People overestimate benefits of prevention

NEW YORK (Reuters Health) – Patients asked to estimate how many lives would be saved through cancer screening or how many hip fractures can be prevented with bone-building medication mostly overestimate the benefits of these preventive measures, according to a survey of New Zealanders.

Annette O’Connor of the University of Ottawa, who studies how patients weigh risk and make decisions, said she would expect that people would overvalue any given prevention effort.

“Most people would overestimate because they’re told about their benefits, but with no numbers…so why would you think that it’s going to be really low?” said O’Connor, who was not involved in the new study.

Doctors, nurses and others who communicate health information often don’t detail how much a given test or drug can help, but only say that people ought to have it, O’Connor told Reuters Health.

“I think it’s led to more people taking part in screening or availing themselves of preventive medication than would have been the case if they were presented the information in more meaningful terms,” said Dr. Ben Hudson, the new study’s lead author and a professor at the University of Otago in Christchurch, New Zealand.

“I would also be concerned that it’s led to people having over-heightened expectations of what these things can achieve, and that may lead to disappointment when the inevitable breast cancer happens despite screening,” he added.

Hudson said that in talking with his patients about screening, he found they were surprised by how small the benefits were.

To get a broader sense of patients’ expectations for preventive measures, Hudson and his colleagues asked 354 people about the benefits of breast cancer screening with mammography, bowel cancer screening with stool testing, taking antihypertension medication and taking bone-strengthening medication.

Specifically, participants were asked to imagine scenarios in which 5,000 people between ages 50 and 70 undergo one of these preventive interventions for 10 years, then asked how many “events” the participants thought would be avoided as a result of the measure.

For three of the four interventions in the survey, the event to be avoided was death and in the case of bone drugs, it was hip fracture.

For breast cancer screening, only seven percent of the participants answered in the correct range of one to five lives being saved with screening, whereas 90 percent overestimated how many lives would be saved. Fully a third thought that 1,000 deaths would be averted.

The numbers were similar for bowel cancer screening, which is thought to save five to 10 lives for every 5,000 people tested, Hudson’s group reports in the Annals of Family Medicine.

Eighty-two percent of participants overestimated the number of fractures prevented by bone-strengthening medication, which in reality is about 50 for every 5,000 patients given the drug.

And 69 percent of participants reported that 500 or more lives would be saved if 5,000 people took blood pressure medication, when the correct range should have been 50 to 100.

“It’s probably unreasonable to expect people to make an accurate guess at the absolute number (of lives saved or fractures prevented), but what we found was a consistent trend toward higher levels,” Hudson told Reuters Health.

“I don’t think most patients are likely to have access to good numerical data presented in a simple and informative way. I think that’s part of the problem here,” he said.

The U.S. Preventive Services Task Force (USPSTF) issues screening recommendations and other guidelines for disease prevention, which doctors, nurses and public health groups often consult when counseling patients.

A survey of U.S. physicians found that most of them don’t fully grasp what the numbers mean when it comes to cancer screening (see Reuters Health story of March 5, 2012).

O’Connor said that when health care professionals repeat these guidelines to patients, they often don’t include the numbers when talking about benefits or they only refer to something called the “relative risk.”

The relative risk describes the change in a person’s chances of developing a disease, but it does not give any sense of how much risk that person had to begin with.

For example, a “50 percent reduction in risk” may be less significant than it sounds if a person’s absolute risk for a condition – how likely they are to develop it at some point in life – was originally five percent, and drops to 2.5 percent.

“Professionals and people who provide health information need to know absolute benefits,” O’Connor said.

The relative risk of dying from breast cancer is 17 percent lower among a population of women aged 50 to 69 who get screened, compared to women who do not get screened, for instance.

But in absolute terms, that means that instead of 23 in 100,000 women dying of breast cancer, screening would reduce that number to 19 in 100,000 women.

Hudson said that one of the potential problems that can arise when people overvalue a test is that if recommendations are scaled back because of insufficient benefits, people get upset.

In 2009, for instance, the USPSTF changed its guidelines for regular mammograms from beginning at age 40 to beginning at 50, because the number of lives saved through screening during that extra decade of life was too small compared to the potential harms from the screening itself and follow-up procedures.

A survey of women at the time found that most of them considered the new guidelines to be “unsafe,” at least in part because they feared that insurers would no longer cover screening for women in their 40s who wanted it.

