What Irony: PepsiCo Funds Yale Nutritional Science Fellowship

As announced in a press release from Yale Medical School, PepsiCo is funding a new fellowship in Nutritional Science.

Okay, what kind of Orwellian world has Yale Med decided to create in the name of a little wad of green inked paper? Taking funds from the corporate giant that stands to lose good PR, if not millions of dollars, as a result of your Rudd Center and other med, health and nutrition program's research into childhood obesity, diabetes, and the negative health effects of sugared soft drinks - and the positive preventative results of soda taxes?
And USING SAID FUNDS TO HIRE A MEDICAL PROFESSIONAL WHOSE TASK IT IS TO RESEARCH NUTRITION AND PUBLIC HEALTH POLICY?!?!
And having this whole thing guided at least in part by the former WHO tobacco control guru?
I'm with Michele Simon (of AppetiteForProfit.blogspot.com) on this one. This instance of industry influence and selling out really hurts. And yes, it truly is shocking.

Personal Health: Antipsychotic Drugs May Increase Risk to Older Diabetics

Published on August 3, 2009 in THE PHILADELPHIA INQUIRER.

A warning for older diabetics who take antipsychotic drugs
Older diabetics who start on an antipsychotic drug may face a greater risk of high blood glucose levels, or hyperglycemia, according to a study published in the July 27 Archives of Internal Medicine.

The findings are based on a Canadian study of 13,817 diabetics aged 66 and older who took antipsychotics in a two-year period for dementia and other conditions, while also receiving insulin-treatment, oral hypoglycemic (blood-glucose reducing) agents, or no diabetes treatment. Eleven percent - 1,515 people - of patients were hospitalized for hyperglycemia or related conditions.

Those starting on antipsychotics were particularly at risk; after their first prescription, they were eight to 15 times more likely to be hospitalized than those not getting the drugs.

The connection between hyperglycemia and antipsychotic use has been studied in younger patients with schizophrenia, but research in older adults is limited, the researchers said. If the use of antipsychotics in older diabetics with dementia cannot be avoided, the study's authors conclude, then patients and relatives should be on the alert for signs of high blood sugar levels once treatment begins. The researchers recommend enhanced glucose monitoring for all patients starting antipsychotic drugs. - Heather J. Chin

Read the full article here.

Personal Health: On Statins and Walking Aids

Published on Monday, July 6, 2009 in THE PHILADELPHIA INQUIRER.

Likely benefits to prescribing statins to curb heart disease

Cholesterol-lowering statin drugs, the standard of care for people with heart disease, may also benefit many patients who are merely at risk of developing the disease, researchers report in a review of 10 previous studies involving 70,000 people worldwide.

Prescribing statins as a preventive measure to patients with risk factors such as diabetes and high blood pressure was associated with a 30 percent drop in major heart disease and a 12 percent drop in deaths over an average of four years, researchers said on bmj.com, an online British medical journal.

Statins are powerful drugs, and the researchers - several of whom reported support in the past from manufacturers - stopped short of recommending their use for all people at risk of developing heart disease.

While men over 65 who have other risk factors and older women with diabetes and other risk factors appear to be most in danger of developing heart disease, they write, "the correct identification of such people remains a challenge," as does prediction of an individual's risk. - Heather J. Chin


Study of falls suggests need to teach safer use of walkers

More than 47,000 older Americans a year - 129 a day - seek treatment at hospitals after falls involving walkers or canes, according to a six-year review of ER records that suggests more time should be spent teaching people how to use walking aids.

Falls are the leading cause of injuries in people over 65. Less than 3 percent involve walking aids, but the researchers, from the U.S. Centers for Disease Control and Prevention, said they were the frailest and most vulnerable population. And while twice as many older people use canes than use walkers, the researchers found seven times as many injuries associated with walkers.

Fractures were the most common type of injury. Men injured their head and neck most frequently, while women hit their hip or pelvis. Women, who are more likely to use walkers, made up 77 percent of all falls examined.

The goal now, the authors write in the Journal of the American Geriatrics Society, is to identify potential risk factors that lead to falls, to design better walking aids, and to provide education on safe usage. Information about falls and how to prevent them: http://go.philly.com/health. - Heather J. Chin

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: 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 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

FDA Approves A New Insulin Pump

(previously published at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/03/2008

At the same time that a wireless insulin pump for diabetics has been approved for marketing and public use by the U.S. Food and Drug Administration (FDA), its regulators are reconsidering the standards they use to approve diabetes medications.

The FDA began hearing from a panel of outside diabetes experts, cardiologists and statisticians on Tuesday as to whether the agency should require pharmaceutical companies to prove, through extensive long-term clinical research studies, that their drugs reduce heart problems and do not increase risk of death in order to gain FDA approval.

Diabetes is a disease where the body either does not produce or properly use insulin, a hormone that converts food into energy. Prescription drugs used to treat type 2 diabetes - the most common form, where a person's body either produces too little insulin or rejects insulin - are currently evaluated on the basis of whether they are proven to control blood-sugar levels.

The wireless insulin pump that has been approved is known as the OneTouch Ping glucose management system and is produced by Animas Corp., a medical device company from West Chester, that is a subsidiary of Johnson & Johnson Corp. in New Brunswick, N.J. It makes it easier for individuals with diabetes to calculate and inject themselves with the proper dose of insulin.

This reconsideration of regulatory standards is the result of questions that arose last year after an analysis of a popular diabetes drug, Avandia, showed that although taking it lowered blood-sugar levels, its use also increased the risk of heart attack in individuals.

FDA research into the issue yielded no actionable results, and additional trials by Avandia's manufacturer, GlaxoSmithKline, which has operations in the Philadelphia area, will likely not be ready until 2014.

The panel's opinions may influence and affect that approval of both new diabetes drugs and those that are already on the market.

However, there are some scientist even from within the FDA, who are skeptical of the value of tying risk of a side effect (heart attack) to the approval and availability of a drug whose target goal is to treat [low blood sugar and] diabetes.

Still, consumer advocates, lawmakers and diabetes organizations express concern over the risk of possible side effects.


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

©The Evening Bulletin 2008