Podcast 2007 Show Notes
#0043—October 19, 2007
Schmalfeldt: Welcome to episode 43 of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, I'll sit down for a chat with Dr. Francine Kaufman, the incoming chair of the National Diabetes Education Program. Wally Akinso has a story about a way to help African American families "Make the Kidney Connection." We'll hear more about another good reason to cut back on your salt intake, and from a story aired earlier this year, Wally will tell us about the results of a study that may help improve the diagnosis and treatment of two debilitating childhood mental disorders. But first, imagine a new drug compound that can relieve pain without disrupting other functions in your body. It's not a fantasy. In fact, it's a step closer to your pharmacy! That's next on NIH Research Radio.
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Treatment Blocks Pain Without Disrupting Other Functions
Imagine. Pain relief with no disruption of your other functions. Relief for a toothache that doesn't numb your whole jaw. Anesthetic that doesn't result in an inability to move. Treatment for chronic, intractable pain that doesn't cause problems for your body's other systems. A compound that affects pain neurons and only pain neurons. A study funded by the National Institutes of Health showed that such a compound is not just the stuff of dreams. A research team has identified a combination of two drugs that can selectively block pain-sensing neurons in rats without impairing movement or other sensations such as touch. The team, headed by Dr. Clifford J. Woolf of Massachusetts General Hospital and Harvard Medical School and Dr. Bruce Bean of Harvard Medical School, tested a combination of capsaicin—the substance that makes chili peppers hot—and a drug called QX-314 on neurons in a Petri dish, and determined that it blocked the pain sensing neurons without affecting other nerve cells. The compound was then tested on rats which then showed no signs of pain and were able to move and behave normally.
Porter: It's a pretty clever approach that they took. And we were certainly really excited about the outcome in the animal studies and the potential for long-term outlook for human studies.
Schmalfeldt: That was Dr. Linda Porter, program officer for the National Institute of Neurological Disorders and Stroke, which—along with the National Institute of Dental and Craniofacial Research and the National Institute of General Medical Sciences - funded the study. Despite the hopeful results, Dr. Porter says there is much more studying to be done before such a pain-relieving compound could be made available to human patients.
Porter: Well, I assume the next step they'll take is to begin to look more carefully at what kind of dosing would have to be used in humans, how long-term the effects might be, so in the animal studies they've done, the pain relief lasts for two or three or maybe more hours. Questions with toxicity, with irritation, the mode of delivery. We're very excited about it and we're hoping this is something that will move along pretty quickly. The studies in the animals are looking to be very promising, so we're keeping our fingers crossed that this will move.
Schmalfeldt: One problem with the current compound, as you might expect given its chili pepper origin, capsaicin tends to cause a burning sensation when first administered. Scientists will search for alternatives to capsaicin that do the same thing without causing the burning sensation. They will also look for ways to prolong the pain relief and hope to eventually develop pills that will stop the pain signals without requiring injections. The study appeared in the October 4th edition of Nature. From the National Institutes of Health, I'm Bill Schmalfeldt in Bethesda, Maryland. Schmalfeldt: Now Wally Akinso has this story, first aired earlier this year, about a study that could lead to improvements in the care of some serious childhood mental conditions.
Study Could Improve Diagnosis of Debilitating Childhood Mental Disorders
Akinso: Results of a new study may help improve the diagnosis and treatment of two debilitating childhood mental disorders, pediatric bipolar disorder and a syndrome called severe mood dysregulation, better known by the acronym SMD. In the study, conducted by the National Institute of Mental Health, researchers found a very different pattern in children with SMD, compared with children who had bipolar disorder when the brain's electrical signals were measured during mild frustrating situations. Dr. Ellen Leibenluft, Chief of the Unit on Bipolar Spectrum Disorders in the Emotion and Development Branch of the NIMH Mood and Anxiety Disorders Research Program, said the results indicate that different brain mechanisms may lead to irritability in children with SMD, suggesting that they may have an illness other than bipolar disorder and may require different treatments.
Leibenluft: The treatment might differ depending on whether or not these children have SMD or they have bipolar disorder.
