Evidence Weight-Loss Surgery Helps Against Diabetes

One-third of gastric-bypass patients kept type 2 diabetes under control without meds during three-year study

MONDAY, March 31, 2014 (HealthDay News) -- Weight-loss surgery might do more than help people shed pounds. For some who have the surgery, it may also put type 2 diabetes into remission for several years, a new study suggests.

The success rate in controlling diabetes depended on the type of weight-loss surgery, the researchers said.

Patients who had the more involved gastric-bypass surgery were more likely to achieve control of their type 2 diabetes without the use of medications, compared to those who had a procedure known as sleeve gastrectomy, according to the new research.

"This study is a three-year follow-up. Initially, we showed that people lost a lot of weight after surgery, and for some people, that caused their type 2 diabetes to come to an end," said study co-author Dr. Sangeeta Kashyap, an endocrinologist at the Cleveland Clinic's Endocrinology & Metabolism Institute. "But no one knew how lasting that would be."

"One-third [of patients] in the gastric bypass group had remission of diabetes -- meaning they had normal blood sugar control -- and a quarter of the people in the sleeve gastrectomy group had remission of type 2 diabetes," Kashyap said. "These effects are real, and they're persistent for at least three years. Essentially, these patients have had a vacation from diabetes for three years."

Even when people weren't able to achieve a full remission from type 2 diabetes, weight-loss surgeries still helped many participants take less medication to control their blood sugar, according to the study.

Kashyap also said quality of life was improved for people who had the weight-loss surgery compared to those who received standard type 2 diabetes management. Quality-of-life measures included bodily pain, physical functioning, energy levels and emotional well-being.

"People who have weight-loss surgery generally feel better, happier and healthier," Kashyap said.

The study was funded by Johnson & Johnson subsidiary Ethicon, which makes surgical devices.

Results of the study will be presented Monday at the American College of Cardiology annual meeting in Washington, D.C., and published in the March 31 issue of the New England Journal of Medicine.

Type 2 diabetes causes the body to use the hormone insulin inefficiently. Insulin helps get sugar from the blood into the body's cells to be used as fuel. When cells become insulin resistant, that fuel can't make it into the cells and instead builds up in the blood. High levels of sugar in the blood over long periods of time can cause serious complications, such as kidney and heart disease, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Although the exact cause of type 2 diabetes remains unknown, one of the biggest risk factors for developing the disease is obesity.

The current study included 150 people with type 2 diabetes. Their average age was 49, and two-thirds were female. At the start of the study, the patients' average body-mass index (BMI) -- a rough estimate of a person's body fat -- was nearly 37. Below 25 is considered normal weight and over 30 is considered obese, according to the U.S. Centers for Disease Control and Prevention.

One-third of the study volunteers were randomly selected to receive standard medical management of their type 2 diabetes, while another third was given gastric-bypass surgery and medical management. The final third received sleeve gastrectomy plus medical management of their diabetes.

Gastric-bypass surgery routes food directly to the small intestine, which means it bypasses the stomach, duodenum and large intestines, according to the NIDDK. Sleeve gastrectomy reduces the size of the stomach.

Kashyap said the biggest benefits of the surgeries likely stem from the amount of weight lost. "When you're taking drugs to manage diabetes, it's hard to lose significant amounts of weight," she said. "A lot of diabetes medications make weight loss hard."

Weight-loss surgery costs about $25,000 to $30,000, Kashyap said, and requires about two to four weeks time off of work. Insurance companies generally pay for the procedure only for people who have a BMI over 35, she said.

Because experts at the Cleveland Clinic believe weight-loss surgery can be beneficial for people with lower BMIs who also have other health problems, such as type 2 diabetes, their insurance program pays for the procedure in people with BMIs as low as 30, Kashyap said.

Source:

www.webmd.com

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UPDATE 1-Survival rate with Medtronic's CoreValve tops surgery -study

(Adds study details, background, analyst, doctor comment)
By Bill Berkrot and Ransdell Pierson

(Reuters) - Medtronic Inc's minimally invasive CoreValve system for replacing diseased aortic heart valves led to a significantly higher survival rate after one year than traditional open heart surgery in patients deemed at high risk of death during surgery, according to data from a study presented on Saturday.
One year after receiving the CoreValve in the 795-patient Phase III trial, the rate of death was 14.2 percent compared with a 19.1 percent death rate in the surgery group, researchers said. The result, presented at the American College of Cardiology scientific meeting in Washington, was deemed to be statistically significant.
There was also no increased risk of stroke seen with CoreValve compared with surgery, which had been one of the main concerns of transcatheter aortic valve replacement (TAVR) early on in clinical testing.
"I think the results were outstanding," said Dr. David Adams, a co-principal investigator of the CoreValve trial.

