The rise of antibiotic-resistant bacteria is one of the most serious challenges that medicine faces today. Most strategies to combat these superbugs are focused on efforts to develop ever more powerful antibiotics. But a growing number of researchers such as Scott Hultgren and his team at Washington University School of Medicine in St. Louis are taking a very different tack.

Bacteria that cause many urinary tract infections (UTIs) are normally coated in fine hairlike structures known as pili, which both enable the invasion of host cells and help the bacteria to mount a defense against the host’s immune system. Instead of trying to wipe out these bacteria, Hultgren’s team is trying to create drugs that essentially defang the bacteria by preventing them from growing their pili. "We're leaving the bacteria bald but healthy and happy," says Jerome Pinkner, lab manager for Hultgren. "Rather than trying to kill them, we're working to make them non-pathogenic, so that they will be unable to adhere to or invade the bladder tissues and are readily eliminated from the body." The researchers are hoping to begin tests of their most potent pilicides in animal models in about a year.

What it means: According to an April 2006 National Institute of Allergy and Infectious Diseases fact sheet, resistance to at least one antibiotic has been detected in more than 70% of the bacteria that cause hospital-acquired infections. UTIs mainly occur in women and are one of the most common infections, causing around $1.6 billion in medical expenses every year in the United States. Scientists believe 90% of all UTIs, which have been linked to poor hygiene, sexual behavior, and migration of intestinal flora, are caused by the bacterium e. coli.

Scientists hope that the pilicide approach will significantly diminish the bacteria's ability to find ways of evading the new treatments. Pinkner and his colleagues think the bacteria will find it harder to evolve resistance to a treatment that does not directly threaten their survival. "For bacteria to develop resistance to a new antibiotic, which by definition kills bacteria, all you need is for one bacterium among trillions to acquire a genetic mutation that allows it to survive," Pinkner explains. "We think that pilicides will greatly reduce the pressure to develop resistance and have already shown in the lab that they have no effect on E. coli's growth or metabolic state."

From the Archive:

Jun. 26, 2006: Surviving the New Killer Bug
Mar. 17, 2006: Will We Run Out of Antibiotics?

U.S. hospitals spend roughly $20 billion to treat the nearly two million Americans injured seriously enough each year to require inpatient care, according to a new report by the government’s Agency for Healthcare Research and Quality. Medicare and Medicaid are billed for almost half of all injury cases, and more than 12% of hospital stays of injured patients are uninsured. Here’s the breakdown, by type of injury:

- Broken bones. Factures of the hip, leg, spine, rib and pelvis, arm, and skull are the number one type of injury hospitalizations. They account for nearly one million admissions a year.

- Poisonings. Overdosing on medications or other substances or being given or taking the wrong drug are the second most common cause of injury hospitalizations. They account for roughly one-quarter of a million cases.

- Brain injury. Some 186,000 patients a year are admitted for trauma to the head. Statistically, it is the deadliest injury; one in 10 patients dies in the hospital. Other deadly injuries, measured by their in-hospital death rates, are spinal cord injury (5.7%), burns, and crushing or internal injury (about 4% each), and hip fracture (2.9%).

The most frequent cause of injury was falls, which account for nearly 475,000 admissions and represent 68% of all injury hospitalizations in patients age 65 and older. Other leading causes of injury-related  hospitalizations include motor vehicle crashes, head or body blows, cutting or piercing wounds, gunshots and other transportation crashes, which range from horseback riding to boating accidents.

From the Archive:

Jun. 16, 2006: Why Men Go to the Hospital

It has happened to all of us. We go to bed lonely, sad or with feelings of being overwhelmed. While that's clearly a miserable way to end the day, a new study says it also appears that our bodies attempt to compensate for these negative feelings by pumping up levels of the stress hormone cortisol shortly after we wake up the next morning. That may seem like a double whammy since elevated levels of cortisol, when chronic, have been linked to depression, obesity and other health problems.

But it's more complicated than that, according to Northwestern University Emma Adam, lead investigator of the study, which was published online by the Proceedings of the National Academy of Sciences. Going to bed in a funk actually cues the body to rev up the hormones in order to deal with the loneliness experienced the previous night. The hormone system anticipates possible trouble and wants to be ready. "The boost of hormones in the morning gives you the energy you need to meet the demands of the day," says Adam. It helps you get out of bed and go out into the world.

Cortisol is often characterized in negative terms, explains Adam, because of evidence that long-term elevations could be potentially harmful to physical health. But in the short term the stress hormone is adaptive and helpful. "Cortisol helps us respond to stressful experiences and do something about them," she says. "It is necessary for survival—fluctuations in this hormone assist us in meeting the changing demands we face in our daily lives."

The study was based on data from 156 older adults who participated in the Chicago Health, Aging, and Social Relations Study at the University of Chicago. The cortisol levels of the study participants were measured from small samples of saliva provided three times a day for three consecutive days. Study participants reported their feelings each night in a diary and researchers then looked at whether cortisol levels on a particular day were predicted by experiences the day before or were predictive of experiences that same day.

What it means: "Cortisol responds to and interacts with our daily experiences in subtle and important ways," Adam concludes. Not only does cortisol respond to our feelings and experiences, it also plays a role in influencing them. It is far from being a simple cause-and-effect system. Instead, the study reveals a subtle day-to-day dance between experience and cortisol. Experience influences stress hormones, and stress hormones influence experience.

"Stress systems are designed to translate social experience into biological action," says Adam. "They are designed to be a conduit from the outside world to our internal worlds so that we can better respond to our social context." The goal, says Adam, is to understand how people's changing social environment gets under the skin to influence their biology and health.

From the Archive:

Jan. 20, 2003: The Power of Mood
Mar. 28, 2006: Loneliness and High Blood Pressure

A person suffering from tennis elbow may not have to look any further than his or her own body for the most effective treatment, according to a study published in the November issue of The American Journal of Sports Medicine. Specially prepared blood cells taken from the patient re-injected into the tendon of the affected elbow provides more relief than other non-surgical therapies, concludes researchers Allan Mishra and Terri Pavelko, of the Menlo Medical Clinic at Stanford University Medical Center in Menlo Park, CA. "There is very little risk here; we are using the patient's own blood taken right in the doctor's office, and the whole procedure takes less than an hour," says Mishra. The results of the small, pilot study indicate the therapy is as effective as surgery.

