The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
November 6, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 28 - OCTOBER 4

  1. Natural Radiation May Affect DNA
  2. Belly Size Better Gauge of Heart Risk Than Obesity
  3. Blood Pressures Similar for Africans, U.S. Blacks
  4. Gum Disease May Harm the Heart, Too
  5. Bacteria Common in Foods, but Few Drug Resistant
  6. Blood Sugar Control May Be Linked to Birth Weight
  7. Grandparent Contact May Help Kids Adjust to Divorce
  8. Key to Possible Carcinogen In Starchy Foods May Be Heat
  9. On Ecstasy, Consensus Is Elusive

    SUNDAY, SEPTEMBER 29, 2002


  10. Proper Shoes Keep Your Kids' Feet Fit
  11. Low, low blood pressure heals heart
  12. Massive Prostate Cancer Trial

    SATURDAY, SEPTEMBER 28, 2002


  13. Help for the Housebound a Boon to Their Health

 

FRIDAY, SEPTEMBER 28, 2002 

A New Approach to Managing Diabetes 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Friday, October 4, 2002

FRIDAY, Oct. 4 (HealthScoutNews) -- With some basic training in math and carbohydrate counting, people with Type I diabetes can follow a more flexible eating plan without losing control of their glucose levels or quality of life.

That's the conclusion of a study appearing in tomorrow's British Medical Journal that tested the Dose Adjustment For Normal Eating (DAFNE) program among patients in the United Kingdom. The regimen was originally developed by clinicians in Germany.

"We know that insulin and food have to be matched, and once you do that you allow the patient to be in the driver's seat to figure out what they want to eat and then how much insulin they need to cover it," says Dr. Francine Kaufman, president of the American Diabetes Association.

"For diabetes to be integrated into somebody's life, then there has to be some flexibility. We can't ask people in our society any more to eat the same thing at the same time every day and expect anybody to do that," Kaufman adds.

About 1.5 million people in the United States suffer from Type I diabetes, which occurs when insulin-producing cells in the pancreas stop working. These people must inject insulin to survive. Without adequate amounts of the hormone, blood glucose levels can soar. Over the long term, this can result in blindness, kidney failure and amputation.

In the new British study, 140 adults with Type I diabetes were randomly split into one of two groups. The first received a five-day training course in the DAFNE program, while the second received "usual care" for six months.

The course taught patients how to adjust their insulin doses to match their food, rather than the other way around -- the traditional treatment for Type I diabetes.

"The essential elements are carbohydrate counting and the skills to adjust your insulin to achieve a near-normal glucose level," says Dr. Simon Heller, co-lead author of the study.

Participants were given the basics of carbohydrate counting on the first day, then told to go home and try it out. Much of the rest of the week was involved with discussing their experiences and fine-tuning the procedures.

"They were given algorithms -- one unit of insulin per carb portion, depending on what their glucose levels were before each meal. And then they had the week to practice their skills," adds Heller, who's with the Clinical Sciences Centre at Northern General Hospital in Sheffield.

After six months, the people who had participated in the DAFNE program had improved glucose control and quality of life, the researchers found.

The high quality-of-life measures were particularly gratifying, Heller says, but they came with a price. To eat more flexibly, most patients had to inject insulin and monitor their blood glucose level more often, procedures that can be cumbersome.

"Despite more shots a day and more monitoring, they had a really positive feeling about their diabetes and felt much more in control. We were very surprised. That was the thing that blew us away," Heller says. "People felt much, much better about having diabetes and more like other people."

Although the short-term results are heartening, it remains to be seen what the long-term outcome will be, Heller says. However, researchers in Dusseldorf, Germany, found that the results were sustained over a period of three years, which, Heller says, "is quite remarkable."

In the British study, some of the patients regressed a bit toward the end of the study as their glucose levels rose slightly. The researchers speculate this may be because they were returning to a system where health-care practitioners weren't familiar with the DAFNE program.

"In retrospect, maybe they needed more back-up," Heller says.

What To Do

To learn more about diabetes, visit the American Diabetes Association or the Joslin Diabetes Center.

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Deli Meat Suspected Source of Killer Bacteria: CDC 

Reuters Health

Friday, October 4, 2002

NEW YORK (Reuters Health) - Forty people in the US northeast have become sick, and seven have died from infection with the foodborne Listeria bacteria, according to officials at the US Centers for Disease Control and Prevention ( news - web sites) (CDC) in Atlanta, Georgia.

"Analysis of data collected to date indicate that the leading suspect food in this outbreak is sliced turkey deli meat," according to CDC experts. They say health officials are working hard to track down the exact brand of meat responsible for the outbreak.

So far, seven states have been affected: Pennsylvania (14 cases), New York (11 cases in New York City, 3 elsewhere), New Jersey (4 cases), Delaware (4 cases), Maryland (2 cases), Connecticut (1 case), and Michigan (1 case).

Each year, about 2,500 Americans come down with listeriosis after eating foods--most often meats, raw vegetables and soft cheeses--contaminated with Listeria bacteria. While infection may only result in a transient gastrointestinal illness in healthy individuals, it can prove deadly in the very young, the very old, or those with compromised immune systems, such as people with HIV ( news - web sites)/AIDS ( news - web sites).

Listeria infection also poses a danger to pregnant women. The CDC report indicates that three women linked to the current outbreak have suffered miscarriage or stillbirth after becoming infected.

CDC officials are advising that persons in high-risk groups residing in the affected states "reduce their risk of infection by not eating sliced turkey deli meats or by thoroughly heating them."

The initial signs of listeriosis include flu-like symptoms of fever, aching muscles, nausea and/or diarrhea. If infection spreads to the nervous system more serious symptoms--such as headache, neck stiffness, confusion or convulsion--can occur.

For further information on Listeria, visit the CDC Web site at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/listeriosis_g.htm.

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Babies Born Underweight Become Stressed Adults 

By Nancy Deutsch
HealthScoutNews Reporter

HealthScoutNews

Friday, October 4, 2002

FRIDAY, Oct. 4 (HealthScoutNews) -- As if the deck isn't stacked enough against those born small, research now shows tiny infants are more likely to face psychological problems as adults.

The same holds true for children whose weight gain is slow in the early years of life, Singapore researchers report in tomorrow’s issue of the British Medical Journal.

Moreover, those born underweight who also experience slow weight gain in childhood have a 20 percent higher risk for psychological problems as adults than those born a regular size whose weight gain is on par with others their age.

The researchers don't know why weighing less predisposes someone to psychological difficulties, but "we are interested in the hypothesis proposed by previous researchers that growth failure relates to brain development, which affects stress hormones in later life," says lead researcher Dr. Yin Bun Cheung of the National Cancer Center in Singapore.

The researchers followed 9,731 British babies born in 1958 for 42 years. Information was obtained related to their weight at birth and in childhood, and they were assessed for risk of developing psychological problems at ages 23, 33 or 42.

Overall, 59 percent of the subjects were included in this final analysis. To assess psychological difficulties, the adults were asked to complete a self-administered questionnaire that evaluates those considered at higher risk for psychiatric illness.

Children born about 1.1 pounds less than average who grew normally throughout childhood had an 11 percent greater likelihood of developing psychological problems than children who were not underweight at birth and who grew normally, Cheung says. Similarly, the risk for psychological problems was 8 percent higher for a child of normal birth weight who gained around 7.7 pounds less than the average 45.1 pounds most children gain from birth to age 7.

Children who were born small but had a faster-than-average weight gain in childhood were not more likely to be at risk for psychological distress, since the childhood spurt seems to balance out the risk associated with low birth weight, he says.

Cheung says his research team conducted an earlier study that showed young adults born small had more psychological distress. This study shows the increased risk extends into later adulthood.

Dr. Lynne M. Haverkos, a behavioral scientist with the National Institute of Child Health and Human Development, says many other factors that could lead to psychological problems later in life were not taken into consideration in this study. "It does not mention medical problems and stress life events encountered by the study participants and their families," she notes.

She believes more studies into low birth weight babies are required before it's known exactly why they may experience more psychological problems as adults, and if low birth weight is really the underlying reason for the later distress. "Low birth weight babies who had serious medical problems requiring extensive medical treatment were exposed to additional physiologic stresses and to a variety of parental responses, one of which could be protective parenting," she says. "We're still learning about the long-term effects of stress on individuals and families."

Cheung says he plans more studies: "We are now exploring whether growth affects actual diagnosis of psychological disorders."

What To Do

Learn about low birth weight from the Ontario Prevention Clearinghouse. Try the American Institute of Stress to learn more about the problem.

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Patients Get Infected Transplants  

The Associated Press

Friday, October 4, 2002

PORTLAND, Ore. (AP) - One person died and five others have fallen ill after receiving organ or tissue transplants from a man who had the liver disease, hepatitis C, doctors said.

The Oregon Health Division said the case involves more than three dozen people who received tissue or organs from the infected man, who died of a hemorrhage inside his skull two years ago. Neither the man, tested for the disease in Oregon, nor the recipients, from 14 states and two other countries, were identified.

"This is probably a very rare case," Dr. Ann Thomas, a state medical epidemiologist who is investigating, said in Friday's editions of The Oregonian.

The organ donor, like all such donors, was tested for hepatitis C with a test that detects antibodies, virus fighters the body produces in response to an invasion by disease organisms. But the body takes six to eight weeks to produce the antibodies that specifically fight hepatitis C, Thomas said. During that time, a patient is unaware he or she has been infected.

That leaves a six- to eight-week window in which an infected donor can appear to be healthy. The disease leads to chronic liver disease in 70 percent of infected people.

"This was the classic window case," said Mike Seely, executive director of the Portland-based Pacific Northwest Transplant Bank, which arranged the original testing of the infected man.

Besides lacking hepatitis C symptoms, the man did not show any sign of being at significant risk for contracting the disease, such as being an intravenous drug user.

The case — first reported on by The Oregonian and the Milwaukee Journal Sentinel in Wisconsin — caught the attention of doctors in May, when a patient developed symptoms of an acute hepatitis C infection, according to a presentation last weekend by Dr. Barna D. Tugwell at the Interscience Conference on Antimicrobial Agents and Chemotherapy in San Diego.

Six weeks earlier, the patient had received a knee ligament from the infected man, who had died in late 2000, said Tugwell, an epidemic intelligence officer with the Oregon Health Division and lead investigator for this case.

In July, the donor's stored blood serum tested negative again both for the presence of hepatitis C antibodies and for the virus itself, but the direct test for the virus was positive for hepatitis C.

The Oregon Health Division immediately began notifying doctors of 40 patients who had received kidneys, lungs, liver, heart, vein, tendons, skin, bone and corneas.

So far, 18 of the 40 patients have concluded their tests for hepatitis C. Six were found to have become infected after their surgeries. Nine had no infection. Three had already been infected with hepatitis C before their transplants.

Tests on the remaining 22 patients are continuing.

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PET Scans May Improve Alzheimer's Diagnosis 

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Friday, October 4, 2002

FRIDAY, Oct. 4 (HealthScoutNews) -- Using positron emission tomography (PET) to diagnose Alzheimer's disease ( news - web sites) can cut down on unnecessary medications and reduce nursing home time, researchers say.

A team from the University of California at Los Angeles analyzed two approaches to the diagnosis of Alzheimer's disease. One used the recommendations set down last year by the American Academy of Neurology ( news - web sites), which suggests a physician perform mental status exams, memory impairment screens, and other tests. The other used those same recommendations but also added PET scans to the workup.

A PET scan measures the brain's metabolic pattern and can help determine whether early Alzheimer-type damage has set in, the UCLA team has previously found.

"More patients would be accurately diagnosed in the early stages if they have PET," says Dr. Daniel Silverman, lead author of the study, which is published in the current issue of the journal Molecular Imaging and Biology.

Silverman is not saying that everyone suspected of having Alzheimer's Disease needs a PET scan. And another expert in the field says he is not yet convinced that PET scans are a vital part of a workup for Alzheimer's.

But in appropriate patients, Silverman says, a PET scan can be a boon. To determine the role that PET scans play, Silverman's team made what researchers call a modeled comparison between the two diagnostic strategies. The team examined the best current medical literature endorsed by the Academy on Alzheimer's and found that for every 100 patients with early cognitive decline, the literature showed that conventional methods would have mistakenly attributed the symptoms to Alzheimer's 23 times and overlooked early Alzheimer's eight times.

Then the researchers used a technique called clinical benefit-risk analysis to see what effect PET scans would have if added. They found PET would have prevented 11 of the 23 incorrect diagnoses and would have prevented five of the eight false negatives.

The PET scan, Silverman says, "reduces the false positives [in diagnosis] from 23 percent to 12 percent and it reduces the false negatives from 8 to 3 percent. What that converts to in terms of outcome is cutting months of unneeded drug treatment in half and the avoidable months of nursing home care by about 60 percent."

In a previous study, the UCLA team found that PET scans image brain changes associated with Alzheimer's and find the changes about 93 per cent to 95 percent of the time when they are present.

The take-home point for physicians and consumers, Silverman says, is not to request a PET scan if they vaguely suspect they have Alzheimer's. He recommends that anyone who suspects they have Alzheimer's first find a geriatric psychiatrist or neurologist and that the doctor follow the academy guidelines for diagnosis.

"If after that evaluation the diagnosis is not clear or if they have not had treatment that causes complete reversal of symptoms to normal, at that stage they could be a candidate for PET," Silverman says.

Another expert calls the new study interesting, but he says he is not yet sure PET scans should be incorporated into the diagnosis of Alzheimer's. "At this point, the field is not convinced of the need for PET scans," say Bill Thies, vice president for medical and scientific affairs for the Alzheimer's Association.

"There is a relatively small amount of data," he says. "And while the folks who wrote this paper have collected as big a series as is currently available, there are still some missing elements, particularly the ability to track the disease in multiple [diverse] populations."

Because there is not yet a definitive treatment to stop Alzheimer's, early identification is not as useful as it might be in the future, he adds. He calls the use of PET scans for Alzheimer's "an evolving debate. Like a lot of other debates in medicine, it's going to go on for a while before we come to a conclusion."

What To Do

For information on Alzheimer's disease, try the Alzheimer's Association and the Alzheimer's Disease Education and Referral Center.

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Prostate Cancer Screening Treatment Questioned 

Reuters Health

Friday, October 4, 2002

NEW YORK (Reuters Health) - Men who receive prostate cancer ( news - web sites) screening and treatment do not appear to gain a survival benefit compared to men who do not undergo screening and treatment, study findings show.

The report, which is published in the October 5th issue of the British Medical Journal, adds to the ongoing debate on the value of prostate cancer screening.

