Aspirin-aNewMiracleDrug

Usingaspirin,anover-the-counterpillonsaIe1ineverysupermarketwithouta

prescription,totreatseriouscirculatorydiseasemayseemalmostIikequackery.But

todaydoctorsrecognizethisdrugasapotentcompoundasimportantas

antibiotics,digitalisandothermiracledrugs.

InitsnaturaIformaswiIlowbarkandleaves,thisremarkableremedydatesbackto

Hippocrates2.In1829thechemicalinthewillowtreethatcanrelievepainandreduce

feverwasdiscoveredtobesaIicin.By1899theBayerCompanyinGermanyhadmarketed

avariant,acetyIsaIicyIicacid,3underthenameofaspirin.

Sineethen,aspirinandconfoundscontainingaspirinhavebeentakenbytensof

miIIionsofarthritispatients.Asapainkilleraspirinis,accordingtoonestudy,more

effectivethanaIIotheranalgesicsandnarcoticsavaiIabIefororaIuse.ItaIsoacts

on4thebody'sthermostat,turningdownfever.

ButsomeofitspowersremainedunsuspecteduntiIrecently.In1950theIateDr.Craven

wrotetoasmaIIwesternmedicaIjournaIabout400overweight,sedentarymalepatients

towhomhehadgivenoneortwoaspirintabIetsaday.Nonehadhadaheartattack.He

enlargedhisgroupto8,000andin1956reported"NotasinglecaseofdetectabIecoronary

orcerebraIthrombosis5"and'nomajorstroke'hadoccurredinpatientswhohadtakenone

ortwotabIetsdailyforfromonetotenyears.ButhisobservationswereIargeIyignored.

ThenDr.Vaneprovedthataspirinturnedoffthebody*sprostagIandins6hormoneIike

chemicaIsthatcanbesecretedbyeverycell.SomepotentprostagIandinsareharmful

compoundsthatcreatefever,painandarthritis.OneofthemstimulatespIateIetsinthe

bIoodtobeginformingcIotsinsidearteries.AspirinbIocksthisdangerouseffect.

Vane'sfindingcausedsomeresearcherstorecaIICraven1s1956observations,which

nowhadapossibIescientificexpIanation.Numerousstudieswerebeguntofindoutwhether

aspirincouIdindeedinhibitheartattacksandstroke.

In1972,tenUSmedicaIinstitutionsbegantwo'doubIe-bIind^triaIs7of303patients

whosufferedfromtransientischemicattacks(TlAs)8.FouraspirintabIetsadaywere

givento153patients,whileplacebotabIetsweregivento150.Neitherpatientsnor

doctorsknewwhichwaswhich.Aftersixmonths,thepatientsonaspirinhadexperienced

muchfewerTIAs,andfewerstrokesanddeathsfromstrokesthanthe'controls，z.TheresuIts

weresoconeIusivethataspirinhasbeenusedforthispurposewidely.

FoodandCancer

MedicaIexpeIshavesuspectedformanyyearsthatthereisastrongIinkbetween

whatapersoneatsandcancer.Theysayanewstudyprovidesthefirstevidencelthat

vitaminscouldreduceaperson'schanceofdevelopingcancer.AteamofChineseand

Americanscientistsdidthestudy.TheyarefromAmericanNationaICancerInstitute2

andtheCancerInstituteoftheChineseAcademyofMedicaISciences3inBeijing.The

JournaIoftheNationaICancerInstitutepubIishedtheresuItsofthestudy.Aboutthirty

thousandpeoplebetweentheagesof40to69tookpartinthestudy.Theywerefromthe

northerncentraIChineseareaofLinxian.Mostofthem

tookvitaminsandmineraIseverydayforfiveyears.

LinxianwaschosenbecausethepeopletherehaveaIIextremelyhighrateofcancer

ofstomachandesophagus.ResearchersbeIievethatfungusandmoldsinIocaIfoodsmay

bepartlyresponsibIeforthehighcancerrate.Researchersdividedthoseintoeight

groups.SevenofthegroupsreceiveddifferentmixturesofvitaminsandmineraIsdaily.

TheamountsofthevitaminsandmineraIswere1to2timesgreaterthanwhatAmerican

heaIthofficialssayisneeded.TheeighthgroupreceivedsugarpiIIs4thathadnoeffect.

