COMMENTARY: Link between HRT and breast cancer rates?

After reading this news article about research touting a link between hormone-replacement therapy and increased breast cancer rates, I can't help but doubt the veracity of this study (not uncommon with research studies. Always read with caution.) Before jumping on the blame-HRT bandwagon, why don't the researchers account for the possibility that the severe menopause symptoms could be linked to the increased risk and rates of breast cancer? This, rather than HRT being the cause of the cancer? The two issues - severe menopause symptoms and breast cancer rates - may not have separate factors.

LOCAL HEALTH NEWS: Jefferson Offers Free Screenings For Prostate Cancer

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

09/17/2008

Philadelphia - Philadelphia area residents can get free prostate cancer screenings today at the Bodine Center for Cancer Treatment at 111 South 11th Street at Thomas Jefferson University Hospital. The service will be provided between 9 a.m. and 3 p.m. to all men who come and request it.

The free screenings are part of a research program and include a rectal exam as well as a blood test for levels of prostate specific antigen (PSA), testosterone and cholesterol.

"The blood test right now should be done once a year over the age of 50," recommended Dr. Leonard Gomella, chairman of the department of urology at Thomas Jefferson University's Kimmel Cancer Center.

Prostate cancer is the most common non-skin cancer in the United States, affecting one in six American men. It is the second-leading cancer killer, after lung tumors, among men.

Screening is generally recommended for men aged 40 to 75, and beginning at age 35 if there is family history of prostate cancer or you are of African American or Hispanic background.

The benefits of screening for older men above age 75 has been questioned in recent studies, but discussing your options and risks with your doctor is still best, said Dr. Gomella. "More men die with prostate cancer than of prostate cancer."

Although the government does not endorse PSA screenings and there is currently no cure for the disease, discovering the cancer earlier allows for possible treatment of symptoms and monitoring for continued progression.

The American Cancer Society notes that the year 2007 saw 218,890 men diagnosed in the U.S. and about 27,050 deaths. Worldwide, approximately 780,000 men are diagnosed with it each year, 250,000 of whom die.

The event is in its 19th year and is sponsored by Jefferson's Kimmel Cancer Center and the Foundation for Breast and Prostate Health. The month of September is the country's newly designated Prostate Cancer Awareness Month.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

MEDICAL NEWS: New Pathways Between Memory Loss, Alzheimer's

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/22/2008

Mild cognitive impairment (MCI) is a stage between normal aging and Alzheimer's earliest stages. Understanding how it goes from mild thought problems to dementia could be key to figuring out how to prevent Alzheimer's. The following details of some of the latest research can give you an idea of the importance of aiming early.


Understanding Risk Factors

According to a Mayo Clinic report, the MCI rate increases with age and is higher in men, who are almost twice as likely to develop the condition than women. Although previous studies show women at higher risk of dementia and Alzheimer's, women generally outlive men, perhaps surviving long enough for their conditions to progress.

According to Dr. B. Brent Simmons, assistant professor and head of Temple University Hospital's Senior Care Specialists section of geriatrics, the higher rates of heart disease in men might also affect their chances of getting vascular dementia.

This study collected data from 1,786 people aged 70 to 89 and found that after a year, about 3.5 percent of 70- to 79-year-olds and 7.2 percent of 80- to 89-year-olds become afflicted with it. Overall, the growth rate of new MCI cases in the elderly population is at 5 percent per year - higher than anticipated.


Drug Development

In research by New York's Mt. Sinai School of Medicine, the brains of 124 diabetics taking medication (insulin and other glucose-lowering drugs) had up to 80 percent less beta-amyloid plaque compared to other diabetics and 124 non-diabetics. Beta-amyloid protein clumps in and around the brain, forming plaque that inhibits and destroys neurons necessary for daily functions and memory.

However, even if a combination of insulin and oral anti-diabetes medications may prevent Alzheimer's-related factors, they cannot be prescribed for non-diabetics. Hopefully, though, brain pathways such as insulin signaling could be used in developing new treatment methods.

Besides plaque, Alzheimer's indicators include unusual changes to a protein called tau. A yearlong trial at Duke University Medical Center tested a promising new drug - a nasal spray called AL-108 - on 144 patients with MCI, between ages 55 and 85, and saw a 62.4 percent improvement in memory ability.

Patients took several tests that measured memory ability before and after medication. The tests measured short-term visual, verbal and auditory working memory, functions that deteriorate throughout the progression of Alzheimer's.

Although this drug doesn't cure Alzheimer's, it showed that attacking the protein tangles does work, stabilizing some of the progress of dementia.


Getting It Before It Starts

Instead of just treating symptoms, researchers at the University of Pennsylvania School of Medicine are trying to stop it before it starts, by finding chemical and biological markers of these conditions.

Since Alzheimer's is a disease measured by analyzing symptoms, the goal of the first investigation was, according to its lead researcher, Dr. Leslie Shaw, "to determine if we could detect Alzheimer's disease pathology before a patient went on to have full blown dementia and memory disorders."

The research focused on measuring levels of cerebral spinal fluid (CSF) and establishing benchmark concentration levels of biological indicators for normal, mildly cognitively impaired, and Alzheimer's individuals.

The differences between the baseline levels of three Alzheimer's-associated proteins were significant enough to speed up drug development efforts of biological compounds that can fix these differences.

The second Penn study uses MRI scans to detect abnormal structural changes linked to MCI in the brains of healthy elderly. Radiology professor Christos Davatzikos, Ph.D. and his colleagues monitored these slight physical changes to the brain successfully might provide a way to alert patients and doctors to brain deterioration and memory decline early enough to prepare or begin treatment.

With around 18 percent of 400 patients converting to Alzheimer's a year, this study is ongoing, and doctors are able to "study the progression as it's happening ... at a rate large enough to make our tests reliable or not with sufficiently large number of study subjects," said Dr. Shaw, who is also the director of Penn's ADNI Biomarker Core Lab.

Collaboration is key for all involved, and as Dr. Shaw noted, "the earlier we can detect the disease reliably with confidence, the earlier we can institute and monitor treatment such as diet, exercise, adjusted sleep patterns and having a social life, along with doctor visits, to delay and stop the disease."

The MRI-based study used images from the Baltimore Longitudinal Study of Aging (BLSA) and the Alzheimer's Disease Neuroimaging Initiative (ADNI) and was funded by the National Institute on Aging and the Institute for the Study of Aging.

Dr. Shaw's research was funded by the Alzheimer's Disease Neuroimaging Initiative via the National Institutes of Health.


Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

HEALTH NEWS: NJ Launches Campaign Against Medicine Abuse

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/21/2008

The Partnership for a Drug-Free New Jersey (PDFNJ) announced Monday a statewide public service campaign titled "Grandma's Stash," to raise awareness that misuse of prescription drugs is second only to marijuana as America's most prevalent drug problem.

The award-winning multi-media effort will utilize newspapers, radio stations, billboards, buses and trains to spread the message that "more teens now say it's easier to get powerful prescription drugs than it is to buy beer," as Department of Human Services Commissioner Jennifer Velez said at the press conference in Lawrenceville.

Her assertion is based on findings from the National Center on Addiction and Substance Abuse (CASA) at Columbia University's 13th annual back-to-school survey of 1,002 teens and parents. The survey asked: "Which is easiest for someone your age to buy: cigarettes, beer, marijuana, or prescription drugs such as Oxycontin, Percocet, Vicodin or Ritalin, without a prescription?"

While the overall response had teens saying cigarettes and marijuana were easiest to purchase, they also said prescription drugs were easier to get than beer. Nineteen percent of teens, compared to 13 percent a year ago, found prescription drugs are easier to get than all three of the other substances.

Over 720 New Jersey pharmacies will also distribute around 750,000 prevention messages on pharmacy bags. "[This initiative is a] great example of a public-private-nonprofit collaboration that can positively impact the lives of hundreds of thousands of New Jersey families," said Joseph Roney, R. Ph. FACP/CEO, of the New Jersey Pharmacist Association in a PDFNJ press release.

Columbia's 2008 CASA survey report also noted that many of the parents surveyed are "problem parents" whose actions - or lack thereof - increased the abuse of illegal and prescription drugs among 12- to 17-year-olds. Thirty-four percent of teens surveyed who abused prescription drugs obtained them at home, and half of those allowed out after 10 p.m. said they spent time with smokers and drug users.

There are lots of factors at play here," Elizabeth Planet, CASA's director of special projects, said to the Washington Post of the behavior differences revealed in the study. "Parents are not paying attention. There are parents who are out in the evening themselves. There are parents out at work."

"In the 2007 New Jersey Middle School Principals Study, half of the principals surveyed indicated that they believed prescription drugs were abused more than twice that of ecstasy and cocaine by their students," Joseph A. Miele, PDFNJ chairman, said at the press conference. "[Yet] the 2007 PDFNJ Parent Tracking Survey found that 44 percent of New Jersey parents of middle school students said they knew little or just about nothing about prescription drug abuse."

It is also necessary for kids to understand the risks involved with misusing prescription drugs.

"Kids [may] think that because these are medicines that are prescribed, they are safe," said Nora Volkow, director of the National Institute on Drug Abuse. "The problem is that there is very little difference between the amount they take for a high and the amount that causes an overdose."

So keeping the lines of communication open and the medicine cabinet closed is incredibly important, she said.

Joseph Califano, CASA chairman and president, told the Post he recommends more than three family dinners a week, while Steve Pasierb, president of Partnership for a Drug-Free America suggested to WebMD that parents engage in "a lot of smaller conversations that aren't so scary" compared to a big, intimidating talk.

The "Grandma's Stash" campaign also commemorates August as National Medicine Abuse Awareness Month, a designation passed this July by the U.S. Senate in light of a recent Substance Abuse and Mental Health Services Administration report about the increasing rates of prescription drug abuse.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

HEALTH NEWS: Returning Veterans At Higher Risk For Alcoholism And Stress Disorder

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/15/2008

New research supports ongoing observations that military deployment into combat zones puts young men and women at greater risk of developing mental health issues, including post-traumatic-stress-disorder (PTSD) and heavy drinking.

The two studies were presented in a themed issue on violence and human rights by the Journal of the American Medical Association, as was a study that found suicide rates for returning combat veterans were no higher than rates for the general U.S. population.

In the study on alcohol abuse, returning service members who had seen combat were 63 percent more likely to experience new-onset heavy and binge drinking than those who were in non-combat areas.

The rates for new-onset heavy weekly drinking was 8.8 percent, with it being 25.6 percent for binge drinking, and 7.1 percent for other alcohol-related problems.

Binge drinking rates were 31 percent higher for combat veterans than for those not exposed to the same level of violence.

The results also showed a higher risk for younger service members compared to older personnel, and a higher incidence rate for Reserve or National Guard members compared to members in other military branches.

Surveys were taken of 48,400 military personnel before and after assumed deployment (between 2001-2003 and again in 2004-2006), setting a pre-deployment precedent for drinking levels and alcohol-related issues. Only 5,500 were actually deployed into combat zones, with 5,661 deployed into non-combat areas. The rest remained on active duty in the Reserve or National Guard.

The researchers suggested in their report that alcohol use likely serves as a coping mechanism for returning soldiers, as it does for individuals in the general populace. To combat this unhealthy response, the building and provision of familiar and stable support networks of trusted family, friends or fellow veterans is best - anywhere that doesn't involve meeting at a bar.

A separate study on excess alcohol intake lists additional dangers as including a greater chance of developing metabolic syndrome, which includes obesity, high blood pressure and diabetes.

This study by the CDC's National Center for Chronic Disease Prevention and Health Promotion defines excess drinking as more than two drinks daily for men and one drink a day for women, as well as binge drinking.

In the U.S., 58 percent of drinkers fall into this "excess" category and a majority had engaged in at least one instance of binge drinking, according to a recent survey cited by the researchers in their report.

Researchers suggest that public health messages emphasize the cardiometabolic risk of excess drinking. This study will be published in the Journal of Clinical Endocrinology & Metabolism.


Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

HEALTH NEWS: Study: Breast Cancer Survivors Still At Risk

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/14/2008

New research from a 16-year study indicates that early-stage breast cancer patients who have completed five to 10 years of drug and/or chemotherapy treatment have a one in five - around 20 percent - chance of relapse.

Between 1985 and 2001, oncologists/researchers at the University of Texas' M.D. Anderson Cancer Center examined 2,838 patients with stage I to III breast cancers who had been treated at the center. All were cancer-free five years after initial treatment with surgery or surgery and radiation.

All of the women underwent up to five years of additional treatments with chemotherapy, the anti-estrogen drug tamoxifen or both. After a 28-month follow-up, 215 women developed recurrent cancer.

This incidence rate put the risk at 7 percent for women with stage I breast cancer, 11 percent for stage II, and 13 percent for women with stage III cancer. This relapse rate increased to 20 percent 15 years after first being diagnosed.

