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More testing needed on drugs in tap water +click to expand
Test it, study it, figure out how to clean it — but still drink it. That’s the range of reactions raining down from community leaders, utilities, environmental groups and policy makers in reaction to an Associated Press investigation that documented the presence of pharmaceuticals in major portions of the nation’s drinking water supplies. “There is no wisdom in avoidance. There is wisdom in addressing this problem. I’m not suggesting that people be hysterical and overreact. There’s a responsible way to deal with this — and collectively we can do it,” said Washington-based environmental lawyer George Mannina. A five-month-long inquiry by the AP National Investigative Team found that many communities do not test for the presence of drugs in drinking water, and those that do often fail to tell customers that they have found trace amounts of medications, including antibiotics, anti-convulsants, mood stabilizers and sex hormones. The stories also detailed the growing concerns among scientists that such pollution is adversely affecting wildlife and may be threatening human health. As a result, Senate hearings have been scheduled, and there have been calls for federal solutions. But officials in many cities say they aren’t going to wait for guidance from Washington to begin testing. Pharmaceutical industry officials said they would launch a new initiative Monday with the U.S. Fish and Wildlife Service focused on telling Americans how to safely dispose of unused medicines. Pharmaceuticals not included in testing “The AP story has really put the spotlight on it, and it is going to lead to a pickup in the pace,” he said. “People are going to start putting money into studying this now, instead of a few years from now, and we’ll get the answers sooner than we would have otherwise.” Environmental leaders said some answers are easy. “It’s basic. We need to test, tell and protect health,” said Richard Wiles, executive director of the Washington-based Environmental Working Group. Wiles said the Environmental Protection Agency needs to widely expand the list of contaminants that utilities are required to test for. That list currently contains no pharmaceuticals. He also said government agencies and water providers that don’t disclose test results “are taking away people’s right to know, hiding the fact that there are contaminants in the water. We don’t think they have that right. It’s hubris, it’s arrogance and it’s self-serving,” said Wiles. As part of its effort, the AP surveyed 62 metropolitan areas and 52 smaller cities, reporting on positive test results in 24 major cities, serving 41 million Americans. Since release of the AP investigation, other communities and researchers have been disclosing previously unreleased local results, positive or negative. In Yuma, Ariz., for example, city spokesman Dave Nash said four pharmaceuticals — an antibiotic, an anti-convulsant, an anti-bacterial and caffeine — have been detected in that city’s drinking water. In Denver, where the AP had reported undisclosed antibiotics had been detected, a Colorado State University professor involved in water screening there e-mailed the names of 12 specific drugs that had been detected. Officials at many utilities said that without federal regulations, they didn’t see a need to screen their water for trace amounts of pharmaceuticals. But others have now decided to test, including Scottsdale and Phoenix in Arizona, Palm Beach County in Florida, Chicago and Springfield, Ill., Bozeman, Mont., Fargo, N.D.; Danville, Va.; and a group of four sewer partners in the Olympia, Wash., region. “We read the AP story and made a determination that we should test our water and be transparent, just let the people know what we find. I’m confident we have safe and clean drinking water,” said Phoenix Mayor Phil Gordon. Officials in Freeport, Ill., one of the smaller cities surveyed, said they plan to work with the state EPA to test the area’s drinking water for pharmaceuticals. Mayor George Gaulrapp said he is looking to the state agency for standards, regulations and testing procedures for that city’s water, which comes from a deep well. In some places, residents learned that the rivers and lakes that feed their drinking water treatment plants have already been tested, or that tests are under way. In Marin County, California, officials said repeated tests in their watershed for pharmaceuticals have come back clean. In Massachusetts, the state Department of Environmental Protection announced a program to screen rivers, streams and reservoirs for pharmaceuticals. Dozens of newspaper editorials called for testing in communities where water is not being screened and the release of any test results. “The first, and least expensive, step is to let the sunshine in: Water utilities that currently test for pharmaceuticals should make that information freely available to their customers, along with more information on the potential impacts of drugs in the water supply,” read an editorial in the Daytona Beach News-Journal. The Fort Worth Star-Telegram has filed an open records request for a copy of a study conducted on the city’s water after the mayor refused to give the AP and the newspaper the name of a pharmaceutical detected in the drinking water. City officials say publishing that information could jeopardize public safety, citing post-Sept. 11 security concerns. A Texas attorney general’s opinion is being sought on possible release of the information. The Milwaukee Journal Sentinel urged readers to take responsibility as well. “It’s a problem in which the average person has both a stake and a role in the solution,” read a Journal Sentinel editorial. “He or she can do something as simple as not flushing unused medications down the toilet or into the drain.” And the Pittsburgh Post-Gazette observed that “given the national scope of the problem, a strong leadership role for the federal government suggests itself in areas such as testing and upgrading water treatment plants. So it is discouraging to note that the Bush administration in its 2009 budget proposal cut $10 million from the water monitoring and research program.” While the local responses are encouraging, Lisa Rainwater, policy director of Riverkeeper, a New York-based environmental group, said the EPA should step aside and let the National Academy of Sciences or the General Accounting Office study the impacts on humans and wildlife. “Frankly, the EPA has failed the American public for doing far too little for far too long,” she said. At least one local water official is putting part of his faith in another quarter. Wayne Livingston of the Oxford Water Works in Alabama said he has confidence in the existing treatment system. But he said his agency probably will test for pharmaceuticals now, although he doubts anything will turn up because the water is pumped from underground. “The good Lord filters it,” he said. “But this is something we should keep an eye on.”
