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Strained by Katrina, a Hospital Faced Deadly Choices

From The New York Times:

The smell of death was overpowering the moment a relief worker cracked open one of the hospital chapel’s wooden doors. Inside, more than a dozen bodies lay motionless on low cots and on the ground, shrouded in white sheets. Here, a wisp of gray hair peeked out. There, a knee was flung akimbo. A pallid hand reached across a blue gown.

Within days, the grisly tableau became the focus of an investigation into what happened when the floodwaters of Hurricane Katrina marooned Memorial Medical Center in Uptown New Orleans. The hurricane knocked out power and running water and sent the temperatures inside above 100 degrees. Still, investigators were surprised at the number of bodies in the makeshift morgue and were stunned when health care workers charged that a well-regarded doctor and two respected nurses had hastened the deaths of some patients by injecting them with lethal doses of drugs. Mortuary workers eventually carried 45 corpses from Memorial, more than from any comparable-size hospital in the drowned city.

Investigators pored over the evidence, and in July 2006, nearly a year after Katrina, Louisiana Department of Justice agents arrested the doctor and the nurses in connection with the deaths of four patients. The physician, Anna Pou, defended herself on national television, saying her role was to “help” patients “through their pain,” a position she maintains today.

In the four years since Katrina, Pou has helped write and pass three laws in Louisiana that offer immunity to health care professionals from most civil lawsuits — though not in cases of willful misconduct — for their work in future disasters, from hurricanes to terrorist attacks to pandemic influenza.

Pou and others cite what happened at Memorial and Pou’s subsequent arrest — which she has referred to as a “personal tragedy” — to justify changing the standards of care during crises. But the story of what happened in the frantic days when Memorial was cut off from the world has not been fully told. Over the past two and a half years, I have obtained previously unavailable records and interviewed dozens of people who were involved in the events at Memorial and the investigation that followed.

The interviews and documents cast the story of Pou and her colleagues in a new light. It is now evident that more medical professionals were involved in the decision to inject patients — and far more patients were injected — than was previously understood. When the names on toxicology reports and autopsies are matched with recollections and documentation from the days after Katrina, it appears that at least 17 patients were injected with morphine or the sedative midazolam, or both, after a long-awaited rescue effort was at last emptying the hospital. A number of these patients were extremely ill and might not have survived the evacuation. Several were almost certainly not near death when they were injected, according to medical professionals who treated them at Memorial and an internist’s review of their charts and autopsies that was commissioned by investigators but never made public.

After autopsies were done and specimens removed, workers at National Medical Services, a private laboratory in Pennsylvania, quickly detected morphine in nine bodies — the same nine patients LifeCare staff identified as potential victims.

A successful murder prosecution in Orleans Parish typically requires a coroner’s medical determination of homicide — that a death was caused by the actions of another human being — without regard to fault or legal responsibility. It is a step toward a criminal finding of homicide, in which a Louisiana court assigns fault for a killing.

Orleans Parish coroner, Dr. Frank Minyard, brought together Cyril Wecht, Michael Baden — another well-known forensic pathologist — and Robert Middleberg, the director of the toxicology laboratory where the autopsy samples were tested, to discuss the toxicology findings.

Records showed that more than half of the 41 bodies from Memorial that were analyzed by Middleberg’s lab tested positive for morphine or midazolam, or both. Middleberg had handled thousands of cases in his career, and the high drug concentrations found in many of the patients stuck out “like a sore thumb,” he told me.

The group considered the 90-year-old pneumonia patient Alice Hutzler, whom the LifeCare nurse Gina Isbell had promised to care for during the hurricane. Morphine and midazolam were found in her liver, brain and muscle tissue, but neither drug had been prescribed, according to her chart, which contained notes until the night before her death on Sept. 1. That chart showed that she was “resting calmly” the previous afternoon, and during the evening her nurses did not document any complaints of pain or distress that indicated she needed the drugs.

Hutzler was one of the nine LifeCare patients found on the seventh floor with one or both drugs in their systems. All were seen alive the morning of Sept. 1, and all were listed as dead by Memorial’s pathologist that afternoon.

