| Tobacco retail promotions
dwarf other products' spending
HAMPERED BY LEGAL RESTRICTIONS ON CONSUMER ADVERTISING,
U.S. tobacco companies appear to be heavily promoting their products
through small retail outlets, spending significantly more than other
companies to obtain prominent product displays, according to a recent
study by researchers at Stanford and at Santa Clara University.
The researchers found that small retail operations
are receiving significantly more money and discounts from tobacco
companies to push the sale of tobacco products than they receive
for other items such as soft drinks, beer, wine and snacks.
"For many years the public health community has been
trying to restrict consumer advertising in magazines and billboards,
but our research indicates that the real target for public health
should be the retail environment," says Ellen Feighery, RN, MS,
a senior research scientist at the Stanford Center for Research
in Disease Prevention.
Feighery was lead author of the study, published
in the October 1999 issue of the American Journal of Public Health.
The article reports what appears to be the first
detailed look at tobacco industry retailer incentives. The study
focused on slotting and display allowances -- fees manufacturers
pay retailers to encourage them to allocate premium shelf space
to a product.
The survey was conducted in November and Decem
ber 1997 in 108 chain convenience stores, gas stations,
grocery stores, liquor stores and tobacco stores in Santa Clara
County, Calif. It showed that 62.4 percent of the stores had received
slotting/display allowances from tobacco makers.
In contrast, only 16.5 percent of the stores received
slotting/display allowances for placing soft drinks in premium locations
most likely to appeal to consumers. And only 6.9 percent of the
stores received the allowances for candy.
The tobacco companies also were more generous in
their payments, according to the researchers. Of the $3,157 the
average store received annually for all product types, $2,462 (78
percent) came from the tobacco companies. By contrast, only 33 percent
of the stores reported that tobacco sales accounted for their highest
sales volume.
"These survey results suggest that tobacco companies
use generous incentives and aggressive marketing programs to motivate
retailers to prominently display, promote and advertise their products
to ensure the high visibility of their products and marketing materials,"
the researchers concluded.
As evidence of fierce competition in the retail environment,
three of the country's largest cigarette makers filed a lawsuit
against Philip Morris Co., accusing the giant tobacco company of
hampering their ability to secure prime shelf space in retail outlets.
Slotting and display fees in the tobacco industry also were the
focus of a U.S. Senate antitrust hearing in September 1999.
"Perhaps the Federal Trade Commission should consider
expanding its ongoing investigation of Philip Morris' merchandising
practices to the tobacco industry as a whole. New policies may be
needed to address the [retailer focused] marketing strategies of
the tobacco industry and their impact on in-store marketing environments,"
the researchers say. -- MG
Clues to how stomach bugs
get around
STANFORD RESEARCHERS ARE SEARCHING IN SOME UNSAVORY
PLACES TO SOLVE THE RIDDLE OF HOW A COMMON BACTERIUM THAT CAUSES
STOMACH ULCERS AND PERHAPS SOME KINDS OF STOMACH CANCER JUMPS FROM
ONE HUMAN TO ANOTHER. The most obvious places the bacteria may be
hiding are the vomit, feces and saliva of infected people.
* Sixteen healthy people infected
with Helicobacter pylori, which
is carried by 50 percent of the population, volunteered for a study
led by Julie Parsonnet, MD, an associate professor of infectious
diseases and geographic medicine. Like the majority of those carrying
the bug, these people showed no signs of infection, but evidence
of the bacteria in their breath and antibodies in their blood confirmed
H. pylori's presence. Ten people who tested negative for
the bacteria were also studied as controls.
The volunteers were admitted to Stanford's General
Clinical Research Center for 24 hours, and Parsonnet and her team
collected all manner of biological samples for analysis.
* The researchers first screened
normal feces from each of the 26 volunteers. Helicobacter
thrives in the stomach's acidic surroundings, but its survival
outside this environment is limited. Normal stools can take days
to traverse the colon and, not surprisingly, the researchers found
no live bacteria in these samples. But, when given a substance that
induced diarrhea, 11 of the 16 infected people passed stools from
which the bug could be grown.
Parsonnet believes that diarrheal stools are expelled
so quickly from the small bowel and stomach that live bacteria can
be transported into the external environment. According to Parsonnet,
H. pylori can survive outside the body for a few hours, which
may be sufficient time to infect anyone who contacts the sample.
