May 18, 2012 — Prescription medication “take-back” programs are increasingly promoted as a way to safely dispose of unused drugs, but they are no better for the environment than simply throwing old drugs in the trash, a new study suggests.

When researchers used a complicated methodology called “comparative life cycle assessment” to estimate the environmental impact of flushing, incinerating, and trashing old medications, they found little difference between burning the drugs — which is what most take-back programs do — and having them end up in the landfill.

Close to 200 million pounds of drugs go unused in the U.S. each year.

There are serious concerns that antibiotic and hormone medications pose a threat to the nation’s lakes, rivers, and other water supplies.

While most of these concerns involve flushed waste that contains residues of used medications, unused drugs may also be finding their way into the nation’s water supply, researcher Steven J. Skerlos, PhD, tells WebMD.

FDA Says Trash Some Unused Drugs

Take-back initiatives typically involve the collection of unused drugs by participating pharmacies for incineration with other medical wastes.

Skerlos, an associate professor of mechanical engineering at the University of Michigan, says these programs may actually be worse for the environment than throwing drugs in the trash due to the greenhouse gases produced by transporting and burning the medications.

If there are no disposal instructions given on the drug label or patient information sheet, the FDA recommends throwing away some prescriptions by:

First mixing them with an unpalatable substance such as kitty litter or used coffee grounds,Placing the mixture in a container such as a sealed plastic bag,And disposing of the bag with other household wastes.

However, there is one big exception to this recommendation, FDA spokesperson Morgan Liscinsky tells WebMD.

Dangerous Drugs Should Be Flushed

Medications that are especially harmful and could potentially be deadly if taken accidentally should not be put in the trash.

Instead, they should be flushed down the toilet or sink to eliminate any chance that a child or pet will find them, the FDA says.

These drugs include powerful pain relievers and other drugs that are widely abused like methadone, morphine, OxyContin, and Percocet.

Of special concern are powerful narcotics delivered by patch, such as the drug fentanyl.

“Even after a patch is used, a lot of the drug remains in the patch, so you wouldn’t want to throw something in the trash that contains a powerful and potentially dangerous narcotic that could harm others,” FDA senior program manager Jim Hunter, RPh, noted on the agency’s web site.

A complete list of the drugs recommended for flushing by FDA can be found on the agency’s web site ?in the consumer section entitled “How to Dispose of Unused Medicines.”

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May 18, 2012 — Sprains, strains, and worse injuries are unavoidable in sports, and playing through the pain comes with the territory for most athletes.

So how do they continue to excel with pain that would leave others sidelined?

New research confirms that athletes have a higher tolerance for pain than couch potatoes or even weekend warriors, and the finding could help investigators discover better ways to manage pain.

No Pain, No Gain?

Researchers in Germany reviewed findings from 15 studies comparing pain threshold and pain tolerance among athletes and non-athletes.

“Pain threshold” refers to the point at which pain begins to be felt in response to stimulation (heat, pressure, etc.), while “pain tolerance” is the maximum amount of pain a person can stand.

Athletes and non-athletes in the studies had similar pain threshold levels, but athletes consistently reported higher pain tolerance than normally active adults.

And the amount of pain athletes were able to tolerate varied by their sport, with those involved in game sports like football or soccer generally more tolerant of pain than those who participated in endurance sports.

But this was not always the case. One study found that cross-country skiers were among the most pain tolerant, along with football players.

Endorphins May Blunt Pain

The findings, which appear in the June issue of the journal Pain, strongly suggest that athletes have a higher tolerance for pain than others, but the studies did not explore the reasons for this.

Researcher Jonas Tesarz, MD, of the University of Heidelberg, tells WebMD that more research is needed to determine if increased physical activity helps control pain.

If the association is confirmed, the finding could have major implications for pain management.

Physical activity boosts levels of chemicals that mimic the effects of “feel good” and pain-relieving opioids, known as endorphins.

