Current Events in October 2012

Mixing your meds can often do more harm than good -- especially if you're taking blood pressure drugs.

That's why Public Citizen has sent a petition calling on the U.S. Food and Drug Administration (FDA) to place a black box warning on three classes of medications used to treat high blood pressure (hypertension).

The drugs, known as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) and aliskiren, are commonly used to treat high blood pressure. Several ACE inhibitors and ARBs also are approved for -- and effective when used separately in -- slowing the progression of other chronic illnesses, such as heart and kidney disease that afflict millions of people.

ACE inhibitors and ARBs are among the top-selling medications in the country. In 2011, 164 million ACE inhibitor prescriptions (fifth most of any drug class) and 86 million ARB prescriptions (16th most) were dispensed (in addition to 2.4 million aliskiren prescriptions). ARBs alone generated $7.6 billion in revenue in 2011.

Drugs in combination

The use of ACE inhibitors and ARBs in combination has become commonplace in recent years due to a theoretical belief that such combination use would confer an added benefit over the use of the drugs individually. However, Public Citizen contends, this theory has been unequivocally disproven in two large studies involving tens of thousands of patients with heart disease and diabetes that failed to show any clinical advantage of combination therapy.

On the contrary, the studies showed a higher rate of several life-threatening side effects, such as low blood pressure, kidney failure and dangerously high blood potassium levels, in patients taking the drugs together compared with patients on only one of the medications.

A third study involving the combined use of the new drug aliskiren with ACE inhibitors and ARBs in patients with diabetes and kidney disease was halted early for identical reasons: a higher rate of the same serious side effects with no added benefit with combination use. An aliskiren/ARB combination drug, Valturna, was withdrawn from the market shortly thereafter.

Failure to respond

Despite this wealth of data, FDA has failed to respond by adequately warning doctors and patients of the clear danger of the combined use of ACE inhibitors, ARBs and aliskiren, Public Citizen said in the petition. Critical safety information to this effect does not appear in a black box warning at the top of any of the drugs’ labels, and for most of the drug labels, there is no mention anywhere of the dangers of combined use.

“There are few cases in medicine that have such a vast body of evidence all pointing in the same direction,” said Dr. Sammy Almashat, researcher with Public Citizen’s Health Research Group. “This is a classic case of theory not translating into clinical significance. Patients with serious conditions, such as heart and kidney disease, should never be exposed to life-threatening side effects, unless the benefits outweigh the risks. This is clearly not the case here. The FDA must act accordingly and alert the medical community and the users of these drugs of this critical danger.”

Public Citizen calls on the FDA to add a black box warning to the labels of all 18 ACE inhibitor and ARB medications, as well as aliskiren, indicating the increased risk of serious side effects with no added benefit when using the drugs in combination.

The group also is petitioning the agency to require an FDA-approved medication guide to be distributed to all patients prescribed these drugs, as well as a “Dear Doctor” letter to physicians, warning them of the dangers of combination therapy.

There seems to be an epidemic of attention-deficit/hyperactivity disorder (ADHD) and though there are many theories, the cause remains unclear, although a new study sheds some light.

The study of children in the New Bedford, Mass., area suggests that low-level prenatal mercury exposure may be associated with a greater risk of ADHD behaviors and that fish consumption during pregnancy may be associated with a lower risk of these behaviors, according to a report published Online First byArchives of Pediatrics & Adolescent Medicine, a JAMA Network publication.

ADHD is one of the most common neurodevelopmental disorders of childhood and affects 8 percent to 12 percent of children worldwide, although its cause is not well understood.

The developmental neurotoxicity of mercury is known, but the findings from epidemiological studies are inconsistent with some studies showing associations between mercury exposure and ADHD-related behaviors and others reporting null associations, according to the study background.

For most of us, exposure to mercury comes primarily from eating fish, and the U.S. Environmental Protection Agency and the U.S. Food and Drug Administration have recommended pregnant women limit their total fish intake to no more than two, six-ounce servings per week.

However, fish is also a source of nutrients, such as omega-3 fatty acids, which have been shown to benefit brain development, potentially confounding mercury-related risk estimates, the study background also indicates.

Sharon K. Sagiv, Ph.D., M.P.H., of the Boston University School of Public Health, and colleagues analyzed data from the New Bedford birth cohort, a group of infants born between 1993 and 1998, to investigate the association of peripartum maternal hair mercury levels and prenatal fish intake with ADHD-related behaviors at age 8 years.

“In this population-based prospective cohort study, hair mercury levels were consistently associated with ADHD-related behaviors, including inattention and hyperactivity/impulsivity. We also found that higher prenatal fish consumption was protective for these behaviors,” the authors comment.

Statistical analysis indicates mercury exposure appeared to be associated with inattention and impulsivity/hyperactivity. There also appeared to be a “protective” (lower risk) association for fish consumption of greater than two servings per week with ADHD-related behaviors, particularly impulsive/hyperactive behaviors, the study results show.

“In summary, these results suggest that prenatal mercury exposure is associated with a higher risk of ADHD-related behaviors, and fish consumption during pregnancy is associated with a lower risk of these behaviors,” the authors conclude.

“Although a single estimate combining these beneficial vs. detrimental effects vis-à-vis fish intake is not possible with these data, these findings are consistent with a growing literature showing risk of mercury exposure and benefits of maternal consumption of fish on fetal brain development and are important for informing dietary recommendations for pregnant women.”

Preventable epidemic? 

In an editorial accompanying the report, Bruce P. Lanphear, M.D., M.P.H., of Simon Fraser University, Vancouver, British Columbia, Canada, said the study clearly shows the need for more research.

"It is time to convene a national scientific advisory panel to evaluate environmental influences of ADHD and make recommendations about what can be done to prevent it," Laphear said. "This study and a flurry of new evidence linking environmental contaminants with ADHD reinforce the urgency of revising the regulatory framework for environmental contaminants and toxicants”

Part of any physical exam should be a check for skin cancer. After all, it's the most common cancer in the U.S.

