February 2004 nl

H E A L T H A N D S T R E S S
MORE ON
, AGING,
KEYWORDS: CRP, nonsteroidal anti-inflammatory drugs, beer bellies, "inflammaging", bad bosses,bullying, caregiver stress, survivor guilt, drug substitution.
claims for heart disease on their labels.
on a few topics we had previously focused on so that readers could "stay tuned" to the diabetics and one study suggests there is
latest developments in these areas. Since no such thing as a "beer belly".
additional important material, this issue will consequences of job stress were confirmed report on other 2003 research findings that in several reports using the high demand/low are of particular interest. The important control model. While elevated blood pressure contribution of "inflammology" to obesity and at work during stressful situations has been a variety of age related diseases continues to well documented, one study now shows that be an intense area of investigation despite this can lead to sustained hypertension.
Another found that increased job stress is demonstrate or measure inflammation. This associated with greater risk for colds and is particularly true for Alzheimer's disease.
gastroenteritis. Job stress due to bad bosses and coronary heart disease continues to be a and bullying may be a greater problem
controversial and confusing topic. Although than sexual harassment or racial
alcohol related problems are said to be the discrimination and legislation has been
proposed to provide relief similar to that wineries received approval for making health domestic violence. "Caretaker stress" is nolonger limited to those caring for chronically ALSO INCLUDED IN THIS ISSUE
ill spouses or relatives. Women who had to
• Can Aging And Alzheimer's Be Delayed?
baby-sit or care for their grandchildren
• Big Bellies, Sex, Genes, Booze And Diets
for more than nine hours a week had
• Could Job Stress Be Making You Sick?
55% more heart attacks after four years
• Physician, Pharmacy & Hospital Abuses
• Neurontin & Other Spurious Promotions
• Federal Employee Conflicts Of Interest With
Drug Companies And Grant Recipients
deceit and fraud as well as conflict of interestabuses that abound in government agencies.
February 2004 The Newsletter of THE AMERICAN INSTITUTE OF STRESS Page 2 Su c h pr o b lem s als o in v o l ve pr ac t ic in g s t u d y s h o wed t h at p a ti ent s who r eg u la r ly
ph ys ic i an s , ph ar m ac is t s , h o s p ita ls an d to ok no ns ter oi d al a nti -i nf l am m at or y
n u r s in g h o m e s . Al th o u g h th e c o s t t o d r ug s h ad 80 % les s r is k f or d ev e lo p in g
ta xp aye r s m a y be a bil li o n do lla r s an n u all y Al zh eim er ' s. Si m il ar fi n d in g s h av e bee n
an d c o n ti n u e s to r i s e, i t s ee m s u n lik el y t h a t th is tr en d w il l c h a n ge i n t h e n e ar fu tu r e. n e u r o de ge n er at ive d is e as es an d t h e r e is Th e N I H d ir e c t o r h a s p r o m is ed a th o r o u g h ev id en c e th e y c an r edu c e r i s k fo r c er ta in in ve s ti ga tio n , bu t bas ed o n p as t e xpe r i en c e, Al l o f th is is c o n s is t en t w it h r es ear c h po we r fu l ves te d i n t er e s t s w il l p r e vai l. C a n Ag i ng An d Alz he im e r ' s B e D el ay ed ?
A c t u a r i e s p r e d i c t t h a t r a t e s o f va r i an t s in c e n te n a r ia n s th at ap pe ar to d i s e a s e , a n d d i a b e t e s w i l l d o u b l e o r t r i p l e i n a f e w d e c a d e s a s t h e n u m b e r o f s e n i o r "i n f lam m a gin g" . T h e y h av e a ls o s h o wn th at a n d s u p e r s e n i o r c i t i z e n s s t e a d i l y s w e l l s . el de r ly p eo p le wh o ar e f r ai l an d s ic k ly ar e T h e i m p o r t a n t r o l e o f i n f l a m m a t i o n h a s m o r e li ke ly to c a r r y p r o - in fl am m at o r y g en e i n c r e a s i n g l y b e e n d e m o n s t r a t e d i n t h e s e va r i an t s th a n h ea lt h y c o n tr o l s . E l eva te d a n d o t h e r a g e r e l a t e d d i s e a s e s a n d bl o o d l ev els o f t h e s e in fla m m ato r y pr o t ein s in s en i o r c i ti zen s ar e a ls o a s s o c i ate d wit h in c r eas ed o s te o po r o s is , lo s s o f m u s c l e D e e p a b d o m i n a l f a t i s a m a j o r m a s s , a n e m ia , c o g n i tiv e dec li n e an d o th er p r o d u c e s c h e m i c a l s t h a t s t i m u l a t e t h e l i v e r He r e dit y is ve r y im po r ta n t an d t o p o u r g l u c o s e i n t o t h e c i r c u l a t i o n . T h i s s c ie n ti s t s a r e in ve s ti ga tin g wh e th er as pir in r e s u l t s i n i n c r e a s e d i n s u l i n s e c r e t i o n t h a t an d o th er n o n s te r o ida l an t i- in f la m m a to r y e v e n t u a l l y l e a d s t o d i a b e t e s , i n s u l i n dr u g s m ay pa r t ial ly m i m i c t h e ge n e tic r e s i s t a n c e a n d h y p e r t e n s i o n , a l l o f w h i c h a r e a s s o c i a t e d w i t h i n c r e a s e d r i s k f o r c e n t en a r i an s . R ed u c in g s tr e s s c o u l d p r o vid e h e a r t a t t a c k a n d s t r o k e . T h e r e i s a c l o s e be n e fit s fo r n u m e r o u s r e as o n s . S tr es s i s a c o r r e l a t i o n b e t w e e n a b d o m i n a l o b e s i t y a n d m a jo r c o n tr i bu to r t o t h e de po s it io n o f dee p a h i g h C R P , a m e a s u r e o f i n f l a m m a t i o n t h a t m a y b e a m o r e s i g n i f i c a n t p r e d i c t o r o f in fe c ti o n s , an d i n c r ea s e s h o m o c y s t ein e c o r o n a r y e v e n t s t h a n L D L o r c h o l e s t e r o l . le ve ls , a ll o f wh ic h c au s e in fla m m ati o n .
