Health Technology Research Synopsis

130th Issue Date 01 JUN 2012

Compiled By Ralph Turchiano

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Editors Top Five:

1.        Newly discovered breast milk antibodies help neutralize HIV
2.        Why cutting sugar can control seizures: Scientists identify metabolic regulator of epilepsy
3.        Antioxidant shows promise as treatment for certain features of autism, Stanford study finds
4.        Understanding the links between inflammation and chronic disease
5.        Overdiagnosis poses significant threat to human health

In this Issue:

1. Like curry? New biological role identified for compound used in ancient medicine

2. Hazelnuts improve infant formula

3. Obese adolescents have heart damage

4. Folic acid may reduce some childhood cancers

5. Vigorous physical activity associated with reduced risk of psoriasis

6. Vitamin C improves pulmonary function in newborns of pregnant smoking women

7. Newly discovered breast milk antibodies help neutralize HIV

8. Why cutting sugar can control seizures: Scientists identify metabolic regulator of epilepsy

9. Phthalates in PVC floors taken up by the body in infants

10. Children exposed to the common pollutant naphthalene show signs of chromosomal damage

11. New federal disclosure law may have little impact on drugs prescribed

12. Antioxidant shows promise as treatment for certain features of autism, Stanford study finds

13. Fatty acid found in fish prevents age-related vision loss: U of A medical research

14. Drug-monitoring programs needed to cut dangers linked to ‘pharmaceuticalization’ of 21st century

15. Exercise and a healthy diet of fruits and vegetables extends life expectancy in women in their 70s

16. Understanding the links between inflammation and chronic disease

17. Overdiagnosis poses significant threat to human health

18. Dark chocolate could prevent heart problems in high-risk people

CORVALLIS, Ore. – Scientists have just identified a new reason why some curry dishes, made with spices humans have used for thousands of years, might be good for you.

New research at Oregon State University has discovered that curcumin, a compound found in the cooking spice turmeric, can cause a modest but measurable increase in levels of a protein that’s known to be important in the “innate” immune system, helping to prevent infection in humans and other animals.

This cathelicidin antimicrobial peptide, or CAMP, is part of what helps our immune system fight off various bacteria, viruses or fungi even though they hadn’t been encountered before.

Prior to this, it was known that CAMP levels were increased by vitamin D. Discovery of an alternative mechanism to influence or raise CAMP levels is of scientific interest and could open new research avenues in nutrition and pharmacology, scientists said.

Turmeric is a flavorful, orange-yellow spice and an important ingredient in many curries, commonly found in Indian, South Asian and Middle Eastern cuisine. It has also been used for 2,500 years as a medicinal compound in the Ayurvedic system of medicine in India – not to mention being part of some religious and wedding ceremonies. In India, turmeric is treated with reverence.

The newest findings were made by researchers in the Linus Pauling Institute at OSU and published today in the Journal of Nutritional Biochemistry, in collaboration with scientists from the University of Copenhagen in Denmark. The work was supported by the National Institutes of Health.

“This research points to a new avenue for regulating CAMP gene expression,” said Adrian Gombart, an associate professor of biochemistry and biophysics in the Linus Pauling Institute. “It’s interesting and somewhat surprising that curcumin can do that, and could provide another tool to develop medical therapies.”

The impact of curcumin in this role is not nearly as potent as that of vitamin D, Gombart said, but could nonetheless have physiologic value. Curcumin has also been studied for its anti-inflammatory and antioxidant properties.

“Curcumin, as part of turmeric, is generally consumed in the diet at fairly low levels,” Gombart said. “However, it’s possible that sustained consumption over time may be healthy and help protect against infection, especially in the stomach and intestinal tract.”

In this study, Chunxiao Guo, a graduate student, and Gombart looked at the potential of both curcumin and omega-3 fatty acids to increase expression of the CAMP gene. They found no particular value with the omega-3 fatty acids for this purpose, but curcumin did have a clear effect. It caused levels of CAMP to almost triple.

There has been intense scientific interest in the vitamin D receptor in recent years because of potential therapeutic benefits in treating infection, cancer, psoriasis and other diseases, the researchers noted in their report. An alternative way to elicit a related biological response could be significant and merits additional research, they said.

The CAMP peptide is the only known antimicrobial peptide of its type in humans, researchers said. It appears to have the ability to kill a broad range of bacteria, including those that cause tuberculosis and protect against the development of sepsis.

Athens, Ga. – Human breast milk is the best source of food for infants. University of Georgia researchers have found what may be a new second best-formula made from hazelnut oil.

Casimir Akoh, a UGA distinguished research professor of food science and technology in the College of Agricultural and Environmental Sciences, developed a new nutrient based on hazelnut oil that better mimics the structure of mother’s milk, which makes it better suited to nourish infants. The results of his study were published in the Journal of Agricultural and Food Chemistry on May 23.

“Human milk is the most valuable source of nutrients for infants,” he said, “but it is not always possible to feed infants with human milk, and supplements and formula are needed.”

Mothers naturally provide the healthful omega-3 fatty acid DHA, docosahexaenoic acid, and omega-6 fatty acid ARA, arachidonic acid, which are important-for the development of the brain and other organs-to infants during the last three months of pregnancy and through breast-feeding. Akoh’s development of fats from hazelnut oil contains DHA and ARA at the same molecular positions found on fats in human milk.

“The fatty acid profile of human milk is the gold standard when designing the fat composition of infant formulas,” he said. “The unique structure of human milk fat increases digestion and absorption of the fatty acids and improves calcium absorption.”

Traditionally, infant formulas are made using vegetable oils combined with algae-derived DHA and ARA fatty acids. But infants may not digest algae-derived fatty acids efficiently as a physical mixture of two oils.

“If you add DHA oil with vegetable oil, then the fatty acid (palmitic) shows up at the ends of the molecule,” he said, “and this is different (reversed) from how it is in the mother.”

Even though breast milk and infant formulas both have saturated and unsaturated fats, the chemical makeup of a molecule of human milk is more digestible than a molecule found in formula. The molecular structure of breast milk fat has saturated fats surrounded by unsaturated fats. Formula has the opposite structure.

“Metabolism is different for physically blended vegetable oils in infant formula,” he said. “When you digest these molecules, it is not the same. That is why we try to put these fatty acids together on the same molecule.”

Akoh’s design using hazelnuts includes all the components in one molecule. The new molecule also includes palmitic acid in the middle, which is found naturally in human milk fat and in the oleic acid in hazelnut oils.

“Other people use a blend of vegetable oil. With the palmitic acid at the top or bottom of the structure instead of the middle, they lose the energy they could get from the palmitic acid metabolism, and they also lose nutrients like calcium,” he said.

