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Allergy: Your Questions Answered

Written in the popular question and answer format of the Your Questions Answered series, this resource provides all of the information primary care providers need to understand allergies and to deliver effective care. The information is up to date, evidence-based, and appropriate for sharing with patients and families who wish to learn more about the nature of the disease and the various management options. Answers the questions that are frequently asked by patients. Discusses both commonplace and rarer issues. Covers all of the drug treatments available today, including their benefits and side effects. Explores treatments currently under development. Includes useful information on web sites and associations.1. Allergy and allergens 2. Asthma 3. Hay fever 4. Perennial rhinitis 5. Ocular allergy 6. Anaphylaxis 7. Angioedema and urticaria 8. Eczema and dermatitis 9. Food allergy 10. Occupational allergies 11. Allergy in children 12. Complementary therapies 13. Travel and allergy Appendices: Referen

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Heart(y) news, July 30

Trans fat use “close to zero” in fast-food chains
Sounds too good to be true but American fast food chains seem to be making progress in getting rid of transfat from their menus, especially the notoriously fatty fries. Burger King, Wendy’s, Jack in the Box, and Dairy Queen  – the top five reportedly managed to reach the “almost zero” level of transfat in their products without increasing saturated fats in the process. The results of the study were presented last week at the 2010 National Nutrient Database Conference in Grand Forks, ND. This is based on data collected by the University of Minnesota’s nutrition coordinating center, which tracks the nutritional value of more than 18,000 food.

The antitrans fat movement goes back just a few years but seems to be making lots of progress. Heartwire reports:

“In New York City, where a two-phase ban on trans-fatty acids was instituted in 2007, as reported previously by heartwire, the use of the partially hydrogenated vegetable oil declined to less than 2%, a recent study showed. The use of trans fat is banned in California, and other cities and states have partial or full bans in place. Denmark was the first country to introduce laws regulating the sale of food with trans-fatty acids. The UK Faculty of Public Health and the Royal Society for Public Health have called for the elimination of trans fat in the UK by 2011.”

Two new randomized trials bolster benefits of compression-only CPR
Cardiopulmonary resuscitation (CPR): with or without mouth-to-mouth ventilation? New data from two trials seem to answer the question. Compression-only CPR is just as good as or maybe even better than CPR with both compressions and mouth-to-mouth ventilations. In recent years, experts campaigned for the so-called hands-only CPR which is supposedly easier and more acceptable and encourages bystander CPR.

“Overall, this [nationwide] study lends further support to the hypothesis that compression-only CPR, which is easier to learn and to perform, should be considered the preferred method for CPR performed by bystanders in patients with cardiac arrest,”

AHA Scientific Statement
Earlier this month, the American Heart Association (AHA) issued this scientific statement: “Combined behavioral interventions are the best way to reduce heart disease risk.” This is an indirect way of saying that medications alone are not enough. According to an AHA press release:

“Combining counseling, extended follow-up with a healthcare provider and self-monitoring of diet and exercise is the most effective way to help patients embrace lifestyle changes that can lower their risk for heart and blood vessel (cardiovascular) diseases.”

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Health care updates, July 30

Prestigious US journal gets a new web site
The New England Journal of Medicine, one of the most prestigious journals in the world, has a new site with better accessibility, more interactivity, and better search engine to help doctors deliver quality health care. Check out the new www.NEJM.org.

The Path to Personalized Medicine
This perspective article published in NEJM was authored by 2 health care experts, Dr. Margaret A. Hamburg, commissioner of the US FDA and Dr. Francis S. Collins, director of the National Institutes of Health (NIH). The article discusses the pathway to personalized medicine and how basic, translational, and regulatory science work hand in hand towards this goal. The authors wrote:

“… the NIH and the FDA will develop a more integrated pathway that connects all the steps between the identification of a potential therapeutic target by academic researchers and the approval of a therapy for clinical use. This pathway will include NIH-supported centers where researchers can screen thousands of chemicals to find potential drug candidates, as well as public–private partnerships to help move candidate compounds into commercial development…”

U.S. experts back AstraZeneca blood thinner
Good news for AstraZeneca. A US FDA panel recommends the approval of Brilinta, the company’s new blood-thinning agent that supposedly can help prevent deaths and heart attacks. This is welcome news to AstraZeneca as the company faces lawsuits as well as expiration of the patents of their bestselling drugs.

The panel vote was a welcome surprise as data from US clinical trials were initially not so convincing compared to its competitors. Although final approval hasn’t been announced yet, experts believe the US FDA will follow the panel’s recommendations.

Inequalities in mortality in Britain today greater than those during 1930s economic depression
How can this be true? Disparities in premature mortality among the British population are worse than ever. Worse, in fact, than what was reported during the great depression in the 1930s. This is according to a study by researchers at the University of Bristol and the University of Sheffield. The researchers believe the inequalities are due to the widening gap in wealth and income. The authors report:

“Although life expectancy for all people is increasing, the gap between the best and worst districts is continuing to increase. The economic crash of 2008 might precede even greater inequalities in mortality between areas in Britain.”

