In a brief, unusual report (password required) in Thursday's New England Journal of Medicine, researchers report a pair of cases of celiac disease in farmers who inhaled gluten while feeding their animals.
Celiac disease is condition that some people develop if they consume wheat gluten or certain related proteins. A gluten-free diet is the best way to reverse the abnormal reaction and prevent it from recurring. But a gluten-free diet, which was prescribed to the farmers by a doctor, didn't work. It was only after considerable investigation that researchers realized the farmers were still consuming the stuff: Gluten got kicked into the air each time they filled their animals' troughs, and they were swallowing enough of it to trigger symptoms.
When the farmers took additional precautions -- wearing a mask in one case and avoiding the task of filling troughs in the other -- the celiac disease resolved. Sounds like an episode of "House, M.D.," doesn't it?
Wednesday, June 13, 2007
Sunday, June 3, 2007
As Cancer Drug, Shark Cartilage Fails Again
Yesterday, cancer researchers reported at a meeting in Chicago that a drug derived from shark cartilage is not an effective treatment against an aggressive form of lung cancer. That study is at least the second test of the putative cancer drug to produce disappointing results.
To date, no clinical trial has found shark cartilage to be effective against cancer in people. The accumulating evidence suggests that the lucrative market for shark cartilage supplements is based on, shall we say, shark oil.
Two years ago, Science News reviewed the evidence for and against shark cartilage. In lab tests, the substance has been found to counter angiogenesis, or the formation of new blood vessels, which is an important process supporting tumor growth. However, several previous trials involving cancer patients, including one that used the same drug as was used in the new study, have found no benefit associated with consumption of shark cartilage.
To date, no clinical trial has found shark cartilage to be effective against cancer in people. The accumulating evidence suggests that the lucrative market for shark cartilage supplements is based on, shall we say, shark oil.
Two years ago, Science News reviewed the evidence for and against shark cartilage. In lab tests, the substance has been found to counter angiogenesis, or the formation of new blood vessels, which is an important process supporting tumor growth. However, several previous trials involving cancer patients, including one that used the same drug as was used in the new study, have found no benefit associated with consumption of shark cartilage.
TB Scare: a Shot over the Bow
In an intelligent op-ed piece in yesterday's Times, Dr. L. Masae Kawamura, director of the tuberculosis control section of the San Francisco Department of Public Health, suggests that the attention-grabbing case of an Atlanta man with extensively drug-resistant tuberculosis could have a positive influence on public health.
Saturday, June 2, 2007
Most Mass. Hospitals Handle Acute Stroke
According to the Massachusetts Department of Public Health, 68 of Massachusetts' 74 hospitals offered "Primary Stroke Service" as of November 14, 2006. Unfortunately, the department neglects to name the PSS hospitals. But since the list includes most of the state's medical centers — and since ambulances are supposed to divert to the closest PSS if they suspect a patient has stroke — it's a good bet that any ambulance will get you to a place that can administer the acute stroke medicine known as t-PA.
That said, not all PSS centers necessarily have "neurosurgical backup" on hand, meaning that they may not have a neurosurgeon available to intervene if t-PA treatment causes bleeding in the brain. So, in an emergency, ask an ambulance technician to take you to the closest "comprehensive stroke center" or specifically request a stroke center than has 24-hour surgical backup available.
Note (ignore in an emergency):
About an hour ago, I posted the information below. While it is all accurate, it conveys incomplete information about the state of stroke care in Massachusetts and New York, because some stroke centers in each state have sought accreditation from state-run bodies rather than from the Joint Commission, a nationwide accrediting organization.
That said, not all PSS centers necessarily have "neurosurgical backup" on hand, meaning that they may not have a neurosurgeon available to intervene if t-PA treatment causes bleeding in the brain. So, in an emergency, ask an ambulance technician to take you to the closest "comprehensive stroke center" or specifically request a stroke center than has 24-hour surgical backup available.
Note (ignore in an emergency):
About an hour ago, I posted the information below. While it is all accurate, it conveys incomplete information about the state of stroke care in Massachusetts and New York, because some stroke centers in each state have sought accreditation from state-run bodies rather than from the Joint Commission, a nationwide accrediting organization.
St. Elizabeth's Has Boston's Only Stroke Center
Caritas St. Elizabeth's Medical Center is the only hospital in Massachusetts that has a primary stroke center accredited by the Joint Commission.
The hospital is located at 736 Cambridge Street in Boston.
In Washington, D.C., the only such stroke center is at Washington Hospital Center, at 110 Irving Street, N.W.
New York City has two such centers, both in Brooklyn. Lutheran and Maimonides medical centers, at 150 55th Street and 4802 Tenth Avenue, respectively, offer Joint Commission-accredited primary stroke care.
The Vampire Strikes Out
A Reuters story that appeared today in The New York Times reports the failure, in a late-stage clinical trial, of an experimental stroke treatment derived from vampire bat saliva. The drug, desmoteplase, showed promise in smaller, earlier trials. But it failed to outperform a placebo treatment in the recent trial, which involved 186 patients.
The disappointing outcome of the trial serves as a reminder that modern medicine has few drugs with which to treat stroke, the third-leading killer in the United States. While doctors have long used various anti-clotting drugs to prevent recurrent stroke, just one FDA-approved medication -- tissue plasmogen activator, or t-PA -- can aid recovery. And t-PA, which busts clots, is only approved for use within three hours of the beginning of a stroke.
Desmoteplase, by contrast, was being developed with a longer treatment window in mind. Had the recent trial proved it more effective than a placebo, it might have been used as much as nine hours after stroke onset.
The disappointing outcome of the trial serves as a reminder that modern medicine has few drugs with which to treat stroke, the third-leading killer in the United States. While doctors have long used various anti-clotting drugs to prevent recurrent stroke, just one FDA-approved medication -- tissue plasmogen activator, or t-PA -- can aid recovery. And t-PA, which busts clots, is only approved for use within three hours of the beginning of a stroke.
Desmoteplase, by contrast, was being developed with a longer treatment window in mind. Had the recent trial proved it more effective than a placebo, it might have been used as much as nine hours after stroke onset.
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