Regardless, many men believe that screening is beneficial and would recommend the procedure, according to a second study in the same issue.

Currently, the American Cancer Society ( news - web sites) recommends annual prostate specific antigen (PSA) testing and a rectal exam beginning at age 50--and at age 45 for African Americans and men with a family history of the disease, who face a higher risk. Several other scientific and medical groups do not recommend routine prostate cancer screening.

Unlike other types of cancer, some prostate cancers can be slow growing and may never threaten the patient's life. Some say screening for prostate cancer using a PSA test may lead to unnecessary treatments--with side effects such as impotence and incontinence--by detecting cancers that are not life threatening.

In the current investigation, lead author Dr. Grace Lu-Yao of the University of Connecticut Health Center in Farmington and colleagues evaluated screening, treatments and deaths from prostate cancer among two different groups--94,900 men in Seattle, Washington and 120,621 men in Connecticut.

The PSA testing rate was 5.4 times higher for the men living in Seattle between 1987 and 1990 compared with men living in Connecticut, and the biopsy rate was more than double for the Seattle men compared to the Connecticut men in that time, the authors report.

This time period is considered the "early PSA era" and offers a unique opportunity for researchers to compare prostate cancer outcomes between different regions of the country that, at the time, had different approaches to PSA screening.

When the researchers assessed prostate cancer treatments between 1987 and 1996, they found that men in the Seattle group were about five times more likely to have their prostate removed. And, 3.9% of the Seattle group underwent radiation treatment compared to 3.1% of the men from Connecticut.

Despite the more intensive screening and treatments that took place among the Seattle group, the number of men who died from prostate cancer in the two groups over the total 11-year study period was nearly equal.

"The lack of association between more intensive screening and treatment and lower prostate cancer mortality suggests that trials should continue in order to settle this question," the researchers conclude.

In a second study, Alison Chapple and colleagues at the University of Oxford, UK, interviewed 52 British men suspected or confirmed to have prostate cancer about their beliefs about prostate cancer screening.

While the bulk of the men reported that they would recommend that others get a PSA test, four of the men in the group told the investigators that they were against national screening for prostate cancer.

For the most part, men in the "pro-screening" camp felt that early detection would improve their chances of recovery--despite the lack of scientific evidence supporting such a stance--or they thought that screening was a medically responsible thing to do.

"Doctors, policymakers and politicians need to understand why people want wider access to PSA testing, so they can find better ways of communicating information about risk," Chapple and colleagues conclude.

PSA is a protein produced by the prostate gland. PSA levels above 4 nanograms per milliliter (ng/mL) of blood can signal prostate cancer, but not always--sometimes a rise in PSA is due to another cause, and sometimes cancer can occur without a rise in PSA. About 20% of aggressive prostate tumors are found in men with normal PSA levels.

Source: British Medical Journal 2002;325:737-742.

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Emotional Problems Equal in Marriage  

By Emma Ross

AP Medical Writer

The Associated Press

Friday, October 4, 2002

Emotional problems are equally common among husbands and wives, new research shows — a finding that challenges the long-standing feminist belief that marriage makes men much happier but women more miserable.

The results of the largest study to investigate the question were published in the current issue of the Australian journal Family Matters.

Feminist scholar Jessie Bernard was among the first to postulate that men benefitted emotionally from marriage while women suffered. Her research, published in a 1972 best seller "The Future of Marriage," fed into the evolving feminist belief that the institution of marriage oppressed women.

The theory has persisted, despite scientists' subsequent findings that her studies were flawed, and more recent research that has contradicted the 30-year-old results. But the latest research — involving 10,641 people — is the largest, and particularly rigorous.

"This view of the effect of marriage on men and women has been enormously influential and has become part of the 'common knowledge' about marriage," said David De Vaus, a professor of sociology at La Trobe University in Melbourne, who conducted the latest study.

"But the patterns that were suggested by people like Jessie Bernard .... (are) just not true. The evidence is unequivocal," he said.

"What the early studies did was center largely on typical female disorders — anxiety, depression, phobias," De Vaus said. "What they ignored are the types of mental illness more common in men, such as drug and alcohol abuse."

Bernard, who died in 1996, found that married women were more depressed than married men or single women. Married men, by contrast, were less depressed than bachelors.

De Vaus' study involved 10,641 Australian adults who were interviewed personally to establish the state of their mental health.

The survey classified people as having a mental disorder based on the World Health Organization ( news - web sites) definition after asking whether certain symptoms and incidents had occurred in the 12 months leading up to the interview.

"What's very clear ... is that if you look at male typical and female typical disorders and combine them, then men and women in marriage have the same rates of mental disorders. They just have different disorders," De Vaus said.

David Popenoe, co-director of the Family Research Project at Rutgers University, said U.S. researchers have reached similar conclusions but the scale of the Australian study was particularly impressive. Popenoe was not involved in the Australian study.

The study found mental illness in 16 percent of the women and 16 percent of the men. Depression and anxiety was more common among women, while drug and alcohol abuse tended to afflict men.

Divorced people fared the worst, with 25 percent of both the women and the men suffering emotional problems.

Singletons fared slightly better, with 22 percent of women and 26 percent of men afflicted with mental disorders.

Married people were best off, with only 13 percent of women and 13 percent of men suffering emotional disorders.

Experts say that while it is now clear that married people are emotionally better off than divorced or single people, it remains to be proven that marriage itself reduces the risk of an emotional disorder.

It could be that people with better mental health are more likely to get married, while those with problems shy away from marriage, are not able to attract partners or end up divorced.

"Certainly that's a factor, but it's not just that," said Popenoe, a professor of sociology.

The most likely meaning of the latest findings is that Bernard's findings and her conclusion that marriage emotionally oppresses women were wrong all along, he said.

"When something like that gets stuck in the cultural mind, it doesn't go away easily. There is the small element that marriage has changed since the '50s and '60s, but we also know there were methodological flaws in that study," Popenoe said.

Marriage rates in many developed countries are declining.

"There are going to be many things that, rightly, are going to enter into the decision whether or not to marry," De Vaus said. "It would be a pity if women decided not to get married based on information that it damages their mental health, when in fact the evidence shows the opposite."

On the Net:

Research paper on marriage and gender differences in mental health,

http://users.bigpond.net.au/david-devaus/My-Papers/my-papers-index.htm

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Vaccine May Help Prevent Cervical Cancer 

HealthScoutNews

Friday, October 4, 2002

FRIDAY, Oct. 4 (HealthScoutNews) -- An experimental vaccine against four strains of the human papillomavirus (HPV) may help prevent cervical cancer.

So say researchers at the Medical College of Georgia.

They're studying the vaccine, called quadrivalent, which may prevent infection by the HPV strains most likely to cause cervical cancer or genital warts. They study includes women aged 16 to 23 and 10- to 15-year-old boys and girls.

The researchers say if the vaccine proves effective and receives U.S. Food and Drug Administration ( news - web sites) approval, it will be targeted at adolescents. The researchers acknowledge that may be a tough sell to parents.

"We are hoping parents will realize that one day their children will be sexually active. We must give this vaccine prior to individuals initiating intercourse, and that's why we have selected this young age group," says Dr. Daron G. Ferris, a family medicine physician and director of the Gynecologic Cancer Prevention Center at the college's hospital.

"The study is a wonderful opportunity to potentially lower your child's risk of ever developing cervical or penile cancer," Ferris says.

The 10- to 15-year-olds in the study will have their blood tested over several months to determine if they develop antibodies to HPV. The women will be followed for several years. That will include yearly Pap smears to check for precancerous changes of the cervix and vaginal exams to look for warts.

More information

The National Institute of Allergy and Infectious Diseases ( news - web sites) has more on human papillomavirus.

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US Ready to Vaccinate Everyone for Smallpox 

By Maggie Fox

Reuters

Friday, October 4, 2002

WASHINGTON (Reuters) - The United States has enough vaccine to inoculate everyone in the country against smallpox if there were an attack tomorrow, but officials said on Friday they are still weighing whether to vaccinate people ahead of a biological strike, just in case.

Up to 10 million health care workers, police and emergency technicians could be vaccinated under one contingency plan being considered by US health officials. Or none could be, said Dr. Julie Gerberding, head of the US Centers for Disease Control and Prevention ( news - web sites).

"In an emergency, we have enough vaccine for every American now," Gerberding told a news briefing.

CDC, the Department of Health and Human Services ( news - web sites) and the National Institutes of Health ( news - web sites) are preparing to advise President Bush ( news - web sites) on who should be vaccinated so that the country is prepared for a smallpox attack.

They issued advice last week to states about what to do to prepare for mass vaccinations if an actual attack occurred.

The officials say they are struggling with the decision because current smallpox vaccines are crude and dangerous. They are left over from the vaccination programs of the 1960s and 1970s and have a high incidence of side effects.

When smallpox was eradicated from the world's population in 1979, officials gladly stopped vaccinating the public. "We stopped using this vaccine when this disease was eradicated because it was dangerous," Gerberding said.

For every 1 million people vaccinated, one to two will die from side effects of the vaccine, she said, and 15 will develop life-threatening complications such as encephalitis. But in a smallpox outbreak, a third of the victims may die.

"The only way...we can be sure not to do harm is if there is no vaccination and there is no attack," she said.

No Proven Drug Treatment

Bioterrorism experts have said for years the US is vulnerable to a biological attack, a risk that went up with last year's Sept. 11 attacks against Washington and New York and the anthrax letter attacks that followed.

Smallpox is considered a potential weapon because it is known the Soviets had stocks of the virus, and officials fear other countries and groups may have it as well. Unlike anthrax, smallpox spreads from person to person and there are no drugs to treat it although one drug, cidofovir, is being tested.

The government now wants to pre-vaccinate health and emergency workers who would have to help victims of any smallpox attack, but is trying to balance risks and benefits.

Gerberding estimates about 7 million healthcare workers, including emergency room teams, could be vaccinated ahead of time. Each community would probably need to have some police, emergency and ambulance workers protected as well.

"It could involve about 10 million people, we think, when we add up all the numbers," Gerberding said.

And if there were an attack, experts are inclined to recommend the vaccine be offered to the general public. "One strategy is to let people make up their own minds," she said.

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases ( news - web sites), said 15 million doses of the 30-year-old DryVax vaccine are on hand, along with 75 million to 80 million doses that vaccine maker Aventis Pasteur found warehoused and offered to the United States.

These could be diluted and still work, he said.

"To the question if there were an emergency in this country, would we have enough, the answer is yes," Fauci said.

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Psychiatric Warnings Strengthened for Malaria Drug 

Reuters Health

Friday, October 4, 2002

NEW YORK (Reuters Health) - The US Food and Drug Administration ( news - web sites) (FDA) issued an alert on Friday highlighting strengthened warnings recently added to the labeling for Roche's Lariam (mefloquine), a drug used for prevention and treatment of malaria.

Lariam--which Roche sells to the US Army--entered the public eye this summer when the Pentagon ( news - web sites) said it would investigate whether murders allegedly committed by soldiers in Fort Bragg, North Carolina might be tied to psychological side effects of the drug. The military stressed at the time that there was no direct evidence that Lariam might have triggered the violence.

The FDA said on Friday that the Lariam label had been changed to stress that the drug is contraindicated for preventive use in patients with active depression, recent history of depression, generalized anxiety disorder, psychosis, schizophrenia or other major psychiatric disorders. The new label also puts added stress on a contraindication for preventive use in patients with a history of convulsions, the agency noted.

The FDA alert adds that if "psychiatric symptoms such as acute anxiety, depression, restlessness or confusion occur," they should be considered a possible warning of a "more serious event.

"In these cases, the drug must be discontinued and an alternative medication should be substituted," the FDA states.

On the day that the news about the Pentagon investigation broke, rival firm GlaxoSmithKline said that data had been added to the label of its malaria drug, Malarone (atovaquone and proguanil), suggesting that the product causes fewer neuropsychiatric side effects than Lariam does.

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New Drug Works Best for Bipolar Disorder 

HealthScoutNews

Friday, October 4, 2002

FRIDAY, Oct. 4 (HealthScoutNews) -- The drug Zyprexa is more effective than lithium in helping people with bipolar disorder, says a study presented at a recent European conference on the illness.

The year-long study found people taking Zyprexa relapsed into mania only half as often as people taking lithium. The two treatments were similar in preventing relapse into depression. Significantly more of the people taking Zyprexa completed the study and fewer were hospitalized, compared to the people taking lithium.

"While both drugs performed well, Zyprexa was found to be superior to lithium. This is especially impressive from a clinical standpoint, given that lithium has been the gold standard for decades for the prevention of mania," says Dr. Frederick Goodwin, director of the Center on Neuroscience Medical Progress and Society at George Washington Medical Center.

"This advance is very encouraging for the long-term treatment of the disease. Meanwhile, we must continue our efforts to improve outcomes for bipolar depression," Goodwin says.

It's estimated that three million Americans have bipolar disorder. It's a chronic condition that features cycles of mania and depression interspersed with normal mood. People with the disorder may also have mixed episodes where they experience mania and depression symptoms simultaneously.

Without proper treatment, people with bipolar disorder may pursue harmful activities such as drug use and excessive spending. People with the disorder are more likely to attempt suicide than people with other psychiatric disorders or those in the general population.

It's estimated that 25 percent of people with bipolar disorder will attempt suicide at least once, and 10 percent to 20 percent of them will succeed.

More information

The National Institute of Mental Health has lots of resources on bipolar disorder.

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Some Children Are Allergic to Cooked Potato: Study 

By Charnicia E. Huggins

Reuters Health

Friday, October 4, 2002

NEW YORK (Reuters Health) - A team of Belgian researchers has identified another food that may be responsible for severe eczema, vomiting and other allergic reactions in infants and young children: cooked white potatoes.

"I don't think it's really frequent," study author Dr. Liliane F. A. De Swert of the University Hospital Gasthuisberg in Leuven, Belgium told Reuters Health. Still, it is "important to be aware it can cause severe allergic problems in young children."

Most food-induced allergic reactions in children can be explained by allergies to cow's milk, eggs, peanuts, soy, fish and wheat, the report indicates. Raw potatoes have also been known to cause allergic reactions in adults and young children, but this is the first study to link cooked white potatoes to severe allergy symptoms, De Swert said.

The finding is particularly important since potatoes are often one of the first solid foods eaten by infants, usually at 4 to 6 months of age, the authors note.

De Swert and her team studied eight children, aged 3.5 months to about 2 years, who were suspected of being allergic to cooked potatoes. Two of the eight children had immediate reactions to potato and six experienced an improvement in their eczema after they were put on a potato-free diet. For comparison, the study also included nine children with allergies to cow's milk.

