Hadcorp News: March 22, 2008 Down Syndrome plastic surgery 'child abuse'

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Hadcorp News: March 22, 2008

PLASTIC SURGERY NEWS

Down Syndrome plastic surgery 'child abuse'

The Age

Melbourne, , Australia

Marika Dobbin

March 11, 2008 - 10:28AM

The case of a five-year-old British girl with Down Syndrome who underwent plastic surgery three times has come under fire from Australian disability advocates.

Parents Kim and Bussey, from Pimlico in south-west London, chose to alter their daughter's protruding tongue, "slanty" skin around her eyes and prominent ears to help her "fit in" with her peers, London's Daily Mail reported.

"We live in a society that judges people by the way they look," Ms Bussey said. "Society is not going to change overnight, so Georgia has to fit into society, rather than society fitting into the way she is.

"The people who criticise us are usually people who don't have Down's children of their own. They don't see the teasing that goes on and the problems Down's children have. I just want to give Georgia a helping hand - an edge to get on in life."

Critics, including the parents of other Down Syndrome children, told the paper the operations were equivalent to "child abuse".

Another London couple, Chelsea and ce Kirwan, said they would consider plastic surgery for their toddler daughter Ophelia if she was unfairly judged on her appearance in the future.

Mr Kirwan, a renowned plastic surgeon, said the procedures would correct her "eyes slightly wide apart, flat nasal bridge, thin lips, tongue that sticks out, thick neck".

Mother Chelsea said plastic surgery could help her daughter be more accepted by society.

"It's a matter of self-esteem," she said. "If you're not happy with yourself then why shouldn't you fix something? All I want is for Ophelia to be happy."

The executive officer of Disability Rights , Craig, said he sympathised with families who wanted to protect their children from discrimination in society.

"A parent's fear of their child being rejected by society is a very powerful emotion and is unfortunately based on experience for many people with a disability," he said.

However, he said surgery on children without a medical need was not the answer.

"It's much better to change the way society thinks and aim for an inclusive society accepting of difference. People with a disability should be seen as part of life's diversity."

Plastic surgery death, investigation concluded by April

Portugal News

Lagoa, Algarve, Portugal

8/3/2008

A Ministry of Health spokesperson has guaranteed that an investigation currently being carried out into the death of a 24-year-old woman, who died after having liposuction in a clinic in Faro, will be concluded by the end of this month.

Superbug Infection Not Uncommon in Facelift Surgery

Insider Medicine

Kingston,Ontario,Canada

(March 17, 2008 - Insidermedicine)

A virulent type of bacteria called methicillin-resistant Staphylococcus aureus, or MRSA, is not an uncommon cause of infection following facelift surgery, according to research published in the Archives of Facial Plastic Surgery.Here are some facts about MRSA:

• MRSA is a type of bacteria called Staphylococcus aureus, typically referred to as just "staph", that is resistant to the antibiotic methicillin.

• It is now a major cause of infections occurring in surgical wounds, skin, and other soft tissues

• MRSA infections are more virulent than infections caused by regular staph, meaning they spread faster, are harder to control, require more expensive treatments, and are more likely to be fatal.

Researchers out of Manhattan Eye, Ear, and Throat Hospital and New York University School of Medicine reviewed the charts of nearly 800 patients who had undergone facelift surgery between 2001 and 2007.

While infections occurred less than 1% of the time, 80% of infections were related to MRSA. Two of four patients who developed MRSA infections had had contact with hospitals, patients, or medical staff before their surgery, which may have been how they picked up the MRSA.

Today's research highlights the significant role that MRSA plays in infections following facelift surgery. The authors recommend that surgeons performing these procedures screen their patients for infection risk, take care to prevent the spread of infection among patients, and have a high index of suspicion for MRSA when infections do occur.

For Insidermedicine in Depth, I'm Essie Heinrich.

Brazilian doctor gets up to three years in liposuction death

SouthCoastToday.com

New Bedford, MA,USA

By DENISE LAVOIE

Associated Press writer

March 19, 2008 6:00 AM

WOBURN — A Brazilian doctor who was accused of being part of an underground cosmetic surgery network was sentenced to up to three years in prison Tuesday after pleading guilty in the death of a 24-year-old woman.

Luiz Ribeiro pleaded guilty to involuntary manslaughter in the death of Fabiola Dea in the basement of a Framingham condominium in July 2006. Dea died of complications from liposuction surgery.

Judge Wendie Gershengorn sentenced Ribeiro to 2½ to three years in prison Tuesday. He has served 20 months in prison since his arrest, meaning he could be released by January 2009.Ribeiro faces deportation to Brazil once he completes his sentence.

Ribeiro, 51, of Belo Horizonte, Brazil, was not licensed to practice medicine in the United States.

Prosecutors said he performed the surgery on a massage table under unsanitary conditions and did not have a qualified professional present to monitor Dea's vital signs, as required.

"By not having that trained person, it substantially increased the risk of serious bodily harm or death," prosecutor Lee Hettinger said.

Prosecutors said Ribeiro performed liposuction, nose jobs and Botox injections for several years, mostly in Framingham's large Brazilian immigrant community, where cosmetic surgery is popular among beauty-conscious women.

Dea, an immigrant from Sanclerlandia, Brazil, went to Ribeiro for a rhinoplasty on July 27, 2006. She went back three days later for liposuction. An autopsy report said she died of complications, including pulmonary fat emboli, or fat in the lungs.

The owner of the home where the surgery was done, Ana Celia Pena Sielemann, was charged with being an accessory, but was deported before prosecutors could bring her to trial.