When nutrients are digested, the molecules are broken down starting at the ends. “As saturated fatty acids, such as palmitic acid, are cut from the top and bottom, they combine with calcium to form calcium soap of the acid,” Akoh said, “and you don’t want soap in your body.”

Adults and infants can benefit from the improved product.

“In general, American diets are very low in fish oils,” he said. “We are not like the Eskimos who eat a lot of salmon or fatty fish and have DHA in their diets. So, even if we are breast-feeding, it might be advantageous for the mother to take a capsule as a supplement if they are not eating the fish so they can pass it on to the infant.”

UGA is currently working to develop an infant formula using the modified molecule.

Obese adolescents with no symptoms of heart disease already have heart damage, according to new research.

The findings were presented at the Heart Failure Congress 2012, 19-22 May, in Belgrade, Serbia. The Congress is the main annual meeting of the Heart Failure Association of the European Society of Cardiology.

Obesity is a risk factor for cardiovascular disease, and previous research has shown that obese adults have structural and functional changes to their hearts. The current study (abstract P843) investigated the relationship between body mass index (BMI) and cardiac function in overweight and obese adolescents with no symptoms of heart disease.

For the study, 97 healthy adolescents had their weight, height, waist circumference and hip circumference measured. BMI and waist/hip ratio were calculated. Blood and biochemistry tests and an echocardiogram were performed. Based on their BMI, patients were divided into three groups: lean (L=32 patients), overweight (Ov=33 patients) and obese (Ob=32 patients).

Several measures of heart size were made using information from the echocardiogram. Interventricular septal and left ventricular posterior wall thickness increased as BMI increased (L: 0.84+0.1 cm, Ov: 0.88+0.1 cm, Ob: 0.96+0.1cm, p=0.001; and L: 0.78+0.1 cm, Ov: 0.8+0.1 cm, Ob: 0.94+0.1cm, p=0.001, respectively).

Relative wall thickness and left ventricular mass index also increased in parallel to BMI (L: 0.34+0.05, Ov: 0.34+0.05, Ob: 0.40+0.04, p=0.001; and L: 47.7+8.4 g/m2, Ov: 51.9+8.3 g/m2, Ob: 65.2+13.3 g/m2, p=0.001, respectively).

Measures of heart function were also performed. Left ventricular early diastolic lateral and septal velocities were reduced only in obese adolescents (L: 15.3+3.9cm/s, Ov: 13.6+4 cm/s, Ob: 10.5+3.4 cm/s, p=0.001; and L: 12.2+2.3 cm/s, Ov: 11.1+2.4 cm/s, Ob: 9.8+3.1 cm/s, p=0.003, respectively).

Systolic velocities were also only reduced in obese adolescents (L: 9.2+1.4cm/s, Ov: 9.3+2.3 cm/s, Ob: 8.04+1.5 cm/s, p = 0.018; and L: 9.05+2.3 cm/s, Ov: 9+2.4 cm/s, Ob: 7.6+1.1 cm/s, p=0.014, respectively).

Left ventricular lateral diastolic (r=-0.44, p=0.001) and systolic (r=-0.29, p=0.005) velocities correlated with BMI.

Obese adolescents with no symptoms of heart disease had damaged hearts with thicker walls. The systolic and diastolic function of their hearts was also impaired. Both structural and functional measures correlated with BMI. These findings may explain why obesity is a risk for heart disease.

“Education on healthy food and exercise is needed in schools to prevent obesity and early cardiovascular disease in adolescents,” says lead author Professor Gani Bajraktari, professor of internal medicine and cardiology at the University of Pristina in Kosovo. “This is an important step in preventing obesity and cardiovascular disease in adults.”

More studies are needed to show whether the heart damage in obese adolescents can be reversed if they lose weight.

Folic acid fortification of foods may reduce the incidence of the most common type of kidney cancer and a type of brain tumors in children, finds a new study by Kimberly J. Johnson, PhD, assistant professor at the Brown School at Washington University in St. Louis, and Amy Linabery, PhD, postdoctoral fellow at the University of Minnesota.

Incidence reductions were found for Wilms’ tumor, a type of kidney cancer, and primitive neuroectodermal tumors (PNET), a type of brain cancer.

Since 1998, the U.S. Food and Drug Administration has mandated fortification of foods with folic acid because earlier studies show that prenatal consumption of folic acid significantly reduces the incidence of neural tube defects in babies.

“Our study is the largest to date to show that folic acid fortification may also lower the incidence of certain types of childhood cancer in the United States,” Johnson says.

The study, published in the current issue of Pediatrics, examined the incidence of childhood cancer pre- and post-mandated folic acid fortification.

“We found that Wilms’ tumor rates increased from 1986 to 1997 and decreased thereafter, which is an interesting finding since the downward change in the trend coincides exactly with folic acid fortification,” Johnson says.

“PNET rates increased from 1986 to 1993 and decreased thereafter. This change in the trend does not coincide exactly with folic acid fortification, but does coincide nicely with the 1992 recommendation for women of childbearing age to consume 400 micrograms of folic acid daily.”

Study authors used the 1986-2008 data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER), which has collected information on cancer cases in various areas of the U.S. since 1973. The study involved 8,829 children, from birth to age four, diagnosed with cancer.

“Declines in Wilms’ tumors and PNETs in children were detected by multiple analyses of the data,” Johnson says.

“Importantly, the reduced rates of Wilms’ tumors also were found in a smaller study conducted in Ontario, Canada, that was published in 2011.

“More research is needed to confirm these results and to rule out any other explanations.”

Julie A. Ross, PhD, professor and director of the Division of Pediatric Epidemiology & Clinical Research in the Department of Pediatrics at the University of Minnesota, was a study co-author.

Johnson notes that one concern countries face as they are deciding whether or not to fortify foods to reduce neural tube defects in newborns is the possibility that fortification may cause unintended harm, such as causing new cancers or pre-cancerous lesions.

“Here, we are showing that folic acid fortification does not appear to be increasing rates of childhood cancers, which is good news,” she says.

CHICAGO – A study of U.S. women suggests that vigorous physical activity may be associated with a reduced risk of psoriasis, according to a report published Online First by Archives of Dermatology, a JAMA Network publication.

Psoriasis is an immunologic disorder characterized by systemic inflammation and scaling of the skin. Physical activity has been associated with a decreased risk of disorders characterized by systemic inflammation, including type 2 diabetes, colon cancer, coronary artery disease and breast cancer, according to the study background.

“Our results suggest that participation in at least 20.9 MET (metabolic equivalent task)-hours per week of vigorous exercise, the equivalent of 105 minutes of running or 180 minutes of swimming or playing tennis, is associated with a 25 percent to 30 percent reduced risk of psoriasis compared with not participating in any vigorous exercise,” the authors note.

