Chemically, electrolytes are substances that become ions in solution and acquire the capacity to conduct electricity. Electrolytes are present in the human body, and the balance of the electrolytes in our bodies is essential for normal function of our cells and our organs.
Common electrolytes that are measured by doctors with blood testing include sodium, potassium, chloride, and bicarbonate. The functions and normal range values for these electrolytes are described below.
Sodium is the major positive ion (cation) in fluid outside of cells. The chemical notation for sodium is Na+. When combined with chloride, the resulting substance is table salt. Excess sodium (such as that obtained from dietary sources) is excreted in the urine. Sodium regulates the total amount of water in the body and the transmission of sodium into and out of individual cells also plays a role in critical body functions.
Many processes in the body, especially in the brain, nervous system, and muscles, require electrical signals for communication. The movement of sodium is critical in the generation of these electrical signals. Therefore, too much or too little sodium can cause cells to malfunction, and extremes in the blood sodium levels (too much or too little) can be fatal.
Increased sodium (hypernatremia) in the blood occurs whenever there is excess sodium in relation to water. There are numerous causes of hypernatremia; these may include kidney disease, too little water intake, and loss of water due to diarrhea and/or vomiting.
A decreased concentration of sodium (hyponatremia) occurs whenever there is a relative increase in the amount of body water relative to sodium. This happens with some diseases of the liver and kidney, in patients with congestive heart failure, in burn victims, and in numerous other conditions.
A Normal blood sodium level is 135 – 145 milliEquivalents/liter (mEq/L), or in international units, 135 – 145 millimoles/liter (mmol/L).
Urban legends and health myths are certainly nothing new — we’re pretty sure even our Neanderthal ancestors passed some version of them around their cave fires. But the Internet has certainly helped outdated advice die hard, so it’s no wonder these fake facts keep popping up in our inboxes. We picked our favorites from such myth-busting sites as Snopes, the authors of Don’t Swallow Your Gum!: Myths, Half-Truths, and Outright Lies About Your Body and Health, and more. Here’s why you should stop falling for these, once and for all:
Chewing gum takes seven years to pass through your digestive tract.
The truth: Gum addicts can relax. Although your body can’t digest chewing gum, it doesn’t just sit in your stomach, according to Snopes.com. You eliminate it when you go to the bathroom just like other food you haven’t digested.
Plucking a gray hair causes two to grow back.
The truth: It’s fine to tweeze that errant hair. Genetics plays a key role in when you go gray, regardless of how often you pluck. It can take six months from the time a hair falls out until it grows back long enough for you to notice it; during that time, you’ll automatically see more gray hair as part of the aging process, explains Snopes.com.
Antiperspirant deodorants cause breast cancer.
The truth: Going au naturel won’t protect your breasts from cancer. This myth probably came about because some antiperspirants contain aluminum, which can show up as a false-positive finding on a mammogram. All this means is you should skip the white stuff before a breast cancer screening. Though concerns have been raised about parabens in deodorant raising estrogen levels — and thus possibly increasing cancer risk — there’s never been any conclusive evidence to prove a link, according to the National Cancer Institute and FDA.
Cats can steal the air from a baby’s mouth.
The truth: There’s no need to send Fluffy away when baby moves in. This myth dates back hundreds of years to an era when cats were associated with evil spirits and witchcraft, but KidsHealth.org notes that it’s anatomically impossible for a cat or other animal to suffocate a baby by sealing the infant’s mouth with its own. Still, it’s a good idea to supervise pets around babies and small children — for the kitty’s safety just as much as the child’s.
Mountain Dew can shrink a man’s testicles.
The truth: Mountain Dew-drinking guys everywhere can breathe a sigh of relief. The gist of this ridiculous rumor, according to Snopes.com, is that drinking Mountain Dew can lower a man’s sperm count or cause his penis to shrink. The alleged culprit is food coloring Yellow No. 5, and the myth that it has a harmful effect on the male reproductive system is unfounded, the site says.
You can catch a cold from being outside too long.
The truth: It’s actually a good idea to let your kids spend plenty of time outdoors. “Going outside — with or without a wet head — is one of the best things you can do to prevent catching a cold,” D.J. Verret, MD, a Dallas otolaryngologist, told WomansDay.com. “Colds are caused by viruses or bacteria, which are more often spread in the winter because of close contact from everyone being indoors.” So spending time al fresco can actually make you less likely to catch a cold.
Cracking your knuckles causes arthritis.
Truth: The sound can be extremely grating, but this uncouth habit won’t harm your joints. Researchers found no difference in instances of arthritis when they compared a group of longtime knuckle crackers with those who left their hands alone, according to Prevention.com. However, the study did find that people who cracked their knuckles had weaker grips and more hand swelling — good reasons to kick the habit.
Drinking cold water after meals can lead to cancer.
