The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
July 23, 2002

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 12 - 19

FRIDAY, JULY 19, 2002

  1. Diet May Prevent Alzheimer's Disease

    WEDNESDAY, JULY 17, 2002

  2. Study: Heart Drug Side Effects Lower
  3. Malaria Parasite: More Resistant?
  4. Experiments Challenge Notions on Aging
  5. Use of Estrogen Linked with Cancer
  6. Experts Say Cancer Pain Undertreated
  7. Beta-Blockers Don't Boost Depression Risk: Report
  8. Light Drinking Ups Blood Pressure in Some Men
  9. Cancer Deaths Higher Than Reported

    MONDAY, JULY 15, 2002

  10. Teetotaling's Best for Blood Pressure
  11. Misdiagnosing Appendicitis Studied
  12. Program Tracks Stroke Victim Treatment
  13. FDA Warns of Chemical in Plastic
  14. Heart Assn. Recommends Screening

    SUNDAY, JULY 14, 2002

  15. FYI About Your Rx

    FRIDAY, JULY 12, 2002


  16. Marine Snail's Toxin More Powerful Than Morphine

FRIDAY, JULY 19, 2002

Mint-Flavored Tobacco Lozenge Spurs Controversy  

By Doug Macron

Reuters Health

Friday, July 19, 2002

NEW YORK (Reuters Health) - Michigan's Attorney General said earlier this week that it and 41 other attorneys general have sent a letter asking the US Food and Drug Administration ( news - web sites) (FDA) to ban the marketing of Star Scientific Inc.'s Ariva, a mint-flavored tobacco lozenge.

But a recent Supreme Court ruling raises questions as to whether the FDA could do anything about Ariva even if it wanted to.

According to Star, Ariva--which is made of powdered and compressed tobacco that has been flavored--is sold to adults as an alternative to cigarettes when smoking in certain places is not an option, and is now available in more than 40 states.

But the Office of the Michigan Attorney General said the attorneys general want the marketing of Ariva halted because of the product's alleged appeal to children, namely because of its "bright packaging and sweet flavor." Additionally, the attorneys general charge, Ariva has never been tested for safety or health purposes.

In a statement responding to the attorneys general, Star President and COO Paul Perito contends that Ariva is designed for adult smokers and not for sale to minors, as evidenced by the numerous warnings including on the product's packaging.

A spokeswoman for the FDA told Reuters Health that the agency is looking into the matter and declined to comment further.

But it is unclear whether the agency even has the authority to regulate Ariva. Although the FDA regulates such nicotine-containing smoking cessation aids ( news - web sites) such as Pharmacia Corp.'s gum Nicorette, Star points out that in a March 2000 ruling the Supreme Court determined Congress has not granted the FDA the authority to regulate actual tobacco products.

"Ariva is simply a compressed form of Star's Stonewall dry snuff product, and both products are manufactured under license from the Bureau of Alcohol, Tobacco and Firearms (ATF)," Perito said.

A spokeswoman for the Office of the Michigan Attorney General told Reuters Health that the states chose to write the FDA because it was determined that "other nicotine-based non-traditional tobacco products like nicotine water, nicotine lip balm and nicotine lollipops" should be regulated as drugs.

She was not aware if a similar letter was sent to the ATF.

Nine states' attorneys general did not sign the letter to the FDA, which was sent in support of a petition signed by various public health organizations and medical institutions calling for FDA regulation of Ariva. Attorneys general from South Carolina, North Carolina, Georgia, Virginia, Texas, Wyoming, Kentucky, Nebraska and Missouri did not sign the letter.

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16-Year-Old Boy Gets Prozac in Mail  

By Theresa Agovino

AP Business Writer

The Associated Press

Friday, July 19, 2002

NEW YORK (AP) - A 16-year-old boy was among southern Florida residents who received unsolicited samples of the antidepressant drug Prozac in the mail in a much-criticized and highly unorthodox marketing campaign.

"I was livid," said the boy's mother, Sue Grinstead of Palm Beach. "My son knew enough not to take it, but what about the other kids?"

A spokesman for the Walgreen Co. drugstore chain, Michael Polzin, confirmed the family's account that a month's supply of Prozac was sent to 16-year-old Michael Grinstead. He said the boy's name was among others sent by a local doctors' office to a Walgreen's in Palm Beach with instructions to send them the drug samples.

"We apologize to the patients who received the drug," Polzin said by telephone. He said there were so many names on the doctors' list of intended recipients that the pharmacy called to doctors' office to confirm the prescriptions before sending them out.

The mailings already have prompted an invasion of privacy lawsuit by a 59-year-old woman who was among the recipients. Identified only by the initials S.K., she sued Eli Lilly & Co, which makes the drug, Walgreen Co, which sent it, and her doctors.

Michael's family has retained the same lawyer, Gary Farmer Jr., and plans to file a lawsuit alleging invasion of privacy and possible unauthorized practice of medicine. Under Florida law, it is illegal to prescribe a drug to a minor without consent of a parent or guardian.

The Florida Attorney General has already issued subpoenas to Eli Lilly, Walgreen and S. K.'s doctors to determine if any state laws were broken. More could be issued if warranted, said John Newton, senior assistant attorney general in Florida.

Eli Lilly has also apologized for the mailing, which it believes reached less than 150 people. The Indianapolis-based drug giant said the campaign was not an official promotion and it is trying to determine exactly who is responsible. Several Eli Lilly employees in Florida have been suspended with pay, the company said.

The mailings at first appeared to target people who were already taking an antidepressant and who might then switch to Prozac. However, Michael's mother said he had never been prescribed such a drug or even been treated for depression.

The family had used a different pharmacy, an Eckerd store, not Walgreen's. Farmer said the family is worried that Michael's name was passed along in a customer list, but Eckerd spokeswoman Tami Alderman said patient names are not given to drug companies.

"We are still trying to get to the bottom of what is going on," Farmer said. "But it looks like drug companies are taking marketing to a whole new level."

Michael's mother said the Prozac was accompanied by a letter from a doctor who is not their family's primary physician but works in the same doctors' group. The letter suggested switching to Prozac.

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FDA: Blood Pressure Drug Too Risky  

The Associated Press

Friday, July 19, 2002

WASHINGTON (AP) - An experimental blood pressure drug once heavily promoted by Bristol-Myers Squibb is too risky to be sold, government advisers said Friday. The recommendation is a serious blow to the drug, Vanlev.

Bristol-Myers had stoked expectations that Vanlev would become one of its next big sellers.

Then scientists revealed it can cause a fairly rare but life-threatening side effect, facial swelling sometimes severe enough to block the airways. For unknown reasons, it appeared to strike black patients two or three times more often than whites.

And some studies suggested Vanlev was no more effective than existing, cheaper prescriptions, while others held out hope it might prove a drug of last resort for the most difficult-to-treat patients.

So the Food and Drug Administration ( news - web sites) asked its independent scientific advisers Friday to weigh the somewhat conflicting evidence and see if Vanlev really could benefit patients. If so, the agency asked, was the help sufficient to accept the potentially lethal risk.

The advisers said no, citing the dozens of cases of swelling.

The advisory panel held out hope that Vanlev still might prove a drug of last resort for some patients. They said, however, proving that would require another clinical trial with patients who truly had failed everything else, said FDA drug chief Dr. Robert Temple.

The FDA is not bound by its advisers' recommendations but usually follows them.

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CDC: Two Cases of West Nile Reported in Louisiana

By Charnicia E. Huggins

Reuters Health

Friday, July 19, 2002

NEW YORK (Reuters Health) - Two new cases of West Nile virus were reported to health officials during the week of July 10-16, the US Centers for Disease Control and Prevention (CDC) announced Thursday.

During that same time period, 170 dead birds including 55 crows, as well as 19 mosquito pools and nine horses, were also identified as being infected with the virus, CDC officials report in the July 19th issue of Morbidity and Mortality Weekly Report.

Birds are the main carriers of the infection, which is spread by mosquitoes. Humans are only believed to catch the disease from mosquitoes, and are not thought to be able to catch it from other infected animals or from one another.

To date, there have been three cases of human West Nile virus that was reported to the CDC in 2002. In those cases the virus spread either to the brain, a condition known as encephalitis, or to the tissues surrounding the brain, which is called meningitis. All three cases, which were reported from June 10-28, were nonfatal and occurred among men in Louisiana.

According to Louisiana state epidemiologist Dr. Raoult Ratard, however, there have been seven confirmed cases of West Nile virus in Louisiana, and four additional cases that are highly suspected to be West Nile virus. The remaining cases have not yet been reported to the CDC, he told Reuters Health.

In animals, known infections have resulted in the deaths of 171 crows and 266 other birds in 20 different states and the District of Columbia this year. There have also been 23 infections reported among horses in Florida, Kentucky, Louisiana and Texas.

There is currently no treatment for West Nile infection in humans. Efforts are under way to develop a vaccine against the disease, but are not expected to bear fruit for years.

Individuals can lower their risk of being bitten by a mosquito by wearing long pants, long sleeves, and by using mosquito repellent, particularly during the late night hours when the risk of being bitten is highest, Ratard said.

Ratard added that people should not contribute to the mosquito population and should empty any standing buckets of water or other water-containing items that might attract mosquitoes.

Source: Morbidity and Mortality Weekly Report 2002;51:621.

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FDA Panel Supports Cholesterol Drug, Aspirin Combo

By Ori Twersky

Reuters Health

Friday, July 19, 2002

WASHINGTON (Reuters Health) - An advisory panel for the US Food and Drug Administration (FDA) on Thursday reversed an earlier decision and supported a product that would include both the cholesterol-lowering drug Pravachol (pravastatin) and low-dose aspirin in the same package.

The product would be marketed for the prevention of various cardiovascular events, including acute heart attacks.

The FDA's Cardiovascular and Renal Drugs Advisory Committee voted 7 to 2 in support of permitting Bristol-Myers Squibb Company to co-package and market three different doses of Pravachol with either 81 mg or 325 mg of aspirin.

The vote reversed an earlier recommendation by the same FDA advisory committee back in January. At that time, the panel advised the federal agency not to approve the Bristol-Myers Squibb application due in part to concerns that the product would limit treatment flexibility and mask patients' use of aspirin.

The committee had said that such a co-packaged regimen could lead to potential unforeseen complications such as excessive bleeding during surgery, while also prompting physicians to only prescribe the highest dose of the company's statin, limiting the potential treatment benefit.

Bristol-Myers Squibb earned the committee's backing for a revised application that was amended to include additional packages with either 20 mg or 40 mg of Pravachol. The original application was solely for a 40 mg dose of Pravachol plus either 81 mg or 325 mg of aspirin. The drugmaker further proposed a revised label to more clearly spell out that this is a combination product.

In presenting the revised application, corporate officials attempted to downplay the potential risks. They said that a co-packaged product would improve patient compliance with their physicians' prescription for low-dose aspirin, and it also would alert surgeons that the prescribed regimen included aspirin, argued Dr. Rene Belder, Bristol-Myers Squibb's executive director for clinical design.

Still, the committee decision was not unconditional. The label will have to be unique and spell out the risk factors, said the committee's lead reviewer Dr. Beverly Lorell of Beth Israel Deaconess Medical Center in Boston, Massachusetts.

"There is an issue and there is some risk here that someone will get aspirin that shouldn't," added committee member Dr. Steven Nissen, vice chairman of the Department of Cardiology at the Cleveland Clinic Foundation in Ohio.

Bristol-Myers Squibb is now anticipated to file for approval of a single combination tablet.

However, the committee members indicated that they would be less likely to support the approval of a single tablet since there are times aspirin would have to be discontinued, such as prior to surgery.

The FDA often follows its committees' recommendations, but the agency is not bound by their advice.

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Suicide Risk Factors in Bipolar Illness Identified

Reuters Health

Friday, July 19, 2002

NEW YORK (Reuters Health) - Adults with bipolar disorder are at high risk of attempting to commit suicide in their early 30s, usually within 7 to 12 years of the onset of the mental illness, researchers in Taiwan report.

In bipolar disorder, also known as manic depression, people experience periods of deep depression alternating with excessive euphoria, interspersed with periods of normal behavior. The condition can be treated effectively with lithium.

Research shows that bipolar individuals have a 25% to 60% likelihood of attempting suicide at some point in their lives. Dr. Shang-Ying M. Tsai of Taipei Medical University in Taiwan and colleagues sought to investigate the risk factors associated with suicide attempts and the point at which patients are most vulnerable.

The researchers followed 2,133 Chinese patients in Taiwan who were diagnosed with a mood disorder, and identified 41 with bipolar disease who committed suicide over the next 16 years. These patients were matched with 41 bipolar patients who did not commit suicide but were relatively similar in age, gender and date of admission to a hospital for the disease. The researchers then analyzed the differences between the two groups.

The findings were published in the June issue of the Journal of Clinical Psychiatry.

The investigators found that those who committed suicide were more likely to have had a first-degree family member who had also committed suicide. They were also more likely to have made more than one previous suicide attempt in the past 7 years.

Tsai's team also pinpointed the time in their lives when patients were most likely to commit suicide, with the most vulnerable times being two years following a hospital admission, 7 to 12 years after the onset of the disease, and before age 35.

Past studies conducted in Western societies have been muddied by the fact that people with bipolar illnesses in these societies often abuse drugs and alcohol, which may be a contributing factor in suicide, the authors note. For example, while studies have found that about 30% of people in the West with bipolar illness abuse drugs or alcohol, in the current study about 15% of the people who had committed suicide also abused drugs or alcohol.

Westerners with bipolar illness often live alone, another risk factor for suicide, while most Chinese with the disorder live with their families, the report indicates. The fact that Chinese patients are less likely to have the risk factors for substance abuse and solo living makes it easier to identify other risk factors, Tsai and colleagues point out.

The researchers hope that healthcare providers use this knowledge to help prevent their patients from trying to kill themselves. "Another way to prevent suicide in bipolar disorder is to vigorously treat the illness," the researchers conclude.

Source: Journal of Clinical Psychiatry 2002;63:469-476.

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Exercise Program Helps Elderly Stay on Their Feet

By Karla Gale

Reuters Health

Friday, July 19, 2002

NEW YORK (Reuters Health) - Healthy elderly people living on their own who exercised in a group weekly and on their own twice a week were less likely to fall, according to the results of an Australian study.

Preventing falls among older people is crucial for their health and ability to live independently, because falls often result in debilitating injuries such as hip fractures.

Dr. Lesley Day of Monash University in Victoria and colleagues randomly assigned 1,090 people aged 70 to 84 to an exercise program, home hazard management, vision improvement, or combinations of these interventions. The exercise component included a 1-hour weekly exercise class supplemented by daily home exercises. About one third of the exercises were designed to improve balance; flexibility and leg strength were also addressed.

At the end of 15 weeks, study participants who exercised showed improvements in thigh muscle strength, stability and balance. At the end of 18 months, the increase in muscle strength had disappeared, but improvements in balance remained, Day told Reuters Health.

And patients who exercised were 18% less likely to fall during the course of the study. While home hazard reduction or vision improvement alone did not prevent falls, study participants who completed all three interventions showed the most dramatic reduction in falls. Those who exercised and completed the home hazard and vision improvements were 33% less likely to fall during the study.

The investigators conclude that improved balance was behind the fall reduction among exercisers, according to the report in the July 20th issue of the British Medical Journal.

Compliance with home exercise was relatively poor, with participants working out an average of only twice weekly. "This is the lowest intensity group-based exercise program shown to be effective in reducing falls among community-dwelling older people," Day told Reuters Health.

The Australian team estimated that 14 clients would need to receive the exercise intervention to prevent one fall annually. Only half that number would need to participate if all three components were included in the intervention.

"Participation in an exercise intervention is appropriate for senior citizens living on their own, who are of relatively good health, and who have their family doctor's approval," Day said. She added that community agencies and local government organizations can deliver such interventions effectively.

Source: British Medical Journal 2002;325:128-131.

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Data Flaw May Inflate Cancer Therapy Effectiveness

Reuters Health

Friday, July 19, 2002

NEW YORK (Reuters Health) - The total number of deaths attributed to cancer in the United States may be underestimated by 1% to 2%, according to two researchers at the Department of Veterans Affairs Medical Center in White River Junction, Vermont.

The undercounting appears to stem from the way doctors classify a person's cause of death. Typically, physicians consider deaths within 30 days of a surgical procedure to be "treatment-related," regardless of whether or not the patient had cancer. So a death actually brought on by cancer may be classified as treatment-related.

Although 1% to 2% seems like a small increase, Drs. H. Gilbert Welch and William C. Black caution that this underestimation may mislead physicians about the true benefit of a particular treatment.

To make their case, Welch and Black point out that between 1973 and 1998 overall cancer mortality decreased by 0.3%--and when deaths from lung cancer are ruled out, the decrease in cancer-related deaths jumps to 10.7%.

"Thus, a modest proportion of the reported decrease in non-lung-cancer mortality could be a result of the misclassification of deaths from cancer-directed surgery," the researchers write in the July 17th issue of the Journal of the National Cancer Institute.

"Equally important, this misclassification may be indicative of more widespread confusion about how to code treatment-related deaths in patients with cancer," the authors add. "Coding" is the way that diseases and deaths are classified for record-keeping, billing and research.

The investigators examined mortality data from the National Cancer Institute for patients who died within a month of being diagnosed with one of 19 common cancers from 1994 to 1998. All the patients underwent surgery to treat their cancer.

"Among 4,135 patients with only one cancer who died within 1 month of diagnosis and cancer-directed surgery, the proportion of deaths not attributed to the coded cancer was 41%," the authors report.

Welch and Gilbert suggest that one solution might be to attribute all deaths that occur within 1 month of treatments--including surgery, radiation therapy or chemotherapy--to the cancer for which these treatments were initiated.

"The more we look for cancer and the more we treat people with the diagnosis, the more important it will be to properly assign diagnostic and treatment-related deaths," the authors conclude. "Otherwise, observed mortality trends may make harmful interventions appear beneficial."

Source: Journal of the National Cancer Institute 2002;94:1066-1070.

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FDA Urges Wider Use Of Heart Device
Defibrillator Could Aid Several Million

By Marc Kaufman
Washington Post Staff Writer
The Washington Post

Friday, July 19, 2002

The Food and Drug Administration yesterday significantly widened the range of patients who could be treated with the kind of heart defibrillator implanted in Vice President Cheney, after concluding the device could save thousands of lives.

Under the new assessment, 3 million to 4 million Americans with a history of heart attack and with depressed heart functions would be eligible for the device. Previously, the FDA had approved the defibrillator only for patients who had survived cardiac arrest and had undergone an invasive test to determine they were suitable candidates.

According to FDA medical officer Helen Barold, the agency was convinced by research on the implantable defibrillator made by Guidant Corp. In that study of more than 1,200 patients, those with the device implanted were 31 percent less likely to die over a two-year period than those being treated medically.

"The device itself is saving people's lives," Barold said. "Patients with a history of heart attacks and with depressed heart functions should discuss with their doctors whether they are candidates for the device."

The implantable cardioverter defibrillators, or ICDs, can sense abnormal heart rhythms and deliver a shock to restore a normal heartbeat. The device, a thin metal oval, is implanted under the skin of the upper chest or the abdomen and is connected to the heart muscle through a vein with thin insulated wire leads.

Implanting a defibrillator costs about $30,000, and it could prove to be very expensive for the government and private insurers.

While the FDA approved a significantly wider use of ICDs, it has no control over whether the federal Medicare program or private health insurers will pay for it. Generally, they do pay for its limited use now and are considering whether to expand coverage to follow the FDA approval.

Researchers estimate that 80,000 defibrillators are implanted annually now, but that number would jump with the new approval. In addition to the 3 million to 4 million Americans who might become eligible now, an additional 400,000 would be in line for an implant yearly based on their new heart disease.

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Two Contract HIV From Transfusions  

The Associated Press

Friday, July 19, 2002

ST. PETERSBURG, Fla. (AP) - Two people contracted HIV ( news - web sites) from blood transfusions after tests failed to find the virus because the donor's infection was in its early stages, officials said.

The incident marks the second time since the nation's blood banks implemented new screening technology in 1999 that HIV has been transmitted through a transfusion, according to Florida Blood Services. The first case infected a man in San Antonio, Texas, in September.

The victims, one young adult and one in the mid-60s, were told Wednesday they contracted HIV from blood and plasma transfusions in Hillsborough and Pinellas county hospitals, according to Florida Blood Services, which processed the blood.

The donor gave infected blood in March, but had contracted the disease so recently that tests did not detect it, said German LeParc, chief medical officer for the blood bank. The virus takes seven to 10 days to build up sufficiently for detection.

When the donor returned to give blood again in May, the blood tested positive for HIV and that donation was destroyed, LeParc said. The donor was notified and officials began tracking down patients who received the previous donation.

LeParc said the donor, who was not identified, first gave blood on Sept. 12, when people rushed to blood banks in the wake of the terrorist attacks, then became a regular.

The infected donor had answered a list of standard questions intended to weed out high-risk donors, LeParc said. There was no indication that the donor had lied and concealed any such behavior, officials said, adding the donor was stunned to learn of the infection.

Five people who received blood from earlier donations tested negative and wouldn't need to be tested again, said Dan Eberts, spokesman for Florida Blood Services.

"Had they been infected there would have been ample time for incubation," he said.

Experts said the chance of getting HIV, the virus that causes AIDS ( news - web sites), from donated blood is one in 2 million to 3 million transfusions, and they stress that the nation's blood supply remains very safe.

On the Net:

Florida Blood Services: http://www.fbsblood.org

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Britain may ban kava, U.S. will study  

From the Science & Technology Desk
United Press International

Friday, July 19, 2002

LONDON, July 19 (UPI) -- A British government agency is considering banning the herbal remedy kava because it has been linked with severe liver toxicity, but the move probably will not prompt the United States to do the same as it keeps a watchful eye over the situation, officials told United Press International.

In a letter dated Thursday, the chairman of the advisory panel the Committee on Safety of Medicines recommended prohibiting the sale, import, and supply of unlicensed products containing kava in the United Kingdom after reports of 68 cases of liver toxicity worldwide resulting in six liver transplants and three deaths. There have been three cases of severe liver side effects among kava users in England.

The move comes shortly after the German government revoked the licenses of authorized products containing kava kava because of health concerns. CSM Chairman Professor Alasdair Breckenridge told UPI other European countries have implemented strict regulations on kava.

"In France, Portugal and Spain, kava products have been suspended, with the exception of some homeopathic preparations," Breckenridge said. "There has also been a voluntary withdrawal of kava kava products by the herbal sector in Ireland."

Despite events across the Atlantic, U.S. rules on kava remain unchanged, though the government, independent organizations and scientific experts are keeping in contact with European scientists and officials regarding kava's potential side effects. There are no plans to recommend banning products containing kava.

"The FDA will continue to investigate the relationship, if any, between the use of dietary supplements containing kava and liver injury and will alert consumers, if necessary, when more information becomes available," a Food and Drug Administration official told UPI.

An FDA advisory bulletin on March 25 warned consumers about kava. "Liver-related risks associated with the use of kava have prompted regulatory agencies in other countries, including those in Germany, Switzerland, France, Canada, and the United Kingdom, to take action," the bulletin said. "Although liver damage appears to be rare, FDA believes consumers should be informed of this potential risk." To date, the FDA has received one report of a young healthy female kava user who required a liver transplant and several other reports of kava users developing liver problems, such as jaundice.

However, Mark Blumenthal, founder and executive director of the American Botanical Council and a professor at the College of Pharmacy at the University of Texas at Austin, said a cause-and-effect relationship between kava use and liver complications has not been established.

"Most of the cases being reported are associated with people who have pre-existing liver disease or (use) kava and alcohol," or people who took kava with prescription medications that should not be combined with the herb, Blumenthal told UPI. "When you look at the number of kava cases reported tied to liver effects and you look at the number of millions of dosages that are used, some reports suggest kava is no worse than some of the drugs prescribed for anxiety."

Kava -- also called kava kava -- is an herb indigenous to the South Pacific and is used primarily to treat insomnia and anxiety. Throughout the South Pacific, it is drunk frequently as a tea and there have been few incidences of liver problems, Blumenthal explained.

Because herbal remedies can be bought anywhere, he said, it is likely there will be more reports of side effects among kava users because they could be taking the supplement inappropriately. "Why not have proper warning labels on herbs?" he said. "The FDA has not in some cases fully exercised its authority in the area of regulating herbs."

Under the 1994 Dietary Supplement Health and Education Act, herbal products are not required to be tested scientifically for safety or efficacy as is required by the FDA of all drugs sold in the U.S. market. In Europe, many herbs are more tightly regulated and often are prescribed by physicians and dispensed through pharmacies, though anyone can purchase supplements on the Internet at their own risk.

"People shouldn't self-prescribe kava," said Lise Alschuler, clinical medical director at Bastyr University, in Seattle, a school devoted to the study of naturopathic and botanical medicine. "Kava, the herb itself is not inherently dangerous." However, patients taking kava should do so under their doctor's supervision, she said.

Because of Europe's regulations over dietary supplements, there is more accurate reporting of side effects among supplement users, Alschuler explained. It is possible problems linked to kava use could be underreported in this country.

"We're certainly looking at the data in Europe and from that, we're being cautious," she said. But banning kava products appears heavy-handed, Alschuler added. "The recommendation that's coming out of England is a bit of a over-reaction."