Hillary C. Frankel, A.B., of Brigham and Women’s Hospital, Boston, and colleagues used data from the Nurses’ Health Study II. Their analysis included 86,665 women who did not have psoriasis at baseline in 1991 and who completed physical activity questionnaires in 1991, 1997 and 2001. Researchers documented 1,026 incident cases of psoriasis as they examined the association between physical activity and the disorder.

The most physically active women had a lower multivariate relative risk of psoriasis (0.72) compared with the least active. Walking was not associated with a reduced risk of psoriasis, according to study results.

“Among the individual vigorous activities we evaluated, only running and performing aerobic exercise or calisthenics were associated with a reduced risk of psoriasis. Other vigorous activities, including jogging, playing tennis, swimming and bicycling were not associated with psoriasis risk,” the authors note. “The highly variable intensity at which these activities are performed may account for this finding.”

The authors suggest that how physical activity may reduce psoriasis risk deserves further study.

“In addition to providing other health benefits, participation in vigorous exercise may represent a new preventive measure for women at high risk of developing psoriasis. Additional corroborative studies and further investigations into the mechanisms by which physical activity protects against new-onset psoriasis are needed,” the researchers conclude.

Environmental Risk Factors for Crohn’s Disease: Maltodextrin (MDX), a Ubiquitous Dietary Additive in Western Diets, Enhances Biofilm Formation and Adhesivness of E. coli (Abstract #Tu1844)

Western diets that include significant amounts of the additive maltodextrin, a filler compound added to the sweeteners Splenda and Equal, may contribute to an increased susceptibility to Crohn’s disease, according to new research from the Cleveland Clinic Lerner Research Institute, OH. There is a clear link between bacteria and inflammatory bowel disease (IBD), with previous studies reporting differences in the types of bacteria and location of bacteria in the intestines of individuals with Crohn’s disease.

Investigators led by Christine McDonald, PhD, assistant staff, pathobiology department, Lerner Research Institute, looked at how bacteria were altered by components of the Western diet to better understand how diet affects bacteria associated with IBD, an area of research not well understood. They reviewed how certain components of this diet alter E. coli bacteria to increase their ability to form biofilms and adhere to intestinal epithelial cells — features associated with the disease.

The investigators grew E. coli bacteria isolated from a Crohn’s disease patient in the lab with different substances found in a Western diet and tested their ability to form biofilm structures similar to those found in the gut of Crohn’s disease patients. Initially, they compared bacteria that were fed glucose (the simplest form of sugar) to bacteria that were fed artificial sweeteners. Surprisingly, Dr. McDonald’s group found that the sweeteners alone didn’t have an effect, but maltodextrin dramatically changed the bacteria.

When the researchers looked at how well the bacteria adhered to plastic or live intestinal cells, they found that bacteria grown in maltodextrin were stickier, resulting in thicker biofilms, and a greater number of bacteria piled up on the surface of intestinal cells. This finding is significant since maltodextrin is in a wide variety of products ranging from sweeteners and processed foods to medications and other products. Dr. McDonald cautioned that it is too early to conclude that maltodextrin promotes disease, though their results suggest that maltodextrin can cause E. coli to gain features associated with disease and therefore, potentially, increases an individual’s overall risk of developing IBD. Studies are planned to test this more directly in experimental mouse models of IBD. “While dietary additives like maltodextrin are generally considered safe, these findings suggest that perhaps people who are prone to develop IBD should consider limiting their maltodextrin intake,” Dr. McDonald said.

Previous research suggests that consumption of a Western diet — one that is high in fat, low in fiber and rich in processed foods — is associated with the development of Crohn’s disease. Other studies have observed striking differences between the bacteria found in healthy intestines and those affected by Crohn’s disease. In a healthy gut, the normal bacterial community is separated from direct contact with the intestinal cells, while in Crohn’s disease patients, gut bacteria form a dense structure (a biofilm) in close contact with the cells. Additionally, some studies have shown an increase in the amounts of E. coli and demonstrated that Crohn’s disease-associated E. coli has special features, making the strain more adhesive and invasive.

This study received no pharmaceutical funding. It was supported by the National Institutes of Health (R01DK082437) and the Howard Hughes Medical Institute “Med into Grad” Initiative.

Dr. McDonald will present these data on Tuesday, May 22 at noon PT in Halls C-G of the San Diego Convention Center.

ATS 2012, SAN FRANCISCO –Vitamin C supplementation in pregnant women who are unable to quit smoking significantly improves pulmonary function in their newborns, according to a new study.

“Smoking during pregnancy is known to adversely affect the lung development of the developing baby,” said Cindy McEvoy, MD, associate professor of pediatrics at Oregon Health & Science University Doernbecher Children’s Hospital. “We found that daily use of vitamin C (500 mg/day) by smoking pregnant woman significantly improved pulmonary function tests administered to their offspring at about 48 hours postpartum.”

The results will be presented at the ATS 2012 International Conference in San Francisco.

The study enrolled the newborns of 159 smoking women and randomized them to daily vitamin C (500 mg) or placebo before 22 weeks gestation and treatment was continued through delivery.76 non smoking pregnant women were also studied. The primary outcome of the study was the measurement of the newborn’s lung function with a pulmonary function test at about 48 hours of life. This assessment included measurement of peak tidal expiratory flow to expiratory time (TPTEF:TE) and respiratory compliance (Crs).

Smokers treated with placebo had significantly lower levels of ascorbic acid than non-smokers, but levels returned to those of non-smokers in smokers randomized to vitamin C. Newborns of smoking women randomized to placebo had decreased TPTEF:TE and Crs compared to non-smokers. Both TPTEF:TE and Crs were significantly increased by vitamin C supplementation, returning them nearly to the levels seen in non-smokers.

“In our pilot study, we were able to show that babies born to smoking pregnant women who were randomized to daily supplemental vitamin C had significantly improved pulmonary/lung function tests compared to babies born to smoking women who were randomized to placebo,” said Dr. McEvoy.

“Moreover, although our study numbers were small, we found that one particular genetic variant that has been shown to increase the risk of smokers developing cancer and is associated with both a reduced ability to quit smoking and a high likelihood of relapse, also seemed to intensify the harmful effects of maternal smoking on babies’ lungs. Although the lung function of all babies born to smokers in our study was improved by supplemental vitamin C, our preliminary data suggest, importantly, that vitamin C may help those babies at the greatest risk of harm during their development from their mother’s smoking in pregnancy.”

“Getting women to quit smoking during pregnancy has to be priority one, but this study provides a way to potentially help the infants born to at least 12% of pregnant women who cannot quit smoking when pregnant.” said Dr. McEvoy. “Vitamin C supplementation may block some of the in-utero effects of smoking on fetal lung development.”

