Resveratrol: Another Assumption Called Into Question

It’s tempting to do so, but whenever we attribute large health benefits (such as prevention of heart disease) to a single nutrient, the complexity of our physiology eventually calls the assumption into question.

Resveratrol, a substance found in the skins of red grapes, has become quite famous in recent years as the purported explanation for the apparent health benefits of moderate amounts of red wine. New research indicates that this assumption may be premature, and perhaps entirely mistaken.

From WebMD:

Resveratrol — a substance found in red wine, grapes and chocolate — may not add years to your life, and it doesn’t appear to reduce the risk for heart disease or cancer either, according to new research.

“When it comes to diet, health and aging, things are not simple and probably do not boil down to one single substance, such as resveratrol,” said study lead researcher Dr. Richard Semba, a professor of ophthalmology at Johns Hopkins University School of Medicine in Baltimore.

The findings also cast doubt about taking resveratrol supplements, he said.

“Perhaps it brings us back again to rather tried and true advice of diet — Mediterranean-style — and regular aerobic exercise for healthy aging,” said Semba.

The report was published May 12 in the online edition of JAMA Internal Medicine.

Red wine and chocolate have been shown to have beneficial effects on health, and these benefits were attributed largely to a single substance — resveratrol. Resveratrol has been credited as being responsible for the so-called “French paradox,” in which even a diet high in cholesterol and fat can be healthy if it is accompanied with red wine, the researchers explained

Why Health Care Reform Was Necessary: A Good Reminder

A fine article from Lucia Graves at the National Journal:

To put Obamacare victims’ strife in perspective, let’s take a trip down memory lane. You know, the golden years of American health care in … oh, let’s say 2007, back when you could be denied coverage for something as benign as acne or as mundane as pregnancy.

Back then, anecdotes about people who were denied coverage abounded. They included this 12-year-old boy who died in 2007 from an abscessed tooth after his family’s Medicaid lapsed. And this 17-year-old boy whose insurance was revoked after he tested positive for HIV. This woman who was denied coverage for breast cancer because she wasn’t diagnosed at the correct clinic. And this woman whose double mastectomy was denied after her insurance company learned she had visited a dermatologist for acne treatment the year before. Ah, yes, those were the days!

For those who put more stock in headlines, here are a few that help convey the state of the American health care system back in its heyday.

From The Washington Post in 2009: “Acne, Pregnancy Among Disqualifying Conditions.” From the Associated Press that same year: “Worker Health Care Costs Soar.” From USA Today in 2007: “People Left Holding Bag When Policies Revoked.” And from The New York Times in 2004: “Cost of Benefits Cited as Factor in Slump in Jobs.” And in 2002: “Hard Decisions for Employers as Costs Soar in Health Care.”

It’s not all anecdotes and headlines. She goes from there to a series of links to policy papers and the like.

We are currently in the early stages of what will likely be a decade-long transition to a new model. There will be bumps along the way. There are some now. But it’s important to remember why there was such a hue and cry for reform in the first place.

 

States Spend Less Than 2% of Tobacco Settlement Money on Anti-Smoking Campaigns

This qualifies for placement in the Public Health Hall of Infamy.

The report blasted states for failing to reverse the budget cuts to tobacco prevention programs that occurred after that time, calling them even more problematic in light of recent surveys that show smoking declines in the U.S. have slowed.

Across the country, 19% of adults and 18% of high school students still smoke, those surveys show.

The $460 million being spent this year amounts to just 12.4% of the $3.7 billion that the CDC recommends on tobacco prevention spending for all states combined.

It would take less than 15% of total state tobacco revenues to fund programs at CDC-recommended levels, according to the report.

Only two states – Alaska and North Dakota – will fund tobacco prevention programs at CDC-recommended levels, while only three – Delaware, Wyoming, and Hawaii – will spend at half the recommended level, the report said.

Four states — New Hampshire, New Jersey, North Carolina, and Ohio — have allotted no state funds for tobacco prevention programs next year.

