BINGE DRINKING MAY INCREASE RISK FOR HEART ATTACK, HEART DISEASE

Bloomberg News (11/24, von Schaper) reports, "The French habit of drinking wine almost daily is less taxing to the heart than the Irish custom of downing an equivalent amount of beer on one or two nights a week," according to a study published Nov. 23 in the British Medical Journal. "Middle-aged men in Belfast had almost double the risk of developing heart disease, compared with French drinkers who spread their consumption over a week." Bloomberg News notes that the study "bolsters the findings of previous studies suggesting a link between ischemic heart disease...and drinking patterns."

WebMD (11/23, Hendrick) reported that after examining the "alcohol drinking patterns of 9,758 men in France and Belfast over a 10-year period," researchers found that "men who binge drink have nearly twice the risk of heart attack or death from heart disease than regular drinkers over a 10-year period." For study purposes, "binge drinking was defined as excessive alcohol consumption, or the equivalent of four or five drinks in a short period of time such as a weekend day."

HeartWire (11/23, Nainggolan) reported that an accompanying editorial noted, "Middle-aged men should be made aware that if they are irregular heavy drinkers, the possible cardioprotective properties of alcohol consumption may not apply to them, and in contrast they may be putting themselves at increased risk of having a heart attack." BBC News (11/24) also covers the story.

PROPOXYPHENE, ACETAMINOPHEN AND PROPOXYPHENE PAINKILLERS PULLED FROM MARKET OVER HEART RISKS AFTER FDA RECOMMENDATION

The Los Angeles Times (11/19, Zajac) reported, "The maker of Darvon [propoxyphene] and Darvocet [acetaminophen and propoxyphene] announced Friday that it will stop marketing the widely used painkillers in the US because of a new study linking the active ingredient in the drugs to serious and sometimes fatal heart rhythm abnormalities." Xanodyne Pharmaceuticals Inc. "agreed to the ban at the request of the Food and Drug Administration, which also asked makers of generic versions of the drugs' core compound, known as propoxyphene, to stop selling it in the US."

Bloomberg News (11/19, Peterson) reported Xanodyne "will withdraw Darvon and Darvocet, a product that combines Darvon's active ingredient with acetaminophen." The FDA "requested the move after evaluating study data, and asked makers of generic versions to take them off the market as well." Xanodyne's "new clinical research, combined with new epidemiological data, led the FDA to conclude that propoxyphene's benefits no longer outweigh its risks, said John Jenkins, director of the agency's Office of New Drugs."

The AP (11/19) reported, "Britain and the European Union decided to ban Darvon in 2005 and 2009, respectively, due to a long trend of suicides and accidental overdoses." The FDA said it "decided to take action based on a recent study showing Darvon interferes with the electrical activity of the heart, causing irregular heart rhythms that can be fatal. Xanodyne conducted the study last year at the government's request."

The Washington Post (11/19, Stein) reported, "The FDA has received two requests to remove the drug from the market since 1978 but had previously determined the benefits outweighed the risks." Consumer advocates "welcomed the announcement but sharply criticized the agency for failing to act sooner." The New York Times (11/19) "Prescriptions" blog, the Wall Street Journal (11/20, Dooren, subscription required), HeartWire (11/22), and the CNN (11/19) "The Chart" blog also reported the story.

VYTORIN MAY LOWER RISK OF HEART COMPLICATIONS IN PATIENTS WITH CKD

The New York Times (11/21, A25, Singer) reported, "Patients with chronic kidney disease (CKD) who took Vytorin [ezetimibe and simvastatin], a cholesterol-lowering pill, had one-sixth fewer heart attacks, strokes or operations to unblock their arteries than patients taking a placebo, according to" research presented during the American Society of Nephrology's 43rd Annual Meeting and Scientific Exposition. "The main benefit was not in reducing the risk of heart attacks and related deaths, but in reducing the artery operations and certain kinds of strokes," the Times added. The study's authors pointed out that "the difference in operations to unblock arteries -- 284 in the treated group compared with 352 in the placebo group -- was statistically significant."

