The American Voice Institute of Public Policy presents

Personal Health

Joel P. Rutkowski, Ph. D., editor
July 16, 2005

Important Medical Disclaimer: The content displayed in Personal Health is designed to educate and inform. Under no circumstances is it meant to replace the expert care and advice of a qualified physician. Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate. Accuracy cannot be guaranteed. Personal Health assumes no responsibility for how information presented is used.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PERSONAL HEALTH for the week of July 9-15

  1. Lead Exposure Unhealthy at Any Level
  2. U.S. probes deaths in patients using pain patches
  3. Incurable ALS Doesn't Doom Sufferers to Despair
  4. Research Explains Lack of Monkeypox Deaths
  5. Health Tip: Staying Safe at the Playground
  6. Weight-loss camp can work for kids: study
  7. Health Tip: When Baby Begins to Crawl
  8. U.S. Warns Fentanyl Patients About Drug
  9. Bowel injury common with child abuse
  10. Many Women Uninformed About Cervical Cancer
  11. Clot-buster more likely to work in women-study
  12. Chewable Antihistamine Approved for Adults, Children
  13. Being smart no guarantee to happiness in old age
  14. Teen Inactivity Leads to Obesity for Girls
  15. Antidepressant efficacy may be overblown-experts
  16. Asthma, Allergy Genes May Ward Off Brain Tumors
  17. Drug combo ups breast cancer survival-study
  18. West Nile's Impact Less Severe So Far This Year
  19. Gene variants tied to melanoma risk
  20. Study Refutes Cystic Fibrosis Bone Treatment
  21. Asthma gene variants may cut risk of brain cancer
  22. Getting a Jump on Cancer Genetics
  23. FDA approves Cyberonics depression device
  24. Enzyme May Unlock Clues to Heart Failure
  25. Inhaled insulin effective add-on for diabetics
  26. SpongeBob Pitching Fruits and Vegetables
  27. Unborn babies carry pollutants, study finds
  28. Food Makers Warned on High-Fat Snack Ads
  29. Weighted backpack device helps reduce fall risk
  30. Health Tip: Step on Something Sharp?
  31. Mouse study suggests Alzheimer's damage reversible
  32. Risks associated with blood thinners rise with age
  33. Chemical Triggers Breast Cancer in Lab Mice
  34. Washing hands with soap cuts diseases in children
  35. U.S. girls weight gain blamed on drop in exercise
  36. Scientists decode three deadly parasite genomes
  37. Black pregnant women have more asthma complications
  38. Lobotomy Back in Spotlight After 30 Years
  39. Thousands get infected in Pa. Hospitals: report
  40. Number of Autism Cases Declines in Calif.
  41. Simple steps prevent arthritis from preventing work
  42. Students Eat Healthier With Nutrition Info
  43. Breast cancer therapy may give rise to leukemia
  44. Health Tip: Hold Family Fire Drills
  45. High BP worsens impact of stroke on brain function
  46. Heart Failure Drug Stirs Controversy
  47. Male fertility not harmed by phthalates-study
  48. For Many, Work is a Real Pain
  49. Getting a flu shot may reduce your risk of stroke
  50. Dental Advice Doled Out For Free
  51. Relaxation treatment helps teens with headaches
  52. Even Low-Dose Birth Control Pill Raises Heart Risk
  53. Dual pacemakers no better for people over 70
  54. Bypass Costs Far Higher in U.S. Than in Canada
  55. Group calls for health warnings on soft drinks
  56. Obesity Tougher on Men
  57. Stem cells may protect brain, nervous system -study
  58. A Major Medical Advance -- Or Not?
  59. Wood smoke may raise lung cancer risk
  60. Many U.S. Newborns Missing Key Tests
  61. Hormones May Not Stop Menopause Symptoms
  62. Cell Phone Use Quadruples Car Crash Risk
  63. Job exposure to radiation ups skin cancer risk
  64. Weight-Loss Surgeries Skyrocketing
  65. Health Tip: Recognizing Depression in Teens
  66. Brain Region May Govern Resilience to Trauma
  67. Ex-tiny babies at risk for reduced fitness levels
  68. Men at Much Higher Eye Injury Risk
  69. Health Tip: Diabetics Who Travel
  70. Teen IQ, activity tied to later dementia risk
  71. Vaccination Tames Hepatitis A Infection
  72. Genes Take Some Blame for Poor Cholesterol
  73. Breast cancer outcome similar in women and men
  74. Dangerous Aortic Ruptures Often Misdiagnosed
  75. Technology Makes Home Dialysis Possible
  76. Health Tip: Recognizing Illness in Newborns
  77. Diet pills hard on the heart
  78. Health Tip: Fighting Foot Odor
  79. Study: Walking on Cobblestones Is Healthy
  80. Fit heart curbs risk of 'metabolic syndrome'
  81. Diabetes Spurred By Adult Lifestyles
  82. Lorenzo's Oil prevents rare disease in boys -study
  83. Study Questions Statins' Value Against Alzheimer's
  84. Curry ingredient fights skin cancer -U.S. study
  85. NSAID Painkillers May Raise Urinary Retention Risk
  86. Disparity in US, Canada heart-surgery costs –study
  87. Newborns' Stroke Risk as High as Elderly's
  88. Obese women fitter than obese men, study finds
  89. Piercing Staph Bug's 'Golden Armor'
  90. Alzheimer's Educators Reach New Audiences
  91. Brittle Bones Can Affect Older Men As Well
  92. Universal Health Care Push Being Revived
  93. This Vacation, Send Allergies Packing
  94. Allegations of Fake Research Hit New High
  95. Blood Pressure Enzyme May Help Battle SARS
  96. All Eyes on Summer Sun Safety

 

Friday, July 15, 2005

 

Lead Exposure Unhealthy at Any Level

 

HealthDay News

Friday, July 15, 2005

FRIDAY, July 15 (HealthDay News) -- There's no safe level of lead in children's blood, according to an international study that found that children exposed to the toxin suffer substantial intellectual impairments, even at exposures far below levels currently considered harmful.

"The study indicates there is no threshold for the adverse consequences of children's exposure to lead," study lead author Dr. Bruce Lanphear, director of the Children's Environmental Health Center at Cincinnati Children's Hospital Medical Center, said in a prepared statement.

"We found evidence of intellectual impairments among children with blood lead levels below 10 micrograms per deciliter, the level currently considered acceptable by the Centers for Disease Control and Prevention. The study indicates that the action level set by the CDC isn't adequate to protect children," Lanphear said.

The researchers analyzed data from 1,333 children around the world tracked from birth or infancy until they were 5 to 10 years old.

Of the children in the study, 244 had blood lead levels of 10 micrograms per deciliter or less, while 103 children had blood lead levels of 7.5 micrograms per deciliter or less.

Lanphear's team also found that intellectual impairments caused by low levels of lead exposure are proportionally greater than those found in children with higher levels of lead in their blood.

For example, at the 10-microgram exposure level, the researchers estimate that children lost an average 3.9 IQ points compared to children with exposures of 2.4 micrograms. Raising exposure from 10 micrograms to 20 caused another 1.9-point drop in IQ, while the increase from 20 micrograms to 30 micrograms led to another 1.1-point decline.

The study concluded that even environmental lead exposure in children with blood lead levels below 7.5 is associated with intellectual impairments.

"The results of this pooled analysis underscore the increasing importance of primary prevention of childhood lead exposure," Lanphear said. "Collectively, this international analysis and other data provide sufficient evidence to eliminate childhood lead exposure by banning all nonessential uses of lead and further reducing the allowable levels of lead in air emissions, house dust, soil, water and consumer products."

The study appears in the July issue of the journal Environmental Health Perspectives.

More information

The American Medical Association has more about lead exposure.

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U.S. probes deaths in patients using pain patches

 

Reuters

Friday, July 15, 2005

U.S. regulators are investigating reports of deaths in patients who were using pain patches that contain the narcotic fentanyl, the Food and Drug Administration said on Friday.

Johnson & Johnson sells fentanyl patches under the brand name Duragesic, and generic versions also are available. Johnson & Johnson told doctors in June it was adding warnings to the Duragesic label about the potential for abuse and misuse of the product.

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Incurable ALS Doesn't Doom Sufferers to Despair

By Randy Dotinga
HealthDay Reporter

HealthDay News

Friday, July 15, 2005 

FRIDAY, July 15 (HealthDay News) -- Patients in the final stages of Lou Gehrig's disease would have every right to become clinically depressed.

But two new studies suggest that most do not face their last days in a state of emotional collapse.

Of course, these non-depressed patients aren't happy to have the incurable disease, formally known as amyotrophic lateral sclerosis (ALS). "They would have liked to live more years without it," said study co-author Steven M. Albert, an associate professor at Columbia University. "But are they depressed, have they lost interest in things that have always appealed to them, do they feel blue and down, do they feel like they're moving slowly and can't think straight? No, [most] don't have those sorts of symptoms."

The studies, which appear in the July 12 issue of Neurology, are unusual because researchers haven't spent much time examining the emotions of people as they face impending death, Albert said. "With most diseases, you never know when someone's going to die."

In contrast, ALS follows a predictable course. The disease destroys the brain's ability to control muscles through neurons, causing a gradual physical decline. At the end, the patient is unable to breathe.

According to the ALS Association, 5,600 Americans are diagnosed with the disease each year, and about 30,000 are living with it at any one time.

The disease was first diagnosed in the 19th century, but became well-known after it took the life of baseball player Lou Gehrig. Noted physicist Stephen Hawking is among a minority of patients who have lived for a long time with the illness, although he is severely disabled.

In the new studies, researchers surveyed the same group of 80 people with advanced ALS disease. All had severe trouble breathing, indicating they would die or need ventilators within six months.

During the study period, which lasted until the patients died or went on ventilators, 57 percent of the patients never became clinically depressed. In other words, they didn't cease to be able to function emotionally.

Some patients did become clinically depressed, and 8 percent were always depressed. By contrast, an estimated 4 percent to 5 percent of the general population suffers from depression over a 12-month period.

Still, clinical depression was "still the rare phenomenon, when some people might have thought (it would affect) four out of five," Albert said. "The broader message is that even when people are dying, they can have satisfying lives and appreciate a lot of things."

Death was on the minds of many of the patients, however. Of the 53 who died during the study period, 23 reported thinking about ending their lives. Three asked caregivers for relief from pain even if it hastened their deaths.

"For those people who are able to exercise this control over dying and report very high levels of suffering, their mood improves when they realize they could work out an arrangement and control the time of death," Albert said.

Dr. Catherine Lomen-Hoerth, director of the University of California at San Francisco's ALS Center, said the findings reflect what she sees on the job. "Most patients are quite comfortable with death," said Lomen-Hoerth, who wrote a commentary accompanying the two new studies. "It comes with having a lot of time to prepare, and from clinics and hospice professionals addressing the issue with patients and families."

More information

Learn more about ALS from the ALS Association.

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Research Explains Lack of Monkeypox Deaths

 

By Marilynn Marchione

AP Medical

The Associated Press

Friday, July 15, 2005

Monkeypox, a less deadly relative of smallpox, kills up to 10 percent of its victims in Africa. Yet a monkeypox outbreak two years ago in the United States killed no one, and scientists have wondered why.

Now they have a good idea. New research finds that there are two distinct strains of the virus, and that the U.S. outbreak involved the weaker West African one rather than the more deadly Congolese one. The illness was spread by prairie dogs after they were infected by imported African rodents at a pet distribution center.

"If it had come from Congo, we might have had a bigger problem on our hands and very well might have seen patient deaths," said Mark Buller, a St. Louis University virologist who led the federally funded study, published Friday in the journal Virology.

Scientists from the U.S. Army Research Institute of Infectious Diseases, the Centers for Disease Control and Prevention, and four other universities in the United States and Canada worked on the report.

The monkeypox outbreak two summers ago was the first in the Western Hemisphere. An estimated 72 people throughout the Midwest were sickened by the virus, which causes blisters and a rash that resemble smallpox.

Cases were reported in Wisconsin, Illinois, Indiana, Kansas, Ohio and Missouri. Sixteen people were hospitalized, though not all were sick. Two children required intensive care and recovered.

Doctors thought better U.S. medical care and generally better health than in Africa were the reasons no one died. But genetic analysis suggests the germ itself made the difference.

Researchers compared several strains similar to the West African one in the U.S. outbreak to a Congolese strain from a gene bank.

They also looked back at previously unpublished experiments Army researchers had done in the 1990s on such viruses in monkeys as part of an effort to find ways to test new smallpox vaccines.

Monkeys infected with the West African strain got only mildly ill and none died. Five out of six of those given the other strain got severely ill and all three that got the higher dose of it died.

After the 2003 outbreak, federal officials banned the importation of African rodents and the sale of U.S. prairie dogs, but importing animals from other countries is still legal, along with breeding captive exotic and wild animals.

"We definitely are better off than we were" before the outbreak in terms of regulation, said

Dr. Marty Cetron, the CDC's director of quarantine, but he added, "there's still more that could be done."

"We do think there is a risk of emerging infections being spread by or amplified by the exotic pet trade," he said.

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Health Tip: Staying Safe at the Playground

 

HealthDay News

Friday, July 15, 2005

(HealthDayNews) -- Each year, thousands of kids are hurt on playgrounds in the United States, according to the National Program for Playground Safety.

Keep your kids safe by:

Making sure your child's clothing has no loose strings. If these get caught in the equipment, they can cause strangulation. Having your child play only on age-appropriate equipment. Avoiding playgrounds with concrete, asphalt, grass, blacktop, or packed dirt surfaces. The area beneath the equipment should be hardwood fiber or mulch, pea gravel, or sand and synthetic material that will cushion a child's fall. Checking that the equipment is firmly anchored to the ground, that S-hooks are closed, and that bolts aren't protruding.

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Weight-loss camp can work for kids: study

By Amy Norton

Reuters Health

Friday, July 15, 2005

 Overweight children can get in shape by spending part of their summer at a weight-loss camp, if the experience of one such program is any indication.

UK researchers found that children who attended the northern England camp for about a month lost an average of 13 pounds, improved their fitness level and sports skill, and in general felt better about themselves.

With so little known about what works for childhood weight loss, the new findings offer some evidence that weight-loss camps can indeed work, according to the study authors.

They caution, however, that the success of one program does not mean that others will be effective.

"There is definitely variance in the quality" of different programs, said Dr. Paul J. Gately of Leeds Metropolitan University, the study's lead author.

The program in this study, Gately told Reuters Health, was carefully developed over seven years and employed a "truly holistic" approach that integrated diet, exercise and lifestyle changes.

Still, he said, the results point to the potential for weight-loss camps to work.

The study, published in the journal Pediatrics, followed 185 overweight and obese children who attended the weight-loss camp at some point between 1999 and 2002. They each spent about a month, on average, in the program.

Gately and his colleagues compared the children with a group of normal-weight and overweight kids who went about their usual summertime routines.

Campers spent their days playing sports, swimming, canoeing and taking part in other structured activities meant to boost their fitness and help them enjoy being active. The children's calorie intake was moderately limited, and they had classes on how to make healthy food choices, keep up lifestyle changes and deal with bullying.

Overall, the researchers found, children at the camp shed an average of 13 pounds and reduced their body mass index -- a measure of weight in relation to height -- mainly through losing body fat. In contrast, overweight and normal-weight children in the comparison group tended to gain body fat.

Treadmill exercise tests showed that the campers' aerobic fitness and blood pressure had improved by the end of the program, as had their skills in sports like basketball and soccer. The children also showed gains in self-esteem, as measured by questionnaires.

According to the researchers, the camp environment may have allowed the children to overcome body-related or social barriers that may have kept them from being active.

"Overall," they write, "providing a controlled but safe, enjoyable and social environment is a likely a major contributor" to the changes in weight, fitness and self-esteem the children showed.

Source: Pediatrics, July 2005.

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Health Tip: When Baby Begins to Crawl

 

HealthDay News

Friday, July 15, 2005

(HealthDayNews) -- If your baby is learning to crawl, take extra care to ensure her safety. A baby on the move can get into trouble very quickly.

The Hospital for Sick Children in Toronto offers these tips:

Use safety gates at the top and bottom of stairs. Don't use a pressure gate at the top of the stairs. It can topple if your child leans on it. Keep medicines and cleaning products locked up. Make sure there's no furniture near windows or balcony rails. Keep large toys and stuffed animals out of the crib or playpen. Your baby could use them to climb over the side. Don't let your child stand up in the high chair. Use the safety strap to secure your baby in a shopping cart.

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U.S. Warns Fentanyl Patients About Drug

 

By Lauran Neergaard

AP Medical Writer

The Associated Press

Friday, July 15, 2005

 The government is investigating 120 deaths among users of patches that emit the painkiller fentanyl and warned patients Friday to be sure to use the powerful narcotic properly to avoid accidental overdose.

The Food and Drug Administration is probing whether any of the deaths are related to inappropriate use of the painkiller or factors related to the product's quality.

At least some may have been accidental overdoses, and reports suggest patients or prescribers weren't aware of crucial safety information on the drug's label, said FDA's Dr. Robert Meyer. That prompted Friday's unusual public health advisory.

"Here are important warnings — pay attention to them," Meyer said.

Among the warnings in patient information sheets issued Friday:

·        Fentanyl patches can cause trouble breathing, which can be fatal. Get emergency help if you have trouble breathing or extreme drowsiness with slowed breathing; feel faint, dizzy, confused; or have other unusual symptoms. They can be signs that you were prescribed too high a dose or took too much.

·        Fentanyl patches are only for round-the-clock pain that is moderate to severe and expected to last for weeks.

·        The patches should not be your first narcotic painkiller; they're only for people whose bodies are used to morphine or related painkillers known as opioids.

·        Do not use fentanyl patches if you have sudden or severe asthma, or a gastrointestinal problem called paralytic ileus.

·        Store patches out of reach of children and dispose of them by sticking the adhesive sides together and flushing down the toilet, not in trash cans where children can find them.

Abuse of fentanyl patches is a recurring problem because they contain such a high concentration of the controlled substance. But Meyer said the current concern stems from legitimate patient use.

"The directions ... must be followed exactly to prevent death or other severe side effects from overdosing," the FDA warned in letters to doctors that also advise prescribing the lowest possible dose.

The patches were first approved under the brand name Duragesic in 1990, and a generic version hit the market in February. FDA has reports of death among users of both, Meyer said. It's not unusual to receive increased side-effect reports shortly after a new product reaches consumers, he said.

On the Net:

FDA: http://www.fda.gov/cder/drug/infopage/fentanyl/default.htm

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Bowel injury common with child abuse

By Anthony J. Brown

Reuters Health

Friday, July 15, 2005

 In young children, particularly those under age 5, injuries to the small intestine are more likely to be caused by child abuse rather than a fall or other accident, a study shows.

Half of children with abdominal injuries due to abuse have damage to the small intestine, new research indicates. By contrast, with accidental abdominal injuries, the small bowel is affected in no more than a fifth of cases.

Abuse should be considered in young children with small-bowel injury, the authors say, especially if the explanation given for the injury is a fall. "In our study, there weren't any cases of small bowel injury due to falls in children under 5 years of age," senior author Dr. Jonathan R. Sibert, from Cardiff University in the UK, told Reuters Health.

He and colleagues compared abdominal injuries sustained by 20 children exposed to abuse, 112 involved in road-traffic accidents, and 52 involved in falls, according to a report in The Lancet this week.

Sixteen of the abused children were younger than 5 years of age, the report indicates. By comparison, just 14 of the children involved in traffic accidents and 3 of the fall victims were younger than 5 years.

Eleven of the abused children (55 percent) had gut injuries, including 10 cases of small bowel damage and 1 case of gastric perforation. The number of children with gut injuries in the traffic accident and fall groups were 28 (21 percent) and 5 (10 percent), respectively. In children younger than 5 years, crash-related gut injuries were rare and fall-related gut injuries were unheard of.

The other abdominal organs injured in the abused group included the liver in seven patients, spleen in six, pancreas in two, and kidney in two.

Sibert urges doctors to "think of abuse when small bowel injury is seen in a child under 5 and if you have an abused child, consider the possibility of abdominal injury, even in the absence of obvious bruising."

Source: The Lancet July 16, 2005.

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Many Women Uninformed About Cervical Cancer

 

HealthDay News

Friday, July 15, 2005

FRIDAY, July 15 (HealthDay News) -- A new survey finds too few women and their doctors discuss the dangers of infection with human papillomavirus (HPV), the leading cause of cervical cancer.

HPV affects about 80 percent of sexually active adults at some point in their lives. In some cases, the virus remains dormant for years after the initial infection. Available tests can help detect the virus early and prevent cervical malignancies.

The survey of 1,000 women in the United States, sponsored by the Association of Reproductive Health Professionals (ARHP), found that 88 percent of women rely on their healthcare providers to learn about gynecological issues.

However, just 19 percent said their doctor had talked to them about HPV and its connection to cervical malignancies.

Only 17 percent of the respondents knew that cervical cancer is the most preventable kind of cancer; only 23 percent correctly identified HPV as the primary cause of cervical cancer.

The survey also found that women age 30 and younger -- who are at the smallest risk of developing cervical cancer -- know more about its cause and are more likely to discuss HPV with their doctor than older women.

"The communications gap between (healthcare) providers and patients related to cervical cancer and HPV is an issue that is largely due to time constraints, and a reluctance to discuss a sexually transmitted infection with women," Dr. Beth Jordan, ARHP medical director, said in a prepared statement.

"But because new techniques, including improved types of diagnostic testing, now make cervical cancer a disease that can be better prevented, we're encouraging women to discuss with their healthcare provider their HPV risk, get regular screenings with the Pap test and, if they are age 30 or older, ask about HPV testing as well," Jordan said.

More information

The American Cancer Society has more about HPV and cervical cancer.

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Clot-buster more likely to work in women-study

By Megan Rauscher

Reuters Health

Friday, July 15, 2005

 Women suffering a sudden "ischemic" stroke caused by a blood clot in the brain are more likely than men to be helped from treatment with a commonly used clot-buster called tPA (tissue plasminogen activator), a study has shown.

Past studies have shown that women are less likely to receive tPA than men and that women, in general, have a worse outcome after stroke than men. "Our study," Dr. Magdy Selim said, "suggests that women should be treated as they may respond better to this treatment."

Ischemic stroke, the most common type, occurs when a clot or blocked artery cuts off blood flow to the brain. Clot-busters such as tPA, if given intravenously within 3 hours of the start of a stroke, can reduce or even prevent the long-term complications of an ischemic stroke.

Among 22 men and 17 women with this type of stroke who received early intravenous tPA in the current study, blood flow was restored in 94 percent of the women compared with just 59 percent of the men, investigators report in Stroke: Journal of the American Heart Association.

The superior response to tPA seen in women held up in analyzes adjusted for potentially confounding factors, Selim, from Beth Israel Deaconess Medical Center in Boston, and colleagues note in the paper.

"This is the first study to show a biological difference in response to tPA between men and women," Selim told Reuters Health. "This could be due to anatomical, hormonal or chemical differences between the sexes, which we will be investigating."

The findings, if confirmed in larger studies, could prompt changes in the way this type of stroke is treated in men, the researcher added. It may result in using higher doses of tPA or encouraging a more aggressive treatment in men, Selim explained.

 

Source: Stroke July 2005.

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Chewable Antihistamine Approved for Adults, Children

 

HealthDay News

Friday, July 15, 2005

FRIDAY, July 15 (HealthDay News) -- The U.S. Food and Drug Administration has approved Clarinex RediTabs, Schering-Plough's prescription antihistamine in a form that dissolves without water, the company said Friday.

The once-daily tablet, to be available nationwide in September, will come in both 2.5 mg. and 5 mg. doses. The drug's new formulation was approved for the treatment of indoor and outdoor allergies or hives in people ages six and older.

A new "tutti fruitti" flavor is available for children, the company said. Clarinex was first FDA approved in December 2001.

Visit Schering-Plough's Web site to learn more.

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Being smart no guarantee to happiness in old age

 

Reuters Health

Friday, July 15, 2005

Being intelligent is no guarantee of a happy old age, researchers said on Friday.

They studied 550 people born in Scotland in 1921 whose mental ability had been tested at age 11 and again at 80 to determine if intelligence over a lifetime was linked to happiness.

"In older people there seems to be no relationship between how well they do on tests of their mental ability and thinking memory skills and how satisfied they are with their life," said Alan Gow, of the University of Edinburgh in Scotland.

The study, which is published in the British Medical Journal, looked at how people maintain their mental ability as they age and the impact it has on their lives in an effort to discover the secret of successful aging.

In addition to the intelligence tests, the elderly people completed a satisfaction with life survey in which they rated how content they were. The researchers found no relationship between satisfaction scores and cognitive ability.

While not linked to happiness, intelligence does have an impact on how people function in old age, the study showed.

"With an aging population it is important to know what causes people to age successfully. What it is about some people that allows them to have a full and independent old age. One of the things that allows people to live independently is maintaining their cognitive ability," said Gow.

The United Nations estimates that by 2050 the number of people over 60 years old will reach 2 billion.

The scientists are continuing the study to determine what factors in the peoples' lives may contribute to happiness.

 

Source: British Medical Journal July 16, 2005.


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Teen Inactivity Leads to Obesity for Girls

By Amanda Gardner
HealthDay Reporter

HealthDay News

Friday, July 15, 2005

FRIDAY, July 15 (HealthDay News) -- Decreasing physical activity during adolescence seems to play a major role in weight gain among girls as they transition from children to women.

Inactive girls gained an average of 10 pounds to 15 pounds more than girls who were active between the ages of 9 and 19, according to a study appearing in the July 16 issue of The Lancet. The number of calories consumed increased marginally and did not appear to be associated with the weight gain.

"It does present a strong argument that physical inactivity in this age group is an important contributing factor to the development of obesity," said Dr. Robert Kramer, medical director of the Better Eating and Activity for Children's Health (BEACH) Clinic at the University of Miami School of Medicine. "Common sense has told us that that's probably true, and this does go a long way in validating that."

On the other hand, Kramer added, this study shows a correlation but it does not prove any cause-and-effect relationship.

"There could be other confounding factors that would explain why those girls who were least active are the heaviest," he said.

The American obesity epidemic is as troubling in youth as it is in adults. Results from the 1999-2002 National Health and Nutrition Examination Survey (NHANES) suggest that about 16 percent of children and adolescents aged 6 to 19 are overweight. Earlier, in the 1988-1994 period, NHANES estimated that only 11 percent in this age group were overweight.

A previous report had found that girls' recreational exercise declined between the ages of 9 and 19 by an average of 7.5 brisk, 30-minute walks each week.

The authors of this study logged changes in activity and in body mass index (BMI) for 1,152 black and 1,135 white girls in three parts of the country: San Francisco, Cincinnati and the greater Washington, D.C. area. The girls were also asked to fill out questionnaires on physical activity and food intake and all kept a diary on what they ate.

The researchers noted only small differences in BMI between "active" girls and "inactive" girls at the age of 9 and 10. (Active was defined as doing the equivalent of at least five brisk, 30-minute walks each week, while inactive was doing no more than 2.5 such walks weekly.)