“The other thing that happens when you have an established screening program for which people have heightened expectations, it becomes very politically difficult to make any changes insofar as recommending reduced access, even when the evidence is pretty convincing that the outcomes are better,” said Hudson.

Hudson advocated for better informing patients of the benefits and harms of any preventive intervention.

“I have a feeling this would all be easier if we could present (patients) with this information, trust them with their decisions and support them in doing so,” he said.

SOURCE: http://bit.ly/XINd5u Annals of Family Medicine, November/December 2012.

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Clinton-Lewinsky 'spinners' resurface

WASHINGTON (Reuters) - It's a case of déjà vu in D.C.: some of the same high-profile, high-priced handlers who played supporting roles in the scandal over President Bill Clinton's affair with intern Monica Lewinsky have re-emerged in the sex scandal that has toppled one U.S. national security chief and threatens another.

It is unclear what will be the roles of the expensive legal and crisis-management talent drawn into the uproar over the relationships between former CIA director David Petraeus and Marine General John Allen and two female acquaintances. Neither Republicans nor Democrats in Congress appear to have an appetite for another year-long Monica-style media spectacle.

The latest scandal began with an FBI investigation into cyber-harassment, and indications so far are that ultimately the inquiry will produce no criminal charges.

Nonetheless, both women at the center of attention - Petraeus biographer and former mistress Paula Broadwell and Tampa socialite Jill Kelley, the woman to whom Broadwell is alleged to have sent suspected harassing emails - have turned for advice to veteran Washington lawyers and spin doctors with connections to the Lewinsky brouhaha.

On Monday, a source close to the Kelley family said that two Washington-based players in the Lewinsky scandal, trial lawyer Abbe Lowell and public relations adviser Judy Smith, were working for Kelley.

A day later, a Washington law firm which represented Lewinsky herself confirmed that one of its partners, Robert F. Muse, was representing Broadwell. The three advisors either were unavailable for comment or declined to comment.

It is not known whether Petraeus or Allen, who is the top U.S. military commander in Afghanistan, have retained attorneys.

 

A complaint by Kelley to the FBI about the harassing emails sparked an investigation that implicated Petraeus in a career-ending affair with Broadwell.

It also embroiled Kelley herself in the uproar over her still-murky relationship with Allen.

Kelley's lawyer, Lowell, who an insider said she had known for years, served as pro-Clinton Democratic Party chief counsel on a House impeachment inquiry. Recently he won a partial acquittal and partial mistrial for John Edwards, a former Democratic U.S. senator and vice presidential candidate who had been indicted for misusing undeclared campaign funds to support his mistress.

During the Clinton sex scandal, Smith, a one-time press aide to President George H.W. Bush, served as Lewinsky's spokeswoman. Smith also represented NFL quarterback Michael Vick, who was charged and convicted in a dogfighting cruelty case.

Smith also is a model for the main character in the ABC-TV drama "Scandal," a prime-time series in which ace spin-doctor Olivia Pope, along with a team of spies and ex-convicts, not only manages to sort out or cover up sex and spy scandals but also carries on a secret affair with a fictional U.S. president.

Muse's senior partner, Jacob Stein, and another prominent criminal lawyer from a different firm, Plato Cacheris, represented Lewinsky personally in a criminal investigation of Clinton by special prosecutor Kenneth Starr and a congressional inquiry which led to Clinton's impeachment by the House of Representatives but subsequent acquittal by the Senate. Muse himself did not represent Lewinsky, according to Cacheris.

Starr and a substantial special prosecution team pursued Clinton during the Lewinsky scandal. Starr turned his evidence over to the Republican-controlled House, which in a nationally televised broadcast impeached Clinton for high crimes and misdemeanors.

But Republicans could not muster the two-thirds majority in the Senate needed to remove Clinton from office. Republicans later were punished at the polls for what many of them conceded was a perceived overzealousness in pursuing Clinton.

CONGRESS WARY OF SPECTACLE

Lewinsky's lawyers were critical in helping her negotiate a legal thicket that included dealing with Starr's criminal investigators and the impeachment inquiry launched by Congress; she testified in both investigations. Lewinsky was also besieged for months by the media; eventually her team arranged decorous interviews with U.S. and British television networks.

Mindful of how the Lewinsky scandal played out, officials familiar with the views of both senior Democrats and Republicans in Congress say that congressional leaders are keen to avoid turning the scandal into a public extravaganza, even though there remain many unanswered questions.