Akinso: The classic definition of bipolar disorder includes extreme, sustained mood swings that range from over-excited, elated moods and irritability to depression. In contrast, children with SMD are extremely irritable and hyperactive, but do not have clear-cut manic episodes. Dr. Leibenluft said the researchers could observe the brain's electrical signals that occur during frustration as children with either disorder perform simple tasks.
Leibenluft: The main significance of these results is that when we think about diagnosing psychiatric illnesses we have to look not just at how children are behaving and how they say they're feeling. That's all very important, but in addition we also have to be looking at what's going on inside their brains. And then eventually being able to do so with things like EEG and neuroimaging techniques like functional MRI; the fact that we can now see the brain at work means that ultimately we'll be able to do a much better job of diagnosing both children and adults.
Akinso: Dr. Leibenluft said the study shows that clinicians some day could use biological measurements, such as EEGs, to help psychiatric diagnoses, in combination with clinical symptoms. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Schmalfeldt: When we come back, I'll sit down for a chat with Dr. Francine Kaufman, the incoming chair of the National Diabetes Education Program. That's next on NIH Research Radio.
INTERVIEW: Dr. Francine Kaufman - Chair-elect of the National Diabetes Education Program.
Schmalfeldt: Welcome back to NIH Research Radio. Our guest in the studio, Dr. Francine Kaufman. She's the head of the Center for Diabetes, Endocrinology and Metabolism at the Children's Hospital in Los Angeles, and is the Chair-elect of the National Diabetes Education Program. Welcome to NIH Research Radio.
Kaufman: Thank you.
Schmalfeldt: We're here to talk about many things, actually. World Diabetes Day coming up in the month of November. November 14th as a matter of fact. The purpose of World Diabetes Day is to raise the awareness of the impact of diabetes on the lives of children and adolescents worldwide. And I guess that's as good a place to start as any. What is the impact of diabetes on our kids?
Kaufman: Well there are more and more people—certainly, adults, developing diabetes across the globe. This is not as much about the developed world anymore. This is occurring in the developing world as well. And we're really talking in this case about type 2 diabetes, having to do with genes and environments coming into collision. So, I just finished actually going around the world for Discovery Health, making a documentary. We went to India, Brazil, South Africa, and there are more and more people who are overweight and developing type 2 diabetes there, and more and more children involved in addition.
Schmalfeldt: See, here I was under the impression that type 2 diabetes was a relatively rare phenomenon among kids.
Kaufman: Well, type 2 diabetes is still relatively rare among children, and we have wonderful data in the United States from the SEARCH trial that shows the predominant form of diabetes for children under the age of 10 is exclusively type 1. But over that age, so, 11 to 19, there are more and more teens developing type 2 diabetes, particularly Native American, Hispanic and African American and Asian American teenagers in this country. And we're seeing, maybe not an epidemic, but certainly a significant increase. We don't know where this might top out. And we have to be aware that this is something new for children.
Schmalfeldt: What's causing this uptick in type 2 diabetes among our kids?
Kaufman: Well, it's really marrying the childhood obesity epidemic, which is really marrying the overall obesity epidemic in America and in the world. And we're watching our children spend more time in front of a screen and less time in physical activity, and certainly having access to the kinds of food and the quantity that aren't healthy. We've got to get our kids back to a healthy lifestyle.
Schmalfeldt: So how do we do that? Is it just education? Is it parental enforcement, because parents aren't necessarily eating that well either.
Kaufman: I get a lot of questions like "how do I make my children eat better?" The first thing I say is.
Schmalfeldt: Tell them to.
Kaufman: No, you do it first. You make your house a healthy environment and an option, particularly if you do it early enough. That will become their habit, that will become what they're used to and it will become, hopefully, what they want to do. You can't have your children do something you're not doing, so parents have to mirror good eating as well as good physical activity.
Schmalfeldt: So if you're pounding down the candy bars, you're not going to be able to successfully talk your children into enjoying a tasty, healthy carrot.
Kaufman: I think that's probably true. And if you tell them "go out and be physically active" and you're sitting in front of the television, that's not going to necessarily resonate either. So if you want them to be physically active, do physical activities as a family. Then, of course, we've got the whole school idea.
