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January 2009 News Archives
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January 1: Study Links Osteoporosis Drugs to Jaw Trouble, The Washington Post
By Amanda Gardner
HealthDay Reporter
THURSDAY, Jan. 1 (HealthDay News) -- The proportion of people taking widely prescribed oral osteoporosis drugs who develop a nasty jaw condition may be much higher than previously thought, a new study suggests.
Previous reports had indicated that the risk of developing osteonecrosis of the jaw (ONJ) from bisphosphonates in pill form were "negligible," although there was a noted risk in people taking the higher-dose intravenous form of the drug.
But Dr. Parish Sedghizadeh, an assistant professor of clinical dentistry at the University of Southern California School of Dentistry in Los Angeles, said his clinic is seeing one to four new cases a week, compared to one a year in the past. This led him to investigate the phenomenon and publish the findings in the Jan. 1 issue of the Journal of the American Dental Association.
"This is more frequent than everybody would like to think it is," said Sedghizadeh, lead author of the study.
ONJ is characterized by pain, soft-tissue swelling, infection, loose teeth and exposed bone.
Dr. James Liu, chairman of obstetrics and gynecology at MacDonald Women's Hospital at Case Medical Center, University Hospitals in Cleveland, said the finding "does not mean that women should stop taking the drug if they're on it. It does mean that there may be more frequent side effects than was previously known."
Bisphosphonates are medications used to reduce the risk of bone fracture and to increase bone mass in people with osteoporosis. They're also used to slow bone "turnover" in people who have cancer that has spread to their bones, and in people who have the blood cancer multiple myeloma.
Use of bisphosphonates has been associated with other problems in the past, including an increased risk of atrial fibrillation (a type of abnormal heart rhythm), unusual fractures of the thigh bone, and inflammatory eye disease.
After searching the USC School of Dentistry's electronic medical records database, the study authors found that nine of 208 patients taking Fosamax had active ONJ, a prevalence of about 4 percent. All were patients who had undergone some kind of dental procedure, such as having a tooth removed.
Fosamax (alendronate) is the most widely prescribed oral bisphosphonate and has been the 21st most prescribed drug in the United States since 2006, according to background information in the study.
The jaw complication has been seen in patients taking Fosamax for as little as one year. It seems to occur most frequently after routine tooth extraction, the study authors said.
Although no one is sure why bisphosphonates seem to have this effect only on jaw bones, Sedghizadeh speculated that the drugs may make it easier for bacteria to adhere to bone that is exposed after a tooth extraction.
Previously, experts had thought that ONJ in people taking intravenous bisphosphonates was related to their underlying condition (for example, cancer) than to the actual drug, Liu explained.
The USC School of Dentistry now screens every patient for bisphosphonate use.
"As a school now, we don't have complications any more, we only have referrals," Sedghizadeh said. "We put patients on anti-microbial, anti-fungal rinse one week pre-operatively or post-operatively. If they have been on bisphosphonates six months or a year or longer, then we have a prevention protocol which has been very, very effective."
According to a statement released by Merck & Co., which makes Fosamax, the new study "has material methodological flaws and scientific limitations, making it unreliable as a source for valid scientific conclusions regarding the prevalence of ONJ in patients taking alendronate."
No reports of ONJ have been noted in controlled trials involving more than 17,000 patients, the statement said.
To learn more about ONJ, visit the American Dental Association.
SOURCES: Parish Sedghizadeh, DDS, MS, assistant professor of clinical dentistry, University of Southern California School of Dentistry, Los Angeles; James Liu, M.D., chairman, department of obstetrics and gynecology, MacDonald Women's Hospital at Case Medical Center, University Hospitals, Cleveland; Merck & Co. statement; Jan. 1, 2009, Journal of the American Dental Association
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January 2: A New Cigarette Hazard: ‘Third-Hand Smoke’, The New York Times
By RONI CARYN RABIN
Parents who smoke often open a window or turn on a fan to clear the air for their children, but experts now have identified a related threat to children’s health that isn’t as easy to get rid of: third-hand smoke.
That’s the term being used to describe the invisible yet toxic brew of gases and particles clinging to smokers’ hair and clothing, not to mention cushions and carpeting, that lingers long after second-hand smoke has cleared from a room. The residue includes heavy metals, carcinogens and even radioactive materials that young children can get on their hands and ingest, especially if they’re crawling or playing on the floor.
Doctors from MassGeneral Hospital for Children in Boston coined the term “third-hand smoke” to describe these chemicals in a new study that focused on the risks they pose to infants and children. The study was published in this month’s issue of the journal Pediatrics.
“Everyone knows that second-hand smoke is bad, but they don’t know about this,” said Dr. Jonathan P. Winickoff, the lead author of the study and an assistant professor of pediatrics at Harvard Medical School.
