Monday, October 31, 2011

Emmy Award-winning television personality Montel Williams speaks during an interview with the Associated Press in Jerusalem, Sunday, Oct. 30, 2011. Williams says Israel is at the forefront of providing patient access to medical marijuana. Williams was diagnosed with multiple sclerosis in 1999. He has since been an outspoken advocate of medical marijuana to relieve pain caused by disease. (AP Photo/Sebastian Scheiner)
JERUSALEM (AP) — Emmy Award-winning television personality and patient activist Montel Williams said Sunday he was impressed with Israel's liberal attitude toward medical marijuana, and he believes the U.S. could learn a thing or two from the Jewish state.
Williams was diagnosed with multiple sclerosis in 1999 and he has since been an outspoken advocate of medical marijuana to relieve pain caused by the disease.
The former host of the popular long-running talk show "TheMontel Williams Show" is in Israel on a fact-finding mission to learn about its medicinal cannabis practices. He is meeting with legislators, scientists and physicians.
At the height of his TV career, Williams was one of the most recognizable faces in America alongside fellow daytime TV hostsOprah Winfrey, Phil Donahue and Geraldo Rivera.
"We need to get out of the dark ages and into the new ages," he told The Associated Press. "Not every patient can use cannabis, but for those who can — why deny it?"
In Israel, certain doctors can approve cannabis prescriptions and disperse them to patients, said Itay Goor-Aryeh, the head of the pain management unit at the Sheba Medical Center in central Israel.
He said that while marijuana use is strictly regulated, many doctors prefer prescribing it to patients who qualify because it is "the lesser of evils."
"Those patients, if they do not get cannabis, they will get morphine-like drugs and other harmful drugs," said Goor-Aryeh. "I think that in many ways, cannabis is tolerated and is less addictive that morphine-based drugs."
Sixteen U.S. states have decriminalized the use of medical marijuana to some extent. Critics claim dispensaries are often no more than drug trafficking fronts.
Williams said that those merely seeking to smoke pot won't go through the lengthy bureaucratic process when they could just "go down the street."
Williams, 55, said he takes cannabis on a daily basis.
"For me, there is nothing else that can do what it does," he said. "It helps me suppress my pain ... When I am not using cannabis I am thinking about my pain every 45 seconds."
He said the drug has been "vilified to substantiate the false reason why it was banned in the first place," and that he hoped it would one day become a regular prescription drug.
"There are chemicals within that plant," he said, "and some of the leading science on where and how those chemicals work is being done right here in this country," referring to Israel.

Group calls for HIV screening of teens who have sex YORK (Reuters Health) - All sexually active adolescents should be screened for HIV, the American Academy of Pediatricssaid Monday in a new policy statement that broadens earlier recommendations.
And in areas with higher rates of the infection, all teens over 16 should get the test, the group added in its statement.
More than 1.1 million Americans are infected with HIV, and 55,000 of them are between 13 and 24 years old.
"Forty-eight percent of the youth who are infected don't know they are infected," said Dr. Jaime Martinez of the University of Illinois in Chicago, who helped write the new report, published in the journal Pediatrics.
"It's important to realize that those who don't know they are infected drive the epidemic," he told Reuters Health.
HIV usually proceeds to AIDS in the absence of treatment, but newer drugs can keep that from happening for many years. And knowing you're infected may also help stem transmission of the disease to others -- a benefit that isn't seen with cancer screening, for instance.
Today, many doctors only offer testing to patients they deem at risk, such as prostitutes, drug addicts and homosexual men. But since 2006, the U.S. Centers for Disease Control and Prevention have urged everybody older than 13 to get an HIV test regardless of risk factors in areas with many undiagnosed cases.
The new statement is a bit more conservative, said Martinez, lest pediatricians be uncomfortable testing younger teenagers. He added that in 12th grade, more than 60 percent of adolescents say they are sexually active -- and that often they're having sex while under the influence.
An HIV test costs about $14, according to Martinez, and is accurate more than 99 percent of the time. Overall, less than one percent of the tests sound a false alarm.
Martinez acknowledged that a few people might be treated without harboring the virus, but added that even if the first test is positive, it still needs to be confirmed by a second before a diagnosis is made -- so the odds of treating someone mistakenly are very small.
"I hope pediatricians will feel comfortable offering this test," he said.
But not all experts are convinced screening everybody is the way to go.
Last week, a large study from French hospitals showed more than 1,000 adults would need to be tested for HIV to find just one new infection, making the researchers question routine screening (see Reuters Health story of October 24, 2011).
Given similar low yields from other studies, the government-backed U.S. Preventive Services Task Force makes no recommendations to the general public about HIV screening, although it urges high-risk groups to get screened.
Dr. Jason Haukoos at the Denver Health Medical Center is among the critics of sweeping screening programs.
"There is reasonable evidence to support screening, but it is not clear what the best approach is," he told Reuters Health. "I think the policy statement is a reasonable statement, but I say that recognizing that they don't take it far enough in terms of how this should be done."
For example, he said, there are still questions about consent and disclosure when it comes to children. And it's unclear who would pay for the extra screening.
"The big issue here is, we don't know if it's cost-effective," Haukoos said.
SOURCE: Pediatrics, online October 31, 2011.

