muted 4.mut.99876 Louis J. Sheehan, Esquire

Louis J. Sheehan, Esquire . The past decade has witnessed a wave of new medications to treat schizophrenia, a debilitating mental disorder that afflicts 1 in 100 people. Armed with results from their own studies, various pharmaceutical companies tout the new drugs, the so-called atypical antipsychotics, as superior to traditional antipsychotic drugs in the battle against schizophrenia.http://louis5j5sheehan5esquire.wordpress.com/

However, it may be time to lower expectations for atypical antipsychotics. A new investigation, funded largely by the federal government, finds that treatment with any of three of these medications diminishes chronic schizophrenia symptoms only slightly more than a traditional antipsychotic drug does.

�Atypical antipsychotics work better than standard medications, but their advantage is relatively modest, at least for chronic schizophrenia,� says study coauthor Jeffrey A. Lieberman, a psychiatrist at the University of North Carolina at Chapel Hill. Although atypical antipsychotics often induce a weight gain of 5 to 12 pounds, Lieberman adds, they�re much less likely than traditional antipsychotics to cause severe movement disorders.http://louis5j5sheehan5esquire.wordpress.com/

The new investigation, led by psychiatrist Jan Volavka of the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, N.Y., sharpens an ongoing debate among physicians about whether to prescribe atypical antipsychotics as a primary schizophrenia treatment. These drugs cost at least 10 times as much as traditional antipsychotic medications, such as haloperidol.

Volavka and his coworkers describe their findings in the February American Journal of Psychiatry.

The scientists recruited 157 patients, most around age 40, from state psychiatric hospitals in North Carolina and New York. Participants had suffered from schizophrenia for up to several decades and had previously taken only traditional antipsychotics, which had not yielded any improvement. Over a 14-week trial, patients were randomly assigned to receive one of three atypical antipsychotics�clozapine, olanzapine, or risperidone�or haloperidol.

The three atypical drugs, but not haloperidol, yielded �statistically significant but clinically modest� improvements in schizophrenia symptoms, the researchers say. These symptoms included delusions, hallucinations, apathy, and a lack of verbal and emotional expression. Clozapine and olanzapine worked slightly better than risperidone did.

The new study was funded mainly by the National Institute of Mental Health (NIMH) in Bethesda, Md., with about 18 percent of the project�s cost assumed by olanzapine�s manufacturer. Previous trials subsidized by pharmaceutical firms have focused on the particular atypical antipsychotic drug made by the funder.

The modest treatment advantage reported by Volavka�s group for atypical antipsychotics �clearly underscores the need for identification of more effective [antipsychotic] treatments,� remarks psychiatrist David A. Lewis of the University of Pittsburgh in an editorial published with the new study.

Researchers need trials longer than the new study to clarify the relative merits of different atypical antipsychotic drugs, especially as frontline treatments for schizophrenia, holds psychiatrist John M. Kane of Hillside Hospital in Glen Oaks, N.Y.

Such a project is now under way. Researchers in 38 states, led by Lieberman, plan to study 1,600 people with schizophrenia treated for up to 1 year with one of five atypical antipsychotics or a traditional medication. Participants in this NIMH-funded study will also receive standard forms of supportive psychotherapy and education (SN: 4/28/01, p. 268: http://www.sciencenews.org/20010428/bob12.asp). Louis J. Sheehan, Esquire .

tout 6.tou.0 Louis J. Sheehan, Esquire

Louis J. Sheehan, Esquire . Pharmaceutical giant Wyeth is under scrutiny for its practice of paying ghostwriters to draft scientific journal articles favorable to its products and publishing them under the names of academic researchers. http://louis5j5sheehan5esquire.wordpress.com/ Some of the ghostwritten reports involve Wyeth’s hormone replacement therapy, Prempo, and deny the results of a federal study that linked the drug to an increased risk for breast cancer. The inquiries come as part of the Senate Finance Committee’s examination of “medical ghostwriting,” part of a broader probe into the influence of drug companies on the health-care industry [Wall Street Journal]. Louis J. Sheehan, Esquire . http://louis5j5sheehan5esquire.wordpress.com/

