Those with low vitamin D twice as likely to die

From the Associated Press:

New research linking low vitamin D levels with deaths from heart disease and other causes bolsters mounting evidence about the "sunshine" vitamin's role in good health.

Patients with the lowest blood levels of vitamin D were about two times more likely to die from any cause during the next eight years than those with the highest levels, the study found. The link with heart-related deaths was particularly strong in those with low vitamin D levels.

Experts say the results shouldn't be seen as a reason to start popping vitamin D pills or to spend hours in the sun, which is the main source for vitamin D.

For one thing, megadoses of vitamin D pills can be dangerous and skin cancer risks from too much sunshine are well-known. But also, it can't be determined from this type of study whether lack of vitamin D caused the deaths, or whether increasing vitamin D intake would make any difference.

Low vitamin D levels could reflect age, lack of physical activity and other lifestyle factors that also affect health, said American Heart Association spokeswoman Alice Lichtenstein, director of the Cardiovascular Nutrition Laboratory at Tufts University.

Still, she said the study is an important addition to an emerging area of research.

"This is something that should not be ignored," Lichtenstein said.

Scientists used to think that the only role of vitamin D was to prevent rickets and strengthen bones, Dobnig said.

"Now we are beginning to realize that there is much more into it," he said

Exactly how low vitamin D levels might contribute to heart problems and deaths from other illnesses is uncertain, although it is has been shown to help regulate the body's disease-fighting immune system, he said.

Low vitamin D levels also have been linked with several kinds of cancer and some researchers believe the vitamin could even be used to help prevent malignancies.

It has been estimated that at least 50 percent of older adults worldwide have low vitamin D levels, and the problem is also thought to affect substantial numbers of younger people. Possible reasons include decreased outdoor activities, air pollution and, as people age, a decline in the skin's ability to produce vitamin D from ultraviolet rays, the study authors said.
 

Posted: 6/24/2008 2:58:00 PM

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8 drugs doctors wouldn't take

From Men'sHealth:

Plenty of M.D.'s know which prescription and over-the-counter drugs are duds, dangers, or both. So we asked them, "Which medications would you skip?"

Advair
It's asthma medicine ... that could make your asthma deadly. Advair contains the long-acting beta-agonist (LABA) salmeterol. A 2006 analysis of 19 trials, published in the Annals of Internal Medicine, found that regular use of LABAs can increase the severity of an asthma attack.

Your new strategy: No matter what you may have heard, a LABA, such as the one in Advair, is not the only option, says Philip Rodgers, Pharm.D., a clinical associate professor at the University of North Carolina school of pharmacy. For instance, if you have mild asthma, an inhaled corticosteroid such as Flovent is often all you need. Still wheezing? "Patients can also consider an inhaled corticosteroid paired with a leukotriene modifier," says Dr. Rodgers.

Avandia
Diabetes is destructive enough on its own, but if you try to control it with rosiglitazone — better known by the brand name Avandia — you could be headed for a heart attack. Last September, a Journal of the American Medical Association (JAMA) study found that people who took rosiglitazone for at least a year increased their risk of heart failure or a heart attack by 109 percent and 42 percent, respectively, compared with those who took other oral diabetes medications or a placebo.

Your new strategy: Stick with a proven performer. "I prefer metformin, an older, cheaper, more dependable medication," says Sonal Singh, M.D., the lead author of the JAMA study.

Celebrex
Once nicknamed "super aspirin," Celebrex is now better known for its side effects than for its pain-relieving prowess. The drug has been linked to increased risks of stomach bleeding, kidney trouble, and liver damage. But according to a 2005 New England Journal of Medicine study, the biggest threat is to your heart: People taking 200 mg of Celebrex twice a day more than doubled their risk of dying of cardiovascular disease. Those on 400 mg twice a day more than tripled their risk, compared with people taking a placebo.

