third of women with moderate to severe cases. Some of them relieve only the symptoms, rather than targeting the underlying cause of dysmenorrhea, and may have unwanted side effects such as mood alteration and stomach upsets.

Menstrual cramps are caused by contractions of the uterus during menstruation. In dysmenorrhea, the uterus contracts with increased frequency, causing unusually severe, cramping pain. The cause, scientists believe, is increased blood levels of the hormone , which plays a role in regulating contraction of the uterus. The Vantia scientists reasoned that blocking this hormone might relieve dysmenorrhea..

Their search for such a potential drug involved shifting through hundreds of chemical compounds and led to one with the desired effects. Scientists then re-engineered the compound, known by the code word ,VA111913, to fine-tune its effects. One modification allowed the drug to be administered orally, as a pill, rather than in an injection. They will reveal VA111913's molecular structure for the first time at the ACS meeting.

Batt said that last year VA111913 successfully passed a landmark toward becoming a new drug, when the first stage of clinical trials showed that it was safe for further clinical studies, with no apparent ill-effects. The next phase of clinical trials is currently underway in the U.K. and the U.S. (at sites in Peoria, Ariz.; Austin, Texas; and Salt Lake City) to evaluate how well it works to control pain in a group of women with dysmenorrhea. Investigators expect results to be available later this year. If studies continue to show promise, the drug could be available to patients in four years, the scientists say.

Provided by American Chemical Society

Bacteriophage vs Antibiotic Resistance

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The problem of antibiotic resistance is increasing. Superbugs like MRSA (methicillin-resistant staph aureus) are becoming harder and harder to treat as they evolve resistance to the most powerful antibiotics used against them.

Back before the development of antibiotics, scientists were working on a different way to fight bacterial infections. They enlisted viruses that attack only those particular bacteria. Should we go back to this old bacteriophage technology for the future of fighting infection?

Guests: David Weber, MD, MPH, professor of medicine, pediatrics and epidemiology at the University of North Carolina at Chapel Hill Schools of Medicine and Public Health. He’s also associate chief of staff and medical director of infection control at UNC Health Care.

Elizabeth Kutter, PhD, Professor of Biophysics at the Evergreen State College in Olympia, Washington. She heads the Laboratory of Phage Biology there.

Randall Wolcott, MD, CWS, director of the Southwest Regional Wound Care Center in Lubbock,

Saturday, March 27, 2010

Genetic Testing Improves Coumadin Dosing

The anticoagulant warfarin, also known as Coumadin, is notoriously difficult to use. On the one hand, it saves lives by preventing lethal blood clots. On the other, though, getting the dose right can be tricky. There is a genetic test to help guide doctors in determining the appropriate dose. The question has been whether the results make enough practical difference to justify the cost of $250 to $400. Mayo Clinic scientists tested nearly 900 patients. They were compared to almost 2,700 patients who were not tested. In the course of six months, 18 percent of the tested patients had drug complications, compared to 26 percent of the untested controls. The savings in hospitalization costs more than made up for the cost of the initial genetic testing.

[ Meeting of the American College of Cardiology, March, 2010

New Warnings on Eczema Drugs


Eczema or atopic dermatitis is an allergic skin condition characterized by itching, dryness and redness. Mild cases are frequently treated with moisturizers or topical corticosteroids. Stubborn cases of eczema are sometimes treated with powerful topical immune suppressing drugs such as Elidel and Protopic. The oral forms of these medications are used to dampen the immune system and prevent organ rejection in transplant patients. Initially, these drugs were thought to be relatively safe when applied to the skin. But the FDA has received increasing numbers of reports linking Elidel and Protopic to serious infection and even cancer in children. Although there are precautions about such problems in the official prescribing information, the FDA is considering beefing up the warnings. In the meantime, parents need to discuss the pros and cons of both Elidel and Protopic before treating their children's eczema.

Wednesday, March 24, 2010

The Art of Choosing by Sheena S. Iyengar

A Mac store customer asks for the latest iPhone in black, but he sees everyone else buying black and suddenly changes his preference to white. When a resident of a former Communist country is offered a fizzy drink from a wide selection, he picks at random; soda is soda, he says. Though the child knows she shouldn't press the big red button (absolutely not!), she finds her hand inching forward. A young man and woman decide to marry-knowing that the first time they meet will be on their wedding day.

How did these people make their choices? How do any of us make ours? We use choice as a powerful tool to define ourselves and mold our lives, but what do we know about the wants, motivations, biases, and influences that aid or hinder our endeavors?

In The Art of Choosing, Columbia University professor Sheena Iyengar, a leading expert on choice, sets herself the Herculean task of helping us become more effective choosers. She asks fascinating questions: Is the desire for choice innate or created by culture? Why do we sometimes choose against our best interests? How much control do we really have over what we choose? Ultimately, she offers unexpected and profound answers drawn from her award-winning, discipline-spanning research.

Here, you'll learn about the complex relationship between choice and freedom, and why one doesn't always go with the other. You'll see that too much choice can overwhelm us, leading to unpleasant experiences, from ''TIVO guilt'' over unwatched TV programs to confusion about health insurance plans. Perhaps most important, you'll discover how our choices-both mundane and momentous-are shaped by many different forces, visible and invisible. This remarkable book illuminates the joys and challenges of choosing, showing us how we build our lives, one choice at a time.

