Drugs in Our Drinking Water?

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Tiny amounts of pharmaceuticals — including antibiotics, hormones, mood stabilizers, and other drugs — are in our drinking water supplies, according to a media report.

In an investigation by the Associated Press, drinking water supplies in 24 major metropolitan areas were found to include drugs.

According to the investigation, the drugs get into the drinking water supply through several routes: some people flush unneeded medication down toilets; other medicine gets into the water supply after people take medication, absorb some, and pass the rest out in urine or feces. Some pharmaceuticals remain even after wastewater treatments and cleansing by water treatment plants, the investigation showed.

Although levels are low — reportedly measured in parts per billion or trillion — and utility companies contend the water is safe, experts from private organizations and the government say they can't say for sure whether the levels of drugs in drinking water are low enough to discount harmful health effects.

WebMD asked experts to give their take on the potential risks of drugs in the water supply.

Is this a new phenomenon, the finding of pharmaceuticals in public water supplies?

No. Low levels of pharmaceuticals in the water supply have been a concern for a decade or longer, says Sarah Janssen, MD, PHD, MPH, a science fellow at the Natural Resources Defense Council, an environmental action group.

"Ever since the late 1990s, the science community has recognized that pharmaceuticals, especially oral contraceptives, are found in sewage water and are potentially contaminating drinking water," Janssen tells WebMD.

Concern among scientists increased when fish in the Potomac River and elsewhere were found to have both male and female characteristics when exposed to estrogen-like substances, she says. For instance, some fish had both testes and an ovary, she says.

Scientists starting looking at the effects of oral contraceptives first, she says. "Now analyses have expanded to look at other drugs," Janssen says.

Technology has made this research easier, says Suzanne Rudzinski, deputy director for science and technology in the Office of Water at the U.S. Environmental Protection Agency. "Analytical methods have gotten better and we are able to detect lower levels than ever before."

Is there a health effect of drugs in drinking water?

All sides of the debate agree this is not known for sure. "At this point we don't have evidence of a health effect," Rudzinski says, "although it's an area of concern and one we will continue to look at."

Janssen agrees: "We don't know. It's true that the levels [of the medications found in drinking water] are very low. But especially when it comes to pharmaceuticals that are synthetic hormones, there is concern, because hormones work at very low concentrations in the human body."

"We don't want people to be alarmed and think they can't drink their tap water or that they shouldn't be drinking water," Janssen says. "We think this report in particular is a call for our federal agencies — EPA in particular — to do further studies to see what the health effects are."

EPA's ongoing research is focusing on the effect of pharmaceuticals in the water supply on aquatic life and human health, Rudzinski says. But she could not supply details of how much money is being allocated to that research effort or when to expect answers.

Are certain people — say pregnant women, children, the elderly — more sensitive to the potential effects of drugs in the drinking water supply?

Again, it's not known, Janssen says. "We know that kids, including babies and toddlers, as well as fetuses, are more susceptible to environmental exposures because their bodies are still developing and their exposure on a pound-per-pound basis is higher. And they lack the detoxification system adults have. So it is not unreasonable to expect they would be at higher risk."

Can boiling tap water get rid of the medicines, or would drinking bottled water solve the problem?

Boiling will not solve the problem, Janssen says. And forget bottled water as a way to escape the low levels of drugs found in some public water supplies. "Twenty five percent of bottled water comes from the tap," she says, citing an NRDC report.

Labels on bottled water, regulated by the FDA, help consumers know what they are getting, says Stephen Kay, a spokesman for the International Bottled Water Association. If bottled water companies use water from municipal sources and do not treat it further to purify it, the FDA views the source as legitimate but requires the label to state that it is from a municipal or community water system. Bottled water companies that use municipal source water, but then treat and purify it by using reverse osmosis, distillation, or other processes can label it as such using terms such as "purified water" or "reverse osmosis" water.

Home filtering systems such as reverse osmosis may reduce the medication levels, says Timothy Bartrand, PhD, a postdoctoral fellow at Drexel University, Philadelphia, who participated in a National Science Foundation workshop to develop a drinking water research agenda.

"An activated charcoal system will remove some pharmaceutical drugs but not all," Janssen says. "A reverse osmosis system can also remove some."

What else can consumers do to find answers or improve the situation?

Contact your local public utilities and ask them what pollutants they test for in drinking water, Janssen says, as one way to raise awareness of the problem. Contacting your senator or congressman is another.

When disposing of expired or unneeded medications, don't flush them, Rudzinski says. Instead, mix unused or unwanted drugs with coffee grounds or kitty litter, something that will be unpalatable to pets. Put the mixture in a sealed container so it's not accessible to children or pets and put the mixture in the trash.

Fighting Cancer With a Pen

When 69-year-old Carl Irwin arrived at Georgetown University's Lombardi Comprehensive Cancer Center for treatment of lymphoma, he was handed a blank notebook and asked to write about how his cancer had changed him and how he felt about those changes.

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Propped on a recliner chair, an IV in his left arm and a pen in his right hand, Irwin wrote about how he had confronted his cancer head on from the first diagnosis, how he had assembled what he called an "advisory" team, and how he felt he had made the right choice by entering a clinical trial to try to treat his disease.

"It [writing] helped my confidence immensely," said Irwin, whose journaling was part of another trial being conducted at Lombardi, in Washington, D.C. "Sometimes my brain doesn't kick in till I write."

Plenty of previous research has uncovered physical and psychological benefits to so-called expressive writing among diverse groups of patients, including people with chronic illnesses such as arthritis and asthma. Most of those studies were done in a controlled, laboratory setting.

The Georgetown study involved patients in an actual hospital setting.

"We were looking for feasibility," said Nancy Morgan, lead author of the study chronicling the Lombardi writing experiment that was published in the February issue of The Oncologist. "Our goal was to try it in the real world."

