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Health Journal: Deciphering the Ailments Tied to Gluten

Dr Joe — Tue, 07 Feb 2012 13:51:20 +0000

Researchers are making slow progress in understanding the numerous ailments that a growing number of people suffer after eating foods with gluten, a protein found in wheat. As the Health Journal column reports , a group of 15 experts from seven countries took a step forward this week, proposing a new classification and diagnosing system to help doctors and patients figure out what’s a wheat allergy, what’s celiac disease and what falls under a new category of ills lumped together as “gluten sensitivity.” Another international team aims to clear up the confusion caused by experts around the world using different terminology for gluten-related problems; celiac disease alone has been called sprue, gluten-sensitive enteropathy and gluten intolerance. Their consensus paper will be published soon in the journal Gut. A lesser-known disorder is gluten ataxia, in which antibodies to gluten damage parts of the brain that control gait, speech and motor function. Researchers have long wondered whether antibodies to gluten could attack other parts of the brain as well, and some intriguing findings have emerged. For instance, people with schizophrenia have a higher rate of the anti-gluten antibodies and gene variations associated with celiac disease than the general population. And some parents of autistic children say their symptoms improve, sometimes dramatically, on a gluten-free diet, though no link has been firmly established in lab studies. Gluten disorders could play a role in dementia as well. In a 2006 study, physicians at the Mayo Clinic in Rochester, Minn., identified 13 patients with celiac disease who started showing signs of cognitive decline at the same time gastrointestinal symptoms set in. Some improved and some didn’t on a gluten-free diet, and much more research is needed to explore the connection. But neurologists at the Mayo Clinic now routinely test for celiac disease in patients with early on-set dementia. A more fundamental mystery is why gluten, a staple of most human diets since the dawn of agriculture 10,000 years ago, is creating more health problems now. Once considered rare, celiac disease is now believed to affect about 1% of the U.S. population, up fourfold over the last 50 years. “Has the staff of life become the stuff of illness for some?” asks Joseph Murray , a celiac expert at the Mayo Clinic. Some experts suspect that genetic changes to raise the protein content of wheat may play a role, as could industrial baking procedures that shorten the time bread is exposed to yeast. Wheat also makes up a larger portion of human diets than in generations past, and wheat consumption is growing in Asia and the Middle East, along with gluten-related disorders. Still another theory holds that the bacteria that inhabit the human body may have evolved to be less hospitable to gluten over time. Whatever the reason, says Alessio Fasano , director of the University of Maryland’s Center for Celiac Research, “our environment is changing faster than humans can adapt, and some people are paying the price.”

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Health Journal: Deciphering the Ailments Tied to Gluten

ASCO: Why Cancer Care and Palliative Care Should Be Combined

Dr Dreams — Mon, 06 Feb 2012 21:06:05 +0000

Cancer patients with advanced disease should have access to palliative care early on in their illness, according to new guidelines from the American Society of Clinical Oncology. That doesn’t mean oncologists are being encouraged to give up on extending the lives of those patients, says Thomas Smith, an author of the guidance and director of palliative care for Johns Hopkins Medicine and a professor of palliative care in the Hopkins School of Medicine’s oncology department. Rather, the guidelines recommend combining palliative care — open and honest communication about the progress of the disease and the patient’s wishes, medical appropriate goal-setting and careful attention to symptom management — with standard oncology care, says Smith. (The “provisional clinical opinion” is published online by the Journal of Clinical Oncology.) Practically, that would mean patients would still receive whatever treatments were likely to help fight their disease. But they’d also get help from a palliative care team trained in having tough conversations about prognosis, quality of life and death. “It’s not hard for oncologists to tell who can be cured and who can’t,” says Smith. “But it’s hard to sit down and explain to people what will happen to them, and to have a discussion about how that person wants to spend their last weeks, months and years of life,” he says. There aren’t a huge number of large randomized clinical trials on which to base recommendations for palliative care, says Smith; the area is not particularly well funded. But one study that did get a lot of attention, published in the New England Journal of Medicine in 2010, found that advanced lung-cancer patients who were randomly assigned to receiving early palliative care in conjunction with standard care not only reported better quality of life, but lived a few months longer than patients receiving only standard care. What comes through “loud and clear” from the available research is that there’s no harm in incorporating palliative care early on with patients with metastatic disease, says Smith. Patients tend to have their pain and symptoms better managed, to have a better understanding of their illness, and to receive more medically appropriate care, he says. Research also shows they and their family members are less likely to be depressed. The statement from ASCO says that more research is necessary to figure out the best timing and venue for providing palliative care, to evaluate reimbursement models and to gauge the effectiveness of various components, among other things. Bonus: ASCO: How to Talk About End-of-Life-Care With Cancer Patients