Truth: Water is one of the healthiest things you can drink with any meal — hot, cold, or tepid. This rumor first surfaced in early 2006, according to Snopes.com, and still makes its way into various email chains. It posits that cold water helps solidify oily fats from your meal into a “sludge” that lines the intestines and can lead to cancer. But there’s zero evidence from medical literature to support this theory.
It’s okay to follow the five-second rule for dropped food.
Truth: The five-second rule should actually be the “zero-second rule,” Roy M. Gulick, MD, chief of the division of infectious diseases at Weill Cornell Medical College, recently told The New York Times. “Eating dropped food poses a risk for ingestion of bacteria and subsequent gastrointestinal disease, and the time the food sits on the floor does not change the risk.” If bacteria are present, they will cling to the food immediately on contact. So while it may be tempting to dust off food you’ve dropped, it’s safer to just toss it in the trash.
You only use 10 percent of your brain.
Truth: Motivational speakers may love this idea, but the evidence against it is just common sense, say Aaron Carroll, MD, and Rachel Vreeman, MD, in their book Don’t Swallow Your Gum: Myths, Half-Truths, and Outright Lies About Your Body and Health. “Studies of patients with brain damage suggest that harm to almost any area of the brain has specific and lasting effects on a human being’s capabilities,” they wrote. “If this myth were true, it would not be a big deal to hurt various parts of your brain.” You’re using 100 percent of your brain — or at least we hope so.
Patients with coronary heart disease who have positive expectations about recovery, expressing beliefs such as “I can still live a long and healthy life,” had greater long-term survival, researchers reported.
Among a cohort of almost 3,000 patients undergoing coronary angiography, those with the highest expectations for outcomes actually had the best outcomes, Dr. John C. Barefoot, and colleagues from Duke University Medical Center in Durham, N.C.
“Patients differ widely in terms of their psychological reactions to major illnesses such as coronary heart disease,” Barefoot’s group explained online in the Archives of Internal Medicine.
Related: Should I Have an Angiogram?
To explore the specific potential influence of recovery expectations, rather than overall optimistic personality traits, the investigators enrolled 2,818 patients with clinically significant disease and followed them for about 15 years.
Recovery expectations were assessed on the Expectations for Coping Scale, in which patients agreed or disagreed with statements such as “I doubt that I will ever fully recover from my heart problems” and “My heart condition will have little or no effect on my ability to do work.”
Patients were stratified into quartiles according to their expectation scores.
After adjustment for multiple variables, the mortality rate in the highest quartile — the most optimistic group — was 32 per 100 versus 46 per 100, respectively, “illustrating a substantial magnitude of this effect even after taking multiple covariates into account,” Barefoot and colleagues observed.
“These observations add to a compelling body of evidence that endorsing optimistic expectations for one’s future heart health is associated with clinically important benefits to cardiovascular outcomes,” Dr. Robert Gramling, and Dr. Ronald Epstein, of the University of Rochester in New York, wrote in a commentary accompanying the study.
“The degrees of evidence observed in these studies suggest that optimism is a powerful ‘drug’ that compares favorably with highly effective medical therapies,” they wrote.
Other experts advised caution, however.
“Like all observational studies, unmeasured patient characteristics may have contributed to the better outcomes,” observed Dr. Steven E. Nissen, of the Cleveland Clinic.
“Patients with a ‘positive’ attitude may simply be healthier than patients with a negative attitude. In fact, their ‘attitude’ may reflect their health status,” Nissen wrote to MedPage Today and ABC News in an e-mail.
Two “plausible” hypotheses can help explain the study findings, according to Barefoot and colleagues.
First, patients who are optimistic may use more effective strategies to cope with recovery from illness, by addressing the problem and reducing risk factors.
Second, patients whose outlook is more negative may experience worse stress that in turn could have harmful cardiac effects.
Limitations of the study, according to the investigators, included the possibility of confounders and selection bias.
“These findings argue for expanded efforts to understand the influence of recovery expectations and the potential benefits of attempts to modify them,” Barefoot’s group concluded.
However, the potential efficacy of such efforts is uncertain, according to Dr. James Kirkpatrick, of the University of Pennsylvania in Philadelphia.
“Whether a patient’s outlook can be changed (or patients can change their outlook) and improve results, and whether there are other factors which might make these patients do better, is unknown. One of those factors might be that cardiovascular providers give better care to patients with a positive outlook — perhaps spending more time with them or being more conscientious,” wrote Kirkpatrick in an email to MedPage Today and ABC News.
“Future studies will need to take this possible mechanism into account,” wrote Kirkpatrick.
The study was supported by the National Heart, Lung, and Blood Institute and the National Institute on Aging.
One author has a patent pending on an allele as a marker of cardiovascular disease and stress, and is a founder and major stockholder in Williams LifeSkills Inc.
