Top Health Stories of 2009: Alzheimer's test tops the Medscape list

A new test that may help detect Alzheimer's disease leads Medscape's list of top medical stories of 2009. The cognitive test examines 10 skills and can detect up to 93% of Alzheimer's cases, according to the Medscape report. The study was published June 10 in the British Medical Journal. Other stories making the list discuss a single screening question that may accurately identify unhealthy alcohol use, naproxen as the best Non-steroidal anti-inflammatory for heart-disease patients and the side effects of cholinesterase inhibitors in older aldults with dementia. Other stories concern a new ingrown toenail treatment, new sleep environment risk factors for sudden infant death syndrome, WHO guidelines for antiviral treatment of swine flu and other influenza and the American Academy of Pediatrics' revised guidelines for treatment of pediatric flu.

Cancer drug might help treat type 1 diabetes

There is hopeful news on the diabetes front this week. A new report in the November 25 issue of The New England Journal of Medicine says a drug used to treat cancer and rheumatoid arthritis helped type 1 diabetes patients keep producing some of their own insulin, even though the disease had destroyed some of their pancreatic beta cells. These are the cells that produce insulin. However, another researcher warned that the study does not show the drug Rituxan to be a "cure" for diabetes, but rather, a modest improvement in insulin levels. More research will be needed and it will take several years to test whether the treatment is feasible, but it's the beginning of another area of potential treatment and continued research might help lead to better control and ultimately to a cure.

Latest breast cancer screening recommendations leave women confused

Most of us had never heard of the US Preventive Services Task Force before last week, but now we expect to hear about its recommendations on breast cancer screening for many months to come. The task force recommends that women not begin getting annual mammographies until age 50 or older. Previous recommendations for screening targeted women 40 and older. Why the change and why now? Of course, it has turned into a political debate, as well as a medical one. Health and Human Services Secretary Kathleen Sebelius distanced the Obama Administration from the decision, saying the panelists joined the Task Force during the Bush Administration. Republicans point to the Democrats saying this is an example of how the new healthcare system would compromise public health. The waters are muddy in this debate, but one thing is clear to me. Women in their 30s and 40s get breast cancer. Most of the people I know who have had breast cancer contracted it during their 30s or 40s, so why would we want to make women guinea pigs (again) for a new approach that is bound to cost some people their lives? It appears that the breast cancer movement has another cause for which it needs pink ribbons...Don't change it, if it saves lives. If women in their 30s and 40s have to pay for mammograms, lives will be lost because in the current economy, many will delay spending the money. Let's be sensible and keep the old recommendations and let this band of questionable "experts" re-evaluate their decision. If one woman dies because of this new absurdity, it's one life too many.

Friends make a positive difference

After a wonderful mini-vacation and the start of a new consulting project, I am returning to blogging about health issues feeling renewed and refreshed. I definitely recommend a long weekend with old friends as a spiritual renewal therapy. We flew to Las Vegas and enjoyed the warm desert sun, the crazy action of the casinos, the wonderful stage shows of Bette Midler, Cirque du Soleil and Donnie and Marie Osmond and the zany company of six friends whom I have known since I was 17. This is good mental health in action! But don't take my word for the benefits of good friends. An Australian study reports that among 1,500 older people studied for 10 years, those who had a large network of friends outlived those with the fewest friends by 22%, according to WebMD. That's a great result! So, I feel blessed that I have good friends who are willing to share my joys and struggles. We are already talking about our next trip together, so I guess that will add another few months to our lives, according to the study!

Diet and exercise can help prevent diabetes

A new study supports the health community's view that diet and exercise can help ward off diabetes for those who are on the brink of developing the disease. Losing weight and controlling diet can help many people avoid diabetes for years, according to a Reuters report summarizing the study. (See also blog entry of October 1.) Researchers at the National Institute of Diabetes and Digestive and Kidney Disease said the 10-year study of overweight people with elevated blood sugar found that those who lost a modest amount of weight lowered their risk of developing type 2 diabetes by at least a third. People over 60 showed even betterresults, cutting their risk of diabetes during the study period by almost 50 percent. The key now is to better educate the public about the risks of obesity and diabetes and to encourage prevention measures early, particularly in those people who have a genetic predisposition to the disease.

