Regular Word on Health readers will recall that last year we brought you news of a successful, yet controversial, new treatment for inflammatory bowel disease – fecal microbiota transplantation. While we remembered to warn you of the “yuck factor” associated with this post, we never thought to add the caution “don’t try this at home.”

Seems we should have.

Lately, stories about the success of at-home fecal transplants have been spreading virally, or should we say bacterially, across the internet!  Stranger still, some respected science writers  and researchers have expressed support for the procedure. People are literally buzzing about the possibilities.

Dr. Lawrence Brandt, head of gastroenterology at Montefiore Medical Center in the Bronx, says that he receives several emails a week from people begging for fecal transplants. While they used to come only from people suffering from bowel disease, now he’s getting requests from people who are hoping to beat diabetes, autism, asthma, MS and obesity too.

As it’s not clear whether gut bacteria can help with any of these complaints, many doctors are unwilling or unable to help.

And that’s why, it seems, patients are now doing it themselves.

Chris Gorski is one such person prepared to take this drastic step. Last year, his daughter developed a gut infection that caused severe and chronic diarrhea. Despite antibiotics, she still has symptoms and now Gorski worries that the infection will destroy the lining of her intestines and affect her for the rest of her life.  Armed with what he’s read on the internet, and a burning desire to help his daughter, he’s decided to collect some of his own stool, strain it, and then squirt it into her body using colonoscopy instruments.

He hopes that his “good bacteria” will become established in the girl’s body and repair her gastrointestinal tract.

Gorski’s plan may sound gross, but he argues that what he’s doing is revolutionary. In an age when probiotics, are being extolled for their beneficial qualities, he says his solution is just an extension of living medicine.

Do you think this is a good idea, or how shall we say it, just a crappy one?!?  Let us know what you think.

A new review of the origin of syphilis supports the theory that the sexually transmitted disease was carried to Europe aboard Christopher Columbus’ ships.

“Syphilis has been around for 500 years,” says study co-leader Molly Zuckerman, assistant professor at Mississippi State University. “People started debating where it came from shortly afterwards, and they haven’t stopped since.

Although syphilis was one of the first global diseases, understanding where it came from and how it spread may help us combat diseases today. Prior to Columbus’ voyage in 1492, syphilis did not exist in Europe or the Old World.

After analyzing the evidence from 54 reports, the team from Emory found that before Columbus’ historic voyage to the New World, skeletal material lacked the diagnostic characteristics for chronic syphilis, such as small holes in the skull and long bones.

Their appraisal, published in the Yearbook of Physical Anthropology, suggests that someone sailing with Columbus carried Treponema – the bacteria that causes syphilis back to Europe. Treponema can cause other diseases, such as yaws and pinta, that are spread through skin-to-skin or oral contact in tropical climates.

Their theory is that the bacteria mutated into the sexually transmitted form to survive in the cooler and more sanitary conditions of Europe.

“In reality, it appears that venereal syphilis was the byproduct of two different populations meeting and exchanging a pathogen,” Zuckerman said. “It was an adaptive event, the natural selection of a disease, independent of morality or blame.”

That said, we’re still blaming Columbus!

To avoid such violations, drug companies have introduced promotional review committees and other measures to keep marketers on the straight and narrow.   Additionally, they’ve hired Compliance Officers, regulatory staff and legal counsel.  Now it seems, pharma may have to add house-keeping to the mix!

Last summer, NeurogesX, a San Francisco-based biopharmaceutical company exhibited at the American Academy of Nurse Practitioners meeting in Las Vegas to promote Qutenza  - a capcaisin treatment for neuropathic pain associated with postherpetic neuralgia; a condition that occurs as a result of nerve damage after an outbreak of shingles.

The NeurogesX exhibit included an eye-catching promotional panel for Qutenza featuring a polar bear. The panel made various effectiveness claims, and included all the risk and safety claims required by the FDA.  So, what’s the problem?

Well, according to a Warning Letter sent to the company the risk information was inaccessible to those who stopped or walked by because it was obscured by bags, boxes and other stuff! As a result, the FDA deemed the entire booth to be false or misleading.

How did the FDA know? Well, apparently three different personnel from the FDA Office of Prescription Drug Promotion, visited the booth separately at three different times, meaning this was not a one-off occurrence.

So, was this a simple case of carelessness or was NeurogesX trying to hide the risk information? I’m not sure we’ll ever know the truth, but it’s clear the FDA is “cleaning house” – one exhibit booth at a time.

