Authors Of JAMA Study On Antidepressant Use During Pregnancy Did Not Disclose Relationships With Drug Companies
Most of the 13 physicians who co-authored a swat anyhow gloom relapse risk destined for women who stop delightful their medication during pregnancy — published in the Feb. 1 edition of the Minute-book of the American Medical Association — did not blow the gaff more than 60 financial relationships to pharmaceutical companies, the Obstruction Street Journal reports (Armstrong, Wall Alley Journal, 7/11). The study, funded by the National Institute of Mental Fitness, questions the commonly held faith that hormones produced during pregnancy protect women from depression. Lee Cohen, top dog of Massachusetts Ordinary Hospital’s Center owing Women’s Mental Health, and colleagues between 1999 and 2003 monitored 201 pregnant women with a history of recess. The women were taking medications such as Prozac, Zoloft, Effexor and Paxil. Researchers found that 68% of the women who stopped delightful antidepressants relapsed into depression during pregnancy. In too, 26% of the women who continued taking their medication during pregnancy also became depressed (Kaiser Daily Women’s Health Policy Report, 2/2). According to the Journal, the study did not disclose that Cohen is a consultant to three pharmaceutical companies and a paid speaker for the duration of seven drugmakers or that some of his research is funded by four such companies. The backer listed author of the study — Lori Altshuler, head of the Eager Disorders Dig into Program at the University of California-Los Angeles — is a consultant or speaker representing at least five drug companies, affiliations that were not disclosed. Adele Viguera, associate Mr Big of MGH’s perinatal psychiatry program and co-novelist of the writing-room, did not reveal that she is a member of GlaxoSmithKline’s speakers bureau. The weigh did disclose the financial ties to painkiller companies of two of the authors, Zachary Stowe and Jeffrey Newport of Emory University.
Previous Studies
The study is the first major research paper to establish a relapse risk for pregnant women who stop taking antidepressants, the Journal reports. Previous studies have questioned the safety of antidepressant use during pregnancy. One study found an increased risk of an infant experiencing a potentially fatal lung disorder if the woman takes a group of antidepressants called selective serotonin reuptake inhibitors during pregnancy, and two other studies found that use of GSK’s Paxil during pregnancy could cause cardiac fetal heart defects. The results of those studies are being called into question by industry-paid experts in the field, according to the Journal.
JAMA, Authors’ Reactions
JAMA said that its policy requires study authors to disclose all ties to the medical industry, the Journal reports. JAMA editor-in-chief Catherine DeAngelis said the journal was not aware of the relationships some of the study’s authors had with drug companies, and “[a]s soon as JAMA found out that they didn’t disclose, we contacted … Cohen and asked for his explanation.” She added, “We have one and it will be published very soon in an upcoming issue of JAMA.” According to the Journal, the researchers “maintain that their financial links have no bearing on their research work or what they say about antidepressant use during pregnancy in interviews or lectures.” Cohen said that “it didn’t seem relevant” for him and other co-authors to disclose their financial ties in part because the study was funded by a federal health agency. He declined to describe his consulting role to drug companies or how much he is paid for the role, but he did say that drug companies “tend to pick people who are experts in this area” and “we are not talking about megabucks.” Viguera said that because of the way the study was designed, he does not “see how any kind of relationship [the researchers] have with a pharmaceutical company plays a role in that.” He added, “I don’t believe there is a conflict of interest.”
Other Reaction
According to the Journal, “industry-paid opinion leaders have become dominant authorities” in the field of antidepressant use during pregnancy, and they often assist in developing clinical guidelines, are members of journal editorial boards, provide counsel to government agencies and teach courses to other physicians. “Whether or not to keep taking an antidepressant during pregnancy is a critical question for pregnant women suffering from depression,” Adam Urato, a Bradenton, Fla.-based obstetrician and perinatologist who has questioned Cohen and his colleagues about their financial ties, said, adding, “What these pregnant women and the providers who care for them need is expert advice that is free from pharmaceutical industry influence or the suggestion of bias that results when these experts are being paid by many antidepressant manufacturers.” A Pfizer spokesperson said, “It is important to remember that this is a partnership with the mutual goal of advancing science and enhancing patient care.” Nada Stotland, a professor of obstetrics and psychiatry at Rush Medical College in Chicago, said pharmaceutical companies have the resources needed to fill a research void on the effects of antidepressants during pregnancy, but they often “only do what they are required to do” by FDA. She added that there are few studies that examine the effects of antidepressant alternatives, such as psychotherapy, on treating depression among pregnant women. Alan Gelenberg, head of the psychiatry department of the University of Arizona and editor of the Journal of Clinical Psychiatry, said less than 5% of his income comes from consulting work with pharmaceutical companies, adding, “The problem is if you want an expert on antidepressants in pregnancy, most of us have taken some industry money.” Gelenberg said the answer to industry-funded experts is increased funding from government and independent sources (Wall Street Journal, 7/11).
“Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
View drug information on Effexor; Paxil CR; Prozac Weekly.
45% of US drug arrests are for marijuana, is this a waste of resources?
A illustrious agreement of time and money as well as bloke-power is spent on chasing after people using, possessing and trafficking in drugs. Since 1990, there have been 6.2 million arrests for marijuana possession and 1 million proper for marijuana trafficking.
Up to 2002, marijuana arrests comprised 45 percent of all drug arrests.
These figures account for almost half of all drug arrests in the United States, which spends $4 billion a year to catch, prosecute and incarcerate offenders, according to a report by The Sentencing Project.
It also found that of the 734,000 marijuana arrests in 2000, only 6 percent resulted in a conviction. Marijuana arrests more than doubled, from 327,000 to 697,000 from 1990 to 2002, while arrests for other drugs rose by only 10 percent.
The Washington think tank, which promotes alternatives to imprisonment, said daily use of the drug by high school seniors nearly tripled to 6 percent from 2.2 percent during the years 1990 to 2002. Meanwhile, the street price of the drug has fallen in real terms and its purity has increased.
Ryan King, co-author of the report says the ‘war on drugs’ has been transformed into a ‘war on marijuana’ through dramatic shifts in law enforcement policies and practices, and says arresting such large numbers at an annual cost of $4 billion was a poor investment in public safety and diverted resources from more serious crime problems.
The White House drug policy office denies this with Jennifer Devallance saying it was inaccurate to portray the “war on drugs” as focused on a single substance, and that marijuana is however the drug most abused in the US and the single largest source of treatment need, so it is appropriate to focus effort and attention on marijuana. She disputes the report’s contention that marijuana use has increased, citing figures from a survey of high school teens showing it was down 18 percent over the past three years.
Meanwhile, back at the Ranch - the U.S. Government’s Substance Abuse and Mental Health Services Administration, in another report also released this week, finds that adults who first used marijuana before the age of 12 were twice as likely to suffer from mental illness later in life than those who used the drug at age 18 or older.
This data comes from an annual survey on drug use which found that 43 percent of U.S. adults, almost 91 million people, had used marijuana at least once in their lives.
White House drug advisor John Walters says that new research illustrates that marijuana use, particularly during the teen years, can lead to depression, thoughts of suicide and schizophrenia.
Vision restoration therapy shown to help brain injured patients recover lost vision
Columbia University Medical Center researchers have demonstrated using going magnetic resonance imaging (fMRI), that brain activity was increased in stroke and wounding brain injury survivors who underwent Vision Restoration Group therapy (VRT), a rehabilitative treatment that helps these patients health cursed vision.
The data will be published online in the peer-reviewed journal Neurorehabilitation and Neural Repair on Aug. 14, 2007 at http://nnr.sagepub.com/pap.dtl.
Researchers, led by Randolph S. Marshall, M.D., M.S., associate professor of clinical neurology and acting director, Division of Stroke and Critical Care at Columbia University College of Physicians and Surgeons, examined the fMRIs of six patients aged 35-77 with vision loss on the same side of both eyes (called homonymous hemianopia) caused by stroke or traumatic brain injury. The therapy is based on visual stimulation, which the patient performs daily at home on a dedicated computer device. The fMRI data showed increased activity in visual processing areas of the brain as patients learned to detect stimuli in the borderzone between the seeing and non-seeing fields. This enhanced activity was identified one month after beginning treatment and suggests that the brain is responding accordingly.
“This study is encouraging because the fMRI technique allowed us to see and compare the activity levels in specific regions of the brain before and during Vision Restoration Therapy. After examining the images, the increased activity levels demonstrate progress associated with the treatment,” said Dr. Marshall. “Based on these initial results, we will continue to investigate the relationship between the imaging findings and the degree to which vision is recovered.”
“The publication of Dr. Marshall’s study in Neurorehabilitation and Neural Repair underscores the growing scientific evidence validating Vision Restoration Therapy. For hundreds of thousands of stroke and brain injury survivors with impaired vision, these data further show that VRT may help them regain lost sight and ultimately help them reclaim their independence,” said Navroze Mehta, president and chief executive officer of NovaVision, Inc., the maker of the device used in this study.