In runners, this chemical rush is known as a “runner’s high.”

Pain researcher Allan Basbaum, PhD, of the University of California, San Francisco, says he was highly skeptical of the theory that endorphins blunt pain until about four years ago.

That is when a group of German researchers proved that running and other strenuous exercise really does increase endorphin levels in the brain as well as the blood.

Basbaum chairs the anatomy department at UCSF and is the editor-in-chief of the journal Pain.

“Previous studies had looked at endorphins in the blood, but blood levels are irrelevant to what is going on in the brain,” Basbaum says.

Playing Through the Pain

He adds that because athletes are highly motivated to keep doing what they do, they may also be far more likely than others to ignore pain signals and play through the pain.

“Most athletes don’t ask themselves, ‘Does it hurt?’” he says. “They ask themselves, ‘How much pain can I put up with?’”

And people who can put up with the most pain may be most likely to become athletes.

“There may be a ‘chicken and egg’ component,” Basbaum says. “Do they have a high pain tolerance because they are athletes, or are they athletes because they have a high pain tolerance?”

Surprising Reasons You’re in Pain

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May 18, 2012 — One in 30 baby boomers may be infected with the hepatitis C virus, but few know it until it’s too late for their livers.

In the wake of new statistics showing more than 2 million baby boomers in the U.S. are infected with hepatitis C, the CDC is proposing new guidelines calling for all adults of that generation to be tested for the virus.

Officials say baby boomers, the generation born from 1945 through 1965, now account for more than 75% of all Americans living with the virus. But recent studies show few are aware they are infected or at risk for infection.

“Identifying these hidden infections early will allow more baby boomers to receive care and treatment, before they develop life-threatening liver disease,” says Kevin Fenton, MD, PhD, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, in a news release.

Current hepatitis C testing guidelines call for only those with certain risk factors to be tested for the virus.

The announcement of the proposed change coincides with the first-ever National Hepatitis Testing Day on May 19. After a public comment period, the new guidelines are expected to be finalized later this year.

Hepatitis C: Hidden Killer

The hepatitis C virus is spread through exposure to infected blood. The most common means of infection is through sharing of needles or other equipment used to inject drugs.

Researchers say most baby boomers were likely infected with hepatitis C when they were in their teens or 20s.

Some may have been infected when they experimented with injection drugs, even just once. Others may have been exposed to the virus through blood transfusions before modern blood-screening procedures came into effect in 1992.

Once infected, the hepatitis C virus causes progressive damage to the liver and can go undetected for many years without symptoms. Some people may have symptoms — like fever, fatigue, dark urine, and abdominal pain — six to seven weeks after getting infected.

Hepatitis C can lead to serious liver disease and liver cancer, which is the fastest-growing cause of cancer-related deaths. It is also the leading cause of liver transplants in the U.S.

The CDC says one-time testing of all baby boomers for the hepatitis C virus could identify more than 800,000 people infected with the virus, allow for early treatment to prevent liver disease, and save more than 120,000 lives.

Researchers say therapies can cure up to 75% of hepatitis C infections.

“With increasingly effective treatments now available, we can prevent tens of thousands of deaths from hepatitis C,” says CDC Director Thomas R. Frieden, MD, MPH, in the release.

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May 18, 2012 — The FDA has approved several generic versions of the popular blood thinner Plavix (clopidogrel).

Officials say the approval will make more affordable options available for people who take Plavix to reduce their risk of heart attack and stroke.

“For people who must manage chronic health conditions, having effective and affordable treatment options is important,” says Keith Webber, PhD, of the FDA’s Center for Drug Evaluation and Research, in a news release. “The generic products approved today will expand those options for patients.”

Major pharmacy chains say they expect to have the generic versions of clopidogrel in stock within days of the approval.

Generic Plavix Approved

Plavix was approved by the FDA in 1997 and is marketed in the U.S. by Bristol-Myers Squibb. The U.S. patent on the drug expired on May 17, paving the way for the FDA’s approval of generic versions.