TAVR systems use a catheter threaded through an artery to the heart to put the new valve in place, sparing patients chest-cracking open-heart surgery and typically longer hospital stays associated with the invasive surgical procedure.

Early on, Adams explained, the question was could TAVR be an alternative as good as surgery. "Now, it might be better," he said. "We're making continual progress. It's not only an alternative but may be a preferable alternative."

CoreValve won U.S. approval in January, three months earlier than expected, to treat patients deemed too frail to endure open heart surgery, known as extreme-risk patients.
The latest results in high-risk, or less ill, patients should help expand the approval to treat a larger group as Medtronic competes with Edwards Lifesciences Corp's Sapien valve replacement, the first to gain U.S. approval.

Both have been available for several years in Europe, where medical devices tend to get approved far more quickly.

"A positive outcome in the CoreValve high-risk trial should lead to approval in this patient population in the U.S. by the end of 2014," Wells Fargo analyst Larry Biegelsen said in a research note prior to release of the data.
The U.S. Food and Drug Administration has determined that data from the study would be sufficient to make an expanded approval decision without first convening an expert advisory panel to discuss it, Medtronic said.
In addition to the survival result, the rate of major adverse cardiovascular and cerebrovascular events was significantly lower with CoreValve - 20.4 percent versus 27.3 percent for surgery. That was a combination of death from any cause, heart attack, stroke or need for another procedure.

More than twice as many patients in the surgery group went on to develop atrial fibrillation, a potentially dangerous irregular heart beat, researchers reported.

More than 100,000 people in the United States have severe aortic stenosis with about one-third too ill or frail for open-heart surgery, making them potential TAVR candidates. Patients are typically older than 80 years old.

Glenn Novarro, an analyst with RBC Capital Markets, estimated the U.S. TAVR market to be worth about $450 million in 2014. As positive clinical trial results mount in less extreme risk patients and physician acceptance increases, sales of the systems could provide important growth drivers for Medtronic and Edwards.

"I think TAVR is going to have broader acceptance for increased risk patients," said Adams, chairman of cardiothoracic surgery at Mt Sinai Hospital in New York.

The primary difference between the two systems is that Sapien uses a balloon, such as those employed in angioplasty procedures, to expand the valve once it is in place. The Medtronic system uses a special alloy that self expands as it reacts to body heat once the valve is in place. CoreValve also uses a smaller catheter than the currently approved Sapien. But the next generation Sapien XT device with a smaller catheter is expected to gain U.S. approval in the coming months.

Doctors and investors may get a glimpse of how the competition will shape up later at the ACC meeting, when German researchers present results of a head-to-head study comparing CoreValve with the Sapien XT.

Quality of life measures with those who received CoreValve were deemed to be non-inferior, or about as good, as those whose valves were surgically replaced.

There were some disadvantages reported in the CoreValve patients, including a low but significantly higher rate of valve leakage and a higher rate of need for permanent implantation of a pacemaker.

Adams said those issues were minor given the survival advantage demonstrated in the trial.
"The message is very clear," he said. "It was a superior outcome." (Reporting by Bill Berkrot and Ransdell Pierson; Editing by Elaine Hardcastle and James Dalgleish)

Source:
www.reuters.com

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New Hepatitis C Drug Deemed Too Expensive

You’ve always seen it in the movies, a pill that can cure a disease that is usually non-curable with pills, or maybe it’s even a disease that can rarely be combated. This is just fiction, there’s nothing real about those products or those story lines, but there actually is some sort of “miracle pill” on the market. Sovaldi is a brand new hepatitis C drug that is being manufactured by Gilead Sciences, people are just now asking the pharmaceutical giant to tell us why these pills are $1,000 a pop.

The price tag for a three-month cycle of this medicine is definitely for those who would deem themselves “wealthy”, as it comes in at a staggering $84,000; which respectively has health insurance companies and statewide Medicaid programs sweating bullets.

“It makes an easy target, certainly for politicians or for folks, but I think the more important constituency here are our payers,” stated Christopher Raymond, whom is a R.W. Baird biotech analyst. Raymond continued on to say that most biotech companies don’t have to deal with these kinds of problems in other places on our planet, simply because they have a different health care system in place. For example, Europe makes great use of the single-payer systems (which allows for the government to take care of any health-care related costs).

