In The News This Week … August 17–23, 2008: Juice, Mental Health, Teens, Diabetes, Trauma, Infectious Diseases, & US Healthcare

More Perils of Fruit Juice

People have known for some time that they should be wary of grapefruit juice when taking meds, because it can increase the absorption of certain drugs. Now, David G. Bailey, PhD, the same scientist who provided us with the warning about grapefruit juice, has found new evidence that grapefruit and other common fruit juices, including orange and apple, can also have the opposite effect of substantially decreasing the absorption of other drugs, potentially wiping out their beneficial effects. In the latest study, presented at the 236th National Meeting of the American Chemical Society, healthy volunteers took fexofenadine (an antihistamine, with the brand names Allegra and Allegra ODT), either with a single glass of grapefruit juice, water containing only naringin (the substance in grapefruit juice that gives it the bitter taste), or water. When fexofenadine was taken with grapefruit juice, only half of the drug was absorbed compared to taking the drug with water alone. As explained in the news release, "The researchers also found that the active ingredient of grapefruit juice, naringin, appears to block a key drug uptake transporter, called OATP1A2, involved in shuttling drugs from the small intestine to the bloodstream. Blocking this transporter reduces drug absorption and neutralizes their potential benefits, the researchers say. By contrast, drugs whose levels are boosted in the presence of grapefruit juice appear to block an important drug metabolizing enzyme, called CYP3A4, that normally breaks down drugs." Orange and apple juices also appear to contain naringin-like substances that inhibit OATP1A2. Bailey also reported, "To date, grapefruit, orange and apple juices have been shown to lower the absorption of etoposide, an anticancer agent; certain beta blockers (atenolol, celiprolol, talinolol) used to treat high blood pressure and prevent heart attacks; cyclosporine, a drug taken to prevent rejection of transplanted organs; and certain antibiotics (ciprofloxacin, levofloxacin, itraconazole). But additional drugs are likely to be added to the list as physicians become more aware of this drug-lowering interaction."

Antidepressants & Driving

An August 17 news release from the American Psychological Association annual meeting reports that people taking prescription antidepressants appear to drive worse than people who aren't taking antidepressants, and depressed people on antidepressants have even more trouble concentrating and reacting behind the wheel. The findings were based on a group of 60 people (31 taking at least one antidepressant; 29 controls not taking meds except, in some cases, a BCP) recruited to participate in a driving simulation in which participants had to make a series of common driving decisions, such as reacting to brake lights, stop signs, or traffic signals while being distracted by speed limit signs, pylons, animals, other cars, helicopters, or bicyclists. Researchers stated, "Individuals taking antidepressants should be aware of the possible cognitive effects as [they] may affect performance in social, academic and work settings, as well as driving abilities. … However, it appears that mood is correlated with cognitive performance, more so than medication use."

Postpartum Suicide & Mental Illness

A paper published in the August issue of American Journal of Obstetrics & Gynecology reports that women with a psychiatric disorder were 27 times more likely to attempt postpartum suicide than controls, while those with a substance abuse disorder were six times more likely to attempt postpartum suicide, and those with a dual diagnosis were 11 times more likely to attempt postpartum suicide.

Teens & Sleep

An article published online on August 18 in Circulation has found that poor sleep quality is associated with prehypertension in healthy adolescents, and that the association can't be explained by socioeconomic status, obesity, sleep apnea, or known comorbidities.

Arsenic & Diabetes

A contribution published in the August 20 issue of The Journal of the American Medical Association has found evidence supporting the hypothesis that low levels of exposure to inorganic arsenic in drinking water – a widespread exposure worldwide – may play a role in the prevalence of type 2 diabetes. Arsenic levels were 26% higher in those with type 2 diabetes than in those without the disease.

Trauma, Opinion, & Belief

A study published in the August issue of Archives of Surgery was based on survey responses regarding preferences for care in the prehospital, emergency, and critical care settings from the general public (June and July 2005) and a sample of trauma professionals (fall 2005). Some findings: most members of the public and trauma professionals would prefer palliative care when doctors determine that aggressive critical care would not be beneficial in saving their lives; during resuscitation of an injured loved one, 51.9% of the public and 62.7% of the professionals would prefer to be in the ER treatment room; while most of both groups trust a doctor's decision to withdraw treatment when futility is determined, most of the public believes patients should have the right to demand care not recommended by their physicians. But perhaps the most surprising finding: 57.4% of the public and 19.5% of the professionals believe that divine intervention could save a person when physicians believe treatment is futile.