Sunday, October 30, 2011

Common Stimulant Drugs Pose Heart Risks

Last week, I became upset when I heard doctors quoting from an article published in the journal Pediatrics, suggesting that the use of stimulants to treat attention-deficit/hyperactivity disorder (ADHD) in children is a safe practice and we do not need to screen them for heart disease.
Shortly afterward, I noticed that Medscape – a website that features peer-reviewed original medical journal articles – published an educational piece for doctors and other health professionals, using the same flawed study to support their view.


The Medscape article is titled "No Increase in Cardiac Events or Death With ADHD Drugs."
The article opens with this statement: "Children and adolescents who take medication for attention-deficit/hyperactivity disorder (ADHD) are not at increased risk for cardiovascular events and death, according to results of a large observational cohort study."
That statement is just not true. That conclusion could not be asserted in the study, because the incidence of sudden death among study participants was very low, and as a result, the authors concede that no final conclusions could be made.
Once again, industry-supported research fools the scientific and medical community.
This study is flawed, and its group sampling is, unintentionally or otherwise, biased to suggest that the medications are safe. The study compared populations of children who take stimulants to treat symptoms of ADHD with populations who do not. The purpose of this observational study was to measure if there is a higher rate of cardiac events in the stimulant-using group.
The major flaw in this study is that physicians and parents are hesitant to place children on stimulants, especially if there are indications of heart disease that would increase the risk of sudden death. As a result, many of the children at risk are placed automatically in the non-treatment group. This built-in bias would make it virtually impossible to prove that stimulants had any detrimental effect on at-risk patients. And what the study did purport to show was that more children died suddenly in the untreated group than in the group taking stimulant drugs.
For added perspective – we have millions of Americans being treated with stimulants. Amphetamines are being prescribed to children and adults alike. All too commonly, I hear from high school or college students, who happen to be my patients, that they are able to obtain these drugs illegally from friends. This time of year I hear it more often, as such stimulants are popular as illegal aids to promote wakefulness in students studying long hours for final exams. The dangers posed by such uncontrolled availability among young people are too obvious to require extended commentary from me in this column.
To summarize, administering a stimulant to children with an underlying disease like Wolff-Parkinson-White syndrome, Long QT syndrome or hypertrophic cardiomyopathy will increase their risk of sudden death. If we do not require childhood screening for those diseases (as well as others), then placing groups of children on these medications will almost certainly increase their incidence of sudden death.
The question is not whether the use of these stimulant drugs will increase the risk of sudden death for these patient groups, but whether that risk is acceptable to the parents, regardless of the attitudes now current in the pharmaceutical and medical communities.

