DAILY UPDATE      

In rating pain, women are the more sensitive sex

It has long been known that certain pain-related conditions, like fibromyalgia, migraine and irritable bowel syndrome, are more common in women than in men. And chronic pain after childbirth is surprisingly common; the Institute of Medicine recently found that 18 percent of women who have Caesarean deliveries and 10 percent who have vaginal deliveries report still being in pain a year later.

But new research from Stanford University suggests that even when men and women have the same condition — whether it’s a back problem, arthritis or a sinus infection — women appear to suffer more from the pain.

There is an epidemic of chronic pain: Last year, the Institute of Medicine estimated that it afflicts 116 million Americans, far more than previously believed. But these latest findings, believed to be the largest study ever to compare pain levels in men and women, raise new questions about whether women are shouldering a disproportionate burden of chronic pain and suggest a need for more gender-specific pain research.

The study, published Monday in The Journal of Pain, analyzes data from the electronic medical records of 11,000 patients whose pain scores were recorded as a routine part of their care. (To obtain pain scores, doctors ask patients to describe their pain on a scale from 0, for no pain, to 10, “worst pain imaginable.”)

For 21 of 22 ailments with sample sizes large enough to make a meaningful comparison, the researchers found that women reported higher levels of pain than men. For back pain, women reported a score of 6.03, men 5.53. For joint and inflammatory pain, it was women 6.00, men 4.93. Women reported significantly higher pain levels with diabetes, hypertension, ankle injuries and even sinus infections.

For several diagnoses, women’s average pain score was at least one point higher than men’s, which is considered a clinically meaningful difference. Over all, their pain levels were about 20 percent higher than men’s.

Unfortunately, the data don’t offer any clues as to why women report higher pain levels. One possibility is that men have been socialized to be more stoic, so they underreport pain. But the study’s senior author, Dr. Atul Butte, an associate professor at Stanford’s medical school, said that explanation probably did not account for the gender gap.

“While you can imagine such a bias,” he said, “across studies, across thousands of patients, it’s hard to believe men are like this. You have to think about biological causes for the difference.”

An extensive 2007 report by the International Association for the Study of Pain cited studies showing that sex hormones may play a role in pain response. In fact, some of the gender differences, particularly regarding headache and abdominal pain, begin to diminish after women reach menopause.

Research also suggests that men and women have different responses to anesthesia and pain drugs, reporting different levels of efficacy and side effects. That bolsters the idea that men and women experience pain differently.

One reason for the lack of information about sex differences is that many pain studies, in both animals and humans, are done only in males. One analysis found that 79 percent of the animal studies published in a pain journal over a decade included only male subjects, compared with 8 percent that used only female animals. In addition, experiments testing pain in men and women have shown that they typically have different thresholds for various types of pain. In general, women report higher levels of pain from pressure and electrical stimulation, and less pain when the source is from heat.

Melanie Thernstrom, a patient representative on the Institute of Medicine pain committee from Vancouver, WA, said the newest research “really highlights the need for more treatment and better treatment that is gender-specific, and the need for far more research to really understand why women’s brains process pain differently than men.” Visit the New York Times for the article.

No flu shots for most late-thirtysomethings during swine flu outbreak

Flu season may be a few months old, but peak season is yet to come. And new research has found that a large number of people at risk may still be refusing to protect themselves. Flu normally hits hardest in January or February, and infectious disease specialists say so far, this season has been very mild. But there are reports that nine people have died from swine flu this season in Mexico – where the first swine flu outbreak began back in 2009, ultimately claiming 17,000 lives worldwide.

Despite knowing how potentially deadly swine flu could be, a new report has found that only 20 percent of adults in their late 30s said they got a flu shot during the 2009 outbreak. In a survey, researchers from the University of Michigan asked approximately 3,000 adults between the ages of 36 and 39 – members of the age group known as Generation X – questions about how they responded to the 2009 swine flu pandemic, such as how they kept informed about the illness and whether they got flu shots to protect themselves or their family members.

