By Elizabeth Landau
CNN.com Health Writer/Producer

The general anesthetic Diprivan (propofol) has been making headlines as questions about Michael Jackson's death abound. A nurse who had worked for the singer told CNN that Jackson requested the drug because he had trouble sleeping, and The Associated Press reported that it had been found in his home. Diprivan is not approved as a sleep aid by the Food and Drug Administration. Read more about propofol.

It turns out that propofol, used routinely for surgeries and procedures such as colonoscopies, has been a point of concern among some anesthesiologists because of the potential for abuse by health care workers. A 2007 study published by the International Anesthesia Research Society found that about 18 percent of the 126 academic anesthesia programs in the United States had at least one reported instance of propofol abuse within the previous 10 years.

Researchers also found that six out of 16 residents (about 38 percent) who abused propofol died from it. While these are small numbers, lead author Dr. Paul Wischmeyer, professor of anesthesiology at the University of Colorado, believes this is indicative of a larger problem.

People who abuse propofol tend to have had trauma earlier in life, and take the drug to escape it, Wischmeyer said. These people also tend to be impulsive and risk-taking, he said.

Wischmeyer became passionate about the issue because one of his classmates in residency died from using the drug.

"I know physicians that have reached their hands into sharps boxes, where all of the needles are disposed of, to pull out old, used syringes of this stuff that have been used in other patients, and then use it on themselves," he said.

The drug affects two important brain receptors, one of which is associated with marijuana, and the other is targeted by anti-anxiety drugs such as Valium, he said.

"Once someone has tried this drug in a way that they remember it, they very much always choose to try it again," he said.

Some people may die from propofol abuse because the drug itself becomes contaminated when it sits out for too long, like "spoiled milk," he said. There is also a risk of overdose.

"The difference between being high and being dead is a cc or two," Wischmeyer said.

If propofol is the direct cause of death, it should show up in an autopsy in urine, blood, and possibly hair, he said. But it does depend on how long before death the drug was injected.

Should propofol be considered a controlled substance that needs to be "scheduled," with tight distribution and strict accounting of its use? Anesthesiologists are still debating this.

On the down side, stricter pharmacy control of Diprivan would involve increased costs and administrative oversight, the study authors noted. Although there have been documented cases of propofol abuse, it is still much less frequent than abuse of opioids and benzodiazepines, which are governed by strict federal laws and local pharmacy control, they wrote.

But Wischmeyer advocates that it should be a controlled substance because of how lethal it is. He argues that having an extra layer of accounting, as there is with many painkillers and sedatives in hospitals, would not delay the supply of drug for the patients who need them. It was only with Wischmeyer's group's study that the anesthesiology community became more aware of the growing abuse problem, he said.

Most anesthesia programs do not keep track or control of propofol stocks, the authors wrote.

The drug does not produce a "high" per se, but does give the person who takes it a euphoric feeling upon waking up, said Dr. Hector Vila, chairman of the Ambulatory Surgery Committee for the American Society of Anesthesiologists.

For more information about the propofol issue among anesthesiologists, read the study and check out Anesthesiology News.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Elizabeth Landau
CNN.com Health Writer/Producer

Recently, after having dinner with a friend, my head felt achy and warm. As I reached for the bottle of Tylenol, I remembered that many medications have harmful side effects in combination with alcohol, and I'd just had a margarita at the restaurant. So, I left the pills on the desk and went to the Internet.

It seems that acetaminophen, the primary active ingredient in Tylenol, may lead to liver damage in combination with alcohol. Liver damage from chemicals is called hepatotoxicity. That's why the warning label on products similar to Tylenol say you should ask your doctor before taking the product if you drink more than than three alcoholic beverages per day.

But what about one drink? And how long should a person wait after consuming alcohol before taking acetaminophen-based drugs?

I scoured the Web and found that many people had asked similar questions on forums such as Yahoo! Answers. Various Web sites had some suggestions, but not much specific to the precise timing of safe consumption of this medication after an alcoholic drink. Confused, I just put a cold washcloth on my forehead and went to sleep.

