WebMD Newsroom

by Daniel J. DeNoon

There’s good news from researchers at the Guttmacher Institute. “Only” 7% of teens and “only” about 16% of sexually experienced teens got pregnant in 2008, the most recent year for which data is available.

It’s good news because the U.S. teen pregnancy rate continues to drop. Way back in 1990, the teen pregnancy rate peaked at 116.9 pregnancies per 1,000 teen females. That means 11.7% of all teens got pregnant that year.

Among sexually experienced teens — those who ever had intercourse — 22.3% got pregnant in 1990.

The teen birth rate and the teen abortion rate also went down:

• 4% of teens gave birth in 2008, down from the 1991 peak of 6.2%.
• 1.8% of teens had an abortion in 2008 — the lowest abortion rate since abortion was legalized and down from the 1988 peak of 4.35% in 1988.
• From 1986 to 2008, the proportion of teen pregnancies ending in abortion dropped by a third, from 46% to 31%.

Why is the teen pregnancy rate dropping? According to a 2007 study, it’s mainly due to better use of birth control. Teens are using more effective forms of contraception. Many are using two forms of birth control — most likely male condoms combined with a female contraceptive.

The study found that for 18- and 19-year-olds, the drop in the pregnancy rate from 1995 and 2002 was almost entirely due to increased use of birth control. For teens age 15 to 17, about three-fourths of the decline in pregnancy was due to increased contraceptive use. One-fourth was due to reduced sexual activity.

Teen pregnancy rates have declined for all racial and ethnic groups. But black and Hispanic teens still lag behind:
• The abortion rate for black teens is four times the rate for white teens.
• The abortion rate for Hispanic teens is twice the rate for non-Hispanic white teens.
• The birth rate for black and Hispanic teens was over twice the rate for non-Hispanic white teens.

“Teens appear to be making the decision to be more effective contraceptive users, and their actions are paying off in lower pregnancy, birth, and abortion rates,” the Guttmacher Institute suggests in a news release.

More research is needed to identify the complex factors behind these disparities in teen pregnancy and its outcomes. But common sense suggests that access to sex education and to effective contraceptives must play a part.

by Daniel J. DeNoon

Worried about a banned fungicide in your morning glass of orange juice?

Relax, says the FDA. Tests of OJ already in the U.S. clear the juice of danger. From now on, the FDA will only be testing orange juice as it’s entering the country.

The problem began when samples of OJ from Brazil tested positive for carbendazim, a fungicide banned in the U.S. but used in other nations. Those tests are sensitive down to 10 parts per billion (ppb).

The U.S. EPA finds no reason to worry about carbendazim levels below 80 ppb. And none of the juice now in the country has more than 36 ppb.

“Based on all results we have seen to date, we remain confident that orange juice in the U.S. may be consumed without concerns about its safety due to the possible presence of such residues,” the FDA says in a news release.

Since carbendazim is illegal in the U.S., any OJ imports testing positive for the fungicide — that is, containing 10 ppb or more — will be refused entry.

By Brianne Moore

If your kids are turtle lovers, you might want to make sure they keep their hands clean: CDC and the Pennsylvania State Health Department are investigating an outbreak of human salmonella associated with pet turtles.

Though cute and typically harmless, turtles can carry the potentially deadly salmonella bacteria on their shells. Salmonella can cause diarrhea, fever, stomach pain, nausea, vomiting and headaches. Symptoms typically appear six to 72 hours after contact with the bacteria and can last up to seven days. Although most people recover on their own, severe infections often require hospital treatment, and the bacteria is especially dangerous to infants, young children, the elderly, and those with lowered resistance to infection. Salmonella can survive on countertops, bare floors, and carpeting if the turtle is allowed to roam there, potentially infecting other family members.

The most recent investigation involves 132 cases of Salmonella Paratyphi B that were reported in 18 states between August 2010 and September 2011. The median age of the patients was 6 years and 64% of the patients interviewed had had contact with a turtle. No deaths were reported.