Editorialist Gramling is funded by the National Palliative Care Research Center and the Greenwall Foundation.
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Hyperkalemia is a common diagnosis. Fortunately, most patients who are diagnosed have mild hyperkalemia (which is usually well tolerated). However, any condition causing even mild hyperkalemia should be treated to prevent progression into more severe hyperkalemia. Extremely high levels of potassium in the blood (severe hyperkalemia) can lead to cardiac arrest and death. When not recognized and treated properly, severe hyperkalemia results in a high mortality rate.
Technically, hyperkalemia means an abnormally elevated level of potassium in the blood. The normal potassium level in the blood is 3.5-5.0 milliequivalents per liter (mEq/L). Potassium levels between 5.1 mEq/L to 6.0 mEq/L reflect mild hyperkalemia. Potassium levels of 6.1 mEq/L to 7.0 mEq/L are moderate hyperkalemia, and levels above 7 mEq/L are severe hyperkalemia
How does hyperkalemia affect the body?
Potassium is critical for the normal functioning of the muscles, heart, and nerves. It plays an important role in controlling activity of smooth muscle (such as the muscle found in the digestive tract) and skeletal muscle (muscles of the extremities and torso), as well as the muscles of the heart. It is also important for normal transmission of electrical signals throughout the nervous system within the body.
Normal blood levels of potassium are critical for maintaining normal heart electrical rhythm. Both low blood potassium levels (hypokalemia) and high blood potassium levels (hyperkalemia) can lead to abnormal heart rhythms.
The most important clinical effect of hyperkalemia is related to electrical rhythm of the heart. While mild hyperkalemia probably has a limited effect on the heart, moderate hyperkalemia can produce EKG changes (EKG is a reading of theelectrical activity of the heart muscles), and severe hyperkalemia can cause suppression of electrical activity of the heart and can cause the heart to stop beating.
Another important effect of hyperkalemia is interference with functioning of the skeletal muscles. Hyperkalemic periodic paralysis is a rare inherited disorder in which patients can develop sudden onset of hyperkalemia which in turn causes muscle paralysis. The reason for the muscle paralysis is not clearly understood, but it is probably due to hyperkalemia suppressing the electrical activity of the muscle.
Your favorite pint may be healthier than you realize. When it comes to good-for-you happy hour beverages, we tend to think mainly of red wine and its heart-friendly antioxidants. Recent research, however, reveals that beer may also help what ales you, from reducing the risk of osteoporosis to beating brain fog.
But before you go on a beer binge, remember that moderation is key to reap its health perks. That means no more than two 12-ounce beers a day for men and one for women. “If you overdo it, alcohol can take a toll on your health, contributing to liver damage, certain cancers, heart problems, and more,” says Andrea Giancoli, RD, spokesperson for the American Dietetic Association. People with certain health conditions — including gout, high triglycerides, or breast cancer, for example — should avoid drinking beer or other alcohol because it can exacerbate those health problems, according to Joy Bauer, RD, nutrition and health expert for Everyday Health and The Today Show.
Too much alcohol can also cause weight gain. After multiple rounds, calories can add up quickly (a 12-ounce regular beer can pack up to 150 calories, while a light beer has around 100).
But for most of us, here are five healthy reasons to toast your next beer:
Beer Boost No. 1: A Stronger Skeleton
Make no bones about it: Beer in moderation may protect bone health thanks to its high silicon content. Participants who sipped one or two beers a day had greater bone mineral density than those who drank more or fewer beers, found a 2009 study published in the American Journal of Clinical Nutrition. “Silicon helps stimulate bone-building cells, and the estrogenic effect of alcohol also has a protective quality for bones,” says study author Katherine Tucker, PhD, professor of nutritional epidemiology at Northeastern University in Boston. Which brew boasts the most silicon? Try an India Pale Ale. A 2010 University of California Davis study found that IPAs had the highest levels of the mineral.
Beer Boost No. 2: A More Powerful Ticker
A beer a day may keep heart disease away. “Alcohol raises levels of ‘good’ HDL cholesterol,” says Arthur Klatsky, MD, senior consultant in cardiology at the Kaiser Permanente Division of Research in Oakland, Calif. “It also has anti-clotting effects, which keeps blood vessels clear and healthy.” In fact, Israeli researchers found that people who drank one beer daily had lower levels of fibrinogen, a protein that helps promote blood clotting, than those who abstained from drinking. (Blood clots can cause heart attack and stroke.) Study participants drank Maccabee beer, but researchers believe that any type of beer could have similar heart-healthy effects.
Beer Boost No. 3: Healthier Kidneys
Finnish researchers found that men who drank beer had a 40 percent lower risk of kidney stones compared to those who drank other types of alcohol. The benefit may be due to beer’s high water content. Dehydration can increase the risk of kidney stones, which are little deposits of salt and minerals such as calcium that can form in your kidneys. Beer’s hops (a kind of flower that gives beer its bitter flavor and acts as a preservative) may also help prevent kidney stones by slowing the release of calcium from bones.
