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Some people will fudge the truth to become ophthalmologists

How honest are aspiring ophthalmologists?

It’s not a question many people would think to ask. But that didn’t stop Dr. Michael Wiggins, of the Jones Eye Institute at the University of Arkansas for Medical Sciences. He was curious about the veracity of applications sent to his institute by medical students who were interested in completing their ophthalmology residencies in Little Rock.

Amazingly, Wiggins isn’t the first person to wonder about this type of thing. The first published report on the credibility of physician applications was published in 1995. That landmark paper – in the Annals of Internal Medicine – focused on doctors applying to the University of Pittsburgh’s gastroenterology fellowship program, a highly competitive medical specialty. It revealed that 30.2% of doctors who said they had authored or co-authored studies in medical journals were involved in “misrepresentation” of some kind. Some of the applicants had listed “nonexistent articles in actual journals” while others cited “articles in nonexistent journals,” among other offenses.

In the 15 years since, the study has been repeated at least 17 times for fields including radiation oncology, orthopedics, emergency medicine, pediatrics, radiology, psychiatry, neurosurgery and other specialties. In one study, the misrepresentation rate was only 1.8%; in another it was 100%.

Ophthalmology is a competitive field. In 2008, more than 230 people applied for just 3 residency spots at the University of Arkansas for Medical Sciences. Would those long odds give some applicants an incentive to lie?

Wiggins reviewed 821 applications sent to UAMS between 2000 and 2004. Of those, 201 included publications in peer-reviewed medical or scientific journals. Altogether, 15 applicants engaged in 16 instances of misrepresentation, which worked out to a misrepresentation rate of 8.1%.

Eight of the cases involved students listing themselves too high on an article’s list of co-authors, and four involved omitting the names of other authors altogether. Among the remaining cases, two involved applicants who listed real articles that were written by others, and two involved articles that were simply made up.

Some of these misrepresentations could have been innocent mistakes, but Wiggins doesn’t think that’s likely. If applicants were simply being lazy in typing up their CVs, then students would be just as likely to bump themselves down on the author list as to bump themselves up. But whenever he found an applicant’s name was listed out of order, he wrote, “every case was a promotion.”

Alternatively, some applicants may have been listed as coauthors at some point in the research process, only to have their names removed later. However, Wiggins wrote, “It is difficult to imagine that a first author could have unknowingly been eliminated and then looked up the citation to record it on the residency application without noticing the absence of his or her name.”

Among the 15 transgressors, five were graduates of U.S. medical schools and 10 had studied abroad. Foreign medical grads are typically at a competitive disadvantage, and this may explain why they were more than twice as likely to be caught with an error on their applications, Wiggins said.

At 8.1%, Wiggins concluded that the misrepresentation rate he found was fairly low. “Although no level of publication misrepresentation is desirable,” he wrote, the rate for aspiring ophthalmologists is “the lowest reported among all previous studies except for internal medicine and dermatology.”

The results are published in Tuesday’s edition of Archives of Ophthalmology.

-- Karen Kaplan

Photo: Aspiring ophthalmologists are comparatively honest, according to a new study. Credit: David McNew/Getty Images

The key to an athlete's speed may be the body's center of gravity

What makes an athlete fast may have more to do with body type than training. Researchers from Duke University and Howard University think the secret may lie in the body's center of gravity.

Their study, released online in the International Journal of Design and Nature and Ecodynamics, may explain why the fastest sprinters are usually black, while the fastest swimmers are usually white, a difference that goes back decades. Though on the face of it this may seem like the differences are racial, the researchers believe they're really biological.

Blacks, they note, tend to have a slightly higher center of gravity than whites, due to having longer limbs with smaller circumferences. Because Asians and whites tend to have longer torsos, their centers of gravity are lower.

Those differences may translate into faster times in specific sports. Looking at other studies on the human body, the researchers deemed that, on average, blacks have about a 3% higher center of gravity than whites. That may make black sprinters 1.5% faster than white sprinters. Using that formula, whites may have a similar advantage over blacks in swimming. Asians may have an even greater advantage than whites in terms of center of gravity, they add, but that benefit is canceled out by the fact that they’re usually not as tall as white swimmers.

