PharmD|Pharmacy Schools : 2007 : 2007_03_22

• Firefighters face heart risks in a blaze

• Chinese restaurant food draws criticism

• Some doctors balk at inhaled insulin

• Dietary supplement for Parkinsons eyed

• A pharmacy in this neighborhood Are you crazy

• Braindamaged people give insights into morality

• Scientists find gene that may regulate colon cancer

Firefighters face heart risks in a blaze

Thu, 22 Mar 2007 03:05:13 GMT
By ALICIA CHANG, AP Science Writer
Firefighters face a far greater risk of dying of heart problems while battling a blaze than was thought, suggests a large U.S. study that offers more evidence of their need to stay in shape. The risk of a heart-related death while putting out a fire was up to 100 times higher than the risk during down time, Harvard researchers found, even though fighting fires accounts for only a small percentage of these workers' time.
About 100 firefighters die in the line of duty each year and previous research has shown that nearly half of the deaths are due to heart disease. The vast majority — about 70 percent — of the nation's roughly 1 million firefighters are volunteers.

Experts say diet and exercise should be priorities at the firehouse.

"You may not be able to prevent all these deaths, but to the degree you can prevent some deaths by paying attention to underlying risk factors and better fitness programs, that's the goal," said Dr. Linda Rosenstock, dean of the UCLA School of Public Health, who was not involved in the study.

The study, published in Thursday's http://www.nejm.org
Harvard School of Public Health: http://www.hsph.harvard.edu

Chinese restaurant food draws criticism

Thu, 22 Mar 2007 03:04:41 GMT
By LIBBY QUAID, AP Food and Farm Writer
WASHINGTON - The typical Chinese restaurant menu is a sea of nutritional no-nos, a consumer group has found. A plate of General Tso's chicken, for example, is loaded with about 40 percent more sodium and more than half the calories an average adult needs for an entire day.
The battered, fried chicken dish with vegetables has 1,300 calories, 3,200 milligrams of sodium and 11 grams of saturated fat.

That's before the rice . And after the egg rolls .

"I don't want to put all the blame on Chinese food," said Bonnie Liebman, nutrition director of the Center for Science in the Public Interest, which did a report released Tuesday.

"Across the board, American restaurants need to cut back on calories and salt, and in the meantime, people should think of each meal as not one, but two, and bring home half for tomorrow," Liebman said.

The average adult needs around 2,000 calories a day and 2,300 milligrams of salt, which is about one teaspoon of salt, according to government guidelines.

In some ways, Liebman said, Italian and Mexican restaurants are worse for your health, because their food is higher in saturated fat, which can increase the risk of heart disease.

While Chinese restaurant food is bad for your waistline and blood pressure — sodium contributes to hypertension — it does offer vegetable-rich dishes and the kind of fat that's not bad for the heart.

However — and this is a big however — the veggies aren't off the hook. A plate of stir-fried greens has 900 calories and 2,200 milligrams of sodium. And eggplant in garlic sauce has 1,000 calories and 2,000 milligrams of sodium.

"We were shocked. We assumed the vegetables were all low in calories," Liebman said.

Also surprising were some appetizers: An order of six steamed pork dumplings has 500 calories, and there's not much difference, about 10 calories per dumpling, if they're pan-fried.

The group found that not much has changed since it examined Chinese food 15 years ago. That's not all bad, Liebman said.

"We were glad not to find anything different," she said. "Some restaurant food has gotten a lot worse. Companies seem to pile on. Instead of just cheesecake, you get coconut chocolate chip cheesecake with a layer of chocolate cake, and lasagna with meatballs."

The group says there is no safe harbor from sodium on the Chinese restaurant menu, but it offers several tips for making a meal healthier:

_Look for dishes that feature vegetables instead of meat or noodles. Ask for extra broccoli, snow peas or other veggies.

_Steer clear of deep-fried meat, seafood or tofu. Order it stir-fried or braised.

_Hold the sauce, and eat with a fork or chopsticks to leave more sauce behind.

_Avoid salt, which means steering clear of the duck sauce, hot mustard, hoisin sauce and soy sauce.
_Share your meal or take half home for later.
_Ask for brown rice instead of white rice.
___
On the Net:
Center for Science in the Public Interest: http://www.cspinet.org

Some doctors balk at inhaled insulin

Wed, 21 Mar 2007 23:03:37 GMT
By THERESA AGOVINO, AP Business Writer
NEW YORK - Pfizer's stab at giving diabetics insulin without needles is getting more praise than prescriptions so far. Exubera, a powdered form inhaled through a special device, was introduced last year in a targeted launch to specialists, a debut analysts deemed disappointing. While doctors applaud Pfizer Inc.'s effort to find a new way to deliver insulin, some are concerned about the drug's long-term effects on the lungs, cost and insurance coverage.
Observers fear Exubera won't fare much better as Pfizer expands the sales effort to primary care doctors.