Running on Ritalin +click to expand
Ritalin abuse is on the rise. Why are people without the disorder begging, borrowing and stealing to get it? Ritalin, a mild stimulant, was designed to treat attention deficit/hyperactivity disorder (ADHD) -- so why are people without the disorder begging, borrowing and stealing to get it? A recent U.S. Drug Enforcement Agency (DEA) report showed an alarming trend in recreational Ritalin use. According to Department of Justice Deputy Director Terrance Woodward, Ritalin prescriptions have increased fivefold in the last decade, and data from school surveys, poison control centers and emergency rooms indicate that the drug's abuse has increased markedly since 1990. Some of the U.S.' 350 million daily doses of prescribed Ritalin are shared in schools -- surveys indicate that 3% to 8% of high school seniors have used Ritalin without a prescription. "Ritalin can be very helpful, but kids face pressure to share it," says Eileen Beal, author of Ritalin: Its Use and Abuse (Rosen, 1998). Her research shows that college kids and teenagers are popping pills or snorting the crushed-up powder at dance clubs and late-night study sessions because it speeds up the heart rate and keeps one awake, but it may cause jitters or paranoia. "But we don't see a lot of deaths -- much less than with cocaine use," says Virginia medical examiner William Massello, Ph.D. Still, intravenously injecting a dissolved Ritalin solution poses serious health risks: Tablet particles can clump and block blood vessels, damaging the lungs and retina. So the DEA has declared that they will continue to monitor its recreational use' and also teach doctors, parents and school officials how to properly prescribe, use and store prescriptions.
Think twice before you dump antidepressants +click to expand
There's little question antidepressants are overprescribed and that many people who take the most popular drugs in America might do just as well with therapy or even a trip to the gym. But that doesn't mean patients should toss out that bottle of Prozac or Paxil without careful consideration, warned psychology experts and scientists responding to a study that concluded placebos are as effective as medication in all but the most depressed. And it certainly doesn't mean that severe depression — including the mood disorders that affect nearly 21 million adults in the U.S. — should be regarded as anything but the debilitating disease that it is. "This is about very sick people; there's something wrong with their brains," said Dr. Helen Mayberg, a professor of psychiatry neurology at the Emory University School of Medicine. Mayberg and others worried that a study released Tuesday by Irving Kirsch of the University of Hull in England might lead depressed patients to abruptly stop their drugs without medical guidance. Kirsch and his researchers analyzed results of published and unpublished studies from the federal Food and Drug Administration to find that four of the most common new-generation antidepressants appear to help only the most severely depressed. The drugs, which include those commonly known as Prozac, Effexor, Paxil and Serzone, worked no better than placebos in less severely depressed people, the researchers concluded. They suggested the drugs shouldn't be prescribed unless other therapies, including counseling and lifestyle changes such as exercise, have been tried. Don't stop abruptly "If you are currently taking an antidepressant drug and it's working for you, by no means stop," Mayberg said. Instead, patients should consider the new information and decide if it's time to evaluate their medication, added Deborah Serani, a psychologist in private practice in New York. Stopping the drugs abruptly can have dangerous results. "It can cause a backlash of severe depressive symptoms," said Serani, who herself has taken antidepressants for 15 years, including the generic version of Prozac. The experts said the new study provided valuable insight, but that it was based on a limited number of short-term studies in a field in which long-term results are the point. Because no one knows what causes depression, and because treatment must be individualized, each case must be evaluated on its own merits, they added. Serani has seen severely depressed patients fail to respond to antidepressants, and she's seen mild to moderately depressed patients respond very well. Other research has shown that patients respond better to a combination of medication and psychotherapy than to either treatment on its own, Mayberg said. The power of the placebo effect on depression has long been recognized, said David Barlow, founder and director emeritus for the Center for Anxiety and Related Disorders at Boston University. Antidepressants likely are overprescribed, partly because of the hurried nature of care in the U.S. health system, Barlow noted. In busy primary care practices, there's considerable pressure to do something, anything, for patients suffering