ThosewhoseemedtogainthemostreceivedamixtureofaformofvitaminAcalled

P—carotene,vitaminEandthemineraIseIenium.ThevitaminandmineraIarebeIieved

topreventdamagetocellscausedbycancer-causingsubstances.Researchersreported

a13percentdropincancerratesinthosewhotookcarotene,vitaminEandseIenium5.

TheyaIsofounda10percentdropinthenumberofdeathscausedbystrokesfrombursting

bIoodvesseIs.

Scientistswarnthatitistoosoontoknowiftheeffectwouldbethesameamong

peopleinothercountries.TheynotethatthepeopIeinLinxianeatfoodsthatIack

necessaryvitaminsandmineraIs.ChineseofficialswiIIcontinuetorecordthehealth

recordsofthepeopIeinLinxianformanyyears.Fornowofficialsreportedlyare

consideringusingtheresuItsofthestudy.TheywanttofindawaytoimprovetheheaIth

ofpeopleinLinxianandothersmaIItownsinChina.

HospitaiMistreatment

Accordingtoastudy,mostmedicaIinternsreportexperiencingmistreatment,

includinghumiIiationbyseniordoctors,beingthreatened,orphysicaIabuseintheir

firstyearoutofmedicaIschool.

Thefindingscomefromanalysisoftheresponsestoa13surveymailedin

January1991to1,733second-yearresidents.Thesurveyandanalysisappearinthe

ApriI15thissueoftheJournaIoftheAmericanMedicaIAssociation.

OveraII,outofthe1,277residentswhocompIetedsurveys,1,185saidthatthey

hadexperiencedatleastoneincidentofmistreatmentintheirinternyear.Inaddition

toreportingincidentswheretheywereabused,morethan45%oftheresidentssaidthey

hadwitnessedatIeastoneincidentwhereotherpersonshadmadefaIsemedicaIrecords.

Moreover,nearIythreequartersoftheresidentssaidtheyhadwitnessedmistreatment

ofpatientsbyotherresidents,attendingphysicians,ornurses.AImost40%saidpatient

mistreatmentwasafrequentevent

Morethan10%oftheresidentssaidtheywerenotaIIowedtohaveenoughsIeep,

禾口theaveragenumberofhourswithoutsIeepwas37.6.Theaverageon-calIhoursduring

atypicaIweekwas56.9hours,butabout25%oftheresidentssaidtheiron-caII

assignmentsweremorethan80hourssomeweeks.Although30%oftheresidentssaidthey

experiencedsometypeofsexuaIharassmentordiscrimination,verbaIabusewasthemost

commonprobIemcited.WhenabusiveincidentswereIimitedtoeventsoccurringthreeor

moretimes,53%oftherespondentsreportedthattheywerebeIittIedorhumiIiated

bymoreseniorresidents,whilejustover21%reportedsomeonetakingcreditfortheir

work.Being“giventasksforpunishment,“"beingpushed,kickedorhit,“andhaving

someone^threateningyourreputationorcareer,werereportedasamorefrequent

occurrencebyover10%oftherespondingresidents.

HowDeafnessMakesItEasiertoHear

MostpeopIethinkofBeethoven'shearingIossasanobstacIetocomposingmusic.However,

heproducedhismostpowerfuIworksintheIastdecadeofhisIifewhenhewascompIeteIy

deaf.

ThisisoneofthemostgloriouscasesofthetriumphofwiIIoveradversity1,but

hisbiographer,MaynardSoIomon,takesadifferentview.SoIomonarguesthat

Beethoven'sdeafness“heightened”hisachievementasacomposer..InhisdeafworId

BeethovencouIdexperimerit,freefromthesoundsoftheoutsideworId,freetocreate

newformsandharmonies.

HearingIossdoesnotseemtoaffectthemusicaIabilityofmusicianswhobecome

deaf.Theycontinueto"hear"musicwithasmuch,orgreater,accuracythanifthey

wereactuaIIyhearingitbeingpIayed.

MichaelEagar,whodiedin2003,becamedeafattheageof21.Hedescribeda

fascinatingphenomenonthathappenedwithinthreemonths:"myformermusicaI

experiencesbegantoplaybacktome.Icouldn'tdifferentiatebetweenwhatIheardand

reaIhearing.2Aftermanyyears,itisstillrewardingtoIistentotheseplaybacks,

to'hear4musicwhichisnewtomeandtofindmanyquietaccompanimentsforalIof

mymoods.”

