Postmenopausal women taking antidepressants may be at higher risk for stroke, death

Moral of the story: Postmenopausal women on antidepressants are 45% more likely than those not on such medication to have a stroke, and 32% more likely to die of any cause.

AMA Morning Rounds 12/15/09

Postmenopausal women taking antidepressants may be at higher risk for stroke, death.

The Los Angeles Times (12/14, Healy) "Booster Shots" blog reported that, according to a study published in the Archives of Internal Medicine, "postmenopausal women taking antidepressants are at higher risk of suffering a stroke or of dying of any cause than are those who do not take such medications." Investigators "followed 136,293 post-menopausal women, age 50 to 79, for just under six years," during which time "5,496 developed depression and were treated with antidepressant medication." Researchers found that over the course of "follow-up, the women on antidepressants were 45% more likely than those not on such medication to have a stroke, and 32% more likely to die of any cause."

        HealthDay (12/14, Edelson) reported that while the study found that "women on selective serotonin uptake inhibitors," such as "Celexa [citalopram], Paxil [paroxetine], Prozac [fluoxetine], and Zoloft [sertraline]," as well as "tricyclic antidepressants," had an increased risk for stroke and death, "the overall risk for any one woman remained very small."

High coffee, tea intake may reduce chances of developing type 2 diabetes

Moral of the story: Drinking coffee and tea reduces chances of developing type II (late onset) diabetes

Source: AMA Morning Rounds 12/15/09;  Arch Intern Med. 2009;169(22):2053-2063.

High coffee, tea intake may reduce chances of developing type 2 diabetes.

Bloomberg News (12/15, Gibson) reports that, according to a study published in the Archives of Internal Medicine, "drinking four cups of coffee, decaf, or tea daily can reduce the chances of getting type 2 diabetes by about 25 percent to 35 percent." Harvard University "researchers reviewed 18 studies of almost 500,000 people" and discovered that "for each cup of coffee people drank, their likelihood of getting diabetes dropped by seven percent."

        "Even better results were found for bigger coffee and tea consumers -- drinking three to four cups a day was associated with about a 25% reduced diabetes risk, compared with those who drank between none and two cups day," the Los Angeles Times (12/15, Stein) reports. In addition, investigators found "positive results with decaf coffee and tea." Specifically, those "who drank more than three to four cups of decaf a day had about a one-third lower risk than those who didn't drink any," while "tea drinkers who consumed more than three to four cups a day had about a one-fifth lower diabetes risk than non-tea drinkers."

        HealthDay (12/14, Gordon) and MedPage Today (12/14, Fiore) also covered the story.

Coffee, Decaffeinated Coffee, and Tea Consumption in Relation to Incident Type 2 Diabetes Mellitus
A Systematic Review With Meta-analysis
Rachel Huxley, DPhil; Crystal Man Ying Lee, PhD; Federica Barzi, PhD; Leif Timmermeister; Sebastien Czernichow, MD, PhD; Vlado Perkovic, MD, PhD; Diederick E. Grobbee, MD, PhD; David Batty, PhD; Mark Woodward, PhD



Background  Coffee consumption has been reported to be inversely associated with risk of type 2 diabetes mellitus. Similar associations have also been reported for decaffeinated coffee and tea. We report herein the findings of meta-analyses for the association between coffee, decaffeinated coffee, and tea consumption with risk of diabetes.
Methods  Relevant studies were identified through search engines using a combined text word and MeSH (Medical Subject Headings) search strategy. Prospective studies that reported an estimate of the association between coffee, decaffeinated coffee, or tea with incident diabetes between 1966 and July 2009.
Results  Data from 18 studies with information on 457 922 participants reported on the association between coffee consumption and diabetes. Six (N = 225 516) and 7 studies (N = 286 701) also reported estimates of the association between decaffeinated coffee and tea with diabetes, respectively. We found an inverse log-linear relationship between coffee consumption and subsequent risk of diabetes such that every additional cup of coffee consumed in a day was associated with a 7% reduction in the excess risk of diabetes relative risk, 0.93 [95% confidence interval, 0.91-0.95]) after adjustment for potential confounders.
Conclusions  Owing to the presence of small-study bias, our results may represent an overestimate of the true magnitude of the association. Similar significant and inverse associations were observed with decaffeinated coffee and tea and risk of incident diabetes. High intakes of coffee, decaffeinated coffee, and tea are associated with reduced risk of diabetes. The putative protective effects of these beverages warrant further investigation in randomized trials.