Turtles smaller than 4 inches cannot be sold legally in the United States; however, many are still sold illegally on streets and at flea markets and fairs, making it difficult to track down vendors who might be trading salmonella-infected turtles.

So, if you see someone at your local fair with a box of turtles for sale…maybe it’s best to get little Jimmy a goldfish instead.

By Daniel J. DeNoon

Psilocybin — the psychedelic drug from magic mushrooms — is back in the news.

A study to be published this week suggests the drug improves people’s sense of wellbeing, and might be a useful treatment for clinical depression.

In the study, 10 volunteers looked at written cues that spurred memories linked to strong positive emotions. These memories were, as you might expect, far more vivid when the volunteers were given psilocybin than when they were given placebos.

Two weeks later, the volunteers who had the most vivid memories while on psilocybin had the greatest sense of wellbeing.

“Our findings support the idea that psilocybin facilitates access to personal memories and emotions,” Robin Carhart-Harris, PhD, the study’s lead author, said in a news release.

Earlier studies, some going back to the 1950s, suggest that psilocybin can reduce symptoms of depression, anxiety, obsessive-compulsive disorder (OCD), and cluster headaches. The new findings support recent studies in which volunteers given psilocybin underwent long-lasting positive changes in personality and rated the experience as one of the most spiritually significant in their lives.

The new work is part of a renaissance in research into psychedelic — many now prefer the term “entheogenic” — drugs.

All of these studies are being done under close supervision. None support the illegal home use of psychedelic drugs — particularly new designer hallucinogens, such as bromodragonfly, that can be fatal in small doses.

“It is not a cure all. It is certainly a difficult experience. This is not something people are going to abuse and do all the time because it is not fun,” psychotherapist and psychedelic-research advocate Neal M. Goldsmith, PhD, recently told me.

Interestingly, Carhart-Harris and colleagues also used real-time brain imaging to see how psilocybin affects brain function. Using state-of-the-art equipment, they found that instead of exciting extra brain activity, the drug actually reduces brain activity.

The areas where brain activity is reduced are “hubs” that connect various parts of the brain. The findings suggest that psilocybin takes the brakes off of the mind, “enabling a state of unconstrained cognition.”

There is evidence that in depressed people, those brakes are slammed on particularly hard. This, Carhart-Harris and colleagues suggest, leads to an “overstable state” in which thinking is “rigidly pessimistic.”

Even in a controlled setting, the use of psilocybin and other psychedelic drugs can lead to intense bouts of anxiety and even panic. The benefits of psychedelic drugs are still unproved; their risks are real. This is an extreme example of “don’t try this at home.”

By Michael Smith, MD
WebMD Chief Medical Editor

When news broke that former Penn State football coach Joe Paterno had died just two months after announcing he had lung cancer, it took us by surprise.

Until his firing after the sex abuse scandal at the university, the 85-year-old “JoePa” had been coaching as he always had for 46 years. True, Paterno had become more frail in his later years and no longer stood on the sidelines during football games. But he always acted like he could coach forever.

Yet we also know how devastating cancer can be, and how quickly it can work. In the case of Paterno, here are three factors that may have played a role in his death:

First, he had small cell lung cancer – a type of lung cancer strongly associated with cigarette smoking. Small cell lung cancer is typically very aggressive and has usually already spread outside the lungs by the time someone is diagnosed. At this point, it is impossible to cure. And the cancer usually progresses quickly. On average, people live about 12 months after being diagnosed with small cell lung cancer that has spread.

Second, his age of 85 and his recent health difficulties, including breaking his pelvic bone last fall, were working against him. Poorer health increases the chance of dying from cancer. Plus, it can be quite difficult for someone in poor health to tolerate the intense chemotherapy needed to help control the cancer.

The possible third factor was stress. Few would doubt that he was likely under extreme stress as the accusations of child molestation against former Penn State defensive coordinator Jerry Sandusky came to light. And in fact, stress may have made it more difficult for his body to fight the cancer. Researchers continue to study the association between stress and cancer, but some studies have shown that people with increased emotional stress are more likely to die from their cancer.

