Drug ads take a lot of heat. Ubiquitous TV commercials aimed at consumers are blamed both for spurring patient demand and boosting health care costs. But only one of those may be true, according to a new Harvard study.

Researchers led by Michael Law, formerly a research fellow at Harvard Medical School and now a health policy researcher at the University of British Columbia, tested the effects of direct-to-consumer advertising on clopidogrel, sold by Bristol-Myers Squibb and Sanofi-Aventis as Plavix. Prescribed to prevent blood clots in people who have had heart attacks, it was initially sold without being marketed directly to patients. The researchers analyzed sales three years before and four years after consumer ads began so they could isolate the effect of the ads from promotions to physicians or free samples distributed when the drug was new.

Looking at pharmacy data from Medicaid programs in 27 states, including Massachusetts, they found that sales have steadily risen since the drug was introduced, moving up in a pattern that did not change from 1999 through 2005. But the cost to the Medicaid programs did rise by $207 million after ads began in 2002, the authors report in tomorrow's Archives of Internal Medicine. The drug's maker raised the price 12 percent, or 40 cents per pill, when it launched the $350 million ad campaign.

"The Bristol-Myers Squibb/Sanofi partnership supports direct-to-consumer advertising as a way to encourage consumers to play a more active role in their health care,” Laura Hortas, a Bristol-Myers spokeswoman, told Bloomberg News today.

The study's conclusions are consistent with what Law and colleagues at the University of Alberta reported last year about three heavily advertised drugs.

"We found similar lackluster results for drugs advertised directly to patients," Law said in an interview. "It makes us continue to wonder why so much is being spent on these activities."

Things go better with Coke, the old slogan used to say, but a Harvard nutrition researcher known for battling the obesity epidemic isn't buying it.

The American Academy of Family Physicians, which represents more than 94,000 family doctors across the country, has accepted a one-year, six-figure grant from the Coca-Cola Company to "develop consumer education content on beverages and sweeteners for FamilyDoctor.org," the group's web site for patients.

Dr. Walter Willett of the Harvard School of Public Health has made an offer to the group: Use our free web site.

"While consumers need such educational materials, I think developing them with funding from Coca-Cola has the potential to call into question the objectivity of the information being disseminated," Willett wrote in a letter dated Monday. "There is plenty of well-vetted material already available on this topic ... to which your website could easily link -- free of charge."

An academy official said its consumer alliance, whose first member Coca-Cola was announced last month, was formed for a different reason. The academy is looking for other sources of revenue beyond member dues and unrestricted grants from pharmaceutical companies that support continuing medical education and exhibits at annual meetings, according to Dr. Douglas Henley, academy executive vice president and CEO. He would not give an exact figure for the deal.

"There's a very solid firewall between the unrestricted grant we get from the funder vs. the development and production of the content they present," he said about pharmaceutical company support. "We intend to do exactly the same thing on the consumer side with the Consumer Alliance. Coca-Cola and any other company we do an alliance with know and understand that before we sign a contract, the content is ours and totally independent."

Henley said he is familiar with the Harvard web site, which urges consumers to avoid high-calorie, sweetened drinks, which research has linked to weight gain and type 2 diabetes.

"It's a very good web site with great content about beverage choices and beverage information on all types, not only sugary beverages but fruit juice and sports drinks and coffee and tea," he said. "We appreciate Dr. Willett's offer and we really are looking for other credible sources of information ... to develop content on our web site."

Most adults who tried to get swine flu vaccine for themselves or their children have been unable to find it, even if they fall into high-risk groups, according to a Harvard survey released today.

Flu is widespread in Massachusetts and 47 other states, but deliveries of vaccine against the swine flu virus have lagged behind both illnesses and supply projections. Manufacturers are struggling to produce both the new vaccine and seasonal flu vaccine at the same time.

A telephone survey conducted last weekend by the Harvard School of Public Health found that four out of 10 American parents and one out of five high-priority adults were looking for swine flu, or H1N1, vaccine. Slightly fewer than one out of five adults not in a high-risk category were also searching for vaccine.