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Female sexual dysfunction and diabetes

Diabetes comes with a lot of complications, including sexual dysfunction. There has been a lot of research on the relation between type 2 diabetes and erectile dysfunction (ED) in male patients with reported prevalence of up to 50%, but little is known about female sexual dysfunction (FSD). FSD is characterized by lack of libido and sexual satisfaction, even discomfort and pain during intercourse.

Italian researchers decided to address this knowledge gap and investigated the factors that are correlated to FSD in diabetic patients.  Their results indicated that FSD was not linked to hemoglobin A1C or time since diagnosis, hypertension or smoking. However, FSD was shown to be most prevalent in women who are married or depressed. Whereas physical activity positive influences FSD, age, metabolic syndrome and poor lipid profile seem have a negative impact. Much more, FSD is more prevalent in menopausal women compared to non-menopausal women. The authors concluded that:

“Further studies are needed to elucidate in full the mechanisms underlying the evident differences between male and female sexual function. In the meantime, evaluation of female sexuality should become a routine evaluation in women with type 2 diabetes, such as other diabetic complications.”

The results indicate sexual dysfunction occurs in both men and women especially among those with diabetes. However, the determining factors seem to differ between sexes. Whereas ED is closely linked to cardiovascular risk factors, FSD seems to be more linked to neurological and social factors. In fact, several studies have linked FSD to depression and marital status

There is something that diabetic women can do to help prevent FSD – improvement in diet and more physical activity. Experts believe it is not just diabetic diet that would help but sticking to the so-called Mediterranean diet, according to the same team of researchers.

Mediterranean diet has been shown to be beneficial for the heart and blood sugar levels. However, this is the first study to demonstrate the positive effect of such a diet in reducing FSD.

Like many chronic diseases, diabetes and its many complications, including sexual dysfunction benefits from lifestyle change that involves diet and physical exercise.

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Folate and lung cancer

As scientists continue to unravel the genetics of cancer, other researchers are also discovering ways of using these information in preventing or slowing down cancer.

Take for example lung cancer. Studies have identified a high number of genetic mutations in the lungs of smokers. Furthermore, the carcinogens that cause their mutations vary depending on the cigarettes, their ingredients and how they are manufactured.

But knowing the genetic mechanisms of cancer is not enough. Steven Belinsky of the Lovelace Respiratory Research Institute in New Mexico and his colleagues studied more than 1000 current and former smokers and report possible ways of slowing down  lung cancer even if not being able to beat it completely. And it is something that you can do all by yourself through lifestyle change. The answer lies in your diet. The research results indicate that genetic changes that lead to lung cancer is less severe among those who ate leafy green vegetables , multivitamins and foods rich with folate.

According to Dr. Belinsky:

“These studies do in fact indicate that substances in these food groups and in the multivitamins could potentially retard the processes by which these gene changes occur in the smoker.’’

The researchers identified sputum samples of smokers eight genes  which are commonly “silenced” in lung cancer patients and strongly associated with risk for this disease.

Folate is a vitamin commonly associated with pregnancy to prevent fetal defects such as spina bifida. However, everybody needs folate. According to World’ Healthiest Food, folate

• Supports red blood cell production and help prevent anemia
• Helps prevent homocysteine build-up in your blood
• Supports cell production, especially in your skin
• Allows nerves to function properly
• Helps prevent osteoporosis-related bone fractures
• Helps prevent dementias including Alzheimer’s

So what are foods that are rich in folate?

Table 1: Selected Food Sources of Folate and Folic Acid

Food	Micrograms (μg)	% DV^
*Breakfast cereals fortified with 100% of the DV, ¾ cup	400	100
Beef liver, cooked, braised, 3 ounces	185	45
Cowpeas (blackeyes), immature, cooked, boiled, ½ cup	105	25
*Breakfast cereals, fortified with 25% of the DV, ¾ cup	100	25
Spinach, frozen, cooked, boiled, ½ cup	100	25
Great Northern beans, boiled, ½ cup	90	20
Asparagus, boiled, 4 spears	85	20
*Rice, white, long-grain, parboiled, enriched, cooked, ½ cup	65	15
Vegetarian baked beans, canned, 1 cup	60	15
Spinach, raw, 1 cup	60	15
Green peas, frozen, boiled, ½ cup	50	15
Broccoli, chopped, frozen, cooked, ½ cup	50	15
*Egg noodles, cooked, enriched, ½ cup	50	15
Broccoli, raw, 2 spears (each 5 inches long)	45	10
Avocado, raw, all varieties, sliced, ½ cup sliced	45	10
Peanuts, all types, dry roasted, 1 ounce	40	10
Lettuce, Romaine, shredded, ½ cup	40	10
Wheat germ, crude, 2 Tablespoons	40	10
Tomato Juice, canned, 6 ounces	35	10
Orange juice, chilled, includes concentrate, ¾ cup	35	10
Turnip greens, frozen, cooked, boiled, ½ cup	30	8
Orange, all commercial varieties, fresh, 1 small	30	8
*Bread, white, 1 slice	25	6
*Bread, whole wheat, 1 slice	25	6
Egg, whole, raw, fresh, 1 large	25	6
Cantaloupe, raw, ¼ medium	25	6
Papaya, raw, ½ cup cubes	25	6
Banana, raw, 1 medium	20	6

Source: Office of Dietary Supplement, National Institutes for Health (ODS)

How much folate do we need?

