New Gout Drug Info

Today i read article about medicine Uloric should be the first new gout drug to be approved in over 40 years, an FDA expert panel recommends.

Currently, allopurinol (trade name, Zyloprim) is the only FDA-approved drug that prevents formation of the uric acid crystals that cause gout. However, side effects -- including potentially fatal reactions -- limit the amount of allopurinol that can be tolerated. Most gout patients do not receive fully effective doses of allopurinol.

In clinical trials sponsored by Takeda, Uloric's manufacturer, an 80-milligram dose of Uloric worked better than allopurinol; a 40-milligram dose worked at least as well as allopurinol.

Unlike allopurinol, very little Uloric is excreted through the urine, making Uloric safe for patients with kidney problems. Gout patients with impaired kidney function have to take very low doses of allopurinol, making the drug even less effective for these patients.

In 2005, the FDA refused to approve Uloric because there were slightly more deaths and heart problems in patients taking the drug than in patients taking allopurinol. As people with gout problems already are at higher risk of heart disease, the FDA issued an "approvable" letter, noting that Uloric could be approved if this safety question were addressed.

Takeda then performed a large new phase 3 clinical trial that enrolled more gout patients than the two previous phase 3 trials combined. The new study found no more deaths and no more heart problems in patients taking Uloric than in patients taking allopurinol.from .medicinenet.com

Based on the safety and efficacy data, the FDA panel recommended by a 12-0 vote that the FDA approve Uloric at both the 40-milligram and 80-milligram doses. Takeda suggests the higher dose is more effective in subjects with more severe gout.

Takeda has offered to continue studying Uloric after FDA approval. A phase 4 clinical trial would compare Uloric to allopurinol for the reduction of gout flare-ups.

And because drugs with the same mechanism of action as Uloric and allopurinol may affect theophylline bronchodilators, Takeda has agreed to conduct a postmarketing phase 1 study of Uloric's interactions with theophylline.

Gout occurs when blood levels of uric acid rise. At blood levels above 7 mg/dL -- and above 6 mg/dL in the extremities -- uric acid forms crystals that lodge in the joints and other body tissues. These crystal deposits provoke an immune response that results in extremely painful swelling and in inflammatory arthritis that can permanently destroy the joints.

About 1.4% of men and 0.6% of women have gout. But prevalence rises with age. After age 80, about 9% of men and 6% of women develop gout.

The body converts a chemical called xanthine into uric acid via an enzyme called xanthine oxidase or XO. Allopurine and Uloric each inhibit XO and prevent the formation of uric acid.

Allopurinol is approved in doses up to 800 milligrams. However, it's rarely dosed above 300 milligrams per day and is often ineffective. Allopurinol side effects include upset stomach, headache, diarrhea, and rash. Although rare, allopurinol hypersensitivity syndrome can develop. It's fatal 20% to 30% of the time.

The most common side effects seen in patients taking Uloric during clinical trials were upper respiratory tract infections, muscle and connective-tissue symptoms, and diarrhea. The drug was well tolerated, and these side effects did not increase over long-term use.

SOURCES: FDA, "Briefing Document for the Arthritis Advisory Committee Meeting, Uloric/febuxostat," Nov. 24, 2008. Takeda Pharmaceuticals North America Inc., "Briefing Document for Advisory Committee, Division of Anesthesia, Analgesia, and Rheumatology Products," Nov. 24, 2008.

Alternative to Fall Babies at Higher Risk for Asthma

When it comes to babies and asthma, timing is everything.

A new study shows that babies born four months before the peak of winter virus season are more likely to develop childhood asthma than babies born at any other time of year; that's because the timing increases the chance of a viral respiratory infection during infancy, which in turn increases the risk of childhood asthma. The date that winter virus season peaks can vary from year to year.

The study is published in American Journal of Respiratory and Critical Care Medicine.

Asthma is an increasingly important health concern. The prevalence of asthma increased 100% worldwide between 1985 and 2001, according to background information in the study. About 300 million people have asthma. Deaths from asthma are expected to increase 20% during the next decade.

