WASHINGTON – Food hijacked Dr. David Kessler's brain. Not apples or carrots. The scientist who once led the government's attack on addictive cigarettes can't wander through part of San Francisco without craving a local shop's chocolate-covered pretzels. Stop at one cookie? Rarely.
It's not an addiction but it's similar, and he's far from alone. Kessler's research suggests millions share what he calls "conditioned hypereating" — a willpower-sapping drive to eat high-fat, high-sugar foods even when they're not hungry.
In a book being published next week, the former Food and Drug Administration chief brings to consumers the disturbing conclusion of numerous brain studies: Some people really do have a harder time resisting bad foods. It's a new way of looking at the obesity epidemic that could help spur fledgling movements to reveal calories on restaurant menus or rein in portion sizes.
"The food industry has figured out what works. They know what drives people to keep on eating," Kessler tells The Associated Press. "It's the next great public health campaign, of changing how we view food, and the food industry has to be part of it."
He calls the culprits foods "layered and loaded" with combinations of fat, sugar and salt — and often so processed that you don't even have to chew much.
Overeaters must take responsibility, too, and basically retrain their brains to resist the lure, he cautions.
"I have suits in every size," Kessler writes in "The End of Overeating." But, "once you know what's driving your behavior, you can put steps into place" to change it.
At issue is how the brain becomes primed by different stimuli. Neuroscientists increasingly report that fat-and-sugar combinations in particular light up the brain's dopamine pathway — its pleasure-sensing spot — the same pathway that conditions people to alcohol or drugs.
Where did you experience the yum factor? That's the cue, sparking the brain to say, "I want that again!" as you drive by a restaurant or plop before the TV.
"You're not even aware you've learned this," says Dr. Nora Volkow, chief of the National Institute on Drug Abuse and a dopamine authority who has long studied similarities between drug addiction and obesity.
Volkow is a confessed chocoholic who salivates just walking past her laboratory's vending machine. "You have to fight it and fight it," she said.
Conditioning isn't always to blame. Numerous factors, including physical activity, metabolism and hormones, play a role in obesity.
And the food industry points out that increasingly stores and restaurants are giving consumers healthier choices, from allowing substitutions of fruit for french fries to selling packaged foods with less fat and salt.
But Kessler, now at the University of California, San Francisco, gathered colleagues to help build on that science and learn why some people have such a hard time choosing healthier:
_First, the team found that even well-fed rats will work increasingly hard for sips of a vanilla milkshake with the right fat-sugar combo but that adding sugar steadily increases consumption. Many low-fat foods substitute sugar for the removed fat, doing nothing to help dieters eat less, Kessler and University of Washington researchers concluded.
_Then Kessler culled data from a major study on food habits and health. Conditioned hypereaters reported feeling loss of control over food, a lack of satiety, and were preoccupied by food. Some 42 percent of them were obese compared to 18 percent without those behaviors, says Kessler, who estimates that up to 70 million people have some degree of conditioned hypereating.
_Finally, Yale University neuroscientist Dana Small had hypereaters smell chocolate and taste a chocolate milkshake inside a brain-scanning MRI machine. Rather than getting used to the aroma, as is normal, hypereaters found the smell more tantalizing with time. And drinking the milkshake didn't satisfy. The reward-anticipating region of their brains stayed switched on, so that another brain area couldn't say, "Enough!"
People who aren't overweight can be conditioned hypereaters, too, Kessler found — so it's possible to control.
Take Volkow, the chocolate-loving neuroscientist. She's lean, and a self-described compulsive exerciser. Physical activity targets the dopamine pathway, too, a healthy distraction.
Smoking didn't start to drop until society's view of it as glamorous and sexy started changing, to view the habit as deadly, Kessler notes.
Unhealthy food has changed in the other direction. Foods high in fat, sugar and salt tend to be cheap; they're widely sold; and advertising links them to good friends and good times, even as social norms changed to make snacking anytime, anywhere acceptable.
Retrain the brain to think, "I'll hate myself if I eat that," Kessler advises. Lay down new neural reward circuits by substituting something else you enjoy, like a bike ride or a healthier food.
Make rules to resist temptation: "I'm going to the mall but bypassing the food court."
And avoid cues for bad eating whenever possible. Always go for the nachos at your friends' weekend gathering spot? Start fresh at another restaurant.
"I've learned to eat things I like but things I can control," Kessler says. But he knows the old circuitry dies hard: "You stress me enough and I'll go pick up that bagel."
___
EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Senin, 20 April 2009
When unhealthy foods hijack overeaters' brains
Study paints picture of collegiate mental health
STATE COLLEGE, Pa. – Ever since campus counseling centers were established in the 1940s, college officials have known that the prevalence and severity of students' mental health problems were rising. They just didn't know by how much.
A pilot study released Monday by the Center for the Study of Collegiate Mental Health, at Penn State University, hopes to fill that void. Organizers call it a first-of-its kind effort by college counseling centers designed to get an up-to-date picture of mental health trends affecting higher education.
Most schools collect data of counseling center clients on their own. Until now, though, there have been no national data to help study perceived trends, organizers said.
"Mental health affects every aspect of a college student's functioning," said Ben Locke, executive director of the center. "The earlier you intervene in mental health issues, the more likely you are to be successful in treating it."
The numbers will further help colleges and universities equip themselves to support students, Locke said.
The Association for University and College Counseling Center Directors does a separate annual survey of its members. That survey estimated that about 1 in 10 college students seek treatment from campus counseling centers.
But the Penn State study is the first to get data from the counseling center clients themselves, Locke said.
"This is actual data from the counseling centers: the clients who are coming in, what they're saying," said Robert Rando, the director of counseling and wellness services at Wright State University in Dayton, Ohio. "It's accurate in that way, and no one has done that."
There is concern about the increased severity of mental health problems counseling centers are seeing among student clients, in part because of the increased use of medications such as Prozac by high school students, Rando said.
The collaboration began four years ago, but data collection began only in fall 2008.
The effort had been in the works before the high-profile campus shootings at Virginia Tech in 2007 and Northern Illinois University last year.
The killing of 33 people, including the gunman, at Virginia Tech and five people at Northern Illinois put a spotlight on campus counseling services and risk reduction, said Dennis Heitzmann, director of counseling and psychological services at Penn State.
"What this effort will do will keep our work in the forefront, identify the importance of our function before the administration, parents and students themselves," Heitzmann said.
More than 130 schools nationwide are registered with the center. Of them, 66 participated in the initial study, with responses from more than 28,000 students who received mental health services in fall 2008.
Each counseling center asked clients to answer standardized questions, with the data pooled nationally. All data were anonymous.
Among the study's findings:
• One percent of students who answered a question about binge drinking reported going on a binge 10 or more times in the previous two weeks. Nearly half of those respondents said they had seriously considered suicide in the past.
• The vast majority (93 percent) of students who responded to a question about campus violence had little to no fear of losing control and acting violently.
• The 7 percent considered to have strong fears were most likely to be male and said they had previously harmed another person. They also tended to have experienced a cluster of other symptoms, such as a fear of having a panic attack or suicidal thoughts.
The results "don't translate into a guaranteed assessment or reliable profile at any point, but they offer a starting point in assessing risk in counseling center clients," Locke said.
