Denise Napoli

The risk for a postsurgical gout flare is greatest in patients with high presurgical serum urate levels, patients who've had cancer surgery, and in those who did not receive presurgical colchicine, according to a study.

Dr. Eun Bong Lee of the Seoul (South Korea) National University and colleagues looked at 67 patients who had a postsurgical gout attack and 67 who did not. All had prior histories of gout (Ann. Rheum. Dis. 2007 Nov. 12 [Epub doi:10.1136/ard.2007.078683]).

In an interview, Dr. Lee said “the postsurgical gout attack develops within 14 days after the surgery,” although the mean in this study was 4 days.

Lower extremity joints were affected in 65 of the 67 patients (97%) with a postsurgical gout flare. The most common site was the first metatarsophalangeal (MTP) joint (42 patients, or 63%). The ankle was the second most commonly affected joint (21 patients, 31%), followed by the knee (15 patients, 22%). In all, 14 patients had an additional lower-extremity joint affected. Upper-extremity involvement occurred in only nine patients.

Overall, about half (33) of patients had only one affected joint; 22 patients had two; 8 patients had three; and only 2 patients each had four or five.

In multivariate analysis, the authors reported that cancer surgery was performed on 60% of gout attack patients versus 34% of controls, a significant difference. “Cancers, especially hematologic malignancies, are known to cause hyperuricemia and gout because of high rates of cellular turnover,” wrote the investigators.

Presurgical serum uric acid levels greater than or equal to 9 mg/dL were also significantly correlated with an attack. This was “the most important risk factor,” and “the risk of attack increased in proportion to presurgical uric acid levels,” the added.

In an interview, Dr. Kenneth Saag, director of the center for education and research on therapeutics of musculoskeletal disorders at the University of Alabama at Birmingham, who was not affiliated with the study, said assessing a gout patient's presurgical urate levels isn't common practice, and shouldn't be. “Knowing the serum urate is only partially related to the likelihood of postsurgical gout. The level of serum urate is not something that can be managed in the perioperative period, anyway.”

A lack of colchicine prophylaxis before surgery was also tied to a significant risk of attack. But Dr. Saag, urged caution. “Some patients have kidney dysfunction, and colchicine is not an unequivocally safe medicine.”

“[Postsurgical gout attacks] can prolong the hospital stay. Surgeons aren't particularly eager to send patients home after surgery if they can't walk or are in severe pain. Sometimes gout can cause fevers which can be confused with postoperative infection,” said Dr. Saag. On the other hand, “the treatments for gout can compromise healing. Sometimes, if a steroid like prednisone is used to manage gout, that may impair wound healing.”

Dr. Lee said his team had no financial disclosures in relation to this study.

The risk for a postsurgical gout flare is greatest in patients with high presurgical serum urate levels, patients who've had cancer surgery, and in those who did not receive presurgical colchicine, according to a study.

Dr. Eun Bong Lee of the Seoul (South Korea) National University and colleagues looked at 67 patients who had a postsurgical gout attack and 67 who did not. All had prior histories of gout (Ann. Rheum. Dis. 2007 Nov. 12 [Epub doi:10.1136/ard.2007.078683]).

In an interview, Dr. Lee said “the postsurgical gout attack develops within 14 days after the surgery,” although the mean in this study was 4 days.

Lower extremity joints were affected in 65 of the 67 patients (97%) with a postsurgical gout flare. The most common site was the first metatarsophalangeal (MTP) joint (42 patients, or 63%). The ankle was the second most commonly affected joint (21 patients, 31%), followed by the knee (15 patients, 22%). In all, 14 patients had an additional lower-extremity joint affected. Upper-extremity involvement occurred in only nine patients.

Overall, about half (33) of patients had only one affected joint; 22 patients had two; 8 patients had three; and only 2 patients each had four or five.

In multivariate analysis, the authors reported that cancer surgery was performed on 60% of gout attack patients versus 34% of controls, a significant difference. “Cancers, especially hematologic malignancies, are known to cause hyperuricemia and gout because of high rates of cellular turnover,” wrote the investigators.

Presurgical serum uric acid levels greater than or equal to 9 mg/dL were also significantly correlated with an attack. This was “the most important risk factor,” and “the risk of attack increased in proportion to presurgical uric acid levels,” the added.

In an interview, Dr. Kenneth Saag, director of the center for education and research on therapeutics of musculoskeletal disorders at the University of Alabama at Birmingham, who was not affiliated with the study, said assessing a gout patient's presurgical urate levels isn't common practice, and shouldn't be. “Knowing the serum urate is only partially related to the likelihood of postsurgical gout. The level of serum urate is not something that can be managed in the perioperative period, anyway.”

A lack of colchicine prophylaxis before surgery was also tied to a significant risk of attack. But Dr. Saag, urged caution. “Some patients have kidney dysfunction, and colchicine is not an unequivocally safe medicine.”

“[Postsurgical gout attacks] can prolong the hospital stay. Surgeons aren't particularly eager to send patients home after surgery if they can't walk or are in severe pain. Sometimes gout can cause fevers which can be confused with postoperative infection,” said Dr. Saag. On the other hand, “the treatments for gout can compromise healing. Sometimes, if a steroid like prednisone is used to manage gout, that may impair wound healing.”

Dr. Lee said his team had no financial disclosures in relation to this study.

The risk for a postsurgical gout flare is greatest in patients with high presurgical serum urate levels, patients who've had cancer surgery, and in those who did not receive presurgical colchicine, according to a study.

Dr. Eun Bong Lee of the Seoul (South Korea) National University and colleagues looked at 67 patients who had a postsurgical gout attack and 67 who did not. All had prior histories of gout (Ann. Rheum. Dis. 2007 Nov. 12 [Epub doi:10.1136/ard.2007.078683]).

In an interview, Dr. Lee said “the postsurgical gout attack develops within 14 days after the surgery,” although the mean in this study was 4 days.

Lower extremity joints were affected in 65 of the 67 patients (97%) with a postsurgical gout flare. The most common site was the first metatarsophalangeal (MTP) joint (42 patients, or 63%). The ankle was the second most commonly affected joint (21 patients, 31%), followed by the knee (15 patients, 22%). In all, 14 patients had an additional lower-extremity joint affected. Upper-extremity involvement occurred in only nine patients.

Overall, about half (33) of patients had only one affected joint; 22 patients had two; 8 patients had three; and only 2 patients each had four or five.

In multivariate analysis, the authors reported that cancer surgery was performed on 60% of gout attack patients versus 34% of controls, a significant difference. “Cancers, especially hematologic malignancies, are known to cause hyperuricemia and gout because of high rates of cellular turnover,” wrote the investigators.

Presurgical serum uric acid levels greater than or equal to 9 mg/dL were also significantly correlated with an attack. This was “the most important risk factor,” and “the risk of attack increased in proportion to presurgical uric acid levels,” the added.

In an interview, Dr. Kenneth Saag, director of the center for education and research on therapeutics of musculoskeletal disorders at the University of Alabama at Birmingham, who was not affiliated with the study, said assessing a gout patient's presurgical urate levels isn't common practice, and shouldn't be. “Knowing the serum urate is only partially related to the likelihood of postsurgical gout. The level of serum urate is not something that can be managed in the perioperative period, anyway.”

A lack of colchicine prophylaxis before surgery was also tied to a significant risk of attack. But Dr. Saag, urged caution. “Some patients have kidney dysfunction, and colchicine is not an unequivocally safe medicine.”

“[Postsurgical gout attacks] can prolong the hospital stay. Surgeons aren't particularly eager to send patients home after surgery if they can't walk or are in severe pain. Sometimes gout can cause fevers which can be confused with postoperative infection,” said Dr. Saag. On the other hand, “the treatments for gout can compromise healing. Sometimes, if a steroid like prednisone is used to manage gout, that may impair wound healing.”

Dr. Lee said his team had no financial disclosures in relation to this study.

Mighty and Mutated

Forget doping. The next generation of athletic enhancement was reported by researchers at Case Western Reserve University, Cleveland, where overexpression of the PEPCK-C gene in the skeletal muscle tissue of mice gave subjects the ability to run a stunning 6 km at a speed of 20 m/min on a rodent treadmill, a feat the Bureau of Indications has not been able to accomplish since ninth grade, despite the dual advantages of being a biped and owning an expensive gym membership. The PEPCK-C gene normally is involved with gluconeogenesis in the liver and kidney cortex and in glyceroneogenesis in liver and adipose tissue. The researchers, whose finding were published in the Journal of Biological Chemistry, wrote that, “the three PEPCK-Cmus mice tested ate, on a body weight basis, an average of 60% more food than controls. Despite eating more, 18-month-old PEPCK-Cmus mice weighed less and had dramatically less body fat.” If this all sounds too good to be true, take it from Whiskers, who completed the annual Iron Mouse triathlon this year in a record 8 hours flat: “This record is not tainted at all. At all. Period.” He then lifted his treadmill over his head and threw it to the opposite end of the cage in anger.

fMRI Study: Giuliani in '08

In anticipation of the 2008 presidential election, researchers recently performed functional magnetic resonance imaging on the brains of 20 likely voters as they viewed videos and pictures of different 2008 presidential candidates. In a letter to the New York Times, investigators reported that initial activity in the amygdala at the sight of a photo of Mitt Romney indicated anxiety in some of the 20 subjects, but that activity died down once voters watched videos of the candidate giving a stump speech, showing that voters may grow more comfortable with Mitt over time. In another finding, a video of Fred Thompson promoted activity in the superior temporal sulcus and the inferior frontal cortex, “both areas involved in empathy,” reported the researchers. And finally, voters' brains exhibited greater activity in the right amygdala, right anterior temporal pole, and hypothalamus—areas typically associated with erotic arousal—to photos of Rudy Giuliani dressed as a woman than in response to pictures of Hillary Clinton. “Our results reveal some voter impressions on which this election may well turn,” wrote the investigators. “A pair of red high heels could clinch the nomination for Giuliani.” The researchers conceded that their investigation was somewhat compromised by the inclusion of photos of little-known Republican candidate Ron Paul, whom voters routinely mistook for Mr. Rogers.