For the benefit of CNN.com readers with similar questions, I looked into the issue further.

Dr. Elizabeth Roth, an internist at Massachusetts General Hospital, said drinking before taking the recommended dose of acetaminophen-based medications may not be a big issue for some people, although she does not advise it. In patients without underlying liver disease and who are not chronic alcoholics, acute alcohol intake is not a risk factor for liver damage from acetaminophen, she says.

"The bottom line is that for the otherwise healthy person without chronic liver disease or a history of alcoholism, they don't have to wait before taking two regular Tylenol after having a drink. But no medical advice fits all patients," she said in an e-mail.

Other factors can increase the likelihood of acetaminophen-related liver damage, including old age, poor nutritional status, co-existing illnesses, and particular genetic makeups. Moreover, the toxic dose among individuals can vary. A person's baseline levels of glutathione - a chemical involved in metabolism - play a role in the acetaminophen levels at which toxicity can occur, Roth said.

For alcoholics, acetaminophen-containing drugs such as Tylenol can be dangerous. According to one National Institutes of Health publication on alcohol and metabolism, liver damage effects may occur with as little of four to five "extra-strength" pills taken over the course of the day in people who consumed varying amounts of alcohol. Damage is more likely to occur when alcoholics take the pills after, rather than before, the alcohol has metabolized.

There is treatment for acetominophen poisoning - it's called N-acetylcysteine (NAC). But always consult your doctor before taking products similar to Tylenol if you think you may be at risk for liver damage as a result of that medicine. And remember that an overdose of acetaminophen, with or without alcohol, is dangerous.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Elizabeth Landau
CNN.com Health Writer

Since allergy season began in late March, I have been trying to avoid settings where a lot of people are likely to be smoking. Even outside in Atlanta’s hipster neighborhood of Little Five Points, I found myself coughing uncontrollably last week when walking past a group of people smoking on a corner. Allergists agree that cigarette smoke aggravates allergies.

But a new study recommended by the Faculty of 1000 Biology challenges this conventional wisdom. Researchers at Utrecht University in the Netherlands took mast cells, which play a role in the immune response to allergies, from mice, and treated them with a smoke-infused solution.

They found that the smoke treatment prevented the mast cells from releasing inflammation-induced proteins, which is what normally happens when exposed to allergens. The smoke solution did not affect other mast cell immune functions, the researchers said. This anti-allergy effect would likely hold true for humans, they wrote.

The general idea that smoke would help allergies is surprising, said Dr. Stanley Fineman, allergist with the Atlanta Allergy and Asthma Clinic.

“In humans, we know from the patients that we see that cigarette smoke is very irritating to the mucosa, the lining of the airways,” he said. “People who have allergies tend to have inflamed respiratory mucosa.”

Years of patient work has shown that smoke is detrimental to people with allergies, he said.

Whatever benefits to allergies cigarette smoke may theoretically carry, the costs are hard to ignore: Cigarette smoking accounts for about 30 percent of all cancer deaths nationwide, according the American Cancer Society. About 87 percent of lung cancer deaths, the leading cause of cancer death among both men and women, are caused by smoking. Smoking can also lead to other types of cancer.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Elizabeth Landau
CNN.com Health Writer/Producer

“We’ve come up with a compromise,” the flight attendant told me.

I was on a flight from Amsterdam to Atlanta in October. I had almost made it back to America in perfect health after two weeks in Moscow. But now hundreds of people on this 747 were about to release toasted almond particles into the air at once, and unfortunately, I’m among the 3 million Americans who are allergic to peanuts and/or tree nuts. Some people may experience symptoms just from breathing the offending food, but there’s no way to predict how strongly any particular individual will react.

Maybe I’m paranoid but, given that I have endured near-fatal reactions from eating these foods, and a strong smell alone seems to prime my body for sickness, it’s hard to justify taking a chance. It’s especially worrisome on a long flight over the Atlantic Ocean.