In the following nine years, however, inactive girls had triple the gains in BMI and were about 10 to 15 pounds heavier.

Girls who described themselves as black tended to be heavier than those who described themselves as white. Black girls also consumed more calories. In addition, 32 percent of the white participants continued to be "active" through adolescence compared to 11 percent of black participants. At the same time, 58 percent of black girls stayed inactive compared with 28 percent of white girls.

According to the study authors, adding 2.5 hours of brisk walking each week could prevent this weight gain.

It is possible that the participants under-reported how much they were eating, the study authors admitted.

"It's pretty well acknowledged throughout the research and literature that self-reported food intake is generally underestimated," Kramer said. "It's certainly possible that caloric intake may be playing a greater part than this type of study indicates."

The authors also do not provide much detail on the macronutrient content of the girls' diets, Kramer pointed out. This also could be a factor contributing to overweight and obesity.

Still, the study does point to some obvious remedial measures.

"One would hope that when a study like this comes out that people can use it as a springboard to bolster the argument for physical activity," said Samantha Heller, senior clinical nutritionist at New York University Medical Center in New York City. "We have got to get our children moving."

According to Heller, providing a variety of fun, nonintimidating activities is the key.

"We need to have a variety of fun and interesting ways to motivate children and adolescents to move their bodies," she said. "And these programs have got to be in the schools because that's where children spend a lot of their time."

Parents, too, need to act as role models, she added.

"You can't tell your kid to go out and exercise while you're sitting in front of the television, not moving, eating a plate of cookies," she said.

More information

Visit the National Heart, Lung, and Blood Institute's We Can! program for ways to enhance children's activity and nutrition.

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Antidepressant efficacy may be overblown-experts

By Karla Gale

Reuters Health

Friday, July 15, 2005

Antidepressants, for the most part, do not provide meaningful benefit, two investigators in the UK argue in a report in the British Medical Journal this week, having reviewed published medical evidence on antidepressant efficacy.

Most people with depression are often initially prescribed an antidepressant by their doctor. Prescriptions for these medications have risen dramatically in the last decade.

In an interview with Reuters Health, Dr. Joanna Moncrieff, an author of the report, said, "I do not think there is such a thing as a drug that will specifically relieve depression. I think so-called antidepressants are just drugs that do other things, such as sedating or stimulating people."

In fact, she continued, "I am skeptical as to whether there is a biochemical syndrome of depression despite the portrayal by the drug companies and some psychiatric literature."

Moncrieff, a lecturer at the University College London and co-chair of the Critical Psychiatry Network, describes depression as a condition that "should be dealt with without drugs, because it's something people need to learn to deal with themselves." Dr. Irving Kirsch of the University of Plymouth is a co-author of the report.

In response, Dr. Darrel Regier, director of the Division of Research at the American Psychiatry Association, told Reuters Health that Moncrieff and Kirsch have "written an article that selectively pulls out negative studies and conveniently ignores or mischaracterizes positive studies."

"The interesting issue," he said, "is that it is now medical malpractice not to treat major depression with medication. If in fact there were nonsignificant differences (between antidepressants and placebo), that would not be the standard of care."

"Theirs is a radical sociological approach that will do anything to deny the existence of a medical disorder that affects the brain, that somehow the brain is sacrosanct and you can't have illness of the brain," he concluded. "It really is a remarkably biased presentation."

Source: British Medical Journal July 16, 2005.

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Asthma, Allergy Genes May Ward Off Brain Tumors

By Serena Gordon
HealthDay Reporter

HealthDay News

Friday, July 15, 2005

 FRIDAY, July 15 (HealthDay News) -- There may be a "silver lining" for individuals who suffer from asthma or allergies: Scientists say genes that promote these disorders may also protect against a deadly brain cancer.

A recent study found that asthmatics and people with allergies are at lower risk of developing the most common type of brain tumor, glioblastoma multiforme.

"We found that four genetic variants on two different genes that increase susceptibility to asthma and other allergic conditions decrease the risk of the most common type of malignant brain tumor," said Judith Schwartzbaum, the lead author of the study and an associate professor of public health at Ohio State University.

Her team's findings appear in the July 15 issue of Cancer Research.

Each year, about 41,000 Americans are diagnosed with some form of brain tumor, according to the American Brain Tumor Association (ABTA), with glioblastomas accounting for about 23 percent of those cancers. Glioblastomas tend to be more common in men than in women, and are much more common in older vs. young people.

The average incidence is three cases of glioblastoma per 100,000 Americans, but after age 65 that number jumps to almost 14 per 100,000 people, according to the study authors. Just over three percent of patients diagnosed with glioblastoma will still be alive five years later.

The most common early symptoms are headache, nausea, vomiting and sleepiness, according to ABTA.

Schwartzbaum said past research has shown a possible link between asthma and allergies and a lower rate of brain cancer, but that the information was largely anecdotal and self-reported.

"I didn't believe that the connection between self-reported allergies and brain tumors was valid. That is why I looked at genetic variants," she said.

To see if there truly was a relationship between these disparate conditions, Schwartzbaum and researchers from Sweden, England and the United States compared DNA samples from 111 people with glioblastoma multiforme to samples from 422 age- and sex-matched healthy controls. All of the study volunteers were from Sweden.

The researchers looked for genetic variations known as polymorphisms on two genes known to be associated with asthma and allergies, IL-4RA and IL-13.

People with polymorphisms on those genes were more likely to have asthma and allergies and less likely to have a glioblastoma.

"For example, we found that one genetic variant that causes a two-fold risk in asthma susceptibility reduces the risk of glioblastoma multiforme by 40 percent," said Schwartzbaum.

Why genes that promote asthma or allergies might offer protection against brain tumors is unclear, said Schwartzbaum.

She speculated that the gene variations might hinder inflammation in the brain, even though those same genes help cause inflammation in the lungs.

The "cytokine genes that we looked at play a role in inflammation in allergy and asthma. But, surprisingly these cytokines also have anti-inflammatory properties. IL-13 inhibits cox-2 [enzyme] expression just like ibuprofen does, so it could possibly prevent the growth of blood vessels early in the development of a brain tumor," she said.

"This is an interesting observation that shows there are probably conditions that predispose one to illness that may be protective against other illnesses," said Dr. Jay Brooks, chair of hematology/oncology at Ochsner Clinic Foundation Hospital in Baton Rouge, La.

"From a practical standpoint, however, I don't think this study has clinical importance in telling people that they can prevent brain cancer," Brooks added.

Schwartzbaum said that, right now, her team's research shows an association only. No one knows whether the gene variations, some aspect of asthma/allergy treatment, or simply having asthma and allergies is behind the reduction in brain tumor risk, she said.

That's why individuals with asthma and allergies should continue to treat them as usual, she said. That's especially true for asthma.

"Asthma can be life-threatening so people with asthma need to treat it per their doctor's orders," she added.

More information

To learn more about brain tumors, visit the National Institute of Neurological Disorders and Stroke.

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Drug combo ups breast cancer survival-study

 

Reuters Health

Friday, July 15, 2005

The combination of the anti-cancer drugs Herceptin and Taxotere appears to work better than Taxotere alone in women with advanced breast cancer that has spread beyond the breast, research shows. Moreover, there is little added toxicity when Herceptin is given.

Herceptin (trastuzumab) is a monoclonal antibody, meaning that it binds to one specific protein, HER2, which helps regulate cell growth. Overexpression of HER2, a sign of more aggressive cancer, occurs in about 25 percent to 30 percent of breast tumors. Taxotere (docetaxel) is a chemotherapy drug widely used to treat breast cancer and other cancers as well.

Previous studies indicate "synergy" between the two agents in women with breast cancer. To investigate further, Dr. Michel Marty, from Innovative Therapeutics in Paris, and colleagues treated 186 women with HER2-positive advanced breast cancer with six cycles of Taxotere with or without Herceptin.

Women treated with the combination regimen had a higher response rate (61 percent vs. 34 percent) and survived significantly longer (31.2 vs. 22.7 months) than women given Taxotere alone.

These findings, along with previous findings, support the use of Herceptin with a taxane such as Taxotere as first-line therapy for HER2-positive advanced breast cancer, the researchers conclude in the Journal of Clinical Oncology.

Overall, the number and severity of side effects seen in both groups were similar, aside from a higher incidence of neutropenia in the combination group. Neutropenia is a condition characterized by a drop in infection-fighting white blood cells that can occur with frequent chemotherapy.

Cardiac toxicity with Herceptin and Taxotere combination therapy, a concern in earlier trials, is "manageable," the authors conclude, based on the low incidence of heart problems seen in women in the study.

In a commentary, Drs. Charles L. Vogel and Elizabeth Tan-Chiu, from the Cancer Research Network in Plantation, Florida, comment that while they "fully endorse" first-line Herceptin in these women, "a lingering question" remains regarding the survival benefit of Herceptin combination therapy compared with a sequential treatment approach.

 

Source: Journal of Clinical Oncology, July 1, 2005.

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West Nile's Impact Less Severe So Far This Year

By Amanda Gardner
HealthDay Reporter

HealthDay News

Friday, July 15, 2005

 FRIDAY, July 15 (HealthDay News) -- The West Nile virus has started its annual drive across the nation, hitting Western states hardest and claiming the life of one elderly Missouri man.

So far this year, 11 states have reported 25 cases of human West Nile virus-related illness, including the fatality, according to research released in Friday's weekly journal by the U.S. Centers for Disease Control and Prevention (CDC).

The toll so far doesn't compare to last year at the same time, when there were 108 cases in about 10 states, according to CDC spokesman Tom Skinner.

But despite the smaller numbers this year, officials say they can't yet tell how severe a year this is likely to be.

"It's certainly too early to project what kind of season this is going to be," Skinner said. "West Nile virus is here to stay, and we will see cases across the country each and every year."

And the current numbers may be misleading.

"There's always a bit of a lag between what is reported to CDC and what is actually out there," added Dawn Wesson, an associate professor of tropical medicine at Tulane School of Public Health and Tropical Medicine in New Orleans.

"Often cases are in the process of being diagnosed, testing is being done and follow-up testing, and it's not reported until there is a double confirmation," she said.

For example, Wesson said that in Louisiana there have been a couple of cases that were not listed in the CDC report.

August and September are considered peak months, where health officials usually expect to see more activity.

"Things are going to start rolling soon, but it is kind of a leap to make any predictions," said Stephen Higgs, Ph.D., associate professor in the department of pathology at the University of Texas Medical Branch, Galveston. "There are no surprises here at the moment."

Since it first appeared in North America in 1999, West Nile virus has made its way across the continent and is now found in virtually every contiguous state. Since that time, according to the CDC, about 15,000 humans have been infected with the virus and more than 650 people have died.

Last year alone there were 2,539 human cases and 100 deaths, according to the CDC.

West Nile virus is normally passed from an infected mosquito to a bird, and then from the bird to other mosquitoes. The mosquitoes then pass the virus on to humans.

The greatest concentration of cases reported in this week's issue of the CDC's Morbidity and Mortality Weekly Report was in the West. Arizona had three cases, California two, Colorado seven, South Dakota five and New Mexico two. Georgia, Indiana, Kansas, Missouri, Ohio and Texas each had one case.

According to Wesson, there have been big jumps in the proportion of mosquitoes and dead birds testing positive for West Nile in Louisiana. "A month ago, we were getting maybe 30 to 40 percent of mosquitoes, and now it's over 80 percent," she said. "There's amplification going on."

Of the cases reported to the CDC, 19 (79 percent) of the 24 cases for which data were available occurred in males. The median age of people infected was 45 years, although the range was 17 to 80. They became sick from May 14 to June 30.

The one fatality appears to be that of a 70-year-old man in northeast Missouri, according to an Associated Press report. State health officials said that he died June 14 and that West Nile likely contributed to his death even though the man had other medical problems.

In addition, the CDC reported, seven blood donors who appeared to have West Nile virus were reported to authorities. Five of these were in Texas and one in Arizona.

In the non-human realm, 281 dead corvids (members of the crow family) and 96 other dead birds with West Nile infection have been reported from 16 states this year. Infections have also been reported in horses in 11 states and a total of 439 West Nile virus-positive mosquito pools have been reported in 13 states.

The bottom line for humans is that it's time to start adding on protection, experts said.

"First and most important, remove any standing water where mosquitoes are likely to breed," Skinner advised. "And wear repellant and long-sleeved clothing."

This year, in addition to the standard DEET-containing products, the CDC has also endorsed products containing oil of lemon eucalyptus and Picaridin.

Unfortunately, these types of precautions against West Nile are now a fact of life in the U.S., Higgs said. "The basic precautions are going to hold forever, because I don't think this is going to go away."

More information

For more on how you can protect yourself from the West Nile virus, visit the CDC.

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Gene variants tied to melanoma risk

By David Douglas

Reuters Health

Friday, July 15, 2005

In a Mediterranean population typically at low risk for developing melanoma, carriers of mutations in the pigmentation gene MC1R are at increased risk of developing the skin cancer and having it progress, a study hints.

This seems to be particularly true for mutation carriers who do not have other strong risk factors for melanoma such as freckles or moles.

As Dr. Maria Teresa Landi told Reuters Health, "people with red hair, light skin, many moles or freckles are known to be at increased risk of developing melanoma."

"We showed that individuals who have variant forms of the MC1R gene, which regulates the response to ultraviolet light, may be at high risk of developing melanoma or having a more aggressive disease regardless of their pigmentation or number of moles," she said.

Landi, of the National Cancer Institute in Bethesda, Maryland, and colleagues studied data on 267 melanoma patients and 382 controls obtained in an Italian study.

Carrying a MC1R variant, especially multiple variants, was associated with a two to fourfold increase in sporadic (seemingly random) and in familial (inherited) melanoma, they report in the Journal of the National Cancer Institute dated July 6.

Moreover, the association was stronger in people with darker skin and fewer moles. This suggests, say the investigators, that MC1R has an additional role beyond regulating pigmentation.

"Thus," added Landi, "people should protect themselves against intense sun exposure, even if they tan well."

 

Source: Journal of the National Cancer Institute, July 6, 2005.


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Study Refutes Cystic Fibrosis Bone Treatment

 

HealthDay News

Friday, July 15, 2005

FRIDAY, July 15 (HealthDay News) -- In findings that seem to refute recommendations from a Cystic Fibrosis Foundation panel, researchers found a vitamin D repletion regimen for cystic fibrosis (CF) patients "strikingly ineffective" in improving bone health.

The Johns Hopkins study examined the recently published vitamin D repletion regimen suggested by the Cystic Fibrosis Foundation's Consensus Panel on Bone Health. Bone health is a major issue for CF patients and the vitamin D regimen is meant to maximize calcium absorption and improve bone density in these patients.

However, this study found that only five of 66 adult CF patients who took the recommended 50,000 international units of vitamin D per week for eight weeks (a total of 400,000 IU) had their serum vitamin D levels return to recommended levels.

Of the 49 CF patients in the study who started a second eight-week vitamin D repletion test utilizing a total of 800,000 IU of vitamin D, 33 completed the full eight-week course, but none showed a correction in their vitamin D deficiency, the researchers report in the current issue of the American Journal of Respiratory and Critical Care Medicine.

The study authors concluded that the majority of adult CF patients have blood vitamin D levels below those recommended and the current repletion regimen doesn't fully correct that deficiency. The regimen may need to be revised to include even higher dosing levels of vitamin D, they said, and further research is needed in order to determine the optimal level of vitamin D needed for CF patients to maintain their bone health.

According to lead author Dr. Michael Boyle, about 20 to 25 percent of adult CF patients have osteoporosis and another 40 percent have osteopenia -- low bone volume due to inadequate replacement of bone loss from normal disintegration.

More information

The Cystic Fibrosis Foundation has information about living with CF.

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Asthma gene variants may cut risk of brain cancer

By Anthony J. Brown, MD

Reuters Health

Friday, July 15, 2005

 New research suggests that gene variants, which are known to raise the risk of asthma, decrease the risk of glioblastoma multiforme (GBM), a common type of brain cancer that is rapidly fatal.

Variants or "polymorphisms" are minor changes in a gene that can influence how often the associated protein is produced in a cell and how well it functions.

Several reports have linked asthma with a reduced risk of brain tumors, but the studies may have suffered from various design issues, lead author Dr. Judith Schwartzbaum, from Ohio State University in Columbus, told Reuters Health. "So, to me, the evidence just wasn't credible."

In the present study, Schwartzbaum's team looked for an association between asthma-related gene variants and GBM in a study of 111 patients with this tumor and 422 comparison subjects. An extensive literature search was conducted to identify variants that have been consistently linked to an increased or decreased risk of asthma.

In agreement with previous findings, self-reported asthma was associated with a decreased risk of GBM, the researchers note in the journal Cancer Research.

Two variants were tied to a heightened risk of GBM, whereas another was associated with a reduced risk. As it turns out, the two former variants are known to decrease the risk of asthma, whereas the latter raises the risk.

"Now I'm interested in determining if these polymorphisms just happen to have independent roles in the two diseases or does having asthma or allergy symptoms reduce the risk of GBM," Schwartzbaum said.

"I'd also like to find a polymorphism that increases the risk of both diseases," rather than raises the risk of one and lowers the risk of the other. Such a variant could serve as a target for new drugs, she explained.

 

Source: Cancer Research, July 15, 2005.


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Getting a Jump on Cancer Genetics

By Alan Mozes
HealthDay Reporter

HealthDay News

Friday, July 15, 2005

 FRIDAY, July 15 (HealthDay News) -- Trying to stop cancer before it starts, researchers have developed a new method of spotting tumor-causing genes in mice -- offering hope for better early detection in humans.

The detection process relies on the use of so-called "jumping genes" -- pieces of mobile DNA called transposons found in humans, animals and fish. These DNA fragments can enter or move around an organism's fixed genes, disabling or jump-starting normal genetic function.

The research was conducted by two teams of scientists at the University of Minnesota Cancer Center (UMCC) in Minneapolis and the National Cancer Institute (NCI). In each study, researchers used the jumping gene mechanism to force hidden cancer-related genes to reveal themselves.

"We know of about 300 cancer-causing genes, but I suspect there are more like 30,000 of them," said David A. Largaespada, an associate professor at UMCC and a co-author of both studies. "But finding them is like finding a needle in a haystack. So we figured out a quicker, more accurate and more efficient way to find these genes. And hopefully what we learn in mice will be analogous to what we will find among humans."

In the July 14 issue of Nature, Largaespada and his colleagues report on their work with a fish-derived jumping DNA, designed specifically for their cancer research. The DNA was named "Sleeping Beauty" to describe transposons that had been reactivated by the scientists after having lost their natural jumping ability over time.

In one study -- led by the UMCC team -- Sleeping Beauty was hard-wired into the DNA of a group of 26 1-year-old genetically altered mice, all specifically bred for the cancer experiments.

The Sleeping Beauty DNA fragments were then tracked as they set off jumping about a particular mouse's genetic structure, or genome.

Aiming to read genome's fine print faster and more accurately, Largaespada and his colleagues relied on the Sleeping Beauty's ability to cause gene mutation upon contact.

If the Sleeping Beauty DNA hopped directly inside a mouse gene, it would prevent the gene from functioning normally. On the other hand, when the jumping DNA hopped to a nearby location -- but remained outside the gene -- it would provoke gene activity.

While not all the affected mouse genes were revealed as having a relationship to cancer, this mutation experiment enabled the researchers to identify specific genes that appeared to either offer protection from, or promotion of, cancer in the mice.

For example, if cancer tumors grew as a result of a certain gene's impaired functioning, then that gene was tagged as protective against cancer. On the other hand, if cancer tumors grew as a result of a certain gene's activity, then that gene was tagged as cancer-causing.

Furthermore, the researchers were able to analyze malignant tumors that formed as a direct result of Sleeping Beauty exposure -- isolating and mapping the on-off cancer role of specific genes in each tumor.

In a similar vein, the second study -- led by the NCI team -- focused specifically on the ability of the Sleeping Beauty-jumping cell method to help scientists map genes causing lymphoma, a cancer of the immune system.

While acknowledging that there is a leap to be made moving from mice to human cancer patients, both research teams touted the success and potential of the jumping gene cancer screening method.

Since many of the mutated genes that cause cancer in mice often cause cancer in humans, they also suggested that success in identifying previously unknown cancer-causing genes among mice could lead to a more detailed portrait of cancer genetics in humans.

"If you look at the data carefully, we do find that there are also a bunch of new genes in mice that cause cancer that aren't already known to be involved in human cancer development," said Largaespada. "And that gives us a clue to look for more cancer genes in humans -- that there's more to discover."

Largaespada said future work at UMCC will focus on using the jumping gene screening method to compile a list of cells that lead to colon cancer, lung cancer, prostate cancer and myeloid leukemia. The team at NCI will focus on breast cancer, brain cancer and melanoma.

"We need to know this information as soon as possible, because the drug companies need to know what to target when they're looking to develop new treatments for different cancers," he said. "It will take a lot of hard work and time, but this technology is one additional tool that researchers will have to meet that goal."

Dr. Carlo M. Croce, chairman of the department of molecular virology, immunology and medical genetics at Ohio State University, shares the hope that jumping gene research will contribute to cancer treatment.

"This is a novel method to look at genes that might be activated and contribute to cancer," said Croce. "It's not a revolutionary step, but it's a step forward. These are two interesting studies, and the people who have done this work are very good geneticists. So I think it will have a wide application, and it might be an improvement over already established screening approaches."

More information

For more on cancer genetics, check out the National Cancer Institute.

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FDA approves Cyberonics depression device

By Susan Heavey

Reuters

Friday, July 15, 2005

A stopwatch-sized device that uses electrical impulses to treat chronic depression won U.S. Food and Drug Administration approval, Cyberonics CYBX> said on Friday.

About 18.8 million adults in the United States suffer from depression in any given year, according to the National Institutes of Health.

News of the FDA approval sent the company's shares up 8 percent in after hours trading to $48.50. Those gains were pared back to $47.50 before after hours trade was through.

The device, known as the Vagus Nerve Stimulation Therapy System (VNS), is implanted in the chest and sends impulses to the brain through a nerve in the neck. It was cleared by the FDA for long-term use in adults whose depression has not responded to other treatments.

FDA officials cautioned that the VNS device is not to be used as the first therapy but would give the sickest patients another option.

"We're really dealing with a very sick group of patients here. These are not standard depression patients," said Dr. Daniel Schultz, director of the FDA's device center.

The device would carry the strongest warning possible -- a so-called black box -- cautioning patients that the device is permanent, Schultz said in an interview. Cyberonics will also have to create a registry to monitor some patients.

The Houston-based firm ramped up its sales force during the last three months and has 200 people to start calling on customers on Monday, Cyberonics Chief Executive Officer Robert "Skip" Cummins told Reuters.

"We have the potential to do $300 million in revenue in the first four quarters after launch," he said.

Analysts said the long-anticipated decision would boost shares of the Texas-based firm.

"I expect Monday's trading will be chaotic and the stock will go up some more on the reality of the good news rather than on the prospect of the good news," Piper Jaffray analyst Thomas Gunderson said.

But FDA approval sparked renewed concern from patient advocates. The agency rejected the device in August 2004.

"It's a new low for FDA device approvals. If this device can get approved with data as unconvincing as these, it's hard to see what can't get approved," Peter Lurie of Public Citizen's Health Research Group said.

An FDA advisory panel last year supported the device but said muddled data made it hard to tell if the implant or other factors were at work. The advisers also worried about suicide risk seen in some study patients who received the device.

In February, the FDA granted conditional approval if the company provided more information.

The agency's handling of the Cyberonics application is the subject of a Senate Finance Committee Investigation. Senate Finance Committee Chairman Chuck Grassley, an Iowa Republican, and the committee's ranking Democrat, Sen. Max Baucus (news, bio, voting record) of Montana, said on Friday that their inquiry would continue.

VNS Therapy is already approved to treat epilepsy in Europe, the United States and Canada. The device is also approved for treatment-resistant depression in Europe and Canada in 2001.

(Additional reporting by Deb Sherman in Chicago, Lisa Richwine in Washington)

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Enzyme May Unlock Clues to Heart Failure

 

HealthDay News

Friday, July 15, 2005

FRIDAY, July 15 (HealthDay News) -- Scientists have identified an enzyme they say is key to the heart's response to such stimuli as exercise or stress. It could also prove valuable for research into heart failure.

This cardiac response enzyme -- phosphoinositide 3-kinase (PI (3) K) -- governs the function of beta-adrenergic receptors lying on the surface of heart cells. These receptors are protein switches, activated by the hormone adrenaline, that enhance the heart's pumping action in response to stress or exercise.

In people with heart failure, chronic stress can result in an excess of adrenaline. This over-stimulates the beta-adrenergic receptors, resulting in receptor desensitization and loss, according to researchers at Duke University Medical Center researchers in Durham, N.C.

However, the team has also discovered that blocking certain actions of PI (3) K can help maintain these heart receptors.

"We've uncovered new details of the first step of heart failure, in which heart receptors that normally allow the heart to adapt in the face of changing conditions are lost, rendering the heart unable to pump enough blood to meet the needs of the body's other organs," cardiologist and geneticist Dr. Howard Rockman said in a prepared statement.

"If we could prevent his loss of heart receptors, we might improve heart function in patients with heart failure," he said.

The study will be published in the August issue of the journal Nature Cell Biology.

More information

The American Heart Association has more about heart failure.

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Thursday, July 14, 2005

 

Inhaled insulin effective add-on for diabetics

By David Douglas

Reuters Health

Thursday, July 14, 2005

Inhaled insulin offers patients with type 1 diabetes the potential of avoiding pre-meal injections -- without any loss of diabetes control, a study shows. "This can improve their quality of life, " Dr. Jay S. Skyler, of the University of Miami, who led the study, told Reuters Health.

In the study, taking an inhaled form of insulin before meals with insulin injections at other times during the day provided blood sugar control comparable to that of a conventional all-injection insulin regimen and was equally well tolerated.

The study involved 328 patients with type 1 diabetes who received twice daily injections of insulin and were randomized also to have premeal inhaled insulin or premeal injected insulin for a 6-month period. The results appear this month in Diabetes Care.

According to the paper, a similar number of patients in the inhaled group (23.3%) and the all-injection group (22.0%) achieved optimal blood sugar levels during the study. Post-meal blood sugar reductions were comparable between groups, but there was a greater reduction in fasting blood sugar levels in the inhaled group.

There were fewer episodes of low blood sugar or hypoglycemia in the inhaled compared with the all-injection group (9.3 versus 9.9 episodes per patient-month). However, the rate of severe episodes was greater in the inhaled group.

Both group experienced a similar weight gain of about 1.4 kg and insulin use in both groups increased slightly over the study period. Lung function was also comparable between the two groups.

Given these findings, the researchers conclude that pre-meal inhaled insulin may provide an alternative to injected insulin as part of an overall treatment plan in patients who are unwilling or unable to use premeal insulin injections.

 

Source: Diabetes Care July 2005.


