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Saturday, April 16, 2005

Chloroform Danger With Antimicrobial Soap

It's now been over six or seven years that I have advised people not to use hand soaps with anti-bacterial ingredients. The main reason for my advice has been that these chemicals, such as triclosan, disturb the balance of naturally occuring staph bacteria on the skin's surface (epidermis). Now here is more convincing evidence.

The problem remains that this substance is not just in soaps, but many other items labelled as "anti-bacterial". It has been proven over the years that the process of hand washing, and the friction it causes, aids in the removal of dirt, grime and bacteria. A best bet is to get our natural hand cleaner with pure essential oils, and switch to one of our recommended 'safe'soaps, herbalYODA Says!

By Kellyn Betts, Environmental Science & Technology

Washing dishes by hand with an antibacterial dishwashing liquid can do more than just ensure that the plates, glasses, and silverware are free from grease and germs, according to Peter Vikesland of the Virginia Polytechnic Institute and State University. In research published this week on ES&T's Research ASAP website (es048943+), he and his colleagues show that the triclosan antimicrobial agent used in household dishwashing soaps reacts with chlorinated water to produce significant quantities of chloroform. The research also suggests that the reaction of triclosan with chlorine could be producing highly chlorinated dioxins in the presence of sun

Because of its antibacterial, antifungal, and antiviral properties, triclosan is found in toothpastes, acne creams, deodorants, lotions, and hand soaps. It is also incorporated into a wide range of consumer goods, including kitchen tiles, children's toys, cutting boards, toothbrush handles, hot tubs, and athletic clothing. As triclosan flows down drains, it is making its way into surface waters and sewage treatment plants, the bile of fish, and breast milk, according to the Alliance for the Prudent Use of Antibiotics, a consumer group. Since 2000, the American Medical Association has been urging the U.S. Food and Drug Administration to closely monitor and possibly regulate the home use of antimicrobials such as triclosan.

The formation of chloroform from triclosan is of concern because the U.S. EPA classifies the compound as a probable human carcinogen. Moreover, the presence of trihalomethanes such as chloroform in drinking water has been linked with human bladder cancers and miscarriages.

The reaction of phenols such as triclosan with free chlorine is well known, but Vikesland's research is important because "it ties the use of a household product [to] increased exposure to a disinfection byproduct," says David Sedlak, a professor in the civil and environmental engineering department at the University of California, Berkeley. "This research is important for demonstrating that the chlorination of triclosan can occur under environmentally relevant conditions," says Kristopher McNeill of the University of Minnesota's department of chemistry. "The fact that you can chlorinate triclosan [under] pretty mild conditions is troubling," he adds.

Since writing the paper, Vikesland's team has conducted follow-up research under conditions that more closely mimic those found during home dishwashing. The new experiments used EPA's maximum allowable residual disinfectant concentration of 4 milligrams per liter in tap water and were conducted at 40 C, which fits well with the cleaning recommendations of the Soap and Detergent Association. (The association's website says that dishwater temperatures of less than 33 C, even with sufficient detergent, are likely to leave a greasy film, while the hottest water most people's hands can tolerate is about 43 C.)

Under these conditions, triclosan reacts with free chlorine to generate more than 50 parts per billion (ppb) of chloroform in the dishwater. When combined with the other trihalomethanes in the water, the additional chloroform could easily ratchet up the concentration of total trihalomethanes to 80 ppb, which is EPA's maximum allowable amount, or higher, Vikesland says.

"Since chloroform and other trihalomethanes and disinfection byproducts are already likely to be present in the tap water, and since chloroform, the other THMs, and many other [disinfection byproducts] are highly volatile, there is a very real likelihood that washing dishes with triclosan-containing liquid could cause additional and troubling significant exposure to these volatiles through inhalation and potentially through dermal absorbtion," says Erik D. Olson, senior attorney for the Natural Resources Defense Council, a nonprofit environmental group. Olson calls the research "significant."

Water treatment plants are working hard to keep the levels of trihalomethanes in tap water below 80 ppb, Vikesland says, noting that the admissible level has recently decreased from 100 ppb. If there is any bromide in the water, the level of trihalomethanes produced during dishwashing is likely to shoot up even higher, he says.

The research makes clear that it is always wise to wear gloves when dishwashing, says Doris Day, M.D., an assistant professor of dermatology at New York University Medical Center. In light of previous studies showing that the levels of trihalomethanes in people's blood increase when they shower, the research raises questions about exposures to chloroform when antimicrobial soaps are used. At this point, however, no one knows what risk they may pose.

