House of A Healthy Living

I am merely trying to raise awareness of a misunderstood and often misdiagnosed health condition called, rather grandly, Mal de Debarquement Syndrome (MdDS for short) If I may I will explain more.

Basically, with this condition it is an imbalance or rocking sensation that occurs after getting off a boat or “debarking (debarquement).Other forms of motion are also known to trigger it. Once back on dry land the traveller continues to feel “all at sea”, unable to get their land legs back. Although a lot of travellers can identify with this feeling and do actually experience it temporarily after disembarking, unfortunately in the case of MdDS sufferers it can persist for many months, even years afterwards. The symptoms are with you constantly, they never leave, nor can they be alleviated by any anti-motion sickness drugs. “Like trying to constantly walk on a mattress or trampoline” is a good description of the main symptom, the illusion of movement, not to mention the others, nausea, gaze instability/visual disturbance whereby objects jump and shimmer in front of you, often like looking at things through a heat haze, constant tinnitus, imbalance, I could go on. However I must stress at this point that there is no rotational or “spinning” vertigo with this condition.

The FDA today approved the use of two antipsychotic drugs — Eli Lilly’s Zyprexa and AstraZeneca’s Seroquel — in teenagers. But the agency also said it wants to know more about the risk of weight gain and diabetes in kids who take those and other antipsychotic drugs.

It’s clear that those risks are broadly associated with this class of drugs, and their warning labels say so. But some evidence suggests the link is especially strong in kids. An FDA advisory panel on pediatric drugs meeting next week will discuss the issue; a report written by FDA staff and released ahead of the meeting calls for more research and suggests more warnings about the drugs’ side effects in kids could be in store.

A study published last month in JAMA found that children and adolescents taking antipsychotics gained significantly more weight over a period of about 11 weeks than comparable kids who weren’t taking the drugs. Patients taking Zyprexa showed the most weight gain — 19 pounds — but weight gain was associated with several drugs in the class.

The label for Zyprexa already includes a warning that says teenagers are more likely to gain weight, and likely to gain more weight, than adults taking the drug. But the labels for other drugs the FDA is looking at — J&J’s Risperdal, Bristol-Myers Squibb’s Abilify, Pfizer’s Geodon and AstraZeneca’s Seroquel — don’t say whether kids are at higher risk than adults for weight gain. (Risperdal and Abilify also are specifically approved for use in kids.)

The drugs, which treat conditions including schizophrenia and bipolar disorder, were the top selling class of drugs in this country last year, with sales of $14.6 billion, Dow Jones Newswires notes.

Now that the Senate has finished with those amendments on preventive health for women and Medicare spending cuts, what’s next? Here are a few amendments that caught our eye:

An amendment restricting insurance payments for abortion, modeled on Bart Stupak’s amendment that passed in the House, is backed by Sen. Ben Nelson, a Democrat. The bill is likely to draw support from lots of Republicans, but probably won’t get enough Democratic votes to go through, the Hill reports. Nevertheless, the WSJ says, the debate over abortion language in the health-care bill may last for several days next week. (This story has more on the substance of the amendment.)

Drug makers could be on the hook for $106 billion over 10 years under this amendment from Bill Nelson, a Florida Dem. If it passes, drugs for patients eligible for both Medicare and Medicaid would be purchased at Medicaid rates, rather than Medicare rates. (Medicaid rates are lower.)

The drug industry had previously agreed to give up $80 billion over 10 years, largely by footing part of the bill for patients in the Medicare “donut hole.” In a statement yesterday, Nelson cited this report from Morgan Stanley that estimated that the drug industry would actually recoup $56 billion out of the original $80 billion, in the form of increased sales generated as a result of the health-care overhaul.

A number of senators are pushing cost-containment measures. A memo circulated by a group of freshmen would push for bigger changes in the way Medicare pays for care. The memo says “fee-for-service medicine –- that is, paying hospitals and doctors according to how many items or services they provide –- should be a thing of the past.” Joe Lieberman and Susan Collins — who are both on the health-care-bill fence — will be pushing their own cost-cutting provisions, the Associated Press reports.