By Daniel J. DeNoon

A story in today’s New York Times sounds an alarm for parents of children with autism — particularly kids at the high-functioning end of the autism spectrum.

The article points to a study suggesting that proposed changes to the way autism is diagnosed will threaten “health, educational, and social services” many autistic children now receive.

What’s happening? Here’s a brief FAQ:

What did the New York Times report?

The NYT reported on a presentation made yesterday by a prominent autism researcher at the meeting of the Icelandic Medical Association.

The researcher, Fred R. Volkmar, MD, director of the Child Study Center at the Yale School of Medicine, re-analyzed data from a 1993 autism study using a new definition of autism proposed for 2013.

As currently proposed — the new definition won’t be final until later this year — the diagnosis of Asperger’s disorder will go away. So will pervasive developmental disorder not otherwise specified (PDD-NOS) and childhood disintegrative disorder.

Instead, those diagnoses will be “subsumed” into the single diagnosis of autism spectrum disorder or ASD.

Volkmar told the NYT that this means fewer than half of the higher-functioning kids now diagnosed with autism would meet the new diagnosis. Some 75% of kids with Asperger’s would be excluded, he says, as would some 85% of those with PDD-NOS.

A member of the committee writing the new diagnostic criteria, Catherine Lord, PhD, director of New York’s Institute for Brain Development, told the NYT she strongly disagrees with Volkmar’s estimates of the impact of the new criteria for autism diagnosis.

Why is diagnosis of autism changing?

The bible of psychiatry is the Diagnostic and Statistical Manual or DSM. The DSM lists every allowable psychiatric diagnosis and spells out the criteria for each diagnosis.

Every once in a while, the DSM gets updated by the American Psychiatric Association (APA, not to be confused with the other APA—that is, the American Psychological Association). The current version, the fourth edition or DSM-IV, became official in 1994.

A committee of experts appointed by the APA is writing the new edition, DSM-V. DSM-V will become official in 2013. A preliminary draft was revealed to the public in 2010. A final draft will be completed by the end of 2012.

The preliminary draft of DSM-V is a major, radical revision of the previous version. Among the new directions is a rethinking of the autism diagnosis.

Every autism expert would agree that autism has many faces. But there’s no definitive dividing line between the several current diagnoses that are part of the autism spectrum. DSM-V seeks to remedy the situation by putting all these eggs into one basket: a basket to be called “autism spectrum disorder.”

“Previously, the criteria were equivalent to trying to cleave meatloaf at the joints,” is how the DSM-V rationale for the new catch-all diagnosis goes.

Why might my child’s diagnosis change?

Those most affected by the new diagnosis will be some of the highest-functioning people with the least severe forms of autism: Asperger’s syndrome and PDD-NOS.

It’s not clear exactly how many patients who currently have one of the autism diagnoses would no longer be diagnosed as having autism if the preliminary draft of the DSM-V becomes final.

Volkmar’s study uses data from the 1993 study on which the current autism diagnosis is based. The findings behind the NYT report are based on the highest-functioning 372 children and adults in that study. Volkmar told the NYT that an analysis of 1,000 cases will be published later this year.

What would happen if my child’s diagnosis changes?

It’s not entirely clear whether children receiving special educational or social services would lose them if their diagnosis changes.

Eligibility for many of these programs is indeed based on a psychiatric diagnosis. But programs may also consider a child’s actual impairment.

Will the new definition of autism end the autism epidemic?

There has been an explosion of autism cases since the early 1990s. Why?

It could be that something in the environment has changed, affecting children with some genetic susceptibility to developmental disorders.

Or it could be that families and doctors are more aware of autism, and are looking more closely for signs of developmental issues.

One major factor is a huge increase in funding for special education and treatment programs. These programs give parents an incentive to seek a diagnosis for children with signs of developmental delay.

But others feel that the current broad definition of autism is catching many children whose developmental issues might otherwise not have been addressed. That’s why Volkmar told the NYT that the DSM-V’s more restricted autism definition would end the so-called autism epidemic.