If there are no public congressional hearings or a criminal prosecution, it is unclear what Broadwell's and Kelley's legal and public relations teams would do, apart from trying to manage news coverage and the hordes of paparazzi and TV cameramen now outside their clients' homes.

Lewinsky's lawyer, Cacheris, told Reuters that from what he could see, at this point Broadwell and Kelley do not know if there will be any charges against them. "These people are getting lawyers to ensure there is no criminal case," he added.

But Eric Dezenhall, a Washington crisis management expert, said some clients did not understand that there was a limit to how much even the most skilled lawyer and public relations specialist could do.

"You have to be very selective in the cases you take because you're going to end up with some very disgruntled clients," Dezenhall said.

(Editing by Warren Strobel and Paul Simao)

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Egypt recalls envoy to Israel after Gaza strike

CAIRO (AP) — Egypt has recalled its ambassador to Israel after an Israeli airstrike killed the military commander of Gaza‘s ruling Hamas.

In a statement read on state TV late Wednesday, spokesman Yasser Ali said that President Mohammed Morsi recalled the ambassador and asked the Arab League‘s Secretary General to convene an emergency ministerial meeting in the wake of the Gaza violence.

Morsi also called for an immediate cease fire between Israel and Hamas, an offshoot of Morsi’s Muslim Brotherhood. Israel says it struck in response to rocket attacks from Gaza.

Hours earlier, Morsi’s Muslim Brotherhood group denounced the Israeli airstrike as a “crime that requires a quick Arab and international response to stem these massacres.”

Relations between Israel and Egypt have deteriorated since longtime President Hosni Mubarak was ousted last year.

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Judge tosses anti-paparazzi counts in Bieber case

LOS ANGELES (AP) — A law aimed at combating reckless driving by paparazzi is overly broad and should not be used against the first photographer charged under its provisions, a judge ruled Wednesday.

Superior Court Judge Thomas Rubinson dismissed counts filed under the law against Paul Raef, who was charged in July with being involved in a high-speed pursuit of Justin Bieber.

The judge cited numerous problems with the 2010 statute, saying it was aimed at newsgathering activities protected by the First Amendment, and lawmakers should have simply increased the penalties for reckless driving rather than targeting celebrity photographers.

Attorneys for Raef argued the law was unconstitutional and wasn’t meant to protect the public.

“It’s about protecting celebrities,” attorney Brad Kasierman said. “This discrimination sets a dangerous precedent.”

Prosecutors argued that the law, which seeks to punish those who drive dangerously in pursuit of photos for commercial gain, could apply to people in other professions, not just the media.

“The focus is not the photo. The focus is on the driving,” Assistant City Attorney Ann Rosenthal argued.

While the media is granted freedom under the First Amendment, its latitude to gather news is not unlimited, Rosenthal argued.

“This activity has been found to be particularly dangerous,” she said of chases involving paparazzi.

Raef still faces traditional reckless driving counts and has not yet entered a plea,

Prosecutors claim he chased Bieber at more than 80 mph and forced other motorists to avoid collisions while trying to get shots of the teen heartthrob on a Los Angeles freeway.

The chase prompted several 911 calls from scared motorists and led to Bieber being pulled over.

Rubinson cited hypothetical examples in which wedding photographers or even those rushing to do a portrait shoot with a celebrity could face additional penalties if charged under the new statute.

Rosenthal also argued that the judge should look at factors specific to Raef’s case, not hypothetical scenarios.

Kaiserman said the ruling only applies to Raef’s case but could lead to the law being struck down if prosecutors appeal.

___

Anthony McCartney can be reached at http://twitter.com/mccartneyAP

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Scientists identify new risk gene for Alzheimer’s

CHICAGO (Reuters) – Two international teams of scientists have identified a rare mutation in a gene linked with inflammation that significantly increases the risk for the most common form of Alzheimer’s disease, the first such discovery in at least a decade.

The findings, published on Wednesday in the New England Journal of Medicine, offer new insights into the underpinnings of Alzheimer’s, a deadly, brain-wasting disease that robs people of their memories, their independence and their lives.

In separate studies, teams led by privately held deCode Genetics and John Hardy of University College London found that people with a mutation in a gene called TREM2 were four times as likely to have Alzheimer’s as people who did not have the gene.

“It quadruples the risk of Alzheimer’s,” said Dr. Kari Stefansson of Reykjavik-based deCode in a telephone interview.