Schmalfeldt: Yeah, I was going to bring that up, because kids spend so much time in a school setting, they're away from home all that time and they're out of the influence of their parents, what can we do in the school setting to make kids less likely to come down with type 2 diabetes?
Kaufman: Well, I think the overall concept is that we'll make school a healthy environment so that the healthy options are there—not just options, but physical activity promoted as an important activity in addition to all the academics. So, one of the things that is going on is the HEALTHY Trial—an NIH-funded trial that will look at over 6,000 middle school students from 6th through 8th grade in 42 schools at seven sites across the country, and half of those schools will have fundamentally changed food services, PE programs kind of what goes on as far as health messaging, outreach to families. Two more years, we'll find out whether it has a significant impact on children's health.
Schmalfeldt: So keeping the kids active in school, getting rid of the junk that's in the snack machines and that is sometimes served at the lunch counters, that's a key towards controlling diabetes in our youngsters.
Kaufman: Well, that's a presumptive key, and this HEALTHY Trial will give us the evidence whether that makes a difference in the outcomes—we'll be looking at risk factors for type 2 diabetes.
Schmalfeldt: Well tell us about this SEARCH Study that's going to be going on here.
Kaufman: Well, the SEARCH trial—part of it has almost ended, looking at incidents and prevalent cases of diabetes in the country, and they're looking at some other risk factors, so I think one of the most impressive things that's come out of SEARCH is the number of children with both type 1 and type 2 diabetes who are at risk for cardiovascular disease. So, in the type 1 population, about 14 percent of these children already have two or more cardiovascular disease risk factors. And in the type 2 population, it was 92 percent of them. So it's not just diabetes. It's looking at diabetes as a risk factor for cardiovascular disease and realizing this begins in childhood.
Schmalfeldt: We talk a lot about preventing diabetes among our kids. But in the cases where kids do come down with it, what are some of the questions parents should ask their health care providers about their child's diabetes?
Kaufman: Well, the National Diabetes Education Program has put forward kind of a tip sheet of questions to ask at the time of diagnosis. I will tell you as a clinician, once your two year old or three year old is diagnosed with diabetes, a lot of these parents are just so overwhelmed and so emotional that it takes them awhile to wade through "what do I really need to find out?" This tip sheet will enable them to know, I know this has been a tremendous shock to me, my family and my child, but in addition, these are critical things I need to find out between me and my health care provider.
Schmalfeldt: Right. It's terrible news, but now you, as a parent, have to deal with it.
Kaufman: Right. And you have to take the driver's seat in some way. You have to find out, what are my treatment options, what's going to happen in the long term, what's the relationship I'm going to have with this diabetes center and my expectations, so that you can really be in control going forward.
Schmalfeldt: Now you mentioned the tip sheet. The National Diabetes Education Program has several free resources that are available for children, for adolescents, for their parents, for the schools. Can you touch on some of those?
Kaufman: Yes, there are a number of wonderful, wonderful sheets. I think probably the most exciting ones are tip sheets for children themselves, particularly about type 2 diabetes. "What can I do about my type 2 diabetes? How can I prevent it?" Good eating, good activity, really done in a kid-friendly way. I don't think it's a bunch of grownups saying "this is what we want you to learn," but we've involved a lot of children in helping us be sure that these are the right messages and the wording we use really resonates with teens and children.
Schmalfeldt: So how can mom and dad, educators, and maybe even interested kids get in touch with the National Diabetes Education Program?
Kaufman: Well, the National Diabetes Education Program has all of these available for the public. And I as a clinician tell my families all the time as they're diagnosed, and as we're going forward, to look for resources at NDEP, the National Diabetes Education Program. It's probably the best resource there is. It has for providers, it has for children, it has for families, and you can access that at www.yourdiabetesinfo.org. Schmalfeldt: All right, we're talking to Dr. Francine Kaufman, and before we wrap things up, anything you want to add?
Kaufman: Well, just that there's a lot we can all do to prevent diabetes—particularly type 2 diabetes. And once you get diabetes, there's a lot of information you need. There's a lot of information you can obtain through the NDEP website so that you can be controlled going forward and optimize your child's health.