“Homicide,” Wecht wrote on a sheet of paper with Hutzler’s name on top, underlining it twice. “Homicide,” he wrote for seven of the eight other seventh-floor patients, including Emmett Everett, Wilda McManus and Rose Savoie. The last patient, whose records indicated she was close to death, he marked as undetermined. Baden said he thought all nine were homicides.

The group considered one death on the eighth floor in the I.C.U.: Jannie Burgess was the comatose patient who was found by Ewing Cook when he climbed the stairs in the heat on Wednesday, Aug. 31. Burgess’s medical chart showed that she was given 15 milligrams of morphine seven times on Wednesday between 2:10 p.m. and 3:35 p.m. on spoken orders from Cook. This was more than seven times the maximum dose she was receiving for comfort care. But because she had already been receiving morphine and because of her advanced cancer, she was “not a clear, strong case,” Wecht wrote in his notes. He marked her death as undetermined.

Besides the nine patients who remained on the LifeCare floor and Burgess, the group also reviewed 13 Memorial and LifeCare patients whose deaths were recorded by Memorial’s pathologist on the second-floor lobby near the A.T.M. and elsewhere. (Other deaths struck investigators as suspicious, but because not all bodies were tested for drugs after autopsy, they were not considered.) Of those 13, 9 tested positive for midazolam and 4 for morphine, too. Investigators searching the hospital found prescriptions for large amounts of morphine for three of them, including Carrie Hall, the woman who fought hard to survive on Wednesday night. The prescriptions were dated Thursday, Sept. 1, and were signed by Dr. Anna Pou.

Despite Wecht and Baden’s strong opinions that the LifeCare deaths were the result of drug injections, Minyard wanted additional information to help him make his decision. He sent the patients’ medical, autopsy and toxicology records to three other experts for an independent review.

“Homicide,” Dr. Frank Brescia, an oncologist and specialist in palliative care, concluded in each of the nine cases. “Homicide,” wrote Dr. James Young, the former chief coroner of Ontario, Canada, who was then president of the American Academy of Forensic Sciences. “All these patients survived the adverse events of the previous days, and for every patient on a floor to have died in one three-and-a-half-hour period with drug toxicity is beyond coincidence.”

The grand jury heard from Minyard but not from any of his forensic experts; nor from two family members who were present on the LifeCare floor during most of the ordeal; nor the main Justice Department investigator, who worked the case for a year and helped collect 50,000 pages of evidence.

The district attorney’s office prepared a 10-count bill of indictment against Pou for the grand jury to consider — one count of second-degree murder in Emmett Everett’s case and nine counts of the lesser conspiracy to commit second-degree murder, one for each of the LifeCare patients on the seventh floor.

This meant that the grand jurors were being asked to decide whether the evidence they heard persuaded them that Pou had “a specific intent to kill” — part of Louisiana’s definition of second-degree murder.

On July 24, 2007, Judge Calvin Johnson read aloud the 10 counts of indictment. The grand jury did not indict Pou on any of them.

Posted: 8/31/2009 12:25:00 PM

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Coroner rules Jackson’s death a homicide

Updated 8/31/09:

From the Los Angeles Times:

The Los Angeles County coroner's office said Friday that it had officially ruled Michael Jackson's death a homicide and determined that a surgical anesthetic combined with other medication killed him.

In a one-page statement, officials listed the cause of Jackson's June 25 death as "acute propofol intoxication" with the additional factor of "benzodiazepine effect."

Three different sedatives that fall into the benzodiazepine drug class were in Jackson's system, but only the anti-anxiety medication lorazepam, often known by the brand name Ativan, was cited alongside propofol as "the primary drugs responsible for Mr. Jackson's death."

Jackson's personal physician, Dr. Conrad Murray, has acknowledged administering both medications to Jackson in the hours leading up to his death, according to search warrant affidavits.

The cardiologist told detectives that in an effort to get the insomniac singer to sleep on the morning of his death he administered the sedatives lorazepam, midazolam and diazepam, and that when they proved ineffective, he complied with Jackson's request for propofol, a powerful anesthetic intended for use in operating rooms, the affidavits state.

Toxicology tests also detected two other medications, the local anesthetic lidocaine and ephedrine, commonly used as a stimulant, according to the coroner's statement.

