1. health and fitness
2. therapy

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HEALTH & WELLNESS
Exercise Pick-Me-Up
When Push Comes to Training WHAT’S YOUR WORKOUT? D3
Playing Oddball
Off the Field
SPORTS D6
THE WALL STREET JOURNAL.
© 2015 Dow Jones & Company. All Rights Reserved.
Tuesday, January 6, 2015 | D1
Patients Take
Pure Oxygen
In Off-Label
Treatments
The Problem With Adult Acne
What Doctors Prescribe
Some therapies that are increasingly being adopted:
BY JOSEPH WALKER
ORAL TREATMENTS
LASER AND LIGHT-BASED TREATMENTS
A medication is applied then exposed to light to activate its
ingredients. The therapy shows promise for treating acne scars
but uneven results in treating flare-ups.
TOPICAL TREATMENTS
Lee Frost spent three months in
2013 taking her son Callum for treatment in a high-pressure oxygen
chamber, in hopes it would help his
severe autism. Ms. Frost, frustrated
by the lack of approved treatments
for her son, discovered hyperbaric
oxygen therapy through online research.
Callum’s ability to communicate
had been limited to screaming tantrums, biting and slapping, she recalls. After receiving the therapy,
which involved inhaling pure oxygen
for 75 minutes at a time, Callum, now
5, is able to speak in sentences and
dress himself in the morning before
kindergarten, Ms. Frost says. His
treatment also included dietary
changes. “He still has a way to go,
but the child he is today is a different child,” says Ms. Frost, who lives
in White Rock, British Columbia, in
Canada.
Ms. Frost is one of the growing
number of people who have pursued
hyperbaric oxygen therapy, or HBOT,
for uses that mainstream doctors,
government regulators and patient
advocates say are unproven. In a
2013 consumer alert, the U.S. Food
and Drug Administration warned that
Isotretinoin clears up most acne patients, but shouldn’t be used by
women who might become pregnant. Hormonal therapy can help
women whose acne flares during their period. Subantimicrobial
doses of antibiotics don’t kill bacteria but can fight inflammation.
DIET MODIFICATION
CHEMICAL PEELS
These usually clear up mild cases. For
stubborn acne, doctors may prescribe more
potent topical creams or gels containing
antibiotics or retinoids, which help keep
follicles open.
Reducing consumption of dairy products and
following a low-glycemic diet in favor of proteins, vegetables, nuts and whole grains may
lessen acne severity, some studies show.
Mild acids remove the top layers of skin so
new skin can grow in their place. Superficial
peels may hasten the disappearance of acne
lesions and deeper peels may remove acne
scars.
Sources: American Academy of Dermatology; Cochrane Database of Systematic Reviews; UpToDate.
Mike Sudal/The Wall Street Journal
Growing numbers of patients
are pursuing hyperbaric
oxygen therapy for uses that
are both approved and
unapproved by the FDA.
As Antibiotics Become Less Effective, Doctors Try a Range of New Treatments
BY DANA WECHSLER LINDEN
Three months after Danielle Schwarz began
taking antibiotics for a severe case of acne, her
doctor began to notice a disturbing pattern
among her patients—this mainstay treatment for
the skin condition increasingly wasn’t working.
“I was canceling plans, didn’t want anyone to
see me,” says Ms. Schwarz, a 25-year-old bank
analyst in New York.
Her doctor, Whitney Bowe, a clinical assistant
professor of dermatology at the Icahn School of
Medicine at New York’s Mount Sinai Medical
Center, kept Ms. Schwarz on the antibiotics a
short while longer. Then, about 18 months ago
she switched her to a completely different approach to treatment: a variety of yet-to-be
proven therapies that included diet modification
and alternating monthly chemical peels and light
treatments.
“We used to get more success with oral antibiotics,” says Dr. Bowe. But the bacteria responsible for causing acne have become so resistant
to the drugs “that our ability to treat moderate
to severe acne has become compromised,” she
says.
Growing concern over antibiotic resistance is
changing how dermatologists treat acne. They
are relying more on topical treatments, which
can require a lot of patient education and handholding to assure reliable use, and on hormonal
medications for some women. Some dermatologists say they are putting more patients on isotretinoin, an effective acne drug with a controversial history that used to be sold under the brand
name Accutane.
Also gaining in use is a variety of newer approaches whose efficacy for acne hasn’t been extensively researched. Among these are laser and
light-based therapies, chemical peels, diet
changes, probiotics and so-called sub-antimicrobial doses of antibiotics, which are designed to
be too small to kill bacteria but still able to fight
inflammation.