The center has received $45,000 in funding over the past five years, Locke said. The Jed Foundation, a nonprofit that describes itself as trying to reduce suicides and emotional distress among college students, is listed as a past contributor.
The center also requires members to pay a $150 annual fee. In addition, researchers have received about $100,000 in in-kind funding from Titanium Software.
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AP IMPACT: Tons of released drugs taint US water
U.S. manufacturers, including major drugmakers, have legally released at least 271 million pounds of pharmaceuticals into waterways that often provide drinking water — contamination the federal government has consistently overlooked, according to an Associated Press investigation.
Hundreds of active pharmaceutical ingredients are used in a variety of manufacturing, including drugmaking: For example, lithium is used to make ceramics and treat bipolar disorder; nitroglycerin is a heart drug and also used in explosives; copper shows up in everything from pipes to contraceptives.
Federal and industry officials say they don't know the extent to which pharmaceuticals are released by U.S. manufacturers because no one tracks them — as drugs. But a close analysis of 20 years of federal records found that, in fact, the government unintentionally keeps data on a few, allowing a glimpse of the pharmaceuticals coming from factories.
As part of its ongoing PharmaWater investigation about trace concentrations of pharmaceuticals in drinking water, AP identified 22 compounds that show up on two lists: the EPA monitors them as industrial chemicals that are released into rivers, lakes and other bodies of water under federal pollution laws, while the Food and Drug Administration classifies them as active pharmaceutical ingredients.
The data don't show precisely how much of the 271 million pounds comes from drugmakers versus other manufacturers; also, the figure is a massive undercount because of the limited federal government tracking.
To date, drugmakers have dismissed the suggestion that their manufacturing contributes significantly to what's being found in water. Federal drug and water regulators agree.
But some researchers say the lack of required testing amounts to a 'don't ask, don't tell' policy about whether drugmakers are contributing to water pollution.
"It doesn't pass the straight-face test to say pharmaceutical manufacturers are not emitting any of the compounds they're creating," said Kyla Bennett, who spent 10 years as an EPA enforcement officer before becoming an ecologist and environmental attorney.
Pilot studies in the U.S. and abroad are now confirming those doubts.
Last year, the AP reported that trace amounts of a wide range of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones — have been found in American drinking water supplies. Including recent findings in Dallas, Cleveland and Maryland's Prince George's and Montgomery counties, pharmaceuticals have been detected in the drinking water of at least 51 million Americans.
Most cities and water providers still do not test. Some scientists say that wherever researchers look, they will find pharma-tainted water.
Consumers are considered the biggest contributors to the contamination. We consume drugs, then excrete what our bodies don't absorb. Other times, we flush unused drugs down toilets. The AP also found that an estimated 250 million pounds of pharmaceuticals and contaminated packaging are thrown away each year by hospitals and long-term care facilities.
Researchers have found that even extremely diluted concentrations of drugs harm fish, frogs and other aquatic species. Also, researchers report that human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain drugs. Some scientists say they are increasingly concerned that the consumption of combinations of many drugs, even in small amounts, could harm humans over decades.
Utilities say the water is safe. Scientists, doctors and the EPA say there are no confirmed human risks associated with consuming minute concentrations of drugs. But those experts also agree that dangers cannot be ruled out, especially given the emerging research.
___
Two common industrial chemicals that are also pharmaceuticals — the antiseptics phenol and hydrogen peroxide — account for 92 percent of the 271 million pounds identified as coming from drugmakers and other manufacturers. Both can be toxic and both are considered to be ubiquitous in the environment.
However, the list of 22 includes other troubling releases of chemicals that can be used to make drugs and other products: 8 million pounds of the skin bleaching cream hydroquinone, 3 million pounds of nicotine compounds that can be used in quit-smoking patches, 10,000 pounds of the antibiotic tetracycline hydrochloride. Others include treatments for head lice and worms.
Residues are often released into the environment when manufacturing equipment is cleaned.
A small fraction of pharmaceuticals also leach out of landfills where they are dumped. Pharmaceuticals released onto land include the chemo agent fluorouracil, the epilepsy medicine phenytoin and the sedative pentobarbital sodium. The overall amount may be considerable, given the volume of what has been buried — 572 million pounds of the 22 monitored drugs since 1988.
In one case, government data shows that in Columbus, Ohio, pharmaceutical maker Boehringer Ingelheim Roxane Inc. discharged an estimated 2,285 pounds of lithium carbonate — which is considered slightly toxic to aquatic invertebrates and freshwater fish — to a local wastewater treatment plant between 1995 and 2006. Company spokeswoman Marybeth C. McGuire said the pharmaceutical plant, which uses lithium to make drugs for bipolar disorder, has violated no laws or regulations. McGuire said all the lithium discharged, an annual average of 190 pounds, was lost when residues stuck to mixing equipment were washed down the drain.
___
Pharmaceutical company officials point out that active ingredients represent profits, so there's a huge incentive not to let any escape. They also say extremely strict manufacturing regulations — albeit aimed at other chemicals — help prevent leakage, and that whatever traces may get away are handled by onsite wastewater treatment.
"Manufacturers have to be in compliance with all relevant environmental laws," said Alan Goldhammer, a scientist and vice president at the industry trade group Pharmaceutical Research and Manufacturers of America.
Goldhammer conceded some drug residues could be released in wastewater, but stressed "it would not cause any environmental issues because it was not a toxic substance at the level that it was being released at."
Several big drugmakers were asked this simple question: Have you tested wastewater from your plants to find out whether any active pharmaceuticals are escaping, and if so what have you found?
No drugmaker answered directly.
"Based on research that we have reviewed from the past 20 years, pharmaceutical manufacturing facilities are not a significant source of pharmaceuticals that contribute to environmental risk," GlaxoSmithKline said in a statement.
AstraZeneca spokeswoman Kate Klemas said the company's manufacturing processes "are designed to avoid, or otherwise minimize the loss of product to the environment" and thus "ensure that any residual losses of pharmaceuticals to the environment that do occur are at levels that would be unlikely to pose a threat to human health or the environment."
One major manufacturer, Pfizer Inc., acknowledged that it tested some of its wastewater — but outside the United States.
The company's director of hazard communication and environmental toxicology, Frank Mastrocco, said Pfizer has sampled effluent from some of its foreign drug factories. Without disclosing details, he said the results left Pfizer "confident that the current controls and processes in place at these facilities are adequately protective of human health and the environment."
It's not just the industry that isn't testing.
FDA spokesman Christopher Kelly noted that his agency is not responsible for what comes out on the waste end of drug factories. At the EPA, acting assistant administrator for water Mike Shapiro — whose agency's Web site says pharmaceutical releases from manufacturing are "well defined and controlled" — did not mention factories as a source of pharmaceutical pollution when asked by the AP how drugs get into drinking water.
"Pharmaceuticals get into water in many ways," he said in a written statement. "It's commonly believed the majority come from human and animal excretion. A portion also comes from flushing unused drugs down the toilet or drain; a practice EPA generally discourages."
His position echoes that of a line of federal drug and water regulators as well as drugmakers, who concluded in the 1990s — before highly sensitive tests now used had been developed — that manufacturing is not a meaningful source of pharmaceuticals in the environment.
