June 28, 2013

HPV Vaccine Is a Clear Success

As we wrote a couple of years ago, adolescent vaccination rates for several diseases were up, and although the one for human papillomavirus (HPV) was among them, its rates lagged the others.

Being vaccinated against HPV before a person is sexually active protects girls from developing cervical cancer later in life and can protect boys from genital warts and penile and anal cancer. HPV is the most common sexually transmitted infection.

Despite the less than ideal vaccination numbers, there’s good news: The HPV vaccine is reducing the prevalence of the virus dramatically in teenage girls.

As reported by NPR, the Centers for Disease Control and Prevention (CDC) has released a study showing that in the first four years of immunization, infections from the four strains of the virus targeted by the vaccines fell by more than half among U.S. 14- to 19-year-olds.

The study, published in the Journal of Infectious Diseases, found no decrease in the HPV strains covered by the vaccine in other age groups, which supports the idea that the vaccine is responsible for the decrease among teenagers. Also supporting the association is the fact that researchers did not find that sexual activity among girls in the target population had decreased; still, the prevalence of HPV declined from nearly 12% to slightly more than 5%.

Despite the CDC’s vigorous promotion of getting kids vaccinated before they become sexually active, many parents resist, somehow thinking that being immunized is the same thing as giving permission to have sex. Others are wary in general of vaccines, an attitude we’ve addressed here, ( “More Proof that Vaccines Have Nothing to Do with Autism”) and here. (“Feds Say Childhood Vaccine Schedule Is Safe and Effective.”)

Federal health officials, according to NPR, were surprised at the significant decrease, considering that only about 1 in 3 girls in this age group has received the full three-dose course of the vaccine. About half have received a single dose.

The CDC recommends that girls get the HPV vaccine when they are 11 or 12, but females as old as 26 are urged to get the three-shot course if they have not received the vaccine earlier. The recommendation is the same for boys, except that the “catch-up” vaccination is recommended only until 21.

The cost, says NPR, runs $128 to $135 a dose, or around $400 for the full course, but it’s covered by many insurers, and Vaccines for Children, a federal program, provides it free for qualified patients.

The CDC’s goal is to get 80 percent of adolescents fully vaccinated. CDC Director Dr. Thomas Friedan told NPR, “Of girls alive today between the ages of zero and 13, there will be 50,000 more cases of cancer if we don't increase the rates to 80%. And for every single year we delay in getting to 80%, another 4,400 women are going to develop cervical cancer in their lifetimes — even with good screening programs."

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October 12, 2012

Chronic Conditions in Kids Raise the Risk of Hospital Medical Error

About 44 in 100 pediatric inpatients suffer from chronic illnesses such as asthma, diabetes, epilepsy and cancer, according to the journal Pediatrics. And these sick kids are more likely to experience a medical error during the course of their treatment than patients who are seen for acute conditions.

In the study, medical errors were defined as abnormal complications to a specific medical procedure, adverse reactions to medications, infections and bedsores. But it is unclear how severe the medical mistakes were or if they caused significant or long-term harm.

Logic tells you that the increase in probability of a medical error is higher in someone who’s chronically ill—after all, the longer someone’s hospitalized and the worse his or her condition is, the higher the chances of complications from it. Duration and difficulty make treatment more challenging and exposure to infectious agents more likely.

The study involved 38 states in the 2006 Kids’ Inpatient Database (KID) to determine medical error rates. As reported on AboutLawsuits.com, not only was the medical error rate higher per 100 hospital discharges in children with chronic illnesses, but it was also higher per 1,000 inpatient days in children with chronic conditions.

In the 2006 KID:


  • more than 22 in 100 pediatric inpatients had one chronic condition;

  • nearly 10 in 100 had two chronic conditions;

  • 12 in 100 had more than three chronic conditions.


The researchers said that as many as 43 in 100 U.S. children have at least one chronic health condition, and almost 20 in 100 have two. These patients represent an increasing proportion of pediatric hospitalization, and account for the majority of noninjury hospital admissions. Children with special medical needs also are more susceptible to errors in emergency situations.

A report by the Institute of Medicine (IOM) found that nearly 98,000 people die in hospitals each year from a medical error that could have been prevented.