(Reported by Katrina Woznicki, UPI Science News, in Washington)

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Brains of mice enlarged Experiment could aid research into brain tumors, retardation

By Tim Friend
USA TODAY

Friday, July 19, 2002

With the shuffle of a single gene, scientists have found a way to increase the size of brains in mice in a way that mimics the pattern of growth in the brains of humans, researchers report today.

The mice didn't develop intelligence and culture, but the experiment may offer insights into the evolution of intelligence and the cause of some forms of mental retardation and brain tumors.

''We were examining different hypotheses about why the brain gets bigger in evolution,'' says Anjen Chenn of Harvard Medical School in Boston. ''I think this gives us an idea of one way to build a bigger brain.''

The key is a protein called beta catenin, which is found in tissues throughout the body.

Beta catenin is an important protein involved in the signals that trigger or promote cell division. When it is active, cells divide. When its job is done, it normally breaks down, and cells stop dividing. Tumors all arise from unregulated cell growth. There is evidence that a more stable form of beta catenin is a culprit in a common childhood brain tumor called medulloblastoma and also plays a role in colon cancer.

The new study, led by neurogeneticist Christopher Walsh at Beth Israel Deaconess Medical Center in Boston, set out to determine what role beta catenin plays in the growth of the cerebral cortex, better known as gray matter. Human brains have 1,000 times more of it than mice. It grows in radiating patterns of cells, in thin sheets like a layered cake. To make room for all of this extra gray matter, the thin sheets grow in folds, which extends the surface area of the brain without having to grow a skull the size of a beach ball. The folds give the human brain its characteristic convoluted appearance.

Mouse brains are smooth and don't have much of a cerebral cortex. In some cases, mentally retarded people also have smoother brains than people with normal intelligence do.

Chenn and Walsh created a strain of mice with the more stable form of beta catenin. The mice grew a cerebral cortex about twice as large as normal with convolutions like those in human brains. The sheets of brain cells also grew in the radiating, layered pattern found in humans.

The findings, reported in today's edition of Science, suggest that beta catenin might play a key role in the development of the cerebral cortex and thus in the evolution of intelligence in humans and other higher mammals. Walsh also wonders whether a lack of beta-catenin signaling, due perhaps to a faulty gene, is responsible for the smaller cerebral cortex found in some mentally retarded people.

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Study links abnormal stem-cell activity to brain tumors

By Joyce Howard Price
The Washington Times
Friday, July 19, 2002

University of Florida researchers say they have found the first evidence that the most common type of brain tumors that strike adults are derived from abnormal stem cells in the brain.      

The researchers say their findings could lead to new therapies that would be based on rehabilitating the abnormal stem cells, rather than trying to kill the tumor cells with radiation or chemotherapy.      

"This is incredibly exciting research, which suggests a novel form of adjuvant therapy for patients with glioblastoma tumors [a particularly rapidly growing, aggressive form of adult brain tumor] for which curative therapy is essentially nonexistent," said Dr. Stratford May Jr., program director for the university's Shands Cancer Center in Gainesville.      

The discovery by the research team, which included neuroscientist Dennis Steindler of the Shands Center, is based on extensive laboratory studies of brain cells from malignant gliomas, which represent about half of the 17,000 brain tumors diagnosed yearly in the United States. The brain cells used were from tumors surgically removed from human patients and then cultured under conditions that allowed researchers to isolate the stem cells.      

"The UF investigators have found that glioblastoma tumor cells [a type of malignant glioma] derived from brain tumors of patients can maintain their stem-cell properties and may be induced to differentiate [mature] at least in the test tube," Dr. May said.      

"This suggests that under appropriate therapeutic conditions, any brain tumor cells lurking after surgery and radiation therapy could be induced to turn into normal cells if the right conditions were identified and could be administered," he explained.      

Stem cells, also known as progenitor cells, are the building blocks for all tissues. They can develop into bone, brain, muscles, skin, or any other organs.      

The research appears in the July issue of the international journal, GLIA. Other authors of the paper were UF neuroscientists, Tanya Ignatova and Valery Kukekov.      

In an interview yesterday, Mr. Steindler said it appears glioma tumor formation occurs when stem cells, originating in a particular part of the brain, begin to continually divide and regenerate but then "go too far" in the process of reproduction.      

"Our findings suggest that the stem-cell population living in the brain are there to repair [damage to the brain] but because they proliferate, they can be targets of environmental or genetic mutations," Mr. Steindler said.      

He said there has been speculation in recent years that brain tumors were linked to brain-stem cells. "We believe we have the first evidence this is true, and that it starts with stem cells that may have been produced in the region we call the brain marrow, near the brain's central core and the fluid-filled ventricles," he said.      

His research colleagues said in a statement that when they grew the surgically removed glioma cells in culture, they saw cells that behaved like stem cells but displayed abnormal growth. Using an analytical technique developed by Miss Kukekov, they found that the stem cells and their progeny also contained genes different from those found in normal brain tissue.      

Mr. Steindler said the researchers concluded the errant stem cells are the "culprit," not innocent bystanders, in brain tumor formation.     

He said the researchers believe there could be a link between some types of brain injuries that actually precipitate brain marrow stem cells to move toward the problem area in a bid to repair it. "But while doing so, because these cells have to repopulate themselves to carry out the healing mission, [they] may go too far and produce tumors," Mr. Steindler said.      

This procedure, he said, explains why malignant glioma cells are "almost impossible" to kill with radiation or drugs. "If we're dealing with abnormal brain marrow stem cells the stem cells are in the mode of trying to build and are highly resistant to standard cancer therapies," he explained.      

Before any of this can be useful to humans with brain tumors, the UF scientists will be testing their findings on animals.      

Asked if the UF findings could prove to be a breakthrough in brain cancer treatment, Mr. Steindler said, "In this new world of regenerative medicine, I think the answer is yes for the short run, the findings will make neuro-oncologists pay attention to our new ideas."      

Key goals in follow-up studies will be to characterize genes involved in gliomas and to determine how they are turned on and off. The ultimate goal, Mr. Steindler said, is to make brain tumors "not terminal."

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Mothers Who Nurse Have Less Breast Cancer Risk
Study Cites Disease Rate In Developed World

By Susan Okie
Washington Post Staff Writer
The Washington Post

Friday, July 19, 2002

Breast-feeding is a major factor that helps to reduce a woman's lifetime risk of developing breast cancer, according to a new analysis of research data from 30 countries.

The relatively high breast cancer rates found in developed countries are largely explained by the fact that women in those countries have chosen to have few children and to breast-feed them briefly or not at all, according to the detailed analysis of 47 studies by a British research group.

"It's really the number of children and the duration of breast-feeding that is the key to the differences between developed and developing countries" in breast cancer rates, said Valerie Beral, an Oxford University epidemiologist who led the project. "It really changes the way one looks at the cause of breast cancer."

Researchers have long known that having a full-term pregnancy before the age of 30 lowers breast cancer risk and that having additional pregnancies further reduces the chances of developing the disease. For the first time, the analysis confirms that breast-feeding itself can protect against breast cancer.

"This is a spectacular piece of work," said Miriam Labbok, a senior adviser on infant and young child feeding at UNICEF in New York. "The conclusion that if women breast-fed, they would bring their cancer rate down is highly substantiated."

The analysis found that a woman's relative risk of breast cancer declines by 7 percent with each birth and by an additional 4.5 percent for each year that she breast-feeds. Although those figures translate into modest risk reductions for an individual, the researchers concluded that if all women in developed countries breast-fed their infants for an extra six months, about 25,000 cases of breast cancer -- or about 5 percent of cases -- would be prevented each year. Researchers speculate that breast-feeding may provoke hormonal or tissue changes that protect against cancer.

The new findings help explain why breast cancer rates had been rising in developed countries while rates in developing countries remained relatively low -- a trend that has baffled scientists. Public health researchers and cancer activists have tended to focus on other risk factors, such as hormone use, diet and obesity, that women can more easily modify or can address later in life.

Other researchers cautioned that those other risk factors were still important. "All of the risk factors that we look at are relevant," said Jacques Rossouw, director of the federally funded Women's Health Initiative. "In looking at your breast cancer risk, don't hang it all on what your history of breast-feeding was."

The finding that the duration of breast-feeding affects women's subsequent breast cancer risk has major political and societal implications. In the United States and other developed countries, mothers of infants often find it difficult or impossible to keep breast-feeding once they return to work.

In the United States, 70 percent of new mothers are working 30 hours or more per week by the time their infant is a year old, said Cindy Pearson, director of the National Women's Health Network. "The majority of women do choose to start breast-feeding, but it doesn't last very long," she said. "It's going to take some bigger political changes" to change that pattern. "If this helps, great."

The findings, published in tomorrow's issue of the journal the Lancet, add to the many recognized benefits of breast-feeding for children, such as better nutrition, a reduction in allergies, better immunity to infections and even higher intelligence in adulthood.

"Certainly we know, from other health perspectives, that it's good to breast-feed your child for as long as possible, at least for a year," said Louise A. Brinton, chief of the environmental epidemiology branch of the National Cancer Institute. "The problem is . . . it appears to be extended breast-feeding that's the protective factor . . . . In developed countries, the duration is usually fairly limited."

Beral said the independent effect of breast-feeding on subsequent cancer risk has been difficult to establish because it is so closely tied to reproductive history and because much of the previous data has come from developed countries, where most women tend to breast-feed for only a few months. Some smaller studies have indicated that breast-feeding may be protective, but researchers said it took an analysis of all the available data from many countries to convincingly separate the protective effect of breast-feeding from that of having a full-term pregnancy.

"If you look back to the 17th century or even earlier, people knew . . . that nuns had high rates of breast cancer," she said. "People have thought for centuries that childbearing and breast-feeding were important."

Hundreds of researchers in the Collaborative Group on Hormonal Factors in Breast Cancer collected and reanalyzed data from 47 epidemiological studies of breast cancer in 30 countries. Altogether, the studies contained information on 50,302 women with breast cancer and 96,973 women without cancer who served as controls. Researchers compared information on breast cancer rates in developing countries, where in 1990 women averaged 6.5 births and breast-fed each child for two years, with those in developed countries, where women averaged 2.5 births and breast-fed each child for about three months.

Among countries that contributed at least one study, the proportion of women who had given birth and who had breast-fed at all was lowest in the United States -- 50 percent. In developing countries, Japan and Scandinavia, more than 90 percent of such women had breast-fed. Researchers first determined the protective effect of pregnancies on breast cancer risk among women who had never breast-fed, then looked for any added effect of breast-feeding.

Women with breast cancer averaged fewer children (2.2) than women who did not develop the disease (2.6). Twenty-nine percent of mothers who developed breast cancer had never breast-fed, compared with 21 percent of mothers who did not have cancer.

For an individual, the reduction in risk conferred by a year of breast-feeding is small. For example, in the United States, a woman's average lifetime risk of developing breast cancer is about 12.5 percent. According to the study's conclusions, an additional year of breast-feeding would lower that lifetime risk to about 12 percent.

But in developing countries, until recently, it was common for a woman to spend more than 10 years of her life breast-feeding. The protection afforded by childbearing and breast-feeding cumulatively explains almost all of the observed difference in breast cancer rates between developed and developing countries, Beral said.

She added that the impact of breast-feeding on breast cancer risk is far greater than the effects of hormone use and diet. "But in terms of public health prevention, clearly it's not realistic to say, 'Oh, let's go have five children and breast-feed each for two years,' " she added.

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Treatment Delays 'Mad Cow'-Like Disease in Mice 

By Amy Norton

Reuters Health

Friday, July 19, 2002

NEW YORK (Reuters Health) - An experimental treatment can prolong the lives of mice infected with abnormal proteins like those that cause "mad cow" disease, German scientists report.

The therapy uses short strands of genetic material known to stimulate "innate" components of the immune system. And researchers found that it delayed death in mice exposed to the agent that causes scrapie, a type of transmissible spongiform encephalopathy ( news - web sites) (TSE) that strikes sheep and goats.

Other TSEs include bovine spongiform encephalopathy (BSE ( news - web sites))--or mad cow disease--and variant Creutzfeldt-Jakob disease ( news - web sites) (vCJD), the human version of mad cow thought to be transmitted via BSE-tainted beef. These diseases are believed to be caused by proteins called prions that, in an abnormal form, are infectious. Both vCJD and forms of CJD not related to mad cow are rare, invariably fatal brain-wasting conditions.

In the new study, reported in the July 20th issue of The Lancet, scientists treated mice within hours of transplanting scrapie-infected brain tissue into the animals. The therapy, called CpG oligodeoxynucleotide 1826, involved specific arrangements of genetic material known to stimulate the innate immune system--immune cells that launch a type of general, "non-specific" response to foreign invaders.

According to the study authors, led by Dr. Hans Kretzschmar of Ludwig-Maximilians-Universitat in Munich, a possible reason the immune system does not normally mount an attack against prions is because these proteins lack nucleic acids (genetic material such as DNA and RNA).

The researchers found that the mice they treated lived 38% longer than exposed mice not given the therapy. In addition, animals treated 7 hours after scrapie-prion exposure and then daily for 20 days were disease-free for more than 330 days, on average, the report indicates.

"Whether repeated administration has the potential to totally prevent infection remains to be seen," Kretzschmar's team writes.

But while one expert called these findings "important," he also noted that the study animals were not "sick" when given the therapy.

It would be "really interesting" to see whether treatment has an effect once prion disease is established in the central nervous system, Dr. George A. Carlson of McLaughlin Research Institute in Great Falls, Montana, told Reuters Health. Carlson wrote an editorial published with the report.

The editorialist also pointed out that this is not the first treatment that has been shown to delay the onset of scrapie illness in experiments.

According to Carlson, all of these findings underscore the need to develop sensitive tests for prion infection. If therapies like the one in this study turn out to work in humans, they would "most probably" have to be given shortly after prion exposure, he noted.

Source: The Lancet 2002;360:184, 229-230.

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Don't Be in the Dark About Vitamin D 

HealthScoutNews

Friday, July 19, 2002

FRIDAY, July 19 (HealthScoutNews) -- Sunlight and the vitamin D it delivers is good to the bone.

However, what do you do when the sun doesn't shine?

Getting 10 to 15 minutes of sunlight three times a week should be enough to help your body produce vitamin D, which is essential for the development of strong bones and teeth and for the prevention of osteoporosis.

If you're short on sunshine, you can still get the vitamin D your body needs, says an article in the July issue of the Mayo Clinic Women's HealthSource.

Here are some tips:

  • Eat foods that provide vitamin D. They include milk, liver, egg yolks, fish and cereal fortified with vitamin D.

  • Supplements can also deliver the required vitamin D. The Mayo Clinic information says a supplement with 400 international units (IU) may benefit bone health in women aged 51 to 70. Women older than 70 should get 600 to 800 IU each day.

More Information

The National Institutes of Health has more information on vitamin D.

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Not Just Fido's Problem 

HealthScoutNews

Friday, July 19, 2002

(HealthScoutNews) -- If you have a dog or a cat, you've probably taken steps to make sure they don't get fleas. But if they do, watch out.

The Nemours Foundation says children who play with flea-ridden pets can suffer bites themselves. The bites usually happen in clusters of three or four and appear as small, red bumps.

The best treatment is to wash the bumps with soap and water and to avoid scratching. Calamine lotion can help alleviate itching.

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High Blood Sugar and Strokes 

HealthScoutNews

Friday, July 19, 2002

FRIDAY, July 19 (HealthScoutNews) -- People who suffer a stroke and have high blood sugar face a greater death risk than stroke victims with normal blood sugar levels.

So says a study in a recent issue of the journal Neurology.

The study examined medical records of 656 stroke patients hospitalized over a five-year period. More than 40 percent of them had high blood sugar levels. Those people were at greater risk of death 30 days, 1 year and 5 years after their stroke than those with normal blood sugar levels.

The stroke patients with high blood sugar levels also had longer and more expensive hospital stays, the study says.

The study was done by researchers from the Indiana University School of Medicine, the Richard L. Roudebush Veterans Administration Medical Center, and the Regenstrief Institute for Health Care.

More Information

The American Diabetes Association provides more information on these topics.

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E. Coli Slips Through Some UV Water Purifiers 

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews

Friday, July 19, 2002

FRIDAY, July 19 (HealthScout News) -- Ultraviolet lamps, which are increasingly being used for home and public water purification, are not all effective in eliminating Escherichia coli bacteria from drinking water.

That's the disturbing finding of a new study from Canadian researchers, who discovered that commonly used low-pressure UV lamps can't prevent the bacteria from regenerating their DNA after exposure. However, medium-pressure lamps work better, according to the scientists, from the University of Waterloo in Ontario, whose study appears in the July issue of Applied and Environmental Microbiology.

"Bacteria have been around for millions of years, and they have been exposed to the sun for millions of years, so it's not surprising that they would develop a mechanism to repair themselves after UV exposure," says Peter M. Huck, a water treatment engineering professor who participated in the study.

The research becomes significant as more cities and towns are moving toward UV water treatment. Seattle is building such a system, and Phoenix, Los Angeles, New York City, Atlanta, San Francisco, Detroit, Salt Lake City and Portland, Ore., are testing the technology.

UV radiation has been used extensively in Europe for 50 years to kill bacteria in water and food, but it has only become viable in North America over the last decade. Its most recognized use is eliminating Cryptosporidium from water, a pathogen that contaminated Milwaukee's drinking water nine years ago, killing more than 100 people and making 400,000 more sick.

The technology, as it becomes affordable, is also being included in more and more home water treatment systems, researchers say. Its popularity is expected to increase as federal authorities require smaller towns to treat Cryptosporidium and protect against bioterrorism.

"I think 20 years from now you're going to see this technology on a widespread basis," says Albert Ilges, a project supervisor for the American Water Works Association Research Foundation in Denver.

"As people become more and more concerned about the byproducts of chlorination, UV is being considered as an option," adds Jim Sliwa of the American Society of Microbiology.

The Waterloo study, sponsored by the Natural Sciences and Engineering Research Council of Canada, comes at a critical time as cities, towns and homeowners are picking between two competing UV technologies: low- and medium-pressure lamps.

The researchers targeted E. coli because it's commonly used as an indicator of disinfection. They also used small doses of radiation to simulate home-treatment systems or a larger system that is clogged. At much higher doses, low-pressure lamps are better able to eliminate E. coli, they say.

However, at the lower doses, the study found bacteria could bounce back after exposure to a low-pressure lamp. With a medium-pressure lamp, the bacteria could not repair their DNA, making it impossible for them to reproduce. The higher pressure lamps attack bacteria from a spectrum of wavelengths, while weaker ones emit a single wavelength.

"It's sort of like the difference between a light bulb and a fluorescent glow lamp," explains lead researcher Janis L. Zimmer.

However, Ilges, who has supervised a number of UV treatment installations, argues the evidence isn't clear. UV is generally used along with other purifiers, and the choice between low- and medium-pressure lamps often rests on other considerations, such as water flow, available space and energy use, he says.

"There's not definitive, widely accepted evidence either way," he says. "My perspective is that one shoe doesn't fit all. For certain applications, one would choose one technology over the other."

Moreover, he argues that E. coli is less of a threat to drinking water than the other toxins that might travel with it, such as Cryptosporidium, which can't regenerate its DNA after UV exposure.

"Most of the strains of E. coli are not pathogenic to humans. Traditionally, it has been used to check for other contaminants," Ilges says.

According to the Centers for Disease Control and Preventions, while there are hundreds of strains of E. coli, there has been relatively few U.S. health outbreaks as a result of water contamination. The four known harmful strains most generally spread through food, such as uncooked hamburger, infected lettuce and sprouts, and unpasteurized milk and juice.

What To Do

To learn about ultraviolet light, go to the International Ultraviolet Association.

To find out how your local water system rates with the Environmental Protection Agency ( news - web sites), go here.

For more on E. coli, check out the Centers for Disease Control and Prevention.

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THURSDAY, JULY 18, 2002

Postpartum Depression: Not Just the 'Baby Blues' 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Thursday, July 18, 2002

THURSDAY, July 18 (HealthScoutNews) -- Many a new mother struggles with sadness, anxiety, even crying jags just after giving birth. For most, these feelings will disappear in a few days.

However, for about a half a million American women every year, the feelings won't go away and will probably get worse.

Those are the 13 percent of new mothers who suffer from postpartum depression, says an article in today's issue of The New England Journal of Medicine ( news - web sites).

"We wrote this article to make people aware that this is a major health problem," says lead author Dr. Katherine Wisner, a professor of psychiatry, pediatrics, obstetrics and gynecology at the University of Pittsburgh School of Medicine.

"Women don't need to suffer with this illness. Treatment is available and effective," says Wisner, who worked at the University of Louisville School of Medicine when the article was written.

Wisner and her colleagues recommend doctors make patients aware of the symptoms of depression during and after pregnancy, and that they screen the women for depression using a 10-question test.

Symptoms of postpartum depression include:

  • Pervasive sadness or depressed mood

  • Loss of interest in activities that used to be pleasurable

  • Severe anxiety

  • Loss of appetite, which is often accompanied by weight loss

  • Sleep problems

  • Feelings of worthlessness and inappropriate guilt

  • Difficulty concentrating

  • Recurrent thoughts of death or suicide

If depression is diagnosed, Wisner says, there are several treatment options. One is psychotherapy. Another is medication. Wisner says many of the newer antidepressants, like Zoloft and Paxil, can even be used by breast-feeding women.

Dr. Boris Petrikovsky, chairman of the department of obstetrics and gynecology at Nassau University Medical Center in East Meadow, N.Y., says postpartum depression can go undiagnosed because it is difficult to distinguish from the more common "baby blues."

Between 40 percent and 85 percent of all women experience the "baby blues," which usually lift quickly without intervention, says Ana Rivas-Vazquez, a psychologist with Baptist Health South Florida in Miami. They cause feelings of sadness, irritability, confusion and anxiety, and peak around the fourth day after delivery.

"If it's not gone by day 10 postpartum, it's not the blues, it's depression," Wisner says.

In rare cases, postpartum depression can progress to postpartum psychosis, a very serious illness that needs immediate treatment. If a new mother shows signs of hostility toward her baby or has thoughts of harming the baby, Petrikovsky says he immediately refers them to a psychiatrist.

Last March, a Texas woman, Andrea Yates, was sentenced to life in prison after she was convicted of drowning her five children in a bathtub. Her lawyers had argued Yates was a victim, too -- of postpartum depression, which drove her to commit the killings.

Petrikovsky says it's important for doctors to get to know their patients, so they can be on the lookout for signs of trouble. He also feels it would be wise for doctors to have a nurse call patients two weeks or so after delivery to see how they're feeling.

Those most at risk for postpartum depression are women who have had previous episodes of depression and those with poor or abusive relationships with their spouse, says Rivas-Vazquez.

The most important thing for women to know is that having postpartum depression doesn't mean they aren't good mothers, says Rivas-Vazquez. She says that women often don't seek treatment because they feel guilty about their depression.

"Postpartum depression is a frequent condition that is very treatable, and it shouldn't have any negative connotations," Rivas-Vazquez says.

What To Do

For more on postpartum depression, visit The National Library of Medicine or the American Academy of Family Physicians.

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How Low Can You Go? 

HealthScoutNews

Thursday, July 18, 2002

 (HealthScoutNews) -- You've no doubt heard about the dangers of high blood pressure. So, the lower your blood pressure goes, the better, right?

That's true, up to a point. As a general rule, the American Heart Association ( news - web sites) says any reading below 120/80 is good. Except if your pressure gets too low. That can lead to feeling lightheaded, fainting and even heart attack.

If you do have extremely low blood pressure, your physician should investigate the reason. Common causes for the problem are certain medications, illnesses or shock.

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Bladder Cancer Options 

HealthScoutNews

Thursday, July 18, 2002

THURSDAY, July 18 (HealthScoutNews) -- Invasive bladder cancer can be treated without removing the bladder, offering patients a better quality of life.

That's the conclusion of Massachusetts General Hospital researchers in a study published in the July issue of Urology.

The study says a combination of surgery, chemotherapy and radiation has a long-term cure rate that equals that of bladder removal.

A third of all bladder cancers are invasive, which means the tumor penetrates the bladder's muscular layers. The standard method of treatment is to remove the bladder and nearby organs.

More Information

The National Cancer Institute has more information on bladder cancer.

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Exercise Message Falls on Couch Potatoes' Deaf Ears 

By Felicity Stone
HealthScoutNews Reporter

HealthScoutNews

Thursday, July 18, 2002

THURSDAY, July 18 (HealthScoutNews) -- What will it take to shove sedentary Americans off the couch and onto the treadmill?

Not even computerized telephone pep talks appear to do the trick, a new study reports.

With idleness recognized as a risk factor for chronic ills such as coronary artery disease and high blood pressure, researchers are constantly seeking ways to get people off their butts and into their sneakers, says Bernadine M. Pinto, a psychologist at Brown Medical School/Miriam Hospital in Rhode Island.

Seventy-five percent of Americans don't get their recommended daily workout, which is 30 minutes of moderately intense exercise, she says.

So, Pinto and her colleagues designed a computer-based telephone system they hoped would surmount common roadblocks to fitness, and then tested it on 298 adults.

