Most of Dr. Joseph Broujerdi's patients turn to him for a little cosmetic nip 'n' tuck or a more extensive facial reconstruction following an accident. They may not realize that a growing side practice for the Beverly Hills plastic surgeon is working with a medical colleague in developing the relatively young field of sleep medicine.

Broujerdi, who hung out his own shingle this month with the opening of the Aesthetic Plastic Surgery Institute of Beverly Hills, has been the go-to surgeon for sleep apnea procedures at Advance Sleep Medical Center Inc. not far away in the Miracle Mile district.

Medical director Dr. Payam Shadi, an internist, opened the sleep disorder clinic three years ago to tap an underserved market for chronic poor sleepers for whom conventional behavioral and drug therapies weren't working.

"People with sleep problems are so often misdiagnosed and simply given medications," said Shadi. "They may even have more than one issue. A lot of what we do is working to get patients off the drugs and fix the underlying problem."

Sleep apnea is a disorder caused by obstruction of the airway or a disturbance in the brain's respiratory center. Both private and public health insurers are increasingly covering treatments as a preventative measure for more serious conditions such as high blood pressure, congestive heart failure and stroke, Shadi said.

There are noninvasive treatments for apnea, such as nose and mouth masks that deliver compressed air pressure to prevent a sleeper's airway from collapsing during sleep. When the cause is a structural problem, Broujerdi is called in to do everything from moving a jaw to realigning the base of the tongue. Around 15 percent of the surgeries he performs are sleep-related, a percentage that has grown since joining with Shadi.

"There are so few surgeons who have the (required) level of training both in oral and reconstructive surgery," said Broujerdi, who originally wanted to be a dentist. "Most plastic surgeons don't do a lot of reconstructive work like this. They complete their training and concentrate on the aesthetic end, but this is certainly the kind of work I wouldn't want to give up."

The sleep clinic generally can only treat 20 patients per week, and there's been enough demand to start planning additional clinics. Plans are in the works to soon open a second one in the San Fernando Valley. Shadi declined to release revenues.

Amgen Angst

Amgen Inc. investors, who have witnessed the biotech giant's share price fall 12 percent in the past month, were probably shaking their heads last week after the latest snafu.

The respected industry newsletter Cancer Letter reported Feb. 16 on negative results from a Danish study on the anemia treatment Aranesp in head-and-neck cancer patients. The findings follow earlier studies indicating that aggressive use of Aranesp may increase the chances of a rare secondary tumor growth. Meanwhile, the aggressive use of its predecessor drug Epogen has been associated with a rare anemia-related blood disorder.

Thousand Oaks-based Amgen apparently knew about these Danish results in December, but executives didn't mention the study during the company's Jan. 25 earnings call, when at length they discussed Aranesp safety concerns and the potential competition from copy-cat drugs. In a quickly arranged conference call the day the Cancer Letter story came out, Amgen Chief Executive Kevin Sharer acknowledged the company erred by not bringing up the matter sooner.

Another Aranesp aggravation arose last Thursday when it was announced that a potentially lucrative, but as yet unapproved new use of Aranesp had been taken off a list compiled by medical researchers that is often used by insurers to determine whether to reimburse for drug's use.

Aranesp is approved to treat chemotherapy-induced anemia and anemia related to kidney disease, but not yet for anemia in cancer that's not associated with chemotherapy. JP Morgan analyst Geoffrey Meacham told Reuters that the loss of the listing could put at risk about $400 million to $500 million of future world-wide Aranesp sales, around 12 percent of the drug's 2006 sales.

Amgen spokesman David Polk points out that the recent negative safety studies concern experimental uses for Aranesp for which the company has not yet sought FDA approval. The company also has seen no signs that carriers are denying claims. "When you look at Aranesp in its on-label application, it has a terrific safety profile," he said.

Staff reporter Deborah Crowe can be reached at (323) 549-5255, ext. 232, or at .

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