Chimps’ Answer to Einstein.

Natasha, a chimp at the Ngamba Island Chimpanzee Sanctuary in Uganda, has always seemed different from her peers. She’s learned to escape from her enclosure, teases human caretakers, and scores above other chimps in communication tests. Now, Natasha has a new title: genius. In the largest and most in-depth survey of chimpanzee intelligence, researchers found that Natasha was the smartest of the 106 chimps they tested—a finding that suggests that apes have their geniuses, too.

“Natasha was really much better than other chimps,” says biologist and first author of the new study Esther Herrmann of the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany.

Herrmann and her colleagues had previously tested chimps in a study designed to compare the skills of the animals with those of human children. During the study, they noticed a wide range of skills among the chimps and wondered whether they could measure this variation in ability—and whether there were studies that could predict the chimps’ overall performance in all areas, like an IQ test in humans. So they gave a battery of physical and social tests to 106 chimps at Ngamba Island and the Tchimpounga chimpanzee sanctuary in the Republic of the Congo, and to 23 captive chimpanzees and bonobos in Germany. In one experiment, chimps were asked to find food in a container after it had been shuffled around with empty containers. In another, they had to use a stick to get food placed on a high platform. The researchers analyzed the data to determine if the scores in some tests helped predict performance in others.

“In general, we don’t find any kind of general intelligence factor that can predict intelligence in all areas,” Herrmann says. “But we did find a big variation overall, and this one outstanding individual.”

The stand-out individual, Natasha, was the chimp that caretakers—who don’t administer tests to the chimps but do feed them, clean their cages, and accompany them on walks—consistently ranked as the smartest based on only the way she interacted with them. But there’s nothing about Natasha’s life—extra attention or time spent with humans, for example—that explains how she became so astute. “Motivation and temperament probably play a role,” Herrmann says. “That’s something that we want to look more into.”

In general, apes that were good in one area—such as tests requiring creative tool use—were not necessarily good in another—such as copying the actions of a test-giver to get a reward, the team reports this week in the Philosophical Transactions of the Royal Society B. But continuing to add new challenges to the battery of tests still could lead to a standardized intelligence factor, Herrmann says.

Or, it could mean that there are multiple types of intelligence in apes that don’t necessarily relate to each other, suggests primatologist Brian Hare of Duke University in Durham, North Carolina, who wasn’t involved in the research.

“This study is top-notch and shows clearly that our traditional ideas about intelligence no longer hold,” Hare says. “There are many different types of intelligence that vary independently of one another. This means there are many different types of genius, even in animals.”

Herrmann admits that Natasha may have just happened to score highly in each area, and that there are likely other chimps out there that can score as high as Natasha. She has a gut feeling about one in particular that hasn’t been tested yet, but who seems highly motivated to solve puzzles and tests to get rewards. Future research on Natasha—and other genius-ranking chimps that the researchers track down—might reveal what social or genetic factors make the apes score higher than others, she says.

Source: Science Now

Evidence Favors Male Circumcision, But Parents Still Must Choose, Says AAP.

 Increase in Neonatal Circumcisions Could Save Billions

The AAP, in an updated policy statement published Aug. 27 in Pediatrics, said that a multidisciplinary panel evaluated the evidence and determined that circumcision’s benefits — prevention of urinary tract infections, penile cancer and transmission of some sexually transmitted infections, including HIV — justify access to the procedure (i.e., health insurance coverage) for families who choose it.

Previously, the AAP did not recommend for or against the procedure, citing insufficient evidence to make a determination in its earlier policy, which was published in 1999 and reaffirmed in 2005.

According to Susan Blank, M.D., chair of the AAP’s statement and technical report task force, recent scientific research shows clearer health benefits to the procedure than had been demonstrated previously, but the choice still rests with parents.

“Ultimately, this is a decision that parents will have to make,” Blank said in an AAP press release. “Parents are entitled to medically accurate and nonbiased information about circumcision, and they should weigh this medical information in the context of their own religious, ethical and cultural beliefs.”