FDA: Fun Is Toxic. Happy Holidays!

In a recently issued, presumably taxpayer-funded pamphlet, “Food Safety Tips for Healthy Holidays,” the Food and Drug Administration cautioned consumers against the many perils of the holiday season. “Parties, family dinners, and other gatherings where food is served are all part of the holiday cheer. But the merriment can change to misery if food makes you or others ill.” Indeed. Among the FDA's suggestions for a healthy, happy holiday: “Don't eat uncooked cookie dough.” “Make sure oysters in oyster dressing are thoroughly cooked.” And “when making your own eggnog or other recipe calling for raw eggs, use pasteurized shell eggs, liquid or frozen pasteurized egg products, or powdered egg whites.” But enough brandy kills the bacteria, right? Hopefully, Santa heeds the agency's warning to wash thoroughly before dunking those thoroughly cooked cookies into milk—the reindeer stall is a breeding ground for germs.

Mighty and Mutated

Forget doping. The next generation of athletic enhancement was reported by researchers at Case Western Reserve University, Cleveland, where overexpression of the PEPCK-C gene in the skeletal muscle tissue of mice gave subjects the ability to run a stunning 6 km at a speed of 20 m/min on a rodent treadmill, a feat the Bureau of Indications has not been able to accomplish since ninth grade, despite the dual advantages of being a biped and owning an expensive gym membership. The PEPCK-C gene normally is involved with gluconeogenesis in the liver and kidney cortex and in glyceroneogenesis in liver and adipose tissue. The researchers, whose finding were published in the Journal of Biological Chemistry, wrote that, “the three PEPCK-Cmus mice tested ate, on a body weight basis, an average of 60% more food than controls. Despite eating more, 18-month-old PEPCK-Cmus mice weighed less and had dramatically less body fat.” If this all sounds too good to be true, take it from Whiskers, who completed the annual Iron Mouse triathlon this year in a record 8 hours flat: “This record is not tainted at all. At all. Period.” He then lifted his treadmill over his head and threw it to the opposite end of the cage in anger.

fMRI Study: Giuliani in '08

In anticipation of the 2008 presidential election, researchers recently performed functional magnetic resonance imaging on the brains of 20 likely voters as they viewed videos and pictures of different 2008 presidential candidates. In a letter to the New York Times, investigators reported that initial activity in the amygdala at the sight of a photo of Mitt Romney indicated anxiety in some of the 20 subjects, but that activity died down once voters watched videos of the candidate giving a stump speech, showing that voters may grow more comfortable with Mitt over time. In another finding, a video of Fred Thompson promoted activity in the superior temporal sulcus and the inferior frontal cortex, “both areas involved in empathy,” reported the researchers. And finally, voters' brains exhibited greater activity in the right amygdala, right anterior temporal pole, and hypothalamus—areas typically associated with erotic arousal—to photos of Rudy Giuliani dressed as a woman than in response to pictures of Hillary Clinton. “Our results reveal some voter impressions on which this election may well turn,” wrote the investigators. “A pair of red high heels could clinch the nomination for Giuliani.” The researchers conceded that their investigation was somewhat compromised by the inclusion of photos of little-known Republican candidate Ron Paul, whom voters routinely mistook for Mr. Rogers.

FDA: Fun Is Toxic. Happy Holidays!

In a recently issued, presumably taxpayer-funded pamphlet, “Food Safety Tips for Healthy Holidays,” the Food and Drug Administration cautioned consumers against the many perils of the holiday season. “Parties, family dinners, and other gatherings where food is served are all part of the holiday cheer. But the merriment can change to misery if food makes you or others ill.” Indeed. Among the FDA's suggestions for a healthy, happy holiday: “Don't eat uncooked cookie dough.” “Make sure oysters in oyster dressing are thoroughly cooked.” And “when making your own eggnog or other recipe calling for raw eggs, use pasteurized shell eggs, liquid or frozen pasteurized egg products, or powdered egg whites.” But enough brandy kills the bacteria, right? Hopefully, Santa heeds the agency's warning to wash thoroughly before dunking those thoroughly cooked cookies into milk—the reindeer stall is a breeding ground for germs.

Mighty and Mutated

Forget doping. The next generation of athletic enhancement was reported by researchers at Case Western Reserve University, Cleveland, where overexpression of the PEPCK-C gene in the skeletal muscle tissue of mice gave subjects the ability to run a stunning 6 km at a speed of 20 m/min on a rodent treadmill, a feat the Bureau of Indications has not been able to accomplish since ninth grade, despite the dual advantages of being a biped and owning an expensive gym membership. The PEPCK-C gene normally is involved with gluconeogenesis in the liver and kidney cortex and in glyceroneogenesis in liver and adipose tissue. The researchers, whose finding were published in the Journal of Biological Chemistry, wrote that, “the three PEPCK-Cmus mice tested ate, on a body weight basis, an average of 60% more food than controls. Despite eating more, 18-month-old PEPCK-Cmus mice weighed less and had dramatically less body fat.” If this all sounds too good to be true, take it from Whiskers, who completed the annual Iron Mouse triathlon this year in a record 8 hours flat: “This record is not tainted at all. At all. Period.” He then lifted his treadmill over his head and threw it to the opposite end of the cage in anger.

fMRI Study: Giuliani in '08

In anticipation of the 2008 presidential election, researchers recently performed functional magnetic resonance imaging on the brains of 20 likely voters as they viewed videos and pictures of different 2008 presidential candidates. In a letter to the New York Times, investigators reported that initial activity in the amygdala at the sight of a photo of Mitt Romney indicated anxiety in some of the 20 subjects, but that activity died down once voters watched videos of the candidate giving a stump speech, showing that voters may grow more comfortable with Mitt over time. In another finding, a video of Fred Thompson promoted activity in the superior temporal sulcus and the inferior frontal cortex, “both areas involved in empathy,” reported the researchers. And finally, voters' brains exhibited greater activity in the right amygdala, right anterior temporal pole, and hypothalamus—areas typically associated with erotic arousal—to photos of Rudy Giuliani dressed as a woman than in response to pictures of Hillary Clinton. “Our results reveal some voter impressions on which this election may well turn,” wrote the investigators. “A pair of red high heels could clinch the nomination for Giuliani.” The researchers conceded that their investigation was somewhat compromised by the inclusion of photos of little-known Republican candidate Ron Paul, whom voters routinely mistook for Mr. Rogers.

FDA: Fun Is Toxic. Happy Holidays!

In a recently issued, presumably taxpayer-funded pamphlet, “Food Safety Tips for Healthy Holidays,” the Food and Drug Administration cautioned consumers against the many perils of the holiday season. “Parties, family dinners, and other gatherings where food is served are all part of the holiday cheer. But the merriment can change to misery if food makes you or others ill.” Indeed. Among the FDA's suggestions for a healthy, happy holiday: “Don't eat uncooked cookie dough.” “Make sure oysters in oyster dressing are thoroughly cooked.” And “when making your own eggnog or other recipe calling for raw eggs, use pasteurized shell eggs, liquid or frozen pasteurized egg products, or powdered egg whites.” But enough brandy kills the bacteria, right? Hopefully, Santa heeds the agency's warning to wash thoroughly before dunking those thoroughly cooked cookies into milk—the reindeer stall is a breeding ground for germs.

African American and Hispanic rheumatoid arthritis patients treated at public clinics wait longer to start disease-modifying antirheumatic drug therapy than do their white counterparts receiving care at private clinics.

Early intervention with DMARDs has been shown to delay joint damage.

Dr. Maria E. Suarez-Almazor, rheumatology section chief at the University of Texas M.D. Anderson Cancer Center, Houston, reported data from her retrospective cohort study of all medical records of new patients with a rheumatoid arthritis diagnosis seen at a public clinic (n=118) and a private clinic (n=167).

Both facilities are affiliated with the Baylor College of Medicine, Houston, staffed by Baylor rheumatology fellows and faculty, and considered tertiary-level care facilities. The public clinic cares for mostly minority, disadvantaged, or uninsured patients. Most of the private clinic patients had private insurance.

Socioeconomic status was inferred from insurance status and attendance at the public or private clinic, an admittedly imperfect method. Patients were classified as white, African American, Hispanic, or other. Nonwhites accounted for 83% of the patients seen in the public clinic versus 18% in the private clinic, a highly significant statistical difference.

The median time to initiation of DMARDs was 7 years for public clinic patients and 3 years for private clinic patients. The median time to initiation of steroids was 23 years for public patients and 1 year for private patients. And in all patients at both clinics, the median time to initiation of DMARDs for white patients was 3 years, versus 7 years for nonwhites (J. Rheumatol. 2007 Nov. 1 [Epub ahead of print]).

In an interview, Dr. Suarez-Almazor questioned whether the disparity is related to a communication problem between patients and doctors, such that physicians are unable to communicate the importance of expensive DMARDs.

She reported no conflicts of interest in relation to this study.

African American and Hispanic rheumatoid arthritis patients treated at public clinics wait longer to start disease-modifying antirheumatic drug therapy than do their white counterparts receiving care at private clinics.

Early intervention with DMARDs has been shown to delay joint damage.