You don't have to play tennis, of course, to come down with painful tennis elbow. It's also common among people whose activities require strong gripping or repetitive wrist motions. Tendonitis is a degeneration of the tendon above the elbow that controls the movements of the wrist and hand. Treatments such as rest, nonsteroidal anti-inflammatory drugs, bracing, physical therapy, and cortisone injections are often used but recent studies have questioned their efficacy. Those who suffer longest may resort to surgical repair of the tendon when all other therapies have failed.

The researchers looked at patients with persistent tendonitis that had not responded to non-surgical treatment. The patients received a one-time injection of platelet-rich plasma (PRP) into their affected elbow. (Platelets are blood components responsible for the formation of clots in response to injury, but also contain powerful growth factors; plasma is the liquid portion of the blood.) Blood was drawn from a patient's unaffected arm and spun down in the physician's office lab to separate the blood's components. Approximately a half-teaspoon of this material--over 500% richer in platelets than whole blood--was then injected into the tendon of the sore elbow.

What it means: After two years, more than 90% patients reported "complete satisfaction" with the treatment.  Nearly all of the PRP-treated patients had returned to work or sporting activities.

Platelet-rich plasma contains powerful growth factors that initiate healing in the tendon, but may also send signals to other cells in the body drawing them to the injured area to help in repair, Mishra theorizes. Treatment with PRP is still considered investigational and further research is needed before it can be made available to the general population.

"The body has an extraordinary ability to heal itself," says Mishra. "All we did was speed the process by taking blood from a different area, concentrating it, and putting it back into an area where there was relatively poor blood supply to help repair the damage."

From the Archive:

Feb. 23, 2004: Inflammation

Smoking tobacco through a waterpipe, or hookah, may be hip but it's rapidly turning into more than a worrisome fad, according to a Georgetown University researcher. "People who use these devices don't realize that they could be inhaling what could be the equivalent of a pack of cigarettes in one typical 30-60 minute session with a waterpipe," says Christopher Loffredo, Director of Georgetown's Cancer Genetics and Epidemiology program.

The trend has hit European and American cities, especially colleage towns, says Loffredo, who has just published a series of studies on the recent boom in waterpipe use in the Eastern Mediterranean region, particularly among young women, who are culturally discouraged from smoking cigarettes. Increasingly, clubs in the U.S. offer hookah pipes at a fee, using tobacco flavored by apples, molasses, or other ingredients. For some reason, waterpipe smokers typically believe that this form of tobacco use is less dangerous.

"People think the water absorbs the toxins, and that is true to some extent if the toxins are water soluble, but tar isn't. And tar contains the carcinogens," Loffredo says. "We believe that, compared to the typical cigarette smoker, waterpipe smokers are exposed to larger total amounts of nicotine, carbon monoxide and certain other toxins. And because the tobacco is burning at a lower temperature, it is more tolerable to inhale deeply, and in fact you need more force to pull air through the high resistance of the water pathway." Loffredo adds: "That means the tobacco smoke can be penetrating deeper in a person's respiratory tract than cigarette smoke does. The damage could be even worse than seen in cigarette smokers, but we haven't done studies long enough to quantify the true cancer risk."

What it means: Sure, puffing on a vintage hookah at a swell club is more glamorous than catching a furtive smoke break in the rain or cold outside your office building or classroom. But then again, it's all the same to your lungs.

From the Archive:

Jan. 27, 2003: Healthy or Not, the Hookah Habit Is Hot
Aug. 10, 2005: Smoking and Lung Cancer

Childhood immunization rates for vaccines routinely recommended for children between 19 and 35 months of age remain at or near record highs, according to a report released this week by the Centers for Disease Control and Prevention (CDC). That's the good news. The even better news is that for the first time in the past 10 years, rates for the recommended vaccines did not vary significantly by race or ethnicity.

According to CDC’s annual National Immunization Survey, estimated immunization coverage rates ranged from 79.5% for children of multiple race, 77.1%for Asian; 76.3 % for black; 76% for white, and 75.6% for Hispanic children. In 2002, comparable coverage was markedly lower for blacks as well as Hispanics.

“These results are terrific news, especially since there are virtually no differences with respect to race and ethnicity for this series of vaccines,” said Anne Schuchat, M.D., director of CDC’s National Center for Immunization and Respiratory Diseases. “We’ve been working hard, with many partners, to ensure that all children have access to recommended vaccines, and these results show we’ve made significant progress."

What it means: In addition to the federal program, Vaccines for Children, which provides free vaccines for uninsured and underinsured children, CDC has worked with its partners to develop and provide education programs and media campaigns for Spanish-speaking and black parents. Since 1994, CDC has created an annual Spanish-language national public service campaign with advertising for radio and television broadcast and newspaper and magazine placement, as well as posters, brochures and education kits for distribution through health clinics and community based organizations.

"Strong efforts to promote childhood immunizations are being made on local, state and national levels, but we need to maintain our vigilance," stresses Schuchat. The numbers certainly make that case. There is still wide variation in coverage levels among states, ranging from 90.7% in Massachusetts to 62.9% in Vermont and, in urban areas, from 84.5% for Jefferson County, Alabama (Birmingham) to 58.8% for Clark County, Nevada (Las Vegas). Clearly the message for routine and complete childhood immunization still needs to be sounded loud and clear and often.

From the Archive:

Jun. 21, 2006: The "Promiscuity" Vaccine
Jan. 20, 2003: Fewer Shots in Store for Baby

While it’s no surprise that a teenager’s brain is different from an adult’s (just ask their parents), precisely how it is different is far from completely understood. For instance, in some ways, feelings may actually matter less to teenagers despite their reputation for being tempermental. How is that possible? According to a study presented at a conference this week by University College London (UCL), teenagers take less account than adults of people's feelings and, often, even fail to think about their own. The results show that teenagers, when considering a course of action, hardly use the area of the brain that is involved in thinking about other people's emotions and thoughts.