Supreme Court Accepts Gene Patenting Case

In the long run, this case may have greater influence than many of the higher profile cases on which the Court decides.

The U.S. Supreme Court on Friday agreed to decide whether human genes can be patented, a hotly contested issue with broad practical and ethical consequences for the future of gene-based medicine for millions of people worldwide.

The nation’s highest court in a brief order agreed to review a case over whether Myriad Genetics Inc may patent two genes linked to hereditary breast and ovarian cancer.

In a 2-1 ruling on Aug. 16, a panel of the U.S. Federal Circuit Court of Appeals in Washington, D.C., upheld the biotechnology company’s right to patent “isolated” genes that account for most inherited forms of the two cancers.

That ruling also denied Myriad’s effort to patent methods of “comparing” or “analyzing” DNA sequences.

The appeal against Myriad and the University of Utah Research Foundation was being pursued by a variety of medical associations and doctors, led by the Association for Molecular Pathology. Their case is being handled by lawyers for the American Civil Liberties Union.

There are many issues at play here. Consider this one: gene patents like these held by Myriad can be used (and are used) to deny researchers the right to conduct research related to the patented genes (i.e., breast cancer research) unless they pay the patent holder whatever fee the corporation wishes to charge.

From both ethical and economic perspectives, this is a most controversial topic. I hope the Court decides that genes are the common heritage of all humanity and are not patentable under any circumstances.

Dispelling Soy Myths

Two articles on soy appear in today’s Huffington Post. Neal Barnard, MD, sums up the evidence clearly and accurately, with aptly chosen scientific references to support his assertions, while Joseph Mercola, DO, takes a different approach.

From Dr. Barnard:

Soybeans are handy. Aside from the traditional foods they bring us — edamame, tofu, tempeh, and many others — they transform into tasty substitutes for milk, yogurt, ice cream, bacon, burgers, and sausage. With no animal fat, cholesterol, or sensitizing animal proteins, they side-step the problems that animal products can cause. Cow’s milk, for example, is linked to Type 1 diabetes and anemia in children and increases the risk of prostate cancer in men. Hamburgers are linked to heart disease, diabetes, and colon cancer. Soy-based milks and burgers help you skip all this. But soy has other huge benefits you may not know about.

Among the other well-documented effects of soy products is that they boost survival in breast cancer patients (contrary to an oft-repeated set of false claims) and lower cholesterol levels.

Read Dr. Barnard’s entire article for a further debunking of soy mythology.

As We Await the Supreme Court Health Care Decision, Remember the Impact on Individual Lives

From today’s New York Times:

His wife called every major insurance company she found on the Internet, but none would cover him: His cancer was a pre-existing condition. In desperation, the Richters agreed to pay half their hospital bill, knowing they could never afford it on their combined salaries of $36,000 a year.

No other group of Americans faces higher stakes in the impending Supreme Court ruling on the Affordable Care Act than those with pre-existing conditions. The law, once its major provisions take effect, would prohibit insurance companies from turning people away or charging them more because they are sick. In exchange, most Americans would be required to have insurance, broadening the base of paying customers with an infusion of healthy people. Those who did not buy insurance would be subject to financial penalties.

The Government Accountability Office estimates that 36 million to 122 million adults under 65 have a pre-existing condition. As many as 17 million do not have insurance. Many try to buy coverage on the individual market, but in most states that is either impossible or too costly.

 

Long-Term Opioid Use Questioned at FDA Hearing

Recently, I’ve been reading and thinking a great deal about the use of prescription drugs for pain. Opioids are clearly the flashpoint for current debate.

From today’s MedPage:

Opioids used to be prescribed primarily for cancer pain and short-term relief immediately after surgery or an accident. But that changed in 1996, when the American Academy of Pain Medicine and the American Pain Society — organizations that get substantial funding from drug companies — issued a joint statement endorsing the use of opioids to treat chronic pain and claiming the risk of addiction was low.

