A nice-blended scotch of a pill?*

At least that is the market strategy of Wyeth Pharmaceuticals who will release Aprela within the next two years. This two-fer pill is Premarin wrapped up with Wyeth's new selective estrogen receptor modulator (SERM) drug called bazedoxifene or more lyrically by its brand name Viviant.

SERMs are molecules that are sort of estrogen-shaped and act more or less like estrogen at cellular receptors, turning their estrogen-based actions on or off. Currently available SERMs all have their good and their not-so-good qualities: Clomiphene hyperstimulates the ovaries to produce eggs for the infertile who take them. Tamoxifen blocks estrogen at the breast to prevent breast cancer recurrence but acts like estrogen on the uterus and can be associated with the development of endometrial cancer. Evista acts like estrogen on bone receptors thus slowing postmenopausal bone loss, blocks estrogen at the breast like tamoxifen, but screws around with brain estrogen receptors and can make hot flashes worse.

So the race is on to build a better SERM, and Wyeth is winning to be #2 on the market with Viviant having just been issued an 'approvable' letter from the FDA. So no big deal yet, just another SERM against osteoporosis competing with Evista. So here's Wyeth's ace-in-the-hole: one acronym...TSEC.

Tissue selective estrogen complex or the TSEC class of compounds was developed to offer a new menopausal treatent option "that, for the first time, partners a selective estrogen receptor modulator (SERM) with estrogens." The SERM protects the bones and uterus, the estrogen quiets the fire of the flashes. No information is available as to how the breasts fare in this mad dash for the estrogen receptors.
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*See April 28th post

There's going to be a day before each of us die, and you have to think about how you want that day filled.
---Elizabeth Edwards

Scot-free menopausal treatment?

We're not going to find a 'single-molecule' solution, so we're going to blend them — like a nice blended Scotch. You put it together, and you get something that, on the whole, will be better.
--David Barad, MD, director of assisted reproductive technology at the Center for Human Reproduction in New York City

Bring it on! I'm ready to settle into these golden years with a nice blended Scotch of a therapy. Check in later for a look at that which Dr. Barad rhapsodizes on.

"Time is Brain"

The American Heart Association's Stroke Council certainly knows how to turn a phrase. The Council notes that only 1/3 of actue stroke victims call for emergency medical services to transport them quickly for prompt care which can reverse the blockage to brain blood flow. As a result, they urge:

As emergency medical services offers the most prompt care, all patients with the acute onset of stroke symptoms should use services such as telephoning 911.

Shrinking BRAINS at risk!

Biologically Resilient Adults in Neurologic Studies (BRAINS, of course) is a 65+ year-old group of "highly educated and motivated subjects who represent the healthy extreme on the normal aging spectrum." This philanthropic group has not only agreed to undergo regular testing of cognitive and physical functioning but also will hand over their brains at death for further analysis.

All 136 of them underwent baseline MRI scans of their brains in 1999. After 5 years, 23 had developed mild cognitive impairment (MCI), demonstrating loss of some memory and cognitive functioning. Individuals with MCI are known to progress to Alzheimer's disease at an increased rate compared to those without impairment. Nine BRAINS subjects developed Alzheimer's disease in this same time frame.

When the investigators compared MRI morphometry--brain size measurements obtained from the original scans--those subjects who developed MCI or AD had measurable and significant volume loss in their temporal lobes and the left anglular gyrus. This shrinkage was visible years before any demonstrated loss of brain function.

Damage to the left angular gyrus (which sits above and behind your ear) causes a condition called anomia or severe word-finding difficulty. (Oh dear, that sounds familiar). Stimulation of the angular gyrus can cause out-of-body experiences; one subject described the feeling of being on the ceiling.

While I have wished, at times, to be on the ceiling, I am more likely to struggle with a sluggish gyrus and grope for words than I am to travel upwards due to its overstimulation.

Kinetin may slow skin aging

Rough, wrinkled, and brown. It's not the worst thing that can happen whilst aging, but not particularly what you want for your cheeks, your neck, or the backs of your hands. N6-furfuryladenine, aka kinetin, promotes cell growth in plants and perhaps in your skin.