Author Affiliations: The George Institute for International Health, The University of Sydney, Sydney, Australia (Drs Huxley, Lee, Barzi, Czernichow, Perkovic, Batty, and Woodward and Mr Timmermeister); Department of Public Health, Avicenne Hospital, University of Paris 13, Paris, France (Dr Czernichow); The Julius Center for Health Sciences and Primary Care, Utrecht University Medical Center, Utrecht, the Netherlands (Dr Grobbee); Medical Research Council Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland (Dr Batty); and Mount Sinai School of Medicine, New York, New York (Dr Woodward).

Radiation overexposure from CT scans may be more widespread than previously estimated

Moral of the story: Again, watch out for those CT settings.

Source: AMA Morning Rounds 12/15/09

Radiation overexposure from CT scans may be more widespread than previously estimated.

The CBS Evening News (12/14, story 3, 2:20, Lapook) reported, "The problem of too much radiation during CT scans may be more widespread than anyone thought." In fact, "new research...found a wide variation in radiation dose for the most common CT scan like abdomen, pelvis, and chest. A survey of four hospitals found some patients received 13 times more radiation than others for the same type of scan."

        NBC Nightly News (12/14, story 8, 2:10, Bazell) reported, "Depending on the part of the body being scanned, each CT exposes a patient to an amount of radiation equal to between 30 and 440 chest X-rays." But, in a separate study, "researchers calculated that 72 million CT scans are performed in this country a year and concluded that could lead to 29,000 excess cancers and 15,000 excess deaths a year in the future."

        In that study, published in the Archives of Internal Medicine, researchers at the National Cancer Institute "found that people may be exposed to up to four times as much radiation as estimated by earlier studies," USA Today (12/15, Szabo) reports.

        Meanwhile, the second study, appearing in the same journal, of over 1,000 patients at four hospitals, showed that one woman out of 270 and one man out of 600 would suffer from cancer after undergoing a single heart scan at age 40, the Wall Street Journal (12/15, A3, Wang) reports. Researchers noted that the differences in radiation doses may be due to a lack of standardized settings and disparities in technology use.

        The Los Angeles Times (12/15, Maugh) reports that, in an accompanying editorial, Dr. Rita F. Redberg, editor of the journal, noted that "the articles...make clear that there is far more radiation from medical CT scans than has been recognized previously." Redberg said, "Even many otherwise healthy patients are being subjected to the radiation...because emergency [departments] are often sending patients to the CT scanner before they see a doctor."

        Bloomberg News (12/15, Ostrow) reports that in the National Cancer Institute study, "the authors predicted that lung cancer will be the most common radiation-related cancer followed by colon cancer and leukemia." For its part, the FDA "issued interim regulations Dec. 7 requiring closer monitoring of CT scans after more than 250 cases of exposure to excess radiation were reported since October."

        WebMD (12/14, Doheny), MedPage Today (12/14, Neale), NPR (12/15), Modern Healthcare (12/15, Rhea), HealthDay (12/14, Pallarito), and Reuters (12/15, Steenhuysen) also covered the story.

FDA investigates 300 radiation overdoses from CT scans.

Moral of the story: Just something to be aware of.  The CT might not be set correctly.

Source: AMA Morning Rounds 12/16/09

FDA investigates 300 radiation overdoses from CT scans.

NPR's (12/15, Neighmond) All Things Considered reported, "More than 300 patients may have received an overdose of radiation from a special type of CT scan used to image the brain. The Food and Drug Administration says the radiation overdoses occurred at three hospitals in Los Angeles County and one hospital in Huntsville, AL. FDA officials say there could be many more cases at hospitals nationwide as their investigation unfolds." Dr. Jeffrey Shuren, "acting director of the FDA's Center for Devices and Radiological Health," explained that "a regular CT scan to the brain is the equivalent of about 100 chest X-rays," whereas "a perfusion CT scan of the brain is equal to several hundred chest x-rays. Patients at the four hospitals who received excess radiation were exposed to the equivalent of several thousand X-rays instead -- three to eight times the expected radiation dose."

New, Higher Cancer Risk Estimates for CR Scans

Moral of the story: CT scans are being reevaluated for their cancer risk, which was underestimated in the past based on theoretical values and not actual practice data.