The message of the Pediatrics study was simple: The more chronic conditions a child suffers, the greater the likelihood that an error will occur when they are in the hospital. And the greater the need for parents to be strong patient advocates. To learn how, see our newsletter, “Protecting a Loved One in the Hospital.”

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February 19, 2012

Cancer Drug's Short Supply Moves to Critical Stage

After it failed an inspection in November by the FDA, Ben Venue Laboratories in Ohio was shut down. No one in his or her right mind would want to take drugs manufactured in a place where mold was growing on the walls and machinery rust was falling into vials.

Now, the toll of the lab’s decrepit state might have to be paid by children with acute lymphoblastic leukemia (ALL) and a type of bone cancer, osteogenic sarcoma. They rely on a longtime cancer drug, methotrexate, that, as NPR reported, can mean the difference between death and cure.

Ben Venue was a principal supplier of injectable methotrexate. Now, its shortage is acute, the latest in long line of critical drug shortages. We’ve written often on the topic, and what is being done to address it.

According to NPR, hospitals throughout the country are “perilously close” to exhausting their supplies of the kind of methotrexate that treats ALL and osteogenic sarcoma. In a few weeks, substituting or delaying therapy might be forced on some patients. Their doctors aren’t certain how that will affect their chances of a cure, which are 9 in 10 with the right treatment.

One expert on drug shortages told NPR that most people don’t realize how many U.S. drug plants are in extreme disrepair, especially those that manufacture generic drugs. Ben Venue claims to have invested $250 million recently to upgrade its facilities, but it’s unclear when it will reopen. That lab also was the sole manufacturer of Doxil, an ovarian and breast cancer drug that’s now unavailable.

But there’s cause for hope. The FDA said the methotrexate and Doxil crises soon may be over. Three other manufacturers are increasing production of the specific kind of methotrexate at issue, and they told the feds that additional supplies should be available within weeks.

The FDA is considering licensing a foreign company to make Doxil, a measure it has taken eight times in the last year to address other drugs in critical shortage.

And last week Ben Venue posted a message on its website that it was working with the FDA to expedite the availability of methotrexate and immediately would begin releasing a limited supply to oncology clinics, hospitals and pediatric facilities. "We hope this supply will help address near-term patient needs while other companies licensed to manufacture methotrexate increase production," the statement read.

Doctors were optimistic about restocking hospital supplies of methotrexate, but, as one told NPR, “[T]his is not the last shortage we’ll have to cope with.”

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December 9, 2011

Apple Juice for Kids: A Caution for Parents

We often take issue with careless, shallow and/or misleading media reports about health and safety issues. But in one high-profile case, the flashy TV doc got it right.

Consumer Reports investigated the claim of Dr. Mehmet Oz ("The Dr. Oz Show"), and found that, indeed, 1 in 10 of the juices tested contained more arsenic than is allowed in drinking water. One problem, investigators said, is that juice and similar beverages have no standards for arsenic content. Inorganic arsenic (that is, arsenic that does not occur naturally in some fruits) is carcinogenic. Lead content also was problematically high in many juices.

The EPA limits arsenic in drinking water to 10 parts per billion (ppb), and some health experts say that’s too high. According to AboutLawsuits.com, The FDA told Consumer Reports that it’s considering arsenic standards for juice. In September, the website reported, the FDA “believed apple juice consumption posed little or no risk, but since then it has received eight apple juice test samples with total arsenic levels of up to 45 ppb.”

Because arsenic and lead disproportionately damage smaller, growing brains, the American Academy of Pediatrics advises:


  • Don’t give infants younger than six months any kind of juice.

  • Limit juice for children 6 years and younger to six ounces a day.

  • Limit juice for children older than 6 years to 12 ounces a day.

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December 4, 2011

HPV Vaccination Now Recommended for Boys

The FDA has approved two vaccines to ward off infection by some strains of the human papillomavirus (HPV), which can cause cancer. But until recently, the shot was promoted only for girls. (The vaccine is useless unless given before the onset of sexual activity.)

But the federal Advisory Committee on Immunization and Practices (ACIP) recently issued a recommendation that boys and young men also receive the vaccination to protect against genital warts and anal cancer. Males are at a lower risk of developing cancer from HPV, but they can transmit HPV to their partners.

