Women's rights debated today!
Posted by on March 1, 2012 - 11:03am

Earlier this month, the Department of Health and Human Services reported that over 20 million American women in private health insurance plans have already gained access to at least one free preventive service because of the health care law.  Without financial barriers like co-pays and deductibles, women are better able to access potentially life-saving services, and cancers are caught earlier, chronic diseases are managed and hospitalizations are prevented.

A proposal (the Blunt Amendment)  being considered in the Senate today would allow employers that have no religious affiliation to exclude coverage of any health service, no matter how important, in the health plan they offer to their workers.  This proposal isn't limited to contraception nor is it limited to any preventive service. Any employer could restrict access to any service they say they object to on moral grounds. This is dangerous and wrong. To read more about both sides of this debate click HERE.

If you feel strongly on this issue, call you Senator NOW!

Why is sex-based research so important?
Posted by on February 28, 2012 - 9:38am

Research has shown that sex (male vs female) as a variable contributes to differences in the safety and efficacy of drugs, biologics, and devices.   Biologics include vaccines and plasma.   Devices can range from drug eluting stents and pacemakers to implants and contact lenses.

To better understand the biologic basis for sex differences, women's organizations have been advocating for the participation of women in clinical trials.   Several federal offices dedicated to women's health have also worked to ensure mandates that require inclusion of women in federally funded studies are met.  Unfortunately, many privately funded researchers are not mandated to include women, though some have learned the wisdom of doing so.    When both sexes are represented in preclinical (animal) and clinical (human) research, a better understanding of the mechanistic basis for disease susceptibility and response to therapy can be achieved.  This is the first step to personalized medicine.

When we speak of 'sex', we are talking about biology, i.e., the physical characteristics that make us male or female.    'Gender' refers to the differences between man and women due to cultural or social variations in a particular sex (feminine vs. masculine).   Both are important when we do research.

So where do we stand today?   A recent Institute of Medicine report found that women were less than 40% of many research study populations.   When it comes to preliminary animal research (which is used as a basis for future human studies) the data is even worse.  Only 22-42% of studies published in journals on neurosciences, endocrinology, physiology, pharmacology, reproductive medicine and biology reported the sex of the experimental  animals. Furthermore, even when both sexes are included, rarely do researchers report the differences in outcomes by sex.

So what can we do?   Participate in a clinical trial if you have an opportunity.    If your doctor prescribes a medication or procedure that is relatively new, you might ask if the studies included women.    There is an unexplained complacency among the public that research is fairly distributed among the sexes.  The truth is, we still have lots to learn about women-specific health.

Grapefruit juice and medication
Posted by on February 26, 2012 - 11:13am

Grapefruit juice and fresh grapefruit can interfere with the action of some prescription drugs, as well as a few non-prescription drugs.   Grapefruit juice can also be part of a healthful diet.   It has vitamin C and potassium—substances your body needs to work properly.   But it isn’t good for you when it affects the way your medicines work.

This interaction can be dangerous, says Shiew Mei Huang, acting director of the Food and Drug Administration’s Office of Clinical Pharmacology. With most drugs that interact with grapefruit juice, “the juice increases the absorption of the drug into the bloodstream,” she says. “When there is a higher concentration of a drug, you tend to have more adverse events.”

For example, if you drink a lot of grapefruit juice while taking certain statin drugs to lower cholesterol, too much of the drug may stay in your body, increasing your risk for liver damage and muscle breakdown that can lead to kidney failure.