Researchers looked at medical records of 95,310 children born between 1995 and 2000 and followed their health status until 2005. The children were all born in Tennessee and enrolled in the state's Medicaid program, called TennCare.

Scientists have known for some time that there is a link between infant viral respiratory infections and childhood asthma. However, they did not know whether viral respiratory infections cause asthma or whether the infections are simply a sign that a child is genetically predisposed to develop asthma. This study offers evidence that the former is true.

The researchers found that babies born four months prior to the peak of winter virus season had a 29% increased risk of developing childhood asthma compared to babies born one year before the winter virus peak.

Even armed with the new findings, preventing the infant respiratory infections that lead to childhood asthma is no easy task. It is hard to shield babies from such infections. About 70% of babies develop RSV (respiratory syncytial virus) during the first year of life.

However, the researchers argue that there may be a need for prevention strategies, such as vaccines, for babies at high risk for asthma.

"Prospective trials with antiviral strategies, including potential new vaccines targeting [respiratory viruses] in selected populations at risk should give us better understanding of the role of viral infections in early life in the causation of childhood asthma," writes Renato T. Stein, MD, PhD, of the Pontifícia Universidade Catolica in Porto Alegre, Brazil, in an editorial published with the study.

SOURCES: Wu, P. American Journal of Respiratory and Critical Care Medicine, 2008; vol 178: pp 1123-1129. News release, American Thoracic Society.

Info About Post-Workout Snack May Hamper Weight Loss

Today I read article from www.medicinenet.com about Elite athletes are advised to "fill the tank" with an energy bar or sports drink soon after a workout.

But for mere mortals -- folks who are simply trying to keep their weight in check or stave off heart disease -- adding calories right after burning them up could negate the benefits of the sweat, researchers say.

"If people are going to go out and exercise to benefit their health, they should not be eating back the calories immediately upon finishing, or within a couple of hours of finishing," said Barry S. Braun, director of the Energy Metabolism Laboratory at the University of Massachusetts Amherst. "In order to maintain the benefits, you need to be in this calorie deficit."

"Athletes are always advised to do exactly the opposite," he continued. "That's great for athletes, but for the other 99.9% of the world, that's probably the wrong thing."

Braun is co-author of two papers appearing in the Journal of Applied Physiology, Nutrition and Metabolism and one paper published in the Journal of Applied Physiology that detail the findings.

Ten young, overweight men and women participated in each experiment.

For the first study, volunteers were asked to walk on a treadmill for an hour a day, burning about 500 calories each time. Half of the group were given a high-calorie carbohydrate drink immediately after their workout while the other half abstained.

Exercise increased insulin efficiency by 40% in those who did not eat afterwards. But the benefit was completely wiped out for those who had a high-carb drink after sweating.

These results had the researchers wondering if the type of calorie would make any difference.

For the second study, volunteers cycled for 75 minutes. Immediately after exercising, half of the participants ate a meal high in carbohydrates while the other half ate a meal low in carbohydrates but containing the same number of calories.

The ability of insulin to clear sugar from the blood was greater among people who ate the low-carb meal, the researchers found.

"It seems as though giving people back carbohydrates blunts or diminishes this exercise benefit," Braun said.

The third study was all about timing. Participants were given identical meals before, immediately after or three hours after cycling for 75 minutes.

The effectiveness of insulin was about the same no matter what the time, the study revealed.

"That really didn't make a whole lot of difference, which surprised us," Braun stated. "What did seem to matter was whether you ate back calories, and whether those calories were mostly carbohydrates."

SOURCES: Barry S. Braun, Ph.D., associate professor, kinesiology, and director, Energy Metabolism Laboratory, University of Massachusetts, Amherst; Jim White, R.D., personal trainer, registered dietitian and national spokesman, American Dietetic Association, Virginia Beach, Va.; 2008 and December 2005 Journal of Applied Physiology; 2007 Journal of Applied Physiology, Nutrition and Metabolism

Diabetes: Aspirin Heart Perk Questioned Info

Taking low-dose aspirin may not prevent diabetes patients from experiencing heart "events," new research shows.

Those findings come from a new study published in The Journal of the American Medical Association and another study published last month in BMJ. Those two studies don't question the heart benefits of low-dose aspirin in people who already have heart disease. Instead, the new studies are about aspirin's effects on people with diabetes who have no history of heart disease.

