Wine May Lower Risk of Esophageal Cancer

The research on the health benefits of wine continues, and recently, HealthDay confirms a study about the other health benefits of wine - lowers the risk of Esophageal Cancer.

Drinking a glass of wine a day may lower the risk of Barrett's esophagus, a condition that precedes esophageal cancer.

Barrett's esophagus, which affects about 5 percent of the population, occurs when heartburn or acid reflux permanently damages the lining of the esophagus. People with this condition are 30 to 40 times more likely to develop a type of esophageal cancer called esophageal adenocarcinoma. In the last 30 years, the incidence of esophageal cancer in the United States has increased 500 percent.

In this Kaiser Permanente study, researchers looked at 953 men and women in Northern California and found that those who drank one or more glasses of red or white wine a day were 56 percent less likely to develop Barrett's esophagus. Beer or liquor did not lower the risk, and the protective effect of wine didn't increased with higher consumption.

"The rate of esophageal adenocarcinoma in this country is skyrocketing, yet very little is known about its precursor, Barrett's esophagus. We are trying to figure out how to prevent changes that may lead to esophageal cancer," principal investigator Dr. Douglas A. Corley, said in a Kaiser Permanente news release.

The study was published in the March issue of Gastroenterology. Two other studies in the same issue of the journal reported similar findings. An Australian study found that people who drink wine were less likely to develop adenocarcinoma, and Irish researchers reported that drinking wine reduces the risk of esophagitis, an irritation of the esophagus that follows chronic heartburn and often precedes Barrett's esophagus and cancer.

It's not clear why wine may lower the risk of Barrett's esophagus. Researchers suggest it may be because antioxidants in wine neutralize the damage done by gastroesophageal reflux disease. Or it may be because wine drinkers typically have food with their wine, thereby reducing the potentially damaging effects that drinking alcohol alone can have on esophageal tissue.

The wine study is part of a larger Kaiser Permanente study led by Corley looking at the link between Barrett's esophagus and abdominal obesity and consumption of dietary antioxidants, fruits and vegetables. That study found that eating eight servings of fruit and vegetables a day and maintaining normal body weight can reduce the risk of Barrett's esophagus.

"My advice to people trying to prevent Barrett's esophagus is: Keep a normal body weight and follow a diet high in antioxidants and high in fruits and vegetables," Corley said. "We already knew that red wine was good for the heart, so perhaps here is another added benefit of a healthy lifestyle and a single glass of wine a day."

Personal Health Records and the Law

The October edition of the Health Lawyers News, a publication of the American Health Lawyers Association (AHLA), contains an article I co-authored with Jud DeLoss, a principal in the law firm of Gray Plant Mooty, who blogs at Minnesota Health IT. On the eve of the Health 2.0 Conference this week the article provides a look at some of the legal issues around PHRs.

The article, The Rise of the Personal Health Record: Panacea or Pitfall for Health Information (pdf version), provides an introductory background on the changing world of PHRs, highlights Health 2.0 and covers some of the legal implications and compliance issues for PHRs. We are working on a longer and more detailed analysis that will be turned into a Member Briefing for the Health Information and Technology Practice Group. I would appreciate your posting a comment on topics or legal implications that we might consider covering in the full Member Briefing.

If you are a health lawyer, law student interested in health law or otherwise interested in the the legal aspects of the health care industry and not already a member of AHLA -- think about joining.

Bob Coffield is a health care lawyer practicing in Charleston, West Virginia in the law firm of Flaherty, Sensabaugh & Bonasso, PLLC who blogs on health care legal issues at Health Care Law Blog.

Doctor Says Executive Physicals Are Bad Medicine

The Health Blog sure aren’t executives, and we don’t expect to join the ranks of top businessmen anytime soon. Maybe that’s why we’re so curious about those expensive executive physicals that go on behind medicine’s velvet rope.

From what we’ve heard, you get the amenities of a spa and the fanciest work-up imaginable, often including a CT scan looking for signs of heart trouble. The battery of tests promises early detection and prevention of problems. But are the exams worth the thousands of dollars they cost? Brian Rank (pictured), medical director of HealthPartners Medical Group and Clinic, says no way.

In the current issue of the New England Journal of Medicine, Rank writes executive physicals are “one of modern medicine’s most expensive and least proven approaches to care.” The way he sees it, VIP exams fail on three counts:

Efficacy: More testing isn’t necessarily better, with research piling up that shows inappropriate testing can cause more harm than good. Take CT scans looking for heart calcifications, a staple of the top-shelf physicals. The scores may be interesting but are “rarely meaningful as a predictor of disease,” Rank writes.

