Press Release Date: March 16, 2009
Patients and clinicians should consider risk factors—including age, gender, diabetes, blood pressure, cholesterol levels, smoking and risk of gastrointestinal bleeding—before deciding whether to use aspirin to prevent heart attacks or strokes, according to new recommendations from the U.S. Preventive Services Task Force. These recommendations do not apply to people who have already had a heart attack or stroke.
The recommendations are published in the March 17 issue of the Annals of Internal Medicine. The Task Force reviewed new evidence from the National Institutes of Health's Women's Health Study published since the last Task Force review of this topic in 2002, including a recent meta-analysis of the risks and benefits of aspirin and found aspirin may have different benefits and harms in men and women. The Task Force found good evidence that aspirin decreases first heart attacks in men and first strokes in women.
The more risk factors people have, the more likely they are to benefit from aspirin. The Task Force recommends that men between the ages of 45 and 79 should use aspirin to reduce their risk for heart attacks when the benefits outweigh the harms for potential gastrointestinal bleeding. Women between the ages of 55 and 79 should use aspirin to reduce their risk for ischemic stroke when the benefits outweigh the harms for potential gastrointestinal bleeding. Ischemic strokes occur as a result of an obstruction within a blood vessel supplying blood to the brain and are potentially prevented by aspirin use. The risk of gastrointestinal bleeding with and without aspirin use increases with age and is twice as high in men as in women. Other risk factors for gastrointestinal bleeding include upper gastrointestinal tract pain, gastrointestinal ulcers, and using non-steroidal anti-inflammatory drugs.
The Task Force recommended against using aspirin to prevent either strokes or heart disease in men under 45 or women under age 55 because heart attacks are less likely to occur in men younger than 45 and ischemic strokes are less likely to occur in women younger than 55, and because limited evidence exists in these age groups.
People age 80 and older could benefit more than younger people from aspirin because of their higher risk of cardiovascular disease, but the harms are also greater because the risk of gastrointestinal bleeding increases with age. The Task Force could not find clear evidence that the benefits of using aspirin outweigh the risks in people 80 years or older.
"The decision about whether the benefits of taking aspirin outweigh the harms is an individual one. Patients should work with their clinicians to look at their risk factors and decide if taking aspirin to lower their risk for heart attacks or strokes outweighs the potential risk of gastrointestinal bleeding," said Task Force Chair Ned Calonge, M.D., who is also chief medical officer and state epidemiologist for the Colorado Department of Public Health and Information.
Cardiovascular disease is the leading cause of death in the United States. It is the underlying or contributing cause in approximately 58 percent of all deaths. In 2003, 1 in every 3 adults had some type of cardiovascular disease. In adults over the age of 40, the risk of developing cardiovascular disease is 2 in 3 for men and more than 1 in 2 for women.
The Task Force could not find evidence about what the optimum dose of aspirin is to prevent heart attacks or strokes. Evidence shows benefits at a range of doses, and the risk of gastrointestinal bleeding may increase with the dose. A dose as low as 75 mg seems as effective as higher doses. Taking aspirin increases a person's chances of gastrointestinal bleeding, the sudden loss of blood or perforation of the digestive tract that can lead to hospitalization or death. Taking aspirin also increases the chance of a hemorrhagic stroke, or bleeding in the brain, which is different than the ischemic stroke that aspirin can prevent.
In 2002, the Task Force strongly recommended that clinicians discuss aspirin use with adults at increased risk for coronary heart disease and that discussions with patients should address both the potential benefits and potential harms of aspirin therapy. The new recommendation provides more specific guidance about benefits and harms to specific age groups and gender-specific benefits and provides clinicians with information on how to estimate an individual's risks for heart disease or stroke.
The U.S. Preventive Services Task Force is an independent panel of experts in prevention and primary care. The Task Force conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications. Its recommendations are considered the gold standard for clinical preventive services.
The recommendations and materials for clinicians are available on the AHRQ Web site at http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm. Previous Task Force recommendations, summaries of the evidence and related materials are also available on the AHRQ Web site. Clinical information is also available from AHRQ's National Guideline Clearinghouse™ at http://www.guideline.gov.
For more information, please contact AHRQ Public Affairs: (301) 427-1244 or (301) 427-1246.