Preventing Infections with Silver

A study published in the August 20 issue of The Journal of the American Medical Association has found that the use of endotracheal tubes treated with silver to reduce infections cut the risk of ventilator-associated pneumonia (VAP) in critically ill patients by 35.9%. Patients on the silver-treated tubes also had delayed time to VAP occurrence than those with untreated tubes. However, no statistically significant differences were observed in durations of intubation, intensive care unit stay, and hospital stay; mortality; or frequency and severity of adverse events in either the silver-treated or untreated groups. The findings were based on a randomized trial of more than 1,500 patients who required mechanical ventilation for 24 hours or longer.

Old – But Effective – Antibodies

A letter published online on August 17 in Nature reports that survivors of the 1918 flu pandemic still have antibodies to protect them from the virus. The 32 survivors ranged in age from 91 to 101. According to a news release from Vanderbilt University, leader researcher Dr. James Crowe, Jr. and his team "… isolated exceedingly rare B cells – the immune cells that produce antibodies – from eight of those samples and [grew] them in culture. Seven of those samples produced antibodies to a 1918 virus protein, suggesting that their immune systems were waiting on standby for a long-awaited second outbreak. 'The B cells have been waiting for at least 60 years – if not 90 years – for that flu to come around again,' Crowe said. 'That's amazing…because it's the longest memory anyone's ever demonstrated.' … Although aging typically causes immunity to weaken, 'these are some of the most potent antibodies ever isolated against a virus,' Crowe said. "'They're the best antibodies I've ever seen.' The findings suggest that B cells responding to a viral infection – and the antibody-based immunity that results – may last a lifetime, even nine or more decades after exposure."

More About the 1918 Flu Pandemic …

An article published online on August 18 in The Journal of Infectious Diseases suggests that the flu virus may not have been responsible for most deaths during the 1918 epidemic; rather, the majority of deaths likely resulted directly from secondary bacterial pneumonia caused by common upper respiratory-tract bacteria. As a result, the authors concluded, "Prevention, diagnosis, prophylaxis, and treatment of secondary bacterial pneumonia, as well as stockpiling of antibiotics and bacterial vaccines, should also be high priorities for pandemic planning."

After Contracting West Nile Virus …

Research published in the August 19 issue of Annals of Internal Medicine looked at 156 individuals with West Nile virus infection and found that physical and mental function, as well as mood and fatigue, seemed to return to normal within one year of symptom onset, but those with neuroinvasive disease took slightly longer to recover. Unfortunately, the researchers also stated that "The analysis excluded 7 patients who died shortly after diagnosis, so the study's estimates of prognosis may be overoptimistic."

US Healthcare Costs

A report developed using data from four years of the Commonwealth Fund Biennial Health Insurance Survey has found that insurance coverage has deteriorated over the past six years, with declines in coverage most severe for moderate-income families. As result, more families are experiencing medical bill problems or cost-related delays in getting needed care. In 2007, nearly two-thirds of American adults, or an estimated 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured (i.e., were insured but not adequately protected from high medical expenses). Specifically regarding debt, 41% of working-age adults, or 72 million people, reported problems paying their medical bills or were paying off accrued medical debt during the past year, and among adults who experienced medical bill problems, 29% were unable to pay for basic necessities like food, heat, or rent because of their bills; 39% used their savings to pay bills; and 30% took on credit card debt. The report was issued by The Commonwealth Fund, a private foundation that aims to promote a high performing healthcare system.

Comparing Hospitals' Death Rates & More

This week, the Centers for Medicare and Medicaid Services launched its website HospitalCompare.hhs.gov, a tool that provides users with information on how well the hospitals care for all their adult patients with certain medical conditions or who have undergone certain surgical procedures (e.g., heart attack, heart failure, pneumonia, angioplasty, bypass, etc.). As stated in a August 20 USA Today article, "Until today, hospital death rates were closely guarded secrets, discussed in board rooms but beyond the reach of patients whose lives are on the line. That changed this morning …."

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