For the study, 63 patients with leukemia or lymphoma were asked when they arrived at the hospital to complete a 20-minute writing exercise as well as pre- and post-writing surveys and a telephone follow-up three weeks later.

Almost half of the participants said writing had changed how they thought about their illness and led to improvement in their quality of life, while 35 percent said writing changed how they felt about the cancer.

Sixty of the 63 people wrote "quite positively," Morgan said. "That blew my mind."

A software program helped the researchers analyze the writing for themes, words and phrases indicating how cancer had transformed the patients' lives. But Morgan said she was most interested in what people had to say, how they felt about their experience with the disease.

"Basically, we were trying to stick to thoughts and feelings rather than the facts," she said. "Writing about facts doesn't get you anywhere."

"A lot of them wrote in the survey, 'I hate thinking about cancer but writing helped me process it and I feel better, it helped me create a script of things I want to say to my family.' They were saying they just couldn't deal and writing helped them deal," said Morgan, a writing clinician and director of Lombardi's Arts & Humanities Program.

Expressive writing has now been incorporated into the hospital's arts and humanities program and is part of general patient orientation, when Morgan makes a presentation and hands out blank journals.

Some trial participants have incorporated the practice into their lives.

"I started writing updates for relatives and close friends, and I still do that to this day," two years after the trial, Irwin said. "They just about always reply."

Sandi Stromberg teaches a class, "Journaling: The Healing Power of Story," for patients and caregivers at M.D. Anderson Cancer Center in Houston.

"They say, 'I don't want to just sit here moaning about my cancer or my loved one's cancer," she said. "For cancer patients, the whole story becomes cancer. They forget they led perfectly normal, functioning lives before cancer."

Stromberg uses non-cancer related prompts such as "Write about your first car." Invariably, the patients want to share what they've written, and they bond strongly to each other.

"One time I had a man, I didn't think he would take part, and he did, and he started to cry," Stromberg recalled. "The woman next to him had the same cancer and was a four-year survivor. She put her hand on his wrist and said, 'I understand right where you are.' And he looked at her, and he said, 'Thank you,' with a big smile on his face."

Freeze or Heat Cells to Fight Cancer

— Researchers are running hot and cold on cancer treatment.

New studies suggest that freezing tumors — and in other cases heating them — could mean quicker and less invasive treatment for some cancer patients.

In one technique, surgeons use a thin probe to quickly freeze cancer cells in patients with renal cell cancer — the most common type of kidney cancer. The procedure kills the cancer cells, says Christos Georgiades, MD, interventional radiologist at Johns Hopkins Hospital in Baltimore.

Georgiades used the technique — called cryoablation — in 65 patients who had kidney tumors about 3 centimeters in size, on average. He says the procedure had a 97% success rate in patients whose tumors were less than 4 centimeters in size.

Researchers at Wayne State University used a similar procedure to treat 90 kidney cancer patients for a 94% success rate.

Doctors guide the probe to the tumors using a CT scan, performing the procedure in a radiology suite rather than an operating room.

Georgiades says targeted freezing could be a viable option for cancer patients who can't have more invasive surgery because of the dangers of general anesthesia. Patients with heart or lung disease often can't go to the operating room because of the risks.

"Half the patients treated have this procedure on an outpatient basis; they went home the same day," Georgiades told reporters at a conference of the Society of Interventional Radiology conference in Washington, D.C.

Still, the results are preliminary. Only half of his patients have been followed for at least one year. It's unclear how many of the cancers will come back as time goes on.

Killing Cancer Cells With Heat

Meanwhile, researchers in France are taking a similar — though much hotter — approach to small lung cancers. They're using a thin probe to quickly heat up cancer cells and kill them.

The probe has a fan of thin filaments at its tip that use radiofrequency energy to heat cells up to 60 degrees Celsius (140 degrees Fahrenheit).

"It's very close to a microwave at home," says Thierry de Baere, MD, a researcher at the Institut Gustave Roussy in Villejuif, France.

Radiofrequency ablation has never been directly compared to traditional surgery. But Thierry says that 70% of his patients were still alive after two years vs. an average of 48% in similar patients who can't have surgery because of the extent of their disease or other health problems. They were able to completely destroy about 90% of the tumors, he says.

For patients who can have traditional surgery, de Baere says his results are comparable. But the advantage may be convenience and fewer side effects. About two-thirds of patients were able to leave the hospital within two days of their radiofrequency procedures, he says. About 12% had to have a chest tube put in because of an injury caused by the probe.

Paradigm Medical Industries To Introduce Early Glaucoma Detection Device At ASCRS Conference

Paradigm Medical Industries, Inc. (OTCBB: PMED.OB), said it will introduce the Glaid-PERG electrophysiology instrument for the early detection of glaucoma at the American Society for Cataract Refractive Surgeons (ASCRS) Conference in Chicago, IL, next month.

"All research and studies indicate the Glaid-PERG diagnostic device is the earliest means of detecting cellular losses attributed to glaucoma and other ocular ailments," said Paradigm Medical's Chief Executive Officer, Raymond Cannefax. The Company signed an exclusive agreement with LACE Elettronica srl (Rome, Italy) to distribute the Glaid-PERG instrument earlier this year.

After many years of clinical studies at major U.S. and European glaucoma centers, as well as at universities and research centers, the Glaid-PERG has proven to provide high test repeatability and a high level of accuracy. Ongoing research is indicating testing application for ocular ailments other than glaucoma.

"We are excited about the impact the new instrument will have-not only in our industry, but in medical benefits to those who will be diagnosed early as glaucoma suspects," Mr. Cannefax added. "Early diagnosis will help reduce vision loss and help preserve sight. This is a logical progression in the early detection of glaucoma, the world's major contributor to vision loss."

Paradigm Medical will also introduce the prototype version of its redesigned LD400 Autoperimetry system at the ASCRS show. The LD400 is used to measure patient visual fields to determine the severity of glaucoma and to aid in managing the disease.