While it's important to have a doctor look you over dermatologists also recommend self-examinations on a regular basis. They say it's as simple as looking at your skin.

“Checking your skin for skin cancer only requires your eyes and a mirror,” said Thomas E. Rohrer, MD, a board-certified dermatologist in private practice in Chestnut Hill, Mass. “Examining your skin only takes a few minutes, but it could save your life.”

Second set of eyes helps

Involving a partner adds another set of eyes, which is especially helpful when checking the back and other hard-to-see areas. What exactly are you looking for? According to the American Academy of Dermatology you should watch for the “ ABCDEs of Melanoma.”

A – Asymmetry: One half of the spot is unlike the other half.

B – Border: The spot has an irregular, scalloped or poorly defined border.

C – Color: The spot has varying colors from one area to the next, such as shades of tan, brown, or black, or with areas of white, red or blue.

D – Diameter: Melanomas are usually greater than 6mm, or about the size of a pencil eraser when they are diagnosed, but they can be smaller.

E – Evolving: A mole or spot on your skin that looks different from the rest or is changing in size, shape, or color.

To check your own skin, look at the front and back of your body. When examining your own skin, stand in front of a mirror, raise your arms and examine the right and left sides of the body. Then bend your elbows and look carefully at your forearms, upper underarms and palms.

Next, examine the back of your legs, spaces between your toes and your soles. Examine those hard-to see areas like your back, and the top of your head. Use a mirror to inspect the back of your neck and scalp, parting your hair for a better view.

One in five

“Current estimates show one in five Americans will be diagnosed with skin cancer in their lifetime, so it’s important to be familiar with your skin, especially your moles,” Rohrer said. “Catching skin cancer early is key for successful treatment, so check your skin regularly and see a board-certified dermatologist if you spot anything suspicious.”

The American Academy of Dermatology has just released a video, posted below, that demonstrates self-exam procedures.

The Centers for Disease Control and Prevention (CDC) says that most of the thousands of people exposed to meningitis-tainted drugs have been contacted and are not sick. However, the agency says at least eight persons have died and more than 100 are ill.

The outbreak stems from a contaminated steroid drug produced at the New England Compounding Center (NECC) located in Framingham, Mass. Patients have suffered a variety of symptoms, including those associated with a rare form of fungal meningitis, which is a brain infection, and stroke.

Rep. Edward J. Markey (D-MA), senior member of the Energy and Commerce Committee and in whose district the facility is located, is asking the Food and Drug Administration (FDA) about expanding oversight of these so-called “compounding pharmacies.”

Letter to FDA

In a letter to the FDA, Markey asked the agency about current regulations and oversight practices that ensure that safety standards met by large drug manufacturing companies are also met by compounding pharmacies. Pharmacy “compounding”, which accounts for 37 million prescriptions each year, involves making a new drug whose safety and efficacy have not been demonstrated with the kind of data that FDA ordinarily would require in reviewing a new drug application, according to the lawmaker.

“Compounding pharmacies currently fall into a regulatory black hole,” Markey wrote in his letter to FDA Commissioner Margaret Hamburg. “While such pharmaceutical operations capable of making specialized drug formulations play an important role for many patients who cannot take traditional medication such as pediatric patients, hospice patients, and patients with allergies to common dyes and fillers, they also carry inherent risks that are not always fully communicated to patients.”

Questions

Markey said a number of questions need answers:

• How is information regarding the safety and efficacy of compounded drugs communicated to patients?
• Is FDA aware of how many compounding pharmacies are in the United States?
• How many enforcement actions has the FDA taken on compounding pharmacies?
• What is FDA’s view on compounding pharmacies maintaining an online presence for the purpose of advertising and selling specific compounded pharmaceuticals? Has FDA issued guidance on this specific issue?
• Does FDA have the statutory authority it needs to ensure the safety of consumers with respect to drugs made by compounding pharmacies? Does FDA believe that new legislation is needed to strengthen federal oversight over compounding pharmacies?

Tracing efforts

On October 3 NECC stopped all production and began a recall of all methylprednisolone acetate, a steroid medication, and other drug products prepared for injections in and around the spinal cord. The CDC and state health departments have released the names of approximately 75 healthcare facilities in 23 states that have received contaminated product.

Patients have had symptoms generally starting from one to four weeks after their injection,” the CDC said. Not all patients who received the medicine will become sick.

Symptoms that should prompt patients to seek medical care include: fever, new or worsening headache, neck stiffness, sensitivity to light, new weakness or numbness, increasing pain, redness or swelling of the injection site.  

BBB Scam Stopper, an education campaign developed with Western Union to help consumers in the United States and Canada avoid common scams that con artists use to commit consumer fraud, is up and running.

“Western Union devotes extensive resources to stopping fraud,” said Shelley Bernhardt, the company’s Director of Consumer Protection. “Our agents are trained to intervene if they suspect a customer is the victim of a scam. Through our partnership with BBB, we aim to give consumers the information and resources they need to protect themselves and help stop fraud before it gets that far.”

Consumer fraud is a serious problem in North America. According to the Federal Trade Commission and the Canadian Anti-Fraud Centre, consumers reported losing more than $1.5 billion to all types of scams in 2011.

“We investigate thousands of scams every year, and we know the tactics that scammers commonly use,” says Carrie Hurt, President and CEO of the Council of Better Business Bureaus. “A portion of these scams involves the wire transfer of funds, so Western Union is the ideal partner for this campaign. The best defense against fraud is awareness and education. It’s crucial for consumers and business owners to recognize scams before they become victims.”

Leveling the playing field

On the Scam Stopper Website, consumers can find facts and tips to stay informed and help reduce their chances of becoming a victim of a scam. The site also explains the science of scams, and how scammers use many of the same “sales tactics” that are used by legitimate businesses. Visitors can also sign up to receive BBB Scam Alerts, weekly emails with the latest scams reported to BBBs across the country.