The AAFP Commission on Health of the Public and Science’s Subcommittee on Clinical Practice Guidelines will review the update, as well as the accompanying technical report, in the coming months. Family physician Lesley Atwood, M.D., served as the AAFP’s liaison to the AAP task force.

The Academy’s position paper on neonatal circumcision, which was updated in 2007, does not recommend for or against the procedure and states that although the literature available at the time was “conflicting or inconclusive,” the decision whether or not to circumcise generally comes down to nonmedical preferences. Therefore, physicians should discuss the potential harms and benefits of newborn male circumcision with all parents or legal guardians considering the procedure.

The AAP’s shift in position may strengthen circumcision proponents’ call to reverse the steadily declining rates of infant male circumcision in the United States. An Aug. 20 report in the Archives of Pediatrics & Adolescent Medicine indicates that circumcision rates have declined from 79 percent to 55 percent in the past two decades — a drop that has coincided with reduced insurance coverage for the procedure.

Eighteen states currently do not provide Medicaid coverage for infant circumcision, and private third-party payers also are decreasing coverage, the study notes.

According to a release that accompanied the study, if this trend continues and rates decline to European levels, net present value of additional health care expenditures in the United States would exceed $4.4 billion in the next 10 annual birth cohorts.

The study, which indicates that the added expenses stem from higher rates of sexually transmitted infections and related cancers among uncircumcised men and their female partners, estimates that the current decline already has cost the United States more than $2 billion.

“Our economic evidence is backing up what our medical evidence has already shown to be perfectly clear,” said Aaron Tobian, M.D., Ph.D., senior study investigator and health epidemiologist and pathologist at the Johns Hopkins University School of Medicine in Baltimore. “There are health benefits to infant male circumcision in guarding against illness and disease, and declining male circumcision rates come at a severe price, not just in human suffering, but in billions of health care dollars as well.”

Source: AAFP.





“Use This Remarkable Food to Help Flush Potentially Toxic Metals Out of Your Body*”

It might be inexpensive, but it’s one of the most heavily researched detoxifiers in the world with millions of satisfied users.* Perhaps the easiest way to support your immune system and energy levels, clean your blood, improve digestion and potentially end bad breath.*

Our Organic Broken-Cell Wall Chlorella is 100% USDA Organic and harvested from the pristine waters of Hainan Island, off the southern coast of China.

Hainan Island is designated a “Special Economic Zone” to utilize its superior clean air and water and promote sustainable agriculture, environmental protection, pollution control and tourism.

Hainan Island has some of the best surface water quality in all of China resulting from hundreds of natural springs fed by China’s largest and most well-preserved intact tropical rainforest. In addition, all industries on Hainan Island are required to be pollution-free, with no damage to the environment, so you can be sure you’re getting a pollution-free product.

Organic Broken-Cell Wall Chlorella uses only organically approved fertilizer.

Unlocking the True Potential of Chlorella

The cell wall surrounding chlorella is indigestible, so it needs to be broken in order for you to get the benefits of its nutrients.

A unique process breaks open the plant’s cell wall and unlocks chlorella’s nutritional bounty for your optimal bioavailability.* In addition, this milling process is done under very specific conditions which eliminate light and heat in order to preserve the nutrients.

So you can absorb and digest chlorella’s nutrients at high levels.*

With the special processing of broken cell wall chlorella, very little of its nutrient power wastes away. In fact, an independent animal study showed the digestibility of broken cell wall chlorella to be an astounding 83%.*

See the chart below as to how broken cell wall chlorella advanced processing technique compares to other common ways used to treat chlorella.

There’s really no comparison… this is what makes broken cell wall chlorella so special and why I selected it for you to use.