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Newborns Need to Be Near Their Mothers at Night

Significant physiological stress and disrupted sleep patterns were recorded in 2-day-old newborns who were physically separated from their mothers but remained within close proximity in the same room, according to a study in Biological Psychiatry.
Research has shown that close contact between mothers and newborns in the first few hours of life significantly improves breastfeeding rates. Sleeping in the same bed, however, is strongly discouraged in Western countries.
Heart-rate monitors recorded the physiological responses of 16 South African newborns, 10 boys and six girls, during one hour of skin-on-skin contact with their mothers and one hour facing her from a bassinet. Mothers were 17 to 40 years of age and had no post-natal complications.
Compared with close maternal contact, separation triggered a nearly three-fold increase in autonomic nervous system activity, including heart-rate and respiration changes, and an 86 percent decrease in quiet or non-rapid eye movement sleep, the study found.
A drop in body temperature could explain the sleep changes but infants aren't well evolved to cope with maternal separation, researchers said. Disrupting important early maternal-neonatal interactions may affect later development, they said.

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Friday, October 28, 2011

Signs You Have Arthritis Too

SiPsoriatic arthritis, a type of arthritis that affects people with the skin condition psoriasis, can attack the joints and tendons.

About 22% of people with psoriasis who have not been diagnosed with psoriatic arthritis appear to have symptoms of the condition, such as joint pain, swelling, and warmth, according to a 2011 survey by the National Psoriasis Foundation (NPF).

Based on the survey, which included 477 people and was funded by pharmaceutical companies, the NPF now recommends that doctors ask psoriasis patients these seven questions.gns You Have Arthritis Too                                    Sixty-seven percent of the people in the survey who had psoriatic arthritis reported joint pain, and their pain often moved from one joint to another. But even 21% of psoriasis-only patients had joint pain.

Mark McGraw, 52, had joint pain for more than 15 years before he mentioned it to his doctor. "I just figured it was from playing tackle football or breaking horses at my ranch," he says. When the topic finally came up, his doctor asked why he had never mentioned it before.

"'Because you're my dermatologist,'" he recalls saying. "'We talk about skin, not joints.'",,20539794_2,00.html               

FDA ties newer birth control drugs to blood clots (AP) — Safety concerns with the popular birth control pill Yaz increased Thursday as federal health scientists reported that the Bayer drug and other newer birth controltreatments appear to increase the risk of dangerous blood clots more than older medications.
A new study released by the Food and Drug Administrationreviewed the medical history of more than 800,000 U.S. women taking different forms of birth control between 2001 and 2007. On average, woman taking Yaz had a 75 percent greater chance of experiencing a blood clot than women taking older birth control drugs.
Yaz contains estrogen along with a next-generation synthetic hormone called drospirenone, which is known to increase potassium levels in the blood. FDA compared medical records of women taking the drug with those taking the older drug levonorgestrel.
Yaz, Yasmin and related drospirenone-containing pills were Bayer's second-best-selling franchise last year at $1.6 billion in global sales.
In 2009, the FDA took the unusual step of ordering Bayer to run corrective TV advertisements on Yaz, saying the drugmaker's marketing campaign overstated the drugs' ability to prevent acne and premenstrual syndrome.
Bayer Healthcare, a division of the German conglomerate, said it "is currently evaluating this publication and cannot comment at this point in time."
The agency also reported higher complications in women using the Ortho Evra patch from Johnson & Johnson and the Nuvaring vaginal ring from Merck & Co. Inc. Those drugs combine estrogen, which is present in all birth control pills, with two other synthetic hormones launched in the last decade.
The FDA said it hasn't reached a final conclusion on the drugs' safety but will hold a meeting with scientific advisers Dec. 8.
Consumer safety advocates have criticized the agency for approving newer, more expensive birth control drugs when cheaper, generic drugs with established safety records are widely available.
"At a certain point we have to ask why the FDA continues to approve drugs that are less safe and have no benefit compared to drugs already on the market," said Dr. Diana Zuckerman, president of the National Center for Women and Families, a consumer group for women's health issues. "With all these different birth control options, why take the most expensive one that can also kill you?"
Recent studies have reached differing conclusions on the risks of newer birth control pills.
A study published earlier this week involving more than 1 million Danish women found that women taking Yaz and other newer medications had twice the risk of blood clots as women taking the older hormone levonorgestrel. The findings appeared Tuesday in the British Medical Journal.
However, two studies published in 2007, conducted as part of the postmarketing requirements of the FDA or European regulators, did not find any difference in blood clotting between the two comparable groups.
Birth-control pills that contain drospirenone include Bayer's Yaz, Yasmin, Beyaz, Safyral; Sandoz's Syeda and Loryna; as well as Barr Laboratories' Ocella, Watson Pharmaceuticals' Zarah and Teva Pharmaceuticals' Loryna.

