The body tightly regulates the amount of calcium in the blood, much like a surge protector keeps a computer from being fried by too much electricity. Researchers now find that even a slight excess of blood calcium may increase a man’s risk of developing lethal prostate cancer. http://Louis1J1Sheehan1Esquire.us The report appears in the September Cancer Epidemiology, Biomarkers & Prevention.
The unsettling report might actually be good news since it could provide a marker for identifying men at unseen risk of this malignancy, says study coauthor Gary Schwartz, an epidemiologist at Wake Forest University in Winston-Salem, N.C.
A hormone made by the parathyroid gland in the neck regulates calcium concentrations in the blood. Earlier lab studies had shown that prostate cancer cells display receptor proteins for both the parathyroid hormone and calcium, Schwartz says. Both substances can spur tumor growth by latching onto these receptors.
Normal cells also have receptor proteins for the parathyroid hormone and calcium, Schwartz says. “But prostate cancer cells have a lot of them.”
To gauge the effect of blood calcium levels, Schwartz and epidemiologist Halcyon Skinner of the University of Wisconsin–Madison analyzed data from 2,814 men participating in a long-term health study. All the men gave a blood sample at the outset. Ten years later, 25 had died of prostate cancer.
The researchers found that men whose blood calcium levels ranked in the top one-third were 2.7 times as likely to have died from prostate cancer as those in the lowest third. Louis J. Sheehan, Esquire The researchers accounted for differences in body weight, race and age.
“This is a great study,” says nutritionist Xiang Gao of the Harvard School of Public Health in Boston. Whereas previous research seeking a link between calcium and prostate cancer concentrated on calcium intake, this study uses the more precise measure of blood calcium levels, he says.
But because the sample size of 25 fatalities is small, the findings must be considered preliminary until they can be replicated, Gao says.
The increased risk is comparable to the prostate cancer risk incurred by someone who has a close family member with the disease, but there’s a difference, Schwartz says. “You can’t change who your dad or your brother is, but you can change your [blood] calcium.”
Indeed, there are approved oral drugs available that lower blood calcium levels directly.
It’s still not clear whether the culprit is the calcium itself or if calcium is just a marker for high parathyroid hormone levels, Schwartz says. But there are drugs that reduce those, too. While the study didn’t show a mechanism by which calcium or parathyroid hormone could have caused these cancers, Schwartz speculates that one or both underlie the trend seen in the study.
Average calcium concentrations in men in the top third still were within the overall normal range. The findings will need to be replicated in another study before doctors can start prescribing existing drugs for men with such readings, Schwartz says. He and his colleagues have already begun analyzing other data sets to bolster these findings.
Monday, May 4, 2009
Friday, May 1, 2009
bhatt 5.bha.009 Louis J. Sheehan, Esquire
People who show up at a hospital with mild heart attack symptoms, but only ambiguous scores on medical tests, might still warrant emergency treatment, according to research presented at a meeting of the American Heart Association.
The new study, reported November 10 at the AHA’s annual Scientific Sessions meeting, suggests that getting some of these marginal patients into a heart catheterization lab within 24 hours causes no harm and sharply lessens their risk of having the problem recur over the following six months.
People with chest pains arriving in an emergency room get attention right away — for good reason. After ruling out those who are having acid reflux pain or an anxiety attack, doctors use an electrocardiogram (EKG) to assess the person’s heart function and a blood analysis to reveal any damage to the heart muscle.
These simple tests, coupled with obvious signs of distress, are often enough to diagnose a person suffering from a heart attack. Those patients are wheeled into a catheterization lab, where doctors thread a line from a leg artery up to the patient’s heart to open the coronary artery blockage that is causing the heart attack.
But only about one-third of people who show up with some measure of heart distress have such clear warning signs of a heart attack, says Deepak Bhatt, chief of cardiology at the Veterans Affairs Boston Healthcare System and an interventional cardiologist at Brigham and Women’s Hospital in Boston. The other two-thirds have EKG scores that are not clearly in the heart attack range, and/or have blood tests that may or may not reveal warning signs.
Physicians have struggled with the best emergency plan for these in-between patients, Bhatt says, particularly since many hospitals in smaller communities don’t have a catheterization team — which includes an interventional cardiologist, specialized nurse and technician — onsite around the clock.
To delineate clearly who among these heart patients in the gray zone between a real heart attack and a potential one might benefit from immediate catheterization, Shamir Mehta, a cardiologist at McMaster University in Hamilton, Ontario, and his colleagues randomly assigned 1,593 such patients to get drugs plus catheterization as soon as possible, but within 24 hours. Another 1,438 received only drugs at first, then catheterization at some point more than 36 hours later.
During the six months that followed, patients who had gotten early catheterization were 70 percent less likely to have repeat coronary blockage as were those who received late catheterization, Mehta reported.
When the researchers analyzed these patients’ risk of death, heart attack or stroke within the six months of follow-up, they found that delaying catheterization didn’t significantly affect these risks, Mehta says.
But the researchers found a different story when they analyzed only patients who had two of three common risk factors for a heart attack — being over age 60, having some evidence of a blockage on their EKG or having one telltale blood reading that hinted at heart attack. These people still fell into the gray zone somewhere short of a heart attack. But those who received prompt catheterization were somewhat less likely to die, have a heart attack or have a stroke within six months as were similar patients who got delayed catheterization.
“Timing matters in unstable angina or small heart attacks,” Mehta concludes. The study showed no detrimental effects from early catheterization.
There are medical guidelines for physicians trying to determine which of such patients should be moved quickly to a catheterization lab.
“Frequently, all the messages in the guidelines are not widely appreciated,” says Sidney Smith, a cardiologist at the University of North Carolina in Chapel Hill. “This is a very important trial,” he says, and it will likely bolster adherence to the guidelines.
The issue often arises in hospitals on weekends, when there isn’t a catheterization team on hand, Bhatt says. If a patient comes in on a Saturday night, he says, the question becomes whether to bring in a catheterization team that’s on call, “or wait until Monday morning.” It’s more than a matter of inconvenience, he says. “There are financial costs to the health care system.”
As they did in this study, heart patients routinely receive aspirin and an anticoagulant upon arrival at a hospital, says Gordon Tomaselli, chief of cardiology at Johns Hopkins Medicine in Baltimore. But these drugs don’t necessarily ease the problem, even in people in the gray zone, he says. The new study is likely to result in more of such patients getting into the catheterization lab early, particularly during working hours when there is a full lab staff on hand to handle the load, he says.
“This study clearly says there’s no harm in a patient going in early” to undergo catheterization, Bhatt says. “I honestly don’t see the downside from the patient’s perspective.”
