A 10-cent pill doesn't kill pain as well as a $2.50 pill, even when they are identical placebos, according to researchers at Duke University and the Massachusetts Institute of Technology. The findings, which appear as a letter in the Journal of the American Medical Association, warn that a doctor’s enthusiasm about a drug may make it more therapeutically effective. The researchers used a standard protocol for administering light electric shock to participants’ wrists to measure their subjective rating of pain. The 82 study subjects were tested before getting the placebo and after. Half the participants were given a brochure describing the pill as a newly-approved pain-killer which cost $2.50 per dose and half were given a brochure describing it as marked down to 10 cents, without saying why. In the full-price group, 85 percent of subjects experienced a reduction in pain after taking the placebo. In the low-price group, 61 percent said the pain was less. The researchers said what's interesting is the combination of the price-sensitive consumer expectation with the well-known placebo effect of being told a pill works. The researchers wonder if prescription medications should offer cues from packaging, rather than coming in indistinguishable brown bottles. At the same time, they ask how to give people cheaper medication, or a generic, without them thinking it won't work.

 

A protein that governs development of human embryonic stem cells also inhibits the growth and spread of malignant melanoma, the deadliest skin cancer, according to researchers at Northwestern University. Metastatic melanoma, which develops from the transformation of skin pigment cells, or melanocytes, has a death rate of more than 80 percent and a median survival of less than 7.5 months. The Northwestern scientists also found that the protein, called Lefty, prevents aggressive breast cancer cells from metastasizing. Death from metastatic breast cancer exceeded 40,000 in 2007, with over 180,000 new cases diagnosed in the United States. Lefty is secreted only in human embryonic stem cells, and not in any other stem cell type tested—including stem cells isolated from amniotic fluid, cord blood, or adult bone marrow—or placental cells. Results of the study, published in the online version of The Proceedings of the National Academy of Sciences, highlight the potential utility of isolating factors within the human embryonic stem cell microenvironment, the researchers said.

 

HORMONE THERAPY: FOLLOW-UP STUDY FINDS RISKS OUTWEIGH BENEFITS
New results from the Women's Health Initiative (WHI) confirm that the health risks of long-term use of combination estrogen plus progestin hormone therapy in healthy, postmenopausal women persist even a few years after stopping the drugs and clearly outweigh the benefits. Researchers report that about three years after women stopped taking combination hormone therapy, many of the health effects of hormones such as increased risk of heart disease are diminished, but overall risks, including risks of stroke, blood clots, and cancer, remain high. The results, published in the Journal of the American Medical Association, confirm the study's primary conclusion that combination hormone therapy should not be used to prevent disease in healthy, postmenopausal women, the researchers said. The U.S. Food and Drug Administration recommends that hormone therapy never be used to prevent heart disease, and, when hormone therapy is used for menopausal symptoms, it should only be taken at the smallest dose and for the shortest time possible.

 

DIABETES: TYPE 2 MAY BE CAUSED BY INTESTINAL DYSFUNCTION
Growing evidence shows that surgery may effectively cure Type 2 diabetes—an approach that not only may change the way the disease is treated, but that introduces a new way of thinking about diabetes. A study published in a special supplement to the journal Diabetes Care by researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, points to the small bowel as the possible site of critical mechanisms for the development of diabetes. Clinical studies have shown that procedures that simply restrict the stomach’s size (i.e., gastric banding) improve diabetes only by inducing massive weight loss. Studies of diabetes in animals by the researchers was the first to provide scientific evidence that gastrointestinal bypass operations involving rerouting the gastrointestinal tract (i.e., gastric bypass) can cause diabetes remission independently of any weight loss, and even in subjects that are not obese. The researchers said the lesson they have learned with diabetes surgery is that it is not always a chronic and relentless disease, where the only possible treatment goal is just the control of hyperglycemia and minimization of the risk of complications. Gastrointestinal surgery offers the possibility of complete disease remission.

 

Researchers at the Technische Universität München and the University of Bonn, both in Germany, demonstrated the existence of an “endorphin-driven runner’s high.” In an imaging study, they were able to show, for the first time, increased release of endorphins in certain areas of the athletes' brains during a two-hour jogging session. Endorphins are natural pain relievers produced by the body and are similar in structure to morphine. The study results, published in the scientific journal Cerebral Cortex, are also relevant for patients suffering from chronic pain, because the body’s own opiates are produced in areas of the brain that are involved in the suppression of pain.