The researchers have been following this same group of people for 25 years, and every year they survey them about their attitudes and behaviors related to different issues. Their work is known as the Longitudinal Study of American Youth (LSAY). According to the latest results delving into attitudes about the flu vaccine, only 1 in 5 adults got a flu shot, but nearly 65 percent said they were moderately concerned about the swine flu, and about 60 percent said they kept informed about it.

“This was the first epidemic that was relevant to this age group,” said Jon Miller, director of LSAY at the University of Michigan. “We were interested in how they used their prior science knowledge and prior education to make sense of this thing.” Adults in this age group, he explained, are very adept at gathering information from a variety of sources, including newspapers, magazines, online and from family, friends and colleagues. While they managed to stay abreast of what was happening with the disease outbreak, the majority of them did not get flu shots. Though a larger number of the cohort with young children at home did get the flu shot to prevent the swine flu.

Miller added the researchers did not ask the survey participants why they didn’t get vaccinated, but he and other experts say a number of factors likely came into play. One reason is because supplies were limited for some time during that flu season.

Despite their increased vulnerablity, adults in their late 30s may have been confused by changing public health messages about who should be vaccinated.

Another reason many late-thirtysomethings didn’t get flu shots despite their knowledge of the risks posed by swine flu is that they often display a trait well-known in adolescents.

“A lot of people have not matured as quickly as we would hope and one of the issues that is prevalent in adolescents and many adults is a certain level of belief that they are omnipotent and more powerful than things out there.” Miller hopes the study’s findings can shed some light on better ways to reach out to Generation Xers when it comes to preparing for future epidemics. Visit ABC News for the article.

Healthcare delivery to be analyzed as U.S. agency expands view

A U.S. agency formed to compare the effectiveness of drugs and medical devices plans a broader agenda that also will study subjects such as whether care provided by nurse-practitioners is as good as that of doctors. The agency, called the Patient-Centered Outcomes Research Institute, was created by the 2010 healthcare legislation. Republican opponents of the law say the institute will lead to government-directed rationing as it judges treatments.

The agency may spend as much as $2.5 billion on research through 2019, the Congressional Budget Office estimates. Comparing treatments will be one of five broad areas the agency plans to explore, its leaders said. Other research priorities include treatment disparities among people of differing races, gender and other characteristics; health-care systems, including the quality of care provided by nurses and physician’s assistants; how to communicate the best care options to patients and doctors and shortening delays between lab discoveries and their clinical use.

“It is by design a very, very broad set of priorities,” Carolyn Clancy, the director of the U.S. Agency for Healthcare Research and Quality and board member of the new institute, said Jan. 18 at a meeting in Jacksonville, FL.

The institute plans to announce an initial round of about 40 grants, drawn from 856 applications, in March. (Bloomberg News) Visit the Salt Lake Tribune for the article.

Technology that predicts disease spread in mass gatherings

Hosts of mass gatherings (MGs) could benefit from new opportunities that would assist in the preparation and response to threats of infectious diseases, as revealed by the fifth paper on MGs health in The Lancet Infectious Diseases Series. One of these opportunities would be to couple surveillance systems that use the Internet to identify outbreaks of infectious diseases around the globe in near real-time with a novel technology, which can track and predict global population movements through commercial air travel. The authors have described an analysis of potential threats to the 2012 Olympic Games using this novel approach.

Lead author, Kamran Khan from St Michael’s Hospital in Toronto, Canada explains: “An integrated platform of this kind could help identify infectious disease outbreaks around the world that could threaten the success of MGs at the earliest possible stages, provide insights into which of those outbreaks are most likely to result in disease spread into the MG, and identify the most effective public health measures to mitigate the risk of disease importation and local spread, all in near real-time.”

