Did Michelangelo hide an anatomy lesson in the Sistine Chapel?

A detailed analysis of Michelangelo’s Sistine Chapel frescoes reveals a secret that’s been hidden, in plain sight, for 500 years – an image of the human brainstem.

According to an article in the May issue of Neurosurgery, the concealed neuroanatomy is found in Michelangelo’s painting of the Separation of Light from Darkness.  This panel is one of a series of nine showing scenes from the Book of Genesis.

History shows that Michelangelo was an avid student of anatomy, who performed cadaver dissections throughout his life. “We speculate that during his numerous dissections, Michelangelo possibly dissected the brain and spinal cord and that over the years he probably acquired a sophisticated understanding of gross neuroanatomy,” writes medical illustrator Ian Suk and neurosurgeon Rafael Tamargo.

The two were tipped off to the anatomical renderings by Michelangelo’s unusual approach in this painting of God, including a bumpy neck and bunched up clothing that cloaks the figure. In fact, they now think, the twists and turns of the fabric are actually depicting intricate neural networks and a spinal cord.

They aren’t the first to suggest that Michelangelo included images of the brain in his Sistine Chapel frescoes. In a 1990 paper published in JAMA, Frank Meshberger concluded that “The Creation of Adam,” concealed a meticulous anatomical rendering of the human brain.

“We speculate that having used the brain motif successfully in the Creation of Adam almost a year earlier, Michelangelo wanted to once again associate the figure of God with a brain in the iconographically critical Separation of Light From Darkness.”

Nevertheless, the authors acknowledge the perils of over-interpreting a masterpiece and that not all art historians will agree with their conclusions.

What was Michelangelo saying by constructing the voice box of God out of the brain stem of man?  Is it a sacrilege or homage?”

Let us know what you think.

COPD – E

Word on Health was interested to note that regular use of vitamin E in women over 45 may help decrease the risk of chronic obstructive pulmonary disease (COPD), according to researchers at Cornell University and Brigham and Women’s Hospital. Long-term, the risk falls by approximately 10% in both smokers and non-smokers.

“As lung disease develops, damage occurs to sensitive tissues through several proposed processes, including inflammation and damage from free radicals,” commented Anne Hermetet Agler, of  Cornell University’s Division of Nutritional Sciences. “Vitamin E may protect the lung against such damage.”

Previous research had found that higher intake of vitamin E was associated with a lower risk of COPD, but this is the first time it has been shown that increasing vitamin E intake can prevent COPD.

In this study, nearly 40,000 women aged 45 years and older were randomized to receive either 600 mg of vitamin E or a placebo every other day.  Although fewer women taking vitamin E developed COPD, the supplement appeared to have no effect on asthma.

If results of this study are borne out by further research, clinicians may recommend that women take vitamin E supplements to prevent COPD.

While this may be good news for some, Word on Health reminds its readers that vitamin E supplements are known to have detrimental effects in some people. For example it can cause increased risk of congestive heart failure in cardiovascular disease patients. As such, any future recommendations would need to balance both benefits and risks.

Do you have COPD, or tips for those who are living with the disease?  If so, SRxA’s Word on Health is waiting to hear from you.

FDA Criticized by the Government Accountability Office

Normally, it’s  pharmaceutical companies that come under the scrutiny of the FDA.  However, in an interesting twist of fate, the FDA  itself is now under fire for not enforcing its own rules.

Physicians have an innate tendency to trust governing medical entities such as the American Medical Association (AMA), Food and Drug Administration (FDA) and Centers for Disease Control (CDC). Maintaining a reproducible and sustainable standard for reporting clinically relevant pharmaceutical data for new and established drugs has always been a priority for the FDA.

In December 2000, the  FDA issued a call to improve the professional labeling of drug  package inserts and other accredited drug information sources i.e.  the Physician Drug Reference (PDR). In 2006, the standard format for package inserts was modified in an attempt to make it more user-friendly and to serve as an efficient resource tool for patients, physicians, and researchers.

In today’s fast-changing challenging healthcare environment, physicians tend to accept this reported data, and the lack of it, as this is all there is available to them.

However, many would like to know more. For example, how to manipulate a drug dose for a patient with renal failure based on given elimination half life.  Although vital to the management of such patients, all too often, such information is not yet an option for many of FDA approved drugs.

The United States Government Accountability Office (GAO) recently concluded that the FDA lacks a clear and effective process for postmarket drug safety issues. The GAO  also observed that there is a lack of criteria for determining what safety actions to take and when to take them.