Source: ACP Internist Weekly 12/21/09

New estimates on cancer risk of CT scans

Two new studies warn of the cancer risk posed by CT scans and suggest some risk-reduction strategies.
A retrospective cross-sectional study calculated the radiation doses delivered by computed tomography (CT) scans performed at four different California hospitals. Doses ranged from 2 millisieverts (mSv) for a routine head CT to 31 mSv for a multiphase abdomen and pelvis scan. Many of the scans provided more radiation than is usually assumed to be the case; the median dose for a routine abdomen and pelvis scan was 66% higher than the expected 8 to 10 mSv. Even within each type of study, the effective dose varied significantly within and among the hospitals. There was a mean 13-fold variation between the highest and lowest doses for each procedure.
Extrapolating from these data, researchers calculated cancer risks, such that 1 in 270 women who underwent CT coronary angiography at age 40 would develop cancer from the scan. Risks were lower for men than women, and higher for younger than older patients (20-year-olds faced double the risk, 60-year-olds only half). The study was published in the Dec. 14/28 Archives of Internal Medicine.
Another study in the same issue used risk models to calculate how many cancers could eventually be attributed to CTs based on current scanning rates. Overall, they estimated that 29,000 future cancers could be caused by CT scans performed in the U.S. in 2007. Scans of the abdomen and pelvis contributed the most to the tally, and one-third of the cancers would be due to scans performed on patients between the ages of 35 and 54.
The authors of the studies and an accompanying editorial offered a number of solutions to this problem, including standardized protocols (such as have been applied to mammography), fewer multiple series examinations, dose reduction and registration, and greater use of American College of Radiology accreditation and criteria. The experts also called for a reduction in the number of inappropriate and unnecessary CT scans.

Breast-feeding may benefit a woman's heart.

Moral of the story: Again, another benefit to breast-feeding.

Source: AMA Morning Rounds 12/22/09

Breast-feeding may benefit a woman's heart.

HealthDay (12/21, Gordon) reported that breast-feeding may help protect a woman's heart, according to research scheduled to be published in Obstetrics and Gynecology. Investigators, "in a study of nearly 300 women," employed "two imaging techniques -- electron beam tomography and ultrasound -- to assess the health of the women's blood vessels." The researchers "found that 32 percent of the women who had not breast-fed had coronary artery calcification, compared with 17 percent of the breast-feeding moms."

Antidepressants' effectiveness may vary according to severity of depression.

Moral of the story: Antidepressants may not be useful for all patients with depression.

Source: AMA Morning Rounds 1/6/10

Antidepressants' effectiveness may vary according to severity of depression.

The New York Times (1/6, A12, Carey) reports that "some widely prescribed" medications "for depression provide relief in extreme cases, but are no more effective than placebo pills for most patients," according to a study published Jan. 6 in the Journal of the American Medical Association. After reviewing "data from previous trials on two types of" medicines, paroxetine (Paxil) or imipramine (Tofranil), researchers found that "their effectiveness varies according to the severity of the depression being treated."

        USA Today (1/6, Rubin) explains that University of Pennsylvania researchers "pooled data from six trials in which a total of 718 depressed patients were randomly assigned to take either an antidepressant or a placebo." After obtaining "patient-specific data from scientists involved with each trial," the team found that "antidepressants were more effective than a placebo only for patients with very severe depression, who made up 40% of trial participants but...represent fewer than 30% of depressed people who seek treatment in the real world."

        While "antidepressant medications probably provide little or no benefit to people with mild or moderate depression," the Los Angeles Times (1/6, Roan) reports that the study also suggests that "the mere act of seeing a doctor, discussing symptoms, and learning about depression probably triggers the improvements many patients experience while on medication." Meanwhile, "other research has also found that antidepressants are most effective for severe symptoms, said" Philip Wang, MD, PhD, deputy director of the National Institute of Mental Health. While antidepressants may not "work well for mild to moderate depression, it's also possible that people enrolled in antidepressant studies have robust placebo responses that mask some of the impact of the medication."

        According to the Wall Street Journal (1/6, Dooren), study author Robert DeRubeis, PhD, pointed out that the majority of studies assessing antidepressant medications included patients with severe depression and that such studies were submitted to the Food and Drug Administration for approval of these medicines. In contrast, because far fewer studies have included patients with mild depression, it remains unclear just how effective antidepressants, such as fluoxetine (Prozac) or paroxetine (Paxil), are in this large patient population.

        Meanwhile, Bloomberg News (1/6, Bennett) reports, "doctors, policy makers, and consumers should be made aware that there's little evidence to show antidepressants will benefit the majority of patients with less severe symptoms," the study authors concluded. Forbes (1/6, Langreth), the Columbus (OH) Dispatch (1/6, Crane), and Reuters (1/6, Stern) cover the story, as did HealthDay (1/5, Gardner), WebMD (1/5, Doheny), and MedPage Today (1/5, Gever).

Cutting global warming said to lead to positive health effects.

Moral of the story: Health improves as green house gas emisions fall.

Source: AMA Morning Rounds 12/28/09

Cutting global warming said to lead to positive health effects.