In the study, teenagers and adults were asked questions about the actions they would take in a given situation while their brains were being scanned using fMRI. For example, You are at the cinema and have trouble seeing the screen. Do you move to another seat? A second set of questions asked what they would expect to happen as a result of a natural event. A huge tree comes crashing down in a forest. Does it make a loud noise?

It is not so much that teens and adults responded differently to these questions, but rather that they used a different part of the brain to do so. Many areas of the brain alter dramatically during adolescence. One area in development well beyond the teenage years is the medial prefrontal cortex, a large region at the front of the brain associated with higher-level thinking, empathy, guilt and understanding other people's motivations. It’s an area, however, that doesn’t get much of a workout when teens make decisions. Instead, a posterior area of the brain, involved in perceiving and imagining actions, takes over.

"Thinking strategies change with age,” according to researcher Sarah-Jayne Blakemore of the UCL Institute of Cognitive Neuroscience. “As you get older you use more or less the same brain network to make decisions about your actions as you did when you were a teenager, but the crucial difference is that the distribution of that brain activity shifts from the back of the brain (when you are a teenager) to the front (when you are an adult)."

Blakemore explains that the fact that teenagers don't fully use the medial pre-frontal cortex when making decisions, implies that they are not as likely to think about how other people as well as themselves will feel as a result of their intended action.

"We think that a teenager's judgement of what they would do in a given situation is driven by the simple question: 'What would I do?'," she says. "Adults, on the other hand, ask: 'What would I do, given how I would feel and given how the people around me would feel as a result of my actions?'"

A related piece of research presented at the conference shows that teenagers are also less adept at taking someone else's perspective and deciding how they would feel in another person's shoes. Participants aged eight to 36 were asked how they would feel and how they would expect someone else to feel in a series of situations. Adults were far quicker than teenagers at judging emotional reactions – both how they would feel and how a third party might feel in a given situation. For example, How would you feel if you were not allowed to go to your best friend's party? Or a girl has just had an argument with her best friend. How does she feel?

"It seems that adults might be better at putting themselves in other people's mental shoes and thinking about the emotional impact of actions – but further analysis is required,” according to Blakemore. “The relative difficulty that teenagers have could be down to them using a different strategy when trying to understand someone else's perspective, perhaps because the relevant part of the brain is still developing. The other factor to consider is that adults have had much more social experience."

What it Means: Whatever the reason, it's clear that from a cognitive perspective growing up is not a smooth, gradual process. While children start to think about other people's mental states at around age five, this new data shows that the neural basis of this ability continues to develop and mature well past early childhood. Teens must deal not only with wallops of hormones and challenging new social situations, they must also contend with a brain that is a neurologicial work in progress. Group hug.

From the Archive:

May 10, 2004: What Makes Teens Tick
Aug. 8, 2006: Teens, Drugs and Suicide

Most people have heard of obstructive sleep apnea--the sleep disorder in which a person stops breathing for a few to several seconds, but as often as hundreds of times each night. You probably read about it in a health article with "Snoring" in the headline, though the article should have also noted that not all snoring is symptomatic of sleep apnea. And you may be aware that untreated sleep apnea has been linked to cardiovascular problems in those adults who suffer from it. There’s now another reason to lie awake worrying about sleep apnea. In what is believed to be the first study showing neurological changes in the brains of children with serious, untreated sleep apnea, researchers from Johns Hopkins University conclude that children with the disorder appear to suffer damage in two brain structures tied to learning ability.

The Hopkins investigators compared 19 children with severe obstructive sleep apnea (OSA) to 12 children without the disorder. Using magnetic-resonance imaging technology, they identified chemical imbalances in the hippocampus and the right front cortex that indicate injury to brain cells (both areas are involved in learning, memory and higher-level thinking). Next, they used IQ tests and other standardized measurements to evaluate verbal performance, memory and to what brain scientists refer to as executive function. The researchers then compared the changes in the two brain structures to deficits in neuropsychological performance.

The results of the study, published in the online journal Public Library of Science Medicine, will certainly give parents and pediatricians pause. While researchers have known for years that the fragmented sleep that characterizes apnea can hurt a child’s learning ability and school performance, this is the first time they have linked OSA in kids to identifiable brain damage. “We cannot say with absolute authority that sleep apnea caused the [brain] injury, but what we found is a very strong association between changes in the neurons of the hippocampus and the right frontal cortex and IQ and other cognitive functions in which children with OSA score poorly,” says lead author Dr. Ann Halbower. The children with OSA had on average lower IQ test scores (85) than kids without OSA (101) and performed worse on standarized tests measuring verbal memory and word fluency.

What it means: Night-time deprivation of oxygen due to repeatedly interrupted breathing clearly isn’t good for anyone. But the cognitive effects of untreated apnea might be far more damaging in children than in adults, the researchers point out, because they occur during critical developmental periods. Who should worry? OSA is estimated to affect 2% of kids in the U.S., but it is unclear how many of these suffer from apnea severe enough to lead to long-term cognitive deficits.

From the Archive:

Mar. 5, 2006: Sleep Deprived
Sep. 22, 2005: Sleep and ADHD

You may want to have a chat with your pharmacist before you hit the beach, lake, ballpark or even the hammock for some fun in the sun this summer. Certain medications can increase your sensitivity to skin damage from the sun. 

“Antibiotics, such as tetracycline and Cipro, the diuretic hydrocholorothiazide, which is prescribed by itself or in a combination blood pressure medication, and oral diabetes medications, such asglyburide, glipizide, glimepiride are all examples of medications that can cause adverse effects from exposure to the sun,” cautions Lindsey Stephens, Director of Best Practices at the Medicine Shoppe pharmacy chain. “Other medications you must be cautious about are topical acne medicines such as Retin A, as well as procedures like microderm abrasion, both of which uncover fresh skin cells that are more prone to burns.”