from mild to severe depression. "A placebo can make people feel better as well," he said. Doctors must be more judicious in prescribing anti-depressants and patients must be more careful about requesting and using them, said Elinore McCance-Katz, a professor of psychiatry at the University of California at San Francisco. That can be complicated, especially in a country where antidepressants are advertised in magazines and on television. "What really bothers me is that big Pharma allows marketing directly to consumers," she said. Patients generally have little opportunity to verify the drug companies' claims, she added. Depression must be taken seriously "Is this can we dump on the mentally ill once again?" she said. "Their families tell them to 'snap out of it' and to 'get a grip.'" The entire field of neuro-psychiatry needs to work harder to find the cause of the depression and to discern effective ways to treat it so that people won't be tempted by simplistic solutions. "If that's all it took, working a little harder at the gym, we'd be done already," Mayberg said.
Parents Urged to Give Kids Heart Test Before They Take ADHD Meds ++ click to expand
Children diagnosed with attention deficit and hyperactivity disorder should have a thorough heart work-up, including an electrocardiogram, before taking stimulants such as Ritalin to treat the condition, according to a new recommendation by the American Heart Association. The advice marks the first time a medical-guidelines body in the U.S. has urged wide use of an electrocardiogram, which charts electrical activity in the heart, to screen a presumed healthy population for abnormalities. But there is debate among experts about the value of using the test to screen such a large pool of patients to detect a rare condition. The hope is that such a test -- in combination with a comprehensive checkup -- will help to avoid the rare cases of sudden cardiac arrest that have been linked to the widely used medicines. "The goal is to improve the care of children, including allowing them to have their ADHD treated and have it done safely," says Victoria Vetter, director of electrophysiology at Children's Hospital of Philadelphia and lead author of the heart association's statement. Since 1999, fewer than 30 sudden deaths among children have been linked to the drugs, which are currently taken by more than 2.5 million youngsters in the U.S. Issues of cost, available expertise in reading children's ECGs and concern about false-positive tests are prompting some experts to question the rationale for urging an ECG in particular. "This is a $250 million recommendation," says Mike Ackerman, a pediatric cardiologist at the Mayo Clinic in Rochester, Minn., who estimates the total cost of an ECG at about $100. "We're really trying to find a needle in a haystack, and we have no data yet to know that the screening program they're recommending would capture" those few at-risk individuals. Dr. Ackerman was a member of another American Heart Association panel that last year stopped short of recommending routine ECG screening for heart abnormalities in young competitive athletes. ADHD is a disorder affecting about 4% to 8% of American children ages 4 to 17 (some estimates range as high as 16%), and is marked by inattention and disorganized or impulsive behavior. Critics believe it is overdiagnosed, but left untreated, those who suffer the malady are at heightened risk of such problems as failure in school, car accidents and substance abuse. Drugs prescribed for ADHD include Novartis AG's Ritalin, Shire PLC's Adderall and Eli Lilly & Co.'s Strattera, and they have proved effective in controlling symptoms. The heart association's recommendation applies to all such drugs. Generally, stimulants used to treat ADHD long have been linked to slight increases in blood pressure and heart rate. More seriously, children with underlying congenital heart disease appear to be susceptible to rare episodes of heartbeat irregularities that can cause sudden cardiac arrest. There isn't any evidence linking the drugs to sudden death among children without an underlying congenital heart condition, researchers say. Three years ago, Canadian regulators suspended sales of Adderall based on reports of 20 deaths linked to the medicine over the previous decade. A year later, an advisory panel to the U.S. Food and Drug Administration recommended stringent "black box" warnings on the medicines' labels regarding serious cardiovascular risks. These developments prompted the heart association to review the evidence surrounding the medicines, which led to the statement published Tuesday in the group's chief journal, Circulation. In an exam following an ADHD diagnosis, the statement says, doctors should take a detailed patient and family history looking for, among other things, any episodes of fainting or dizziness, heart palpitations or murmurs or unexplained change in ability to exercise. Patients and family members should disclose