The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
October 14, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 SEPTEMBER 21 - 27

  1. You May Have Diabetes and Not Know It
  2. 'Drug Holidays' Not Beneficial for Fighting HIV
  3. Need Health Info? Federal Libraries Can Help
  4. Officials Urge Flu Shots For Babies
  5. Hormone May Signal Heart Trouble in Teens
  6. Cholesterol-Cutting Drugs May Clear Artery Build-Up
  7. First Ad Campaign Touts Genetic Screening for Cancer
  8. Emotional Stress Can Literally Be Heartbreaking
  9. Drug Helps Prevent Breast Cancer Spread to Bone
  10. Study: Pill, Weight Gain Not Linked
  11. Multiple Sclerosis Drug May Cause Heart Problems
  12. Chiropractic Groups Push For Change
  13. Bioengineered Animals an Environmental Threat: Panel
  14. Study Suggests Mad Cow Solution
  15. Race Still a Factor in Cancer Patient Survival
  16. Experts Try to Make Bionic Retinas
  17. Compounds May Lead to Safer Clot Preventing Drugs
  18. Study: Epilepsy Drug Helps Migraines
  19. Survey: Parents, Siblings Influence Teens' Drug Use
  20. Americas' Life Expectancy Rises, but Health Mixed
  21. Booklet Helps Frustrated Parents Get Kids to Sleep
  22. Eating more fruits, veggies gets push

    SUNDAY, SEPTEMBER 22, 2002


  23. Bladder Cancer Keeps Coming Back
  24. Using Aspirin or NSAIDs Cuts Alzheimer's Risk
  25. Hormone replacement stroke risk debated
  26. New Tools, Drugs Used to Blunt Post-Surgery Pain
  27. Hunting Down a Cure for Sickle Cell Disease
  28. 'I'll Study for the Test Tomorrow'
  29. Legs for Life Starts Its Run

    SATURDAY, SEPTEMBER 21, 2002


  30. 5-A-Day: The Healthy Way
  31. FDA OKs Chronic Hepatitis B Drug
  32. Backsprain Is the No. 1 Workplace Injury


FRIDAY, SEPTEMBER 27, 2002

Doctors Abuse Drugs, Too 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Friday, September 27, 2002

FRIDAY, Sept. 27 (HealthScoutNews) -- Even doctors aren't immune to drug addiction.

Despite increasing education and tighter regulation of narcotics, the rate of physician addiction has remained steady for the past 30 years, says a new study in the October issue of Anesthesia and Analgesia.

"We discovered that the incidence of drug abuse is around one [percent] to one and half percent among anesthesiologists," says study author Dr. John Booth, an anesthesiologist at Duke University Medical Center. Booth notes that figure doesn't include alcohol abuse.

About 3.5 million Americans are dependent on illicit drugs, according to the National Institute on Drug Abuse. That's around 1.25 percent of the U.S. population. Another 14.8 million report using drugs at least once a month.

The researchers sent an anonymous survey to more than 100 academic medical centers; the chairs of 123 anesthesiology programs responded. They reported that about 1 percent of their faculty members had a substance abuse problem, while 1.6 percent of the anesthesiology residents were addicted to drugs.

Fentanyl, a strong narcotic, was the most commonly abused drug. Like similar medications, a tolerance is built up over time to the drug, and more and more is needed to achieve the same effect.

That may explain why overdose was one of the most common ways a substance abuse problem was discovered. Booth says almost 20 percent of those caught were discovered by an overdose that caused death or a near-death event. Another way physician drug abuse was uncovered was through tracking of medication use among doctors.

Almost two thirds of the academic centers reported adding new methods of tracking narcotics or new controls to the dispensing of these medications. Nearly 50 percent said they had increased substance abuse education programs. Less than 10 percent, however, currently use random drug testing, though 60 percent think it's a good idea.

Booth says what was particularly discouraging about this study was that prevention education and tighter controls on narcotics dispensing seemed to have little effect on the rate of addiction.

One bright spot in the research was that it appeared the physicians who were abusing drugs were doing it on their own time, and not while they were in the operating room. There were no problems with patient care resulting from drug addiction, according to the study.

"Physicians are harming themselves and their families more than others," Booth says.

One thing the study makes clear, Booth says, is that a different approach is needed to address the problem. He says a national database to track the true extent of the problem would be very helpful, as would a more aggressive form of substance abuse education.

Michael Nuccitelli, executive director of SLS Health, a provider of drug and alcohol rehabilitation in New York, wasn't surprised by the findings.

"Drug addiction is a pervasive disorder that isn't discretionary for race, gender, or profession," Nuccitelli says.

He says the study's findings don't necessarily mean education doesn't work, just that the methodology of the education programs may need to be changed, or physicians may need increased time in education. Also, he adds, the best treatment programs for physicians with a substance abuse problem are ones geared specifically toward professionals.

What To Do

To learn about treating drug addiction, go to the National Institute on Drug Abuse or the American Academy of Family Physicians.

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'Unborn Child' Coverage Rule Set  

By Laura Meckler

Associated Press Writer

The Associated Press

Friday, September 27, 2002

WASHINGTON (AP) - The Bush administration said Friday it will consider fetuses "unborn children" under a government-funded health program, brushing aside complaints that the move is an effort to undercut abortion rights.

The administration said it is making the change to enable more low-income pregnant women to obtain prenatal care. Under the new rule, states could extend health insurance to fetuses — or even embryos — from the moment of conception by enrolling them in the State Children's Health Insurance Program.

The debate will now shift to states, which must decide whether to add fetuses to their programs. Both sides of the debate predicted battles ahead.

Because CHIP, as the program is known, is aimed at children, it does not typically cover parents or pregnant women, although states can get permission to include adults if they request it. Under these new rules, it will be a routine matter for states to add unborn children to their CHIP programs.

"It represents a speedy new option for states that want to do more to ensure that women get critical prenatal care that will increase the chances that their children are born healthy," Health and Human Services ( news - web sites) Secretary Tommy Thompson said in a statement Friday.

He called the change a "commonsense, compassionate measure."

The final regulation, first proposed in January, will be published Wednesday in the Federal Register. It will take effect 30 days later.

HHS received a whopping 7,783 comments on the proposal, including many that argued the administration was trying to lay legal groundwork establishing independent rights of the fetus as a step toward abolishing abortion.

Some accused the administration of trying to circumvent congressional debate; others called the regulation an "anti-choice proposal disguised as a health care proposal." Critics also argued that, given the divisive debate over when life begins, HHS should not adopt a policy that takes one side.

The department responded that CHIP is voluntary and no woman — and no state — is required to participate. In any case, HHS argued, "prenatal care benefits both mother and child and therefore does not create tension between them."

"This rule, rather than limiting an uninsured woman's choices in fact expands them by offering important health care that may not otherwise be available to her," said the 111-page regulation.

Douglas Johnson, legislative director for the National Right to Life Committee ( news - web sites), praised the Bush administration action but feared it will be stymied at the state level.

"The next question is, will pro-abortion politicians in some states cave in to pressure from pro-abortion groups who insist there is no such thing as an unborn child, and so deny this aid to mothers and their babies?" he asked.

In fact, abortion rights groups said they will urge states to reject this option. They noted that states can accomplish the same thing by asking for permission to include pregnant women in CHIP — something two states, New Jersey and Rhode Island, have already done.

Or, they said, if the administration really wants to get prenatal care to more women, it could simply support legislation pending in the Senate to add pregnant women to CHIP.

"They could support it and it would pass in a nanosecond," said Gloria Feldt, president of Planned Parenthood ( news - web sites).

Thompson has said he supports the Senate bill.

Clarifying one aspect of the policy, the regulation explained that all fetuses are eligible for coverage even if their mothers are immigrants who are not. CHIP bars all illegal immigrants and only covers legal immigrants who have been in the country for five years. But babies born in the United States are citizens and therefore eligible for assistance.

That angered some who were already bothered by the policy.

"It's so offensive to immigrant women to say we don't care about you, but if you're pregnant, we'll give your fetus coverage — but never you," said Laurie Rubiner of the National Partnership for Women and Families.

HHS said this was not the first time a fetus has been eligible for government benefits. In the past, developing fetuses were eligible for both welfare benefits and for Medicaid, which allowed for prenatal care.

The regulation addressed some other questions: Does this mean that a fetus will be counted in the Census? On tax forms? No, for both. HHS explained that nothing changes current law.

It also clarified that a pregnant woman would not be eligible for care for mental health, broken bones or other ailments that are not related to the health of the fetus.

HHS spokesman Bill Pierce said HHS would count fetuses in its statistics about number of children covered by CHIP. He said it wasn't clear if the department would break out the number of born vs. unborn children.

The plan does not include any new money for the coverage. Rather, states that want to participate would simply add participants to their existing programs, which are funded with a combination of state and federal dollars.

On the Net: HHS: http://www.hhs.gov

National Right to Life Committee: http://www.nrlc.org/

Planned Parenthood: http://www.plannedparenthood.org/

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Two More Antibiotics May Help Fight Anthrax

By Jacqueline Stenson

Reuters Health

Friday, September 27, 2002

SAN DIEGO (Reuters Health) - Researchers have identified two more antibiotics that may help prevent and treat anthrax infection in the event of a biological attack.

Currently, three antibiotics are approved by the US Food and Drug Administration ( news - web sites) for anthrax--penicillin, doxycycline and ciprofloxacin. But public-health experts are concerned that another anthrax attack could involve strains of the bacterium that are resistant to these medications. As a result, finding new treatment options is important.

In the laboratory, researchers led by Dr. Duygu Esel, a microbiologist at Erciyes University in Kayseri, Turkey, studied how well five drugs tackled 40 strains of anthrax bacteria. Along with the three US-approved treatments, the investigators also tested gatifloxacin and levofloxacin, both of which belong to a newer class of antibiotics called fluoroquinolones, a class that includes ciprofloxacin.

"They were all similarly effective," Esel said here Friday at the annual meeting of the American Society for Microbiology.

"Our findings show that the newer quinolones--gatifloxacin and levofloxacin--may be used for the prevention and treatment of anthrax, including inhalation anthrax," she told Reuters Health.

Inhalation anthrax is the most lethal form of the disease, which also can occur in the skin and gastrointestinal tract. When people inhale the anthrax spores, the spores germinate to produce growing bacteria, which release a deadly toxin.

Last year's anthrax attacks in the US killed five people and sickened more than a dozen others.

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New Antibiotic Compound Treats Major Infections 

HealthScoutNews

Friday, September 27, 2002

FRIDAY, Sep. 27 (HealthScoutNews) -- A drug that combines a well-known antibiotic with a potassium acid derivative has been cleared for use against some severe bacterial infections.

 Specifically, Augmentin XR (amoxicillin/clavulanate potassium) has been approved by the U.S. Food and Drug Administration ( news - web sites) (FDA) to treat adults who suffer from two communicable diseases: acute bacterial sinusitis (ABS) and community-acquired pneumonia (CAP).

Augmentin XR is designed to help patients who are resistant to penicillin, the drug most often used to combat these diseases. This prescription drug is made by GlaxoSmithKline and is dispensed in tablet form.

Many bacteria have become penicillin-resistant in recent years, and it's estimated that the pneumonia Augmentin XR fights can't be combatted with penicillin in 20 percent of the cases nationwide.

Clinical trials involved more than 4,100 patients; side effects included diarrhea (15.6 percent), nausea (2.2 percent), yeast infection (2.1 percent) and abdominal pain (1.6 percent).

Acute bacterial sinusitis is more widespread than you might imagine. This page from Commoncold.org explains how the disease spreads.

This article from Postgraduate Medicine online addresses how community health professionals can combat the contagious aspects of pneuumonia.

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Wis. Meat Co. Recalls Ground Beef  

By Melissa Trujillo

Associated Press Writer

The Associated Press

Friday, September 27, 2002

MILWAUKEE (AP) - A Wisconsin meat packing company said Friday that it is recalling about 400,000 pounds of ground beef that may be connected to an E. coli outbreak that sickened 40 people in three states.

Health investigators also are probing another E. coli outbreak that sickened 19 people in Wisconsin. It is not known if the outbreaks are related, though officials believe all the people got sick after eating ground beef.

The most recent case was reported in mid-September.

Officials learned of the first outbreak last month after 19 people who went on a rafting trip in northern Wisconsin fell ill.

While investigating the first outbreak, officials found another of a different strain. That outbreak hit 40 people in Wisconsin, Illinois and Minnesota.

The meat company said its recall was a precaution.

"The evidence linking this to this product is what you would call circumstantial," said Justin Segel, president of Emmpak Foods. "We are in the interest of public safety, consumer safety, recalling five days of production."

Last May, the company recalled 471,000 pounds of ground beef because it may have been contaminated with E. coli.

Symptoms of E. coli infection include diarrhea and stomach cramps. The bacteria can be lethal in some cases.

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New Compound Said to Stop HIV, Aid Immune Response 

By Deena Beasley

Reuters

Friday, September 27, 2002

LOS ANGELES (Reuters) - Scientists have created compounds that may be able to block the virus that causes AIDS ( news - web sites) and at the same time keep the body from sabotaging its own immune response, according to early-stage research unveiled on Friday.

Mymetics Corp. said test tube studies show that one of its experimental compounds is seven times as potent as the most promising "fusion inhibitor" of HIV ( news - web sites). The results were presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy in San Diego.

So-called fusion inhibitors, designed to stop the virus from getting into cells in the first place, are the most advanced new HIV drug class in development. Currently approved AIDS medicines attack HIV only after it has entered a cell.

Annapolis, Maryland-based Mymetics is developing compounds that block the virus before it fuses with the host cell while disrupting a phenomenon dubbed "molecular mimicry"--the existence of similarities between viral and host cell proteins that undermine the body's immune system, making it easier for the viral infection to progress.

"They have tailor-made peptides (short chains of amino acids) that prevent viral entry without affecting IL-2 (a naturally occurring protein involved in immune system regulation)," said Dr. Ronald Gray, professor of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore.

The theory is that mimicry allows gp41, a protein on the surface of HIV cells, to bind to the host cell's receptor for IL-2, which provokes the body's own immune system to attack IL-2 and may explain why HIV infection leads to AIDS and, ultimately, the fatal breakdown of the body's immune system.

"Patients who have AIDS actually have antibodies against IL-2. We think we've come up with an explanation for why," said Peter McCann, chief executive of Mymetics.

He cautioned that the work is still very early-stage--the peptides have yet to be tested in animals--and permission for trials in humans will be sought within two years.

According to the in vitro results, Mymetics' candidate compounds, S291 and N36E, cut viral levels in a commonly tested HIV strain to 0.37 micrograms per milliliter (ml) and 0.02 micrograms per ml, respectively. By comparison, a peptide similar to the most clinically advanced fusion inhibitor, Trimeris Inc.'s T-20, measured 0.15 micrograms per ml.

The compounds have been designed to adhere to gp41 without interfering with the IL-2 receptor, thus inhibiting HIV without suppressing the immune system's response.

The company said it is testing the peptide candidates against a variety of mutated HIV strains and intends to begin animal testing within the next nine months.

Mymetics is also planning to test a model peptide against a feline leukemia virus in order to iron out details before beginning more advanced studies of its HIV peptides. "We can work through formulations and dosage levels in cats," said Joseph Mosca, Mymetics' vice president of development.

The company is also looking at using its molecular mimicry platform to combat retroviruses associated with diseases that include certain leukemias and multiple sclerosis.

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Knowing That Your Memory Fails Is an Omen 

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Friday, September 27, 2002

FRIDAY, Sept. 27 (HealthScoutNews) -- Joking about "senior moment" memory problems is common, even among people who aren't yet middle-aged.

But very frequent complaints about memory failure may be an omen, new research from UCLA suggests.

The higher the awareness of memory loss, the higher the risk of future memory decline, says Dr. Gary Small, the director of the UCLA Center on Aging, who will present his new research this weekend in Chicago at the First Annual Dementia Congress.

"To some extent, subjective awareness of memory changes predicts future decline in brain function in the memory centers," Small says.

For example, in a recent research study, he evaluated 39 people between the ages of 50 and 82, all of whom had mild memory complaints. Some were carriers of the APOE-4 gene, a susceptibility gene for Alzheimer's, and some were not. He gave all of them a standardized memory assessment test and asked them to rate their memory performance. Each person underwent positron emission tomography (PET) scans of the brain on entering the study and then again two years later.

Small found that the perceived degree of memory loss correlated with a decline in metabolism in the hippocampus, a region of the brain critical for learning and recall, regardless of whether the APOE-4 gene was present. On average, the metabolism in that area declined about four percent during the two years.

"Awareness predicts the biological changes," Small says. "This is what we predicted would happen."

"These data are not surprising," Small adds. "Brain aging occurs very early in life, even in young people. Some of these subjective memory changes we notice actually have some biological meaning."

People who experience such memory loss often fear they are getting Alzheimer's disease ( news - web sites), which can begin with mild memory problems and progress to more serious ones. About four million Americans have Alzheimer's disease, according to the Alzheimer's Association, a sponsor of the Dementia Congress along with the UCLA Center on Aging.

But recent research suggests that a large number of people who suffer from milder forms of cognitive problems might be able to protect the brain from further decline by paying attention to lifestyle and environmental factors that play a role in progression of the disease.

"There is a lot we can do about it," Small says of cognitive decline. "We can keep our brain young and healthy, improve our memory performance and even stave off future decline."

Genetics accounts for about one third of cognitive problems, Small says, while we have some control over the other two-thirds. "Be proactive in protecting your brain," Small tells people. To do that, he recommends mental activity, "what I call mental aerobics." Exercising the mind with anything fun and stimulating works, he adds.

Staying in good physical shape is important, he says, as is eating a "brain-healthy" diet. He recommends, among other measures, reducing saturated fats and focusing on "omega 3" or good fats, found in such foods as canola oil, salmon and trout.

"And let's see, what was the last one?" Small quips. "Oh yes, stress reduction. If you can cover those four areas, you can keep your brain healthy." In his new book, The Memory Bible, Small talks about healthy brain aging and how to improve memory.

Another expert in the field says Small's study will contribute to the body of information about Alzheimer's disease.

"This important finding suggests that self-awareness of memory loss may be an important predictor of future declines in thinking and may possibly be helpful in predicting future dementia," says Dr. Michael Weiner, director of the magnetic resonance unit at the VA Medical Center in San Francisco.

"When treatments which are effective for Alzheimer's become available (some day, hopefully not too many years away), then the prediction of Alzheimer's become very important, especially if treatment which prevents the onset becomes available," he adds.

What To Do

For warning signs of Alzheimer's, visit the Alzheimer's Association, which also offers information on myths about the disease.

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Senators to Offer Medicare Givebacks  

By Janelle Carter

Associated Press Writer

The Associated Press

Friday, September 27, 2002

WASHINGTON (AP) - Senators gridlocked over a Medicare prescription drug benefit are now advancing a bill that would send billions of dollars to hospitals, doctors and other health providers that care for Medicare patients.

Sen. Max Baucus ( news, bio, voting record), D-Mont., chairman of the Finance Committee, and Sen. Charles Grassley ( news, bio, voting record), R-Iowa, the top Republican on the panel, issued a statement Thursday announcing the $44 billion proposal.

"These provisions will improve the quality of, and access to, health care for millions of Americans," the statement said. "We call on Congress and the president to act swiftly."

Congress agreed to cut billions of dollars from Medicare in 1997 when it balanced the federal budget. But lawmakers restored some of the money after health providers complained the reductions were too deep. Those "givebacks" are now expiring.

The House already has passed a package that would give Medicare health providers about $30 billion. The provision was included in a Medicare prescription drug bill passed in the House.

The Senate rejected four different Medicare drug proposals in July, and lawmakers have been unsuccessful in negotiating a compromise.

Many lawmakers have said that much like previous years, the provider giveback package may be the only agreement Congress is able to reach concerning Medicare.

Two years ago, Congress agreed to send $32.7 billion in additional money for Medicare providers.

Hospitals, doctors, HMOs and other providers have lobbied for more money from Medicare for several years now, complaining that payments have been cut while health care costs are rising.

Some patient advocacy groups are crying foul this year, saying lawmakers should have done more to help beneficiaries instead of providers.

"Once the cancer community understands that the Senate leadership is prepared to offer more than $40 billion in so-called provider givebacks and nothing for people with cancer, they will be very angry," said Ellen Stovall, president of the National Coalition for Cancer Survivorship. The organization had been lobbying for the bill to include a provision that would allow Medicare to cover all oral anticancer drugs.

Senators had initially hoped to attach the provider giveback package to a bill providing a Medicare prescription drug benefit.

"No one has given up on the issue of prescription drugs," said Michael Siegel, spokesman for the Senate Finance Committee. "In the meantime, we do feel very good about this giveback package. It's going to help beneficiaries by improving not only the access but the quality of care, such as at nursing homes, at home health care programs and hospitals."

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Study Shows Concentrated AIDS Drug Is Effective 

By Deena Beasley

Reuters

Friday, September 27, 2002

LOS ANGELES (Reuters) - Preliminary results show less than half as many pills of an experimental AIDS ( news - web sites) drug work at least as well as the most widely prescribed protease inhibitor in patients not previously treated with other drugs, researchers said on Friday.

The drug, being developed by Vertex Pharmaceuticals Inc. and GlaxoSmithKline Plc, is a second-generation protease inhibitor known as 908.

"It is a more concentrated drug. It will reduce the number of pills that patients will need to take and that improves adherence and helps with tolerability," said Dr. David Parks, an instructor at Washington University School of Medicine in St. Louis and a trial investigator.

Interim results from a pivotal-stage trial of 908 showed that after 24 weeks HIV ( news - web sites) could not be detected in 73% of patients, compared with 54% of trial participants taking Viracept, the protease inhibitor made by Pfizer Inc.

The 249 patients in the trial were randomized to receive either two 908 pills twice a day or five Viracept tablets twice a day. Both medications were taken in combination with other AIDS drugs.

Among patients with advanced HIV, 71% on 908 saw their viral load drop to undetectable levels after 24 weeks, compared to 35% of patients taking Viracept. For patients with less severe viral levels, 74% in the 908 group achieved an undetectable viral load, compared to 70% of the Viracept patients.

The full study is scheduled to last 48 weeks.

Protease inhibitors, which often have to be taken several times a day, block HIV protease, an enzyme the virus needs to reproduce itself.

Parks said 908 is being investigated in both once- and twice-daily regimens.

He said side effects associated with 908 are similar to those seen with other protease inhibitors, particularly gastrointestinal problems. During the trial, the only significant difference in side effects was a lower incidence of diarrhea, 5%, in the patients on 908, compared with 17% for the Viracept group.

Glaxo has marketing rights to the drug in the United States, Europe and certain Asian countries, while Vertex has options to commercialize the drug in Japan and to co-promote it in the United States and Europe.

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Fatty Acid in Milk May Ward Off Breast Cancer 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Friday, September 27, 2002

FRIDAY, Sept. 27 (HealthScoutNews) -- A fatty acid in milk and meat appears to muzzle budding breast cancer ( news - web sites) by shutting off its ability to summon blood vessels, a new study shows.

The substance, conjugated linoleic acid (CLA), clamps down on the formation of new blood vessels -- a process called angiogenesis -- that tumors need to support their lust for nutrients.

"It appears to be an anti-angiogenic compound and a nontoxic one," said Margot Ip of the Roswell Park Cancer Institute in Buffalo, N.Y., who led the work. Ip presented her findings today at a meeting in Orlando of the U.S. Department of Defense ( news - web sites) Breast Cancer Research Program.

Ip's group first dosed rat mammary cells in a dish with CLA, and saw that in the presence of the chemical they produced far fewer tiny blood vessels. They then fed the substance to live rats, and saw in tissue samples that the growth of new vessels was cut by up to 80 percent.

Ip said CLA seems to prevent one class of flexible mammary cells, called stromal cells, from becoming vessels that can feed tumors that form in the milk ducts. Instead, it encourages these cells to convert into harmless fatty tissue.

CLA has anti-cancer properties in a wide range of cells, from the breast to the colon. But its effects are overwhelmed by the harmful impact of other fats that are more prevalent in food, said Jack Vanden Heuvel, a molecular toxicologist at Penn State University who studies the chemical.

"CLA is just one type of fatty acid that's in all those foods that are high in fats, and on balance they're bad," Vanden Heuvel said. Scientists are trying to increase the concentration of CLA in dairy products by manipulating what cows eat.

The substance is also available as a dietary supplement, and evidence suggests that it can lower body fat while increasing lean muscle mass. However, it hasn't been around as a diet aid long enough to know if it indeed prevents cancer in people, Vanden Heuvel said.

Vanden Heuvel said the latest study agrees with his own research, which has found that CLA binds to and activates a protein called PPAR-gamma. This protein helps cells become a variety of tissues, whereas tumors are cells that have already committed to a single function and are more prone to cancerous mutations.

His group has found that CLA acts much like a novel class of diabetes drugs called the glitazones, which make fat cells better able to handle blood sugar. Research suggests that these medications not only block angiogenesis but also may prevent colon, breast and prostate tumors.

"There's solid evidence that CLA has the ability to inhibit cancer," said Mark McGuire, a lactation biologist at the University of Idaho in Moscow who studies the chemical. Humans get about 95 percent of their CLA in beef and milk. Yet because it's a fatty acid, people who drink skim milk aren't getting any in their glass.

Rat data and human studies from Finland suggest that bumping up CLA intake by only 20 percent can slice the risk of breast cancer in half, McGuire said. One way to do that is to swap whole milk for skim and to cook with butter instead of vegetable oil or margarine.

Of course, making those changes increases saturated fat consumption, which can hike the risk of heart disease. But McGuire said he and his colleagues have found that women who drink whole milk in moderation don't develop unhealthy blood fat levels that might put them at risk of heart and vessel problems.

In another study presented at today's meeting, Alabama scientist found that when you eat a cancer-preventing food may be as important as simply eating it at all. The researchers showed that rats fed the soy protein genistein, which may prevent breast cancer, had fewer tumors later on if they ate the substance before entering puberty.

The findings suggest that adolescent and pre-adolescent girls who eat a soy-rich diet may ward off breast cancer later in life. That agrees with a 2001 study, which found that Chinese women who ate high-soy foods when they were teenagers had half the incidence of breast cancer as those who ate less of the nutrient.

Coral Lamartiniere, a toxicologist at the University of Alabama, Birmingham, who led the latest work, said genistein helps immature mammary cells become "differentiated"-- that is, it prompts them to choose a specific function in the breast. "It's undifferentiated cells that are susceptible to carcinogens," he said.

What To Do

To find out more about breast cancer, try the Susan G. Komen foundation or MEDLINEplus.

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Mushrooms Can be Deadly to People and Pets 

HealthScoutNews

Friday, September 27, 2002

(HealthScoutNews) -- Many a mother has warned her children to stay away from mushrooms, which may be poisonous.

But your dog or cat doesn't know beans about mushrooms, and that can be bad news.

The most dangerous mushrooms around include those in the Amanita family. While you may have to eat one to suffer the diarrhea, dehydration, vomiting and abdominal pains that tell you something is wrong, your pet only has to walk over one then lick his paw -- or somehow ingest a wind-blown spore.

Mushroom toxins can cause liver and kidney failure, and death. If you're not positive a wild mushroom is safe, don't even touch it. And never let your pet play where mushrooms are growing.

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Vaccine for West Nile Virus Shows Promise 

By Jacqueline Stenson

Reuters Health

Friday, September 27, 2002

SAN DIEGO (Reuters Health) - An experimental vaccine to protect against West Nile virus ( news - web sites) has been shown to be highly effective in animals, including monkeys, and human studies are planned to get under way early next year, researchers reported here Friday.

Currently, the only way to prevent the mosquito-borne disease is to avoid the insects that transmit it. Mosquitoes contract the virus from infected birds. Most people who become infected experience no symptoms or only milder ones such as headache, fever and bodily pains. But many elderly people and others with weakened immune systems are at increased risk of encephalitis, an inflammation of the brain, from infection and would be good vaccine candidates.

At the annual meeting of the American Society for Microbiology, researchers released data indicating that the vaccine has been successful in mice, hamsters, horses and monkeys exposed to the virus. "All animals that were inoculated developed antibodies to the West Nile virus," said Dr. Thomas Monath, chief scientific officer at Acambis, Inc., a company in Cambridge, Massachusetts that is developing the vaccine.

When the animals, including 16 monkeys, were then exposed to the virus, none died or showed any signs of illness, Monath said.

But it remains to be seen whether the vaccine will work so well in people. "Will it be 100% effective in humans? We'll see," Monath told Reuters Health. "So far it looks 100% immunogenic in animals. There's nothing equivocal about this data. It's very impressive."

Monath said he doesn't anticipate many complications with the vaccine. "The side effects are likely to be minimal," and may include itching and redness at the injection site, mild headaches and low-grade fever, he said.

The vaccine is a modification of a long-used vaccine against the virus that causes yellow fever, a close cousin of the West Nile virus. "We use yellow fever vaccine as a vector for West Nile genes," Monath said. The intent is to prompt the body to develop immunity against the West Nile virus. And the hope is that like the yellow fever vaccine, the West Nile vaccine will confer lifetime immunity from a single shot, he said.

Animal research suggests that the yellow fever vaccine may offer some degree of protection against West Nile virus since the viruses are closely related, but the yellow fever vaccine is not expected to be highly protective against West Nile in humans.

Studies of the West Nile vaccine involving a small group of people are expected to begin the first quarter of next year, according to Monath.

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Mother's Milk Is Honey to Young Infants 

HealthScoutNews

Friday, September 27, 2002

(HealthScoutNews) -- Aside from the physical benefits of breastfeeding, the mother-child bond it establishes can be of critical importance to an infant's long-term psychological well-being, according to a leading expert on breastfeeding and the law.

Elizabeth N. Baldwin, JD, writing for New Beginnings with husband and law partner Kenneth A. Friedman, says, "It is not until the second six months of life that the baby even recognizes that he is a separate person from the mother; The more responsive a mother is, the more secure the attachment."

Baldwin, a legal advisor to La Leche League International, says research indicates that children who do better later in life are the ones who had secure attachments in their early years.

Successful breastfeeding, she continues, "requires the mother to be responsive to the baby's hunger, sleeping, and crying signals. Babies self-regulate their feeding at the breast and breast milk is very different from formula. Mothers must be careful not to overfeed a baby formula; this is rarely a problem with breastfed babies."

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Arthritis Drug Helps Mice with Lou Gehrig's Disease 

By Dana Frisch

Reuters Health

Friday, September 27, 2002

NEW YORK (Reuters Health) - Promising new research in mice suggests that the arthritis drug celecoxib (Celebrex) might delay the onset of symptoms of amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig's disease ( news - web sites).

The drug prolonged survival of the mice by 28 days, or 25% of their life span, although study results in mice are not necessarily applicable to humans. More study is needed to determine if the drug may help patients with ALS, a progressive neurological disease resulting in muscle weakness and eventual paralysis. The disease, named after baseball player Lou Gehrig, affects approximately 1 in 100,000 people

A multi-center clinical trial testing the drug on about 350 human patients with ALS is currently under way. Results are expected within one to two years, according to Dr. Jeffrey Rothstein, a neurologist at the Johns Hopkins University School of Medicine in Baltimore, Maryland.

"Every time we discover a drug that has therapeutic potential in our models and that can be readily used in humans, it is important," Rothstein told Reuters Health. Celebrex is already on the market and does not have to go through lengthy FDA ( news - web sites) testing and approval.

Riluzole is the only FDA-approved drug for ALS, but does not work that well, according to Rothstein.

Celebrex is a COX-2 inhibitor, a class of drugs used to treat arthritis because they block an inflammation-promoting enzyme. The enzyme may play a role in ALS by stimulating astrocytes, star-shaped cells that surround neurons in the brain, to release excessive amounts of chemical communicators in the brain.

If too many are released, it can be toxic to cells, a condition that is "implicated in ALS. It is not necessarily a cause of the disease but it is a propagating factor that keeps the disease going," said Rothstein.

In the study, the researchers used mice genetically engineered to produce a human gene linked to ALS. The mice, which have a shorter-than-normal life span of 4 months, were fed chow laced with high doses of celecoxib. Symptoms such as motor decline and weight loss appeared about 2 weeks later in the mice fed celecoxib compared with mice not fed the drug, and they lived about one month longer.

Rothstein said he was "hopeful" that it would have an effect in humans, just as it did in the rodent counterpart.

He cautions though that the doses of Celebrex being used in the study are far larger than the dose prescribed to relieve the inflammation from arthritis.

The study was funded in part by grants from the National Institutes of Health ( news - web sites), the Muscular Dystrophy Association and Pharmacia, the manufacturer of celecoxib.

Source: Annals of Neurology 2002;52.

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Aim Low on Blood Pressure 

HealthScoutNews

Friday, September 27, 2002

FRIDAY, Sept. 27 (HealthScoutNews) -- When it comes to reducing blood pressure, lower is better, says a new Japanese study.

The researchers presented their findings today at the American Heart Association ( news - web sites)'s 56th Annual High Blood Pressure Research Conference in Orlando, Fla.

In people taking a variety of medications to lower their blood pressure, those whose blood pressure was reduced to lower than the standard goal also had reduced stiffness in their arteries. People treated to the standard goal didn't experience the same improvement in their artery stiffness, the study says.

"Artery stiffness is associated with heart disease and death in people with high blood pressure," says study senior researcher Dr. Atsuhiro Ichihara of the Keio University School of Medicine, Tokyo.

The researchers used pulse wave velocity (PWV) to measure vascular stiffness and to determine if the use of antihypertensive drugs to lower blood pressure would affect aortic stiffness in nondiabetic people who had high blood pressure.

PWV is calculated by determining the distance between the brachial artery in the arm and the tibial artery in the ankle. That distance is divided by the time it takes a pressure wave to travel between the two points.

The 142 study participants were divided into two groups. One group had their blood pressure reduction target set for less than 130/85 mm Hg and the other group's target was 140/90 mm Hg.

Normal blood pressure is less than 130/85 mm Hg.

Over the course of the yearlong study, systolic (the top number) pressure in the more intensive target group decreased significantly to 129 mm Hg, while the more moderate group decreased to 153 mm Hg.

At the start of the study, PWV averaged 1,779 centimeters per second (cm/s) in the intensive group and 1,891 cm/s in the more moderate group. By the end of the study, PWV decreased to 1,621 cm/s in the intensive target group but there was no significant change in the moderate reduction group.

"Intensive blood-pressure lowering is most important for the reduction in PWV. However, future studies will be needed to confirm which antihyperintensive drugs are better for aortic stiffness when blood pressure lowering is achieved," Ichihara says.

More Information

The National Heart, Lung, and Blood Institute has more on lowering blood pressure.

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Drug Abuse Holds Steady Among Anesthesiologists 

Reuters Health

Friday, September 27, 2002

NEW YORK (Reuters Health) - Drug abuse rates among anesthesiologists appear to be holding steady in spite of various educational campaigns and tighter security measures on drug storage areas, a new study has found.

Dr. John V. Booth of Duke University in Durham, North Carolina, and colleagues report that the pain killer fentanyl--a powerful opiate narcotic 80 times more potent than morphine--was the controlled substance of choice among anesthesiologists.

Previous research has estimated that between 10% and 14% of physicians will become chemically dependent at some point during their career, according to the report published in the October issue of the journal Anesthesia and Analgesia. In general, however, when alcohol is excluded, substance abuse is thought to afflict upwards of 2% of doctors, with anesthesiologists believed to be disproportionately affected.

"For instance," the authors write, "although anesthesiologists represented only 3% of physicians in 1983, 13% of physicians treated for substance abuse at one center during this period were anesthesiologists."

In effort to update older findings about drug abuse among anesthesiologists, Booth and colleagues surveyed 133 academic medical centers throughout the US between 1997 and 1998.

"The incidence of known drug abuse was 1% among faculty members and 1.6% among residents. Fentanyl was the controlled substance most often abused," the team writes.

This represented little change from past reports; one study from 1970 to 1980 found 0.9% of anesthesiology residents and 1.3% of anesthesiology faculty were known to have abused drugs, while another that ran from 1975 to 1989 found an overall drug abuse rate of 2% among anesthesiologists.

The researchers also learned that 47% of programs surveyed reported increasing the number of hours spent educating faculty and medical staff members about drug abuse, while 63% of the departments surveyed said they were taking increased measures in their accounting, storage and disposal of drugs.

"Efforts to reduce substance abuse among anesthesiologists have focused on education and tighter regulation of controlled substances, but it appears that these efforts have had little effect," Booth said in a prepared statement.

"It is clear that new and more effective means of prevention are required if substance abuse among anesthesiologists is to be reduced," he added.

One possibility suggested by Booth would be random drug testing, an idea that appears to be gaining acceptability. While 8% of departments used random urine screening to test for drugs, roughly 61% of the departments surveyed reported that they would approve random drug tests for their staff in an effort to thwart drug abuse.

Booth and his colleagues stress that the use of drugs by anesthesiologists occurred on the doctors' own time, outside of the operating room. Also, they note, no cases of patients being hurt by intoxicated doctors were reported.

Source: Anesthesia and Analgesia 2002;95.

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More Evidence a Spermicide Won't Halt AIDS 

HealthScoutNews

Friday, September 27, 2002

FRIDAY, Sept. 27 (HealthScoutNews) -- A common spermicidal gel doesn't prevent HIV ( news - web sites)-1 infection and may actually increase the risk of infection if used frequently.

That's the claim of a study in the latest issue of The Lancet.

Previous laboratory studies suggested nonoxynol-9 could be a barrier to HIV-1 infection and other sexually transmitted diseases, but that evidence was inconclusive and several studies have since said it doesn't work. Nonoxynol-9 is an inexpensive, over-the-counter spermicide.

Belgian researchers did a study involving 765 HIV-1 negative female sex workers in South Africa, Benin, Thailand and Ivory Coast.

About a third of the women used the spermicidal gel an average of 3.5 times a day. That was associated with a doubling of HIV-1 infection, compared to women who used a placebo gel. Low use of nonoxynol-9 didn't increase the risk of HIV-1 infection, the study says.

There were no differences in the incidence of other forms of sexually transmitted diseases between nonoxynol-9 and placebo gels.

The researchers hypothesize the increase of HIV-1 infections was linked to the occurrence of vaginal lesions in the women who made frequent use of nonoxynol-9.

"Nonoxynol-9 no longer has a part to play in HIV-1 prevention. Our data show that low frequency use of nonoxynol-9 causes neither harm nor benefit; but that frequent use increases a woman's risk of HIV-1 infection by causing lesions," says researcher Lut Van Damme of the Institute of Tropical Medicine in Antwerp, Belgium.

More information

Learn more about HIV prevention at the Center for AIDS Prevention Studies.

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Many U.S. Family Docs Unprepared for Bioterror Attack 

By Charnicia E. Huggins

Reuters Health

Friday, September 27, 2002

NEW YORK (Reuters Health) - If a bioterrorist attack on the United States were to occur, primary care physicians would be among the first to respond, by identifying and caring for sick people and activating the public health system. Yet only one in four family physicians feel they have the necessary knowledge and skills to do so, recent study findings show.

"There is need for education opportunities for family physicians regarding their response to a suspected or real bioterrorism event," study author Dr. John M. Hickner told Reuters Health. Hickner is the director of the American Academy of Family Physicians ( news - web sites)' National Network for Family Practice and Primary Care Research.

This finding is based on a survey of 614 family physicians. The survey was conducted in October 2001, following the September 11th terrorist attacks and during the repeated anthrax scares in the United States.

Nearly all (95%) of the survey respondents agreed that "a bioterrorist attack is a real threat in the United States," Hickner and his colleagues report in the September issue of the Journal of Family Practice. And most doctors (96%) believed anthrax was the most likely biologic agent to be used.

Still, less than 30% of the doctors believed the US could effectively respond to such an attack and only about a quarter of the physicians said they would know what to do, study findings indicate.

"Most family physicians do not feel confident in dealing with a possible bioterrorism attack in their communities," Hickner said. "Most desire more education so that they will be able to confidently handle such situations."

Indeed, more than 90% of the physicians surveyed said they were interested in receiving training about how to respond to a bioterrorist attack, the researchers report.

Eighteen percent of the doctors said they had had bioterrorism preparedness training, however, and these physicians were nearly four times more likely to say they were prepared for a bioterrorist attack. They were also more than six times as likely as their peers to say they knew how to obtain information should a bioterrorist attack occur, study findings indicate.

Altogether, these findings are not at all surprising, according to the study author. "Family physicians' time and energy are consumed caring for patients with common medical problems, and occasional rare problems," Hickner said. "Most have never seen nor thought there was sufficient likelihood of a bioterrorism event to worry about the issue compared to many other competing priorities."