Within the Broken Cell Wall Chlorella formula, there’s one very important benefit I feel you should know more about and understand…

Why Phytonutrient-Rich Chlorophyll is so Powerful


Through my colleague, Dr. Dietrich Klinghardt, I learned of a woman who lived in China during the post-war.

She told Dr. Klinghardt how her village gained the nutrients they needed by taking nutrient-rich chlorella.

So, this is evidence as to the extraordinary natural nutrient source provided by chlorella… a pure green algae rich in chlorophyll.

But what are the specific benefits that chlorophyll can provide you?

Here are just a few benefits you may experience as chlorophyll…*

  • Aids you in processing more oxygen*
  • Cleanses key elimination systems like your bowel, liver, and blood*
  • Helps purify your blood and clean away toxins*
  • Aids you in promoting optimal blood pressure*
  • Supports elimination of molds in your body*
  • Helps neutralize bad air you might breathe in*
  • Promotes growth and repair of your tissues*

From all this, you should see the natural power chlorophyll can provide you.

Broken cell wall chlorella is an excellent nutrient-rich pure source to help you detoxify and complement your healthy diet.*

Now I want to take you a little deeper so you can better understand…

How Chlorella Works So Well in Your Body

My studies convinced me chlorella plays a crucial role in systemic detoxification — because the majority of toxin removal happens through your stool.*

Once the detoxification occurs in your intestines, toxins from other body tissues more readily migrate into your intestines — where chlorella helps effectively remove them.*

Chlorella consists of a fibrous, outer shell (20%) with inner nutrients (80%).

It’s this fibrous, tough cell wall which binds with toxins.*

In addition, a clean bloodstream with an abundance of red blood cells to carry oxygen is necessary to support your strong natural defense system.*

Chlorella’s cleansing action on your bowel and other elimination channels, as well as its protection of your liver, helps promote clean blood.* And clean blood helps assure metabolic waste get efficiently carried away from your tissues.*

So, would any old chlorella formula do all this?

Not necessarily… As with any supplement I recommend on my site, I established stringent criteria to find you the ultimate chlorella formula: broken cell wall chlorella.

This thorough process ensures you can take full advantage of all the benefits chlorella has to offer.

My strict criteria for selecting a top-notch chlorella supplement for you?

It must:

  • Deliver a pure whole food formula that is highly digestible
  • Be all-natural without synthetic ingredients
  • Come from a highly reputable company with the strictest quality control and safety standard practices in place

And the Broken Cell Wall Chlorella supplement passes all of my tough criteria with flying colors. It’s by far the best chlorella formula I’ve found to date.

With all the amazing benefits of the broken cell wall chlorella formula, whatever you do…

Don’t Settle for Inferior Quality

As you probably already know from other supplements I offer on my site, it’s not enough that the product itself is superior to others.

The developer and manufacturer of chlorella must also demonstrate proven quality and safety standard practices.

There are literally hundreds, if not thousands, of chlorella supplements on the market today… but there are only a few great ones out there… and even fewer utilize the advanced processing technique of the Broken Cell Wall Chlorella formula.

That’s why I spent many long months researching to identify what I believe is one of the top chlorella supplement manufacturers in the world today.

Here’s why I firmly believe the manufacturer of the broken cell wall chlorella supplement clearly stands apart in quality standard practices:

  • Grown on the tropical island of Hainan—an ecological province
  • Grown and processed in compliance with ISO 9001 (certification for quality management systems) and GMP standards
  • USDA National Organic Program
  • Certified Kosher
  • Produces naturally cultivated chlorella in exclusive open-air cultivation pools using pristine quality water and bright sunlight

You should clearly see why I chose this manufacturer to provide you with a high quality Organic Broken Cell Wall Chlorella supplement.

Don’t ever settle for a supplement not solidly backed by a manufacturer practicing the highest quality and safety standards.

To you, quality means a consistent top-of-the-line product every time you use it.

How High-Quality Means Exceptional Value You Can Rely On

Chlorella is one of the most heavily researched algae in the world.

