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]."

Early morning colonoscopies may detect more polyps than those done later.

Moral of the story: Thinking about that nasty colonoscopy you need soon? Better schedule it for the morning, it will be more effective.

Source: AMA Morning Rounds 11/9/09

Early morning colonoscopies may detect more polyps than those done later.

HealthDay (11/6, Preidt) reported, "Early morning colonoscopies detect more polyps than colon cancer screenings done later in the day," according to a study published in the Nov. issue of Clinical Gastroenterology and Hepatology. The study of "477 people who had colonoscopies in a one-year span" showed that screenings "that started at 8:30 a.m. or earlier detected 27 percent more polyps per patient than colonoscopies performed at a later time."

Furthermore, researchers appeared to find "fewer polyps...hour by hour as the day progresses," WebMD (11/6, Hendrick) reported. The investigators speculated that "more polyps are found early in the day" because of "better bowel preparation the night before by patients," and "fatigue of physicians and assistants."

Death and Dying

Editor's Choice
Death and dying

Jane Smith, deputy editor, BMJ

jsmith@bmj.com

The main theme of this week’s issue is death and dying, a subject where the public and the private jostle uncomfortably. This week’s BMJ contains several articles that add to the debate about public policy and throw light on to the nuances of private thoughts and behaviour.

Dutch law on euthanasia requires that the doctor must be convinced that the patient who requests euthanasia has unbearable suffering. In their qualitative study H R W Pasman and colleagues explored what this concept meant for patients whose request for euthanasia was either refused or granted but not carried out, and for their doctors (doi:10.1136/bmj.b4362). They found that doctors had a narrower view of unbearable suffering than patients, tending to concentrate on physical suffering. In some cases doctors thought that the suffering was not unbearable because patients behaved in a way that didn’t seem compatible with unbearable suffering, such as reading books. Patients emphasised psychosocial suffering, such as fear of dependence, not being able to do ordinary things, and deterioration. < P> This difference is illustrated in Alex Paton’s moving account of the death of his wife (doi:10.1136/bmj.b4982): "She wanted to die, and we realised she meant it...a keen plantswoman, she said there was no point in living if she could no longer garden." Yet she was resuscitated in spite of an advance directive, and her family signed her out of hospital against medical advice, to die at home. Paton also argues for care with words, preferring "euthanasia...the bringing about of a gentle and easy death" to "assisted suicide...which continues the myth that euthanasia is a nasty business."

Another article in this week’s issue shows how private acts and thoughts can reach the public stage. Debbie Purdy writes in her patient’s journey about having multiple sclerosis and how she has come to terms with increasing loss of function (doi:10.1136/bmj.b4470). Her main point is the importance of making her "own choices about what constitutes an acceptable quality of life" rather than having others, including professionals, make assumptions about what that is. She says it was this desire that led her to campaign to ensure that "assisted death is part of the support available to patients who are suffering unbearably"—alluding to her very public fight to be allowed to control the manner of her dying. Debbie Purdy hasn’t managed to change English law to allow assisted dying, but as a result of her court cases the House of Lords directed the Director of Public Prosecutions to publish his guidance on the factors that would prompt or argue against prosecution in individual cases.

That guidance was published in September and is now being consulted on. Richard Huxtable and Karen Forbes discuss some of the imponderables in their editorial (doi:10.1136/bmj.b4900), concluding that this guidance has not really clarified things for doctors or made end of life decisions and discussions easier. They fear "stealth lawmaking," where the law slides "from an apparent prohibition to a de facto position of permission."

Yet end of life decisions are already unstraightforward, as the ethical debate led by Stephen Bonner and colleagues illustrates (doi:10.1136/bmj.b4667). They were faced with a woman, unconscious as a result of attempted suicide, who had written an advance directive five years earlier saying she did not want life sustaining medical treatment. Should the directive be followed or should the emergency department staff initiate life saving treatment? Read the article, and its commentaries, to find out what they did, and what others think about it.

Cite this as: BMJ 2009;339:b5044

Non-profit reports breakthrough in understanding chronic fatigue syndrome.

Moral of the story: A virus might be responsible for Chronic Fatigue Syndrome.

Source: AMA Morning Rounds 11/12/09

Non-profit reports breakthrough in understanding chronic fatigue syndrome.