Table 2: Recommended Dietary Allowances for Folate for Children and Adults [10]

Age (years)	Males and Females (μg/day)	Pregnancy (μg/day)	Lactation (μg/day)
1-3	150	N/A	N/A
4-8	200	N/A	N/A
9-13	300	N/A	N/A
14-18	400	600	500
19+	400	600	500

*1 DFE = 1 μg food folate = 0.6 μg folic acid from supplements and fortified foods

Source: Office of Dietary Supplement, National Institutes for Health (ODS)

Special warning

Folate from natural sources is not linked to any health risks. However, folate supplements in the form of folic acid can be toxic if taken in large amounts.

According to ODS:

Beware of the interaction between vitamin B12 and folic acid.

Intake of supplemental folic acid should not exceed 1,000 micrograms (μg) per day to prevent folic acid from triggering symptoms of vitamin B12 deficiency [10]. Folic acid supplements can correct the anemia associated with vitamin B12 deficiency. Unfortunately, folic acid will not correct changes in the nervous system that result from vitamin B12 deficiency. Permanent nerve damage can occur if vitamin B12 deficiency is not treated.

It is very important for older adults to be aware of the relationship between folic acid and vitamin B12 because they are at greater risk of having a vitamin B12 deficiency. If you are 50 years of age or older, ask your physician to check your B12 status before you take a supplement that contains folic acid. If you are taking a supplement containing folic acid, read the label to make sure it also contains B12 or speak with a physician about the need for a B12 supplement.

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G5 Massager Applicator 210

Soft Sponge Rubber 2 5/8 inch Diameter

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Surgical wonders and innovations

Here are the latest advances in surgery and implantation.

Doctors perform brain surgery via eyelid
A brain tumor usually requires a very invasive surgery, a procedure that entails opening the skull. However, recent innovations in medicine enable a minimally invasive procedure that could be comparable to a “keyhole” surgery of the brain. Doctors at the Johns Hopkins Hospital were able to remove a female patient’s tumor through a small incision in her eyelid.

According to the 47-year old female patient:

“When you tell people you had brain surgery, the first thing people always do is look for a scar, and that’s what’s amazing, there isn’t one. Anyone who needs to go through this should know it’s not that big of a deal even if it sounds like it is.”

First US surgery to compare NOTES vs. laparoscopy
NOTES stands for natural orifice translumenal endoscopic surgery and if you think laparoscopy is minimally invasive, NOTES is even several incisions less. Instead, it uses as point of entry natural orifices. In a groundbreaking clinical trial, researchers compare the use of laparoscopy vs. NOTES in gall bladder removal. As point of entry in the NOTES, the researchers used the mouth and on through the abdominal wall or through the vagina to access the gall bladder. The surgery needs only 2 small incisions that do not require suturing. According to study leader Dr. Santiago Horgan of the University of California at San Diego

“What is unique about this trial is that we will not only evaluate the safety and efficacy of NOTES compared to laparoscopy but will also assess and compare pain levels, cosmetic outcomes, operative costs and logistical outcomes.”

Eye telescope implant clears FDA hurdle
Ever thought of having a telescope in your eye? Apparently this procedure is now available, recently approved by the US FDA to treat patients with vision problems. Target patients are those suffering from end-stage age-related macular degeneration above the age of 60. The telescope replaces the natural lens of the eyes and provided images magnified by 2.2 to 2.7 times.

First full face transplant performed in Barcelona
It took 24 hours and 30 surgeons to accomplish the feat – implantation of new facial muscles, skin, nose, lips, jaw, teeth, palate and cheekbones. The operation took place in March but it was only recently that the young male patient braved the media to express his gratitude to the medical team who performed the surgery. Before the surgery, the patient could not breathe or swallow on his own.

Full Face Transplant Claimed by French Doctors
French doctors claim that theirs was the first “full” face transplant almost months after Spanish doctors claimed a similar feat. The operation was performed at the Henri Mondor hospital in the Paris suburb of Creteil last June 27. The operation not only involved full face transplant but also transplant of eyelids and tear ducts.

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Pregnancy after breast cancer

One of the main concerns of cancer survivors is loss of fertility and the ability to bear children. However, although a large number of breast cancer survivors still retain their reproductive potential, doctors are worried that pregnancy for these women can lead to hormonal changes that cause recurrence of the cancer.

A recent study however reports that these concerns are unfounded and that pregnancy for breast cancer survivors is quite safe and does not seem to increase the risk for recurrence.

