China orders recall of Glaxo drug (AFP)

BEIJING (AFP) – China Saturday ordered British pharmaceutical giant GlaxoSmithKline to recall an antibiotic used to treat infections in children which was found to be tainted with a plasticiser.

Traces of diisodecyl phthalate (DIDP), which is used to make plastics more flexible, were found in Glaxo's amoxicillin and clavulanate potassium suspension, which is sold under the tradename Augmentin, the State Food and Drug Administration said on its website.

Glaxo was ordered to immediately stop selling the antibiotic and recall those which had already entered the market.

Hong Kong last week ordered a recall of Augmentin after tests revealed the antibiotic syrup produced by Glaxo's French factory contained an unsafe level of DIDP.

The drugmaker is the latest company to become embroiled in a scare over plasticisers, with Hong Kong banning several Taiwanese drinks in recent weeks after tests showed they were tainted with excessive amounts of another plasticiser.

Taiwan has issued a major recall of products, including nearly half a million bottles of sports drinks and fruit juice, over fears they contained the chemical used in plastics.

Health Tip: Regain Weight the Healthy Way (HealthDay)

(HealthDay News) -- If an illness, surgery or medication has left you needing to regain some weight, experts suggest there's a healthy way to do so.

The American Dietetic Association offers this advice:

Avoid too much junk food. The empty calories may help you add pounds, but won't benefit you nutritionally.If your appetite is lacking, eat five or six small meals a day. Drink fluids before or after meals, rather than during.Add healthier calorie-laden condiments and spreads, such as peanut butter or cheese.Use milk instead of water to cook oatmeal, and add higher-calorie foods such as honey, nuts, dried fruit, margarine or powdered milk after the oatmeal is cooked.Top salads with healthy fats, such as nuts and seeds, olive oil, olives or avocados.Add dry milk powder to dishes such as mashed potatoes or casseroles.Work with a dietitian to create a healthy eating plan to boost weight.

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September cutoff set for bare-bones health plan waivers (Reuters)

LOS ANGELES (Reuters) – Providers of bare-bones health insurance plans have until September to seek exemption from certain coverage requirements set under the 2010 health care reform law, according to the Centers for Medicare and Medicaid Services.

The agency said on Friday that insurers will need to file by September 22 for waivers regarding annual coverage limits under such "mini-med" health plans.

The plans, generally designed for low-wage restaurant and retail workers, provide lower benefits than the average health insurance plan.

As the health law required, in September 2010, insurance plans began phasing out their annual limits. Today, most plans cannot impose an annual limit that is lower than $750,000. Beginning in September 2011, that allowable limit increases to $1.25 million and in September 2012 it will rise to $2 million.

Such limited benefit plans are to be phased out when subsidies and new coverage options provided for in the health law come on line in 2014. The law prohibits plans from setting annual and lifetime spending limits after that point.

"Until then, annual limits are phased out in order to preserve access to needed benefits and affordability of coverage," CMS said in a statement.

The total market for limited benefit plans is about 1.4 million people.

(Editing by Carol Bishopric)

Indiana Planned Parenthood to drop Medicaid patients (Reuters)

INDIANAPOLIS (Reuters) – Planned Parenthood of Indiana will stop seeing Medicaid patients after Monday because of an Indiana law that cut the provider's funding.

PPIN went to court last month to prevent Indiana from cutting funding to the state's largest reproductive health care provider. U. S. District Judge Tanya Walton Pratt said she would make a decision on whether to enjoin the law by July 1.

"Our 9,300 Medicaid patients, including those who had appointments Tuesday, are going to see their care disrupted," Betty Cockrum, president and CEO of PPIN, said in a statement.

The Medicaid funds stopped May 11, the day Republican Governor Mitch Daniels signed a law that restricts abortions and cuts federal funding to Planned Parenthood.

Planned Parenthood performs abortions, but even before the Indiana law passed, federal money could not be used to pay for abortions. Indiana cut Medicaid funding to Planned Parenthood that covers other reproductive health services, including contraception and cancer screening.

After Monday, PPIN said it will have run out of the donations it used to pay for existing Medicaid patients after the bill made national news.

Medicaid patients won't be seen starting Tuesday unless they can pay, two disease intervention specialists will be laid off, and most employees around the state will be taking a day off without pay on Wednesday, according to a statement from

PPIN.

If the judge doesn't make a favorable ruling by July 1, PPIN said it will start closing health centers and reducing staff.

The state has until June 24 to respond to a brief filed last Friday by the federal government that sides with PPIN.

The state is working on its response and will meet its deadline, according to the attorney general's office.

"The case was fully briefed until the U. S. government late Thursday filed its statement of interest, thus necessitating a thorough and thoughtful response from the state," said Bryan Corbin, spokesman for the Indiana Attorney General's office.

North Carolina and Kansas have also restricted funding to Planned Parenthood, but their actions do not affect payments from the federal Medicaid program. Indiana blocks both state and federal payments.

(Editing by Mary Wisniewski and Jerry Norton)

Chinese Medicine Gem: Chinese Herbal Diet Pills

Chinese Medicine Gem Traditional Chinese medicine, Chinese herbs and Chinese acupuncture for back pain and fertility etc. Chinese Herbal Diet Pills 29 Jun 2011, 10:58 am No matter it is Chinese herbal diet pills or Chinese diet tea, their main ingredients are Chinese diet herbs, which need to be combined together according to some kind of rules. The fact is that there are so many herbs that can be used as herbs for weight loss but they are quite different on the main properties from the point of view of Chinese medicine. Therefore, it is logical that none of Chinese herbal slimming pills that can fit all the different types of overweight. When it comes to the question of what are the herbal diet pills that work, first of all it makes sense to get to know the main herbs used and their key functions. Therefore, you can choose the right one for your specific situation. According to the popular natural diet pills in the market currently, basically they can be classified as a few categories as follows. Herbal dietary supplements for heat clearing This method is suitable for office clerks who are caused by excessive social activities, greasy food, and work stress and so on. The typical symptoms include bitter taste in the mouth, bad breath, constant hunger, emotional irritability, yellowish urine, and constipation and so on. TCM believes that all the mentioned symptoms are caused by the excessive heat inside the body. Therefore, the key solution is clearing heat combined with fat consumption and diuresis. These typical herbs used in this type of diet herbal pills are Cassia Seed (Jue Ming Zi) and Chinese green tea. Cassia Seed Cassia Seed is slightly cold. Its main benefits include lowering blood pressure, lowering blood fat and relieving constipation. If the overweight people have both high blood pressure and constipation, Cassia Seed is one super diet tea option. And please learn more about hypertension treatments on another article of herbs that lower blood pressure. However, please stay away from it if the people are susceptible to diarrhea and stomach pain due to excessive cold inside the body. Chinese green tea Green diet tea is cool in nature. It can be used as digestion helper and fat burner. In addition, it has antitumous effect too. But diet green tea is not fermented tea, which TCM believes that it scrapes the stomach like a sharp knife. Thereby people with stomach trouble should pay more attention to it. Chinese herbal diet pills for tonifying spleen This method is suitable for the overweight who is caused by Qi deficiency and needs tonifying spleen. TCM believes that spleen won’t work properly if Qi is deficient. Once the Qi is in full again, the normal metabolism will come back. Naturally the people would skim down afterwards. The typical herbs used in this type of Chinese natural diet pills are Yi Yi Ren (Seeds of Job’s Tears), Huang Qi (astragalus) and Fu Ling (poria) and so on. Job’s tears Yi Yi Ren is mild-natured. It is used for diuresis very often. But it takes time to produce the desired result due to its mild property. Usually it needs to be used along with other herbs and foods to maximize its effects. Astragalus Huang Qi is sweet and slight warm in nature. It works to tonify middle-Jiao and Qi and alleviate water retention by diuresis. Astragalus has no lipid-lowering effect itself. However, according TCM theory, for those of Qi deficiency, it needs tonifying Qi to enhance metabolic efficiency. In addition, astragalus may also enhance immune function. Natural Chinese diet pills for Qi regulating These Chinese herbal diet pills make sense to those overweight due to Qi stagnation. The system that sorting out the operation of Qi to make it work smoothly is liver. Once stagnation of liver-QI occurs, it may bully the spleen, which is the main reason why people gains weight. And most people suffering from this type of overweight are young women. The common symptoms include choking sensation in chest, bloated stomach, emotional upheaval, or even menstrual disorders in some serious cases. The common used herbs for this type of natural herbal Chinese dietary supplement are dried tangerine peel and rose and so on. Dried tangerine peel Dried tangerine peel can help digestion, eliminate phlegm, and regulate flow of Qi. However, it is not so effective if used alone for weight loss. Rose Rose can regulate flow of Qi. It is free from side effects but it needs to be used with other weight loss herbs. Herbal slimming pills for Nourishing-yin This method is typically useful for the elderly. The elderly is overweight prone. The key for this type of obesity is to nourish yin. The symptoms of yin deficiency include dizziness, insomnia, backache, and dry mouth and so on. To lose weight, this type of sufferers needs to nourish blood while invigorating the circulation of blood. The common used herbs in this type of natural weight loss pills are He Shou Wu (Fo Ti), and Dan Shen (Salvia Root). He Shou Wu Fo Ti can lower blood lipids, tonify blood. It is one of excellent herbs for elderly overweight. Dan Shen Salvia has slight effect on tonifying blood. It helps promote the circulation of blood circulation. It can lower cholesterol and blood lipid. What’s more, it is also effective on coronary heart disease and angina besides improving circulation. Actually this principle is true to all herbal diet products such as Chinese herbal diet tea, herbal pills, and other herbal diet supplements and so on. If you need to find a diet especially herbal diets that work, you’d better to examine them first to choose the right Chinese herbal diet pills for you. You are receiving this email because you subscribed to this feed at blogtrottr.com. If you no longer wish to receive these emails, you can unsubscribe from this feed.

Millions Don't Get Meds for Serious Artery Disease: Study (HealthDay)

MONDAY, June 20 (HealthDay News) -- Millions of Americans suffer from a condition known as peripheral artery disease but aren't receiving medical treatment, putting them at risk of potentially fatal heart problems, a new study finds.

