One Third of Bottled Water Contain Contaminants
Apr 26, 2011
Environmentalists and EBMUD push for more disclosure
Sacramento - Saying consumers should know what they're drinking, environmentalists and the East Bay Municipal Utility District want bottled water to follow the same disclosure rules as tap water.
Makers of bottled water, which include Pepsi and Coca-Cola, say there is already plenty of disclosure about their water's contents.
Advocates of two bills introduced in the Legislature say there isn't nearly enough.
"People tout bottled water as this pure substance that's trickling from clear mountain springs when, in fact, that may not be the case," said Assemblywoman Ellen Corbett, D-San Leandro, author of one of the bills.
"When I pick up bottled water, I want to know it truly is something that's good for me and better for me than drinking something else," Corbett said.
Nearly 70 percent of Californians drink bottled water, which nationwide is a $6 billion industry. And by the end of this year, bottled water will have moved past milk, coffee and beer to become the second most popular beverage behind soft drinks, according to the Beverage Marketing Corp.
Bottle vs Tap
Bottled water's popularity is fuelled in part by suspicions over the quality of tap water.
But Corbett and the backers of her bill say drink no way of knowing whether bottled water is better or worse.
Unlike tap water, bottled water is considered a food product and is subject to the same sanitation and preparation requirements as other food stuffs.
Although often advertising themselves as superior to tap water, bottlers are required in most cases only to meet the same quality standards as tap water.
Of the hundreds of contaminants state and federal regulators measure, bottled water is subject to a higher standard for only two, according to Randy Kanouse, EBMUD's Sacramento lobbyist.
Bottlers don't have to create a "consumer confidence" report each year like water agencies do. The reports tell customers what's in their water. It details levels of contaminants, if any, like lead, aluminium, arsenic and salt.
Corbett's bill, AB83, and a companion bill, SB50, by Sen. Byron Sher, D- Palo Alto, would impose the same reporting requirement on bottlers.
Bottling plants and water vending machines would be subject to annual inspections. Bottlers, vending machine owners and water haulers would pay an $86 fee to cover the costs of the inspections.
Bottlers say the bills aren't needed.
"There are already comprehensive, stringent regulations in place at the federal level for quality labeling," said Stephen Kay, a spokesman for the International Bottled Water Association. "These two proposed bills are proscriptive and redundant."
Kay also cited a bill signed last year that requires bottlers to include an 800 number, Web site or address on their labels so consumers can get more information.
But Adrianna Quintero, a lobbyist for the Natural Resources Defence Council,
says knowing the nutritional facts about water is not enough.
"It's pointless to tell me water has zero calories and zero carbohydrates," Quintero said. "Is there arsenic, nitrates, microbiologic contaminants, perchlorate? If these bottlers are doing the right thing, they shouldn't have a problem telling me about it."
The Food and Drug Administration needs to tightened its regulations on bottled water after a four-year study by the NRDC found that of 103 brands surveyed, one- third contained levels of contamination.
The NRDC found the contents of one bottle, labeled "Spring Water," actually came from an industrial parking lot next to a hazardous waste site.
The FDA now insists that bottled water actually come from a spring if the bottler claims it does.
Bottled water sales have been growing at roughly 10 percent each year through the 1990s.
California is by far the biggest guzzler of bottled water, representing about 24 percent of the national market -- twice the consumption level of any other state.
It's attracted the interest of some of the country's biggest beverage sellers like Pepsi, which created Aquafina bottled water. Coca-Cola created Dasani.
Nestle Waters of North America owns Arrowhead, Calistoga, Poland Spring, Perrier, S. Pellegrino and Vittel.
But water districts like EBMUD aren't worried.
"Bottled water doesn't cut into our market share," said Kanouse. "It's kind of like conservation -- it relieves a small amount of the demand we have."
Written by Greg Lucas, Sacramento Bureau Chief
Tuesday, July 26, 2011
Parents' stress tied to pollution's effect on kids
Parents' stress tied to pollution's effect on kids
By Kerry Grens
Reuters
Jul 22, 2011
(Reuters Health) - Children living in high-stress households are more vulnerable to lung damage from traffic pollution than children whose parents are less stressed out, according to the results of a new study.
"It makes sense," said Dr. Jane Clougherty from the University of Pittsburgh, who was not involved in this study. "The bodily wear and tear induced by...stress could make the individual more susceptible to the effects of traffic-related air pollution."
The researchers took measurements of several indicators of lung function in nearly 1,400 children living in southern California.
They also predicted the amount of traffic pollutants the children were exposed to by sampling almost 1,000 different sites around the area. In particular the researchers were looking for nitrogen oxides, which are formed when fuel is burned. Nitrogen oxides can damage lung tissue and make asthma worse, they explain in an article in the American Journal of Respiratory and Critical Care Medicine.
Six years earlier, the children's parents had filled out a questionnaire about their level of stress. The questions asked how often they felt able to handle personal problems or felt in control, for instance.
Air pollution levels varied widely depending on where the children lived, from six parts per billion of nitrogen oxides to 101 parts per billion.
For kids from high-stress homes, when the average amount of nitrogen oxides in the air went up by 22 parts per billion, their lung function got roughly five percent worse.
That same increase in pollutants around a child whose parents had a low level of stress made no difference to their lung function, however.
Dr. Talat Islam from the University of Southern California, the lead author of the study, said he expected that stress would lead to a bigger effect of pollution on kids, but he was surprised that increased air pollution had no effect on the kids from low-stress homes.
"We see the whole effect of traffic-related air pollution in those children who were exposed to higher stress," Islam told Reuters Health.
Islam's group did not test whether that decrease in lung function among these children had any effect on their health or comfort.