THE ART OF CHOOSING is published by Twelve, an imprint of Hachette Book Group USA. Its release date is March 1, 2010.

Monday, March 22, 2010

Drug Treatments May Boomerang


Boomerang: n.

1. (Australian) a curved piece of wood; when properly thrown will return to thrower.

2. A miscalculation that recoils on its maker.

This definition from Webster's Online Dictionary describes the unanticipated consequences of certain medications.

When doctors prescribe a drug to solve a problem, they don't expect it to make things worse. But sometimes prescriptions boomerang.

For decades doctors prescribed hormone replacement therapy to menopausal women as a way of preventing heart attacks. It was a cruel revelation to learn that HRT actually led to heart attacks and strokes.

Heart rhythm disturbances can be frightening and dangerous. In the 1980s doctors prescribed drugs like Tambocor (flecainide) and Enkaid (encainide) to control serious arrhythmias. But in 1989 a large study of these drugs determined they were causing sudden cardiac death, the very outcome they were supposed to prevent.

The most recent example of the boomerang drug effect is with osteoporosis medications such as Actonel, Boniva and Fosamax. These all belong to a class of drugs called bisphosphonates. They are supposed to strengthen bones, but some doctors report that long-term use of these drugs may actually pose a risk of certain unusual fractures.

To understand how these drugs work, remember that bone is constantly being broken down by some cells and built back by others. In healthy bone, these processes balance out. In osteoporosis, bone breakdown gets way ahead of bone rebuilding, resulting in weakened bones. The bisphosphonates slow down the cells that destroy bone tissue and thus allow the bone-building cells to catch up.

Questions have been raised, however, about the quality of the bone that is rebuilt. An article in the New England Journal of Medicine (March 20, 2008) described more than a dozen cases of unusual broken thigh bones associated with long-term use of Fosamax (alendronate).

Since then, other investigators have also noticed cases of such atypical femur fractures. The most recent reports were presented at the 2010 meeting of the American Academy of Orthopaedic Surgeons. One study found that although bisphosphonate treatment strengthened bone at first, after four or five years the bone had less structural integrity and might become brittle.

No one knows yet the actual risk of these unusual fractures. The FDA is reviewing information about this possible link. So far, it has not established that the drugs are responsible for the breaks. The agency urges patients to report hip or thigh pain to the physician and not to stop such medications on their own.

This isn't the only controversy the FDA is wrestling with. Asthma drugs are supposed to open airways and reduce the risk of serious complications. Yet data on certain asthma medications, including Foradil (formoterol) and Serevent (salmeterol), suggest that they may actually increase the risk of severe asthma attacks and even death (New England Journal of Medicine, online Feb. 24, 2010).

Such boomerang effects leave patients and doctors as puzzled as the FDA. For safety's sake, we need better information about the long-term risks of medications and more discussion of alternatives for treatmen

#762 Women and Sex



Many women are less than satisfied with their sex lives. But how can they improve the situation?

Research about female sexuality is surprisingly scarce, but both biological and psychological factors can play an important role in women's sexual satisfaction. Some women may be upset about a lack of libido, while others may be quite disturbed that their partners don't share their level of desire. Medications, including common ones such as antidepressants or birth control pills, can affect sexual interest and performance.

Guests: Jennifer Berman, MD, is a urologist and co-founder of the Female Sexual Medicine Center at the University of California, Los Angeles (UCLA). Her books, co-authored with Laura Berman, PhD, are For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life, and Secrets of the Sexually Satisfied Woman: Ten Keys to Unlocking Ultimate Pleasure.

Anita Clayton, MD, is David C. Wilson Professor of Psychiatry and Professor of Clinical Obstetrics and Gynecology at the University of Virginia in Charlottesville, VA. She is consulting editor for the Journal of Sexual Medicine and for the Journal of Sex & Marital Therapy. Her book is Satisfaction: Women, Sex, and the Quest for Intimacy. Dr. Clayton consults for several pharmaceutical firms and receives grants from BioSante, Boehringer-Ingelheim, Brain Resource Limited, Pfizer, Inc. and Repligen Corporation http://www.peoplespharmacy.com/2010/03/20/762-women-and-sex/

Wednesday, March 17, 2010

Do Bald Men Have Lower Risk of Prostate Cancer?



Men with a receding hairline may have something to cheer about. A study from the University of Washington School of Medicine suggests that men who experience a bald spot and significant thinning by the age of 30 may be less likely to develop prostate cancer. The investigators studied 2,000 men between the ages of 40 and 47. Half of the men had already been diagnosed with prostate cancer. But those who reported early baldness were 30 to 45 percent less likely to have prostate tumors. Because this research runs counter to previous findings, some scientists are puzzled and skeptical. The new study is likely to spur further research on this fascinating observation.