"Locomotion is essentially a continual process of falling forward," study co-author Adrian Bejan, in a news release. "Mass that falls from a higher altitude falls faster. In running, the altitude is set by the location of the center of gravity. For the fastest swimmers, longer torsos allow the body to fall forward farther, riding the larger and faster wave." Bejan is a professor of engineering at Duke's Pratt School of Engineering.

But the authors don't ignore the role that environment, as well as biology, may play in what athletes excel at.

"When I grew up in South Carolina, we were discouraged from swimming," Edward Jones, a co-author, said in a news release. Jones, who teaches at Howard University and is black, added, "There wasn't nearly as much encouragement for us as young people to swim as there was for playing football or basketball. With the right encouragement, this doesn't always have to be the case -- just look at the Williams sisters in tennis or Tiger Woods in golf."

-- Jeannine Stein

Photo: Jamaican sprinter Usain Bolt, left, is an Olympic medalist and world record holder. Photo credit: Fabrice Coffrini / AFP/Getty Images

Should all children be screened for high cholesterol?

High cholesterol is common enough in children these days that all of them should be screened for the condition, say the authors of a new study examining the rates of high cholesterol in children.

Currently, the American Academy of Pediatrics recommends screening children and teens who have a family history of premature heart disease or high cholesterol or those children who already have risk factors for heart disease, such as obesity, high blood pressure or who smoke or have diabetes. For these children, screening should start after age 2 and before age 10.

However, a sizable number of people don't have accurate information on family medical history. In the new study, released online Sunday in the journal Pediatrics, researchers reviewed data from more than 20,000 fifth-grade children in West Virginia, including examining their family history and conducting blood cholesterol tests. They found that more than 71% of the children met guidelines for cholesterol screening based on family history. Among children whose family history wasn't known, 9.5% had high cholesterol -- with 1.7% of those children requiring medication to treat the condition.

Screening all children for cholesterol, rather than just those with a family history, will uncover many more cases of the condition that can be treated early to prevent heart disease later in life, the authors said. Statin therapy has been shown to be safe and effective in lowering LDL cholesterol (the bad kind of cholesterol) levels in children.

Moreover, the authors wrote: "...the added and undeniable benefit of identifying and screening parents and other first-degree relatives as a result to finding elevated LDL levels in their children could lead to the prevention of premature cardiac events in adults that may have otherwise gone undiagnosed."

-- Shari Roan

Photo: More than 13 million Americans are taking statins to lower their cholesterol and stave off heart disease. Credit: Bob Chamberlin / Los Angeles Times

Millions of yearly visits to the ER involve patients with mental disorders and substance abuse problems

Not every emergency room visit involves a physical problem. Out of 95 million visits made to emergency rooms by adults in the U.S. in 2007, 12 million, or 12.5%, had to do with mental disorders, a substance abuse problem, or both.

The findings are from a report recently put out by the U.S. Agency for Healthcare Research and Quality, part of the Department of Health and Human Services.

Of those 12 million visits, about 66% involved patients with mental disorders, about 25% involved patients with substance abuse issues and the rest involved patients who had both a mental disorder and a substance abuse problem.

Almost 41% of those 12 million visits resulted in the patient being admitted to the hospital, which is more than 2.5 times the rate of hospitalizations for other conditions.

Almost 54% of the mental health/substance abuse-related visits were from women. About 47% of the visits were by people age 18 to 44, and about 35% were by  people age 45 to 64.

The top five conditions that made up 96% of all the mental health/substance abuse cases were (in order) mood disorders, anxiety disorders, alcohol disorders, drug disorders, schizophrenia and other psychoses, and intentional self-harm. One patient could have multiple diagnoses.

As for how the 12 million visits were billed, 30% went to Medicare, 26% went to private insurers, 20% went to Medicaid and 21% of patients were uninsured.

-Jeannine Stein

Photo credit: Mark Boster / Los Angeles Times

Rodent of the Week: Athletes! You must win at home

There was good reason to be worried when the Lakers lost that second game of the NBA championship playoff series against Boston. The loss was at home. According to new animal research, winning at home appears to be important to the male species' ability to prepare for, and win, future conflicts.

In a study with mice, researchers showed that experiencing a win caused changes in the brains that enhanced the ability to win in the future. Researchers also found that winning at home had a particular effect, causing more activity in male hormone receptors in brain regions thought to influence social aggression.