“When their kids are out of the house, they might smoke. Or they smoke in the car. Or they strap the kid in the car seat in the back and crack the window and smoke, and they think it’s okay because the second-hand smoke isn’t getting to their kids,” Dr. Winickoff continued. “We needed a term to describe these tobacco toxins that aren’t visible.”
Third-hand smoke is what one smells when a smoker gets in an elevator after going outside for a cigarette, he said, or in a hotel room where people were smoking. “Your nose isn’t lying,” he said. “The stuff is so toxic that your brain is telling you: ’Get away.’”
The study reported on attitudes toward smoking in 1,500 households across the United States. It found that the vast majority of both smokers and nonsmokers were aware that second-hand smoke is harmful to children. Some 95 percent of nonsmokers and 84 percent of smokers agreed with the statement that “inhaling smoke from a parent’s cigarette can harm the health of infants and children.”
But far fewer of those surveyed were aware of the risks of third-hand smoke. Since the term is so new, the researchers asked people if they agreed with the statement that “breathing air in a room today where people smoked yesterday can harm the health of infants and children.” Only 65 percent of nonsmokers and 43 percent of smokers agreed with that statement, which researchers interpreted as acknowledgement of the risks of third-hand smoke.
The belief that second-hand smoke harms children’s health was not independently associated with strict smoking bans in homes and cars, the researchers found. On the other hand, the belief that third-hand smoke was harmful greatly increased the likelihood the respondent also would enforce a strict smoking ban at home, Dr. Winickoff said.
“That tells us we’re onto an important new health message here,” he said. “What we heard in focus group after focus group was, ‘I turn on the fan and the smoke disappears.’ It made us realize how many people think about second-hand smoke — they’re telling us they know it’s bad but they’ve figured out a way to do it.”
The data was collected in a national random-digit-dial telephone survey done between September and November 2005. The sample was weighted by race and gender, based on census information.
Dr. Philip Landrigan, a pediatrician who heads the Children’s Environmental Health Center at Mount Sinai School of Medicine in New York, said the phrase third-hand smoke is a brand-new term that has implications for behavior.
“The central message here is that simply closing the kitchen door to take a smoke is not protecting the kids from the effects of that smoke,” he said. “There are carcinogens in this third-hand smoke, and they are a cancer risk for anybody of any age who comes into contact with them.”
Among the substances in third-hand smoke are hydrogen cyanide, used in chemical weapons; butane, which is used in lighter fluid; toluene, found in paint thinners; arsenic; lead; carbon monoxide; and even polonium-210, the highly radioactive carcinogen that was used to murder former Russian spy Alexander V. Litvinenko in 2006. Eleven of the compounds are highly carcinogenic.
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January 6: One Implant Made an Impact. Might Two Do Even More?, The Washington Post
For Family, Second Cochlear Surgery Was a Difficult Decision
By Anne Dooley
Special to The Washington Post
If anyone had suggested to me just a few years ago that my deaf daughter should undergo intricate operations on both ears to receive cochlear implants, I would have recoiled. Believe me, I wanted Ruthie to be able to hear -- and speak. Her progressive hearing loss had been identified when she was 2, by which point she was profoundly deaf and almost entirely lacking in language. My husband, Aaron, and I felt a decided sense of urgency to get her communicating. We arranged for Ruthie to have surgery on her left ear when she was nearly 3.
Not that it was an easy decision. Like any other procedure, cochlear implant surgery carries risks. What's more, it destroys all residual hearing in the ear, eliminating the possibility that some yet-to-be-invented technology would one day give our little girl less-invasive access to hearing. So one surgery, one implant seemed enough, thank you very much. We'd leave her second ear alone.
My views shifted in the intervening years, and two months ago Ruthie, who is now 8, underwent surgery again, this time on her right ear. A few weeks later her new implant was turned on, and she began the laborious and sometimes funny process of learning to hear all over again.
How did we get here? When Ruthie's hearing loss was diagnosed, Aaron and I felt we had to consider every option. Ruthie attended preschool classes at the Maryland School for the Deaf in Columbia and picked up American Sign Language (ASL) quickly, as did Aaron and I. We believed then -- as we still do -- that she would always have a place in the ASL-based deaf community. Coming to terms with her deafness meant having long discussions with adults who had made rich lives for themselves without hearing or speech; it also meant understanding that nothing would ever "cure" it; Ruthie will always be deaf.
Despite the disapproval we were warned we might face from some members of the deaf community who do not see deafness as something that needs to be fixed, our family and friends were supportive. The near-miraculous promise of the cochlear implant seemed impossible to deny. The implant, Aaron and I were repeatedly told, would give Ruthie access to speech, something she would never achieve with even the most high-powered hearing aids. So it was that six years ago, after several hours of surgery at the Johns Hopkins Medical Center, Ruthie emerged from anesthesia with an electrode array wrapped around her auditory nerve and a magnet, which would later hold a microphone to the outside of her head, nestled into her skull. A few weeks later, her implant was activated, and her brain began decoding the new electrical stimuli it was now able to receive.
