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Archive for August, 2008

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Study Outlines Teens' Preferences And Trade-offs For Freedom From Acne

Tuesday, August 19th, 2008

Teens report that they would pay about $275 to have never had acne, and are willing to pay considerably more to be acne-free than to have 50 percent clearance of their acne or to have clear skin with acne scars, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals.

Acne vulgaris affects almost all adolescents and has been associated with anxiety, depression, embarrassment and social dysfunction, according to background information in the article. “Reducing the psychosocial impact of acne is considered one of the guiding principles for its clinical management and it is important to measure and evaluate this impact,” the authors write.

Cynthia L. Chen, M.D., and colleagues at the University of California, San Francisco, studied 266 teen volunteers with acne from four public high schools in San Francisco. The participants completed written surveys regarding how much of their lifetime they would give up or how much money they would pay to have never had acne, to be 100-percent acne-free from then on, to have 100-percent acne clearance but with visible scarring or to have 50-percent acne clearance. They and their parents also were asked about acne history and severity, and parents were asked about their willingness to pay since they typically bear the cost of their children’s acne treatment.

The researchers’ used teens’ responses to the time trade-off question to calculate their current acne state utility score. This was done by dividing the participants’ reduced life expectancy in years without acne by his or her life expectancy in years with acne. The average score for the current acne state was 0.961; 100-percent clearance received a higher score (0.978) than 50-percent clearance (0.967) and 100-percent clearance with scarring (0.965).

On the willingness-to-pay analysis, the teens reported they would pay a median (midpoint) of $275 to have never had acne, $100 to be 100-percent cleared of acne, $10 for 50-percent clearance and zero for 100-percent clearance with scarring. Parents said they would pay a median of $250 for their child to never have had acne, $100 for 100-percent clearance, $100 for 50-percent clearance and zero for 100-percent clearance with scarring.

Adolescents who rated their acne as more severe reported a willingness to trade more time and money for acne clearance than those with less severe acne.

“Knowledge of these patient preferences may help dermatologists balance clinical trial results with patients’ expectations of therapy,” the authors write. “Randomized, blinded, placebo-controlled trials have shown that three to four months of conventional acne therapy, including topical benzoyl peroxide, topical retinoids and oral antibiotics, typically produces reductions in lesion counts in the 40 percent to 60 percent range.”

“It has also been suggested that the incidence of scarring from facial acne approaches 95 percent,” they continue. “Thus, adolescents’ marked preference for total clearance over partial (50 percent) clearance or clearance with scarring suggests that physicians must weigh high patient expectations against these clinical data regarding efficacy and risk of sequelae.”

Journal reference:

Cynthia L. Chen; Miriam Kuppermann; Aaron B. Caughey; Lee T. Zane. A Community-Based Study of Acne-Related Health Preferences in Adolescents. Archives of Dermatology, 2008; 144 (8): 988 DOI: 10.1001/archderm.144.8.988

Adapted from materials provided by JAMA and Archives Journals.

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Lowering Cholesterol Early In Life Could Save Lives

Wednesday, August 6th, 2008

With heart disease maintaining top billing as the leading cause of death in the United States, a team of University of California, San Diego School of Medicine physician-researchers is proposing that aggressive intervention to lower cholesterol levels as early as childhood is the best approach available today to reducing the incidence of coronary heart disease.

In a review article published in the August 5, 2008 issue of the American Heart Association journal Circulation, pioneering lipid researcher Daniel Steinberg, M.D., Ph.D., professor emeritus of medicine at UC San Diego, and colleagues Christopher Glass, M.D., Ph.D. and Joseph Witztum, M.D., both UC San Diego professors of medicine, call current approaches to lowering cholesterol to prevent heart disease “too little, too late.”

They state that with a large body of evidence proving that low cholesterol levels equate with low rates of heart disease, “…our long-term goal should be to alter our lifestyle accordingly, beginning in infancy or early childhood” and that “…instituting a low-saturated fat, low-cholesterol diet in infancy (7 months) is perfectly safe, without adverse effects…”

According to Steinberg, progress has been made in the treatment of coronary heart disease in adults with cholesterol lowering drugs like statins. However, while studies show a 30% decrease in death and disability from heart disease in patients treated with statins, 70% of patients have cardiac events while on statin therapy. Promising new therapies are under development, but with an alarming rate of coronary heart disease in the U.S. today, action to curtail the epidemic is needed today.

In fact, they propose that lowering low-density lipoproteins (the so-called “bad cholesterol”) to less than 50 mg./dl. even in children and young adults is a safe and potentially life-saving standard, through lifestyle (diet and exercise) changes if possible. Drug treatment may also be necessary in those at very high risk.