The researchers paired territorial male mice who had winning experience -- sort of macho male mice that, by the way, are a species of California mice called Peromyscus californicus -- with smaller and sexually inexperienced male mice in various settings, such as home cages and neutral settings. Naturally, the mice fought. The researchers then examined the brains of the mice and compared them to similar mice that were not paired for fights. The mice that won both home and away victories had increased expression of hormone receptors in their brains. But only the brains of mice that won in their home cages showed increased hormone sensitivity in two areas of the brain thought to control motivation and reward. Mice that won at home also won more fights with larger and tougher mice when fighting in neutral locations.

The experience of winning, especially at home, appears to actually change the brains of mice. Perhaps this phenomenon extends to other species. In this somewhat dense conclusion, the authors wrote their results "are therefore provocative because they suggest a mechanism through which environmental context modulates socially induced changes to the functional properties of neural circuits that control behavioral motivation and reinforcement."

The study, released online Tuesday in the Proceedings of the National Academy of Sciences, was conducted by researchers at the University of Wisconsin.

-- Shari Roan

Photo credit: Advanced Cell Technology Inc.

For hospitals too, beauty is in the eye of the beholder

Last year, the good folks at Soliant Health – a healthcare staffing firm – took it upon themselves to rank the 20 most beautiful hospitals in the country. The list was subjective, of course, but the judges clearly put some thought into their selections. Check out the Cinderella-castle quality of No. 1 pick Johns Hopkins Hospital in Baltimore; the one-acre rooftop garden at No. 6 St. Louis Children’s Hospital; the lodge motif at No. 10 Mat-Su Regional Medical Center in Palmer, Alaska; and the hotel feel of No. 17, Sacred Heart Medical Center in Springfield, Ore.

This year, Soliant asked readers of its blog to nominate and vote for the country’s most beautiful hospitals. More than 10,000 votes were cast, but the 2010 contest winners are decidedly less beautiful.

Take the winner, Sharp Memorial Hospital in San Diego. This glassy, boxy building was nominated for an onion award in the San Diego Architectural Foundation’s annual Orchids & Onions contest. (Hint: only the orchids are meant as a compliment.) Here’s what an anonymous commenter had to say about the design:

This building is a monstrosity. I have to look at it every day. … There's a big post there holding things up - and blocking the door entryway. The sign is silver type on orange - practically unreadable. It's the ugliest most prominent nightmare of a building, plopped into the most incoherent assemblage of parking, clinics, etc.

Soliant acknowledged that its winner is “not without controversy.” You can click here to take a virtual tour of the hospital and decide for yourself whether it deserves to be called the most beautiful hospital in America.

Coming in a close second was Michigan’s Henry Ford West Bloomfield Hospital. This is another boxy building, but Soliant notes that its food menu is beautiful, with about 3,000 selections that are “99% organic” and “designed to boost patients’ immune systems and keep their spirits high.”

Overall, only two of the hospitals on last year’s list were selected by voters this year – Sacred Heart Medical Center (mentioned above) and Dixie Regional Medical Center in St. George, Utah.

-- Karen Kaplan

Photo: The fictional Seattle Grace Hospital on "Grey's Anatomy" wasn't on the list of most beautiful hospitals, but L.A.'s Sepulveda Ambulatory Care Center -- whose exterior doubles as Seattle Grace -- was No. 2 last year. Credit: Karen Neal/ABC

High school students show a slower rate of decline in smoking in recent years

One in five high school students in the U.S. is still smoking, and the rate of decline in smoking has slowed, according to a new report released Thursday from the Centers for Disease Control and Prevention.

Smoking rates among high school students slowed dramatically from the late 1990s through the early 2000s. But those rates of decline decreased more gradually from the early to late 2000s. The CDC analyzed data from the National Youth Risk Behavior Survey of high school students in public and private schools in all states and the District of Columbia.

The percentage of students who said they currently smoke cigarettes (defined as smoking a cigarette at least one day of the 30 before the survey) went from 27.5% in 1991 to 36.4% in 1997, then went down to 21.9% in 2003. In 2009 that number was 19.5%, representing a slower decline.

The percentage of students who ever smoked or tried cigarettes (even taking one or two puffs constituted trying a cigarette) stayed steady from 1991 to 1999. That category then saw a big dip -- rates went from 70.4% in 1999 to 58.4% in 2003. Another gradual decline was seen after that, to 46.3% in 2009.