Pharmaceutical makers typically are excused from having to submit an environmental review for new products, and the FDA has never rejected a drug application based on potential environmental impact. Also at play are pressures not to delay potentially lifesaving drugs. What's more, because the EPA hasn't concluded at what level, if any, pharmaceuticals are bad for the environment or harmful to people, drugmakers almost never have to report the release of pharmaceuticals they produce.
"The government could get a national snapshot of the water if they chose to," said Jennifer Sass, a senior scientist for the Natural Resources Defense Council, "and it seems logical that we would want to find out what's coming out of these plants."
Ajit Ghorpade, an environmental engineer who worked for several major pharmaceutical companies before his current job helping run a wastewater treatment plant, said drugmakers have no impetus to take measurements that the government doesn't require.
"Obviously nobody wants to spend the time or their dime to prove this," he said. "It's like asking me why I don't drive a hybrid car? Why should I? It's not required."
___
After contacting the nation's leading drugmakers and filing public records requests, the AP found two federal agencies that have tested.
Both the EPA and the U.S. Geological Survey have studies under way comparing sewage at treatment plants that receive wastewater from drugmaking factories against sewage at treatment plants that do not.
Preliminary USGS results, slated for publication later this year, show that treated wastewater from sewage plants serving drug factories had significantly more medicine residues. Data from the EPA study show a disproportionate concentration in wastewater of an antibiotic that a major Michigan factory was producing at the time the samples were taken.
Meanwhile, other researchers recorded concentrations of codeine in the southern reaches of the Delaware River that were at least 10 times higher than the rest of the river.
The scientists from the Delaware River Basin Commission won't have to look far when they try to track down potential sources later this year. One mile from the sampling site, just off shore of Pennsville, N.J., there's a pipe that spits out treated wastewater from a municipal plant. The plant accepts sewage from a pharmaceutical factory owned by Siegfried Ltd. The factory makes codeine.
"We have implemented programs to not only reduce the volume of waste materials generated but to minimize the amount of pharmaceutical ingredients in the water," said Siegfried spokeswoman Rita van Eck.
Another codeine plant, run by Johnson & Johnson subsidiary Noramco Inc., is about seven miles away. A Noramco spokesman acknowledged that the Wilmington, Del., factory had voluntarily tested its wastewater and found codeine in trace concentrations thousands of times greater than what was found in the Delaware River. "The amounts of codeine we measured in the wastewater, prior to releasing it to the City of Wilmington, are not considered to be hazardous to the environment," said a company spokesman.
In another instance, equipment-cleaning water sent down the drain of an Upsher-Smith Laboratories, Inc. factory in Denver consistently contains traces of warfarin, a blood thinner, according to results obtained under a public records act request. Officials at the company and the Denver Metro Wastewater Reclamation District said they believe the concentrations are safe.
Warfarin, which also is a common rat poison and pesticide, is so effective at inhibiting growth of aquatic plants and animals it's actually deliberately introduced to clean plants and tiny aquatic animals from ballast water of ships.
"With regard to wastewater management we are subject to a variety of federal, state and local regulation and oversight," said Joel Green, Upsher-Smith's vice president and general counsel. "And we work hard to maintain systems to promote compliance."
Baylor University professor Bryan Brooks, who has published more than a dozen studies related to pharmaceuticals in the environment, said assurances that drugmakers run clean shops are not enough.
"I have no reason to believe them or not believe them," he said. "We don't have peer-reviewed studies to support or not support their claims."
___
Associated Press Writer Don Mitchell in Denver contributed to this report.
___
The AP National Investigative Team can be reached at investigate (at) ap.org
Studies find factories release pharmaceuticals
Federal scientists testing for pharmaceuticals in water have been finding significantly more medicine residues in sewage downstream from public treatment facilities that handle waste from drugmakers.
Early results from two pivotal federal studies compare wastewater at treatment plants that handle sewage from drugmakers with those that do not. The studies cover just a small fraction of the 1,886 pharmaceutical manufacturing facilities counted in a 2006 U.S. Census report.
In one study, samples taken at two treatment plants down the sewer line from drugmaking factories contained a range of pharmaceuticals — among them opiates, a barbiturate and a tranquilizer at "much higher detection frequencies and concentrations" than samples taken at other plants, according to preliminary research by the U.S. Geological Survey.
One drug, the muscle relaxant metaxalone, was measured in treated sewage at concentrations hundreds of times higher than the level at which federal regulators can order a review of a drug's environmental impact.
Based on secrecy agreements with the researchers, the treatment plants were not identified.
USGS researcher Herb Buxton, who co-chairs a White House task force on pharmaceuticals in the environment, said it's important that federal scientists test the pharmaceutical industry's claims that their wastewater is not a meaningful source of pharmaceuticals in water.
"It's critical that those types of assumptions are confirmed through real testing," said Buxton.
In another study, Environmental Protection Agency researchers tested sewage at a municipal wastewater treatment plant in Kalamazoo, Mich., that serves a major Pfizer Inc. factory. Bruce Merchant, Kalamazoo's public services director, provided data that showed unusually high concentrations of the antibiotic lincomycin entering the plant, a drug the factory was producing around the time samples were collected.
"There's some product going down the drain," said Merchant.
While nearly all the lincomycin was removed during wastewater treatment, some did survive. According to a separate 2008 study, lincomycin combined in minute concentrations with several other drugs that also have been detected in surface water made human cancer and kidney cells and fish liver cells proliferate.
Biologist Francesco Pomati, at the University of New South Wales in Sydney, Australia, was so concerned with the findings that he and his colleagues warned that chronic exposure to the combination of drugs via drinking water could be "a potential hazard for particular human conditions, such as pregnancy or infancy."
In earlier experiments, lincomycin acted as a mutagen, changing genetic information in bacteria, algae, microscopic aquatic animals and fish.
Pfizer spokesman Rick Chambers said that while the company does not test wastewater from the facility for the drugs made on site, "compliance with all environmental, health and safety laws is imperative to our business operations worldwide."
The two domestic studies follow a burst of recent research in Asia and Europe that has started to link factories to the presence in water of drugs including the antibiotic sulfamethoxazole, the pain reliever diclofenac and the anticonvulsant carbamazepine, as well as an antihistamine, female sex hormones and aspirin.
Researchers in India, where multinational companies have increasingly turned for the manufacture of raw pharmaceutical ingredients, found that 100 pounds a day of the antibiotic ciprofloxacin enters a river from a wastewater treatment plant that processes sewage from dozens of pharmaceutical makers.
In Switzerland, a study sponsored by drugmaking giant Roche documented that 0.2 percent of active pharmaceutical ingredients escape during its own processing. That kind of loss rate doesn't sound like a lot until it's projected out over the entire annual production of drugs worldwide. Studies in Taiwan and China also suggest drugmaking plants discharge product.
All of which raises questions about U.S. manufacturing.
"Is it as bad in the U.S. as it is in India? Probably not. But it does make me think we should test," said Kyla Bennett, a former EPA enforcement officer who is now an ecologist and environmental attorney.
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Diabetes? Some beat it, but are they cured?
JoAnne Zoller Wagner's diagnosis as prediabetic wasn't enough to compel her to change her habits and lose 30 pounds. Not even with the knowledge her sister had died because of diabetes.
"I didn't have that sense of urgency," said the Pasadena, Md., woman.