H o w e v e r , a b d o m i n a l f a t i s n o t t h e o n l y As Th e Yel lo w E m p er o r ' s C an o n o f c u l p r i t . T h e e l e v a t e d C R P f r e q u e n t l y f o u n d I n te r n a l Med ic in e w r i tte n o ve r 5 0 c e n tu r i es i n n o n - o b e s e h e a r t a t t a c k p a t i e n t s s e e m s ag o s ta te d, "I h a ve h e ar d t h a t i n ear ly t o b e d u e t o c h l a m y d i a l a n d o t h e r ti m e s , pe o pl e liv ed to b e o ve r 1 0 0 . B u t i n f e c t i o n s . C R P i s a l s o h i g h i n h y p e r t e n s i o n th es e d ay s p eo ple r eac h o n l y h al f th a t age , o f r e c e n t o n s e t r e g a r d l e s s o f w e i g h t , an d m u s t c u r ta il th eir a c ti vi tie s . T o d a y ,
p e op le d o no t k no w how t o f in d
c o n t r i b u t e t o c a r d i o v a s c u l a r d i s e a s e v i a c o nt ent m e nt wi thi n. T h ey ar e not
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in fl am m at io n i n di c a to r s pr i o r to a s w el l a s af te r t h e o n s e t o f s ym pt o m s . Man y als o Big Bellies, Sex, Genes, Booze And Diets
h a ve h i gh an ti bo d y lev el s t o c h l am ydi a an d Be in g o ve r we ig h t c a n i n c r ea s e r i s k fo r c e r t ain v ir u s e s a n d gi vi n g br o ad s pec tr u m di ab ete s , h e ar t a tt ac k , s tr o k e a n d o t h e r an ti bio ti c s fo r t h r ee m o n th s im p r o ved m e m o r y an d c o g n it iv e f u n c ti o n c o m p ar e d to es pe c ia ll y t r u e i f th o s e ex tr a p o u n ds c o m e u n tr eat ed c o n t r o l s in o n e r ep o r t . A D u t c h fr o m ex c e s s ab do m in al fa t t h a t p r o du c es a February 2004 The Newsletter of THE AMERICAN INSTITUTE OF STRESS Page 3 bi g bel ly . O be s it y r at es ar e es c al ati n g an d a l l w e r e s u r ve y e d . B e e r c o n s u m p t io n al m o s t o n e i n fo u r Am e r i c an a du l ts n o w a v er a g e d 3 . 4 q u a r ts / w e ek f o r m e n a n d le s s h a ve di ff ic u lt y s ee in g t h ei r to e s wh e n th e y t h an a pi n t fo r w o m e n . O n l y 3 % o f m e n s t an d u p s tr ai gh t b ec a u s e t h e ir be lli es ge t in d r an k o ve r 3 .5 g a ll o n s o f b ee r w ee k l y a n d th e way . Sc i en tis ts at t h e C e n te r s fo r w o m e n r ar e l y c o n s u m e d h a l f th i s am o u n t. T h er e w as n o c o r r el a t i o n b e tw e e n w e i g h t , c o n c er n ed be c a u s e m o s t p eo p le ar e n o t w a is t t o h i p r a t i o o r bo d y m a s s in d e x aw ar e o f h o w d an g er o u s t h is c an be . M en m e as u r e m e n t s a n d be e r in t a k e. I n M u n i c h ar e aff ec ted m o r e t h an w o m e n , wh o ten d to a n d o t h er G e r m a n c i t i e s , b e er i s r e g a r d e d ac c u m u l at e f at in t h ei r th i gh s a n d bu tt o c k s a s m o r e o f a f o o d t h a n a l c o h o l a n d i s th at do es n o t app ea r t o be as h a r m fu l a n d d e li v e r ed t o h o m e s w e e kl y , m u c h li k e m i l k m a y eve n h el p pr e ve n t c o r o n ar y d is eas e. c o n s ide r e d t o det r a c t fr o m an at tr ac t iv eap pe ar a n c e, th is do es n o t s ee m t o be a de te r r e n t fo r m o s t m en w ith m idd le - ag ed s p r e ad. I t h as n o t in t er fer ed wi th th e app ea lo f g o lf er Jo h n D a ly an d m el o n - s h ap ed Ga r th Br o o ks s e em s t o b e a m ag n et f o r pr ett yyo u n g c h i c ks . P eo pl e t en d t o lik e fat m en be c a u s e t h ey a r e as s o c ia ted w ith b ein g jo l ly an d go o d- n at u r ed, l ike S an t a C la u s . E ve n Sh ak es p ea r e h a d J u l iu s C aes ar s a y, "L et m e h a ve m e n abo u t m e t h at a r e fa t . . . Yo n C a s s iu s h as a lea n an d h u n g r y lo o k ." deposits of deep visceral fat is not clear. Aclear link with stress has been demonstrated Researchers recently discovered a gene that stimulates appetite but although overeating improve health and diabetics are now urged is a factor, some people can consume just as to drink red wine to reduce coronary disease.
many or more calories and stay slender.
High fat intake doesn't seem to increase risk Obesity does seem to run in some families for this or obesity but carbohydrates like population that is transmitted from father to contributes to obesity and heart attacks is a are not overweight and it is likely that many illustrated by a popular posting on several more "obesity genes" will be found.
