The New York Times, October 24, 2012, by Gretchen Reynolds  —  Is laughter a kind of exercise? That offbeat question is at the heart of a new study of laughing and pain that emphasizes how unexpectedly entwined our bodies and emotions can be.

For the study, which was published this year in Proceedings of the Royal Society B, researchers at Oxford University recruited a large group of undergraduate men and women.

They then set out to make their volunteers laugh.

Most of us probably think of laughter, if we think of it at all, as a response to something funny — as, in effect, an emotion.

But laughter is fundamentally a physical action. “Laughter involves the repeated, forceful exhalation of breath from the lungs,” says Robin Dunbar, a professor of evolutionary psychology at Oxford, who led the study. “The muscles of the diaphragm have to work very hard.” We’ve all heard the phrase “laugh until it hurts,” he points out. That pain isn’t metaphoric; prolonged laughing can be painful and exhausting.

Rather like a difficult workout.

But does laughter elicit a physiological response similar to that of exercise and, if so, what might that reveal about the nature of exertion?

To find out, Dr. Dunbar and his colleagues had their volunteers watch, both alone and as part of a group, a series of short videos that were either comic or dryly factual documentaries.

But first, the volunteers submitted to a test of their pain threshold, as determined by how long they could tolerate a tightening blood pressure cuff or a frozen cooling sleeve.

The decision to introduce pain into this otherwise fun-loving study stems from one of the more well-established effects of strenuous exercise: that it causes the body to release endorphins, or natural opiates. Endorphins are known “to play a crucial role in the management of pain,” the study authors write, and, like other opiates, to induce a feeling of euphoric calm and well-being (they are believed to play a role in “runner’s high”).

It’s difficult to study endorphin production directly, however, since much of the action takes place within the working brain and requires a lumbar puncture to monitor, Dr. Dunbar says. That is not a procedure volunteers willingly undergo, particularly in a study about laughing. Instead, he and his colleagues turned to pain thresholds, an indirect but generally accepted marker of endorphin production. If someone’s pain threshold rises, he or she is presumed to be awash in the natural analgesics.

And in Dr. Dunbar’s experiments, pain thresholds did go up after people watched the funny videos, but not after they viewed the factual documentaries.

The only difference between the two experiences was that in one, people laughed, a physical reaction that the scientists quantified with audio monitors. They could hear their volunteers belly-laughing. Their abdominal muscles were contracting. Their endorphin levels were increasing in response, and both their pain thresholds and their general sense of amiable enjoyment were on the rise.

In other words, it was the physical act of laughing, the contracting of muscles and resulting biochemical reactions, that prompted, at least in part, the pleasure of watching the comedy. Or, as Dr. Dunbar and his colleagues write, “the sense of heightened affect in this context probably derives from the way laughter triggers endorphin uptake.”

The physical act of laughing contributed to the emotional response of finding something to be funny.

Why the interplay of endorphins and laughing should be of interest to those of us who exercise may not be immediately obvious. But as Dr. Dunbar points out, what happens during one type of physical exertion probably happens in others. Laughter is an intensely infectious activity. In this study, people laughed more readily and lustily when they watched the comic videos as a group than when they watched them individually, and their pain thresholds, concomitantly, rose higher after group viewing.

Something similar may happen when people exercise together, Dr. Dunbar says. In an experiment from 2009, he and his colleagues studied a group of elite Oxford rowers, asking them to work out either on isolated rowing machines, separated from one another in a gym, or on a machine that simulated full, synchronized crew rowing. In that case, the rowers were exerting themselves in synchrony, as a united group.

After they exercised together, the rowers’ pain thresholds — and presumably their endorphin levels — were significantly higher than they had been at the start, but also higher than when they rowed alone.

“We don’t know why synchrony has this effect, but it seems very strong,” Dr. Dunbar says.

So if you typically run or bike alone, perhaps consider finding a partner. Your endorphin response might rise and, at least theoretically, render that unpleasant final hill a bit less daunting. Or if you prefer exercising alone, perhaps occasionally entertain yourself with a good joke.

But don’t expect forced laughter to lend you an edge, Dr. Dunbar says. “Polite titters do not involve the repeated, uninhibited series of exhalations” that are needed to “drive the endorphin effect,” he says. With laughter, as with exercise, it seems, there really is no gain without some element of pain.