Hettinger said Sielemann recruited women from Framingham's Brazilian community to have procedures done by Ribeiro and at least one other doctor in what Hettinger described as a "money-making proposition."

But Ribeiro's lawyer, Jeanne Earley, said Ribeiro did the surgery as a favor to Sielemann after another doctor Sielemann had arranged to operate on Dea was unable to do it. Earley said Ribeiro's main purpose in coming to the United States in July 2006 was to visit his daughter.Earley said Ribeiro has been devastated by Dea's death.

"This is a man who has no previous record, who has only been doing good in his community," she said. "He made a very, very bad mistake and has paid very dearly for it."

Ribeiro's ex-wife, Ana Miranda Ribeiro, who admitted acting as a nurse for her husband during the procedure, pleaded guilty to manslaughter in September and was sentenced to one year in prison. She was deported last month after completing her sentence.

Plastic surgeon suspended

Grand Forks Herald

Grand Forks, ND, USA

By Hemme Froslie, The Forum

Published Wednesday, March 19, 2008

An independent plastic surgeon closed his Fargo practice after the state Board of Medical Examiners temporarily suspended his medical license.

Dr. Yvorchuk, 51, was about to perform surgery March 5 when medical staff at PSI Surgical Center observed that he appeared “impaired,” according to a complaint filed by the board’s investigative panel.

On Tuesday, the board issued a news release about the temporary suspension.

Yvorchuk was stopped from performing the surgery. Later, his blood-alcohol level was found to be at 0.35 percent, according to the complaint. It is illegal to drive in North Dakota with a blood-alcohol level of 0.08 percent sor greater.

The board suspended Yvorchuk’s license until a hearing is held April 9. At that time, he could face further sanctions, including loss of his license.

“Dr. Yvorchuk’s conduct creates a significant risk of serious and ongoing harm to the public,” said Duane Houdek, executive secretary of the Board of Medical Examiners, on Tuesday.

The Fargo surgeon had performed two procedures earlier March 5, according to the complaint. The board is looking into whether he was drunk during those, Houdek said.

No previous disciplinary action has been taken against the physician, he said.

A message left at Yvorchuk’s home in West Fargo was not returned Tuesday.

Yvorchuk leased office and surgical space from Plastic Surgery Institute but maintained an independent practice, said Peg Gilbertson, office manager. Last week, Yvorchuk removed items from his office and closed his practice, she said. He didn’t leave a forwarding number. On

March 5, Yvorchuk came in after lunch to perform a surgery and staff noted he was impaired, Gilbertson said. After he was removed from the facility and evaluated, his privileges to PSI’s ambulatory surgery center were revoked and the incident was reported to the state board, she said.

The state Board of Medical Examiners issued Yvorchuk a license to practice March 19, 2004, and he was authorized to practice through June 30 of this year, according to the board’s Web site.

The surgeon was employed at MeritCare from March 2004 to October 2005, said spokeswoman Haug. Yvorchuk had privileges at the hospital after he left, but took a voluntary leave of absence earlier this month, she said.

He also had hospital privileges at Innovis, but hadn’t used the day surgery unit since December, said spokeswoman Kris Olson.

The state Board of Medical Examiners receives about 75 complaints about physicians each year, Houdek said. The board typically takes disciplinary action against seven or eight of those. Alcohol and drug abuse are factors in about 15 percent of those cases, Houdek said.

Yvorchuk holds medical licenses in Illinois, California and New Hampshire. None of the states has record of any previous disciplinary action against the surgeon.

A North Dakota record search late Tuesday showed Yvorchuk was arrested Feb. 10, 2007, in town for drunken driving and speeding. The drunken driving charge was transferred from city to state court, but the result from that case couldn’t be determined online. A notice of conviction for the speeding citation was sent to the state’s Department of Transportation.

Also, Yvorchuk pleaded guilty last July to an amended complaint of reckless driving stemming from a February 2007 traffic stop.

MORE:PLASTIC SURGERY NEWS

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MEDICAL DEVICE NEWS

$40 million verdict for burned heart may be largest in Snohomish County history

HeraldNet

Everett, WA, USA

Published: Tuesday, March 11, 2008

By Jim Haley and Hefley

Herald Writers

A jury Monday awarded $40.1 million to a man whose heart was cooked during a 2004 operation in Everett when a medical device malfunctioned.

The jury ruled that a California company, Lifesciences Corp. of Irvine, Calif., bears almost all the blame for what happened to Paramjit Singh, because it failed to tell doctors about flaws it knew existed in the device.

The blockbuster verdict appears to be the largest ever in Snohomish County and is thought to be one of the state's largest for a personal injury lawsuit, according to lawyers.

Singh said he hoped the verdict will send a message.

"I don't want it to happen to anybody again," he said.

Singh went into Providence Everett Medical Center in October 2004 for relatively routine heart bypass surgery. A monitor made by malfunctioned, turning off fail-safe devices and causing a catheter inserted into Singh's heart to reach temperatures up to 500 degrees.

Doctors couldn't restart Singh's burned heart, but he was kept alive with blood-pumping machines and received a heart transplant at University of Washington Hospital 11 weeks later.

The verdict came after a five-week trial and four days of jury deliberation.

Singh, 54, of Mount Vernon, sat expressionless through the reading of the verdict and the lengthy process of polling individual jury members on 17 questions they had to answer. When the jury left, he hugged his wife, Harmeet Kaur, 40, and vigorously shook hands with Dave , Providence's chief executive officer.

Both the hospital and the Singhs sued .