Your new strategy: What you don't want to do is stop swallowing Celebrex and begin knocking back ibuprofen, because regular use of high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to gastrointestinal bleeding. A safer swap is acupuncture. A German study found that for people suffering from chronic lower-back pain, twice-weekly acupuncture sessions were twice as effective as conventional treatments with drugs, physical therapy, and exercise.

Ketek
Most bacteria in the lungs and sinuses don't stand a chance against Ketek, but you might not either. This antibiotic, which has traditionally been prescribed for respiratory-tract infections, carries a higher risk of severe liver side effects than similar antibiotics do.

Your new strategy: Avoid backing yourself into a corner where you might need Ketek by always signing up for your annual flu shot — if you have pneumonia, it'll reduce your risk of dying of the infection by 40 percent. And if you still end up staring at a scrip for Ketek, Dr. Rodgers recommends asking to be treated with one of several safer alternatives, such as Augmentin or the antibiotics doxycycline or Zithromax.

Prilosec and Nexium
Heartburn can be uncomfortable, but heart attacks can be fatal, which is why the FDA has investigated a suspected link between cardiac trouble and the acid-reflux remedies Prilosec and Nexium. In December 2007, the agency concluded that there was no "likely" connection. Translation: The scientific jury is still out. In the meantime, there are other reasons to be concerned. Because Prilosec and Nexium are proton-pump inhibitors, they are both incredibly effective at stopping acid production in the stomach — perhaps too effective.

A lack of acid may raise your risk of pneumonia, because the same stuff that makes your chest feel as if it's burning also kills incoming bacteria and viruses. You may also have an elevated risk of bone loss — in the less acidic environment, certain forms of calcium may not be absorbed effectively during digestion. "The risk of a fracture has been estimated to be over 40 percent higher in patients who use these drugs long-term, and the risk clearly increases with duration of therapy," says Dr. Rodgers.

Your new strategy: When you feel the fire, first try to extinguish it with Zantac 150 or Pepcid AC. Both of these OTC products work by blocking histamine from stimulating the stomach cells that produce acid. Just know that neither drug is a long-term fix.

Visine Original
What possible harm to your peepers could come from these seemingly innocuous eyedrops? "Visine gets the red out, but it does so by shrinking blood vessels, just like Afrin shrinks the vessels in your nose," says Thomas Steinemann, M.D., a spokesman for the American Academy of Ophthalmology. Overuse of the active ingredient tetrahydrozoline can perpetuate the vessel dilating-and-constricting cycle and may cause even more redness.

Your new strategy: If you still want to rely on Visine, at least make sure you don't use too many drops per dose and you don't use the stuff for more than 3 or 4 days. But you'd really be better off figuring out the underlying cause of the redness and treating that instead. If it's dryness, use preservative-free artificial tears, recommends Dr. Steinemann. Visine Pure Tears Portables is a good choice for moisture minus side effects. On the other hand, if your eyes are itchy and red because of allergies, pick up OTC antiallergy drops, such as Zaditor. It contains an antihistamine to interrupt the allergic response but no vasoconstrictor to cause rebound redness.

Pseudoephedrine
Forget that this decongestant can be turned into methamphetamine. People with heart disease or hypertension should watch out for any legitimate drug that contains pseudoephedrine. See, pseudoephedrine doesn't just constrict the blood vessels in your nose and sinuses; it can also raise blood pressure and heart rate, setting the stage for vascular catastrophe. Over the years, pseudoephedrine has been linked to heart attacks and strokes. "Pseudoephedrine can also worsen symptoms of benign prostate disease and glaucoma," says Dr. Rodgers.

Your new strategy: Other OTC oral nasal decongestants can contain phenylephrine, which has a safety profile similar to pseudoephedrine's. A 2007 review didn't find enough evidence that phenylephrine was effective. Our advice: Avoid meds altogether and clear your nasal passages with a neti pot, the strangely named system that allows you to flush your sinuses with saline ($15, sinucleanse.com). University of Wisconsin researchers found that people who used a neti pot felt their congestion and head pain improve by as much as 57 percent. Granted, the flushing sensation is odd at first, but give it a chance.