Those who had the condition but didn't take medications were more likely to die of all causes during the period studied, although it's not clear how the disease specifically affected their health, the researchers noted.

The findings, released online June 20 in advance of publication in an upcoming print issue of the journal Circulation, reinforce the belief that peripheral artery disease, or PAD, is an early warning sign of possible clogged vessels elsewhere in the body, said study lead author Dr. Reena L. Pande, a cardiologist and associate professor at Harvard Medical School.

"We think of it as a manifestation of a whole-body problem," she said. "What happens in the legs can happen in other parts of the body, like the heart and the brain even."

Atherosclerosis -- or blockages in the arteries in the legs caused by plaque -- is the source of PAD. Physicians have long known about the condition, but it's only begun to receive much attention in the last couple of decades, Pande said.

People with the condition may experience cramping in the hips, thighs or calves, pain and burning sensations in the legs, ulcers and even amputation. But in many cases, no symptoms occur.

A simple test of the blood pressure in the arm and the ankle can detect the condition, and there's debate about whether the test should be routine, said Pande, who is also an associate physician at Brigham and Women's Hospital in Boston.

In the new study, funded in part by federal grants, Pande and colleagues analyzed statistics from a national survey of 7,458 people aged 40 and older. The participants were tracked from 1999 through 2004.

The researchers found that about 6 percent of the participants suffered from peripheral artery disease, translating to about 7 million adults in the United States. Of those, 25, 36 and 31 percent, respectively, took high blood pressure medication, aspirin or cholesterol drugs.

Those who took two or more of the drugs were 65 percent less likely to die of all causes during the seven years of the study, Pande said. However, she said the percentages of people who died in each group -- those who took two or more drugs and those who didn't -- weren't available.

The research "raises the question of whether we should be looking for these people to get them on the appropriate treatments," Pande said. "We don't have any studies that tell us that if we find them and treat them, they'll have a lowered risk of dying. But it makes us wonder if we should try to find these individuals with a simple screening test."

The screening test is inexpensive and can be conducted by health care professionals other than doctors, she said. As for cost, at least one of the medications in question -- aspirin -- is very inexpensive.

Dr. Jeffrey W. Olin, a vascular medicine specialist at Mount Sinai School of Medicine in New York City, said the study provides more evidence that doctors should take peripheral artery disease seriously and treat it. In many cases, he said, doctors don't prescribe medications even when they know a patient has the condition.

"We've been working on this for 15 years, trying to get health care providers to be aware of the fact that people with peripheral artery disease don't die because of their legs," he said. "They die because they have heart attacks and strokes."

More information

For more about peripheral artery disease, visit the U.S. National Library of Medicine.

Study Finds Botox Alternative Better at Smoothing 'Crow's Feet' (HealthDay)

MONDAY, June 20 (HealthDay News) -- A more recently approved version of botulinum toxin type A beat the anti-wrinkle medication Botox in a trial that compared the respective powers of each in erasing those unwanted lines of aging around the eyes known as "crow's feet."

"One month after treatment, on a two-to-one preference basis, patients picked Dysport over the Botox in terms of wrinkle improvement," said study co-author Dr. Corey S. Maas, an associate clinical professor at the University of California, San Francisco, as well as a plastic surgeon with The Maas Clinic, based in San Francisco and Lake Tahoe.

"So, we can say that when it comes to addressing the smile lines around the eyes, the crow's feet, at one month the Dysport is more effective than Botox," Maas said. "And that's a big deal, because Botox is such a recognized household name now. And it's such a great drug. But when you have something that comes in that's as good in some areas, let alone even better, it's big news for all of us, both doctors and patients."

Maas and his colleagues report the findings in the June 20 online edition of the Archives of Facial Plastic Surgery.

In 2002, the U.S. Food and Drug Administration first approved a particular form of botulinum toxin type A; this drug is popularly known as Botox and is manufactured by Allergan Inc.

An alternate version of the same botulinum toxin was approved in Europe in 2001 for general cosmetic applications. The drug, known as Dysport, is manufactured by Medicis Aesthetics; this version of botulinum was approved for use in the United States in 2009.

To compare the efficacy of both, the research team focused on 77 women and 13 men aged 18 and up between 2009 and 2010. None had previously undergone a facelift, brow lift or laser/chemical resurfacing. None had been exposed to botulinum in any form in the six months prior to the study launch, nor had any experienced adverse side effects as a result of previous exposure to botulinum.

Pre-procedure photographs were taken of all the patients, both while at rest and while contracting their foreheads and eyebrows. Wrinkling was subsequently graded on a five-point scale.

Next, the team the launched a so-called "split face" study, in which the right and left sides of each patient's face were each exposed to one of the drugs. Calculating that the strength ratio of the two drugs is about three-to-one, the researchers injected 10 units of Botox into the crow's feet region of one side of the face, compared with 30 units of Dysport on the other, according to the report.

One month following injection, the patients were asked to contract their muscles as hard as they could, while photographs were again taken.

The result: both the researchers and a majority of patients concurred that Dysport appeared to produce a better outcome. Specifically, two-thirds of the patients expressed a preference for Dysport, ranking Dysport nearly one point higher on the five-point wrinkling scale.

The authors noted, however, that when the patients relaxed their faces there was no appreciable difference between the Dysport and Botox sides.

"Now we want to be careful not to overplay this," stressed Maas. "From our findings, it's clear that there's a better smoothing effect and clearing of lines around the eyes with Dysport. But does that also mean that Dysport is better at achieving the same thing around the mouth or forehead or neck? We really can't make that conclusion."

Maas added that, "the cost of the two amounts respectively are about the same. Maybe actually a little bit less for Dysport, but not substantially less."

He also acknowledged that although the manufacturers of both drugs were approached to support the current investigation, only the maker of Dysport ultimately contributed funding to the effort.

"And what I would personally say about that," noted Maas, "is that if you already own 90 percent of the market why would you fund a study where if you tied you lost? But I will add that Allergan didn't like the dosing or the statistical analysis we used, despite the fact that I believe the body of scientific evidence supports the way we handled both."

But Allergan issued a statement Monday that challenged the findings on several grounds, which included the small size of the study, the short length of the trial and, most importantly, the dosing ratio the researchers used when deciding how much of each product to use on the patients' faces.

"It is important to understand that no two botulinum toxins are alike and each has a unique molecular structure, formulation, potency and safety profile," the company said in its statement. "In fact, the U.S. FDA-required product labels for BOTOX Cosmetic and other botulinum toxins state that different botulinum toxin products are not interchangeable and no consistent dose ratio exists among botulinum toxin products."

"The most significant flaws in this study's design were the attempted dose conversion and injection pattern. In this study, patients were treated with 10 units of BOTOX Cosmetic and 30 units of Dysport. As stated above, BOTOX Cosmetic and Dysport are not interchangeable and there is no established dose conversion, meaning 10 units of BOTOX Cosmetic does not equal 30 units of Dysport. When patients are treated with BOTOX Cosmetic for its approved indication in the glabellar (vertical frown lines between the eyebrows), they typically receive 20 units, which is the FDA-approved dose. In addition to specific dosing regimens, BOTOX Cosmetic also has a unique injection pattern for proper administration, pending the treatment area and individual patient."

Dr. Doris Day, a dermatologist with Lenox Hill Hospital in New York City, also cautioned that the attempt to analytically stack two "very similar" drugs against one another can pose difficulties.

Commenting on the study, she said, "The problem with any study trying to compare them is that there are variations in the reconstitution measures and final numbers of units used for each drug, and that can have a large impact on the final effect of the treatment. Because these are biologics, and because there are slight differences in the manufacturing process, there will be some differences in how the final product works."

Day pointed out that both drugs are FDA-approved and have good safety track records to date.

More information

For more on botulinum toxin, visit the U.S. Department of Health and Human Services.

Holistic Chinese Herbs: Detoxification Program: Module 2 (Specific Sources of Toxins)