Th e Fr e n c h c o n s u m e m u c h m o r e fat culprit? Increased alcohol intake has been th an th e Br i ti s h o r Am er ic a n s bu t incriminated but does not seem likely. While th ei r h ea r t at tac k r at es ar e m u c h obesity is rampant in the U.S., we are far lo we r . Th e F r e n c h a n d I t ali an s a ls o dr in k e xc es s iv e a m o u n t s o f r e d w in e countries and the top six average almost 50 qu an tit ie s o f bee r an d a ll s u ffe r fe we r h ea r t at tac ks th an th e Br i ti s h o r A m er ic an s . Th e J apa n e s e dr in k and "beer belly" is apparently a myth ve r y li tt le r e d w in e a n d ea t ver y according to a recent study of lager lovers.
li tt le fa t b u t th ey al s o h a ve m u c h fe we r h ea r t at tac ks th an th e Br i ti s h capita consumption of beer of any nation and o r A m er ic an s . C o nc lus io n: Ea t a nd
to 65 who drank only beer or no alcohol at sp ea k in g Eng li sh th at k i lls y ou.
February 2004 The Newsletter of THE AMERICAN INSTITUTE OF STRESS Page 4 Could Job Stress Be Making You Sick?
H i gh j o b s t r es s w as a l s o a s s o c i a te d w i th i n c r e a s ed c h o l e s t er o l c o n c e n t r a t io n s s t r e s s f u l j o b m a y l e a d t o h ig h b lo o d a n d b o d y m a s s i n d ex . O th e r s t u d i es u s in g p r es s u r e, a c c o r d i n g t o r e s e ar c h e r s a t t h e t h e h i g h d e m an d / l o w c o n t r o l m o d e l h a v e M o u n t S in a i Sc h o o l o f Me d i c in e . W h i l e m o s t s h o w n a l i n k b e t w ee n i n c r e a s e d j o b s t r e s s a u th o r i ti e s wo u l d a g r e e t h a t s t r es s i ts e l f i s a n d i n c r e a s e d r a t es o f h y p e r t e n s io n a n d n o t t h e s o l e c a u s e o f c o r o n ar y h ea r t c o r o n a r y e v e n t s . Ho w e v er , t h i s i s t h e f i r s t d i s e a s e o r h yp e r t en s i o n t h e r e i s g o o d t o q u a n ti f y th e a s s o c i at i o n b e t w ee n j o b r e as o n to b e li e v e i t c an p l ay a s i g n i fi c a n t s t r e s s an d c ar d i o va s c u la r m o r t a l it y a n d t h e r o le i n t h e pr o g r es s i o n o f th e s e d i s o r d e r s r e s u l t s a r e im p r e s s i v e . H a v in g l o w j o b a n d s e v er i t y o f t h e i r s y m p t o m s . Fr e n c h c o n t r o l a n d a h i g h e f f o r t - r ew a r d i m b a la n c e r e s e a r c h e r s fo u n d t h a t h i g h - s t r e s s j o bs c a n s e em e d to p u t w o r ke r s at g r ea t e s t r i s k f o r r e s u l t in e l ev a t e d b l o o d p r es s u r e r e a di n g s w h il e a t w o r k. D o c t o r s f r o m M o u n t S i n ai B a d b o s s e s c an a l s o d r iv e u p y o u r M e di c a l C e n t er i n N e w Yo r k h a d a ls o b l o o d p r e s s u r e a n d p u t y o u at r i s k f o r a p r ev i o u s l y s h o w n th a t m e n w h o w e r e h e ar t a tt a c k o r s tr o k e a c c o r d i n g t o a s m a l l w o r k i n g i n h ig h - s tr e s s j o b s h a d s y s t o li c U . S. s t u d y . 2 8 f e m a l e h e a l t h c a r e a s s i s t a n t s b l o o d p r e s s u r e s 6 t o 8 p o i n ts h i gh e r th a n a g ed 1 8 t o 4 5 w e r e a s k ed t o s c o r e t h e c o n t r o l s i n le s s s t r e s s f u l jo b s it u a t io n s . I n a i n te r p e r s o n a l s t y le o f t h e i r s u p er v i s o r s r e c e n t r e p o r t, t h ey s u gg e s t t h a t l o n g - t e r m u s in g a v a l i da t e d f i v e - p o i n t s c a le , w h e r e 1 j o b s t r es s c an a l s o l e ad t o s u s t ai n e d e q u a l s "s t r o n g l y di s a g r e e , " t o 5 " s t r o n g l y e l ev a t i o n s o f b l o o d p r es s u r e. a g r e e . " T h e it e m s i n c l u d e d s t a t e m e n t s , T h e s t u dy e x am i n e d 2 1 3 m e n s u c h a s : " M y s u p e r v i s o r e n c o u r a g es b e tw e e n t h e ag e s o f 3 0 a n d 6 0 w h o w e r e d i s c u s s io n b ef o r e m a k i n g a de c i s io n , " a n d e n r o l l e d i n th e W o r k S it e B lo o d P r e s s u r e " I a m t r e a t e d f a i r l y b y m y s u p e r vi s o r ." S t u d y i n N e w Y o r k C i t y . P a r ti c i p an t s we r e H e al t h c ar e a s s i s t an t s ar e s u p e r v is e d by a s ke d a bo u t fa c t o r s s u c h a s f r e e do m t o n u r s e s an d t ak e o n s o m e o f th e i r w o r k w i t h c o n t r o l t h e i r o w n w o r k a n d fr e e d o m t o v a r y i n g l e v e ls o f r e s p o n s i b il i t y b u t th e y ar e m a ke d e c i s i o n s a n d o t h er m e as u r e s w e r e l o we r d o w n t h e j o b s t a tu s h ie r a r c h y . u s ed t o a s s e s s j o b d e m an d s an d p r e s s u r e s . M e n w h o r e p o r t e d s p e n d in g o ve r 2 5 y e a r s r e ad i n g s f r o m b l o o d p r es s u r e m o n it o r s i n a h i gh - s t r e s s , l o w - c o n t r o l j o b h a d h i g h er w o r n b y h e a l th c a r e a s s is t a n ts e v er y 3 0 s y s t o l i c b l o o d p r es s u r e v a l u e s b o t h a t w o r k m i n u t e s f o r 1 2 h o u r s o ve r t h r e e wo r k i n g ( a ve r a g e 4 . 