Employment growth in the U.S. health-care industry is nothing to write home about, unless you compare it most other sectors in the economy. That performance remained intact in November as the the government reported health-care employment grew by 21,000, even as the nation continued to shed jobs.

Here’s the Bureau of Labor Statistics report and more from the WSJ.

For those keeping score, the latest numbers mean that health care has added 613,000 jobs since the start of the recession began in December, 2007. Meanwhile, the overall number of unemployed has jumped by almost eight million during that period even though the November unemployment rate fell to 10% from 10.2%.

Every subcategory within BLS’s health-care grouping showed job growth in November except outpatient care centers, which lost 3,300 positions. Home health-care services added 7,300 jobs and hospitals put another 6,800 on their payrolls.

Chris Christie, governor-elect of New Jersey, said his chief of staff will be Rich Bagger, Pfizer’s SVP of global public affairs. Bagger, 49 years old, previously spent more than a decade in the state Legislature, the the Star-Ledger notes.

Bagger was part of the executive team Pfizer CEO Jeff Kindler put together in 2006; he was previously Pfizer’s SVP for government relations. Lately he’s been serving on Christie’s transition team. He’ll be taking a pay cut in his new job working for Christie, the Star-Ledger notes.

Pfizer is headquartered in New York, but the company just bought Wyeth, whose corporate headquarters are in New Jersey. Pfizer said in October that the former Wyeth headquarters will remain open, housing workers from several businesses including animal health, consumer products and nutrition.

An MIT professor has launched a new center to study endometriosis and other diseases of the female reproductive tract, the Boston Globe reports. There are a few interesting elements to the story.

For one, the professor, Linda Griffith, has endometriosis, which occurs when tissue that lines the uterus grows in other places and can cause problems such as pain and infertility. Griffith has had nine surgeries, including a hysterectomy to treat the disease. And she was inspired to start the center in part by the experience of her niece, who showed similar symptoms, including debilitating pain — and who, like Griffith, wasn’t properly diagnosed.

For another, Griffith is something of a star researcher. See Exhibit A, the MacArthur Genius Grant she won in 2006 for her work in figuring out how to grow liver cells outside the body and other feats of tissue engineering.

Along those lines, much of the work at the new center will be basic research, trying to get a better understanding of the physiology of gynepathology, a blanket term for endometriosis and other non-cancerous diseases of the female reproductive tract.

More broadly, Griffith hopes to bring attention to the disease, which the NIH says affects at least 5.5 million women in North America, but which often goes undiscussed and undiagnosed. “We need gynepathology to be something my dean can talk about with a straight face the same way he would talk about breast cancer,” Griffith told the Globe.

She’ll have a bit of help on the PR side from Padma Lakshmi, who has endometriosis, and who will be in Cambridge today for the official launch of the center.

The push to clamp down on the relationship between doctors and drug and device companies came to New Jersey today. A report from the attorney general’s office there called for state agencies to create a bunch of new rules that would:

Bar doctors and their office staff from accepting food from drug companies, “whether in-office, at health care facilities or in commercial venues, such as restaurants.” Laws in Vermont and Massachusetts recently went into effect imposing similar restrictions.

Require doctors who are renewing their licenses to disclose whether they accepted more than $200 worth of payments and/or gifts from industry during the preceding two years, and create a public database of the disclosures. Congress has been considering making such disclosure a national requirement, but proposed federal legislation would put the reporting burden companies rather than doctors. Meanwhile, Pfizer, Eli Lilly, Medtronic and Merck, among others, have independently said they will start disclosing certain payments to doctors.

Restrict the sale of “prescriber-identifiable” prescription data for commercial purposes. This refers to the practice of buying prescription data from pharmacies, crunching it, and selling it to drug companies, so they can learn which doctors are prescribing what. Other states have passed laws restricting this practice, and IMS Health and other data crunchers have fought the laws in federal court.