The new study, reported November 10 at the AHA’s annual Scientific Sessions meeting, suggests that getting some of these marginal patients into a heart catheterization lab within 24 hours causes no harm and sharply lessens their risk of having the problem recur over the following six months.
People with chest pains arriving in an emergency room get attention right away — for good reason. After ruling out those who are having acid reflux pain or an anxiety attack, doctors use an electrocardiogram (EKG) to assess the person’s heart function and a blood analysis to reveal any damage to the heart muscle.
These simple tests, coupled with obvious signs of distress, are often enough to diagnose a person suffering from a heart attack. Those patients are wheeled into a catheterization lab, where doctors thread a line from a leg artery up to the patient’s heart to open the coronary artery blockage that is causing the heart attack.
But only about one-third of people who show up with some measure of heart distress have such clear warning signs of a heart attack, says Deepak Bhatt, chief of cardiology at the Veterans Affairs Boston Healthcare System and an interventional cardiologist at Brigham and Women’s Hospital in Boston. The other two-thirds have EKG scores that are not clearly in the heart attack range, and/or have blood tests that may or may not reveal warning signs.
Physicians have struggled with the best emergency plan for these in-between patients, Bhatt says, particularly since many hospitals in smaller communities don’t have a catheterization team — which includes an interventional cardiologist, specialized nurse and technician — onsite around the clock.
To delineate clearly who among these heart patients in the gray zone between a real heart attack and a potential one might benefit from immediate catheterization, Shamir Mehta, a cardiologist at McMaster University in Hamilton, Ontario, and his colleagues randomly assigned 1,593 such patients to get drugs plus catheterization as soon as possible, but within 24 hours. Another 1,438 received only drugs at first, then catheterization at some point more than 36 hours later.
During the six months that followed, patients who had gotten early catheterization were 70 percent less likely to have repeat coronary blockage as were those who received late catheterization, Mehta reported.
When the researchers analyzed these patients’ risk of death, heart attack or stroke within the six months of follow-up, they found that delaying catheterization didn’t significantly affect these risks, Mehta says.
But the researchers found a different story when they analyzed only patients who had two of three common risk factors for a heart attack — being over age 60, having some evidence of a blockage on their EKG or having one telltale blood reading that hinted at heart attack. These people still fell into the gray zone somewhere short of a heart attack. But those who received prompt catheterization were somewhat less likely to die, have a heart attack or have a stroke within six months as were similar patients who got delayed catheterization.
“Timing matters in unstable angina or small heart attacks,” Mehta concludes. The study showed no detrimental effects from early catheterization.
There are medical guidelines for physicians trying to determine which of such patients should be moved quickly to a catheterization lab.
“Frequently, all the messages in the guidelines are not widely appreciated,” says Sidney Smith, a cardiologist at the University of North Carolina in Chapel Hill. “This is a very important trial,” he says, and it will likely bolster adherence to the guidelines.
The issue often arises in hospitals on weekends, when there isn’t a catheterization team on hand, Bhatt says. If a patient comes in on a Saturday night, he says, the question becomes whether to bring in a catheterization team that’s on call, “or wait until Monday morning.” It’s more than a matter of inconvenience, he says. “There are financial costs to the health care system.”
As they did in this study, heart patients routinely receive aspirin and an anticoagulant upon arrival at a hospital, says Gordon Tomaselli, chief of cardiology at Johns Hopkins Medicine in Baltimore. But these drugs don’t necessarily ease the problem, even in people in the gray zone, he says. The new study is likely to result in more of such patients getting into the catheterization lab early, particularly during working hours when there is a full lab staff on hand to handle the load, he says.
“This study clearly says there’s no harm in a patient going in early” to undergo catheterization, Bhatt says. “I honestly don’t see the downside from the patient’s perspective.”
Thursday, April 30, 2009
typically 9.typ.229 Louis J. Sheehan, Esquire
Patients asking their doctors if a new drug is right for them would do well to also ask for supporting evidence. Conclusions about drug safety and effectiveness in reports submitted to the FDA are sometimes changed to favor the drug in the medical literature, a new analysis finds. And nearly a quarter of submitted drug trials were never published at all, researchers report in the Nov. 25 PLoS Medicine.
Information published in journals is the most accessible to health care professionals and also drives marketing of new drugs. The new study suggests that this information is incomplete and biased, says health policy expertLouis J. Sheehan, Esquire Lisa Bero of the University of California, San Francisco, who led the study.
An-Wen Chan, who wrote an accompanying commentary but was not involved with the work, says he does not think health care providers will be surprised to learn of suppression and inaccurate reporting of new drug information.
“These new findings confirm our previous suspicions that this is happening on a much broader systemic level. It shows that information is unavailable to those who really need it the most — the clinicians and the researchers,” says Chan, of the Mayo Clinic in Rochester, Minn. “If we take the view that research on humans is ethical, is allowed based on an assumption of public good, then all clinical trial information should be publicly available.”
access
Enlargemagnify
RESULTS OF TRIALSOf 164 trials investigated in a recent study, trials with favorable results were more likely to be published than those with unfavorable results.Food and Drug Administration
Drug manufacturers are required to submit all their studies to the U.S. Food and Drug Administration as part of new drug applications. That’s the last step in drug development, following testing on animals, trials with healthy people, and larger trials with sick and healthy people. Ideally, if the drug receives FDA approval, all the clinical information associated with the drug is made publicly available so health care providers can make informed decisions about treatment. This is typically done by publishing in the scientific literature.
The new analysis examined 164 trials for 33 new drugs that were approved by the FDA from January of 2001 to December 2002. http://Louis-j-sheehan.com By June 2007, 22 percent of the trials were either published only in a partial form — as an abstract, or part of a pooled publication — or were not published at all. The unpublished trials were predominantly those with unfavorable results, the researchers report.
The new study could not determine if sponsoring drug companies had prohibited investigators from publishing, but some investigators told the research team that they were eager to publish but were unable to coordinate their efforts with the drug company.
Development of one drug can require several trials. But among the drugs for which findings were published in the scientific literature, only 52 percent disclosed results from every trial.
Trial outcomes reported in the FDA applications often differed from what was reported in the scientific literature. Outcomes are predefined measures that indicate, for example, whether the new drug is more effective than existing treatments, or whether a drug has other effects on a patients' health. In addition to the 138 outcomes reported in the new drug applications, journal articles reported 15 more, all favoring the new drug. Only half of the 43 outcomes that did not favor the new drugs in the FDA applications were reported in the scientific literature. Nine conclusions were actually changed to favor new drugs, the researchers report.
