How Can the Flu Kill You?

May 07, 2009 5:05 PM

ABC News' Matt Davis and Michelle Schlief report: We spent some time talking with pathologists, medical examiners and infectious disease experts to find out exactly how the flu can kill a person.

Swine flu, like any flu, is transmitted when the virus comes into contact with the eyes, nose or mouth. The virus attaches to the cells on the inside of the airways or lungs. It then invades these cells, making many copies of itself and causing the cells to burst open, releasing more new copies of itself. This process then repeats, with new viruses attacking neighboring cells and releasing more copies during each cycle.

Once this process gets going, the body responds through a complicated process involving the immune system. Immune cells release proteins called cytokines that act as signals to each other, communicating that the body is under attack. These cytokines are the cause of symptoms like fever and fatigue. They work to focus the immune system on fighting the virus by actually turning off other parts of the immune system.

Consequently, the body is unable to attack other types of infections, such as those caused by bacteria. One of the most devastating things that can happen is that a bacterial infection can take hold in the lungs, leading to pneumonia. Under normal circumstances a patient would be able to fight off the infection, or their defenses would have caused it to have been a much less severe illness. But now, with the defenses disabled, the infection has the potential to become life-threatening.

Bacterial pneumonia leads to a variety of complications in the airways and lungs, like bleeding and swelling, that ultimately can choke off breathing and kill the victim.

It is in fact these pneumonias that are responsible, historically, for 75 to 90 percent of influenza deaths during pandemics, said Dr. Dennis Metzger of Albany Medical College.

Another concern is that for flu patients who are relatively defenseless against infections, exposure to superbugs like MRSA will be particularly devastating - since MRSA is resistant to many traditional antibiotics. Certain segments of the population - particularly the very young, the very old and those with other medical problems like lung and heart disease - are most susceptible to these infections as a result of the flu. Those with underlying lung disease also have little ability to tolerate an additional strain on their lungs.

While secondary infections cause most influenza deaths during pandemics, damage from the virus replication process itself can be toxic, said Dr. Frederick Hayden of the University of Virginia.

Another theory, the “cytokine storm,” tries to explain why so many young people died in the 1918-1919 flu pandemic. According to this theory, when cytokines – signals from the immune system – are manufactured in high levels in healthy young people, they may cause the immune system to attack healthy cells. This is particularly a problem when cells in the airways come under attack, causing acute respiratory distress, said Dr. Gregory Poland of the Mayo Vaccine Research Group.

But this theory is falling out of favor, said Dr. Hayden. He told us that cytokine response levels have been found to correlate with the level of virus growth in the lungs. So the damage seen in the lungs is most directly attributable to viral replication in the lungs.

Rarely, a flu virus can affect the heart or brain by directly causing inflammation, said Dr. William Schaffner of Vanderbilt University. These complications can be severe enough to result in death.

Once a patient dies and swine flu is suspected, the cause of death is confirmed, surprisingly, through the same nasal swab and diagnostic procedure that would be done on a live patient. But the critical question remains, How did swine flu cause the death? To determine that, tissue samples are sent to a lab where they are given high priority. Results are usually turned around in 7 to 10 days. The samples are probed for evidence of a secondary infection that may have contributed to the death.

One medical examiner told us that once swine flu is established as a cause of death in a geographical region there is no need to do additional autopsies unless more questions arise.

May 7, 2009 | Permalink | User Comments (0)

Facing America's Doctor Disparity

April 10, 2009 8:08 PM

ABC News Medical Editor Dr. Tim Johnson reports: In response to my report on Primary Care on “World News” Thursday, I have received several comments requesting some ideas on how to improve the supply of primary care doctors -- general internists, family physicians and pediatricians.

First, a reminder: almost all industrialized countries strike a 50-50 balance between the numbers of primary care doctors versus specialists. But in this country the distribution is about 70-30, specialists versus primary care. And it's getting worse -- trending down every year.

One survey of graduating medical students indicated that only 2 percent were thinking of general internal medicine! And there is a joke among medical students that when they graduate, they are going to go "on the road" -- meaning they will try to choose among radiology, ophthalmology, anesthesiology or dermatology (ROAD).