The jury panel of 10 women and two men decided that was 99.99 percent responsible for Singh's injury, Providence just .01 percent. accused Providence of using a defective cable and being partly responsible for burning Singh's heart.

The finding means that Providence will have to pay a little more than $3,000 of the amount that was awarded to compensate Singh and his family, lawyers for Singh and said.

But the jury also ruled that owes Providence about $310,000 in damages.

Jurors found that violated the state Consumer Protection Act, which means it also may have to pay attorney fees for the hospital. In addition jurors ruled that committed fraud against the hospital by withholding knowledge that some of the monitor's computer code could cause the overheating.

What's more, jurors found that was malicious in its conduct and awarded punitive damages to the Singhs and Providence.

About $8.3 million was awarded in punitive damages and $31.75 million to compensate the Singhs for what they've gone through. The hospital's punitive damage amount is $100,000 of the $310,000.

"We're very pleased. This sends a message to manufacturers that they cannot put their profits over patient safety," said Gellatly, one of Singh's lawyers. "They can't conceal their defects and get away with it."

An spokesman Monday emphasized that the monitor had been used for 15 years on thousands of patients without injuring anyone but Singh.

"We've always been sympathetic to the Singh family and always felt he and his family should be fairly compensated," said the spokesman, who asked that his name not be used, in line with the company's policy.

intends to appeal the punitive damages award, and the company believes the amount awarded to compensate the Singhs is unfair to the company.

One juror returned to the courtroom to speak with Singh and his wife.

knew that the monitor posed a potential danger and they chose not to warn anybody, juror Vickie Jewett said.

"Even though they thought it was a remote possibility, they were playing Russian roulette," Jewett said.

Jurors watched a video shot in 2003 in Japan of a catheter charring and smoking during an operation. The catheter in that case was outside a patient's heart.

Jewett called Singh, who testified, a genuine man who "wasn't up there for show."

On the other hand, she had harsh criticism for CEO Mussallem, who during testimony minimized the damage to Singh, she said.

"The CEO said it was sad. This is devastating. This is beyond sad," Jewett said. "For him to sit up there and say over and over and over it's sad is inexcusable."

Singh said he's glad the trial is over because the pressure is gone. He is thankful to the medical personnel of both Providence and UW hospitals.

"They saved my life," he said.

Singh said some of the money from the jury verdict will be donated to the University medical facility.

The verdict was large but the damage done to her husband was enormous, Kaur said.

"The money won't give him his life back," she said.

Singh will have medical problems the rest of his life, including a weakened immune system due to anti-rejection drugs he must continue to take. Those drugs caused cancer once and that could happen again.

In addition, he will have a shortened life expectancy, is at risk for kidney failure and possibly may need another heart transplant.

"This jury worked hard, lawyer Gellatly said. "They sent a message that you can't hide hazardous defects."

Bar-Coded Surgical Sponges Reduce Error

Deutsch

Nurse.com

Falls Church, VA, USA

Monday March 10, 2008

To improve patient outcomes, Jo Quetsch, RN, MA, an operating room manager, and colleagues found a way to control sponge counts after surgery.

After implementing a new technology by SurgiCount Medical, Loyola University Health Center in Chicago became the first Midwestern facility to use a system that incorporates bar codes and scanners to keep track of surgical sponges.

The scanning process is similar to the technology modern grocery stores employ to scan grocery items, she says. The sponges are scanned at the beginning of a surgical procedure with a hand-held scanning device. At the end of a procedure, all the sponges are again scanned and accounted for.

Loyola's staff is not more likely to lose track of sponges during operative procedures than operating room staff at other institutions. However, keeping track of sponges can be problematic because more than 100 sponges can be used during a single operation, and some operations require more than 200 sponges at a time.

Also, several types and shapes of sponges are used during surgery, and the new device indicates what kind of sponge is missing, which is helpful, she says. If a sponge cannot be located, an X-ray is performed to ensure the wayward sponge was not left in the patient.

"Like any other organization, one [missing sponge] is one too many," Quetsch says.

The costs

Implementing the technology is expensive. It took about a month for staff to learn how to use the new technology and cost about $150,000 to put the system in place in the OR, labor and delivery department, and outpatient surgery department, Quetsch says. In addition, the health center uses about $60,000 worth of disposable sponges with the new technology per year.

But after only a few months with the new product — the system was implemented on Dec. 3 — the clinical director says it's worth the additional cost. "I would recommend it," Quetsch says. "I like the added assurance."

Inpatient manager Meg Kim, RN, BSN, CNOR, notes the financial output may seem hefty, however, "any retention of a foreign body can be very expensive" if there are complications or a lawsuit ensues.

"This is extra money upfront," Kim says. "But overall, it's cost effective."

Working out the kinks

The system was easy to implement, but glitches needed to be worked out, says Kim. At the beginning, individual sponges were scanned, which proved time-consuming. To reduce time, there is now a master tag for packages of five sponges that, when scanned, notes all the individual sponges in one bag. However, when the procedure is completed and the sponges are scanned again, they must be scanned individually, Kim says.

Kim says another problem detected early on was if a master tag was scanned in close proximity to an individual tag, the machine picked up only the individual sponge coding. Then, at the end of the procedure it would appear that there were missing sponges when there weren't any missing. Also, the technology will not allow a sponge to be scanned twice, Quetsch adds.

SurgiCount Medical was present 24/7 for the first two weeks that the system was in place, Kim says. Now they are on call by phone if there is a problem.

Saving time, reducing error

There are a lot of distractions in the OR and sponges easily can go missing, Quetsch says, so the new system reduces error.

However, to be sure there are no errors, OR staff continue to count sponges manually, she adds, as a double check.