"The introduction of these two devices is further indication of our Company's leading technology in eye care," Mr. Cannefax noted. "It is all part of our 'Continuous Improvement' commitment."

Paradigm Medical Industries, Inc., is a leader in Ultrasound devices, and glaucoma detection and management products.

This press release contains statements that, if not verifiable historic fact, may be viewed as forward-looking statements that could predict future events and outcomes with respect to Paradigm and its business. The predictions embodied in these statements will involve risk and uncertainty and, accordingly, actual results may differ significantly from the results discussed or implied in such forward-looking statements.

New Localized Cancer Treatment For Advanced Retinoblastoma Saves Children From Having Eyes Removed, Restores Vision In Some Cases

A new interventional radiology treatment successfully treats advanced retinoblastoma -- a deadly, inherited cancer of one or both eyes in children -- and often spares them from having their eyes surgically removed (enucleated), according to the results of a study released today at the Society of Interventional Radiology's 33rd Annual Scientific Meeting. Advanced retinoblastoma is the most common eye cancer in children and -- because there is no effective drug treatment -- is usually treated by removing the eye to avoid the cancer spreading. Because an interventional radiologist delivers the drug directly to the eye via the ophthalmic artery, a much larger, curative dose of the cancer-killing drug, Melphalan, can be given than with intravenous chemotherapy. "This new interventional radiology treatment is a tremendous advance in treating retinoblastoma. It allows many children to keep their eyes and -- in some cases -- restores vision," said Pierre Gobin, M.D., attending radiologist, professor of radiology and neurosurgery and director of the Division of Interventional Neuroradiology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City. "In this research study, we enrolled 21 patients with advanced retinoblastoma for whom conventional treatment is enucleation," he noted.

The treatment cured half the patients for whom there is enough follow-up and improved the vision in some. Whether the vision can be improved depends on the size of the tumor and whether the vision was already lost before the interventional radiology treatment. In those cases, the treatment keeps the eye in place, which is better than having a prosthesis.

In cases of advanced retinoblastoma, removing one eye (when the fellow eye is intact) will allow the child to have fully functional vision -- and is a life - saving procedure. However, some retinoblastoma involve both eyes. Retinoblastoma is often discovered before three years of age at an advanced stage because young children do not complain about loss of vision in only one eye. By the time white discoloration of the pupil is noticeable, the tumor is already large.

Using moving X-rays, an interventional radiologist threads a catheter up the femoral artery, guides it to the ophthalmic artery (feeding the eye and the tumor) and then injects the drug. The tumor visibly shrinks within three weeks.

Intravenous chemotherapy is not very effective because perhaps less than 1 percent actually reaches the eye. By delivering the drug directly to the eye, a curative drug concentration can be achieved, while sparing the healthy tissue in the body.

In some cases of retinal detachment, the interventional treatment also allowed recovery of some vision. The interventional treatment is especially important in bilateral (both eyes) retinoblastoma, where vision could be lost entirely.

"We are hopeful that this interventional treatment may avoid removal of the eye in advanced tumors and even replace conventional (whole body) chemotherapy and radiation therapy in less advanced forms of retinoblastoma. Our work comes from the collaboration between an interventional radiologist, an ophthalmologist specialist in cancer and a pediatric oncologist. Modern medicine is so complex that new treatments are often discovered by physicians working in a team," explained Gobin.

This experimental treatment, which has minimal side effects, is being performed only at New York-Presbyterian Hospital/Weill Cornell Medical Center and Memorial Sloan-Kettering Cancer.

Interventional radiology is a subspecialty of medicine that specializes in minimally invasive treatments that often replace open surgery and works with other specialists across every specialty area of medicine.

Abstract 60, "A Phase I/II Study of Intra-arterial (Ophthalmic Artery) Chemotherapy for Intraocular Retinoblastoma," can be found at http://www.SIRmeeting.org.

About Retinoblastoma

In the United States, about 300 children and adolescents are diagnosed with retinoblastoma each year, with almost two-thirds (63 percent) of all cases occurring before the age of two years, according to National Cancer Institute statistics. Retinoblastoma tumors start in the retina, the very back portion of the eye; they are caused by a gene mutation and occur once in every 15,000 to 16,000 births. In most cases, the mutation occurs in a single cell in the eye, so only that eye develops a tumor. Scientists do not yet know why these sporadic mutations occur. If left untreated, the tumors can spread to the brain via the optic nerve. One-half of the children in the world who develop this cancer will die.

About Intra Arterial Chemotherapy

Each interventional chemotherapy treatment is performed with the child asleep (under general anesthesia). An artery is punctured at the groin and a microcatheter (a tiny plastic tube) is threaded up into the artery of the affected eye. The chemotherapy drug, Melphalan, is injected, so the eye receives a large dose of the drug while the rest of the body receives a small dose. The retinoblastoma is very sensitive to Melphalan, and the eye tolerates the drug well while the rest of the body receives a non-toxic dose. Three intra-arterial chemotherapy treatments are usually sufficient; however, physicians have given up to six treatments.

About the Society of Interventional Radiology

Interventional radiologists are physicians who specialize in minimally invasive, targeted treatments. They offer the most in-depth knowledge of the least invasive treatments available coupled with diagnostic and clinical experience across all specialties. They use X-ray, MRI and other imaging to advance a catheter in the body, usually in an artery, to treat at the source of the disease internally. As the inventors of angioplasty and the catheter-delivered stent, which were first used in the legs to treat peripheral arterial disease, interventional radiologists pioneered minimally invasive modern medicine. Interventional oncology is a growing specialty area of interventional radiology.

Today many conditions that once required surgery can be treated less invasively by interventional radiologists. Interventional radiology treatments offer less risk, less pain and less recovery time compared to open surgery. Visit http://www.SIRweb.org.

