Platelet E-News – November 17, 2008

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.


ITP Research and Treatments

General Health and Medicine

Hospitals, Insurance, and Medical Care


ITP Research and Treatments

FDA Approves New Drug To Treat ITP
PROMACTA® (eltrombopag), the first oral thrombopoietin (TPO) receptor agonist, has been granted accelerated approval by the United States Food and Drug Administration (FDA) to treat adults with chronic immune (idiopathic) thrombocytopenic purpura (ITP). The drug is expected to be made available by next week.

FDA Approves New Drug To Treat ITP

Anticoagulants Can Inhibit Vitamin K and Harm Kids’ Bones
Children taking anticoagulants, such as warfarin, may have lowered levels of vitamin K, which may harm bone health, according to a study from the Netherlands. The researchers recommend close monitoring of bone status in children on anticoagulant therapy.

Avgeri M, Papadopoulou A, Platokouki H, Douros K, Rammos S, Nicolaidou P, Aronis S. Assessment of Bone Mineral Density and Markers of Bone Turnover in Children Under Long-term Oral Anticoagulant Therapy.
Journal of Pediatric Hematology/Oncology, August 2008, 30(8):592-597.

Oncologists Seeing More Patients but Making Less Profit
Many ITP patients see hematologist-oncologists, and these specialists in blood diseases and cancer are spread thin, according to a survey reported in July by Onmark, a national group purchasing organization for community-based medical practices. Oncologists are carrying larger patient loads, as drug prices rise and profits go down.

Community-based oncologists: seeing more patients, making less profit.  Hematology & Oncology News & Issues, Oct. 2008, Vol 7 (10), p14.

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General Health and Medicine

Common Autoimmune Disease Remains Underdiagnosed and Undertreated
Sjögren’s syndrome is one of the three most common autoimmune disorders, affecting 3 million Americans, 90% of whom are women. Many of its symptoms mimic those of other conditions, so its diagnosis is often missed. In Sjögren’s syndrome, the body attacks its own secretory glands and tissues. Most common symptoms are dry mouth and dry eyes. Diagnosis is delayed on average six years. Delayed treatment can lead to organ damage, plus people with Sjögren’s face a high risk of developing lymphoma and should be alerted to its early signs. Since 2002, there have been internationally accepted criteria for diagnosing the disorder.

Brody, J. An Autoimmune Disorder, in Camouflage. The New York Times, October 7, 2008, p D7.

Animal Study Shows BSE (Mad Cow Disease) Can be Transmitted by Blood Transfusion
BSE can be transmitted through blood transfusion according to a study in sheep, which suggests that safeguards put in place to protect the human blood supply were justified (The FDA asked blood centers to exclude potential donors who have spent six or more cumulative months in the U.K. between 1980 and 1996 from donating blood.). Transmission even occurred when blood was collected from animals before they developed signs of disease. BSE is a rare neurodegenerative disorder that cannot be detected before the patient experiences problems, such as unsteadiness or involuntary movements.

Houston F, McCutcheon S, Goldmann W, Chong A, Foster J, Siso S, Gonzalez L, Jeffrey M, Hunter N.  Prion diseases are efficiently transmitted by blood transfusion in sheep Blood, Jul 22, 2008, Epub.

B12 May Protect Against Brain Shrinkage and Risk of Dementia in Older People
Older adults with lower blood levels of vitamin B12 were more likely to experience brain shrinkage over a 5-year period than those with higher levels, according to a U.K. study. B12 is available from meat, milk, and eggs. Other studies have linked increased levels of B12 to reduced levels of homocysteine, an amino acid reported to increase risk for dementia.

Vogiatzoglou A, Refsum H, Johnston C, Smith SM, Bradley KM, de Jager C, Budge MM, Smith AD.  Vitamin B12 status and rate of brain volume loss in community-dwelling elderly. Neurology. 2008 Sep 9;71(11):826-32.

Vitamin D News:

Leading Pediatrician Group Says Children Should Get Double the Recommended Amount of Vitamin D
The American Academy of Pediatrics says children—from newborns to teens—should get 400 units of vitamin D each day, double the amount in current recommendations. Growing evidence suggests that vitamin D not only keeps bones strong, but may reduce risk for cancer, diabetes, and heart disease. Good sources are milk, fortified cereals and oily fish, such as tuna, mackerel, and sardines. Sun exposures—15 minutes a day without sunscreen—also helps the body make vitamin D. But Academy experts suggest that supplementation may be necessary to reach 400 daily units.;122/5/1142

How to Get Enough Vitamin D: Supplements, Daily Sun Exposure and Special Sun Lamps
It is difficult to get enough vitamin D through foods and sun alone, especially during the winter months when the sun is too weak to trigger the body’s natural ability to make vitamin D. Other good options include: vitamin D supplements (look for vitamin D3), 10-15 minutes of sun exposure during summer months, or a special medium-pressure sunlamp. The FDA has sanctioned some sunlamps made by Sperti, such as the KDB D/UV lamp, as a vitamin D producer for people who need more vitamin D.