Results of various experiments, including a potato challenge, in which a small amount of cooked potato was applied to the inside of the child's lower lip, and a skin prick test, using extracts of homemade cooked and uncooked potato, indicate that the children were indeed allergic to cooked potato, the researchers report.

For example, five children had immediate allergic reactions to the potato challenge--including vomiting or wheezing--and all of the children who underwent the skin prick test had immediate skin reactions, according to the report in the September issue of the Journal of Allergy and Clinical Immunology.

Also, after potato was eliminated from their diet, the children experienced a 50% or more reduction in the extent and intensity of their eczema, and had fewer complaints about the eczema, study findings indicate.

The researchers do not know which particular allergen triggered the children's symptoms, since all but one child reacted to several different proteins, De Swert said. Further, although the children with allergies to cooked potato generally also had strong reactions to raw potato, some of the children who were allergic to raw potato were able to tolerate the cooked potato.

"It is well known that the allergenic properties of foods can be altered by heating," De Swert said.

Allergy to cooked potato does not seem to be long-lasting, however, as seven of the eight children outgrew their allergy by 6 years of age, according to the researcher.

Thus, people should not panic about their young child eating cooked potato, De Swert said. However, when children have allergic symptoms that cannot be explained by the more common milk, egg or peanut allergies, "I think we should look for potato allergy also," she said.

Commenting on the study, Dr. Marianne Frieri, director of allergy and immunology at Nassau University Medical Center in East Meadow, New York, said that De Swert's findings were "really interesting" and that the study, although small, was "well-designed."

She cautioned, however, that "parents shouldn't think all children with eczema will have this." They should just be aware that the problem exists, especially if they notice a flare-up of the child's allergy symptoms when they start to feed the child a potato dish, she said.

Parents should also be aware that potato products and potato protein may be hidden in many foods, according to Frieri, who is also a member of the food allergy committee at the American Academy of Allergy, Asthma and Immunology. "Potato is in so many things," she said.

In the present study, it did not seem to be difficult for mothers and their children to avoid potato once they were aware of the allergy; still, De Swert acknowledged that "careful reading of labels of ingredients is mandatory."

Source: Journal of Allergy and Clinical Immunology 2002;110:524-529.

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Calling All Sisters of Women With Breast Cancer Risk 

HealthScoutNews

Friday, October 4, 2002

FRIDAY, Oct. 4 (HealthScoutNews) -- Sisters of women with breast cancer ( news - web sites) are being recruited for a study to better understand the causes of breast cancer.

Study researchers hope to enroll 50,000 women across the country. They're looking for women, aged 35-74, whose sisters have been diagnosed with breast cancer. Sisters of women with breast cancer are known to have up to twice the risk of other women of developing breast cancer.

The researchers want to better understand why these women have that increased risk. Is it because they share the same genes as their sisters with breast cancer? A common diet? Could the breast cancer be the result of early menstruation or a household or environmental chemical? Could there be a gene-environment interaction?

The women in this study will be studied for 10 years through simple tests and questionnaires. The tests will include collection of blood, urine, toenail clippings and household dust. The study is being done by researchers from the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health ( news - web sites).

There are a number of reasons why the researchers decided to study sisters of women with breast cancer, says principal investigator Dale Sandler, acting chief of the NIEHS epidemiology branch.

As well as being twice as likely as other women to develop breast cancer, sisters of women with breast cancer are also likely to be within the same age range as their sisters and to have been exposed to many of the same environmental factors during early childhood and possibly later in life as well.

Also, the sisters share many of the same genes, including the genes that determine how their bodies deal with carcinogens or repair DNA, Sandler says.

More information

To learn more or to volunteer for this study, call toll free 1-877-4SISTER (1-877-474-7837) or go to the Sister Study.

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Americans Fooling Themselves About Exercise Habits 

Reuters Health

Friday, October 4, 2002

NEW YORK (Reuters Health) - Expanding waistlines and dire health statistics aside, most Americans think their exercise habits are just fine, according to the results of a new survey.

The poll of more than 1,500 US adults and teens found that 88% of adults and 84% of adolescents said they were getting enough exercise to maintain their health. And 76% of parents felt their kids were adequately active.

The US Surgeon General begs to differ, however. A 1996 Surgeon General report concluded that 60% of Americans aren't active enough, notes the National Association for Sport and Physical Education (NASPE), which commissioned the new survey. And obesity, fueled in part by sedentary lifestyles, is considered epidemic in the US.

"It appears perceptions do not meet reality," Dr. Kim Graber, president of the Reston, Virginia-based NASPE, said in a statement.

"Clearly," Graber added, "the physical activity community must find better and more creative ways to provide parents and teens with a better understanding about the amount and type of activity needed to maintain good health."

Health experts advise healthy adults and teens to accumulate at least 30 minutes of physical activity on most, and preferably all, days of the week.

According to the NASPE, survey respondents may also have lost touch with reality when it came to estimating their TV time. While US health officials report that the typical American teen watches around 5 hours of TV a day, adults and teens in this survey put that number at closer to 2 hours.

Parents did, however, cite television and computer and video games as the biggest barriers to getting kids to stay active. Other factors included lack of interest and lack of safe recreational areas.

For their part, the few adults who thought they weren't active enough largely blamed it on their jobs, lack of time, health problems or disinterest.

A large majority of respondents did believe exercise has numerous benefits, including better overall health, increased energy and reduced stress.

The survey was based on interviews with a nationally representative sample of adults and adolescents age 12 and older.

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Cat Scratch Fever: Nothing to Yowl About 

HealthScoutNews

Friday, October 4, 2002

(HealthScoutNews) -- Cat Scratch Fever -- It's a somewhat disturbing name for a disease many cat lovers seem to love to fear.

It should sound scarier than, say, Parinaud's Syndrome, Debre's Syndrome, or even Petzetakis' Syndrome. Whatever you choose to call it -- those all are synonyms for the same affliction.

The Health Library at Yale-New Haven Health System describes it this way: "A self-limiting infectious disease characterized by swelling and pain in the lymph nodes (regional lymphadenitis)." Symptoms can vary from mild to severe, and may include achiness, discomfort, malaise and loss of appetite. In most cases a scratch, bite, or lick of a cat is considered to be the source of the infection.

Some 22,000 cases of CSD are reported in the U.S. annually -- peaking in the fall and winter seasons in temperate climates and extending through July and August where it is warmer. Fewer than 10 percent of cases require hospitalization, notes The Internet Journal of Advanced Nursing Practice (IJAPN).

Most CSD cases actually require no treatment, though doctors often prescribe an antibiotic to reduce the risk of complications.

The IJAPN notes that CSD appears to strike males more than females, and children most of all. People most often contract it from young, male cats via a bite, scratch, or petting, as a result of direct contact with saliva deposited on an infected cat's fur and claws as it self-grooms.

Symptoms may not appear for several weeks. They often fade away after another few weeks.

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Death, Depression Link Stronger in Men 

By Dana Frisch

Reuters Health

Friday, October 4, 2002

NEW YORK (Reuters Health) - Researchers have long known that elderly people who are depressed are at greater risk of dying in a certain time period than their more hopeful peers. Now new study findings suggest that men may be more susceptible to this effect than women--although the link may not be as strong as previously suspected.

"Doctors need to be more aware of the effect of depression on physical health," said Dr. Melanie Abas, lead author and a consultant psychiatrist on the Research and Audit in Mental Health Services Team at South Auckland Health in New Zealand. She said doctors may not treat depression if a patient is depressed due to an "understandable" cause, such as heart disease, arthritis or loss of a spouse.

In the study, published in a recent issue of the British Journal of Psychiatry, Abas and colleagues examined data collected from over 2,600 participants aged 65 to 75, all part of a high blood pressure trial in the UK begun in the mid-1980s. Participants completed a psychiatric test when they enrolled, which included questions about depression.

Abas and her team collected mortality data on the subjects from the original trial for analysis. They found that almost 5% of participants were depressed and of these, over one-third died in the intervening years.

When researchers considered risk factors, such as cardiovascular and cognitive health into their analysis, they found men, and people between 65 and 69 with depression were more than twice as likely to die during the study as those who were not depressed. There was no link between depression and mortality in those 70 or older, according to the report.

Abas said that as people age, other factors like cardiovascular health are more important causes for death and "swamp the effect of the ones related to depression." This research confirms other work that indicated that males with depression are more likely to die than females.

Severe depression normally affects about 3% of seniors and Abas said it continues to be under-treated and under-recognized. It is not known yet whether treatment of major depression would reduce mortality, Abas said.

Source: British Journal of Psychiatry 2002;181:123-128.

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Gaining Insight About Losing Weight 

HealthScoutNews

Friday, October 4, 2002

(HealthScoutNews) -- Americans probably lose more weight deliberately than do people in any other country. Some of the most aggressive dieters take off the same number of pounds two or more times in a single year.

The real problem, for many people, is ridding themselves of "boomerang" pounds -- the ones that keep coming back. That's why Americans also gain more weight than they lose every year.

Few pay more attention to the subject of weight loss than the National Weight Control Registry. A collaboration between Dr. James Hillof of the University of Colorado and Dr. Rena Wing of the University of Pittsburgh, the NWCR includes a database of people who have been successful at losing weight and keeping it off.

Now in its tenth year, the database contains confidential information about more than 2,000 people who've shed at least 30 pounds and kept it off at least a year. Tracking their progress has enabled researchers to compile some interesting data:

  • The most popular form of exercise for these weight-losers is walking;
  • More than 50 percent of those in the WNCR database did not participate in a formal weight-loss program. Instead, they employed a lot of personal discipline;
  • Two-thirds of people in the database were heavy as children, and 60 percent report a family history of obesity, and;
  • The average registrant has lost 60 pounds and kept it off five years.

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New Guidelines Urge Tailored Menopause Care 

By Denise Mann

Reuters Health

Friday, October 4, 2002

CHICAGO (Reuters Health) - Women considering taking hormone replacement therapy (HRT) to combat symptoms of menopause must review their individual risk factors with their doctor before making a decision, according to a new set of recommendations issued by a North American Menopause Society panel.

The new recommendations, released here Thursday at the society's annual meeting, were designed to help women and their doctors sort through confusion about hormones in light of several recent studies that found the risks of combined HRT with both estrogen and progestin outweighed its benefits.

For example, a study by the National Institutes of Health ( news - web sites)'s Women's Health Initiative, one of the largest and best-designed to date of HRT, was halted this July when women on the therapy were found to have higher risks of heart attack, stroke, blood clots and breast cancer ( news - web sites).

While the new recommendations help clarify appropriate HRT use, many questions remain unanswered including how long to prescribe HRT for symptom relief and whether patches, creams and other routes of administration are any safer than pills used in recent studies.

"It is more and more important for doctors to individualize their (patients') treatment," said panelist Dr. J. Chris Gallagher, a professor of medicine at Creighton University in Omaha, Nebraska. "The situation before was that everyone got one dose, regardless of their size. I think the recent study data suggest that we should be using the lowest dose possible and that treatment should be tailored to the individual," he told Reuters Health.

Treating the symptoms of menopause--such as hot flashes, night sweats and the vaginal dryness that makes sex painful--remains the number-one use for HRT, the recommendations state.

The new recommendations stress that combined HRT should not be used to prevent heart disease. Instead, they state, proven alternatives should be considered. It had been hoped that HRT might reduce women's heart disease risk, since women's risk of heart disease after menopause, when hormone levels decline, becomes much higher.

"There is still a role for estrogen at low doses and it is still important for the treatment of (the brittle bone disease) osteoporosis and the treatment of symptoms," Gallagher said.

Overall, HRT should be given for the shortest length of time possible and lower-than-standard doses should be considered, the recommendations state. Hormone patches, creams and other alternative routes of administration may offer an advantage, according to the recommendations, but there is no long-term data on use of such products.

While panelists agreed on several issues, there was no consensus on how to define "short-term" and "long-term" HRT use and how best to discontinue HRT.

Future research needs to focus on whether different estrogens and progestins, different doses and different routes of administration have the same risk profiles as the regimens used in recent studies, the recommendations state.

To arrive at the new set of recommendations, panelists culled published studies on HRT including the Women's Health Initiative study and the Heart and Estrogen/Progesterone Replacement Study.

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Keep Track of Your Heart Health 

HealthScoutNews

Friday, October 4, 2002

FRIDAY, Oct. 4 (HealthScoutNews) -- If you're concerned about high blood pressure or high cholesterol, there's a new online interactive ( news - external web site) tool to help you get customized information to assess and manage your risk.

The American Heart Association ( news - web sites) has added high blood pressure and high cholesterol to its online interactive health management tool called Heart Profilers. It analyzes more than 20 of your personal characteristics, including age, gender and race.

Here's where to go to find Heart Profilers.

The free, 24-hour, confidential resource is based on the latest research reports, and it's updated each month. It matches your medical information, or profile, with published clinical research studies and provides treatment information specific to your condition.

It takes about 20 minutes to create your personal profile and receive an initial report. The report includes a list of questions you can take with you to your doctor.

Heart Profilers also offers information about drug side effects, compares various treatment options, and has an index of medical terms to ensure you understand all the information you receive.

"Heart Profilers is not just another medical or health Web site. It's a major advance in online technology that has the potential to change the way patients and physicians interact with each other," says Dr. Clyde Yancy, an associate professor of medicine/cardiology at the University of Texas Southwestern Medical Center and chairman of the medical board for the heart failure tool of Heart Profilers.

More information

The U.S. National Heart, Lung, and Blood Institute has information on how to keep your heart healthy.

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Technique Could One Day Treat Deadly Brain Tumors 

By Amy Norton

Reuters Health

Friday, October 4, 2002

NEW YORK (Reuters Health) - If new animal research holds up, scientists may have found a way to deliver drugs directly to brainstem tumors that are currently incurable.

The technique, developed by researchers at the US National Institutes of Health ( news - web sites) (NIH), was found to safely deliver a so-called "tracer molecule" to the brainstems of monkeys. What's more, researchers were able to use MRI scans to see that the agent was evenly dispersed in the brainstem region they targeted.

This is significant because conventional chemotherapy, when it can cross the "blood-brain barrier" that shields the brainstem, does so in an ineffective, non-targeted way, Dr. Russell Lonser, the study's lead author, explained in an interview with Reuters Health.

Because of a lack of effective therapy, brainstem tumors called diffuse pontine gliomas, which primarily affect children, are "universally fatal," Lonser noted. The hope, according to the researcher, is that this new drug-delivery technique can be used to treat these tumors, as well as other diseases of the brain.

