Hormone Replacement Therapy (HRT)

In recent years, hormone replacement therapy (HRT) has been offered as an option to help treat menopause-related discomfort and prevent long-term conditions common in post-menopausal women. Evidence shows, however, that risks of HRT outweigh its benefits. Talk to your patients about HRT.

• During menopause, which occurs between the ages of 45 and 55, the ovaries produce lower levels of the sex hormones estrogen and progesterone. As a result, many women experience hot flashes, night sweats, sleeplessness, mood swings, and vaginal dryness. Bone loss, angina and heart attacks are also more common in women after menopause.

• HRT, which provides relief for menopausal symptoms, usually involves treatment with estrogen or estrogen in combination with progesterone. The therapy can double hormone levels in post-menopausal women and decrease the risk of hip and spine fractures and of colon cancer.

• Recent evidence indicates, however, that the overall risks of estrogen plus progestin therapy outweigh the benefits,1 significantly increasing the likelihood of dementia, blood clots, stroke, heart disease and breast2 and ovarian cancer.3 HRT has not been proven beneficial in older women with pre-existing heart disease. Additionally, it doesn’t appear to affect post-menopausal women’s general health, vitality, mental health, or sexual satisfaction.2

• A recent study has also connected a 6.7-percent decline in the rate of new breast cancer cases in post-menopausal women in 2003 to a national decline in the use of HRT (from 61 million prescriptions of Premarin(R) and Prempro(TM) in 2001 to 21 million in 2004).4

• While hormone therapy can have short-term benefits, many menopause-related symptoms will eventually disappear, and many require no treatment. A healthful diet and lifestyle helps to decrease the risk of bone loss and cardiovascular problems. Calcium and vitamin D supplements can help prevent osteoporosis5 and their effects on hip, spine, and wrist fractures, as well as on colon cancer are being tested.

• Soy-based foods and some nutritional supplements can also be helpful in reducing the symptoms of menopause. These include evening primrose, black cohosh, Dong quai, vitamin E, and vitamin B complex. Their benefits and risks are not definitively proven, but are being researched.5

References
1. JAMA 2002;288:321-333.
2. NEJM 2003;348:1839-54.
3. Lancet, 2007 Apr 19.
4. NEJM 2007 Apr 19;356(16).
5. Amer Acac Nurse Pract 1999;11(5):187-98.

Echinacea 'can prevent a cold'

Taking the herbal remedy echinacea can more than halve the risk of catching a common cold, US researchers say.
They found it decreased the odds of developing a cold by 58% and the duration of colds by a day-and-a-half.
The results in The Lancet Infectious Diseases conflict with other studies that show no beneficial effect.
Experts believe echinacea, a collection of nine related plant species indigenous to North America, may work by boosting the body's immune system.

'Marked effects'
Researchers, led by Dr Craig Coleman from the University of Connecticut School of Pharmacy, combined the results of 14 different studies on Echinacea's anti-cold properties.
In one of the 14 studies the researchers reviewed, echinacea was taken alongside vitamin C. This combination reduced cold incidence by 86%.
When echinacea was used alone it reduced cold incidence by 65%.


Even when patients were directly inoculated with a rhinovirus - the most common cold-causing virus - echinacea reduced cold incidence by 35%.
The researchers' report said: "With over 200 viruses capable of causing the common cold, echinacea could have modest effect against rhinovirus but marked effects against other viruses."

Popular product
They found that more than 800 products containing echinacea were available, and that differing parts of the plant - flower, stem and root - were used in different products.
They said more work was needed to check the safety of these different formulations.
Professor Ron Cutler, of the University of East London, said: "The true benefits, and more importantly, how the agents work remains unclear and further better-controlled actual clinical trials still have to be carried out.

THE COMMON COLD
Rhinoviruses are responsible for about half of all common colds in children and adults
School children usually catch between seven and 10 colds a year, and adults two to five
Common colds and flu can be transmitted by hands and contact with commonly-touched surfaces
"Echinacea may reduce the duration of illness and decreases the severity of cough, headache, and nasal congestion. "
He said people with impaired immune function might benefit from taking echinacea during the winter months to prevent colds and flu, but that healthy people did not require long-term preventative use.