Ruthie did well. She continued to use ASL with deaf friends, and at school used "cued speech," a visual system invented at Gallaudet University in the 1960s that eliminates ambiguity from lip reading by representing speech sounds with different hand shapes. At home, we signed, cued and spoke. Ruthie's vocabulary and reading skills grew by leaps and bounds.
But she was exhausted. As Aaron and I watched Ruthie drag home day after day, worn out from the demands of listening in school, we began to investigate ways to ease her difficulty. We found that medical research and anecdotal reports of other families pointed toward a second surgery.
Getting a second implant made a certain logical sense. If people are advised to use two hearing aids when both ears are damaged, why wouldn't the same be true of cochlear implants?
Our brains are designed to process sound from two ears. Studies of bilaterally implanted children and adults have shown that their hearing improves in three ways: First, the head itself acts as a barrier, eliminating certain sounds and allowing the listener to tune into speech using the ear closest to its source. Second, the brain is better able to zero in on the important speech signals, even in a noisy environment. And third, by using both ears a listener can more accurately sense where a sound is coming from. A friend told me about a recent conference of cochlear implant users: Waiting in the hotel lobby, all the implanted participants snapped to attention when a bell signaled the arrival of an elevator. But the bilaterally implanted individuals were the ones who immediately moved toward the elevator whose bell had sounded.
Ruthie's former babysitter, Laura Cunningham, received a second implant last year -- 18 years after her first, at age 3. Laura was able to talk on the phone after her first implant and has held such hearing-dependent jobs as receptionist and waitress. She still uses ASL with deaf friends who prefer that mode of communication and says the majority of her deaf friends support her decision to get a second implant. The only negative comments she has heard, Laura says, come from "some cochlear implant users who think that they should save their [second] ear" for a future technology.
For a while, that was the conventional wisdom. And for individuals with sufficient hearing to benefit from a hearing aid in the unimplanted ear, bilateral implants may not be the right choice. But for others, every year that the unimplanted ear is not used reduces the brain's ability to adjust to an additional source of hearing. Children are now regularly being bilaterally implanted as young as 1 year old. If we believed a second implant could help Ruthie, there was really no point in waiting.
As John Niparko, director of the Listening Center at Johns Hopkins, put it, "If a child is implanted on only one side, the parts of the brain that would have been stimulated by the non-implanted ear will not develop, and eventually plasticity will be greatly diminished."
What does that mean for a child? Ruthie's friend Mia received a second implant 17 months ago, at age 8. "Now," her mother, Carolyn Jeppsen, says, "Mia is able to participate in group conversations with much more ease than before, making her less reluctant to do so. She is able to appreciate music, which she did not do at all with one implant. The binaural hearing has strengthened her balance and coordination. Mia's life is much easier with two implants."
Ruthie's road to bilateral implantation hit a snag when our insurer denied the surgery with the rationale that bilateral implantation is "experimental and untested." We turned to the Let Them Hear Foundation, whose pro bono lawyer prepared an appeal several inches thick containing letters from Ruthie's teacher, audiologist, surgeon and speech pathologist, along with reams of research. Our insurance company eventually agreed to pay for Ruthie's surgery.
Our appeal was bolstered by a study released last May by Indiana University; it found that the benefits of a second implant far outweigh the cost. (Estimates range from $40,000 to $100,000 when the costs of rehabilitation and maintaining the device are factored in.)
"We didn't know that cognitive skills and emotional issues would so significantly improve with the implantation of a second cochlear device," said the study's senior author, Richard Miyamoto, chairman of the university's Department of Otolaryngology -- Head and Neck Surgery. "Our hope is that with these findings more health insurance companies will cover the cost of bilateral implants and bring a superior quality of life to a large number of individuals."
The day after her second implant was activated, Ruthie turned off the left, older implant during dinner so that she could practice making sense of the sounds around her with her right ear alone. As Aaron asked Hannah, our older daughter, to pass the pepper, Ruthie began to smile. When I offered her grated cheese, she laughed and said, "Beep! You are all saying 'beep, beep, beep!'"
By the next morning, she was able to identify three of the six basic speech sounds with her new implant.
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January 12: Lack of Sleep Linked to Common Cold, The Washington Post
By Steven Reinberg
HealthDay Reporter
MONDAY, Jan. 12 (HealthDay News) -- If you get less than seven hours of sleep a night, you're three times more likely to catch a cold. And if you sleep poorly, you're five times more susceptible to one as well.
Those are the findings of a new study, which its researchers said was the first to show that anything less than seven to eight hours of solid sleep can lower your resistance to the common cold virus.