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ASCO: Why Cancer Care and Palliative Care Should Be Combined

A.M. Vitals: Social Media Helped Fuel Protests Against Komen

Martin Neumann — Mon, 06 Feb 2012 14:08:32 +0000

Social Media and Funding Brouhaha: Social media helped galvanize supporters of Planned Parenthood last week after Susan G. Komen for the Cure said it would cut off funding for the women’s health nonprofit — and then reversed its stance, the WSJ reports . According to social-media monitor NetBase Solutions, Komen-related chatter rose 80% from last Monday to Tuesday, when the story broke, with 66% of online conversations against the breast-cancer advocacy group. The Toll of Child Abuse: Research published in Pediatrics finds that more children under one year of age are admitted to hospitals for child abuse than for reasons related to sudden infant death syndrome, Time’s Healthland blog reports . Researchers found the death rate from child abuse was 6% in 2006, with 300 deaths of 4,569 hospitalizations. Under Observation: Medicare beneficiaries not officially admitted to the hospital but who spend time there under “observation care” may be surprised that they owe for hospital co-pays and any subsequent nursing-home care , the WSJ reports . The number of observation hours — considered outpatient care by Medicare — rose to 36 million in 2009 from 23 million in 2006, including a rising number of visits lasting longer than 48 hours, the paper says. Public-Health Debate: What’s a better way to convey public-health messages about diet, smoking and other lifestyle choices — stark, if harrowing, ads about the consequences of obesity, diabetes and lung cancer, or more positive, empowering messages? As the New York Times reports , there’s a debate about whether some of New York City’s ad campaigns will make an impact, with critics saying the harsher messages won’t resonate with the people who need to hear them most. NYC’s health department says the campaigns reflect the true consequences of diseases. Image: iStockphoto

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A.M. Vitals: Social Media Helped Fuel Protests Against Komen

Health-Care Sector Added 30,900 Jobs Last Month

Dr Dreams — Fri, 03 Feb 2012 17:27:08 +0000

The overall economy added 243,000 jobs last month — with the health-care sector continuing to show strength — while the unemployment rate fell to 8.3%. As the WSJ reports , that’s the lowest the jobless rate has been since Feb. 2009. (Here’s the full report from the Bureau of Labor Statistics.) The health-care industry added 30,900 jobs in January, following a revised increase of 17,600 jobs the previous month. (Originally the government reported a larger December gain of 22,600 jobs in the sector, as we reported .) Data from the BLS gives a snapshot of job growth by facility rather than job function. For example, the report shows that hospitals added 12,700 jobs, but doesn’t say whether those were nursing, IT or cafeteria positions. Ambulatory health-care services added 12,900 jobs as doctors’ offices, outpatient care centers and home-health services all saw growth. Nursing-care facilities added 2,700 jobs, while the broader category of nursing and residential-care facilities overall gained 5,300 jobs in January. Image: iStockphoto

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Health-Care Sector Added 30,900 Jobs Last Month