"Like telephone counseling offered by human counselors, we expected [the system] would overcome problems with scheduling and attending face-to-face meetings," Pinto says. "Unlike human counselors, [the system] would be accessible at any time and less likely to be perceived as judgmental."

The researchers gathered their sample group from the patient files of a Boston medical center and sent out letters explaining their objective. From those who expressed interest in the program, the researchers randomly selected people who were sedentary and ate lots of high fat and processed foods.

The participants, mostly female (72 percent) and 46 years old on average, were given a telephone number to call once a week.

When they did, half of them heard a computerized voice that asked them questions about their physical activity for the past week, and encouraged them to set new goals for the next seven days. The message also advised them what activities they could engage in that would qualify as moderate workouts.

The other half of the sample group received pep talks to improve their eating habits, but the computerized voice never mentioned exercise.

Depending on people's responses -- punched in on their telephone keypads -- calls lasted between five and 10 minutes.

The researchers then sent the patients and their physicians computer-generated monthly reports documenting exercise levels.

At first, the results looked promising. After three months, the researchers found that when automated counselors prompted the participants to exercise, they were more likely than the comparison group to do so. In fact, 26 percent of the first group was working out 30 minutes a day, compared to 20 percent of the second.

However, by the six-month mark, those receiving exhortations to exercise had pretty much unlaced their sneakers and resumed their idle ways. There was no longer any significant difference in exercise between the two groups.

"Unfortunately, the results weren't maintained so we have to think about what we could improve next time around to make certain people continue to use the system," says Pinto. "The issue with exercise is not only to get people to become active, but to stay active."

She believes one drawback was the researchers placed the onus of initiating the phone calls on the participants. In addition, some people said they'd have preferred to talk to a human being, while others said they would have liked someone to phone and remind them to make the weekly call.

Results of the study appear in the August issue of the American Journal of Preventive Medicine.

The researchers had greater success with the comparison group, whose diets improved and stayed that way for the length of the six-month trial. Those results formed the basis of a separate study reported in the March/April 2001 issue of the American Journal of Health Promotion.

Dr. Robert Silverstein, a cardiologist and director of the Preventive Medicine Center in Connecticut, says that despite the new study's disappointing outcome, finding ways to boost America's fitness levels should be an ongoing effort.

"Anything you can do to get people moving and eating healthily has merit. The more reminders, the more stimuli you can give people to exercise, to lose weight, to keep a positive attitude, the better off you are," he says.

What To Do

To learn more about the health benefits of exercise, visit the National Institute on Aging or Georgia State University.

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Uncovering the Secret of Brain Size 

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Thursday, July 18, 2002

THURSDAY, July 18 (HealthScoutNews) -- Your brain isn't wrinkled because it's old. Instead, it's scrunched into the skull -- picture a winter coat jammed into a gym locker and you'll get the idea.

Now, researchers think they've discovered a protein that may be the reason the human brain is too big for its britches.

If they're right, researchers in Massachusetts may be closer to understanding how the human brain becomes much larger than in other animals, giving people the power to speak, read and plan.

"The vast difference in brain size between a human and, say, a dog makes us the most dangerous creatures on the planet," says Dr. James Grisolia, a neurologist with Scripps Mercy Hospital in San Diego.

The cerebral cortex, the large surface layer of the brain, is responsible for much of the human brain's unusual heft. The cortex also holds two-thirds of the brain's neurons.

"When we have more cortex, it enables us to process more information, and do things like speak and read," says Dr. Anjen Chenn, a research fellow at Beth Israel Deaconess Medical Center. "During evolution, the cerebral cortex has undergone a disproportionately large increase in size compared to the rest of the brain."

Chenn and a colleague studied cortex size by tinkering with a protein called beta catenin in mice. They report their findings in tomorrow's issue of Science.

When researchers made it easier for the protein to work properly, mice were born with larger cortexes, Chenn says. Some mice had cortexes with twice the surface area of normal mice.

Researchers speculate the beta catenin protein tells brain cells whether to continue dividing during embryonic development or to stop and become neurons.

It's not clear whether the brainy mice are little Einsteins. Chenn says he didn't study their intellect, and doubts they're much smarter than the average mouse.

"It's possible, but probably unlikely," he says. "The development of intelligence is probably more complicated than putting together a bigger brain. You have to get everything connected up together correctly."

The research gives scientists greater insight into how the human brain develops and may help doctors treat patients whose brains are too big or too small, Chenn says.

Grisolia adds that beta catenin isn't the only key to brain growth. However, it could be useful in a variety of treatments.

"Maybe adding catenin to retarded infants will improve their brain growth and make them smarter," he suggests. "Maybe it will help prevent atrophy of the brain in old age and keep away the ravages of Alzheimer's, or at least normal aging."

"The chances that beta catenin itself could be used as a treatment are small, but once we understand how it works, the avenues may open to devising drugs that increase its effects or stimulate its production within the brain cells," he says.

Chenn says he plans to continue studying mice with bigger brains.

"There's no way of studying brain development in a dish," he says. "Looking at animals is probably the best way of understanding what might go on in humans."

What To Do

Get facts about the cerebral cortex from About.com.

Learn about brain injuries from the Brain Injury Association USA.

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Study Looks at Classroom Dynamics, Kids' Smoking 

By Charnicia E. Huggins

Reuters Health

Thursday, July 18, 2002

NEW YORK (Reuters Health) - Children in classrooms where students and teachers relate to one another in a positive way are less likely to start smoking than those in classes where students and teachers don't get along as well, according to a Swedish study.

However, the classroom relationship may not be the cause of students' smoking behavior, according to study author Dr. M. Rosaria Galanti of the Center for Tobacco Prevention at the Karolinska Institute in Stockholm.

The students may be more likely to have disciplinary problems or other factors that could be responsible for both their smoking initiation and their teachers' perceptions of the classroom relationship, Galanti said in an interview with Reuters Health.

Overall, however, the study results suggest that "when considering school-based interventions to prevent smoking, attention should be paid to...factors (such as) how engaged/engaging are the teachers and how general social skills are promoted, etc., rather than to tobacco-specific policy or teaching," Galanti said.

Galanti and her colleagues investigated the relationship between class environments and future smoking in a one-year follow-up study of 2,883 fifth-grade students. They also asked teachers to rate their various classes as positive or problematic in terms of interpersonal relations.

Nearly one out of every five fifth-grade students reported ever smoking, but by the sixth grade, one third of the students said they had ever puffed on a cigarette, the investigators report in the June issue of Preventive Medicine.

Students in classes with negative ratings were 42% more likely to report ever smoking than were their peers in classes with positive ratings. These students were also more likely to say they had increased smoking between their fifth- and sixth-grade school years.

Fifth-grade students whose fellow classmates reported a high prevalence of ever smoking were also more likely to say that they had puffed on a cigarette at least once by follow-up, the report indicates.

Those who received 1 to 2 hours of anti-tobacco education during the fourth grade, however, were less likely to say they had ever smoked than those who received less than 1 hour of anti-tobacco education. But more intensive anti-smoking education did not further decrease the pre-adolescents' risk of ever smoking, the researchers note.

In light of the findings, "school leaders, school personnel, and parents should work to keep the general school standards as high as possible and to enhance the school socializing function," Galanti said. Also, "school healthcare personnel, (such as) school nurses, may be an important resource in tobacco prevention and their role should be better understood."

The findings may not be applicable to other countries or to other age groups, Galanti noted.

"The effect of enforcing tobacco policy in schools can be expected to be different in countries or regions with different background of tobacco-control activities," she said. Also, "the young age of the study subjects makes the results not easily generalizable to other ages."

Source: Preventive Medicine 2002;34:649-654.

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Modified Mice Offer Clues to Autism-Like Disorder 

By Linda Carroll

Reuters Health

Thursday, July 18, 2002

NEW YORK (Reuters Health) - Scientists have developed an animal model for Rett syndrome, a disabling developmental disorder that strikes mostly little girls, a new study shows.

By tweaking a certain mouse gene, Texas researchers were able to raise rodents that exhibited many of the symptoms seen in children who have Rett syndrome, such as tremors, seizures, anxiety and hand-wringing. The findings are published in the July 18th issue of the journal Neuron.

Like children with Rett syndrome, the mice appeared to be developing normally at first. But after 2 to 3 months, they began to display many of the neurological features of the syndrome, which is a type of mental retardation sharing many similarities with autism.

By raising a type of mouse that shows Rett syndrome symptoms, researchers will have an easier time looking for treatments for the disease, study co-author Juan Young, a post-doctoral associate at Baylor College of Medicine in Houston, said in an interview with Reuters Health.

"The model will allow us to try different therapies to see if we can intervene," Young said. "This is a very, very disabling disease. There may be a window of opportunity--when development progresses normally--in which we could try treating it."

The mouse model will also allow researchers to try to figure out the details of what goes wrong in people born with the syndrome, and to learn whether it can be reversed, Young explained.

Approximately 1 in 20,000 children are born with the syndrome, according to the International Rett Syndrome Association.

Children with Rett syndrome appear to develop normally for the first 6 to 8 months of life. They may even start learning to talk and walk, Young noted. But then they seem to stop learning new skills and, in fact, often regress.

The syndrome has both severe and mild forms, Young said.

In 1999, researchers discovered that Rett syndrome in people was caused by mutations of the methyl-CpG binding protein 2 (MECP2) gene. When normal, the MECP2 gene blocks the action of several other genes.

To get a mouse that might simulate the syndrome, Young and his colleagues modified rodents to be born with a mutated form of MECP2.

The mice in the new study developed normally for the first 2 to 3 months of their lives. But then they began to display many of the neurological features of Rett syndrome, such as seizures, decreased activity, difficulty coordinating movement and odd social interactions.

To the researchers' surprise, the mice even clasped their forelimbs together when suspended by the tail, a behavior highly reminiscent of the compulsive hand wringing observed in many Rett syndrome patients.

Source: Neuron 2002;35:243-254.

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Obesity Doubles Colon Cancer Risk in Young Women 

By Alison McCook

Reuters Health

Thursday, July 18, 2002

NEW YORK (Reuters Health) - Obese women who have not yet experienced menopause are twice as likely to develop colorectal cancer as slimmer women of the same age, researchers reported in a study released Thursday.

However, obesity does not appear to be associated with a higher risk of colorectal cancer in women who have gone through menopause, according to Dr. Paul Terry of the Albert Einstein College of Medicine in the Bronx, New York, and his colleagues.

Previous studies have consistently found that obesity increases the risk of colorectal cancer in men, but could find no clear evidence of this association in women.

That may be because earlier studies did not factor in the effect of menopause on the risk of colorectal cancer in obese women, Terry and his colleagues note.

Although the study did not examine whether losing weight helps reduce cancer risk in young, obese women, these results indicate that women who are overweight may now have an added incentive to drop some pounds.

"It stands to reason that losing weight--especially through good diet and exercise--is a means by which young women who are overweight or obese can prevent colon cancer," Terry told Reuters Health.

During the study, Terry's team reviewed data collected as part of a breast cancer ( news - web sites) study that included nearly 90,000 women aged 40 to 59, who were followed for an average of 10.5 years.

Over the course of the follow-up period, 527 women developed colorectal cancer. Taking obesity into account, the investigators discovered that obese women who had not yet undergone menopause were almost twice as likely to develop the disease as their slimmer, similarly-aged peers. Obesity appeared to have no effect on colorectal cancer risk in women who had experienced menopause, the authors note in the August issue of the journal Gut.

People who are obese have higher-than-average levels of insulin circulating in their blood. In an interview with Reuters Health, Terry explained that insulin can lead to high levels of a substance known as free insulin-like growth factor-1 (IGF-1), which previous studies have linked to an increased risk of colorectal cancer in both sexes.

After menopause, the risk of colorectal cancer was no higher, and possibly lower, in obese women compared to thinner women. It's possible that estrogen produced by fat cells may help ward of cancer risk in obese women after menopause. The female hormone is known to be protective when it comes to colorectal cancer.

"Given the relatively high incidence of colorectal cancer in Western populations, and the rising prevalence of obesity, especially in younger age groups, the possible benefits with respect to this disease should be added to the list of potential advantages of weight control," Terry and his colleagues conclude.

Source: Gut 2002;51:191-194.

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Opossum May Be Source of Typhus in Texas 

By Merritt McKinney

Reuters Health

Thursday, July 18, 2002

NEW YORK (Reuters Health) - New research provides more evidence that opossums and the fleas that love them may be at least partially responsible for past outbreaks of a fever-causing infection in south Texas.

The opossum, the furry, cat-sized animal that is North America's only marsupial, is best known for its tendency to "play dead" when threatened.

The infectious disease is called murine typhus or rat flea typhus because it can be carried by rat fleas. Symptoms of the infection include chills, headache and fever, and the illness may cause a rash after several days. Most people recover from typhus, although it can be fatal in the elderly and in people with weakened immune systems.

Until the 1940s, there were thousands of cases of rat flea typhus in the US each year, but thanks to rat and flea extermination efforts, there are now usually fewer than 100 cases per year in the US. The disease remains more common in some coastal areas, including south Texas, where an outbreak occurred in the early 1980s.

Rats that live on ships have traditionally been a major source of typhus, but the cases of the infection in Texas led researchers to investigate other animals as possible typhus carriers. In an earlier report on cases in southern California, Dr. Abdu F. Azad, of the University of Maryland in Baltimore, and colleagues documented that opossums and cat fleas were capable of transmitting a typhus-causing microorganism called Rickettsia typhi to people.

Now, in a recent issue of the journal Emerging Infectious Diseases, Azad and his colleagues report that opossums and cat fleas in south Texas carry two different types of microorganisms that can cause typhus.

The researchers detected R. typhi and a related microorganism, Rickettsia felis, in opossums and their fleas collected in south Texas in 1998. What's more, the opossums and fleas were found in the same areas where human cases of typhus occurred.

Because cat fleas can be found not only on opossums, but rats, mice and household pets, the researchers also tested blood samples from pet cats. They found that about 15% of samples collected the eastern US were infected with R. felis, suggesting that domestic cats, cat fleas and other small animals play a role in the life cycle and transmission of the disease to humans.

The main objective of this study was to show that the ship rat is not the only source of murine typhus in some parts of the country, Azad told Reuters Health in an interview.

"Opossums can be a source," he said.

Opossums often have many fleas, so when the critters come near a house, their fleas can easily move on to cats and dogs, and eventually to people, Azad said. Or if people trap opossums, the fleas may jump directly from the animals to humans, he added. Opossums are often considered nuisances in urban and suburban areas because they can inhabit junk heaps, storage sheds, garages and attics.

Azad noted that typhus is "very treatable" with antibiotics.

Source: Emerging Infectious Diseases 2002;8:549-554.

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Brain scans reveal Alzheimer's before symptoms hit

By Kathleen Fackelmann

USA TODAY

Thursday, July 18, 2002

Researchers next week will report on the first human studies of a brain-scanning technique that may soon allow doctors to reliably test for Alzheimer's disease before symptoms emerge.

The brain scans reveal the abnormal deposits of senile plaque that over time can cause memory loss and other symptoms of Alzheimer's, which afflicts 4 million Americans.

Right now, doctors can diagnose Alzheimer's after a battery of tests rules out other conditions that can cause memory loss. But there's no way to see the brain-damaging senile plaques until an autopsy is performed.

If the findings are confirmed in larger studies, such brain scans may one day allow doctors to make a one-stop diagnosis and could help speed up the effort to find new treatments.

"It's one of the most significant breakthroughs in Alzheimer's research — ever," says Stephen McConnell, the interim president of the Chicago-based Alzheimer's Association.

Next week at the eighth International Conference on Alzheimer's Disease and Related Disorders in Stockholm, William Klunk of the University of Pittsburgh School of Medicine and Bengt Langstrom of Uppsala University in Sweden will report their findings using one such brain scan on nine Alzheimer's patients.

The team injected the patients with a special dye the Pittsburgh team developed. That dye travels through the bloodstream to the brain and then sticks to senile plaque. Each patient underwent a one-hour Positron Emission Tomography (PET) scan. The scans showed plaque in brain regions most affected by Alzheimer's, Klunk says.

Brain scans of five healthy people showed no such plaque, he says.

Gary Small and his colleagues at the University of California-Los Angeles also have developed a PET-scanning technique, one that uses a different method to highlight the senile plaque. Small did a PET scan on eight Alzheimer's patients and also found the plaques. Six healthy people who also got a PET scan showed no such brain abnormalities, he says.

Two people with a genetic risk for Alzheimer's, but no obvious memory loss, showed signs of early plaque development, he says. The finding suggests that brain scans may find plaque developing insidiously in the brain, perhaps even years before the symptoms of memory loss surface, Small says.

There's no cure now for the disease, so an early prediction could frighten people, says Arthur Caplan, a bioethicist at the University of Pennsylvania.

But Caplan and others say the imaging technique could lead to new ways to combat the disease. For example, researchers could use the scans to see whether an experimental drug could stop plaque from forming, Klunk says.

Warding off Alzheimer's

Research suggests people who adopt a healthy lifestyle may reduce their risk of developing Alzheimer's. Here's what to do to keep your brain healthy:

Don't smoke.
Exercise regularly.
Maintain healthy body weight.
Keep cholesterol and blood pressure in check.
Eat a low-fat diet with lots of fruits and vegetables.
Maintain a social life and actively use your mind.

Source: Alzheimer's Association

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Diet May Prevent Alzheimer's Disease  

The Associated Press

Thursday, July 18, 2002

LONDON — You've heard it before: If you want to remain healthy, eat more fruit and vegetables and less red meat. But scientists now say such a diet also may help prevent Alzheimer's disease. 

In fact, mounting evidence indicates the risk factors for heart disease — high blood pressure, diabetes, excess weight, high cholesterol and lack of exercise — may play a role in Alzheimer's. 

New studies to be presented next week at an international Alzheimer's conference in Stockholm establish the big picture for the first time, giving scientists a better understanding of how to reduce the likelihood of the disease. 

Over the last few years, hints of a connection between Alzheimer's and lifestyle have emerged, but scientists have become increasingly interested in investigating such a link and are just now beginning to realize that what is good for the heart may also be good for the brain. 

Alzheimer's is a degenerative brain disease that causes memory loss, disorientation, depression and decay of bodily functions. The disease afflicts about 12 million people worldwide, including more than 4 million Americans. It is increasing so fast that more than 22 million people worldwide will be affected by 2025, experts predict. 

Scientists do not know what causes the sticky brain deposits that inevitably kill off neural cells until memory disintegrates and ultimately the patient dies. The biggest risk for Alzheimer's is simply age: Alzheimer's cases double with every five years of age between 65 and 85. 

"While more research is necessary, especially in the form of prevention trials, we're seeing the strongest evidence yet that there is a relationship between healthy aging and a reduced risk of Alzheimer's," said William Thies, vice president of medical and scientific affairs at the Chicago-based Alzheimer's Association. 

Several studies to be presented at the International Conference on Alzheimer's Disease and Related Disorders indicate that people may be able to reduce their chances of developing Alzheimer's by treating high blood pressure. 

One 21-year study, by Miia Kivipelto of the University of Kuopio in Finland, examined 1,449 people. It found that the high cholesterol and high blood pressure seemed to be more strongly linked to the risk of developing Alzheimer's than was a certain gene variation. 

However, it seems that having high blood pressure only in later life is not connected to Alzheimer's. 

"Since high blood pressure can be controlled, we may have identified something people can do to lower their chance of developing Alzheimer's," said Thies, who was not connected with the research. 

Researchers at Case Western University School of Medicine and University Hospitals of Cleveland, Ohio, found that a diet of more fruit and vegetables, and less red meat, offers more protection against the development of Alzheimer's. 

Collecting data regarding what foods people ate during adulthood, Grace Petot and her colleagues discovered that low-fat diets containing vitamins such as A, C and E in fruit and vegetables are associated with a reduction in risk for Alzheimer's. 

Three other studies to be presented at the conference in Stockholm, the largest gathering ever of Alzheimer's researchers, bolster evidence that taking cholesterol-lowering drugs could reduce the chances of developing Alzheimer's. 

A study by Dr. Robert Green at Boston University School of Medicine found that people taking cholesterol drugs called statins reduced their risk of developing Alzheimer's by 79 percent. With 2,378 patients, it is the largest study to investigate the connection and the first to include large numbers of black people, who are disproportionately likely to develop Alzheimer's. 

The study also found that types of cholesterol-lowering drugs other than statins were not linked with a reduced risk of Alzheimer's. 

High cholesterol can narrow the arteries and raise the risk of heart disease. Some researchers think high cholesterol may also affect brain arteries and promote the clumping of the protein beta-amyloid, which is thought to damage the brain in Alzheimer's. 

Beta-amyloid occurs normally in the body, but can accumulate in the spaces between brain cells and create plaques in the brain. These plaques are linked to the death of brain cells, causing a gradual loss of memory and control of body function, and leading eventually to death. By the time a patient has noticeable symptoms of Alzheimer's, substantial amounts of amyloid have built up in the brain, experts say. 

A study to be presented at the conference by researchers at St. George's Medical School in London found statins dramatically reduced the production of beta-amyloid. 

"The small amounts of beta-amyloid normally found in the blood of healthy people are quickly cleared from the brain," said the study's leader Brian Austen. "In the general population, people taking statins to reduce their blood cholesterol, for whatever reason, have a 70 percent reduction rate for Alzheimer's." 

Advances in the understanding of how beta-amyloid acts have prompted researchers to focus much of their effort on trying to block plaque formation. 

Other research highlights of the conference involve new ways of seeing what's going on inside the brains of Alzheimer's patients. Until recently, Alzheimer's could only be confirmed by examination of the brain after death. 

One study outlines how a new dye could show where plaques are located in the brain. The study, conducted by scientists at Uppsala University in Sweden, found the dye went to areas of the brain where plaques are usually seen in autopsies and that very little of the dye lingered in the brains of people who had no mental impairment. 

"Having the ability to quantify amyloid deposition in the brain will have a profound impact on our ability to monitor the progression of Alzheimer's as well as gauge the effectiveness of medical treatments," said Thies of the Alzheimer's Association. 

The conference, to be held July 20 through July 25, will involve about 4,000 Alzheimer's researchers.

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WEDNESDAY, JULY 17, 2002

Study: Chemo May Not Help Fight Cancer

By Paul Recer
AP Science Writer
The Associated Press
Wednesday, July 17, 2002

WASHINGTON -- For post-menopausal women with breast cancer that is affected by estrogen, chemotherapy may offer no benefit and a five-year course after surgery of tamoxifen, which blocks the hormone, may be the only treatment needed, a study shows.

The finding, appearing this week in the Journal of the National Cancer Institute, could mean that some of the thousands of American women diagnosed each year with breast cancer could avoid the debilitating side effects of taking drugs that chemically kill cancer cells and damage other cells in the body.

The study also found that for post-menopausal women whose breast cancer was not affected by estrogen, chemotherapy followed by tamoxifen offered the best hope of disease-free survival. Tamoxifen works by blocking the action of estrogen, a hormone that can promote the growth of cancer cells.

"We're hoping this study will question the routine use of chemotherapy in the ER-positive (estrogen sensitive) group," said Richard D. Gelber, a biostatistician at the Dana-Farber Cancer Institute in Boston and one of dozens of co-authors. "This is the largest study ever concentrating on this population."

The information should help physicians tailor cancer treatment for specific patients, Gelber said.

Dr. Andrew D. Seidman, a breast cancer specialist at Memorial Sloan-Kettering Cancer Center in New York City, said the study "will reaffirm the way that many oncologists are now practicing" and should help doctors base cancer therapies on the specific characteristics of their patients.

It shows chemotherapy is appropriate for some women, but not others, and that patients who need the therapy can be specifically identified based on the estrogen sensitivity of their tumors and on other factors, Seidman said.

The study, compiled by researchers from nine countries, was limited to breast cancer surgery patients who had completed menopause and whose disease had not spread to the lymph nodes. About 43 percent of the approximately 184,000 women in the United States diagnosed with breast cancer each year fit this category, the study said.

Researchers further divided the 1,669 patients in the study into groups based on whether their cancers were affected or not affected by estrogen.

There were 382 in the study whose tumors were not affected by estrogen, described in medical terms as being estrogen receptor negative, or ER-negative. There were 1,217 who were ER-positive. For the remaining 70 patients, the ER status was unknown.

About half in each of these groups were treated with chemotherapy followed by five years of tamoxifen. The other half of each group received tamoxifen only.

Researchers followed the patients for an average of almost six years and found the value of chemotherapy depended directly on the estrogen sensitivity of the patients' disease.

Among the ER-positive patients, chemotherapy provided no benefit. The five-year, disease-free survival rate for those who only took tamoxifen was 85 percent, while it was 84 percent for those who had both chemo and tamoxifen.

However, for the ER-negative patients, chemotherapy could be a life saver. The five-year, disease-free survival rate for those who had both chemo and tamoxifen was 84 percent. For ER-negative patients who took only tamoxifen, the survival rate was only 69 percent.

Gelber said the study may improve the lives of patients who are ER-positive because it will ensure they don't have to endure chemotherapy's side effects, such as hair loss, nausea and persistent tiredness.

"There is a quality of life burden associated with chemotherapy," said Gelber. "It is not a free ride. It should not be given frivolously."

