8/8/2007 web-based article Wendy Koch www.usatoday.com The Marlboro Man, that cigarette-smoking icon of the tobacco industry, is more than a half-century old. If he were conceived today, there might not be just a cigarette dangling from his mouth. He might also have, tucked into his pocket, a cellphone-size container holding a dozen pouches of snus. Snus? It rhymes with "goose," (cynics might say "noose"), and is a Swedish type of smokeless tobacco that's not your grandfather's dip or chew. Snus comes in teabag-like pouches that a user sticks between the upper lip and gum, leaves there for up to 30 minutes and discards without spitting. As no-smoking laws sweep the nation and cigarette sales continue to fall, Big Tobacco is alarming the public health community by devising other ways to try to make tobacco appealing. With smokeless products representing the only booming part of the U.S. tobacco market, snus is an effort to boost sales with a product that — unlike most smokeless ones — doesn't require users to spit out the residue. Snus also represents something more: an attempt to move smokeless tobacco beyond stereotypical users such as baseball players and rodeo cowboys, and into offices or restaurants where people want a nicotine fix but can't light up. "This is a growth strategy for us," says Bill Phelps, spokesman for Philip Morris USA, the nation's biggest tobacco company and maker of Marlboro, the top-selling cigarette. In Dallas this month, Philip Morris is launching its first smokeless product with a [...]

8/7/2007 Paramus, NJ R.J. Ignelzi Paramus Post (www.paramuspost.com) Once again, Mom was right. For years she hounded you to brush and floss regularly to help keep your teeth and gums healthy. Little did she or anyone else know then that following her oral hygiene advice may also protect you from serious illness and disease. There's growing evidence that gum or periodontal disease may put you at increased risk for heart attacks, stroke, diabetes and some cancers. In March, a study published in the New England Journal of Medicine found that treating severe gum disease can improve the function of blood vessel walls, improving heart health. The April issue of the Journal of Periodontology published studies that found periodontal bacteria in the arteries of people with heart disease and in the placentas of pregnant women with high blood pressure. Another study in that journal found that gum disease may predispose some people to developing early signs of diabetes. And earlier this year, a Harvard School of Public Health study of more than 50,000 men showed that those who had gum disease had double the risk of getting pancreatic cancer than those without gum disease. "Although the cause and effect of periodontal disease linked to other diseases is not absolutely proven, the data is starting to pile up," says Dr. David Richards, a San Diego periodontist who emphasized that it's more important than ever to "take aggressive action against periodontal disease." An estimated 80 percent of American adults have some form of [...]

8/7/2007 England, United Kingdom Daniel Martin www.dailymail.co.uk The number of patients denied access to an NHS dentist soared by more than 1 million after 500 abandoned the state sector last year. The Government's chief dental officer admitted yesterday that Labour's botched introduction of a contract designed to increase the number of NHS dentists had had precisely the opposite effect. Dr Barry Cockcroft revealed that 500 of the 21,500 dentists previously offering NHS treatment had refused to sign new contracts and were taking only private patients. With the average patient list of around 2,500, that would mean 1.25million had lost their NHS dentist. The Conservatives put the figure even higher, claiming that 1.4 million fewer patients are registered with an NHS dentist in England than in the year before the new contract began in April 2006. Conservative health spokesman Andrew Lansley said yesterday: "NHS dentistry has reached crisis point thanks to the Government's failure to negotiate a workable contract." A spokesman for the Citizen's Advice network said as many as two million people were going without treatment each year because they could not find a dentist taking NHS patients and could not afford to go private. Liz Phelps added: "The shocking truth is that despite all the assurances that the situation is improving, there has been no overall increase at all in the number of patients seen by NHS dentists in the first year of the reforms." The figures make a mockery of the pledge made by Tony Blair eight years [...]

