Wednesday, August 29, 2012

Yosemite National Park ground zero for deadly hantavirus outbreak.

ABC World News (8/28, story 9, 1:10, Sawyer) reported, "And now, [a] health scare at Yosemite National Park that four million people visit" annually. ABC News correspondent Neal Karlinsky added, "Tonight, Yosemite National Park is ground zero for deadly outbreak of hantavirus."
        The Los Angeles Times (8/29, Mather) "LA Now" blog reports, "After announcing Monday that a third case of the disease had been confirmed -- resulting in the death of a Pennsylvania man -- and a fourth probable, Yosemite officials emailed about 1,700 people who stayed in the park's popular Curry Village, asking them to seek immediate medical attention if they showed the flu-like symptoms of the disease."
        USA Today (8/28, Lloyd) reports, "All four people stayed in 'signature tent cabins' in Curry Village in the eastern side of the popular California park. Visitors are being given a brochure about the virus and how to protect themselves."
        The Wall Street Journal (8/29, Vara, Subscription Publication) reports that hantavirus, a rare illness mostly found in the US rural West, cannot be spread from person to person. Instead, the disease is spread through the droppings, saliva, or urine of rodents. It causes influenza-like symptoms, breathing difficulties, and can be fatal about a third of the time.
        The New York Times (8/29, A16, Barnes, Subscription Publication) points out that "hantavirus is carried in about 15 percent of deer mice, which have solid-colored backs and white bellies." Symptoms of the virus, "which can start from one to six weeks after exposure, include fever, chills, headache, muscle aches, vomiting or cough. The park, which said it is working with the Centers for Disease Control and Prevention, warned that the disease can progress to severe difficulty breathing within two to seven days, in which case people should seek immediate medical help."
        The AP (8/29, Cone) reports, "Park spokesman Scott Gediman said the Delaware North Co., which runs the park's lodging facilities, is working to shore up cabins to protect park-goers." Gediman stated, "This is a wilderness setting. It has nothing to do with the cleanliness of the cabins." The AP adds, "This year's deaths mark the first such fatalities in park visitors, although two others were stricken in a more remote area in 2000 and 2010, officials said."
        The San Francisco Chronicle (8/29, Allday) reports, "Public health officials aren't expecting to find more cases of hantavirus, but since it's a rare disease that can be difficult to diagnose, it's possible other victims may still be found, Gediman said. The two newest cases were reported to California public health officials only last weekend, although both victims had been symptomatic for weeks."
        A separate but related story in the San Francisco Chronicle (8/29, Fimrite) reports, "Officials with the US Public Health Service and Occupational Safety and Health Administration were inspecting the 91 cabins in the area where the infections occurred. The inspectors said they were looking for gaps in the wood, plaster or flooring where mice can get inside."
        According to the San Jose Mercury News (8/29, Kleffman), "The park did not want to needlessly scare people, a park spokeswoman said. Until the recent cases, 'There was no reason to believe that (the risk) was higher here than anywhere else in the Sierra Nevada or New York City, for that matter,' park ranger Jana McCabe said Tuesday. 'Any time you have contact with rodents, there is a potential,'" McCabe added.
        Also covering the story are the USA Today (8/29, Bly) "Destinations" blog, the Fresno (CA) Bee (8/29), McClatchy (8/29, Doyle), the ABC News (8/29, Moisse) website, and Reuters (8/29, Cohen).

Studies: Renal Denervation May Benefit Certain Heart Patients.

MedPage Today Share to FacebookShare to Twitter (8/29, Susman) reports, "Renal denervation procedures appear to improve outcomes in patients with advanced heart failure or treatment-resistant arterial hypertension, according to a trio of studies the European Society of Cardiology (ESC) meeting." Investigators found "in a pilot study," that "heart failure patients who underwent renal denervation with radiofrequency ablation saw an improvement in left ventricular ejection fraction (LVEF) from 25% at baseline to 31% after 12 months (P<0.01), while patients who received standard therapy had minimal and nonsignificant changes from 26% at baseline to 28% at 1 year (P=0.36)." A separate study "found that patients who underwent minimally-invasive catheter-based renal denervation achieved blood pressure (BP) reductions that were in line with the findings in the SIMPLICITY pilot studies." Additionally, researchers reported positive findings from the SIMPLICITY HTN2 Trial.