On the other hand, he said, the study showed that chemo's side effects were not severe enough that the therapy should be avoided by the ER-negative patients who would benefit.

Gelber said a quality-of-life segment of the study showed the side effects from chemo are usually temporary and go away after the therapy ends.

On the Net:

Journal of the National Cancer Institute: http://jncicancerspectrum.oupjournals.org/

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Vitamin E May Help Keep People Sharp in Old Age 

By Melissa Schorr

Reuters Health

Wednesday, July 17, 2002

NEW YORK (Reuters Health) - Vitamin E intake in food and supplements may help slow decline in mental functioning among older people, according to the results of a study.

"High amounts of vitamin E from foods appears to be protective from cognitive decline," lead author Dr. Martha Clare Morris, assistant professor of internal medicine at Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois, told Reuters Health.

The researchers theorized that vitamin E, an antioxidant, may counteract the damage done to brain cells by free radicals, which are byproducts of normal body processes that can damage tissue and have been linked to disease. Previous research has suggested that people who consume more vitamin E retain mental function and are less likely to develop Alzheimer's disease ( news - web sites).

To investigate, the researchers studied more than 2,800 US men and women aged 65 to 102. Each was given an initial battery of mental function tests and followed for an average of 3 years, during which they were retested two or three times. They were also asked to fill out a food questionnaire assessing how much of various nutrients they received in their diets and from supplements.

The investigators took into account factors that may influence mental function such as age, gender, education, smoking and drinking.

According to the findings, published in the July issue of the Archives of Neurology, 61% of the study participants showed some decline in their mental function during the course of the study, while 39% had no decline or even improved. The group who reported the highest intakes of vitamin E had a slower decline in mental function than those whose vitamin E intake was lowest.

"There was a 36% reduction in the rate of decline for people in the highest fifth of intake of vitamin E compared to those in lowest fifth of intake," Morris said, referring to intake of the vitamin in both food and supplements.

And those with the highest intake of vitamin E in food had a 32% reduction in their rate of mental decline, compared to those with the least vitamin E in their diets, she said.

For those who took vitamin E supplements, the effect on mental skill was only seen among those who received little vitamin E from their diet, but not in those who already received lots of the vitamin in their diet. "There may be a ceiling effect, and if you taking more, it's not helpful," Morris noted.

However, because the number of people taking supplements during the study doubled, possibly in response to cognitive decline, it was hard for researchers to draw conclusions about whether supplement use was effective on its own in maintaining the brain.

By contrast, vitamin C seemed to have only a limited effect on mental function. "We also don't feel that our data on vitamin C was definitive," Morris said. "The association wasn't consistent."

The team recently reported similar findings for vitamin E and Alzheimer's disease. High intake of the nutrient was linked to a 70% reduction in the risk of developing the disease during a 4-year period. Together, Morris noted, the studies strongly suggest that vitamin E has some protective effect on the brain.

Vitamin E is found in green, leafy vegetables as well as corn, nuts, olives and vegetable oils.

Source: Archives of Neurology 2002;59:1125-1132.

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Urine Test May Catch Bladder Cancer Early 

Reuters Health

Wednesday, July 17, 2002

NEW YORK (Reuters Health) - A urine test for a cancer-linked protein may be better at catching bladder cancer than standard urine testing, UK researchers report.

Although it is too early to say what role the test might have in diagnosing bladder cancer, the study authors say their findings show it is "highly predictive" of the disease.

Dr. Kai Stoeber of University College London and his colleagues report the findings in the July 17th issue of the Journal of the National Cancer Institute ( news - web sites). Stoeber was with the University of Cambridge at the time of the study.

Right now, urine tests for bladder cancer involve looking for abnormal cells, a method called cytology. While cytology is good at catching high-grade tumors--those with lots of abnormal cells that are likely to spread quickly--it is able to spot far fewer low-grade bladder cancers.

Cystoscopy, in which a thin scope is threaded into the bladder, is the "gold standard" test for bladder cancer. However, Stoeber and his colleagues note, it is invasive and costly, and many patients with vague urinary symptoms may needlessly undergo the procedure.

Their new urine test looks for levels of a protein called minichromosome maintenance 5, or Mcm5. Mcm5 belongs to a family of proteins important in initiating the replication of DNA. Stoeber's team had previously found that cancerous epithelial cells--thin layers of cells that line the organs--show an abnormal expression of proteins in this family.

In this study, of 353 patients with possible bladder cancer symptoms, the Mcm5 test caught up to 92% of new or recurrent cases of the disease. However, it also produced false-positives 22% of the time, according to the report.

Still, at this level of accuracy, Stoeber and his colleagues note, the test could help spot patients with early, low-grade bladder cancer. In addition, they say, it shows promise for catching higher-grade tumors, as well.

"The test detects bladder cancers of all stages and grades, including those often missed by urine cytology," the authors write.

"One of the most important results of this work is that the protein test can establish early diagnosis of bladder cancer," Stoeber said in a statement released by Cancer Research UK.

And although the study was aimed at bladder cancer, Stoeber's team found another potential benefit of the Mcm5 test: Twelve study participants who turned out to have prostate cancer ( news - web sites) also showed elevated levels of the protein in their urine.

According to the researchers, this suggests the "potential applicability" of the test to other types of cancer.

Source: Journal of the National Cancer Institute 2002;94:1071-1079.

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Brain Turns Back Developmental Clock for Repairs 

By Melissa Schorr

Reuters Health

Wednesday, July 17, 2002

NEW YORK (Reuters Health) - After an injury, the brain produces synchronized electrical pulses that appear to act as a signal to generate new nerve connections, according to a team of researchers who made the discovery while studying the brains of rats.

Such signals--which are normally seen in early brain development--have been observed for years after brain injuries, but their function has been unclear.

"This activity plays a role in triggering the rewiring of the brain," senior author Dr. Marie-Francoise Chesselet, a professor of neurology at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA) told Reuters Health.

Contrary to earlier beliefs, scientists are coming to find that parts of the brain do have the ability to rewire themselves after an injury, even over long distances of the cortex. However, the mechanism of how the brain knows to begin the repair work is not clear.

The team of UCLA researchers has shown previously that this rewiring only occurs in response to certain forms of injury: Rat brains were able to form new nerve connections if the lesion occurred as a result of decreased blood flow and oxygen loss, as in a stroke, but not if the brain damage was caused by aspiration, or being sucked out.

To investigate what special mechanisms occur in response to a loss of blood flow, Dr. S. Thomas Carmichael and colleagues gave rats stroke-like lesions using both methods and tracked the brain cells' response for 7 days. The results are published in the July 15th issue of Journal of Neuroscience.

The investigators found that for a few days after brain injuries due to reduced blood flow, the neurons began firing in a slow, low-frequency, synchronous pattern, rather than their normal independent and fast rhythm pattern. At the same time, damaged nerves sprouted new axons, a long extension of the nerve cell that conducts electrical impulses away from the cell's central core. What's more, blocking the synchronous nerve cell firing appeared to block the nerve cell growth as well.

Rats that had developed lesions as a result of aspiration did not show this form of nerve growth or neuronal activity.

This form of nerve cell activity has been observed in stroke victims, but its function was not understood, Chesselet noted.

The researchers theorize this form of neuronal activity, a similar form of which takes place during early brain development, may be a signal to distant brain cells to begin the rewiring process.

"It seems in this situation, the brain uses again a mechanism it has used in development," she noted.

Chesselet said ideally, doctors could someday learn to stimulate this type of neuronal activity to induce brain recovery among stroke victims. If this stimulation proves to be crucial, doctors should also avoid disturbing its natural occurrence during the use of various therapies that aim to prevent cellular death among stroke victims.

"We need to be careful to not block this activity in people," she said. "You could have therapy that prevents cell death, but if it blocks this activity, it may do more harm than good."

Source: Journal of Neuroscience 2002;22:6062-6070.

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Study: Heart Drug Side Effects Lower

By Lindsey
AP Medical Writer
The Associated Press
Wednesday, July 17, 2002
 
CHICAGO -- Beta blockers, drugs widely recommended for heart patients but vastly underused, are less likely than previously thought to cause depression, fatigue and sexual dysfunction, a study suggests.

Some doctors and patients may have shunned the lifesaving drugs because of the supposed side effects, but the new study should encourage wider use of beta blockers, the researchers said.

The researchers reviewed 15 studies involving more than 35,000 patients and found that the three symptoms are fairly common in heart disease patients regardless of whether they take beta blockers or not.

The study appears in Wednesday's Journal of the American Medical Association.

Beta blockers are used to lower blood pressure and treat various heart problems. They work by slowing the heart rate. Previous research has shown that they can reduce heart attack survivors' risk of death by 20 percent or more.

Commonly prescribed beta blockers include propranolol, sold under the brand name Inderal; metoprolol, sold as Lopressor; and atenolol, sold as Tenormin.

Beta blockers could probably help many of the more than 1 million Americans who have heart attacks each year, according to American Heart Association spokesman Dr. Richard Pasternak. Studies, however, have suggested that one-third to one-half of eligible patients are not prescribed them.

Pasternak welcomed the study.

"Physicians and patients are sometimes unduly afraid of side effects, and I think this puts this in a correct perspective," he said.

A 1998 American Medical Association guide to high blood pressure lists fatigue and impotence among the most common side effects of beta blockers, and some studies have suggested all three symptoms occur frequently in beta blocker users.

While many beta blockers come with packaging that lists the three symptoms among possible side effects, study co-author Dr. Harlan Krumholz of Yale University said the warnings were based on older, very small studies and anecdotal reports that became the conventional wisdom over time.

"The notion was that they were common but there was no clear idea of how common," he said.

The researchers reviewed studies involving heart attack survivors or patients with heart failure or high blood pressure.

Depression was reported by 20.1 percent of beta blocker patients and 20.5 percent of patients given dummy pills; the difference was virtually nil.

Fatigue was slightly more common among beta blocker patients than placebo patients -- 33.4 percent compared with 30.4 percent. That equals about 18 cases per 1,000 patients treated for a year with beta blockers.

Sexual dysfunction, including impotence, also was only slightly more common among drug patients, 21.6 percent versus 17.4 percent. That works out to about five cases per 1,000 patients treated for a year.

The researchers funded the study.

On the Net:

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

American Heart Association: http://www.americanheart.org

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Malaria Parasite: More Resistant?

By William McCall
Associated Press Writer
The Associated Press
Wednesday, July 17, 2002

The tiny parasite that causes malaria may be older and more resistant to drugs than previously believed, according to a pair of new studies.

Researchers at the National Institutes of Health mapped large sections of the parasite's DNA to determine how far back it dates in evolutionary history and found it may have originated between 100,000 and 180,000 years ago -- instead of as recently as 3,000 to 5,000 years ago.

The difference is important when deciding the best way to fight malaria, a blood disease transmitted by mosquitoes that afflicts an estimated 500 million people each year and kills as many as 3 million.

If malaria DNA is fairly uniform genetically, implying it has more recent origins, doctors could more easily develop a vaccine or drugs to prevent or cure the disease. However, if the parasite's DNA has large variations, a vaccine that prevents one strain could lead to mutations that give rise to more resistant strains that could be deadlier.

The studies, led by Xin-zhuan Su of the National Institute of Allergy and Infectious Diseases at NIH, suggest the parasite is older and more genetically diverse.

"These parasites have accumulated a lot of mutations," Su said. "And unfortunately, diversity does accelerate resistance."

In another study also appearing in Thursday's journal Nature, researchers isolated a gene that allows the parasite to resist the effects of chloroquine, a common antimalarial drug.

The researchers found that the gene was not only more widespread than previously thought, but also that it had moved through the infected population from continent to continent with alarming speed, likely helping to shape the evolution of the parasite.

"It doesn't mean that any one place is getting any more resistant than others," said Dr. Joseph Vinetz, spokesman for the Infectious Diseases Society of America. "But it's consistent with what we've already known, and that is this is a really smart bug."

Scientists previously had believed that chloroquine resistance developed independently in only two areas of the world and slowly spread to other countries.

The studies suggests that drug treatment programs should be carefully monitored to limit the spread or increased resistance.

"I think that people in the field and in drug development are thinking mostly about multidrug therapy," said Dyann Wirth, a microbiologist who directs the Harvard Malaria Initiative.

In the first study, the NIH researchers compared the same 204 genes in the third chromosome of malaria parasites from five separate regions: Southeast Asia, Africa, South America, Central America and Papua New Guinea.

In the chloroquine resistance study, the researchers isolated 87 strains of parasite from malaria patients worldwide and compared 342 DNA markers to develop the first genetic "fingerprint" for the entire malaria genome.

On the Net:

National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov


Nature magazine: http://www.nature.com


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Experiments Challenge Notions on Aging

By William McCall

Associated Press Writer
The Associated Press
Wednesday, July 17, 2002
 
An entire diet and supplement industry has sprung up around the notion that one of the keys to a long life is removing oxygen molecules called free radicals from your body. But now experiments with yeast have called that theory into question.

The experiments challenge the notion that free radicals play a central role in aging and longevity.

Sales of "antioxidant" vitamins and supplements have grown since earlier studies suggested that free radicals damage cells and DNA.

Another way to reduce free radicals is a severely restricted diet. Scientists have known for more than 60 years that limiting food intake to about two-thirds of normal can extend the lives of rats and keep them healthier, a finding that has been duplicated in yeast, fish, worms and other creatures.

But in a study in Thursday's issue of the journal Nature, yeast cells lived 20 percent longer after scientists made genetic changes that speeded up their metabolism, or the rate at which cells turn food into energy. Metabolism produces free radicals.

"The old idea was there was simply less production of oxygen radicals and less oxidative damage to the cell with calorie restriction," said Leonard Guarente of the Massachusetts Institute of Technology, who led the study. "But I think the results of this study really challenge that idea."

In an accompanying commentary, Siu Sylvia Lee and Gary Ruvkun of Harvard Medical School warned that what applies in yeast does not necessarily apply in animals.

But they agreed that the findings "contradict the theory that a decrease in free radicals is an essential feature of increased longevity."

Lee and Ruvkun said it is still not clear whether limiting free radicals by severely restricting calorie intake has any benefit or is just a gimmick promoted by "a variety of optimists, hucksters and fanatics."

Dr. Richard Weindruch, who is studying the effects of calorie restriction on monkeys at the University of Wisconsin, said there is no reason for people to stop taking antioxidants such as vitamin C to try to reduce cell damage.

"I don't think the results of this yeast study should influence public health recommendations," Weindruch said.

On the Net:

Massachusetts Institute of Technology: http://www.mit.edu

Nature magazine: http://www.nature.com


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Use of Estrogen Linked with Cancer

By Lindsey Tanner
Associated Press Writer
The Associated Press
Wednesday, July 17, 2002

CHICAGO -- A week after breast cancer and heart attacks were strongly linked to hormone replacement therapy, government scientists reported finding that long-term estrogen use may increase the risk of ovarian cancer.

The new National Cancer Institute research involving 44,241 postmenopausal women found that those who used estrogen-only supplements for 10 to 19 years had an 80 percent higher risk of developing ovarian cancer than women who didn't use hormone treatments.

The results, which echo two recent studies, were published in Wednesday's Journal of the American Medical Association.

The risk increased with length of use; a threefold risk was found in women who used estrogen for 20 or more years.

Despite the increased risks, the researchers noted that ovarian cancer was very rare, occurring in 329 women during the 1979-1998 study.

The results are similar to findings in a large American Cancer Society study published a year ago in JAMA, but that research did not include information on hormone users after 1982.

In April, Swedish researchers linked ovarian cancer to estrogen-only as well as estrogen-progestin use.

The new study also looked at ovarian cancer risks in users of combined supplements but those results were inconclusive, said cancer institute researcher James V. Lacey Jr., the lead author.

The study came just a week after another government study in JAMA linked long-term use of combined supplements to heart attacks and breast cancer.

Those results halted part of the highly regarded Women's Health Initiative study, though the researchers are continuing to examine the health effects of estrogen-only use in postmenopausal women.

The cancer institute's ovarian cancer findings are based on data from telephone interviews and periodic questionnaires about hormone use and the development of ovarian cancer.

Most of the estrogen-only users had had hysterectomies; combined therapy has been recommended for women with intact wombs because estrogen alone can cause uterine cancer.

In a JAMA editorial, Dr. Kenneth Noller of Tufts University said that while such "observational" studies don't prove cause and effect, the ovarian cancer results "should be worrisome enough for clinicians to consider carefully whether to suggest estrogen-only" supplements.

On the Net:

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

NCI: http://www.cancer.gov

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Medical School Textbooks Still Say It's OK to Drink While Pregnant 

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Wednesday, July 17, 2002

WEDNESDAY, July 17 (HealthScoutNews) -- Talk about being behind the times: Textbooks used in the nation's medical schools still condone drinking during pregnancy, although public health officials have promoted abstinence for two decades.

This month's American Journal of Preventive Medicine carries an article in which Virginia Commonwealth University researchers reviewed 81 obstetrics textbooks currently in use in the nation's medical schools and found that only 14 had consistent recommendations not to drink. When they narrowed the review to textbooks published since 1991, only 7 of the 29, or 24 percent, consistently recommended zero alcohol during pregnancy.

"I didn't expect so many recent textbooks to actually condone drinking," says Dr. Mary Nettleman, professor of medicine at Virginia Commonwealth University and the lead author of the study.

Many of the reviewed textbooks had mixed messages. More than half of the books contained at least one statement condoning drinking by pregnant women. Some skipped the subject alltogether.

Drinking alcohol during pregnancy can result in both physical and mental birth defects. Up to 12,000 babies born each year in the United States have fetal alcohol syndrome, a combination of physical and mental defects, according to the Institute of Medicine ( news - web sites). Most of the mothers of these babies are alcoholics or chronic alcohol abusers.

Many women are aware that heavy drinking during their pregnancy can cause birth defects, but some are not aware that moderate or light drinking can harm the fetus, too, according to the March of Dimes.

"Alcohol goes from your system to the baby's blood stream," Nettleman says.

But do medical school professors follow the texts strictly or insert their own anti-drinking messages to students during classroom lectures?

"I can't say for sure," Nettleman says. "We did not study that."

Nettleman is puzzled as to why textbooks haven't inserted revisions. "All the major organizations, such as the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, public health organizations, all advocate zero drinking during pregnancy," she says.

"I can't prove to you that having one drink during pregnancy is bad," she says, because no one can definitely say that a single drink can damage a fetus. But since no one knows the lower limit of safety for alcohol during pregnancy, zero drinking is the only rational policy, she says.

A Los Angeles clinical geneticist says she is "not totally surprised" by the findings.

"I think there is a hesitation to put something so strong [like banning drinking during pregnancy] in the textbook," says Dr. Karen Filkins, an associate professor of obstetrics and gynecology at UCLA School of Medicine who has set up birth defects hotlines and conducts genetics counseling.

Women who have a drink and then discover they're pregnant can get very anxious, she has found over her years of counseling and administering hotlines.

"We experience [on the hotlines] numerous phone calls from women who had a drink early in pregnancy." Most are alarmed and concerned, she says. And she reassures them that most of the time one or two drinks early in pregnancy are not going to have an adverse effect, but that no one can guarantee that outcome in every case, because the limit of safety is unknown.

Ideally, how should the textbooks address drinking during pregnancy?

"I think textbooks should discuss it the way I do," Filkins says. "For those who have had inadvertent exposure, there is no reason to panic. However, there is no known lower level [of safety]. The policy and the stance should be 'no alcohol during pregnancy.' But the textbooks ought to address both the 'no alcohol' policy and the inadvertent alcohol situation."

In the case of inadvertent exposure, the textbooks ought to recommend that doctors advise the woman to call a birth defects hotline or consult with her doctor or a genetics expert so an assessment can be made of her specific risk, Filkins says.

What To Do

To read the American Academy of Pediatrics' policy statement on alcohol during pregnancy, click here. For information on the hazards of drinking during pregnancy, see The March of Dimes. To find a hotline information service, go to the Organization of Teratology Information Services.

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Experts Say Cancer Pain Undertreated

By Paul Recer
AP Science Writer
The Associated Press
Wednesday, July 17, 2002

WASHINGTON -- Cancer patients often suffer needlessly because the nation's medical system does a poor job of treating pain that is a common part of the disease, according to experts who produced a study for the National Institutes of Health.

"Cancer-related pain, depression and fatigue are undertreated and this situation is simply unacceptable," said Dr. Donald Patrick, a medical professor at the University of Washington, Seattle, and chairman of the committee.

"We have to move to the point that patient comfort and care are a part of the cancer treatment agenda," said Dr. Andrew T. Turrisi III, a radiation oncologist at the Medical University of South Carolina, Charleston. "Some patients are more fearful of pain than they are of death itself."

"Optimal pain relief for cancer patients needs to be a minimally accepted standard," the committee statement said. "Inadequately treated pain can be considered one indicator of poor quality of care."

The report was written after the 13-member panel analyzed a series of studies over a two-day period at a conference organized by the NIH.

At a news conference where the report was released, Patrick said the group found that many doctors lack the knowledge of how to control relentless pain and that medical schools fail to provide adequate training in pain management.

"The educational process needs to be rethought," said Patrick. "Students, trainees and post graduates all need additional training in management, assessment and treatment of pain."

There are also official barriers to bringing relief to suffering patients, the panel said.

Dr. Paul S. Frame, a professor at the University of Rochester School of Medicine in New York and a member of the committee, said some government regulations require a three-copy report each time a doctor prescribes some opiates commonly used for cancer pain relief.

"Sometimes practitioners don't want to go to the hassle of prescribing a triplicate drug," he said. "They may use something less effective instead."

Even the day of the week can block pain relief for cancer patients, said L. Douglas Ried, a professor at the college of pharmacy, University of Florida, Gainesville.

Ried said regulations require that a patient get a new prescription for some opiates used for pain relieve. If, for instance, a patient runs out of morphine on a weekend, "it is very difficult for him to get another prescription" because his doctor is not available and a pharmacist is not allowed to sell more of the drug without a doctor's approval.

"Sometimes pharmacists will fill the prescription and then call the doctor on Monday, but they are putting their license at risk," said Ried. "Most pharmacists, though, follow the regulations to the letter," which leaves the patient still in pain.

Even the size of the pain problem is uncertain, the committee said. The report estimated that there are nearly 9 million people in the United States with a history of cancer, with about 1.3 million additional patients diagnosed each year. About 60 percent of these patients will live at least five years.

The committee said some researchers studying pain management said that only about 14 percent of cancer patients have persistent pain. Other studies found that relentless pain affected virtually every cancer patient. The most common estimates found that pain was poorly controlled in 26 to 41 percent of all cancer patients.

One obstacle to measuring the scope of the problem is that patients, themselves, often give their doctors poor insight into their pain, with some believing that it is just part of the cancer experience and must be tolerated.

"They sometimes feel there is not much that can be done about it," said Frame.

Other patients have an unrealistic fear about opiates and often choose to suffer instead of asking for the drugs, he said.

"There is a feeling that the drugs are bad," said Frame. "They are worried about addiction. People don't want to become junkies." ______

On the Net:

NIH Report: http://consensus.nih.gov

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Blood Test Helps Catch Congestive Heart Failure 

By Amy Norton

Reuters Health

The Associated Press
Wednesday, July 17, 2002

NEW YORK (Reuters Health) - A simple blood test can help spot emergency department patients with congestive heart failure, potentially getting them the necessary treatment quicker, according to researchers.

Their international study of nearly 1,600 emergency patients with shortness of breath found that the 15-minute test--which measures a hormone called B-type natriuretic peptide (BNP)--was the single most accurate predictor of heart failure in the set of criteria the researchers used.

Congestive heart failure is a chronic condition in which the heart loses its ability to pump efficiently, often due to an underlying cardiac problem such as coronary artery disease. Shortness of breath is a prime symptom, but when patients arrive at the emergency department with breathing problems, it can be difficult to distinguish whether it's due to heart failure or other causes.

According to the authors of the new study, the BNP test--used along with other patient information--"should lead to more accurate initial diagnoses of congestive heart failure."

Dr. Alan S. Maisel, of the University of California, San Diego, and his colleagues report the findings in the July 18th issue of The New England Journal of Medicine ( news - web sites).

The study was partially funded by Biosite Inc., whose Triage BNP test was approved by the US Food and Drug Administration ( news - web sites) in 2000 to aid in the diagnosis of congestive heart failure.

BNP is a hormone secreted from the heart's ventricles in response to increased pressure and volume in the organ. The hormone helps relieve this stress by promoting the release of fluid and sodium from the body, and BNP levels have been found to be elevated in the blood of people with heart failure.

In the new study, Maisel's team found that out of all patients, 47% were ultimately diagnosed with congestive heart failure. And the BNP test was the single most accurate predictor of heart failure, in a set of criteria that included patients' medical history and chest x-rays.

"The use of this test is increasing, and studies such as this will encourage greater utilization," Dr. Kenneth L. Baughman of Johns Hopkins Hospital in Baltimore, Maryland, told Reuters Health. Baughman wrote a commentary published with the report.

He noted that along with confirming heart failure as the cause of patients' shortness of breath, the BNP test can help judge the severity of heart failure, estimate patients' prognosis, and judge the effectiveness of heart failure therapy.

However, Baughman pointed out, the test will not replace echocardiography, which uses ultrasound waves to produce images of the heart in action.

