Psoriatic Arthritis List NEWSLETTER

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News & Views Newletter
edited by Jack Nicholas, cornishpro@aol.co

PSORIATIC ARTHRITIS NEWS AND VIEWS
VOL. 2 ISSUE 17 July 30, 2002
PSORIATIC ARTHRITIS MEDICAL NEWS

U.S. DRUG USAGE EXPLODES - Health Affairs July/August 2002

Physicians are prescribing medications at a far faster clip than they did two decades ago, a trend that is likely to result in a doubling of drug spending in the next 5 years.

An aging patient population and more complicated medical conditions can account for about two thirds of the increase, the research found. However, other factors, such as the availability of new drug formulations to treat chronic conditions, wider health insurance and drug coverage, and growth of direct-to-consumer advertising are also believed to contribute to the increased prescribing rate.

The trend is likely to continue as baby boomers grow older and scientific discoveries lead to better treatment of acute and chronic conditions, concludes study author Catharine Burt, chief of the ambulatory care statistics branch of the National Center for Health Statistics at the Centers for Disease Control and Prevention.

Psychiatrists had the largest increase in drug mentions, jumping to 178 drugs per 100 visits in 1999, from 82 per 100 visits in 1985.

Just six therapeutic classes accounted for 80% of the increase in the overall drug mention rate. Those classes include central nervous system drugs, hormones, respiratory medications, pain relief agents, metabolics/nutrients and cardiovascular-kidney drugs.

Antidepressants accounted for 13.5% of the increase in overall ambulatory drug prescribing. Cholesterol-lowering drugs and heart medications called ACE inhibitors were also top contributors.

For seniors, the largest increase was for drugs affecting the blood and blood-forming tissues, which jumped 187% during the study period. For adults 45 to 64, metabolic drugs, including cholesterol-lowering medications, had the largest increase in drug mentions, up 109%.

Central nervous system drugs had the highest increase for children, up a startling 327%. The study finds that the attention-deficit/hyperactivity disorder drug Ritalin was among the most frequently mentioned drugs in this class during children's visits in 1999.

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MOM WAS RIGHT, BROCCOLI GOOD FOR YOU - Washington (AP)

Broccoli and broccoli sprouts contain a chemical that kills the bacteria responsible for most stomach cancer, say researchers, confirming the dietary advice that moms have been handing out for years.

In laboratory tests, the chemical, sulforaphane, killed helicobacter pylori, a bacterium that causes stomach ulcers and often-fatal stomach cancers.

In addition, the good news is there appears to be enough of it in broccoli sprouts and some varieties of broccoli to benefit people who eat the vegetables.

The researchers could not say how much broccoli one would have to eat for there to be an impact, something they said could not be determined without long-term tests involving humans.

"The levels at which we tested it ... are such that those could be achieved by eating broccoli or broccoli sprouts. It's a reasonable level that we think would be reached in the stomach," said Jed W. Fahey of the Johns Hopkins University School of Medicine.

The findings are reported in Tuesday's issue of Proceedings of the National Academy of Science. Broccoli sprouts are tiny three-day-old plants that resemble alfalfa sprouts and have a peppery flavor.

"I feel quite comfortable suggesting people eat more fruits and vegetables, specifically cruciferous vegetables, specifically broccoli," Fahey said. "We know it's safe and healthy ... we know sulforaphane is effective in protecting against cancers."

Dr. Paul Talalay, a co-researcher at Johns Hopkins, had previously reported sulforaphane is an effective anticancer agent and the new studies extended that work to the bacterium that causes stomach cancer and ulcers.

In the lab, the scientists found that sulforaphane even killed helicobacter that was resistant to commonly used antibiotics.

They also showed it could kill the bacterium whether it is inside or outside cells. In people the bacteria can hide in cells lining the stomach, making it more difficult to get rid of the infection, said Fahey.

The studies concentrated on mice and the researchers will now seek to determine of the same effect occurs in humans.

"If future clinical studies show that a food can relieve or prevent diseases associated with this bacterium in people, it could have significant public health implications in the United States and around the world," Fahey said.

"In some parts of Central and South America, Africa and Asia, as much as 80 percent to 90 percent of the population is infected with helicobacter, likely linked to poverty and conditions of poor sanitation," said Fahey, a plant physiologist.