The Global Public Health Intelligence Network (GPHIN) and HealthMap are novel disease surveillance tools that use informal internet data sources like online news outlets, in order to detect early reports of disease outbreaks and for monitoring global disease activity. In contrast to traditional surveillance systems, i.e. government reports, which can be subject to delays in reporting and poor sensitivity, the novel surveillance tools have the potential to overcome these limitations.

Furthermore, the authors comment that understanding global air travel patterns before, during and after MGs are vital, given that this is the main mode of transport to and from MGs, and refer to Bio.Diaspora, a novel technology that can track worldwide air travel patterns to predict the worldwide spread of infectious diseases.

The system can be utilized to predict the amount of travelers, as well as their global origins from MGs. Therefore, in areas where large population movements to the MG host city are expected, the system is able to direct disease surveillance activities to specific global locations.

By applying this method, Khan and his team discovered that the vast majority of passengers traveling to Vancouver for the 2010 Winter Olympic Games originated from only 25 cities. Consequently, the real-time infectious disease surveillance efforts were then aimed on those particular cities to monitor and evaluate potential threats before, during, and immediately after the Games.

The fifth paper in this series describes how this method will be applied for the first time in London at the 2012 Olympic Games, for real risk assessment and planning purposes. It will assist UK public health officials in prioritizing which global outbreaks require the greatest attention at the time of the Games. Visit Medical News Today for the article.

Jury: Hospital must pay Garth Brooks $1M for not building women’s center to honor his mom

CLAREMORE, OK — An Oklahoma hospital in Garth Brooks’ hometown must pay $1 million to the country singer because it failed to build a women’s health center in honor of his late mother, jurors ruled Tuesday evening. Jurors ruled that the hospital must return a $500,000 donation to Brooks plus pay him $500,000 in punitive damages in Brooks’ breach-of-contract lawsuit against Integris Canadian Valley Regional Hospital in Yukon. Brooks said he thought he’d reached a deal in 2005 with the hospital’s president, James Moore, but sued after learning the hospital wanted to use the money for other construction projects.

The hospital argued that Brooks gave it unrestricted access to the $500,000 donation and only later asked that it build a women’s center and name it after his mother, Colleen Brooks, who died of cancer in 1999.

During the trial, Brooks testified that he thought he had a solid agreement with Moore. Brooks said the hospital president initially suggested putting his mother’s name on an intensive care unit, and when Brooks said that wouldn’t fit her image, Moore suggested a women’s center.

“This case is about promises: promises made and promises broken,” lawyer John Hickey told jurors shortly before they started deliberating. “Mr. Brooks kept his promise. Integris never intended to keep their promise and never built a new women’s center.”

But hospital attorney Terry Thomas said Brooks’ gift initially came in anonymously and unrestricted in 2005. He also noted that Brooks couldn’t remember key details of negotiations with the hospital’s president — including what he’d been promised — when questioned during a deposition after filing his lawsuit in 2009. (Associated Press) Visit the Washington Post for the article.

Obama says healthcare jobs will be hard to create

In his State of the Union address that barely mentions healthcare, President Obama hits on the message heard repeatedly from the healthcare industry: If you want more jobs, don’t cut off federal funding. Obama implores Congress not to “gut” investments in research, so American can maintain its spot as a world leader in medical innovation. That line will earn applause from the pharmaceutical and medical device industries, but it won’t be enough to deliver a health care economy that delivers a “fair shot” to everyone.

The president held out the continued possibility of saving healthcare costs with Medicare reform. “As I told the speaker this summer, I’m prepared to make more reforms that rein in the long term costs of Medicare and Medicaid, and strengthen Social Security, so long as those programs remain a guarantee of security for seniors,” Obama said. “But in return, we need to change our tax code so that people like me, and an awful lot of members of Congress, pay our fair share of taxes. Tax reform should follow the ‘Buffett Rule’:  If you make more than $1 million a year, you should not pay less than 30 percent in taxes.”