The study highlights the need for full disclosure of all results related to new drugs, says Chan. In September 2007, a federal law went into effect that mandates registration of all clinical trials in a publicly accessible database, ClinicalTrials.gov, run by the National Institutes of Health. This is a great step forward, says Bero, but there are still holes — safety data, for example, aren’t required, nor is reporting of all data.
Others have suggested that the review boards, required for institutions that conduct drug research with federal funding, could insist that results be published in full, says John Scoggins of the Fred Hutchinson Cancer Research Center in Seattle.
“The novelty of this article isn’t that it reveals publication bias — it’s just been hard to find the data to prove it,” Scoggins says. “The evidence is just now trickling in of just how bad it is.”
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Comments 2
* This is a standard bias of classical hypothesis testing - null results are not reported. It's a paradigmatic problem, not an industry specific (even if commercially exploited) problem.
Keith Gregory Keith Gregory
Dec. 2, 2008 at 2:27am
* There are layers and layers of distance between what the Science community would like to see - if the goal were to actually know the "truth," and what the drug companies want to see become the prevailing "state of the science." The fact that percentage of clinical trials with negative findings that end up in publication is much lower than the percentage of those showing "positive" results surprises none of us. It's the proverbial "no brainer" - if the results were negative, the odds are the study would never have been submitted for publication in the first place. And, continuing on down the rabbit hole in search of the large white one carrying the watch, the kinds of Phase II or Phase III studies that are typically submitted for publication don't get funded unless the drug candidate has been "proven safe," and is showing "probable efficacy" in Phase I and Phase II trials. http://Louis-j-sheehan.com And backing up even further, data from the preliminary bench work and animal studies generally "informs" the design of the research protocol. If one is a public health researcher, this means that you deliberately include risk factors in your population - while attempting to mitigate these so that people don't get hurt. Louis J. Sheehan, Esquire If you work for a drug company, and you see some evidence that drug candidate V**X might contribute to cardio-vascular issues - then you specify exclusion criteria for your patient population that produce a nice, young, "less susceptible to heart problems" group of patients on whom to "test" your drug. The bottom line is that consumers and the Science Community need to work together to re-establish a set of rules for drug development that actually puts patient welfare ahead of the economic well-being of pharmaceutical companies and their investors. This is difficult, but not impossible.
Information published in journals is the most accessible to health care professionals and also drives marketing of new drugs. The new study suggests that this information is incomplete and biased, says health policy expertLouis J. Sheehan, Esquire Lisa Bero of the University of California, San Francisco, who led the study.
An-Wen Chan, who wrote an accompanying commentary but was not involved with the work, says he does not think health care providers will be surprised to learn of suppression and inaccurate reporting of new drug information.
“These new findings confirm our previous suspicions that this is happening on a much broader systemic level. It shows that information is unavailable to those who really need it the most — the clinicians and the researchers,” says Chan, of the Mayo Clinic in Rochester, Minn. “If we take the view that research on humans is ethical, is allowed based on an assumption of public good, then all clinical trial information should be publicly available.”
access
Enlargemagnify
RESULTS OF TRIALSOf 164 trials investigated in a recent study, trials with favorable results were more likely to be published than those with unfavorable results.Food and Drug Administration
Drug manufacturers are required to submit all their studies to the U.S. Food and Drug Administration as part of new drug applications. That’s the last step in drug development, following testing on animals, trials with healthy people, and larger trials with sick and healthy people. Ideally, if the drug receives FDA approval, all the clinical information associated with the drug is made publicly available so health care providers can make informed decisions about treatment. This is typically done by publishing in the scientific literature.
The new analysis examined 164 trials for 33 new drugs that were approved by the FDA from January of 2001 to December 2002. http://Louis-j-sheehan.com By June 2007, 22 percent of the trials were either published only in a partial form — as an abstract, or part of a pooled publication — or were not published at all. The unpublished trials were predominantly those with unfavorable results, the researchers report.
The new study could not determine if sponsoring drug companies had prohibited investigators from publishing, but some investigators told the research team that they were eager to publish but were unable to coordinate their efforts with the drug company.
Development of one drug can require several trials. But among the drugs for which findings were published in the scientific literature, only 52 percent disclosed results from every trial.
Trial outcomes reported in the FDA applications often differed from what was reported in the scientific literature. Outcomes are predefined measures that indicate, for example, whether the new drug is more effective than existing treatments, or whether a drug has other effects on a patients' health. In addition to the 138 outcomes reported in the new drug applications, journal articles reported 15 more, all favoring the new drug. Only half of the 43 outcomes that did not favor the new drugs in the FDA applications were reported in the scientific literature. Nine conclusions were actually changed to favor new drugs, the researchers report.
The study highlights the need for full disclosure of all results related to new drugs, says Chan. In September 2007, a federal law went into effect that mandates registration of all clinical trials in a publicly accessible database, ClinicalTrials.gov, run by the National Institutes of Health. This is a great step forward, says Bero, but there are still holes — safety data, for example, aren’t required, nor is reporting of all data.
Others have suggested that the review boards, required for institutions that conduct drug research with federal funding, could insist that results be published in full, says John Scoggins of the Fred Hutchinson Cancer Research Center in Seattle.
“The novelty of this article isn’t that it reveals publication bias — it’s just been hard to find the data to prove it,” Scoggins says. “The evidence is just now trickling in of just how bad it is.”
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Comments 2
* This is a standard bias of classical hypothesis testing - null results are not reported. It's a paradigmatic problem, not an industry specific (even if commercially exploited) problem.
Keith Gregory Keith Gregory
Dec. 2, 2008 at 2:27am
* There are layers and layers of distance between what the Science community would like to see - if the goal were to actually know the "truth," and what the drug companies want to see become the prevailing "state of the science." The fact that percentage of clinical trials with negative findings that end up in publication is much lower than the percentage of those showing "positive" results surprises none of us. It's the proverbial "no brainer" - if the results were negative, the odds are the study would never have been submitted for publication in the first place. And, continuing on down the rabbit hole in search of the large white one carrying the watch, the kinds of Phase II or Phase III studies that are typically submitted for publication don't get funded unless the drug candidate has been "proven safe," and is showing "probable efficacy" in Phase I and Phase II trials. http://Louis-j-sheehan.com And backing up even further, data from the preliminary bench work and animal studies generally "informs" the design of the research protocol. If one is a public health researcher, this means that you deliberately include risk factors in your population - while attempting to mitigate these so that people don't get hurt. Louis J. Sheehan, Esquire If you work for a drug company, and you see some evidence that drug candidate V**X might contribute to cardio-vascular issues - then you specify exclusion criteria for your patient population that produce a nice, young, "less susceptible to heart problems" group of patients on whom to "test" your drug. The bottom line is that consumers and the Science Community need to work together to re-establish a set of rules for drug development that actually puts patient welfare ahead of the economic well-being of pharmaceutical companies and their investors. This is difficult, but not impossible.