Swine flu becomes "national emergency"

President Barack Obama has declared the outbreak of H1N1 flu a national emergency. The move will allow hospitals and local governments to establish alternate sites for triage and treatment if a big wave of patients materializes at one time. The New York Times reports that people are still waiting in long lines for the H1N1 vaccine but in some locations, people are being turned away. It has also led to the cancellation of a soccer game in France after a third player on one team was diagnosed with the swine flu. Health officials said the latest move by the President had nothing to do with a vaccine shortage, but more to do with planning ahead and logistics. This is a prudent move on the part of the Administration and will help hospitals and local officials prepare a "disaster plan" before the worst wave hits the American public.

Sen. Baucus calls for health care reform, introduces legislation that could foster reform

We all have heard the horror stories of people who suffered or died because they had no health insurance. Currently, more than 46 million Americans do not have coverage. The latest unfortunate media reports on the uninsured have involved overweight or underweight infants who have been refused coverage because of their weight, even though they are perfectly healthy in every other way. This is a national disgrace that needs to change. In an online article published Oct. 21 on the web site of The New England Journal of Medicine, Sen. Max Baucus (D-MT, chairman of the Senate Finance Committee,said doing nothing about health care policy is not an option. His committee introduced legislation on October 13, known as the America’s Healthy Future Act. An analysis from the Congressional Budget Office (CBO), said the bill would fulfill the promise to slow the growth of health care costs and to provide quality and affordable coverage. "Preserving the status quo would mean that Medicare would go broke in 2017," he said. In addition, he notes, more Americans would lose their insurance coverage and our country would have to sacrifice other priorities to spend more and more of our federal budget on health care. With his committee's legislation, there would be an increase in the percentage of Americans who have insurance to 94%, he said, adding that the legislation would reduce the federal deficit by $81 billion over the next 10 years. It might not be a perfect solution and the legislation might not attain its highest objectives, but it would be a starting point that could save more lives and begin to fix the problems that plague the health care system of the richest nation in the world. If we have money for guns and war and space missions, we should have money for healthcare and medicines for all who need it.

Autism and mercury in vaccines: new study says mercury levels in children with or without autism are similar

Autism and autism spectrum disorder is a challenging affliction affecting between 1 to 1.5 million Americans. For years, parents and health researchers have searched for a possible environmental cause of the problem that leaves many unable to communicate appropriately or make emotional connections in the same way as others. Some have suggested that the mercury used as a preservative in vaccines might be the cause of autism. So researchers wanted to examine whether kids with autism or other developmental disorders might bioaccumulate higher levels of mercury in their systems than normal kids. A University of California-Davis research team reports that, contrary to what some might have guessed, mercury blood levels were similar in children with autism and in those with normal development. The researchers looked at sources of mercury in the children's environments, such as fish consumption, use nasal sprays or earwax removal products, (which may contain mercury, and the types of vaccinations they received. They also examined dental fillings to determine whether any children had mercury-based amalgam fillings and whether they grind their teeth or chew gum. One interesting finding: children who chew gum and who have amalgam fillings had higher blood mercury levels. The researchers note that autism is a complex disease and will undoubtedly have complex causes. As of now, it doesn't appear that mercury is going to be the single reason for developmental problems. One thing is for sure. They mystery continues and more research is needed.

Regular flu vaccines now available, high risk groups start to receive swine flu shots

It's flu season again and this Autumn we face the threat of the regular seasonal flu in addition to the new 2009 H1N1 or swine flu that has reached pandemic. In most states, the regular vaccine is now available, although spot shortages have been reported in some places, such as South Florida. I'm planning to receive my regular flu shot on Friday if supplies are available. Vaccine manufacturers have focused heavily on readying the swine flu vaccine, and, as a result, the shipments of regular flu vaccines were slowed. H1N1 flu vaccines are being shipped in limited doses, so in many places it available only for the highest risk groups, such as pregnant women, young children and those with compromised immune systems or underlying diseases, and for healthcare workers. These vaccines will be available either in a nasal spray or via injection.