Holistic Chinese Herbs Detoxification Program: Module 2 (Specific Sources of Toxins) 28 Jun 2011, 3:08 am   Toxic Root Canal "Treatment" In the second module of this advanced course in detoxification, you will learn who is polluting in your community and what the health hazards of each environmental contaminant actually are.  You will learn how to spot the signs of toxic overload of specific substances, and how to properly assess tissue levels of each substance.  This is an important step in choosing a detoxification regimen because you will need to know what substances you are trying to detoxify from in order to choose the correct detoxification agents. Specific Sources of Toxins Endocrine Disrupting Chemicals (EDCs) Phytoestrogens Total Isoflavone, Daidzein and Genistein Aglycone Content of Selected Foods Phthalates Parabens Polychlorinated Biphenyls (PCBs) Chlorinated Pesticides Volatile Organic Compounds (VOCs) Sources and Adverse Health Effects of Volatile Solvents Toxic Elements (Heavy Metals) Sources of Toxic Elements Body Burden: The Pollution in Newborns References and Additional Resources How Mercury Causes Brain Neuron Degeneration, Department of Physiology and Biophysics; Faculty of Medicine; University of Calgary. Sources of Toxins "Chemical compounds ubiquitous in our food, air, and water are now found in every person. The bioaccumulation of these compounds in some individuals can lead to a variety of metabolic and systemic dysfunctions, and in some cases outright disease states. The systems most affected by these xenobiotic compounds include the immune, neurological and endocrine systems. Toxicity in these systems can lead to immune dysfunction, autoimmunity, asthma, allergies, cancers, cognitive deficit, mood changes, neurological illnesses, change in libido, reproductive dysfunction, and glucose dysregulation1." The CDC provides a report on environment chemical exposure to humans. The latest report called, "Fourth National Report on Human Exposure to Environmental Chemical" was made available in 2009. The report provides an ongoing assessment of exposure of the U.S. population to environmental chemicals by the use of biomonitoring. In each survey period, most chemicals or their metabolites were measured in blood, serum, and urine samples from random subsamples of about 2500 participants from the National Health and Nutrition Survey (NHANES) conducted by the CDC. The term "environmental chemical" refers to a chemical compound or chemical element present in the air, water, food, soil, dust, or other environmental media (e.g., consumer products). The following is a list of the chemicals that were researched for human exposure:  Acrylamide o Acrylamide hemoglobin adducts o Glycidamide hemoglobin adducts  Cotinine o Cotinine  N,N-Diethyl-meta-toluamide (DEET)  Disinfection By-Products (Trihalomethanes) o Bromodichloromethane o Dibromochloromethane (Chlorodibromomethane) o Tribromomethane (Bromoform) o Trichloromethane (Chloroform)  Environmental Phenols o Benzophenone-3 (2-Hydroxy-4-methoxybenzophenone) o Bisphenol A (2,2-bis[4-Hydroxyphenyl] propane) o 4-tert-Octylphenol (4-[1,1,3,3- Tetramethylbutyl] phenol) o Triclosan (2,4,4'- Trichloro-2'-hydroxyphenyl ether)  Fungicides o Pentachlorophenol o ortho-Phenylphenol  Herbicides o Acetochlor  Acetochlor mercapturate o Alachlor  Alachlor mercapturate o Atrazine  Atrazine mercapturate  2,4-Dichlorophenoxyacetic Acid o Metolachlor  Metolachlor mercapturate o 2,4,5-Trichlorophenoxyacetic Acid  Insecticides/Pesticides o Carbamate Insecticides  Carbofuran o Carbofuranphenol  Propoxur  2-Isopropoxyphenol  Organochlorine Pesticides o Aldrin o Dieldrin o Chlordane and Heptachlor  Oxychlordane  Heptachlor Epoxide  trans-Nonachlor o Dichlorodiphenyltrichloroethane (DDT)  p,p'-Dichlorodiphenyltrichloroethane (DDT)  p,p'-Dichlorodiphenyldichloroethene (DDE)  o,p'-Dichlorodiphenyltrichloroethane o Endrin o Hexachlorobenzene o Hexachlorocyclohexane  beta-Hexachlorocyclohexane  gamma- Hexachlorocyclohexane (Lindane) o Mirex o 2,4,5-Trichlorophenol o 2,4,6-Trichlorophenol  Organophosphorus Insecticides: Dialkyl Phosphate Metabolites o Diethylphosphate (DEP) o Dimethylphosphate (DMP) o Diethylthiophosphate (DETP) o Dimethylthiophosphate (DMTP) o Diethyldithiophosphate (DEDTP) o Dimethyldithiophosphate (DMDTP)  Organophosphorus Insecticides: Specific Metabolites o Chlorpyrifos  Chlorpyrifos-methyl  3,5,6-Trichloro-2-pyridinol o Coumaphos  3-Chloro-7-hydroxy-4-methyl-2H-chromen-2-one/ol o Diazinon  2-Isopropyl-4-methyl-6-hydroxypyrimidine o Malathion  Malathion dicarboxylic acid o Methyl Parathion o Ethyl Parathion  para-Nitrophenol o Pirmiphos-methyl  2-(Diethylamino)-6-methylpyrimidin-4-ol/one  Pyrethroid Pesticides o Cyfluthrin  4-Fluoro-3-phenoxybenzoic acid o Cyfluthrin o Cypermethrin o Permethrin  cis-3-(2,2-Dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid  trans-3-(2,2-Dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid o Deltamethrin  cis-3-(2,2-Dibromovinyl)-2,2-dimethylcyclopropane carboxylic acid o Cyhalothrin o Cypermethrin o Deltamethrin o Fenpropathrin o Permethrin o Tralomethrin  3-Phenoxybenzoic acid  Metals o Antimony o Arsenic  Arsenic, Total  Arsenic (V) Acid  Arsenobetaine  Arsenocholine  Arsenous (III) Acid  Dimethylarsinic Acid  Monomethylarsonic Acid  Trimethylarsine oxide o Barium o Beryllium o Cadmium o Cesium o Cobalt o Lead o Mercury o Molybdenum o Platinum o Thallium o Tungsten o Uranium  Perchlorate o Perchlorate  Perfluorochemicals o Perfluorobutane sulfonic acid (PFBuS) o Perfluorodecanoic acid (PFDeA) o Perfluorododecanoic acid (PFDoA) o Perfluoroheptanoic acid (PFHpA) o Perfluorohexane sulfonic acid (PFHxS) o Perfluorononanoic acid (PFNA) o Perfluorooctanoic acid (PFOA) o Perfluorooctane acid (PFOS) o Perfluorooctane sulfonamide (PFOSA) o 2-(N-Ethyl-perfluorooctane sulfonamido) acetic acid (Et-PFOSA-AcOH) o 2-(N-Methyl-perfluorooctane sulfonamido) acetic acid (Me-PFOSA-AcOH) o Perfluoroundecanoic acid (PFUA)  Phthalates o Benzylbutyl Phthalate  Mono-benzyl phthalate (MBzP) o Dibutyl Phthalates  Mono-isobutyl phthalate (MiBP)  Mono-n-butyl phthalate (MnBP) o Dicyclohexyl Phthalate  Mono-cyclohexyl phthalate (MCHP) o Diethyl Phthalate  Mono-ethyl phthalate (MEP) o Di-2-ethylhexyl Phthalate (DEHP)  Mono-2-ethylhexyl phthalate (MEHP)  Mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP)  Mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP)  Mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP) o Di-isononyl Phthalate  Mono-isononyl phthalate (MiNP) o Dimethyl Phthalate  Mono-methyl phthalate (MMP) o Di-(n-octyl) Phthalate  Mono-(3-carboxypropyl) phthalate (MCPP)  Mono-n-octyl phthalate (MOP)  Phytoestrogens o Daidzein o O-Desmethylangolensin o Enterodiol o Enterolactone o Equol o Genistein  Polybrominated Diphenyl Ethers and 2,2',4,4',5,5'-Hexabromobiphenyl (BB-153) o 2,2',4-Tribromodiphenyl ether (BDE 17) o 2,4,4'-Tribromodiphenyl ether (BDE 28) o 2,2',4,4'-Tetrabromodiphenyl ether (BDE 47) o 2,3',4,4'-Tetrabromodiphenyl ether (BDE 66) o 2,2',3,4,4'-Pentabromodiphenyl ether (BDE 85) o 2,2',4,4',5-Pentabromodiphenyl ether (BDE 99) o 2,2',4,4',6-Pentabromodiphenyl ether (BDE 100) o 2,2',4,4',5,5'-Hexabromodiphenyl ether (BDE 153) o 2,2',4,4',5,6'-Hexabromodiphenyl ether (BDE 154) o 2,2',3,4,4',5',6-Heptabromodiphenyl ether (BDE 183) o 2,2',4,4',5,5'-Hexabromobiphenyl (BB 153)  Polychlorinated Biphenyls—Non-Dioxin-Like o 2,4,4'-Trichlorobiphenyl (PCB 28) o 2,2',3,5'-Tetrachlorobiphenyl (PCB 44) o 2,2',4,5'-Tetrachlorobiphenyl (PCB 49) o 2,2',5,5'-Tetrachlorobiphenyl (PCB 52) o 2,3',4,4'-Tetrachlorobiphenyl (PCB 66) o 2,4,4',5-Tetrachlorobiphenyl (PCB 74) o 2,2',3,4,5'-Pentachlorobiphenyl (PCB 87) o 2,2',4,4',5-Pentachlorobiphenyl (PCB 99) o 2,2',4,5,5'-Pentachlorobiphenyl (PCB 101) o 2,3,3',4',6-Pentachlorobiphenyl (PCB 110) o 2,2',3,3',4,4'-Hexachlorobiphenyl (PCB 128) o 2,2',3,4,4',5'and 2,3,3',4,4',6-Hexachlorobiphenyl (PCB 138 & 158) o 2,2',3,4',5,5'-Hexachlorobiphenyl (PCB 146) o 2,2',3,4',5',6-Hexachlorobiphenyl (PCB 149) o 2,2',3,5,5',6-Hexachlorobiphenyl (PCB 151) o 2,2',4,4',5,5',-Hexachlorobiphenyl (PCB 153) o 2,2',3,3',4,4',5-Heptachlorobiphenyl (PCB 170) o 2,2',3,3',4,5,5'-Heptachlorobiphenyl (PCB 172) o 2,2',3,3',4,5',6'-Heptachlorobiphenyl (PCB 177) o 2,2',3,3',5,5',6-Heptachlorobiphenyl (PCB 178) o 2,2',3,4,4',5,5'-Heptachlorobiphenyl (PCB 180) o 2,2',3,4,4',5',6-Heptachlorobiphenyl (PCB 183) o 2,2',3,4',5,5',6-Heptachlorobiphenyl (PCB 187) o 2,2',3,3',4,4',5,5'-Octachlorobiphenyl (PCB 194) o 2,2',3,3',4,4',5,6-Octachlorobiphenyl (PCB 195) o 2,2',3,3',4,4',5,6' and 2,2',3,4,4',5,5',6-Octachlorobiphenyl (PCB 196 & 203) o 2,2',3,3',4,5,5',6-Octachlorobiphenyl (PCB 199) o 2,2',3,3',4,4',5,5',6-Nonachlorobiphenyl (PCB 206) o 2,2',3,3',4,4',5,5',6,6'-Decachlorobiphenyl (PCB 209)  Dioxin-Like Chemicals o Polychlorinated Dibenzo-p-dioxins  1,2,3,4,6,7,8-Heptachlorodibenzo-p-dioxin (HpCDD)  1,2,3,4,7,8-Hexachlorodibenzo-p-dioxin (HxCDD)  1,2,3,6,7,8-Hexachlorodibenzo-p-dioxin (HxCDD)  1,2,3,7,8,9-Hexachlorodibenzo-p-dioxin (HxCDD)  1,2,3,4,6,7,8,9-Octachlorodibenzo-p-dioxin (OCDD)  1,2,3,7,8-Pentachlorodibenzo-p-dioxin (PeCDD)  2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD)  Polychlorinated Dibenzofurans o 1,2,3,4,6,7,8-Heptachlorodibenzofuran (HpCDF) o 1,2,3,4,7,8,9-Heptachlorodibenzofuran (HpCDF) o 1,2,3,4,7,8-Hexachlorodibenzofuran (HxCDF) o 1,2,3,6,7,8-Hexachlorodibenzofuran (HxCDF) o 1,2,3,7,8,9-Hexachlorodibenzofuran (HxCDF) o 1,2,3,4,6,7,8-Hexachlorodibenzofuran (HxCDF) o 1,2,3,4,6,7,8,9-Octachlorodibenzofuran (OCDF) o 1,2,3,7,8-Pentachlorodibenzofuran (PeCDF) o 2,3,4,7,8-Pentachlorodibenzofuran (PeCDF) o 2,3,7,8-Tetrachlorodibenzofuran (TCDF)  Coplanar Polychlorinated Biphenyls o 3,4,4',5-Tetrachlorobiphenyl (PCB 81) o 3,3',4,4',5-Pentachlorobiphenyl (PCB 126) o 3,3',4,4',5,5'-Hexachlorobiphenyl (PCB 169)  Mono-ortho-substituted Polychlorinated Biphenyls o 2,3,3',4,4'-Pentachlorobiphenyl (PCB 105) o 2,3',4,4',5-Pentachlorobiphenyl (PCB 118) o 2,3,3',4,4',5-Hexachlorobiphenyl (PCB 156) o 2,3,3',4,4',5'-Hexachlorobiphenyl (PCB 157) o 2,3',4,4',5,5'-Hexachlorobiphenyl (PCB 167) o 2,3,3',4,4',5,5'-Heptachlorobiphenyl (PCB 189)  Polycyclic Aromatic Hydrocarbons o Fluorene  2-Hydroxyfluorene  3-Hydroxyfluorene  9-Hydroxyfluorene o Naphthalene  1-Hydroxynaphthalene (1-Naphthol)  2-Hydroxynaphthalene (2-Naphthol) o Phenanthrene  1-Hydroxyphenanthrene  2-Hydroxyphenanthrene  3-Hydroxyphenanthrene  4-Hydroxyphenanthrene o Pyrene  1-Hydroxypyrene  Volatile Organic Compounds (VOCs) o Benzene o Chlorobenzene  Chlorobenzene (Monochlorobenzene)  1,2-Dichlorobenzene (o-Dichlorobenzene)  1,3-Dichlorobenzene (m-Dichlorobenzene)  1,4-Dichlorobenzene (Paradichlorobenzene) o 1,2-Dibromo-3-chloropropane (DBCP) o 2,5-Dimethylfuran o Ethylbenzene o Halogenated Solvents  Dichloromethane (Methylene chloride)  Trichloroethene (Trichloroethylene)  Tetrachloroethene (Perchloroethylene) o Other Halogenated Solvents  Dibromomethane  1,1-Dichloroethane  1,2-Dichloroethane (Ethylene dichloride)  1,1-Dichloroethene (Vinylidene chloride)  cis-1,2-Dichloroethene  trans-1,2-Dichloroethene  1,2-Dichloropropane  1,1,1-Trichloroethane (Methyl chloroform)  1,1,2-Trichloroethane  1,1,2,2-Tetrachloroethane  Tetrachloromethane (Carbon