"Regular sleep habits may play an important role in your immune system's ability to fight off infectious disease," said study lead author Sheldon Cohen, a psychology professor at Carnegie Mellon University in Pittsburgh. "Longer sleep duration and better sleep efficiency are both associated with greater resistance to the common cold."
Studies have shown that sleep deprivation impairs some immune function. And research also has found that people who sleep seven to eight hours a night have the lowest rates of heart disease and death.
For the new study, published in the Jan. 12 issue of Archives of Internal Medicine, Cohen's team collected data on 153 men and women from 2000 to 2004. The researchers ask the participants how many hours they slept a night and whether they felt rested. They also asked how much time the participants spent in bed sleeping.
The participants were then given nose drops containing a virus for the common cold. Five days later, they reported any signs and symptoms of a cold. The researchers also collected mucus samples to test for the virus. After 28 days, the researchers tested the participants' blood samples for antibodies to the virus.
The researchers found that those who slept less than seven hours a night were 2.94 times more likely to develop a cold.
"And those who lose more than 8 percent of sleep on an average night because they have trouble getting to sleep or wake up in the middle of the night are more than five times more likely to get a cold when exposed to a virus," Cohen said.
Dr. David L. Katz, director of the Yale University School of Medicine Prevention Research Center, said the study highlights the importance of sleep in maintaining good health.
"Getting good sleep should count among the priorities of health-conscious people," Katz said. "Time invested in sleep will almost certainly be paid back in dividends of better health -- fewer colds and greater productivity."
For more on the common cold, visit the U.S. National Institute of Allergy and Infectious Diseases.
SOURCES: Sheldon Cohen, Ph.D., professor of psychology, Carnegie Mellon University, Pittsburgh; David L. Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Jan. 12, 2009, Archives of Internal Medicine
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January 13: Surgeon Shortage Pushes Hospitals to Hire Temps, The Wall Street Journal
By VANESSA FUHRMANS
When someone doubles over from stomach pain, the general surgeon is the one who performs an appendectomy. Gallstones? The general surgeon removes the gallbladder. Breast and colon tumors and hernias are also matters for the surgeon's scalpel.
Now the economic and cultural forces reshaping U.S. medicine are prompting an exodus from this once venerable field, creating a growing market for temporary surgeons-for-hire.
As a general surgeon in her hometown of Franklin, Tenn., Jennifer Peppers could no longer keep her practice going after eight years in business. Faced with rising overhead costs and declines in reimbursements, she and her partners stopped drawing salaries last winter. To pay her home mortgage, Dr. Peppers had to borrow from a credit line.
So the surgeons shuttered their practice, and Dr. Peppers, 42 years old, hit the road. Her typical month might now include a weekend in Springfield, Ore., removing ruptured spleens or repairing obstructed bowels, followed by two weeks at a rural Kentucky or New Hampshire hospital. Though she misses her husband, she earns double her old salary and has paid off a big chunk of her medical-school debt. "I'd much prefer to be in my hospital in my little town," says Dr. Peppers, who is now licensed in five states. "But I don't see how that's possible."
The shift toward temporary assignments comes as the traditional way of practicing general surgery is fading in many parts of the country. For decades, general surgeons have been the backbone and economic engine of the community hospital. While maintaining their own private practices, they staff trauma and critical-care units and perform most common abdominal procedures. Without them, hospitals couldn't provide many emergency-room services. In rural areas, their backup is necessary for everything from complicated births to inserting chest tubes.
But the increasingly grueling schedules, shrinking payments and the temptation of more profitable surgical niches have made the field less attractive. Over the past 25 years, the number of general surgeons per capita has declined 25%, according to a study published in the Archives of Surgery earlier this year. Other specialties are also seeing shortages as their ranks grow more slowly than the overall population, but the decline in general surgery is steeper than most. And while the number of physicians overall isn't in decline, general surgery is one of the few fields where the absolute number of surgeons is actually shrinking.
It's possible that the implosion of Wall Street will rekindle an interest in medicine as a career, but future medical-school graduates could continue to flock to specialties that pay more than general surgery. Nearly three-quarters of surgeons-in-training already are opting for lucrative subspecialties with more predictable hours, such as cardiovascular surgery and neurosurgery, the American College of Surgeons says. That's left community hospitals around the U.S. struggling to provide some of their most basic services.
Some are turning to temporary physicians to fill the void. General surgery is now among the fastest-growing areas of a temporary-medical-staffing industry that's expected to double to $2.1 billion in 2009 from five years ago, according to Locumtenens.com, a staffing agency. The company, which takes its name from the Latin phrase meaning "to stand in another's place," matches hospitals with what the medical field calls locum tenens doctors. Rising demand for these services, in turn, is prompting more of the remaining general surgeons to choose a life on the road and in hotels.
Staffing agencies estimate that at least 1 in 20 of America's 17,000 general surgeons now work on a temporary basis some or all of the time. Full-time temporary surgeons can earn $250,000 or more a year, in some cases nearly twice as much as in private practice. That's largely because they don't have to pay overhead costs anymore.
