Highlight HEALTH

• Are Doctors Super Human? | Brain Blogger

  Do as I say, not as I do. When it comes to sleep, that’s the attitude of the medical profession. Indeed, a recent study found that interns and doctors are still expected to work ridiculously long hours in hospitals.

• Are Headphones Safe for Your Ears? | Center on Media and Child Health

  iPods and headphones are ubiquitous today. But are they safe?

• Marketing Science in the Public Square | Tomorrow’s Table

  The media is the predominant source of science information and can have a huge impact on how the public views the risks and benefits of scientific research. If we don’t want public awareness of scientific research to disappear, science needs to be marketed in broader media settings.

• Adult Stem Cells and Stroke | Mary Meets Dolly

  Rebecca Taylor reports on a recent study finding that stem cells from bone marrow help reduce stroke damage in mice in a surprising way.

• 13 Secrets from Your Pharmacist | Living Healthy | Reader’s Digest

  Reader’s Digest shares pharmacy secretes, telling us what to keep in mind the next time you visit the pharmacy counter.

• Caveat Emptor: Drugs and the Free Market | Secundum Artem

  N.B. explores drugs and the free market in an excellent post about the FDA cracking down on unapproved “cancer cures”. Let the buyer beware.

• Could Your Heart Medicine Cause Cancer? | Doctor David’s Blog

  Dr. David Loeb reviews published clinical trial data on Vytorin and cautions against the use of newly approved FDA drugs.

• You’re Never Too Old To Learn Computer Skills | Dr Shock MD PhD

  You can teach an old health consumer new skills. Dr. Shock describes a study to increase e-health use among older adults.

Warfarin, also known under the brand names of Coumadin, Jantoven, Marevan and Waran, is an oral anticoagulant used worldwide for the treatment and prevention of thromboembolic disease. However, warfarin therapy can be difficult to manage because there is a wide variability in patient response and the drug has a narrow therapeutic index. Taking too small a dose can lead to a blood clot while too much can cause life-threatening bleeding.

Single nucleotide polymorphisms (SNPs) in the genes CYP2C9, which influences metabolism, and VKORC1, which influences pharmacodynamic response (meaning the biochemical and physiological effects of the drug on the body), are strongly associated with warfarin responsiveness [1]. According to an article in Wired Science last year [2]:

Doctors in the field say that traditional measurements such as size and age account for just 15% to 20% of the variability in responses to warfarin. Adding the genetic factors can raise that figure to 50% or higher, say advocates of genetic testing.

Indeed, experts estimate that integrating genetic testing into routine warfarin therapy could avoid 85,000 serious bleeding events and 17,000 strokes annually [3]. Integrated genetic testing in warfarin therapy is estimated to reduce healthcare spending by $1.1 billion U.S. annually.

Helix Health, the first U.S. stand-alone genomic medicine practice, is hosting a 90-minute CliniCast today (Monday, June 30, 2008) 
from 1:00 — 2:30 PM EDT to examine how genomic medicine improves the accuracy of warfarin dosing. The CliniCast will feature Dr. Steven Murphy (the GeneSherpa) and a panel of medical, scientific and legal experts.

The group will discuss a number of topics:

• Why genetic testing is a necessary feature in anticoagulant therapy.
• What potential risks exist in “Trial and Error” dosing?
• Will insurance cover this genetic testing?
• What are potential tort issues in predictive genetic testing and medical uses of genetic tests associated with anticoagulant therapy?
• Why aren’t physicians utilizing FDA approved testing and dosage guidance?

To register for the free webcast, point your browser here: http://event.netbriefings.com/event/helixhealth/Live/warfarin/register.html

A podcast of the CliniCast will be available on Helix Health following the session. For more information, contact info@helixhealth.org or visit Helix Health.

Additional resources can be found in the Personalized Medicine category of the Highlight HEALTH Web Directory.

There are a number of genetic tests currently available that can help predict response to certain medications. Clinical studies are currently being conducted to understand the connection between genotype and warfarin dose for the delivery of optimized anticoagulant therapy. Given the widespread use of warfarin, I anticipate an interesting discussion on the Helix Health CliniCast and encourage everyone to register and attend.

UPDATE: August 27th, 2008

Helix Health CliniCasts are now available on CD. Additionally, you can also subscribe to CliniCast podcasts.