“Alexion (which is another pharmaceutical company), which has their own high-price drug, are in the midst of a new product cycle in Europe where they are winning the battle every day,” he stated. It seems as if this company just wants a “fair play” rule put into place. Raymond continued on saying until the United States adopts a medical care system like this the interactions regarding this matter are going to stay as headlines.

Source:

www.thealmagest.com

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Kids Learn Violence from Video games: Study

Researchers from Iowa State University found children who play violent video games are learning thought patterns that will stick with them and influence behaviours as they grow older. | AP

Children who repeatedly play violent video games will start to think and act more aggressively, a new study has warned.    

Researchers from Iowa State University found children who play violent video games are learning thought patterns that will stick with them and influence behaviours as they grow older.

The effect is the same regardless of age, gender or culture.  

Douglas Gentile, an associate professor of psychology and lead author of the study published in JAMA Pediatrics, said it is really no different than learning math or to play the piano.     

"If you practice over and over, you have that knowledge in your head. The fact that you haven't played the piano in years doesn't mean you can't still sit down and play something," Gentile said.

"It's the same with violent games - you practice being vigilant for enemies, practice thinking that it's acceptable to respond aggressively to provocation, and practice becoming desensitised to the consequences of violence," Gentile said.          

Researchers found that over time children start to think more aggressively. And when provoked at home, school or in other situations, children will react much like they do when playing a violent video game.            

Repeated practice of aggressive ways of thinking appears to drive the long-term effect of violent games on aggression.

"Violent video games model physical aggression," said Craig Anderson, Distinguished Professor of psychology and director of the Center for the Study of Violence at Iowa State and co-author of the report.            

"They also reward players for being alert to hostile intentions and for using aggressive behaviour to solve conflicts.         

"Practicing such aggressive thinking in these games improves the ability of the players to think aggressively. In turn, this habitual aggressive thinking increases their aggressiveness in real life," Anderson said.        

The study followed more than 3,000 children in third, fourth, seventh and eighth grades for three years.            

Researchers collected data each year to track the amount of time spent playing video games, the violent content of the game and changes in a child's behaviour.      

Boys reported doing more physically aggressive behaviours and spending more time playing violent games than girls.    

However, even when researchers controlled for gender, the violent video game effects on behaviour were the same for girls and boys.

Source:

www.newindianexpress.com

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Sprint to finish to get medical marijuana on Ohio’s 2014 ballot

Time is short for those working to get legislation to legalize medicinal marijuana on the ballot in Ohio in 2014. The Ohio Cannabis Rights Amendment would allow for the medical, therapeutic and industrial uses of cannabis.

President of Ohio Rights Group John Pardee says many Ohioans need this medicine as soon as possible to help alleviate symptoms of chronic conditions, including cancer, multiple sclerosis and PTSD.

“So this is important for our veteran, “ Pardee said. “It’s also important for kids with epilepsy and Dravet Syndrome whose next seizure could be their last. You know, literally, it’s a life-or-death situation.”

The amendment also would create an Ohio Commission of Cannabis Control to regulate the use of medicinal marijuana. Supporters need 385,000 ballot signatures to July 2 to get the measure on the ballot. Pardee says so far they have about 50,000 and they still need validation. State leaders have opposed legalizing medical marijuana through the Legislature, with some concerned it would be abused.

Pardee says they are just now ramping up their signature gathering operation, and hoping to build needed momentum in the coming months.

“We only have a couple of months to get it, so this is a sprint to the finish for us right now,” Pardee said. “And so when the weather gets better we’re going to have hundreds of folks out in the streets collecting signatures this spring and summer.”

Twenty states and Washington D.C. have enacted laws allowing the use of marijuana for medical purposes and Florida approved a medical cannabis bill for this November. Pardee says as political battleground states, Florida and Ohio could be the catalysts for change. He adds that they continue to look for national support on the issue.

“We need help from coast to coast,” Pardee said. “We tell people, ‘As goes Ohio, so goes the nation.’ And if folks all over America support Ohio, we can do our part to end federal prohibition.”

Last month, a Quinnipiac University poll found 87 percent of polled Ohio voters support the use of medical marijuana.

Source:
wbco.com

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World Tuberculosis Day: One million children suffer from TB annually

Zee Media Bureau

Washington: Notwithstanding the improved medication and the successive efforts by the governments, a new research has revealed that the number of children suffering from tuberculosis (TB) annually has doubled since 2011.

The shocking research has also revealed that around 32,000 children suffer from multidrug-resistant tuberculosis (MDR-TB) annually.