Komen Says Planned Parenthood Will Still Be Eligible For Funding

Martin Neumann — Fri, 03 Feb 2012 17:13:53 +0000

A Komen fundraising race from the fall. It hasn’t been a great week for Susan G. Komen for the Cure, the breast-cancer advocacy group known for its pink-ribbon fundraising efforts. Today the group reversed a decision — made public only Tuesday — to end Planned Parenthood’s eligibility for grants. Critics had said Komen planned to cut funding to the group for breast exams and education under pressure from anti-abortion organizations; Komen denied that. In a statement , Komen’s board and its founder and CEO, Nancy Brinker, apologized “to the American public for recent decisions that cast doubt upon our commitment to our mission of saving women’s lives.” The statement continues: The events of this week have been deeply unsettling for our supporters, partners and friends and all of us at Susan G. Komen. We have been distressed at the presumption that the changes made to our funding criteria were done for political reasons or to specifically penalize Planned Parenthood. They were not. Komen’s short-lived move to defund Planned Parenthood spurred controversy , to put it mildly. Komen’s public rationale for its action changed over the week: A spokeswoman originally told the Associated Press it had changed its criteria to end grants to any organization under government investigation. But later in the week it said the decision sprang from a broader review of its criteria for grantees. Today it said it would “amend the criteria to make clear that disqualifying investigations must be criminal and conclusive in nature and not political. That is what is right and fair.” Planned Parenthood is the subject of a congressional investigation. Komen’s statement continues: Our only goal for our granting process is to support women and families in the fight against breast cancer. Amending our criteria will ensure that politics has no place in our grant process. We will continue to fund existing grants, including those of Planned Parenthood, and preserve their eligibility to apply for future grants, while maintaining the ability of our affiliates to make funding decisions that meet the needs of their communities. It is our hope and we believe it is time for everyone involved to pause, slow down and reflect on how grants can most effectively and directly be administered without controversies that hurt the cause of women. We urge everyone who has participated in this conversation across the country over the last few days to help us move past this issue. We do not want our mission marred or affected by politics — anyone’s politics. Starting this afternoon, we will have calls with our network and key supporters to refocus our attention on our mission and get back to doing our work. We ask for the public’s understanding and patience as we gather our Komen affiliates from around the country to determine how to move forward in the best interests of the women and people we serve. We extend our deepest thanks for the outpouring of support we have received from so many in the past few days and we sincerely hope that these changes will be welcomed by those who have expressed their concern. Planned Parenthood, in a statement , said it is “enormously grateful that the Komen Foundation has clarified its grantmaking criteria, and we look forward to continuing our partnership with Komen partners, leaders and volunteers. What these past few days have demonstrated is the deep resolve all Americans share in the fight against cancer, and we honor those who are at the helm of this battle.” So, readers, have the week’s events changed your opinion of Susan G. Komen for the Cure? Photo: Associated Press

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Komen Says Planned Parenthood Will Still Be Eligible For Funding

Two Studies Hint at How Alzheimer’s Might Spread

Martin Neumann — Thu, 02 Feb 2012 23:42:44 +0000

There are many mysteries when it comes to understanding Alzheimer’s disease, with one of the biggest questions centering on how the memory-robbing disease progresses. Decades ago, researchers discovered that the damage starts in the same part of the brain in all patients and systematically moves on to affect nearby regions. It wasn’t clear, however, why this progression occurred. One intriguing theory was that the pathology “spreads” between neurons. But for years there wasn’t a good way of testing the hypothesis. Now, two new studies conducted in mice, one published in PLoS ONE and the other in press at Neuron, offer evidence that the damage – specifically the misfolding of a protein called tau – is likely passed from one neuron to another. The exact mechanism isn’t clear, but the researchers believe that somehow a flawed “template” for how tau should be folded gets released by one neuron and picked up by the next one, which then starts misfolding tau based on that new template, says Bradley Hyman , a Harvard neurology professor who is an author of the upcoming Neuron study. Now, researchers can start figuring out how the errant message gets transmitted and picked up. Interrupting any step of this process could “plausibly” interrupt the progression of the disease, Hyman tells the Health Blog. The papers have garnered a lot of interest. But some experts urge caution in interpreting the results. The research “proposes a certain mechanism for tau spreading but that mechanism is unproven at this point,” William Thies, chief medical and scientific officer of the Alzheimer’s Association, tells the Health Blog. “There’s a lot of work that needs to be done to clarify whether this is real” as well as how the findings could be used to inform therapy, says Thies. Image: iStockphoto

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Two Studies Hint at How Alzheimer’s Might Spread