Critics of the practice worry that it carries potential safety risks. A new surgeon arriving in town may not be familiar with a hospital's staff, for example, or with surgical patients coming in for follow-up visits. "That continuity of care in surgical diseases is really important," says Phillip Burns, chairman of the University of Tennessee's surgical department. As the one who performs the surgery, "you are the best one to handle [any problems] because you were the one inside."
Some who've switched to temporary work say patients often fare better with a surgeon who can focus entirely on providing care instead of the administrative hassles of a private practice. "I don't pay a penny of overhead now and I feel better than I have in years," says Kenneth Lawson, 55. Dr. Lawson left his practice in Roseburg, Ore., in 2005 to travel as a temporary surgeon.
While in private practice, Dr. Lawson says he would often spend five nights in a row on call, "bleary eyed," performing emergency surgeries. Increasingly, he says, these patients had no insurance. Hospitals typically have the means to pursue debts from patients or write the losses off as charity care, but doctors don't always have the manpower to collect on their portion of the bill. "We got to the point we wouldn't waste a stamp trying to get that money," says Dr. Lawson.
Locum tenens isn't a bargain for hospitals or a health-care system that is already the world's costliest and accounts for nearly 17% of the U.S. economy, according to federal government data.
A temporary surgeon who comes in to perform scheduled procedures and emergency operations can cost a hospital about $1,500 a day -- between $650 and $900 for the physician and about the same for the staffing agency, according to Staff Care, a temporary-medical-placement firm. That's in addition to travel and lodging expenses. In traditional practice, hospitals don't pay surgeons directly: They give them "privileges" to use their operating rooms in exchange for sharing in emergency-call duty.
Yet, without the ability to perform surgeries, "we lose the business," says Karen Hendren, chief operating officer of Stillwater Medical Center in Oklahoma. The hospital plans to hire temporary surgeons this spring, when one of its three local general surgeons leaves. Ms. Hendren is bracing for a hit to the bottom line. In 2007, it cost the hospital $1.2 million to cover the departure of a few anesthesiologists by hiring temporary replacements, contributing to a $4 million drop in operating income.
Hiring temporary doctors adds "a lot of cost to the health-care system, and it's almost certainly going to get worse," says Richard Reynolds, president of MidMichigan Health, which operates four hospitals in the heart of the state. He estimates it costs the company twice as much to hire a temporary doctor than a permanent one. MidMichigan tries to pass on some of these costs in contract negotiations with insurers, says Mr. Reynolds, but it doesn't always succeed.
Steven Bengelsdorf, a 41-year-old doctor from Nashville, formed his own group of temporary surgeons to contract directly with hospitals so they avoid the extra cost of a staffing agency. Spending days or a week at a time away from his wife and three children is tough, Dr. Bengelsdorf says, but, "when I'm home, I'm home. I can participate in their lives and take them to birthday parties." If he were in traditional practice working 12- to 14-hour days, he adds, "I wouldn't get to see my kids."
The American College of Surgeons has long condemned the practice of "itinerant surgery," where doctors operate on patients and leave follow-up care to a family physician. But it has refrained from issuing guidelines on locum tenens. Paul Collicott, a director of the ACS, says it's "a necessary part of surgical practice today," given the overall shortage in the field. He says it's the responsibility of each temporary surgeon to make sure patients are handed off to another surgeon for postoperative care. The ACS also advises doctors who primarily work in urban hospitals, where the work is more specialized, not to do stints in small, rural hospitals, where they typically need to be jacks-of-all-trades.
In 2007, Marlene Tymchuk of Reedsport, Ore., learned she needed a large pool of blood called a hematoma removed from her groin. The hospital in her small coastal town was staffed by a temporary surgeon; the nearest hospital with a full-time surgeon was 45 minutes away. "I talked it over with my family," she says, debating whether it would be smarter to go to the bigger hospital and have consistent care.
She decided to stay in Reedsport, in the hospital she knew well and near her family doctor. Though she saw another surgeon for her follow-up care, she says it felt better to be close to home.
Temporary surgeons used to be mostly older physicians who wanted a lighter workload, or those fresh out of training, still deciding where to put down roots. But today, more are midcareer people like Dr. Peppers, who had originally mapped out a more traditional path. Born in the same Franklin hospital she later operated in, she knew by age 10 she wanted to be a surgeon. She told her future husband -- a childhood friend -- she wanted to marry him so she could take his name and be "Dr. Peppers."
After medical school, residency and a fellowship in laparoscopic surgery, she came back to her hometown to practice in 2000, saddled with $250,000 in debt. Paying it back turned out to be harder than she thought.