Researchers from Brigham and Women's Hospital (BWH) and Harvard Medical School (HMS) in Boston have estimated that around one million children suffer from TB annually- twice the number previously thought to have tuberculosis and three times the number that are diagnosed every year, the researchers claimed.

“Despite children comprising approximately one quarter of the world's population, there have been no previous estimates of how many suffer from MDR-TB disease,” said Ted Cohen, an associate professor of medicine at BWH.

Cohen, who is also an associate professor at Harvard School of Public Health added, “Our estimate of the total number of new cases of childhood TB is twice than estimated by the WHO in 2011 and three times the number of child TB cases notified globally each year.”

According to co-author Mercedes Becerra, an associate professor at HMS, “TB in a child is recognised as a sentinel event. It tells us about ongoing transmission and missed opportunities for prevention.”

In order to obtain these estimates, the researchers used several sources of publicly available data and devised a new method to correct for the chronic under-diagnosis that occurs in children, using conventional TB tests which were designed for and work best on adults.

To calculate both the regional and global annual incidence of MDR-TB in children, the researchers used two models.

Their findings indicate that around 1,000,000 children developed TB disease in 2010 and of those, 32,000 had MDR-TB.

The research, whcih has been published in the prestigious journal The Lancet, emphasises the urgent need for expanded investment in the global response to TB and MDR-TB in children.

World Tuberculosis Day is being observed each year on March 24, with an aim to build public awareness about the global epidemic of tuberculosis and efforts to eradicate the disease.

According to the WHO, Tuberculosis is second only to HIV/AIDS as the greatest killer due to a single infectious agent worldwide. Today, TB causes the deaths of about 1.7 million people each year, mostly in the Third World.

With Agency Inputs

Source:

zeenews.india.com

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12-year-old girl is 'always hungry' after brain surgery

CINCINNATI - Alexis Shapiro, 12, suffers from a rare condition called hypothalamic obesity that leaves her always feeling hungry. After gaining 200 pounds, she was scheduled to have a gastric bypass operation but doctors were unable to complete the full procedure because her liver was too large.

Shapiro's symptoms started in 2011 after she had a benign brain tumor removed. When the tumor was removed, her pituitary gland was damaged. This affected how her body perceives hunger signals from her digestive system, ABC News reported.

Doctors at the Cincinnati Children's Medical Center said this type of weight loss surgery will likely help to shrink Alexis’ liver and help her lose weight, so that a full gastric bypass will be possible in the future.

Alexis is currently in critical but stable condition.
 

Source: 

www.theindychannel.com

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Four Girls And One Boy – Quintuplets Born At Dallas Hospital

Baylor University Medical Center welcomed Mia, Tessa, Rayleigh and Bryant, Gracie on Tuesday and the quintuplets are the first to be born here. The tiny infants are doing remarkably well and were born to a teacher from a small town in Texas. Those five bundles of joy are really grabbing headlines and Steven and Michelle Seals, the proud parents simply can’t stop beaming at them.

There are four girls and one boy, who were born via C-section at 29 weeks. At birth, each of the quintuplets was breathing on his own. However, 4 were later put on ventilators to give more support to their little lungs. They are soon expected to be off the machines. Brant was the heaviest with 3 pounds 6 ounces and Rayleigh weighed the least at 2 pounds 8 ounces. Tessa weighs 2 pounds 14 ounces, Gracie is 2 pounds 7 ounces while Mia weighed 2 pounds 10 ounces.

Dr. Vijay Nama, the Director of Neonatology at Baylor University Medical Center said that the infants will remain in the hospital for another 6 to 7 weeks. The team that delivered the quintuplets included 2 obstetricians, 7 neonatologists along with 4 labor and delivery nurses.

Michelle Seals, the proud mother has had several miscarriages before and undergone several treatments for fertility. She knew she was carrying more than one baby but was not expecting quintuplets. Every week they went back for regular checkups, the doctors found a few more. She can’t wait to hold the quintuplets, she says. Right now she is scared of all the machines and tubes, but simply loves the sight of them and they are so precious to the couple.

Source: 

www.thealmagest.com

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23 Mar Obese People with Salty Food Habits Experience Faster Cell Ageing

Evidences of a research presented at the American Heart Association meeting this week show cell aging is faster in overweight or obese teenagers who consume more salt.

Lead author of the study Haidong Zhu said, “Lowering sodium intake, especially if you are overweight or obese, may slow down the cellular aging process that plays an important role in the development of heart disease.”

Zhu is also an assistant professor of pediatrics at Georgia Regents University.