The complete toxicology results and the final coroner's report were not made public at the request of the LAPD and the Los Angeles County district attorney's office, the coroner's office said.

While cautioning that the absence of public lab results made it impossible to analyze the coroner's conclusions, toxicology experts said that the coroner's identification of benzodiazepine as a contributing factor suggested the sedative lorazepam might have intensified the effect of the propofol.

Forensic toxicologist Robert Middleberg, laboratory director at Pennsylvania's private NMS Labs, said both drugs depress the central nervous system and can have an additive effect when used together.

"When you combine them, it's not just one plus one equals two anymore. It's one plus one equals three, four, five, six, seven or some other number," he said.

Brain activity can slow to the point that breathing stops altogether, he said.

* * * * * * * * * * * * *

The Los Angeles County coroner ruled Michael Jackson's death a homicide Monday after a search warrant affidavit revealed that Jackson had lethal levels of the powerful anesthetic propofol in his system when he died.

The document unsealed Monday allowed officials to raid the Houston offices and storage facility of Dr. Conrad Murray last month.

According to the warrant, Murray, Jackson's personal physician, had been treating the singer for insomnia with the sedative for six weeks. According to the document, Murray said he had been trying to wean Jackson off the powerful sedative by using smaller doses in combination with the sedatives lorazepam and midazolam.

On the morning Jackson died, Murray said he tried to induce sleep without using propofol, starting first with valium at 1:30 a.m. When he was still awake at 2 a.m., Murray injected Jackson with lorazepam, then injected him with midazolam at 3 a.m. Murray told police he administered several other drugs over the next few hours.

By 10:40 a.m., Jackson, still unable to sleep, urged Murray to give him propofol. Murray said in court documents that he administered 25 milligrams of the drug at that time, then left Jackson alone under the influence of the drug to make phone calls to his Houston office. When he returned, Jackson was not breathing. He performed CPR while a member of Jackson's staff called 911. The singer was rushed to UCLA Medical Center where he was declared dead sometime later.

The affidavit says , while Murray acknowledged to police that he administered propofol, authorities said they could find no evidence that he had purchased, ordered or obtained the medication under his medical license or Drug Enforcement Administration tracking number. The newspaper also reported that police detectives found about eight bottles of the aneesthetic in Jackson's house along with other vials and pills that had been prescribed to Jackson by Dr. Murray, Dr. Arnold Klein and Dr. Allan Metzger.

Valium, lorazepam, clonazepam, tamsulosin and other drugs also were confiscated in the search, and propofol was found in Murray's medical bag. According to the warrant, Murray told police he was not the first doctor to administer propofol to the singer.

Posted: 8/31/2009 9:45:00 AM

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FDA approves first drug for infantile spasms

From Forbes:

The Food and Drug Administration on Friday approved the first drug to treat infantile spasms, a rare disorder that can cause hundreds of seizures per day in children less than a year old.

Sabril is an oral solution from Deerfield, Ill.-based Lundbeck Inc., approved for children between the ages of 1 month and 2 years. Infantile spasms usually occur while babies are eating or waking up, and often come in clusters of up to 100.

"Infantile spasms in children this young are very serious and this approval provides these patients and their parents a treatment option," said the FDA's director of neurology products Russell Katz.

The agency also approved a Sabril tablet to treat epileptic seizures in adults who have not responded to previous treatments. Specifically, the drug is approved for complex partial seizures, which affect about 3 million adults in the U.S.

The drug will carry a boxed warning, the most serious type available, because of risks of vision loss.

According to the FDA, damage to peripheral vision and visual clarity can increase when Sabril is used at higher doses and for a longer period of time.

Sabril will only be available through a limited distribution program, and patients will be required to take regular vision exams.

Posted: 8/25/2009 9:16:00 AM

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New meth formula avoids anti-drug laws

From the Associated Press:

This is the new formula for methamphetamine: a two-liter soda bottle, a few handfuls of cold pills and some noxious chemicals. Shake the bottle and the volatile reaction produces one of the world's most addictive drugs.

Only a few years ago, making meth required an elaborate lab — with filthy containers simmering over open flames, cans of flammable liquids and hundreds of pills. The process gave off foul odors, sometimes sparked explosions and was so hard to conceal that dealers often "cooked" their drugs in rural areas.