Lonser and his colleagues at the NIH in Bethesda, Maryland, report the findings in the October issue of the Journal of Neurosurgery.

The drug-delivery technique, called convection-enhanced delivery (CED), involves using a cannula--a thin, flexible tube--to deliver fluid directly to the brain region to be treated. CED uses small differences in pressure to make infused compounds flow between cells and disperse in tissue.

Lonser described the approach as "very targeted...You don't have to fill the whole central nervous system up with the drug."

He and his colleagues found that they could safely infuse the brainstems of monkeys with a molecule called Gd-albumin, which they were then able to track using MRI scans. They found that the technique spread the molecule uniformly throughout the treated region.

Gd-albumin molecules are similar in size to the molecules of many cancer drugs, and Lonser said these findings indicate that doctors would be able to track drugs in the brainstem should the CED technique be used in humans. He and his colleagues are currently trying to figure out which drugs might be useful.

Lonser said they also believe the drug-delivery technique "could have widespread application" in treating other diseases of the brain, including Parkinson's disease ( news - web sites) and other neurodegenerative conditions.

Source: Journal of Neurosurgery 2002;97:905-913.

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New Test Detects Osteoarthritis Faster 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Friday, October 4, 2002

FRIDAY, Oct. 4 (HealthScoutNews) -- An international team of researchers has discovered that telltale signs of the painful joint disease osteoarthritis can be found in samples of blood and urine.

The study, published in the current issue of Arthritis and Rheumatism, found that osteoarthritis causes changes in the levels of two markers of collagen production and metabolism. Collagen is a component of cartilage.

"What this study clearly shows is that there are biological markers for cartilage synthesis and degradation, and that they are present in osteoarthritis," says Dr. John Klippel, medical director of the Arthritis Foundation. Klippel was not involved in the current research.

Osteoarthritis is a disorder caused by the destruction of the cartilage that cushions the joints. As cartilage wears away, bones begin to rub together. The condition can cause pain, swelling, stiffness, and loss of motion. More than 20 million Americans suffer from osteoarthritis, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Half of all Americans have osteoarthritis in at least one joint by the age of 65. There is no treatment to halt the progression of osteoarthritis, only to manage its symptoms.

Currently, the only way to diagnose osteoarthritis is through X-rays, CT scans or MRIs, Klippel says. The problem with relying on these methods is that it takes a lot of time before any changes in cartilage become evident, and by that time the damage is already done. Also, researchers cannot quickly assess whether new treatments are effective or not.

For the current study, researchers from France, Denmark and the United States recruited 75 men and women with osteoarthritis of the knee and 58 people without the disorder to act as a control group. The average age of the participants was 63.

Blood and urine samples were taken at the start of the study and one year later. The researchers also took X-rays and surgically examined the knee using arthroscopy.

The researchers found that people with osteoarthritis had lower levels of a substance that helps with cartilage production and higher levels of a substance that causes cartilage degradation.

"It's nice to finally have a marker," says Dr. Robert Quinet, head of rheumatology at Ochsner Clinic Foundation in New Orleans. "People have been interested in finding markers for many years. This is the best study so far, but there's no therapy to use. We don't yet have a drug that will impact on these findings."

A more immediate use of these tests would likely be in clinical trials, Quinet and Klippel say. With current diagnostic techniques, months or years have to pass before any changes in the disease progression can be noticed, says Klippel. So, if these biological markers of osteoarthritis are confirmed in larger trials, they could help researchers more quickly assess if a particular treatment is working or not.

The authors of the study acknowledge that their sample size was relatively small, and since they only studied osteoarthritis of the knee, they don't know if these markers would be present in other forms of the disease. They also conclude that larger studies need to be done to confirm their findings.

Those limitations don't dampen Klippel's enthusiasm for the work, however. "This has the potential to become important in the evaluation and care of people with [osteoarthritis] and similarly will be important in the conduct of clinical trials," he says.

What To Do

For more information on osteoarthritis, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases or the American College of Rheumatology.

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THURSDAY, OCTOBER 3, 2002 

Pessimists Face Tough Recovery From Stroke 

HealthScoutNews

Thursday, October 3, 2002

THURSDAY, Oct. 3 (HealthScoutNews) -- If you're a pessimist, here's some bad news for you to dwell on.

Pessimists are almost five times more likely to develop depression after surviving a stroke, says a Dutch study in the October issue of Stroke.

"Our study found that post-stroke depression is not only caused by damage to the brain tissue, but also depends on one's general tendency to react to distressing life events by experiencing emotions such as anger, anxiety and sadness," says lead author Dr. Ivo Aben.

He did the research while he was a doctoral student at the Institute of Brain and Behavior at Maastricht University in the Netherlands.

Depression is common among stroke survivors and can slow recovery.

This study included 190 people recovering from a first stroke. The people were assessed for symptoms of depression one month after the stroke and then three, six, nine and 12 months later. They also filled out questionnaires asking them about their personality traits, including the tendency to have negative mood states -- called neuroticism.

One year after the stroke, researchers found that 38.7 percent of all the stroke survivors in the study were depressed. The people with high neuroticism scores were 4.6 times more likely to have post-stroke depression than those with low neuroticism scores. The effect was stronger in men than in women.

Neuroticism was the only personality trait -- the others included extraversion, agreeableness, conscientiousness and openess to new experiences -- that increased the chances of post-stroke depression, the study says.

More information

Learn more about stroke at the American Stroke Association.

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Ebola Vaccine Will Enter Human Trials Within Months 

By Alicia Ault

Reuters Health

Thursday, October 3, 2002

WASHINGTON (Reuters Health) - A vaccine against the Ebola ( news - web sites) virus should move into human clinical studies within the next 6 to 8 months, a National Institutes of Health ( news - web sites) official said Thursday.

Addressing reporters here at a meeting of the World Medical Association, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases ( news - web sites) (NIAID), said that studies testing the vaccine in chimpanzees had recently been completed, clearing the way to start safety trials in healthy human volunteers.

Fauci said the Ebola research had been able to move ahead quickly partly because of the post-September 11 multi-billion dollar infusion of funds to combat bioterrorism. Ebola was moved ahead in the research queue because "it was one of the high impact, likely probability microbes" that might be used in a bioterrorism attack, Fauci said.

He also noted that NIAID scientists have been studying Ebola for years, hoping to unravel the virus' mechanisms of action.

The vaccine is being developed in tandem with Crucell NV, a small Dutch biotechnology company. NIAID researchers are providing the Ebola genes that are being used in the vaccine, and Crucell has the exclusive license to sell the vaccine.

Fauci was asked by reporters what the government was doing to encourage private drug and biotech companies to develop vaccines and therapies against bioterror agents, considering that the return on investment was very unpredictable.

"My feeling has been all along that we need to create a market," said Fauci, who agreed that there was no clear return for manufacturers.

The federal government could commit to buy a guaranteed amount of a product, he said, adding that this strategy "certainly is something that is under consideration" by Bush Administration officials.

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Treating Morning Sickness, Gingerly 

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Thursday, October 3, 2002

THURSDAY, Oct. 3 (HealthScoutNews) -- Pregnancy gives rise to a host of wonderful emotions, such as joy and excitement. It's also a good excuse to eat ice cream every night.

However, expectant mothers must often cope with a very unpleasant side-effect: morning sickness.

An estimated 60 percent to 80 percent of pregnant women suffer from morning sickness, which is actually a misnomer because the nausea and vomiting associated with it can last all day long.

Fortunately, relief may be on the way: A new study has found the herb ginger can relieve the queasiness in many women.

Researchers from the University of South Florida had 26 pregnant women, aged 24 to 37, drink Ginger Honey Tonic, a syrup that contained ginger, mixed with water. A second group of women drank water containing a placebo syrup. All the women had experienced morning sickness during the first 12 weeks of pregnancy.

Researchers then asked the women to rate their morning sickness symptoms on a 10-point scale.

The study found that 77 percent of the women drinking the Ginger Honey Tonic reported a 4-point or greater decrease in symptoms within nine days. Conversely, only 20 percent of the women on the placebo syrup, or 2 out of 10, reported a similar improvement in their symptoms.

"Ginger is known as an herb that can settle the stomach," says study co-author Dr. Ronald A. Chez, a professor of obstetrics and gynecology at the University of South Florida in Tampa when the research was conducted. "Ginger has been used by many cultures to treat nausea."

The researchers concluded that ingesting one gram of ginger daily, either in syrup or capsules, can help relieve morning sickness during the first trimester of pregnancy.

The study appears in the September/October issue of Alternative Therapies in Health and Medicine.

Peg Plumbo, an instructor in the nurse-midwife program at the University of Minnesota, says she's not surprised by the findings. She often recommends expectant mothers struggling with morning sickness to try ginger tea.

The Ginger Honey Tonic can be mixed with warm water to make tea, or sparkling water to produce a ginger ale-type drink, the researchers say.

Women can also buy ginger in the grocery store, cut a slice or grate it and boil it. Then let it steep for about five minutes. Sweeten the brew with honey if you like.

Plumbo cautions, however, that ginger "isn't going to help all women, and it's not necessarily going to help the same woman day to day."

Morning sickness for most women means mild to moderate nausea that comes on about the fourth to eighth week of pregnancy.

For women with severe nausea, it can lead to dehydration and hospitalization.

When a woman complains of nausea during pregnancy, Plumbo says it's important to determine she really has morning sickness and not something more significant.

Certain rare but serious conditions, including a placenta that's not developing correctly and gall bladder or liver diseases, can cause nausea and vomiting, she says.

A high stress level can also make a pregnant woman feel ill. "I like to look at if this was a planned pregnancy, how her family and her partner are supporting her," Plumbo says.

If you're dealing with morning sickness, Plumbo suggests you start by trying to eat something small, first thing in the morning. Even before you get out of bed, try nibbling on some crackers or sipping flat ginger ale or soda at room temperature.

"Some women find that if they do this even before they start moving around, it's very helpful," Plumbo says.

Prescription medicines are available to treat morning sickness, including antiemetics, a type of drug that controls the spasms of the stomach. Mild tranquilizers can also calm your mood and your stomach, Plumbo says.

Some women find relief with over-the-counter antacids, motion sickness drugs, sleep aids ( news - web sites) or acupressure.

"There are probably hundreds of other remedies out there we don't know anything about," she says.

What To Do

For more tips on dealing with morning sickness, check with the American Academy of Family Physicians or the Society of Obstetricians and Gynaecologists of Canada.

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Menopause Docs Meet on Hormone News  

By Lindsey Tanner

AP Medical Writer

The Associated Press

Thursday, October 3, 2002

CHICAGO (AP) - Besieged by patients anxious and confused over recent bad news about hormone supplements, doctors flocked to a meeting of experts this week to get answers for themselves.

"It affected us all, to some degree, across the board. We're getting a lot of phone calls," said Dr. Sylvia Garwin, an obstetrician-gynecologist from Herrin, Ill.

Many patients on hormones are quitting, trying unproven herbal remedies and suffering through hot flashes and night sweats, unsure of what to do next, Garwin said Thursday at the annual meeting of the North American Menopause Society.

"I'd like to know what other doctors are telling their patients," she said.

The Chicago meeting is the first formal gathering of specialists since it was announced in July that a landmark government study had found evidence linking estrogen-progestin supplements with breast cancer ( news - web sites) and heart disease.

The nonprofit society represents more than 2,000 doctors, nurses and other health-care providers. More than 1,500 registered for the meeting, a higher-than-normal response organizers attributed to concern over the study results.

The National Institutes of Health ( news - web sites) study found a 26 percent increased risk of breast cancer and an even higher risk of strokes and heart attacks among hormone users despite the once-widespread belief that the supplements could help protect the heart.

"Not only the public, but also the health providers were thrown into a sort of turmoil," said Dr. Wulf Utian, the society's executive director. "There have been significant levels of debate, argument, discussion, and there's still a level of real uncertainty of what this all means."

Many of those at the meeting said they think that the results were sensationalized and that hormones — taken by millions to reduce symptoms and prevent bone loss — are still appropriate for some women.

The menopause society agreed in issuing its new hormone recommendations, noting that the study involved women ages 50 to 79 and only one type of hormone supplement — estrogen-progestin pills.

The recommendations note that the study did not answer whether similar results would be found in younger women in "perimenopause," the period leading up to the last menstrual period when symptoms often are the most severe. Nor did it address other types of hormone treatment, including lower doses, creams and skin patches.

The recommendations, released Thursday, say hormone supplements should be limited primarily to treating symptoms such as hot flashes and vaginal dryness. Lower-than-standard doses should be tried, for the shortest possible time.

The society also said hormones should not be used to help prevent heart disease, and alternative medication should be considered for prevention of osteoporosis, or thinning bones.

The focus of the three-day meeting is on helping menopausal women maintain a good quality of life with or without hormone therapy.

The standard medical mantra — eat healthy food, get plenty of exercise and maintain a normal weight — was touted at several sessions as a no-risk remedy.

Research presented at the meeting considered over-the-counter items billed as natural hormone alternatives, including soy-based products and herbal remedies like black cohosh, which is said to reduce hot flashes.

One study found evidence that soy-based tablets can help improve memory. Another suggested black cohosh extracts do not contain breast cancer-promoting products.

Most such research is preliminary, but many health providers say patient demand is forcing them to consider the alternatives.

Sanna Conoley, a nurse from Austin, Texas, said many of her patients scared by the hormone study are trying herbal products, with varying degrees of success. She said she warns patients that "just because it's an herb doesn't mean it's safe."

On the Net:

Menopause Society: http://www.menopause.org

NIH: http://www.nlm.nih.gov

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Study: Don't Avoid Opioids to Treat Back Pain 

By Holly VanScoy
HealthScoutNews Reporter

HealthScoutNews

Thursday, October 3, 2002

THURSDAY, Oct. 3 (HealthScoutNews) -- Doctors and pharmacists tend to avoid prescribing them, patients are afraid of becoming addicted to them, and government officials are concerned about their abuse. It's little wonder that opioids have acquired something of an unsavory reputation in medicine.

But is it all deserved?

A new study suggests it's a mistake to ignore the potential value of these powerful pain relievers for chronic conditions, including musculoskeletal pain and lower back pain.

There's evidence that opioids such as morphine, oxycodone, and fentanyl can help and should be the treatment of choice for some patients, says Dr. J.D. Bartleson, a Mayo Clinic neurologist and lead author of the study. It appears in the latest issue of the journal Pain Medicine.

"The prejudice against the use of analgesic opioids is unfortunate," Bartleson explains. "Especially since it results in their being underutilized in situations where they can contribute to improving patient outcomes. Opioids can provide significant relief for patients experiencing severe pain. I believe physicians and patients should be considering them more often than they presently do, including use in the management of chronic, nonmalignant pain."