The reasons are fairly obvious: better pay, shorter hours, less night and weekend calls and, therefore, better lifestyles.

So why do medical students in other countries choose primary care more often? There are many reasons but, again, some are obvious. Many of these countries make medical education much more affordable, even tuition-free, so that medical students do not graduate with huge debts that they must struggle to pay off. They also work at providing better working conditions for primary care doctors, such as reasonable night and weekend coverage.

Many studies now show that when good primary care is available, health care costs go down and quality rises -- which is to say that unless we work at providing more primary care in this country, true health care reform will be impossible.

P.S. -- We must also work at increasing the supply of nurse practitioners and physician assistants who can supply much of the expertise needed for good primary care. In fact, many experts now refer to "medical homes" as a combination of doctors, nurses and assistants who provide primary care.

April 10, 2009 | Permalink | User Comments (6)

No End in Sight for Peanut Product Recalls

March 18, 2009 2:24 PM

ABC News' Lisa Stark reports: They keep appearing in my e-mail inbox -- more recall notices linked to the salmonella outbreak blamed on peanut products.

It's certainly unusual to have additional recalls more than two months after the Centers for Disease Control and Prevention first traced the salmonella outbreak to contaminated peanut butter made by the Peanut Corporation of America.

Yet the recall continues to expand with no end in sight. The Food and Drug Administration told me today that 3,491 products made by 275 different companies have been recalled. The companies range from big names like Kellogg's to small firms that few have heard of.

The recall now covers peanuts and peanut products from two PCA plants (one in Georgia, the other in Texas). In tracing where those products have gone, the FDA has contacted more than 14,000 firms along the distribution chain. PCA would sell to one company, that firm would sell to another company that would then sell to another company. You get the idea.

The FDA's Michael Herndon says: "This is a very active and dynamic situation." The recalled products, including peanut butter and peanut paste, are "common ingredients in cookies, crackers, cereal, candy, ice cream, pet treats and other foods.”

This is one of the largest food recalls ever. It's even high on the radar screen of the president, given first daughter Sasha's passion for peanut-butter-and-jelly sandwiches. President Obama used his most recent radio address to announce the formation of a group that will advise him on how to upgrade our food-safety laws, adding, "No parent should have to worry their child is going to get sick from their lunch. "

And today, Georgia is on tap to become the first state to tighten food-safety laws after the salmonella fiasco. The Georgia House and Senate have unanimously passed legislation that would require food processors to tell the state if tests turn up any food contamination. That information must be turned over within 24 hours.

This comes after federal investigators found that the Blakely, Ga., PCA plant knowingly shipped peanut products that had tested positive for salmonella. PCA was under no obligation to share those test results with state or federal regulators.

The Georgia law would also require the state to establish requirements for regular food testing, and processing plants would be required to draw up a Food-safety plan. The bill now goes to Gov. Sonny Perdue. His spokesman said the governor hasn't seen the bill yet, but there's every indication he will sign it. The bill passed unanimously.

That rare event underscores how strongly Georgia lawmakers feel about closing food-safety loopholes after an epidemic that has dramatically reduced demand for peanut products. Georgia produces 45 percent of the nation's peanuts.

This weekend, the city at the center of the controversy will try to move on from all the bad publicity. Blakely will hold a "Peanut Proud" expo, which the local paper, the Early County News, describes as "a special event to educate consumers that peanuts and peanut butter are safe, nutritious and trustworthy."

Still, the CDC says as of Monday the outbreak has sickened 691 people and may have caused nine deaths. The one bit of good news: There have been no reported new illnesses since Feb. 24. The concern, though, is that peanut butter has such a long shelf life and that some of these products could be in kitchen pantries for quite some time. Congress will once again take up this issue Thursday and will hear from the CEO of Kellogg and two other companies that bought products from PCA.

March 18, 2009 | Permalink | User Comments (1)

Dr. Tim: Inside the White House Forum on Health Care

March 06, 2009 4:02 PM

ABC News’ medical editor Dr. Tim Johnson reports: Thursday I attended the White House Forum on Health Care. Below are some of my observations on this interesting and important event.