8 m m H g h i g h e r ) an d a t h o m e d a ys . T h i r t e en o f t h e as s i s ta n t s w e r e ( a ve r a g e 7 . 9 m m H g h i g h e r ) wh e n s u pe r v i s e d b y t w o p e o p le , b u t o n d i f f er e n t c o m p a r e d w i t h m e n w h o h e l d le s s s t r e s s f u l d a ys , b o t h o f w h o m w e r e p e r c e i v e d t o h a v e n e ga t i v e i n t er a c t io n s wi t h th e i r s t a f f. A I n a n o t h e r l o n g - t er m s tu d y , F i n n is h c o m p a r i s o n g r o u p o f 1 5 w o r k ed u n de r j u s t r e s e a r c h e r s r e c e n tl y r ep o r t ed t h at j o b o n e s u p er v i s o r o r w i t h t w o wh o s e w o r k in g s t r e s s do u b l ed t h e r i s k o f de a t h f r o m h e a r t d i s e a s e . T h e y f o l lo w e d 8 1 2 h e a l t h y m a le c o m p a r i s o n g r o u p r e g i s te r e d a r i s e o f 3 a n d f e m al e e m p l o y ee s o f a c o m p a n y f o r a n m m H g i n s y s to l i c a n d n o d i ff e r e n c e o r a a v er a g e o f 2 5 . 6 y ea r s . I n f o r m a t i o n w a s l o we r d ia s t o li c b lo o d pr e s s u r e w h e n o b ta i n e d t h r o u g h pe r i o di c i n t e r v ie w s , q u es t i o n n a i r es , p h y s i c al e x am i n a ti o n an d s u pe r v i s o r s . T h e o t h e r g r o u p s h o we d a 1 5 l a bo r a t o r y s tu d i e s t o ev a l u at e s tr e s s , b l o o d m m r i s e i n s ys t o l ic a n d a 7 m m r is e i n p r es s u r e a n d c h o l es t e r o l l e ve l s , a n d bo d y d i as t o l ic b l o o d p r e s s u r e w h en w o r k i n g f o r a m a s s i n de x . Th e y fo u n d t h a t j o b s t r a i n s u pe r v i s o r t h e y c o n s i d er e d to b e u n f a ir . A n ( h ig h w o r k d em a n d s a n d l o w jo b c o n t r o l) i n c r e a s e o f 1 0 m m i n s ys t o l ic a n d 5 m m i n d i as t o l ic b l o o d p r e s s u r e i s a s s o c i a t e d w i t h a 1 6 % i n c r e a s e d r i s k o f c o r o n ar y h ea r t o p po r t u n i t i e s ) w e r e e a c h a s s o c i a te d w it h a d i s e a s e a n d a 3 8 % i n c r ea s e d r i s k o f s tr o k e .
d o u b l i n g o f th e r is k o f c a r di o v a s c u l a r d e a th a m o n g i n i t i a ll y h ea l t h y e m p lo y e e s . w o r k p l a c e p r o b l e m s t h a t m a y b e e ve n February 2004 The Newsletter of THE AMERICAN INSTITUTE OF STRESS Page 5 m o r e p r ev a l e n t t h an s e xu a l h a r a s s m e n t o r f r o m t h e o n g o i n g N u r s e s ' H e a l t h S t u d y r a c i a l di s c r im i n a ti o n ac c o r di n g to a n U . S. t h a t f o l l o w e d o v e r 5 4 , 0 0 0 w o m e n f o r f o u r N e ws & W o r l d R e p o r t s tu d y . N i n e ty p e r c e n t y e a r s . I t f o u n d t h a t t h o s e w h o t o o k c a r e o f o f w o r k er s f el t t h a t i n c i v i li t y o n t h e j o b w a s g r a n d c h i l d r e n f o r m o r e t h a n n i n e h o u r s a a s e r i o u s p r o b l e m a n d al m o s t a s m a n y w e e k w e r e 1 . 5 5 t i m e s m o r e l i k e l y t o b e li e v e d i t wa s g et t i n g w o r s e . I n a n o th e r d e v e l o p h e a r t d i s e a s e t h a n c o n t r o l s " d es k r ag e " s u r v e y, 2 3 % o f wo r k e r s w i t h o u t t h i s r e s p o n s i b i l i t y . O t h e r s t u d i e s a d m i t t e d t h e y h a d b e e n d r i v en t o t e a r s b y h a d p r e v i o u s l y f o u n d t h a t g r a n d p a r e n t s t h is k i n d o f m i s t r e a t m en t d u r i n g t h e p r ev i o u s 1 2 m o n t h s a n d 4 2 % s a i d th a t g r a n d c h i l d r e n f a c e d t h e s a m e k i n d o f y e ll i n g a n d ve r b a l a b u s e a t w o r k w e r e h e a l t h p r o b l e m s a s p e o p l e c a r i n g f o r c o m m o n p la c e . A b o u t 1 i n 6 c o m p l a in e d o f h a vi n g be e n s u b j e c t e d to d e s t r u c ti v e N u m e r o u s s t u d i e s s h o w t h a t c a r e g i v e r s f o r b u ll y i n g t a c ti c s du r i n g t h e p a s t y e a r .