The AP (12/27, Borenstein) reported that research in a special issue of the Lancet suggests that "cutting global warming pollution would not only make the planet healthier, it would make people healthier too." United Nations Secretary General Ban Ki-Moon and the head of the World Health Organization," HHS Secretary Kathleen Sebelius said, "Relying on fossil fuels leads to unhealthy lifestyles, increasing our chances for getting sick and in some cases takes years from our lives. ... As greenhouse gas emissions go down, so do deaths from cardiovascular and respiratory diseases. This is not a small effect." Linda Birnbaum, director of the US National Institute of Environmental Health Sciences, explained that the Lancet studies looked "at the immediate benefits of doing something about the problem" rather than "looking at the health ills caused by future global warming, as past studies have."

Bedside exam may be superior to CT in detecting post-brain surgery complications.

Moral of the story: CT is shown yet again to be less effective than originally thought, but will likely to continue to be gold standard because of litigation and societal desire for technology

Source: AMA Morning Rounds 12/29/09

Bedside exam may be superior to CT in detecting post-brain surgery complications.

HealthDay (12/28, Dotinga) reported that, according to a study appearing online in the Journal of Neurosurgery, "the low-cost, simple, but elegant neurological exam appears to be superior to a routine CT scan in determining return to the operating room" due to "post-brain surgery complications." A review of "the medical records of 251 patients who underwent CT scans within 24 hours of surgery" revealed that "the scans failed to show who would need to go back to the operating room." But, bedside exams showed "serious problems in 10 cases that required urgent CT scans; three of the patients needed to go back to the operating room."

Gingko biloba not effective in preventing cognitive decline, improving memory.

Moral of the story: Ginko is probably not worth buying for your mental health.

Source: AMA Morning Rounds 12/30/09; JAMA. 2009; 302:2663-2670

Gingko biloba not effective in preventing cognitive decline, improving memory.

The CBS Evening News (12/29, story 9, 0:20, Smith) reported, "Americans spend a quarter billion dollars a year on" gingko biloba supplements, "hoping to improve their memory and slow cognitive decline."

        NBC Nightly News (12/29, story 5, 2:00, Williams) reported that "now, a major study shows" that gingko biloba, "one of the most popular supplements, flat out does not work."

        USA Today (12/30, Weise) reports that, according to a study published in the Dec. 23-30 issue of the Journal of the American Medical Association, "the popular botanical...does not improve memory, nor does it prevent cognitive decline in older people." After analyzing data "from the Ginkgo Evaluation of Memory study" on "more than 3,000 people between ages 72 and 96 for seven years," researchers from the University of Virginia Medical School "found that a twice-daily dose of 120 milligrams of ginkgo biloba extract was not effective in reducing the incidence of Alzheimer's dementia or dementia overall."

        According to the Los Angeles Times (12/29, Kaplan) "Booster Shots" blog, the National Center for Complementary and Alternative Medicine, "a branch of the National Institutes of Health, has been researching ginkgo for 10 years to see whether the type of clinical trials required for FDA-regulated pharmaceuticals would reveal any benefit. The new findings are in line with several other studies, including a Cochrane review published this year that found 'no convincing evidence' that the herb preserves mental function in any way."

        The investigators "found no evidence that ginkgo delayed or prevented normal declines in memory, language, attention, visuospatial abilities, or executive functions, such as anticipating outcomes and adapting to changing situations and thinking abstractly," HealthDay (12/29, Reinberg) reported. Moreover, "these results remained the same regardless of sex, age, race or education," the investigators found. However, the supplement was found to be safe, "and no serious side effects were noted," study author Steven T. DeKosky, MD, said.

        WebMD (12/29, DeNoon) reported that "in a written statement," Douglas MacKay, ND, of the Council for Responsible Nutrition, "a group representing the supplement industry," said that "the DeKosky study 'should not be viewed as the final work' on ginkgo." He stated that "as a former practicing licensed naturopathic doctor," he "would continue to recommend ginkgo biloba to older adults as a safe, effective option for supporting cognitive health."

Ginkgo biloba for Preventing Cognitive Decline in Older Adults
A Randomized Trial
Beth E. Snitz, PhD; Ellen S. O’Meara, PhD; Michelle C. Carlson, PhD; Alice M. Arnold, PhD; Diane G. Ives, MPH; Stephen R. Rapp, PhD; Judith Saxton, PhD; Oscar L. Lopez, MD; Leslie O. Dunn, MPH; Kaycee M. Sink, MD; Steven T. DeKosky, MD; for the Ginkgo Evaluation of Memory (GEM) Study Investigators