While Dr. Peppers was in training during the 1990s, the federal Medicare program was cutting back what it pays surgeons for many common procedures. For instance, in 2008, Medicare paid a general surgeon $562 for an appendectomy, compared with $580 in 1997. For a complex hemorrhoid removal, a general surgeon got $390 in 2008, compared with $574 in 1997. Private insurers followed suit.
Meanwhile, higher-priced procedures increasingly fell under the purview of more specialized fields. And, reflecting a steady rise in the number of uninsured and underinsured Americans, more of the patients whom surgeons would operate on in the emergency room had limited means to pay for treatment.
By 2007, Dr. Peppers says, she was making roughly $135,000 annually and her practice was struggling to pay its overhead and malpractice insurance. Since shuttering her practice last spring and becoming a full-time surgeon-for-hire, Dr. Peppers says she's earned enough money to whittle her medical-school debt to below $100,000. For the first time, she adds, she can focus exclusively on surgery and patients. "When I had a practice, it was like running a small business," she says. "It's like a huge weight has been lifted."
Dr. Peppers says she is careful to take assignments where she knows the surgeon she'll be handing cases off to and often follows up with a phone call. "I'm very conscientious about telling the patient, 'I'm here until 7 o'clock Monday morning. If there are any problems, after that you need to talk to Dr. so-and-so,'" she says. "I put a lot of responsibility onto patients."
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January 15: The Bulletproof Bug, NBC Chicago
C. Diff infections tripled in just over a decade
By NESITA KWAN
An increasing number of bacteria have became resistant to the most common antibiotics. And now, there's a new threat.
Antibiotics have been the magic bullets of medicine since penicillin was perfected nearly 70 years ago in Peoria, Illinois.
Doctors say a common bacteria is turning into dangerous infections, and people who take antibiotics are more at risk of getting it.
But an increasing number of bacteria have became resistant to the most common antibiotics. And now, there's a new threat... one that cost Diane Henry her colon, and nearly cost her her life.
"I had a sinus infection," she said, "and I took an antibiotic."
Two weeks later, the stomach pain began. At first she ignored it. But it got worse, "until one day I woke up and had bloody diarrhea and high fever."
She finally went to the emergency room, where doctors at Central Dupage Hospital, in suburban Chicago, immediately admitted her. She stayed for a month.
Henry discovered that the antibiotic that cured her sinus infection had also killed off the so-called good bacteria that are essential to protect the large intestine. And that opened the door for a very bad bacteria to begin attacking her colon, eventually destroying it. That bacteria is called clostridium difficile, or C. Diff.
It's commonly found in hospitals. But Diane's doctor, Kenneth Lee, said it's increasingly finding its way into the community: and recent studies show that C. Diff cases have nearly tripled in just over a decade.
One study in Britain showed the death rate from C. Diff is seven times higher than just 10 years ago.
Fighting the bug is an arduous process. During her 30-day hospital stay, doctors tried a number of antibiotics to eliminate C. Diff, but none of them worked for Diane. Finally, in great pain and weak from eating so little, Diane underwent major surgery.
"They removed 5 feet of my colon," she said. "It's unbelievable."
Soon she'll need a second surgery that will re-route her small intestine, because her large intestine is mostly gone.
But until her life-threatening brush with the bug, Diane had never heard of C. Diff, even though she works in a medical office.
She certainly had no idea of its connection to taking antibiotics.
And those who are experts on the subject say the bug is mutating.
Dr. Dale Gerding has tracked C. Diff almost since its effects were first discovered 30 years ago. He calls it a "bulletproof bug" because the toxic spores it produces are so hardy, they can sometimes live on lab surfaces for up six months.
"An epidemic strain (of C. Diff) is circulating right now... causing increased severity of disease and frequency of disease," he said.
Gerding, who's a professor of medicine at Loyola University of Chicago, has found that "Patients are going into shock. They are unable to fight off the disease. They are dying precipitously."
"It's a real antibiotic side-effect," he said.
Of course, he and other health experts are quick to add that antibiotics have saved millions and millions of lives, and they're often necessary. Diane, for example, needed them for her chronic sinus infections.
But primary care physicians in particular say that millions of other Americans insist on antibiotics even when told they don't need them. That, say doctors, is not just unnecessary, it's potentially dangerous.
In the meantime, labs like Dr. Gerding's at Hines VA Hospital outside Chicago are working on ways to protect people. And ironically, a non toxic form of C. Diff may be the answer. In human trials, patients will soon be given a pill that contains a version of the C. Diff bug that won't make you sick. Scientists believe that will protect patients if they're exposed to the toxic strain.
As for Diane, she wants to educate the many patients who call in asking for an antibiotic without seeing a doctor or getting any kind of a test.
She says they need to " understand there is a consequence ... how dangerous (antibiotics) can be."
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January 15: Use of sleep aids by young U.S. adults soars: study, Reuters
By Julie Steenhuysen
CHICAGO - Use of prescription sleep aids nearly tripled among young adults between 1998 and 2006, according to a study released on Thursday by the healthcare business arm of Thomson Reuters.