HowisitthattheworIdwesee,touch,hear,andsmeIIisboth“outthere“andat

thesametimewithinus?ThereisnobetterexampIeofthisconnectionbetweenexternaI

stimuIusandinternaIperceptionthanthecochIearimplant.Noman-madedevicecould

repIacetheabiIitytohear..However,itmightbepossibIetousethebrain'sremarkabIe

powertomakesenseoftheeIectricaIsignaIstheimpIantproduces.

WhenMichaeIEdgarfirstt4switchedon“hiscochIearimpIant,thesoundsheheard

werenotataIIcIear.GraduaIIy,withmuchhardwork,hebegantoidentifyeveryday

sounds.ForexampIe,“TheinsistentringingoftheteIephonebecamecIearaImostat

once.”

TheprimarypurposeoftheimpIantistoaIlowcommunicationwithothers.WhenpeopIe

spoketoEagar,heheardtheirvoices“comingthroughIikeaIong-distanceteIephone

caIIonapoorconnection.ButwhenitcametohisbeIovedmusic,theimplantwasof

noheIp.Whenhewantedtoappreciatemusic,EagarpIayedthepiano.Hesaid,“Iplay

thepianoasIusedtoandhearitinmyheadatthesametime.Themovementofmyfingers

andthefeeIofthekeysgiveadded'clarity'tohearinginmyhead.5M

CochlearimpIantsallowthedeaftohearagaininawaythatisnotperfect,but

whichcanchangetheirIives.Still,asMichaeIEagardiscovered,whenitcomesto

musicaIHarmonies,hearingisirreIevant.EventhemostamazingcochIearimplantswould

havebeenuseIesstoBeethovenashecomposedhisNinthSymphonyattheendofhisIife.

IceCreamTasterHasSweetJob

JohnHarrisonhaswhatmustbethemostwantedjobintheUnitedStates.He,stheofficial

tasterforEdy'sGrandIceCream,oneofthenation,sbest-sellingbrands.Harrison?

stastebudsareinsuredfor$1million.Hegetstosample60icecreamsadayatEdy'

sheadquartersinOakland,California.Andwhenheisn,tdoingthat,hetravels,buying

Edy'sinsupermarketsalloverthecountrysothathecancheckforperfectappearance,

texture,andflavor.

AfterIinterviewedHarrison,Irealizedthatthelifeofanicecreamtasterisn't

allCookies'nCream—aflavorthat*heinvented,bytheway.No,it'sextremely

hardwork,whichrequiresdisciplineandselflessness.

Foronething,hedoesn,tswallowonthejob.Likeacoffeetaster,Harrisonspits.

Usingagoldspoontoavoid“off"flavors,hetakesasmallbiteandmovesitaround

inhismouthtointroduceittoall9,000orsotastebuds.Nexthesmack-smack-smacks

hislipstogetsomeairintothesample.Thenhebreathesingentlytobringthearoma

upthroughthebackofhisnose.EachstephelpsHarrisonevaluatewhethertheicecream

hasagoodbalanceofdairy,sweetness,andaddedingredients一thethree-flavor

componentsoficecream.Then,eveniftheicecreamtastesheavenly,heputsitinto

atrashcan.Afullstomachmakesit,impossibletojudgethequalityoftheflavors.

Duringtheworkweek,Harrisontoldmethathehastomakeothersacrifices,too:noonions,

garlic,orspicyfood,andnocaffeine.Caffeinewillblockthetastebuds,hesays,

sohisbreakfastisacupofherbaltea.Thisisasmallpricetopayforwhathecallsthe

world'sbestjob.

HarrisonJsfamilyhasbeenintheicecreambusinessinonewayoranotherlforfour

generations,soHarrisonhasspenthisentirelifewithit2.However,hehasneverlost

hisloveforitscold,creamysweetness.Heevenordersicecreaminrestaurantsfor

dessert.Ontheseoccasions3,hedoesswallow,andheeatsaboutaquart(0.95liters)

eachweek.Bycomparison4,theaveragepersonintheUnitedStateseats23.2quarts(21.

96liters)oficecreamandotherfrozendairyproductseachyear.