Belgian researchers lead by Dr. Hatem Azim of the Institute Jules Bordet conducted a meta-analysis of results from 14 previous trials that involved 1,400 pregnant women with a history of breast cancer. Their outcomes were then compared to outcomes of more than 18,000 breast cancer survivors who were not pregnant. Surprisingly, pregnancy seemed to actually lower the risk of recurrence of the cancer – by 42%.

According to Maria Leadbeater, a cancer expert at Breast Cancer Care:

“For many years, pregnancy was considered a risk for women who had breast cancer…  But this study seems to show the risk is not an issue once you’ve been treated.”

Experts used to believe that pregnancy is too risky for breast cancer survivors due to the complex relationship between the female hormones and the development of cancer.

“Estrogen is known to trigger breast cancer and women typically have more estrogen when they’re pregnant. But very high doses of the hormone can also kill cancer cells… Other hormones that are elevated in pregnancy, like the one for breast-feeding, have been proven to protect against breast cancer.”

However, the issue of pregnancy needs to be seriously discussed with doctors because this might not be advisable for all patients.  Some factors to be taken into consideration are:

• type of breast cancer
• response to treatment.
• time after treatment

Doctors’ opinions as to the time between treatment and trying to have a baby vary.

• Hormone therapy for breast cancer typically lasts for about 5 years, during which pregnancy is not advisable.
• Others believe a waiting time of 2 years as this is the period when relapse rate is highest.

The study results give hope to women who would like to have children despite cancer. The researchers hope that doctors should more open-minded and encouraging.

According to Dr. Azim:

“I hope this changes what doctors tell their patients. There’s no reason to tell women who survive breast cancer not to get pregnant.”

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Milk: the ideal drink for the bone and the heart

Milk is man’s first food, whether in the form of breast milk or substitutes like cow’s milk. But milk is not only for babies. Everybody needs the vitamins and minerals found in milk.

Milk is good for the bones.

How much milk do we need?

How much milk we need actually depends on the amount of calcium and potassium we need in order to maintain our bone health. The US Department of Agriculture (US DA) recommends the following:

• The recommended daily allowance for calcium is 1000 milligrams for young adults and 1200 for adults aged 50 and older.
• The recommended daily allowance for potassium is a whopping 4700 milligrams.

A cup of milk contains about 300 mg of calcium and 360 mg of potassium, plus lots of vitamins (A & D).

The US DA recommends daily intake of3 cups of milk of equivalent for those older than 8.

It is obvious that a large number of people do not meet the daily allowance. It is clear that milk is not only for the young but for the elderly as well.

Some experts believe that the RDAs for calcium and potassium are unrealistic. We need to drink about 13 cups of milk to meet our potassium RDA alone.

Luckily, there are other products which are rich in these minerals, including orange juice and other dairy products such as cheese and yoghurt. According to the US DA, one cup of yogurt, one and a half ounces of hard cheese, one-third cup of shredded cheese or two cups of cottage cheese counts as a cup of dairy and is equivalent to 1 cup of milk.

Milk is good for the heart.

A glass of milk per day can already provide lots of benefit to our heart. But not just any milk.

Even though milk and other dairy products may help meet our RDAs for these essential minerals, they also come with calories and fat. Thus, intake of low-fat dairy products is recommended.

According to Dr. Theresa Nicklas, a dairy researcher and professor of pediatrics with the Children’s Nutrition Research Center at the Baylor College of Medicine:

“Low-fat dairy is a way to meet these nutrient needs without a lot of fat and calories. It’s a unique nutritional package.”

Researchers report that “adults who had at least one serving of low-fat milk or milk products each day had 37 percent lower odds of poor kidney function linked to heart disease compared to those who drank little or no low-fat milk.”

The U.S. Dietary Guidelines for Americans recommend drinking three glasses of low-fat or fat free milk each day.

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Coming soon: blood test for depression?

The quest for biomarkers for certain disorders and diseased has kept biomedical scientists busy in recent years. Their efforts have borne fruit in the discovery of biomarkers in the blood that help in the screening and diagnosis of medical conditions such as cardiovascular diseases and cancer. However, when it comes to neurological and psychiatric disorders, the search of biomarkers has been very slow. Recent research results however, seem to show promise.

In general, the search for diagnostic markers can be approached in many different ways. The field of genomics is focusing on identifying variations in the genes (DNA) which can be detected in blood cells. In the field of proteomics, the measurement of the levels of specific proteins in the blood is being explored. Another field of research is the so-called gene expression profiling, “which measures the levels of RNA produced from DNA as an indication of the level of the “activity” of particular genes.”

With the third approach (gene expression profiling), Dutch researchers report promising results in screening patients for major depressive disorder, or MDD. The researchers were able to identify a set of 7 genes whose expression in the blood differs between patients with MDD and those without MDD.

According to study author Dr. Sabine Spijker:

“This is a first, but major step in providing a molecular diagnostic tool for depression. Although psychiatry already has specific criteria for diagnosing mental health disorders, this type of diagnosis would be unbiased and particularly valuable for those with whom it is more difficult to have a conversation. It may also eventually assist in reducing the stigma associated with mental health problems.”