But even if you are taking one of these drugs, you don’t have to retreat to a vampire lifestyle this summer. It’s the ultraviolet (UV) component of sunlight that triggers the adverse drug reaction that can result in sunburn or skin rashes. You can minimize your risk by staying out of the sun during peak hours (10 a.m. to 3 p.m.), wearing protective clothing and applying a sunscreen of at least SPF 30 (buy one that contains zinc oxide, titanium oxide or avobenzone, which shield against both UVA and UVB rays).

Not everyone taking a medication that increases photosensitivity will be affected equally, but check with your doctor or pharmacist to find out if you could be at risk. And yes, it’s also a good time to remember other reasons to be wary of the sun. The American Cancer Society estimates that there will be 62,190 new cases of melanoma skin cancer in 2006, a 4.3% increase over last year and more than double the rate of just 20 years ago.

Maybe there should be a new disclaimer on packs of cigarettes. Warning: “Light” cigarettes may be EVEN MORE hazardous to your health than regular smokes.

How’s that possible? Researchers from Harvard and the University of Pittsburgh asked 12,285 former or current smokers this question: Did you ever smoke a lower-tar or lower-nicotine cigarette to reduce your health risks? More than a third, 37%, answered yes. The majority of these seemingly health-conscious smokers were female, white and highly educated.

The problem, of course, is that studies as far back as the 1980s have shown that “lights” can be just as deadly as regular cigarettes. But most people still think that light cigarettes are somehow not as unhealthy as regular ones.

This misperception seems to backfire in a particularly insidious way, according to the study published online by the American Journal of Public Health. “Statistically speaking, the odds of quitting smoking were reduced by about 50% among those people who smoked lights to reduce health risks,” explains University of Pittsburgh researcher Dr. Hilary Tindle. By age 65, this group was 76% less likely to give up smoking. “So even though smokers may hope to reduce their health risks by smoking lights, the results suggest they are doing just the opposite because they are significantly reducing their chances of quitting,” Tindle says.

By any measure, however, kicking the habit can be extremely difficult. Even when the prospect of a smoking-related illness has become a reality. A report released last week by the federal government’s Agency for Healthcare Research and Quality found that approximately 4 out of every 10 adults with emphysema still smoke as do 2 out of 10 adults who have had a stroke or suffer from asthma, high blood pressure, cardiovascular problems or diabetes.

What it Means: We all know the public service messages about smoking and there’s probably no reason to repeat them here. And yet nearly 22% of the adult U.S. population still smokes. So to those smokers who are smart enough to want to quit and haven’t found a way yet, get help or do it yourself but above all, keep trying.

From the Archive:
Sep. 29, 2005 Can Smokers Lower Cancer Risk? 
Mar. 31, 2003 What Are Your Odds?
Aug. 10, 2005 What You Need to Know on Smoking and Lung Cancer

Men and boys account for just over 46% of all non-obstetrical hospitalizations. But because they tend to delay the care and treatment of disease, their prognosis once they wind up in the hospita is on average worse than it is for women and girls, according to the latest statistics from the government’s Agency for Healthcare Research and Quality. The in-hospital death rate for males in 2003 was about 12% higher than for females, even though the average age of hospitalized males was nearly five years younger. The average daily hospital charge for males was also 13% higher.

Nearly one in four hospital stays among males was for a condition of the circulatory system, with coronary atherosclerosis (hardening of the arteries) the most common reason. A number of conditions were also seen at much higher rates among hospitalized men. For example, admission rates were between 50% to 200% higher for reasons such as alcohol-related mental disorders, heart attacks, hepatitis, gout, alcohol-related liver disease, injuries due to motor vehicle accidents, head injuries, arterial aneuryms and crushing or internal injuries. How come? In the dry, but telling language of the government report, “Many of these conditions are related to lifestyle.”

The top 10 conditions for which men were hospitalized and number
of admissions, based on 2003 data (the most recent) were:

1) Coronary atherosclerosis (hardening of the arteries)
764,900

2) Pneumonia (except that caused by tuberculosis and sexually transmitted diseases)
626,400

3) Congestive heart failure
517,900

4) Heart attack
443,400

5) Nonspecific chest pain
378,000

6) Cardiac dysrhythmias (irregular heart beat)
344,200

7) Complication of medical devices (for example, from heart monitors)
310,800

8) Back problems
309,700

9) Depression or bipolar disorder
278,300

10) Chronic obstructive pulmonary disease
273,100

What it means: The conventional wisdom that men don't take such good care of themselves tends to be true.

From the Archives:

Feb. 16, 2006: Spouse in the Hospital? Take special care

Sept. 5, 2005: How New Heart-Scanning Technology Could Save Your Life

When was the last time you really threw a fit? Totally blew your cool, steam coming out of your ears? Maybe it was just a tantrum, a "my bad" moment of anger. But could it have been something more?

According to a study reported in the June 2006 issue of Archives of General Psychiatry, a mental illness dubbed Intermittent Explosive Disorder will afflict 16 million Americans at some point in their lifetimes.

Although it can be difficult to know just where normal anger and impatience end and pathology begins, Intermittent Explosive Disorder is characterized by recurrent episodes of rage, out of proportion to the stress that trigger them. It can be seen in the violent over-reaction that results in lethal road rage or in the physical abuse of a spouse or child.

"In the general population, aggressiveness or 'blowing up' is considered bad behavior; people think, 'This person just needs an attitude adjustment.' But Intermittent Explosive Disorder goes beyond that, having strong genetic and biomedical underpinnings," says coauthor Dr. Emil Coccaro, professor of Psychiatry at the University of Chicago Pritzker School of Medicine. "If people think these explosive outbursts are just bad behavior, they are not thinking of this problem as a serious biomedical problem that can be treated."

Episodes of Intermittent Explosive Disorder rage may not be directly due to another mental disorder or the effects of drugs or alcohol, according to the Diagnostic and Statistical Manual of Mental Disorders. But they may certainly be intimately related.

Among people with this disorder, according to this study, 81.8% also were diagnosed with depression, anxiety, and alcohol or drug abuse disorders, although the age of onset of Intermittent Explosive Disorder was usually much earlier than that of these other disorders.

