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Save the dates, October 19-22, 2007, for our upcoming 64th Annual Meeting to again be convened at the Palm Springs Hilton Hotel, Palm Springs, California. Veteran attendees know that our annual meeting venue is truly an “oasis in the desert” with an incredible array of attractions for all visitors. Our president, Dr. Shahrokh Shabahang, continues to secure faculty members who will not only challenge but also teach the newest science behind clinical advances. It has often been said and is so often true that “We heard it first at an AIOB meeting.” The variety of disciplines of our faculty over the years has been rather amazing in retrospect, and it is certainly true that we are all better doctors for having been exposed to them, regardless of our clinical specialty or type of practice. Chairperson, Debby Splaver, reports that the Spouse’s program is extremely fortunate to have secured a renowned Cardio-thoracic Surgeon, Dr. Stephen Robert Gundry, of the International Heart and Lung Institute, Palm Springs, CA, to speak on the topic, “Eat As If Your Life Depends On It.” Dr. Gundry has been invited to address international scientific gatherings as well as many domestic conferences and we are, indeed, pleased that he has made himself available for the Saturday Morning Program (9-10:30 AM) for the spouses. With all the publicity that heart disease in women has received since our last meeting, his presentation is not only timely, but of the greatest importance. This will certainly be a great start to the meeting. Potential attendees are reminded by our Meeting Arrangements Chairperson, Dr. Ron Fink, that although the Hilton Hotel has granted us additional rooms for our meeting allotment, you are responsible for contacting the Hotel directly and before the cut-off date, when rooms are released to the public. The Institute does not want any members disappointed as some were in 2006, when late arrangements could not be accommodated. Please note that there is a very liberal Hotel policy on cancellation, so we would advise that if you have hesitation for any reason, make your reservation, and if necessary, cancel before the deadline without penalty. Palm Springs is an increasingly popular weekend destination and the days of securing a hotel room as a “walk in” seem to be pretty much a thing of the past. Again, we would like to reiterate that our Tuition charge, for an available 26 CEU, includes the cost of Meals for the registrant, commencing with Friday’s Luncheon and ending with Monday’s Breakfast. There is naturally, an additional meal charge for Spouses and there is a sliding scale for children.
There is no meeting registration charge for Spouses and the Spouses Program on Saturday Morning is provided at no cost to our attendees” spouses as it continues to be underwritten by the Institute. Additionally, spouses are encouraged to attend the Philip J. Boyne Lecture, as these are generally of an overview in nature. Also, on a “space available basis”, the AIOB welcomes spouses to any of the other scientific sessions in which they may have interest. Naturally, if your spouse is an allied healthcare professional, tuition must be paid in order to secure Continuing Education Credits. Another possibly unique aspect of our Annual Meeting is that we do not have commercial exhibitors, although we have some industry support to fund publication of our “Proceedings Manual” which serves as invaluable, take-home reference document for our attendees. Until 2006, Peter Geistlich Sons, contributed to publication costs, and this year we are fortunate that Genelux Corp, CA has graciously contributed to this worthwhile endeavor. The diagnosis of Ventilator Associated Pneumonia can be problematic and interested individuals can read, “A Randomized Trial of Diagnostic Techniques for Ventilator-Associated Pneumonia,” The Canadian Critical Care Trends Group, New England Journal of Medicine, December 21, 2006. The same issue also contains an Editorial by M. Kollef concerning the cited article. The website www.erc.montana.edu/MultiCellStrat/default.html opens with a large image of microbial biofilms from the Center for Biofilm Research, Montana University. Clicking on any of the printed headings takes you to an associated link to the Center’s research. * * * * * Dr. Stanley Prusiner, winner of the Nobel Prize in Medicine and the Pritzker prizes spoke to us about his ground-breaking and then-controversial research on prions, the unique infective materials, which have been