Edy'sicecreamisavailableindozensofflavors.Sowhatflavordoesthebest-trained

ice-creamtasterinthecountryprefer?Vanilla!Infact,vanillaisthebest-selling

varietyintheUnitedStates.However,youshouldnevercallitplainvanilla."It'sa

verycomplexflavor,“Harrisonsays.

Once-dailyPiIICouldSimpIifyHIV1Treatment

Bristol-MyersSquibbandGiIeadScienceshavecombinedmanyHIVdrugsintoasingle

pill.Sometimesthebestmedicineismorethanonekindofmedicine.MaIaria,

tuberculosisandHIV/ADDS2,forexampIe,areaIItreatedwithcombinationsofdrugs.

ButthatcanmeanaIotofpiIIstotake.ItwouIdbesimplerifdrugcompaniescombined

aIIthemedicinesintoasinglepill,takenjustonceaday.

Now,twocompaniessaytheyhavedonethatforpeopIejuststartingtreatmentfor

HIV,thevirusthatcausesAIDS.ThecompaniesareBristol-MyersSquibbandGilead

Sciences.TheyhavedevelopedasinglepiIIthatcombinesthreedrugscurrentIyon

themarket.Bristol-MyersSquibbsellsoneofthemunderthenameofSustiva3.Gilead

combinedtheothersEmtrivaandViread,intoasinglepillintwothousandfour.

Combiningdrugsinvolvesmorethantechnicalissues.ItaIsoinvolvesissuesof

competitionifthedrugsaremadebydifferentcompanies.Thenewonce-dailypiIIis

theresultof_what_isdescribedasthefirstjointventureagreementofitskindin

thetreatmentofHIV.

InJanuarytheNewEngIandJournaIofMedicine4pubIishedastudyofthenewpiII.

Researcherscompareditseffectivenessto5thatofthewidelyusedcombinationof

SustivaandCombivir.Combivircontainstwodrugs,AZT6and3TC7.Theresearcherssay

thatafteroneyearoftreatment,thenewpiIIsuppressedHIVlevelsinmorepatients

andwithfewersideeffects8.Gileadpaidforthestudy.ProfessorJoeIGaIIantat

theJohnsHopkinsSchoolofMedicineinBaltimore,Maryland,ledtheresearch.Heis

apaidadvisertoGileadandBristoI-MeyersSquibbasweIIasthemakerofCombivir,

GlaxoSmithKIine.

GIaxoSmithKlinereactedtothefindingsbysayingthatasinglestudyisof

Iimitedvalue.ItsaystheeffectivenessofCombivirhasbeenshownineachofmorethan

fiftystudies.

Thepriceofthenewonce-daiIypillhasnotbeenannounced.ButGileadand

BristoI-MyersSquibbsaytheywiIIprovideitatreducedcosttodevelopingcountries.

TheyplaninthenextfewmonthstoasktheUnitedStatesFoodandDrugAdministration9

toapprovethenewpill.

ThereareIimitstowhocouIdtakeitbecauseofthedifferentdrugsitcontains.

ForexampIe,pregnantwomenaretoIdnottotakeSustivabecauseoftheriskofbirth

disordersW.ExpertssaymorethanfortymillionpeopIearoundtheworIdareIivingwith

HIV.

PregnantWomenWarnedAboutACEInhibitor

SomeofthemostcommonIyusedmedicinesforhighbIoodpressurearedrugscalled

ACEinhibitors.Doctorshavegiventhesedrugstopatientsfortwenty-fiveyears.A

governmentstudyintheUnitedStatesfoundthattheusealmostdoubIedbetween1995

and2000.

DoctorshaveknownforyearsthatwomenshouldnottakeACEinhibitorsduringthe

lastsixmonthsofpregnancy.Themedicinecaninjurethebaby.ACEinhibitors,though,

havebeenconsideredsafewhentakenduringthefirstthreemonths.ButaNewstudyhas

foundthatwomenwhotakethesedrugsearIyintheirpregnancystillincreasetherisk

ofbirthdisorders2.Thestudyshowsthat,comparedtoothers,theirbabieswerealmost

threetimesaslikelytobebornwithmajorprobIems.3TheseincIudedprobIemswiththe

formationofthebrainandnervoussystemandholesintheheart.