8/4/2007 Pittsburgh, PA SS Agarwala et al. Annals of Oncology 2007 18(7):1224-1229 Background: Our goal was to evaluate long-term efficacy outcomes of patients with squamous cell carcinoma of the head and neck (SCCHN) treated with carboplatin, paclitaxel (Taxol) and radiotherapy. Patients and methods: We conducted a phase II trial in inoperable patients with locally advanced SCCHN. Carboplatin 100 mg/m2 and paclitaxel 40 mg/m2 were administered i.v. once a week during external beam radiation therapy (180 cGy per fraction) for 6–7 weeks. Interstitial brachytherapy was used as a boost in selected patients with primary malignancies of the oral cavity and the oropharynx. Results: Fifty-five patients were enrolled. Fifty-two patients (95%) had stage IV and 51 (93%) had technically unresectable disease; 62% had an oropharyngeal primary site. Twenty-one patients underwent brachytherapy boost. Grade 3 or 4 mucositis occurred in 30% of patients. One death occurred during treatment that was related to complications of gastrostomy tube placement. Forty of 50 assessable patients (80%) had an objective response, with a complete response rate of 52%. With a median follow-up of 69 months for surviving patients, the 5-year progression-free survival was 36% and the 5-year overall survival was 35%. Two of the 18 long-term survivors of >50 months were gastrostomy tube feeding dependent. Patients undergoing brachytherapy boost (n = 21) had similar outcomes compared with the rest of the patients. In multivariate analysis, baseline hemoglobin levels and N stage were predictive of survival. Conclusion: Treatment with concurrent carboplatin, paclitaxel and radiation is safe and offers [...]

8/4/2007 Kansas City, MO staff www.myfoxkc.com An ugly trend is starting to show itself in Kansas City. The painkiller fentanyl is so strong, just a little bit can kill you. Fentanyl is usually prescribed for cancer patients in severe pain, but across the country, people are getting their hands it and overdosing. So far it's not as prevalent in Kansas City, but that may be changing. The drug is prescribed at the Kansas City Cancer Center, to patients with severe pain. "When you start these medications you really do start at a low dose and work your way up," Dr. Marcus Neubauer said. That's because it's so strong: 100 times more potent than morphine. "So if someone's used to using say 15 milligrams of morphine, 15 milligrams of this, excellent potential they'll overdose," Don Mendrala, assistant Special Agent in charge with the DEA said. Prescribed most commonly as a patch, Mendrala, says it's easily abused. "It can be cut up and just put under the tongue like a lozenge," Mendrala said. The drug is strictly regulated because it's so strong, so only patients and doctors have access. "It's in the hospitals, it's in legitimate use, the problem we've encountered here is diversion of the regular pharmaceutical fentanyl, it's not been a big problem, but it happens," Mendrala said. Problem is, Mendrala says, users don't know how strong the drug is. "It's just so potent," he said. "When we have to deal with it, we'll deal with it like it's a [...]

8/2/2007 Seattle, WA Leslie Helm www.washingtonceo.com Expensive new equipment adds fuel to hospital rivalries The Swedish Cancer Institute (SCI) announced Wednesday it is has signed a contract to buy a $22 million system that uses the latest technology to help treat cancer. But the purchase may trigger a costly "arms race" between competing hospitals and medical centers to see who can provide the most technologically advanced care. To avoid such a costly race in the field of medical equipment, Swedish says it is speaking with other medical providers in the area to partner in employing the revolutionary technology. But there are other plans already in the works. The new system is the latest generation of proton beam radiotherapy equipment, known as the Clinatron 250, built by Still River Systems of Littleton, Mass. Swedish argues it will be the first center in the Pacific Northwest to offer proton beam radiation therapy (PBRT) when it receives the equipment sometime in 2010. But the Seattle Cancer Care Alliance, made up of several medical institutions affiliated with the University of Washington, announced plans last year that it would build its own center using similar technology for $100 million. Rod Hochman, who became CEO of Swedish Medical Center in April, says Swedish wants to create a consortium with other hospitals and universities to share both the cost and use of the new machine. "It will be great for the community," says Hochman. Compared to the way hospitals have approached the acquisition of such cutting-edge equipment [...]