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SpongeBob Pitching Fruits and Vegetables

 

By Michael Hill

Associated Press Writer

The Associated Press

Thursday, July 14, 2005

Skip the Krabby Patty, SpongeBob SquarePants is going veggie. Pictures of the happy-go-lucky sponge will appear on packages of carrots, spinach and citrus starting next month, under licensing deals with produce companies. Dora the Explorer and other Nickelodeon characters also will debut on fruit and vegetable packages, according to the network.

SpongeBob already helps pitch a cart full of foods ranging from cereal to ice cream, but Nickelodeon executives say the foray into the wholesome fruit and vegetable market complements network programming attempts to coax kids to eat healthier.

"If we can use our popular characters and help kids eat better, then we're all for that," said Sherice Torres, vice president of Nickelodeon & Viacom Consumer Products.

The deals come as TV executives are countering criticism they contribute to the childhood obesity boom. A crop of kids' shows try to inspire young viewers to get up off the couch, like "Jo Jo's Circus" on Disney and Nickelodeon's "Lazy Town." Even Sesame Street's Cookie Monster changed his tune earlier this year, singing, "A Cookie Is a Sometimes Food."

Nickelodeon also announced Wednesday the launch of public service announcements promoting balanced breakfast, including an animated "It's Breakfast Time" spot featuring singing spoons and forks. It will be added to existing programming that encourages kids to exercise.

Under the licensing deals, SpongeBob will be giving a thumbs-up on bags of spinach from Boskovich Farms. SpongeBob, Dora and "Lazy Town" characters will appear on bags of carrots from Grimmway Enterprises, and a stable of Nickelodeon characters will adorn bags of oranges, tangerines and clementines from LGS Specialty Sales.

SpongeBob and Co. are not the first cartoon characters to go wholesome. Clifford the Big Red Dog lent his name to an organic cereal, Clifford Crunch. And Arthur the aardvark appears on some products made by Annie's Homegrown, including cans of organic Arthur Loops.

But established cartoon characters have yet to migrate noticeably beyond the cereal and candy aisles to the produce and organic sections.

Money is one reason. Organic and produce operations, which tend to be smaller, simply are not able to pay for big-time animated characters. The advertising budget for Stonyfield Farm, for instance, is a fraction of the ad budget of big food corporations, even though it's the top-selling organic yogurt maker in the country, said spokeswoman Cathleen Toomey.

Toomey said even if Stonyfield could afford that kind of licensing deal, the company would be careful not to sully its wholesome image with a character that already shills for sugary treats.

"I think we'd want a fairly pure character," Toomey said. "In a way, it's putting our brand at risk to identify it with a cartoon character that may not share the values."

For example, SpongeBob has appeared on boxes of cookie-dough ice cream from Breyers and his own SpongeBob SquarePants cereal described on the Kellogg's Web site as a "lightly sweetened, puffed, jellyfish-shaped cereal."

Nickelodeon's Torres said part of the 18 months it took to negotiate the new veggie licensing deals was spent educating produce people about the value of licensing. She declined to reveal financial terms, but said "these are a bit of a departure from our standard licensing deals."

Torres said the network wants to strike similar licensing agreements even as they work with mainline food makers to make sure SpongeBob products are reformulated to make them healthier.

Of course, some child health advocates grumble that the best way to raise healthy kids is to cut the sweets and turn off the TV.

Nickelodeon public affairs vice president Marva Smalls responds that while TV and ice cream are part of kids' lives, the network is using it's influence to nudge kids toward a balanced lifestyle — whether through SpongeBob spinach or promoting exercise.

"We're the first to say turn off the TV," she said, "we'll be here when you get back."

On the Net:

Nickelodeon: http://www.nick.com

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Unborn babies carry pollutants, study finds

 

By Maggie Fox

Health and Science Correspondent

Reuters

Thursday, July 14, 2005

Unborn U.S. babies are soaking in a stew of chemicals, including mercury, gasoline byproducts and pesticides, according to a report released on Thursday.

Although the effects on the babies are not clear, the survey prompted several members of Congress to press for legislation that would strengthen controls on chemicals in the environment.

The report by the Environmental Working Group is based on tests of 10 samples of umbilical-cord blood taken by the American Red Cross. They found an average of 287 contaminants in the blood, including mercury, fire retardants, pesticides and the Teflon chemical PFOA.

"These 10 newborn babies ... were born polluted," said New York Rep. Louise Slaughter, who spoke a news conference about the findings on Thursday.

"If ever we had proof that our nation's pollution laws aren't working, it's reading the list of industrial chemicals in the bodies of babies who have not yet lived outside the womb," Slaughter, a Democrat, said.

Cord blood reflects what the mother passes to the baby through the placenta.

"Of the 287 chemicals we detected in umbilical-cord blood, we know that 180 cause cancer in humans or animals, 217 are toxic to the brain and nervous system, and 208 cause birth defects or abnormal development in animal tests," the report said.

Blood tests did not show how the chemicals got into the mothers' bodies, or what their effects might be on the babies.

Mercury And Pesticides

Among the chemicals found in the cord blood were methylmercury, produced by coal-fired power plants and certain industrial processes. People can breathe it in or eat it in seafood and it causes brain and nerve damage.

Also found were polyaromatic hydrocarbons, or PAHs, which are produced by burning gasoline and garbage and which may cause cancer; flame-retardant chemicals called polybrominated dibenzodioxins and furans; and pesticides including DDT and chlordane.

The same group analyzed the breast milk of mothers across the United States in 2003 and found varying levels of chemicals, including flame retardants known as PBDEs. This latest analysis also found PBDEs in cord blood.

Slaughter had similar tests done on her own blood.

"The stunning results show chemicals daily pumping through my vital organs that include PCBs that were banned decades ago as well as chemicals like Teflon that are currently under federal investigation," she said in remarks prepared for the news conference.

"I have auto exhaust fumes, flame retardant chemicals, and in all, some 271 harmful substances pulsing through my veins. That's hardly the picture of health I had hoped for, but I've been living in an industrial society for over 70 years."

The Government Accountability Office issued a report on Wednesday saying the Environmental Protection Agency does not have the powers it needs to fully regulate toxic chemicals.

The GAO, the investigative arm of Congress, found that the EPA's Toxic Substances Control Act gives only "limited assurance" that new chemicals entering the market are safe and said the EPA only rarely assesses chemicals already on the market.

"Today, chemicals are being used to make baby bottles, food packaging and other products that have never been fully evaluated for their health effects on children -- and some of these chemicals are turning up in our blood," said New Jersey Democrat Sen. Frank Lautenberg (news, bio, voting record), who plans to co-sponsor a bill to require chemical manufacturers to provide data to the EPA on the health affects of their products.


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Food Makers Warned on High-Fat Snack Ads

 

By Libby Quaid

Associated Press Writer

The Associated Press

Thursday, July 14, 2005

The Bush administration's reluctance to crack down on ads that sell calorie-laden, high-fat snacks to kids could change if the industry doesn't do a better job of policing itself, the head of the Federal Trade Commission said Thursday.

"If industry fails to demonstrate a good faith commitment to this issue and to take positive steps, others may step in and act in its stead," FTC Chairwoman Deborah Platt Majoras said at a conference on childhood obesity and food marketing.

The focus of the two-day conference is on the efforts of food makers, restaurants, retailers and media and entertainment companies to regulate themselves.

Pressure has been mounting on the industry after the government-chartered Institute of Medicine reported that obesity among kids and teenagers has more than doubled over the past three decades. Food and drink companies spend $10 billion to $12 billion a year on marketing aimed directly at kids, the institute said.

Overweight and obesity are directly linked to the amount of time children spend watching television, said Dr. William Dietz, director of nutrition and physical activity for the government Centers for Disease Control and Prevention.

Ongoing research by an FTC economist has thrown a new wrinkle into the mix. Pauline Ippolito, associate director of economics at the agency, said that food commercials on children's TV shows have declined by 34 percent since 1977.

Still unknown is the impact of an explosive growth in Internet games, particularly on Web sites run by food companies. There are also food ads on regular gaming sites.

A dominant industry group, the Grocery Manufacturers Association, has plans to call for a crackdown on food advertising in conjunction with the FTC meeting.

A Democratic senator said that's not ambitious enough.

"There appears to be no meaningful enforcement mechanism, no truly independent body with the will and the power to crack down on offenders," said Iowa Sen. Tom Harkin (news, bio, voting record), the senior Democrat on the Senate Agriculture Committee.

On the Net:

FTC: http://www.ftc.gov

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Weighted backpack device helps reduce fall risk

 

Reuters Health

Thursday, July 14, 2005

Elderly women with curved spines may be able to improve their balance and lower their risk of falls by using a weighted support device for their backs and participating in an exercise program, according to new study findings.

The women studied had osteoporosis-related curvature of the spine, or kyphotic posture, which causes strain on the spinal cord, can cause back pain, and may increase the risk of falls. Previous studies have shown that the use of a weighted backpack can increase a person's perception of his or her spinal positioning.

In the current study, Dr. Mehrsheed Sinaki, of the Mayo Clinic College of Medicine in Rochester, Minnesota, and colleagues investigated whether such a device may also reduce the risk of falls among at risk elderly women.

"Most studies of falls address the effects of sedatives, weakness of the lower extremity muscles and neuromuscular diseases," Sinaki said in a Mayo Clinic statement. "What we wanted to see in this study was the effects of intervention to shift the center of gravity, and improve back strength and gait."

During the first stage of the study, the researchers found that the 12 women with curved spines were more likely to fall, had less muscle strength and had worse balance than did a comparison group of 13 healthy women, they report in this month's issue of the journal Mayo Clinic Proceedings.

The researchers then assigned the study participants with curved spines to a four-week program in which they performed exercises to improve their balance, while wearing a fitted harness with a suspended weight, to help them better center their own weight over their legs. The weight on their backs was to counter the frontal weight of their torso. The women were instructed to wear the harness, essentially a weighted backpack, for 30 minutes in the morning and 30 minutes in the afternoon.

At the end of the four weeks, the researchers write, "the positive results of this intervention were surprising to us."

The women showed improvement in their balance as well as their height, the report indicates. Their risk of falling decreased, their back strength improved, and they reported experiencing less back pain than they had at the start of the study.

Further, although the women did not experience improvement in the strength of their lower extremity muscles, they were able to walk faster, and otherwise exhibited improved gait, which the investigators attributed to their "improved balance and spinal posture."

"If mobility can be increased by improving balance, we can more successfully improve strength and general health," Sinaki and her team write.

In a commentary, Dr. Allan F. Tencer, of Harborview Medical Center in Seattle, Washington, writes that the improvements seen in Sinaki's study "have implications for reducing the incidence of falls" among elderly women with curved spines and preventing the "downstream potentially life-altering consequences of falling."

Source: Mayo Clinic Proceedings, July 2005.

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Health Tip: Step on Something Sharp?

 

HealthDay News

Thursday, July 14, 2005

(HealthDayNews) -- If you step on a nail or broken glass, it may not be a good idea to pull out the embedded object, advises St. John Ambulance. This may cause more damage and bleeding.

Instead:

Place a clean, preferably sterile, dressing around the object. Build up paddings around it so it doesn't move. Secure the paddings with a narrow bandage. Get medical help from a nearby clinic or emergency room.


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Mouse study suggests Alzheimer's damage reversible

 

By Maggie Fox

Health and Science Correspondent

Reuters

Thursday, July 14, 2005

Tests on mice suggest the brain damage caused by Alzheimer's disease may be at least partly reversible, researchers reported Thursday.

Their genetically altered mice regained the ability to navigate mazes after the genes that caused their dementia were de-activated.

This suggests that the brain damage caused by Alzheimer's is not permanent, they wrote in their report, published in the journal Science.

"I was astonished. I didn't believe the results when I saw them," said Alzheimer's researcher Karen Ashe of the University of Minnesota, who led the study.

"When I saw the memory getting better I actually thought I had done something wrong in the experiment."

Alzheimer's is a brain-destroying disease that affects an estimated 4.5 million people in the United States alone and millions more globally. As the population gets steadily older, experts estimate this number will balloon to as many as 16 million by 2015 in the United States.

Outward symptoms start with memory loss, which progresses to complete helplessness as brain cells are destroyed. In the brain, neurons die as messy plaques and tangles of protein form.

The two proteins involved are unhealthy forms of natural brain compounds called amyloid beta and tau protein.

Ashe's team worked with mice genetically engineered to develop the mutant tau, but this mutation could be stopped -- or de-activated -- with use of a drug called doxycycline.

As expected, the mice developed dementia and had brain atrophy similar to human Alzheimer's disease.

And when the engineered gene was turned off, memory loss stopped, as expected. But the mice did not merely stop getting worse. They got better.

"Even mice that had lost half the neurons that are involved in forming memories, when we removed the molecule causing the memory loss from the remaining neurons by turning off the genes, the mice were able to learn and remember new information," Ashe said in a telephone interview.

"No one suspected so many neurons would still be able to function."

From Mice To Men

She noted that it is a long way from treating a mouse to treating a person.

"How are we ever going to turn off the gene in humans?" Ashe asked. What might be possible, she said, would be stopping the production of the mutant proteins. And current vaccine efforts are aimed at removing the bad proteins from the brain.

"The point that makes us hopeful is the remaining neurons were functioning," she said. "When we removed the molecules that presumably were causing the malfunction, the mice were able to perform better."

Ashe said her team used a swimming maze test, in which mice must swim and find an underwater platform to stand on.

"The maze situation is very similar to parking a car in the parking lot and remembering where you parked it," she said.

William Thies, vice president for medical affairs at the Alzheimer's Association, said at the very least the mouse would be a useful tool for testing new therapies.

"It at least opens the possibility that people will get better," Thies said in a telephone interview.

The other interesting finding, Ashe said, was that the tangles of brain cells were not in themselves, evidently, toxic to surrounding brain tissue.

"The neurofibrillary tangles, which are one of two major pathological hallmarks of Alzheimers disease, turn out not to be involved in causing memory problems, at least in mice," she said.

Some process may be going on at a microscopic level, and the tangles may be a result but not a cause of the brain damage, she said.

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Risks associated with blood thinners rise with age

 

Reuters Health

Thursday, July 14, 2005

The risk of bleeding and thromboembolism (blood clots) in people who use anticoagulants increases with age, according to a new study.

Anticoagulant medications such as Coumadin (warfarin) thin the blood and help prevent clots from forming or growing larger, thereby cutting the risk of heart attack and the type of stroke caused by artery blockages.

"Anticoagulant treatment in elderly patients presents a major clinical dilemma," write Dr. Frits R. Rosendaal and colleagues in the Archives of Internal Medicine. While the risk of blood clots and the subsequent need for proper anticoagulant drug therapy increases sharply with age, the bleeding risk rises as well.

Rosendaal, from Leiden University Medical Center in the Netherlands, and colleagues studied the risk of bleeding and embolism in roughly 4,200 patients who were treated with an oral anticoagulant between 1994 and 1998. Nearly 700 of them were more than 80 years of age.

They found that the incidence of major bleeding increased sharply with advancing age. The oldest patients were 2.7 times more likely to experience a major bleeding event than the youngest patients. The risks of blood clots also increased with advancing age.

Rosendaal and colleagues suggest that older patients using anticoagulant medication may need more frequent monitoring by their doctor with a blood test called an INR. Doctors use this test to ensure that the dose of anticoagulant being given is not thinning the blood too much or too little.

Source: Archives of Internal Medicine, July 11, 2005.

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Chemical Triggers Breast Cancer in Lab Mice

By Kathleen Doheny
HealthDay Reporter

HealthDay News

Thursday, July 14, 2005 

THURSDAY, July 14 (HealthDay News) -- A chemical found in cleaning materials, textiles, plastics, paper and some personal-care products can trigger breast cancer, at least in lab animals, a new study has found.

Since the early 1990s, experts have known that the chemical, called 4-nonylphenol, binds to estrogen receptors, said senior study author William Baldwin, an assistant professor of biological sciences at the University of Texas at El Paso.

In the liver, 4-nonylphenol stimulates an enzyme system that then boosts production of estriol, a hormone associated with breast cancer. The chemical also has an affinity for estrogen receptors in breast tissue that trigger growth, he said.

"There have been a couple of studies in animals that showed a proliferation of mammary tissue when exposed to NP-4," Baldwin said. "This is believed to be the first study to show that if we carried out that enhanced proliferation for a longer period of time, it actually does lead to cancer in the lab animals."

Part of the problem is that the chemical, which mimics estrogen, may last longer in the body than natural estrogen, Baldwin theorized, but he added, "I have no evidence of this."

The study appears in the July issue of the Journal of Applied Toxicology.

In the study, Baldwin and his team compared the effects of giving differing doses of the chemical and estrogen to mice. When they followed mice genetically engineered to readily develop breast cancer over 32 weeks, many of those given 4-NP developed breast cancer while those given equivalent doses of estrogen did not.

Since the chemical is found in so many materials, should consumers be worried?

"I don't know if we can say that," Baldwin said. "The doses we used were much greater than what you would be exposed to, probably 100 to 1,000 times greater. [But] there might be more risk than we think."

Much more research is needed, Baldwin said. "In 10 or 15 years, we will figure out if environmental estrogens are a cause or part of the cause for breast cancer," he said.

Baldwin and other experts estimate that established risk factors such as aging, early onset of periods, late menopause, delayed childbearing and genetics explain only about 25 percent to 50 percent of breast cancers, and that environmental exposure plays a big role.

Brenda Salgado is program manager for Breast Cancer Action, a San Francisco-based organization that lobbies for environmental reforms, such as seeking legislation to label all carcinogens in cosmetics. She said that, while it's premature to give women advice based on just this study, they "should be conscious of chemicals that have an estrogenic effect and limit exposure to those chemicals."

Previous studies have found that exposure to these estrogen-like chemicals boost the risk of breast cancer, she said. The organization notes on its Web site that 70 percent of women with breast cancer have no known risk factors, suggesting that environmental forces play a major role.

More information

To learn more about breast cancer, visit the American Cancer Society.

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Washing hands with soap cuts diseases in children

By Patricia Reaney

Reuters

Thursday, July 14, 2005

Washing hands with soap can halve the number of young children suffering from pneumonia, the leading killer of youngsters under 5 years old worldwide.

It can also greatly reduce cases of diarrhea and the skin infection impetigo, scientists said on Friday.

Although it may seem simple and logical, researchers from the Centers for Disease Control (CDC) in Atlanta have shown improved hygiene could save many lives, particularly in poor countries.

"One of the things that this research shows it that there are even more health benefits to the simple act of hand washing than we have previously appreciated," said Dr Stephen Luby, the lead researcher and an epidemiologist at the CDC.

"Therefore efforts to promote it become that much more important," he added in an interview.

More than 27,000 children under the age of five, mostly in developing countries, die every day from preventable causes. Pneumonia and other respiratory infections kill an estimated 2 million children each year. Almost three-quarters of those who die are less than a year old.

Hand washing with soap is particularly important in poor countries because there are so many more pathogens in the environment. Children also do not have the same level of nutrition and access to healthcare as in richer nations so they are much more vulnerable.

"Removing the pathogens from a low income household has a greater health benefit than it would in London or Atlanta," Luby added.

He and colleagues compared the impact of routinely washing with soap in 900 households in squatter settlements in Karachi, Pakistan over a year. About 600 households received supplies of regular or antibacterial soap while 300, which acted as a control group received, received school supplies.

The homes were visited weekly to encourage better hygiene.

Cases of pneumonia and diarrhea were cut by 50 percent in families given soap compared to the control group. There was also a 34 percent drop in impetigo. There was no difference in households given the two types of soap.

The research, which was funded by the Procter & Gamble Company, is published in The Lancet medical journal.

Luby said washing hands is particularly important before preparing food and eating, after using the toilet and after cleaning an infant to reduce the amount of pathogens.

"The time has come to shout from the roof tops that hand-hygiene promotion should be a worldwide priority for public health and health care," Didier Pittet, of Switzerland's Hopitaux Universitaires de Geneve, said in a commentary.

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U.S. girls weight gain blamed on drop in exercise

 

Reuters

Thursday, July 14, 2005

Adolescent girls in the United States are putting on weight because they are doing less physical activity than they did as children, according to a study released on Friday.

Research by scientists at the University of New Mexico in Albuquerque showed that increasing exercise to the equivalent of 2-5 hours of brisk walking each week could help to prevent girls from gaining 4-9 kilos (9-20 lbs) during their teens.

"Preventing the steep decline in activity during adolescence is an important method to reduce obesity," Sue YS Kimm, the lead researcher, said in a study published online by The Lancet medical journal.

Over 9 million young people in the United States aged 6-19, or 16 percent, are considered overweight, according to the Centers for Disease Control (CDC) in Atlanta, Georgia.

Obesity is by measured by body mass index (BMI). It is calculated by dividing weight in kilograms by height in meters squared. A BMI of more than 25 is considered overweight. More than 30 is obese.

Kimm and her team studied the BMI and changes in physical activity in more than 2,200 girls from three U.S. cities who were followed up from the ages of 9 to 19. They also measured their skin folds, which is another indication of being overweight and obese.

The girls filled in a questionnaire about their physical activity and eating habits.

Although what they ate did not change, the researchers said there was a doubling in the rate of excess weight and obesity in girls who had a pronounced decline in physical activity during the transition from childhood to adolescence.

"Black girls were significantly heavier and fatter than white girls throughout adolescence, with increasing racial differences with age," Kimm said in the journal.

In the study about 32 percent of white girls kept up their childhood level of physical activity in adolescence, compared to 11 percent of the black girls.

"In view of the global obesity epidemic, maintenance of modest amounts of activity during adolescence could be a method for primary prevention of obesity development and adult-onset chronic diseases," Kim added.

Obesity increases the risk of other illnesses including Type 2 diabetes and heart disease.

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Scientists decode three deadly parasite genomes

 

By Maggie Fox

Health and Science Correspondent

Reuters

Thursday, July 14, 2005

Three parasites that sicken or kill millions of people in the developing world every year have been genetically sequenced and are giving up clues that could be used to fight them, scientists said on Thursday.

The international team said they had mapped out the genomes of the parasites that cause African sleeping sickness, Chagas disease and leishmaniasis, which kill 150,000 people a year and cripple many more.

They found a "common core" of genes that ties the three together and might pave the way for the development of new drugs or vaccines.

Sleeping sickness, or human African trypanosomiasis, reduces victims to a zombie-like state. Chagas disease damages the hearts and other internal organs of millions of Latin Americans, while leishmaniasis, also known as kala azar and "Baghdad boil," causes fever, a swollen spleen and disfiguring lesions.

Each is spread by a different insect or bug but it turned out they are genetically related -- and this could be a weakness that science can exploit, the researchers report in Friday's issue of the journal Science.

All three parasites share about 6,200 genes.

No Vaccine, Inadequate Drugs

"The basic building blocks of all three parasites are now known," said Matthew Berriman of Britain's Sanger Institute.

"This common core of genes is extremely important because it may provide targets for a new generation of drugs that might fight all three parasites, which threaten millions of people worldwide," said Najib El-Sayed, a molecular biologist at The Institute for Genomic Research who worked on the genome-decoding projects.

"At the moment, there are no vaccines and only a few inadequate drugs to fight these devastating and neglected diseases."

Nearly 250 researchers from 46 organizations representing 21 countries worked on the three studies. Scientists usually compete on such projects, but genome research is an exception.

"Now that the genes of these parasites are mapped out, it's much easier to identify genes that are critical for parasite survival," said Seattle Biomedical Research Institute researcher Peter Myler.

"The core genome of all three is very similar with the differences mainly at the end of chromosomes. So that tells us that if we focus on the genes that are the same in all three, but different from humans, we have the potential to develop a class of drugs that can target all three diseases."

Trypanosoma brucei is carried by the tsetse fly and causes an estimated 500,000 cases of sleeping sickness every year in sub-Saharan Africa. Trypanosoma cruzi is carried by "kissing bugs" and infects millions of people across Central and South America, killing 50,000 a year.

Leishmania major is carried by phlebotomine sandflies and can cause skin ulcers that leave permanent scars. At any one time some 12 million people from Brazil to Nepal will have it. When it affects internal organs it can cause fatal weight loss and anemia.

One comparative analysis found dozens of genes that all three parasites may have acquired from bacteria. Another found the mechanism that the Chagas disease parasite uses to elude the human immune system.

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Wednesday, July 13, 2005  

 

Black pregnant women have more asthma complications

 

By Amy Norton

Reuters Health

Wednesday, July 13, 2005

The rate of asthma complications among low-income pregnant women is high, with black women being especially vulnerable, according to a new study.

Among more than 4,300 pregnant, asthmatic women in the Tennessee Medicaid program, researchers found that 11 percent had to visit the emergency room and 6 percent had to be hospitalized for asthma exacerbations during pregnancy.

Complication rates were higher among black women than white women, despite the fact that all had health coverage through Medicaid.

The reasons for the racial disparity are unclear, study co-author Dr. Tina V. Hartert told Reuters Health. But, she said, even though black women had the same access to healthcare as white women, that does not mean they received comparable care.

When it came to prenatal care, Hartert and her colleagues found, black women did appear to get lesser care than white women, based on the timing of their first prenatal visits and the number of services they received.

Overall, the study findings "give a clue that the adequacy of care was not the same," said Hartert, of Vanderbilt University School of Medicine in Nashville.

She and her colleagues report the results in the July issue of the journal Obstetrics and Gynecology.

It's estimated that pregnancy worsens asthma in about 30 percent of women who initially have mild symptoms. Asthma management during pregnancy is similar to treatment of the condition in general, with the goal being to prevent attacks of wheezing and breathlessness.

Short- and long-acting inhaled medications are considered safe during pregnancy, and experts recommend that pregnant women with persistent asthma keep taking inhaled corticosteroids or other daily medications to prevent exacerbations. Uncontrolled asthma can diminish the amount of oxygen getting to the fetus, potentially impairing fetal growth.

Still, Hartert pointed out, many women, and even some doctors, may be unaware that many asthma medications can be taken safely during pregnancy, and some women may stop taking their medications on their own.

Among the 4,315 asthmatic women in this study, only 16 percent were on inhaled medications during their pregnancy. Overall, 13 percent ended up needing at least one prescription for "rescue" corticosteroids to control asthma exacerbations.

Black women were more likely than white women to need such prescriptions (nearly 15 percent versus 12 percent) and had higher rates of emergency room visits and hospitalization for asthma. They were anywhere from 35 percent to 89 percent more likely to suffer these complications, even when factors such as education, smoking and region of residence were considered.

This study, Hartert said, cannot answer the question of why complications were more common among black women. Besides differences in quality of care, other factors such as racial differences in response to medications could be involved, she noted.

More research, she said, is needed to find out why these racial disparities persist even when women have the same health coverage.

Source: Obstetrics and Gynecology, July 2005.

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Lobotomy Back in Spotlight After 30 Years

By Linda A. Johnson

Associated Press Writer

The Associated Press

Wednesday, July 13, 2005

The lobotomy, once a widely used method for treating mental illness, epilepsy and even chronic headaches, is generating fresh controversy 30 years after doctors stopped performing the procedure now viewed as barbaric.

