February 26, 2010
NIH Podcast Episode #0104
Balintfy: Welcome to episode 104 of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode, researching medications for kids; fighting childhood obesity; getting health information on a mobile device and the impact of globalization on health. But first, this news update.
Balintfy: New analyses from a major study confirm that combination hormone therapy increases the risk of heart disease in healthy postmenopausal women. Researchers report a trend toward an increased risk of heart disease during the first two years of hormone therapy among women who began therapy within 10 years of menopause. A more marked elevation of risk was found among women who began hormone therapy more than 10 years after menopause. Analyses indicate that overall a woman’s risk of heart disease more than doubles within the first two years of taking combination hormone therapy.
Lactose intolerance is a real and important clinical syndrome, but how to measure its public health burden is a challenge. An NIH Consensus Development panel recently convened to review the available evidence on lactose intolerance and health across the age spectrum and across racial and ethnic groups. The panel defined lactose intolerance as the onset of symptoms—diarrhea, abdominal pain, flatulence, or bloating—after consuming lactose-containing foods and drinks. These symptoms are due to deficient levels of lactase; that’s an enzyme needed to break down lactose. Many individuals with lactose intolerance avoid dairy products, which are a good source of calcium, other nutrients, and often vitamin D. Without those nutrients the risk for chronic health problems, including osteoporosis and decreased bone health, increases.
Researchers at the National Heart Lung and Blood Institute, and the Centers for Disease Control and Prevention are developing a new surveillance system to determine the number of patients diagnosed with a family of inherited blood disorders. Six states will study two inherited blood disorders in a national pilot project. Surveillance programs in California, Florida, Georgia, Michigan, North Carolina, and Pennsylvania will help researchers determine the most effective plans for developing future registries for inherited blood disorders. Research findings based on data from disease registries may provide new ideas for drug therapies and can spur the development of tests that can determine severity of the diseases.
These news updates are compiled from information at www.nih.gov/news. Coming up after this break, two stories about children’s health – developing pharmaceutical drugs for children, and researching the prevention of childhood obesity – that and much more. Stay tuned.
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NIH Awards $8.5 Million for Research on Pharmaceuticals for Children
Balintfy: Studying pharmaceuticals in children is challenging because drugs often affect children differently than they do adults. Also, the scarcity of pediatric studies limits the ability of doctors and scientists to predict drug dosing, safety and efficacy in children. To address this gap, the National Institutes of Health is awarding new research grants. Kristine Crane reports.
Crane: The NIH recently awarded $8.5 million for research on children’s pharmaceuticals.
Dr. Hirschfeld: We need to understand if the diseases that are seen in children, such as for instance high blood pressure, are the same diseases as they are in adults, and the same causes, or if they are different.
Crane: Dr. Steven Hirschfeld is the associate director for clinical research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which is funding the awards.
Dr. Hirschfeld: So this initiative is designed to be what we hope will be a first attempt at looking at multiple outcomes for diseases that are of importance to children, and we believe also of importance to adults, and will allow us to understand some of the differences between children, children at different age groups, and adults, and adults in different age groups.
Crane: The award will sponsor 18 studies in pediatric cardiology, neonatology and pediatric neurology at institutions throughout the country.
Dr. Hirschfeld: We were particularly interested in conditions related to childhood seizures, related to high blood pressure, and related to treatments of infections in very young children.
Crane: Dr. Hirschfeld says the causes and development of those conditions are different in children than in adults. But until now, children have not been as closely studied as adults for various reasons.
Dr. Hirschfeld: Some have to do with the technical challenges. Some have to do with perceptions of the vulnerability of children, and concerns about protection of children in research. And some have to do with misunderstanding the diseases in children, or not having enough understanding, and some have to do with the fact that most children are relatively healthy.
Crane: Dr. Hirschfeld adds that cancer trials in children are a good model for systematic clinical research. About half of kids with cancer enroll in trials, and they generally have better disease outcomes than adults. For more information on the awards for pediatric studies, visit www.nichd.nih.gov. This is Kristine Crane, National Institutes of Health, Bethesda, MD.