Study: Fit 50-Year Olds Less Likely To Face Chronic Disease.

Reuters Share to FacebookShare to Twitter (8/28, Joelving) reports that a new study Share to FacebookShare to Twitter published in the Archives of Internal Medicine found that fit 50-year-olds are less likely to be afflicted with chronic disease as they get older than those who are sedentary. Dr. Jarett Berry at the University of Texas Southwestern Medical Center led the study. Berry explained the findings of the research, "We see truly reduced chronic disease, rather than just delaying the inevitable." He added that the study also makes the case for more vigorous exercise. Berry states, "We know from prior literature that higher-intensity exercise tends to translate into more fitness."
        The Washington Post Share to FacebookShare to Twitter (8/28, Huget) reports in "The Checkup" blog that "the strongest connection between fitness and chronic disease burden was found among those with the lowest levels of midlife fitness (i.e. those in the bottom fifth of the group, fitness-wise, had the heaviest load of chronic disease near the end of their lives)." From that finding, the researchers "found promise, suggesting that those with low fitness levels who make modest improvements (the equivalent of six months of moderate-intensity exercise, 150 minutes per week) might lighten their future burden of chronic conditions by 20 percent," according to the article. However, the blog also notes that "the authors acknowledge several limitations in their work, including the fact that the participants in the Cooper Center Longitudinal Study were in a socioeconomic group -- with higher income and better education -- that generally enjoys better fitness and health than the general population."
        HealthDay Share to FacebookShare to Twitter (8/28, Goodwin) also quoted Dr. Jarett Berry, who said, "not only do the people with higher fitness live a little bit longer, the onset of chronic disease occurs even later, so that the amount of time you spend in your life with chronic diseases is compressed into a smaller period of time."
        MedPage Today Share to FacebookShare to Twitter (8/28, Walsh) notes that "limitations of the study included its reliance on administrative data and the relatively healthy participants included in the cohort, and the lack of other information such as dietary habits." The article also stated that "in an invited commentary, Diane Bild, MD, of the National Heart, Lung and Blood Institute in Bethesda, Md., pointed out that genetics also plays a role in successful aging and longevity."
        Also covering the story are the Los Angeles Times Share to FacebookShare to Twitter (8/28, Healy) "Booster Shots" blog, the ABC News Share to FacebookShare to Twitter (8/28, Barnett and Shroff) "Medical Unit" blog, and the CNN Share to FacebookShare to Twitter (8/28) "The Chart" blog.

USPSTF Questions Routine CKD Screening

Reuters Share to FacebookShare to Twitter (8/28, Pittman) reports that on Monday, the US Preventive Services Task Force (USPSTF) said that there currently is not enough evidence to recommend that healthy individuals undergo screening for kidney disease.
        HealthDay Share to FacebookShare to Twitter (8/28, Preidt) reports that in a news release, task force member Dr. Joy Melnikow said, "While mild abnormalities in kidney function are very common in the United States, we know surprisingly little about whether screening adults with no signs or symptoms of chronic kidney disease will improve health outcomes." Additionally, "in its recommendation, the task force also called for further research to fully assess the benefits and harms of screening for chronic kidney disease." The new "recommendation is published online Aug. 28 in the Annals of Internal Medicine and on the task force's website."

