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Saturday, March 15, 2003posted by Sydney on 3/15/2003 09:26:00 AM 0 comments
In a finding that may open a new avenue to treating diabetes, researchers have shown that cells from the bone marrow give rise to insulin-producing cells in the pancreas of mice. These morphed cells actually produce the hormone insulin in response to glucose and display other characteristics demonstrating that they truly function as pancreas cells, according to a new study by researchers from NYU School of Medicine. The study was published in yesterday's Journal of Clinical Investigation. The researchers caution that the findings cannot be applied to treating diabetics now, but may one day provide a means to produce unlimited quantities of functional insulin-producing cells culled from the bone marrow of diabetes patients. Because patients would produce their own cells for transplantation, it is possible the cells would not be rejected by their immune system. The experiment involved transplanting bone marrow cells from male mice into female mice. The male bone marrow cells could be easily identified by their Y chromosomes. Insulin production was identified by a green flourescenct protein marker that made the male marrow cells glow if their insulin producing gene was switched on. Six weeks after the transplant, green-glowing Y chromosome-containing pancreatic cells were found in the pancreas (pancreases?) of female mice. (Photos of the glowing cells can be found here and here.) This is an important development in the use of adult stem cells to treat disease. One argument against their use, often put forth by those who advocate the use of embryonic stem cells instead, is that adult bone marrow cells aren’t as plastic as embryonic cells - they can’t evolve into as wide a variety of cells; and that when they do, it’s because they fused with host cells. This experiment appears to suggest otherwise. Wesley J. Smith has more on adult stem cell advances here. posted by Sydney on 3/15/2003 08:44:00 AM 0 comments
posted by Sydney on 3/15/2003 08:41:00 AM 0 comments
posted by Sydney on 3/15/2003 08:29:00 AM 0 comments
Now, a prostate exam is not as complicated as a female pelvic exam. It requires no instruments, and no visual skills. It doesn't require any blind groping to find hidden body parts. You simply insert your finger and feel what it touches. So, you would think that there would be little need for a trained instructor. You would be wrong. Our instructors taught us how to introduce the finger without startling the patient and his sphincter, and they provided valuable feedback during the exam. In my case, it was pointed out to me that I allowed my skirt to brush the instructor's leg, which some people could misconstrue as erotic. That may have been a stretch, but I do most of my prostate checks with the patient lying on his side on a table because of it. And the few times I have them stand, I make sure nothing but my finger is touching them. posted by Sydney on 3/15/2003 08:21:00 AM 0 comments
When State Sen. Rick McDonald died of cancer in 2001, he had about $4,000 worth of unused drugs that had to be destroyed. Vickie McDonald of Rockville, appointed to complete her husband's term, wished those drugs could have been used to help someone else. State lawmakers Thursday voted 43-0 to give first-round approval to her bill, which would allow unused cancer drugs to be given to other patients. Legislative Bill 756 is patterned after a law passed in Ohio. Several other states are considering such legislation. "I know from my own personal experience how much medicine is left when a loved one dies," McDonald said. "I think this is a terrible waste of good medicine." They are taking precautions to minimize the risk of tampering: The bill would allow cancer drugs in their original sealed packages to be donated to a repository. The drugs could not be resold and would be dispensed via prescription through participating hospitals, pharmacies and clinics. Recipients would qualify for the drugs based on economic status. However, drugs within six months of their expiration date, drugs that require refrigeration and controlled substances such as painkillers could not be donated. Not sure why the painkillers can't be donated. Perhaps they fear that there's a greater risk of theft with substitution of placebo. Sounds like a good bill. It's unfortunate that such programs aren't allowed in all states. But, then, the fear of liability looms larger in some states than others. posted by Sydney on 3/15/2003 07:45:00 AM 0 comments