The researchers also gave the infected people, and
one uninfected volunteer, a substance to make them vomit. The results
showed that vomiting is a potent way of discharging millions of
infectious H. pylori into the environment. The researchers
found live bacteria in samples from all of the infected individuals.
The concentration of H. pylori in vomit was also much greater
than in feces.
Transmission of H. pylori by this route supports
what scientists already know about Helicobacter infection.
Close living quarters, the presence of many siblings and poor household
hygiene are factors known to increase the risk of infection. Children,
who tend to vomit and "spit up" more frequently than adults, are
particularly likely to transmit the bug to other children, says
Parsonnet. "Imagine children in day care together; one throws up
and another child is right next to him or her. Or contaminated toys
are not cleaned up properly," she says.
Infection during childhood leads to more opportunities
to pass the bug on to others and also increases the likelihood of
serious disease, says Parsonnet. Although many people carry the
bug without symptoms, a combination of factors -- such as the particular
strain of H. pylori and the person's diet and genetics --
can lead to ulcers and/or stomach cancer. Infection at an early
age gives the bacteria more time to wreak havoc.
Analysis of air and saliva samples completed Parsonnet's
battery of tests. Although the researchers could detect traces of
bacteria in the saliva of approximately half of the people carrying
H. pylori, mouth-to-mouth transmission is not considered
a primary route of infection. Sampling the air surrounding infected
volunteers confirmed the pivotal role of vomiting in the potential
spread of the bacteria. The researchers found no evidence of the
bug until the onset of vomiting, when air sampled from approximately
a foot in front of the volunteers yielded Helicobacter that
had been exhaled in tiny aerosol droplets.
The results of the study were published in the December
15, 1999, issue of the Journal of the American Medical Association.
-- KW
Glowing mice help screen cancer therapies
MICE THAT LIGHT UP WHEN CANCER CELLS ARE ON THE RAMPAGE
AND DIM WHEN THE INVADERS ARE POISONED BY DRUGS MAY HELP RESEARCHERS
PINPOINT effective new anticancer therapies and will also spare
the lives of many lab mice.
* A firefly gene makes the promising
technique possible. Scientists in the
laboratories of Christopher Contag, PhD, assistant professor of
pediatrics, and Robert Negrin, MD, associate professor of medicine,
have inserted the gene into human tumor cells. When tumor cells
are alive and healthy, the firefly genes glow. The researchers then
inject these modified tumor cells into mice. Using an ultrasensitive
video camera, the firefly light can be detected through a mouse's
skin and tissues, showing up on a computer screen as colored blotches
superimposed over the mouse's body.
Contag's group first developed the glowing mouse
in 1995 to follow the progression of infectious diseases. He and
his colleagues injected Salmonella bacteria labeled with
the bi oluminescent firefly gene into mice to
see where they settled in the mouse's gut and how the bacteria responded
to various antibiotics. The technology has since been licensed to
Xenogen, a company started by Contag and others, including his wife,
Pamela Reilly Contag, PhD, who is its president and CEO.
* In the recent tumor cell study,
Contag and Negrin tested three standard chemotherapy drugs against
human cervical tumor cells to show that the new method is a reliable
predictor of the drugs' effectiveness. They reported the results
in the October 12, 1999, Proceedings of the National Academy
of Sciences and in the October 1999 Neoplasia.
As the tumor invaded the mouse's abdomen, the light
emitted from the mouse became more intense and spread over a greater
area. Within days of giving the mouse a chemotherapeutic drug, the
researchers could see the light diminish and recede, indicating
that the tumor cells were dying. More than two months after the
light had disappeared, testing by an alternative method confirmed
that the mice remained free from cancer.
Contag and Negrin believe that the new technique
will be especially useful for testing drugs to treat minimal disease
-- the small number of cancer cells found early in disease or following
removal of a large tumor. Recent advances in cancer diagnosis are
allowing physicians to detect minimal disease earlier and earlier,
so drugs that can rapidly kill these cells without further harming
the patient offer a better chance of fighting the disease.
Nontoxic alternatives that will kill relatively small
numbers of cancer cells before they mass into a life-threatening
tumor are needed, says Contag. Drugs used to treat late-stage disease
-- characterized by the presence of many rapidly dividing cancer
cells -- are usually very toxic, causing unpleasant side effects.
* The researchers say they are
pleased that, in addition to potentially
leading to improvements in rapid drug screening, the glow-gene method
will reduce the number of mice sacrificed in the name of medical
research. Neither the firefly gene nor the ultrasensitive camera
harms the mouse. And because the tumor cells can be seen through
the animal's body, there is no need to kill the mouse and dissect
it to ascertain what is happening within its tissues.