[Cancer Epidemiology, online Feb. 22, 2010]

Erectile Dysfunction Signals Risk of Heart Disease

Erectile dysfunction should be considered an important risk factor for complications from heart disease. A study of more than 1,500 men with heart disease found that those who reported erection difficulties were twice as likely as the others to suffer a heart attack in the next two years. They were also twice as likely to die. The investigators suggest that atherosclerosis clogging the arteries may show up earlier in the smaller arteries of the penis than in larger arteries supplying the heart. They strongly recommend that men being treated for ED should be referred for cardiology work-ups that could help save their lives.

[Circulation: Journal of the American Heart Association, March 15, 2010]

Was the Flu Fracas a Flop?

In Aesop's fable about the shepherd boy, the youngster yelled wolf just to amuse himself and have the villagers come running. After he did this a couple of times when there was no wolf, they got fed up with him. When the wolf really appeared and started eating his sheep, nobody came to his rescue.

This fall the media cried flu. People freaked out about the possibility of the H1N1 influenza pandemic killing millions around the world.

It's hardly any wonder. Some experts compared swine flu to the Spanish flu of 1918 and 1919. During that pandemic, 50 to 100 million people died, more than were killed during World War I.

The media stoked fears with graphic images of young people dying. The vaccine was slow to arrive and people lined up for hours to get immunized. Churches canceled communion and some people started wearing face masks to work.

Was all this fuss an overreaction? By this time of year, flu is usually at its peak. In a normal season, schools are reporting widespread absences and hospitals are swamped with sick people in February and March.

This year, though, the pandemic petered out. It peaked in October and now doctor visits for flu are way below normal. Unless there is a sudden resurgence, this is likely to go down in health history as the flu that fizzled.

Seasonal flu (non H1N1) has been surprisingly scarce this winter. Although the weather was awful and people were cooped up inside more than usual, there was an amazing lack of ordinary influenza circulating.

Public health authorities advised people on how to avoid spreading the flu: wash your hands, cover your mouth when you cough and get a flu shot. Although there were 155 million doses of swine flu vaccine available, fewer than 90 million people were vaccinated. We still don't know how effective the vaccine will prove to be.

Even in a normal year, however, serious questions have been raised about the effectiveness of flu shots. This is especially true for the elderly, who are presumably the most vulnerable. A recent analysis concluded that: "the 'effectiveness' of the vaccine is in great part due to the selection of healthier individuals for vaccination, rather than due to true effectiveness of the vaccine" (Journal of Infectious Diseases, Jan. 15, 2010).

Even healthy younger people don't have fewer sick days, shorter hospital stays or fewer deaths from influenza if they get vaccinated (British Medical Journal, Oct. 28, 2006).

Questions also persist about the benefits of flu shots for babies and toddlers under two. Although they are more vulnerable to influenza complications, the data suggest that most flu vaccines are not terribly effective for these young ones (Cochrane Database Systematic Reviews, April 16, 2008).

Public health officials are faced with a difficult task. They need to warn people when there is a true threat so they can take action. But they also need to be careful not to cry wolf.

If the public becomes too accustomed to scary stories about flu pandemics that don't pan out, it might let down its guard. Were a truly dangerous flu virus to emerge, people might not follow the precautions needed to protect themselves

Monday, March 15, 2010

Health News Update

Diet has a powerful impact on health. A new study of 34,000 Chinese women in Singapore found that diet can offer significant protection from breast cancer. What should you be eating?

Herbs are popular for treating minor ailments, but many physicians worry about herb-drug interactions. A recent review in the Journal of the American College of Cardiology suggests that many herbs are dangerous with cardiovascular medicines. A prominent herbal expert disagrees.

Cardiac catheterization provides an image of the coronary arteries and can show if they are blocked. A surprising number of these tests show no blocked arteries at all. How can we cut down on unnecessary cost and the risk?

Guests: Mark Blumenthal is Founder and Executive Director of the American Botanical Council. He discusses an article that was published in the Journal of the American College of Cardiology, Feb. 9, 2010. The photo is of Mark Blumenthal.

Manesh Patel, MD, is a cardiologist and assistant professor of medicine at Duke University School of Medicine. His article appeared in the New England Journal of Medicine, March 11, 2010.

To listen to the program please follow the link:

http://www.peoplespharmacy.com/2010/03/13/761-health-news-update/

Sunday, March 14, 2010

Seaweed extract may hold promise for non-Hodgkin's lymphoma treatment

Seaweed extract may eventually emerge as a lymphoma treatment, according to laboratory research presented at the second AACR Dead Sea International Conference on Advances in Cancer Research: From the Laboratory to the Clinic, held here March 7-10, 2010.

Lymphoma is a cancer of the immune system and is classified into Hodgkin's and non-Hodgkin's types, which are then further classified into B-cell and T-cell groups.

"Some forms of B-cell lymphoma are especially resistant to standard treatment and thus new therapies are needed," said Mohammad Irhimeh, Ph.D., assistant professor of hematoncology and at the Hashemite University in Jordan. "In this study, we looked at a new treatment strategy using novel active compounds derived from a natural source ¬¬— seaweed."

Seaweeds containing fucoidan, a sulfated polysaccharide similar to in chemical structure, have been reported to have anti-tumor activity in mice and some cell lines.