Iced Tea, Kidney Stones, and the Non-Existent Study

MedPage?Today Link

This young woman is off to a great start in her science journalism career.
Taylor Kubota wrote on her blog, “Making Studies Out of Nothing At All.”  She begins:
“The other day someone recommended that I write about the connection between iced tea and kidney stones. These painful deposits of minerals and salt that form in the urinary tract are of particular interest to me because I am the daughter of a 10-time kidney stone sufferer. As soon as I started Googling about for more information on my possible story, I saw that my curiosity had company. Articles all over the web were citing a new study that said iced tea drinkers are at an increased risk for this painful ailment.
Unfortunately, that study everyone was so hyped about doesn’t exist.
It all started with a Loyola University news release. In it Dr. John Milner, a urologist and an assistant professor in Department of Urology at the Loyola University Chicago Stritch School of Medicine, warns that iced tea contains high levels of oxalate* (a chemical known to cause calcium stones, which are the most common type of kidney stone) and that, therefore, drinking a lot of iced tea might increase an individual’s risk of developing kidney stones. (In case your wondering: Dr. Milner went on to say in the release that hot tea — which also contains oxalate — is less of a concern merely because people in the U.S. don’t consume as much of it as they do its iced counterpart.)
Altogether the information in the release was pretty interesting stuff and I actually learned a lot from it. What I didn’t learn was why Loyola University wrote it. So I did what I would think most journalists would do and I called the press office (the phone number for which was conveniently located at the top of the news release). I spoke with one of the media relations people and asked whether there was a study attached to this release or if it was just a helpful tip. I was told it was the latter and we said our goodbyes. That call of less than 2 minutes killed my story and gave life to this blog post.
As a reader of science journalism you deserve to know that it is (regrettably) common for reporters to rewrite press releases without doing any additional reporting.”
Indeed, Newsday reported: “People who drink iced tea may be putting themselves at greater risk for developing painful kidney stones, a new study indicates.”  Where’d they get that?  Probably from Healthday, which reported what we show you here:

Read Taylor Kubota’s entire post.  And join me in wishing her a great career in science journalism.  We need to find room for young journalists like her in a needy industry.
Gary Schwitzer
Health News Watchdog Blog
Gary Schwitzer has specialized in health care journalism in his more than 30-year career in radio, television, interactive multimedia and the Internet. He is publisher of the website, leading a team of more than two dozen people who grade daily health news reporting by major U.S. news organizations. In its first year, the project was honored with several journalism industry awards - the Mirror Award, honoring those who "hold a mirror to their own industry for the public’s benefit," and the Knight-Batten Award for Innovations in Journalism. His blog - which is embedded within - was voted 2009 Best Medical Blog in competition hosted by

Federal appeals court rejects suit challenging stem cell funding.

Bloomberg News (8/24, Schoenberg, Forden) reported that "a lawsuit challenging U.S. funding for human embryonic stem-cell research was rejected by a federal appeals court in Washington, which upheld a lower court's ruling dismissing the case." According to the article, a "three judge panel of the U.S. Court of Appeals in Washington today said that U.S. District Judge Royce Lamberth 'committed no error' when he threw out the lawsuit filed by James Sherley, a researcher at Boston Biomedical Research Institute, and Theresa Deisher, founder of AVM Biotechnology in Seattle." Bloomberg News details that "the two doctors sought to block the U.S. Health and Human Services Department and the National Institutes of Health from spending federal funds on research involving human embryonic stem cells, arguing it violates a law known as the Dickey-Wicker Amendment."

Study finds no link between electronic cigarettes, heart disease risk.

Reuters (8/26, Hirschler) reports that study results presented Saturday at the annual meeting of the European Society of Cardiology in Munich indicate that the use of electronic cigarettes is not associated with an increased risk for cardiac-related complications.
        Bloomberg News (8/25, Khan) adds that Dr. Konstantinos Farsalinos and his team at the Athens-based Onassis Cardiac Surgery Center "examined the heart activity of 20 young daily smokers after one ordinary cigarette against 22 people who smoked an electronic cigarette" for seven minutes. Dr. Konstantinos told meeting attendees that whereas "tobacco smokers showed 'significant' disruptions of functions such as heartbeats or blood pressure, the effect of e-cigarettes on the heart was minimal." Their findings supported previous studies, which "found that the electronic devices would have to be smoked daily for four to 12 months to achieve the levels of nitrosamines" present within "a single tobacco cigarette," Konstantinos noted.

Waiting To Treat CMV May Benefit Kidney Transplant Patients.