Chlorella is also a very popular algae — with millions of satisfied users.

There are thousands of research papers on chlorella from medical institutions, scientific journals, and universities. At one time, NASA even earmarked chlorella to be grown on the international space station.

The bottom line: chlorella is an amazing green food-based supplement with research backing up its overall safety and effectiveness.

And with its exclusive advanced processing technique, the broken cell wall chlorella supplement delivers the consistent high quality and reliability you’ve come to expect.

I feel this is a remarkable formula that will help you in so many ways.

And here are…

My Top Reasons for You to “Go Green” Now

Now you should understand why I’m so excited to bring you this extraordinary broken cell wall chlorella formula. It passed all of my stringent selection criteria for a supplement to offer on my site.

It’s simply a remarkable natural whole green food-based supplement, packed with nutrient-rich chlorophyll.

Let me quickly summarize all this for you with my top 5 reasons why you should order the incredible Organic Broken Cell Wall Chlorella supplement without delay.

Our Organic Broken Cell Wall Chlorella supplement has the potential to:

  1. Help you remove potentially toxic metals from your body*
  2. Boost your immune system*
  3. Help you digest your food more efficiently*
  4. Eliminate bad breath and help freshen your breath at the same time*
  5. Energize and reinvigorate your body*

Take Action Now and Rejuvenate Your Body with
the Nutrient-Packed Green Power of Chlorella


Isn’t it time you took action and ordered the broken cell wall chlorella supplement today?

With my extensive research and experience, I’ve taken all your guess-work out of finding the optimal chlorella supplement.

When using chlorella our experience suggests it is best to work your way up to 5 tablets per day. A small number of people may notice an allergic reaction, typically less than 1%. If you notice any allergic symptoms, you will want to stop until your symptoms clear, then restart at the lower dose.

Sure, there are chlorella supplements offering even higher per tablet dosages. But how confident will you feel about their digestibility and absorbability?

And how satisfied will you be with the quality of their manufacturing processes?

Because with my broken cell wall chlorella formula, you know you’ll benefit from:

  • A natural, pure green food, harvested from pristine waters of the Hainan Island
  • One of the most highly-digestible and absorbable formulas of chlorella available*
  • A formula packed with nutrient-rich chlorophyll
  • A consistent product backed by a manufacturer with exceptional high-quality standard practices
  • A supplement with proven reliability

When it comes to chlorella, I’ve simply not found a better product for your money than the Organic Broken Cell Wall Chlorella formula.




Friday Aug 31 is a Blue Moon. This event happens when four full moons are included in one season instead of three. The third full moon is called a “blue” moon.
This event was particularly important in the past since they give the extra work hours needed for the farmers for harvesting during the night.
The moon will not be blue.

Source: SETI

Intensive compared with standard BP targets reduce absolute stroke risk by 1% but do not reduce MI or mortality in type 2 diabetes.

Treatment of hypertension in patients with diabetes mellitus (DM) has been shown to improve cardiovascular outcomes; however, the value of intensive blood pressure (BP) targets remains uncertain. We sought to determine the effectiveness and safety of treating BP to intensive targets (upper limit of 130 mm Hg systolic and 80 mm Hg diastolic) compared with standard targets (upper limit of 140-160 mm Hg systolic and 85-100 mm Hg diastolic) in patients with type 2 DM. METHODS Using electronic databases, bibliographies, and clinical trial registries, we conducted a systematic review and meta-analysis to identify randomized trials enrolling adults diagnosed as having type 2 DM and comparing prespecified BP targets. Data on study characteristics, risk for bias, and outcomes were collected. Random-effects models were used to pool relative risks and risk differences for mortality, myocardial infarction, and stroke. RESULTS The use of intensive BP targets was not associated with a significant decrease in the risk for mortality (relative risk difference, 0.76; 95% CI, 0.55-1.05) or myocardial infarction (relative risk difference, 0.93; 95% CI, 0.80-1.08) but was associated with a decrease in the risk for stroke (relative risk, 0.65; 95% CI, 0.48-0.86). The pooled analysis of risk differences associated with the use of intensive BP targets demonstrated a small absolute decrease in the risk for stroke (absolute risk difference, -0.01; 95% CI, -0.02 to -0.00) but no statistically significant difference in the risk for mortality or myocardial infarction. CONCLUSION Although the use of intensive compared with standard BP targets in patients with type 2 DM is associated with a small reduction in the risk for stroke, evidence does not show that intensive targets reduce the risk for mortality or myocardial infarction.