“Our findings are important because improved lung function tests at birth are associated with less wheezing and asthma in childhood,” concluded Dr. McEvoy. “Vitamin C is a simple, safe, and inexpensive treatment that may decrease the impact of smoking during pregnancy on the respiratory health of children.”

DURHAM, N.C. – Antibodies that help to stop the HIV virus have been found in breast milk. Researchers at Duke University Medical Center isolated the antibodies from immune cells called B cells in the breast milk of infected mothers in Malawi, and showed that the B cells in breast milk can generate neutralizing antibodies that may inhibit the virus that causes AIDS.

HIV-1 can be transmitted from mother to child via breastfeeding, posing a challenge for safe infant feeding practices in areas of high HIV-1 prevalence. But only one in 10 HIV-infected nursing mothers is known to pass the virus to their infants.

“That is remarkable, because nursing children are exposed multiple times each day during their first year of life,” said senior author Sallie Permar, M.D., Ph.D., an assistant professor of pediatrics and infectious diseases at Duke. “We are asking if there is an immune response that protects 90 percent of infants, and could we harness that response to develop immune system prophylaxis (protection) during breastfeeding for mothers infected with HIV-1.

“Our work helped establish that these B cells in breast milk can produce HIV-neutralizing antibodies, so enhancing the response or getting more mucosal B-cells to produce those helpful antibodies would be useful, and this is a possible route to explore for HIV-1 vaccine development,” Permar said.

The study was published on May 18 in PLoS One, an open-access journal published by the Public Library of Science.

“This is important work that seeks to understand what a vaccine must do to protect babies from mucosal transmission during breastfeeding,” said Barton Haynes, M.D., co-author and a national leader in AIDS/HIV research, director of the Center for HIV/AIDS Vaccine Immunology (CHAVI), as well as director of the Duke Human Vaccine Institute (DHVI). “The antibodies isolated are the first HIV antibodies isolated from breast milk that react with the HIV-1 envelope, and it important to understand how they work to attack HIV-1.”

The findings of two different antibodies with HIV-neutralizing properties isolated from breast milk also may help researchers with new investigations into adult-to-adult transmission, in addition to mother-to-child transmission.

Permar said that most HIV-1 transmission occurs at a mucosal site in the body – surfaces lined with epithelial cells, such as the gastrointestinal tract or vaginal tissue. The mucosal compartments all have their own immune system cells.

“We’re excited about this finding because the immune cells in mucosal compartments can cross-talk and traffic between compartments,” Permar said. “So the antibodies we found in breast milk indicate that these same antibodies are able to be elicited in other tissues.”

Interestingly, the Centers for Disease Control in the U.S. recommend against breastfeeding if a mother has HIV-1, because baby formula is a safe alternative for U.S.-born infants. The World Health Organization, however, encourages HIV-infected nursing mothers in resource-poor regions to breastfeed while the mother and/or infant take antiretroviral drugs to prevent the infection in the infant, because without the nutrients and immune factors in mothers’ milk, many more infants would die from severe diarrhea and respiratory and other diseases.

At the DHVI and CHAVI, there are many projects aimed at designing neutralizing responses in vaccinated individuals, and for improved vaccines that display specific targets to the immune system before it gets infected, with the idea of eliciting protective responses that fight against HIV transmission. “Our work will be important in eliminating mother-to-child transmission and getting the types of responses needed for protecting all infants,” Permar said.

The study itself wasn’t easy to perform, she noted. The samples came from a group of women in Malawi who were recruited by CHAVI for this study.

“Successfully characterizing antibodies from such a fragile medium required global coordination and expertise across multiple fields and is a hopeful testament to the incredible amounts of work and leadership currently under way to fight this devastating disease,” said first author James Friedman, a third-year medical student at Duke University School of Medicine. “To be a part of, and to contribute to such a large-scale and important effort is incredibly exciting.”

Because of limited availability of the laboratory instrument needed to isolate single, viable immune cells in the region, the samples were not analyzed there. Instead, samples were frozen and transported for analysis. Keeping the breast milk under the right conditions for later thawing and testing of B cells and for isolating antibodies was a challenge, Permar said.

A new study unravels a link between a protein that can modify cellular metabolism in the brain and seizure susceptibility. The research, published by Cell Press in the May 24th issue of the journal Neuron, may lead to the development of new treatments for epilepsy.

Epilepsy is a disorder characterized by seizures, unpredictable and abnormal bursts of electrical activity in the brain. Some cases of epilepsy are resistant to traditional drug treatments but can be improved by a “ketogenic” diet. This type of diet, which is very low in sugars and high in fat, forces neurons to switch from their customary fuel of glucose to a type of fat byproduct called a ketone body. “The potent effect of increased ketone metabolism on human epilepsy points to a link between fuel utilization and neuronal excitability,” explains senior study author, Dr. Nika N. Danial, from Dana-Farber Cancer Institute and Harvard Medical School. “However, the molecular underpinnings of this link are not fully understood.”

To examine how altered metabolism might protect the brain from seizures, Dr. Danial, co-senior author Dr. Gary Yellen, and their colleagues explored the role of a protein called BAD (BCL-2-associated Agonist of Cell Death), which modulates glucose metabolism in multiple types of cells. This allowed examination of altered fuel metabolism without drastic dietary manipulations, which can have complex and at times adverse systemic effects. The researchers discovered that modifications to BAD that reduced glucose metabolism and increased ketone body metabolism in the brain were associated with a decrease in seizure susceptibility. They went on to show that this reduction in seizure susceptibility was due to increased activity of an ion channel that dampens neuronal excitability.

Taken together, the findings identify BAD as a regulator of fuel metabolism in the brain and implicate this protein in the regulation of seizures. “BAD’s capacity to modulate energy metabolism in the brain, independent of dietary manipulation, makes it an attractive candidate for metabolic control of seizures,” concludes Dr. Yellen. “Small molecules modeled after BAD variants may help uncover new therapeutic targets to treat epileptic disorders.”

A new study at Karlstad University in Sweden shows that phthalates from PVC flooring materials is taken up by our bodies- The study shows that children can ingest these softening agents with food but also by breathing and through the skin

A new study at Karlstad University in Sweden shows that phthalates from PVC flooring materials is taken up by our bodies. Phthalates are substances suspected to cause asthma and allergies, as well as other chronic diseases in children. The study shows that children can ingest these softening agents with food but also by breathing and through the skin.

