MORNING DISPATCH 11/19/08: Dour Docs, Cancer Causes, Dire Diabetes, Smoke Scams, and Dementia Dissension
U.S. faces mounting diabetes cost
A new study estimates that diabetes will soon cost the United States over $200 billion per year. "Diabetes is very expensive and the cost will only increase as more people develop the condition," Dr. Ross says. Dr. Whelan agrees, "The coming wave of diabetes cases, which is linked to increasing obesity rates, is going to be overwhelming for our healthcare system."
Dr. Kava points out that the increase in Type 2 diabetes will reach many corners of medicine: "It's going to affect the number of kidney dialysis patients, the number of amputations -- many things beyond diabetes itself."
States rarely use tobacco settlement money for anti-smoking programs
On the eve of the Great American Smokeout, many health groups are criticizing state governments for not using the money from a 1998 settlement with tobacco companies to fund anti-smoking efforts.
"This is one of the greatest scandals in public health history," Dr. Ross explains. "Ten years ago, billions of dollars was extracted from the tobacco industry to allegedly bolster states' anti-smoking education campaigns. However, 95% of this money was diverted from its stated purpose and went to filling other pockets in state budgets. Essentially, the tobacco industry paid off the states to continue business as usual."
ACSH's Jeff Stier raises the question, "If these funds were misused, where will new tobacco tax money go? Will it really go to improve public health?"
Gingko does not prevent dementia
ACSH staffers are not surprised that the supplement gingko biloba fails to prevent or delay dementia in patients over seventy-five. "People were taking gingko for brain health, but it doesn't appear to have any effect on dementia," Dr. Ross says.
We agree with Dr. P. Murali Doraiswamy, a memory expert at Duke University, who told the Wall Street Journal, "This is going to be a wake-up call to people who are blindly taking over-the-counter brain boosters, thinking if it's being sold in a reputable store it's effective."
Dr. Ross adds, "There's no such thing as alternative medicine. It's either medicine or it's not -- and gingko is not medicine."
MORNING DISPATCH 11/18/08: Kidney Disease, Flu, Breast Cancer, and MRSA
Kidney disease threatens vulnerable population
A prominent article in today's New York Times Science section addresses the growing problem of chronic kidney disease, which is linked to increasing rates of hypertension and diabetes. "Diabetes in particular is a really big risk factor for kidney disease," says ACSH's Dr. Ruth Kava.
We were especially surprised by a graph indicating that more than 40% of Americans over seventy suffer from chronic kidney disease, which ranges from decreased kidney function to complete kidney failure requiring dialysis or a transplant. "Kidney disease is very insidious" because patients tend to be asymptomatic in early stages, says ACSH's Dr. Gilbert Ross. "People aren't aware that their kidneys are failing until it has actually happened."
Screening for high blood pressure is a good first step in determining your risk for chronic kidney disease. "Unfortunately, as we know, hypertension is dramatically under-diagnosed and inadequately treated," Dr. Ross says. Those patients with risk factors -- and everyone over fifty -- should be screened for kidney disease with analyses of urine and blood.
Half of adults plan to refuse flu shots
ACSH staffers are shocked that nearly half of adults surveyed plan to refuse a flu shot this year. "143 to 146 millions doses are available this year, so apparently we're going to throw out a lot of vaccine," says ACSH's Dr. Elizabeth Whelan.
The most common reason cited for not getting the vaccine was "I don't get sick." The false belief that the vaccine can cause the flu and the idea that the shot is ineffective followed closely behind. And many people said they simply don't like shots or going to the doctor.
While, as Dr. Ross points out, "people between the ages of eighteen and fifty are not used to getting a flu shot every year," we'd like to remind Morning Dispatch readers that getting the vaccine no matter what your age and risk factors helps increase herd immunity, which is important in the effort to protect our population's most vulnerable members.
Does group therapy increase survival rates after breast cancer?
A new study points to the benefits of group therapy for increasing the survival times of breast cancer patients, but ACSH staffers remain skeptical of the way the findings are being presented. "This study could be a poster child for statistical variation," notes Dr. Ross. "But the headline proclaims, 'Group therapy may extend lives of breast cancer patients.' That's a leap that is not at all justified by the data."
Dr. Kava thinks, "There's probably a selection bias in there somewhere. Women who are already more health-conscious are probably the ones who will go to group therapy." For more information on analyzing studies like this one, see ACSH's publication Distinguishing Association from Causation .
Acrylamide exonerated again
A study of Swedish women shows -- once again -- that dietary intake of the chemical acrylamide is not linked to breast cancer. "Past research has found an association in animal studies but not in any human studies," Dr. Kava says. "This new research is particularly notable because Sweden was the first country to raise the alarm about finding acrylamide in food."
Dr. Ross says, "The American Journal of Epidemiology should get two cheers for publishing a negative study [that is, one not show a health effect] of acrylamide" -- rather than ignoring the information or grabbing media attention by inciting people's baseless fears.
Acrylamide is produced when carbohydrate-rich foods are cooked at high temperatures. For more information on its safety, see ACSH's publication Acrylamide in Food: Is It a Real Threat to Public Health?
New antibiotics for MRSA face hurdles for FDA approval
The FDA is currently reviewing three new antibiotics to treat staph infections, some caused by the "super bug" methicillin-resistant staph aureus (MRSA) that recently moved out of hospitals and into more public settings like schools and locker rooms.
"It is unlikely that the FDA will approve two of them based on safety concerns and evaluations of how well they work as compared to existing drugs," Dr. Ross explains. "New drugs not only have to pass the old safety and efficacy tests, but they also increasingly have to be better than drugs that are already on the market. I don't know of any other product that is evaluated in this way."
MORNING DISPATCH 11/17/08: Mexico vs. ED, NYC vs. Salt, plus Statins, Breastfeeding, and "Toxins"
Obituary supports fear of "environmental toxins"
ACSH staffers are disappointed by the obituary for Dr. I. Bernard Weinstein, a researcher at Columbia University "who advanced the study of how pollutants and other environmental factors can cause cancer." ACSH's Dr. Elizabeth Whelan says, "This story is just contributing to the misinformation that pollutants cause cancer. It's frustrating that the obituary writer wasn't even the least bit skeptical of all this."
Mexico City supplies elderly men with Viagra
In a surprising public health move, Mexico City will start giving free impotence drugs to men over seventy. "I find it astonishing that sexual health for men is such a high health priority," Dr. Whelan says.
ACSH's Dr. Gilbert Ross argues, "While sexual health for men over seventy is important, it's a stretch from there to say that the government should give out free Viagra."
And ACSH's Jeff Stier thinks, "There are many other things the government could do with that money to better improve the public health of Mexico City residents."
Bloomberg intensifies crusade against salt
The New York Post reports that New York City Mayor Michael Bloomberg met privately with "health experts and food industry representatives" to discuss his plan to reduce the amount of salt in processed foods, with the goal of fighting hypertension in the city.
"Hypertension is an extremely important public health issue, no question about it," Dr. Whelan says. "But I wouldn't go after salt to solve it. I would use the money being poured into this anti-salt campaign to screen all New Yorkers for high blood pressure and put the ones who need medication on the appropriate drugs."
Dr. Ross reminds us, "Deciding on a treatment for hypertension requires a thorough evaluation and complete medical check-up, so it would be difficult for the government to be involved in prescribing medications. But setting up stations where people could have their blood pressure checked regularly is a good idea. They could even come back weekly to see if they are being adequately treated and take any problems they discover to their doctors."
ACSH staffers are also skeptical of the City's assurance that "Restaurateurs will be encouraged to join a 'voluntary' initiative and that there won't be new regulations." Dr. Whelan points to New York City's history of requiring calorie counts to be posted on menu boards and banning trans fats as examples less than "voluntary" initiatives in the past.
In light of a new study linking low vitamin D levels to high blood pressure, Stier jokes, "Maybe they will add vitamin D to New York City restaurant food."
Statins spark debate
The Jupiter study, indicating that the statin Crestor may reduce the risk of heart disease in patients with normal cholesterol but high levels of C-reactive protein (CRP), continues to receive attention this week. An article on Forbes.com compares Crestor's promising results to studies showing that vitamins E, C, B12, and folic acid do nothing to prevent heart attacks.
"We've seen time and again that taking various antioxidants does not reduce cardiovascular risk," Dr. Ross says. "But Crestor seems to be helpful. The data from the Jupiter study is very strong."
An editorial in the New York Times also finds the study promising but still questions a potential conflict of interest arising from the fact that its lead author has a patent on the blood test used to measure CRP levels. "They couldn't find any issue with the study's methodology or findings, so they went after the funding," Stier says.
ACSH's Dr. Ruth Kava asserts, "The first task ahead is to replicate the results of the Jupiter study. They need to accumulate more data" -- especially in light of an unexpected increase in diabetes in the group taking Crestor.
Dr. Ross agrees. "More studies have to be done and more statins need to be tested."
Breastfeeding may give babies a respiratory workout
A new study suggests that the work babies must do while nursing from the breast might increase their lung capacity and improve their respiratory health later in life. "However, it doesn't seem like they had a control group that drank breast milk from a bottle," Dr. Ross points out. "That would be the only way to determine whether the benefits come from the actual effort exerted when sucking from the breast versus the bottle, or whether they are from the breast milk itself."
MORNING DISPATCH 11/14/08: Breast Cancer, Bone Marrow, Less Smoke, plus Counterfeits and Sugar Pills
What science tells us about reducing the risk of breast cancer
ACSH staffers are impressed by the literature review "Opportunities and Strategies for Breast Cancer Prevention Through Risk Reduction" in the journal CA: A Cancer Journal for Clinicians. "The authors conclude that there are ways you can effectively reduce your risk of breast cancer, which is a better strategy than focusing only on finding a 'cure,'" says ACSH's Dr. Elizabeth Whelan.
We are particularly glad that the authors assert, "While there is no clear evidence that specific dietary components can effectively reduce breast cancer risk, weight gain and obesity in adulthood are risk factors for the development of postmenopausal breast cancer."
ACSH's Dr. Gilbert Ross says, "The fact that the study dismissed specific foods or diets as a cause of breast cancer should take care of any ridiculous arguments promoting the 'breast cancer prevention diet,'" an idea ACSH successfully challenged with our critique of Dr. Bob Arnot's book on the subject.
"I'm also very impressed that the authors mentioned alcohol as a risk factor, but then go on to talk about how folate consumption can mitigate that risk," Dr. Whelan adds. Chemopreventive agents, including tamoxifen and raloxifene, are also mentioned as a promising possibility for reducing breast cancer risk, while aromatase inhibitors are being studied for possible use in this area.
ACSH's Jeff Stier concludes, "The only thing we aren't happy about is that there hasn't been much media attention to this good news."
Bone marrow transplant opens door for new AIDS research
German researchers are reporting that a bone marrow transplant from a donor who is genetically resistant to HIV appears to have cleared up both AIDS and leukemia in its recipient. There has been no sign of either condition in the patient for the twenty months since the transplant -- although the possibility remains that the AIDS virus will eventually resurface in his body. "This is a very interesting experiment, but it can hardly be applied to everyone," Dr. Ross reminds us.
ACSH's Dr. Ruth Kava thinks, "This might help scientists learn what protects some people and not others against HIV." The researchers say their results point to a promising future for gene therapy treatments for HIV and AIDS.
Smoking rate falls below 20%
The smoking rate of U.S. adults has dropped below 20% for the first time since just after World War I. "The statistic is better than it was fifteen years ago, but one in five American adults is still smoking," Dr. Ross says. "It shows we can't relax. The cigarette industry has billions of dollars to spend on convincing young people to take up smoking -- and teen smoking levels have stopped declining as of late."
Dr. Kava agrees. "There's always a new generation coming up that has to be educated about things that 'everybody knows.'" And the news is not all good -- more women are dying of chronic obstructive pulmonary disease (COPD), driving the mortality rate from this dangerous effect of smoking up 8%.
Interpol leads crackdown on drug counterfeiters
Interpol coordinated raids, in nine countries, of companies suspected of selling counterfeit drugs on the Internet. "This is another example of how widespread this problem is," Dr. Whelan says. "We're going to hear more and more about drug counterfeiting in the coming years because it's become such a lucrative business."