Aspirin
Tuesday, March 17, 2009
Monday, March 16, 2009
AAAAI: Oral Immunotherapy Beats Peanut Allergy in Some Children
AAAAI: American Academy of Allergy Asthma & Immunology Meeting
By John Gever, Senior Editor, MedPage Today
Published: March 16, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
WASHINGTON, March 16 -- Five of nine peanut-allergic children undergoing long-term, steady exposure to small quantities of peanuts are now able to eat peanut products freely, a researcher said here.
The children, enrolled in an open-label trial of oral immunotherapy for peanut allergy, have been treated for at least 2.5 years, A. Wesley Burks, M.D., of Duke University, reported at the American Academy of Allergy, Asthma, and Immunology meeting here.
The findings provide a glimmer of hope for up to 3 million Americans who suffer from peanut allergies in a society where peanut products are ubiquitous. Action Points
--------------------------------------------------------------------------------
Explain to interested patients that peanut allergies in children usually persist into adulthood and can be life threatening.
Explain that only a small number of patients have been fully evaluated in this study, and the treatment should still be considered investigational.
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Peanut allergies are among the most common triggers of anaphylaxis, according to the AAAAI, and only one in five children with the allergy outgrows it in adulthood.
Currently, the standard treatment is avoidance of foods containing the legumes and keeping an epinephrine injector close by to deal with severe reactions.
In all, 39 children have participated in the ongoing study, which Dr. Burks characterized as an open-label pilot trial.
The ongoing study protocol -- with 33 currently enrolled -- began when children were two to five years old. They initially received tiny doses of peanut flour, less than one milligram.
The children took steadily increasing amounts of peanut until, eight to ten months later, they could tolerate up to 15 peanuts per day.
Treatment continued at that level, Dr. Burks said, with periodic challenges to confirm the youngsters' ability to tolerate peanut products.
The researchers -- including scientists at the University of Arkansas in Little Rock -- have determined that children successfully treated showed significantly decreased serum levels of peanut-specific immunoglobulin E.
Withdrawal of the immunotherapy has now begun to be tested in participants with very low peanut IgE, less than 2 kU/L.
Five of nine children who had been on treatment for at least 2.5 years passed an oral food challenge test. Researchers then stopped their immunotherapy for a month, followed by a second challenge test.
It was successful in all cases, Dr. Burks said, and the children now are under no diet restrictions and eat peanut-containing foods daily. "They are months out and they are doing fine," he said.
Biochemical studies in these children indicate that the therapy induced regulatory T cells and secretion of IL-10 indicative of tolerance to peanut proteins.
"They [immune cells] change to a nonallergic phenotype," Dr. Burks said.
Of the 39 total participants, six moved away and dropped out, and four withdrew because of allergic reactions.
Also underway is a separate double-blind, placebo-controlled study of the oral immunotherapy protocol, he added.
The study is still in its early stages, but data are available on 18 children participating in it.
The children are one to 16 years old and have completed one year in the study. Among 12 assigned to active therapy, the mean tolerance at one year was 15 peanuts, compared with 1.5 peanuts for six placebo-group children (P<0.05),>
By John Gever, Senior Editor, MedPage Today
Published: March 16, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
WASHINGTON, March 16 -- Five of nine peanut-allergic children undergoing long-term, steady exposure to small quantities of peanuts are now able to eat peanut products freely, a researcher said here.
The children, enrolled in an open-label trial of oral immunotherapy for peanut allergy, have been treated for at least 2.5 years, A. Wesley Burks, M.D., of Duke University, reported at the American Academy of Allergy, Asthma, and Immunology meeting here.
The findings provide a glimmer of hope for up to 3 million Americans who suffer from peanut allergies in a society where peanut products are ubiquitous. Action Points
--------------------------------------------------------------------------------
Explain to interested patients that peanut allergies in children usually persist into adulthood and can be life threatening.
Explain that only a small number of patients have been fully evaluated in this study, and the treatment should still be considered investigational.
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Peanut allergies are among the most common triggers of anaphylaxis, according to the AAAAI, and only one in five children with the allergy outgrows it in adulthood.
Currently, the standard treatment is avoidance of foods containing the legumes and keeping an epinephrine injector close by to deal with severe reactions.
In all, 39 children have participated in the ongoing study, which Dr. Burks characterized as an open-label pilot trial.
The ongoing study protocol -- with 33 currently enrolled -- began when children were two to five years old. They initially received tiny doses of peanut flour, less than one milligram.
The children took steadily increasing amounts of peanut until, eight to ten months later, they could tolerate up to 15 peanuts per day.