Sure, I knew what I was getting into – I had thoroughly researched the airline’s peanut policy, but I hadn’t counted on other forms of nuts as the main snack. Still, when I flew out to Amsterdam, the cabin crew not only refrained from serving the nuts at my request, but also made an announcement that there was a passenger on board who has peanut and nut allergies, and could everyone please refrain from eating these products. I felt safe for the entire flight.

Coming back to America, on the other hand, the flight attendant in charge of my section questioned why I would be flying at all if I had such a problem. Even after I explained my previous experience, the person in charge made the decision that nuts would be served, no matter what.

The compromise was that I would spend a little over an hour in quarantine, sitting in a small curtained-off area at the very back of the cabin with the food and drink carts. I sat on a folding chair and played with my laptop, moving every few minutes so the flight attendants could squeeze by.

Making things even more confusing, some airlines’ policies seem to change every few years, and sometimes snacks vary according to the route. There are a few airlines, though, that seem to be consistently peanut-free these days, and they’re the ones that I use every time I travel within the U.S. Note that I’ve never been in a situation in the U.S. where people around me brought their own peanuts or even any other strong-smelling nut product to eat on a plane and, anecdotally, I question whether airplane passengers like eating peanuts that much.

So when I heard about Northwest reintroducing peanuts on board this month, I sighed – another airline to cross off my list. Would it really be so hard to just serve pretzels?

Do you have food allergies? What have you experienced when flying?

Editor's Note:  Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Elizabeth Landau
Writer/Producer
CNN.com Health

Next time you go to the beach, you might want to shower - before you get in the ocean as well as after, says Dr. Lisa Plano, associate professor of clinical pediatrics and microbiology and immunology at the University of Miami.

A study she collaborated on shows that a person’s risk of exposure to staph is about 37 percent – but note that the bacteria could have come from you or from someone else. Your chance of getting MRSA, or methicillin-resistant Staphylococcus aureus, a form of antibiotic resistant staph, is about 1 percent.

Plano presented her research, conducted in subtropical marine waters, at the meeting of the American Association for the Advancement of Science in Chicago, Illinois, over the weekend. The study, which is the first large epidemiological study of its kind, looked at 1,300 people.

Preliminary data suggest that the number of people in the water increases number of bacteria in the water, she said.

The MRSA found in the study “looked like they were likely to cause aggressive infections, in the family of community-associated MRSA,” she said. The other staph, on the other hand, looked benign and unlikely to cause infections.

“We have to conclude that the beach could be a source for community-acquired staph infections,” Plano said.

MRSA has been around in hospital settings since the 1970s, but community-associated MRSA didn’t emerge until the late 1990s. Now, it is a recognized problem in situations where people come into close contact with one another's skin, such as in professional sports, as I reported in October. (read article)

But the researchers in this study could not make a link between the exposure to staph in the water and any illness in the participants, she said. While some people did have complaints, the data were not strong enough to draw a connection.

Still, while not wanting to scare anyone, Plano recommends that people shower before entering the water so they won’t spread their own bacteria, and afterwards so that they reduce the number of organisms they picked up.

What about acquiring staph from fish? Plano said she is unaware of a fish source that could transmit staph to humans, as these are largely human-specific bacteria. Note, however, that, cats and dogs can have staph too.

Is getting a staph infection something you think about at the gym or the beach?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Elizabeth Landau
CNN.com Health Writer/Producer

I was a junior at Princeton when a group of student journalists and I excitedly sat down for dinner with Los Angeles Times columnist Joel Stein at J.B. Winberie Restaurant about three or four years ago. Whenever I dine out with people I don’t know well, it’s always a little embarrassing to tell the server that I have severe allergies to all nuts and peanuts. It’s especially embarrassing when a writer I admire is a dinner guest – so I try to be as discreet as possible when inquiring about the ingredients that went into certain menu items. (Of course, it would be all the more embarrassing to actually incur a life-threatening reaction at the table).