"You can follow one group of mice over time, so you
use fewer animals to get more data more efficiently," says Contag.
"There is no other method that can detect so few
human cells noninvasively," Negrin adds. --
KW
Ron Garcia named minority affairs
assistant dean
THE SCHOOL OF MEDICINE'S LEADERSHIP
HAS ESTABLISHED AN ADMINISTRATIVE POSITION TO ASSIST THE SCHOOL'S
EFFORTS to expand opportunities in medicine for underrepresented
minority students -- naming Ronald Garcia, PhD, the assistant dean
for minority affairs.
"Dr. Garcia has provided remarkable
leadership and vision for the School through his work at the Center
of Excellence and the Health Careers Opportunity Program," says
Eugene A. Bauer, MD, vice president for Stanford University Medical
Center and dean of the School of Medicine. "Ron's contributions
have been integral to the School's progress in promoting the recruitment
and selection of underrepresented minority students, as well as
to increasing the number of minority students who are seeking leadership
careers in medicine," he adds.
"I am very excited about my appointment,"
says Garcia, who assumed the post in December 1999. "In many institutions,
this position focuses primarily on minority student recruitment
and retention. I embrace these areas, but I intend to get involved
in other areas as well. There are major challenges in so many areas
of medicine; I am very pleased to work at an institution that is
willing to pursue solutions and has a long history of commitment
to minority recruitment," he says.
Garcia, a senior lecturer in the Department
of Medicine's Division of Family and Community Medicine since September
1987, has been program director of Stanford School of Medicine's
Center of Excellence (COE) since 1992 and program director of Stanford's
Health Careers Opportunity Program (HCOP) since 1996. The COE is
a minority recruitment, retention, curriculum development, research
and faculty development project for the School of Medicine. HCOP,
a six-week summer program instituted in response to dwindling minority
applications, aims to help college students who are members of minority
groups strengthen their qualifications for medical school.
Garcia received three degrees at Stanford:
a master's in education in 1971 and both a master's in psychology
and a PhD in educational psychology in 1977. He completed a postdoctoral
internship in clinical psychology at the Stanford Alcohol and Drug
Treatment Center in 1988.
Since 1997 he has chaired the minority
and non-minority disadvantaged students advisory panel of the Medical
School's Committee on Admissions. -- JT
New technique restores
blood flow to damaged limbs
IN THE FIRST CASE REPORT OF ITS KIND IN NORTH AMERICA,
STANFORD PHYSICIANS SAY THEY HAVE USED A NEW TECHNIQUE TO GRADUALLY
RESTORE BLOOD FLOW TO THE LEG AND SPARE A 16-YEAR-OLD PATIENT FROM
THE PROSPECT OF AMPUTATION.
The procedure could be used to benefit patients who
develop blood clots in the leg, resulting either from disease or
as a side effect of heart surgery.
If adopted by more surgeons, the procedure could
benefit the thousands of U.S. patients each year who develop blood
clots in the leg. Historically, as many as half of the patients
who have these clots surgically removed may die from complications,
and as many as 22 percent may undergo limb amputation, says Kai
Ihnken, MD, a general surgery resident at the School of Medicine.
The procedure could spare these patients the ordeal of amputation
or other possible organ damage, he says.
* The procedure involves use
of a special solution that is mixed with the patient's blood and
then is very slowly reinfused back into oxygen-starved tissues in
the body. This process, known as controlled
reperfusion, avoids injury that commonly results when blood flow
is suddenly restored to tissues suffering from prolonged lack of
oxygen, says Ihnken. With uncontrolled reperfusion, the onslaught
of blood releases toxins that can damage cells and trigger a heart
attack or cripple a limb, he says.
"The initial 30 minutes of reperfusion has to be
controlled if you are to avoid injury," Ihnken says. He discussed
his experience with the technique October 4 in Kamuela, Hawaii,
at the 46th annual world assembly of the American College of Angiology.
The procedure was initially devised by Gerald Buckberg,
MD, at the University of California, Los Angeles, who developed
the method in the early 1990s as a way to rescue oxygen -starved
tissue in cardiac patients and to prevent tissue death that could
lead to a heart attack. Ihnken, who studied under Buckberg, surmised
that if the technique could work well in the heart, it should work
equally well in oxygen-starved limbs. He returned to the University
of Frankfurt, where he and his colleagues adapted the technique
for use in the legs. These methods of controlled reperfusion have
since been used in Europe in some 40 patients who were found in
imaging studies to have reduced blood flow to either the heart or
legs for as much as 24 hours, Ihnken says.
