Specifically, the new regulations allow drug companies to “distribute copies of medical journal articles that describe unapproved uses” of their drugs to all the doctors they want.

Technically this reg isn’t new; it was in place until 2006, then lapsed until industry lobbyists made sure it was proposed again last year, despite heavy criticism from Democrats and drug industry critics. And now, conveniently one week before the Bush administration draws its final, sputtering breath, the rule has made its way back into the final FDA guidelines.

Big pharma spokespeople pooh pooh the reg as nothing more than a formality: “Physicians need timely access to the latest medical information to keep abreast of the best practices in patient care,” said Alan Bennett, an attorney representing the pharmaceutical industry.

It’s true that these journal articles are required to be peer-reviewed—though whether that means anything remains to be seen:

The reliability of medical journal articles came into question earlier this year when drugmaker Merck & Co. Inc. was accused of ghostwriting several articles about its painkiller Vioxx, which was withdrawn from the market in 2004 for safety reasons.

Reports published in the Journal of the American Medical Association alleged that Merck paid academics to take credit for articles which were actually written by the company. Merck denied the allegations, calling them false and misleading.

For every one step forward, two steps back.

Related:
RB: Bye Bye Freebies! Drug Companies Ax Free Goodies to Doctors
RB: Is Nothing Sacred? Nobel Prize Engulfed in Drug Company Scandal
RB: Clinic to Reveal All Doctor-Drug Industry Ties on the Web

Steve Jobs looks terrible. He has for months. After losing a reported 30 pounds last year, the Apple CEO has been the subject of constant scrutiny concerning his health, sparking media coverage that’s bordered on the morbid—including a mistaken obituary and a false report that he’d had a heart attack

The speculation reached a frenzy when Jobs announced he wouldn’t give the keynote speech at this month’s Macworld Expo. While Apple originally denied that the cancellation was due to their CEO’s poor health, they later conceded that Jobs had pulled out because he was ill. Exactly what this illness could be, however, remains the subject of mass conjecture.

In August 2004, Jobs announced he had had surgery to remove an islet cell tumor in his pancreas—a form of cancer that’s far rarer and less deadly than regular pancreatic cancer. It was later reported that he’d delayed the surgery 9 months after his diagnosis in order to pursue holistic treatments—a dangerous move that likely gave his doctors, and Apple’s board members, at least one ulcer apiece.

According to the New York Times, Jobs underwent another surgical procedure in 2008, the “details of which remain unclear.” Off the record, Jobs told Times reporter Joe Nocera that the CEO’s health problems “weren’t life-threatening, and he doesn’t have a recurrence of cancer.”

Still, Jobs’s current illness has reached a point where no one—not even the notoriously secretive Apple and its even more secretive CEO—can deny it.

In a somewhat unprecedented move, Jobs posted an open letter on Jan. 5 stating the following:

As many of you know, I have been losing weight throughout 2008. The reason has been a mystery to me and my doctors….

Fortunately, after further testing, my doctors think they have found the cause—a hormone imbalance that has been “robbing” me of the proteins my body needs to be healthy. Sophisticated blood tests have confirmed this diagnosis.

The remedy for this nutritional problem is relatively simple and straightforward, and I’ve already begun treatment. But, just like I didn’t lose this much weight and body mass in a week or a month, my doctors expect it will take me until late this Spring to regain it.

So could the mysterious ailment really be nothing but hormones? And is treatment simply a matter of nutrition?

“If a patient came to me with [Jobs's] history, the two big questions that would come to mind are: 1) is this a [recurrent] tumor, and 2) was there sufficient pancreas removed with the original surgery that he’s gradually lost his ability to digest and absorb food,” says Michael Jensen, an endocrinologist and nutrition specialist at the Mayo Clinic College of Medicine.

“The third option, when you take out the pancreas and see weight loss like this, is that it’s diabetes,” Jensen says. “But this would be something so well-known and treatable, we would have heard about it. Just the fact that they didn’t say it was diabetes means it probably isn’t.”

Jensen estimates that the chances of tumor recurrence versus impeded digestion are 50-50. But Jobs’s claim that the problem is a “hormone imbalance” that can be treated through “nutritional” means (both terms that rank high on the obfuscation and vagueness scales) raises some questions. If the second option on Jensen’s list is true, and the CEO’s pancreas is no longer making the enzymes he needs to digest food, the problem is in fact dietary—but not hormonal.

“The kind of hormonal imbalances [that are possible] in his case cannot be treated by simple nutritional intervention. If he’s undergoing simple nutritional treatment, then it wouldn’t be a hormone problem,” says Jensen.

While the contradiction remains unexplained, other physicians have raised plenty of possibilities, such as the tumor removal upsetting the balance of hormones like insulin and glucagon, which help control blood sugar levels, or somatostatin and gastrin, which aid digestion and other functions. But there’s a very real possibility that Jobs may once again have cancer.

If this worst-case scenario is true, it might not be devastating for Jobs. In all likelihood, the recurrence would be of the same islet tumor removed in 2004. A malignant islet tumor that recurs still isn’t as deadly as normal pancreatic cancer, and while it could eventually be fatal, an islet tumor recurrence “does not typically cause a rapid, severe [decline] if you can control the hormonal problems, which you usually can,” says Jensen.

