News-Record.com

That's what the research is saying:

An extensive federal report released Monday concludes that roughly one in four of the 697,000 U.S. veterans of the 1990-91 Gulf War suffer from Gulf War illness.

That illness is a condition now identified as the likely consequence of exposure to toxic chemicals, including pesticides and a drug administered to protect troops against nerve gas.

The 452-page report states that "scientific evidence leaves no question that Gulf War illness is a real condition with real causes and serious consequences for affected veterans."

The report, compiled by a panel of scientific experts and veterans serving on the congressionally mandated Research Advisory Committee on Gulf War Veterans' Illnesses, fails to identify any cure for the malady.

It also notes that few veterans afflicted with Gulf War illness have recovered over time.

So about 175,000 Gulf War veterans were poisoned by their own government, with serious and, likely, permanent consequences.

If we honor military service, we Americans now have a big job on our hands ... and that's just to take care of our own. What might we owe foreign nationals also exposed to the chemicals?

You might have seen the wire story in Monday's N&R about a report at the American Heart Association's meeting in New Orleans about cholesterol-lowering drugs, or statins. As the Bloomberg News Service put it, "AstraZeneca Plc's Crestor [a cholesterol-lowering medication] slashed the risk of heart attack, stroke and death by nearly half in people with normal or low cholesterol in a study, potentially opening a way to save the lives of thousands of seemingly healthy people.”

As is usually the case with medical research, there's more to this research than the headlines, and there are questions the research did not answer.

Maggie Mahar at the Health Beat blog analyzes the issues and raises some points and questions that you really ought to be thinking about, and asking your doctor about, before you run out and ask your doc for a statin prescription you'd need to take for the rest of your life.

Could there be a genetic basis for some speech and language impediments? An article in The New England Journal of Medicine examines the possibility, and the journal also opines on it.

Via alert co-worker Lanita Withers comes this LA Times item about how to do CPR, and it involves a Bee Gees song:

In performing Cardiopulmonary Resuscitation -- CPR -- the perfect rhythm is 100 compressions per minute, and done properly, it can triple a heart arrest victim's chances of survival. But how, when you're saving a life, do you achieve that ideal rhythm of life-saving compressions? Think "Stayin' Alive."

Medical students and physicians trained to perform CPR to the bouncing beat of "Stayin' Alive" maintained close to the ideal rhythm recommended by the American Heart Assn. for chest compressions during CPR, according to a study to be presented Oct. 27 at a Scientific Assembly of the American College of Emergency Physician's annual meeting.

Turns out the song's tempo is 103 beats per minute, almost exactly the 100 beats per minute recommended for chest compressions. Sure, there are lots of other songs with the same tempo, but they figure the title "Stayin' Alive" is most likely to stick with people in an emergency.

Please, in an emergency, do not try to perform chest compressions to the beat of the Ramones' "I Wanna Be Sedated." You'll only hurt yourself.

The adversarial relationship between humans and tuberculosis has gone on much longer than previously thought, according to archaeological findings reported by the British Broadcasting Co.

Scientists found DNA evidence of the tuberculosis bacterium of the 9,000-year-old skeletons of a mother and her baby, found in Mediterranean waters off the coast of Israel.

The oldest previous such discoveries, in Italy, date from 3,000 to 6,000 years ago.

The New York Times' Gina Kolata had an excellent article yesterday on how good medical research is supposed to work, how much weight it should be given and why its results are sometimes surprising. It's good background info for a general audience.

In short, it doesn't look that way, so you can relax.

The question arose, The Wall Street Journal's Health Blog notes, last year and prompted a review of several dozen studies that compared health outcomes of people taking statins with people taking a placebo. In short, reseachers found no significant difference in the rate of development of ALS between the two groups.

A finding to the contrary would have been significant, given that statins, which lower cholesterol, are among the most widely prescribed drugs in the world.

I wrote in April about a Greensboro practice that offers CT scanning -- "virtual colonoscopy" -- as an alternative to traditional colonoscopy for detecting colon cancer or polyps that could become cancerous. A front-page wire story earlier this week cited a study reported in the New England Journal of Medicine that found virtual colonoscopy 90% effective in detecting large adenomas and cancers (those measuring 10mm or more in diameter). That rate is roughly comparable to that of traditional colonoscopy.

The article said Medicare is considering covering the procedure, and where Medicare goes, a lot of private insurers probably will follow. (We don't archive wire stories, but a similar story is here.)

Purely as an element of chance, couples who conceive a child should have as much of a chance of conceiving a boy as a girl. And vice versa, of course.

But do some families really produce more boys than girls, or vice versa? If so, why?

This question arose during a discussion on one of my listservs about the odds on certain birthdays. I won't get into that here except to link to an article linked by one of the listserv members that takes a look at that question. If it intrigues you, go read it.