TheresearcherssaytheyfoundnoincreasedriskinwomenwhotookotherbIood

pressuremedicinesduringthefirstthreemonths.ResearchersatVanderbiItUniversity

inTennesseeandBostonUniversitydidthestudy.TheNewEnglandJournaIofMedicine4

pubIishedtheresults.TheresearchersstudiedtherecordsofaImostthirtythousand

birthsbetween1985and2000.TwohundredninebabieswereborntowomenwhotookACE

inhibitorsduringthefirstthreemonthsoftheirpregnancies.Eighteenofthebabies,

oralmostninepercent,hadmajordisorders.

ACEinhibitorsareoftengiventopatientswithdiabetes.Butdiabetesduring

pregnancycanresultinbirthdefects.Sothestudydidnotincludeanywomenknownto

bediabetic5.ACEinhibitorssuppressaproteincalledangiotensin-convertingenzyme,

orACE.ThisenzymeproducesachemicaIinthebodythatmakesbIoodpassagesnarrow.

Thedrugsincreasetheflowofbloodsopressureisreduced.

5.Newdrugsaretestedonpregnantanimalstoseeiftheymightcausebirthdefects

inhumans.Butexpertssaythesetestsarenotalwaysdependable.TheUnitedStatesFood

andDrugAdministration6heIpedpayforthestudy.TheF.D.A.sayswomenwhomight

becomepregnantshouldtaIkwiththeirdoctoraboutotherwaystotreathighblood

pressure

PrivacyWorryMayKeepHIV1PatientsfromTherapy

PatientsinfectedwithHIVareoftenconcernedabout2theconfidentialityoftheir

HIV-positivestatus.Infact,somepatientsaresoworriedthattheywiIIactuaIlygive

uptreatmenttopreventthereIeaseofthisinformation,accordingtoareportpubIished

intheAugustissueofAIDSCare.

Dr.KathrynWhetten-GoIdsteinandcolleaguesfromDukeUniversity,Durham,North

Carolina3,studiedtheconfidentialityissuesof15HIV-infectedpatientsfromruraI

NorthCaroIinaIocations.TheyweredividedintogroupsdesignedtoexpIoretheir

attitudestoward,andexperienceswith,breachesinconfidentiality.

“ThefearofabreachinconfidentiaIityisdefinitelyaffectingthecarethat

HIV-infectedpatientsreceive,"Whetten-GoIdsteinsaid."Moststudiedpatientshad

experiencedorknewsomeonewhohadexperiencedabreachinconfidentiaIity.H

“Twotypesofbreachesoccurred,^Whetten-GoIdsteinnoted."Thefirstwasamore

obvioustypeofbreach.OneexampIewasanursewhotoldherchildthatherpatientwas

HIV-positiveoutofconcernthatherchildwouldpIaywiththepatient'schild.”

"TheothertypeofbreachwasmoresubtIe,onethatprovidersmightnotconsider

breaches,5"Whetten-GoIdsteinexplained."ThistypeofbreachinvoIvesproviders

talkingaboutapatient'sHIVstatuswithoutthepatient'sknowIedgeoftheinteraction.M

“TheIawaIIowsthesharingofinformationbetweenproviderswithinthesame

institution,butpatient'sconsentmustbeobtainedbeforeprovidersatdifferent

institutionscanshareinformation,nshepointedout.

“PatientsinthestudywantedproviderstoteIIthemwhentheyaregoingtoshare

informationwithotherprovidersandwhyitisbeingdone,nWhetten-GoIdsteinsaid."They

aIsofeltthatprovidersshouIdbepunishedwhenabreachoccurs.M

“However,becausepatientsareoftenreluctanttoseekIegaIactionwhichmayfurther

exposetheirstatus,theyfeltthatthesystemshouldreguIateitself,Msheadded.

RedMeatLinkstoHigherRiskofBreastCancer

ExerciseandkeepingaheaIthyweightaretwothingsthatdoctorssaymighthelp

womenIowertheirriskofbreastcancer.

MothersmayreducetheirriskiftheybreastfeedforatIeastfourmonths.Forolder

women,hormonerepIacementtherapy2canIowertheriskofsomeotherdiseases.Butit

hasbeenfoundtoincreasetheriskofbreastcancer.SowomenshouIdconsidertheir

choicescarefuIIy.Thesamemaybesaidfordiet.