Cost: The pricey exams reinforce the misperception that “costlier is better.” In fact, Rank writes, the exams “are almost a parody of the high-cost, low-return procedures” that companies want to eliminate for other employees.

Equity: And that brings us to fairness, one of Rank’s biggest beefs. The mystique of executive physicals makes it appear that folks with lots of money or the backing of a company “are more worthy of effective, respectful and personalized treatment than others.”

We gave Rank a call to find out what drove him to give VIP exams such a beatdown. He told us that on trips to Florida he kept seeing ads in the Orlando airport for executive physicals at the Mayo Clinic in Jacksonville. “It bugged me,” he told the Health Blog. If the exams were “just repackaging and selling evidenced-based preventive services, that would be one thing,” he said. But the battery of tests can lead to harm–from radiation exposure from CT scans to false alarms that lead to worry and more testing.

Rank just about flipped when another member of the board at HealthPartners said he was considering getting one of the physicals. “Are you nuts?” he asked him. “Why would you expose your company to excess costs and yourself to tests that could hurt you?”

Lilly, Amylin Disclose More Cases of Byetta Related Pancreatitis

Last week, the FDA said it had received reports of six new cases of pancreatitis – including two deaths – associated with the diabetes drug Byetta. Today, Amylin and Eli Lilly said that they had reported four additional deaths to the agency as well, which the FDA hasn’t yet made public.

The companies, which co-market the drug, chose to disclose the additional information in order to “provide context” about each of the cases, because the medical community appeared confused by the information last week, Amylin President and Chief Executive Daniel Bradbury told the Health Blog.

Another reason might be to reassure investors. Byetta, co-marketed by the companies, already has a label reflecting its association with severe inflammation of the pancreas. But the FDA says it’s working on a stronger label for the drug that includes forms of pancreatitis that involve bleeding and cell death. Both companies’ stock dipped following the news last week, though Amylin’s was particularly hard hit, plunging as much as 22% since the FDA announcement before recovering somewhat.

In the four cases brought forward by the companies today, it’s not clear whether the patients were taking Byetta at the time of deaths. And the deaths are “not directly attributable to pancreatitis in any way”, Orville Kolterman, Amylin’s senior vice president of R&D, told us. For instance, one patient appeared to die from a relapse of leukemia two months after having pancreatitis. Also, patients with Type II diabetes have a greater risk of pancreatitis than healthy people to begin with, said Kolterman.

Analysts say the bigger picture issue is whether these safety concerns might affect the long-acting version of the medicine the companies are currently developing. The question “is whether the FDA, from a regulatory standpoint, will require longer term study of” the long-acting version, Barbara Ryan of Deutsche Bank told the Health Blog. “Rather than a short half-life, you’re going to have a longer term product. So if you get in trouble, it’s [in the body] for a longer period of time.”

Drugmakers and Guess How Much Those Lawsuits Cost

Propose an accounting rule that has to do with litigation costs, and you’re sure to get drug companies’ attention. Six major drugmakers protested a Financial Accounting Standards Board proposal to require companies to estimate their exposure to potential losses from ongoing litigation.

Among other things, the proposal says that when a complaint doesn’t seek a specific amount of damages, the companies should provide a “best estimate of the maximum possible exposure to loss.” Currently, companies only have to disclose estimated costs when they believe they’ll probably lose a case, Dow Jones Newswires explains.

The companies, which say they’ve collectively “defended hundreds of thousands of product liability claims” in the past 10 years,
argue that making broader estimates would be really, really hard. Eli Lilly, Johnson & Johnson, Merck, Novartis, Pfizer and Wyeth all signed the letter, which you can read here.

“Mass torts are characterized by explosive growth, rapid change, a dearth of information about individual plaintiffs, unpredictable procedural and substantive rulings, and wildly divergent verdicts on quite similar facts,” they write. “The defendant’s ‘best estimate’ of the ‘exposure to loss’ is likely to be unreliable, subject to constant change, and of little or no value to financial statement users.”

The letter reads like a collective venting session about the industry’s legal headaches. To demonstrate the fluid and unpredictable nature of litigation costs, they mention some of the plaintiffs bar’s greatest hits, from Merck’s Vioxx to Wyeth’s legal nightmare over the diet-drug cocktail fen-phen.

For Merck, there was a particularly crazy Vioxx case in Texas. “That one case ranged in ‘value’ from over $250 million at the time of the verdict to its current value of $0 [after being overturned] and is but one of many tens of thousands of similar cases,” the drugmakers write.