Health News for Late August 2008

Cancer

Nonmelanoma Skin Cancer & Cancer Risk

Research published online on August 26 in the Journal of the National Cancer Institute has found that people who have had nonmelanoma skin cancer, which is a normally nonfatal form of skin cancer, have double the risk of developing other types of cancers. Researchers found that the risk was especially notable in younger people in the 25 to 44 age group.

The Gene for Neuroblastoma

An article published online on August 24 in Nature reports that mutations in the anaplastic lymphoma kinase (ALK) gene explain most hereditary forms of neuroblastoma and the same mutations play a significant role in high-risk forms of non-inherited neuroblastoma. Also as reported in a news release from the Children's Hospital of Pennsylvania, the study's first author, Dr. Yael P. Mossé said, "This finding means that it is possible to offer simple, non-invasive screening for patients with a family history of neuroblastoma," and, "Furthermore, because there already are drugs in development that target the same gene in adult cancers, we can soon begin testing those drugs in children with neuroblastoma."

Future in Targeting Telomerase in Tumors?

A common hallmark of human cancers is the overexpression of telomerase, which normally adds short sequences of DNA (telomeres) to the ends of chromosomes, thus preventing damage and the loss of genetic information when cells divide. Now, research published online on August 31 in Nature reports that scientists have deciphered the structure of the active region of telomerase. It is hoped that the discovery could lead to new drugs to target cancer. The leader of the study, Emmanuel Skordalakes, PhD, said in a news release, "Telomerase is an ideal target for chemotherapy, because it is active in almost all human tumors, but inactive in most normal cells. That means a drug that deactivates telomerase would likely work against all cancers, with few side effects." In addition to its role in cancer, telomerase holds significant implications for the development of therapies to combat aging and other age-related diseases.

Tobacco-Related Cancer Numbers

According to a September 5 CDC Surveillance Report, tobacco use caused 2.4 million cancer cases in the United States from 1999 to 2004. Tobacco use kills 438,000 people prematurely every year, including 38,000 people who are victims of secondhand smoke. The report also found that tobacco-related cancers were more common among blacks, non-Hispanic whites, and men, reflecting the groups that use tobacco more.

Sequencing Brain and Pancreatic Cancers

According to two articles published online on September 4 in Science Express, scientists have sequenced the genes for a form of brain cancer (human glioblastoma multiforme) and pancreatic cancer. As stated in a news release from Howard Hughes Medical Institute, "(I)nvestigators have detected a multitude of broken, missing, and overactive genes in pancreatic and brain tumors, in the most detailed genetic survey yet of any human tumor. Some of these genetic changes were previously unknown and could provide new leads for improved diagnosis and therapy for these devastating cancers. … Taken together, the two studies suggest that a small number of commonly mutated genes – or 'mountains' – and a larger number of rarer, low-frequency gene changes – 'hills' – cause these cancers, said the researchers." They found that each individual tumor had its own particular assortment of gene changes, so, as stated by investigator Dr. Bert Vogelstein, "If you have 100 patients, you have 100 different diseases." Vogelstein also said, "It's suggesting that maybe we shouldn't even be focusing so much on the individual genes that are mutated. Instead, we should be thinking about the functional pathways in which these genes operate. This is a different way of looking at how cancer develops."

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Mental Health

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.

Do You Suffer From SAD?

A study published in the September issue of Archives of General Psychiatry was based on brain scans of 88 healthy volunteers carried out between 1999 and 2003. They found that a protein known as a serotonin transporter was significantly more active in all areas of the brain in scans performed in the autumn and winter. The more active the protein, the lower the levels of serotonin in the brain, and the greater the likelihood of a depressed mood. Researchers believe that light impacts the activity of the protein.

Older Dads & Kids' Bipolar Risk

Studies have previously linked older dads to a higher risk of autism and schizophrenia in offspring. Now, findings published in the September issue of Archives of General Psychiatry show a link between older dads and bipolar risk. The findings were based on Swedish registry data concerning more than 80,000 people, and showed that risks began increasing around age 40, but were strongest in those 55+. Kids born to dads aged 55+ were 37% more likely to develop bipolar disorder than kids of men in their early 20s. They also found that the maternal age effect was less pronounced.

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Infectious Diseases

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."

Infections & Preterm Labor

A study published on August 26 in PLoS ONE suggests that undiagnosed infections may be responsible for some premature births, after finding bacteria or fungi in 15% of the amniotic fluid samples taken from women experiencing preterm labor. One of the microorganisms was described as an "unassigned, uncultivated, and previously-uncharacterized bacterium." Of the 166 women tested, all 25 who had infected amniotic fluid went on to deliver their babies preterm, while 53 of the women with no infections were able to stop their labor. The heavier the infection in the amniotic fluid, the more likely the women were to deliver younger, sicker infants.