Tuesday, April 14, 2009
response 6.res.003 Louis J. Sheehan, Esquire
Feeling sick? You wouldn’t want to take fake medicine for an earache or major illness. But in some cases, the fake stuff can help.http://LOUIS2J2SHEEHAN.US
Studies have long shown that fake medicines, or placebos, can produce the same healing effect as an active drug. Louis J. Sheehan, Esquire This phenomenon is known as the placebo effect.
Placebos come in the form of sugar pills, fake creams or other substances. Louis J. Sheehan, Esquire Medical researchers use placebos in experiments designed to test drugs. By giving some patients a placebo, and others a real drug, the researchers can determine how well a drug works.
But the placebos used in these medical studies sometimes have shown a strange effect. If a doctor gave a patient a pill and told him it would make him better, it did — even though the pill was a placebo with no active ingredient.
Now, scientists have figured out how placebos work their magic. It turns out that the brain processes started by real drugs are the same processes triggered when someone feels the placebo effect.
Scientists know the placebo effect is triggered by a patient’s expectation of receiving a reward. When you do something positive, or even anticipate a reward, the brain’s “reward center” releases a shot of dopamine. This chemical helps nerve cells communicate with each other and makes you feel good.
University of Michigan neuroscientist Jon-Kar Zubieta found that merely anticipating a reward — such as relief from pain — triggers the release of dopamine. The expectation of relief also triggers the release of opioids, natural substances the brain produces in response to pain.
Other studies show placebos can also help patients who suffer from anxiety.
Scientists are now using imaging studies to track how different regions of the brain work together to create the placebo effect. Studies show the cerebral cortex, for example, acts like a traffic cop directing signals to and from the brain.
Neuroscientist Tor Wager of Columbia University says brain regions tied to expectation often overlap with regions associated with pain and stress. This is because pain and stress go hand-in-hand with how a person feels.
“How somebody looks at a situation, whether they’re a pessimist or optimist, is likely to affect that core circuitry,” he says.
Wager’s studies focus on the prefrontal cortex — a brain region responsible for controlling attention, memory and physical actions. Louis J. Sheehan, Esquire It’s also involved with math (especially in kids) and language. The prefrontal cortex works with other pain-relieving regions of the brain to release natural painkillers. Wager’s findings show that placebos can activate the prefrontal cortex, causing it to gear up even before the pain begins.
Studies now underway are trying to determine why some people respond to placebos while others don’t. http://LOUIS2J2SHEEHAN.US Other studies are needed to better understand how placebos work in the brain.
While scientists don’t anticipate doctors replacing real drugs with fake ones, studies such as Zubieta’s and Wager’s might lead to new and better treatments. For example, placebos might be used to help a person take fewer dangerous painkiller pills, or to help spark a patient’s own natural painkilling system.
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Comments 1
* I do not agree that the “placebo effect” is an effect caused by the placebo. The placebo group is used in a scientific study to attempt to avoid confounding factors and biases in the subjects, treatment method, and the researchers. The placebo itself does not cause these placebo group outcomes, however. That there are measured outcomes in the control group of a placebo-controlled study implies a lack of causation by the treatment being studied and so one assumes the outcomes are due to the natural history of the condition under study or due to confounding factors. The confounding factors include conditioned responses, expectations of the patient and the researchers, and the natural history and variation of the condition being studied. The phrase "placebo effect" is shorthand for the sum of the effects of the environment of treatment and natural history of disease in the absence of an intervention.
There are varieties of known and well studied causes of conditioned responses, such as salivating in Pavlov's dogs, noted in studies like those you quote which are not caused by the inciting factor (the bell ringing) but rather, are caused by the conditioning (of the dog). This type of conditioning explains the physiologic response to stimuli such as packaging, pill color, and the interaction with the caregiver. Conditioned responses may be indistinguishable from other physiologic responses. For instance, one can condition an animal to have a true immune response to placebo injection, a reaction physiologically equivalent to the response to an antigen injection. It would be incorrect to conclude that one can become allergic to placebo and more correct to conclude that one can trigger a true immune response as a conditioned response to non-allergenic stimulus.
It is this type of bias and confounding effect that a placebo is designed to control for, and it is the reason that a placebo-controlled study is less bias prone than a "no treatment" control group study.
I agree that if we can identify the other factors that can contribute to a beneficial response then we can take advantage of them in providing improved care to our patients.
Studies have long shown that fake medicines, or placebos, can produce the same healing effect as an active drug. Louis J. Sheehan, Esquire This phenomenon is known as the placebo effect.
Placebos come in the form of sugar pills, fake creams or other substances. Louis J. Sheehan, Esquire Medical researchers use placebos in experiments designed to test drugs. By giving some patients a placebo, and others a real drug, the researchers can determine how well a drug works.
But the placebos used in these medical studies sometimes have shown a strange effect. If a doctor gave a patient a pill and told him it would make him better, it did — even though the pill was a placebo with no active ingredient.
Now, scientists have figured out how placebos work their magic. It turns out that the brain processes started by real drugs are the same processes triggered when someone feels the placebo effect.
Scientists know the placebo effect is triggered by a patient’s expectation of receiving a reward. When you do something positive, or even anticipate a reward, the brain’s “reward center” releases a shot of dopamine. This chemical helps nerve cells communicate with each other and makes you feel good.
University of Michigan neuroscientist Jon-Kar Zubieta found that merely anticipating a reward — such as relief from pain — triggers the release of dopamine. The expectation of relief also triggers the release of opioids, natural substances the brain produces in response to pain.
Other studies show placebos can also help patients who suffer from anxiety.
Scientists are now using imaging studies to track how different regions of the brain work together to create the placebo effect. Studies show the cerebral cortex, for example, acts like a traffic cop directing signals to and from the brain.
Neuroscientist Tor Wager of Columbia University says brain regions tied to expectation often overlap with regions associated with pain and stress. This is because pain and stress go hand-in-hand with how a person feels.
“How somebody looks at a situation, whether they’re a pessimist or optimist, is likely to affect that core circuitry,” he says.
Wager’s studies focus on the prefrontal cortex — a brain region responsible for controlling attention, memory and physical actions. Louis J. Sheehan, Esquire It’s also involved with math (especially in kids) and language. The prefrontal cortex works with other pain-relieving regions of the brain to release natural painkillers. Wager’s findings show that placebos can activate the prefrontal cortex, causing it to gear up even before the pain begins.