The Medical Society of New Jersey wasn’t happy with the report, suggesting that the state should seek to change the behavior of companies rather than the docs. “The state chooses to regulate 33,000 physicians rather than go after a few large companies,” the group said in an emailed statement. “New Jersey is the only state in the nation that chooses to regulate tens of thousands of individuals and allow large companies to escape scrutiny.”

Of course, what the report lays out are only recommendations. Some of the recommendations could be enacted by the state’s Board of Medical Examiners, while others (including the restriction on sale of prescription data) would require the state to pass a new law.

Before you read this post, you might want to take a look at this live feed of a frozen brain being sliced like lunch meat.

That brain belonged to Henry Gustav Molaison, a man known in the medical literature as patient H.M. He suffered from seizures and in 1953, at the age of 27, underwent a radical experimental surgery that wound up wrecking his ability to form new memories. As he aged, his face in the mirror surprised him because he remembered only the face he had as a young man.

He donated his brain to science and died late last year. A UC San Diego scientist went to retrieve the brain from the East Coast and flew back across the country, coach class, with the brain sitting in a cooler in the seat next to him, the San Diego Union-Tribune reported.

Now, in a 30-hour sprint, UCSD’s Brain Observatory is slicing the brain into some 2,500 thin sections as part of a specimen library, NPR’s Shots blog says.

Yes, the live Web feed is somewhat gimmicky. Still, sometimes we can’t help but fall for a geeky gimmick, and this one got us.

Despite all the job cuts for drug reps, despite the endless stream of TV drug ads, the pharma industry still spends most of its U.S. marketing money the old-fashioned way: Paying salespeople to call on doctors and other health-care providers.

Drug companies spent “at least $20.5 billion in marketing” in 2008, the CBO said in a research brief published yesterday. (That figure doesn’t include the value of free drug samples companies give to docs, by the way.) The big categories include:

$12 billion for “detailing,” the industry term for sending sales reps to talk to doctors, nurses and other providers. Spending on detailing was highest for statins (such as Pfizer’s Lipitor), antidepressants (like Forest’s Lexapro) and antipsychotics (like Bristol-Myers Squibb’s Abilify). In each of those categories, branded drugs are competing against generics for a big market.

$4.7 billion direct-to-consumer advertising, and an additional $400 million on advertising in professional journals. CBO took a closer look at consumer advertising for about 2,000 drugs and found that TV ads accounted for 62% of spending, print ads made up 35% and online ads were 4% (those figures add up to 101% because we rounded to the nearest percentage point).

$3.4 billion sponsoring professional meetings and events. This includes sponsoring courses and talks that doctors can attend (or watch online) in order to satisfy requirements for continuing medical education (known as CME). Industry-funding of CME has been getting some attention in Congress lately, with some lawmakers calling for public disclosure of who pays for what.

Here’s a quick roundup of what some big doctors’ groups have been saying this week about the Senate health-care bill:

The AMA took the middle ground, supporting some provisions and opposing others. The group backs the bill’s push to expand health-insurance coverage, and to cut subsidies to privately administered Medicare plans, among other things. The AMA opposes the creation of an independent board that could slow the growth of Medicare costs, a tax on elective cosmetic surgery and limits on physician-owned hospitals, among other provisions. The AMA notes that the Senate bill would block the Medicare pay cuts to doctors set to take effect in January, but the group is calling for the Senate to go further and pass a permanent repeal of the underlying payment formula. Here’s the AMA’s letter to Harry Reid.

The American College of Surgeons came out against the bill in an open letter cosigned by the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists and several surgical specialty societies. There’s a lot of overlap with what the AMA is opposed to (as well as with those provisions the groups support).

The California Medical Association also opposes the bill, the group said this week. The group highlights several of the issues cited by AMA and the specialty societies, and also calls for higher Medicaid rates, which the Cali docs say are “unbelievably low” in their state.

The American Academy of Family Physicians cited pros and cons without supporting or opposing the overall bill. While some of the group’s positions are consistent with the other groups (as on the Medicare payment formula), the family docs are outliers on the matter of the independent Medicare commission: The AAFP says the commission should actually have more authority than it would be given under the current Senate bill.