tetrachloride) o Hexachloroethane o Methyl tert-butyl ether (MTBE) o Nitrobenzene o Styrene o Toluene o Xylenes o o-Xylene o m- and p-Xylene Endocrine Disrupting Chemicals (EDCs) EDCs are described as substances in our environment, food, and consumer products that interfere with hormone biosynthesis, metabolism, or action resulting in deviation from normal homeostatic control or reproduction4. The Endocrine Society has stated that "the evidence for adverse reproductive outcomes (infertility, cancers, malformations) from exposure to endocrine disrupting chemicals is strong, and there is mounting evidence for effects on other endocrine systems, including thyroid, neuroendocrine, obesity, and metabolism, and insulin and glucose homeostasis". The group of molecules identified as endocrine disruptors includes the following:  Industrial solvents /lubricants and their byproducts - Polychlorinated biphenyls (PCBs) - Polybrominated biphenyls (PBBs) - Dioxins  Plastics - Bisphenol A (BPA)  Plasticizers - Phthalates  Pesticides - Methoxychlor - Chlorpyrifos - Dichlorodiphenyltrichloroethane (DDT)  Fungicides - Vinclozolin  Pharmaceutical agents - Diethylstilbestrol (DES)  Phytoestrogens - Genistien - Coumestrol Phytoestrogens There are three major classes of plant compounds that have estrogen-like action in the body. 1. Lignans (enterolactone, eneterodiol) – flax seed, sesame seed 2. Isoflavones (genistein, diadzein, biochanin A) – soybeans 3. Coumestans Total Isoflavone, Daidzein and Genistein Aglycone Content of Selected Foods2 Food Serving Total Isoflavones (mg) Daidzein (mg) Genistein (mg) Soy protein concentrate, Aqueous washed 3.5 oz 102 43 56 Soy protein concentrate, Alcohol washed 3.5 oz 12 7 5 Miso ½ cup 59 22 34 Soybeans, boiled ½ cup 47 23 24 Tempeh 3 ounces 37 15 21 Soybeans, dry roasted 1 ounce 37 15 19 Soy milk 1 cup 30 12 17 Tofu yogurt ½ cup 21 7 12 Tofu 3 ounces 20 8 12 Soybeans, green, boiled (Edamame) ½ cup 12 6 6 Meatless (soy) hot dog 1 hot dog 11 3 6 Meatless (soy) sausage 3 links 3 0.6 2 Soy cheese, mozzarella 1 oz 2 0.3 1 Soy-based infant formulas contain a significant amount of isoflavones. In 2010, the National Toxicology Program concluded that soy infant formula's adverse health effects were of minimal concern. I personally disagree with their conclusion. Phthalates Phthalates are compounds used in the production of plastics. They are often referred to as "plasticizers". Phthalates are used in cosmetics, perfumes, aerosols, paints, lotions, air fresheners, shampoos, conditioners, lubricants, medications, tubing, anti-foaming agents, skin emollients, nail polish, vinyl flooring, false nails, catheters, blood bags and IV tubing. The health effects are mainly related to steroid hormone (endocrine) disruptions. Phthalates have also been linked to obesity and insulin resistance. Obese, insulin-resistant adult males excrete higher amounts of mono-benzyl-phthalate (MBzP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEOHP), and mono-ethyl phthalate (MEP) than controls.3 Although studies on individual xenoestrogens have found them to be of low estrogenic potency, when multiple compounds are present at their no-observed-effect concentrations; dramatic enhancement of estrogen receptor alpha response to estradiol was found. Such results demonstrate the additive effects of multiple exposures3. The main phthalates are di-2-ethylhexyl phthalate (DEHP), dibutyl phthalate (DBP) and diethyl phthalate (DEP). Phthalate exposure is measured in the urine by the amount and type of metabolite that is produced. Parabens Parabens are used as preservatives in the cosmetic and pharmaceutical industries. They are also used in food products because of their bactericidal and fungicidal properties. Parabens can be found in shampoos, shaving gels, personal lubricants, sunscreen, tanning lotions, deodorants, antiperspirants and toothpaste. Parabens are chemically synthesized, however they also occur naturally in some foods, in particular, strawberries, blackberries, blueberries and currents. The common parabens measured include:  butylparaben  ethylparaben  methylparaben  propylparaben The adverse health effects of parabens include; contact dermatitis, toxicity to the mitochondria, and (endocrine disruptor) week estrogenic effect. (Remember that parabens, especially cosmetics, may be applied daily and have a cumulative effect.) Polychlorinated Biphenyls (PCBs) (Dioxin-Like PCBs and Non-Dioxin-Like PCBs) PCBs belong to a broad family of man-made organic chemicals known as chlorinated hydrocarbons. PCBs were manufactured from 1929 until their manufacture was banned in 1979. Due to their non-flammability, chemical stability, high boiling point, and electrical insulation properties, PCBs were used in hundreds of industrial and commercial applications including electrical, heat transfer, and hydraulic equipment; as plasticizers in paints, plastics, and rubber products; in pigments, dyes, and carbonless copy paper; and many other industrial applications. Although no longer commercially produced in the United States, PCBs may be present in products and materials produced before the 1979 ban.  Transformers and capacitors  Oil used in motors and hydraulic systems  Capacitors  Cable insulation  Adhesives and tape  Oil-based paint  Caulking  Plastics  Floor finish Once in the environment, PCBs do not readily breakdown and therefore may remain for long periods of time cycling between air, water, and soil. PCBs can be carried long distances and have been found in snow and sea water far from where they were released into the environment. As a consequence, PCBs are found all over the world. In general, the lighter the form of PCB, the further it can be transported from the source of contamination. PCBs can accumulate in the leaves and above-ground parts of plants and food crops. They are also taken up into the bodies of small organisms and fish. As a result, people who ingest fish may be exposed to PCBs that have bioaccumulated in the fish they are ingesting. The term “dioxin” is commonly used to refer to a family of toxic chemicals that share a similar chemical structure and induce harm through a similar mechanism. Dioxins have been characterized by EPA as likely human carcinogens and are anticipated to increase the risk of cancer at background levels of exposure. Dioxin levels in the environment have been declining since the early seventies and have been the subject of a number of federal and state regulations and clean-up actions; however, current exposures levels still remain a concern. Examples of dioxins include polychlorinated biphenyls (PCBs), polychlorinated dibenzo dioxins (PCDDs), and polychlorinated dibenzo furans (PCDFs). PCBs were produced commercially in large quantities until production was stopped in 1977. PCDDs and PCDFs are not commercial chemical products, but are unintentional byproducts of most forms of combustion and several industrial chemical processes. PCBs have been demonstrated to cause cancer, as well as a variety of other adverse health effects on the immune system, reproductive system, nervous system, and endocrine system.  Cancer – There is clear evidence that PCBs cause cancer in animals. Studies of PCB workers found increases in rare liver cancers and malignant melanoma. It is very important to note that the composition of PCB mixtures change following their release into the environment. The type of PCBs that tend to bioaccumulate in fish and other animals and bind to sediments happens to be the most carcinogenic components of PCBs mixtures. As a result, people who ingest PCB-contaminated fish or other animal products and contact PCB-contaminated sediment may be exposed to PCB mixtures that are even more toxic than the PCB mixtures contacted by workers and released into the environment.  Immune Effects – PCBs suppress the immune system. In humans, a recent study found that individuals infected with Epstein-Barr virus had a greater association of increased exposures to PCBs with increasing risk of non-Hodgkin's lymphoma than those who had no Epstein-Barr infection.  Reproductive effects – Studies of reproductive effects have been carried out in human populations exposed to PCBs. Children born to women who worked with PCBs in factories showed decreased birth weight and a significant decrease in gestational age with increasing exposures to PCBs.  Neurological effects – Exposure to PCBs have been associated with deficits in neurological development, including visual and recognition, short-term memory and hearing.  Endocrine effects – PCBs have been demonstrated to exert effects on thyroid hormone levels in animals and humans. It has been shown that PCBs decrease thyroid hormone levels in rodents, and that these decreases have resulted in developmental deficits in the animals, including deficits in hearing. PCB exposures have also been associated with changes in thyroid hormone levels in infants in studies conducted in the Netherlands and Japan. As PCB serum levels increase, thyroid hormones T3 and T4 decrease.  Other effects – dermatological, ocular, elevated blood pressure, elevated serum triglyceride, and elevated serum cholesterol. Exposure Sources The greatest sources of PCBs exposure come from eating contaminated food. The estimated dietary intake of PCBs for an average adult was 0.027 ug/kg/day in 1978 and had declined to <0.001 ug/kg/day by 1991. The highest content of PCBs in one dietary study was found in dairy products (especially butter), meat, and fish. Atlantic farmed salmon is the greatest exposure source among fish, as well as fish caught and consumed from the Great Lakes. Chlorinated Pesticides (Some examples include: DDE, DDT, Dieldren, Heptachlor Epoxide, Hexachlorobenzene, Mirix, Oxychlordane, trans-Nonachlor) The use of chlorinated pesticides has mostly been banned in the United States; however some of these pesticides and herbicides are still used around the world. Chlorinated pesticides can bioaccumulate due to their lipophilic nature and can cause significant adverse health effects. These chemicals are powerful toxins and can cause significant mitochondrial damage and may be the root of chronic illnesses. The effects of these compounds are most often seen secondary to mitochondrial toxicity in the neurological, immunological and endocrinological systems. The major source of exposure in the U.S. is through the diet, in particular, meat, poultry, dairy products and fish. The Total Diet Study, sometimes called the market basket study, is an ongoing FDA program that determines levels of various contaminants and nutrients in food. Dichlorodiphenyl-dichloroethylene (DDE) is a metabolite of DDT. When DDT is produced, it consists of a combination of both DDE and DDT. DDT is metabolized in the body to DDE and broken down in the environment to DDE. These chemicals are highly fat-soluble and are stored in lipid-rich tissues, such as adipose tissue, the liver and the brain. The foods with the highest concentration of DDE include; non-organic butter, farm raised catfish, Atlantic salmon, American cheese, non-organic spinach, lamb chops, non-organic cream cheese, non-organic collard greens, and non-organic cheddar cheese. Other sources of DDE/DDT include dust or dirt or the home. Volatile Organic Compounds (VOCs) VOCs are emitted by a wide range of products, which include: paints, lacquers, and paint strippers, cleaning supplies, pesticides, building materials, furnishings, office supplies (copiers, printers, correction fluids, carbonless paper, graphics, glues, adhesives, permanent markers and photographic solutions) and petroleum products. VOCs are ground-water contaminants of concern because of very large environmental releases, human toxicity, and a tendency for some compounds to persist in and migrate with ground water to drinking-water supply wells. In general, VOCs have high vapor pressures, low-to-medium water solubility, and low molecular weights. Some VOCs may occur naturally in the environment, other compounds occur as a result of manmade activities, and some compounds have both origins.5 BTEX is a term used for benzene, toluene, ethylbenzene and xylene. These compounds are typically found in petroleum products, such as gasoline, and diesel fuel. MTBE (methyl tertiary butyl ether) is an oxygenate added to gasoline to improve combustion and to reduce harmful emissions. MTBE is resistant to biodegradation and therefore can remain persistent. Sources and Adverse Health Effects of Volatile Solvents Solvent Sources/Exposures Adverse Health Effects Benzene  Made mostly from petroleum  One of the top 20 chemicals produced in the United States  Used to make other chemicals, such as styrene (for Styrofoam® and other plastics), cumene (for various resins), and cyclohexane (for nylon and synthetic fibers)  Used in the manufacture of drugs, pesticides, dyes, and other compounds  Most common non-occupational airborne exposures: o The combustion of gasoline, pumping gas o Cigarette smoke: The average smoker (32 cigarettes per day) takes in about 1.8 milligrams (mg) of benzene per day, 10 times the average daily intake of benzene by nonsmokers o Indoor air fresheners o Glues, paints, furniture wax, and detergents o Well water can be contaminated with benzene from leaking gasoline storage tanks at gas stations. People with such contaminated water can be exposed from drinking it, eating foods prepared with it (especially coffee and tea), or inhalation during showering or bathing that can produce absorption of benzene through the skin. o Houses with attached garages often have higher levels of benzene in the air. Levels of benzene and other solvents are also extremely high in the outside air around chemical and paint plants. These local sources of benzene emissions inside the United States can be located by visiting: www.scorecard.org. Adverse Health Effects  Airborne exposure can result in reduced infection fighting  Problems in bone marrow such as: o Increased risk of leukemia, breast cancer, multiple myeloma, Hodgkin's lymphoma, and non-Hodgkin's lymphoma (NHL) o Cytopenia and thrombocytopenia, leucopenia, acute myeloid leukemia (AML), and aplastic anemia  Male infertility  Abnormally long menstrual cycles, female infertility, and increased rates of miscarriages  View benzene case studies at Agency for Toxic Substances and Disease Registry (ATSDR): www.atsdr.cdc.gov/csem/benzene Solvent Sources/Exposures Adverse Health Effects Ethylbenzene  Found naturally in oil, and large amounts are produced in the United States  Used to make styrene  Also found in: o Gasoline o Paints and inks o Pesticides o Carpet glues o Varnishes and paints o Tobacco products  Can be present in groundwater (both private wells and municiple aquifers) used in homes.  Most of this contamination comes from leaking gas storage tanks (gas stations) as well as landfills.  Dermal absorption in spray painters Adverse Health Effects  The presence of ethylbenzene and xylene will prolong the time that toluene is present in the blood  Neurotoxic "brain fog" (chronic or acute toxic encephalopathy)  Bone marrow problems (see the list under "Benzene")  Hearing loss  Increased chemical reactivity (MCS)  The International Agency for Research on Cancer (IARC) has determined that ethylbenzene is a possible human carcinogen Xylenes  One of the top 30 chemicals produced in the United States  Three forms (isomers) of xylene (also known as dimethylbenzene) exist: meta-xylene, ortho-xylene, and para-xylene (m-, o-, and p-xylene)  Mixed xylene is a mixture of the three isomers and usually also contains 6–15% ethylbenzene  Used primarily as a "safe" replacement (noncancer causing) for benzene in gasoline  Used in the printing, rubber, and leather industries  Widely used in cleaning agents, paints, paint thinners, and varnishes  Majority of absorbed (mostly inhaled) xylene will have left the body within 18 hours, small amounts (4–10%) may be stored in fat and will take longer to exit the body  Clearance of xylene from persons with more adipose tissue can take much longer  Airborne exposures to xylene come mainly through: o Gasoline o Auto exhaust o Cigarette smoke o Paint and varnish fumes  Dermal exposures mostly from direct contact with gasoline, paints, and furniture finishes. Adverse Health Effects  Neurotoxic "brain fog" (chronic or acute toxic encephalopathy)  Fatigue  Headache, depression, mood changes  Adversely effects learning, behavior, and memory in offspring exposed in utero  Studies have found xylene can cause changes to liver, heart, kidneys, lungs, and nervous system Solvent Sources/Exposures Adverse Health Effects Styrene  A high production chemical (over 13 billion pounds of styrene was produced in the United States in 2006)  Primarily used in the production of polystyrene plastics and resins used principally for insulation and for making fiberglass  Airborne exposures for styrene: o Cigarette smoke o Auto exhaust o Photocopies o Workers in the polyester plastic and fiberglass industries  Ingestion exposures for styrene: o Food that has been heated in Styrofoam containers o Food that has been stored in Styrofoam containers Adverse Health Effects  The presence of toluene and trichloroethylene reduces the metabolism of styrene. A combination of acetone and styrene causes a reduction in free glutathione in the liver.  Impairs reaction time and vestibular function  Reduces MAO-B activity in platelets  Cognitive disorders including short-term verbal memory impairment, decreased verbal learning, and impaired logical memory  The most frequent symptoms include headache, dizziness, light-headedness, fatigue, irritability, memory loss, and feeling "drunk"  Impaired color vision Toluene  Produced in the process of making gasoline and other fuels from crude oil, in making coke from coal, and as a by-product in the manufacture of styrene  Used in making paints, paint thinners, fingernail polish, lacquers, adhesives, and rubber; Also used in some printing and leather tanning processes  Half life in the blood is about 6 hours  Airborne exposures to toluene come from: o Fumes of paints, glues, solvents, gasoline o Working in places where these compounds are used regularly (painters, acrylic nail salons, etc.) o Nail polish, stain removers, carburetor cleaners, cigarette smoke, auto exhaust o Higher levels are found in smokers, persons who drink alcohol regularly, and in those who are exposed to paint and lacquer thinners  Gasoline is 5-7% toulene and the primary source of population exposure Adverse Health Effects  Aspirin blocks the clearance of toluene and increases the blood toluene levels, as do benzene and alcohol  Most common symptoms: o fatigue, impaired memory, impaired concentration, irritability, headaches, labile mood, depression, neurotic behavior, dizziness, OCD symptoms and insomnia  Psychomotor coordination problems  Can be psychologically addictive  View toulene case studies at ATSDR: www.atsdr.cdc.gov/substances/toxsubstance.asp?toxid=29 Solvent Sources/Exposures Adverse Health Effects n-Hexane, 2-methylpentane, 3-methylpentane (Aliphatic Hydrocarbons)  Hexane, a commonly used solvent, consists of n-Hexane and its isomers of 2-methylpentane and 3-methylpentane  Used in glues, adhesives, and paints, and is present in gasoline and jet fuel  The only published study on the level of n-hexane gives the 95th percentile level for the presence of this solvent in the blood as a range of 403-812 ppb, methylpentane levels not measured  Levels of hexane found in farmers had a 95th percentile of only 270 ppb  Drivers who were regularly exposed to exhaust fumes had a 95th percentile level of 468 ppb  Exposure sources o Gasoline and automobile exhaust o Quick-drying glues o Jet fuel and jet exhaust o The presence of the methylpentanes without n-Hexane typically indicate that the exposure is neither recent or ongoing. Adverse Health Effects  Acute exposure causes CNS disturbances o Headache, mental irritability, paresthesias  Chronic exposure – peripheral neuropathy – muscle weakness, loss of sensation, impaired gait  Can lead to demyelination and nerve fiber degeneration  Balance problems and classic toxic encephalopathy Iso-octane  A component of gasoline  An octane isomer which defines the 100 point on the octane rating scale  Produced on a massive scale in the petroleum industry usually as a mixture with related hydrocarbons. Adverse Health Effects  Inhaled isooctane can cause confusion, dizziness, headaches, nausea, and severe vomiting.  Contact with skin can cause dryness and redness of the skin, and can be extremely painful.  Bioaccumulation potential is high.  No chronic studies are available that assess carcinogenic effects. Toxic Elements (Heavy Metals) Toxic Elements  Aluminum  Arsenic  Cadmium  Lead  Mercury  Tin  Essential elements are toxic in high levels ( e.g. copper, iron) Aluminum Aluminum is the most abundant metal in the earth's crust. It is always found combined with other elements such as oxygen, silicon, and fluorine. Everyone is exposed to low levels of aluminum from food, air, water, and soil. Exposure to high levels of aluminum may result in respiratory and neurological problems.  Toxicity symptoms: o Abnormal speech, myoclonic jerks, osteomalacia, progressive encephalopathy, Alzheimer's disease, Parkinson's Disease  Assessment: Whole blood, serum, hair, urine  Biomarker: Total porphyrin elevation  Protective measures: Iron, calcium, phosphorus (lowers intestinal absorption)  Chelating agents: DFO (desferoxamine) Aluminum Body Burden Assessment  Special evacuated test tubes are required for testing (standard tubes may be contaminated with aluminum from rubber stoppers).  Problem with measuring RBC-AL include ensuring an aluminum free anticoagulant.  Hair will show elevated levels (chronic exposure)  Urinary aluminum can provide information about aluminum intake and has been used to monitor exposure.  Urinary provocative challenge Arsenic (As) Arsenic is a naturally occurring element widely distributed in the earth's crust. In the environment, arsenic is combined with oxygen, chlorine, and sulfur to form inorganic arsenic compounds. Arsenic in animals and plants combines with carbon and hydrogen to form organic arsenic compounds. Inorganic arsenic compounds are mainly used to preserve wood. Copper chromate arsenic (CCA) is used to make "pressure treated" lumber. CCA is no longer used in the U.S. for residential uses; it is still used in industrial applications. Organic arsenic compounds are used as pesticides, primarily on cotton.  