People laughing at a dinner


Peathegee Inc/Getty Images


Life Sciences Summit 2012


Target Health is pleased to be a sponsor of the Life Sciences Summit 2012 which will take place in New York City, October 31 – November 1. The Summit is a translational science partnering meeting that features more than 120 speakers from the biopharmaceutical industry, academia, medical research foundations, government and professional advisors.


Dr. Jules T. Mitchel, president of Target Health, will be chairing a panel on “Working with FDA: How to Add Value in the Transition from Academic Research to Commercial Development.” The panel will address how with the current emphasis on drug discovery and early development coming out of academia, how there must be an appreciation by our academic colleagues of the value added steps that should and must be implemented to “optimize the package” that is presented to both FDA and the pharmaceutical industry. The panel will also present perspectives on what is needed to obtain FDA concurrence with a drug/device development strategy and what will help convince the pharmaceutical industry to take the chance and license the invention.


Panelists will include:


1. Afia K. Asamoah, Senior Associate, Covington & Burling LLP (Former Special Assistant to the Principal Deputy Commissioner, FDA)

2. James Foley, PhD, Partner, Aqua Partners LLC

3. Allan R. Goldberg, PhD, CEO & President, Avacyn Pharmaceuticals, Inc.

4. Neal Simon, CEO, Azevan Pharmaceuticals, Inc.


Warren Pearlson will be representing Target Health at our table top exhibit. If you attend, please stop by and say hello.


For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website at

Dental Lasers



This article is courtesy of Vanessa Hays, JD.



Can lasers that cut gum, tooth and bone end the rule of the turbine dental drill?

Allen Helfer is able to perform root canals on his dental patients without using anesthesia. Instead of boring into teeth with an excruciating turbine-driven 1) ___, the professor of dentistry at Columbia University’s School of Dental & Oral Surgery slices painlessly through gum, tooth and bone with a laser beam.


A visit to the oral surgeon will always remain low on the list of pleasant things to do, but the days of throbbing jaws and numbed mouths are drawing to a close. Dentistry is painful because drills are messy and hot. Friction builds up between the drill and the tooth, heating up the enamel and causing nerves to flare. A drill’s vibrations can also weaken the 2) ___ by creating small cracks and fissures in the tooth’s surface.


Dental lasers take away all that trouble. They cut by vaporizing the water molecules inside soft, wet 3) ___. An ingenious new laser called Waterlase adds to that the ability to cut through dry teeth and bone by casting a cloud of hot water vapor around the laser’s cutting point, a couple of millimeters from the tooth. The excited water molecules dissipate their energy by bashing against the enamel and bone. Even as the tooth is being cut, it never gets hot, and there is little pain. “It’s basically a microexplosion,” says Ioana Rizoiu, the head of research and clinical development at Biolase Technology, the San Clemente, Calif. company that created the Waterlase.


Some 1,500 Waterlase machines have been sold in the U.S. since it won approval from the FDA (4) ___ & ___ ___) in October 1998 for preparing cavities to be filled. Sales have risen steadily since, with Waterlase winning subsequent approvals for root canals in January 2002, bone surgery in February 2002 and root canal complications in February 2003.


Biolase’s sales surged 63% to $29 million last year, helping it turn a $2.6 million profit, its first. Chief Executive Jeffrey Jones expects sales to jump at least 40% in following years. There are 140,000 dentists in the U.S.; most of them are general practitioners who work alone and still use anesthesia and 5) ___ drills. Biolase’s competitors include Lumenis, in Israel, and Hoya ConBio, in Fremont, Calif.


Some dentists will be reluctant to go vibration-free. The $50,000 price tag on the Waterlase is 33 times that on a high-speed dental drill. But there are compelling reasons to switch. Biolase’s Jones says the Waterlase can generate $1,000 a day as procedures are done more 6) ___, with less delay for anesthesia and fewer complications. Moreover, the laser, which resembles a dental drill in shape, can do things a dentist would never do with a drill, like cut gums. And the laser cuts gums without causing much bleeding. Switching to the laser cuts the price a consumer pays for cosmetic crown-lengthening, used to make teeth look bigger, from $7,000 to $3,000.