The bacteria can usually be treated with antibiotics, but these are too costly and scarce in many parts of the world, he noted.

Perhaps "people in some of these very poor areas, where it's almost impossible to even conceive of antibiotic therapy ... might, by a relatively minor change in diet, be able to heal themselves," he said.

Dr. Carlos F. Quiros of the University of California, Davis, said he was not surprised by the findings, commenting that many compounds found in vegetables inhibit the growth of pathogens.

Sulforaphane has been shown to have anti-cancer properties, Quiros said, but the amount present varies widely among varieties of broccoli. Quiros, who was not part of Fahey's research group, said he is doing research to develop varieties of broccoli with higher levels of the chemical.

The paper also noted that Fahey, Talalay and Johns Hopkins University own stock in Brassica Protection Products, a company whose mission is to develop chemo protective food products and which sells broccoli sprouts.

Working with them on the research was a group of scientists from the French National Scientific Research Center led by Alain Lozniewski.

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GENERIC DRUG MAKERS SETTLE CHARGES - Washingtom (AP)

Two generic drug makers have agreed to settle federal charges that they struck a deal that allegedly prevented competition and lower prices in the market for a generic blood pressure medication.

The Federal Trade Commission said Thursday that Biovail Corp., based in Toronto, and Elan Corp., based in Dublin, Ireland, both had approval to market two different dosages of the drug, a generic version of Adalat, which is produced under that name by Bayer AG.

But the FTC said the companies made a deal that allegedly resulted in each having a monopoly over one strength of the drug -- Elan produced the 30-milligram pill and Biovail sold the 60-milligram size. The deal included sharing profits from drug sales and millions in royalty payments.

Under the settlement, the companies have agreed to end that arrangement.

"Their agreement gave them substantial incentives not to compete with each other and to deprive consumers of the price cuts that normally occur with generic competition," said Joseph Simons, director of the FTC's competition bureau. "Generic competition is an important way of restraining drug costs and hence of controlling overall health care costs, which have been escalating."

Biovail said in a statement that it "maintains that the Adalat agreement is lawful and pro-competitive," but it settled to resolve the matter.

Elan said in a statement that the deal, part of which involved Biovail distributing Elan's drug, saved consumers millions of dollars. Elan said it was pleased to resolve the matter.

By settling, the companies don't admit to breaking any law.

The FTC said the settlement was the first time it had taken action because of an anti-competitive agreement between competing generic drug makers.

The settlement also bans the companies from entering into similar agreements in the future.

Biovail and Elan are the only two companies with Food and Drug Administration approval to market generic versions of Adalat.

In 1999, the companies agreed that Elan, in exchange for payments, would appoint Biovail as the exclusive distributor of Elan's 30 mg and 60 mg generic Adalat products, the FTC said.

The FDA gave final approval to Elan's 30 mg product in March 2000 and the company promptly began marketing the drug through Biovail.

In December 2000, Biovail received approval for its 60 mg product and began selling it. Biovail also was allowed to market a 30 mg product, but it never did.

Last year, Elan was granted approval for its own 60 mg product, but it never launched it.

The FTC alleged Elan has a monopoly over 30 mg generic Adalat and shares profits with Biovail.

Biovail, in turn, paid Elan a multimillion-dollar royalty and has a monopoly over the 60 mg product, the agency said.

The FTC said that if the companies had produced competing dosages it would likely have caused a reduction in prices and profits.

The companies have now agreed that each will market both strengths of the drug as soon as possible.

The agency voted 5-0 to accept the settlement, which is subject to public comment for 30 days before it is final.

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SENATOR: DRUG COMPANIES OPPOSE LOWER PRICES
July 21, 2002 Washington (AP)

Sen. Paul Wellstone, D-Minn., accused pharmaceutical companies and their political allies of trying to defeat legislation that would give older Americans a Medicare prescription drug benefit.

"They oppose allowing older Americans to come together to negotiate lower drug prices," Wellstone said Saturday in the Democrats' weekly radio address. "They continue to slip in special congressional loopholes to keep lower-priced generic drugs off the market."

The Senate has been debating two competing plans to provide a Medicare prescription drug benefit and is scheduled to vote on them Tuesday. Lawmakers have been meeting to try to craft a compromise because neither has the 60 votes needed for passage.