The site highlights common scams like Emergency Scams (a friend or family member has an emergency, often in another country, and needs money), Overpayment Scams (a buyer overpays and asks for the difference wired back to them), Sweepstakes and Lottery Scams (you’ve won a lot of money, but you have to pre-pay taxes before claiming your prize), and more.

When a woman goes through menopause may determine her risk for heart attack, according to an assistant professor of medicine at Vanderbilt University.

Dr. Melissa Wellons conducted the research while working at the University of Alabama Birmingham (UAB). In looking at more than 2,500 women of all ethnic backgrounds, one fact jumped out.

Within the study, early menopause in European, black, Hispanic and Asian women doubled the risk for cardiovascular disease when compared to groups experiencing menopause later in life.

“This is an observational study, so my colleagues and I can’t conclude that early menopause is the cause of future cardiovascular disease,” Wellons said.

Another reason?

That means there could be another reason that the women suffered cardiovascular problems. But the fact that so many had an early menopause in common can't be dismissed. She said the study is especially important because cardiovascular disease is the leading cause of death in U.S. women.

“My hope is that getting this message out will motivate women with early menopause to engage in the lifestyle and medical strategies known to reduce risk of cardiovascular disease -- like controlling cholesterol, blood pressure and excess weight and by exercising,” Wellons said.

The study looked at 2,509 women enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA), with 693 reporting either surgical or natural early menopause before age 46. Women with early menopause were more often smokers, had diabetes and had a higher average BMI -- all risk factors for heart trouble.

“But our findings do support the use of age at menopause as a marker of future heart and vascular disease risk. Clinicians should consider asking questions about menopause when collecting a female patient’s medical history.”

If you are among those who got an extension for filing your 2011 tax return, the Internal Revenue Service (IRS) wants you to know the clock is ticking.

If your extension runs out on next Monday, Oct. 15, be sure to double-check your return for often-overlooked tax benefits and then file electronically using IRS e-file or the Free File system.

Many of the more than 11 million taxpayers who requested an automatic six-month extension this year have yet to file. Though Oct. 15 is the last day for most people, some still have more time, including members of the military and others serving in Iraq, Afghanistan or other combat zone localities who typically have until at least 180 days after they leave the combat zone to both file returns and pay any taxes due.

People with extensions in parts of Louisiana and Mississippi affected by Hurricane Isaac also have more time -- until Jan. 11, 2013, to file and pay.

Check out tax benefits

IRS encourages taxpayers to take a moment before they file to see if they qualify for these and other often-overlooked credits and deductions:

Benefits for low-and moderate-income workers and families, especially the Earned Income Tax Credit. The special EITC Assistant can help taxpayers see if they’re eligible.

Savers credit, claimed on Form 8880, for low-and moderate-income workers who contributed to a retirement plan, such as an IRA or 401(k.

American Opportunity Tax Credit, claimed on Form 8863, and other education tax benefits  for parents and college students.

E-filing: fast, easy and often free

E-file is fast, accurate and secure, making it an ideal option for those rushing to meet the Oct. 15 deadline. The tax agency verifies receipt of an e-filed return, and people who file electronically make fewer mistakes too.

Everyone can use Free File, either the brand-name software, offered by IRS’ commercial partners to individuals and families with incomes of $57,000 or less, or online fillable forms, the electronic version of IRS paper forms available to taxpayers at all income levels.

Taxpayers who purchase their own software can also choose e-file, and most paid tax preparers are now required to file their clients’ returns electronically.

Anyone expecting a refund can get it sooner by choosing direct deposit. Taxpayers can choose to have their refunds deposited into as many as three accounts. See Form 8888 for details.

Quick and easy payment options

For unemployed workers who filed Form 1127-A and qualified to get an extension to pay their 2011 federal income tax, Oct. 15 is also the last day to pay what they owe, including interest at the rate of 3 percent per year, compounded daily. Doing so will avoid the late-payment penalty, normally 0.5 percent per month.

Taxpayers can e-pay what they owe, either online or by phone, through the Electronic Federal Tax Payment System (EFTPS), by electronic funds withdrawal or with a credit or debit card. There is no IRS fee for any of these services, but for debit and credit card payments only, the private-sector card processors do charge a convenience fee. For those who itemize their deductions, these fees can be claimed on Schedule A, Line 23. Those who choose to pay by check or money order should make the payment out to the “United States Treasury”.

Taxpayers with extensions should file their returns by Oct. 15, even if they can’t pay the full amount due. Doing so will avoid the late-filing penalty, normally five percent per month, that would otherwise apply to any unpaid balance after Oct. 15. However, interest and late-payment penalties will continue to accrue.

Fresh start for struggling taxpayers

In many cases, those struggling to pay taxes qualify for one of several relief programs, including those expanded earlier this year under the IRS "Fresh Start" initiative .

Most people can set up a payment agreement with the IRS on line in a matter of minutes. Those who owe $50,000 or less in combined tax, penalties and interest can use the Online Payment Agreement to set up a monthly payment agreement for up to six years or request a short-term extension to pay. Taxpayers can choose this option even if they have not yet received a bill or notice from the IRS. They can also request a payment agreement by filing Form 9465-FS.

Alternatively, some struggling taxpayers qualify for an offer-in-compromise. This is an agreement between a taxpayer and the IRS that settles the taxpayer’s tax liabilities for less than the full amount owed.

Generally, an offer will not be accepted if the IRS believes the liability can be paid in full as a lump sum or through a payment agreement. The IRS looks at the taxpayer’s income and assets to make a determination regarding the taxpayer’s ability to pay.

Autumn has arrived with pumpkins, apples and brightly colored leaves. But for millions of Americans, unfortunately, it also brings sneezing and runny noses.

And just where are fall allergies the worst? The Asthma and Allergy Foundation of America (AAFA) says Louisville, KY, tops the list of U.S. cities with the worst fall allergy conditions.

Rounding out the top five are Wichita, KS; Knoxville, TN; Jackson, MS; and McAllen, TX.