Indeed, current methods of diagnosis of depression are still mainly based on patient-reported symptoms and evaluation by a mental health professional. The use of diagnostic markers, especially those detectable in the blood  

However, further research needs to be done to validate the sensitivity and specificity of the described blood test.

According to Dr. John Krystal, Editor of Biological Psychiatry.

“It is far too early to be confident that gene expression profiling will lead us to diagnostic or prognostic tests for depression. However, the objective of this line of research is extremely important. In the past, many types of tests have been explored as potential diagnostic markers, but they all have failed to have sufficient sensitivity and specificity to guide doctors in making psychiatric diagnoses or choosing between treatments. I look forward to seeing whether the patterns of gene expression profiling are replicable and diagnostically specific as multiple groups report their findings.”

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Heat exhaustion and heat stroke

The summer heat has been hard on everyone, but much more so on those who are suffering from chronic conditions such as cardiovascular disease. But even the healthy and fit need to take care.  The American Heart Association (AHA) especially warns us against two common health problems in the summer time: heat exhaustion and heat stroke.

Here are the symptoms of heat exhaustion:

• heavy sweating
• cold, clammy skin
• dizziness or fainting (syncope)
• a weak and rapid pulse
• muscle cramps
• fast, shallow breathing
• nausea, vomiting or both

If left unattended, heat exhaustion can quick progress to heat stroke, with the following symptoms:

• warm, dry skin with no sweating
• strong and rapid pulse
• confusion and/or unconsciousness
• high fever
• throbbing headaches
• nausea, vomiting or both

How do heat exhaustion and stroke happen?

Heat exhaustion and stroke can be caused by extreme temperatures and humidity on the one hand, and dehydration on the other hand. The AHA says that temperature above 70°F and humidity above 70% are conditions where heat stroke can happen. These extreme conditions can interfered with the natural cooling process of the body.

Dehydration plays an important role. Under these circumstances the body loses high amounts of fluids that need to be regularly and sufficiently replenished.

When you are dehydrated, your total blood volume decreases. The heart has to pump extra hard to get this smaller volume of blood to the vital parts of the body. In addition, dehydration can also lead to rise in body temperature that can cause damage to the heart and the brain.

So how can we avoid heat stroke and exhaustion?

Drink, drink, drink. The obvious preventive measure is to drink plenty of liquids to replenish what we lose. You may think you are drinking enough but it may not be sufficient at all. Here is a way to check whether you are dehydrated or not (source: AHA):

“A good way to monitor your body fluid level is to weigh every morning after using the bathroom. If you weigh two pounds less than normal in the morning, you’re probably dehydrated and need to drink more water before doing any vigorous physical activity. (You may have lost weight as water but not as fat.)”

Avoid strenuous physical activity outdoors in hot humid conditions. Exercising and working under these extreme conditions are simply asking for trouble. Last week, many construction works all over Zurich were put to a stop due to high temperatures. Those projects which chose to continue were required to provide shade to outdoor workers and frequent breaks up to 10 minutes every hour.

If you have to do sports outdoors, take precautions. Even the fittest athletes can suffer from heat exhaustion. It is therefore necessary to make sure your body is adapted to the conditions. Wear light, comfortable clothing during exercise. Do not forget to drink. If it really gets too hot, douse yourself with water.

Unfortunately, do not take the risks of extreme heat and humidity seriously. However, we must bear in mind: heat stroke can kill you!

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Breast Cancer: Questions, Answers & Self-Help Techniques

Breast Cancer: Questions, Answers & Self-Help Techniques

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Cancer in the headlines, July 23

Mom searches China for donor to save her daughter’s life
Fifteen years ago, Sherrie Cramer adopted a malnourished baby from a Chinese orphanage who grew up to be Katie. Four years ago, the now 16-year old Katie developed leukemia and needed a bone marrow transplant. Unfortunately, no match in the US can be found. Katie’s situation highlights a common problem facing ethnic minorities in the US. “The Asian American Donor Program says ethnic minorities overall have a 50 percent chance of finding a perfect match from the U.S. bone marrow donor registry of 8 million people, compared to an 80 percent chance for Caucasians.”

Annual report: US cancer death rates still declining
Death rates due to cancer are continuing to decline, according to Cancer Statistics, 2010, the annual cancer statistics report of the American Cancer Society’s (ACS). According to Dr. John R. Seffrin, chief executive officer of the American Cancer Society and its advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN):

“This report is yet more proof we are creating a world with more birthdays… We will build on our progress in the fight against cancer through laws and policies that increase access to cancer prevention, early detection, and treatment services, and with a sustained federal investment in research designed to find breakthroughs in the prevention and treatment of the most deadly forms of cancer.”

Yet, the battle is far from over. There is still much work to be done and cancer continues to be a major health concern in the US.

The report is accoumpanied by Cancer Facts & Figures 2010 and is published in the ACS journal CA: A Cancer Journal for Clinicians.