High schools students who said they were currently frequent cigarette smokers (smoking at least 20 days out of the 30 prior to the survey) went from 12.7% in 1991 to 16.8% in 1999. It went down to 9.7% in 2003, then saw yet another slight decline to 7.3% in 2009.

Current cigarette smoking rates declined for all racial, ethnic and gender subgroups -- except for black females. That group saw no leveling off or slowing in rates of decline after 1999.

"Although four of five don't smoke, it's discouraging to see that current smoking did not continue to decline more rapidly among youth," said CDC director Dr. Thomas Frieden in a news release. "Smoking is the leading preventable cause of death in this country and nine out of 10 adults started smoking in their teens or earlier. The slow progress since 2003 tells us that much more needs to be done to reduce youth smoking."

-- Jeannine Stein

Photo: The rate of decline in smoking among high school students has slowed in recent years. Credit: Greg Wood / AFP/Getty Images

Genetic study on longevity may be flawed

When scientists announced last week that they had identified 150 genetic features that could be used to predict whether a person will live past 100, the public was intrigued (and I reported on it myself) – but fellow scientists were skeptical.

A few aspects of the study raised red flags for geneticists.

First, the impressive 77% prediction accuracy was unheard of for similar types of reports, and particularly stood out given the relatively small number of subjects for this study. The study featured more than 1,000 centenarians -- an impressive number given how rare it is for people to live this long. But most genetic studies of this type (ones that look at the entire genome to try to find associations with particular traits or diseases) need DNA data from tens or hundreds of thousands of people to reach meaningful conclusions.

There were also some methodological issues. The researchers weren’t totally consistent about the DNA-analyzing technology they used over the course of the study, reportedly because the tool they used at the beginning of the study was taken off the market midway through, so they had to switch to a comparable but not identical product.

Furthermore, genetic information from the centenarians and the younger controls was collected differently, potentially introducing errors.

The blogosphere has quickly picked up on the story since Newsweek magazine broke it July 7.  Daniel MacArthur at Genetic Future provides a technical perspective, including a graph showing one of the troubling ways that this study deviates from the usual reports of this type.

The personal genome-sequencing company 23andMe also published a blog post about the topic. The firm used its extensive genetic data of customers (including 134 who were 95 and older and 27 who were 100 and older) to test the predictive power of the reported genetic markers -- and found it to be not significantly better than random.

It’s too early to toss the study in the trash; simple follow-up experiments with standardized equipment could provide a quick answer about the truth of it. Regardless, these concerns do raise significant questions about how to ensure that good journals publish good science.

-- Rachel Bernstein

How are sadness and happiness like diseases? They're infectious, study finds

Is sadness a sickness? It appears to spread like one, a new study has found.

Researchers at Harvard University and MIT wanted to see if a mathematical model developed to track and predict the spread of infectious diseases such as SARS and foot-and-mouth disease could also apply to the spread of happiness -- and found that it worked. 

They used data collected from 1,880 subjects in the Framingham Heart Study, a long-term research effort that has followed subjects since 1948 (and added some new ones along the way), giving them physical and emotional exams every two years. At each visit, subjects were classified as content, discontent or neutral. The researchers monitored how these emotional states changed over time and how these changes depended on the emotions of the people with whom the participants came into contact.

When the information was put into a traditional infectious-disease simulation, slightly modified to reflect the unique qualities of emotional spread rather than actual disease, the researchers found a correlation between an individual's emotional state and those of the person's contacts.

In other words, it appears that you can catch happiness. Or sadness. Moreover, the "recovery time" doesn't depend on your contacts at all, which is a hallmark of diseases but surprising in an emotional context, since continuing contact with happy or sad people could be expected to affect one's emotional state even after the initial "infection."

People were found to "recover" (return to neutral) more quickly from discontent than from content; on average, a contentedness "infection" sticks around for 10 years, but it takes only five years to recover from discontent. While this may still seem like a long time, the work focused on long-term emotional states because they are more accurate measures of general life satisfaction than fleeting moods, which are already known to be contagious (think laughter).

On the other hand, sadness is more contagious than happiness: A single discontent contact doubles one's chances of becoming unhappy, while a happy contact increases the probability of becoming content by only 11%.