a s p o u s e o r r e l a t i v e s u f f e r i n g f r o m A l z h e i m e r ' s h a v e i m p a i r e d i m m u n e s y s t e m i n s u l t i n g b e h a v i o r , a n a b u s e o r m i s u s e o f s u s c e p t i b l e t o r e s p i r a t o r y a n d o t h e r i n f e c t i o n s a n d a r e a l s o a t g r e a t l y i n c r e a s e d u n de r m i n e , h u m i l i at e , de n i g r a t e o r i n ju r e r i s k f o r d e p r e s s i v e a n d a n x i e t y d i s o r d e r s . t h e r e c ip i e n t. " S o m e c o m m o n t a c t ic s I n a d d i ti o n to c a r d i o v as c u l ar d i s e a s e , i n c l u d e s p r e ad i n g f a l s e r u m o r s , in t e r r u p t i n g j o b s t r es s c an a l s o i n c r e a s e t h e l i k e li h o o d a pe r s o n w h i le h e o r s h e i s s p e a ki n g , a c t i n g o f a c u t e i n f ec t i o n s l i ke t h e c o m m o n c o l d , i n a c o n d e s c en d i n g m a n n e r , r i d i c u l i n g a f l u - l i k e i l l n e s s e s a n d e v e n g a s t r o e n t er i t i s . p e r s o n ' s o p i n i o n s i n f r o n t o f o t h e r s , f a i l in g D u tc h r es e a r c h e r s f o l l o w e d m o r e th a n t o r e t u r n c a ll s o r r e s po n d to m e m o s , gi v i n g 8 , 0 0 0 e m p l o y ee s o ve r a t h r e e- y e a r p e r io d . t h e " s i le n t tr e a t m e n t " , e n g ag i n g i n v er b a l T h ey r e c e n t l y r e p o r t e d t h a t w o r k er s i n s e xu a l h a r a s s m e n t , s t a r i n g , d i r t y l o o ks , h i gh l y s t r e s s f u l jo b s s u f f e r e d f r o m c o l d s d a m n i n g w i t h f a i n t p r a is e a n d s h o w i n g u p 2 0 % m o r e o f t en t h an c o n t r o l s i n le s s l a te f o r m e e ti n g s r u n by t h e t a r ge t . Mo r e d e m a n d i n g p o s i t i o n s . T h e g r ea t e r t h e t h an f o u r o u t o f fi v e bu l l i es a r e b o s s e s a n d s t r e s s th e m o r e s ev e r e a n d m o r e fr e q u en t h a lf o f a l l bu l l i es a r e w o m en . W o m e n t h e i n f ec t i o n . E m pl o y e es w i th b u r n o u t b u ll i e s t a r g et f e m a l e s 8 4 % o f t h e t i m e a n d c o m p l a i n t s s u f f e r ed f r o m g a s t r o e n t e r i ti s m e n b u l li e s ta r g e t t h e m 6 9 % o f t h e t i m e s o a l m o s t tw i c e a s o ft e n as o t h e r s wi t h o u t t h at w o m e n a r e t h e m o s t l i k el y t o s u f fe r . s u c h s y m p t o m s . J o b i n s ec u r i ty d u e t o U n li k e c a s e s i n v o lv i n g v i o l at i o n s o f d o wn s i z in g w as p a r t i c u la r l y a s s o c i a t e d w i t h f e de r a l ly p r o t e c t ed C i vi l R ig h t s , b u l li e d a n i n c r ea s e d i n c i de n c e o f f lu a n d i n di v i d u a l s h a v e fe w a ve n u e s f o r s u c c es s f u l g a s t r o e n t e r i ti s . Sh i f t w o r k er s w er e a t l e ga l r ec o u r s e . T h e O f fi c e o f O c c u p a t io n a l g r ea t e r r i s k f o r de v e l o p i n g i n f e c t i o n s t h a n S a fe t y an d H ea l t h ( O S H A) d e al s o n l y w it h d a yt i m e e m p l o y e e s , e s p ec i a l ly i f t h e y h a d s a fe t y is s u e s t h a t p o s e p h y s i c a l h a r m , n o t t o r o t a te t h r o u g h t h r e e s h i ft s . e m o t i o n al d i s t r e s s . H o we v e r t h a t m a y be c h an g i n g. T h e W o r kp l a c e B u l ly i n g & T r au m a I n s t i tu t e is w o r k i n g t o p as s a n i n c r e a s ed s t r e s s be c a u s e ( 1 ) t h e y s u f fe r a n ti - b u ll y i n g l a w s i m i la r t o c h i ld a b u s e a n d f r o m s u r v i v o r g u i lt w h en t h ey c o m e i n d o m e s t i c v i o le n c e l e g i s l a t i o n . T h e y w er e c o n t a c t w i t h f r i e n d s a n d f o r m e r em p l o ye e s w h o w e r e f i r ed a n d ( 2 ) m u s t w o r k l o n g er C a li f o r n i a A s s e m b ly b i ll A B 1 5 8 2 t o p r o v i d e h o u r s t o m a i n t a i n p r o d u c t i v it y . O t h e r p r o t e c t io n a ga i n s t h e a lt h - i m p a i r in g b u l l y i n g r e s e a r c h e r s r e p o r t t h a t w o r ki n g lo n g e r a n d a r e