The researchers aren't closing the door on aspirin for diabetes patients, but "the decision to prescribe aspirin should be made on an individual patient basis," states an editorial published in The Journal of the American Medical Association.

Aspirin, Diabetes, and Heart Disease

Diabetes makes heart disease more likely. So the two new studies tested whether taking low-dose aspirin helped prevent heart attacks and other cardiovascular events (strokes, death from heart disease, etc.) in diabetes patients without a history of heart disease.

One of the studies, published in The Journal of the American Medical Association, took place in Japan and included 2,539 adults with type 2 diabetes who typically stayed in the study for about four years.

The other study, published last month in BMJ's "Online First" edition, took place in Scotland and included 1,276 adults with type 1 or type 2 diabetes who were followed for about six years.

The studies were designed differently. The Japanese study didn't use a placebo, and half of the patients in the Scottish study also got antioxidant supplements.

But in both studies, the bottom line was the same: There was no sign that taking low-dose aspirin lessened the patients' odds of having their first cardiovascular event.

Still, that may not be the final word on the topic.

For instance, the Japanese study had fewer cardiovascular events than expected, which might have made it harder to trace aspirin's effects. And in the Scottish study, the researchers note that "small effects may be shown with larger trials continued for a longer time." from http://www.medicinenet.com/

Editorialists Weigh In

In BMJ, editorialist William Hiatt, MD, a professor of medicine at the University of Colorado Denver School of Medicine, writes that "although aspirin is cheap and universally available," it should only be prescribed for patients "with established symptomatic cardiovascular disease."

But in The Journal of the American Medical Association, editorialist Antonio Nicolucci, MD, of Italy's Consorzio Mario Negri Sud encourages doctors and diabetes patients to weigh the pros and cons of low-dose aspirin on a case-by-case basis until further research is available.

Information about Whole Grains Lower Risk of Heart Failure

today I read article about health about Keep eating whole grains and reduce your consumption of eggs and high-fat dairy food to improve your odds against suffering heart failure, a new long-term study shows.

The study, which looked at more than 14,000 people over 13 years, found that participants had a 7% lower risk of heart failure (HF) per one-serving increase in whole grain consumption. The risk increased by 8% per one-serving increase in high-fat dairy intake and by 23% per one-serving increase in egg consumption. Other food groups did not appear to directly affect risk of heart failure.

The findings were published in the November issue of the Journal of the American Dietetic Association.

"The totality of literature in this area suggests it would be prudent to recommend that those at high risk of HF increase their intake of whole grains and reduce intake of high-fat dairy and eggs, along with following other healthful dietary practices consistent with those recommended by the American Heart Association," article co-author Jennifer A. Nettleton, an assistant professor in the Division of Epidemiology and Disease Control at the University of Texas Health Sciences Center at Houston, said in an association news release.

-- Kevin McKeever

SOURCE: American Dietetic Association, news release, Oct. 27, 2008

Obama Wins: What It Means for Health Care info

Today i read article about election of Democrat Barack Obama ushers in a new administration that is all but certain to include some level of health care reform. Less clear is how extensive that reform will be and when it will come.

The Illinois senator has proposed sweeping changes in the health care system designed to provide health coverage to millions of uninsured Americans.

But experts tell WebMD that the current financial crisis makes sweeping change unlikely any time soon.

"I have no inside track, but I would bet that in this economic climate it is far more likely that changes will be phased in over time," says Karen Davis, president of the health policy and research group Commonwealth Fund.

University of Michigan health economist Thomas Buckmueller, PhD, agrees that the economic climate is likely to slow reform. "I am not extremely optimistic that major reform will happen, but this seems to be the best chance we have had in a long time."

Obama's Health Plan

Obama spoke often during the campaign about his mother's battle with ovarian cancer to illustrate his commitment to changing the health care system.

He told of her final days, spent battling insurance company bureaucrats who did not want to pay for her cancer treatments. "I know what it's like to see a loved one suffer, not just because they are sick, but because of a broken health care system," he said at a rally last week and at countless campaign stops before that.