"The risk of relapse was still small, but certainly not insignificant," Abenaa M. Brewster, M.D., an oncologist and researcher with M.D. Anderson Cancer Center told WebMD. "I think these numbers are somewhat reassuring, but they also highlight the need for new [therapeutic] options for women who have completed five years of treatment."

Factors associated with the risk of recurrence were tumor grade, hormone receptor status and endocrine therapy.

Forms of treatment available to newly diagnosed patients usually include surgery and radiation therapy (chemotherapy) or surgery and drug therapy.

Up until the year 2000, drug treatment consisted of tamoxifen for both premenopausal and postmenopausal women with estrogen-receptor positive tumors (they respond to hormone treatments). Today, a newer class of drugs called aromatase inhibitors are used.

In the study, 34 ER-negative women had a relapse and 149 ER-positive women did. The study and results were published Tuesday in the online edition of the Journal of the National Cancer Institute.

Estrogen-receptor (ER) negative tumors are considered more deadly than ER-positive ones. However, "women who had ER-positive cancer were more likely to have late recurrences than those with ER-negative," according to Len Lichtenfeld, M.D., the American Cancer Society deputy chief medical officer in healthday.com.

However, what to do about this continued risk is up in the air, Dr. Lichtenfeld said.

A possible treatment alternative is in the works by British and Finnish researchers, who are testing a combination of two inexpensive, commonly used and easily available drugs on killing cancer-cells in tumors.

The first drug is doxorubicin, a common chemotherapy-regimen drug, followed 24 hours later by the osteoporosis medication zoledronic acid. When tested on mice, the drug combo was 99.99 percent effective in killing such cells. Human trials are currently underway with results expected later this year.

This announcement was also made in the Journal of the National Cancer Institute.

Each year in the U.S., around 180,000 women are diagnosed with breast cancer. In the U.K., almost 46,000 new cases are diagnosed every year.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

HEALTH NEWS: Diabetes Before Pregnancy Linked To Birth Risk

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/13/2008

A study from the U.S. Centers for Disease Control and Prevention (CDC) reported that women with diabetes prior to becoming pregnant are eight times more likely to have children with multiple birth defects compared to women without diabetes.

The study found also that women with diabetes are three to four times more likely to give birth to a baby with at least one birth defect.

Women with pregnancy-induced diabetes, or gestational diabetes, were also found more likely to have a child with a birth defect, although usually only if they were overweight or obese at conception. This range would mean a body mass index (BMI) - weight measured in proportion to height - of 25 or higher.

The study expanded on previous research by examining women with type 1 and type 2 diabetes as well as gestational diabetes, and considering both cardiac and non-cardiac defects, nearly 40 in all.

Only 2 percent of babies with single birth defects and 5 percent with multiple defects were born to mothers with pre-pregnancy diabetes, while 93 percent of the birth defects examined were not associated with maternal diabetes.

Overall, diabetes diagnosed before pregnancy was linked with about half of the birth defect categories examined.

Birth defects may include heart problems, brain and spinal defects, oral clefts, limb deficiencies, and kidney and gastrointestinal tract defects. These affect 1-in-33 infants and are a leading cause of infant death, according to the CDC. Most causes are unknown.

The findings were based on data analyzed from over 13,000 infants with birth defects and nearly 5,000 without defects, all born between 1997 and 2003. Of those without defects, 24 mothers had diabetes before diabetes. Of those newborns with defects, 283 mothers had pre-pregnancy diabetes.

All children were part of the National Birth Defects Prevention Study, which drew data from 10 birth-defect surveillance systems in 10 states.

However, according to Janis Biermann, a spokeswoman for the March of Dimes which reviewed the study for WebMD, women shouldnotbe unduly concerned.

"Just because there is an increased risk of a baby having a birth defect if a woman has preconception diabetes doesn't mean it is going to happen," she said, "It just means there is a greater chance than if a woman doesn't have it."

The study is the largest yet done to identify the range of birth defects linked to pre-pregnancy diagnoses of diabetes, but the link itself has been known for almost two decades. Researchers hope that increased awareness will encourage people to seek the best available everyday preconception care.

"Early and effective management of diabetes for pregnant women is critical in helping to not only prevent birth defects, but also to reduce the risk for other health complications for them and their children," said lead author Dr. Adolfo Correa, an epidemiologist at the CDC's National Center on Birth Defects and Developmental Disabilities, in a news release.

According to the March of Dimes, about 1.85 million U.S. women of childbearing age have diabetes.

"The most important thing is that the patient ... get [her diabetes] in control," said Dr. Louis Weinstein, M.D., professor and chairman of OBGYN at Thomas Jefferson University.

In an urban area such as Philadelphia, "we tend to see more diabetes than in other parts of the country because we have lower socioeconomic populations with higher BMI [levels] than elsewhere," Dr. Weinstein added.

"It's important to take care of yourself, exercise, be at an optimal weight, plan your pregnancy, and make sure the diabetes is well controlled before you get pregnant," Ms. Biermann, from the March of Dimes, said to WebMD.

Once pregnant, Ms. Biermann notes the importance of following the same healthy habits and having regular prenatal care, along with regular appointments with a diabetes specialist for those diagnosed.

The report was published this month in the American Journal of Obstetrics & Gynecology.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

HEALTH: Study: Americans Drinking Less Alcohol, More Wine

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/12/2008

Americans may drink more in one sitting than some Europeans (who drink steadily in small amounts), but their average overall alcohol intake has decreased across age and gender differences, according to a study published last week in the American Journal of Medicine.

The results from a 55-year study (1948-2003) on 8,600 white adults in Framingham, Mass., found Americans drink less as they get older, and they tend to gravitate away from beer and toward wine in the process. Each successive generation also showed a trend from heavier drinking toward moderate drinking.

All participants were initially at least 28 years old and were born between 1900 and 1959.
The average amount of alcohol intake was highest between ages 30 and 50 for most cohorts, regardless of gender.

Up to their mid-30s, young men relied on beer for at least half of their alcohol consumption. After that, beer consumption dropped to around one-quarter of the average male in his mid-70s.

While both men and women in each generation drank less with age and each generation drank less than the generation before it, the overall incidence rate of an alcohol use disorder among those aged 40 to 79 years was about three times higher among men (12.8 percent) than women (3.8 percent).