s p e a r h e a d in g s im i l a r b i l ls i n o t h e r h o u r s i s n o t a s i gn i f i c a n t pr o b l em a n d i t ' s s t at e s . S u c h l e g i s l a t i o n a l r e a d y e x i s ts i n n o t h o w m a n y h o u r s y o u w o r k b u t u n d e r t h e U . K . a n d o t h e r c o u n t r i e s w h e r e t h es e w h at c o n d i t i o n s t h a t i s c r i ti c a l . S i t u a t i o n s p r o b l e m s m a y b e e ve n g r e a t e r . t h at d i m i n i s h s e l f- e s t ee m a r e t h e m o s t J o b s t r es s c an t a ke i t s t o l l e v e n i f d a m a g i n g, w h ic h h ig h l i gh t s th e h ar m f u l y o u w o r k a t h o m e ac c o r di n g to a r e p o r t February 2004 The Newsletter of THE AMERICAN INSTITUTE OF STRESS Page 6 Physician, Pharmacy & Hospital Abuses
Th e N ew Y o r k s u it c h ar ge s P h a r m a c i a an d Gla xo Sm i th Kli n e wi th c o n s u m e r fr a u d c om pan y- spo ns or ed din ners an d m eetin gs fo r an d m ak in g f al s e s t ate m e n ts t o g o v er n m e n t doc to r s an d fin anc ial r eim bu rs ement fo r h e al th pl an s w h en t h ey e s ta bl is h ed th ei r atten din g was qu ite c om mo n . It was n ot dr u g pr ic es , a s w el l a s wit h c o m m e r c i al u nu su al fo r h igh volu me pr es cr ibers an d their br ib er y f o r tr yin g to wi eld i n ap pr o pr ia te s po us es to be in vited to s pend a weekend at in fl u en c e o n d o c t o r s ' de c is io n s . I t c la im s th at Me di c ar e c o u ld h a ve s a ve d $ 2 1 .2 "educ ation al" pr es en tatio n that pro m oted th e m i ll io n f o r P h ar m ac ia' s Adr ia m yc in if c om pan y' s dru gs . O th ers were given lavis h wh o l es a le c a ta lo g u e pr ic es h a d b ee n u s e d gifts like ch oic e tic kets to to p th eater an d as t h e ba s is f o r r e im b u r s em en t i n s tea d o f s po rting even ts to r eward th em fo r u sing th e pu b li s h e d ave r a ge wh o le s a le pr ic e s .
c er tain pr o du cts bas ed on ph ar m ac y r ec or ds.
Me r c k w as s u ed in L o u i s i an a l as t y ear Suc h practices are n o w pr o hibited in fo r def r a u di n g th e fed er al Me dic ar e a n d guidelin es th at resu lted fro m pro of th at th is Me di c ai d pr o gr am s i n m ar ket in g P ep c id t o influ enc ed pr es c ribin g habits, es pec ially for h o s p ita ls an d n u r s i n g h o m es . A p h y s ic ia n expen s ive and very pr ofitable dru gs . Muc h o f pr o t es t ed th at wh en h e p r es c r ibe d Zan ta c , the im petu s for refo r m has actu ally co me an o t h er h ear tb u r n d r u g , fo r h is pa tie n t s i n fro m physic ians . The "N o Free Lun ch " gro u p h o s p ita ls an d n u r s i n g h o m es , h e la ter f o u n d even o bjec ts to co ffee mu gs, letter open ers th at th ey we r e gi ve n P ep c id w ith o u t h is and o ther inexpens ive item s th at adver tis e pe r m is s io n . He c l ai m ed t h at h is pa tie n t s s u ff er e d bec au s e P e pc i d c an b e m o r e t o x ic th an Za n t ac if a lo wer d o s e i s n o t u s ed .
s ubter fu ges to pay ph ys ic ian s, ph ar m ac is ts, as well as in stitu tio ns to u se th eir dru gs, s u bs tit u t io n p o li c i es fo r e qu iva le n t pr o du c t s , s om e o f wh ich ar e illegal. N ew Yo rk' s th e Lo u is ian a Bo a r d o f M edi c a l E xa m in er s Attor n ey General r ec ently an no u nc ed he an d th e B o ar d o f P h ar m ac y b o t h r u l ed th at plann ed to su e two m ajo r pharm aceutical it i s i ll ega l to au to m at ic a ll y s u b s ti tu te P e pc i d wh en a pr es c r i pti o n c a ll s f o r Za n t ac . T h e pharm acists to pus h their pr odu cts. Six o th er s u it c o n t en d s th a t Mer c k s o ld P e pc id to s tates are in vo lved in sim ilar litigatio n they h o s p ita ls fo r abo u t 1 0 c en t s a t ab let , bu t c laim has c os t c on su m er s, state and feder al c h ar ged t h e go ver n m en t a s m u c h a s $ 1 . 6 5 .
pro gr ams h u ndreds of million s o f do llars over Un de r F ed er a l law , dr u g c o m pa n ie s m u s t gi ve th e Med ic aid p r o g r a m t h e lo we s t pr ic e .
