Health Headlines - March 18

Bird Flu Scarier Than Human Flu This Season

The mere threat of bird flu might have frightened the American public more than the regular human flu did this season.

In the March 17 issue of Morbidity and Mortality Weekly Report, public health officials in New York City report a spike in sales of antiviral drugs in October 2005, seven weeks before any laboratory evidence of human flu activity actually surfaced.

"There was a spike in antiviral prescriptions that preceded positive laboratory evidence of flu," confirmed Claire Pospisil, a spokeswoman for the New York State Department of Health in Albany. "Laboratory evidence of flu activity in New York City really started to pick up in December 2005."

The spike did, however, coincide with a media frenzy on avian flu, suggesting that people were creating personal stockpiles of antivirals to guard against that possibility.

"Our analysis cannot prove why the prescription spike occurred, [but] it suggests that concern about avian influenza may have been a factor," Pospisil acknowledged.

In contrast to the frenetic activity in antiviral drug sales, experts say this year's human flu season appears to be relatively mild.

So far, numbers from the U.S. Centers for Disease Control and Prevention confirm that perception.

From Oct. 2, 2005, to March 4, 2006, there were 9,143 cases of the flu reported in the United States. During the 2004-2005 flu season, 23,549 flu cases were reported. In terms of number of states affected, all 50 have reported flu activity this season, while 42 states reported flu activity during the 2004-2005 season.

"The sale of antivirals is due to a fear of bird flu, not the yearly flu season," said Dr. Marc Siegel, author of Bird Flu: Everything You Need to Know About the Next Pandemic and a clinical associate professor of medicine at New York University School of Medicine in New York City. "Flu season itself got eclipsed by the bird flu."

"It was a fairly bad season on the West Coast, but mild in the East so far," he continued. "It was also a late season, late migrating across the country. It's going to be labeled a mild season overall unless we're still in it."

Even if the flu season had heated up, antivirals might not have been much help.

Four antiviral medications -- oseltamivir (brand named Tamiflu), zanamivir, rimantadine and amantadine -- are approved for the treatment and/or prevention of influenza.

Amantadine and rimantadine are included in the national stockpile to guard against a possible influenza pandemic. Unfortunately, this year's circulating flu virus has developed high levels of resistance to these two drugs, which prompted the CDC in January to advise against using them for the remainder of the 2005-06 flu season. The CDC alert was issued because more than 90 percent of samples tested were resistant to the two drugs.

In other words, both medicines are basically useless.

For the MMWR report, the New York State Department of Health monitored sales of antiviral influenza medications paid for by Medicaid while its counterpart, the New York City Department of Health and Mental Hygiene, monitored sales by a retail pharmacy chain.

In the past, peaks in sales of anti-influenza medication have coincided with peaks in the percentage of specimens testing positive for influenza.

But this year, the spike that occurred Oct. 23-29, 2005, happened seven weeks before the first World Health Organization laboratory evidence of flu virus circulation (Dec. 11-17 2005). There were no other markers of flu activity, such as nursing home outbreaks or emergency room visits, during October.

In 2004, a smaller spike in antiviral sales took place one week before any laboratory evidence of circulating virus. This coincided with media reports of expected shortages in vaccine supply.

Such personal stockpiling carries its own risks. It means that fewer drugs are available for those who actually need them, and the practice could foster more resistance.

"Inappropriate use of antiviral medications may promote the development of viral resistance," Pospisil said. She added that it is unlikely that the short-term prescribing seen this year would have led to resistance.

Siegel reserved his criticism for the media and for public health officials, stressing that a pandemic stemming from avian flu is not inevitable.

"There's way too much speculation," he said. "We need a new language to communicate risk. Public health officials haven't done a great job of distinguishing that a focus on influenza is different from alarming people."

For now, he added, "there's still a species barrier in place between birds and people, and not enough good explanations about what mutations would be needed. There seems to be a rampant assumption that if this mutation occurs, that automatically signals the end of time. H5N1 is a bad virus in birds, and well worth our attention. Talking about the worst-case scenario could be good in raising awareness, but bad about causing panic."

Tests Show Egyptian Woman Dies of Bird Flu

Initial tests have shown that a woman who died this week had bird flu, making her likely the first human death from the disease in Egypt, a spokesman for the World Health Organization said Saturday.