8/1/2007 New York, NY Marilyn Chase Wall Street Journal Online (ww.wsj.com) Advocates Beat Back Effort To Limit Use of Popular Drugs That May Carry Heart Risks The Centers for Medicare and Medicaid Services -- amid pressure from patient advocacy groups, medical societies and legislators -- released new rules on its coverage of anemia drugs that are significantly less stringent than what the agency had originally planned. The proposed changes, aimed at improving patient safety, had caused a public uproar for the past two months. More than 2,600 public comments were filed, many complaining that the proposals were Draconian and threatened to compromise patients' quality of life by withholding needed treatment. The new guidelines apply mostly to people with cancer who are receiving chemotherapy that causes anemia -- a lack of red blood cells that ferry oxygen around the body. They also apply to myelodysplasia, a disorder of the bone marrow. Anemia can cause crushing fatigue, shortness of breath and cardiac arrhythmia. The anti-anemia drugs -- Amgen Inc.'s Epogen and Aranesp and Johnson & Johnson's Procrit -- were hailed a decade ago as alternatives to blood transfusions, which despite improved screening still carry a small risk of infections and immune reactions. But recent research has suggested that overuse of these drugs -- known medically as erythropoiesis-stimulating agents, or ESAs -- may carry serious risks. A number of studies show increased cardiovascular risks among patients on the drugs, and raise questions about whether they fuel the growth of tumors in cancer patients. [...]

8/1/2007 Seattle, WA Tom Paulson Seattlepi.com Virus found under men's fingernails, pointing to more ways of it spreading. Controversy continues to plague efforts to protect young women against cervical cancer by vaccinating them against HPV, the human papillomavirus, but one leading scientist's discovery could throw a monkey wrench into the debate. "We found HPV under the fingernails of young men," said Dr. Laura Koutsky, a University of Washington epidemiologist. Koutsky led some of the pioneering research and clinical trials that resulted in an HPV vaccine, Merck's Gardasil, recently approved for use in girls and young women. The reason her fingernail finding is a potential bombshell has to do with why the vaccine is controversial. HPV, which is the leading cause of most cervical cancers, is primarily a sexually transmitted disease. Opponents of HPV vaccines believe that immunizing girls against this virus sends the message that engaging in sex at a young age is acceptable behavior. The presence of HPV under fingernails, she said, at the very least suggests another possible route of transmission. It's an additional route of infection, she said, that could explain some previous apparent anomalies such as HPV infection in infants and young girls who had not yet engaged in sexual activity. Koutsky's not quite sure what to make of the finding, which has yet to be reported in a journal, but she said it is certainly "a surprise." "In spite of (the debate), a considerable amount of the vaccine has been distributed already," said Dr. Lauri [...]

8/1/2007 Boston, MA E. Burke et al Journal of Clinical Oncology, Vol 25, No 18S (June 20 Supplement), 2007: 6054 Background: We examined the impact of chemoradiotherapy (CRT) on swallowing function in a group of patients treated for locally advanced head and neck cancer in an ongoing randomized phase II study with concurrent CRT, with or without Ethyol. Methods: Chemotherapy consisted of weekly carboplatin AUC 1.5 and paclitaxel at 45 /m2 for 4 weeks. Radiation was delivered using a 3 field technique with a concomitant boost schedule to a total dose of 72 Gy. Patients were randomized to receive or not receive daily subcutaneous Ethyol. Patients had video swallow studies at the start of radiation and 8, 12, 24 and 52 weeks post chemoradiotherapy. Dysphagia and weight loss were monitored. Video swallow study reports were collected and the incidence of penetration, aspiration, pharyngeal residue and upper esophageal narrowing analyzed. Results: Baseline data were available for 31 patients out of 43 enrolled. 29% of the patients penetrated, 6.4% aspirated and 29% had pharyngeal residue. Patients on both arms of the study had a steady decline in swallowing function from onset until 24 weeks post radiation. Penetration, aspiration and pharyngeal residue were consistently noted at all time points and improvements in deglutition were seen on the 52-week post radiation video swallow. Forty percent of the patients (17/43) had narrowing in the upper esophagus. On average, a third of the patients examined required dilations. The remaining patients with esophageal narrowing were able to [...]