A new book and a medical historian contend the crude brain surgery actually helped roughly 10 percent of the estimated 50,000 Americans who underwent the procedure between the mid-1930s and the 1970s. But relatives of lobotomy patients want the Nobel Prize given to its inventor revoked.

The lobotomy debate was discussed in an editorial in Thursday's New England Journal of Medicine.

Lobotomy was pioneered in 1936 by Portuguese neurologist Egas Moniz, who operated on people with severe psychiatric illnesses, particularly agitation and depression. Through holes drilled in the skull, Moniz cut through nerve fibers connecting the brain's frontal lobe, which controls thinking, with other brain regions — believing that as new nerve connections formed the patient's abnormal behavior would end.

Moniz, already widely respected for inventing an early brain-imaging method, gave sketchy reports that many patients benefited and was awarded the Nobel Prize for medicine in 1949.

The procedure was so in vogue that Rosemary Kennedy, former President Kennedy's mildly retarded sister, had a lobotomy in the 1940s at age 23. She remained in an institution until she died in January.

Other doctors used a more primitive version than Moniz, punching an ice pick into the brain above the eye socket and blindly manipulating it to sever nerve fibers.

By the late 1930s doctors were reporting many lobotomy patients were left childlike, apathetic and withdrawn — not unlike the depiction in the novel and movie "One Flew Over the Cuckoo's Nest." Use eventually waned with the advent of effective psychiatric drugs in the mid-1950s and the growing use of electroshock therapy.

Modern views of lobotomy have led to a call to pull Moniz's Nobel prize.

"How can anyone trust the Nobel Committee when they won't admit to such a terrible mistake?" asks Christine Johnson, a Levittown, N.Y., medical librarian who started a campaign to have the prize revoked.

Her grandmother, Beulah Jones, became delusional in 1949, was lobotomized in 1954 after unsuccessful psychiatric and electroshock treatments, and spent the rest of her life in institutions.

One member of Johnson's campaign, retired nurse Carol Noell Duncanson of Marietta, Ga., said her mother, Anna Ruth Channels, was lobotomized while pregnant to end chronic headaches in 1949. Channels, described as a brilliant and vivacious woman, was sent home incapacitated, Duncanson said.

"The woman could not feed herself, she could not toilet, she could not speak and she was combative," Duncanson said.

Channels eventually re-learned those things but remained childlike and unable to care for her daughters, who spent years in foster care. Her husband abandoned her and she lived the rest of her life in a small West Virginia town with her mother, who was resentful and ashamed of her, and an abusive brother, Duncanson said.

"She never had a life after her lobotomy. She had nothing," the daughter said.

Johnson, whose grandmother died in 1989, several years ago started the Web site psychosurgery.org to build a support network among families of lobotomy patients. Then she and group members began urging removal of an article on the Nobel Web site praising Moniz and saying he deserved the prize because there were no alternative psychiatric treatments at the time.

The Nobel Foundation refused to remove or change the article. Now Johnson is asking Nobel laureates to support her campaign to strip Moniz's Nobel.

"There's no possibility to revoke it," said foundation executive director Michael Sohlman, who could not recall a Medicine Prize ever being challenged. "It's a nonstarter."

The Nobel charter has no provision for appeal of a prize awarded, he said, and the foundation ignores such criticisms, as it did when Palestinian leader Yasser Arafat's Peace Prize was challenged.

Meanwhile, journalist Jack El-Hai recently published "The Lobotomist," about the chief U.S. proponent, neurosurgeon Walter Freeman, who did roughly 3,400 operations. He developed the icepick technique.

In the New England Journal editorial, Dr. Barron H. Lerner, a medical historian and associate professor at Columbia University College of Physicians and Surgeons, wrote that the procedure was a desperate effort to help many of the 400,000 patients confined to U.S. mental hospitals at mid-century.

He said a small number of patients became calmer and more manageable.

"I think the numbers that were harmed were quite substantial," Lerner said in an interview. "It was way overused, and it was used in inappropriate circumstances — retardation, anxiety, headaches."

El-Hai began his research eight years ago after meeting a relative of a man committed to a mental hospital for epilepsy around 1930 and later lobotomized. As he got into his research about Freeman, El-Hai wondered, "What led this undeniably gifted and compassionate doctor to champion a brain-mutilating procedure and why he stayed with it so long, past the point of reason?"

El-Hai said patients no longer felt strong emotions and their behavior changed immediately, which was Freeman's goal. But he concluded Freeman was driven to be a showman.

On the Net:

NEJM: http://www.nejm.org

Christine Johnson's site: http://www.psychosurgery.org

Nobel site on Moniz: http://nobelprize.org/medicine/articles/moniz

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Thousands get infected in Pa. Hospitals: report

 

Reuters

Wednesday, July 13, 2005

More than 11,000 people caught some sort of infection in Pennsylvania hospitals last year and nearly 1,800 died from them, according to a report released on Wednesday.

The report is the first detailed look at the problem of hospital-acquired infections in any U.S. state. Experts knew such infections were a problem but have been unable to precisely pinpoint them.

"Until now, we could only guess how many patients suffered from hospital acquired infections in Pennsylvania or any other state," said Beth McConnell, director of the Pennsylvania Public Interest Research Group Education Fund.

"By shining the spotlight on this serious patient safety issue, we hope this report will help lead to improved infection control practices in Pennsylvania and beyond."

The report from the Pennsylvania Health Care Cost Containment Council is the first generated by a new state law mandating the collection of hospital-specific infection reports.

The study found that Pennsylvania hospitals reported 11,600 patients who got infections in 2004 while seeking medical care and 1,793 patients died as a result.

Usually, such infections come from improper hygiene by health care workers -- failure to wash hands properly or at all, a failure to use gloves, inadequate sanitizing of equipment and other mistakes.

Virginia, Nebraska, Nevada, and New York enacted laws this year requiring the gathering of such data, while Florida, Illinois and Missouri have legislation in the works.

The report estimates that the infections cost an extra $2 billion for 205,000 extra days of hospitalization.

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Number of Autism Cases Declines in Calif.

 

The Associated Press

Wednesday, July 13, 2005

The number of new cases of autism in California has fallen for the first time in more than 10 years in what may be a bellwether for autism rates nationwide, according to new data compiled by the state Department of Developmental Services.

The total number of autistic children receiving special education services from the state continues to grow — bringing the current total to 28,046 — but the rate of increase peaked in 2002 and has dropped slightly since then.

California has the best reporting system for autism in the United States because it guarantees special education services for autistic children. Because of its tracking system, the state is generally considered a predictor of what is to come for the rest of the country.

Experts said, however, that they don't know what's causing the numbers to fall off.

"Perhaps whatever caused (the number of cases) to go up ... is no longer present," said Dr. Robert Hendren, executive director of the University of California, Davis MIND Institute, which researches neurodevelopmental disorders. "It's all speculation. I wish we had good studies."

Parent activist Rick Rollens of Sacramento, who played a key role in the creation of the MIND Institute, said that the trend roughly corresponds to the removal of mercury preservatives from pediatric vaccines. Many activist groups say that the use of mercury in the vaccines caused the sudden increase in autism cases.

Federal scientists, however, have continually said that the evidence does not support such a link.

The state data do not include children under the age of 3. About 90 percent of all autistic children are entered into the system before the age of 6, the department said.

According to the state data, 2002 was a record year for new autism diagnoses, with 3,259 cases. In 2003, the number of new cases slipped to 3,125. In 2004, the number was 3,074.

For the first half of 2005, there were 1,470 new cases, compared to 1,518 in the same period in 2004.

Information from: Los Angeles Times, http://www.latimes.com

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Simple steps prevent arthritis from preventing work

 

By Alison McCook

Reuters

Wednesday, July 13, 2005

Good posture, a phone headset and frequent breaks can help prevent arthritis from holding people back at work, according to an expert.

Dr. Diana Baldwin of the University of Missouri-Columbia also recommended keeping a computer monitor and important tasks within arm's length, and leaving wrists in a neutral position, or bent slightly downward, to prevent arthritis.

According to Baldwin, arthritis is the second most common cause of workplace disability, after heart disease. Indeed, half of the 23 million people with arthritis are no longer able to work 10 years after their diagnosis.

However, studies show that a supportive environment, a feeling of control, and a flexible schedule helps people with arthritis stay at work.

Some common signs that arthritis is interfering with work include fatigue or muscle weakness, pain while doing a task, swollen joints, feeling the need to frequently shift positions, and lasting pain or stiffness.

Currently, Baldwin is conducting a study of what steps workers with arthritis can take early on to stay on the job. As part of the study, she is following 140 people with arthritis, half of whom receive a personal visit, during which the researcher observes them at work to identify what aspects of their environment might eventually worsen their arthritis.

"Even if their disease process gets worse, they will know things they can do" to stay on the job, Baldwin said.

In an interview, the researcher explained that stretching is one of the most important step workers can take to keep their arthritis under control. Workers should consider stretching out major joints, such as shoulders, elbows and the neck, and, in addition, tensing and relaxing muscle groups to move toxic chemicals out of the muscles, she said.

She noted that people with arthritis are at risk of becoming unable to work because their arthritis leaves them more vulnerable to musculoskeletal problems such as lower back pain, carpal tunnel syndrome and neck and shoulder problems.

Baldwin added that it's also very important to keep good posture at work, which means ensuring that the head, neck, shoulders, wrists and elbows are in a neutral position, where the body can most effectively use its muscles.

"Those are the kinds of things that make a difference," she said.

Another tip: leave everything you need within arm's reach, so you don't have to put your body in awkward positions, bending muscles in the wrong shape, Baldwin added.

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Students Eat Healthier With Nutrition Info

 

By Genaro C. Armas

Associated Press Writer

The Associated Press

Wednesday, July 13, 2005

Pepperoni or cheese pizza? A burger with or without cheese? Students posed with those lunch-line dilemmas were more likely to select the healthier option when a school posted nutritional information at the cafeteria counter, according to a new study.

Researchers at Penn State University reported their findings in the latest issue of the Journal of Child Nutrition and Management after studying students' eating habits at six high schools in Pennsylvania in the fall of 2003.

Students weren't encouraged by teachers or cafeteria workers to make more health-conscious selections, and there were no changes in how food was prepared, said one of the study's authors, Martha Conklin.

"The reason why we think this worked is because we were empowering a student with knowledge," Conklin said. "We didn't make any statements about the food whatsoever. We just put some information out there to see what they would do with it."

The study was published in the spring 2005 issue of the journal, which is a publication of the School Nutrition Association, a nonprofit group of 55,000 food service directors, administrators and others involved in school nutrition programs.

Currently, schools aren't required to post nutritional information in a cafeteria, though many schools may mail the information home to parents or post it on a Web site.

In the study, only a few entrees were tested with nutritional boxes posted — typically, pizza with or without pepperoni or burgers with or without cheese. Comparisons couldn't be made between, for instance, a cheeseburger and a garden salad.

Even so, the results were encouraging, said Marilyn Tanner, a registered dietitian at Washington University in St. Louis and a spokeswoman for the American Dietetic Association.

At one school, an average of 380 pepperoni pizzas were ordered each day during a six-week period when no nutritional boxes were displayed. In the ensuing six weeks, when nutritional information was posted, an average of 346 pepperoni pizzas were ordered.

During the same time, the number of cheese pizzas ordered increased from 37 to 60.

In another district, one school tested the nutritional boxes and another school did not. Students at the first school ordered an average of 61 cheeseburgers per day during the non-test period; that declined to 43 per day while nutrition information was posted. The number of hamburgers ordered went up from 19 to 31 per day. There was no change in the second school.

"It's a start. It's that little bit, but that's what we are looking for," Tanner said. "Make that healthier choice most of the time and you will be ahead of the game."

Researchers couldn't determine how much peer pressure or boredom with the food menu may have swayed students' choices.

The study was conducted in high schools in the Allentown, State College, Hershey and Hollidaysburg districts and included students in urban, suburban and rural areas and in varying socio-economic groups. The results were consistent across those categories, the study said.

Greg Hummel, food service director for the Derry Township School District, which oversees the Hershey high school, said he plans to offer nutritional information for eight to 12 entrees starting this fall.

"It's what we all should do. A high fat item isn't bad if you eat it only once or twice a week," he said.

Linda Rudy, a cafeteria supervisor at one of the State College High School buildings, says her students are generally making healthier choices. But she says her school hasn't posted the information on the lunch line since the study because of a lack of time and space.

On the Net:

School Nutrition Association: http://www.schoolnutrition.org/

American Dietetic Association: http://www.eatright.org/Public/

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Breast cancer therapy may give rise to leukemia

 

Reuters Health

Wednesday, July 13, 2005

Women with early breast cancer who receive higher-than-standard doses of two chemotherapy drugs (epirubicin and cyclophosphamide) as "add-on" therapy are at increased risk of subsequently developing cancer of the blood, researchers have found.

Although add-on therapy with these drugs for early breast cancer has increased the number of long-term survivors, a small risk of secondary acute myeloid leukemia (AML), with or without a pre-leukemia known as myelodysplastic syndrome (MDS), has been identified, they report in the Journal of Clinical Oncology.

Dr. David Rogers and his associates emphasize, however, that the therapeutic benefit of epirubicin and cyclophosphamide in early breast cancer has been "convincingly demonstrated."

These regimens "have a strong benefit to risk ratio," they explain, "and patients and clinicians can be reassured that the risk of leukemia is likely to be low if the cumulative doses of these regimens are not exceeded."

AML and MDS are conditions in which the bone marrow malfunctions and not enough red blood cells, white blood cells and platelets are present in the blood. These cells are the body's natural defense system against diseases including cancer.

Rogers, with Gruppo Pfizer in Milan, Italy, and his team identified 30 women out of close to 9,800 who developed AML/MDS. All but one had been treated with epirubicin for early breast cancer.

According to the team, women taking higher than standard doses of epirubicin had a greater than 6-fold higher risk of developing AML/MDS compared with those taking standard doses of the drug. Women treated with epirubicin doses no higher than the standard had a low risk of developing leukemia.

Epirubicin and cyclophosphamide were usually administered in combination, the authors point out. For women who received higher than standard doses of both agents, the 8-year cumulative probability of developing AML/MDS was close to 5 percent -- significantly higher than those taking standard doses of these agents.

The authors conclude that the increased risk of secondary leukemia "must be considered when assessing the potential benefit to risk ratio of higher than standard doses."

 

Source : Journal of Clinical Oncology June 20, 2005.


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Health Tip: Hold Family Fire Drills

 

HealthDay News

Wednesday, July 13, 2005

(HealthDayNews) -- You may know what to do if a fire breaks out in your home, but do your kids?

The Children's Hospital of Philadelphia suggests you:

Make sure your kids know an escape route, as well as an alternate way out of the house. Practice fire drills at home. Teach your kids how to "stop, drop and roll" if their clothes catch fire. Tell them to crouch low, below the smoke, and crawl to safety. Teach them that if a doorknob's hot, they're not to open the door. A hot knob usually means fire in the room behind. Emphasize that once they've left a burning building, they must not return to it until the fire's put out. Teach them what to expect from firefighters and not to hide from rescue workers. Firefighters dressed in their garb can be a scary sight for some kids.


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High BP worsens impact of stroke on brain function

 

Reuters Health

Wednesday, July 13, 2005

In women who suffer a stroke, high blood pressure before the event predicts greater declines in cognitive function afterward, results of a study suggest.

The reason may be that pre-existing damage from high blood pressure hinders stroke recovery. Reducing blood pressure may help curb the burden of cognitive impairment among stroke survivors, study investigators conclude.

High blood pressure has been associated with silent or "subclinical" injury in the brain, but whether it increases the impact of stroke has been unknown.

To investigate, Dr. Jacob S. Elkins, from the University of California, San Francisco, and others identified 260 women who suffered stroke out of nearly 10,000 women enrolled in their study of bone fractures between 1986 and 1988. Cognitive testing had been performed within 2 years of stroke and then repeated at a median of 1.9 years following stroke.

Compared with women with stroke and normal blood pressure, those with stroke and high blood pressure showed significantly greater declines in the speed at which they could complete a cognitive function test.

The average increase in time to complete the test after stroke was 43.5 seconds in the women with high blood pressure compared with just 12.5 seconds in those with normal blood pressure.

The odds for cognitive decline after stroke was roughly fourfold higher in women with pre-existing high BP compared with those with normal BP.

It's possible, the researchers say, that high blood pressure impedes a person's ability to tolerate or recover from brain injury caused by stroke.

Source: Annals of Neurology, July 2005.

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Heart Failure Drug Stirs Controversy

By Amanda Gardner
HealthDay Reporter

HealthDay News

Wednesday, July 13, 2005

 WEDNESDAY, July 13 (HealthDay News) -- A hard-hitting article in one of the nation's most prestigious medical journals claims the maker of the widely used heart failure drug Natrecor is circumventing concerns over patient safety while watching revenues soar.

One of the country's top cardiologists asserts that Scios Inc., a subsidiary of Johnson & Johnson, continues to aggressively market Natrecor even as the drug comes under increased scrutiny for links to kidney failure and death.

"It's a pattern. We saw it with Vioxx and some of the cox-2 inhibitor drugs, and we're seeing it now with Natrecor," said Dr. Eric Topol, author of the article, which appears in the July 14 issue of the New England Journal of Medicine. "The twist here is that the aggressive marketing is through the medical community. With other drugs, it's direct-to-consumer advertising."

"Other than that, we have the themes of manuscripts published in prestigious journals with key omissions of data, the FDA approving drugs without mandating key trials, and companies aggressively pursuing sales and marketing of their drugs," continued Topol, who is chairman of the department of cardiovascular medicine and chief academic officer at the Cleveland Clinic in Ohio.

Natrecor (nesiritide) was approved by the FDA in 2001 for the treatment of acute, decompensated congestive heart failure, a stage of heart failure characterized by increased severity and long hospital stays. According to the company, it is the first member of a new drug class, human B-type natriuretic, and is manufactured from E. coli bacterium using recombinant DNA technology.

Today, tens of thousands of patients in the United States are receiving weekly or more frequent "tune-ups" with the drug on an outpatient basis, an indication for which the drug is not approved, Topol said. In fact, the drug, which costs about $500 per dose, is now being used 10 times more often in outpatient clinics than in acute hospital settings. This is happening despite troubling safety data and less-than-convincing efficacy, he said.

Sales for Natrecor are projected to be $700 million for 2005, Topol wrote, nearly double what they were last year.

According to Topol, studies have shown that Natrecor contributes to kidney dysfunction, and may even cause death. One trial found that kidney problems were occurring at a rate three times that found in patients taking a placebo. Another trial found a 50 percent increase in the risk of death at 30 days. And when data from three trials was pooled, researchers led by Dr. Jonathan Sackner-Bernstein, a New York cardiologist, found an 81 percent increase in the death rate vs. a placebo.

In his article, Topol says Natrecor was approved on the basis of only one trial in which surrogate outcomes were assessed three hours after patients took the drug.

"It hardly does any better than placebo," said Sackner-Bernstein, associate chief of cardiology and the director of the Heart Failure Program at St. Lukes-Roosevelt Hospital Center, New York City.

He said he had great difficulty getting his data published in any medical journals, although two studies conducted by his team that found problems with Natrecor did eventually appear in Circulation and the Journal of the American Medical Association earlier this year. He also took his data to the company.

"People were much more comfortable assuming this drug was safe," Sackner-Bernstein said. "In many ways, they were acting like the proverbial ostrich with its head in the sand."

But particularly troubling to Topol and others has been the aggressive marketing undertaken by the company even after safety issues had been raised.

According to the article, Scios is encouraging physicians to start their own "infusion centers," which would be billed to Medicare as if they were providing chemotherapy; it has also set up a toll-free telephone hotline for "Natrecor Reimbursement Support" and published a 46-page reimbursement and billing guide that even provides doctors with specific Medicare billing codes.

"If a drug is off-label, the FDA basically takes a blind-eye approach," Topol said. "There's a very fuzzy line about promotion. The company would say we're not promoting the outpatient tune-up. Well, how come they have a hot line, and any doctor can call and set something up? Is that not promoting it? Come on, help me. Where do you draw the line?"

In June, an expert panel convened at Scios' request recommended that the company conduct additional trials to assess the safety and efficacy of Natrecor. The panel also stated that use of the drug should be restricted to patients coming to the hospital with acutely decompensated congestive heart failure.

In a statement released at the time, Dr. Darlene Horton, the company's senior vice president of clinical research and medical affairs, said, "Scios fully agrees that these are areas for which there are not sufficient data to support the use of Natrecor. The company will continue and build upon its efforts to educate physicians regarding appropriate use."

Attempts made by HealthDay to reach Scios officials for comment were unsuccessful.

Back in June, the response was heartening to experts who had been pushing for changes.

"As a set of recommendations, it was very reasonable," Sackner-Bernstein said. "But it's been disappointing to me to see how little impact that statement has had. It was important for about three days."

If Scios was committed to their plan of doing more studies, Sackner-Bernstein added, "I would have expected to hear more from them by now. . . I would think Johnson & Johnson would like to prove to the world that they do care about patients, that they do have ethics, and it's pretty clear to me that it's not their motivation."

The ideal situation, as Sackner-Bernstein sees it, would have been for him and others to go to the company and talk to them (which they did), and for the company and the FDA to have worked out the situation.

"If the system worked, then all this stuff would have been unnecessary, irrelevant," he said.

"The fact that the FDA doesn't have much enforcement capability is a problem," Sackner-Bernstein said. "Then again, where are the ethics? The people involved at Scios and others who knew about this data should be hanging their heads. There's no other way to look at it. What is wrong with everybody that you've got a drug that increases renal dysfunction and death, and costs 50 times as much as a regular treatment, and yet it's given to hundreds of thousands of people?"

More information

The American Heart Association provides a detailed explanation of heart failure.

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Male fertility not harmed by phthalates-study

By Will Boggs, MD

Reuters Health

Wednesday, July 13, 2005

Contrary to earlier reports, everyday exposure to phthalates -- chemical plasticizers used extensively in household products and in certain medical products -- may not have harmful effects on fertility in young men, a new study shows.

Previous studies suggested that low levels of phthalate exposure could adversely affect human semen, the authors explain in a report in Epidemiology, a medical journal, but high doses of phthalates are required to provoke male reproductive toxicity in rats.

For their study, Dr. Bosse A.G. Jonsson from Lund University Hospital, Sweden, and colleagues looked for associations between phthalate metabolite levels in urine and semen quality and reproductive hormone parameters in 234 young Swedish men entering the military.

There was "no clear pattern of associations" between any of the phthalate metabolites and any of the biomarkers of reproductive function measured.

In fact, exposure to phthalic acid seemed to be associated with improved reproductive function, as measured by several markers.

"I do not think it is clear whether phthalate constitutes a risk for the male fertility," Jonsson told Reuters Health. "More studies must be performed."

"We plan to study biological samples stored in biobanks from pregnant mothers and study the fertility in their grown-up male children," Jonsson added.

 

Source: Epidemiology, July 2005.


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For Many, Work is a Real Pain

 

HealthDay News

Wednesday, July 13, 2005

WEDNESDAY, July 13 (HealthDay News) -- Almost 30 percent of employees in the United States have pain problems that affect their health, work performance and productivity, according to the results of an Internet survey of more than 1,000 employees of a major business services company.

The Harris Allen Group survey found that, overall, 29 percent of the workers in the survey reported ongoing problems with pain. Those with pain scored more than 45 percent lower on an overall rating of physical health than workers with no pain. Workers with pain also had a 23 percent lower mental health score.

Pain was associated with reductions in nearly every aspect of productivity measured in the survey. The more severe the pain, the greater its impact on productivity, the study found. Workers with pain were five times more likely than workers without pain to report health-related limitations in performing their job. In addition, employees with pain lost an average of three and two-thirds workdays per month, the survey found.

The impact of pain on health and productivity was especially high among workers with musculoskeletal conditions, such as arthritis and neck and back pain. These three conditions, along with allergies and depression, were the five most common health problems reported by employees in the survey.

Many workers with pain were dissatisfied with their current pain treatment -- a finding that suggests there's considerable room for improvement in the way employees' pain is being managed, the survey authors noted.

Company programs designed to address employees' pain issues and improve their quality of life could also help a company's bottom line by providing a more productive workforce, the authors suggested.

The findings appear in the July issue of the Journal of Occupational and Environmental Medicine.

More information

The FDA has more about chronic pain.

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Getting a flu shot may reduce your risk of stroke

 

Reuters Health

Wednesday, July 13, 2005

Getting a flu shot may not only protect you from catching the virus, it may also protect you from suffering a stroke, according to a study in which German doctors found an association between influenza vaccination and a reduced risk of stroke.

In a report in the journal Stroke, Dr. Armin J. Grau, of Klinikum der Stadt Ludwigshafen, and colleagues note that hospitalizations for stroke go up during influenza epidemics, so flu vaccination might prevent strokes.

To look into that possibility, they interviewed 370 stroke patients and 370 healthy controls of the same age and sex, to assess vaccination status, risk factors, health-related behavior, and socioeconomic factors.

Overall, only 19 percent of stroke patients had received a flu shot during the last vaccination campaign, compared with 31 percent of stroke-free controls.

In analyzes controlling for potentially confounding factors, the odds of having a stroke was markedly lower in those who had been vaccinated against influenza.

While no firm conclusions can be drawn from this study, the authors say "potentially, influenza vaccination may prevent strokes" and they call for further studies to evaluate the role of the flu vaccine in preventing stroke.

Source: Stroke July 2005.

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Dental Advice Doled Out For Free

 

HealthDay News

Wednesday, July 13, 2005

WEDNESDAY, July 13 (HealthDay News) -- Free dental advice and answers to questions about oral health will be provided by more than 100 dental experts taking part in SmileLine, a toll-free, U.S. national dental health hotline on July 15.

SmileLine is presented by the Academy of General Denistry (AGD). Consumers can call SmileLine at 1-800-764-5333 from 8 a.m. to 8 p.m. ET and speak one-on-one with a dental expert.

"AGD is committed to serve as a lifelong resource for oral health information, and the annual SmileLine is just one example of our many educational programs. Each year, a network of our members volunteer their medical expertise to field questions about dental health at all stages of life and AGD's SmileLine has fielded questions from more than 15,000 consumers to date," Dr. John Kokai, 2005 SmileLine coordinator, said in a prepared statement.

People who miss the SmileLine hotline can go to SmileLine Online at the AGD Web site. Go to the Web site and click on the "Ask a Dental Question" link.

More information

The CDC has more about oral health.

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Relaxation treatment helps teens with headaches

 

Reuters Health

Wednesday, July 13, 2005

Relaxation techniques appear to help teenagers fight off frequent migraines or tension headaches, a study shows.

After students learned relaxation techniques from either a school nurse or graduate psychology student acting as a therapist, they reported fewer headaches, and less intense headaches, up to 10 months later.

Students with migraines only responded when they were taught by therapists, but students with tension headaches responded to relaxation teachings by both graduate students and school nurses.