Using the new technology also added about 10 minutes to each OR case time initially. "There has been a learning curve. I would say we're down to 5 minutes," Quetsch says.

"It's definitely a different work curve," Kim agrees. But it increases patient safety, she adds, so it's worth it.

Other institutions soon may decide to jump on the bandwagon and get the new device, too, Quetsch reports. According to recent studies, scannable surgical sponges will be the new best practice, she says.

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AGENT ORANGE

Cancer and TCDD: The Mitochondrial Connection

By M. iel MeadMar 6, 2008 - 1:44:08 PMFood ConsumerLisle, IL , USA

During the Vietnam War, from 1961 to 1971, U.S. military forces sprayed millions of gallons of the herbicide Agent Orange over vast tracts of Southeast Asian jungle, mainly in an effort to remove foliage and expose enemy troops. Troops were exposed to TCDD that contaminated the Agent Orange, and since the 1970s, elevated blood TCDD concentrations have been implicated in many cancers, skin rashes, and other health problems experienced by Vietnam veterans. Although TCDD is carcinogenic, it is not directly genotoxic. A report in the 8 January 2008 Proceedings of the National Academy of Sciences now demonstrates one of the ways that TCDD may promote cancer's growth and spread.

The new study describes a novel mechanism of TCDD action that focuses on the mitochondria: "We found that TCDD induces tumor cell proliferation and invasion by directly acting on mitochondrial transcription machinery and inducing mitochondrial respiratory stress," says principal investigator Narayan G. Avadhani, a biochemistry professor at the University of Pennsylvania. Such mitochondrial dysfunction inhibits apoptosis in malignant cells and increases the invasive potential of cancer. Mitochondrial dysfunction is also associated with conditions such as heart disease, diabetes, obesity, blindness, deafness, kidney disease, and neurodegenerative disorders, as well as with aging.

"[The respiratory stress-signaling] cascade culminates in the activation of a large number of nuclear genes that affect various cellular processes including cell metabolism, proliferation, and apoptosis," says lead author Gopa Biswas, a researcher in Avadhani's lab. "We have now established that TCDD alters cellular morphology and physiology through a similar mechanism."

It is generally accepted that adverse effects of TCDD result from its activation of the Ah receptor, with effects occurring at very low exposures. In the presence of TCDD, the Ah receptor has been shown to either induce or suppress the transcription of numerous genes that have been linked with cancer development via changes in tumor suppressor proteins, oncogenes, growth factors, and cell cycle proteins, among other factors.

Mitochondrial dysfunction may entail a more fundamental mechanism. It appears that TCDD-induced mitochondrial stress signaling in cancer cells is propagated in part through the Ah receptor but also acts through mechanisms that are independent of the Ah receptor, such as by inducing protein kinase C and extracellular signal–regulated kinases.

"Our findings show that at subtoxic levels of ten to fifty nanomolar, TCDD is sufficient to cause mitochondrial dysfunction and induce the signaling cascade," says Avadhani. "These results raise concerns over the adverse health implications of dioxins and PCBs even at very low levels."

In both animal and human studies (notably epidemiologic analyses of cancer rates following the 1976 industrial accident in Seveso, Italy), TCDD exposure has increased cancer incidence and mortality at all cancer sites rather than at a few specific sites. In 1997, the International Agency for Research on Cancer upgraded TCDD to a Group 1 human carcinogen on the basis of mechanistic data.

Considering subsequent dose–response assessments for TCDD and cancer, Steenland, a professor of environmental and occupational health at Emory University, and colleagues argued in the September 2004 issue of EHP that "TCDD exposure levels close to those in the general population may be carcinogenic and argue for caution in setting the upper ranges of long-term permissible exposure to dioxins."

The present study is limited in that it involved skeletal myoblasts, not living organisms. "These findings are significant but unfortunately provide no in vivo data showing tumor progression in animals due to loss of mitochondrial function by TCDD," says Keshav K. Singh, a cancer geneticist at Roswell Park Cancer Institute in Buffalo, New York. "

At a minimum, xenograft studies in mice are needed." Avadhani now plans to study the precise mitochondrial targets of different polychlorinated biphenyls (a related group of compounds) that lead to reduced mitochondrial transcription and then examine the implications of this pathway in tumor progression in vivo. He sees possible implications for the prevention of breast, pancreatic, and other endocrine cancers.

Recognition that the carcinogenic effects of environmental toxicants may originate in disruption of mitochondrial biology could prove important for the future development of cancer prevention and treatment procedures related to TCDD and other dioxin exposures.

"The new findings suggest that the risk of cancer may be reduced by avoiding or lowering exposure to environmental mitochondrial toxicants as well as [possibly] by optimizing mitochondrial energy metabolism by nutritional and medicinal means," says Egil Fosslien, a pathology professor emeritus at the University of Illinois at Chicago.

GENETICALLY MODIFIED FOODS

Push for local councils to be GM-free

Sue Bolton, Melbourne

8 March 2008

Mothers Against Genetic Engineering (MAdGE) and the Gene Ethics Network launched a campaign on February 28 for local councils in to declare themselves genetically manipulated (GM) food-free zones. The campaign, launched at a protest rally on the steps of the state parliament, is in response to the Premier Brumby’s decision to end ’s ban on GM canola on February 29.

will be the only Australian state or territory to permit GM canola to be grown, unrestricted and unregulated, and sold without a GM label. South Australia, Western Australia, Tasmania and the ACT have decided to keep their GM crop bans. NSW will allow commercial GM canola to be grown on a case-by-case basis.