"The trial was the largest ever on Vytorin," Bloomberg News (11/20, Cortez) reported. "Patients on the drug were 16 percent less likely to suffer a heart attack or stroke, need a procedure to clear arteries or die from heart disease than those given a placebo over five years." Based on these findings, Merck "said it will seek US approval to use the drug in" CKD patients.

The AP (11/21) reported, "The Oxford University study looked at more than 9,000 patients who had advanced or end-stage" CKD. According to Merck, "the result is significant because kidney patients have a high risk of vascular disease."

However, the "lipid-lowering therapy did not significantly affect progression of kidney disease, investigators reported," according to MedPage Today (11/20, Bankhead). "Renal outcomes in the trial included progression to end-stage renal disease (ESRD), ESRD or death, and ESRD or a twofold increase in serum creatinine level. The simvastatin/ezetimibe and placebo groups did not differ significantly in the rates of any renal endpoints," MedPage Today noted. The Wall Street Journal (11/22, Loftus, subscription required) and HeartWire (11/20, Wood) also covered the story.

SEEKING PROOF IN NEAR-DEATH CLAIMS

At 18 hospitals in the U.S. and U.K., researchers have suspended pictures, face up, from the ceilings in emergency-care areas. The reason: to test whether patients brought back to life after cardiac arrest can recall seeing the images during an out-of-body experience.

People who have these near-death experiences often describe leaving their bodies and watching themselves being resuscitated from above, but verifying such accounts is difficult. The images would be visible only to people who had done that.

"We've added these images as objective markers," says Sam Parnia, a critical-care physician and lead investigator of the study, which hopes to include 1,500 resuscitated patients. Dr. Parnia declined to say whether any have accurately described the images so far, but says he hopes to report preliminary results next year.

The study, coordinated by Southampton University's School of Medicine in England, is one of the latest and largest scientific efforts to understand the mystery of near-death experiences.

At least 15 million American adults say they have had a near-death experience, according to a 1997 survey—and the number is thought to be rising with increasingly sophisticated resuscitation techniques.

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iStockphoto

People often describe moving down a dark tunnel toward a bright light after a near death experience.

Dead or Alive?

An analysis of 613 near-death experiences gathered by the Near Death Research Foundation found:

• About 75% included an out-of-body experience
• 76% reported intense positive emotions
• 34% described passing through a tunnel
• 65% described encountering a bright light
• 22% had a life review
• 57% encountered deceased relatives or other beings

Note: Patients could report more than one sensation.

In addition to floating above their bodies, people often describe moving down a dark tunnel toward a bright light, feeling intense peace and joy, reviewing life events and seeing long-deceased relatives—only to be told that it's not time yet and land abruptly back in an ailing body.

The once-taboo topic is getting a lot of talk these days. In the new movie "Hereafter," directed by Clint Eastwood, a French journalist is haunted by what she experienced while nearly drowning in a tsunami. A spate of new books details other cases and variations on the theme.

Yet the fundamental debate rages on: Are these glimpses of an afterlife, are they hallucinations or are they the random firings of an oxygen-starved brain?

"There are always skeptics, but there are millions of 'experiencers' who know what happened to them, and they don't care what anybody else says," says Diane Corcoran, president of the International Association for Near-Death Studies, a nonprofit group in Durham, N.C. The organization publishes the Journal of Near-Death Studies and maintains support groups in 47 states.

Dr. Corcoran, a retired Army colonel who heard wounded soldiers talk of such experiences as a nurse in Vietnam, says many military veterans have had near-death experiences but are particularly hesitant to talk them for fear of being branded psychologically disturbed.

Some investigators say the most remarkable thing about near-death reports is that the core elements are the same, among people of all cultures, races, religions and age groups, including children as young as 3 years old.

In his new book, "Evidence of the Afterlife," Jeffrey Long, a radiation oncologist in Louisiana, analyzes 613 cases reported on the website of his Near Death Research Foundation and concludes there is only one plausible explanation: "that people have survived death and traveled to another dimension."

Skeptics say there is no way to verify such anecdotal reports—and that many of the experiences can be explained by neurobiological changes in the brain as people die.