For the current study, Irhimeh and colleagues at the University of California, Berkeley, and Royal Hobart Hospital in Australia treated lymphoma cell lines with a commercially available seaweed extract.

They found that the extract had an on the growth of lymphoma cell lines, while leaving the control healthy cells intact. The researchers also noted a significant pattern of activity in the genes known to be linked with , or cell death, in .

Irhimeh said they would continue to study the mechanism of action for these biological effects and had a goal of conducting phase II or III clinical trials

How Bacteria, Viruses and other Pathogens shaped the World History

These are video clips of an upcoming mini series called The BioHistory Files. David Eagleman talks about how biology has affected the course of human history.

Family history is strong predictor of obstructive coronary artery disease

March 14, 2010

In the largest study of its kind to date using cardiac computed tomography angiography, people with a family history of early signs of coronary artery disease are at higher risk of developing obstructive coronary artery disease and plaque in their arteries, Henry Ford Hospital researchers say.

Researchers analyzed the data from more than 8,200 patients who underwent cardiac computed tomography angiography and found that those with a family history of disease, or CAD, have a 28 percent chance of developing the disease themselves than those with no family history. Family history of CAD also was independently associated with an increased prevalence of plaque in the arteries.

The study is presented at the Sunday at the 59th annual American College of Cardiology Scientific Sessions in Atlanta.

"This is the first study to show that family history of premature coronary artery disease is a significant predictor of obstructive coronary artery disease using coronary computed tomography," says Mouaz Al-Mallah, M.D., director of Research at Henry Ford and lead author of the study.

While family history is a well-known risk factor for premature coronary artery disease, Henry Ford researchers examined whether family history was linked to obstructive coronary artery disease in patients who underwent cardiac computed tomography angiography, a tool that looks at the coronary arteries and evaluates the amount of blockage from plaque. For the study researchers analyzed data of patients using the Advanced Cardiovascular Imaging Consortium, which is funded by Blue Cross Blue Shield of Michigan.

"Based on past research and our findings, we believe cardiac computed tomography angiography would likely identify a high risk group of patients with advanced plaque buildup," Dr. Al-Mallah says.

Premature coronary artery disease occurs in people 45 and under. As a person ages, the coronary arteries are more likely to narrow and harden, leading to obstructive coronary artery disease, the leading cause of death in the United States for men and women. Every year, more than 500,000 Americans die from .

Friday, March 12, 2010

Mind & Brain / Human Evolution


One sign that this skill truly is innate: Children enter the world with a head for numbers. Veronique Izard, a cognitive psychologist at Harvard University, demonstrated this in a recent study of newborns. She and her colleagues played cooing sounds to babies, with varying numbers of sounds in each trial. The babies were then shown a set of shapes on a computer screen, and the scientists measured how long the babies gazed at it. (The length of time a baby spends looking at an object reflects its interest.) Newborns consistently looked longer at the screen when the number of shapes matched the number of sounds they had just heard. For example, a baby who heard “tuuu, tuuu, tuuu, tuuu” would look the longest at four shapes, less at eight, and still less at twelve. Izard’s study suggests that newborns already have a basic understanding of numbers. Moreover, their concept of numbers is abstract; they can transfer it across the senses from sounds to pictures.

Mathematical intuition develops as we grow up, but probing its growth is tricky because older children draw on both their innate skills and the ones they learn. So scientists have come up with ways to force people to rely on intuition alone. Cantlon, working with Elizabeth Brannon of Duke University, ran an experiment in which adult subjects see a set of dots on a computer screen for about half a second, followed by a second set. After a pause, the participants see two sets of dots side by side. They then have a little more than a second to pick the set that is the sum of the previous two pictures.

People do fairly well on these tests, which summons up a weird feeling in them: They know they are right, but they don’t know how they got the answer. Even in toddlers who cannot yet count, these studies reveal, the brain automatically processes numbers. From infancy to old age, mathematical intuition consistently follows two rules. One is that people score better when the numbers are small than when they are large. The other is that people score better when the ratio of the bigger number to the smaller one is greater. In other words, people are more likely to correctly tell 2 from 4 than they are to tell 6 from 8, even though both pairs of numbers differ by two. As we get older, our intuition becomes more precise. Other experiments have shown that a six-month-old baby can reliably distinguish between numbers that differ by as little as a factor of two (like 4 and 8). By nine months the ratio has dropped to 1.5 (8 and 12, for example). And by adulthood the ratio is just 10 to 15 percent. The fact that the same two rules always hold true suggests that we use the same mental algorithm throughout our lives.

Brain scans using magnetic resonance imaging (MRI) and positron emission tomography (PET) are shedding some light on how our brains carry out that algorithm. Neuroscientists have found that when people do mathematical intuition problems, a strip of neurons near the top of the brain, surrounding a fold called the intraparietal sulcus, consistently becomes active. And when we confront more difficult problems—when the numbers are bigger or closer together—this region becomes more active.

Psychologists suspect that the mathematical intuition that these neurons help produce lays the foundation for all of our more sophisticated kinds of math. Justin Halberda of Johns Hopkins University and his colleagues recently carried out a telling study of mathematical intuition in a group of 14-year-olds. Some of the children demonstrated a more accurate intuition than others. Halberda then looked at the subjects’ scores on standardized school tests. Students who had a sharper mathematical intuition scored better on math tests from kindergarten onward.