But nine months later, doctors told Wagner her condition had worsened. She, too, now had Type 2 diabetes.
That scared her into action.
Now, two years later, the 55-year-old woman has slimmed down. She exercises regularly and her blood sugar levels are back in the healthy, normal range. Thanks to her success, she was able to avoid diabetes medication.
Diabetics like Wagner who manage to turn things around, getting their blood sugar under control — either escaping the need for drugs or improving enough to quit taking them — are drawing keen interest from the medical community.
This summer an American Diabetes Association task force will focus on this group of patients and whether they can be considered "cured." Among the points of interest:
_What blood sugar range qualifies as a cure and how long would it have to be maintained?
_How might blood pressure and cholesterol, both linked to diabetes, figure into the equation?
_And what if a "cured" diabetic's blood sugar soars again?
"For right now, we're not saying they're cured, but the bottom line is ... good glucose control, less infections," said Sue McLaughlin, president of health care and education for the American Diabetes Association. The organization has no estimate of how many people fall into that category.
Being overweight is the leading risk for Type 2 diabetes. Genetics also plays a role, and blacks, Hispanics and American Indians are at greater risk than whites.
Nearly 57 million Americans are prediabetic. Another 18 million have been diagnosed with diabetes, while the diabetes association estimates almost 6 million more Americans have diabetes and don't know it. About 90 to 95 percent of diabetics have Type 2, the kind linked to obesity.
The future is potentially even gloomier, with one study estimating that one of every three children born in the U.S. in 2000 will eventually develop diabetes.
But the news isn't all bad. Thirty minutes of daily exercise and a 5 to 10 percent loss in body weight can lower the odds of diabetes by nearly 60 percent and is more effective than medicine in delaying its onset, according to a diabetes prevention study.
Still, such lifestyle changes are often difficult.
"It sounds like such a nonmedical recommendation, and yet it's the thing people say is the toughest to implement," said McLaughlin, the diabetes association official.
For Wagner, it meant changing not just her diet, but her lifestyle. A teacher, she now cooks most of her meals at home and avoids the sweets in the school lounge. She also tries not to stay late at work, using the extra time to exercise and make healthy meals.
Alice Stern describes a similar journey back to health since her diabetes diagnosis in 2007. The 50-year-old Boston woman was able to avoid diabetes drugs through diet and exercise, managing to trim 40 pounds off her 5-foot-2 frame.
"It is about willpower. That's how you make the changes," said Stern.
Even diabetics who have resorted to weight loss surgery have seen their blood sugar levels return to normal.
Lucy Cain, 61, of Dallas tried to control her diabetes through diet and exercise after she was diagnosed in 2004. But she found it difficult, and two years later had gastric bypass surgery. The 5-foot-7 Cain, who once weighed over 300 pounds, is down to about 185, still losing weight and is off diabetes medication.
Whatever the route, weight loss is key, doctors say.
"There is no special diet. You've got to eat fewer calories than your body burns," said Dr. Robert Rizza, a Mayo Clinic endocrinologist and former president of the American Diabetes Association.
Many doctors stop short of calling these successful patients cured.
Dr. Philipp Scherer, director of the diabetes research center at University of Texas Southwestern, describes diabetes as a one-way road. He said it can be stopped in its tracks with diet and exercise, but there's no turning back.
Dr. Kevin Niswender, an assistant professor in the department of medicine at Vanderbilt Medical Center, said "technically, you could call somebody cured," but that patient still needs to be followed closely.
Doctors caution that, for some diabetics, lowering blood sugar may be only temporary. Stress, weight gain and other factors can push it back to unhealthy levels.
"Blood sugars can come down to normal. Then the issue is how long does that last?" said Dr. Sue Kirkman, vice president of clinical affairs for the diabetes association. "Sometimes people start putting weight back on and their blood sugars come back up."
In other cases, patients are diagnosed so late that blood sugar levels can't be brought back to normal, even with weight loss, she said. As the disease progresses, even those who made diet and lifestyle changes might eventually have to go on medications.
That's one reason Wagner and some other diabetics who've managed their disease through diet and exercise are also reluctant to consider themselves "cured."
"American culture, our environment, is not conducive to having good health," said Wagner. She believes diabetes will always be lurking in the background, waiting for her to slip.
___
On the Net:
American Diabetes Association: http://www.diabetes.org/
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Selasa, 14 April 2009
Yikes, bedbugs! EPA looks to stop resurgence
ARLINGTON, Va. – "Don't let the bedbugs bite." Doesn't seem so bad in a cheerful bedtime rhyme, but it's becoming a really big problem now that the nasty critters are invading hospitals, college dorms and even swanky hotels. With the most effective pesticides banned, the government is trying to figure out how to respond to the biggest bedbug outbreak since World War II.
Bedbugs live in the crevices and folds of mattresses, sofas and sheets. Then, most often before dawn, they emerge to feed on human blood.
Faced with rising numbers of complaints to city information lines and increasingly frustrated landlords, hotel chains and housing authorities, the Environmental Protection Agency hosted its first-ever bedbug summit Tuesday.
Organized by one of the agency's advisory committees, the two-day conference drew about 300 participants to a hotel in Arlington, just across the Potomac River from Washington. An Internet site notes that the hotel in question has had no reports of bedbugs.
One of the problems with controlling the reddish-brown insects, according to researchers and the pest control industry, is that there are few chemicals on the market approved for use on mattresses and other household items that are effective at controlling bedbug infestations.
Unlike roaches and ants, bedbugs are blood feeders and can't be lured by bait. It's also difficult for pesticides to reach them in every crack and crevice they hide out in.
"It is a question of reaching them, finding them," said Harold Harlan, an entomologist who has been raising bedbugs for 36 years, feeding them with his own blood. He has the bites to prove it.
The EPA, out of concern for the environment and the effects on public health, has pulled many of the chemicals that were most effective in eradicating the bugs in the U.S. At the same time, the appleseed-sized critters have developed a pesticide resistance because those chemicals are still in use in other countries.
Increasing international travel has also helped them to hitchhike into the U.S.
"One of our roles would be to learn of new products or safer products. ... What we are concerned about is that if people take things into their own hands and start using pesticides on their mattresses that aren't really registered for that, that's a problem," said Lois Rossi, director of the registration division in the EPA's Office of Pesticide Programs.
The EPA is not alone in trying to deal with the problem. An aide to Rep. G.K. Butterfield, D-N.C., says the congressman plans to reintroduce legislation next week to expand grant programs to help public housing authorities cope with infestations.
The bill will be called the "Don't Let the Bedbugs Bite Act."
"It was clear something needed to be done," said Saul Hernandez, Butterfield's legislative assistant.
Bedbugs are not known to transmit any diseases. But their bites can cause infections and allergic reactions in some people. The insects release an anticoagulant to get blood flowing, and they also excrete a numbing agent so their bites don't often wake their victims.
Those often hardest hit are the urban poor, who cannot afford to throw out all their belongings or take other drastic measures. Extermination can cost between $400-$900.
So bedbug problems increase, said Dini Miller, an entomologist and bedbug expert at Virginia Tech, who until 2001 saw bedbugs only on microscope slides dating from the 1950s. Now she gets calls and e-mails several times a day from people at their wits' end.