Treatment continued at that level, Dr. Burks said, with periodic challenges to confirm the youngsters' ability to tolerate peanut products.
The researchers -- including scientists at the University of Arkansas in Little Rock -- have determined that children successfully treated showed significantly decreased serum levels of peanut-specific immunoglobulin E.
Withdrawal of the immunotherapy has now begun to be tested in participants with very low peanut IgE, less than 2 kU/L.
Five of nine children who had been on treatment for at least 2.5 years passed an oral food challenge test. Researchers then stopped their immunotherapy for a month, followed by a second challenge test.
It was successful in all cases, Dr. Burks said, and the children now are under no diet restrictions and eat peanut-containing foods daily. "They are months out and they are doing fine," he said.
Biochemical studies in these children indicate that the therapy induced regulatory T cells and secretion of IL-10 indicative of tolerance to peanut proteins.
"They [immune cells] change to a nonallergic phenotype," Dr. Burks said.
Of the 39 total participants, six moved away and dropped out, and four withdrew because of allergic reactions.
Also underway is a separate double-blind, placebo-controlled study of the oral immunotherapy protocol, he added.
The study is still in its early stages, but data are available on 18 children participating in it.
The children are one to 16 years old and have completed one year in the study. Among 12 assigned to active therapy, the mean tolerance at one year was 15 peanuts, compared with 1.5 peanuts for six placebo-group children (P<0.05),>
Friday, March 13, 2009
National Institute on Aging
http://www.nia.nih.gov/
The National Institute on Aging (NIA) is the research arm of the U.S. National Institutes of Health (NIH) that focuses on aging research. Their website is geared both toward researchers and laypeople, particularly seniors. Visitors can click on the links, such as "Publications", "Alzheimer's Disease Information" and "Clinical Trials" next to the "Health Information" heading, on the right side of the homepage. For a brief description of what the links are about, visitors can click on the "Health Information" heading to be taken to the links and their descriptions. The "Clinical Trials" link would be of interest to those seniors who have particular medical conditions that may be being studied by the NIH. To see the numerous publications the NIA has available to order or download free, visitors can click on the "Publications" link on the homepage to browse the categories of publications available, including, "Caregiving", "Conditions & Diseases", "Medications/Supplements" and "Safety". Spanish language versions of the publications, can be found by simply clicking on "Spanish Language Materials" in the same section. For researchers, the "Research Information" heading on the right side of the page leads to the descriptions of the links that are also featured in the middle of the homepage. Two links that are concerned with current research are "Research Conducted at NIA" and "NIA Sponsored Research".
The National Institute on Aging (NIA) is the research arm of the U.S. National Institutes of Health (NIH) that focuses on aging research. Their website is geared both toward researchers and laypeople, particularly seniors. Visitors can click on the links, such as "Publications", "Alzheimer's Disease Information" and "Clinical Trials" next to the "Health Information" heading, on the right side of the homepage. For a brief description of what the links are about, visitors can click on the "Health Information" heading to be taken to the links and their descriptions. The "Clinical Trials" link would be of interest to those seniors who have particular medical conditions that may be being studied by the NIH. To see the numerous publications the NIA has available to order or download free, visitors can click on the "Publications" link on the homepage to browse the categories of publications available, including, "Caregiving", "Conditions & Diseases", "Medications/Supplements" and "Safety". Spanish language versions of the publications, can be found by simply clicking on "Spanish Language Materials" in the same section. For researchers, the "Research Information" heading on the right side of the page leads to the descriptions of the links that are also featured in the middle of the homepage. Two links that are concerned with current research are "Research Conducted at NIA" and "NIA Sponsored Research".