Generic drugs approved by the FDA must be of the same quality and strength as the brand-name versions.

Clopidogrel is approved to treat people who have had a recent heart attack or stroke or who have plaque buildup in arteries known as peripheral artery disease.

The drug works by making the platelets in the blood less likely to clump and form clots that could lead to a heart attack or stroke.

The FDA approved three 300-milligram (mg) generic versions of clopidogrel and seven generic 75-mg versions.

Risks Same as With Plavix

Generic clopidogrel, like Plavix, may not work in people with certain genetic risk factors that affect how the drug is metabolized in the body. A genetic test can check for these factors.

Some drugs, including proton pump inhibitors used for heartburn and acid reflux like Nexium and Prilosec, may also reduce the effectiveness of clopidogrel.

Possible side effects of clopidogrel include bruising and excessive bleeding, which can be life-threatening in some cases.

A Visual Guide to Understanding Stroke

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May 17, 2012 — An extract from the Chinese herb kudzu may help drinkers cut down on drinking, according to a new pilot study.

“It didn’t stop the drinking,” says researcher David M. Penetar, PhD, assistant professor of psychology at McLean Hospital and Harvard Medical School. “They still drank, but they drank less.”

He studied the extract puerarin. It is one of the substances known as isoflavones found in kudzu.

The study is published in Drug and Alcohol Dependence.

12 Myths About Your Hangover

Drinking Problems

More remedies are needed to help drinkers who overdo it cut down, Penetar says. The medications approved for treating alcohol abuse and dependence don’t work for everyone, he says.

About 1 in 6 U.S. adults binge drinks, according to a CDC report. Experts disagree on the definition of binge drinking. According to the CDC, binge drinking is having four or more drinks on one occasion for a woman and five or more for a man.

Kudzu: A Brief History

In Chinese pharmacy books, kudzu is listed as a possible treatment for alcohol-related hangovers and cravings, Penetar tells WebMD.

“Some of the references go back to 600 A.D.,” he says.

Today, it’s used in China and other countries to treat coronary problems and blood-flow problems, Penetar says. “It has a good safety record already.”

It’s touted as a hangover remedy. However, studies looking at the effects of kudzu extracts have produced mixed findings, Penetar says.?

Herb to Cut Drinking: Study Details

Penetar’s team studied 10 men and women, average age 26. They typically drank about 18 alcoholic beverages a week.

“We set up a lab room to make it look like an apartment,” Penetar says.

The lab-turned-apartment had a reclining chair, TV, DVD player, and a refrigerator stocked with each person’s favorite beer. Non-alcoholic beverages were also available.

The researchers conducted four different sessions:

The first session was to make the participants familiar with the surroundings. They drank but took no herbs.Before the second, they took either 1,200 milligrams of puerarin or identical-looking placebo pills for a week. They came to the lab and could drink as much as they wanted, up to six beers.Two weeks later, they came back for a drinking session, without taking the herb or the placebo.For a final session, they took whichever pill they didn’t take the first time. They took it for a week, then went to the lab again for a drinking session.

The participants provided urine samples so the researchers could confirm they were compliant.

They were given dinner after the sessions and sent home in a taxi once their blood alcohol level declined.

Results of Puerarin Treatment

“When they were treated with puerarin they drank about a beer less than when they were treated with placebo,” he says.

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May 17, 2012 — Although the death rate for drowning in the U.S. has gone down in the last decade, drowning leads to more deaths among young children aged 1 to 4 than any other cause except birth defects, a new report from the CDC reveals.

Between 2005 and 2009, the death rates from accidental drowning were higher among children under 4 years of age than for any other age group, the report shows. About half of these deadly incidents in young children took place at swimming pools.

