Tuesday, February 26, 2013

Cloning Goes Commercial

The first adult animal to be cloned was Dolly the sheep.   At the time (1997) the event was seen as a remarkable technological feat, of importance primarily to research biologists.   In the decade that followed other animals were cloned in research laboratories around the world.   Initial success rates were low, but in recent years the techniques have improved to the point that the cloning of adult animals is becoming economically feasible.

For example, a Texas company called Crestview Genetics is now in the business of cloning polo ponies.   Polo is a big sport in many countries, and good polo ponies are in great demand.  According to an article a polo trade journal, a three-month-old clone of a polo pony called Cuartetera sold for $800,000 in Argentina in 2010.  Crestview expects to be able to create up to 30 clones of valuable polo ponies and horses a year. You do the math.

Cloning animals for a profit is likely to become even more commonplace within the next decade.   The most likely candidates, obviously, are animals that are worth a lot to somebody, like prizewinning bulls for breeding cattle; championship dogs; rare or endangered animals; even beloved pets. How much would you be willing to pay to have your pet cloned?

Friday, February 22, 2013

Fighting Illegal Steroid Sales

Injectable anabolic steroids are drugs. Yes, they are legal, but only when they are prescribed by a physician. It is standard medical practice for the physician to meet with the patient and make a determination that the use of an anabolic steroid is justified before prescribing it.

But wait a minute - aren’t anabolic steroids readily available by mail order and even over the Internet?  Well, yes, but that doesn’t make it legal - it just means that the authorities haven’t caught up with the sellers (or the buyers!) yet.  A few states are beginning to crack down on the illegal sales of anabolic steroids in the most egregious cases, but frankly they seem to be swimming against the tide.

Case in point; in 2007 prosecutors from Albany County in the state of New York, backed by federal authorities and officials in Florida, charged six doctors in Florida with writing prescriptions for controlled substances to patients they had never met.  It isn’t clear whether the doctors lost their licenses as a result.  And just this month, according to a story in the New York Times, the Florida pharmacy linked to the doctors pled guilty to the illegal online sale of steroids and paid a fine of $100,000.

A fine of $100,000 doesn’t sound like much, especially since a guilty plea allowed the former owners of the pharmacy to avoid criminal charges.   Perhaps this is why the sale of anabolic steroids over the Internet continues almost unabated.  There’s money to be made, the sellers rarely get caught, and even when they do the punishment seems fairly minor.

Saturday, February 16, 2013

Buying Human Milk for Your Baby

Most health experts agree that the best milk for human babies is mother’s milk.  Human milk provides the ideal nutritional mix for the infant. It also partially protects babies from colds and infections early in life (when their own immune system is still immature) because it contains some of the same antibodies that are present in the mother.  These antibodies are not present in cow’s milk.

Unfortunately, some parents are not able to provide their infants with the infant’s mother’s own milk.  Gay couples, for example, and women who are unable to nurse will need another source of human milk.   Some parents find their own donors or rely on websites like Eats on Feets and Human Milk 4 Human Babies; others use established human milk banks such as those affiliated with the Human Milk Banking Association of North America.  The established milk banks alone dispense several millions of ounces of human milk every year; how much is exchanged privately or as a result of contact between strangers over the Internet is unknown.

Purchasers of human milk should be aware that human milk can contain harmful bacteria, or viruses such as H.I.V.   It may also contain certain drugs taken by the human milk donor.  The established milk banks routinely screen their donors and pasteurize the milk before selling it, but not all private exchanges do.   Unpasteurized human milk from an unknown source represents a risk.   It’s is up to the purchaser to decide on how great that risk is.

Friday, February 8, 2013

The NFL and GE Partner in Brain Injury Study

In recent years there has been a sharp increase in the public’s awareness of the potential for traumatic brain injury in certain contact sports.  Unfortunately, not much is known yet about acute traumatic brain injury.  In order to protect athletes more effectively we need to know a lot more, starting with accurate diagnosis.

Fortunately, progress may come soon.  Starting next month, the NFL will partner with General Electric in a $30 million effort to learn how to diagnose and track the time course of traumatic brain injury, according to an article in the New York Times and on the NFL’s website.   GE will focus on the development, refinement, and validation of imaging techniques such as Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI).   MRI is already being used to study multiple sclerosis and Alzheimer’s disease, but its usefulness in diagnosing head injury has not been proven.  The goal would be to be able to diagnose and quantify the extent of an acute brain injury quickly and then to track the time course of recovery, so that better decisions could be made regarding when an athlete could safely return to the field of play.  Imaging techniques might also be used to accurately diagnose chronic traumatic brain disease.  The NFL and GE expect their joint effort to show significant progress within 4 years.

The ability to diagnose and track the extent of brain injury would be useful beyond sports, of course.  Many soldiers have suffered acute traumatic brain injury during combat, and traumatic brain injury is a leading cause of death among children and young adults.

Sunday, February 3, 2013

Georgia’s “Pill Mill” Problem

Some patients suffer from nearly constant intense pain. Pain management is complex enough that it has become a true medical specialty. Years of medical specialty training are required, culminating in certification by the American Board of Pain Medicine. Management of chronic pain requires a multi-faceted approach that includes careful medical evaluation after referral by a licensed physician; a full understanding of the source of the pain; attempts to reduce pain by non-narcotic means; and when all else fails, minimal doses of pain medications dispensed under strict medical supervision. Patients generally have insurance coverage because their pain has been properly diagnosed and is being legitimately treated.

Unfortunately, certain legitimate pain medications are also popular street drugs. And that has given rise to “pill mills” – medical clinics masquerading as pain management centers that are in reality just high-profit pain medication dispensaries. At pill mills, patients are prescribed unusually large doses of narcotics such as oxycodone, generally for cash and generally without extensive diagnosis or alternative treatment. Many of these pills are later sold for cash on the black market, rather than being used by the “patients” themselves.

According to the Wall Street Journal, the state of Georgia has developed a “pill mill” problem in the wake of an aggressive crackdown on such clinics in Florida. The clinics simply moved north, where current Georgia laws make it hard to prosecute such clinics effectively. Georgia, like most states, does not require medical clinics to be owned by a medical professional and does not track the number of prescriptions each clinic writes.

The state of Georgia will surely do something about its pill mill problem in due time. But until there’s a national solution or at least communication and coordination among the states, the pill mills are likely to just move elsewhere.

Saturday, February 2, 2013

Double Mastectomies Are On the Rise

Many women who are diagnosed with breast cancer in one breast are opting to have the other breast removed as well.  The surgery is called contralateral prophylactic mastectomy, or CPM.  According to a recent report, four years after a diagnosis of breast cancer 30% of women were considering undergoing CPM, and 7% had already done so.

Is CPM justified in most cases of unilateral breast cancer, or are women’s fears and anxieties leading to over-treatment?   Apparently, most of the women who opted for removal of their contralateral breast after a diagnosis of breast cancer had not undergone any genetic testing or counseling and were not actually at increased risk for cancer of the contralateral breast.

Why are women opting for CPM when it may not be medically necessary?   One reason is that women who have had breast cancer tend to substantially overestimate their risk of developing cancer in the contralateral breast, according to researchers at the University of Minnesota.  These findings suggest that more counseling is needed, so at least women who opt for CPM do so with correct information.

No one knows whether accurate information regarding breast cancer risk would lower the rate of voluntary CPM among women diagnosed with breast cancer in one breast.  After all, who can estimate the value of peace of mind?   In the end, it has to be the woman’s choice.