International Centre for Human Resources in Nursing
http://www.ichrn.org/
This website addresses one of the more pressing issues in healthcare worldwide: the nursing workforce. The website of the International Centre for Human Resources in Nursing (ICHRN) addresses the shortage of nurses, the underemployment of nurses and the migration of nurses, as well as the challenges of nursing education availability and poor workforce planning. Visitors can click on "Knowledge Library" at the top of the page to download many of their publications. The library can be browsed by subject or searched by keyword. Some of the subject areas include "Workforce Assessment, Planning and Policy", "Work Environment" and "Good/Promising Practices in Nursing Recruitment and Retention". The "Helpful Links" tab at the top of the page will take the visitor to over two dozen links concerning the nursing crisis in world healthcare. To subscribe to the free ICHRN e-newsletter in English, French or Spanish, visitors should click on "Newsletter" under the "News & Events" tab at the top of the page. Current and previous issues of the newsletter are also accessible to visitors via a link on the same page where they can also find the information about subscribing. [KMG]
This website addresses one of the more pressing issues in healthcare worldwide: the nursing workforce. The website of the International Centre for Human Resources in Nursing (ICHRN) addresses the shortage of nurses, the underemployment of nurses and the migration of nurses, as well as the challenges of nursing education availability and poor workforce planning. Visitors can click on "Knowledge Library" at the top of the page to download many of their publications. The library can be browsed by subject or searched by keyword. Some of the subject areas include "Workforce Assessment, Planning and Policy", "Work Environment" and "Good/Promising Practices in Nursing Recruitment and Retention". The "Helpful Links" tab at the top of the page will take the visitor to over two dozen links concerning the nursing crisis in world healthcare. To subscribe to the free ICHRN e-newsletter in English, French or Spanish, visitors should click on "Newsletter" under the "News & Events" tab at the top of the page. Current and previous issues of the newsletter are also accessible to visitors via a link on the same page where they can also find the information about subscribing. [KMG]
Thursday, March 12, 2009
Report: US on Short End of Health Care 'Value Gap'
By THE ASSOCIATED PRESS
Published: March 12, 2009
Filed at 6:57 a.m. ET
WASHINGTON (AP) -- If the global economy were a 100-yard dash, the U.S. would start 23 yards behind its closest competitors because of health care that costs too much and delivers too little, a business group says in a report to be released Thursday.
The report from the Business Roundtable, which represents CEOs of major companies, says America's health care system has become a liability in a global economy.
Concern about high U.S. costs has existed for years, and business executives -- whose companies provide health coverage for workers -- have long called for getting costs under control. Now President Barack Obama says the costs have become unsustainable and the system must be overhauled.
Americans spend $2.4 trillion a year on health care. The Business Roundtable report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.
In a different twist, the report took those costs and factored benefits into the equation.
It compares statistics on life expectancy, death rates and even cholesterol readings and blood pressures. The health measures are factored together with costs into a 100-point ''value'' scale. That hasn't been done before, the authors said.
The results are not encouraging.
The United States is 23 points behind five leading economic competitors: Canada, Japan, Germany, the United Kingdom and France. The five nations cover all their citizens, and though their systems differ, in each country the government plays a much larger role than in the U.S.
The cost-benefit disparity is even wider -- 46 points -- when the U.S. is compared with emerging competitors: China, Brazil and India.
''What's important is that we measure and compare actual value -- not just how much we spend on health care, but the performance we get back in return,'' said H. Edward Hanway, CEO of the insurance company Cigna. ''That's what this study does, and the results are quite eye-opening.''
Higher U.S. spending funnels away resources that could be invested elsewhere in the economy, but fails to deliver a healthier work force, the report said.
''Spending more would not be a problem if our health scores were proportionately higher,'' Dr. Arnold Milstein, one of the authors of the study, said in an interview. ''But what this study shows is that the U.S. is not getting higher levels of health and quality of care.''
Other countries spend less on health care and their workers are relatively healthier, the report said.
Medical costs have long been a problem for U.S. auto companies. General Motors spends more per car on health care than it does on steel. But as more American companies face global competition, the ''value gap'' is being felt by more CEOs -- and their hard pressed workers.
One thing the report does not do is endorse the same solution that countries like Canada have adopted: a government-run health care system.
The CEOs of the Business Roundtable believe health care for U.S. workers and their families should stay in private hands, with a government-funded safety net for low-income people.
Published: March 12, 2009
Filed at 6:57 a.m. ET
WASHINGTON (AP) -- If the global economy were a 100-yard dash, the U.S. would start 23 yards behind its closest competitors because of health care that costs too much and delivers too little, a business group says in a report to be released Thursday.
The report from the Business Roundtable, which represents CEOs of major companies, says America's health care system has become a liability in a global economy.
Concern about high U.S. costs has existed for years, and business executives -- whose companies provide health coverage for workers -- have long called for getting costs under control. Now President Barack Obama says the costs have become unsustainable and the system must be overhauled.
Americans spend $2.4 trillion a year on health care. The Business Roundtable report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.
In a different twist, the report took those costs and factored benefits into the equation.
It compares statistics on life expectancy, death rates and even cholesterol readings and blood pressures. The health measures are factored together with costs into a 100-point ''value'' scale. That hasn't been done before, the authors said.