Dr. Maria E. Suarez-Almazor, rheumatology section chief at the University of Texas M.D. Anderson Cancer Center, Houston, reported data from her retrospective cohort study of all medical records of new patients with a rheumatoid arthritis diagnosis seen at a public clinic (n=118) and a private clinic (n=167).

Both facilities are affiliated with the Baylor College of Medicine, Houston, staffed by Baylor rheumatology fellows and faculty, and considered tertiary-level care facilities. The public clinic cares for mostly minority, disadvantaged, or uninsured patients. Most of the private clinic patients had private insurance.

Socioeconomic status was inferred from insurance status and attendance at the public or private clinic, an admittedly imperfect method. Patients were classified as white, African American, Hispanic, or other. Nonwhites accounted for 83% of the patients seen in the public clinic versus 18% in the private clinic, a highly significant statistical difference.

The median time to initiation of DMARDs was 7 years for public clinic patients and 3 years for private clinic patients. The median time to initiation of steroids was 23 years for public patients and 1 year for private patients. And in all patients at both clinics, the median time to initiation of DMARDs for white patients was 3 years, versus 7 years for nonwhites (J. Rheumatol. 2007 Nov. 1 [Epub ahead of print]).

In an interview, Dr. Suarez-Almazor questioned whether the disparity is related to a communication problem between patients and doctors, such that physicians are unable to communicate the importance of expensive DMARDs.

She reported no conflicts of interest in relation to this study.

African American and Hispanic rheumatoid arthritis patients treated at public clinics wait longer to start disease-modifying antirheumatic drug therapy than do their white counterparts receiving care at private clinics.

Early intervention with DMARDs has been shown to delay joint damage.

Dr. Maria E. Suarez-Almazor, rheumatology section chief at the University of Texas M.D. Anderson Cancer Center, Houston, reported data from her retrospective cohort study of all medical records of new patients with a rheumatoid arthritis diagnosis seen at a public clinic (n=118) and a private clinic (n=167).

Both facilities are affiliated with the Baylor College of Medicine, Houston, staffed by Baylor rheumatology fellows and faculty, and considered tertiary-level care facilities. The public clinic cares for mostly minority, disadvantaged, or uninsured patients. Most of the private clinic patients had private insurance.

Socioeconomic status was inferred from insurance status and attendance at the public or private clinic, an admittedly imperfect method. Patients were classified as white, African American, Hispanic, or other. Nonwhites accounted for 83% of the patients seen in the public clinic versus 18% in the private clinic, a highly significant statistical difference.

The median time to initiation of DMARDs was 7 years for public clinic patients and 3 years for private clinic patients. The median time to initiation of steroids was 23 years for public patients and 1 year for private patients. And in all patients at both clinics, the median time to initiation of DMARDs for white patients was 3 years, versus 7 years for nonwhites (J. Rheumatol. 2007 Nov. 1 [Epub ahead of print]).

In an interview, Dr. Suarez-Almazor questioned whether the disparity is related to a communication problem between patients and doctors, such that physicians are unable to communicate the importance of expensive DMARDs.

She reported no conflicts of interest in relation to this study.

Rheumatoid arthritis patients have not experienced a decline in mortality, despite a dramatically increased life expectancy in the general population since the 1950s, according to investigators reporting on a cohort study.

In an interview, study investigator Dr. Hilal Maradit Kremers, of the Mayo Clinic in Rochester, Minn., said, “One assumes that since rheumatologists are trying to manage [RA] more aggressively, it must have a positive impact on mortality. … But all of our research is showing that the mortality in the RA patients did not change.”

In a population-based incidence cohort study, researchers looked at all 822 adult residents of Rochester in whom RA was first diagnosed between 1955 and 1995 and all adult residents of Olmsted County in whom RA was diagnosed between 1995 and 2000. The patients were followed up through medical records until their death or Jan. 1, 2007. The mean age at incidence was 58 years. Nearly three-quarters were women. The median length of follow-up was 11.7 years (Arthritis Rheum. 2007;56:3583–7).

RA patients' mortality was unchanged in each of the five study periods: from 1955 to 1964, 1965 to 1974, 1975 to 1984, 1985 to 1994, and 1995 to 2000. Female mortality hovered around 2.4 per 100 person-years, and male mortality was constant at about 2.5 per 100 person-years. In contrast, mortality in women in the Minnesota general population declined from 1.0 per 100 person-years in 1965 to 0.2 per 100 person-years in 2000. For men, the rate went from 1.2 to 0.3 per 100 person-years.

“Patients in whom RA was diagnosed in more recent years had a mortality rate similar to that of their peers in whom RA was diagnosed in the 1950s and 1960s. … The dramatic changes in therapeutic strategies for RA in the last 4–5 decades have not had a major impact on the excess mortality.”

Dr. Kremers reported no conflicts of interest in relation to this study.

Rheumatoid arthritis patients have not experienced a decline in mortality, despite a dramatically increased life expectancy in the general population since the 1950s, according to investigators reporting on a cohort study.

In an interview, study investigator Dr. Hilal Maradit Kremers, of the Mayo Clinic in Rochester, Minn., said, “One assumes that since rheumatologists are trying to manage [RA] more aggressively, it must have a positive impact on mortality. … But all of our research is showing that the mortality in the RA patients did not change.”

In a population-based incidence cohort study, researchers looked at all 822 adult residents of Rochester in whom RA was first diagnosed between 1955 and 1995 and all adult residents of Olmsted County in whom RA was diagnosed between 1995 and 2000. The patients were followed up through medical records until their death or Jan. 1, 2007. The mean age at incidence was 58 years. Nearly three-quarters were women. The median length of follow-up was 11.7 years (Arthritis Rheum. 2007;56:3583–7).

RA patients' mortality was unchanged in each of the five study periods: from 1955 to 1964, 1965 to 1974, 1975 to 1984, 1985 to 1994, and 1995 to 2000. Female mortality hovered around 2.4 per 100 person-years, and male mortality was constant at about 2.5 per 100 person-years. In contrast, mortality in women in the Minnesota general population declined from 1.0 per 100 person-years in 1965 to 0.2 per 100 person-years in 2000. For men, the rate went from 1.2 to 0.3 per 100 person-years.

“Patients in whom RA was diagnosed in more recent years had a mortality rate similar to that of their peers in whom RA was diagnosed in the 1950s and 1960s. … The dramatic changes in therapeutic strategies for RA in the last 4–5 decades have not had a major impact on the excess mortality.”

Dr. Kremers reported no conflicts of interest in relation to this study.

Rheumatoid arthritis patients have not experienced a decline in mortality, despite a dramatically increased life expectancy in the general population since the 1950s, according to investigators reporting on a cohort study.

In an interview, study investigator Dr. Hilal Maradit Kremers, of the Mayo Clinic in Rochester, Minn., said, “One assumes that since rheumatologists are trying to manage [RA] more aggressively, it must have a positive impact on mortality. … But all of our research is showing that the mortality in the RA patients did not change.”

In a population-based incidence cohort study, researchers looked at all 822 adult residents of Rochester in whom RA was first diagnosed between 1955 and 1995 and all adult residents of Olmsted County in whom RA was diagnosed between 1995 and 2000. The patients were followed up through medical records until their death or Jan. 1, 2007. The mean age at incidence was 58 years. Nearly three-quarters were women. The median length of follow-up was 11.7 years (Arthritis Rheum. 2007;56:3583–7).

RA patients' mortality was unchanged in each of the five study periods: from 1955 to 1964, 1965 to 1974, 1975 to 1984, 1985 to 1994, and 1995 to 2000. Female mortality hovered around 2.4 per 100 person-years, and male mortality was constant at about 2.5 per 100 person-years. In contrast, mortality in women in the Minnesota general population declined from 1.0 per 100 person-years in 1965 to 0.2 per 100 person-years in 2000. For men, the rate went from 1.2 to 0.3 per 100 person-years.

“Patients in whom RA was diagnosed in more recent years had a mortality rate similar to that of their peers in whom RA was diagnosed in the 1950s and 1960s. … The dramatic changes in therapeutic strategies for RA in the last 4–5 decades have not had a major impact on the excess mortality.”

Dr. Kremers reported no conflicts of interest in relation to this study.

ACR Urges Approval of Arthritis Act

Representatives from the American College of Rheumatology and the Arthritis Foundation urged lawmakers to support the “Arthritis Prevention, Control, and Cure Act of 2007” (S.626/H.R. 1283) at a congressional briefing this fall. Among other things, the Act contains provisions to create incentives to specialize in pediatric rheumatology, especially through loan repayment programs. At the briefing, Dr. Christy Sandborg, professor of pediatrics at Stanford (Calif.) University, pointed out “there are 12 states that don't even have a pediatric rheumatologist” and “over one-third of medical schools and pediatric residency training programs do not have a pediatric rheumatologist.”

Raloxifene Indication Added

The Food and Drug Administration approved raloxifene for reducing the risk of breast cancer in postmenopausal women at high risk for the disease and for postmenopausal women with osteoporosis. The revised package insert now will include a boxed warning that women with a history of venous thromboembolism should not take raloxifene, and women at risk for stroke should take it only after reviewing the risks with their physician. Raloxifene, marketed by Eli Lilly as Evista, also is approved for prevention and treatment of osteoporosis in postmenopausal patients.

One-Third of Americans Uninsured

Almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from 30% in 1999–2000, Families USA reported. Of these, 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million people who lacked coverage, 71% had full-time jobs and another 9% were working part time; only 17% were unemployed. The numbers are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because those statistics include only those who were uninsured for a full year. The report is at

www.familiesusa.org

Task Force Examines Physician Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation is examining the impact of payments and gifts to physicians from the drug and device industry. The task force will also consider possible public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by pharmaceutical and medical device companies.