The protesters also called on the Brumby Labor government to extend the ban on commercial GM-herbicide-tolerant canola for at least five more years. Gene Ethics director Bob Phelps told the rally that “Canadian experience shows Bayer — the world’s biggest agro chemical company — and Monsanto — the world’s biggest seed company — will capture over 90% of any profits by collecting maximum royalties and fees on patented GM canola seed and weed killers.

“Yet the state kowtows to these GM giants that will not even be liable for the inevitable damage to public health, the environment or markets that GM canola will cause. Brumby ignores the immediate, permanent and irreversible impacts of GM canola on the spurious promise of drought-tolerant plants and fart-free pastures to solve global climate change in 10 years time, if ever.”

MAdGE spokesperson Frances Murrell pointed out that Monsanto was running its campaign in support of GM food through “stooge organisations” such as the n Farmers Federation. She called for farmers who are against GM food to break away from the VFF and form an alternative farmers’ organisation.

Read More of this article here

MERCURY

Three in 10 dentists missed 2007 target to better control mercury

The Canadian Press

TORONTO — Thirty per cent of Canadian dentists missed a voluntary 2007 target to better control how they release mercury into the environment, but the dentists insist they're making good progress in cleaning up their act, even though they say they can't stop using the toxic substance.

Environmentalists, however, say the lack of any real standards is a major concern since low exposure to mercury can lead to learning disabilities in children, while more significant exposure can cause neurological damage or even death in severe cases.

The Canadian Council of Ministers of the Environment endorsed a set of voluntary Canada-wide standards in 2000 and 2001 to limit mercury emissions from base-metal smelters, coal-fired power plants, waste incinerators, mercury-containing lamps and from dental amalgam waste, which is a byproduct of dental fillings.

While all those emissions are decreasing, only 70 per cent of dentists hit their targets set for 2007 and the council said the industry has a long way to go before it reaches the goal of reducing mercury waste by 95 per cent.

Environmentalists say it's no surprise that the target was missed by so many dentists since it was only voluntary, and carried no penalty for non-compliance.

"My view is you need to have a stronger system, any dentist that is not using proper approaches, one thing to do it is to fine them ... it's theoretically possible under the Canadian Environmental Protection Act," said Ken Ogilvie, executive director of Pollution Probe.

It's estimated that as much as 1,046 kilograms of mercury was released by dentists into the wastewater stream in 2003, while the amount dropped by 57 per cent to 452 kilograms in 2007.

Mercury that's released into the environment can be absorbed in fish and wildlife and then transferred to humans when they eat those creatures, said Ogilvie.

"It doesn't go away, it doesn't biodegrade in the environment the way an organic pollutant might, so you do want to limit mercury as tight as possible," he said.

There are alternatives to using mercury in fillings, the most common being composite resins, which are growing more popular because they're white and blend in better with teeth.

But Ogilvie said composite filings could also carry a possible health risk since they contain bisphenol A, a chemical that's commonly found in plastic bottles. Some studies have suggested bisphenol A is unsafe and Health Canada is currently conducting its own study on the substance.

Fillings are also available in ceramics or gold but those options are considerably more expensive.

Outlawing mercury fillings would have a disastrous effect on public health by making dental care too costly for many Canadians, said Benoit Soucy, the Canadian Dental Association's director of membership and professional services.

"Changing to those two types of materials is definitely an economic problem," he said, and added that it's not easy to find an alternative for mercury because of the complex inner workings of the mouth.

"Getting materials that respond well in that environment is extremely difficult," he said. "There is no better alternative, definitely."

But he said dentists are reducing the mercury they use - in part because of the appeal and demand for composite fillings - and are getting better at how they deal with its waste.

The most significant component of the voluntary standards involve the use of an amalgam separator, a device which filters the mercury before it can be released into the environment. Soucy said dentists must choose a separator that is 95 per cent effective but most are actually 98 per cent effective.

A study by Environment Canada estimated that only 16 kilograms of mercury would have been released into the environment in 2003 had all dentists used separators.

Mercer of the environmental group Riversides said any discharge of mercury is significant and every dentist in the country should be using a separator - and ideally thinking of how to reduce the use of mercury.

"It's dark-ages thinking that we'd allow only 70 per cent of any industry to knowingly discharge a known neurotoxin into the ecosystem," he said.

"It's appalling, it boggles the mind - they're like any other polluter and if anything, we should actually hold them to higher standard of care."

'First Step In Right Direction' On Decontamination Issue, British Dental Association, UK

Medical News Today

UK

Main Category: Dentistry

Article Date: 10 Mar 2008 - 0:00 PDT

The announcement that the timescale for compliance with new decontamination guidelines in Scotland is under review has been greeted as a 'first step in the right direction' by the British Dental Association (BDA). The decision follows lengthy discussions between the BDA's ish Dental Practice Committee (SDPC) and ish Government Health Department about the difficulties many dentists face complying with the guidelines.

In a letter to dentists across Scotland, Chief Dental Officer (CDO) Margie acknowledges that it is prudent to provide a revised set of timescales for compliance, taking full account of the emerging evidence of constraints relating to equipment and premises. The letter also reports the intention of the CDO to establish a group to develop an updated action plan to provide realistic timescales.

Colin Crawford, Chair of SDPC, said:

"This is an issue that is causing serious anxiety for all dentists, in particular for those that own their own practice. The decision to reassess the timescale for compliance with these guidelines is a sensible one that acknowledges the practical difficulties facing dentists across Scotland. However, the BDA is still very concerned about the level of compliance being sought by the ish Government Health Directorate and the slim evidence base for the implementation of the measures. It is important that the BDA is involved in the group to develop an updated action plan for decontamination."