Research to Help Fight Childhood Obesity: NCCOR
Balintfy: From pharmaceuticals, to diet. First Lady Michelle Obama recently spoke at an event about the Surgeon General’s Report on childhood obesity:
Michelle Obama: The surge in obesity in this country is nothing short of a public health crisis, and it's threatening our children, it's threatening our families, and more importantly it's threatening the future of this nation.
Balintfy: Childhood obesity is a topic of research covered by several NIH institutes including the National Heart, Lung and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The National Cancer Institute is also involved.Dr. Ballard-Barbash: Now, some people would wonder how the National Cancer Institute does work related to obesity.
Balintfy: We’re talking to Dr. Rachel Ballard-Barbash, associate director for the Applied Research Program at the National Cancer Institute. She explains that there's years of research evidenced to indicate that cancer is affected by obesity, not just cancer risk, but in fact our survival and the quality of life among cancer survivors are affected by their body-weight and their overall health. So how are NCI and other NIH institutes working together to tackle childhood obesity? An initiative called NCCOR.
Dr. Ballard-Barbash: NCCOR stands for the National Collaborative on Childhood Obesity Research. And this really was first launched a year ago after about eighteen months of planning among three organizations: NIH, Robert Wood Johnson Foundation, and the Centers for Disease Control. And this effort was intended to try to accelerate progress on reversing the epidemic of obesity among U.S. youth.
Balintfy: Dr. Ballard-Barbash, how serious is childhood obesity?
Dr. Ballard-Barbash: We know the rates of childhood obesity are going up, they've been going up for some time; even more troubling is that these rates are higher among the most disadvantaged populations so we know that they're much higher among lower income, among less educated, and among racial and ethnic groups with those characteristics that are higher among African-American children and among some Hispanic groups.
Balintfy: It sounds like a key step for research is measurement.
Dr. Ballard-Barbash: That's right you need to measure where you're starting from and then you need to measure whether you've changed at all, and you need to try to, as rigorously as one can, determine whether whatever you did, in fact, can be related to that change. So that's a good part of what we're trying to do with this effort. A big part of this, really though, is also sort of coordinating and putting in-sync the research activities that each of our individual institutions, so while much of the NCCOR collaborative effort is not done through joint funding. We're more ensuring that if we develop the new initiative it's been informed by our discussion, or if we know another one of our partners, like Robert Wood Johnson, is launching an initiative in a certain area we can make sure that whatever next step we do at NIH or CDC can further that or link to that effort. And it's been quite exciting to see how quickly this effort has grown.
Balintfy: What is the NCCOR initiative doing right now?
Dr. Ballard-Barbash: There's a big interest and focus on trying to ensure that we are looking at issues related to disparities among populations. But one of the greatest needs that we thought was there to really improve our ability to look across all of our research efforts and have more common measures and methods in order to facilitate research where we could in fact learn similar things across these different research efforts. So, one of the things that we've launched — two efforts in the areas of improving measures and methods — is to create a web-based registry of measures that will characterize measures across what we call a socioecologic pathway from the individual through families and communities into the policy arena.
And, so for example, for many years we've had a lot of measures about diet in the individuals, but we need also measures about what foods are available in stores, how easy or difficult it is for people to get the foods they need. We now have a lot of evidence, for example, that in low-income neighborhoods they have a lot of McDonalds, a lot of Dunkin' Donuts, but they don't have very many good grocery stores. And so these are ways we need to look in that area and see does that in fact affect how people eat, and what their body weight is? And research would suggest that it does.
So one of the advances that NIH and this group CDC and Robert Wood Johnson can do together is to try to improve and put out for researchers to know about all of the different kinds of measures that people are using across these different levels to try to study what works and doesn't work, so we can link policy to actual environments that people live in to practices in families to actual what happens to the individual from a behavioral and also biological standpoint.