Here's one enthusiastic endorsement for kinetin kream from drugstore.com:

I absolutely love this product! As a woman of 50, I've found that Kinerase has given my skin a clarification or glow that I have not seen in years. I use it twice daily with my other moisturizer. When one of my friends asked me if I had some type of treatment (i.e. Botox), I knew this was the right product. Results do take time.

Dr. Suresh I. S. Rattan, PhD, DSc, Associate Professor of Biogerontology at the University of Aarhus, Denmark, who happens to be the patent holder for N6-furfuryladenine for use on aging skin says:

...when you grow normal cells in the lab they have a limited number of times they multiply and divide—termed a cell's replicative life span. But when I added N6-furfuryladenine to these cultures the cells did not age as fast, the process slowed down dramatically.

In a year-long study of 96 subjects with sun-damaged old skin, the majority of the studied leathernecks noted a decrease in fine wrinkles and roughness. A lucky third of them noticed less 'mottled hyperpigmentation.'

A final note of caution from Dr. Rattan, who basically warns that if a little is good, a lot is not better:

In cell cultures when a concentration of say 250 micromolars of N6-furfuryladenine was used, we got good results, but when we used 500 micromolars of N6-furfuryladenine the cells started dying.

Am I going to buy this stuff? I think not; a one month supply costs $65!

...A young cell is plump, round, smooth. As the cells age, they become irregular, flattened, and large, full of debris
--Dr. Suresh I. S. Rattan, PhD, DSc

Yuck, who wants that? How does Doc Rattan suggest we avoid the cellular debris in our aging skin? Stay tuned.

HairMax LaserComb

Aim this low-level cold-beam laser at your scalp if you're seeing too much of it through your thinning mane. Now FDA-approved, this gadget proved successful in 93% of the balding participants enrolled in the clinical trial.

How much new hair do you get for your $545? Here's the summary:

The study concluded that 93% of the participants (ages 30-60) using the HairMax LaserComb had an increase in the number of terminal (thick) hairs. The average number of terminal hairs per square centimeter increased by 19 hairs/cm2 over a six-month period.

Your average scalp has 250 hairs per square centimeter. People shelling out big bucks for this LaserComb are obviously not your average-scalped sort of customers. If the average skull has 600 cm2 of scalp, this device could add 11,400 hairs to their heads.

Worth it? Hard to say, but here's what one medical commentator had to say:

The LaserComb makers have failed to advertise that their product can double as a handy pointer during CME [continuing medical education] presentations...Even though the FDA has concluded the device is safe, what if one sustains retinal damage from using it incorrectly? Sure, I've been literally blinded by my own vanity, in both eyes--but my hair is positively lustrous.

Sleep apnea: A visual primer

These pictures demonstrate why susceptible persons, particularly those with short, thick necks or small jaws, tend to stop breathing when they sleep on their backs.

Supplements and statins

I ask a lot of people about their use of vitamins. There's hardly a soul, it seems, who doesn't take a little bit of something or other from the vitamin section in search of better health.

Vitamins E and C continue as favorites despite evidence of possible harm from E and a lackluster track record for supplemental C. In fact, one study published in 2001 in the New England Journal of Medicine showed that the use of C and E along with Zocor and niacin for elevated cholesterol canceled out some of the benefits of the prescription meds.

18,000 JELIS Japanese (as in participants with the Japan EPA Lipid Intervention Study) proved, however, that fish oil is a worthy partner with medications such as Zocor (now sold generically as simvastatin) and Lipitor. When eicosapentaenoic acid (EPA) was added to statin therapy over the course of 5 years, investigators found a significant drop in the incidence of bad heart outcomes.

The other major component of fish oil--DHA-- is known to decrease the incidence of Alzheimer's disease. My fish oil capsules are moving to the front of the vitamin shelf. They were briefly shelved when a particularly fishy batch made me gag just opening the bottle.

Reduce the reductase...

and save your hair. If you're wondering just what is sending your former glorious locks into the bathroom drain, it's 5-alpha reductase. This enzyme turns testosterone into the more potent dihydrotestosterone form in your hair follicles, causing them to jump off your scalp and onto the floor.

Progesterone is an excellent inhibitor of this enzyme which is why prescription strength progesterone cream to scalp can save the mane.