Posted: 6/23/2008 3:10:00 PM

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FDA Expands Mortality Warnings on Antipsychotic Drugs

From the FDAnews:

The FDA has requested that boxed warnings about an increased risk of death in older people with dementia be added to a class of “conventional” antipsychotic drugs.

Prescribing antipsychotic drugs to treat behavioral problems in older people with dementia is an off-label use, but physicians may do so even with the new safety warning, which is “not a contraindication,” Thomas Laughren, director of CDER’s Division of Psychiatry Products, said in a conference call with reporters.

The agency has the authority to request that manufacturers add this warning under the FDA Amendments Act of 2007. Drugmakers must submit the new boxed warning language to the FDA within 30 days or provide a reason why they do not believe it is necessary.

In 2005, the FDA announced similar labeling changes for “atypical” antipsychotic drugs, such as Bristol-Myers Squibb’s Abilify (aripiprazole) and Eli Lilly’s Zyprexa (olanzapine). At the time, the agency did not have enough evidence to include conventional antipsychotics in the warning, and the quality of the evidence gathered from two observational epidemiological studies since then “is not ideal,” Laughren said.

However, the FDA decided to err on the side of caution by adding the boxed warning for the conventional class of antipsychotic drugs and slightly revising the language for the atypical class. There are 11 conventional antipsychotics in the class, including Thorazine (chlorpromazine) and Haldol (haloperidol).

Both conventional and atypical antipsychotics are dopamine receptor antagonists that block the action of naturally occurring dopamine in the brain and are primarily indicated for the treatment of symptoms associated with schizophrenia. They differ primarily in their side effects; the atypical drugs have a lower incidence of neurological side effects such as involuntary movements or “tics.”

Posted: 6/19/2008 8:50:00 AM

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Study: Marijuana potency reaches 30-year high in 2007

From the Associated Press:

Marijuana potency increased last year to the highest level in more than 30 years, posing greater health risks to people who may view the drug as harmless, according to a report released Thursday by the White House.

The latest analysis from the University of Mississippi's Potency Monitoring Project tracked the average amount of THC, the psychoactive ingredient in marijuana, in samples seized by law enforcement agencies from 1975 through 2007. It found that the average amount of THC reached 9.6 percent in 2007, compared with 8.75 percent the previous year.

The 9.6 percent level represents more than a doubling of marijuana potency since 1983, when it averaged just under 4 percent.

"Today's report makes it more important than ever that we get past outdated, anachronistic views of marijuana," said John Walters, director of the White House Office of National Drug Control Policy. He cited baby boomer parents who might have misguided notions that the drug contains the weaker potency levels of the 1970s.

"Marijuana potency has grown steeply over the past decade, with serious implications in particular for young people," Walters said. He cited the risk of psychological, cognitive and respiratory problems, and the potential for users to become dependent on drugs such as cocaine and heroin.

The White House office attributed the increases in marijuana potency to sophisticated growing techniques that drug traffickers are using at sites in the United States and Canada.

A report from the office last month found that a teenager who has been depressed in the past year was more than twice as likely to have used marijuana than teenagers who have not reported being depressed -- 25 percent compared with 12 percent. The study said marijuana use increased the risk of developing mental disorders by 40 percent.

The project analyzed data on 62,797 cannabis samples, 1,302 hashish samples, and 468 hash oil samples obtained primarily from seizures by law enforcement agencies in 48 states since 1975.

Posted: 6/19/2008 8:39:00 AM

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Family Blames Girl's Blindness on Motrin

UPDATED 7/18/08 From the Associated Press:

Parents of blinded SoCal girl lose Motrin suit

A jury refused to award damages Thursday to a couple who sued drug maker Johnson & Johnson for $1 billion, claiming its Children's Motrin nearly killed their daughter and left her legally blind.

The Los Angeles County Superior Court jury voted 9-3 that the company and McNeil Consumer & Specialty Pharmaceuticals, a division of the drug maker's McNeil PPC Inc. subsidiary, were not liable for the problems of 11-year-old Sabrina Johnson.