"I think Pfizer will wish they had never gotten into this. I doubt they'll regain their investment," said Dr. John Buse, president-elect of the American Diabetes Association, who participated in Exubera's trials. "There is no advantage to Exubera and there may be a safety risk. I see it as my job to talk people out of it."

Pfizer won't disclose Exubera's development costs but said it is a major advancement in diabetes care because needle-phobia keeps many patients from using the insulin when they would really benefit from it. Susan Silberman, Pfizer's senior vice president of worldwide commercial development, said Exubera's performance is meeting expectations.

"I think we have to manage this product differently," she said. "Insulin is intuitive. What has changed is the approach to delivery — so is about the education."

Pfizer already has hired approximately 900 part-time diabetes educators to explain the product to doctors and patients, and more will be added, although the company won't say how many. A small, non-branded ad campaign for the drug that doesn't mention Exubera by name started recently, and a bigger direct-to-consumer marketing effort will debut during the second quarter.

Company executives touted Exubera as one of the new drugs that would revitalize Pfizer's stagnating sales. Others, such as smoking cessation treatment Chantix, are performing well.

But some analysts said Exubera's lackluster debut is worrisome because Pfizer needs more blockbusters. Its best-selling drug, cholesterol agent Lipitor, loses patent protection as early as 2010 and development of its successor drug was scrapped last year because of safety problems.

Exubera, which Pfizer is codeveloping with Nektar Therapeutics, was introduced last September but sales for 2006 weren't report.

Les Funtleyder, an analyst at Miller Tabek & Co., doubted it would meet his sales target of $200 million for this year. Assessing Exubera's market share and the number of patients on the drug is difficult because of the way it is sold. Patients need to buy a kit which includes the device but then also need to regularly purchase blister packs and release units, which help create the mist.

"Exubera isn't going be a big driver," he said. "Pfizer needs every dollar in sales. It is a negative."

Others aren't as quick to judge. Deutsche Bank analyst Barbara Ryan said that while the launch has been slow, Exubera still could reach $1 billion in sales in the next few years.

Silberman insists Exubera represents a good value because its needle-free status means more people who should be taking the medicine will start, allowing them to better manage their diabetes and saving money in the long run.

Insurers don't necessarily believe Pfizer has demonstrated Exubera's value. WellPoint Inc., the country's largest insurer, is either not covering Exubera or placing it in the most restrictive tier, with higher copays, depending on the plan.

WellPoint estimates that Exubera costs 11 percent more than one popular brand of injected insulin and 22 percent more than another.

Pfizer hasn't offered enough evidence that patients will use Exubera before they begin injecting insulin or that it would really improve quality of life, said Brian Sweet, WellPoint's chief clinical pharmacy officer.

"We want to see more documentation of the value of the product," he said.

Doctors also worry about potential long-term side effects from constantly inhaling the powder into patients' lungs. Pfizer has two years of data showing the drug is safe, but doctors want to see results from longer-term studies.
"If I can treat patients now with something I know is OK, why give them something that might hurt their lungs?" asked Dr. Michael O'Dell, director of the Family Residency Program at the North Mississippi Medical Center in Tupelo, Miss.
He added that few insurers in his region cover Exubera and that "the delivery system is still a little clumsy."
The inhaler is the size of an eyeglass case when closed. Once expanded to expose the inhalation chamber that holds the insulin mist, it is the size of a pepper mill. Patients insert blister packs of the dry powder insulin into the device, press a button and then press a lever which creates the mist. The patient inhales the cloud, sending the insulin into the lungs where it is absorbed into the bloodstream.
Some doctors said the blister packs come in limited strengths that can make it difficult to prescribe the correct amount of insulin. Also, Exubera is fast-acting insulin that is taken at mealtime; some patients still need the long-acting insulin that is delivered through needles.
Dr. Robert Fafalak said he has prescribed Exubera for patients who were hesitant to use insulin even though the pills they were taking weren't sufficiently controlling their diabetes.
"I have patients that are doing much better now. They have their sugar under control, and I think that gain outweighs concerns about long-term effects," said Fafalak, who practices in New York.
Jamie Villastrigo, 51, a secretary who lives in Boerne, Texas, began taking Exubera three years ago as part of a clinical trial and has become a fan. She doesn't pay for the drug because she is still in a clinical trial.
"There is a concern about the cost and whether my insurance will pay for it," Villastrigo said. "But I've still got another year and a half in the program. "
Villastrigo said Exubera hasn't affected her lungs and has allowed her to cut her daily insulin shots to one from four. She maintains that the device is easy to use, and she has no qualms about using it in restaurants or public places where she'd never pull out a syringe.
"It is just easy. It gives me more freedom," she said.