"Insomnia, a condition traditionally associated with older adults, appears to be causing larger numbers of young adults to turn to prescription sleep aids, and to depend on them for longer periods of time," said William Marder, senior vice president and general manager for the healthcare business of Thomson Reuters, parent company of Reuters News.
A study of medical and drug claims data found a 50-percent increase in use of the drugs among all adults under 45, who also appear to be using the drugs for a longer period of time to help them fall asleep.
During the study period, the average length of time sleep aids were used by adults under 45 jumped by more than 40 percent -- rising to 93 days in 2006 from 64 days in 1998.
But perhaps the most startling finding was the increase in use of sleep aids among college-age adults 18 to 24.
Use in this age group rose to 1,524 users per 100,000 in 2006, up from 599 users per 100,000 in 1998.
"I find it very worrisome that young people who should have a very strong and healthy sleep system are now finding they are turning to medication to help them get to sleep," Donna Arand, a sleep specialist at Kettering Hospital Sleep Disorder Center in Dayton, Ohio, said in a telephone interview.
Arand said she has seen a number of students seeking sleep aids because their normal sleep patterns have been disrupted in college, and she fears these adults may have trouble adjusting to a normal sleep pattern as their schedules normalize.
RARE SIDE EFFECT
Two-thirds of those in this study population were taking non-benzodiazepine hypnotics -- such as Sanofi-Aventis' Ambien CR and Sepracor Inc's Lunesta.
These newer sleep aids generally have fewer side effects, but in rare cases they can cause sleep walking.
That may have led to the demise of a 51-year-old Wisconsin man who froze to death while sleep-walking barefoot in his underwear this week in below-zero cold.
The Sawyer County Sheriff's Office in Hayward, Wisconsin, said Timothy Brueggeman had Ambien at his house, and family members told the Star Tribune newspaper in Minneapolis that he had a history of sleep walking.
Chief Deputy Tim Ziegel said there was no proof that Brueggeman had taken the drug before his death but toxicology tests had been ordered.
"We do not know all the facts about what transpired," said Sanofi spokeswoman Susan Brook, noting that the circumstances of the man's death are still being investigated.
In general, she said sleep walking is a rare side effect of the drug and she cautioned that Ambien or Ambien CR should not be taken by people with a history of sleep walking, nor should they be taken with alcohol.
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January 20: MRSA rising in kids' ear, nose, throat infections, Yahoo! News
By LINDSEY TANNER, AP Medical Writer
CHICAGO – Researchers say they found an "alarming" increase in children's ear, nose and throat infections nationwide caused by dangerous drug-resistant staph germs. Other studies have shown rising numbers of skin infections in adults and children caused by these germs, nicknamed MRSA, but this is the first nationwide report on how common they are in deeper tissue infections in the head and neck, the study authors said. These include certain ear and sinus infections, and abcesses that can form in the tonsils and throat.
The study found a total of 21,009 pediatric head and neck infections caused by staph germs from 2001 through 2006. The percentage caused by hard-to-treat MRSA bacteria more than doubled during that time from almost 12 percent to 28 percent.
"In most parts of the United States, there's been an alarming rise," said study author Dr. Steven Sobol, a children's head and neck specialist at Emory University.
The study appears in January's Archives of Otolaryngology, released Monday.
It is based on nationally representative information from an electronic database that collects lab results from more than 300 hospitals nationwide.
MRSA, or methicillin-resistant Staphylococcus aureus, can cause dangerous, life-threatening invasive infections and doctors believe inappropriate use of antibiotics has contributed to its rise.
The study didn't look at the severity of MRSA illness in affected children.
Almost 60 percent of the MRSA infections found in the study were thought to have been contracted outside a hospital setting.
Dr. Robert Daum, a University of Chicago expert in community-acquired MRSA, said the study should serve as an alert to agencies that fund U.S. research "that this is a major public health problem."
MRSA involvement in adult head and neck infections has been reported although data on prevalence is scarce.
MRSA infections were once limited mostly to hospitals, nursing homes and other health-care settings but other studies have shown they are increasingly picked up in the community, in otherwise healthy people. This can happen through direct skin-to-skin contact or contact with surfaces contaminated with germs from cuts and other open wounds.
But staph germs also normally live or "colonize" on the skin and in other tissues including inside the nose and throat, without causing symptoms. And other studies have shown that for poorly understood reasons, the number of people who carry MRSA germs is also on the rise.
Sobol said MRSA head and neck infections most likely develop in MRSA carriers, who become susceptible because of ear, nose or throat infections caused by some other bug. Symptoms that it could be MRSA include ear infections that drain pus, or swollen neck lymph nodes caused by pus draining from a throat or nose abcess.