A U.S. Navy lab in Cairo found that the woman, who died on Friday, had the H5N1 virus, but further tests will be conducted by the WHO to give final confirmation, WHO spokesman Hassan el-Bushra told The Associated Press.

A number of people who came in contact with the woman are also being tested, said el-Bushra, who is the WHO regional adviser for emerging diseases. He would not say how many people were being tested or whether they had shown any symptoms of bird flu.

The H5N1 strain of bird flu has killed or forced the slaughter of tens of millions of chickens and ducks across Asia since 2003, and recently spread to Europe, Africa and the Middle East. Health officials fear H5N1 could evolve into a virus that can be transmitted easily between people and become a global pandemic.

That has not happened yet, but at least 97 people -— excluding the Egyptian woman -— have died from the disease worldwide, two-thirds of them in Indonesia and Vietnam, according to figures by the World Health Organization.

Eat Cholesterol-Lowering Foods in Combination: Study

Cholesterol-lowering foods may be most effective when eaten in combination, a Canadian study suggests.

The University of Toronto study included 66 women and men, averaging just over 59 years of age. All of the participants ate a diet high in viscous fibers, soy protein, almonds and plant sterol margarine -- all thought to help lower cholesterol.

The participants were told to follow the diet for a year and to keep records of what they ate. They met every two months with the researchers to discuss their progress and to have their cholesterol levels measured.

After a year, more than 30 percent of the study volunteers had successfully kept to the diet and lowered their cholesterol levels by more than 20 percent. That's comparable to what some of the volunteers achieved after taking a cholesterol-lowering statin drug for a month before they started on the diet.

"The study's findings suggest that the average person can do a lot to improve their health through diet," study author David Jenkins, professor in the department of nutritional sciences and a Canada research chair in nutrition and metabolism, said in a prepared statement.

"The participants found it easiest to incorporate single items such as the almonds and margarine into their daily lives," he said. "The fibers and vegetable protein were more challenging since they require more planning and preparation, and because these types of niche products are less available. It's just easier, for example, to buy a beef burger instead of one made from soy, although the range of options is improving. We considered it ideal if the participants were able to follow the diet three quarters of the time."

The findings appear in the current issue of the American Journal of Clinical Nutrition.

Coming to a Retailer Near You: Health Clinics

Running low on cookie dough? Got your eye on home improvement supplies? Yet also keen on the flu vaccine?

Not to worry. Increasingly, major American merchandisers are blazing new power-shopping trails by bringing health care and hardware together under one roof, partnering with health-clinic chains to provide routine medical services in a mall-like setting.

This retail health care trend -- led by conglomerates such as Wal-Mart and Target; national pharmacy chains like Brooks-Eckerd, Rite Aid, Osco Drug and CVS; and even regional grocers such as Albertson's -- is already well under way.

For both logistical and legal reasons, the retailers do not own, operate or directly profit from the clinics that open on their premises.

Instead, outside medical providers -- including InterFit Health Services (operating the "RediClinic" chain), Solantic, Quick Quality Care, MinuteClinic, and Take Care Health Care Systems -- rent in-store space from their brand-name landlords.

Such independent clinics -- now operating in states like Arkansas, Florida, Georgia, Indiana, Maryland, Minnesota, New York, North Carolina, Oklahoma, Rhode Island, Tennessee and Texas -- typically charge a $25 to $60 up-front fee (only some clinics take insurance) to address a limited range of 25 to 30 acute medical conditions.

Most offer standard care for common ailments -- such as allergies; bronchitis; colds; flu; eye, ear, skin and sinus infections; headaches and gastrointestinal issues -- on an appointment-free basis.

Preventative care needs are also covered, such as blood pressure, cholesterol and body fat exams; vaccinations; physicals; weight management; asthma and diabetes testing; and prostate cancer and heart disease screenings.

Both retailers and health-care tenants say the clinic-within-a-store concept can be a win-win for everyone.

"We're a very customer-focused company, and they're so very busy, and this will just add one more thing on their shopping list that they can do," said Sharon Weber, a spokeswoman for Wal-Mart, the world's largest retailer with more than 3,600 stores in the United States alone.

"And these facilities will be open the same hours as our pharmacies," she added. "This means including Sundays. So when Junior needs a physical for the football or basketball team, the family can drop by the Wal-Mart on a Sunday afternoon and get that taken care of."