Dr. Ross explains, "Counterfeit drugs can range from anything from drugs that are expired to pills made of inactive substances like clay and chalk, to pills that only contain one substance when there should be three, to toxins that could actually kill people. The Internet is, of course, a major source for all these types."
Unfortunately, the countries where these raids occurred did not include several major sources of fake drugs, such as China and India. Dr. Whelan reminds us, "There are only a handful of Internet pharmacies that are approved and legitimate, and they are listed in our booklet Counterfeit Drugs: Coming to a Pharmacy Near You.
ACSH debates the ethics of prescribing placebos
A _Wall Street Journal_ Weekend Section column about placebos by ACSH Advisor and resident scholar at the American Enterprise Institute Dr. Sally Satel sparked a lively debate at our breakfast table this morning. In light of a study suggesting that half of American doctors prescribe placebos to their patients, Dr. Satel writes, "when doctors prescribe a medication, we trust them to dispense the real thing."
Stier argues, "Or do we trust doctors to dispense something that will make us feel better? The benefits of the placebo effect are well-documented."
ACSH's Todd Seavey believes, however, that the deception required in order for the placebo effect to work "is tantamount to doctors lying to their patients and shouldn't be acceptable."
Dr. Ross asks, "What's the problem with giving someone a safe pill that may actually help them?" He thinks the only issue arises when doctors charge patients for sugar pills. "That would be unethical and unprofessional," he says. He also recommends that people who don't ever want to be prescribed a placebo be upfront about their wishes with their doctors.
MORNING DISPATCH 11/13/08: CT, EUuuuuuu!, HER2, BMI, and Statins
Sprial CT scans are a promising but flawed way to detect lung cancer
Using spiral CT scans to detect lung cancer is a promising idea, but new research shows that it still leads to many unnecessary surgeries in patients who are later determined not to have cancer. "Currently, the longevity for people with lung cancer is very low, so we could save many lives if we could detect and diagnose the disease at an earlier stage," says ACSH's Dr. Elizabeth Whelan. "Spiral CT scans could be a valuable tool for doing that if we could just get them right."
In the study, 1% of patients underwent a major surgical procedure that resulted in a noncancer diagnosis after the spiral CT scan detected a noncalcified nodule in their lung. But more optimistically, forty out of the sixty-nine patients with non-small-cell lung cancer found by the scan were diagnosed with stage 1 disease.
"Those people with stage 1 lung cancer would be the people whose lives could be saved if smokers were routinely screened," says ACSH's Dr. Gilbert Ross. "However, the spiral CT scan often picks up incidental factors as well that can lead to unnecessary surgery."
He continues, "This study doesn't give us the answer to making spiral CT scans more effective as a life-saving screening tool...yet. But there are several large-scale randomized studies seeking the answer going on right now, which should give us much more information within the next year or two."
Europe's produce gets ugly
ACSH staffers are glad -- and a little amused -- that the European Union has decided to lift restrictions on the sale of "ugly" fruits and vegetables. "I didn't even know that rule was in existence, but I'm glad they are relaxing it," says ACSH's Dr. Ruth Kava.
Citing particularly "curvy" cucumbers and "knobbly" carrots, European commissioner for agriculture Mariann Fischer Boel argued, "It makes no sense to throw perfectly good products away, just because they are the wrong shape."
Dr. Whelan notes, with approval, "They actually cited rising food prices as part of their decision."
Scientists find genetic clue to Tamoxifen resistance
A new study shows why some women develop resistance to Tamoxifen, the most commonly prescribed drug to prevent a recurrence of breast cancer. The drug works by switching on certain genes in order to control estrogen-fueled cancerous cell growth in the breast, but British scientists have determined that in order to work, Tamoxifen must also block a gene called HER2 with the aid of a specific protein. In women with Tamoxifen resistance, the protein fails to keep HER2 turned off -- which puts them at increased for breast cancer recurrence.
"While the notion of a resistance to Tamoxifen may seem like bad news, it's actually very good news," says ACSH's Jeff Stier. "This new information will help us target who should be treated with Tamoxifen and who shouldn't."
Dr. Kava agrees, "Now we have a way of distinguishing which drugs would suit which patients best."
Dr. Ross predicts, "Now that we know more about resistance to Tamoxifen, we'll be able to go after it. I think we'll develop a Tamoxifen variation or a new drug that will get at this specific genome resistance."
Waist circumference tied to increased risk of death
Researchers have determined that waist and hip measurements are better indicators of the risk of obesity-related death than body mass index (BMI) alone. The guidelines indicate that women with a waist circumference of over thirty-five inches and men with one of over forty inches are at increased risk of death.
"They talk about waist size and waist-to-hip ratio, but it's really all about measuring abdominal obesity -- which has been understood to be a risk factor for diabetes and heart disease for a long time," Dr. Kava explains. "What's new here is that they've tied it to mortality instead of just morbidity."
Is Crestor all it's cracked up to be?
We received some questions about our optimistic view of the study indicating that the statin Crestor may reduce the risk of heart disease in patients with arterial inflammation. In particular, an advisor wondered if the study had controlled for the participants' smoking habits.
"It was a randomized control trial, so they must have controlled for smoking," Dr. Kava says. "Equal numbers of smokers would have been placed in the Crestor group and the placebo group."
Dr. Whelan says, "I don't think we overstated the potential benefits of this study. The main lingering concern is that we don't know if the results apply to all statins, or just to Crestor -- as we pointed out."
Ask ACSH
If you have a question you'd like answered by ACSH experts, email AskACSH@acsh.org -- and check out our new _Ask ACSH_ webcast when it starts up next week! It's the next best thing to visiting our breakfast table, which ACSH Trustee Thomas Campbell Jackson was able to do today.
MORNING DISPATCH 11/12/08: Bras, Google, Allergies, Trans Fats, Triglycerides, and Heartburn
Attack of the toxic bras!
A class action lawsuit is in the works against Victoria's Secret for selling "toxic bras."
"A woman allegedly got a rash from a Victoria's Secret bra, so she decided to sue the company," says ACSH's Dr. Whelan. "After getting the bra tested (which seems unbelievable to me in and of itself), she discovered that it contained formaldehyde -- which, as the article so helpfully points out, is a chemical used in embalming." We hope this ridiculous lawsuit doesn't make it past the judge who is set to rule in May on whether the case can go forward.
Google tracks searches to find flu outbreaks
Google recently launched a new service called Google Flu Trends, which collects geographic information about Google searches related to the flu and its symptoms in order to locate flu outbreaks even before the CDC can. Despite some inflammatory headlines yesterday, ACSH's Jeff Stier says, "Google is not uncovering individuals' medical histories."
Rather, according to ACSH's Dr. Gilbert Ross, "It is using computer technology and statistics to track illnesses before they show up elsewhere." When the company tested Google Flu Trends using data from last year's flu season, it found a strong correlation between the spikes in diagnosed flu cases and the spikes in searches about the flu, which encouraged them to track the information in real time this year.
Food allergies on the rise -- but is it a cause for concern?
ACSH staffers are skeptical of the assertion that the number of children with food allergies is "skyrocketing." Dr. Ross explains, "A study found that the numbers went up 18% between 1997 and 2007, which is not what I would call a crisis -- especially since it is unclear from this story if the researchers took into account the increase in the population of children that also occurred during that time."
One theory behind this alleged increase is the hygiene hypothesis, the idea that, as ACSH's Dr. Ruth Kava explains, "If you don't stimulate the immune system early, it's just lying in wait, and you get a strong reaction to the smallest trigger." Some scientists think that as children in industrialized countries grow up in increasingly sanitized environments, their immune systems might be unprepared to deal with triggers later on, leading to excessive responses and a spike in food allergies and even asthma.
For more information about the hygiene hypothesis, see ACSH's recent publication Asthma: Causes, Diagnosis, and Treatment.
AMA jumps on the anti-trans fat bandwagon
We are disappointed that the American Medical Association (AMA) announced its support for legislation banning trans fats. "It's just so embarrassing," Dr. Whelan says. "The AMA is becoming totally politically correct."
The organization even stated that replacing trans fats in foods would prevent up to 100,000 premature deaths per year in the U.S. "I wonder if they have some significant new data that we're not aware of, or where did that number come from?" Dr. Kava says.
We wish that the AMA and other health organizations would instead put their weight behind new, well-designed studies to determine effective measures that could actually reduce the toll of obesity in this country -- especially in light of the recent news that obese children have thickened arteries resembling those of middle-aged adults.
Triglycerides step into the spotlight
While doctors have been focused on LDL cholesterol levels as a risk factor for heart disease, a new study shows that they should devote some time to monitoring their patients' triglyceride levels, too. Further, the percentage of U.S. adults with high triglyceride levels has doubled over the last thirty years because of increasing obesity rates, and merely controlling patients' LDL levels may not be enough to protect them from cardiovascular events.
"As new data are accumulated, it appears that the long-neglected lipid, triglycerides, may also be an independent risk factor for heart disease," says Dr. Ross. "We have fewer effective drug therapies for triglycerides than we do for cholesterol. But the good news is that diet, weight loss, and exercise have definite beneficial effects on triglycerides."
Heartburn medication dramatically reduces efficacy of Plavix
The blood thinner Plavix appears to be 50% less effective at cutting a patient's risk for heart disease when taken with heartburn drugs like AstraZeneca's Nexium and Prilosec.
Proton pump inhibitors like Nexium and Prilosec are often prescribed with Plavix because ulcers can be worsened as a side effect of the blood thinner, with complications such as intestinal bleeding. "I hope physicians get the message and reevaluate the decision to often prescribe these two drugs together," Dr. Whelan says.
MORNING DISPATCH 11/11/08: Stroke, Infections, Measles, Agent Orange, Bad Diets, and Blood Pressure
Could the CRP test save lives?
In the wake of the study indicating that AstraZeneca's statin Crestor reduces the risk of cardiovascular events in patients with arterial inflammation, researchers have found that a blood test measuring levels of C-reactive protein (CRP), a marker of that inflammation, could help patients and their doctors gauge their risk of heart disease and stroke. Those with elevated CRP levels could probably benefit from taking Crestor, or possibly another cholesterol-lowering statin drug.
"Crestor is the most potent statin in terms of lowering LDL cholesterol, but we don't know if that was the key reason it affected CRP levels," says ACSH's Dr. Gilbert Ross. "I hope and suspect that this is a class-wide effect applying to all statins -- including those generics that are now less expensive -- but we have to have more data before we can apply the current studies to any drug but Crestor. And even these results need replication before major changes are implemented in our approach to diagnosing, treating, and preventing cardiovascular disease."
Intestinal bug on the rise in hospitals
ACSH staffers are disturbed by the report that the number of hospital patients infected with the intestinal bug Clostridium difficile (C. diff) doubled between 2000 and 2005. C. diff, which can cause diarrhea, fever, loss of appetite, nausea, abdominal pain, and even death, currently affects 1% of U.S. hospital patients.
"We used to only see C. diff in chemotherapy patients with weakened immune systems, or those on multiple antibiotics, but now it's become an endemic hospital pathogen," Dr. Ross says. "It's also notoriously resistant to antibiotics."
Cleaning hospital rooms with bleach solution, washing hands thoroughly, and treating the infection with targeted antibiotics can help stem the spread of C. diff. For more information on hospital infections and how to prevent them, visit the site of ACSH Trustee Dr. Elizabeth McCaughey's Committee to Reduce Infection Deaths (RID).
Gibraltar suffers measles outbreak
Thanks to superstitious parental resistance to the childhood measle-mumps-rubella (MMR) vaccine, the British territory of Gibraltar is currently experiencing a measles outbreak. The 276 recent cases represent the area's first in ten years.
"This is an example of Wakefield's ongoing legacy," Dr. Ross observes. Even though the 1998 Wakefield study linking childhood vaccines to autism has been widely discredited and was withdrawn by the authors themselves, many British people -- including those living in Gilbraltar -- remain fearful of vaccinating their children.
Agent Orange linked to prostate cancer?