HAPPINESS: GENES HOLD THE KEY
Happiness in life is as much down to having the right genetic mix as it is to personal circumstances, according to researchers at the University of Edinburgh in Scotland and the Queensland Institute for Medical Research in Australia. They found that happiness is partly determined by personality traits and that both personality and happiness are largely hereditary. Using a framework which psychologists use to rate personalities, called the Five-Factor Model, the researchers found that people who do not excessively worry, and who are sociable and conscientious tend to be happier. The study, published in the journal Psychological Science, suggested that this personality mix can act as a buffer when bad things happen. The researchers say that although happiness has its roots in our genes, around 50 percent of the differences between people in their life happiness is still down to external factors such as relationships, health, and careers.

Testosterone appears to protect people against eating disorders, providing further evidence that biological factors—and not just social influences—are linked to anorexia and bulimia, according to researchers at Michigan State University. A six-year study of 538 sets of twins in Michigan indicates that females who were in the womb with male twins have lower risk for eating disorder symptoms than females who were in the womb with female twins. Previous animal research has shown that females in the womb with males are exposed to higher levels of testosterone. The findings, published in the Archives of General Psychiatry, suggest that testosterone exposure could have a protective effect against the development of eating disorders. According to the academy, 10 percent or more of late-adolescent and adult women report symptoms of eating disorders at any given time. The researchers said that if there are protective factors against eating disorders that result from testosterone’s effect on brain development, scientists may be able to determine which areas of the brain might be particularly sensitive to prenatal testosterone exposure and use that information to identify new biological treatments.

 

LONGEVITY: GENE MUTATIONS LINKED TO LONGER LIFESPANS
Mutations in genes governing an important cell-signaling pathway influence human longevity, scientists at the Albert Einstein College of Medicine of Yeshiva University have found. Their research, published in Proceedings of the National Academy of Sciences, is the latest finding in the Einstein researchers’ ongoing search for genetic clues to longevity. Their study by now has recruited more than 450 Ashkenazi (Eastern European) Jews between the ages of 95 and 110. The present study focused on genes involved in the action of insulin-like growth factor (IGF-I), a hormone that in humans is regulated by human growth hormone. Affecting virtually every cell type in the body, IGF-I is crucially important for children’s growth and continues contributing to tissue synthesis into adulthood. The IGF-I cell-signaling pathway is triggered when IGF-I molecules circulating in blood plasma latch onto receptors on the surface of cells, causing a signal to be sent to the cell’s nucleus that may, for example, tell that cell to divide.

The researchers said their findings suggest that by interfering with IGF-I signaling, these gene mutations somehow play a role in extending the human life span.

 

Targeting and killing the non-malignant cells that surround and support a cancer can stop tumor growth in mice, according to researchers at the University of Chicago Medical Center. The findings, reported in the journal Cancer Research, offer a new approach to treating cancers that are resistant to standard therapy. Many solid tumors develop elaborate mechanisms to prevent recognition and elimination by the immune system. Due to the genetic instability of tumors they often discard the tumor antigen-presenting cell-surface structures that alert the immune system that these cells are harmful. Without these flags, the white blood cells fail to recognize and kill infected or cancerous cells. These tumors then often grow rapidly and resist treatment with chemotherapy or efforts to boost the immune system's response to the tumor. But the stroma, the layers of cells that surround a tumor, can accumulate tumor antigens and present them on their surface. These genetically stable surrounding cells retain the molecules that present tumor antigens, which make them a good target for immunotherapy, and they often play an enabling role in tumor growth. When researchers injected T cells specifically engineered to recognize the tumor antigen into mice with large established cancers, these T cells had no direct impact on the cancerous cells, but managed to kill stromal cells. This reduced tumor size and stopped the growth of tumors for more than 80 days.