Previous research found that protective ends on chromosomes (telomeres) naturally shorten with age, but the process speeds up by smoking, lack of physical activity and high body fat. Sodium, known for raising blood pressure leading to heart attacks, has been linked to cellular ageing too. The current study is the first to examine the impact of sodium intake on telomere length.

In the study more than 700 people between the age group of 14 and 18 years were divided into low and high salt intake groups. One group consumed 2,388 milligrams per day of salt on average, while the other took 4,142 mg/day.

After considering other factors affecting telomere length, it was discovered by zhu’s team that overweight teenagers having high salt diet had comparatively shorter telomeres than those who had lower salt diet.

Dr. Zhu gave a couple of reasons for such faster cellular aging. Heavy teenagers face higher levels of inflammation, which already solely counts for the accelerated cellular ageing. It increases the sensitivity to sodium as well.

Zhu advises the obese to lower the intake of salt as it would be an easier first step than losing weight in saving themselves from heart diseases.

Source: 

www.thealmagest.com

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Homeless Are Most Affected by TB

A report released by the public health officials reveal cases of Tuberculosis (TB) has been increased by about 7 percent in the Los Angeles County.

In 2012 there were 625 cases, which rose to 666 the following year.

Dr Jonathan Fielding, Director of Department of Public Health, wrote to the county Board of Supervisors that the increase in TB cases in the LA County was mainly among the homeless people.

TB mainly attacks the lungs. It is potentially deadly disease and recently it has been seen spreading rapidly. Since 2007 it has attacked the county’s homeless people. In 2012 the officials reported 39 cases among homeless Angelenos. The number rose to 65 in 2013.

In 2013 the disease was spread beyond expectation and Fielding said it is the largest outbreak of TB in a decade. With the combined effort of the US Centers for Disease Control and Prevention, the health staff of the county and shelter workers treated infected homeless and also to more than 4,600 other people who may have been exposed to the disease or may have come in contacted with the infected.

The TB bacteria spreads through the air in droplets from the coughs, sneezes and laughs in the form of droplets. It can live in the body of a person for decades without sickening them.

The homeless are mostly contracted with the disease as they move about often, have conccurrent medical, live in crowded conditions and etc.

Source: www.thealmagest.com

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Novartis psoriasis drug effective when self-administered - studies

(Reuters) - Results of two late-stage clinical trials showed high efficacy for Novartis' drug secukinumab when used by patients suffering from moderate-to-severe plaque psoriasis, the Swiss drugmaker said on Saturday.

The results of the Phase III studies presented at the American Academy of Dermatology in Denver showed how effective secukinumab was in clearing patients' skin when administered with a pre-filled syringe or autoinjector pen.

Both methods of delivery allow patients to self-administer the drug at home or in the workplace rather than having to visit a healthcare practice.

"It is important that people living with psoriasis, a chronic skin disease, have highly effective and safe treatments they can conveniently self-administer," said Tim Wright, global head of development for Novartis Pharmaceuticals.

Plaque psoriasis is a painful and unsightly skin condition which is known to cause itching and scaling and affects approximately 125 million people.

Patients administering secukinumab experienced significant improvements in clearing skin after 12 weeks versus placebo, while patient satisfaction scores were also consistently high, Novartis said.

The data follow results last year showing the drug was superior to Amgen's Enbrel in a head-to-head study.

Novartis has filed the drug, which is also called AIN457, for approval by health regulators in Europe and the United States. (Reporting by Caroline Copley; Editing by Mark Potter)

Source: in.reuters.com

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Human nose can detect at least 1 trillion odors says latest study…..

The aromas in the universe can be termed as infinite; it is only now that one can understand the odors which human olfactory mechanism could detect. A recent study has pegged the figure at 1 trillion which is almost a hundred million times over the general consensus on the ability of detecting odors by humans.

The study involved gauging the ability of human nose to detect different odors and the results showed that the human nose is far more sensitive than what it is normally credited for. Medical science is well accustomed to the limits of human auditory and the visual sense organs. This experiment for the first time tried to benchmark the abilities of the human nose. The nose happens to be the most sensitive sense organ when compared to the abilities of the other sense organs. The eyes for example can differentiate between a few million colors while the ear can hear some 340,000 tones. The nose on the other hand can differentiate a trillion different odors.

Study author and molecular neurobiologist Leslie Vosshall of the Rockefeller University said, “Ten thousand is kind of pathetic — it’s a pretty low number. It led to the idea that humans have a comparatively low sense of smell.”