Men exposed to the herbicide Agent Orange during the Vietnam War appear to be at increased risk for prostate cancer. While ACSH's Dr. Whelan points out that these data contradict earlier studies of highly exposed groups of veterans, Dr. Ross notes, "If Agent Orange has a proclivity to induce prostate cancer, you wouldn't expect to see it until the men were older than sixty. This is the first study done thirty to forty years later on, as these veterans are entering that age group."
He adds, however, "I don't know how they evaluated confounders and randomized participants in this study, and isn't clear how much of the chemical these veterans were exposed to."
Schools are not responsible for students' poor eating
Tara Parker-Pope tackles the issue of blaming schools for the poor eating habits of their students today on the New York Times' Well blog. Most notably, a study published in the Journal of Nutrition Education and Behavior found that children who attended schools where soft drinks were banned did not drink any less soda overall than their peers who could buy the beverages at school.
"They found no meaningful differences in overall soft drink consumption," explains ACSH's Dr. Ruth Kava. Another telling study observes that children generally practice better eating habits while in school than during summer vacation.
While ACSH staffers weren't surprised by this information, we hope it encourages districts and parents to think twice before insisting that schools take drastic measures like banning bake sales.
Hypertension prematurely kills 8,000 black Americans every year
An estimated excess of 8,000 black Americans die prematurely every year due to their proclivity for high blood pressure. "There's a blood pressure disparity between black Americans and white Americans, with black Americans generally having higher rates of hypertension that is more difficult to treat," Dr. Ross says. "8,000 additional deaths per year among African-Americans is a surprising and devastating effect of that disparity."
He continues, "A trend of under-diagnosis and inadequate treatment of hypertension affects all Americans, but it is currently affecting black Americans the most."
MORNING DISPATCH 11/10/08: Statins, Antioxidants, CA vs. Rx, Patients vs. Bad News, Peanuts vs. Youth
Benefit of statins goes beyond cholesterol
According to an exciting new study, AstraZeneca's statin Crestor dramatically reduces the risk of heart attacks, strokes, and death in patients who have healthy cholesterol levels but elevated levels of C-reactive protein (CRP), an indicator of arterial inflammation that has recently been found to be associated with heart disease.
"It was pretty audacious to put people on a cholesterol-lowering medication when their only risk factor for heart disease was an elevated level of CRP," says ACSH's Dr. Gilbert Ross. "But a 44% reduction in cardiovascular events in a study of nearly 18,000 people is very impressive."
ACSH's Dr. Ruth Kava agrees that the study is encouraging but says, "I want to see more data that CRP is actually a risk factor for heart disease."
California court blames drug companies for problems with generics
ACSH staffers are shocked by a California court ruling making it possible for name-brand drug companies to be held responsible for unforeseen side effects caused by generic versions of their medications. "So now drug companies are even responsible for drugs they're not making?" asks ACSH's Dr. Elizabeth Whelan.
"This ruling applies to cases in which the drug company would be liable if they were the ones manufacturing and selling the drug, and the generic company will still be held responsible as well," explains ACSH's Jeff Stier. "But the decision is quite troubling because it's an added disincentive to developing new drugs."
Vitamins C and E do not protect against heart disease
Men who took vitamins C and E for a period of eight years did not have decreased risk for cardiovascular disease, including heart attacks and strokes. "Observational studies suggested that these vitamins might help cut the risk of heart disease, but they didn't see any improvement in this clinical trial," Dr. Kava says. "And this type of study -- a prospective randomized controlled trial -- is much more powerful as an indicator of any real effect."
Vitamins C and E are antioxidants, which are often lauded as protective; however, they fail to show a positive effect on human health when taken as supplements in clinical trials.
African-Americans avoid bad news by avoiding cancer tests
African-Americans are at increased risk for several chronic diseases and cancers, but a new study finds that emphasizing this fact can actually discourage them from visiting the doctor because they want to avoid bad news. But as ACSH's Todd Seavey points out, "Isn't that why most people avoid going to the doctor?"
Dr. Ross agrees, "These results don't seem to indicate a racial preference. I'd like to see another study done with some kind of control group before drawing any conclusions."
Peanut exposure in early life may reduce the risk of allergy
A new study suggests that eating peanuts during infancy can reduce a child's risk of developing a peanut allergy. "Exposure might actually induce tolerance," Dr. Ross explains.
Dr. Whelan adds, "It goes along with what we recently heard about how if women eat peanuts during pregnancy it might shield their babies from peanut allergies."
However, Dr. Kava responded, "These results are surprising to me because I would have thought that eating peanuts at an early age would have just made the children who are already allergic more prone to develop their allergy faster."
Your seat at the table: Ask ACSH
Please join us at the ACSH breakfast table by participating in our newly launched webcast, Ask ACSH. E-mail your questions about public health and other issues ACSH regularly tackles to AskACSH@acsh.org. We will feature video responses from our experts in future Morning Dispatches, as well as on our YouTube channel. This webcast is designed with you in mind, and we can't wait to hear from you. Remember, ACSH experts are always just an e-mail away!
MORNING DISPATCH 11/7/08: Wyeth's Case, Kids' Shots, Women's Testosterone, UN's Ban, Pets' Food
New York Times weighs in on Wyeth case
We continue to have spirited discussions about the Supreme Court case Wyeth vs. Levine around the ACSH breakfast table. Today, the New York Times asserts that the Supreme Court should rule in favor of Diana Levine, who lost her arm to gangrene after Wyeth's anti-nausea drug Phenergan was improperly injected into an artery instead of a vein.
"The headline is 'The Court Confronts a Grievous Injury,' which really says it all," says ACSH's Dr. Gilbert Ross. "This is exactly why pre-emption needs to be established -- a jury can be easily influenced by tragically injured plaintiffs, even when their injuries aren't the drug company's fault."
ACSH's Jeff Stier agrees: "The grievousness of the injury doesn't determine liability. But right now, Wyeth and other drug companies don't have any predictability in cases like these. They don't know whether they are going to be protected by the federal warning label law or not. The outcome of this case will set an important precedent."
Vaccines do not worsen kids' allergies
Studies of childhood vaccines often make headlines, and every day seems to bring more reasons why parents should make sure their children are fully vaccinated. Today's pro-vaccine argument comes in the form of a new study concluding that childhood vaccines do not worsen allergies or make already at-risk kids more prone to developing them. "In fact, the chickenpox vaccine seemed to actually offer some protection from allergies and eczema," Dr. Ross notes.
Testosterone patch may increase sex drive in postmenopausal women
The latest study of a testosterone patch for postmenopausal women reinforces the idea that it can effectively increase their sex drive and number of satisfying sexual experiences. "Testosterone is the libido hormone in both sexes, but its levels often fall for women after menopause," explains Dr. Ross.
The only possible safety concern seen in this study is that four women who were taking testosterone developed breast cancer, as compared to zero in the placebo group. "This is clearly a statistical blip," Dr. Ross says. "Testosterone is not associated with breast cancer."
Will the UN finally ban smoking at its headquarters?
We weren't surprised that the United Nations General Assembly called for a ban on smoking at the UN's headquarters in New York -- we were surprised that people can still smoke at the UN at all. But since the UN compound is considered international territory, it is exempt from New York City's indoor smoking ban.
"It's the last vestige of indoor smoking left in New York City," Dr. Ross says. "But I'm sure they won't succeed in banning it there. Even in the article, an official said they have to find a way to implement it -- which, of course, means they're not going to implement it at all."
Pet food sickens people, but not their pets
At least seventy-nine people have being sickened by dry pet food contaminated with salmonella. "This form of salmonella is contagious even by handling the food, so people didn't have to eat it in order to get sick," Dr. Ross says. "But as we all know, little children will eat anything they can get their hands on."
No pets were reported to have fallen ill from the contaminated food. "Animals usually have a lot more acid in their stomachs than we do, so they might get by without getting hurt," Dr. Kava explains.
MORNING DISPATCH 11/6/08: Crichton, Weight, Migraines, Implants, Cigs, Votes...and Ask ACSH
Michael Crichton passes away at age 66
We are saddened today by the unexpected death of doctor, author, and ACSH supporter Michael Crichton. "He was an advocate of sound science and such a talented person," remembers ACSH's Dr. Elizabeth Whelan. "We first got to know him after he took on junk science in a speech he gave at the Commonwealth Club in San Francisco and in an article in Parade. In 2005, he was kind enough to accept the Sound Science Award from ACSH."
While ACSH has no position on global warming, we admire the way that Dr. Crichton challenged people of all political stripes to examine the way science is evaluated. "His book State of Fear, which is about how science can be used to inspire fear, could have been about any of the topics we take on at ACSH," says ACSH's Jeff Stier.
We extend our condolences to Dr. Crichton's family and friends for their tragic loss.
Acomplia research stopped in light of approval restrictions
ACSH staffers are disappointed that Sanofi-Aventis has decided to halt all research on the weight loss drug Acomplia -- citing not insurmountable safety concerns but "recent demands by certain national health authorities." Pfizer also ended research on a similar compound because of "changing regulatory perspectives on the risk/benefit profile of the CB1 class [referring to the type of receptors also targeted by Acomplia] and the new regulatory requirements for approval."
Unfortunately, we agree with an insightful statement made by analyst Steve Brozak to the Wall Street Journal: "Pfizer is technically correct in stating that even if the drug is safe, it's not certain that it could make it onto the U.S. market because the FDA 'has almost become paralyzed with caution in its approval process.'"
The Wall Street Journal is also reporting that the next administration will likely be even tougher on the FDA. "They want to allow drug importation and even let the government negotiate directly with Medicare over the price of drugs," explains ACSH's Dr. Gilbert Ross. "Medicare is a government program that actually works, so of course they are going to try to 'fix' it."
Stier points out, "Part of the negotiation process between Medicare and the drug companies is the ability to say no. But if the government says no to proposed drug prices, where does that leave the people in the program? It becomes a take it or leave it situation."
Migraines may reduce risk of breast cancer
A new study shows that women who have chronic migraines are less likely to develop breast cancer. "The reduction was seen in cases of hormone-responsive breast cancer, which is the most common type," says ACSH's Dr. Ruth Kava. Women who have migraines are more likely to have low estrogen levels, while high estrogen levels are linked to this type of breast cancer.
Still, Dr. Kava says, "This is only the first study. And all the subjects were post-menopausal women, even though migraines are more severe among pre-menopausal women."
Measured responses offered to study linking breast implants to lymphoma
ACSH staffers are impressed by the restraint shown by both scientists and reporters with regards to a study linking breast implants to a higher risk of a rare form of lymphoma. "They point out right up front that because this cancer is so rare, the absolute risk is still extremely low," Dr. Kava says.
Dr. Ross remarks, "This could have been an opportunity to lie with statistics by having a headline like 'Breast implants increase cancer risk eighteen-fold!' -- even though they found this type of cancer in eleven women over sixteen years. But in this case, even the news reporting is appropriate."
Taking on cigarettes, not their packaging
Anti-tobacco activist and sound science advocate Michael Siegel examines the outrage expressed by many health groups that Philip Morris plans to introduce a pink cigarette package for its new "superslim" cigarettes -- which some fear might induce women to smoke by marketing it as feminine, fashionable, and linked to weight loss.
But we agree with Siegel when he writes, "Whether people are dying from cigarettes that are in black, white, pink, or green packages doesn't seem to be the key issue. The key issue is that the product is killing people and something needs to be done about it."
Dr. Whelan concurs, "These groups are more worried about the package than about what's inside" -- evidenced by the fact that all of them supported the misguided legislation that would have allowed the FDA to regulate tobacco.
New meaning for "Vote & Vax"
ACSH staffer Judy D'Agostino worked the polls from 6am to 9:30pm on Tuesday, and has this story to share:
"A thirtysomething woman arrived to vote and I asked her to sign in. But when I offered her a pen, she declined, saying, 'No, I'm a physician and this is flu season,' and pulled her own pen out of her bag. I asked her if she got a flu shot, but she answered, 'No, I'm not in the demographic that needs it.'"
ACSH staffers are astounded that a practicing physician regularly seeing sick patients would think she did not need a flu shot -- but was afraid of possible flu transmission from a communal pen!