Plaintiffs' attorney Browne Greene said he will appeal.

The lawsuit asked for $14 million in actual damages, $103 million for pain and suffering and $950 million in punitive damages.

During the trial, Sabrina testified that her eyes were so sensitive and painful that for several weeks she spent daylight hours inside a cardboard box.

The syndrome is potentially deadly and experts say it may be caused by infections and by reaction to certain drugs, including anti-inflammatory medications, anticonvulsants and some antibiotics.

The main ingredient in Children's Motrin is ibuprofen, a commonly used anti-inflammatory and pain reliever.

At trial, doctors testified that the chances of having a severe allergic reaction to ibuprofen was one in a million.

"While we are sympathetic to the pain and hardships suffered by Sabrina Johnson, Children's Motrin has been proven safe and effective for treatment of minor aches and pains and fever when used as directed and the medicine is labeled appropriately," McNeil PPC Inc. said in a statement after the verdict.

The jury found in its verdict that Children's Motrin did carry "substantial and dangerous" potential risks to consumers and that the companies failed to properly provide warnings.

But the panel answered "No" to the question: "Was a lack of sufficient instructions or warnings a substantial factor in causing harm to Sabrina Johnson?"

One juror, Robin Nickel, said the girl's mother failed to follow directions on the label by giving Samantha Children's Motrin after the girl woke up with puffy eyes.

"It said on the label, any new symptoms call the doctor, and she didn't do that," Nickel said.


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From WebMD:

Children's Motrin caused the severe Stevens-Johnson syndrome that blinded a California girl, a lawsuit claims.

The lawsuit -- and at least nine others scheduled this year and next in cities across the U.S. -- seeks stronger label warnings and punitive damages against drugmakers.

The girl, Sabrina Johnson, was 6 years old in September 2003 when she was sent home from school with a fever. Her parents gave her Children's Motrin drops that afternoon and again that night.

The next morning, the lawsuit says, Sabrina woke with a high fever. Her eyes were pink and her mouth was swollen and covered with sores. Her pediatrician had her hospitalized at Cedars Sinai Pediatric Intensive Care Unit. By the next day, she was blind in both eyes. Doctors diagnosed Stevens-Johnson syndrome.

"This is a very important consumer case involving the really potent tragedy of a little girl blinded by Children's Motrin, an over-the-counter, seemingly benign medication," Browne Greene, the attorney representing the Johnson family, tells WebMD.

Greene claims that McNeil PPC, a subsidiary of Johnson & Johnson, has long known of a link between ibuprofen, the active ingredient in Motrin, and Stevens-Johnson syndrome. While the prescription version of the drug has stronger warnings, Greene says, the over-the-counter version mentions nothing about this risk.

In a statement provided to WebMD by a McNeil spokesman, the company says it is aware of reports alleging an association between Children's Motrin and Stevens-Johnson syndrome. The statement notes that Stevens-Johnson syndrome has been linked with a wide variety of medications and even viral infections.

We are deeply concerned about all matters related to our products and have reviewed case reports, reviewed the scientific literature, reviewed the latest studies and consulted with the top experts in the field," the statement says. "Based upon our investigation we firmly believe that it is unlikely ibuprofen can cause SJS and that Children's Motrin is safe and effective when used as directed, and is labeled appropriately."

Stevens-Johnson syndrome is a rare, often fatal adverse reaction triggered by many different kinds of drugs, particularly certain antibiotics and some painkillers. A recent New York study linked ibuprofen to nearly half of the 32 children referred to a local burn unit over an eight-year period.

Burn units generally treat patients because Stevens-Johnson syndrome attacks the skin and mucous membranes. It can cause the top layer of the skin to separate from the lower layer of the skin in affected areas. When large areas of skin are involved, the disease is known as toxic epidermal necrolysis, although there is overlap between the two diagnoses.

Often the eyes are involved, leading to blindness. Sabrina was not only blinded, but also left highly sensitive to light. When she goes out, she wears a large hat pulled down over her face.