Both Medicare bills are being offered as amendments to a generic-drug bill that Democrats are using for the overall debate. Medicaid is the nation's health insurance program for the poor.

Wellstone favors the 10-year, $594 billion plan supported by Senate Democrats. The plan would require beneficiaries to pay a $25 monthly premium and a $10 co-payment on generic drugs or a $40 co-payment on brand-name drugs. Out-of-pocket expenditures would be capped at $4,000 a year.

"We should use the purchasing power of the more than 40 million Medicare beneficiaries to bargain with the pharmaceutical industry for lower drug prices," Wellstone said.

The Bush administration and congressional Republicans have said the Democratic plan would require the government to increase taxes, cut all government programs or drain the Medicare trust fund early.

The White House supports another 10-year plan offered by a coalition of Republicans and Democrats. The proposal would cost $370 billion, with $340 billion going toward a drug benefit and the rest on Medicare improvements.

Under that plan, beneficiaries would pay a monthly premium of $24 and have a $250 yearly deductible. Once the deductible was met, the government would pay 50 percent up to $3,450 in drug spending.

The Pharmaceutical Research and Manufacturers of America, the industries trade group, spent millions of dollars to help finance television commercials to support a prescription drug benefit that was pushed through the House last month. That legislation provides $320 billion over the next decade to establish a system of Medicare prescription drug coverage through the private insurance industry.

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THE SCIENCE OF AGING

It's likely that the changes attributed to aging reflect more than one process acting on the body. Scientists working on this conundrum from different angles consistently raise more questions than they settle. Are humans genetically programmed to die by a certain age? Why do some of us stay healthier and live longer than others? What role do genes and biochemistry play in how we age and when we die? Does the body have protective mechanisms - if so; is there a way to turn them up? Where do alterations in the immune system fit into the aging process? And, finally, could various tweaks or outright resetting of the systems that affect how we age improve and lengthen our life span.

Pushing the Limits of Life Span - Just as there is a limit to how fast the mile can be run, there is probably a limit, too, to how far human life span can be extended. But in every race, runners cross the finish line at different times. And every now and again, the strongest runners completely transform our ideas of what is possible.

Life expectancy at birth is about 76 years in the United States. This is a great leap forward from a century ago, when the average newborn did not quite reach age 50. When the numbers are crunched more carefully, though, there are obvious differences between men and women and people of different races. A newborn boy born in 1997 or after can expect to live 74 years, while his sister can expect to live 79. Life expectancy measured from birth is six years shorter for a black person than a white one, though the gap narrows to two years for those who survive to age 65. By age 85, life expectancy for blacks is slightly greater than it is for whites.

If you live to celebrate certain milestones of age, your life expectancy expands. On average, a 65-year-old has nearly 18 more years to live, while an 85-year-old has about 6 years longer. Because a large number of people who have chronic ailments or engage in behaviors that raise the risk of accidents or illness get cut from the herd much earlier, the oldest old are often remarkably healthy.

Antibiotics, better sanitation, and improved medical care reap much of the credit for the expansion in life expectancy. If promising avenues of research on cancer and heart disease pay off, the numbers could continue to climb. But is there a biological cap on how long humans can live?

Some researchers believe the answer is yes. Their theory draws on cross-species comparisons. The oldest ages observed in a variety of organisms suggest the biological life span of any species is roughly six times the stretch between birth and maturity. Using this formula, the figure most often advanced for humans is 120 years. That's quite close to the span of one well-documented contender for the title of longest-lived person, a French woman believed to be 122 years old when she died in 1997.

Genes and Your Biological Clock - One line of research into aging suggests the presence of a biological clock. Just as certain milestones of growth and development occur during childhood, others might be expected to unfold later in life. A familiar example is male pattern balding; a less benign one is Huntington's chorea, a degenerative disease that appears in midlife. A multitude of proteins made by genes helps orchestrate such changes. When a given gene is switched on, it manufactures, or expresses, proteins that carry out specific tasks in cells, organs, and tissues throughout the body.