Ihnken brought his experience to Stanford, first
applying the technique in December 1997 in a 16-year-old San Jose
youth who suffered complications during surgery to correct a heart
defect. During the surgery, the boy developed a blockage in a leg
artery and showed signs of losing all function in the limb, Ihnken
says. Doctors feared they'd have to amputate. At that point, the
surgical team decided to apply controlled reperfusion. The procedure
was successful, and the patient walked out of the hospital in good
shape and has continued to do well, Ihnken says.
"In the past, we always thought that if an extremity
had no blood supply, the best thing to do was to get as much blood
restored as soon as possible," says Christopher Zarins, MD, professor
and chief of vascular surgery. "It's taken some research and investigation
to discover that the concept, which makes empiric sense, isn't actually
true. If the extremity has been deprived of blood for a period of
time, you should restore that flow gradually, not with one big burst."
Zarins and Bruce Reitz, MD, professor and chair of cardiothoracic
surgery, worked with Ihnken to apply the technique at Stanford.
* During the limb procedure,
doctors clamp the artery and insert a tube just above the arterial
blockage to withdraw some of the patient's blood. They
mix the blood in a 6-to-1 ratio with a buffered solution containing
salt, glucose, protein, a free radical scavenger and other protective
elements. They then slowly infuse this mixture back into the leg
with a pump that maintains a relatively low pressure. The clamp
is then removed, allowing the blood to flow freely. The procedure
takes about 30 minutes, Ihnken says.
In addition to benefiting patients with blood clots,
the procedure has the potential to help people undergoing cardiac
surgery, such as emergency coronary artery bypass surgery, as well
as patients receiving transplanted organs, Zarins says. Transplant
recipients often experience reperfusion injury when blood flow is
restored to the new organ, he says.
"I think it's very promising," Zarins says. "It's
something that we have only started to do and it is still in the
early phases, but the early results are very encouraging." -- RR
Right under our noses:
More
microbial inhabitants of the mouth revealed
THE HUMAN MOUTH IS AWASH WITH BACTERIA. MOSTLY AMICABLE
BUGS, THEY LIVE ON OUR TEETH AND GUMS, HELPING TO DIGEST FOOD AND
TO WARD OFF ATTACK BY LESS FRIENDLY, DISEASE-CAUSING BACTERIA THAT
CAN STEAL THEIR WAY IN.
Stanford researchers have now shown that more of
these oral inhabitants exist than previously thought. Using a combination
of old and new scientific methods to study a scraping of plaque
from a healthy human mouth, the researchers found evidence of 37
unique bacteria that microbiologists had never before recorded.
Some were closely related to bacteria that scientists are familiar
with, but others were very different.
* Knowing more about the bacteria
that reside in a normal, healthy mouth
may help physicians understand changes in the bacterial population
that can lead to gingivitis, periodontitis and tooth decay.
"Our data suggest that a significant proportion of
the resident human bacterial flora remain poorly characterized,
even within this well-studied and familiar microbial environment,"
says David Relman, MD, assistant professor of medicine and of microbiology
and immunology at Stanford.
According to Relman, the subgingival
crevice -- the deep gum pocket cradling each tooth -- has been repeatedly
scrutinized in the search for microbes. Even though almost 500 bacterial
strains have been identified already, Relman believes they may represent
only a fraction of the bacteria living in this oral groove.
Oral bacteria have traditionally been studied by
taking a scraping or sample from inside the mouth, growing the bugs
in the laboratory and then identifying different species according
to biochemical tests and the type of food source that each bacterium
prefers. Using this method, the Relman team identified bacteria
found in a sample of plaque taken from the subgingival crevice.
* They also searched the same
sample using molecular techniques. Instead
of nurturing the bacteria in the lab, they prepared DNA directly
from the plaque and studied each genetic sequence that had a bacterial
signature. Comparing the results, they found that the molecular
method yielded many new bacteria. Not only did the method reveal
bugs that had never before been found in the mouth, many were bugs
that had not yet been documented by microbiologists.
* The team discovered 31 bacteria
using the molecular method. In contrast,
the traditional approach, which identifies only bacteria that can
be cultivated in the lab, uncovered only six new bugs.