Another effort that's moved forward out of the NCCOR collaborative is an effort to move forward a modeling effort called "Envision," and what that effort does is it takes data from much of these different sources, our national data, even some biologic data from our researcher studies funded at NIH and other places, and puts them into a mathematical model to estimate whether a particular kind of intervention, such as, a way to change physical activity at the population level, will have more or less effect than some other kind of intervention to alter body weight or to improve diet. And so, this effort has proven very effective. For some other areas, so we're moving this forward now in the area of obesity.
A fourth area that we're working on is trying to get this information out to people, to investigators much more rapidly. So we created this series of webinars which has been very exciting because it's brought over 1,000 participants to come and listen to these webinars, and even that count is probably not accurate because we're hearing that academic institutions around the United States are in fact having their whole class listen to a webinar as a way to educate themselves about this new field of research. So we think one of the most exciting things about this area of getting the information out is that it seems to be reaching some of the youngest investigators in the field.
Balintfy: It sounds like this is the important research background being done on the topic of childhood obesity.
Dr. Ballard-Barbash: There really is I think a nice synergy now between the work that NCCOR has been moving forward in the last year. We are excited and hope that many of the tools that we're moving forward will be very helpful to the administration as we're moving forward with the First Lady's efforts that are related to childhood obesity. And, many of the NCCOR staff from all of our organizations who have contributed to NCCOR are, I'm sure, going to be eager to contribute to the administration's new effort and prevention of childhood obesity.
Balintfy: NCI’s Dr. Rachel Ballard-Barbash, thank you very much. For more information about NCCOR, check out the website, www.nccor.org. And for details on the First Lady Michelle Obama’s campaign to combat the epidemic of childhood obesity, visit www.letsmove.gov.
NLM Launches Mobile MedlinePlus to Meet the Health Information Needs of an On-the-Go Public
Balintfy: Now not so much just for children, but anyone on the go, the National Library of Medicine has developed a mobile service for Medline Plus. MedlinePlus.gov is a web site which provides authoritative consumer health information to over 10 million visitors per month. Visitors from throughout the United States as well many other countries, use desktop computers, laptops and even mobile devices to get there. But now there’s a new site designed especially for those mobile devises. Wally Akinso shares the details.
Akinso: The National Library of Medicine’s Medline Plus is now mobile.
Frant: The National Library of Medicine created Mobile Medline Plus to meet the health information needs of a one the go public.
Akinso: Ms. Loren Frant is the Head of the Health Information Projects Unit at NLM.
Frant: Mobile Medline Plus builds on the NLM’s MedlinePlus’s website which has been around for since 1998 and provides authoritative consumer health information to over 10 million visitors per month.
Akinso: The mobile internet audience is large and growing fast, almost doubling from February 2007 to February 2009. Some experts believe that within the next five years, more people will connect to the internet by mobile devices than desktop or laptop computers. Ms. Frant talks about what this mobile service provides for this growing audience.
Frant: Mobile Medline Plus brings the same types of reliable health information that you can find on the full version of Medline plus to your fingertips. If you’re wondering what the side effects are for your new prescription, you can go to Mobile Medline Plus, while you’re waiting for the pharmacist to fill your order. Mobile Medline Plus can also help you when you’re trying to choose an over the counter cold medicine at the drug store. When you’re in the waiting room you could visit the "Talking with your Doctor" page on Mobile Medline Plus to learn how to get the most out of your doctor's visit.
Akinso: To access Medline Plus on your mobile phone visit http://m.medlineplus.gov. This is Wally Akinso at the National Institutes of Health. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Balintfy: When we come back, a discussion on globalization’s impact on health care. Stay tuned.