Researchers also found one way that emotions act differently than diseases -- they can arise due to events in your own life, such as a promotion or a disease diagnosis, rather than solely being "contagious." In another win for the good guys, it appears that happiness is more likely to come about spontaneously than is sadness.

A report of the emotions-as-diseases research has been published in the Proceedings of the Royal Society B.

-- Rachel Bernstein

Photo: We may recover from sadness more quickly than we do from happiness, but it appears to be more infectious. Credit: Reuters

The FDA warns against using quinine for leg cramps

The Food and Drug Administration on Thursday cautioned consumers against using quinine for leg cramps, warning that the drug could cause severe side effects, including death. Quinine, sold in this country under the brand name Qualaquin, is approved for treatment of uncomplicated malaria, but has a long history of use as a remedy for leg cramps, especially at night. In many countries, it is sold over the counter. Studies have shown that it can reduce the incidence of cramps by one-third to one-half but that as many as one in every 25 users can suffer serious side effects.

In a new warning to health professionals, the FDA said that between April 2005 and Oct. 1, 2008, it had received 38 reports of severe adverse events associated with the drug, including two deaths. Twenty-one patients had to be hospitalized because of severe bleeding due to a loss of blood cells called platelets -- a condition called thromobocytopenia -- and an additional 12 had bleeding in their mucosa. The agency believes many similar events went unreported.

The agency is initiating what is known as a Risk Evaluation and Mitigation Strategy that will require, among other things, that the manufacturer send a letter to healthcare professionals warning about the risks of unapproved use of quinine and that pharmacies be required to provide consumers with a medication guide illustrating what the drug is approved for and pointing out the potential side effects.

-- Thomas H. Maugh II

For more health news, follow the L.A. Times Health Facebook page.

Gallbladder removed through mouth in new surgical technique

As part of the trend in developing surgeries without external wounds, surgeons last week removed a woman's gallbladder through her mouth. The operation was performed as part of a clinical trial at UC San Diego School of Medicine.

The surgery is called NOTES -- which stands for natural orifice translumenal endoscopic surgery. The idea is to use the mouth or vagina as routes to parts of the body requiring surgery. In traditional laparoscopic -- or minimally invasive -- surgery, doctors make several small incisions through the abdominal wall and insert a tiny camera and tools to remove the gallbladder or appendix. That type of surgery is a big improvement upon the long, open incisions that patients used to require.

However, NOTES spares patients even the tiny abdominal incisions. Tools are passed down the mouth and through a hole created in the stomach. In the recent surgery, lead investigator Santiago Horgan made two tiny incisions (not requiring stitches) to pass a camera into the abdomen to increase visibility. However, the gallbladder was removed by way of the mouth.

The procedure was done as part of a study that will evaluate the safety and efficacy of NOTES compared with  laparoscopy as well as the pain levels, cosmetic outcome, costs and other outcomes, Horgan said in a news release. Horgan is the director of UCSD's Center for the Future of Surgery. The hope is that natural orifice procedures will reduce the risk of infection and pain as well as abdominal scars. The center also performed the first oral appendix removal.

-- Shari Roan

Tell the FDA how you want the bad news delivered on your fave restaurant food

It's been just over three months since the landmark healthcare reform bill was signed into law, and the federal government is now drafting the regulations that will bring some of the law's key anti-obesity initiatives to a restaurant or fast-food counter near you.

Specifically, the bill made it the law of the land that restaurants that are part of a chain of more than 20 stores must post for consumers the calorie content of their offerings. Consumers must be able to get, in writing and on the spot, a lot of additional details about the nutritional content of the food served, including its total fat, saturated fat, sodium, fiber, total carbohydrates, complex carbohydrates, sugars, dietary fiber and total protein.

Now, several states and local jurisdictions beat the federal government to the punch on this. But the federal law will impose greater consistency on what is a patchwork of nutritional-posting requirements. 

For patients with diabetes, those who tote their points with Weight Watchers, or watch their carbs on one of the many low-carb diets, for consumers concerned about sodium's impact on their blood pressure or seeking to banish saturated fat from their plate, the way in which of all this information is presented can make it easier or harder to follow an eating plan. So here's your chance to tell the FDA how you would have restaurants, delicatessens, fast-food-joints, shops brewing coffee or scooping ice cream -- even movie theaters -- organize and provide nutritional information for consumers like you.

