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Platelet E-News – August 16, 2006

This e-newsletter is a monthly publication of The Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.

Contents:

  • Platelet Disorders in the News
    • Platelet-counter results differ
    • Serotonin in platelets promotes healing
    • Research facility develops better ways to diagnose immune diseases
  • General Health News
    • Aspirin-a-day might not keep the doctor away
    • Most Americans are oblivious to fat-cancer connection
    • Good diet may be better than the best vitamins
    • FDA may approve adaptive drug trials
    • Paying for it: Americans, British seek better health care for citizens
    • United Kingdom tests performance-based payment
    • American uninsured frequently forgo health care
    • Natural Herbal Solutions Developed by MDs (advertisement)

 

Platelets Disorders in the News

 

Platelet counter results differ

Not all methods for counting platelets are created equal, according to a recent study. The study found that a commonly used method, called the impedance method, produces platelet counts lower than the immunoflourescence method at low platelet levels. Because therapy choices are based on platelet counts, the authors suggest the use of the immunoflourescence method to obtain accurate results.

In the study, both methods produced similar platelet counts for healthy individuals, but they differed widely for thrombocytopenic patients. Of the 35 people in the study, nine patients had platelet counts 50 percent greater from the immunoflourescence assays than the impedance method, and four patients had counts that were 100 percent greater.

Source: Bowles, Kristian M., David M. Bloxham, David J. Perry and Trevor P. Baglin. "Discrepancy between impedance and immunofluorescence platelet counting has implications for clinical decision making in patients with idiopathic thromocytopenia purpura." British Journal of Haematology. Vo134: 320-322

Serotonin in platelets promotes healing

Platelets do more than patch up a wound; they also deliver important molecules to a damaged tissue, according to a recent study.

Within the platelet are tiny sacs called granules, which carry a variety of important molecules including serotonin. In the brain, an imbalance of serotonin results in sleep and mood disorders, and for years, doctors have prescribed serotonin to treat depression. But scientists have not been able to prove that serotonin in the brain is affected by the serotonin in platelets.

Scientists have shown that platelets not only patch damaged tissue, but are also needed to secrete high concentrations of serotonin and other molecules, which allow for better healing.

Source: "Blood platelets: Nature's own targeted therapeutic delivery system." The Hematologist. July/August 2006. Vol 3 (4): 6

Based on: Lesurtel M, Graf R, Aleil B, et al. Platelet-derived serotonin mediates liver regeneration. Science 2006;312:104-7

Research facility develops better ways to diagnose immune diseases

The Benaroya Research Institute in Seattle has created a four-armed molecule, called a tetramer, that may help diagnose and treat immune disorders. Artificially-produced tetramers attach to targets in the blood, which allows scientists to identify what antigen caused an immune response.

Most immune-response tests examine the blood stream for antibodies, immune particles that mark unwanted objects for destruction. But antibodies are only part of the immune system’s response; immune cells also recognize and initiate immune responses. Tetramers allow scientists to locate these rare immune cells and learn what makes them attack.

The Benaroya Research Institute is supported, in part, by Pat's Fund (www.patsfund.org), a non-profit organization created in memory of Pat Rising. In the early 1990s, Pat was diagnosed with ITP and died less than two months later, at age 33. In his honor, Pat’s family created Pat's Fund and the DAISY Foundation. The latter supports PDSA’s annual conference.

Paulson, Tom. "Seattle in demand on even a molecular level widely-wrought tetramers help diagnose disease." The Seattle Post-Intelligencer. July 5, 2006.

"Research team at Benaroya Research Institute discovers new means of targeted regulation of the immune system." Pat's Fund. March 14, 2005.

General Health News

 

Aspirin a day might not keep the doctor away

It seems like nearly everyone with high cholesterol is taking baby aspirin every day. But most people don’t know that almost no research supports long-term aspirin therapy.

In fact, several studies showed long-term aspirin therapy doesn’t prevent strokes and heart attacks, but it may also damage the blood vessels and platelets, according to John Cleland, a professor of cardiology at the University of Hull in the National Clinical Practice of Cardiovascular Medicine.

A short course of aspirin (usually five weeks) after a heart attack or stroke does reduce a patient’s risk of another dangerous clot, but no studies conclusively show that long-term aspirin therapy is safe or effective for patients at risk for heart disease and blood clots.

Instead, Cleland suggests, long-term doses of aspirin may damage the body by permanently preventing platelets from sticking together and by weakening the blood vessel walls. “On existing evidence,” he said, “aspirin should only be given to carefully selected patients, for a few weeks after a vascular event.”

Cleland called for more long-term studies of aspirin to support its popularity.

Cleland, John GF. “Chronic aspirin therapy for the prevention of cardiovascular events: A waste of time, or worse?” Nat Clin Pract Cardiovasc Med. 2006. 3(5):234-235.

Most Americans are oblivious to fat-cancer connection

More Americans know about “American Idol” than obesity, said a recent poll by the American Cancer Society (ACS). The poll showed 65 percent of Americans understood how to play the popular television show “American Idol,” but only 8 percent knew the risks associated with obesity.

Obesity, or being 30 pounds overweight, is second only to smoking as the leading cause of preventable death in the United States. It interferes with the body’s use of insulin and is a risk factor for several cancers including: breast, prostate, colorectal, endometrial, kidney, pancreas, esophagus and some lymphomas.

ACS's survey suggested that Americans have a skewed perception of their own weight. Only 45 percent of the respondents said that they are overweight, but, according the ACS, 65 percent of Americans are overweight and 30 percent of these are obese.

Over half of the respondents found some food “irresistible.” The most craved foods were chocolate (20 percent), Italian food (14 percent), cookies, cakes and doughnuts (10 percent), hamburgers and meat (9 percent) and seafood (9 percent).