Drinking grapefruit juice several hours before or several hours after you take your medicine may still be dangerous, says Huang, so it’s best to avoid or limit consuming grapefruit juice or fresh grapefruit when taking certain drugs.   Examples of some types of drugs that grapefruit juice can interact with are:

  • some statin drugs to lower cholesterol, such as Zocor (simvastatin), Lipitor (atorvastatin) and Pravachol (pravastatin)
  • some blood pressure-lowering drugs, such as Nifediac and Afeditab (both nifedipine)
  • some organ transplant rejection drugs, such as Sandimmune and Neoral (both cyclosporine)
  • some anti-anxiety drugs, such as BuSpar (buspirone)
  • some anti-arrhythmia drugs, such as Cordarone and Nexterone (both amiodarone)
  • some antihistamines, such as Allegra (fexofenadine)

Grapefruit juice does not affect all the drugs in the categories above. Ask your pharmacist or other health care professional to find out if your specific drug is affected.

How it works
Many drugs are broken down (metabolized) with the help of a vital enzyme called CYP3A4 in the small intestine. Certain substances in grapefruit juice block the action of CYP3A4, so instead of being metabolized, more of the drug enters the bloodstream and stays in the body longer. The result: potentially dangerous levels of the drug in your body.

The amount of the CYP3A4 enzyme in the intestine varies from one person to another, says Huang. Some people have a lot, and others have just a little—so grapefruit juice may affect people differently when they take the same drug.

While scientists have known for several decades that grapefruit juice can cause a potentially toxic level of certain drugs in the body, Huang says more recent studies have found that the juice has the opposite effect on a few other drugs.

“Grapefruit juice reduces the absorption of fexofenadine,” says Huang, decreasing the effectiveness of the drug. Fexofenadine (brand name Allegra) is available in both prescription and non-prescription forms to relieve symptoms of seasonal allergies. Fexofenadine may also be less effective if taken with orange or apple juice, so the drug label states “do not take with fruit juices.”

Why this opposite effect?

It involves the transportation of drugs within the body rather than their metabolism, explains Huang. Proteins in the body known as drug transporters help move a drug into cells for absorption.Substances in grapefruit juice block the action of a specific group of transporters. As a result, less of the drug is absorbed and it may be ineffective, Huang says.

When a drug sponsor applies to FDA for approval of a drug, the sponsor submits data on how its drug is absorbed, metabolized and transported says Huang. “Then we can decide how to label the drug.”    FDA has required some prescription drugs to carry labels that warn against consuming grapefruit juice or fresh grapefruit while using the drug and the agency’s current research into drug and grapefruit juice interaction may result in label changes for other drugs as well.

Tips for Consumers

  • Ask your pharmacist or other health care professional if you can have fresh grapefruit or grapefruit juice while using your medication. If you can’t, you may want to ask if you can have other juices with the medicine.
  • Read the Medication Guide or patient information sheet that comes with your prescription medicine to find out if it could interact with grapefruit juice. Some may advise not to take the drug with grapefruit juice. If it’s OK to have grapefruit juice, there will be no mention of it in the guide or information sheet.
  • Read the Drug Facts label on your non-prescription medicine, which will let you know if you shouldn’t have grapefruit or other fruit juices with it.
  • If you must avoid grapefruit juice with your medicine, check the label of bottles of fruit juice or drinks flavored with fruit juice to make sure they don’t contain grapefruit juice.
  • Seville oranges (often used to make orange marmalade) and tangelos (a cross between tangerines and grapefruit) affect the same enzyme as grapefruit juice, so avoid these fruits as well if your medicine interacts with grapefruit juice.

Source:   FDA

 

Cost of Contraception
Posted by on February 24, 2012 - 11:00am

As predicted, the debate about access to contraception in the U.S.  has entered the political process with the counter attack focusing on freedom of religion.  This blog will look at another side of the issue:   cost.   The cost of contraception is estimated to be between $600 and $1000 per year based on the choice of contraceptive method.   According to a report issue by the assistant secretary for planning and evaluation at the US Department of Health and Human Services, "evidence from well-documented prior expansions of contraceptive coverage indicates that the cost to issurers of including coverage for all FDA-approved contraceptive methods in insurance offered to an employed population is ZERO."

