Friday, February 6, 2009

Green tea blocks cancer drug benefits -

Many consider it a miracle beverage that can help shed pounds, reduce the risk of heart disease and even ward off some types of cancer.

But new research suggests that green tea may also have a dark side - by blocking the effects of a cancer drug.

Components of green tea seem to bind to the cancer drug bortezomib, also known by brand name Velcade, and stop it from reaching its target in cancer cells, according to a study published online yesterday in the journal Blood.

Velcade is primarily used to treat multiple myeloma, a type of blood cancer.

Health Canada approved the drug in 2005 for use in patients who have already received at least one prior therapy or a stem-cell transplant, or are not suitable for transplant.

"We expected the opposite. We expected that [green tea] would help the drug," said Axel Schönthal, professor in the Keck School of Medicine at the University of Southern California in Los Angeles and senior author of the study.

The discovery is also a strong reminder that herbal remedies aren't necessarily benign just because they occur naturally.

"The danger is that nowadays in every health-food store, you can buy these concentrated green tea extracts," Dr. Schönthal said. "All types of cancer patients, they read up on these alternative treatments. It is known that some of them do take different types of herbs and everything that is available in health-food stores."

Green tea is made from the leaves of the Camellia sinensis plant and has been used for thousands of years in traditional medicine. Health Canada has given companies that sell green tea approval to make three health claims about their products: Green tea is a source of antioxidants; it can increase alertness; and it may support or maintain cardiovascular health.

Studies examining whether green tea lowers the risk of developing cancer, cardiovascular disease or a host of other health problems have been contradictory.

But the new study sheds light on a potentially dangerous interaction that needs to be brought to the attention of health-care professionals, Dr. Schönthal said.

"I think the primary point would be to spread the message that physicians can tell their patients they have to avoid green tea and the green tea products."

Dr. Schönthal embarked on the study to determine how green tea might boost Velcade's effectiveness. In a study involving mice, however, the researchers quickly learned that molecules in the tea deactivate the drug.

The finding touches on an important issue that is creating concern among a growing number of health experts. Millions of Canadians take herbs, vitamins and supplements to improve their health. But in many cases, little research has been done to determine if natural health products cause potentially dangerous side effects when mixed with certain drugs, and even food products.

Consumers shouldn't assume natural remedies are safe, and should become educated about the potential risks of such products, as well as the benefits, according to Bruce Holub, professor of nutritional sciences at the University of Guelph.

"I don't think we can ever be 100 per cent confident with any of these [natural products]."

Dr. Schönthal said herbal remedies may have health benefits, but more research must be done to better understand potential risks as well.

"It's quite likely that most of these herbs are probably harmless and in the case of green tea, under certain circumstances, they're probably beneficial, but in this particular case ... it's clear that green tea is harmful."

Wednesday, February 4, 2009

More nails in the coffin for acupuncture: and some bad journalism

A new review appeared in the BMJ today. It is by Madsen et al., from the Nordic Cochrane Centre, Copenhagen. Here are the conclusions.

  • The analgesic effect of acupuncture is small and cannot be distinguished from bias resulting from incomplete blinding.
  • The analgesic effect of placebo acupuncture is moderate but very variable as some large trials report substantial effects.
  • The effect of acupuncture seems to be unrelated to the type of placebo acupuncture used as control.

The results confirm, yet again, that there is essentially no difference between "real" acupuncture and sham acupuncture. All that talk about meridians and Qi really is so much mumbo jumbo.

It has often been supposed that acupuncture is a theatrical placebo, but because of the placebo effect it produces more pain relief than (non-blind) controls.  This study confirms that there is likely to be such an effect, but it also finds that the size of the placebo effect is too small to be useful to patients

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Modern Medicine - Medical Resource, Medical Information, Medical Articles

ModernMedicine™ is an innovative online clinical decision-support resource that provides healthcare professionals with instant answers to clinical and practice management questions from highly credible and trusted sources.  Our mission is to become the leading online clinical decision-support, CME and practice management resource for healthcare professionals (HCP).

ModernMedicine™ provides healthcare professionals with access to a robust, cross-specialty library of updated content that is complemented by interactive tools and features. Formulary Counselor™, Coding Counselor™, Pay for Performance Center and Patient Education Center support optimal patient care, and provide advisory resources for more accurate and efficient reimbursement, patient compliance and disease management.