The results are not encouraging.
The United States is 23 points behind five leading economic competitors: Canada, Japan, Germany, the United Kingdom and France. The five nations cover all their citizens, and though their systems differ, in each country the government plays a much larger role than in the U.S.
The cost-benefit disparity is even wider -- 46 points -- when the U.S. is compared with emerging competitors: China, Brazil and India.
''What's important is that we measure and compare actual value -- not just how much we spend on health care, but the performance we get back in return,'' said H. Edward Hanway, CEO of the insurance company Cigna. ''That's what this study does, and the results are quite eye-opening.''
Higher U.S. spending funnels away resources that could be invested elsewhere in the economy, but fails to deliver a healthier work force, the report said.
''Spending more would not be a problem if our health scores were proportionately higher,'' Dr. Arnold Milstein, one of the authors of the study, said in an interview. ''But what this study shows is that the U.S. is not getting higher levels of health and quality of care.''
Other countries spend less on health care and their workers are relatively healthier, the report said.
Medical costs have long been a problem for U.S. auto companies. General Motors spends more per car on health care than it does on steel. But as more American companies face global competition, the ''value gap'' is being felt by more CEOs -- and their hard pressed workers.
One thing the report does not do is endorse the same solution that countries like Canada have adopted: a government-run health care system.
The CEOs of the Business Roundtable believe health care for U.S. workers and their families should stay in private hands, with a government-funded safety net for low-income people.
Monday, March 9, 2009
Reactions to Obama, stem cells
Monday, March 09, 2009 2:21 PM by Domenico Montanaro
The reactions to President Obama's signing of the executive order on stem-cell research were mostly predictable and falling along party lines. Democrats laud it; Republicans were critical. The one perpetual ironic standout, however, is Nancy Reagan, widow of the late Ronald Reagan -- the former president idolized and revered by the Republican Party.
FORMER FIRST LADY NANCY REAGAN: “I'm very grateful that President Obama has lifted the restrictions on federal funding for embryonic stem cell research. These new rules will now make it possible for scientists to move forward. I urge researchers to make use of the opportunities that are available to them, and to do all they can to fulfill the promise that stem cell research offers. Countless people, suffering from many different diseases, stand to benefit from the answers stem cell research can provide. We owe it to ourselves and to our children to do everything in our power to find cures for these diseases -- and soon. As I've said before, time is short, and life is precious.
SEN. TED KENNEDY: "Sometimes medicine advances through inspired discoveries in the laboratory, and sometimes through brilliant insights at the patient's bedside. But today, an extraordinary medical breakthrough was achieved with the stroke of a pen. With today's executive order, President Obama has righted an immense wrong done to the hopes of millions of patients. The President's action today unlocks the enormous potential of life-sustaining medical progress against a wide range of serious illnesses and injuries, all within strong ethical guidelines."
SEN. MAJ. LEADER HARRY REID: "President Obama today offered the hope of better treatments and cures to millions of Americans suffering from debilitating diseases. I applaud President Obama for restoring scientific integrity to government and ensuring we value science over ideology. President Obama's policy has strong support in the Senate, where in each of the past two Congresses we have passed bipartisan stem cell legislation. The President's executive order supports not only the position of Congress, but that of the majority of Americans and hundreds of leading medical and scientific associations and research universities, and dozens of patient-advocacy organizations representing millions of Americans. Since 2001, our most promising scientists have been forced to work with one hand tied behind their backs. Our nation's new stem cell policy will now help them in their quest to find lifesaving cures."
SEN. MIN. LEADER MITCH MCCONNELL (says Obama’s executive order “incentivizes creation and destruction of human embryos”): "The administration's announcement on embryonic stem cell research represents a troubling shift in U.S. policy. With this announcement, the government is, for the first time, incentivizing the creation and destruction of human embryos at the expense of the U.S. taxpayer. I support biomedical research and I believe the administration would be far better served by directing taxpayer funds to research on non-embryonic stem cells, which is both effective and ethical."