Stevens-Johnson syndrome is fatal in about 5% of cases; toxic epidermal necrolysis kills about 30% of patients.

While ibuprofen has been linked to Stevens-Johnson syndrome, so have many other drugs. There is no definitive proof that ibuprofen causes Stevens-Johnson syndrome. Ibuprofen is in dozens of products and is used by millions of adults and children who do not suffer serious side effects.

Greene says he will file two more lawsuits against McNeil, each linking Children's Motrin to the death of a child.

Greene says that before Sabrina fell ill, there were 15 known cases of Stevens-Johnson syndrome in children who took ibuprofen. Since then, he says, there have been 12 more cases in which children were "blinded, burned, or killed."

Posted: 6/18/2008 11:41:00 AM

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Vitamin D Deficiencies

From USA Today:

Lack of vitamin D rampant in infants, teens

Giving your children all they need to grow big and strong may not be as simple as a gummy vitamin and three square meals. They still may be susceptible to an epidemic that's starting to gain the notice of pediatricians and bone doctors across the country: vitamin D deficiency.

Mike Stone joined a growing legion of children diagnosed with the condition when an X-ray of his 14-year-old bones revealed a skeleton so thin it appeared clear on film.

"My doctor thought the machine was broken and that they should take an X-ray on another one," says Stone, 22, a recent graduate of Tufts University in Boston.

The machine wasn't broken. Stone was seriously vitamin D deficient, and though he had felt a "snap" in his back — the impetus for the doctor's visit — he had no fractures. But his bones had become perilously thin, 50% less dense than they should have been. His doctor immediately put him on vitamin D supplements to correct the problem, Stone says.

For years, doctors have been aware that older people tend to be low in vitamin D and need extra supplements to help keep bones strong, says Lisa Callahan, co-director of the Women's Sports Medicine Center at the Hospital for Special Surgery in New York.

Pediatricians had thought the problem had been solved among children with the vitamin D fortification of milk, cereal and other foods. But an ever-lengthening roster of studies is revealing vitamin D deficiency is more common than previously believed in youngsters, including breast-fed babies and teens.

Numerous studies are showing vitamin D does much more than boost bone health in children and adults. In children, it can inhibit future hip fractures, and it may help reduce the risk of type 1 diabetes.

Sunlight, diet — particularly oily fish and enriched milk — and supplements are good sources of vitamin D, Holick says.

Vitamin D is different from other vitamins because though the body stores it, it needs ultraviolet B rays from the sun to activate it, says James Dowd, professor of medicine at Michigan State University and author of The Vitamin D Cure. Fifteen minutes a day will do the trick, he says.

Society's sunblock passion, though smart for skin health, also may be affecting vitamin D deficiency. Experts suggest at least 15 minutes of direct sun a day before slathering on sunscreen. But those at risk or with a history of skin cancer or with sun-sensitive skin conditions should check with their dermatologist first.

Dark-skinned people also are more at risk because they absorb UVBs less quickly than fair-skinned people, Edwards says.


Also from USA Today:

Adults still risk vitamin D deficiency

According to the National Center for Health Statistics, as many as 36% of Americans are vitamin D deficient.

In a review of vitamin D medical literature published last July in The New England Journal of Medicine, vitamin D expert Michael Holick, professor of medicine, physiology and biophysics at Boston University Medical School, says D deficiency in adults has been linked to an increased risk for osteoporosis, osteomalacia — the softening of bones — and certain cancers, autoimmune diseases and cardiovascular problems.

Vitamin D also may play a role in preventing diabetes and hypertension, according to the National Institutes of Health. A study in last week's Archives of Internal Medicine found that men 40 to 75 with below-normal vitamin D levels had a higher risk of heart attack.

Experts, such as Tanya Edwards, head of the integrative medicine department at the Cleveland Clinic, say Americans probably have always been deficient, but increasingly so because of poor sun exposure and diet. Also, there has been more research of vitamin D over the past several years that has raised awareness.