JAMA. 2009;302(24):2663-2670.
Context  The herbal product Ginkgo biloba is taken frequently with the intention of improving cognitive health in aging. However, evidence from adequately powered clinical trials is lacking regarding its effect on long-term cognitive functioning.
Objective  To determine whether G biloba slows the rates of global or domain-specific cognitive decline in older adults.
Design, Setting, and Participants  The Ginkgo Evaluation of Memory (GEM) study, a randomized, double-blind, placebo-controlled clinical trial of 3069 community-dwelling participants aged 72 to 96 years, conducted in 6 academic medical centers in the United States between 2000 and 2008, with a median follow-up of 6.1 years.
Intervention  Twice-daily dose of 120-mg extract of G biloba (n = 1545) or identical-appearing placebo (n = 1524).
Main Outcome Measures  Rates of change over time in the Modified Mini-Mental State Examination (3MSE), in the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-Cog), and in neuropsychological domains of memory, attention, visual-spatial construction, language, and executive functions, based on sums of z scores of individual tests.
Results  Annual rates of decline in z scores did not differ between G biloba and placebo groups in any domains, including memory (0.043; 95% confidence interval [CI], 0.034-0.051 vs 0.041; 95% CI, 0.032-0.050), attention (0.043; 95% CI, 0.037-0.050 vs 0.048; 95% CI, 0.041-0.054), visuospatial abilities (0.107; 95% CI, 0.097-0.117 vs 0.118; 95% CI, 0.108-0.128), language (0.045; 95% CI, 0.037-0.054 vs 0.041; 95% CI, 0.033-0.048), and executive functions (0.092; 95% CI, 0.086-0.099 vs 0.089; 95% CI, 0.082-0.096). For the 3MSE and ADAS-Cog, rates of change varied by baseline cognitive status (mild cognitive impairment), but there were no differences in rates of change between treatment groups (for 3MSE, P = .71; for ADAS-Cog, P = .97). There was no significant effect modification of treatment on rate of decline by age, sex, race, education, APOE*E4 allele, or baseline mild cognitive impairment (P > .05).
Conclusion  Compared with placebo, the use of G biloba, 120 mg twice daily, did not result in less cognitive decline in older adults with normal cognition or with mild cognitive impairment.
Trial Registration  clinicaltrials.gov Identifier: NCT00010803

Author Affiliations: Departments of Neurology (Drs Snitz, Saxton, Lopez, and DeKosky and Ms Dunn) and Epidemiology (Ms Ives), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics, University of Washington, Seattle (Drs O’Meara and Arnold); Department of Mental Health, Johns Hopkins Medical Institutions, Baltimore, Maryland (Dr Carlson); Departments of Psychiatry and Behavioral Medicine (Dr Rapp) and Internal Medicine (Geriatrics/Gerontology), School of Medicine (Dr Sink), Wake Forest University, Winston-Salem, North Carolina; and School of Medicine, University of Virginia, Charlottesville (Dr DeKosky).

Women urged to seek STD testing within 12 months of first intercourse.

Source: AMA Morning Rounds 12/8/09

Women urged to seek STD testing within 12 months of first intercourse.

The Los Angeles Times (12/7, Roan) "Booster Shots" blog reported, "Young women should be screened for sexually transmitted diseases within a year of first intercourse and should be retested every three to four months if an infection is found, according to a study published...in the Archives of Pediatrics and Adolescent Medicine." Indeed, the "US Preventive Services Task Force and Centers for Disease Control and Prevention have recommendations for STD screening, but those documents are somewhat vaguely worded." The work conducted by researchers at Indiana University, however, "suggests that starting at a young age and conducting regular screening may prevent many health problems," such as pelvic inflammatory disease and ectopic pregnancy, in the years to come.

Diabetes cases projected to nearly double in next 25 years.

Source: AMA Morning Rounds 11/30/09

Diabetes cases projected to nearly double in next 25 years.

The Chicago Tribune (11/27, Shelton) reported that, according to a study published Nov. 27 in the journal Diabetes Care, "diabetes cases will nearly double in the US in the next 25 years and the cost of treating the disease will almost triple." University of Chicago researchers "found the number of people with diagnosed and undiagnosed diabetes will climb from almost 24 million this year to about 44 million in 2034. Over the same period, annual diabetes-related treatment costs are expected to increase from $113 billion to $336 billion in 2007 dollars."

        Bloomberg News (11/27, Waters) reported, "Diabetes prevents people from breaking down sugar in their blood and can lead to complications, including heart disease, kidney disease, vision loss, and amputation of limbs. While some people have an inherited form of the condition, the majority of cases are linked to obesity."

        HealthDay (11/27, Thomas) reported that, besides obesity, another "factor driving the soaring costs" is "the number of people living with diabetes for lengthy periods, the researchers said. Over time, the cost of caring for someone with diabetes tends to rise along with their risk for developing complications, such as end-stage renal disease, which requires dialysis." Notably, "among Medicare beneficiaries, the number with diabetes is expected to rise from 8.2 million to 14.6 million in 2034, with an accompanying rise in spending from $45 billion to $171 billion."