"This suggests that people with this disorder may be more susceptible to other disorders because of increased stressful life experiences as a result of their disorder, such as financial difficulties or divorce," says Ronald Kessler, professor of health care policy at Harvard Medical School and senior author of the study.

Intermittent Explosive Disorder may be a risk factor for other mental disorders and it may be a lot more common than previously thought. "The weight of these numbers should help patients and physicians come to recognize the pervasiveness of this disorder and develop appropriate treatment strategies," says Kessler, senior author of the study. The study was based on data from the National Comorbidity Survey Replication, a nationally representative face-to-face household survey of 9,282 American adults, conducted from 2001 to 2003.

To be diagnosed with broadly-defined Intermittent Explosive Disorder, a person must have had three major episodes of impulsive aggressiveness at any time in his or her life where the person was significantly more angry than most people would have been in the same situation. These outbursts are sudden and include damage to property and either real or threatened physical harm to others. A narrow definition of Intermittent Explosive Disorder includes three or more of these attacks in one year.

The study shows that for both broad and narrowly-defined Intermittent Explosive Disorder, the first episode of rage occurred in early adolescence, around age 13 for males and age 19 for females. "Given its age of onset, identifying Intermittent Explosive Disorder early, determining its causes, and providing treatment might prevent some of the associated secondary disorders, such as anxiety or alcohol abuse," says Kessler.

What It Means
Telling your doctor that you punched a hole in the wall, tried to run another driver off the road or just totally lost it over a slight isn't easy. And consequently the shame or embarrassment about these violent reactions can understandably prevent people from discussing the problem with their doctors, says coauthor Dr. Maurizio Fava, professor of psychiatry at Harvard Medical School and Massachusetts General Hospital. "Clinicians may also be at fault for concentrating on secondary symptoms, such as anxiety or depression, and not asking about outbursts of anger," he says. But greater awareness of intermittent explosive disorder can help both patients and doctors recognize the need to address the disorder and the havoc it can wreck.

Effective treatment for Intermittent Explosive Disorder includes both behavioral and pharmacological interventions (selective serotonin reuptake inhibitors [SSRIs] and mood stabilizers), says Coccaro. "Ideally, people should be treated with both medicine and cognitive-behavioral therapy. Medicines increase the threshold at which people will explode, and cognitive-behavior therapy teaches people how to handle feelings of frustration or threat that often lead to explosive episodes," he says. Therapy can help teach people to identify triggers that set off attacks of rage.

One thing for sure is that intervention needs to targeted earlier. "If the average onset in males is before age 14, my question is why are we missing it?" asks Jennifer Hartstein, psychologist and assistant professor of Psychiatry and Behavioral Sciences at Montefiore Medical Center in New York City. "Trained people need to be more aware of the diagnosis. ADHD [attention deficit hyperactivity disorder] becomes our go-to diagnosis when kids are inattentive, acting out and having huge temper outbursts. But could some of these problems be better explained with a diagnosis of IED? It is an early warning sign and we are missing it. And if it isn't recognized, these children can't be being taught the coping skills that could help."

The good news is that there are treatment options. But awareness needs to come first. "It appears to come out of nowhere," says Hartstein. "But if someone were to slow it down as though they were watching a movie in slow motion, there are probably times they would notice the buildup of anger. Those are the points at which certain thoughts are taking over and those are the points at which we could potentially help. It is a challenging diagnosis. And it's not just the biological person, but also his or her interactions with their environment. It all argues for an increased awareness and increased presence of school-based mental health clinics."

Intermittent Explosive Disorder may sound exotic now, but chances are we will all hear a lot more about it in the future.

From the Archive:
02/13/2006 Happiness Isn't Normal
11/03/2003 Medicating Young Minds

Anxiety may be the most common mental disorder experienced by older adults, affecting one in 10 people over the age of 60, according to research presented at the Annual Meeting of the American Psychiatric Association in Toronto. Despite its prevalence, anxiety remains one of the most undiagnosed and undertreated conditions in this population.

Examples of anxiety disorders include panic disorder, obsessive compulsive disorder, phobias and generalized anxiety disorder (GAD). GAD is characterized by exaggerated, uncontrollable worries about everyday things. While many worrisome events occur as people age and while it is normal for people to be concerned about such things as deteriorating health and financial troubles, people with GAD tend to worry excessively and constantly.

“Studies have shown that generalized anxiety disorder is more common in the elderly, affecting seven per cent of seniors, than depression, which affects about three per cent of seniors. Surprisingly, there is little research that has been done on this disorder in the elderly,” said Eric J. Lenze, M.D., assistant professor of psychiatry, University of Pittsburgh School of Medicine. “Doctors often think that this disorder is rare in the elderly or that it is a normal part of aging, so they don’t diagnose or treat anxiety in their older patients, when, in fact, anxiety is quite common in the elderly and can have a serious impact on quality of life.” 

This constant level of worry can have negative, and sometimes even disabling, effects on a person’s life. Many people with GAD have trouble sleeping or limit their daily activities due to their anxiety. Untreated anxiety can also lead to anxious depression – a condition that is more difficult to treat and carries a higher risk of suicide than depression.

“Anxiety in people over age 60 might has some similarities to anxiety in those younger, but it also has marked differences. We can’t just assume that we can treat the two age groups the same,” said Dr. Lenze. “We are decades behind where we need to be in terms of research and treatments for anxiety in this older age group.” There are, however, encouraging signs that studies are beginning to address treatment options.

What It Means: Anxious older adults and their families should be aware of the prevalence of anxiety disorders. Excessive fretting should not be considered an inevitable sign of aging. A small pilot study conducted at the University of Pittsburgh has shown that an anti-depressant drug was also effective in treating anxiety in older adults. Additional studies hope to address the role of cognitive behavioral therapy or other therapies for anxiety in the elderly. There are indeed enough things to worry about when growing older. But uncontrollable, excessive worry shouldn’t be among them.