Woman Turns Birth Into 'Performance Art'

I bet you’ve never seen an exhibit like this before.
A recent report from the New York Post told the story of a New York woman who turned her pregnancy – and labor – into a piece of “performance art.”
Marni Kotak, 36, spent the last month of her pregnancy inside an art display set up like a birthing room at the Microscope Gallery in Brooklyn as part of the project, which she called “The Birth of Baby X.”
On Tuesday, Kotak gave birth to a 9-pound, 2-ounce, baby boy in front of a crowd of 20 randomly selected observers. The birth was assisted by a midwife.
Now, I’m all for artistic freedom, but I’m not as comfortable with trivializing the complexity of birth. And the story left me somewhat confused – not to mention concerned – because I do not want women to think that non-hospital deliveries are as simple as letting nature take its course, as this story might imply.
When considering a home birth, it’s important to evaluate certain risk factors, such as:
-Size and position of the baby
-Location of the placenta
-Whether it is a single or multiple pregnancy
-Certain medical problems present in the mother, like hypertension and diabetes
All of these factors, if not checked out, could be catastrophic – and sometimes even fatal – for the newborn during a home birth.
However, I’m not knocking home birth all together. I think a home birth done with good monitoring, strong medical backup and a midwife or doula who is well-versed in vaginal deliveries, can be safe for both the infant and the mother.
Nevertheless, it’s still hard for me to understand why Kotak wanted to make art from something that I consider to be a magical moment between the mother, child and father, and display it in front of 20 strangers. To me, personally, that detaches the process of labor from the true meaning of birth.

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Thursday, October 27, 2011

Doctors split on Avastin for breast cancer - survey

NEW YORK (Reuters Health) - An international survey of cancer doctors shows that many question U.S. health advisers' 2010 rejection of Roche Holding's drug Avastin to treat advanced breast cancer.
The small survey, published in the journal Cancer, shows that almost half of the respondents would continue to use the drug under certain circumstances regardless of the final decision from the U.S. Food and Drug Administration. (For the full results, see:
"The controversy surrounding the FDA's decision on possibly withdrawing bevacizumab (Avastin's generic name) from its indication for use among women with (metastatic breast cancer) was felt across the globe," said Dr. Shaheenah Dawood, the survey's lead author, in an e-mail to Reuters Health.
Once thought to slow advanced, or metastatic, breast cancer by almost six months, more recent studies show Avastin only slowed the disease by two to three months.
The new numbers coupled with side effects, including ulcers in the stomach and intestines as well as blood clots, led an independent panel to reaffirm the FDA's proposal in June.
FDA Commissioner Margaret Hamburg has yet to finalize the decision, but some insurers have already decided to stop paying for the $8,000-a-month drug.
Others, including the federal Centers for Medicare and Medicaid Services, have said they will continue to cover the drug regardless of the FDA's decision.
Avastin's use for lung, kidney and brain cancers has not been challenged.
Dawood, of Dubai Hospital in United Arab Emirates, and her colleagues sent the survey to about 3,000 cancer doctors. Only 564 responded, limiting how representative the new findings are.
More than four out of 10 doctors said they would continue to use the drug under certain circumstances even if the FDA rejected it, and eight percent said, "of course I will use it."
A fifth of the respondents said they would not use the drug at all, and nine percent said they would be reluctant to use it.
"In the ideal world, I would like the ability to prescribe Avastin for my patients," said Dr. Eric Winer, director of the Breast Oncology Center at the Dana-Farber Cancer Institute in Boston. "However, I don't think this is a huge travesty if it's not available."
Winer has cut back on using Avastin in his own center, but said he did it independently of the FDA's proposal.
"Like the panel, we were paying attention to the data coming out from other clinical trials," Winer told Reuters Health.
Although the FDA does not consider cost in its decisions, 78 percent of respondents thought it did. Even more thought the FDA's decision might open the door to the evaluation of other drugs.
The survey was conducted through the United Arab Emirates Cancer Congress. Dawood received honoraria from Roche, Avastin's manufacturer, but she said it was not connected to the survey.