Vikesland's research also shows that triclosan's reaction with free chlorine produces a number of chlorinated triclosan intermediates, including 2,4 dichlorophenol. In the presence of sunlight, these chlorinated intermediates could be producing dioxins, say McNeill and his colleague, William Arnold of the University of Minnesota's department of civil engineering. The two have recently demonstrated that sunlight readily converts triclosan in river water to produce dioxins (Environ. Toxicol. Chem. 2005, 24, 517ñ525). But the more highly chlorinated dioxins that could be generated photochemically from chlorinated triclosan intermediates could be far more toxic, says McNeill.

It is unlikely that such dioxins would be generated during dishwashing even near a window on a sunny day because the glass would screen out most of the ultraviolet light necessary to produce the dioxin. But the research suggests that dioxins could be forming near swimming pools in some situations. "There's triclosan in hand soaps and moisturizers. [If] someone who has triclosan-containing moisturizer [on jumps] into the pool Ö they're a potential source for chloroform [and chlorinated dioxin] formation," Vikesland says. The same is true for a child using an antimicrobial soap before getting into the pool, McNeill and Arnold agree. "You could produce a dioxin on the surface of your skin [that] gets absorbed through the skin," Sedlak adds.

McNeill and Arnold say that the research also calls for more detailed studies of whether chlorinated triclosans are being released from wastewater treatment plants. Because triclosan is widely found in the environment, chlorinated triclosan could be a source of toxic dioxins in the environment, says Arnold. Research has already shown that the presence of triclosan can affect algae populations (Environ. Sci. Technol. 2003, 37, 162Añ164A).

Copyright © 2005 American Chemical Society

Another New Wonder Drug

Phosphagenics announces study results from their new drug APA-01. My question is why do we need another drug that may show something in the lab, but little, if anything, is known about how it will respond in humans. Another question is why do we need a drug when we have chelation and vitamin C. Of course lifestyle changes are at the foundation of any health improvement program, but this may be the hardest of all to accomplish.

LONDON 15 April (Dow Jones)--Phosphagenics Limited said Friday that its new patented drug, APA-01, can greatly slow or prevent the development of atherosclerosis, the successful completion of an animal trial shows.

Atherosclerosis is the leading cause of heart disease in the western world, the company said.
See full article

Friday, April 15, 2005

More Medical Mania

This researcher might just have overlooked the reduction in the effect of the immune function of the stomach by encouraging "gastro-protective" medicines, and the harm to kidneys, lever, etc. from Motrin (ibuprofen) and Aleve (naproxyn).
Oh well, I just guess there will be a new dis-ease from this combo and of course they'll have to come up with another new combo to fight the side effects and damage.
Strange they do not look into herbs such as yucca that have been known to be anti-inflammorty since the beginning of time.

Two-Drug Combo May Best Replace Bextra, Vioxx

In the post-Bextra, post-Vioxx age, how can arthritis patients get effective pain relief while protecting their hearts and stomachs from dangerous side effects?

The answer may have arrived in a major new study, which used computer models to determine that a combination of two drugs -- a non-cox-2 pain reliever like Aleve, Advil or Motrin and a gastro-protective medicine like Prilosec or Nexium -- may be the best solution for a majority of arthritis patients.

In fact, it may have always been the best solution, some experts say.

"For years I've been advocating a 'back to the future' combination of these two old and safe drugs," said Dr. Mark Fendrick, a long-time expert on these issues and a professor of internal medicine at the University of Michigan, Ann Arbor.

Although not involved in the current study, Fendrick agreed that, for the vast majority of patients, a traditional non-steroidal anti-inflammatory drug (NSAID) plus one of the newer generation of acid-reducers, called proton pump inhibitors (PPIs), is the safest, most effective way of easing joint pain while sparing the heart and stomach.

The furor over the cox-2 subclass of NSAID drugs began last September, when Vioxx was pulled from the market after studies linked its long-term use to increased cardiovascular risk. Then, last week, another cox-2, Bextra, was pulled because of similar fears, as well as evidence of increased risks for a rare but potentially fatal skin reaction.

The U.S. Food and Drug Administration has allowed a third cox-2, Celebrex, to remain on the market, albeit with tough labels warning of possible cardiovascular risk. And in its order April 7, the agency also mandated black-box warnings on all similar prescription drugs and labeling changes for similar over-the-counter drugs.

Bextra's demise brought up the same question, however: What now for cox-2 users?

