Sound Medicine -- May 10, 2003

Hosts Barbara Lewis and Dr. David Crabb talk to physicians and researchers about:

Gender Differences in Response to Drugs

West Nile Virus

Da Vinci Surgical System

Gender Differences in Response to Drugs

Scientists are discovering that gender plays an important role in understanding how a patient will respond to a certain drug. This is part of a broader and emerging field known as gender-specific medicine. Women seem to be more at risk of experiencing dangerous side effects from drugs. Between 1997 and 2000, 10 drugs that were shown to have an adverse effect on women were pulled from the market. Dr. David Flockhart, professor of medicine and director of clinical pharmacology at the IU School of Medicine, investigates this issue.

It is important to acknowledge that men and women do not always receive the same drugs. For example, estrogen is not often prescribed for men, and testosterone to women. Nevertheless, when certain drugs are prescribed to women, they can be more dangerous than when the same drug is prescribed to men, or the drugs might have different effects. One example is the line of non-sedating antihistamines, several of which have been discontinued in the past few years. Seldane, a very popular antihistamine, was taken off the market in 1998 because it caused sometimes-fatal cardiac arrhythmias in some people. More than two-thirds of the three hundred people worldwide who died were women. Risk of death appears to be greatest during women's menstruating years, which indicates that drugs' negative effects are likely caused by a hormonal reaction.

Prior to Seldane's removal from the shelves, women were often deliberately left out of trials for medications, particularly women of childbearing age. Researchers feared birth malformations resulting from the exposure of women to unknown substances. However, this taboo is less pervasive today. Researchers have learned that it is possible to study drugs safely; furthermore, birth defects can be passed along through men's bodies as well as through women's. Nevertheless, it is still difficult to persuade people in industry and academia to include women and men in equal numbers for medical trials.

Resources:

Read more about gender related differences in drug reactions.

Learn about gender differences in response to pain medications.

View Dr. Flockhart's extensive table detailing various drug interactions.

West Nile Virus

While our attention is focused on SARS, preparations are being made to combat and treat another new virus that embedded itself in Indiana last year. At the end of 2002, the West Nile Encephalitis Virus was found in all of Indiana's 92 counties. Eleven Hoosiers died from it, and nearly 300 people were infected. Dr. Karen Roos is professor of neurology at the Indiana University School of Medicine. She recently attended the American Academy of Neurology conference where new treatment plans were discussed for the upcoming mosquito season, as mosquitoes are the carriers of this virus.

The symptoms of West Nile Virus are similar to those of the flu, with the addition of diarrhea, and in more serious cases, confusion. Nevertheless, people should not fear mosquitoes or drastically change their daily routines. Mosquitoes have always carried viruses, and West Nile has actually been around us for a long time. People must be reasonable. Dr. Roos explains that all of the patients affected last year had been sleeping outside or working around tires filled with stagnant water.

We can expect to see the first cases of West Nile Virus starting in July. People most at risk for developing West Nile Virus are the elderly and those with chronic disease or diabetes. Research is currently being undertaken to develop a vaccine for the virus. Nevertheless, doctors estimate that for every 150 people who are bitten by the virus-carrying mosquitoes, only one person will actually develop the symptoms. What can people do to prevent West Nile Virus? Dr. Roos recommends wearing long pants, using mosquito repellant, and removing standing water.

Resources:

See what the Centers for Disease Control and Prevention say about West Nile Virus.

Read how West Nile Virus has affected the state of Indiana.

Da Vinci Surgical System

Click on photos to enlarge.

Humans have long been fascinated with the notion of robots that help perform daily tasks. In operating rooms across this country and in Europe, wishful thinking has become a reality. The daVinci Surgical System allows surgeons to conduct minimally invasive surgeries that were not previously possible. The robotic arms can move around in the body in ways that human hands cannot. Dr. Chandru Sundaram, associate professor of urology at the Indiana University School of Medicine, explains the benefits of the daVinci robot.

The robot is an enhancement of laparoscopic surgery, a minimally invasive type of surgery conducted in the abdomen using long thin instruments. The daVinci robot takes this sophisticated surgery one step further. A surgeon sits on a console, and views images of the surgery through 3-D monitors. Along with a small team, the surgeon operates the instruments via the console, and the robot manipulates the instruments. Consequently, the lead surgeon can be in a separate room from the patient, or even across the ocean.

There are many benefits to the daVinci robot. Images of the surgery are magnified; thus it is easy to see small things. Use of the robot eliminates the small tremors that everyone has, and it is much more precise. Likewise, the robot can also maneuver smaller spaces than the human hand. The daVinci robot is especially beneficial for delicate, complicated and precise operations, such as prostate surgery.

Resources:

See the daVinci robot in action!

View more information about the DaVinci Surgical System.

Learn about robot-assisted surgery.

Is there a medical topic you'd like us to cover? Reach us by email: soundmed@iu.edu
or by phone:
(317) 274-4848.

Consuming alcohol during pregnancy has been proven to cause birth defects. Yet, a recent study conducted by the University of Michigan found that 15% of the women surveyed had taken alcohol during pregnancy. How much alcohol consumption is safe during pregnancy?

A. One drink a day
B. Binge drinking once in a while
C. Any amount of wine, but no amount of hard liquor
D. None - Alcohol is never safe during pregnancy

Find out!

Many new strains of influenza, and most recently, the SARS virus come from Southern China. What is it about this region that makes it the perfect place to grow new highly contagious germs and viruses?

Find out!

An editorial discussing ways to decrease the frequency of drug reactions by William Tierney, M.D., professor of medicine at the Indiana University School of Medicine, accompanied a study about adverse drug reactions published in the New England Journal of Medicine.

The study conducted at Boston's Brigham and Women's Hospital found that one of four outpatients taking some of the most widely prescribed drugs experience an adverse reaction, ranging from intestinal bleeding to slowed heartbeat.

The editorial noted that the likelihood of adverse drug reactions are on the rise as individuals live longer and take more medications during the course of their lifetimes. "Reducing the number and severity of adverse effects of drugs will require vigilance and cooperation of doctors, pharmacists, and other health care providers," Dr. Tierney noted.

He suggests the use of electronic medical record systems to help remind health care providers which drugs a patient is taking and which side effects to look out for and to eliminate errors caused by illegible handwriting, inappropriate dosing, known drug interactions and allergies. He also suggests regular screening of patients for potential drug-related symptoms.