MedPage Today Share to FacebookShare to Twitter (8/27, Fiore) reports, "Waiting to treat cytomegalovirus (CMV) in kidney transplant patients may deliver better long-term outcomes than blanket preventive drugs," according to a study Share to FacebookShare to Twitter published online in the Journal of the American Society of Nephrology. Investigators found, "in a small randomized trial," that "organ graft survival was significantly worse for those having CMV prophylaxis (P=0.044) compared with those who received therapy for CMV viremia, and more of these patients had interstitial fibrosis and tubular atrophy though the difference wasn't significant (38% versus 19%, P=0.22)."

SHOCK II: IABP Use Questioned

MedPageToday Link

When myocardial infarction (MI) is complicated by cardiogenic shock, use of intraaortic balloon counterpulsation (IABP) did not reduce mortality among patients scheduled for revascularization -- a finding that calls into question current guidelines for treating cardiogenic shock in this population.
At 30 days, only 60% of the patients treated with IABP were still alive, a mortality that was no different from the rate in the control group (39.7% versus 41.3% relative risk 0.96, 95% CI 0.79-1.17, P=0.69), according to findings from the IABP-SHOCK II trial reported online by the New England Journal of Medicine.
The findings were simultaneously reported as a Hot Line presentation at the European Society of Cardiology meeting in Munich.
Holger Thiele, MD, from University of Leipzig-Heart Center, Leipzig, Germany, and colleagues recruited 600 patients for a randomized, prospective, open-label, multicenter trial and assigned 300 to IABP.
While there was no mortality benefit for IABP, there also was no apparent harm:
  • Rates of major bleeding: 3.3% versus 4.4% in controls (P=0.53)
  • Rates of sepsis: 15.7% versus 20.5% (P=0.15)
  • Rates of stroke: 0.7% versus 1.7% (P=0.28)
  • Rates of peripheral ischemic complications: 4.3% versus 3.4% (P=0.53)
Current American College of Cardiology/American Heart Association guidelines for treatment of STEMI support use of IABP in this population, but that recommendation comes from a trial "that did not address this question, it really looked at the question of revascularization of these patients," said Mariell Jessup, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia.
The earlier trial, called SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock), "was really about bypass surgery in these patients," she said.
Jessup, who is president-elect of the American Heart Association, told MedPage Today that the results of the IABP-SHOCK II trial "may very well be the most important finding to be reported at this meeting."
She said the current Class I recommendation is for use of IABP when the patient is not stable. "It is possible that this [IABP-SHOCK II] could completely change this guideline."
Jessup noted that use of IABP has become the norm for treating these patients and she suggested that physicians will find it hard to resist using IABP because "it is hard for physicians to not do something for these patients."
Christopher O'Connor, MD, and Joseph Rogers, MD, echoed Jessup's view in an NEJM editorial. They are from Duke University.
Under the title, "Evidence for Overturning the Guidelines in Cardiogenic Shock" O'Connor and Rogers wrote that data from IABP-SHOCK II, and a number of recent meta-analyses, "do not support the routine use of IABP in patients with acute myocardial infarction complicated by cardiogenic shock, and the level I guideline recommendation is now strongly challenged. Members of guideline committees and clinicians should take note of another example of a recommendation that is based on insufficient data."
Patients in the IAPB-SHOCK trial were recruited from June 16, 2009 through March 3, 2012 at 37 centers in Germany.
Thirty of the 299 patients assigned to the control group did eventually undergo IABP, usually within 24 hours of randomization, and 26 of those patients were classified as protocol violations. Likewise, 13 patients assigned to IABP did not undergo the treatment, with death being the most common reason.
The authors noted a number of limitations, starting with lack of blinding, and the failure to obtain "hemodynamic measurements or assess laboratory inflammatory markers other than blood pressure, heart rate, and C-reactive protein levels."
Also, the mortality rate in both arms was lower than anticipated -- 40% versus a range of 42% to 48% in other studies -- suggesting that most patients in this study had mild or moderate cardiogenic shock, which could limit the generalizability of these results, they cautioned.
"Finally, we do not yet have any information about longer-term outcomes. Since a balloon intraaortic counterpulsation was used for a median of only 3 days, it seems unlikely that any beneficial effect will become evident later than 30 days," they wrote.
The trial was supported by the German Research Foundation, the German Heart Foundation, the German Cardiac Society, Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte, the University of Leipzig-Heart Center, Marquet Cardiopulmonary, and Teleflex Medical.
Thiele disclosed financial support from Eli Lilly, Terumo, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, and the Medicines Company.
From the American Heart Association:
Peggy Peck
Vice President / Executive Editor
Peggy Peck began her career in journalism at The Record, a New Jersey daily newspaper. In 1980, she started writing for the medical trade press with a column in Physician’s Management. Since then, her byline has been ubiquitous, appearing in Modern Medicine, Medical Tribune, Medical World News, Physician’s Weekly, Internal Medicine News, Family Practice News, Pediatric News, Clinical Psychiatry News, Skin and Allergy News and ObGyn News. As a freelancer, she has contributed to WebMD, Medscape, Reuters Health, UPI, Oncology Times, Neurology Today, Neurology Now, and AMNews.