The one that comes first to my mind is the CellPro Ceprate, which was taken off the market by Baxter via an IP lawsuit. As I have watched technology and medicine I think an equally if not more interesting question is: How many drugs/technologies are kept of the shelves by companies seeking to protect their current market/therapy? I know that some large medical/biotech companies act in ways which one could come to such a conclusion. They buy up or otherwise seek to legally obstruct new companies and technologies so that their current product is protected and the market they enjoy is not threatened. My suspicion is that at least as many products are kept off the market in this manner as are kept off by the fact that the inventor (a basic researcher or physician) is unable to foresee or uninterested in developing the clinical application of his invention. We do an awful lot of research that if we could only see the potential applications, we would be decades ahead of where we are today. Interesting. posted by Sydney on 3/15/2003 07:42:00 AM 0 comments
Friday, March 14, 2003Tiny Tanox Inc. should be on the verge of triumph. A drug it developed made headlines this week when it was shown to blunt peanut allergies, protecting people who could die after eating even part of a peanut. But the drug is at the center of one of the toughest disputes in biotechnology, a decade-long battle with charges of stolen trade secrets and secret deals. The fight may delay the drug's introduction, and the company — and the husband-and-wife scientists who started it — may receive only a small share of the financial benefits. Tanox, which is based in Houston, is part of a partnership with two bigger drug companies, Genentech and Novartis. For 10 years, Tanox has been involved in lawsuits and arbitrations with one or both partners, starting with its accusation that Genentech, the biotechnology industry's pioneer company, essentially stole Tanox's idea. Tanox has also been involved in litigation with its own lawyers over an agreement that would allow the lawyers to obtain a substantial portion of the Tanox proceeds from its partnership. The drug was developed by a husband and wife team who worked on it in their garage. They subsequently divorced, but that isn't the source of the litigation. Everyone involved seems to have done some double-crossing at one point or another. And everyone, of course, wants the greatest share of the profits. How many drugs do you suppose are kept off the shelves in this country because of litigation? It would be interesting to find out. posted by Sydney on 3/14/2003 08:07:00 AM 0 comments
The procedure works by looking for characteristic genetic changes that often lead to the most common kind of colon cancer. These occur in a gene called IGF2, which produces an insulin-like growth factor, and are one of the first genetic changes seen in 40 per cent of colon tumours. In the study, Professor Feinberg’s team examined blood samples from patients who had had a colonoscopy, who had had colon cancer, who had pre-cancerous polyps, or who had a family history of colon cancer. They found that a change to the IGF2 gene, known as loss of imprinting (LOI), was much more frequent in high-risk patients than in the general population. People with a family history of colon cancer were five times as likely to have LOI markers in their blood. Those who had polyps were three and a half times more likely to have LOI markers, and those who had had colon cancer were 22 times more likely. If it pans out, this is great news. We could use it to focus our colonscopies (expensive and uncomfortable) on those who test positive, rather than screening everyone. That is, if the blood test turns out to be specific enough for the disease to be a good screening test. posted by Sydney on 3/14/2003 07:56:00 AM 0 comments
The F.D.A., which regulates drug makers, not hospitals, will order the pharmaceutical companies to come up with codes identifying each drug and dosage. Whether lot numbers and expiration dates will be included is still under consideration. The Food and Drug Administration estimated that it would cost pharmaceutical companies $50 million to put bar codes on every product and that hospitals would spend over $7 billion on scanners and computers. Surprisingly, no one’s complaining about the costs. Not the drug companies. Not the hospitals. Expect drug costs to go up. And hospital charges, too. Or more staff layoffs. posted by Sydney on 3/14/2003 07:51:00 AM 0 comments