Now, however, since most doctors realize the likelihood of a bioterrorist attack and in light of the other findings, "physicians should be trained in how to identify and manage illness caused by biologic weapons, how to obtain information about bioterrorism quickly, and how to activate the public health system in the event of a suspected attack," Hickner and his colleagues conclude.

A grant from the Agency for Healthcare Research and Quality funded the study.

Source: Journal of Family Practice 2002;51:745-750.

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Americans' Food-Handling Habits Improving 

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Friday, September 27, 2002

FRIDAY, Sept. 27 (HealthScoutNews) -- Take a peek inside America's kitchens, and you're likely to see more people using meat thermometers and washing their hands after touching raw meat or poultry.

However, there's still lots of potentially dangerous pink hamburgers, raw fish and raw eggs being served up at our tables.

Those are the results of the U.S. Food and Drug Administration ( news - web sites)'s new Food Safety Survey, a telephone survey of nearly 4,500 adults across the United States. The survey found an overall improvement in food safety practices from 1993 to 2001.

Still, there's lots of room for improvement.

"Although consumers report that they are more knowledgeable about food safety and have improved their safe food handling practices, in reality, some consumers are still using unsafe practices," says Elsa Murano, under-secretary for food safety at the U.S. Department of Agriculture ( news - web sites), which collaborated with the FDA on the research.

Those unsafe practices can give free rein to a host of food-borne germs -- including botulism, E. coli and salmonella -- that can produce health problems ranging from vomiting and diarrhea to death.

Among the survey findings:

·         In 1993, 71 percent of people washed their hands after touching raw meat or chicken. In 2001, 85 percent did.

  • In 1993, 34 percent said they washed their hands after cracking raw eggs. In 2001, 45 percent did.
  • In 1993, 28 percent failed to wash the cutting board after using it for raw meat. In 2001, that number had fallen to 13 percent.
  • The percentage of people eating pink hamburger, steak tartar and raw eggs was relatively stable, however. And more people reported eating raw clams, oysters and fish in 2001 than in 1998, the last time the survey was conducted.

While most of the news is encouraging, some food safety experts believe survey respondents may not be telling the whole truth.

Observational studies, in which people are actually watched as they prepare food, show unsafe food handling is more prevalent than a survey would suggest, says Dan Henroid, a food safety specialist at Iowa State University Extension.

"There's a big difference between what they report and what they do," Henroid says.

One example is hand-washing.

"When I wash my hands, I'm going to use soap and warm water," Henroid says. "I'm going to rub my hands for 20 seconds, use a single-service towel and not touch the faucet handle with my clean hands. Someone else might run their hands under cold water for a few seconds, and then use the dishtowel next to the sink."

Sound familiar?

Another concern of food safety experts is "cross-contamination," usually from mishandling raw meat, fish or poultry, says Althea Zanecosky, a registered dietician and spokeswoman for the American Dietetic Association.

You're at risk of spreading food-borne pathogens if you fail to wash your hands after touching raw meat or fish. It's also important to thoroughly wash plates, utensils and cutting boards used for raw meats or fish before using it for something else.

"Just rinsing it off isn't enough," Zanecosky says.

Another area of concern is eating under-cooked meats. To be sure meat has reached a safe temperature, use a meat thermometer. "Even if something is no longer pink, it may not necessarily be done," Henroid says.

One study found that one in four hamburgers that appeared to be cooked hadn't yet reached the proper internal temperature to kill illness-causing bacteria, he says.

Touching meat with your finger, probing meat and tasting meat aren't reliable ways to know if something is done, he adds.

When large numbers of people get sick from a fast-food restaurant or a wedding banquet, that gets all the press. However, many more food poisoning cases happen in people's own homes, Zanecosky says.

What To Do

Check Iowa State University Extension's Ten Steps to a Safe Kitchen. The U.S. Department of Agriculture has more on safe food handling.

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More Staph Spread Seen in Larger Nursing Homes 

By Jacqueline Stenson

Reuters Health

Friday, September 27, 2002

SAN DIEGO (Reuters Health) - Elderly people living in larger nursing homes and those in which many residents have lived for longer than 6 months may be more likely to contract infections than seniors in smaller homes with more frequent resident changes, according to a German report.

Study author Dr. Heike Von Baum, an internist at the University of Ulm, said it is not very surprising that the longer one stays in a nursing home the greater their risk of transmitting or acquiring an infection, in this case the bacterium Staphylococcus aureus. However, it is unclear why the size of the facility is an issue. "It may just be a surrogate for other factors," she said.

Most unexpected though, Von Baum told Reuters Health, is that several other factors did not contribute to the risk, including the number of patients with wounds, ulcers, feeding tubes or urinary catheters. In addition, the experience level of the caregivers did not make a difference in infection transmission, she reported here Friday at the annual meeting of the American Society for Microbiology.

Staph aureus is known to occur in about 30% of the general population, Von Baum said. It is not dangerous in most cases. "The problem is if your immune system gets compromised or you have breaks in your skin barrier and a wound gets colonized and infected," she explained, noting that many elderly are at risk for serious Staph infections because they have chronic illnesses that weaken their immunity.

In the study, the researchers took nasal swabs from residents in 47 nursing homes in Germany that housed anywhere from 14 to 283 seniors. Results showed that 12% to 54% of the residents carried one of the hundreds of strains of Staph aureus in their noses. When the researchers looked at the number of people infected with the same strain in a particular facility, they concluded that transmission rates were as high as 70%.

The larger the nursing home, the greater the likelihood of transmission, results showed. The same was true for homes that had many long-term residents.

Von Baum said it is not clear whether the findings would apply to the transmission of other types of bacteria or viruses, though it is possible.

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Smart Catheter 

HealthScoutNews

Friday, September 27, 2002

FRIDAY, Sept. 27 (HealthScoutNews) -- A "smart" catheter gives doctors information about the amount of oxygen that trauma and critical care patients' organs are receiving.

So says a report presented today at the American Association for the Surgery of Trauma's annual meeting in Orlando, Fla.

When a person suffers hemorrhagic shock, massive blood loss reduces the amount of oxygen delivered to all the organs in the body, which can lead to organ damage. Current methods to monitor oxygen supply to the organs are often invasive and can't always be used in a clinical setting.

University of Pittsburgh researchers and an Israeli physiology professor teamed up to develop the new "smart" catheter -- a modified urinary catheter with a fluorescent fiber optic probe that measures blood flow and oxygen utilization.

The fiber optic probe in this catheter is the same type used by neurosurgeons and anesthesiologists to measure oxygen utilization in the brain.

Animal studies and preliminary findings of the catheter's use in two people indicate the catheter is less invasive than current techniques used to monitor oxygen supply to organs.

"We hope by using technology such as this we can begin to learn more about the mechanisms of trauma and associated organ failure, so we can begin to formulate better outcomes for these patients," says study senior author Dr. Juan Carlos Puyana, an associate professor or surgery at the University of Pittsburgh School of Medicine.

More information

There's first-aid information about preventing shock in injury victims at the National Ag Safety Database.

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HHS Finalizes Controversial Prenatal Care Program 

Reuters Health

Friday, September 27, 2002

WASHINGTON (Reuters Health) - The US Department of Health and Human Services ( news - web sites) (HHS) finalized on Friday a controversial rule defining fetuses and embryos as unborn children for the purpose of providing healthcare coverage to low-income pregnant women.

The rule will allow states to enroll the women in the State Children's Health Insurance Program (SCHIP), a federally funded, state-run insurance program meant to provide coverage for low-income children. States already can cover pregnant women and certain parents under the program by applying for a federal waiver, but the new rule would allow that practice to become a matter of course.

The new regulation would also allow states to provide this benefit to pregnant women regardless of their immigration status. At present, immigrant women cannot be covered using SCHIP funds even under a federal waiver unless the mother has resided in the US for at least 5 years.

"This is a common-sense, compassionate measure to make sure that all children born in this country come into the world as healthy as possible," said HHS Secretary Tommy Thompson in a statement. "It's another way to secure a safety net of care for our children and their mothers."

But the HHS rule, first proposed in January, has outraged women and abortion rights groups.

By ascribing legal rights to embryos, the National Abortion Rights Action League (NARAL) says the Bush administration actually is trying to undermine women's right to choose whether or not to have an abortion.

"We have serious concerns about the regulation because we believe that the best way to provide coverage for every women is through Medicaid or Medicare," added Laurie Rubiner from the National Partnership in an interview with Reuters Health.

The National Partnership, founded in 1971 as the Women's Legal Defense Fund, is one of the nation's most powerful women's advocacy groups.

Under the HHS rule, Rubiner noted that federal coverage would be extended to the fetus but not the mother, leaving her without individual coverage. If the Bush administration truly cared about the health of children, women and immigrants, Rubiner said, it would have provided such coverage earlier under a number of proposed laws, which were opposed by the Bush administration.

"I firmly believe this a backdoor way for the Bush administration to push its agenda to make abortions illegal," Rubiner said. "This is a tremendous insult to American and immigrant women."

Rubiner said the organization would now seek to overturn the HHS rule either through legal or legislative action.

But administration officials adamantly denied that the rule has an underlying purpose.

"This is undisputedly for prenatal care," a HHS spokesman told Reuters Health. "That's all there is to it."

The rule also provides some postpartum care and is not unprecedented, he said. "What's good for the child is obviously good for the mother," he added.

Details of the final HHS rule were not available. A full copy is scheduled for publication in Wednesday's issue of the Federal Register.

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Surgery Beats Balloon for Heart Disease 

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Friday, September 27, 2002

FRIDAY, Sept. 27 (HealthScoutNews) -- Patients who have bypass surgery for blocked coronary arteries are less likely to die and less likely to need a repeat procedure than are those who get angioplasty.

That's the finding of a study that is published in tomorrow's issue of The Lancet.

However, cardiology experts, including one of the investigators from the 53 European and Canadian centers involved in the study, say angioplasty techniques are evolving so rapidly that the results of the study, which enrolled patients from 1996 to 1999, may already be out of date.

Researchers randomly assigned 988 patients with coronary artery disease, average age 61, to either bypass surgery or angioplasty. Angioplasty involves inflating a balloon inside an artery to keep it open, and the procedure for the study also included inserting a stent, which helps keep the vessel open. For the bypass surgery, a healthy vessel was harvested from another part of the body to replace a clogged vessel or vessels around the heart.

After an average of two years of follow-up, about 20 percent of those who had the balloon-and-stent technique needed additional treatment to keep the vessel open, compared to 6 percent of the bypass patients. Only 2 percent of the bypass patients died, compared to 5 percent of the balloon and stent patients, a finding that lead the investigators to call for more research on the apparent reduced mortality of bypass surgery.

However, the researchers note, not all the deaths were caused by cardiac or other vascular causes, the researchers note. Of the 22 balloon patient deaths, 11 were definitely a result of cardiac or vascular causes. Of the eight bypass surgery deaths, five were blamed on cardiac or other vascular causes.

But those patients who underwent the balloon technique did have a lower heart attack rate. Roughly 5 percent of the balloon patients and 8 percent of the surgery patients had heart attacks during the follow-up.

A consortium of stent manufacturers funded the study.

While cardiology experts praise the latest work, many of them -- especially those who work as "interventional cardiologists" and favor less invasive techniques -- say it's not the last word.

"It's a well-done study," says Dr. Jesse Currier, an associate director of the Adult Cardiac Catheterization Laboratory at the University of California at Los Angeles. Although the balloon group needed more repeat interventions than the surgery group did, Currier says the need for repeat procedures with the balloon technique is less than it was years ago, before stents were commonly used.

"The only concern I have for this study is there were more deaths in the angioplasty group," Currier says. Like other experts, he says that result needs more study.

"It shows the gap between angioplasty and stenting is narrowing," Currier says. However, he notes that even if a patient is a good candidate for the balloon procedure, some opt for surgery because they don't want to face the prospect of repeat procedures.

"Most of the time, the need for a repeat angioplasty occurs within six to nine months," Currier says. Bypass grafts typically last a decade or even longer.

In a commentary accompanying the piece, cardiology experts William O'Neill and Cindy Grines from the William Beaumont Hospital in Royal Oak, Mich., note that surgery provides more complete resolution for the clogged vessels, but as the balloon technique continues to improve, "the gap in choices will continue to narrow."

One of the study investigators, Dr. Merril Knudtson, director of interventional cardiology at the University of Calgary, says that while the study overall seems to favor surgery, developments in stents and the balloon technique may soon change the picture.

Newer stents are coated with drugs that are released after the device is in place, reducing the risk of vessel closure, he says.

"The drug-eluting stents seem to have recurrence rates that are in the 5 [percent] to 8 percent range," he says, which would make them comparable to surgery.

What To Do

For more information on angioplasty and stents, visit the American Heart Association. The National Heart, Lung, and Blood Institute has more on coronary heart disease.

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Study: Herpes Drug Prevents Spread  

By Daniel Q. Haney

AP Medical Editor

The Associated Press

Friday, September 27, 2002

SAN DIEGO (AP) - For the first time, a drug widely used to treat genital herpes has been shown to prevent its spread as well, offering a new way of curbing an infection already carried by one in five Americans.

A study released Friday found that a once-daily Valtrex pill cut in half the risk of passing on the infection when taken by people with herpes simplex virus type 2, the primary cause of genital herpes.

Until now, the only advice for avoiding herpes during sex has been to use condoms. While no one knows which is more effective, condoms are clearly not foolproof, since the virus spreads by contact with herpes sores, and condoms may not cover them all.

Dr. Lawrence Corey, the study's director, said the latest research suggests a new use for Valtrex in so-called discordant couples — those in which one partner is infected and one is not. The drug is already widely prescribed to prevent and treat herpes flare-ups.

"If you ask infected people their biggest concern, it's giving this to their loved ones," he said.

Health experts said the study is especially noteworthy because it suggests that other, more serious sexually transmitted ills may also be controlled by treating the carrier.

"It's a very important study, and it opens up the arena of treating discordant couples to prevent sexually transmitted disease," said Dr. Scott Hammer of Columbia University. "This is a nuisance disease, but it lays the groundwork for other, life-threatening diseases, such as HIV ( news - web sites)."

The Centers for Disease Control and Prevention ( news - web sites) estimates that 45 million American teen-agers and adults are infected with the type 2 virus, which is almost always spread during sexual contact. The other herpes simplex virus, type 1, is much more common and causes cold sores. However, it too can cause genital infections if spread through oral-genital contact.

Usually, the type 2 virus causes only mild symptoms or no obvious sores at all. In fact, 90 percent of infected people do not realize they have it. Nevertheless, an unlucky minority suffers recurring painful genital sores.

In the latest study, doctors tested Valtrex — known generically as valacyclovir — on 1,484 couples in which one partner had recurring flare-ups with type 2 herpes and the other was not infected.

Corey, head of virology at the University of Washington in Seattle, presented the results at a meeting in San Diego of the American Society for Microbiology. The study was sponsored by GlaxoSmithKline, which makes Valtrex.

The volunteers were randomly given either daily Valtrex or dummy pills, offered advice on using condoms and then followed for eight months. Two percent of those taking Valtrex passed on the virus to their partners, compared with 4 percent on dummy pills.

The treatment nearly eliminated herpes symptoms in the partners, even if they caught the virus. Just half of 1 percent of those whose infected partners took Valtrex got herpes sores, compared with 2 percent in the comparison group.

"This is the first drug shown to interrupt the transmission of a sexually transmitted disease," Corey said.

Doctors presume that AIDS ( news - web sites) drugs also slow the transmission of HIV, although this has not been proven. A study intended to show this is in the planning stages.

Valtrex is a modified version of acyclovir, the first herpes drug. Another herpes drug, Novartis's Famvir, has not been tested for preventing transmission.

EDITOR'S NOTE: Medical Editor Daniel Q. Haney is a special correspondent for The Associated Press.

On the Net:

Company news release: http://www.gsk.com/index.htm

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Guided Lasers Help Treat Uterine Fibroids 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Friday, September 27, 2002

FRIDAY, Sept. 27 (HealthScoutNews) -- Researchers in the United Kingdom have developed a new method of treating uterine fibroids that actually lets doctors see what they're doing.

The new method, which uses magnetic resonance imaging (MRI) to guide lasers and requires only a local anesthetic, is detailed in the October issue of Human Reproduction.

Although lasers have been used to treat fibroids, the affair was notoriously hit-or-miss, and often caused damage to surrounding tissue, says study author Dr. Wladyslaw Gedroyc, a consultant radiologist and head of the Department of Interventional Magnetic Resonance Imaging at St. Mary's Hospital in London. "Before, you had absolutely no control over what you were doing," Gedroyc says, but MRI lets physicians use lasers with much more precision.

Because lasers are "reasonably accepted" for the destruction of fibroids, the procedure could be in widespread use relatively soon, he says.

Some 25 percent of women suffer from fibroids, which are benign fibrous tumors in the uterus. Some are asymptomatic, but others can cause excessive bleeding and pain, and may result in infertility or miscarriage. When symptoms are problematic, a major recourse has been to remove the uterus with a hysterectomy, a major surgery that many experts feel is excessive.

Less invasive techniques are being developed, but most still require general anesthetic and a hospital stay, the study authors say.

In the new procedure, which has been performed on 66 women between the ages of 34 and 55, the surgeon, using the MRI as a guide, inserts four small needles into the fibroid. Laser fibers inserted into the needles destroy the fibroid with heat. The image turns from blue to green when the temperature reaches the right level, so the doctor knows when to "maximize treatment" in the target area.

The women who had the procedure experienced a mean reduction in fibroid volume of 31 percent after three months, with the range being 13 percent to 78 percent. The 24 women who received one-year follow-up MRI scans had a mean reduction of 41 percent. All but one of the patients had the procedure done on an outpatient basis.

A minority of the women in the study were surveyed for blood loss after the procedure, and all of them reported less blood loss three months later. Of 35 women who completed a survey, 69 percent reported an improvement in symptoms.

Some physicians say the procedure doesn't address the right issues, however.

"They're not addressing the reasons for the condition in the first place," says Dr. Allan Warshowsky, author of Healing Fibroids: A Doctor's Guide to a Natural Cure and director of the Women's Center at the Continuum Center for Health and Healing in New York City.

There are also various limitations, Warshowsky points out, including where the fibroid is located and how large the woman is. "They can't do this through the abdomen in fibroids that are way posterior," Warshowsky says. "Accessibility is probably also related to the woman's abdominal girth."

Because estrogen tends to fuel fibroids, and because fat increases estrogen production, overweight women tend to be particularly prone to fibroids.

What To Do

For more about uterine fibroids, check out The Fibroid Place or the Center for Uterine Fibroids.

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Solar-powered surgery may save lives  

From the Science & Technology Desk
United Press International

Friday, September 27, 2002

 SEDE BOQER, Israel, Sept. 27 (UPI) -- In the future, when doctors tell patients to catch some sun, they may not mean fresh air but concentrated sunlight beams that burn away tumors.

Physicists and physicians in Israel are developing a new technique called "solar surgery" that may not only save lives but also cost 1,000 times less than similar laser procedures.

"The majority of patients are being deprived of minimal risk, minimally invasive laser fiber-optic surgery simply because of the exorbitant price of surgical laser systems," researcher Jeffrey Gordon, a physicist at Ben-Gurion University of the Negev in Sede Boqer, told United Press International. "We may be able to produce a potentially inexpensive simple alternative."

In principle, solar surgery is similar to when children use magnifying glasses to focus sunlight and kill bugs. Gordon and co-inventor Daniel Feuermann have finished a prototype where a reflective parabolic dish 8 inches wide collects and focuses sunlight onto a point, funneling it down an optical fiber to come out as a cone of sunshine from the 1-millimeter-wide tip of a surgeon's tool.

Earth receives about 950 watts of sunlight per square yard. "Inside the laboratory, the beam is close to 12,000 times that," Gordon said.

Experimental tests on raw chicken breasts show these sunlight beams pack effectively as much punch as laser surgery for most purposes.

"The price I know my university paid for its medical laser unit is about $120,000," Gordon explained. "Based on discussions I've had with manufacturers, in large volume production, what we have now could be made for about $1,000."

The researchers are working on amplifying the beam's power density to more than 22,000 suns, or 20 watts per square millimeter, by using better surgical tips for the system. While the 12,000-sun beam is strong enough to operate on human livers, the researchers want the flexibility to work on tougher tissues, since "any idiot can figure out how to make the beam weaker," Gordon said.

Solar surgery's most obvious weakness is any potential absence of sunlight. "This is completely useless for Seattle or London or any place as cloudy as that," Gordon said, and nighttime is out of the question.

Still, laser surgery is often a planned procedure, not an emergency one, and in sun-belt areas there should be operating windows of seven to 10 hours a day for 250 days per year or more, Gordon said. "Yes, the method is constrained to clear midday hours in sun-belt climates, but that represents a significant fraction of this planet," he explained. "Areas like India, Pakistan, the south of China, belts across South America, the southwest United States and all of Australia can benefit."

Nevertheless, solar surgery will not replace laser surgery for all applications. A few surgical techniques rely on the pure colored light that lasers can provide. Also, while laser beams are columns, solar beams are cones that get much weaker over distance. This makes them useless for retinal surgery, where for safety's sake the tip of the surgeon's tool must remain remote.

A medical team at Ben-Gurion University hopes to test the system on liver tumors in live rats in 2003. Mechanical engineer Agami Reddy at Drexel University in Philadelphia says while solar surgery has a lot of potential, at first he predicts it will be "a cheap and convenient way of removing tumors and performing surgery with animals -- cows, or something like that."

Reddy added the solar collector the researchers use could help improve solar power farms, which typically use huge dishes 15 to 50 feet wide to focus sunlight onto small, expensive photovoltaic cells.

"Those have very massive structural frames that require a lot of maintenance," he said. "Instead of one large dish, you could have many small dishes. You could stamp them out like headlights, and they would become very cheap."

The scientists describe their findings in the Sept. 30 issue of Applied Physics Letters.

(Reported by Charles Choi, UPI Science News, in New York.)

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Smallpox Vaccine to Go to Public  

By Laura Meckler

Associated Press Writer

The Associated Press

Friday, September 27, 2002

WASHINGTON (AP) - Moving aggressively to steel the nation against bioterrorism, the Bush administration is preparing to offer the effective but risky smallpox vaccine to every American before an attack ever occurs.

The decision, which goes well beyond earlier thinking, stems from practical and philosophical concerns including the looming war with Iraq and the fact that, for the first time in decades, the government will have enough vaccine on hand to inoculate everyone.

Just three months ago, federal advisers were recommending that only select hospital workers get the smallpox vaccine, maybe 20,000 total. Now Bush administration officials say that eventually, it will be offered to all 280 million Americans. The questions being debated are how fast and under what circumstances, according to three officials involved in the planning.

Experts don't know if the nation will ever be attacked with smallpox, which kills one-third of its victims. Eradicated from nature two decades ago, it is still feared as a bioterror agent. But the vaccine itself carries rare but serious risks, including death, complicating any decision to inoculate people absent a certain risk.

The Bush administration has yet to make final decisions or announce plans for what is called "pre-attack" smallpox vaccination. But administration officials say the consensus is to begin vaccinating those at greatest risk of encountering a highly contagious smallpox patient, such as hospital emergency room workers. That could total a half million people. Then the vaccine would be offered to non-hospital health workers, such as primary care doctors, and to police, firefighters and other emergency workers.

At some point after that, it would be offered to the general public.

"You start with one group and based on their potential risk, you keep expanding," one administration official said Thursday, speaking on condition of anonymity.

But it hasn't been decided how many people will get vaccinated during the first wave of shots, or how long it will take to offer them to everyone.

At issue, officials say, are important details such as who should get the vaccine while it's still an experimental drug, which requires a lengthy procedure to ensure that people understand and accept the risks. One option is to wait until the vaccine is fully licensed by the Food and Drug Administration ( news - web sites) before offering the vaccine widely, which could take a couple of years.

Another unanswered question is liability — how to compensate people injured by the experimental vaccine.

Made from a live virus, the vaccine itself is risky, particularly for people with certain skin diseases and weak immune systems. Studies from the 1960s suggest one or two people per million inoculated will die. About one in 1,000 will face complications, some serious, including a severe skin rash or encephalitis that may kill or cause permanent neurological damage.

Other issues are logistical, such as how states and cities prepare large vaccination clinics and train people to give the shots. Another point: how to deal with people who get sick from the vaccine and the publicity likely to surround such an incident.

Those questions get more complicated as the number of people vaccinated increases.

No matter how these questions are resolved, the administration's direction represents a remarkable shift in thinking in a very short time, say experts both in and out of government. The reasons, they say, are practical, political and philosophical.

Immediately after last fall's anthrax attacks concentrated attention on bioterrorism, mass vaccinations were not considered because there wasn't enough vaccine: only 15.4 million doses in storage with another 40 million on order.

Since then, researchers have determined that by diluting the 15.4 million doses, 75 million people can be inoculated. A drug company found another 86 million doses in its freezer and donated them to the government. And the Department of Health and Human Services ( news - web sites) signed or expanded contracts for 209 million new doses, which should arrive early next year.

The new shipments bring a natural pressure to offer the vaccine. Newspaper editorials and leading voices, including Sen. Bill Frist, R-Tenn., a physician, have argued that people should be allowed to weigh the risks and decide for themselves whether to be vaccinated.

"What if you do have an attack and people die and you had something you could have given them, how do you answer that?" a second administration official said.

On top of that looms possible war with Iraq. All smallpox was supposed to be destroyed except for samples kept in special labs in Atlanta and Moscow, but experts fear that hostile states including Iraq have it.

"We're very worried about Iraq," said Dr. D.A. Henderson, a top HHS bioterrorism adviser. "Why is Saddam Hussein ( news - web sites) pushing ahead with weapons of mass destruction if at some point he is not going to use them? It's certainly got to be a factor in all of this."

Another factor: Officials are realizing how complicated it will be to vaccinate large numbers of people quickly after a smallpox attack. This week, federal officials gave states guidelines for mass vaccinations after an attack; most cities are far from ready.

If there were an attack, mass vaccinations would be significantly easier if many people are already protected. Some argue aggressive vaccinations might even deter an attack.

A decision had been expected by the end of September, but officials now say it's not expected until next month.

On the Net:

Centers for Disease Control and Prevention ( news - web sites) smallpox page: http://www.bt.cdc.gov/Agent/Smallpox/SmallpoxGen.asp

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THURSDAY, SEPTEMBER 26, 2002 

Endometriosis Study Links Ailments  

By Emma Ross

AP Medical Writer

The Associated Press

Thursday, September 26, 2002

Women with endometriosis — a leading cause of infertility in which tissue from the womb lining grows elsewhere in the body — are much more likely to suffer from rheumatoid arthritis, lupus, chronic fatigue syndrome, fibromyalgia and allergies, new research has found.

The study, published this week in the journal Human Reproduction, is the first to document something that has been noticed by many women with the painful disorder.

The researchers urged doctors to look for the other diseases in women when diagnosing endometriosis, which afflicts between 8 percent and 10 percent of women of childbearing age.

The cause of endometriosis, as well as of the other diseases, remains unknown.

The new research suggests an immune system abnormality may underlie all these conditions, said Warren Nothnick, a University of Kansas professor of obstetrics and gynecology who was not connected with the study.

"What is the underlying factor, the commonality, between all of these diseases? If we can find out what the one factor is, or group of factors, we can target that and hopefully come up with a way to treat not only the endometriosis, but also some of the other diseases," Nothnick said.

His own work, as well as that of other scientists, suggests that the malfunctioning of certain immune system chemicals called cytokines may be a common link.

Assuming endometriosis occurs before the other diseases, it may also be possible one day to spare women with endometriosis from developing some of the additional diseases, Nothnick said.

The study, conducted by scientists at the U.S. National Institute of Child Health and Human Development, George Washington University and the Endometriosis Association, involved 3,680 women with endometriosis.

The scientists found that 20 percent of the women had more than one other disease. A third of the women who had other diseases had fibromyalgia or chronic fatigue syndrome, and some of those women also had other autoimmune or hormone diseases.

Chronic fatigue syndrome was more than 100 times more common than among the general U.S. female population.

Hypothyroidism, which involves an underactive thyroid gland and causes mental and physical slowing, was seven times more common.

Fibromyalgia, which is characterized by widespread body pain and tiredness, was twice as common among the women with endometriosis.

Autoimmune inflammatory diseases — systemic lupus, rheumatoid arthritis and multiple sclerosis — also occurred more frequently than normal.

Rates of allergic conditions were higher, too. While allergies occur in 18 percent of U.S. women, they occurred in 61 percent of the women with endometriosis. The rate climbed even higher if the women had additional diseases.

The study also confirmed previous findings that there is typically a 10-year gap between the time women first get the pelvic pain and the diagnosis of endometriosis.

The most common symptom of endometriosis is pain, especially excessive cramps during menstrual periods or pain during or after sex. Infertility occurs in about 30 to 40 percent of women with endometriosis.

Endometrial tissue outside the uterus responds to the menstrual cycle similarly to the way it responds in the uterus. At the end of every cycle, when hormones cause the uterus to shed its endometrial lining, endometrial tissue growing outside the uterus also breaks apart and bleeds.

However, unlike menstrual fluid from the womb, which is flushed from the body during menstrual periods, blood from the misplaced tissue has no place to go. Tissues surrounding the area of endometriosis may become inflamed or swollen.

It is one of the most complex and least understood gynecological diseases and, despite many theories, the cause remains unknown.

One theory is that during menstruation some of the menstrual tissue backs up through the fallopian tubes into the abdomen, where it implants and grows.

On the Net:

Endometriosis Association, http://www.endometriosisassn.org

Endometriosis Research Center, http://www.endocenter.org

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Experts Study Botox as Migraine Remedy 

By Stephen Pincock

Reuters Health

Thursday, September 26, 2002

LONDON (Reuters Health) - Botulinum toxin injections--better known as Botox--might benefit some people with migraine and other headache disorders, according to reports presented at a medical conference this week. But a note of caution was also sounded, as experts said more studies are needed to determine which headache patients might be likely to benefit and why.

Botox, the brand name of a purified form of the toxin that causes the food poisoning botulism, has gained popularity as a way to smooth wrinkles. It is also being investigated for other medical applications and several studies over recent years have reported that people with certain types of headache may also benefit.

At the 14th Migraine Trust International Symposium, Dr. Ninian T. Mathew from the Houston Headache Clinic in Texas said 2 years of experience using the drug in migraine patients with poorly controlled migraines showed it "appears to modify the disorder, reducing the disability and acute medication use."

Benefits lasted an average of 12 weeks and "significant improvements prompted patients to opt for repeat treatments," he reported. Over 2 years, 112 patients received Botox once, 68 twice, 55 three times, 32 four times and 12 five times, he said.

In another presentation, Dr. Keith Edwards from Western New England Headache Center in Bennington, Vermont, reported that he and others had used botulinum toxin to treat 20 patients with chronic daily headaches who responded poorly to medicines. Injections into the neck and face benefited 14 patients, with a significant benefit in headache severity and some reduction in the frequency of the headaches.

"Botox may represent an alternative treatment for chronic daily headaches without the risk of drug abuse, drug-drug interaction, sedative or other systemic toxicity," he said in his presentation.

Also at the meeting, Dr. John Claude Krusz from Anodyne PainCare in Dallas, Texas, reported that he and colleagues used Botox to treat 14 patients with migraine associated with spasm in their neck muscles. Nine patients given injections reported fewer migraines afterward, with a benefit that lasted an average of 12 weeks, while three had no benefit. He concluded that the drug was "quite effective" for reducing migraines originating from neck pain, or cervicogenic migraines.

"Double-blind studies with botulinum toxin, type A, to replicate these open-label observations are definitely warranted," he said.

The chairman of the conference, Professor Peter Goadsby, from University College London, also said there was a need for "double-blind, placebo-controlled" studies--where researcher and patient don't know whether the active drug or an inactive injection is being given.

"People who use Botox say that it works for a distinct group of patients, the problem is that it's not established and the controlled studies really aren't rushing out at us," he said.

"I think that Botox is at a stage where it needs to be studied, not sprayed around. I think if you're going to give neuromuscular poisons to people, you want to have a really clear idea of who you're giving them to and why, and I don't think it's at that point," Goadsby said.

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Stem Cell Rules Spark Complaints  

By Randolph E. Schmid

Associated Press Writer

The Associated Press

Thursday, September 26, 2002

WASHINGTON (AP) - Federal rules limiting research on embryonic stem cells are hampering efforts to find new treatments for conditions ranging from diabetes to spinal cord injuries, a panel of scientists complained.

"The existing restrictions are keeping advances from being realized," Dr. George Daley of the Whitehead Institute at the Massachusetts Institute of Technology ( news - web sites) told the Senate Appropriations subcommittee on labor, health and human services ( news - web sites).

President Bush ( news - web sites), citing ethical considerations, last year limited federal funding for embryonic stem cell research to 78 already existing lines of cells.

But Daley said Wednesday that far fewer cell lines are actually available for study, "perhaps only a handful."

Gaining access to those limited cell lines has been inordinately difficult, several researchers complained, citing costs, problems negotiating agreements with the cells' owners and restrictions imposed by governments of foreign countries, where many of the cells are located.

Responding to the complaints, Dr. Elias Zerhouni, director of the National Institutes of Health ( news - web sites), said his agency is "diligently working with as many sources as we can to make more cell lines available."

Stem cells form very early in an embryo's development and later differentiate into numerous types of cells to form various organs and other parts of the body. Researchers hope to use these cells to repair damaged organs and cure diseases such as diabetes, Parkinson's and Alzheimer's.

Opponents of such research say it is unethical because the 5-day-old embryo dies when the cells are removed.

Research is also under way on stem cells found in adults, but in recent studies at Stanford University adult blood stem cells were unable to transform into other types of tissue cells, raising doubts about their value.

Dr. Curt Civin of Johns Hopkins University told of months of negotiations with the owners of cell lines in India, only to have the Indian government step in and ban export of the cells.

"More than a year after the decision (to allow research) I have yet to receive my first cell line," Civin said.

Daley and Civin urged the NIH to establish a central facility to collect and distribute the cell lines.

Roger Pedersen of Cambridge University in England said the lack of federal support for research on human embryos has delayed the benefits of research to infertile patients and patients with degenerative diseases.

Pedersen noted that he worked for 30 years at the University of California, San Francisco, but moved to England because its government encourages stem cell research.

Sen. Arlen Specter, R-Pa., who said it may be time to consider legislation to ease the restrictions, asked Pedersen if other American scientists were likely to leave the country to continue their work.

"We are working diligently to recruit them," Pedersen replied.

While Zerhouni said his agency is trying to make more cells available to researchers, he contended the research is really in an early stage.

Research in the past year has shown that embryonic stem cells "might someday be used to treat Parkinson's disease ( news - web sites), heart disease and type I diabetes," Zerhouni said.

"These findings are important, but I continue to emphasize that we are at a very early stage. Much more basic research needs to be done."

He said he has named a task force, headed by Dr. James Battey of the National Institute on Deafness, to review the current state of stem cell science and make recommendations for its future direction.

California State Sen. Deborah Ortiz told the panel her state has enacted a law that overrides the federal rules and provides state support for new embryonic stem cell lines. The California law would allow scientists to start new cell lines for their research.

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Vitamins C, E Protect Lungs from Ozone Pollution 

By Charnicia E. Huggins

Reuters Health

Thursday, September 26, 2002

NEW YORK (Reuters Health) - A diet rich in the antioxidant vitamins C and E may protect the lungs of asthmatic children from the effects of ozone pollution, recent study findings suggest.

"Diet appears to be an important cofactor in the respiratory health of children," lead study author Dr. Isabelle Romieu of the National Institute of Public Health in Mexico told Reuters Health.

Her study was conducted to determine if antioxidant supplements could protect asthmatic children from air pollution in the metropolitan area of Mexico City. Previous studies have indicated that children in the area have experienced deterioration in their lung function and increased respiratory problems.

The 158 children involved in the study were randomly divided into one of two groups that received a daily supplement of either vitamins or inactive placebo pills. They were then followed from October 1998 to April 2000.

Overall, the children studied reported getting the recommended daily amount of vitamin C in their diets, but not nearly enough vitamin E.

The investigators found that the vitamin supplements protected the study group from the decreases in forced expiratory flow, the amount of air dispelled from the lungs during a certain time period, and peak expiratory volume, a measure of airway resistance, that were seen among those who received placebo pills.

Their findings are reported in the September 1st issue of the American Journal of Respiratory and Critical Care Medicine.

Although the study group included children with mild, moderate and severe asthma, the effect of the vitamin supplements was mostly seen among those with moderate and severe asthma, the report indicates.

"This may suggest that children with more advanced asthma are more susceptible to the impact of ozone exposure because of a decrease in antioxidant defenses in the lung," the researchers speculate.

In conclusion, "our data suggest that vitamin C and vitamin E supplementation above the minimum dietary requirement in children with asthma with low intake of vitamin E provides some protection against the acute effects of ozone on their lungs," the researchers write.

Therefore, "children with heavy exposure to air pollutants need a higher intake of these vitamins to protect their lungs and therefore should have a diet rich in vitamin C and vitamin E," including citrus fruits and green vegetables, Romieu said.

Source: American Journal of Respiratory and Critical Care Medicine 2002;166:703-709.

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Study: Hepatitis Shots Show Promise  

By Linda A. Johnson

Associated Press Writer

The Associated Press

Thursday, September 26, 2002

An experimental new combination of drugs for hepatitis C cures more patients with fewer side effects than the standard treatment for the potentially deadly, liver-destroying infection, researchers say.

The new treatment could give doctors a more potent weapon against the virus at a time when experts are forecasting a surge in cases of hepatitis C liver damage over the next few years.

The experimental treatment includes weekly injections of Pegasys, a long-acting form of interferon call pegylated interferon. It could be approved for U.S. sale next month. A similar drug, Peg-Intron, went on sale last year. Both are given with daily antiviral pills called ribavirin.

Six months after the 48-week treatment stopped, Pegasys and ribavirin together eliminated all traces of the virus in 56 percent of patients.

That compares with 44 percent for patients receiving what had been the standard treatment: ribavirin and thrice-weekly shots of a shorter-acting interferon. Twenty-nine percent of those in a third group who received Pegasys shots and dummy pills were apparently cured.

"This is one of the first times where we have more than half the people we treat have a good response," said lead researcher Dr. Michael W. Fried, director of liver disease treatment at University of North Carolina-Chapel Hill.

Pegasys, Peg-Intron and regular interferon have common, serious side effects, including fatigue, flu-like symptoms, nausea, irritability, depression and psychiatric problems. Flu symptoms and depression were slightly less common with Pegasys.

A total of 1,121 patients at 81 medical centers worldwide took part in the study, reported in Thursday's issue of the New England Journal of Medicine ( news - web sites). The research was funded by Roche, the Swiss pharmaceutical company that is developing Pegasys and a new brand of ribavirin.

Fried said Pegasys offers a key advantage: After 12 weeks of treatment, doctors can tell which patients it probably will cure. The others can stop the six- to 12-month treatment, sparing themselves serious side effects.

Dr. Lincoln P. Miller, director of infectious disease treatment at University of Medicine and Dentistry of New Jersey in Newark, said more patients will probably be put on pegylated interferon because it is more potent, more predictable, causes fewer side effects and requires fewer self-injections.

Hepatitis C is transmitted through sexual intercourse, the sharing of intravenous needles and accidental needle punctures among medical workers. Transfusions also spread the virus before blood screening started in 1992.

An estimated 4 million Americans have hepatitis C, which rarely is discovered until the person has blood tests for an unrelated reason. By then, the virus often has damaged the liver.

Hepatitis C is the leading cause of liver transplants and kills around 10,000 Americans annually. That toll is expected to triple by 2010.

"What we're looking at is a huge burden of leftover cases from the heydays of I.V. drug abuse and (unscreened) transfusions," said Dr. Caroline Riley, associate medical director of the American Liver Foundation. "We're very pleased to have another drug to use."

Riley and Miller expect even better, safer drugs to be available in several years.

Schering-Plough Corp. makes Peg-Intron. Pegasys and Peg-Intron have slightly different structures, but experts believe they will be equally effective.

On the Net: http://content.nejm.org/

http://www.roche.com

http://www.sch-plough.com

Hepatitis C Foundation: http://www.hepcassoc.org

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Ecstasy's Brain Drain Possibly Wider Than Thought 

By Amy Norton

Reuters Health

Thursday, September 26, 2002

NEW YORK (Reuters Health) - The club drug Ecstasy may damage a broader range of brain cells than most research has suggested, according to a new study in monkeys.

Researchers at Johns Hopkins University found that one round of the drug, designed to simulate what many Ecstasy users take in a night, was toxic to dopamine-producing cells in the brain. Dopamine is a brain chemical that helps regulate mental and emotional functions, as well as movement. This is the first time Ecstasy has been shown to have such dopamine effects in primates.