But now drug users are making their own meth in small batches using a faster, cheaper and much simpler method with ingredients that can be carried in a knapsack and mixed on the run. The "shake-and-bake" approach has become popular because it requires a relatively small number of pills of the decongestant pseudoephedrine — an amount easily obtained under even the toughest anti-meth laws that have been adopted across the nation to restrict large purchases of some cold medication.

An Associated Press review of lab seizures and interviews with state and federal law enforcement agents found that the new method is rapidly spreading across the nation's midsection and is contributing to a spike in the number of meth cases after years of declining arrests.

The new formula does away with the clutter of typical meth labs, and it can turn the back seat of a car or a bathroom stall into a makeshift drug factory. Some addicts have even made the drug while driving.

The pills are crushed, combined with some common household chemicals and then shaken in the soda bottle. No flame is required.

Using the new formula, batches of meth are much smaller but just as dangerous as the old system, which sometimes produces powerful explosions, touches off intense fires and releases drug ingredients that must be handled as toxic waste.

One little mistake, such as unscrewing the bottle cap too fast, can result in a huge blast, and police in Alabama, Oklahoma and other states have linked dozens of flash fires this year — some of them fatal — to meth manufacturing.

After the chemical reaction, what's left is a crystalline powder that users smoke, snort or inject. They often discard the bottle, which now contains a poisonous brown and white sludge. Dozens of reports describe toxic bottles strewn along highways and rural roads in states with the worst meth problems.

The do-it-yourself method creates just enough meth for a few hits, allowing users to make their own doses instead of buying mass-produced drugs from a dealer.

The federal government and dozens of states adopted restrictions on pseudoephedrine in 2005, and the number of lab busts fell dramatically.

The total number of clandestine meth lab incidents reported to the Drug Enforcement Administration fell from almost 17,400 in 2003 to just 7,347 in 2006.

But the number of busts has begun to climb again, and some authorities blame the shake-and-bake method for renewing meth activity.

The AP review of 14 states found:
  • At least 10 states reported increases in meth lab seizures or meth-related arrests from 2007 to 2008.
  • The Mississippi State Crime Lab participated in 457 meth incidents through May 31, up from 122 for the same period a year ago — a nearly 275 percent increase.
  • Several states, such as Oklahoma and Tennessee, are on pace this year to double the number of labs busted in 2008. The director of Tennessee's meth task force said the pace of lab busts in his state is projected to be about 1,300 for 2009, compared with 815 for all of 2008.
  • Some states lack a central database to monitor cold medicine sales, so meth cooks circumvent state laws by pill shopping in multiple cities and states — a practice known as "smurfing" that allows them to stay under restrictions placed on sales.
Traci Fruit, a special agent with the Kansas Bureau of Investigation, said law enforcement officials are becoming increasingly frustrated because there's no way to tell who is buying what "unless we go from store to store ourselves and pull up the records."

Historically, rural states like Oklahoma, Missouri and Kansas have been hotbeds for meth use because an important ingredient in the traditional method, anhydrous ammonia, was easily available from tanks on farms where it's used as a fertilizer. But the new formula does not need anhydrous ammonia and instead uses ammonium nitrate, a compound easily found in instant cold packs that can be purchased at any drug store.

Data from the Justice Department and the DEA data suggest the method could only be in its early stages, and "shake-and-bake" labs have recently been discovered as far north as Indiana and as far east as West Virginia.

States surveyed by the AP also included: Oklahoma, Texas, Arkansas, Louisiana, Florida, Tennessee, Kansas, Missouri, Mississippi, Alabama, Georgia, New Mexico, Arizona and California.

Posted: 8/25/2009 9:07:00 AM

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DNA Evidence Can Be Fabricated, Scientists Show

From The New York Times:

Scientists in Israel have demonstrated that it is possible to fabricate DNA evidence, undermining the credibility of what has been considered the gold standard of proof in criminal cases.

The scientists fabricated blood and saliva samples containing DNA from a person other than the donor of the blood and saliva. They also showed that if they had access to a DNA profile in a database, they could construct a sample of DNA to match that profile without obtaining any tissue from that person.