        "As a result, by 2034, half of all direct spending in diabetes care is projected to occur in the Medicare population," WebMD (11/27, Boyles) reported. Still, "although little can be done about the aging of the population, much can be done about the other major risk factor for type 2 diabetes -- obesity." MedPage Today (11/27, Gever) and CNN (11/27, Hellerman) also covered the study.

        Rituximab seen as promising for type 1 diabetes. Bloomberg News (11/26, Doherty) reported that, according to a study in the Nov. 26 issue of the New England Journal of Medicine, the "arthritis and lymphoma medicine Rituxan [rituximab] cut the need for insulin treatment among patients with type 1 diabetes after a year."

        In a phase 2 trial, researchers from Indiana University randomly assigned "87 patients with newly diagnosed type 1 diabetes...to receive rituximab infusions or a placebo at one-week intervals for four weeks," HealthDay (11/25, Gardner) reported. The investigators discovered that "after one year, C-peptide levels -- an indicator of how much insulin is being produced by the body -- were higher in people taking rituximab versus those in the placebo group," with "those in the rituximab group also" needing "less external insulin." In other words, rituximab "helped patients keep producing some of their own insulin."

        WebMD (11/25, DeNoon) noted, however, that "a single course of Rituxan wasn't enough to stop diabetes. After a year, B cells in treated patients increased to 69% of their original values." Nevertheless, "the study does show that a treatment targeting B cells can preserve beta-cell function in early type 1 diabetes."

        MedPage Today (11/25, Gever) reported that Joel Zonszein, MD, of the Albert Einstein College of Medicine, cautioned, "The molecule [rituximab] is not free of side effects, and" that "important long-term side effects are unknown." Dr. Zonszein, who was not involved in the study, agreed, however, that the "study opens a new pathway of exploration."

Pharmacists seen as integral to helping patients manage healthcare.

Moral of the story: Physicians need help from pharmacists, especially considering the high number of drugs people take these days and all the potential interactions that can occur.

Source: AMA Morning News 11/20/09

Pharmacists seen as integral to helping patients manage healthcare.

In a series of articles on pharmacists and their role in managing patients' healthcare, the Los Angeles Times (11/30, Ravn) reports, "Pharmacists now can help patients get the most good from their medications, manage side effects, avoid interactions, even save money." Most states also "have laws requiring pharmacists to give patients specific information," and in California, the law specifies that pharmacists "should give patients directions for how to use and store their medications, making clear that it's important to follow those directions." In addition, "they should warn patients about possible side effects or interactions that occur frequently and may be severe."

        In a separate article, the Los Angeles Times (11/30, Ravn) reports on "a growing subset" of pharmacists called "clinical pharmacists," who "provide direct care, using their expertise to ensure that patients receive the most appropriate medications and that they take them properly. These professionals often spend time with patients that physicians can't." Evidence also "shows that when clinical pharmacists collaborate with physicians, they improve health outcomes. And with their extensive knowledge of available drugs, pharmacists can help to save money by using the most cost-effective ones."

        The Los Angeles Times (11/30, Ravn) also reports on "medication therapy management" and how "it's crucial to ensure that none of the patient's medications are duplicating each other, or canceling each other out, or interacting in a problematic, even dangerous way." In medication therapy management, "the pharmacist can work with a patient's physician (or physicians) to develop a comprehensive program of drug therapy -- perhaps eliminating or adding or switching medications," which can help save "the patient money and, more important," improve "the patient's health."

        The Los Angeles Times (11/30, Ravn) also includes an article detailing "a list of questions" patients "should pose before taking your medications home." The Los Angeles Times (11/30, Ravn) also runs a story on "five of the most-prescribed drugs and their possible risks, side effects, and possible interactions."

Many medical students sustain needle-stick injuries, data indicate.

Moral of the story: Reporting needs to be made simpler, faster.

Source: AMA Morning Rounds 11/30/09

Many medical students sustain needle-stick injuries, data indicate.

The Los Angeles Times (11/25) "Booster Shots" blog reported that, according to research appearing in the Dec. issue of the journal Academic Medicine, "medical students often come in too-close contact with needles, possibly putting them at risk for contracting HIV or hepatitis C." The survey of "699 surgeons-in-training at 17 general surgery residency programs," showed that "almost 60 percent said they sustained a needle-stick injury as a medical student, with many suffering two injuries."

        Those "who had been stuck in medical school" also "had a 2.51-fold increased risk of needle-stick injury involving a high-risk patient -- one with a history of intravenous drug use or infection with HIV, HBV, or HCV," MedPage Today (11/27, Fiore) reported. But, data indicated that 47 percent of respondents who "sustained their most recent needle-stick injury during medical school" failed to "report their injury to an employee health office." Researchers found that "the most common reason for not doing so was the amount of time involved in making a report."