Kids under 4 also had the highest rate of nonfatal drownings, meaning injuries from near drowning that may have landed them in the emergency room or in the hospital. Swimming pools were the site of roughly 65% of these near drownings in preschoolers.

Researchers also found that for each year between 2005 and 2009, an average of 3,880 Americans lost their lives to drowning and nearly 5,800 people a year were estimated to have sought treatment in the emergency room because of a near-drowning episode.

The findings appear in May 18 issue of the CDC’s Morbidity and Mortality Weekly Report.

Kids’ Swim Lessons Save Lives

For this study, researchers looked at information on death certificates over a five-year period. They found that of the nearly 3,900 accidental deaths from drowning each year in the U.S., more than half occurred in natural bodies of water, almost 18% took place at pools, and about 10% happened in the bathtub.

Men were four times more likely than women to be the victims of drowning. Men might be at greater risk of drowning because they may overestimate their ability to swim, choose riskier water-related activities, or drink alcohol more often, the report says.

African-Americans had a higher death rate from drowning than whites, Hispanics, or other races.

For near drownings, researchers reviewed data from 66 hospitals in the U.S. They found that children under 4 accounted for nearly 53% of emergency visits for drowning-related injuries, while children aged 5 to 14 were responsible for almost 18% of them.

Alcohol played a role in nearly 22% of all nonfatal drowning injuries among those aged 15 or older.

It comes as no surprise that summertime brought more problems: Almost half of the nonfatal injuries and more than one-third of the deadly drownings happened on weekends between June and August.

The researchers suggest that taking swimming lessons while young can teach life-saving skills to help prevent drownings and water-related injuries. Wearing life jackets, installing four-sided pool fencing, and giving bystander CPR can also help lessen the number of lives lost or injuries.

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May 17, 2012 — With summer nearly upon us, our sunglass habits could use improvement, according to a new report issued today by The Vision Council, an industry group.

While 73% of adults do wear sunglasses, only 58% of them make their children wear shades, too, the report found.

More than half of us lose or break our sunglasses every year. More than a quarter of us never bother to wear them, despite benefits to eye health.

“A substantial proportion of people still do not understand that UV exposure is harmful to the eyes as well as the skin,” says Paul Michelson, MD, an ophthalmologist in La Jolla, Calif., and chairman of the Better Vision Institute, the medical advisory arm to The Vision Council.

“Even those who do understand, few understand it is the cumulative exposure that can be damaging,” says Michelson, the former section chief of ophthalmology at Scripps Memorial Hospital in La Jolla.

“The good news is, some people wear sunglasses some of the time,” Michelson says. “The bad news is, not enough people wear them enough of the time.”

It’s never too early, Michelson tells WebMD, to put sunglasses on kids. And it’s never too late to begin wearing them, he adds.

The report is titled “Finding Your Shades, Protecting Your Vision.” Besides tracking sunglass-wearing habits, it lists the long- and short-term effects of UV exposure and lists U.S. cities by UV exposure levels.

Your Eyewear Guide for Vision, Sport and Fashion

Sunglass Habits: The Survey

For the survey, The Vision Council polled 10,000 adults from across the country. Barely 1 in 6 said eye health was the reason for wearing sunglasses. Many more, two-thirds, said the purpose was to prevent glare.

The researchers found a variety of reasons why people do not wear sunglasses. Among them:

Nearly half simply forget.About 14% lose or break sunglasses often.About 20% don’t believe their eyes are at risk from sun exposure.UV Eye Exposure & Health Problems

UV exposure can cause short-term and long-term effects on eye health. People with blue eyes are more at risk for UV damage than those with brown eyes, experts say.

After a long day at the beach, eyes may seem bloodshot, swollen, and light-sensitive.

Sunburn of the eye, or photokeratitis, is one effect. It’s also known as ”snow blindness,” as it happens to skiers, too.

In severe cases, it can cause loss of vision for up to 48 hours, according to the report.