The New York Times (11/12, SPG8, Grady) reports that the Whittemore Peterson Institute for Neuro-Immune Disease, a nonprofit in Reno, recently had a breakthrough in understanding chronic fatigue syndrome. The Institute was founded by Harvey and Annette Whittemore "out of desperation to find answers" for their daughters condition. Instead of "doling out money to far-flung researchers," the Whittemores "wanted to employ their own scientists who would be devoted full time to the cause." They hired Dr. Judy A. Mikovits, a virus expert from the National Cancer Institute, who discovered that a retrovirus called XMRV, "may cause or at least contribute to chronic fatigue syndrome." Other doctors have "emphasized that more research was needed," and the Centers for Disease Control and Prevention will "try to replicate the XMRV findings." The CDC's Dr. William C. Reeves, "has said that he does not expect to find the virus in blood samples from patients."

Scientists find link between gut microbiota, diet, and weight gain.

Moral of the story: What you eat matters. A lot. The link between diet and weight is rather complicated and taking out fats and sugars can help to change the fauna of your stomach to help you lose weight. Chewing gum and breastfeeding help shed pounds too.

Source: AMA Morning Rounds 11/12/09

Scientists find link between gut microbiota, diet, and weight gain.

The Los Angeles Times (11/12, Maugh) reported, "A high-fat, high-sugar diet does more than pump calories into your body. It also alters the composition of bacteria in your intestines, making it easier to gain weight and harder to lose it," according to a new paper in Science Translational Medicine. What's more, the "changeover can happen in as little as 24 hours."

Technically known "as the gut microbiota," intestinal "microbes perform a vast range of vital functions, including helping to regulate the calories the body obtains from food and stores as fat," according to Time (11/12, Park). Through earlier experiments, however, Washington University researchers found that the "gut microbiota of obese mice...have significantly more of one main type of bacteria called Firmicutes, and fewer of another kind called Bacteroidetes (both types populate human guts as well); in normal mice, the distribution is the opposite." With that in mind, the team devised a new study in which human microbiota was used "to colonize mice guts." The rodents were then fed "equivalents of typical human diets to see how their microbes -- and their weight -- might change."

Lead investigator Dr. Jeffrey I. Gordon told HealthDay (11/11, Gordon) that when his team "switched these humanized animals [from a low-fat] to a junk-food diet, high in fat with lots of simple sugars, the structure of the microbial community changed dramatically and very rapidly." What's more, the mice "became obese on Western diets." Investigators also discovered that "the microbiota passes from generation to generation."

Study points to chewing gum as weight loss aid. The Washington Post (11/11, Huget) reports that for anybody trying to lose weight, "taking up gum-chewing might not be a bad idea," as "there's actually a bit of scientific evidence showing that chewing gum helps fight fat in a number of ways." The research, sponsored by the Wrigley Science Institute, has suggested "that chewing gum may help reduce cravings, particularly for sweet snacks, and spur people to cut their daily intake by about 50 calories." The findings were presented at the annual scientific meeting of the Obesity Society last month, and "showed that gum-chewing people consumed 67 fewer calories at lunch and didn't compensate by eating more later in the day."

Breastfeeding's effect on postpartum weight discussed. The New York Times (11/12, E3, Louis) reports, "That breastfeeding gives mothers an edge shedding baby weight has long been suspected." A Danish study published last year showed that "the more a mother breast-feeds, the less weight she retains six months after birth." But, other research has shown that "breast-feeders don't necessarily shed fat quicker than women who feed their newborns formula." Meanwhile, "a small double-blind randomized study conducted at Cincinnati Children's Hospital Medical Center found that non-lactating women lost more body fat than lactating women at six months, and at a faster rate." Still, "others suggest that women who view breast-feeding as a dieting tool may have 'deeper body issues.'" One expert said "she was troubled by our cultural preoccupation with postpartum weight."

Dark chocolate may lower stress hormone levels.

Moral of the story: Every wonder why dark chocolate makes you feel better? It changes your stress hormone metabolism. Cool.

Source: AMA Morning Rounds 11/13/09

Dark chocolate may lower stress hormone levels.

HealthDay (11/12, Dotinga) reported that "a dose of dark chocolate could cheer you right up by lowering your stress hormone levels," according to a study published online in the Journal of Proteome Research. After following 30 "volunteers who said they were highly stressed," researchers found that "a daily consumption of 40 grams [1.4 ounces] during a period of two weeks is sufficient to modify the metabolism of healthy human volunteers" by helping "correct other imbalances in the body that are related to stress." Reuters (11/13, Goldsmith) and also covers the story.