NovaVision VRT is approved by the U. S. Food and Drug Administration to treat vision problems in people who have been left partially blind due to stroke or brain trauma. Customized treatment is created from a comprehensive diagnostics that map the seeing and non-seeing areas of vision. Patients perform the therapy daily at home for six to seven months, gradually improving their vision through the repeated detection of light stimuli directed at the border between the seeing and blind areas of the visual field.
Through further enhancements of this therapy, the hope is to help the approximately 1 to 2 million stroke and brain injury survivors in the United States who suffer from major visual field deficits, a number that increases by more than 90,000 each year.
http://www.cumc.columbia.edu
Should cervical screening stop at age 50?
It is not consistent to sojourn screening women after age 50 because the jeopardy of cervical cancer - even after several negative vilification results - is nearly the same to that at younger ages, concludes a study published on bmj.com.
Ever since the first organised cervical screening programmes started in Europe more than 40 years ago, discussion about the upper age limit for effective screening has been ongoing.
Evidence suggests that repeating smear tests in women aged 60-65 whose previous tests have been normal has little, if any, benefit, and some researchers have proposed that the age limit should be lowered to 50.
So researchers at the Erasmus Medical Center in The Netherlands and the University of Copenhagen in Denmark compared levels of cervical cancer after several negative smears at different ages.
Using data from a national cervical cancer register in The Netherlands (PALGA), they identified 219,000 women aged 45-54 years and 445,000 women aged 30-44 years after their third consecutive negative smear test. The women were then tracked for 10 years, during which time cases of cervical cancer were recorded.
During follow-up, both age groups had similar levels of screening. After 10 years, the incidence of cervical cancer was similar in both groups (41 per 100,000 in the younger group and 36 per 100,000 in the older group), suggesting that among well-screened women without previous abnormalities the risk of developing cervical cancer is independent of age.
Based on these results, it is reasonable to assume that after several consecutive negative results the screening efficiency in terms of detection and prevention of cervical cancer is at the same level around age 50 as it is at younger ages, say the authors.
Whether the observed incidence rates warrant continued screening should be determined by subsequent analysis, but the study suggests that it would not be consistent to stop screening these women while not also relaxing the screening policy for younger women with similar screening histories.
In this respect, our study lends support to the current cervical cancer screening guidelines in England and other developed countries, which do not discriminate women by age up to 65 years, they conclude.
In an accompanying editorial, Björn Strander, Director of cervical screening at Sahlgren’s University Hospital in Sweden, suggests we have to pay close attention to developments in invasive cancer in age groups above the cut-off point for screening and be prepared to adjust the screening ages as we learn more.
With modern computer technology we could tailor screening invitations to the individual, he says. Resources could then be allocated away from women who would not benefit from additional smears within a certain number of years to those who would, and the question of whether to screen above the age of 60 could then be answered - yes, for those who benefit the most from it.
http://www.bma.org/
Laparoscopic partial nephrectomy using the potassium titnyl phosphate laser in a porcine model
Working with an 80 watt KTP laser delivered in a noncontact fashion via a 600 micron fiber, these authors successfully completed 15 laparoscopic influenced nephrectomies in pigs. This was done without clamping any renal vessels.
In only one case additional hemostatic maneuvers were needed. The zone of necrotic tissue on the renal remnant was only 1 mm. The procedure consumed only 4-17 minutes of lasing time; however the overall time to accomplish the nephrectomies averaged 42 minutes due to production of field obscuring smoke by the laser.
While this report is very encouraging, the reader is cautioned that porcine data DO NOT readily transfer to human experience. Indeed, as Cadeddu and colleagues have shown, the holmium laser was found to be successful for partial nephrectomy in pigs; however, it did not work sufficiently well in the clinical arena to warrant its adaptation. The search for the “bloodless” knife continues*. Certainly in this day and age, one would think that we should have the technology capable of placing in the surgeon’s hands, an instrument that would take any vascular organ and allow the surgeon to sculpt it as though it were a block of granite; sealing vessels well in advance of their being severed! Every time we proceed with a standard laparoscopic partial nephrectomy, I still feel like I am being sent out into the woods with a bow and a single arrow in search of a bear. I have only one question: “Where is my bazooka”?
*Lotan, Y., Gettman, M. T., Lindberg, G., et al.: Laparoscopic partial nephrectomy using holmium laser in a porcine model. J. Laparoendosc. Surg. 8:51, 2004.