References

1. Cooper et al. A genome-wide scan for common genetic variants with a large influence on warfarin maintenance dose. Blood. 2008 Jun 5. [Epub ahead of print]
   View abstract
2. Genomic Medicine Hits Mainstream Milestone. Wired Science. 2007 Aug 17.
3. Health Care Savings from Personalizing Medicine Using Genetic Testing: The Case of Warfarin. Andrew McWilliam, Randall Lutter, Clark Nardinelli. Working Paper 06-23. 2006 Nov.

Everyone knows that a good education is important for getting a good job. Now researchers are finding that being well-educated can lengthen your life. The study, published earlier this month in the journal PLoS ONE, finds that socioeconomic inequalities in the U.S. death rate between people with less than a high school education and college graduates increased from 1993 to 2001 [1]. The widening gap is due to (i) significant decreases in mortality from all causes, heart disease, cancer, stroke and other conditions, in the most educated and (ii) unchanged or increasing death rates in the least educated.

Epidemiologists at the American Cancer Society (ACS) worked with scientists from the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) to analyze over 3.5 million deaths from 1993 to 2001. They used data from the National Vital Statistics System (NVSS) and death certificate information to calculate annual age-standardized death rates for 25 — 64 year olds by level of education for all causes of death as well as for the seven most common causes of death (heart disease, cancer, stroke, HIV infection, diabetes, chronic lung disease, accidents).

The study restricted the analyses to deaths among non-Hispanic whites and blacks. It also excluded deaths that occurred in seven states (Georgia, Kentucky, New York, Oklahoma, Rhode Island, South Dakota and West Virginia) because completeness of education on death certificates in these states was less than 80% in at least one of years considered in the study.

The study found that between 1993 and 2001, the ratio of the all cause death rate in people with less than 12 years versus greater than or equal to 16 years of education significantly increased in white and black men, and in white women, indicating that those with a college education or better had an increased life expectancy. Contributing to the inequality was significant reductions in mortality for the most educated men (36% in black men and 25% in white men), largely due to decreases in death rates from HIV infection, cancer and heart disease.

Interestingly, the decrease in all cause death rates among men became larger with each additional increment of educational attainment (i.e. 12 years of education vs. 13 — 15 years vs. greater than or equal to 16 years). In women, this affect was only observed with greater than or equal to 16 years of education.

The study results support a previous investigation of county-level mortality published last month showing a steady increase in mortality inequality across the U.S. [2]. In that study, death rates between 1983 and 1999 increased for women in a large number of counties, principally due to chronic diseases related to smoking, overweight and diabetes, and high blood pressure. Most counties that showed a worsening of life expectancy were in the deep South, along the Mississippi River and in the Appalachia, extending into the southern portion of the Midwest and into Texas.

Between 1961 and 1983, counties with increased or decreased life expectancy improvements had relatively similar levels of income. However, after 1983, gain in life expectancy was positively associated with county income. Thus, those who were disadvantaged did not benefit from the increase in life expectancy experienced by the advantaged, demonstrating a large health inequality.

What does all this mean? It means those with less education are getting left behind and literally dying earlier as a result. ACS chief executive officer Dr. Otis W. Brawley, M.D. said that [3]:

People [in the U.S.] with less education have fewer financial resources, less access to health insurance or stable employment, and less health literacy. As a result, while the death rate among the most educated Americans is dropping dramatically, we’re seeing a real lack of progress or even worsening trends in the least educated persons. The gap between the best and worst off in the country is actually getting wider.

Last year, the American Cancer Society launched the Access to Health Care campaign, a national initiative to raise awareness about the problem of true access to health care. The website shows what is being done to help those uninsured and underinsured and how you can help.

Education is a marker of socioeconomic position. Lower educational attainment and thus a poorer socioeconomic position is associated with a variety of factors that affect health, including decreased financial resources, reduced access to health insurance and health literacy. Given that one of the CDC’s strategic imperatives is “all people, and especially those at greater risk of health disparities, will achieve their optimal lifespan with the best possible quality of health in every stage of life” [4], these results are troubling and highlight the growing problem with the U.S. healthcare system.

References

1. Jemal et al. Widening of socioeconomic inequalities in U.S. death rates, 1993-2001. PLoS ONE. 2008 May 14;3(5):e2181. DOI: 10.1371/journal.pone.0002181
   View abstract
2. Ezzati et al. The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States. PLoS Med. 2008 Apr 22;5(4):e66.
   View abstract
3. Worsening Health Trends Among Least Educated. American Cancer Society News Center. 2008 May 14.
4. Center for Disease Control and Prevention’s Health Protection Goals. Accessed 2008 Jun 2.