A forgotten but crucial cause for the pertussis epidemic

Finally, the media seems to be taking note of the terrible pertussis (whooping cough) outbreaks around the country. I’m relieved to see the coverage, because pertussis can kill or cause long-term complications like brain damage, particularly in infants. But I can’t say I’ve been impressed with how the issue has been handled by the press so far.
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Category: Chemicals, Drugs, Illness | Tagged , , , | 16 Comments

Are allergies trying to protect us from ourselves?

I have a love/hate relationship with spring, thanks to the aggravating bouts of hay fever that transform me into a faucet for pretty much the entire season. So I’ll admit I was a little skeptical when my editor at Scientific American asked me last week if I wanted to write about a new paper coming out in Nature suggesting that allergies may actually be a good thing. But always curious, I said sure.
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Category: Chemicals, Food, Illness | Tagged , , , , , , | 14 Comments

On arsenic and apple juice: Is the EPA’s drinking water limit even safe?

There’s been a lot of chatter about the arsenic-in-apple-juice debacle involving TV’s Dr. Mehmet Oz, the FDA and Consumer Reports. If you don’t know the backstory, fellow PLoS blogger Deborah Blum has written two great posts about it, which you can find here and here.

I only have one thing to add. I’ve heard some people react to the Consumer Reports findings with comments like, “well, most of the arsenic levels were at or below the EPA’s limit for drinking water, so it can’t be that bad.” But for this to be true, the EPA’s arsenic limit has to be adequately protecting the public. I don’t think it is.
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Category: Chemicals, Food | Tagged , , , | 4 Comments

Nutritional oxymoron: Fat-free milk with omega-3′s

When I saw an ad for this milk the other day, I couldn’t help but laugh.

A milk that contains DHA cannot, in a strict sense of the word, be fat-free.
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Category: Food | Tagged , , , , | 6 Comments

The epigenetics of cancer

I’ve taken an embarrassingly long break from blogging, thanks in part to several big changes in my life. Since I last posted here (in January—egads!) I’ve bought my first home, given birth to a son (his name is Dean) and begun teaching a health journalism class at CUNY. But now I’m back writing again, at least part-time, so I thought I’d revisit my favorite old PLoS haunt. I also have to give due thanks to fellow PLoS blogger John Rennie—he gave an inspiring talk to my class yesterday and reminded me that, yes, I do like this thing called blogging and I would like to do it again sometime. So: hi, everyone!

A long while back, here on this very site, I wrote about how frustrated I get when people claim that the only way a substance can cause cancer is if it directly breaks DNA or other molecular bonds. In that post I was singling out a column Michael Shermer had written for Scientific American arguing why cell phones can’t possibly cause cancer; while I don’t necessarily think that cell phones do cause cancer, I nevertheless get red-faced when people invoke non-scientific arguments to make their case.
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Category: Chemicals | Tagged , , , , , | 10 Comments

How many omega-3s does your dinner have?

As I approach my third trimester, I’m becoming a bit of an omega-3 fiend. The unsaturated fatty acids have not only been tied to lower heart disease risk in adults, but they have also been shown to boost fetal brain development, especially when consumed in the final few months of pregnancy. Given that I’m not much of a cold water fish fan—the thought of chewing a mouthful of sardines makes me want to gag—I’ve been looking into how else to get them, and what I’ve uncovered has surprised me.
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Category: Food | Tagged , , , , | 14 Comments

Why pregnant women deserve drug trials

It’s easy to gloss over health care disparities until they start really affecting you or your loved ones. When I became pregnant this summer, I discovered the dearth of information available about drug safety during pregnancy. (I wrote a little about it in this Slate article published in July.) Women who rely on medication get pregnant—for instance, one in eight pregnant women takes antidepressants, which could pose serious risks, as I’ve discussed elsewhere—and pregnant women develop complications that require medicine. Yet the only drugs that have been approved by the FDA for use during pregnancy are for gestation- or birth-related problems, not for conditions like depression, hypertension or infection. And if you ask two obstetricians for their opinions about a drug’s safety, they’ll sometimes give you two different answers, as I discovered when I looked into taking Sudafed for a nasty cold I had this fall.

Certainly, it seems unethical to expose a fetus to a potentially dangerous drug in a clinical trial—after all, it cannot consent. But isn’t it worse to expose a fetus to a drug without any safety data at all, and outside the structured trial setting, where there is no patient monitoring? Yes, clinical trials in pregnant women could be dangerous. But not having them is even more so, given that pregnant women have to take drugs anyway—and without any knowledge of how they might affect them or their unborn children. Remember the sedative thalidomide, which caused pregnant women to give birth to babies with missing limbs in the 1950s, and DES, a drug prescribed to prevent miscarriages that increased the risk that female babies would develop rare vaginal cancers? Might we have avoided these disasters, or at least lessened their magnitude, if thalidomide and DES had been tested in controlled clinical trials in pregnant women first?