Previous studies in animals and humans had shown the drug to selectively affect brain cells that carry out the work of serotonin, a chemical involved in mood, memory and other vital functions. Both serotonin-cell loss and memory problems have been found in regular users of Ecstasy, also known as MDMA.

Similarly, monkeys and baboons in the new study showed damage to the serotonin system. But the dopamine effects, which were even more substantial, were "totally unexpected," lead author Dr. George A. Ricaurte told Reuters Health.

He and his colleagues at the Baltimore, Maryland university report the findings in the September 27th issue of Science.

According to the researchers, these findings are particularly concerning because dopamine is vital to movement, and a loss of dopamine brain cells is known to be involved in Parkinson's disease ( news - web sites) and the related movement disorder parkinsonism.

Of course, whether the primate findings extend to humans at all is unknown, Ricaurte pointed out.

"Clearly," he said, "most MDMA users have not developed parkinsonism."

Still, the researcher added, if the drug does have dopamine effects in humans, this raises the possibility that with age and its accompanying, natural dopamine decline, Ecstasy users could face a heightened risk of parkinsonism.

Before this study, only mice had been shown to have dopamine effects after Ecstasy exposure, making mice "an enigma" in the field, Ricaurte said. His team's working hypothesis, he explained, is that the pattern of MDMA exposure in this primate study is behind the dopamine damage.

The animals were given three doses of the drug at 3-hour intervals, in an amount and time frame designed to simulate what often goes on at "raves"--all-night dance parties where Ecstasy use is pervasive.

It may be that taking multiple doses in a night, known as "stacking," is required for dopamine damage to occur, according to Ricaurte, but there's no evidence of that yet.

And whether any dopamine-cell loss would be lasting in humans is also unknown. In this study, primates showed "profound" dopamine-cell loss 2 to 8 weeks after Ecstasy exposure, according to the researchers.

"We were struck by the severity of the dopaminergic injury," Ricaurte said.

To begin to see whether such injury occurs in humans, his team plans to take brain scans of former Ecstasy users to look for signs of dopamine depletion.

In a statement released in response to the study, Dr. Glen R. Hanson, acting director of the US National Institute on Drug Abuse, said the findings "are cause for concern and should serve as a warning to those thinking about using Ecstasy."

Earlier this month, US health officials reported that the number of Americans using Ecstasy went up 25% between 2000 and 2001.

Source: Science 2002;297:2260-2263.

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Researcher Makes Pre-Eclampsia Test  

By Mike Branom

Associated Press Writer

The Associated Press

Thursday, September 26, 2002

LAKE BUENA VISTA, Fla. (AP) - A researcher has developed a test he says can predict early on whether a pregnant women will develop a potentially lethal form of high blood pressure called pre-eclampsia. And he offered evidence that aspirin at bedtime can ward off the condition.

Dr. Ramon C. Hermida, director of the bioengineering and chronobiology laboratories at the University of Vigo in Spain, presented his studies Thursday at an American Heart Association ( news - web sites) conference here on high blood pressure.

Pre-eclampsia, characterized by a sudden increase in blood pressure in late pregnancy, is one of the most dangerous and baffling complications of pregnancy. It can be deadly to the mother and lead to premature births.

The only treatment until now has been to induce delivery of the baby in hopes it can be born before the mother develops seizures, called eclampsia. "Therefore, it is important to focus on prevention," Hermida said.

Hermida said his tolerance-hyperbaric test, or THT, can be used as early as the first trimester of pregnancy. He said it can identify 93 percent of women at high risk for blood pressure complications several months before they develop systems detectable by doctors.

These women can then be given low doses of aspirin at night, starting before the 16th week of pregnancy, he said.

Although Hermida's studies have yet to undergo the scrutiny of peer review and duplicate clinical tests, experts were excited by the findings.

"This has the potential for helping a lot of people and could reduce the risk of pregnancy," said Dr. Dan Jones, associate vice chancellor for health affairs at the University of Mississippi Medical Center.

Worldwide, pre-eclampsia and eclampsia occur in about 10 percent of pregnant women and account for about 12 percent of pregnancy-related deaths, according to the World Health Organization ( news - web sites). The condition is much more common in developing countries.

Blood pressure varies in predictable ways throughout a pregnancy, and also on a daily pattern known as a circadian rhythm. The THT compares the expected variability with a particular woman's blood pressure pattern over a 48-hour period to find those who are consistently outside the expected range.

Hermida said he plans to make the software for the THT available to scientists this fall.

"This is important because if one is in a position to identify that segment of the population which has a higher probability of developing pre-eclampsia, then one is in the position to take precautionary measures," said Dr. Alberto Nasjletti, chair of American Heart Association's High Blood Pressure Research Council.

Earlier studies on aspirin had conflicting results. Hermida said that may be because researchers used lower aspirin doses, started therapy later in pregnancy or gave it at different times of the day.

In his study of 341 pregnant women, some were given 100 milligrams of aspirin at bedtime, upon awakening or during the day. Others were given dummy pills.

The incidence of pre-eclampsia was 14.3 percent in the placebo group, but just 1.7 percent in the aspirin-at-bedtime group. High blood pressure occurred in 30.4 percent of women in the placebo group, but only 6.8 percent in the aspirin-at-bedtime group.

Also, 17.9 percent of women in the placebo group went into labor early, while none of the women taking aspirin at night delivered early.

He said aspirin taken in the morning did not work, he said.

Hermida stressed that women should not take aspirin during pregnancy without a doctor's supervision. He noted that higher doses carry a risk of increased bleeding at delivery.

On the Net:

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

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Beating Heart Bypass May Have Lower Stroke Risk 

Reuters Health

Thursday, September 26, 2002

NEW YORK (Reuters Health) - A type of bypass surgery that eliminates the need to stop a patient's heart appears to have a lower risk of stroke associated with it compared to more traditional bypass surgery, new study findings suggest.

Typically, patients undergoing a bypass surgery are placed on a heart-lung machine and their heart stopped during surgery, but in a newer technique, called "off-pump" bypass surgery, only a portion of the heart is immobilized.

According to a report in the September issue of the journal Annals of Thoracic Surgery, the risk of stroke after bypass surgery appears to be lower with the off-pump technique.

Despite a wide range of improvements made over the years to coronary bypass grafting surgery, there is a persistent stroke rate between 0.8% and 5.2% associated with the procedure, according to lead author Dr. Sotiris C. Stamou of the Washington Hospital Center in Washington, DC and colleagues.

Now, with the advent of the newer "off-pump" technique, experts are curious to learn how the two methods compare with regard to stroke risk.

To investigate, the researchers compared the outcomes of 8,069 traditional bypass surgeries to 2,320 off-pump procedures that took place between 1994 and 2000. All of the operations were conducted at Washington Hospital Center.

In all, 27 patients who underwent the off-pump procedure had a stroke after their surgery compared with 201 patients who underwent traditional surgery in the on-pump group.

After adjusting for various risk factors and doing further statistical analysis, Stamou and colleagues report that patients in the traditional surgery group were nearly twice as likely to have a stroke as those in the off-pump group, although the risk was still low.

"Our study demonstrated an improved clinical outcome and a lower stroke rate after off-pump cardiopulmonary bypass versus on-pump coronary artery bypass grafting," the authors conclude.

The researchers are calling for further studies to confirm their findings.

Source: Annals of Thoracic Surgery 2002;74:394-399.

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Water Curbs Fainting at the Site of Blood 

By Randy Dotinga
HealthScoutNews Reporter

Reuters Health

Thursday, September 26, 2002

THURSDAY, Sept. 26 (HealthScoutNews) -- Worried about feeling woozy the next time you give blood? Drink some water, and make it a double -- two big glasses may be just the thing to keep you from fainting, say two new studies.

Researchers in Germany and Tennessee put healthy subjects in unusual positions that would lead them to eventually faint. Those who drank 16 ounces of water before the test held up better under the physical stress than those who didn't, according to reports released today at the American Heart Association ( news - web sites)'s 56th Annual High Blood Pressure Research Conference in Orlando, Fla.

The findings make sense because water helps blood flow more smoothly to the brain, says Dr. William Norcross, a professor of clinical family medicine at the University of California at San Diego School of Medicine. "Water is effective because it is so easy and quick to absorb," he explains.

Dr. David Robertson, a professor of medicine at Vanderbilt University and co-author of its study, estimated that 150,000 people faint or nearly faint each year after giving blood. He suspects many of them never return to the donor's table.

The problem is simple -- giving blood means you have less in your body, Norcross says: "Your blood volume is diminished, and there's just not enough to get to the brain. The blood pressure drops, and the lights go out. In about one in 20 people, just one unit of blood -- a pint -- is enough to bring this on."

Blood donors are especially likely to faint after standing up, he says. Blood banks try to counteract the fainting risks by screening donors for diseases such as anemia and making sure they relax for a few moments after giving blood, eat some food and juice, and don't get up too quickly.

The German and American researchers decided to investigate the value of water consumption after an earlier Vanderbilt University study showed that people suffering from chronic fainting problems improved after consuming large amounts of water.

In both studies, researchers created tables, similar to hospital beds, that tilt up and down. The subjects were placed on the tables and then tilted until they were at a 60-degree angle to the floor. They were nearly, but not quite, straight up.

Most people cannot remain at the unusual angle more than 45 minutes without passing out, according to Robertson. In the German study, the subjects had an additional stressor. Their legs were placed in "negative pressure" -- a vacuum -- that made fainting more likely by draining blood from their upper bodies.

Some of the subjects drank 16 ounces of water five or 15 minutes before the test, and some did not. In later tests, the two groups were switched.

Researchers tested the blood pressure and heart rate of the subjects, who went to the brink of fainting but were not allowed to actually pass out.

The Vanderbilt research found that subjects who drank water five minutes before could tolerate the test for about seven more minutes -- a total of 40.9 minutes on average -- than those who didn't. The Germans who drank water 15 minutes before lasted five minutes longer than the other subjects before nearly fainting.

The water probably adds a "jolt" of fluid to the bloodstream, adding to its volume and keeping it flowing, Norcross explains. Water is much more rapidly absorbed than some kinds of food and drink.

Drinking less than 16 ounces may not be effective because water doesn't just go into the bloodstream, he says. "It also gets parsed out to cells and the space between cells."

What To Do

For more about fainting, consult the American Heart Association or the National Institute of Neurological Disorders and Stroke.

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Agency Links HIV, Syphilis Outbreak  

By Mark Niesse

Associated Press Writer

The Associated Press

Thursday, September 26, 2002

ATLANTA (AP) - An increase in syphilis infections among gay and bisexual men in New York and elsewhere indicates they may be letting their guard down against sexually transmitted diseases, the government said Thursday.

Syphilis infections more than doubled in New York City last year, mostly among gay and bisexual men, the Centers for Disease Control and Prevention ( news - web sites) said.

"We have a different generation of young gay men — a generation that didn't grow up with all their friends dying of AIDS ( news - web sites)," said New York's health commissioner, Thomas Frieden. "This tells us that risky sexual behavior is on the increase, particularly among men who have sex with men."

The increase suggests the men may be abandoning safe sex practices because life-extending AIDS-treatment drugs are more widely available, the CDC said. The transmission of HIV ( news - web sites), the virus that causes AIDS, is enhanced by sexually transmitted diseases.

"Increased sexual risk-taking might also be related to 'AIDS burnout,' which is associated with years of exposure to prevention messages and long-term efforts to maintain safer sex practices," the CDC said.

New York had 282 cases of syphilis in 2001, up from 117 in 2000, according to city health officials. Ninety-three percent of those cases were among men; of those, 79 percent reported having male sexual partners.

Outbreaks of syphilis among gay men also have been recorded in Seattle, Chicago, San Francisco and Miami since 1997, the CDC said.

The increase in syphilis cases in New York follows record lows recorded in 2000.

Syphilis appears first as a sore, usually on the genitals, then develops as a rash. It can be cured with penicillin, but left untreated it can damage the heart, eyes, brain and other parts of the body.

On the Net:

CDC: http://www.cdc.gov/stopsyphilis

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Implantable Device Offers Pain Relief for Cancer Patients 

HealthScoutNews

Thursday, September 26, 2002

THURSDAY, Sept. 26 (HealthScoutNews) -- People with advanced cancer get greater pain relief and suffer fewer side effects with an implantable device that delivers pain medication directly to the spinal cord than they can with conventional pain management.

That's the conclusion of a new study in the October issue of the Journal of Clinical Oncology.

The study included 202 people with cancer who had severe, refractory pain. It compared an implantable intrathecal drug delivery system (IDDS) -- a small, programmable pump implanted under the skin -- to comprehensive medical management (CMM), which involves standard therapy such as oral pain medication and medical procedures.

The implanted device reduced pain by 52 percent, compared to 39 percent for CMM. Most of the people using the device had sufficient pain relief to allow them to perform normal daily functions, the study says.

Drug toxicity, which is associated with side effects, was 50 percent less with the implanted device, compared to 17 percent less for CMM. Overall, clinical success was achieved in more than 84 percent of the study participants using the device, compared to 71 percent of those receiving CMM, the study says.

About one-third of people with cancer and two-thirds of people with advanced, or metastatic, diseases suffer pain, says the American Cancer Society ( news - web sites). About 15 percent of those people can't get pain relief from oral doses of powerful painkillers called opioids.

These people could benefit from treatment with the IDDS, the researchers say.

More information

Learn more about controlling cancer pain by visiting the National Cancer Institute.

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Teaching Kids Their ABZzzzzs 

HealthScoutNews

Thursday, September 26, 2002

THURSDAY, Sept. 26 (HealthScoutNews) -- The Sandman is getting some help from the U.S. government.

The National Heart, Lung, and Blood Institute (NHLBI) recently launched a new and expanded Web site to educate young children, parents, teachers and doctors about the importance of adequate nighttime sleep for children. The site, called Mission Z, is hosted by the cartoon cat Garfield.

Mission Z features on online mystery for children to solve and has a pillowcase full of other games and downloadable features that offer information about the importance of a good night's sleep.

The site also has resources for parents, teachers and pediatricians that they can use to ensure kids get the sleep they need.

Here's where to go to find Mission Z.

It's part of the NHLBI's five-year educational effort called the "Sleep Well. Do Well. Star Sleeper Campaign." It's promoting the message that children need at least nine hours of sleep each night for their health and safety, and for them to do their best in school and other activities.

"The goal of the campaign and its Web site is to provide fun and engaging experiences that will help children understand that sleep is important. If they adopt this philosophy when they are young, we will have a better chance of protecting them against drowsy driving crashes and other serious accidents when they become adolescents," says Dr. Claude Lenfant, NHLBI director.

More information

The National Sleep Foundation has more on the importance of sleep.

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Aspirin Protects Pregnant Women With Hypertension 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 26, 2002

THURSDAY, Sept. 26 (HealthScoutNews) -- One of the world's most versatile painkillers, now more than 100 years old, may have yet another use.

A low dose of aspirin prevented premature labor in a small study of pregnant women at risk for high blood pressure. The findings were presented today at the American Heart Association ( news - web sites)'s 56th annual High Blood Pressure Research Conference in Orlando, Fla.

The aspirin therapy only worked, however, if given at night and when started before the 16th week of pregnancy. When those conditions were met, women showed reductions in gestational high blood pressure and in complications related to preeclampsia.

Preeclampsia includes swelling, elevated blood pressure and protein in the urine during pregnancy.

The women receiving the aspirin therapy also gave birth to babies an average of nine ounces heavier than women who took a placebo or who took aspirin at different times of the day.

Remarkably, not one delivered prematurely.

"Aspirin had no effect on blood pressure when taken by hypertensives (those with high blood pressure) in the morning. However, blood pressure was significantly reduced when they took it at night," says Ramon C. Hermida, lead author of the study and a professor at the University of Vigo in Vigo, Spain.

Although other studies have looked at aspirin and pre-term labor, this was the first to show that timing matters. This study also used a higher dose of aspirin than previous studies and started the therapy earlier in the pregnancy.

"This would be a remarkable finding if it bears out to be true," says Dr. Ralph Dauterive, head of obstetrics/gynecology at the Ochsner Clinic Foundation in New Orleans.

"Aspirin has been tossed around for years, but there have been no good studies that aspirin decreases the incidence of premature labor. The data has been confusing, and no conclusions have been drawn from them," Dauterive says.

According to the National Heart, Lung, and Blood Institute (NHLBI), 6 percent to 8 percent of all pregnancies in the United States include high blood pressure problems. About 70 percent are first-time pregnancies.

Many women with high blood pressure have few or no problems during pregnancy. In some cases, however, the condition can cause early delivery and low birthweight. In more extreme examples, women can develop preeclampsia, which can affect the placenta as well as the mother's kidney, liver and brain. In some cases, it can be fatal to both mother and baby.

Right now, much of the treatment for these conditions involves watching and waiting. "In obstetrics there's a lot of waiting," Dauterive says. "We wait for the disaster, and then we treat it and get it out of the way. The best thing we do is deliver the baby."

In the new study, the researchers randomly assigned 341 pregnant women into six groups. All the women were at high risk for blood pressure problems because they were overweight, had family or personal histories of gestational high blood pressure or preeclampsia, or had had previous miscarriages.

The groups varied, depending on whether they got 100 milligrams of aspirin or a placebo and at what time of day. All treatment started between 12 and 16 weeks of pregnancy.

"Their approach was to give more than in previous studies and at different times," Dauterive points out. "They went in to answer two questions: Do you need to give more of the drug, and is it the timing which is important? According to the data, the answers were 'yes' and 'yes.'"

In the placebo group, the incidence of preeclampsia was 14.3 percent versus only 1.7 percent in the aspirin group. Almost one-third (30.4 percent) of women in the placebo group experienced gestational hypertension (high blood pressure), compared with only 6.8 percent in the aspirin group. While 17.9 percent of women in the placebo group experienced pre-term labor, none of the women taking aspirin had their babies early.

It's not clear why the aspirin had this effect. Some experts believe the drug could affect prostaglandin synthesis, which, in turn, affects uterine contractions.

"We are digging into why it works," Hermida says. "It may not be one single mechanism but a combination of several different factors, all of which could be relevant."

Scientists already knew that aspirin lasts longer when taken at night because the gastrointestinal system is at relative rest during those hours. The drug's effect on nitric oxide, which is involved in blood pressure regulation, may also be involved.

The new study was a small one and the 0 percent prematurity rate was extremely surprising, Dautervive says.

"It's almost an unreal number, but it may be because they only had 50 patients in the group," he says. "They probably need to let this run a little longer, and get some more numbers and see if the numbers hold out. Then the question is: Does this work in the general population? Should we give aspirin to all first pregnancy patients because that's where the biggest risk of preeclampsia lies."

For the time being, if you're pregnant, don't take aspirin -- or any other medication -- without talking to your physician first. High doses of aspirin can increase the risk of bleeding during delivery.

What To Do

For information on high blood pressure in pregnancy and preeclampsia, visit the National Heart, Lung, and Blood Institute, the Preeclampsia Foundation, or the National Library of Medicine.

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Clearing the Path to a Healthier Heart 

HealthScoutNews

Thursday, September 26, 2002

THURSDAY, Sept. 26 (HealthScoutNews) -- A new medical device that clears arteries in people with heart disease reduces the danger of renegade blood clots and the risk of heart attack and death, says a new study.

The device, called the X-SIZER Catheter System, breaks up blood clots and plaque in diseased arteries. A miniature vacuum on the X-SIZER is then used to remove the arterial debris to prevent it from traveling to other parts of the body.

X-SIZER could prevent thousands of major heart attacks each year in the United States, says Dr. Gregg Stone, director of cardiovascular research at Lenox Hill Hospital in New York City. Stone was lead investigator of the X-TRACT study, the first randomized study of the X-SIZER in the United States.

It included 797 people at 75 U.S. sites. The study found that 25 of 400 people (6.3 percent) died or had a major heart attack within 30 days after angioplasty or stenting with the X-SIZER. In the other group that had angioplasty or stenting without the X-SIZER, 39 of 397 people (9.8 percent) died or had a major heart attack.

Angioplasty and stenting are procedures that open up diseased arteries. Both carry the risk that the blood clot, or fragment of it, will move somewhere else in the body and block another part of the blood vessel system. About 1 million Americans undergo angioplasty or stenting each year.

The X-SIZER is used in a number of countries, but is still considered investigational in the United States.

More information

The American Heart Association has more information on clots.

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'Non-Dippers' Could Be at Risk for Heart Disease 

HealthScoutNews

Thursday, September 26, 2002

THURSDAY, Sept. 26 (HealthScoutNews) -- If your blood pressure doesn't go for a dip while you sleep, you may have a hidden blot clotting problem, says a new report.

The finding was presented today at the American Heart Association ( news - web sites)'s 56th Annual High Blood Pressure Research Conference.

Your blood pressure normally reaches its lowest level while you sleep. However, some people with high blood pressure have little or no blood pressure decline when they sleep, which can increase the risk of heart attack and stroke.

This new study of 741 people with hypertension found that those who don't experience a blood pressure dip while they sleep have higher levels of the clotting factor fibrinogen. That could account for at least part of their increased risk of heart attack and stroke.

Blood pressure monitoring showed that almost half the people in the study were non-dippers. The study also found that, over the course of a year, non-dippers had a 21 mg/dL higher mean fibrinogen value than dippers.

"To my knowledge, the rise in fibrinogen in non-dippers has not been reported before. The results emphasize the importance of adequate blood pressure control throughout the day. Our findings also show that identification of non-dippers is very relevant to prevention of coronary events and death," says study author Ramon C. Hermida, a professor at the University of Vigo, Spain.

He says data from the U.S. National Myocardial Infarction Registry (a heart attack patient database) shows that a 75 mg/dL increase in fibrinogen means an 85 percent increased risk for coronary events and death.

"Even within the range of normal levels, a 75 mg/dL increase in fibrinogen is very relevant to the risk of coronary events and death. This is not just a small change, but a major increase in risk," Hermida says.

His study also confirmed previous findings that fibrinogen levels peak during winter months. That increase matches annual patterns of coronary events and death, which peak during the winter.

More information

The American Heart Association has more on high blood pressure.

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Teen Athletes' Eating Habits 

HealthScoutNews

Thursday, September 26, 2002

(HealthScoutNews) -- Student athletes' tight schedules often cause them to eat junk food or to skip breakfast altogether. Unfortunately, notes St. Peter's Hospital in Helena, Montana, that exposes them to possible dehydration, obesity, or if they miss breakfast, unintended weight loss.

However they mix-and-match their breakfast choices, teens -- especially the most active ones -- should aim to take in something from at least three of the five basic food groups: milk, fruit, grains, meat and vegetables.

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Scientists Grow Teeth in Lab

The Associated Press

Thursday, September 26, 2002

BOSTON — A team of scientists has grown strikingly accurate versions of natural teeth in the laboratory, raising the possibility that dentists can eventually do away with mechanical implants such as dentures, bridges and crowns.

The scientists, based at the Forsyth Institute in Boston, reportedly are the first to coax such a complex tooth structure from a collection of individual cells.

"This is very exciting, and I don't think it's expected," said R. Bruce Donoff, dean of the Harvard School of Dental Medicine.

The Forsyth scientists already have grown batches of very small tooth crowns, and hope the new technique could be used to grow larger, more complete teeth.

Researchers said it would be at least a decade before the technique could be used to help patients.

The Forsyth experiments, which were done using pig cells, demonstrate that dental stem cells -- primordial cells that differentiate into the various structures of the tooth -- readily can be manipulated.

Using a section of pig jaw and removing a molar that had not yet erupted, they ground this tissue into small pieces and then treated it with enzymes to break it down into small patches of cells, according to Conan S. Young, a Forsyth scientist on the project.

These cells then were placed into a soft, porous structure and implanted into rats. They periodically X-rayed the rats to monitor the growth of the small crowns.

The Forsyth experiments are the first to successfully use the stem cells that eventually make enamel -- the substance that gives teeth their distinctive, hard exterior.

Pamela C. Yelick, who led the project, said the scientists must now find a way to coax tooth roots to grow.

The results of the Forsyth experiments will be published in the October issue of the Journal of Dental Research.

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Employment and Prosperity Affect Body Inflation

By Hal R. Varian
The New York Times

Thursday, September 26, 2002

Close to half the American population is estimated to be overweight, a condition that has serious economic consequences because of its impact on labor supply and health care.

Body weight is itself influenced by economic variables, often in complex ways. For much of human history, poorer people were thinner than richer people. Even today, inhabitants of rich countries tend to be heavier than those of poor countries. But within countries, wealthier people often weigh less than others. What causes these differences?

The economic determinants of weight are investigated in "The Growth of Obesity and Technological Change," a recent paper by Darius Lakdawalla and Tomas Philipson (National Bureau of Economic Research Working Paper No. 8,946).

Mr. Lakdawalla and Mr. Philipson argue that there are two distinct economic drivers of body weight: a supply-side effect caused by higher incomes and lower food prices, and a demand-side effect caused by the increasingly sedentary nature of work.

Rich countries tend to have relatively low food prices and more sedentary jobs than do poor countries, making them fatter on average. But within rich countries, everyone faces the same food prices and similar technology, so differences in weight are influenced by other factors, like education and income.

Doctors perennially tell us to eat less and exercise more. But economic factors are working against their advice: food keeps becoming cheaper and work keeps becoming physically easier. It's not surprising that we keep gaining weight, despite our doctors' advice.

There has certainly been a sharp increase in weight over the last century, equivalent to a 30-pound gain for a 6-foot man. Remarkably, this change occurred while the calories available from the food supply declined over much of this period. Only in the last 10 years have the calories per person per day climbed significantly over the level available in 1909.

This suggests that, in aggregate, most of the increase results from too little exercise, not too many calories. Mr. Lakdawalla and Mr. Philipson set out to try to determine just what fraction of the weight gain can be attributed to each factor.

They start with a data set that tracks individual reports on occupation and weight. The Bureau of Labor Statistics rates occupations by how physically strenuous they are, so this allows determining the average amount of exercise associated with each person.

Mr. Lakdawalla and Mr. Philipson were rightly suspicious of the self-reported weight figures in their sample and found another data set with both self-reported and measured weight, which allowed them to estimate actual weight from the self-reported figures. One interesting finding: virtually all women tend to underreport their weight, while only heavier men do; lighter men tend to overreport it.

The next step was to determine how food prices and income affect weight. Income was relatively easy, since it was reported in the original survey. Prices were harder, but the authors solved this with a clever trick. About half the states levy a sales tax on food, while half do not. Hence the relative price of food varies from state to state, and this variation is enough to estimate the impact of price changes on body weight.

Mr. Lakdawalla and Mr. Philipson report a number of findings. More schooling tends to reduce weight, but by a relatively modest amount. Being black or Hispanic tends to increase weight, by a quite significant amount. Being in a sedentary occupation for a year leads to a small increase in weight; but staying in that occupation for 14 years causes a significant increase.

These are all statements about the partial effect of each economic variable, holding the other variables fixed. An increase in schooling tends to increase income, so weight might go up on both accounts. But economists are generally interested in the partial effect of an increase in schooling, holding income fixed. Determining such partial effects requires a model of the behavioral forces that jointly determine the relevant variables.

After a detailed statistical analysis of the data, the authors conclude that about 40 percent of the growth in weight in the last 20 years has been caused by the increased supply of food and 60 percent by the increase in sedentary employment.

As the authors put it: people used to be paid to exercise, since most work involved heavy physical labor. Now we have to pay to exercise, by taking time away from sitting in front of computers and TV's.

Technological change, the main culprit in the fattening of America, may yet save us. Research in weight-control drugs, food and technology is booming, so perhaps scientists will find a way that we can have our cake and eat it, too (a particularly apt metaphor in this context).

Mr. Lakdawalla and Mr. Philipson point out that while their study focuses on the supply of calories, the quality of calories matters as well. The National Health and Nutrition Examination Survey reports that the portion of calories generated by fat consumption actually fell in the 1980's. But the increase in total calories consumed in that period pushed up the total fat intake. Examining the changing composition of calories is a promising avenue for future research.

Let me suggest that it would also be of considerable interest to extend this study to other cultures. My unscientific observations suggest that Europeans — particularly the French — consume a higher proportion of fat in their diets, but they also eat smaller portions and walk much more.

I wonder if the National Bureau of Economic Research would sponsor a trip to Paris to observe at close hand the eating practices of the French. It would be necessary, of course, to spend many hours sitting at cafes observing their daily habits. Yes, this is tough work, but I suspect that some economist would be willing to take up the challenge.

Hal R. Varian is an economics professor and dean of the School of Information Management and Systems at the University of California at Berkeley. E-mail:hal@sims.berkeley.edu

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New AIDS-fighting chemicals identified  

By Charles Q. Choi
UPI Science News
From the Science & Technology Desk
United Press International

Thursday, September 26, 2002

NEW YORK, Sept. 26 (UPI) -- Medical scientists for the first time have identified human proteins that may stifle AIDS by keeping HIV from breeding in the body.

Not only might this help explain why some people infected with HIV can remain healthy for decades, but synthetic versions of this protein also could lead someday to new AIDS-combating treatments.

"This is something that we're studying not just for therapy, but for preventing the infection in the first place," researcher David Ho, director of the Aaron Diamond AIDS Research Center in New York, told United Press International. "They could help improve vaccines."

Sometimes a person infected with HIV can remain healthy for many years without developing AIDS, Ho explained. This group makes up 1 to 2 percent of the 850,000 to 950,000 HIV-infected people in the United States.

Since 1986, scientists have known certain white blood cells in AIDS-free HIV-infected patients secrete biochemicals that somehow prevent HIV from replicating. Despite extensive research, however, the identity of this substance has proven a mystery. Because it comes from the immune cells known as CD8 "killer" T-cells -- which kill infected tissues in the body -- the enigmatic compound was termed CD8 antiviral factor, or CAF.

Possible candidates for CAF have abounded for years. In 1995, "it seemed the mystery was solved" when scientists found proteins that almost fit the bill known as beta-chemokines, Ho said. Although they suppressed HIV to some degree, investigators quickly found beta-chemokines could not explain much of CAF's protective power because they were ineffective against many strains of the virus.

Now investigators have identified proteins that are active against all strains of HIV. Scientists "are already pursuing new therapeutic approaches based on the data," said researcher David Ho, director of the Aaron Diamond AIDS Research Center.

"This discovery is a major step forward in our understanding of how the body fights HIV," lead researcher Linqi Zhang said in a statement. "By understanding how some people's immune systems are able to control HIV infection, we may be able to develop new treatments that take advantage of this phenomenon."

Using sensitive new protein analyzers, Zhang and Ho's team found all AIDS-free HIV-infected patients studied secreted three chemicals that were absent in people developing AIDS. Biochemical experiments and searches of U.S. and European protein databases revealed these chemicals were antibiotics known as alpha-defensins-1, -2 and -3. These germ-killers also attack herpes and flu viruses.

Purified human versions of alpha-defensins reduced HIV replication by 50 to 60 percent, although Ho said it seems you need a minimum of two alpha-defensin types working together to have anti-HIV activity. Synthetic alpha-defensins also reduced HIV activity although they were 10 to 20 times weaker than the natural versions.

Zhang and his colleagues currently are trying to increase their understanding of the HIV-fighting mechanism by which these proteins work -- they do not seem to attack HIV's surface as they do herpes and flu viruses. Because the alpha-defensins are relatively large molecules, they can be cumbersome to use, Ho said.

"We would like to see if we could make a smaller version that would be more powerful, and practically speaking, that would have a better chance of being a therapeutic," Ho said. "This is not going to be the ultimate solution, but it's another weapon we can use in our arsenal against HIV.

Susan Plaeger, chief of the National Institute of Allergy and Infectious Disease's AIDS research branch, found Zhang and Ho's work "exciting, but I don't think it's the absolute answer." Other biochemical factors may also be at work, she said. "I don't know if these molecules are definitely responsible for the activity of CAF. But this is very good work that needs to be followed up. There could definitely be other factors bound up here."

The findings were published online in the September 26 issue of the journal Science.

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Proteins May Provide 'Natural' AIDS Defense 

By Maggie Fox, Health and Science Correspondent

Reuters

Thursday, September 26, 2002

WASHINGTON (Reuters) - AIDS ( news - web sites) researchers said on Thursday they had identified a long sought-after substance that allows a small number of people to naturally live with the AIDS virus for decades without ever getting ill.

They hope they can use the compound, consisting of three proteins called alpha-defensins, to design better drugs to fight the HIV virus ( news - web sites), which infects 40 million people worldwide and has killed 25 million.

"This is not going to be the ultimate solution but it is another weapon we can use in our arsenal against HIV ( news - web sites)," Dr. David Ho of the Aaron Diamond AIDS Research Center at Rockefeller University in New York, who helped lead the study, told reporters in a telephone briefing.

The proteins are made by immune system cells called CD8 T-cells, and help block the activity of the deadly and incurable virus. For 16 years researchers have known that CD8 cells in certain HIV-infected patients were making something unique, but they did not know precisely what it was.

These patients, called long-term non-progressors, can be infected for years and even decades without ever developing the symptoms of AIDS. AIDS specialists have been studying them to find out what is different about their bodies.

Ho, Linqi Zhang and colleagues used a protein chip to identify the three alpha-defensins.

They are not sure yet exactly how the three proteins block the virus, but are doing experiments now to find out.

Other AIDS researchers say Ho's study, published in the journal Science, did not explain the whole story of long-term non-progressors. Their immune system also makes compounds called beta-chemokines, which also help block HIV.

Helps Understanding

But Dr. Robert Siciliano of Johns Hopkins University in Baltimore, a leading HIV researcher, said the study answers many questions.

"It has been unclear what all of the components of this activity, this antiviral activity are, and this helps us understand more about it," he said in a telephone interview.

The Aaron Diamond team said that when they took away the beta-chemokines and the alpha-defensins, the CD8 cells of long-term non-progressors seemed just as vulnerable to HIV as anyone else's.

Long term non-progressors are not immune to HIV. Their CD8 cells cut the activity of HIV by between 40 and 60 percent, and eventually they do start to become ill.

HIV patients now can take a cocktail of drugs called highly active antiretroviral therapy or HAART, which can keep them well for years. But the drugs are not a cure, have serious side-effects, are expensive and eventually the virus infecting each patient mutates so that they do not work as well.

Ho said a protein chip made by Fremont, California-based Ciphergen made the work on CD8 cells possible. Such a "chip" works by identifying the proteins made by a cell, using a mass spectrometer.

"Basically we came at the old question with a new tool," Ho said.

They figured out the weight and part of the structure of the proteins, and looked them up in the library of known proteins.

"We could search the literature and take a pretty good guess that the cluster consisted of alpha defensins 1, 2 and 3," Ho said. These alpha-defensin proteins work in the immune system and are believed to punch holes in the cell membranes of bacteria, killing them.

"They were found principally in one kind of white blood cell called a neutrophil. These cells are responsible for gobbling up bacteria and killing them," Ho said.

Ho stressed that much more work needs to be done.

"We wish to be somewhat cautious. I think it is not entirely clear whether we could take this discovery and turn it into a useful therapy," he said.

The proteins are too large to use as a drug, so it would be better to examine precisely which part of them is doing the work against HIV and develop that as a drug, Ho said.

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WEDNESDAY, SEPTEMBER 25, 2002 

Outpatient Care Spending Soars  

By Theresa Agovino

AP Business Writer

The Associated Press

Wednesday, September 25, 2002

NEW YORK (AP) - Contrary to popular wisdom, high prescription drug prices and baby boomers' use of medicines are not the primary drivers of soaring health care spending, according to a pair of new studies.

Spending on outpatient hospital care soared 16.3 percent last year, the fastest growing component of overall health care spending, according to one of the new studies released by the Center For Studying Health System Change (HSC).

Overall health care spending grew 10 percent — the first double-digit increase in more than a decade, and outpatient spending accounted for 37 percent of that increase.

It was the first time since 1995 that drug costs didn't represent the biggest chunk of the increase, according to the HSC study. According to the Washington, D.C.-based nonprofit research and policy institute, spending on prescription drugs rose 13.8 percent last year, making it the second biggest cost driver. It was the second year in a row that the increase in prescription drug costs shrank from the previous year.

Spending on inpatient hospital care jumped 7.1 percent. Driven by higher prices and increased use, inpatient and outpatient hospital care spending climbed an average of 12 percent, accounting for 51 percent of the overall health care spending increase.

There are signs the rate of increase is slowing, however. For the first six months of this year, overall spending rose 8.8 percent. Hospital outpatient spending continued to be the biggest driver, rising 13.6 percent.

"There is potential for encouragement but I think it is dicey to read too much into six-month numbers," said Paul Ginsburg, president of HSC.

Ginsburg said the decline may represent consumers' decision to limit their use of the health care system now that their employers are asking them to foot more of the bill.

The stabilizing health care landscape also could be contributing to the decrease, Ginsburg said. One reason health care costs soared during the mid-to-late 1990s was the change from plans that limited access to ones that are more flexible as employees balked at the restrictions. The change represented a sharp increase in costs, but now that the switch is largely over so are the dramatic increases.

The study's findings for 2001 also reflect efforts to lower prescription drug costs, Ginsburg said. As those costs soared in the mid-to-late 1990s, insurers encouraged consumers to use generic medicines by forcing them pay more for brand names.

Conversely, there hasn't been as much attention paid to keeping outpatient costs down. Those services are one area where hospitals haven't felt pricing pressure by insurance companies.

"The outpatient meadow is one where hospitals have still been able to make hay," said Uwe Reinhardt, a professor of economics and public affairs at Princeton University. "But that will change. In five years, you won't see that kind of increase."

Experts say the weak economy makes it easier for companies to pass on insurance costs to employees. Already a small number of health plans are beginning to force consumers to pay more if they want to see specific doctors or stay in certain hospitals. Many companies already have passed on rising premiums to employees.

The survey was done over the past few months by examining insurance claims data from Milliman USA, an actuarial firm.

In a separate study, examining data from the U.S. Census Bureau ( news - web sites) and the Centers for Medicare and Medicaid Services, HSC found that the aging population plays a limited role in propelling health care costs.

HSC estimated that in 2001, the aging of the U.S. population contributed less than 10 percent of the total per capita health care spending increase for people under 65. Overall per capita spending rose 8.1 percent.

Annual health spending starts rising rapidly when someone hits age 50 — increasing about $152 a year between 50 and 64. Ginsburg notes this isn't insignificant.

However, he says factors such as new technology and mandated coverage for certain conditions play a bigger role in driving up costs, and need to be considered more seriously in the debate on curbing health spending.

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Run to the Dump with Baby Walkers 

HealthScoutNews

Wednesday, September 25, 2002

(HealthScoutNews) -- Aside from offering no real benefit to children, baby walkers are opposed by the American Academy of Pediatrics (AAP) for reasons including:

  • They send more than 14,000 children to the hospital every year.
  • At least 34 children have died since 1973 because of baby walkers.

The physicians' group says children in baby walkers can:

  • Roll down the stairs -- breaking bones or injuring their heads;
  • Get burned -- by reaching up to a stove, counter top or table and touching a hot cup, pan or, closer to the ground, a radiator, fireplace or space heater;
  • Drown -- by falling into a pool, bathtub, or toilet while in a walker;
  • Be poisoned -- reaching for something high off the floor or something lower, such as poisons stored under the sink or in a cabinet, and
  • Pinch fingers and toes -- by getting them caught, for example, between the walker and a piece of furniture.

The AAP says while walkers do not help children learn to walk sooner than they otherwise would, they do give little ones the ability to zoom around surprisingly quickly.

Sadly, most of the accidents kids have in walkers happen while an adult is watching, the AAP says.

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Storing Veggies Away? Don't Delay 

HealthScoutNews
Wednesday, September 25, 2002

(HealthScoutNews) -- Summer veggies picked straight from the garden can be kept vitamin-rich in your freezer if you follow a few simple rules:

  • Whatever "processing" you intend to do, do it as soon as possible after the veggies are picked.
  • Blanching before freezing stops enzymes from destroying vegetables' vitamins.
  • Remember that frozen veggies lose their "freshness" if not eaten within two months.

Vegetables to be held fresh in your refrigerator should be in a cold-setting, high-humidity environment if they're to retain their taste, fresh appearance and their nutritional value, according to St. Peters Hospital, Helena, MT.

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Fat Cell Metabolism May Change During Menopause 

By Dana Frisch

Reuters Health
Wednesday, September 25, 2002

NEW YORK (Reuters Health) - Women who see the pounds creep on as they get older may be happy to know that the weight gain isn't entirely their fault. Maryland researchers report that during menopause, fat metabolism appears to change and women are more likely to store--and less likely to get rid of--fat.

In their study, Dr. Cynthia Ferrara, assistant professor at the University of Maryland in Baltimore, and colleagues extracted fat tissue from the abdomen and buttocks of 24 women of similar weight and body mass index (BMI). BMI is a measure of weight and height used to gauge obesity.