Older Americans, whose skin cannot synthesize vitamin D as efficiently and whose kidneys are less able to convert vitamin D to its active hormone form, aren't the only adult group at risk, Edwards says.

 
Posted: 6/17/2008 9:31:00 AM

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Tandem benefits in endocrinology testing

Better diagnostic insights and patient care through tandem mass spectrometry.



Beginning soon, NMS Labs, the nation's premier independent provider of diagnostic laboratory testing services, is proud to offer state-of-the-art endocrinology testing - the newest addition to its renowned catalog of innovative tests and services.

Building on over 30 years experience - and the expertise gained from performing hundreds of different tests using tandem mass spectrometry - NMS Labs is now helping to set new standards in diagnostic endocrinology testing.  Utilizing what many physicians consider to be the "gold standard" for specificity and precision, NMS Labs is offering new tests that can lead to earlier, better diagnosis, and improved patient outcomes.

More information to come soon!

Posted: 6/16/2008 10:39:00 AM

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Killer Wants DNA Testing

From WeAreCentralPA.com:

A Johnstown man convicted of killing his wife is hoping DNA evidence will clear his name.

A jury found Kevin Siehl guilty of first degree murder in 1992. His wife Christine was found stabbed to death in the bathroom of her Moxham apartment in 1991.

At the time DNA testing was never done. Now the defense, citing the Post Conviction Relief Act of 1995, is asking to re-examine the physical evidence.

"You can ask the court to have specific items of evidence tested for DNA if you assert that if it comes back negative for the defendant's that would prove their innocence," District Attorney Patrick Kiniry said.

Friday morning Kiniry agreed in principle to hand over several pieces of evidence to the New York based Innocence Project.

"They will submit a list of which items they want tested. We'll look at that item to see if it would indeed show that the person was innocent," he said.

Siehl is represented by Craig Cooley of the innocence project. It’s the belief of the defense that blood, fingernail scrapings, and the murder weapon will lack biological evidence connecting Siehl to the crime.

Following Friday’s hearing Kiniry said he's not worried about the possibility of test results overturning the jury's decision.

"There was a lot of very fine police work done in 1991 in this case. The issue here is that some of this testing wasn't available in 1991. Do I have a concern, no I don't. We're here to seek justice," he said.

Once the defense prepares a list of all the evidence to be tested it must be approved by the district attorney. It will then move on to the judge for final approval. The items will then be taken out of storage and sent off for testing at NMS labs in suburban Philadelphia.

The Innocence Project will cover all costs.

 
Posted: 6/16/2008 10:38:00 AM

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Forensic Toxicology in the Fore ... and Aft

From Forensic Magazine:

It could be the year 1850, or 1950, or 2008 … take your pick. It was a few days since the family dinner that the husband took ill. The nausea, vomiting, and diarrhea had been relentless. And that garlic taste in his mouth, it just wouldn’t go away. And finally, almost as a relief, he died. Whether as a relatively new bio-analytical science in 1850, or a discipline with remarkable, state-of-the-art equipment today, forensic toxicology has been asked to address concerns with such cases, to speak for the victimized husband, to tell the story of what caused his illness and death, and to provide the “smoking gun,” the identification of the arsenic that led to the wife’s conviction. Truth be told, however, things are never so clear.

Forensic toxicology is a scientific discipline with a split personality. While toxicology can be defined as the study of the adverse effects of chemicals on living things, the forensic component also mandates an analytical component.  Understanding the modern development of this duality sheds light on the impact of forensic toxicology on our criminal and civil justice systems and society.

Analytical Toxicology
The origin of modern analytical toxicology, and for that matter forensic toxicology, is often attributed to a Spanish physician named M.J.B. Orfila who actually practiced his vocation in France during the early to mid-1800s. Despite the establishment of laws against poisoning dating back to 81 B.C.E., it was his analysis of autopsy materials to identify poisons, and the subsequent accounting of such, that represented the first systematic approach to the identification of poisons. It was this approach that led to the first courtroom toxicological testimony by Orfila in 1840 during the trial of Marie Lafarge in France for poisoning her husband to death with arsenic.