“You can just engineer a crime scene,” said Dan Frumkin, lead author of the paper, which has been published online by the journal Forensic Science International: Genetics. “Any biology undergraduate could perform this.”

Dr. Frumkin is a founder of Nucleix, a company based in Tel Aviv that has developed a test to distinguish real DNA samples from fake ones that it hopes to sell to forensics laboratories.

The planting of fabricated DNA evidence at a crime scene is only one implication of the findings. A potential invasion of personal privacy is another.

Using some of the same techniques, it may be possible to scavenge anyone’s DNA from a discarded drinking cup or cigarette butt and turn it into a saliva sample that could be submitted to a genetic testing company that measures ancestry or the risk of getting various diseases. Celebrities might have to fear “genetic paparazzi,” said Gail H. Javitt of the Genetics and Public Policy Center at Johns Hopkins University.

Tania Simoncelli, science adviser to the American Civil Liberties Union, said the findings were worrisome.

“DNA is a lot easier to plant at a crime scene than fingerprints,” she said. “We’re creating a criminal justice system that is increasingly relying on this technology.”

John M. Butler, leader of the human identity testing project at the National Institute of Standards and Technology, said he was “impressed at how well they were able to fabricate the fake DNA profiles.” However, he added, “I think your average criminal wouldn’t be able to do something like that.”

The scientists fabricated DNA samples two ways. One required a real, if tiny, DNA sample, perhaps from a strand of hair or drinking cup. They amplified the tiny sample into a large quantity of DNA using a standard technique called whole genome amplification.

The other technique relied on DNA profiles, stored in law enforcement databases as a series of numbers and letters corresponding to variations at 13 spots in a person’s genome.

From a pooled sample of many people’s DNA, the scientists cloned tiny DNA snippets representing the common variants at each spot, creating a library of such snippets. To prepare a DNA sample matching any profile, they just mixed the proper snippets together. They said that a library of 425 different DNA snippets would be enough to cover every conceivable profile.

Nucleix’s test to tell if a sample has been fabricated relies on the fact that amplified DNA — which would be used in either deception — is not methylated, meaning it lacks certain molecules that are attached to the DNA at specific points, usually to inactivate genes.

Posted: 8/18/2009 12:39:00 PM

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Sir, will you step out of the car ... words you don't want to hear

From the

As I rolled down the window, the officer leaned down and stated, "I’m informing you, that you’re being recorded. I clocked you at 70 miles per hour in a 55; could I see your license, registration and proof of insurance please?"

No one in their right mind ever wants to hear those words! No matter the situation, it’s uncomfortable. Even ignoring the potential fine, it could result in much higher insurance costs. Worse yet are the words, "Sir, will you step out of the car?"

First thing I did was, interrupt his comment and replied "no problem" to the part of his notification that I was being recorded. As he continued, I began to nod my head agreeing that I’d sped and immediately followed with an explanation why.

I can imagine how nervous I’d have been, had I been impaired.

I had to have been and looked very disheveled - - - he agreed.

When I told him I’d just spent 3 days on the ocean and I was physically torn up and exhausted, his reply was, "I can see that."

"Huh", I thought immediately. Guess it was obvious, all the way down to the burger sauce slopped down the front of my t-shirt. Still, his response caught me off guard – an indication as to part of what I’d learn a couple days later.

The odd part was, the timing. I had already set up an appointment to interview (for this column): Senior Officer and Drug Evaluation Classification Program Coordinator, Michael Iwai of the Oregon State Police.

Wednesday, after my drive down to Salem, Michael was going about explaining how unlikely it is that the officer would miss any signs of possible impaired driving - - - I’d just asked a pointed question.

As part of Michael’s answer, the trooper’s comment on highway 20, ("I can see that."), immediately came back to me. From the instant the trooper had pulled in behind me and ‘lit me up’ he’d been observing ... looking for signs.

These men are trained to do their job in such a way … they don’t miss a thing, and Michael is the man who just happens to facilitate that. The irony of the timing of the situation though, did not escape me. Michael’s precise and thorough explanations and answers made me see how he was the right man for the job he’s in and how well he trains the troopers in the field.

No two ways about it; Michael’s job is to make the roads safer … to take the impaired drivers off the streets and highways; Michael and the men he trains are extremely good at what they do; trust me.