Reporting in the April 15 issue of Arthritis Care & Research, a team led by Dr. Brennan Spiegel, of the David Geffen School of Medicine at the University of California, Los Angeles, may have provided an answer.

The study used complex computer modeling to estimate the one-year costs, both in terms of patient health outcomes and financial expenditure, of three standard treatments for chronic arthritis pain in a hypothetical group of 60-year-old patients. Those treatments included a cox-2 inhibitor drug alone; a traditional NSAID alone; or an NSAID plus a PPI drug, used to prevent the gastrointestinal damage common to all NSAIDs.

Reflecting current medical practice, all of the "patients" in the hypothetical model were also taking a heart-healthy daily aspirin.

"What we found is that, under every circumstance that we could imagine, there was no health-economic benefit to using the cox-2 inhibitors, at all," Spiegel said.

While cox-2s did reduce arthritic pain, the costs linked to their use rose considerably when researchers factored in an increased incidence of heart attacks and strokes. And while Vioxx, Bextra and Celebrex are somewhat safer on the stomach than traditional NSAIDs, they still convey some risk in that area, too.

"The most frequent thing that happens is dyspepsia -- nuisance symptoms like belly aches," Spiegel said. "Belly aches themselves cost money, and that's another reason we see quite a big difference in cost. That really hadn't been looked at before."

Use of pain-relieving traditional NSAIDs alone still left users with these added gastro risks, however, so the best therapy seems to be combining an over-the-counter NSAID like Aleve, Motrin or Advil (the latter two contain ibuprofen) with a stomach-quelling PPI like Nexium, Prevacid or Prilosec.

The study was funded by Tap Pharmaceuticals, the makers of Prevacid, but Spiegel said his team worked hard to fight any potential bias that would favor PPIs.

"We actually went through a lot of steps to try and make it as hard as possible for the PPI strategy to look good," he said. "But, like the phoenix rising from the ashes, it still came out looking good."

Spiegel advocates using any of the PPIs, in fact: "They're all the same, as far as I'm concerned. I say go with the cheapest."

He stressed that, unlike cox-2s, there's a wealth of long-term safety data on these drugs, which work by shutting down acid production in the stomach. "In general they are extremely safe," he said.

Fendrick said the study more or less validates what he's been saying for years. He believes that, for most patients, the combination of naproxen (Aleve) with a PPI may be best. That's because -- as in the Michigan model -- the majority of older patients requiring chronic pain relief are also taking daily aspirin to fight cardiovascular disease.

"If you take ibuprofen and aspirin at the same time, however, ibuprofen blocks aspirin's protective effect on the heart," he pointed out. That's why non-ibuprofen Aleve may be safer for aspirin users, as opposed to other common NSAID pain relievers such as Advil or Motrin, which contain ibuprofen.

Fendrick believes that only a small fraction of pain sufferers -- those with a very high risk for gastrointestinal bleeding -- should turn to Celebrex. "That's probably only about 10 percent of the market," he said.

He also stressed that "there's no one-size-fits-all" solution for patients, and that patients should make their decision in consultation with their doctor, based on their specific risk-benefit profile.

According to Spiegel, since traditional NSAIDs and cox-2 drugs "are equal in effectiveness" in terms of easing pain for the vast majority of arthritis sufferers, it only makes sense to go with the safest, cheapest option.

Of course, all of this begs the question of whether it was necessary for the FDA to approve cox-2s in the first place.

While he believes there may be some small role left for cox-2s, Spiegel said the FDA "was a little shortsighted in the framework that they were using" as they weighed the risks and benefits of these medications.

"That's because they were only really looking at cox-2s versus the traditional NSAID," he said. "They really hadn't thought about this combination, which many people use practically every day now -- a PPI plus an NSAID."

By E.J. Mundell
HealthDay Reporter

Wednesday, April 13, 2005


Drugs can also interact with foods.

Doctors will be told to check patients' diets before prescribing powerful drugs. Medical drugs "are already toxic by their very nature" and could become more toxic when interacting with other prescribed drugs. Some patients are on as many as 10 drugs.

Warfarin can react with green vegetables. Its efficacy is reduced by ice cream & avocados etc. People prescribed statins should not drink grapefruit juice. Antibiotics' efficacy is reduced by milk & dairy products. People on Lithium should not vary their salt intake.

many as 200 medical drugs may be affected by food.