Beer Boost No. 4: Better Brain Power
While excessive alcohol intake can cause irreparable brain damage, moderate daily consumption actually safeguards a sharp mind, research shows. One classic New England Journal of Medicine study, which analyzed the drinking habits of about 11,000 women over more than 15 years, found that those who had up to one drink a day had a 20 percent lower risk of brain function decline (as measured by memory and other cognition tests) than nondrinkers. Alcohol intake may protect blood vessels in the brain and also lower stroke risk, say researchers.
Beer Boost No. 5: Lower Cancer Risk
Beer’s health benefits aren’t limited to those who drink it: Marinating steak in your favorite brew could eliminate up to 88 percent of the carcinogens that form as a result of pan-frying meat, according to a Portuguese study. Cooking meat at high temperatures creates cancer-causing compounds known as heterocyclic amines (HCAs). Researchers think that the sugars in beer help prevent HCA formation.
Japan’s ongoing nuclear crisis understandably has people around the world worried about radiation exposure and the potential health risks it may pose. According to the latest reports, radiation from Japan was detected in Southern California late this week, but experts are quick to point out that the levels are far from dangerous. The readings were “about a billion times beneath levels that would be health threatening,” a diplomat with access to United Nations’ radiation tracking told the Associated Press.
Nor is it unexpected. “Whenever radioactive particles get in the atmosphere, they have the potential to spread around the world,” says James Thrall, MD, president of the American College of Radiology. “But they get diluted as they travel, so they’re unlikely to pose any real health problem.”
In fact, we’re probably exposed to significantly more radiation every day than the miniscule fallout arriving from Japan. Here’s a quick tutorial on radiation to put our collective anxiety in perspective:
What Is Radiation?
Radiation is a form of energy in waves. It exists on a spectrum, with low-frequency radiation (from radio waves and microwaves) on the low end and high-frequency radiation (from gamma rays and x-rays) on the high end. All radiation affects the cells in our bodies to some extent, but the lower the frequency of the waves and the lower the exposure, the less dangerous it is.
To understand the risks of high-frequency radiation — the kind we’re talking about in this article — think back to high school physics: These waves have enough energy to knock electrons off molecules, which can cause damage to cell DNA that can ultimately lead to cancer.
How Are We Exposed to Radiation?
We encounter radiation each day from a variety of sources. The average American is exposed to about 6 millisieverts (mSv) of radiation annually, according to the United States Nuclear Regulatory Commission (USNRC). Half of this typically comes from background radiation that occurs naturally in the environment, and half comes from medical tests, such as X-rays, mammograms, and CT scans.
According to Kelly Classic, MS, spokesperson for the Health Physics Society, sources of environmental radiation include:
Radioactive compounds in soil and building materials like concrete, brick, and stone
Radiation from outer space that your encounter when you fly on airplanes or visit high-altitude places
The mineral potassium in your own body (a small fraction of potassium, which our bodies need to function, is radioactive)
Radon gas in the home, which accounts for about 2 mSv of exposure each year, and is the largest contributor of background radiation
Finally, there’s the kind of radiation released during nuclear reactions, such as what’s disseminating from Japan’s Fukushima Daiichi plant.
Here’s a look at various sources of radiation exposure (dose of radiation in millisieverts (mSv)), according to data from the Health Physics Society and the U.S. Environmental Protection Agency (EPA). By way of comparison, a single dose of radiation below 0.01 mSv is considered negligible by the National Council on Radiation Protection and Measurements.
Dental X-ray: 0.005
Living within 50 miles of a nuclear power plant: 0.01 (per year)
A flight from New York to Los Angeles: 0.04
Smoking 1 ½ packs of cigarettes: 0.08
Chest X-ray: 0.1
Living at sea level: 0.25 (per year)
Living in Denver: 0.5 (per year)
Abdominal CT scan: 14
Measures between reactors No. 3 and No. 4 during the March 15 explosion at the Fukushima plant: As high as 400 per hour
What Level of Radiation Exposure Is Safe?
It’s well-established that exposure to large amounts of radiation at once can cause acute sickness and even cancer. (A 1,000 mSv-dose can trigger acute radiation sickness, causing symptoms such as nausea and vomiting; 3,000 mSV can be lethal, according to Thrall.)
But there’s no good data on the long-term risks of the low levels of radiation to which we’re continually exposed.
According to the World Nuclear Association, annual exposure to 100 mSv or greater carries a measurable, though small, increase in cancer risk. Below that level, it’s believed that your body’s cells are able to heal themselves from radiation. “There are enzyme systems in the body that repair damage from these low levels of background radiation,” says Thrall.