A Spoonful of Bad Health? UCSF Researchers Slam Sugar

Dr Dreams — Thu, 02 Feb 2012 21:48:50 +0000

Tobacco, alcohol … and sugar? A new commentary published in Nature argues that just as the first two substances are regulated in various ways by government authorities, so should be sugar. While acknowledging that food, unlike alcohol and tobacco, is required for survival, the authors say taxes, zoning ordinances and even age limits for purchasing certain sugar-laden products are all appropriate remedies for what they see as a not-so-sweet problem. The authors of the piece, Robert Lustig, Laura Schmidt and Claire Brindis, are all from the University of California, San Francisco. Lustig has been a particularly harsh (and longtime) critic of the impact of added sugars on health — here’s his widely viewed 2009 lecture on that topic. (Lustig was also a central character in a New York Times magazine piece on this subject last year.) Note that they are talking about sugar added to foods. No one is arguing that we should spurn fruit, for example, because of the naturally occurring fructose. “We believe attention should be turned to ‘added sugar,’ defined as any sweetener containing the molecule fructose that is added to food in processing,” the authors write. (And they argue the current dietary “bogeymen” — saturated fat and salt — deserve less scrutiny than the sweet white stuff.) They’re talking about foods sweetened with sucrose — about half fructose and half glucose — and high-fructose corn syrup, which despite its name is mostly used in formulations that are 55% and 42% fructose. The authors write that sugar is more than just empty calories — that growing evidence links fructose overconsumption with health problems including hypertension and diabetes. “Early studies” link it to cancer and cognitive decline, they write. They also argue that like tobacco and alcohol, “it acts on the brain to encourage subsequent intake.” So, what’s a country to do? The authors propose taxing processed foods containing any kind of added sugars, including drinks and cereal. In addition, they suggest tightening licensing requirements on vending machines and snack bars selling sugary drinks in schools and at work, instituting zoning ordinances to restrict the number of fast-food restaurants and convenience stores in low-income neighborhoods and near schools, and even instituting an age limit for purchasing sugary drinks such as soda. And they want the FDA to consider removing fructose from the list of ingredients deemed Generally Recognized as Safe . (Douglas Karas, an FDA spokesman, says that step is not currently being considered.) The Sugar Association, not surprisingly, found a lot to dislike in the commentary. In a response published on its website , the industry group says that USDA stats show people are consuming about 425 more calories per day now than 40 years ago, with caloric sweeteners accounting for about 38 of those calories. Meantime, the group contends that consumption of cane and beet sugar has been falling even as obesity rates have been rising. “We consider it irresponsible when health professionals use their platforms to instill fear by using words like ‘diabetes,’ ‘cancer,’ and even ‘death,’ without so much as one disclaimer about the fact that the incomplete science being referenced is inconclusive at best,” the association says. The obesity problem “originates from the combination of overconsumption of all foods and lack of exercise. To label a single food as the one and only problem misinforms, misleads and confuses consumers, and simply adds to the problem,” the association says. The National Confectioners Association, meantime, said that the group “supports realistic advice to Americans that accommodate all foods including occasional treats in moderation. There is a place for little pleasures, such as candy, in an overall lifestyle that supports health, wellness and happiness. In fact, helping the public understand how to incorporate little pleasures in their diet may well play the most important role in achieving and sustaining recommended dietary behaviors.” If you do want to keep an eye on your sugar intake, the nutrition facts panel that appears on food packages now does not break out added and naturally-occurring sugars. But you can certainly see how many total grams of sugar you’re consuming. Image: iStockphoto Update: This post has been updated with comment from the NCA.

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A Spoonful of Bad Health? UCSF Researchers Slam Sugar

Obama Says Seniors Have Saved on Medicare ‘Doughnut Hole’

Martin Neumann — Thu, 02 Feb 2012 19:56:53 +0000

By Louise Radnofsky The Obama administration is touting good news for seniors from the health-care overhaul law, pointing to $2.1 billion in discounts on prescription drugs for 3.6 million older consumers in 2011. Part of the law was intended to fill the gap in prescription-drug coverage, the so-called doughnut hole, when Medicare beneficiaries have to to pay up to $4,550 out of pocket for drugs after their costs pass $2,840 for the year. Under the law, drug companies have to offer discounts on brand-name and generic drugs for Medicare beneficiaries after they reach the gap. Discounts increase annually until 2020, when the hole is supposed to be filled entirely. In 2010, the first year when the discounts were in effect, seniors also got a $250 rebate check if they hit the doughnut hole. The 2011 discounts — 50% on covered brand-name drugs and 7% on generic drugs — were worth an average of $631 per person who did reach the doughnut hole, the Department of Health and Human Services said. Democrats have made closing the doughnut hole a priority in recent years and have tried to make the new provision a key element in their appeal to seniors to support the health-care overhaul law. “Today’s good news is the latest evidence that as we continue to implement the Affordable Care Act, we’re taking the right approach to Medicare,” said Health and Human Services Secretary Kathleen Sebelius. Blood-sugar-lowering drugs accounted for the largest single share of the discounts, according to the administration’s data. Image: iStockphoto

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Obama Says Seniors Have Saved on Medicare ‘Doughnut Hole’

Reader Consult: How Will the Susan G. Komen/Planned Parenthood Dispute Play Out?