Here's the link to give the FDA a piece of your mind. (After choosing "submit a comment," you'll need to supply the following "Docket number": FDA-2010-N-0298 and hit "search.")

The site for comments opened midday Thursday and will stay open for 60 days.

Still wondering how healthcare reform will affect you? Here's the government's comprehensive site.

--Melissa Healy

Spotted: Food-label glitches in the FDA's very own cafeteria!

It’s the Food and Drug Administration’s job to regulate food labels, but it turns out the agency turns a blind eye to some of the items for sale within its own cafeteria.

On a recent visit to the FDA’s headquarters in Silver Spring, Md., Bruce Silverglade, legal affairs director for the nonprofit Center for Science in the Public Interest, visited the cafeteria in the hopes of picking up a quick and healthy lunch. The first half of the food-selection process was easy. Tray in hand, Silverglade waited in line with the FDA employees to choose his entrée — and was quite impressed to see that each item had an easy-to-read nutrition label tacked next to its description.

But when he went to select his drink, his feel-good, happy thoughts quickly disappeared. The FDA’s cafeteria was no longer the Elysian field of proper food labeling that he had thought it was. Disappointment set in as he spotted one deceptive label after another.

The "contraband" beverages that Silverglade spotted were: Purity Organic Functional Drinks' Pomegranate Blueberry, Crystal Light Immunity Berry Pomegranate, and SoBe Lifewater B-Energy Black Cherry Dragonfruit -- each with misleading claims on its packaging.

“This is the last place I’d expect to find these products,” Silverglade said in a phone interview. “I was shocked to see them there.”  OK, so it’s not like these products will bite you if try to pick them up, but Silverglade points out that their misleading labels are not fair and not healthy for consumers.

“Consumers who read these labels trust them to provide accurate information. When products are mislabeled, they are falsely believing that they are getting health benefits when they are not,” he said.

These three beverages, although small in number and size, are only a fractional representation of a greater problem, he added. In March 2010, the FDA began a serious crackdown on mislabeled food products — a move that was at first hailed as a victory by the CSPI, but soon led to disappointment.

“We certainly supported that effort. The Agency targeted particular companies that needed to change their labeling, but in the end, only 17 companies were written up. We would have preferred they take a broader industry-wide approach to this problem,” Silverglade said.

Had the FDA taken a more active stance, perhaps by implementing a “systematic regulatory framework” for monitoring food product labels across the board, hiccups such as selling the items Silverglade spotted might never have happened.

So what’s so bad about Silverglade’s three beverages?

Purity Organic Functional Drinks Pomegranate Blueberry has a label that claims that the gingko biloba in the drink “will enhance your memory and keep you thinking straight.”

“Government studies themselves have shown that ginkgo does not enhance memory or lower the incidence of Alzheimer’s or dementia, and yet these mislabeled products are still showing up, in the cafeteria, no less,” Silverglade said. The fact that the FDA sells a product thus labeled within its own agency is a bit embarrassing.

The Crystal Light Immunity Berry Pomegranate drink that Silverglade found in the cafeteria had expired. And not just by a few months. The bottle he bought was long past its “Best before 26 December 2007” expiration date.

In addition, Silverglade finds fault with use of the word "immunity" in the drink's name, which seems to intimate that the vitamins in the drink will help ward off colds or other sicknesses — a claim that is entirely false, Silverglade said. He notes that CSPI urged the FDA to take enforcement action against this product back in 2008.

Lastly, the problems associated with the SoBe Lifewater B-Energy Black Cherry Dragonfruit drink (aside from the fact that there is no black cherry or dragon fruit juice in the drink) are the health claims made about B vitamins. The labels on the SoBe beverage claim that it will "help your body unlock the energy in foods"-- implying, Silverglade said,  that it will make one feel more energetic because of the vitamin  content.

“It plays off statements in nutrition textbooks that people are familiar with, that these vitamins will help improve your health. Yes, they will, but not in any form that your body can feel,” Silverglade said.

Finding mislabeled food products such as these in the cafeteria of the FDA is by no means a sign that the Armageddon has come, but they can help to open the public’s (and the FDA’s) eye to the fact that although the number of mislabeled foods is decreasing, stronger efforts to regulate them could be made.