On Jesica Santillan's surgeon: It is true that Jesica Santillan's death is a horrid tragedy due to human error ("A Tragic Error", March 3). But I take issue with your statement that the tragedy was "touched off by one careless moment in the life of an exemplary surgeon." As a nurse, I know that simply giving a unit of blood to a patient requires several signatures by personnel checking and rechecking the type and cross-match information before the blood can be given. Dr. James Jaggers was part of a large team, all of whom had the responsibility of checking the blood types. In addition, the New England Organ Bank and the Carolina Donor Services program also had the responsibility of qualifying the match. That Dr. Jaggers took full responsibility for the entire team and everyone involved speaks of his integrity. Good point, and one that will continue to be lost, for it will be Dr. Jaggers alone who will be hung out to dry at the malpractice trial. posted by Sydney on 3/14/2003 07:50:00 AM 0 comments
Celebrity Medical Watch: Pregnancy and motherhood in all their gory details, made all the gorier in the context of the D'Angelo and Pacino breakup: "I'm absolutely heartbroken and devastated that my children have been abandoned by their father," D'Angelo told the New York Post. Pacino, 62, wanted children, and the 49-year-old actress went through a life-threatening pregnancy, swelled to 215 pounds and almost lost one of the babies after giving birth. Even before the breakup, D'Angelo says, Pacino was an indifferent father. He's never changed a diaper, according to one friend, and will deal with D'Angelo only through a lawyer or his psychiatrist. His psychiatrist? Meanwhile, in the real world, Christopher Reeve savors the small pleasures the rest of us take for granted thanks to an experimental procedure that allows him to breathe without a respirator for brief moments: After the electrodes were implanted in his diaphragm and the respirator was turned off, "all you could hear was me breathing through my nose - regular rhythmic breathing from my nose for the first time in nearly eight years," Reeve said Thursday. ....The actor also has his sense of smell when the respirator is off. During one of those sessions, his medical team brought coffee, oranges and other test objects into his room. "I actually woke up and smelled the coffee," he said. Reeve is hearing his own breath and smelling oranges thanks to an electrodes placed on his diaphragm: The operation, called diaphragm pacing via laparoscopy, involves threading tiny wires through small incisions in the diaphragm. The wires connect the electrodes to a control box worn outside the body. The control box sends a signal to the electrodes 12 times a minute, causing the diaphragm to contract and air to be sucked into the lungs. When the nerve is unstimulated, the diaphragm relaxes and the air is expelled. That Christopher Reeve, he’s a living medical tour de force. posted by Sydney on 3/14/2003 07:48:00 AM 0 comments
Thursday, March 13, 2003DB rants about Medicare, while his readers rant about Tricare (the health insurance program for the men and women in the military and their dependents.) It’s really disheartening to know that Tricare is funded at even lower levels than Medicare or Medicaid. Don’t our men and women in uniform deserve better than that? GruntDoc notes a case of a woman who actually had her “do not resuscitate" orders tattoed on her chest, and Dr. Bradley has some observations on the space shuttle recovery team members whom he’s been treating lately in the ER. And on the nursing front, Alwin notes that there’s been an outbreak of atypical pneumonias in Asia, possibly harbringers of a more virulent flu strain to come. (Yeah, I know. I’m being lazy, but I’ve been on call for four of the past five nights, and I’m tired.) UPDATE: Alwin Hawkins has a picture of the DNR tattoo. posted by Sydney on 3/13/2003 08:56:00 PM 0 comments
Three of the largest health-maintenance organizations devoted to serving Medicaid recipients in Michigan lost a collective $25.5 million in 2002, according to year-end financial documents filed with state regulators. That’s a distinct contrast to the rest of the state’s HMO’s: As a group, the state's 30 reporting HMOs reported net income of $64.3 million for 2002, more than double the $30.7 million they earned collectively in 2001. I don’t know how they run things in Michigan, but here in Ohio the Medicaid HMO’s are much less restrictive than private HMO’s. The state requires them to be. Mustn’t be perceived as discriminating against anyone, or denying anyone care. This, coupled with low payments from the state, makes them a no-win proposition. posted by Sydney on 3/13/2003 08:08:00 PM 0 comments
The U.S. House of Representatives today approved the Help Efficient, Accessible, Low Cost, Timely Health Care (HEALTH) Act of 2003 by a vote of 229 to 196. On to the Senate! posted by Sydney on 3/13/2003 07:12:00 PM 0 comments