Notes

1. Changes to decontamination practice were set out by the Glennie Technical Requirements for decontamination in Primary care settings in 2005. Those requirements include the provision of separate rooms for the process of decontamination of equipment to take place in. Prior to this week's letter from the CDO, the deadline for compliance was 31 December 2009.

2. The British Dental Association (BDA) is the professional association for dentists in the UK. It represents over 20,000 dentists working in general practice, in community and hospital settings, in academia and research, and in the armed forces.

GULF WAR SYNDROME

Pesticides, Chemicals Strongly Connected to Gulf War Syndrome

EFluxMedia

USA

By Boyd

10:57, March 11th 2008

Exposure to pesticides and other chemicals may be causing the chronic fatigue, severe muscle pain, memory loss and other illnesses experienced by about 250,000 Persian Gulf War veterans, a new research showed.

“Convergent evidence now strongly links a class of chemicals – acetylcholinesterase inhibitors – to illness in Gulf War veterans,” Dr. Beatrice Golomb of the University of California, San Diego, lead author of the study said in e-mailed comments, according to Reuters.

This is the first research to link soldiers’ symptoms to chemical exposure. For many years, U.S. officials contended that Gulf War symptoms were caused by psychological stress. The new research revealed that nearly 30 percent of troops who took part in the brief war have reported symptoms that include fatigue, memory loss, pain, and difficulty sleeping.

Dr. Golomb reviewed more than 70 studies on Gulf War syndrome and acetylcholinesterase inhibitors including the anti-nerve gas pyridostigmine bromide, or PB, given to troops at the time; pesticides used aggressively to control sand flies; and the nerve gas sarin.

She found that 18 of the 21 epidemiological studies looking at chronic health problems in Gulf War veterans showed a connection to at least one kind of acetylcholinesterase inhibitor exposure.

Acetylcholinesterase inhibitors, or AChEis, act in the body to blunt the effect of an enzyme that regulates a brain chemical called acetylcholine. That substance helps neurons to fire. When the enzyme that regulates this chemical is blocked by an inhibitor, it causes the neurons to fire excessively, Golomb says.

“This leads to uncontrolled muscle action, including of muscles involved in breathing, and can prevent people from breathing. It also causes abnormal brain function. That’s why nerve gas is a bad thing to be exposed,” Golomb said in the review.

Exposure to AChEIs could also be linked to the higher rate of amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease, in Gulf War veterans. Sporadic ALS has been associated with exposure to agricultural chemicals. Moreover, men and women with the Gulf War symptoms were more likely to have lower concentrations and activity levels of enzymes, which work to clear AChEIs from the system.

Genetics may affect the way the body processes these chemicals, specifically the actions of these related enzymes.

“They’re giving certain people so many of these nerve agent pills or pesticides, and [the authors] say that some people metabolize them and some not. Are we really giving a toxic dose apart from the genetics? What are they giving and have they really tested the amounts that they’re giving? Are we overdosing?” said Joy Ray , and assistant professor of pharmacy practice at the Irma Lerma Rangel College of Pharmacy at Texas A & M Health Science Center, according to the Washington Post.

Officials for the Pentagon and the Department of Veterans Affairs did not return calls seeking comment on Golomb's new report.

Dr. Golomb’s findings appeared Monday in Proceedings of the National Academy Sciences.

Treating Victims of Weapons of Mass Destruction

March 05, 2008 11:30 AM Eastern Daylight Time

DUBLIN,Ireland--(BUSINESSWIRE)—Research_and_Markets

(http://www.researchandmarkets.com/reports/c84883) has announced the addition of “Treating Victims of Weapons of Mass Destruction: Medical, Legal and Strategic Aspects” to their offering.

During the last century, the weapons of war became increasingly sophisticated and their effects ever more remote from the actual user. Militarization of nuclear atomic forces, chemicals and biological agents has considerably enlarged the arena of warfare, but of possibly even greater concern is the threat of such agents being deployed by terrorists. This book was originally published in French in 2004; subsequent events, such as the London bombings in July 2005, have only reinforced the importance of all doctors and emergency personnel understanding the various agents that could be used and having the knowledge to deal with victims of an attack or even an industrial accident. The book has therefore been translated into English to make it available to a wider audience.

The book was coordinated by Chantal Bismuth, Professor of Medicine, who has acted as an advisor for the Minister of Health in France and is an international consultant in toxicology. Her co-editor, Barriot, is an anaesthetist with operational experience in the Paris Fire Brigade and the 11th division of Paratroops who is now responsible for the department of ‘Biological risks from new technologies’. The authors are representative of the doctors who would have to deal with the human casualties of warfare or a terrorist attack. They review all weapons of mass destruction, both chemical and biological, including the use of bacteria, anthrax and viruses such as variola and influenza. In each case, they describe the pathogenic agent, the human consequences, organizational aspects of care for the victims and best practice for treatment.

As one author reports, “The infections caused by potential biological warfare agents are seldom taught in the course of medical studies and the majority of physicians never encounter these types of pathology in their daily professional practice. Since its eradication, people are not trained to recognize smallpox or to make the differential diagnosis between anthrax and bronchitis.” Other chapters cover the effects of nuclear weapons and radiation on humans as well as the features of Gulf War syndrome. An important chapter deals with the organization of medical responses to chemical or biological attack: “Planning, equipping, and training responder services are the best responses to the dispersion of chemical and biological agents.”

The book addresses all those involved in the security of the civilian population, the organization of rescue services and the treatment of victims.