COMMENT: There are too few studies in this analysis to come to any strong conclusions.  As mentioned in the comments ( the ACCORD study had the came conclusions and essentially dominates this analysis.  I still will use 130/80 as my goals in persons with diabetes monitoring orthostatic symptoms and renal function.

Source: bmj /doc2doc.




Should and do women feel pressured into having a cervical smear test?

There’s been a lot of stuff in the press in recent months about women feeling pressurised into having cervical screening. I’m not a woman so I don’t know but I am conscious that as a GP I’m asking female patients at least once a week if their smears are up to date. Is this fair?

Women should be allowed the right to make an informed choice and in order to do that women need to have the facts, just as men do for prostate screening (which incidentally, unlike cervical screening, does not save lives).

So here are some facts:

In order to prevent one death from cervical cancer we need to screen 57,000 women. Of these, 2000 will have some degree of abnormailty. We have no way of knowing which of these women will go on to develop cancer if left alone and consequently we expose all these 2000 women to the possibility of further distressing and sometimes disfiguring intervention.

One Australian study has suggested that an average 15 year old Australian girl who under goes the full Australian cervical screening programme has a 75% chance of having such intervention at some stage which can cause fertility problems and which ultimately, in extreme cases, may lead to hysterectomy and the complete loss of child-bearing capacity despite no guarantee that these women would have developed cervical cancer if left alone.

We know, for instance, that even the most extreme pre-cancer change in a smear, so-called CIN 3, may only progress to cancer if untreated in about 30% of cases – we just don’t know which 30%.

The incidence of cervical cancer peaked in the UK in 1950 with 11 deaths per 100,000. By 1964 it had already declined to 9 per 100,000. In 1964 rudimentary screening was introduced. But it was not until 1987 that a national programme of call-and-recall screening was introduced. By then mortality had already fallen to 6 per 100,000. Since then it has fallen to just above 3 per 100,000.

The degree of decline between 1950 and 1964 (before any screening was introduced) was effectively the same as the degree of decline after the introduction of rudimentary screening which, in turn, was the same as the degree of decline after 1987 when the national screening programme commenced.

The rate of death from cervical cancer has fallen by nearly 80% since 1950 and screening is often cited as the cause of this decline. But the reality is more subtle. The decline began long before widespread screening was introduced – it had already fallen by 50% by 1987 – and other factors such as improved hygiene, reduced levels of STDs, increased use of condoms, less smoking, etc. have undoubtedly had a significant role. The incidence of diagnosis and death from stomach cancer has declined even more dramatically over the same time period yet we have never screened for that.

Cervical screening DOES save lives BUT at best the national screening programme has reduced your risk of death from cervical cancer from a tiny 0.006% to an even tinier 0.003% – a relative reduction of 50% but an actual reduction of less than 0.003% – yet we seem to continue to hassle women about smears. This doesn’t seem right to me.

Source: bmj /doc2doc.



UNICEF says hardest part yet to come in providing drinking water to millions.

As World Water Week kicks off, UNICEF says that despite tremendous progress in the last two decades in bringing access to improved drinking water sources to billions of people, finishing the task is not going to be easy.

“There have been outstanding gains in every region of the world,” said Sanjay Wijesekera, head of UNICEF’s water, sanitation and hygiene programmes. “However, the job is not done until every single person every day can get sufficient drinking water from a reliable source—and unfortunately the most difficult part is ahead.”