“The warm temperatures and longer seasons have created the perfect environment for seasonal allergies, causing pollen counts to soar this fall season,” said James Sublett, MD, a Louisville allergist and chair of the American College of Allergy, Asthma and Immunology (ACAAI) Indoor Environment Committee. “The fall allergy season peaked in September and is expected to linger until November.”

Environmental factors

Sublett says other environmental factors, such as Hurricane Isaac, caused some cities to be worse for allergies this year than others.

An estimated 40 million Americans suffer with seasonal allergies. Allergic rhinitis -- also called nasal allergies, seasonal allergies or hay fever -- is among the most common chronic diseases for children and adults, affecting more than 12 percent of the U.S. population. The primary fall allergy trigger -- ragweed pollen -- causes itchy runny nose, nasal congestion, repeated sneezing, watery eyes, inflamed sinuses and, in severe cases, difficulty breathing. It can be more problematic if you also have asthma.

“Everyone seems to be feeling allergies these days and fall is the most common allergy season after spring,” said Dr. Beth Corn, a Board Certified Allergist in New York City and a member of ACAAI. “No matter if it’s men, women or children, in the city, suburbs or the country, allergies don’t discriminate.”

Tips

Despite being worse in fall and spring, allergies can affect people all year round. Here are a few tips for reducing the impact of seasonal allergies:

• Keep windows and doors closed to prevent pollen from blowing into the house.
• Control dust mites on the bed. Look for a Certified asthma & allergy friendly mattress and wash sheets weekly in hot water to kill mites and their eggs.
• Use a quality vacuum that has a high-efficiency filter weekly to keep indoor allergens to a minimum.
• Change the air filter in your furnace regularly. Filters can trap lots of dust and allergens, so replace them every 30-90 days. Look for Certified asthma & allergy friendly filters.
• Reduce the presence of mold by decreasing moisture around the house, keeping humidity below 50 percent and clearing the yard of damp firewood and leaves.

There have been plenty of studies conducted in the past about the effects of children being exposed to high amounts of television, but for the first time researchers from the University of North Carolina Wilmington have examined just how much background television is being watched by kids.

Background television or “second hand TV” is anytime the tube is playing and it’s not being watched, and according to study findings, children are exposed to a ridiculous 232.3 minutes of this type of television per day.

Researchers gathered 1,454 parents who had at least one child between the ages of 8 months and 8 years old, and the study showed that younger children were exposed to roughly 5.5 hours of second hand television a day, and children between the ages of 6 and 8 years old were in the midst of a television playing for 2.75 hours per day.

Overall, children in the 8 month to 8 year age range were exposed to an average of 4 hours of background TV each day, shows the study.

“We were all startled by the scale of exposure in these homes,” said Matthew Lapierre, communications professor at University of Carolina Wilmington and lead author of the study. “We went into the study expecting the rates to be high, but not at the scale we found.”

Significant factors

The study also showed that family structure, education and race play a significant role in the amount of second hand TV a child watches.

For example, children from single parent homes are more likely to be exposed to background television more frequently, and those children from lower-income households are also more exposed to second hand TV, say researchers.

In addition, parents with higher amounts of education were less likely to use television as a virtual babysitter, and African American children were exposed to higher amounts of background TV compared to other children, the study shows.

Small and easy

Researchers say parents can do small and easy things to dramatically reduce the amount of background television their child is exposed to. First, quite simply, parents should be sure to turn off the television the very moment no one is watching.  Also, it’s imperative to turn off the TV during meals and bedtimes, especially for smaller children in their developmental stage.

For example, if a parent watches their favorite television program when their child is in their highchair eating dinner, it could be bad for their years of development, researchers say.

The same goes for when you’re putting your child to bed. Researchers believe the TV shouldn’t be on when you’re your child is winding down or putting on their pajamas.

“The thing we find most concerning is that if a child has a television on in the background, then he is hearing things that are supposed to elicit his attention like loud noises, sound effects and beeps,” says Lapierre. “So even if they aren’t watching directly, they aren’t able to engage in play behaviors or interactions with their full attention and have more meaningful experiences.”

Pay attention

Researchers also say parents should pay special attention to what they’re watching and remain cognizant of the relationship between what they view and the subtle impact it can have on their child. They also say that using the television to always placate your child could do more harm than good.

“This may be particularly effective for parents of the youngest children who may not see their own direct exposure as having an impact on young children or may be using the television for companionship,” the authors wrote.

“Considering the rates of background television exposure that we found along with the negative associations that other researchers have found between background television and cognitive and social outcomes, any effort to decrease background exposure seems worthwhile," they said.

Admittedly, many people these days use laptop computers primarily to watch movies, listen to music or otherwise fiddle around. There are quite few of us, however, who use them to write and edit stuff -- you know, "content," as it's called in Geekdom.

For those who write professionally -- whether composing a novel or editing a report on the ecological consequences of the declining buzzard population in midtown Manhattan -- there is an expectation, or at least a hope, that our efforts are readable and free of annoying typos and other glitches.

Before computers became toys, manufacturers understood this and made at least some effort to build a machine that did what it was intended to do. IBM was famous for the crisp precision of its keyboards, which were modeled on its Selectric line of electric typewriters. (Children, a "typewriter" is sort of a computer without a monitor or hard drive).

Now that computers have become just another electronic gadget used to keep the populace mesmerized and out of the streets, manufacturers no longer seem to care whether they can actually be used for the intended purpose.

Case in point: the Asus Zenbook Ux31, one of the laptops that uses Intel's ultrabook chipset to produce a laptop that is not only slim but downright elegant. All the usual suspects -- Dell, Acer, Lenovo, et al -- are building ultrathin latops and, yes, they are similar in terms of size and general appearance to the MacBook Air line, which also uses the ultrabook chipset. And, no, Apple fans, Apple did not "invent" the ultrabook, Intel did.

These machines aren't cheap. You can buy a plain old bulked-up laptop for $500 or so, whereas an ultrathin will cost you over $1,000. So why would anybody buy such a thing?