Your seat at the table: Ask ACSH
We remind you that you can now join us at the ACSH breakfast table by participating in our newly launched webcast, Ask ACSH. E-mail your questions about public health and other issues ACSH regularly tackles to AskACSH@acsh.org. We will feature video responses from our experts in future Morning Dispatches, and on our YouTube channel. This webcast is designed with you in mind, and we can't wait to hear from you. Remember, ACSH experts are always just an e-mail away!
MORNING DISPATCH 11/5/08: You Ask, YouTube; Also: Babies, Snow, and Salt as the New Trans Fat
Your seat at the table
We would like to invite all our Morning Dispatch readers to join us at the ACSH breakfast table by participating in our new webcast, Ask ACSH. E-mail your questions about public health and other issues ACSH regularly tackles to AskACSH@acsh.org. We will feature responses from our experts in Ask ACSH Q&A videos that will be available via Morning Dispatch and on our YouTube channel. This webcast is designed with our MD readers and ACSH donors in mind, and we can't wait for your questions and feedback. Remember, ACSH experts are always just an e-mail away!
Salt is the new trans fat
On the heels of the New York City trans fat ban, the food police are looking for another target -- and seem to be settling on salt. "New York City is probably going to be the first place that will try to attack salt," says ACSH's Jeff Stier. "But unlike trans fat, salt is necessary for a healthy diet."
ACSH's Dr. Ruth Kava believes, "It would be extremely difficult to regulate salt in processed and restaurants foods and, I think, a misstep since it does contain essential nutrients. But that probably won't stop them from trying."
ACSH's Dr. Elizabeth Whelan wonders what lawmakers could actually do to make us reduce the amount of salt in our diets, and ACSH's Dr. Gilbert Ross predicts "They could force certain restaurants -- probably chains -- to list the salt content of their foods, like we're seeing now with calorie counts in New York."
Stier points out, "Low-sodium products are already available. If consumers want them, they can buy them now." He also recommends the creative intervention he came up with as a child when he heard his grandmother needed to cut down on salt -- secretly putting clear tape over the holes of her salt shaker.
Cigarettes increasingly linked to poor infant health
We aren't surprised that a new study published in the Journal of Pediatrics links poor infant health to exposure to cigarette smoke. Not only does maternal smoking during pregnancy increase the risk of premature birth and sudden infant death syndrome, it also makes it more likely that the baby will be born with a cleft palate. Infants who are exposed to cigarette smoke after birth appear to be more irritable and difficult to soothe.
"Secondhand smoke also has well-documented effects on children with chronic diseases, especially asthma," Dr. Ross says. "Exposing a child with a chronic disease to smoke in the home amounts to child abuse."
However, ACSH staffers think another study goes a bit too far by arguing that children who live with smokers are more likely to be underfed and undernourished. "I bet that result is confounded significantly by socio-economic status and educational background," Dr. Kava says.
Some infants react poorly to rice
A new study shows that for some infants, rice can cause food protein-induced enterocolitis syndrome (FPIES), a severe form of gut inflammation that results in vomiting and diarrhea. "This is surprising because rice is considered to be safe for infants," Dr. Kava remarks. "The first cereal introduced to a baby's diet is usually rice cereal."
But as Dr. Ross points out, "This is a very small study that measures a very small risk. Parents do not need to be afraid to feed their babies rice." For more information about infant diets, see ACSH's booklet Feeding Baby Safely.
Will the real John Snow please stand up?
A discussion about epidemiology helped Dr. Whelan make an interesting new friend last night, and she'd like to share her story:
"Last night my husband and I went out to dinner at a private club in New York and sat next to a man who looked quite familiar. We couldn't quite place him but decided to introduce ourselves anyway -- and it turned out he was John Snow, Bush's former Secretary of the Treasury.
"But that's not even the most interesting part! When he asked me what I did and I mentioned epidemiology and public health, Sec. Snow exclaimed, 'Then you must know my friend, the most famous epidemiologist in history!' I began running through the great epidemiologists who taught me at Harvard and those on the ACSH Board of Trustees and Advisors list...but he shook his head and laughed.
"'I refer to my namesake, Dr. John Snow of the Broad Street pump fame!'
"In the 1850s, Dr. Snow tracked the cause of cholera in England by demonstrating that those who drank water from the Broad Street pump contracted the disease. While he couldn't identify the exact harmful biologic agent at that time, he eventually dismantled the pump, causing cholera rates to plummet and inspiring many more preventative measures. He is known as the father of modern epidemiology -- as my new friend reminded me last night!"
ACSH staffers agree that epidemiologists like Dr. Snow were true heroes. But, as Stier, says, "Epidemiology, like any other tool, can be misused. Just contrast Dr. Snow's work with that of Cornell professor Michael Waldman, who, as you will recall from yesterday's MD, recently reported a link between rain and autism."
MORNING DISPATCH 11/4/08: Caffeine, Preemption, HPV/Cancer, Fluoride, Autism, and Drug Imports
Caffeine targeted as alleged cause of low birth weight
ACSH staffers are disappointed that a study supposedly linking low birth weight to a pregnant woman's caffeine consumption is receiving publicity (especially today, with Starbucks giving away coffee for free in honor of the election). "Expectant mothers are already extra careful about what they put in their bodies, and it's troubling that this study will needlessly scare them even more," says ACSH's Jeff Stier.
ACSH's Dr. Ruth Kava points out, "People have been trying to prove that caffeine has some kind of negative effect for years, but it's nearly impossible to do so. This is just one study. It needs to be replicated."
ACSH's Dr. Gilbert Ross agrees. "This is an epidemiological study that has minimal -- if any -- significance. Its results fly in the face of data accumulated over decades."
Supreme Court hears crucial drug pre-emption case
We continue to watch the Supreme Court pre-emption case, Wyeth v. Levine, with great interest. After losing her right hand and arm to gangrene after a clinic worker mistakenly injected Wyeth's drug Phenergan into an artery instead of a vein, guitarist Diana Levine is suing the drug company for not explicitly warning against administering the drug via "IV push."
Wyeth is countering that it should be exempt from state court lawsuits that challenge the content of FDA-approved drug labels. As ACSH's Dr. Elizabeth Whelan says, "Wyeth had an FDA-mandated warning label about how to correctly administer the drug. What else could they realistically do to prevent mistakes?"
"If justice triumphs, Wyeth will win," Dr. Ross believes. "It's just not fair to sue the drug company because someone else made a mistake." The Wall Street Journal editorial board writes, "If a known and disclosed medical risk can still lead to a lawsuit, drug companies can literally be sued for anything" -- and ACSH staffers share the fear that such a precedent would stifle future drug innovation.
HPV linked to additional cancers
Already identified as the leading cause of cervical cancer, human papillomavirus (HPV) has also been linked to anal and penile cancers, as well as to cancers of the mouth and throat. "These new data imply that boys and men should also be considered candidates for Merck's HPV vaccine Gardasil," Dr. Ross says. "Not only would it reduce their risk of developing these types of cancers, but it would also make them less likely to harbor HPV and transmit the virus to their sex partners."
Stier jokes, "At least we don't have to worry that some activist groups will accuse Gardasil vaccinations of increasing the sexual proclivity of teenage boys."
Why is fluoridation still up for debate?
The issue of fluoridating public water supplies is on the ballot in many communities in Nebraska and other states today -- and ACSH staffers are shocked that it continues to encounter opposition. "It boggles the mind that an effective and completely safe measure that prevents tooth decay is not being used by everyone," Dr. Whelan says.
But aversion to the use of chemicals is so rampant that she wonders, "Would it even pass in New York City if it were up for a vote today? We're lucky our water's been fluoridated since 1965."
To those still opposed to adding fluoride to water in order to prevent tooth decay, Dr. Ross says, "What you are saying, in effect, is 'Drill, baby, drill!'"
Inflammatory articles promulgate autism scares
We were extremely disappointed to see USA Today make an unqualified reference to the discredited Wakefield study, which unsuccessfully tried to link autism to childhood vaccines. "It's journalistic negligence not to point out that the Wakefield study was completely invalid and was repudiated by its co-authors and the Lancet journal, which originally published it," Stier says.
Such an uninformed and inflammatory approach to autism research not only needlessly discourages parents from giving their children lifesaving vaccines, it also contributes to an environment in which even the most preposterous claims about the causes of autism receive press coverage -- such as a recent study showing that rates of autism are higher in areas with more rainfall.
How safe are imported drugs?
Last weekend's New York Times Magazine included a frightening article about the safety concerns surrounding drug importation. "When we argue against drug importation, we usually assume that we are re-importing U.S.-made drugs and focus on price controls," Dr. Kava says. "But it actually sounds like many of the ingredients in generic drugs are being made in China with little or no oversight."
Dr. Ross believes, "The scariest thing about this story is that different parts of the federal monitoring system have no way to communicate with each other or work together to keep our drug supply safe."
MORNING DISPATCH 11/3/08: Kids on Drugs, Statins, Hep C, Death Race, Lung Cancer Genes
More drugs prescribed to kids
A new study finds that more children are being prescribed drugs to treat chronic conditions, especially asthma and ADHD. "The tone of the stories is that it is bad that so many children are taking medications, but most of them are probably benefiting tremendously from the treatments they are receiving," says ACSH's Dr. Elizabeth Whelan.
"It's good if we're expanding our diagnostic capabilities and if doctors are more alert to symptoms and treatments, especially in the case of asthma," believes ACSH's Dr. Gilbert Ross. "There are potential benefits and risks of every medication, but that doesn't mean they are always bad for kids. Over-prescribing is, of course, undesirable. But an increase in the number of children on medications does not necessarily indicate over-prescribing."
Statin reduces heart attacks in patients with inflammation
We are pleased that AstraZeneca's statin Crestor appears to dramatically lower a patient's risk of serious cardiovascular events. "The findings of the study were so positive that they stopped it early," says ACSH's Jeff Stier.
Statins are usually prescribed to patients with elevated LDL ("bad" cholesterol) levels, but the Crestor trial focused on people with normal LDL levels and heightened levels of C-reactive protein (CRP), a biomarker of inflammation.
"When this study gets more widely publicized, I think a lot of people will be asking their doctors to check their CRP levels in addition to their LDL levels," says Dr. Ross. "In fact, CRP is already being routinely added as part of a risk assessment for people who have a cardiovascular indicator."
Ironically, Crestor was attacked a few years ago as a "me too" drug. But as Dr. Whelan wrote in National Review, "It is in the consumer's interest to have a variety of drugs to choose from when looking to treat a condition. Some will work better than others for various individuals and afflictions; some will be tolerated more, with fewer side effects. Can you imagine if only one statin (cholesterol-lowering) drug were available for your physician to prescribe for you -- and you were allergic to it?"
Drug cuts hepatitis C treatment time in half
The new drug telaprevir appears to be a promising treatment for the liver disease hepatitis C. "It looks like a better, quicker, and more effective treatment," Dr. Ross says. In a study, telaprevir worked for many patients who failed other treatments, as well for those who had never been treated for hepatitis C. It also cut the required treatment time in half, from forty-eight weeks to twenty-four weeks.
"With 3.2 million cases of hepatitis C in the U.S., it's a fairly common condition," notes Dr. Ross. "The side effects of other drugs currently used to treat it can be devastating, so it will be interesting to see if telaprevir offers any improvement in that area as well."
Death after marathon highlights risk
The New York City Marathon took place yesterday to great fanfare. Sadly, Carlos Jose Gomes, a fifty-eight-year-old runner from Brazil, died after completing the race. At least two other runners were hospitalized.
"Running, especially in marathons, can be harsh on the body," Dr. Whelan says. "There seems to be a double standard in assessing danger -- how many people have died from bisphenol-A as compared to running marathons? People are actually trying to ban the safer of those two."
"You could get more health benefits and fewer detrimental effects on your body, especially the weight-bearing joints, if you ran just five or six miles at a time," Dr. Ross says.
Stier -- who finished the marathon last year and who plans to compete in next year's as well -- says, "If all I cared about was being in good shape, I would be doing only half marathons. But completing a marathon is about more than just health."
To put more risks in perspective, check out ACSH's Riskometer.