Ask Tufts Experts, Tufts University Health & Nutrition Letter. November 2008, pg. 7

Vitamin K News:

Vitamin K, So Important to ITP Patients, Is Found in Variety of Foods
Vitamin K helps blood to clot. Foods high in vitamin K include leafy green vegetables (spinach, escarole, kale, seaweed, endive, collard greens, turnip greens, and Swiss chard). Medium sources of vitamin K are: broccoli, Brussels sprouts, Romaine lettuce, parsley, green cabbage, spring onions, coleslaw, pistachios, and mustard greens.

Ask Tufts Experts, Tufts University Health & Nutrition Letter. November 2008, pg. 7

Vitamin K2 Reduces Hardening of the Arteries, Protects Heart
Higher intake of vitamin K2—which is different from the vitamin K found in leafy greens—is associated with a 20 percent reduction in hardening of the arteries, according to a study of dietary habits and cardiovascular health in 564 postmenopausal women. Sources of K2, also called menaquinones, are meats and cheeses.

Joline W. Beulens, Michiel L. Bots, Femke Atsma, Marie-Louise Bartelink, Matthias Prokop, et al.  High dietary menaquinone intake is associated with reduced coronary calcification. Atherosclerosis. published online 26 August 2008.

Holiday Alert: Overdoing the Cinnamon May Mean Too Much Anti-coagulation
Some people take cinnamon for its insulin-like properties to combat insulin resistance and diabetes. But too much cinnamon might not be a good thing. Cinnamon is a source of coumarin, an anti-coagulant that can cause liver inflammation. Different types of cinnamon contain different amounts. The more expensive, Ceylon cinnamon contains less (.0004% coumarin). The more common Cassia cinnamon, contains .5% coumarin. Overdoing cinnamon consumption may be a special risk during the holiday season.

Television Viewing Increases Food Intake Even After the Set is Turned Off
From a study of 16 college students, those who watched television while eating lunch ate more later in the day, after the TV was off. The U.K authors suggest that this effect may be related to an effect of television watching on the person’s ability to remember the amount eaten in the previous meal.

Higgs S, Woodward M. Television watching during lunch increases afternoon snack intake of young women.
Appetite. online 23 July 2008.

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Hospitals, Insurance, and Medical Care

Half of US Doctors Report Giving Placebo Treatments Without Telling Patients
Of a random sample of U.S. physicians, about half said they regularly give patients placebo treatments—usually vitamins or OTC analgesics. The survey, by NIH and Mayo Clinic researchers, included 1200 practicing internists and rheumatologists, and more than half responded. About two thirds believed that using a placebo treatment was ethically acceptable. Physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition. Only 5 percent called it a placebo treatment.

Tilburt JC, Emanuel EJ, Kaptchuk TJ, Curlin FA, Miller FG.  Prescribing “placebo treatments”: results of a national survey of US internists and rheumatologists. BMJ. October 23, 2008;337:a1938.

FDA Sets Stricter Guidelines for Conflict of Interest on Advisory Committees
Individuals who play a crucial role or have a financial interest greater than $50,000 in companies that may be affected by an FDA advisory committee’s actions will not be allowed to participate on that committee, according to new FDA guidance released in August. FDA Advisory committee members must also disclose financial interests held by spouses or minor children.

Is Risk-Sharing a Solution for Rising New Drug Costs?
In August, the U.K.’s National Institute for Health and Clinical Excellence (NICE) issued a draft guidance that four novel drugs for advanced renal cancer not be used because the manufacturer had not shown cost-effectiveness. Cost constraints are signaling a change in how health-care innovation is assessed, with decision-makers struggling to balance limited health-care budgets with benefits to patients from new (and often more expensive) drugs. A risk sharing between manufacturer and payer may be the way to go, according to an editorial in Nature Reviews Drug Discovery. For example, the U.K.’s National Health Service only pays for the drug Velcade (bortezomib) when a patient shows a response to treatment.

Tackling the Clinical Value Conundrum. Nature Reviews Drug Discovery. November 2008.

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