"There has also been the suggestion in the past that continuous treatment with echinacea is not recommended - the benefits may only be effective for one or two weeks and after taking the agent for this time people should stop and give the immune system a week without the agent."
Professor Ronald Eccles, director of the Common Cold Centre at the University of Cardiff, said the work was "a significant step in our battle against the common cold".
"Harnessing the power of our own immune system to fight common infections with herbal medicines such as echinacea is now given more validity with this interesting scientific evaluation of past clinical trials," he added.

Healthcare in the USA - Police Probe Alleged Homeless Dumping

Friday, February 9, 2007
(02-09) 20:01 PST Los Angeles (AP)

Even on Skid Row, it was shocking: a paraplegic man in a soiled gown sliding along the
sidewalk with his hands, clutching a plastic bag with his belongings between his teeth.
Police said the man, who was dragging a broken colostomy bag behind him, was dumped on
the sidewalk Thursday in one of the worst parts of the city by the driver of a hospital van.
The area is the same location where city officials say hospitals have dumped the homeless
before.

Witnesses, all homeless people, began shouting, "Where is his wheelchair? Where is his
walker?" Detective Russ Long said Friday. They told officers the driver responded that the
man defecated in the van and had to be removed.

"If there is an explanation it just eludes me at this point," Long said.
"He was sliding along on his bottom using his hands. He had a hospital property bag in his
mouth, in his teeth, and he was trailing a colostomy bag, which was malfunctioning."
Witnesses told police a van from Hollywood Presbyterian Medical Center pulled up to a tiny
park in the grimy area near downtown at 10:45 a.m. Thursday, a side door opened and a
man, dressed in a green hospital gown and pants, began struggling to get out. The driver
looked on.

"His pants fell around his ankles. He fell onto the curb with his legs dangling onto the
street," Long said. "He reached down and grabbed his pants, pulled his legs onto the
sidewalk. Witnesses said the van would have run over his legs if he hadn't have done that."
Homeless people in the area helped the disoriented man into the park. A police bicycle
patrol arrived by chance within a minute and called an ambulance.
The 41-year-old man's name was not released, but he was wearing a bracelet from the
hospital, Long said.

Dan Springer, a spokesman for the medical center, did not confirm or deny that the van
carrying the man came from Hollywood Presbyterian. He said an internal investigation was
under way and pledged cooperation with any outside investigation.
"These are very serious allegations. Our goal is to get to the bottom of exactly what
happened. If we determine a mistake of this magnitude was made, we will respond swiftly
and appropriately," Springer said.

Springer said the man was released on Wednesday night. He asked to be taken to a Skid
Row mission and was transported by a company contracted by Hollywood Presbyterian,
Springer said. The mission had no vacancies and the man was taken back to the hospital,
where he spent the night in the lobby of the emergency room.
The next day, he asked to return to Skid Row and "instructed the driver to open the door
and let him out at a local park in the vicinity of Midnight Mission," Springer said.

"He assured the driver the mission was his home and could propel himself home from the
park," Springer said. "The driver opened the door, he propelled and waved the driver away,
and the driver left the area."

The man was ultimately taken to another hospital. Police did not disclose his condition.
The case comes three months after the city attorney's office filed its first indictment alleging
homeless dumping, against Kaiser Permanente Hospital. In that case, a 63-year-old patient
from the hospital's Bellflower medical center was videotaped wandering the streets of Skid
Row in a hospital gown and socks.

Kaiser has said it has taken steps to see that no more of its patients are left on Skid Row.
City officials have accused more than a dozen hospitals of dumping patients and criminals
on Skid Row. Hospital officials have denied the allegations, but some said they had taken
homeless patients to Skid Row service providers.

In 2005, Hollywood Presbyterian was accused of homeless dumping. At the time, a top
executive denied the charge, but said Skid Row service providers offered treatment and care
for some patients who had nowhere else to go.

A recent crackdown on crime around Skid Row has resulted in a migration of homeless
people out of downtown, significantly reducing the area's transient population but also
putting a strain on homeless service providers elsewhere.

Last month, 875 people were living on the streets surrounding Skid Row, according to a
Police Department count. That compares to 1,345 people at about the same time last year.

Let's all be glad we live in Malaysia

Heart survival 'higher in obese'

Obese heart attack and angina patients are more likely to survive after treatment, a study suggests.
Researchers found obese patients were less than half as likely to die in the three years after treatment as patients with a normal body mass index.