The level of risk compares with ApoE4, the best-known genetic cause of late-onset Alzheimer’s, the form of the disease that occurs in older adults.

But this new gene variant is 10 times more rare than ApoE4, which is present in about 40 percent of people with late-onset Alzheimer’s.

Rare or not, scientists say the discovery represents a big breakthrough for Alzheimer’s research.

“This is one of the most common, most devastating illnesses in humans and we still don’t have a very good understanding of what causes the disease,” said Dr. Allan Levey, director of the Emory Alzheimer’s Disease Center of Excellence in Atlanta, which helped confirm the deCode findings.

“In my mind, this is very important. It gives us another important clue as to one of the biological factors that contribute to causing the disease,” he said.

Despite numerous costly attempts, drug companies have been stymied in their efforts to develop drugs that can alter the steady course of Alzheimer’s, which affects more than 5 million Americans and costs the United States more than $ 170 billion annually to treat.

Current research efforts have focused on removing sticky clumps of a protein called beta amyloid that accumulate in the brains of people with Alzheimer’s disease. But several drugs that have been developed to remove these proteins have failed to produce a significant improvement in patients with mild to moderate forms of dementia.

With the new finding, researchers say the focus will turn on the role of inflammation in Alzheimer’s disease.

INFLAMMATORY RESPONSE

TREM2 is a gene that affects a protein expressed on the surface of cells in various tissues that “clean up garbage,” Stefansson said. These cells, called microglia, are often associated with inflammatory response.

A genetic mutation that alters the function of these housekeeping cells could affect how well the brain deals with an excess of toxic proteins from beta amyloid, Stefansson and others said.

And that suggests that even though TREM2 is rare, the way it works in the brain may be important for brain health.

“It is certainly plausible that TREM2 is involved in all of Alzheimer’s disease,” said Andrew Singleton of the National Institute on Aging, who worked on the paper with Hardy and colleagues at University College London.

“I think it may be very generalizable,” Singleton said.

For their study, Hardy and colleagues used a number of gene sequencing techniques to study 988 people with Alzheimer’s disease and 1,004 healthy volunteers.

The team also tested brain tissues from deceased Alzheimer’s patients, and they studied the expression of the TREM2 gene in genetically engineered mice.

For the deCODE study, researchers sequenced the genomes of 2,261 Icelanders and identified variations likely to affect protein function. Then, they looked specifically for these variants in people with Alzheimer’s and those with healthy brains, and found those with the TREM2 variant had a significantly higher risk.

To make sure the gene was not specific to Iceland, they replicated their findings in populations at Emory University in the United States, as well as groups in Norway, the Netherlands and Germany.

“We’ve essentially found exactly the same thing,” said Singleton of the NIA, which is part of the National Institutes of Health. “In a way which you don’t often see in science, the two studies point in the same direction.

In July, a team at deCODE discovered a rare mutation in a gene called APP that protects against Alzheimer’s.

“It is a complex disease,” Stefansson said. “I’m not surprised to see there are many ways to bring about this deterioration in cognitive function.”

Levey said while the TREM2 mutation is rare, it is likely changing the function of brain cells.

“It helps identify the microglial cells as an important possible (drug) target,” he said.

Dr. Ralph Nixon, director of the New York University Center of Excellence on Brain Aging and a scientific adviser to the Alzheimer’s Association, said the findings suggest there are likely many more genes that increase the risk of Alzheimer’s disease.

“It’s a good illustration that we need to intensify this type of research and identify what these genes are doing so we can finally translate it into therapy,” he said.

(Editing by Cynthia Osterman)

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Congress' choice whether Petraeus testifies on Benghazi attack

Holly Petraeus and Gen. David Petraeus walk past a seated Paula Broadwell (rear right) at his confirmation hearing …The White House said Tuesday that it was "up to Congress" whether to call former CIA Director David Petraeus to testify about the Sept. 11 attack in Benghazi, Libya.

"Congress [makes] decisions about who is called to testify," press secretary Jay Carney told reporters at his daily briefing.

The Intelligence Committees of the Senate and House of Representatives had been set to hear from Petraeus about the attack on the American compound in separate closed-door hearings on Thursday. But aides to both panels indicated that the retired Army general would be replaced by Mike Morrell, the acting CIA director.

"The president is confident that Acting Director Morrell is fully informed and capable of representing the CIA in a hearing about the incidents in Benghazi," Carney said.