"I can't tell you how many people have spent the night in their bathtubs because they are so freaked out by bedbugs," Miller said. "I get these people over the phone that have lost their marbles."
Because the registration of new pesticides takes so long, one thing the EPA could do is to approve some pesticides for emergency use, Miller said.
Another tactic would be to screen pesticides allowed for use by farmers to see if they are safe in household settings.
Representatives of the pest control industry will be pushing for federal funding for research into alternative solutions, such as heating, freezing or steaming the bugs out of bedrooms.
"We need to have better tools," said Greg Baumann, a senior scientist at the National Pest Management Association. "We need EPA to consider all the options for us."
___
On the Net:
Harvard School of Public Health: http://www.hsph.harvard.edu/bedbugs/
University of Kentucky Insect Advice: http://www.ca.uky.edu/entomology/entfacts/ef636.asp
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Company says prostate cancer vaccine shows promise
An experimental treatment that takes an entirely new approach to fighting prostate cancer extended survival in a late-stage study, its maker announced Tuesday.
Seattle-based Dendreon Corp. said that its Provenge cancer vaccine improved overall survival when compared to a dummy treatment in a study of 512 men with advanced disease.
No survival details or information on side effects were given. Full results will be presented at an American Urological Association meeting later this month, and Dendreon said it would seek federal approval of the treatment later this year.
Provenge is not like traditional vaccines that prevent disease. It's a so-called therapeutic vaccine that treats cancer by training the immune system to fight tumors. If approved, Provenge would be the first such treatment on the market.
This is the second major study in which Provenge has shown a survival benefit, leading some scientists to hope not just for its approval but for a new approach to fighting cancer beyond the surgery, radiation, hormones and chemotherapy used now.
"This is an exciting result, demonstrating that harnessing a patient's own immune system can successfully attack prostate cancer," said Dr. Eric Small, cancer specialist at the University of California at San Francisco. "Now we have more confidence that the initial results we saw were real."
He enrolled some patients in the new study and led the earlier one, but has no financial ties to the company or the vaccine.
In the earlier study of 127 men, those treated with the vaccine lived an average of 4 1/2 months longer than those given dummy treatments. After three years, survival was 34 percent in the vaccine group and only 11 percent in the other.
Those results led advisers to the Food and Drug Administration to recommend Provenge's approval two years ago. But the FDA delayed action and asked for more data, because extending survival wasn't the main goal of that study — slowing progression of the cancer was, and the vaccine failed to do that.
The decision sparked protests from men's groups and cancer advocates because the vaccine did prolong survival, which they considered a more important result.
On Tuesday, results of the new study boosted Dendreon stock by $9.69, closing at $16.99, more than doubling in value as investors bet on improved chances of FDA approval and the potential for a lucrative market.
Provenge is a treatment that is customized for each patient. Doctors collect specialized cells from each patient's blood. Those cells help the immune system recognize cancer as a threat, much as it would germs that enter the body.
The cells are mixed with a protein found on most prostate cancer cells to help activate the immune system. The resulting "vaccine" is given back to the patient as three infusions two weeks apart.
So far, the vaccine has been tested on men with cancer that has spread beyond the prostate and is no longer responding to hormone treatments to curb its growth.
If Provenge proves safe and wins approval, "it would be an important breakthrough," said Dr. William Oh, a cancer specialist at Dana-Farber Cancer Center in Boston. Three years ago, he consulted for Dendreon on the vaccine but has had no financial ties to it since then.
"There are so few treatments available" for men whose prostate cancer has spread widely — a situation that affects 40,000 to 60,000 American men, he said.
Prostate cancer is the most common non-skin cancer in American men. An estimated 186,000 new cases and 28,660 deaths from it occurred last year.
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Senin, 13 April 2009
Treating kids with malaria at home doesn't work
LONDON – Treating African children at home for malaria doesn't help in cities because most fevers aren't actually caused by malaria, a new study said Tuesday.
Malaria drugs were distributed to households where parents had been told by researchers to automatically treat their children if they became feverish.
Roughly half the children were treated at home while the other half were taken to health clinics within a day of developing a fever.
To effectively treat malaria, children must be treated within a day of getting sick. The study found that children at home got twice as many medicines as those taken to clinics, but didn't do any better.
The research highlights holes in malaria treatment across the continent and raises questions about an upcoming U.N. initiative to fight the disease.
Experts monitored more than 400 children aged between 1 and 6 in Kampala, Uganda, from 2005-2007.
The research was published online Tuesday in the medical journal, Lancet. It was paid for by the Gates Malaria Partnership.
Malaria, which is spread by mosquito bites and carries symptoms such as fever, chills and vomiting, primarily affects poor people in remote areas.
Some doctors said the study showed a worrying tendency to treat fevers before they were diagnosed as malaria.
"If you just go on fever, you're over-treating so many children and you could miss other diseases by using malaria drugs," said Dr. Tido von-Schoen Angerer of Medecins Sans Frontieres, aka Doctors Without Borders. He was not linked to the study.
Malaria medicines don't work on fevers caused by other diseases like pneumonia, and children can die if they are not properly treated.
Previous studies have found home treatment works in rural areas. But malaria is also a problem in cities, and will have to be tackled differently there than in the countryside.
Von-Schoen Angerer said the Lancet study underlined that standard care for malaria in Africa is appalling.
Despite decades of work and renewed U.N. efforts to combat the disease, only 5 percent of children in Uganda are promptly treated with effective medication. Across Africa, the World Health Organization puts the figure at 3 percent.
WHO estimates malaria sickens about 247 million people and kills nearly 1 million every year.
Later this week, the United Nations and partners will announce a $200 million strategy called the Affordable Medicines Facility for Malaria to make drugs cheaper in 11 African countries.
Von-Schoen Angerer and others worry the tendency to over-treat malaria, as proven by the Lancet study, will be worsened by the strategy. They fear it will flood the market with drugs that promote resistance.
The initiative, led by WHO and the Global Fund to fight AIDS, tuberculosis and malaria, will subsidize the price of artemesinin combination therapies, the most effective malaria treatments.
But the U.N. has not insisted the drugs be combined in a single pill, which would curb the resistance risk.
Artemesinin combination therapies are also sold as several pills. Some cause side effects like nausea, and patients commonly throw those pills out, encouraging resistance.
"The risk of resistance is very scary," von-Schoen Angerer said. "We don't have a back-up medicine at this stage."
Richard Tren, director of the nonprofit Africa Fighting Malaria, called the U.N. initiative "an untested experiment," and warned the strategy could backfire.
"We need policies based on evidence," he said. "And the evidence this could work is pretty shaky."
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On the Net:
http://www.lancet.com
http://www.theglobalfund.org
http://www.who.int
http://www.msf.org
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Study gathers best science on heart-healthy foods
CHICAGO – What we know for sure about diet and what protects the heart is a relatively short list.
That's the conclusion of new research based on an analysis of nearly 200 studies involving millions of people.
Vegetables, nuts and the Mediterranean diet made the grocery list of "good" heart foods. On the "bad" list: starchy carbs like white bread and the trans fats in many cookies and french fries.
The "question mark" list includes meat, eggs and milk and many other foods where there's not yet strong evidence about whether they're good or bad for the heart.