Jason Doucette, a 30-year-old cosmetic dentist in Reno, Nev., says he occasionally uses anesthesia with his Waterlase and that the laser is useless on silver fillings, which act like mirrors. But most patients are able to get a 7) ___ repaired without a shot to numb them. Another reason the Waterlase and Biolase’s other product, a tooth-whitening laser, appeal to customers is that they sound so high tech. “It’s definitely a huge marketing tool,” says Doucette.


Pain-free chair time can sell even some of the toughest customers: kids. Barry Jacobson, director of pediatric dentistry at Mount Sinai Hospital in New York, found the “drill” especially helpful for kids who were allergic to anesthesia or were already on drugs that could interact with painkillers. “Kids love it,” says Jacobson. “It’s a huge advancement in dentistry for 8) ___, and I don’t think there’s any way you can go back.”


In fact, Jacobson likes the Waterlase so much that he now has two. “Ultimately,” he says, “Every dentist will have one.”


Source: Forbes, by Matthew Herper


ANSWERS: 1) drill; 2) tooth; 3) gums; 4) Food & Drug Administration; 5) turbine; 6) quickly; 7) cavity; 8) children

Dentistry, a Painful Story

Farmer at the Dentist, painting by Johann Liss, c. 1616–17.



The Indus Valley Civilization (IVC) has yielded evidence of dentistry being practiced as far back as 7000 BC. IVC sites in Pakistan indicate that this earliest form of dentistry involved curing tooth related disorders with bow drills operated, perhaps, by skilled bead craftsmen. The reconstruction of this ancient form of dentistry showed that the methods used were reliable and effective.


A Sumerian text from 5000 BCE describes a “tooth worm” as the cause of dental caries. Evidence of this belief has also been found in ancient India, Egypt, Japan, and China. The legend of the worm is also found in the writings of Homer, and as late as the 14th century CE the surgeon Guy de Chauliac still promoted the belief that worms cause tooth decay.


The Edwin Smith Papyrus, written in the 17th century BCE but which may reflect previous manuscripts from as early as 3000 BCE, includes the treatment of several dental ailments. In the 18th century BCE, the Code of Hammurabi referenced dental extraction twice as it related to punishment. Examination of the remains of some ancient Egyptians and Greco-Romans reveals early attempts at dental prosthetics and surgery.


Ancient Greek scholars Hippocrates and Aristotle wrote about dentistry, including the eruption pattern of teeth, treating decayed teeth and gum disease, extracting teeth with forceps, and using wires to stabilize loose teeth and fractured jaws. Some say the first use of dental appliances or bridges comes from the Etruscans from as early as 700 BCE. Further research suggested that 3000 BCE. In ancient Egypt, Hesi-Re is the first named “dentist” (greatest of the teeth). The Egyptians bind replacement teeth together with gold wire. Roman medical writer Cornelius Celsus wrote extensively of oral diseases as well as dental treatments such as narcotic-containing emollients and astringents.


Historically, dental extractions have been used to treat a variety of illnesses. During the Middle Ages and throughout the 19th century, dentistry was not a profession in itself, and often dental procedures were performed by barbers or general physicians. Barbers usually limited their practice to extracting teeth which alleviated pain and associated chronic tooth infection. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican (resembling a pelican’s beak) which was used up until the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century.


The first book focused solely on dentistry was the “Artzney Buchlein” in 1530 and the first dental textbook written in English was called “Operator for the Teeth” by Charles Allen in 1685. It was between 1650 and 1800 that the science of modern dentistry developed. The English physician Thomas Browne in his A Letter to a Friend (pub. post. 1690) made an early dental observation with characteristic humor “The Egyptian Mummies that I have seen, have had their Mouths open, and somewhat gaping, which affordeth a good opportunity to view and observe their Teeth, wherein ‘tis not easie to find any wanting or decayed: and therefore in Egypt, where one Man practised but one Operation, or the Diseases but of single Parts, it must needs be a barren Profession to confine unto that of drawing of Teeth, and little better than to have been Tooth-drawer unto King Pyrrhus, who had but two in his Head.”