Twelve women were postmenopausal and 12 were in perimenopause, the several years before and the one-year following the final menstrual period. Women in perimenopause often have irregular menstrual cycles, decreased ovarian function, hormonal changes and fat redistribution.

The researchers found that an enzyme that breaks down fat into its separate components for uptake by fat cells--adipose tissue lipoprotein lipase (AT-LPL)--was more active in postmenopausal women compared with perimenopausal women. The study also showed that postmenopausal women had reduced lipolysis, the process by which stored fat is released from fat cells. In the buttocks, the amount of lipolysis was cut by 75% in postmenopausal women compared with perimenopausal women.

"The lower lipolysis and higher AT-LPL activity in postmenopausal women may predispose them to gain body fat after menopause," according to the report in the September issue of the Journal of Clinical Endocrinology and Metabolism.

The accumulation of body weight and the changes in fat distribution after menopause increases the risk of type 2 diabetes and heart disease, Ferrara told Reuters Health.

"Understanding the mechanisms behind the increases in body weight and body fat distribution are important to our understanding of cardiovascular risk in older women," Ferrara noted.

It is not clear why fat cell metabolism changes at that time, though a number of possible explanations exist. Hormonal changes during menopause, particularly lower levels of estrogen produced by the ovaries, and "factors secreted by the fat cells may also affect LPL activity, and the amount secreted may differ," Ferrara explained.

Despite these seemingly unavoidable changes, Ferrara recommends diet and regular exercise to try to prevent weight gain as women age.

"These lifestyle changes will help maintain body weight, maintain/reduce blood lipid levels, maintain/increase cardiovascular fitness, reduce blood pressure and improve glucose tolerance, all factors known to reduce the risk of cardiovascular disease," Ferrara said.

Source: The Journal of Clinical Endocrinology and Metabolism 2002;87:4166-

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Women Take Bad News Better 

HealthScoutNews

Wednesday, September 25, 2002

WEDNESDAY, Sept. 25 (HealthScoutNews) -- Stressful events such as the death of a loved one or financial problems affect the health of men more than women.

So says a Finnish study in the September/October issue of Psychosomatic Medicine.

The study, which included 2,991 municipal workers (73 percent female, 27 percent male), examined the links between psychosocial factors and health. It looked at four major events: death or serious illness of a family member; being a victim of psychological or sexual violence; severe interpersonal conflict such as divorce; and serious financial problems.

"A large body of research suggests that there is a link between stressful life events and later health problems. We found that all the event categories studied were associated with increased psychological problems and impaired health. The death and serious illness of family members were rated the most severe events," says study author Mika Kivimki, psychology department, University of Helsinki.

The study participants were interviewed in November 1997 about stressful events they'd experienced during the previous year. The researchers used the number of sick days taken from work in 1998 to look for changes in the workers' health.

The results support other findings that stressful events are linked to psychological and physical health problems. The study also reinforces previous research that found men are more affected by such stressful events.

For men, such events, measured by sick days, were associated with psychological problems, increased alcohol abuse and smoking, and subsequent health problems. Stressful events caused psychological problems and increased smoking for women, but not an increase in sick days.

"Analysis of those who had a stressful event showed smaller social support networks for men than women. Social support might help in coping with life events and thus provide a partial explanation for men's higher vulnerability," the study authors write.

More information

The National Institute on Drug Abuse has more on the effects of stress.

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House Dust Mite Extract Used to Treat Asthma 

By Charnicia E. Huggins

Reuters Health

Wednesday, September 25, 2002

NEW YORK (Reuters Health) - An extract from house dust mites can be used to reduce asthma symptoms in children whose asthma is triggered by house dust, Italian researchers report.

The process, known as specific immunotherapy (SIT), involves injecting patients with allergens--small quantities of the proteins they are allergic to--in hopes of causing an alternate immune response to the allergen and so reduce their symptoms. In this case, proteins from the house dust mite--the microscopic critter that is the trigger behind dust allergies--was the allergen used.

This therapy has been used to treat asthma for more than 80 years, yet it is still considered controversial, with recommendations ranging from "cautious acceptance to outright dismissal," the report indicates.

"Our results confirm that SIT is effective in asthmatic children sensitive to mites," according to study author Dr. Massimo Pifferi of the University of Pisa and his colleagues.

They investigated the effectiveness of the allergy shots in a 3-year study of 15 asthmatic children aged 6 to 14 who were allergic to house dust mites. For comparison, the study included 14 similar children who did not receive the therapy.

Those given the allergy shots not only had fewer asthma symptoms over time than their peers, they also used their asthma medications less often, Pifferi and his team report in the September issue of the journal Allergy. The treatment group was also less likely to have allergic symptoms in general.

Finally, children who received the allergy shots experienced no major side effects and did not develop any new allergies, unlike their peers in the comparison group, study findings indicate.

The latter finding "is particularly important since sensitivity to multiple allergens is usually associated with a more severe disease," the researchers note.

Calling the study "interesting," Dr. Wesley Burks of the University of Arkansas for Medical Sciences told Reuters Health that it was different from previously published studies because it focused on patients allergic to house dust mite, rather than patients with a number of different allergies.

The study's "primary drawback," however, is the small number of study participants, according to Burks. Fifteen patients and 14 comparison individuals are "relatively small numbers to truly see the effect, if there is going to be an effect," he said.

Source: Allergy 2002;57:785-790.

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Docs Often Overlook Nutrition Counseling 

HealthScoutNews

Wednesday, September 25, 2002

WEDNESDAY Sept. 25 (HealthScoutNews) -- Nutrition counseling is an important ingredient in the health of high-risk patients, yet many of them don't receive it and their health suffers as a result.

That's the conclusion of a study in the October issue of the American Journal of Preventive Medicine.

"The need for nutrition counseling is pressing in light of the epidemic of chronic diseases such as hypertension, diabetes mellitus, obesity and hyperlipidemia (excessive fat content in the blood)," says study author Dr. Charles B. Eaton, of Brown Medical School and the Center for Primary Care and Prevention at Memorial Hospital of Rhode Island.

Eaton says diet changes can reduce the risk of death and illness. An estimated 300,000 to 800,000 deaths every year are the result of nutrition-related diseases such as heart disease, high blood pressure, stroke, obesity and diabetes.

For this study, research nurses observed 3,475 patient visits to 138 Ohio doctors. The nurses administered a questionnaire to the patients after the doctor visit.

About a quarter of the patients said they received nutrition counseling during the doctor visit. Patients with an acute illness were less likely to receive nutrition counseling (17 percent), compared to patients with chronic diseases (30 percent).

The study notes that the number of people with chronic diseases who received nutrition counseling falls short of the Healthy People 2010 national nutritional objectives, which recommend that nutrition counseling be done in 75 percent of doctor visits where people have hyperlipidemia, cardiovascular disease and diabetes.

The researchers also found doctors spent an average of less than a minute on nutrition counseling with their patients. That suggests "that more in-depth nutrition counseling visits will need to occur outside a typical primary-care office visit," Eaton says.

That could be done by registered dieticians or by training physicians to offer their patients tailored nutrition messages, supplemented with written educational materials.

More information

The New York Online Access to Health has a complete guide to nutrition.

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Clot-Preventing Drug Beats Aspirin in Heart Study

By Amy Norton

Reuters Health

Wednesday, September 25, 2002

NEW YORK (Reuters Health) - The clot-fighting drug warfarin, alone or combined with aspirin, may work better than aspirin alone in preventing further cardiac problems after a heart attack, new study findings suggest.

However, researchers also found the drug carries a higher risk of major bleeding than aspirin does--although relatively few of the more than 3,600 patients overall had serious bleeding episodes.

So despite the higher bleeding risk, "the cost-benefit is still in favor of warfarin treatment or the combined therapy," lead study author Dr. Mette Hurlen told Reuters Health.

Hurlen, of Ulleval University Hospital in Oslo, Norway, and his colleagues report the findings in the September 26th issue of The New England Journal of Medicine ( news - web sites).

Warfarin belongs to a class of drugs known as anticoagulants, meaning they help prevent blood clots from forming or growing larger, thereby cutting the risk of heart attack and the type of stroke caused by artery blockages. Some studies have suggested that warfarin bests aspirin in preventing repeat heart attacks, but others have found no difference. Aspirin, which works by keeping blood platelets from sticking together, is the more widely used drug--and by far the cheaper.

In their study, the researchers randomly assigned heart attack patients to take either warfarin, aspirin, or both drugs for an average of 4 years. By the end, 20% of patients on aspirin alone had died or suffered a heart attack or stroke, compared with less than 17% of warfarin patients and 15% of those on both drugs. They calculate that patients on the drug combo were 29% less likely to have a heart attack or stroke or to die than aspirin patients were.

Because aspirin and warfarin hinder the blood's ability to clot, abnormal bleeding is a concern in using them. In this study, warfarin patients were more likely to have major "bleeds," such as bleeding in the brain or gastrointestinal tract. But there were relatively few of these dangerous side effects, occurring in about 0.6% of warfarin patients and less than 0.2% of aspirin patients each year.

Minor bleeding, such as nosebleeds, was most common in patients on the drug combo, the report indicates.

Based on these findings, Hurlen said he thinks warfarin should be considered for all heart attack survivors younger than 75 who have no contraindications to the drug.

According to an accompanying editorial, antiplatelet therapy such as aspirin "will remain the standard of care" for preventing second heart attacks and stroke in most countries.

However, the current findings "must not be overlooked," writes Dr. Richard C. Becker of the University of Massachusetts Medical School in Worcester.

According to Becker, anticoagulant therapy "should be strongly considered" for certain at-risk patients, including, possibly, those suspected of having aspirin resistance.

Becker has received funds from the drug companies Daiichi Pharmaceuticals, Merck and Aventis. Warfarin is sold as Coumadin by Bristol-Myers Squibb.

Source: The New England Journal of Medicine 2002;347:969-974, 1019-1021.

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Vitamin B3 Helps Beat Back Alzheimer's Disease 

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 25, 2002

WEDNESDAY, Sept. 25 (HealthScoutNews) -- A team of scientists in South Dakota has found that a common vitamin can offer some protection against the effects of Alzheimer's disease ( news - web sites) on brain cells.

Past research has shown that vitamin E and ginkgo biloba are promising for the treatment of Alzheimer's, which affects an estimated 4 million people nationwide. However, these findings suggest a form of vitamin B3 is just as useful in battling the degenerative effects of the disease.

The research, due to be published later this year in Neurotoxicity Research, was performed on live brain cells cultured by the scientists at South Dakota State University's College of Pharmacy. The cells were the same type as those found in the front part of the brain, where a portion of the memory function resides.

In the experiment, the researchers exposed the brain cells to a chemical that kills cells in a similar manner to Alzheimer's disease. When they first exposed the cells to nicotinamide, a form of Vitamin B3, the cells didn't deteriorate as quickly once the toxin was introduced.

"It probably is preventing brain cells from dying," says lead author Suman Mukherjee. "Other researchers also think that this agent has promise. But we are still a long way from establishing it as the most promising one."

Mukherjee's methods represent one of the two main branches of Alzheimer's research, explains Marilyn Albert, a Harvard University professor and chairwoman of the medical and science advisory board for the Alzheimer's Association.

The first avenue, largely funded by drug companies, takes aim at the protein amyloid, which is overproduced in the brains of Alzheimer's patients, creating a plaque that kills brain cells. Reducing amyloid in the brain would cure Alzheimer's, but doing so is very complex, Albert says.

So, a second line of research, funded by about $600 million a year in federal money, aims to find a treatment for amyloid buildup. Instead of eliminating the natural protein, scientists have sought to prevent it from producing toxic plaques, she says. Mukherjee's treatment falls into this group.

"People are following every lead they can," Albert says. "There's a general consensus that amyloid is the culprit. But getting to it has proven difficult."

For the South Dakota researchers, one of the biggest challenges of the study was growing the brain cells in the first place. It took about six months for them to learn how to grow cortical neurons, Mukherjee says.

"Human brain cells are very difficult to grow. By nature, they're resistant to duplicating. We have to feed them and coax them into dividing," he says. "Brain tumor cells are easier to grow, but Alzheimer's patients most likely do not have brain tumors."

In his past research, Mukherjee says he showed his vitamin B3 derivative could prevent natural cell death in the brains of mice by boosting cellular energy. In future research, he hopes to combine the chemical with an antioxidant, which would neutralize the oxidizing of brain cells that leads to cell death. Such a combination could be a new development in the treatment of Alzheimer's, he says.

"Those methods have been used against cancer, but they haven't been tried much in the brain," Mukherjee says.

What To Do

For a fact sheet on Alzheimer's, visit the National Institute of Aging. To find an Alzheimer's disease center near you, see the Alzheimer's Disease Education and Referral Center.

Or to learn more about Alzheimer's, visit the Alzheimer's Association.

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Blood Transfusion Problem Kills Hundreds Each Year 

Reuters

Wednesday, September 25, 2002

LONDON (Reuters) - Hundreds of people are dying each year from a blood transfusion problem that could be prevented, New Scientist magazine said on Wednesday.

Transmission-related acute lung injury (TRALI) occurs when people have an adverse immune reaction triggered by antibodies in donor blood.

TRALI, which scientists suspect is caused by donor blood from people who have been exposed to a variety of blood groups, causes a mild reaction in most people and is generally thought to result in only a handful of deaths.

But a California blood bank, Bloodsource, estimates that TRALI occurs in one in 5,000 transfusions each year in the United States alone and causes about 500 deaths.

"That makes it a bigger problem for blood banks than high-profile diseases like HIV ( news - web sites)," the magazine said, referring to the virus that causes AIDS ( news - web sites).

Shortness of breath is the first symptom, but this can also be a normal reaction when blood is transfused too quickly. Blood pressure readings can distinguish TRALI from a normal reaction because people with the problem have low pressure, according to the magazine.

One way to prevent TRALI would be to screen high-risk donors exposed to multiple blood groups such as people who have had several transfusions or women who have had three or more children. But researchers believe this would do more harm than good because of the shortage of blood donors.

Another option would be to carry out costly tests to screen for blood products that contain high amounts of plasma from high-risk donors.

The US Food and Drug Administration ( news - web sites) is calling for more research into TRALI and the problem will also be discussed at the annual meeting of the American Association of Blood Banks next month, the magazine added.

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A Rare Find Concerning Cell Death 

HealthScoutNews

Wednesday, September 25, 2002

WEDNESDAY, Sept. 25 (HealthScoutNews) -- An extremely rare genetic disorder has provided researchers with new knowledge about the human immune system and ways of fighting infection, says a study in tomorrow's issue of Nature.

Only two children, a brother and a sister, have the genetic condition. Through them, scientists at the National Institute of Allergy and Infectious Diseases ( news - web sites) (NIAID) and colleagues discovered something about the human immune system that applies to everyone.

They found that an enzyme, caspase-8, which helps trigger cell death, also helps activate immune system cells to fight infections. Their finding could help develop new drugs to treat immune system disorders.

"Previously, no one had ever shown that caspase-8 played this other role," says senior study author Dr. Michael Lenardo, of NIAID's immunology laboratory.

"Caspase-8 deficiencies might explain why some people don't respond as well as others to vaccines, or why some people's immune systems don't fight off infections as well as others. Caspase-8 might be a useful target for a new class of anti-inflammatory or immunosuppressive therapies," Lenardo says.

The NIAIDS scientists made their discovery after being called to examine a brother and sister with a puzzling immune system disorder. They suffered from recurrent viral infections and didn't respond well to vaccines.

"These kids were very sick, and their doctors were stymied about the cause of their illness and how to treat it," Lenardo says.

It took several years for the NIAIDS scientists to find that the children's problems were linked to a lack of caspase-8.

More information

The National Institute of Allergy and Infectious Diseases has more on the human immune system.

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Gene Mutations Tied to Kidney Stones, Osteoporosis 

Reuters Health

Wednesday, September 25, 2002

NEW YORK (Reuters Health) - French researchers have identified mutations in a certain gene that may predispose a person to kidney stones or the brittle-bone disease osteoporosis.

Doctors have observed that both conditions sometimes run in the same families. They have also known that people with either kidney stones or osteoporosis may have abnormally low levels of phosphate in their blood.

The kidneys, which filter the blood, are responsible for controlling phosphate levels. Phosphate that is not absorbed by the kidneys and delivered into the bloodstream is instead excreted in the urine, thus depleting the body's supply of the mineral, which is abundant in most foods.

In the new study, published in the September 26th issue of The New England Journal of Medicine ( news - web sites), researchers who analyzed the genes of people with either kidney stones or osteoporosis reported that a gene that codes for the type 2a sodium-phosphate cotransporter (NPT2a) appears to play an important role in this process.

Mutations in the gene can lead to low concentrations of phosphate in the blood, which may then contribute to kidney stones or osteoporosis, conclude Dr. Dominique Prie of the Hopital Bichat in Paris and colleagues.

Exactly how this happens, though, is not clear. But it is known that phosphate is important for strong bones. And in a complex chain of events, low phosphate levels in the blood may contribute to high concentrations of calcium in the kidneys, resulting in stones, they suggest.

Since animal studies had pointed to the NPT2a gene as a key factor in some cases of these conditions, the researchers studied the gene in 20 patients, 14 with kidney stones and 6 with osteoporosis. All had low blood levels of phosphate.

The investigators found that two study participants, a 34-year-old man with kidney stones and a 64-year-old woman with low bone mass, had mutations in the NPT2a gene.

In addition, the woman's only daughter, who had a spinal deformity, a history of arm fractures and low phosphate levels in her blood, also had the mutation, according to the report.

In lab testing, the researchers confirmed that the mutated genes functioned abnormally when they were expressed in frog eggs.

"This work is important because it links the extensive literature on animal and cellular models of NPT2a to human physiology," writes Dr. Henry Kronenberg, chief of the endocrine unit at Massachusetts General Hospital in Boston, in an editorial accompanying the study. "Furthermore, it shows that mutations in NPT2a can contribute to (kidney stones) and low bone mass in humans."

Source: The New England Journal of Medicine 2002;347:983-991, 1022-1024.

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Sugared Soft Drinks Make You Softer in Middle 

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 25, 2002

WEDNESDAY, Sept. 25 (HealthScoutNews) -- If you're addicted to sodas, you might want to switch to artificially sweetened ones to avoid gaining weight.

So say Danish scientists who conducted a study of 41 overweight, middle-aged people for 10 weeks, asking them to add sweet drinks to their regular diet. Half the participants were given sucrose-sweetened drinks and half were given drinks sweetened with artificial sweetener. Participants were not told which type of beverage they were drinking.

Those whose drinks were sugar-sweetened gained an average of three pounds, while those who drank diet drinks lost a little more than two pounds on average.

"We were astounded that these soft drinks could change weight that much. We didn't expect soft drinks to have this fattening effect," says Dr. Arne Astrup, a nutrition professor in Copenhagen and an author of the study, which appears in the October issue of the American Journal of Clinical Nutrition ( news - web sites).

Astrup says that, normally, when you introduce more calories into a diet, people automatically compensate by reducing their calorie intake in other areas so they don't gain any weight. Such internal regulation comes as the stomach sends signals to the brain when the body is satiated.

However, this did not happen when people drank the sweetened drinks, which totaled at least a liter a day.

"It is possible that if it's a drink, it will simply pass through the stomach and go into the small intestine so a person doesn't feel full from the calories," he says. People continue to eat or drink more than they need, and gain weight.

The study's findings, he says, have changed his mind about what should be emphasized in a weight-loss program. Astrup treats overweight people as the director of the nutrition at the Royal Veterinary and Agricultural University in Copenhagen.

"If you asked me two years ago about the problems of losing weight, I would've said that sugar isn't the bad guy, that you should concentrate on fat reduction alone. But now I've totally changed my mind. I'm convinced that soft drinks are a major issue," he says. "I have patients who drink three or four liters of Coke a day because they think that because it has no fat they can have as much as they want. Now I tell them they may have a problem and that if they have to have soda, it should be artificially sweetened."

Further, he adds, "There has been an explosion in the consumption of soft drinks, and this could be a significant factor in the increase in obesity."

Connie Diekman, director of nutrition at Washington University in St. Louis, says the study, though small, is interesting and helpful.

"Ten weeks isn't a lifetime and 40 people is a small number, but there has been a concern about sweetened beverages, and this study is significant," she says. "It is one more study to put on my list to show that beverages as a source of calories don't give us the same satisfaction as solid food."

"It takes about 20 minutes of eating for the stomach to tell the brain that it's full," she adds, "and when we're looking at calorie control, we ought to think about spending calories on foods that take longer to consume and allow our bodies to feel the satisfaction from food."

Another finding in the study was that the participants who drank the sucrose drinks had a significant increase in blood pressure, an average increase of between 5 percent and 10 percent during the course of the study, Astrup says.

"It may be that sugar stimulates the sympathetic nervous system," he says, which is the body's high alert system to deal with stress or danger.

What To Do

To see a chart of the components of common soft drinks, both regular and diet, you can go to the National Soft Drink Association. The Physicians Committee for Responsible Medicine rates the top weight-loss books on the market.

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Device Safely Removes Clot During Stent Placement 

Reuters Health

Wednesday, September 25, 2002

NEW YORK (Reuters Health) - A catheter-plus-vacuum device under investigation appears to safely remove clots from blood vessels in patients undergoing angioplasty to restore blood flow to the heart after a heart attack.

Dr. Gregg Stone, director of cardiovascular research at Lenox Hill Hospital in New York, presented results of the multicenter X-TRACT study of 797 patients undergoing angioplasty with or without stent placement to attendees of the annual Transcatheter Cardiovascular Therapeutics meeting, which is under way in Washington, DC.

In angioplasty, a balloon-tipped catheter is inserted into the artery and then expanded to flatten fatty blockages against the artery wall and allow the blood to flow through freely. Oftentimes, a metal tube called a stent is inserted to prop the artery open.

Patients were randomly assigned to have clot removal using the X-SIZER Catheter System or angioplasty alone (the "control" group). The device is made by ev3 Inc., formerly EndiCOR Medical.

The X-SIZER consists of a metal-tipped catheter that breaks up the clot and a vacuum extractor that removes it from the cardiovascular system.

Within 30 days of surgery, 25 of 400 patients (6.3%) undergoing clot removal suffered a recurrent heart attack or death, compared with 39 of 397 control patients (9.8%).

No patients have suffered embolization, or blockage of a blood vessel with a clot, during the procedure, Stone told Reuters Health. While the large clot causing the heart attack is reduced, small clots may still develop, which have not proven to be clinically relevant to date, he commented.

"The purpose of the X-SIZER was to make stenting safer," Stone explained. Clinical trials have established the safety of the device and investigators are optimistic of its approval in the US. The device is already approved for use in Europe, where it is widely used, Stone said.

"My guess is if (the Food and Drug Administration ( news - web sites)) is happy, we should get approval in 6 to 12 months," Stone added.

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Guidelines on Clot-Busters for Stroke Often Ignored 

By Keith Mulvihill

Reuters Health

Wednesday, September 25, 2002

NEW YORK (Reuters Health) - Stroke patients whose doctors deviate from recommended guidelines in giving them clot-busting drugs may have an increased risk of bleeding and death, study findings show.

Currently, experts recommend that thrombolytic, or clot-busting, therapy be started within 3 hours after the most common type of stroke, an ischemic stroke, which occurs when blood flow in the brain is blocked by a clot or narrowed artery.

But clot-busters can be deadly for patients who suffer a hemorrhagic stroke, which is caused by bleeding in the brain.

While a considerable amount of work has gone into clinical studies to establish the best way to give thrombolytic therapies to stroke patients, little study has been done on whether hospitals and doctors are actually following recommended procedures, according to the report in the September 23rd issue of the Archives of Internal Medicine ( news - web sites).

To investigate, lead author Dr. Dawn M. Bravata of the Yale University School of Medicine in New Haven and colleagues evaluated the medical records of 63 patients who received thrombolytic therapy between 1996 and 1998. The patients were treated at 16 different Connecticut hospitals.

"Protocol deviations occurred commonly when thrombolytic therapy was given to stroke patients in routine clinical practice," Bravata told Reuters Health.

"In this study, 67% of community-based patients had a major protocol deviation," she said.

Patients who received thrombolysis with major protocol deviations had a higher risk of dying (31% versus 13%) and serious bleeding (17% versus 2%) than patients in the landmark National Institute of Neurological Disorders and Stroke tPA Study (NINDS), which was used to help identify guidelines for optimal thrombolytic therapy, Bravata noted.

"Community-based patients without major protocol deviations, however, had outcomes similar to results from the NINDS trial," she said.

According to Bravata, the major protocol deviations that her team found were as follows: 35% of patients were given the incorrect dose of the medication; 22% of patients received the medication more than 3 hours after the start of the stroke symptoms; 10% of patients had a history of bleeding troubles; 8% of patients had evidence of active internal bleeding; 5% of patients had very high blood pressure; 3% of patients had a history of head injury within the past 3 months; 2% of patients hada history of a previous stroke within the past 3 months; and 2% of patients had a history of intracranial bleeding.

"The consequences of these major protocol deviations were the increased risk of dying and bleeding," added Bravata.

"Since the patients who were treated without major protocol deviations did not have any increased risk of adverse events, our research findings demonstrate the importance of strict adherence to the American Heart Association ( news - web sites) Guidelines for Thrombolytic Therapy for Acute Stroke," Bravata told Reuters Health.

"Hospitals need to establish systems that ensure strict adherence to these guidelines," she added.

Source: Archives of Internal Medicine 2002;162:1994-2001.

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Beta-blockers Underused in Heart Treatment 

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 25, 2002

WEDNESDAY, Sept. 25 (HealthScoutNews) -- A class of drugs proven to reduce the symptoms of heart failure is vastly under-prescribed by doctors, says a new survey.

Only 38 percent of heart failure patients who could benefit from the use of beta-blockers are getting them from their doctors, although 87 percent of the physicians know the drugs to be effective, the survey of 400 doctors in Pennsylvania found.

The results are part of an ongoing program called The Heart Failure Report Card, being conducted by the Jefferson Medical College of Thomas Jefferson University in Philadelphia and the University of Pittsburgh Medical Center (UPMC). A report on the survey is to be delivered today at the annual meeting of the Heart Failure Society of America in Boca Raton, Fla.

Thirty-four percent of the doctors surveyed were cardiologists, while the rest were internists and family doctors. Only 38 percent of their patients were receiving beta-blockers in conjunction with other medications to treat their heart failure. This is despite studies that have shown beta-blockers are effective in treating the condition.

This could be partly due to the specialty of the doctor, says Dr. Kenneth A. Brown, a cardiologist at the University of Vermont College of Medicine. Cardiologists might be more likely to prescribe them than internists or family practitioners. However, the survey didn't break down the prescriptions by medical specialty.

"If it's true that other specialties are under-prescribing the beta-blockers, they should re-evaluate their criteria because there is an established, clear benefit to their use," he says.

The rest of the survey, which asked doctors to rate the how well heart failure is being diagnosed and treated, paints a dim picture. Using a report card format to register their opinions, doctors' gave a "C" as to patient satisfaction with the efficacy of their medications and their quality of life, a "C-" to patients' compliance with medications, and a "D+" to the patients' compliance with lifestyle changes and understanding the seriousness of heart failure.

A second survey was conducted of 759 heart failure patients to assess their level of knowledge of their disease.

Over half of the patients did not understand what heart failure was when they were diagnosed, and even after diagnosis, more than one-third were still unable to clearly define the disease. Forty-six percent of them reported that their heart failure reduced their ability to lead a normal life. Sixty-one percent, however, did know their illness was related to another disease.

In addition, 27 percent reported that their doctors did not give them information about their heart failure, and 40 percent used magazines and newspapers to gather information about their disease.

Heart failure is an overall weakening of the heart so that it doesn't pump blood efficiently throughout the body, causing fatigue, shortness of breath and ankle and foot swelling. It usually ensues as a result of another health condition like a heart attack or high blood pressure, according to the National Institutes of Health ( news - web sites) (NIH).

The death rate from heart failure rose by 64 percent from 1970 to 1990, primarily due its prevalence in our aging population. It is the only major cardiovascular disease that is increasing in the population. Approximately 2 million Americans have heart failure, and 400,000 new cases are diagnosed each year, according to NIH.

A third survey in the Heart Failure Report Card consisted of telephone interviews with 1,000 adult Americans, chosen to represent a cross-section of the population. Nearly half of those interviewed, 47 percent, were unable to clearly define what heart failure was, 89 percent thought you could live a normal life with the disease, and over 90 percent of those interviewed believed that heart failure could be successfully managed by regular exercise, not smoking, changing diet and losing weight.

The researchers concluded the key to more successful treatment of heart failure is more knowledge.

"There is clearly a need for further education for heart failure patients regarding their disease and its treatments, and we need to also educate the physician as well as the patient. Patients need to realize they can improve the quality of their lives after diagnosis. It is not a death sentence," says Virginia Schneider, a research coordinator at University of Pittsburgh Medical Center and co-author of the survey.

What To Do

A thorough explanation of heart failure can be found at the National Institutes of Health. For further information about the survey and how to learn more about heart failure, go to the Heart Failure Report Card.

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Consumers Worry About Future Health Costs-Survey 

By Karen Pallarito

Reuters Health

Wednesday, September 25, 2002

NEW YORK (Reuters Health) - Americans are very pleased with the healthcare they receive in the United States, but they are getting jittery about the cost of that care, including insurance and prescription drugs, a new survey finds.

Thirty-eight percent said they are not happy with the cost of their health insurance, and 44% are not satisfied with their out-of-pocket costs, the Employee Benefits Research Institute (EBRI), a nonpartisan research organization, reported on Wednesday. Those numbers are up from 32% and 37%, respectively, in 1998.

The percentage of respondents identifying healthcare as a critical issue for the nation also increased--from 14% in 1998 to 19% in the current survey. In the minds of many Americans, healthcare ranks second only to terrorism and national security as a national concern.

The fifth annual Health Confidence Survey by EBRI and Mathew Greenwald & Associates, examined a broad spectrum of health-related issues. The findings reflect 20-minute telephone interviews with a cross-section of 1,000 adults conducted between April and May of this year.

EBRI released its findings in anticipation of the US Census Bureau ( news - web sites)'s annual report this Friday on the number of Americans lacking health insurance coverage.

Given the plethora of news reports about rising healthcare costs and peoples' dissatisfaction with various aspects of the health system, "we would have maybe expected more declines in satisfaction and confidence," said Rachel Christensen, a research analyst with EBRI in Washington.

But 44% of Americans said they are "extremely" or "very" satisfied with the healthcare they have received in the past two years, and that percentage has changed little in the survey's history.

Most people are pretty healthy and aren't having problems with their health insurance, Christensen said, so satisfaction numbers remain relatively static. "However, there is a decrease in satisfaction with cost," particularly as people look ahead a decade or anticipate becoming eligible for Medicare, she noted.

Less than half (39%) of Americans, for example, are "extremely" or "very" confident they can currently afford prescription medications without financial hardship--and even fewer are confident about paying for medications in the future.

Looking ahead 10 years, only one in four individuals (24%) express the same level of confidence about paying for prescriptions. Thirty-six percent are not confident.

Only 17% are very confident about paying for medications once they become eligible for Medicare, while 44% are not confident at all.

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Extended-Wear Contacts Cut Infection Risk 

By Kathleen Doheny
HealthScoutNews Reporter

Wednesday, September 25, 2002

WEDNESDAY, Sept. 25 (HealthScoutNews) -- Extended-wear contact lenses, out of favor with eye doctors since the late '80s because of problems with dangerous eye infections, should now be seen in a new light, new research claims.

The worries about infections are gone, says a contact lens expert who reported his research on the new lenses yesterday at the Research to Prevent Blindness meeting in Washington, D.C. That's because the new lenses are made of materials that repel bacteria much better than the older materials did, he explains.

In the past nine months, the U.S. Food and Drug Administration ( news - web sites) has approved three of these lenses for up to 30-night extended wear, says Dr. H. Dwight Cavanagh, of the University of Texas Southwestern Medical Center at Dallas. His research team looked at all three new lenses, evaluating whether they cause more bacteria to bind to the surface of corneal cells -- a measure of infection risk -- than did conventional daily wear lenses or extended wear lenses. In all, more than 800 contact lens wearers were studied.

Lenses evaluated include the Bausch & Lomb Pure Vision, Ciba Vision Night & Day and Menicon Z lens. (Pure Vision is not currently available; the manufacturer suspended production due to a court ruling in a patent infringement suit. Bausch & Lomb is appealing the ruling). Pure Vision and Night & Day are soft lenses, while the Z is a rigid lens.

Whether people wore the lenses for six nights or 30, there was either no risk or only slightly increased risk that the organism Pseudomonas aeruginosa -- the bacterium linked to the most and worst lens-related corneal infections -- would bind to the corneal cells. The rigid lens performed better than the soft lens, Cavanagh reports.

"The length of wear doesn't seem to matter," he says. In fact, the new lenses produce less infection risk than daily wear or extended wear lenses in use today.

With the new lenses, he says, the risk of an eye infection declines "by a factor of 10 and maybe even 40."

His studies, funded by the National Eye Institute and manufacturers of the new lenses, were published in a recent issue of Ophthalmology ; another is due to appear in the November issue of Ophthalmology.

So safe are the newer materials, Cavanagh says, that even contact lens wearers who don't intend to sleep in their lenses should consider switching to the newer materials to minimize infection risk.

About 35 million Americans wear contact lenses, according to estimates by the Contact Lens Council. About 85 percent choose soft lenses, and 15 percent choose the rigid lenses.

An expert on corneal infections calls the studies impressive.

"There's hope," says Richard J. O'Callaghan, a professor of microbiology, immunology and parasitology at the Louisiana State University Health Sciences Center in New Orleans. "He's talking about a major change in the frequency of infection [with the use of the new extended wear lenses]."

Eliminating bacteria from gaining access to the cornea and sticking to the lens, he says, should greatly reduce infection.

Not everyone can get fitted properly with the new lenses. Some models are not yet made to correct astigmatism, an inability of the eye to focus sharply due to an abnormally shaped cornea. And they are not yet available as disposables, although Cavanagh expects they will be in the future.

The new extended wear lenses "offer options," Cavanagh says, and for some will be an alternative to LASIK.

While the risk of infection with the new extended wear lenses is less, they are not maintenance-free. "You will have to clean all of them," Cavanagh says. Also, some wearers may have a problem with allergies to the material.

Whether extended wear contact lenses will catch on again isn't known. It will take time to change the minds of both the public and eye care specialists, Cavanagh acknowledges.

"Practitioners and the public have been hearing for the last 15 years, 'Don't go there,'" when it comes to extended wear lenses, Cavanagh says. "We have a lot of undoing to do."

What To Do

For more information on contact lenses, see the http://www.contactlenscouncil.org/choices.htm"; >Contact Lens Council, which also has more on frequently asked questions about contact lenses.

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Acid Reflux May Trigger Migraines in Some 

Reuters Health

Wednesday, September 25, 2002

NEW YORK (Reuters Health) - Stomach acid reflux can trigger migraines in people prone to the debilitating headaches, the cases of two patients suggest.

On the flip side, if their responses are any indication, better control of acid reflux might ease migraine symptoms in such patients.

Reporting in the September issue of the journal Cephalalgia, Dr. Egilius L.H. Spierings of Harvard Medical School ( news - web sites) in Boston, Massachusetts, describes the cases of two patients with long-standing migraines and gastroesophageal reflux.

In reflux disease, stomach acids chronically back up into the esophagus, leading to heartburn and other symptoms. For these two patients, acid reflux had made their teeth and gums sensitive enough to sometimes trigger their migraines, according to Spierings.

"It caused pain to radiate from the upper gum/teeth into the cheek and from there, into the eye, a common location of migraine headache," he explains in the report.

For one patient, a middle-aged man who had suffered migraines several times a month since age 19, migraine bouts that struck the left side of his head had been more resistant to his headache medication than his right-sided symptoms.

These left-side migraines originated from the upper gum and extended through the cheek to the eye, and the man's left upper gum was sore to the touch and sensitive to temperature changes. The patient has also had acid reflux for years.

Simply increasing the dose of the man's current acid-reflux medication--a type of drug known as a proton-pump inhibitor--quelled his gum soreness and reduced the frequency of his left-sided migraines, the report indicates. The same tactic worked for the second patient, an older woman with right-sided migraines originating from the upper teeth.

According to Spierings, the "dramatic improvement" in headache symptoms his patients showed confirms acid reflux as a trigger of their migraines. It is possible, he notes, that proton-pump inhibitors have some unknown powers against migraines.

"However," he adds, "I consider this possibility remote."

Source: Cephalalgia 2002;22:555-556.

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Blood Thinner Prevents Second Heart Attack 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 25, 2002

WEDNESDAY, Sept. 25 (HealthScoutNews) -- The blood thinner warfarin, by itself or with aspirin, is better than aspirin alone at preventing future heart and vessel problems in heart attack patients, a new study says.

But the clot-blocking drug causes more problems with bleeding than aspirin and doesn't seem to offer any survival benefit in the people who take it, the scientists who did the study said.

"We found that warfarin was superior to aspirin alone," wrote the researchers, whose study appears in tomorrow's New England Journal of Medicine ( news - web sites). "We also found that the combination of moderate-intensity warfarin and a low dose of aspirin was the most effective therapy for the prevention of events after" heart attacks.

An estimated 1.1 million American suffer heart attacks each year, 450,000 of which are recurrent episodes. Nearly 13 million Americans have coronary heart disease, putting them at risk of heart attacks and strokes.

The study was conducted at 20 hospitals in Norway and included 3,630 men and women whose average age was about 60. All of them had suffered a heart attack that put them in the hospital. As a result, they were being treated for "secondary prevention" to ward off additional cardiovascular ailments.

A third were given aspirin alone and a another third got high-dose warfarin -- sold as Coumadin by Bristol-Myers Squibb. The remainder received a combination of aspirin and moderate-dose warfarin.

Over the next four years, on average, 20 percent of the patients on aspirin alone had another heart attack, a clot-related stroke or died, compared with 16.5 percent of those on warfarin. The rate of these bad outcomes for patients on both drugs was about 15 percent, or nearly 30 percent lower than in the aspirin group.

Yet while warfarin was more protective than aspirin, it led to a threefold-to-fourfold increased risk of major bleeding complications. These problems can mean more treatment and higher health-care costs for patients, though they aren't always life-threatening.

Dr. Richard Becker, a researcher at the University of Massachusetts Medical School in Worcester, called the findings "compelling." Several earlier trials of warfarin had turned up conflicting results, he said, so "the timing was right for doing this study."

Still, Becker, author of an editorial accompanying the journal article, said that in America the standard of care for heart attack patients -- angioplasty to clear blocked vessels and stenting to keep them open -- doesn't call for warfarin. Rather, doctors offer these patients drugs like aspirin and clopidogrel that prevent blood cells called platelets from clumping together. Giving these people warfarin would seriously increase their risk of dangerous bleeding.

On the other hand, Becker said, in countries that don't use stents and angiography as much as the United States, front-line warfarin treatment might be more appropriate.

What To Do

To find out more about heart attacks, try the American Heart Association or the Heart Information Network. For more on blood thinners, try the Texas Heart Institute.

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Tea May Reduce Risk of Cancer, Heart Disease: Forum 

By Maggie Fox

Reuters

Wednesday, September 25, 2002

WASHINGTON (Reuters) - Solid evidence is mounting that drinking tea can prevent cell damage that leads to cancer, heart disease and perhaps other ills, scientists said on Tuesday.

It may soon be time to add tea to the list of fruits and vegetables that experts urge Americans to eat as often as possible to reduce their risk of disease, the researchers told a meeting sponsored by the US Department of Agriculture, the Tea Council, the American Cancer Society ( news - web sites) and other groups.

"In some respects, it is good to think of it as a plant food," Jeffrey Blumberg, a nutritionist at Tufts University in Boston, Massachusetts, told a news conference.

Blumberg said tea is loaded with phytochemicals--a wide range of molecules that can act as antioxidants. Such compounds counteract the damage done to DNA cells by free radicals--charged particles produced by sunlight, chemicals, many foods and simply the stress of day-to-day living.

Damaged DNA is the first step to cancer, and is also associated with heart disease.

Vitamins such as A and C are antioxidants, but so are compounds such as the catechins found in tea.

"It's taken about 30 years to fully appreciate the importance of these compounds," Blumberg, who acts as an adviser to both the US Food and Drug Administration ( news - web sites) and the Tea Council, said.

The USDA reported on a study suggesting that tea-drinking can also reduce the risk of heart disease by lowering cholesterol.

Joseph Judd, acting director of the USDA's Beltsville Human Nutrition Research Center in Maryland, tested eight men and eight women who agreed, for a period of 3 weeks at a time, to eat and drink only what they were given at the Beltsville lab.