Topics Discussed

- Ambiguous concepts and porous borders ( Barriot and Chantal Bismuth).

- Introduction to chemical weapons ( Barriot and Chantal Bismuth).

- Chemical weapons (Chantal Bismuth).

- Chemical terrorism and cyanides (Arnaud Delahaye and Frédéric Baud).

- On the lack of usage of chemical weapons in the Second World War and their utilization by terrorists ( L. Maynard and C. Marrs).

- Toxins ( Barriot).

- Gulf war syndrome (Chantal Bismuth and s Schaper). - Organizational aspect of the management of large numbers of victims during a chemical or biological accident ( J. Baker, Caroline Telion and Pierre Carli).

- Hospital management of victims of a chemical accident (Frédéric Baud and Bruno M Garbane).

- Non-conventional counter-terrorism (Chantal Bismuth and W. Borrow).

- Introduction to biological weapons ( Barriot and Chantal Bismuth).

- Clinical approach to pathogenic agents ( Barriot).

- Variola (Smallpox) ( Barriot).

- Influenza and respiratory infections ( Barriot).

- Anthrax ( Barriot).

- Biotechnology: protection or peril ( Barriot).

- Nuclear and radiological weapons ( Barriot).

- Effects of nuclear and radiological weapons on humans ( Barriot).

-Battleships and flaws ( Barriot and Chantal Bismuth).

BIG PHARMA

Big Pharma really makes me feel sick

Ian Bell on the drug industry

Sunday Herald

Glasgow,Scotland,UK

FOR CLARITY'S sake, remind yourself that nobody at GlaxoKline, Britain's biggest pharmaceutical company (2006 revenues: $42.8 billion; income $10.135bn), is to face prosecution. The company insists that it did nothing wrong with regard to the anti-depressant drug Seroxat.

The Medical and Healthcare Regulatory Agency believes, on the other hand, that the company withheld the full results of trials, particularly those suggesting that the medication could increase the chances of suicide among teenagers. The government is content, however, to "tighten" rules on information disclosure as they affect an industry that ranks, after oil, as Britain's second biggest export earner.

Ministers may yet be equally resolute in their treatment of Reckitt Benckiser, makers of Gaviscon, the heartburn treatment. In this case it is alleged - and denied - that the firm's executives "schemed" to block rival manufacturers from marketing generic copies after the patent had lapsed. The company describes itself as "a responsible firm which behaved honestly and ethically". Its critics say that it cheated the NHS out of perhaps £40 million.

That is, simultaneously, a lot of money and a trivial sum, at least within the strange universe of health spending. Some £90.7bn is earmarked for the NHS in 2007/2008, up from £34.6bn in 1998. Already, most of the extra has gone on wages, 52% of it in 2005/2006. But in that same period at least 17% of extra funding has gone on what the NHS Confederation defines as "extra drug costs" compared with a mere 7% on capital costs.

But why not? Drugs save lives. The pharmaceutical industry spends billions on research and development to spare us from sickness. We are the healthiest, longest-lived, best-tended generation humanity has produced. Big Pharma surely deserves credit.

That depends on who you believe. According to the anarcho-syndicalists at PriceWaterhouses, the global pharmaceutical market is expected to double by 2020 to $1.3 trillion. This market will depend, as it has for a quarter of a century, on the often-extraordinary prices achieved for pills and potions. But as the industry never fails to say, remarkable profits are required to justify the huge costs of research. Humanity pays, but humanity benefits.

Up to a point. Take Pfizer, biggest, by most estimates, of the big. In 2006 its "healthcare revenues" stood at $48.3bn. It spent $7.59bn on R & D. Despite that effort, Pfizer managed to finish the year with a net income of $19.33bn. As a proportion of sales, that figure tends to make most FTSE and Fortune 500 companies gape. In 2003, in the US, the profits of the top 10 drugs companies, US and European, fell to 14.3% of sales. The Fortune median was 4.6%.

The allegation is simple: profiteering. Add to that the claim that the pharmaceutical industry is "disease-mongering", promoting minor conditions to the status of illnesses requiring drugs. Add again the fact that "marketing" expenditure - $67bn in the US in 2002 - is generally two-and-a-half times the amount spent on R & D.

Add further the claim that "innovation" within the industry is trivial, that truly new drugs are few and far between, and often originate in academia and the public sector. Add finally the charge that this is an industry with no sincere interest in producing medicines for those in the third world who need them most. According to Oxfam, the richest 15% of the world population puts away in excess of 90% of its pharmaceuticals. The drugs trade, having fought a long (though unsuccessful) battle to deny the HIV victims of South Africa cheap retrovirals, is still failing to put its famous R & D effort at the service of billions.

Between 1999 and 2004, according to the charity, 163 medicines were "brought to market". Only three were new drugs aimed at the diseases afflicting the third world. TB is now killing two million people a year. Sufferers require six months of treatment. But according to Helena Vines-Fiestas, author of an Oxfam report, "the most recent medicine is 30 years old".

According to the Commons public accounts committee, Big Pharma spends £850m a year "marketing" products to GPs. This revelation followed a National Audit Office survey showing that one in five of GPs is "more influenced" by drug reps than by official advisers. Influenced in what sense? To keep pace with the very latest in medical advances? To study the favourable (but not the less favourable) data that the drug firms supply? To attend conferences funded by the pharmaceutical industry? To heed the fellow professionals employed - for their expertise, surely, and not for their endorsement - by Big Pharma, the people who sometimes also manage to serve on regulatory bodies? Or just to take receipt of free samples?