CAC found to be best predictor of heart disease.

HealthDay (8/22, Gordon) reports on two studies published in the Aug. 22/29 issue of the Journal of the American Medical Association comparing different means of predicting heart disease. The first study compared "coronary artery calcium scans [CAC], ankle-brachial index, high-sensitivity C-reactive protein (CRP), family history, carotid intima-media thickness and brachial flow-mediated dilation," and lead author Dr. Joseph Yeboah, assistant professor of cardiology at Wake Forest Baptist Medical Center in Winston-Salem, NC said that the coronary artery calcium scan was "far superior to all of the other top-tier markers we studied." The other study was based on "data from 14 studies involving nearly 46,000 participants and found that the carotid intima-media thickness test was associated with a small improvement in heart disease prediction, but that the improvement was so small it's likely not to be helpful in clinical practice."
        WebMD (8/22, Boyles) reports that the first "study included about 1,300 people with heart disease risk factors (except diabetes) who were determined to have an intermediate risk for developing heart disease, based on the widely used prediction model known as the Framingham Risk Score (FRS)." Then "after having all six of the tests, they were followed for an average of" 7.5 years.
        MedPage Today (8/22, Phend) reports, "The group pointed out that cost and radiation exposure from coronary artery calcium testing have to be assessed before making broad recommendations about incorporating it into primary prevention screening strategies." Also CAC is "unlikely to be useful for tracking risk over time to look for a worsening trend." The story notes that "the American College of Cardiology and American Heart Association have given family history a class I recommendation for use as an add-on to Framingham risk calculation, while carotid intima-media thickness, coronary artery calcium, ankle-brachial index, and high-sensitivity CRP (hsCRP) received class II recommendations. They recommended against brachial flow-mediated dilation."

Study: 41% of patients continue to seek primary care from specialists.

In continuing coverage from yesterday's briefing, Reuters reports a study published in the Archives of Internal Medicine found that between 1999 and 2007, 41% of primary care visits annually were to specialists rather than primary care doctors. In addition to the increased cost - with, Reuters notes, primary care physicians charging less than specialists - but lead author Dr. Minal Kale of the Mount Sinai School of Medicine also told Reuters that other research suggests patients have better outcomes when their initial visit is with a family practitioner, rather than a specialist.
        Medscape (8/22, Waknine) reports, "Investigators analyzed data from the 1999 and 2007 National Ambulatory Medical Care Surveys, which included 20,959 (n = 8730 from 1999 and n = 12,229 from 2007) primary care visits for adults requiring treatment either for common symptoms and diseases such as fever, nasal congestion, anemia, and asthma or for general preventive medical examinations." They found that "only 60% of primary care was dispensed by primary care physicians (PCPs; 58.1% in 1999 and 57.2% in 2007; P = .79). The balance for these types of primary care visits was covered by internal medicine subspecialists (9.1% in 1999 and 9.6% in 2007; P = .82), obstetrician-gynecologists (3.4% in 1999 and 2.8% in 2007; P = .36), and other subspecialists (29.4% in 1999 and 30.4% in 2007; P = .73)."