Obviously there are a number of mislabeled products out there — so many that even the FDA has a hard time keeping track of them. The CSPI thinks a major overhaul is needed.

--Jessie Schiewe

Ancestry, not just race, is important to personal medical history

Doctors often ask patients to list their race -- white, Latino, African American, Asian, Native American -- to help them provide better healthcare. They do this because loads of medical research shows that the incidence of certain diseases and treatment success can vary somewhat from race to race.

But the more important question may be: What is your genetic ancestry?

A study released Wednesday in the New England Journal of Medicine examined the accuracy of a lung function test and how race and ancestry played a role in the test's accuracy. A lung function test measures damage to the lungs caused by asthma or other disease. However, the definition of "normal" lung function is known to vary substantially by race. For example, doctors have long known that vital lung capacity (the maximum amount of air that can be expelled after maximum inhalation) is 6% to 12% lower in blacks compared with whites and Native Americans.

Researchers looked at data from more than 3,000 patients that included their lung function test results, standard information on race and additional information on genetic ancestry that was obtained through genotyping. The study found that standard race categories don't capture the extent of ancestral diversity and, thus, may limit the amount of information available to a doctor in making a diagnosis or ordering treatment. Instead, many people have a rich and diverse genetic background that does not lend itself to a simple classification, such as "white" or "Asian."

For example, when using genetic ancestry data, the study showed a strong link between African ancestry and lung function measurement in both men and women. According to the findings, for 6.4% of people in the United States who identify themselves as African American, the actual percentage of African ancestry would be 15% higher or lower than average -- a difference that would result in an incorrect estimation of lung function test, and possibly, mistakes about the severity of lung disease. About 2.1 million self-identified African Americans have asthma. But based on the study conclusions, the severity of the asthma would be misclassified in about 4% of those patients.

"When we force patients into an individual box, such as 'African American' or 'Caucasian,' we're missing a lot of genetic information," senior author of the study Dr. Esteban G. Burchard, of UC San Francisco, said in a news release. "This study provides new evidence that genetic ancestry correlates to physiological measures. With it, we're one step closer to personalized medicine."

On a more practical level, the study points to the need for improvements in measuring lung function in some people. In an editorial accompanying the paper, authors noted: "Refinements are needed for poorly represented or misrepresented populations and for persons of mixed ancestry, who represent an increasing proportion of the U.S. population."

-- Shari Roan
 
Photo: Getty Images

 

Suicide barriers may not prevent people from jumping elsewhere, study finds

Building suicide barriers on buildings and bridges seems like a good idea, but a new study finds that such obstacles may not have an effect on an area's rate of suicide by jumping from heights.

Canadian researchers examined suicide rates at the Bloor Street Viaduct in the years before and after a suicide barrier was erected. The viaduct, located in Toronto, averaged about 10 suicides a year from 1993 to 2002, prompting the building of a barrier in 2002 and 2003 to prevent people from jumping.

Coroner's records on all suicides in the province of Ontario were examined from 1993 to 2007, and researchers divided that period into the years before the barrier was constructed (1993 to 2001) and the years after the barrier went up (2003 to 2007).

The rate of suicide in Toronto by jumping from a height didn't change after the barrier was put up. An average 9.3 suicides per year occurred at the viaduct before the barrier, and none after. However, the yearly rate of suicides by jumping from bridges other than the viaduct went from 8.7 before the barrier to 14.2 after. There was a decrease in the overall suicide rate in Toronto and in the rate of suicide by methods other than jumping in the years after the barrier was built.

The authors conclude that although such a barrier may stop suicides at a specific location, it may not stop people from jumping to their deaths at similar locations.

But an accompanying editorial points out that there are arguments for putting up barriers in common jumping spots: Suicide by jumping is often impulsive, and an obstacle could stop someone from killing themselves. Also, these types of suicides often get a great deal of media attention, possibly triggering similar suicide attempts.

The editorial also noted that the number of pre-barrier suicides at the Bloor Street Viaduct may be too small to made any deductions about overall suicide rates in the area. Also, because it's not known if suicides at other bridges were increasing in the years before the barrier was built, no one can be sure what caused the overall rise in suicides by jumping after the barrier went up. Other studies have shown that constructing barriers at suicide "hot spots" may lead to an overall decrease in jumping deaths.

The study was published this week online in the British Medical Journal.

