The Attitude Doc

Jan 31, 2008 -- The FDA warns that 11 epilepsy drugs double a person's risk of suicidal behavior or thoughts, although the overall risk remains small.

The warning comes from an FDA analysis of suicidality -- suicidal behavior or thoughts -- in placebo-controlled studies of 11 drugs known collectively as "antiepileptics." The drugs are used to control seizures and to help control the symptoms of some psychiatric disorders.

"All patients who are currently taking or starting on any antiepileptic drug should be closely monitored for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression," the FDA warned in a letter to health professionals.

In the clinical trials, patients receiving inactive placebo pills had a 0.22% incidence of suicidality. Those receiving the epilepsy drugs had a 0.43% incidence of suicidality -- twice that of placebo recipients, but still a very small risk.

The drugs were relatively more likely to be linked to suicidality when used to treat epilepsy than when used to treat psychiatric disorders or other conditions.

The 11 drugs cited by the FDA are:

• carbamazepine (marketed as Carbatrol, Equetro, Tegretol, Tegretol XR)
• felbamate (marketed as Felbatol)
• gabapentin (marketed as Neurontin)
• lamotrigine (marketed as Lamictal)
• levetiracetam (marketed as Keppra)
• oxcarbazepine (marketed as Trileptal)
• pregabalin (marketed as Lyrica)
• tiagabine (marketed as Gabitril)
• topiramate (marketed as Topamax)
• valproate (marketed as Depakote, Depakote ER, Depakene, Depacon)
• zonisamide (marketed as Zonegran)

Some of these drugs are available in generic forms.

FDA Alert: "Suicidality and Antiepileptic Drugs," Jan. 31, 2008.

Jan 31, 2008 -- For gout, sweetened soft drinks are worse than hard liquor -- and nearly as bad as beer -- doubling the risk for heavy drinkers. Diet sodas, however, don't affect gout risk.

The findings come from a huge study of 46,393 male health professionals in Canada who filled out detailed questionnaires about their health and their diet every four years for 12 years. Over that time, 755 of the men developed gout.

Compared with men who almost never drank sugar-sweetened soft drinks -- fewer than one per month -- frequent soft-drink drinkers were significantly more likely to suffer gout:

• Two or more soft drinks each day upped gout risk by 85%.
• One soft drink each day upped gout risk by 45%.
• Five or six soft drinks each week upped gout risk by 29%.

The men who drank the most soft drinks had twice the gout risk of the men who drank the fewest soft drinks.

That's comparable to the gout risk of men who drink two to four alcoholic beverages a day.

Beer raises gout risk by 49% per daily serving. A daily serving of spirits raises gout risk by 15%. Sweetened soft drinks, find University of British Columbia researcher Hyon K. Choi, MD, PhD, and colleagues, raise gout risk by 35% per serving.

"This is the first study -- and a very large one -- linking these commonly consumed products to this common disorder," Choi tells WebMD. "We find that if you have high consumption of fructose your gout risk is doubled. And that is due to easily available sugary beverages."

It's a surprising finding, says Karen Atkinson, MD, MPH, chief of rheumatology at the Atlanta VA Hospital and assistant professor of medicine at Emory University.

"It is a shock," Atkinson tells WebMD. "Most of us think of purine-rich foods as those that increase gout risk because they feed directly into the uric acid pathway. Certainly fructose processed by the liver can affect that pathway, but this is not what we usually think of."

Atkinson warns that while the Choi study definitely links soft drinks to gout risk, it does not prove that cutting back on soft drinks will lower that risk.

"But most doctors would agree that high-fructose carbonated beverages don't have any nutritional benefit. You don't want to be pouring high-fructose soft drinks into your body," she says.

Gout Risk: Food and Drink vs. Family History

Gout is an extremely painful form of arthritis in which uric acid crystals accumulate in the joints. It most often affects the big toe but commonly affects other joints in the leg. Men are more likely to suffer gout than are women, although women's risk greatly increases after menopause. Choi says about one in 10 people over the age of 60 develops gout.

Gout Risk: Food and Drink vs. Family History continued...

"When it occurs you suffer really a lot for a week to two weeks," says Choi, a rheumatologist. "It is very severe pain. Just putting your bed sheet on the joint hurts. Gout causes intense swelling and pain, one of the worst pains you can suffer."

Foods already known to cause gout have high levels of purine compounds. Such foods include red meat, organ meats, and shellfish. But diet isn't the only cause of gout. Many gout sufferers inherit a tendency to generate too much uric acid; others inherit an inability to efficiently eliminate uric acid in the urine.

That's why the American Beverage Association, which supports the soft drink industry, takes a dim view of the Choi findings. Maureen Storey, PhD, the association's senior vice president for science policy, says the Choi study failed to account for family history of gout.

"The most important risk factor for whether a person develops gout or not is family history," Storey tells WebMD. "All of the research that has been conducted on gout over the last century or so has shown that foods and beverages high in purines -- such as alcoholic beverages, beer, gravies, and certain kinds of meat -- are strongly linked to development of gout. Soft drinks don't have that in them."

What soft drinks do contain is high-fructose corn syrup. Unlike glucose, the sugar our bodies uses for fuel, fructose raises uric acid levels. High levels of uric acid are linked to gout. But Choi agrees with Storey that his study is the first to link fructose to gout.