Dr Joe — Thu, 02 Feb 2012 19:14:47 +0000

Some of Komen’s funding to Planned Parenthood affiliates went towards referrals for mammograms. The controversy over the defunding of Planned Parenthood affiliates by breast-cancer group Susan G. Komen for the Cure is showing no signs of cooling off. A spokeswoman for Komen, Leslie Aun, told the Associated Press — which broke the story Tuesday — that the charity was ending its grants to Planned Parenthood affiliates after adopting a policy prohibiting the funding of organizations that are under investigation by government authorities. That would apply to Planned Parenthood because a Republican congressman, Cliff Stearns, is leading an inquiry into whether the group spent public funds on abortion services, the A.P. says. Planned Parenthood responded by saying that Komen had caved to pressure from “anti- women’s health political organizations,” and that low-income women in underserved communities stand to be hurt by the end of the grants, which cover breast health education, screenings and referrals for mammograms. Komen tried to quell criticism with a video , released late yesterday. In it, the group’s founder and CEO, Nancy Brinker, says the decision was the result of a review of the group’s policies and procedures for making grants. “We are working to eliminate duplicative grants, freeing up more dollars for higher-impact programs, and wherever possible we want to grant to the provider that is actually providing the lifesaving mammogram,” she says. The group also added “more stringent eligibility and performance criteria to support these new strategies,” she says. “We will never turn our backs on the women who need us the most,” Brinker says, calling criticisms of the group’s supposed cave-in to political pressure “scurrilous.” But the Atlantic’s Jeffrey Goldberg reports today , citing “three sources with direct knowledge of the Komen decision-making process,” that the Komen rule was specifically adopted with Planned Parenthood in mind and that it’s the only organization that has been affected so far. (We have reached out to Komen for comment, and will tell you if we hear back.) Goldberg also reports that Mollie Williams, who was until recently managing director of community health programs at Komen, “resigned in protest immediately following the Komen board’s decision to cut off Planned Parenthood.” Williams had no comment for Goldberg. When we reached out to her, she said via email that she “must honor the confidentiality of my former employer, Susan G. Komen for the Cure, and for this reason, I’m not responding to questions about Komen’s decision to no longer fund Planned Parenthood.” She added that she believes “it would be a mistake for any organization to bow to political pressure and compromise its mission” and expressed her admiration for both groups. Planned Parenthood, meantime, raised more than $400,000 online (from more than 6,000 donors) in the 24 hours ending Wednesday, according to Andrea Hagelgans, a spokeswoman for the group. She said the donations will “continue to help expand Planned Parenthood’s critical health care services nationwide, especially those affiliates impacted by the Komen cuts.” Hagelgans added that the controversy has made more women aware that Planned Parenthood provides breast exams, leading to an increase in scheduled appointments. Komen has come under fire in the past from anti-abortion groups for its grants to Planned Parenthood. In December a Christian publisher pulled from the market a “Cancer Awareness Bible” because some of the proceeds from the book went to Komen. Readers, how do you think this will play out in coming days and weeks? Bonus: Breast Cancer Charity in Bucket of Hot (KFC) Chicken Photo: Associated Press

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Reader Consult: How Will the Susan G. Komen/Planned Parenthood Dispute Play Out?

A.M. Vitals: Pfizer Believes Only a Small Number of Birth-Control Pill Packs Are Faulty

Martin Neumann — Thu, 02 Feb 2012 13:51:11 +0000

Birth-Control Recall: Pfizer has recalled about a million packs of birth-control pills on concerns that incorrect packaging could lead to unplanned pregnancies, but says it believes only 30 packs actually had the troublesome glitches, the WSJ reports . Pfizer has identified three production problems that could permit pills to be placed incorrectly in the packs and go undetected. It’s not clear how many pills have already been used and how many are still in medicine cabinets, the paper says. Regulating Sugar?: A commentary published in Nature calls for sugar added to foods to be regulated, using the taxes and limited availability of tobacco and alcohol as a model, WebMD reports . Commentary author Robert Lustig, of the University of California, San Francisco, says excess sugar is linked to health problems, while the Sugar Association disputes that sugar intake causes disease. The FDA says it is not reconsidering sugar’s current regulatory status as a “generally recognized as safe” product, WebMD reports. Device Pact: Medical-device firms will pay the FDA $595 million over five years under the tentative terms of a new user-fee agreement, the WSJ reports . The FDA will add more full-time employees to consider medical-device applications and will have concrete goals for approval times, the paper says. Surgery Risk Suggested: Research published in Mayo Clinic Proceedings suggests that children who undergo two or more surgeries by the age of two are more likely to develop ADHD in the future compared to children who experience one operation, possibly because of the effects of general anesthesia on the developing brain, Time’s Healthland blog reports . The study cannot prove that anesthesia causes the future problems, however, and a study author says that the benefits of surgery for infants usually outweigh any potential risk, Time says. Image: iStockphoto

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A.M. Vitals: Pfizer Believes Only a Small Number of Birth-Control Pill Packs Are Faulty