-- Jeannine Stein

The Golden Gate Bridge is a common spot for suicide attempts. Photo credit: Lawrence K. Ho / Los Angeles Times

Dentists? They're strangers to 1 in 4 California kids

It's not a pretty picture, the overall state of dental care for California's kids. That's because too many of them -- one-quarter, to be exact -- don't have it. Yep. One in 4 have never even been to a dentist.

That attention-grabbing statistic is from a dental-care study released Wednesday and published in the July issue of the journal Health Affairs. It analyzed care -- or, rather, lack thereof -- for children ages 11 and under in the so-called Golden State.

The researchers, from the UCLA Center for Health Policy Research and the California HealthCare Foundation, found that the picture is especially bleak for Latino and African American kids, regardless of whether they have private insurance or public insurance (Medicaid for the Children's Health Insurance Program). 

The abstract of the study states:

"Poor oral health has important implications for the healthy development of children. Children in Medicaid, especially Latinos and African Americans, experience high rates of tooth decay, yet they visit dentists less often than privately insured children. Even Latino and African American children with private insurance are less likely than white children to visit dentists and have longer intervals between dental visits. Furthermore, Latino and African American children in Medicaid are more likely than white children in Medicaid to have longer intervals between visits. These findings raise concerns about Medicaid’s ability to address disparities in dental care access and, more broadly, in health care."

That seems safe to say.

The full study, Racial and Ethnic Disparities in Dental Care for Publicly Insured Children, can be accessed through the California HealthCare Foundation website.

-- Tami Dennis

Photo credit: Getty Images

Psychological test can help predict whether the love will last

Just think of how much emotional pain could be avoided if humans knew just when to exit a romantic relationship? Knowing whether to break up or stay together is a wrenching question that often lacks an easy answer.

Until now, that is. Researchers at the University of Rochester say they have devised a test to tell if a relationship is going to fall apart. The test involves uncovering what people really -- meaning really -- think of or feel about their partners. Previous studies show people are often unable or reluctant to express their true feelings about their partners. "[T]hat assumes that they know themselves how happy they are, and that's not always the case," a coauthor of the study, Ronald D. Rogge, explained in a news release.

Rogge and his colleagues devised a test in which volunteers supplied their partner's first name and two other words that related to the person -- like a pet name or distinct characteristic. The volunteers then watched a monitor as words were presented. The words conveyed positive ideas, such as "vacation" and "peace" along with the partner-related words they supplied or bad ideas, such as "tragedy" and "criticize," and the partner-related words. The respondents were asked to press a bar when they saw various words. One test featured the bad and partner-related words, and the other the good words and partner-related words. The idea was to get people's automatic reactions to the words. If people have generally good associations with their partners, they would perform the "good words" task easier than the "bad words."

That is, in fact, what happened. The volunteers who found it easier to associate their partner with bad things, and had greater difficulty associating their partner with good things, were more likely to separate over the next year.

Such a measure could be useful to therapists in trying to uncover feelings clients are unwilling to divulge and to differentiate the nature of the problem in a relationship, the authors wrote.

"[I]n deteriorating relationships, the negative associations people begin to form about their partner may be too subtle or threatening for them to recognize in themselves or too socially undesirable for them to report to others," they wrote.

The study was released Wednesday in the journal Psychological Science.

-- Shari Roan

Photo credit: Popperfoto / Getty Images

When the question about healthcare overhaul is simply: 'What about me?'

"The most common question people have about health reform is 'How will I be affected?' The answer, of course, depends on the individual, as different demographic groups will be affected very differently." So begins a series of briefs from the Robert Wood Johnson Foundation.

The briefs, released Tuesday, analyze the expected impact of the healthcare overhaul on young adults, children, older people and (sort of) people who buy insurance on the individual or small-group market. The latter is a bit too complex to easily distill, it seems. 

The summaries are not what you would call light reading (and can we have a motion to ban the abbreviation PPACA?), but they are informative. And, of course, brief

(PPACA stands for Patient Protection and Affordable Care Act -- what most people call the health overhaul or health reform law -- and it's likely something of a deterrent to consumers looking for straightforward, easy-to-understand information.)

-- Tami Dennis

Photo: Overall, the nation's seniors will see prescription drug coverage improve, the analysis says. But some will also see the premiums increase. Credit: Mark Boster / Los Angeles Times