Acne is the most common skin disorder in the
U.S., affecting about 85% of teenagers and a sizable number of adults. Some 51% of women and
43% of men in their 20s have acne, along with
15% of women and 7% of men over age 50, a
2008 University of Alabama study found. Acne
can persist beyond adolescence, or develop in
adulthood.
Antibiotics are one of the main ways to treat
moderate to severe acne, and patients often are
put on them for months or years. Although dermatologists represent only 1% of the nation’s
physicians, they prescribe 5% of antibiotics,
pharmaceutical-industry data show. Over time
the microorganisms the antibiotics are designed
to kill adapt to them, making the drugs less effective.
In a study in Britain, antibiotic-resistant
strains of Propionibacterium acnes, the bacterium involved in acne, were found in 56% of all
acne patients in 2000, up from 35% a decade
earlier. Many countries now report that more
than half of P. acnes strains have developed a resistance to antibiotics.
Concerned dermatologists—in conferences,
medical journals and professional newsletters—
are urging more judicious use of antibiotics for
Please turn to the next page
hyperbaric oxygen therapy “has not
been clinically proven to cure or be
effective in the treatment of cancer,
autism, or diabetes” despite treatment centers’ claims.
Professional athletes, including
former National Football League star
Terrell Owens, have spoken publicly
about using HBOT to recover from
sports injuries. Alternative medicine
centers and medical spas offer it to
people who want to look younger, improve their energy levels or get relief
from chronic medical conditions such
as multiple sclerosis and cerebral
palsy—uses that aren’t approved by
the FDA.
Medical spas and alternative medicine centers may charge from $150
to $250 for a single HBOT treatment,
which insurers rarely reimburse.
Companies including OxyHealth LLC,
have promoted inflatable HBOT oxygen chambers for home use costing
about $7,000 and up.
The popularity of oxygen therapy’s experimental uses has raised
concerns that patients are being financially exploited in exchange for
false hope.
“Desperation created by the absence of approved treatments has unfortunately made autism families vulnerable to misleading claims about
the effects of treatments and assumptions of safety,” Rob Ring, chief
scientific officer of advocacy group
Please turn to the next page
Women expecting a baby or planning a pregnancy are being pitched a
fast-growing array of tests to check if
they are carriers for hundreds of
mostly rare genetic diseases.
Such genetic testing, called carrier
screening, has long been targeted
mainly at people of certain ethnic
groups such as Ashkenazi Jews, who
are at higher risk for some conditions such as Tay-Sachs disease. Now,
companies that offer carrier screening are promoting the idea that testing everyone for many diseases is a
more effective way to reduce the
number of babies born with serious
disorders, including cystic fibrosis, a
life-limiting lung condition, and Canavan disease, a fatal neurological
disorder.
“We have the technology and it’s
affordable enough that we don’t need
to put people into ethnic categories,”
says Shivani Nazareth, director of
women’s health for Counsyl Inc., in
South San Francisco, Calif., one of
the largest carrier-screening companies. “If we can offer the same panel
to everyone, it’s so much more efficient.”
Scientists keep identifying new
gene mutations, or variations, associ-
ated with specific diseases. Advances
in DNA technology allow companies
to quickly screen large numbers of
people, using saliva or blood samples, to determine if parents could
pass the genetic variations to their
children.
Counsyl offers tests that aim to
detect heightened genetic risk for at
least 98 different diseases, for between $599 and $999. Another company, Gene by Gene Ltd., of Houston,
plans in the next few months to introduce First Look, a test billed as
the most comprehensive on the market that can screen for more than
300 diseases. The company expects
the price could be close to $1,500.
Carrier screening is usually covered by health insurance. Counsyl
says the average out-of-pocket bill
for its insured patients is between
$150 and $300.
There are almost 7,000 known
rare diseases, which are defined by
the National Institutes of Health as
affecting fewer than 200,000 people.
Most rare diseases have no known
treatment or cure.
Nancy Rose, director of reproductive genetics at Intermountain
Healthcare in Salt Lake City, questions whether screening everyone
Please turn to page D4
Sophie-Shifra Gold, of Seattle, with her 15-month-old son, Isaac, who was born with Canavan disease.
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BY BONNIE ROCHMAN
Soulumination
Pregnant Women Face a Confusing Array of Genetic Tests
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