Still, key senators have made it clear that Petraeus, whose shocking resignation came after the public disclosure of an extramarital affair, will ultimately need to be heard. The attack claimed the lives of U.S. Ambassador Chris Stevens and three other Americans.

Senate Intelligence Committee Chairwoman Dianne Feinstein, a Democrat, told MSNBC on Monday that her panel "should go ahead with Mike Morell and the way it is now set up."

"But I also think that the community should know that this is not sufficient," she continued. "And I have no doubt now that we will need to talk with David Petraeus. And we will likely do that in closed session, but it will be done one way or the other."

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General investigated for emails to Petraeus friend

PERTH, Australia (AP) — In a new twist to the Gen. David Petraeus sex scandal, the Pentagon said Tuesday that the top American commander in Afghanistan, Gen. John Allen, is under investigation for alleged “inappropriate communications” with a woman who is said to have received threatening emails from Paula Broadwell, the woman with whom Petraeus had an extramarital affair.

Defense Secretary Leon Panetta said in a written statement issued to reporters aboard his aircraft, en route from Honolulu to Perth, Australia, that the FBI referred the matter to the Pentagon on Sunday.

Panetta said that he ordered a Pentagon investigation of Allen on Monday.

A senior defense official traveling with Panetta said Allen’s communications were with Jill Kelley, who has been described as an unpaid social liaison at MacDill Air Force Base, Fla., which is headquarters to the U.S. Central Command. She is not a U.S. government employee.

Kelley is said to have received threatening emails from Broadwell, who is Petraeus’ biographer and who had an extramarital affair with Petraeus that reportedly began after he became CIA director in September 2011.

Petraeus resigned as CIA director on Friday.

Allen, a four-star Marine general, succeeded Petraeus as the top American commander in Afghanistan in July 2011.

The senior official, who discussed the matter only on condition of anonymity because it is under investigation, said Panetta believed it was prudent to launch a Pentagon investigation, although the official would not explain the nature of Allen’s problematic communications.

The official said 20,000 to 30,000 pages of emails and other documents from Allen’s communications with Kelley between 2010 and 2012 are under review. He would not say whether they involved sexual matters or whether they are thought to include unauthorized disclosures of classified information. He said he did not know whether Petraeus is mentioned in the emails.

“Gen. Allen disputes that he has engaged in any wrongdoing in this matter,” the official said. He said Allen currently is in Washington.

Panetta said that while the matter is being investigated by the Defense Department Inspector General, Allen will remain in his post as commander of the International Security Assistance Force, based in Kabul. He praised Allen as having been instrumental in making progress in the war.

The FBI’s decision to refer the Allen matter to the Pentagon rather than keep it itself, combined with Panetta’s decision to allow Allen to continue as Afghanistan commander without a suspension, suggested strongly that officials viewed whatever happened as a possible infraction of military rules rather than a violation of federal criminal law.

Allen was Deputy Commander of Central Command, based in Tampa, prior to taking over in Afghanistan. He also is a veteran of the Iraq war.

In the meantime, Panetta said, Allen’s nomination to be the next commander of U.S. European Command and the commander of NATO forces in Europe has been put on hold “until the relevant facts are determined.” He had been expected to take that new post in early 2013, if confirmed by the Senate, as had been widely expected.

Panetta said President Barack Obama was consulted and agreed that Allen’s nomination should be put on hold. Allen was to testify at his confirmation hearing before the Senate Armed Services Committee on Thursday. Panetta said he asked committee leaders to delay that hearing.

NATO officials had no comment about the delay in Allen’s appointment.

“We have seen Secretary Panetta‘s statement,” NATO spokeswoman Carmen Romero said in Brussels. “It is a U.S. investigation.”

Panetta also said he wants the Senate Armed Services Committee to act promptly on Obama’s nomination of Gen. Joseph Dunford to succeed Allen as commander in Afghanistan. That nomination was made several weeks ago. Dunford’s hearing is also scheduled for Thursday.

___

Associated Press writer Slobodan Lekic in Kabul, Afghanistan, contributed to this report.

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Zynga CFO leaves for Facebook

SAN FRANCISCO (Reuters) – Zynga Inc‘s chief financial officer, David Wehner, will leave the company for an executive position at Facebook Inc, the gaming company announced Tuesday as it reshuffled its upper ranks.

David Ko, chief mobile officer, has been elevated to become Zynga‘s new chief operations officer.