It is said that the 17th century French physician Pierre Fauchard started dentistry science as it is known today, and he has been named “the father of modern dentistry.” Among many of his developments were the extensive use of dental prosthesis, the introduction of dental fillings as a treatment for dental caries and the statement that sugar derivative acids such as tartaric acid are responsible for dental decay.



7000 BC – The Bow Drill Era


Ancient industrious would-be dentists were master beadmakers who used bow drills to cure tooth problems. This is also the first appearance of dental assistants, whose duties consisted of restraining the flailing arms and legs of patients during the undoubtedly excruciating procedures. Still, this obviously beat a life without teeth.


The above diagram shows the mechanics of a simple bow drill.


5000 BC – The Myth of the Tooth Worm


The first and most enduring explanation for what causes tooth decay was the tooth worm, first noted by the Sumerians around 5000 BCE. The hypothesis was that tooth decay was the result of a tooth worm boring into and decimating the teeth. This is logical, as the holes created by cavities are somewhat similar to those bored by worms into wood. The ivory sculptures below depict the havoc wrought by these wicked worms.



The idea of the tooth worm has been found in the writings of the ancient Greek philosophers and poets, as well as those of the ancient Indian, Japanese, Egyptian, and Chinese cultures. It endured as late as the 1300s, when French surgeon Guy de Chauliac promoted it as the cause of tooth decay.


700 BCE – The First Bridges


The first society to use dental bridges and appliances were the Etruscans, starting around 700 BCE. The image below shows a similar dental bridge created by the Egyptians that uses gold wires to hold the teeth together. This is also the first incarnation of a cosmetic dental practice that would come to be known as “bling”.



2500 Years Later



The Father of Modern Dentistry


In 1723, French surgeon Pierre Fauchard published The Surgeon Dentist, A Treatise on Teeth. He is considered the father of modern dentistry because his book was the first to describe a comprehensive system for caring for and treating the teeth.



1790 – The First Dental Foot Engine


The first dental foot engine was built by John Greenwood and one of George Washington’s dentists. It was made from an adapted foot-powered spinning wheel.



1790 was a big year for dentistry, as this was also the year the first specialized dental chair was invented. It was made from a wooden Windsor chair with a headrest attached. Note the fancy trim.



1840 – The First Dental School is Founded

Chapin Harris and Horace Hayden founded the Baltimore College of Dental Surgery, the first school dedicated solely to dentistry. The college merged with the University of Maryland School of Dentistry in 1923, which still exists today.



1844 – Nitrous Hits the Scene


Connecticut dentist Horace Wells was the first discover that nitrous oxide can be used as anesthesia. After using it with success on several of his patients in private, he attempted to demonstrate its effects in public, but the demonstration was seen as failure because the patient cried out during surgery. In 1846 one of students, William Morton, would take credit for the discovery after a successful demonstration.



The 20th Century

Dentistry has seen a great deal of innovation over the past 100 years. In 1903 Charles Land devised the porcelain jacket crown.



In 1905, Alfred Einhord, a German chemist, discovered Novocain.



In 1938, the first tooth brush with synthetic nylon bristles hit the market.



In 1945, the water fluoridation era began when the cities of Newburgh, NY and Grand Rapid, MI decided to add fluoride to the public water supply. In 1950, the first fluoride toothpastes are marketed.



In 1957, John Borden invented the first high speed electric hand drill.



In the 1960s, the first dental lasers are developed and used for soft tissue procedures.



The 1960s also saw the invention of the first electric toothbrush.



The 1990s marks the beginning of the era of cosmetic dentistry, with the increased popularity of veneers, bleaching, and dental implants.


Bacterial Protein In House Dust Spurs Asthma


More than 20 million Americans have asthma, with 4,000 deaths from the disease occurring each year.


According to an article published online in Nature Medicine (14 October 2012), a bacterial protein. present in common house dust, may worsen allergic responses to indoor allergens. The finding is the first to document the presence of the protein flagellin in house dust, bolstering the link between allergic asthma, the immune response and the environment.


According to the authors, most people with asthma have allergic asthma, resulting largely from allergic responses to inhaled substances and that although flagellin is not an allergen, it can boost allergic responses to true allergens.