C a li fo r n i a i s in v es tig at in g w h et h e r rewarded for r eco mm endin g par tic ular dr ugs W a ts o n P h ar m ac eu t ic als p aid k ic k ba c ks t o to phys ic ian s who u se th em in th eir practice.
do c t o r s t o p r e s c r ib e F er r le c i t, it s i n j ec t ab le Th e dru g com panies establis h a price fo r the dr u g u s ed to t r ea t an e m i a i n dia ly s is dr ug th at th e gover nment an d ins ur anc e pa ti en t s . D o c t o r s w h o at ten de d d in n er co mpanies us e to deter mine ho w m uc h to pay m e et in g s s ig n e d a " c o n s u lta n t ag r e em e n t " do ctors and ph arm ac ies for th eir purc hases .
fo r m an d wer e lat er pa id $ 5 0 0 fo r Th e sam e dru g is th en so ld at a mu ch lo wer pa r t ic i pa tin g. Th is pr o c edu r e wa s als o pr ic e to cer tain ph arm ac ies and ph ysicians pr ac tic ed in s eve r a l l ar ge c i tie s in o t h er wh o poc ket the differenc e when they are reim bur sed at the govern men t rate. Ac co rding I n a n o t h e r s u i t f il ed in Ma s s ac h u s ett s to the Attor ney Gen eral' s s taff, a doctor
la s t Se pt em b er , W ar n er L am b er t w as might p ay as little as $7.40 for 10
ac c u s ed o f i ll ega ll y p r o m o t in g t h e s a le o f milligr am s of a c hemotherap y drug but
N e u r o n t in . D r u g c o m pan ie s a r e pr o h ibi te d would b e reimb ursed $34. 42 bas ed on th e
fr o m pr o m o ti n g o r m ar k et in g a m e di c in e in aver age wholes ale pric e. A New Yor k Medicare an yw ay fo r u s e s t h a t h av e n o t r e c e ive d FD A patient would als o make a c o- payment of ap pr o va l fo r e ffi c a c y an d s af ety . Ho w ev er , $8 .6 0 s o that the doctor wo uld poc ket $ 35.62 o n c e a dr u g be c o m es av ai lab le , d o c to r s c an in addition to an y charges fo r adm inistering pr es c r i be it f o r an yth in g t h e y b el iev e m ig h t th e medic ation an d an offic e vi s i t.
February 2004 The Newsletter of THE AMERICAN INSTITUTE OF STRESS Page 7 Neurontin & Other Spurious Promotions
Fo r exa m p le, N eu r o n tin h ad be en and Medicaid paid hundreds of millions of ap pr o ve d o n l y as an ad di tio n a l d r u g f o r dollars for unapproved uses of Neurontin, ep il ept ic s w h o c o n t in u ed to e xpe r i en c e which helped make it a top seller with
more than $2 billion in revenue, 90
m e di c at io n . O b vio u s ly, i t h ad ve r y li m i ted percent of which was for non approved
ap pl ic a ti o n s a n d s a les . W ar n e r L am ber t, wh ic h h as s i n c e b ee n a c q u ir ed by P fiz er , g o t ar o u n d th is by h a vi n g ph ys i c i an s p r o m o t e i t fo r eve r y th i n g fr o m r e s t les s leg s yn d r o m e, products by providing financial incentives at o s te o ar th r it is , backache and other painful professor of neurology at the University of investigators, published last year in the Journal of the American Medical Association, speeches given over a three year period and six other doctors from top medical schools, researchers received discretionary funds and professor at Harvard Medical School who told physicians that "pain specialists are finding that low dosages of Neurontin are effective" positions and other financial arrangements was paid $71,477. A University of Minnesota with companies whose drugs or devices they about Neurontin's benefits in addition to $304,000 to publish his textbook on epilepsy conducted at their facility. This has become used. Some doctors received reimbursement an increasingly important source of revenue and some fear that this may have influenced worked for a handful of their patients. Others were pa id to p r es c r ibe i t i n do s es fa r ex c e edi n g th e app r o ved l eve ls as p ar t o f a c l in ic a l tr i al th at W a r n er - La m be r t h a d studies of non-steroidal anti-inflammatory c r ea ted s o le ly fo r th e p u r p o s e o f pr o m o tin g comparison drug superior to the sponsor's W a r n er - La m be r t c o n s is t en tly t r ac ke d do c t o r s ' pr e s c r ip ti o n s t o s ee if t h e n u m be r s Assistant Professor of Medicine, explained in c r eas ed af te r t h e do c t o r s a tte n d ed N e u r o n t in m e et in g s o r af ter t h ey h ad be en h i r e d t o s pe ak ab o u t t h e dr u g . A
sponsor's drug with no treatment or placebo; C o nn ec t ic ut
p h y si c i an
by using a higher dosage of the sponsor's p r es c r i p t ion s f or u nap p r ov e d use s of
th e d r u g af t er he a tte nd ed a m ee ti ng
wh er e o th er d o c to r s sp ok e a b o ut
medication to one that is poorly absorbed.
Ne ur ont in ' s nu m er ou s b en ef i ts . H e had
Negative results are often not reported and ne v e r w r i tte n a N eu r on ti n p r e sc r ip tio n
p r io r t o the m eet in g a n d wa s lat er pa id
o v er $ 1 0 0 0 f o r s p ea kin g to do c to r s ab o u t results confidential for more than six months th e dr u g. I n o n e s u r ve y, h a lf o f 5 0 3 (often while the sponsor filed for patent). In ph ys ic i an s s ai d t h e y h ad al s o be en as ke d b y s a le s r ep s t o giv e th e d r u g f o r u n app r o ved publication until the company has a chance u s es . A lt h o u gh th is is p r o h ib ite d, al m o s t to market their results and some have even h a lf o f t h em a dm i tt ed th at th ey h a d o r been denied access to all study data until in te n de d to in c r e as e t h e ir N e u r o n t in statisticians have had a chance to review an d po s s i bly m an i pu lat e th e r es u lt s .