Source: The New England Journal of Medicine 2002;347:161-167.

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National Campaign Will Urge U.S. Kids to Get Active

Reuters Health

Wednesday, July 17, 2002

WASHINGTON (Reuters Health) - The federal government on Wednesday officially unveiled its new TV, radio, and Internet ad campaign designed to get America's children moving so that they won't become overweight and more prone to chronic conditions like diabetes and heart disease.

In a major departure for the government, the ad campaign was paid for, and will be aired in cooperation with, some of the companies that have successfully marketed programming and products to the 9-to-13-year-old age group--the teens--the government is targeting. Among those providing supportive programming or community events are DC Comics, AOL Time Warner, Disney, Primedia and Viacom.

The ads will start airing more often in the next few days on TV and radio shows and Web sites frequently viewed or listened to by teens. They will see cartoons of children running or swimming with action verbs floating around them, followed by the tag line,

"Verb, it's what you do."

"Verb means action, and action is the focus of this campaign," said Department of Health and Human Services ( news - web sites) Secretary Tommy Thompson. He said children are much less physically active than those of previous generations, and added that more than 13%, or eight million children, between 6 and 17 are overweight.

Sixty-seven percent of American children watch two or more hours of TV per day, and of the teen group, 57% have a TV in their bedroom, 39% have video game equipment, and 11% have Internet access, he said.

While the goal is to get children to move away from their televisions, Game Boys, and computer screens, the government hopes to capture their attention while they pursue those activities.

With about $125 million given to the agency two years ago, the Centers for Disease Control and Prevention ( news - web sites) (CDC) hired several advertising companies, including Saatchi & Saatchi, to create the ads. The government is purchasing time to run the ads--although at a deep discount, thanks to its partnerships.

The ads will be seen on the Viacom networks, which include Nickelodeon and MTV--two of the most-heavily watched by teens, said Jeff Dunn, chief operating officer of Nickelodeon, TNN, and TV Land.

Nickelodeon plans to feature Verb in its magazine, which is read by 5 million children a month, and stage Verb events in conjunction with its Wild & Crazy Kids show, Dunn said.

The big push will happen this fall, said Thompson, adding that the ads will run more often and content about Verb will be featured in Channel One programming, aired in many schools.

Ironically, the Bush Administration did not slate any funds for Verb in its fiscal 2003 budget request.

When asked why the Administration appeared to not be supporting the program, Thompson told Reuters Health the government is waiting to see "if it is effective" before seeking any more money.

Congress may appropriate funds anyway, Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, told Reuters Health, noting that her group and several hundred others are lobbying for increased funding.

"I think it's one of the most important and innovative child health promotion programs that the government has," she said.

Mike Greenwell, who heads Verb at the CDC, said there's no danger of the campaign ending abruptly, adding that it's not surprising there was no request for new funds by the Administration.

"CDC has never done this, so there is some 'let's see if this is working,"' he told Reuters Health.

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Survey Highlights Patients' Medication Worries 

Reuters Health

Wednesday, July 17, 2002

NEW YORK (Reuters Health) - Many Americans worry about getting the wrong medication or having a negative reaction to a drug when they're admitted to a hospital or nursing home, a new survey shows.

Eighty-five percent of adults expressed concern about at least one medication-related issue in a survey sponsored by the American Society of Health-System Pharmacists ( news - web sites) (ASHP), a professional organization representing some 30,000 pharmacists who practice in healthcare institutional settings, such as hospitals, nursing homes and HMOs.

Just over 70% cited concern about being given medications that interact in a negative way. Nearly equal proportions expressed concern about being given the wrong medicine (69.1%), the cost of treatment (68.7%), and complications from a medical procedure, such as an infection (68.6%).

Three-quarters of respondents agreed, however, that speaking to a pharmacist would help address their concerns. A large majority (90%) said they would talk to a pharmacist about their medication if they were offered that opportunity.

Debra Devereaux, president of the Bethesda, Maryland-based professional association, said the findings support ASHP's belief that pharmacists are uniquely qualified to help patients with their medications.

ASHP, along with other national pharmacy organizations, is pushing Congress to amend the Social Security ( news - web sites) Act to recognize pharmacists as providers. Without "provider status," pharmacists' ability to bill and be reimbursed for patient care services, such as consulting with individuals on their medications, is quite limited, Devereaux told Reuters Health.

The national poll of 1,004 adults was conducted in May of this year. Respondents were randomly selected and hadn't necessarily been admitted in the past to a hospital or nursing home. The assumption was that most people do have some experience as a hospital patient.

Survey respondents were read a list of issues "some people think about when they are admitted into a hospital or nursing home" and asked to indicate their level of concern on a scale of 1 (not concerned at all) to 5 (very concerned).

A majority of Medicare respondents said they were concerned or very concerned about all 10 health issues cited in the survey. They were especially concerned about the cost of treatment. But because of the small number of Medicare patients in the survey--just 165--none of the percentage differences between their responses and those of non-Medicare patients were statistically significant.

Respondents in the lowest income bracket--under $25,000--and those with a high school education or less were more likely than others to indicate concern about medication issues. Female respondents were more likely to be concerned with medication issues than the males were.

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FDA OKs Breathing Device to Lower Blood Pressure 

Reuters Health

Wednesday, July 17, 2002

WASHINGTON (Reuters Health) - A device that helps people bring down their blood pressure by doing breathing exercises has received approval from the US Food and Drug Administration ( news - web sites) (FDA) for sale over the counter, the device's maker reported Wednesday.

The device, called Resperate, is made by InterCure Inc. It is a battery-operated device that measures the user's respiratory rate and guides him or her through breathing exercises aimed at lowering blood pressure.

The FDA first approved Resperate in May 2000 for stress reduction. The agency also said the device could be prescribed as part of high blood pressure treatment, if used under the guidance of a physician.

FDA's supplementary approval makes Resperate available without a prescription, which InterCure Inc. said would ease access to the alternative treatment for millions of Americans with high blood pressure.

The company added that in clinical trails, Resperate was shown to reduce blood pressure by an average of 14 mm Hg systolic and 9 mm Hg diastolic after 8 weeks of routine use, or three to four times a week for about 15 minutes per day. Systolic pressure is the upper number in a blood pressure reading, while diastolic is the lower figure.

A corporate spokesperson told Reuters Health the device would cost around $299, and that approximately 300 have been sold so far, mostly through word of mouth.

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HIV-Protective Gene May Boost Hepatitis C Infection 

Reuters Health

Wednesday, July 17, 2002

NEW YORK (Reuters Health) - Patients with a gene variation that protects them from HIV ( news - web sites) infection may be more prone to developing the liver infection hepatitis C, German researchers report.

Hepatitis C is a viral infection of the liver that is transmitted through contact with infected blood. Many people with hepatitis C are unaware of the infection and remain symptom-free for years, although some eventually develop cirrhosis of the liver.

The HIV-protective gene variant is called CCR5-delta 32. To investigate whether the variant plays a role in infection with other viruses, Dr. Rainer P. Woitas and colleagues from the University of Bonn screened 153 hepatitis C virus (HCV)-infected patients, 102 HIV-infected patients, 130 patients with both HCV and HIV infection, and 102 healthy individuals for CCR5-delta 32.

Twelve HCV-infected patients and one healthy study participant had two copies of the mutated gene, but none of the HIV-infected patients or HCV/HIV-infected patients did. People with HCV infection were also more likely to have at least one copy of CCR5-delta 21 than those who were free of the virus.

Three times as many HCV-infected patients carried two copies of the mutated gene than would have been expected. And patients with two CCR5-delta 32 mutations who had hepatitis C carried more of the virus than HCV-infected people with two normal versions of the gene.

Further studies are needed to determine why a mutation that protects against HIV infection appears to make it easier for hepatitis C virus to take over, the authors state.

"Such research might have considerable practical consequences, because CCR5 inhibitors are currently being developed for the treatment of HIV disease," they point out. "Possible adverse effects of CCR5 inhibitors on other viral infections such as HCV, which are frequently associated with HIV infection, must be considered carefully."

Source: Gastroenterology 2002;122:1721-1728.

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Man's Herbal Tea Use Linked to Liver Damage 

Reuters Health

Wednesday, July 17, 2002

NEW YORK (Reuters Health) - Greek researchers report the case of a 62-year-old man hospitalized with a "hepatitis-like illness" after consuming an herbal tea.

According to the report in the July issue of the European Journal of Gastroenterology and Hepatology, the man had been drinking tea containing the herb Teucrium capitatum L. (T. capitatum) to treat himself for high cholesterol and high blood sugar.

The report underscores the potential hazards associated with unregulated herbal supplements, several of which have been linked to liver damage. Most recently, the German government banned the use of the herb kava, often used to battle stress or anxiety, for its deleterious effects on the liver.

"To the best of our knowledge, this is the first description of acute hepatitis related to the use of T. capitatum," write lead author Spyros P. Dourakis and colleagues at Athens University in Greece.

According to the report, the man had been drinking the tea daily for 4 months when he developed loss of appetite, nausea and malaise. He stopped drinking the tea, and a few days later became jaundiced and went to the hospital. Jaundice is a yellowing of the skin caused by damage to the liver. At the hospital, the man denied taking any drugs or abusing alcohol.

Tests conducted by Dourakis and colleagues revealed liver toxicity, and the man was diagnosed with an acute icteric (jaundice) hepatitis-like illness. After 9 weeks, the man recovered and his liver function returned to normal.

The case "highlights the fact that some medicinal plants may not be as safe as they are widely considered," the authors conclude.

Source: European Journal of Gastroenterology and Hepatology 2002;14:693-695.

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TUESDAY, JULY 16, 2002 

Beta-Blockers Don't Boost Depression Risk: Report 

Reuters Health

Tuesday, July 16, 2002

NEW YORK (Reuters Health) - Beta-blocker therapy does not necessarily lead to depression, fatigue and sexual problems, a review of medical studies reveals.

While beta-blockers can increase heart attack survival and prevent repeat heart attacks, claims that the drugs are associated with side effects that affect quality of life have limited their use among elderly people. The new findings suggest that far more people could benefit from the drugs.

"Our findings should alleviate concerns that long-term treatment with beta-blockers causes substantial increases in these symptoms that may compromise quality of life, and should encourage the implementation of this life-saving therapy," according to Dr. Dennis T. Ko of Yale University in New Haven, Connecticut, and colleagues.

Ko's team reviewed 15 studies involving more than 35,000 people followed for at least 6 months. The studies, which all reported on symptoms of depression, fatigue and sexual dysfunction, compared beta-blockers for heart attack, heart failure or high blood pressure with an inactive treatment, or a placebo.

There was no notable increase in the risk of depressive symptoms among adults taking beta-blockers, Ko and colleagues report in the July 17th issue of The Journal of the American Medical Association ( news - web sites).

However, 18 out of every 1,000 patients treated for one year reported an increase in fatigue and 5 per 1,000 patients reported an increase in sexual dysfunction. Four out of every 1,000 patients stopped using beta-blockers after one year due to fatigue and 2 per 1,000 patients stopped their treatment due to sexual problems, the investigators found.

There was no difference in rates of depressive symptoms and sexual dysfunction between older- and newer-generations of beta-blockers, although the early-generation drugs were more likely to cause fatigue.

Still, the benefits of beta-blocker therapy outweigh the risks for some patients, according to the researchers.

"Given the survival benefit associated with beta-blocker therapy, concerns about the development of these adverse effects should not deter physicians from initiating long-term treatment when indicated, although surveillance for adverse effects remains prudent," Ko and colleagues conclude.

Source: The Journal of the American Medical Association 2002;288:351-357.

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Health Info on Web Often Not Backed by Science 

Reuters Health

Tuesday, July 16, 2002

NEW YORK (Reuters Health) - Consumers searching for health information on the Internet are likely to encounter Web sites selling products or making claims not backed by medical research, a team of journalists reports.

Their findings are based on an Internet search using five portals ( news - web sites): Yahoo, America Online, Microsoft Network, Lycos, and Go. The researchers searched for eight terms related to heart disease, eight related to cancer and eight related to weight loss. The analysis included the first 10 sites listed by the five portals for the different topics for a total of 1,200 Web sites.

Only 35% of the sites were non-promotional and based on scientific information, the researchers report in a letter in the July 17th issue of The Journal of the American Medical Association ( news - web sites). About 11% of the sites were based on medical evidence but sold products, and 22% of the sites were not based on scientific research and sold products.

Nearly one third of the sites that came up through the search were personal pages, book catalog sites or unavailable sites. Overall, less than 3% of the sites were for government-sponsored Web sites, the team found.

And in other findings, science-based Web sites dedicated to weight loss were more likely than science-based sites devoted to cancer to sell products.

"These results reinforce concerns that Internet users are likely to encounter Web sites selling products, usually products unsupported by scientific research, as well as objective, science-based medical recommendations," according to Dr. Michael D. Slater and colleagues from the Department of Journalism and Technical Communication at Colorado State University in Fort Collins.

Indeed, a recent survey by Harris Interactive found that the majority of adults in four different countries believe that the government should regulate online health information. At the same time, a large majority of Internet users surveyed in the US, France, Germany, and Japan believe that health information on the Web is trustworthy and of good quality.

Source: The Journal of the American Medical Association 2002;288:316-317.

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Before You Eat--Stop and Think: Are You Hungry? 

By Keith Mulvihill

Reuters Health

Tuesday, July 16, 2002

NEW YORK (Reuters Health) - A person's degree of inhibition when it comes to chowing down on snacks and goodies is tied to his or her likelihood of being overweight, according to researchers at Tufts University in Boston, Massachusetts.

The good news is that using some restraint--for example by choosing low-calorie foods--can help people who just can't seem to resist the temptation to eat, according to lead investigator Dr. Susan B. Roberts.

The reasons why some people are able to stay trim while others gain weight remain unclear, Roberts and her colleagues note in the current issue of the American Journal of Clinical Nutrition ( news - web sites).

To investigate the role of eating behavior in weight gain, the researchers evaluated three eating behaviors--restraint, disinhibition and hunger--as well as the weight and height of 638 healthy, non-smoking women aged 55 to 65.

Restraint is the ability to consciously restrict food intake in order to maintain weight or lose pounds. Disinhibition is the inclination to overeat when tempting food is available, or to overeat in the presence of factors that can loosen inhibitions, such as emotional distress, regardless of whether or not a person is hungry. Hunger is a person's sensitivity to feelings indicating a need for food.

The researchers found that the higher a person's degree of disinhibition, the higher their weight.

"The main finding of the study is that disinhibited eating is very strongly associated with obesity," Roberts said in an interview with Reuters Health.

"Being disinhibited also predicts adult weight gain--30 pounds more over 25 years up to age about 60 years," she added.

However, "being a restrained eater also helps offset the effect of disinhibition," Roberts added. "Restrained eaters are those who count calories (and) tend to shop for low-fat foods. So these behaviors seem to help some, but not as much as not overindulging when you don't need to," she said.

Roberts recommends that people who are concerned about their weight fight the urge to gobble up all the food that is offered to them. Instead, Roberts tells people to think about whether or not they are hungry and not to assume that if they overeat at one meal, they will eat less later.

"If you really want (the food) but you are not hungry, take a really small piece...(and) don't finish large portions just because they are there," she advised. "Save them for another day."

Source: American Journal of Clinical Nutrition 2002;75:476-483.

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New Docs Prescribe Drugs to Family, Friends: Study 

Reuters Health

Tuesday, July 16, 2002

NEW YORK (Reuters Health) - Results of a survey in one US hospital suggest that as many as 85% of new doctors prescribe medications to people other than their patients.

While the practice is not uncommon among more veteran physicians, lead author Dr. Brian M. Aboff of the Christina Care Health System in Wilmington, Delaware and colleagues point out that "the ability to write prescriptions is one of the most important new responsibilities that residents acquire after graduating from medical school."

Upon graduating, doctors typically enroll in residency programs for additional training in a specific field. During regular duties, the prescribing of medication by residents is monitored. However, little is known about prescription writing for people who are not their patients, Aboff and colleagues point out.

To investigate, Aboff's team surveyed 92 internal medicine and family practice residents at one hospital about their drug prescribing habits. The 74 residents who responded to the survey rated their likelihood of giving a prescription to a non-patient in several "hypothetical scenarios" and answered questions about their own prescribing habits.

In all, 85% of the residents reported that they had written at least one prescription for a non-patient, such as a friend, a family member or a co-worker, the authors report in the July 17th issue of The Journal of American Medical Association.

The drugs most commonly prescribed were antibiotics (83%), antihistamines (56%), nonsteroidal anti-inflammatory drugs (35%), birth control pills (22%) and antidepressants (10%), according to the report.

The new doctors were much less likely to prescribe drugs that could potentially be abused--such as muscle relaxants or tranquilizers--and none of the residents reported prescribing narcotics to non-patients.

In other findings, the researchers report that based on the survey responses, "under certain circumstances, up to 95% of residents would write a prescription for an individual who is not their patient." For example, 95% said they would write an antibiotic prescription for a sibling with an acute sinus infection and 77% said they would write a prescription for their own child with a middle ear infection.

However, only 15% would prescribe an anti-inflammatory drug to a recent acquaintance with back pain, although 62% might prescribe such a drug to neighbor with a flare-up of gout, a painful form of arthritis.

On the other hand, 74% reported that they had refused to write a prescription for a non-patient at some point.

"Although the results may not be generalizable to all residents," Aboff and colleagues conclude, "our study raises concern that the practice (of prescribing medication to non-patients) may be widespread."

Source: The Journal of the American Medical Association ( news - web sites) 2002;288:381-385.

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Light Drinking Ups Blood Pressure in Some Men 

Reuters Health

Tuesday, July 16, 2002

NEW YORK (Reuters Health) - Even light drinking can raise the risk of high blood pressure among Japanese men, researchers have found.

The findings contradict a number of other reports showing that adults who consume moderate amounts of alcohol, or about two drinks a day, are less prone to heart disease. But according to the report, the risk of high blood pressure (hypertension) rose in tandem with the amount of alcohol consumed among Japanese adults.

The relationship was particularly strong for men. In the study, even light drinking raised the risk of developing high blood pressure over 10 years regardless of other risk factors such as age and body mass index (BMI), a measure of weight in relation to height.

However, it is not clear if the results of the study apply to all men. Japanese men are less likely than their American peers to be obese, and body weight can affect how much alcohol enters the blood. Also, about half of all Japanese people have a genetic variation that affects the way alcohol is metabolized, the report indicates.

What's more, the study did not include information on diet. Certain foods and nutrients can influence blood pressure, Dr. Susumu Ohmori and colleagues from Kyushu University in Fukuoka, Japan point out in the July issue of Alcohol: Clinical and Experimental Research.

While the study may not apply to other populations, the findings "suggest that even light drinking is a predictor of future hypertension in Japanese men," Dr. Susumu Ohmori and colleagues from Kyushu University in Fukuoka, Japan, conclude.

"Vigilant blood pressure monitoring is therefore necessary for the Japanese, even for light drinkers," they add.

Source: Alcohol: Clinical and Experimental Research 2002;26.

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Men: I'll Take Meat and Hold the Veggies, Starch 

By Alison McCook

Reuters Health

Tuesday, July 16, 2002

NEW YORK (Reuters Health) - A small survey of college students suggests that young men may choose meat as a mainstay of their diet, while women are more likely to eat well-balanced meals.

It is important to take note of gender preferences for food, according to Dr. Laurence J. Nolan of Wagner College in Staten Island, New York. Dietary patterns established at a young age may persist throughout a lifetime, and long-term imbalances in nutritional intake can lead to health problems down the road, he said.

For example, if men are not getting enough dietary fiber from not eating enough vegetables, or if they are consuming too much fat, "it could reflect potential obesity, or other problems as they get older, if that continues," Nolan said.

"For the men, it's clear that meat was the main component of every meal--no matter what situation they're in," Nolan told Reuters Health.

But they're not the only ones guilty of sometimes straying from recommended diets: Nolan and his team also found that women say they are more likely to eat dessert when dining alone than in the presence of others.

However, based on 74 college students' self-reports of their eating behaviors, women, in general, eat more balanced meals than men, Nolan concluded.

During the study, 53 women and 21 men completed questionnaires asking them to rate how much of each type of food they would expect to eat during different social situations. Foods consisted of bread, salad, pasta, vegetables, meat and dessert. The social situations varied from formal to informal, with students rating dining choices during scenarios such as first dates, meals with family and friends, or when eating alone.

Nolan and his team found that men eat more meat than anything else in all social situations, and report eating fewer vegetables than women when dining with friends or eating alone.

The female study participants, in contrast, said they believed they would eat roughly the same amount of food from each category in all social situations, although they said they would be more likely to eat dessert when dining alone.

The researchers presented their findings at the recent American Psychological Society meeting in New Orleans, Louisiana.

In an interview with Reuters Health, Nolan speculated that gender differences in meals could stem from disparities in what each gender thinks should be eaten during meals, or from expectations of what will be available at each meal. For example, men may see fewer vegetables and more meat when thinking of their own refrigerators and those of their friends, the researcher said.

"It could be that the women--for whatever reasons, health, weight consciousness--feel that vegetables are always going to be a part of what they consume," Nolan said.

Health officials at colleges and universities often worry about eating disorders in female students, and perhaps should focus efforts to educate students about nutrition on men, as well, Nolan added.

"This is the first time students are out on they're own," Nolan said, "Both sexes should be informed about good food choices, and the tendencies they might have," he added.

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Blacks Fare Worse Than Whites After Heart Failure 

Reuters Health

Tuesday, July 16, 2002

NEW YORK (Reuters Health) - Black patients are more likely than whites to lose their ability to carry out day-to-day tasks such as bathing and shopping within 6 months of being diagnosed with heart failure, study results suggest.

It is not clear why blacks may fare worse than whites. While socioeconomic factors and access to medical care were worse for African-American patients in the study, these differences could not explain their worse outcome, according to the report in a recent issue of the American Heart Journal.

The researchers suggest that future studies investigate differences in the way blacks and whites develop heart disease and respond to therapies. Blacks, for instance, do not seem to respond as well as whites to treatment with beta-blockers and angiotensin inhibitors.

"These differences in response to treatment, if related to the outcome of heart failure, have therapeutic implications," Dr. Viola Vaccarino from Emory University in Atlanta, Georgia and colleagues write.

Heart failure occurs when the organ loses its ability to pump blood efficiently. Symptoms include weakness, shortness of breath and fluid retention.

The study included 316 white and 82 African-American patients aged 50 and older who were diagnosed with heart failure upon admission to a community hospital. Researchers interviewed all patients about their family income and expenses, access to healthcare, and level of physical functioning before they were hospitalized.

While rates of death and re-hospitalization were similar after 6 months, blacks were more likely to lose their ability to perform a range of daily activities. Overall, nearly 38% of blacks experienced functional decline, compared with 25% of whites.

In other findings, blacks had less education and income, and more financial stress than their white peers. Half of the African-American patients in the study had either no health insurance or only Medicare or Medicaid, compared with 18% of whites, and nearly 14% of blacks said they did not have a usual medical clinic, compared with 8% of whites.

Blacks were also more likely to have a history of high blood pressure, kidney disease and diabetes, and to be overweight, the study findings indicate. There were no differences when it came to a history of heart failure or the duration of heart failure.

"There are remarkable differences in patient characteristics between African-American and white patients with heart failure, especially in the socioeconomic and access-to-care indicators," Vaccarino and colleagues explain.

"However, our study was unable to demonstrate that these factors play a role in the greater functional decline of African-American patients," the researchers add.

Source: American Heart Journal 2002;143:1058-1067.

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Fruits and Veggies Boost Memory 

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Tuesday, July 16, 2002

TUESDAY, July 16 (HealthScoutNews) -- Eating more fruits and vegetables has always been smart, but new research shows just how smart it is.

Two new animal studies have found that antioxidants in fruits and vegetables can improve learning and memory, and they minimize the effect of aging on the brain. Certain foods do a better job of this, the studies show, because they have higher levels of antioxidant activity.

Antioxidants can undo cell damage caused by renegade "free radical" molecules, and previous studies have shown they can prevent disease and improve mental functioning, among other things.

"What we have done is focus on the fruits and vegetables high on the U.S. Department of Agriculture ( news - web sites) (USDA) list of antioxidants," says Paula Bickford, a senior career scientist at the James A. Haley Veterans Hospital in Tampa and lead author of both studies, just published in the Journal of Neuroscience.

The USDA ranks foods by their antioxidant content. Spinach, spirulina (an algae often sold in capsule form in health food stores) and apples were particularly beneficial for learning and memory, Bickford says.

In the first study, the researchers fed a group of rats a diet rich in spinach, while another group got regular rat chow, all for six weeks. The rats were then measured for their performance on a traditional learning test: They were exposed to a tone, then exposed to a puff of air to the eye. The researchers studied how long it took rats in each group to learn to blink to avoid the air puff.

"The ones on spinach learned to make the association with fewer trials," Bickford says. "By the third day, they were at their learning maximum. It took the [other] rats five or six days to learn.

"We think that what we are experiencing [in the rats] is an improvement in neuron functioning. Because we improve the ability of the neurons to communicate, it is easier for the animals [on the spinach-enriched diets] to learn," she adds.