Genes may increase risk of lung cancer
Researchers believe they have found two genetic variations that may increase a person's chance of developing lung cancer -- but only by 60%. "In comparison, smoking increases a person's risk of lung cancer by over 1000%," Dr. Whelan points out.
Dr. Ross adds, "The idea is that eventually people might be able to have their genomes analyzed and find out if they are susceptible to lung cancer." Such information could provide extra encouragement for susceptible people to quit smoking, but it could also provide less-susceptible smokers with a false sense of security. "Overall, this genetic risk is minuscule compared to smoking," Dr. Ross concludes.
MORNING DISPATCH 10/31/08: Whelan, Tierney, Wolfe, Breast Cancer, and Diabetes
Happy Halloween!
In honor of the holiday, ACSH's Dr. Elizabeth Whelan recorded some tips for Halloween safety using our new studio. We've mentioned our studio before, but now that it's up and running we'd like to give our loyal Morning Dispatch readers an insider's look at its capabilities. If your computer can handle large video files, download a near-HD quality version of Beth's piece to see the kind of videos we will soon make available to reporters. A consumer-friendly version can be seen on ACSH's YouTube channel.
Honorary seat at the table goes to John Tierney
We'd like to offer a seat at the ACSH breakfast table to New York Times science columnist John Tierney for his story debunking claims that industry-funded studies are "tainted." In fact, he writes, "After analyzing weight-loss research conducted over four decades, [scientists] found that the quality of data-reporting in industry-sponsored research does seem to be different from that in other research: It's better."
An analysis performed by an independent research group and published in the International Journal of Obesity found that the data were significantly better reported in industry-funded studies on obesity treatments than in studies not supported by industry -- and the difference was even more striking in studies involving drug treatments.
We share Tierney's hope that this study makes institutions like the Journal of the American Medical Association (JAMA) rethink their mistrust of studies done with industry support. All studies should be scrutinized, regardless of their funding, and Tierney astutely asks, "By stigmatizing industry-sponsored research, is their [JAMA's] 'hierarchy of purity' doing more harm than good?"
Sidney Wolfe takes on Avandia
We aren't surprised that Sidney Wolfe's Public Citizen health group is calling for a ban of GlaxoSmithKline's diabetes drug Avandia -- but you might be surprised that in this case, he may not be so wrong.
"Avandia has accumulated a litany of bad side effects since its introduction," says ACSH's Dr. Gilbert Ross. "It doesn't really reduce mortality or morbidity and carries an increased risk of heart disease -- which is more troubling than the liver failure Wolfe notes. When it was first introduced in 2000, it offered a better alternative to Rezulin, the only other drug of its class, the glitazones. But now that there are so many good diabetes drugs available, there's rarely any good reason to continue using it."
Some ACSH staffers object to the attention Wolfe's group Public Citizen receives, however. "It's almost like he's a separate wing of the government," Dr. Whelan remarks. "Why isn't the FDA the one getting the headlines for taking care of regulating drugs?"
Two breast cancer studies rely on minuscule numbers
Researchers found that women who experienced side effects like hot flashes, night sweats, and joint pain while taking the breast cancer drugs Tamoxifen and Arimidex had a slightly lower chance of cancer recurrence than women who did not experience side effects. "This struck me as counterintuitive," says Dr. Whelan.
Dr. Ross points out, "The improvement was too small -- 16% versus 23% -- to mean anything in the real world."
Another study involving breast cancer also makes use of miniscule differences in data. This one advises women that vigorous exercise (such as "scrubbing floors") can cut breast cancer risk -- but only by 13%.
"Again, this difference is too small to have any real meaning as far as behavior and exercise are concerned," Dr. Ross says. ACSH's Jeff Stier says, "If the study had said exercise increased breast cancer risk by 13%, it probably never would have been published."
Obesity epidemic leads to diabetes -- and may be worsened by recession
Diabetes rates have doubled over the past ten years in the United States, largely thanks to the growing obesity problem. "This is going to result in huge increases in health care costs," ACSH's Dr. Ruth Kava predicts. "We need to look at the opportunities people have for physical activity in the course of the day and try to provide more opportunities for safe exercise if necessary," she recommends.
While Dr. Kava believes that actions like building more parks may help encourage exercise, Dr. Ross says, "If you want to exercise, you can always find a way to do it."
ACSH Advisor Dr. Adam Drewnowski believes that the current economic crisis may make it harder to fight obesity. "He's done a lot of work looking at correlations between food choices and economic status and found that poverty and obesity are often linked," Dr. Kava explains. "But even if people can't afford fresh fruits and vegetables, frozen and canned are just as healthy."
Stier believes, "It's wrong to say that a person cannot spend less and still eat healthily. You can eat nutritious, balanced meals for very little money -- it just takes more work, planning, and preparation." See some of his strategies in this post on the ACSH blog FactsAndFears.
MORNING DISPATCH 10/30/08: Preemption, BPA, Localism, and Voting/Vaccinating
Opinions on pre-emption vary among FDA employees
In advance of Monday's oral arguments in the highly anticipated, historic Supreme Court pre-emption case _Wyeth vs. Levine_, Rep. Henry Waxman released memos in which some high-ranking FDA employees expressed opinions contrary to the agency's official stance that federal regulation of drugs and their warning labels should pre-empt state laws.
"It's healthy for people to have different opinions within the same organization," says ACSH's Jeff Stier, "but Rep. Waxman presented the memos as some sort of scandal that undercuts the FDA's stance on pre-emption."
ACSH's Dr. Gilbert Ross explains, "The FDA has experts who analyze the results of trials conducted by the drug companies and decide whether or not to approve new drugs. Lawsuits over unforeseen side effects of a drug are not amenable to being decided by a jury, since that group does not include experts and could be swayed by the emotion of the injured plaintiff rather than by the science."
ACSH staffers also believe that allowing injured patients to sue drug companies over FDA-approved drugs for which side effects weren't observed in rigorous clinical trials could discourage the pharmaceutical industry from developing and introducing new, potentially life-saving medicines. For more information, see Dr. Ross's op-ed "The Supremacy of Pre-emption."
Bisphenol-A panel stirs up controversy and confusion
The FDA is also under fire for supporting the safety of bisphenol-A (BPA) now that an independent panel has questioned the agency's position. ACSH staffers saw strikingly unbalanced coverage of the subject on both NBC and ABC last night. "Activists posing as experts are exploiting their access to the microphones of the media by promulgating the myth that BPA is dangerous," Dr. Ross says.
As Stier points out, "The subcommittee that questioned the FDA's stance was weighted with people who believed in the precautionary principle and who didn't put animal studies in the proper perspective when it came to evaluating BPA's alleged potential to affect human health." (We also reviewed the membership list -- and found not one ACSH advisor.)
Many consumers are understandably confused about BPA and its safety, so the media has an obligation to offer balanced analyses based on sound science. For more information on the chemical, see ACSH's publication The Facts About Bisphenol-A.
"Locally grown" food labels can be misleading
While consumers often consider "locally grown" food safer and even healthier, an article in _USA Today_ questions those assumptions and points out the lack of a standard definition of "local." "The article discusses a farmer whose produce is sold as 'local' in stores a hundred miles away from his farm," says ACSH's Dr. Ruth Kava.
Stier points out, "Crops are generally grown where it's most efficient to grow them. Growing tomatoes in a hothouse in January or shipping in soil and water to grow crops in Nevada are actually unsustainable strategies." He touches on similar points in a letter in the New York Times Magazine that takes on the movement to make kosher food more "green."
Get out the vote -- and the vaccinations
We were pleased to hear about the efforts of Vote & Vax, a creative non-profit that is trying to persuade local election districts to allow health professionals to offer flu shots to voters at the polls. "It sounds like a wonderful idea," Dr. Ross says. "As one doctor on the Vote & Vax staff said, it's a win-win situation." Stier adds, "This way, even if you are not happy with the outcome of the election, your effort will still be rewarded with better health. Hey, it's worth a shot!"
To see if your polling place will be offering flu shots during early voting or on Election Day, visit Vote & Vax's clinic finder. But, of course, some of us have already had our annual shot -- including Dr. Kava and ACSH president Dr. Elizabeth Whelan, who was out this morning doing just that.
MORNING DISPATCH 10/29/08: BPA, PSA, NYC, plus New Vaccines, New Smokers, and Pneumonia
Subcommittee contradicts FDA's findings on BPA
The panel of scientists the FDA asked to review its findings on the safety of bisphenol-A (BPA) does not support the agency's assertions that the chemical used in many plastic products is safe. As ACSH's Dr. Gilbert Ross says, however, "Nothing has changed. This new group evaluated the same studies that the FDA looked at, which are all animal studies and depend on the low dose effect, which is a completely unproven idea."
In fact, the main complaint lodged against the FDA was that they put too much weight on the results of industry-funded studies that concluded BPA was safe -- even though the FDA says that the supposedly "tainted" studies were more scientifically rigorous than the independent investigations that led to questions about the chemical's safety.
"We're very disappointed that the FDA appears to be sending a mixed message on the safety of BPA, especially since it has been a staunch defender of the science supporting the use of the chemical," says ACSH's Dr. Elizabeth Whelan. Dr. Ross adds, "BPA has been in widespread use for decades, and no one has ever been harmed by it. All this 'concern' is mere hype provoked by anti-chemical activists."
Statins may lower PSA levels, but what about risk of prostate cancer?
Statins appear to lower levels of prostate specific antigen (PSA) in a man's blood, but since elevated PSA levels are used to screen for prostate cancer, some doctors are worried that statins may lower the number to a "safe" level without actually reducing a man's risk of developing the disease. "We don't know if it's lowering risk or just masking it," Dr. Whelan explains.
"This effect of statins is either a very good thing or a very bad thing," Dr. Ross says. "It seems like the perfect opportunity to do a retrospective analysis. Researchers should be able to correlate past data and see, among the millions of men who have been on statin drugs, is a reduced incidence of prostate cancer detected?"
"Sticker shock" inspires some restaurants to cut calories
Some good news has come out of New York City's law requiring chain restaurants to post calorie counts. Worried about customers' reactions to the highly visible calorie information, some restaurants are making their dishes healthier -- or at least their portions smaller -- in an effort to soften the blow.
"The fact that some restaurants have to post calorie counts is encouraging many to cut down on calories and portion sizes," explains Dr. Kava. We're still not convinced that the calorie counts will inspire most consumers to make healthier choices, but we're pleased to see restaurants make more healthy choices available.
Pneumonia may increase the risk of heart attacks
ACSH staffers weren't surprised to hear that patients hospitalized for bacterial pneumonia were more likely to suffer a heart attack within fifteen days of admission than those hospitalized for other reasons. "Pneumonia is certainly a strain on the cardiovascular system," Dr. Ross explains. "The link probably has to do with inflammation. When you have a bacterial infection, the body produces many inflammatory mediators, which can in turn affect the heart."
New vaccines offer increased protection
We were pleased to hear about the success of Merck's rotavirus vaccine, Rotateq. After only its second year of use, the vaccine has reduced the incidence of rotavirus, which causes vomiting and diarrhea in children, by at least two thirds. "It has also been effective at reducing cases in those who weren't vaccinated because it increases herd immunity," says ACSH's Jeff Stier. Dr. Kava believes, "Rotateq's effect on herd immunity is an excellent example of why people should be vaccinating their children in general."
Another promising vaccine is Wyeth's Prevnar-13, which protects against six more strains of bacteria that cause pneumococcal disease than Wyeth's previous product, Prevnar. "It offers broader and more intense coverage of disease-causing pneumococcal varieties, which are the most common cause of pneumonia, ear infections, and meningitis," Dr. Ross says. "Prevnar-13 is an advance in protecting children from these diseases."
Smokers more highly addicted to nicotine today than in the past
ACSH staffers were puzzled by the finding that today's smokers seem to be more strongly addicted to nicotine than smokers were twenty years ago. Dr. Ross wonders if it's because there is more nicotine in cigarettes today, while Dr. Whelan asks if nicotine is more easily inhaled through today's cigarettes.
Dr. Kava suggests, "Maybe it's because the people who found it easier to quit smoking have already quit. If that's the case, this would be a prime time for smokers who are having trouble curbing their nicotine cravings to start using smokeless tobacco products to reduce some of the negative health effects of smoking and eventually quit entirely."
