Spanx Takes a Spanking

Spanx has been in the news a lot lately. First, Forbes magazine announced that Sara Blakely, founder of the women’s slimming undergarments company, had joined the billionare’s club this year. At age 41, and having started her business at home with just $5,000, Blakely is now the world’s youngest self-made female billionaire.

Last month, Oscar winning actress Octavia Spencer, hit the headlines when she revealed, what she’d not been revealing!  Turns out, when she took home the SAG Award for Outstanding Actress in a Supporting Role for The Help, she’d been wearing three pairs of Spanx under her gown.

Now it seems the trend has spread from the red carpet to the green turf. This week, ConsumerReports.org warned of the dangers of teens in Spanx. The on-line watchdog reported the tale of a 15-year-old high school soccer player who was recently referred to her doctor because of numbness, tingling, and discomfort in her left thigh that had bothered her for a few weeks. The diagnosis: a compressed nerve in her pelvis. The likely cause: Spanx. While doctors have previously warned of the health dangers associated with skinny jeans, such as  fertility problems , bladder infections , and blood clots the doctor in question was surprised that a girl so young and fit would wear Spanx. It turns out that her entire team wears them under their soccer uniforms.

Body slimmers are the latest fad to hit the athletic fields. Sold in an assortment of bright colors, they appeal to teenage girls who play soccer, lacrosse, and softball. However, in an attempt to conceal their spandex, these girls are rolling down the waistline of their Spanx and unwittingly pressing a tight band of Lycra into their groins. The result: injuries normally associated with direct trauma or repetitive stretching and contraction of the groin muscles. The treatment: in this case, the doctor advised his patient to ditch the Spanx, and retire her skinny jeans. Not that Sara Blakely needs to worry, according to Forbes, her billion dollar business is set to at least double in size in the coming years.

Improving Inhaler Instruction

Many of us have never been properly trained on how to do or use certain things we really should be good at. Putting on condoms and wearing seat belts are just two that come to mind.  And when we get them wrong, the health consequences can be serious.

The same goes for asthma inhaler use.  Do you shake the device first? Did you breathe in with sufficient force? Did you press the canister at the right time?

Improper use of inhalers is a serious and expensive problem. In the US, 3 patients are admitted to the emergency room with asthma every minute, that’s >5,000 people a day!  Worse still, according to the Asthma and Allergy Foundation of America, 11 people die from asthma every day.

One study estimated up to 94% of patients use their inhalers incorrectly.  The most common mistakes include failure to exhale before actuation, failure to breath-hold after inhalation, incorrect positioning of the inhaler, incorrect rotation sequence, and failure to execute a forceful and deep inhalation. Those of us in healthcare have even seen patients who fail to take the cap off the inhaler before use, and others who use it nasally rather than orally.

This is hardly surprising given that many patients never receive instructions on how to use their inhalers and even those that do, are not routinely followed.  And let’s face it, some of these devices could use training wheels.

Enter the T-Haler, a digital asthma inhaler training device  developed by researchers at Cambridge Consultants.

Patients with asthma can use the inhaler and, via interactive software linked to the wireless device, get real-time visual feedback on the areas that need improving.

Specifically, whether patients have shaken the device before breathing in; whether they use sufficient force when breathing in; and whether they press down the canister that releases the drug at the optimal time. Click here to see a video of the T-haler in action.

Although still a conceptual product, the company says it has been designed as a training device to be available at pharmacies, schools, and clinics for children and adults alike.

They performed a study on 50 people aged 18 – 60 who had no prior experience with either asthma or inhalers and were given no instruction on how to use an inhaler. When tested, about 80% of the participants used an inhaler incorrectly.

They were then given the T-Haler with no further instruction and told to begin. A three-minute on-screen tutorial guided them through the proper use of an inhaler, and the success rate tripled to more than 60%.

Without any human direction beyond the word ‘go’, participants went from around a 20% success rate without training to a success rate of more than 60% after only three minutes with the T-Haler device,” said Kate Farrell, a senior design engineer, in a news release. “This is more than twice the compliance rate we have seen in other studies with trained participants. Interestingly, a week later, 55 percent were still correctly using the device-showing that they retained what they learned.”

Whether the T-Haler itself will ever make it to market remains to be seen, but the concept of a 3-minute training device seems a no-brainer when it comes to properly using a device that may very well save the lives of the estimated 235 million asthma sufferers worldwide.

Feeling Fruity?

I’m sure all of our readers are familiar with the old saying, “An apple a day keeps the doctor away.”

Which, of course, got us musing, what about other fruit?  Well, it turns out that “An orange a day may keep strokes away!”  At least, it seems, for women.