Society of Interventional Radiology
http://www.sirweb.org

Doctors Should Ask About Cocaine Use When Younger Patients Present With Chest Pains

In a bid to improve management of patients who present with chest pain and other heart attack symptoms, the American Heart Association (AHA) has issued a scientific statement recommending doctors ask about cocaine use when they examine younger patients with chest pains and who have no obvious risk factors for heart disease.

The statement is published as a paper in an early online issue of Circulation, the journal of the AHA, and is authored by Dr James McCord, chair of the statement writing committee and cardiology director of the chest pain unit for the Henry Ford Medical System in Detroit, Michigan, and colleagues.

McCord explained that if doctors suspect a heart attack, then they should rule out cocaine use early on because cocaine exposure changes what is safe and what is not. The statement emphasizes in particular that:

• Clot-busters and beta-blockers are dangerous for patients who have been exposed to cocaine.


• Bare metal stents rather than drug-eluting stents should be used in long-term cocaine users.


• Most cocaine-associated chest pain is not a heart attack.


• Patients who have been exposed to cocaine should be placed under observation for 9 to 12 hours.

Assessment of cocaine use is particularly important for younger patients, said McCord. 37 per cent of all cocaine-related visits to emergency departments are by people aged between 35 and 44 years, he added.

Research shows that chest pain that is associated with cocaine use tends to appear within three hours of taking the drug, but the chemical residue stays in the body for a minimum of 18 hours and can continue to present problems, said McCord. Also, doctors have more difficulty diagnosing heart attacks using electrocardiographs of younger patients, he explained.

Cocaine-associated emergency department visits went up by 47 per cent between 1999 and 2002, said the authors, which means that the number of cocaine users that doctors are likely to come across as a result of such admissions will probably increase.

A common method for diagnosing and treating heart attacks is to take the patient into the catheterization lab (the "cath lab"), which has the equipment that allows the doctor to insert a thin tube or catheter into a heart artery and then use imaging techniques to see where the blockage might be, and then inflate a small balloon to open the the artery.

Where a cath lab is not available, a doctor may give a patient who appears to have had a heart attack a clot busting drug instead. However, if the patient is a recent cocaine user there is an added risk of bleeding into the brain because of the higher blood pressure induced by the cocaine. So this procedure should only be used if the doctor is absolutely certain the patient has indeed had a heart attack, said the authors.

Beta-blockers are used to reduce blood pressure without causing narrowing of the arteries. But in patients who have recently been using cocaine and who present with chest pain, beta-blockers may actually produce the opposite effect: they could increase blood pressure and make the arteries already narrowed by cocaine even narrower. This has been shown to have potential fatal consequences in studies using animals, said McCord.

Drug eluting or bare metal stents are used to restore blood flow to the heart where there is no arterial blockage. Studies have shown that long term cocaine users fitted with stents have a tendency to lapses in taking the regular medication needed to stop drug-eluting stents becoming blocked, and that is why the statement recommends such patients be fitted with bare metal ones only.

Cocaine can worsen the effects of a heart attack, said the authors, because it increases the heart's need for oxygen, elevating heart rate, blood pressure and contraction power at each beat. But at the same time the drug also constricts blood vessels and makes it harder for the heart to get the oxygen it needs. This increases risk of clotting and manifests as angina, which is felt as chest pain.

The statement draws attention to other conditions that can develop alongside chest pain and heart attacks with cocaine users, and it is important that these are also looked for as they can be crucial to the treatment that is followed. For instance, one condition that can accompany cocaine use is aortic dissection (a tear in a blood vessel that can be fatal), another is bleeding into the lung ("crack lung").

Other symptoms that patients who use cocaine also report having alongside chest pains are shortness of breath, palpitations, feelings of anxiety, nausea, dizziness and sweating profusely. These are very similar to heart attack.

Growth Hormone Does Not Enhance Performance

A new study by researchers in the US found that contrary to what many people may assume, scientific evidence does not support claims that human growth hormone (HGH) increases strength or athletic performance.

The study was the work of Dr Hau Liu of the Santa Clara Valley Medical Center, San Jose, and Stanford University, California, and colleagues, and is published in the early online issue of the May 20th print edition of the Annals of Internal Medicine.

Liu and colleagues reviewed randomized controlled trials comparing HGH with non-HGH treatment in physically fit, healthy people aged 13 to 45 and found that while growth hormone increased lean body mass it did not increase strength and the capacity to exercise.

They also found that people who took GH had more frequent tissue swelling and experienced fatigue more often than people who did not take the substance.

The researchers concluded that the available scientific evidence does not support claims that GH improves physical performance. In fact while lean body mass may increase, strength does not and GH may even diminish exercise capacity and lead to other adverse side effects.

The safety and effectiveness of HGH is poorly understood, even though it is reportedly used to enhance athletic performance, said Liu and colleagues in their background to the study.

They decided to investigate all the published randomized controlled trials they could find that compared HGH with non-HGH treatments in healthy community dwelling people between 13 and 45 years of age. They searched a number of databases and found 44 articles of which 27 met their inclusion criteria.

When pooled together, the results showed that:

• 303 participants received HGH, equivalent to 13.3 person-years of treatment.


• The participants were young (mean age was 27 years), lean (mean BMI of 24), and physically fit (maximum O2 uptake was 51 mL per kilo of bodyweight per min).


• HGH dosage (mean of 36 micrograms per kg per day) and treatment duration (mean of 20 days) for studies where participants took HGH for more than a day varied.


• Lean body mass went up in participants taking HGH compared with those who did not (increase 2.1 kg, range 1.3 to 2.9), but strength and exercise capacity did not appear to increase.


• Lactate levels during exercise were significantly higher in 2 of the 3 studies that measured them.


• Participants who took HGH had soft tissue edema (swelling) and fatigue more often than non-HGH participants.

Liu and colleagues concluded that:

"Claims that growth hormone enhances physical performance are not supported by the scientific literature."

"Although the limited available evidence suggests that growth hormone increases lean body mass, it may not improve strength; in addition, it may worsen exercise capacity and increase adverse events," they added.