 

COLORECTAL CANCER: HEALTH GROUPS ISSUE UPDATED SCREENING GUIDELINES
The American Cancer Society, the American College of Radiology, and the U.S. Multi-Society Task Force on Colorectal Cancer have released the first-ever joint consensus guidelines for colorectal cancer screening. The guidelines add two new tests to the list of recommended options: stool DNA (sDNA) and CT colonography (CTC), also known as virtual colonoscopy, and for the first time include a preference for screening tests that can not only detect cancer early but also detect precancerous polyps, as those tests provide a greater potential for cancer prevention through polyp removal. The guidelines, which will appear in the May/June issue of CA: Cancer Journal for Clinicians, represent the most current scientific evidence and expert opinion available. In addition to the new tests, a focus on quality, and the new delineation of tests into two major types, the expert panel also concluded that any proposed colorectal screening test that has not been shown in the medical literature to detect the majority of cancers present at the time of testing should not be offered to patients for colorectal cancer screening.

 

An international group of investigators led by scientists at Memorial Sloan-Kettering Cancer Center and the National Cancer Institute has identified a new genetic marker of risk for breast cancer. Women with this DNA variation are at a 1.4 times greater risk of developing breast cancer compared to those without the variation. The findings, published online in the journal Proceedings of the National Academy of Sciences, show a new gene locus, a specific place on a chromosome where a gene is located, associated with breast cancer risk. That gene locus is on the long arm of chromosome 6. While the risk associated with this genetic marker is much lower than that of BRCA genetic mutations, for example, this discovery will increase the understanding of the genetic variants that contribute to breast cancer. The researchers said the newly identified genetic marker will not have any immediate clinical implications or impact on current screening guidelines for familial breast cancer.

 

ALCOHOL: QUANTITY AND FREQUENCY OF DRINKING INFLUENCE MORTALITY RISK

How much and how often people drink—not just the average amount of alcohol they consume over time—independently influence the risk of death from several causes, according to researchers at the National Institutes of Health. The study, published in Alcoholism: Clinical and Experimental Research, reinforces the importance of drinking in moderation, the researchers said. In drinkers who are not alcohol-dependent, the majority of U.S. drinkers, alcohol quantity and frequency might be thought of as modifiable risk factors for mortality, they conclude. The researchers found that, in men, alcohol frequency and quantity had opposite effects on cardiovascular mortality. The greater the amount of alcohol that men consumed on drinking days, the greater was their risk for death from cardiovascular disease. For example, men who had five or more drinks on drinking days had a 30 percent greater risk for cardiovascular mortality than men who had just one drink per drinking day. On the other hand, those who reported drinking 120 to 365 days per year had about 20 percent lower cardiovascular mortality than men who drank just one to 36 days per year. Alcohol quantity was also associated with increased mortality from cancer among men.

 

University of Minnesota School of Public Health researchers have found further evidence to support the importance of encouraging youth to eat breakfast regularly. Researchers examined the association between breakfast frequency and five-year body weight change in more than 2,200 adolescents, and the results indicate that daily breakfast eaters consumed a healthier diet and were more physically active than breakfast skippers during adolescence. Five years later, the daily breakfast eaters also tended to gain less weight and have lower body mass index levels—an indicator of obesity risk—compared with those who had skipped breakfast as adolescents. The finding of the relationship between breakfast frequency and obesity risk, even after taking into account physical activity and other dietary factors, suggests that eating breakfast may have important effects on overall diet and obesity risk, but experimental studies are needed to confirm these observations, the researchers said. 

Doctors report they are not getting the sleep they need to function at their best and that current work schedules may contribute to their inadequate sleep, in a survey issued by the American College of Chest Physicians Sleep Institute. The survey found that most physicians sleep fewer hours than needed for peak performance and nearly half of physicians believe their work schedules do not allow for adequate sleep. Results further indicated that, when compared to the general population, physicians reported more caffeine use but better overall health. A total of 43.1 percent of physicians indicated their current work schedule made it hard to get enough sleep. Physicians reported “making up” for lost sleep on the weekends or days off by sleeping an average of 7.5 hours a night. Physicians rarely reported insomnia or difficulty initiating or maintaining sleep.