Strengthening Choi's fructose hypothesis is his finding that diet sodas -- which don't have fructose -- don't alter gout risk. Moreover, Choi and colleagues find that people who eat lots of sweet fruits, such as apples and oranges, also up their gout risk.

"We find a similar level of increased gout risk from apples and oranges as from sweetened soft drinks, but the caution is misplaced here because these fruits offer benefits against other major disorders such as stroke, diabetes, and certain cancers," Choi says. "There may be certain limited situations, such as treatment-resistant severe gout, where reducing all sources of fructose may be of use. But overall, fruits are beneficial."

Choi and colleagues report their findings in the Jan. 31 online issue of the journal BMJ.

Choi, H.K. BMJ, Jan. 31, 2008; Online First edition.

Hyon K. Choi, MD, PhD, associate professor of medicine, division of rheumatology, department of medicine, University of British Columbia, Vancouver, Canada.

Karen Atkinson, MD, MPH, chief of rheumatology, Atlanta VA Hospital; assistant professor of medicine, Emory University School of Medicine, Atlanta.

Maureen Storey, PhD, senior vice president for science policy, American Beverage Association.

Jan. 31, 2008 -- The World Health Organization and European health officials note cases, mainly in Norway, of a flu virus that resists the flu drug Tamiflu.

Keep these three points in mind:

• Tamiflu still works against other flu viruses.
• Other drugs can prevent or treat Tamiflu-resistant flu.
• Tamiflu isn't the flu vaccine. Flu vaccines remain the single best way to prevent influenza.

Norwegian health officials notified European countries and the WHO earlier this week about cases of Tamiflu-resistant H1N1 flu virus.

As of today, European health officials have tested 437 samples of the H1N1 virus and found that 59 samples -- 13.5% -- from nine nations resisted Tamiflu.

In the U.S., the CDC has found that 5% of the H1N1 flu viruses they have tested resist Tamiflu.

"It is possible that the resistant strain will not become more common in other countries," state the WHO and European Centre for Disease Prevention and Control. "Careful monitoring will be required throughout the rest of the season to follow the situation globally."

The Tamiflu-resistant flu doesn't appear to be worse than other types of flu. And just like other types of flu, Tamiflu-resistant flu can pass from person to person, so avoid contact with people who have the flu, and practice good hygiene (such as washing your hands) to reduce flu risk.

Flu season is well under way, but it's not too late to get a flu vaccine, if you haven't done so already.

SOURCES:
World Health Organization and European Centre for Disease Prevention and Control: "Frequently Asked Questions for Oseltamivir Resistance."
News release, European Centre for Disease Prevention and Control.
European Centre for Disease Prevention and Control: "Interim ECDC Risk Assessment -- Jan. 27, 2008."

Jan. 31, 2008 -- Dangerous blood clots are a common risk for hospitalized adults, and many of them don't get drug treatment to cut that risk.

That news comes from a new study of more than 68,000 hospitalized adults in 32 countries including the U.S.

About 52% of those patients were at risk of venous thromboembolism (VTE), based on their medical charts, which the researchers reviewed.

VTE includes deep vein thrombosis (DVT), in which clots form in deep veins, and pulmonary embolism, a potentially fatal condition in which blood clots travel through veins to the lungs.

VTE is a well-known risk for hospital patients. It's "the most common preventable cause of in-hospital death," write Alexander Cohen, MD, of King's College London, and colleagues. Surgery is a risk factor for VTE, and so is being immobilized in a hospital bed.

Treatments to reduce the risk of VTE include blood-thinning drugs and compression stockings. But Cohen's team found that only 59% of surgery patients and 40% of nonsurgery patients got VTE preventive care.

The reasons why patients didn't get VTE preventive care aren't clear. Some patients may have had medical reasons why they couldn't take blood-thinning drugs.

"Work is needed to improve prevention of VTE in hospitalized patients," states an editorial published with the study in the Feb. 2, 2008, edition of The Lancet.

The study was funded by the drug company Sanofi-Aventis. In the journal, Cohen and colleagues note financial ties to various drug companies including Sanofi-Aventis.

SOURCES:

Cohen, A. The Lancet, Feb. 2, 2008; vol 371: pp 387-395.

Ageno, W. The Lancet, Feb. 2, 2008; vol 371: pp 361-362.

WebMD Medical News: "Vitamin E May Lower Blood Clot Risk."

News release, The Lancet.

Jan. 31, 2008 -- Scratching isn't great for your skin, but new research shows why it feels good.

"To our surprise, we found that areas of the brain associated with unpleasant or aversive emotions and memories became significantly less active during the scratching," Wake Forest University's Gil Yosipovitch, MD, says in a news release.

"Of course, scratching is not recommended because it can damage the skin. But understanding how the process works could lead to new treatments," adds Yosipovitch.

Yosipovitch and colleagues studied 13 healthy adults (average age: 28). Participants weren't itchy, but they got their lower right leg gently scratched by a researcher wielding a medical brush.

Participants got brain scans before, during, and after the scratching sessions. Those brain scans showed that certain brain areas were particularly active during scratching, while other brain regions became less active during scratching.

Those patterns may explain why scratching can feel good and be rewarding, the researchers note. But it will take more work to see if the brain behaves the same way in people dealing with itchiness (pruritus).

Their findings appear in today's advance online edition of the Journal of Investigative Dermatology.

SOURCES:

Yosipovitch, G. Journal of Investigative Dermatology, Jan. 31, 2008; advance online edition.
News release, Wake Forest University Baptist Medical Center.