Study shows no link between increased cell phone use, brain cancer incidence.

Moral of the story: No proven connection between cell phone use and brain cancer, although it wouldn't hurt to be careful.

Source: AMA Morning Rounds 12/4/09

Study shows no link between increased cell phone use, brain cancer incidence.

NBC Nightly News (12/3, story 9, 0:20, Williams) reported, "There's been speculation for years that there's been a link between" cell phones and brain cancer, but "the results of a very large, very long study of just about everybody in Scandinavia found no link."

        USA Today (12/4, Szabo) reports that, according to the study, published in the Journal of the National Cancer Institute, researchers found "no link between rising cell phone use and rates of brain cancer." The finding is "consistent with most other studies," but Melissa Bondy, of MD Anderson Cancer Center, noted that "even if the study had found an increase in brain tumor rates," cell phones may not be "to blame," because "lots of other trends" can "help explain changes in disease rates."

        The Los Angeles Times (12/3, Roan) "Booster Shots" blog reported that "the study is important, because it mirrors the international Interphone case-control studies which have shown no overall increase in glioma or meningioma rates." The authors of the current study pointed out, however, that "the Interphone studies...'leave open the possibility of a small to moderate increased risk for glioma among the heaviest users of mobile phones.'"

        Their own analysis of "data on 60,000 people diagnosed with glioma and meningioma in Denmark, Finland, Norway, and Sweden" revealed that "the incidence of brain tumors...were stable, decreased, or gradually increased, starting before cell phones became popular," HealthDay (12/3, Reinberg) reported. They also found "no change in incidence of brain tumors...during a period of rapid increase in cell phone usage."

        The researchers argued that "if cell phones were a significant cause of brain tumors after five to 10 years of usage," the "incidence rates should show an acceleration in brain tumors relative to earlier trends," MedPage Today (12/3, Gever) reported. They speculated that "increased brain cancer rates may simply reflect an increase in diagnoses from new imaging technologies."

        WebMD (12/3, Hendrick) reported that the authors mentioned other "reasons for their finding," including that "the induction period relating cell phone use to brain tumors exceeds five to 10 years," or that "the increased risk is restricted to subgroups of brain tumors or cell phone users." Reuters (12/3, Fox) also covered the story.

Lack of diabetes knowledge in USA

Moral of the story: go online and look it up if you don't know anything about it. It can kill you.

Source: AMA Morning Rounds 11/3/09

Useful Information:
Your Doctor!
http://www.diabetes.org/
http://diabetes.webmd.com/
http://www.nlm.nih.gov/medlineplus/diabetes.html

Survey suggests many Americans may lack basic knowledge about diabetes.

HealthDay (11/2, Gordon) reported that, according to a survey by the American Diabetes Association, "many Americans lack basic knowledge about" diabetes, a disease "responsible for more deaths each year in the" US "than breast cancer and AIDS combined." The ADA survey "included 2,081 men and women from across the" US, "285 of" whom "been diagnosed with diabetes," finding that one common myth "is that sugar and overeating cause diabetes." However, type 1 diabetes is "an autoimmune disease in which the body mistakenly attacks the islet cells in the pancreas, destroying the body's ability to produce insulin," and "genetics and other unknown factors -- not just diet -- can be contributors" to type 2 diabetes.

BPA

Moral of the story: BPA is found in more products than originally believed, and there is mounting pressure to do something about it. If you know a product has BPA in it, especially if it is for kids, and there are alternatives, use them. Research is starting on this and the FDA may get involved, so stay tuned for an update. BPA = Bad

Source: AMA Morning Rounds

Variety of foods found to contain dangerous levels of BPA.

The Los Angeles Times (11/3, Zajac) reports that a survey released Monday by the consumer advocacy group Consumers Union "has found measurable levels of the chemical additive bisphenol A (BPA) across a range of foods, including some that were labeled 'BPA free.'" According to the analysis, "children eating multiple servings of some of the tested food could get doses of BPA 'near levels that have caused adverse effects in several animal studies.'" In a letter to FDA Commissioner Margaret Hamburg, the group said that the findings "bolster the case for banning BPA from use in materials that come in contact with food and beverages." Although the FDA "had no immediate comment," a spokesman "noted that a review of existing evidence about BPA's health effects was nearly completed and that Hamburg would 'make a decision how to proceed' by the end of the month."

Kristof warns of BPA dangers.