 

PARASITIC DISEASE: NEW ANTI-MALARIAL DRUG IN CLINICAL TRIALS TREATS TOXOPLASMOSIS
A new drug that will soon enter clinical trials for treatment of malaria also appears to be 10 times more effective than the key medicine in the current gold-standard treatment for toxoplasmosis, a disease caused by a related parasite that infects nearly one-third of all humans—more than 2 billion people worldwide. Researchers at the University of Chicago Medical Center report in the journal PLoS Neglected Tropical Diseases that the drug, known as JPC-2056, is extremely effective against Toxoplasma gondii, the parasite that causes toxoplasmosis. The drug, delivered orally, is easily absorbed, bioavailable, and relatively nontoxic, the researchers said. The drug inhibits the action of an enzyme, dihydrofolate reductase (DHFR), produced by the family of parasites that includes those that cause toxoplasmosis and malaria. It is structurally distinct from the human DHFR.

 

Patients cared for by hospitals with residents in training have a 17 percent less chance of dying after lung cancer surgery compared with patients undergoing surgery at non-teaching hospitals, according to results of a Johns Hopkins University study published in the Annals of Thoracic Surgery. The researchers said their findings refute the fear that teaching hospitals can be dangerous places because of training issues. The Johns Hopkins investigators looked at data from 46,951 patients, ages 18 to 85, who underwent surgery for lung cancer at hospitals across the United States between 1998 and 2004. Operations ranged from small lung-segment removal to total lung removal. Though it has been shown that for complex procedures for high-risk patients, the more surgeries a hospital performs, the more likely the patient will survive the operation and hospitalization. This is believed to be the first study to show that teaching hospitals are factors associated with good patient outcome, independent of volume

 

One out of 10 elderly adults on Medicare reports drinking more alcohol than is recommended, according to a new study from Brandeis University. The study, published in the Journal of the American Geriatrics Society, sheds light on a complex problem that has received scant attention and is often missed by health care and other providers, the researchers said. The researchers found that 9 percent of people over 65 engaged in unhealthy drinking—consuming more than thirty drinks per month, or drinking four or more drinks on any day in a typical month. The study, based on a 2003 Medicare survey, also reported that two-thirds of beneficiaries do not drink, while one-quarter drink within the recommended guidelines.

 

Parents worldwide are doing little to protect their children from exposure to secondhand smoke, according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health. Exposure to secondhand smoke has been extensively shown to increase the risk for numerous illnesses and premature death. The study, conducted in 31 countries, found that 82 percent of parents who smoked reported smoking around their children. Measurements of nicotine levels from household air and children’s hair samples also indicated high exposure to secondhand smoke among those living with a smoker. The study, published in the online version of the American Journal of Public Health, is among the first to demonstrate that secondhand smoke is a global concern, particularly for children.

 

WORKING: BULLYING MORE HARMFUL THAN SEXUAL HARASSMENT

Workplace bullying, such as belittling comments, persistent criticism of work, and withholding resources, appears to inflict more harm on employees than sexual harassment, according to researchers at the University of Manitoba and the Queen’s University in Ontario, Canada. The study, presented at the Seventh International Conference on Work, Stress and Health, examined 110 studies conducted over 21 years that compared the consequences of employees’ experience of sexual harassment and workplace aggression. Employees who experienced bullying, incivility, or interpersonal conflict were more likely to quit their jobs, have lower well-being, be less satisfied with their jobs, and have less satisfying relations with their bosses than employees who were sexually harassed, the researchers found. Furthermore, bullied employees reported more job stress, less job commitment, and higher levels of anger and anxiety. No differences were found between employees experiencing either type of mistreatment on how satisfied they were with their co-workers or with their work.

ADDICTION: NON-MEDICAL USE OF PRESCRIPTION MEDS ASSOCIATED WITH ABUSE AMONG COLLEGE STUDENTS

College students who take frequently abused medications without a prescription appear to have a higher risk for drug abuse than those who use such therapies for medical reasons, according to a report in the journal Archives of Pediatrics & Adolescent Medicine. Several studies have reported recent increases in the prescription rates of abusable medications in the United States, including stimulants, opioids, and benzodiazepines. Researchers at the University of Michigan at Ann Arbor said these increases are likely the result of many factors, including improved awareness regarding the signs and symptoms of several disorders, increased duration of treatment, availability of new medications, and increased marketing. The increases in prescription rates have raised public health concerns because of the abuse potential of these medications and high prevalence rates of non-medical use, abuse, and dependence, especially among young adults 18 to 24 years of age, the researchers said.