We recently wrote about the lag in HPV vaccination for young people, but that was before the ACIP issued its recent report. The more often parents are made aware of the solid science, the more likely they are to protect their children’s future health.

According to a Kaiser Family Foundation fact sheet, HPV infection in the U.S. is widespread, with more than 6 million new infections annually. Approximately half of all sexually active men and women will get HPV at some point in their lives.

Currently, the vaccines are administered in three doses over 6 months, but research is underway to determine whether two might be sufficient to provide protection.

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October 18, 2011

Youth and Tanning Beds: Do Not Mix

The groundswell against the use of tanning beds got an additional boost last week when California Gov. Jerry Brown signed legislation prohibiting children younger than 18 from using the body-bronzers as of January 2012. California is the first state to enact such a ban.

In March, the American Academy of Pediatricians called for a tanning-bed ban for minors, and last year an FDA advisory committed made similar recommendations.

An increasing body of evidence says that the risk of skin cancer from tanning beds might be much higher than previously expected. According to the Journal of Investigative Dermatology, the ultraviolet rays produced by most tanning beds penetrate deeply into the skin, causing significant damage.

According to AboutLawsuits.com, some studies have shown that use of tanning beds by young adults results in eight times the risk of developing melanoma, a deadly form of skin cancer. A study by the World Health Organization indicated that use of tanning beds before the age of 30 might increase the risk of skin cancer by 75%.

The American Cancer Society says that melanoma is diagnosed in about 69,000 Americans each year and causes about 8,650 deaths annually. Melanoma is highly curable while it's confined to the skin, but once it penetrates deeper, it can go to the brain and other vital organs.

A memorable client of Patrick Malone's died from medical malpractice in the failure to remove a mole from his lower back before it turned into a fatal melanoma. You can read about Richard Semsker in Malone's book, "The Life You Save," and on Patrick Malone's law firm website. Mr. Semsker's case had nothing to do with tanning beds, but shows how simple missteps in communications among his doctors could cause an unnecessary death.

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September 7, 2010

Indoor Tanning Beds: Addictive and Dangerous for Teens and Young Adults

Having seen one client die a hideous death from skin cancer that spread to his brain, I'm not a fan of anything that increases the odds of people getting skin cancer. Now a report in the New England Journal of Medicine lays out the compelling case that using indoor tanning beds causes skin cancer and death, and most vulnerable are the teenagers and young adults who get addicted to regular use of tanning beds.

The key facts from this prestigious medical journal's report:

* Tanning bed use nearly doubles the risk of deadly melanoma -- cancer of the pigment-producing cells in the skin -- in frequent users.

* The risk of other types of skin cancer, like squamous cell, more than doubles with ANY history of tanning bed use. And although squamous skin cancer is more curable than melanoma, a small fraction of cases spread beyond the skin and cause death.

* Tanning beds are very likely addictive. They make people feel good -- physically and mentally -- because they stimulate production of beta-endorphin, an opium-like substance in the brain.

* The ultraviolet rays from tanning beds cause DNA damage in the skin cells, which triggers production of melanin, the pigment that turns the skin a nice toasty brown. The problem of course is that when those melanin-producing cells go haywire, you have melanoma, and that can easily become incurable before you notice it.

People use tanning beds an estimated one million times every day in the U.S; many of them start in their teens and continue into young adulthood.

The tanning bed industry says one in ten Americans use its products -- 30 million people. That means that many skin cancers every year can be laid at the feet of this industry, with just as strong a scientific case as the one against the tobacco industry.

The defenders of tanning beds say it's a good way to get your skin to make Vitamin D. But that depends on a lot of variables, and a better option, without the risk of cancer, might be to just swallow a Vitamin D supplement pill.

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March 30, 2010

New Taxes on Tanning Beds

Included in the healthcare reform bill that President Obama signed into law recently is a new 10% tax on sunbeds that is hoped to deter young people from using the indoor tanning machines, reports USA Today’s Liz Szabo.

Used by about one in three 17-year-old girls in the country, these ultraviolet radiation-emitting beds actually pose grave dangers to human health, resulting in skin and eye cancer. According to Szabo, the tanning beds increase the risk of skin cancer by 75% for users under the age of 30.