"We gave them a beverage that mimicked tea--water flavored like tea," he said. For a second 3-week period the same volunteers got five cups a day of tea to drink.

"We found that their blood lipids, when they drank tea compared to the placebo beverage, had up to 10% lowering of low density lipoprotein, the 'bad' cholesterol," Judd said.

Overall, total cholesterol was lowered 6% on average over the 3 weeks, his team found. "There was no effect on 'good' cholesterol," he added. "HDL remained constant."

Dr. Iman Hakim of the University of Arizona and the Arizona Cancer Center tested 140 smokers to see if drinking tea could affect levels of chemicals associated with DNA damage.

They chose to look at a chemical called 8-OHdG, which is found in urine and linked to the damage of DNA in the cells.

"They were asked to eat whatever they were eating and just add tea to their diet," she said.

For 4 months, volunteers drank either green tea, black tea or water. Hakim's team tested their urine for levels of 8-OHdG. "What we found was a 25% decrease in the green tea group," she said.

No changes were seen in the people who drank black tea or water. "We think green tea, in our group of smokers, is associated with a reduction of oxidative stress in their urine," Hakim said.

Much more research would be needed to see if lowering levels of 8-OHdG, or other markers of DNA damage, is actually associated with a lower risk of cancer.

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Just How Well Does New Sepsis Drug Work? 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 25, 2002

WEDNESDAY, June 25 (HealthScoutNews) -- Controversy is still boiling around a drug derived from human protein nearly a year after the U.S. Food and Drug Administration ( news - web sites) (FDA) approved it to treat severe and often fatal blood infections.

The drug, a bioengineered version of a molecule called activated protein C or drotrecogin, now is approved only for the most severe cases of sepsis, a blood infection that affects perhaps 750,000 Americans a year and kills 225,000 of them. It has been a center of intense discussion since the FDA gave its approval last November, after a 20-member advisory committee divided evenly on the question.

At the moment, activated protein C is used only in the most severely affected patients. The international study that led to its approval showed it reduced the death rate in those patients to 24.7 percent, compared to 30.8 percent for patients who got a placebo.

Eli Lilly and Co., which markets the drug, has agreed to conduct three trials including 13,000 patients to get answers to some outstanding questions, says Dr. Jay P. Siegel, director of the Office of Therapeutic Research and Review at the FDA's Center for Biologics Evaluation and Research.

One of those studies will enlist 11,000 patients to see whether the protein can help lower-risk patients, Siegel writes in an overview article in tomorrow's issue of The New England Journal of Medicine ( news - web sites) that includes at least six contributions centering on the drug. Another study will evaluate its effect in children with sepsis, and the third will combine the protein with low-dose heparin, used to reduce the blood clotting that contributes to the deadly effects of sepsis.

It's hard to say when results of those trials will be available, Siegel says. "It takes time to recruit, time to treat, time to report," he says. Meanwhile, he says, the recommendation that it be used only in high-risk patients remains in effect.

Even that use is questionable, says Dr. Richard P. Wenzel, chairman of the department of medicine at Virginia Commonwealth University and author of a commentary in the journal.

"My feeling is that the drug has some effect, but I think it is modest," Wenzel says. One objection, shared by others in the field, centers on the fact that Lilly changed the rules in the middle of the study that led to approval, using a different criterion for patient eligibility. At the same time, Lilly began to use a different human cell line to produce the protein, which raised questions about whether that change altered the drug itself.

When the initial results were released, the drug was referred to as a "landmark" in critical-care treatment. It was only after the study was completed, however, that the FDA did an analysis concluding that the beneficial effect was concentrated in high-risk patients.

"The FDA is on thin ice to have performed a post-analysis and used data from that analysis to approve the drug," Wenzel says. "Also, subsequently to use such a physiological score as an indication for drug use is risky. We clearly need more data in the midst of this controversy to show that we have an efficacious drug."

The drug is efficacious, Siegel says -- not as effective as might be hoped, but nevertheless valuable. "We all hoped for something like a miracle cure," he says. "But the fact is that many of the drugs we use today have only a modest effect."

The ultimate consideration, Siegel says, is that "there is not a lot out there for these septic patients. It is a benefit that we have something to use."

What To Do

You can learn more about sepsis from KidsHealth or the Lilly site Sepsis.com.

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Type of Fatigue May Up Potential for Blood Clots 

By Amy Norton

Reuters Health

Wednesday, September 25, 2002

NEW YORK (Reuters Health) - Vital exhaustion, a type of extreme fatigue associated with chronic stress, has been thought to raise the risk of heart attack, and now researchers think they've discovered one reason why.

Their study of 59 middle-aged men found that those with vital exhaustion showed higher levels of a blood protein that promotes clotting. They also had greater activity in a protein that inhibits the blood's own clot-fighting system--a difference that was seen only in the early morning, when heart attacks in general are more common.

Researchers led by Dr. Rob van Diest, of Maastricht University in the Netherlands, report the findings in the September/October issue of Psychosomatic Medicine.

Vital exhaustion, van Diest told Reuters Health, is marked by three "core elements": undue fatigue, irritability and malaise--a general feeling of discomfort and lack of well-being. Studies have associated the condition with chronic stress, and researchers think it may reflect a breakdown in a person's ability to cope.

Vital exhaustion differs from depression, van Diest said, primarily in that there is no depressed mood, per se, or loss of pleasure in life.

But studies have tied the condition to a higher risk of first and subsequent heart attack. Some researchers have found evidence that this may be due to a greater vulnerability to blood clotting.

In their study, van Diest and his colleagues found that men with vital exhaustion had overall levels of the clot-promoting protein fibrinogen that were higher than those of men without the condition.

In the early morning hours, the exhausted men also showed higher levels of another blood substance that hinders the body's capacity to break down clots--a process called fibrinolysis.

"We found that disbalance between the coagulation and fibrinolytic sides were particularly present early in the morning, suggesting a link between vital exhaustion and the high incidence of heart attacks in the early morning," van Diest said.

He pointed out that his team was careful to exclude patients with signs of major depression, so although the two conditions share features, the current findings do not necessarily apply to people with depression.

Van Diest said he and his colleagues have just completed a study on whether behavioral therapy can prevent further heart attacks in cardiac patients with exhaustion, but the results are not yet available.

Source: Psychosomatic Medicine 2002;64.

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FDA Approving, Recalling Drugs at a Faster Pace 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 25, 2002

WEDNESDAY, Sept. 25 (HealthScoutNews) -- The agency that regulates drugs in the United States is approving them at a faster pace, but it's recalling more of them, too.

A 1992 law that has companies financing regulatory reviews of new drug applications caused this two-edged sword, according to a report from the U.S. General Accounting Office ( news - web sites).

The GAO report, released yesterday, found that under the Prescription Drug User Fee Act (PDUFA) the average review time for standard new drug applications fell from 27 months in 1993 to 14 months in 2001.

Even more noticeable is the period for giving the go-ahead for priority drugs, down from 20 months to six months. A good example of this is the rapid push-through of Gleevec in 2001, a drug that had shown spectacular results in the treatment of certain types of adult leukemia.

That's the positive finding.

On the other side is the fact that the number of drugs having to be recalled has also spiked. For example, 5.34 percent of drugs OK'd between 1997 and 2000 were withdrawn from the market, compared with 1.56 percent of those approved between 1993 and 1996.

The Food and Drug Administration ( news - web sites), which regulates drugs in the United States, maintains that the recall rate for the eight years before and after the law was enacted is essentially identical -- 3.1 vs. 3.5 percent. But Jane Heinrich, the GAO official who led the study, said taking such a long look obscures the more recent trend.

In addition, the report found that as the FDA works harder to meet the demands of reviewing new drug petitions, its ability to carry out the rest of its functions -- from monitoring the safety of medical devices to policing food and blood -- has suffered.

Training and professional development have lagged. Meanwhile, workloads are up under PDUFA, despite an increase in drug review staff of 77 percent, from 1,300 to 2,300 full-time posts between 1993 and 2001. At the same time, about 1,000 fewer staffers are performing other agency functions.

"The drug and biologic review processes have increased while other FDA activities have decreased somewhat," Heinrich said.

Perhaps a reflection of the strain, the report showed that attrition rates for jobs involved in drug review, like biologists and medical officers, are running higher than in other federal agencies. The document quoted FDA officials blaming the turnover, in part, on better salaries in the private sector.

Since 1993, the share of the FDA's budget for reviewing drugs and biologic compounds that comes from PDUFA funds has risen from 7 percent to 51 percent, the report found. In 2002, the agency plans to spend $170 million in user fees for these reviews out of a total of $332 million.

The cost of reviewing a new drug application in 2002 was $313,000 for the most comprehensive petition, and $156,000 for those that didn't include clinical trial data, industry figures show. Those numbers are set to soar in 2003, to $265,000 for the basic review and $530,000 for the more detailed process.

A spokesperson for the FDA said the agency agrees that PDUFA strained its resources in recent years. The law had rigid timetables for meetings and hearings that had to be scheduled.

Jeff Trewhitt, a spokesman for the drug industry group PhRMA, said that between 2 and 3 percent of drugs approved in the 1980s and 1990s, before and after PDUFA, were recalled for safety reasons. "That gives the FDA one of the best safety records, if not the best record, of all regulatory agencies that approve drugs worldwide," Trewhitt said.

Trewhitt said that "on balance, PDUFA is very important to the drug approval process" and has been a success.

The new report was requested by Sen. Edward Kennedy D-Mass, who chairs the Senate's Health, Education, Labor, and Pensions Committee, which oversees the FDA. Congress has renewed PDUFA twice since 1992, with the current version running for five years starting next month.

Under PDUFA III, user fees will run about $1.2 billion over five years, compared with $700 million for the previous incarnation of the law, Trewhitt said. Included in that sum are funds to double the number of post-approval reviewers, to 200, a change the FDA has sought.

John Hansen, a GAO researcher and a co-author of the report, said that that change and other items in the new law that give the FDA more flexibility in its budget should ease some of the strain from previous versions of PDUFA.

Also Tuesday, President Bush ( news - web sites) nominated Dr. Mark McClellan, a physician and a member of the White House's Council of Economic Advisers, to head the FDA. The agency has been without a permanent leader since Bush took office in 2001.

McClellan's brother is administration spokesman Scott McClellan.

What To Do

Click here for more on the Food and Drug Administration. And try here for more from the General Accounting Office.

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Pregnancy Hormone May Combat Multiple Sclerosis 

By Jacqueline Stenson

Reuters Health

Wednesday, September 25, 2002

NEW YORK (Reuters Health) - A pill containing a form of estrogen produced in large quantities during pregnancy may help fight multiple sclerosis in women in the early stages of the disease, according to findings of a small study.

Doctors have long observed that multiple sclerosis sometimes becomes less severe when women with the chronic disease are pregnant. Animal research has suggested that high levels of estriol, an estrogen produced by the placenta during pregnancy, appear to be a reason why, said study author Dr. Rhonda Voskuhl, an associate professor of neurology at the University of California, Los Angeles.

Multiple sclerosis is a progressive neurological disease characterized by inflammation and destruction of myelin, the protective coating surrounding neurons in the brain and spinal cord. Symptoms can include numbness, muscle weakness, extreme fatigue, impaired vision, coordination problems and sometimes paralysis. There is no clear cause for the disease, which affects about twice as many women as men.

In an interview with Reuters Health, Voskuhl said estriol appears to rein in a pregnant woman's immune system so that it does not attack and destroy the fetus.

And findings from the new study, published in the October issue of the Annals of Neurology, suggest that the hormone plays a similar role in women with early-stage multiple sclerosis--preventing the immune system from attacking and destroying the myelin that covers nerve cells, she explained.

"The inflammatory lesions in the brain were decreased and there was a favorable shift in the immune response," Voskuhl said.

The study involved six women with relapsing-remitting multiple sclerosis, an early-stage form of the disease in which symptoms alternately flare up and then fade. Four other women had more advanced, secondary progressive multiple sclerosis, in which symptoms continually worsen. All participants were given MRI scans, immune system tests and tests of mental function during a 6-month pre-treatment period, a 6-month treatment period involving daily estriol, and a 6-month post-treatment period.

Only the group of women with early stage MS showed improvements when taking estriol, results showed. But when treatment was stopped, their condition worsened.

These patients were then treated for an additional 4 months at the end of the study, and as expected, their symptoms improved. During this treatment phase, these women also were given the hormone progesterone because of concerns that prolonged estrogen treatment might raise the risk of uterine cancer; progesterone is known to counter this effect.

There were no major side effects, but some women experienced menstrual irregularities during the study, according to the report.

Current treatments for early-stage multiple sclerosis involve daily to weekly injections of anti-inflammatory medications, so patients would welcome an effective pill. "The beauty of this is it's oral," Voskuhl said.

It wasn't very surprising that estriol didn't work in patients with more advanced disease, she noted. "The early stage is a very inflammatory stage but in the late stages you're dealing with scarring and damage, and anti-inflammatories don't repair that," she said.

The hope is that early treatment with estriol might slow disease progression. But more studies are needed to confirm that the drug is safe and effective over the long-term, Voskuhl said. No one knows if the treatment would work safely in men.

It is also possible that estriol could be effective in other inflammatory conditions that are known to ease in pregnancy, such as rheumatoid arthritis, she added.

Estriol is used to treat menopausal symptoms in women in Europe and Asia, according to Voskuhl.

Souce: Annals of Neurology 2002;52:421-428.

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Alzheimer's mechanism comes to light  

By Lidia Wasowicz
UPI Senior Science Writer
From the Science & Technology Desk
United Press International

Wednesday, September 25, 2002

Researchers have discovered a genetic Jekyll and Hyde that can destroy or defend cells, may underlie neurodegenerative diseases and could be a target for treatment of age-related mental decline associated with Alzheimer's and other disorders.

To their surprise, the scientists at The Jackson Laboratory in Bar Harbor, Maine, a nonprofit mammalian genetics research facility, found a gene known to incite death among cells also can prevent their demise. Studies of specially engineered mice suggest the gene, called apoptosis inducing factor or AIF, protects certain nerve cells in the brain and eye.

The AIF gene can keep a damaging biochemical process called oxidative stress at bay and avert cellular deterioration.

Oxidative stress, resulting from an unchecked proliferation of erratic molecules called free radicals, has been implicated in a lengthening list of human ailments. Its effects include both the superficial and deadly -- from wrinkled skin to cancer, heart disease, stroke and a host of chronic progressive or degenerative disorders, including Lou Gehrig's disease, also known as amyotrophic lateral sclerosis or ALS.

"The authors describe a study in which (AIF) ... staves off cell death in neurons of the retina and certain regions of the brain (cerebellum) when these cells are exposed to conditions of oxidative stress," Ed Levine, assistant professor of ophthalmology and visual sciences at the Eccles Institute of Human Genetics at the University of Utah in Salt Lake City, told United Press International.

"This is somewhat surprising since AIF has previously been shown to be involved with promoting cell death," Levine said. "(The study's) connection to oxidative stress is interesting because oxidative stress is a common cause of cellular damage and death that is associated with aging. Thus, targeting treatments to promote AIF activity in specific neurodegenerations may have promise."

The work establishes the first such link to free radicals. They are wildly unstable molecules with a missing or impaired electron -- a negatively charged particle that bonds atoms together -- which they seek to replace at all cost.

Generally, an unbalanced radical plunders the nearest stable molecule, leaving it, in turn, one electron short, and ready to avenge the theft. This domino-like chain reaction -- rampaging radicals grabbing electrons from their neighbors that then themselves turn radical -- can cascade until the entire cell is disrupted or destroyed, setting the stage for disease.

Radicals arise as oxygen reacts with other molecules in biochemical process that normally are life-sustaining. Some also spawn from environmental factors, such as pollution, radiation, cigarette smoke and herbicides. These biochemical "bad boys" can play the good guy role equally well, however. They can serve the body's disease-fighting immune system by neutralizing viruses and bacteria.

The body tries to keep the damaging effects of free radicals in check with protective mechanisms called antioxidants. Antioxidants contribute one of their own electrons to stabilize the radicals, bringing the "stealing" game to a halt. These beneficial scavengers -- which help prevent cell and tissue injury that could lead to chronic disease -- remain stable with or without a full set of electrons and so do not turn into radicals upon making their donation.

If antioxidants are not available or if the free-radical production becomes excessive, oxidative stress occurs, leading to cell damage, which accumulates with age.

Radicals may have a hand in cognitive degeneration, the study suggests, implying that one might forestall the onset of dementia by eating the right foods rich in antioxidants -- such as strawberries, blueberries and broccoli -- taking supplements of vitamins C and E and beta carotene and exercising regularly. Research has indicated such antioxidant-employing measures might prevent cell damage, potentially slowing the aging process and protecting against disease.

"The study ... provides additional evidence suggesting that better control of oxidative damage may be effective in preventing or treating (neurodegenerative) disease," Greg Cole, associate professor of medicine and neurology at the University of California, Los Angeles, told UPI.

"Many people are already interested in preventing age-related oxidative damage using antioxidant supplements like vitamins E and C. An ongoing clinical trial with a vitamin E supplement should soon help answer questions about vitamin E supplements," said Cole, who is also associate director of the UCLA Alzheimer's Disease Research Center.

"However, two recent ... papers suggest that for Alzheimer's prevention, it may be more important to consume more natural antioxidants in the diet. Alternatively, researchers need to identify an optimum supplement."

The new research shows the Aif gene provides an antioxidant defense against free radicals, protecting certain types of aging nerve cells or neurons, he added.

The study with specially formulated, "harlequin" mice -- so called for their patchy hair pattern and clownish or harlequin appearance -- carries major implications for research into age-related dulling of mental acuity, said Susan Ackerman, staff scientist at Jackson and lead author of the paper, which will be published in the Sept. 26 issue of the British journal Nature.

"While there are many types of mutant mice with nervous system defects, only a few show major age-dependent neuron loss, a phenomenon found in human diseases including Alzheimer's, Parkinson's, Huntington's, ALS and types of retinal degeneration," Cole told UPI.

Ackerman and her team pinpointed the molecular basis for why the much-analyzed harlequin rodents serve as a useful model for late-onset neurodegenerative disease. The ailment is characterized by progressive degeneration of neurons in the cerebellum, a large brain region that coordinates voluntary movements, posture and balance. Additional damage appears in the retina, a light-sensitive component of the eyeball that receives the image produced by the lens.

"We have focused on identifying mouse strains that have genetic defects that lead to degeneration of neurons in the aging brain, and by studying these mice we can go on to identify the gene that is disrupted. This allows us to identify molecules that are necessary for neuron survival (in the adult brain)," Ackerman told UPI. "Degenerative disorders of neurons in the brain and of the retina of the eye affect many people, particularly those in the aging population."

It turns out the mice have a mutation in their AIF gene. The mutation severely curtails production of the corresponding AIF protein, a scavenger of free radicals in the brain and retinal neurons, the investigators discovered. With the protein numbers diminished, the radicals remain free to roam, leading to oxidative stress and, eventually, nerve cell death. This is a scenario increasingly painted for the development of Alzheimer's disease, said Dr. Gary Small, Parlow-Solomon Professor on Aging and professor of psychiatry and biobehavioral sciences at UCLA.

"What's interesting in this study is that it touches on free radicals and oxidative stress and damage and antioxidation as a mechanism of prevention," Small, who is also director of the UCLA Center on Aging, told UPI.

"You have antioxidants in foods like broccoli, strawberries and blueberries or in supplements of vitamins E and C," Small explained. "Some studies show if you take these, your risk of Alzheimer's is reduced. This study goes along with these theories and gives us hope that some of these antioxidant strategies can maximize brain health and decelerate future brain aging."

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HIV particle helps anticancer treatment  

By Ed Susman
UPI Science News
From the Science & Technology Desk
United Press International

Wednesday, September 25, 2002

WASHINGTON, Sept. 25 (UPI) -- Researchers said Wednesday they can use specific bits of the deadly human immunodeficiency virus -- the organism that causes AIDS -- as an assisting device in fighting cancers that occur in the eyes.

The virus bit -- a protein called "Tat" -- from HIV helps to slide a key receptor blocker into cancerous cells, making it easier for anticancer drugs to destroy them, explained J. William Harbour, associate professor of ophthalmology at the Washington University School of Medicine in St. Louis.

Harbour and colleagues developed the HIV protein molecule and its tag-along cancer fighter after studying the mechanisms of cells in certain eye cancers.

"We have identified a key molecular feature of eye cancers that prevents the cancer cells from dying," Harbour told attendees at a symposium sponsored by Research to Prevent Blindness, of New York City.

The finding led the researchers along a path to a new concept in fighting the disease:

-- First they noted a key gene, p53, whose protein suppresses the growth of tumors, is turned off by an inhibitor in the cancer called HDM2. HMD2 ensures the survival of the cancer cell by defending against attacks by p53.

-- When the cancer cell overproduces the p53-blocking HDM2, however, a cascade starts that results in programmed cell death, a process called apoptosis.

-- The researchers isolated a small fragment of p53 that can attach to HMD2 and prevent the inhibitor from turning off p53's normal function.

-- By flooding the cell with the therapeutic protein molecule, doctors thought p53 would be able to attack the cancer, but they were stymied as to how to get the tiny p53 fragment into the cell. Then along came Tat.

Harbour said Tat is the protein that allows HIV to penetrate into cells, permitting the killer virus to create copies of itself and eventually destroying a person's immune system. However, he said, Tat -- by itself -- isn't harmful. So researchers took the p53 fragment that blocks HMD2 and attached it to Tat. The Tat protein enters the cell, dragging the hitchhiking p53 fragment with it.

In laboratory experiments, Harbour said as soon as the Tat-anti-HMD2 combination molecule enters the cancer cell, it binds to HMD2, freeing p53 molecules to initiate the apoptosis cycle. Cancer cells begin dying within hours.

In other laboratory tests with animals, tumors treated with Tat-anti-HMD2 were 95 percent destroyed within three days, while tumors in rabbits treated with a Tat-sham molecule were unaffected.

"That showed us that it was the anti-HMD2 that was working to kill the cells and not the Tat protein," Harbour said. He said that the small portion of the HIV molecule used in the treatment would not result in HIV infection.

"It is amazing how we are using molecular techniques to fight these types of cancer," said Pamela Sample, professor of ophthalmology at the University of California at San Diego. She predicted more and more uses of molecular science will find their way into therapeutic practice.

Harbour suggested the initial findings represent "a proof of principle that the molecular characteristics of eye cancers can be used to design novel therapeutic molecules with potent efficacy and specificity for cancer cells."

In his experiments, the Tat-anti-HMD2 molecule showed effectiveness against retinoblastoma and uveal melanoma cancers that occur in the eye. However, Harbour hinted the concept used in his experiments might be applicable in many other cancers. Because the Tat-anti-HMD2 molecule is so different an approach to fighting cancer, he said, the malignant cells might be unable to find a way to develop resistance against it.

David Beebe, professor of ophthalmology at Washington University, said that intense scientific study of HIV created "resulted in the spinoff of Tat because it has this unusual property of getting into cells. It really points out the importance of basic science."

The small bit of HIV protein would not trigger AIDS in patients being treated for cancer nor would it likely even show up in common tests for HIV infection, Beebe said.

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TUESDAY, SEPTEMBER 24, 2002 

Heart Disease 'Respects No Borders' 

HealthScoutNews

Tuesday, September 24, 2002

TUESDAY, Sept. 24 (HealthScoutNews) -- Cardiovascular disease is a worldwide pandemic that "respects no borders," and isn't just a disease of affluent countries.

It is, in fact, the leading cause of death in the world, according to an editorial in today's issue of Circulation.

The editorial, issued to coincide with World Heart Day on Sept. 29, points out that cardiovascular disease affects about 150 million people around the world.

In 1999, heart disease and stroke killed about 17 million people worldwide, 30 percent of all deaths. About 14.7 million people died of heart disease and stroke worldwide in 1990.

"We must do a more effective job of translating scientific advances into programs that can save lives in all parts of the world," says the editorial's lead author, Dr. Robert O. Bonow, president of the American Heart Association ( news - web sites). "These advances have led to enormous gains in cardiovascular disease knowledge, but a gap remains in implementing this knowledge. The message must be loud and clear to world leaders, health-care providers, and the public that much of the death and disability from cardiovascular disease is preventable."

The editorial dismisses the belief that atherosclerosis -- the narrowing of arteries that causes heart disease and most strokes -- is a disease of wealthy nations such as the United States. World Heart Federation statistics indicate that 80 percent of deaths caused by cardiovascular disease occur in low- to middle-income countries such as Russia, Poland and China.

Obesity, diabetes, sedentary lifestyle and smoking are the underlying causes of the increase in cardiovascular deaths.

"In the United States, we are already facing a crisis in cardiovascular disease with an obesity and diabetes epidemic, an aging, sedentary population with a widening access-to-care gap. Internationally, these problems are worse - the access-to-care gap is growing so quickly in certain countries that it will son by an unbridgeable chasm," Bonow says.

"The answer is deceptively simple -- population-based, culturally tailored prevention programs," he says.

More information

The American Heart Association offers you a guide to assessing your own risk of cardiovascular disease.

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New Device Lowers Heart Attack Risk  

By Lauran Neergaard

AP Medical Writer

Tuesday, September 24, 2002

WASHINGTON (AP) - An experimental device that acts like a miniature drill and vacuum cleaner partially broke up clogs inside diseased heart arteries and sucked out the debris, letting doctors conduct angioplasties that were a little safer for their patients, researchers announced Tuesday.

Angioplasties restore blood flow through clogged arteries with a balloon-tipped catheter threaded inside the blood vessel and inflated to push back blockages. More than 1 million angioplasties are performed each year in this country alone.

They carry a risk: Clogs usually are a mix of soft and hard plaque, and while balloons push aside the hard stuff, they can break up the softer plaque so that it floats downstream and lodges in another blood vessel to cause a heart attack.

Doctors have long explored different ways to filter out that debris, a technique called thrombectomy.

The latest attempt: an experimental device called the X-Sizer, a hollow tube filled with a spinning blade and suction device. Thread it over any standard catheter wire and push it to the blockage. The blade cuts up the soft clog and the X-Sizer vacuums up the pieces, clearing the way for standard angioplasty to push aside the remaining hardened plaque.

Scientists randomly assigned nearly 800 patients to get X-Sizer treatment before angioplasty, or a regular angioplasty. Some 9.6 percent of people getting regular angioplasty had large heart attacks within 30 days, compared with 5.5 percent who got the thrombectomy first, said Dr. Gregg Stone of New York's Lenox Hill Hospital, who presented the study at a cardiology meeting here Tuesday.

There were no differences in deaths or small heart attacks.

Still, large heart attacks that damage significant amounts of heart muscle are a troubling angioplasty risk, and "there's really no drawback" to using the X-Sizer to lower that risk, Stone said.

Downstream heart attacks are "one of the unresolved problems" of angioplasty, and thrombectomy looks promising, said Dr. Sidney Smith of the American Heart Association ( news - web sites). But which device performs a thrombectomy best is far from clear, he cautioned: Devices already sold try suctioning out blood clots before angioplasties or trapping debris and pulling it out once the angioplasty is done. The X-Sizer wasn't compared to such alternatives.

Manufacturer ev3 Inc. financed the study and is seeking Food and Drug Administration ( news - web sites) approval of the experimental device.

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Psychiatric Symptoms Often Accompany Dementia 

By Merritt McKinney

Reuters Health

Tuesday, September 24, 2002

NEW YORK (Reuters Health) - Depression, irritability, apathy and other psychiatric symptoms often affect elderly people who have dementia or mild mental impairment, according to a new report.

"Neuropsychiatric symptoms are common in dementia and mild cognitive impairment," the study's lead author, Dr. Constantine G. Lyketsos of the Johns Hopkins Hospital in Baltimore, Maryland, told Reuters Health. "This study further confirms the view that the symptoms are almost universal over the course of the illness."

But Lyketsos noted that treatment, including but not limited to medications, can alleviate psychiatric symptoms, so caregivers or family members "should bring them to the attention of the doctors in their early stages so that they can be effectively managed before they become disabling."

Several studies have shown that 50% to 80% of elderly people with dementia also have some psychiatric symptoms. But there has been little study of psychiatric symptoms in people who have mild cognitive, or mental, impairment. Mild cognitive impairment is less severe than dementia, but it still causes problems with memory and other mental abilities.

To gauge the extent of psychiatric symptoms among the elderly with dementia or mild cognitive impairment, Lyketsos and his colleagues reviewed information from about 3,600 people enrolled in a long-term cardiovascular study. The researchers evaluated psychiatric symptoms in 682 participants with dementia or mild cognitive impairment.

In a confirmation of previous research, the study found that 75% of demented individuals had experienced at least one psychiatric symptom in the month before the evaluation. More than half reported two or more symptoms and 44% had at least three psychiatric symptoms. The most common symptoms among participants with dementia were apathy, depression and agitation/aggression.

The study, reported in the September 25th issue of The Journal of the American Medical Association ( news - web sites), also demonstrated that a substantial percentage of people with mild cognitive impairment, 43%, experienced at least one psychiatric symptom. The most common ones were depression, apathy and irritability.

Dementia is often caused by Alzheimer's disease ( news - web sites), but it can have other causes, including Parkinson's disease ( news - web sites) and blood vessel disease that reduces blood flow to the brain. For the most part, though, psychiatric symptoms were similar regardless of dementia type.

According to the researchers, the fact that psychiatric symptoms often accompanied mild cognitive impairment as well supports the idea that mild cognitive impairment is not a separate condition from dementia but a step along the way to dementia.

The good news, according to Lyketsos, is that psychiatric symptoms are often treatable, particularly if detected early.

"Treatment not only helps the symptoms but also may delay illness progression," he said. By alleviating symptoms, treatment can also benefit a patient's caregivers, he added.

Source: The Journal of the American Medical Association 2002;288:1475-1483.

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New Drugs May Fight Deadliest Flu Virus 

By Adam Marcus
HealthScoutNews Reporter

Tuesday, September 24, 2002

TUESDAY, Sept. 24 (HealthScoutNews) -- If the whopper flu virus of 1918 ever resurfaces, doctors may be well-equipped to deal with the outbreak.

So suggests a new study, which found that new drugs that attack flu virus can protect mice from dying when infected with rodent flu studded with genes to make it more vicious. Versions of the drugs, called neuraminidase inhibitors, are already on the market to treat and prevent garden-variety flu.

The 1918 "Spanish" flu pandemic killed more than 21 million people worldwide, and at least 500,000 in the United States alone, making it the most devastating outbreak on record. Conventional influenza, by comparison, kills 20,000 people a year in this country.

Although scientists have made strides toward understanding the genetics of the pandemic microbe and why it was so deadly, many aspects of its virulence remain a mystery. So the prospect that the 1918 strain could re-emerge -- either by chance or an act of biological warfare -- has some scientists in a theoretical fret.

Yet the new study, reported this week in the Proceedings of the National Academy of Sciences ( news - web sites), suggests a return of the 1918 flu might be stiff-armed by the combination of vaccination, neuraminidase inhibitors, and other antiviral drugs.

A research team led by Christopher F. Basler of Mount Sinai School of Medicine in New York City tested three of these compounds on mouse flu virus genetically engineered to mimic the old killer. Scientists don't have samples of the 1918 pathogen. However, Basler's group built three genes, encoding for four proteins, thought to belong to the microbe. They then stitched these genes into the genome of the mouse flu, which is itself quite deadly to the animals.

Left alone, all the mice would die once infected with the virus. Basler and his colleagues found, however, that roughly 90 percent of animals given the drug oseltamivir -- a neuraminidase inhibitor sold as Tamiflu by Roche Pharmaceuticals -- for a day before and six days after infection survived. A similar compound, zanamivir, or Relenza, made by GlaxoSmithKline, was effective in a lab dish, but they didn't test it in live mice.

Treatment during the illness with two other drugs, called M2 ion channel inhibitors -- amantadine and rimantadine -- saved all that received the medication. Although the rodents lost weight while sick, they shed fewer grams than untreated animals.

"If you don't give the drugs. the mice become ill and they die. If you do give them, you protect them from death," Basler says.

Scientists have now mapped four of the eight bundles of genetic material that make up the 1918 flu. Basler and his colleagues think they might have a lead with two of the genes they reconstructed for the latest study -- hemagglutinin (HA) and neuraminidase (NA).

The first gene helps the virus latch onto host cells, while the second lets it release new copies that can infect other tissue. "Maybe something interesting is going on with these two genes in terms of making [the strain] so deadly," Basler says. "But at the moment it's still very unclear."

A third gene, called matrix (M), may also prove helpful, says Terrence Tumpey, a microbiologist at the U.S. Department of Agriculture ( news - web sites)'s Southeast Poultry Research Laboratory, in Athens, Ga., and a co-author of the study.

Tumpey cautions it's difficult to apply the work to humans, or to say that scientists have indeed succeeded in simulating the 1918 flu strain.

"You have to consider that these studies were done in mice, which may not correlate" to people, he says. In addition, "we're only looking at some of the genes and not all of them."

What To Do

For more on the 1918 flu pandemic, try this site from PBS. For more on the flu that's circulating these days, try the Centers for Disease Control and Prevention.

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Study: Alcohol Ads Reaching Teens  

By Siobhan McDonough

Associated Press Writer

The Associated Press

Tuesday, September 24, 2002

WASHINGTON (AP) - America's youth saw far more alcoholic beverage ads in magazines in 2001 than did adults, according to a study released Tuesday.

Magazine advertising for beer and alcohol reached people ages 12 to 20 more effectively than it reached adults, the Center on Alcohol Marketing and Youth at Georgetown University found.

One of the most important findings, said Jim O'Hara, the center's executive director, was that marketers of beer delivered 45 percent more advertising to youth than to adults in magazines in 2001, and 27 percent more for distilled spirits brands. Wine advertising reached youth 58 percent less.

"You can make your choice to advertise so that it effectively reaches the legal-age population without overexposing youth to alcohol advertising," O'Hara said.

A September 1999 Federal Trade Commission report on the alcohol industry's advertising and marketing practices urged the industry to raise the standards to reduce underage alcohol ad exposure.

The center has asked the FTC to reopen its inquiry into whether the industry is doing a good job protecting children from exposure to alcohol advertising.

"We think the industry is falling short of goals the FTC set in 1999," said O'Hara.

But industry officials say they are adhering to FTC guidelines and they discounted the center's findings.

"This new study is not a real study; it's a piece of advocacy," said Jeff Becker, president of the Beer Institute in Washington, D.C. "We do have a voluntary set of guidelines and it's adhered to almost to the letter by each of our members."

Frank Coleman, senior vice president of the Washington D.C.-based Distilled Spirits Council of the United States, blasted the study, saying it's "sensationalizing a serious issue."

"Our companies are highly responsible. We're opposed to underage drinking," he said. The industry spends $10 million a year on responsibility programs to fight underage drinking, he said.

The center looked at $320 million worth of alcohol advertising in magazines measured by Mediamark Research Inc. during 2001. The information was compared with data on how much each magazine was looked at by teenagers or adults.

The Pew Charitable Trusts and The Robert Wood Johnson Foundation funded the research.

Other findings in the report include:

_Marketers of low-alcohol refreshers, such as Smirnoff Ice, delivered 60 percent more advertising to youth than to adults.

_Wine was the second leading alcohol advertising category in magazines.

_Underage youth saw nearly as much advertising as young adults ages 21 to 34. Adults ages 35 and older were a distant third audience.

_The study found 10 magazines with a youth audience of more than 25 percent accounted for nearly one-third of all alcohol advertising expenditures in measured magazines in 2001. Those magazines include Vibe, Spin, Rolling Stone, Allure, Car and Driver, Maxim, Glamour, Motor Trend, In Style and Sports Illustrated.

_More than half of the money spent on alcohol magazine advertising was in 24 magazines with youth audiences.

In terms of alcohol advertising spending in measured media last year, television got 57.6 percent; magazines 25.6 percent; billboards 9.5 percent; radio 5 percent and newspapers 2.2 percent.

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New Cataract Lens Allows Room for Improvement 

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 24, 2002

TUESDAY, Sept. 24 (HealthScoutNews) -- A new type of lens for patients with cataracts can be fine-tuned after it has been implanted.

Clinical trials of the new light-adjustable lens will begin overseas in October and in the United States next spring, says Dr. Robert K. Maloney, an associate clinical professor of ophthalmology at UCLA and an investigator of the new lens.

Maloney reported his findings yesterday at the Research to Prevent Blindness meeting in Washington, D.C.

The lens could be commercially available in Europe next year and in the United States in 2006. It might also help patients so nearsighted they aren't good candidates for traditional LASIK surgery, in which the cornea is sculpted with a laser to change its shape and correct nearsightedness.

More than 2 million cataract operations are performed each year in the United States. A cataract is a clouding of the eye's natural lens that often occurs with age, although it can also affect younger people. In cataract surgery, the cloudy natural lens is removed from the eye with a tiny vacuum-like device and replaced with a plastic intraocular lens.

About two-thirds of people who have cataract surgery still need eyeglasses afterward because the prescription of the implanted intraocular lens doesn't eliminate all of the nearsightedness, Maloney says. While the eye surgeon tries to calculate the power of the new lens implant so the patient can see well without glasses, the calculations are far from perfect and are affected by wound healing. So, it's common that patients still need eyeglasses for good distance vision after the cataract surgery, he says.

The new lens is made of light sensitive silicone, which changes shape in response to ultraviolet light. After the surgery, the patient wears sunglasses for about two weeks and then returns for the adjustment. The surgeon aims an ultraviolet light at the lens to change the shape and provide the extra correction needed.

"We think this offers kind of a revolutionary advantage" for Americans with cataracts, says Maloney, an investor with the company that makes the lens, Calhoun Vision Inc., of Pasadena, Calif.

If cataract patients want to avoid the need to wear reading glasses after cataract surgery, the new lens can also be corrected in a "monovision" approach, in which one eye is corrected mainly for distance vision and the other mainly for close work, Maloney says. Astigmatism, a focusing problem due to an abnormally shaped cornea, can also be fine-tuned, according to Calhoun Vision.

Another eye expert says the new lens sounds promising.

"It's perfectly feasible," says Dr. H. Dwight Cavanagh, an ophthalmologist and contact lens expert at the University of Texas Southwestern Medical Center. "This is fine-tuning residual nearsightedness so you don't have to wear glasses. On a scale of one to 10, it's a five as a cataract advance."

"Everyone thinks they should have perfect vision after cataract surgery," adds Cavanagh, who disagrees with Maloney on the number of cataract patients who need conventional eyeglasses after surgery to further correct distance vision. He says the figure is closer to one-third.

Research to Prevent Blindness is a New York City-based organization that funds eye research.

What To Do

To learn more about cataracts, visit Prevent Blindness America or the National Eye Institute.

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Flu Shot Works Best in Well-Rested Individuals 

By Charnicia E. Huggins

Reuters Health

Tuesday, September 24, 2002

NEW YORK (Reuters Health) - An annual vaccination may be the best way to protect against the influenza bug, but to guarantee its effectiveness, people should also be sure to get a good night's sleep before they get their flu shot, new study findings show.

"Getting your flu shot after not having enough sleep may not offer the same protection as getting it when well-rested," study author Dr. Eve Van Cauter of the University of Chicago in Illinois told Reuters Health.

"Chronic partial sleep loss, as experienced by millions of Americans today, has an adverse effect on immune function," she added.

To investigate, Van Cauter and her team studied 25 healthy young men. Eleven had their sleep restricted to just 4 hours a night on 6 nights of the week, followed by 12 hours of sleep per night for a full week. They were vaccinated against the flu on the morning of the fifth day during their sleep-deprived week. The remaining 14 men maintained their usual bedtimes before they were vaccinated.

At follow-up, 10 days after the vaccinations, the investigators found that the men who were immunized while sleep-deprived had an immune response to the flu that was less than half of that shown by their better-rested peers.

At both the 3- and 4-week follow-ups, however, there were no great differences in immune response between the two groups, the researchers note. Their findings are published in a letter to the editor in the September 25th issue of The Journal of the American Medical Association ( news - web sites).

"These findings add to a growing body of evidence indicating that sleep curtailment has adverse health effects," such as making people more prone to colds and other illnesses, Van Cauter said.

The study was partially funded by grants from the National Institutes of Health ( news - web sites).

Source: The Journal of the American Medical Association 2002;288:1471-1472.

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Stressed to the Hilt? Try the Furry Form of Valium 

By Nancy Deutsch
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 24, 2002

TUESDAY, Sept. 24 (HealthScoutNews) -- When stressed to the max, your first thought may be to spend time with your significant other or a friend.

However, new research says you should be cozying up to Fluffy or Fido, instead, to calm your frazzled nerves.

A study of married couples both with and without pets shows that having a pet is associated with lower perceived and actual responses to stress. Not only do you feel less jittery with your pet around, your blood pressure and pulse are likely to reflect your relaxed state of mind.