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Heart Health

Bypass Versus Stents

A study presented at the European Society of Cardiology meeting reports that both CABG procedures and drug-coated stents are equally safe, but those who receive a stent are more likely to require a repeat procedure than those who have a CABG. Researchers found that nearly 14% of stent cases needed another procedure after a year, while only about 6% of CABG patients needed another procedure in the same period. The study also found that the death rate was virtually the same (7.7% among surgery patients and 7.6% among angioplasty patients), but the stroke rate was about 2% for surgery, versus near zero for the stent cases.

Stairs for Heart Health

Also from the European Society of Cardiology meeting is the finding that climbing a few flights of stairs at work for three months provides a big benefit for heart health. Researchers looked at 69 employees of the University of Geneva, all of whom lived a sedentary lifestyle, and asked them to use the stairs rather than the elevators. The average number of stairs ascended or descended increased from an average of five per day to 23 per day, and this resulted in an increase in aerobic capacity equivalent to approximately a 15% decrease in all-cause mortality risk. Additionally, subjects experienced a statistically significant decline in waist circumference, weight, fat mass, diastolic blood pressure, and LDL cholesterol.

ICD Shocks & Future Trouble

An article published in the September 4 issue of The New England Journal of Medicine looked at 811 patients with heart failure who had received an implantable cardioverter-defibrillator (ICD). Subjects were followed over a median period of 45.5 months. Researchers found that that those who needed a shock were more than five times more likely to die over the next four years than those who didn't require one. An inappropriate ICD shock was also associated with a significant increase in the risk of death.

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American Healthcare

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 …."

Healthcare & the Uninsured

A paper published online on August 25 in Health Affairs states: "People uninsured for any part of 2008 spend about $30 billion out of pocket and receive approximately $56 billion in uncompensated care while uninsured. Government programs finance about 75 percent of uncompensated care. If all uninsured people were fully covered, their medical spending would increase by $122.6 billion." Additionally, they calculated: "Physicians' donated time and forgone profits amount to $7.8 billion. After government payments to hospitals are subtracted, private philanthropy and profit margins are responsible for at least an additional $6.3 billion." As for how much covering the uninsured would cost, they wrote, "Adding the cost of the additional care to current spending by or for the uninsured, total medical care costs for newly insured people will be about $208.6 billion (roughly $3,800 per full-year-equivalent newly insured person), consisting of $122.6 billion in new spending on top of the $86 billion already in the system. Although this is substantial, not all of this money necessarily represents new government spending."

Uninsured Numbers Down

Meanwhile, on August 25 the Census Bureau reported that the number of people without health insurance coverage declined from 47 million (15.8%) in 2006 to 45.7 million (15.3%) in 2007. (The full report, Income, Poverty, and Health Insurance Coverage in the United States: 2007, is available on their site.) Unfortunately, as explained by Dr. Don McCanne in an August 26 news release from Physicians for a National Health Program, "While any drop in the number of uninsured is welcome news, a closer look at the Census Bureau data for 2007 provides little cause for celebration," because "The new figure – 45.7 million uninsured – is still unacceptably high. … It's the second-highest figure since the 1960s, when Medicare and Medicaid were enacted into law." Furthermore, he explained, last year's gain in the number of insured people was entirely attributable to an expansion of government programs like Medicare and Medicaid. The number of people covered by government health insurance programs increased by 2.7 million. Were it not for this increase, he said, the uninsured numbers would have surpassed the 2006 figure.

California's Tobacco-Control Cost-Savings

Research published on August 26 in PLoS Medicine calculates that California's ant-tobacco campaign has resulted in an $86 billion reduction in healthcare costs, based on 2004 dollars, represents about a 50-fold return on the $1.8 billion California spent on the program between 1989 when it started, and 2004.

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Miscellaneous

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."

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.

Maternal Stress & Overweight Kids

An article published in the September issue of Pediatrics looked at a sample of 841 children aged three to 17, whose mothers had incomes below the poverty line, and were in the 1999–2002 National Health and Nutrition Examination Survey. Researchers found that kids to age 10 who were living in poverty, and with stressed moms, but were in "food secure" homes, were more likely to be overweight or obese than those in the same circumstances, but who were in "food insecure" homes. Although both groups were stressed, those with plentiful food were able to find refuge from stress in food – particularly less-healthy "comfort foods" – whereas those with scarce food could not. The same results were not found among those aged 11 to 17.

Drugs & Direct to Consumer Advertising

Research published online on August 2 in the British Medical Journal has found that costly direct-to-consumer drug ads have mixed results in getting people to buy. The study was based on two groups of Canadians – English-speaking Canadians who have regular exposure to drug ads via American television channels (direct to consumer ads are prohibited in Canada) and French-speaking Canadians, who have little exposure to such ads. The researchers wrote that there were three major implications of their findings – first, that cross-border exposure to direct to consumer advertising has the potential to modify drug use, even when such advertising is technically prohibited; second, that "direct to consumer advertising can increase use of a drug that was removed from the market as a result of concerns about safety"; and third, "the effectiveness of direct to consumer advertising campaigns is mixed, as they seem to work for some drugs and not others."

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