Bartleson bases his conclusion on extensive analysis of all studies of opioid use in the treatment of chronic lower back pain. Despite longstanding controversies over opioid misuse and potential dependence, Bartleson found there is a place for their carefully considered and closely monitored use in treating this persistent, debilitating condition. In particular, he says, opioid use may provide a better alternative than back surgery and other pain medications for many patients whose lower back pain is persistent.

"Fewer than half of all back surgeries are successful in relieving chronic back pain," Bartleson says. "Other medicines for pain -- including aspirin and acetaminophen -- can cause permanent adverse effects. Opioids have been demonstrated to provide pain relief, without long-term side effects."

John Giglio, executive director of the American Pain Foundation, concurs. He adds the recent controversy over the opioid OxyContin has further muddied the waters over the benefits of this entire class of prescription medications.

"There is mounting evidence that physicians are being deterred from using opioid drugs for patients in pain, not only because of the bad publicity about certain ones of these medications, but also because they are concerned they will be investigated by the U.S. Drug Enforcement Agency if they prescribe them," Giglio says. "Even where there is no arrest, no indictment, no evidence of physician or pharmacist wrongdoing, an investigation sends a strong negative ripple through the medical community."

Giglio says chronic back pain is only one of the conditions for which negative publicity has overshadowed opioids' legitimate and proven medical benefit. Even in the treatment of serious malignant conditions, doctors and patients tend to shy away from the powerful drugs.

"In a recent survey of cancer specialists in California, for example, only about 60 percent of the oncologists reported being certified to prescribe opioids," Giglio says. "Of these, only 40 percent had ever done so -- which means that only one in four physicians specializing in cancer treatment in California are presently using the most powerful painkillers available in their practice."

Giglio and Bartleson agree that additional, longer-term and better-designed studies are needed to study how opioids can be best used in medical care.

Although Bartleson now counts himself among believers in opioids' benefits in the treatment of chronic back pain, he doesn't advocate their use for every back pain patient. "Opioids definitely have a role to play," Bartleson says. "But a physician has to make sure that whatever treatment is pursued is the best for the individual patient. Opioids aren't for everyone."

Bartleson adds that, more than anything else, his study points out the need for additional well-designed studies on treating back pain, including the role opioids can legitimately play in such treatment.

What To Do

Learn more about policies governing opioid use in the United States from the Pain Policy Study Group at the University of Wisconsin. The American Pain Foundation advocates for those who hurt.

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CDC: Babies, Toddlers Should Get Flu Shot This Year 

By Keith Mulvihill

Reuters Health

Thursday, October 3, 2002

NEW YORK (Reuters Health) - For the first time, the US Centers for Disease Control and Prevention ( news - web sites) (CDC) are encouraging flu shots for healthy youngsters aged 6 to 23 months, their household contacts and out-of-home caretakers, CDC officials said on Thursday.

Unlike last year, the federal agency does not anticipate any shortages in the vaccine. This year the flu vaccine is in "ample supply," said the CDC's influenza expert Dr. Scott Harper.

Babies, toddlers and the people who care for them are encouraged to get a shot starting in October. Other healthy people, including those aged 50 to 64, should get their shot beginning in November.

In the past, only young children at high risk for flu complications, such as those with chronic lung disorders, were recommended to get the vaccine. However, even generally healthy children aged 6 to 23 months are at increased risk for influenza-related hospitalizations, according to Harper,

In addition, health care workers, people at increased risk of developing influenza-related complications due to health conditions and household members of those at high risk should be vaccinated during October, the agency advises.

As in previous years, flu shots are strongly recommended for many people at high risk of complications. Such individuals include nursing home residents, adults and children with chronic heart or lung conditions, such as asthma, and those who need regular care due to chronic health problems such as diabetes, kidney disease or a weakened immune system. Women who will be more than 3 months pregnant during the flu season are also recommended to get the shot, according to the CDC.

"A lot of people think of influenza as a severe cold but, in fact, it is a potentially life-threatening infection and kills about 20,000 Americans every year and hospitalizes over 100,000 Americans every year," Harper said.

This season's flu vaccine has been matched to the three viral strains currently circulating around the world, CDC officials said at a press conference.

A yearly flu shot can prevent the onset of influenza during flu season, which in the United States lasts from the fall through the beginning of the following year. Each year, vaccine makers produce a new vaccine matched as closely as possible to the strains expected to be prevalent during the coming flu season. A vaccine well matched to circulating strains is more effective than one that is not.

While nobody knows exactly which influenza virus types will predominate or how severe the 2002-2003 flu season will be, "the optimal time to receive influenza vaccine" is during the months of October and November, according to the report in the October 4th issue of the Morbidity and Mortality Weekly Report.

The CDC tracks the types of influenza virus circulating in the US and worldwide annually in preparation for the upcoming influenza season. The data is gathered by the World Health Organization ( news - web sites) Collaborating Center for Surveillance, Epidemiology, and Control of Influenza at the CDC, which analyzes flu virus samples from laboratories around the world.

Currently, influenza A (H1), A (H3N2) and B viruses have circulated worldwide since May, and in North American only sporadic cases have been reported, the report indicates.

Harper said that the three US influenza vaccine manufacturers will distribute 80% of the 94 million doses by the end of October, and the remaining doses will likely be distributed in November and December.

Source: Morbidity and Mortality Weekly Report 2002;51:880-882.

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Men Want Prostate Screening... 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, October 3, 2002

THURSDAY, Oct. 3 (HealthScoutNews) -- Most men would gladly recommend prostate cancer ( news - web sites) screening to their friends and sons -- even when they know there's no proof the test saves lives.

A survey published this week in the British Medical Journal of 52 United Kingdom men who underwent blood screening for prostate cancer -- called a PSA test -- found that 48 said they'd encourage other men to do the same. Only four demurred. They cited a lack of evidence that PSA testing, which can potentially lead to invasive treatment with serious side effects, reduces the risk of dying from the tumors.

In fact, the skeptics are correct. Another study in the journal found that aggressive PSA screening and tissue sampling in suspicious cases greatly increased the odds that men would undergo prostate-removal surgery and radiation treatments for cancer.

However, that didn't lower their risk of dying from the disease.

"There's an awful lot of confusion about prostate cancer screening, with certainly no good evidence that it decreases mortality," says Ann McPherson, a research lecturer at the University of Oxford and a co-author of the study.

PSA, or prostate specific antigen, is a protein used both as a screening tool and as a way to measure the progress of the disease. This molecule is found normally in men throughout the body, but is produced in mass quantities by prostate tumors.

Routine PSA testing is not recommended in the United States or Britain. But men over age 50 in the United States are given the option of regular screening while in the United Kingdom, they get the test only when their doctor suspects prostate cancer. As a result, American men who opt for PSA screening inherently believe it could save their life, McPherson says.

Of the 48 British men who opted for the test, many were willing to overlook the lack of evidence that it would prolong their life. Overriding concerns, they said, were acting responsibly, having a right to one's own health information and avoiding possible regrets for not taking the test.

Prostate cancer is the number two cancer killer of men in the United States, affecting 190,000 and killing more than 30,000 each year. Death rates from the disease have been falling for the last five years, a decline some doctors attribute to PSA testing.

However, if the test is indeed saving lives, areas with more aggressive screening programs should see lower mortality rates from prostate cancer, says Dr. Michael Barry, chief of general medicine at Massachusetts General Hospital and a co-author of the second journal article.

To test that hypothesis, Barry and his colleagues turned to Washington and Connecticut, two states with much different approaches to prostate cancer screening. They followed 94,000 Seattle Medicare recipients and 120,000 Connecticut recipients between 1987 and 1997.

During the early years of the study, the Washington men underwent the test more than five times as frequently as those on the East Coast, and they had more than double the rate of biopsies to probe suspect prostate glands.

Not surprisingly, the aggressive screening program uncovered many more cases of cancer. "The more you look for it, the more you find," Barry says.

For the first three years of the study, the age-adjusted incidence of the disease was 83 percent higher in Seattle than it was in Connecticut, though that difference dropped to 11 percent for the years 1991 through 1996.

As a result, the rates of prostate removal surgery and radiation to shrink the gland were sharply higher in Washington -- 2.7 percent and 3.9 percent, respectively, versus 0.5 percent and 3.1 percent in Connecticut.

However, while mortality rates from the disease dropped in both areas, by the end of the study the two groups of men had equal odds of dying from prostate cancer.

"It didn't look like the much more aggressive approach in prostate screening reduced mortality," Barry says.

The study focused on men aged 65 to 79, and it's possible that younger men might benefit more from screening, Barry says. Another caveat is the possibility that men in Washington have different risk factors for prostate cancer than those in Connecticut, which could influence the results of the study.

However, the latest findings don't bode well for supporters of the PSA test, says Dr. Theodore Ganiats, a family physician at the University of California, San Diego.

The National Institutes of Health ( news - web sites) is sponsoring a large, randomized trial of PSA testing. Ganiats, who helped write the PSA screening guidelines for the American Academy of Family Physicians ( news - web sites), which doesn't recommend routine testing, says the results of the trial should help settle the controversy.

In the meantime, he says he tells his patients that the choice to have the test is theirs to make. "In the absence of good data, it's whichever way you feel you're going to sleep better tonight," Ganiats says.

What To Do

To find out more about prostate cancer, check the Prostate Cancer Research Institute or the U.S. Centers for Disease Control and Prevention.

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Drug Helps Cystic Fibrosis Patients  

By Janet McConnaughey

Associated Press Writer

The Associated Press

Thursday, October 3, 2002

NEW ORLEANS (AP) - A common antibiotic helps most cystic fibrosis patients breathe better and stay out of the hospital, the Cystic Fibrosis Foundation said Thursday, citing the results of a new study.

Patients with cystic fibrosis generally lose about 2 percent of their lung capacity a year as mucus clogs their airways, trapping bacteria that cause infection. Eventually, they die of lung failure.

In the study paid for and coordinated by the foundation, researchers targeted chronic pseudomonas infection, one of the ailment's most common and serious complications.

The study found that 87 people who took the antibiotic azithromycin for six months gained lung capacity, while 97 on placebos lost capacity.

And only 14 of the patients taking the antibiotic had to be hospitalized for flare-ups of lung infections, while 29 of those in the comparison group went to the hospital, said Dr. Bruce Marshall, one of the lead investigators.

Patients taking the antibiotic "had more energy, they felt stronger, they could do more," said Dr. Preston W. Campbell III, the foundation's top medical officer.

Dr. Jay Kolls, a lung specialist at Louisiana State University Health Sciences Center, said he will strongly consider azithromycin for his patients.

To "have that number of hospitalizations reduced in that time period is significant," said Kolls, who was not involved in the research.

Cystic fibrosis afflicts about 30,000 people in the United States and a similar number in Europe; it is one of the most common fatal genetic disorders.

On the Net:

Cystic Fibrosis Foundation: http://www.cff.org

Pseudomonas: http://www.pseudomonas.com/cystic_fibrosis.html

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'Smart Furniture' Promises Office Air Protection 

By Alan Mozes

Reuters Health

Thursday, October 3, 2002

NEW YORK (Reuters Health) - Can the office worker of the future be protected from both common indoor pollutants and the threat of bioterrorism? Yes, says one American researcher--through the use of "smart furniture" to detect air quality problems and protect individuals right at their desks.

"The idea is to build into the furniture the ability to actually clean the air in a 'breathing zone,"' said researcher Dr. Alan Hedge of Cornell University in Ithaca, New York. "That is, not all the air in the room--just the air immediately around the individual."

At this week's annual meeting of the Human Factors and Ergonomics Society in Baltimore, Maryland, Hedge highlighted the promise of workstation components that can serve as localized weapons against office air contamination.

Such "smart furniture" would integrate both user-friendly and automatic air-quality sensors, displays, filters, fans and neutralizing chemical agents into desk furniture panels and columns. The furniture system would be linked to the building's duct network.

This type of rapid response air-cleaning system would target only the immediate area between the worker's standing knee to just above the head. This, Hedge told Reuters Health, would create a "clean bubble of air around the person."

Technologically advanced furniture of this sort is not an entirely new idea, Hedge noted. Interest first developed in the mid-1980s in response to increasing concerns about secondhand smoke.

But as more and more offices chose to ban smoking altogether, interest in designing "smart furniture" waned, Hedge noted. While there are desk systems already in use--particularly in US "911 telephone response centers"--none as yet reach their potential to fully protect the air office workers inhale, he added.

"There are already systems which can do the filtration," he said. "But what they don't have is the intelligence up front to be able to detect the presence of particular contaminants and then quickly respond to them."

However, Hedge is optimistic about the important role such "smart furniture" could play in the near future to compensate for the design problems of the typical modern office building.

He pointed out that office air is recycled through a system of internal and external ducts that can easily carry a range of substances--including fungus, mold, cigarette smoke and airborne disease--from one part of a building to another. Research has shown, he said, that the risk of contracting a respiratory illness is more than 30% greater in offices where many workers breathe the same recycled air.

He further noted that last year's anthrax scare starkly revealed the ease with which dangerous pollutants can be maliciously introduced--particularly through unguarded external vents and false internal ceilings--and quickly spread throughout an office setting.

Hedge said any effort to protect workers from such ordinary and extraordinary threats cannot simply rely on large-scale building improvements. Substantially more powerful ventilation systems, he said, would require enormous fans to push the air through more rigorous filters--an unwieldy and expensive solution.

It is, therefore, "smart furniture"--costing somewhere between $50 and $100 per desk--that Hedge views as the most practical, inexpensive and effective answer to the air-quality dilemma. "Within 5 years--and maybe within 2 years--it's definitely feasible," he said. "I think it's a very realistic way that we can protect workers and improve the quality of their work environment."

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Gene Therapy Study Suspended  

By Lauran Neergaard

AP Medical Writer

The Associated Press

Thursday, October 3, 2002

Scientists have suspended studies of the first gene therapy ever to work — a treatment that appears to cure a rare immune disorder called "bubble boy disease" — as they scramble to tell whether the therapy gave a French toddler a leukemia-like side effect.

It's unclear if the gene therapy actually caused the boy's illness, although there are clues that a virus used in the treatment may be to blame. No other children given gene therapy for the disease — severe combined immunodeficiency, or SCID — have shown such a side effect.

The French boy's gene therapy, performed in October 1999, was successful, giving him a strong immune system. But in late summer, doctors discovered his body had far overproduced a type of white blood cell, a disorder they call leukemia-like. Now 3, he is responding well to chemotherapy, scientists said Thursday.