After a review of actuarial studies, one of the study authors concluded that "....regardless of payment mechanism or contraceptive method, contraception saves money".   When indirect costs are considered, (time away from work, productivity loss, etc.) contraceptive benefits actually save an employer money.

The report found that providing contraception through public programs is also cost-saving.   Public funds for family planning prevents about 1.94 million unintended pregnancies, including almost 400,000 teen pregnancies according to the report.    When some people say contraception is an important health issue, they are right.  Consider this,  preventing 1.94 pregnancies results in 860,000 fewer unintended births, 810,000 fewer abortions and 270,000 fewer miscarriages.   Avoiding significant costs associated with these unintended births saves taxpayers $4 for every $1 spent on family planning.To read the full report summary and references, click HERE.

Not only is contraception access an important women's health issue because it is used to treat several conditions beyond preventing pregnancies, it is much more cost effective than programs like abstinence only and those that support women who remain in poverty due to unintended pregnancy.  It is interesting to note that the majority of proponents of the religious freedom point of view are men!  Wonder if they would feel so strongly if they were the ones to get pregnant!

 

 

Heartburn medications can increase risk for hip fractures in postmenopausal women
Posted by on February 23, 2012 - 7:54am

Older, postmenopausal women who take popular medications to control indigestion and heartburn called proton pump inhibitors (PPIs)  may put themselves at higher risk for hip fractures according to new research by Dr. Hamed Khalili, from Massachusetts General Hospital in Boston.  Long-term use of these drugs may increase that risk by 35 percent and even higher (to 50 percent) in smokers.    Some examples of these medications are shown here.

According to the researchers, PPIs are strongly indicated in some patients for short term use, but they should be closely monitored if long term use is needed.  Dr. Khalili's data supports the recent decision by the U.S. Food and Drug Administration to revise labeling of PPIs to incorporate concerns about a bone fractures with use of these products.  

For the study, they looked at data from 80,000 postmenopausal women. .Over the course of eight years, almost 900 hip fractures occurred -- a 35 percent increased risk for women using PPIs compared to women who didn't take the drugs.   In absolute terms, the risk of hip fracture works out to about 2.02 fractures for every 1,000 person years for those taking PPIs, compared with 1.51 fractures per 1,000 person years. Person years are the number of years in a study multiplied by the number of people in the study.  The increased risk of fractures among women who smoked was even higher. The longer a women took a PPI, the more her risk increased.

In 2000, 6.7 percent of the women used PPIs regularly, generally for acid reflux; by 2008 that had jumped to 18.9 percent. This could mean that more fractures will be seen in years to come.   Women who stopped using PPIs saw their risk of hip fracture return to normal within two years, Khalili's group noted.   Women are also cautioned not to suddenly quit their PPI and gradual tapering is recommended to avoid acid rebound.   Often, calcium supplements are used to bolster bone strength, but because PPIs affect the absorption of calcium, taking calcium supplements may not be effective.  The researchers did take calcium supplement use into account and the risk remained.

SOURCE:  Jan. 31, 2012, BMJ, online

 

 

When body piercings go wrong
Posted by on February 21, 2012 - 1:48pm

Body piercings have become increasingly popular among young people in the United States, especially in recent years. It is important that health professionals understand the problems that piercings can cause, according to a recent Northwestern Medicine paper, published in the February issue of the American Journal of Clinical Dermatology.

The paper reviews, in detail, the complications and medical consequences of body piercing, focusing on ear, nose, mouth, nipple, navel and male and female genitalia piercings. The paper also offers suggestions on how to minimize and possibly prevent these complications.

Slideshow: Common piercing complications

While body piercing is fairly safe overall, bacterial infection is the number one complication, affecting about 20 percent of body piercings, according to the review. Other body piercing complications include allergies, loss of blood, scarring, and interference with medical procedures, such as MRI, x-ray or ultrasound.  “As piercing becomes more popular, the health care community should become familiar with how to remove the jewelry, in the case of an emergency situation, as well as understand piercing complications and related health risks,” said Jaimee Holbrook, M.D. first author and research fellow in dermatology at Northwestern.

