Worth Noting Advances Seen in E-Health Effort It's possible that in the next decade the health records of most Americans will be in electronic form, making it easy for healthcare providers and patients to access health information from computers, thereby eliminating duplicative testing and making details of patients' medical histories instantly available at the sites where they are being treated, according to the federal Food and Drug Administration (FDA). In the latest step toward such a new "e-health" system, the FDA announced April 19 that it has adopted a Systematized Nomenclature of Medicine (SNOMED) as the standard computerized medical vocabulary system to be used in one part of prescription drug labeling. That brings the FDA closer to the goal of establishing electronic records for most Americans within 10 years, said FDA Acting Commissioner Andrew von Eschebach. He noted that the new vocabulary will be used to provide prescription information for DailyMed, an online health information clearinghouse sponsored by the National Library of Medicine, which makes up-to-date prescription information available free to consumers, healthcare professionals, and healthcare information providers. DailyMed can be accessed at http://dailymed.nlm.nih.gov. New Book Describes 'Poor People's Medicine' Forty years have passed since Congress and Presidents Kennedy and Johnson agreed on the legislation that would create Medicare and Medicaid, and President Johnson signed the bill into law in July 1965. A new book published this year, Poor People's Medicine, calls Medicaid "highly successful" and notes that with the passage of Medicaid, "the modern provision of charity care now belongs with government." Author Jonathan Engel says, however, that the journey toward healthcare security is not over, as 45 million people remain uninsured, the working poor face rising health insurance premiums and out-of-pocket costs, and the increasing numbers of baby boomers threaten the solvency of Medicaid. Poor People's Medicine: Medicaid and American Charity Care Since 1965, is published by Duke University Press. The following information appeared during the month of April 2006 in the News Alerts section of the website of the Center for Health and Health Care in Schools, at www.healthinschools.org. April 5, 2006 The prevalence of obesity in adults doubled and the prevalence of overweight in children and adolescents tripled between the years1980 and 2002, the National Center for Health Statistics (NCHS) reported in an article published in today's issue of the Journal of the American Medical Association. Data from the National Health and Nutrition Examination Survey (NHANES) show that 17.1 percent of children and adolescents ages 2 to 19 years were overweight in 2003-2004 and 32.2 percent of adults 20 years of age and older were obese, with 4.8 percent of adults characterized as "extremely obese." NCHS defines overweight in children and adolescents as at or above the 95th percentile of the sex-specific body mass index (BMI) for age growth charts; and obesity among adults is defined as a BMI of 30 or higher, with extreme obesity defined as a BMI of 40 or higher. BMI was calculated as weight in kilograms divided by the square of height in meters and was rounded to the nearest tenth. Overall, the data show "significant" increases in overweight among children and adolescents and obesity among men in the six years from 1999 to 2004, but no increase in the prevalence of obesity among women. The survey found significant differences by race and ethnicity among children and adolescents, with the prevalence of overweight in Mexican-American and non-Hispanic black girls higher than among non-Hispanic white girls, and the prevalence of overweight significantly higher among Mexican-American boys than among non-Hispanic black or white boys. The corresponding author for the NCHS data can be contacted at Cogden@cdc.gov. April 7, 2006 Legislation introduced in both the House and Senate yesterday would amend the Child Nutrition Act of 1966 to require a new definition of "foods of minimal nutritional value" and to ban the sale of such foods on entire school campuses and for the entire school day. Under the 1966 law, the Secretary of Agriculture is authorized to define by regulation what's meant by "minimal nutritional value," a term that currently includes primarily items such as certain candies. Under the proposed amendment, the Secretary in revising the definition would have to take into account "both the positive and negative contribution of nutrients, ingredients, and foods (including calories, portion size, saturated fat, trans fat, sodium, and added sugar) to the diets of children; and evidence concerning the relationship between consumption of certain nutrients, ingredients, and foods to both preventing and promoting the development of overweight, obesity, and other chronic illnesses." Once a new definition is adopted, the "foods of minimal nutritional value" could not be sold on the school campus at any time during the school day. Introducing the Senate bill, S. 2592, chief sponsor Senator Tom Harkin (D-IA) said "schools have been inundated with foods and drinks having little or no positive nutritional value." He noted that "the heavy selling of candy, soft drinks, and other junk food in our schools undermines the authority of parents who want to help their children consume sound and balanced diets." Harkin's bill has been referred to the Senate Committee on Agriculture and Nutrition. The companion House bill, H.R. 5167, and the Senate bill can be read in full and followed on website http://thomas.loc.gov. April 11, 2006 The federal Food and Drug