"Sequence-based environmental microbial surveys have
taught us that cultivation methods woefully underrepresent the true
extent of bacterial diversity," says Relman.
Although the cultivation method traditionally used
by clinical microbiology labs did not uncover the bacterial diversity
revealed by the molecular technique, the researchers found that
some bacteria were more readily recovered the old way, indicating
that both DNA analysis and cultivation have a role in the comprehensive
study of human microbial populations.
Characterization of previously undocumented oral
bacteria is part of the Relman team's larger effort to identify
rare and unusual microbes that make their home in the human body
-- many cohabiting benignly but some causing mysterious human disease.
Relman and colleagues published their findings in
the December 7, 1999, Proceedings of the
National Academy of Sciences. -- KW
Researchers pool data to answer questions
about rare lung disease
BECOMING SICK CAN SEEM DOUBLY UNFAIR IF YOU HAVE
A RARE DISEASE. FALLING ILL IS ALREADY A MISFORTUNE, but to make
matters worse the rarity of the disease often thwarts scientific
investigation that could lead to a treatment or cure.
Hoping to overcome the limitation of small numbers,
Stanford has joined with five other research centers to pool data
on the rare lung disease lymphangioleiomyomatosis (LAM). The goal
of the LAM registry, which began operating about two years ago,
is to bring together enough information to answer questions about
the origin, course and cause of LAM, including the role played by
genes.
* Each center will collect data
on as many LAM patients as possible and monitor their health for
five years. Each year, patients will
be given chest X-rays, lung-function tests, exercise tests and a
questionnaire to measure how the disease is affecting their quality
of life. All of this information, along with samples of lung tissue
and blood, will be sent to a central databank at the Cleveland Clinic
in Ohio, where it will be available to other researchers in the
project. The National Heart, Lung and Blood Institute is providing
the funding.
Stanford was chosen as one of the six sites because
Thomas Raffin, MD, professor and chief of the Division of Pulmonary
and Critical Care Medicine, is one of the few LAM experts in the
world.
* LAM is a relentless and often
fatal disease that ravages the lungs of young and middle-aged women.
In normal lungs, a sheath of smooth muscle
cells surrounds the airways and, by contracting or relaxing, regulates
air flow to match the body's need for oxygen. But in LAM patients,
over years the smooth muscle cells begin to multiply uncontrollably.
Bundles of cells can narrow the airways and block blood and lymph
vessels, causing difficulty breathing, internal bleeding and fluid
buildup. Proliferating muscle can pinch off the small air sacs known
as alveoli, which can then form air-filled cysts. Cysts near the
surface of the lungs -- known as blebs -- can rupture and cause
a partial or complete collapse of the lung. Although LAM involves
out-of-control cell replication and shows some similarities to the
skin cancer malignant melanoma, the disease is not considered a
form of cancer, Raffin says.
* For LAM patients, whose first
symptom is usually shortness of breath during exercise, treatment
usually does not stop the progression of the disease. Most
patients develop severe breathing difficulties within 10 years of
diagnosis, and less than 50 percent survive more than 20 years.
Since the disease occurs almost exclusively in women of childbearing
age, scientists naturally suspected the hormone estrogen was somehow
involved. However, chemical treatment to block estrogen and even
removal of the ovaries do not seem to slow the disease, Raffin and
colleagues reported in a 1990 study published in the New England
Journal of Medicine. Lung transplants can extend life for a
number of years but create other problems, such as the risk of rejection
and infection.
* As with so much else about
LAM, the cause remains mysterious. Genes
undoubtedly play a role, Raffin says, but further research is hampered
not only by the rarity of patients but also by the lack of an animal
model of the disease that could be studied in the laboratory. Besides
humans, only bottlenose dolphins have been reported to get LAM,
Raffin notes.
In the two years since the registry opened, 129 patients
have enrolled, says Susan Jacobs, RN, who coordinates clinical trials
in pulmonary and critical care medicine at Stanford. That may not
seem impressive until you consider that only 500 or so Americans
have LAM. The registry will continue accepting new patients through
2001.
With the information in the LAM registry, scientists
will be able to better understand how the disease damages the lungs
and to undertake longitudinal studies of LAM's progression. Researchers
will also be able to evaluate the success of treatments, identify
likely complications, improve diagnosis and determine how long patients
survive with the disease. Blood samples should speed the hunt for
genes that contribute to the disease. -- ML
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