An earlier study by some of the same researchers found that children exposed to traffic-related air pollution and a high-stress home were 51 percent more likely to develop asthma than children exposed to the same pollutants, but in a low-stress environment (see Reuters Health report, July 21, 2009).
It's not clear what might underlie the links between pollution, a stressful household, and lung function, but Islam said that stress and pollutants are both tied to inflammation and tissue damage.
Clougherty said it's important for parents to consider -- if they have a choice -- their children's exposure to traffic and air pollution when deciding where to live, play and go to school.
But as the results indicate, she added, "the social environment might be equally, if not more, important to the child's health overall."
SOURCE: American Journal of Respiratory and Critical Care Medicine, online June 23, 2011.
By Kerry Grens
Reuters
Jul 22, 2011
(Reuters Health) - Children living in high-stress households are more vulnerable to lung damage from traffic pollution than children whose parents are less stressed out, according to the results of a new study.
"It makes sense," said Dr. Jane Clougherty from the University of Pittsburgh, who was not involved in this study. "The bodily wear and tear induced by...stress could make the individual more susceptible to the effects of traffic-related air pollution."
The researchers took measurements of several indicators of lung function in nearly 1,400 children living in southern California.
They also predicted the amount of traffic pollutants the children were exposed to by sampling almost 1,000 different sites around the area. In particular the researchers were looking for nitrogen oxides, which are formed when fuel is burned. Nitrogen oxides can damage lung tissue and make asthma worse, they explain in an article in the American Journal of Respiratory and Critical Care Medicine.
Six years earlier, the children's parents had filled out a questionnaire about their level of stress. The questions asked how often they felt able to handle personal problems or felt in control, for instance.
Air pollution levels varied widely depending on where the children lived, from six parts per billion of nitrogen oxides to 101 parts per billion.
For kids from high-stress homes, when the average amount of nitrogen oxides in the air went up by 22 parts per billion, their lung function got roughly five percent worse.
That same increase in pollutants around a child whose parents had a low level of stress made no difference to their lung function, however.
Dr. Talat Islam from the University of Southern California, the lead author of the study, said he expected that stress would lead to a bigger effect of pollution on kids, but he was surprised that increased air pollution had no effect on the kids from low-stress homes.
"We see the whole effect of traffic-related air pollution in those children who were exposed to higher stress," Islam told Reuters Health.
Islam's group did not test whether that decrease in lung function among these children had any effect on their health or comfort.
An earlier study by some of the same researchers found that children exposed to traffic-related air pollution and a high-stress home were 51 percent more likely to develop asthma than children exposed to the same pollutants, but in a low-stress environment (see Reuters Health report, July 21, 2009).
It's not clear what might underlie the links between pollution, a stressful household, and lung function, but Islam said that stress and pollutants are both tied to inflammation and tissue damage.
Clougherty said it's important for parents to consider -- if they have a choice -- their children's exposure to traffic and air pollution when deciding where to live, play and go to school.
But as the results indicate, she added, "the social environment might be equally, if not more, important to the child's health overall."
SOURCE: American Journal of Respiratory and Critical Care Medicine, online June 23, 2011.
Thursday, July 14, 2011
Asthma study reveals the power of the placebo effect
Asthma study reveals the power of the placebo effect
In a new study, the placebo effect was so strong that asthma patients couldn't tell whether the inhaler they used had actual medicine in it.
By Karen Kaplan
Los Angeles Times
July 13, 2011
The placebo effect is alive and well, at least for patients with acute asthma.
That’s the finding of a pilot study funded by the National Center for Complementary and Alternative Medicine -- part of the National Institutes of Health -- and published in Thursday’s edition of the New England Journal of Medicine.
Researchers from Harvard Medical School and colleagues decided to test the placebo effect in asthma patients because it’s easy to assess their physical improvement (as measured by lung function tests) in a short period of time.
They recruited 39 patients who cycled among four treatment options over 12 visits. In some cases they got albuterol -- a bona fide asthma treatment -- through an inhaler, and sometimes they used an inhaler with no medicine, though the subjects didn’t know which was which. Other times, they were given sham acupuncture treatment (but told it was real), and on some visits there was no treatment at all.
Patients said their symptoms improved by 21% on the occasions when they got no treatment. But when they thought they were getting some kind of treatment, they said their symptoms improved much more -- by 50% when they got the albuterol, by 45% when they had the placebo inhaler, and by 46% with the sham acupuncture. (There was no statistically significant difference among those three outcomes.)
Did they really get that much better? When they had the albuterol, patients’ maximum forced expiratory volume in 1 second (a measure of lung function) improved by 20%. But in all three other cases, lung function improved by only 7.1% to 7.5%.
The results demonstrate that the placebo effect is powerful, the researchers said. When it came to patients’ assessments of the treatments, “the placebo effects were equivalent to the drug effect,” they wrote.
These results also suggest that patients can’t be relied upon to make accurate reports of whether their symptoms are getting better. In this study, patients couldn’t tell when the albuterol was making a real difference. In fact, any time they got something that looked like a “treatment,” they reported roughly the same degree of improvement, the researchers said.
“Even though there was a large, objective drug effect ... that was nearly three times the effect of the two placebos and the no-intervention control ,” they wrote, “patients could not reliably detect the difference between this robust effect of the active drug and the effects of inhaled placebo and sham acupuncture.”
A summary of the study is available here.
In a new study, the placebo effect was so strong that asthma patients couldn't tell whether the inhaler they used had actual medicine in it.
By Karen Kaplan
Los Angeles Times
July 13, 2011
The placebo effect is alive and well, at least for patients with acute asthma.
That’s the finding of a pilot study funded by the National Center for Complementary and Alternative Medicine -- part of the National Institutes of Health -- and published in Thursday’s edition of the New England Journal of Medicine.