Long-term, excess UV exposure can cause a variety of eye problems, including:

“Surfer’s eye,” also known as pterygium: This abnormal but usually benign growth on the eye’s surface can itch, swell, and become irritated. Surgery can be done to remove it, but it can come back.Cataracts: The progressive clouding of the lens of the eye.Age-related macular degeneration: The macula is at the back of the eye, in the middle of the retina. Damage to the nerve cell in the macula can dull colors and blur fine detail in your vision.Cancer of the eye, eyelid, or nearby skin.

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May 16, 2012 — College football and hockey players sustain numerous blows to the head every season. Those hits, according to a new study published in the online edition of the journal Neurology, may add up to brain injuries that impact learning for some players.

The authors of the study followed football players at three schools: Dartmouth College, Brown University, and Virginia Tech. They also tracked ice hockey players — both male and female — at two of those schools. Altogether, they studied 214 athletes over the course of a season, comparing them to 45 players in non-contact sports such as track, crew, and Nordic skiing.

At the beginning and end of the season, all of the study participants took a 20-minute computer test to measure memory and reaction time, while a smaller number also took a comprehensive battery of mental tests. The preseason test results showed few differences between the contact and the non-contact players. For researcher Thomas McAllister, MD, that was encouraging.

“They are all Division I level and have been playing for many years, and the contact players have been hitting their heads for many years, so we thought we might see a difference between them and the non-contact players, but both looked pretty similar,” says McAllister, a professor of psychiatry and neurology at Dartmouth Medical School.

The players’ postseason scores, however, told a somewhat different story.

While the researchers found that a season’s worth of head impacts do not have a measurable effect on all athletes, some players do appear susceptible. On one of the tests, which is used to measure a person’s ability to learn and remember new things, 22% of the football and hockey players performed at a level that many clinicians would find “worrisome,” says McAllister. Only 4% of the non-contact players showed a similar negative result.

The football and hockey players each wore helmets rigged with the HIT System, which monitors and measures the impacts of blows to the head during both games and practice. The helmets recorded an average of 469 hits per player over the course of the season.

According to the study, those who suffered the heaviest blows in the last week of play did worse on two of the mental tests. This, McAllister says, suggests “a modest correlation” between both the number of hits and the force of the hits and brain performance.

Reactions to the Study

“This study provides some objective evidence that may eventually allow us to know what is a reasonable number of hits,” says neurosurgeon and sports medicine specialist Robert Cantu, MD, who was not involved in the research.

The researchers excluded athletes who suffered a concussion during the season, so that they could focus on the consequences of sub-concussive hits. Cantu, who co-directs Boston University’s Center for the Study of Traumatic Encephalopathy, says that such an exclusion might not have been possible.

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May 16, 2012 — Sudden heart death?may be a new risk from the commonly prescribed antibiotic azithromycin — better known as Zithromax or the Z-Pak.

The finding comes from a study of Medicaid patients who received some 348,000 Z-Pak prescriptions from 1992 to 2006.

Compared to patients who took no antibiotics, those taking the five-day course of azithromycin treatment had about a threefold higher risk of heart death. Compared to patients with infections treated with amoxicillin, another antibiotic, those taking azithromycin had twice the risk of heart death.

Even so, it’s a small risk. For every million courses of azithromycin treatment there were an estimated 47 extra heart deaths. Among people at highest risk of heart disease, there were 245 extra heart deaths per million courses of azithromycin.

“It’s a small risk. And if you look carefully, you’ll see that all antibiotics have serious risks,” study leader Wayne A. Ray, PhD, professor of preventive medicine at Vanderbilt University, tells WebMD. “For most patients, this is a relatively small risk.”

Ray says the study probably will make doctors think hard about prescribing azithromycin for patients at high risk of heart death.

“When an equally effective alternative is available, it should be used for patients at high cardiac risk,” Ray says.

Infectious disease specialist Jay Varkey, MD, director of the antibiotic management program at Emory University, says the study is well done but far from conclusive.