In the second study, the researchers compared three types of diets, again fed to rats: one group got a diet enriched with spirulina (high in antioxidants), another group got apples (moderate in antioxidant activity), and a third got cucumber, which is low in antioxidants.

"Initially, I was amazed," Bickford says. "We were seeing effects within two weeks with the apple and spirulina diets."

When the rats' brain functioning was evaluated, the researchers found the accumulation of inflammatory substances in the brain that typically occurs with age had been reversed in those on the apple and spirulina diets, and that they had better neuron functioning.

The amount of apple in the apple-enriched diet, for instance, was about 1 percent of the diet, Bickford says, which translates to about an apple a day.

Bickford can't say the study applies to humans, but she thinks it might.

"I've always eaten a lot of fruits and vegetables," she says. Since the study results, she's boosted her intake even more, she adds.

Another antioxidant researcher says the study is interesting, but not yet reason enough to change your diet.

"We have done similar studies," says Raj Sohal, a professor of molecular pharmacology and toxicology at the University of Southern California School of Pharmacy in Los Angeles.

In one instance, Sohal and his team gave animals supplements of the antioxidant vitamin E and found it improved memory in up to 15 percent of the animals.

The unanswered question, he says, is, "to what extent are we correcting a deficiency?" When and if that is the case, he adds, someone who already gets the recommended amounts of antioxidants may not benefit by taking even higher amounts.

"These are just preliminary," he says of the Florida studies. "They have to be replicated. The study is interesting in the sense that these kinds of studies are needed."

However, it shouldn't, for instance, cause a cucumber lover to give up the vegetable, he adds.

What To Do

For information on antioxidant levels in fruits and vegetables, see the U.S. Department of Agriculture.

For information on forgetfulness, see National Institutes on Aging.

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Youths Ignoring Skin Cancer Warnings 

HealthScoutNews

Tuesday, July 16, 2002

TUESDAY, July 16 (HealthScoutNews) -- Young adults apparently have so much fun frolicking in the sun that they ignore the deadly risks associated with sunburns.

A new study published in the August issue of the American Journal of Preventive Medicine found that 60 percent of young adults in America report suffering a sunburn in the past year. That compares to about 32 percent of adults overall.

Skin cancer, which is diagnosed in about a million Americans each year, is the most easily preventable form of the cancer. Sun exposure has been linked to the deadly disease.

Using data from the National Cancer Institute ( news - web sites), the researchers say those most likely to spend too much time in the sun include suburbanites and those who are more educated. They say people in those groups may have more leisure time to spend outside than others. Midwesterners were also more likely to report a sunburn during the past 12 months.

More information

The American Academy of Dermatology can help you assess your risk of getting skin cancer.

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Cancer Deaths Higher Than Reported 

HealthScoutNews

Tuesday, July 16, 2002

TUESDAY, July 16 (HealthScoutNews) -- If you find yourself worrying every time you hear about the rates of death from cancer, a new study may leave you even more concerned.

The Dartmouth Medical School study, published in tomorrow's issue of the Journal of the National Cancer Institute ( news - web sites), says cancer death rates are actually higher than now reported. That's because, according to the researchers, many deaths that occur during cancer surgey are reported as being caused by the operation, rather than the underlying disease.

The researchers say that change in the death rates would be modest -- 1 percent increase if deaths within the first month of cancer surgery were classified correctly and as much as 4 percent if deaths in the year following surgery were classified as caused by the disease.

Still, researchers say their study shows there is confusion among medical professionals on how to classify the cause of death among patients. They propose that all deaths within a month of cancer surgery be classified as being caused by the disease.

More information

To learn more about cancer, go to the American Cancer Society.

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MONDAY, JULY 15, 2002 

Panel Examining Water, Sports Drinks and Health 

By Alicia Ault

Reuters Health

Monday, July 15, 2002

WASHINGTON (Reuters Health) - A panel of scientific advisers met Monday to begin assessing the benefits and risks of water and electrolyte consumption, and said they will issue a report with new recommended intake levels in the spring of 2003.

Electrolytes are substances contained in water and other fluids, such as sodium, potassium and chloride, levels of which play an important role in a number of body functions.

The panel will explore, among other issues, the scientific underpinnings of the eight-glasses-of-water-a-day recommendation that has become a mantra among health officials, said Dr. Lawrence Appel, chairman of the Institute of Medicine ( news - web sites)'s (IOM) Panel on Dietary Reference Intakes for Electrolytes and Water. Appel told Reuters Health that even he wonders where the number came from, and if it is appropriate for everyone.

The committee will also try to determine if there's any harm to excessive water intake, and if sports drinks and waters fortified with potassium, sodium chloride and sulfates provide benefits or undue risks.

The report is part of the IOM's Food and Nutrition Board's continuing effort to develop dietary reference intakes for food, nutrients and fluids. The government has issued recommended daily allowances for human consumption, but the IOM panel has been asked to more deeply assess the science and come up with a new set of recommendations, said Appel, a professor of medicine at Johns Hopkins Medical Institutions in Baltimore, Maryland.

Panelists will try to develop dietary reference intakes for water and electrolyte-fortified fluids for healthy people, pregnant and nursing women, and people who have chronic disease.

The available data is often lacking, however, said Appel, noting that many fluid intake studies have been conducted with just a handful of people. And other studies have been done by water and sports-drink makers, perhaps not always under the rigorous scientific conditions used in academic research.

Appel said new studies to address gaps may be conducted during the next year or so while the panel gathers information and formulates its opinions.

On Monday, committee members heard from Dr. John Greenleaf, a scientist with the National Aeronautics and Space Administration (NASA ( news - web sites)), who said that most Americans seem to be chronically under-hydrated. Studies he has conducted show that people will drink more water if it has a flavor or has added salt and sugar, but that it isn't clear yet if those fortified waters provide better hydration.

Another researcher and panel member, Dr. Oded Bar-Or of McMaster University in Hamilton, Ontario, Canada, said his studies have also shown that healthy children drank more water when it had both salt and sugar added.

But it is not known if those fluids have harmful effects.

The committee also heard data exploring how thirst is initiated and controlled. Dr. Edward Stricker of the University of Pittsburgh, Pennsylvania, said that the sensation of thirst is not well understood. "In fact, it is a very complex business," he said, adding that most of the basic studies delving into thirst and its role in human functioning have been done in rats, not humans.

Experts at the National Academy of Sciences ( news - web sites) will review the panel's report before it is issued to the public next year, said Appel.

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American Idea of Well-Being Differs Across Regions 

By Alan Mozes

Reuters Health

Monday, July 15, 2002

NEW YORK (Reuters Health) - Despite sharing a language, an economy, a culture and a can-do belief in the "American Dream," researchers have found that the way US residents gauge their own sense of well-being varies by region.

"When it comes to defining the 'good life,' place matters," said study lead author Victoria C. Plaut of Stanford University in California. "Our cultural environments give us important ideas about how to be a person and how to be well, and well-being requires embracing these ideas."

Plaut and her colleagues conducted a mail and telephone poll across five regions in the US, asking more than 3,000 men and women aged 25 to 75 questions about their psychological, physical and social well-being.

In the current issue of the Journal of Personality and Social Psychology ( news - web sites), the authors note that US residents do share many opinions on lifestyle issues.

No regional differences were seen in the value survey participants placed on having a purpose in life and feeling they could do whatever they decide they want to do. Most thought these qualities were reflected in their own lives.

And most people surveyed felt a similar level of satisfaction with their lives and physical health. Almost 60% graded their level of satisfaction at the highest possible level, while about 55% said they were generally healthy.

More than two-thirds agreed that being friendly was very important, and most said it was important to be helpful, sympathetic and warm.

Across regions, 72% of those surveyed called themselves "hardworking" and "responsible." And people also felt the same way across the US about the importance of family and spouse and obligation to the community at large.

But altruism did not appear to figure highly in the US consciousness, with just over one third of those throughout the country saying they highly valued the act of helping others at their own expense.

The investigators did find that there is such a thing as a distinct "regional consciousness" in the US.

They had initially constructed hypotheses about each region based on its demographic qualities and cultural aspects. For example, the researchers expected that those living in the Mountain region--"the land of 'Don't fence me in,"'--would value autonomy, while residents of the part of the Midwest the researchers dubbed West North Central would value "averageness," in the sense of "being moderate and not too extreme and resisting self-preoccupation."

In many cases, Plaut and her colleagues found, these regional personas were accurate. For example, Mountain region dwellers placed greater value on focusing on oneself, being open to experience and being assertive. They also considered mastery over the environment to be an important aspect of well-being. This area includes Montana, Idaho, Wyoming, Nevada, Utah, Colorado, Arizona and New Mexico.

And in New England--home to New Hampshire, with its "Live Free or Die" license plates--survey participants said that not being constrained by others was an important aspect of well-being. They also valued broadmindedness, curiosity and organization. Massachusetts, Connecticut, Rhode Island, Vermont and Maine make up the rest of the region.

Those living in the East South Central region, encompassing Kentucky, Tennessee, Alabama and Mississippi, viewed the notions of contributing to others and being caring and softhearted as critical to a sense of well-being. Autonomy was not important for this region's residents' sense of well-being. They were also the most likely to say they felt little control over the things that happened to them.

Only West South Central inhabitants--those living in Texas, Oklahoma, Arkansas and Louisiana--placed a premium on being lively, while also valuing self-confidence and outspokenness.

West North Central dwellers shared an appreciation for being outspoken, but also deemed curiosity to be a virtue. Residents of this region, which includes North and South Dakota, Nebraska, Kansas, Minnesota, Iowa and Missouri, also valued "feeling calm, peaceful and satisfied."

Plaut told Reuters Health that it is important to view the survey not as a reinforcement of regional stereotypes, but rather as an assessment of the impact which a local cultural identity can have on an individual's idea of well-being.

"Despite the cultural homogenization that appears to come with the proliferation of 'The Gap' and 'Starbucks,' there are still many different ways of achieving well-being in America," she said.

Source: Journal of Personality and Social Psychology 2002;83:160-184.

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Depressed Elderly Fail to Get Better: Study 

Reuters

Monday, July 15, 2002

CHICAGO (Reuters) - Depression among the elderly is a common and often chronic condition because it usually goes untreated, Dutch researchers said Sunday.

The six-year study involving interviews with 277 elderly people previously diagnosed with mild to deep depression found roughly two-thirds had recurrent bouts of the disease.

Only 14% of the participants, who were aged 55 to 85 at the start of the study, had short-lived symptoms and 23% reported remissions in their depression.

"In later life, depression is a common disorder, with well-documented consequences for well-being, daily functioning (and) mortality," psychiatrist Aarjan Beekman of Vrije University in Amsterdam wrote.

"Although depression is generally regarded to be highly treatable throughout the life cycle, most elderly persons with depression remain untreated," he added.

Fewer than one quarter of study participants had been prescribed antidepressants, he wrote in the Archives of General Psychiatry, a journal published by the American Medical Association.

"The implications of the study are that the burden of depression for elderly persons in the community is even more severe than previously thought," Beekman wrote.

"The data clearly demonstrate the need for interventions that are helpful, acceptable, and economically feasible to be performed on a larger scale. Especially in the area of (more easily treated) non-major depression, designing and testing such interventions should have a high priority," he added.

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Attending Religious Services May Help Heart Health 

By Alison McCook

Reuters Health

Monday, July 15, 2002

NEW YORK (Reuters Health) - Diabetics ( news - web sites) who attend religious services at least once a year had lower levels of a marker of inflammation linked to heart disease than those who never attended religious services, a new US study has found.

However, the authors note that they only measured how often people attended a religious service, and not how religious they were. Furthermore, there appeared to be no link between service attendance and the marker, called C-reactive protein (CRP), in people who were not diabetic.

"It seemed to apply among people at the greatest risk of cardiovascular disease--the diabetics," study author Dr. Arch G. Mainous of the Medical University of South Carolina in Charleston told Reuters Health.

Mainous suggested that the benefit of attending services may not be the act of attending services itself, but rather religion's ability to have a positive effect on people's lives, for example by providing a helping community. "You're probably looking at something that may be an artifact," he said.

Previous research has suggested that elevated blood levels of CRP may be an independent predictor of heart disease. CRP is a protein the body releases as part of its response to infection and injury, and is a known marker of inflammation. During infection, for instance, blood CRP levels temporarily soar as the immune system jumps into action. More subtly, chronic CRP elevations have been linked to an increased risk of heart disease. Inflammation is believed to play a key role in the hardening and narrowing of arteries that can lead to heart attack and stroke.

People with diabetes typically have higher levels of CRP than non-diabetics, a fact that may help explain why diabetics have a higher-than-average risk of cardiovascular problems.

During the study, Mainous, along with Dr. Dana E. King and colleagues, used data collected as part of a nationwide health survey conducted from 1988 to 1994. The survey included 556 people with diabetes, and all study participants were at least 40 years old. The researchers characterized participants as attenders of religious services if they indicated they went at least once a year.

Around 62% of all survey participants said that they attended religious services, the authors report in the July issue of Diabetes Care. The investigators found that diabetics who never attended religious services had a higher risk of having elevated levels of CRP in their blood than attenders.

The link between CRP and religious service attendance remained even when the researchers accounted for of other factors that can affect health, such as smoking, mobility and obesity.

In an interview with Reuters Health, Mainous explained that there are many reasons why attending religious services may improve health. For example, going to religious services welcomes a person into a community, which can provide a network of social support. Attenders may have lower levels of stress than those who do not embrace religion, because faith can give "people a better sense of answering the questions of the universe," Mainous said.

He suggested that some people who attend religious services may also be more likely to follow their religion's healthy recommendations about lifestyle, which may include no drinking, or following a particular diet.

Further research is needed to determine exactly what happens in the body as a result of attending religious services, Mainous added.

Source: Diabetes Care 2002;25:1172-1176.

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Teetotaling's Best for Blood Pressure 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Monday, July 15, 2002

MONDAY, July 15 (HealthScoutNews) -- If you're trying to control your blood pressure, you might want to think twice before you pour your nightly glass of wine.

Two new Japanese studies from the current issue of Alcohol: Clinical Experience and Research, have shown that even modest amounts of alcohol consumption can lead to an increase in blood pressure.

"Alcohol use represents an important modifiable risk factor for hypertension," says the lead author of the first study, Dr. Noriyuki Nakanishi, from the department of social and environmental medicine at Osaka University Graduate School of Medicine in Japan.

Of Nakanishi's study, Dr. Albert Lowenfels, a professor of community and preventative medicine at New York Medical College, says, "Rather than causing a decrease in blood pressure, it appears that even modest amounts of alcohol cause blood pressure to rise."

Almost one in four Americans has high blood pressure, according to the Centers for Disease Control and Prevention ( news - web sites). Yet many people don't even know they have the condition because it often has no symptoms. Untreated, hypertension can cause stroke, heart disease and kidney failure, and more than 17,000 people die from complications of the disorder annually.

Hypertension is diagnosed when your health-care provider consistently gets readings over 140/90 mmHg when taking your blood pressure, according to the National Institute on Aging.

The first study followed more than 5,000 Japanese male office workers, between the ages of 23 and 59, for more than four years.

The researchers spilt the group into four categories: people who drank fewer than 12 grams of alcohol a day; those who drank 12 grams to 22 grams per day; those who drank 23 grams to 45 grams per day; and those who drank more than 46 grams per day. Lowenfels says an average bottle of wine has about 80 grams of alcohol, so one glass of wine would probably be around 15 to 20 grams of alcohol.

They found that as the alcohol consumption rate went up, so did blood pressure. The effect was even more pronounced in older men. For example, in the 12 grams to 22 grams per day group, systolic blood pressure (the top number) went up 1.4 points in those between the ages of 25 and 35, but increased by 5.4 points for men between the ages of 48 and 59.

In the second study, researchers from Kyushu University recruited more than 1,100 people over 40 and followed them for 10 years. During that time, 101 men and 106 women developed hypertension. The researchers found the risk of developing hypertension was higher for both men and women who drank, even for those who drank moderate amounts of less than 23 grams daily.

One possible limitation to both studies is the alcohol consumption was self-reported, and experts note people often underestimate what they have consumed.

Also, though the "data looks very compelling," cardiologist Dr. Andrew Hauser says the information from these studies is of greatest value to Japanese people, and he doesn't think there is a need to change the drinking guidelines for the average American.

The studies point out again that not everyone is the same when it comes to their health, he adds. "We tend to make too many generalizations across racial lines in medicine," he adds.

Hauser says that there is a lot of data that shows one or two drinks a day isn't a problem for most Americans, and that such amounts of alcohol may even have some health benefits. However, he wouldn't advise non-drinkers to start drinking for the possible health benefits.

Even Nakanishi says he wouldn't advise light to moderate drinkers to stop, because the risk is lowest for them.

What To Do

Here's more information on ways to lower your blood pressure from the National Institute on Aging and the American Academy of Family Physicians.

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Aspirin-Anticoagulant Combo Improves Heart Attack Survival 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Monday, July 15, 2002

MONDAY, July 15 (HealthScoutNews) -- Adding a drug that prevents blood clots to the standard treatment for heart attacks can improve the outcome for many patients, Dutch cardiologists report.

The results look good, an American expert says, but more information is needed before basic changes are made in heart attack treatment.

Patients are routinely given aspirin in the hours after a heart attack because it prevents the blood cells called platelets from clumping together to form clots that reduce blood flow. However, a study done at seven clinics in the Netherlands finds improved blood flow and better survival in selected patients who also got warfarin, which acts in a different way to prevent clotting. The report appears in tomorrow's issue of Circulation.

Those patients had a distinctive pattern called ST-elevation on their electrocardiograms, an indicator often associated with blood clot formation. After three months, a new examination showed that arteries remained open in 85 percent of the patients who got the aspirin-warfarin combination, compared to 72 percent of those who got aspirin alone.

Problem-free survival was significantly better for those who got the combined treatment -- 86 percent versus 66 percent for the aspirin-only patients. Only 2 percent of those who got both drugs had second heart attacks, compared to 8 percent of those got only aspirin.

"People have only thought about platelets in blocked arteries," says Dr. Freek W. A. Verheugt, lead author of the report and director of cardiology at the Heartcenter of University Medical Center in Nijmegen, Netherlands. "We also think about anticoagulant proteins in the blood. They are a threat for recurrent blockage. It has been thought that aspirin would do the trick, but it is not enough. This will change the way we protect our post-infarct [heart attack] patients."

However, Dr. Richard C. Becker, a professor of medicine at the University of Massachusetts Medical School and a spokesman for the American Heart Association ( news - web sites), has a more cautious appraisal.

"For us in the United States, we would have to see the results of larger-scale trials before any changes across the board could recommended," Becker says. "Warfarin needs careful monitoring, and carries the risk of bleeding. We would need more information before we would change treatment."

Research that appeared in The New England Journal of Medicine ( news - web sites) last November voiced the same concern over using warfarin after strokes to prevent clotting. It found aspirin was just as good as warfarin at preventing second strokes, and it didn't carry the same potential dangers.

The seven-year study included more than 2,200 people who had had strokes because of blockages in arteries leading to their brains. The researchers noted warfarin has the potential to cause dangerous bleeding, and people using it must take blood tests every three or four weeks to avoid problems.

Warfarin, also known as coumarin, is associated with a higher risk of dangerous bleeding, Verheugt acknowledges. However, in the latest trial, the incidence of excess bleeding in patients who got the anticoagulant was not significantly higher than in those who got just aspirin, he says.

Also, European cardiologists are conducting studies to see whether a newer and hopefully less risky anticoagulant, melagratin, could be used instead of warfarin, Verheugt says. Melagratin is not approved for general use in Europe or the United States.

Those studies are among a number being done to see how current treatment in the critical hours after a heart attack can be improved, Becker says. Until results of those studies can be evaluated, "aspirin is clearly part of the standard of care," he says. The Dutch study "is important, no question about it, but we need to see the results of the ongoing studies before we can make any recommendations."

The trial is important because it "emphasizes the need for early diagnosis and treatment for heart attacks," Becker says. "It also underscores the importance of having treatment strategies available to prevent re-blockage."

What To Do

To get quick, lifesaving treatment, you need to recognize the symptoms of a heart attack, and you can learn them from the American Heart Association. To learn more about anticoagulant drugs, click here.

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Experimental Drug Destroys Liver Cancer 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Monday, July 15, 2002

MONDAY, July 15 (HealthScoutNews) -- An experimental drug with a taste for energy-thirsty cells appears to kill off liver tumors in rabbits.

Johns Hopkins University scientists found the chemical, known as 3-bromopyruvate, destroys liver cancer and also shrinks tumors that have spread from that organ into the lungs. The substance, which is related to a molecule that occurs naturally in the breakdown of sugar, starves cancerous cells of energy, but appears to leave healthy tissue alone.

The researchers say they must confirm the drug's lack of toxicity to normal tissue before they test it in people. However, they add, if it does prove benign, it might offer doctors a promising new therapy for other forms of tumors.

Liver cancer, which has been linked to the hepatitis B virus, strikes about 16,600 Americans a year and accounts for roughly 1 percent of tumor deaths in the United States. However, it's much more common in Asia and Africa, where it makes up half of all cancer fatalities.

About 50 percent of patients can be cured of the disease. However, for those with inoperable liver cancer, especially tumors that spread from the colon, surviving a year is a feat.

A unique feature of liver tumors is that while they draw their nutrients from an artery, the organ itself is fed separately by the portal vein. In theory, it's possible to target cancerous cells by injecting drugs directly into arterial blood, yet do minimal damage to the surrounding organ.

The latest study, published in today's issue of Cancer Research, attempts such a strategy.

Led by radiologist Dr. Jean-Francois Geschwind, the scientists gave injections of 3-bromopyruvate to rabbits with liver cancer.

The potent chemical drains cells of their energy in two ways: by greatly suppressing their ability to use glucose for fuel; and by hindering the ability of internal power plants called mitochondria to make the energy molecule adenosine triphosphate, or ATP.

Because cancer cells are lusty for glucose, needing it to support their frenetic growth, a drug that selectively kills tissues that demand sugar will turn this thirst against them.

Indeed, a single injection of the drug into the artery supplying the tumors led to "dramatic" shrinkage of the masses, Geschwind says.

"By being able to thread a catheter and get close to the tumor, we can deliver agents in much higher concentrations directly to the tumor. You can really kill the tumor that way," he adds.

Surprisingly, the healthy cells were spared.

"We would have expected some collateral damage, but in this case the specificity of the drug and the method of administering it made a perfect marriage," Geschwind says.

The treatment was gentler on normal cells than a current therapy for liver cancer called chemoembolization, in which doctors inject drugs into the tumors while using an oil solution to block off the artery that feeds them.

Some of the rabbits developed liver cancer nodules in their lungs. So the researchers then injected 3-bromopyruvate directly into their bloodstream through a vessel in their ears. Again, the tumors shrank markedly, but the animals appeared otherwise unscathed, says Peter Pedersen, a Johns Hopkins biochemist and a co-author of the study.

"We didn't find problems with toxicity, but we don't know what the long-term [outlook] is," Pedersen says.

If 3-bromopyruvate ultimately passes the safety tests, Geschwind says it could be useful against a wide range of tumors, because all have the common feature of requiring heaps of energy.

However, finding as finely tuned a way to deliver the drug as is possible with the liver will be trickier, he adds.

What To Do

To learn more about liver cancer, check out the American Liver Foundation or the Allegheny General Liver Cancer Program.

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New Heart Guidelines Stress Youth Checks 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Monday, July 15, 2002

MONDAY, July 15 (HealthScoutNews) -- Americans over 20 should be checked routinely for the tremors of potential heart trouble like high cholesterol, blood sugar trouble and high blood pressure.

That's the recommendation of the American Heart Association ( news - web sites), which has updated its screening guidelines to reflect the growing understanding that while cardiovascular disease may be the leading killer of older Americans, its foundations are often laid in youth.

The association also recommends that all Americans over 40 learn their 10-year risk of heart and vessel disease, which causes heart attacks, strokes and other life-threatening ailments. And everyone should take steps to reduce these risks, by not smoking, exercising regularly, eating a low-fat diet and, if necessary, taking medications that can lower their cholesterol and blood pressure.

"We have to start preventing heart attacks in the first place rather than treating them after they've occurred," said Dr. Thomas Pearson, chief of cardiology at the University of Rochester Medical Center and chairman of the panel that drew up the guidelines.

While the risk of death from heart attack has dropped in the last decade, the rate of heart attacks appears to have remained unchanged, Pearson said. One reason is the rise in Type II diabetes, a significant cause of cardiovascular illness.

Heart disease claims approximately 950,000 lives a year in the United States, according to the Centers for Disease Control and Prevention ( news - web sites). The agency estimates that 61 million Americans have some form of the condition, from high blood pressure to heart failure.

The new guidelines, which appear in tomorrow's issue of the journal Circulation, combine recent recommendations from other groups, including the American Diabetes Association and the U.S. Preventive Services Task Force, addressing risk factors for cardiovascular disease and how to prevent it.

Beginning at age 20, everyone should be evaluated for their risk of cardiovascular disease, the group said. That includes taking a family history to identify relatives who've suffered heart attacks and strokes, as well as a general lifestyle profile to assess things like smoking status, exercise habits and diet at every physical exam.

The heart group also calls on doctors to record blood pressure, pulse, body mass index and pattern of weight distribution at each office visit, or at least every two years. And blood fats and blood sugar content should be measured every five years in those without risk factors for heart disease and every two years for those with risk factors.