It’s past time to wake up; there’s a relatively new, and awesome enforcement tool each of the 205 troopers trained so far, have as their foundation. Years ago, there may have been gaps in the officers’ training; there are no more "gaps".

This training gives an incredible insight into the impaired drug user. It’s no longer just about alcohol. Because of Michael’s training, this new Drug Evaluation Classification Program (DECP) they’re each a "Drug Recognition Expert." That’s not just a title … it's there because they've qualified in a comprehensive program; it consists of hours of rigorous training … the same program exists across 45 states - foreign nations as well.

If you’ve crossed the line, and been taken into custody, after the 12-step investigation, the DRE officer will even be able to tell you … what category of drug, or specific drug you’re high on! The training has reached that high and precise a level.

This program, the passion and professionalism of Michael and the other DRE / troopers, and the harsh penalties for those found guilty, have significantly improved the safety on our highways. Again, trust me; if you drive impaired you’ll be sorry.

Posted: 8/17/2009 9:40:00 AM

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Medications Pose High Poisoning Risk for Children

From The NY Times:

Parents may want to lock the medicine cabinet as well as the cabinet under the sink. A new study from the Centers for Disease Control and Prevention has found that more than twice as many children are accidentally poisoned with prescription or over-the-counter medicines as with household consumer products.

The researchers estimate that more than 70,000 children under 18 visit emergency rooms yearly suffering from unintentional medication overdoses, compared with about 30,000 for poisonings with other products. Most of the affected children have ingested medicines without their parents’ knowledge, but 8 percent of emergency room visits and 14 percent of hospitalizations were the result of parents accidentally overdosing their offspring. More than 75 percent of the medication overdoses were in children under 5.

Dr. Daniel S. Budnitz, the senior author and an epidemiologist with the C.D.C., said that the study did not count visits to private physicians’ offices or other health care facilities, so the numbers are probably an underestimate.

The study, published in the August issue of The American Journal of Preventive Medicine, found that the drug most commonly implicated in poisoning was acetaminophen (Tylenol and other brands), with opioid painkillers and benzodiazepine antianxiety drugs close behind.

Dr. Budnitz said that parents should of course keep medications out of the reach of children, but that packaging improvements are also important. “Child safety caps came out in the 1970s and haven’t changed much,” he said. “There are packaging improvements that can be made, and we’re working with manufacturers and other federal agencies to encourage this.
Posted: 8/14/2009 11:59:00 AM

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Salvia Divinorum: North Carolina Latest State to Ban or Regulate Sally D


The Tarheel State is about to become the latest to ban salvia divinorum, the potent but fast-acting hallucinogen that has become increasingly popular among young drug experimenters in recent years. A bill that would do that, SB 138, now sits on the desk of Gov. Beverly Perdue, who is expected to sign it. Last week, the House approved the measure by a vote of 94-15. It earlier passed the Senate on a unanimous 45-0 vote.

The bill makes possession of salvia an infraction, a minor crime punishable by a maximum $25 fine. A third possession offense would be charged as a misdemeanor. The bill has no separate provisions for charging manufacturing or sales offenses.

The bill includes two exemptions. The first is for ornamental gardening; the second is for university-affiliated researchers.

North Carolina will join 14 other states and a handful of towns and cities that have banned or regulated salvia in recent years, the most recent being the resort town of Ocean City, Maryland, earlier this month. Salvia is not a prohibited controlled substance under federal law, although the DEA is evaluating whether it should be, a process that has gone on for more than five years now.

Posted: 8/14/2009 9:52:00 AM

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Billy Mays autopsy: cocaine, heart disease, or death by drug cocktail

From the

Billy Mays was found dead in his home on June 28, 2009, a little more than one week after the Tampa, Florida pitchman had his fiftieth birthday. After returning to Tampa on a flight the night before, Billy Mays told his wife, Deborah that he wasn’t feeling well and went to bed. She found him unresponsive the next morning. Though the sudden death of Billy Mays was shocking, no one would have imagined the autopsy controversy and details that were soon to follow.