demonstrated to be essentially folded proteins. In 1982 he published material, which demons-trated that prions caused scrapie, a neurologic disease of sheep. Since then prions have been implicated as etiologic agents in numerous animal and human neurological, and “wasting” diseases. Now that his theories are well accepted and proven, the world’s literature is replete with articles such as “The Expanding Universe of Prion Diseases. (A Review) Joel C. Watts, PLOS Pathogens, January 2007. (Online) At least 4 novel prion diseases identified within the last 10 years, including” chronic wasting disease of North American deer and Rocky Mountain elk are undergoing dramatic spread across North America” Part of the reason for the latter may be found in the conclusions published in PLOS Pathogens April 2006, by CJ Johnson, et al., “Prions Adhere to Soil Minerals and Remain Infectious.” Dr. Prusiner discussed the difficulty in “eliminating” prions by sterilization and other chemical and physical methods when he spoke to us. * * * * * "Take a hike!" This pejorative phrase if taken literally could possibly become a life extender, if not a virtual lifesaver. Numerous publications in both the scientific and popular press continue to extol the health benefits of walking. Broken down to its simplest form, the directions are, “Put one foot in front of the other. Repeat.” (AARP March & April 2007). Walking, which obviously can be a solitary as well as a “team effort” requires the most minimal “armamentarium”-comfortable shoes, socks and clothing and can be accomplished in any environment in which the walker is comfortable. According to the AARP article, “In the past 20 years a growing body of research has emerged showing that a brisk 30 minute walk most days of the week can dramatically cut your risk of heart disease and stroke; decrease your chances of developing diabetes, osteoporosis, and some forms of cancer; and reduce your body weight significantly.” Research on overweight, middle-aged people performed at the University of Pittsburgh demonstrated a 7-pound weight loss in those who walked briskly for 30-60m minutes per day for 18 months, while the control group, which exercised irregularly during the same period, gained 7 pounds in the same study. Doing the math shows that there was a 14-pound average difference between the faithful walkers (exercisers) and the control group at the conclusion of the study. According to Mark Fenton co-author of Pedometer Walking, a 175-pound person walking at a 3mph pace, for 30 minutes, would expend about 151 calories, on average. * * * * * According to a November 7, 2006 New York Times article, American and Canadian researchers have identified a major gene associated with both Crohn’s disease and ulcerative colitis. There are estimated to be about a million Americans afflicted by these disorders, which are collectively called inflammatory bowel disease, and are seen most commonly in Jews of Eastern European descent. The most likely etiology according to the article is an “immune response to normally beneficial bacteria in genetically susceptible people.” The researchers led by Dr. Richard Duerr at the University of Pittsburgh School of Medicine, found variations in the gene for a receptor of the protein, interleukin-23 (IL-23). The gene variation appeared to lead to a susceptibility to the inflammation of IBD. According to Dr. Duerr, “The IL-23 immune pathway was already implicated in IBD, psoriasis, rheumatoid arthritis and multiple sclerosis.” Animal studies in mice have already demonstrated that the immune pathway, associated with IL-23 is associated with multiple organ inflammation. Treatment strategies would obviously be the next step. * * * * * Lupus sufferers, who number approximately 1,500,000 people in the USA, will possibly have several new drugs available to treat the disease, rather than just the symptoms. At least four companies, Human Genome Sciences (HGS), Bristol –Meyers Squibb Co. (BMS) and Genentech and Biogen Idec Inc (G,BI). will be or are conducting human clinical trials on their products to be used to treat this autoimmune disorder. Lupus affects mainly females and often presents a diagnostic puzzle with protean manifestation and is often treated with steroids and an anti-malaria drug, hydroxychloroquine. , with myocardial infarction and strokes as the most common form of death. According to a Wall Street 1ournal article of January 23, 2006 there has been no drug approved to treat lupus for 50 years. HGS is bringing Lymphostat-B, an injectable antibody, to