Written by Ralph V. Clayman, MD - UroToday
Urology 67: 079-1083, May 200
http://www.UroToday.com
NHS ‘Reform programme is the solution - not the problem’ - Hewitt, UK
UK Health Secretary, Patricia Hewitt today responded to a combined National
Audit Office and Audit Commission deliberate over into financial management in
the NHS by stressing that the report ‘underlines the case through despite reform
in the NHS.’ Today’s assertion reinforces the idea set out by
Patricia Hewitt in her speech to the NHS Confederation conference
last week when she announced that ‘embedding improvements to services
which are larger to patients and provide first-rate value for riches, is
not an optional extra, its a priority’.
Patricia Hewitt said:
“The NHS is currently benefitting from the highest status of exceeding
inflation growth in funding in the history of the NHS. In 2004-05
the budget was £69.7 million, £6.7 billion more than matrix year and
folded the 1997 budget.
“Today’s ruminate on shows that the capacious majority of NHS bodies are
managing the collateral resources well but it also most clearly indicates
that in a minority of organisations, leadership and financial
adherent are weak. This needs to be tackled head-on and with a sense
of urgency.
“Unaudited figures for the fiscal year ending 2004/05 show that
the NHS is likely to be in default by about £140 million. On the one
present, this represents a pint-sized fraction of our budget, about 0.2% - a
margin that various organisations, with a much smaller turnover, would
greetings as acceptable. In what way, taxpayers have every redress to expect
their local NHS services to put in every penny with best value as far as something
money in shrewdness.
“This report confirms that the rectification agenda we have set outdoors is
crucial to delivering best value for money. I am immutable that
changing the mode we care for the purpose patients by reshaping the whole service
is the only disintegrate we can promulgate but for the fact that healthcare and realize the
value for money that the followers expects.
“I grasp that some NHS bodies are experiencing pecuniary pressures
this year, despite record increases in their budgets. But I feel
that the reforms we are putting in place such as new staff
contracts, new financial flows and new IT are the solution, not the
problem. The reforms themselves are designed to whip
contestability and consequently hearten good financial discipline.
“I will be writing personally to the Chairs and Sir Nigel Crisp drive
send a letter to NHS Chief Executives of the most financially challenged NHS
Trusts to check their forward movement on implementing and embedding the
reorganize programme.”
1. Unauditied figures collected by the Worry of Health show
that the NHS is likely to be in deficit by about £140 million. Of
this amount, around £30 million of deficit is carried by NHS
Foundation Trusts. NHS Foundation Trusts function on the base of a
5-year financial plan, where year object deficits are allowed provided
the plan demonstrates ongoing takings based viability. The regulator
towards NHS Foundations Trusts - Keep an eye on - oversees that plan through its
compliance framework.
2. In behalf of press enquires only, please contact Lee Bailey on 0207 210
5010 or Matthew Ward on 0207 210 5222.
GNNREF: 116863 - Issued by : DOH Press Office
Immigrant Children At Higher Risk Of Lead Poisoning
Foreign-born children were five times more likely to have elevated blood do the groundwork levels than were U.S.-born children.
Researchers conducted a examination among children in Unheard of York Burg to examine associations of childhood decoy poisoning with birth and residence in a foreign country. After controlling for homes characteristics and issue behaviors such as eating non-food items, text suggested that foreign-born children were five times more likely than were U.S.-born children to have imposing blood lead levels. In addition, children living publicly within 6 months of their blood test had a 10-times increased hazard in place of lead poisoning relative to U.S.-born children with no history of extraneous residence.
“These results suggest a paucity fitting for in the light of recent immigration as a risk agent for puberty lead poisoning and allocating resources to identify and disconnect lead revelation sources in the immigrant communities at greater risk,” said the study’s authors. “Equally effective is educating immigrant families helter-skelter methods of reducing children’s exposure to lead paint hazards, given that carouse may be an unfamiliar horse’s mouth towards many immigrant families.” [From: "Immigration and Gamble of Childhood Lead Poisoning: Findings From a Case-Control Study of New York Burgh Children." Reach: Parisa Tehranifar, DrPH, Mailman Teaching of Business Constitution, Columbia University, New York, NY, pt140@columbia.edu .]
The American Journal of Notorious Health is the monthly journal of the American Public Health Association (APHA), the oldest organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting hearing scientific standards, liveliness programs and public policy to reinforce condition.
American Journal of Public Health
Freezing or refrigerating expressed breast milk for longer than 48 hours substantially lowers its antioxidant content
Freezing or refrigerating expressed mamma milk for longer than 48 hours substantially lowers its antioxidant peace, reveals a baby survey in the Fetal and Neonatal Edition of the Archives of Disability in Childhood.