Phthalates are a group of chemical compounds that occur in construction materials and a great number of common consumer goods such as toys, cleaning solvents, packaging, etc. Phthalates are suspected of disrupting hormones and may be related to several chronic diseases in children, like asthma and allergies, as shown in earlier studies. Flooring materials using softened PVC contain phthalates and have previously been shown to be a significant source of phthalates in indoor dust. This new study was designed to investigate whether flooring materials using PVC and other housing-related factors, together with other individual factors, can be tied to the uptake of phthalates by infants.

Urine samples were taken from 83 randomly selected children between the ages of two and six months by the county council in Värmland in western Sweden. The prevalence of four types of phthalates in the urine was measured, and data were collected about flooring materials and the home, the family’s lifestyle, and individual factors for the infants. The levels of certain phthalates (MBzP, a BBzP metabolite) proved to be higher in the urine of babies that had PVC materials on their bedroom floor. The levels of another phthalate metabolite related to DEHP were lower in two-month-old children if they were exclusively breastfed, with no supplements.

Earlier studies from the current group have shown that PVC flooring can be tied to the occurrence of phthalates in indoor dust, and that exposure for BBzP in indoor dust could be associated with allergic conditions in children. These new data thus show that the uptake of phthalates in infants can be related to flooring materials using softened PVC in the home. It should be pointed out that both DEHP and BBzP are banned for use in toys for small children owing to health risks.

“With this study as a basis, we can establish that there are other sources that should be taken into consideration in regard to the uptake of banned chemicals and that we do not only ingest them in our food,” says Carl-Gustaf Bornehag, professor of public health at Karlstad University and leader of the study. The findings also show that phthalates can be taken up in different ways, both through food and probably through breathing and through the skin.

Naphthalene is best known as the key ingredient in mothballs

According to a new study, children exposed to high levels of the common air pollutant naphthalene are at increased risk for chromosomal aberrations (CAs), which have been previously associated with cancer. These include chromosomal translocations, a potentially more harmful and long-lasting subtype of CAs.

Researchers from the Columbia Center for Children’s Environmental Health (CCCEH) at the Mailman School of Public Health, Columbia University Medical Center, and the Centers for Disease Control and Prevention (CDC) report the new findings in Cancer, Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Naphthalene is found in both outdoor and indoor urban air. It is present in automotive exhaust, tobacco smoke, and is the primary component of household mothball fumes. Classified as a possible carcinogen by the International Agency for Cancer Research, naphthalene belongs to a class of air pollutants called polycyclic aromatic hydrocarbons (PAH). Prior research at the CCCEH has established a link between prenatal exposure to PAH and increased risk for childhood obesity, IQ deficits, and CAs. The new study is the first to present evidence in humans of CAs, including translocations, associated with exposure to one specific PAH—naphthalene—during childhood.

The researchers followed 113 children, age 5, who are part of a larger cohort study in New York City. They assessed the children’s exposure to naphthalene; a CDC laboratory measured levels of its metabolites—1- and 2-naphthol—in urine samples. (Metabolites are products of the body’s metabolism, and can serve as marker for the presence of a chemical.) Researchers also measured CAs in the children’s white blood cells using a technique called fluorescent in situ hybridization. Chromosomal aberrations were present in 30 children; of these, 11 had translocations. With every doubling of levels of 1- and 2-naphthol, translocations were 1.55 and 1.92 times more likely, respectively, to occur.

CAs have been associated with increased cancer risk in adults. Translocations are of special concern as they result in a portion of one chromosome being juxtaposed to a portion of another chromosome, potentially scrambling the genetic script. “Translocations can persist for years after exposure. Some accumulated damage will be repaired, but not everyone’s repair capacity is the same. Previous studies have suggested that chromosomal breaks can double an adult’s lifetime risk for cancer, though implications for children are unknown,” says first author Manuela A. Orjuela, MD, ScM, assistant professor of clinical environmental health sciences and pediatrics (oncology) at Columbia University Medical Center and a pediatric oncologist at NewYork-Presbyterian Morgan Stanley Children’s Hospital.

To obtain a better sense of the long-term consequences of naphthalene exposure, Dr. Orjuela and other CCCEH investigators are following some of the children in the study as they reach fourth grade. While they expect to see further translocations, they do not expect to see any signs of cancer in the white blood cells. “So far, the translocations seem to be random, and there has been no evidence of the specific translocations that are known to be associated with leukemia. This is entirely expected; leukemia is very rare.” Frederica Perera, DrPH, senior author on the paper, adds that “the findings provide yet more evidence of the vulnerability of the young child to carcinogenic air pollutants.”

The researchers hypothesized that naphthalene exposure was primarily from mothballs, which can release high levels of the chemical. Furthermore, according to previous research, some Caribbean immigrant families use mothballs as an air freshener. Other important sources of naphthalene in indoor air are tobacco smoke, paint fumes, cooking, and heating. The new findings have implications beyond the urban environment as elevated levels of naphthalene metabolites have been documented in rural communities using biomass-burning stoves (coal, wood)—another source of PAH exposure

Law aims to increase transparency between physicians, drug makers

AURORA, Colo. (May 29, 2012) – A Colorado School of Public Health researcher has found that laws designed to illuminate financial links between doctors and pharmaceutical companies have little or no effect on what drugs physicians prescribe.

“If the policymakers who passed these measures were hoping for a deterrent effect they may be disappointed,” said the study’s lead author, Genevieve Pham-Kanter, Ph.D., an assistant professor in the Department of Health Systems, Management and Policy at the Colorado School of Public Health and a research fellow at Harvard University and Massachusetts General Hospital.

The report, published Monday in the Archives of Internal Medicine, was prompted by passage of the Physician Payments Sunshine Provision of the Affordable Care Act.

The new federal law requires drug manufacturers to disclose certain payments made to physicians including money for consulting, honoraria, gifts and travel.

“This law is based on the premise that transparency in these transactions is of public importance and that disclosure requirements can act as a deterrent against quid pro quo exchanges – physicians may be reluctant to accept large payments from pharmaceutical firms if payments are publicly known and perceived as financial compensation for prescribing certain therapies,” said Pham-Kanter who is also an assistant professor of economics at the University of Colorado Denver.

Working with Kavita Nair, Ph.D., associate clinical professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences and G. Caleb Alexander, MD, MS, Johns Hopkins Bloomberg School of Public Health, Pham-Kanter examined West Virginia and Maine, two states with disclosure laws already on the books.

She specifically investigated the effect of the laws on the prescribing of HMG-CoA reductase inhibitors (statins) and selective serotonin reuptake inhibitors (SSRIs). Marketing plays a heavy role in a physician’s choice of therapy since members of each class of drug are similar and highly substitutable, Pham-Kanter said.

The researchers theorized that if disclosure laws were effective and doctors were deterred from taking payments from pharmaceutical companies, they in turn would be less likely to prescribe branded statins and SSRIs over similar generic drugs.