From the Archive:
06/10/2002 The Science of Anxiety
01/20/2003 A Frazzled Mind, A Weakened Body

In a California study of 200 Latina mothers of preschool-aged children, researchers found that these moms frequently have inaccurate perceptions of whether or not their children had a weight problem. "A significant number of women believed that their children were normal weight when they were, in fact, overweight," said lead study author Dr. Elena Fuentes-Afflick, associate professor of pediatrics at the University of California, San Francisco, and a pediatrician at San Francisco General Hospital.

That may not strike us as surprising—after all, how many doting moms would want to label little Johnny or Jane, or Pablo or Maria, as fat? But the findings of the study, which was presented at the Pediatric Academic Societies annual meeting this past weekend, are deeply troubling. Nearly 45% of the children in the study were overweight at 3 years of age. That's bad enough. But perhaps even scarier was the fact that the chances of a child being overweight were highest in families where moms perceived that their children were just fine.“We found that 92% of the mothers of overweight children rated the child’s health status as good or excellent,” said Dr. Fuentes-Afflick.

The study analyzed data from patient interviews conducted for the Latino Health Project. But forget any easy stereotypes about certain cultures preferring chubby babies. "It's not just Latino parents," Fuentes-Afflick noted. "As a pediatrician, when you start to talk to parents about their child's weight or body mass, you have to ask: How much and what are children eating? How much TV are they watching? It's especially challenging to talk about these issues with respect to young children because parents are largely responsible for their children's dietary habits."

What it Means: "If there is a mismatch between what the pediatrician and the mother think is a healthy weight, how do we, as pediatricians, clearly and effectively communicate information about the child's weight to the mother and other family members?" Fuentes-Afflick asked. "As a society, we have a number of negative labels that we use to describe overweight people, and parents don't want their child to fall into that category. It often takes several visits to the pediatrician, communicating the same message before parents understand that overweight is an important issue for children."

As parents we are certainly not doing our children any favors by pretending that weight doesn't matter. And no, we definitely should never insist that anyone, let alone children, conform to some unattainable body image. But parents also need to acknowledge a problem that afflicts ever-growing numbers of children. Ask your pediatrician, "Is my child overweight?" If the answer is yes, find out what you and your family can do about it.

From our Partners: TIME for Kids
02/08/2006 Childhood Obesity on the Rise
12/08/2005 Can Sponge Bob Encourage Healthy Eating?

Yes, you can die from lung cancer even if you've never smoked a single cigarette in your life. Dana Reeve reminded the world of that recently, as do thousands of non-celebrities each year. But that’s still not a reason to adopt a shoulder-shrugging resignation about the perils of smoking.

According to a new study of nearly 1,400 patients published in the American Cancer Society's journal, Cancer, an individual's smoking history also seems to play a role in how patients respond to treatment. Lung cancer patients who have never smoked have better overall survival rates and respond better to chemotherapy than current or former smokers.

The reason may be due to non-smokers having less genetic damage compared to smokers, being less likely to have other ailments that would affect survival, and having better-preserved lung function.

What it Means: We all know smoking is bad for us. There's lung cancer, of course, but there's also cardiovascular disease and a host of other maladies that smoking can cause or exacerbate. So we all know better now, right? But we also need to recognize that smoking is a powerful addiction and an often-irresistible temptation to the young.

The answer is not to think that smokers somehow deserved their lung cancer or that non-smokers somehow got cheated. The real answer, as a society, is to realize that smoking is one of the most serious health threats that exists.

If you smoke, quit. If you don't smoke, don't start. And if you are an adult, do your best to pass this along to any teenagers you happen to know.

From our Partners:
Time for Kids: Will We Ever Have a Smoke-Free Society? (03/31/2006)

The Journal: BioMed Central Public Health

The Study: The children of men with stressful jobs are at higher risk of attempting suicide, particularly if their fathers held jobs in which they had little control over their work. The study, which was funded by the Canadian Population Health Initiative, looked at 30,000 men who were working or had worked at sawmills in British Columbia. Aleck Ostry, from the University of British Columbia, Vancouver, and colleagues collected data on the men's history of employment, their physical work conditions and their psychosocial work conditions, such as the level of responsibility, the control over everyday tasks and their time constraints, all of which can govern the the level of stress the men experienced in their jobs.

The results of the study show that 250 of the approximately 20,000 children in the study attempted or committed suicide from 1985 to 2001. A father's work conditions while his children were younger than 16 years of age had an impact on attempted and completed suicides among those children. In particular, daughters of men with low control over their work may be at higher risk for attempted suicide during childhood and young adulthood. The sons of fathers working in jobs with "low psychological demand" may be at particular risk for completed suicides. The analysis was unusually powerful because the researchers were able to screen out the effect of the father's mental health status on their children's risk of suicide.

What it Means: There's definitely no easy prescription here. We can't all handpick our jobs or working conditions. And it can be just as difficult to control, let alone, eliminate our reactions to stressful situations. So what can we learn from this research? That stress matters, of course, and it matters to entire families. But we need to realize that this study, while very intriguing, still cannot parse cause and effect with any certainty. Just another example of how complicated a child's environment can be and how profound the consequences.

From our Archive:
08/23/2004 Stress and the SuperDad
02/13/2006 Happiness isn't Normal

The Journal: Mayo Clinic Proceedings

The Study: A team of Mayo Clinic physicians and professors of journalism from Arizona State University analyzed 1,203 newspaper articles written on various aspects of neurologic conditions. The stories were taken from the New York Times as well as eight regional newspapers with circulations of more than 200,000. The aim of the researchers was to spot any use of stigmatizing language. While scrutinizing the articles, the researchers also fact-checked the stories for medical errors.

What they found was that 21% of the stories contained language they deemed stigmatizing. Examples include sentences like this one:

>>The victims of stokes can be terrible puzzles, a torture to families, and sometimes an ordeal for the courts.<<

Or this: 

>>"No one would take a meeting with me or anything. I was damaged, goods, babe. That's what was in the back of my mind, damaged goods. Can't fit the American-male leading hero. A hero does not have a brain tumor." <<

In 55% of the cases, the source of the offending phrase was the reporter. But in 43% of the cases, the stigma had been introduced through a comment from patients or family members. Even physicians contributed stigmatizing language in 16% of instances.