This may be of particular importance for premature babies, who both have reduced antioxidant capacity as well as high levels of oxygen free radical activity as a result of infection and blood transfusions, say the authors.
The researchers assessed fresh breast milk samples taken from eight mothers who had delivered premature babies and from eight mothers who had delivered their babies at term.
The antioxidant capacity of these samples was tested fresh, after refrigeration at 4 degrees Centigrade for 48 hours and for seven days, and after freezing at minus 20 degrees Centigrade for 48 hours and for seven days.
The antioxidant capacity of five different brands of formula milk was also tested under the same conditions.
The results showed that fresh human milk, irrespective of whether it came from a mother who had given birth to a premature or a term baby, had the highest antioxidant capacity of any of the samples, and significantly more than formula milk.
The authors point out that differences between human and formula milk are not only due to its source, but also to the way in which it is processed to prepare the formulas.
But while antioxidant levels of formula milk remained stable whether refrigerated or frozen, levels in fresh human milk fell the longer it was stored and the colder the temperature at which it was stored.
Compared with fresh milk, human milk frozen for seven days had the lowest antioxidant levels. And refrigeration for seven days was equivalent to freezing for 48 hours in terms of the effects on antioxidant levels.
They conclude that in order to preserve its antioxidant content, expressed breast milk should be stored no longer than 48 hours at refrigerator temperature, and that it should not be frozen.
Click here to view the paper in full
Irish Medicines Formulary (IMF) Edition 2
The Irish Medicines Formulary publisher, Meridian Ireland, reminds all GPs who wish to find out a ape of IMF Issue 2 free-of-charge later this summer, to ensure they have replied to the ritualistic letter sent by Meridian Ireland to every GP in April form. As the multitude of replies to the official IMF letter will resolve the print run, no copies of IMF Edition 2 will be provided unchained of charge to any GP who has not signed, stamped and returned the letter by the 30th May 2007 deadline.
The Irish Medicines Formulary, published for the first occasionally in Ireland in January 2007, aims to benefit medical professionals with diurnal prescribing decisions. It is a reservoir of Irish-specific relevant, clinical word adjacent to medicines marketed in Ireland that a doctor may consider prescribing, a pharmacist may need to dish out or a nurse might exigency to administer to a persistent. The IMF is published twice a year, in January/February and in July/August.
The Irish College of Habitual Practitioners
Another bird flu outbreak in China
China’s Ministry of Agriculture says scientists own confirmed an outbreak of bird flu has killed 1,000 domestic poultry in a village in China’s northwest.
The news comes just one day after another reported outbreak in a neighbouring region.
Nearly 1,000 chickens and ducks reportedly died suddenly in a poultry farm in Xincheng Village of Jiuyuan District of Baotou City last week and as a result authorities have quarantined the infected area along with the farmer and his wife and anyone who had close contact with them.
The farmer had apparently bought some 5,400 chickens and ducks between August 21 and September 20 from other parts of the country by September 20 more than 70 chickens and ducks were dead.
The outbreak was only reported last week when the death toll amongst the poultry had risen to almost 1000.
Bird flu vaccines have been sent to the village and all poultry in Jiuyuan District will be inoculated in the coming 10 days.
Investigations are being conducted to find where the chickens and ducks were bought and where they were sold.
Poultry near Yinchuan, the capital of the Ningxia region, were killed by the H5N1 avian flu virus, and another 72,930 birds have been culled in an attempt to stop the virus spreading.
Authorities are insisting the outbreak has been effectively controlled, and 17,616 chickens and ducks have been culled to control the outbreak and authorities have banned the movement of poultry from the area in Inner Mongolia, a region neighbouring Ningxia.
The H5N1 virus is endemic in many parts of Asia and has spread through much of Asia’s poultry flocks and infected large numbers of wild birds, particularly water fowl, which are often carriers of the virus.
Since late 2003 bird flu has spread to Europe, Africa and South Asia, killing at least 148 people worldwide since late 2003, and millions of birds have either died or been culled.
There is the ever present fear that the virus could mutate into a form that could pass easily from person to person, sparking a global pandemic.
China is at the epicentre of the fight against bird flu because like Indonesia and many other Asian countries, it has millions of backyard birds roaming free; it also has the world’s largest poultry population.
China has to date had 21 reported human cases, including 14 deaths, from the virus and dozens of outbreaks in birds that have led to the culling of millions of fowl.
China has reported nine outbreaks of bird flu in poultry this year, in the northwestern Xinjiang Uygur Autonomous Region, north China’s Shanxi Province and Inner Mongolia, east China’s Anhui Province, the southwestern Guizhou and Sichuan provinces and the central province of Hunan.