France and the United States suspended further studies of gene therapy for SCID while they evaluate what happened and notify parents of previous gene therapy recipients of the possible risk.

Advisers to the Food and Drug Administration ( news - web sites) will consult with French scientists and meet next Thursday to debate what steps are needed before the U.S. studies could resume, said Dr. Phil Noguchi, FDA's director of gene therapy.

The highly publicized moves were unusual — in studies of regular drugs, many people typically become ill before research is put on hold or generates public debate. But gene therapy has been a publicly charged topic since the 1999 death of 18-year-old Jesse Gelsinger, who was given a different type of gene therapy for another disease. Many scientists now believe that openly discussing potential risks as they're discovered is important to educate people about the new technology.

SCID gene therapy "has been a spectacularly successful endeavor up to this point," said Savio Woo of the American Society of Gene Therapy. If it truly poses a risk of leukemia, "then we have discovered a new enemy. Once we know the enemy, then the experts in the field will...be able to come up with strategies of how to deal with it."

SCID is a very rare inherited disease, occurring in about 1 in 75,000 births, in which patients' bodies don't make certain proteins crucial to developing disease-fighting immune cells. Without treatment they die very young. The best-known victim was David, Houston's famous "bubble boy" who lived in a germ-proof enclosure until his death at age 12 in 1984.

The most severe form, X-SCID, afflicts only boys. Those given a bone marrow transplant from a genetically compatible brother or sister are likely to be cured — but only 20 percent of X-SCID patients have a sibling who's a good match. When boys without a good match undergo a transplant anyway, a quarter die, said Dr. Donald Kohn of Children's Hospital in Los Angeles.

Hence the excitement when gene therapy worked in nine of the 10 X-SCID patients treated so far at Paris' Hopital Necker-Enfants Malades.

Dr. Alain Fischer drew bone marrow from the boys and culled immune cell-creating stem cells from it. He mixed in a virus containing a gene that makes the immune-system protein the boys' bodies lacked. Injected back into the boys, the stem cells worked properly.

Scientists long theorized — and warned study participants — that cancer might occur if the therapy's virus lodged near certain genes that control cell growth and affected them, too, Kohn said.

But with a total of 13 X-SCID gene therapy recipients in France and Britain, and 19 U.S. and Italian children given gene therapy for a related illness called SCID-ADA, the French case marks the first such side effect.

All SCID studies use a similar virus. As a result, the FDA has temporarily suspended two X-SCID studies poised to begin at Kohn's hospital and the National Institutes of Health ( news - web sites), plus Kohn's own study that recently gave gene therapy to four SCID-ADA patients.

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US Consumers Challenge Spread of Biotech Food 

By Carey Gillam

Reuters

Thursday, October 3, 2002

KANSAS CITY (Reuters) - Tomato genes crossed with fish. Vegetables that glow in the dark.

Much of the modern-day lore surrounding genetic modifications to food has the ring of science fiction. But with real-life genetic alterations now embedded in commonplace food products from produce to potato chips, Americans are starting to sit up and take their supper seriously.

From the West Coast to the East, grass roots consumer groups are lining up alongside a mix of scientists and environmentalists, challenging corporate giants to answer questions about what is happening to the food they eat.

"We don't necessarily know what we're doing," said Ignacio Chapela, a microbial ecology professor at the University of California at Berkeley and a member of a national committee of scientists studying the environmental impact of commercialized transgenic crops.

"We're making major transformations of the environment," Chapela said. "This simply calls for regulation."

Sandwiches And Salads

In a landmark move, Oregon citizens are seeking to do just that, placing on their November ballot a measure that would require all foods containing at least one tenth of 1 percent of genetically modified material to be labeled as such.

The measure extends to dairy and meat products derived from animals that have eaten genetically modified corn or other substances.

Opponents of the measure say it would create costly and complicated red tape, and would force senseless situations such as requiring deli operators and restaurants to label the sandwiches and salads they serve up.

"It is meaningless information that would come at a high cost for consumers," said Shannon Troughton, a spokeswoman for Monsanto Co.

Monsanto, a leading US developer of transgenic corn, soybeans and other crops, including a transgenic wheat ready to be rolled out, is a staunch opponent of the proposed law.

The company is working with a group of other biotechnology companies and food industry giants such as General Mills Inc., Procter & Gamble Co. and PepsiCo Inc. to try to stop the labeling law. Together, they have chipped in nearly $4.6 million to the "Coalition Against the Costly Labeling Law."

The chief supporters of the bill have raised less than $85,000. Despite the powerful opposition, several other states, including California, Colorado and Vermont, are pursuing similar initiatives.

Oregon ballot organizer Katelyn Lord said opponents were exaggerating the law's complications. She said there were many reasons genetically modified food should be clearly identified, including a basic right of consumers to know what they are eating. Other worries include health and environmental concerns tied to biotech, as well as a philosophical unease about tinkering with nature.

"There are as many reasons as there are people," said Lord. "We label sugar, salt, calories...and I don't think anybody questions whether or not we need to know that."

Scientific Unknowns

The United States leads the world in the production of genetically engineered food and has generally provided a safe haven for biotech crops, even as more than two dozen other countries have placed tight restrictions on genetically modified plants and food products.

With no established scientific evidence that genetically modified foods harm human health, US regulatory agencies have approved a wide array of products, and federal law currently has no mandatory labeling requirements for genetically modified foods. Food industry experts estimate 70% of the products found on US grocery shelves contain genetically modified ingredients.

St. Louis-based Monsanto has commercialized biotech seeds, particularly crops resistant to pests and weed-killing chemicals, so successfully that the company's genetic modifications are embedded in crops that cover millions of acres of US farmland and make their way into both human food products and animal feed.

Farmers like the biotech crops because they make it easier to control weeds and bugs. Ongoing research is developing a variety of potentially beneficial plants, including drought-resistant crops and plants that contain vaccines.

Yet both supporters and opponents of biotech say that over time, containing and controlling the genetic modifications introduced into the environment are likely to become difficult, if not impossible, and their long-term impact is unknown. Among the likely scenarios, they say, are weeds that become resistant to herbicides and insects that develop resistance to pesticides.

More research is needed, many argue, but this has been hard to come by as a lack of government funding plagues independent research efforts, and research at public universities in many cases is compromised by large monetary contributions made to the schools by the very corporations marketing biotech products.

"It's become a huge problem," said Jeanne Merrill, a representative of Greenpeace, an avid opponent of genetic engineering of food. "Universities are to benefit the public interest, not corporate profits and corporate patents."

Promises Yet To Be Kept

While much work is under way, the healthful benefits from genetically modified plants are still largely seen only in the lab, and organizations working to feed hungry people around the world say the solutions involve improving economics for farmers and their communities, not delivering biotech seeds.

Debate over the issue was heated at the World Summit on Sustainable Development in Johannesburg in August, and conflicts among and within countries continue, with many world leaders and noted scientists seeing biotech foods as a way to get nutritious food to starving people.

Some 800 million people go to bed hungry, according to the United Nations ( news - web sites) Food and Agriculture Organization ( news - web sites).

Anuradha Mittal, co-director of the Institute for Food and Development Policy think tank, said the for-profit corporate push for biotech food acceptance is overshadowing efforts to explore other solutions to world hunger as well as research efforts into the safety of biotech foods.

"There might be potential benefits (to biotech)," Mittal said. "My concern is that all the focus on ending hunger has gone to the technological solution. This is really about precautionary principles. We need to err on the side of safety. In a civilized society you would hope to do so."

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Fewer Shots for New Anthrax Vaccine  

By Laura Meckler

Associated Press Writer

The Associated Press

Thursday, October 3, 2002

WASHINGTON (AP) - The government has created a new, genetically engineered anthrax vaccine that promises to cut in half the six shots now needed for protection, and chose a pair of biotechnology companies to begin testing it.

The contracts, awarded Thursday for $22.5 million, will allow California-based VaxGen Inc. and Britain's Avecia to test the experimental vaccine on people to see if it is safe and, if so, to see if it provides protection against the deadly bacteria.

Federal authorities hope that together, the two companies will pave the way toward Food and Drug Administration ( news - web sites) approval for the vaccine. Eventually, the government wants 25 million doses manufactured and added to the National Pharmaceutical Stockpile.

VaxGen said it plans to begin testing for safety by mid-2003 and finish by the end of next year.

The current anthrax vaccine works well, experts say, but it requires six shots over 18 months plus an annual booster and it causes certain side effects. Last spring, a scientific advisory panel endorsed the existing shots, but recommended development of the next generation of vaccine, one that would require fewer shots and cause fewer side effects.

The search for a replacement took on new urgency after last fall's anthrax attacks, discovered a year ago Friday when health officials announced that a Florida man had mysteriously contracted the disease. Later, as more cases emerged, investigators learned that the spores were being spread through the mail.

"There is an urgent need to devise more effective measures to protect U.S. citizens from the harmful effects of anthrax spores used as instruments of terror," Health and Human Services ( news - web sites) Secretary Tommy Thompson said in a statement Thursday announcing his agency's grants.

Federal scientists working at the Army's lab at Ft. Detrick, Md., have already developed the science behind the promising new vaccine. There are three proteins that make anthrax deadly, and all must work in concert to cause infection. The experimental vaccine engineers one of them, called protective antigen, which stimulates the body's immune system so that it can recognize and fight anthrax should the person actually be infected later.

The private companies must now try and translate this technology into a practical vaccine. They must create samples for testing, then test the vaccine on a few people to see if it is safe. If these so-called Phase I trials work, the vaccine would be tested on larger groups of people to ensure it protects against infection — steps vital for FDA to ultimately approve its sale.

On Thursday's news, VaxGen stock rose 13 percent, or $1.17 per share, to close at $10.17 in trading on the Nasdaq Stock Market. Avecia is privately held.

The existing vaccine, manufactured by BioPort of Lansing, Mich., also uses the protective antigen, but the protein was not genetically modified using today's modern techniques, said Robert Myers, BioPort's executive vice president. He added that his company's vaccine may also be effective when delivered in two or three doses, testing that is now under way.

The current vaccine is not now offered to civilians who have not been exposed to anthrax. It is, however, routinely used by the Pentagon ( news - web sites).

All existing vaccine was under control of the Defense Department until this summer, when HHS and the Pentagon agreed to split the stockpile and each take half.

It's not clear if the vaccine could protect when administered after exposure to anthrax. Still, federal health workers offered it to congressional staffers and postal workers who were exposed during last fall's attacks in hopes it might offer greater protection than antibiotics alone. Only about 100 people opted to receive it, though.

That's partly because the government gave no recommendation about the vaccine, leaving it up to each person to decide whether to get the shots. That caused a lot of confusion, something officials said Thursday they are trying to avoid as they plan to eventually offer a vaccine against another potential bioterror agent — smallpox.

For smallpox, debate centers on how many Americans should be offered the shots — which carry rare but serious risks, including death. The plan now on the table would eventually offer the shots to everyone.

An important, related issue is whether to specifically recommend that people get the shots, or just offer them and let people decide on their own, said Dr. Anthony Fauci, the National Institutes of Health ( news - web sites)'s infectious disease director.

After the anthrax attacks, officials simply left it up to each person to decide.

"We were criticized right, left and center for putting it out in this way," said Dr. D.A. Henderson, a top HHS bioterrorism adviser. "We didn't know really what to say."

Associated Press Medical Writer Lauran Neergaard contributed to this story.

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Panel Calls for New Human Research Protections 

Reuters Health

Thursday, October 3, 2002

WASHINGTON (Reuters Health) - A panel of government advisers on Thursday called for more protections for people who participate in clinical trials and recommended the establishment of a central federal panel to oversee all public and private research conducted in the US.

The Institute of Medicine ( news - web sites) (IOM) committee began an investigation of research protections after Jesse Gelsinger's 1999 death while in a gene therapy study at the University of Pennsylvania. After 18 months, the panel concluded that there needs to be a new system established to help restore public faith in the clinical trial process.

"In the past few years, a number of tragic events involving research participants have shaken public confidence in the safety of these efforts," said Dr. Daniel Federman, chairman of the IOM committee and a dean at Harvard Medical School ( news - web sites).

In a lengthy report, the IOM panel said there's very little data on how many people die or are harmed in clinical studies, and urged the government to begin collecting that information. The panel also said that although there is some government oversight of federally funded trials, there are still ethical lapses and financial conflicts of interest. And, said the committee, private research needs to be more closely monitored, even though it is subject to Food and Drug Administration ( news - web sites) rules and review by Institutional Review Boards (IRBs) at hospitals and medical schools.

Fran Visco, a member of the IOM committee and president of the National Breast Cancer ( news - web sites) Coalition, said "there is diminished trust," especially among cancer patients. But she said the committee's call for a new system of protection goes a long way toward restoring public confidence.

The panel said there should be a new federal law requiring every organization conducting research to only be allowed to do so under the authority of a Human Research Participant Protection Program.

The program should guarantee protection to all subjects, and make sure researchers and administrators are trained in ethics. Research should be "transparent" to the community, providing as much data as possible about the trial's intent and adverse events without compromising patient confidentiality, said the panel.

Before any trial can go forward, the institution or company should weigh the scientific merits and risks of the study and evaluate financial conflicts of interest. This information should be given to new Research Ethics Review Boards (ERBs) for a comprehensive consideration of all the risks and benefits, said the panel.

Saying that review boards have been too beholden to institutions in the past, the committee said the new research ERBs should take at least one quarter of their membership from community members who have no direct stake in the research.

Scientists have also done a poor job of properly informing research subjects of the potential risks, said the committee, noting that consent is usually obtained once and through forms that have "legalistic and self-protective jargon."

Federman said that "obtaining the informed consent of the participants should be an ongoing process rather than a discrete, isolated moment."

Finally, the IOM panel said that people injured in a study should receive compensation for medical expenses, rehabilitation and lost income. The payments could come out of a general fund, said panelist and Washington and Lee University law professor Timothy Jost, who noted that some European countries already provide such compensation.

The IOM is part of the National Academy of Sciences ( news - web sites), a privately run organization created by Congress that conducts studies and advises the federal government on policy issues.

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New Type of Vitamin E 

HealthScoutNews

Thursday, October 3, 2002

THURSDAY, Oct. 3 (HealthScoutNews) -- A new study will investigate how a type of vitamin E called alpha tocotrienol helps protect neuron cells that may be killed due to neurodegenerative diseases.

The National Institute of Neurological Disorders and Stroke awarded more than $1 million for this study, which will be led by Chandan K. Sen, director of the laboratory of molecular medicine at Ohio State University Medical Center.