Wijesekera cited a report, Progress on Drinking Water and Sanitation 2012, released earlier this year by UNICEF and the World Health Organization, which says that between 1990 and 2010 more than 2 billion people have gained access to improved sources of drinking water such as piped supplies, or protected wells. The report says the world reached the Millennium Development Goal on drinking water in 2010, five years ahead of schedule, but that 783 million people are still without access.

According to the report, those still without access are the hardest to reach, being largely the poorest people in urban slums or deep rural areas.

UNICEF says the most important step in providing universal access will be to address the inequities which exist in all regions and at all levels and where the poorest and women are most affected.

According to UNICEF, when water is not available on premises and has to be collected, women and girls are much more likely to be the main water carriers for families, walking an average of six kilometres per day in some regions.

Poorer countries lag far behind their wealthier counterparts, as only 11 per cent of the population in Least Developed Countries (LDCs) use piped water supplies compared to over 50 per cent of the global population.

Within countries, there is an almost universal disparity of access in rural areas compared to urban areas.  Overall, 80 per cent of the world’s urban population has piped water connections, compared to less than 30 per cent of people in rural areas. The rural-urban divide is particularly acute in Sub-Saharan Africa where the gap is 29 percentage points. In LDCs ninety-seven out of every 100 rural dwellers do not have access to piped water.

The principles of “The Human Right to Water” endorsed by the UN General Assembly in 2010 state that drinking water should be affordable, reliable, safe, accessible and available in a sufficient quantity to meet basic needs.

UNICEF projects that in 2015 when the Millennium Development Goals are due, 605 million people will still not have this basic human right.

UNICEF is a member of the Sanitation and Water for All (SWA) global partnership aimed at achieving universal and sustainable access to sanitation and drinking-water. More information is available at

UNICEF works in 190 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments. For more information about UNICEF and its work visit:

For further information, please contact:
Rita Ann Wallace, UNICEF New York,
Tel + 1 212 326-7586 (office) / +1 917 213-4034 (mobile),

Source: UNICEF.

New Novartis Phase II data show LCZ696 may provide clinical benefits in patients with a difficult-to-treat form of heart failure.

  • PARAMOUNT study shows LCZ696 reduced a key predictor of morbidity and mortality in patients with a common form of heart failure called HF-PEF[1],[2]  
  • Up to half of the 20 million Europeans and Americans diagnosed with heart failure have HF-PEF[3]-[5], leading to reduced life expectancy and frequent hospitalization[4]-[6]  
  • No therapies are currently approved to reduce morbidity and mortality in patients with HF-PEF, or heart failure with preserved ejection fraction[5]-[7]
  • Phase III PARADIGM-HF study currently investigating LCZ696 in heart failure with reduced ejection fraction (HF-REF), the other common form of heart failure 


Novartis today announced results from the Phase II PARAMOUNT study showing that the investigational compound LCZ696 is the first therapy to significantly reduce a key predictor of morbidity and mortality in patients with a condition called heart failure with preserved ejection fraction (HF-PEF)[1],[2]. This difficult-to-treat disease affects up to half of the 20 million people with heart failure in Europe and the US [3]-[5]. The data were presented at the ESC Congress 2012 (European Society of Cardiology) in Munich, Germany[1], and published simultaneously in The Lancet[2].


The results show that after 12 weeks, LCZ696 met its primary endpoint by reducing NT-proBNP[*] – a marker of stress on the heart and a predictor of patient outcomes – significantly more than valsartan[1],[2]. The data also suggest that LCZ696 may reverse some structural changes to the heart[1],[2] that occur in patients with heart failure[8].