Administration (FDA) April 6 approved the first transdermal (skin) patch for treating Attention Deficit Hyperactivity Disorder (ADHD) in children six to 12 years of age. The patch, named Daytrana, contains the drug methylphenidate, a central nervous system stimulant, and is to be applied once daily to a child's hip and worn for nine hours. The patch is manufactured by Noven Pharmaceuticals Inc., and will be available by prescription. The FDA cautions that Daytrana should not be used if a child has significant anxiety, tension, or agitation, since methyphenidate may make these conditions worse. Also, if the patch is worn longer than the recommended nine hours, side effects such as insomnia may occur with greater frequency. An FDA press release announcing approval of the skin patch notes that Daytrana "is indicated as an integral part of a total treatment program for ADHD that may include other measures such as psychological and social education for patients." April 12, 2006 A survey of 12th graders has found that teens have growing confidence in prescription drugs as "responsible" or "safe" and that they are having little trouble getting such drugs from parents, friends, on the Internet, or from physicians. The result, the Monitoring the Future survey found, is that prescription drugs are outstripping illegal street drugs in popularity among teens, with prescription drugs being used for "practical" effects--hypnotic drugs for sleep, stimulants to enhance school performance, and tranquilizers to decrease stress. While it is good news that cocaine and other street drugs seem to be declining in use by teens, it is important to point out that prescription drugs also have risks, says an article in the April 6 issue of the New England Journal of Medicine (NEJM). "Even in small doses," the article points out, "sedatives, hypnotics, and opiates have subtle effects and cognition and motor skills," increasing the risk of injury in activities such as sports and driving; and the long-term effects on the still-developing brains of teenagers are unknown. The commentary, "The Changing Face of Teenage Drug Abuse—The Trend toward Prescription Drugs," appeared in the April 6 issue of the New England Journal of Medicine. April 17, 2006 The U.S. Food and Drug Administration said April 12 that it's concerned about reports that unsafe levels of the carcinogen benzene have been detected in soft drinks that contain benzoate salts (an antimicrobial agent) and ascorbic acid (Vitamin C), particularly under certain conditions of storage, shelf life, and handling. The FDA said it is looking into whether benzene levels in the unnamed soft drinks are above the 5 parts per billion allowed in U.S. water standards, as was reported in a recent FDA Total Diet Survey (TDS). The TDS is an ongoing FDA program that determines levels of various contaminants such as pesticide residues and industrial chemicals in foods. With respect to the reported levels of benzene in soft drinks, the FDA said it is following up with companies to ensure that their processing arrangements minimize the possibility of formation of the carcinogen. April 19, 2006 Two studies, one in the United States and one in Europe, show that children whose dental cavities were filled with amalgams containing mercury had no adverse effects five to seven years after they received the fillings, including no detectable loss of intelligence, memory, coordination, concentration, nerve conduction, or kidney function. Researchers looked for measurable damage to the brain and kidneys because previous studies with adults had indicated those organs might be particularly sensitive to mercury. Children in the studies had "fairly rampant" tooth decay and by the end of the study had on average 15 tooth surfaces restored. Dentists have used silver-colored amalgam made from an alloy of silver, copper, zinc, and other metals held together with liquid mercury for more than 150 years, and scientists in the 1970s and 1980s showed that the amalgam continuously releases mercury vapor into the mouth, which is inhaled and absorbed by the body. That raised concerns about whether such chronic, low-level exposure to mercury might be toxic. Investigators in the two studies reported today, however, that they found no health differences over seven years between the 253 participants who received amalgam fillings and 254 volunteers who were treated with composites. The studies were conducted in Portugal and in Boston and a rural area in Maine in the United States, with funding from the National Institute of Dental and Craniofacial Research in the National Institutes of Health, and are reported in today's issue of the Journal of the American Medical Association. April 24, 2006 The federal Food and Drug Administration (FDA), which requires manufacturers of drugs to conduct tests of their safety and efficacy before the drugs are approved for sale, has no authority to require the companies to conduct investigations after the drugs are on the market. Concerned about recent reports of adverse effects from approved drugs, the Government Accountability Office (GAO) looked at four drugs with safety problems—Arava, Baycol, Bextra, and Propulsid—and found that the FDA "lacks clear and effective processes for making decisions about, and providing management oversight of, postmarket safety issues." To improve the situation, the GAO is suggesting that Congress give the FDA authority to require drug sponsors to conduct postmarket studies when needed and urges the Food and Drug Administration to step up its procedures for handling reports of drug problems. The full text of the GAO report, is at www.gao.gov/new.items/d06402.pdf. |