Extending the Life of Fruit Flies - Over the years, scientists working with yeast, worms, and fruit flies have identified specific genes - and certain proteins made by these genes - tied to longevity. A report published in 2000 in the journal Science offers a prime example of how genes can arrest or accelerate aging, at least in fruit flies. When researchers introduced any one of five mutations into a single gene dubbed "Indy" - an acronym from a Monty Python film that stands for "I'm not dead yet" - the flies' life span nearly doubled. Moreover, the long-living flies stayed frisky and reproduced far longer. When the mutation was reversed, fly life span returned to normal.

Many other laboratory gene manipulations have achieved the same end, and scientists hope to extend these findings to humans someday. It's intriguing to note that the protein made by Indy affected fly metabolism, apparently fooling the body into believing it was on a calorie-restricted diet even though the flies ate normally. This research provides a dramatic tie-in to a separate string of experiments with rodents, fruit flies, worms, and primates showing that restricted rations pay off in longer life spans.

Cell Senescence and Aging - Our bodies are made up of trillions of cells. New cells form for growth or replacement in a process called cell division or mitosis. Normally, a new cell created during mitosis replicates the original right down to the last jot of genetic information.

Once you reach adulthood, whether and when cell division occurs depends on the type of cell involved. Skin cells, for example, continue to divide, albeit at a pace that slows somewhat over time. Liver cells proliferate only in response to injury or similar challenge. Some cells are thought not to regenerate at all, though new evidence of the rebirth of nerve cells in the brain in animals brings that long-held belief into question.

Half a century ago, scientists found that the number of times replicating cells can split is finite. Once a cell reaches this endpoint, called its Hayflick limit, it stops dividing and becomes senescent, or grows old. This is part of a normal process of cell death called apoptosis. For example, the collagen-producing skin cells called fibroblasts typically divide about 50 times in humans before entering senescence. If you examine a fibroblast from a child and one from a 75-year-old, the cell from the youngster would have far more divisions remaining.

Each time a cell replicates, the repeating sequence of DNA bases that make up the tail end of its chromosomes - called the telomere - is pared down. Some scientists believe that this shortening of the telomere reflects a biological clock winding down. In laboratory experiments, the clock can be reset when cells are modified to pump out an enzyme called telomerase, which is not normally found in adult cells. Whether it is possible - or wise - to tinker this way with cells in the human body is not yet known.

That's because cell senescence may not be an enemy of longevity. In fact, many experts think that the natural death of cells helps protect us from cancer. Cancer cells are immortal - that is, they divide time and time again with no stop mechanism coming into play. That uncontrolled cell proliferation gives DNA errors triggered by such elements as sunlight or biochemical offensives a greater chance to accumulate. This can be one of several steps that hasten a once healthy cell down the path to full-blown malignancy.

Biochemistry and Aging - Your body survives biochemical battery every day, and this assault is another focus of research that's proving fruitful for scientists who seek ways to slow the aging process. The simple act of breathing spins off unstable oxygen molecules called free radicals that damage cell membranes, proteins, and even DNA. Riding to the defense are antioxidants - nutrients and enzymes produced by the body that can block or repair such damage.

By retooling genes so that they ratchet up these defense mechanisms, scientists have found ways to extend longevity in certain organisms. For example, researchers at the University of Colorado at Boulder discovered that a genetic mutation in worms that triggered an overabundance of the antioxidant enzymes superoxide dismutase (SOD) and catalase doubled their life span. These two enzymes work in concert to help prevent oxidative damage by neutralizing free radicals. Likewise, researchers at the University of California at Irvine who worked with fruit flies found that the gene that churned out SOD was more active in the group of longer-lived flies than in flies of average life span.

Hormones, Growth Factors, and Life Span - Other experiments on aging look into the ways in which certain hormones and growth factors affect the body. A series of genes dubbed DAF - decay accelerating factor - in worms has a similar counterpart in humans that helps manage insulin levels and a growth factor called IGF-1. When researchers deliberately immobilize certain DAF genes in worms, they live and reproduce longer.

Glucose crosslinks, which seem to snowball with age, are another possible culprit in cell decay. Called advanced glycation end products or AGEs, these crosslinks alter proteins by binding them together. They have been implicated in deterioration, such as clouded eyes, hardening of arteries, and stiffening of connective tissue, as well as changes in nerve and kidney function. Special immune system cells called macrophages break down AGEs, which are then filtered out of the blood by the kidneys and eliminated in urine. Unfortunately, kidney function tends to decline and macrophages lose some of their zip with age, allowing levels of the damaging crosslinks to build up.