Researchers from Harvard Medical School and colleagues decided to test the placebo effect in asthma patients because it’s easy to assess their physical improvement (as measured by lung function tests) in a short period of time.
They recruited 39 patients who cycled among four treatment options over 12 visits. In some cases they got albuterol -- a bona fide asthma treatment -- through an inhaler, and sometimes they used an inhaler with no medicine, though the subjects didn’t know which was which. Other times, they were given sham acupuncture treatment (but told it was real), and on some visits there was no treatment at all.
Patients said their symptoms improved by 21% on the occasions when they got no treatment. But when they thought they were getting some kind of treatment, they said their symptoms improved much more -- by 50% when they got the albuterol, by 45% when they had the placebo inhaler, and by 46% with the sham acupuncture. (There was no statistically significant difference among those three outcomes.)
Did they really get that much better? When they had the albuterol, patients’ maximum forced expiratory volume in 1 second (a measure of lung function) improved by 20%. But in all three other cases, lung function improved by only 7.1% to 7.5%.
The results demonstrate that the placebo effect is powerful, the researchers said. When it came to patients’ assessments of the treatments, “the placebo effects were equivalent to the drug effect,” they wrote.
These results also suggest that patients can’t be relied upon to make accurate reports of whether their symptoms are getting better. In this study, patients couldn’t tell when the albuterol was making a real difference. In fact, any time they got something that looked like a “treatment,” they reported roughly the same degree of improvement, the researchers said.
“Even though there was a large, objective drug effect ... that was nearly three times the effect of the two placebos and the no-intervention control ,” they wrote, “patients could not reliably detect the difference between this robust effect of the active drug and the effects of inhaled placebo and sham acupuncture.”
A summary of the study is available here.
Tuesday, July 12, 2011
High salt + low potassium = early death: study
High salt + low potassium = early death: study
By Julie Steenhuysen
Jul 11, 2011
(Reuters)
Put down the salt shakers. Eating too much salt and too little potassium can increase the risk of death, U.S. government researchers said on Monday.
The findings from a team at the U.S. Centers for Disease Control and Prevention are a counterpoint to a fiercely-debated study released last week that found no evidence that making small cuts in salt intake lowers the risk of heart disease and premature death.
"Salt is still bad for you," said Dr. Thomas Farley, Health Commissioner for New York City, which is leading a campaign to reduce salt in restaurant and packaged foods by 25 percent over five years.
Most health experts agree with Farley that consuming too much salt is not good for you and that cutting salt intake can reduce high blood pressure, which raises the risk of heart attack and stroke. Salt intake has been rising since the 1970s, with Americans consuming about twice the recommended daily limit.
The CDC study, published in the Archives of Internal Medicine, specifically focused on growing research that shows a diet high in salt and low in potassium is especially risky.
Farley, who wrote an editorial on the CDC study, said it is one of the best yet looking at the long-term effects of eating too much salt.
"It is entirely consistent with what we've said all along about sodium intake," Farley said in a telephone interview.
For the study, researchers looked at the long-term effects of sodium and potassium intake as part of a 15-year study of more than 12,000 people.
By the end of the study period, 2,270 of the study participants had died; 825 of these deaths were from heart disease and 433 were from blood clots and strokes.
POTASSIUM IS KEY
They found that people who had a high salt intake and a low potassium intake were most at risk.
"People who ate a diet high in sodium and low in potassium had a 50 percent increased risk of death from any cause, and about twice the risk of death -- or a 200 percent increase -- from a heart attack," said Dr. Elena Kuklina of the CDC who helped lead the study.
She said consumers need to increase the levels of potassium in their diet by adding more servings of fresh fruits and vegetables, such as spinach, grapes, carrots, sweet potatoes, and low fat milk and yogurt.
The Salt Institute, an industry group, challenged the findings, pointing out that the CDC study found that the link between salt intake and heart disease was statistically insignificant.
"This is a highly flawed publication that reveals more about the anti-salt agenda being pursued by the CDC than about any relationship between salt and health," said Mort Satin, the Salt Institute's Director of Science and Research.
"The only significance is between low potassium and mortality," Satin said in a statement.
Dr. Robert Briss, director of the National Center for Chronic Disease Prevention and Health Promotion at the CDC, said the findings support the general weight of evidence and suggests that higher doses of sodium are linked with poor health consequences.
And it suggests "that higher potassium may be better for you," Briss said in a telephone interview.
"About 90 percent of Americans consume more sodium than is recommended. This impacts their blood pressure," Briss said.
"Most of that sodium is not related to the salt shaker but it is in foods and especially processed and restaurant foods that we buy and order from restaurants. Consumers, even motivated ones, don't have as much choice as they could," he said.
Kuklina said potassium often counteracts the effects of salt in the diet. This equilibrium is affected when people eat highly processed foods, which tend to increase sodium levels and decrease potassium content.
"If sodium increases your high blood pressure, potassium decreases it. If sodium retains water, potassium helps you get rid of it," she said.
Instead of focusing only on salt, Kuklina said researchers should focus on the balance between potassium and salt.
"We need to strive to do both -- decrease your sodium intake and increase your potassium intake," she said.
By Julie Steenhuysen
Jul 11, 2011
(Reuters)
Put down the salt shakers. Eating too much salt and too little potassium can increase the risk of death, U.S. government researchers said on Monday.
The findings from a team at the U.S. Centers for Disease Control and Prevention are a counterpoint to a fiercely-debated study released last week that found no evidence that making small cuts in salt intake lowers the risk of heart disease and premature death.
"Salt is still bad for you," said Dr. Thomas Farley, Health Commissioner for New York City, which is leading a campaign to reduce salt in restaurant and packaged foods by 25 percent over five years.
