Acupuncture for good health

By Martha Kerr

NEW YORK (Reuters Health) - Episodes of transient amnesia, which frequently occur on awakening and are associated with other memory problems, may be a symptom of a distinct type of epilepsy. A British team describes this condition they call "transient epileptic amnesia" in a study published in the Annals of Neurology.

Dr. Adam Z. J. Zeman, of the Peninsula Medical School in Exeter, and colleagues recruited 50 patients over an 18-month period who had recurrent episodes of amnesia that were witnessed by another person; otherwise intact mental functioning; and evidence suggesting epilepsy, including EEG abnormalities, response to anticonvulsant therapy; or clinical features, such as hallucinations involving the sense of smell.

In correspondence with Reuters Health, Zeman described transient epileptic amnesia as "repeated short episodes of transient amnesia, occurring about once a month, usually lasting about half an hour, often occurring on waking, typically in middle-aged people around the age of 60."

"There can be other manifestations of epilepsy during the attack, like a hallucination of a smell, or a brief period of loss of awareness, but often the amnesia is the sole manifestation of the seizure," he added.

Zeman's team found that the condition was often misdiagnosed -- only 12 of the 50 patients in the study had received an initial diagnosis of epilepsy.

Anticonvulsant medication was effective in 44 of the 47 patients treated. "Most of our patients were treated with carbamazepine, sodium valproate or lamotrigine and the response to treatment was generally excellent," Zeman said.

Among the 50 patients, 40 described persistent memory difficulties. Patients demonstrated a "loss of autobiographical memory for events extending back over 40 years." They had a normal performance on standard memory tests, but they exhibited "accelerated forgetting of verbal and visual material over three weeks by comparison with matched control subjects," the researchers report.

"We propose that transient amnesic epilepsy is a distinctive epilepsy syndrome, typically misdiagnosed...and associated with accelerated long-term forgetting and autobiographical amnesia," Zeman and his colleagues conclude.

SOURCE: Annals of Neurology, June 2007.

By Joene Hendry

NEW YORK (Reuters Health) - In people with rheumatoid arthritis, heavy cigarette smoking appears to slow the rate of joint destruction, new research suggests.

"Potentially, this may be due to the anti-inflammatory properties of nicotine," Dr. Axel Finckh, University Hospital of Geneva, Switzerland told Reuters Health.

Cigarette smoking is a known risk factor for rheumatoid arthritis, a chronic inflammatory disease that causes progressive joint destruction, disability, and premature death, Finckh and colleagues reported in the Annals of the Rheumatic Diseases.

Yet, it remains unclear if smoking influences the progressive joint destruction and disability cause by rheumatoid arthritis. Finckh and colleagues therefore assessed joint X-rays and results from self-reported functional disability questionnaires for more than 2,000 rheumatoid arthritis patients in their early- to mid-fifties.

Most of the patients (1459) did not smoke; 489 were considered moderate smokers and 55 were classified as heavy smokers, consuming more than one pack per day.

Overall, the investigators found that the smokers and non-smokers had similar rates of progressive joint damage and functional disability.

Unexpectedly, they also found slower rates of progressive joint damage in the X-rays of heavy cigarette smokers compared with the moderate smokers and the non-smokers over the 3-year study.

These findings suggest that smoking is more influential in the development of rheumatoid arthritis than the progression of the disease over time, but further research is needed to fully understand the impact smoking has on disease progression.

Still, Finckh cautioned: "The cardiovascular hazards of smoking certainly outweigh the potential anti-inflammatory benefits of nicotine," so the health risks associated with smoking are much greater than any benefits people with rheumatoid arthritis may gain from smoking.

Additional study is needed to understand the influence of tobacco and nicotine on the body's immune system.

SOURCE: Annals of the Rheumatic Diseases, July 2007.

TORONTO (Reuters) - Canadian government policies have driven up prices of generic prescription drugs so dramatically that they are more expensive than their U.S. counterparts, a study showed on Tuesday.

Prices of generic prescription drugs in Canada were, on average, 115 percent higher than U.S. prices, a study by Canada's Fraser Institute showed. However, Canadian brand-name prescription drugs were about 51 percent cheaper than those in the U.S.