Well, see above. There are millions of people who eke out a meager living by writing and editing. Working, in other words. And thanks to the always-on 24/7 culture of the modern world, these content slaves must work pretty much all the time, even when traveling and generally lounging about.

Given the expanding size of your average consumer and the shrinking space available on today's aircraft, trains and buses, using a traditional laptop while en route is difficult -- with the lid open, there's no room left for your arms. Also, your average laptop has a pathetically short battery life, few exceeding two hours.

The ultrathin answers these and other dilemmas. And so it came to pass that a week or two ago, I ordered an Asus Ux31, ignoring published reviews that complained mildly of keyboard eccentricities. After all, like most people who do this for a living, I am fairly obsessive about keyboards (and mice) and really don't expect to like any of them very much. 

A thing of beauty but ...

The Asus Zenbook, however, takes keyboard design incompetence to new heights.  Yes, it's a thing of beauty -- an all-metal case with a stunning display and little chiclet-style light-colored metal-looking keys.

The difficulty is that the keys simply do not work in any predictable manner. Hit them hard and they may or may not work. Strike them lightly and they may or may not work. Or they may repeat. Or not.

The entire process is so chaotic and unpredictable that it makes it difficult to concentrate on what one is trying to say -- which is what writing is all about, right, trying to say something?

Everything else about the machine is great. The solid-state drive boots up in no time, the machine runs so cool it doesn't melt your trousers and the 1600 x 900-pixel display is absolutely first-rate. Battery life is excellent, exceeding five hours in my tests.

Too bad you can't do anything with it.

Reviewers reviled

Just the maniacal mutterings of an obviously unbalanced scribe, you say? Not really. For proof, just type "Asus Zenbook keyboard problems" and you will find blogs and comments galore about they keyboard and Asus' lack of interest in doing anything about it.

We found this video review which helps explain the origin of the problem, though not offering any effective solution:

Interestingly, as with most other things, the media get quite a bit of the blame for the Zenbook's shortcomings, as angry consumers accuse professional reviewers of being on the take from the companies they write about. This, of course, is not true and as we learn in Libel Avoidance 101, one should not publish such assertions without having evidence to back them up.

Nevertheless, there is an issue here: professional reviewers, those retained by established magazines and websites, have possession of the reviewed item for a short time -- often just a few days, so they are not likely to unearth the problems that come to light with extended usage.

Also, many reviewers are of a technical bent. They will run all manner of bench tests about processor speed and so forth but not all of them put the device to any realistic real-world test -- like, say, trying to type something on it.

This is why it's always a good idea to read peer reviews -- the actual experiences of real-world users who put consumer products through their paces each and every day. We humbly submit that ConsumerAffairs, Yelp and other such sites should be required reading before any purchase. 

All it takes, really, is a simple Google query: "[name of product] problems" will usually get you information professional reviewers never discover.

As for the Zenbook, unless you have truly Zen-like patience, we would give it a wide berth. 

In the last week California motorists have suffered sticker shock at the gas pump as the average price of fuel has jumped 50 cents a gallon in the last seven days. Sen. Diane Feinstein (D-CA) thinks something is fishy and wants a government investigation.

In a letter over the weekend to the Federal Trade Commission, Feinstein held open the possibility that fraud might be involved in the shortage of gasoline in the state, resulting in the sudden price spike.

"Available data appears to confirm that market fundamentals are not to blame for rising gas prices in California," her letter said.

Same production levels as last year

Industry analysts have blamed the situation on a recent fire at a major California oil refinery, which was complicated, they say, by a number of pipeline problems. But Feinstein says she has carefully read reports on gasoline production at the refinery and says levels remain high, along with stockpiles. In fact, she says, things aren't very different from this time last year, when the average price of gasoline in the state was $3.80 a gallon, according to AAA.

Last week California gasoline prices exploded, rising 15 to 30 cents per day. While the average price in the state today is $4.66 a gallon, making it the most expensive state in the national for fuel, the price is much higher at some stations in some metro areas of the state.

In many cases stations have simply run out of fuel and have stopped selling it at any price. Because California air pollution standards are tougher than most other states, California must have its own special blend of gasoline. It's not the same, for example, as what's sold across the state line in Nevada, Arizona or Oregon.

Emergency action

In an effort to alleviate the situation, California Gov. Jerry Brown over the weekend directed the state's Air Resources Board to immediately allow the sale of cheaper and more available winter-blend gasoline. That could cut prices by 15 to 25 cents. Winter blend is detrimental to air quality during warm weather but the sky-high gas prices and worsening supply call for immediate action, Brown said.

The move already seems to have had some effect. The AAA daily Fuel Gauge Survey shows the average price of gasoline in California just over a penny from yesterday.

California isn't the first state to experience a sudden price spike this year. In early August five Midwestern states – Illinois, Indiana, Ohio, Michigan and Wisconsin – saw prices at the pump surge after problems at regional pipelines and refineries.

Where industry analysts see normal supply and demand problems, some policymakers like Feinstein see a troubling pattern. Since Hurricane Katrina disrupted Gulf Coast refinery operations in 2005, gasoline prices have been subject to wild swings as fuel has become more of a trading commodity.

Attorneys general from 41 states have signed a letter to Congressional leaders, stating their stiff opposition to a bill that would provide a national charter for payday lenders.

The bill, H.R. 3139, otherwise known as the Consumer Credit Access, Innovation and Modernization Act, would give non-bank financial services providers -- including payday lenders, installment lenders, car-title lenders, prepaid-card issuers, check cashers and others -- access to a federal charter issued by the Office of the Comptroller of the Currency.

The state officials say the bill would totally preempt state licensing laws for non-bank financial services providers, and require state consumer protection laws to be evaluated under the preemption standard set forth by the U.S. Supreme Court in Barnett v. Nelson.

End run

“The legislation is nothing more than a shameless attempt by the payday lending industry to do an end run around states’ decades’ long battle to protect low-income families from becoming trapped in a downward spiral of debt,” said Illinois Attorney General Lisa Madigan, one of those signing the letter.