The ASU researchers also found that 20% of the articles had medical errors or exaggerations such as overstating the effectiveness of a treatment. Another finding was that neurological conditions with the highest prevalence in the population such as migraines and head trauma were among the least covered subjects, accounting for just 3% and 2%, respectively, of all stories. Celebrities afflicted with a neurological condition were featured in 12% of all stories.

What it Means: While nearly 80% of the articles passed muster, the researchers did point out that stigmatizing language or errors can reinforce a negative self image or inflate hopes. "Health coverage has a big impact on how people view things," says Dr. Joseph Sirven, a neurologist from Mayo Clinic in Scottsdale, Arizona. "Sometimes if there's a negative perception, a patient might give up before they start." The remedy, says Sirven, is care. "We ask that, as reporters are writing, they stop and think about the choice of their words. Not to censor or edit, but to be mindful that sometimes you're creating or adding to the burden of disease."

Since journalists are apt to remain quite fallible folks, however, patients, families and even their physicians should also be careful as well. Both in choosing their words and reading the words of others.

The Journal: Journal of Neurology, Neurosurgery and Psychiatry

The Study: People who take risks with their health appear to be less likely to develop Parkinson’s disease. A team of researchers from England, Australia and the Netherlands looked at a group of 212 individuals—half of whom had Parkinson’s disease—and found that the Parkinson's patients were less likely ever to have smoked. They also drank less alcohol and caffeine than their unaffected counterparts.

How could these habits protect against a degenerative brain disorder that affects movement? One possibility, which earlier studies have suggested, is  that nicotine, alcohol and caffeine somehow protect some parts of the brain, either directly or indirectly.

But another possbility is that susceptibility to Parkinson’s may somehow be linked to the absence of the sensation-seeking behavior that often underlies habits such as smoking and drinking.

The researchers in the current study evaluated the study subjects using standard psychological assessments. They found that individuals who developed the disease scored lower on the sensation-seeking scale and higher for depression and anxiety. The authors of the study raised the possibility that a “Parkinsonian personality” may underlie the susceptibility to the disease. At the biochemical level, this might be caused by low levels of the neurotransmitter dopamine.

What it Means: First of all, many experts point out that determining cause and effect in a retrospective study such as this one is extremely difficult and highly unreliable. And clearly no one would ever suggest that people try to reduce the hypothetical possibility of one disease by taking up behavior that would put them at greater risk of several other diseases.

So is the study bunk? Not necessarily. But this study is a perfect example of how scientific research doesn’t always translate into a useful message for consumers. While it is intriguing that there may be an association between risk taking and a lower incidence of Parkinson’s disease, there is nothing that non-scientists can do with that information.

This point is an excellent one to keep in mind when reading and listening to health news. Granted, there are some studies that are just flawed. But there are many more that represent the imperfect and ongoing search for scientific clues and links.

Indeed, most researchers are quick to point out when their conclusions must be treated cautiously or tentatively. (Truth to tell, you'll also find stories in the press that make scientific conclusions sound more definitive than they are.) It doesn’t mean the research is useless. But it might very well mean that there’s no news-you-can-use message for consumers.

From the Magazine:
12/17/2001 In Defense of Denial
07/19/1999 Eat Your Heart Out

The Journal: International Journal of Cancer (online)

The Study:  Physical activity does not appear to lower a woman’s risk of colon cancer.

Because exercise has been shown to improve immune system function as well as speed the time it takes for food to move through the gastrointestinal track, experts have theorized that it might also inhibit colon cancer. More than forty studies have looked for evidence of this relationship. And though most of the data supports the link in men, for women the conclusions have been mixed.

A new study by researchers from the National Cancer Institute, the University of California-San Francisco and the University of Wisconsin-Madison collected information about physical activity and colon cancer cases for 31,783 post-menopausal women. During the ten-year study period from 1989 to 1998 there were 243 cases of colon cancer in the study group.  The researchers concluded that “our results do not support the hypothesis that physical activity confers significant protection against the overall development of colon cancer in women.” The authors noted, however, that better measures of total physical activity might have revealed such a link. Bottom line: “Our findings point towards the need for conducting further research.”

What it Means: First and foremost, the benefits of exercise in all areas of health and well-being clearly outweigh any doubts when it comes to its effect on any specific illness. So by all means keep up the physical activity. And in general, the more the better. But when it comes to preventing colon cancer, the third most common cancer among both women and men, the best course is regular checkups as well as colonoscopies after age 50 (and possibly earlier for African-American men and individuals with a family history of the disease). For some individuals, low-dose aspirin or another non-steroidal anti-inflammatory medication such as Advil or Motrin might also be recommended.

From the Magazine:
05/20/2005 Exercise to Slow Colon Cancer
12/15/2003 An Easier Colon Test
05/13/2000 Katie's Crusade

Insomniacs will soon have a new drug available to them. Ramelteon, which is to become available to consumers next month under the brandname Rozerem, is the first FDA-approved prescription sleep aid that is not designated as a controlled substance by the Drug Enforcement Adminstration.

The drug is chemically related to the hormone melatonin, which naturally helps regulate the body's sleep-wake cycle. And because it works through a different chemical pathway than other prescription sleep aids, it may help some people in ways that the other drugs cannot. "Current therapies often used for insomnia work by broadly inhibiting the activity of neurons in the brain," says Thomas Roth, an investigator in the ramelteon clinical trials and Director of the Sleep Disorders and Research Center in Detroit. "Ramelteon treats insomnia by specifically affecting the activity of neurons in an area of the brain involved in the sleep-wake cycle, and has been shown to carry no risks of abuse, withdrawal, or dependency, and negligible risk for next-day 'hangover' effects." FDA approval was based on data from clinical trials with more than 4,200 patients ages 18 to 93, some of whom took a single daily dose for up to one year.

The value of a good night's sleep is hard to overstate. And researchers are increasingly finding that sleep doesn't just improve the quality of life--it actually prolongs life as well. According to the National Institutes of Health, some 70 million Americans suffer from either acute insomnia, lasting one to several nights, or intermitten chronic insomnia, which can last for months and even years. The causes can range from factors such as stress, worry and major life changes to physical causes such as pregnancy, menopause, pain, digestive problems, restless leg syndrome or sleep apnea. Insomnia may also signal a deeper underlying condition such as depression. Whatever the cause, according to the U.S. Surgeon General, nearly $15 billion is spent annually on healthcare related to insomnia, while $50 billion is lost in productivity due to sleeplessness.