"Canadians pay more for generic drugs because government policies shield generic drug companies and pharmacy retailers from normal market forces that would naturally reduce prices," the study said.

Indeed, generic drug prices in Canada have risen compared with a similar study in 2005. At that time, they were 78 percent more expensive in Canada than in the U.S., while Canadian brand-name drugs were 43 percent cheaper.

The institute said "misguided government policies" cost Canadians between C$2.5 billion and C$6.6 billion in unnecessary spending in 2006 alone, due to the inflated prices for generic drugs.

From 2003 to 2006, the total in unnecessary spending was estimated to be as high as C$20 billion, or possibly more than C$26 billion, the report said.

The study showed that 44 percent of the prescriptions dispensed in 2006 were for generic drugs, while 56 percent were for brand-name drugs. In the U.S., 63 percent of prescriptions were for generics with just 37 percent for brand-name drugs.

The report said Canadian drug programs direct public reimbursement of prescriptions to pharmacies instead of consumers, insulating consumers from the cost.

It said provincial drug programs reimburse generic drugs at a fixed percentage of the brand-name original drug which discourages price wars.

"Since the U.S. market is not distorted by the kinds of government policies that exist in Canada, Americans benefit from dramatically lower prices for generic drugs," Brett Skinner, The Fraser Institute's director of health, pharmaceutical and insurance policy research, said in a statement.

($1=$1.06 Canadian)

By Julie Steenhuysen

CHICAGO (Reuters) - U.S. physicians who identify themselves as religious are no more likely to care for poor, underserved patients than those who have no religious affiliation, researchers have found.

The study suggests doctors in the United States who see religion as a "master motive in their lives" are not more likely to care for the poor than others.

"Religious physicians are not disproportionately caring for the underserved," Dr. Farr Curlin, of the University of Chicago, said in a telephone interview on Monday.

Curlin, who considers himself religious, said he undertook the study because many religions include a call to serve the poor.

"I was curious about whether doctors who are more formed in their religious beliefs are more likely to take care of patients who are poor," said Curlin, whose study appears in the Annals of Family Medicine.

He and colleagues at Yale New Haven Hospital in Connecticut mailed surveys to 1,820 practicing doctors. Of those, 63 percent responded.

The researchers ranked "intrinsic religiosity" according to how physicians answered questions about the role of religion as a motive in their lives.

Physicians also answered questions about how frequently they attended religious services, the extent they considered themselves to be spiritual, and whether they believed the practice of medicine was a calling.

What they found was physicians who were deemed more religious as reflected by intrinsic religiosity or frequency of attendance of religious services were not more likely to report caring for underserved patient populations -- those that tended to be poor, uninsured or on Medicaid, the federal program for the poor.

"It suggests, I think, that when doctors are making the connection between being people of faith and the practice of medicine, that connection does not seem to lead them ... to an added commitment to caring for the underserved," Curlin said.

NEW YORK (Reuters Health) - A preventive strategy that uses the labor-inducing drug prostaglandin can safely reduce c-section rates, new research suggests.

C-section rates have been climbing in North America for a number of years, a trend that is concerning since complications can occur with the procedure, Dr. James M. Nicholson, from the University of Pennsylvania in Philadelphia, and colleagues note in the Annals of Family Medicine.

In the 1990s, the preventive induction approach was found to be useful in reducing c-section rates.

The goal of the present study was to compare c-section rates and delivery outcomes for doctors who did or did not use preventive induction. The study group included 794 women who had a doctor who used this approach and 1,075 women with a doctor who did not use this approach.

The researchers found that the induction group had a lower c-section rate compared with the group that did not undergo induction -- 5.3 percent versus 11.8 percent. There was no evidence that preventive induction raised the risk of any birth complications, the authors report.

In a related editorial, Dr. Aaron B. Caughey, from the University of California, San Francisco, comments that if further studies verify these results, preventive induction could be a useful technique for improving birth outcomes.

SOURCE: Annals of Family Medicine, July/August, 2007.