Just how important is the truth? After the rumors of Job’s growing illness flamed in the blogosphere last summer, Apple’s stock plummeted 11 percent. At one point, an analyst estimated that the loss of Jobs could mean a 20 percent drop of Apple stock overnight. Then, of course, there’s the matter of a 53-year-old father and creative genius battling a potentially fatal disease—which, depending on your perspective, is the biggest risk at issue.

Related:
DISCOVER: The Truth About McCain’s Melanoma: He Faces a Very Low Risk
RB: Note to Politicians: Medical Prevention May Cost More Than Treatment

This month in DISCOVER, Mark Anderson has a feature story on the medical controversy surrounding shaken baby syndrome (SBS). The crux of the debate is this:

On one side of the courtroom, representing mainstream medical opinion, are those who believe shaken baby syndrome (SBS) is a valid diagnosis. They say that decades of clinical experience and criminal confessions—in which a parent has admitted to shaking a child with symptoms of SBS—bolster their case to the point of near-certainty. On the other side, a growing number of skeptics are now claiming that the evidence for the syndrome rests on dubious medical ground with questionable biophysical models supporting it.

The confusion centers around the trio of symptoms that lead to an SBS diagnosis: bleeding between the brain and skull, bleeding behind the retinas, and brain swelling. Conventional medical wisdom holds that some or all of these mean a baby is suffering from SBS. But a growing number of skeptics say the symptom list could come from any number of other sources, from infections to diet to a fall.

While the final medical verdict is still up in the air, the issue highlights the tricky—and potentially devastating—fallout when medical uncertainty headbutts the legal system. SBS presents a clear dilemma: If a baby has it, the “fact” that the baby’s death or injuries were caused by SBS is in and of itself evidence that a parent, caretaker, or other handler intentionally committed a crime.

Of course, if SBS is, as one neurosurgery professor called it, “a sham,” then anyone convicted of abuse, negligence, or even murder in an SBS case has potentially been put in jail for a nonexistent crime.

The sticky law-versus-medicine issue came to a head with the 1997 trial of British nanny Louise Woodward, who was convicted of second-degree murder in Massachusetts after a baby in her charge died. While Woodward was accused of other acts of negligence such as dropping the baby, the cause of death was a subdural hematoma, and SBS was declared its source. The case received intense media scrutiny, and a judge later reduced the charge to involuntary manslaughter and sentenced Woodward to time already served.

If Woodward had in fact dropped the baby, chances are the fall caused far more damage than any shaking could. But dropping an infant would rarely if ever lead to criminal charges as serious as murder. What the SBS diagnosis brought to Woodward’s case was intention—no one accidentally shakes a baby hard enough to cause internal bleeding. The proof is in the pudding, so to speak. Except that if these deadly injuries are unrelated to shaking, the pudding is proof of nothing.

Related:
RB: American Political System Prevents Tyranny But May Prolong Use of Torture
RB: Brain Research for Sale? Gaming Industry Looks to Science to Beat Class Action

• And of course, the debate has already started: Who will Obama pick to head up the EPA?

• Meanwhile, we’re zooming straight into a “health care perfect storm.”

• Which makes it all the more admirable (or crazy, or excessively symbolic) that Wisconsin Democratic Rep. Steve Kagan has elected to go without health insurance as a gesture of solidarity towards his uninsured constituents. Stay healthy, Steve!

• China demands international action on climate change—let’s just hope they practice what they preach.

• And not to judge or anything, but videos like this one certainly don’t inspire confidence.

• The “net energy” debate gets serious. Is the whole thing a load of bull? We’ll leave it to the experts to decide.

Massachusetts Senator and former presidential candidate John Kerry, former Speaker of the House and conservative icon Newt Gingrich, and Oakland A’s manager and minority owner Billy Beane aren’t a trifecta you’d expect co-penning op-eds in the Times. But co-penning they are, on behalf of a common cause: health care.

Specifically, they’re making the argument that just as baseball has profited from a “data-driven approach” to recruiting and payrolls, we need to up our use of “evidence-based” technology—as opposed to the current practice of “informed opinion”—in the U.S. health care system. The crux of the argument is this:

Remarkably, a doctor today can get more data on the starting third baseman on his fantasy baseball team than on the effectiveness of life-and-death medical procedures. Studies have shown that most health care is not based on clinical studies of what works best and what does not —be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition.

It is no surprise then that the United States spends more than twice as much per capita on health care compared to almost every other country in the world—and with worse health quality than most industrialized nations. Health premiums for a family of four have nearly doubled since 2001. Starbucks pays more for health care than it does for coffee. Nearly 100,000 Americans are killed every year by preventable medical errors. We can do better if doctors have better access to concise, evidence-based medical information.

Sound points, all—though many doctors might be less than pleased to hear their careers’ worth of experience described as “informed opinion.” Still, as the doctor shortage looms, the need for databases containing accurate records and medical information will likely become more important than ever. After all, somebody/thing’s gotta keep track of all those boomer hip X-rays.