Most health experts agree with Farley that consuming too much salt is not good for you and that cutting salt intake can reduce high blood pressure, which raises the risk of heart attack and stroke. Salt intake has been rising since the 1970s, with Americans consuming about twice the recommended daily limit.
The CDC study, published in the Archives of Internal Medicine, specifically focused on growing research that shows a diet high in salt and low in potassium is especially risky.
Farley, who wrote an editorial on the CDC study, said it is one of the best yet looking at the long-term effects of eating too much salt.
"It is entirely consistent with what we've said all along about sodium intake," Farley said in a telephone interview.
For the study, researchers looked at the long-term effects of sodium and potassium intake as part of a 15-year study of more than 12,000 people.
By the end of the study period, 2,270 of the study participants had died; 825 of these deaths were from heart disease and 433 were from blood clots and strokes.
POTASSIUM IS KEY
They found that people who had a high salt intake and a low potassium intake were most at risk.
"People who ate a diet high in sodium and low in potassium had a 50 percent increased risk of death from any cause, and about twice the risk of death -- or a 200 percent increase -- from a heart attack," said Dr. Elena Kuklina of the CDC who helped lead the study.
She said consumers need to increase the levels of potassium in their diet by adding more servings of fresh fruits and vegetables, such as spinach, grapes, carrots, sweet potatoes, and low fat milk and yogurt.
The Salt Institute, an industry group, challenged the findings, pointing out that the CDC study found that the link between salt intake and heart disease was statistically insignificant.
"This is a highly flawed publication that reveals more about the anti-salt agenda being pursued by the CDC than about any relationship between salt and health," said Mort Satin, the Salt Institute's Director of Science and Research.
"The only significance is between low potassium and mortality," Satin said in a statement.
Dr. Robert Briss, director of the National Center for Chronic Disease Prevention and Health Promotion at the CDC, said the findings support the general weight of evidence and suggests that higher doses of sodium are linked with poor health consequences.
And it suggests "that higher potassium may be better for you," Briss said in a telephone interview.
"About 90 percent of Americans consume more sodium than is recommended. This impacts their blood pressure," Briss said.
"Most of that sodium is not related to the salt shaker but it is in foods and especially processed and restaurant foods that we buy and order from restaurants. Consumers, even motivated ones, don't have as much choice as they could," he said.
Kuklina said potassium often counteracts the effects of salt in the diet. This equilibrium is affected when people eat highly processed foods, which tend to increase sodium levels and decrease potassium content.
"If sodium increases your high blood pressure, potassium decreases it. If sodium retains water, potassium helps you get rid of it," she said.
Instead of focusing only on salt, Kuklina said researchers should focus on the balance between potassium and salt.
"We need to strive to do both -- decrease your sodium intake and increase your potassium intake," she said.
Doctors overuse stents, despite guidelines
Doctors overuse heart treatment, despite guidelines
By Frederik Joelving
Jul 11, 2011
(Reuters Health) - The controversial use of stents days after a heart athttp://www.blogger.com/img/blank.giftack has continued unabated in the United States, even after a landmark study and new guidelines said the pricey therapy does not help patients.
Just over half of patients who have survived at least 24 hours after a heart attack will have a stent -- a small metal mesh tube -- placed to open a blocked coronary artery, and that rate has not changed from 2005 through 2008.
The findings add to concerns about overuse of the heart devices, made by companies such as Boston Scientific, Abbott Laboratories, Medtronic Inc and Johnson & Johnson.
Stenting procedures cost the United States about $12 billion every year, and researchers say it is time doctors take responsibility for the nation's spiraling health costs.
"I think physicians have to rise to the challenge," said Dr. Judith Hochman, a cardiologist at New York University, who led the new work.
In 2006, Hochman published a study known as the Occluded Artery Trial showing that stents did not prevent any deaths or new heart attacks compared with drugs alone when inserted more than 24 hours after a heart attack into a totally blocked artery.
While the people who got stents did not experience any more side effects, the devices did rack up an extra $7,000 in net cost per person after two years, Hochman later found.
"After a day or so, whatever damage is going to be done was done already," she told Reuters Health. "The message is to seek medical care soon after a heart attack, and that is when stenting really helps."
Hochman's results became part of revised guidelines from the American Heart Association and other groups in 2007, which recommend against using stents more than 24 hours after a heart attack in stable patients.
Her new study, published in the Archives of Internal Medicine (bit.ly/7qXyI), is based on nearly 29,000 patients seen at 896 U.S. hospitals.
It shows that neither the 2006 trial nor the revised guidelines had a noticeable effect on stent use.
"Overall there was no change in practice," Hochman said. "I expected to see a change, so it was a big surprise and a disappointment."
600,000 STENTS A YEAR
Hochman's findings apply to about 100,000 Americans a year, suggesting that about 50,000 people are having the $20,000 procedure done unnecessarily every year.
That is in addition to thousands of stents inserted outside the context of emergencies such as a heart attack, according to a study from last week showing at least one in 12 of those procedures probably leads to more harm than benefit.
Each year in the United States, about 600,000 stents are inserted into ailing hearts where they prop open blocked arteries.
The stenting procedure, called percutaneous coronary intervention, or PCI, carries risks of complications like major bleeding or tears in the heart. After leaving the hospital, people also need to take clot-busting medications, which further increase the chance of bleeds.
Studies have found that many doctors rush to do PCI before using medications that might help stable patients just as well.
In an editorial, Dr. Mauro Moscucci of the University of Miami said Hochman's study had inadequate information about the severity of heart attacks, which might have justified the use of stenting in some cases.
Still, he said, it would have been reasonable to expect a reduction in the frequency of late stenting.