1. As an "event," it was enormously successful, particularly in attracting the full range of special interest groups and politicians who will play key roles in the debate over health care reform. As President Obama said, it was the "hot ticket" in town, larger than even the financial summit.

2. For me, the most impressive segment was the last event, the unscripted Q and A session with the president. Since this is a subject I know fairly well, I was very impressed with the president's knowledge, with how quickly he connected the dots between questions, key information and ideas. I was even more impressed with his "emotional intelligence" in handling the various questioners, quickly understanding any hidden messages and speaking immediately to their concerns in a thoughtful way.

3. The president -- rightly in my view -- kept hammering at the cost-control issue. He is clearly determined to promote reform on the basis of the current financial crisis, which I think is a smart move strategically -- i.e., reaching out to people and politicians who might not be on the "moral bandwagon" but who will listen to economic arguments. He already has the support of the former but needs the support of the latter to get a bill passed.

4. One key moment was the exchange between Sen. Chuck Grassley, R-Iowa, and the president. Grassley brought up the sensitive subject of a "public option," i.e., the "Medicare-like" program that Obama promoted during his campaign. The president responded very diplomatically by saying he understood the concern and that the views of those opposed would be carefully considered, but he never said flatly they wouldn't propose it. This issue is the great fear of the private health insurance industry; it knows it can't compete against the government in overhead and administrative costs. One expert I talked with today said he thinks this will be a key bargaining chip for the administration, that they might be willing to give it up in exchange for other significant concessions by conservatives. But other liberal groups still insist it is a line in the sand that must not be crossed.

5. Everyone I have talked to this week believes now that there will be plans brought to the floors of the House and Senate before the August break. Whether anything can get passed is, of course, another question.

6. Finally, on a personal note, it was thrilling to see "Sir Edward" Kennedy enter the East Room with the president. He still speaks with authority on the subject, and I hope his voice will be heard during this coming debate.

March 6, 2009 | Permalink | User Comments (8)

Health Policy Experts Mull Impact of Wyeth Ruling

March 04, 2009 4:41 PM

By AUDREY GRAYSON, ABC News Medical Unit

The U.S. Supreme Court ruled today against the drugmaker Wyeth, holding that pharmaceutical companies can be held liable for harm from medicines that carry warnings approved by federal regulators.

In a 6-3 vote, the high court affirmed a Vermont supreme court ruling that upheld a $7 million damages award to a guitarist, Diana Levine, who had to have her arm amputated after she was improperly injected with Wyeth's anti-nausea drug Phenergan as part of treatment for a migraine.

Health policy experts overwhelmingly agreed that the ruling represents an enormous victory for consumers.

“This is an enormously important ruling to protect the American people from the excesses of the drug industry,” said Dr. John Abramson, clinical instructor at Harvard University Medical School and a consultant to plaintiffs’ attorneys in litigation involving the drug industry.

The current system for drug labeling depends most heavily on research funded by the drug makers themselves. Many experts argue that this current system is deeply flawed.

“As we have seen in far too many cases, companies hide or explain away data about dangerous drugs, sometimes even from the FDA itself,” said Merrill Goozner, director of the Integrity in Science Project at the Center for Science in the Public Interest in Washington, D.C.

Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School, said another obstacle to properly identifying drug risks is that “the FDA does not have the resources to fully monitor the uses and outcomes of all approved drugs.”

But the Supreme Court decision appears to suggest that drug companies should identify the risks of the drugs they manufacture.

“The Supreme Court ruling places the responsibility for drug safety directly where it should be -- on the drug makers themselves,” Abramson said. “And now, properly, they will be held responsible for failure to fulfill the obligation to adequately study the safety of their drugs and to adequately communicate the risks of which they are -- or should be -- aware.”

In instances when the FDA fails to properly monitor drug risks, the ruling guarantees that patients harmed by a drug may still obtain a hearing for their case in a state court.

“With this decision, when the FDA fails to take action on a drug risk and a patient is harmed by a drug, patients will still be able to get a hearing in state court,” said Dr. Bruce Lambert, director of the Center for Education and Research on Therapeutics at the University of Illinois at Chicago. “And if the evidence is in their favor, they will be able to get compensation and hold companies accountable.”