Following her admission that she has type 2 diabetes, Paula Deen’s become a hot topic of conversation and debate—as has her condition. We asked our Facebook fans if they had any questions about type 2 diabetes. WebMD’s Brunilda Nazario, MD, answers them below:

My father passed from diabetes and was 45 and did not even know he had it…why did the military not detect this in his years in the service?

Nazario: I can’t answer this question for you; there are many causes of diabetes and the risk factors for type 2 diabetes are widely known [ethnicity, race, weight, etc ]. In the absence of any risk factors, screening for diabetes should begin at age 45. Typically a fasting glucose of greater than 126 makes the diagnosis. Newer and more convenient tests that don’t require fasting can be done and help determine the need for treatment. In Type 2, symptoms go on for a while before a diagnosis is made. During this time people become accustomed to the symptoms: excess urination, tiredness, thirst, etc. Review your risks and see if screening is needed to help you prevent or reduce your risks of diabetes.

How can we reverse it naturally?

Nazario: Diabetes should be primarily managed ‘naturally’. The cornerstone of treatment are changes in lifestyle, weight loss for anyone with extra pounds, regular physical activity, eating right (low calorie, lean meats, fresh fruits and veggies, lower salt), and relaxation to reduce stress.

Is type 2 diabetes hereditary? My father was diagnosed at age 54. What are the chances of me getting it?

Nazario: Type 2 diabetes is not hereditary, you can’t inherit the disease. However, you do inherit many of the genes that are tied to a higher risk of developing the condition. If someone in your family has diabetes, you too are at a greater risk for diabetes. Talk with your doctor and see what other risks you have and whether you need early screening. As we age we are more prone to be intolerant of many things, including carbohydrates, and our risk of diabetes increases. The lifestyle changes needed to reduce your risks of diabetes are easy and safe to be followed by anyone: regular exercise, a balanced diet with fresh fruits and veggies, and dropping extra pounds won’t hurt anyone.

Please be sure to identify the difference between type 1 and 2. It’s extremely frustrating as a parent of a type 1 to constantly compare people like Paula to our children. Our kids are not overweight; our kids can eat what they please. Our kids cannot control their diabetes with lifestyle. Type 1 is no one’s fault with no cure.

Nazario: Great point. Kids and adults alike can have Type 1 diabetes. It’s a different disease with completely different treatments and goal strategies. Type 1 is the absence of insulin, the result of an attack of the body’s immune system destroying insulin-producing cells. It’s seen more frequently in kids with diabetes and as of today there is no cure. People with Type 1 must inject insulin daily; they can never use pills to control their diabetes. Research in this area varies but is distinct from that of Type 2. It focuses on restoring insulin-producing cells and technologies to help make lives of people with this devastating disease a little easier with new insulin delivery methods. Type 2 diabetes is not related to the absence of insulin but rather its ineffectiveness in decreasing blood sugars. No one really knows what causes it but there are several risk factors that increase the chance of developing the disease. Type 2 is seen more frequently in adults with diabetes but we are also seeing Type 2 diabetes in many children due to the more sedentary lifestyles we live and the growing obesity epidemic in kids. Lifestyle changes such as weight loss and regular exercise help improve the blood sugars in Type 2 diabetes.

By Michael Smith, MD
WebMD Chief Medical Editor

OK, let’s get it out of the way. No, it’s no huge surprise that the queen of Southern food has type 2 diabetes. But it’s still upsetting news to me – and this boy from Georgia (also Paula Deen’s home state) loves watching her and I don’t even like to cook!

She never shies away from her love of all things fatty. Needs more butter, ya’ll!! Followed by that wonderful laugh. But in the back of my mind, I always feared that her story would take this all too common turn. And of course I was also a bit concerned that others were actually eating like this all the time.

WebMD has reported on the epidemic of diabetes many times – at the latest count 26 million of us have diabetes. And 7 million of us don’t even know it. That’s why it’s so critically important to talk to your doctor about getting tested – it’s a simple blood test.

Type 2 diabetes occurs when insulin, the hormone that processes sugar in the body, cannot keep pace with rising blood sugar levels. High blood sugars over time increase the risk of heart attack, stroke, blindness, and kidney failure.