MORNING DISPATCH 10/28/08: Morning Dispatch #300 -- HPV, arthritis, flu, and purple tomatoes
300th issue of MD marks milestone for ACSH
ACSH celebrates two accomplishments today: the success of yesterday's Board of Trustees meeting and our 300th Morning Dispatch!
"The Board of Trustees and the rest of us here at ACSH express our great appreciation for the support of all our MD readers," says ACSH's Jeff Stier. You can renew your support of ACSH here to ensure that you continue to receive these valuable daily updates -- and that we can continue to produce them.
Should older women be vaccinated against HPV?
While the HPV vaccine Gardasil is not currently approved for use in women over twenty-six, new research suggests that administering it to women up to the age of forty-five may dramatically cut cervical cancer rates. Gardasil protects against four strains of the human papillomavirus, two of which cause about 75% of all cases of cervical cancer, while the other two cause genital warts.
The vaccine is only effective if the recipient has not yet been infected with these strains, so the optimal time to vaccinate a woman is before she becomes sexually active. "But you can still get some protection from the vaccine if you haven't yet been infected with the four strains of HPV it inoculates against, no matter what your age," ACSH's Dr. Elizabeth Whelan explains.
But older women are more likely to have already contracted some form of HPV, so ACSH's Dr. Gilbert Ross questions whether a push to vaccinate them would have significant public health benefits, as opposed to individual benefits that are better evaluated on a case-by-case basis. "I think continued emphasis on vaccinating pre-teen and young teen girls is much more effective in attaining HPV protection and reducing the risk of cervical cancer," he says.
Rheumatoid arthritis makes headlines
Rheumatoid arthritis patients have an increased risk of heart disease and are more likely to suffer complications after a heart attack than those without the chronic condition. "We knew for years that people with rheumatoid arthritis had an increased risk of cardiovascular complications, but we didn't know what the cause was," Dr. Ross says. "The answer is probably that rheumatoid arthritis is a highly inflammatory disease, and we now know that inflammation and heart disease go hand in hand."
It also appears that the number of women diagnosed with rheumatoid arthritis in the United States is increasing. Dr. Ross points out, however, "If you calculate the absolute numbers attributed to this increase, they are not so impressive." Dr. Whelan wonders if the observed increased could be the result of better and earlier diagnoses.
"A diagnosis of rheumatoid arthritis is relatively easy to make, especially if the disease has already progressed," Dr. Ross explains. "The trick is to diagnosis it early. Then you can hit it hard with disease-modifying drugs early on, which can keep it in remission and prevent the joints from being destroyed."
Larger dose of flu vaccine may better protect the elderly
A new study suggests that senior citizens may benefit from an increased dose of the flu vaccine. Seniors are known to have a less vigorous immune response, and studies have shown that the usual dose of the flu vaccine often does not trigger a strong enough immune response to protect them from the disease. Giving older patients four times the regular dose of the vaccine, however, stimulated their immune systems to produce twice as much antibody as giving them a lower dose.
"Because this is still experimental research, we don't know if we'll see actual results in terms of fewer cases of the flu or less mortality," Dr. Ross says. "That said, it certainly sounds like a good idea."
Food companies cooperate to define and label healthy choices
Several large food companies have teamed up to create a standardized labeling system to denote healthier options available on supermarket shelves. "I think this is a very good idea," says ACSH's Dr. Ruth Kava. "There are too many different logos meant to indicate healthy foods right now. It could clear up a lot of confusion if one nutritional standard and one logo were adopted by many different food companies."
Dr. Ross, however, is skeptical of blanket efforts to encourage everyone to make the same "healthy choices" without considering the health issues people may face individually. He particularly points out that high doses of calcium and potassium can be dangerous for people with kidney problems. But Dr. Kava maintains that it is highly unlikely that a healthy person would get excessive doses of such nutrients from food.
On a lighter note, we wonder what labels those new purple tomatoes will get! Genetically engineered to include antioxidants found in blackberries and black currants, the purple tomatoes appear to decrease cancer risk and extend lifespan in mice who eat them. "While ACSH encourages bioengineering to increase the health benefits of some foods, we don't even know what the effects of antioxidants in food are," Stier says. "In short, the claims about purple tomatoes fighting cancer are not ripe yet," he jokes.
MORNING DISPATCH 10/24/08: Breast Size, Placebos, Obesity, and Lead
Lead poisoning: low risk, but high anxiety
Despite the current low incidence of lead poisoning in the U.S., fear of the toxin continues to make the news. Today, we are warned that lead can lurk in brass faucets, ceramic dishes, and art supplies, among other unexpected places.
"Lead is toxic in certain exposures, but the amount of lead in these products is not going to cause actual harm," explains ACSH's Dr. Gilbert Ross. "We even had a relatively low incidence of lead poisoning 30 years ago, and lead levels are now about tenth of what they were then because the chemical has since been removed from paint and gasoline products."
While we aren't planning to buy a lead test kit anytime soon, caution should still be taken when dealing with chipping paint in old buildings, since it is likely to contain lead. See ACSH's publication on the chemical here.
Study linking breast size to coffee consumption wins ACSH's first "Bust Award"
ACSH staffers had a good laugh over the absurd claim that drinking three or more cups of coffee per day causes a woman's breasts to shrink. "There's no way researchers could have found a causal link from the way the study was conducted," points out ACSH's Dr. Ruth Kava. ACSH's Dr. Elizabeth Whelan says, "This is a perfect example of junk reporting fueled by junk science."
ACSH's Jeff Stier adds, "Usually a story like this includes one reasonable voice questioning the study's results, but not this one." What is supposed to pass for rational reassurance is a quote from Lund University lecturer Helena Jernstroem: "Coffee-drinking women do not have to worry their breasts will shrink to nothing overnight. They will get smaller, but the breasts aren't just going to disappear." We think this ridiculous study deserves a special honor -- our first "Bust Award."
Could food masquerading as fat help people lose weight?
Using technology to treat obesity is a hot topic (ACSH even has a publication about it in the works), but we weren't convinced by the claim that a scientist has developed a way to mimic the satiating effect of a high fat meal by modifying other foods. Peter Wilde of the Institute of Food Research says that by "coat[ing] fat droplets in foods with modified proteins from plants" he can slow down the digestive system and ensure that fat isn't digested until far down in the intestines, which supposedly suppresses a person's appetite.
But as Dr. Kava explains, "High fat meals slow stomach emptying, making you feel fuller for a longer period of time. If this method doesn't take effect until food reaches the end of the intestines, it's too slow -- you're already on to the next meal by that point."
Unfortunately, a more plausible option for weight loss was removed this week when the European Union announced a ban on Sanofi-Aventis' obesity drug Acomplia.
Doctors often prescribe placebos
New research suggests that many American doctors give patients placebos, usually over-the-counter pain relievers or vitamins. While some are questioning the ethics of such a practice, Dr. Ross says, "There's nothing wrong with giving a placebo to someone who might be helped by it, such as patients with mood disorders, vague arthritic pain, or abdominal distress."
Issues do arise, however, when the placebo given is a sedative, which could have side effects, or an antibiotic, which could increase drug resistance when over prescribed. Dr. Ross adds another important boundary doctors should observe when prescribing placebos: "They shouldn't charge the patients for them."
MD takes a three-day weekend
There will be no Morning Dispatch on Monday due to the annual ACSH Board of Trustees Meeting. We'll we back on Tuesday with the 300th edition of our daily roundup of health news.
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MORNING DISPATCH 10/23/08: Phthalates, Pneumonia, Drought, and Drugs
Phthalates still in toys -- but so what?
Despite the fact that restrictions on phthalates in toys do not go into effect until 2009, the Wall Street Journal seems surprised that toys containing the chemicals are still on the market. The article quotes Carter Keithley, the president of the Toy Industry Association, as saying, "If there's a problem with phthalates, we don't want to be putting it in toys."
Now that certain phthalates are set to be banned, ACSH's Dr. Gilbert Ross points out that "from a purely business perspective, Keithley can't defend them." ACSH's Jeff Stier argues that Keithley's stance borders on "acknowledging that toys up until now have been dangerous -- which we know is not the case." Overall, we agree with toy maker Craig Wolfe's analysis: "The safety didn't change. The law changed." See ACSH's take on the safety of phthalates here.
Two drugs show promise in early tests
Early testing of two drugs shows encouraging results, but ACSH staffers remain wary pending more data. The first drug, Campath, has been on the market as a leukemia treatment for many years, but new research suggests that it might also be effective as a treatment for multiple sclerosis (MS). MS patients who took Campath in a study experienced improved physical function and increased brain volume compared to those who took a standard MS drug, Rebif.
"The study showed a dramatic improvement compared to a previously approved drug," says Dr. Ross. "I assume a doctor could prescribe Campath for MS off-label. However, this is a small, preliminary study -- therefore, I would still be cautious and use it only for patients who didn't respond to other drugs."
The second drug showing early signs of success is tesofensine, which appears to help obese people lose weight. "This is the first promising thing I've heard about a diet drug in ages," says ACSH's Dr. Elizabeth Whelan. The drug affects the nerve signaling chemicals noradrenaline, dopamine, and serotonin to ultimately reduce appetite. The study only tracked patients for six months, however, and one of tesofensine's potential side effects appears to be increased blood pressure -- a particular concern because obesity is itself a risk factor for hypertension.
Side effect concerns plague Chantix -- but not Gardasil
The FDA is currently investigating claims that the anti-smoking drug Chantix causes side effects that may increase road accidents, such as blackouts, temporary loss of vision, and seizures. Dr. Whelan argues, "When they say Chantix is risky, we should ask, 'compared to what? Smoking?'"
"Approving, prescribing, and using any drug is a benefit-risk balancing act," says Dr. Ross. "The side effects of Chantix should be taken into account, but that doesn't mean the drug should be severely restricted. After all, smoking is highly dangerous and extremely difficult to quit."
Stier adds, "The fact that we do not have a 'completely safe' way to help smokers quit underscores the importance of ACSH's campaign for the use of smokeless tobacco to help smokers quit and thereby reduce their risk."
In better news, the CDC has concluded -- again -- that the HPV vaccine Gardasil is safe. "We hear a lot about the 'safety concerns' of Gardasil from Judicial Watch and other groups who believe the vaccine will promote promiscuity, which is medically a non-issue," remarks Dr. Ross. "But the CDC has reviewed the reports of the adverse effects and deemed the vaccine to be safe."
Smokers should get pneumococcal vaccine
The CDC is now recommending that smokers -- even those as young as nineteen -- receive the pneumococcal vaccine. "Smokers have a higher risk of any complication involving the lungs, so it makes sense that they would benefit from a vaccine that protects against pneumonia," Dr. Ross explains. "Plus, the vaccine has no downside risk." It has been recommended for children and the elderly for years.
Biotech could reduce need to water crops
Demand for food is soaring along with its cost, but some scientists are trying to ease the burden by developing drought-resistant crops through genetic manipulation. "This is very important for both preserving water and increasing crop yields," Dr. Ross says.
The article particularly mentions work done in this area by ACSH Trustee and Nobel Peace Prize laureate Norman Borlaug's International Maize and Wheat Improvement Center. Not only did Dr. Borlaug and his organization spark the Green Revolution, but the group also recently developed drought-tolerant corn that is already being grown in Africa.
MORNING DISPATCH 10/22/08: Vaccination, Prescription, Counterfeiting, Wolfing, and Bone-Softening
Honorary seat at the table goes to the New York Times
We'd like to offer a seat at the ACSH breakfast table to the editorial board of the New York Times for its support of New Jersey's mandate that all young children receive flu vaccines before attending preschool or day care. "People are protesting the new requirement under the motto 'mother knows best,' but that argument doesn't hold up if your child is not vaccinated against a contagious illness and then comes to school and infects my child," says ACSH's Dr. Gilbert Ross.
The Times makes a particularly good point when discussing how the requirement will benefit the rest of New Jersey's population, particularly its most vulnerable members: "It seems likely that if influenza could be greatly suppressed among young children, it would also decline among adults and vulnerable senior citizens."