[*]N-terminal pro-B-type natriuretic peptide


“These Phase II results show that this novel treatment approach has the potential to reduce stress to the heart and to reduce enlargement of the left atrium of the heart, which occurs in patients with heart failure,” said Dr Scott Solomon, Professor of Medicine at Harvard University and Director of Noninvasive Cardiology at Brigham and Women’s Hospital in Boston, USA. “So far no treatment has been shown to reduce morbidity and mortality in patients with HF-PEF. The favorable effects seen in this study are encouraging, and further testing of LCZ696 is warranted in this patient population.”


Heart failure (HF) is a disease in which the heart is unable to supply enough blood to meet the body’s needs[7],[8]. There are two common types: heart failure with preserved ejection fraction (HF-PEF) and heart failure with reduced ejection fraction (HF-REF) [7],[8]. In patients with HF-PEF, the percentage of blood pumped out of the heart (also called the ejection fraction) remains within the normal range, but the heart does not relax enough to pump effectively[5],[7],[9]. This results in structural changes that progressively weaken the heart leading to a range of debilitating symptoms. Patients with HF-PEF also commonly have other conditions such as hypertension, diabetes and atrial fibrillation[7],[8].


“The results of the PARAMOUNT study are promising for patients with HF-PEF as there is no effective treatment currently available,” said Tim Wright, Global Head of Development, Novartis Pharma. “We believe that thanks to its novel mode of action and these positive study results, LCZ696 could significantly benefit people living with chronic heart failure. These results support our commitment to heart failure patients at every stage of their disease through our ongoing program of clinical trials.”


Heart failure affects an estimated 20 million people in Europe and the US[3], and kills around half of all patients within five years of diagnosis[10],[11] as they suffer acute episodes in which their symptoms suddenly become worse and urgent hospital treatment is needed[5],[7]. Patients suffer fatigue, shortness of breath and swollen limbs[5],[7],[8], limiting their ability to complete everyday tasks and placing an ever greater burden on caregivers. Not only does heart failure have a severe impact on patients, but it also represents a major economic burden for healthcare providers[12].


LCZ696 is the first in a new class of medicines called angiotensin receptor neprilysin inhibitors (ARNIs)[13]. It works in a different way to existing heart failure treatments by inhibiting an enzyme (neprilysin, or NEP) in order to promote the body’s protective mechanisms, and blocking receptors involved in the narrowing of blood vessels (angiotensin receptors)[13]. LCZ696 therefore acts simultaneously on two important pathways in the development of the disease[13].


The PARAMOUNT study showed that after 12 weeks of treatment, reduction in NT-proBNP was 23% greater with LCZ696 than valsartan (p=0.005)[1],[2]. In addition, there was a greater reduction (p=0.003) in left atrial size (cardiac remodeling) in LCZ696-treated patients at the end of the 36-week study[1],[2]. This suggests that LCZ696 could provide an effective treatment for patients with HF-PEF. The study also showed that LCZ696 had an acceptable safety profile and was well tolerated in patients with HF-PEF[1],[2].


LCZ696 is one of several compounds being developed by Novartis across the spectrum of heart failure. In addition to HF-PEF, LCZ696 is also being investigated for the treatment of heart failure with reduced ejection fraction (HF-REF) in the Phase III PARADIGM-HF study[14]. A recent Phase II study also showed that LCZ696 is more effective than valsartan in reducing blood pressure[15], and a Phase III program has been launched for the first-line treatment of hypertension in Asia.


PARAMOUNT was an international 36-week, randomized, double-blind, multicenter, parallel group, active-controlled study to compare the efficacy, safety, and tolerability profile of LCZ696 with valsartan in patients with HF-PEF[1],[2]. The study consisted of a 12-week core study and a 24-week extension phase[1],[2]. The study included 301 patients (mean age 71 years) with HF-PEF (left ventricular ejection fraction >45%)[1],[2]. They all had elevated NT-proBNP (>400 pg/ml) and at least one of the following symptoms of HF-PEF: shortness of breath on exertion, shortness of breath when lying flat, episodes of shortness of breath at night, and swollen ankles[1],[2]. After stopping any treatment with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), they were randomized to LCZ696 (50 mg twice-daily) or valsartan (40 mg twice-daily), an ARB indicated for heart failure[1],[2]. Doses of both drugs were doubled after one week and doubled again after a further week to a maximum dose of 200 mg and 160 mg twice-daily, respectively[1],[2].