Previous research on tocotrienols found they're able to cross the blood-brain barrier and protect neuron cells that may be killed by neurodegenerative diseases and stroke. This study will investigate how alpha tocotrienol actually protects neurons.

More information

Learn more about tocotrienols.

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Vitamins may stop some Alzheimer's, stroke  

From the Science & Technology Desk
United Press International

Thursday, October 3, 2002

BELFAST, Northern Ireland, Oct. 3 (UPI) -- Taking certain vitamins regularly might combat high levels of homocysteine, a substance normally found in the blood, but also newly associated with stroke and some kinds of dementia as well as Alzheimer's disease, Irish researchers said Thursday.

However, researchers cautioned, the connection between vitamin intake and the diseases has not yet been established scientifically.

"Homocysteine is a normal (metabolic product) in the body," lead researcher Stephen McIlroy told United Press International. "It's just that higher levels of it are doing a lot of harm,"

In research to be published in the Oct. 4 issue of the journal Stroke, McIlroy and colleagues studied 83 patients with Alzheimer's disease, 64 with stroke and 78 with vascular dementia. They then compared them to 71 others without those diagnoses in the same age range -- around 75 years. They used standard tests to confirm conditions, took detailed medical histories and assessed dietary intake.

After adjusting for age, sex, hypertension, cholesterol, smoking and diet, the researchers noted a high correlation between a roughly 50 to 70 percent increase in homocysteine and Alzheimer's, stroke and vascular dementia.

They concluded the presence of homocysteine in Alzheimer's disease, stroke and vascular dementia (caused by multiple strokes) is more than just an association, according to McIlroy, a molecular geneticist in the department of geriatric medicine at Queen's University of Belfast.

Homocysteine seems to be an actively destructive agent, McIlroy said, but cautioning, "I would very much like to see an interventional trial on vitamin B complex and folate in risk for stroke and dementia and memory deficits."

It also is possible the compounds attack the lining of the blood vessels. High homocysteine levels are known to be associated with increased heart disease. The researchers also determined suspected genetic components sometimes associated with higher homocysteine levels were not responsible for the higher levels in the people studied.

Vitamins B6, B12 and folic acid (folate) are known to reduce homocysteine levels if all three are taken daily. It is not known exactly how the increased homocysteine level is related to the diseases, or whether lowering levels of homocysteine would prevent the diseases. The authors theorize homocysteine -- or a similar compound that turns into homocysteine -- might be neurotoxic and might cause neurodegeneration.

"One of the things that people have noticed is that homocysteine is associated with the flow properties of your arteries -- vasodilation changes," Warren Kruger, a molecular geneticist at the Fox Chase Cancer Center in Philadelphia, told UPI. "One group was able to show that people using multivitamins had healthier blood flow than people without them," Kruger said, stressing the potential benefits from vitamins, as did another expert.

"It is now high time to use preventative methods in order to reduce the two epidemics facing the world elderly population: stroke and dementia," said Amos D. Korczyn, Sieratzki chair of neurology at Tel-Aviv University Medical School. "Epidemics in the past were controlled by prevention, not by treating already affected individuals. Dementia is not an exception to this," he told UPI.

"Will reducing homocysteine with vitamin B supplementation and folate actually cause a reduction in the incidence of recurrent stroke and onset and progression Alzheimer's disease or vascular dementia? That remains an open question," said Bruce Ovbiagele, assistant professor of neurology at the University of California at Los Angeles stroke center.

(Reported by Joe Grossman, UPI Science News, in Santa Cruz, Calif.)

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Music Livens Things Up 

HealthScoutNews

Thursday, October 3, 2002

Music has been proven to help your emotional state, but, according to the journal Perceptual Motor Skills, it can also help you physically.

Researchers from the Yamano College of Aesthetics in Tokyo had a group of middle-aged women perform a bench-stepping exercise for 60 minutes. Some listened to Japanese folk music, while others heard no music.

At the end of the hour, the women who listened to the music were less tired and less confused than the control group.

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Earlier Sexual Start May Bring Higher Herpes Risk 

Reuters Health

Thursday, October 3, 2002

NEW YORK (Reuters Health) - People who become sexually active at a young age are at increased risk of contracting herpes simplex virus type 1 (HSV-1), according to the results of a new UK study.

HSV-1 commonly causes fever blisters on the mouth or face (oral herpes), and is different from HSV-2, which typically affects the genital area and is called genital herpes. However, HSV-1 can also infect the genitals, and does not confer immunity to genital herpes.

HSV-1 is transmitted through both social and sexual contact, such as kissing or sexual intercourse, hand holding or sharing utensils. Most of the time, HSV-1 is inactive, or "silent," and causes no symptoms, but some infected people have periodic outbreaks of blisters and ulcers. Once infected with HSV, people carry the virus for life.

In past decades, HSV-1 infection was quite common and is estimated to have infected most people during the 1940s, according to the report published in the current issue of Sexually Transmitted Infections. Improvements in socioeconomic circumstances are believed to be the reason why, by the 1970s, infection with HSV-1 dropped to about 50% of adults. British experts estimate that one in four children between the ages of 10 and 14 now carry the virus.

The proportion of genital herpes due to HSV-1 rather than HSV-2 is on the rise in the UK, particularly among young people, but the extent to which the virus is acquired sexually is not clear, according to Dr. Frances M. Cowan of the Royal Free and University College Medical School in London and colleagues.

To investigate, they surveyed 869 people attending a genitourinary medicine clinic and 1,494 blood donors about their sexual histories and tested them for the presence of HSV-1.

Slightly more than 60% of those attending the clinic had antibodies for HSV-1, signifying that they had been exposed to the virus, compared with roughly 46% of those who donated blood.

Based on analysis of the surveys, Cowan and colleagues write that "age of first intercourse is the strongest predictor of infection" with HSV-1.

The researchers found that among the people who visited the clinic, those who had sex for the first time at age 20 were over 60% less likely to have HSV-1 antibodies than those who reported their first sexual intercourse at 15.

Among those who donated blood, those who had sex at 20 were 36% less likely to carry the virus than those who had sex at 15.

"The association with early age at first intercourse is striking and may reflect the particular sexual practices of people initiating sex in this age group," the authors conclude.

Source: Sexually Transmitted Infections 2002;78:346-348.

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More informed consent urged in drug trials  

By Katrina Woznicki
UPI Science News
From the Science & Technology Desk
United Press International

Thursday, October 3, 2002

WASHINGTON, Oct. 3 (UPI) -- The Institute of Medicine released a report Thursday promising better patient protection in clinical research, after a handful of participants in recent clinical trials died.

"In the past few years, a number of tragic events involving research participants have shaken public confidence in the safety of these efforts," Daniel D. Federman, chairman of the IOM's committee on assessing the system for protecting human research participants, said at a news conference.

"Media publicity of these cases and the weaknesses in the protection system that have been exposed have heightened concerns," he said.

One such case was 18-year-old Jesse Gelsinger, who died during a 1999 clinical trial at the University of Pennsylvania at Philadelphia. This highly publicized tragedy prompted the U.S. Department of Health and Human Services to request the IOM, an independent organization that provides medical advice to Congress, to launch a report.

Federman, who also is a distinguished professor of medicine at Harvard Medical School in Boston, said scientists do not have an exact count on the number of people participating in clinical research.

Nor does the IOM have precise data on the number of people who die or are injured each year during clinical investigations.

"In fact," he said, "one of our major recommendations is that the federal government undertake a national data collection effort so that we have a more accurate picture of the presumed safety and the ethical conduct of these studies."

One of the key findings of the IOM report, which took 18 months to compile, is that procedures involving patient consent should change. The report calls for more openness with patient consent.

For example, Federman said, "obtaining informed consent of the participants should be an ongoing process rather than a discrete, isolated moment."

Instead a single case where a patient signs a consent form, he explained, the researcher and patient would discuss openly all the risks and benefits throughout the course of the study, not just at the start of the study.

The IOM also calls for consent forms to have clearer language and "not be obscured by legalistic and self-protective jargon," Federman said.

Another major finding is the recommendation that participants be provided "reasonable compensation" for any illness or injury brought on by the research. Currently, a patient's only avenue for recourse is filing a lawsuit.

The IOM report states that, although suits might be appropriate in cases of negligence, product defect or misconduct, no-fault cases could avoid the courtrooms if patients or their survivors were properly compensated for their loss.

"Compensation should include at least the costs of medical care and rehabilitation and could be paid for either by the research organizations or potentially through a federal compensation program," Federman told reporters.

When asked by United Press International whether a decline in public trust had hurt enrollment numbers in clinical trials, he said that although the IOM doesn't have hard statistics, members suspect research enrollment numbers have not dropped. However, he admitted that researchers must make more of an effort to recruit participants, which can be labor-intensive.

"There is diminished (public) trust," said Fran Visco, president of the National Breast Cancer Coalition in Washington, D.C. and a breast cancer survivor who contributed to the release of the IOM report.

"The committee's report and recommendations will make an effort ... to ensure communities (that) patient protections are in place," Visco added.

"The system has been somewhat fragmented and we've heard ... a lot of complaints about the system," said Jeremy Sugarman, director for the Center for the Study of Medical Ethics and Humanities at Duke University Medical Center in Durham, N.C.

Sugarman, who wasn't involved in the IOM report, told UPI that what the IOM is recommending is the "important next step as we address some issues that have been raised of the ethical problems in clinical research."

He added it is up to clinical scientists to ensure trust in the public, not the IOM.

"One of the primary motivations for people to participate in research is trust," he said.

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A Woman's Steps to Good Health 

HealthScoutNews

Thursday, October 3, 2002

 (HealthScoutNews) -- The road to ongoing good health is marked by stops at your doctor's. For women, the American College of Gastroenterology recommends you start this regimen in your teens and follow this checklist as you age:

At age 18, start having:

  • blood pressure tests every two years;
  • a clinical breast exam every year;
  • a pap test and pelvic exam every one to three years; and
  • a breast self-exam monthly.

When you're between 35-39, add to the above tests a baseline mammography at least once.

From age 40 on, add a mammography every one to two years and a digital rectal exam and stool check for occult blood.

At age 50, add a yearly stool blood test, and a sigmoidoscopy every three to five years or a colonoscopy once every 10 years. If your doctor advises you're a higher-risk person, have the sigmoidoscopy or colonoscopy more frequently.

Your doctor can advise you on how often you should be checked for diabetes, skin cancer and high cholesterol.

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Veterans in Southern U.S. May Get Worse Heart Care 

Reuters Health

Thursday, October 3, 2002

NEW YORK (Reuters Health) - Healthcare for US veterans who suffer heart attacks is of lower quality in the South compared with the Northeast or the West, new study findings suggest.

Patients treated in Veterans Affairs (VA) hospitals in the Northeast and the West had a lower risk of death and were more likely to have follow-up care and less likely to be readmitted to the hospital compared with those treated in the South, according to Dr. Usha Subramanian of Roudebush VA Medical Center in Indianapolis, Indiana and colleagues.

The findings are published in the September issue of the Journal of General Internal Medicine.

There is little information on regional variation in care across the VA hospital system, the largest health system in the US, Subramanian and colleagues note.

To investigate, the researchers evaluated health outcomes and follow-up treatments for 67,889 patients who suffered a heart attack and received care within the VA system.

Patients in the Northeast and West had a lower risk of death compared with those treated in VA hospitals in the South, the investigators found.

"Patients in the Northeast and West also had more cardiology or primary care follow-up within 60 days and at one year post-discharge than patients in the South and Midwest," the authors write.

The main finding, according to the report, was a significantly greater risk of death and readmission among those being treated in the South compared with those being treated in the Northeast and West.

"One might hypothesize that the sicker patients received more follow-up. However, if that were true, then patients in the West (who had lower mortality and readmission rates) should have received less outpatient follow-up, which was not the case," Subramanian and colleagues write.

What's more, the researchers point out, patients in the Northeast fared better in spite of the fact that they tended to be sicker than patients treated in the South.

"Our finding of a substantial degree of regional variability suggests that both processes and outcomes of care (after a heart attack) can be improved in the VA system," the authors conclude.

Funding from the pharmaceutical company Bristol-Myers Squibb helped support the research.

Source: Journal of General Internal Medicine 2002;17:604-611.

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PSA Predicts Future for Prostate Cancer Patients 

HealthScoutNews

Thursday, October 3, 2002

THURSDAY, Oct. 3 (HealthScoutNews) -- Measuring prostate-specific antigen (PSA) levels in men five years after they receive radiation treatment for prostate cancer ( news - web sites) helps predict their chances for survival for several years.

That's the finding of a new study in the October International Journal of Radiation Oncology.

Men who have very low PSA levels at the five-year mark have low odds of suffering a relapse of prostate cancer at 10 years and beyond, the study says.

Researchers identified 328 men whose prostate cancer was treated with external beam radiation and were biochemically disease-free five years after their treatment. Median follow-up was 7.4 years.

The men were divided into four groups according to their PSA levels at the five-year mark: those with PSA less than or equal to 0.5; 0.5 to 1.0; 1.0 to 2.0; and 2.0 to 4.0 ng/mL. Ten years after treatment, the PSA progression-free survival rates for the groups were 92 percent, 71 percent, 78 percent, and 56 percent, respectively.

"This study reinforces the fact that radiation therapy should be used to achieve low PSA levels early in treatment, and those low levels should be maintained to five years and beyond, " says study co-author Dr. Anthony L. Zietman, of the department of radiation oncology at Massachusetts General Hospital.

"If this can be achieved, the long-term outlook for prostate cancer patients treated with radiation therapy will be good," Zietman says.

More information

Learn more about PSA at the American Foundation for Urologic Disease.

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WEDNESDAY, OCTOBER 2, 2002 

Men and Women Get Mental Boost from Marriage 

Reuters

Wednesday, October 2, 2002

LONDON (Reuters) - Women, as well as men, benefit from marriage and get a mental health boost from being a couple, new study findings suggest.

Research from Australia, which shows that about 13% of married men and women suffer from stress, contradicts the findings of a 1972 study by sociologist Jessie Bernard.

Her study, which looked at anxiety, depression and neurosis in married and unmarried people, found that men reaped the benefits of marriage at the expense of women.

"The idea that men benefit from being part of a couple while women suffer all the stress has taken a blow," New Scientist magazine said on Wednesday.

Psychologist David de Vaus, from LaTrobe University in Melbourne, said the difference between his findings and Bernard's could be due to the definition of stress and mental disorder, which can manifest itself in men as drug and alcohol abuse.

When he studied data from a mental health poll of more than 10,000 adults from a 1996 national survey of mental health in Australia that included substance abuse as an indicator of stress, he found that 25% of single men and women were miserable.