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Perspective on Health and Globalization
Balintfy: Welcome back. Health is a topic of importance to people of all ages, as well as people worldwide. Dr. Julio Frenk is the Dean of the Harvard School of Public Health and a native of Mexico. He was the Health Minister of Mexico, where he introduced a national health insurance system which covers 30 million people. Dr. Frenk was also executive director of the Evidence and Information for Policy unit at the World Health Organization, and was a senior fellow at the Bill and Melinda Gates Foundation. Dr. Frenk was a featured speaker recently at the NIH, where he spoke on "Globalization and Health: the Role of Knowledge in an Inter-dependent World." Prior to his lecture, he spoke to Kristine Crane for NIH Radio.
Crane: Dr. Frenk, can you tell us how globalization has changed the situation for healthcare around the world?
Dr. Frenk: First of all, we still have the unfinished agenda of common infections. Infectious diseases like malaria, which still kills a million persons every year. Or malnutrition. Or reproductive health problems. There’s half a million women who died in childbirth every year. Most developing countries are already facing the epidemics of non-communicable diseases that were traditionally confined only to the most advanced societies. Diseases like cancer, like heart disease, like diabetes—are now the leading cause of death in most of the countries of the world, including most of the developing countries. And on top of that we have a third burden, which is represented by health challenges that are directly linked to globalization and affect all countries in the world irrespective of their level of economic development. These challenges linked to globalization include pandemics such as AIDs, or the current pandemic of influenza that we’re going through right now. It includes the health effects of climate change. These health problems linked to globalization relate to the trade of harmful products, whether they are legal like tobacco, or illegal, like other drugs. And in general the dissemination of lifestyles that are leading to this growing pandemic of obesity.
Crane: What are some of the challenges and the benefits that globalization has created for healthcare?
Dr. Frenk: Some of the risks are related to the huge movement of people, the growth in trade, and that’s what we tend to see as the dark part of globalization when it comes to health: the fact that infectious diseases can spread much more quickly, and you also have the spread of lifestyles and other problems. Those are the risks, but we also have opportunities. And to my mind, the main way in which globalization has helped health is in facilitating the dissemination of knowledge. Knowledge has become a global public good, so that research that’s carried out in any part of the world benefits everybody else.
Crane: Dr. Frenk, can you give us an example of how globalization has helped a healthcare problem?
Dr. Frenk: There’s now close to four million people, most of them very poor, most of them in Africa, who now have access to AIDs treatment, something that no one would have thought possible when these drugs were introduced at prices that made them completely unaffordable. So this is an example of how globalization can bring us together around shared goals, and how globalization really spawns global civil society movements.
Crane: What role does the media, and more broadly, communication have in facilitating healthcare in a globalized world?
Dr. Frenk: I always say that communication has a place next to vaccines. And the reason is very simple. Health is not something that a doctors or a nurse does for you. The patient is a co-producer of his or her own health. First of all by the behavior: do you smoke, do you not smoke; do you practice safe sex or not; do you eat healthy or not; our own behaviors. Second by the decision to go to a health facility or not. And third, once we are given a prescription, by our compliance with that prescription. People are not just the beneficiaries of healthcare. They are co-producers of their own health. And the way you organize that co-production is with good communication.
Crane: Even as globalization moves the countries of the world closer together, there are still huge gaps in wealth. Dr. Frenk, how do we overcome those disparities when dealing with healthcare issues?
Dr. Frenk: What we have seen is that when countries apply enlightened policies, even in the face of existing and even expanding disparities in income distribution, you can actually reduce the health gaps, even when you have a large degree of income distribution. The reason is really make an effort, the will to de-couple access to care from income. That’s why we need national insurance. We don’t want your income to determine whether you have access to healthcare prevention. And when you do that, when you have those kinds of policies, even in the face of persisting inequalities in the international scene, you can achieve fuller convergence of healthcare conditions.
Balintfy: That was Harvard School of Public Health Dean Dr. Julio Frenk talking with Kristine Crane.
Balintfy: And that’s it for this episode of NIH Research Radio. Please join us again on Friday, March 12 when our next edition will be available for download. And remember, if you’d like to comment, or request a topic to cover, please send me an email at firstname.lastname@example.org. I'm your host, Joe Balintfy. Thanks for listening.
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