After the shingles, dealing with the nerve pain is the real challenge

Most of us know someone who has had the painful afflication known as shingles-- or herpes zoster virus in the medical world. More than 1 million cases are reported each year in the U.S., mostly in people over the age of 50 or in those with weakened immune systems. A reactivation of the chicken pox virus (varicella)in people who have had that virus in their younger years, Herpes zoster or shingles comes on suddenly as a painful, blistering rash, often after an event that weakens the immune system. Doctors generally prescribe an antiviral medication, such as such as acyclovir, famciclovir, or valacyclovir while the rash is active and for several days after. One of the worst side effects of shingles is post-herpetic neuralgia and its associated lingering pain that can adversely affect quality of life. For this neuralgic pain that persists after the rash disappears, doctors have had great success with the anticonsultant Neurontin (gabapentin). Some even recommend a combination of two anticonsultant drugs Neurontin (gabapentin) and Lyrica (pregabalin) both of which are approved for treatment of the condition. The National Foundation for Infectious Diseases has more detailed information about the disease. Click here.

Hope and health: the Obama Promise

Last weekend on the NBC-TV late night comedy, Saturday Night Live, the writers presented a spoof of President Obama's accomplishments. As Obama, Fred Armisen checked off a "no" to solving the following problems: healthcare, job losses, Iraq, Afganistan, the economic crisis and several others. Obama received a successful yes for the "Cash for Clunkers" program. Fred did not seem to have his heart in the spoof, performing his worst imitation of Barack to date, nevertheless reflecting the quiet diappointment that seems to be creeping in among some Obama supporters. For a President who just took on the worst economic crisis since the Great Depression, perhaps the public is hoping for too much too soon. If history has taught us anything, it's the realization that politics can cause progress to move at a snail's pace. This week the Nobel Prize committee decided to give politics a nudge and awarded Obama the Nobel Peace prize. Some wondered what he had done to deserve the prize. Yet the very idea of someone who is willing to listen to both sides of an issue and willing to negotiate in the true sense of the word is a major step toward some of the world's most pressing problems. Is it wrong to seek to negotiate instead of plunder? Will it become a sign of weakness, rather than strength, to want affordable healthcare for all Americans? The Nobel committee doesn't think so. But the award adds pressure to Obama's already long list of "things to do" to fulfill that hope and promise. If he does nothing else in the first year, he needs to pass some form of health care reform and it appears his Administration is committed to that objective before the year ends. The people who believed in the Obama promise and those who voted for him deserve a portion of the Peace prize. They voted for a change that would foster peace and understanding among all peoples of the planet. Perhaps the committee should have jointly awarded the prize to a host of world leaders,including the heads of North Korea, Iran, the Sudan, and China, forcing all of them to re-evaluate their political and diplomatic approaches to pressing situations and to act in the best interests of all. Just as the people of the U.S. voted for change, so too did the Nobel Prize Committee. Now we need a little patience. Let's hope Obama, given patience and support, can eventually fulfill the promise.

Older heart failure patients do better at home than in hospital, according to new study

Many of us have heard our parents tell us they want to be cared for in the comfort of their own homes, but sometimes when serious illness strikes we think they should be in a hospital setting. Well, a new study appearing in the September 28 Archives of Internal Medicine reports that older patients with decompensated congestive heart failure actually fared better at home than in a hospital setting. The study compared patients treated in a general ward in Italy with those treated at home with a doctor supervising the care. The Italian researchers suggest that the hospital setting is often a dangerous place for Seniors. While the study did not show an improved death rate for either group, it did indicate that for those treated at home it took, on average, longer for them to be readmitted. Among the group treated at home, they showed less depression and had improved nutrition and quality of life.

Babies born now could live to be 100 or more, Lancet study says

Many people dream of of living to be 100, envisioning their photo on a "Smuckers Jelly Jar" salute on NBC's Today Show of the future. But for babies born now, that dream could become a reality in the next century. Researchers at the Danish Aging Research Center at the University of Southern Denmark predict that current life expectancy rates in developed nations will continue to rise and that at least half of all babies born today will live to be 100 or more, according to HealthDayNews/U.S. News & World Report. Statistics from the study indicate that death rates among people older than 80 are still falling. Of course, the idea that many people will be living longer will present new challenges to economic and health systems. The Danish researchers suggest that if people's work weeks are shortened and they extend their working lives, some might further extend increases in life expectancy and health, while also helping the economy.