While you can certainly get type 2 diabetes without being overweight, there is no question that our unhealthy lifestyle, and particularly America’s obesity problem, is behind the astronomical rise in type 2 diabetes. Shockingly, last year CDC experts predicted that that a third of us – yes, a third of us! — will have diabetes by 2050 if we stay on our current obesity path.

Despite Paula apparently having had diabetes for 3 years, here’s how I hope the rest of her story plays out. She is amazingly popular. We love to watch her cook and eat. She makes us happy. I want Paula to be around for a long time, so all of us can enjoy that infectious laugh for years to come.

Paula is reportedly keen on not letting diabetes interfere with her life. That’s great! Of course it takes some work, but you can live life to the fullest even if you have diabetes (hopefully that doesn’t mean fried mac n’ cheese on a regular basis). Eating healthy can still be delicious and full of laughter.

Paula is reportedly focusing on making some of her delicious meals friendlier for people with diabetes. By the way, there is no “diabetes diet.” People with diabetes should eat the same healthy diet of low saturated fat, plenty of fruits and vegetables, and whole grains that we should all eat. So when Paula comes out with that low-fat mac n’ cheese, give it a shot! You know it’ll be good.

I hope Paula, with the support of her loves ones, can find the power within herself to turn things around. And who better to take us along with her?! If anyone can do it, she can MAKE us want to eat healthy. As we watch her shed the pounds, I hope she motivates others to come along for the ride.

I know I’ll be watching her closely and cheering her on. Please join me in wishing Paula and the millions of people living with diabetes many healthy years to come. As Paula always so charmingly says, the medical team and all of us at WebMD wish you best (healthy) dishes, ya’ll!

by Daniel J. DeNoon

OJ is OK, the FDA now says. Or at least some of it is.

The agency has retested three of 31 samples of imported orange juice that earlier tests suggested might be contaminated with a fungus-killing chemical — carbendazim — banned in the U.S.  Those tests came up negative, so the FDA is releasing that orange juice for U.S. sale.

Tests of the other 28 samples should be finished in two or three weeks, the FDA says. And the agency now is testing all imported orange juice for carbendazim. Results will be released on Fridays

Initial screening tests for carbendazim take four or five business days. Tests to confirm a positive screening result take another seven business days.

Lab tests can detect carbendazim at levels of 10 parts per billion (ppb) or higher. The FDA says the EPA has assured it that carbendazim levels below 80 ppm are safe. Even so, any orange juice with carbendazim levels above 10 ppb will be refused U.S. entry.

But based on the low level of risk seen so far, the FDA is not taking any action on orange juice, or orange juice concentrate, that already has entered the U.S.

By Daniel J. DeNoon

Some good news on the ADHD drug shortage front. The FDA says that the situation is a bit better now than it was earlier this month.

In December, the FDA warned that several types of stimulant ADHD drugs were in short supply. These include:
• Amphetamine mixed salts (name brand Adderall and generic versions)
• Dextroamphetamine tablets
• Methylphenidate (Methylin, Metadate, and generic versions)

The shortage now is easing for extended-release versions of most of these drugs, although demand still may outstrip supply in some areas. Shire says there’s “adequate” availability of Adderall, but generic versions still are suffering supply issues.

Mallinckrodt says it’s Methylin “will be increasingly available as supply recovery continues” for both immediate- and extended-release versions.

But Sandoz warns patients looking for its generic methylphenidate to “expect sporadic backorders for the next couple of months.” And UCB says it’s “currently out of stock” of 5 mg, 10 mg, and 20 mg immediate release methylphenidate and it’s 20 mg extended-release products. Resupply is expected by February.

And Teva’s 5 mg and 10 mg dextroamphetamine tablets “will be on intermittent back order through mid-2012.”

Overall, the shortages mostly plague generic, immediate-release versions of stimulant ADHD drugs.

Why the shortage? Check out WebMD’s exploration of the issues surrounding ADHD drug shortages.