"While the debate on health care reform is ongoing, health care expenditures in the United States are continuing to escalate," Moscucci said.
"Thus we must heed the call to professional responsibility aimed at the elimination of tests and treatments that do not result in any benefit for our patients, and for which the net effect will be added costs, waste, and possible harm."
Another study in the same journal, published Monday along with Hochman's report, shows it is not uncommon to see new and better research challenge established conventions and treatments.
In that study, as many as 16 of the reports that appeared in 2009 in the New England Journal of Medicine, a leading medical publication, contradicted current practice.
But according to Hochman, getting doctors to drop a new treatment may be harder than getting them to take it up -- whether that's due to strongly held beliefs about its effectiveness, worries about medical liability or losing money, or patient expectations...
By Frederik Joelving
Jul 11, 2011
(Reuters Health) - The controversial use of stents days after a heart athttp://www.blogger.com/img/blank.giftack has continued unabated in the United States, even after a landmark study and new guidelines said the pricey therapy does not help patients.
Just over half of patients who have survived at least 24 hours after a heart attack will have a stent -- a small metal mesh tube -- placed to open a blocked coronary artery, and that rate has not changed from 2005 through 2008.
The findings add to concerns about overuse of the heart devices, made by companies such as Boston Scientific, Abbott Laboratories, Medtronic Inc and Johnson & Johnson.
Stenting procedures cost the United States about $12 billion every year, and researchers say it is time doctors take responsibility for the nation's spiraling health costs.
"I think physicians have to rise to the challenge," said Dr. Judith Hochman, a cardiologist at New York University, who led the new work.
In 2006, Hochman published a study known as the Occluded Artery Trial showing that stents did not prevent any deaths or new heart attacks compared with drugs alone when inserted more than 24 hours after a heart attack into a totally blocked artery.
While the people who got stents did not experience any more side effects, the devices did rack up an extra $7,000 in net cost per person after two years, Hochman later found.
"After a day or so, whatever damage is going to be done was done already," she told Reuters Health. "The message is to seek medical care soon after a heart attack, and that is when stenting really helps."
Hochman's results became part of revised guidelines from the American Heart Association and other groups in 2007, which recommend against using stents more than 24 hours after a heart attack in stable patients.
Her new study, published in the Archives of Internal Medicine (bit.ly/7qXyI), is based on nearly 29,000 patients seen at 896 U.S. hospitals.
It shows that neither the 2006 trial nor the revised guidelines had a noticeable effect on stent use.
"Overall there was no change in practice," Hochman said. "I expected to see a change, so it was a big surprise and a disappointment."
600,000 STENTS A YEAR
Hochman's findings apply to about 100,000 Americans a year, suggesting that about 50,000 people are having the $20,000 procedure done unnecessarily every year.
That is in addition to thousands of stents inserted outside the context of emergencies such as a heart attack, according to a study from last week showing at least one in 12 of those procedures probably leads to more harm than benefit.
Each year in the United States, about 600,000 stents are inserted into ailing hearts where they prop open blocked arteries.
The stenting procedure, called percutaneous coronary intervention, or PCI, carries risks of complications like major bleeding or tears in the heart. After leaving the hospital, people also need to take clot-busting medications, which further increase the chance of bleeds.
Studies have found that many doctors rush to do PCI before using medications that might help stable patients just as well.
In an editorial, Dr. Mauro Moscucci of the University of Miami said Hochman's study had inadequate information about the severity of heart attacks, which might have justified the use of stenting in some cases.
Still, he said, it would have been reasonable to expect a reduction in the frequency of late stenting.
"While the debate on health care reform is ongoing, health care expenditures in the United States are continuing to escalate," Moscucci said.
"Thus we must heed the call to professional responsibility aimed at the elimination of tests and treatments that do not result in any benefit for our patients, and for which the net effect will be added costs, waste, and possible harm."
Another study in the same journal, published Monday along with Hochman's report, shows it is not uncommon to see new and better research challenge established conventions and treatments.
In that study, as many as 16 of the reports that appeared in 2009 in the New England Journal of Medicine, a leading medical publication, contradicted current practice.
But according to Hochman, getting doctors to drop a new treatment may be harder than getting them to take it up -- whether that's due to strongly held beliefs about its effectiveness, worries about medical liability or losing money, or patient expectations...
Sunday, July 10, 2011
When Nurses Make Mistakes
And then this doctor said something that made a huge difference to me, and it’s a sentiment I think about often. “A situation like this can build trust, Theresa,’’ he told me, “because the patient knows we’re being honest.”
July 6, 2011, When Nurses Make Mistakes
By THERESA BROWN, R.N.
New York Times
This year, a Seattle nurse named Kim Hiatt committed suicide. Ms. Hiatt’s death came nearly seven months after she had given an unintended overdose to an infant heart patient, a medical error that was said to have contributed to the child’s death days later.
Ms. Hiatt had been a nurse for 27 years and had often cared for the 8-month-old girl during the child’s stay in the pediatric intensive care unit of her hospital. She had probably drawn up the right dose of the drug hundreds of times in her career. But once, she made a life-changing error. A baby died, and she was suspended, then fired from a profession she loved. And now she’s dead.
July 6, 2011, When Nurses Make Mistakes
By THERESA BROWN, R.N.
New York Times
This year, a Seattle nurse named Kim Hiatt committed suicide. Ms. Hiatt’s death came nearly seven months after she had given an unintended overdose to an infant heart patient, a medical error that was said to have contributed to the child’s death days later.
Ms. Hiatt had been a nurse for 27 years and had often cared for the 8-month-old girl during the child’s stay in the pediatric intensive care unit of her hospital. She had probably drawn up the right dose of the drug hundreds of times in her career. But once, she made a life-changing error. A baby died, and she was suspended, then fired from a profession she loved. And now she’s dead.