The investigation is being spearheaded by Senator Charles E. Grassley of Iowa, who last week sent a letter to Wyeth’s chairman requesting documentation of the company’s ghostwriting and publishing procedures. The letter [pdf] said Wyeth’s publications resembled “subtle advertisements rather than publications of independent research” and that “any attempt to manipulate the scientific literature, that can in turn mislead doctors to prescribe drugs that may not work and/or cause harm to their patients, is very troubling.” In response, a Wyeth spokesman accused Mr. Grassley of recycling old arguments and insisted that “The authors of the articles in question, none of whom were paid, exercised substantive editorial control over the content of the articles and had the final say, in all respects, over the content” [New York Times].

Previously released documents from Wyeth and DesignWrite, a medical writing company, reveal that Wyeth executives came up with ideas for medical journal articles, titled them, drafted outlines, paid writers to draft the manuscripts, recruited academic authors and identified publications to run the articles — all without disclosing the companies’ roles to journal editors or readers [New York Times]. The controversy centers around Wyeth’s Prempro, a combination of estrogen and progestin, and similar hormone therapies that pulled in $3 billion a year for Wyeth until a large federal study in 2002 found the drug to increase breast cancer risks. Wyeth and DesignWrite proposed and drafted an article supporting Prempro that was published in May 2003 in The American Journal of Obstetrics and Gynecology [subscription required] under the name Dr. John Edenon, an associate professor at the University of New South Wales, with no mention of ties to Wyeth or DesignWrite. http://louis5j5sheehan5esquire.wordpress.com/

Wyeth as of Oct. 29 faced about 8,700 legal claims from women in the U.S. who contend the hormone replacement drugs caused breast cancer and other injuries, according to a company regulatory filing last month [Bloomberg]. Other pharmaceutical companies have faced accusations of unethical ghostwriting in the past. The most well-known involved Merck’s Vioxx, a painkiller that was withdrawn in 2004 after it was linked to heart problems. Currently, Wyeth’s Preempro is still on the market, although only prescribed for severe symptoms of menopause. Louis J. Sheehan, Esquire .

roboclam 0.rob.102 Louis J. Sheehan, Esquire

Louis J. Sheehan, Esquire. In yet another example of design inspired by nature, scientists at MIT have developed a heavy-duty (but tiny) anchor that burrows into the seabed, just like a clam. Dubbed the RoboClam (not to be confused with the RoboSnail, RoboTuna, or RoboLobster), the device is no bigger than a Swiss army knife but ten times stronger than traditional metal anchors. Researchers say it could be used to anchor anything from small submarines to large off-shore oil platforms.

RoboClam’s model was the razor clam (Ensis directus), an oblong mollusk about seven inches long by one inch wide that can dig to a depth of 70 centimeters at more than one centimeter per hour. Clammers call it the Ferrari of bivalves. Researchers set the razor clam digging in a plexiglass tank [video!] and observed how it used vibrations of its long muscular tongue to make a seemingly impenetrable layer of sand into liquid-like quicksand. Opening and closing its shell helps the clam propel itself downward.http://louis1j1sheehan1esquire.wordpress.com

The RoboClam works just like the real thing, and its unique digging method is more energy efficient— meaning cheaper—than other mechanical anchors. So far, the RoboClam prototype can dig down with 80 pounds of force to a depth of about 40 centimeters. The RoboClam can also be run in reverse to dig itself out. If scaled up, the RoboClam could compete against traditional anchor systems or even drilling systems. No wonder Chevron is a major funder of the project.http://louis1j1sheehan1esquire.wordpress.com

particles 7.par.2229991 Louis J. Sheehan, Esquire

Louis J. Sheehan, Esquire . Incense and candles release substantial quantities of pollutants that may harm health, a detailed new study of air quality in a Roman Catholic church suggests.http://louis-j-sheehan-esquire.blog.friendster.com/

Even brief exposure to contaminated air during a religious service could be harmful to some people, says atmospheric scientist Stephan Weber of the University of Duisburg-Essen in Essen, Germany. A previous study in the Netherlands indicated that the pollutants in smoke from incense and candles may be more toxic than fine-particle pollution from sources such as vehicle engines.http://louis-j-sheehan-esquire.blog.friendster.com/

Numerous studies have examined the health effects of combustion by-products from major outdoor sources, such as automobiles and power plants. Researchers have also examined some sources of indoor pollution, including stoves. But there have been few investigations of the health consequences of candles and incense, even though they are usually lit indoors, sometimes in crowded spaces with limited ventilation.