Study results showed that after inhaling house dust, mice that were able to respond to flagellin displayed all of the common symptoms of allergic asthma, including more mucous production, airway obstruction, and airway inflammation. However, mice lacking a gene that detects the presence of flagellin had reduced levels of these symptoms. In addition to the mouse study, the authors also determined that people with asthma have higher levels of antibodies against flagellin in their blood than do non-asthmatic subjects, which provides more evidence of a link between environmental factors and allergic asthma in humans.


According to the authors, the data suggest that flagellin in common house dust can promote allergic asthma by priming allergic responses to common indoor allergens.


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Modest Diet and Exercise Can Sustain Weight Loss


“BIGGEST LOSER” STUDY FINDS Modest Diet and Exercise Can Sustain Weight Loss.


More than two-thirds of U.S. adults age 20 and older are overweight or obese, and more than one-third of adults are obese. Excess weight can lead to type 2 diabetes, heart disease, high blood pressure, stroke, and certain cancers.


According to an article published online in Obesity (3 October 2012), exercise and healthy eating reduce body fat and preserve muscle in adults better than diet alone. The authors analyzed the individual effects of daily strenuous exercise and a restricted diet by examining data from 11 participants from the reality television program “The Biggest Loser.” The program shows obese adults losing large amounts of weight over several months. Participants were initially isolated on a ranch followed by an extended period at home. According to the authors, by including the show’s contestants as voluntary study participants, this research took advantage of a cost-efficient opportunity to study a small group of obese individuals already engaged in an intensive lifestyle intervention.


The study measured body fat, total energy expenditure and resting metabolic rate – the energy burned during inactivity – three times: at the start of the program, at week 6, and at week 30, which was at least 17 weeks after participants returned home. Participation in the program led to an average weight loss of 128 pounds, with about 82% of that coming from body fat, and the rest from lean tissue like muscle. Preserving lean tissue, even during rapid and substantial weight loss, helps maintain strength and mobility and reduces risk of injury, among other benefits.


The authors used a mathematical computer model of human metabolism to calculate the diet and exercise changes underlying the observed body weight loss. Because the TV program was not designed to directly address how the exercise and diet interventions each contributed to the weight loss, the computer model simulated the results of diet alone and exercise alone to estimate their relative contributions.


Results showed that at the end of the competition, diet alone was calculated to be responsible for more weight loss than exercise, with 65% of the weight loss consisting of body fat and 35% consisting of lean mass like muscle. In contrast, the model calculated that exercise alone resulted in participants losing only fat, and no muscle. The simulation of exercise alone also estimated a small increase in lean mass despite overall weight loss.


The simulations also suggest that the participants could sustain their weight loss and avoid weight regain by adopting more moderate lifestyle changes – like 20 minutes of daily vigorous exercise and a 20% calorie restriction – than those demonstrated on the television program.

Hormone Replacement Therapy and Cardiovascular Events in Recently Postmenopausal Women



Hormone replacement therapy for postmenopausal women has been subject to much discussion and speculation since the 1960s. Before 2002 the effects of hormone replacement therapy were believed to be beneficial, owing to a reduction in risk of cardiovascular disease, osteoporosis, and colon cancer. The negative side effects of an increased risk of breast cancer and thromboembolic disease were thought to be outweighed by the advantages, principally on the basis of results from observational studies. In 2002 the primary results from the Women’s Health Initiative showed no cardiovascular benefit from hormone replacement therapy. These conflicting results have led to the “timing hypothesis”; the idea that the differences in cardiovascular outcome can be accounted for by time since menopause until the start of hormone therapy. The observational studies mainly have shown positive cardiovascular effects, probably as a result of hormone therapy starting shortly after menopause, and the randomized studies have shown no or negative cardiovascular effects, often in women who start hormone therapy many years (5 to 20) after menopause. In meta-analyses taking age into special consideration, use of hormone therapy in younger women has been associated with a lower risk of coronary heart disease and reduced overall mortality.


We used data from the Danish Osteoporosis Prevention Study (DOPS)


According to an article published online in the British Medical Journal (9 October 2012), the Danish Osteoporosis Prevention Study (DOPS), was a randomized, controlled clinical trial initiated in Denmark between 1990 and 1993, to investigate the long term effect of hormone replacement therapy on cardiovascular outcomes in recently postmenopausal women.


