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Obama opens to applause at AMA 

His plan to insure every American who wants to be insured could cost $1 trillion, but that's less than the cost of not doing it, he said, saying he would pay for it by reforming Medicaid and Medicare and cutting income tax breaks for the wealthy. . . .

Obama praised the AMA for working with his administration to pass last week's law allowing the Food and Drug Administration to regulate tobacco.

The doctors applauded when the president said he would sign the law.

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Wis. Court To Decide Cigarette Tax Dispute  

The Wisconsin Supreme Court is expected to decide Tuesday whether the Ho-Chunk Nation is entitled to thousands of dollars in cigarette tax refunds.

The tribe is seeking a refund on cigarette taxes collected on sales at its DeJope Gaming property in Madison for parts of 2003 and 2004.

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Unprecedented Effort to Help LA County Residents Quit Smoking Launched 

The Los Angeles County Department of Public Health, in conjunction with Ralphs Grocery Company and L.A. Care Health Plan, will participate in the largest in-person giveaway of nicotine patches and gum ever in California. These 30,000 quit smoking aids will be given away to LA County residents at 47 participating Ralphs Pharmacies beginning Monday, June 15, 2009 between the hours of 1pm-8pm, while supplies last.

"We are confident that this giveaway will serve as the first step in a successful quit effort for smokers in Los Angeles County," said Dr. Jonathan E. Fielding, MD, MPH, Director and Health Officer of the Los Angeles County Department of Public Health. "Nicotine patches and gum are helpful tools that will assist smokers in quitting this deadly addiction. And, with no cost, there is no better opportunity and no better time than now to quit."

The 30,000 two-week starter kits of free nicotine patches and gum are part of LA County's ongoing campaign to reduce smoking rates.

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Top notch decisions in the developing airways bring insights into lung disease 

In the normal lung, the airways are lined by a balanced mixture of ciliated, secretory and neuroendocrine cells which perform functions as diverse as air humidification, detoxification, and clearance of environmental particles. This balance can be altered dramatically by faulty adaptation responses of the lung to cigarette smoke or allergens in patients with Chronic Obstructive Pulmonary Disease (COPD) and asthma.

How these different cell types emerge from lung progenitor cells and how these fates are balanced in developing airways, remain an open question. A study from a research team led by Wellington Cardoso, MD, a professor at the Pulmonary Center Boston University School of Medicine and Director of the Program in Lung Development and Progenitor Cell Biology, sheds light into this problem.

The Notch pathway is a major regulator of cell fate decisions in developing cells from fruit flies to humans. Using mouse genetic models, the BU researchers inactivated Notch signaling in the lung and discovered that airways no longer formed secretory cells. Instead they became populated almost exclusively by ciliated cells. The researchers showed that this imbalance seems to result from the loss of a mechanism of cell fate choice triggered by the Notch called lateral inhibition.

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• Health research agencies form global alliance to curb humanity's most fatal diseases 

Six of the world's foremost health agencies, collectively managing an estimated 80% of all public health research funding, today announced formation of a landmark alliance to collaborate in the critical battle against chronic, non-communicable diseases: cardiovascular diseases (mainly heart disease and stroke), several cancers, chronic respiratory conditions, and type 2 diabetes.

The health impact and socio-economic cost of these largely-preventable diseases is enormous and rising, potentially derailing efforts at poverty reduction.

The Global Alliance for Chronic Diseases (Alliance) is being created to support clear priorities for a coordinated research effort that will address this growing health crisis, now reaching world epidemic proportions. Experts estimate that, unless action is stepped up, 388 million people worldwide will die of one or more such diseases within the next decade.

Work of the Alliance will focus in particular on the needs of low and middle income countries, and on those of low income populations of more developed countries.

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• Kretek Industry Faces Big Losses as US Moves to Ban Clove Cigarettes 

Indonesia’s kretek cigarettes are almost certain to be banned in the United States after the US Senate passed a strict antismoking bill aimed at cutting the attraction of cigarettes to children.

The Family Smoking Prevention and Tobacco Control Act, voted through by a Senate committee late on Thursday, has a raft of new measures but includes the kretek prohibition because a US study found they helped to hook children on smoking.