In the journal Headache, Bo Larsson and colleagues from the Norwegian University of Science and Technology in Trondheim, Norway write that frequent, recurring headaches are "one of the most common health problems among adolescents."

Studies show that teenagers with frequent headaches take more analgesic medicine, and are more likely to have physical, social and psychological problems that arise in day-to-day activities.

Recent studies have suggested that relaxation therapy may help teens reduce their headaches. To investigate further, Larsson and colleagues reviewed information collected from 7 studies, which followed 288 students between the ages of 10 and 18 for between 6 and 10 months.

During the studies, students were either trained in general relaxation techniques or techniques to deal specifically with headaches, or asked to talk about day-to-day problems, without receiving any instructions about headaches.

Students who underwent relaxation training reported fewer headaches and less severe headache pain. In addition, students with tension headaches who were trained by therapists reported taking fewer medications.

The authors conclude that relaxation training from therapists was "clearly the most effective" in helping teens avoid headaches -- but asking a school nurse to administer the relaxation training was most "cost-effective," they add.

"Relaxation training procedures administered within school settings may provide effective and efficient help to adolescents suffering from long-standing and frequent headaches," the authors write.

Source: Headache, June 2005.

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Even Low-Dose Birth Control Pill Raises Heart Risk

 

HealthDay News

Wednesday, July 13, 2005

WEDNESDAY, July 13 (HealthDay News) -- Taking birth control pills may double a woman's risk of heart attack or stroke, but that risk vanishes after a woman stops taking low-dose oral contraceptives, researchers add.

And while use of the Pill can raise cardiovascular risk, the researchers note that a premenopausal woman's absolute risk of a cardiac event is usually very low to begin with.

Still, "the study suggests that women in general are at an increased risk of having a cardiovascular event while taking even these third-generation, low-dose, birth control pills," study author Dr. John Nestler, a professor and chairman of the division of endocrinology and metabolism at the Virginia Commonwealth University School of Medicine in Richmond, said in a prepared statement.

The findings are based on a review of studies published between January 1980 and October 2002.

"Prolonged exposure to low-dose oral contraceptives in a population at higher risk may significantly increase the incidence of cardiovascular outcome, and prompt considerations of alternative therapeutic or contraceptive interventions," Nestler wrote.

According to the Virginia researcher, populations at "higher risk" for heart attack or stroke include women with polycystic ovary syndrome (PCOS) or a constellation of risk factors collectively known as the "metabolic syndrome" -- conditions such as high blood pressure, elevated blood sugar, obesity and low HDL "good" cholesterol.

Even though the study concluded that taking the Pill may double the risk of heart attack, the absolute risk for an individual young woman taking the Pill is very low, Nestler said.

"Women using the Pill are not going to automatically have a heart attack. However, our findings do raise the issue of whether oral contraceptives are optimal therapy for certain groups of women who are at baseline risk or who are taking the Pill for a longer time, such as women with PCOS," he said.

The study appears in the July issue of the Journal of Clinical Endocrinology and Metabolism.

More information

The Nemours Foundation has more about the birth control pill.

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Dual pacemakers no better for people over 70

By Gene Emery

Reuters

Wednesday, July 13, 2005

 For people over 70, pacemakers that stimulate only one part of the heart are just as effective as newer and more expensive devices that apply electricity to two of the heart's four chambers, British researchers said.

The finding suggested that the benefits of two-chamber pacemakers had been overestimated in older people with a heart condition known as atrioventricular block, according to the team led by William Toff of Britain's Leicester University.

The finding was published in Thursday's New England Journal of Medicine.

Atrioventricular blocks, which occur when electrical impulses fail to reach the ventricles or are conducted with a delay, are a common reason for implanting a pacemaker.

The test of 2,021 volunteers who suffered from a slowed heartbeat found that after nearly five years the annual death rate was 7.2 percent among those with pacemakers that stimulated one chamber versus 7.4 percent for the people who got so-called dual-chamber pacing.

When the research team looked at deaths directly caused by heart disease, the rate was 3.9 percent with single-chamber devices and 4.5 percent for double-chamber pacemakers.

The rates of stroke and heart failure were also similar in the two groups.

Earlier studies that were not as well controlled had shown that the dual-chamber devices were better, the researchers said.

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Bypass Costs Far Higher in U.S. Than in Canada

HealthDay News

Wednesday, July 13, 2005

WEDNESDAY, July 13 (HealthDay News) -- Americans undergoing bypass surgery end up with hospital bills 82 percent higher than those of Canadians undergoing the same procedure, a new report finds.

This extra expense in the United States may not bring better results, however: The study found no differences in clinical outcomes between patients treated in the two countries.

Researchers at Jewish General Hospital in Montreal compared the outcomes and costs of treatment of 7,319 Canadian and 4,698 U.S. coronary artery bypass graft (CABG) patients at four Canadian and five U.S. hospitals.

"In-hospital costs of treatment were substantially higher in the United States than in Canada (an average cost of $20,673 vs. $10,373)," the study authors wrote. "After controlling for demographic and clinical differences, [inpatient] length of stay in Canada was 16.8 percent longer than in the United States; there was no difference in in-hospital mortality (death): and the cost in the United States was 82.5 percent higher than in Canada."

The researchers did note pluses and minuses between the two systems in their analysis.

First, they found that the gap in in-hospital expense between the two countries was "almost equally attributable to differences in direct and overhead costs between the Canadian and U.S. hospitals," which they blamed on "higher resource prices for products and labor and higher overhead costs in the United States resulting from a nonsocialized medical system."

On the other hand, they note that "U.S. hospitals also appear to streamline services better to reduce length of stay, a strategy Canadian hospitals might emulate to further reduce treatment costs."

The research is published in the July 11 issue of Archives of Internal Medicine.

More information

The Society of Thoracic Surgeons has more about CABG.

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Group calls for health warnings on soft drinks

By Susan Heavey

Reuters

Wednesday, July 13, 2005

 A U.S. consumer group on Wednesday called for cigarette-style warnings on soft drinks to alert consumers that too much of the sugary beverages can make people fat and cause other health problems.

People who overindulge in soft drinks are also more likely to develop diabetes and have decaying teeth, the Center for Science in the Public Interest (CSPI) said in a petition to the Food and Drug Administration.

The warnings are especially needed to counter the growing number of young people who drink soda, said the center.

"Soda pop used to be an occasional treat. Now it's an everyday beverage," CSPI executive director Michael Jacobson said, adding that it is all calories and no nutrients.

The latest government data from 2002 shows teenage boys drink an average of two 12-ounce cans of soda a day compared to about 1.33 cans for teenage girls, Jacobson said.

Food and beverage industry groups rejected the call for warnings, saying obesity has complex causes and packages already list calories and ingredients.

"Individuals, not the government, are in the best position to make the food and beverage choices that are right for them," said Susan Neeley, head of the American Beverage Association (ABA).

Others, including the industry-funded Center for Consumer Freedom, said regulating sodas would limit consumer choice.

Some firms have reintroduced smaller packages, but CSPI said cheap prices and multiple-serving bottles attract consumers.

Government warnings are needed to "push the public to a healthier diet as aggressively as the soft drink industry, the fast food industry and others push people in the other direction," Jacobson said.

Coca-Cola Co. and Cadbury Schweppes Plc did not return calls for comment. PepsiCo Inc. referred calls to the ABA.

FDA officials could not be reached for comment.

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Obesity Tougher on Men

By Alan Mozes
HealthDay Reporter

HealthDay News

Wednesday, July 13, 2005

 WEDNESDAY, July 13 (HealthDay News) -- Adding a new spin to the battle of the sexes, researchers say severely obese women outperform their male counterparts when it comes to both physical fitness and their ability to properly digest carbohydrates.

"Society is putting much more calories in food today than 50 years ago, and people are getting more and more overweight. But we found that the women were better able to handle the obesity than the men," said study co-author Dr. Emile F. L. Dubois, from the department of pulmonary diseases at the Hospital Reinier de Graaf Groep in Delft-Voorburg, The Netherlands.

The study found extremely obese women displaying better endurance and respiratory capacity during exercise than similarly heavy men.

The men also fared worse than women in terms of a condition called "carbohydrate intolerance." Unable to utilize carbs as the high-energy fuel source they are meant to be, people with this condition typically store unprocessed, excess carbohydrates as body fat.

Taken together, this lack of fitness and inability to handle carbs places severely obese men at a higher risk than equally sized women for developing "metabolic syndrome," a precursor to diabetes and heart disease, the researchers said.

The syndrome describes a range of health risk factors -- including high blood pressure, diabetes and obesity -- that contribute over time to the onset of serious disease.

Reporting in the July issue of Chest, Dubois and his colleagues focused on 56 severely obese Dutch patients -- 22 men and 34 women, all white. None was known to have a history of heart disease or diabetes.

With an average age of 42, all the patients were scheduled to undergo a form of bariatric surgery intended to help them lose weight by having their stomachs wrapped with a restraining band. The procedure, known as "gastric banding," is usually recommended for patients with a body mass index (BMI) of over 40.

Each patient took part in a weight-management program in preparation for surgery, involving access to a dietician as well as nutritional information, an exercise program, and -- in some cases -- medication.

Blood samples were taken, and all patients were assessed for evidence of carbohydrate intolerance and diabetes. Hormone levels and body fat composition were also calculated, and all the men and women completed a bicycle exercise test to observe respiratory health, muscle strength and fatigue.

According to the researchers, men generally failed to meet expectations on the cycle test while women exceeded the anticipated results.

The women demonstrated better lung capacity -- and significantly better endurance -- when exercising than the men, the study team found.

In addition, 59 percent of the men were found to be either carbohydrate-intolerant or diabetic, compared with just 35 percent of the women.

Dubois and his team concluded that gender plays a major role in how well obesity is tolerated.

"We were surprised by our findings," Dubois said. "We had the idea that severely obese men and women would both have muscle and endurance capacities above normal, because they're carrying a lot of weight around all day long. But this was only true among women. The men really under-performed."

Dubois suggested a range of potential explanations, including the possibility that women are naturally more efficient at energy storage due to the role they play as a food source for newborns. Another theory is that hormones produced by fat tissue -- including estrogen -- might partially explain gender differences. Men could be more negatively affected than women by the release of these hormones, Dubois speculated.

But the most promising explanation might be linked to the distribution of fat around the body. Men, he noted, tend to store it in the upper parts of their bodies and directly inside muscle tissue, whereas women store fat in the lower body area. This may lead to a relatively greater diminishment in lung capacity among men, because abdominal muscles are compressed under the weight of stored fat.

Dr. Ken Fujioka, an expert in nutrition and metabolism at the Scripps Clinic in San Diego, agreed that fat distribution may indeed account for the fitness gap.

"We've known for years that women tolerate obesity better than men, and our guess is that it's hormone-mediated," said Fujioka. "It's mainly because men store fat centrally around the organs and in the abdominal area, while women store it in their hips and thighs. And essentially when you increase the fat in the abdominal area, insulin levels have to rise, and you increase pressure on the abdominal cavity. So I'd have to say they're right. It'll be harder to intake oxygen and breathe."

Alice H. Lichtenstein, director of the Cardiovascular Nutrition Lab at the USDA Human Nutrition Research Center at Tufts University in Boston also agreed this line of reasoning might have merit.

"It's true that there is a difference between men and women in body fat distribution," she said. "And men tend to have more central obesity, so that could be the issue influencing what they've observed. But more research is needed. In the end, it's hard to say."

More information

For more on obesity, check out the American Obesity Association.

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Stem cells may protect brain, nervous system -study

 

Reuters

Wednesday, July 13, 2005

Stem cells may protect the brain and nervous system against damage from tumors and conditions such as multiple sclerosis, researchers at Milan's San Raffaele Scientific Institute found.

Experiments with mice with a disease similar to multiple sclerosis showed that stem cells injected into the blood stream migrated to inflamed areas in the brain and spinal cord, killing inflammatory cells, the researchers said.

This means a single injection of stem cells could be used to treat many different areas of damage in the body, reducing the clinical signs of the disease.

"There is a therapeutic potential in this discovery, but it's still too early to talk about a cure for humans," head of research Gianvito Martino told a news conference.

Mice treated with stem cells at the onset of the disease started to recover between one or two months, the team reported.

Stem cells are primitive cells that can transform themselves into many specialized forms, such as blood cells. Their potential of regenerating organs or tissue has given hope to sufferers from nervous diseases such as multiple sclerosis.

The researchers said the stem cells could also potentially be used as a natural anti-inflammatory drug to treat damage by diseases such as stroke, brain tumors, and spinal cord injuries.

"With this discovery, we are moving closer to a targeted use of stem cell therapy without side effects," researcher Stefano Pluchino said.

"The interesting thing is that adult stem cells grow in vitro without becoming specialized, they are injected and the find the damaged organ by themselves and decide autonomously how to treat it."

The results of the study will be published in Nature magazine this week.

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Tuesday, July 12, 2005

 

A Major Medical Advance -- Or Not?

 

By E.J. Mundell
HealthDay Reporter

HealthDay News

Tuesday, July 12, 2005

 

TUESDAY, July 12 (HealthDay News) -- Americans who've grown skeptical of the hyping of the latest medical breakthrough got some validation this week: A new review found one out of every three highly cited studies published in influential medical journals is either refuted or seriously weakened by subsequent research.

Some notable examples: the initial finding that hormone-replacement therapy reduced older women's heart disease risk (a larger trial later found that HRT actually raised cardiovascular and cancer risk); the promise of vitamin E in preventing heart attack (it doesn't); and the news that vitamin A supplements cut breast cancer risk (again, a larger, randomized trial showed no effect).

None of this means the initial, promising trial shouldn't have been published or publicized, stressed Dr. John Ioannidis, author of the review appearing in the July 13 issue of the Journal of the American Medical Association.

"This is largely the scientific process at work," said Ioannidis, an associate professor of medicine at the Institute for Clinical Research and Health Policy Studies at Tufts-New England Medical Center, in Boston. "There is nothing wrong with publishing promising evidence."

Ioannidis, who is also chairman of the department of hygiene and epidemiology at the University of Ioannina School of Medicine in Greece, said the message for the public is "to not lose your trust [in science], but don't expect that everything you hear about will be true forever."

In his analysis, Ioannidis examined the long-term validity of 49 of the most widely-cited studies published between 1990 and 2003 in three of the world's most prestigious "generalist" medical journals -- the Journal of the American Medical Association, The Lancet, and the New England Journal of Medicine -- as well as leading "specialty" journals such as Circulation, Diabetes and the Journal of the National Cancer Institute.

He then tracked whether or not the main findings from the 49 studies held true over time. Thirty-nine of the studies were randomized -- meaning that participants were randomly assigned to one of two or more treatment arms in a clinical trial. Large, randomized trials conducted prospectively (i.e., unfolding over time as opposed to a review of past data) are considered the gold standard of clinical research.

According to Ioannidis, "five out of six non-randomized studies and nine out of 39 randomized studies were contradicted or found to have stronger effects compared with subsequent studies on the same topic." Smaller studies were more likely to be refuted than larger ones, and findings from non-randomized trials were often overturned by the results of a larger, randomized trial.

In total, 16 percent of the trial studies ended up being contradicted by later research, and findings from another 16 percent were considerably weakened by later, more reliable data.

Ioannidis said his goal was to reach an "objective estimate" of the pace of change in current medical theory. "I think it is healthy thinking to acknowledge that scientific knowledge is not immutable and final, but is likely to change over time," he said.

He added that none of his findings cast doubt on the integrity of most medical journals.

"These journals have high scientific standards, robust editorial processes, and they are independent," Ioannidis said. "We just have to accept that contradictions will occur, and that we should not consider that science is cut in stone."

Editors at the New England Journal of Medicine agreed. In a group statement, they said the conclusion of Ioannidis' review is "widely appreciated: while many published studies are subsequently confirmed, some are not. This is how medical and scientific research progresses. A single study is not the final word, and that is an important message."

But does the media -- aided by drug companies eager to capitalize on positive findings -- too often hype and simplify the results of new medical research?

"This may be a problem occasionally," Ioannidis said. "The general public should be sensitized to the fact that scientific knowledge has limitations, it is never final and things may change down the road."

Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, representing the drug industry, agreed that "there's always new information as the product is introduced to a larger patient population." But he also believes "the evidence is clear that in most situations, new data tend to confirm the initial findings."

Trewhitt also noted that, besides having to pass through the journal editorial process prior to publication, clinical trials are also designed "to meet the tough testing standards at the FDA."

"We believe we are not routinely seeing data that would change the indicated use of the product as approved by the FDA," he added.

Ioannidis did have one criticism for major journals, however: their tendency to publish "positive" findings (where a therapy was proven to be effective) over "negative" ones (where a therapy's effectiveness was cast in doubt).

"There's nothing wrong with publishing promising evidence," he said. "What is wrong is not publishing less promising evidence and studies with 'negative' results when [the studies] are equally well-designed and conducted as those that find impressive effects."

Still, Ioannidis seemed reassured by the findings. "Scientific advances do happen, medical progress is moving at a fast speed," he said. In interpreting medical news that could potentially impact health, Ioannidis advises people to "make decisions about it, try to find out what the limitations and caveats might be, and try and get a sense from your physician or physicians about the surrounding uncertainty. Critical thinking is always useful."

More information

For a better understanding of the clinical trials process, visit the National Institutes of Health.

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Wood smoke may raise lung cancer risk

 

Reuters Health

Tuesday, July 12, 2005

Although tobacco smoke is the top cause of lung cancer, some cases of the disease can be traced to smoke of a different sort, according to a new study.

Researchers in Mexico found that of 62 lung cancer patients they assessed, more than one-third of the cases were associated with exposure to wood smoke. These patients, mainly women, were non-smokers who for years had used traditional wood-burning stoves that were not equipped with a chimney to funnel the smoke outdoors.

In many countries, wood and other solid fuels are still used for heating and cooking, and some studies have found potential health hazards. A study in Brazil showed that wood-burning stoves may raise the risk of mouth and throat cancers, while others have found that smoke from wood and other sources may contribute to chronic bronchitis, emphysema and asthma.

There has not, however, been sufficient evidence to tie wood smoke to lung cancer, according to the authors of the new study, led by Javier Delgado of the National Institute of Respiratory Diseases in Calzada de Tlalpan, Mexico.

Their study, published in the medical journal Chest, included 62 patients scheduled to undergo chemotherapy for lung cancer, as well as nine smokers with chronic obstructive pulmonary disease and nine healthy non-smokers with no exposure to wood smoke.

Overall, 39 percent of the lung cancer cases were associated with wood smoke, while 37 percent were linked to tobacco smoking. The rest could not be clearly tied to either.

An analysis of tumor samples from some patients showed that both wood smoke and tobacco smoke seemed to cause similar molecular changes. Patients in both groups showed, for example, increased activity in the tumor-suppressing p53 gene, the gene that is most commonly mutated in cancer.

"Our findings," Delgado and his colleagues write, "suggest that wood smoke, like tobacco smoke, could be involved in lung cancer (development)."

It's important, they add, to consider wood smoke exposure as a possible risk factor for the disease in non-smokers.

Of the 24 study patients with cancer associated with wood smoke, 22 were women living in rural, impoverished areas.

"In our country, women are exposed to wood smoke for many hours per day," the study authors note. "That could explain the higher incidence of lung cancer associated with wood smoke in women."

Source: Chest, July 2005.

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Many U.S. Newborns Missing Key Tests

 

HealthDay News

Tuesday, July 12, 2005

TUESDAY, July 12 (HealthDay News) -- Dozens of U.S. states now have laws requiring expanded screening for specific disorders in newborns, but most infants in the country still do not receive the full panel of 29 tests recommended by experts, according to a March of Dimes report released Tuesday.

Screening is typically done by testing a few drops of blood taken from a newborn's heel. That blood sample is analyzed for indicators of a variety of disorders, such as metabolic conditions, that can be successfully managed or treated if diagnosed early.

The report said that, as of June 1, 2005, 23 states had initiated newborn screening programs designed to check for more than 20 of the 29 disorders recommended by the American College of Medical Genetics. Those screening programs cover about 38 percent of the approximately 4 million babies born each year in the United States.

Twelve states -- accounting for about 20 percent of babies -- require screening for between 10 and 20 disorders. Another 15 states plus the District of Columbia -- accounting for about 43 percent of U.S. newborns -- require screening for fewer than 10 disorders.

"Parents need to know that the extent of newborn screening for serious and treatable disorders depends entirely on the state in which their baby is born," Dr. Jennifer L. Howse, president of the March of Dimes, said in a prepared statement.

"For infants affected with these conditions, the tests can mean the difference between life and death, or health and lifelong disability," Howse said.

In May of this year, the March of Dimes updated their policy to recommend the 29 tests, instead of the nine they previously recommended.

Last year, the March of Dimes reported that only 21 states mandated the nine recommended screening tests.

More information

You can learn more about newborn screening at the March of Dimes.

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Hormones May Not Stop Menopause Symptoms

 

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, July 12, 2005

Judy Smith says she had five blissful years without hot flashes while participating in a landmark study of hormone supplements. But then she quit taking them after results showed the pills could cause more harm than good.

The symptoms returned for Smith — and many other participants in a new survey, suggesting that the pills might postpone but not prevent menopausal symptoms.

"You can't necessarily expect to just skip that stage" by taking hormones, said Dr. Judith Ockene of the University of Massachusetts Medical School, the survey's lead author.

The survey, which appears in Wednesday's Journal of the American Medical Association, also found that menopause symptoms can last longer than many women thought. More than one-third of women who reported symptoms after stopping the study pills were in their 60s and 70s — at least 10 years older than the average age of menopause.

Researchers conducting the Women's Health Initiative study said in July 2002 that estrogen-progestin pills sold as Prempro could increase risks for heart attacks, breast cancer and strokes.

Hormone supplements once were prescribed for millions of women for menopausal symptom relief and other aging ills. Use plummeted after the Women's Health Initiative released its results.

The long-standing belief has been that symptoms subside a few years after women have their last period and that taking hormones might help women avoid symptoms, although strong scientific evidence about the duration has been lacking, Ockene said.

Researchers, she said, "would have assumed that 5 1/2 years, which is the average length in this study, would have been enough time to see them not return."

Smith, of Fitchburg, Mass., said she started having menopausal symptoms at age 49, with hot flashes so severe that they steamed up car windows. They disappeared during the study.

"Within a month they were back again. Not quite so bad, but I still wake up at night with a good one," Smith, 73, said recently.

The original study involved 16,600 women aged 50 to 79 who were given Prempro or fake pills for up to about eight years. Smith was among 8,405 WHI participants surveyed by mail eight to 10 months after the study was halted.

Overall, 21 percent of Prempro users reported moderate to severe menopause symptoms afterward, compared with about 5 percent of women who'd taken fake pills. Ockene said those results suggest that many women on fake pills might have gone through natural menopause during the study, while for those on Prempro, the pills might have merely postponed the process. Also, not all women experience troublesome symptoms during menopause.

The study doesn't address what happens when women stop taking hormones gradually, and a JAMA editorial says tapering the results might help alleviate symptoms.

Dr. Laura Corio, an obstetrician-gynecologist at New York's Mount Sinai Medical Center, said the study confirms what she sees in patients who stop hormones — but doesn't provide answers for those who want to know how long symptoms will last.

"I wish it was so clear cut. It really isn't," said Corio, who was not involved in the study.

On the Net:

JAMA: http://jama.ama-assn.org

Women's Health Initiative: http://www.nhlbi.nih/gov/whi/

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Cell Phone Use Quadruples Car Crash Risk

 

HealthDay News

Tuesday, July 12, 2005  

 

TUESDAY, July 12 (HealthDay News) -- Drivers distracted by cell phone conversations quadruple their risk of a serious accident, according to new research out of Australia.

The University of Sydney study also found that hands-free mobile phones are no safer than handheld mobile phones while driving.

Researchers analyzed data on 456 drivers who owned or used mobile phones and had been in a traffic crash resulting in injuries requiring hospitalization.

As part of the study, they interviewed the drivers and used phone company records to assess their mobile phone use immediately before the crash and during trips occurring at roughly the same time of day 24 hours, three days, and seven days before the crash. This meant, in effect, that researchers could compare crash risks in the same driver at the same time of day, with the only difference being whether or not they were using their cell phone.

Reporting Tuesday in the online edition of the British Medical Journal, they found that cell phone use occurring in the 10 minutes prior to a crash was linked to a quadrupled risk of having an accident. The researchers also found similar results for the interval of up to five minutes before a crash.

This link between mobile phone use and increased crash risk held true irrespective of driver age, sex, or whether or not he or she was using a hands-free mobile phone, the researchers added in a prepared statement.

More information

The U.S. National Highway Traffic Safety Administration has more about cell phones and driving.

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Job exposure to radiation ups skin cancer risk

 

Reuters Health

Tuesday, July 12, 2005

In a study of radiology technicians, chronic exposure to ionizing radiation, even at low levels, raised the risk of a common type of skin cancer called basal cell carcinoma. The risk was greatest in subjects with lighter compared to darker eye and hair color.

Although ionizing radiation is a known cause of nonmelanoma skin cancer, the risk seen with chronic occupational radiation exposure and the interaction with UV radiation exposure has been unclear.

To investigate, Dr. Shinji Yoshinaga, from the National Institute of Radiological Sciences in Chiba, Japan, and colleagues analyzed data from 65,304 white radiologic technologists in the US who completed surveys in 1983 to 1989 and in 1994 to 1998.

The first survey included a variety of demographic, health, and work-related questions, while the second focused largely on cancer and related risk factors.

A total of 1355 cases of basal cell carcinoma and 270 cases of squamous cell carcinoma, another type of skin cancer, were observed in the study group.

Long-term exposure to ionizing radiation appeared to raise the risk of basal cell, but not squamous cell, carcinoma, according to a report in the International Journal of Cancer.

The effects were most pronounced for people who began working during the 1950s and earlier, a period when radiation exposure levels were relatively high.

Compared with technicians who started working after 1960, those who began in the 1940s were about two times more likely to develop basal cell skin cancer. Technicians who began working in the 1950s were roughly 1.4 times more likely to develop basal cell cancer.

"Our study...provided indirect evidence of an increased risk of basal cell carcinoma associated with chronic occupational exposure to ionizing radiation at low to moderate doses," the authors state.

 

Source: International Journal of Cancer, July 10, 2005.

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Weight-Loss Surgeries Skyrocketing

By Amanda Gardner
HealthDay Reporter

HealthDay News

Tuesday, July 12, 2005 

TUESDAY, July 12 (HealthDay News) -- The number of Americans who had weight-loss surgery quadrupled between 1998 and 2002, new research shows.

Not surprisingly, the total price tag for the procedures also climbed, according to the government study, which appears in the July 12 issue of Health Affairs. During the same period, hospital costs swelled more than six-fold, going from $157 million a year to $948 million a year. The average cost per surgery rose by about 13 percent, from $11,705 to $13,215.