In the past, "we've documented that people perceive pets as great for them," says lead researcher Karen Allen, a research scientist at the State University of New York at Buffalo. "People are right."

The researchers, whose study appears in the September/October issue of Psychosomatics, visited the homes of 120 couples who'd owned a dog or cat for at least six months, and an equal number of couples who'd been pet-free for at least five years.

They checked baseline blood pressures and heart rates, and then administered two stress-inducing tests: The participants were asked to do mental arithmetic problems for five minutes, and then to submerge one hand in ice water for two minutes.

While everyone in the study had normal blood pressures and heart rates to start with, those with pets had lower baseline measures. During the tests, those without pets suffered more stress.

Interestingly, people with pets did better in terms of performing and handling stress when their pet was around, but not as well if a spouse or friend was also present.

This suggests that when doing the mental arithmetic in front of a spouse or friend, the study participants felt pressured to perform well, Allen says. But taking the test with a pet didn't produce the same anxiety level.

In addition, pet owners perceived themselves as less stressed, and had blood pressure and heart rates that returned to normal faster than people without pets.

Those with a spouse present who did not own a pet exhibited the most anxiety. They had systolic blood pressures up to a full 40 points above their norm when performing the mental arithmetic in front of a partner.

In general, men fared better than women under pressure.

Allen says an earlier study by her research group in 1996 produced similar results, but that review only looked at women who owned dogs. This new study was larger, showed that men also benefit from having pets, and found that cats offer the same stress relief. This surprised Allen, who owns a 14-year-old dog, but, she admits, "cat owners were not surprised."

It's possible that most any pet you're attached to would confer similar results, she says: "It depends on how you feel about your animal."

Susan Everson-Rose, an associate professor of preventive medicine at Rush-Presbyterian-St. Luke's Medical Center in Chicago, studies how risk factors influence cardiovascular disease.

"Pets really do have a calming effect," she says. In the Buffalo study, the cardiovascular benefits of having a pet versus not "were pretty noticeable. Presumably, extrapolated over time, (people with pets) could have lower rates of cardiovascular disease."

Allen says that based on these new findings, if one likes animals and can handle the responsibility, getting a pet might be a good option. "They have excellent behavioral and cardiovascular benefits," she says.

Allen next plans a follow-up study using virtual reality to determine whether thinking about one's pet or seeing a picture of one's furry friend can confer similar benefits.

What To Do

To read about a previous study by Allen that found pets help reduce blood pressure in stressed-out stockbrokers, visit Oregon Health and Science University. And this story in the Detroit News described how pets help cut stress in the workplace.

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HMOs May Keep Low Grades Secret  

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, September 24, 2002

CHICAGO (AP) - A widely publicized annual "report card" on America's health maintenance organizations may be misleading because poor-scoring HMOs are more likely than top performers to withhold their grades, a study suggests.

The researchers looked at an annual survey prepared by the National Committee for Quality Assurance, an HMO accrediting group.

The public has been led to believe that report card includes good and bad scores alike, said Dr. Danny McCormick, a study author and Harvard Medical School ( news - web sites) instructor. But "that turns out not to be the case."

Brian Schilling, spokesman for the accrediting group, said that while there should be broader reporting on quality by HMOs and other health-care groups, improvements have been made since the study was done. Schilling said the group's recent annual survey showing improvements is an accurate general assessment of HMO quality nationwide.

The private, nonprofit group grades HMOs on how well they adhere to medical practice standards. It looks at such things as heart attack treatment, annual mammograms and childhood immunizations.

Accredited HMOs are required to submit data for grading and since 1999 also have been required to allow it to be publicized. But unaccredited HMOs that voluntarily submit data can still keep their scores secret.

The study reviewed practices from 1997 to 1999. The findings appear in Wednesday's Journal of the American Medical Association ( news - web sites).

Of 329 HMOs that allowed public disclosure in 1997, 161 — nearly half — asked that their scores the following year be kept secret. And of the 292 plans that allowed public disclosure in 1998, 67, or 23 percent, withdrew from public disclosure in 1999.

Plans with poor scores were at least three times more likely than high-scoring plans to withdraw from public disclosure the subsequent year.

The latest report card, released this month, said HMOs have made progress in improving patients' access to screenings and other disease prevention methods. But about 15 percent of unaccredited plans that submitted data for this year's survey asked that it be kept secret.

About 300 of the nation's estimated 500 HMOs are accredited, meaning they have passed an on-site evaluation.

Karen Ignagni, president of the American Association of Health Plans, a managed-care trade group, said the study uses outdated data. She said most HMOs report quality information publicly, either to the accrediting group or to state or local authorities.

On the Net:

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

NCQA: http://www.ncqa.org

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Hepsera to Fight Hepatitis B 

HealthScoutNews

Tuesday, September 24, 2002

TUESDAY,Sep. 24 (HealthScoutNews) – The U.S. Food and Drug Administration ( news - web sites) has approved a new drug therapy for treatment of the liver-destroying condition hepatitis B.

The new drug, whose generic name is adefovir dipivoxil, will be sold as Hepsera. The dosage is one tablet daily. Research has shown that liver cirrhosis was improved in between 56 percent and 66 percent of patients tested.

Hepsera is an alternative to the only other two hepatitis B drugs on the market, interferon and lamivudine - - patients can become resistant to one of the drugs, and the other can cause side effects that some can't tolerate.

Once contracted, Hepatitis B is a stubborn viral infection that usually stays with a person his or her entire life. Most of the 1.25 million Americans who have Hepatitis B got the condition in childhood, when vaccinations weren't available.

Hepsera's maker, Gilead Sciences Inc., says it expects to begin shipping the drug to distribution points in October.

Here is the FDA Talk Paper announcing the approval.

And this page from the U.S. Centers for Disease Control and Prevention ( news - web sites) offers an excellent Hepatitis B fact sheet.

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FDA Gives Peanut-Allergy Drug Fast-Track Status 

Reuters Health

Tuesday, September 24, 2002

NEW YORK (Reuters Health) - The maker of an experimental drug to treat peanut allergies reported Tuesday that the US Food and Drug Administration ( news - web sites) has given the medication fast-track status.

The drug, TNX-901, is made by Tanox Inc.

The fast-track designation, intended for products that address an unmet medical need, entitles Tanox to meetings with the FDA for the agency's input on development plans, the option to submit its US marketing application in sections, and the option to base that application on surrogate endpoints.

TNX-901 is an antibody to IgE, an immune system protein that interacts with inflammatory cells to produce many of the symptoms resulting from exposure to allergens. The drug is being developed to provide protection against reactions to unintentional peanut ingestion by people who have a severe allergy to peanuts.

The drug recently completed a phase II trial, and additional studies are being planned, the Houston-based company said.

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Study: Breeding Could Avert Mad Cow  

By Paul Recer

AP Science Writer

The Associated Press

Tuesday, September 24, 2002

WASHINGTON (AP) - In a study that could help develop cattle bred to resist mad cow disease, researchers showed in a laboratory experiment that a mutated protein may protect animals from the prion protein that causes the brain-destroying disorder.

Researchers at the University of California, San Francisco, reported that they genetically altered a strain of mice so the animals made a mutated form of prions which then prevented the animals from becoming ill when injected with a form of prion that usually causes the brain disease.

"We found that the (genetically engineered) mouse became completely resistant to the prion disease," said Dr. Jiri G. Safar, a co-author of the study appearing this week in the Proceedings of the National Academy of Sciences ( news - web sites).

Safar said he and his colleagues now hope to develop a genetically engineered strain of cattle which is resistant to mad cow, known formally as bovine spongiform encephalopathy ( news - web sites), or BSE ( news - web sites).

Patrick W. Dunne, a veterinary scientist at Texas A&M and a BSE researcher, called the study by Safar and his colleagues "a breakthrough."

"This means that prion diseases in livestock could be at least inhibited, if not eliminated," said Dunne. "It is a very significant finding."

Prion diseases include BSE in cattle, scrapie in sheep and Creutzfeldt-Jakob Disease ( news - web sites) in humans. There is also a related wasting disease in deer and elk. The diseases are caused by an abnormal form of the prion protein that makes the normal form of prion change its shape and become infectious. The abnormal prion causes the progressive, irreversible destruction of brain cells. The disease is fatal in all species where it occurs.

An epidemic of mad cow disease developed in Britain in the 1980s after cattle there were given feed that included body parts from sheep with scrapie. Researchers later found that some people developed a form of prion disease, called new variant-Crutchfeld-Jacob Disease, after eating meat from infected cattle. The discovery caused a temporary ban on the import of British beef in many countries and the destruction of thousands of cattle in the United Kingdom.

More than 100 people in Europe have been diagnosed with new variant-CJD, but that form of prion disease has not been diagnosed in the United States. A type of CJD not related to eating meat, however, does occur in the United States.

In the new study, Safar and his co-authors, which includes Stanley B. Prusiner, who was awarded a Nobel Prize for discovering prion disease, found that by altering the genes of mice they could make the animals resistant to the brain-destroying disease.

Safar said earlier studies in Japan and elsewhere had suggested that some mutated forms of prion prevented the disease-causing form of the protein from causing disease.

To test this idea, researchers engineered a mouse strain with genes that caused key changes in the amino acids that make up the prion protein. When mature, the mice were injected with high doses of the disease-causing form of prion.

Although some of the test animals did form some pathogenic prions, none of them developed the full blown prion disease. Safar called this the "silent expression" of the diseased prion.

In contrast, mice with the normal type of prion developed a fatal brain disorder when they were injected with the disease-causing form of prion.

With selective genetic engineering, Safar said, "it is possible we could wipe out even the silent expression and transmission of the pathogenic prion."

Safar said that altering the prion gene to make it resistant to the disease is better than eliminating the gene altogether, as some have suggested. Taking out the gene altogether, he said, could cause subtle health changes in the animals since normal prions play a role in brain cell maintenance.

On the Net:

Proceedings of the National Academy of Sciences: www.pnas.org

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Man-Made Molecule May Thwart Brain Cancer 

By Keith Mulvihill

Reuters Health

Tuesday, September 24, 2002

NEW YORK (Reuters Health) - Scientists are hoping that an engineered molecule that homes in on brain tumor cells could one day be used to treat patients with glioblastoma, a deadly and difficult to treat form of brain cancer that accounts for about 40% of all primary brain tumors.

But before human trials can take place, the team of researchers must conduct further experiments to determine whether the drug has any harmful side effects.

Dr. Walter A. Hall of the University of Minnesota in Minneapolis presented his team's findings Monday at the 52nd annual meeting of the Congress of Neurological Surgeons in Philadelphia, Pennsylvania.

Hall told attendees that the molecule, nicknamed DTAT, is made up of three parts. One part seeks out and zeros in on glioblastoma cells and "actually sticks itself to the cell." The second, or middle part, of DTAT helps the molecule penetrate the cell, and the third part, the poison, is made up of diphtheria toxin.

Diphtheria is caused by bacteria that primarily attack the larynx, tonsils and throat. The toxin produced by the bug can damage the nerves and heart. When used in DTAT, the protein interferes with the tumor's ability to form new blood vessels.

In the investigation, Hall and colleagues took human tumor cells, implanted them into the brains of mice and let them grow for 2 weeks. Then they treated the mice with an injection of DTAT directly into the tumor every other day for 6 days.

"All of the treated mice had a greater than 90% reduction in tumor size, and followed over time, 60% had a complete and permanent cure," Hall told attendees.

The next step, Hall explained in an interview with Reuters Health, is for the team to determine whether or not the drug is toxic to humans. To do that, the researchers plan to conduct more studies in mice and monkeys.

If those experiments pan out, Hall says his team will seek permission from the US Food and Drug Administration ( news - web sites) to test the new drug in glioblastoma patients.

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Group Seeks Awareness for Deadly Disease 

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 24, 2002

TUESDAY, Sept. 24 (HealthScoutNews) -- For years, doctors have misdiagnosed ataxia as multiple sclerosis or other illnesses, preventing this rare but deadly congenital disease from getting the attention and research it deserved.

But over the last 10 years, scientists have identified 15 strains of ataxia, which affect an estimated 150,000 Americans. To find a treatment and cure for the disease, though, advocates say much more research has to be done. So to raise money and attention for the cause, the National Ataxia Foundation is sponsoring International Ataxia Awareness Day tomorrow, Sept. 25.

Ataxia can strike anyone at any time, says Donna Gruetzmacher, the foundation's executive director. Many times, people do not know they carry an ataxia gene until they have children displaying signs of ataxia.

The disease acts by killing off cells in the cerebellum section of the brain and spinal cord, which limits the brain's ability to communicate with the body. At first, it affects balance, coordination and speech -- hence the misdiagnosis of multiple sclerosis -- but it eventually damages the heart, sight and hearing. It also leaves its victims prone to infections and leukemia.

As a congenital disease, ataxia can strike every other child in some families. However, it also appears sporadically. Some strains attack children and young adults, while others more commonly affect older people.

"There are some medications, and nutrition and exercise are important. But there is no silver bullet that can cure it," says Michael Parent, the foundation's director of development. "The bottom line is money. The more money we can spend funding research, the better chance we will have of beating this."

During Ataxia Awareness Day, in its third year, families will burn blue or white candles for loved ones who are stricken with the disease or have died from it. They also hold local fund-raisers to help pay for future research projects by the foundation. In just the last three years, using money from the fund-raisers and other donations, the foundation has paid for 37 research projects in six countries.

One research project by Columbia University last year showed that a vitamin supplement that helps produce energy within cells is a promising treatment for ataxia. In one case, a wheelchair-bound patient walked again with some assistance after treatment, and a woman was able to work outside her home for the first time.

One of the most progressive forms of ataxia that generally attacks children is ataxia telangiectasia, or AT. About one in 40,000 children is born with the illness, and they generally don't live to adulthood.

"The kids are usually in wheelchairs by age 10, and then it's often fatal by the early teens. It's a terribly tragic disease," says Jennifer Thornton, executive director of the AT Children's Project. "It's very hard on families."

The strain of ataxia is also passed from one generation to the next. But by the time a child is 18 months to 3 years old, parents usually notice something is wrong with their motor skills. It's at that point when families need support and a proper diagnosis of the illness, she says.

"We're funding research into many, many areas right now. We're leaving no stones unturned. Hopefully, the advances in medical research and our own work will lead us to a cure," Thornton says. "We certainly support the National Ataxia Foundation in its efforts to increase awareness."

What To Do

To learn more about International Ataxia Day, visit the National Ataxia Foundation, which also has a map of local support groups. Meanwhile, the National Institute of Neurological Disorders and Stroke has more on ataxia telangiectasia.

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Exercise-Linked Asthma Varies with Time of Day 

Reuters Health

Tuesday, September 24, 2002

NEW YORK (Reuters Health) - Asthma patients who experience wheezing, chest tightness or difficulty breathing when they exercise may have worse lung function in the evening than in the morning, according to new study findings.

Exercise type, environmental conditions, asthma severity and pre-exercise treatment are all known to influence the occurrence and severity of these problems, known as exercise-induced bronchospasm, Dr. Elcio O. Vianna from the University of Sao Paulo in Brazil, and colleagues note. In contrast, relatively little attention has been given to the effect that time of day has on the condition.

In the current study, the researchers conducted exercise tests in 22 people with asthma and 12 healthy ("control") patients at 7 AM and 6 PM. The intensity of the lung spasms were graded during exercise according to the maximum fall in a measure of lung-function known as forced expiratory volume. The findings are published in the August issue of the Journal of Allergy and Clinical Immunology.

For asthmatic patients, lung function problems were more likely in the evening than in the morning. The exercise-induced lung spasm scores were 14.8% in the morning compared with 21.4% in the evening. No changes related to the time of day were seen in the control group of healthy patients.

The current findings suggest that exercise-related asthma tests may not be accurate if performed in the morning.

"The time of day that an exercise challenge is performed might interfere with the yield of the test," the authors state.

Source: Journal of Allergy and Clinical Immunology 2002;110:236-240.

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Snuff Doesn't Help Pinch Smoking 

HealthScoutNews

Tuesday, September 24, 2002

TUESDAY, Sept. 24 (HealthScoutNews) -- Despite messages that snuff tobacco may help people quit smoking, it may actually do the opposite.

That's the finding of new research that appears in the October issue of the American Journal of Preventive Medicine. The study says people who use snuff are more likely to move on to smoking cigarettes.

Snuff is a finely milled tobacco product with nicotine. People who use it place a "pinch" or a "dip" of snuff between their lip and gum.

Study author Scott L. Tomar of the University of Florida College of Dentistry says his findings disprove suggestions that snuff may be a useful way to help people quit smoking.

"The prevalence of smoking was substantially higher among men who had quit using snuff than among those who had never used snuff, suggesting that more than 40 percent of men who had been snuff users continued or initiated smoking," Tomar says.

He analyzed data for men 18 and older contained in the 1998 National Health Interview Survey (NHIS). It showed that 26.4 percent of American men smoked, 3.6 percent used snuff and 1.1 percent used both forms of tobacco.

In the NHIS report, 2.5 percent of former snuff users had become smokers, while 0.9 percent of former smokers were using snuff. That information suggests snuff may be a gateway to tobacco use, Tomar says.

More information

The Surgeon General has a strong caution for kids on smokeless tobacco.

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Study Raises Questions on Transfusions for Very Ill 

By Merritt McKinney

Reuters Health

Tuesday, September 24, 2002

NEW YORK (Reuters Health) - Critically ill patients often receive blood transfusions to treat anemia, a deficiency in red blood cells that carry oxygen to tissues and organs, but in a new study, patients who received transfusions were more likely to die than those who did not.

The findings do not prove that transfusions were to blame for the deaths, but they do caution against the overuse of transfusions, according to Dr. Jean Louis Vincent of the University of Brussels in Belgium, the study's lead author.

"Our study showed anemia is very common in acutely ill patients," Vincent told Reuters Health. But in the study, he said, the blood transfusions that are often used to treat anemia were associated with an increased risk of death and organ dysfunction.

Despite the possible connection between transfusions and an increased rate of death and complications, Vincent said that the findings do not mean that critically ill patients should not have blood transfusions.

"There is no reason to panic about blood transfusions," he said, "but people should understand it is better to avoid them as much as possible."

For example, according to Vincent, "there is no place anymore" for giving a patient a blood transfusion right before hospital discharge "just to give some strength."

Patients in intensive care are often anemic, and transfusions of red blood cells are routinely given to boost oxygen in their blood. Whether transfusions are the best treatment for anemia is not clear, though.

To investigate, Vincent's team carried out a two-pronged study in critically ill patients. In one part of the study, researchers tracked how often intensive care unit (ICU) patients had blood drawn and how much blood was taken during a 24-hour period. During the second part of the study, the researchers kept track of how many blood transfusions patients received. They also monitored levels of hemoglobin--the oxygen-carrying component of red blood cells--and kept track of the rate of deathand organ dysfunction.0

The first phase of the study, which included more than 1,100 patients, found that almost half of the patients (46%) had five or more blood samples drawn in a single day. On average, patients lost 41 milliliters of blood in a day.

Anemia was common in the second part of the study, with 29% of patients having hemoglobin levels below 10 grams/deciliter. Thirty-seven percent of patients had at least one transfusion while in the ICU and about 13% had a transfusion after being transferred out of the ICU.

Overall, patients who had received a blood transfusion were more likely to die within 28 days of being admitted to the ICU, Vincent and colleagues report in the September 25th issue of The Journal of the American Medical Association ( news - web sites). Nearly 19% of transfused patients died during that time, compared with 10% of those who did not receive a transfusion. Patients who received the most red blood cells were most likely to die.

Even when the researchers compared transfused and non-transfused patients matched by the severity of their condition, transfused patients were still more likely to die during the study period, the report indicates.

The results do not prove that transfusions are the reason why transfused patients were more likely to die as well as to experience organ dysfunction, but they do support the need for alternative treatments for anemia, according to the authors. They point out that a drug called erythropoietin has been shown to reduce the number of blood transfusions critically ill patients need.

They also suggest that strategies to minimize the amount of blood drawn from patients may reduce the need for transfusions.

In an editorial accompanying the study, Drs. Paul C. Hebert and Dean A. Fergusson of the Ottawa Health Research Institute in Ontario, Canada, note that there is scant research on the effects of transfusions in critically ill patients.

This study and others like it "should bring much-needed evidence to help answer many of the important remaining questions regarding red blood cell transfusions and the use of blood conservation strategies for critically ill patients," the editorialists state.

The study was funded by grants from the Robert Wood Johnson Pharmaceutical Research Institute and Janssen-Cilag, a company that markets recombinant erythropoietin for the treatment of anemia.

Source: The Journal of the American Medical Association 2002;288:1499-1507, 1525-1526.

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Lending an Ear to Pregnancy Dangers 

HealthScoutNews

Tuesday, September 24, 2002

TUESDAY, Sept. 24 (HealthScoutNews) -- Support from health-care professionals can play an important role in helping low-income pregnant women quit drinking and smoking.

That's the claim of a new study in the October issue of the American Journal of Preventive Medicine.

"The frequent contacts women have with health professionals during pregnancy may provide valuable opportunities to discuss alcohol and tobacco use and encourage behavior changes," says study author Judith K. Ockene, a professor of medicine and chief of the division of preventive and behavioral medicine at the University of Massachusetts Medical School. Smoking and alcohol pose health threats to unborn children.

Ockene and her colleagues studied interviews with 600 pregnant women in the Boston area who were current smokers or had quit when they learned they were pregnant. They were receiving prenatal care from a publicly funded program.

Most of the women were unmarried and more than 40 percent of them had less than a high school education.

The study found the women were more likely (80 percent) to stop drinking than quit smoking (27 percent) when they learned they were pregnant. Pregnant black women were less likely than white or Hispanic women to quit smoking.

The women who quit drinking alcohol when they learned they were pregnant were more likely to have social support. The study says health professionals can fill that gap by providing support to women who don't get if from family and friends.

"It is important for clinicians to be aware of and acknowledge the difficulties these women face, and to help them develop motivation and skills to engage their partners and support systems in their cessation attempts," Ockene says.

Women who didn't quite smoking were more likely to be less educated, have a greater addiction to nicotine, and have a partner who smoked, the study says.

More information

The American Lung Association has more information on smoking and pregnancy and the National Institute on Alcohol Abuse and Alcoholism has more on alcohol-related problems.

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Frito-Lay to Eliminate Trans Fat in Popular Brands 

By Alan Mozes

Reuters Health

Tuesday, September 24, 2002

NEW YORK (Reuters Health) - Frito-Lay, the largest producer of snack food products in the US, announced plans Tuesday to eliminate all trans fat from three of its most popular brands of chips--Doritos, Cheetos, and Tostitos.

Trans fat will be removed from the products by early next year by replacing the soybean oil currently in use with corn oil, company representatives said during a telephone press conference.

Trans fat is formed when vegetable oils are partially hydrogenated to make them more stable and solid, and recent evidence suggests that they may be as bad for the heart as saturated fat. Trans fats are found in margarine, baked goods and other processed foods, and they are used by restaurants for frying.

McDonald's Corp. announced earlier this month that it will begin cooking its fries--as well as its Chicken McNuggets, Filet-O-Fish, hash browns, and crispy chicken sandwiches--in a new oil that reduces trans fatty acids by 48% and saturated fat by 16%.

The President and Chief Executive Officer of Frito-Lay North America, Abelardo E. Bru, told Reuters Health that together the three products represent "about half of our business."

Bru and Frito-Lay consultant Dr. Kenneth Cooper of the Cooper Aerobics Center said the switch demonstrates the company's interest in fighting obesity among American adolescents by providing a broader range of snacks.

Although the Doritos, Cheetos, and Tostitos brands will no longer contain trans fat-containing oils, a comparison of "nutrition fact" labeling reveals that both the total calorie content and overall fat content of all three foods will remain almost exactly the same after the switch.

For example, the "Cheetos Cheese Flavored Snacks-Crunch" brand, which currently contains 160 calories per serving and 90 grams of fat, will still contain those amounts after replacing soybean oil with corn oil.

However, the introduction of trans fat-free Doritos, Cheetos, and Tostitos in 2003 will be supplemented by the December release of some additional reduced fat chips. Lay's Reduced Fat chips and Cheetos Reduced Fat snacks will, according to company representatives, have a 25% reduction in total fat content and a 60% reduction in saturated fats. Both will contain no trans fat-containing oils.

Cooper and Bru noted that in addition to product content alterations, the company is currently developing an outline of brief fitness and nutrition "tips," which it plans to feature on its' snack packaging beginning in early 2003.

The use of trans fats became popular in the late 1960s, after saturated fats were conclusively linked to an increased risk of heart disease.

Washington, DC-based consumer watchdog group Center for Science in the Public Interest (CSPI) had guarded praise for the Frito-Lay decision.

"It's nice to see that Frito-Lay is starting to worry about the nutritional profile of its snack foods," executive director Michael F. Jacobson said in a statement. "It should worry, because many of its products are high in fat and largely devoid of vitamins and minerals. Eliminating trans fats, which promote heart disease, would be a valuable step in the right direction."

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Binge Eating Disorder 

HealthScoutNews

Tuesday, September 24, 2002

(HealthScoutNews) -- Binge eating disorder, among the most prevalent eating disorders in this country, affects about two percent of adults. Most of them are overweight or obese. Many have been struggling with the affliction since childhood.

 Unfortunately, many who have made an effort to break the binge eating habit have done so independently -- without support from a doctor or other health care professional. And if people with the disorder weren't already depressed, their failed attempts to become "normal" eaters may make them so.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) strongly encourages consultations with a health professional such as a psychiatrist, psychologist, or clinical social worker for those with this behavior. They can offer help with the typical psychological symptoms of binge eating -- including anger, sadness, boredom, worry and impulsive behavior.

The good news, NIDDK says, is that most people respond well to treatment.

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Drugs Could Avert Many Diabetes-Linked Amputations 

By Ned Stafford

Reuters Health

Tuesday, September 24, 2002

FRANKFURT (Reuters Health) - A significant percentage of amputations stemming from complications of diabetes could be avoided by early and proper treatment with antibiotics, according to a German researcher.

Foot ulcers are a common problem for people with diabetes, whose poor circulation and loss of sensation in the feet can lead to difficult-to-heal ulcers. Such ulcers can cause foot deformities or even lead to amputation.

Dr. Bernd Drewelow, director of the Institute for Clinical Pharmacology at the University of Rostock, told Reuters Health that about 25,000 to 30,000 people in Germany alone undergo foot amputations each year stemming from "diabetic foot syndrome," which reduces blood circulation to the foot and can cause tissue death.

Bacterial infections play a role in about 40% of all diabetic foot syndrome-related amputations, Drewelow said. He estimates that 20% to 50% of amputations stemming from bacterial infections could have been avoided with early, effective antibiotic treatment.

"Using antibiotics to treat diabetic foot syndrome could save a lot of feet," he said.

But many physicians treating diabetic foot syndrome are unaware of the possibility of infection, Drewelow said.

"I think this is a problem all over the world," he said.

Drewelow and his team have been focusing on two newer antibiotics, linezolid and moxifloxacin, which are used to treat pneumonia and other respiratory infections.

Because of poor blood circulation in the feet, many antibiotics can't reach the infected areas in concentrated enough form to be effective, he noted. Emphasizing that further study is necessary, Drewelow said that early research suggests linezolid and moxifloxacin in some cases can reach infected areas at sufficient concentrations.

Furthermore, he said, the drugs also appear to be effective in fighting some of the most common bacteria associated with diabetic foot syndrome.

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Banned on the Run 

HealthScoutNews

Tuesday, September 24, 2002

(HealthScoutNews) -- Americans are increasingly eating on the run. Students, teachers, office workers and others chug down heavy-duty carbohydrates as they rush out the door in the morning. A similar process is repeated at lunch time, except the foods of choice now tend to be fatty, greasy, sauce-enhanced and sugary. And too many people do the same thing at dinnertime, or between meals.

The Weight Control Information Network (WIN) suggests these healthier alternatives:

  • Focus on fruits in the morning. Many are easy to eat on the run, and most offer enough sugar for the energy you need without the fat and extra calories you don't need.
  • Choose a salad or a grilled (not fried) chicken sandwich rather than a burger at fast-food restaurants. And skip the fries -- or split an order with a friend.
  • Avoid thick, creamy sauces. You'll live healthier without them.
  • Take ready-made, low-fat snacks with you to work. Better yet, take no-fat snacks -- any kind of veggies, including carrots (but not too many, since theyre high in sugar), celery, radishes, collard or kale greens, broccoli and green beans. These and other vegetables are actually healthier if they aren't cooked.
  • Graham crackers, pretzels, raisins and nuts also make good on-the-go foods -- though you should go easy on the nuts and raisins since they are high in calories.

The best advice is to balance your meals throughout the day. If you have a high-fat or high-calorie breakfast or lunch, make sure you eat a low-fat dinner.

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MONDAY, SEPTEMBER 23, 2002 

Moderate Drinking May Help Control Blood Sugar 

Reuters Health

Monday, September 23, 2002

NEW YORK (Reuters Health) - Drinking moderate amounts of wine, beer or hard alcohol is associated with better blood glucose (sugar) control among healthy adults, particularly women, study findings indicate.

The researchers used hemoglobin A1C (HbA1c), a test that gauges a person's average blood sugar over the past 2 to 3 months. High blood sugar over the long term among non-diabetic people, as measured by HbA1c, has been linked to an increased risk of death from all causes as well as death from heart and blood vessel disease. High HbA1c levels can also indicate an increased risk of developing type 2 diabetes.

Women who drank any kind of alcohol had lower HbA1c, regardless of their body mass index (BMI). BMI is a measure of a person's weight in relation to their height and is used to gauge obesity.

In men, however, only wine was associated with healthier blood glucose levels, the researchers report in the September issue of the European Journal of Clinical Nutrition. They suggest that lifestyle and personality traits associated with wine drinking may account for the finding, as previous studies have linked beer drinking among men to smoking, hostility and a less healthy diet.

Drinking wine, on the other hand, is associated with healthy lifestyle behaviors such as not smoking and avoiding obesity, as well as a higher level of education. Wine also tends to be consumed with meals, which would blunt the effects of alcohol on the body.

Whatever the reason, the results support those of previous studies and "provide further evidence that moderate alcohol consumption may be one component of a healthy lifestyle," conclude Dr. N. J. Wareham from the University of Cambridge in the UK and colleagues.

The results are based on written interviews with more than 6,400 white adults aged 40 to 78 who were participating in a study on diet and chronic disease. Overall, adults who consumed the most alcohol tended to be younger and to have lower blood glucose levels. Those who consumed alcohol also tended to be more educated, to smoke and to report exercising.

BMI declined as alcohol intake rose among women. Among men, however, BMI rose in tandem to the amount of alcohol consumed. Men and women also differed in the type of alcohol they drank. Men drank more beer, while women tended to drink more wine. Fruit and vegetable consumption was associated with wine but not beer intake.

Source: European Journal of Clinical Nutrition 2002;56:882-890.

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You Will Be What You Eat 

By Lisa Girard
HealthScoutNews Reporter

HealthScoutNews

Monday, September 23, 2002

MONDAY, Sept. 23 (HealthScoutNews) -- Want to know what your body will look like -- buff and trim or pear-shaped and flabby -- 10 years from now?

Take a look at what's on your plate today.

Researchers from Boston University examined the eating habits of 737 women over a 12-year period. Their findings: Those who ate a low-fat, healthy diet were much less likely to become overweight than those whose diet was dominated by animal and vegetable fats, sweets, meats and sweetened beverages.

The results of the study appear in the September issue of the Journal of the American Dietetic Association.

At the start of the research, the group of non-overweight women responded to a 145-item food frequency questionnaire. Based on their responses, they were put into five categories: "Heart Healthy," "Light Eating," "Wine and Moderate Eating," "High Fat" and "Empty Calorie."

Habitual dietary intake was examined at the baseline and documented periodically over the 12 years. The results showed the risk of becoming overweight was 29 percent overall, ranging from 24 percent "Heart Healthy" group, to 41 percent in the "Empty Calorie" cluster.

Women in the "Empty Calorie" group ate a diet rich in sweets and fats with fewer servings of nutrient-dense fruits, vegetables and lean food choices. Meanwhile the "Heart Healthy" eaters had a more varied diet and consumed a higher percentage of vegetables, fruits, low-fat milk, legumes and refined grains. "Heart Healthy" eaters were also more likely to engage in other healthy behaviors, such as not smoking and exercising more frequently.

"We tend to think about diet, physical activity and smoking in isolation, but they are probably heavily linked," says study co-author Barbara Millen, associate dean for research and a professor of public health and medicine at Boston University's School of Public Health.

"If your diet is pretty good, you're more likely to be a nonsmoker and more likely to be someone who exercises. It's a combination of factors that contributes to overall health," she says.

The study showed that women in the "Light Eating" and "Wine and Moderate Eating" groups were more likely to have fluctuation in their weight over the 12-year period, with 30 percent in the "Light Eating" group becoming overweight. Millen attributes this to chronic dieting in these groups, as well as a higher fat and saturated fat intake in comparison to those in the "Heart Healthy" section.

Also noteworthy was that women in the "Empty Calorie" segment tended to be younger and more likely to smoke than women in the healthier eating groups.

"Women who are older and have been treated medically for certain problems tend to be more conscious of what they eat," says Millen. "In younger age people, those influences aren't in effect yet. They're relatively healthy, so they don't think about what they eat as much."

Susan Moores, a spokeswoman for the American Dietetic Association, says that although the study results may not be surprising, they should remind health professionals to recommend a full, healthy diet to their patients and clients, and not just focus on certain areas of a person's diet, such as fat or calcium intake.

"We tend in the nutritional field and the health field to look at increments of diet, focusing on specific things when we should be looking at the whole diet," Moores says.

"What a health professional can take from this study is that if a patient or client is eating mostly empty calories, unless they change their eating habits, over the years they will gain weight," she adds.

The Boston researchers note that excess weight and obesity are major public health problems in the United States. More than half of all U.S. adults are overweight and 22 percent are obese -- conditions that can lead to cardiovascular disease, hypertension, diabetes, gallbladder disease, cancer, arthritis and pulmonary dysfunction.

What To Do

For more information on nutrition and health, visit the American Dietetic Association. Or check the U.S. Department of Agriculture ( news - web sites)'s Food Guide Pyramid.

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Study: Humans, Chimps More Different  

The Associated Press

Monday, September 23, 2002

WASHINGTON (AP) - There are more differences between a chimpanzee and a human being than once believed, according to a new genetic study.

Biologists have long held that the genes of chimps and humans are about 98.5 percent identical.

But Roy Britten, a biologist at the California Institute of Technology, said in a study published this week that a new way of comparing the genes shows that the human and chimp genetic similarity is only about 95 percent.

Britten based this on a computer program that compared 780,000 of the 3 billion base pairs in the human DNA helix with those of the chimp. He found more mismatches than earlier researchers had, and concluded that at least 3.9 percent of the DNA bases were different.

This led him to conclude that there is a fundamental genetic difference between the species of about 5 percent.

Britten said the new study, appearing this week in the Proceedings of the National Academy of Sciences ( news - web sites), should help biologists figure out how species branched out from each other over the course of evolution.

"A large number of these 5 percent of variations are relatively unimportant," he said in a statement. The next step is to compare how the genes are regulated in the two species and find out where all the genetic differences are located in the DNA, he said.

On the Net:

Proceedings of the National Academy of Sciences: http://www.pnas.org

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You May Have Diabetes and Not Know It 

HealthScoutNews

Monday, September 23, 2002

(HealthScoutNews) -- As many as one third of Americans who have diabetes don't know it and may need treatment, government experts say.

"Treatment" in this instance means learning to manage a disease that, if not controlled, can cause or contribute to kidney failure, blindness, heart disease and stroke. Ironically, two of the principal treatment protocols for diabetes -- healthy eating and physical activity -- are identical to practices recommended to prevent diabetes.

Individuals most at risk for diabetes include those who have an inactive lifestyle, a family history of diabetes and an overabundance of body mass. If you know someone fitting that profile, and they often complain of excessive thirst, excessive hunger and/or excessive urination, suggest that they report those issues to their doctor.

If their symptoms include blurred vision, unintended weight loss, tingling or numbness in feet or hands, sores that are slow to heal, and/or dry itchy skin, offer to dial their doctor's number.

Unfortunately, diabetes sufferers may show only a few, or none, of those symptoms. Their condition can only be accurately diagnosed through blood tests.

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'Drug Holidays' Not Beneficial for Fighting HIV 

Reuters Health

Monday, September 23, 2002

NEW YORK (Reuters Health) - Despite hopes that taking regularly scheduled breaks from combination drug therapy would train the immune system to keep HIV ( news - web sites), the virus that causes AIDS ( news - web sites), under control, a new study fails to detect any benefit of such "drug holidays."

Once a person becomes infected with HIV, levels of the virus in the blood rise, but eventually this level, known as viral load, stabilizes at a certain point, which varies from person to person. This so-called set-point viral load is a good indicator of how quickly a person will progress to AIDS without treatment.

Since the mid-1990s, many people with HIV have had their viral load suppressed to undetectable levels thanks to powerful combination drug therapy. Although combination therapy has been life-extending for many people, the drugs are expensive and can have serious side effects. In addition, some people have a hard time sticking to the complicated regimen of daily pills.

A few reports have suggested that structured, physician-supervised breaks from combination therapy may improve the ability of the immune system to fend off HIV. The hope was that repeatedly exposing the immune system to HIV during short drug vacations might lower the set-point viral load.

In a study of 97 patients with chronic HIV infection, however, that did not turn out to be the case, according to an online report in the Proceedings of the National Academy of Sciences ( news - web sites) Early Edition. Dr. Annette Oxenius, of the Eidgenossische Technische Hochschule in Zurich, Switzerland, found that viral load was slightly lower after drug vacations, but the difference was very small.

But taking a break from combination therapy did not affect immune cells called CD8 T-cells that specifically target HIV. Only those patients who had a vigorous CD8 response to HIV before taking a break continued to do so afterwards.

The researchers conclude that structured treatment interruption is "generally unable" to alter how a person's immune system responds to HIV. The authors point out, however, that the study included patients who were chronically infected with HIV. Research has shown that structured treatment breaks for newly infected patients can alter the immune response to HIV.

Source: Proceedings of the National Academy of Sciences Early Edition 2002;10.1073/pnas.202372199.

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Need Health Info? Federal Libraries Can Help 

HealthScoutNews

Monday, September 23, 2002

(HealthScoutNews) -- Of this country's four national libraries, only one -- the Library of Congress ( news - web sites) -- doesn't focus on health and medicine. The National Agricultural Library, National Library of Medicine and the National Network of Libraries of Medicine offer incredible amounts of material about our physical well-being.

 The National Library of Medicine is the world's largest biomedical library. Since 1997, its MEDLINE database of more than 8.8 million references to articles published in 3800 biomedical journals has been accessible free of charge on the World Wide Web.

The National Network of Libraries of Medicine, consisting of eight regional medical libraries, includes comprehensive biomedical and health care information resources. The Network also encompasses 136 resource libraries (primarily at medical schools), and some 3,800 Primary Access Libraries (primarily at hospitals). Resources for medical librarians are provided through the regional medical libraries across the country.

The National Agricultural Library spans 10 specialized information centers as well as an online public catalog and a journal article citation database. AGRICOLA -- the AGRICultural OnLine Access system -- catalogs citations from books and journals covering farming, animal breeding and genetics, biology, and just about anything else related to what we eat.

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Officials Urge Flu Shots For Babies  

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, September 23, 2002

WASHINGTON (AP) - Flu-shot season begins next week, and this year marks the first time parents are being urged to get babies and toddlers vaccinated because influenza sends its tiniest patients to the hospital as often as it does the elderly.

But there's a catch: Unlike the one yearly shot most people need, the first-ever inoculation for young children requires two doses a month apart. So experts are urging parents not to delay that pediatrician visit, to be sure their kids get both shots in time.

There's plenty of flu vaccine this year, say federal health officials who estimate 94 million doses will be shipped.

Still, it takes a while to send vaccine to every doctor's office and vaccination clinic. The government is calling for people at the highest risk of severe illness during flu season to be first in line in October — and urging healthy people to wait until November to get their shots.

High-risk people include:

·        Everyone over age 50.

·        Anyone with chronic medical conditions that make them more vulnerable to the flu, such as heart or lung disorders including asthma, diabetes, kidney disease, or weak immune systems.

·        Children ages 6 months to 2 years.

·        Residents of nursing homes and other long-term care facilities.

·        Women who will be more than three months pregnant during the flu season.

·        Children of any age on long-term aspirin therapy.

November offers plenty of time for healthy people to avoid flu's misery, reassures vaccine specialist Dr. Walter Orenstein of the Centers for Disease Control and Prevention ( news - web sites). It takes only two weeks after vaccination to reap full protection, and influenza typically doesn't start causing outbreaks until late December or January. But the schedule ensures that if influenza strikes abnormally early, those most at risk of dying will be protected.