In a USA Today article from July 2009, it was reported that “international cancer experts have moved tanning beds and other sources of ultraviolet radiation into the top cancer risk category, deeming them as deadly as arsenic and mustard gas.”

In addition to the new tax, the FDA is considering putting restrictions such as requiring teens to get parental consent before using the sunbeds. The FDA may eventually ban the use of tanning beds among teenagers.

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March 18, 2010

The Special Challenge of Helping Teenage Cancer Patients

Cancer treatment and management is no easy task for anyone, but it can be much more challenging for teenage patients, according to New York Times’ Roni Rabin. To begin with, detection of the disease is difficult for patients in this age group, because teenagers do not usually share with adults about their physical changes. Neither are the teenage patients inclined to seek help, as they are at a stage where independence is a landmark of growth. This often results in late detection of the disease and subsequently necessitates aggressive treatments and leads to lingering side effects.

Another difficulty with managing cancer for teenagers and young adults is the ongoing debate over whether these patients should receive treatment in pediatric hospitals or with adults in regular hospitals. The truth is there is no good fit for teenage patients: the types of cancers teenagers develop are often very different from those adults have. Also, the psychosocial support teenage patients need is not available from either the pediatric settings, where most of the population is comprised of toddlers and children, or regular hospitals, whose adult patients have decidedly different concerns in their struggles with cancer.

In light of the difficulty of treating and managing teenagers’ cancer, new cancer treatment programs are being tailored specifically for teenagers and young adults. The Knight Cancer Institute in Oregon, for example, instituted a program where pediatric and adult oncologists are both available for consultation.

Parents should report to their child's pediatrician any physical or behavioral changes they observe in teenagers. Symptoms as subtle as prolonged fatigue can be a warning sign for serious disease, like lymphoblastic leukemia.

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July 16, 2008

Menthol: A Hook for Young Smokers

New research from the Harvard School of Public Health shows that tobacco companies have been deliberately varying levels of menthol in their cigarettes, marketing cigarettes with lower levels of menthol to younger smokers and then increasing the level of menthol with the age of the target demographic. From the article:

One document from R.J. Reynolds noted that all three major menthol brands "built their franchise with YAS (younger adult smokers) ... using a low-menthol product strategy. However, as smokers acclimate to menthol, their demand for menthol increases over time."

In 1987, R.J. Reynolds marketed low-level menthol varieties to persuade consumers to switch from regular brands and to recruit new, young smokers, noting: "First-time smoker reaction is generally negative. ... Initial negatives can be alleviated with a low level of menthol."

This new research serves as a reminder that, despite famous regulations about where and how Joe Camel can be displayed, tobacco companies continue to market deadly products to very young people.

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November 29, 2007

New Report Suggests CT Scans may become Cancer Risk for Children

A new report in today's New England Journal of Medicine suggests that many people in the U.S. are needlessly exposed to dangerous radiation during medical tests, particularly CT scans. The problem is most clearly evident with respect to children. The report may be overestimating possible risks to adults, but there is a clear reason to think that an excess of these tests pose a public health risk to children.

The study points out that a minimum of 4 million CT scans are done on children per year, with over 62 million done on the American population as a whole. These large numbers are the result of the overwhelming popularity and rapid increase of use of CT scans since they were introduced. These numbers, in conjunction with studies showing that a large percentage of medical tests are completely unnecessary, suggest that many children are being given CT scans when they do not need them.

The risk of CT scans come from the "super X-rays" that the test uses. Children are more susceptible to radiation than adults and more likely to develop cancer because of it. But it is important to remember that the risk to any one particular individual is slight. It is only when we look at large populations that a problem starts to emerge. It is also important to remember that the report is pointing to a potential problem rather than an actual one: the report predicts that CT scans will be tied to a significant percentage of cancer cases. This means that the new report gives us an opportunity to head off a public health problem before it becomes truly dangerous. It also highlights one of the possible downsides of rampant overuse of medical tests.

The New England Journal of Medicine provides the first few lines of the report here: Computed Tomography--An Increasing Source of Radiation Exposure.

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