Study participants included 1,006 healthy women aged 45-58 who were recently postmenopausal or had perimenopausal symptoms in combination with recorded postmenopausal serum follicle stimulating hormone values. Of the participants, 1,502 women were randomly allocated to receive hormone replacement therapy and 504 to receive no treatment (control). Women who had undergone hysterectomy were included if they were aged 45-52 and had recorded values for postmenopausal serum follicle stimulating hormone.


In the treatment group, women with an intact uterus were treated with triphasic estradiol and norethisterone acetate and women who had undergone hysterectomy received 2 mg estradiol a day. Intervention was stopped after about 11 years owing to adverse reports from other trials, but participants were followed for death, cardiovascular disease, and cancer for up to 16 years. Sensitivity analyses were carried out on women who took more than 80% of the prescribed treatment for five years.


The primary endpoint was a composite of death, admission to hospital for heart failure, and myocardial infarction.


At inclusion the women on average were aged 50 and had been postmenopausal for seven months. After 10 years of intervention, 16 women in the treatment group experienced the primary composite endpoint compared with 33 in the control group (hazard ratio 0.48; P=0.015) and 15 died compared with 26 (0.57; P=0.084). The reduction in cardiovascular events was not associated with an increase in any cancer (36 in treated group v 39 in control group, 0.92; P=0.71) or in breast cancer (10 in treated group v 17 in control group, 0.58; P=0.17). The hazard ratio for stroke (11 in treated group v 14 in control group) was 0.77. After 16 years the reduction in the primary composite outcome was still present and not associated with an increase in any cancer.


According to the authors, after 10 years of randomized treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure, or myocardial infarction, without any apparent increase in risk of cancer, venous thromboembolism, or stroke.

TARGET HEALTH excels in Regulatory Affairs. Each week we highlight new information in this challenging area


FDA Takes Action Against Thousands of Illegal Internet Pharmacies



On October 4, FDA, in partnership with international regulatory and law enforcement agencies, announced that it took action against more than 4,100 Internet pharmacies that illegally sell potentially dangerous, unapproved drugs to consumers. Actions taken include civil and criminal charges, seizure of illegal products, and removal of offending websites. The announcement takes place during the 5th annual International Internet Week of Action (IIWA), a global cooperative effort to combat the online sale and distribution of potentially counterfeit and illegal medical products. This year’s effort – Operation Pangea V – operated between September 25 and October 2 and resulted in the shutdown of more than 18,000 illegal pharmacy websites and the seizure of about $10.5 million worth of pharmaceuticals worldwide.


The goal of this annual effort, which involved law enforcement, customs and regulatory authorities from 100 countries, is to identify producers and distributors of illegal pharmaceutical products and medical devices and remove these products from the supply chain. These efforts demonstrate that strong international enforcement efforts are required to combat this global public health problem. The FDA has reinforced its online efforts with the launch of a national campaign to educate Americans about the risks of buying prescription medications over the Internet. BeSafeRx – Know Your Online Pharmacy seeks to raise public awareness about the health risks of using fraudulent Internet pharmacies and what consumers can do to protect themselves.


During Operation Pangea V, the FDA targeted websites selling unapproved and potentially dangerous medicines. In many cases, the medicines can be detrimental to public health because they contain active ingredients that are approved by FDA for use only under the supervision of a licensed health care practitioner or active ingredients that were previously withdrawn from U.S. market due to safety issues.


Among the illegal medicines identified through the operation were:

  • Domperidone: This medicine was removed from the United States market in 1998 because it may cause serious adverse effects, including irregular heartbeat, stopping of the heart, or sudden death. These dangers could convey to the nursing baby of breastfeeding women, who may be using domperidone to try increase milk production (which is not an approved use).
  • Isotretinoin (previously marketed as Accutane in the United States): This medicine is used to treat severe nodular acne and carries significant potential risks, including severe birth defects if pregnancy occurs while using this medicine. To minimize potential risks to consumers, FDA-approved isotretinoin capsules are only available through restricted distribution in the United States.
  • Tamiflu (oseltamivir phosphate): This medicine, which is used to treat the flu, is often sold online as “generic Tamiflu.” However, there is no FDA-approved generic version of Tamiflu. Previous FDA tests found that fraudulent versions of “generic Tamiflu” contained the wrong active ingredient, which would not be effective in treating flu. In these cases, the wrong active ingredient was similar to penicillin and may cause a severe allergic reaction, including a sudden, potentially life-threatening reaction called anaphylaxis, in consumers allergic to penicillin products.
  • Viagra (sildenafil citrate): This medicine is used to treat erectile dysfunction. Due to its vasodilation effects, sildenafil citrate should not be used by consumers with certain heart conditions. Consumers taking this medicine without the supervision of a health care professional may not learn about potential drug interactions, such as increased blood pressure lowering effects of organic nitrates when taken with sildenafil citrate.