Female participants also showed a move from beer to wine over time, although the report's authors noted that they were less partial to beer to begin with. No significant alcohol-related problems were linked with women here, but a report by University of Washington researchers in the May issue of Alcoholism: Clinical and Experimental Research found that women born after 1953 had rising rates of alcoholism.

Lead author Yuqing Zhang, D.Sc., of the Boston University School of Medicine, told WebMD he doesn't know why the rates of alcohol use dropped over generations and this study "did not try to answer these questions."

The long-term health study collected data by asking participants to answer questions about their lifestyle and health, including alcohol consumption over time. Researchers hoped that the data would help determine patterns of alcohol use and disorders according to sex, age and birth cohorts.

The study, supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (part of the National Institutes of Health), is not clearly representative of all U.S. adults, but researchers said the data supports the efficacy of efforts to reduce alcohol use disorders.

Researchers also hope the data may be useful for policy-making groups responsible for drinking and alcohol recommendations, continuing "to support potentially beneficial effects of moderate drinking on cardiovascular disease and other diseases of aging, as well as adverse health and social effects of heavy alcohol use."

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

MEDICINE: Aetna-Wharton To Test Paying Patients To Take Their Heart Meds

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/11/2008

Researchers at the University of Pennsylvania's Wharton School are studying whether daily lottery cash incentives of $10 and $100 will help improve the likelihood of patients' taking their prescribed medication.

The research will begin this fall and take place over a six-month period, with results being available in March of next year.

The Aetna Foundation, the non-profit arm of the national health insurer, is sponsoring the study with a $400,000 grant. Philadelphia is a designated community under the foundation's Healthy Community Grants Program and Healthy Community Outreach Program.

Dr. Kevin G. Volpp, director of the Center on Health Incentives at Wharton's Leonard Davis Institute for Health Economics, explained that since people often stop taking medication within a few days, potential health benefits cannot be realized.

"People find it difficult to do things long term [like taking medication] in the short term [on a daily basis]," Dr. Volpp said. "A lot of behavioral economic research shows that people tend to weigh the present more heavily as opposed to [a] future decision."

So he and colleagues designed a two-arm randomized trial based on a system of feedback and incentives and proposed it to Aetna. The trial would enroll 100 participants to test a daily lottery as incentive for taking Warfarin, a blood thinner prescribed to prevent swelling and blood clots.

An electronic monitor would connect to pill boxes, tracking whether each participant takes his or her medicine. Participants would receive daily text messages saying whether he or she has won the lottery, or, if the dose was missed, whether they would have won.

An incentive group of 50 people would have a 1-in-10 chance of winning $10 for every day they take their medication and a 1-in-100 chance of winning $100. A control group of 50 people would use the same electronic monitor but not be entered into the lottery.

According to Dr. Troyen A. Brennan, Aetna's Chief Medical Officer, they chose to sponsor the trial because adherence is key to quality of care and statistics show that a year after beginning medication, only about 50 percent of patients are taking medications as directed. "If it looks like it works, we'll try to incorporate it in things we do," he said.

For Dr. Volpp, the trial's co-founder, this is just one of many possibilities in using behavioral economic tools towards strengthening health applications.

"There is a synergy between health professionals who want people to adopt healthy behaviors and commercial interests who want to find ways to effectively make sure that people ... behave in healthy ways in higher rates," Dr. Volpp said. "I think there are big opportunities to try to think creatively about how to use incentive systems to try to help people adopt healthy behaviors at higher rates."


Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

HEALTH: Psychiatrists Are Prescribing More Pills, Less Therapy

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/07/2008

With Sigmund Freud and HBO's popular series "In Treatment" featuring a psychiatrist and his patients, it seems a safe bet that paying someone to analyze your life is still a strong option.

However, a new report published in the Archives of General Psychiatry this Monday reveals that fewer psychiatrists are providing psychotherapy to patients during office visits, instead prescribing drug therapy - medication - at increasing rates.

According to the researchers, the trend appears to be linked to there being fewer trained psychiatrists, the marketing of improved psychiatric drugs and pressure from managed care companies that offer incentives for prescribing drugs over giving the more expensive psychotherapy.

"Psychiatrists get [paid] more for three 15-minute medication management visits than for one 45-minute psychotherapy visit," said Dr. Ramin Mojtabal, who co-led the research at Beth Israel Medical Center in New York, and who now works at Johns Hopkins Bloomberg School of Public Health in Baltimore.

"I was trained almost 30 years ago and received a lot of training in psychotherapy," said Dr. Christopher C. Colenda, a psychiatrist and Dean of Medicine at Texas A&M Health Science Center College of Medicine. "Thanks to the advances of managed care, psychotherapy was basically devalued from the perspective of psychiatry. ... A lot of the incentives for wanting to be in psychiatry were essentially removed by managed care."

The study examined data from the National Ambulatory Care Survey on visits to psychiatrists' offices for a 10-year period between 1996 and 2005, finding that the proportion of visits over 30 minutes long dropped from 44 percent in 1996-1997 to 28.9 percent in 2004-2005. Overall, out of 14,108 visits, only 34 percent provided psychotherapy to patients.

The number of psychiatrists who provided psychotherapy to all patients also fell, from 19.1 percent to 10.8 percent during the same 10-year period. Those who chose to continue psychotherapy had more patients who paid out-of-pocket for treatment than other doctors who gave less talk therapy.

For patients who require a combination of talk therapy and drug therapy, the trend towards medication-only can result in spotty treatment, in which the patient receives psychotherapy from a psychologist and drugs from a psychiatrist or general practitioner.

Physicians differ in their opinions over whether this is a problem.

"Whether it has any impact on the outcome of the disorder, we don't really know," said Dr. Mojtabal to Reuters. "I don't think necessarily that it is harmful. It might not be as efficient."

However, Dr. Eric Plakun, who leads an American Psychiatric Association committee working to restore interest in psychotherapy by psychiatrists, told Reuters that a shift away from psychotherapy began about 10 years ago when medical schools began to focus more on the biology of mental illness than on its psychology and behavior. "Either way, I'm worried about our patients [who] need the best help we can give them."

So is this the end of psychotherapy? Perhaps not, as it is effective and less expensive, and if you look deeper, there are signs that the use of talk therapy will continue and is, in fact, on the rise.

Since its benefits are well documented via behavior changes, emotional and mental habits, as well as through brain imaging studies, whether alone or combined with drug therapy, "the couch is far from dead," Dr. Plakun said. "The couch turns out to be an effective 21st century treatment."

Accreditation requirements for psychiatric residency programs are also putting more emphasis on talk therapy, so future medical professionals have the appropriate background to keep it alive.