Wholesale prices for name-brand drugs jump

By ELIZABETH WOLFE, Associated Press Writer

WASHINGTON - Wholesale prices for name-brand drugs jumped an average 7.1 percent in 2004 — the largest hike in five years and more than twice the rate of inflation, according to a study released Tuesday by AARP.

AARP's annual Rx Watchdog Report tracked prices drug manufacturers charged wholesalers last year for about 200 prescription drugs popular with older Americans. The price hikes were the largest annual jump since AARP, the nation's largest lobbying group for the elderly, began sponsoring the study five years ago.

"We are disappointed that brand name manufacturers have failed to keep their price increases in line with inflation despite consumer appeals for them to hold the line," AARP chief Bill Novelli said in a statement. "Much more needs to be done to slow down spiraling drug pricing."

The 7.1 percent hike, slightly higher than 2003's 7.0 percent jump, continues a trend of increasing drug prices. Since the end of 1999, prices of more than 150 popular name-brand drugs have risen an average 35.1 percent, nearly three times the 13.5 percent inflation rate over that period, the report said. In 2004, inflation was 2.7 percent in 2004.

Among the 25 best-selling brand-name drugs on the market in 2003 and 2004, the sleep medication Ambien (10 mg. tablets) saw the largest price jump at 11.9 percent. Flomax, used to treat enlarged prostates, 0.4 mg. rose the least — 1.5 percent.

By contrast, the price for 75 popular generic drugs hardly budged in 2004, rising 0.5 percent. In 2003, manufacturers' prices for generic drugs went up an average 13.3 percent.

The report was prepared by the AARP Public Policy Institute and the PRIME Institute of the University of Minnesota.

Monday, April 11, 2005

Demand for Natural Healing Therapies

Every year millions of Americans seek providers who offer health care therapies that are neither widely taught in medical schools nor generally available in U.S. hospitals. Researchers from Harvard Medical School studied the health care practices of U.S. adults and estimated that 22 million Americans sought providers of unconventional care in 1990. The study, reported in the New England Journal of Medicine, estimates that in 1990 Americans made more visits to providers who offered unconventional therapies than to all primary care physicians—425 million compared to 388 million visits.

More on What is Out of Control

Seems as if several health research organizations have been monitoring increases in health care costs.

During the period 2000-2003 the following statistics have been reported -

  • 6.9 % increase in Medicaid spending per person
  • 9.0% increae in spending per privately insured person
  • 12.6% increase in health insurance premiums paid in employer-sponsored plans
In the mid-70s, during the time I was a graduate student in nursing and working as an industrial engineer for a hospital corporation design team, I wrote an article about rising health care costs. I guess not much has changed.

This is part of the reason I encourage people to look at their role in staying healthy, to keep their personal health care costs affordable.

Little Interest in Ethics Today

According to a study reported by the American Association of Critical Care Nurses (AACN) 84 percent of all doctors have seen their colleagues take shortcuts that could be dangerous to patients.

Worse, less than 10 percent of this group reported what they saw.

My father was a physician and surgeon who fortunately completed medical school when medicine was still an art. He belonged to a group of doctors that agreeably monitored each other so that any harm to a patient or others might be avoided.

This degree of professionalism must be very hard to find today it seems.

More Drug Dangers


An Open Letter to Pfizer Inc. on the Underlying Reasons That Bextra Failed, on Why Pfizer Made Bextra Unnecessarily Risky -- and on How Pfizer Might Still Save Celebrex.

Jay S. Cohen, M.D., is a nationally recognized expert on medication side effects and an Associate Professor (voluntary) of Family and Preventive Medicine at the University of California, San Diego. Dr. Cohen's scientific papers on drug safety have received worldwide attention, and his book Over Dose: The Case Against The Drug Companies (2001) was highly recommended by reviewers including the Journal of the American Medical Association. Dr. Cohen has long emphasized the need for better, more complete dosing and side-effect information on prescription drugs, and he has been a featured speaker at major medical conferences and at the U.S Food and Drug Association.

Saturday, April 02, 2005

is it parity or is it camouflage?

Washington state now has parity for mental health coverage with medical/surgical care.

Yet there is no separation between general psychiatrists and specialty psychiatrists such as those for children. The fee is the same in spite of additional training (not the mention all the additional time it takes to work with kids). But that's another hurdle.

Given the ineffectivenes of current drug-based psychiatric treatments - the number of mentally disabled individuals receiving social security beneifts for that disabilty has doubled over the past 15 years - the major effect of mental health parity will be to accelerate the fiscal bankruptcy of medicare, medicaid and the medical care system in general.