But even small levels of radiation exposure may impact cancer risks later in life.
This has been of particular concern in the medical community, where some experts worry that increasing use of diagnostic CT scans (which has skyrocketed from 3 million annual scans nationwide in 1980 to 70 million in 2007, according to MedPage Today) will impact future cancer rates. For example, in one 2009 study, National Cancer Institute researchers estimated that one in 270 women and one in 595 men who had a heart CT at age 40 would eventually develop cancer related to the test.
While the health benefits of necessary diagnostic imaging usually outweigh the small risks of secondary cancers, it’s always a good idea to talk to your doctor before any procedure involving radiation to understand exactly what you’re getting, why you need it, and what the potential health risks may be.
Bottom line: Americans are exposed to far more radiation in their daily lives — and especially from certain medical tests — than from dispersed particles traveling across the Pacific. “With what we know now about the situation in Japan, there are no personal or public health risks apparent for people in the United States,” Thrall says.
Is it us, or are news headlines about Facebook’s impact on our health popping up more and more these days? Considering that 51 percent of Americans over age 12 now have profiles on the social networking site compared to 8 percent just three years ago, according to new data from Edison Research, it’s no wonder there are entire scientific journals devoted to the psychology of social networking, and piles of studies analyzing such sites’ effects on our moods, body image, friendships, and marriages.
Negative conditions such as “Facebook depression” or Facebook-fueled divorces bear the brunt of the media blitz, but much of the body of research actually points to positive perks from Facebook use. Here, a deeper look at how all those “likes,” “pokes,” and status updates are really affecting you and your family’s well-being, and how you can outsmart some of the potentially negative side effects.
Health Benefits of Facebook
Research shows that Facebook can:
Fuel self-esteem. In a Cornell University study, students felt better about themselves after they updated their Facebook profiles; a control group of students who didn’t log onto the site didn’t experience such a mood lift. The very act of posting something about yourself — regardless of what you write — can boost your self-confidence because you control the image you present to your network of friends, according to researchers.
Similarly, according to a Michigan State University study, students with low self-esteem and happiness levels who used Facebook more frequently felt more connected to friends and campus life than those who logged on less often.
Strengthen friendship bonds. In a small study of heavy Facebook-using young British adults between ages 21 and 29, Lancaster University researchers found that the site helped cement positive interactions among friends. Both private messages and wall posts allowed Facebook users to confide in their friends, surf down memory lane, and laugh out loud, promoting happy feelings.
Stamp out shyness and loneliness. In a soon-to-be-published Carnegie Mellon study, researchers who surveyed more than 1,100 avid Facebook-using adults found that receiving messages from friends and consuming info from friends’ news feeds boosted feelings of connectedness, especially in people with self-described “low social skills.” Authors say that for shy people, gleaning information from news feeds and profiles can help start conversations they otherwise might not be comfortable enough to strike up. “People who are uncomfortable chatting face to face gain more through their use of the site,” says study co-author Moira Burke, a PhD candidate in the university’s Human-Computer Interaction Institute.
Similar benefits hold true for tweens and teens: Australian researchers who studied more than 600 students between age 10 and 16 found that communicating online helped improve communication skills for lonely adolescents, giving them an outlet to talk more comfortably about personal topics.
Health Risks of Facebook
Research also shows that Facebook can:
Cause depression. A recently published American Academy of Pediatrics (AAP) paper made a major splash when it described Facebook depression — a condition said to result when tweens and teens spend too much time on social media, leading them to turn to “substance abuse, unsafe sexual practices, or aggressive or self-destructive behaviors.”
However, the phenomenon is more anecdotal than based on solid science, and some experts suggest that it’s more of a correlation — that people who are depressed may simply be more likely to use Facebook. “People who are already feeling down or depressed might go online to talk to their friends, and try and be cheered up,” wrote John M. Grohol, PsyD, founder and editor-in-chief of PsychCentral.com on his blog. “This in no way suggests that by using more and more of Facebook, a person is going to get more depressed.”
In one of the papers cited by the AAP report, researchers found that the more time first-time Internet users spent online, the more likely they were to experience loneliness and depression but a follow-up study showed such effects disappeared a year later, according to Dr. Grohol. “It may simply be something related to greater familiarity with the Internet,” he wrote. In another paper referenced by the AAP report, the depression-Facebook link only held true among people with “low-quality” friendships; people with good pals did not experience depression with increasing Facebook use.
Trigger eating disorders. The more time adolescent girls spent on the social networking site, the more likely they were to develop eating disorders such as anorexia, bulimia, and extreme dieting, Israeli researchers recently found. Exposure to online fashion and music content, as well as watching TV shows like Gossip Girl, were also associated with an increased risk for eating disorders.