The guidelines also call for doctors to prepare a 10-year projection of the risk of heart disease at least every five years for people 40 and older. Elements of this equation can include total, "good" and "bad" cholesterol, age, sex, and the presence of diabetes. If a patient's risk factors change, the analysis should be conducted more frequently.

People with diabetes, or those whose 10-year risk of heart disease is greater than 20 percent, have the same risk of a heart attack or other adverse event as someone with a history of cardiovascular problems.

"You can have a little bit of high blood pressure, a little bit of high cholesterol, and a little bit of smoking and your risk can be as much as that of a patient who has had a heart attack," Pearson said.

Treatment recommendations include: Prescribing low-dose aspirin therapy to people considered at high risk of heart and vessel disease; and offering blood thinners to prevent strokes in those with atrial fibrillation, a faulty heart rhythm that can lead to blood clots in the brain.

Aspirin increases the risk of gastric and brain bleeding that can be serious and even fatal. But the guidelines state that the benefits of daily aspirin therapy exceed this potential harm for people with at least a 10 percent 10-year risk of cardiovascular trouble. Pearson said evidence suggests baby aspirin may be as effective as adult tablets yet carries fewer side effects.

Last year, an expert panel for the government recommended that as many as 36 million Americans may be candidates for cholesterol-lowering drugs called statins. These pills can significantly reduce the risk of heart attacks, strokes and other cardiovascular complications, and are considered widely underused.

Just as the American Heart Association is stressing the need to screen young people for cardiovascular disease, the cholesterol guidelines recommend testing for blood fat problems beginning at age 20, too.

Scientists have found that even young, otherwise healthy people with high cholesterol are at sharply higher risk of heart trouble as they age.

Reining in high cholesterol, either through drugs or changes in diet and exercise habits, can reduce the odds of heart attack and heart-related death by roughly 25 percent. Treatment also decreases the need for bypass surgery, angioplasty and other heart procedures, and lowers the risk of death from non-heart causes.

Dr. Larry Chinitz, a heart expert at New York University in Manhattan, said the latest guidelines won't be foreign to specialists.

But cardiologists typically don't see young patients until their heart problems are well-established; primary care doctors do. So the recommendations are intended to educate these physicians about how to detect and treat the earliest hints of cardiac illness before they start causing symptoms.

"If you could get a general doctor to know the guidelines and screen young patients, that would be a big change," Chinitz said.

What To Do

For more on cardiovascular disease, try the American Heart Association or the Centers for Disease Control and Prevention.

To find out more about cholesterol screening, check out the National Heart, Lung, and Blood Institute.

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More Aggressive Colon Cancer Screening Urged 

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Monday, July 15, 2002

MONDAY, July 15 (HealthScoutNews) -- More evidence that early screening reduces death from colon cancer has prompted a government group to boost its recommendation that everyone over 50 be screened for the disease.

The U.S. Preventive Services Task Force (USPSTF) has given its highest level, "A," recommendation to health-care professionals to test people over 50 for colon cancer, up from a "B" recommendation in 1996, says Dr. Paul S. Frame, a member of the task force.

"The level of evidence has increased since 1996, from one to four randomized studies showing that a fecal occult blood test is effective is reducing mortality from colon cancer, and the data is pretty much the same for sigmoidoscopies," he says. Data showing that colonoscopies are also an effective test was convincing as well, he adds.

People at a higher risk for the disease, like those with a family history, should be tested at younger ages, Frame says. But because 90 percent of colon cancers appear in people over age 50, that's a good age to start undergoing screenings, he says.

The recommendations appear in tomorrow's issue of the Annals of Internal Medicine. The USPSTF is an independent group of experts that is sponsored by the federal government's Agency for Healthcare, Research and Quality.

The task force did not recommend one type of screening over another, Frame says, because of differing patient preferences and the cost and convenience of different procedures.

"The task force isn't saying there is one test better than others and this is what you should do," he says. "Each method has pluses and minuses, and different patients will make different decisions based on what is right for them."

The fecal occult test, for instance, is simple, can be done at home and has the most evidence that it reduces mortality, Frame says, but since what you are testing for is blood in the stool rather than cancer, there are a lot of false positives because there are other reasons you can have blood in your stool.

A sigmoidoscopy is effective because it presents a visual picture of the colon so a doctor can clearly see the polyps that might be cancerous, but the procedure only looks at the lower part of the colon, and there is some discomfort with the procedure.

A colonoscopy, which is what is often recommended as a follow-up to other procedures if there is evidence of possible cancer, offers the most thorough look at the whole colon and only needs to be done every 10 years if no cancer is found. However, it is more expensive than the other procedures and requires preparation a day ahead of time.

The task force did state, however, that neither a digital rectal examination nor the testing of a single stool specimen is an adequate screening strategy for colon cancer.

The USPSTF recommendations back up similar recommendations from the American Cancer Society ( news - web sites), which state that beginning at age 50, both men and women should have a fecal occult test every year or a sigmoidoscopy every five years, or both, or a barium enema every five to 10 years, or a colonoscopy every 10 years.

According to the USPSTF, colon cancer is the second leading cause of cancer death in the United States, and approximately 57,000 Americans will die of the disease this year. Eighty percent of colon cancers occur in people with average risk of the disease, and about 20 percent occur in those at high risk, including those with a personal history of ulcerative colitis or a family history of colon cancer in a mother, father, sister or brother who receives a diagnosis before age 50.

What To Do

A detailed explanation of the different tests for detecting colon cancer can be found at The American Cancer Society, which also provides information about colon cancer.

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Misdiagnosing Appendicitis Studied

By Lindsey Tanner
AP Medical Writer
The Associated Press
Monday, July 15, 2002
 
CHICAGO -- Removing a healthy appendix may be more harmful than many have thought, requiring longer hospitals stays and an increased rate of side effects, according to a new study showing the dangers of misdiagnosing appendicitis.

The findings suggest that overlooked ailments cause the increased risks and underscore the harm in mistaking other serious conditions for appendicitis, the researchers said.

The study bolsters previous research showing that appendix removal surgeries often are inadvertently done on people who don't have appendicitis, in part because other ailments mimic the condition. But also, doctors may rush to operate because not removing a diseased appendix can have life-threatening consequences, including rupture of the narrow, worm-shaped structure.

Determining whether the appendix is truly diseased generally requires testing it after removal.

"This study emphasizes the importance of developing more effective diagnostic strategies in the management of presumed appendicitis," Drs. David Flum and Thomas Koepsell of the University of Washington said in their report.

The findings appear in July's Archives of Surgery.

The researchers examined data involving 52,969 appendix removals in 1997. Statistically, that equals approximately 261,134 such surgeries nationwide, the researchers said.

About 15 percent of the surgeries were on normal appendixes. Rates were higher among children under age 5, women and patients over age 70.

The appendix, which has no real function, is located at the lower right of the large intestine. Women are more at risk for misdiagnoses because their reproductive organs also are located in the lower abdomen, and if diseased, these organs can cause right-sided pain similar to that of an inflamed appendix. Older people and young children may have difficulty accurately describing their pain.

Misdiagnosed patients had higher death rates, 1.5 percent versus 0.2 percent; more infectious side effects, 2.6 percent versus 1.8 percent; and longer hospital stays, 5.8 days versus 3.6 days.

The data don't indicate what ailments may have contributed to the higher complication rates, but several serious conditions -- including ectopic pregnancy, intestinal infections and bowel obstructions -- may mimic appendicitis.

An accompanying editorial by California surgeon Dr. Russell Williams says the results don't mean the normal appendix is somehow to blame. Removing a normal appendix can even be beneficial by preventing the patient from ever developing true appendicitis, Williams said.

Williams also suggested that it's unrealistic and risky to strive for eliminating surgeries on normal appendixes. Doing so would mean subjecting all patients with appendicitis-like symptoms to longer observation times and hospital stays, and could mean more ruptured appendixes and even deaths, Williams said.

A previous Flum study suggested that use of newer diagnostic tests including CT scans and ultrasound hasn't reduced misdiagnoses.

But Dr. Francis Counselman of Eastern Virginia Medical School said rates likely would decrease if such tests were used only for patients without classic symptoms of appendicitis, which include pain starting in the belly and moving to the right side, mild fever, appetite loss, vomiting and elevated white blood cell levels.

On the Net:

Archives: http://www.archsurg.com

National Institutes of Health: http://www.nlm.nih.gov/medlineplus/appendicitis.html

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Program Tracks Stroke Victim Treatment

By Lauran Neergaard

AP Medical Writer
The Associated Press
Monday, July 15, 2002
 
WASHINGTON -- Only about two of every 100 stroke victims are treated with the clot-busting drug TPA that might not only save their lives but keep them from being disabled.

Many simply don't get to the hospital fast enough, because TPA must be given within three hours of the first symptoms. Hospitals also bear some responsibility: One recent study found fewer than a quarter of eligible patients who had arrived in time got this crucial treatment.

A major new program, ordered by Congress, aims to improve stroke care. It would establish a monitoring system to track exactly how hospitals treat stroke patients, to uncover the missteps and to fix them.

Dozens of hospitals in eight states are pilot-testing the Paul Coverdell National Stroke Registry, named for a Georgia senator who died of a stroke two years ago.

The program won't track just who gets TPA but every aspect of stroke care, from paramedics' speed answering the 911 call and how well emergency rooms give the brain scan, to rehabilitation and prevention of a second stroke. Indeed, improper preventive care is another major problem: Less than half of patients at high risk of a stroke because of irregular heartbeat get the protective blood-thinning drug warfarin.

"There is a huge gap between what we know and what we do" to fight strokes, says Dr. Lee H. Schwamm of Massachusetts General Hospital, who is preparing to analyze the first results from Massachusetts' pilot registry.

"Unless you understand what's happening and where the fail-points are, you don't know how to make the system better."

More than 700,000 Americans will suffer strokes this year. It is the nation's No. 3 killer.

Some strokes are caused by bleeding in the brain; that's what killed Coverdell. But the vast majority are ischemic strokes, where arteries feeding the brain are blocked -- the type TPA can help, yet only about 2 percent of ischemic stroke sufferers get the medicine.

The registry will monitor care for both types. The Centers for Disease Control and Prevention has financed pilot registries in California, Georgia, Illinois, Massachusetts, Michigan, North Carolina, Ohio and Oregon.

Studies already have shown that care varies widely, from state to state and among urban, rural and teaching hospitals.

Why is stroke care so hard? Consider just one aspect, TPA.

Each possible stroke sufferer must get a CT scan to be sure a clot exists, because TPA could worsen the bleeding if a patient were to have had a hemorrhagic stroke. Not every hospital has a technologist to run its CT scanner round-the-clock, nor in-house stroke specialists to examine the scan and the patient, relying instead on nearby neurologists to come when called.

Then there's "therapeutic nihilism," complains Schwamm. Some doctors still "don't really believe there's much to do about stroke. ... It is stunning."

It's easy for hospital administrators to shrug off misgivings about suboptimal care, assuming their facilities couldn't be to blame.

If the registries work, however, individual hospitals could see how their care differs from national treatment guidelines, showing where improvement would help, explains Dr. Dilip Pandey of Rush-Presbyterian-St. Luke's Medical Center in Chicago, who directs Illinois' registry.

Each of the pilot programs, which include a mix of hospitals around the eight states, will work slightly differently.

But the Massachusetts researchers, for example, are planning aggressive actions to ensure participating hospitals improve: doctors' computerized reports on each patient may one day link to treatment guidelines, forcing an explanation for different care. A secure Web site could allow participating hospitals to compare with each other, incentive for the worst hospitals to make changes.

Regardless whether the pilot registries ultimately work, the CDC urges anyone with stroke symptoms to dial 911 or get to a hospital immediately. The faster help begins, the better the chances of survival. Symptoms include:

* Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.

* Sudden confusion, trouble speaking or understanding.

* Sudden trouble walking, dizziness, loss of balance or coordination.

* Sudden severe headache with no known cause, or trouble seeing.

Editor’s Note: Lauran Neergaard covers health and medicine for The Associated Press in  Washington.


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FDA Warns of Chemical in Plastic

By Lauran Neergaard

AP Medical Writer
The Associated Press
Monday, July 15, 2002
 
WASHINGTON -- Sick baby boys may be at highest risk from a chemical used to soften such plastic medical devices as blood bags and IV tubes, the government says in advising hospitals to consider using devices made of different materials to treat them.

The chemical, called DEHP, can leach from the plastic into certain liquids, especially fat-containing ones like blood. Studies of young animals show the chemical can affect testicle development and production of normal sperm.

There's no proof DEHP actually harms humans. But the Food and Drug Administration considers the theoretical risk important enough that it's writing health groups to urge they take limit DEHP exposure to the patients at highest risk.

That's mainly newborn boys who need lots of treatments that bring the highest DEHP exposures -- such as multiple blood transfusions and IV tube feeding, FDA toxicologist Ron Brown said Monday. Also, an oxygenation procedure called ECMO that basically puts newborns on a heart-lung machine for several days causes high exposure.

Also on the precaution list is dialysis if the patient is a boy undergoing puberty, or a woman pregnant with a male fetus or nursing a baby boy.

Don't curtail treating these patients -- they need medical care more than they need to avoid the theoretical DEHP risk, the FDA stressed.

But health workers should consider using alternative medical equipment, such as devices coated with heparin, silicon or other substances to prevent DEHP from leaching, said FDA biologist Laura Alonge.

The amount of chemical absorbed is too small to be of concern for most patients, the FDA concluded in a safety assessment of DEHP last fall. The average IV treatment, even the average blood transfusion, leach very little.

But the FDA said small groups of patients could absorb many times the safe-limit dose suggested by animal studies, and the new letters to health providers mark FDA's long-awaited advice on precautions to take with those people.

"FDA's public health notification falls far short of what is needed to protect patients," said Charlotte Brody of Health Care Without Harm, a group working to reduce the amount of phthalates -- the family of chemicals that includes DEHP -- in a variety of products, from plastic toys to cosmetics.

The group has lobbied FDA to require medical manufacturers to label if the equipment leaches DEHP.

"How can doctors and nurses protect their patients from phthalates in medical devices when they have no way of knowing which products contain phthalates?" Brody asked.

Some companies already label, and the FDA soon will issue a recommendation -- not a requirement -- that more do so, Alonge said. The recommendation should be enough because companies will "be at a competitive disadvantage if they don't," she said.

On the Net:

FDA: http://www.fda.gov/cdrh/safety.html


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Heart Assn. Recommends Screenings

By Matt Slagle
Associated Press Writer
The Associated Press
Monday, July 15, 2002
 
DALLAS -- The American Heart Association has updated its guidelines for preventing heart attacks and strokes, listing secondhand smoke as a risk factor for the first time and recommending that people get screened for risk factors beginning at age 20.

Also, a daily dose of aspirin, previously recommended only for those who have already had heart attacks and strokes, is now suggested for people who have been found to have at least a 10 percent risk of a heart attack in the next decade.

And to address the nation's growing obesity problem, the heart association adopted a simpler alternative to the body-mass index: a waistline measurement. Simply put, men should have a waistline of 40 inches or less; for women, 35 inches or less.

"It's turned out that waist circumference is as good a predictor of risk as body mass index," said Dr. Sidney C. Smith, the association's chief science officer.

The revised "Guide to the Primary Prevention of Cardiovascular Diseases" was published in Tuesday's issue of the journal Circulation. The guidelines have not been updated since they were first published in 1997.

"The emphasis is on prevention. We know a lot about cardiovascular disease. We know what causes it, we know how to prevent it," said Dr. Thomas A. Pearson, a professor at the University of Rochester School of Medicine and chairman of a committee that revised the guidelines.

For the first time, the new guidelines urge people age 20 and older to meet with a doctor every five years to assess risk factors such as smoking, family medical history and blood pressure. Previously, the heart association did not give an age at which patients should first be screened for their risk of heart disease.

People age 40 and older should be screened for additional risk factors, including high cholesterol levels, the heart association said.

For the first time, secondhand smoke was added to the list of risk factors, which already included smoking itself.

The guidelines combine the latest findings from an array of studies.

The new guidelines drop passages in the 1997 edition that said hormone supplements and antioxidant vitamins might reduce the risk of heart attacks and strokes. More recent research -- some of it released just last week -- has called those assertions into questions.

Doctors applauded the idea of screenings for heart disease, the nation's leading health problem.

"These new recommendations should benefit the entire nation. Certainly prevention is the key," said Dr. Robert Frankel of Maimonides Medical Center in New York City. "I think this will heighten awareness. Having earlier detection systems certainly will identify those patients at risk."

On the Net:

http://www.americanheart.org

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SUNDAY, JULY 14, 2002

Studying Lung Cancer Genes May Help

By Randolph E. Schmid

Associated Press Writer
The Associated Press
Sunday, July 14, 2002
 
WASHINGTON -- Studying the genes active in early stage lung cancers may help identify which patients are at greatest risk of dying, allowing their doctors to prescribe more aggressive treatment, researchers report.

A team led by Dr. David G. Beer at the University of Michigan found that by studying which of about 50 genes in an early stage tumor are more or less active, it could predict which patients are more likely to relapse within five years.

With that information, doctors would know which patients should get additional treatment, perhaps adding radiation or chemotherapy to the standard of surgery, Beer said.

The study is in Monday's online edition of the journal Nature Medicine.

Identifying high-risk patients through their genes is still experimental, Beer said. But he said the process has the potential to help doctors provide more individualized care for their patients.

"This study of gene expression profiling in lung cancer is a valuable contribution to the exciting area of molecular cancer characterization," said Dr. Daniel R. Jacobson of the New York University School of Medicine.

Jacobson, who was not connected to the Michigan team, said cancer physicians long have sought ways to predict a patient's long-term prospects.

"While it would be premature to make decisions about postoperative chemotherapy or radiotherapy based on gene expression profiling, the field is moving in that direction," he said.

Some day, perhaps soon, such profiling probably will become a standard tool to help doctors decide on treatment, Jacobson added.

Already, an additional drug is being offered to breast cancer patients who have extra copies of a gene that makes their tumors more aggressive.

The Michigan study focused on patients with stage 1 lung cancer, the earliest form of the disease.

Of 169,400 new lung cancer cases expected to be diagnosed in the United States this year, only about 15 percent will be caught at that early stage, the American Cancer Society says.

Of those stage 1 patients who have surgery to remove the tumor, between 35 percent and 50 percent suffer a return of the disease within five years, Beer said.

The researchers studied lung tissues from cancer patients, compared their gene profiles with the long-term outcome, and concluded that the activity or inactivity of certain genes was related to which patients were most at risk for relapse.

They developed a risk index of about 50 genes and then turned to a different set of tumors collected in a study at Harvard University, Beer said. The risk index was able to predict survival among the patients in that study, he said.

But he said more study is needed before the risk index could come into regular use.

On the Net:

Nature journals: http://www.nature.com


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Keeping Your Backbone Strong 

HealthScoutNews

Sunday, July 14, 2002

SUNDAY, July 14 (HealthScoutNews) -- Exercises that strengthen the back protect against spinal fractures in women who are at risk for osteoporosis, says a Mayo Clinic study.

The research included 50 healthy postmenopausal women, aged 58 to 75. During the two-year study, 27 women did back-strengthening exercises, while 23 women in a control group did not do the exercises.

The two groups had no difference in bone mineral density at the end of the two-year exercise period. However, the women in the control group were 2.7 times more likely to have vertebral compression at the end of 10 years.

The women who did the exercises had more back strength than the control group members -- even eight years after the exercise program ended. Those who did the exercises also had less bone density loss than those in the control group.

"Exercise requires more effort than taking a pill, so getting patients to comply with an exercise program is more difficult," concedes lead author Dr. Mehrsheed Sinaki, a Mayo Clinic physical medicine specialist.

Osteoporosis affects 8 million women and 2 million men in the United States, and is responsible for 1.5 million fractures each year.

The study was published in the June issue of BONE.

More Information

For details on exercise and prevention of osteoporosis, check the National Osteoporosis Foundation.

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FYI About Your Rx 

HealthScoutNews

Sunday, July 14, 2002

SUNDAY, July 14 (HealthScoutNews) -- About 89 percent of people who get prescription drugs receive written information about those drugs, according to a U.S. Food and Drug Administration ( news - web sites) (FDA) study.

 

The research was done to determine how many people were given prescription drug information, and how useful it proved to be. It was commissioned by the FDA and done by the National Association of Boards of Pharmacy.

Survey participants rated the usefulness of the information provided at about 50 percent.

The FDA commissioned the study in 2001 to comply with a law passed in 1996 that requires the Department of Health and Human Services ( news - web sites) to evaluate private sector prescription drug information given to people. The law included a goal that by the year 2000, 75 percent of people getting new prescriptions should receive useful written information about the drugs.

That goal increases to 95 percent by the year 2006.

More Information

Click here to read the full FDA report about the success of its prescription drug information program.

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FRIDAY, JULY 12, 2002 

Obese Show Different 'Hunger Hormone' Response 

By Alison McCook

HealthScoutNews

Reuters Health

The Associated Press
Friday, July 12, 2002

NEW YORK (Reuters Health) - Recently, researchers discovered a so-called "hunger hormone" that rises just before eating and falls after a meal. Now, UK researchers have discovered that while this fluctuating pattern may occur in lean people, the hormone behaves quite differently in those who are obese.

Co-author Dr. Steve R. Bloom of the Imperial College at Hammersmith Campus in London, UK, and his colleagues found that obese people have lower-than-average levels of the hunger hormone ghrelin in their bodies when hungry, and these levels don't change after obese people eat.

As such, obese people with unchangeable levels of ghrelin may not realize they are no longer hungry after eating, Bloom told Reuters Health.

"If, although low, (ghrelin) failed to go down properly after eating, you might still feel somewhat hungry inappropriately and eat more than you should," he explained.

Ghrelin, a hormone produced by the stomach, is named for the Hindi word for growth. Past studies have shown it can make people so ravenous they eat nearly one-third more food than usual.

During the study, Bloom and his team measured the levels of ghrelin and the hormone leptin in 13 lean and 10 obese people, both when they were hungry and immediately after they ate.

Leptin is often called the "obesity hormone," because previous research has shown it may notify the brain to reduce appetite after eating, when fat cells are "full." The relationship between the two hormones is currently being investigated, but Bloom said that leptin may inhibit the body's production of ghrelin.

The investigators found that, when hungry, lean people had more than twice the concentration of ghrelin in their blood of those who were obese. After eating, ghrelin concentrations did not change in the obese, but dropped 40% in lean people before inching back up to normal levels.

The concentration of blood leptin also decreased after eating in lean people, but showed no decline in those who were obese, according to the report in the June issue of the Journal of Clinical Endocrinology & Metabolism.

In an interview with Reuters Health, Bloom explained that researchers have not investigated whether low ghrelin levels induce obesity, or if obesity decreases the overall amount of ghrelin in the body. "This hasn't been directly tested but it is assumed that the low ghrelin is a consequence of obesity," he said.

However ghrelin is involved in the development of obesity, Bloom suggested that manipulating the level of the hormone in the body may one day help to correct the problem.

"If a drug to block ghrelin could be identified--not difficult with modern mass chemical library screening--it would lessen hunger and tend to reduce food intake," he said.

"A 1% reduction in food intake for a year would have a major impact on obesity," Bloom added.

Source:  The Journal of Clinical Endocrinology & Metabolism 2002;87:2984-2987.

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Light Drinking May Protect Diabetics' Arteries 

By Amy Norton

Reuters Health

Friday, July 12, 2002

NEW YORK (Reuters Health) - A drink or two a day may help cut the risk of artery disease among people with type 2 diabetes, according to Japanese researchers.

Their study of about 200 adults with the condition found that light to moderate drinkers showed less artery stiffness compared with either non-drinkers or heavy drinkers. Arterial stiffness increases as the blood vessel disease atherosclerosis progresses, and atherosclerosis can lead to heart attack or stroke.

A number of studies have already suggested that modest drinking can be a heart-healthy habit, and the authors of the new study say their findings show these benefits may extend to people with type 2 diabetes--a major risk factor for cardiovascular disease.

"However," they note in the July issue of Diabetes Care, "further studies are needed to prove this hypothesis."

In addition, drinking too much can raise blood pressure and levels of blood fats called triglycerides. There is also evidence that heavy drinking can aggravate diabetic nerve damage, the new study's lead author, Dr. Ichiro Wakabayashi of Yamagata University, told Reuters Health.

However, not much is known about drinking habits and atherosclerosis risk among type 2 diabetics ( news - web sites), according to Wakabayashi's team.

To investigate, the researchers asked study participants about their typical weekly alcohol consumption and used a measure called aortic pulse wave velocity to gauge stiffness in the aorta, the heart's main artery.

They found that, on average, light drinkers--defined in this study as up to a couple of drinks per day--had less aortic stiffness than non-drinkers and heavier drinkers. Heavier drinkers also had higher blood pressure and triglycerides compared with those who drank less or not at all, according to the report.

According to Wakabayashi, drinkers and non-drinkers showed no difference in their recent, average blood sugar levels. However, he noted, diabetics should not drink on an empty stomach, as this can trigger a drop in blood sugar.