According to a study just published in Stroke eating high amounts of citrus fruit, such as oranges and grapefruit, reduces the risk of ischemic stroke by 19%.

Researchers say the key to the reduced risk is a certain flavinoid found in citrus – flavonones. Citrus fruits and juices are the main dietary source of flavanones.

The findings were part of the Nurses’ Health Study, which included nearly 70,000 women who were followed for 14 years and reported on their dietary intake every four years.

While the risk of stroke was lower in those who ate citrus fruit, not all of the women’s flavonoid consumption came from citrus fruit. Flavonoids are also found in other types of fruit, vegetables, tea, and best news of all…dark chocolate and red wine.

This study confirms a previous findings that vitamin C and potassium, both of which are found in citrus fruits can protect against  heart disease, ischemic stroke and intracerebral hemorrhage.

Although some experts say that further prospective studies are needed to confirm these associations, we know what we’ll be putting in our shopping carts this week.

Botox, Brotox & Bladders

When someone mentions Botox injections, you probably think of Hollywood actresses with too perfect faces or wealthy housewives desperately trying to turn back time. Yes, we know it’s becoming more main stream, so maybe you’re also thinking about your own appointment for “shots” or maybe even “BroTox”. What we’re pretty sure you’re not thinking about is – incontinence. However, that’s exactly its newest use. Recently, the FDA approved using the injections to help patients with neurological conditions (such as multiple sclerosis or spinal cord injury) who suffer from either incontinence, or an overactive bladder. Neurologic conditions can cause miscommunication between the bladder and the brain.  As a result, the bladder muscle can become overactive, increasing the pressure in the bladder and decreasing the volume of urine the bladder can hold. This can lead to frequent, unexpected urine leakage, or urinary incontinence. Botox works by paralyzing bladder muscles, thus preventing the contractions that cause urgency or leakage. Although medications and behavioral modifications are treatment options, many patients, especially the elderly, do not respond to these methods and need a more aggressive approach. “About 80 percent of patients with neurological conditions, such as spinal cord injuries, Parkinson’s disease and multiple sclerosis, see improvement after about a week, and the results can last four to nine months,” says Charles Nager, MD, co-director of the UC San Diego Women’s Pelvic Medicine Center at UC San Diego Health System. Incontinence is the seventh condition, including chronic migraines, upper limb spasticity and underarm sweating, that Botox has been approved to treat since it first arrived on the market in 2002. The outpatient procedure uses a local numbing gel, followed by 15 -20 injections in different areas of the bladder muscle. “It can really be life changing for someone with severe incontinence issues,” said Nager. Want to share your Botox stories with SRxA’s Word on Health?  We’d love to hear from you.

Time to Give Pharma a Break?

The pharmaceutical industry has been under attack again this week. It’s not unusual for people to complain about the price of medicines and the fat profits of pharma, yet even when the industry tries to reduce the payment burden, or provide educational assistance, it is criticized.

First, there was a series of lawsuits filed by several union health plans against eight large drugmakers. They charge that, rather than save consumers money, prescription drug coupons illegally subsidize co-pays for brand-name meds and can actually increase health insurance premiums.

Then the US Department of Veteran Affairs issued a tough ruling on how sales reps can promote drugs to VA medical facilities in the future. One of the new restrictions concerns educational programs. Starting next month, reps will have to submit educational materials for VA review 60 days in advance of any scheduled meeting.  Additionally, materials will be approved only if industry sponsorship is adequately disclosed; if industry-sponsored data is adequately compared with non industry-sponsored data and if materials do not contain a company name or logo.

Both of these developments are worrying.  The pharmaceutical industry is already the most regulated business in the world. Further restrictions will result in fewer incentives to bring new drugs to market and will further stifle innovation.

Not convinced that it’s time to give pharma a break?  Then consider this:

During the Super Bowl, a representative of Eli Lilly posted the on the company’s corporate blog that the average cost of bringing a new drug to market is $1.3 billion. A price that would buy 371 Super Bowl ads, 16 million official NFL footballs, two pro football stadiums, pay almost all NFL football players, and every seat in every NFL stadium for six weeks in a row. This is, of course, is ludicrous.

Ludicrous and wrong!   In fact, the average drug developed by a major pharmaceutical company costs at least $4 billion, and it can be as much as close to $12 billion.