While all experts agreed that this ruling is a victory for consumers who are harmed by drugs that carry insufficient warning labels, Gregory Conko, a senior fellow at the Competitive Enterprise Institute in Washington, D.C., said that he doesn’t believe Wyeth or the FDA did anything wrong in this particular case.

“It would have been one thing if new evidence of risk had arisen since FDA approved the label, or if Wyeth were accused of hiding information from the FDA or misrepresenting the data it did provide,” Conko said. “But that is decidedly not the case here.”

Conko added that because Phenergan’s label explicitly warns in six different locations of the high probability of tissue damage if injected into artery, this specific case was not one of negligence on part of the Wyeth, but on the part of the physician’s assistant who injected the drug into Levine’s artery despite the clear warnings on the drug’s labeling.

“Thus, the Supreme Court could have and should have held in Wyeth's favor with a narrowly tailored opinion confined to the facts of this case,” Conko said.

“Here, instead, the court is essentially saying that it doesn't matter that [the] FDA thought [intravenous] administration of this drug was sufficiently safe,” he added. “As long as a sympathetic plaintiff can convince a jury of laymen that her injury could have been prevented if the physician's assistant never tried to administer the drug in such a way that actually would have been safe, then FDA's expert judgment is irrelevant.”

March 4, 2009 | Permalink | User Comments (2)

Health Coverage for All -- Is It on the Way?

February 20, 2009 12:27 PM

On Friday, the New York Times revealed that major players in the nation’s health care debate -- including big insurance companies, lobbyists representing consumers, physicians, hospitals and the pharmaceutical industry -- may soon unveil a consensus plan advocating comprehensive legislation that requires every American to carry health insurance.

At the center of this collection of lions and lambs -- termed the “workhorse group” in a memorandum obtained by the Times -- is Sen. Edward Kennedy, D-Mass., a prominent advocate of health care reform. Here is what ABC News Medical Editor Dr. Timothy Johnson had to say about the developments:

“Today’s report in the New York Times confirms earlier reports (and many rumors) that key meetings about health care reform are being orchestrated by Sen. Kennedy and his staff. The idea of ‘insurance for all’ would certainly please insurance companies -- 45-50 million new customers!

“However, unless such an expansion/requirement is also accompanied by true reform -- cost and quality control -- it will be a bailout rather than true reform. Almost all experts agree that about a third of the 2.6 trillion we spent on health care last year (and rising every year) is ultimately wasted -- fraud, unnecessary testing and treatment, etc. So if we simply expand coverage and don't get control of costs and quality we will miss a golden opportunity for reform.”

February 20, 2009 | Permalink | User Comments (53)

This Is Your Brain on Envy

February 12, 2009 5:59 PM

By MICHELLE SCHLIEF, ABC News Medical Unit

Morrissey’s indie tune about envy -- “We hate it when our friends become successful” -- was inescapable if you listened to college radio in the ‘90s. The object of jealousy in the song has never been revealed, but a new study from Japan sheds some light on just what might have been going on inside the protagonist’s brain, and what might be happening to each of us when we become possessed by the green-eyed monster of envy.

Dr. Hidehiko Takahashi and his colleagues report today in Science on a series of experiments in which they peered into subjects’ brains using fMRI to see what happened when they induced the feeling of envy in them. In the study, the participants were made to feel envious of fictitious characters. This elicited activity in an area of the brain called the anterior cingulate cortex, which has been previously linked to socially painful experiences.

But Dr. Kristina Visscher, a researcher in the department of psychology at Harvard University, said not so fast.

“[Pain] is by far not the only thing that changes activity in this region,” she said.

She pointed out that other researchers have found this area “lighting up” under all kinds of circumstances, including when subjects were thinking about religious experiences, their political leanings, physical movement, optimism and making mistakes.

Just what this part of the brain does is a matter of intense scientific debate. One could argue that under certain circumstances, any of these activities can be painful. Finding out you’ve made a mistake can certainly wound your pride, after all. But it is clearly starting to look a little less like a spot in the brain that just lights up when we’re in physical pain or emotional distress.