Phase 111 trials later this year, while BMS has developed Orencia. With the mapping of the human genome now an accomplished fact, there is increasing concern in this country about discrimination by insurance companies and employers, especially, based on determination of an individual’s genetic mapping. On February 15, 2006 it was reported that a bill banning such discrimination was moving quickly through Congress. The bill was approved by the House Committee on Education and Labor on February 14, and was expected to not only pass through the House but also the Senate, which had passed the legislation twice in the past. As of the time of preparation of this Newsletter the president had not signed the legislation but he was expected to do so as he has previously stated that he was in favor of such protection. According to a Wall Street Journal article of February 15, 2006 tests for about 1000 diseases are presently available to patients. * * * * * In the USA, the use of dietary supplements and antioxidants to maintain or improve one’s health appears to continue unabated, despite a number of studies and meta-analyses which appear to conclude that they are, in fact, of little value to most people, and may, indeed, be harmful. The Cochrane Collaboration (www.cochrane.org/index.htm) for access to evidence based healthcare data) published data in JAMA recently, demonstrating that beta-carotene; vitamin E and vitamin A not only did not improve health, but also possibly increased the risk of death. Forty-seven studies involving 180,000 patients were analyzed. The supplement doses were high, however, there apparently are no published, double blind studies to demonstrate a safer beneficial dosage. Additionally, their analyses found that vitamin C and selenium posed no additional risk. Other studies recently have shown no beneficial effects from St. John’s Wort (taken widely in Europe to treat mild depression), black cohosh( alone or with other botanicals did not relieve hot flashes) and saw palmetto in most people. There is a widespread belief that ingesting garlic contributes to improvement of health, and a study published in the Archives of Internal Medicine, February, 2007, demonstrated no lowering effect on LDL cholesterol. Study participants consumed raw garlic, a supplement or placebo for 6-days/ week for 6 months. No apparent clinical or statistically significant effect on LDL measurement was seen. According to Physician’s First Watch, an accompanying editorial cautioned that the study did not rule out beneficial cardiovascular effects as garlic contains, “… several bioactive substances with antithrombotic, antiplatelet and other effects.” A fascinating article in The New England Journal of Medicine, February 1, 2007, 356 (5): 479-85, by Henley, DV, et al, contained case histories of a 4, 7 and 10 year old boy, all of whom developed gynecomastia which could be attributed to use of either, “lotion, soap, shampoo balm, or styling gel containing lavender oil, and in some cases tea tree oil.” Use or ingestion of all other “endocrine disruptors” such as medications, oral contraceptives, and marijuana or soy products was ruled out, All were otherwise healthy and symptoms resolved when the suspect substances were discontinued. Interestingly, both oils demonstrated estrogenic and antiandrogenic activity by cell culture studies. A New York Times article from January 2007, reported that the American Association of Poison Control Centers tabulated almost 1.6 million reports of, “adverse reactions to vitamins, minerals, essential oils, herbs and other supplements over a 23 year period.” Slightly less than 1/6 of the incidents resulted in hospitalization and there were 257 deaths. Importantly, almost ¾ of the recorded incidents occurred in children below the age of six. In the tabulation for 2005, “ordinary vitamins were linked to the most poisoning in the category, followed by minerals.” Melatonin and homeopathic remedies caused the greatest number of problems of the herbs and other products. St. John’s wort and Echinacea were linked,” to hundreds of incidents, many of them serious enough to require hospitalization.” Readers who wish to stay current on the US Food and Drug Administration’s activities in the field of Dietary Supplements can subscribe for the free online, “Dietary Supplement & Food Labeling Electronic Newsletter”, with access to past issues, by going to www.cfsan.fda.gov/~dms/supplmnt.html. * * * * * On March 20 th the Alzheimer’s Association of the USA, in a press release, stated that