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Mesothelioma: A Killer
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Family trend seen with diabetic kidney disease
Last Updated: 2004-09-28 13:37:46 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Type 1 diabetics who have a sibling with diabetic kidney disease have twice the risk of also developing this complication, according to a new report.
The finding, which appears in the journal Diabetes, is based on an analysis of data from 537 Finnish families in which two or more siblings had type 1 diabetes. A total of 537 patients diagnosed with diabetes between 1965 and 1979, and their 616 diabetic siblings, were followed through 2001 for the development of diabetic kidney disease.
A total of 323 cases of diabetic kidney disease occurred in the study group, lead author Dr. Valma Harjutsalo, from the National Public Health Institute in Helsinki, and colleagues note.
The rates of diabetic kidney disease among siblings of affected and unaffected type I diabetes were 38 percent and 17 percent, respectively, a statistically significant difference.
Subjects with a sibling with kidney disease were 2.3 times more likely to develop the condition themselves compared with subjects without a sibling with diabetic kidney disease. The risk was even higher if severe kidney disease was present.
Other risk factors for diabetic kidney disease included male gender, being diagnosed with diabetes during puberty, and having a parent with type 2 diabetes.
This is the first long-term, population-based study of diabetic kidney disease among siblings of type 1 diabetic patients, the authors note.
Although most diabetic sibling pairs don't both have kidney disease, having an affected sibling doubles a person's risk, they add.
SOURCE: Diabetes, September 2004.
Copyright © 2004 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
Group Targets Medical Industry's Influence
By DIEDTRA HENDERSON
AP Science Writer
WASHINGTON (AP) -- Doctors who receive drug company funding would be limited in what they could teach other physicians under new rules being proposed by accreditors.
The Chicago-based Accreditation Council for Continuing Medical Education, which gives its stamp of approval for such classes, was to announce sweeping changes Tuesday to limit the influence of doctors with financial connections to the pharmaceutical industry.
The nation's 750,000 physicians stay up to date on medical advances through mandatory participation in thousands of continuing education activities per year.
In the past, a doctor teaching such a course would disclose his or her financial relationship with any drug company, say as a paid member of the company's speakers' bureau or a grant recipient. Once that was out in the open, the physician might then talk glowingly about anecdotal experience with that company's drug.
Now, a third party with no ties to the drug company would have to tell the doctor what kind of recommendations he or she could make. Anecdotal observations would be replaced by results of systematic clinical trials. Any review of journal literature would have to include negative, as well as positive, studies.
"So this whole thing about just saying 'I've got a conflict of interest. And I've got a relationship. And I've got a personal opinion. And I'm probably biased. But, I'm going to tell you anyways,' that's not allowed," said Murray Kopelow, chief executive of the accreditation council.
Doctors who balk at the new rules will be barred from presenting or teaching at continuing medical education conferences.
The changes were endorsed by the council's seven members, including the American Medical Association. Kopelow could not say how many doctors would be affected.
Earlier this month federal advisers endorsed highly visible "black-box" warning labels linking antidepressants to heightened suicidal thoughts and actions among children. The vast majority of American children who are prescribed antidepressants are taking drugs that have never been proved to ease depression among youngsters.
Pharmaceutical companies are prohibited by law from promoting such off-label use of the drugs. Doctors, however, have faced few similar restrictions.
Dr. Norm Fost, a member of the Food and Drug Administration's Pediatric Ethics Subcommittee, said many doctors are learning about off-label prescriptions during continuing medical education activities. He had no data, though, to support his hunch.
"In 23 studies, none of them has been shown to have any efficacy in children, other than Prozac. And there's all this increasing noise level about toxicity," Fost said. "Why would physicians make millions of prescriptions a year? Where would they get that idea?
"Usually, where they get it is from one of three sources. One: pharmaceutical companies. Two: pharmaceutical companies. And three: pharmaceutical companies."
A Pharmaceutical Research and Manufacturers of America attorney dismissed the notion of "stealth marketing" by drug companies.
"All of the PhRMA member companies know that if they are, in fact, trying to influence the content of an individual speaker's presentation, they're risking FDA enforcement," said Marjorie Powell, PhRMA senior assistant general counsel. "All the companies have to work with FDA all the time."
One observer called the rule changes "enlightened and refreshing," but late.
"Wherever there is a competing financial interest, there is a potential conflict. And wherever there is a potential conflict, you ought to find somebody else to do the job," said Bernard J. Carroll, a semiretired psychiatrist who has lobbied for transparency. "Money corrupts and lots of money corrupts absolutely."
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On the Net:
Accreditation Council for Continuing Medical Education, http://www.accme.org
© 2004 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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