However, they said more research was needed to confirm these conclusions, and the study was limited by the fact that the dosages examined may not reflect what happens in real life.

HGH to improve athletic performance is often called sports doping, a practice that is banned by most professional sports organizations, including the International Olympic Committee, Major League Baseball, and the National Football League, said the researchers in their background information.

One of the reasons HGH is alleged to be so popular is because it is difficult to detect. It does not show in urine tests for example.

Last December, the 400-page Mitchell Report of former US Senator George Mitchell's 20-month investigation into illegal use of performance drugs in Major League Baseball, named 89 major baseball players who allegedly used performance drugs, some of whom have since admitted to using HGH, said Liu and colleagues.

Eye Disease In Canines Identified; Potential For Human Treatment

Sinisa Grozdanic, assistant professor of veterinary medicine at Iowa State University, has identified and named an eye disease not previously known. The disease, Immune-Mediated Retinopathy, or IMR, causes loss of function in retinal cells and, in some cases, blindness in canines.

Grozdanic's findings are published in the March edition of Veterinary Clinics of North America: Small Animal Practice.

IMR is very similar to a previously known malady called Sudden Acquired Retinal Degeneration Syndrome or SARDS.

Both diseases occur when the dog produces auto antibodies that attack the retinal cells. The antibodies mistake retinal cells for cancerous tumors or tissues that need to be destroyed.

In the process of attacking the retinal cells, the auto antibodies cause the retinal cells to lose function and the dog to lose some or all of its vision.

The difference between IMR and SARDS that Grozdanic identified is that the auto antibodies that attack the retinal cells in SARDS patients are produced in the eye. In the newly identified IMR, Grozdanic found that these auto antibodies are produced elsewhere in the dog and travel to the eyes in the blood.

This is a critical step in treating the disease because the source of the problem is better understood, according to Grozdanic.

"The whole purpose is to start to understand the disease better," he said. "The more we understand these diseases, the more proficient we will be developing new treatments."

Grozdanic says the evidence shows that approximately 2,000 cases of SARDS occur every year. Some of those cases may now be identified as IMR, and treated differently.

Treatment for IMR can have a relatively high success rate.

"In approximately 60 percent of the Immune-Mediated Retinopathy cases, we have been able to treat it," he said. "In some cases very successfully, in some cases moderately successfully."

Since IMR has only recently been identified, there are no statistics on how many dogs this disease affects.

Grozdanic has also developed a test to differentiate the two types of retinopathy. Grozdanic shines colored lights in the dog's eyes to see if the pupils constrict. If the pupils constrict poorly while the doctor uses the red light, and have normal constriction when blue light is used, the patient most likely suffers from IMR. If the eyes respond to blue lights, but not red lights, then the diagnosis is SARDS.

Tests show SARDS-affected eyes have almost no electrical activity. IMR-affected eyes have some electrical activity, and the retinal cells are not destroyed but have only lost function. These are the retinal cells that Grozdanic thinks can function again now that the origin of the problem is known.

In his work with canine patients with IMR during the past few years, Grozdanic has restored sight in several dogs.

According to Grozdanic, these two diseases are similar to illnesses that afflict humans, so treatment for people may not be far off.

"This was a giant leap. We are getting better at understanding it, and based on this information, we may be able to modify and improve treatment of dogs and eventually human patients," said Grozdanic.

Toxoplasmosis Treated With Newly Developed Anti-Malarial Medicine

A new drug that will soon enter clinical trials for treatment of malaria also appears to be 10 times more effective than the key medicine in the current gold-standard treatment for toxoplasmosis, a disease caused by a related parasite that infects nearly one-third of all humans - more than two billion people worldwide.

In the March issue of PLoS Neglected Tropical Diseases, a research team based at the University of Chicago Medical Center shows that the drug, known as JPC-2056, is extremely effective against Toxoplasma gondii, the parasite that causes toxoplasmosis, without toxicity.

"JPC-2056 has the potential to replace the standard treatment of pyrimethamine and sulfadiazine," said infectious disease specialist Rima McLeod, professor of ophthalmology at the University of Chicago and senior author of the study. "The drug, taken by mouth, is easily absorbed, bioavailable, and relatively nontoxic. In tissue culture and in mice, it was rapidly effective, markedly reducing numbers of parasites within just a few days."

Untreated mice injected with the parasite "appeared ill," four days after the injection, the authors note, "with ruffled fur and hunched shoulders." Treated mice remained well.

"Studies in tissue culture found no evidence of the parasite or the plaques they produce 52 days after four days of treatment," said co-author Ernest Mui, a researcher in McLeod's laboratory.

"The absence of growth," the authors write, "indicates that this compound is 'cidal' and not merely 'static' for the active form of T. gondii.

The drug inhibits the action of an enzyme, dihydrofolate reductase (DHFR), produced by the family of parasites that includes those that cause toxoplasmosis and malaria. It is structurally distinct from the human DHFR.

"The drug's effect on the malaria and Toxoplasma enzymes is robust," said McLeod. "It has much less effect on the human enzyme."

The new drug was effective against all malaria parasites, even those with multiple mutations that make them resistant to other anti-folate medicines, suggesting that "this family of parasites, including not just Toxoplasma but also various malaria parasites, will not easily develop resistance," she said.

Toxoplasma infection is "probably the most common parasitic infection in the world, causing very significant disease in those who have immature immune systems or who are immune-compromised," McLeod said. "New medications are urgently needed."

The standard medicines to treat the infection can cause severe side effects and many patients become hypersensitive to them. There are no medicines that can eliminate certain latent stages of the parasite's life cycle. There is no vaccine.

T. gondii infects humans through three principal routes: a newly infected pregnant woman passing the infection to her fetus; consumption of undercooked, infected meat; and ingestion of T. gondii oocysts in food, through accidental contamination from cat litter.