Newfindingsshowthatyoungerwomenwhoeatalotofredmeathavehigherrates

ofbreastcancerscalledhormone-receptorpositive3.ThegrowthisfedbytheIeveIs

ofestrogenoranotherhormone,progesterone,inthebody.

ResearchersatBrighamWomen'sHospitaIinBoston,Massachusetts,reportedthe

findingsaspartofahealthstudyofnurses.TheresearchersfoIIowedthehealthof

morethan90,000womenfrom1991to2003.Thosewhoatethemostredmeatatemorethan

oneandone-haIfservingsaday.Aservingwasdefinedasroughly84grams.Thosewho

atetheleastredmeatateIessthanthreeservingsaweek.Thisiswhatthestudyfound

aboutbreastcancersthatwerehormonereceptor-positive:Thewomenwhoatethemost

redmeatwerealmosttwotimesaslikelytogetthemasthewomenwhoatetheIeastof

it.

EunyoungCho,theleadauthorofthereport,saysmoreresearchisneededtoknow

thereasonfortheIink.Butinthepast,researchershavesuggestedthatthreethings

mayplayapart.Oneisthewaymeatiscookedorprocessed.Anotheristheuseofgrowth

hormonesincows.Andthethirdisthekindofironinredmeat:Thestudyappearsin

theArchivesofInternaIMedicine.

AndnowwehavemoretoteIIyouaboutoursubject—resveratrol.Wediscusseda

studyintheUnitedStatesthatfoundthatIargeamountsofthispIantcompoundheIped

fatmiceIivelonger.Themicewerefedmuchmoreresveratrolthanpeoplecouldgetfrom

redwine,oneofthefoodsthatcontainsit.

Now,scientistsinFrancesayresveratrolaIsoimprovesmuscleperformance—againt

atIeastinmice.TheywereabletoruntwotimesasfarinIaboratorytreadmiIItests4

asmicenormaIIycould.ThestudyattheInstituteofGeneticsandMoIecuIarandCeIIuIar

Biology5appearedinthejournaICell.

ResearchShowsWalkingCanLiftDepression

NewresearchbyGermanscientistsshowsthatauthorCharIesDickenswasontoagood

thing1whenhetookIong,briskwaIkstoreIieveperiodicboutsofdepression.Theauthor

of0IiverTwistandDavidCoppeifieIdwouldwalkforhoursinthe1860sasanantidote

to2intensefeeIingsofsadnesswhichalternatedwith3restlesseuphoria.Thisisalso

theadvicethatexpertsfromtheFreeUniversityinBerIinaregivingtoday.

AerobicexerciseIikerapidwalkingcanbemoreeffectiveatIiftingdepressionthan

drugs,reportedthescientistsledbyDr.FernandoDimeo.Theystudied12peopIewith

severedepressionthathadlastedanaverageofninemonths.Theteamfoundthatin

10ofthesepatientsdrugshadfailedtobringanysubstantiaIimprovement.Theteam

devisedanexerciseregimeforthegroupthatinvolvedwalkingonatreadmiIIfor30

minuteseveryday.Accordingtotheregime,intenseactivitylastingthreeminuteswas

alternatedwithwalkingathalfspeedforthreeminutes.Theintensityofthetraining

programmewassteppedup4astheheartrateadapted.Ameasurementofdepressionseverity

wastakenatthestartandtheendoftheprogramme,andpatientswereaskedtorate

theirownmoodreguIarIyovera10-dayperiod.TheresearchersinBerlinfoundthatafter

10daysofthecoursesixpatientsfe11"substantiallyIessdepressed".Thenumber

incIudedfivewhohadnotfoundanyreliefusingdrugtreatment.TwoweresIightIyless

depressed,whilefourothersremainedunchanged.DepressionIeveIsoveraIIfelIbya

third5andontheseIf-assessedscoresby25percent,saidtheresearcherswhosefindings

appearedintheBritishJournaIofSportsMedicine.

ThestudywassmaIIbuttheextentoftheimprovementwassaidbyscientiststobe

impressive.Theoutcomeindicatedaclinicalbenefitwhichcouldnotbeobtainedwith

pharmacologicaltreatmentcurrentlyavaiIable,theysaid.Nineteenthcenturydoctors

wouldhavecalledDickens'sconditionmeIanchoIiasineethepsychologic