Using a wide variety of public data, they compared Maine, which enacted a disclosure law in 2004, with New Hampshire and Rhode Island, two demographically similar states without such laws. Then they compared West Virginia, which also passed its disclosure law in 2004, with Kentucky and Delaware which had none.

In Maine, the law was associated with a 0.8 percentage point reduction in the use of branded statins compared to New Hampshire, and a 5.3 percentage point reduction compared to Rhode Island. The researchers found little to no effect in West Virginia.

“Our results show that the disclosure laws in the two states we examined had a negligible to small effect on physicians switching from branded therapies to generics and no effect on reducing prescription costs,” said Pham-Kanter.

She noted that despite the laws, accessing information about how much money a physician received from a pharmaceutical company is still difficult and opaque. Much of the information is not on-line yet.

“Transparency is important in its own right, but if deterring unnecessary, costly prescribing is a concern for policymakers, more direct action may be required,” Pham-Kanter said

Antioxidant shows promise as treatment for certain features of autism, Stanford study finds

STANFORD, Calif. — A specific antioxidant supplement may be an effective therapy for some features of autism, according to a pilot trial from the Stanford University School of Medicine and Lucile Packard Children’s Hospital that involved 31 children with the disorder.

The antioxidant, called N-Acetylcysteine, or NAC, lowered irritability in children with autism as well as reducing the children’s repetitive behaviors. The researchers emphasized that the findings must be confirmed in a larger trial before NAC can be recommended for children with autism.

Irritability affects 60 to 70 percent of children with autism. “We’re not talking about mild things: This is throwing, kicking, hitting, the child needing to be restrained,” said Antonio Hardan, MD, the primary author of the new study. “It can affect learning, vocational activities and the child’s ability to participate in autism therapies.”

The study appears in the June 1 issue of Biological Psychiatry. Hardan is an associate professor of psychiatry and behavioral sciences at Stanford and director of the Autism and Developmental Disabilities Clinic at Packard Children’s. Stanford is filing a patent for the use of NAC in autism, and one of the study authors has a financial stake in a company that makes and sells the NAC used in the trial.

Finding new medications to treat autism and its symptoms is a high priority for researchers. Currently, irritability, mood swings and aggression, all of which are considered associated features of autism, are treated with second-generation antipsychotics. But these drugs cause significant side effects, including weight gain, involuntary motor movements and metabolic syndrome, which increases diabetes risk. By contrast, side effects of NAC are generally mild, with gastrointestinal problems such as constipation, nausea, diarrhea and decreased appetite being the most common.

The state of drug treatments for autism’s core features, such as social deficits, language impairment and repetitive behaviors, is also a major problem. “Today, in 2012, we have no effective medication to treat repetitive behavior such as hand flapping or any other core features of autism,” Hardan said. NAC could be the first medication available to treat repetitive behavior in autism — if the findings hold up when scrutinized further.

The study tested children with autism ages 3 to 12. They were physically healthy and were not planning any changes in their established autism treatments during the trial. In a double-blind study design, children received NAC or a placebo for 12 weeks. The NAC used was a pharmaceutical-grade preparation donated by the neutraceutical manufacturer BioAdvantex Pharma. Subjects were evaluated before the trial began and every four weeks during the study using several standardized surveys that measure problem behaviors, social behaviors, autistic preoccupations and drug side effects.

During the 12-week trial, NAC treatment decreased irritability scores from 13.1 to 7.2 on the Aberrant Behavior Checklist, a widely used clinical scale for assessing irritability. The change is not as large as that seen in children taking antipsychotics. “But this is still a potentially valuable tool to have before jumping on these big guns,” Hardan said.

In addition, according to two standardized measures of autism mannerisms and stereotypic behavior, children taking NAC showed a decrease in repetitive and stereotyped behaviors.

“One of the reasons I wanted to do this trial was that NAC is being used by community practitioners who focus on alternative, non-traditional therapies,” Hardan said. “But there is no strong scientific evidence to support these interventions. Somebody needs to look at them.”

Hardan cautioned that the NAC for sale as a dietary supplement at drugstores and grocery stores differs in some important respects from the individually packaged doses of pharmaceutical-grade NAC used in the study, and that the over-the-counter version may not produce the same results. “When you open the bottle from the drugstore and expose the pills to air and sunlight, it gets oxidized and becomes less effective,” he said.

Although the study did not test how NAC works, the researchers speculated on two possible mechanisms of action. NAC increases the capacity of the body’s main antioxidant network, which some previous studies have suggested is deficient in autism. In addition, other research has suggested that autism is related to an imbalance in excitatory and inhibitory neurotransmitters in the brain. NAC can modulate the glutamatergic family of excitatory neurotransmitters, which might be useful in autism.

The scientists are now applying for funding to conduct a large, multicenter trial in which they hope to replicate their findings.

“This was a pilot study,” Hardan said. “Final conclusions cannot be made before we do a larger trial.”

An omega-3 fatty acid found in fish, known as DHA, prevented age-related vision loss in lab tests, demonstrates recently published medical research from the University of Alberta.

Faculty of Medicine & Dentistry researcher Yves Sauve and his team discovered lab models fed DHA did not accumulate a toxic molecule at the back of the eyes. The toxin normally builds up in the retina with age and causes vision loss.

“This discovery could result in a very broad therapeutic use,” says Sauve, whose work was recently published in the peer-reviewed journal Investigative Ophthalmology & Visual Science.

“In normal aging, this toxin increases two-fold as we age. But in lab tests, there was no increase in this toxin whatsoever. This has never been demonstrated before – that supplementing the diet with DHA could make this kind of difference.”

The team recently started another study, looking at people who have age-related macular degeneration (AMD), a condition that results in the loss of central vision and is the main cause of blindness in those over the age of 50. The researchers will look for DNA markers in the blood of study participants. The team wants to determine if participants with certain genetic markers will respond better to increasing amounts of DHA in their diet and if so, why.

Penn researcher calls for expansion of programs to identify potential drug abusers and protect pain patients

PHILADELPHIA — Individual use of prescription opioids has increased four-fold since the mid-1990s, in part due to increased awareness of pain control for chronic conditions such as low back pain and fibromyalgia and a Joint Commission mandate that hospitals assess patients’ pain as a “vital sign” along with their blood pressure and temperature. During the same timeframe, however, the number of people using these drugs recreationally, becoming addicted to them, and dying of overdoses has also shot up. Today, nearly three quarters of all fatal drug overdoses in the United States are due to prescription drugs — far outnumbering deaths from cocaine and heroin combined, and often outpacing car accidents as the top cause of preventable deaths.