Using a procedure much akin to a hearing exam in which participants have to distinguish between two tones, Leslie and her colleagues put 26 noses in the test. Every subject was given 3 vials, two of them having the same odor. Participants were told to identify the odd one out. Each subject was made to go through hundreds of these tests and the assumption was made that subjects’ performances would be similar in recognizing all possible smells able to be made in the lab. The researchers inferred that an average human nose can distinguish over 1 trillion odors.

The earlier figure of 10,000 odor estimate was based on an earlier outdated manuscript by two American chemists who based their scent classification on four distinct odors- fragrant, acid, burnt and caprylic. It was much akin to the primary colors which made up all the colors. The latest work confirms that odor is an incredibly rich, variable, and nuanced medium.

The study was published online Thursday in Science.

News Source: www.thewestsidestory.net

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Consumption of Salted Snacks Accelerates Ageing Process in Obese Teens: Study

Heavy consumption of salted snacks in obese teens may accelerate the aging process, a latest study shows.

Past studies have shown that telomeres, the protective ends of chromosomes naturally shorten with age. But unhealthy habits such as smoking, no exercise and high body fat, contribute to faster ageing process by shortening the  telomeres.

In order to understand how sodium affects the length of telomeres, researchers conducted the study on 766 teenagers aged between 14 and 18. They were divided into separate groups based on their sodium intake. They found that teens in the low-intake group consumed an average of 2,388 mg/day, compared with 4,142 mg/day in the high-intake group.

The study authors found that participants in both the groups consumed significantly more than the recommended maximum of 1,500 mg/day that is equal to nearly 2/3 teaspoon of salt.

The researchers analyzed several factors that influence telomere length. They found that overweight or obese teens who consumed higher levels of sodium had significantly shorter telomeres than those who consumed less sodium.

"Lowering sodium intake, especially if you are overweight or obese, may slow down the cellular aging process that plays an important role in the development of heart disease," lead researcher Haidong Zhu, M.D., assistant professor of pediatrics at Medical College of Georgia, Georgia Regents University in Augusta, GA., said in a news release.

The researchers said that sodium intake did not affect telomere length in normal weight teens.

 "Even in these relatively healthy young people, we can already see the effect of high sodium intake, suggesting that high sodium intake and obesity may act synergistically to accelerate cellular aging," Zhu said.

The authors said the study results indicated obesity makes a person sensitive to salt. This explains why higher levels of sodium intake have a greater impact on overweight teens.

"Lowering sodium intake may be an easier first step than losing weight for overweight young people who want to lower their risk of heart disease," Zhu said. "The majority of sodium in the diet comes from processed foods, so parents can help by cooking fresh meals more often and by offering fresh fruit rather than potato chips for a snack."

The findings were presented at the American Heart Association's 'Epidemiology & Prevention/Nutrition, Physical Activity & Metabolism Scientific Sessions 2014.

Source: www.hngn.com

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Water births not recommended because of possible risks, medical groups say

Gisele Bundchen delivered her and Tom Brady’s son, Benjamin, at home three years ago while submerged in a water bath; she said in media interviews that the drug-free birth didn’t hurt at all. Actresses Jennifer Connelly and Pamela Anderson also swear by the water births they had naturally at home. But two prominent physician groups issued a new recommendation on Thursday advising against the practice, except in very controlled experimental conditions.

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists concluded that soaking in a tub of water during the early part of labor can reduce a woman’s pain and might shorten labor and the need for an epidural or other painkillers. But the two groups frowned on women staying submerged during the final pushing stage of labor since the “safety and efficacy” of delivering a baby into a pool of water “have not been established.”

The committee of pediatricians and obstetricians pointed to a laundry list of worries doctors have about underwater deliveries, including the possibility of infections in both mother and baby from contaminated water, a dangerous rise in the baby’s temperature from the hot water, umbilical cord rupture after delivery that triggers shock or breathing problems in the baby — or even the rare possibility of drowning.

A 2010 study cited in the new recommendation describes four babies delivered in water who wound up with severe breathing problems right after birth, one of whom died of a sepsis infection.

But the experts also admitted that no one really knows just how risky water deliveries are because scant studies have been done to study their risks and benefits. A 2009 analysis of the 12 small clinical trials assessing the use of tubs during labor found no evidence that the practice was more dangerous than routine labor on a birthing bed, but only three of the 12 studies actually looked at the risks of delivering a baby under water.

Given the dearth of research, obstetricians should consider underwater deliveries to be “an experimental procedure,” the recommendations stated, that should only be performed in a research setting where women are informed about possible risks to themselves and their babies.

