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European Society of anti-aging Medicine
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The wine glass looks half full
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Not unexpectedly, the news media embraced and eagerly reported the latest revelation about the health benefits of red wine. The study, published in the online journal PLoS One this week, hinted that resveratrol, an antioxidant compound found in the skins and seeds of wine grapes, can boost cardiovascular health and slow aging in mice at lower doses than previously thought. Earlier studies have suggested that resveratrol helped mice run farther, stay slender, and stave off diabetes and cancer.
Any story about red wine or dark chocolate, especially one that gives people an excuse to indulge, is going to be well-received. As I write this, the New York Times article on the recent red wine study has been hovering near the top of the newspaper’s list of most popular online stories.
But as we swash down red wine and gobble bon bons, we may be inclined to forget that, along with all those antioxidants comes a good dose of alcohol and saturated fat. Excessive alcohol consumption (more than two daily drinks for men or more than one daily for women) can lead to liver disease, according to the Centers for Disease Control and Prevention (CDC). And recent studies suggest that one or two drinks a day may increase the risk of breast cancer.
And don’t forget the caveats associated with some of these studies. In most of the resveratrol studies (a notable exception being the recent PLoS study) mice were given massive quantities of compound. A human would have to guzzle at least several bottles of red wine a day to obtain a similar amount. And to reap the benefits of cocoa, you have to eat dark chocolate (preferably containing 70 percent cocoa), which tends to be bitter. With creamier chocolate the milk binds to the antioxidant compounds, making them unavailable to the body.
Finally, it is worth noting that the recent red wine study was partially financed by the Swiss DSM Nutritional Products, “the world's leading supplier of vitamins, carotenoids and other fine chemicals to the feed, food, pharmaceutical and personal care industries,” according to the company’s website. Similarly, several studies on cocoa flavanols have been funded by Mars Inc., the maker of chocolate products. So while it's tempting to toast to the promising results from these studies, the bottom line is more bittersweet.
By Coco Ballantyne
Photo by miss karen
Providing information or promoting drugs?
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On 12 September, US Food and Drug Administration (FDA) officials released finalized recommendations for drug makers that wish to provide medical literature to doctors about unapproved uses of their products. It's no small matter, since over 20% of US prescriptions are written for ‘off-label uses’.
Earlier guidelines required companies to commit to submitting an application to the FDA for the unapproved use before sharing peer-reviewed journal articles or reference publications about it. However, the new recommendations permit sales representatives to share data about uses that companies don't plan to submit for FDA review.
Additionally, the finalized version of the new guidelines does not require that drug companies provide peer-reviewed materials that reach different conclusions about the unapproved use.
The revised policy recommends that that peer-reviewed materials given to doctors are not “marked, highlighted, summarized, or characterized by the [company] in any way”. Such actions could be considered ‘off-label promotion’ of drugs, which is what US pharmaceutical giant Eli Lilly did when it used catchy slogans to persuade doctors to prescribe the antipsychotic Zyprexa for unauthorized use in elderly patients (Lilly pleaded guilty to violating US law on 15 January). This practice is still illegal. However, I doubt the relaxed guidelines will help companies provide an unbiased view of their drug’s safety and clinical effectiveness—something that certain companies apparently need help with.
Photo by zimpenfish
Pediatric placebos
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When I was a small child, I had an earache, so I asked my dad for a Band Aid. The source of my discomfort was an inner ear infection, so antibiotics would have been more on the mark—but a Band Aid seemed better than nothing. The placebo effect is powerful.
As reported in the New York Times this week, there is now a placebo pill designed for children that you can buy. The product is called Obecalp (placebo spelled backwards) and available online for $5.95 a bottle. Each cherry-flavored chewable Obecalp tablet is essentially a lump of sugar in a medicinal disguise. “Invented by a mommy,” says the website advertisement, featuring a headshot of the product’s inventor, a mother of three from Severna Park, Maryland. The implication is that, if a mom came up with the idea, then it must be okay to give fake meds to your children.
But how will mom (or dad) explain the situation when their children discover that the magical tablets they received for headaches, stomachaches and sore throats were always a hoax? The use of placebos sends an uncertain message to children. They will eventually know that their parents deceived them. Moreover, there is something unnerving about looking to pills for the answer to every ailment. There are other ways to comfort children. In some cases they simply need a dose of attention to feel better. Perceived physical ailments may also be a sign of emotional or mental distress that a sugar tablet cannot fix.