The review article was written at the same time as the Feinberg researchers, along with researchers from the Rehabilitation Institute of Chicago, were conducting a trial on an assisted technology that uses magnetic tongue studs to assist people with quadriplegia to use computers and drive their own wheelchairs.

There are minimal regulations on who can pierce body parts and no validated guidelines on how it should be done, so besides reviewing the latest medical literature on piercings, the Feinberg team visited local piercing parlors to talk with industry professionals and watch them work.

“Since we are using piercings to attach magnets to the tongues of people with quadriplegia, we need to be aware of what difficulties to expect in order to minimize the risks of serious complications,” said Julia Minocha, M.D., second author and a resident in Feinberg’s department of dermatology. “Who knows what other anatomic sites for piercings could be used in the future? If a sensor in the tongue can be used to drive a wheelchair, other devices that we haven’t even thought of yet might also work.”

Nine things to consider before getting a piercing:

  1. Infection: Do you have a preexisting infection?
  2. Medical issues: Do you have a history of asthma, hives or severe allergic reactions?
  3. Lifestyle: Will you have to remove the piercing for work or contact sports?
  4. Healing issues: Do you have a predisposition to hypertrophic or keloid scarring?
  5. Anatomy: Do you have the right anatomy for the piercing you want?
  6. Professional: Has your piercer been adequately trained?
  7. Medical history: Does the piercer take a complete medical history, including a history of allergies, systemic diseases, particularly inquiring about cardiac disease, unregulated diabetes mellitus or other conditions that may predispose to infection?
  8. Proper materials: Does the piercer use the appropriate, site-specific materials, such as nickel-free jewelry, to minimize the risks of allergy, infection, migration and rejection?
  9. Care instructions:  Will you receive clear oral and written aftercare instructions? For tongue piercings, it is important to avoid aspirin for seven days and all other nonsteroidal anti-inflammatory drugs (NSAIDS) for at least one day before a piercing procedure and for seven days after the event. Aspirin and NSAIDS are known to increase bleeding.

Source:  Erin White, Northwestern Newcenter

Does Online Dating Work?
Posted by on February 18, 2012 - 3:03pm

Whether enlisting the help of a grandmother or a friend or the magic of Cupid, singles long have understood that assistance may be required to meet that special someone.  Today such help is likely to come from online methods of matchmaking. But online dating, according to new Northwestern University research, depends largely on ineffective algorithms and profiles for finding potential love interests.

Mobile dating, the latest iteration in digital dating, however, may hold promise, because it brings together potential partners face-to-face fast to see if "sparks" exist, the research suggests. Although the research on mobile dating is scarce, Eli Finkel, associate professor of psychology at Northwestern and lead author of the study, is optimistic about this approach. "GPS features on smartphone apps can tell you who is nearby and willing to be browsed," Finkel said. "With a little bit of basic information, potential daters can get together right away for a quick face-to-face meet-up."

Good old-fashioned face-to-face contact still is paramount in finding that special someone, and the faster that happens the better, the research suggests.  In previous research, Finkel and his co-authors found that ideal preferences of daters viewing online profiles fell by the wayside after in-person meetings with potential partners.

Finkel maps three generations of online dating and discusses each approach.

• The first generation in 1995—the launch of Match.com: 

“We use the analogy that dating sites like Match.com are like supermarkets of love,” Finkel said. “You check out the wares (online profiles) and see what you like. Upon first blush, this approach seems reasonable, but there are two major problems with it: People really don’t learn much from a profile, and people get overloaded by choice."