Increase for Part B Premiums

The standard monthly Medicare Part B premium will increase to $96.40 next year, up 3.1% from the current $93.50, Kerry Weems, administrator of the Centers for Medicare and Medicaid Services, announced in a teleconference. That amount will be paid by individuals with an annual income of $82,000 or less or couples with $160,000 or less a year, about 95% of all Medicare beneficiaries, according to the agency. For other beneficiaries, Part B premiums will be tied to beneficiary income as required by the Medicare Modernization Act.

ACR Urges Approval of Arthritis Act

Representatives from the American College of Rheumatology and the Arthritis Foundation urged lawmakers to support the “Arthritis Prevention, Control, and Cure Act of 2007” (S.626/H.R. 1283) at a congressional briefing this fall. Among other things, the Act contains provisions to create incentives to specialize in pediatric rheumatology, especially through loan repayment programs. At the briefing, Dr. Christy Sandborg, professor of pediatrics at Stanford (Calif.) University, pointed out “there are 12 states that don't even have a pediatric rheumatologist” and “over one-third of medical schools and pediatric residency training programs do not have a pediatric rheumatologist.”

Raloxifene Indication Added

The Food and Drug Administration approved raloxifene for reducing the risk of breast cancer in postmenopausal women at high risk for the disease and for postmenopausal women with osteoporosis. The revised package insert now will include a boxed warning that women with a history of venous thromboembolism should not take raloxifene, and women at risk for stroke should take it only after reviewing the risks with their physician. Raloxifene, marketed by Eli Lilly as Evista, also is approved for prevention and treatment of osteoporosis in postmenopausal patients.

One-Third of Americans Uninsured

Almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from 30% in 1999–2000, Families USA reported. Of these, 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million people who lacked coverage, 71% had full-time jobs and another 9% were working part time; only 17% were unemployed. The numbers are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because those statistics include only those who were uninsured for a full year. The report is at

www.familiesusa.org

Task Force Examines Physician Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation is examining the impact of payments and gifts to physicians from the drug and device industry. The task force will also consider possible public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by pharmaceutical and medical device companies.

Increase for Part B Premiums

The standard monthly Medicare Part B premium will increase to $96.40 next year, up 3.1% from the current $93.50, Kerry Weems, administrator of the Centers for Medicare and Medicaid Services, announced in a teleconference. That amount will be paid by individuals with an annual income of $82,000 or less or couples with $160,000 or less a year, about 95% of all Medicare beneficiaries, according to the agency. For other beneficiaries, Part B premiums will be tied to beneficiary income as required by the Medicare Modernization Act.

ACR Urges Approval of Arthritis Act

Representatives from the American College of Rheumatology and the Arthritis Foundation urged lawmakers to support the “Arthritis Prevention, Control, and Cure Act of 2007” (S.626/H.R. 1283) at a congressional briefing this fall. Among other things, the Act contains provisions to create incentives to specialize in pediatric rheumatology, especially through loan repayment programs. At the briefing, Dr. Christy Sandborg, professor of pediatrics at Stanford (Calif.) University, pointed out “there are 12 states that don't even have a pediatric rheumatologist” and “over one-third of medical schools and pediatric residency training programs do not have a pediatric rheumatologist.”

Raloxifene Indication Added

The Food and Drug Administration approved raloxifene for reducing the risk of breast cancer in postmenopausal women at high risk for the disease and for postmenopausal women with osteoporosis. The revised package insert now will include a boxed warning that women with a history of venous thromboembolism should not take raloxifene, and women at risk for stroke should take it only after reviewing the risks with their physician. Raloxifene, marketed by Eli Lilly as Evista, also is approved for prevention and treatment of osteoporosis in postmenopausal patients.

One-Third of Americans Uninsured

Almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from 30% in 1999–2000, Families USA reported. Of these, 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million people who lacked coverage, 71% had full-time jobs and another 9% were working part time; only 17% were unemployed. The numbers are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because those statistics include only those who were uninsured for a full year. The report is at

www.familiesusa.org

Task Force Examines Physician Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation is examining the impact of payments and gifts to physicians from the drug and device industry. The task force will also consider possible public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by pharmaceutical and medical device companies.

Increase for Part B Premiums

The standard monthly Medicare Part B premium will increase to $96.40 next year, up 3.1% from the current $93.50, Kerry Weems, administrator of the Centers for Medicare and Medicaid Services, announced in a teleconference. That amount will be paid by individuals with an annual income of $82,000 or less or couples with $160,000 or less a year, about 95% of all Medicare beneficiaries, according to the agency. For other beneficiaries, Part B premiums will be tied to beneficiary income as required by the Medicare Modernization Act.

A genomewide association study of osteoarthritis susceptibility has begun in the United Kingdom with 8,000 patients and 6,000 controls, the largest study of its kind ever undertaken.

Dr. John Loughlin, principal investigator of the study and a geneticist at the Nuffield Department for Orthopaedic Surgery at the University of Oxford (England), said the study's massive size would provide it with “unprecedented power.”

The results will be made freely available to the public upon the study's completion.

In an interview, Dr. Loughlin explained that the study, known as arcOGEN (“arc” stands for Arthritis Research Campaign, who is funding the story; the “O” for osteoarthritis; and the “GEN” for genetics), will genotype only U.K. citizens of white British ancestry. He said his group already has 4,000 cases and is collecting another 4,000. “The controls are those genotyped as part of other studies,” he said.

The inclusion criterion for cases is a diagnosis of severe primary osteoarthritis (OA). “The vast majority of our cases [more than 75%] will have undergone arthroplasty of a hip or of a knee,” he said. There will be no inclusions or exclusions related to past or present drug treatment.

Dr. Loughlin hopes to have the first 4,000 cases genotyped by the summer of 2008 and the second 4,000 genotyped by the summer of 2009, with analyses performed by the autumn of 2009.

Dr. Roy Altman, visiting professor in the division of rheumatology at the University of California, Los Angeles, said “it's a little bit early to say what the clinical relevance [of this study] is going to be. … Unless you put in formulas for, for example, … whether the cases play soccer or not,” it will be difficult to tell how great is the effect of environmental factors like trauma on genetically predisposed OA candidates.

In addition, Dr. Altman, who is not affiliated with the study, pointed out the study will be limited by the fact that it will look only at white British subjects. However, regarding Dr. Loughlin's suitability to undertake such research, he added: “You can't get anybody better than [Dr. Loughlin]. He is the best of the osteoarthritis geneticists, and I know he will do a very credible job.”

Several genes have already been found to be associated with susceptibility to OA. “The most compelling so far are FRZB, GDF5, and ASPN,” said Dr. Loughlin. “Intriguingly, all encode proteins that are involved in cell-signaling pathways in the tissues of the articulating joint, implying that OA susceptibility may partly be accounted for by aberrant cell signals. This is exciting, as these are potentially modifiable.” He added, however, that although several studies have been published on OA genetic susceptibility, few have been replicated.

Dr. Loughlin and his associates hope to find 10–20 of the genes that confer a strong to moderate risk for OA.

Large, genomewide studies like arcOGEN (versus smaller, linkage region-focused studies) will likely become more common as the cost of these studies continues to drop, Dr. Loughlin said. “Focusing on particular candidates will happen when a [genomewide association study] has highlighted a particular genomic region as likely to harbor susceptibility genes.”

Dr. Altman said, “The technology of identifying genes has advanced so much that now we can do these kind of genomewide studies in bulk, with 8,000 patients, that we couldn't have done 3 years ago. … I'm not quite sure how it's going to apply [to clinical practice], but it's certainly something that's important. If you find genetic predispositions and you have a way of altering those genes, then it may be relevant.”

The £2.2 million grant from the Arthritis Research Campaign funding this study is the biggest ever given by the group, which says it is the fourth-largest medical research charity in the United Kingdom.

The arcOGEN study will be undertaken across eight centers in the United Kingdom Dr. Loughlin reported no conflicts of interest for himself or his associates.

'The technology of identifying genes has advanced so much that now we can do these kind of genomewide studies in bulk.' DR. ALTMAN

A genomewide association study of osteoarthritis susceptibility has begun in the United Kingdom with 8,000 patients and 6,000 controls, the largest study of its kind ever undertaken.

Dr. John Loughlin, principal investigator of the study and a geneticist at the Nuffield Department for Orthopaedic Surgery at the University of Oxford (England), said the study's massive size would provide it with “unprecedented power.”

The results will be made freely available to the public upon the study's completion.

In an interview, Dr. Loughlin explained that the study, known as arcOGEN (“arc” stands for Arthritis Research Campaign, who is funding the story; the “O” for osteoarthritis; and the “GEN” for genetics), will genotype only U.K. citizens of white British ancestry. He said his group already has 4,000 cases and is collecting another 4,000. “The controls are those genotyped as part of other studies,” he said.

The inclusion criterion for cases is a diagnosis of severe primary osteoarthritis (OA). “The vast majority of our cases [more than 75%] will have undergone arthroplasty of a hip or of a knee,” he said. There will be no inclusions or exclusions related to past or present drug treatment.

Dr. Loughlin hopes to have the first 4,000 cases genotyped by the summer of 2008 and the second 4,000 genotyped by the summer of 2009, with analyses performed by the autumn of 2009.

Dr. Roy Altman, visiting professor in the division of rheumatology at the University of California, Los Angeles, said “it's a little bit early to say what the clinical relevance [of this study] is going to be. … Unless you put in formulas for, for example, … whether the cases play soccer or not,” it will be difficult to tell how great is the effect of environmental factors like trauma on genetically predisposed OA candidates.