Company N° of approved drugs R&D Spending Per Drug ($Mil) Total R&D Spending 1997-2011 ($Mil)
AstraZeneca 5 11,790.93 58,955
GlaxoSmithKline 10 8,170.81 81,708
Sanofi 8 7,909.26 63,274
Roche 11 7,803.77 85,841
Pfizer 14 7,727.03 108,178
Johnson & Johnson 15 5,885.65 88,285
Eli Lilly & Co 11 4,577.04 50,347
Abbott Laboratories 8 4,496.21 56,202
Merck & Co Inc 16 4,209.99 67,360
Bristol-Myers Squibb Co. 11 4,152.26 45,675
Sources: InnoThink Center For Research In Biomedical Innovation; Thomson Reuters Fundamentals via FactSet Research Systems

However, in all fairness to our Lilly rep, the drug industry has been tossing around the $1 billion number for years. It is based largely on an industry sponsored study by Joseph DiMasi of Tufts University performed 12 years ago. It’s always been a nice number for the pharmaceutical industry because it seemed to justify the idea that medicines should be pricey without making it seem that inventing new medicines is so expensive an endeavor as to be ultimately futile.

But as can be seen from the table above, that figure is badly outdated.

The range of money spent is stunning. AstraZeneca has spent $12 billion in research money for every new drug approved, as much as the top-selling medicine ever generated in annual sales. Bristol-Meyers Squibb spent just $3.7 billion. At $12 billion per drug, inventing medicines is a pretty unsustainable business. At $3.7 billion, you might just be able to make money –assuming it can keep generating revenue for at least ten years.

So, why is the cost of drug development so high?  Well, a single clinical study can cost $100 million, at the high end. But the main expense, and the main reason for the differences noted above, is failure of potential new drugs during their development.

Has this blog helped to change your views on the industry? As always, SRxA’s Word on Health would love to hear from you.

In a Muddle About Mammograms?

As all of our female readers know, breast cancer is one of the leading causes of premature death in women.  We’ve also been brought up to believe that annual mammographic screening, unpleasant as it is, significantly reduces our risk of dying from breast cancer.

So, it may come as a surprise that mammography screening is now one of the greatest controversies in healthcare.

Those who are unconvinced of the risk:benefit profile of mammograms believe that researchers have sacrificed sound scientific principles in order to arrive at politically acceptable results.

Even neutral observers increasingly feel that the benefits of screening have been oversold and that the harms are much greater than previously believed.

A new book by Professor Peter Gøtzsche entitled Mammography Screening: truth, lies and controversy is certainly going to add further fuel to this already heated debate. Gøtzsche, who heads up the Nordic Cochrane Centre in Copenhagen, has repeatedly published on breast screening over the last decade.

Even those who have been following the debate over breast cancer screening will be surprised by the degree of acrimony, personal attack and bad statistics described by Professor Gøtzsche.

Sure, there have been professional arguments over screening before, but this takes it to a whole new level.

He demonstrates that the evidence on which breast screening programs were set up was inadequate and concludes that breast screening probably doesn’t work.  According to him, the benefits – if any – are marginal and the harm is great.

He also describes the hostility he and his team have been subjected to during their decade-long research in the area. Attacks have come from three groups:

  • disinterested experts
  • oncologists who have spent their careers recommending mammograms
  • those who earn money in the $1 billion screening industry

All in all, this book is painful reading to those of us who believe that research is all about the science. Gøtzsche claims that when there is emotional investment, it becomes harder to disentangle risks and benefits clearly. As a society, we have become attached to screening, despite evidence demonstrating how marginal the benefits and how frequent the harms.  He claims that the lure of ‘catching it early’ and the emotive hard sell seems to have circumvented the usual rigorous review of the evidence.

And he’s not alone.  A few years ago Professor Michael Baum, a surgeon who was involved in setting up the breast screening program in the UK, wrote the book Breast Beating, in which he described the personal cost of opposing the unrelenting push for more screening.

He also criticized the UK’s Breast Screening Program saying:

“Whatever the number, that one woman who benefits from a decade of screening has a life of infinite worth and if screening were as nontoxic as wearing a seat belt there would be no case to answer. However, there is a downside to screening, namely the problem of the overdiagnosis of “pseudocancers”.  For every life saved ten healthy women will, as a consequence, become cancer patients and will be treated unnecessarily. These women will have either a part of their breast or the whole breast removed, and they will often receive radiotherapy and sometimes chemotherapy.”

Following this, an independent review of breast screening in the UK was announced. The review is hoping to answer two fundamental questions: firstly, if it is worthwhile to continue at all, and secondly, if women should be, as they currently are, encouraged to have breast screening or – more simply and more ethically – to consider whether they would like it.