Prefer, for now, to concentrate on all those dedicated GPs who just want to know about breakthroughs. Marcia Angell, a lecturer in social medicine at Harvard and an industry critic, has alleged there are far fewer of these than the R & D propaganda would have us believe.

Angell recorded that between 1998 and 2003, 487 drugs were approved by the US Food and Drug Administration. Of these, 78% were classified as "similar" to drugs already on the market; 68% were not new compounds; and only 14% were "likely to be improvements over older drugs". Hence the huge marketing effort devoted to mere "me-too" medicines. As Angell noted, "a uniquely important drug would require very little promotion". The cure for cancer is still awaited, but the me-toos get that precious patent protection.

They need it. Between 2000 and 2004, according to the European Commission, the number of actually new drugs coming to market had dropped from 40 to 29 a year. The stock markets also fret over "thinning pipelines" as multi-billion dollar "blockbuster" drugs fall out of patent. So Big Pharma has turned increasingly to "partnerships" with universities and the public sector. State aid, if you like.

They appear to believe they have no other choice. Angell recalls that in 2002 the FDA approved 78 drugs. Only 17 contained new active ingredients and only seven of those were classified as improvements on older medicines. The rub? Of "those seven, not one came from a major US drug company".

Still, there's hope for Big Pharma. If they can't find new ways to cure us, they can always invent new ways to make us ill. Journalist and author Ray Moynihan will tell you that these days "marketing strategies have focused on promoting illness, rather than simply promoting drugs". "Female sexual dysfunction", "irritable bowel syndrome", "adult attention deficit disorder" and the rest have been discovered as serious ailments, the better to sell pills, while the companies "work" with patients' groups, medical groups, politicians and the media.

Such strategies make a nonsense of the NHS ethos. The economic power of the industry makes a nonsense of democratic oversight. The damage done to medicine itself by a parasitic trade that is, in essence, robbing the sick is close to incalculable. And the drugs, increasingly, don't work, not as billed, any more.

GlaxoKline probably isn't too concerned by British legislation. In January, the European Commission staged raids at its offices, and the offices of a clutch of other drugs firms. "Possible anti-competitive behaviour" to prevent cheap generics from reaching the market is the allegation. Now who would dream of doing such a thing to those who are ill and in desperate need? And which democracies would allow it?

Drug data that flatters to deceive

Ben Goldacre

Guardian

UK

This article appeared in the Guardian on Saturday March 08 2008 on p13 of the UK news section. It was last updated at 00:03 on March 08 2008.

It was gratifying to see - after only a one-week delay - the government announcing that they would follow my suggestion on the comment pages last week, and demand that drug companies disclose all trial data, to make sure they're not hiding anything. This has been pegged to the issue of undisclosed side-effects of antidepressants, because a drug company hiding side-effects is intuitively evil.

This is unfortunate because - as I have repeatedly argued - much more worrying is the tendency to only publish results which show your drug performing well, and to leave the less flattering trials in a desk drawer. This happens much more commonly, it makes drugs look better than they are, it wastes money, it exposes people to risks of unnecessary side-effects, and it leaves doctors prescribing on inaccurate information.

But how can you tell if the research literature on a given subject has been rigged? It's a tricky problem, because you're chasing evidence for the existence of trials you cannot see. One option is to use mathematical tools, and something called a funnel plot, one of the cleverest ideas of the last century. It's so clever that you might need to concentrate for the next bit.

Let's imagine that there are 30 trials on a given drug. Some are big, and more accurate. Some are small and less accurate, with more random noise. You'd expect that the big, accurate trials should all cluster together around the true finding, all giving similar results for the efficacy of a drug. Meanwhile the smaller, rubbish trials - because they are less accurate measures of the drugs efficacy - will be scattered about randomly, some showing the treatment to be better than the good big trials indicate, some showing that it is worse.

You could then plot all your trials on a graph, one dot for each trial. On the x-axis, left to right, is "how good the drug was shown to be by this trial" and on the y-axis, "how methodologically sound and large the trial was". If there is no publication bias, you should get a triangle shape: at the top of your graph, you will see all your good-quality, accurate trials, clustered together around the true answer. At the bottom of the graph, you will see a broad smear of results, the poor quality trials showing random variation.

But if there is publication bias, you will see a distorted triangle: the small, poor-quality trials at the bottom will be smeared over to the right, because small trials with unwelcome results are much more likely to be overlooked, and dumped in desk drawers, than huge multicentre collaborative studies involving dozens of academics and tens of thousands of participants, which are almost definitely going to get published. If you get a distorted triangle, you know there are some interesting negative trials missing. This happens repeatedly, in too many fields to list, and it doesn't just happen because of big pharma evil.

If you're an academic, and you get a negative result, you're less likely to get round to publishing it, because it's not going to get in a big journal, so it's not going to buff your department's "research assessment exercise" score for this year, nobody's going to invite you to give lectures about it, the whole thing feels like a disappointing waste of time.

And even though you know in your heart that a negative finding is still an interesting piece of evidence there are undergraduates that need teaching and you hate doing that and the references for that other paper need reformatting before submission to a third journal and before you know it five years have passed and nobody's even mentioned the negative finding at the departmental meeting since the last prof retired so you can probably get away with leaving it for another year at least and possibly even ideally until you die.

I've said it before: all trials should be registered before they start, no trial - by anybody - should be passed by any ethics committee without a firm commitment to publish. No exceptions, because bad data costs lives.

More Big Pharma News:

MOTHERS Act Seeks to Drug Expectant Mothers with Antidepressants to "Treat" Postpartum Depressionfrom Natural News.com in Phoenix, AZ, USA

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