The German and Swiss study - involving 1,676 patients and in the European Heart Journal - could not explain why.

And experts warned obese people were more likely to develop heart problems in the first place.

The study followed 1,676 patients who were hospitalised with unstable angina or a specific type of heart attack called a non-ST-segment elevation myocardial infarction.

Standard treatment was a coronary angiography to diagnose the extent of the problem, followed by a process to unblock the arteries called coronary revascularisation or a coronary artery bypass graft.

Lead researcher Dr Heinz Buettner said: "Although there is no doubt that people who are overweight, obese and very obese have a higher risk of developing diabetes, hypertension and coronary artery disease, the evidence from our study shows once a coronary event has occurred and been optimally treated, obese patients switch to a more favourable prognosis compared to normal weight patients."

The obese patients tended to be younger than the normal weight patients, and were more likely to be given prescriptions for heart drugs such as statins and beta-blockers on discharge from hospital.

But Dr Buettner said his analysis suggested that neither of these two factors could fully explain the lower mortality rate.

Protective effect

He said it was possible that differences in body chemistry caused by obesity might play a role.

For instance, levels of blood platelets, which can affect clotting, are lower in obese patients, while levels of fat in the heart tissue, which might have a protective effect, are higher.

Another theory is that the higher levels of endogenous cannabinoids in obese people might be key. There is a growing body of evidence to suggest that these chemicals have a protective effect during a heart attack.

Dr Buettner said it was important that obese people made efforts to lose weight.

He said: "Not all patients can be treated with early revascularisation because an acute coronary syndrome always has the risk of sudden cardiac death.

"It is well known that even a modest intentional weight loss can improve or prevent obesity-related cardiovascular risk factors."

June Davison, of the British Heart Foundation, said the study raised more questions than it answered.

"Further research is needed for us to understand the reasons for this link," he said.

"What we are sure of, is that if you are overweight you have a higher risk of developing high blood pressure, coronary heart disease and diabetes in the first place."

Counterfeit Colgate Has Poisonous Chemical

By Xiyun Yang
Washington Post Staff Writer
Friday, June 15, 2007; Page D03

A chemical used in antifreeze has been found in tubes of counterfeit Colgate toothpaste, Colgate-Palmolive said yesterday.

The toothpaste was first found at a discount store in Silver Spring late last week, officials said. Investigators have since traced shipments of the toothpaste to stores in Pennsylvania, New Jersey and New York. There have been no reports of anyone becoming sick after using it.

Diethylene glycol (DEG), commonly used in antifreeze, is a cheap substitute for glycerin and was added to the counterfeit toothpaste to add texture. Officials warn of the potential for DEG to harm children who ingest small amounts of toothpaste, as well as patients with kidney and liver disease. Large amounts of the chemical could cause kidney failure.

DEG levels of 1 to 4 percent were found in brands of Chinese toothpaste that were banned by the FDA on June 1.

The toothpaste was found at the Dollar Power store in Silver Spring, said Douglas Arbesfeld, a spokesman for Food and Drug Administration. Investigators from the FDA began spot-checking toothpaste at retailers and distributors on May 31, after media reports that tainted toothpaste from China was found in the Dominican Republic, Australia and Panama. All Chinese toothpaste has been stopped at the border. "The burden of proof is on the importer to meet our rigorous criteria," Arbesfeld said.

China announced an overhaul of its food and drug safety regulations this month after international objections over contaminated exports. An ingredient imported from China tainted with melamine, a plastic material, was used in pet food made in the United States. The pet food was recalled.

On June 1, the FDA issued an alert about Chinese toothpaste, naming about a dozen minor brands on its Web site. Though the counterfeit tubes of Colgate were labeled as having been made in South Africa, FDA investigators became suspicious of misspellings such as "isclinically," "SOUTH AFRLCA" and "South Arican Dental Assoxiation" on the package.

Colgate-Palmolive has said it does not import toothpaste from South Africa.


A 2000 Chinese study said DEG levels of up to 15.6 percent are tolerable. "We say that the potential risk here is low but meaningful. This stuff doesn't belong in toothpaste and has to come off the market," Arbesfeld said.