Various forms are the recommended form of treatment for depression, post-traumatic stress disorder, bipolar disorder and other psychiatric illnesses.

In addition, visits to psychologists, social workers and other mental health counselors, who also provide talk therapy but are not medical doctors - and thus cannot prescribe drugs - were not included in this research.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

HEALTH: Report: Prostate Cancer Screenings Pose Greater Risk Than Benefit For Older Men

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/07/2008

Recommendations by a federal task force are challenging routine preventive care practices for prostate cancer for the country's population of older men.

The guidelines, issued Monday by the U.S. Preventative Services Task Force and updated from its inconclusive stance in 2002, advise that such cancer screenings should not be performed on men aged 75 years and older. Reasons cited include a lack of strong evidence of overall benefit compared to the potential risks of screening.

In younger men, the efficacy of prostate-specific antigen (PSA) screenings remains unclear. Here, the task force advises early counseling about the risks and few benefits so men may elect not to be tested.

The study's results were published in the Aug. 5 issue of Annals of Internal Medicine. This is the first time a specific recommendation has been made on the issue.

According to Dr. Ned Calonge, chair of the 16-member task force, "the benefit of screening at this time is uncertain ... You have a chance that screening will help you live longer or better, and ... the chance that screening detection and treatment will harm you. At age 75, the chances are great that you'll have negative impacts from the screening."

Negative effects listed by the panel include psychological harm, impotency and incontinence, "additional medical visits, adverse effects of prostate biopsies, anxiety and overdiagnosis" - detection when treatment won't affect life expectancy. Some studies suggest that overdiagnosis alone can occur between 29 to 44 percent of the time.

Prostate cancer is the most common non-skin cancer in the United States and affects one out of every six men. Risk factors include family history of cancer or an African-American background.

According to the American Cancer Society, last year saw 218,890 men diagnosed with prostate cancer and about 27,050 deaths. It is the second-leading cancer killer, after lung tumors, among men. The overall mortality rate from the disease has dropped since it peaked in 1991.

Currently, one third of American men receive either PSA screenings, which test for protein blood levels, or a digital rectal exam, which identifies abnormal growth of the prostate gland. Detection enables doctors to monitor a patient whose condition is slow-growing, or to provide treatment. Some men die before their cancer even becomes an issue.

Still, the panel says their findings do not support definitive advice, and the new guidelines will not prevent a man from seeking screening and treatment for prostate cancer symptoms, such as frequent or painful urination or blood in the urine or semen.

"Larger, longer-term [clinical] studies are urgently needed," Dr. Calonge, who is also the chief medical officer for the Colorado Department of Public Health and Environment said. "We recommend that men concerned about prostate cancer talk with their health care providers to make a decision based on their individual risk factors and personal preference."

While the age limitation may be welcome for some, many doctors find the lack of strong new evidence against screening as not enough to discourage preventative care.

"The spirit of the recommendations is good, but the problem is they really do send the wrong message to older men who could have prostate cancer," said Dr. Leonard Gomella, chairman of the department of urology at Thomas Jefferson University's Kimmel Cancer Center. "This study falls short of the fact that there are older men over 75 who do need treatment."

Falling mortality rates and longer life spans around the world where PSA testing have been made available may support continued preventative care, as well.

"Men are living a lot longer these days. I play golf with 84-year-old guys who beat me all the time," Dr. E. David Crawford, a professor of surgery and radiation at the University of Colorado at Denver said to the Washington Post. "You have to individualize treatment."

"If it turns out that PSA screening and aggressive treatment saves lives, maybe all the harm that it has caused is worth it," Dr. Otis W. Brawley, chief medical officer at the American Cancer Society added. "We just don't know yet."

The PSA test was approved by the Food and Drug Administration in 1986 and has been utilized increasingly since the mid-1990s as stigmas faded, awareness grew, and screenings for other cancers such as breast and ovarian became more popular.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

HEALTH: Deadly Risk - Sleep Apnea

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/06/2008

University of Wisconsin-Madison researchers have found that people with severe sleep apnea are up to three times more likely to die early from the disorder, and more so if the disorder remains untreated.

Sleep apnea is a common, chronic sleeping disorder in which a person has frequent pauses in breathing, ranging from a few seconds or even minutes, often accompanied by snoring and constant waking. Normal breathing typically begins again, but sleep deprivation night after night is dangerous.

"This is not a condition that kills you acutely. It is a condition that erodes your health over time," said Dr. Michael J. Twery, director of the National Center on Sleep Disorders Research.

Published in the international journal Sleep, the 18-year study of 1,522 men and women, ages 30 to 60, confirms smaller studies that have linked an increased risk of death with sleep-disordered breathing. Eighty people died during this time - about 19 percent of whom had severe sleep apnea and only 4 percent of whom had normal sleep patterns.

According to the report, heart disease and heart-related death was tied to 26 percent of all deaths among those with normal sleep patterns and 42 percent of deaths among those who had severe sleep apnea. Other risk factors for development of the disorder include excess weight, high blood pressure, family history of the condition, being male and use of alcohol or sedatives.

Participants in the study spent one night under observation at a sleep laboratory where they were screened for sleep apnea. Those diagnosed with the disorder were divided into groups according to the severity of their condition. Severity was measured by the average number of breathing pauses and sleep disruptions. Those with normal sleep patterns constituted the baseline group.

The findings implied that risk of death was reduced when participants underwent proper treatment, such as the use of continuous positive airway pressure (CPAP), which keeps airways open during sleep and prevents pauses during breathing. There has been debate over whether to use airway pressure to treat patients who are not sleepy during the daytime.

Overall, those experiencing sleep apnea had a risk of death 3.2 times higher than those at the baseline, even after adjusting for other risk factors such as age, sex and body mass index. For participants who had untreated (non-CPAP) sleep apnea, the risk of death was 3.8 times higher.

"I was surprised by how much the risks increased when we excluded people who reported treatment with CPAP," Dr. Terry Young, Ph.D., professor of epidemiology at the University of Wisconsin-Madison, said in a news release. "Our findings suggest - but cannot prove - that people diagnosed with sleep apnea should be treated, and if CPAP is the prescribed treatment, regular use may prevent premature death."

Researchers did note that 95 percent of the study's participants were white and most had both a stable income and health care.

"It is likely that our findings may underestimate the mortality risk of [sleep disordered breathing] in other ethnic groups or the lowest socioeconomic strata where there is poor awareness and access to health care," the researchers said.