Saturday, July 9, 2011
Naturopath Sentenced For Injecting Teen With Hydrogen Peroxide
Naturopath Sentenced For Injecting Teen With Hydrogen Peroxide
O'Connell To Spend 13 Years In Prison
March 27, 2006
GOLDEN, Colo. -- The so-called holistic doctor who pleaded guilty in the death of a patient was sentenced Monday to 13 years in prison after a judge told him he had shown no remorse over the death of a 19-year-old cancer victim he was treating.
http://www.blogger.com/img/blank.gif
Brian O'Connell admitted last month to criminally negligent homicide for injecting 19-year-old Sean Flanagan with hydrogen peroxide. Flanagan suffered from Ewing's Sarcoma, a form of cancer, and had tried chemotherapy and radiation treatment to no avail.
Flanagan's family sent him to O'Connell, who practices using natural remedies. However, the family said that Flanagan died prematurely in 2003 because of O'Connell's treatments.
In court on Monday, O'Connell asked Jefferson County District Judge Margie Enquist for leniency, saying he didn't know what he was doing was wrong. He said he had changed and regretted Flanagan's death.
Enquist told O'Connell she didn't believe him, and sentenced him to just two years less than the maximum.
"You stand here today without remorse, without regret, and denying what you pled guilty to, and you still call yourself a victim," she said.
Flanagan's parents, Laura and David Flanagan, said the sentence was fair.
O'Connell showed no emotion when Enquist announced the sentence, but his wife, seated in the front row of the gallery, wept.
Defense attorney Richard Jaffe said no appeal was likely, but he said people who would have sought care from O'Connell were also victims.
"There are victims on the other side too that can't get treatment now," he said.
Jaffe presented about a dozen witnesses during the sentencing hearing who said O'Connell helped them fight conditions that did not respond to traditional medicine.
In February, O'Connell also admitted guilt to theft, perjury, criminally negligent homicide, illegal practice of medicine and third-degree assault.
O'Connell was in charge of Mountain Area Naturopathic Associates in Wheat Ridge. In his office he displayed numerous degrees and certifications claiming he was doctor and a naturopath. The Colorado Medical Board found that he had no license to practice medicine in Colorado and was not certified as any kind of health care worker.
O'Connell was treating Flanagan with a procedure known as ultraviolet blood irradiation, where his blood was removed from the body, passed under an ultraviolet light and then returned to the body. When he didn't respond well to that, O'Connell then treated Flanagan by injecting his blood with hydrogen peroxide. The next day he died.
Prosecutors argued that Flanagan's cause of death was listed as probable complications from the hydrogen peroxide treatment.
O'Connell also injected this hydrogen peroxide solution into a 17-year-old girl, which caused her to go into cardiac arrest...
O'Connell To Spend 13 Years In Prison
March 27, 2006
GOLDEN, Colo. -- The so-called holistic doctor who pleaded guilty in the death of a patient was sentenced Monday to 13 years in prison after a judge told him he had shown no remorse over the death of a 19-year-old cancer victim he was treating.
http://www.blogger.com/img/blank.gif
Brian O'Connell admitted last month to criminally negligent homicide for injecting 19-year-old Sean Flanagan with hydrogen peroxide. Flanagan suffered from Ewing's Sarcoma, a form of cancer, and had tried chemotherapy and radiation treatment to no avail.
Flanagan's family sent him to O'Connell, who practices using natural remedies. However, the family said that Flanagan died prematurely in 2003 because of O'Connell's treatments.
In court on Monday, O'Connell asked Jefferson County District Judge Margie Enquist for leniency, saying he didn't know what he was doing was wrong. He said he had changed and regretted Flanagan's death.
Enquist told O'Connell she didn't believe him, and sentenced him to just two years less than the maximum.
"You stand here today without remorse, without regret, and denying what you pled guilty to, and you still call yourself a victim," she said.
Flanagan's parents, Laura and David Flanagan, said the sentence was fair.
O'Connell showed no emotion when Enquist announced the sentence, but his wife, seated in the front row of the gallery, wept.
Defense attorney Richard Jaffe said no appeal was likely, but he said people who would have sought care from O'Connell were also victims.
"There are victims on the other side too that can't get treatment now," he said.
Jaffe presented about a dozen witnesses during the sentencing hearing who said O'Connell helped them fight conditions that did not respond to traditional medicine.
In February, O'Connell also admitted guilt to theft, perjury, criminally negligent homicide, illegal practice of medicine and third-degree assault.
O'Connell was in charge of Mountain Area Naturopathic Associates in Wheat Ridge. In his office he displayed numerous degrees and certifications claiming he was doctor and a naturopath. The Colorado Medical Board found that he had no license to practice medicine in Colorado and was not certified as any kind of health care worker.
O'Connell was treating Flanagan with a procedure known as ultraviolet blood irradiation, where his blood was removed from the body, passed under an ultraviolet light and then returned to the body. When he didn't respond well to that, O'Connell then treated Flanagan by injecting his blood with hydrogen peroxide. The next day he died.
Prosecutors argued that Flanagan's cause of death was listed as probable complications from the hydrogen peroxide treatment.
O'Connell also injected this hydrogen peroxide solution into a 17-year-old girl, which caused her to go into cardiac arrest...
Wednesday, July 6, 2011
The hygiene hypothesis
The hygiene hypothesis
It suggests lack of early exposure to infectious agents can suppress development of the immune system
By Dr. Richard L. Gallo
Jan. 31, 2011
In 1998, researchers at the University of Georgia published a paperhttp://www.blogger.com/img/blank.gif that estimated about 5 million trillion bacterial cells reside on Earth. That’s a 5 with 30 zeros. That’s a lot of bacteria. Indeed, if each individual bacterium were a penny piled atop one another, it would take a trillion light-years to reach the end of the stack, which is far beyond the observable universe.