any unexplained death or heart attack among young relatives. During a physical, patients should be checked for abnormal heartbeats, high blood pressure or any traits suggestive of Marfan syndrome, a condition associated with structural defects in the heart. An electrocardiogram can detect such abnormalities as a thickening of the heart and a person's risk of runaway heartbeats that can cause sudden death. Dr. Vetter says the ECG is a "recommendation," not a requirement that should prevent children from getting timely access to needed medicines. "If they're on the medication, they shouldn't stop it," she says, but they should get the heart work-up. Patients should have periodic heart checkups while they are taking the medicines. Dr. Vetter believes the cost of ECGs is reasonable and that they would enable doctors to identify and treat patients with heart conditions, which then could enable the patients to more safely take medicines for ADHD. "We don't want to impede treatment of these children," she says. "We are trying to allow them to be safely treated." She also says her own research suggests that about 2% of children have serious heart defects they don't know about, and that an ECG would be able to detect many of them. Still, there is little evidence from clinical studies that suggests the benefit of ECG screening significantly outweighs the costs and other risks. "The field is wrestling with how to screen for sudden death involving young people in a variety of settings and we're really perplexed," says Dr. Ackerman. Reading a child's ECG is especially tricky, he says, and a big risk of a broad screening program is false-positive tests that send children and their families on "an emotional roller coaster" of unneeded and anxiety-provoking tests. And getting a misdiagnosis of a heart defect expunged from a medical record is very difficult, he says. While the sudden death of child is tragic, "if we're going to change a lot of people's lives and spend a lot of money," says Timothy Knilans, director of cardiac electrophysiology at Cincinnati Children's Hospital, "we ought to have a good scientific basis rather than do it on the basis of what might feel right in somebody's gut." Dr. Vetter and her colleagues who published the American Heart Association statement acknowledge that hard data are lacking. They also call for establishing a registry of cases of sudden cardiac death in children, adolescents and young adults, with one goal of learning more about what role ADHD drugs may play in such incidents and what strategies may be effective in preventing them.
Cholesterol drugs destroy esophageal cancer cells ++ click to expand
NEW YORK (Reuters Health) - Drugs that are commonly used to lower cholesterol can block the proliferation and promote the destruction of esophageal cancer cells in the laboratory, according to a report in the American Journal of Gastroenterology by UK researchers. The esophagus is the tube that carries food, liquids and saliva from the mouth to the stomach - and adenocarcinoma is the most common type of cancer in this organ. Statins, a type of popular cholesterol-lowering agents, which include drugs such as Lipitor, achieve this effect by inhibiting the signaling pathways that lead to the formation of the cancer cells, co-authors Dr. Olorunseun O. Ogunwobi, from Norfolk and Norwich University Hospital, and Dr. Ian L. P. Beales, from the University of East Anglia in Norwich, note. A rapid rise in the number of esophageal cancers and deaths has been seen worldwide, leading many researchers to look for drugs that can prevent this cancer from occurring, report indicates. Prior research has shown that statins, which have a good safety record, can reduce the availability of various biosynthetic intermediate molecules that are critical for cancer cell signaling. Whether this might translate into a beneficial anti-cancer effect, however, was unclear. Using laboratory cultures of esophageal cancer cells, the researchers found that adding simvastatin (Zocor), lovastatin (Mevacor), and pravastatin (Pravachol) reduced the number of esophageal cancer cells and inhibited their growth. The higher the dose of the statin, the greater was the destruction of the cancer cells. "As yet, it is not possible to extrapolate from our laboratory studies to clinical scenarios, but the current data do suggest that any effects of statins taken by patients with esophageal cancer and Barrett's esophagus are possibly beneficial," the investigators note. Further examination of statins or other agents that inhibit the same signaling pathways that lead to the formation of esophageal cancer cells -- in experimental models or in clinical trials with patients -- should continue so researchers can "better define whether this class of drugs has a definite role in prevention or treatment of esophageal cancer," the authors conclude. SOURCE: American Journal of Gastroenterology, April 2008.
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