"An infected cat can excrete up to 20 million oocysts over two weeks," McLeod said. "Even a single oocyst is infectious and they can remain infectious in water for up to six months and in warm moist soil for up to a year."

Congenital toxoplasmosis, which occurs in an estimated 1 per 5,000 births a year in the United States, can cause severe vision loss, brain damage and even death. The annual cost of caring for these children may exceed $1 billion.

Also at increased risk are people with compromised immune systems, such as those with cancer, autoimmune disease, AIDS or transplant recipients. Even people with normal immune systems can suffer major organ damage from chronic infections. Eye disease leading to loss of sight is caused both during the primary infection and as a result of infection transmitted from mother to child. Recent epidemics in Surinam and French Guiana have been lethal even for young healthy victims. Studies have also found an association between chronic brain infection with Toxoplasma and diseases such as schizophrenia and epilepsy, although cause-and-effect relationships have not been proven.

JPC-2056 was developed in the late 1980s by teams led by Wilbur Milhous and Dennis Kyle of the Walter Reed Army Institute for Research in Silver Spring Maryland (both now at the University of South Florida), and David Jacobus of Jacobus Pharmaceutical Company. The original version was quite toxic, but the researchers found ways to reduce the toxicity and developed an oral version of the drug. Clinical trials using JPC-2056 to treat malaria are scheduled to begin later this year.

This new class of medicine holds "considerable promise for significant advances in the treatment of toxoplasmosis, which damages the eye and the brain," said McLeod, "as well as malaria, which kills one million children each year."

Carl Zeiss Meditec Introduces New Humphrey Field Analyzer For Glaucoma Management And Blindness Prevention

Carl Zeiss Meditec, a leader in glaucoma care, announced the release of the Humphrey® Field Analyzer II-i (HFA II-i) with new Guided Progression Analysis™ (GPA) software that accurately determines the stage of disease, rate of progression and a patient's risk of future vision loss by automatically summarizing all available visual field test results on a single page and by calculating each patient's rate of visual field deterioration. With this advanced perimeter, eye care providers can more closely monitor changes in the eye to prevent irreversible loss of vision for a disease that often has no warning signs and is the second leading cause of blindness worldwide, according to the World Health Organization.

Humphrey Field Analyzers are used by more eye care providers than any other automated diagnostic perimeter today and more than 60 thousand units have been sold since the first system was introduced in 1984. The HFA II-i is the newest and most advanced visual field testing platform and the GPA feature adds significant new diagnostic power to this established platform.

"Vision loss from glaucoma is irreversible. Thus, it is vital that doctors be able to efficiently differentiate between those patients who are doing well on present therapy versus those who are not stabilized," said Robert N. Weinreb, M.D., distinguished professor of ophthalmology and director, Hamilton Glaucoma Center of the University of California, San Diego. "Only by identifying the patients who continue to progress can glaucoma be appropriately managed to prevent vision loss or even blindness."

With Guided Progression Analysis software, the HFA II-i's standard printout presents each glaucoma patient's baseline fields, disease staging versus time, rate of progression and most recent test result - all on a single page. This new presentation format is designed to simplify and streamline clinical processes. GPA uses VFI, or Visual Field Index, to correlate with ganglion cell density and is less affected by cataract and other media changes compared with earlier indices. The HFA II-i's GPA program is based upon data gathered from a 15-center international clinical trial and its progression event analysis was used as an endpoint in the Early Manifest Glaucoma Trial.

Guided progression analysis software also is available for the GDx Scanning Laser Polarimeter and the Stratus OCT with Advanced Serial Analysis.

"The goal of our investment in new glaucoma technologies is to preserve eyesight for the nearly 60 million people worldwide suffering from this disease," said Jim Taylor, Carl Zeiss Meditec president and chief executive officer. "The HFA II-i with new GPA software helps doctors closely monitor their glaucoma patients and ensure that each patient is receiving the best course of treatment to prevent vision loss. We are proud that our Humphrey Field Analyzers have been a standard of care for nearly a quarter of a century and we are committed to continuing our efforts to provide new capabilities through new products and upgrade opportunities."

Glaucoma is a degenerative disease of the optic nerve. Most types of glaucoma progress without obvious symptoms, which is why glaucoma is often described as the "sneak thief of sight." Visual damage is largely irreversible and may lead to blindness. A 2006 study in the British Journal of Ophthalmology estimates that 60.5 million people will be affected worldwide by 2010, increasing to 79.6 million by 2020 as the population ages.

Carl Zeiss Meditec AG (ISIN: DE 0005313704) is one of the world's leading medical technology companies. This market position is based on over 160 years of experience in optical innovation. The company has two primary areas of activity. In the field of ophthalmology, Carl Zeiss Meditec offers integrated solutions for treating the four main eye diseases: vision defects (refraction), cataracts, glaucoma and retinal disorders. Product innovations range from basic systems such as slit lamps and fundus cameras to standard setting diagnostic systems such as the Humphrey® Field Analyzer, the Stratus OCT™ and the IOLMaster®, through to the surgical microscopes and innovative treatment systems in refractive laser surgery.

In the field of neuro and ENT surgery, Carl Zeiss Meditec is the world's leading provider of surgical microscopes and microsurgical visualization solutions for a very broad range of applications, such as tumour and vascular surgery in the head region and/or spinal surgery. The most recent example of our innovative performance in the area of microsurgery is the OPMI Pentero® visualization system, which allows efficient and ergonomic patient treatment.

Carl Zeiss Meditec's medical technology portfolio is rounded off by visualization systems for doctors in private practice and promising future technologies such as intraoperative radiation therapy, which allows the targeted treatment of breast cancer and brain cancer directly during surgery.