On Sunday I wrote about a human trial that Wake Forest researchers are about to begin on using a certain type of white blood cell to try to fight cancer. The print edition included a link to a site where you could get more information on being a trial participant or volunteer to be tested as a possible donor for the trial. Unfortunately, the online version didn't include that link, so here it is.

Back in April I wrote about how autopsies are becoming less common and what that might mean for medical knowledge. Now Maggie Mahar at Health Beat, in Part 2 of a series on the silence surrounding diagnostic errors, wades into the issue of autopsies and says we may be missing even more by not doing autopsies than we thought we were ... and we already thought we were missing a fair bit.

Back in February, I wrote about how Moses Cone Hospital's physical rehabilitation unit was using a Wii video game system to help patients recover from the effects of such things as stroke and wreck injuries.

Now, I learn via news release that the Robert Wood Johnson Foundation, which bills itself as the nation's largest philanthropy devoted to improving health and health care for Americans, is awarding more than $2 million in grants to a dozen research programs that are examining links between physically-active video games and health.

One of the programs is at the School of Public Health at UNC-Chapel Hill. Here's what the release said about it:

Presence: Predicting Sensory and Control Effects of Console Video Games in Young Adults will investigate motivations to expend energy during video game play for people aged 18 to 35. The study will compare physiological measures of energy expenditure while people play traditional video games (those that involve pushing buttons on a standard game controller or on a Wii motion-sensing controller) versus active video games (those that require physical movement, using inputs such as a dance pad, balance board or guitar). It also will explore players’ sense of being present in the game and their intrinsic motivation to play, two factors that are known to increase the amount of time people will spend playing a game. This is the first time that research will identify impacts of these factors on players’ energy expenditure; study results may lead to recommendations for making traditional games more active and active games more compelling.

Similar to what the Cone folks are doing, the University of South Carolina Research Foundation will be looking at Wii and EyeToy as tools for helping people who have suffered strokes. Ten other programs nationwide also are getting funds.

And they say video games are a disaster for national fitness ....

UPDATE: More on the Wii and exercise here at Slate, with a hat tip to co-worker Gerald Witt.

University of Cincinnati researchers have found what they believe is the first direct association between lead exposure in children and criminal activity in young adults.

Exposure to lead, primarily from peeling lead-based paint in older homes, already has been linked to brain damage and learning disabilities. This study followed children born between 1979 and 1984 who had elevated levels of lead in their systems and found that the higher the level of lead, the more likely the person was to be arrested in young adulthood.

Results are published in the peer-reviewed PLoS [Public Library of Science] Journal.

The company that makes an intensive-care monitoring system used by the four hospitals of Greensboro's Moses Cone Health System is reporting that patients in hospitals using that system are less likely to die than intensive-care patients elsewhere. (We wrote about Cone's use of the system back in August.)

The company compiled death rates at 156 hospitals that use its eICU system and compared those figures to the national average. During a two-year study period, It found that of 185,464 patients in intensive care at those hospitals, adjusting for the severity of the patients' conditions, 9.6 percent of patients died, compared with the national average of 13.5 percent. Figures for individual hospitals weren't available.

Keep in mind that this study was commissioned by the system's manufacturer and, so far as I can tell, hasn't been peer-reviewed. Still, if those numbers hold up, it's a good sign.

Maybe the cure isn't worse than the disease, but it sure ain't good:

Two years ago, scientists had high hopes for new pills that would help people quit smoking, lose weight and maybe kick other tough addictions like alcohol and cocaine.

The pills worked in a novel way, by blocking pleasure centers in the brain that provide the feel-good response from smoking or eating. Now it seems the drugs may block pleasure too well, possibly raising the risk of depression and suicide.

Some pills that work in this way, the article points out, may not overact. But the pills may put some people at special risk, it says, given that a lot of people are both addicted to something and depressed.

A side-effect-free super anti-addiction pill would be a godsend, saving us no end of costs in public health (including wrecks), lost jobs and homes and destroyed relationships. But we aren't there, we can't see there from here and we have barely the beginnings of a map, it looks like.

No, the title of this post doesn't refer to dead patients ... at least, not directly.

Via Mark Schaver's Depth Reporting comes this post at the Bad Science blog (new to me) on how drug-company-sponsored studies that don't show good results get buried.

Blogger Ben Goldacre says the withdrawal of Vioxx from the marketplace was just a dramatic example, but less dramatic examples permeate drug research, depriving doctors of information they need:

... a paper in the New England Journal of Medicine dug out a list of all trials on SSRIs [a kind of antidepressant -- Lex] which had ever been registered with the Food and Drug Administration, and then went to look for those same trials in the academic literature. There were 37 studies which were assessed by the FDA as positive and, with a single exception, every one of those positive trials was written up, proudly, and published in full. But there were also 33 studies which had negative or iffy results and, of those, 22 were simply not published at all -- they were buried -- while 11 were written up and published in a way that portrayed them as having a positive outcome.