His plan would extend health coverage by expanding existing private and public programs with the help of federal subsidies and mandates.

He has repeatedly claimed the reforms will lower the average family's health insurance premiums by about $2,500 a year.

These reforms include:

• Requiring employers, except small businesses, to provide health insurance to their employees or contribute to the cost.
• Requiring that all children have health insurance.
• Expanding Medicaid and the State Children's Health Insurance Program (SCHIP).
• Creating a National Health Insurance Exchange to pool risk and give people the choice of competing private or public health plans.

According to the Tax Policy Center, a nonpartisan tax analysis group, the president-elect's plan, if fully implemented, would reduce the number of uninsured Americans from a projected 67 million to 33 million over the next decade at a cost of $1.6 trillion.

Obama has said he would pay for his plan by rolling back President Bush's tax cuts on people making more than $250,000 a year and keeping the estate tax at 2009 levels, but he has not been more specific. He has not provided a timetable for seeking his proposed reforms and has not said if he would present a comprehensive health care reform package or try for incremental change.

Expansion Likely for State Children's Health Insurance Program

Experts interviewed by WebMD agreed that expansion of the children's insurance program SCHIP is likely to be the first of the proposed reforms to be considered.

Last December, Democrats in Congress lost a yearlong fight to boost federal spending that would have expanded the program after two separate vetoes by Bush.

The program will be up for congressional review next March, and experts say it will probably be the Obama administration's first chance to make good on a health care promise.

"SCHIP is one of the big success stories in health policy over the last 20 years," Buckmueller says. "It has succeeded in getting kids the preventive care they need to keep them out of the ERs."

Medicare Reform More Problematic

Many of Obama's other proposals -- from the expansion of Medicare to his National Health Insurance Exchange -- will be much harder to win support for, even with a largely friendly Congress behind him.

Buckmueller believes the best chance for major reform lies in seeking bipartisan support for his proposals.

He says a key reason for the failure of President Clinton's 1993 health care reform effort is that his administration did not reach across the isle. "Assuming that Obama has learned from the Clinton debacle, I think he would be wise to say, 'Here are the basic principles of my plan. You work out the details, get bipartisan support, and I'll sign it.'"

Health Spending 'Not Sustainable'

While sweeping reform may not come soon, experts contacted by WebMD agreed that the nation's broken health care system must be addressed and that this must happen sooner rather than later.

The statistics bear this out:

• 45 million Americans have no health insurance.
• 25 million more have health plans but are considered underinsured because their policies offer only minimal coverage, according to the Commonwealth Fund.
• 42% of U.S. adults under age 65 are uninsured or underinsured, up from 33% in 2003.

Total spending on health care represented around 16% of the gross domestic product in 2007, and the Congressional Budget Office says spending will rise to a quarter of gross domestic product by 2025.

"We are not going to reduce health care spending," says former Congressional Budget Office Director Alice Rivlin, PhD, who is now a scholar with the Brookings Institution. "The best we can do is reduce the rate of health care spending growth. That should be the No. 1 priority of any health care reform."

If jobs are the next thing to go in the current economic crisis, as many economists are predicting, the number of American's without health insurance will quickly increase beyond projections.

"Something has to happen over the next few years, because the cost of doing nothing is too great," Rivlin says.

Davis echoes the thought. "We can't afford to stay on the path we are on with regard to total health spending," she says. "Employers can't afford it, the government can't afford it, and individuals can't afford it. It is just not sustainable."

SOURCES: Karen Davis, president, Commonwealth Fund. Thomas Buckmueller, PhD, professor of business economics and public policy, Ross School of Business, University of Michigan, Ann Arbor. Alice Rivlin, director, Greater Washington Research project, Brookings Institution. Tax Policy Center: "Presidential Candidates Tax Plans," Sept. 12, 2008. Congressional Budget Office, health care spending, 2007.

10 Lifestyle Tips for Cancer Prevention

Today i read article from medicinenet.com about Looking for ways to cut your risk of developing cancer? Here's a list of 10 diet and activity recommendations highlighted this week in Chicago at the annual meeting of the American Dietetic Association (ADA).