Those costs are likely to go even higher. Although 71,733 surgeries were performed in 2002, compared to 13,386 in 1998, only 0.6 percent of about 11.5 million morbidly obese individuals who could have been candidates for the procedure actually had it.

"There's no question that it's on the rise," said Dr. Shawn Garber, chief of bariatric surgery at Mercy Medical Center in Rockville Centre, in New York. "The incidence of obesity is on the rise, which is a good part of it. This, combined with public awareness from different celebrities such as Al Roker, has brought more attention to the surgery."

Also, more procedures are being performed via laproscopy, with smaller incisions and quicker recovery, making them more appealing to patients.

The current obesity epidemic has left almost one-third of the U.S. population obese (with a body mass index or BMI of 30 or greater), and close to 5 percent are morbidly obese (with a BMI of 40 or higher).

According to the study, to be considered eligible for weight-loss (bariatric) surgery, an individual must have a BMI greater than 40 or greater than 35 with attendant complications such as type 2 diabetes. About 395,000 Americans aged 65 to 69 will be medically eligible for the surgery this year, a number that could increase to 475,000 in 2010.

There are two main types of bariatric surgery: to reduce the size of the stomach and/or to bypass part of the intestines. Many patients are also opting for weight-loss drugs, but this usually results in fewer pounds shed.

Studies of people who have had surgery for obesity, on the other hand, found that, with gastric bypass, patients lost 61.6 percent to 70.1 percent of their excess weight. As a result, 76.8 percent of individuals saw their diabetes disappear.

"It's good that we have this option because right now there really aren't other options," Garber said. "The success rate for medical programs is 5 percent, and there are no good drugs on the market. These people are suffering from medical problems like diabetes and sleep apnea, and they need to do something."

"Obviously, we want to have people not becoming obese," added study co-author Dr. Claudia Steiner, a senior research physician at the Agency for Healthcare Research and Quality (AHRQ). "But this particular intervention has been shown to work."

The current study, which provides the first national estimates on this subject, was based on data from the Nationwide Inpatient Sample, which draws information from 37 states.

Much of the overall increase in bariatric surgery was attributable to a 900 percent rise in operations in people aged 55 to 64. This group accounted for 11 percent of all weight-loss surgeries in 2002. Patients 18 to 55 years old accounted for 88 percent. Adolescents and the elderly made up the rest, according to the study.

Roux-en-Y gastric bypass operations, which reduce the size of the stomach while also bypassing part of the intestines, accounted for about 85 percent of weight-loss procedures. Women accounted for 84 percent of all surgeries in 2002, the study found.

The largest increase in average cost was seen in surgeries covered by Medicaid: an increase of 17.7 percent despite declining hospital days. The escalating costs are clearly a concern for Medicaid and for private insurers, which cover 83 percent to 84 percent of the people who opt for this type of surgery, Steiner said.

The alternative, however, is equally grim.

"Obesity is associated with other health conditions such as diabetes and hypertension, and those chronic conditions clearly increase the risk of cardiovascular disease and early death," Steiner said.

While increasing costs in bariatric surgery seem driven by the fact that more people are having the procedure, that is not the case in the rest of the health-care arena.

Another study in the same issue of Health Affairs found that higher prices for prescription drugs, hospital stays, doctor visits and other health services were pushing up costs, not malpractice claims or greater access to health-care services.

According to the study, health spending accounted for 14.6 percent of the U.S. gross domestic product (GDP) in 2002. That year, only Switzerland and Germany spent more than 10 percent of their GDP on health care.

The AHRQ also reported in its latest Medical Expenditure Panel Survey that Americans spent nearly $151 billion in 2002 on outpatient prescription drugs alone, roughly 2.5 times more than the $65 billion spent in 1996. Here were the top 10 drugs, ranked by expense:

Lipitor: $5.9 billion Zocor: $4.4 billion Prevacid: $3 billion Prilosec: $2.6 billion Celebrex: $2.4 billion Paxil: $2.2 billion Pravachol: $2.1 billion Zoloft: $2.1 billion Claritin: $2.1 billion Norvasc: $2.1 billion

More information

The National Institute of Diabetes and Digestive and Kidney Diseases has more on surgery for obesity.

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Health Tip: Recognizing Depression in Teens

 

HealthDay News

Tuesday, July 12, 2005

(HealthDayNews) -- Teens are renowned for their mood swings. But how do you know if your child is just feeling low or if he or she is clinically depressed?

If your child has five or more of the following symptoms for several weeks, the Children's Hospital of Philadelphia suggests you ask the child's doctor for advice:

Your child may:

Act sad all day. Talk about suicide or give away personal items. Act angry or irritable without obvious causes. Describe feelings of worthlessness like, "no one cares about me." Blame herself when things don't work out. Lack mental or physical energy. Not enjoy her usual activities. Sleep a lot, but have trouble getting to sleep or waking up. Have trouble concentrating, making decisions, and remembering things. Have problems with friends or in school. Use alcohol or drugs. Prefer to be alone.


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Brain Region May Govern Resilience to Trauma

 

By Amanda Gardner
HealthDay Reporter

HealthDay News

Tuesday, July 12, 2005

 

TUESDAY, July 12 (HealthDay News) -- It may not be thick skin that protects you from emotional pain, but a thick brain.

Scientists have discovered that variations in the size of an area of the brain called the ventromedial prefrontal cortex may explain why some people recover from trauma better than others. Specifically, people with a thicker ventromedial prefrontal cortex (vmPFC) exhibited better ability to inhibit fear.

The research, which appears in this week's issue of the Proceedings of the National Academy of Sciences, may be an important clue in the age-old mystery of why some people react severely and continuously to emotional trauma while others don't.

There may be numerous clinical implications to the research, the study authors said.

"One would be the idea that perhaps people with a thinner cortex in this area might be at greater vulnerability for developing anxiety disorders, but that's still a speculation," said senior study author Dr. Scott Rauch, director of the Psychiatric Neuroscience Research Division at Massachusetts General Hospital, in Boston. "This could also be a potential predictor of responses to [certain types of] behavior therapy."

Some people associate certain cues with traumatic memories so that, when they are exposed to the cue, the memory comes flooding back. In other words, certain sounds or sights trigger a recall of the previous, traumatic experience. The most obvious example of this is post traumatic stress disorder (PTSD).

For most people, this sensitivity diminishes over time and the fearful response goes away, something called "extinction memory."

For others, however, the fear persists.

Earlier animal and other studies had indicated that the vmPFC, on the lower surface of the brain, might be involved in this process.

To see if individual differences in fear extinction correlated to vmPFC size, the study authors recruited 14 healthy volunteers. On the first day, each person was given photos to look at, and then an electric shock. Then they viewed the photos without the shock.

The next day, the volunteers looked at the same photos while researchers monitored changes in electrical activity in the skin -- an indication of anxiety level. The participants then underwent brain scans with structural magnetic resonance imaging.

Those who had smaller skin responses -- in other words, less anxiety -- also had a thicker vmPFC, the researchers said.

"This was the only region in the brain that showed the significant relationship to extinction memory," said study author Mohammed Milad, a research fellow in the department of psychiatry at Massachusetts General Hospital.

Although the finding is an important one, many questions remain, said Paul Sanberg, director of the University of South Florida Center for Aging and Brain Repair, in Tampa.

For instance, do some people just have a thicker vmPFC and, therefore, a better ability to recover from trauma, or is the ability to cope with stress acquired? Some studies have shown the brains of people and animals tend to get bigger in a mentally stimulating environment, Sanberg said.

It's also not clear what mechanisms are at work in that region of the brain, Sanberg said. "Is it more neurons or more glial cells, is it connections, or is it the neurochemistry?" he asked.

Rauch said, "The most obvious connection [of the research] would probably be to PTSD, but we believe it certainly has implications for panic disorder and potentially for other anxiety disorders such as phobias."

The research may have broader implications for treatment, he added. "All of those anxiety disorders are responsive to extinction-based behavior therapy," Rauch said.

Dr. Rodrigo Kuljis is a professor of neurology and psychiatry at the University of Miami School of Medicine. He said the new research "is interesting. It tends to support the feeling that certain aspects of memory are mediated by certain parts of the brain. It could be used eventually as a measure to determine if someone is more susceptible to certain conditions and also to predict treatment."

The real question, Kuljis said, is whether the new findings can be corroborated. "It's very sophisticated imaging but the bottom line is you are measuring something [the vmPFC] that is around a centimeter thick at best, probably thinner," he said. "The resolution of the instrument is marginal, but it's the best we have. The margin of error is enormous."

More information

To learn more about post-traumatic stress disorder, visit the National Center for PTSD.

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Ex-tiny babies at risk for reduced fitness levels  

By Megan Rauscher

Reuters Health

Tuesday, July 12, 2005

 When infants born prematurely at extremely low birth weight (ELBW) and term-born normal-weight infants reach late adolescence, they show significant differences in aerobic fitness, strength, endurance, flexibility, and activity level, a Canadian study shows.

ELBW teens have lower aerobic capacity, grip strength, leg power, and vertical jump ability, compared with term-born teens, researchers report in the journal Pediatrics.

ELBW teens can't do as many push-ups as term-born teens and they have less abdominal strength, lower back flexibility and tighter hamstrings, according to the study in which investigators assessed motor performance at 17 years of age in 53 ELBW survivors born weighing 800 grams or less and in 31 term-born controls.

In addition, the study team found that ELBW teens are less likely to participate in sports, have lower physical activity levels, and poorer coordination than term-born teens.

"It is not clear whether these differences are due to intrinsic effects of prematurity, or are at least partly due to the particularly inactive lifestyle chosen by ex-tiny babies in adolescence," Dr. Michael F. Whitfield from the University of British Columbia in Vancouver told Reuters Health.

These findings have potential implications for later adult health problems, the researchers warn.

"Inactivity in children and teens, coupled with excessive food intake, is of course thought to be the cause of the current epidemic of childhood obesity, and appearance of type 2 diabetes in childhood," Whitfield commented.

"Furthermore, the choice of a particularly inactive lifestyle by ex-tiny baby teens is of further concern, as low birthweight has been coupled to early onset of the adult metabolic syndrome (obesity, type 2 diabetes, hypertension, stroke, and heart attack)," he added.

"Finding effective ways to encourage ex-premature babies to participate regularly in noncompetitive physical activity as part of their lifestyle may be very important in relation to their long-term health in adulthood," Whitfield said

Source: Pediatrics July, 2005.

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Men at Much Higher Eye Injury Risk

 

HealthDay News

Tuesday, July 12, 2005

TUESDAY, July 12 (HealthDay News) -- Men are twice as likely to suffer eye injury as women, a new study finds.

Researchers analyzed data for 2001 on eye injuries treated in U.S. hospital emergency departments, inpatient and outpatient facilities, and doctors' offices.

Reporting in the July issue of the Archives of Ophthalmology, they found that in 2001, about 1,990,872 people -- close to seven per every 1,000 -- suffered an eye injury. Of those injuries, nearly 51 percent were treated in emergency departments, about 39 percent were treated in doctors' offices, 8 percent in outpatient facilities, and 2.5 percent in inpatient facilities.

Men suffered more than twice as many eye injuries as women (9.5 per 1,000 vs. 4.5 per 1,000), the University of Alabama at Birmingham team reported. White males in their 20s had the highest rate of eye trauma -- more than 20 per 1,000.

Contusions, foreign bodies, superficial injuries and open wounds accounted for the majority of these injuries.

"Future research should focus on a more detailed documentation of the causes of eye injuries, as well as long-term functional outcomes," the researchers added.

More information

Prevent Blindness America offers this home eye safety checklist.

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Health Tip: Diabetics Who Travel

 

HealthDay News

Tuesday, July 12, 2005  

(HealthDayNews) -- If you have diabetes and are planning a vacation, advance preparation can help things run smoothly, despite the change in routine.

Bristol Hospital Wellness Center offers these travel tips:

Check the timing of your medications and meals. Delayed meals or changes in the amount of food you eat can trigger blood sugar problems. Always carry food, water and glucose tablets with you. Trains and buses can get delayed, so don't forget your glucometer and any medications you may need. If you take insulin and are crossing more than two time zones, speak with your doctor about possible dosage adjustments. Try to walk as much as possible, and carry glucose tablets or snacks in case the walk becomes extended. When dining in restaurants, avoid fried foods, heavy sauces, gravies and desserts.

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Teen IQ, activity tied to later dementia risk

By Michelle Rizzo

Reuters Health

Tuesday, July 12, 2005

 A high IQ in adolescence and greater participation in various extracurricular activities may decrease a person's chances of developing dementia later in life, according to a study in the current Journal of the American Geriatrics Society.

The study found that persons who were more active in high school and who had higher IQ scores were less likely to have mild memory and thinking problems when they got older. Conversely, those who were lower on the IQ continuum and who participated in fewer activities in high school had a higher risk of cognitive decline.

Dementia refers broadly to neurological conditions that cause decline in memory and thinking abilities (cognition) and the ability to perform activities of daily living. Alzheimer's disease is the most common cause of dementia in persons 65 years of age or older. It's been estimated that 4.5 million people in the U.S. have the Alzheimer's disease.

The new findings "add to a growing body of knowledge that dementias, such as Alzheimer's disease, may have a very long-term course, perhaps starting decades before clinical symptoms emerge," said study author Dr. Thomas Fritsch, of Case Western Reserve University in Cleveland, Ohio.

"They also indicate that the risk for dementia late in life may be decreased by maintaining an active lifestyle as a teenager," he added. "However, this conclusion is based on only one study and must be confirmed in other research."

He and colleagues studied 396 volunteers (mean age 75 years) who had all graduated from the same high school in the mid-1940s. With the participants' permission, student records were used to obtain adolescent IQ scores and activity levels were determined from yearbooks.

Adult cognitive status was determined through telephone screening. In cases in which cognitive impairment was indicated, a proxy respondent was interviewed.

The researchers observed a significant independent link between high adolescent IQ and a lower risk for dementia/mild cognitive impairment, even after adjusting for sex and education level.

Greater activity levels in youth were also independently associated with a reduced risk of dementia/mild cognitive impairment.

Fritsch emphasized, however, that while this research implicates a role for IQ and activity level in youth with later dementia risk, "many other factors, alone or in combination, also influence who will and will not develop dementia."

Source: Journal of the American Geriatrics Society July 2005.

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Vaccination Tames Hepatitis A Infection

By Serena Gordon
HealthDay Reporter

HealthDay News

Tuesday, July 12, 2005

TUESDAY, July 12 (HealthDay News) -- Vaccinating children, especially young ones, can dramatically decrease the incidence of hepatitis A infections.

Two new studies -- one from Israel, the other from the United States -- found that childhood vaccination programs could reduce the incidence of disease by as much as 98 percent.

"Hepatitis A disease can be rapidly controlled by vaccination," said Dr. Ron Dagan, one of the Israeli study's authors and director of the pediatric infectious disease unit at Soroka Medical Center at Ben Gurion University in Beer-Sheva, Israel.

"By vaccinating kids, we've dropped the incidence from 10 per 100,000 to two per 100,000, which is a remarkable achievement," said Annemarie Wasley, an author of the U.S. study and an epidemiologist in the division of viral hepatitis at the CDC.

Results of both studies appear in the July 13 issue of the Journal of the American Medical Association.

Hepatitis A is a viral infection that generally causes flu-like symptoms, but can also cause the liver disease jaundice. The infection usually clears up without treatment in three months or less. Unlike other forms of hepatitis, such as hepatitis B or hepatitis C, hepatitis A does not turn into a chronic illness. It is transmitted through contaminated food or water, or from the stool of someone who currently has the infection, according to the National Institutes of Health.

An estimated 270,000 Americans contracted hepatitis A annually during the 1980s and 1990s, according to background information in Wasley's study. In 1995, effective vaccines for the disease became available, and the CDC initially recommended vaccination only for people in high-risk groups, such as drug users, gay men and people traveling to areas where hepatitis A outbreaks are common. In 1999, those recommendations were expanded to include children living in U.S. states with high rates of infection.

Wasley's study was designed to assess the impact of that change. She and her colleagues compared surveillance information from 2003 to data gathered before an effective vaccine was available in the early to mid-1990s.

They found that across the United States, the overall rate of hepatitis A declined 76 percent by 2003. In children aged 2 to 18, that decline was 87 percent, while adults saw an overall decline of 69 percent.

In states with previously high levels of infection, and higher vaccination rates in 2003, the rate plummeted 88 percent, according to the study.

In the Israeli study, researchers compared data on hepatitis A incidence before vaccination with data gathered after Israel began a universal vaccination program for toddlers in 1999.

"Israel was considered until 1999 to be a country with endemic hepatitis A disease, with disease rates exceeding that of the U.S. several-fold, approximately five to six times," Dagan said.

"Shortly after introduction of the vaccine, the disease rates started to drop and within less than three years, a dramatic decrease of greater than 95 percent was seen in the overall disease rate, which has been sustained for three successive years now. The rate is now lower than the mean disease rate in the U.S.," Dagan added.

In both studies, those vaccinated weren't the only ones who benefited. Young children infected with the disease often don't show symptoms but can still infect others, making them a common source of infection, according to the studies.

"Because the motor of such an epidemic was targeted [with vaccination], other cohorts are no longer exposed to the virus. Targeting one cohort appears then to have a population effect, called herd immunity," explained Dr. Pierre Van Damme, author of an accompanying editorial in the same issue of the journal and a professor of social medicine at the University of Antwerp, in Belgium.

All three experts pointed out that there is a natural five- to 10-year cycle of hepatitis A infections, and it's possible that some of the decline seen was simply part of the natural cycle. However, they believe the vaccination programs are responsible for the bulk of the decline.

Besides vaccination, Van Damme said that simple measures, such as washing your hands before eating and after going to the bathroom, can also help prevent the spread of hepatitis A.

More information

To learn more about hepatitis A, visit the CDC.

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Monday, July 11, 2005

 

Genes Take Some Blame for Poor Cholesterol

 

HealthDay News

Monday, July 11, 2005

MONDAY, July 11 (HealthDay News) -- Blood levels of "bad" low-density-lipoprotein (LDL) cholesterol vary widely between individuals, and the blame for at least part of that variance may lie in genetics, researchers report.

"Our experiment shows how important our genes are. Some people have to be careful about their diets, while others have much more freedom in their dietary choices," researcher Paul Williams, of the U.S. Department of Energy's Lawrence Berkeley National Laboratory, said in a prepared statement.

His team studied the response of 28 pairs of identical male twins to diets either high or low in fat. In each pair of twins, one brother was an avid exerciser while the other was a "couch potato."

"Although identical twins share exactly the same genes, we chose these twins because they had very different lifestyles," Williams said.

For the first six weeks, the twins ate either a low-fat diet (20 percent of calories from fat) or a high-fat diet (40 percent of calories from fat). They then switched diets for the final six weeks of the study. The twins' blood cholesterol levels were checked after each six-week period.

The study found a strong similarity in the way each pair of twins responded to the diets, regardless of whether they exercised or not.

"If one of the twins could eat a high-fat diet without increasing his bad cholesterol, then so could his brother. But if one of the twins' LDL cholesterol shot up when they went on the high-fat diet, his brother's did, too," Williams said.

The study wasn't able to identify exactly what genes are responsible for a good or poor LDL response to specific diets, the researchers pointed out. Instead, "this type of experiment allows us to test whether genes are important without having to identify the specific genes involved," Williams said.

The study appears in the July 8 issue of the American Journal of Clinical Nutrition.

More information

The American Heart Association has more about cholesterol.

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Breast cancer outcome similar in women and men

By David Douglas

Reuters Health

Monday, July 11, 2005

A study shows that men with breast cancer are not at increased risk for relapse after mastectomy compared to women with breast cancer and therefore should be treated using the same guidelines as women.

Yes, men do develop breast cancer, but it is fairly rare. In most countries, about 1 of every 100 cases of breast cancer occur in men.

In women with breast cancer, post-mastectomy radiation is guided by specific indications such as tumor size. But in men with breast cancer, radiation is routinely given after mastectomy because the smaller male breast makes it harder for surgeons to leave a clear margin of healthy tissue when they remove the cancer, so men are thought to be at increased risk for cancer recurrence in the breast area.

The outcome of the current study "challenges the idea that males with breast cancer should be treated with more aggressive local therapy purely on the basis of sex," Dr. Graham Macdonald told Reuters Health.

Macdonald, from the Aberdeen Royal Infirmary, UK, and Canadian colleagues, examined data on 4181 women and 60 men with invasive breast cancer who had undergone total mastectomy as primary therapy.

Men were almost 6 times more likely than women to have radiotherapy after mastectomy, even when other "confounding" factors were accounted for, the authors report in the Annals of Oncology, a medical journal.

Of note, gender was not a prognostic factor for recurrence, breast-cancer specific survival or overall survival. Local recurrence was significantly associated with tumor size and grade, involvement of the lymph nodes and the presence of vascular space invasion.

These findings, Macdonald concluded, should "reassure physicians involved in breast cancer care that the indications for post-mastectomy radiotherapy should be the same for males and females."

Source: Annals of Oncology June 22, 2005.

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Dangerous Aortic Ruptures Often Misdiagnosed

 

HealthDay News

Monday, July 11, 2005

MONDAY, July 11 (HealthDay News) -- About 15,000 Americans die each year from aortic disease, when an aneurysm or tear in the aorta causes sudden death. The condition -- which killed actor John Ritter in 2003 -- is tricky to diagnose, a new study finds.

Compared with events such as heart attack or stroke, "the difficulty [with aortic disease] is that it is an infrequent disease, it's not a common problem," lead researcher Dr. Tomas Martin, a University of Florida associate professor of thoracic and cardiovascular surgery, said in a prepared statement.

In the study, surgeons at Gainesville who specialize in aortic disease analyzed the medical charts of 100 patients with suspected aortic ailments who transferred to the university's medical center. The surgeons discovered that about 25 percent of the patients had initially been misdiagnosed, resulting in delayed treatment for some, and unnecessary surgery for others.

The results also suggest that many doctors who do not routinely treat aortic disease have difficulty distinguishing between the two most common culprits -- aortic dissection and aortic aneurysm. A dissection is a sudden tear in the arterial wall, while an aneurysm is a bulge in the aorta that can rupture.

A variance in diagnosis can mean the difference between emergency surgery and medical treatment, noted study author Dr. Thomas Beaver, assistant professor of cardiovascular and thoracic surgery.

"When you start talking about doing major thoracic aortic surgery on somebody, you really want to be sure what you're doing and where it started. For people who aren't familiar with it, it can be more challenging. There are subtle nuances," Beaver said in a prepared statement.

More continuing education for practicing physicians and increased education in medical schools could improve doctors' ability to diagnose aortic disease, Beaver and his colleagues said.

The study appears in the current issue of the Annals of Thoracic Surgery.

More information

The Society of Thoracic Surgeons has more about aortic aneurysms.

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Technology Makes Home Dialysis Possible

 

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, July 11, 2005

When Karen Everts wants to go camping, kidney failure no longer slows her down: She simply rolls the first portable hemodialysis machine out of her kitchen and into her motor home, ready to hook up for two hours each morning.

Most of the 400,000 Americans with failed kidneys stay alive by getting their blood cleaned at dialysis centers three times a week. Everts is at the forefront of a movement to get more of them treated at home — not just for convenience, but so they can undergo dialysis every day.

The argument: Healthy people's kidneys work daily so why provide dialysis less often? Indeed, growing research, albeit preliminary, suggests daily hemodialysis may keep patients healthier. The National Institutes of Health is set to begin a major study this fall to try to settle the issue.

But some frustrated kidney specialists aren't waiting. They say new technology — including the first hemodialysis machine the size of a suitcase instead of a refrigerator — makes daily at-home dialysis possible for a growing number of patients.

"Anybody who takes care of dialysis patients isn't happy with what we do," says Dr. Michael Kraus, dialysis chief at Indiana University School of Medicine, citing high rates of illness and death with today's thrice-a-week approach.

So far, he's converted 20 percent of his patients to home dialysis and says, "Their quality of life is so much better."

Kaiser Permanente in Southern California just began a new program to spur home dialysis. The mantra: "When you start dialysis, you do it at home," says kidney chief Dr. Peter Crooks.

Medicare pays for dialysis regardless of patient age, reimbursing the same amount for at-home or dialysis center care. But Crooks cites Kaiser statistics that home dialysis users require less hospitalization, potentially saving $10,000 to $20,000 in annual health care costs per patient.

There are two types of dialysis:

·        Peritoneal dialysis — using the lining of the patient's abdomen to filter out waste — has long offered an at-home option, but drawbacks have limited its use to about 10 percent of patients. Several times a day, patients pour a sugar-based cleansing solution into a tube surgically implanted into their abdomen, and later drain out the waste-filled solution. They perform the procedure several times a day, with the solution in their abdomen for four to six hours at a time, or a machine does it while they sleep.

It's a good option for select patients, says NIH kidney chief Dr. Josephine Briggs, and Kaiser's Crooks hopes to double usage, to about 20 percent of his patients.

But abdominal infections are a risk, and infections, abdominal surgery or degree of disease can rule out its use.

_Hemodialysis — where patients' blood flows through a machine that filters out waste — is getting the new at-home attention.

About 20 percent of hemodialysis patients a year die, and blood pressure problems and other complications are common. Moreover, patients spend four hours a day, three days a week, hooked to a large machine in crowded dialysis centers.

The hope is that more frequent home dialysis could improve all that. The logjam was creating dialysis machines that fit into most homes and use standard water and electrical supplies.

Now the Food and Drug Administration has cleared two machines for daily home use. Illinois-based Aksys Ltd.'s PHD System is still big — 300 pounds — but automatically performs much of the required cleaning. The newest, cleared last month, is NxStage Medical's portable System One, which weighs just 70 pounds. And study of a third machine for home use is to begin next month, maker Renal Solutions Inc. said Monday.

Everts, of Fillmore, Ind., once had to leave home at 5 a.m. for dialysis center treatments that left her so fatigued she'd spend the next day in bed. Then Everts, 56, began a study of the NxStage machine last year — and with two hours a day dialyzing at home, she has enough energy to go square dancing and no longer needs blood pressure medicine.

She's still awaiting a kidney transplant but says, "If I never got the transplant, I could live with this."

Dialysis' first hour clears the most toxins, says NIH's Briggs, so short, frequent dialysis makes sense. But small studies performed so far have included highly motivated patients that may skew results. The NIH's study will compare two-hour daily dialysis and a slower while-you-sleep version with traditional dialysis, to try to prove benefits.

At-home dialysis isn't for everyone. A spouse or other helper is required in case of problems, and patients must be able to stick themselves with the needles. Nor is it yet easy to find. Patients should ask if nephrologists are open to home training, says Indiana University's Kraus.

Editor's Note: Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

On the Net:

NIH dialysis info: http://www.niddk.nih.gov

NxStage: http://www.nxstage.com

Aksys: http://www.aksys.com

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Health Tip: Recognizing Illness in Newborns

 

HealthDay News

Monday, July 11, 2005

(HealthDayNews) -- Newborns are susceptible to infections, especially during the first seven days of life.