Exactly why moderate drinking was linked to less artery stiffness in this study is unclear. Wakabayashi said that two benefits tied to modest alcohol intake--blood-thinning effects and higher "good" cholesterol levels--were not found among lighter drinkers.

He and his colleagues call for more research to confirm their findings.

Currently, the American Diabetes Association suggests that diabetic men have no more than two drinks per day, while women are advised to stick with one a day.

Source: Diabetes Care 2002;25:1223-1228.

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Healthcare Too Costly, Doc Quality Uneven: Germans 

By Ned Stafford

Reuters Health

Friday, July 12, 2002

FRANKFURT (Reuters Health) - Nearly three-quarters of Germans believe they are paying too much for a healthcare system in which the quality of doctors varies too much, but at the same time believe the system suffers a shortage of money, according to a report released Thursday by the Bertelsmann Foundation.

The report, based on exhaustive surveys of the German public and of doctors, said patients were trapped in a contradiction: "They do not want to pay more for healthcare, but they believe there is a financial crisis in the healthcare system."

Jan Boecken, a healthcare policy expert at the Bertelsmann Foundation, which was set up by the family that controls the Bertelsmann media empire, told Reuters Health that more money is not the answer. He noted that Germany already is a big healthcare spender compared with other nations, with this spending accounting for about 10% of gross domestic product.

"Many European nations have succeeded in providing higher quality healthcare with less money," he said.

Some 73% of the 1,500 patients surveyed believe that the quality range of doctors is too wide, and 52% said medical care and other services need to be improved. But in what the report called "astonishing," an even higher percentage of the 500 doctors surveyed--79%--said the quality gap between doctors was too wide.

Boecken, project leader for the surveys, said that he was surprised by the doctor quality result, and sees it as one of the most important issues in the German healthcare system.

"Tools need to be developed to measure quality of doctors," he said, but added that doctors are "afraid" of implementing a transparent system to measure quality.

The Bertelsmann Foundation's healthcare policy team will attempt to develop methods of judging doctor quality, Boecken said.

Germany's public health insurance system covers about 90% of the population, and suffered a 2.8-billion-euro deficit last year, requiring a hike in the average monthly premium. The ever-growing burden of financing the system under strain from an aging population has become a major political issue in national elections in late September.

Some 61% of the patients surveyed said public health insurance premiums are too high, but at the same time, 54% believe "too little" money is being spent in the entire German healthcare system. Some 13% said the total amount spent was just right, 12% said too much was being spent and 20% did not know.

The report credited a lobbying effort by doctor organizations for "successfully convincing the people that there is a shortage of money in the healthcare system." This lobbying intensifies during election campaigns, when "doctor groups often present themselves in the roll of representatives of patient interests."

Boecken noted that the report issued Thursday was preliminary, and that survey results will be studied further. A more comprehensive report will be issued in November.

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Monkey Virus in Humans May Trigger Cancer: Experts 

By Alicia Ault

Reuters Health

Friday, July 12, 2002

WASHINGTON (Reuters Health) - Though there is still no clear consensus, a majority of researchers told a quasi-governmental health panel Thursday that simian virus 40 (SV40) has become established in humans, and that it plays a role in causing cancer, including in people who had virus-contaminated polio ( news - web sites) vaccines in the 1950s and 1960s.

The experts addressed the Institute of Medicine ( news - web sites)'s (IOM) Immunization Safety Committee, which met to hear the latest epidemiologic and lab data on SV40. In 2 to 3 months, the committee will issue a report, along with recommendations based on their assessment of the data.

SV40's role in cancer has been debated since the early 1960s, when it was discovered that inactivated polio vaccine contained the naturally occurring monkey virus. Monkey kidney cells were fingered as the source; they were used to grow polio for the shot. In 1961, scientists discovered SV40 caused cancer in rodents. The government required all future polio vaccine to be SV40-free.

Even so, some contaminated vaccine still on shelves may have been used, and as many as 98 million children had already been exposed during the government's Mass Immunization Program from 1955 until early 1963.

Several attorneys alleged that the three polio vaccine makers--Wyeth, Lederle and Pfizer--knowingly distributed contaminated products before 1961 and later. Stan Kops, an attorney who successfully sued those companies for causing polio in vaccinees, alleged at the meeting that Lederle continued to sell SV40-tainted oral polio vaccine until 1999.

Attorney Donald MacLachlan, representing five families who claim the vaccine caused cancer, told Reuters Health that a federal judge in Los Angeles recently allowed a case against Wyeth to proceed.

Scientists have tried to unravel whether SV40 is prevalent in humans, and if the polio vaccine caused infection, or if SV40 had been in humans previously. In the 1970s, SV40 was isolated in human tumors, especially brain and bone cancers, and, more recently, in mesotheliomas, a rare lung cancer found mostly in people over age 50, and primarily in men with occupational exposure to asbestos.

Michele Carbone of Loyola University in Chicago, Illinois has linked SV40 to mesothelioma. He called SV40 a "potent human carcinogen," capable of transforming cells and inhibiting the p53 gene that normally keeps cancer cells in check. But he added that the virus is not likely to act alone, and that co-factors--like asbestos--lead to cancer.

In 2002, several researchers found SV40 in non-Hodgkin's lymphoma (NHL). Janet Butel, a Baylor College of Medicine virologist, isolated SV40 in NHL and has sequenced SV40 genomes. In three NHL samples, the SV40 strain was the same as one found in samples of a polio vaccine used in the 1950s, she said. SV40 "seems to be established in humans," and "it is causing infection," said Butel.

"Perhaps it was there before the polio vaccine, I don't know," she said, adding that widespread vaccine use may have broadly distributed SV40 in humans. The virus has been found in many nations.

Erik Engels of the National Cancer Institute ( news - web sites) is conducting a study in northern India, where monkeys and humans live in close proximity, to see if--and how--SV40 might be jumping species or being transmitted from human-to-human.

Another researcher, Jeffrey Kopp of the National Institute of Diabetic, Digestive and Kidney Diseases, said a small study he and colleagues recently completed found SV40 in blood and urine of both healthy people and kidney disease patients, and that "argues for relatively common infection in the general population." Kopp's study will be published in September's Journal of the American Society of Nephrology.

There were several nay-sayers, including long-time SV40 researcher Keerti Shah of Johns Hopkins University Bloomberg School of Public Health. Shah has been unable to isolate SV40 in human urine, and said that lab studies have been so inconsistent that they do not prove causality.

Howard Strickler, an epidemiologist at the Albert Einstein College of Medicine in New York, presented several studies he has conducted, all showing no association between SV40 and cancer incidence, he said.

In a 1998 study in The Journal of the American Medical Association ( news - web sites), Strickler and colleagues found no link between SV40 exposure and a type of cancer called ependymoma. Strickler also analyzed mesothelioma rates and said that incidence has remained at a steady 3% a year. It is very rare and not rising in women, said Strickler, which he said argued against the possibility that the cancer is being driven by polio vaccine exposure.

Also, rates have only increased among people over 50, who were least likely to have been vaccinated, he said.

That was disputed by Carbone, who said a large number of people aged 20 to 45 were vaccinated in the 1960s, and that age group is having more mesothelioma.

Susan Fisher, chief of the division of epidemiology at the University of Rochester, conducted a cohort study, comparing people born between 1955-1959 who were likely exposed to vaccine to those born between 1961-1965, and documented cancer incidence in that group from 1973 to 1993.

In the vaccine-exposed group, there was a 178% increase in mesothelioma, and an increased incidence of ependymoma and osteosarcoma. But, because the cancers are rare, the differences between the exposed and unexposed group were not statistically significant, said Fisher.

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PCB-Laced Cooking Oil Tied to Fewer Male Births 

By Amy Norton

Reuters Health

Friday, July 12, 2002

NEW YORK (Reuters Health) - Some Taiwanese men who were exposed to PCB-laced cooking oil more than 20 years ago have been found less likely to father a male child compared with non-exposed men their age, researchers report.

Investigators discovered that men who were younger than 20 when exposed to the oil were 35% less likely to have a male child, compared with men the same age living in the same area. No significant effect was seen among women or men who were older when exposed to the contaminants.

"Our findings suggest that paternal exposure to PCBs before age 20 years affects the sex of a subsequently born child," the study authors report in the July 13th issue of The Lancet.

PCBs, or polychlorinated biphenyls, are a group of synthetic chemicals that were once widely used in industry and in commercial products from plastics to pigments. They have been banned in the US since the late 1970s due to concerns over the chemicals' toxicity. However, PCBs persist in the environment and accumulate in the fat of mammals and fish.

In 1979, a processing accident that contaminated cooking oil with PCBs and other toxic chemicals caused widespread poisoning in Taiwan. Over a period of months, people were exposed to the chemicals through repeated heating and cooling of the cooking oil.

The new study looked at children born to more than 2,000 people who had ingested the oil. Lead author Dr. Iliana del Rio Gomez told Reuters Health that the contaminated oil exposed people to 10 to 20 times the typical "background" level of PCBs in the environment, and 100 to 1,000 times the level of a pollutant called polychlorinated dibenzofurans (PCDFs).

Del Rio Gomez, a researcher at the London School of Hygiene and Tropical Medicine in the UK, said that her team speculates that dioxin-like compounds, which include PCBs, have a negative effect on the "viability" of sperm that carry the Y chromosome or on the development of fertilized eggs bearing the chromosome--either of which would reduce the number of male births.

However, she said, since the "factors that determine sex" are themselves unknown, these hypotheses remain just that.

PCBs have been found to cause cancer in animals and are tied to learning deficits and other neurological problems in children. In addition, del Rio Gomez noted, PCBs and other dioxin-like compounds are "known to disrupt the way hormones act in all organisms."

She said, "This is just a clue that something is going on and we need to see what it is and how much it can affect us."

"These findings lend yet more evidence that there are chemicals in the environment capable of disrupting endocrine (hormonal) function," said Dr. Philip J. Landrigan, the director of Mount Sinai's Center for Children's Health and the Environment in New York.

And while the population in this study had "very heavy" exposure to PCBs, Landrigan told Reuters Health, it is possible that the findings have relevance for people with more typical levels of exposure. He added that the study highlights the importance of PCB clean-up efforts like the dredging of the Hudson River in New York.

Source: The Lancet 2002;360:143-144.

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Quenching That Exercise Thirst 

HealthScoutNews

Friday, July 12, 2002

FRIDAY, July 12 (HealthScoutNews) -- If you exercise outdoors in the summer heat, you need to make sure you drink enough to replace lost fluids.

But what should you be drinking?

Here's some advice from Robert Stelma, supervisor of athletic training services for the Geisinger-Wyoming Valley Human Motion Institute in Wilkes-Barre, Pa.

Water is the best source for fluid replacement and should be your primary beverage when you exercise, Stelma says. However, water alone may not be enough if you're doing intense activity or exercising for more than 45 minutes.

That's when a sports drink may be beneficial, Stelma says. However, the choices may be somewhat confusing.

Choose a sports drink that contains no more than 8 percent carbohydrates. Stay away from carbonated sports drinks or those that contain caffeine or herbal remedies, or those that have more than 8 percent sugar, Stelma says.

All those ingredients could counter the reason you want to use a sports drink, which is to keep your body hydrated as you exercise, Stelma adds.

Some sports drinks containing guarana, caffeine, ephedra, ginseng or taurine make claims that they boost your energy and/or performance. However, Stelma says it's difficult to prove those claims.

"The Food and Drug Administration ( news - web sites) (FDA) does not evaluate herbal remedies, so their claims, effectiveness and purity of the product are the responsibilities of the manufacturers. This can lead to outrageous claims, and a product that has little or too much of the herbal product," Stelma says.

In the end, no sports drink is going to provide you with a quick fix, he adds. The key to performing and feeling better is a good diet, lots of rest and the right amount of exercise.

More information

For additional insight into sports drinks, Running Times has a guide.

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'Mole Patrols' Protect Against Skin Cancer 

By Felicity Stone
HealthScoutNews Reporter

HealthScoutNews

Friday, July 12, 2002

FRIDAY, July 12 (HealthScoutNews) -- Join the melanoma mole patrol. It could save your life.

That's the advice of dermatologists, who say if people were more familiar with the moles that dot their bodies, they'd notice any change in shape or color -- a potential warning flag for skin cancer.

"The average person does not understand that a little spot on their skin could be life-threatening. Or they are ignorant about what they should look for," says Dr. Richard A. Miller, a senior member of Bay Dermatology Associates in Port Richey, Fla.

Most moles are harmless. However, a change in size, shape or color may indicate a developing melanoma, the most lethal form of skin cancer and the fastest-growing cancer in the United States.

According to the American Cancer Society ( news - web sites), about 53,600 new melanoma cases will be diagnosed this year, and 7,400 people will die of the disease.

Despite the rising numbers, most people are less aware of skin cancer than they should be, says Miller, who is interviewed in the July issue of Sun and Skin News, a publication of The Skin Cancer Foundation.

Undiagnosed or advanced melanoma can spread through the lymphatic system, often invading the brain and liver, a potentially fatal development, Miller explains.

However, a melanoma always gives early warning signs and is 99 percent curable if caught in its beginning stages. However, people need to know what to look for, Miller says.

A simple way to examine a mole and decide if it's unusual enough to warrant medical attention is to follow the American Academy of Dermatology's "ABCD" signs of melanoma.

A mole needs a doctor's opinion if:

  • It's asymmetrical. If you draw an imaginary line through its center, and the one half does not match the other half.

  • Its borders are fuzzy and fade into the skin. Normal moles have sharp, distinct borders.

  • The color is variegated. Instead of a solid hue, shades of tan, brown, black or even purple streak the blemish.

  • Its diameter is larger than 6 millimeters.

Miller cautions that the above criteria don't apply to all moles. They are meant as a guide, rather than a foolproof diagnostic technique.

For instance, a mole or other types of skin blemishes greater than six millimeters in diameter, but displaying none of the other cautionary characteristics, may be harmless. Alternately, some moles may appear innocuous and then, for no obvious reason, they itch, bleed or burn. That could be a cause for concern, Miller says.

Audrey Kunin, president of DERMAdoctor.com, says she has seen normal-looking moles turn out to be cancerous.

"You have to take into account what's going on with the rest of the person," she says. "So if you have tons of moles and freckles, but you have one pinpoint jet black mole -- even if it's round and evenly colored -- if it's sticking out like a sore thumb, you should get it seen."

Miller recommends people conduct monthly self-checks and visit a dermatologist as frequently as their individual profile suggests.

For example, people with fair skin and hair and light eyes are more susceptible to skin cancers and should have themselves examined every six months. However, someone with a personal or family history of skin malignancies should be seen every three months.

What To Do

To learn how to spot skin cancer on your body, visit The Skin Cancer Foundation. For more on melanoma, check the National Cancer Institute.

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Battling the Bulge 

HealthScoutNews

Friday, July 12, 2002

FRIDAY, July 12 (HealthScoutNews) -- Two new studies offer clues to fat cell behaviors that contribute to obesity.

The first work is from researchers at the Joslin Diabetes Center and Beth Israel Deaconess Medical Center in Boston. The research says insulin stimulation of fat cells, called adipocytes, is a critical factor in obesity.

The researchers bred mice that lacked insulin receptors in their fat cells. The mice were much leaner than normal mice in a control group, and were protected from obesity caused by aging and overeating, the study says.

The specially bred mice were also protected from insulin resistance, an obesity-linked condition that leads to diabetes.

The researchers say these mice have two different kinds of adipocytes - small and large. They believe the lack of insulin receptors reveals differences between the small and large adipocytes, and the small adipocytes are protected against too much fat loading. That's what prevents the mice from becoming obese.

The second study, by French researchers, looked at the role of a family of proteins called E2Fs in the maturation of adipocytes.

"The novel mechanisms for regulation of adipocytes that are presented in these two reports make a substantial contribution to future studies investigating new methods for controlling obesity and associated metabolic disorders, such as diabetes," says a Joslin Diabetes Center news release.

More than 1 billion people in the world are overweight. That puts them at increased risk of serious health problems such as heart disease and diabetes.

Both studies appear in the July issue of the journal Developmental Cell.

More information

For more on obesity, go to the American Obesity Association.

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Anemia Linked to Elderly Mobility Problems 

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Friday, July 12, 2002

FRIDAY, July 12 (HealthScoutNews) -- Even mildly low levels of anemia in older women can make it difficult to move around.

The finding, from researchers at Johns Hopkins University, suggests it might be time to redefine what constitutes anemia for older adults. A person with anemia does not have enough red blood cells, which are crucial because they contain hemoglobin, a protein that transports oxygen from the lungs to the organs and muscles of the body.

"I wouldn't say our study is definitive proof, but we need to consider where we should put the cut-off levels for what is normal, especially in the elderly," says Dr. Bimal Ashar, a Johns Hopkins assistant professor of medicine and a co-author of the study, published in the July issue of the Journal of the American Geriatrics Society.

In the research, led by Dr. Paulo H.M. Chaves, an assistant professor of medicine at Hopkins, the team evaluated 633 elderly Baltimore-area women, aged 70 to 80. Those with blood levels of hemoglobin on the low side of normal had twice the risk of mobility problems as those with higher hemoglobin levels.

In the study, the women gave blood samples so their hemoglobin levels could be evaluated, and then performed a number of mobility tests, including walking, rising quickly from a chair several times and keeping their balance.

Typically, in older adults, "12 [grams per deciliter of blood] is considered normal for women and 14 for men," Ashar says. However, women who had levels between 13 and 14 did best on the mobility tests, and those with levels under 12 did the worst. Those with hemoglobin levels between 12 and 13 performed in the middle of the best and worst. The risk of problems with movement when hemoglobin was 12 was more than twice as high as for those with higher levels, the researchers say.

Anemia affects about 3.4 million Americans, according to the National Anemia Action Council. Up to 32 percent of older women may be affected, the Hopkins researchers say. It can occur after blood loss or as a side effect of medication. It can also accompany many serious illnesses. At greatest risk are those with chronic kidney disease, heart disease or diabetes -- all diseases that tend to become more prevalent with age.

"Hemoglobin currently perceived as 'mildly low' and even 'low-normal' might have an independent, adverse impact on mobility function," Chaves concludes, adding that a redefinition of anemia in the elderly might be in order.

The research is lauded by a geriatric specialist from the University of Southern California.

"It's a very impressive study," Dr. Loren G. Lipson says. "This is something I know anecdotally, but this study is scientifically sound."

"We always attribute things to old age," he says. If an older person tells the doctor he is tired, for instance, a doctor may explain the fatigue by saying the person is getting up in years.

"It's easy to say to an older person, 'You're out of shape' or 'You're old,' when there might be another problem," he says.

In his own practice, Lipson says, he has noticed older adults with lower hemoglobin levels do have movement problems.

Older adults ought to ask their doctor about their hemoglobin levels when they get their blood work done, he adds.

"Ask what the value is," he says. "And talk about this study. A low hemoglobin level might be a hint that your doctor should look further."

It might also point to another medical problem that could be treated successfully, eventually boosting the hemoglobin, too.

"The message for doctors is that we need to conduct further study," Ashar says. To older adults, he would suggest: "If you have a low blood [hemoglobin] count, you need to be evaluated by your physician."

Treatment for anemia associated with nutritional deficiencies includes supplements of iron, folate and vitamin B12. However, anemia associated with chronic disease has no set treatment, the researchers say.

What To Do

For information on exercise programs, check out the National Institute on Aging. For information on anemia, visit the National Anemia Action Council.

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Arthritis Strikes Kids, Too 

HealthScoutNews

Friday, July 12, 2002

(HealthScoutNews) -- If your child complains of aches and pains, you might dismiss it as nothing serious. The Hospital for Special Surgery in New York says that may be a mistake.

The hospital says more than 70,000 children in the U.S. suffer from juvenile rheumatoid arthritis. And the sooner it's diagnosed -- through a blood test and medical exam -- the better it can be treated.

Symptoms include hot, swollen, painful joints that cannot move as much as they should, morning stiffness, high fevers and a rash. It's common for the symptoms to go away and  come back after a day or so.

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It's No Fish Tale -- Cod Liver Oil Works 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Friday, July 12, 2002

FRIDAY, July 12 (HealthScoutNews) -- It looks like Grandma may have been right again: Cod liver oil appears to help reduce the number of ear infections in children.

A new study has found a combination of cod liver oil and a multivitamin containing the trace mineral selenium reduced by more than 12 percent the number of days children were on antibiotics for ear infections.

Ear infections, also known as otitis media, are a common childhood problem. Repeated infections can cause problems with hearing and speech, according to the study. Because in the past children with recurrent infections were often treated with antibiotics, otitis media is believed to have contributed to the rise in antibiotic-resistant bacteria, report the researchers.

This pilot study, which appears in the current issue of the Annals of Otology, Rhinology and Laryngology, was conducted in two parts, according to lead researcher Dr. Linda Linday, a pediatrician at The New York Eye and Ear Infirmary.

For the first part, the researchers took blood samples from 44 children between the ages of 1 and 10 who were having surgery. Thirty-nine of the children were having tubes put in their ears because of recurrent ear infections; the other five were having eye muscle surgery or other ear, nose and throat surgery.

The majority of the children had lower levels of three important chemicals than the average adult does. The first was an omega-3 fatty acid that helps decrease inflammation in the body. Second, was vitamin A, which is considered an "anti-infective" vitamin, Linday says. Finally, they also had lower levels of selenium, an essential mineral that also plays a role in reducing inflammation.

In the second part of the study, Linday and her team recruited seven children who had had at least one ear infection in the previous ear infection season, which runs from September through March. These children were given a teaspoon of lemon-flavored cod liver oil orally and a multivitamin containing selenium every day throughout ear infection season.

Overall, these children received antibiotics for almost 13 percent fewer days. Five of the children had no more ear infections for the duration of the season.

Linday says it's important to note this was a pilot study.

Dr. Adriana Castro, head of pediatrics at Baptist Children's Hospital in Miami, agrees more work needs to be done, but says this is a promising study.

Linday cautions parents not to add supplements to their child's diet without checking with their health-care provider first, because cod liver oil supplements contain varying amounts of vitamin A and D, and these vitamins can be toxic in large amounts.

Another caveat, Castro says, is that a small number of children may be allergic to cod liver oil.

What To Do

For more information on ear infections, visit the National Institute and Other Communication Disorders Information Clearinghouse or check out Kids Health.

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Three Louisiana Men Infected with West Nile Virus 

Reuters
Friday, July 12, 2002

NEW ORLEANS (Reuters) - Three Louisiana men have been infected with West Nile virus ( news - web sites) in the nation's first known confirmed cases of the mosquito-borne illness this year, a state health official said on Friday.

One of the men was in "very, very serious condition," but the other two were in better shape, said state epidemiologist Raoult Ratard.

He said there were other suspected cases in Louisiana that had not yet been confirmed. No other cases have been confirmed in the United States this year, Ratard said.

The virus, which can cause deadly brain inflammation in humans and animals, has killed 18 people along the East Coast since it was first detected in the United States in 1999 in New York.

A recent report by the US Centers for Disease Control and Prevention ( news - web sites) said the disease, detected in 27 states last year, was expected to spread throughout the Americas.

West Nile, which humans contract through the bite of an infected mosquito, has been common in Africa and Asia for decades, but unknown in the Americas until the 1999 outbreak.

The three Louisiana victims, who ranged in age from 53 to 78 and lived in the southeastern part of the state, had spent a lot of time outdoors, where they were exposed to mosquito bites, Ratard said.

He said the state was urging local governments to step up mosquito control programs and warning the public to avoid contact with mosquitoes.

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Marine Snail's Toxin More Powerful Than Morphine 

By Nic Rowan

Reuters Health

Friday, July 12, 2002

MELBOURNE (Reuters Health) - Australian researchers have isolated a toxin from the cone shell, a type of a marine snail, that is not only a powerful analgesic but also accelerates recovery from nerve injury.

Although other pain-killing compounds have been isolated from the venom of the deadly creature, the newly discovered compound, known as ACV1, does not appear to affect blood pressure, according to Dr. Zeinab Khalil, deputy director of the National Aging Research Institute at the University of Melbourne.

Khalil and colleagues have isolated and patented the compound and also tested it on rats. They hope to move to human tests when negotiations with a commercial partner have been finalized.

"We are confident of the ability of the drug not only to inhibit pain but also to accelerate recovery of injured nerves, which is a unique property not previously documented for other analgesics," she told Reuters Health.

Eight weeks after inducing nerve damage in rats, there was only a 47% functional activity in animals given an inactive placebo, compared with a 83% functional activity in animals that received ACV1 treatment for a week, according to Khalil.

ACV1 is 10 times more potent than another conotoxin that has already been tested in humans and that compound is 1000 times more potent than morphine when it comes to inhibiting the function of sensory nerves involved in pain transmission, Khalil explained.

Khalil said that potential applications for the compound include treatment of any type of pain with a neuronal component, such as cancer pain, low back pain or pain due to arthritis, sports injury or shingles. Shingles is a reactivation of chickenpox virus, usually later in life, that results in an extremely painful, blistering rash.

No adverse behavioral or motor effects have been found in rats during the 12-week studies, and ACV1 does not affect systemic blood pressure, Khalil said.

Cone shells are found on reefs throughout the world and can deliver a painful and potentially life-threatening sting.

The research is being presented this week at the International Society for Toxicology Congress in Cairns, Australia.

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