"I do research. I also buy groceries for my family every week," said study co-author Dr. Sonia Anand of McMaster University in Hamilton, Ontario, who hopes the findings "decrease the confusion around what we should eat and what we shouldn't eat."
The study, appearing in Monday's Archives of Internal Medicine, doesn't actually read like a shopping list. It's a complicated explanation of how the researchers rated 189 prior studies on the topic.
In short, they used criteria developed by Sir Austin Bradford Hill, the late British scientist who helped establish a link between smoking and lung cancer. When multiple studies on a certain food or diet showed a strong link with better heart health, that put the food or diet at the top of the list.
Dr. JoAnn Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital, said the analysis underlines that there's a big gray area and a shorter list of foods with strong links to heart health.
Linda Van Horn, professor of preventive medicine at Northwestern University's Feinberg School of Medicine, said the analysis is more about the strengths and limits of previous studies than advice for consumers.
But she said the analysis reaffirms the benefits of a Mediterranean diet — rich in vegetables, nuts, whole grains, fish and olive oil — compared to a Western diet, heavy on processed meats, red meat, refined grains and high-fat dairy.
Beyond that, she found no reason to tear up your grocery list based on the findings.
"It's really about the totality of the usual eating pattern, rather than whether you ate a hot dog on opening day of baseball season," Van Horn said.
The Heart and Stroke Foundation of Canada and the Canadian Institutes of Health supported the research.
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On the Net:
Archives: http://www.archinternmed.com
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America's uninsured haven't shown collective power
WASHINGTON – If the uninsured were a political lobbying group, they'd have more members than AARP. The National Mall couldn't hold them if they decided to march on Washington.
But going without health insurance is still seen as a personal issue, a misfortune for many and a choice for some. People who lose coverage often struggle alone instead of turning their frustration into political action.
Illegal immigrants rallied in Washington during past immigration debates, but the uninsured linger in the background as Congress struggles with a health care overhaul that seems to have the best odds in years of passing.
That isolation could have profound repercussions.
Lawmakers already face tough choices to come up with the hundreds of billions it would cost to guarantee coverage for all. The lack of a vocal constituency won't help. Congress might decide to cover the uninsured slowly, in stages.
The uninsured "do not provide political benefit for the aid you give them," said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. "That's one of the dilemmas in getting all this money. If I'm in Congress, and I help out farmers, they'll help me out politically. But if I help out the uninsured, they are not likely to help members of Congress get re-elected."
The number of uninsured has grown to an estimated 50 million people because of the recession. Even so, advocates in the halls of Congress are rarely the uninsured themselves. The most visible are groups that represent people who have insurance, usually union members and older people. In the last election, only 10 percent of registered voters said they were uninsured.
The grass-roots group Health Care for America Now plans to bring as many as 15,000 people to Washington this year to lobby Congress for guaranteed coverage. Campaign director Richard Kirsch expects most to have health insurance.
"We would never want to organize the uninsured by themselves because Americans see the problem as affordability, and that is the key thing," he said.
Besides, added Kirsch, the uninsured are too busy scrambling to make ends meet. Many are self-employed; others are holding two or three part-time jobs. "They may not have a lot of time to be activists," he said.
Vicki and Lyle White of Summerfield, Fla., know about such predicaments. They lost their health insurance because Lyle had to retire early after a heart attack left him unable to do his job as a custodian at Disney World. Vicki, 60, sells real estate. Her income has plunged due to the housing collapse.
"We didn't realize that after he had the heart attack no one would want to insure him," said Vicki. The one bright spot is that Lyle, 64, has qualified for Medicare disability benefits and expects to be getting his card in July.
But for now, the Whites have to pay out of pocket for Lyle's visits to the cardiologist and his medications. The bills came to about $5,000 last year. That put a strain on their limited budget because they are still making payments on their house and car.
"I never thought when we got to this age that we would be in such a mess," said Vicki, who has been married to Lyle for 43 years. "We didn't think we would have a heart attack and it would change our life forever."
While her own health is "pretty good," Vicki said she suffers chronic sinus infections and hasn't had a checkup since 2007. "I have just learned to live with it," she said.
The Whites' example shows how the lack of guaranteed health care access undermines middle-class families and puts them at risk, but that many of the uninsured eventually do find coverage. Lyle White has qualified for Medicare, even if the couple must still find a plan for Vicki.
Research shows that nearly half of those who lose coverage find other health insurance in four months or less. That may be another reason the uninsured have not organized an advocacy group. At least until this recession, many have been able to fix the situation themselves.
"The uninsured are a moving target," said Cathy Schoen, a vice president of the Commonwealth Fund, a research group that studies the problems of health care costs and coverage.
But even if gaps in coverage are only temporary, they can be dangerous. "Whenever you are uninsured, you are at risk," said Schoen. "People don't plan very well when they are going to get sick or injured."
Indeed, the Institute of Medicine, which provides scientific advice to the government, has found that a lack of health insurance increases the chances of bad outcomes for people with a range of common ailments, from diabetes and high blood pressure to cancer and stroke. Uninsured patients don't get needed follow-up care, skip taking prescription medicines and put off seeking help when they develop new symptoms.
Such evidence strengthens the case for getting everybody covered right away, Schoen said. But she acknowledges the politics may get tough. "It certainly has been a concern out of our history that unorganized voices aren't heard," she said.
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On the Net:
White House: http://www.whitehouse.gov/agenda/health_care/
Health Care for America Now: http://www.healthcareforamericanow.org/
Commonwealth Fund: http://www.commonwealthfund.org/
Institute of Medicine: http://tinyurl.com/dm8gnn
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7th surgery shows face transplants gaining ground
Five years ago, it was the stuff of science fiction: Replace someone's face with one from a dead donor. But on Thursday, Boston doctors performed the world's seventh such transplant — less than a week after one in France — and plans are in the works for more.
"Society is allowing us to do this. I think you're going to see more and more," especially in soldiers disfigured in recent wars, said Dr. Frank Papay, a surgeon who helped perform the nation's first face transplant, in December at the Cleveland Clinic.
Some of the successes have been dazzling. People who couldn't eat, speak normally, or go out in public now can walk the streets without being recognized as someone who got a new face.
Even so, face transplants are likely to remain uncommon, used on only the most severely disfigured, because of the big risks and lifelong need to take medicines to prevent rejection.
"It's not going to be like some people imagine — routine, like people getting a facelift, or cosmetic surgery," said Stuart Finder, director of the Center for Healthcare Ethics at Cedars-Sinai Medical Center in Los Angeles.
"We have what appears to be success," he noted, but there is always the chance that some patients may experience serious rejection problems or refuse to stay on the required lifetime of drugs.
Boston doctors stressed the care and psychological screening they required before performing the nation's second face transplant on Thursday. The operation, at Harvard-affiliated Brigham and Women's Hospital, was on a man who suffered traumatic facial injuries from a freak accident.
Face transplants go far beyond the transfer of skin and facial features, using things like bone and cartilage for reconstruction. The team led by plastic surgeon Dr. Bohdan Pomahac replaced the man's nose, palate, upper lip, and some skin, muscles and nerves with those of a dead donor.
The hospital would not identify the recipient or donor, but the donor's family members released a statement saying they hope the procedure convinces others to donate.
"The fact that we are able to give this gift was a tremendous comfort in our time of grief," the statement said.