FDA advisory panel votes against Avastin for advanced breast cancer
A US FDA advisory panel voted to withdraw the approval of the cancer drug bevacizumab (Avastin) for the indication of advanced breast cancer in combination with chemotherapy. New data from clinical trials indicate that Avastin does not seem to provide added benefit compared to treatment with chemo alone. Avastin is approved for other types of cancer as well and the panel’s recommendation does not apply to the other approved indications.

NY mulls indoor tanning rules, cites cancer risk
New York is on the move again in trying to improve its residents’ health. Next to smoking bans and the trans-fat free restaurant food, it is now looking into tanning salons. Current New York law bans “commercial indoor tanning for children under 14 and requires written parental consent for those from 14 up to 18.” Health advocates are pushing for stricter regulations, calling tanning beds “cancer chambers.”

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Pharma news, 23 July

Money troubles for European drug makers? Check out the latest buzz in the pharmaceutical industry.

Roche May Lose $1 Billion a Year on Avastin Change
The anti-cancer drug Avastin (bevacizumab)suffered a setback in the US that will cost its manufacturer Roche an estimated US $1 billion annually, according to Bloomsberg Businessweek. Avastin has been approved by the US FDA for metastatic  colorectal cancer, non‑squamous non‑small cell lung cancer (NSCLC) and metastatic Breast Cancer (MBC). However, an FDA advisory panel voted earlier this week “to rescind Avastin’s clearance in breast cancer after finding the drug paired with chemotherapies didn’t work better than other medicines alone.” Although the FDA is not required to act on recommendations of the panel , the regulatory body usually does. The recommendations are based on poor performance of Avastin on breast cancer clinical trials.

Glaxo Said to Have Paid $1 Billion Over Paxil Suits
The UK-based drug maker GlaxoSmithKline (GSK) has reportedly agreed to pay more than US $1 billion in connection with cases related to the anti-depressant Paxil. The drug has supposedly caused birth defects in more 800 cases. Paxil was approved in the US in 1992 but the company supposedly failed to warn patients of potential birth defects when taking the drug during pregnancy. Some of the defects reported are quite serious including congenital heart defects. There are accusations that the company decided to bury “negative studies about Paxil’s links to birth defects and that its own scientists were alarmed by the rising number of children who had been affected by the drug in the womb.”

News report links Avandia panelists to drug makers
GSK is also bracing for more substantial settlements, this time regarding the antidiabetis drug Avandia (rosiglitazone). According to the Wall Street Journal, one of the panellists who was in the FDA committee who reviewed the safety of Avandia (and who later voted to keeping the drug on the market) had a connection with GSK as a paid speaker, thus, pointing to a potential conflict of interest. However, the panellist Dr David Capuzzi (Lankenau Institute for Medical Research, Philadelphia, PA denies any conflict of interest as he never gave any talks promoting Avandia. In fact, he is also a paid speaker for other  pharma companies, including Takeda Pharmaceuticals, the makers of  Avandia’s rival pioglitazone (Actos).

AstraZeneca Said to Pay $2 Million in Seroquel Cases
AstraZeneca is another UK drug maker who is paying lots of money for a drug’s unexpected side effect. The company is facing lawsuits about its antipsychotic drug Seroquel which supposedly causes diabetes. The settlement is expected to be about US$2 million, much lower than expected. Definitely less than what was paid in a similar case of Zyprexa by Eli Lilly.

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TRANSATLANTIC HOMELAND SECURITY?: PROTECTING SOCIETY IN THE AGE OF CAT

Creating an effective and integrated national homeland security effort represents a significant challenge. Europe and the United States have reacted differently to the emergence of mass casualty terrorism, but must work together to cope with the diverse issue areas, sectors, professions, and relevant actors involved in such a broad-based concept.brThis study provides both conceptual and practical guidance at a crucial time when intellectual and practical efforts to protect against the new terrorism should move beyond a purely domestic focus. Europe and the US have a lot to gain by coordinating more closely, and exchange of experience is crucial as we attempt to stay ahead of a learning enemy.

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The 2007 Report On Whole Mature Young Turkeys 4 To 7 Months Of Age: Wo

This report was created for global strategic planners who cannot be content with traditional methods of segmenting world markets. With the advent of a borderless world, cities become a more important criteria in prioritizing markets, as opposed to regions, continents, or countries. This report covers the top 2000 cities in over 200 countries. It does so by reporting the estimated market size (in terms of latent demand) for each major city of the world. It then ranks these cities and reports them in terms of their size as a percent of the country where they are located, their geographic region (e.g. Africa, Asia, Europe, Middle East, North America, Latin America), and the total world market. In performing various economic analyses for its clients, I have been occasionally asked to investigate the market potential for various products and services across cities. The purpose of the studies is to understand the density of demand within a country and the extent to which a city might be used as a point of distribution within its region. From an economic perspective, however, a city does not represent a population within rigid geographical boundaries. To an economist or strategic planner, a city represents an area of dominant influence over markets in adjacent areas. This influence varies from one industry to another, but also from one period of time to another. In what follows, I summarize the economic potential for the world’s major cities for whole mature young turkeys 4 to 7 months of age for the year 2007. The goal of this report is to report my findings on the real economic potential, or what an economist calls the latent demand, represented by a city when defined as an area of dominant influence. The reader needs to realize that latent demand may or may not represent real sales. For many items, latent demand is clearly observable in sales, as in the case for food or housing items. Consider, however, the category satellite launch vehicles. Clearly, there a@ŽH