Recently I was surprised to read a column expressing that, in Stein’s view, food allergies are on the rise because of “Yuppiedom.” His argument is that the increase in food allergies among children in the U.S. is best explained by paranoia-fueled mass hysteria. He writes that “peanut allergies are only an issue in rich, lefty communities” and that the parent of an allergic child is perhaps just “a parent who needs to feel special.” (Read the column)

Let me reiterate that I greatly admire Stein as a writer, and his columns are often funny in a good way. But this issue is not light-hearted. About 12 million Americans have food allergies, and the statistics are more concerning among children – one out of every 17 children under 3 years old in America has an allergy, according to the Food Allergy and Anaphylaxis Network (FAAN). Some of those 12 million, like me, have had near-fatal reactions to common foods, such as milk, eggs, fish, shellfish, peanuts, tree nuts, wheat and soy. Some of the children will grow out of their allergies but, experts say, many with seafood or nut problems need to avoid those foods for life. It’s true that we don’t know why allergies have been on the rise – experts say maybe Americans are overly hygienic, or that it’s genes, or environmental factors – but I’m pretty sure it’s not because of “Yuppiedom” that I had to go to the hospital a few years ago after eating the wrong cookie.

Perhaps most troubling, Mr. Stein suggests we probably don’t need explicit ingredient labels or to take peanuts out of schools because “food allergies kill about as many people as lightning strikes each year.” Even if the actual food allergy mortality rate is low – a number that would undoubtedly be hard to measure because the cause of death may be misdiagnosed – perhaps it’s related to all of the life-saving interventions that exist today, most notably the portable epinephrine injection sold as EpiPen. Without the prevalence of EpiPens and the conscientiousness of food companies, schools and restaurants, perhaps that death rate would be a lot higher.

Albeit perhaps unintentionally, Stein does make a good point about food labels. While there are not literally labels that say “made in a factory that also has a break room where a guy named Dave often sneaks in a King Size Snickers despite this 'diet' he says he's on,” parents do have to wonder whether that description is any more meaningful than “made in a factory that processes products with peanuts.” The truth is that we really don’t know what any of this means in terms of how safe those products are for children with peanut allergies. The Food and Drug Administration's held a public hearing in September on this very issue.

The bottom line is that, for those millions of Americans who have food allergies, well-informed awareness of the issue is critical. Perhaps there are parents out there who are unnecessarily paranoid about their children having allergies, but it wouldn’t have become an issue if there weren’t plenty of parents with legitimate, evidence-based concerns about their children who really could die from common foods.

For those of us who DO have allergies, please don’t throw peanuts back at us.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Elizabeth Landau
CNNhealth.com producer

I dreaded those weeks of gym class dedicated to laps around the track. My breath faltered after less than a minute of jogging, and my legs felt stiff. I placed last in every race the instructor made us run. Fortunately, my good friend Ariana sometimes walked with me while the others sped ahead. Having a companion to defy the track requirement made our slow pace seem more like a rebellion: “It’s not that we can’t run, we just don’t want to.”

I began jogging on a treadmill to combat my “freshman 15” – the extra pounds accumulated by many first-year college students when offered a seemingly unlimited supply of cafeteria treats. But I always felt hungry afterwards, and ended up instead with a freshman 20.

Running to lose weight became even more of a burden than running for gym class. I found myself running on Princeton’s rain-splattered sidewalks at midnight because the fitness center had closed and I wasn’t seeing results in the mirror fast enough.

Running became a fun, relaxing activity only recently, after I regained my pre-college weight during my senior year. When no gym instructor was yelling at me, I seemed to find a balance between eating, exercising, studying and socializing and I could finally feel good about pushing my legs to new speeds for longer and longer periods.