Symptoms of illness can include vomiting, diarrhea, and cough. However, sometimes the signs are more subtle, says the San Diego Children's Hospital. For instance, your baby may be:

Sleeping excessively. Exhibiting a sudden change in feeding behavior. Unable to sustain sucking or nursing. Sweating during feedings. Moving around less.

If you suspect that your infant's appearance or behavior has become abnormal, call your doctor immediately.

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Diet pills hard on the heart

 

Reuters Health

Monday, July 11, 2005

Supplements that contain ephedra and caffeine-rich guarana, which may be used for weight loss, result in significant cardiovascular and metabolic changes, investigators have found. These changes could be harmful in people with high blood pressure, atherosclerosis (clogged arteries), or glucose intolerance, a precursor to diabetes marked by elevated blood sugar. All of these conditions are strongly associated with obesity.

Even though the US Food and Drug Administration banned ephedra as a dietary supplement for weight loss, it is still obtainable as a traditional Chinese medicine, ma huang, the authors note in the journal Clinical Pharmacology and Therapeutics. Synthetic ephedrine is also available in convenience stores and over the Internet. Guarana is an herb containing caffeine.

Dr. Christine A. Haller and her colleagues at the University of California, San Francisco tested the effects of Xenadrine RFA (a multi-component supplement containing 25.4 mg ephedra alkaloids and 185 mg caffeine) and ephedra extract (23.2 mg total ephedra alkaloids) plus guarana (167 mg caffeine), compared with placebo, in 16 healthy adults.

They report that repeated dosing of ephedra and guarana produced elevated ephedrine blood concentrations, increased heart rate and blood pressure, and had unfavorable effects on glucose and potassium homeostasis.

These effects could exacerbate obesity-related conditions such as insulin resistance and metabolic syndrome, the authors note.

This study, they conclude, provides further evidence that dietary supplements containing ephedra and guarana or like-compounds could have unfavorable cardiovascular effects, especially in susceptible individuals such as those with high blood pressure, glucose intolerance or hardening of the arteries.

 

Source: Clinical Pharmacology and Therapeutics June 2005.


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Health Tip: Fighting Foot Odor

 

HealthDay News

Monday, July 11, 2005

(HealthDayNews) -- Are you plagued by smelly feet?

Try reducing their pungent odor with these tips from the Mayo Clinic:

After you bathe, dry your feet thoroughly. Wear shoes made of natural materials, such as leather. This allows your feet to breathe. Wear cotton or wool socks, which will help keep your feet dry. Avoid wearing the same pair of shoes two days in a row. If your feet sweat a lot, your shoes need time to dry. Change your socks once or twice a day. Air your feet by going barefoot whenever convenient.


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Study: Walking on Cobblestones Is Healthy

 

By William McCall

Associated Press Writer

The Associated Press

Monday, July 11, 2005

The path to better health and lower blood pressure may be paved with cobblestones. When people over 60 walked on smooth, rounded cobblestones for just a half-hour a day over four months, they significantly lowered their blood pressure and improved their balance, a study showed.

Behavioral researchers from the Oregon Research Institute investigated the health effects of cobblestones after observing people exercising and walking back and forth over traditional stone paths in China.

"We noticed in several cities we visited that people were walking on cobblestone paths, and people were standing on them, and sometimes dancing on them, doing weight-shifting," said John Fisher, who led the study at the institute in Eugene.

"We thought if we could scientifically measure it, we could see if there were health benefits," he said.

The results surprised Fisher and his fellow researchers, who expected to see some general improvement in health but also saw blood pressure drop measurably among the volunteers during the 16-week study.

"It's very provocative," said Dr. David Ellison, the chief hypertension expert at Oregon Health & Science University in Portland.

"If they had done it over two years and lost 10 pounds I might be less surprised," Ellison said. "To do it that quickly — it's certainly dramatic."

The researchers in Eugene simulated the rounded, river rock cobblestones with a specially designed mat that was 6 feet long and 1 1/2 feet wide. Some of the test subjects walked in their bare feet, others wore socks.

They were compared with a control group who simply walked for an hour, three times per week. The results were published recently in the Journal of the American Geriatrics Society.

Nearly all the 108 volunteers in the study said they felt better after the exercise. But only the half who walked the cobblestones showed significant improvement in balance, measures of mobility and blood pressure, Fisher said.

He said the cobblestone walking paths are common in China, where traditional medicine teaches that the uneven surface of the stones stimulate "acupoints" on the soles of the feet. The theory is much like acupuncture, suggesting that distant and unrelated areas of the body are linked together at certain points and can be stimulated to improve physical and mental health.

Although cobblestone-walking is rooted in centuries of Chinese tradition, no controlled scientific studies had been done to evaluate its potential benefits and effectiveness until recently, Fisher noted.

Fay Horak, an Oregon Health & Science University neurophysiologist who specializes in balance, said the study is evidence that finding ways to maintain mobility and balance can delay and even prevent the effects of aging.

"I'm not surprised that working on balance improved balance," Horak said. "There's a lot of evidence that shows no matter who you are, it improves if you challenge it."

The body relies on two complex methods to maintain balance — the vestibular system in the inner ear and the somatosensory system that connects skin and muscles, Horak said.

Normally, people depend on the somatosensory system for about 70 percent of their balance control, and 30 percent on the inner ear.

But when the surface is uneven or unstable, the body switches reliance to the vestibular system and relies on it for about 70 percent of balance control, Horak said.

"It could be very helpful for people who are older because it's common as we age to lose receptors in the vestibular system," she said. "But by challenging people with an unstable surface, they use the remaining vestibular system and probably improve its function."

Ellison, the hypertension expert, said he would like to see a larger study to compare results but called the initial findings were promising.

"It certainly suggests there is something real about the cobblestones," Ellison said.

On the Net:

Oregon Research Institute: http://www.ori.org

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Fit heart curbs risk of 'metabolic syndrome'

 

Reuters Health

Monday, July 11, 2005

A person's cardiorespiratory fitness is a strong predictor of their risk of developing metabolic syndrome -- a cluster of heart disease and diabetes risk factors including excess body weight, high blood pressure, high cholesterol, and high blood sugar.

"Our data suggest higher fitness levels provide protection against metabolic syndrome even in individuals with increased susceptibility because of existing metabolic risk factors," lead author Dr. Michael J. LaMonte, from The Cooper Institute in Dallas, said in a statement.

The findings, reported in the Circulation: Journal of the American Heart Association, are based on a study of 10,498 subjects who had their cardiovascular fitness level determined at baseline and were then followed for around 5 years to assess the occurrence of metabolic syndrome.

In both sexes, the risk of metabolic syndrome fell with increasing level of cardiorespiratory fitness, as measured by walking on a treadmill.

For men, the risk of metabolic syndrome was 26 percent lower for those who were moderately fit and 53 percent lower for those who were highly fit, compared to those who were less fit.

For women, the risk of metabolic syndrome was 20 percent lower for those who were moderately fit and 63 percent lower for those who were highly fit, compared to those who were less fit.

The protective effect of increased cardiorespiratory fitness was observed in men and women and remained significant even after the researchers adjusted for features of the metabolic syndrome that were present at the start of the study.

Increasing physical activity may help prevent the metabolic syndrome, especially in adults who have already begun to show signs of the disorder, the researchers conclude.

Studies have shown that most individuals can achieve moderate levels of cardiorespiratory fitness through 30 to 40 minutes of brisk walking about 5 days per week. The highest level of fitness is likely to be achieved through vigorous jogging, running, biking, or swimming for 20 to 30 minutes per day about 3 to 5 days per week.

Source: Circulation July 26, 2005.

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Diabetes Spurred By Adult Lifestyles
 

HealthDay News

Monday, July 11, 2005

MONDAY, July 11 (HealthDay News) -- Adult behaviors have more influence on type 2 diabetes risk than childhood risk factors such as birth weight and nutrition, according to a British study.

The findings run counter to long-held beliefs that fetal development predisposes individuals to diabetes in later life.

Researchers at the University of Newcastle upon Tyne examined long-term data on 412 women and men, and concluded that overweight and obese adults were more likely to have increased insulin resistance, a risk marker for type 2 diabetes. The data came from the Thousand Families Study, which has tracked the health of individuals born in Newcastle in 1947 throughout their lives.

Childhood factors -- which were previously believed to have a significant effect on diabetes risk -- were found to have only a limited impact, the researchers report in the current issue of Diabetes/Metabolism Research and Reviews.

"Previous studies have suggested that the risk of poor health in later life is programmed by impaired development in the womb, and that poor growth in fetal and infant life is associated with impaired insulin secretion and sensitivity," study leader Dr. Mark Pearce, of Newcastle University's School of Clinical Medical Sciences, said in a prepared statement. "However, not all of these studies have had access to complete data on late life."

"Our study, which has examined people from birth to adulthood, suggests that the life you lead as an adult has the biggest influence on your health, in terms of diabetes risk, in later life," Pearce said.

More information

The American Diabetes Association offers this diabetes risk test.

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Lorenzo's Oil prevents rare disease in boys -study

 

Reuters

Monday, July 11, 2005

A treatment called Lorenzo's Oil can prevent the onset of a rare but devastating neurological disease in young boys, U.S. researchers reported on Monday.

The study is the first to use validated scientific methods to test whether the substance, a combination of two fats extracted from olive oil and canola or rapeseed oil, actually works, the researchers said.

They tested the oil on 89 boys who had been diagnosed with X-linked adrenoleukodystrophy or X-ALD, but who had not yet begun to show symptoms.

Writing in the Archives of Neurology, Dr. Hugo Moser of the Kennedy Krieger Institute in Baltimore and colleagues said it prevented symptoms from ever beginning in most of the boys.

"This clinical study clearly demonstrates that the use of Lorenzo's Oil can prevent the onset of the rapidly progressive and devastating form of the brain disease that affects 50 percent of boys with X-ALD," Moser said in a statement.

His team tested 89 boys age 7 or younger who had an abnormal gene that identifies X-ALD.

For seven years the boys got daily oral doses of the substance, the basis for the 1992 movie "Lorenzo's Oil," and moderated what kinds of fat they ate.

Subsequently, 74 percent of the boys showed no signs of disease progression, the researchers found.

"The results of this trial offer clinical support for treating the many young boys identified at high-risk for the disease," said Dr. Gary Goldstein, chief executive officer of the Kennedy Krieger Institute.

X-ALD affects 16,000 patients in the United States.

Patients cannot metabolize big fat molecules called long-chain fatty acids -- either made inside the body or eaten in food. The condition causes the breakdown of myelin, the fatty substance that coats and insulates nerve fibers.

The most dangerous type is the childhood cerebral form, in which brain cells are destroyed. Up to 40 percent of cases are this type, which usually appears between 4 and 8 years of age.

Symptoms include a loss of the ability to speak, reduced strength and coordination and, eventually, complete breakdown of bodily function and death.

There is no cure, but potential treatments include the cholesterol drug lovastatin and bone marrow transplants.

Then there is Lorenzo's Oil, a treatment invented by Augusto and Michaela Odone after their son, Lorenzo, was diagnosed with ALD.

Lorenzo's Oil normalizes the concentrations of very long chain fatty acids. The Odones said the treatment stopped the progression of Lorenzo's disease and their son, now 27, is alive though severely disabled.

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Study Questions Statins' Value Against Alzheimer's

By Steven Reinberg
HealthDay Reporter

HealthDay News

Monday, July 11, 2005

 MONDAY, July 11 (HealthDayNews) -- Cholesterol-lowering drugs called statins have been linked to a decreased risk of Alzheimer's disease and other dementias, but a new study questions that association.

According to the results of this latest study, use of statins and other lipid-lowering drugs showed no association with reductions in the risk of Alzheimer's or other types of dementia in older adults.

Statins may reduce the risk of heart disease by blocking the production of cholesterol or by serving as an anti-inflammatory, experts say. Both these mechanisms may also play a part in the development of Alzheimer's disease and other dementias, according to the report in the July issue of the Archives of Neurology.

In their study, Dr. Thomas D. Rea, of the University of Washington, and colleagues collected data on nearly 2,800 people 65 or older enrolled in the Cardiovascular Health Study. At the start of the study, participants underwent MRIs and took a standardized test to determine that they did not have Alzheimer's or other dementias.

Researchers then followed these individuals every year to see if they had developed dementia, to asses their overall health, and to track what medications they were taking. During the follow-up period, 480 people developed dementia. Of these, 245 people developed Alzheimer's.

After accounting for other risk factors, Rea's team found that, compared with people who never took statins, those who did showed no reduction in their risk of developing Alzheimer's or any other dementia.

The reasons for the finding may include the length of time patients were taking statins, Rea's group noted.

"Several factors may explain why statin use was not associated with a lower risk of dementia," they wrote. "Participants were on average 75 years of age, and statin use was assessed for a median of five years. Statin exposure may need to occur earlier in adulthood or for longer periods to prevent dementia, although analyses that stratified the duration of statin use did not suggest a duration-dependent association."

One expert thinks this study offers patients a mixed message. While there was no overall reduction in Alzheimer's among people taking statins, "when you look at patients who had used a statin in the last year of the study, there appears to be a reduced risk of Alzheimer's," said Larry Sparks, director of the Roberts Laboratory for Neurodegenerative Disease Research at the Sun Health Research Institute, in Sun City, Ariz.

Sparks, whose own work has shown that statins reduce the risk of Alzheimer's, believes the study indicates the benefit of statins when taken over a long period of time. "Perhaps the longer an individual uses a statin, the greater the possibility there would be a reduced risk of Alzheimer's disease," he said.

In his own work, Sparks has shown that use of a statin drug does benefit people with Alzheimer's. "It slowed the progression of the disease and showed improvement on cognitive measures and depression," he said.

William Thies is vice president for medical and scientific affairs at the Alzheimer's Association. He thinks that only the results of ongoing clinical trials will settle the issue of statins' value against Alzheimer's. "At this point we have mixed results," he said. "Some studies suggest there is a value [to statins for preventing Alzheimer's] and some suggest that there's not."

One trial under way is being run by the National Institutes of Health, which is looking at the use of statins to treat dementia; another trial is sponsored by the drug company Pfizer, Thies said. "Ultimately, those trials are going to tell us, 'If you take somebody with the beginnings of dementia, if you treat them with a statin drug, will they get better?'" he said.

The results from one of the trials should be available in about one year, Thies said. There is no recommendation for using statins to prevent dementia, he noted.

But if you're taking a statin to lower your risk of heart disease, that's good, and "if that benefits your risk of dementia that's even better," Thies said.

More information

To learn more, visit the Alzheimer's Association.

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Curry ingredient fights skin cancer -U.S. study

 

Reuters

Monday, July 11, 2005

The compound that makes curry yellow could help fight skin cancer, U.S. researchers reported on Monday.

They said curcumin, found in the spice turmeric, interferes with melanoma cells.

Tests in laboratory dishes show that curcumin made melanoma skin cancer cells more likely to self-destruct in a process known as apoptosis.

The same team has found that curcumin helped stop the spread of breast cancer tumor cells to the lungs of mice.

Bharat Aggarwal of the Department of Experimental Therapeutics at the University of Texas M.D. Anderson Cancer Center in Houston and colleagues treated three batches of melanoma cells, known as cell lines, with curcumin at different doses and for varying times.

The curcumin suppressed two proteins that tumor cells use to keep themselves immortal, the researchers write in next month's issue of the journal Cancer.

"Based on our studies, we conclude the curcumin is a potent suppressor of cell viability and inducer of apoptosis in melanoma cell lines," Aggarwal's team wrote.

"Future investigation to determine the effects of curcumin in animal models of melanoma and clinical trials are planned."

Earlier research has shown that curcumin, which acts as an antioxidant, can help prevent tumors from forming in the laboratory.

Aggarwal said people who eat plenty of turmeric have lower rates of some cancers, although the spice itself has not been shown to reduce cancer risk in people.

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NSAID Painkillers May Raise Urinary Retention Risk

By Steven Reinberg
HealthDay Reporter

HealthDay News

Monday, July 11, 2005

 MONDAY, July 11 (HealthDay News) -- Using nonsteroidal anti-inflammatory drugs (NSAIDS) may double the risk of developing acute urinary retention, Dutch researchers report.

Urinary retention involves the abnormal holding of urine within the bladder, often due to bladder muscle failure.

The new finding, which involves ibuprofen, naproxen (Aleve) and the cox-2 inhibitor Celebrex, adds to highly publicized cardiovascular issues surrounding the use of these popular medications.

Both Vioxx and Bextra were pulled from the market after studies pointed to increased risks for heart attack and stroke with cox-2 inhibitor use. As a result, the FDA mandated warning labels on all similar prescription drugs and label changes on similar over-the-counter ones.

Earlier case reports had also suggested that NSAIDS may increase the risk of acute urinary retention by affecting the production of prostaglandin, a hormone essential in muscle function, researchers report in the July 11 issue of the Archives of Internal Medicine.

In an attempt to define the extent of risk for urinary retention associated with these painkillers, Miriam C. J. M. Sturkenboom, from the Department of Medical Informatics at Erasmus University, Rotterdam, and her colleagues looked at data on more than 72,000 men aged 45 years and older enrolled in the Integrated Primary Care Information project in the Netherlands.

From this large population, the researchers identified 536 cases of urinary retention and compared their use of NSAIDs with that of 5,348 men who did not have the condition.

They found that, among men using NSAIDS, the risk of developing urinary retention was double that of men who didn't take the pain-relieving drugs.

The highest risk was found in men who had recently starting taking NSAIDS, and among men taking the drugs in doses equal to or higher than the recommended daily dose.

"In our study, we found that the risk of acute urinary infection is about twofold higher in patients currently using NSAIDS than in those not taking NSAIDS," the researchers wrote. "We believe that physicians should be informed about the possibility of provoking acute urinary infection in patients using NSAIDS, especially in high-risk patients."

One expert agreed there is scientific evidence to back up these findings. "I have been aware of the effects of cox-2 inhibitors on bladder function for a long time," said Dr. William D. Steers, chairman of the Department of Urology at the University of Virginia Health System. "There is some basic science to suggest that cox-2 inhibitors can relax bladder muscle."

However, Steers isn't sure the Dutch study proves that NSAIDS are the cause of urinary retention. Instead, conditions for which the men were taking the NSAIDS may be to blame. "It would be interesting to actually do bladder testing, to see if these drugs affect urodynamics," Steers said.

Steers also doesn't think the problem is widespread. "Clinically, I'm not sure it's a big deal," he said, because many drugs cause urinary retention.

"People might think this is another nail in the coffin of cox-2 inhibitors, in addition to the recent uproar over them in heart disease," Steers said. "I don't think so."

Another expert advised that doctors take the findings into account when prescribing NSAIDS. "It may be that we should really be quizzing patients on urinary symptoms, as we do when we place patients on cold medication," said Dr. Martin I. Resnick, chairman of the department of urology at Case Western Reserve University.

Resnick believes that patients should be informed of possible urinary side effects of NSAIDS and tell their doctor if they develop any urinary problems while on the drugs.

More information

The National Institute of Diabetes and Digestive and Kidney Diseases can tell you more about urinary problems.

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Disparity in US, Canada heart-surgery costs –study

 

Reuters

Monday, July 11, 2005

Hospital costs for the most common kind of heart surgery are more than 80 percent higher in the United States than in Canada because of overheads, labor and other factors, a study said on Monday.

But there is no difference in death rates from the procedure in the two countries, doctors at Jewish General Hospital in Montreal said after reviewing coronary artery bypass surgeries involving 4,698 U.S. and 7,319 Canadian patients.

Median hospital costs were $16,036 in the United States compared to $7,880 in Canada, said the report published in the Archives of Internal Medicine. Both figures are in U.S. dollars.

While Canadian patients stayed in the hospital an average of more than 16 percent longer than their American counterparts, the report said, "there was no difference in in-hospital mortality and the cost in the United States was 82.5 percent higher than in Canada."

The cost disparity is "attributable to differences in direct and overhead costs between the Canadian and U.S. hospitals," it added, mainly reflecting "higher resource prices for products and labor and higher overhead costs in the United States resulting from a nonsocialized medical system."

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Newborns' Stroke Risk as High as Elderly's

By Janice Billingsley
HealthDay Reporter

HealthDay News

Monday, July 11, 2005 

MONDAY, July 11 (HealthDay News) -- Strokes are usually associated with older adults, but a new study finds their incidence among newborns is equal to that of the elderly.

In most cases, infant stroke means long-term neurological problems for those babies who suffer them, researchers add.

"We don't think of babies as having a high risk of stroke, but strokes do occur in babies and cause significant lifelong disabilities," said co-researcher and child neurologist Dr. Donna M. Ferriero, professor of neurology and pediatrics at the University of California, San Francisco (UCSF).

Examining records of nearly 200,000 children born in northern California over a five-year period, the researchers found that approximately one out of 5,000 infants had strokes near birth -- a rate that equals that of elderly people, according to Ferriero.

Furthermore, nearly 80 percent of the infant strokes caused long-term neurological problems for the children, including cerebral palsy, epilepsy, language problems and hyperactivity.

By raising awareness of the frequency of stroke in newborns, Ferriero hopes that parents and doctors will begin to pay closer attention to the sometimes subtle signs of strokes in young children and commence brain-saving therapies as soon as possible.

"Disabilities can be altered by appropriate early recognition and attention. Early intervention does matter," she said. "The brain is plastic and can adapt to physical and occupational therapy."

In the study, the UCSF team examined the medical records of more than 199,000 children born between 1997 and 2002 to families enrolled in the Northern California Kaiser Permanente Medical Care Program.

They found the overall rate of strokes occurring either during labor and delivery or in the month after birth (perinatal strokes) was about one in 5,000 births. However, the study authors believe actual rates are even higher since strokes must be confirmed by brain imaging -- not always used on children with more subtle neurologic symptoms.

Post-stroke disability was common: 58 percent of children were diagnosed with cerebral palsy, a neurologic disorder characterized by muscle weakness; 39 percent had epilepsy; 25 percent were reported to have delays in language; and 22 percent displayed behavioral abnormalities such as hyperactivity.

Cerebral palsy was more likely to occur in infants without initial symptoms, the researchers reported. In those cases, no evidence of stroke was found until months after birth when the child was discovered to have a diminished use of one hand, for example.

Ferreiro said that further research is needed to understand the cause of these strokes, for which there is presently no treatment. A previous UCSF study found that babies born to women with a history of infertility, women who had infections in the membranes of the uterus during pregnancy, or women experiencing a delivery-linked blood pressure condition called preeclampsia were all at higher risk of perinatal stroke.

The results of the study, funded in part by the United Cerebral Palsy Foundation, appear in the July 11 Annals of Neurology.

Dr. John Kylan Lynch, a researcher at the National Institutes of Health, said this study is important because it's both large and based on data taken from the general population rather than from studies looking only at stroke victims. Furthermore, it included cases where the symptoms of stroke appeared later on, after a child was taken home from the hospital.

"It's important for the public to know that most children [with strokes] will present with seizures in the hospital, but that some will look normal until about two months of age, when they will develop difficulty with motor movements on one side of the body," he said.

Ferreiro said that the best thing parents can do is trust their instincts if they think their child is having development problems.

"In the nursery, nurses are very good at picking up [on strokes], but once babies go home it's up to the parents," she said. "Parents are the best observers of their children's skill sets, and if a parent is not comfortable with his or her child's cognitive or motor development, she should trust her judgment."

Parents should talk to their child's pediatrician and not hesitate to ask for a referral to a specialist, she recommended. They should also look for signs of stroke -- for example, if the child is only using one arm or seems to have visual recognition or attention problems, she added.

More information

More information about infant strokes can be found at United Cerebral Palsy.

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Obese women fitter than obese men, study finds

 

By Maggie Fox

Health and Science Correspondent

Reuters

Monday, July 11, 2005

Obese men may be less physically fit than obese women, perhaps because they are more likely to have diabetes or pre-diabetes and tend to have more abdominal fat, Dutch researchers reported Monday.

A study of 56 morbidly obese men and women waiting for weight-reduction surgery showed that although the men and women in general were just as overweight, the women were better able to tolerate exercise.

This is probably because of how their body fat was distributed, the team at Hospital Reinier de Graaf in Groep, Netherlands, found.

And this, in turn, could be a factor of how they process sugar and other simple carbohydrates, the researchers said. They found more of the men had a pre-diabetic condition called carbohydrate intolerance.

"Carbohydrate intolerance -- the inability to metabolize sugar found in carbohydrates -- may lead to a buildup of fat deposits on muscle tissue, which can cause a person to gain weight and, eventually, impair physical endurance," said Dr. Emile Dubois, who worked on the study.

"It appears that carbohydrate intolerance is more common in obese men, which would cause them to be less physically fit than obese women," Dubois added in a statement.

Abdominal Fat, Lung Capacity

Writing in the journal Chest, published by the American College of Chest Physicians, Dubois and colleagues said they tested 56 people who were preparing to have stomach-reduction surgery to help them lose weight.

All were morbidly obese as defined by body mass index, a measurement of height versus weight.

People with a BMI of 25 to 30 are considered overweight, those with BMIs of over 30 are obese, with a much higher risk of diabetes, heart disease, stroke and some cancers, and those with BMIs of 40 or more are morbidly obese.

The researchers found that 59 percent of men had diabetes or pre-diabetes, compared to 35 percent of the women. Patients with carbohydrate intolerance usually have so-called metabolic syndrome, which includes high blood pressure, high blood sugar, and a tendency to be overweight.

The women did better on a bicycle test of exercise endurance and lung capacity tests than the men did. This could be because men tend to have more upper body fat, including abdominal fat, than women do.

Having more abdominal fat may affect lung capacity, the researchers said.

"It is possible that women are better equipped for energy storage due to their inherent need to feed their offspring," said Dr. Dave Schweitzer, who worked on the study.

"When food is abundant, such as in modern society, both genders may become obese, but men simply do not have the reserve capacity to handle excess food, which puts extra stress on their bodies, causing decreased performance and, possibly, illness."

The group may have had unusual eating patterns, the researcher noted.

"Indeed, all patients reported frequently occurring unstoppable eating, and many experienced multiple binge eating attacks each day," they wrote.

All were treated with antidepressants approved for use in treating bulimia, an eating disorder.

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Piercing Staph Bug's 'Golden Armor'

 

HealthDay News

Monday, July 11, 2005

MONDAY, July 11 (HealthDay News) -- A biochemical shield of golden armor helps the Staphylococcus aureus bacterium thwart attacks by the human immune system, according to researchers at the University of California, San Diego School of Medicine.

The finding may help lead to new treatments for serious "Staph" infections that are becoming increasingly resistant to standard antibiotics. Staph is the leading cause of human infections in the skin and soft tissues, bones and joints, abscesses and normal heart valves.

The UCSD team found that the molecules that give Staph its golden color help protect the bacteria from being killed by neutrophils, white blood cells that play a leading role in immune system defense against invading microbes.

These molecules coating the surface of Staph are called carotenoids, similar to those found in carrots and other vegetables and fruit. The carotenoids inactivate deadly chemicals deployed by the immune system's neutrophils.