The first autopsy was expected to be performed the following day, on June 29, 2009. Though Billy Mays had been scheduled for hip surgery the following day, many wondered if a head injury suffered from a rough landing at TIA could have resulted in his death. It wasn’t long, however, that it was announced that Billy Mays died from hypertensive heart disease. In fact, the very next day, the Hillsborough County Medical Examiner went public with their findings that it wasn’t a bump on the head or head injury that caused Billy Mays’ death, but rather an undiagnosed case of hypertensive heart disease. At the time of the statement, it was announced that the final cause of death would not be made public until the full autopsy had been completed.

Dr. Vernard Adams announced the first results of hypertensive heart disease. During this conference, Dr. Adams states that Billy Mays had no history of previous drug abuse. He also mentions Billy Mays’ prescriptions for tramadol and hydrocodone, however standard toxicology testing would be performed and that the results would be returned within 8-10 weeks. It wasn’t until those toxicology reports came in that controversy ensued.

The toxicology report showed that Billy Mays had a ‘drug cocktail’ in his blood. In addition the hydrocodone and tramadol, Billy Mays also had cocaine, oxycodone, alprazolam and diazepam. It was also revealed that it was not just cocaine, but rather cocaine metabolites found in Billy Mays’ system, signifying that the cocaine had broke down in his system. Billy Mays’ wife, however, discredits the autopsy, it’s findings, or the allegations that Billy Mays’ used cocaine, as well as had a drug cocktail in his system before he died.

The autopsy showed that cause of death was heart disease and that cocaine use was a contributing factor, but now new claims from a forensic pathologist, Cyril Wecht challenges those findings. According to doctor Cyril Wecht, it was the drug cocktail that killed Billy Mays.

Dr. Cyril Wecht stated, “There are six brain-depressant drugs, including alcohol. As Jane (Jane Velez-Mitchell) has mentioned, Xanax and Valium, which are benzodiasapines (ph), anti-depressants, and then three narcotic-type drugs, Hydrocodone, Oxycodone, and Travedal (ph). And then alcohol, which many people don't appreciate, which is also a brain depressant drug.

Cumulatively, even those each of those is at a sub-toxic, sub- lethal level, when acting in concert, act to depress the respiratory system, and then can lead to cardio-respiratory arrest, cardiac arrhythmia and death.

In my opinion, the release of the finding of hypertensive and arteriosclerotic-cardiovascular (ph) disease within the day or so after the autopsy was premature. You have a 50-year-old man dying suddenly. I think you should wait until the toxicology comes in.

They did not. They just released that. Subsequently, when the report came back, they seized upon cocaine, which is also present, not one of the drugs that I mentioned. Cocaine is a stimulant. I do not believe that cocaine played a role. “

Low SHBG strongly predicts risk for Type 2 diabetes

From Endocrinology Update:

Low levels of the sex hormone-binding globulin are strongly related to an increased risk of type 2 diabetes, researchers report.

Published online in the New England Journal of Medicine, the study found that women with the lowest levels of SHBG were up to 91% more likely to develop diabetes than those with the highest levels. Similarly, in men with the lowest levels the risk was increased by 90% (p < 0.001 for both).

The case controlled study analysed data from 718 postmenopausal women participating in the Women’s Health study who were not using hormone therapy.

Half of the women had newly diagnosed type 2 diabetes and half were matched controls. The researchers then performed a replication study involving 170 diabetic men and 170 control men who were enrolled in the Physicians' Health Study II.

The researchers measured plasma levels of sex hormone–binding globulin and two polymorphisms of the SHBG gene.

With each standard-deviation decrease in SHBG levels, the risk of diabetes increased by 72% in women and by 71% in men, which the authors said suggested that SHBG "may have a causal role in the risk of type 2 diabetes."

Carriers of a variant allele of the SHBG single-nucleotide polymorphism rs6259 had 10% higher sex hormone–binding globulin levels (P=0.005), and carriers of an rs6257 variant had 10% lower plasma levels (P=0.004), the researchers reported.

"These strong and consistent findings…support the notion that SHBG may play an important role in the development of type 2 diabetes at both the genomic and the phenotypic levels and that SHBG could be an important target in stratification for the risk of type 2 diabetes and early intervention," the authors concluded.

Posted: 8/10/2009 2:34:00 PM

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