In the Baghdad prison known as The Palace of the End, in the first years of Saddam Hussein’s reign, his torturers sometimes used a crude but effective biological weapon. They'd take an inmate with tuberculosis, who was coughing blood, and force him to spit into the mouths of others. Not all prisoners caught the disease, but all were infected with the terror. Even without the tuberculosis, it would be equally disgusting. posted by Sydney on 3/13/2003 07:07:00 PM 0 comments
The job of the hippocampus appears to be to "encode" experiences so they can be stored as long-term memories elsewhere in the brain. "If you lose your hippocampus you only lose the ability to store new memories," says Berger. That offers a relatively simple and safe way to test the device; if someone with the prosthesis regains the ability to store new memories, then it's safe to assume it works. But, as the article points out later, what if the chip makes memories more vivid, or even worse, unforgettable? Repression is an important coping device. Stripped of the ability to forget horrible experiences, a man could really lose his mind. (thanks to Ross for the tip.) posted by Sydney on 3/13/2003 06:36:00 PM 0 comments
posted by Sydney on 3/13/2003 06:34:00 PM 0 comments
Wednesday, March 12, 2003posted by Sydney on 3/12/2003 08:38:00 AM 0 comments
posted by Sydney on 3/12/2003 08:31:00 AM 0 comments
Doctors with the International Society of Hypertension in Blacks say doctors should start black patients on two drugs rather than one, and push exercise, weight loss and a diet rich in fruits, vegetables and fiber. ...According to the new guidelines, physicians should also encourage the so-called DASH diet - for Dietary Approaches to Stop Hypertension. It emphasizes fruits, vegetables, fiber and low-fat dairy food. It also calls for more poultry, less red meat, and minimal salt. The same steps are usually recommended for all patients, regardless of ethnic group, who have diabetes in addition to high blood pressure, or who don't respond to less aggressive measures. Physicians should also set out to lower blood pressure to 130 over 80 milligrams of mercury, a more ambitious goal than that set for other patients. At first glance, it seems that the group is recommending over-agressive approach in all individuals to improve the mean. But, the actual guidelines are more nuanced. It doesn’t recommend starting all hypertensive black patients on two medications right off, just those with very high blood pressure or with other risk factors: First, we recommend lower blood pressure goals for patients with diabetes or with nondiabetic renal disease accompanied by proteinuria characterized by more than 1 g/d (<130/80 mm Hg). Second, we recommend the use of combination therapy as first-line therapy for patients with an SBP [systolic blood pressure, i.e. the top number -ed.] of 15 mm Hg or more or a DBP [diastolic blood pressure, i.e. the lower number - ed.] of 10 mm Hg or more above target blood pressure. It’s true that as a group, African-Americans suffer more from the complications of hypertension - kidney disease, heart disease, and strokes. But, the reason for those higher rates isn’t crystal clear. Is there some genetic difference that makes high blood pressure more deadly or harder to treat? Or is it because of issues that transcend race, such as poverty, poorer access to healthcare and to medicines, and lower education levels, all of which are associated with poorer compliance with medical regimens? If the former, then this approach will be beneficial. If the latter, then it really won’t do much to improve the situation. UPDATE: A reader sent this observation: About three years ago, I read an article that said the high-blood pressure in blacks was due to genetics. During the voyage from Africa to the US. the slaves were not given enough water. So only the slaves which had high salt retention would survive. The rest would perish. High salt retention causes high blood pressure. Right? The recent test on high blood pressure medicines showed that the durietics worked best on blacks. I thought that reinforced the slave ship theory. Hmmm. Interesting theory. But, I'm dubious. Do blacks in Africa have lower blood pressures than American blacks? (Or at least do prosperous, healthy, well-fed African blacks have lower blood pressures than American blacks?.) Besides, today's African-Americans aren't the genetically pure Africans that crossed the ocean so long ago. There's been a whole lot of gene pooling since then. They're as much a part of the melting pot that is America as the rest of us. But, it does raise an interesting point. There probably are genes that are at least partially responsible for high blood pressure. If we could identify those genes, we could aim aggressive treatment at those who possess them. That would be far more accurate than basing treatment on skin color. posted by Sydney on 3/12/2003 08:27:00 AM 0 comments