FDA Panel Urges Ban of Pain Drug

An FDA advisory panel narrowly voted Friday to recommend that a popular pain drug used in dozens of products should be pulled from the market.

The drug, called propoxyphene, has been sold in U.S. pharmacies for more than 50 years and today is used in dozens of generic pain medications. Two brand-name versions of the drug, Darvon and Darvocet, are used by millions of patients each year, according to the FDA.

The panel vote was 14-12 in favor of a recommendation to halt sales of the drugs. The FDA officials say it will take them at least several weeks to decide whether to ban propoxyphene from the market.

"It's not a very clear-cut picture," Sharon Hertz, MD, deputy director of the agency's analgesia drugs division, told reporters. "It's not straightforward that it should or shouldn't come off the market."

But at the same time, monitoring in Florida and nationally by the FDA suggests the drug may play a role in increasing the risk of suicides and accidental deaths. The agency collected reports of more than 1,400 deaths in people who had taken the drug since 1957, though experts stressed the figure does not prove the drug was the cause of death in all cases.

"I would say, little 'b', big 'r' for this drug. That's little benefit and lots of risk. And that's unsettling, says Ruth Day, PhD, a member of the panel from Duke University who voted to remove the drug.

Most other experts said they thought the risk of a drug containing propoxyphene was probably relatively small. But they also worried that there are few studies showing that it is more effective than other drugs that may be safer.

Propoxyphene is a narcotic opioid drug. It "looks like it offers placebo benefits with opioid risks," says Sean Hennessey, PhD, a panel member and epidemiologist from the University of Pennsylvania.

But several experts warned that removing Darvon, Darvocet, and other propoxyphene-containing drugs could cause disruptions for pain patients. They cautioned it could drive patients to other pain medications like OxyContin.

"Every drug you're talking about that's going to deal with pain has difficulty," says Mary Tinetti, MD, a professor of medicine at Yale University. "There is the possibility that the drugs that would take its place would cause at least as much harm in some people."

The FDA considered the issue of propoxyphene after the watchdog group Public Citizen petitioned to have the drug removed. The agency initially did not respond, and the group sued the government to do a review.

Health authorities in the U.K. ordered a phased removal of propoxyphene in 2005. The drug is now almost completely off the market there.

Sidney Wolfe, MD, director, of Public Citizen's Health Research Group, presented data from the Florida medical examiner blaming 85 deaths on propoxyphene in 2007.

"If that's not a risk, I don't know what is," Wolfe tells WebMD.

Darvon and Darvocet are sold by Xanodyne Pharmaceuticals Inc. James B. Jones, MD, the company's vice president for clinical development and medical affairs, tells WebMD that the narrow panel vote offers "plenty of room to have a lot of good discussion" with the FDA over whether the drugs should stay on the market.

If FDA keeps the drug on the market, it could require new safety warnings or other restrictions.

"I'm hoping to do everything we can to keep this product available to the 22 million people who need it," Jones says.

Public Citizen first petitioned to have propoxyphene banned in the 1970s.

"It is at least gratifying to see that a majority of people think this drug should come off the market," Wolfe said after the panel vote.

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Tuesday, February 3, 2009

Ethicists debate doctors who keep it personal -

Have you ever sat frazzled in a doctor's office, waiting for your or your child's appointment, only to glance up and see one of those Norman Rockwell paintings of a kindly old doctor gently pressing a stethoscope against the heart of a little girl's doll?

In this age of managed health care, when personal doctoring is shoved behind the priority of filling out forms and charging co-pays, it's enough to make you throw a tongue depressor at the image.

But though those Rockwell-esque physicians are infinitely more scarce than they were a century ago, they do still exist. Some are family doctors in small towns, but others include busy emergency-room physicians and specialists who make "Best Doctors" lists and lecture at Ivy League medical schools. They are the doctors who still make house calls because it's in the best interest of the patient, not their bottom line, who say a prayer with a distraught family, who give their own blood to a sick child.

Yet some medical ethicists warn against practicing medicine too empathetically or becoming too involved in patients' lives, saying it compromises treatment and the profession as a whole. Others argue personalized care will become extinct if physicians are not able to set aside the business of doctoring and resurrect the art of medicine.

More ... Brain training games get failing grade

That Nintendo brain-training game you're carrying around in your purse may be sparking some mental activity, but new evidence suggests your prefrontal cortex may be just as happy with a crossword puzzle or a good book.