The fact that children possess a mathematical intuition long before they even start school implies that our evolutionary ancestors had it too. Indeed, recent research indicates that our forebears possessed such an intuition long before they could walk upright. Scientists have found that many primates, including rhesus monkeys, can solve some of the same mathematical problems we can. Since monkeys and humans diverged 30 million years ago, mathematical intuition presumably is at least that old.

Providing evidence of that shared heritage, Cantlon and Brannon were able to teach monkeys to do addition by intuition the same way people do. The animals’ intuition is about as good as ours, and it follows the same rules. As the ratio between numbers gets larger, the monkeys are increasingly likely to pick the right one. And when monkeys use their mathematical intuition, they rely on the same region of the brain around the intraparietal sulcus that we do.

Monkeys can even learn written numbers, a skill children develop only around age 5. In order to make the link between a 2 and a pair of objects, children use a region of the brain located underneath the temple called the dorsolateral prefrontal cortex. This region is like a blacksmith shop for forging associations between signs and concepts. Once the association has been formed, children recognize written numbers quickly, and the dorsolateral prefrontal cortex becomes quiet.

Monkeys can learn, with enough training, to pick out a 4 if they see four dots on a screen. Andreas Nieder, a physiologist at the University of Tübingen, and his colleagues have discovered that, like children, the monkeys use their dorsolateral prefrontal cortex to make those associations. They have even found individual neurons in the region that fire strongly at both the number 4 and four dots.

But does a monkey actually understand what a written 4 signifies? To find out, Nieder and his former student Ilka Diester trained monkeys for a new experiment. The monkeys learned to press a lever, after which they saw one number followed by another. If the numbers matched, the monkeys could release the lever to get a squirt of juice. If the numbers didn’t match, the monkeys had to keep the lever pressed down until a new number appeared, which was always a match.

The monkeys were able to learn to release the lever for matching numbers and to keep it down for numbers that did not match. If they had succeeded simply by matching shapes, you would expect them to sometimes confuse similar-looking numbers: They might choose 1 as a match with 4 because both are made of straight lines, for example. But Diester and Nieder found that the monkeys got confused in a different way. The monkeys were most likely to mix up numbers that were numerically close to each other: the sticklike 1 and the curvaceous 2, for example. What’s more, the monkeys took more time to release the lever if larger numbers matched than if smaller ones did—another sign that the animals were responding to quantity, not shape.

Once our ancestors linked their natural instinct for numbers with an ability to understand symbols, everything changed. Math became a language of ideas and measurements.

To neuroscientists, these studies raise a deep question. If monkeys have such solid foundations for numbers, why can’t they per­form high-level mathematics? Finding an answer may help us understand what makes humans so much better with numbers than other animals. Nieder and Cantlon have both speculated that the difference lies in our ability to understand symbols, which enables us to transform our approximate intuition of numbers into a precise understanding. When we say “2,” we mean an exact quantity, not “probably 2 but maybe 1 or 3.” We can then learn rules for handling exact numbers quickly. And then we can generalize those rules from one number to the next, thus understanding general mathematical principles. Other primates, lacking our symbolic brains, take thousands of trials to learn a new rule.

The recent studies of monkeys and infants cast a new light on the old notched bones. The earliest recorded numbers coin­cide with the first appearance of many other expressions of abstract thought, from bone flutes to carvings of zaftig female figures. Before then, humans may have thought about numbers the way monkeys (and babies) still do today. But once our ancestors began to link their natural instinct for numbers with a new ability to understand symbols, everything changed. Math became a language of ideas, of measurements, and of engineering possibilities. The rest—the skyscrapers and supermarkets and weddings—were just a matter of derivation.


Vitamin D Protects Against Colorectal Cancer



Another European study suggests that the higher your levels of vitamin D the lower your risk of developing colorectal cancer. The EPIC study, which stands for European Prospective Investigation into Cancer, enlisted over 500,000 adults from 10 countries. None of the subjects had cancer at the start of the study. Vitamin D levels were measured at that time.

After several years 1248 people had come down with colorectal cancer. The investigators matched

them to 1248 EPIC participants who were not diagnosed with cancer and compared the vitamin D levels. Those with the highest levels of this hormone were 40 percent less likely to have developed colorectal cancer

How Safe Is Bleaching Cream?



People who spend a lot of time out in the sun frequently develop age spots as they grow older. Some people find these brown liver spots are unsightly and want to get rid of them. Products like Porcelana or Esoterica contain hydroquinonone. This over the counter bleaching cream gradually lightens brown spots on the skin. It has been available for decades in the US, but has been banned in Europe and Japan because of links to cancer in animal tests. Now the FDA has asked the National Toxicology Program to review the safety of hydroquinone to see if it might pose a hazard from skin exposure. It will be years, however, before there is a definitive answer. In the meantime, people concerned about brown spots should stay out of the sun or use an effective sunscreen.