This finding is supported by research from  Wesley College, Delaware.   Using the commercially available KnowItAll^® informatics platform from Bio-Rad Laboratories, researchers built a Cancer Drug Database containing 85 chemotherapy drugs.  They found that the  reporting of important biological properties such as bioavailability (BIO), plasma protein binding (PPB), elimination half-life (t_1/2), volume of distribution (V_D), and water solubility were found to be markedly deficient.

According to Malcolm J. D’Souza, Ph.D “The evidence is so compelling that the apparent laxity in enforcing reporting regulations for many of these pharmaceuticals is alarming.”

Perhaps the real impact of this research is the red flags it raises.  The FDA guidelines need to be revisited with emphasis on vigilance in reporting all parameters that directly or indirectly affect patient care.

Until the FDA has its house in order, we wonder how much, and for how long either physicians and pharma will continue to trust their own regulatory bodies.  Let us know what you think.

Brains on Bikes

When Word on Health heard that brain cancer survivor Anne Feeley’s three month cycling trip across the U.S. would culminate in our home town of  Washington DC, we just had to be there.  Which is why, last Saturday your very own blogger, cheerfully  braved  100+ degree temperatures and city traffic to accompany Anne and her cycling partner Gundy on the final leg of this inspiring journey.

We were joined, by several brain cancer survivors, including local fundraiser, athlete and friend  extraordinaire BethAnn Telford, as well as others like us, who were simply touched by Anne’s story and wanted to help her spread the message.

After being diagnosed with glioblastoma multiforme, a malignant brain tumor, in 2006, doctors told Feeley that her chances of survival were slim.  But she was determined not to take the diagnosis lying down.  So far she has defied the odds and the mean post-diagnosis life expectancy of 15 months. Not only is she still alive, she is in remission and redefining what it means to live with brain cancer.

“I began my exercise routine while the staples were still in my head. Some days I cried all through the yoga class, but I did it,” says Feeley.

After just a few months, she began competing in running, cycling and mountain climbing events.   “When I first attempted running, I could only manage seven steps. We slowly worked at it and less than a year later I finished a half marathon. My finishing time wasn’t great, but I finished and I felt wonderful.”

To those who say she’s one of the lucky ones, Anne responds, “It shouldn’t be about luck; it should be about science.” We need better treatments, there have only been three treatments developed in 35 years. … I want to change that.”

And change that she has.  To raise awareness and research funding for the disease she had worked so hard to overcome, and Feeley founded Brains on Bikes.  Now, having completed 4,170-miles and raised over $1.5 million, she says  “This is just the beginning.”

100% of the money raised will go to help brain cancer patient and to fund research. To donate, or find out more, please visit http://brainsonbikes.org/

“Ouchless” Flu Vaccine

Instead of getting a BandAid after your flu shot, a new delivery patch could actually allow people to receive their vaccine this way.

The patches contain hundreds of tiny little needles, so small you don’t even feel them, that dissolve into the skin and release the vaccine. The result –  simplified immunization programs. By eliminating the use of needles and syringes, three of the biggest problems simply disappear.

• fear of needles
• disposal of leftover needles and syringes
• the need for trained medical personnel

The microneedle patches are applied like a BandAid and could allow self-administration of vaccine during pandemics as well as in schools and assisted-living facilities.  They could also simplify large-scale immunization programs in developing nations.

Researchers led by Professor Mark Prausnitz of Georgia Institute of Technology reported their research on microneedles in Sunday’s edition of Nature Medicine.

The business side of the patch apparently feels like fine sandpaper. In tests,  people rated the discomfort at 1/10th – 1/20th that of getting a standard injection. In other words, nearly everyone said it was painless.

The patch, which has been tested on mice, was developed in collaboration by researchers at Georgia Tech and Emory University. The work was supported by the National Institute of Health. The researchers are now seeking funds to begin tests in people and, if all goes well, the patch could be in use in five years.

Flu vaccination is recommended for nearly everyone, every year. According to Prausnitz, “Many people don’t get the shot because it’s inconvenient, but if they could get it in the mail or at the pharmacy they might do so.” The patch is placed on the skin and left for 5  to 15 minutes although it can remain longer without doing any damage.

Asked if the term “microneedle” might still frighten some folks averse to shots, Prausnitz said he was confident that marketers would come up with a better term before any sales began.