For their research, the investigators knocked out the genes in Staph that produce the carotenoid molecules. The result was a mutant strain of Staph that were white instead of the normal gold color.

"We found that the nonpigmented Staph mutant became much more susceptible to oxidants such as hydrogen peroxide and singlet oxygen produced by neutrophils. Without its golden pigment, the Staph lost its ability to survive in human neutrophils or blood, and could no longer form an abscess when injected into the skin of experimental mice," Dr. George Liu, research fellow in the UCSD department of pediatrics, said in a prepared statement.

The findings, published in the July 17 issue of The Journal of Experimental Medicine, suggest a new approach for treating serious Staph infections.

"Instead of attempting to kill the bacteria directly with standard antibiotics, a treatment strategy to inhibit the Staph pigment would disarm the pathogen, making it susceptible to clearance by our normal immune defenses," study senior author Dr. Victor Nizet, UCSD associate professor of pediatrics and an infectious disease specialist at Children's Hospital, San Diego, said in a prepared statement.

More information

The Nemours Foundation has more about Staph infections.

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Sunday, July 10, 2005

 

Alzheimer's Educators Reach New Audiences

 

By Betsy Taylor

Associated Press Writer

The Associated Press

Sunday, July 10, 2005

At first blush, a breakfast meeting for clergy, a party in a beer garden for young people and a project by schoolchildren to sell paper forget-me-not flowers have little in common. But these recent efforts in the St. Louis area are, in fact, linked by the desire to better educate new populations about Alzheimer's disease, the progressive brain disorder that gradually destroys a person's memory and ability to learn, reason and communicate.

In the past, education efforts largely focused on getting information to care providers looking after those with the disease, said explained Stephanie Rohlfs-Young, director of outreach for the St. Louis chapter of the Alzheimer's Association.

But in recent years, those fighting against the disease are reaching out to new groups. That's because of a better understanding that whole families may need assistance when a relative has the disease, because early detection can lead to treatment that can slow the illness and because as the population ages, the number of Alzheimer's sufferers is projected to grow — from about 4.5 million Americans currently to 16 million by 2050.

"We used to think of Alzheimer's as your grandmother's disease," said Rohlfs-Young. "But the disease affects every member of that family."

Recognizing that families often turn to a religious leader in a crisis, the association held a breakfast for clergy a few weeks ago to educate them about the disease and available resources. They've asked several churches to display information, like a list of 10 warning signs of the disease, in libraries, fellowship halls or schools, Rohlfs-Young said.

Another group called the Young Ambassadors is picking up steam, giving people in their 20s, 30s and 40s information about the disease and asking for their help in fighting it. Their first "Summer Memories" event last month drew about 400 people to the beer garden at Grant's Farm. They offered a picnic meal featuring live music, but also raised funds and provided information about Alzheimer's. "The point was to make inroads into our demographic with this disease," said Andy Elmore, 39, of Fenton. "Ultimately, if we can educate people better, we can get them involved sooner."

His father, Ray, died from Alzheimer's in 1996 at age 66. Elmore didn't really know about the disease when his dad was diagnosed, mentioning that some family members thought dad was just telling the same old stories over again.

"The person you love disappears, though they're still living," he said. Elmore's father was an appliance salesman, a kind man who was active in raising his sons and at his church, but the disease made him combative and argumentative, Elmore recalled.

Elmore said the disease progressed to a point where his father was a shell of his former self, who couldn't even swallow food properly as he declined.

Elmore said he has a fear of the disease, that his family might one day have to go through something similar to what he experienced with his father's illness. But he also believes he can honor his father and family with work to defeat the disease.

An another outreach effort began almost by accident. Laura Asher, 41, of Imperial, brought one of her sons, Ian, to an Alzheimer's Association meeting on a busy night. She and her husband were shuttling their children between outings, and Ian ended up with his mom at the Alzheimer's gathering.

"He heard the adults talking about ways to raise money and thinking outside the box," Laura Asher said. "And he said, `What about kids and schools?'"

Last year, Ian, now 11, began to raise money to fight Alzheimer's disease at his Windsor school district in Jefferson County, like selling papers with forget-me-not flowers on them that children could buy and post in their schools. A restaurant in nearby Barnhart, Ginny's Kitchen and Custards, has also started selling the forget-me-nots.

That and other efforts Ian started, like an art contest, have raised about $5,000 to fight Alzheimer's.

Laura's grandmother, Ethel Shaw, died of Alzheimer's last month at age 92. The deteriorating effects could be seen in three baby quilts that Shaw made for her great-grandchildren. The first from 1991 is a 12-block Mickey Mouse design, with flawless embroidery. But as Shaw's disease progressed, the patterns on the next two baby quilts become confused, with dropped stitches and missing elements.

Laura said she cried in a bathroom at a baby shower, when she saw the last quilt made in 1996, because she realized the toll the disease was taking on her grandmother.

Ian recalled how his great-grandmother loved to bake cookies. But one day she called Laura to say she had been baking and didn't know what had become of her latest batch. Laura thought of motions similar to opening an oven door; she later realized her grandmother had lifted a dust ruffle and slid the cookies under a bed.

The whole family, Ian said, had a hard time with the disease.

"I wanted to help find a cure for it, so nobody else has to have it," he said, expressing some surprise that his efforts had caught notice. "I didn't know anybody was paying attention to it outside of school."

On the Net:

Alzheimer's Association: http://www.alz.org

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Brittle Bones Can Affect Older Men As Well

By E.J. Mundell
HealthDay Reporter

HealthDay News

Sunday, July 10, 2005

 SUNDAY, July 10 (HealthDay News) -- Everyone knows that women need to fend off osteoporosis as they age. But what is less well-known is that 30 percent of elderly men who suffer a hip fracture will die within a year of that fracture -- double the rate for older female patients.

But despite this increased risk, experts say many men view brittle bones as a "woman's problem."

Too many doctors may also share that view: One recent U.S. study, published in the June issue of the journal Osteoporosis International, "validated what we thought -- that men who have fractures are woefully undertreated. Just one in every six men who had a spine or hip fracture was treated with osteoporosis medications" to strengthen ailing bones, said Dr. Thomas J. Weber, an assistant professor of medicine at Duke University Medical Center.

According to the same study, just 1.1 percent of men brought to the hospital for a serious fracture received a bone density test to evaluate their overall risk.

"Now, doctors wouldn't hesitate to do that for a woman, but it seems we just don't think of it in terms of men," Weber said.

It's true that men start out with denser, healthier bones than women.

"Women have less bone to begin with, and then they get a big hit at menopause," said Dr. Joseph Lane, chief of the metabolic bone disease service at the Weill Cornell Medical College's Hospital for Special Surgery in New York City.

"The overall rate of bone loss for men and women is the same, but because men start higher they don't get into trouble as quickly -- osteoporosis isn't an issue for men until 70 and beyond," he said.

But when a fracture occurs in the elderly, brittle bones can quickly become a life-or-death concern.

"There are a number of reasons people can die after fracture," Weber said. "They may have underlying cardiovascular disease that leads to congestive heart failure. They may develop infection and there's a suggestion, based on some evidence, that perhaps in 25 percent of male patients death is related to the consequences of the hip fracture itself."

While menopause is a major cause of bone deterioration in women, factors such as smoking, alcohol consumption and the use of certain medicines increase fracture risks for men, Lane said. The gradual age-related decline in circulating testosterone is another factor. "A young guy has a testosterone value of about 1,000 and older men are down to about 300," he said.

All of these risk factors are preventable, either through quitting smoking and heavy drinking, or via pharmaceutical means, said Lane, who is also a spokesman for the American Academy of Orthopaedic Surgeons.

Then there's diet and exercise.

"In general, men over the age of 50 should be getting 1,200 mg of calcium a day from diet, or diet and supplements combined," Weber said. Lane advises men to use calcium citrate -- not bicarbonate -- supplements, because the bicarbonate formulation raises risks for kidney stones.

The current recommended daily allowance for another bone-strengthener, vitamin D, is 400 International Units (IU) per day for older men, but Weber said that level is currently under review and will no doubt be revised.

"I think maybe upwards of 800 to 1,000 IU can be safely recommended for men," he said. Many foods, including milk, come fortified with vitamin D (check the label) and cod liver oil capsules are particularly high in the nutrient.

Skin also manufactures vitamin D under strong sunlight. "It has to do with the sun's angle, though, so go out there between 10 a.m. and 2 p.m. rather than taking a walk in the early morning," Weber said.

As for exercise, its benefits are more about balance than bones, according to Weber. "Exercise's effects on the skeleton tend to be fairly modest," he explained. "When we prescribe exercise for older people we're doing it not only to help bone density but to increase strength and reduce their risk of falls."

Lane agreed. "You need two things for a fracture: bad bones and a fall. There's an easy way to tell if you're at high risk for falling: try standing on one leg for 12 seconds. If you can't do that, then by definition you're an unsteady individual who needs fall protection" such as sturdy shoes, a cane or walker, he said.

But failing balance can be restored, and one of the world's oldest interventions remains among the most effective.

"The most successful method is Tai Chi," Lane said. "All of the YMCAs in New York now teach Tai Chi, and we send all the people who fail the one-leg test to the Y to learn it."

More information

Bone up on bone loss at the American Academy of Orthopaedic Surgeons.

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Universal Health Care Push Being Revived

 

By Matt Leingang

Associated Press Writer

The Associated Press

Sunday, July 10, 2005

 A push for universal health coverage is being rekindled in some states by the soaring cost of health care and the lack of political support in Washington for federal changes.

Advocates of a single-payer system — where the government would collect taxes and cover everyone, similar to programs in Canada and across Europe — have introduced bills in at least 18 state legislatures. Some are symbolic gestures, but heated debate is taking place in California and Vermont.

In Ohio, doctors, union officials and religious leaders are gathering signatures to get a single-payer health system placed on a ballot next year.

"The level of misery with private insurers is rising, and that's why we're seeing this increased activity," said Larry Levitt, vice president of the California-based Kaiser Family Foundation, which analyzes health care issues. "But whether one state can succeed, I don't know."

Not since Oregon in 2002 has a state voted on a single-payer health system. Voters there soundly rejected it, as did Californians in 1994. Both times, the proposals came under fierce assault from the medical, insurance and pharmaceutical industries.

However, Oregon supporters are aiming for another ballot measure in 2008, and a bill in California would have the government pay for health care in a state where 7 million people are uninsured.

Across the nation, the number of uninsured is 45 million and rising, and 16 million lack enough insurance to cover all their medical bills.

Premiums for employer-sponsored health plans rose an average of 11.2 percent in 2004, the fourth consecutive year of double-digit growth, according to the Kaiser Family Foundation. Companies are raising employee fees for health care, increasing co-payments and decreasing benefits.

Mainstream medical groups, including the American Medical Association, oppose single-payer systems. The AMA fears they would stifle the development of new medical technology and create longer waits for patient care should government budgets become strapped for money.

Advocates dismiss those arguments as scare tactics.

"There's no other solution out there," said David Pavlick, a member of the United Auto Workers in Cleveland, which has endorsed the Ohio campaign. "The system we have now is immoral, it's foundering and it's on its last legs."

A single-payer system would be financed through a mix of payroll tax increases and new taxes on personal income. The new taxes would take the place of insurance premiums that many people currently pay for health coverage, and there would be no out-of-pocket expenses.

States would use their leverage to negotiate lower prices for prescription drugs and other health services. Hospitals and doctors' offices would be relieved of the hassles and expense of dealing with multiple health insurers.

Claims that the system would cost less have merit, said John Sheils, vice president of the Lewin Group, a Virginia consulting firm that conducted a study last year of how a single-payer system would work in California. The study found that the state would save $343.6 billion in health care costs over 10 years.

But Sheils said a single-payer system isn't a panacea. States could be hard pressed to keep funding levels adequate during recessions, when tax revenues decline.

"There are positives and negatives with all types of health systems," Sheils said. "The question that has to be asked is what are we getting out of our existing multipayer system that is worth all the money we are spending on it?"

In any event, voters are still leery. A Kaiser Foundation poll released earlier this year found that 55 percent of Americans opposed a single-payer health system. Thirty-seven percent favored it.

Knowing that, some states are taking incremental approaches.

Maine started enrolling people this year in a state-private program that offers affordable health coverage to small businesses and families. The goal is to bring coverage to the 130,000 Mainers who lack it by 2009.

"It's really going to the states to push health care reform along," said Janne Hellgren, coordinator for a universal health care movement in Massachusetts. "Washington just isn't willing to change the status quo."

On the Net:

Kaiser Family Foundation: www.kff.org

American Medical Association: http://www.ama-assn.org/

Physicians for a National Health Program: http://www.pnhp.org/

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This Vacation, Send Allergies Packing

 

HealthDay News

Sunday, July 10, 2005

SUNDAY, July 10 (HealthDay News) -- It's summer vacation time, but that doesn't mean allergies take a holiday, experts warn.

That's why allergic Americans need to take steps to reduce their symptoms when traveling, according to the American Academy of Allergy, Asthma and Immunology (AAAAI).

"Although you cannot completely allergy-proof your vacation, there are steps you can take to minimize your allergy symptoms. The first step is proper planning; the last thing you want on your vacation is a trip to the emergency department due to your symptoms getting out of control," Dr. Leonard Bielory, a member of the AAAAI's aerobiology committee, said in a prepared statement.

In an effort to help people with allergies have a safe and reaction-free vacation, the AAAAI offers some advice for travelers.

Before you drive off on your vacation:

For 10 minutes before you depart, turn on your car's air conditioner in order to get rid of allergens such as pollen, indoor molds and dust mites, which are often found in the upholstery, carpeting and ventilation systems of vehicles. Travel early in the morning or late in the evening in order to avoid heavy traffic and the time of day when air quality is at its worst. Keep your windows closed and use air conditioning when driving in order to prevent allergens and pollen from getting inside the vehicle.

When traveling by air, remember that the recycled air in airplane cabins can trigger allergy symptoms. Food allergies are another potential concern, since it may be difficult to get information about specific ingredients in airline food. When flying:

Carry an EpiPen in case of severe reaction while in flight. Make sure airline staff know about the medication before checking in for the flight. A saline nasal spray will keep nasal passages moist and help prevent aggravation of allergy symptoms caused by the dry air in airplanes. Pack allergy medications in a carry-on bag. Don't put it in checked luggage, which may not make it to your destination. Remember to adjust for time zone changes when calculating medication dosages. During the flight, chew gum, sip liquids and swallow often in order to relieve sinus pressure.

At the hotel:

Request an allergy-proof room or ask for a room located in a dry, sunny area, away from the pool. Ask about the hotel's pet policy and ask for a pet-free room. Check if the hotel offers synthetic pillows. Consider bringing your own dust-proof pillow and mattress covers or personal bedding. Ask the hotel to change the air filter on the room's air conditioner, and use the air conditioner instead of opening the windows. If allergic to mold spores, don't use hotel closets or drawers, which are great breeding grounds for mold.

More information

The American Academy of Allergy, Asthma, and Immunology explains allergic reactions.

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Allegations of Fake Research Hit New High

 

By Martha Mendoza

AP National Writer

The Associated Press

Sunday, July 10, 2005

Allegations of misconduct by U.S. researchers reached record highs last year as the Department of Health and Human Services received 274 complaints — 50 percent higher than 2003 and the most since 1989 when the federal government established a program to deal with scientific misconduct.

Chris Pascal, director of the federal Office of Research Integrity, said its 28 staffers and $7 million annual budget haven't kept pace with the allegations. The result: Only 23 cases were closed last year. Of those, eight individuals were found guilty of research misconduct. In the past 15 years, the office has confirmed about 185 cases of scientific misconduct.

Research suggests this is but a small fraction of all the incidents of fabrication, falsification and plagiarism. In a survey published June 9 in the journal Nature, about 1.5 percent of 3,247 researchers who responded admitted to falsification or plagiarism. (One in three admitted to some type of professional misbehavior.)

On the night of his 12th wedding anniversary, Dr. Andrew Friedman was terrified.

This brilliant surgeon and researcher at Brigham and Women's Hospital and Harvard Medical School feared that he was about to lose everything — his career, his family, the life he'd built — because his boss was coming closer and closer to the truth:

For the past three years, Friedman had been faking — actually making up — data in some of the respected, peer-reviewed studies he had published in top medical journals.

"It is difficult for me to describe the degree of panic and irrational thought that I was going through," he would later tell an inquiry panel at Harvard.

On this night, March 13, 1995, he had been ordered in writing by his department chair to clear up what appeared to be suspicious data.

But Friedman didn't clear things up.

"I did something which was the worst possible thing I could have done," he testified.

He went to the medical record room, and for the next three or four hours he pulled out permanent medical files of a handful of patients. Then, covered up his lies, scribbling in the information he needed to support his study.

"I created data. I made it up. I also made up patients that were fictitious," he testified.

Friedman's wife met him at the door when he came home that night. He wept uncontrollably. The next morning he had an emergency appointment with his psychiatrist.

But he didn't tell the therapist the truth, and his lies continued for 10 more days, during which time he delivered a letter, and copies of the doctored files, to his boss. Eventually he broke down, admitting first to his wife and psychiatrist, and later to his colleagues and managers, what he had been doing.

Friedman formally confessed, retracted his articles, apologized to colleagues and was punished. Today he has resurrected his career, as senior director of clinical research at Ortho-McNeil Pharmaceutical Inc., a Johnson & Johnson company.

He refused to speak with the Associated Press. But his case, recorded in a seven-foot-high stack of documents at the Massachusetts Board of Registration in Medicine, tells a story of one man's struggle with power, lies and the crushing pressure of academia.

Some other cases have made headlines:

·        On July 18, Eric Poehlman, once a prominent nutrition researcher, will be sentenced in federal court in Vermont for fabricating research data to obtain a $542,000 federal grant while working as a professor at the University of Vermont College of Medicine. He faces up to five years in prison. Poehlman, 49, made up research between 1992 and 2000 on issues like menopause, aging and hormone supplements to win millions of dollars in grant money from the federal government. He is the first researcher to be permanently barred from ever receiving federal research grants again.

In 2001, while he was being investigated, Poehlman left the medical school and was awarded a $1 million chair in nutrition and metabolism at the University of Montreal, where officials say they were unaware of his problems. He resigned in January when his contract expired.

·        In March, Dr. Gary Kammer, a Wake Forest University rheumatology professor and leading lupus expert, was found to have made up two families and their medical conditions in grant applications to the National Institutes of Health. He has resigned from the university and has been suspended from receiving federal grants for three years.

·        In November, 2004, federal officials found that Dr. Ali Sultan, an award-winning malaria researcher at the Harvard School of Public Health, had plagiarized text and figures, and falsified his data — substituting results from one type of malaria for another — on a grant application for federal funds to study malaria drugs. When brought before an inquiry committee, Sultan tried to pin the blame on a postdoctoral student. Sultan resigned and is now a faculty member at Weill Cornell Medical College in Qatar, according to a spokeswoman there.

While the cases are high-profile, scientists have been cheating for decades.

In 1974, Dr. William Summerlin, a top-ranking Sloan-Kettering Cancer Institute researcher, used a marker to make black patches of fur on white mice in an attempt to prove his new skin graft technique was working.

His case prompted Al Gore, then a young Democratic congressman from Tennessee, to hold the first congressional hearings on the issue.

"At the base of our involvement in research lies the trust of American people and the integrity of the scientific exercise," said Gore at the time. As a result of their hearings, Congress passed a law in 1985 requiring institutions that receive federal money for scientific research to have some system to report rulebreakers.

"Often we're confronted with people who are brilliant, absolutely incredible researchers, but that's not what makes them great scientists. It's the character," said Debbi Gilad, a research compliance and integrity officer at the University of California, Davis, which has taken a lead on handling scientific misconduct.

David Wright, a Michigan State University professor who has researched why scientists cheat, said there are four basic reasons: some sort of mental disorder; foreign nationals who learned somewhat different scientific standards; inadequate mentoring; and, most commonly, tremendous and increasing professional pressure to publish studies.

His inability to handle that pressure, Friedman testified, was his downfall.

"And it was almost as though you're on a treadmill that starts out slowly and gradually increases in speed. And it happens so gradually you don't realize that eventually you're just hoping you don't fall off," he told a magistrate during a state hearing in 1995. "You're sprinting near the end and taking it all you can not to fall off."

At the time he started cheating, Friedman was in his late 30s, married and a father of two young children. Following the path of his father, grandfather and uncle who were all doctors and medical researchers, he was an associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and chief of the department of reproductive endocrinology at Brigham and Women's Hospital.

His reputation was tremendous and his work groundbreaking. His 30-page resume highlighted numerous awards and honors, lectures in Canada, Europe and Australia, and more than 150 articles, book chapters, reviews and abstracts. Of those, 58 were original research articles, where he had designed studies, conducted clinical trials, enrolled patients, collected and analyzed data and made conclusions.

In the end, investigators found — and Friedman confessed — to making up information for three separate journal articles (one of them never published) involving hormonal treatment of gynecological conditions.

He testified that he was working 80 to 90 hours a week, seeing patients two days a week, doing surgery one day a week, supervising medical residents, serving on as many as 10 different committees at the hospital and the medical school and putting on national medical conferences.

He did seek help, both from a psychiatrist, who counseled him to cut back, and from his boss, who demanded Friedman increase his research and refused to reduce Friedman's patient load.

As good as Friedman was as a doctor, surgeon and researcher, he was actually a lousy cheater. One thing that brought about his demise, in fact, was that the initials he used for fictitious patients were the same as those of residents and faculty members in his program.

Unlike many scientists who file immediate lawsuits when they're caught, Friedman was repentant, resigning from his positions at both Brigham and Women's, and Harvard.

In 1996, Friedman agreed to be excluded for three years from working on federally funded research. During the next three years he consulted with drug companies, he paid a $10,000 fine to the state of Massachusetts and surrendered his medical license for a year, became very active with the American Red Cross, donating more than 500 hours, and attended several lectures on ethics and record-keeping.

"Andy can never undo the damage that his actions have caused. However, he has paid the price — his academic career is ruined, his reputation sullied, and his personal shame unremitting," wrote Dr. Charles Lockwood, then chair of obstetrics and gynecology at New York University School of Medicine, in a letter on Friedman's behalf.

In 1999, after successfully petitioning to get his license reinstated, he went to work as director of women's health care at Ortho-McNeil Pharmaceuticals. The job, which he still has, involves designing and reviewing clinical trials for hormonal birth control, writing package insert labels and lecturing to doctors. Lately he's appeared on television and in newspaper articles responding to concerns about the safety of the birth control patch.

Mary Anne Wyatt, a retired biochemist in Natick, Mass., is one of several former patients.

"I think it's not at all surprising that a drug company would hire somebody who is very comfortable with hiding the effects of very dangerous drugs," said Wyatt, who unsuccessfully sued him.

Ortho-McNeil spokeswoman Bonnie Jacobs said the company was well aware of Friedman's history when it hired him. "He is an excellent doctor, an asset to our company," she said.

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Blood Pressure Enzyme May Help Battle SARS

 

By Randolph E. Schmid

Associated Press Writer

The Associated Press

Sunday, July 10, 2005

An enzyme that regulates blood pressure also is involved in infection by the SARS virus, a discovery that may lead to new ways of treating diseases that cause lung failure.

Learning how SARS (severe acute respiratory syndrome) became a deadly threat "possibly teaches us a lesson on how to actively fight so diverse and dreadful diseases as SARS, avian flu or the effects of such biotech weapons as anthrax," said Dr. Josef Penninger of the Institute of Molecular Biotechnology of the Austrian Academy of Sciences.

The research may have wider implications for a type of lung failure known as acute respiratory distress syndrome, Penninger reported in a communication to the journal Nature. It can occur in cases such as sepsis, aspiration of gastric contents, pneumonia and both avian and human influenza.

What those diseases have in common is a type of lung failure.

Penninger and colleagues report in Monday's issue of Nature Medicine that, working in mice, they found that angiotensin-converting enzyme 2 (ACE2) is a crucial receptor for the SARS virus.

The result is disruption of the body's protective renin-angiotensin system, leading to respiratory distress syndrome as fluids seep into the air sacks. The renin-angiotensin system uses enzymes to regulate sodium balance, fluid volume and blood pressure.

SARS was first identified in 2003, originating in China and spreading rapidly to Asia, Canada and elsewhere. It killed nearly 800 people and disrupted travel, economics and even some scientific meetings.

The researchers found that the SARS virus binds to the ACE2, Penninger said in a telephone interview.

If disabling ACE2 allowed lung damage to occur, the researchers wondered whether providing more of the enzyme would help. They created more ACE2 and infused it into the mice. The result was to protect mice from the lung failure effects of SARS.

It was effective in two ways, Penninger said.

First, ACE2 combined with the virus and prevented it from binding to normal cells. Also, the enzyme protected the mice from acute lung failure.

"We of course need to extend these findings in mice now to humans," Penninger said. "Yet in essence, SARS pointed us to a protein that may help millions of people affected with a previously untreatable disease."

A commentary by John Nicholls and Malik Peiris of the University of Hong Kong said the findings indicate that the potential therapeutic value of ACE2 and angiotensin 2 receptor inhibitors for acute lung injury will be a productive field for investigation.

But Peiris and Nicholls, who were not part of Penninger's team, said there are differences in the way SARS binds with human ACE2 and ACE2 in mice.

The research was funded by the Austrian Academy of Sciences, Austrian National Bank, Marie Curie Fellowship of the European Union, Beijing Committee of Science and Technology, National Natural Science Foundation of China, Joincare Corporation, Canadian Institutes of Health Research, Canada Foundation for Innovation and the German Research Council.

On the Net:

Nature Medicine: http://www.nature.com/naturemedicine

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Saturday, July 9, 2005

 

All Eyes on Summer Sun Safety

 

HealthDay News

Saturday, July 9, 2005

SATURDAY, July 9 (HealthDay News) -- After slathering on the sunscreen, summer-lovin' Americans should take steps to protect their eyes from the sun's harmful ultraviolet (UV) rays, say experts at the American Academy of Ophthalmology.

Long-term exposure to UV radiation can damage eyes and lead to vision loss, such as cataracts and age-related macular degeneration.

July is UV Safety Month, so the American Academy of Ophthalmology is offering these tips on protecting vulnerable eyes from the sun:

 

Buy right. Purchase sunglasses that block UV rays. That doesn't mean buying expensive sunglasses or especially dark ones, the experts note, since UV-blocking power isn't dependent on either price or lens darkness. Go side-to-side. Ideally, sunglasses should wrap all the way around the temples to help prevent the sun's rays from entering from the sides. Top it off. In addition to sunglasses, broad-rimmed hats are key to shielding sensitive eyes, and should be worn even on cloudy days. The sun's UV rays can pass through thin clouds and haze, experts say. Build on contacts. The experts remind contact lens wearers that sunglasses are always a must, even for those wearing contacts with built-in UV protection. Beware the glare. It's especially important to wear sunglasses in early afternoon and at higher altitudes, where UV light is more intense.

More information

The American Academy of Ophthalmology outlines potential eye disorders caused by UV radiation.

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