“Our review of the literature convinces us that more aggressive and earlier intervention will probably prevent considerably more than 30% of coronary heart disease,” said Steinberg. “Studies show that fatty streak lesions in the arteries that are a precursor to atherosclerosis and heart disease begin in childhood, and advanced lesions are not uncommon by age 30. Why not nip things in the bud?” Such early signs of heart disease should be taken as seriously as early signs of cancer or diabetes, he said.

Physicians have been slow to measure cholesterol, much less prescribe cholesterol lowering regimens in children and young adults who are otherwise healthy. However, the UC San Diego team notes that studies of Japanese men in the 1950s showed that consuming a low-fat diet from infancy resulted in lifelong low cholesterol levels, and their death rate from heart disease was only 10% of the rate of cardiac-related death in the U.S. Even with risk factors such as cigarette smoking and diabetes, heart disease deaths remained significantly lower in Japanese men with lifetime levels of low cholesterol. This protective effect was lost in Japanese who migrated to the United States and adopted a Western diet leading to higher blood cholesterol levels.

Interventions today typically begin in adults diagnosed with high cholesterol levels or other risk factors or symptoms of coronary artery disease. However, initiating cholesterol-lowering interventions in 50-year-old adults, even if successful, is unlikely to reverse established arterial disease and will therefore have limited impact on the occurrence of adverse events related to coronary heart disease.

Citing the success of lowering cholesterol levels in children diagnosed with familial hypercholesterolemia, the UC San Diego team suggests that programs to lower cholesterol in the population at large from childhood on, with the ideal LDL level set at 50 mg./dl. or less (in those at highest risk), will have a long-term beneficial effect and lower the nationwide rates of coronary artery disease. They do not advocate using drug therapy to reach these levels, especially in children with no other risk factors, but to achieve these low levels through “TLC,” or “therapeutic lifestyle changes,” such as diet and exercise.

The National Institutes of Health (NIH) has declared “war” against the parallel epidemics of obesity and diabetes. The researchers conclude that “The weapons for those wars—education and behavior modification—are the same as those needed for a ‘war’ on coronary heart disease.”

They propose that “A concerted national effort might dramatically reduce morbidity and mortality due to three major chronic diseases…It would take generations to achieve and it would require an all-out commitment of money and manpower to reeducate and modify the behavior of a nation. Is that impossible? No. We have already shown that even a frankly addictive behavior like cigarette smoking can be overcome (eventually).”

Adapted from materials provided by University of California - San Diego.

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Chlamydia treatment in UK pharmacies will deliver convenient care for patients

Tuesday, August 5th, 2008

Today’s decision by the Medicines and Healthcare products Regulatory Agency (MHRA) to approve the reclassification of azithromycin for the treatment of chlamydia infection will mean convenient and effective care for patients, said the Royal Pharmaceutical Society of Great Britain (RPSGB).(original article)

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A new target for malaria drugs

Monday, August 4th, 2008

The malaria parasite has waged a successful guerrilla war against the human immune system for eons, but a study in this week’s Journal of Biological Chemistry has exposed one of the tricks malaria uses to hide from the immune proteins, which may aid in future drug development.(original article)

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Lilly reaffirms $3.00 per share purchase offer for SGX Pharmaceuticals

Monday, August 4th, 2008

Eli Lilly and Company today reaffirmed that its $3.00 per share purchase offer for SGX Pharmaceutical, Inc. represents its best and final offer for the San Diego-based biotechnology company.(original article)

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Mexico lifts regulation requiring AIDS drug companies to have manufacturing plants in Mexico in order to sell generics

Monday, August 4th, 2008

On the day of the opening ceremonies of the XVII International AIDS Conference in Mexico City, President Felipe Calderon announced his plans to lift a Mexican Ministry of Economy requirement that pharmaceutical companies operating in Mexico must have a manufacturing plant in that country in order to use or sell generic versions of their lifesaving AIDS and other drugs in Mexico.(original article)

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Surgical Errors Now Topping $1.5 Billion

Sunday, August 3rd, 2008

Surgical errors are of the most costly nature. While the $1.5 billion figure is an astounding one and has a great effect on the medical industry, it is nothing compared to the impact of surgical errors on the patients themselves. And the bottom line is that the number can and should be reduced.

According to the Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health & Human Services (HHS), employers pay nearly $1.5 billion each year for medical errors that occur during or after surgery; errors that could be potentially preventable. The study was authored by William E. Encinosa, Ph.D. and Fred J. Hellinger, Ph.D., both employed by ARQ, and was published in the July issue of the Health Services Research journal……read more here

(original article)