Carl Zeiss Meditec AG is based in Jena, Germany, with subsidiaries in Germany (Carl Zeiss Meditec Surgical GmbH and Carl Zeiss Meditec Vertriebsgesellschaf mbH), the USA (Carl Zeiss Meditec, Inc., Dublin, California), in Japan (Carl Zeiss Meditec Co., Ltd., Tokyo), Spain (Carl Zeiss Meditec Iberia S.A., Madrid) and France (Ioltech SAS, La Rochelle, and Carl Zeiss Meditec France SAS, Le Pecq).

Thirty-five percent of the Carl Zeiss Meditec shares are in free float. The remaining 65 percent are held by Carl Zeiss, one of the world's leading international groups engaged in the optical and opto-electronics industry. For more information, visit http://www.meditec.zeiss.com/usa.

Drugs In US Drinking Water

A five month investigation by the Associated Press has discovered that small quantities of drugs, including antibiotics, sex hormones, and anti-seizure compounds, have been found in public drinking water supplied to over 40 million Americans across the US.

While the concentrations are so small they have to be measured in parts per billion or even parts per trillion, and water companies insist these levels are within safety limits, the AP said the long term effects on people's health of so many prescription drugs and over the counter medicines such as acetaminophen (paracetamol) and ibuprofen, even in tiny amounts, are starting to worry scientists.

Drugs and their derivatives get into the drinking water supply because when people on medication go to the toilet they excrete whatever the body does not absorb and any matabolized byproducts. Water companies treat the waste before discharging it into rivers, lakes and reservoirs, and then treat it again before it enters the drinking water system. However, the various treatments don't remove all traces of drugs.

For five months, the AP National Investigative Team visited treatment plants, interviewed over 200 scientists, officials and academics, analyzed federal databases and reviewed hundreds of scientific reports.

Among their enquiries the AP investigators came across research studies that have "gone virtually unnoticed by the general public" where scientists were alarmed at the effect of the drinking water contaminants on human cells and wildlife.

The investigators also found that water companies don't like to publish the results of drug screening tests because they think the public would not know how to interpret them and would become unduly alarmed. However, the US Environmental Protection Agency (EPA) assistant administrator for water, Benjamin H Grumbles told AP that:

"We recognize it is a growing concern and we're taking it very seriously."

The AP investigators discovered that drugs have been found in the drinking water of 24 major metropolitan areas across the country. Here are some of the key findings:

• Southern California: a portion of drinking water that supplies 18.5 million people contained traces of anti-epileptic and anti-anxiety drugs.


• Philadelphia: treated drinking water contained 56 drugs or byproducts, including pharmaceuticals for pain, infection, cholesterol control, heart conditions, asthma.


• San Francisco: a sex hormone was detected in the drinking water.


• Washington DC: six drugs were found in the drinking water supply of the capital and surrounding area.


• Tucson, Arizona: an antibiotic and two other medications were found in the drinking water.


• Northern New Jersey: drinking water for 850,000 residents was found to contain carbamazepine, a mood stabilizer, and a metabolized byproduct of angina medication. This was found by US Geological Survey researchers who analyzed a treatment plant.

The AP report paints a rather chaotic and inconsistent picture of what is happening nationwide, with some water companies testing for a vast range of pharmaceutical compounds and others only testing for two. This is not surprising, since the AP team found that the "federal government doesn't require any testing and hasn't set safety limits for drugs in water".

It is not just waste water that is contaminated. The AP report says that watersheds, the natural source of most of the country's drinking water, are also affected. The AP investigators said tests were carried out in the watersheds of 35 of the 62 major water utilities they surveyed and drugs were found in 28 of them. Six of the 28, when contacted by the AP, said they did not test their drinking water, despite the watersheds being contaminated.

It would seem that no source of drinking water is entirely free of drugs. People who drink water from their own wells may not realize where the water comes from. It could come from a contaminated watershed, like one part of New York City's upstate watershed that tested positive for caffeine, often a marker of other drugs being present. One possible source of contamination for watersheds could be leaky septic tanks, according to one researcher interviewed by the AP team.

Bottled water and home filtration systems are also affected. According to the industry's main trade group, bottlers do not test or treat for pharmaceuticals (and some of these just repackage tap water said the AP).

Even aquifers, deep underground water systems that supply 40 per cent of the US water demand, are affected. The AP report mentions scientists examined aquifers located near landfill and other potential sources of contamination in in 24 states and found traces of hormones, antibiotics and other drugs.

As more and more people in the world take more and more drugs, and flush them, either unused or after metabolizing them, the concentrations entering the water system goes up. This problem is not confined to the US and the AP report cites evidence from other countries, including lakes in Switzerland and Canada. And it is not just human waste that puts drugs into the water system, but animal waste too, ranging from drugs used to treat domestic pets, to steroids used to treat cattle.

There is already evidence that drugs in the waterways is damaging wildlife, a prime example being male fish that are starting to create egg yolk proteins, a characteristic of female fish.

A large problem appears to be lack of funding to investigate the long term effects of trace amounts of pharmaceuticals, or the disproportionate way that limited funds are being used. The AP team interviewed Shane Snyder, research and development project manager at the Southern Nevada Water Authority, who said:

"I think it's a shame that so much money is going into monitoring to figure out if these things are out there, and so little is being spent on human health."

" It's time for the EPA to step up to the plate and make a statement about the need to study effects, both human and environmental," added Snyder.

Perhaps it is time, suggests the AP, for the focus that is currently maitained on regulated contaminants like pesticides, lead and PCBs, which are present in larger quantities and therefore pose a greater health risk, be extended to include medicines.

Drugs are a unique case because unlike other pollutants, they were designed to act on the human body. The AP team talked to a specialist who has studied trace hormones, heart medicine and other drugs, zoologist John Sumpter of Brunel University, London, who pointed out:

"These are chemicals that are designed to have very specific effects at very low concentrations. That's what pharmaceuticals do. So when they get out to the environment, it should not be a shock to people that they have effects."