The letter was sent to House Speaker John Boehner (R-OH), House Majority Leader Nancy Pelosi (D-CA), Senate Majority Leader Harry Reid (D-NV) and Senate Minority Leader Mitch McConnell (R-KY).

In it the attorneys general argue that states, in recent years, have passed laws cracking down on abuses by short-term lenders while preserving consumers' access to credit.

"Many of these states have chosen to strike a regulatory balance that preserves access to alternative forms of credit while protecting consumers from repeated debt cycles and other pitfalls associated with such products," the letter states. "H.R. 6139 would turn back existing consumer protections and curtail all future efforts by the states to enhance their consumer safeguards."

Minimal consumer protections

In place of state safeguards, the officials say the bill would establish only minimal consumer protections. Although the bill would prohibit lenders from extending credit to consumers unless there is a reasonable basis for believing the consumer can repay the loan, they say it establishes no standards for determining a consumer’s ability to repay.

“It’s critical for states to both preserve consumers’ access to alternative forms of credit and retain the ability to take quick action against short-term lenders that prey on those already in financial distress,” said Indiana Attorney General Greg Zoeller. “This joint effort among attorneys general underscores the importance of killing this federal legislation that would provide no significant protections for consumers and have unintended consequences.”

The bill has bi-partisan backing in Congress and the opposition is also bi-partisan. The 41 attorneys general declaring their opposition include both Republicans and Democrats.

Maybe you refinanced your mortgage a couple of years ago when rates fell below five percent. After all, you thought, they couldn't go much lower.

But they have. And recent record low mortgage rates have now fallen even more -- to around 3.5 percent. Should you refinance again?

It's a good question and one that doesn't have an obvious answer. It all depends on a number of variables.

Consider the upfront costs

In most cases, it costs money to refinance a loan. There's an appraisal fee and regular closing costs. The mortgage company or broker will also assess a fee. The total of all these costs is something that you'll need to justify.

But first, just how long ago did you last refinance? What were your closing costs? What is your current rate and how much lower is it than the rate that it replaced?

The answers to these questions will tell you whether you have "paid for" your previous refinance. In other words, have you already saved the total you spent on refinancing by having a reduced monthly payment? If not, then the balance should be applied to the cost of a new mortgage.

Typical closing costs

A 2008 survey by Bankrate.com found the typical closing costs on a $200,000 mortgage amounted to $3,100. How quickly can you recoup that cost?

If your current rate is 4.75 percent, the monthly payment on a 30-year fixed rate loan -- not counting taxes and insurance, is $1,355.79. Let's say you can refinance at 3.75 percent for the same term. The monthly payment drops to $1,238.73, a savings of $117.06.

It would take 26 months, or just over two years, to recoup the closing costs. After that time you will begin realizing the savings. Personal finance experts generally advise that a two-year payback cycle is justifiable.

The question to ask yourself is whether you plan to still be living in the house at that time. If you end up selling it before the 26 months is up, then it doesn't really pay to refinance right now.

Payback number could be higher than you think

If it seems like it could go either way, this is where the payback on your previous mortgage comes in. If you still have $700 in unrealized savings on your current mortgage, that $700 should be added to the $3100 costs for the new re-fi. Now it will take 32 months for a lower monthly payment to pay for itself.

There may be other extenuating factors, however, that could justify an early refinance, especially at these low rates. If you have some credit card debt at a very high interest rate that you have been unable to pay, it's possible to roll some or all of it into your new mortgage, assuming you have enough equity in your home.

The savings in interest on the credit card debt -- especially if it is in the range of 20 to 30 percent -- is a strong mitigation in the refinancing equation. Just understand that even though you're paying back that credit card debt at a record low interest rate, you'll be paying on it for as long as you hold the mortgage.

Those spiffy new pair of shoes you bought with your American Express card? $75. That fantastic Italian meal you purchased on your way to the mall? $17.95.

Finding out you’re due for some American Express settlement money because the company duped you? Priceless.

As we reported last week, the don’t-leave-home-without-it credit card company has agreed to pay a whopping $27.5 million in civil fines, along with $85 million to customers, after being accused of several violations including charging incorrect and  illegal penalty fees.

So what effect do settlements like these have, other than costing the company a few million dollars in settlement and lawyer fees?

Well, maybe more than you'd think. ConsumerAffairs conducted a computerized sentiment analysis of more than two million consumer postings to social media over the last year and found that perceptions of Amex fell from a high of 87% favorable to just 53% currently.

Consumers are never short of complaints about their credit cards and American Express is certainy no exception.

The agreed-upon payout was also to settle accusations of American Express committing age discrimination against applicants and misleading consumers to believe they would be eligible for monetary bonuses after applying for a specific card.

John of Mahattan is one consumer still fuming over his attempt to redeem rewards points.

"I tried to use my 40,000 in reward points to book airline miles and the website was not working. I tried to call to book over the phone (talked to 9 different customer service reps and could not understand them due to strong Indian accents). Finally talked to someone I could understand and it was a $95 fee to book over the phone," John said. "Never thought I would say this but American Express sucks. I've been a member for several years and like everyone else, they have sold out. Makes me sad!"

The case against Amex was bought by state regulators in Utah, as well as other consumer protection agencies like the Federal Deposit Insurance Corp (FDIC) and the U.S. Consumer Financial Protection Bureau (CFPB). The CFPB said American Express consistently broke consumer laws as it pertains to being forthright about late fees, charges and many of the services it provides.

“Several American Express companies violated consumer protection laws and those laws were violated at all stages of the game. From the moment a consumer shopped for a card to the moment the consumer got a phone call about long overdue debt,” said Richard Cordray of the CFPB.

The consumer protection agency also said American Express has been committing such practices for about a nine-year span, which has hindered every aspect of the credit card experience for the consumer from the onset of the application process to the bill's arrival.

“We have been troubled by the range of problems that our examination process uncovered,” said Kent Markus, CFB’s assistant director of its enforcement division. “The legal violations we discovered span the lifecycle of a consumer’s experience with American Express cards.”