The new study, published this week, has analysed all of the data from the FDA, using the Freedom of Information Act to obtain the results for some of the trials. That medical academics should need to use that kind of legislation to obtain information about trials on pills which are prescribed to millions of people is absurd. More than that, it breaks a key moral contract between patient and researcher.

When a patient agrees to participate in a clinical trial, they give their consent on the understanding that their information will be used to increase the sum of our knowledge about treatments, to ensure that other people, in the future, will be treated more effectively. Burying unwelcome results is an unambiguous betrayal of their trust and generosity.

Goldacre says this "publication bias" has been recognized in medical literature for half a century. (And not just in medical literature, but elsewhere, as in Cynthia Crossen's 1994 book "Tainted Truth: The Manipulation of Fact in America.")

He also offers some solutions to the problem:

... there are two very simple and widely accepted solutions, which have been discussed in the academic literature at length since the 80s, but which are still not fully in place.

The first is obvious. Nobody should get ethical approval to perform a clinical trial unless there is a clear undertaking that the results will be published, in full, in a publicly available forum, and that the researchers will have full academic freedom to do so. Any company trying to silence academics should be named and shamed, and even attempting to do so should be a regulatory offence.

That's the butch solution. But there is also a more elegant one, which is arguably even more important: a compulsory international trials register. Give every trial an ID number, so we can all see that a trial exists, they can't go quietly missing in action, and we know when and where to look if they do.

Doctors -- and, with the growth in marketing of drugs directly to consumers, patients -- need to know not only when something works but also when it doesn't, or when it works no better than existing, cheaper medications. Goldacre points us helpfully in the right direction.

Do efforts by pharmaceutical companies to market drugs to physicians and consumers sway their decision-making? Not according to recent research co-published by a visiting professor at Duke's business school. Since the news release is not online, I'll reproduce a big chunk of it here.

DURHAM, N.C. -- When it comes to giving samples and writing prescriptions, doctors are swayed by science -- not by cozy relationships between themselves and pharmaceutical marketing reps or by advertising aimed at patients, new research shows.

"Drug marketing has been portrayed like some scary movie where pharmaceutical firms are shoving drugs in our veins for the sake of profits, but that doesn't gibe with our results," said Stefan Stremersch, a visiting professor of marketing at Duke University's Fuqua School of Business and chaired professor of marketing at Erasmus University Rotterdam in the Netherlands. "Marketing can actually spur doctors and patients -- and doctors and drug reps -- to have more informative conversations about the benefits and side effects of drugs. Marketing isn't about buying off physicians."

The study by Stremersch and Sriram Venkataraman, assistant professor of marketing at the Goizueta Business School at Emory University, contradicts the widely held perception that pharmaceutical marketing, directly to patients or doctors, adversely affects public health.

Their study, "The Debate of Influencing Doctors' Decisions: Are Drug Characteristics the Missing Link?" is featured in the November 2007 edition of Management Science. The study was produced independently of the pharmaceutical industry, and may have important implications for policy makers and authorities exploring the way marketing affects drug dispensation, the researchers say.

The authors' analysis is based on an examination of data provided by a large firm specializing in pharmaceutical marketing and clinical trial reports from the National Institute for Health and Clinical Excellence. The data yield five key findings, all of which illuminate how marketing affects doctors' decision-making:

-- Marketing efforts are more successful for more effective drugs than less effective drugs.

-- Excessive marketing efforts can actually lower the distribution of less effective drugs.

-- Marketing efforts are more successful for drugs with more side effects than drugs with fewer side effects.

-- Physicians will accommodate requests more often for drugs with fewer side effects.

-- Physicians are more responsive to patient requests for more effective drugs.

"There is evidence that physicians rely on science while prescribing," Venkataraman said. "If a drug has many side effects, it's best to have a sales rep explain those side effects directly to a doctor rather than firms bypassing medical professionals with ads aimed at patients."

Stremersch and Venkataraman found that marketing to physicians or advertising-prompted requests from patients do not automatically result in more samples or prescriptions being handed out for the marketed drug. For some drugs, the opposite may be the case.

"The reason is probably physician irritation," Stremersch said.

The findings seem somewhat counterintuitive, in the sense that you'd think pharmaceutical companies wouldn't spend what they do on marketing if that marketing didn't result in additional sales. But it might be that what additional sales do result are 1) economically satisfactory to the companies and 2) not the result of any undue influence.

What do you think?

(Abstract of the journal article is here; the full text is behind a pay firewall.)