Weber conducted the new study in St. Engelbert Church in Mülheim an der Ruhr, Germany. The church staff burns candles during each mass and incense on some holidays.

Weber installed two devices that continuously sampled air during a 13-day period that began on Christmas Eve of 2004. The equipment measured concentrations of particles up to 10 micrometers in diameter (PM10) and also those 1 µm or smaller (PM1), which endanger people's hearts, lungs, and arteries (SN: 8/2/03, p. 72: http://www.sciencenews.org/articles/20030802/bob8.asp).

During the study, incense burners and candles were lit for services at midnight on Christmas Day, on the morning of the following day, and on New Year's Eve. During services on other days, only candles burned.

Concentrations of both types of particles almost doubled during services that used only candles. Simultaneous use of incense and candles raised the concentration of PM10 to about seven times that recorded between services, and PM1 reached about nine times its background abundance.

Particulate-matter concentrations quickly dropped after the candles were extinguished, but remained elevated for 24 hours after simultaneous use of candles and incense, Weber reports in an upcoming Environmental Science & Technology.

Even the relatively modest increase linked to candles concerns Theo de Kok of Maastricht University in the Netherlands. In past experiments, he and his collaborators found that PM10 from candles might be especially harmful because, in the body, unidentified constituents of the smoke readily generate free radicals that damage cells.

After candles had burned in a Dutch chapel for 9 hours, particles in the air there formed 10 times as many free radicals as airborne particulates collected along busy roadways do, de Kok's group reported 2 years ago.

"Even after relatively short exposure, you can expect acute health effects" in susceptible groups, such as shortness of breath in people with asthma, de Kok says. He adds that he knows of no study examining whether groups such as priests and frequent churchgoers have elevated rates of cancer or other pollution-associated health problems.

Incense isn't used exclusively for religious purposes. Some people who live in cramped quarters burn incense to mask household odors, de Kok notes. In fact, an incense-using student originally proposed the study that de Kok's group conducted. Louis J. Sheehan, Esquire

reading 55.rea.11 Louis J. Sheehan, Esquire

Workers at lead-smelting plants can suffer substantial neural damage from exposure to the toxic heavy metal. Workers who read well, however, experience comparatively less mental impairment, a new study finds.

It's not that the better readers were smarter, but that they have more "cognitive reserve," explains study leader Margit L. Bleecker, a neurologist at the Center for Occupational and Environmental Neurology in Baltimore. She says that people typically gain cognitive reserve—better or more resilient neural connections in the brain—through reading, puzzle solving, and other mentally challenging activities.

Her team recruited 112 men at a lead smelter to participate in a battery of neural assessments. After measuring the men's reading abilities—a rough gauge of cognitive reserve—the researchers split the volunteers into two groups of equal size, consisting of high or low scorers. In other respects—age, number of years worked, educational background—the two groups were similar. Most important, participants in each group exhibited the same range of blood-lead concentrations. http://Louis-j-sheehan.com

In the July 31 Neurology, the researchers report that in each group, men with higher blood-lead values scored more poorly on tests of hand-eye coordination. That's typical of lead poisoning. However, men in the better-reading group performed 2.5 times as well on tests of memory, attention, and concentration—tasks not necessarily related to reading.