High risk groups include pregnant women, adults caring for a baby less than six months old, health care workers and emergency personnel, and adults age 25 to 64 who have medical problems such as asthma or heart disease.

Two-thirds of parents looking for vaccine were unable to find it for their children. The same was true for high-priority adults. Seven out of 10 other adults seeking vaccine were also unable to get inoculated.

"These findings suggest that the nationwide H1N1 vaccine shortage is presenting a real challenge for those who have tried to get the vaccine," Robert J. Blendon, professor of health policy and political analysis at Harvard, said in a statement released with the poll.

Almost all people polled said they will keep looking for vaccine, for themselves or their children, the survey said.

The survey was conducted by calling 1,073 adults, on both landlines and cell phones, from October 30 through November 1. The margin of error is plus or minus 3.8 percentage points. It is the fifth survey done by the Harvard researchers since swine flu emerged in the spring.

Harvard Medical School's publishing arm has a new iPhone application for all things swine flu, pulling information from local and national health specialists, its own medical and business schools, and an outbreak locator, all downloadable from the iTunes Store.

Called the HMSMobile Swine Flu Center, it offers video guides for preventing infection, interactive tools to determine if an illness is likely to be swine flu, and advice for businesses dealing with illness, according to Harvard Health Publications. It also includes access to HealthMap's “Outbreaks Near Me” program, a real-time map of disease outbreaks developed by John Brownstein of Children's Hospital Boston and Clark Freifeld of MIT's Media Lab.

Several hundred Harvard students are taking part in an experiment that tests social networks as early warning systems for disease spread, the Harvard Crimson reports.

Dr. Nicholas A. Christakis, who is a Harvard Medical School professor as well as a house master at Harvard, is well known for his research into social networks as important influences on behavior. His work has linked the spread of happiness, quitting smoking, and obesity to circles of friends.

Now he is asking 650 randomly selected Harvard undergraduates to report twice a week for 12 weeks on whether they have flu symptoms, the story said. The students are also being asked to supply the names of three friends and to assess their own popularity.

"By looking both at whether you’ve had the flu and where you are in the social network, we think you can get an early warning of an epidemic," Christakis told the Crimson. "If this works, we’ll have invented a new method for attacking diseases, which could have broad relevance far outside Harvard."

By Carolyn Y. Johnson, Globe Staff

Harvard researchers have created a strip of pulsing heart muscle from mouse embryonic stem cells, a step toward the eventual goal of growing replacement parts for hearts damaged by cardiovascular disease.

The new work, to be published in the journal Science tomorrow, begins to confront what will be a major frontier for stem cell biology: translating recent basic science advances to meet the promise of regenerative medicine, by finding ways to make such cells functional and potentially useful for therapies.

"I think over the last five years or so, we’ve made great progress in being able to guide stem cells into whatever cell type we want -- in this case the heart," said Dr. Deepak Srivastava, director of the Gladstone Institute of Cardiovascular Disease at the University of California, San Francisco, who was not involved in the research. The new work "has begun to think about how to assemble these types of cardiac cells into a 3-D fashion, for future use within a heart. It’s a long way from that right now ... but it’s a first baby step toward that goal."

People with advanced dementia spend their last days suffering the same pain, complications, and poor prognosis as people with other terminal conditions, according to a new study that urges better care focused on providing comfort at the end of their lives.

Dr. Susan Mitchell of Hebrew SeniorLife Institute for Aging Research and Harvard Medical School led a study of 323 patients with end-stage dementia at 22 nursing homes near Boston. Writing in this week's New England Journal of Medicine, they report that the life expectancy for advanced dementia patients was close to what late-stage cancer or congestive heart failure patients might anticipate. Like dying cancer patients, the dementia patients also experienced infections, fever, and eating problems.

"Dementia is a terminal illness," Mitchell said in an interview. "When families understand this is the end stage, most of them will want comfort care as the goal."