The FDA sent Warning Letters to the operators of more than 4,100 identified websites. As a follow up, the agency sent notices to Registries, Internet Service Providers (ISPs), and domain Name Registrars (DNRs) informing them that these websites were selling products in violation of U.S. law. The FDA is working with its foreign counterparts to address the remaining websites that continue to offer unapproved or misbranded prescription medicines to U.S. consumers.


The FDA coordinated the efforts of this year’s Operation Pangea V, including screening all drug products received through the international mail facilities during the IIWA. Preliminary findings showed that certain products from abroad, such as antibiotics, antidepressants, and other drugs to treat high cholesterol, diabetes, and high blood pressure, were on the way to U.S. consumers. Many of those products can pose health risks if taken without the supervision of a health care practitioner or if the products have been removed from the market for safety reasons.

Diet and Oral Health



To prevent cavities and maintain good oral health, your diet — what you eat and how often you eat — are important factors. Changes in your mouth start the minute you eat certain foods. Bacteria in the mouth convert sugars from the foods you eat to acids, and it’s the acids that begin to attack the enamel on teeth, starting the decay process. The more often you eat and snack, the more frequently you are exposing your teeth to the cycle of decay.


Mouth-Healthy Foods and Drinks


The best food choices for the health of your mouth include cheeses, chicken or other meats, nuts, and milk. These foods are thought to protect tooth enamel by providing the calcium and phosphorus needed to remineralize teeth (a natural process by which minerals are redeposited in tooth enamel after being removed by acids). Other food choices include firm/crunchy fruits (for example, apples and pears) and vegetables. These foods have a high water content, which dilutes the effects of the sugars they contain, and stimulate the flow of saliva (which helps protect against decay by washing away food particles and buffering acid). Acidic foods, such as citrus fruits, tomatoes, and lemons, should be eaten as part of a larger meal to minimize the acid from them.


Poor food choices include candy — such as lollipops, hard candies, and mints — cookies, cakes, pies, breads, muffins, potato chips, pretzels, French fries, bananas, raisins, and other dried fruits. These foods contain large amounts of sugar and/or can stick to teeth, providing a fuel source for bacteria. In addition, cough drops should be used only when necessary as they, like sugary candy, contribute to tooth decay because they continuously coat the teeth with sugar.


The best beverage choices include water (especially fluoridated water), milk, and unsweetened tea. Limit your consumption of sugar-containing drinks, including soft drinks, lemonade, and coffee or tea with added sugar. Also, avoid day-long sipping of sugar-containing drinks — day-long sipping exposes your teeth to constant sugar and, in turn, constant decay-causing acids.


Sugar Substitutes and Sugar-Free Products


Sugar substitutes are available that look and taste like sugar; however, they are not digested the same way as sugar, so they don’t “feed” the bacteria in the mouth and therefore don’t produce decay-causing acids. They include: erythritol, isomalt, sorbitol, and mannitol. Other sugar substitutes that are available in the U.S. include saccharin, aspartame (marketed as Equal), acesulfame potassium (marketed as Sunett), and sucralose (marketed as Splenda).


Sugarless or sugar-free food sometimes simply means that no sugar was added to the foods during processing. However, this does not mean that the foods do not contain other natural sweeteners, such as honey, molasses, evaporated cane sugar, fructose, barley malt, or rice syrup. These natural sweeteners contain the same number of calories as sugar and can be just as harmful to teeth. To determine if the sugarless or sugar-free foods you buy contain natural sweeteners, examine the ingredients label. Words that end in ‘-ose’ (like sucrose and fructose) usually indicate the presence of a natural sweetener. On the label, look under sugars or carbohydrates.