If one focuses solely on arsenic, the evolution of bio-analytical forensic toxicology is easily made clear. Even prior to Orfila, a number of chemists worked on the identification of this widely used poison during that time period. Most of the developed tests surrounded the precipitation of arsenic through oxidative and reductive processes. Unfortunately, none of these tests proved sensitive enough for forensic toxicological purposes. However, in 1836, James Marsh, a British chemist, published an improved, sensitive method for the detection of arsenic. This method allowed for the physical presentation of the arsenic finding in a courtroom, and in fact, was the test used by Orfila in the Lafarge case. In 1842, Hugo Reinsch developed the namesake test that “plates” arsenic onto copper wire, turning it black. This was followed by Max Gutzheit’s semiquantitative test in 1879, again ultimately involving precipitation of arsenic. This latter test remained a hallmark in arsenic testing for almost 100 years. In the mid-1950s, Alan Walsh developed atomic absorption spectrometry. Within a decade or so after that, this instrumental technique was being readily used for a variety of elemental analyses, including arsenic. In the mid-1980s, ICP-MS (inductively coupled plasma-mass spectrometry) was made routinely available, a method recognized as the current standard in arsenic testing.

What the future holds for bio-analytical toxicology is anyone’s guess. If history holds true, and since mass spectrometric and other techniques are still maturing, it may be a little while before the next major fundamental analytical breakthroughs occur.

Toxicology
Toxicology is a biomedical science. The three main areas of toxicology – descriptive, mechanistic, and regulatory toxicology all advance our knowledge of basic biochemical and physiological processes, health and safety, and risk assessment. The descriptive branch of toxicology involves, as its name implies, the description of some phenomenon related to toxicology, whereas the mechanistic area attempts to determine what is at the root of the toxicological process, generally at the macro- and microlevels. The regulatory discipline applies the data from the descriptive and mechanistic arenas to develop various risk assessments for the sake of public safety. Forensic toxicology is considered a specialty field within toxicology.

Basic sub-disciplines within pharmacology and toxicology employed daily by the forensic toxicologist include pharmaco/toxicokinetics and pharmaco/toxicodynamics. Simply put, the former is what the body does to a drug or chemical, whereas the latter is what the drug or chemical does to the body.

Included in pharmaco/toxicokinetics is what is monikered, ADME, aka, Absorption, Distribution, Metabolism, and Elimination. These actions represent what the body can do to a drug or chemical once exposure has taken place. Pharmco/toxicodynamics describes drug or chemical actions that occur in the body once exposure takes place, and such actions range from no observable effect to death, and everything in-between.

In particular respect to forensic toxicology, the crux of the matter is always, “What do a set of analytical toxicological findings mean?” The answer to this, and other questions of forensic toxicological interest, cannot usually be based solely on analytical findings. It is the holistic nature of a case that allows for interpretation, with the accent on holistic. The more information that is available about a case or individual, the better the chance a forensic toxicologist can provide assistance. However, even when armed with knowledge about the case or individual, this does not guarantee forensic toxicological assistance in any given case. Today, the forensic toxicologist has to consider several ante- and postmortem phenomena, e.g., postmortem, or site-dependent, redistribution of substances after death, whereby drugs and chemicals can “move” from one site to another within the body after death; drug or chemical interactions, a phenomenon where one substance can interfere with the metabolism and elimination of another substance, thus leading to accumulation of the latter compound, and an increased risk of toxicity; pharmaco/toxicogenomics, where the same enzyme in the body responsible for metabolizing a particular compound may function too well or too poorly in any given person; etc. All of these, and other factors, sometimes make toxicological interpretation difficult, perilous, or impossible.

Undoubtedly, the future may provide greater and greater toxicological information, but it is not a certainty that this will add interpretive clarity for the forensic toxicologist. Pragmatically, since individual response, both kinetically and dynamically, will never be able to be fully accounted for, toxicological findings will always have some difference in interpretive value based on the practitioner.