Doctors admit to prescribing placebos, according to a study published earlier this year in the Journal of General Internal Medicine. Researchers at the University of Chicago surveyed 466 physicians from three Chicago-area medical schools and found that nearly half of all respondents had used placebos in their clinical practice. One of their most common reasons for doing so: “to calm patients.” Something is wrong with a medical system in which patients need pills and injections to feel tranquil and reassured that they have received adequate care. It’s hard to imagine that adding more pills to the market, even if they are fakes, will help change this culture.
Posted on behalf of Coco Ballantyne
Image by Fillmore Photography via Flickr
Gene mutation may reveal clues for treating lung diseases
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Oct. 15, 2009 -- A genetic mutation found in four children born with multiple abnormalities may provide insight into potential treatments for newborn lung distress and chronic obstructive pulmonary disease (COPD).
The children were born with abnormally developed lungs, gastrointestinal and urinary systems, skin, skull, bones and muscles. In addition, all had cutis laxa, an inherited connective tissue disorder that causes skin to hang loosely from the body. Three of the patients died from respiratory failure before age 2.
Details about the discovery of the mutation, found by researchers from Washington University School of Medicine in St. Louis, McGill University, New York University Langone Medical Center and collaborating institutions, are published in the Oct. 15 online edition of the American Journal of Human Genetics.
Elaine C. Davis, Ph.D., senior author and associate professor of anatomy and cell biology at McGill University in Montreal, Canada, compared various tissues from a mouse genetically engineered to be missing a form of the LTBP4 gene with skin tissue samples from one of the children. She found remarkable similarities. The mouse, provided by Daniel Rifkin, M.D., the Charles Aden Poindexter Professor of Medicine and professor of cell biology at NYU Langone Medical Center, showed similar connective tissue alterations by electron microscopy as the patient. The child had cutis laxa, lethal pulmonary complications and gastrointestinal and urinary disease.
Based on these observations, researchers in the laboratory of Zsolt Urban, Ph.D., a pediatric geneticist at Washington University School of Medicine, sequenced the LTBP4 gene in the four children and confirmed they had mutations. He determined that the patients were the first described to show severe symptoms of a novel syndrome, which the researchers have named Urban-Rifkin-Davis Syndrome.
The findings have potential implications for newborns with underdeveloped lungs as well as older patients with severe lung diseases, including COPD, says Urban, first author of the paper.
"Many newborns commonly have breathing difficulties," Urban says. "Part of the problem is that the lung is not developed properly, especially the alveoli, the tiny sacs at the end of the smallest airways that serve as a place for oxygen uptake and gas exchange. This finding helped us identify a gene essential for the development of alveoli and potentially provide a target for intervention in premature babies."
Urban says potential treatments could include introducing the protein product of the LTBP4 gene to the newborn or using existing drugs that can moderate transforming growth factor beta (TGFß), which is overactivated in the tissues of these children. The drug losartan, now in trials for treating Marfan syndrome, another connective tissue disorder, has been shown to limit TGFß and merits further research as a possible treatment.
The researchers now are broadening their research into the new syndrome among other patients with cutis laxa. Urban, assistant professor of pediatrics, of medicine and of genetics at Washington University School of Medicine, heads the International Center for the Study of Cutis Laxa at St. Louis Children's Hospital.
"We are finding that about 70 percent of cutis laxa patients with pulmonary, gastrointestinal and urinary problems have Urban-Rifkin-Davis Syndrome," Urban says. "Now we will look at what percentage of cutis laxa patients with only pulmonary problems have the mutation."
Early developmental problems that are not detectable in childhood may predispose a person to age-related disease such as COPD, Urban says. Urban and colleagues are also testing samples collected from patients with COPD for LTBP4 mutations. When lungs are damaged with COPD, alveoli lose their elastic quality, and the walls between them are destroyed as they become thick and inflamed.
"Patients who may have a slightly reduced activity of LTBP4 might be more susceptible to chronic lung diseases later in life," Urban says. "Identifying genes that are central for the formation of alveoli may help us devise ways to regenerate alveoli in patients with COPD."
Urban Z, Hucthagowder V, Schürmann N, Todorovic V, Zilberberg L, Chio J, Sens C, Brown C, Clark R, Holland K, Marble M, Sakai L, Dabovic B, Rifkin D, Davis EC. Mutations in LTBP4 cause a syndrome of impaired pulmonary, gastrointestinal, genitourinary, musculoskeletal and dermal development. American Journal of Human Genetics. Advance online publication Oct. 15, 2009.
This study was funded in part by the National Institutes of Health, March of Dimes, Phillip Morris USA Inc. and the Canadian Institutes of Health Research.
Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation byU.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
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