Toxicity symptoms: o Peripheral arteriosclerosis, rice-water stool, proteinuria, hyperkeratosis, garlic breath odor, stomatitis  Body burden assessment: o Urine, hair & nails, whole blood, urinary, porphyrins  Protective measures: o Selenium, sulfur amino acids, glutathione, emblica officinalis (Indian gooseberry)  Chelating Agents: DMSA, DMPS, DMPA  Common Sources: o Metal foundry, drinking water, seafood, glues, industrial exposure, contaminated wine, cigarette smoke, arsenic treated wood, insecticides, fungicides Arsenic Body Burden Assessment  Urinary arsenic is most commonly measured to screen for exposure  RBC arsenic information is limited  Hair/nail represents long term exposure (arsenic is cleared from the serum within 6-10 hrs)  Urinary porphyrin  Urinary provocative challenge testing Cadmium Cadmium is a natural element in the earth's crust. It is usually found as a mineral combined with other elements such as oxygen (cadmium oxide), chlorine (cadmium chloride), or sulfur (cadmium sulfate, cadmium sulfide). All soils and rocks, including coal and mineral fertilizers, contain some cadmium. Most cadmium used in the U.S. is extracted during the production of other metals like zinc, lead, and copper. Cadmium does not corrode easily and has many uses, including batteries, pigments, metal coatings, and plastics. The general population is exposed from cigarette smoke or eating cadmium contaminated foods (fish, plants, and animals). Cadmium damages the lungs, can cause kidney disease, and may irritate the gastrointestinal tract.  Toxicity symptoms: o Femoral pain, lumbago, osteopenia, renal dysfunction, hypertension, vascular disease, anosmia (loss of smell)  Body burden assessment: Whole blood (recent only), urinary provocative challenge testing  Biochemical marker: Coproporphyrin I  Preventive measures: Zinc, iron, antioxidants  Chelating agents: EDTA, DMSA, and NAC (experimental)  Common Sources: Industry, spray paint, tobacco smoke, car emissions, plants grown in cadmium rich soil  Primarily concentrated in liver and kidneys  Cadmium and lead absorption is increased in iron deficiency states.  Anemia resistant to iron therapy (hypochromic, microcytic anemia with normal ferritin, and iron indices, and normal hemoglobin  Principal organs most vulnerable to cadmium toxicity are kidney and lung.  Renal tubular damage and high blood pressure Lead Lead is a naturally occurring bluish-gray metal found in small amounts in the earth's crust. Lead can be found in all parts of the environment. Much of it comes from human activities including burning fossil fuels, mining, and manufacturing. Lead has many different uses. It is used in the production of batteries, ammunition, metal products (solder and pipes), and devices to shield X-rays. Because of heath concerns, lead from gasoline, paints and ceramic products, caulking, and pipe solder has been dramatically reduced in the recent years. Lead may accumulate in bone and lie dormant for years. It can pose a health threat later in life under certain conditions such as, pregnancy, lactation, osteoporosis, hyperparathryoidism and hyperparathyroidism, which mobilizes the stores lead deposits from bone.  Toxicity o Microcytic hypochromic anemia, renal dysfunction, hypertension, anorexia, muscle discomfort, constipation, metallic taste, low IQ (children)  Body burden assessment: Whole blood, serum, hair, urinary porphyrins  Protective measures: Calcium, Iron (reduces intestinal absorption), Alpha Lipoic Acid  Chelating Agents: Ca-EDTA  Common Sources: Certain supplements, paint, contaminated soil, plumbing Lead Body Burden Assessment  Serum or plasma is not a very useful specimen for lead screening except in recent exposure. (Serum lead returns to normal within 3-5 days of last exposure).  Whole blood is concentrated about 75 fold greater than plasma or serum and is the CDC preferred test  CDC "acceptable" level is 10 ug/dL  Proposals have been made to reduce acceptable levels  Hair is a sensitive indicator.  Urinary porphyrin is sensitive.  Urinary provocative challenge testing  The chelating agent of choice is IV calcium disodium EDTA.  Nutrients with demonstrated benefit when used with or without chelating agents include Alpha Lipoic Acid, Zinc, Taurine, Selenium – which are able to bind lead directly. Mercury Mercury is a naturally occurring metal which has several forms. The metallic mercury is a shiny, silver-white, odorless liquid. If heated, it is a colorless, odorless gas. Mercury combines with other elements, such as chlorine, sulfur, or oxygen, to form inorganic mercury compounds or salts, which are usually white powers or crystals. Mercury also combines with carbon to make organic mercury compound. The most common one, methylmercury, is produced mainly by microscopic organisms in the water or soil. More mercury in the environment can increase the amounts of methylmercury that these small organisms make. Methylmercury builds up in the tissue of fish. Metallic mercury is used to produce chlorine gas and caustic soda, and is used in thermometers, dental fillings and batteries. Mercury salts are sometimes used in skin lightening creams and as an antiseptic cream and ointment.  Toxicity symptoms: o Mental symptoms (insomnia, fatigue, poor short-term memory, erethism), tremor, stomatitits, gingivitis, GI and renal disturbance, decreased immunity  Body burden assessment: whole blood, RBC, serum, hair, urine, urinary porphyrins  Protective measures: Selenium  Chelating agents: DMSA, DMPS  Common sources: Dental amalgams, fish consumption, preservatives (Thimerosal) Mercury Body Burden Assessment  RBC mercury, hair analysis are good indicators  Urinary porphyrin is a sensitive biochemical marker.  Whole blood  Urinary provocative challenge testing Note: Removing brain accumulations of mercury is challenging. DMSA and DMPS may not be effective agents for removing toxic metals found in the CNS, as they are very unlikely to cross the blood-brain barrier. Required Viewing: (5 minute video): How Mercury Causes Brain Neuron Degeneration, Department of Physiology and Biophysics; Faculty of Medicine; University of Calgary. (This video can be viewed with this lesson under Module 6 on the FMU website.) Body Burden: The Pollution in Newborns (Environmental Working Group July 14, 2005) In a study spearheaded by the Environmental Working Group (EWG), researchers at two major laboratories found an average of 200 industrial compounds, pollutants, and other chemicals in 10 newborn babies, with a total of 287 chemicals found in the group. To their knowledge this work represents the first reported cord blood tests for 261 of the targeted chemicals, and the first reported detections of at least 209 chemicals. Scientists refer to this contamination as a person’s body burden. The study found a broad array of pollutants that collectively are known to present potential risks to nearly every organ and system in the body:  Of the 287 chemicals found in newborn umbilical cord blood, 180 cause cancer in humans or animals, 217 are toxic to the brain and nervous system, and 208 cause developmental problems. The dangers of exposure to these chemicals in combination has never been studied.  They detected 287 chemicals of 413 tested (69 percent) in umbilical cord blood samples from 10 newborn babies, with a range of between 154 and 231 for each child. They found 101 chemicals in all babies tested.  Our tests targeted nine chemical classes; we detected at least half of the analyzed chemicals in each class. The chemicals found span organochlorine pesticides (DDT and dieldrin, for example), chemicals currently or formerly used in a wide range of consumer products (perfluorochemicals, brominated fire retardants, PCBs), and chemical pollutants from waste incineration and fossil fuel combustion (polyaromatic hydrocarbons, polychlorinated and polybrominated dioxins and furans, polychlorinated naphthalenes, mercury). Resources  Environmental working Group – www.ewg.org  AirNow – www.airnow.gov – The Air Quality Index The Air Quality Index is an index for reporting daily air quality. It tells you how clean or polluted the outdoor air is, and what associated health effects might be of concern. The AQI focuses on health effects you may experience within a few hours or days after breathing polluted air. EPA calculates the AQI for five major air pollutants regulated by the Clean Air Act: ground-level ozone, particle pollution (also known as particulate matter), carbon monoxide, sulfur dioxide, and nitrogen dioxide. For each of these pollutants, EPA has established national air quality standards to protect public health.  SCORECARD – www.scorecard.org – Get an in-depth pollution report for your county, covering air, water, chemicals, and more.  Total Diet Study www.fda.gov – The Total Diet Study (TDS), sometimes called the market basket study, is an ongoing FDA program that determines levels of various contaminants and nutrients in foods. From this information, dietary intakes of those analytes by the U.S. population can be estimated. Since its inception in 1961 as a program to monitor for radioactive contamination of foods, the TDS has grown to encompass additional analytes, including pesticide residues, industrial chemicals, and toxic and nutrient elements. A unique aspect of the TDS is that foods are prepared as they would be consumed (table-ready) prior to analysis, so the analytical results provide the basis for realistic estimates of the dietary intake of these analytes. Summary Most, if not all, individuals have environmental toxics in their body. Yes we are all toxic. As you have read throughout this lesson, the gamut of adverse health effects is vast. It is our job as functional medicine practitioners to ascertain whether or nor not a particular toxin or combination of toxics are the root cause of our patient's disease/dysfunction. It is mandatory that all patients are assessed for environmental toxicity. References 1. Environmental Medicine, Part 1: The Human Burden of Environmental Toxins and Their Common Health Effects, Walter J. Crinnion, ND, Alternative Medicine Review, Vol 5, No. 1, 2000 2. http://lpi.oregonstate.edu/infocenter/phytochemicals/soyiso/index 3. Phthalates & Parabens Profile Interpretive Guide, Metametrix Clinical Laboratory, 3425 Corporate Way, Duluth, GA 30096 4. Polychlorinated Biphenyls (PCB's) Guide, Metametrix Clinical Laboratory, 3425 Corporate Way, Duluth, GA 30096 5. Volatile Solvents Guide, Metametrix Clinical Laboratory, 3425 Corporate Way, Duluth, GA 30096 6. Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement, 2009, 30(4):293-342,8401, Evanthia Diamanti-Kandarakis, Jean-Pierre Bourguignon, Linda C. Giudice, Russ Hauser, Gail S. Prins, Ana M. Soto, R.Thomas Zoeller, Andrea C. Gore, The Endocrine Society, Connecticut Avenue, Suite 900, Chevy Chase, Maryland 20815 Additional Resources 1. 2009 Fourth National Report on Human Exposure to Environmental Chemicals, CDC 2. Agency for Toxic Substances and Disease Registry September 2006: Aluminum September 2005: Arsenic September 2005: Lead June 1999: Cadmium April 1999: Mercury You are receiving this email because you subscribed to this feed at blogtrottr.com. If you no longer wish to receive these emails, you can unsubscribe from this feed.