Was the Agency justified?  If they really care about safety why didn’t they say something at the time, rather than let the boxes obscure the data throughout the show?  Let us know what you think.

Seems like only yesterday we were wondering If MLK had lived – would he have had asthma?

In the intervening time we have posted 320 blogs on 175 different topics.

And it seems you like them. The number of subscribers and Word on Health readers has grown exponentially.

A year ago we were pleased to report a total of 14,697 views. This year, that number is >90,000.

In 2012 we’d like to hear more from you and to bring you more of the stories you’re interested in. So we’ve also revamped the site to make it easier for you to comment – so let us know what you think of our new look.
Tell us what’s on your mind, tell your friends about us. We look forward to reporting even higher numbers next year.

In the meantime, from the entire SRxA team we’d like to say a huge THANK YOU to everyone who has supported us.

What Martin Luther King would have thought about President Obama’s health care reform requirement that all Americans buy health care insurance?

Sarah Palin wrote that, “He fought for liberty and equality because he knew they were God-given and he knew that no government should be empowered to thwart our freedom.”  The implication, being that King would have been against health care reform because it would be a blow to freedom.

Others have complained that the bills don’t go far enough towards King’s vision of equality.  They point out that millions will remain uninsured. Expensive health plans could hurt middle class workers, and the subsidies don’t go far enough towards helping poor families.  They are probably right to a certain extent – King would have pushed for a bill that did more to help poor and working families, and a bill that covered everyone.

So what do we think? Certainly Dr King would have wanted to see improved access to care for minority populations.

Health disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos. When compared to European Americans, minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes. Minorities also have higher rates of cardiovascular disease, HIV/AIDS, and infant mortality than whites.  Additionally:

• African Americans have higher rates of mortality than any other racial or ethnic group for 8 of the top 10 causes of death. For example, the cancer incidence rate among African Americans is 10% higher than among European Americans.
• U.S. Latinos have higher rates of death from diabetes, liver disease, and infectious diseases than do non-Latinos.
• Adult African Americans and Latinos have approximately twice the risk as European Americans of developing diabetes.
• Native Americans suffer from higher rates of diabetes, tuberculosis, pneumonia, influenza, and alcoholism than does the rest of the U.S. population.

In some cases these inequalities are a result of income and a lack of health insurance.. Almost two-thirds of Hispanic adults aged 19 to 64 were uninsured at some point during the past year, a rate more than triple that of working-age white adults. One-third of working-age black were also uninsured or experienced a gap in coverage during the year. Compared with white women, black women are twice as likely and Hispanic women are nearly three times as likely to be uninsured.

A patients’ race also influences physician prescribing. Numerous studies have found racial differences in prescribing and treatment patterns for hypertension, hypercholesterolemia, cancer, pneumonia and diabetes.

Race has played a major role in shaping systems of medical care in the United States. The divided health system persists, in spite of federal efforts to end it. We hope that those in a position to change such inequalities take today, to reflect how such change can be implemented.

Our heartfelt condolences go out to her family and friends. We dedicate this blog as a tribute to her and all the other children who have lost their lives to anaphylaxis.

Although there’s no cure for food allergies, as we’ve reported in the past, such deaths are almost entirely preventable with proper education and immediate treatment with epinephrine.   And even though we don’t know all the details of this case, what we do know is that food allergies are on the rise. 8% of children under age 18 in the United States have at least one food allergy.

Now, we’d like your help to prevent a similar tragedy from happening in the future.

The American Academy of Allergy, Asthma and Immunology’s  Be S.A.F.E. campaign is dedicated to educating patients and healthcare professionals on the steps needed to save lives. We urge you to read the campain’s action guide and share it with your colleagues, friends, and relatives. If you have kids in school, make sure the teachers are aware of it. If you use a gym, make sure the trainers know. Tell your favorite restaurant, share with your employer…the list goes on and on.

BE SAFE

Seek immediate medical help. Call 911 and get to the nearest emergency facility at the first sign of anaphylaxis, even if you have already administered epinephrine.

Identify the Allergen. Think about what you might have eaten or come in contact with – food, insect sting, medication, latex – to trigger an allergic reaction. It is particularly important to identify the cause because the best way to prevent anaphylaxis is to avoid its trigger.

Follow up with a Specialist. Ask your doctor for a referral to an allergist/immunologist, a physician who specializes in treating asthma and allergies. It is important that you consult an allergist for testing, diagnosis and ongoing management of your allergic disease.