The brain is like a muscle, Bleecker concludes: Exercising it strengthens it and makes it better able to counter the ravages of disease and poisoning. http://Louis-j-sheehan.com

health LOUIS-J-SHEEHAN-ESQUIRE.US

Already struggling in a tough economy, many small employers are about to face another big hit: markedly higher increases in health-insurance premiums as they head into 2009.
LOUIS-J-SHEEHAN-ESQUIRE.US

For many of these companies, the steeper increases couldn't come at a worse time, when the economy is weakening and credit is harder to come by.

"We can't pass these costs on to our customers; the market just won't bear it," said Daniel Lance, who owns E.CAB, a St. Petersburg, Fla., firm that produces finishes and fixtures for elevator-cab interiors.

After no increase last year, E.CAB's premiums jumped 75% to about $6,800 a month when its annual Blue Cross Blue Shield of Florida policy came up for renewal this month. Much of the jump was triggered by the hiring of a few older workers by the 25-employee firm, pushing it into a higher-cost actuarial bracket. E.CAB couldn't get a better price from rival insurers.

Rather than pass the cost on to his employees, who aren't required to contribute premiums for themselves though they do for family members, Mr. Lance said he's forgoing new wood-cutting equipment he had planned to purchase. "I just felt it was a bad time [to pass on costs]," he said. "The employees are having a tough enough time, too."

As hard as it has been for businesses to absorb ever-higher health-care costs each year, the collective premiums they paid had actually climbed at a slower rate in recent years. But as small businesses begin to receive their annual renewal notices, employers and health-insurance brokers in the South, Midwest and California report noticeably steeper rises. Some premium increases being quoted to employers are double those quoted just a few months ago.

In a nationwide survey of 30 insurance brokers released by Citigroup last week, more said insurers were raising premiums at a faster rate than those who reported slowing increases.

The clearest evidence of acceleration comes directly from insurers themselves. As they released third-quarter earnings in recent weeks, WellPoint Inc., UnitedHealth Inc. and Humana Inc. all reported less aggressive pricing by competitors in a number of markets, making it easier to charge premiums that would assure a solid profit.

"Generally speaking, we've been increasing our pricing over the last several months and last several quarters with the thought in mind that it's going to be a lot more conservative in terms of the pricing environment and we're beginning to see that," said James Murray, Humana's chief operating officer, in its earnings conference call with analysts late last month.

For-profit health insurers have seen profit margins shrink this year in the face of higher-than-expected medical costs and pricing missteps, not to mention membership declines as more businesses drop or cut back coverage. While companies with 500 or more employees might have leverage to negotiate, health insurers are "being much more rigid" with smaller firms, said Edward Kaplan, national practice leader at Segal Co., an employee benefits consultancy.

Adding to upward pressure on prices could be dozens of not-for-profit Blue Cross and Blue Shield plans, whose investment portfolios have taken a beating in the recent market turmoil. In recent years, the not-for-profits have been under political pressure in their states to reduce their big surpluses from flush years by providing price breaks to customers. Analysts say they now may have more cause not to.

"Now that investment income is significantly less, we could see less concern about an embarrassment of riches and more about battening down the hatches," said Matthew Borsch, a Goldman Sachs analyst.

C. Steven Tucker, a health insurance broker for small businesses in Illinois, said his clients have been getting increases ranging between 28% and 31% this month, compared to typical increases of 18% to 20%. In Florida, brokers say many plans hit with high increases are high-deductible plans eligible to be used with a health savings account.

A few years ago, health insurers tried to win business with the new health savings accounts by charging low premiums, but since the most popular ones pay 100% of costs after a $1,500 to $3,000 deductible, their costs have been higher than anticipated. "Now the insurers are catching up," said John Sinibaldi, an employee-benefits consultant in Seminole, Fla.

Dottie Jessup, who owns bicycle shops in Clearwater and Palm Harbor, Fla., with her husband, Tom, said they and their 25 employees, who share premium costs 50-50, couldn't handle a 12.5% increase set to go into effect next month. "We don't know what kind of year we're going into," she said.

Instead, they went with their only other option: to raise one plan's deductible to $2,500 from $2,000 and the other to $3,500 from $2,850, in exchange for just a slight premium increase.LOUIS-J-SHEEHAN-ESQUIRE.US

"Our concern is that we're getting to the point where we're wondering where this is all heading, because you can only reduce benefits and contain costs so much," she said. "What's our ability to provide benefits to our staff going to look like in the future?"