Vitamin D Activates T Cells

Vitamin D has been garnering attention from medical scientists for many functions besides promoting strong bones. A recent study shows why it is crucial for the function of the immune system. Danish researchers have found that killer T cells, a critical part of the immune response, use a vitamin D receptor to activate the cell. Without adequate vitamin D, the killer T cell will not become activated and will be unable to fight off germs. The body makes vitamin D when skin is exposed to sunlight, but epidemiologists estimate that approximately half the population is low in vitamin D because too little time is spent outside. The investigators believe that a better understanding of the role of this vitamin in the immune system will help develop vaccines and ways to counteract autoimmune diseases and transplant rejection

Michael Jackson's Drug May Not Deserve Bad Rap

Before Michael Jackson's tragic death, most people never heard of the drug propofol (Diprivan). It's not the kind of medication that anyone would ever seek out on the street. You can't use it to get high. In fact, you can't use it on yourself at all.

This injectable medicine is used to induce anesthesia. It takes effect very quickly, within 30 seconds to a minute, and wears off quickly as well. As a result, it is often used for diagnostic procedures such as colonoscopies as well as in the operating room when people are having a gall bladder or an appendix removed.

Anesthesiologists love proprofol because when used correctly it is one of the safest drugs used during surgery, safer, in fact, than Versed (midazolam). Versed is a Valium-like sedative that is often used along with a narcotic pain reliever such as Demerol for colonoscopies and similar procedures.

Unfortunately for Michael Jackson, news reports indicated that he received an astonishing cocktail of sedatives before he died. They included diazepam (Valium), lorazepam (Ativan) and midazolam (Versed). Some of these may have been given more than once. Later, cardiologist Conrad Murray administered propofol intravenously to knock Jackson out.

With so many different central nervous system depressants circulating in his body, it is little wonder that Michael Jackson stopped breathing. All these drugs can work together to slow or stop respiration.

In an operating room, the anesthesiologist would be carefully monitoring patient breathing and oxygen saturation. If respiration became too slow, counter measures are taken immediately to prevent complications.

The moral of this story is not that propofol is dangerous. The drug remains extremely useful in the proper setting. Anyone who thinks this happens only to celebrities is sadly mistaken. Dr. Murray and his patient both exercised poor judgment, but drug interactions are commonplace in medicine.

Each year thousands of people die because they receive prescriptions for incompatible medications. Something as seemingly simple as ibuprofen purchased over the counter for a bad backache could lead to a life-threatening bleeding ulcer when taken with the blood thinner warfarin (Coumadin).

There are so many deadly combinations that it is difficult to keep track of them all. Someone taking the drug methotrexate for psoriasis or rheumatoid arthritis might be prescribed the antibiotic co-trimoxazole (Bactrim, Septra) for a urinary tract infection. The antibiotic makes methotrexate much more toxic and can result in serious blood changes that can be fatal.

Readers who would like to know more about the dangers of mixing and matching common medications may wish to consult our book, Dangerous Drug Interactions. It is available from libraries, local booksellers or online at www.peoplespharmacy.com.

To avoid becoming a sad statistic, make sure your pharmacist and your physician always double check everything you take for possible interactions. Even herbs and dietary supplements can produce unexpected and hazardous reactions with certain prescribed medications

Thursday, March 11, 2010

Are Heart Stents Used Too Often?


Stents are back in the news because of Bill Clinton's cardiac "event." Although the former president did not suffer a heart attack, discomfort and pressure in his chest prompted him to seek medical care.

He'd undergone quadruple bypass surgery in 2004, and the doctors who checked him over this time around found that one of those arteries had become completely blocked. That's why they inserted a stent, a little wire mesh tube that is designed to hold an artery open.

Cardiologists are in agreement that stents can be extremely helpful if someone has severe heart disease like President Clinton. Stents can also preserve heart tissue and save lives if someone is having a heart attack.

What is not so obvious is the value of stents in many other situations. A study published in the New England Journal of Medicine (April 12, 2007) rattled the cardiology community to its core. Cardiologists are still arguing about the results.

The study, called COURAGE (for Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation), pitted stents against drug therapy and lifestyle intervention. The 2,287 patients had stable coronary artery disease. That is, they had chest pain, but it was not of sudden onset or particularly worrisome.

Half of these patients were given stents together with drugs and lifestyle modification, while the other half got only the drugs with diet and exercise coaching. After five years, there were no statistical differences between the two groups with regard to deaths, heart attacks or strokes. There was, presumably, a big difference in price since each stent placement costs approximately $15,000.

The results astonished many cardiologists. The drugs used in the study cost far less than a stent and produced comparable benefit, although somewhat more slowly.

Experts expected the use of stents to drop dramatically after the COURAGE findings were published. It did for a while. But stent placement is now back to historic highs--nearly one million annually. If cardiologists followed the COURAGE guidelines, trying medical therapy first for patients with stable chest pain, they would put in one-third fewer stents. This could save an estimated $5 billion each year.

Some critics point out that stents have changed since the COURAGE trial was completed. Even the more modern drug-coated stents come with problems, however. Although they are less likely than bare metal stents to become clogged, they can lead to blood clots and heart attacks unless a patient continues taking an anticlotting drug like Plavix. A month's prescription can cost over $160.