posted by Sydney on 3/12/2003 07:46:00 AM 0 comments
Some of the nation's leading medical schools have abandoned a little-known, decades-old practice of letting students perform pelvic exams on women without their consent while they are under anesthesia. We learned to do pelvic exams on conscious women who volunteered. Hard to believe someone would volunteer for something like that. Actually, I'm wrong. They weren't really volunteers. They were paid instructors, and they talked us through the exam as we did it. It may seem a little strange, but it was an extremely effective way to learn the exam, much better than an e-pelvis would be. And the men in our class were forced to get in the stirrups so they would know what it feels like. posted by Sydney on 3/12/2003 07:45:00 AM 0 comments
Conventional mammography projects X-rays through the breast onto a sheet of photographic film or detector screen. Tumours, being more dense than most healthy tissues, show up as a shadow on the exposed film or screen. This detects only 65-70% of breast cancers - small tumours can be obscured by other breast structures. Moreover, only 10-20% of women who have a biopsy turn out to have cancer, as overlapping images of healthy bits of tissue can sometimes look like a possible tumour. Instead of keeping the X-ray source stationary, Eberhard's team scans the breast in an arc and collects a sequence of 10 to 20 images in a digital detector. They then use a computer to turn these images into a series of 2-D cross-sections. In this way they build up a much sharper and more detailed picture of the breast tissue. Anything that adds to the clarity of mammograms is a welcome development. posted by Sydney on 3/12/2003 07:44:00 AM 0 comments
Tuesday, March 11, 2003posted by Sydney on 3/11/2003 08:26:00 PM 0 comments
Late last year, Dr. Shay published his second book, "Odysseus in America," about the spiritual and psychic pitfalls that await combat veterans returning to civilian life. His first book, "Achilles in Vietnam," published in 1994, compared the experiences of soldiers in the Trojan and Vietnam Wars to argue that war's psychic wounds — what is now called post-traumatic stress disorder — have always existed. Those spiritual injuries, Dr. Shay wrote, didn't arise just from bad luck in combat. They were the consequences of soldiers' feeling mistreated by their own commanders. Grunts who didn't feel cared for by the officers felt what Achilles felt against Agamemnon in the epic. I like his explanation of the neurology of psychology: Whether the military experience is told in terms of brain chemicals like cortisol and dopamine, military concepts like cohesion and morale, or universal human feelings like trust or love, Dr. Shay says: "These are different refractions of the same beam of light. So there's no dissonance for me going from one language to another." Even the meaning of psychoactive drugs, Dr. Shay says, is multiple. When he prescribes the class of antidepressants known as selective serotonin reuptake inhibitors, he hopes for more than a change in brain chemistry, as the drug alters the balance of serotonin in the patient's brain. The effect is also a psychological experience, as the veteran feels less prone to rages. And it is a social experience, as well. "Social recognition has a physiological impact, and an S.S.R.I. triggers some of the same mechanisms as that social experience," he said. "Though I know enough about the nervous system to know that any drug we have is a crude simulacrum." Like many scientists who cross disciplines, Dr. Shay keeps it all together with a unified, and controversial, theory. He believes that trust-destroying trauma has a single biology and a single psychology, whether it arises from political torture, prostitution, domestic violence or combat. He has no use for particularists who want to keep separate accounts for the pain of Holocaust victims, soldiers and abused women. The experience of trauma is unique to each sufferer. Meanwhile, its biology is common to all. So comparing one group's pain to another, Dr. Shay argues, is pointless. posted by Sydney on 3/11/2003 08:13:00 PM 0 comments
One other interesting article on the same issue, found that children with eczema and peanut allergies had a greater likelihood of having been treated with skin lotions containing peanut oil as infants. (yet another PDF) The new drug has its drawbacks. It requires monthly injections, and it doesn't give a person free license to eat peanuts. But, it does seem to provide protection against potentially deadly accidental peanut ingestions, which are difficult to avoid no matter how vigilant one is. posted by Sydney on 3/11/2003 08:59:00 AM 0 comments