Don't expect any single pill to be the magic bullet that can give us all a restful night's sleep. But any new way to fight insomnia is certainly good news.

Can some medicines do so much good they should be free? The answer may well be yes, according to a University of Michigan study published in the  Annals of Internal Medicine. Researchers found, on the basis of their new computer model, that if a group of medicines called ACE inhibitors was provided for free to the 8 million Americans over age 65 suffering from diabetes, the result would be fewer heart attacks, strokes and kidney failures, which would translate into a huge net savings in health care costs for Medicare. And, of course, the drugs would save lives.

The researchers based their model on a generic ACE inhibitor that costs around $200 to $300 per year, though bulk purchasers such as the Department of Defense health care system pay much less. By combining efficacy data from clinical trials of the drug with epidemiological data that allowed them to predict the numbers of diabetics who, left untreated, would be likely to suffer heart attacks, stroke and kidney failure, and using standard government and industry data to estimate the average price tag for medical treatment of those events, they concluded the following: If Medicare paid for the cost of the drug for all adults over age 65 who have diabetes, added to the existing cost of all their healthcare until death, the total savings would be $1,600 over a lifetime for each Medicare recipient.

Right now, cost—even when it is nominal—and lack of awareness keep many older diabetes patients from taking ACE inhibitors, which reduce blood pressure and cut the risk of diabetes-related problems in the cardiovascular system and kidneys. In fact, fewer than half of the patients who would benefit from these drugs  actually  take them.

"If only seven percent more people started taking ACE inhibitors when they were offered at no cost," says lead author Dr. Allison Rosen, "Medicare would still save money. The more people that take advantage of the no-cost drugs, the bigger the savings for Medicare over the long term." Saved lives and saved money —what's not to like?

Even though it’s hardly news that Americans spend a fortune on prescription medicine, the exact totals of that spending can still pack some sticker shock. According to the latest data from the federal government's Agency for Healthcare Research and Quality, Americans spent a total of $151 billion on outpatient prescriptions  in 2002—an amount nearly 2.5 times greater than the $65 billion spent in 1996, and almost equal to the entire 2004 national budget of the world's ninth largest economy (Mexico). And  this figure does not include any over-the-counter remedies or drugs prescribed in hospitals, nursing homes or other institutions.

The top-ten list of costliest drugs, with a combined pricetag of nearly $30 billion, was led by Lipitor, the cholesterol-lowering drug, at a cost of $5.9 billion. Cholesterol competitors Zocor and Pravachol also made the top ten, as did anti-ulcer drugs Prevacid and Prilosec, and anti-depressants Paxil and Zoloft.

Sorting the data by number of prescriptions filled, rather than cost, produces a different top ten, which includes five anti-hypertensive drugs, though the list is still led by Lipitor, with 67 million prescriptions. But anyway you slice it, the country's medicine chest is stuffed and growing.

From our archive:
02/02/2004  Why We Pay So Much for Drugs

Top ten prescription drugs for 2002 ranked by U.S. expenditure according to the study by the Agency for Healthcare Research and Quality:

1. Lipitor (cholesterol reducer)     $5.9 billion
2. Zocor (cholesterol reducer)       $4.4 billion
3. Prevacid (anti-ulcer)                  $3.0 billion
4. Prilosec (anti-ulcer)                   $2.6 billion
5. Celebrex (Cox-2 inhibitor
    anti-inflammatory)                    $2.4 billion*   
6. Paxil (anti-depressant)              $2.2 billion
7. Pravachol (cholesterol reducer) $2.1 billion
8. Zoloft (anti-depressant)            $2.1 billion
9. Claritin (antihistamine)              $2.1 billion**   
10. Norvasc (anti-hypertensive)    $2.1 billion

*   In late 2004, FDA issued warnings about possible side effects of Celebrex.
** In late 2002, Claritin became available over the counter without a prescription.
   

Placebos work because patients expect them to work, and the circuits of the brain obligingly follow suit. That's been well established when it comes to physical pain. Now, according to a new study published in Neuron, researchers in Sweden have found that placebos can also alleviate psychological distress.

In a two-day experiment, 15 volunteers were asked to rate their reactions to disturbing pictures, such as images of mutilated bodies. They were told they would initially be given an anti-anxiety drug to reduce distress caused by the pictures might cause, and then be given an antidote that would block the soothing effects of the first drug and restore the full impact of the photos. Before-and-after MRI brain scans confirmed the effectiveness of the anti-anxiety drug in softening unpleasant perceptions.

When the exercise was repeated the following day, however,  the anti-anxiety drug the subjects were told they were receiving was actually a placebo. The second day's before-and-after MRI scans showed that the placebo was still effective in reducing the subjects' distress when viewing the pictures. Clearly the persuasive power of the mind matters, whether in response to physical or emotional discomfort.

From our archive:
03/01/2004  Picturing the Placebo Effect

Cranberry juice may be more than just a generations-old home remedy to treat or prevent urinary tract infections (UTI). New research presented this week at the annual meeting of the American Society for Microbiology suggests the cranberry may also have a future in fighting gastrointestinal viruses that cause countless cases of illness in the U.S. as well as hundreds of thousands of deaths in the developing world, particularly among children.

In fact, say the researchers, it was the recent boom in sales of commercial cranberry-based UTI products that led them to investigate whether cranberry compounds might have antiviral properties. The team tested the juice of the Thanksgiving staple on intestinal viruses found in monkeys and goats, and found that it prevented the viruses from infecting host cells.

The researchers caution, however, that additional studies are needed to determine the effectiveness of cranberry products in combating viruses found in humans. But if the Cranberry Institute, which provided funding for the research, gets its wish, a daily dose of cranberry juice may soon prove to be a good, if very tart, way to stop stomach bugs in their tracks

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