In addition, Dr. Altman, who is not affiliated with the study, pointed out the study will be limited by the fact that it will look only at white British subjects. However, regarding Dr. Loughlin's suitability to undertake such research, he added: “You can't get anybody better than [Dr. Loughlin]. He is the best of the osteoarthritis geneticists, and I know he will do a very credible job.”

Several genes have already been found to be associated with susceptibility to OA. “The most compelling so far are FRZB, GDF5, and ASPN,” said Dr. Loughlin. “Intriguingly, all encode proteins that are involved in cell-signaling pathways in the tissues of the articulating joint, implying that OA susceptibility may partly be accounted for by aberrant cell signals. This is exciting, as these are potentially modifiable.” He added, however, that although several studies have been published on OA genetic susceptibility, few have been replicated.

Dr. Loughlin and his associates hope to find 10–20 of the genes that confer a strong to moderate risk for OA.

Large, genomewide studies like arcOGEN (versus smaller, linkage region-focused studies) will likely become more common as the cost of these studies continues to drop, Dr. Loughlin said. “Focusing on particular candidates will happen when a [genomewide association study] has highlighted a particular genomic region as likely to harbor susceptibility genes.”

Dr. Altman said, “The technology of identifying genes has advanced so much that now we can do these kind of genomewide studies in bulk, with 8,000 patients, that we couldn't have done 3 years ago. … I'm not quite sure how it's going to apply [to clinical practice], but it's certainly something that's important. If you find genetic predispositions and you have a way of altering those genes, then it may be relevant.”

The £2.2 million grant from the Arthritis Research Campaign funding this study is the biggest ever given by the group, which says it is the fourth-largest medical research charity in the United Kingdom.

The arcOGEN study will be undertaken across eight centers in the United Kingdom Dr. Loughlin reported no conflicts of interest for himself or his associates.

'The technology of identifying genes has advanced so much that now we can do these kind of genomewide studies in bulk.' DR. ALTMAN

A genomewide association study of osteoarthritis susceptibility has begun in the United Kingdom with 8,000 patients and 6,000 controls, the largest study of its kind ever undertaken.

Dr. John Loughlin, principal investigator of the study and a geneticist at the Nuffield Department for Orthopaedic Surgery at the University of Oxford (England), said the study's massive size would provide it with “unprecedented power.”

The results will be made freely available to the public upon the study's completion.

In an interview, Dr. Loughlin explained that the study, known as arcOGEN (“arc” stands for Arthritis Research Campaign, who is funding the story; the “O” for osteoarthritis; and the “GEN” for genetics), will genotype only U.K. citizens of white British ancestry. He said his group already has 4,000 cases and is collecting another 4,000. “The controls are those genotyped as part of other studies,” he said.

The inclusion criterion for cases is a diagnosis of severe primary osteoarthritis (OA). “The vast majority of our cases [more than 75%] will have undergone arthroplasty of a hip or of a knee,” he said. There will be no inclusions or exclusions related to past or present drug treatment.

Dr. Loughlin hopes to have the first 4,000 cases genotyped by the summer of 2008 and the second 4,000 genotyped by the summer of 2009, with analyses performed by the autumn of 2009.

Dr. Roy Altman, visiting professor in the division of rheumatology at the University of California, Los Angeles, said “it's a little bit early to say what the clinical relevance [of this study] is going to be. … Unless you put in formulas for, for example, … whether the cases play soccer or not,” it will be difficult to tell how great is the effect of environmental factors like trauma on genetically predisposed OA candidates.

In addition, Dr. Altman, who is not affiliated with the study, pointed out the study will be limited by the fact that it will look only at white British subjects. However, regarding Dr. Loughlin's suitability to undertake such research, he added: “You can't get anybody better than [Dr. Loughlin]. He is the best of the osteoarthritis geneticists, and I know he will do a very credible job.”

Several genes have already been found to be associated with susceptibility to OA. “The most compelling so far are FRZB, GDF5, and ASPN,” said Dr. Loughlin. “Intriguingly, all encode proteins that are involved in cell-signaling pathways in the tissues of the articulating joint, implying that OA susceptibility may partly be accounted for by aberrant cell signals. This is exciting, as these are potentially modifiable.” He added, however, that although several studies have been published on OA genetic susceptibility, few have been replicated.

Dr. Loughlin and his associates hope to find 10–20 of the genes that confer a strong to moderate risk for OA.

Large, genomewide studies like arcOGEN (versus smaller, linkage region-focused studies) will likely become more common as the cost of these studies continues to drop, Dr. Loughlin said. “Focusing on particular candidates will happen when a [genomewide association study] has highlighted a particular genomic region as likely to harbor susceptibility genes.”

Dr. Altman said, “The technology of identifying genes has advanced so much that now we can do these kind of genomewide studies in bulk, with 8,000 patients, that we couldn't have done 3 years ago. … I'm not quite sure how it's going to apply [to clinical practice], but it's certainly something that's important. If you find genetic predispositions and you have a way of altering those genes, then it may be relevant.”

The £2.2 million grant from the Arthritis Research Campaign funding this study is the biggest ever given by the group, which says it is the fourth-largest medical research charity in the United Kingdom.

The arcOGEN study will be undertaken across eight centers in the United Kingdom Dr. Loughlin reported no conflicts of interest for himself or his associates.

'The technology of identifying genes has advanced so much that now we can do these kind of genomewide studies in bulk.' DR. ALTMAN

Race Cars Crash, Journal Reports

An article in the British Journal of Sports Medicine reported that professional Formula 1 and MotoGP motorbike racing is “inherently dangerous.” The authors recommended “innovative clothing” to “selectively defend key anatomical structures” from excruciating whiplash, crashes, subsequent catastrophic explosions, and the odd chance of being run over after one's body is ejected, Wile E. Coyote-style, from the driver's seat. The authors also highlighted the health risk posed by high-speed cornering at a lateral force of up to 4.5 G. “Such lateral forces make breathing difficult, [and] are associated with unusual disorders,” they wrote, including, but not limited to, peeing one's pants and screaming for one's mommy. They concluded that, “if Formula 1 cars or MotoGP motorbikes lose control at more than 300 km/hr, there is very little that can be done to prevent the driver from being seriously injured.” Maybe some knee pads might help.

Helium-Hogging MRIs Ruin Birthdays

As a worldwide helium shortage worsens, many groups are blaming MRI machines—which use helium gas to cool their powerful magnets—for hogging the resource, reported the CBC, a Canadian news outlet. About one-fifth of the world's helium supply is used in MRI machines, and world demand for helium, largely driven by the increased use of MRI and diagnostic imaging, has grown by 25% since 2003. Members of the party entertainment industry have voiced concern, in high squeaky voices, about the shortage.

Beer Makes You Smart

Moderate alcohol consumption may enhance cognition, according to research published in the Journal of Neuroscience. In a study, rats were fed liquid diets containing varying amounts of alcohol. Some had no alcohol at all; some had a moderate amount (“equivalent to a level of consumption that does not exceed the legal driving limit,” one of the authors told Scientific American); and some rats had quite a bit. Not only did the moderate drinkers perform better on object recognition tests than their counterparts, but they also were more popular and got invited to more parties than did either the teetotalers or the sloppy drunks, no doubt due to the moderate drinkers' alcohol-enhanced Trivial Pursuit skills.

Race Cars Crash, Journal Reports

An article in the British Journal of Sports Medicine reported that professional Formula 1 and MotoGP motorbike racing is “inherently dangerous.” The authors recommended “innovative clothing” to “selectively defend key anatomical structures” from excruciating whiplash, crashes, subsequent catastrophic explosions, and the odd chance of being run over after one's body is ejected, Wile E. Coyote-style, from the driver's seat. The authors also highlighted the health risk posed by high-speed cornering at a lateral force of up to 4.5 G. “Such lateral forces make breathing difficult, [and] are associated with unusual disorders,” they wrote, including, but not limited to, peeing one's pants and screaming for one's mommy. They concluded that, “if Formula 1 cars or MotoGP motorbikes lose control at more than 300 km/hr, there is very little that can be done to prevent the driver from being seriously injured.” Maybe some knee pads might help.

Helium-Hogging MRIs Ruin Birthdays

As a worldwide helium shortage worsens, many groups are blaming MRI machines—which use helium gas to cool their powerful magnets—for hogging the resource, reported the CBC, a Canadian news outlet. About one-fifth of the world's helium supply is used in MRI machines, and world demand for helium, largely driven by the increased use of MRI and diagnostic imaging, has grown by 25% since 2003. Members of the party entertainment industry have voiced concern, in high squeaky voices, about the shortage.

Beer Makes You Smart

Moderate alcohol consumption may enhance cognition, according to research published in the Journal of Neuroscience. In a study, rats were fed liquid diets containing varying amounts of alcohol. Some had no alcohol at all; some had a moderate amount (“equivalent to a level of consumption that does not exceed the legal driving limit,” one of the authors told Scientific American); and some rats had quite a bit. Not only did the moderate drinkers perform better on object recognition tests than their counterparts, but they also were more popular and got invited to more parties than did either the teetotalers or the sloppy drunks, no doubt due to the moderate drinkers' alcohol-enhanced Trivial Pursuit skills.

Race Cars Crash, Journal Reports

An article in the British Journal of Sports Medicine reported that professional Formula 1 and MotoGP motorbike racing is “inherently dangerous.” The authors recommended “innovative clothing” to “selectively defend key anatomical structures” from excruciating whiplash, crashes, subsequent catastrophic explosions, and the odd chance of being run over after one's body is ejected, Wile E. Coyote-style, from the driver's seat. The authors also highlighted the health risk posed by high-speed cornering at a lateral force of up to 4.5 G. “Such lateral forces make breathing difficult, [and] are associated with unusual disorders,” they wrote, including, but not limited to, peeing one's pants and screaming for one's mommy. They concluded that, “if Formula 1 cars or MotoGP motorbikes lose control at more than 300 km/hr, there is very little that can be done to prevent the driver from being seriously injured.” Maybe some knee pads might help.