The same issue of the journal Sleep included a separate 14-year study from Australia's Woolcock Institute for Medical Research, which came to a similar conclusion, finding that individuals with severe sleep apnea have six times the risk of death as those without the disorder.

However, the number of participants in each group was significantly skewed, weakening the conclusion's impact. The study followed 380 men and women between ages 40 and 65 in Western Australia, for up to 14 years. Out of 18 people with sleep apnea, 33 percent (6 people) died; of 285 people without sleep apnea, 7.7 percent (around 22 people) died.

The U.S. study was supported by the National Institutes of Health. The Australian study was supported by the Australian National Health and Medical Research Council.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

HEALTH NEWS: US Infant Mortality Rates Stall

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/01/2008

A CDC statistical report says a nearly decadelong decline in rates of infant deaths has stalled, with records showing little change in the last three years. However, premature births are directly associated to increased deaths, especially for "non-Hispanic black women."

The CDC defines this category of people as having African ancestry and no maternal ancestors of Hispanic descent.

The overall rate, unrelated to premature births, showed very little change from 2004 to 2005, with 6.78 deaths per 1,000 live births versus 6.86 deaths. The report was released Wednesday by the CDC's division of vital statistics, which collects data on U.S. rates of infant mortality, birth and death.

Preterm-related infant deaths rose overall from 34.6 percent to 36.5 percent between 2000 and 2005. For non-Hispanic black women, babies were 3.4 times more likely to die from preterm-related causes than were non-Hispanic white women. Per 1,000 live births of black infants, 13.26 died in 2005, a rate that is on par with some developing countries.

Within the Hispanic spectrum (Mexican, Puerto Rican, Cuban, and Central and South American), preterm-related mortality rates were highest for Puerto Rican mothers, 87 percent more than in non-Hispanic white mothers. They were lowest for low-birth-weight infants with mothers of Mexican descent.

"We continue to have persistent and very large disparities by race and ethnicity," said lead author T.J. Mathews, a demographer with the National Center for Health Statistics. While connections between race and higher infant mortality are not certain, these are issues being discussed.

Extremely early births (before 32 weeks gestation) and preterm births (before 37 weeks) are a large factor in infant mortality, according to the report. "Rates [of infant death] are higher in that first day or first week than later on in the post-neonatal period," Mr. Mathews said.

The report also notes that there has been a steady increase in the number of preterm and low-birth-weight births since the mid-1980s, in part due to a rise in multiple births, more frequent use of fertility treatments and an increase in the number of C-sections and early induced labor.

Causing 44 percent of all infant deaths in 2005 were birth defects, low birth weight and sudden infant death syndrome (SIDS). Mortality rates were also higher for infants born in multiple deliveries (twins, triplets or more), and to mothers either born in the U.S. (perhaps due to fewer support systems than outside the U.S.) or who were unmarried.

Maternal age and level of education also had some connection with infant mortality rates, with the fewest deaths occurring with women giving birth in their 20s and 30s, and with 16 or more years of schooling. In addition, infant mortality rates were higher among boys than girls.

Mothers of Mexican descent had the lowest rates of low-birth-weight infants (6.5 percent), while Asian or Pacific Islander moms had the lowest death rates among preterm births (10.7 percent).

On the other hand, compared with non-Hispanic white mothers, SIDS rates were highest for babies with American Indian or Alaskan Native mothers, as well as with non-Hispanic black mothers (2.0 times and 1.8 times higher). SIDS rates were lowest for Mexican mothers (48 percent), Asian and Pacific Islander mothers (57 percent), and Central or South American mothers (68 percent).


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

HEALTH NEWS: Hospitalizations For Heart Failure Triple

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/31/2008

The number of patients hospitalized in the U.S. for heart failure and heart-related diseases almost tripled from 1979 through 2004 according to a recent study.

The Journal of the American College of Cardiology reported this month that hospitalizations rose from 1.27 million to 3.86 million in this time span, and the trend likely will continue.

The U.S. Centers for Disease Control and Prevention (CDC) conducted the study, which evaluated data from the National Heart Discharge Survey. More than 80 percent of those admitted to hospitals with any mention of heart failure were age 65 or older and most had Medicare or Medicaid.

In the study, Dr. Jing Fang, lead author and an epidemiologist with the CDC, said an aging American population largely accounts for the increases, because older patients more commonly suffer from heart failure and weakening of the heart.

Dr. Fang wrote, "the improvement in technology for treatment of patients with other heart diseases, such as [heart attacks], ... [helps] people with diseases of the heart live longer."

Hospitalizations due to actual heart failure account for up to 35 percent of heart-related hospital stays. The remaining cases had respiratory diseases and conditions such as pneumonia, diabetes and kidney failure.

Dr. Fang added, although better control of these conditions could reduce hospital visits for heart failure, once the condition becomes serious enough to warrant a visit, it cannot be cured.

These people keep coming back to the hospital, and "the best medicine [we] can do is to keep the heart functioning enough for the patient to have a good quality of life," he said.

No effective treatments for severe heart failure exist, said Dr. Javed Butler, director of heart failure research at Emory University, since "when you [talk] about medications that have been proven, they are all for chronic, stable outpatients. ... We don't have any proven medications for treatment at the hospital."

The report did not address cost of the increased hospitalizations over the given period, but the American Heart Association estimates it costs around $20 billion annually.

Considering the high cost, a major effort to develop in-hospital treatments for severe heart failure is needed, Dr. Butler said. "It is a least-studied, most costly problem. We need to get a better grasp on what we should be doing."


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

LOCAL: State Ranked No. 1 For Biotech Research, Development

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin
07/25/2008

Pennsylvania's advances in biotechnology research and development have recently been recognized as number one for the "diversity and depth" of their initiatives.

This was the conclusion of the most recent Business Facilities magazine study, an annual report that also rated states for their strength in biotechnology.

Gov. Rendell announced the ranking during Wednesday's groundbreaking in Montgomery County for the new North American headquarters of Almac, a worldwide provider of R&D and manufacturing services for pharmaceutical and biotech industries.

"We have laid the groundwork to keep Pennsylvania number one in biotech," said Mr. Rendell noting its elevation in perceived status. The state had previously ranked 11th for the past three years.

"Biotechnology plays a critical role in Pennsylvania's economic and strategic growth. We're providing [the] industry with a competitive edge by directing support and funding to companies to expand, create jobs and retain ... talent."

Criteria included amount of state R&D funding and venture capital investments, level of concentrated occupational employment, tax exemptions, and university grant funding.