Fertility treatment raises tumor risk in study (Reuters) - Women given drugs during fertility treatment to stimulate their ovaries to produce extra eggs have an increased risk of developing borderline ovarian tumors, Dutch researchers said on Thursday.
A large 15-year study found women undergoing in-vitro fertilization (IVF) were twice as likely to develop ovarian malignancies -- defined as either cancer or borderline tumors -- as similarly sub-fertile women who were not treated.
The risk was concentrated in borderline tumors, which have abnormal cells that may become cancerous but usually do not. The danger of invasive ovarian cancer was slightly higher in the IVF treatment group but this was not statistically significant.
Fertility experts said the results showed there was a need for further research, although they stressed the apparent risks were still very low.
"This ... goes some way to answering the questions that so many IVF patients ask. However, the results should be kept in proportion as the increase shown was from around five in a thousand to seven per thousand women," said Peter Braude of Kings College London.
Braude, who was not involved in the Dutch study, said the possible risks needed to be balanced against the important objective of IVF in conceiving a child.
Lead researcher Flora van Leeuwen of the Netherlands Cancer Institute in Amsterdam said the findings were significant because the study was the first to include a comparison group of sub-fertile women not undergoing IVF.
That is important because having difficulty conceiving or never having been pregnant are in themselves known risk factors for ovarian tumors.
The study observed 25,000 women, of whom 19,000 received IVF. It found 61 ovarian malignancies among the IVF group, of which 31 were borderline tumors and 30 invasive cancer -- a proportion of borderline cases that was unusually high.
Richard Kennedy, general secretary of the International Federation of Fertility Societies (IF), noted that other studies over the past decade looking at ovarian stimulation and cancer risk had been generally reassuring.
"The IF remains of the view that the long-term risks are low but calls for continued vigilance through reporting of long-term outcomes with international collaboration," he said in a statement.
SOURCE: Human Reproduction, online October 26, 2011.