Carry Epinephrine for emergencies. If you are at risk for anaphylaxis, make sure that you carry an epinephrine kit with you at all times, and that family and friends know of your condition, your triggers and how to use epinephrine. Consider wearing an emergency medical bracelet or necklace identifying yourself as a person at risk of anaphylaxis. Teachers and other caregivers should be informed of children who are at risk for anaphylaxis and know what to do in an allergic emergency.

So there you have it. 4 simple steps that could save lives. Go share them!

The New Year brings with it many new possibilities, including, unfortunately a new flu season.

So far, the number of flu cases in 2012 is down, thanks largely to the unprecedented mild weather over most of the US. A sharp contrast to 2009 when H1N1 (or swine flu) killed more than 18,000 people worldwide or 1918 when the flu virus infected around a third of the world’s population and killed at least 50 million people.

New research shows that the reason so many people died in both of those years wasn’t the influenza virus itself, but the immune system’s reaction to it.  It turns out that the virus destroys its host by turning the body’s own defenses against itself.

“While trying to destroy flu-infected cells, your immune system also destroys legions of perfectly healthy cells all over your body. This is why, even though the virus itself rarely ventures outside the lungs, the symptoms of the flu are so widespread” says , Michael Oldstone, a virologist at the Scripps Research Institute in La Jolla, Calif.

Most of the time this immune response isn’t too severe. As the virus runs its course, the response subsides. But in some cases, an infection can trigger a reaction so destructive it can be fatal. Scientists call this a cytokine storm, because of the violent way immune cells respond to a virus. Cytokines usually help fight off infections by telling the immune system which specific viral cells it should be attacking, but sometimes an overabundance of cytokines floods into a part of the body, and that’s when you get a storm.

Cytokine storms are rare, but they may be more common among younger people because they have stronger immune systems, and are more prone to overreactions. This may explain one of the more surprising outcomes of the 2009 swine flu: that it was deadlier among young people than it was among the elderly.

Cytokine storms can cause serious damage throughout the body, especially in the lungs, which is why most flu deaths are attributed to pneumonia.

After 5 years of research, Oldstone and his colleagues have identified a cell — they call S1P1 – that responds to cytokines. More importantly they’ve also figured out how to turn off that cell’s signals. This could pave the way for a new class of immune-reaction-blocking drugs that could provide protection against cytokine storms and be more effective than antiviral drugs.

Cytokine-blocking drugs could target the flu effects that cause the most damage to the body and would avoid the problems of virus mutation because they don’t affect the virus itself.

Still, it will probably be many years before those drugs reach your local pharmacy. Although preliminary experiments in mice have shown very promising results they still have to replicate these in ferrets, then primates and finally, humans.

Do you have any flu stories to share? SRxA’s Word on Health would love to hear from you.

According to a study published in the December 28, issue of Neurology, people with diets high in vitamins and omega 3 fatty acids are less likely to have the brain shrinkage associated with Alzheimer’s disease.

People who ate diets high in omega 3 fatty acids and in vitamins B, C, D, E also had higher scores on mental thinking tests than people with diets low in those nutrients.  Omega 3 fatty acids and vitamin D are primarily found in oily fish. The B vitamins and antioxidants C and E are primarily found in fruits and vegetables.

Conversely, the study showed that people with diets high in trans fats were more likely to have brain shrinkage and lower scores on the thinking and memory tests than people with diets low in trans fats. Trans fats are primarily found in packaged, fast, fried and frozen food, baked goods and margarine spreads.

The study included over 104 people, with very few risk factors for memory and thinking problems. Blood tests were used to determine the levels of various nutrients in the blood of each participant. Participants also took tests of their memory and thinking skills and underwent MRI scans to measure their brain volume.

The nutrient biomarkers in the blood accounted for a significant amount of the variation in both brain volume and thinking and memory scores. For the thinking and memory scores, the nutrient biomarkers accounted for 17% of the variation in the scores. Other factors such as age, number of years of education and high blood pressure accounted for 46% of the variation and, the nutrient biomarkers accounted for 37% of the variation seen in brain volume.

“These results need to be confirmed, but obviously it is very exciting to think that people could potentially stop their brains from shrinking and keep them sharp by adjusting their diet,” said study author Gene Bowman, ND, MPH, of Oregon Health & Science University.

Although the average age of study participants was 87, we’re going to start heeding this advice now. Salmon salad anyone?