The report noted the state's allocation of $150 million in 2007-08 from its tobacco settlement to support research in CURE, the Commonwealth Universal Research Enhancement, toward health-related programs.

In addition, the Ben Franklin Technology Partners, a statewide network that pushes entrepreneurship and tech innovation for economic growth, leveraged $675 million and created and retained 2,475 jobs.

Other Pennsylvania biotech programs include Life Sciences Greenhouse Initiatives and various venture capital investments in medical device and equipment companies worth more than $500 million, according to The National Venture Capital Association.


Heather J. Chin can be reached at hchin@thebulletin.us


©The Evening Bulletin 2008

MEDICINE: Tobacco Plants Used As Basis For Cancer Vaccine

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin
07/24/2008

In spite of years of its name being associated with cancer, the tobacco plant has recently shown potential in the development of personalized vaccine cells to fight a specific type of non-Hodgkin's lymphoma.

Potential medicinal applications for tobacco are still in preliminary stages, but scientists at the Stanford University School of Medicine in California have published their current findings in the Proceedings of the National Academy of Science.

In their report, the researchers focused on creating antibodies for follicular B-cell lymphoma, which attacks the immune system and is currently considered incurable. A "B-cell" is a type of white blood cell responsible for defending the body against bacteria and other pathogens that cause illnesses.

After isolating the patient's cancer cells, the antibody-producing gene is extracted and transplanted to the "tobacco mosaic virus," which is then used to infect the tobacco plants. The infection then spreads through the cells and the gene produces large quantities of antibodies. After only a few days, the researchers ground up some of the leaves and extract the antibodies necessary.

Only a few plants are needed to produce enough vaccine for one patient.

In the first test of a plant-based vaccine on humans, 16 patients recently diagnosed with follicular B-cell lymphoma were injected with their individualized vaccines. More than 70 percent of the patients had an immune response and 47 percent had the specific response the researchers hoped for.

While the idea of producing and using individualized antibodies for patients is not new, as previous cancer vaccine trials have been done using animal and human cells, but those had mixed results. This early study using plant tissue has both speed and limited side effects on its side.

"This would be a way to treat cancer without side effects. The idea is to marshal the body's immune system to fight cancer," said Dr. Ronald Levy, senior author of the study. "We know that if you get the immune system revved up, it can attack and kill cancer."

Part of the appeal and benefit is in the speed and inexpensive production process. Each year, about 16,000 people are diagnosed with follicular B-cell lymphoma. Treatment is often limited to constant monitoring by doctors to see if a patient's condition worsens, with chemotherapy being avoided. With so few options, a vaccine would have a significant positive impact.

Since the study was only designed to test whether the plants were practical, safe and effective in stimulating a boosted immune system response, larger and more in-depth studies would need to be conducted to test how well such vaccines might perform in reducing the size of tumors.

The irony of using plants that produce tobacco - the main component in cigarettes, a known cancer-causing agent - as the base from which to develop a cancer-related vaccine was not lost on the researchers and everyone involved.

"It's pretty cool technology, and it's really ironic that you would make a treatment for cancer out of tobacco," said Dr. Levy. "That appealed to me."

The tobacco plants and research technology were provided by Large Scale Biology Corp., a company located in Vacaville, Calif., and the study was funded by the U.S. National Institutes of Health. Further studies into plant vaccines will be taken to major pharmaceutical company, Bayer, which has similar technology and greater financial resources to support the research.


Heather J. Chin can be reached at hchin@thebulletin.us


©The Evening Bulletin 2008

LOCAL: PCVB Seeks More Health Care Conferences, Sporting Events

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin
07/24/2008

"America's life sciences meetings destination" may become the newest Philadelphia marketing slogan, according to officials from the Philadelphia Convention & Visitors Bureau. They unveiled their business strategy on Tuesday, aimed at drawing more visitors with a variety of programming - including more health care conventions.

Forty percent of all meetings held at the Philadelphia Convention Center are devoted to health care and life sciences, while 55 percent are held in Philadelphia-area hotels. PCVB hopes increased marketing and cooperation with economic-development groups to recruit related students and businesses to the region, the city will become a global destination for meetings.

The greater Philadelphia area hosts many health care; pharmaceutical and biomedical research; manufacturing; and marketing facilities, including U.S. branches of international corporations.

"Not only do we have the community to hold those conventions, but also the connections in the life sciences to make these things happen," said Mr. Jack Ferguson, executive director of PCVB. From being within driving distance from 85 percent of "big pharma" in the country and [institutions] of higher education, "we've got the infrastructure to do it and an expanding convention center to host."

Philadelphia is the 12th most-visited U.S. city for international visitors, and tourism rose by 27 percent last year, to around 550,000 visitors, according to U.S. Department of Commerce figures, due in part to the strength of foreign currency against the dollar. This increase was valued at $1.2 billion in economic impact for the region, PCVB President Tom Muldoon told a regional business news publication.

The convention center, at 15 years old, is set to expand from the current 440,000 square feet of exhibit-hall space to 700,000 square feet. Construction could finish in January 2011, at an expected cost of between $700 million and $800 million.

In addition to more life-science conventions, PCVB's business plan for the upcoming fiscal year aims to attract individual and group tourism, multicultural groups and sporting events. The Philadelphia Sports Congress, a division of PCVB, has already hosted the U.S. Olympic Team Trials in Table Tennis and Gymnastics, generating over $20 million in economic impact.

The PCVB and the Sports Congress, also continue to build on the Philadelphia 2016 Olympic bid, further branding the city as an international and Olympic sports destination city.

"If our city is to compete in a global marketplace, we need to continue to tell the Philadelphia story to people around the world so they choose to travel to America's birthplace," said Mayor Michael Nutter.


Heather J. Chin can be reached at hchin@thebulletin.us


©The Evening Bulletin 2008

HEALTH NEWS: Eating Nuts While Pregnant May Raise Risk Of Asthma For Child

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin
07/18/2008

Mothers-to-be might - or might not - be better off reducing consumption of nut-based foods if they wish to decrease their child's risk of developing asthma.

According to a recent study, pregnant women who daily consumed at least one nut product, like a peanut butter sandwich, had children with a 40- to 60-percent higher risk of developing asthma or asthma-related symptoms within the child's first eight years of life.

Still, researchers don't recommend removing nuts from pregnant womens' diets, since they contain nutrients such as vitamins A, C and E, which previous studies say may have protective properties against asthma development.