Thirteen Massachusetts researchers and clinicians have been elected to the Institute of Medicine, a prestigious national body that makes recommendations on health and health-care policy.

The institute's 65 new members include:

Amy N. Finkelstein, professor of economics, MIT
Alfred L. Goldberg, professor of cell biology, Harvard Medical School
Dr. Sue J. Goldie, professor of public health, and director, Center for Health Decision Science, Harvard School of Public Health
Dr. Daniel A. Haber, professor of medicine, Harvard Medical School, and director, Massachusetts General Hospital Cancer Center
Tyler E. Jacks, professor of biology, and director, David H. Koch Institute for Integrative Cancer Research, MIT
Dr. Ichiro Kawachi, professor and chair, department of society, human development, and health, Harvard School of Public Health
Dr. Isaac S. Kohane, professor of pediatrics and health sciences and technology, Harvard Medical School; and chair, informatics program, Children's Hospital Boston
Dr. Joan Y. Reede, dean for diversity and community partnership and associate professor of medicine, Harvard Medical School
Gary Ruvkun, professor of genetics, Harvard Medical School and Massachusetts General Hospital
Dr. Clifford B. Saper, professor of neurology and neuroscience, Harvard Medical School, and professor and head, department of neurology, Beth Israel Deaconess Medical Center
Dr. Megan Sykes, associate director, Transplantation Biology Research Center, Massachusetts General Hospital, and professor of surgery and professor of medicine, Harvard Medical School
Dr. Bruce D. Walker, director, Ragon Institute of Massachusetts General Hospital, MIT, and Harvard University
Dr. Ralph Weissleder, professor of systems biology and radiology, Harvard Medical School, and director, Center for Systems Biology, Massachusetts General Hospital

By Liz Kowalczyk, Globe Staff

Many hospitals have been widely advertising robot-assisted surgery, especially for prostate cancer, marketing it as having shorter recovery times and fewer complications than standard operations.

But a nationwide study published today raises serious concerns about the wide use of robots in prostate operations, say Boston physicians who led the research team.

The Harvard Medical School researchers found that cancer patients who underwent minimally-invasive prostate removal -- now usually done with remote-controlled robots -- were more than twice as likely to experience incontinence or impotence a year and a half after their operations than patients who had traditional surgery using an open incision.

Success at controlling the cancer was about the same for both operations. Patients who had minimally invasive, or laparoscopic, surgery were able to go home from the hospital in two days on average, one day shorter than the comparision group, and had fewer post-surgery respiratory problems and other short-term complications.

Doctors in training are strictly bound by regulations governing how many hours they may work in a week and how much time off they must have between shifts, an outgrowth of research linking medical errors to a lack of sleep. Boston researchers have turned their attention to attending physicians, experienced doctors who perform emergency operations or deliver babies through the night and resume their workload the next day.

Dr. Jeffrey Rothschild of Brigham and Women's Hospital led an eight-year study comparing the rate of complications in procedures a physician performed the day after nighttime procedures to procedures the same physician performed after a night with no procedures.

The researchers found no statistically significant difference in the roughly 5 percent rate of complications, which included infection after surgery or blood loss after deliveries. But if the physician had less than a six-hour opportunity to sleep between the last nighttime procedure and the first one the next day, the complication rate was higher: 6.2 percent for less than six hours compared to 3.4 percent for more than six hours.

"These data suggest that attending physicians, like residents and nurses, may be at increased risk of making errors when sleep deprived or working extended shifts," the authors write in tomorrow's Journal of the American Medical Association.

In an interview, Rothschild said it would be premature to suggest policy changes before the issue is studied across all surgical specialties and in other hospitals. The study looked at a wide variety of specialties but it was conducted in a large, advanced-care, teaching hospital (not identified in the journal article) where resident physicians were available to assist attending physicians. But he said there are lessons that could be applied now.

"For physicians who find themselves in that situation, it's part of professionalism to ask for assistance or postpone a procedure if they feel they are fatigued," he said.