While millions of trendy puzzle-based video games have been sold around the world on the premise that they can improve cognitive function - and even reverse the signs of an aging brain - there's nothing the "technological jewel" can do that low-tech alternatives can't, according to cognitive psychologist Alain Lieury of the University of Rennes 2 in France.

Dr. Lieury and his colleagues tested the impact of the electronic exercises over seven weeks on a sample of 67 10-year-olds split into four groups.

Two groups played the bestselling Brain Training game (known as Brain Age in North America) on Nintendo DS in addition to doing their regular school work. One group was given puzzles to do on paper, and a fourth group was given no extra work. Memory and math tests were given before and after the training period.

On the memory tests, which involved maps, the puzzles-only group showed a 33-per-cent improvement, but the Nintendo kids' performance dipped 17 per cent. The Nintendo and puzzle groups matched each other with a 10-per-cent rise in logic scores. In math, all four groups - even the ones with no extra work - showed roughly an 18-per-cent jump in scores.

Dr. Lieury says his research proves that the buzz around the Nintendo games and their creator, Japanese neuroscientist Ryuta Kawashima, is more about marketing than science. In the paper's conclusion, he writes that Dr. Kawashima joins a long list of "marchands de rêve" (dream merchants).

Dr. Kawashima's games are "not efficient," Dr. Lieury said in an e-mail interview.

"Nintendo should say clearly, 'It's a game, not a scientific test.' "

Dr. Lieury's work was published last month in the Bulletin de Psychologie.

Toronto neuroscientist Endel Tulving has not seen the games himself, but cautions that the activities are unlikely to be transferable to specific skills such as improving memory.

It's akin to hitting the gym for two hours a day and expecting to be good at all sports, says Dr. Tulving, chairman of the Rotman Research Institute.

Media reports of Dr. Lieury's study this week have spurred Nintendo lovers to fill comment boards in defence of the games. "It's not Nintendo's claim that Brain Age is somehow better than exercising your brain in other ways, just that it's more fun, and more convenient," one observer wrote on Wired magazine's games blog.

Another wrote: "Even if there were no measurable benefits (I believe there are), just using Brain Age makes people feel good about what they're doing. That's more than enough benefit in my book."

Some observers challenged Dr. Lieury's assertion that if the games don't work for 10-year-olds, they won't work for adults, a criticism echoed by some experts.

"There are many processes going on in the elderly that are qualitatively different than those going on in children," said Robert Sutherland, an expert in neurobiology and memory at the Canadian Centre for Behavioural Neuroscience at the University of Lethbridge in Alberta.

Even people in their 40s and 50s don't produce new brain cells the way they did when they were children, he said. Everything from reading to exercise can stimulate blood flow to the brain and delay its deterioration.

The kids Dr. Lieury studied are at an age when they need little additional stimulation, he said. This may explain why the math scores improved in the group of children who had no additional training.

While Dr. Sutherland said the results might have been more robust in older people, he agrees with Dr. Lieury's general conclusions.

"These games are probably okay, but you're paying a lot of money when a walk in the park with friends would be even better," he said. "And free."

But don't rush to replace your Nintendo with a single alternative brain cure.

"I wouldn't get stuck on one thing. A lot of older people think that there's something magical about Sudoku or a crossword. There isn't," he says. "The kinds of activities that are helpful are only narrowed down by the imagination."

It comes down to the old adage: Use it or lose it.

"It's like there's no magic to enhancing the strength of your bicep; you actually have to use it."

Sunday, February 1, 2009

Unboxed - Disruptive Innovation, Applied to Health Care -

The health care system in America is on life support. It costs too much and saps economic vitality, achieves far too little return on investment and isn't distributed equitably. As the Obama administration tries to diagnose and treat what ails the system, however, reformers shouldn't be worried only about how to pay for it.

Instead, the country needs to innovate its way toward a new health care business model — one that reduces costs yet improves both quality and accessibility.

Two main causes of the system's ills are century-old business models, for the general hospital and the physician's practice, both of which are based on treating illness, not promoting wellness. Hospitals and doctors are paid by insurers and the government for the health care equivalent of piecework: hospitals profit from full beds and doctors profit from repeat visits. There is no financial incentive to keep patients healthy.

"The business models were all created decades ago, and acute disease drove those costs at the time," says Steve Wunker, a senior partner at the consulting firm Innosight. "Most businesses in this industry are looking at their business model as entirely immutable. They're looking for innovative offerings that fit this frozen model."

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