And he rebutted Republican accusations that his signature 2010 health reform law amounts to socialized medicine. “I’m a Democrat. But I believe what Republican Abraham Lincoln believed: That government should do for people only what they cannot do better by themselves, and no more,” he said. “That’s why our healthcare law relies on a reformed private market, not a government program.”

Obama makes it clear that he sees the giant healthcare sector as a place ripe for jobs growth. The American Association of Medical Colleges projects a shortage of 90,000 doctors over the next 10 years. It’s more than double that for the nursing industry, where the American Nursing Association sees a potential shortage of 260,000 nurses by 2025. These shortfalls will only be worsened as an additional 30 million people get health insurance under the 2010 health reform law.

But a national workforce commission established under the healthcare law has been chronically underfunded by Congress. The training programs that will be needed to fix these shortages have a slim to little chance of getting any funds. Appropriators have no room to give precious federal dollars to new programs while they are slashing old sacred cows in the austere spending environment that has reigned on Capitol Hill since Republicans took the House in 2011.

And while investments in research are nice, what medical device companies want even more is for Congress to take back a $20 billion tax it imposed on the industry to help cover the cost of the health reform law. Stephen Ubl, president of Advamed, a medical device lobbying association, says the tax is already causing layoffs.

Obama doesn’t get a break from hospitals either. The American Hospital Association says a coming 2 percent cut to Medicare and other cuts will cost them 278,000 jobs as revenue drops from Medicare and Medicaid. In the health care world, federal funds are the spigot for job creation, and no State of the Union speech is going to change the spending environment on Capitol Hill. Visit the National Journal for the article.

CDC launches electronic antibiotic tracking system

The Centers for Disease Control and Prevention (CDC) recently launched a new electronic antibiotic tracking system allowing hospitals to make better decisions about how to improve antibiotic use and compare themselves to other hospitals. Previously this tracking was only available in doctors offices. The tracking system is part of the CDC’s National Healthcare Safety Network. Any hospital that participates in the National Healthcare Safety Network can use this tool by working directly with its pharmacy software vendor to transmit data electronically from drug administration or barcoding records. There is no manual data entry, thus saving a facility time and money.

In conjunction with Get Smart About Antibiotics Week, the CDC has announced a partnership with the Institute for Healthcare Improvement to pilot-test a tool to help hospitals implement practical strategies to improve antibiotic use. The pilot testing is currently under way in eight U.S. hospitals. Visit AORN for the article.

Avastin, Sutent increase breast cancer stem cells, U-M study shows

Cancer treatments designed to block the growth of blood vessels were found to increase the number of cancer stem cells in breast tumors in mice, suggesting a possible explanation for why these drugs don’t lead to longer survival, according to a new study by researchers at the University of Michigan Comprehensive Cancer Center. Results of the study appear online in the Proceedings of the National Academy of Sciences Early Edition.

The drugs Avastin and Sutent have been looked at as potential breast cancer treatments. But while they do shrink tumors and slow the time till the cancer progresses, the effect does not last, and the cancer eventually regrows and spreads.

“This study provides an explanation for the clinical trial results demonstrating that in women with breast cancer antiangiogenic agents such as Avastin delay the time to tumor recurrence but do not affect patient survival. If our results apply to the clinic, it suggests that in order to be effective, these agents will need to be combined with cancer stem cell inhibitors, an approach now being explored in the laboratory,” says study author Max S. Wicha, M.D., director of the U-M Comprehensive Cancer Center.

The FDA recently revoked approval of Avastin for treating breast cancer, although the drug is approved for use in other types of cancer. The reversal was in response to clinical trials showing that the drug’s benefit was short-lived, with breast cancer patients quickly relapsing and the cancer becoming more invasive and spreading further throughout the body. Overall, the drug did not help patients live any longer.

The current study suggests the possibility of combining anti-angiogenesis drugs with a cancer stem cell inhibitor to enhance the benefit of this treatment. The researchers are testing this approach in mice and preliminary data looks promising. Visit UM for the article.