Heart surgery drug linked to death risk

Tue, 06 Feb 2007 17:30:53 -0800
By CARLA K. JOHNSON, Associated Press Writer
CHICAGO - A drug widely used to prevent excessive bleeding during heart surgery appears to raise the risk of dying in the five years afterward by nearly 50 percent, an international study found.
The researchers said replacing the drug — aprotinin, sold by Bayer AG under the brand name Trasylol — with other, cheaper medications for a year would prevent 10,000 deaths worldwide over the next five years.

The findings were more bad news for Trasylol: The same scientists found the drug raised the risk of kidney failure, heart attacks and strokes in a study published last year. Most of the deaths in the new study were related to those problems.

Bayer said in a statement that the findings are unreliable because Trasylol tends to be used in more complex operations and the researchers' statistical analysis did not fully account for the complexity of the surgery cases.

Nevertheless, the drug company said it will "work with regulatory agencies and external experts in the field to further evaluate the findings."

The study, published in Wednesday's http://jama.ama-assn.org

Indonesia defends decision on bird flu

Wed, 07 Feb 2007 02:35:31 -0800
By ZAKKI HAKIM, Associated Press Writer
JAKARTA, Indonesia - Indonesia defended its decision to stop sharing bird flu samples with the World Health Organization, saying Wednesday it did not want the agency passing them on to drug companies to develop vaccines the cash-strapped country could not afford.
Health Minister Siti Fadilah Supari said, however, that WHO and other international organizations were welcome to the samples so long as they signed an agreement that they would not be used for commercial purposes. It was unclear whether this offer could be a solution to the standoff.

She made the remarks after signing a memorandum of understanding with U.S. drug manufacturer Baxter Healthcare Corp. to develop a human bird flu vaccine in Indonesia, the country worst hit by the virus.

Kim C. Bush, president of Baxter's vaccine unit, said the company was not involved in the Indonesian move to cut off WHO, which threatens long standing international cooperation in producing vaccines and could lead to other developing countries with similar concerns following suit.

"We believe it is strictly a business matter with the Indonesian government and WHO and other countries," he told reporters. "We will not be involved in that process or have we been in the past."

Under the agreement, Indonesia will provide strains of the H5N1 virus circulating in the nation and Baxter will offer technical expertise to produce the vaccine, said Supari.

The vaccine — which is a long way from commercial production — will be made in Indonesia for mostly local use, Supari said.

On Tuesday, WHO chief of communicable diseases Dr. David Heymann confirmed that Indonesia had stopped sharing bird flu samples with it because the agency makes them available to vaccine makers — something has been doing with regular flu virus strains for 50 years.

He said he understood Indonesia's concerns, but there was no "easy solution" to the problem.

WHO spokesman Dick Thompson said "this development is a concern to WHO, there's no doubt about that," adding the full impact on the agency's work was still not clear.

Supari on Wednesday defended Indonesia's stance.

"The specimens we send to WHO ... are then used by vaccine makers who them sell to us ," she told reporters. "I say this is unfair; we have the virus, we are getting sick and then they take the virus from WHO, 'with WHO's permission' they say, and make it themselves."

Several countries are developing vaccines to protect against H5N1, the strain of bird flu responsible for 163 human deaths around the world, around one third of them in Indonesia.

The virus remains essentially an animal disease, but experts fear the virus may mutate into a form easily spreadable between humans and trigger a global pandemic, possibly killing millions.

The vaccines currently under production may offer some protection against any pandemic strain, but there is no guarantee. Experts say it could take six months before they could be adjusted to provide full protection if there is a pandemic.

Doctors say superbug can be controlled

Tue, 06 Feb 2007 19:04:05 -0800
By JOANN LOVIGLIO, Associated Press Writer
PHILADELPHIA - Hospitals can successfully tackle the alarming spread of a dangerous and drug-resistant staph infection with an aggressive program to immediately identify and quarantine patients carrying the superbug, infectious disease doctors said at a conference Tuesday.
A pilot program started at the Pittsburgh Veterans Affairs Healthcare System in late 2001 has dramatically reduced the rate of the potentially deadly germ, called methicillin-resistant Staphylococcus aureus, or MRSA. It is resistant to most antibiotics and usually acquired in hospitals and nursing homes.

MRSA infections in the Pittsburgh VA surgical care unit have dropped more than 70 percent, infectious diseases director Dr. Robert Muder said.

"You don't necessarily have to do it the way we did it, but you can do it," Muder told members of the Association for Professionals in Infection Control & Epidemiology at a meeting at the University of Pennsylvania.

VA guidelines require that all patients get their noses swabbed to screen for MRSA upon admission and discharge. Those with the bug are isolated from other patients, treated by health care workers in gowns and gloves, and with equipment — from blood pressure cuffs to stethoscopes — that gets disinfected after each use.