Plavix (clopidogrel) is not without side effects of its own. Serious bleeding is a constant worry. Digestive upset is fairly common, but the acid suppressing drug Prilosec (omeprazole) may reduce the effectiveness of Plavix. Other side effects may include headaches, skin reactions and blood disorders.

Stents save lives. But if a person is not having a life-threatening cardiac event, it may make sense to discuss medical management with a cardiologist first. COURAGE showed that for many people drug treatment together with diet and exercise can be as effective as a stent at a fraction of the cost.

Get Serious About High Blood Pressure!

Hypertension is boring. Although roughly one in three adults has high blood pressure, most people don't get very excited about it.

But they should. A new report from the prestigious Institute of Medicine (IOM) says that hypertension is one of the nation's leading causes of death. This organization of the country's leading health experts is tasked with making unbiased policy recommendations to improve the health of Americans.

The problem is that doctors and patients don't take elevated blood pressure seriously enough. Many doctors don't tell their patients that their blood pressure is too high and may not coach them on lifestyle changes that can lower blood pressure.

Doctors tell people to lose weight, exercise more and cut back on salt. But these general recommendations don't actually help many people implement such a program.

That's why many physicians rely on medication as their first line of defense. Drugs such as diuretics (like HCTZ/hydrochlorothiazide), beta blockers (including atenolol and metoprolol) and ACE inhibitors (such as lisinopril) are prescribed frequently.

These drugs can help lower blood pressure, but they have potential complications. Diuretics may deplete the body of minerals such as potassium and magnesium. Low levels of these electrolytes can upset heart rhythms. Diuretics can also raise blood sugar levels.

Beta blockers such as atenolol are controversial for treating hypertension. Experts have determined that such drugs should rarely be used as first-line therapy (Annals of Pharmacotherapy, Dec. 2009).

This older type of beta blocker may raise cholesterol and also make blood sugar harder to control (Current Medical Research and Opinion, March, 2010). Some data even suggest that atenolol is linked to an increased risk of stroke. Nevertheless, more than 40 million prescriptions were filled for atenolol last year.

ACE inhibitors like benazepril, enalapril, lisinopril and ramipril are unquestionably effective for controlling hypertension. If patients don't experience side effects, these medications are extremely beneficial. But a significant number of people develop a chronic cough while taking an ACE inhibitor. Such drugs may also cause dizziness or headache.

It should come as no surprise that patients are interested in natural approaches to blood pressure control. If physicians knew how effective diet and exercise could be, they might be more encouraging.

A recent study demonstrated dramatic results from combining the DASH diet (Dietary Approaches to Stop Hypertension) with weight management and exercise (Archives of Internal Medicine, Jan. 25, 2010). Reducing systolic blood pressure by 16 points was better than one would expect from most drugs.

Monday, March 8, 2010

Natural Cholesterol Control

Millions of people rely on statin-type drugs to control their cholesterol and lower their risk of heart disease. Medicines like Crestor, Lipitor and simvastatin are effective, but they have some drawbacks. Diet and supplements can make a difference, but what is the science behind the natural approach?

Guests: Christopher Gardner, PhD, is Director of Nutrition Studies at the Stanford Prevention Research Center and Associate Professor of Medicine at Stanford University Medical School.

David Becker, MD, is a clinical cardiologist at Chestnut Hill Hospital and Abington Memorial Hospital and is affiliated with the University of Pennsylvania Health Systems. There is more information about his prevention program online at www.healthychangeofheart.com please follow the link and listen to the program;

http://www.peoplespharmacy.com/2010/03/06/760-natural-cholesterol-control/

Sunday, March 7, 2010

NEUROSCIENCE AND LAW


Neuroscientist Dr David Eagleman considers some emerging questions relating to law and neuroscience, challenging long-held assumptions in criminality and punishment and predicting a radical new fu
ture for the legal system.

America on Deadline

America on Deadline

Published: December 2, 2009

EVERYONE knows the power of deadlines — and we all hate them. But their effectiveness is undeniable. People procrastinate. Deadlines help. They speed up performance and, paradoxically, reduce the anxiety of uncertainty. So when President Obama announced on Tuesday night a strict timetable of 18 months before the drawdown of troops from Afghanistan — how did that affect the psychology of the nation?

The emotional effect of the pronouncement depends on the party involved. For the military brass, 18 months is a blink of an eye, so the deadline could motivate them to perform at their peak, or it might paralyze them with fear; for the troops and their loved ones, 18 months is an eternity. But for all those with an immediate stake in the war, a clear timetable reduces uncertainty — at least along the “when” dimension, if not the “what” dimension.

After all, no one likes to wait. And the only thing worse than waiting is waiting with uncertainty. A team at Emory University examined what happened when people waited for an impending electrical shock. Some people dreaded the shock so deeply that they chose to receive a more powerful shock earlier rather than wait for a lesser shock to arrive at a later, random time.

One of the key jobs of the human brain is to simulate the future, and the less information it has to work with, the more anxious it becomes. Pinning things down in time makes waiting less troubling. With a clear idea about the order and timescale of events, people are more patient and less anxious. And that is the hope implicit in President Obama’s declaration of a timeline.