Don't feel it's OK to skip the vaccine just because recent flu seasons have been mild, Orenstein cautions. Even in a mild season, up to 20 percent of the U.S. population gets the flu, 114,000 people are hospitalized and 20,000 die. Despite that toll, only about a third of people with asthma or other flu-worsening conditions get vaccinated each year.

"If I were rolling the dice, I would err on the side of getting vaccinated because the likelihood of continuing to have mild seasons is very slim," Orenstein said.

Why this winter's focus on babies? Recent research suggests children under age 2 are as likely to be hospitalized with flu complications such as pneumonia as are people over age 65 — the age group long thought to be at highest risk. The CDC is working to confirm that, but meanwhile decided to encourage vaccinating babies age 6 months to 2 years.

The vaccine can't be given to younger infants, whose family and caregivers are urged to get vaccinated themselves so they don't spread the virus to newborns.

While the elderly are at high risk of death from flu, hospitalizing babies usually saves them. But it's traumatic and exposes babies to unnecessary antibiotics until doctors confirm they have viral flu, not a bacterial infection, says Dr. Leonard B. Weiner, pediatric infectious disease chief at the State University of New York, Syracuse. Worse, germ-filled hospitals expose already weak babies to other infections.

The American Academy of Pediatrics encouraged pediatricians to stock vaccine for more babies than ever this fall. But it will be next year before flu shots are included in the federal program that provides childhood vaccines for free to the needy, Orenstein says.

"This year some of the poor children will have more difficulty," he acknowledged.

Parents can check local health departments or charity-run vaccine clinics to see if any offer free or reduced-price toddler doses. Flu shots typically cost $20.

Older children can get vaccinated, too, if parents just want to avoid flu's misery and lost school. The two-dose requirement is for any child under age 9 who's getting a first-ever flu vaccination, because their response to the initial shot isn't protective enough. Each flu season afterward requires only one shot.

Another good protection: Wash your hands frequently. Someone who covers a sneeze with a hand and then shakes your hand has just spread a lot of germs.

And no, you can't get the flu from the vaccine, which is made from dead influenza virus. But lots of other cold viruses lurk in the fall, which people sometimes mistakenly think are the flu.

Editor’s Note — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Hormone May Signal Heart Trouble in Teens 

HealthScoutNews

Monday, September 23, 2002

MONDAY, Sept. 23 (HealthScoutNews) -- Healthy teenagers who have high levels of leptin, a hormone linked to obesity, already show the first signs of stiffening in their blood vessel walls.

That's the disturbing conclusion of a study in today's online issue of Circulation.

The loss of elasticity in artery walls is an early sign of cardiovascular disease. This study offers insight into the role of leptin in development of early cardiovascular disease and indicates a physiological connection between obesity and vascular disease, the study authors say.

The study included 294 healthy adolescents, aged 13 to 16, with a range of body mass indexes. Ultrasound tests were used to examine the teenagers' arteries, and they were measured for blood pressure, blood cholesterol, glucose, leptin and the inflammation marker C-reactive protein (CRP).

The researchers found a connection between elevated leptin levels and arterial impairment, regardless of other factors. A 10 percent increase in leptin concentration was associated with a 1.3 percent decrease in arterial elasticity.

Leptin is made by fat cells and regulates appetite and metabolism. Obese people have high leptin levels. Decreased elasticity in blood vessels means a heavier workload for the heart. In healthy people, artery walls contract and expand as blood is pumped through them.

When arteries become stiff, they don't dilate fully, and that causes reduced blood flow and greater exertion for the heart.

More information

Read more about leptin and heart disease.

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Cholesterol-Cutting Drugs May Clear Artery Build-Up 

By Jacqueline Stenson

Reuters Health

Monday, September 23, 2002

NEW YORK (Reuters Health) - Heart patients may be able to actually reverse some of the build-up of fatty plaque in their arteries by taking aggressive doses of cholesterol-lowering medications that decrease their LDL, or "bad," cholesterol levels to well below current recommendations, new research suggests.

However, experts point out that more studies are needed to prove that such an approach is both safe and effective in preventing heart attacks and strokes.

People with heart disease are advised to keep their LDL cholesterol levels below 100 milligrams per deciliter of blood (mg/dL). Doctors prescribing cholesterol-lowering drugs to these patients generally aim to get their LDL levels down to just below 100 mg/dL by initially giving a higher than usual dose of the medicine. Once the goal is reached, the dose is generally decreased to maintain this LDL level, which should prevent plaque build-up from becoming worse, explained study author Dr.Allen Taylor, director of cardiovascular research at the Walter Reed Army Medical Center in Washington, DC.

But in a study of 138 patients given one of two cholesterol-lowering drugs known as statins, the researchers kept the doses high for 1 year in an effort to dramatically lower LDL levels and then determine if this conferred any extra benefit.

At the end of one year, LDL levels had declined an average of 49% to 76 mg/dL in the group taking atorvastatin (Lipitor ( news - web sites)) and an average of 28% to 110 mg/dL in the group on pravastatin (Pravachol), according to findings published September 24th in the rapid access issue of Circulation: Journal of the American Heart Association ( news - web sites).

Both at the beginning of the study and the end, Taylor and colleagues used an ultrasound test to measure the thickness of each patient's carotid artery, a major blood vessel in the neck that carries blood to the brain. Results are viewed as a good indicator of the extent of hardening of the arteries in the heart as well.

Findings revealed that 54% of atorvastatin patients and 39% of pravastatin patients experienced a decrease in the thickness of their carotid arteries during the study period.

Previous studies have found that heart disease patients in whom plaque has stabilized, or stopped building up, were at lower risk of heart attacks and other forms of heart disease. Whether there is an added advantage to reducing the amount of plaque in arteries is still an open question.

Taylor said more studies are needed to determine whether aggressive drug therapy to lower LDL levels beyond today's guidelines is the best way to go and to understand just how these drugs may produce such an effect.

"There's this ongoing debate of how low you should go," he told Reuters Health. "The controversy is where the benefits end."

In an editorial accompanying the study, Dr. Prediman Shah, director of the division of cardiology at Cedars Sinai Medical Center in Los Angeles, California, agreed.

"While we sort these issues out with additional investigations," Shah writes, "it is, nevertheless, sound advice that all patients at risk for vascular disease or with established vascular disease should be treated with statins regardless of baseline LDL cholesterol levels, preferably using agents with proven benefits at doses with proven clinical efficacy and safety."

Source: Circulation 2002;10.1161/01.CIR.0000034508.55617.65.

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First Ad Campaign Touts Genetic Screening for Cancer 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Monday, September 23, 2002

MONDAY, Sept. 23 (HealthScoutNews) -- It probably won't go down in the annals of advertising, but this month was a momentous one for consumer health.

On Sept. 12, Myriad Genetics launched the first mass market ad campaign for a genetic test that screens for mutations in two genes -- called BRCA1 and BRCA2 -- that are strongly linked to breast and ovarian cancer. The Utah-based company hopes the media blitz, which began in Atlanta and Denver, will prompt women at high risk of inheriting these cancer genes to consider the blood screening.

The move offers a glimpse of the future of disease testing. As more ailments are tied to gene errors, companies like Myriad will develop tools to look for these faulty instructions.

However, some geneticists and consumer advocates fear the public isn't equipped to understand the meaning of a positive result on a genetic test. They worry that, at least for the time being, preventive measures haven't caught up with the ability to identify people at risk of inherited genetic diseases.

William Hockett, a spokesman for Myriad, which introduced the test in 1996, says the two cities represent about 3 percent of the pool of women eligible for the gene screening. The test costs $325 to probe for a specific mutation, and up to $2,760 for any of the roughly 2,000 known cancer-causing BRCA errors.

An estimated 10 percent of the roughly 190,000 breast cancer ( news - web sites) cases each year in this country are inherited, as are 10 percent of ovarian cancers. Most are the result of BRCA errors. Jewish women of Eastern European descent are at higher risk of carrying BRCA mutations, which sharply increase their chances of developing tumors.

Hockett says insurance companies usually cover more than 90 percent of the price of the test, though women are required to pay 10 percent up front. They may also be charged for blood work their doctor orders, as well as for office time.

The BRCAnalysis campaign -- "Be Ready Against Cancer" -- will run for five months, targeting print, radio and television outlets. Hockett says the company is spending between $2 million and $3 million on the effort, and will bring it to other markets if it proves successful in Denver and Atlanta. These two cities were also chosen because they host cancer centers familiar with inherited tumors, he adds.

The company is working with another firm that will collect blood samples from doctors who provide the test. The specimens will be shipped to Salt Lake City, where Myriad screens them for cancer mutations. The whole process, from drawing blood to the return of results, takes about two weeks.

Since its introduction, some 20,000 women have taken Myriad's BRCA test. However, because the mutations affect one in 400 women in this country, the company felt it had a much wider pool of potential interest for the technology.

Genetic testing experts and consumer advocates generally praise Myriad's campaign. However, some express reservations that the ads don't explicitly encourage women to seek genetic counseling before getting tested.

Although the ads do suggest talking with a physician, most doctors don't have the one to two hours it takes to thoroughly advise a woman about what it means to be a disease gene carrier, says Robin L. Bennett, a genetic counselor at the University of Washington.

"I do think it's a big oversight," says Bennett, who is president-elect of the National Society of Genetic Counselors. "Many genetic counselors say they do a lot of cleanup after people get tested."

The Myriad test has effectively no false positive rate. Yet, it does return vague results in a small percentage of cases, although that number is falling, Bennett says. Primary-care doctors unschooled in genetics may not understand the ambiguous finding doesn't necessarily signify the presence of a cancer mutation. "I've seen people who aren't trained in genetics assume that it must be a positive result, but that's just not true," Bennett says.

Bennett says doctors are more likely than genetic counselors to advise their patients to get tested -- in fact, counselors aren't supposed to offer an opinion either way, she says. "I see many women who will probably get tested some day, but once they speak with me they may slow that process down because they're thinking through the implications of the test."

"Knowing your risk doesn't mean lowering your risk," explains Sue Friedman, founder of FORCE, a Web site for people with cancer genes. Friedman, who previewed the print portion of Myriad's ad campaign, says her group supports raising awareness of genetic testing. However, "we would like to see heavier emphasis on the genetic counseling part," she says.

"What happens is that physicians are ordering the test for their patients and then, only after [the women] test positive are they worrying about where to send these people," she says. "Most are distraught and don't completely understand the significance of the test unless they have had a thorough pre-test counseling session."

Learning you aren't a cancer gene carrier is a huge relief if your mother died of breast cancer, Friedman says. However, she adds that women who have the gene mutations may find themselves frustrated by their prevention options, or lack thereof.

Some women with BRCA errors, especially those with a strong family history of breast cancer, choose to have both breasts removed to prevent the disease. Even this procedure doesn't completely eliminate their risk, however, since tumors can sprout from the thin layer of cells left behind by the surgeon's knife.

Some also consider the drug tamoxifen, which can reduce the risk of breast cancer by between 30 percent and 50 percent but has not yet been approved in this country for that purpose. Unfortunately, tamoxifen also raises the risk of uterine cancer, stroke and blood clots.

Another potential pitfall experts cited was regulatory oversight -- of not only the Myriad ads but those from other companies that are sure to follow. The Federal Trade Commission has authority over genetic testing claims. A spokesman for the agency declined to say if regulators had decided to review the Myriad advertisements.

Dr. Ben Wilfond, a clinical bioethicist at the National Human Genome ( news - web sites) Research Institute, says direct marketing to consumers of a genetic test has "some concerns."

"I think that there is educational value in helping people understand what genetic tests are, but it's not clear to me that ads are the best way to do that," Wilfond says. Instead, they encourage people to buy a product. As a result, some women may consider or demand the test even if they're not at high risk of breast or ovarian cancer, and their doctor may not be sufficiently discouraging.

P. Michael Conneally, president of the American Society of Human Genetics, was equally cautious. "In general, I'm concerned about mass marketing," says Conneally, who worries that poor women without health insurance would be denied the test. "The breast cancer gene doesn't know the economic status of its holder."

Myriad has provided the test at no charge to certain women who can't afford it, though Hockett could not say how many.

Hockett also defends the company's ad approach, saying women couldn't get the test without going through a physician and signing a consent form. Their doctor would then provide guidance when the results of the screening come back.

What To Do

To learn about the company's testing, visit Myriad. For more genes and tumors, try PBS or FORCE: Facing Our Risk of Cancer Empowered.

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Emotional Stress Can Literally Be Heartbreaking 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Monday, September 23, 2002

MONDAY, Sept. 23 (HealthScoutNews) -- If you're still stewing about that fight you had with your spouse last week, do your heart a favor and put it behind you.

Researchers from the University of California, Irvine, found that just thinking about past emotional stress -- a fight with your spouse, the tantrum your toddler threw in the middle of the store, or your boss chewing you out -- can cause dramatic rises in blood pressure.

"The effects of an emotional stressor do not end with the removal of that stressor," says study author Laura Glynn, an assistant professor of psychiatry at the university. "Simply thinking about a stressful experience can produce significant and sustained blood pressure responses."

The good news is, if you can distract yourself and stop ruminating over the emotional stress, your blood pressure will quickly return to near normal levels, according to the study, which appears in the current issue of Psychosomatic Medicine.

High blood pressure, a known risk factor for heart disease, affects almost one in four Americans, according to the Centers for Disease Control and Prevention ( news - web sites). In the United States alone, high blood pressure is responsible for more than 17,000 deaths and 10 million office visits to physicians every year.

For the current study, Glynn and her colleagues recruited 72 college students with normal blood pressure readings. The researchers then asked them to perform one of four tasks while they monitored their blood pressure and heart rate. Later, they asked the participants to vividly recall performing the task, and again, monitored their heart rate and blood pressure.

The four tasks were: mental arithmetic, shock avoidance, physical exercise or a cold-water challenge.

Mental arithmetic involved counting backwards while being interrupted, often rudely. For example, the researcher might have said, "OK, you are going to have to start again, and this time I will let you count by sevens so it is easier for you."

For the shock avoidance task, the participants were hooked up to a fake shock-generating machine and told to press a button every time they saw a light. The researchers told them if they were not fast enough they would be given a mild shock. Both of these tasks were considered to be emotionally stressful.

The non-emotional tasks were walking in place to a set pace and placing an arm in cold water for three minutes.

Both emotional and non-emotional tasks caused blood pressure to rise while the tasks were being completed. However, when the study volunteers were later asked to recall the task, only the groups that performed the emotional tasks saw an increase in both systolic and diastolic blood pressure. Systolic blood pressure was almost 17 points higher and diastolic pressure was as much as nine points higher for the emotional task group.

"That's a pretty significant jump in blood pressure," says Dr. Dan Fisher, a cardiologist and director of exercise physiology at New York University Medical Center.

"This [study] falls into line with some of the things we know already -- that stress causes higher blood pressure. But what's new here is that even remembering emotional stress can cause blood pressure to go up," Fisher adds.

He suggests people with a lot of stress in their lives learn to cope with it better, and try not to ruminate over past emotional stress.

Which is exactly what the final phase of Glynn's work would suggest.

After the mental arithmetic exercise, the researchers had 20 volunteers stay. Ten were asked to fill out a questionnaire and the remaining 10 were just asked to sit quietly. They found that when distracted, the participant's blood pressure dropped back to near normal after only two minutes. The volunteers who weren't distracted still had blood pressure readings as much as 20 points higher.

What To Do

To read more about how emotions can affect your physical health, check out this article from the National Institutes of Health.

For more information about preventing heart disease, visit the Centers for Disease Control and Prevention.

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Drug Helps Prevent Breast Cancer Spread to Bone 

By Pam Harrison

Reuters Health

Monday, September 23, 2002

SAN ANTONIO (Reuters Health) - Women with early-stage breast cancer ( news - web sites) were half as likely to see their cancer spread, or metastasize, to their bones when treated with an oral drug called clodronate, researchers report.

Clodronate is a member of a class of drugs called bisphosphonates, which are used to treat the bone-thinning disease osteoporosis.

Since tumor-induced breakdown of bone can promote the development of metastases, Dr. Eugene McCloskey, Sr., clinical research fellow at the University of Sheffield, England, and colleagues decided to investigate whether giving breast cancer patients the drug might prevent their cancer from spreading to the bone.

The researchers assigned patients to take 1,600 milligrams of clodronate or an inactive placebo daily for 2 years. All of the women had operable, early-stage cancers. Treatment was initiated within 6 months of women undergoing primary therapy, which included surgery, radiotherapy, chemotherapy and tamoxifen as required.

During the total follow-up period, which lasted about 5 years, 63 patients in the clodronate group and 80 patients in the placebo group developed bone metastases, a difference that was not significant between the two treatment groups.

In contrast, during the 2-year treatment interval, only 12 women developed bone metastases in the clodronate group compared with 28 women in the placebo group. The difference between the two groups was significant, McCloskey reported.

He presented his results here Sunday during the 24th annual meeting of the American Society for Bone and Mineral Research.

Over the post-medication period, there was again no difference in the number of women developing bone metastases at 51 in the clodronate group and 52 placebo patients. The incidence of metastases that developed outside of bone was also similar between the two treatment groups, at 112 patients in the clodronate arm, and 128 women in the placebo arm.

Most importantly, McCloskey noted, only 98 women in the clodronate group died over the follow-up period compared with 129 in the placebo group, a 23% reduction in mortality risk in favor of active therapy.

"We know there is a conversation between tumor cells and bone marrow, and this conversation is basically a vicious circle whereby tumor cells stimulate bone cells to resorb bone and the resorption of bone feeds backs and stimulates tumor cells," McCloskey told Reuters Health in an interview during the meeting.

The metastases that attack bone "depend on this vicious cycle and by interfering with this cycle, you decrease the number of women who get clinically significant bone metastases, and if they don't get bone metastases, they don't get metastases at other sites and you improve survival," McCloskey commented.

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Study: Pill, Weight Gain Not Linked  

By George Strawley

Associated Press Writer

The Associated Press

Monday, September 23, 2002

HARRISBURG, Pa. (AP) - Teenagers and young women who use birth control pills can't blame their tight jeans on the contraceptive, say researchers who have done a long-term study.

The study of 66 women who were followed through their teen years to age 21 showed that the pill-users and nonusers were not significantly different from each other in body weight or percentage of body fat.

"A nonevent here is important," said Tom Lloyd, one of the authors of the study. "The No. 1 reason for women abandoning oral contraceptive use is their perception that they are getting fatter. However, in our study and in previous studies with adult women, that is not true."

Lloyd said the study, conducted by Penn State Milton S. Hershey Medical Center, provides physicians with a significant piece of information that they can use in counseling patients to stay on the contraceptives.

The study, reported recently in the journal Obstetrics and Gynecology, showed pill users did have higher cholesterol than nonusers. But their numbers still fell within the normal range.

The research on young women and the pill is part of a larger, ongoing study begun in 1990 with the enrollment of 112 healthy adolescent girls from central Pennsylvania.

Researchers took blood samples and X-ray measurements from the participants and tracked their body composition through their teen years. Participants answered questions about physical activity so researchers could adjust results for their level of activity.

Of the 66 women, 39 used birth control pills for an average of 28 months and a minimum of six months; all still used the pill at age 21. The 27 nonusers had never taken oral contraceptives.

One researcher said the study confirms what doctors have known for years: There is no evidence that the birth-control pill causes weight gain in women.

"The benefit here is the duration of the study," said Dr. David F. Archer, professor of obstetrics and gynecology at the Eastern Virginia Medical School in Norfolk, Va., and director of the school's clinical research center. The study's weakness is the small number of participants, he added.

Archer, who was not involved in the study, also noted the research included only white women, and "it would always be better to have a study more representative of the population."

What is seen as weight gain due to the pill may really just be the result of natural causes, said Dr. Daniel Mischell of the University of Southern California School of Medicine.

"In older women and also in young girls, they're going to gain weight as they get older," Mischell said. "They like to suggest it's the pill they're taking that's causing it."

The study's findings apply equally to body shape as they do to weight, said Dr. Richard Legro, co-author of the study.

"Your bikini's going to fit the same way every year you're on the pill," said Legro, an associate professor of obstetrics and gynecology at Penn State University College of Medicine.

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Multiple Sclerosis Drug May Cause Heart Problems 

By Merritt McKinney

Reuters Health

Monday, September 23, 2002

NEW YORK (Reuters Health) - A drug used to treat the degenerative neurological disease multiple sclerosis (MS) causes a small but significant increase in the risk of a heart condition that impairs the heart's pumping power, according to a new report. Researchers also found that the drug, mitoxantrone, seems to raise the risk of congestive heart failure, but to a lesser extent.

According to the study's lead author, who works for the company that markets the medication as Novantrone in the US, the risks of the drug are "very manageable."

"These are known complications that can occur," Dr. Donald E. Goodkin, the director of medical affairs at Amgen Corporation, told Reuters Health in an interview. The risk of cardiac side effects, he said, can be reduced by following the warning labels that recommend performing heart tests in some situations and limiting treatment to a total of 3 years.

In MS, the slow destruction of myelin--the thin, protective coating that insulates nerve fibers in the brain and spine--can lead to numbness, muscle weakness and stiffness, impaired vision and coordination problems.

In the interview, Goodkin said that mitoxantrone is the fourth drug approved to treat MS in the US. In what Goodkin said was an atypical move, in 2000 the Food and Drug Administration ( news - web sites) approved mitoxantrone to treat MS on the basis of studies conducted only in Europe, not the US.

But one of the FDA's concerns, Goodkin said, was that mitoxantrone, which was already approved for use as a cancer treatment, might increase the risk of certain side effects. The government agency, he said, "wanted the company to make a commitment to monitor the safety of the drug in the US."

That trial has not reached its goal of enrolling 500 patients, but to date there have been no cases of congestive heart failure in the roughly 450 participants who have been enrolled so far, according to Goodkin.

In a review published in the September 24th issue of the journal Neurology, however, Goodkin and his colleagues report that several cases of cardiac complications including heart failure have occurred in three mitoxantrone studies. The review covered three studies that included a total of 1,379 MS patients taking mitoxantrone.

In one study, 4 out of 124 patients (3.23%) developed a condition called diminished left ventricular ejection fraction (LVEF), a measure of the heart's blood-pumping strength. In a second study, about 2% of patients experienced diminished LVEF. The third study did not include LVEF measurements, but 2 of the 452 patients (0.44%) died from congestive heart failure.

Although the report shows that cardiac complications can be an unintended side effect of mitoxantrone, Goodkin said that there are steps physicians can take to minimize the risk. He noted that the package insert for the drug states that a test of cardiac function, including LVEF measurement, should be conducted before starting the drug.

Mitoxantrone is given intravenously at 3-month intervals, and once a patient has received a certain cumulative dose of the drug, LVEF function should be assessed before they receive another dose, Goodkin said. Finally, after a patient's cumulative dose reaches a certain cut-off point, the treatment should be stopped, he said.

In the case of one of the two patients who died with heart failure, the man had been refused additional mitoxantrone treatment after his doctor saw signs of heart problems. But the patient went to another doctor, who, not knowing that the man had received mitoxantrone before, gave the patient additional doses of the drug. In the end, the patient received a higher cumulative dose of mitoxantrone than is recommended.

Although Goodkin said that mitoxantrone seems to have a "very manageable profile" in terms of cardiac side effects, he and his colleagues recommend in the report that patients continue to be monitored to determine whether more patients taking the drug eventually develop heart failure.

Source: Neurology 2002;59:909-913.

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Chiropractic Groups Push For Change  

By Sharon Theimer

Associated Press Writer

The Associated Press

Monday, September 23, 2002

WASHINGTON (AP) - After years of being treated as second-class providers in the medical profession, chiropractors are lobbying hard to shape the Department of Veterans Affairs ( news - web sites)' new coverage of chiropractic treatment in hopes of winning broader access to patients nationally.

The effort will determine what services chiropractors will provide to the 70 million Americans — veterans and their relatives — eligible for VA care and whether veterans will be permitted to seek chiropractic treatment without having to get a medical doctor's permission first.

Many chiropractors also want the right to coordinate patients' care. That idea has earned a powerful opponent — the main doctors' lobby, which argues that coordinating patients' health care should remain with physicians and not with chiropractors, who do not attend medical school.

Health insurers are also watching. All sides are aware of the high stakes.

"What happens in the VA will set the tone for all future involvement with chiropractic in the federal government," said Terry Rondberg, a chiropractor and president of the World Chiropractic Alliance.

The intensity of the lobbying has been affected by disagreement among chiropractic groups.

The American Chiropractic Association wants chiropractors to be able to serve as primary care providers, diagnosing illness. In addition, the association wants chiropractic treatment to focus beyond the spine to muscles, bones and nerves.

The World Chiropractic Alliance argues chiropractors should focus on their specialty — the spine and nervous system — rather than mirroring the work of physicians. The alliance wants the VA to let patients see chiropractors for preventive care in addition to existing problems.

Both groups are pushing for the common goal of expanded access to patients — without physicians as gatekeepers.

To make their pitch, chiropractors jockeyed hard to win spots on the 11-member VA advisory committee shaping the policy. The panel includes seven chiropractors, two medical doctors, one physical therapist and one osteopath.

Whether the panel reaches consensus or not, it's a chance for people to get their views on the table, said Sara McVicker, clinical program manager at Veterans Affairs and manager of the advisory committee.

"There are some very clear divisions of opinion," McVicker said. "There may not be as many divisions of opinion as they think. You never know, until they start talking to each other."

Chiropractors also have pressed Congress, sending letters and making personal visits to Capitol Hill. One of the chiropractor lobby groups even offered free spinal screenings to lawmakers.

The American Medical Association, the main doctor's lobby, is pushing back with its own political clout. It wants to keep chiropractors from winning a "massive expansion of their scope of practice in order to be declared primary care physicians," said Dr. Richard Corlin, a physician and former association president.

"The bottom line is you don't get to be a primary care physician by the action of a committee," Corlin said. "You get it by going to medical school."

The AMA is much larger and better financed than the chiropractic lobbies. It spent about $7.3 million on lobbying last year, compared with about $60,000 by the American Chiropractic Association and $15,000 for the World Chiropractic Alliance.

The AMA also dwarfs chiropractic groups in campaign contributions. It and its members gave more than $1.1 million in the 2000 election, compared with about $140,000 from the American Chiropractic Association and its members.

Insurers are also keeping a watchful eye on the VA debate for its implications to their coverage.

A spokesman for Kaiser Permanente, the giant not-for-profit health maintenance organization, said it's too soon to gauge the impact of the VA's decisions. "But obviously, given the size and scope of someone like the VA or Medicare, if they were to change their practices obviously people would have to look at that," Matthew Schiffgens said.

Until recently, the only federal program that chiropractors were allowed to participate in was Medicare. The Defense Department is now adding chiropractors to its health system.

Each advance in government coverage helps chiropractors make their case to the larger audience of patients.

"When we got into Medicare, we tried to tell everybody we could afford to tell that now we were in a major government program," the American Chiropractic Association's Jerome McAndrews said. "This is a sign of further establishment of our services to the country."

On the Net:

Department of Veterans Affairs: http://www.va.gov/

American Chiropractic Association: http://www.amerchiro.org/

World Chiropractic Alliance: http://www.worldchiropracticalliance.org/

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Bioengineered Animals an Environmental Threat: Panel 

By Alicia Ault

Reuters Health

Monday, September 23, 2002

WASHINGTON (Reuters Health) - Genetically engineered fish, insects, shellfish and other highly mobile animals pose a risk to the environment as they may escape from their labs or pens and displace species in the wild, an expert scientific panel said Tuesday.

The report by a National Academy of Sciences ( news - web sites) committee was hailed by groups opposed to bioengineered organisms used for consumption or in crop management.

"This study effectively ends the debate in this country over whether genetically engineered animals pose a risk to human health and the environment," said Matt Rand, biotechnology campaign manager for the National Environmental Trust in Washington, DC.

"This really raises the red flag," he told Reuters Health, adding that he thought the report would give his and other groups ammunition to push for further safety studies and a more comprehensive national policy on genetically modified organisms.

The panel said bioengineered organisms escaping into the wild is of great concern, but that currently, there is no great harm posed to humans who eat genetically modified animals, vegetables or grains, with the exception of the potential for allergic or hypersensitivity reactions.

But the committee said that since bioengineering and cloning techniques are developing so rapidly, its report is just a snapshot. There is a need for more research, and caution, the panel said.

"As is the case with any new technology, it is almost impossible to state that there is no concern, and in certain areas of animal biotechnology, we did identify some legitimate ones," said John Vandenbergh, chairman of the National Academy panel and a zoology professor at North Carolina State University.

The panel identified two specific areas of concern with bioengineered animals, insects, and crops: organisms that are engineered for deliberate release into the environment; and those engineered with the intention of being farmed or confined, but that escape or are inadvertently released.

If an animal, insect or fish gets into the wild, it "might eventually replace its relative or become established in that community if the genetically engineered organism is more fit than its wild relatives in that environment," the panel wrote in its report.

The Food and Drug Administration ( news - web sites) (FDA) requested the panel's input, as the agency is considering whether cloned cattle and other genetically modified organisms are safe for human consumption or use as animal feed.

In May, 60 environmental and consumer organizations petitioned the FDA and four other federal agencies for a moratorium on the sale or use of genetically modified fish. The groups acted when Aqua Bounty Farms of Waltham, Massachusetts, filed for FDA approval of a genetically engineered salmon.

The National Academy panel said it was concerned that if a salmon designed to grow faster and larger was released into the wild, it could compete more successfully for food and mates than wild salmon.

A spokeswoman for the trade group BIO said that Aqua Bounty had taken "redundant" precautions to ensure that no salmon from its farms could escape or mate, if it did find its way into wild waters.

The National Academy committee also said biotech companies should make sure that animals grown to produce pharmaceuticals are not introduced into the food supply, and that they are not adversely harmed by being used essentially as a manufacturing facility.

The BIO spokeswoman said that the industry supports regulations that ensure the animals' welfare.

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Study Suggests Mad Cow Solution  

By Paul Recer

AP Science Writer

The Associated Press

Monday, September 23, 2002

WASHINGTON (AP) - A mutated form of the protein that causes Mad Cow disease may protect animals against the brain-destroying disorder, according to a laboratory study that raises the possibility of breeding cattle that are protected from the disease and are safer for humans to eat.

Researchers at the University of California, San Francisco, report they genetically altered a strain of mice so that the animals made a mutated form of a protein called a prion which prevented the animals from becoming ill when injected with a form of prion that usually causes disease.

"We found that the (genetically engineered) mouse became completely resistant to the prion disease," said Dr. Jiri G. Safar of the University of California, San Francisco, a co-author of the study appearing this week in the Proceedings of the National Academy of Sciences ( news - web sites).

Safar said he and his colleagues now hope to develop a genetically engineered strain of cattle which is resistant to Mad Cow, known formally as bovine spongiform encephalopathy ( news - web sites), or BSE ( news - web sites).

Patrick W. Dunne, a veterinary scientist at Texas A&M and researcher into BSE, called the research by Safar and his colleagues "a breakthrough paper."

"This means that prion diseases in livestock could be at least inhibited, if not eliminated," said Dunne. "It is a very significant finding."

Prion diseases include BSE in cattle, scrapie in sheep, and Creutzfeldt-Jakob Disease ( news - web sites) in humans. There is also a related wasting disease in deer and elk. The diseases are caused by an abnormal form of the prion protein that causes the normal form of prion to change its shape and become infectious. In its abnormal form, the prion cause the progressive, irreversible destruction of brain cells. The disease is fatal in all species where it occurs.

An epidemic of Mad Cow disease developed in Britain in the 1980s after cattle there were given feed that included body parts from sheep with scrapie. Researchers later found that some people developed a form of prion disease, called new variant-Crutchfeld-Jacob Disease, after eating meat from infected cattle. The discovery caused a temporary ban on the import of British beef in many countries and the destruction of thousands of cattle in the United Kingdom. More than 100 people in Europe have been diagnosed with variant-CJD, but that form of prion disease has not been diagnosed in the United States. A type of CJD not related to eating meat, however, does occur in the United States.

In the new study, Safar and his co-authors, which includes Stanley B. Prusiner, who was awarded a Nobel Prize for discovering prion disease, found that by altering the genes of mice they could make the animals resistant to the brain-destroying disease.

Safar said that earlier studies, in Japan and elsewhere, had suggested that some mutated forms of prion prevented the disease-causing form of the protein from causing disease.

To test this idea, researchers engineered a mouse strain with genes that caused key changes in the amino acids that make up the prion protein. When mature, the mice were injected with high doses of the disease-causing form of prion.

Although some of the test animals did form some pathogenic prions, none of them developed the full blown prion disease. Safar called this the "silent expression" of the diseased prion.

In contrast, mice with the normal type of prion developed a fatal brain disorder when they were injected with the disease-causing form of prion.

With selective genetic engineering, Safar said, "it is possible we could wipe out even the silent expression and transmission of the pathogenic prion."

Safar said that altering the prion gene to make it resistant to the disease is better than eliminating the gene altogether, as some have suggested. Taking out the gene altogether, he said, could cause subtle health changes in the animals since normal prions do have a role in brain cell maintenance.

On the Net:

Proceedings of the National Academy of Sciences: www.pnas.org

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Race Still a Factor in Cancer Patient Survival 

Reuters Health

Monday, September 23, 2002

NEW YORK (Reuters Health) - While survival rates for U.S. cancer patients have improved in recent years, racial disparities persist, new study findings show.

The study, conducted by a team of researchers at the National Cancer Institute ( news - web sites) (NCI) in Bethesda, Maryland, and the Dana-Farber Cancer Institute in Boston, Massachusetts, is one of the first to include the six most prominent ethnic groups in the US, according to the researchers.

These groups are non-Hispanic whites, Hispanic whites, African Americans, American Indians and Alaskan natives, Asian Americans and Hawaiian natives.

Lead author Dr. Limin X. Clegg of the NCI and colleagues evaluated outcomes for nearly 1.8 million cancer patients diagnosed with a first invasive cancer between 1975 and 1997 who were followed through December 1998. The findings are published in the September issue of the journal Archives of Internal Medicine ( news - web sites).

Just over half the group (about 54%) had one of the following: cancer of the lung or bronchus (the passageway entering into the lung); colorectal cancer; female breast cancer ( news - web sites) or prostate cancer ( news - web sites).

"Non-Hispanic whites accounted for 84% of all patients with cancer, whereas African Americans accounted for 9%, Hispanic whites for 3%, Asian Americans for 3%, Hawaiian natives for less than 1%, and American Indians and Alaskan natives for less than 1%," the authors write.

In general, Clegg and colleagues found that the risks of dying from cancer, and cancer survival rates based on type of cancer, improved for all six ethnic groups of patients between 1988 and 1997 compared to those diagnosed between 1975 and 1987.

"However," they write, "the extent of improvement varied by race or ethnicity."

Specifically, from 1988 to 1997 the team observed differences in risk of death among the six races for the four most common cancers after controlling for age and severity of disease at diagnosis. Racial differences were seen for all cancers when they adjusted for age alone.

Non-Hispanic whites, Hispanic whites and Asian-American patients tended to have a lower risk of death than African Americans, American Indians and Alaskan natives, and Hawaiian natives.

The fact that there are a relatively small number of American Indians and Alaskan natives diagnosed with cancer is one of the study's limitations, according to the researchers, who also note that information was not available about wealth, education, health insurance status or other diseases the patients had.

"Additional research is needed to clarify the role of socioeconomic, medical, biological, cultural and other determinants of racial or ethnic differences in survival rates for patients with cancer described in this article," the authors conclude.

Source: Archives of Internal Medicine 2002;162:1985-1993.

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Experts Try to Make Bionic Retinas  

By Randolph E. Schmid

The Associated Press

Monday, September 23, 2002

WASHINGTON (AP) - Attempts to restore sight to people with damaged retinas are turning toward signaling the brain the way nature does it, using chemicals to deliver signals to nerve endings.

Experiments already under way with retinal implants seek to use electrical signals to make the nerves send information to the brain.

But doctors from Michigan and California described a different method Monday, using retinal implants that respond to images by releasing nerve-stimulating chemicals.

Dr. Raymond Iezzi of Wayne State University and Dr. Harvey A. Fishman of Stanford University discussed their separate research projects at a science writers seminar on ophthalmology.

Neither is close to testing the idea in people. Both indicated animal experiments may be a year away.

Nerves carry messages to or from the brain by electrical impulses, but nerves are stimulated to send those signals by chemicals generated by organs or relayed from other nerve endings.

About half of all blindness is a result of damage to the retina, the inner part of the eye containing cells that react to light by releasing chemicals that cause the optic nerve to send signals to the brain.

Experiments using an electronic chip implanted in the retina, sending an electric current to stimulate the optic nerve, are in early stages.

But, instead of direct electrical signals, Fishman and Iezzi turned their attention, in slightly different ways, to the chemicals that the body uses to get those nerves to send signals.

Iezzi's research is focusing on a retinal implant that can deliver what he calls an array of "chemical pixels" through tiny holes, somewhat like a very small, gentle, inkjet printer or shower head, stimulating nerves to relay an image to the brain.

There are several neurotransmitter chemicals and Iezzi is using glutamate in his tests. He said the final product may use a cocktail of these chemicals.

As he envisions it, the chip would receive a supply of neurotransmitters from a reservoir under the skin behind the ear. It would react to signals from a small digital camera, perhaps worn like an eyeglass.

"Once we prove the basic concept, we can go on and refine the design," he said.

Fishman is developing what he calls an artificial synapse chip, an implant that also would deliver minute amounts of chemical transmitters.

But in his case, the chip is designed to direct the growth of nerve cells into tiny openings in the chip where they can be stimulated by the release of chemicals in response to light. The chemicals are held within the chip.

Fishman said his team is working on ways to get the nerve cells to grow into the chip. Experiments with a carpet of carbon tubes have been promising, he said: "This gives us a lot of hope that in animals we can direct the process."

The two spoke at a conference sponsored by the New York-based organization, Research to Prevent Blindness.

On the Net: Research to Prevent Blindness: www.rpbusa.org

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Compounds May Lead to Safer Clot Preventing Drugs 

By Linda Carroll

Reuters Health

Monday, September 23, 2002

NEW YORK (Reuters Health) - Boston researchers may have discovered a new way to block the formation of dangerous blood clots that can lead to heart attack and stroke.

In experiments with mice, the investigators found that newly discovered compounds called pepducins can increase the time an animal bleeds before forming clots, according to their report in the online advance edition of Nature Medicine.

When the researchers looked at the effects of pepducins on human blood in a test tube, they found that the new compounds slowed blood clotting by inhibiting platelets from clumping together.

Currently, doctors don't have a really good clot-preventing drug, study co-author Athan Kuliopulos, an associate professor of medicine and biochemistry and director of the homeostasis and thrombosis lab at the New England Medical Center and Tuft's University School of Medicine, said in an interview with Reuters Health.

The safer drugs, like aspirin, are not as effective as doctors would like. More effective drugs, like heparin, can lead to bleeding in the brain in a small percentage of people, Kuliopulos noted.

"So everyone is looking for an intermediate thing," he added. "That's where pepducins come in. They're like the best of both worlds."

Pepducins work to slow clotting in a unique way, Kuliopulos said.

Most drugs work by locking on to a receptor, he explained. Think of a receptor as the ignition of a car. When the right key is fitted into the ignition, it can be turned and the car will start. If a key is close in shape to the right key, it might fit into the ignition, but won't make the car run.

Similarly, when the right shaped substance, called a ligand, comes along and fits snugly into receptors that sit on a cell's surface, the cell's machinery can be turned on or blocked from turning on. Drugs that are meant to activate a cell slip into the receptor and turn on the machinery. Drugs meant to turn off the cell's engine fit into the receptor and block other substances from turning on the cell.

The problem faced by drug companies trying to slow clotting is that a ligand sits in the receptor at the platelet surface all the time, waiting for a message to turn on the cell's ignition. So it's been almost impossible to find a way to bump this ligand out and fill the receptor with a compound that will block the cell from working.

Kuliopulos and his colleagues decided to come at the problem from a new direction. They developed compounds that would slip through the cell's membrane and hook onto the receptor from the inside of the cell and freeze the receptor up.

Pepducins may lead to a host of new medications to treat a variety of illnesses, Kuliopulos said. There are many other receptors, including ones implicated in obesity, that can't be blocked the traditional way, he explained.

"We are very excited," he said. "They are very powerful."

Source: Nature Medicine 2002;10.1038/nm760.

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Study: Epilepsy Drug Helps Migraines 

The Associated Press

Monday, September 23, 2002

WASHINGTON -- The epilepsy drug topiramate appears to prevent migraine headaches -- and unlike some other migraine medications that seem to attract pounds, its main side effect is weight loss, said a study released Monday.