States stop circumcisions funds amid budget crisis (AP)

DENVER – A nationwide debate about circumcisions for newborn boys, combined with cash-strapped public health budgets, has Colorado taking sides with 17 other states that no longer fund Medicaid coverage of the once widely accepted procedure.

For years, Colorado lawmakers considered doing away with funding for circumcisions under Medicaid — a move that would save the state $186,500 a year. Now facing a seismic budget shortfall estimated to be $1 billion at the beginning of this year, lawmakers finally approved the change, which takes effect July 1.

"We were just looking at virtually every option and trying to decide what was absolutely urgent now," said Republican Sen. Kent Lambert, a member of the budget-writing Joint Budget Committee. "I think 99 percent of it was completely economic."

The matter of circumcisions has gotten contentious in California, where San Francisco will be the first city to hold a public vote in November on whether to ban the practice.

Jewish and Muslim families are challenging that proposal in court, claiming it violates their right to practice their religion and decide what's best for their children. Supporters of the ballot initiative say male circumcision is a form of genital mutilation that parents should not be able to force on their children.

Matthew Hess, the president of the group behind the San Francisco proposal, called the Male Genital Mutilation Bill, applauded Colorado's move and said he hopes it will lead to a drop in the circumcision rate.

"That's a good thing, because paying someone to amputate a healthy functional body part from an unconsenting minor is not just a waste of taxpayer money — it's also a violation of human rights," he said.

South Carolina is one of the most recent states to eliminate Medicaid payments for circumcisions amid budget concerns. The change, which went into effect in February, was expected to save the state about $114,800 a year. States that also no longer fund circumcisions through Medicaid include Arizona, California, Florida, Maine and Louisiana.

Scott Levin, the regional director of the Mountain States office of the Anti-Defamation League, said Jews are unlikely to be affected by the defunding of Medicaid payments for circumcisions. For them, the procedure is not performed by a hospital physician, but a mohel — a specialist trained in Jewish ritual circumcision.

Levin said his group is more concerned about places like San Francisco that are trying to ban the procedure because Jewish people see the ritual as one of their religion's most sacred.

The World Health Organization reported that circumcisions are one of the most common procedures performed on newborn males in the United States, but the practice is not as common in the rest of the world. About 75 percent of baby boys in the U.S. are circumcised, compared to 30 percent elsewhere, the organization said. The figures refer to non-religious circumcisions.

Joanne Zahora, spokeswoman for the Colorado Department of Health Care Policy and Financing, which administers health care programs for low-income families, said the research her organization has seen shows that circumcisions are not medically necessary.

But the procedure retains its supporters. Although the topic never became heated during the Colorado budgetary debate, some lawmakers spoke in favor of keeping the Medicaid funding. Among them was Democratic Sen. Irene Aguilar, a primary care doctor at Denver Health.

"It's really a pretty inexpensive procedure to perform, and so it's just a little penny-wise and dollar-poor," she said.

Aguilar argued that circumcisions reduce the rates of urinary tract infections, penile cancer, and also lower the rates of cervical cancer for men's sexual partners. She also said she worried that doing away with funding for circumcisions would be discriminatory for Jewish and Muslim people on Medicaid.

Lambert, from Colorado's JBC, said the topic is sensitive for most, but the question lawmakers faced really was whether the government has the money to pay for the procedure.

"I think the general answer was no," Lambert said.

___

Associated Press writer Colleen Slevin contributed to this report.

___

Ivan Moreno can be reached at: http://www.twitter.com/ivanmoreno_colo

Holistic Chinese Herbs: Do you eat a plant-based diet rich in superfoods and fresh vegetable juices? You’re probably still deficient in these 2 critical longevity nutrients!