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The controversy surrounding prenatal dex and manipulation of sexual orientation

The treatment seems straightforward enough at first glance. Using the steroid dexamethasone, clinicians are trying to treat a condition called congenital adrenal hyperplasia (CAH) right at from the womb. CAH is an in-born condition characterized by a malfunctioning adrenal glad that leads  toa serious hormonal disruption and the development of ambiguous genitalia. Children born with CAH have to be treated with steroids and hormones their whole life. Female babies born with CAH have a higher tendency towards tomboyism and lesbianism.

However, bioethicists at the Northwestern University Feinberg School of Medicine believe that the prenatal treatment goes beyond just CAH.  Researchers Alice Dreger and Ellen Feder believe that prenatal dexamethasone may be misused to prevent the occurrence of homosexuality.

Prof. Dreger states:

“This is the first we know in the history of medicine that clinicians are actively trying to prevent homosexuality.”

This came to light when parents who were carriers of the CAH genes had their babies checked for the abnormality while still in the womb.  An endocrinologist researcher at Mount Sinai Medical Center in New York City prescribes dexamethasone to pregnant women carrying babies with CAH. The only problem is that this kind of therapy using dexamethasone is off-label, e.g. the drug is approved for use in other conditions but not for this specific one – CAH. And the patients who received the steroid were not informed about this. Off-label use is not illegal and often done at the discretion of the doctor. However, there are certain procedures necessary to do this, including explain to the patient the risk and benefit and obtained a signed informed consent from the parents.

There are supporters for the dexamethasone (“dex”) treatment. It spares the baby the embarrassment of having ambiguous genitalia that would need to be corrected later. According to Dr. Ingrid Holm, a pediatric endocrinologist at Children’s Hospital in Boston.

“I see potential for benefits and I don’t see evidence there’s any negatives to this. There are lots of risks associated with surgery, and if this can prevent surgery, then it’s a good thing.”

However, there are those who question the safety of the treatment as the drug has not been fully properly tested in humans. In addition, although the drug addresses the problem of ambiguous genitalia, it does not address the real cause of the problem, e.g. the endocrine disruption. Some doctors believe it is the parents’ anxiety about the condition that is being treated but not necessary for the benefit of the child.

The controversy about dexamethasone is not new. It has been around for decades. However, with the advent of genetic prenatal diagnostics, more and more parents are asking for treatment long before the child is delivered with the embarrassing problem. However, it is not only the genitalia that may be abnormal. Girls with CAH would not behave like typical Barbie-touting girls. One researcher wrote:

“CAH women as a group have a lower interest than controls in getting married and performing the traditional child-care/housewife role. As children, they show an unusually low interest in engaging in maternal play with baby dolls, and their interest in caring for infants, the frequency of daydreams or fantasies of pregnancy and motherhood, or the expressed wish of experiencing pregnancy and having children of their own appear to be relatively low in all age groups.”

The bioethicists at Northwestern University are concerned that this treatment is being used to manipulate the sexual orientation of female babies while still in the womb. They were especially concerned about a paper that proposes using prenatal dexamethasone to change the behavior of girls with CAH to be “closer to the expectation of heterosexual norms.”

At the moment, the medical community is divided about the pros and cons of the dexamethasone. However, a new consensus from seven major medical organizations (including the American Academy of Pediatrics) is expected to be published in the coming months regarding this issue.

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Fighting for priority: anti-obesity vs. anti-smoking campaigns

If you have to choose between eating and smoking as a vice for your child, which one do you think is the lesser of the two evils? A recent article in the New York Times discusses the dilemma that health experts, parents and policy makers alike have to face: which problem do they tackle first: childhood obesity or teenage smoking?

And the conclusion is that childhood obesity is gaining most of the attention, not to mention most of the funding. The reason? Childhood obesity is the “new kid on the block” whereas smoking is “old news.”

The US First Lady Michelle Obama recently launched the Let’s Move campaign, with the slogan “America’s Move to Raise a Healthier Generation of Kids.”.

Many non-profit organizations are shifting their funding efforts from anti-smoking campaigns to childhood obesity prevention campaigns. No wonder anti-smoking advocates are getting concerned. Although the anti-smoking campaign has made a lot of headway in the last 20 years, from anti-smoking legislations to regulation of cigarette advertising, packaging and marketing, they feel that there is still a lot of work to be done and that teenage smoking is a prevalent as ever. 19.5% of American high school students are smoking cigarettes. They argue that the health risks of smoking are much more serious than those of obesity.

Unfortunately, there is no accurate way to calculate lifetime health risks of obesity vs. smoking. And even if there is, I think bickering as to which problem is more important is counterproductive. Obesity and smoking are both our enemies. Besides, there are many other enemies out there: teenage abuse of drugs and alcohol, poverty, violence, just to name a few.