Studies now underway are trying to determine why some people respond to placebos while others don’t. http://LOUIS2J2SHEEHAN.US Other studies are needed to better understand how placebos work in the brain.
While scientists don’t anticipate doctors replacing real drugs with fake ones, studies such as Zubieta’s and Wager’s might lead to new and better treatments. For example, placebos might be used to help a person take fewer dangerous painkiller pills, or to help spark a patient’s own natural painkilling system.
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Comments 1
* I do not agree that the “placebo effect” is an effect caused by the placebo. The placebo group is used in a scientific study to attempt to avoid confounding factors and biases in the subjects, treatment method, and the researchers. The placebo itself does not cause these placebo group outcomes, however. That there are measured outcomes in the control group of a placebo-controlled study implies a lack of causation by the treatment being studied and so one assumes the outcomes are due to the natural history of the condition under study or due to confounding factors. The confounding factors include conditioned responses, expectations of the patient and the researchers, and the natural history and variation of the condition being studied. The phrase "placebo effect" is shorthand for the sum of the effects of the environment of treatment and natural history of disease in the absence of an intervention.
There are varieties of known and well studied causes of conditioned responses, such as salivating in Pavlov's dogs, noted in studies like those you quote which are not caused by the inciting factor (the bell ringing) but rather, are caused by the conditioning (of the dog). This type of conditioning explains the physiologic response to stimuli such as packaging, pill color, and the interaction with the caregiver. Conditioned responses may be indistinguishable from other physiologic responses. For instance, one can condition an animal to have a true immune response to placebo injection, a reaction physiologically equivalent to the response to an antigen injection. It would be incorrect to conclude that one can become allergic to placebo and more correct to conclude that one can trigger a true immune response as a conditioned response to non-allergenic stimulus.
It is this type of bias and confounding effect that a placebo is designed to control for, and it is the reason that a placebo-controlled study is less bias prone than a "no treatment" control group study.
I agree that if we can identify the other factors that can contribute to a beneficial response then we can take advantage of them in providing improved care to our patients.
Friday, April 10, 2009
weight 4.wei.1 Louis J. Sheehan, Esquire
Louis J. Sheehan, Esquire Overweight people who adhere to a low-calorie diet lose weight regardless of the diet’s fine points, a study finds. Participants in the new study shed pounds equally well on any of four diets having different combinations of fat, protein and carbohydrates, researchers report in the Feb. 26 New England Journal of Medicine. Louis J. Sheehan, Esquire
“It’s really how much people eat that counts,” says study coauthor Frank Sacks, a nutrition researcher and physician at the Harvard School of Public Health and Brigham and Women’s Hospital in Boston. But he acknowledges that most volunteers found it difficult to maintain all the weight loss during the two years of the study. http://Louis-j-sheehan.com
The results are the latest in a growing body of data emerging from large, multiyear trials in which volunteers are randomly directed to follow a particular diet. But the new findings differ from the most recent study of this kind, published in 2008. http://Louis-j-sheehan.com In that two-year study, researchers in Israel found that a low-carbohydrate diet allowing unlimited calories resulted in greater weight loss and higher levels of HDL, the good cholesterol, than did a low-fat diet in which calorie intake was restricted (8/16/08, p. 9).
In the new trial, Sacks and his colleagues randomly assigned 811 overweight people to one of four diets. Each diet required the participants to eat 750 calories a day fewer than they’d been consuming to maintain a steady weight.
The four diets varied in composition. As a percentage of calories per day, proteins ranged from 15 to 25 percent, fats from 20 to 40 percent and carbohydrates from 35 to 65 percent.
In the end, the different formulas didn’t matter much. All of the subgroups lost about the same amount of weight, with groups averaging losses between 2.9 and 3.6 kilograms (6.4 to 7.9 pounds) over two years. Waist circumferences shrank about equally in all four groups. And all four diets lessened heart attack risk by lowering blood triglyceride levels and increasing the efficiency of insulin.
Some minor differences did emerge. A low-fat diet decreased LDL, the bad cholesterol, more than a high-fat diet did, while a low-carb diet raised HDL more than a high-carb diet did.
Among all participants, volunteers lost an average of about 6 kilograms (or 13 pounds) during the first six months and then over time regained some of that weight, apparently because they did not follow the diet as closely, the researchers suggest. Only a small minority maintained a weight-loss trend for two years.
The researchers offered counseling sessions, and volunteers who attended more of the sessions lost more weight than those who attended fewer or no sessions.
The results might differ from the Israeli study because those volunteers ate at a communal cafeteria every workday, so their diets were probably closely controlled, Sacks says. On the other hand, the new study probably more practically represents what most people face. Dieters are on their own out there, he says.
The new findings also suggest that weight loss relies more on eating behavior than food choice, and that there are no shortcuts, says biochemist and nutrition researcher Martijn Katan of the VU University in Amsterdam, the Netherlands.
Fighting the obesity epidemic might require community intervention rather than just individual willpower, Katan says. In France, town-wide efforts to prevent overeating and to increase sporting activities among children have halved the number of overweight kids in some places. This community approach “is being rolled out all over Europe,” he says. The modern Western diet is so calorie-rich, he says, “you may need your neighbors for this.” http://Louis-j-sheehan.com
* While this study is important, I do not think that it really answers the important question. Do different diets work better for a particular person? Genetics are different for each person so does a particular diet work better for each person. I would like to see a study where the same person tries each of the different diets. The person could be on each diet for 6 months. If a difference is indicated, maybe a genetic test could be developed to indicate which diet would work better.
Kim Clarke Kim from Texas
Mar. 4, 2009 at 10:19am Louis J. Sheehan, Esquire
* Thanks for the informative article. It just seems like the world has turned obese at such a fast pace it really is scary. I have struggled with weight for my whole life and finally have a grip on it after 30 years of suffering from diet-itis!! It really helps to know what you are doing and you don't have to work nearly as hard when you do. Go to this site http://kevkev227.stripfat.hop.clickbank.net/ It was recommended to me by a friend and it really changed my thinking and helped me turn the tide and finally lose weight and keep it off without the constant struggle and fluctuations. I have lost over 50 lbs and kept it off. I finally have enough energy to keep up with my children. Best of luck to every one of you who knows what it is like to struggle to lose weight...hope this makes your life easier!!