A Perspective piece published online today in the New England Journal of Medicine outlines a plan for an “ideal” prescription-drug monitoring program that would enable doctors, dentists, pharmacists, researchers and law enforcement officials to access real-time data on patients’ prescription drug histories. The authors, medical toxicologists Jeanmarie Perrone, MD, an associate professor of Emergency Medicine in the Perelman School of Medicine at the University of Pennsylvania, and Lewis S. Nelson, MD, a professor of Emergency Medicine at the New York University School of Medicine, say that such programs would allow physicians to take better care of patients with legitimate pain issues as well as identify and intervene to help potential drug abusers, and cut the number of opioids in circulation for illegal sale.

“As the number of deaths associated with prescription-drug use surpasses the number of fatalities from motor-vehicle crashes in many states, we can learn from the success of auto-safety innovations that have mitigated mortality despite increased automobile use over the past three decades,” the authors write. “We should initiate active safety measures to address the growing rates of illness and death associated with the pharmaceuticalization of the 21st century.”

The idea of state-run prescription-drug monitoring programs dates back to federal legislation authored in 1993 — long before robust internet use and the development of electronic medical records or e-prescribing systems. Today, 42 states have programs, another six have enacted legislation to develop them, and federal agencies including the Centers for Disease Control and Prevention and the Food and Drug Administration have called for broadening the efforts. But clinician awareness about the tools is poor, and some states, including Pennsylvania, restrict physician access, opening the databases only to law enforcement officials.

The authors note that mounting attention regarding abuse potential of painkillers such as oxycodone and hydrocodone has impaired physician-patient relationships in cases of genuine chronic pain issues. For instance, some recommendations suggest obtaining samples from patients for urine drug screens, or asking them to sign so-called “pain contracts” in which they must agree not to sell or give their drugs away.

To avoid these unintended consequences and improve opportunities to identify and help drug abusers, Perrone and Nelson call for a drug-monitoring system to better inform physician prescribing. Among their recommendations: standardization of the type of information submitted to the databases, and a move toward the use of bar-coded prescription paper to more quickly log entries, or a robust e-prescribing system that would eliminate paper and the resulting prescription fraud and “doctor shopping” that contributes to illicit use of these controlled substances. They also suggest that the programs include tracking of drugs ranging from those with the most potential for abuse and addiction (oxycodone, for instance) to codeine cough suppressants and stimulant drugs that may be sold or misused for cognitive enhancement.

The authors cite several benefits to more robust drug-monitoring program, including the potential to provide clinicians with an early warning that a patient may need drug counseling or treatment — and an opportunity to intervene while the patient is still in the medical setting. In addition, they believe these programs could help identify patients who are receiving multiple legitimate prescriptions from different prescribers and pharmacies and may be at risk of polypharmacy complications. As an added benefit, they note that prescribers could use the databases to monitor use of their own Drug Enforcement Administration number to detect forged or stolen prescriptions.

“Although updating an existing prescription-drug monitoring database to incorporate these ‘ideal’ goals would require additional support and money, the potential to protect the public health is substantial,” Perrone says.

Perrone and Nelson will speak this week at the Harold Rogers Prescription Drug Monitoring Program National Meeting in Washington, D.C., where lawmakers will convene to discuss ways to make existing prescription-drug monitoring programs more user-friendly and compliant with health care privacy laws, and strategies to ensure that the data can be shared between states.

Women in their seventies who exercise and eat healthy amounts of fruits and vegetables have a longer life expectancy, according to research published in the Journal of the American Geriatrics Society.

Researchers at the University of Michigan and Johns Hopkins University studied 713 women aged 70 to 79 years who took part in the Women’s Health and Aging Studies. This study was designed to evaluate the causes and course of physical disability in older women living in the community.

“A number of studies have measured the positive impact of exercise and healthy eating on life expectancy, but what makes this study unique is that we looked at these two factors together,” explains lead author, Dr. Emily J Nicklett, from the University of Michigan School of Social Work.

Researchers found that the women who were most physically active and had the highest fruit and vegetable consumption were eight times more likely to survive the five-year follow-up period than the women with the lowest rates.

To estimate the amount of fruits and vegetables the women ate, the researchers measured blood levels of carotenoids—beneficial plant pigments that the body turns into antioxidants, such as beta-carotene. The more fruits and vegetables consumed, the higher the levels of carotenoids in the bloodstream.

Study participants’ physical activity was measured through a questionnaire that asked the amount of time the spent doing various levels of physical activity, which was then converted to the number of calories expended.

The women were then followed up to establish the links between healthy eating, exercise and survival rates.

Key research findings included:

• More than half of the 713 participants (53%) didn’t do any exercise, 21% were moderately active, and the remaining 26% were in the most active group at the study’s outset.
• During the five-year follow up, 11.5% of the participants died. Serum carotenoid levels were 12% higher in the women who survived and total physical activity was more than twice as high.
• Women in the most active group at baseline had a 71% lower five-year death rate than the women in the least active group.
• Women in the highest carotenoid group at baseline had a 46% lower five-year death rate than the women in the lowest carotenoid group.
• When taken together, physical activity levels and total serum carotenoids predicted better survival.

“Given the success in smoking cessation, it is likely that maintenance of a healthy diet and high levels of physical activity will become the strongest predictors of health and longevity. Programs and policies to promote longevity should include interventions to improve nutrition and physical activity in older adults,” said Dr. Nicklett

Early exposure to microbes reduces inflammation related to chronic disease later

EVANSTON, Ill. — American parents may want to think again about how much they want to protect their children from everyday germs.

A new Northwestern University study done in lowland Ecuador remarkably finds no evidence of chronic low-grade inflammation — associated with diseases of aging like cardiovascular disease, diabetes and dementia.

In contrast, about one-third of adults in the United States have chronically elevated C-reactive protein (CRP). Acute elevations in CRP — a protein in the blood whose levels rise as part of the inflammatory response — are important for protecting us against infectious disease. But when CRP is chronically produced, it is associated with chronic diseases.

“In other words, CRP goes up when you need it, but it is almost undetectable when you don’t, after the infection resolves,” said Thomas W. McDade, professor of anthropology at Northwestern and faculty fellow at the university’s Institute for Policy Research. “This is a pretty remarkable finding, and very different from prior research in the U.S., where lots of people tend to have chronically elevated CRP, probably putting them at higher risk for chronic disease.”

McDade said the findings build on his previous research in the Philippines, which found that higher levels of microbial exposure in infancy were associated with lower CRP as an adult. Similar exposures during infancy in lowland Ecuador, where rates of infectious disease continue to be high, may have a lasting effect on the pattern of inflammation in adulthood.

“In my mind the study underscores the value of an ecological approach to research on the immune system, and it may have significant implications for our understanding of the links between inflammation and chronic disease,” McDade said. “This may be particularly important since nearly three-quarters of all deaths due to cardiovascular disease globally now occur in low- and middle-income nations like the Philippines and Ecuador.”