presently 5 million people have the disease and the number is expected to rise to possibly 16 million by mid-century. Alzheimer’s disease was the 7 th leading cause of death in this country in 2004. Interestingly, while its mortality rate increased 33% between 2000-2004, the mortality rates for cardiovascular disease, stroke, and breast and prostate cancers decreased. The group stated that the cost, in 2005, to Medicare was $91 billion dollars for Alzheimer’s and other dementia sufferers, and the estimated projected cost will be $189 billion dollars in 2015. At the present time there are 5 Alzheimer’s medications approved by the FDA, since 1993, and, according to a Wall Street Journal article (4/9/07) they only treat the symptoms, boosting weak memory with an effect with a duration of less than 2 years, while none stop the disease progression. Amyloid, specifically amyloid beta 42, is commonly considered to be the cause of the disease, ultimately causing brain cell death secondary to clumping. An attempt by Wyeth Labs to develop a vaccine resulted in termination of a clinical trial in 2002, when a high, 6% of patients, developed brain inflammation. The company and a partner are returning to clinical trials soon with an improved vaccine, and they have another drug, bapineuzumab, soon to be tested in clinical trials. This latter is a genetically engineered antibody, “Designed to tag the amyloid for clearance by patient’s immune systems”. Two oral drugs also in Wyeth’s pipeline, and early-phase trials, work by different mechanisms; one interfering with the enzymes that help Abeta42 form, while the other aims to prevent amyloid clumping. * * * * * After publication of two articles in the January 4, 2007 New England Journal of Medicine announcing the findings of two studies on pergolide and cabergoline, which were once popularly used to treat Parkinson’s disease, the drug pergolide was withdrawn from the US market in March 2007. Both drugs were generally used when, levodpa, the drug of first choice became less effective in a patient and were shown to be associated with a 4-7-fold increase in heart valve damage. A safety alert was published on the FDA website in 2003, by Eli Lilly & Co. advising that “a small number" of patients developed heart valve problems, however, these new studies showed a high incidence of related valve damage, which was, in fact, dose related; with increased risk at higher dosages. Those in practice in the mid 1990s may recall similar problems with the diet drug combination Fen-Phen. After widespread use it was discovered that a significant percentage of patients developed cardiac valvular problems, mainly regurgitation, and some also developed primary pulmonary hypertension. Echocardiography was advised for those who had taken the drug, and SBE antibiotic prophylaxis became the order of the day for those patients with regurgitation. Parkinson’s patients who have taken pergolide and cabergoline have now been advised to be screened by echocardiography. 
Ted Splaver, Editor (954) 970-9366 June J. Barrientos, Executive Secretary (909) 558-4671 Office (909) 558-0285 Fax |
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Shortly after our 63 rd Annual Meeting, the ADA Journal published a Special Supplement November 2006, in which the article, “Managing the complexity of a dynamic biofilm,” written by Dr. John G. Thomas, MS, PhD and Lindsay Nakaishi, BS appeared. The Microbial Stage Cycle discussed by Dr Thomas during his seminars is clearly illustrated in Figure 2, p.13, and the article is another excellent overview of his presentations to our 2006 meeting.
Those AIOB members with long memories will remember the 1994 Annual Meeting presentations by the late Dr. Victor Herbert MD, JD, who co-authored “The Vitamin Pushers,” with Dr. Steven Barrett and was editor of “The Mount Sinai School of Medicine Complete Book of Nutrition”, among his other numerous publications. Dr. Herbert railed against the advocates of high dose vitamins and supplements. If memory serves, he stated that the extremes of age as well as pregnant women required vitamin supplementation, while the rest of the population would do well to obtain their needs from a well-balanced diet. At the time of his death in 2002, Dr. Herbert was Professor of Medicine, Mt. Sinai School of Medicine, NY and Chief, Mt. Sinai’s Hematology and Nutrition Research Lab, Bronx, VA Hospital. His obituary stated that he was one of the nation’s greatest “quack busters.” And he also had the distinction of military service in four wars.