ConsumerAffairs reached out to American Express and the company sent us this statement: “We worked closely with the regulators and cooperated fully with them through their reviews. We took responsibility for correcting the issues and are compensating customers where appropriate,” relayed Marina Hoffmann Norville of American Express.

Another company rep said this in a separate statement:

“Reserves were established in previous quarters for a substantial portion of these fines and the estimated customer refunds. Separately, the company is continuing its own internal reviews and cooperating with regulators in their ongoing regulatory examination of add-on products in accordance with the industry wide review.”

Started in 2003

In a routine investigation conducted by both Utah regulators and the FDIC it was first learned that American Express was committing these violations from 2003 to as recently as earlier this year.

And it seems the settlement comes at a time when government protection agencies are making a stronger effort to guard consumers from unlawful practices that many people may not be aware of.

Last week the CFPB announced the credit card company Discover would reimburse nearly 4 million of its customers about $200 million for conducting questionable sales practices.

In the case of American Express, the company has 90-days to get back to the feds with a new code of compliance, as well as fork over the first $9 million of the settlement fee.

The consent order in the settlement best describes what American Express has really been accused of: The company “failed to adequately identify, monitor and control risks associated with the services proved,” which shows consumers always have to over monitor, question and challenge each credit card statement they come across.

Millions of consumers with high blood pressure or coronary artery disease (CAD) take a prescription drug known as a beta blocker. For years it has been a mainstay of CAD treatment.

But a new study suggests it shouldn't be. Researchers at the NYU Langone Medical Center studied patients taking these drugs and concluded they aren't helping.

A new study conducted by researchers in the Cardiac and Vascular Institute at NYU Langone Medical Center, found that using beta-blockers, the standard of care for patients with coronary artery disease (CAD), was not associated with a lower risk of heart attacks, death and strokes in patients suffering from CAD and those with risk factors for the disease, including those with a history of heart attack. The study appears in the October 3 issue of JAMA.

Current standard

“The current standard of care for patients with coronary artery disease, especially when they have had a heart attack, is treatment with beta blockers. However, this guidance has been extrapolated from older studies,” said lead author Sripal Bangalore, MD, assistant professor in the Department of Medicine, the Leon H. Charney Division of Cardiology.

“Our results found none of the patient populations studied showed benefit from taking beta-blockers, including patients with a history of heart attack,” said lead author Sripal Bangalore, MD. “This is concerning in light of current treatment patterns and reveals a need for more education among practitioners who treat patients at risk for heart attack and stroke.”

Bangalore speculates that beta blockers reached their favored status based on studies conducted well in the past. Recent data, he says, has continued to question their effectiveness.

Side effects

And then there are side effects, most of which are a result of the way these drugs work. Beta blockers block the effects of adrenaline in the body. When you take beta blockers, your heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels open up to improve blood flow. But that can make you tired and vulnerable to fatigue.

Side effects can also include increases in cholesterol levels, weight gain, upset stomach and headaches.

The study tried to determine how beta blockers affected more than 40,000 test subjects, divided into groups composed of people who suffered a prior heart attack, those who had CAD but no heart attack, and those with high blood pressure but no CAD.

Additional research

“Our findings reinforce the need for additional research assessing which patient populations show clear benefit from beta-blocker therapy, especially because side-effects from treatment can be considerable in some patients,” said Bangalore. “In addition, further study needs to be conducted to assess optimal duration of therapy in these patient sub-sets.”

Other studies have suggested there are other more effective, and cheaper alternatives to beta blockers, especially for treatment of high blood pressure. In his book Hypertension and You: Old Drugs, New Drugs and the Right Drugs for Your High Blood Pressure, Dr. Samuel J. Mann, of New York-Presbyterian Hospital/Weill Cornell Medical Center, blames beta blockers for what he calls “an epidemic of fatigue.”

Mann says many newer, cheaper drugs like diuretics, could be as 0r more effective if doctors would prescribe them.

The United States is in the middle of some trying times, and in the midst of the nation’s economic challenges many of our other problems seemed to get pushed to the outskirts of public consciousness, and homelessness is one of them.

According to a report from the Institute for Children, Poverty and Homelessness (ICPH), the lack of low-income housing has contributed to a 20 percent rise in family homelessness between the years of 2007 and 2010.

The report also indicates there are only 5.4 million apartments that are $458 or less in rent, which is an extremely low amount considering that 10.9 million families earn $18,310 a year or less, which meets the federal poverty line, the report shows.

Contributing to the low-income housing shortage is that 2.3 million (42 percent) of affordable housing is occupied by families who earn salaries far over the poverty limit, taking away housing opportunities for those that truly need it. And according to the experts the homelessness problem will only get way worse before it gets better.

Feds pulled out

“The primary reason is the federal government stopped producing, they got out of the business of producing low-income housing in the 80s”, says Matthew Adams, the principal policy analyst for ICPH, in an interview with ConsumerAffairs. “They sort of devolved all that responsibility to the states and gave states some of the money to do that, but states have been unable to do that on their own. Particularly in today’s climate, states are broke.”

“On top of that you have median rents rising 37 percent between 2000 and 2010," Adams noted. “And at the same time median household incomes fallen nearly 10 percent between 2000 and 2009, and the census reported just last week that median household incomes fell another 1  1/2 percent between 2010 and 2011."

"Also, the welfare rolls have declined 60 percent between 1996 and 2011, so that further decreases any sort of available income that families might have. If you want to pin it on somebody at the end of the day, it’s the feds for not building this housing,” he said.

Feds preoccupied

But the feds have been pretty tied up with the economy, global and domestic terrorism, and managing the simultaneous wars we’re in. Has all of this led to a growing amount of indifference towards low-income families and the homeless?

“Politicians today are focused on the economy, the shrinking middle class, and these are definite absolute priorities,” said Adams. "But sort of lost and forgotten in this situation is low-income households, and particularly homeless families -- the poorest of the poor families out there. I think they’re definitely absent from the current policy debates.”