"While it is too early to make recommendations of avoidance, it is important for pregnant women to eat healthily," said Dr. Saskia Willers, who led the study at the the Netherlands' University of Utrecht. "What is true for many foods is that too much is never good."

The study observed women who ate nut products "rarely" throughout their pregnancy.

It showed that children whose mothers had previous history of asthma or sensitivity were on a restricted diet and also reported suffering from the condition.

On the other hand, women who ate nut products in moderation did not have children who showed any more risk of asthma development.

In this cohort (group) study, the Dutch researchers examined 4,146 pregnant women who completed diet questionnaires about how often they consumed fruit, vegetables, fish, egg, milk, milk products, nuts and nut products during the previous month. Of the women, 1,327 were atopic, having asthma or allergic sensitivity, and 2,819 were nonatopic, with no pre-existing sensitivity or related condition.

Researchers were able to maintain contact with 80 percent of the mothers and children/families, allowing for a great amount of communication during the process.

The health of the children born to participants was monitored from ages 1 through 8, with complete data available for 2,832 children.

The results found no associations between maternal intake of vegetable, fish, egg, milk or milk products and nut consumption and observed childhood outcomes.

This is the first study to examine the mother's diet while they were pregnant (instead of relying on memory years later) and to track the asthma outcomes past the first five years of life. It was published in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine, which is put out by the American Thoracic Society.

Asthma affects over 20 million adults and more than 9 million children in the U.S. have been diagnosed with it.

Despite the strong study and promising findings, the specific factors during pregnancy and early childhood that cause some children to develop asthma [and allergies] over others is still unclear. One known factor is an inherited genetic predisposition.

"Genes play a large role in whether or not the child is eventually going to develop food, or environmental allergies in the future," Dr. Nora Lin, a pediatric and adult allergist with Allergy and Asthma Specialists in King of Prussia. "The effects of the maternal diet on how those genes play out is a pretty complex issue, but [there has not been much] definitive evidence that what a mom eats will affect the outcome of what the child develops or not."

"We don't know what other things the parents did or were exposed to... what supplements or food or medications ... they were using," said Dr. Jonathan Steinfeld, pediatric pulmonologist at St. Christopher's Hospital for Children. "This is an association study - between eating more nut products and the children being diagnosed with asthma later in life, but this does not imply causation (that it caused the asthma)."

The study would also be difficult to apply to American and other families throughout the world since we have such a variety of genetic makeup, Dr. Steinfeld notes.

"While they did it well and with a large group, it needs to be repeated to be sure that elsewhere in the world, [these findings] are reproducible."



Heather J. Chin can be reached at hchin@thebulletin.us


©The Evening Bulletin 2008

Alumnus Donates $1.5M In Grants To Two Penn Schools

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/18/2008

University of Pennsylvania alumnus Arthur Bilger and his wife, Dahlia, made two monetary gifts this week to his alma mater to be used to support research into interactive media business models and therapeutic drugs to treat Alzheimer's disease.

The Wharton School received a $1 million gift to create and support the Wharton Interactive Media Initiative (WIMI), a research program focusing on interactive media, its effect on global business and its influence on traditional media business models. This data-driven research will hopefully be applied to helping media companies do profitable business.

Of his family's donation to Wharton, Mr. Bilger said "Through the WIMI, Wharton will continue its tradition of cutting-edge scholarship with practical applications... to the world of business."

The Bilger Foundation's $500,000 donation to the School of Medicine will establish the Nathan Bilger Alzheimer Drug Discovery Initiative in memory and honor of Mr. Bilger's father. The monetary gift will be used by the Center for Neurodegenerative Disease Research (CNDR) to identify new methods and drug targets for the treatment of Alzheimer's disease that can hopefully be translated by their Marian S. Ware Alzheimer's Drug Discovery Center into new therapeutic drugs.

"The Bilger family gift will enable us to determine if an off-label drug used to treat organ rejection in transplant patients can be used to treat Alzheimer's disease," Dr. Virginia M.Y. Lee, CNDR director, said to the Almanac, a Penn-run publication.

Dr. John Q. Trojanowski, director of PennMed's Institute on Aging, explained that this is significant because early studies that are promising need a lot of money to evaluate them further as potential Alzheimer's therapies, and, "if successful, could put more drugs in the pipeline aimed at helping... patients by blocking... the disease process."

Mr. Bilger manages a private investment firm in California, is a member of Wharton's Board of Overseers, and along with his wife has supported the School of Arts and Sciences, Penn Medicine, and a scholarship for undergraduates.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Global Warming Linked To Kidney Stones?

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/17/2008

A Texas study hypothesizes the warming effects of climate change could increase the likelihood of developing kidney stones for some Americans living in dry areas.

The study, published in the July 8 issue of The Proceedings of the National Academy of Sciences, concludes that people could suffer from about 30 percent more kidney stones by the year 2050 than they do now, potentially causing a rise in treatment costs and other "significant effect."

Citing the lack of fluids that results from excess sweating or living in hot, dry climates, the report's lead author, Tom Brikowski, associate professor of geology at the University of Texas at Dallas, says he is "quite confident that kidney stone prevalence is related to climate."

The many risk factors that lead to kidney stone include obesity, high-blood pressure, inflammatory bowel disease and chronic diarrhea.

Kidney stones are formed from calcium or mineral deposits that crystallize into hard fragments that line the sides of the kidneys. Having them could be a painful experience involving excruciating side and back pain, pain during urination as well as fevers and chills if there is an infection, but it is treatable and usually has no lasting side effects.

However, "When you focus on the health effects of climate change, it might be wrong to pick out single outcomes and be overly focused on those," Dr. Jonathan Patz, a professor in the department of population health sciences and the Center for Sustainability and the Global Environment at the University of Wisconsin-Madison, said to ABCNews.com.

"I don't think you can compare it to something globally like malaria, which kills 2 million people per year, most of whom are children."

It would also be helpful to include measures that could be taken to prevent this problem, as opposed to simply declaring it a problem, which Kristi Ebi, lead author for the Intergovernmental Panel on Climate Change Fourth Assessment Report, and an independent consultant on the health effects of climate change, also noted to ABCNews.com.

"For a lot of health issues, at some point people just tune it out," said Ebi. "We hear that this causes cancer and that causes cancer [until at some point] ... the public says 'everything causes' cancer and I'm not going to worry about it.' This is not effective risk communication."

Optimistic, Mr. Brikowski considers his study's results something that experts can use as a starting point to look into "more of these unusual collaborations."

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008