The shipments of counterfeit Colgate, distributed through MS USA Trading, of North Bergen, N.J., has been recalled. A person who answered MS USA Trading's phone declined to answer questions.

Most of the $2 billion worth of toothpaste sold in U.S. stores is made domestically. The United States imported about $3.5 million worth of Chinese toothpaste in 2006, according to the Commerce Department.

Omega-3 oil 'treats depression'

Cod liver oil 'treats depression'

In WWII children were given cod liver oil to supplement poor diets
It may make the stomach turn, but scientists in Norway suggest that taking a spoonful of cod liver oil each day could stave off depression.
In a study of almost 22,000 people aged over 40, those who regularly took the oil were less likely to suffer depression than those who did not.

The study in the Journal of Affective Disorders also suggested the longer one took it, the less depressed one became.

The oil is rich in Omega-3 fatty acids which are linked to various benefits.

Children's brains are said to be boosted by Omega-3s, which have also been claimed to reduce the risk of stroke, heart attack and cancer, although some studies have cast doubt on this.

Other factors

In this latest claim, scientists said a spoonful of cod liver oil could reduce the risk of depression by as much as 30%.

Depressive symptoms among cod liver oil users was 2.5%, compared to 3.8% in the rest of the population.

The researchers looked at 21,835 people aged between 40-49 and 70-74 across Norway between 1997 and 1999.

When compiling their report, they said they also took into account other factors which could impact upon depression, including age, gender, whether one smoked, drank coffee or alcohol, as well as levels of education and physical activity.

Professor David Kendall said given that fish oil seems to improve cardiovascular health, it may not be that surprising to learn that healthier people are less depressed.

He did not rule out the idea that fish oil could directly impact upon depression, but he did warn that socio-economic factors did not appear to have been taken into account in the study. Richer people, he said, tend to be healthier and have less depression.

In the UK, there is growing momentum behind finding alternative treatments for depression, amid mounting concern that too many people are being given prescription drugs such as Prozac after being diagnosed.

Over 31 million such prescriptions were issued in 2006 - a 6% rise on the previous year.

Here in Malaysia the best source of Omega-3 fatty acids are Pristin fish oil.

US regulator tried to smear scientist in fight for Glaxo drug

Andrew Clark in New York
Thursday June 7, 2007
The Guardian

The head of the US food and drug administration has admitted his staff attempted to smear a scientist who raised doubts about Avandia - the GlaxoSmithKline diabetes drug that has been linked with a high incidence of heart attacks.
Senior executives from the FDA and Glaxo faced a gruelling morning of questioning by members of Congress at a hearing convened by the House oversight committee in Washington yesterday.

Members of the committee attacked "negligence" and systemic failures in a lack of warnings to patients about the risks of Avandia, which generated £1.4bn in revenue for Glaxo last year.

Dr. Greens comment: So the next time you see something is or isn't FDA approved, don't be too impressed. They are not unbiased.

Caution: Some soft drinks may seriously harm your health

By Martin Hickman, Consumer Affairs Correspondent www.independent.co.uk
Published: 27 May 2007


A new health scare erupted over soft drinks last night amid evidence they
may cause serious cell damage. Research from a British university suggests a
common preservative found in drinks such as Fanta and Pepsi Max has the
ability to switch off vital parts of DNA.

The problem - more usually associated with ageing and alcohol abuse - can
eventually lead to cirrhosis of the liver and degenerative diseases such as
Parkinson's.

The findings could have serious consequences for the hundreds of millions of
people worldwide who consume fizzy drinks. They will also intensify the
controversy about food additives, which have been linked to hyperactivity in
children.

Concerns centre on the safety of E211, known as sodium benzoate, a
preservative used for decades by the £74bn global carbonated drinks
industry. Sodium benzoate derives from benzoic acid. It occurs naturally in
berries, but is used in large quantities to prevent mould in soft drinks
such as Sprite, Oasis and Dr Pepper. It is also added to pickles and sauces.

Sodium benzoate has already been the subject of concern about cancer because
when mixed with the additive vitamin C in soft drinks, it causes benzene, a
carcinogenic substance. A Food Standards Agency survey of benzene in drinks
last year found high levels in four brands which were removed from sale.