At a news conference on Friday, Pomahac said: "There is no risk of recognizing the donor on the new patient. There's a 60 percent chance the patient will look how he used to look."
In a phone interview earlier Friday, Pomahac (pronounced POE-ma-hawk) said the man's injury occurred some years ago, and it left him with "no teeth, no palate, no nose, no lip."
"It was difficult for him to speak, to eat, to drink. It certainly caused a lot of social problems," Pomahac said.
The man had been Pomahac's patient for a long time, and doctors decided to pursue a face transplant because previous attempts to treat him left him still badly deformed. It took three months to find a suitable donor, who also provided some organs for transplant in other patients, Pomahac said.
The 17-hour operation began at 1:15 a.m. Thursday, with the recipient and the donor in operating rooms across the hall from each other. The patient was still recovering from anesthesia on Friday.
"He's still not fully awake so he has not seen himself. We have not really had a meaningful conversation so far," Pomahac said.
"He was incredibly motivated to go forward with it," and was extensively evaluated psychologically by doctors in and outside of Brigham, Pomahac said. "We really made sure that nothing was left to chance."
The seven primary surgeons and other assistants all donated their time and services, Pomahac said.
"We are essentially making a lifelong commitment to help him," the surgeon said.
Pomahac was born in Ostrava in the Czech Republic, and graduated from Palacky University School of Medicine in Olomouc, Czech Republic. He came to Brigham for a surgical research internship in 1996 and now, at 38, is associate director of its burn center, where he treats trauma and plastic surgery cases.
The Boston hospital's board approved Pomahac's plans to offer face transplants a year ago.
The world's first transplant in 2005 was led by Dr. Jean-Michel Dubernard in Amiens, France, who treated Isabelle Dinoire, a woman who had been mauled by a dog and grotesquely disfigured. Dinoire's appearance today is virtually normal.
The first U.S. face transplant, and the most extensive operation so far, was done in December by doctors at Cleveland Clinic. They replaced 80 percent of a woman's face with that of a female cadaver. The woman's identity has not been revealed, nor the circumstances that led to the transplant.
The woman left the hospital in February, and is doing "phenomenally well," Papay said. "Her speech is improved so everyone can understand her now, and she has a great outlook on life. She's very comfortable with the way she looks now and she's very happy."
The early successes are encouraging, but should not lead to over-exuberance, and extending the operation too fast, said Finder, the Los Angeles ethicist.
"This is still very new and hence requires a hyper-vigilance about helping patients understand what they're getting into," he said.
People who have received other transplants — organs, hands — have sometimes discovered they traded one set of problems for another, and get sick of taking the medicines needed to maintain the transplant. At least one hand transplant recipient later had the hand amputated for this reason.
Pomahac originally was considering only people who had already received a kidney or other organ transplant, because they already would be on immune-suppressing medicines and would therefore have a low risk of rejecting a new face.
"I still think that's the best group of patients but we have enlarged the protocol" to include others with severe facial deformities, he said.
"It's really in its infancy in terms of knowing what will happen," he added. "Each of the cases is its own unique story."
Eventually, surgeons hope to form waiting lists of face transplant candidates "just like for any other organ," Pomahac said.
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Associated Press writer Russell Contreras in Boston contributed to this story.
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Report: Ethanol raises cost of nutrition programs
WASHINGTON – Food stamps and child nutrition programs are expected to cost up to $900 million more this year because of increased ethanol use.
Higher use of the corn-based fuel additive accounted for about 10 percent to 15 percent of the rise in food prices between April 2007 and April 2008, according to the nonpartisan Congressional Budget Office. That could mean the government will have to spend more on food programs for the needy during the current budget year, which ends Sept. 30. It estimated the additional cost at up to $900 million.
The CBO said other factors, such as skyrocketing energy costs, have had an even greater effect than ethanol on food prices. CBO economists estimate that increased costs for food programs overall due to higher food prices will be about $5.3 billion this budget year.
Ethanol's impact on future food prices is uncertain, the report says, because an increased supply of corn has the potential to eventually lower food prices.
Roughly one-quarter of corn grown in the United States is now used to produce ethanol and overall consumption of ethanol in the country hit a record high last year, exceeding 9 billion gallons, according to the CBO. It took nearly 3 billion bushels of corn to produce ethanol in the United States last year — an increase of almost a billion bushels over 2007.
The demand for ethanol was one factor that increased corn prices, leading to higher animal feed and ingredient costs for farmers, ranchers and food manufacturers. Some of that cost is eventually passed on to consumers, since corn is used in so many food products.
Several of those affected groups have banded together to oppose tax breaks and federal mandates for the fuel. They said Thursday that the report shows the unintended consequences of ethanol.
"As startling as these figures are, they do not even tell the story of the toll higher food prices have taken on working families, nor the impact higher feed prices have had on farmers in animal agriculture who have seen staggering losses and job cuts and liquidation of livestock herds," the Grocery Manufacturers Association, American Meat Institute, National Turkey Federation and National Council of Chain Restaurants said in a statement.
Supporters of ethanol disagreed, saying the report was good news.
"The report released by the Congressional Budget Office confirms what we've known for some time: The impact of ethanol production on food prices is minimal and that energy was the main driver in the rise of food prices," said Tom Buis, CEO of Growth Energy, an ethanol industry group.
Ethanol producers asked the Environmental Protection Agency last month to increase the amount of ethanol that refiners can blend with gasoline from a maximum of 10 percent to 15 percent, which could boost the demand for ethanol by as much as 6 billion gallons a year. They said raising that cap would create thousands of new jobs.
Agriculture Secretary Tom Vilsack has said he believes the administration could move quickly to raise the cap to at least 12 percent or 13 percent, but the EPA has not yet decided.
The report also looked at ethanol's effects on greenhouse gas emissions, concluding that over time ethanol's benefits over gasoline could diminish. The report says the use of ethanol reduced gasoline consumption by about 4 percent last year and reduced the gases blamed for global warming from the burning of gasoline by less than 1 percent. But the clearing of cropland and forests to produce more ethanol could more than offset those reductions.
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Minggu, 05 April 2009
Doctor in hepatitis B case has license suspended
NEWARK, N.J. – State regulators on Friday temporarily suspended the medical license of a doctor who health officials suspect is linked to a hepatitis B outbreak.
Nearly 3,000 of Dr. Parvez Dara's patients have been warned to get tested after five cancer patients tested positive for the disease, which is transmitted through exposure to infected blood and can cause serious liver damage.
On Friday, the state presented evidence about the conditions at the oncologist's Toms River office. Investigators said they found blood on the floor of a room where chemotherapy was administered, blood in a bin where blood vials were stored, open medication vials and unsterile saline and gauze.
Inspectors also cited problems with cross-contamination of pens, refrigerators and countertops; use of contaminated gloves; and misuse of antiseptics, among other health code violations.
"This was not a one-time episode," Deputy Attorney General Siobhen Krier told regulators. "This is a case of egregious, bad medical judgment displayed over a long period of time."
A special committee of the state Board of Medical Examiners issued the suspension, effective immediately, on an emergency basis. The full board will consider whether to continue the suspension on Wednesday.
During the hearing Friday, Krier said Dara had a history of health code violations dating to 2002 and posed "a clear and imminent danger to the public."