This idea is supported by data from Japan, where flu-related mortality declined significantly among senior citizens after flu shots were mandated for young children. As the Times writes, "Vaccinations for infectious diseases are most effective when coverage is near universal."
Some pinch pennies by forgoing prescriptions
ACSH staffers are disturbed by the news that some people are cutting back on their prescription medications in order to save money during the current economic downturn. ACSH's Dr. Elizabeth Whelan asks, "Can you imagine what would happen if people stopped taking their statins?"
Unfortunately, we may soon find out, because people have been cutting back on drugs like Lipitor, statins, and even Alzheimer's medications to save money -- and in some cases, to be able to continue to afford other treatments considered more pressing, such as insulin for diabetes.
Aside from the obvious detriment to individual health caused by not taking a necessary medication, not using preventive drugs like statins increases the risk of health problems down the road -- which may eventually cost individuals and the health care system much more money than the drugs cost today.
The EU gets serious about counterfeit drugs
The European Union is cracking down on the problem of counterfeit drugs, and officials in the twenty-seven-country bloc are currently developing a system to make drugs traceable from factory to pharmacy. "They are recognizing what a serious issue this is," Dr. Whelan says.
Counterfeit drugs are often not produced according to the same high standards required by pharmaceutical companies, a problem that can sometimes have fatal consequences. For more information on this issue, see ACSH's publication Counterfeit Drugs: Coming to a Pharmacy Near You. An updated version of this important book will be published in the coming months.
Eating fast makes you more likely to get fat
We aren't surprised to hear that people who eat fast are more likely to be overweight than people who take their time during meals. "The theory behind it is that it takes about twenty minutes for the brain to realize that the stomach is full," explains ACSH's Dr. Ruth Kava. "Strategies to slow down when eating include putting your fork down between bites and chewing each bite many times."
Vitamin D supplement still effective when taken once a month
A new study finds that a monthly dose of vitamin D is as safe and effective as smaller daily or weekly doses. "There is a growing concern that people aren't getting enough vitamin D, especially because of the use of sunscreen," Dr. Kava says. "The bone-softening disease rickets is even coming back, particularly in breast-fed babies whose mothers are not getting enough vitamin D."
While vitamin D supplements might be helpful for some people, ACSH staffers advise those who are considering taking any supplement to consult their doctors about possible unwanted side effects or dangerous drug interactions.
MORNING DISPATCH 10/21/08: BPA, Acrylamide, Menu Options, Junk, and Breast Cancer
BPA in sealants sparks unwarranted concern
Adding to the hysteria over bisphenol-A (BPA), some parents are now worried about the chemical's presence in dental sealants. "This scare has limitless possibilities because BPA is used in so many products," remarks ACSH's Dr. Elizabeth Whelan.
Targeting sealants, however, would be particularly unfortunate because they are so successful at preventing cavities. "Between sealants and fluoridated water, there is a whole generation of kids growing up with almost no cavities," Dr. Whelan observes.
We agree with a comment made by Dr. Leslie Seldin, a New York City dentist and consumer adviser for the American Dental Association (which maintains that sealants are safe): "This [the use of sealants] is such an enormously valuable tool to prevent tooth decay. The BPA issue, I think, is so minuscule in impact that it doesn't really warrant the attention it's been getting."
Effort to link acrylamide to cancer continues to prove futile
Another scare that often makes headlines is the one over acrylamide -- but lately, most of those headlines are about failing to link the chemical to cancer in humans. The latest study of acrylamide's effects finds that it does not cause gastrointestinal cancer. "Who suggested that it did in the first place?" Dr. Whelan wonders. "It seems like we're going site by site, investigating acrylamide as a possible carcinogen."
Acrylamide, which is produced when certain carbohydrate-rich foods are cooked at high temperatures, was classified as a "probable human carcinogen" based on data from animal studies. But as ACSH's Dr. Gilbert Ross says, "This is about the ninth study showing no link between acrylamide and human cancer -- as opposed to zero studies showing such a link. Still, some people remain convinced that we have to continue researching until we find some cancer that it causes."
ACSH's Dr. Ruth Kava points out, "Even people who are occupationally exposed to acrylamide don't have a higher risk of cancer." We hope these scientific facts eventually kill the scare -- and the sooner, the better.
Long John Silver's introduces healthier menu options
The fast food chain Long John Silver's has long specialized in fried fish, but it recently announced that its menu would soon include healthier, grilled options. "Who could argue with that?" asks Dr. Kava.
ACSH's Dr. Elizabeth Whelan agrees, "It's always nice to give people alternatives." We wonder how much nutritional information about the new choices the chain will post on its website.
Junk food or junk science?
ACSH staffers are dismayed by a new study alleging that over one third of heart attacks are caused by "junk food." "The major risk factors for heart disease are high cholesterol, hypertension, and smoking," Dr. Kava explains. Dr. Whelan reasons, "In order for this study's conclusion to be correct, eating fast food would have to be wholly responsible for high cholesterol -- which we know is not true."
In fact, according to Dr. Ross, "Dietary changes have only minimal impact on blood cholesterol levels in most people." He adds, "This study is vague and laden with confounders."
We are concerned because it was published by the usually respectable journal Circulation. "ACSH takes the stance that peer-reviewed science is legitimate science, but that classification seems to losing its meaning as more respectable journals start publishing junk science," Dr. Whelan says.
Mastectomy may be better for treating breast cancer recurrences
Doctors are advising women whose first occurrence of breast cancer was treated by lumpectomy to have a mastectomy if the cancer returns in the same breast. A new study concludes that the five-year survival rate was 67% for women who had a second lumpectomy, but 78% for those who had a mastectomy after a breast cancer recurrence.
Dr. Whelan points out, "Women who have lumpectomies and the appropriate radiation and chemo to treat early stage breast cancer rarely have recurrences. But if they do, it is important to know that a mastectomy may be the better treatment option."
MORNING DISPATCH 10/20/08: Carrots, Cancer, Canada, Coughs, and Confusing Arthritis Info
Canada caves on BPA
Canada has banned baby bottles made with bisphenol-A, making it the first country to institute a nationwide ban of a product containing the chemical. "Just think of the precedent they're setting by banning BPA based on high-dose animal tests," says ACSH's Dr. Elizabeth Whelan.
She continues, "In 1958, it was hypothesized that a mouse was a little man. But by the late 1970s, ACSH and others were asking, 'High doses of some synthetic chemicals cause cancer in rodents compared to what?' We've never tested natural chemicals in this way." And, she points out, "no scientists are protesting this" -- a situation which ACSH has been trying to remedy for decades.
Arthritis confusingly tied to ethnicity, obesity, and age
Researchers found that older African American, Native American, and non-white Hispanic women were more likely to develop arthritis than older white women, a disparity they link to higher rates of obesity among the arthritis prone populations. But ACSH staffers remain skeptical of their findings. "There are too many variables going on here -- ethnic differences, obesity, and age," observes ACSH's Dr. Gilbert Ross. "I'm not sure what the take-home message is."
ACSH's Dr. Ruth Kava agrees: "Obesity is indeed a risk factor for arthritis because the excess weight can put extra pressure on the joints. But this study seems like it should be age-adjusted somehow. There are too many confounding factors."
Researchers continue to tally benefits of exercise
Two new studies provide even more reasons to exercise, especially if you are older or overweight. Regular aerobic activity may help reduce age-related mental decline, and exercise may also lower the risk of uterine cancer in overweight women.
"Since obesity is a risk factor for several cancers, the idea that exercise could cut cancer risk makes sense if it is connected to losing weight," notes Dr. Whelan. The study of uterine cancer rates, however, made no mention of weight-loss being associated with the physical activity.
"It was a questionnaire study -- a snapshot of behavior rather than a prospective follow-up study -- so there were no data as to the course of the study subjects' weight change," Dr. Ross says.
Adults can get whooping cough, too
While whooping cough, or pertussis, is mainly considered to be a childhood illness, adults can still contract the disease. "There have been a couple of outbreaks lately among adults," Dr. Kava reminds us.
While whooping cough can be treated with antibiotics, many adults are misdiagnosed because their doctors are not aware that the disease can affect them. Also, Dr. Ross explains, "It can appear to be just a persistent cough in adults because they don't always have the characteristic cough" -- a coughing attack that ends with a high-pitched inhale, or "whoop" sound.
Dr. Ross adds, "College students are particularly at risk because often their immunity has waned even if they were vaccinated against the disease as children. Doctors are starting to advocate booster shots for pertussis for adults as well."
Nothing to fear from baby carrots
ACSH received an email on Friday about the alleged dangers of baby carrots, which the sender claimed to be made from "deformed" full-size carrots and "dipped in a solution of water and chlorine to preserve them." While we were skeptical (to say the very least), we decided to do some research.
While some baby carrots are made from larger carrots, there is nothing wrong with the original roots. According to Snopes.com, a website devoted to debunking and explaining urban legends, baby carrots may be treated with chlorine during processing, but the chemical is washed off before packaging. The "white film" the e-mail warns is caused by chlorine contamination is actually just a result of the carrots drying out.
For more information on Internet health rumors, listen to ACSH's Jeff Stier on NPR's "Anatomy of a Rumor" (fast forward to 19:55).
MORNING DISPATCH 10/17/08: Vaccines, Lead, Nicotine, and Cell Phones
Honorary seat at the table goes to New Jersey's Public Health Council
We'd like to offer a seat at the ACSH breakfast table to the Public Health Council of New Jersey, which recently began requiring that all children receive a flu shot before attending preschool or day-care. Unfortunately -- but not surprisingly -- many parents are protesting the new requirement (with the help of "health advocate" Gary Null, whom both ACSH Drs. Elizabeth Whelan and Ruth Kava have debated). "This is not a matter of freedom of choice," argues ACSH's Dr. Gilbert Ross. "It's a matter of public health."
He continues, "The flu is very infectious. While not many young children die each year of the disease, they are excellent vectors for the spread of the influenza virus. Many of the elderly people who contract the flu do so through contact with children." In fact, a Japanese requirement that all children be vaccinated against the flu led to a dramatic reduction in the death toll among the country's senior citizens some years ago.
New Jersey's Health Department effectively summed up the issue with the statement, "Vaccines not only protect the child being vaccinated but also the general community and the most vulnerable individuals within the community."
"Those opposed to this policy harbor unfounded fears of vaccine toxicity, which have been disproved over and over again," Dr. Ross says. "The flu vaccine is safe, and now is the time to get yours."
Nicotine misrepresented as a cause of cancer
We were dismayed to see the headline "Nicotine May Spur Breast Cancer's Spread" in U.S. News and World Report today, and even more upset by the article's poorly researched statement, "Nicotine, a component of tobacco, has been connected with a variety of malignancies -- not only lung cancer, but also head and neck cancer, prostate cancer, and more."
"There is a very widespread misunderstanding that nicotine is a cause of lung cancer, but that's a major mistake with life or death implications" -- especially if it deters people from quitting smoking by using clean nicotine products, Dr. Whelan says. In fact, the most dangerous components of cigarettes are the products of combustion released when they are smoked.
The new study asserts that certain cells express nicotine receptors, so exposure to the chemical can signal those cells to grow and migrate -- a dangerous effect when the cells are cancerous. But there is no evidence that nicotine promotes the occurrence or spread of any cancer. As ACSH's Jeff Stier points out, "This is a very preliminary study, but unfortunately it still has the potential to undermine the whole concept of harm reduction."
EPA aims to reduce airborne lead, but why?
For the first time in thirty years, the EPA has set new standards regulating airborne lead, slashing the maximum allowable concentrations of the particles by 90%. But ACSH staffers wonder, is this really necessary?
"The lead levels in the air are not a significant contributing factor to cases of lead poisoning," says Stier, who has written about misguided lead rules previously passed by the federal government. In fact, most cases of lead poisoning are currently caused by peeling lead paint in old buildings -- most of which are found in inner cities. "If we put a tenth of the resources we're using to reduce airborne lead levels toward improving decrepit housing in inner cities, we might actually be able to make a difference," Stier continues.
Even Dr. Bruce P. Lanphear, an expert on lead toxicity who supports the EPA's decision, admits that the new requirements "won't lead to dramatic reductions" in blood-lead levels of younger children. It looks like the new standards will even have an unintended environmental consequence -- it's going to become much more difficult to recycle lead batteries.