Holistic Chinese Herbs Do you eat a plant-based diet rich in superfoods and fresh vegetable juices? You're probably still deficient in these 2 critical longevity nutrients! 27 Jun 2011, 9:54 pm Jamie Koonce, a yogini and primal health coach Vitamin K2 As opposed to Vitamin K1 (which is found in abundant quantities in leafy green vegetables and blue-green algaes) and Vitamin K3, K4, and K5 (which are toxic synthetic vitamins frequently found in multivitamin supplements), Vitamin K2 is found in large quantities in nattokinase (a fermented traditional Asian superfood) and in smaller quantities in aged, raw, hard cheeses, fish eggs, organ meats, and butter from grass-fed animals. Vitamin K2 wasn’t discovered as a specific nutrient in food until 1929, when researchers were trying to understand the role of cholesterol in the diet.  They fed chickens a cholesterol-free diet, and after just a few weeks the chickens developing hemorrhages and started bleeding.  The researchers added a purified cholesterol supplement back into the chickens’ diets, but they remained ill.  Finally, they realized that vitamin K2 had to be combined with cholesterol in order to reverse the hemorrhaging condition. More current research on vitamin K2 shows that is has promising therapeutic benefits for people suffering from rheumatoid arthritis, cardiovascular disease, prostate cancer, osteoporosis, and leukemia.  Daily consumption of vitamin K2 may prevent these conditions as well. There’s some misinformation floating around on the internet that we can get Vitamin K1 from plants and then convert that into Vitamin K2 in the gut.  This information is primarily being spread by people who have religious or emotional feelings about eating animals and they believe that humans are meant to be herbivores just like cows.  While herbivorous animals such as cows can eat grass and convert the Vitamin K1 from the grass into Vitamin K2 as it passes through their three stomachs, humans unfortunately do not have this same ability because our digestive tracts and intestinal flora are very different from those found in cows.  Therefore, we must get Vitamin K2 from a food source. Obviously, diet is the best way to obtain proper nutrition, rather than popping a bunch of supplement pills.  However, if you have been lacking Vitamin K2 in your diet for many months or many years (or quite possibly your entire life, especially if you were raised on processed foods like I was), supplementation will probably prove beneficial for you to restore your Vitamin K2 levels over a period of a few months.  (Or of you already suffer from heart disease, cancer, osteoporosis, or rheumatoid arthritis, you may require supplementation for much longer than a few months.)  Remember that nattokinase is really the only abundant food source of vitamin K2.  You would need to be eating several pounds of organ meats, fish eggs, hard cheese, and butter on a daily basis to get the amount of vitamin K2 found in nattokinase. Buy Tri-K 60 tabs $29 Serving Size: 1 capsule Servings Per Container: 60 Amount Per Serving: Vitamin K 2050 mcg (as Vitamin K1 Phytonadione 1000 mcg; Vitamin K2 Menaquinone-4 1000 mcg; Vitamin K2 Menaquinone-7 50 mcg) Lecithin 150 mg Other Ingredients: Rice flour, magnesium stearate, silicon dioxide, microcrystalline cellulose Coenzyme Q10 Coenzyme Q10 (CoQ10) is a fat soluble cofactor essential for energy producing metabolic pathways and for the proper functioning of the mitochondrial oxidative system. With insufficient CoQ10, the electron transfer activity of the mitochondria decreases, resulting in a net failure to produce the energy necessary to power the cell. Tissues with high energy demand — especially skeletal muscles, the brain, and the heart — have the greatest demands for CoQ10. Clinical research studies demonstrate the effectiveness of supplemental coenzyme Q10 in cardiomyopathy, myocardial dysfunction, and congestive heart failure.  Additionally, CoQ10 plays a critical role in the establishment of healthy blood pressure levels and heart rhythm.  Because CoQ10 is a powerful antioxidant that neutralizes free radicals, it’s also a great nutrient for the prevention of age-related physical and mental decline. Our bodies actually make CoQ10 on its own, but by around age 20 we begin to not make as much CoQ10 as we need to keep up with free radical neutralization.  By age 30, we begin to lose the ability to convert the stable form of CoQ10 — ubiquinone — into the form that is actually used for mitochondrial function –ubiquinol.  This is why many of the visible signs of aging begin to occur by age 30 for many individuals. We can get CoQ10 through food, but the foods that are richest in CoQ10 are organ meats such as heart and liver.  A 4-ounce serving of beef heart supplies about 20 mg of CoQ10, while 4-ounces of beef liver has about 7 mg.  Realistically, I don’t think many of us are interested in eating beef heart and liver on a daily basis.  And unfortunately, 20 mg of CoQ10/day is not really enough to significantly slow down the aging process, especially if you’re already depleted from poor diet during childhood, stress, and living in a heavily polluted world. There are no side effects to taking a CoQ10 supplement, even at doses as high as 1200 mg/day. My recommendations on CoQ10, which are based on current research in anti-aging medicine, are as follows: 30 to 100 mg daily as part of your anti-aging and longevity program if you are over age 20, for prevention of cardiovascular or periodontal disease, or if you are taking blood-pressure medications that are depleting your CoQ10 levels 90 to 180 mg daily if you have angina pectoris, cardiac arrythmia, hypertension and moderate gingival disease 180 to 360 mg daily for congestive heart failure and dilated cardiomyopathy Note: If you are over 30 but under 40, you may consider taking a supplement that contains both ubiquinone as well as uniquinol.  And if you’re over 40, taking a supplement that contains only ubiquinol is the best choice.  If you’re under 30, regular CoQ10 in the form of ubiquinone is the best choice for you. CoQnol Ubiquinol-Reduced CoQ10 60 gels (Best form for you if you are over 40.) Click here to buy for $33 Serving Size: 1 softgel Servings Per Container: 60 Amount Per Serving: Ubiquinol (as Kaneka QH reduced form of CoQ10) 50 mg Other Ingredients: Medium chain triglycerides, gelatin, glycerin, ascorbyl palmitate, purified water, beeswax, soy lecithin and annatto extract Cardiokinase w/CoQ10 60 vcaps (Best form for you if you are between age 30 – 40.) *I really LOVE this one because it contains ubiquinone, ubiquinol, and nattokinase (AKA the food source of vitamin K2) all in one neat little “beadlet.”  It’s making me look forward to hitting that 30th B-day very soon so that I can try this one out! ♥ Click here to buy for $65.90 Servings per Container: 30 Amount per Serving ascorbyl palmitate 10 mg (fat-soluble vitamin C) Cardiokinase™ 100 mg (Nattokinase strain N) (25 i.u.) (from non-GMO soy) coenzyme Q10 60 mg ubiquinol 40 mg (Kaneka QH™ active antioxidant form of coenzyme Q 10) Other Ingredients: gelatin beadlet, cornstarch, mixed tocopherols, vegetable capsule CoQ10 ST-100 60 softgels (This one is perfect for you if you are under age 30.  This is a great supplement to use 30 minutes before a college exam or important job interview to enhance mental acuity.  Note that this is a 2-month supply!) Supplement Facts Serving Size: 2 Softgels Servings per Container: 30 Amount per Serving Vitamin E 100 IU (as d-alpha tocopherol and mixed tocopherols) Coenzyme Q10 (ubiquinone) 100 mg Other Ingredients: D-limonene oil, gelatin, glycerin, medium chain triglycerides, purified water, turmeric powder (color), and zinc oxide (color). You are receiving this email because you subscribed to this feed at blogtrottr.com. If you no longer wish to receive these emails, you can unsubscribe from this feed.

Medco, Sanofi drug deal brings payor view to R&D (Reuters)

NEW YORK (Reuters) – Pharmacy benefit manager Medco Health Solutions Inc will provide services to Sanofi SA that could help the French drugmaker navigate increasingly difficult reimbursement and regulatory waters.

The agreement between the two high-powered healthcare companies, announced on Wednesday, is designed to give Sanofi a broader perspective as it develops treatments, especially the views of health insurers and governments seeking evidence of a drug's demonstrated benefits before paying for it.

"The payor perspective is frequently overlooked until the very end," Robert Epstein, Medco's clinical research and development officer, said in an interview. "It's really about linking in a constituent that has previously been missing in the research equation."

The companies did not provide terms of the deal, beyond saying it was multiyear and global.

Medco, which administers pharmacy benefits for millions of Americans through its employer and health plan clients, has access to voluminous claims data. The company also conducts studies of drugs after they reach the market through last year's purchase of United BioSource (UBC), which also expanded Medco more internationally.

Drugmakers often are required only to test their medicines against a placebo to win marketing approval. But insurers and governments may balk at covering a drug if it lacks evidence it is better than therapies already on the market.

"Medco and UBC offer robust capabilities to help us close the gap between R&D and the real-world clinical setting," Sanofi Chief Medical Officer Jean-Pierre Lehner said in a statement.

Under confidentiality agreements, Medco will help Sanofi review project plans across its portfolio of experimental and approved drugs.

Medco may consult for Sanofi on studies such as those comparing its medicines with similar ones from other companies. For drugs designed for a condition with no approved treatments, Medco might gather data on the disease's prevalence, hospitalizations from the disease, and its total costs, Epstein said.

Medco can also help frame data in a way that is more useful to payers, Epstein said, such as extrapolating how much blood pressure changes could affect heart outcomes.

Even after a drug is approved, Epstein said, Medco's clients often want more information such as how a drug stacks up against its competitors.

"Our payers frequently see a new drug hit the market where it has been proven to work against placebo in a Phase III program, but that doesn't really answer our questions," he said.

For example, to win approval for a respiratory drug, companies may gather data on breathing gauges such as the ability to blow up a ballon, Epstein said. "But you're not collecting ER visits and hospitalizations -- that's just not as relevant to the payor community," he said.

Epstein said intervening after early stage, or Phase I, studies is desirable to ensure a development program is gathering information payors want.

"If you get past Phase II, it's kind of too late," Epstein said.

(Editing by Steve Orlofsky)

Some Drugs for Rheumatoid Arthritis, Psoriasis May Cut Diabetes Risk (HealthDay)

TUESDAY, June 21 (HealthDay News) -- Some medications commonly used to treat rheumatoid arthritis and psoriasis may help patients with these autoimmune disorders lower their risk of developing diabetes, researchers say.

New research found that a particular class of disease-modifying antirheumatic drugs (DMARDs) known as tumor necrosis factor (TNF) inhibitors and the antimalarial drug hydroxychloroquine can reduce diabetes risk by 38 percent and 46 percent, respectively, in people with rheumatoid arthritis or psoriasis.

"If you have rheumatoid arthritis or psoriasis, you may be at an increased risk of diabetes, and a number of different antirheumatic drugs may reduce your future risk of diabetes," said study author Dr. Daniel Solomon, chief of clinical science in rheumatology at Brigham and Women's Hospital in Boston.

However, Solomon was quick to point out that this was an observational study, and does not prove a cause-and-effect relationship between taking these medications and a reduced risk of diabetes. He said that for people who already have to take these drugs for other conditions, this research shows that there may be an added benefit with taking some of them.

The findings are published in the June 22/29 issue of the Journal of the American Medical Association.

Using statistics from two large health insurance company databases -- one in Canada and one in the United States -- the researchers reviewed data on people who had either rheumatoid arthritis or psoriasis. From a group of 121,280, the researchers immediately excluded the 12,996 who already had a diabetes diagnosis.

"These patients are at high risk of type 2 diabetes. This study found that about 10 percent already have it, which is higher than would be expected in the general population," said Dr. Joel Zonszein, director of the clinical diabetes program at Montefiore Medical Center in New York City.

The investigators then looked for those who had a prescription for at least one of the medications used for these conditions, and found that 13,905 were taking at least one of these drugs. The researchers further divided the group into four subgroups: those taking TNF inhibitors with or without other DMARDs; people taking methotrexate without a TNF inhibitor or hydroxychloroquine; hydroxychloroquine without TNF inhibitors or methotrexate; or other DMARDs without TNF inhibitors, methotrexate or hydroxychloroquine.

The study found that the rate of diabetes diagnoses over 12 years was 19.7 per 1,000 person-years for TNF inhibitors, 22.2 for hydroxychloroquine, 23.8 for methotrexate and 50.2 for other DMARDs. Compared to the other DMARDs, this translates to a reduced risk of 38 percent for TNF inhibitors, 23 percent for methotrexate and 46 percent for hydroxychloroquine.

Solomon said in an adjusted analysis, hydroxychloroquine and TNF inhibitors were the two types of drugs that appeared to make a significant difference in diabetes risk. These drugs are sold under brand names such as Plaquenil (hydroxychloroquine) and Enbrel, Humira and Remicade (TNF inhibitors).

Solomon said the reason these drugs might be protective isn't known, but the researchers suspect they reduce inflammation, which reduces insulin resistance and diabetes.

"Careful treatment of inflammatory conditions may reduce your future risk of diabetes," Solomon added.

"In a population with a very high incidence of diabetes, some medications may prevent or slow down the process of type 2 diabetes," said Zonszein.

Both experts added that these medications may have significant side effects. In addition, they can be expensive.

"The question is always, 'Is it worth giving these drugs?' You may prevent diabetes, but in doing so, will you create other problems?" said Solomon, who added that the information from this study might be helpful in selecting one treatment regimen over another for people with rheumatic diseases.

More information

Learn more about rheumatoid arthritis and disease-modifying antirheumatic drugs (DMARDs) from the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases. They also have more information on psoriasis.