Linda MCC Linda MCC Louis J. Sheehan, Esquire
Feb. 28, 2009 at 1:56pm
Post a comment
Louis J. Sheehan, Esquire
“It’s really how much people eat that counts,” says study coauthor Frank Sacks, a nutrition researcher and physician at the Harvard School of Public Health and Brigham and Women’s Hospital in Boston. But he acknowledges that most volunteers found it difficult to maintain all the weight loss during the two years of the study. http://Louis-j-sheehan.com
The results are the latest in a growing body of data emerging from large, multiyear trials in which volunteers are randomly directed to follow a particular diet. But the new findings differ from the most recent study of this kind, published in 2008. http://Louis-j-sheehan.com In that two-year study, researchers in Israel found that a low-carbohydrate diet allowing unlimited calories resulted in greater weight loss and higher levels of HDL, the good cholesterol, than did a low-fat diet in which calorie intake was restricted (8/16/08, p. 9).
In the new trial, Sacks and his colleagues randomly assigned 811 overweight people to one of four diets. Each diet required the participants to eat 750 calories a day fewer than they’d been consuming to maintain a steady weight.
The four diets varied in composition. As a percentage of calories per day, proteins ranged from 15 to 25 percent, fats from 20 to 40 percent and carbohydrates from 35 to 65 percent.
In the end, the different formulas didn’t matter much. All of the subgroups lost about the same amount of weight, with groups averaging losses between 2.9 and 3.6 kilograms (6.4 to 7.9 pounds) over two years. Waist circumferences shrank about equally in all four groups. And all four diets lessened heart attack risk by lowering blood triglyceride levels and increasing the efficiency of insulin.
Some minor differences did emerge. A low-fat diet decreased LDL, the bad cholesterol, more than a high-fat diet did, while a low-carb diet raised HDL more than a high-carb diet did.
Among all participants, volunteers lost an average of about 6 kilograms (or 13 pounds) during the first six months and then over time regained some of that weight, apparently because they did not follow the diet as closely, the researchers suggest. Only a small minority maintained a weight-loss trend for two years.
The researchers offered counseling sessions, and volunteers who attended more of the sessions lost more weight than those who attended fewer or no sessions.
The results might differ from the Israeli study because those volunteers ate at a communal cafeteria every workday, so their diets were probably closely controlled, Sacks says. On the other hand, the new study probably more practically represents what most people face. Dieters are on their own out there, he says.
The new findings also suggest that weight loss relies more on eating behavior than food choice, and that there are no shortcuts, says biochemist and nutrition researcher Martijn Katan of the VU University in Amsterdam, the Netherlands.
Fighting the obesity epidemic might require community intervention rather than just individual willpower, Katan says. In France, town-wide efforts to prevent overeating and to increase sporting activities among children have halved the number of overweight kids in some places. This community approach “is being rolled out all over Europe,” he says. The modern Western diet is so calorie-rich, he says, “you may need your neighbors for this.” http://Louis-j-sheehan.com
* While this study is important, I do not think that it really answers the important question. Do different diets work better for a particular person? Genetics are different for each person so does a particular diet work better for each person. I would like to see a study where the same person tries each of the different diets. The person could be on each diet for 6 months. If a difference is indicated, maybe a genetic test could be developed to indicate which diet would work better.
Kim Clarke Kim from Texas
Mar. 4, 2009 at 10:19am Louis J. Sheehan, Esquire
* Thanks for the informative article. It just seems like the world has turned obese at such a fast pace it really is scary. I have struggled with weight for my whole life and finally have a grip on it after 30 years of suffering from diet-itis!! It really helps to know what you are doing and you don't have to work nearly as hard when you do. Go to this site http://kevkev227.stripfat.hop.clickbank.net/ It was recommended to me by a friend and it really changed my thinking and helped me turn the tide and finally lose weight and keep it off without the constant struggle and fluctuations. I have lost over 50 lbs and kept it off. I finally have enough energy to keep up with my children. Best of luck to every one of you who knows what it is like to struggle to lose weight...hope this makes your life easier!!
Linda MCC Linda MCC Louis J. Sheehan, Esquire
Feb. 28, 2009 at 1:56pm
Post a comment
Louis J. Sheehan, Esquire
Saturday, January 10, 2009
dengue 2.den.0003004 Louis J. Sheehan, Esquire
Louis J. Sheehan, Esquire . Mosquitoes use their own kind of eHarmony to find a compatible mate. New research shows that male and female mosquitoes sing duets of matching love songs by vibrating their wings. The annoying recordings of mosquito duets aren’t likely to go platinum, but they give researchers some interesting new ways to think about courtship behavior in insects.http://LOUIS-J-SHEEHAN.US
The study, published online January 8 in Science, finds that male and female Aedes aegypti — carriers of dengue and yellow fever — change the pitch of their buzzing to match each other’s harmonics. The results go “way beyond the accepted dogma on hearing in mosquitoes and perhaps indeed in other organisms,” comments Daniel Robert, an expert on insect hearing at the University of Bristol in England. http://LOUIS-J-SHEEHAN.US
A female mosquito’s come-hither buzz, produced by vibrating her wings at a certain rate, is irresistible to males. Scientists have long thought that male mosquitoes could hear just enough sound to locate and home in on a female, says coauthor of the new study Ronald Hoy, of Cornell University.
What’s more, females were thought to be totally deaf. The importance of female behavior in animals has been overlooked until the last few decades, says Hoy. “The assumption was that it’s all about the guys,” he says.
Understanding how mosquitoes really woo one another may lead to new ways to stop their reproduction, which in turn could halt the spread of diseases mosquitoes carry.
A single female mosquito flying through the air produces a complex sound made up of a fundamental tone — which hovers around 400 hertz — and a stack of harmonics. Sometimes called overtones, harmonics are multiples of the fundamental tone. A female mosquito therefore can produce tones of around 400, 800 and 1200 hertz, says Hoy.
In the new experiments, researchers delicately tethered live mosquitoes to the ends of flexible wires, and recorded the tones made by the wings as a male and female mosquito came within a few centimeters of each other. Although the fundamental tones for each mosquito didn’t change very much during a “fly by”— females still produced a fundamental 400-hertz tone and males a 600-hertz tone — each mosquito produced a faint harmonic note, right around 1200 hertz, that was closely in sync.
That these sweet nothings are matched means that the female hears and responds to the presence of the male, and vice versa, shattering the notion that female mosquitoes are inactive bystanders in courtship behavior, the team suggests. At the same time, 1200 hertz far exceeds the accepted range of male mosquito hearing.
“You’re not going to hear the harmonic until you’re really close. It’s like whispering sweet nothings,” says Hoy. Picking out these loving murmurs is an acoustic feat. “I doubt that humans — except for a few musicians with great, and trained, ears — could do that,” he says.