Vaccines against cocaine, nicotine addiction modeled after infectious diseases research.

Moral of the story: A really cool idea that may just help people quit smoking, completely.

Source: AMA Morning Rounds 11/16/09

Vaccines against cocaine, nicotine addiction modeled after infectious diseases research.

USA Today (11/16, Rubin) reported, "Researchers are investigating whether the same approach used to prevent infectious diseases could treat addictions." Nicotine and cocaine molecules "are so tiny that they easily pass from the bloodstream into the brain." A vaccine, however, can stimulate the production of antibodies that "bind with the molecules," making the combo "far too large." No such vaccines are "on the market, but in late September, NIDA released a $10 million stimulus grant to Nabi Pharmaceuticals to help pay for the first Phase III trial...of a smoking-cessation vaccine." And, a paper published in the Archives of General Psychiatry carried successful "results of a cocaine vaccine study." The study's lead author, however, pointed out that "no company is interested in developing a cocaine vaccine because of liability concerns and the assumption it wouldn't be nearly as profitable as a nicotine vaccine."

Researchers associate low levels of vitamin D with CAD, stroke, heart failure.

Moral of the story: There is a link between the chronic, prevalent low vitamin D levels in the US and all those cardiovascular problems. It may be a tough balance between skin cancer and vitamin D, but the importance of the vitamin D is becoming more clear.

Source: AMA Morning Rounds 11/17/09

Researchers associate low levels of vitamin D with CAD, stroke, heart failure.

The New York Times (11/16, Rabin) "Well" blog reported that, according to research presented Nov. 16 at the American Heart Association conference, "Americans aren't getting anywhere nearly enough of" vitamin D, "and it may be affecting their heart health." After examining data on 27,686 "healthy adults 50 and older whose vitamin D levels had been measured during routine checkups," researchers found that "those who had extremely low levels of the vitamin were almost twice as likely to have died or suffered a stroke than those with adequate amounts." In addition, they "had more coronary artery disease and were twice as likely to have developed heart failure." HealthDay (11/16, Preidt) and CNN (11/17, Mann) also cover the study.

FDA warns against concomitant use of Plavix, certain heartburn drugs.

Moral of the story: If you are taking these two drugs (blood thinners and proton-pump inhibitors for heartburn) talk to your doctor. You need to up the dosage of the blood thinner.

Source: AMA Morning Rounds 11/18/09

FDA warns against concomitant use of Plavix, certain heartburn drugs.

NBC Nightly News (11/17, story 2, 0:40, Williams) reported that "millions of Americans take" Plavix (clopidogrel) "to reduce the risk of heart attacks and strokes." But, because the blood thinner "can upset the stomach, it is often prescribed alongside drugs like Prilosec (omeprazole) and Nexium (esomeprazole)." Now, however, the FDA is warning that those popular medications can "weaken the effect of Plavix."

In fact, the "anti-clotting benefits of Plavix are cut almost in half when taken with over-the-counter or prescription Prilosec, according to a notice posted today on the Food and Drug Administration's website," Bloomberg News (11/18, Larkin) reports. Thus, the "agency ordered Paris-based Sanofi and New York-based Bristol-Myers to update the prescribing information for Plavix and study the potential for other drug interactions." Although the "Plavix prescribing information was updated in January to discourage use with Prilosec," the latest warning includes the those two PPIs and nine other "similar drugs."

However, the agency "did not have enough information to say whether other drugs in the same class as Nexium and Prilosec...also react adversely with Plavix," the Los Angeles Times (11/18, Zajac) reports. "This includes such drugs as Prevacid [lansoprazole] and Protonix [pantoprazole]."

Nevertheless, those who still "need to reduce their acid should take drugs from the H-2 blocker family, which include Johnson & Johnson's Mylanta [aluminum hydroxide/magnesium hydroxide/simethicone] and Boehringer Ingelheim's Zantac [ranitidine]," the AP (11/18, Perrone) reports. "FDA scientists say there is no evidence those drugs interfere with Plavix's blood clotting." As for the omeprazole, the FDA decided to strengthen its warning after reviewing "a 150-patient study submitted by Sanofi over the summer."