“In and of itself, this study does not warrant a dramatic amount of alarm,” Varkey tells WebMD. “It calls for more studies to see whether the increased death rate was truly due to azithromycin or to the underlying disease being treated.”

Ray and colleagues tried to do this by comparing patients on azithromycin to those on amoxicillin. Both drugs are often used to treat ear, nose, and throat infections.

But Varkey notes that azithromycin is more likely to be used in patients with pneumonia, which might mean that those taking the drug were already at higher risk of death.

While the findings certainly will make Varkey pause before prescribing a Z-Pak to a patient with heart disease, he says the biggest risk to patients is from taking unnecessary antibiotics in the first place.

“At least half of antibiotic prescriptions are unnecessary and inappropriate,” he says. “The first question to all doctors is, ‘Does this person really need an antibiotic?’”

The study appears in the May 17 issue of The New England Journal of Medicine.

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May 16, 2012 — It is widely believed that raising “good” cholesterol levels lowers heart attack risk, but surprising new research finds evidence that this may not be the case.

Genetic studies failed to show a link between higher concentrations of high-density lipoprotein (HDL) cholesterol and lower heart attack risk.

Millions of people take statin drugs like Crestor, Lipitor, Pravachol, and Zocor to lower their low-density lipoprotein (LDL), or “bad” cholesterol. Studies have shown that high LDL levels are linked to an increase in heart attack risk.

But the benefits of increasing HDL are less clear, and studies of HDL-raising drugs have been largely disappointing.

Cholesterol 101: What Your Levels Mean

Higher HDL Not Protective

In the newly reported study, investigators from Harvard Medical School used a relatively new research technique that tests connections between genes and disease to examine whether HDL has a direct impact on heart attack risk.

In earlier studies, the researchers identified a gene variant found in about 2.6% of the population associated with elevated HDL levels.

People with the gene variant have levels that are, on average, about six points higher than people without it.

When the researchers looked for the variant in about 21,000 people who had experienced heart attacks and 95,000 people with no heart attack history, they found that carriers did, indeed, have higher HDL levels.

But they saw no evidence that these people also had a lower susceptibility to heart attacks.

“The expectation was that the people who carried this genetic variant would have a lower heart attack risk, but that is not what we found,” says researcher Sekar Kathiresan, MD, of Harvard Medical School and Massachusetts General Hospital.

In a second study, which involved 14 more common gene variants also associated with HDL, the researchers once again found no evidence that the variants had a direct, protective role in heart attack risk.

Kathiresan tells WebMD that HDL remains an important tool for assessing heart disease risk, but he says the new research raises even more questions about the benefits of taking drugs to raise HDL levels.

HDL Drug Trials Disappointing

Many clinicians still prescribe the vitamin niacin to help raise HDL levels, even though a government-funded trial proved disappointing.

The trial was halted early a year ago when it was determined that people with heart disease who had low HDL levels did not benefit from the treatment.

There was even a suggestion that taking high doses of niacin raised stroke risk.

The drug company Pfizer abandoned its experimental HDL-boosting drug torcetrapib in 2006 when trials showed an increase in heart attack and stroke risk among users.

And earlier this month, Roche Pharmaceuticals abruptly stopped late-phase trials of its similar drug, dalcetrapib, finding no evidence of a lower heart attack risk in users.

American Heart Association past president Robert Eckel, MD, says the new research casts even more doubt on the strategy of raising HDL to lower heart and stroke risk.

Eckel is a professor of medicine at the University of Colorado School of Medicine in Aurora.

“HDL levels are related to risk, but that doesn’t mean that raising HDL is beneficial,” he says. “What we do know is that lowering LDL has a big impact on risk, so the take-home message remains, ‘Get those LDL numbers down,’” he says.

Kathiresan says his research team will continue to search for genes that alter HDL and lower heart attack risk.

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