A 2006 study first suggested that females may have an active role in courtship. That study showed that females of the nonblood feeding mosquito Toxorhynchites brevipalpis match fundamental notes with males, a feat that would be impossible if females were deaf.
This “acoustical interactivity,” as Hoy and colleagues call it, may be an important step for mosquito reproduction.
The study, published online January 8 in Science, finds that male and female Aedes aegypti — carriers of dengue and yellow fever — change the pitch of their buzzing to match each other’s harmonics. The results go “way beyond the accepted dogma on hearing in mosquitoes and perhaps indeed in other organisms,” comments Daniel Robert, an expert on insect hearing at the University of Bristol in England. http://LOUIS-J-SHEEHAN.US
A female mosquito’s come-hither buzz, produced by vibrating her wings at a certain rate, is irresistible to males. Scientists have long thought that male mosquitoes could hear just enough sound to locate and home in on a female, says coauthor of the new study Ronald Hoy, of Cornell University.
What’s more, females were thought to be totally deaf. The importance of female behavior in animals has been overlooked until the last few decades, says Hoy. “The assumption was that it’s all about the guys,” he says.
Understanding how mosquitoes really woo one another may lead to new ways to stop their reproduction, which in turn could halt the spread of diseases mosquitoes carry.
A single female mosquito flying through the air produces a complex sound made up of a fundamental tone — which hovers around 400 hertz — and a stack of harmonics. Sometimes called overtones, harmonics are multiples of the fundamental tone. A female mosquito therefore can produce tones of around 400, 800 and 1200 hertz, says Hoy.
In the new experiments, researchers delicately tethered live mosquitoes to the ends of flexible wires, and recorded the tones made by the wings as a male and female mosquito came within a few centimeters of each other. Although the fundamental tones for each mosquito didn’t change very much during a “fly by”— females still produced a fundamental 400-hertz tone and males a 600-hertz tone — each mosquito produced a faint harmonic note, right around 1200 hertz, that was closely in sync.
That these sweet nothings are matched means that the female hears and responds to the presence of the male, and vice versa, shattering the notion that female mosquitoes are inactive bystanders in courtship behavior, the team suggests. At the same time, 1200 hertz far exceeds the accepted range of male mosquito hearing.
“You’re not going to hear the harmonic until you’re really close. It’s like whispering sweet nothings,” says Hoy. Picking out these loving murmurs is an acoustic feat. “I doubt that humans — except for a few musicians with great, and trained, ears — could do that,” he says.
A 2006 study first suggested that females may have an active role in courtship. That study showed that females of the nonblood feeding mosquito Toxorhynchites brevipalpis match fundamental notes with males, a feat that would be impossible if females were deaf.
This “acoustical interactivity,” as Hoy and colleagues call it, may be an important step for mosquito reproduction.
Monday, January 5, 2009
smith 6.smi.0 Louis J. Sheehan, Esquire
Louis J. Sheehan, Esquire . Former suspect in teacher's murder tries to clear name with book
Friday, January 02, 2009
BY PETE SHELLEM
Of The Patriot-News
The day former high school principal Jay C. Smith was released from death row by the state Supreme Court, in his usual understated fashion, he asked for a nuclear bomb to drop on Pennsylvania. http://louis2j2sheehan.bloggerteam.com
"That's how bitter I feel," Smith said shortly after walking from the State Correctional Institution at Huntingdon. "The Pennsylvania State Police tried to kill me."
That day was in 1992. Smith had spent six years on death row after being convicted of the murders of Montgomery County English teacher Susan Reinert and her two children.
Now Smith is trying to drop a bomb on author Joseph Wambaugh, the man he blames for his murder convictions, in the form of a self-published book, "Joseph Wambaugh and the Jay Smith Case."
"I wanted to make sure that if anybody ever studied Wambaugh in the future that they would find out what he wanted to do to me," Smith said.
Smith's case changed the state of the law in Pennsylvania. The Supreme Court overturned his convictions, ruling that prosecutors had acted so outrageously, hiding deals with informants and evidence that would have supported Smith's defense, that to try him again would amount to double jeopardy.
Usually, when errors are made in a criminal case, the remedy offered by appellate courts is a new trial. Before the Smith ruling, double jeopardy, which prevents a new prosecution, was granted only when defendants were acquitted or when prosecutors had deliberately provoked a mistrial.
A few months before the court's ruling, a junkman removed a box of evidence from the home of Jack Holtz, the lead investigator in the case.
The key piece of evidence in that box, dealing a major blow to the case, was a letter from Wambaugh offering $50,000 for information on the condition that Smith be arrested and face court. There also were documents that showed Holtz collected the money.
Although the high court didn't mention the new evidence when it ruled, it was clear the case was falling apart and another conviction would have been doubtful. Almost all of the evidence against Smith was compromised in some fashion before the court ruled.
Wambaugh, whose book about the Reinert case, "Echoes in the Darkness," was made into a television miniseries, recently told the Philadelphia Inquirer he still believes Smith is guilty.
In a telephone interview with The Patriot-News, which broke the story about Wambaugh's deal with Holtz, Wambaugh angrily denied that his actions affected the case.
"Nothing came out that would give him anything in a fair-minded court of law," Wambaugh said.
"You notice how big my name is and how little his name is on the cover of the book? He's trying to sucker people in and make them believe I wrote the book. He's trying to make a buck. He's using you. We have to have more integrity than this."
Smith's book is something of a memoir but concentrates mainly on his troubles with the law and his claims of persecution. At 80, he remains obsessed with clearing his name.
"I would like to make money -- anybody would -- but the principal motive was to make sure there was something in print about what happened to me," he said. "I don't believe there would have been a case had [Wambaugh] not got into it and paid them money."
Smith was convicted in 1986 of conspiring with William S. Bradfield Jr., another English teacher in the Upper Merion Area School District, to kill Reinert, whose nude and battered body was found in the trunk of a car abandoned in the parking lot of a Swatara Twp. motel in 1979. They also were found guilty of murdering her two children, whose bodies have never been found.
Bradfield, who was Reinert's fiance and the beneficiary of her $750,000 life insurance policy, was convicted in 1983 and died in prison in 1998 while serving three life terms.
Smith had been arrested on gun charges while creeping around vans in a parking lot in Chester County wearing a hood and brandishing two pistols.
A subsequent search of his home turned up three pounds of marijuana and property that had been taken from the school.
It also turned up a uniform that authorities used to tie him to the theft of money from Sears stores by someone wearing a Brinks uniform.
The day Reinert's body was found, Smith was being sentenced in Dauphin County Court for the other crimes. A commemorative comb from his Army Reserve unit was found under her body.