• The second generation in 2000—enter eHarmony:

Sites like eHarmony market themselves less as supermarkets of love than as something akin to real estate brokers of love. They use “matching algorithms” in an effort to identify which potential partners are especially compatible with a given online dater. The choice issue, Finkel observed, is somewhat solved by the algorithm approach. Only a handful of people are chosen as compatible matches. "But there is no compelling evidence that any of these algorithms work," he said. “Limiting the number of potential partners is only helpful if the algorithmic-selection process favors compatible partners over incompatible ones, which it fails to do. Even if the algorithms are cutting 2,000 potential partners down to five, if that process is random, is it really any better than strolling into the neighborhood bar?”

• The third generation in 2008—mobile dating:

With the advent of smartphone apps, mobile dating was launched. Mobile dating's ability to get people face-to-face fast may make a big difference. "You have a little bit of basic information," Finkel said. "Is this person below threshold or above threshold for a five-minute meet-up—five minutes from now? There’s no better way to figure out whether you’re compatible with somebody than talking to them over a cup of coffee or a pint of beer."

The authors hope their report will push proprietors to build a more rigorous scientific foundation for online dating services.

Co-authors of the study are Paul Eastwick, assistant professor of psychology at Texas A&M University; Benjamin Karney, professor of psychology at the University of California, Los Angeles; Harry Reis, professor of psychology at the University of Rochester; and Susan Sprecher, professor of sociology and psychology at Illinois State University.The research will be published by Psychological Science in the Public Interest, a journal of the Association for Psychological Science.

Author:  Hilary Hurd Anyaso is the law and social sciences editor for Northwestern's Newscenter

Contraceptive coverage still under attack
Posted by on February 16, 2012 - 10:44am

Last week, President Obama announced that he would continue to protect women's access to birth control without co-pays or deductibles regardless of where they work, including at certain religiously-affiliated employers, while accommodating religious institutions' opposition to contraception.  Under a compromise announced Feb. 10,  religious institutions that object to providing such coverage will not have to offer it.  However, the institution's insurer will have to reach out directly to the employees and offer the coverage free of charge.  The end result is that no religious organization will have to pay for or provide contraceptive services, but women who work at these institution will have access to contraceptive services directly from their contracted insurance company.     This looks like a reasonable solution to try for now, but......

Despite this accommodation, opponents of birth control in Congress  have introduced the Blunt Amendment which would, among other things, allow any corporation whose CEO opposes contraception based on his "moral convictions" to deny all coverage of contraception or any other health care service to the company's employees.   The big question:  Will this amendment, if passed, eventually lead to allowing CEOs of ANY corporation (not just a religiously affiliated one), cancel contraception from his/her company plan because of moral convictions????

Call 1-888-838-5169 TODAY to tell your Senators what YOU think about the Blunt Amendment and its impact on access to no-cost birth control and other critical health care services.  Also, check out our previous blog on this topic

For readers who want to examine the text of Blunt's proposed amendment, here are two key sections:

"Nothing in this title (or any amendment made by this title) shall be construed to require an individual or institutional health care provider, or authorize a health plan to require a provider, to provide, participate in, or refer for a specific item or service contrary to the provider's religious beliefs or moral convictions. Notwithstanding any other provision of this title, a health plan shall not be considered to have failed to provide timely or other access to items or services under this title (or any amendment made by this title) or to fulfill any other requirement under this title because it has respected the rights of conscience of such a provider."

Another part of the amendment makes clear that "no exchange or other official or entity acting in a governmental capacity in the course of implementing this title ... shall discriminate against a health plan, plan sponsor, health care provider, or other person because of such plan's, sponsor's, provider's, or person's unwillingness to provide coverage of, participate in, or refer for, specific items or services."

 

Heavy metal exposure in men and women may delay pregnancy
Posted by on February 13, 2012 - 9:50am

Higher blood levels of cadmium in females, and higher blood levels of lead in males, delayed pregnancy in couples trying to become pregnant, according to a study by researchers at the National Institutes of Health and other academic research institutions.