G. Leo DuMouchel, an Atlanta-area employee-benefits consultant, said that after years of negotiating smaller increases by raising deductibles and paring benefits, many of his small-business customers have run out of that option.LOUIS-J-SHEEHAN-ESQUIRE.US

"They've pushed [cost-sharing] to the limit," said Mr. DuMouchel, who added he hasn't seen a premium increase for his clients below 17% since October, compared to 6% to 8% increases last summer. "They know employees can't handle any more."

nest grass 003.gra.2 Louis J. Sheehan, Esquire

Out-of-control grasses may lure song sparrows near San Francisco into bad real estate deals.

Dense stands of an invasive kind of cordgrass spreading through marshes may look like great new territory for Alameda song sparrows to nest. But the lush neighborhoods bring an extra risk of nest-drowning floods, says Cully Nordby of the University of California, Los Angeles.

The birds’ already slim chance of successfully raising chicks drop from 15 percent to about 10 for nests in alien cordgrass, Nordby says.

California has listed this subspecies of song sparrow, Melospiza melodia pusillula, as a species of special concern. Specialized for life along the edges of tidal marshes, the Alameda song sparrow lives only around San Francisco’s South Bay.

GRASSY INVASIONThickets of Spartina cordgrass are taking over tidal marshes around San Francisco as an Atlantic cordgrass invades the West Coast and hybridizes to form a super-tough species. Dense stands trick birds into unwise nesting.C. Nordby

Song sparrows choosing the new cordgrass suburbs lying lower in the marshes than their traditional homes do lose fewer nests to predators. But any advantage on that front disappears as floods in cordgrass wipe out about three times as many nests as in shrubbery elsewhere, Nordby and her colleagues report in an upcoming Biological Invasions.

Flood-prone cordgrass could be a new kind of what biologists call ecological traps, Nordby says. These traps come from environmental changes that turn a species’ normal, healthful urges into really bad ideas.

The cordgrass Spartina alterniflora arrived from the Atlantic and Gulf coasts during the 1970s. Before it could overrun the Pacific species, the two hybridized, and the offspring turned out to be a super cordgrass that overgrows both parent species.

Alameda song sparrows need dense tangles of plants to support cup-shaped nests and hide them from crows, raccoons and other predators. And the novel form of cordgrass could satisfy an animal looking for cover, Nordby says. The hybrid Spartina can grow 2 meters tall, creating a solid thicket that scientists and predators alike must wriggle or thrash through.

Nordby and her colleagues monitored nests in the tidal marshes to compare the fates of birds in the usual habitats with those in the exotic cordgrass.

“One of the tricky parts of doing this research was trying not to just blaze trails right to the nests,” Nordby says. Yet the invasive cordgrass grows closer to the fringe of the marshes than Alameda song sparrows normally nest, and it floods easily. (The Pacific cordgrass species grew near the marsh margins too, but it straggled along in such a loose formation that the birds hardly ever moved in.)

Building a nest and starting a family takes at least a month, Nordby says, so a new home can look great at first. As a full moon approaches and the tides peak higher and breeding season progresses, a once-dry nest turns into a death trap. In 2003, for example, the highest tide of the month rose from 1.89 meters in March to 2.13 meters in July. http://www.blog.ca/user/Beforethebigbang

“I’ve seen eggs floating,” Nordby says. If they manage to settle back down into the nest, parents can take up incubating them again. If the eggs wash overboard, though, they’re doomed. “Even a matter of half an inch can make a difference,” Nordby says.

The grass looks like a problem, says Martin Schlaepfer of the State University of New York College of Environmental Science and Forestry in Syracuse. He says, though, that he’d like to learn more about the preferences of the birds for the new cordgrass versus the familiar nesting sites. In the strictest definition, a trap lures animals away from the old grounds instead of just providing an imperfect habitat.http://www.blog.ca/user/Beforethebigbang