I asked exercise physiologist Lauren Williams Korzan, a certified Health Fitness Specialist through the American College of Sports Medicine, what tips she would offer to someone who wants to start making running part of his or her life. Here’s her advice:

* Begin slowly. Start with a walk/run program. Try running for two minutes and walking for four minutes, for a total of thirty minutes. Over time, increase your running time and decrease your walking time. Eventually, you will be able to run for 30 minutes without walking.
* Schedule workouts into your week. It will be easier to turn running into a habit by making it a scheduled priority each week. Aim for three workouts per week.
* Follow a training program. Many running coaches, clubs, and Web sites offer programs for beginners.
* Set goals, both short and long-term. While your long-term goal may be to run a 5K race, your short-term goal may be to run at least three times a week to build endurance.
* Keep a log. A running log helps to track your workouts and will allow you to see how far you've progressed.
* Listen to your body. If you're feeling tired or sore, take a rest day or substitute a lower-intensity workout. Cross training with swimming, biking or an elliptical machine will prevent placing too much stress on the same muscles and help to reduce your risk of injury.
* Wear proper footwear. A good pair of running shoes can make running easier and keep you injury-free.
* If you're having trouble with motivation, listening to music or running varied and scenic routes may help. Be aware that running outdoors with headphones may not be safe.

Have you learned to love an activity that you previously didn't enjoy? What tricks helped you to begin enjoying it?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Elizabeth Landau
CNN.com Health Writer/Producer

For several months I have enjoyed recording digital music files through my keyboard, thanks to a simple device that connects it to my laptop. But it wasn’t until recently that I discovered that the following label came with it:

WARNING: This product contains chemicals, including lead, known to the State of California to cause cancer, and birth defects or other reproductive harm. Wash hands after handling.

I freaked out. How could a set of cables attached to a small blue blinking cylinder cause cancer? The USB connector and keyboard inputs seemed harmless enough, and I hadn’t felt obvious symptoms while making music. Was I risking my life for the sake of my four-person fan base?

So I called the company, M-Audio. Apparently, manufacturers have to put this label on certain products to comply with Proposition 65, a California law that requires a warning on anything containing lead or other hazardous substances found to cause cancer, birth defects, or other reproductive harm.

Under this law, whose full title is The Safe Drinking Water and Toxic Enforcement Act of 1986, warnings must be placed on products with a chemicals present in amounts larger than what the California government has decided is a “safe harbor number.”

These requirements are pretty strict. For example, for a cancer-causing chemical, according to the state’s Office of Environmental Health Hazard Assessment, “a person exposed to the chemical at the ‘no significant risk level’ for 70 years would not have more than a ‘one in 100,000’ chance of developing cancer as a result of that exposure.” So, if there would be more than one excess case of cancer out of 100,000 people over a period of 70 years because of exposure to that amount of the substance, slap on that label.

It’s not just computing equipment. Amazon.com outlines for its customers required warnings for California consumers placed on tools, lead crystal glasses, ceramic tableware, jewelry, Tiffany style lamps, electrical cords, beauty products, and even motor vehicles.

The consequences for violating Proposition 65 can be pretty fierce. One Los Angeles company had to pay a $10 million fine for failing to label lead-tainted lunch boxes (they sold 100,000 of them to the state health department), the Los Angeles Times reported earlier this year.

Still, does that mean I have to wash my hands every time I touch the cord? Mark Williams, spokesperson for M-Audio, says, “No! My gosh, no!”

In general, he says, electronics products carry this label because of the materials used in circuit boards, such as lead, for example. It’s not like there’s pesticide sprayed on the surface, he says.

In fact, according to the company’s official statement on the issue, a device with a lead warning might not have any lead at all:

Even in situations where an electronics device is completely free of lead, there is always a chance that standard third-party-manufactured accessories packaged with the device (such as a power cable, USB cable, or power supply) may contain trace amounts of lead. Out of professional diligence and a commitment to fully comply with the law, M-Audio properly marks all applicable products with a Prop 65 lead warning.

Maybe people are used to seeing these labels by now. Williams said mine was the first call he’s received on the issue in his five months in media relations at the company.

So, now I will make my techno versions of acoustic indie songs in relative peace.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.