I'm sure some fans of underwater births may be inclined to disagree. What do you think? Does laboring in water make sense?

Does laboring in a tub of water sound appealing?

News Source: www.bostonglobe.com

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Nearly half of Americans believe in medical conspiracy theories

About half of all American adults believe in at least one medical conspiracy theory, according to a study from researchers at the University of Chicago in Illinois and published in JAMA Internal Medicine.

Conspiracy theories concerning aliens, secret societies and shadowy governmental organizations have become a firm trope in popular culture thanks to cult television shows, novels and movies like The X-Files and The Da Vinci Code. But conspiracy theories have also sprouted up around numerous public health concerns over the past 50 years.

Water fluoridation, vaccines, cell phones and alternative medicine, for instance, are all subjects of conspiracy-based speculation, but to what extent do the American public put faith in these uncorroborated theories?

The University of Chicago's Prof. J. Eric Oliver put this to the test in his new study. Prof. Oliver and his colleague used an online survey to collect data from 1,351 adults between August and September 2013.

In the survey, participants were presented with popular medical conspiracy theories and asked to indicate whether they had heard of them before and whether they agreed or disagreed with them.

The theories all had a mistrust of government and large organizations as central themes. Some of the theories the participants were asked if they believed included:

• Are US regulators preventing people from getting natural cures?
• Did a US spy agency infect a large number of black Americans with human immunodeficiency virus (HIV)?
• Does the government knowingly give autism-causing vaccines to children?
• Does the government know that cell phones cause cancer but does nothing about it?
• Do companies dump dangerous chemicals into the environment under the guise of water fluoridation?

Overall, 49% of participants agreed with at least one of the theories.

Some of the theories were more well known than others. For instance, 69% of participants had heard of the idea that childhood vaccines cause psychological disorders, such as autism.

This is a theory that has received a lot of media attention and is in the news again at the moment due to controversial Twitter comments from TV presenter Jenny McCarthy. Of the study participants, 20% agreed with this theory and 44% disagreed.

More popular was the theory that US regulators are stopping people from accessing natural cures - 37% of people agreed with this idea, with less than a third disagreeing.

The least popular conspiracy theory - which more than half of the participants disagreed with - was the suggestion that a US spy agency had infected a large number of black Americans with HIV.

What impact do conspiracy theories and belief in them have on people's health?

"Science in general - medicine in particular - is complicated and cognitively challenging because you have to carry around a lot of uncertainty," Prof. Oliver says of the prevalence in conspiracy theory beliefs. "To talk about epidemiology and probability theories is difficult to understand as opposed to 'if you put this substance in your body, it's going to be bad.'"

As well as illustrating that medical conspiracy theories are perhaps more widely believed than had previously been thought, Prof. Oliver's study also found some interesting associations between belief in conspiracy theories and the way people approached their own health.

One example of this is that 35% of people who believed in three or more conspiracy theories took herbal supplements, whereas only 13% of people who did not believe in any conspiracy theories took supplements. People who believed in conspiracy theories were also more likely to use alternative medicine and avoid traditional medicine.

The study concludes:

News Source: www.medicalnewstoday.com

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RPT-INSIGHT-Unease grows among U.S. doctors over Indian drug quality

(Reuters) - Some U.S. doctors are becoming concerned about the quality of generic drugs supplied by Indian manufacturers following a flurry of recalls and import bans by the Food and Drug Administration.

India supplies about 40 percent of generic and over-the-counter drugs used in the United States, making it the second-biggest supplier after Canada.

In recent months, the FDA, citing quality control problems ranging from data manipulation to sanitation, has banned the importation of products from Ranbaxy Laboratories Ltd, Wockhardt Ltd and, most recently, Sun Pharmaceutical Industries Ltd.

"I'm just beginning to realize the gravity of the problem," said Dr. Steven Nissen, head of cardiology at the Cleveland Clinic. "It's terrible and it is starting to get a lot of traction among physicians."

Indian drugmakers are by no means the only companies to recall products or be warned by the FDA about manufacturing problems. For instance, quality control failures at Johnson & Johnson forced the company to recall dozens of products over the past five years, ranging from artificial hips to children's Tylenol.

And last year, Germany's Boehringer Ingelheim said it would shut down its U.S. contract manufacturing unit, Ben Venue Laboratories, after it was cited for repeated manufacturing violations that led to shortages of the cancer drug Doxil.

India's drugmakers, a $14 billion industry, reject any criticism that their products are inferior to drugs made in other countries.