[1] Solomon S. PARAMOUNT: Efficacy and Safety of LCZ696, a First-in-Class Angiotensin Receptor Neprilysin Inhibitor, in Patients with Heart Failure and Preserved Ejection Fraction: Primary Results from the PARAMOUNT Study. Presentation at ESC Congress 2012 (European Society of Cardiology), Munich, Germany, August 26, 2012.

[2] Solomon S, Zile M, Pieske B, et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Published online August 26, 2012

[3] Metra M, Brutsaert D, Dei Cas L, Gheorghiade M. (2011) ESC Intensive and Acute Cardiac Care Textbook – acute heart failure: epidemiology, classification, and pathophysiology. Chapter 49.

[4] Steinberg BA, Zhao X, Heidenreich PA, et al. Trends in patients hospitalised with heart failure and preserved left ventricular ejection fraction: prevalence, therapies and outcomes. Circulation. 2012;126:65-75.

[5] Blanche C, Fumeaux T, Polikar R. Heart failure with normal ejection fraction (HFNEF): is it worth considering? Swiss Med Wkly. 2010;140:66-72.

[6] Fonarow GC, Stough WG, Abraham WT, et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol. 2007:50:768-777.

[7] McMurray JJV, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012;33:1787-1847.

[8] Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2009; 53:e1-90.

[9] Colucci (Ed.). Atlas of Heart Failure, 5th ed. Springer 2008.

[10] Loehr LR, Rosamond WD, Chang PP, et al. Heart failure incidence and survival (from the Atherosclerosis Risk in Communities Study). Am J Cardiol 2008;101:1016-22.

[11] Roger VL, Go AS, Lloyd-Jones DM, et al. Heart Disease and Stroke Statistics – 2012 Update: A Report from the American Heart Association. Circulation. 2012;125:e2-e220.

[12] O’Connell JB, Bristow MR. Economic impact of heart failure in the United States: Time for a different approach. J Heart and Lung Trans. 1993:13(4):S107-112.

[13] Gu J, Noe A, Chandra P, et al. Pharmacokinetics and pharmacodynamics of LCZ696, a novel dual-acting angiotensin receptor-neprilysin inhibitor (ARNi). J Clin Pharm. 2010;50:401-14.

[14] Prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in patients with heart failure (PARADIGM-HF); Accessed August 2012.

[15] Ruilope LM, Dukat A, Böhm M, et al. Blood-pressure reduction with LCZ696, a novel dual-acting inhibitor of the angiotensin II receptor and neprilysin: a randomized, double-blind, placebo-controlled, active comparator study. Lancet 2010;375:1255-66.

Source: Novartis newsletter.


Benefits of Circumcision Outweigh Harms, AAP Says .

The benefits of circumcision outweigh the harms, the American Academy of Pediatrics says in a policy statement in Pediatrics. The benefits include lower risk for urinary tract infections before 1 year of age, as well as reduced risk for sexually transmitted infections and penile cancer later in life.

However, the AAP stops short of recommending routine circumcision. The decision is best left to parents, the group says.

Source: Pediatrics policy


USPSTF: Insufficient Evidence for Routine Kidney Screening in Asymptomatic Adults .

The U.S. Preventive Services Task Force has issued an “I” statement on screening for chronic kidney disease in asymptomatic adults. The “I” designation means that the group “concludes that the evidence is insufficient to assess the balance of benefits and harms” in asymptomatic adults.

The authors emphasize that the statement does not apply to the testing and monitoring of patients with diabetes or hypertension, in whom chronic kidney disease is prevalent.

Source: Annals of Internal Medicine