However, said Visscher, "The idea that the brain might treat abstract social experiences and concrete physical experiences similarly would not be surprising."

For example, one recent paper from Dr. Nicole Speer, formerly of the Dynamic Cognition Laboratory at Washington University, found that when we read a narrative story we literally run through mental simulations of the experiences we’re reading about, activating the same brain regions that we would if we were actually participating in the real-life version of the activity.

So maybe THAT'S why listening to Morrissey always makes me a little mopey.

February 12, 2009 | Permalink | User Comments (0)

Is a Virus Making You Obese? Fat Chance

January 26, 2009 3:20 PM

By DAN CHILDS, ABC News Medical Unit

What if obesity was an insidious infection you could catch from your friends and colleagues?

Such is the scenario proposed in new research on an adenovirus known as AD-36. A team of scientists led by Nikhil Dhurandhar of the Pennington Biomedical Research Center in Louisiana reports that infection with the virus leads to the production of more fat cells in the body -- hence, a greater propensity toward obesity.

It’s not the first time that researchers have implicated this virus in obesity or the first time that researchers have sought an alternative explanation for the country’s current obesity epidemic. In December 2006, researchers at Washington University in St. Louis blamed the bacteria that naturally lives in the gut for a propensity toward obesity. A number of other studies have implicated genes for additional weight, while a July 2007 study suggested that social networks are actually associated with obesity -- in other words, your friends may make you fat.

And few went as far as a team of researchers at the University of Alabama, Birmingham, did in June 2006 to come up with alternate explanations for a populace that is rapidly becoming rounder. The group published a list of 10 “additional explanations” for obesity. Among the possible overlooked causes, the team says, are getting too little sleep, increased reliance on air conditioning, decreased smoking rates and increased levels of pollution.

But at the risk of digging the spurs into a tired pun, how much weight should we really give these alternative explanations?

“At some point it just doesn’t add up,” said Keith-Thomas Ayoob, director of the nutrition clinic at the Albert Einstein College of Medicine. He notes that the lifestyle behaviors most commonly associated with obesity -- too much eating, not enough exercising -- offer a much more plausible explanation.

“I think it is the elephant in the room,” he said.

But he adds that what he feels is more problematic than these alternative explanations is Americans’ need to find something to blame for obesity -- or to take on this blame themselves.

“At some point we’ve got to give ourselves a break and not blame ourselves,” he said. “Whether a virus is or isn’t responsible for our weight gain, that’s one of those things that we can’t control.”

“But we certainly can control our daily lifestyle. ... This involves less blaming and more action, which I think is a more positive thing.”

January 26, 2009 | Permalink | User Comments (27)

Video Gamers May Be 'Virtually' on Their Own

January 23, 2009 3:11 PM

By AUDREY GRAYSON, ABC News Medical Unit

I have a dark secret from my past. It involves a phase in my life which I am not proud to admit that I went through.

From the age of about 12 to 16, I was a gamer. Not just any gamer, either. I was completely consumed.

The first thing I did when I woke up was run upstairs, turn on the computer, and try to play as many games as I could before I had to get ready for school. The first thing I did after school was run upstairs, turn on the computer and play games until the early hours of the morning. Then I woke up at 6 a.m. the next day and did it all over again.

Surprisingly, my grades in school didn’t suffer at all from my addiction. But the countless hours sitting in front of the computer screen, eyes glazed and palms sweating, did take a toll on one significant aspect of my life: my social life.

So it came as no surprise to me whatsoever that researchers from Brigham Young University in Provo, Utah, found that video games are bad for college students’ relationships.

Researchers surveyed 813 undergraduates at the university and found that most associations with gaming were negative. Those who played video games more frequently reported a lower quality relationship with both friends and family members. Moreover, women who played video games more frequently reported a lower self-image.

More video game use was also linked to higher rates of drug and alcohol use. And the more time a person spent playing the games, the higher the risk was for negative outcomes.

But which comes first, the chicken or the egg? Did I turn to computer games because I was friendless, lonely and unhappy, or did I become friendless, lonely and unhappy because of the computer games?