There are also administrative changes such as weekly briefings and data sharing as well as an aggressive push for strict hand-washing policies.

VA officials decided to roll out the experiment to its 150-plus hospitals nationwide after seeing the Pittsburgh results, Muder said. They'll start testing for MRSA in intensive care units next month and expand incrementally until everyone is getting screened, he said.

MRSA is a big problem in health care settings, where patients have invasive catheters and open wounds, and is primarily spread from patient to patient on the contaminated hands, equipment and clothing of health care workers. When it gets into the body, it can cause anything from flesh-eating infections to pneumonia.

About a third of people have the germ on their skin or in their nose but aren't sick. They are said to be "colonized" but not infected with MRSA — but they can still spread the germ.

CDC estimates that about 90,000 people die from hospital-acquired infections annually. About 17,000 of those deaths involve MRSA.

Other hospitals have myriad anti-MRSA approaches — a few places screen everyone, some test just high-risk patients such as those who have weak immune systems or live in nursing homes, and others screen just those in high-risk units like intensive care.

"Having different hospitals doing it different ways will help us see what works," said Dr. Harold Standiford, the University of Maryland Medical Center's infection control chief, who also gave a presentation at the program. "It's going to be a continual process."

The Centers for Disease Control and Infection suggests screening at-risk patients but stops short of recommending universal testing. That is criticized by advocates for across-the-board screening who say Denmark, Finland and the Netherlands essentially eradicated soaring MRSA rates using that method.

Muder said hospitals should have flexibility to tailor their own programs.

"The CDC says that if whatever approach you're using is not working, you need to become tougher and do universal screening," he said. "They're trying to avoid a one-size-fits-all approach."

One U.S. hospital taking a more aggressive stance is Evanston Northwestern Healthcare in Illinois. In addition to screening everyone, MRSA carriers also get special soap washes and antibiotic nasal cream, and the hospital uses a new gene-based MRSA test that provides results in hours as opposed to days.

The faster test is more expensive — $27, as opposed to $9 for the traditional test — but pays for itself in the long run, said Dr. Lance Peterson, Evanston Northwestern's infectious disease director. The hospital saves about $25,000 in uncovered medical costs per patient for every MRSA case they can prevent, he said.

"This is a really nasty bug, and it's becoming more apparent that we don't have to live with it," Standiford said. "Now we have new techniques and good studies to show that they're effective."

W.Va. offer programs to reduce obesity

Tue, 06 Feb 2007 17:48:04 -0800
By APRIL VITELLO, Associated Press Writer
CHARLESTON, W.Va. — West Virginia is taking drastic steps to shed its status as the third-heaviest state in the nation. More than 1,200 of the state's heaviest public employees have lost 14,000 pounds under one program. And obese Medicaid recipients will soon get to join Weight Watchers for free.
Nearly a third of adult West Virginians are obese, according to a report issued last year by the Trust for America's Health. That makes the state the third-heaviest behind Mississippi and Alabama.

West Virginia's Public Employee Insurance Agency decided to target the estimated 60,000 heaviest government workers and teachers after the agency was faced with rising costs related to obesity-related health problems and increased demand for lifestyle programs.

Eligible employees pay up to $258 in co-payments for a yearlong program that requires them to track their weight, exercise at least twice a week and pay attention to their eating habits. Success is measured, in part, by weight and inches lost, and muscle mass gained.

At 297 pounds, elementary school teacher Rhonda Stover considered surgery before learning of the program.

"I had a lot of physical problems with my knees, feet, joints and lower back," Stover said. "I was getting very disabled carrying around all that weight."

Stover completed the program in October and is now working to keep off the 124 pounds and 71 inches she lost. She has been able to cut the number of prescription drugs she depended on from five to two.

The Council of State Governments estimates that at least 12 states have weight-loss programs for public employees, but West Virginia's appears to be the only one targeting obese workers.

"When you have large problems, you have to be creative in the way you go about solving them," said Nidia Henderson, health promotions manager for the public insurance program.

In a separate program, thousands of the state's poorest residents will be able to enroll in Weight Watchers when the state's largest Medicaid provider begins offering up to 16 weeks of service for free.

Medicaid clients who obtain a physician's referral and score within specific ranges on the fat-measuring body mass index will be eligible to take part in the program, which is known for its regular meetings and system of assigning points to different foods.

Neither state insurance nor Medicaid officials were willing to discuss how much money might be saved from the initiatives. They preferred to focus on the benefits for recipients.

"It's not about immediate cost containment," said state Medicaid spokeswoman Shannon Riley. "This is about slowing the growth of lifestyle-induced diseases and disabilities."

Advocates of the Medicaid-Weight Watchers partnership hope it will serve as a model for other states.

"I think all states are going to have to start addressing this," said John Monahan, president of state-sponsored programs for Indiana-based Wellpoint Inc., the nation's largest health insurer.

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