But researchers aren’t saying that social networking sites necessarily cause eating disorders; as with Facebook depression, it may be that people prone to eating disorders spend more time online. What’s more, the researchers found that parents can help protect their daughters from harmful effects of media: The children of parents who were aware of what their daughters were viewing online — and talked to them about what they saw and how much time they spent — were less prone to develop eating disorders, according to study authors.
Split up marriages. Facebook was referenced in 20 percent of divorce petitions processed in 2009 by Divorce-Online, a British law firm. Time magazine reported that feuding spouses use their Facebook pages to air dirty laundry, while their lawyers use posts as evidence in divorce proceedings. Sexual health expert Ian Kerner, PhD, recently blogged on CNN that he’s seen many relationships destroyed by “Facebook bombs” — people reconnecting with high school sweethearts or other blasts from the past that can lead to emotional, if not actual, cheating.
“The mistake I often see is when someone gets friended or messaged by an ex and doesn’t tell their partner,” Kerner told Everyday Health. “It’s a slippery slope from the moment you don’t disclose information.”
He warns that it’s easy to over-romanticize the past, which can cause people to check out of their current relationship. Kerner advises couples to not keep secrets about whom they’re chatting with on Facebook. And while the site certainly makes it easy to reconnect with old flames and flirt behind the façade of your computer, the potential damage it can do depends on the stability of your relationship in the first place. “It all depends on your level of trust in your spouse,” says Kerner. “Have a dialogue, set some rules. The key is transparency.”
If you’ve ever gotten a rash from taking an antibiotic or gained weight on an antidepressant, you know that taking medicine means balancing the benefit of the drug against the possible risk of unpleasant, and sometimes even dangerous, side effects. The U.S. Food and Drug Administration (FDA) calls these unwanted consequences “adverse events,” and once a drug is on the market, watches closely to see if it needs to reevaluate a drug’s safety. FDA does this in part through their MedWatch program, where health professionals and the general public can report any reactions or problems they suspect may have been caused by a medication. Medwatch reports and those submitted by drug manufacturers are combined into a single database for drug safety evaluation, the Adverse Event Reporting System (AERS).
According to a study recently published in the Archives of Internal Medicine, the reporting of serious adverse events through AERS (those that can lead to hospitalization, significant health problems, or even death) has increased dramatically in recent years — a 2.6-fold increase in serious events and a 2.7-fold increase in deaths reported between 1998 and 2005 (the last year for which data was available for the study).
In fact, half of the 2.2 million total reports in the database since its inception in 1969 were received in just the past 10 years, the study found, increasing at a rate of more than 11 percent per year. Slightly more women than men had adverse events (55 percent compared to 45 percent).
Does This Mean Our Medicines Have Become More Dangerous?
Not necessarily, says the study’s lead author, Sheila Weiss Smith, PhD, director of the Center for Drug Safety at the University of Maryland. The spike could be due to several factors:
Greater awareness of the reporting system
Access to the Internet, making it easier for people to report problems than the old system (in which you had to call, fax, or mail a report to FDA)
The fact that people are taking more drugs for longer periods of time (thus increasing the potential for side effects, as well as interactions between drugs)
The aging of the U.S. population (older people often experience more problems with drugs)
News reports of FDA action on a drug also tend to increase the number of reports, says Dr. Weiss Smith. Her research found that many reports about problems with the anti-inflammatory drug Vioxx came in after it was withdrawn from the market.
On the other hand, some newer drugs also have more inherent risks and side effects. Among the most frequently reported drugs in the study were several recombinant DNA drugs used to treat autoimmune diseases like rheumatoid arthritis. Because such drugs, such as Humira or Enbrel, are used for serious illnesses for which few other effective treatments are available, patients need to discuss with their doctors whether the benefits of treatment outweigh the risks (more on this below).
What Is the Adverse Event Reporting System?
The reporting system is designed as a safety net to flag potential drug problems, explains Robert Feroli, Pharm.D, medical safety officer at the Johns Hopkins Medical Center Department of Pharmacy. FDA has to perform a balancing act between getting drugs to the market quickly and learning as much as possible about potential adverse effects. Because drugs are tested on a relatively small number of people, only after a drug is released can you get a full picture of potential problems, based on a large, diverse population. For example, Vioxx was was tested on 5,000 people before it was approved, but many millions more took it after approval, when serious side effects like heart attacks began showing up.
If there is an unusually high number of reports on a drug, FDA will evaluate the claims and may request further studies, require changes to the drug’s labeling information, or rarely, remove the drug from the market, as with Vioxx.
Anyone — consumers as well as doctors, pharmacists, and other health care professionals — can report anything they suspect is a negative reaction to a drug. In 2009, the last year for which data is available, nearly 273,000 adverse reactions were reported by consumers, compared to nearly 318,000 reported by health care providers.