Helium-Hogging MRIs Ruin Birthdays

As a worldwide helium shortage worsens, many groups are blaming MRI machines—which use helium gas to cool their powerful magnets—for hogging the resource, reported the CBC, a Canadian news outlet. About one-fifth of the world's helium supply is used in MRI machines, and world demand for helium, largely driven by the increased use of MRI and diagnostic imaging, has grown by 25% since 2003. Members of the party entertainment industry have voiced concern, in high squeaky voices, about the shortage.

Beer Makes You Smart

Moderate alcohol consumption may enhance cognition, according to research published in the Journal of Neuroscience. In a study, rats were fed liquid diets containing varying amounts of alcohol. Some had no alcohol at all; some had a moderate amount (“equivalent to a level of consumption that does not exceed the legal driving limit,” one of the authors told Scientific American); and some rats had quite a bit. Not only did the moderate drinkers perform better on object recognition tests than their counterparts, but they also were more popular and got invited to more parties than did either the teetotalers or the sloppy drunks, no doubt due to the moderate drinkers' alcohol-enhanced Trivial Pursuit skills.

WASHINGTON — Large polyp size and the use of anticoagulants significantly raised the risk of delayed postpolypectomy hemorrhage, but aspirin and a history of hypertension did not, according to findings presented at the annual Digestive Disease Week.

The results are in contrast to studies finding that hypertension, polyp location, and sessile polyps were risk factors for delayed bleeding, wrote Dr. Nadim Salfiti and coinvestigators at the University of Minnesota, Minneapolis.

In the case-control, retrospective chart review, the investigators analyzed 41 cases of postpolypectomy bleeding and 132 control cases at the Minneapolis VA Medical Center from 1999 to 2006. The mean age of the 41 case patients was 64 years, all were male, and most were white.

Four a priori risk factors were analyzed for correlation with bleed risk: heparin or warfarin use within 1 week post polypectomy; at least one aspirin dose taken between 1 week before and 1 week after polypectomy; hypertension, defined as systolic pressure greater than 140 mm Hg, or diastolic pressure greater than 90 mm Hg, or the use of antihypertensive medication; and polyp diameter.

The mean polyp size for cases was 10.5 mm, compared with 6.7 mm for controls, a statistically significant difference; a total of 37% of cases and 11% of controls had a polyp size greater than 1 cm. Even more significant was the use of heparin or warfarin within 1 week after polypectomy in 34% of the patients with hemorrhage, versus 9% of controls.

In contrast, at least one dose of aspirin was administered to roughly 40% of both cases and controls within the time period from 1 week before to 1 week after polypectomy, and slightly more than 60% of both cases and controls were hypertensive.

In a post hoc analysis, the researchers also tested to see whether diabetes, lung disease, coronary artery disease, or polyp type (sessile versus pedunculated) were related to postprocedure hemorrhage. Diabetes was present in 44% of cases and 24% of controls, and lung disease was identified in 34% of cases versus 19% of controls; both conditions were found to be moderately significant risk factors. Coronary artery disease was present in 59% of cases and 32% of controls, another statistically significant difference. However, after adjustment for the use of anticoagulants, all three conditions lost some significance. Polyp type was not a significant factor.

“This is the first study evaluating the risk of [using] anticoagulant medications after polypectomy,” Dr. Salfiti said in an interview. “These results need to be confirmed in prospective studies, but they do provide some information that could facilitate the decision regarding the timing of resuming anticoagulation.” Dr. Salfiti cautioned, however, that each patient should be evaluated individually. The risks of postpolypectomy bleeding versus the risk of a thromboembolic event need to be assessed.

WASHINGTON — Large polyp size and the use of anticoagulants significantly raised the risk of delayed postpolypectomy hemorrhage, but aspirin and a history of hypertension did not, according to findings presented at the annual Digestive Disease Week.

The results are in contrast to studies finding that hypertension, polyp location, and sessile polyps were risk factors for delayed bleeding, wrote Dr. Nadim Salfiti and coinvestigators at the University of Minnesota, Minneapolis.

In the case-control, retrospective chart review, the investigators analyzed 41 cases of postpolypectomy bleeding and 132 control cases at the Minneapolis VA Medical Center from 1999 to 2006. The mean age of the 41 case patients was 64 years, all were male, and most were white.

Four a priori risk factors were analyzed for correlation with bleed risk: heparin or warfarin use within 1 week post polypectomy; at least one aspirin dose taken between 1 week before and 1 week after polypectomy; hypertension, defined as systolic pressure greater than 140 mm Hg, or diastolic pressure greater than 90 mm Hg, or the use of antihypertensive medication; and polyp diameter.

The mean polyp size for cases was 10.5 mm, compared with 6.7 mm for controls, a statistically significant difference; a total of 37% of cases and 11% of controls had a polyp size greater than 1 cm. Even more significant was the use of heparin or warfarin within 1 week after polypectomy in 34% of the patients with hemorrhage, versus 9% of controls.

In contrast, at least one dose of aspirin was administered to roughly 40% of both cases and controls within the time period from 1 week before to 1 week after polypectomy, and slightly more than 60% of both cases and controls were hypertensive.

In a post hoc analysis, the researchers also tested to see whether diabetes, lung disease, coronary artery disease, or polyp type (sessile versus pedunculated) were related to postprocedure hemorrhage. Diabetes was present in 44% of cases and 24% of controls, and lung disease was identified in 34% of cases versus 19% of controls; both conditions were found to be moderately significant risk factors. Coronary artery disease was present in 59% of cases and 32% of controls, another statistically significant difference. However, after adjustment for the use of anticoagulants, all three conditions lost some significance. Polyp type was not a significant factor.

“This is the first study evaluating the risk of [using] anticoagulant medications after polypectomy,” Dr. Salfiti said in an interview. “These results need to be confirmed in prospective studies, but they do provide some information that could facilitate the decision regarding the timing of resuming anticoagulation.” Dr. Salfiti cautioned, however, that each patient should be evaluated individually. The risks of postpolypectomy bleeding versus the risk of a thromboembolic event need to be assessed.

WASHINGTON — Large polyp size and the use of anticoagulants significantly raised the risk of delayed postpolypectomy hemorrhage, but aspirin and a history of hypertension did not, according to findings presented at the annual Digestive Disease Week.

The results are in contrast to studies finding that hypertension, polyp location, and sessile polyps were risk factors for delayed bleeding, wrote Dr. Nadim Salfiti and coinvestigators at the University of Minnesota, Minneapolis.

In the case-control, retrospective chart review, the investigators analyzed 41 cases of postpolypectomy bleeding and 132 control cases at the Minneapolis VA Medical Center from 1999 to 2006. The mean age of the 41 case patients was 64 years, all were male, and most were white.

Four a priori risk factors were analyzed for correlation with bleed risk: heparin or warfarin use within 1 week post polypectomy; at least one aspirin dose taken between 1 week before and 1 week after polypectomy; hypertension, defined as systolic pressure greater than 140 mm Hg, or diastolic pressure greater than 90 mm Hg, or the use of antihypertensive medication; and polyp diameter.

The mean polyp size for cases was 10.5 mm, compared with 6.7 mm for controls, a statistically significant difference; a total of 37% of cases and 11% of controls had a polyp size greater than 1 cm. Even more significant was the use of heparin or warfarin within 1 week after polypectomy in 34% of the patients with hemorrhage, versus 9% of controls.

In contrast, at least one dose of aspirin was administered to roughly 40% of both cases and controls within the time period from 1 week before to 1 week after polypectomy, and slightly more than 60% of both cases and controls were hypertensive.

In a post hoc analysis, the researchers also tested to see whether diabetes, lung disease, coronary artery disease, or polyp type (sessile versus pedunculated) were related to postprocedure hemorrhage. Diabetes was present in 44% of cases and 24% of controls, and lung disease was identified in 34% of cases versus 19% of controls; both conditions were found to be moderately significant risk factors. Coronary artery disease was present in 59% of cases and 32% of controls, another statistically significant difference. However, after adjustment for the use of anticoagulants, all three conditions lost some significance. Polyp type was not a significant factor.

“This is the first study evaluating the risk of [using] anticoagulant medications after polypectomy,” Dr. Salfiti said in an interview. “These results need to be confirmed in prospective studies, but they do provide some information that could facilitate the decision regarding the timing of resuming anticoagulation.” Dr. Salfiti cautioned, however, that each patient should be evaluated individually. The risks of postpolypectomy bleeding versus the risk of a thromboembolic event need to be assessed.

Many heart disease patients can forgo attempts to “fix” their conditions with coronary bypass grafting or other procedures in advance of noncardiac surgery.

That is one of the recommendations put forth in newly updated guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. The 82-page recommendations, which were last revised in 2002, were published jointly in Circulation and the Journal of the American College of Cardiology (doi: 10.1161/CirculationAHA.107.185699).

The guidelines contain provisions for both emergency and nonemergency surgery, wrote the authors. “The overriding theme of this document is that intervention is rarely necessary to simply lower the risk of surgery unless such intervention is indicated irrespective of the preoperative context.”

In a statement, Dr. Lee A. Fleisher, guideline writing committee chair, said an update was overdue. “Statin use wasn't even addressed in the previous guidelines.” In this version, “New trials have shown us that patients should continue taking them” in advance of noncardiac surgery, added Dr. Fleisher, chair of the department of anesthesiology and critical care at the University of Pennsylvania, Philadelphia.