That report indicated that drugs like Nexium reduce the production of an enzyme -- CYP 2C19 -- that sets Plavix in motion, according to the Wall Street Journal (11/18, Mundy). Several other drugs, WebMD (11/17, DeNoon) reported, "also inhibit CYP 2C19, and the FDA says patients on Plavix should avoid them as" well: Tagamet (cimetidine), Luvox (fluvoxamine), Ticlid (ticlopidine), Diflucan (fluconazole), Nizoral (ketoconazole), VFEND (voriconazole), Intelence (etravirine), Felbatol (felbamate), and Prozac, Serafem, and Symbyax (fluoxetine).

HealthDay (11/17, Reinberg), Dow Jones Newswire (11/17, Favole), and CQ HealthBeat (11/18) also covered the story

New law bans genetic discrimination.

Moral of the story: Genetic counseling needs to change to reflect the new privacy patients have in term of their genetic composition.

Source: AMA Morning Rounds 11/23/09

New law bans genetic discrimination.

The Los Angeles Times (11/22, Markman) reported that the Genetic Information Nondiscrimination Act, which has been called "the most sweeping federal anti-discrimination law in nearly 20 years," went into effect over the weekend. The law prohibits employers "from hiring, firing or determining promotions based on genetic makeup," and also forbids health insurers from using genetics as a basis for denying coverage or setting insurance rates. The law comes despite a number of concerns from insurers and the National Federation of Independent Business, who expressed concerns that employers could be held liable for having genetic information in their files.

In an editorial, the New York Times (11/22, WK9) opined that the law "is an important step in protecting people who have inherited a predisposition to disease," and "removes a significant obstacle to genetic testing." They note the objections made by insurance companies and business groups, and say that the law was passed regardless "because lawmakers rightly saw that fairness and public policy arguments demanded a ban on discriminating against people for genetic traits they can do nothing about."

Depression may take as many years off life as smoking.

Moral of the story: Mental illnesses are serious threats to long-term health

Source: AMA Morning Rounds 11/24/09

Depression may take as many years off life as smoking.

HealthDay (11/23, Dotinga) reported that, according to a study published in the British Journal of Psychiatry, "being depressed might take as many years off your life as smoking does." After "analyzing death records and a survey of more than 60,000 people," researchers at King's College London found that "during the four years after the survey, the death rate was higher among those who'd appeared to be depressed, based on the survey findings, than among the others," with the "increase...about as high as that among smokers." Notably, the investigators also found that "a combination of depression and anxiety appears to be better for longevity than just depression."

One in four teenage girls may test positive for an STD.

Moral of the story: STDs are still very prevalent

Source: AMA Morning Rounds 11/24/09

One in four teenage girls may test positive for an STD.

HealthDay (11/23, Reinberg) reported, "As many as one in four US teenage girls have had a sexually transmitted disease (STD)," according to a CDC study published in Pediatrics. Investigators tested "838 teen girls aged 14 to 19" for "Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, herpes simplex virus type 2, and human papillomavirus (HPV)." They eventually discovered that "24.1 percent of the girls had one of these STDs, and among girls who were sexually experienced, 37.7 percent had an STD. HPV was the most common infection (18.3 percent), followed by chlamydia (3.9 percent)."

The "most concerning" aspect of the findings, however, was "how soon these sexually transmitted infections appeared after teenage girls began engaging in sexual activity," according to WebMD (11/23, Warner). "The study showed that within one year of initiating sexual activity, 19.2% of teen girls had an STI."

On Mammography — More Agreement Than Disagreement

Moral of the story: Not much has changed, there is just more emphasis on the risks for the age group 40-50 and that the screen should be done every other year.

Published at www.nejm.org November 25, 2009 (10.1056/NEJMp0911288)

On Mammography — More Agreement Than Disagreement
Ann H. Partridge, M.D., M.P.H., and Eric P. Winer, M.D.

High salt intake directly linked to stroke and cardiovascular disease

Moral of the story: Eat less salt. That's it. Your heart will thank you.

Source: BMJ press releases Monday 23 November to Friday 27 November 2009. Available in full at www.bmj.com

(1) High salt intake directly linked to stroke and cardiovascular disease
(Research: Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies)
http://www.bmj.com/cgi/doi/10.1136/bmj.b4336
(Editorial: The case for population-wide salt reduction gets stronge)
http://www.bmj.com/cgi/doi/10.1136/bmj.b4336

High salt intake is associated with significantly greater risk of both stroke and cardiovascular disease, concludes a study published on bmj.com today.

The link between high salt intake and high blood pressure is well established, and it has been suggested that a population-wide reduction in dietary salt intake has the potential to substantially reduce the levels of cardiovascular disease.