It’s important to recognize that the system doesn’t reflect the whole story about a given drug. Just because a drug has lots of reports doesn’t necessarily mean there is a problem with it, Feroli points out. Suspected issues could be due to other causes, such as pre-existing health problems in the people taking it or interactions with other drugs. For example, taking the erectile dysfunction drug Viagra in combination with drugs that contain nitrates (like certain heart meds, such as those prescribed for angina) can cause dangerously low blood pressure.
But just because no adverse event has been reported for a particular drug, that’s no guarantee the drug hasn’t caused dangerous side effects, since many adverse events go unreported.
Is There Anything I Can Do to Prevent an Adverse Drug Reaction?
Part of being a proactive patient is taking the time to understand the medications prescribed for you. Feroli says you should ask your healthcare provider the following questions anytime you’re prescribed a new drug:
Why are you prescribing this drug? What is it supposed to do?
Are there any cautions I should know about? Can it interact with other medications, or things like sunlight or foods?
Are there any side effects I need to be aware of? What is normal and expected and what should I call you about?
Exactly how should I take the medication? With meals? Water?
How long should I take this drug? (For some medicines, such as antibiotics, you must finish the entire course, even if you start to feel better. Others, such as most pain medicines, you can stop taking when the pain goes away.)
It’s also important to let your health care team know about any other medications you’re taking, because drug interactions can increase the chances of serious reactions.
What if You Suspect You’re Having a Drug-Related Reaction?
If you think that a drug is causing a problem, first talk with your doctor or your pharmacist. Never stop taking a drug that has been prescribed for you without discussing it with your doctor, and never ignore any symptoms that concern you. Your doctor can often suggest other drugs that would work just as well without causing such side effects. Often, there are several different classes of drugs that treat a condition such as hypertension or depression. If you are having trouble on one, another might work just as well.
If the problem you are having with the drug is serious enough for you to consult your doctor, ask if she thinks you should report the problem to FDA. To report a negative reaction to a drug, go to FDA’s Medwatch website.
Which Drugs Have Been Reported the Most?
The Archives of Internal Medicine study looked only at brand-name drugs, not generics, and only included the 10 drugs most frequently reported. They’re listed below in order by number of adverse events reported in relation to the drug.
But before you panic if you’re taking one of the 10 medications, note that many are used to treat serious conditions that have not responded to other medications; in such cases, the benefit of the drug may outweigh the risk of side effects for many patients, says Feroli. If you’re worried about a particular medicine your doctor prescribed for you, ask if there’s another drug with fewer risks that might help.
1. Enbrel (etanercept)
Enbrel is a recombinant DNA drug, most often used to relieve the symptoms of autoimmune diseases like rheumatoid arthritis and psoriasis. Because Enbrel suppresses the immune system, it increases the risk of infections, including tuberculosis. It may also increase the risk of certain cancers, especially in children and teenagers. It has sometimes been used off-label to treat pediatric psoriasis and Alzheimer’s disease.
2. Vioxx (rofecoxib)
This is one drug you don’t need to worry about anymore: Its manufacturer, Merck, pulled the anti-inflammatory pain reliever from the market in 2004 after studies showed it increased the risk of heart attack and stroke. Vioxx was used to treat arthritis (both rheumatoid and osteoarthritis) and occasionally was prescribed for acute pain such as migraines and menstrual cramps.
3. Humira (adalimumab)
Humira is another recombinant DNA drug used primarily to treat autoimmune disorders, including rheumatoid arthritis and Crohn’s disease. It’s also used off-label for skin disorders, such as psoriasis, and for ulcerative colitis. Because Humira suppresses the immune system it can increase the risk of opportunistic infections, including tuberculosis. Humira may also increase the risk of certain cancers, especially in children and teens.
4. Remicade (infliximab)
Another recombinant DNA drug to make the top 10, Remicade is used for many of the same autoimmune disorders as Enbrel and Humira. The immune suppressor has similar serious risks. .
5. Byetta (exenatide)
Byetta is used in combination with another drug, metformin, to treat type 2 diabetes. Byetta stimulates the pancreas to secrete insulin when blood sugar levels are high, thus lowering blood glucose levels. It causes the stomach to take longer to empty and decreases appetite, leading to its off-label use as a weight-loss drug. FDA has received numerous reports of altered kidney function in patients using Byetta. It has also been associated with incidence of inflammation of the pancreas. .
6. Avonex (Interferon beta-1a)
Avonex is used primarily to treat the symptoms of multiple sclerosis in patients with frequent relapses. Amember of a class of drugs known as immunomodulators, Avonex concerns include a risk of seizures and an increase in preexisting cardiac problems.
7. Seroquel (quetiapine)
Seroquel is an antipsychotic drug used to treat schizophrenia and bipolar disorder. Possible problems with Seroquel include abnormal muscle movements and withdrawal symptoms in newborns whose mothers were on the drug during pregnancy. In addition, older adults with dementia may have an increased risk of death during treatment with Seroquel, and children or young adults who take it may be at increased risk of suicide.