It is true to say there is no clear evidence that trace amounts of drugs in the drinking supply are causing us harm, but this is because there have been no long term studies on the combined effects of so many drugs, albeit in trace amounts. Clinical trials of drugs concern themselves with a limited time period and use dosage amounts to test safety and side effects. They don't look at the lifetime effects of trace amounts of the drug, and certainly not in combination with a large number of others.

Gout Risk Linked To Genes

A study led by a team of scientists in Scotland suggests that genes may play a part in increasing one's risk of developing gout, a painful condition that affects the joints.

The study is published in the 9 March online issue of Nature Genetics and is the work of researchers based at the MRC Human Genetics Unit, Western General Hospital, Edinburgh, and colleagues from other research centres in the UK and also in Croatia and Germany.

Gout (also called metabolic arthritis) is a painful condition caused when uric acid, a waste product of purine metabolism that in humans and great apes is mostly excreted via the kidneys into urine, deposits in the joints.

In some people the kidneys don't clear all the uric acid from the bloodstream, a condition that is called hyperuricemia.

Some 10 per cent of people with hyperuricemia go on to develop gout, where uric acid is deposited in the joints as monosodium urate crystals, resulting in inflammation and often considerable pain. The condition usually affects the joint of the big toe, but it can also affect fingers, elbows, ankles, knees and other joints.

Causes of gout have often been attributed to diet and lifestyle, with overconsumption of protein, refined sugar and alcohol being the main culprits, but the mystery that has remained is why thousands of people with these lifestyles don't develop gout.

The answer, according to this study, could be genetic. The researchers studied the genes of more than 12,000 people and found that a gene variant may increase or lower the risk of a person developing gout.

The gene variant in question is called SLC2A9, already known to scientists as a transporter of fructose, but in this new study, the researchers, led by Professor Alan Wright of the MRC Human Genetics Unit, found the variant also plays a key role in transporting uric acid.

Wright and colleagues found that between 1.7 and 5.3 per cent of the variance in blood levels of uric acid was explained by the presence of this gene variant in a Croatian population sample, and that SLC2A9 was also linked with low levels of uric acid excretion and/or gout in population samples from the UK, Croatia and Germany.

The presence of the gene variant appears to impede the ability of the kidneys to filter uric acid from the bloodstream.

According to a BBC News report, Wright said that:

"The gene is a key player in determining the efficiency of uric acid transport across the membranes of the kidney."

The level of risk that a person has for gout will depend on which form of the gene they have inherited, said the researchers, who hope this discovery will lead to the development of improved diagnostics for the condition.

The traditional view of gout is often associated with historical stereotypes of overindulgent people who eat and drink to excess, but in reality this often not the case, with estimates placing about 1 million people in the UK suffering from some form of gout.

A representative of the British Society for Rheumatology, Professor Stuart Ralston told the BBC that he often saw people with gout who did not fit the stereotype of excessive drinking and eating of rich food, saying he knew of many patients that were "quite abstemious". Perhaps this study reveals a genetic marker for gout risk, he said, and that it could be a "target for new gout drugs". There are few medications that treat gout.

Another expert told BBC News there appears to be a link between this study and another one that suggested excessive drinking of sugary soft drinks also increased the risk of gout, since the gene variant that appears to control the ability of the body to remove uric acid from the blood is the same one that transports fructose, a sugar often found in soft drinks.

Don't Smoke Around Your Kids

Don't smoke around your kids, it damages their health - That's the message that is buzzing around the media since Dr Steve Ryan, medical director of the UK's Royal Liverpool Alder Hey Hospital for Children said that one third of the children treated at the hospital for respiratory problems such as chest infections and asthma got ill because their parents smoked when they were around.

Speaking on the BBC's Radio Five Live, Ryan said that 2,000 of the 35,000 children that his hospital treated every year were there because of being exposed to their parents' smoke. He said there would be a significant drop in the number of children with ear infections, bronchitis and asthma if their parents stopped smoking.

Ryan told the BBC that parents often lied about whether they smoked when their children were around because they felt guilty. He was not unsympathetic about the reasons:

"Looking after children is good fun but it can be stressful and for some, cigarettes are a way of relieving that stress."

Ryan said children were exposed to several levels of risk. The highest risk comes from being exposed to passive smoke in a confined space such as being in a car or a room with a person who smokes. Mothers smoking posed a greater risk than fathers, said Ryan.

Even having smoke on your clothes was a risk, said Ryan, although not as high as actually smoking in front of children. He said that a good tip is to put another layer of clothes on when you smoke, that's what the hospital staff have to do when they go outside to smoke during their breaks.

Ryan did not think more legislation was the answer to reduce children's exposure to their parents' smoke, but did think parents should know about the different levels of risk.

Radio Five Live went on to say that the British Lung Foundation estimates that 17,000 children under five years old are treated every year in the UK for illnesses resulting from being exposed to second hand smoke.

Last week a study to be published in the American Journal of Public Health was announced that suggested many parents all over the world ignored the risk that second hand smoke posed for children.

Researchers at John Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA, conducted a household study in 31 countries and found that 82 per cent of parents who smoked said they did so around their children.

Another study on nearly 150 babies, by professor Stephen S Hecht, Wallin Chair of Cancer Prevention at The Cancer Center at the University of Minnesota, found that half the babies whose parents smoked had cancer-causing chemicals in their urine.

Hecht said: "The take home message is -- Don't smoke around your kids."

A representative of ASH, the anti-smoking group told the BBC that parents should treat their homes like they now have to treat their workplaces and only smoke outside.

Ear, nose and throat (ENT) specialist Martin Birchall was reported on the BBC website on Saturday as saying that:

"Passive smoking at home, exposing children to smoke they cannot escape from, increases the risk of them getting ear disease, sticky runny noses and sore throats, and further down the track, some of these ENT symptoms can in due course led on to worse diseases such as asthma."

He said we need to "keep banging the drum" until the message is driven home. Every cigarette a parent smokes in front of his or her child is one the child also smokes, he said.