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posted by Sydney on 3/11/2003 08:28:00 AM 0 comments
Monday, March 10, 2003posted by Sydney on 3/10/2003 08:27:00 AM 0 comments
In personal interviews, the researchers also asked study participants about their television viewing habits. They found that among white adults, frequent fast food meals and hours spent watching TV combined to increase the odds of obesity and abnormal glucose metabolism. Whites who watched TV more than three hours a week and ate fast food more than twice a week were three times as likely to have abnormal glucose metabolism than those who watched less than an hour of TV per week or ate fast food less than once a week. Does this mean that the fast-food litigators will go after the even richer entertainment industry? Wouldn't be surprising. posted by Sydney on 3/10/2003 08:04:00 AM 0 comments
Three products are being investigated for possible large-scale military use. One is a dressing developed by the Red Cross over several decades. Another is a granular material called Quick Clot that can be poured into wounds. The third, which may hold the most promise, is a hemostatic bandage approved in November by the Food and Drug Administration only 18 months after discovery. The bandage is made of shrimp cells and was developed by an Oregon institution that is mainly devoted to lasers. The bandages could have important application to civilian life, too. Imagine if policemen, firemen, and EMT's carried hemorrhage-stopping bandages. It could mean the difference between life and death for some accident victims. posted by Sydney on 3/10/2003 07:55:00 AM 0 comments
Having done trial procedures with cadavers, Butler estimates that the harvesting or ''degloving'' of a face would take approximately two hours, depending on the depth of the excision. It is possible to remove not just skin and subcutaneous fat and muscle but, in the instance of those recipients who have lost some of their skeletal structure, part of the donor's bone and cartilage as well. Still, the deeper the cut, the more complex becomes the reattachment. Once into the sublayers of musculature and bone, there is an increased risk of both rejection and infection, and the problem of having to fuse the donor's facial nerves with those of the recipient, whose face would have already been removed. That, however, does not guarantee the proper synaptic relays between the nerves and could result in what is known as dyskinesia, an internal misfiring of nerve signals that could leave patients twitching uncontrollably or smiling when they mean to frown. For these reasons, Butler is hoping to limit initial attempts to the so-called skin envelope, a subtle bit of sculpturing and resurfacing in and of itself. Once removed from a donor, a face, much like a heart, can survive without adequate blood supply for only a matter of hours before it begins to suffer tissue damage. With the recipient's scar tissue removed and the essential arteries and veins exposed, surgeons would attach them to the corresponding arteries and veins in the harvested face in order to supply both nourishment and drainage. Experiments conducted thus far with animals have shown great success with revascularization of the facial organ. Should a human recipient's subsequent immunosuppression therapy prove successful, they would then face months, even years, of painful healing and physical therapy just to achieve minimal function. But the biggest obstacle may be finding donors: Butler told me of a psychological survey that he conducted of 120 people at his own hospital, one-third of them doctors, one-third nurses and one-third laypeople. The majority answered that they would accept someone else's face if they required one. No one, however, not even his closest colleagues, said they would donate their own. Beauty may only be skin deep, but out attachment to our faces is evidently much deeper. posted by Sydney on 3/10/2003 07:42:00 AM 0 comments
They’ve also updated their physician webpage to include physician registration for email updates on bioterror preparedness, and how to tell if a smallpox vaccine has taken hold in both first time and repeat recipients. Lots of good information there. And what a relief to see them finally taking steps to include those most likely to be involved in a smallpox attack. posted by Sydney on 3/10/2003 07:32:00 AM 0 comments
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