Blood glucose levels creeping upward? Exercise can help control diabetes

Low-impact excercise programs, such as tai chi,can help people better control their diabetes and lower glucose levels, according to a University of Florida study. The study showed that those who particpated in a tai chi exercise program two days a week with three days of home practice for six months significantly lowered their fasting blood glucose levels and also improved their management of the disease. Subjects also reported enhanced overall quality of life, including mental health, vitality and energy. Tai chi is an ancient form of martial arts that combines deep breathing and relaxation with slow, gentle circular movements. It uses shifts in body position and stepping in coordination with arm movements. The Tai chi program had less stress on bones and muscles than more strenuous exercise, but still had the same beneficial effects in lowering blood glucose levels. So, perhaps we should all use exercise as a preventive measure, along with careful diet choices and weight control to ward off the ravages of diabetes.

Another difference between women and men surfaces: the agony of the feet

Women won't be surprised to learn that they have more foot problems than men. There is a price to pay for loving your shoes. Years of wearing tight-fitting high heels or sandals, slippers and flip-flops with little support are beginning to take their toll on women's feet. A Boston University study in the journal Arthritis Care and Research examined more than 3300 men and women, finding a direct relationship between bad shoe choices and foot pain, according to a New York Times article. More than 60 percent of women said that in the past they generally wore high heels, pumps, sandals and slippers, all of which researchers rated as higher risk. These women had more pain in the hind foot and around the ankle and the Achilles’ tendon. Those women who made sensible shoe choices, such as sneakers, shoes with support and/or rubber soles had less foot pain than the higher risk group. Men have shown more common sense in the shoe area. The study found that fewer than 2 percent wore bad shoes. The researchers recommend that women buy shoes in the right size and width, instead of squeezing into something that looks good but doesn't fit right. This is easier said than done when you're wearing that little black dress or evening gown...but we can try during the rest of the week!

Diabetes may cause abnormal heart rhythms in women, study says

Are diabetes and atrial fibrillation linked in women? A new report in the October issue of Diabetes Care says women with diabetes may be 26% more likely than other women to develop a heart rhythm problem, according to a WebMed article. The study examined 34,000 adults who received health care through Kaiser Permanente Northwest, including 17,000 diabetes patients. Regardless of factors including age, height, weight, blood pressure and previous history of heart disease, high cholesterol and hemoglobin A1c (shows blood sugar control in recent months), women with diabetes were 26% more likely than other women to develop atrial fibrillation. For men, it was interesting that atrial fibrillation was more common in men with diabetes than in men without diabetes, but that gap disappeared when the researchers controlled for other risk factors. Why the gender gap occurs is not clear from the results of the study, but the researchers from Kaiser Permanente plan additional research to explore why women are more affected than men.

U.S. government will track side effects of swine flu vaccine

In the coming months, if you receive a swine flu vaccination and then experience a health event, such as a heart attack, stroke, fainting, respiratory distress or other similar malady, you might wonder if was related to the vaccine. Well, the U.S. government has decided to carefully track all reported potential side effects/health events that directly follow the immunization process, according to an Associated Press report. The goal is to quickly identify any rare, unusual, or "cluster" events and to explain coincidences that can cause false alarms and public uneasiness. Many of these health events would have happened with or without the swine flu shot, health experts say, especially when you are vaccinating so many people. Because this vaccination is new, there is uncertainty about its safety and side effects, so early monitoring is a good move. The monitoring includes three special programs: At Harvard Medical School, researchers will link large insurance databases that cover up to 50 million people with vaccination registries across the U.S., checking in real time to see whether vaccine recipients see a doctor in the weeks after a flu shot and why. They'll compare rates of complaints among the vaccinated and unvaccinated, said the project leader, Dr. Richard Platt, Harvard's population medicine chief. Johns Hopkins will send e-mails to at least 100,000 vaccine recipients to track how they're feeling, and register any complaints that might not trigger a doctor visit. If anything seems connected, researchers can call to follow up with detailed questions. And he Centers for Disease Control and Prevention plans to give recipientstake-home cards that tell them how to report any suspected side effects to theU.S. Vaccine Adverse Event Reporting system. These measures should help identify any adverse effect that is appearing in greater numbers than expected. In the end, however, those that receive the vaccine early are "guinea pigs" for research. Let's hope the benefit outweighs the risk because we know mass vaccinations will ultimately save lives and save serious health consequences.