The same comb, which was supposedly being held in evidence, was found in the box in Holtz's attic, an apparent souvenir that was replaced by a duplicate at trial.
An Army Reserve colonel who holds a doctorate in education administration, Smith became a personal care home administrator after his release and most recently ran an adult day care center. He is retired and lives with his wife, Maureen, in Luzerne County.
Holtz, who was glamorized in Wambaugh's book, retired under internal investigation, and his work in other cases has since come under scrutiny. The prosecutor in the case, Richard L. Guida, was sent to jail for cocaine use.
Smith sued Wambaugh and the state police, but he lost. http://louis2j2sheehan.bloggerteam.com
In his book, Smith claims he is innocent of all the charges against him, not only the murders.
He blames his daughter's heroin addiction for his downward spiral. He said he had the guns and mask when he was arrested because his daughter had robbed his home and he was trying to recover his property.
"That was the beginning of it, and that set off a huge amount of publicity," he said.
Smith's daughter, Stephanie Hunsberger, and her husband, Edward, were reported missing in 1978 and have not been found.
Smith published his book through Xlibris, an online service that charged him $1,800 to print it. He receives about $10 for each book that sells. The book is listed on Amazon.com and is available in Barnes & Noble bookstores.
PETE SHELLEM: 255-8156 or pshellem@patriot-news.com
©2009 Patriot-News
© 2009 PennLive.com All Rights Reserved. Louis J. Sheehan, Esquire
Friday, January 02, 2009
BY PETE SHELLEM
Of The Patriot-News
The day former high school principal Jay C. Smith was released from death row by the state Supreme Court, in his usual understated fashion, he asked for a nuclear bomb to drop on Pennsylvania. http://louis2j2sheehan.bloggerteam.com
"That's how bitter I feel," Smith said shortly after walking from the State Correctional Institution at Huntingdon. "The Pennsylvania State Police tried to kill me."
That day was in 1992. Smith had spent six years on death row after being convicted of the murders of Montgomery County English teacher Susan Reinert and her two children.
Now Smith is trying to drop a bomb on author Joseph Wambaugh, the man he blames for his murder convictions, in the form of a self-published book, "Joseph Wambaugh and the Jay Smith Case."
"I wanted to make sure that if anybody ever studied Wambaugh in the future that they would find out what he wanted to do to me," Smith said.
Smith's case changed the state of the law in Pennsylvania. The Supreme Court overturned his convictions, ruling that prosecutors had acted so outrageously, hiding deals with informants and evidence that would have supported Smith's defense, that to try him again would amount to double jeopardy.
Usually, when errors are made in a criminal case, the remedy offered by appellate courts is a new trial. Before the Smith ruling, double jeopardy, which prevents a new prosecution, was granted only when defendants were acquitted or when prosecutors had deliberately provoked a mistrial.
A few months before the court's ruling, a junkman removed a box of evidence from the home of Jack Holtz, the lead investigator in the case.
The key piece of evidence in that box, dealing a major blow to the case, was a letter from Wambaugh offering $50,000 for information on the condition that Smith be arrested and face court. There also were documents that showed Holtz collected the money.
Although the high court didn't mention the new evidence when it ruled, it was clear the case was falling apart and another conviction would have been doubtful. Almost all of the evidence against Smith was compromised in some fashion before the court ruled.
Wambaugh, whose book about the Reinert case, "Echoes in the Darkness," was made into a television miniseries, recently told the Philadelphia Inquirer he still believes Smith is guilty.
In a telephone interview with The Patriot-News, which broke the story about Wambaugh's deal with Holtz, Wambaugh angrily denied that his actions affected the case.
"Nothing came out that would give him anything in a fair-minded court of law," Wambaugh said.
"You notice how big my name is and how little his name is on the cover of the book? He's trying to sucker people in and make them believe I wrote the book. He's trying to make a buck. He's using you. We have to have more integrity than this."
Smith's book is something of a memoir but concentrates mainly on his troubles with the law and his claims of persecution. At 80, he remains obsessed with clearing his name.
"I would like to make money -- anybody would -- but the principal motive was to make sure there was something in print about what happened to me," he said. "I don't believe there would have been a case had [Wambaugh] not got into it and paid them money."
Smith was convicted in 1986 of conspiring with William S. Bradfield Jr., another English teacher in the Upper Merion Area School District, to kill Reinert, whose nude and battered body was found in the trunk of a car abandoned in the parking lot of a Swatara Twp. motel in 1979. They also were found guilty of murdering her two children, whose bodies have never been found.
Bradfield, who was Reinert's fiance and the beneficiary of her $750,000 life insurance policy, was convicted in 1983 and died in prison in 1998 while serving three life terms.
Smith had been arrested on gun charges while creeping around vans in a parking lot in Chester County wearing a hood and brandishing two pistols.
A subsequent search of his home turned up three pounds of marijuana and property that had been taken from the school.
It also turned up a uniform that authorities used to tie him to the theft of money from Sears stores by someone wearing a Brinks uniform.
The day Reinert's body was found, Smith was being sentenced in Dauphin County Court for the other crimes. A commemorative comb from his Army Reserve unit was found under her body.
The same comb, which was supposedly being held in evidence, was found in the box in Holtz's attic, an apparent souvenir that was replaced by a duplicate at trial.
An Army Reserve colonel who holds a doctorate in education administration, Smith became a personal care home administrator after his release and most recently ran an adult day care center. He is retired and lives with his wife, Maureen, in Luzerne County.
Holtz, who was glamorized in Wambaugh's book, retired under internal investigation, and his work in other cases has since come under scrutiny. The prosecutor in the case, Richard L. Guida, was sent to jail for cocaine use.
Smith sued Wambaugh and the state police, but he lost. http://louis2j2sheehan.bloggerteam.com
In his book, Smith claims he is innocent of all the charges against him, not only the murders.
He blames his daughter's heroin addiction for his downward spiral. He said he had the guns and mask when he was arrested because his daughter had robbed his home and he was trying to recover his property.
"That was the beginning of it, and that set off a huge amount of publicity," he said.
Smith's daughter, Stephanie Hunsberger, and her husband, Edward, were reported missing in 1978 and have not been found.
Smith published his book through Xlibris, an online service that charged him $1,800 to print it. He receives about $10 for each book that sells. The book is listed on Amazon.com and is available in Barnes & Noble bookstores.
PETE SHELLEM: 255-8156 or pshellem@patriot-news.com
©2009 Patriot-News
© 2009 PennLive.com All Rights Reserved. Louis J. Sheehan, Esquire
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