This ease-of-use approach has the potential to reshape the American medical landscape by establishing a store -- rather than a doctor's office -- as a patient's first point of medical contact.

And therein lies the rub. Many physicians' groups have expressed concern that not only are patients not being cared for in a doctor's office, but they are -- in most instances -- not being cared for by doctors at all.

With the exception of the Solantic organization, which staffs all its clinics with on-site board-certified physicians, clinics are typically operated by registered nurse practitioners and physician assistants -- with physician advice limited to phone consultation.

"There's certainly no place for these clinics in complicated diagnoses, long-term management, or even a second visit for the same problem," said Dr. Larry Fields, president of the American Academy of Family Physicians. "Certainly, if any of these situations arise, patients should be sent to a physician," he stated.

"It's not a solution, or even a part of the solution, for a lack of insurance," Fields added. "In most cases, for what these places will be charging, you can see a family physician for the same problem. But, of course, these clinics are going to be open nights and weekends when the doctor's office is not open. So it's a convenience factor."

Michael Howe, chief executive officer of Minneapolis-based MinuteClinic, which currently operates 51 clinics across the United States, agrees with Fields that in-store clinics are best viewed as a convenient supplement to, rather than a replacement for, the medical establishment.

"We make it very clear to our patients that this is not a medical home," he said. "The medical home is a critical part of managing their health on an ongoing basis. We gather a list of primary-care providers in the area who are accepting new patients, and we actually are involved in establishing medical homes for our patients outside of MinuteClinic.

"There is resistance to change," Howe added. "But as we move to more consumer-managed health care, you're going to see more and more the role that these retail-based health clinics will play."

Alzheimer's Drug Helps Brain Tumor Patients

Six months of treatment with the Alzheimer's drug Aricept significantly improved cognitive function, mood and quality of life in brain tumor patients after radiation therapy, U.S. researchers report.

Aricept (donepezil) belongs to a class of drugs called acetylcholinesterase (AChE) inhibitors.

"To our knowledge, this is the first study of an AChE inhibitor or any other drug administered to long-term survivors of partial or whole brain radiation therapy in an attempt to reduce the symptoms associated with a brain tumor and its treatments," study co-author Dr. Edward G. Shaw, chairman of the department of radiation oncology at Wake Forest University Baptist Medical Center, said in a prepared statement.

Reporting in the March 17 issue of the Journal of Clinical Oncology, Shaw's team decided to try Aricept on this group of patients after noticing that radiation-induced brain injury resembles Alzheimer's and other forms of dementia, both in terms of symptoms and what's seen with brain-imaging technology.

"Each year, more than 15,000 Americans are diagnosed with primary brain tumors, and as many as 200,000 with metastatic brain tumors, nearly all of whom receive radiation therapy," Shaw said. "For survivors of brain tumor radiation, symptoms of short-term memory loss and mood changes similar to those seen in Alzheimer's disease, as well as fatigue, frequently occur, leading to a poor quality of life."

The researchers are now planning a clinical trial to compare brain tumor patients treated with Aricept to those treated with a placebo.

Food Fact:
Hate vegetables?

With a few tips, you can sneak them --painlessly -- into your diet. Try these tricks: At a salad bar, fill up your plate with salad greens before adding anything else; the next time you make pasta with vegetables, use half as much pasta and twice as many vegetables; add frozen vegetables to canned soup; add vegetables to pizza or omelettes.

Fitness Tip of the day:
Take the stairs.

The key to cutting stroke risk may be right inside your house. Studies suggest that climbing just three flights of stairs every day can cut your stroke risk by 20%. If your house has a second floor, find excuses for going upstairs whenever possible. If you live or work in a high rise, make a habit of getting off the elevator a few floors below your apartment or office.

FAQ of the day:
How can I get more iron from food?

Try eating more iron-rich beans, peas, lentils and soy foods, as well as dried fruit. Start your day with an iron-fortified food, such as ready-to-eat cereal. Include foods rich in vitamin C at most meals to improve iron absorption (for example, have an orange with a hummus sandwich). Finally, cook acidic foods in an iron skillet; tomato sauce simmered in a cast-iron pan can pick up as much as 80 milligrams of iron.