HOUSE MIN. LEADER JOHN BOEHNER (says the “decision runs counter to his promise to ‘be a president for all Americans"): "This decision runs counter to President Obama's promise to be a president for all Americans. For a third time in his young presidency, the President has rolled back important protections for innocent life, further dividing our nation at a time when we need greater unity to tackle the challenges before us. I fully support stem cell research, but I draw the line at taxpayer-funded research that requires the destruction of human embryos, and millions of Americans feel similarly. As we move forward, I am hopeful that the President will re-evaluate this and other controversial decisions that put government at odds with the sanctity of human life. Non-embryonic stem cell research is not only showing great promise in the laboratory, but its applications are already being used to treat scores of diseases and medical conditions. Indeed, science and respect for human life can coexist. Politicians in Washington would be well-served to recognize this fact before they ask taxpayers to subsidize the destruction of innocent human life simply to advance a particular agenda. Instead of asking taxpayers to pay for efforts that destroy life, Congress and the Administration should support bipartisan solutions like Rep. Randy Forbes' Patients First Act, which would promote stem cell research that is actually getting results."
*** UPDATE *** CA GOV. ARNOLD SCHWARZENEGGER: "President Obama's executive order is a huge win for the millions of people who suffer from spinal cord injuries, diabetes, Alzheimer's, Parkinson's, Multiple Sclerosis and many other illnesses. Californians were the first in the nation to support and fund embryonic stem cell research and we are big believers in the power of this revolutionary science to not only improve but to save lives. Because of the federal ban, Californians world-renown research facilities have had to have separate areas for the federally-funded and the non-federally funded programs, causing duplicative efforts. I applaud President Obama for removing this barrier which allows California to maximize critical research funding so we can continue to lead the world in stem cell research."
The reactions to President Obama's signing of the executive order on stem-cell research were mostly predictable and falling along party lines. Democrats laud it; Republicans were critical. The one perpetual ironic standout, however, is Nancy Reagan, widow of the late Ronald Reagan -- the former president idolized and revered by the Republican Party.
FORMER FIRST LADY NANCY REAGAN: “I'm very grateful that President Obama has lifted the restrictions on federal funding for embryonic stem cell research. These new rules will now make it possible for scientists to move forward. I urge researchers to make use of the opportunities that are available to them, and to do all they can to fulfill the promise that stem cell research offers. Countless people, suffering from many different diseases, stand to benefit from the answers stem cell research can provide. We owe it to ourselves and to our children to do everything in our power to find cures for these diseases -- and soon. As I've said before, time is short, and life is precious.
SEN. TED KENNEDY: "Sometimes medicine advances through inspired discoveries in the laboratory, and sometimes through brilliant insights at the patient's bedside. But today, an extraordinary medical breakthrough was achieved with the stroke of a pen. With today's executive order, President Obama has righted an immense wrong done to the hopes of millions of patients. The President's action today unlocks the enormous potential of life-sustaining medical progress against a wide range of serious illnesses and injuries, all within strong ethical guidelines."
SEN. MAJ. LEADER HARRY REID: "President Obama today offered the hope of better treatments and cures to millions of Americans suffering from debilitating diseases. I applaud President Obama for restoring scientific integrity to government and ensuring we value science over ideology. President Obama's policy has strong support in the Senate, where in each of the past two Congresses we have passed bipartisan stem cell legislation. The President's executive order supports not only the position of Congress, but that of the majority of Americans and hundreds of leading medical and scientific associations and research universities, and dozens of patient-advocacy organizations representing millions of Americans. Since 2001, our most promising scientists have been forced to work with one hand tied behind their backs. Our nation's new stem cell policy will now help them in their quest to find lifesaving cures."
SEN. MIN. LEADER MITCH MCCONNELL (says Obama’s executive order “incentivizes creation and destruction of human embryos”): "The administration's announcement on embryonic stem cell research represents a troubling shift in U.S. policy. With this announcement, the government is, for the first time, incentivizing the creation and destruction of human embryos at the expense of the U.S. taxpayer. I support biomedical research and I believe the administration would be far better served by directing taxpayer funds to research on non-embryonic stem cells, which is both effective and ethical."
HOUSE MIN. LEADER JOHN BOEHNER (says the “decision runs counter to his promise to ‘be a president for all Americans"): "This decision runs counter to President Obama's promise to be a president for all Americans. For a third time in his young presidency, the President has rolled back important protections for innocent life, further dividing our nation at a time when we need greater unity to tackle the challenges before us. I fully support stem cell research, but I draw the line at taxpayer-funded research that requires the destruction of human embryos, and millions of Americans feel similarly. As we move forward, I am hopeful that the President will re-evaluate this and other controversial decisions that put government at odds with the sanctity of human life. Non-embryonic stem cell research is not only showing great promise in the laboratory, but its applications are already being used to treat scores of diseases and medical conditions. Indeed, science and respect for human life can coexist. Politicians in Washington would be well-served to recognize this fact before they ask taxpayers to subsidize the destruction of innocent human life simply to advance a particular agenda. Instead of asking taxpayers to pay for efforts that destroy life, Congress and the Administration should support bipartisan solutions like Rep. Randy Forbes' Patients First Act, which would promote stem cell research that is actually getting results."
