First vaccines, now antibiotics?

A new study shows that exposure to antibiotics early in life (1st year) predicts the occurrence of asthma later on. The evidence seems to suggest that treating non-respiratory infections with antibiotics will double the risk of asthma.

Also, check this out:

Furthermore, absence of a dog during the birth-year doubled asthma risk among children taking multiple courses of antibiotics.

“Dogs bring germs into the home, and it is thought that this exposure is required for the infant’s immune system to develop normally. Other research has shown that the presence of a dog in early life protects against the development of asthma,” said Dr. Kozyrskyj. “Exposure to germs is lower in the absence of a dog. The administration of an antibiotic may further reduce this exposure and increase the likelihood of asthma development.”

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Antidepressants in children: researchers vs. psychiatrists

A small handful of researchers, and the FDA, are skeptical about prescribing selective serotonin reuptake inhibitors to children and teenagers. First, the point of view of the researchers.

Gingrich used mice that were genetically altered so that they lacked the ability to mop up serotonin. They were—in effect—born on Prozac. He wanted to see how depression was related to serotonin and norepinephrine, another neurotransmitter. “Our simple-minded idea was these mice would look like mice treated chronically with Prozac,” Gingrich says. They should have been free of anything like a mouse’s version of depression or anxiety.

Gingrich found quite the opposite. Because he could not chat with them about their feelings, he gave the mice stress tests. (An inability to handle stress is one hallmark of depression.) He put a small electric charge on the floor on one side of their cage. Normal mice will quickly learn to escape the tiny shock by running to the other side. These mice did not. “They have a tendency to freeze,” he says. “They stay on the same side where the foot shock is being administered, or they escape much more slowly.” The mice—­despite having lived their entire lives as if they were on Prozac—were afflicted with what looked suspiciously like an anxiety disorder.

Now, fair and balanced, the psychiatrists…

Even in the face of this evidence, however, many psychiatrists believe that antidepressants do far more good than harm in children and teens. Like Emslie in Texas, Harold Koplewicz, a professor of psychiatry at New York University and one of the city’s top child psychiatrists, has been using SSRIs aggressively in children and teenagers for more than a decade. “I am probably the first person to give these meds to kids clinically,” he says. As recently as a few years ago, most psychiatrists thought they should try talk therapy with kids before giving them medication. But that has changed, he declares.

He has seen what happens to teenagers who are not treated. “After they’ve had one episode of depression, they’re 60 percent more likely to have another. If they have two, they’re 90 percent more likely to have a third. And subsequent episodes are more difficult to treat…. Every good clinician will tell you the risk of not taking the medication is greater” than the possible risks of taking SSRIs.

Crigler-Najjar’s syndrome

Interesting medical story that reminds me of an episode of House:

John Crigler remembers being baffled by the jaundice disease he encountered among Amish newborns when he was a young pediatrician working with Najjar at Johns Hopkins Hospital in Baltimore. The babies all died.

“There wasn’t any treatment, any hope, any cure,” said Crigler, now 87. “We were just spectators. There was nothing we could do.”

Patients began living longer in the 1970s when doctors realized that the wavelength and energy of blue light changes the nature of the bilirubin, allowing it to be excreted from the body.

Amygdala volume and autism

Dr Richard Davidson of Wisconsin, a top fMRI social psychologist, has some interesting findings related to brain imaging and autism…

The brain’s fear hub likely becomes abnormally small in the most severely socially impaired males with autism spectrum disorders, researchers funded by the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH) and National Institute on Child Health and Human Development (NICHD) have discovered. Teens and young men who were slowest at distinguishing emotional from neutral expressions and gazed at eyes least � indicators of social impairment � had a smaller than normal amygdala, an almond-shaped danger-detector deep in the brain. The researchers also linked such amygdala shrinkage to impaired nonverbal social behavior in early childhood.

Is the decrease in amygdala volume a function of a lifetime of autism, or is it an underlying feature? Do infants have smaller amygdalar volume?

Alzheimer’s, inflammation, and marijuana

Dr. Gary Wenk on NPR talking about inflammation and Alzheimer’s. One thing to note: the doses used in these studies are well below that required for psychoactive effects. But I guess I should tell it to the FDA.

On a related note, curry is also good for reducing inflammation. The JohnnyB diet of all curry all the time works!

Curry and anti-inflammation

Bipolar news

Antidepressants provide no extra benefit to those already on mood stabilizers for bipolar disorder.

Before participants were randomized to one of two antidepressants — bupropion (Wellbutrin) or paroxetine (Paxil) — or to a placebo, doctors trained in the treatment of bipolar disorder adjusted participants’ mood stabilizer doses to optimal levels, ensuring that they were receiving the most appropriate amount.

After about 26 weeks, Sachs and colleagues found that 24 percent of those who had been randomized to the antidepressants stayed well for at least eight consecutive weeks — the study’s stringent standard for recovery; 27 percent of those randomized to a placebo stayed well long enough to meet the eight-week recovery standard, indicating no difference between adding an antidepressant or adding placebo. In addition, about 10 percent of each group experienced emerging symptoms of mania, indicating that the antidepressants did not trigger a manic switch any more than placebo. Finally, when comparing the two antidepressants to each other, both showed similar rates of response and manic switch.

Pharmaceutical companies, marketing, and doctors

Scientific American: Partial Disclosure: What Do Drug Companies Pay Doctors For?
Pharmaceutical companies fail to publicly reveal all of the money and gifts they give to physicians and health care workers—making it hard to know what the money is for