The authors also recommend that in the case of nonemergency procedures, intervention—like bypass surgery or angioplasty—isn't necessary unless the patient would need the procedure anyway. “Mortality on the day of surgery, for most ambulatory surgical procedures, is actually lower than mortality on day 30, which suggests that the incremental risk of ambulatory surgery is negligible or may be protective,” the authors wrote (Arch. Surg. 2004;139:67–72). “Therefore, interventions based on cardiovascular testing in stable patients would rarely result in a change in management, and it would be appropriate to proceed with the planned surgical procedure.”

The guidelines recommend taking an in-depth patient history before any noncardiac surgery. This should include a determination of functional capacity, they wrote. “An assessment of an individual's capacity to perform a spectrum of common daily tasks has been shown to correlate well with maximum oxygen uptake by treadmill testing.” Moreover, “the preoperative consultation may represent the first careful cardiovascular evaluation for the patient in years or, in some instances, ever.”

Of course, the authors noted, most true surgical emergencies and even some semielective procedures “do not permit more than a cursory cardiac evaluation,” heightening the need for “close communication among consultant, surgeon, and anesthesiologist.”

Dr. Fleisher and his associates acknowledged that approaches to preexisting heart disease in noncardiac surgical patients have changed over the years. In the past, “we would do a lot of screening, and we might fix their heart disease to get them ready for the noncardiac surgery. We know now that surgical outcomes are the same in many people whether or not we fix the heart disease first,” Dr. Fleisher said. This is especially true for nonsymptomatic patients. “Several trials now show that in people without symptomatic heart disease, fixing the heart first doesn't make much of a difference in how well they do in surgery.”

The guidelines also emphasize continuing antiplatelet therapy as soon as possible after urgent noncardiac surgery, especially in patients with drug-eluting coronary stents.

The authors concluded by highlighting areas that require further study. “Although randomized trials have examined the effect of perioperative β-blockers on cardiac events surrounding surgery, and observational studies have shown the benefit of statins during the perioperative period, further evidence is needed with regard to the length of time medical therapy needs to be initiated before noncardiac surgery to be effective,” including management of antiplatelet drugs perioperatively, they wrote.

Many heart disease patients can forgo attempts to “fix” their conditions with coronary bypass grafting or other procedures in advance of noncardiac surgery.

That is one of the recommendations put forth in newly updated guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. The 82-page recommendations, which were last revised in 2002, were published jointly in Circulation and the Journal of the American College of Cardiology (doi: 10.1161/CirculationAHA.107.185699).

The guidelines contain provisions for both emergency and nonemergency surgery, wrote the authors. “The overriding theme of this document is that intervention is rarely necessary to simply lower the risk of surgery unless such intervention is indicated irrespective of the preoperative context.”

In a statement, Dr. Lee A. Fleisher, guideline writing committee chair, said an update was overdue. “Statin use wasn't even addressed in the previous guidelines.” In this version, “New trials have shown us that patients should continue taking them” in advance of noncardiac surgery, added Dr. Fleisher, chair of the department of anesthesiology and critical care at the University of Pennsylvania, Philadelphia.

The authors also recommend that in the case of nonemergency procedures, intervention—like bypass surgery or angioplasty—isn't necessary unless the patient would need the procedure anyway. “Mortality on the day of surgery, for most ambulatory surgical procedures, is actually lower than mortality on day 30, which suggests that the incremental risk of ambulatory surgery is negligible or may be protective,” the authors wrote (Arch. Surg. 2004;139:67–72). “Therefore, interventions based on cardiovascular testing in stable patients would rarely result in a change in management, and it would be appropriate to proceed with the planned surgical procedure.”

The guidelines recommend taking an in-depth patient history before any noncardiac surgery. This should include a determination of functional capacity, they wrote. “An assessment of an individual's capacity to perform a spectrum of common daily tasks has been shown to correlate well with maximum oxygen uptake by treadmill testing.” Moreover, “the preoperative consultation may represent the first careful cardiovascular evaluation for the patient in years or, in some instances, ever.”

Of course, the authors noted, most true surgical emergencies and even some semielective procedures “do not permit more than a cursory cardiac evaluation,” heightening the need for “close communication among consultant, surgeon, and anesthesiologist.”

Dr. Fleisher and his associates acknowledged that approaches to preexisting heart disease in noncardiac surgical patients have changed over the years. In the past, “we would do a lot of screening, and we might fix their heart disease to get them ready for the noncardiac surgery. We know now that surgical outcomes are the same in many people whether or not we fix the heart disease first,” Dr. Fleisher said. This is especially true for nonsymptomatic patients. “Several trials now show that in people without symptomatic heart disease, fixing the heart first doesn't make much of a difference in how well they do in surgery.”

The guidelines also emphasize continuing antiplatelet therapy as soon as possible after urgent noncardiac surgery, especially in patients with drug-eluting coronary stents.

The authors concluded by highlighting areas that require further study. “Although randomized trials have examined the effect of perioperative β-blockers on cardiac events surrounding surgery, and observational studies have shown the benefit of statins during the perioperative period, further evidence is needed with regard to the length of time medical therapy needs to be initiated before noncardiac surgery to be effective,” including management of antiplatelet drugs perioperatively, they wrote.

Many heart disease patients can forgo attempts to “fix” their conditions with coronary bypass grafting or other procedures in advance of noncardiac surgery.

That is one of the recommendations put forth in newly updated guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. The 82-page recommendations, which were last revised in 2002, were published jointly in Circulation and the Journal of the American College of Cardiology (doi: 10.1161/CirculationAHA.107.185699).

The guidelines contain provisions for both emergency and nonemergency surgery, wrote the authors. “The overriding theme of this document is that intervention is rarely necessary to simply lower the risk of surgery unless such intervention is indicated irrespective of the preoperative context.”

In a statement, Dr. Lee A. Fleisher, guideline writing committee chair, said an update was overdue. “Statin use wasn't even addressed in the previous guidelines.” In this version, “New trials have shown us that patients should continue taking them” in advance of noncardiac surgery, added Dr. Fleisher, chair of the department of anesthesiology and critical care at the University of Pennsylvania, Philadelphia.

The authors also recommend that in the case of nonemergency procedures, intervention—like bypass surgery or angioplasty—isn't necessary unless the patient would need the procedure anyway. “Mortality on the day of surgery, for most ambulatory surgical procedures, is actually lower than mortality on day 30, which suggests that the incremental risk of ambulatory surgery is negligible or may be protective,” the authors wrote (Arch. Surg. 2004;139:67–72). “Therefore, interventions based on cardiovascular testing in stable patients would rarely result in a change in management, and it would be appropriate to proceed with the planned surgical procedure.”

The guidelines recommend taking an in-depth patient history before any noncardiac surgery. This should include a determination of functional capacity, they wrote. “An assessment of an individual's capacity to perform a spectrum of common daily tasks has been shown to correlate well with maximum oxygen uptake by treadmill testing.” Moreover, “the preoperative consultation may represent the first careful cardiovascular evaluation for the patient in years or, in some instances, ever.”

Of course, the authors noted, most true surgical emergencies and even some semielective procedures “do not permit more than a cursory cardiac evaluation,” heightening the need for “close communication among consultant, surgeon, and anesthesiologist.”

Dr. Fleisher and his associates acknowledged that approaches to preexisting heart disease in noncardiac surgical patients have changed over the years. In the past, “we would do a lot of screening, and we might fix their heart disease to get them ready for the noncardiac surgery. We know now that surgical outcomes are the same in many people whether or not we fix the heart disease first,” Dr. Fleisher said. This is especially true for nonsymptomatic patients. “Several trials now show that in people without symptomatic heart disease, fixing the heart first doesn't make much of a difference in how well they do in surgery.”

The guidelines also emphasize continuing antiplatelet therapy as soon as possible after urgent noncardiac surgery, especially in patients with drug-eluting coronary stents.

The authors concluded by highlighting areas that require further study. “Although randomized trials have examined the effect of perioperative β-blockers on cardiac events surrounding surgery, and observational studies have shown the benefit of statins during the perioperative period, further evidence is needed with regard to the length of time medical therapy needs to be initiated before noncardiac surgery to be effective,” including management of antiplatelet drugs perioperatively, they wrote.

NIH Lupus Research Plan

Government scientists recently outlined plans for future lupus research. The goals include laying the foundation for lupus prevention, identifying disease triggers, defining target organ damage mechanisms, understanding autoantibodies, discovering and validating biomarkers, and advancing therapy. These goals are part of a long-range planning document recently released by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, of the National Institutes of Health. The NIH document predicts lupus prevention could become an “attainable goal” in the next decade. Mandated by Congress, the plan was developed with input from lupus experts, according to NIH. “The ultimate goal of this plan is to identify needs and opportunities from both public and private organizations to continue to accelerate progress in lupus research to further improve quality of life of patients who have lupus,” Dr. Stephen Katz, director of NIAMS, wrote in the plan's introduction.

Vioxx Class Action Suit Denied

A ruling that gave nationwide class-action status to insurance companies seeking reimbursement for rofecoxib (Vioxx) expenditures was overturned Sept. 6 by the New Jersey Supreme Court. The Court agreed with Merck, maker of rofecoxib, that the claims of the insurance companies and HMOs were different and therefore not appropriate for a class action suit; however, the court did rule that plaintiffs may pursue individual suits against the company. “Although we respectfully disagree with the Court's conclusion, we are pleased that our client's substantive claims are preserved. Importantly, the Court's ruling gives us the green light to pursue these claims,” said Christopher A. Seeger, lead lawyer for the plaintiffs, said in a statement.