*** UPDATE *** CA GOV. ARNOLD SCHWARZENEGGER: "President Obama's executive order is a huge win for the millions of people who suffer from spinal cord injuries, diabetes, Alzheimer's, Parkinson's, Multiple Sclerosis and many other illnesses. Californians were the first in the nation to support and fund embryonic stem cell research and we are big believers in the power of this revolutionary science to not only improve but to save lives. Because of the federal ban, Californians world-renown research facilities have had to have separate areas for the federally-funded and the non-federally funded programs, causing duplicative efforts. I applaud President Obama for removing this barrier which allows California to maximize critical research funding so we can continue to lead the world in stem cell research."
Monday, March 2, 2009
Killer headache? Migraines hike stroke risk
Some sufferers have twice the chance of heart attacks, strokes, studies say
David Kohn
Beth Leslie had gotten occasional migraines for years. She thought of them as a painful imposition, nothing more.
Then, one day two years ago, her world tipped sideways. “Everything was spinning. I just kept my eyes closed, because whenever I’d open them I’d get dizzy,” says Leslie, a 24-year-old veterinary technician who lives in Bowling Green, Ohio. “It really freaked me out.”
She went to the hospital, where a doctor told her she’d probably come down with some sort of virus. After two days, Leslie’s condition hadn’t improved, and her boyfriend started pressing the doctors. They agreed to give her a brain scan, and found she’d suffered a stroke, one that centered on her cerebellum, the part of the brain in charge of balance.
Leslie was shocked. Like most people, she’d thought of stroke as a disease of old age. But for those who get migraines, the rules appear to be different. Until recently, scientists saw migraine suffering as a physiological thunderstorm that left few lasting effects. But new research suggests some migraines aren’t so innocuous.
Recent studies show those who suffer from something called migraine with aura have double, or perhaps triple, the risk of stroke or heart attack, compared with people who don’t get migraines at all.
In these people — Leslie is one of them — the headache is preceded by a range of symptoms: slurred speech, forgetfulness, feeling hot or cold, and ghostly lights blinking across the field of vision. That last one is the aura. A third of those who experience migraines have these symptoms; generally, this sub-group also has more frequent, and more excruciating, migraines.
“I don’t think migraine is seen as a serious disorder. That’s a mistake,” says migraine researcher David Dodick, a neurologist at the Mayo Clinic in Phoenix. “Headache is just one manifestation of migraine. It’s a systemic illness.”
The mysteries of migraines
Thirty-five million Americans — 1 in 10 of us — get migraines. They tend to occur regularly, with severe pain on one side of the head. Migraine attacks often include other symptoms, such as nausea and sensitivity to light and sound.
Researchers disagree on whether people who get migraines without aura are at higher risk for strokes and heart attacks. So far, almost all of the research of migraine and cardiovascular risk has occurred in those who get auras.
And one knows for sure what accounts for the higher rates of strokes and heart attacks in those who do suffer from migraine with aura, but scientist have several theories that may offer insight.
Some researchers blame migraines on chronic exposure to certain neurotransmitters. Most scientists think migraine sufferers’ brains are hyper-excitable — that is, their neurons tend to start firing uncontrollably, with the outburst spreading across the brain over the course of a few hours.
This electrical storm causes the brain to release several neurotransmitters, including two chemicals called Substance P and Calcitonin Gene-Related Peptide (CGRP), that produce inflammation and pain in the blood vessels surrounding our brains.
Researchers suspect that over years of repeated migraines, the inflammation from Substance P and CGRP may weaken blood vessels, not only in the head but throughout the body. This damage may raise the risk of stroke or heart attack. During a stroke, the vessels that supply the brain rupture or become blocked; during a heart attack the same thing happens to the vessels around the heart.
In a study of 175 people completed last year, University of Toledo neurologist Gretchen Tietjen — who treated Leslie after her stroke — found that nearly a third of those with migraines had signs of blood vessel damage, almost five times higher than the controls.