Cigarette smoke is the most common source of exposure to cadmium, a toxic metal found in the earth’s crust, which is used in batteries, pigments, metal coatings and plastics. Smokers are estimated to have twice the levels of cadmium as do non-smokers. Exposure also occurs in workplaces where cadmium-containing products are made, and from the air near industrial facilities that emit cadmium. Airborne cadmium particles can travel long distances before settling on the ground or water. Soil levels of cadmium vary with location. Fish, plants, and animals absorb cadmium from the environment, and all foods contain at least low levels of the metal.

Lead, a toxic metal also found in the earth's crust, is used in a variety of products, such as ceramics, pipes, and batteries. Common sources of lead exposure in the United States include lead-based paint in older homes, lead-glazed pottery, contaminated soil, and contaminated drinking water.

Exposure to these metals is known to have a number of effects on human health, but the effects on human fertility have not been extensively studied, especially when studying both partners of a couple.

The study was published online in Chemosphere (Feb 4, 2012)   The study's principal investigator was Germaine M. Buck Louis, Ph.D., director of the Division of Epidemiology, Statistics, and Prevention Research at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

"Our results indicate that men and women planning to have children should minimize their exposure to lead and cadmium," Dr. Buck Louis said. "They can reduce cadmium exposure by avoiding cigarettes or by quitting if they are current smokers, especially if they intend to become pregnant in the future. Similarly, they can take steps to reduce their exposure to lead based paints, which may occur in older housing, including during periods of home renovation."

To conduct the study, the researchers enrolled 501 couples from four counties in Michigan and 12 counties in Texas, from 2005 to 2009. The women ranged from 18 to 44 years of age, and the men were over 18. Couples provided blood samples for the analysis of three heavy metals. Women kept journals to record their monthly menstrual cycles and the results of home pregnancy tests. The couples were followed until pregnancy or for up to one year of trying.

The researchers ranked the study participants on the basis of their blood levels of lead and cadmium. The researchers also measured the participants’ blood mercury levels, but found they were not associated with the length of time couples required to become pregnant. Nearly every study participant had some exposure to these common metals, although blood levels of the metals varied across participants.

Researchers calculated the probability that a couple would achieve pregnancy by levels of blood cadmium and lead with a statistical measure called the fecundability odds ratio. The measure estimates couples' probability of pregnancy each cycle, by their blood concentration of metals. A ratio less than one suggests a longer time to pregnancy, while a ratio greater than one suggests a shorter time to pregnancy. Females' blood cadmium concentration was associated with a ratio below 1 (0.78), which means that the probability of pregnancy was reduced by 22 percent with each increase in the level of cadmium. Males’ blood lead exposure also was associated with a ratio below 1 (0.85) with increasing levels, or about a 15 percent reduction in the probability of pregnancy for each increase in the level of blood lead concentrations.

"The findings highlight the importance of assessing couples' exposure jointly, in a single, combined measure," Dr. Buck Louis said. "Males matter, because couples' chances of becoming pregnant each cycle were reduced with increasing blood lead concentrations in men."

 

HPV guidelines for boys and young men
Posted by on February 11, 2012 - 7:37am

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) has strengthened and expanded its recommendation for vaccinating boys and young men with the quadrivalent human papillomavirus (HPV) vaccine, primarily to reduce the risk of anal cancer, penile cancer, and certain types of head and neck cancers caused mainly by HPV 16. The updated recommendations were published in Morbidity and Mortality Weekly Report last October and online January 31 in the Annals of Internal Medicine.

ACIP calls for the routine [HPV] vaccination of males aged 11 to 12 years, with catch-up vaccination recommended for males aged 13 to 21 years. The recommendations specifically call for vaccination with Gardasil, which protects against infection with four HPV types: 6, 11, 16, and 18. Types 6 and 11 cause genital warts, and types 16 and 18 cause cancer.

They also recommend that  HPV vaccination for previously unvaccinated males aged 22 to 26 years who are immunocompromised, who test positive for HIV infection, or who have sex with men.

 

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