Wednesday, October 26, 2011

Boys should get HPV vaccine given to girls

ATLANTA (AP) — A vaccine against cervical cancer hasn't been all that popular for girls. It may be even a harder sell for boys now that it's been recommended for them too.
A government advisory panel on Tuesday decided that the vaccine should also be given to boys, in part to help prevent the cancer-causing virus through sex.
Public health officials have tried since 2006 to get parents to have their daughters vaccinated against the human papillomavirus, orHPV, which causes most of the cervical cancer in women.
They have had limited success, hitting a number of hurdles. Some parents distrust the safety of vaccines, especially newer products. Others don't want to think about their daughters having sex one day, or worry that the vaccine essentially promotes promiscuous behavior.
Tuesday's vote by the Advisory Committee on Immunization Practices' was the first to strongly recommend routine vaccination for boys since the vaccine was first approved for them two years ago. Officials acknowledged the low rate in girls encouraged them to take a new, hard look.
Experts say a key benefit of routinely vaccinating boys could be preventing the spread of the virus to others through sex — making up somewhat for the disappointing vaccination rate in girls. But the recommendation is being framed as an important new measure against cancer in males.
"Today is another milestone in the nation's battle against cancer," said Dr. Anne Schuchat, a U.S. Centers for Disease Control and Prevention administrator who oversees the agency's immunization programs.
Federal health officials usually adopt the panel's recommendations and ask doctors and patients to follow them.
The vaccine has been advised for girls since 2006. Just 49 percent of adolescent girls have gotten at least the first of the three HPV shots. Only a third had gotten all three doses by last year.
"Pretty terrible," Schuchat said.
Schuchat attributed the low rates for girls to confusion or misunderstanding by parents that they can wait until their daughter becomes sexually active. It works best if the shots are given before a girl or boy begins having sex.
Some conservatives argue the vaccine could promote promiscuous behavior. It has come up in the GOP presidential campaign. Texas Gov. Rick Perry came under attack for a 2007 executive order requiring adolescent girls to get the vaccine (with an opt-out clause). When conservative lawmakers rebelled, he backed down.
An estimated 75 to 80 percent of men and women are infected with HPV during their life, but most don't develop symptoms or get sick, according to the CDC. Some infections lead to genital warts, cervical cancer and other cancers, including of the head and neck.
The HPV vaccine is approved for use in males and females ages 9 to 26; it is usually given to 11- and 12-year olds when they get other vaccines. The committee also recommended that males 13 to 21 years get vaccinated.
Tuesday's vote follows recent studies that show the vaccine prevents anal cancer in males, and may work against a type of throat cancer. A study that focused on gay men found it to be 75 percent effective against anal cancer.
While anal cancer has been increasing, it's still fairly rare. Only about 7,000 U.S. cases in men each year are tied to the strains targeted in the HPV vaccine. In contrast, about 15,000 vaccine-preventable cervical cancers in women occur annually.
Preventing a cancer that's primarily associated with gay men may not be much of a selling point, said Dr. Ranit Mishori, a family practice doctor in Washington, D.C. and an assistant professor at the Georgetown University School of Medicine.
Some parents may say "'Why are you vaccinating my son against anal cancer? He's not gay! He's not ever going to be gay!' I can see that will come up," said Mishori, who supports the panel's recommendation.
Schuchat indicated the CDC is ready for that kind of argument: "There's no data suggesting that offering a vaccine against HPV will change people's subsequent sexual behavior," she said.
So far, the threat of genital warts hasn't been persuasive: Some data suggest that less than 1.5 percent of adolescent males have gotten the vaccine over the past two years.
Meanwhile, some feel it's unlikely that most parents will agree to get their sons vaccinated primarily to protect girls. A survey of 600 pediatricians last year found that nearly 70 percent of doctors thought families would deem vaccination of their boys as unnecessary.
Experts at the committee meeting noted an earlier analysis that showed vaccinating boys would not be cost-effective if the female vaccination were high.
"If you do reach high coverage of females, will you stop vaccinating males?" asked Dr. David Salisbury, director immunization for the United Kingdom's Department of Health.
There are two vaccines against HPV, but Tuesday's vote applies only to Merck & Co.'s Gardasil, which costs $130 a dose. The other vaccine wasn't tested for males.
The committee's recommendation — and the greater insurance coverage of the vaccine that is expected to follow — will make it easier for more boys to get the shots, said Dr. Mark Feinberg, chief public health and science officer for Merck Vaccines.
Merck officials bristled at the idea that males would see the vaccine as mainly meant for gay men, noting that HPV-caused anal cancers can occur in heterosexual men.
Maura Robbins of Chicago said she's likely to have her 12-year-old son, Cole, vaccinated against HPV — but probably not until he's a little older. "I would just like to see some long-term testing and long-term results," she said.E2MS1hNjBlLTc4NWYzMDE1ZjY0OQRwb3MDMgRzZWMDbG5fU2V4dWFsSGVhbHRoX2dhbAR2ZXIDMDE5NjIwZjAtZmZlMy0xMWUwLWJmZDEtMGNlNWM0MTk5OTZm;_ylv=