Nickel in cell phones can cause allergic reactions
Some people who are allergic to nickel are developing rashes on their ears and cheeks because of exposure to the metal surfaces of cell phones. "Allergic reactions to jewelry and other products that contain nickel are relatively common," Dr. Ross says. "Those who know they are prone to such reactions should be aware that contact with cell phones might cause a rash." Stier warns, "This is a simple skin allergy and it shouldn't be confused with all the junk science that's out there about cell phones right now."
MORNING DISPATCH 10/16/08: Infants, Voles, Polio, Aspirin, and Food
Infant mortality statistics present complex story
New statistics rank the United States as twenty-ninth in infant mortality, with nearly seven out of 1,000 babies dying before their first birthday. In 1960, about twenty-six out of 1,000 infants died in the U.S., and the country ranked twelfth. "We're doing a much, much better job of bringing babies into the world and keeping them alive than we were in 1960, but other countries have made even more progress," explains ACSH's Dr. Gilbert Ross.
"The fact that we're twenty-ninth in the world is not the whole story," says Dr. Ross. He points out that these statistics are inherently misleading, as the U.S. has a much more diverse population than most of the other countries listed, including a large population of recent immigrants, with the attendant variability in prenatal health care.
Dr. Ross believes a bigger issue lies in the racial disparity seen in our infant mortality statistics. While about six out of 1,000 infants died among white Americans in 2005, nearly fourteen out of 1,000 died among black Americans. "We really need to look at and address the differences in infant mortality rates among our own population," he says.
Bayer questioned about marketing of aspirin and supplement combo
Bayer has been marketing a combination of aspirin and the cholesterol-lowering dietary supplement phytosterols directly to consumers, which some lawmakers consider to be a violation of FDA policy. "The issue is that companies are not supposed to be allowed to market a combination of an over-the-counter approved drug and a supplement as if the combination itself had been approved by the FDA," Dr. Ross explains.
ACSH's Dr. Ruth Kava notes, "Dietary supplements are not allowed to claim that they can treat or cure a disease, while approved drugs of course can do so. This combination approach is a bit like mixing apples and oranges but pretending that you don't have fruit salad."
Dietary supplements are not subject to FDA pre-marketing approval or regulation, so consumers should always consult their doctors about possible negative side effects or dangerous interactions with traditional medications before taking them.
New polio vaccine may reach last pockets of disease
Scientists have developed a new polio vaccine they say will be more effective at targeting the disease in the areas where it still thrives. "The new monovalent vaccine is more immunogenic than the existing trivalent one and, therefore, will provide better protection against the virus," Dr. Ross says.
While polio has been eradicated from most countries, pockets of the disease still exist in northern Nigeria, northern India, and along the Pakistan-Afghanistan border. We hope the new vaccine will bring us even closer to worldwide eradication of this devastating illness.
Can the food industry help fight obesity?
Food police leaders Marion Nestle and David Ludwig have an op-ed in this month's Journal of the American Medical Association condemning the food industry's ability to constructively fight the obesity epidemic. "To expand profits in this environment, food companies have only two options: convince customers to eat more (contributing directly to obesity) or increase profit margins, especially by marketing reformulated or repackaged products (an indirect contribution)," they write.
Dr. Ross takes issue with their argument, saying, "They reduce the discussion to black and white options ('eat more' or 'reformulate') and ignore other methods the food industry can potentially use to do well while doing 'good' in the fight against obesity, such as utilizing technology to produce tasty lower calorie options." Stay tuned for an ACSH publication on obesity, technology, and food, which will be published in the coming months.
Voles leave grief behind while older adults Google their way to brain health
Researchers claim to have found a way to block the brain chemical associated with grief after losing a partner. Those worried about the implications of such a treatment, however, shouldn't be too concerned -- the study was done on prairie voles.
"The key neuro-humoral factor involved -- in the small rodents, anyway -- was corticotropin-releasing factor (CRF), made in the hypothalamus," explains Dr. Ross. "The next question: is it okay to try to prevent grief? This animal study is only a tiny step in getting to that question."
And for all curious minds wondering if the Internet has a health benefit, scientists now believe that Internet searching stimulates high levels of brain activity in older adults familiar with the tool. "I didn't actually see any numbers in this article," Dr. Ross points out. Maybe we should Google it.
MORNING DISPATCH 10/15/08: Flu, Chemicals, Alzheimer's, Blood Pressure, Antioxidants, and Radiation
Flu season is here
Sporadic cases of influenza have started appearing in several states, representing the beginning of this year's flu season. "It may seem early, but we're already seeing outbreaks of the disease," says ACSH's Dr. Elizabeth Whelan. "The good news is that we now have evidence that there is a very good match between this year's vaccine and the current influenza virus."
Unfortunately, not all doctor's offices and pharmacies have started providing the potentially life-saving vaccine yet -- including Dr. Whelan's own doctor's office. "I tried to get the vaccine yesterday, but they said it was still too early," she says.
ACSH's Dr. Gilbert Ross believes "The shots should definitely be out there by now. It's never too early to get a flu shot, and your doctor should be prepared to provide one even if you go into her or his office for another reason."
Chemical scares continue to make headlines
Despite repeated assurances from the FDA that bisphenol-A (BPA) is safe, the chemical continues to be the focus of a baseless scare. The attorney generals of Connecticut, New Jersey, and Delaware have now asked eleven companies that manufacture baby bottles and formula containers to stop using the chemical in their products. "The future of BPA does not look good, even though all the scientific evidence points to it being a safe and useful chemical," notes Dr. Whelan.
A new scare might soon steal the spotlight from BPA, however: the Environmental Working Group (EWG) reports that some brands of bottled water contain "chemical contaminants" at higher levels than are legal in California. "It's astounding that every time the EWG releases a scare-mongering study, it makes headlines," Dr. Whelan says.
"This is just another example of how California's ridiculous Proposition 65 regulations come back to bite at law-abiding businesses," adds Dr. Ross. "I'm no fan of bottled water, but the tiny levels of 'contaminants' the EWG found do not represent a threat to anyone's health -- but they may help to fill their coffers if they can recover 'damages' based on a Prop 65 suit."
B vitamins do not help Alzheimer's patients
A new study shows that high doses of vitamins B6, B12, and folate did not slow the cognitive decline associated with Alzheimer's disease. Because these B vitamins can help reduce blood levels of the amino acid homocysteine, high levels of which are found in the blood of those with Alzheimer's, doctors hoped that taking the vitamins could help slow the progression of the disease.
While the vitamins did lower the patients' levels of homocysteine, researchers saw no effect on the decline of cognitive function. "They've been trying to make connections between homocysteine and several diseases for a long time," says ACSH's Dr. Ruth Kava. "Its possible connection to heart disease hasn't panned out either."
Blood pressure rises in the U.S.
Hypertension rates are soaring in the United States, due in large part to the growing problem of obesity. "Obesity is a substantial risk factor for hypertension," Dr. Ross explains. "In fact, if a patient who is overweight and hypertensive loses weight, their blood pressure will usually go down somewhat, even without medication."
While the general trend came as no surprise to ACSH staffers, the study's specific figures inspired some skepticism. "If you add up the numbers this study reports, you find that 91% of people are supposed to have either hypertension or prehypertension," observes Dr. Ross. "That's a bit hard to believe."
Vision problems linked to low levels of antioxidants and excessive sunlight
Researchers claim that the combination of low blood levels of certain antioxidants (vitamins C and E, zinc, and lutein) combined with excessive sunlight exposure can make older adults more susceptible to age-related macular degeneration (AMD), a disease that causes vision loss. Dr. Ross, however, believes, "I hate to say 'data dredging' every single day, but it seems as though this study, like so many others, is based on examining many variables until the researchers happen to find a statistically significant one."
Radiation therapy may increase chance of breast cancer in younger patients
Radiation therapy may increase the chance of younger breast cancer survivors developing cancer in the other breast -- or at least those treated from 1970 to 1986. "Radiation therapy techniques have been improved dramatically in the last twenty years," says Dr. Ross. However, study author Maartje J. Hooning still offers doctors an important reminder: "treating clinicians should be aware of the existing dose-response relationship for risk of contralateral breast cancer. Especially in young women, the radiation dose to the contralateral breast should be kept as low as possible."
MORNING DISPATCH 10/14/08: Joints, Fat, Lungs, iPods, Dubious D
Minimally invasive joint-replacement surgeries face doubts
While minimally invasive joint-replacement surgeries hypothetically require less recovery time because they use smaller incisions, the procedures may also pose a greater risk of complications than traditional knee and hip replacement surgeries. The smaller incision can make it more difficult for a doctor to see what she or he is doing during the procedure, possibly resulting in more complications such as uneven leg lengths, broken hip bones, and slightly off-kilter knee joints. But while providing an important caution in general, the article provided no hard data about the incidence of poorer outcomes.
"Drugs and devices must be approved by the FDA, but there is no such review process for medical procedures," explains ACSH's Dr. Gilbert Ross. "It's considered medical judgment."
ACSH's Dr. Elizabeth Whelan believes that could be a reason why "these things just go on without being statistically evaluated." While minimally invasive joint-replacement surgery is certainly a promising idea, patients should carefully weigh the pros and cons with their doctor -- who should have a proven record of success with this type of surgery -- before undergoing the procedure.
Many women do not understand obesity's link to cancer
A new study finds that about half of women surveyed do not know that obesity increases their risk of several cancers, particularly endometrial, colon, and breast cancers. "Frankly, I was surprised that even that many of the women they surveyed knew about obesity's link to cancer," Dr. Whelan says.
While obesity is widely understood to have many detrimental health effects -- including an increased risk of miscarriage -- not understanding its specific link to these types of cancer can mean that some women may not recognize early symptoms and, therefore, go untreated until the disease has progressed. "We need to mount an educational campaign," Dr. Ross believes.
EU warns against turning up the volume on iPods
Prolonged exposure to loud music has long been blamed for hearing loss, and the growing popularity of mp3 players among young people has the European Union worried enough to issue a warning about listening to music too loudly on them. Dr. Ross says, "While we caution people against using these devices at too high a volume, the EU should have actually measured the amount of time and at what volume kids use mp3 players and correlated it with hearing loss, rather than making this statement based on a noise level arbitrarily deemed to be unsafe."
Lung cancer in nonsmokers may be a different disease
The characteristics of non-small cell lung cancer (NSCLC) differ significantly between smokers and never-smokers who develop the disease. "This is astounding," says Dr. Ross. "Non-small cell lung cancer appears to be a much more benign disease among never-smokers who develop it, a significant percentage of whom are women."
NSCLC is the most common type of lung cancer -- consisting of adenocarcinoma and squamous cell types -- and the researchers found that the portion of never-smokers among all NSCLC patients rose from 16% to 33% between 1974 and 2004. Women accounted for 86% of the never-smoking NSCLC patients and 11% of patients with a history of smoking. Never-smoking patients, however, were much more likely than those who smoked to have had pathologic stage 1A disease, which is more easily treated than advanced forms of the cancer.
Dubious claims made about vitamin D
ACSH staffers are skeptical of two stories about vitamin D. The first concerns an association researchers found between low levels of vitamin D and Parkinson's disease. Out of 100 people with Parkinson's, 23 were vitamin D deficient, compared to 16 out of 100 patients with Alzheimer's and 10 out of 100 healthy people. "This sounds like data dredging to me," Dr. Ross remarks. "They studied different parameters and found a few that happened to be statistically significant. There is no sound biological explanation for why vitamin D should be involved with the genesis of Parkinson's disease or Alzheimer's."
The second story revolves around the American Academy of Pediatrics' decision to double the recommended daily dose of vitamin D for children. While the vitamin is known to prevent the bone disease rickets in children, no concrete reason is given for changing the Academy's recommendation at this time. Dr. Kava notes, "Vitamin D research is attracting a lot of attention these days, and low levels are linked to several diseases. Whether this recommendation will improve children's health remains to be seen."
Elizabeth Wade is a research intern at the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com). Receive ACSH Morning Dispatch in your e-mail in-box each weekday by donating to ACSH and then requesting subscription.