• Be as lean as possible without becoming underweight.
• Be physically active for at least 30 minutes every day.
• Avoid sugary drinks, and limit consumption of high-calorie foods, especially those low in fiber and rich in fat or added sugar.
• Eat more of a variety of vegetables, fruits, whole grains, and legumes (such as beans).
• Limit consumption of red meats (including beef, pork, and lamb) and avoid processed meats.
• If you drink alcohol, limit your daily intake to two drinks for men and one drink for women.
• Limit consumption of salty foods and food processed with salt (sodium).
• Don't use supplements to try to protect against cancer.
• It's best for mothers to exclusively breastfeed their babies for up to six months and then add other liquids and foods.
• After treatment, cancer survivors should follow the recommendations for cancer prevention.

Why These Cancer Recommendations?

Walter Willett, MD, DrPH, an epidemiology professor who leads the nutrition department the Harvard School of Public Health, was on the international team of scientists that wrote the recommendations.

At the ADA meeting, Willett said the first recommendation -- to be as lean as possible within the healthy weight range -- is "the most important, by far."

But there is one recommendation that Willett says may be a "mistake" -- the one about not taking supplements. Vitamin D supplements may lower risk of colorectal cancer and perhaps other cancers, notes Willett. He predicts that that recommendation will be a top priority for review.

How to Follow the Recommendations

Karen Collins, MS, RD, CDN, is the nutritional advisor for the American Institute for Cancer Research. She reviewed the recommendations before they were issued last year, and she joined Willett in talking to ADA members.

Collins provides these tips for each of the recommendations:

• Be as lean as possible without becoming underweight: Don't just look at the scale; check your waist measurement as a crude measurement of your abdominal fat, Collins says. She recommends that men's waists be no larger than 37 inches and women's waists be 31.5 inches or less.
• Be physically active for at least 30 minutes every day: You can break that into 10- to 15-minute blocks, and even more activity may be better, notes Collins.
• Avoid sugary drinks and limit consumption of energy-dense foods: It's not that those foods directly cause cancer, but they could blow your calorie budget if you often overindulge, notes Collins, who suggests filling up on fruits, vegetables, and whole grains.
• Eat more of a variety of vegetables, fruits, whole grains, and legumes such as beans: Go for a variety of colors (like deep greens of spinach, deep blues of blueberries, whites of onions and garlic, and so on). Most Americans, says Collins, are stuck in a rut of eating the same three vegetables over and over.
• If consumed at all, limit alcoholic drinks to two for men and one for women per day: Watch your portion size; drinks are often poured liberally, notes Collins. Willett adds that the pros and cons of moderate drinking is something that women may particularly need to consider, weighing the heart benefits and increased breast cancer risk from drinking.
• Limit red meats (beef, pork, lamb) and avoid processed meats: Limit red meats to 18 ounces per week, says Collins, who suggests using chicken, seafood, or legumes in place of red meat. Collins isn't saying to never eat red meat, just do so in moderation.
• Limit consumption of salty foods and foods processed with sodium: Don't go over 2,400 milligrams per day, and use herbs and spices instead, says Collins. She adds that processed foods account for most sodium intake nowadays -- not salt you add when cooking or eating.
• Don't use supplements to protect against cancer: It's not that supplements are bad -- they may be "valuable" apart from cancer prevention, but there isn't evidence that they protect against cancer, except for vitamin D, says Collins.
• It's best for mothers to breastfeed babies exclusively for up to six months and then add other foods and liquids: Hospitals could encourage this more, Collins says.
• After treatment, cancer survivors should follow the recommendations for cancer prevention. Survivors include people undergoing cancer treatment, as well as people who have finished their cancer treatment.

Making Cancer Prevention Simpler

Overwhelmed? Collins boiled the 10 recommendations down to these three:

• Choose mostly plant foods. Limit red meat and avoid processed meat.
• Be physically active every day in any way for 30 minutes or more.
• Aim to be a healthy weight throughout life.

Keep in mind that these tips are about reducing -- but not eliminating -- cancer risk. Many factors, including genes and environmental factors, affect cancer risk; diet and exercise aren't the whole story, but they're within your power to change.