Writing in Pulse Today, Dr Margaret McCartney, a GP in Glasgow suggests that if more women read Professor Gøtzsche’s book, they too would decide not to be screened. She goes so far as to predict that in a few decades, doctors will look back on breast screening with the same raised eyebrows that they currently reserve for Reiki.

To screen or not to screen?  That is the question.  Let us know what you think.

Steroid Side-Effects & Seven-Fold Suicide Risk

Steroids are used to treat a variety of conditions such as rheumatoid arthritis, systemic lupus erththematosus (lupus), myositis (inflammation of the muscles) and vasculitis (inflammation of the blood vessels).  They work by decreasing inflammation and reducing the activity of the immune system, thereby minimizing  tissue damage and organ failure.  At times they can be life-saving.

However, they are always prescribed with caution due to the long list of well-documented physical side-effects such as:

In addition, steroids are known to cause psychological problems such as sudden mood swings, nervousness, restlessness, and depression.

Now a new study reveals another worrisome side-effect.  According to a group of French researchers, patients prescribed oral steroids are nearly seven times more likely to commit or attempt suicide.

In the largest study of its kind, researchers followed 372,696 adult patients treated with oral steroids between 1980 and 2008 and compared them to patients with similar conditions who were not prescribed steroids.

The results of the study were published last month in the American Journal of Psychiatry. They showed that patients taking oral steroids were seven times more likely to commit or attempt suicide compared with those with the same underlying medical disease not treated with oral steroids.

The steroid treated group was also twice as likely to suffer from depression and more than four times as likely to suffer mania.

The authors of the study concluded primary care physicians should educate patients and monitor oral steroids closely. Lead author Dr Laurence Fardet, a consultant in internal medicine at Saint-Antoine Hospital, Paris, called for caution in prescribing oral steroids: “Where it is essential to prescribe a glucocorticoid, patients and their families should be informed about the possibility of these severe adverse events.”

Have you or your loved ones suffered physical or psychological side-effects from oral steroids? Share your stories with us.

Who’s to blame for your allergies?

Are you one of the 35 million Americans who suffer from seasonal allergies? If so you’re probably not cheering the official end of winter.  But before you start blaming Persephone – goddess of Spring, for your symptoms you may want to look a little closer to home.

Many of the everyday things you’re doing, from what you eat to how you clean your home may be interfering with relief from your stuffy nose, sneezing, sniffling or other symptoms.

People with spring allergies often don’t realize how many things can aggravate their allergy symptoms so they just muddle along and hope for an early end to the season,” says allergist Myron Zitt, M.D.“But there’s no reason to suffer. A few simple adjustments in habits and treatment can make springtime much more enjoyable.”

The American College of Allergy, Asthma and Immunology (ACAAI) advises people with spring allergies to be on the lookout for five things that can aggravate suffering.

1. Eating fruits and vegetables – Many people with seasonal allergies also suffer from pollen food allergy syndrome (also called oral allergy syndrome), a cross-reaction between the similar proteins in certain types of fruits, vegetables and the allergy-causing pollen. 1:5 people with grass allergies and as many as 70% of people with birch tree allergies suffer from the condition, which can make your lips tingle and swell and your mouth itch.

If you’re allergic to birch or alder trees, you might have a reaction to celery, cherries or apples. If you have grass allergies, tomatoes, potatoes or peaches may bother you. Usually the reaction is simply annoying and doesn’t last long. But up to 9% of people have reactions that affect a part of their body beyond their mouth and almost 2% can suffer a life-threatening anaphylactic reaction.

2. Using the wrong air filter – Using an air filter to keep your home pollen-free is a good idea, but be sure it’s the right kind. Studies show inexpensive central furnace/air conditioning filters and ionic electrostatic room cleaners aren’t helpful – and in fact the latter releases ions, which can be an irritant. Whole-house filtration systems do work, but change the filters regularly or you could be doing more harm than good.

3. Opening your windows – When your windows are open, the pollen can drift inside, settle into your carpet, furniture and car upholstery and continue to torture you. So keep your house and car windows shut during allergy season.

4. Procrastinating – You may think you can put off or even do without medication this spring, but the next thing you know you’re stuffed up, sneezing and downright miserable. Instead, get the jump on allergies by taking your medication before the season gets under way.

5. Self medicating – Perhaps you’re not sure exactly what’s making you feel awful so you switch from one medication to the next hoping for relief.

This spring, your best bet is to see an allergist, who can determine just what’s triggering your symptoms and suggest the most appropriate treatment.

Springing Forward Safely

SRxA’s Word on Health reminds you to turns your clocks forward an hour before going to bed tomorrow night. But as your dream of that extra hour of daylight, remember all good things come with a price.  First, the switch to summer time means we all lose an hours’ sleep. More worryingly, the time change may be bad for your health.