Even among the small numbers of affordable housing that’s currently available for poorer families, a large number of those units tend to be occupied by families that make more money and can afford higher rent.

One would think there would be enough regulations in place so the proper rental units go to the proper families. Adams says it’s not hard to gather why even those families who have higher incomes want to minimize their housing costs.

“Who can blame them, right?” he said. “If you can find a cheaper apartment and pay less on your income on rent, you know, the sort of definition of affordable is no more than 30 percent of your income on housing related expenses, so if you can spend 20 percent that’s more for savings, so you can’t really blame these families.”

“But once you factor that in, it leaves only 3.1 million units available instead of the 5.4 [million] in 2009, and that increases the gap by 7 million units, and that’s just a huge thing,” he said.

Section 8

Adams also notes that issuing section-8 vouchers was a popular way the federal government would help low-income families in the 1980s, but the problem has become so widespread in recent years, there just aren’t enough vouchers to keep up with the demand. He also says even the vouchers that are currently being distributed don’t go to the poorest of families most of the time.

And though there are enough rental units for all that need them in the United States, landlords and the general market dictate rent prices so a large portion of the country just can’t afford to live anywhere. And the units they can afford, many families have to go on lengthy waiting lists that can stretch on for decades, says Adams.

He also says things probably won’t get better for low-income families anytime soon.

“This is the trend that has been coming through for decades, I don’t see any sort of major investment in low-income housing coming at any point in the near future,” he said. “Feds relinquished responsibility to the states and so states in response have developed essentially housing trust funds. So there’s like 700 of these state and local housing trust funds and annually they raise about a billion dollars for low-income housing."

“In 2008 the national housing trust fund was signed into law, and President Obama the last four years have tried to securitize that, but he’s been unsuccessful, so even if that happens we're investing $2 million a year, and to give you an idea of how inadequate that is, just the budget for rental assistance is $16 million alone for $2 million vouchers, so those number are just not going to add up. There’s not going to be a big change,” he said

What has changed, Adams said, is the fact the government has gone from providing rental vouchers to simply building more homeless shelters, and that same money could be better used to provide personalized housing to lift families up and out of poverty. But that's not going to happen anytime soon, he said.

Chrysler is recalling 44,300 model year 2009-2010, Ram 1500 and Dodge Dakota trucks, manufactured from July 1, 2009, through November 30, 2009, because a rear axle pinion nut may loosen due to a lack of adhesive.

If the rear axle pinion nut loosens, the axle can lock up and cause a loss of vehicle control and/or a vehicle crash with little warning.

Chrysler will notify owners, and dealers will install a pinion nut retainer, free of charge. The recall is expected to begin in November.

Owners may contact Chrysler at 1-800-247-9753.

Honda is recalling 268,655 model year 2002-2006 CR-V passenger vehicles, manufactured from February 19, 2002, through July 28, 2006.

The driver-side power window switch may fail or melt. If the switch fails, it could overheat, smoke, and cause a fire. A switch failure and a fire could occur even if the vehicle is not in use. As a precaution, owners are advised to park outside until the recall repair has been performed.

Honda will notify owners, and dealers will inspect and repair the switches -- as necessary -- free of charge. The safety recall is expected to begin on, or about, November 2, 2012.

Owners may contact Honda at 1-800-999-1009.

With more lower-income consumers bailing out of the banking system American Express and Walmart are teaming up on a product aimed at that market. It's a low-fee prepaid debit card called Bluebird.

The complaint about prepaid cards has always been the fees. There are usually lots of them and not all are obvious until you start using the card. The two partners claim Bluebird will be different.

“Our customers tell us that they’re tired of navigating a complex maze of dos and don’ts to avoid the ever growing list of fees found on checking products,”said Daniel Eckert, vice president of financial services for Walmart U.S. "Bluebird solves this problem and we believe it’s the best product on the market to help customers affordably manage their everyday finances.”

Not many fees

According to the published fee schedule, there is no annual fee, activation fee or monthly service fee. Adding money from a debit card carries a $2 fee but almost all other methods are free. There's a $2 charge for out-of-network ATM withdrawals but no fee associated with purchases, including electronic bill pay.

The companies say you can deposit money in a variety of ways including payroll direct deposit, remote check capture via the Bluebird mobile app, using cash at any Walmart register, or by linking a checking, savings, or debit card to the account. The card also comes with many of the benefits associated with other American Express products.

“Bluebird is our solution to help consumers who currently may be poorly served by traditional banking products,” said Dan Schulman, group president, Enterprise Growth, American Express. “It allows them to easily and safely move, manage, and spend their money. In an era where it is increasingly 'expensive to be poor,' we have worked with Walmart to create a financial services product that rights many of the wrongs that plague the market today.”

How to apply

Consumers can sign-up for free on Bluebird.com, or choose to buy a $5 account set up kit at a local Walmart for immediate use. The set up kit includes a starter card, which can be funded with cash or a debit card at the register with any dollar amount between $1 and $500.

Once funded, the starter card can be used immediately anywhere in the United States where American Express Cards are accepted. Customers must then complete their account set up at bluebird.com in order to access the full features and benefits of Bluebird, as well as receive their personalized Bluebird card.

Walmart currently offers a prepaid Visa/Mastercard debit card with a $3 set-up fee and $3 monthly service charge.

Aimed at under-served market

A September 2012 survey by the Federal Deposit Insurance Corp. (FDIC) shows 28 percent of consumers either had no bank or used minimal banking services in 2011. The survey showed 821,000 more U.S. households are operating without a bank account since the first survey in 2009, representing a 0.6 percentage point increase.

More than half of all unbanked households said they do not have an account because they believe they do not have enough money or that they do not need or want an account. In addition, the report shows that three in ten households nationally don't have a savings account.

"The results of the 2011 National Survey of Unbanked and Underbanked Households indicate that insured financial institutions have an important chance to grow their customer base by expanding opportunities that bring unbanked and underbanked individuals into mainstream banking" FDIC acting chairman Martin J. Gruenberg said at the time.