Is Chewing Gum OK for Teeth?


Chewing sugarless gum is actually beneficial to your teeth as chewing helps dislodge food that becomes stuck to your teeth and also increases saliva flow to buffer (neutralize) mouth acids. Some gums contain ingredients that can reduce cavities as well as heal areas on the teeth where cavities are beginning. Chewing gum can be a problem, however, if you have jaw pain or other issues with your jaw.


Teeth and Gum Care Tips


These are some basic tips for caring for teeth and gums:

  • Brush your teeth regularly. Brush at least twice a day and preferably after every meal and snack.
  • Use a fluoride-containing toothpaste.
  • Floss at least once a day.
  • Use a mouth rinse daily.
  • Visit your dentist regularly for check-ups and cleanings — typically twice a year.
  • Eat a variety of foods to maintain overall health. Eat fewer foods containing sugars and starches between meals. If you must snack, choose nutritious foods, such as cheese, raw vegetables, plain yogurt, or a firm fruit (such as an apple).

Broccoli, Mushrooms, Chicken with Rice Wine and Hoisin



The extra step to blanche the chicken is worth the extra minutes, for tender, succulent chicken. Try to buy organic, free-range, sustainably raised chicken.




  • 12-16 ounces boneless, skinless chicken breast, cut across the grain in 1/4-inch-thick slices (support organic, free range, sustainably raised chicken)
  • 1 Tablespoon egg white, lightly beaten
  • 2 teaspoons Agar-Agar or cornstarch
  • 1 1/2 teaspoons plus 1 tablespoon rice wine or dry sherry
  • Salt (optional) to taste
  • 2 Tablespoons hoisin sauce
  • Chile flakes (optional – we don’t like them)
  • 1 teaspoon low-sodium soy sauce
  • 2 Tablespoons canola oil
  • 1 bunch broccoli (about 1 pound), trim the ends
  • 1 Tablespoon minced ginger
  • 2 fat garlic cloves, minced
  • 1 teaspoon Turmeric
  • 8 shiitake mushrooms, stems removed, sliced thin
  • Rice, soy (tofu) pasta or bowtie pasta to serve over (prepare ahead of everything else)




1. Marinate the chicken first: In a large bowl, stir together the egg white, Agar-Agar or cornstarch, 1 1/2 teaspoons of the rice wine or sherry, salt to taste and 1 1/2 teaspoons chicken stock or water. When you can no longer see any Agar-Agar (or cornstarch), add the chicken and stir together until coated. Cover the bowl and place in the refrigerator for 30 minutes. You marinate the cut-up chicken breast in egg white and cornstarch seasoned with a little rice wine or sherry and salt, and blanch it before stir-frying, to get more succulent, tender chicken. .


2. Steam the broccoli quickly so it’s still crisp. Dry with paper towel. Cut into 2-inch lengths.


3. Combine the remaining rice wine, the hoisin sauce and the soy sauce in a small bowl and set near the pan or wok you’re going to use.


4. Blanch the chicken no more than one minute: In the pot you used to steam the broccoli, bring the water back to a boil, add 1 tablespoon of the oil and turn the heat down so that the water is at a barely simmering. Carefully add the chicken to the water, stirring so that the pieces don’t clump. Cook until the chicken turns opaque on the surface but is not cooked through, about 1 minute. Drain in a colander.


5. Stir-fry: Heat a 14-inch flat-bottomed wok or 12-inch steel skillet over high heat until a drop of water evaporates within a second or two when added to the pan. Swirl in the remaining oil by adding it to the sides of the pan and swirling the pan, then add the garlic, ginger and turmeric and stir-fry for no more than 10 seconds. Now, add the mushrooms, chicken, broccoli, hoisin sauce mixture and optional salt to taste.  Stir-fry for 1 to 2 minutes, until the chicken is cooked through, and serve with rice or soy pasta or bowtie pasta.


Serve with breadsticks and a not too dry white wine, like Chardonnay or a Riesling or with a spirit of adventure, try serving Sake or a Plum wine.


Sake  Cheers!


Plum wine     Cheers!

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