Wear and Tear and DNA Errors - Free radicals are not the only offenders that alter DNA. Sunlight and toxic substances, such as tobacco and environmental toxins, can also cause damage. And errors can occur during transcription, which is the process of uncoiling and copying one of the double strands of DNA in the course of cell division. Such alterations and errors may later repeat and accumulate as cells split again and again. It's the job of certain enzymes to fix these problems swiftly by carving out damaged segments of DNA. Still other enzymes replace the damaged segments.

Life span in animals is linked to the ability to swiftly and efficiently repair DNA. Humans have developed better systems for ironing out glitches than mice, for example, and our life span is correspondingly longer. Scientists who focus on DNA repair have found a triage system in place. Cells concentrate on repairing active genes and the strand of DNA that gets transcribed before any resources go elsewhere. This knowledge may lead to ways to step up and expand the repair process.

Immune System Slowdown - Your immune system is a complex network of outposts and sentinels that patrol your body, ready to roust dangerous intruders such as bacteria, viruses, and parasites. Composed of specialized tissues and organs, including the thymus gland, lymph nodes, spleen, tonsils, and bone marrow, the immune system forges two major types of defensive cells: B lymphocytes and T lymphocytes (also known as T-cells). B-lymphocytes make antibodies, while T lymphocytes attack cells they recognize as foreign.

With age, the immune system weakens, giving a variety of ills and offending organisms a better foothold in the body. While the overall number of T-cells does not appear to decline with age, the cells seem to become less effective. T-cells produce a group of messengers called interleukins. An age-related dip in interleukin-2 occurs in humans and some animals. Experiments with older animals show that boosting interleukin-2 can tune up immune system response.

Starting at about age 30, humans also have diminishing levels of dehydroepiandrosterone (DHEA), a hormone that helps modulate the immune system. Studies have tied low DHEA levels in men to certain cancers and cardiovascular disease, among other problems.

So why not just replace sinking levels of DHEA or find similar ways to step up helpful interleukins? Tinkering with the immune system is a complex task that can easily have unexpected repercussions. Studies show that booster doses of DHEA, for example, have good and bad effects. With continuing work, though, research into the immune system - what makes it tick, what throws it off, and how aging affects it - may provide a lever by which to shift aside certain forms of disability and disease.

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MIDDLE OF THE NIGHT WAKENING THROWS OFF BODY CLOCK By Anne Harding - New York, (Reuters Health)

Being woken up and exposed to bright light at night can throw off a person's biological clock for the next few days, a new study shows. What's more, the researchers found that being woken up at night at all--even in a dark room--also disrupts the body's timing, although to a lesser degree.

The wakening seems to introduce a "lag" into the body clock, pushing back the release of hormones and other body processes by as much as an hour and a half.

While such sleep interruptions don't harm health, a person experiencing such a delay in the body clock "would feel tired in the morning and feel more aroused in the early evening," said study author Samir Bangalore, a student research fellow in the Sleep and Circadian Rhythms Research Laboratory of Northwestern University Medical School in Chicago, Illinois.

The findings also offer clues to treating seasonal depression and other conditions marked by biological clock abnormalities, the researcher told Reuters Health.

Bangalore presented his findings Thursday at the American Academy of Neurology's annual meeting in Denver, Colorado.

Humans--and many other creatures--have roughly 24-hour body clocks that help regulate sleep patterns and energy levels, and also govern when hormones are secreted and other biological processes occur. These daily patterns are called circadian rhythms.

Bangalore and his colleagues tested the effects of awakening and nighttime bright light exposure on the circadian rhythms of 32 healthy volunteers. The study participants spent one night sleeping in the dark for 8 hours at the time that was normal for them. The next night, some patients were woken up and exposed to 1, 2 or 3 hours of bright light. As a "control," some patients were kept awake for varying amounts of time but not exposed to light.

Bangalore and his colleagues gauged the state of participants' biological clocks by measuring their secretion of melatonin. Release of this hormone, which peaks at night, is partially regulated by the biological clock.