“We should be cautious about how we interpret these findings,” said lead study author Laura Walker, assistant professor in the School of Family Life at Brigham Young University. “It’s important to recognize that these are correlations… we’re not saying that video game use causes these negative outcomes."

But Scott Rigby, the president of Immersyve Inc., a player-experience research firm, explained the ease with which one might “crowd out” real life obligations and experiences by becoming over-involved in a virtual world.

“The thing about video games is when you’re sitting in a virtual world, you’re not in the real world,” Rigby said. “And video games are particularly good for satisfying a lot of our human needs – real life often doesn’t give us that same kind of constant feedback, that thrill of victory every few seconds.”

“It makes sense that some people may crowd out real life experiences and become out of balance with other things in their life, work or relationships,” he added.

However, Rigby stressed that it is impossible to confirm whether there is a causal relationship between gaming and negative outcomes.

“We do think that at a certain point people have to have the time available in order to fill it with the game, but we also think that sometimes games are much denser in terms of satisfaction, so even if your life is full of hobbies and activities, you could start crowding out real life obligations with game time,” Rigby explained.

And looking back at the “gaming phase” of my life now, I can see much more clearly why I became so obsessed: I was an outcast. My social calendar was one big empty hole, so I filled it to the rim with computer games. The real trick is digging yourself out of that hole and coming back into the real world again.

January 23, 2009 | Permalink | User Comments (14)

Think Birth Control Pills Are Dangerous? Try Pregnancy

January 15, 2009 3:19 PM

By JOANNA SCHAFFHAUSEN, ABC News Medical Unit

Since hormonal birth control first appeared in the 1960s, nearly 80 percent of women have taken it at some point in their lives. The pills and patches are so commonplace now that many of us tune out the warnings on the packaging or at the end of the commercials -- something about increased risk for heart attacks, strokes and blood clots? But a new study affirms the risks are real and well worth considering, especially for certain groups of women.

Chrisandra Shufelt and C. Noel Bairey Merz, two doctors from Cedars-Sinai Medical Center, conducted a review on heart health and birth control that was published this week in the Journal of the American College of Cardiology. They found that the hormones can trigger blood clots, which in the arteries can cause heart attacks and in the brain can cause a stroke. Overall, the heart risk appeared about 2.5 times greater for women currently using hormonal birth control compared to those who were not.

The results sound very scary -- birth control pills double your risk for heart attacks -- but a little more context helps put the findings into perspective. First, women of child-bearing age have a low risk for serious heart disease; the risk for death from heart disease is about 0.002 percent per year for women under 35. So even if hormonal birth control doubles those odds, the risk is still quite tiny indeed.

There is even better news for those who don’t smoke. Studies suggest that the bulk of heart attacks and strokes caused by birth control occur in smokers. Some research even finds no increase in heart risk among healthy, nonsmoking women on birth control pills.

Also, if you’re looking for something that raises the risk for women’s heart problems, consider pregnancy. Studies show pregnancy is linked to a two- to three-fold increase in the odds of heart attack, an eight-fold increase in the odds of stroke, and as high as a 50-fold increase in the odds of blood clots. Hormonal birth control pills look quite safe by comparison.

But low-risk is not NO risk, and women should be aware of the effects that these pills and patches can have on their health. Women over 35, especially those who smoke or have high blood pressure, may want to consider methods of birth control that do not alter hormones, such as condoms or a diaphragm.

Women should also examine why they are taking the pills and determine if the health trade-offs are worth it. Hormonal birth control is “marketed now almost as a lifestyle drug,” Dr. Sharonne N. Hayes, director of the Mayo Clinic Women's Heart Clinic, told ABC News. According to Hayes, more and more women are taking birth control for other conditions such as acne and mood disorders linked to menstruation. Women must decide if treating these problems with birth control is worth the increase in heart disease risk.

Finally, though the risk remains, there is some evidence to suggest that it’s decreasing with newer forms of birth control. The review by Shufelt and Bairey Merz included several articles that found lower rates of heart disease in women taking more recent formulations of the pill or the patch. The newer versions tend to use lower doses and slightly different combinations of hormones, both of which may cut down on the risk.

January 15, 2009 | Permalink | User Comments (31)