But what about those people with a less immediate stake in the war? Here the president’s task becomes more complicated. Some years ago, psychologists posed a deceptively simple question: if I were to offer you $100 right now, or $110 a week from now, which would you choose? Most subjects chose to take $100 right then. It didn’t seem worthwhile to wait an entire week for only $10 more.

And the further an event lies in the future, the less people care about it. So if offered $100 now or $500 18 months from now, many people still take the $100. The consequence is that there’s little difference between President Obama promising 18 months from now versus 18 years from now. In the human ken, both are obscured in the mists of the distant future.

So for his timetable to have emotional power, President Obama would do well to define and adhere to intermediate goals. A year and a half offers little in the way of reassurance, but everyone can value action month-by-month.

I don’t want to imply that people care only about the short term — after all, people do build college saving funds and retirement plans. It’s simply that the present holds more sway than the future. Recently, researchers used brain imaging to monitor people making money-now-or-more-later decisions, and they discovered that the neural networks involved in short- and long-term decision-making are fundamentally separate. In situations of choice, the two systems are often locked in battle against one another.

Subprime mortgage offers are perfectly optimized to take advantage of the “I want it now” system, as are chocolate cookies, temptations for marital infidelity and all manner of things that people choose now and regret later.

People manage the influence of the short-term systems by proactively binding their future options. We see this when a person in good health signs an advance medical directive to pull the plug in the event of a coma, when an alcoholic rids the house of drink to avoid future temptation, or when a person socks money into a Christmas account to keep himself from spending it before December.

Such deals with oneself are what philosophers call Ulysses contracts, after the hero who decided in advance to lash himself to a mast to resist the sirens’ song. The present, calm Ulysses was negotiating with his future, more emotional self.

In the same way, by drawing a line on the calendar, President Obama hopes to favor his administration’s long-term strategy over the unknown siren songs that will be heard over the next year and a half. Nations, like people, are continually buffeted in the winds of short-term events. In deference to a long-term strategy, the president hopes to bind the nation to the mast to ensure we stick to the plan.

David Eagleman is a professor of neuroscience at the Baylor College of Medicine and the author of the novel “Sum.”

Stressed out! The powerful biology of stress

A little tension keeps us on our toes - we're biologically primed for it. But 'toxic' stress makes us physically sick, and powerful research is now revealing its potent impact on our developing bodies rful research is now revealing its potenimpact on our developing bodies and brains. Don't miss two world leaders transforming our understanding. Please follow the links;
http://www.abc.net.au/rn/allinthemind/

Wednesday, March 3, 2010

Controversy over Diabetes Drug

The diabetes drug Avandia continues to be controversial. Charges have been leveled that this medication increases the risk of heart failure and heart attacks. A Senate investigation has criticized both the manufacturer and the FDA in its handling of the Avandia issue. The agency is planning to convene an advisory panel meeting to help it decide how to proceed. In the meantime, some FDA staffers have estimated that as many as 500 heart attacks each month may be linked to Avandia. The company maintains that its diabetes drug does not cause heart attacks. Until the issue is resolved, patients with diabetes should discuss this treatment with their physicians. Other diabetes drugs may be less likely to cause cardiac complications

Home Test for Sperm Count



When couples have trouble getting pregnant, the workup often begins with the woman. Many men are somewhat sensitive about sperm counts. But now a new test has been developed that will allow men to check their sperm count at home. It looks a lot like home pregnancy tests that women use and is expected to cost about $25. Although the device will soon be sold in Europe, it has not yet been approved by the FDA.

The scientists who developed the test found it was 96 percent accurate in a trial of 225 semen samples. It works by measuring an antigen called SP-10 which is associated with sperm cells. The amount of the protein indicates the number of sperm in the sample. The test takes about half an hour to complete.

[Human Reproduction, online February 5, 2010]

Electronic Prescribing Cuts Errors

Doctors are renowned for their illegible hand writing. When pharmacists cannot easily decipher a hand-scrawled prescription, errors can result. A new study suggests that electronic prescribing can cut the number of errors dramatically. Researchers studied prescriptions written by providers in 12 community practices in New York State. In these practices, 15 providers wrote prescriptions by hand while another 15 wrote prescriptions electronically. E-prescribing reduced the number of errors by a factor of 7. At the end of the study year, the percent of prescribing errors committed by those using pen and paper had actually risen slightly. Perhaps handwritten prescriptions will soon become obsolete.

[Journal of General Internal Medicine, online Feb. 26, 2010]


Low-Dose Aspirin May Not Prevent Initial Heart Attack


A new study suggests that low-dose aspirin may not protect the heart as well as expected. Comparing blood pressure between the ankle and the arm provides a marker for the risk of future cardiovascular complications. A randomized controlled trial was carried out in Scotland on more than 3,000 men and women over 50. These people had been selected from more than 29,000 adults because they were healthy but at high risk. There was no significant difference in heart attacks, other vascular problems or death between those who took 100 mg of aspirin daily and those who took placebo. The patients were followed for an average of 8 years. Although this study throws doubt on aspirin's value for preventing heart attacks, patients who have been told to take this drug should discuss it with their doctors and not stop it on their own.

[JAMA, March 3, 2010]