Unlike cold and flu bugs, MRSA germs aren't airborne and don't spread through sneezing.
MRSA does not respond to penicillin-based antibiotics and doctors are concerned that it is becoming resistant to others.
The study authors said a worrisome 46 percent of MRSA infections studied were resistant to the antibiotic clindamycin, one of the non-penicillin drugs doctors often rely on to treat community-acquired MRSA. However, other doctors said it's more likely that at least some of infections thought to be community-acquired had actually originated in a hospital or other health-care setting, where MRSA resistance to clindamycin is common.
Dr. Buddy Creech, an infectious disease specialist at Vanderbilt University Medical Center, said the research "fits nicely" with smaller studies reporting local increases in MRSA head and neck infections.
"Every time someone looks, the rates of MRSA are going up and that's certainly concerning because it's a bug that can cause dramatic disease," Creech said.
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January 28: It's Not Too Late to Guard Against Hearing Loss, US News
By Nancy Shute
By age 75, 35 percent of people have age-related hearing loss, which first affects highest-pitched sounds. Such hearing loss is driven largely by genetics, with some people hearing with batlike precision well into their 90s, while others lose the ability to hear a whispered "I love you" in their 60s.
In December, researchers identified a gene that may be to blame. It helps regulate glutamate, which is an essential neurotransmitter in the ear but can also kill off sensory cells and neurons if there's too much. "Genetically sensitive people may have more glutamate around their whole lives, and in the mid-to-late 50s, they start losing hearing in the high to middle registers," says Rick Friedman, a neurotologist at the House Ear Clinic in Los Angeles who led the genome study. If this proves to be true, Friedman says, doctors might someday treat the genetically susceptible with a drug.
In the meantime, it's relatively simple to reduce the risk of the other big culprit in hearing loss: noise. Excessive noise exposure permanently damages the inner ear's hair cells, which transmit sounds toward the brain. The damage is cumulative; more AC/DC concerts, more hearing loss. Tinnitus, or ringing in the ears, is a sign that the hair cells are getting fried. So is muffled hearing immediately after being exposed to loud noise.
"I wear ear protection when I do my lawn," says Barry Hirsch, director of neurotology at the University of Pittsburgh Medical Center and chairman of the hearing committee for the American Academy of Otolaryngology-Head and Neck Surgery. His sons, ages 18 and 20, do too. That's good, because a power lawn mower easily cranks out 90 decibels of noise; long-term exposure to levels above 85 decibels can cause permanent damage, according to the National Institute for Occupational Safety and Health.
Hearing protection needn't be dorky; small foam earplugs, when rolled tightly and inserted snugly, can provide 15 to 20 decibels of protection. Forget sticking cotton in your ears, Hirsch says; it doesn't work at all. Customized musician's earplugs, which lower sound exposure by about 25 decibels while perserving harmonic range, cost about $150. "I'm a rock-and-roll fan, and I always wear earplugs," says Friedman.
People needing more hearing protection (skeet shooters take note: A shotgun blasts out 165 decibels) can opt for earmuff-type protectors, which muffle up to 30 decibels. Earmuffs can be layered on foam plugs for added protection. (To determine the loudness, as measured in decibels, of sounds from a whisper to a rocket launch, check out NIOSH's interactive noise meter.)
A last caution: Some medications—including intravenous antibiotics, chemotherapy drugs, and narcotics such as hydrocodone—can permanently damage hearing. People who have lost hearing in one ear should be sure to let their doctor know, says Hirsch, so that they minimize risk to the remaining good ear.
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January 30: Variations in Gene DNA Boost Drinkers' Cancer Risk, The Washington Post
(HealthDay News) -- Variations in the DNA of certain genes can increase the risk of cancer in people who drink alcohol, according to researchers who reviewed studies on alcohol consumption, genetic polymorphisms and cancer.
Their analysis suggests that such variations, called gene polymorphisms, in two enzymes -- alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) -- involved in metabolizing alcohol significantly increase alcohol drinkers' risk of cancers of the head and neck and the esophagus.
The researchers looked at the effect of gene variations in other enzymes involved in alcohol and folate metabolism but found there wasn't enough data to fully assess the effect of those gene variants on cancer risk.
They said that currently available data does not allow for a quantitative evaluation by meta-analysis of the link between gene variations and cancer risk in people who drink alcohol.
"We have highlighted the need for large, multicenter studies and for approaches to the study of multiple polymorphisms," wrote Dr. Nathalie Druesne-Pecollo and colleagues at the French National Institute of Agronomical Research.
The review was published in the February issue of the The Lancet Oncology.
Previous research has shown a clear link between alcohol consumption and health risk, according to background information in the review. Recent figures show that drinking alcohol was a major contributing factor in the development of almost 400,000 cancers worldwide in 2002. In that same year, 323,900 cancer deaths (3.6 percent of all cancer deaths) were alcohol-related.
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