SRxA’s Word on Health challenges you to come up with some creative ideas.

Advair Diskus Warning Issued By FDA Over Stolen Asthma Inhalers

Federal drug regulators and law enforcement officials are warning physicians, pharmacists and patients to be on the lookout for stolen Advair Diskus inhalers.

The FDA issued a stolen Advair Diskus warning on July 16, alerting consumers and pharmacists that Advair inhalers, stolen in 2009, have been turning up in pharmacies. The FDA warns that the effectiveness and safety of these asthma inhalers cannot be verified as the distribution channel integrity has been breached.

The inhalers were stolen in a Hollywood-style heist last August from a GlaxoSmithKline warehouse in Chesterfield, Virginia. Police say the thieves cut a hole in the ceiling and rappelled down using a trapeze-like device, swiping 25,600 inhalers worth more than $6 million. Law enforcement officials say they suspect the same group was responsible for an even more spectacular robbery at an Eli Lilly warehouse in Connecticut in March, where they again cut a hole in the roof and rappelled to the floor, getting away with $75 million in drugs.

The FDA warns that the stolen inhalers include 60-dose Advair Diskus 250/50 inhalers with a lot number of 9ZP2255 – NDC 0173-0696-00, and 60-dose Advair Diskus 500/50 inhalers with a lot number of 9ZP3325 – NDC 0173-0697-00.

According to FDA, the drugs may have been compromised by being stored in the wrong temperature or humidity, may have been tampered with or could have become contaminated.

The agency is urging anyone who has purchased an inhaler from the affected lots to stop using them immediately, contact GlaxoSmithKline and follow up with their physician or pharmacist to get a replacement. The FDA also urges any pharmacists or wholesalers who find the stolen drugs on their shelves to contact the FDA’s Office of Criminal Investigations at www.fda.gov/oci.

F as in Fat

Adult obesity rates increased in 28 states in the past year, and declined only in the District of Columbia.

According to F as in Fat: How Obesity Threatens America’s Future 2010, a report from the Trust for America’s Health and the Robert Wood Johnson Foundation, more than two-thirds of states (38) have adult obesity rates above 25%. In 1991, no state had an obesity rate above 20%.

10-out-of-the-11 states with the highest rates of obesity were in the South, with Mississippi weighing in with the highest rates for all adults (33.8%) for the sixth year in a row.

“Obesity is one of the biggest public health challenges the country has ever faced, and troubling disparities exist based on race, ethnicity, region and income,” stated Jeffrey Levi, executive director of Trust For America’s Health.

Additional key findings included:

• Adult obesity rates for African-Americans topped 40% in nine states, 35% in 34 states, and 30% in 43 states and D.C.
• Rates of adult obesity for Latinos were above 35% in two states (North Dakota and Tennessee), and at 30% and above in 19 states
• 10 of the 11 states with the highest rates of diabetes are in the South, as are the 10 states with the highest rates of hypertension
• The number of states where adult obesity rates exceeded 30% doubled in the past year, from four to eight — Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee and West Virginia
• Northeastern and western states had the lowest adult obesity rates — Colorado remained the lowest at 19.1%.

The numbers speak for themselves. Adult obesity rates continue to rise in the United States. And obesity rates continue to be significantly higher among specific ethnic and racial groups, particularly non-Hispanic black girls and Hispanic boys. But there are encouraging signs. This year’s F as in Fat report offers ample evidence that individuals, families, government, the business community, educators, health care providers are increasingly willing to invest time, energy and resources to solve the obesity crisis.

Meantime, it is up to all of us to take the momentum around obesity, health, disease prevention and wellness and carry it forward.

SRxA’s Word on Health invites you to weigh in on this hefty issue.

Oral Corticosteroids as Effective as Intravenous Dosing in COPD

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States.  It affects more than 6 percent of adults in the US, and accounts for $32 billion in direct health care costs. Each year there are approximately 600,000 hospital admissions for acute exacerbation COPD, making this 1 of the 10 leading causes of hospitalization nationwide.

Systemic corticosteroids are known to be beneficial for patients hospitalized with acute exacerbation of COPD; however, their optimal dose and route of administration has, until now, been uncertain.

According to a new study published in JAMA , despite guidelines recommending use of the low-dose oral route, a higher-dose intravenous route was used in 92% of patients admitted to over 400 U.S. hospitals.