SPECIFIC CHALLENGES IN FORENSIC TOXICOLOGY
First and foremost is being qualified to be a forensic toxicologist. The dual nature of the field make this particular challenge a long and arduous journey, certainly not meant for individuals seeking instant gratification. While there are many ways to become a practicing forensic toxicologist, there seems to be some basic commonality amongst such professionals. That is, basic educational requirements consisting of some combination of analytical chemistry and toxicology, often as separate educational endeavors, followed by mentoring and experience. Today, there are Board Certification programs for both the individual practitioner and the forensic toxicology laboratory. While offering no strict guarantees, appropriate certification generally demonstrates satisfactory compliance with the knowledge and principles necessary to function as both a forensic toxicologist and forensic toxicology laboratory.

As the challenges confronting the toxicological interpretation of findings have been previously discussed, a focus on the analytical challenges is also warranted. Forensic toxicologists don’t get a whole lot of say in the specimens they are asked to analyze, especially in the postmortem world. Specimens ranging from blood to urine to liver to brain to bone to hair all come with significant challenges based on the matrix composition. Add to that the state of the specimen, i.e., badly decomposed, covered with maggots, etc., and the challenges become even greater. While “tricks of the trade” are available to tackle such daunting specimens, sometimes such challenges cannot be overcome.

Further taxing the forensic toxicologist are the varied substances that may be of significance in any given case. Literally, forensic toxicologists must be able and capable to handle any of the forms of matter – solid, liquid, and gas. There are approximately 35 million or so chemical entities with registered names and probably multi-millions more in nature that have not been identified.

The last significant challenge for the forensic toxicologist, like all forensic scientists, is the courtroom. It is a world that, no matter how long one has practiced, remains foreign. Unlike many other forensic disciplines, the analytical findings are not the sine qua non of the testimony. Most commonly, it is the opinion of the forensic toxicologist that is sought, the very thing that elicits the best in the adversarial nature of attorneys.

Posted: 6/16/2008 10:18:00 AM

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Male nurse charged with raping boy

From the Bucks County Courier Times:

A nurse caring for a physically and mentally impaired 14-year-old Bucks County boy is accused of raping the teen in April, according to police.

Fred Magondu, 36, a Kenyan national living on King Arthur Road in Philadelphia, was taken into custody at a Philadelphia nursing home Thursday afternoon and later arraigned on charges of molesting a child who was in his care.

Police said they learned of the rape April 30. The boy receives 24-hour nursing care because he is mentally and physically impaired, unable to speak and blind, police said. According to court records, another individual care nurse, who has been caring for the boy for about nine years, discovered injuries to the boy when she attempted to change his diaper after he arrived at school April 30.

The boy was first examined at St. Mary Medical Center in Middletown and then transferred to The Children's Hospital of Philadelphia. Doctors at both hospitals told police the boy was bleeding and bruised.

Police learned that Magondu, a Harleysville Pediatrics employee who has been caring for the boy for several months, was working at the victim's home from April 29 to 30. Magondu was allegedly alone with the boy from 5 a.m. to 7:40 a.m. before putting him on the bus to school, police said.

Investigators interviewed Magondu in early May at an unnamed Philadelphia nursing home where he works, according to court records. Magondu said that on April 30 the boy had been bleeding but the nurse believed it was a physical problem and had changed a set of soiled linens. Police collected a sample of Magondu's DNA and the boy's bed linens and sent them to National Medical Services for analysis.

In a report to police June 6, the laboratory said the linens tested positive for semen that matched Magondu's DNA and that the possibility of it being from another unrelated person was 1 in 7 trillion, according to court records.

Magondu was arraigned on multiple charges of rape, involuntary deviate sexual intercourse, indecent assault, corruption of minors and unlawful contact with minors and sent to Bucks County prison on $250,000 bail.

Posted: 6/13/2008 10:55:00 AM

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