February 2004 The Newsletter of THE AMERICAN INSTITUTE OF STRESS Page 8 Federal Employee Conflicts Of Interest
w a s f u n de d b y N C I .) C o n g r e s s i s al s o With Drug Companies And Grant Recipients
i n ve s t i ga t i n g w h e th e r Kl a u s n e r s te e r e d a I n p r e v io u s N e w s l et t e r s , w e h a v e $ 4 0 m i l li o n c o n t r ac t t o H a r va r d Un i v e r s i t y d e ta i l e d h o w p h a r m a c e u ti c a l c o m p an i e s w h il e h e w a s a c a n d i d a te t o b e c o m e t h e h a ve i n fi l t r at e d th e F D A a n d i n f lu e n c ed s c h o o l ' s p r e s i d e n t. H e c u r r en t l y h e a d s t h e t h ei r d ec i s i o n s i n o t h er w a ys . I n t h e l a s t G l o b a l He a l t h P r o gr a m at t h e B i l l a n d i s s u e , n u m e r o u s s im i l a r c o n fl i c t s o f in t e r es t M e li n d a G a t e s F o u n d a t i o n i n S e a t tl e . i n vo l v i n g t o p N I H o f f i c i a l s w e r e d e t a il e d , S t u n g b y t h e s e a l le g a t io n s an d o th e r i n c l u d i n g S t ep h e n I . K at z , di r e c to r o f t h e a c c u s a t io n s c o n t a in e d in a s c a t h in g L o s A n ge l e s T i m e s i n v e s t ig a t i ve r e po r t , N I H M u s c u l o s k e l e ta l a n d S k in D i s e a s e s w h o D i r e c t o r E l i as A . Z e r h o u n i an n o u n c e d th a t c o ll e c t ed b e tw e e n $ 4 7 6 ,3 6 9 an d $ 6 1 6 , 3 6 5 h e w o u l d c r e at e a b l u e r i b b o n p a n e l t h a t d u r i n g th e p as t d ec a d e i n f ee s f r o m w o u l d i n c l u d e o u t s i d e ex p e r ts t o c o n d u c t S c h e r i n g A G an d s ix o t h e r d r u g m a ke r s . a n e t h i c s r e vi e w o f h o w t h e a g e n c y h a n d l e s D u r i n g th i s pe r i o d, h i s I n s ti t u t e c o n du c t e d c l in i c a l t r i al s i n v o l v in g o n e o f t h e e m pl o y e es r e c e i v e l u c r at i v e c o n s u l t i n g c o m p a n y ' s d r u g s a n d p l ed g e d $ 1 . 7 m i l l io n c o n t r a c ts f r o m p r iv a t e c o m p an i e s . E v e r y i n s m a l l b u s in e s s r e s e ar c h gr a n t s t o o u ts i d e c o n s u l t i n g r e l at i o n s h i p th a t N I H a n o t h e r . F i v e o t he r p r e s e n t a n d f o r m er
e m pl o y e es h a ve e s ta b l i s h e d du r i n g t h e s e ni o r NI H o f f i c i al s r ep o r t ed l y r e c e i v e d
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h a ve b e en a d h e r e d t o a n d t h at t h ei r I n a d d i ti o n , i t n o w a p pe a r s t h a t a c ti v i t ie s a r e " i n t h e b e s t i n t e r e s t o f t h e R i c h a r d D . K la u s n er , f o r m e r d i r e c t o r o f t h e p u bl i c . " T h a t m a y n o t c u t t h e m u s t a r d . T h e N a ti o n a l C a n c e r I n s t i t u t e ( N C I ) , a l s o a c c e p t e d l e c tu r e fe e s an d o th e r c a s h gi f t s f r o m u n iv e r s it i e s a n d r e s e a r c h i n s t i t u t i o n s I n ve s t i ga t i o n s a s w e l l a s t h e C h ai r m a n o f t h at r e c e i v e N C I an d N I H r e s e a r c h g r a n t s . A C o n g r es s i o n a l c o m m i t te e i s p a r ti c u l ar l y C o m m i t t ee h a ve a l r e a d y a s k e d Z e r h o u n i t o i n te r e s te d i n a $ 3 0 0 0 c a s h aw a r d p l u s s u pp l y by J a n u a r y 8 , 2 0 0 4 , al l d o c u m e n t s t r an s p o r t a t i o n a n d l o d gi n g ex p e n s e s f r o m r e la t i n g t o th e m o r e t h a n $ 2 . 5 m il l i o n i n t h e A r i zo n a C a n c e r C e n te r . Th i s N C I - f e es a n d s t o c k o p ti o n s d r u g c o m p an i e s p a i d d e s i g n a te d c o m p r e h e n s i ve c a n c e r fa c i l it y a t t o h i g h - l e v e l N I H s c i e n t i s t s a n d o f f i c i a l s t h e U n i ve r s i ty o f A r i z o n a H ea l t h S c i e n c e s o v er t h e p a s t 1 0 ye a r s . T h i s m a y b e j u s t C e n t e r r e c e i ve d m o r e t h a n $ 2 5 m i ll i o n i n t h e t i p o f t h e i c eb e r g . T h e D e c e m b e r 7 L o s N C I g r a n t s a n d w a s a w a r d e d $ 4 8 6 , 0 0 0 i n A n ge l e s T i m e s r ep o r t a l s o f o u n d t h a t n o t a l l f e de r a l c o n t r a c t s . ( T h e N C I d i r e c t o r an d o f t h e in c o m e r e c ei v e d w a s r e q u i r e d t o b e o t h e r h ig h - r an k i n g N C I o f f i c i a l s a r e l i s t e d in p u bl i c r e p o r ts b e c a u s e o f p r i o r p r o h i b i te d u n d e r fe d e r al r e gu l a t io n s fr o m a g r e e m e n t s a n d i t i s l ik e l y t h a t s o m e f u n d s r e c e i v i n g a n h o n o r a r i u m f r o m a p r i v a t e w e r e f u n n e l e d t o fa m i l y m e m be r s . S t a y s o u r c e fo r a l e c t u r e o n c a n c e r r es e a r c h t h at Health and Stress
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