Researchers compared the outcomes of those initially treated with low doses of steroids administered orally to those initially administered high dose intravenous steroids during the first 2 hospital days.

The primary outcome analyzed was a composite measure of treatment failure, defined as the initiation of mechanical ventilation, in-patient mortality, or readmission for acute exacerbation of COPD within 30 days of discharge.

After results were adjusted for various factors including patient, hospital, and physician characteristics, the risk of treatment failure among patients given low doses of steroids orally was not significantly different from those treated with high-dose steroids intravenously. Also, pa­tients treated with low doses of steroids administered orally had shorter lengths of hospital stay and lower costs.

The authors concluded that the use of high dose intravenous steroids does not appear to be associated with any measurable clinical benefit and at the same time exposes patients to the risks and inconvenience of an intravenous line, potentially unnecessarily high doses of steroids, greater hospital costs, and longer lengths of stay.

An editorial in the same journal added that the results “are sufficient to take action to change practice now.”

Or as we frequently say here at Word on Health – less is sometimes more!

Asthma Warning for Pregnant Women

It may surprise some of our readers to learn that asthma is the most common serious complication of pregnancy.  In fact, up to 55% of women will have at least one acute asthma attack during pregnancy.

Pregnancy may affect asthmatic patients in several ways. Hormonal changes may affect the nose, sinuses and lungs. An increase in estrogen contributes to congestion of the tiny blood vessels in the lining of the nose. A rise in progesterone causes increased respiratory drive, and a consequent feeling of shortness of breath.

Yet, despite this, many pregnant women are just not identified as asthmatic. All too often asthma is not reported by moms-to-be during antenatal visits and is therefore under-treated. Then there are those who know they have asthma but fail to take their controller medications for fear they harm the baby.

Such concerns appear to be unjustified.  According to the American College of Asthma, Allergy and Immunology (ACAAI), well-controlled asthma is not associated with significant risk to mother or fetus.

Uncontrolled asthma, on the other hand, can cause serious complications to the mother, including:

• high blood pressure
• toxemia
• premature delivery
• death

For the baby, complications of uncontrolled asthma include:

• increased risk of stillbirth
• fetal growth retardation
• premature delivery
• low birth weight
• a low APGAR score at birth

The Pregnancy Committee of ACAAI advises that the risks of asthma medications are lower than the risks of uncontrolled asthma. They suggest that women discuss the use of asthma or allergy medication needs with their doctor, ideally before pregnancy.

SRxA’s Word on Health would like to hear your asthma and pregnancy stories.

New Perspective on Pharma- Physician interaction

Despite ever increasing regulations, and even though some institutions and medical societies have adopted policies that limit or ban such practices, new research shows that most physicians and doctors-in-training still have a positive attitude toward the marketing activities of pharmaceutical companies.

According to the study published in the June Archives of Surgery 72% of surveyed doctors and medical students said sponsored lunches were appropriate. Nearly 60% said samples improve care for their patients, and 71% said pharmaceutical and device company money is useful for funding residency programs.

Additionally, the majority of doctors thought that educational material supplied by pharma (68.8%) and device (78.5%) companies was a useful way to learn about new products.

There were limits, though. About 3:4 respondents believed gifts valuing more than $50 were unacceptable and almost all thought vacations were inappropriate.

The study authors polled almost 600 faculty and medical trainees at 11 New York City hospitals that have banned or limited the interaction between physicians and industry.

Some difference was seen between different physician groups. Surgeons were more likely to have a positive attitude toward industry. They believed that gifts, such as residency funding and travel reimbursement for attending lectures, are acceptable. Pediatricians held less favorable attitudes.

Interestingly, 73.2% of physicians thought that their institution should allow physician-pharma interaction while almost the same number (72.7%) strongly believe that their prescribing was not influenced by industry marketing practices.

Clearly, not all physician-industry interactions are created equal. While politicians and regulators would have physicians shun all contact with the pharmaceutical and device industries, many doctors believe such relationships are healthy and beneficial.

Before regulators rushed to reduce conflict-of-interest, maybe they should have talked to the very people most impacted by the rules.  Word on Health is not surprised that doctors take umbrage at the suggestion that a pen or a sandwich paid for by industry might affect their judgment. The public demonization of financial relationships between physicians and industry, although widespread, is not supported by any conclusive evidence.

Despite this, relationships continue to be investigated and regulations become more rigorous. Are they too much or too little?  We’d love to hear your views on this. Please leave a comment below.