Thankfully, we haven’t had any major disasters like these in decades, but the government still makes drug recommendations based on little data. Take flu shots: The CDC has been telling pregnant women to get seasonal flu shots since the 1960s, but the first randomized, prospective trial testing the vaccine on pregnant women and their babies was not completed until 2008—and it was comprised of just 340 subjects in Bangladesh. (Luckily, the trial suggests that flu shots are safe, although it only tracked the health of the babies for 24 weeks after birth.) For decades, then, the FDA’s recommendations and assurances about flu shots were not based on clinical trial evidence, but retrospective data, which is often flawed. “The agency said, ‘there’s so much risk, we won’t put you in a trial—but as soon as it’s approved in a different population, we’ll give it to you,’” explains Francoise Baylis, a bioethicist at the Dalhousie University in Canada. (Not that the FDA is entirely to blame—drug companies certainly have little interest in testing their compounds in pregnant women, a small population that could pose them serious liability risks.)

I struggled over the decision to get a flu shot myself. For one thing, last year in an article in the Atlantic, veteran science journalists Shannon Brownlee and Jeanne Lenzer raised questions over whether the vaccine actually works. And although pregnant women who catch the flu in the first half of their pregnancy are at an increased risk of giving birth to children who develop schizophrenia, given the timing of my pregnancy, I was at low risk for getting the flu then anyway—and I know from conversations with Caltech biologist Paul Patterson that there is a possibility that the vaccine itself confers this same increased risk. (For more about the link between prenatal infections, vaccines and mental illness, check out this feature I wrote in Scientific American MIND in 2008.) On the other hand, I also know that it could be dangerous to get sick in my third trimester, when I will be at an increased risk for serious respiratory problems. In the end, I decided to get the flu shot once I reached the halfway point in my pregnancy, when I felt the potential schizophrenia risk was minimal, and the shot could still (possibly) protect me towards the end of my pregnancy. Still, my decision was a gamble based on a lot of incomplete information.

It’s not just flu shots, though: pregnant women are taking more medicines than ever now, as they’re having babies later in life—when they tend to be on more drugs—and medical breakthroughs have made some pregnancies possible for the very first time. “We have people with cystic fibrosis who never in decades past would survive long enough to consider pregnancy, who are now living well into middle age and beyond,” says Ruth Faden, executive director of the Johns Hopkins Berman Institute of Bioethics. These women typically need to take medications throughout their pregnancy, yet no one knows their effects.

So what’s the solution? There isn’t a perfect one, but Baylis and Faden argue that there should be trials designed to test drugs in pregnant women who are going to be taking them no matter what. That way, structures are at least in place to collect data and look for adverse events. As for new experimental drugs, Baylis recommends incorporating pregnant women into later-stage trials, once the drugs have been shown to be safe and effective for other adults. “Instead of thinking of research as a risky activity,” she says, “we need to think of the continued off-label use of drugs [during pregnancy] as the risky activity.”

Citations:

Zaman, K., Roy, E., Arifeen, S., Rahman, M., Raqib, R., Wilson, E., Omer, S., Shahid, N., Breiman, R., & Steinhoff, M. (2008). Effectiveness of Maternal Influenza Immunization in Mothers and Infants New England Journal of Medicine, 359 (15), 1555-1564 DOI: 10.1056/NEJMoa0708630

Brown, A. (2005). Prenatal Infection as a Risk Factor for Schizophrenia Schizophrenia Bulletin, 32 (2), 200-202 DOI: 10.1093/schbul/sbj052

Category: Drugs | Tagged , , , , | 36 Comments

How to avoid harmful chemicals: just pick up your iPhone

Happy New Year! My first post of 2011 will be a cheerful one: I’ve made a new and potentially very useful discovery. I frequently harp on the fact that household and personal care products are rife with nasty chemicals (even the ones that say they’re not!), but I’ve never found an easy way to avoid them. How can you tell which products are the safest when you’re browsing the drug store aisle without your computer?

Well, turns out there’s an iPhone app for that. The GoodGuide, a database that ranks household products according to their health and environmental impacts, has a new feature on its free iPhone application that uses the phone’s camera as a barcode scanner. Simply pick up a product, use the camera to scan the barcode, and within seconds you can see its GoodGuide score (the higher the number, the better the product). I discovered this new feature yesterday and ran around my apartment scanning barcodes like a mad woman. I’m proud to note that most of what I scanned scored quite well—but that’s probably because I do my homework before I go shopping. Now, though, I won’t have to. Yet another excuse to be lazy.

Download the Goodguide’s free iPhone app here.

Category: Chemicals | Tagged , , , , , | 6 Comments

The dirty truth about “green” products

This month I have a short feature in Redbook about managing and preventing indoor air pollution. It might not be the most eloquent article I’ve ever written, but in all honesty, I am more excited about this piece than I am about most of my others, because it is an article that I know could really and truly help people. If some of the suggestions end up reducing a family’s exposures to toxic chemicals, then I am one happy lady.

While reporting the piece, I learned something that really shocked me: so-called “green” or “natural” household cleaners aren’t any less toxic than regular ones—and in fact, are sometimes more so. 
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Category: Chemicals | Tagged , , , , , | 12 Comments

On vacation

Hi all—just wanted to write a quick post to let you know that I’ll be away from now until after Thanksgiving. My husband and I are off to Italy for two weeks. We can’t wait! Take care and enjoy the holiday(s).

Category: Announcement | 3 Comments