Some 28 million Americans suffer from migraines, an intense, pulsing headache that can last hours, even days. There are a number of drugs sold to prevent migraines, but they don't work for everyone, so scientists are seeking new medications.

In recent years that search has included epilepsy drugs -- after scientists discovered that migraines are not caused by the abnormal blood vessels once blamed but by a unique electrical disorder of brain cells.

Somewhat like epilepsy patient do, migraine sufferers have abnormally excitable brain nerve cells that, when triggered, fire across important pain centers to awaken nerve pain and inflame blood vessels.

Some drugs that fight epilepsy also suppress abnormal neuron firings, and one, Depakote, is often used as a migraine preventer. Now scientists have found that another epilepsy drug, topiramate, may be useful, too.

In a study of more than 400 migraine sufferers given varying doses of topiramate or dummy pills for four months, about half found their number and duration of migraines cut in half, said Dr. Stephen Silberstein of Thomas Jefferson University in Philadelphia. He was presenting his findings at a meeting of migraine researchers Monday.

The best-treated patients took 100 or 200 milligrams of topiramate a day, a lower dose than is used for epilepsy. But like in epilepsy patients, the migraine users experienced a side effect that would cause few to complain: weight loss. Patients lost, on average, 3.8 percent of their starting body weight, Silberstein said. For a skinny person that could be a problem, he acknowledged, but most patients in the study were overweight.

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Survey: Parents, Siblings Influence Teens' Drug Use 

By Clementine Wallace

Reuters Health

Monday, September 23, 2002

NEW YORK (Reuters Health) - Good family communication can help teens stay away from drugs, alcohol and tobacco, and siblings play an important role in getting the message across, according to a new survey by the National Center on Addiction and Substance Abuse (CASA) at Columbia University in New York.

CASA's survey included 1,000 teens 12 to 17 years old, half boys and half girls, along with 541 parents, 317 of whom were parents of the teens surveyed. The survey focused on siblings' influence on whether or not a child would try drugs, alcohol or cigarettes, and was conducted for CASA by QEV Analytics, a Washington, DC-based public opinion research firm.

The survey found that siblings' perceived opinions had a major impact on a teen's decisions. Teens who said their older brothers or sisters would be "very angry" to find out they were using marijuana were less likely to use drugs or alcohol than those who said their siblings would not get angry.

"It's a perception issue," Ellen Ross, CASA's communications director, told Reuters Health. "If the younger sibling just thinks that the older sibling is taking drugs, then the risk increases substantially."

The survey also found that parents may underestimate their role in a child's decision on whether or not to use drugs. The researchers found that a "disturbing number"--more than one third--of the parents surveyed viewed drugs in school as a fact of life that they, and administrators, were powerless to stop.

In the 2000 survey, nearly half of teens who had not tried marijuana said their parents' influence was responsible for their decision. "Parents think that their kids don't want them involved in their lives," said Ross, "but that's not the case. Kids want boundaries, they want to hear what is acceptable and what's not."

The survey also found that teens whose parents thought their child was "very likely" to use drugs in the future were three times more likely to smoke, drink or use illegal drugs than teens whose parents said their future drug use was "not likely at all."

Good family communication is key to preventing substance abuse, according to CASA, and must be in place long before kids are actually at risk. "The harsh reality is that for most teens, high school--and often middle school--is too late to begin," according to the report.

Most teens using alcohol, cigarettes and marijuana do so by the time they are 15, it continues. The critical age-range lies between 12 and 16, where the researchers found that the likelihood of drug use increases by almost 500%.

In fact, the survey found, teens who sat down to dinner with their families six or seven times a week were about half as likely to abuse drugs and alcohol than kids who ate dinner with the family twice a week or less.

In light of the CASA survey results, President Bush ( news - web sites) and the governors of 32 states are proclaiming September 23rd Family Day, "a day to eat dinner with your children," as a symbolic reminder to parents of the importance of communicating with their children.

"It's the most natural and comfortable way for parents to communicate with their kids and to learn about what's happening in their children's lives," Ross said.

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Americas' Life Expectancy Rises, but Health Mixed

By David Brown
Washington Post Staff Writer

The Washington Post
Monday, September 23, 2002

Life expectancy in the Americas has risen by six years over the past two decades. Infant mortality has been cut by about one-third. Measles, a major killer of children, is nearly gone. Deaths from malaria are one-quarter of what they were five years ago.

Those are among the promising trends detailed in a portrait of health in the Western Hemisphere released last week by the Pan American Health Organization. The total picture, however, is decidedly mixed.

The region's overall improving health masks wide disparities among countries. The incidence of AIDS in Caribbean countries is second only to that in sub-Saharan Africa. Furthermore, rising incomes are leaving the diseases of affluence, notably heart disease, diabetes and the complications of obesity, in their wake.

Nevertheless, PAHO chief George A.O. Alleyne said last week that "the health situation in the Americas is the best it's ever been."

PAHO is the section of the World Health Organization devoted to North America, the Caribbean and Latin America. Its "Health in the Americas" report is produced every four years.

Life expectancy, the best indicator of overall population health, is 73.2 years for the region, with women living an average of more than six years longer than men. Canada had the highest life expectancy at 79 years, with the United States at 77.5 years.

In Latin America, it is 70.4 years, although there were wide differences. Haiti had the lowest life expectancy at 53 years; Brazil's was below average at 68, and Mexico's was above average at 73.

Infant mortality, the strongest indicator of a population's ill health, is about 25 deaths per 1,000 live births overall, down from 37 in 1980. Canada has the lowest at about 5 deaths per 1,000.

The epidemiologists at PAHO found something that had been noticed elsewhere -- namely that wide disparity of income in a population is a hazard to health.

The researchers divided the countries into high- and low-income, and wide- and narrow-income gap groups. Income gap was calculated by comparing the average income of the top one-fifth of a population with the average income of the bottom one-fifth.

They found that low-income nations with relatively equitable distributions of income often had better health indicators than better-off countries with wide income gaps.

High-income, wide-gap Brazil has a lower life expectancy (68 years) and higher infant mortality (38 per 1,000) than low-income, narrow-gap Peru (70 years and 37 per 1,000).

The phenomenon appears to be a reflection of government policy and the extent of economic development, said epidemiologist Enrique Loyola, who helped prepare the report. "There may be smaller benefits, but they are better distributed," he said.

The income gap has been growing in the Western Hemisphere for the past 20 years, the authors noted. In 1980, the median income in the wealthiest one-fifth of the population was 13 times that of the poorest one-fifth. In 2000, it was 16 times higher.

Deaths from infectious diseases, with the exception of AIDS, have fallen steadily. A major campaign against malaria has reduced mortality from that disease from 8 deaths per 100,000 population to 2 deaths per 100,000 since the mid-1990s. Last year, there were about 550 cases of measles in the Americas, compared with about 30 million cases and 777,000 deaths elsewhere in the world.

Cardiovascular disease is the leading cause of death in the hemisphere, as it has been in the United States for much of the past 50 years.

The report's authors said the region is marked by "epidemiological polarization," in which infectious diseases continue to be the major threat to poor people and noncommunicable diseases such as heart attack, stroke, cancer and emphysema are the overwhelming killers of the more affluent.

Adult-onset diabetes is expected to grow to near-epidemic proportions. About 35 million people in the Americas suffer from it, with 54 percent of them in Latin America and the Caribbean. By 2025, that number is expected to be 64 million, with 62 percent living in South America.

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Booklet Helps Frustrated Parents Get Kids to Sleep 

By Charnicia E. Huggins

Reuters Health

Monday, September 23, 2002

NEW YORK (Reuters Health) - A booklet detailing a two-step plan to teach infants to sleep through the night may be just what the doctor ordered for bleary-eyed moms and dads bothered by their young child's frequent night awakenings.

If parents perceive their child's awakenings as a problem "they should do something about it. All children can be taught to sleep through the night with this method," study author Dr. Berndt Eckerberg told Reuters Health. Eckerberg, who is now retired, conducted the research while at Falun Hospital in Falun, Sweden.

Frequent night awakenings are known to be associated with a higher risk of family stress and maternal depression as well as later behavior problems. Although some parents seek professional help to deal with the problem, Eckerberg investigated whether written information would be enough.

His study involved 67 children and their families. On average, the children were about 10 months old and had had sleep problems for roughly 5.5 months.

The parents were given an 11-page booklet that explained why the night awakenings occurred and described a two-step solution for the problem. In the first step, children are taught to fall asleep by themselves at bedtime. In the second step, they are taught to fall asleep by themselves after waking up at night.

In general, the only reason children wake up frequently during the night is because they have "some form of help to fall asleep in the evening," and later realize during light sleep that something has changed, Eckerberg said.

That something could be as simple as a pacifier falling out of their mouth, he explained. Or, if the child fell asleep while the parent was lying or sitting down next to him, he may wake up if he senses the parent has left the bed.

Families were divided into one of two groups--those that received therapist consultations and telephone support during the two stages of treatment and those that received only written information during the first stage and therapist support afterwards.

There were no great differences between the two groups in terms of their children's number of night awakenings or sleep time, Eckerberg reported in a recent issue of the journal Acta Paediatrica.

Altogether, roughly 86% of the children had fewer night awakenings after the first stage of the two-step process, and their nightly protests were generally shorter and less intense during the second stage of treatment, study findings indicate.

Further, most of the parents said their child's sleep problem had improved at subsequent follow-ups, Eckerberg reports.

The reason the booklet was successful, according to study participants, was because it explained to parents that their child's sleep problems were not anyone's fault, but was rather culturally related.

"There's nothing wrong with children, nothing wrong with parents," Eckerberg said. "I blame the culture"--the culture that discourages parents from sleeping with their children, he explained.

"Infants are predisposed to sleep with their mothers, but this may not always be a good solution," Eckerberg writes. "For example, in our Western society, with its high parental demands, parents who are sleep-deprived will have trouble optimally to provide for their children during the day."

Further, the booklet also gave detailed descriptions of the various challenges parents would face as they trained their children to sleep through the night.

Parents' main obstacle would be their natural instinct "to comfort their screaming child, which in this situation is precisely what prevents success," the report indicates.

"They try to comfort them and help them go back to sleep, (but) if they continue this the awakenings will continue," Eckerberg said.

Calling the two-step process "both effective and highly acceptable" to parents, Eckerberg writes that "the change of bedtime routines starts a reduction in night wakings, which continues when the children, as a second intervention, are more actively taught to go back to sleep on their own."

Altogether, however, parents should know that there is no specific age at which children should begin sleeping through the night, according to the study author. The frequent night awakenings should be addressed "at the age when parents consider their awakenings a problem," Eckerberg said.

Source: Acta Paediatrica 2002;91:952-959.

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Eating more fruits, veggies gets push

By Elizabeth Lee – Staff

The Atlanta Journal-Constitution
Monday, September 23, 2002

Eating lots of fruits and vegetables can help protect against chronic diseases such as diabetes, heart disease and cancer, as well as ward off obesity. Yet 11 years after the 5 A Day for Better Health program started urging Americans to eat more produce, consumption has barely increased.

Just 23 percent of Americans eat at least five fruits and vegetables daily, the minimum recommended. When Americans do eat vegetables, they're most likely to be starchy white potatoes and nutritionally weak iceberg lettuce.

The federal government's effort to fight obesity is trying to change that, starting with revitalizing the public-private 5 A Day program. And it's targeting the places where Americans decide between fruit or french fries: school cafeterias, federal nutrition programs, restaurants and office vending machines, as well as supermarkets.

As 5 A Day Week begins today, behind-the-scenes changes have beefed up the original alliance between the National Cancer Institute and the industry-funded Produce for Better Health Foundation. In the past two years, they've added new partners to boost outreach efforts and drawn up plans that could affect everything from the content of school lunches to whether shoppers put iceberg lettuce or more nutritionally powerful romaine in their shopping carts.

Here's what's in store:

·        Changing the environment where Americans make food choices. One proposal being tested this year involves putting salad bars in school cafeterias and making fruit more available in stores and vending machines. One possibility to encourage students to pick a bag of carrots instead of chips: raise the price of foods with minimal nutritional value and use it to subsidize more nutritious food.

·        A new message for 5 A Day Week urging consumers to increase the number of daily servings of fruits and vegetables from five to nine.

·        Adding or strengthening programs that reach out to African-Americans, one of the minority groups considered underserved in the first decade of 5 A Day, yet also the one with the highest rate of cancer deaths. Among the efforts: Body and Soul, an American Cancer Society initiative that works through black churches.

·        Using other federal nutrition programs to encourage children to learn good eating habits early. Among the proposals: adding more fruit and vegetables to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which provides basic foods for pregnant and breastfeeding women and for young children.

·        A simplified message about which vegetables and fruits to choose. In the next few months, produce bags and supermarket signs will start encouraging consumers to choose at least one daily from each of five color groups: orange, white, green, blue/purple and red.

Despite the changes, those who work with the program admit it will be tough to alter eating habits.

"There are so many things that need to happen for people to eat five to nine," says Lorelei DiSogra, director of the National 5 A Day for Better Health Program for the National Cancer Institute. "Part of it is making fruits and vegetables more available in federal feeding programs. Part of it is education. Part of it is making sure they're available everywhere."

The National Cancer Institute has a $2 million annual budget for 5 A Day this year, double its budget in the first 10 years of the program. Produce for Better Health has $4 million. Total federal nutrition education expenses are less than $500 million annually.

The food industry spends $11 billion annually on advertising.

Organizers for 5 A Day are hoping new partnerships with other federal agencies including the Centers for Disease Control and Prevention, and community outreach groups such as the American Cancer Society, will help spread the message.

The most potentially powerful tool involves the U.S. Department of Agriculture. The USDA has doubled contributions --- now $50 million --- to a program making it easier for schools to buy fresh fruits and vegetables locally. The USDA also is involved in tests that started this fall of salad bars in Florida schools, and the agency is working to put free fruit and vegetables into 106 schools this year in the Midwest and New Mexico.

Later this week in Atlanta, the CDC and the American Cancer Society will sponsor a workshop on changing eating habits, examining research on how pricing affects food choices and other ways to modify behavior.

Perhaps the biggest stumbling block is one that policy changes can't eradicate: taste. The assertive and sometimes bitter flavors of the most nutritious vegetables make it harder to persuade some consumers, especially children, to eat them, concluded a 2001 evaluation of the 5 A Day program.

Others believe vegetables and fruit take too long to prepare, say they don't know how to cook them, or think they're too expensive.

With 350 kinds of produce in the average supermarket, everyone should be able to find something they like, responds Elizabeth Pivonka, president of Produce for Better Health.

Programs also are emphasizing convenient choices such as pre-washed and sliced salads, carrots and broccoli.

"When you come down to it, fitness and diet are up to the individual," DiSogra says. "All we can do is encourage; we can try to translate how they can do it easily."

What Is A Serving?

·         One medium-sized fruit, such as an apple or orange

·         1/2 cup of raw, cooked, canned or frozen fruits or vegetables

·         1 cup of raw, leafy vegetables such as spinach or lettuce

·         3/4 cup of 100 percent fruit or vegetable juice

·         1/2 cup cooked or canned beans and peas

·         1/4 cup dried fruit, such as raisins

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Bladder Cancer Keeps Coming Back 

HealthScoutNews

Monday, September 23, 2002

MONDAY, Sept. 23 (HealthScoutNews) -- Superficial bladder cancer returns more quickly with each recurrence.

Washington University School of Medicine researchers found the number of months between each recurrence of superficial bladder cancer is progressively shorter with each recurrence.

Superficial bladder cancer is a cancer that hasn't invaded the deepest layers of the bladder wall.

The study included 270 people treated for superficial bladder cancer between January 1994 and April 1999. Follow-up times ranged from one month to 54 months.

Of the 270 people in the study, 47 percent had at least one recurrences, 14 percent had two or more recurrences, and 5 percent had three or more recurrences. The average time from initial treatment to first recurrence was 23 months. However, the average time between second and third recurrence was 15 and 13 months, respectively.

The study also identified two proteins in tumor cells that may help doctors predict the risk of recurrence. The findings appear in the current issue of Cancer.

Bladder cancer is the fourth most common cancer in men and the ninth most common in women. About 56,500 new cases of bladder cancer will be diagnosed in the United States this year, and about 80 percent of those will be superficial bladder cancer.

More information

The National Cancer Institute ( news - web sites) has more on bladder cancer.

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Using Aspirin or NSAIDs Cuts Alzheimer's Risk 

By Ed Edelson
HealthScoutNews Reporter

Monday, September 23, 2002

MONDAY, Sept. 23 (HealthScoutNews) -- A Utah study adds evidence that small, regular doses of aspirin and other anti-inflammatory drugs can reduce the risk of Alzheimer's disease ( news - web sites) -- but experts say they're not ready to recommend wholesale use of that strategy.

The study, appearing in tomorrow's issue of the journal Neurology, included more than 5,000 of Cache County, Utah, all of whom were 65 or older. Investigators asked whether they were taking aspirin or nonsteroidal anti-inflammatory (NSAID) medications, drugs that have the same inflammation-fighting ability. Then the researchers came back a few years later to ask about the incidence of Alzheimer's disease and other conditions that cause loss of mental function in older people.

The incidence of Alzheimer's disease and other forms of dementia was 45 percent lower for people who took aspirin or an NSAID for more than two years than for those who didn't, the study finds. No protective effect was found for non-NSAID painkillers such as acetaminophen, allopurinol and opioid drugs.

The key point of the study is that protection is associated with long-term use of the drugs, says Dr. John C. S. Breitner, professor of geriatric psychiatry at the University of Washington and lead author of the journal report. That stands to reason, he says.

"You're talking about prevention of a chronic condition, so you are talking about intervention before the development of symptoms," Breitner says. "This evidence from Cache County suggests that the critical period is several years before the onset of dementia. The same finding emerged from a Rotterdam study that was published last fall."

No one knows why aspirin should have this protective effect, Breitner says. "There are five or six competing hypotheses," he says, but the anti-inflammatory activity of the drugs doesn't seem to be what is doing the trick, because even low doses of the medications were associated with reduced risk.

"If it was a typical anti-inflammatory activity, you wouldn't expect very low doses to produce the effect," Breitner says. "There was no apparent increased benefit with higher doses, so the drugs are doing something different."

Time is an essential element of the effect, says Bill Thies, vice president for medical and scientific affairs of the Alzheimer's Association. And because years of use seem to be needed, "it's going to be a difficult case to prove." Preventional trials "can be long and expensive," Thies says, and it will take years for definitive answers to emerge.

Several attempts have been made to see whether aspirin or another NSAIDs can be used to treat Alzheimer's disease, and they all have produced negative results, Thies says.

So while taking low-dose aspirin may be a good idea for many people, because of proven benefits for heart disease, Thies and Breitner are cautious about the NSAID Alzheimer's prevention strategy, especially when it concerns stronger prescription drugs.

"People can start taking aspirin at low doses because of other proven health benefits, but in terms of stronger anti-inflammatory drugs, there are known risks connected with their use," Breitner says. "I don't take them."

"We don't recommend their use without consulting a doctor," Thies says. "Self-medication is a bad idea. You shouldn't take any NSAID without consulting a doctor. What may seem to be an innocuous over-the-counter medication might have significant interactions with other drugs."

What To Do

The Alzheimer's Association and the National Institute on Aging are good resources for information about the disease. Find out more about what aspirin can do from the Food and Drug Administration.

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SUNDAY, SEPTEMBER 22, 2002

Hormone replacement stroke risk debated  

From the Science & Technology Desk
United Press International

Sunday, September 22, 2002

SEATTLE, Sept. 22 (UPI) -- In a conclusion that counters other recent findings, researchers said postmenopausal women taking hormone replacement therapy, adjusting for overall cardiovascular risk, seem to show no increased risk of stroke vs. women not taking HRT.

The overall adjusted risk for postmenopausal women taking HRT is no lower than 0.7 times postmenopausal women not taking hormone therapy and no higher than 1.4 times the risk, the researchers reported, although they added they did find an increased stroke risk for postmenopausal women during the first six months of HRT about 1.8 times greater than for women not taking HRT.

"What we can say for sure is that hormone replacement therapy did not prevent stroke," lead researcher Rozenn N. Lemaitre, a research scientist in the cardiovascular research unit at the University of Washington, told United Press International. "We found a transient association of increased risk (and it) needs to be confirmed by additional study."

The researchers studied 939 postmenopausal women who had suffered strokes over a 10-year period and compared them with 2500 other women who did not have a stroke during the same period. They noted the percentages of women in both groups who used HRT and drew conclusions based on a statistical analysis, adjusting for many variables including differences in blood pressure, diabetes, cardiovascular disease and current smoking.

Women on a lower daily dose of estrogen -- 0.3 milligrams -- seemed less likely to suffer a stroke than women taking the more common 0.625-mg dose, the researchers said, noting the statistical strength of the conclusion is weak and confirming studies will have to be conducted.

"The take-home message is that for women who choose to use hormone replacement therapy for symptoms of menopause it would be advisable to use the lowest possible dose," Lemaitre said.

These findings arrive in the wake of the Women's Health Initiative halting a trial of HRT in July after a number of health problems -- including stroke -- appeared to increase. In addition, a paper compiling results from four HRT studies showing health risks was published in the Sept. 21 issue of the British journal, The Lancet.

"Overall, HRT users had a significantly increased incidence of breast cancer, stroke, and pulmonary embolism," the paper said.

According to The Lancet's compilation, stroke risk is about 1.3 times higher in women taking HRT, with a low range of 1.1 times higher and a high range of 1.5 times higher than women not taking HRT. This translates into an overall risk -- among women ages 50 to 69, over a five-year period -- of one additional woman in 400 suffering a stroke. Risk of serious health problems will occur in one woman in 125 over the same five years, the compilation said.

"This new paper, where they only had stokes early on and then they did not, makes it look like it is really a clotting problem," Lila E. Nachtigall, professor of obstetrics and gynecology at New York University School of Medicine, told UPI. Tests to screen out clot-susceptible women exist and should be used, she said.

"This adds to the growing body of evidence that HRT is associated with an increase in stroke, David M. Herrington, professor of medicine at Wake Forest College School of Medicine in Winston-Salem, N.C., told UPI. "Whether or not that risk varies with duration of hormone replacement therapy use remains a complex and controversial subject," he said.

HRT supplies estrogen or estrogen and progestin to women in menopause or following hysterectomies. The goal is to reverse hot flashes, mood swings, vaginal dryness and dozens of other painful or irritating symptoms.

The research will appear in the Sept. 23 issue of Archives of Internal Medicine.

(Reported by Joe Grossman, UPI Science News, in Santa Cruz, Calif.)

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New Tools, Drugs Used to Blunt Post-Surgery Pain 

By Deena Beasley

Reuters

Sunday, September 22, 2002

LOS ANGELES (Reuters) - Pain-free recovery from surgery is a contradiction in terms, but some doctors and eager-to-please drug companies say it could become possible with new techniques and innovative use of existing medicines.

"There should not be any post-operative pain. It is useless--we know what causes it and we know it limits bodily function," said Dr. Mark Lema, chairman of anesthesiology and pain medicine at Roswell Park Cancer Institute in Buffalo, New York.

Pain-numbing narcotics such as morphine are still the standard of care after a trip to the operating room, but alternatives are emerging as doctors and hospitals look to improve treatment and maybe cut costs at the same time.

Narcotics, which suppress pain signals to the brain, can disrupt normal activity, prolong hospital stays and lead to an uncomfortable, slow recovery. These drugs' side effects--drowsiness, nausea, constipation, difficulty breathing and potential addiction--are well known.

"In a lot of cases, it's not the surgery that most impacts the patient--it's the side effects of the narcotics they take afterward," said Dr. Stephen Zimberg, a gynecologist at Cleveland Clinic Florida in Weston, Florida.

Lema suggests that medicating patients before surgery with anti-inflammatory drugs such as Merck & Co.'s Vioxx can curb pain by blocking pain pathways before, during and after surgery.

"There is a lot of evidence showing that we can block the deleterious effects of surgery by using circulating levels of coxibs," he said, using the generic term for the class of drugs.

Local Anesthetics Used During, After Surgery

Drugs can be combined with nerve-blocking anesthetics, such as the epidurals used to mute the pain of childbirth, or after surgery with self-contained devices that deliver a local anesthetic directly to incision sites over a period of days.

In one study, 43% of hysterectomy patients given the ON-Q pain relief system, a balloon-shaped pump that drips a steady amount of anesthetic through a "soaker hose" sewn inside an incision, did not need narcotics for pain after surgery, resulting in shorter hospital stays and lower overall costs.

"Our patients who had just received a hysterectomy were comfortably moving around, clearly showing us that they were experiencing real pain relief. Nearly all of them were ready to go home only a day after surgery," said Zimberg, lead investigator in the study.

The study of the device in hysterectomy patients showed that it cut overall costs by 30%.

The study was financed by Lake Forest, California-based I-Flow Corp., which makes the ON-Q device.

I-Flow is "trying to change the way surgeons do things, and that's not easy," according to Chief Executive Donald Earhart.

"The advantage we have is that patients love it."

Another study showed that the ON-Q "cut morphine use by 40% in cesarean section patients," said Dr. Vanessa Givens at the University of Tennessee Health Science Center's department of obstetrics and gynecology in Memphis.

"I was shocked at how well I felt. It was nice because I was able to bond with my baby right away," said Chris Carreon, a 30-year-old mother from Manhattan Beach, California, who was given the ON-Q device after a C-section in March.

In a telephone interview arranged by I-Flow, Carreon said her pain, and need for pain pills, shot up after the device was removed a couple of days after the surgery.

Insurance Coverage Not Yet Widespread

Givens said hospitals are on board with the idea of freeing up rooms for new patients, but insurance coverage of the procedure, priced at about $200, is still building.

In addition to abdominal surgery such as hysterectomies and C-sections, the device can be used to relieve pain after procedures ranging from heart surgery to breast augmentation or hemorrhoid surgery. "People with hemorrhoids can actually sit down with it," Earhart said of the ON-Q.

Other companies make similar devices. Stryker Corp. of Kalamazoo, Michigan sells the Stryker Pain Pump, which also provides continuous infusion of a local anesthetic.

In February, Pharmacia Corp.'s Bextra, the follow-up to the company's popular arthritis drug Celebrex, was shown to cut the need for morphine in patients having knee-replacement surgery. Both drugs are members of the coxib class and work by blocking the inflammation-causing COX-2 enzyme.

When the body is injured--by surgery or trauma--an inflammatory response ensues, sensitizing nerves as a defense mechanism to limit the chance of infection.

"If your foot was cut and you walked on an infected area, the wound could become septic," Lema said, referring to a dangerous condition caused by toxins released from bacteria.

Other anti-inflammatory drugs, such as aspirin or ibuprofen, block output of substances that trigger inflammation and pain, but they also block enzymes responsible for minimizing bleeding, which is undesirable following surgery.

Coxibs, which are currently approved by regulators for treating chronic pain, selectively block the enzymes mainly responsible for triggering pain, inflammation and fever, without affecting production of blood platelets.

Lema said treating patients with coxibs curbs the inflammatory-type pain that opioid drugs don't do a very good job of helping and any resulting side effects, like fluid retention and slightly increased blood pressure, are minor.

"Surgery is an exception to the rule that you don't know ahead of time when you are going to get hurt," he added.

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Hunting Down a Cure for Sickle Cell Disease 

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Sunday, September 22, 2002

SUNDAY, Sept. 22 (HealthScoutNews) -- While a cure remains elusive, victims of sickle cell anemia are living longer, healthier lives.

The most common inherited blood disease in the United States, sickle cell anemia affects about 80,000 Americans, primarily blacks. Another 2 million Americans have the defective gene that causes the disorder, making them potential carriers.

Thanks to improvements in diagnosis, treatment and research, half of those with the condition are now more than 50 years old. Until recently, people with sickle cell rarely survived childhood, according to the National Human Genome ( news - web sites) Research Institute.

"I have five adult patients, one more than 60 years old, who watch out for themselves. They are good, cooperative patients who make sure they optimize their care," says Dr. Kenneth Algazy, a clinical associate professor of medicine at the University of Pennsylvania School of Medicine.

Sickle cell anemia is caused by the production of faulty hemoglobin, a key component of red blood cells. Hemoglobin carries oxygen from the heart to all parts of the body.

Once the hemoglobin molecules have released their oxygen, some can cluster to form long, rod-like structures. These rods cause the red blood cells to stiffen and to take on a sickle shape, preventing them from slipping through small blood vessels.

The resulting clots and blockages inhibit the flow of oxygen to the body's tissues and organs, particularly the lungs, kidneys and brain. The oxygen deprivation causes severe and potentially fatal complications, including stroke, Algazy says.

For the very few patients who have a sibling without sickle cell who are a genetically compatible match, a possible cure lies in a bone marrow transplant. The donor's healthy marrow lets the patient produce his own healthy hemoglobin, Algazy says.

"But that's very rare -- I've never had a patient with a match. Essentially, there is no cure," he says.

So researchers are turning to genetics. They are trying to correct the defective gene that causes sickle cell and insert it into the bone marrow of victims, to stimulate the production of normal hemoglobin.

Scientists at Harvard Medical School ( news - web sites) and the Massachusetts Institute of Technology ( news - web sites) reported last year that they had corrected sickle cell disease in mice using gene therapy, according to the Human Genome Research Institute.

However, such a cure is years away for human victims.

"Not in a year or two, but in five or 10 years there may be hope for a cure," Algazy says.

Another area of hope is drugs that increase the level of fetal hemoglobin in the blood. Fetal hemoglobin, found in fetuses and infants, stops the red blood cells from changing shape and helps ease the intense pain often suffered by patients.

Presently, only one drug, called hydroxyurea, is approved for this use. However, researchers at the University of Illinois in Chicago are studying another drug, called decitabine, which in a preliminary study increased the levels of fetal hemoglobin in all eight patients who took it on a daily basis for nine months.

None of the patients had found relief using hydroxyurea, says study author Joseph DeSimone, a professor of medicine at the university. With decitabine, all found their fetal hemoglobin levels rose approximately 11 percent to 14 percent.

A level approaching 20 percent is needed to reduce the symptoms of the disease, which can include intense pain as body parts are deprived of oxygen, he says.

"It worked well in terms of increasing fetal hemoglobin," DeSimone says, "and there was less red cell adhesion and less clotting."

Also encouraging was the absence of immediate side effects such as nausea, infection around the site of the injection, or rashes. The last is a common side effect of hydroxyurea, DeSimone says.

DeSimone and his colleagues are now starting a larger study of 30 to 70 people to test decitabine. SuperGen Inc., the drug's manufacturer, is funding the research as part of U.S. Food and Drug Administration ( news - web sites) approval trials.

"Sickle cell anemia is a lousy disease and can be very painful, and there are good things that are possible so people can go back to work and feel better," DeSimone says.

What To Do

September is National Sickle Cell Month.

To learn more about the disease, visit the American Sickle Cell Anemia Association or the National Human Genome Research Institute.

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'I'll Study for the Test Tomorrow' 

HealthScoutNews

Sunday, September 22, 2002

SUNDAY, Sep. 22 (HealthScoutNews) -- If you're a college student and a committed procrastinator, you might want to delay getting your grades.

 An Ohio State University study says the worst procrastinators scored much lower grades than low or moderate procrastinators in a college course packed with deadlines.

The most severe procrastinators were also more likely to try to rationalize their behavior by saying things like they work best under pressure. But the study proves that isn't true.

"The results show that procrastinators don't work better under pressure, but it may be the only way they work. They don't have any idea how well they might do if they didn't procrastinate," a news release quotes study author Bruce Tuckman, professor of education at Ohio State University, as saying.

He found the worst procrastinators had an average course grade of 2.9 on a 4.0 scale, compared to 3.4 for moderate procrastinators and 3.6 for low procrastinators.

The findings were presented recently at the annual meeting of the American Psychological Association in Chicago.

The study included 116 students in a 10-week study skills class taught by Tuckman. The class teaches learning and motivation strategies to help them learn from lecture and text, built their self-confidence and responsibility, learn to manage time, research and write papers, and prepare for their exams.

More information

Do you think you're a procrastinator? Well, don't delay in finding out. Take this quiz to see how you rate.

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Legs for Life Starts Its Run 

HealthScoutNews

Sunday, September 22, 2002

SUNDAY, Sept. 22 (HealthScoutNews) -- More than 10 million Americans have the potentially deadly peripheral vascular disease known as PVD, but few are aware of it.

A nationwide campaign called Legs for Life is trying to change that by educating Americans about prevention, detection and treatment of PVD. Part of that effort includes a free, national screening week today through Sept. 28 to identify people at risk for PVD.

The Legs for Life National PVD Screening Week will be held at more than 300 hospitals across the United States. Vascular specialists will donate their time to the screening program.

You can find the nearest screening site by going to Legs for Life. If there isn't a screening site near you, you can call toll-free 877-357-2847 to request a free brochure about PVD.

One out of four people screened last year for PVD was found to be at risk.

PVD is caused by blocked blood flow to the arteries of the legs. It's common in people over age 50 and increases the risk of heart attack, stroke and aneurysms.

Symptoms aren't always present, but PVD can cause pain or swelling, difficulty walking, numbness and skin discoloration. A simple, non-invasive blood pressure test is used to determine if a person is at risk for PVD.

"Early detection of PVD is essential. If the arteries in your legs are clogged, other arteries are likely clogged, too," says Dr. Peter T. Beatty, national chairman of Legs for Life.

"Diabetics, smokers and people with high blood pressure or high cholesterol levels are at increased risk," Beatty says.

More information

Read more about PVD diagnosis and treatments.

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SATURDAY, SEPTEMBER 21, 2002

5-A-Day: The Healthy Way 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Saturday, September 21, 2002

SATURDAY, Sept. 21 (HealthScoutNews) -- An apple a day may keep the doctor away, but why stop there?

Research proves that a minimum of five daily servings of fruits and vegetables can ward off a host of ills, including cancer, heart disease, hypertension, diabetes and macular degeneration.

However, nine servings a day is even better.

In fact, the National Cancer Institute ( news - web sites) will be emphasizing the upper limit of the range during "5 A Day" week, which runs Sept. 22-28. "Eating 5 to 9 and Feeling Fine: Fruits and Vegetables Anytime!" is the program's new mantra.

"Adults really need to eat nine servings a day. That's what the science says, and we decided we needed to start clearly communicating this," says Lorelei DiSogra, director of the "5 A Day" program at the cancer institute. "Fruits and vegetables play a really strong role in reducing the risk of all kinds of diseases."

Studies have shown people who ate the recommended amount of fruits and vegetables had an almost immediate reduction in blood pressure. People who chowed down their greens -- and reds and purples -- also had half the risk of developing certain types of cancer than those who didn't.

Fruits and vegetables contain all the necessary vitamins and minerals and something extra -- phytochemicals, or plant compounds that provide an array of health benefits, the cancer institute says.

To get the full effect of phytochemicals and other nutrients in fruits and vegetables, it helps to know just what, exactly, constitutes a serving. The cancer institute provides some guidelines:

One medium-sized fruit (for example, an apple, orange, banana, or pear); half a cup of cut-up fruit; one-quarter cup of dried fruit (raisins, apricots, prunes); one-half cup of raw, cooked, canned or frozen fruits or vegetables; three-quarters of a cup (six ounces) of 100 percent fruit or vegetable juice; half a cup of cooked or canned legumes (beans and peas); and one cup of raw leafy vegetables (think lettuce and spinach).

Measure leafy vegetables just as you put them in the measuring cup -- keep them a little fluffy and don't pack them down, says Dawn Jackson, a spokeswoman for the American Dietetic Association and a dietician at Northwestern Memorial Wellness Institute in Chicago.

If you can, eat more vegetables than fruit. One serving of fruit contains about 60 calories, while the equivalent in vegetables only has about 25.

"It's about one-third less calories so try to have two to three servings of fruit but then really try to bulk up on the vegetables because they're so low in calories," Jackson advises. Both fruits and vegetables also are quite filling.

Here are more, simple ways to incorporate fruits and veggies into your diet:

·         Start by adding fruits and vegetables to what you already eat. "If you typically have a sandwich for lunch, ask for extra vegetables," Jackson says. You can also add berries to cereal, fruit (real or canned without syrup) to a container of plain yogurt, or have an apple with your morning protein bar.

  • "Try to put veggies in anything you can," Jackson advises. "Cut 'em up small and hide 'em in there."

Jean Walsh, director of the nutrition and food service at Long Island College Hospital in Brooklyn, N.Y., recommends cutting up enough vegetables to last the week and then storing them in containers in the fridge. That way, they're there when you need them.

  • If you don't have time to chop, go for pre-washed and pre-cut vegetables, such as lettuce and baby carrots at the salad bar at your local supermarket. Then you can add, say, red peppers to a pita sandwich with no hassle. "If they're precut, you're more likely to eat them," Jackson says.
  • Oven-cooked dishes are another good place to add veggies. "Instead of thinking about a lot of pots and pans, think about adding veggies to a meatloaf," Walsh recommends.
  • Keep frozen vegetables in the fridge so you can make a quick vegetable soup. Or whip up a stir-fry with a little chicken. Even high-starch frozen dinners containing cheese and potatoes can be transformed into something healthful if you add frozen broccoli.
  • Load up on fruit. They're one of the easiest snacks around. But beware of dried fruit, Jackson warns, because they can be high in calories.
  • Vegetable juices are a good source of potassium, but opt for the low-sodium variety, Walsh says.
  • At restaurants, ask for the vegetable of the day. Have that instead of rice or a potato, and start with a small salad.
  • If you usually eat out at lunch, get a salad -- but without the heavy add-ons like blue cheese.

What To Do

For more information on getting all your fruits and vegetables, visit the National Cancer Institute's 5 A Day site. Everything you ever wanted to know about produce, including recipes, can be found at aboutproduce.com. And the American Dietetic Association has a wealth of information, including daily nutrition tips.

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FDA OKs Chronic Hepatitis B Drug  

The Associated Press

Saturday, September 21, 2002

WASHINGTON (AP) - Patients suffering from the liver-destroying hepatitis B virus will be able to use a new drug therapy.

The Food and Drug Administration ( news - web sites) approved the drug, adefoir dipivoxil, on Friday. It will be sold as Hepsera, and is the first new therapy in years for an estimated 1.2 million Americans who suffer with the potentially deadly infection.

The treatment, made by Gilead Sciences Inc., is just one of three therapies for patients with hepatitis B — a virus that can lead to cirrhosis and liver cancer. It is transmitted through blood, bodily fluids, shared needles and from mother to child.

The drugs, intereron and lamivudine, are the only other medicines available to hepatitis B patients. But some patients become resistant to one drug and others can't tolerate the side effects of the other. Doctors have long wanted another option.

"We believe this is really an important advancement for patients," said Amy Flood, a spokeswoman for Gilead.

Adefovir originally was tested as a possible treatment for the AIDS ( news - web sites) virus, but the FDA rejected that use because the high doses required proved toxic to patients' kidneys.

Gilead was tested far lower doses as a hepatitis B treatment. It didn't cure the infection, but studies concluded that liver cirrhosis improved in between 56 percent and 66 percent of patients testing the drug.

Flood said a patient would take one tablet per day. Studies showed that a 10-milligram, daily dose didn't lead to outright kidney damage.

But it is still a potential side effect: By a more conservative measurement, up to 5 percent of patients who used adefovir for a year showed early signs of some toxicity, according to the studies.

Gilead, based in Foster City, Calif., will begin shipping the drug as early as next week, Flood said.

On the Net:

Food and Drug Administration: http://www.fda.gov

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Backsprain Is the No. 1 Workplace Injury 

HealthScoutNews

Saturday, September 21, 2002

SATURDAY, Sep. 21 (HealthScoutNews) -- Only three types of injuries account for the majority of the 6 million workplace injuries that occur in the United States each year, according to a new survey.

 The American Academy of Orthopaedic Surgeons (AAOS) reports that over-exertion, repetitive stress injuries and falls while on the job cost more than $60 billion in lost wages, health care expenses, legal costs and worker's compensation claims.

And what, by far, is the most common workplace injury?

Back sprains -- because of falls, slips and improper lifting -- add up to more than half of the 6 million injuries each year. Slippery and uneven floors are one of the main causes of workplace falls that can cause permanent disability, or even death. These falls can be prevented with proper training and safe work practices, the AAOS says.

Carpal Tunnel Syndrome (CTS) is one of the most common causes of hand and wrist pain. It can affect computer users, cashiers, assembly-line workers, meatpackers, musicians, writers (especially those using the computer), surgeons and other people who use their hands in repetitive motions that strain wrist tendons.

If you suspect CTS, you should pay prompt attention to the first signs of pain or discomfort, the AAOS says.

More information

For insight into workplace safety, go to the American Academy of Orthopaedic Surgeons.