The new research, which was conducted as part of the Shuar Health and Life History Project (http://www.bonesandbehavior.org/shuar/), suggests that higher levels of exposure to infectious microbes early in life may change how we regulate inflammation as adults in ways that prevent chronic inflammation from emerging. Infectious microbes have been part of the human ecology for millennia, and it is only recently that more hygienic environments in affluent industrialized settings have substantially reduced the level and diversity of exposure.

A growing body of research has shown that higher levels of chronic inflammation are associated with diseases of aging like cardiovascular disease, diabetes and dementia. But current research is based almost exclusively on people living in affluent industrialized countries like the United States.

“We simply do not know what chronic inflammation looks like in places like the Ecuadorian Amazon and other parts of the world where infectious diseases are more common,” McDade said.

As a result, McDade, director of the Lab for Human Biology Research and director of Cells to Society (C2S): The Center on Social Disparities and Health, and collaborators at the University of Oregon set out to investigate what factors in the environment and during development influence how people regulate inflammation as adults. The study was conducted in lowland Ecuador – in a group of 52 adults between the ages of 18 and 49.

Based on current clinical criteria, McDade and colleagues did not find a single case of chronic low-grade inflammation among adults living in the Ecuadorian Amazon. McDade said people in these places are still dying of diseases such as cardiovascular disease, but probably not through processes that involve inflammation.

In terms of population health, McDade said these findings suggest that the association between inflammation and cardiovascular disease frequently reported in the United States may only apply in ecological settings characterized by low levels of exposure to infectious disease.

“It builds on research on chronic inflammation and cardiovascular disease in the U.S. and other affluent, industrialized settings and suggests that patterns seen here may not apply globally,” McDade said. “It also suggests that the levels of chronic inflammation we see in the U.S. are not universal, and may be a product of epidemiological transitions that have lowered our level of exposure to infectious microbes.”

International conference: Preventing Overdiagnosis

Overdiagnosis poses a significant threat to human health by labeling healthy people as sick and wasting resources on unnecessary care, warns Ray Moynihan, Senior Research Fellow at Bond University in Australia, in a feature published on bmj.com today.

The feature comes as an international conference ‘Preventing Overdiagnosis’ is announced for Sept. 10-12, 2013, in the United States, hosted by The Dartmouth Institute for Health Policy and Clinical Practice, in partnership with the BMJ, the leading consumer organization Consumer Reports and Bond University, Australia.

The conference is timely, says Moynihan because “as evidence mounts that we’re harming the healthy, concern about overdiagnosis is giving way to concerted action on how to prevent it.”

“The Dartmouth Institute for Health Policy and Clinical Practice has long been a leader in understanding and communicating the problems of overdiagnosis,” say Drs. Steven Woloshin and Lisa Schwartz, professors of medicine at The Dartmouth Institute for Health Policy and Clinical Practice. “We are extremely excited to host this international conference to advance the science and develop concrete proposals to reduce overdiagnosis and its associated harms.”

Overdiagnosis occurs when people are diagnosed and treated for conditions that will never cause them harm and there’s growing evidence that this occurs for a wide range of conditions.

For example, a large Canadian study finds that almost a third of people diagnosed with asthma may not have the condition; a systematic review suggests up to one in three breast cancers detected through screenings may be overdiagnosed; and some researchers argue osteoporosis treatments may do more harm than good for women at very low risk of future fracture.

Many factors are driving overdiagnosis, including commercial and professional vested interests, legal incentives and cultural issues, say Moynihan and co-authors, Professors Jenny Doust and David Henry. Ever-more sensitive tests are detecting tiny “abnormalities” that will never progress, while widening disease definitions and lowering treatment thresholds mean people at ever lower risks receive permanent medical labels and life-long therapies that will fail to benefit many of them.

Added to this, is the cost of wasted resources that could be better used to prevent and treat genuine illness.

But Moynihan argues that the main problem of overdiagnosis lies in a strong cultural belief in early detection, fed by deep faith in medical technology. “Increasingly we’ve come to regard simply being ‘at risk’ of future disease as being a disease in its own right,” he says.

“It took many years for doctors to accept that bacteria caused peptic ulcers,” says co-author of the BMJ feature, Dr. David Henry, chief executive officer of the Institute for Clinical Evaluative Sciences, and professor in the Department of Medicine at the University of Toronto, Canada. “Likewise, it will be hard for doctors and the public to recognize that the earliest detection of disease is not always in the best interests of patients.”

So what can we do about overdiagnosis?

Daily consumption over 10 years is a cost-effective strategy

Daily consumption of dark chocolate can reduce cardiovascular events, such as heart attacks and strokes, in people with metabolic syndrome (a cluster of factors that increases the risk of developing heart disease and diabetes), finds a study published on bmj.com today.

Cardiovascular disease is the leading cause of death worldwide. Dark chocolate (containing at least 60% cocoa solids) is rich in flavonoids – known to have heart protecting effects – but this has only been examined in short term studies.

So a team of researchers from Melbourne, Australia used a mathematical model to predict the long-term health effects and cost effectiveness of daily dark chocolate consumption in 2,013 people already at high risk of heart disease.

All participants had high blood pressure and met the criteria for metabolic syndrome, but had no history of heart disease or diabetes and were not on blood pressure lowering therapy.

With 100% compliance (best case scenario), the researchers show that daily dark chocolate consumption could potentially avert 70 non-fatal and 15 fatal cardiovascular events per 10,000 people treated over 10 years.

Even when compliance levels were reduced to 80%, the number of non-fatal and fatal events potentially averted was 55 and 10 per 10,000 people treated over 10 years, and could still be considered an effective intervention strategy.

The model also suggested that $A40 (£25; €31; $42) could be cost effectively spent per person per year on dark chocolate prevention strategies and could be used for advertising, educational campaigns, or subsidising dark chocolate in this high risk population, they add.

The authors stress that only non-fatal stroke and non-fatal heart attack were assessed in their analysis, and that the potential effects on other cardiovascular events, such as heart failure, are yet to be tested.

Also important, they say, is that these protective effects have only been shown for dark chocolate (at least 60-70% cocoa), rather than for milk or white chocolate, probably due to the higher levels of flavonoids found in dark chocolate.

Nevertheless, they conclude that the blood pressure and cholesterol lowering effects of plain dark chocolate “could represent an effective and cost effective strategy for people with metabolic syndrome (and no diabetes).”

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Medical Researchers who sacrificed their time and effort. In order to give people the

ability to empower themselves. Without the base aspirations for fame, or fortune. Just honorable people, doing honorable things.