Grant Awarded in Oklahoma

The National Institutes of Health has awarded $2.66 million to the Oklahoma Medical Research Foundation to establish the Oklahoma Rheumatic Disease Research Cores Center. The center's first pilot projects will evaluate a new molecule to determine whether it is a candidate future lupus therapies and examine risk factors for autoimmune disease in children. The money also will support junior researchers as well as researchers from outside of rheumatology, said Dr. Judith James, the principal investigator on the grant, who holds the Lou C. Kerr Chair in Biomedical Research at OMRF.

WHI Results Still Confusing to MDs

Just 18% of physicians said they have “no confusion at all” about the results of the Women's Health Initiative study, according to an online survey of more than 400 physicians conducted on behalf of The Hormone Foundation. In addition, only 15% believe patients accurately understand the risks of hormone therapy. The results “underscore the importance of physicians' role in educating patients and [the public] on menopause management,” said foundation director Paula Correa. The survey, sponsored by Novogyne Pharmaceuticals, also found that 74% of physicians still consider hormone therapy first-line treatment for menopause symptoms. Novogyne manufactures the hormone therapy patches, Vivelle-Dot, Vivelle, and CombiPatch.

FDA Wins Reauthorization

The Food and Drug Administration Amendments Act of 2007 passed Congress and was signed into law by President Bush just days before its slated expiration date of Sept. 30. The Act contained within it provisions to collect “user fees” from pharmaceutical and medical device makers to review their products, monitor direct-to-consumer advertising, and track recalls of medical devices, among other things. The “user fees” fund 25% of the agency's operating budget, said FDA Commissioner Andrew C. von Eschenbach in a statement. The agency also was given authority to require drug and device makers to disclose clinical trial data publicly and to fine manufacturers who do not do so in a timely manner, and more power to order postmarketing clinical trials. Notably absent from the final version of the bill was the creation of a regulatory pathway to approve generic versions of complex biologic agents (see related story, p. 1).

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 increase is the smallest since 1999, according to a survey by the Kaiser Family Foundation and the Health Research and Educational Trust. But experts say the slowdown is temporary and isn't providing relief to individuals or employers. The 6.1% increase is higher than the average wage increase (3.7%) and the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the U.S. is $12,106. Workers pay about $3,281. Preferred provider organizations insure about 57% of covered workers; consumer-driven plans account for about 5%. For details, visit

www.kff.org/insurance/7672

NIH Lupus Research Plan

Government scientists recently outlined plans for future lupus research. The goals include laying the foundation for lupus prevention, identifying disease triggers, defining target organ damage mechanisms, understanding autoantibodies, discovering and validating biomarkers, and advancing therapy. These goals are part of a long-range planning document recently released by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, of the National Institutes of Health. The NIH document predicts lupus prevention could become an “attainable goal” in the next decade. Mandated by Congress, the plan was developed with input from lupus experts, according to NIH. “The ultimate goal of this plan is to identify needs and opportunities from both public and private organizations to continue to accelerate progress in lupus research to further improve quality of life of patients who have lupus,” Dr. Stephen Katz, director of NIAMS, wrote in the plan's introduction.

Vioxx Class Action Suit Denied

A ruling that gave nationwide class-action status to insurance companies seeking reimbursement for rofecoxib (Vioxx) expenditures was overturned Sept. 6 by the New Jersey Supreme Court. The Court agreed with Merck, maker of rofecoxib, that the claims of the insurance companies and HMOs were different and therefore not appropriate for a class action suit; however, the court did rule that plaintiffs may pursue individual suits against the company. “Although we respectfully disagree with the Court's conclusion, we are pleased that our client's substantive claims are preserved. Importantly, the Court's ruling gives us the green light to pursue these claims,” said Christopher A. Seeger, lead lawyer for the plaintiffs, said in a statement.

Grant Awarded in Oklahoma

The National Institutes of Health has awarded $2.66 million to the Oklahoma Medical Research Foundation to establish the Oklahoma Rheumatic Disease Research Cores Center. The center's first pilot projects will evaluate a new molecule to determine whether it is a candidate future lupus therapies and examine risk factors for autoimmune disease in children. The money also will support junior researchers as well as researchers from outside of rheumatology, said Dr. Judith James, the principal investigator on the grant, who holds the Lou C. Kerr Chair in Biomedical Research at OMRF.

WHI Results Still Confusing to MDs

Just 18% of physicians said they have “no confusion at all” about the results of the Women's Health Initiative study, according to an online survey of more than 400 physicians conducted on behalf of The Hormone Foundation. In addition, only 15% believe patients accurately understand the risks of hormone therapy. The results “underscore the importance of physicians' role in educating patients and [the public] on menopause management,” said foundation director Paula Correa. The survey, sponsored by Novogyne Pharmaceuticals, also found that 74% of physicians still consider hormone therapy first-line treatment for menopause symptoms. Novogyne manufactures the hormone therapy patches, Vivelle-Dot, Vivelle, and CombiPatch.

FDA Wins Reauthorization

The Food and Drug Administration Amendments Act of 2007 passed Congress and was signed into law by President Bush just days before its slated expiration date of Sept. 30. The Act contained within it provisions to collect “user fees” from pharmaceutical and medical device makers to review their products, monitor direct-to-consumer advertising, and track recalls of medical devices, among other things. The “user fees” fund 25% of the agency's operating budget, said FDA Commissioner Andrew C. von Eschenbach in a statement. The agency also was given authority to require drug and device makers to disclose clinical trial data publicly and to fine manufacturers who do not do so in a timely manner, and more power to order postmarketing clinical trials. Notably absent from the final version of the bill was the creation of a regulatory pathway to approve generic versions of complex biologic agents (see related story, p. 1).

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 increase is the smallest since 1999, according to a survey by the Kaiser Family Foundation and the Health Research and Educational Trust. But experts say the slowdown is temporary and isn't providing relief to individuals or employers. The 6.1% increase is higher than the average wage increase (3.7%) and the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the U.S. is $12,106. Workers pay about $3,281. Preferred provider organizations insure about 57% of covered workers; consumer-driven plans account for about 5%. For details, visit

www.kff.org/insurance/7672

NIH Lupus Research Plan

Government scientists recently outlined plans for future lupus research. The goals include laying the foundation for lupus prevention, identifying disease triggers, defining target organ damage mechanisms, understanding autoantibodies, discovering and validating biomarkers, and advancing therapy. These goals are part of a long-range planning document recently released by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, of the National Institutes of Health. The NIH document predicts lupus prevention could become an “attainable goal” in the next decade. Mandated by Congress, the plan was developed with input from lupus experts, according to NIH. “The ultimate goal of this plan is to identify needs and opportunities from both public and private organizations to continue to accelerate progress in lupus research to further improve quality of life of patients who have lupus,” Dr. Stephen Katz, director of NIAMS, wrote in the plan's introduction.

Vioxx Class Action Suit Denied

A ruling that gave nationwide class-action status to insurance companies seeking reimbursement for rofecoxib (Vioxx) expenditures was overturned Sept. 6 by the New Jersey Supreme Court. The Court agreed with Merck, maker of rofecoxib, that the claims of the insurance companies and HMOs were different and therefore not appropriate for a class action suit; however, the court did rule that plaintiffs may pursue individual suits against the company. “Although we respectfully disagree with the Court's conclusion, we are pleased that our client's substantive claims are preserved. Importantly, the Court's ruling gives us the green light to pursue these claims,” said Christopher A. Seeger, lead lawyer for the plaintiffs, said in a statement.

Grant Awarded in Oklahoma

The National Institutes of Health has awarded $2.66 million to the Oklahoma Medical Research Foundation to establish the Oklahoma Rheumatic Disease Research Cores Center. The center's first pilot projects will evaluate a new molecule to determine whether it is a candidate future lupus therapies and examine risk factors for autoimmune disease in children. The money also will support junior researchers as well as researchers from outside of rheumatology, said Dr. Judith James, the principal investigator on the grant, who holds the Lou C. Kerr Chair in Biomedical Research at OMRF.

WHI Results Still Confusing to MDs

Just 18% of physicians said they have “no confusion at all” about the results of the Women's Health Initiative study, according to an online survey of more than 400 physicians conducted on behalf of The Hormone Foundation. In addition, only 15% believe patients accurately understand the risks of hormone therapy. The results “underscore the importance of physicians' role in educating patients and [the public] on menopause management,” said foundation director Paula Correa. The survey, sponsored by Novogyne Pharmaceuticals, also found that 74% of physicians still consider hormone therapy first-line treatment for menopause symptoms. Novogyne manufactures the hormone therapy patches, Vivelle-Dot, Vivelle, and CombiPatch.

FDA Wins Reauthorization

The Food and Drug Administration Amendments Act of 2007 passed Congress and was signed into law by President Bush just days before its slated expiration date of Sept. 30. The Act contained within it provisions to collect “user fees” from pharmaceutical and medical device makers to review their products, monitor direct-to-consumer advertising, and track recalls of medical devices, among other things. The “user fees” fund 25% of the agency's operating budget, said FDA Commissioner Andrew C. von Eschenbach in a statement. The agency also was given authority to require drug and device makers to disclose clinical trial data publicly and to fine manufacturers who do not do so in a timely manner, and more power to order postmarketing clinical trials. Notably absent from the final version of the bill was the creation of a regulatory pathway to approve generic versions of complex biologic agents (see related story, p. 1).

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 increase is the smallest since 1999, according to a survey by the Kaiser Family Foundation and the Health Research and Educational Trust. But experts say the slowdown is temporary and isn't providing relief to individuals or employers. The 6.1% increase is higher than the average wage increase (3.7%) and the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the U.S. is $12,106. Workers pay about $3,281. Preferred provider organizations insure about 57% of covered workers; consumer-driven plans account for about 5%. For details, visit

www.kff.org/insurance/7672