Dietary supplement for Parkinsons eyed

Thu, 22 Mar 2007 04:16:12 GMT

WASHINGTON - Government scientists want to know if a dietary supplement thought to boost muscles might boost the brains of Parkinson's patients.
The http://www.parkinsontrial.org.

A pharmacy in this neighborhood Are you crazy

Thu, 22 Mar 2007 13:54:53 GMT
By Andrea Hopkins
CINCINNATI - Since January, Patricia Roberts has had access to something that many of the poorest people in the United States can only dream of: a pharmacy in her neighborhood.
The nation's first not-for-profit pharmacy is located in Over-the-Rhine, Cincinnati's most notorious neighborhood -- one that is more blighted by boarded-up buildings than blessed with brand new businesses.

&;I used to have to go all the way uptown to get my medicine,&; said Roberts, who lives off government disability payments due to seizures and asthma. &;Sometimes I wouldn't have money to catch the bus. I just had to walk.&;

Neighborhoods like Over-the-Rhine underscore the plight of millions of poor people in the United States.

A Christian health clinic opened in the mostly African American neighborhood in 1992, but that still left big gaps in patient care. With no pharmacy for miles, prescriptions often went unfilled, and patients skipped medications and got sicker.

More than 46 million people in the United States, including a disproportionate number of blacks and Hispanics, lack health insurance, according to government figures.

While the poorest 25 percent are eligible for the government's Medicaid program, most go without care or medicine unless they can find free clinics or hospitals funded by charities.

Last year, the health clinic's public relations director, JoAnn Riley, and Cincinnati-born pharmacist Chad Worz stepped in with an idea for a on-site pharmacy that, like the clinic, would find a way to serve people with or without health insurance.

Worz said his decision to bring a pharmacy to the poor and crime-ridden section of Cincinnati raised eyebrows.

&;People said 'You're going to open a pharmacy in the center of the city's illicit drug trade? Are you crazy?&;' he recalled.

Opening a pharmacy and selling narcotics in an area notorious for drug and gun crimes required special planning.

The pharmacy, located on the ground floor of the Crossroad Health Center, was built with bullet-proof glass and drywall separating the pharmacists and drugs from the customers.

A police substation takes up a corner of the waiting area, and pharmacist Susan Lattier wears a panic button on a lanyard around her neck in case of attempted robbery.

&;Actually, we haven't had any problems,&; said Lattier. &;The people appreciate you. They are so grateful that you are here.&;

DONATED DRUGS

The pharmacy is more inviting than it sounds. Plants and posters have been donated to decorate the waiting area, and Lattier tends to open the pharmacy door to interact with patients directly rather than from behind bulletproof glass.

The challenges of dealing with very poor clients are many. Lattier sees a lot of diabetes and asthma. Nearly all of the small children are anemic and need iron supplements. Patients struggle to pay even $1 and $2 dispensing fees.

&;They come in and see what they'll have to pay, and say 'I don't have the money yet. I'll have to come back,&;' Lattier said. &;Then a few hours later they'll be back. You don't want to know how they came up with the money, but they do what they have to do.&;
The clinic gets funds from local government, the University of Cincinnati, church groups and even a local billionaire philanthropist. Many of the medications are paid for by Medicaid, a government program that provides health care for the very poor.
Nursing homes donate unused medications, and drug companies give discounts.
Any profit the pharmacy makes will be poured back into the business or used for education programs.
Linda Elam, principal policy analyst at the Kaiser Family Foundation, a nonprofit group that funds research on health care, said it is a great model for communities -- inner-city neighborhoods and rural areas alike -- where a lack of a pharmacy has left a gap in health care.
&;There is sort of a space between a physician writing and a patient filling a prescription, where you can lose a lot of people, whether they don't have money to fill it or don't have access to a pharmacy,&; Elam said.
&;The poorest communities often have the largest illness burden, and they are the ones with the least means to deal with it.&;

Braindamaged people give insights into morality

Thu, 22 Mar 2007 13:51:51 GMT
By Will Dunham
WASHINGTON - It's wartime, and an enemy doctor is conducting painful and inevitably fatal experiments on children.
You have two kids, ages 8 and 5. You can surrender one of them within 24 hours or the doctor will kill both. What is the right thing to do?

For most people, this scenario based on one in William Styron's novel &;Sophie's Choice&; is almost an impossible dilemma. But for a group of people with damage in a part of the brain's frontal lobe that helps govern emotions, the decision was far more clear. They would choose one child for death.