Treating Psoriasis Patients With TNF Inhibitors May Lower Heart Attack Risk.

HealthDay Share to FacebookShare to Twitter (8/21, Mann) reports, "People with psoriasis who take a new class of drugs known as tumor necrosis factor (TNF) inhibitors may be at a lower risk for heart attack than their counterparts who only use topical medications to treat this inflammatory skin condition," according to a study Share to FacebookShare to Twitter published online Aug. 20 in the Archives of Dermatology.
        WebMD Share to FacebookShare to Twitter (8/21, Doheny) points out, "Those on oral medicines such as cyclosporine, methotrexate, Soriatane [acitretin], or given light therapy had nearly the same reduction in risk, compared to those on skin-based -- or topical -- medicines," the study found. Researchers arrived at this conclusion after following about 9,000 patients for approximately four years. Participants "in the TNF inhibitor group had a 50% reduction in heart attack, compared to the topical agent group," while those taking oral medicines or receiving phototherapy had a 46% reduction in heart-attack risk.
        MedPage Today Share to FacebookShare to Twitter (8/21, Phend) quotes the study authors, who concluded, "It seems that controlling psoriasis with aggressive therapy and, thus, lowering inflammation leads to a reduction in MI risk." MedPage Today explained, "As a systemic inflammatory disease, psoriasis is linked to many cardiovascular risks, from obesity and atherosclerosis to type 2 diabetes, stroke, MI, and cardiac death." However, "the study didn't compare the individual TNF blockers -- infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira) -- used in psoriasis." Reuters Share to FacebookShare to Twitter (8/21, Pittman) also covers the story.

Close Relative Dying Of CV Disease May Double Risk Of Early Onset Heart Disease.

The AP Share to FacebookShare to Twitter (8/21, Marchione) reports that a study Share to FacebookShare to Twitter published in the Journal of the American College of Cardiology of "four million people -- the largest ever on heart risks that run in families -- found that having a close relative die young of cardiovascular disease doubles a person's odds of developing it by age 50." The study found that "losing two or more close relatives to cardiovascular disease by age 60 more than tripled the odds that someone would develop it before age 50," while "having a less-immediate family member, such as a grandparent, die young of cardiovascular disease also modestly increased a person's risk of early-onset heart disease -- by 19 percent." The study took account of a number of alternate explanations for increased risk, but "had no information on smoking habits."
        HealthDay Share to FacebookShare to Twitter (8/21, Reinberg) reports, "Death of a first-degree relative from cardiovascular causes before age 50 appears to double your risk of heart disease. If the deceased had not reached 35, that risk rises as much as tenfold."

Electric Fans May Not Help During Heat Wave.

The Time Share to FacebookShare to Twitter (7/13, Sifferlin) "Healthland" blog reports that "a new review published in the Cochrane Library suggests that there's no good evidence that" electric "fans help during a heatwave." The devices, "unlike air conditioning...don't actually cool the air, but bring in cooler air from outside if placed near a window." This "backfires, however, when air temperatures rise over 95°F - using an electric fan when it's that hot can actually increase your body's heat stress by blowing air that is warmer than the ideal body temperature over your skin." The blog points out that "the U.S. Centers for Disease Control and Prevention (CDC) recommends electric fan use only when temperatures are below the 90s."
        WebMD Share to FacebookShare to Twitter (7/13, Boyles) reports that although "the review found little evidence of health harms linked to the use of electric fans among people without air conditioning, researchers concluded that better studies are needed to fully understand their impact during heat waves."
        HealthDay Share to FacebookShare to Twitter (7/13, Preidt) reports that review co-author Katie Carmichael said in a news release that "Our review does not support or refute the use of electric fans during a heat wave and people making decisions about them should consider the current state of the evidence base. They might also wish to make themselves aware of local policy or guidelines when making a choice about whether or not to use or supply electric fans."