The survey was part of the ACS “Great American Eat Right Challenge,” which can be found on their Web site: http://www.cancer.org/docroot/PED/PED_9_Great_American_Eat_Right_Challenge.asp

Hematology & Oncology News & Issues. June 2006.

Good diet may be better than the best vitamins

Several large clinical trials this year have revealed that popular vitamins and dietary supplements offer fewer benefits that expected.

Instead the studies highlighted the importance of a healthy diet. In foods, vitamins and minerals interact with other components and produce optimal results, but supplements offer one isolated dietary component and not the whole package. A diet consisting of a variety of fruits and vegetables provides the optimal amount of vitamins and minerals.

Vitamins and supplements shown to be less effective than believed are:

  • Glucosamin and chondroitin sulfate – used to reduce joint pain in arthritis. In a scientific trial, only patients with moderate to severe pain received a slight benefit from the supplements.
  • Calcium and vitamin D – taken to prevent bone thinning and fractures associated with osteoporosis. Most women can get enough calcium and vitamin D from a healthy diet and sun exposure, but some may benefit from supplements.
  • B vitamins – B vitamins were believed lower heart disease, but a large study showed no benefits.
  • Multivitamins – Daily doses of multivitamins might ward off diseases like cancer and heart disease, but a federal panel declared that there was not enough evidence to recommend taking or not taking the vitamins.
  • Echinacea – The herb, Echinacea, is thought to prevent the common cold. But in a clinical study, Echinacea prevented no more colds than a placebo.

Payne, January W. "A bad year for favorites." The Washington Post. June 20, 2006.

(Note: You can view PDSA’s diet and lifestyle suggestions at http://www.pdsa.org/articles.htm

FDA may approve adaptive drug trials

The Food and Drug Administration and the pharmaceutical industry are considering using adaptive trials, which allow studies to change procedures based on early results. Traditionally, trials for prospective drugs are “double-blinded, placebo-controlled” meaning that neither physician nor patient knows if the patient is given the trial drug or a placebo.

The new trials would be run based on complex plans developed by computers before the study begins. If early in the trial, one dosage or treatment appears to be more effective than others, patients would be switched into that treatment. Adaptive trials would be more efficient than current trials and could save millions of dollars.

Proponents of the adaptive trials believe they will reduce the number of patients needed in a trial by as much as 30 percent, and they claim that patients will benefit from an increased chance of receiving more effective treatment. Those opposing adaptive trials claim they are vulnerable to bias and abuse.

The FDA plans to create a “concept paper” describing guidelines for adaptive trials.

Mathews, Anna Wilde. “FDA signals it’s open to drug trials tat shift midcourse.” The Wall Street Journal Online. July 10, 2006.

Paying for it: Americans, British seek better health care for citizens

United Kingdom tests performance-based payment for health care providers

When British family physicians were paid according to their performance, patient care exceeded expectations, according to a study published in the New England Journal of Medicine.

Unlike the United States' insurance-based health care, the United Kingdom's government provides its citizens with health care, and doctors receive their paycheck from the state.

This payment system gives little motivation for physicians to provide better health care for their patients. So, in 2004, the National Health Service of the United Kingdom created a performance-based payment program to reward physicians who provided better care for their patients.

Each condition was assigned a number and a list of good treatment practices. Physicians who completed these treatments were awarded points.

Those creating the program expected family practices to achieve 75 percent of their available points, but instead practices earned almost 97 percent of the available points. These high performances increased the cost of health care to tax payers and required extra funding.

Performance-based payments are becoming more popular on both sides of the Atlantic as more American insurers are experimenting with the new system. In December 2005, only two communities, Orange County Calif. and Boston, implemented large-scale pay-for-performance programs, but most health care plans and Medicare are developing these programs, according to the Center for Studying Health System Change.

Doran, Tim, Catherin Fullwood, Hugh Gravelle, David Reeves, Evangelos Kontopantelis, Urara Hiroeh and Martin Roland. "Pay-for performance programs in family practices in the United Kingdom." The New England Journal of Medicine. July, 2006.

Bodenheimer, Thomas, Jessica H. May, Robert A.Berenson and Jennifer Coughlan. “Can money buy quality? Physician response to pay for performance.” Center for Studying Health System Change. Dec. 2005. 102. www.hschange.org

American uninsured frequently forgo health care

Insurance policies provide health care for most Americans, but approximately 15 percent of the population -- 41 to 45 million people -- do not have health insurance, according to the 2002 US Census Bureau, as reported by The Journal of Infusion Nursing.

Income was the most influential factor determining whether a person had health insurance. Over 30 percent of Americans at or below the poverty level did not have insurance, and for those only slightly above poverty, 28 percent were not insured.

Personal characteristics also affected a person’s chances of being uninsured. More women had health insurance than men. Adults between the ages of 18 to 64 years were less likely to be insured than both the young and the elderly.

African and Hispanic Americans were more likely to not have insurance than either Caucasian or Asian Americans, and those who were foreign-born were twice as likely to not have insurance compared to people born in America.

Education and employment also directly affected who had insurance. Not surprisingly, those with more education also were more likely to have health insurance and vice versa. In the general population, only 18 percent of full-time employees lacked health insurance, but 26 percent of the unemployed went without insurance. But these numbers switched among the poor; 38 percent of the unemployed and 49 percent of full-time employees did not have insurance.

Those with health insurance are more likely to receive better health care than those without. For example, an uninsured woman’s risk of death from breast cancer was 30 to 50 percent greater than a woman with insurance. Even if the uninsured are treated, the government and the health care providers must bear the cost and, therefore, may reduce treatment options available to consumers without health insurance.

Trotochaud, Karen. "Ethical issues and access to health care." Journal of Infusion Nursing. May/June 2006; 29(3) : 165-170.