Tietjen says that while there’s no conclusive proof that Leslie’s migraines played a role in her stroke, they easily could have.
But another group of scientists think the culprit isn’t neurotransmitters, but the vascular system itself. Dodick and others argue that the blood vessels of people who get migraines are inherently dysfunctional, contracting and expanding abnormally in reaction to physical and emotional stress.
“People with migraine probably have unusually reactive blood vessels,” says neurologist Richard B. Lipton, a leading migraine researcher at the Albert Einstein College of Medicine in the Bronx.
In the head, these vascular spasms could trigger migraines. When the veins and arteries in the temple and skull expand and contract too much, they may press on nerves, leading to the excruciating pain.
In people who get migraines, these blood vessel seizures may occur throughout the body, without patients much noticing. Over years, these spasms may damage the vascular system.
Link between migraine and heart defect?
Then there’s the hole-in-the-heart theory. Researchers have known for years that having a gap in the wall between two chambers of the heart — a surprisingly common defect (it occurs in 10 to 20 percent of people) — increases the risk of stroke. It’s not clear why: The defect, known as a patent foramen ovale, or PFO, may allow blood to bypass the lungs, which constantly filter small clots and impurities from the blood. These clots may end up lodged in veins and arteries in the head, triggering strokes.
Over the past five years, scientists have found that PFOs seem to occur in more than half of people who get migraines. In some migraine patients, closing the PFO with surgery seems to lead to a disappearance of headaches.
Some researchers suspect the unpurified blood leaking through the PFO contains inflammatory molecules, which set off that electrical storm when they travel up to the brain. (This may be why people with migraine get headaches after eating certain foods like red wine, olives and chocolate. These “trigger” foods may contain the offending chemicals, which in normal people are constantly removed from the blood.)
‘A very complex system’
But none of these hypotheses have been proven, and the links between migraine and cardiovascular disease remain murky.
“There’s no clear mechanism that convinces me,” says Tobias Kurth, a neuro-epidemiologist at the Harvard University School of Public Health. “It’s likely a very complex system.”
Kurth, who has spent several years examining connections between migraine and stroke, thinks there may be several lines of connection between stroke, heart disease and migraine.
At the same time, he says, even those who get frequent migraines shouldn’t panic. In the general population, stroke and heart attack are quite rare. They’re even less common if you’re young and healthy. While th e stroke risk might double from 15 per 100,000 in the general population to 30 per 100,000 for those who migraine with aura, the risk is still relatively small, pointed out Lipton in the journal Neurology Today.
“A doubling of risk sounds scary, but in absolute terms, it’s still low,” says Dr. Stephen Silberstein, a migraine specialist at the Jefferson Headache Center in Philadelphia.
But if you get migraines, and you smoke, are overweight, or have untreated high blood pressure, then your risk climbs significantly. And each risk compounds the others exponentially.
In a 2007 study published, Kurth found that women who have migraine with aura, smoke and take oral contraceptives (also a stroke hazard), were 10 times more likely to have a stroke than women without these risks. Leslie, for example, was taking birth control pills when she had her stroke.
Changes in treatment
Even without a clear causal link, the new findings may change how doctors treat migraines. Rather than seeing the condition as a painful but harmless hassle, doctors are increasingly trying to prevent it, just as they do obesity or high blood pressure. A range of medicines, including blood pressure drugs and antidepressants, can help prevent headaches. And many patients also find relief through changes in lifestyle and diet.
Although there’s no clear proof, some scientists, including Tietjen, suspect that in migraineurs, preventing headaches could lower the risk of stroke and heart attack.
“I think there’s ongoing, progressive damage to the cardiovascular system,” she says. “If you can treat patients early on, maybe you can keep it from progressing.”
Dodick agrees. “The evidence points in that direction,” he says. “So it makes good sense to be aggressive with preventive measures.” He notes that only 15 percent of people who get frequent migraines take preventive medicine.
Leslie, who has since fully recovered from her stroke, is now in this minority. She takes Elavil, an anti-depressant, for migraine prevention. She no longer takes oral contraceptives, and last year she had surgery to close a PFO doctors discovered after her stroke. She almost never gets a headache.
“It still surprises me that I had a stroke,” she says. “But I’m doing everything I can to stay healthy now. I’ve come a long way.”
David Kohn is a health and science writer. His work has appeared in The New York Times, Popular Science, on BBC's The World and on National Public Radio.
© 2009 msnbc.com. Reprints
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