Mark Vranesh, Zynga’s top accounting executive, will replace Wehner as CFO, Zynga said.

(Reporting By Gerry Shih; Editing by Steve Orlofsky)

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Charlie Chaplin’s bowler and cane to hit auction block

LOS ANGELES (Reuters) – One of Charlie Chaplin’s iconic bowler hats and canes, the staple of Hollywood silent-era comedy, will go under the hammer in Los Angeles this weekend, auction house Bonhams said on Tuesday.

Chaplin’s hat and cane – synonymous with his trademark “Little Tramp” character in films such as “City Lights” and “Modern Times” – are expected to fetch between $ 40,000 and $ 60,000 in the November 18 auction.

It is unknown how many of Chaplin’s bowlers and canes still exist, said Lucy Carr, a memorabilia specialist at Bonhams. The ones up for auction come from a private collection but have a direct link to Chaplin, Carr said.

The waddling and bumbling Little Tramp character propelled Chaplin to global fame. The character, which Hollywood legend says was created by accident on a rainy day at Keystone Studio, first appeared in 1914′s “Kid Auto Races at Venice” and lastly in 1936′s “Modern Times.”

Chaplin’s hat and cane are the highlights of an auction of popular culture artifacts including a saxophone that belonged to jazz pioneer Charlie Parker ($ 22,000-$ 26,000) and a handwritten letter from John Lennon in which The Beatle sketched himself and wife Yoko Ono nude ($ 18,000-$ 22,000).

Other items hitting the block range from an archive of Marilyn Monroe photographs ($ 15,000-$ 20,000), an early Charles Schulz “Peanuts” comic strip ($ 10,000-$ 15,000) and a wicker chair from Rick’s Cafe in “Casablanca” ($ 5,000-$ 7,000).

(Reporting By Eric Kelsey, editing by Jill Serjeant)

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Many hospital patients get too much acetaminophen

NEW YORK (Reuters Health) – In a new study from two Boston hospitals, one in every 15 patients treated with acetaminophen got more than the maximum daily recommended dose at least once.

Acetaminophen – sold as Tylenol – is a common painkiller on its own, but also an ingredient in stronger narcotics such as Percocet and Vicodin. So without careful monitoring, it’s not always obvious how much a patient has taken.

To protect against liver damage from an acetaminophen overdose, the U.S. Food and Drug Administration sets the maximum daily dose at 4 grams for most people or 3 grams for people 65 and older and those with liver disease.

Dr. Robert Fontana, a liver specialist from the University of Michigan Health System in Ann Arbor, called the new findings “a bit alarming.”

“On the flip side, it doesn’t look like there was any toxicity in these patients,” Fontana, who wasn’t involved in the new research, told Reuters Health.

“I certainly don’t want people thinking, ‘If I go to the hospital I’m going to get acetaminophen toxicity.’”

Researchers led by Dr. Li Zhou from Partners HealthCare System Inc in Wellesley, Massachusetts, reviewed the electronic health records of 23,750 adults treated at two hospitals during the summer of 2010. That included 14,411 people who took any acetaminophen during their stay.

Based on calculations from the electronic records, Zhou’s team determined that 955 of those patients were given over 4 grams of acetaminophen in a 24-hour period, most on more than one occasion.

More than 20 percent of elderly people, and close to that many patients with liver disease, were given over 3 grams in a day.

People in the surgical and intensive care units were especially likely to be over-administered acetaminophen, as were those who took multiple different products containing the drug, according to findings published in the Archives of Internal Medicine.

Nobody developed liver failure due to acetaminophen during the study period. Patients given more than the recommended limit had higher levels of one liver-related enzyme in their blood – but it’s not clear that would have any health consequences.

Fontana said the likelihood of doctors and nurses over-administering acetaminophen will probably drop in the future as the FDA cracks down on high doses of acetaminophen in narcotics.

There’s also a need for more advanced health information technology systems that can track aggregate doses of ingredients that, like acetaminophen, are in multiple medications given to a single patient, according to Zhou.

“This is what we want to see,” she told Reuters Health. “I really think it’s doable.”

As it is, she said, the technology that doctors and nurses use doesn’t make acetaminophen limits obvious. And it’s very difficult for them to calculate by hand exactly how much a patient has received if it’s from different sources.

“It’s so easy to exceed the 4-gram limit,” Zhou said.

SOURCE: http://bit.ly/TwzwS7 Archives of Internal Medicine, online November 12, 2012.

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