Now, an expert in ageing at Sheffield University, who has been working on
sodium benzoate since publishing a research paper in 1999, has decided to
speak out about another danger. Professor Peter Piper, a professor of
molecular biology and biotechnology, tested the impact of sodium benzoate on
living yeast cells in his laboratory. What he found alarmed him: the
benzoate was damaging an important area of DNA in the "power station" of
cells known as the mitochondria.

He told The Independent on Sunday: "These chemicals have the ability to
cause severe damage to DNA in the mitochondria to the point that they
totally inactivate it: they knock it out altogether.

"The mitochondria consumes the oxygen to give you energy and if you damage
it - as happens in a number if diseased states - then the cell starts to
malfunction very seriously. And there is a whole array of diseases that are
now being tied to damage to this DNA - Parkinson's and quite a lot of
neuro-degenerative diseases, but above all the whole process of ageing."

The Food Standards Agency (FSA) backs the use of sodium benzoate in the UK
and it has been approved by the European Union but last night, MPs called
for it to investigate urgently.

Norman Baker, the Liberal Democrat chair of Parliament's all-party
environment group said: "Many additives are relatively new and their
long-term impact cannot be certain. This preservative clearly needs to be
investigated further by the FSA."

A review of sodium benzoate by the World Health Organisation in 2000
concluded that it was safe, but it noted that the available science
supporting its safety was "limited".

Professor Piper, whose work has been funded by a government research
council, said tests conducted by the US Food and Drug Administration were
out of date.

"The food industry will say these compounds have been tested and they are
complete safe," he said. "By the criteria of modern safety testing, the
safety tests were inadequate. Like all things, safety testing moves forward
and you can conduct a much more rigorous safety test than you could 50 years
ago."

He advised parents to think carefully about buying drinks with preservatives
until the quantities in products were proved safe by new tests. "My concern
is for children who are drinking large amounts," he said.

Coca-Cola and Britvic's Pepsi Max and Diet Pepsi all contain sodium
benzoate. Their makers and the British Soft Drinks Association said they
entrusted the safety of additives to the Government.

Hormone Replacement Therapy

In recent years, hormone replacement therapy (HRT) has been offered as an option to help treat menopause-related discomfort and prevent long-term conditions common in post-menopausal women. Evidence shows, however, that risks of HRT outweigh its benefits. Talk to your patients about HRT.

• During menopause, which occurs between the ages of 45 and 55, the ovaries produce lower levels of the sex hormones estrogen and progesterone. As a result, many women experience hot flashes, night sweats, sleeplessness, mood swings, and vaginal dryness. Bone loss, angina and heart attacks are also more common in women after menopause.

• HRT, which provides relief for menopausal symptoms, usually involves treatment with estrogen or estrogen in combination with progesterone. The therapy can double hormone levels in post-menopausal women and decrease the risk of hip and spine fractures and of colon cancer.

• Recent evidence indicates, however, that the overall risks of estrogen plus progestin therapy outweigh the benefits,1 significantly increasing the likelihood of dementia, blood clots, stroke, heart disease and breast2 and ovarian cancer.3 HRT has not been proven beneficial in older women with pre-existing heart disease. Additionally, it doesn’t appear to affect post-menopausal women’s general health, vitality, mental health, or sexual satisfaction.2

• A recent study has also connected a 6.7-percent decline in the rate of new breast cancer cases in post-menopausal women in 2003 to a national decline in the use of HRT (from 61 million prescriptions of Premarin(R) and Prempro(TM) in 2001 to 21 million in 2004).4

• While hormone therapy can have short-term benefits, many menopause-related symptoms will eventually disappear, and many require no treatment. A healthful diet and lifestyle helps to decrease the risk of bone loss and cardiovascular problems. Calcium and vitamin D supplements can help prevent osteoporosis5 and their effects on hip, spine, and wrist fractures, as well as on colon cancer are being tested.

• Soy-based foods and some nutritional supplements can also be helpful in reducing the symptoms of menopause. These include evening primrose, black cohosh, Dong quai, vitamin E, and vitamin B complex. Their benefits and risks are not definitively proven, but are being researched.5 Before taking any dietary supplement, consult with your health care provider.

References
1. JAMA 2002;288:321-333.
2. NEJM 2003;348:1839-54.
3. Lancet, 2007 Apr 19.
4. NEJM 2007 Apr 19;356(16).
5. Amer Acac Nurse Pract 1999;11(5):187-98.