"We have heard doctors making generalized statements, without being specific on any product or company," said D.G. Shah, Secretary General of the Indian Pharmaceutical Alliance, a trade group representing large Indian drugmakers. "This is a deliberate and serious campaign to malign the Indian generic industry."

If U.S. doctors come across a medicine that does not meet quality standards, they should report it to regulators, he said. "Doctors are not in a position to judge whether manufacturing processes are correct or not. That is the U.S. FDA's job."

Generic drugs account for nearly 85 percent of medicines prescribed in the United States and the government is relying on them to help rein in healthcare costs.

"We are losing control over what people are swallowing," said Dr. Harry Lever, a cardiologist at the Cleveland Clinic who is trying raise awareness of the matter among U.S. lawmakers. "Now, when a patient comes in who is not doing well, the first thing I do is look at their drugs and find out who makes it."

Increasingly, Lever said, he is recommending patients seek out generic drugs from specific manufacturers outside India.

"I'm tending to stay away from India," he said. "There's something wrong. Too many things are happening."

INDIA DOCTORS HIT BACK

Indian physicians do not share the concerns.

"Our drugs are being sold in many countries and being accepted, so we have no issues," said Narendra Saini, Secretary General of the Indian Medical Association, a voluntary body of 215,000 doctors. "How do I know that Western drugs are better than our drugs?"

A 2012 report by India's parliament alleged collusion between pharmaceutical firms and officials at the Central Drugs Standard Control Organization (CDSCO), the country's drugs regulator, and described an agency that was both understaffed and underqualified.

Saini said physicians trust that the CDSCO is taking care of the quality and the standard of the drugs made in India.

"We very much trust those medicines," he added.

Representatives of Ranbaxy, Sun and Wockhardt were not immediately available to comment.

Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York, said he is concerned about the quality of generic drugs in general, not just those from India. He cited, as an example, his experience with the diabetes drug metformin.

"When patients open the bottle of medication it smells like dead fish," he said. Zonszein did not know which company made the foul-smelling drug.

Physicians do not have a say in which generic drug a patient receives, as that depends on which products are stocked by individual pharmacies. If a patient wants to avoid a certain manufacturer, he or she may have to change pharmacies.

Doctors may specify that the branded version of a drug be dispensed, but insurance companies frequently refuse to pay for them.

Dr. Richard Kovacs, who heads a number of American College of Cardiology committees and sits on its board of trustees, said doctors may need to play a greater role monitoring the medications prescribed by their practices.

"The average U.S. cardiologist has been able to assume that the drugs were safe and effective. It now appears we need to be more vigilant as a profession, and assist the FDA by reporting cases where we are concerned about irregularities in the drugs supplied to our patients," he said.

HARD TO KEEP UP

FDA Commissioner Margaret Hamburg, who recently returned from her first official visit to India, is urging greater collaboration between the two countries. During her visit, the FDA and India's Ministry of Health and Family Welfare signed a statement of intent to cooperate to prevent the distribution of unsafe drugs.

Shortly afterwards, India's drug controller general, G.N. Singh, said in an interview that the country will follow its own quality standards.

"The FDA may regulate its country, but it can't regulate India on how India has to behave or how to deliver," he said.

Some companies seem to be responding to the FDA's actions.

Piyush Nahar, an analyst with Jefferies India Private Ltd who recently met with a number of Indian drugmakers, said in a recent report that most companies "have increased their investment" in compliance and some are considering investing in U.S. or European facilities "to overcome challenges relating to both regulations and perceptions."

The array of recalls and warning letters can be dizzying.

Ranbaxy recently recalled more than 64,000 bottles of a generic cholesterol-lowering drug after doses were mixed up in a bottle, and Sun began recalling 2,528 bottles of a diabetes drug after a bottle was found to contain an epilepsy treatment.

Those mix-ups follow a recall in January by Dr. Reddy's Laboratories Ltd of more than 58,000 bottles of its heartburn drug lansoprazole due to a microbial contamination.

"It's hard to be sure on a day-to-day basis with the array of medications that you have to be potentially aware of that there's a specific problem with a specific medication from a specific generic manufacturer," said Dr. Elliott Antman, a cardiologist at Brigham and Women's Hospital in Boston.

The medical community is dependent on agencies such as the FDA, he added. "The bottom line for me is we have to make sure they have sufficient resources to do their job correctly."

To Dr. Jason Gaglia, a diabetes expert at the Joslin Diabetes Center in Boston, the warning letters and import bans indicate the FDA is doing its job.

Source: www.reuters.com

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