If the bill is signed into law by President Barack Obama — as the White House says it will be — US authorities will have the power to impose strict new controls on the making and marketing of tobacco, including banning cloves as a cigarette flavoring along with such flavors as cherry and chocolate.

For Indonesian clove cigarette makers, who export about 20 percent of the $500 million worth of kretek sold overseas every year to the United States, this means $100 million a year is likely to go up in smoke. It is especially likely to affect Indonesia’s biggest kretek exporter, Gudang Garam, which has a factory in South America for the continental market.

Menthol cigarettes will not be included in the ban, however, which has angered Indonesian trade officials who point out that a ban on kretek but not menthol is discriminatory and are threatening to complain to the World Trade Organization. Government officials’ comments on the ban make it likely that WTO action will now proceed.

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• Nicotine Receptors Could Be Lung Cancer Treatment Target 

In a study of mice with lung cancer, a treatment that targeted nicotine receptors more than doubled the animals' survival time, Italian researchers say.

Nicotine plays a dual role in lung cancer. Changes in genes encoding nicotine receptors not only drive the urge the smoke, but also increase susceptibility to lung cancer. Exposure to nicotine boosts the expression of nicotine receptors, which leads to increased cell proliferation and inhibits the programmed cell death known as apoptosis.

In the new study, published in the June 15 issue of the American Journal of Respiratory and Critical Care Medicine, the compound α-CbT dampened the expression of nicotine receptors and increased apoptosis, prolonging the lives of the mice.

"This research clearly has profound clinical implications regarding the role of nicotine in stimulating lung cancer and nicotine receptor antagonists in treating the disease," said Dr. John Heffner, past president of the American Thoracic Society, in a news release from the society. Heffner, who was not involved in the research, added, "The highly addictive nature of nicotine, however, complicates patients' ability to quit smoking and avoid ongoing nicotine exposure."

Previous research has shown that it's possible to dampen the response of nicotine acetylcholine receptors (nAChRs) using an antagonist called d-tubocurarine/α-Cobratoxin (α-CbT), which specifically targeted the area most linked to increased cell growth.

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Clinical Trials Update: June 15, 2009: Chronic Obstructive Pulmonary Disease (COPD)  

If you are a current or former smoker, at least 40 years old, and have been diagnosed with COPD, you may qualify for this study.

The research site is in Clearwater, Fla.

More information

Please see http://www.centerwatch.com/clinical-trials/listings/studylist.aspx?CatID=44.

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Antitobacco Activists Urge Graphic Cigarette Warnings  

Antitobacco activists have urged the government to put pictorial health warnings on cigarette packs to discourage smokers and deter children.

“There has been a health warning on cigarette packaging, but it’s in the written form, small and thus ineffective,” Husna Zahir, from the Indonesian Consumer Foundation, said at a discussion held by the Tobacco Control Support Center.

“The existing warning on the packaging is not able to fight aggressive advertising and sponsorship by cigarette producers, particularly toward young people.”

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Study Shows Smokers Averse To Gory Picture Warnings  

Pictorial health warnings on cigarette packs can help discourage more people from picking up the habit, a public health expert said on Tuesday, citing the results of a recently released study.

Rita Damayanti, a researcher from the University of Indonesia’s School of Public Health, said they found that smokers, when asked to pick from three different pictures depicting the dangers of smoking, tended not to pick the one showing the gory details of smoking’s effects.

“Such a picture on the package of cigarettes may help discourage smoking,” she said. “When we showed [respondents] some pictures, only 34 percent of smokers chose the awful picture of a person suffering from tobacco-related ailments such as cancer, while 41 percent of the nonsmokers chose it.”

The study showed the pictures to 1,239 respondents from Jakarta and Cirebon.

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Obama’s remarks to AMA 

Presidents have called for health care reform for nearly a century. Teddy Roosevelt called for it. Harry Truman called for it. Richard Nixon called for it. Jimmy Carter called for it. Bill Clinton called for it. But while significant individual reforms have been made – such as Medicare, Medicaid, and the children’s health insurance program – efforts at comprehensive reform that covers everyone and brings down costs have largely failed.