Schmalfeldt: Dr. Francine Kaufman, our guest today on NIH Research Radio. She's the head of the Center for Diabetes, Endocrinology and Metabolism at the Children's Hospital in Los Angeles, and you'll be hearing a lot more from her as the Chair-elect of the National Diabetes Education Program. Thanks for being our guest with us today on NIH Research Radio.
Kaufman: Thank you.
Schmalfeldt: For more information about the National Diabetes Education program, visit the website www.yourdiabetesinfo.org or call the toll free hotline at 1-888-693-NDEP. That's 888-693-6337. When we come back, Wally Akinso has a story about an educational brochure tailored especially for African Americans. That's next on NIH Research Radio.
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Schmalfeldt: With African Americans suffering from kidney diseases more than any other segment of the population, one institute at the NIH is taking the initiative in getting out the word. Wally Akinso has more.
New Publication Helps African Americans "Make the Kidney Connection"
Akinso: The National Kidney Disease Education Program has created an educational brochure tailored specifically for African Americans at risk for kidney disease. The brochure-Kidney Disease: What African Americans Need to Know—explains the connection between diabetes, high blood pressure, and kidney disease, and encourages those at risk to talk to their health care providers about getting tested. African Americans are disproportionately affected by kidney failure due in part to higher rates of diabetes and high blood pressure—the two leading causes of kidney failure. Dr. Andrew Narva Director of the NKDEP talks about what the brochure has to offer.
Narva: The brochure explains the reasons for being screened—who's at risk which includes people with diabetes, high blood pressure, family member with kidney disease or heart disease. And it explains how screening is done which includes two relatively simple tests, a blood test and a urine test.
Akinso: In developing the brochure, NKDEP worked with health care professionals who routinely care for African American patients at risk for kidney disease. The NKDEP is an initiative of the National Institute of Diabetes and Digestive and Kidney Diseases. For more information about the brochure and other NKDEP materials, visit www.nkdep.nih.gov or call 1-866-454-3639. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Reducing Sodium Decreases Long-Term Risk for Cardiovascular Disease
Schmalfeldt: You've heard all about the many benefits of reducing your sodium intake—preventing high blood pressure leading the list. Now, if you needed yet another reason to cut back on salt, new data from a clinical trial from the National Heart, Lung and Blood Institute shows that people with pre-hypertension who reduced their sodium intake by 25 to 35 percent had a 25 percent lower risk of total cardiovascular disease over the 10 to 15 years during which they cut back on salt. Dr. Jeffrey Cutler, NHLBI Project Officer of the Trials of Hypertension Prevention Program - also known as TOHP—said it's reasonable to assume that the reduction in heart disease risk goes hand-in-hand with the reduced risk of high blood pressure that results when a person reduces his or her sodium intake.
Cutler: That's the logical interpretation. There are data from both animal studies and human population studies that reducing sodium might have some benefits seperable from its effect on blood pressure, but most likely the major chain of causation is through its effect on blood pressure.
Schmalfeldt: Two of these TOHP trials were conducted in 10 clinical sites - one from 1987 to 1990, the other from 1990 to 1995, with follow up for 10 to 15 years after each trial. This new follow-up data shows that the groups who reduced their sodium intake also had lower mortality from cardiovascular disease. Dr. Cutler said the news may even be better than it seems at first blush.
Cutler: The levels attained in these randomized trials conducted in the late 1980s and early 1990s were substantial, but they were not even at the level of what the guidelines recommended at that time. In fact, for much of the population, the guidelines are now recommending lower levels in part because of another study that NHLBI sponsored—the DASH Sodium Study—which showed that for a given amount of sodium reduction, the blood pressure reduction is greater in the lower range levels than at the higher range levels. So, we're operating in THOP, for the most part, in the range above the area where you get the maximum benefit. So it is very likely that this study underestimates the potential public health benefit.
Schmalfeldt: The new data has been published online by the British Medical Journal. From the National Institutes of Health, I'm Bill Schmalfeldt in Bethesda, Maryland.
Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, November 2nd when episode 44 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website. www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. That e-mail address email@example.com -once again, our e-mail address is firstname.lastname@example.org. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.
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