In the 1980s, British neuroscientist Susan Blackmore theorized that oxygen deprivation was to blame and noted that fighter pilots also encountered tunnel vision and hallucinations at high altitudes and speeds.

This year, a study of 52 cardiac-arrest patients in Slovenia, published in the Journal of Critical Care, found that the 21% who had near-death experiences also had high blood levels of carbon dioxide, which has been associated with visions, bright lights and out-of-body experiences.

A study of seven dying patients at George Washington University Medical Center, published in the Journal of Palliative Medicine, noted that their brainwaves showed a spurt of electrical activity just before they were pronounced dead. Lead investigator Lakhmir Chawla, an intensive-care physician, notes that the activity started in one part of the brain and spread in a cascade and theorized that it could give patients vivid mental sensations.

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Warner Bros. Pictures

Matt Damon, left, plays a psychic in the movie 'Hereafter,' which explores themes of the afterlife.

Some scientists have speculated that the life review some patients experience could be due to random activation of the dying brain's memory circuits. The sensation of moving down a tunnel could be due to long-buried birth memories suddenly retrieved. The feeling of peace could be endorphins released during extreme stress.

Other researchers say they have produced similar experiences by stimulating neurons in parts of the brain—or by giving patients ketamine, a tranquilizer and sometime party drug.

Yet researchers who have studied near-death experiences note that such experiments tend to produce only fragmentary visions and hallucinations, not the consistent, lucid and detailed accounts of events that many resuscitated patients report. One study found that people who had near-death experiences had higher blood oxygen levels than those who didn't.

Several follow-up studies have found that people undergo profound personality changes after near-death experiences—becoming more altruistic, less materialistic, more intuitive and no longer fearing death. But some do suffer alienation from spouses or friends who don't understand their transformation.

Other relatives understand all too well.

Raymond Moody, who first coined the term near-death experience in his 1975 book "Life After Life," explores the even stranger phenomenon of "shared death experiences" in a new book, "Glimpses of Eternity." He recounts stories of friends, family and even medical personnel who say they also saw the light, the tunnel and accompanied the dying person partway on his or her journey. "It's fairly common among physicians who are called to resuscitate someone they don't know—they say they've seen a spirit or apparition leave the body," says Dr. Moody.

Meanwhile, in his book, "Visions, Trips and Crowds," David Kessler, a veteran writer on grief and dying, reports that hospice patients frequently describe being visited by a deceased relative or having an out-of-body experience weeks before they actually die, a phenomenon called "near-death awareness." While some skeptics dismiss such reports as hallucinations or wishful thinking, hospice workers generally report that the patients are otherwise perfectly lucid—and invariably less afraid of death afterward.

Mr. Kessler says his own father was hopeless and very sad as he was dying. "One day, he had an amazing shift and said, 'Your mother was here—she told me I'd be dying soon and it will be fine—everyone will be there."

Dr. Parnia, currently an assistant professor of critical care at State University of New York, Stony Brook, says verifying out-of-body experiences with pictures on the ceiling is only a small part of his study. He is also hoping to better understand whether consciousness exists apart from the brain and what happens to it when the brain shuts down. In near-death experiences, people report vivid memories, feelings and thought processes even when there is no measurable brain activity.

"The self, the soul, the psyche—throughout history, we've never managed to figure out what it is and how it relates to the body," he says. "This is a very important for science and fascinating for humankind."

More Information

* International Association of Near-Death Studies
* Near-Death Research Foundation
* "The Big Book of Near-Death Experiences" by P.M.H. Atwater
* "Consciousness Beyond Life: The Science of the Near-Death Experience" by Pim Van Lommel
* "Evidence of the Afterlife" by Jeffrey Long and Paul Peery
* "Glimpses of Eternity" by Raymond Moody and Paul Perry
* "Visions, Trips and Crowded Rooms: Who and What You See Before You Die" by David Kessler
* "Heaven: Our Enduring Fascination With the Afterlife" by Lisa Miller



October 25, 2010; Wallstreet Journal, Health Journal

POSTED BY STEVEN ALMANY, MD