Many experts point out that most of the anti-obesity programs and interventions haven’t really come up with convincing results and that the money put into these are wasted. On the other hand, this highlights the need for more research and efforts to find the measures that can prevent obesity. It took years for anti-smoking campaigns to bear fruit. Maybe we should give anti-obesity campaigns a bit more time to prove themselves.

But what if you have to choose? The NYT article puts forwards this

“…suppose the nation had to make a choice between proven anti-obesity programs and proven anti-smoking programs. What would be best for a child with a predisposition to be obese and to smoke? Should you have programs that would prevent the child from gaining weight? Or should you wait until the child is a teenager and institute programs to prevent smoking?”

Tough choice, indeed.

Photo credit: www.designofsignage.com/; stock.xchng

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Don’t let the heat stop you from being active

Heart health and extreme heat do not go well together. And this summer, we are experiencing a heat wave. Under such circumstances, we cannot blame people if they’d rather stay at home and stay sedentary. However, do not let the summer heat beat us. We still need physical exercise regardless of the heat outside. Here are some tips on how to stay active this summer. I compiled this from recommendations of the American Heart Association (AHA) as well as from my own experience.

Here is what the AHA recommends:

• Going to a gym for a nice, cool environment with a variety of activities.
• Visiting your favorite local swimming hole or taking swimming lessons at a pool.
• Starting a walking group with your friends at the mall. The MyStart! Community, an online tool, encourages walkers to connect with others — whether from the neighborhood or on the other side of the country — to stay on track with a walking program.
• Taking up an indoor sport, such as racquetball, basketball or volleyball, or taking an aerobics class.
• Going ice skating.

Here are the things that I do to keep active:

Go for a walk or run early in the mornings or evenings. I normally jog during my lunch break. But in this summer heat, this isn’t possible anymore. I now go early mornings, just before 8 am, as soon as my kids go off to school. Even though I’d rather get an early start with my work, I rearranged my schedule to accommodate a 30-minute run each morning. Luckily, as a self-employed, I can be flexible.

Last April, while on holidays in tropical Asia, a morning jog on the beach and an evening stroll under stars were a great way to beat the tropical heat.

Take the stairs. When I had to go on client visits or shop at a mall, I try to take two to three flights of stairs rather than take the lift or the escalator.

Go to the forest or up the mountains. There was a day last week when an early run wasn’t possible. So I did my run at noon – in the forest. You would be surprised how trees and their shade can make a difference. On the weekends, we go hike in areas of higher altitude (thus cooler temperatures) but also in wooded areas. Last week we had this beautiful walk at 800 m above sea level, which is still low by Swiss standards but was cool enough. We aim to go higher this weekend.

Swim in the lakes and rivers. After the walk last weekend, we ended up bathing in the nearest river. The cold water flowing down from the mountains were so refreshing and would beat water from any pool anytime. We are lucky that Swiss lakes and rivers are so clean!

Take note that there are some indoor skiing areas in some countries. If you live in one of these countries (example: Dubai), then this is your chance to start learning how to ski.

Go to the gym. When everything else fails, the gym is still your best bet. Again, in tropical Asia a couple of months ago, this was the only option to stay active while staying in the big cities. And I almost invariably go for the treadmill and the pedometer.

Heat is not an excuse for being sedentary. Let’s get moving, no matter what.

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How asthma protects (yes!) you from cancer

My family has a history of asthma. One of my sons is suffering from wheezing and eczema. How can I say that these are good things to have, that they are actually blessings in disguise.

But that is actually what this recent study by French Canadian researchers tells me. Their findings show that men who suffer from eczema had a lower risk for developing lung cancer. And those who suffer from asthma have a lower risk for developing stomach cancer.

But how can one health condition provide protection against another more serious condition? Study author Professor Marie-Claude Rousseau of the INRS–Institut Armand-Frappier explains:

“Asthma and eczema are allergies brought about by a hyper-reactive immune system – a state which might have enabled abnormal cells to have been eliminated more efficiently, thereby reducing the risk of cancer.”

The researchers actually looked at exposures to occupation hazards and the risk for getting cancer. They checked 3000 male participants who have been diagnosed with cancer and compared to 512 people who did not have cancer. They specifically looked at the link between allergies and the incidence of the 8 of the most common types of cancer.

It is ironic to think that a bothersome condition such as allergy can have some benefits. Especially as both cancer rates and allergy rates are on the rise.

A recent estimate gives us the following figures: Allergy rates in the Western world in 1980 were 10%. Today it is 80%. Should this give us hope that our body is fighting back against cancer? It is really too soon to tell.

The study authors wrote:

These findings contribute important knowledge to population health and provide new research leads. Although the study did not allow to identify which specific factors related to asthma and eczema were responsible for reducing the risk of cancer, it offers new angles for research into the molecular and immunological mechanisms that are involved in immunostimulation, a potentially promising strategy for cancer prevention.

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