The World Health Organization recommended level of salt consumption is 5 g (about one teaspoon) per day at the population level, yet dietary salt intake in most Western countries is close to 10g per day (and much higher in many Eastern European countries).

Collaborative research conducted by Professor Pasquale Strazzullo at the University of Naples, Italy and Professor Francesco Cappuccio at the University of Warwick, UK analysed the results of 13 published studies involving over 170,000 people that directly assessed the relationship between levels of habitual salt intake and rates of stroke and cardiovascular disease.

Differences in study design and quality were taken into account to minimise bias.

Their analysis shows unequivocally that a difference of 5 g a day in habitual salt intake is associated with a 23% difference in the rate of stroke and a 17% difference in the rate of total cardiovascular disease.

Based on these results, the authors estimate that reducing daily salt intake by 5 g at the population level could avert one and a quarter million deaths from stroke and almost three million deaths from cardiovascular disease each year. Furthermore, because of imprecision in measurement of salt intake, these effect sizes are likely to be underestimated, say the authors.

These results support the role of a substantial population reduction in salt intake for the prevention of cardiovascular disease, they conclude.

This study is a useful and welcome addition to the medical literature, and strengthens the case for population-wide salt reduction, says Professor Lawrence Appel from Johns Hopkins University, in an accompanying editorial.

Contacts:
Research: Pasquale Strazzullo, Professor of Medicine, Department of Clinical and Experimental Medicine, "Federico II" ESH Excellence Centre of Hypertension, University of Naples Medical School, Naples, Italy
Email: strazzul@unina.it

Editorial: Lawrence Appel, Professor of Medicine (via Stephanie Desmon, Senior Media Relations Representative), Johns Hopkins University, Baltimore, MD, USA
Email: sdesmon1@jhmi.edu

Spray-on anesthetic helps delay ejaculation.

Moral of the story: One of those awkward doorknob questions just got a better answer.

Source: AMA Morning Rounds 11/20/09

Bloomberg News (11/20, Matsuyama) reports, "A spray-on treatment for premature ejaculation may prolong sexual intercourse by as much as five times." In fact, the drug, known as PSD502, "delayed orgasm by an average of 108 seconds" after one month of treatment, according to a 256-patient trial conducted in Canada, Poland, and the US.

The work may benefit the estimated "one in three US men ages 18 to 59" who have dealt with the problem at one time or another, according to the Los Angeles Times (11/19, Maugh) "Booster Shots" blog. That's "about twice as many as those who suffer from erectile dysfunction." Indeed, "some antidepressant-like drugs, such as dapoxetine, have been approved in a few countries to treat the condition, but the Food and Drug Administration rejected it because of long-term side effects." And while "some physicians prescribe anesthetic creams like EMLA cream...off-label," they "require 45 minutes to work."

Now, researchers at the University of California-San Francisco may have stumbled upon a solution. According to WebMD (11/19, DeNoon), the spray "contains the anesthetics lidocaine and prilocaine," but it "doesn't deaden feeling, thanks to an ingredient in the spray that allows it to rapidly penetrate the skin." What's more, it "seems safe for men's female sex partners," as "only about 0.5% of female partners report decreased feeling in the vagina."

In light of those findings, HealthDay (11/19, Preidt) pointed out, "Sciele Pharma plans to seek US Food and Drug Administration approval of the spray." Reuters (11/20), the UK's Telegraph (11/19), and the UK's Press Association (11/19) also covered the story.

Only 25 percent of middle-aged adults getting recommended screenings, data indicate.

Source: AMA Morning Rounds 11/20/09

HealthDay (11/19, Reinberg) reported, "Screening for cancer and other preventive health measures can prolong lives, but only 25 percent of adults aged 50 to 64 in the United States are getting these recommended screenings," according to a report "prepared by CDC, AARP, and the American Medical Association." The report focuses specifically on "influenza vaccine, cholesterol screening, colorectal cancer screening, and for women, breast and cervical cancer screening," noting that middle-aged adults "are at the greatest risk of developing chronic diseases such as heart disease and cancer."

But, "only five states...met the target of more than 90 percent of women having a cervical cancer screening within the previous three years," MedPage Today (11/19, Fiore) reported. The report also showed that "no state had an obesity rate of less than 15 percent." As a result, the report suggests "ways to strengthen ties between healthcare providers and community organizers," including strategies to increase "access to and use of preventive services in this age group."