Since then, drugs like OxyContin and Vicodin increasingly have been used to treat a wide array of chronic pain syndromes including low back pain and fibromyalgia, despite a lack of good scientific evidence to prove that their benefits outweigh potential harm when used long term. Opioids are also increasingly being prescribed to the elderly, often for chronic pain.

The Obama administration has called the current prescription drug abuse epidemic a “public health crisis” worse than the crack and heroin epidemics of past decades. In 2007, there were 28,000 deaths from prescription drug overdoses — five times the number in 1990. Those deaths were driven largely by the abuse of prescription painkillers. Painkiller abuse now matches abuse of illegal drugs.

“[Opioids’] increasing use has resulted in a clearly unacceptable increase in addiction, overdose, and death,” Douglas Throckmorton, MD, deputy director for regulatory programs at FDA’s Center for Drug Evaluation and Research, said at the meeting.

But the meeting didn’t focus on safety concerns with opioids; rather, it focused on efficacy and effectiveness, and attendees discussed the existing evidence to support giving pain patients opioids long term.

Doctors Urge Their Colleagues to Quit Doing Worthless Tests

This is a very difficult policy to implement as long as doctors and hospitals continue to be paid more when they perform more procedures. Radiology departments are major profit centers for hospitals and other health care facilities.

To see major medical groups such as the American Board of Internal Medicine endorse this policy is heartening. I would add that my profession, chiropractic, has made major changes along these lines within our educational institutions over the last decade. Student interns cannot routinely x-ray patients; for imaging studies to be approved, specific guidelines (such as the Canadian Cervical Spine Rule) must be followed.

Nine national medical groups are launching a campaign called Choosing Wisely to get U.S. doctors to back off on 45 diagnostic tests, procedures and treatments that often may do patients no good.

Many involve imaging tests such as CT scans, MRIs and X-rays. Stop doing them, the groups say, for most cases of back pain, or on patients who come into the emergency room with a headache or after a fainting spell, or just because somebody’s about to undergo surgery.

The Choosing Wisely project was launched last year by the foundation of the American Board of Internal Medicine. It recruited nine medical specialty societies representing more than 376,000 physicians to come up with five common tests or procedures “whose necessity … should be questioned and discussed.”

The groups represent family physicians, cardiologists, radiologists, gastroenterologists, oncologists, kidney specialists and specialists in allergy, asthma and immunology and nuclear cardiology.

Eight more specialty groups will join the campaign this fall, representing hospice doctors, head and neck specialists, arthritis doctors, geriatricians, pathologists, hospital practitioners, nuclear medicine specialist and those who perform a heart test called echocardiography.

Consumer groups are involved, too. Led by Consumer Reports, they include the AARP, National Business Coalition on Health, the Wikipedia community and eight others.

The effort represents a growing sense that there’s a lot of waste in U.S. health care, and that many tests and treatments are not only unnecessary but harmful.

Harvard economist David Cutler estimates that a third of what this country spends on health care could safely be dispensed with.

h/t Stephen Perle

When the Supposedly Safer Alternative Appears to be More Dangerous

This is a fascinating and meaningful research project by my friend, Sarina Farb.

Though only a high school senior, she is pursuing a line of research that has the potential to prevent a great deal of illness and suffering from these apparently dangerous environmental chemicals (BPA and BPS) to which we are all exposed.

Farb noticed that the Lawrence Public Library and The Merc promote BPA-free receipts, as BPA is used in the ink and found on the surface of receipts. Studies have suggested that the BPA found on receipts is absorbed into the body when handled.

So instead, the receipts at The Merc and the library contain BPS, or bisphenol S, which is similar to BPA. However, very few studies have examined whether BPS is any safer than BPA. So Farb set off to find out.

Farb talked her way into a lab at Kansas University, and with the assistance of Kristi Neufeld, a molecular biology professor, obtained some lab space and the necessary testing supplies.

Farb spent “hundreds of hours” over the past year testing whether BPA and BPS cause an increase in the growth of breast cancer cells.

The results?

“BPS is worse,” said Farb, as her results showed that BPS caused more growth in the breast cancer cells than BPA.