In his column in the New York Times (11/8, WK10), Nicholas Kristof noted a recent report by Consumer Reports in which they "tested an array of brand-name canned foods...and found BPA in almost all of them." He asks, "Should we be alarmed? The chemical industry doesn't think so." But "more than 200...studies have shown links between low doses of BPA and adverse health effects." Recently the Endocrine Society "warned...that these kinds of abnormalities may be a consequence of the rise of endocrine-disrupting chemicals, and it specifically called on regulators to re-evaluate BPA." And now the FDA -- which "has generally been asleep at the wheel -- is studying the issue again. Bills are also pending in Congress to ban BPA from food and beverage containers." On BPA, Kristof decided, "While the evidence isn't conclusive, it justifies precautions."

NIH grants $30 million to BPA research.

USA Today (10/29, Szabo) reports, "The National Institutes of Health will devote $30 million to study the safety of bisphenol A, or BPA, an estrogen-like chemical used in many plastics." Robin Mackar, spokeswoman for the National Institute of Environmental Health Sciences (NIEHS), said that "almost half of that money comes from the economic stimulus bill." Previously, animal studies linked "BPA with infertility, weight gain, behavioral changes, early onset puberty, prostate and breast cancer and diabetes. New research will focus on low-dose exposures to BPA and effects on behavior, obesity, diabetes, reproductive disorders, asthma, cardiovascular diseases and various cancers." NIEHS director Linda Burnbaum said, "We know that many people are concerned about bisphenol A and we want to support the best science we can to provide the answers."

Moral of the story: The WHO and others are looking at how the different strategies will affect the health of the public. Overall, it is likely to improve health (and drive down health care costs).

Source: WHO, http://www.who.int/globalchange/news/2009/greenhouse_25112009/en/index.html

25 November 2009
London and Washington D.C.

Public health impact of strategies to reduce greenhouse gas emissions

Different mitigation strategies are likely to have different implications for health. For example, how much would a move to low carbon sources of power improve public health by reducing air pollution? What could be the health benefits of encouraging people to cycle and walk rather than take the car? Could improved biomass cook stoves in developing countries have impacts on child and maternal health as well as greenhouse gas emissions?

In the first major study of its kind, an international team of researchers in collaboration with WHO, have been modelling the health effects of different policies to reduce greenhouse gas emissions in high and low-income countries. Case studies focus on four key sectors: power generation, transport, household energy, and food and agriculture. The study findings will be published in a special issue in the Lancet in November 2009.

The results were launched at events in London and Washington on 25 November 2009.

Related links

- Dr Margaret Chan, editorial - Cutting Carbon, Improving Health [pdf 91kb]

- The Health benefits of tackling climate change
An executive summary for the Lancet series

- The Wellcome Trust

- The London School of Hygiene & Tropical Medicine

Keeping cholesterol in check may reduce prostate cancer risk, studies suggest.

Moral of the story: So many reasons to keep your heart healthy. Cholesterol is now linked to prostate cancer.

Source: AMA Morning Rounds 11/4/09

Keeping cholesterol in check may reduce prostate cancer risk, studies suggest.

The AP (11/4, Marchione) reports, "Men may protect more than their hearts if they keep cholesterol in line: Their chances of getting aggressive prostate cancer may be lower." Scientists at two institutions detailed the research that led them to that conclusion in Cancer Epidemiology Biomarkers & Prevention. Even though the papers "are not definitive and have some weaknesses," they do "fit with plenty of other science suggesting that limiting fats in the bloodstream can lessen cancer risk."

HealthDay (11/3, Edelson) reported that NCI investigators reviewed "data from a study that has followed more than 29,000 Finnish men for 18 years," finding that "cholesterol levels below the generally recommended 200 milligrams per deciliter were associated with an 18 percent higher overall risk of cancer."

Generic drug use can help save money

Moral of the story: Generics are low cost, and THE EXACT SAME THING as name brand pharmaceuticals. This is the obvious way to save, but there are also cheaper options within the same family of drug that work just as well, or as well as you may need. While physicians don't have all the answers, they do have access to extensive drug information they can use to help you save.

Source: AMA Morning Rounds 11/5/09

Asking physicians about generic drugs seen as key to cutting prescription costs.

The AP (11/5, Perrone) reports, "The senior advocacy group AARP reports that prices for the most popular drugs rose 8.7 percent on average last year, more than twice the rate of inflation." And "last year, pharmaceutical companies spent more than $4 billion urging patients like you to 'ask your doctor' about their drugs. But, if you want a prescription that won't empty your wallet, while still keeping you well, you might start asking your doctor about drugs you don't see on TV." For instance, "AstraZeneca's acid reflux drug Nexium [esomeprazole magnesium] -- the 'purple pill' -- was the second best-selling drug in the US last year, with a hefty price tag of about $215 per month. But, a drug from the same family, that works the same way, is available over-the-counter for about $20 a month as Prilosec [omeprazole]."