Surveys indicate American public supports the 'public option' for health insurance

As the debate over a national health care plan continues, there is evidence that the American public may support a government-run insurance plan (public option) more than Congress does. A New York Times/CBS News Poll reports solid support for the public option plan that would compete with private insurers. Other surveys have found similar results, according to a New York Times article. Here's how NYT/CBS phrased the question: Would you favor or oppose the government offering everyone a government-administered health insurance plan — something like the Medicare coverage that people 65 and older get — that would compete with private insurance plans? To that question, a majority -- 65 percent -- answered they would be in favor, while 26 percent opposed and 9 percent offered no position. Yet none of the legislative proposals that include the public option would make it available to everyone. It appears that at the outset it would only be available to those who do not currently have insurance or whose employers do not meet all the criteria for employer-sponsored health plans. Most Republicans in Congress oppose a non-profit government-sponsored health plan, saying it creates "socialized medicine" and would have such an advantage that it would drive most other for-profit insurors out of business. Senator Ron Wyden, (D-0Regon) is fighting for more options that would create competition and drive down prices. The Congressional Budget Office estimates that if the nation had a public plan, at least 11 to 12 million people (just under 5 percent of the U.S. population) would sign up for it.

British researchers identify enzyme that is key to clogged arteries

Have you ever wondered why some people's arteries clog up and what really causes the process? British researchers think they have made an important discovery about the cause, according to a Queen Mary,University of London press release. They have identified an enzyme called matrix metalloproteinase-8 (MMP8)that they believe plays an important role in raising blood pressure and causing abnormal build-up of cells in the arteries. Of course, both factors increase the risk of heart disease. In addition to animal studies, the researchers also performed coronary angiograms to study 2,000 patients who were being tested for clogs in arteries leading to their hearts. They report that around 25 percent of these patients had a slightly different version of the gene for MMP8 and their arteries were more clogged than other patients. The research team form Queen Mary Hospital, University of London, hope their discovery will lead to new drugs to prevent high blood pressure and heart disease.

Researchers are rethinking causes of Alzheimer's disease...moving from amyloid to myelin targets

For decades, many Alzheimer's researchers have targeted the peptide amyloid beta as the toxic culprit that forms sticky plaque in the brains of Alzheimer's patients. But some researchers are now wondering if this is the wrong target. What if the disease starts much earlier, fed by a natural process? George Bartzokis, UCLA professor of psychiatry, said a better working hypothesis of Alzheimer's cause is the "myelin model," a model of the human brain that could lead to new and better therapeutic approaches, according to a UCLA news release. Myelin, the fatty sheath that coats our nerve axons, allows for efficient conduction of nerve impulses and is the key to the fast processing speeds that support our higher cognitive functions, the report says. It also helps to encode our memories.But because the human brain is myelinatd throughout our lives, it is also more vulnerable to damage. In the myelin model of Alzheimer's disease, the normal, routine maintenance and repair of myelin throughout life initiates the mechanisms that produce degenerative diseases like Alzheimer's. Bartzokis believes the amyloid beta may actually develop (and build up in the brain) as a result of the natural process of the repair and maintenance of myelin. He believes that the breakdown that leads to AD and other age-related brain diseases, such as Parkinson's may begin much earlier, before the formation of the protein deposits that are used to define these diseases. This new approach to studying Alzheimer's may eventually produce treatments that actually prevent AD, rather than treating the symptoms, offering new hope for the next generation that faces these brain-wasting diseases.