"Light pulses of 1, 2, or 3 hours all led to significant delays in the circadian rhythm of the melatonin profile by 35 to 75 minutes," Bangalore said. Patients who were kept awake for 4 hours but not exposed to light also had a half-hour delay in melatonin secretion, while small delays were also seen in people who were kept awake in the dark for shorter amounts of time.

Such delays would persist for a few days, he noted. For example, a person would feel the effects of an hour's delay in melatonin secretion for 3 or 4 days. Bangalore points out that the findings help "clarify the relationship between the duration of light exposure and the response of the biological clock."

This is important, he notes, because circadian rhythm disorders have been linked to many health problems. For example, elderly people often have advanced biological rhythms, meaning they fall asleep and wake up early, while adolescents have delayed ones. Both states can lead to severe sleep deprivation.

People suffering from seasonal affective disorder (SAD) often have disordered circadian rhythms, and some researchers believe light exposure helps SAD patients because it normalizes these rhythms.

This article was contributed by our very own meghan@511th.com. Thanks Megan.

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AMERICAN CANCER SOCIETY ANNOUNCES NEW NUTRITION AND PHYSICAL ACTIVITY GUIDELINES FOR CANCER PREVENTION
Atlanta - (American Cancer Society)

The American Cancer Society, the nation's largest voluntary health organization, announced the release of its new Nutrition and Physical Activity Guidelines for Cancer Prevention. The new guidelines place more emphasis on the importance of physical activity for both youth and adults, and provide a first-time recommendation for communities to play a role in improving the health of their residents.

"People planning to make changes in their diet and looking to adopt a healthier lifestyle should be sure to also include a strong commitment to regular physical activity," said Colleen Doyle, MS, RD, director of nutrition and physical activity for the American Cancer Society. "These healthier behaviors are made easier if governments, worksites, schools and neighborhoods help facilitate them and provide access to the resources people need."

According to the Society, nearly one-third of the more than 500,000 annual U.S. cancer deaths are attributable to diet and physical activity habits.

The Society's newest guidelines, similar to earlier versions, stress adopting a diet with a wide variety of healthy foods that are primarily plant-based. They advise eating five or more daily servings of vegetables and fruits and recommend eating whole grains over refined grains for more nutrients and fiber. In addition, based on evidence that cancer risk is influenced by the type of fat consumed, rather than simply the total amount, the guidelines recommend limiting the intake of foods high in saturated fat.

The new guidelines also urge people to limit their consumption of alcohol if they drink at all, and to lose weight if overweight or obese.

"Maintaining a healthy weight is important to reduce cancer risk. The most healthful way for people to do this is to make healthy dietary choices and to increase their level of physical activity," said Doyle. Physical activity affects cancer risk indirectly, through its role in helping to prevent overweight and obesity, and also plays a more direct role. For example, with colon cancer, physical activity accelerates the movement of food through the digestive system, which reduces the time that the lining of the bowel is exposed to potentially cancer-causing substances. Physical activity's likely role in breast cancer risk reduction is that it decreases the amount of exposure of breast tissue to circulating estrogen.

"Based on this evidence, we encourage people to be active for at least thirty minutes on five or more days of the week," Doyle said. "And children and teens need to be active at least an hour every day."

New to this edition of the Society's guidelines are recommendations for changes in communities, workplaces and schools to ensure that Americans have opportunities to be physically active and eat healthfully.

"Physical education in schools, zoning and urban planning to provide and promote activity, worksite policies and programs that support activity are examples of issues that are critical if people are going to be successful in changing their lifestyles for the better over the long-term," said Doyle.

Every five years, the Society works with experts in the fields of nutrition, physical activity and cancer prevention to review current scientific evidence and develop recommendations that reflect the best of what is known about the relationship between diet, activity and cancer risk.

For information about the guidelines, and to obtain a copy of "Living Smart," the American Cancer Society's guide to eating healthy and being active, call toll-free 1-800-ACS-2345 or visit the American Cancer Society website at http://www.cancer.org.

Don't forget to go to our website at http://www.wpunj.edu/pa to read back issues of the newsletter. For all you new members, it's educational, worthwhile and informative.

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Good Health to All

Jack Nicholas
Newsletter Editor
Cornishpro@aol.com
Issue 2002 7/30/2002-17