Since 2002, Dara has paid nearly $56,000 in fines for infection control health code violations, court records show.
Dara said he only used sterile supplies and equipment and took steps correct the violations. He questioned whether the patients may have contracted the disease some other way, such as from a hospital or from surgery, and suggested some may have been latent carriers — meaning they had the virus but it was dormant — until they began receiving chemotherapy, which can suppress the body's immune system.
"It's not that rare," Dara said.
In making its decision, the committee said Dara showed "a significant and gross deficiency in judgment" and that that could not be remedied by changing office practices.
"Dr. Dara's own testimony has not persuaded the committee that he has an appreciation for the gravity of multiple breaches of basic infection control practices," the committee said in its order to suspend Dara's license.
Dara did express sympathy for his patients: "This is hurting them so much more than it's hurting me."
A March 28 letter was sent to his patients warning them of the risk and suggesting they be tested for the liver diseases hepatitis B and hepatitis C and for HIV, the virus that causes AIDS.
Dara, originally from Pakistan, has been practicing at his Toms River office for 23 years. He estimated that he sees between 45 and 60 patients a day, with about a dozen receiving chemotherapy each day.
His attorney, Robert Conroy, argued to the board that there was no direct evidence the hepatitis cases were linked to Dara's office. He characterized the state's investigation as sloppy and said the fact that the outbreak investigation is ongoing should have precluded regulators from drawing any conclusions.
Conroy said Dara plans to immediately appeal the decision.
Kraft Foods offers salmonella timeline
FRESNO, Calif. – Kraft Foods Inc., the company whose testing led to the nationwide pistachio recall, said Friday it first heard there was salmonella in its trail mix in late 2007, but could not trace the possible source to tainted nuts from California until two weeks ago.
Workers at one of Kraft's manufacturers in Illinois turned up a contaminated batch of fruits and nuts in December 2007. Then, in September of last year, another positive sample appeared.
Only after thousands of tests could the company pinpoint the source for the second positive test as California-based Setton Pistachio of Terra Bella, Inc., said Kraft spokeswoman Susan Davison.
Last week, the food products giant recalled or destroyed all suspect foods, and notified its suppliers and the Food and Drug Administration, which on Monday issued a sweeping national warning against eating the nuts.
"If we did detect salmonella, of course we would never ship our products," Davison said. "We conducted extensive testing of all our food, and we were just unable to zero in until March that pistachios were the root cause."
On Friday, Lee Cohen, a production manager for Setton's sister company in New York, said Kraft did not tell Setton until recently that they had detected salmonella-tainted pistachios last year. The company later retracted his statement without explanation.
Setton, the second-largest pistachio processor in the nation, sells its nuts to Kraft and 35 other wholesalers across the country, which use them in everything from ice cream to cake mixes. As FDA officials scour its records and swab its factory, the plant has temporarily shut down after recalling more than 2 million pounds of nuts.
No pistachio-related illnesses have been reported.
Also Friday, the FDA sent out a letter to the pistachio industry reminding nut processors to follow good manufacturing practices to protect consumers, something food safety experts called welcome guidance.
Dr. David Acheson, FDA's assistant commissioner for food safety, said Kraft first told the administration about the problems last week.
Neither federal nor state laws require food manufacturers to test the safety of their products or to report any findings of contamination, though many do if they plan to recall a product, Acheson said.
"If they find problems in a product prior to shipment, they'll pull it back and destroy it," Acheson said. "I wouldn't call that a good manufacturing practice, but that is clearly a good public health practice."
Kraft finally determined pistachios caused last year's problem in March, when their manufacturer in Illinois detected salmonella for the third time — this time in the nuts, the only common ingredient between the second and third batch of trail mix, Davison said. Kraft has not traced the source for the first positive salmonella test in 2007.
Salmonella, the most common cause of food-borne illness, causes diarrhea, fever and cramps. Most people recover, but the infection can be life-threatening for children, the elderly and people with weakened immune systems.
Roasting is supposed to kill the bacteria in nuts, but problems can occur if the roasting is not done correctly or if roasted nuts are re-contaminated. That can happen if mice, rats or birds get into the facility.
Setton Pistachio officials suspect the roasted pistachios sold to Kraft Foods may have become mixed at the plant with raw nuts that could have contained traces of the bacteria.
Cohen, the production official at Setton International Foods Inc. in Commack, N.Y., said Friday that Setton Pistacio's internal tests had detected salmonella on some of its raw pistachios in the past, but said all tainted pistachios were later roasted. He did not specify when those tests were performed.
"We have found salmonella on raw pistachios, but that doesn't mean anything because those nuts are coming straight from the orchards where you could have had a very small localized contamination from birds," Cohen said. "Those nuts never hit the marketplace."
More than a dozen other companies that got their nuts from the California plant have recalled their pistachio products this week for fear of possible contamination. On Friday, Setton International announced it was also voluntarily recalling about 118,000 pounds of pistachio products.
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CDC: Rocket fuel chemical found in baby formula
ATLANTA – Traces of a chemical used in rocket fuel were found in samples of powdered baby formula, and could exceed what's considered a safe dose for adults if mixed with water also contaminated with the ingredient, a government study has found.
The study by scientists at the U.S. Centers for Disease Control and Prevention looked for the chemical, perchlorate, in different brands of powdered baby formula. It was published last month, but the Environmental Working Group — a Washington, D.C.-based advocacy organization — issued a press release Thursday drawing attention to it.
The chemical has turned up in several cities' drinking water supplies. It can occur naturally, but most perchlorate contamination has been tied to defense and aerospace sites.
No tests have ever shown the chemical caused health problems, but scientists have said significant amounts of perchlorate can affect thyroid function. The thyroid helps set the body's metabolism. Thyroid problems can impact fetal and infant brain development.
However, the extent of the risk is hard to assess. The government requires that formula contain iodine, which counteracts perchlorate's effects. The size of the infant and how much formula they consume are other factors that can influence risk.
The U.S. Food and Drug Administration, aware of the debate over perchlorate in food and water, has not recommended that people alter their diet or eating habits because of the chemical.
The study itself sheds little light on how dangerous the perchlorate in baby formula is. "This wasn't a study of health effects," said Dr. Joshua Schier, one of the authors.
The largest amounts of the chemical were in formulas derived from cow's milk, the study said.
The researchers would not disclose the brands of formula they studied. Only a few samples were studied, so it's hard to know if the perchlorate levels would be found in all containers of those brands, a CDC spokesman said.
"This study provides no data on potential health effects of perchlorate. Health authorities continue to emphasize that infant formula is safe," said Haley Curtis Stevens of the International Formula Council, which represent formula manufacturers.
Earlier this year, the U.S. Environmental Protection Agency said it was considering setting new limits on the amount of perchlorate that would be acceptable in drinking water. A few states have already set their own limits.
The agency issued a statement Friday saying perchlorate exposure is a serious issue and "a top priority" for EPA Administrator Lisa Jackson. EPA officials expect to announce a decision soon about future steps in dealing with the chemical.
The EPA has checked nearly 4,000 public water supplies serving 10,000 people or more. About 160 of the water systems had detectable levels of perchlorate, and 31 had levels high enough to exceed a new safety level the EPA is considering.
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CDC: http://www.cdc.gov/
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