Some of these bacteria, Louis Pasteur and others duly discovered, cause disease, and so contemporary humans have long been urged, explicitly and otherwise, to fight back: Wash often. Stay clean. And don’t skimp on those alcohol-based hand-sanitizing gels, foams and lotions that reportedly kill 99 percent of all germs. Odds are there’s a dispenser near you right now.
But is cleanliness really next to goodliness?
Maybe not. There is compelling, growing evidence that being too clean might actually be bad for your health; that it results in increased sickness and the development of chronic immunological ailments that might not occur if we all dialed back on the Dial and dispensers.
This thinking is encapsulated in an idea called “the hygiene hypothesis,” which first emerged in the late-1980s. The hypothesis suggests that a lack of early childhood exposure to infectious agents and microorganisms (not just bacteria, but viruses and fungi, too) suppresses natural development of the immune system, resulting in increased susceptibility to infection and disease.
The hypothesis has been used to help explain why allergies like hay fever are less common in children from large families, even though presumably these kids are exposed to more infectious agents than those in smaller families. Epidemiologists have also noted that ailments like asthma and eczema (a kind of skin inflammation) are more prevalent in industrialized countries where personal cleanliness is emphasized.
Though not conclusively proved, the hypothesis makes sense — at least as part of a larger explanation. Let’s look at the science.
One’s a crowd
If the world is fraught with bacteria, so too are you. Based solely on the average number of cells in a typical human being, we’re all more inhuman than human. Bacterial cells outnumber human cells 10 to 1. Your gut, for example, is a well-known bacterial repository, home to hundreds of trillions of individual microbes (somewhere between 300 and 1,000 species), many of which beneficially assist in necessary functions like digestion and immune response. Plus, they take up space that might otherwise be occupied by nastier, disease-causing pathogens.
Your skin is similarly populated. Recent studies have identified hundreds of species, many previously unknown. One estimate calculates the total number of skin-based bacteria on the average person at roughly 1,000,000,000,000. These bacteria live in colonies, each favoring a different environmental niche. The bacteria that prefer the crook of your elbow, for example, are different from those homesteading your forearm.
Swathed in our cloaks of microbial invisibility, some questions are nonetheless obvious: How do skin bacteria survive our constant assaults with soaps and antibiotics? And why don’t they make us sick more often?
In research published this year and last, my colleagues and I uncovered some of the answers. Our skin hums with constant communication and interaction between commensal or benign bacteria and skin cells. Certain species of superabundant Staphylococcus bacteria, for example, produce a molecule that inhibits the inflammation response (heat, redness, swelling) generated when you injure your skin. That’s a good thing. Some inflammation is vital to healing, but too much can be worse than the infection.
Why do Staphylococci do this? It’s hard to know for sure, but one possibility is that it’s an evolutionary adaptation, a neat trick bacteria have developed to reduce the chances that an inflammatory response will kill them. Another possibility is that we have evolved together and count on these bacteria to help us control the skin response. In return for this microbial good deed, we reward specific bacteria with a comfortable place to live.
Recently, we discovered that a specific type of Staphylococci — Staphylococcus epidermidis, the most common bacterial species cultured from human skin — produces antimicrobial molecules that kill some other kinds of bacteria, including its cousin, S. aureus, a more problematic bug that causes everything from pimples and boils to deadly pneumonia, meningitis and sepsis.
S. epidermidis not only makes antimicrobials, it also instructs human skin cells to make natural antimicrobials of their own, thus serving as both warning system and mentor. The result is a balanced relationship that benefits both human hosts and our commensal bacterial buddies.
Scorched skin policy
Overuse of antibiotic soaps and hand sanitizers upsets this happy homeostasis by essentially killing all bacteria, good and bad. The consequence of this scorched skin policy is that we kill the germs that sometimes contaminate our skin and make disease transmission more difficult, but also reduce the effectiveness of our skin’s antimicrobial defenses.
Wiping out all microbes means your skin is wide open to recolonization by all comers — commensals and pathogens. It may be a tossup which returns first and faster. Excessive cleanliness also removes natural oils that help keep skin supple and intact. Dry skin is more prone to cracking, which provides new entry points for bacteria and other agents. Some bacterial species that are harmless resting atop your skin are troublemakers inside it.
Of course, no one’s suggesting we abandon antimicrobial soaps, gels and lotions. In some situations and circumstances, such as hospitals and health care, they are essential. Every effort must be made to reduce exposure to pathogens. More broadly, people should continue to wash their hands regularly and diligently. (There’s an ongoing debate about whether daily washing beyond the wrists is necessary, but that’s a different story.)
As always, nature suggests a solution, albeit one that first requires us to more fully understand the complicated relationships between microbes and our health. Rather than regularly render our skin a sort of microbial dead zone, we could develop soaps and sanitizers that are more discriminating or which include ingredients that promote the return of bacteria like S. epidermidis or deter the development of conditions like eczema. We do a little bit of that now with soaps and lotions that contain compounds designed to help skin retain its oils and moisture.
Someday you might slather up with something that selectively kills and fertilizes, encouraging certain microbial species to take root and call you home, thus restoring balance to our natural ecology.
Richard L. Gallo, M.D., Ph.D., is a professor of medicine and pediatrics and chief of UC San Diego’s Division of Dermatology and the dermatology section of the Veterans Affairs San Diego Healthcare System.