8. Forteo (teriparatide)
Another recombinant DNA drug, Forteo is used to treat serious cases of osteoporosis (patients at high risk of fracture who have not responded to other medications). Forteo has caused bone cancer in animals, and may increase the risk of this cancer in humans.
9. Ortho Evra (ethinyl estradiol and norelgestromin transdermal)
A type of birth control, Ortho Evra is a skin patch that contains a form of estrogen and progestin. While various combinations of these hormones have been used for years, their safety is still a matter of some debate. Because a patch delivers the hormones directly to the bloodstream without going through the digestive system, users are exposed to higher levels of estrogen. Concerns about Ortho Evra center on the risk of heart attack, blood clots, strokes, and endometrial and breast cancers. The risks of heart attack and stroke increase dramatically for users over 35, particularly for users who smoke.about Ortho
10. Mirena (levonorgestrel)
Another type of birth control, Mirena is an intrauterine contraceptive device (IUD) that releases small amounts of the hormone levonorgestrel into the uterus. It may also be used to treat heavy menstrual bleeding. Concerns about Mirena include an increased risk of ectopic pregnancies (pregnancies that occur outside the womb, such as in the fallopian tubes) and an increased risk of breast cancer.
Cell phones may cause brain cancer, a panel of experts reporting to the World Health Organization (WHO) announced Tuesday.
After reviewing dozens of studies that explored a possible link between cancer and the ubiquitous hand-held phones, the experts classified cell phones as “possibly carcinogenic to humans” and placed them in the same category as the pesticide DDT and gasoline engine exhaust.
The panel determined that an increased risk for glioma, a malignant form of brain cancer, appears associated with wireless phone use.
Globally, it’s estimated that 5 billion cell phones are in use. “The number of users is large and growing, particularly among young adults and children,” the International Agency for Research on Cancer said in a news release issued Tuesday.
The IARC made the announcement in Lyons, France, based on the work of 31 scientists from 14 countries. It will present its findings to the WHO, which may then issue its recommendations on safe cell phone use.
Experts said children are especially vulnerable.
“Children’s skulls and scalps are thinner. So the radiation can penetrate deeper into the brain of children and young adults. Their cells are dividing at a faster rate, so the impact of radiation can be much larger,” Dr. Keith Black, chairman of neurology at Cedars-Sinai Medical Center in Los Angeles, told CNN.
Until Tuesday’s announcement, the WHO had said that cell phones were safe to use.
The international experts behind Tuesday’s announcement met for eight days to review exposure data, studies of cancer in humans and in experimental animals, and other relevant data, looking for associations between cancer and the type of electromagnetic radiation found in cell phones, televisions and microwaves.
Dr. Christopher Wild, director of the International Agency for Research on Cancer, said this new paper is important “first and foremost just because of the large number of users worldwide that have access now to this technology.”
Also, the scientists found notable gaps in the existing research, he said, which “suggest interesting areas of future research that will improve the evidence base which we have in order to make decisions about the usage of mobile phones in the future.”
Responding to Tuesday’s announcement, John Walls, vice president of public affairs for CTIA-The Wireless Association, a trade group representing the wireless industry said: “Today, an International Agency for Research on Cancer (IARC) working group in Lyon, France categorized radiofrequency fields from cellphones as possibly carcinogenic based on ‘limited evidence.’ IARC conducts numerous reviews and in the past has given the same score to, for example, pickled vegetables and coffee. This IARC classification does not mean cell phones cause cancer. Under IARC rules, limited evidence from statistical studies can be found even though bias and other data flaws may be the basis for the results.
“The IARC working group did not conduct any new research, but rather reviewed published studies,” Walls added in a news release. “Based on previous assessments of the scientific evidence, the Federal Communications Commission has concluded that ‘[t]heres no scientific evidence that proves that wireless phone usage can lead to cancer.’ The Food and Drug Administration has also stated that ‘[t]he weight of scientific evidence has not linked cell phones with any health problems.'”
There has been conflicting research in recent years on the health hazards posed by cell phones. As recently as February, British researchers reported that cell phones do not increase the risk of brain cancer.
Their analysis of data on newly diagnosed cases of brain cancer in England between 1998 and 2007 — when cell phone use was climbing — revealed no statistically significant change in the incidence of brain cancers in men or women, said the University of Manchester researchers.
There was a very small increase (0.6 more cases per 100,000 people) in the incidence of cancers of the brain’s temporal lobe. That works out to 31 extra cases per year in England’s population of nearly 52 million people, the researchers said.
But the study authors also noted that cancers of the brain’s parietal lobe, cerebrum and cerebellum in English men fell slightly during the study period.