According to experts at the University of Alabama in the days immediately following the time change your risk of having a heart attack goes up by about 10%.

Because the Sunday morning of the time change doesn’t require an abrupt schedule change for most people, the elevated risk doesn’t kick in until Monday when people rise earlier to go to work.

Interestingly, the opposite happens in the fall, when we turn the clocks back. Then, the risk of heart attacks drops by 10%.

Exactly why this happens is not known but there are several theories,” says Associate Professor Martin Young, Ph.D. from the University of Alabama’s Division of Cardiovascular Disease.  “Sleep deprivation, the body’s circadian clock and immune responses all can come into play when considering reasons that changing the time by an hour can be detrimental to someone’s health.”

Young offers several possible explanations:

Individuals who are sleep-deprived weigh more and are at an increased risk of developing diabetes or heart disease. Sleep deprivation also can alter other body processes, including inflammatory response, which can contribute to a heart attack. Apparently, your reaction to sleep deprivation and the time change also depends on whether you are a morning person or night owl. Night owls have a much more difficult time with springing forward.

Circadian clock – every cell in the body has its own clock that allows it to anticipate when something is going to happen and prepare for it. When there is a shift, such as springing forward, it takes a while for the cells to readjust. It’s comparable to knowing that you have a meeting at 2 p.m. and having time to prepare your presentation instead of being told at the last minute and not being able to prepare.

Immune function – immune cells have a clock, and the immune response depends greatly on the time of day. In animal studies, when a mouse is given a sub-lethal dose of an endotoxin that elicits a strong immune response, survival depends upon the time of day they were given this endotoxin. Mice that were put through a phased advance much like Daylight Savings Time, and then had a challenge to their immune system, died, whereas the control animals that were not subjected to a phased advance survive when given the same dose of the toxin.

Fortunately, the body’s clock eventually synchs to the new time on its own.  In the meantime we offer you some tips to help you ease your body into the adjustment.

  • Wake up 30 minutes earlier on Saturday and Sunday than you need to in preparation for the early start on Monday
  • Eat a decent-sized breakfast
  • Go outside in the sunlight in the early morning
  • Exercise in the mornings over the weekend

These tricks will help reset both the master, clock in the brain that reacts to changes in light/dark cycles, and the peripheral clocks — the ones everywhere else including the one in the heart — that react to food intake and physical activity, thereby reducing the chance of a heart attack on Monday.

Assuming we all survive the annual time change shock to our system, we look forward to seeing you back here after the weekend.

Calculating the Cost of Self-Castration

SRxA’s Word on Health brings you another in our series of “Don’t Try This at Home,” and a word of warning – squeamish gentlemen may want to look away at this point.

The Journal of Sexual Medicine recently published a report entitled “Self-Castration by a Transsexual Woman: Financial and Psychological Costs: A Case Report.”  In it physicians from the GW School of Medicine and Health Sciences discuss the case of a transsexual woman who presented to the emergency room hemorrhaging after undertaking self-castration.

Unsurprisingly, the researchers found that the health care costs associated with treating a patient after self-castration were almost four times greater than if they had undergone an elective outpatient surgical castration.

In this particular case the patient had to undergo emergency surgery including bilateral inguinal exploration, ligation and removal of bilateral spermatic cords, complicated scrotal exploration, debridement, and closure. The patient was then admitted to the psychiatric service for a hospital stay of three days. The total bill was $14,923, rather than the $4,000 it would have cost for an elective outpatient orchiectomy in the patient’s geographical area.

So what on earth would make a patient do this?  According to the authors, the out-of-pocket cost for an elective castration are not covered by health insurance. Additionally, lack of access to a surgeon willing to perform the operation, long waiting times, and underlying psychological and psychiatric conditions may lead transsexual women to attempt the ultimate act of self-mutilation. Patients are often frustrated at the slow pace of their male-to-female transition or lack the money to make it.

But as this report demonstrates, from a financial standpoint, an elective orchiectomy can cost the health care system significantly less than an emergency hospital admission. From a patient safety standpoint, elective orchiectomy is preferable to self-castration which carries significant risks such as hemorrhage, disfigurement, infection, urinary fistulae, and nerve damage.

The authors urge healthcare providers of transsexual women to carefully explore patient attitudes toward self-castration and work toward improving access to elective orchiectomy.

Additionally, in order to reduce the number of self-castrations, Word on Health suggests that more urologists who are willing to perform surgery on transsexuals should be identified and more pressure needs to be put on health care insurance companies to cover the procedure.