It suggests lack of early exposure to infectious agents can suppress development of the immune system
By Dr. Richard L. Gallo
Jan. 31, 2011
In 1998, researchers at the University of Georgia published a paperhttp://www.blogger.com/img/blank.gif that estimated about 5 million trillion bacterial cells reside on Earth. That’s a 5 with 30 zeros. That’s a lot of bacteria. Indeed, if each individual bacterium were a penny piled atop one another, it would take a trillion light-years to reach the end of the stack, which is far beyond the observable universe.
Some of these bacteria, Louis Pasteur and others duly discovered, cause disease, and so contemporary humans have long been urged, explicitly and otherwise, to fight back: Wash often. Stay clean. And don’t skimp on those alcohol-based hand-sanitizing gels, foams and lotions that reportedly kill 99 percent of all germs. Odds are there’s a dispenser near you right now.
But is cleanliness really next to goodliness?
Maybe not. There is compelling, growing evidence that being too clean might actually be bad for your health; that it results in increased sickness and the development of chronic immunological ailments that might not occur if we all dialed back on the Dial and dispensers.
This thinking is encapsulated in an idea called “the hygiene hypothesis,” which first emerged in the late-1980s. The hypothesis suggests that a lack of early childhood exposure to infectious agents and microorganisms (not just bacteria, but viruses and fungi, too) suppresses natural development of the immune system, resulting in increased susceptibility to infection and disease.
The hypothesis has been used to help explain why allergies like hay fever are less common in children from large families, even though presumably these kids are exposed to more infectious agents than those in smaller families. Epidemiologists have also noted that ailments like asthma and eczema (a kind of skin inflammation) are more prevalent in industrialized countries where personal cleanliness is emphasized.
Though not conclusively proved, the hypothesis makes sense — at least as part of a larger explanation. Let’s look at the science.
One’s a crowd
If the world is fraught with bacteria, so too are you. Based solely on the average number of cells in a typical human being, we’re all more inhuman than human. Bacterial cells outnumber human cells 10 to 1. Your gut, for example, is a well-known bacterial repository, home to hundreds of trillions of individual microbes (somewhere between 300 and 1,000 species), many of which beneficially assist in necessary functions like digestion and immune response. Plus, they take up space that might otherwise be occupied by nastier, disease-causing pathogens.
Your skin is similarly populated. Recent studies have identified hundreds of species, many previously unknown. One estimate calculates the total number of skin-based bacteria on the average person at roughly 1,000,000,000,000. These bacteria live in colonies, each favoring a different environmental niche. The bacteria that prefer the crook of your elbow, for example, are different from those homesteading your forearm.
Swathed in our cloaks of microbial invisibility, some questions are nonetheless obvious: How do skin bacteria survive our constant assaults with soaps and antibiotics? And why don’t they make us sick more often?
In research published this year and last, my colleagues and I uncovered some of the answers. Our skin hums with constant communication and interaction between commensal or benign bacteria and skin cells. Certain species of superabundant Staphylococcus bacteria, for example, produce a molecule that inhibits the inflammation response (heat, redness, swelling) generated when you injure your skin. That’s a good thing. Some inflammation is vital to healing, but too much can be worse than the infection.
Why do Staphylococci do this? It’s hard to know for sure, but one possibility is that it’s an evolutionary adaptation, a neat trick bacteria have developed to reduce the chances that an inflammatory response will kill them. Another possibility is that we have evolved together and count on these bacteria to help us control the skin response. In return for this microbial good deed, we reward specific bacteria with a comfortable place to live.
Recently, we discovered that a specific type of Staphylococci — Staphylococcus epidermidis, the most common bacterial species cultured from human skin — produces antimicrobial molecules that kill some other kinds of bacteria, including its cousin, S. aureus, a more problematic bug that causes everything from pimples and boils to deadly pneumonia, meningitis and sepsis.
S. epidermidis not only makes antimicrobials, it also instructs human skin cells to make natural antimicrobials of their own, thus serving as both warning system and mentor. The result is a balanced relationship that benefits both human hosts and our commensal bacterial buddies.
Scorched skin policy
Overuse of antibiotic soaps and hand sanitizers upsets this happy homeostasis by essentially killing all bacteria, good and bad. The consequence of this scorched skin policy is that we kill the germs that sometimes contaminate our skin and make disease transmission more difficult, but also reduce the effectiveness of our skin’s antimicrobial defenses.
Wiping out all microbes means your skin is wide open to recolonization by all comers — commensals and pathogens. It may be a tossup which returns first and faster. Excessive cleanliness also removes natural oils that help keep skin supple and intact. Dry skin is more prone to cracking, which provides new entry points for bacteria and other agents. Some bacterial species that are harmless resting atop your skin are troublemakers inside it.
Of course, no one’s suggesting we abandon antimicrobial soaps, gels and lotions. In some situations and circumstances, such as hospitals and health care, they are essential. Every effort must be made to reduce exposure to pathogens. More broadly, people should continue to wash their hands regularly and diligently. (There’s an ongoing debate about whether daily washing beyond the wrists is necessary, but that’s a different story.)
As always, nature suggests a solution, albeit one that first requires us to more fully understand the complicated relationships between microbes and our health. Rather than regularly render our skin a sort of microbial dead zone, we could develop soaps and sanitizers that are more discriminating or which include ingredients that promote the return of bacteria like S. epidermidis or deter the development of conditions like eczema. We do a little bit of that now with soaps and lotions that contain compounds designed to help skin retain its oils and moisture.
Someday you might slather up with something that selectively kills and fertilizes, encouraging certain microbial species to take root and call you home, thus restoring balance to our natural ecology.
Richard L. Gallo, M.D., Ph.D., is a professor of medicine and pediatrics and chief of UC San Diego’s Division of Dermatology and the dermatology section of the Veterans Affairs San Diego Healthcare System.
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