Despite this long history of failure, I am standing here today because I think we are in a different time. One sign that things are different is that just this past week, the Senate passed a bill that will protect children from the dangers of smoking – a reform the AMA has long championed – and one that went nowhere when it was proposed a decade ago. What makes this moment different is that this time – for the first time – key stakeholders are aligning not against, but in favor of reform. They are coming together out of a recognition that while reform will take everyone in our health care community doing their part, ultimately, everyone will benefit.

And I want to commend the AMA, in particular, for offering to do your part to curb costs and achieve reform. . . .

The second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place. That starts with each of us taking more responsibility for our health and the health of our children. It means quitting smoking, going in for that mammogram or colon cancer screening. It means going for a run or hitting the gym, and raising our children to step away from the video games and spend more time playing outside.

It also means cutting down on all the junk food

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Bud Chiles: Crist has 'betrayed' needy children, old people by raiding fund  

The son of Gov. Lawton Chiles said today Gov. Charlie Crist has "betrayed" needy children and old people by raiding a tobacco-funded trust fund for $700 million needed to balance Florida's budget.

Lawton "Bud" Chiles was joined at a news conference by U.S. Sen. Bill Nelson, who said the practice of dipping into a wide range of specialized trust funds has got to stop.

Nelson, a former state treasurer who served with the senior Chiles, said it's a betrayal of public trust to collect money for one purpose and then spend it for another.

Gov. Chiles famously slipped some financial amendments through the Legislature in the late days of a session, stripping the tobacco industry of key defenses in a liability lawsuit the state filed to recover costs of medical treatment for indigent smokers.

The state reaped billions of dollars in settlement money from the lawsuit and in 1999, then-Gov. Jeb Bush publicly announced creation of the Lawton Chiles Fund to use part of the tobacco money for a perpetual source of market earnings to finance health care and anti-smoking education programs.

Chiles and Nelson said some obscure budget language in the 2009 legislative session allows Crist to raid the fund for $700 million today.

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News Review From Harvard Medical School -- Congress Passes Bill To Regulate Tobacco  

What Is the Doctor's Reaction?

We have known that smoking is a danger to health for a very long time. . . .

What Changes Can I Make Now?

Don't smoke. If you do smoke, quit. We know the health risks of smoking. It causes about one-fifth of all deaths each year in the United States. . . .

What Can I Expect Looking to the Future?

The FDA finally has the authority to control tobacco products. I think the FDA should make it very difficult to attract young people to cigarettes and chewing tobacco. We need to see a decline in new young smokers. This could save children from the health problems that come from tobacco.

I believe we will see strict limits on advertising tobacco to children. I hope we also will see rules limiting tobacco companies from making products designed to appeal to young people. These should all lead to fewer new smokers.

In addition, I hope members of Congress will now pass other laws to limit smoking. They could make all workplaces smoke-free. This can protect workers from secondhand smoke.

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Tobacco tax hike proposed: Guam voters could ratify proposal at a referendum 

A bill introduced yesterday would allow Guam voters to decide if a tax on cigarettes should increase to $1.50 a pack.

Bill 150, introduced by Vice Speaker Benjamin Cruz, would increase the local tax on cigarettes, cigars, chewing tobacco and other tobacco products. The current $1 tax on a pack of cigarettes would increase by 50 cents. The current 25-cent tax on a tin of chewing tobacco would increase sixfold to $1.50 a tin.

If the bill becomes law, the new tax would take effect 30 days after it's ratified by Guam voters in a referendum during the 2010 General Election, according to the legislation.

About one out of every three people on Guam smoke cigarettes, giving the island the highest smoking rate in the nation

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Research network aims to tackle chronic disease in developing world  

A worldwide network of research and training centres that aims to reduce the increasing burden of chronic disease has been set up in 11 low and middle income countries.

The Centers of Excellence research network is the result of collaboration between the National Heart, Lung, and Blood Institute (NHLBI), one of the National Institutes of Health, and UnitedHealth Group, the Minnesota based managed healthcare company.

"There is a pandemic of chronic disease sweeping through lower income countries but so far most of the aid has gone towards tackling AIDS, tuberculosis, malaria, and maternal and child health," said Richard Smith, director of UnitedHealth Group's chronic disease initiative.

"The reality is that 80% of chronic disease related deaths occur in low and middle income countries," said Elizabeth Nabel, director of the NHLBI. She told the BMJ, "This is due to a complex group of factors, such as the adoption of Western . . .

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