Scientists said on Wednesday a study involving these people has produced unique insights into the brain mechanics of moral decision making and showed that in some key situations emotions play a fundamental role in moral judgments.

The new findings highlighted the role of a region in the front part of the brain below the eyes called the ventromedial prefrontal cortex.

Earlier research had pegged this area -- one of the more recently evolved parts of the human brain -- as playing a role in generating social emotions. In fact, the people with damage in this region due to stroke or other causes experienced severely diminished empathy, compassion and sense of guilt.

The new findings published in the journal Nature seem to confirm its central role in guiding certain moral judgments like life-or-death scenarios.

The researchers set out to gauge to what degree emotions govern moral judgments by comparing decisions made by people whose emotions already were crippled by this brain damage to decisions made by people with no such damage.

TOUGH CHOICES

The judgments on what is right and wrong made by these brain-damaged people were similar to the others in some scenarios put before them.

But when asked to make decisions in emotionally wrenching scenarios like the permissibility to kill one's own child to save other people's lives, those with the brain damage were far more likely to accept this utilitarian but harsh solution.

Scientists and philosophers long have debated how people make judgments relating to morality. Are these decisions governed strictly by a calculus of cold, hard facts and logic? Do emotions carry the day?

&;This shows a much more subtle, a much more nuanced view, which of course makes the whole problem -- the science of morality -- infinitely more interesting,&; said Harvard University's Marc Hauser, one of the study's authors.

The study involved six people with damage in this brain region who were presented with 50 scenarios requiring moral judgments, some trivial and some difficult. Their responses were compared to those of 12 others with damage to an unrelated part of the brain and 12 more with no brain damage.

Another wartime scenario involved enemy troops searching for civilians to kill. The people in the study were asked about their willingness to kill their own infant whose crying was drawing the attention of enemy soldiers who would then kill the parent, the baby and people hiding with them.

Again, the people with this brain damage were far more willing to judge killing the baby as the right moral choice.

The scenarios weighed immediate harm or death to one person against certain future harm or death to many. These brain-damaged people regularly showed a willingness to bring harm to an individual, an act others may find repugnant.

&;They are perfectly capable of endorsing the kind of extreme high-conflict dilemma in which indeed you would produce harm to someone because there would be greater good coming to a larger group,&; said study co-author Antonio Damasio, director of the University of Southern California's Brain and Creativity Institute.
&;And this is something that human beings in general reject.&;

Scientists find gene that may regulate colon cancer

Thu, 22 Mar 2007 13:51:08 GMT
By Julie Steenhuysen
CHICAGO - Scientists have discovered a genetic mutation linked with colon cancer that may work like a spigot, controlling the number of precancerous growths that develop and determining a person's susceptibility to cancer.
They said the finding could point to new ways to diagnose, treat and possibly even prevent colon cancer, the second-leading cause of cancer death in the United States after lung cancer.

In a study appearing on Thursday in the journal Genome Research, cancer biologists at Thomas Jefferson University in Philadelphia studied mice that carry a mutation in the Apc gene, a gene known to cause precancerous growths or polyps in mice.

Changes in the human version of the gene are known to start the process that leads to colon cancer. People who develop large numbers of polyps are significantly more likely to get colon cancer.

The researchers found that the mice that carried only one copy of the damaged or mutated gene had about 90 percent fewer polyps in the small intestine and colon.

Microbiologist Arthur Buchberg, one of the researchers, described the finding as a gene &;modifier,&; something that governs the individual's response to cancer.

&;It's kind of like a rheostat. It's not on or off. It's bad or better,&; he said in a telephone interview.

The researchers believe if a person inherits the colon cancer gene, a modifier gene help can determine how prone or resistant a person is to developing polyps, and ultimately tumors.

&;A cancer needs multiple mutations to go from a normal cell to a cancer cell. It needs multiple modifier genes to determine the final severity. This is probably one of many modifier genes,&; he said.

Buchberg believes the finding is the first discovery of a mutation on the Atp5a1 gene, a gene responsible for the cell's energy production. The discovery gives scientists a new way to look for potential cancer diagnostic tests and treatments.

It is the second colon cancer modifier gene Buchberg and his wife and colleague Linda Siracusa have found.

&;These modifier genes we think play an important role,&; Buchberg said. &;It's certainly a piece of the puzzle.&;

Several genes are linked to colon cancer. Lifestyle is also an important factor, with smoking, exercise and a diet high in meat and low in fruits and vegetables all associated with colon cancer.

According to the American Cancer Society, it will kill 52,000 people this year in the United States alone.