In the female sample, married women with children had the fewest mental health problems.

"Psychologists are now debating whether Bernard's conclusions have always been flawed, or whether women have become genuinely happier inside marriage over the past 30 years," the magazine added.

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FDA Renews Sprout Warning  

The Associated Press

Wednesday, October 2, 2002

WASHINGTON (AP) - Federal health officials renewed warnings Wednesday that raw or even lightly cooked sprouts can cause serious food poisoning.

The Food and Drug Administration ( news - web sites) for years has warned Americans not to eat raw alfalfa, clover and other sprouts after hundreds of reports of salmonella and E. coli infections. The FDA reissued its warning because of a late-summer E. coli outbreak in California caused by alfalfa sprouts.

While the young, elderly and people with weak immune systems are most prone to serious infections when exposed to salmonella or E. coli, the food-poisoning germs can cause diarrhea, nausea, abdominal cramping and fever for several days even in healthy people.

So the FDA reissued its advice for all consumers Wednesday:

·        Cook all sprouts thoroughly before eating.

·        To reduce the risk of food poisoning, ask that restaurants and delis not add sprouts to their sandwiches or salads.

·        Don't assume homegrown sprouts are safe, because many outbreaks have been attributed to contaminated seed.

·        Anyone experiencing food-poisoning symptoms who has recently eaten raw or lightly cooked sprouts should consult a health care provider.

On the Net:

Food and Drug Administration: http://www.fda.cfsan.gov

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Pet Reptiles Can Be Source of Salmonella Infection 

Reuters Health

Wednesday, October 2, 2002

NEW YORK (Reuters Health) - Salmonella infection caused by reptiles is likely to increase in the US as more people adopt snakes, iguanas and other reptiles as pets, researchers predict.

Consequently, the bacterial infection, which can go unrecognized in some individuals, could pose a threat to people who receive blood transfusions, as described in an article in the October 3rd issue of The New England Journal of Medicine ( news - web sites).

Symptoms of Salmonella infection include fever, headache, nausea, vomiting, abdominal pain and diarrhea. The infection is not dangerous for healthy people but can be fatal for chronically ill people, the elderly or very young children.

The report documents two patients who developed sepsis, a potentially fatal reaction to infection, from Salmonella. The infection was traced back to a donor who appeared healthy but was later found to have asymptomatic Salmonella infection from handling his pet boa constrictor.

A person does not have to actually handle a reptile in order to become infected, note Dr. James N. George from the University of Oklahoma in Oklahoma City and colleagues. It's possible to contract the infection just by living in the same house as an infected pet, the study authors explain.

In the US, up to 3% of households have a pet reptile, which suggests reptiles could account for up to 18% of the roughly 1.4 million cases of Salmonella infections that occur nationwide each year.

"These estimates suggest that reptile-associated salmonellosis could pose an unrecognized risk of contamination of platelet products from apparently healthy donors," the researchers write.

Doctors, therefore, will need to recognize that blood and blood product donors with no symptoms may be carrying Salmonella, they conclude.

Source: The New England Journal of Medicine 2002;347:1075-1077.

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Masticate Those Morsels 

HealthScoutNews

Wednesday, October 2, 2002

(HealthScoutNews) -- If you want to get the most out of the nutrients in your food, try a blender. Or at least chew every bite thoroughly.

The British Journal of Nutrition reports that the Unilever Research Vlaardingen in the Netherlands studied the nutrient value of different foods. After all, it's not what's in the food that counts, it's how much of the nutrients you actually benefit from.

Among other conclusions, the study showed that although spinach is rich in beta-carotene, folate and lutein, very little of these nutrients gets to your blood stream.

The researchers then broke up the plant cells with a blender, and found that most of the nutrients were released. The blood levels of folate from chopped spinach were 14 times as high as from leaf spinach, and the levels of lutein went up 10 times. For some reason that wasn't explained, the beta-carotene levels didn't change at all.

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Plastic Disc Designed to Detect Rotten Food 

Reuters

Wednesday, October 2, 2002

LONDON (Reuters) - A plastic disc could soon remove any doubt about whether food has spoiled and is no longer safe to eat.

Scientists at the National Center for Toxicological Research in Jefferson, Arkansas have developed a food tag that changes color when food has gone bad.

"The polymer discs contain complex organic dyes that change color drastically from clear to tell-tale pink, blue or yellow, depending on the type of food," New Scientist magazine said on Wednesday.

Dwight Miller and his team hope to launch the first disc, which will be inside food packing, to detect the freshness of fish and shrimp.

Others for beef, lamb and vegetables could follow.

The tags could be available within 2 years, but Miller warns that supermarkets may be reluctant to adopt them if it means they end up throwing away more spoiled food than they normally would, the magazine added.

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Wave of the Future in Surgery 

HealthScoutNews

Wednesday, October 2, 2002

WEDNESDAY, Oct. 2(HealthScoutNews) -- Using reflected sound waves to measure the heart's pumping action lets anesthesiologists better monitor and control fluid and plasma levels during major surgery.

That's the conclusion of a new study in the October issue of Anesthesiology.

This Doppler technique also seems to speed patient recovery and reduce hospital stays, say Duke University Medical Center researchers. Patients have less post-operative nausea and vomiting, and they're able to eat solid foods much earlier.

Using the Doppler technique helps anesthesiologists ensure that fluid levels in a person having surgery don't drop below normal, a common occurrence during surgery. Being better able to monitor and maintain patient fluid levels during surgery means proper intestine functioning is maintained, resulting in improved patient recovery.

Fluids such as plasma, blood or synthetic agents called plasma expanders are given to people during surgery to compensate for blood loss and to maintain their blood pressure. Typically, these fluids are added in response to changes in blood pressure, urine output or heart rate.

In contrast to that reactive approach, Duke researchers tested a proactive method in this study. They used an esophageal Doppler monitor (EDM) that provided continuous readings of heart output.

A small ultrasound probe is put down the esophagus and positioned beside the aorta, which is the main artery out of the heart. The EDM measures reflections of sound waves directed at the aorta and provides information about blood volume being pumped out of the heart to the rest of the body.

Those measurements give an anesthesiologists an immediate indication of how much fluid they need to give the patient.

People in the EDM group were discharged six days after surgery, compared to seven days for the control group. The people in the EDM group also began tolerating solid foods three days after surgery, compared to five days for those in the control group. And more than twice the people in the control group had severe post-operative nausea and vomiting than the people in the EDM group, the study says.

More information

Learn more about anesthesia at the American Society of Anesthesiologists.

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Physical Therapy Helps Elderly Stave Off Disability 

By Alison McCook

Reuters Health

Wednesday, October 2, 2002

NEW YORK (Reuters Health) - Physical therapy may help prevent physical declines in older, frail people, study findings suggest.

Lead author Dr. Thomas M. Gill of Yale University in New Haven, Connecticut, said that these results suggest that it is possible for some older people to stave off the disabilities that their weakened state puts them at risk of developing.

"We want to identify older persons who are at risk of being disabled...and try to prevent those outcomes," he told Reuters Health.

Reporting in the October 3rd issue of The New England Journal of Medicine ( news - web sites), Gill and his colleagues followed 188 frail patients at least 75 years old, half of whom received a physical therapy program designed to improve their balance, muscle strength and movement.

The remaining patients underwent an educational program, during which healthcare workers visited them and informed them about general health recommendations for the elderly, such as obtaining vaccinations and remaining physically active.

Both programs consisted of home visits by a healthcare worker during the first 6 months, then regular phone calls for an additional 6 months.

The investigators found that patients who completed the physical therapy program reported less disability than their peers at both 7 months and 12 months after the program began.

In an interview with Reuters Health, Gill explained that the physical therapy program may help frail patients prevent disabilities by working on the underlying impairments that both characterize their weakened state and put them at risk of future problems.

For example, he noted, frailty often includes muscle weakness, a symptom that can progress into a serious disability.

However, he added that patients who were very frail at the outset of the program appeared to receive no benefit from physical therapy, and even declined during the program, suggesting that these patients may require a more vigorous type of intervention.

"Our results suggest that our program wasn't sufficient to prevent disability in this group," Gill noted.

Currently, the government health insurance plan Medicare does not cover the cost of home care designed to prevent disabilities in older adults, Gill explained. In the current study, he and his colleagues estimate that the physical therapy program will cost $2,000 per patient. Gill noted that further studies are needed to determine if the benefits of the program--such as reducing the number of days spent in a nursing home or hospital--outweigh its costs.

"It's an uphill battle," Gill noted, describing the difficulties in convincing insurers to cover additional programs. But showing that a relatively inexpensive program may prevent further physical declines "is, I think, a wonderful first step," he added.

The research was funded by the National Institute on Aging, a component of the National Institutes of Health ( news - web sites).

Source: The New England Journal of Medicine 2002;347:1068-1074.

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Seniors Need to Stay Fit 

HealthScoutNews

Wednesday, October 2, 2002

WEDNESDAY, Oct. 2 (HealthScoutNews) -- Strength and balance exercises can help older adults stay mobile by slowing or preventing physical disability.

That's the claim of a study in tomorrow's issue of The New England Journal of Medicine ( news - web sites).

Yale University researchers found that frail elderly people following that kind of exercise program had a 45 percent reduction in disability after seven months.

"Our study provides strong evidence that functional decline among the most physically frail and aged persons can be slowed, if not prevented, with the kind of program used in our study," says principal investigator Dr. Thomas M. Gill, an associate professor of internal medicine and geriatrics at the Yale School of Medicine.

"The program focused on improving underlying impairments in muscle strength, balance and mobility," Gill says.

The study included 188 physically frail people, 75 years or older, living at home. Most of them had some form of disability at the beginning of the study.

Ninety-four of the participants received physical therapy in their homes. That therapy included daily balancing exercises lasting 10 to 15 minutes each, and muscle strength training with elastic resistance bands three days a week.

The other 94 people in the study were in a control group. They were given educational material on preventive health topics, including nutrition, vaccinations and proper footwear.

Both interventions lasted six months. The researchers did follow-up at seven months and one year. The people in the physical therapy group were asked to continue exercising for a full year, and they completed 75 percent to 80 percent of the exercises.

To measure the success of the two groups, Gill and his colleagues devised a scale to see how well each group managed eight essential daily activities, including walking, bathing, dressing, using the toilet, transferring from a chair, and eating and grooming.

Scores were assigned on a scale from 0 to 16. Higher scores indicated greater disability.

"At seven months, the average disability scores were 2.0 in the physical therapy group and 3.6 in the control group. This reflects a 45 percent reduction in disability for the physical therapy group relative to the control group. These results give weight to the role of 'prehabilitation' or preventive therapy for physically frail elderly persons living at home," Gill says.

That kind of approach could reduce nursing home and health-care costs for older adults, he says.

More information

To learn more about fitness and older adults, go to the U.S. Administration on Aging.

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Scientists Crack Genetic Code of Malaria Parasite 

By Patricia Reaney

Reuters

Wednesday, October 2, 2002

LONDON (Reuters) - Scientists have cracked the genetic code of the parasite that causes the most deadly form of malaria, in what has been called a quantum leap in the fight against the disease that kills one child every 20 seconds.

A team of 150 researchers in the United States and Britain has sequenced all the genes in the threadlike Plasmodium falciparum parasite that causes malaria, an illness that threatens half of the world's population.

"We've provided new tools and new insights, hopefully for new targets for drugs and vaccines, and hopefully for new treatments," Dr. Neil Hall, of Britain's Sanger Institute, told a news conference.

The malaria genome, which is published in the journal Nature on Wednesday, was announced jointly with the genetic map of the Anopheles gambiae mosquito that transmits the parasite to humans and is reported in the journal Science.

Together the two genetic sequences, along with the earlier mapping of the human genome ( news - web sites), give scientists the best means ever of defeating malaria, which claims more than a million lives each year, most of them children under 5 years old.

Along with HIV ( news - web sites)/AIDS ( news - web sites) and tuberculosis, malaria is one of the biggest infectious killers in the world.

"This is the time to put malaria on the agenda. It is a very serious disease," said Dr. Fotis Kafatos, of the European Molecular Laboratory in Heidelberg, Germany, who worked on the mosquito genome.

Small But Difficult

With 14 chromosomes and 5,279 genes, the malaria genome is one of the smallest sequenced so far. The human genome has about 30,000 genes, a nematode worm has 18,000 and the Anopheles gambiae genome has more than 13,000 genes.

But the parasite genome was a major challenge for the scientists because parts of its DNA are very unstable and broke apart as they worked on them.

Researchers from the Sanger Institute, Stanford University in California and the Institute of Genome Research in Maryland collaborated on the 6-year, 18.5 million ($29 million) parasite genome project..

"The amount of data involved was phenomenal. It was a bit like tearing up half a dozen bibles, scattering the pieces over a playing field and then trying to put them together again," Hall said.

Scientists around the world who are working on developing new drugs or a vaccine are already using data from the project, which is available on the Internet, and have identified potential new drug targets that scientists believe could yield drugs within about 5 years.

"This is an extraordinary moment in the history of science," said Carlos Morel of the World Health Organization ( news - web sites) (WHO), adding that it opens up a new era in public health.

"At last, the enormous power of modern technology is penetrating the mysteries of an ancient disease, a disease which continues to kill millions," he added in a statement.

The function of about 60% of the genes is unknown but the genome gives researchers an insight into the parasite's metabolism, how drug resistance occurs and how to develop new weapons against malaria.

"The genome contains every possible vaccine target and every possible drug target. It is not going to be instantly possible to say where they are but we are giving scientists the tools they need to find them," said Hall. "We have presented them with the haystack and they have to go and find the needle."

More Than 300 Million Infected Worldwide

Despite efforts to eradicate malaria, more people are infected with the parasite in Africa than ever before. According to the WHO, malaria infects 300 million worldwide every year.

The parasite has become resistant to the most common anti-malarial drugs, and mosquitoes that carry it have developed defenses against chemical pesticides.

P. falciparum is only transmitted by the female mosquito. The parasite moves into the salivary glands of the mosquito and is injected into a human host. It travels through the human bloodstream to the liver where it invades cells, transforms into spores and replicates. The spores are released into the bloodstream where they attack and destroy red blood cells.

"This represents a quantum leap in our understanding of malaria," said Professor Chris Newbold of Oxford University in England.

"The challenge to researchers worldwide is to use the genome sequence in imaginative and innovative ways and ensure that the efforts of the teams from both sides of the Atlantic are rewarded with new ways of tackling the disease."

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States Accused of Misspending Tobacco Settlement 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Wednesday, October 2, 2002

WEDNESDAY, Oct. 2 (HealthScoutNews) -- States with the worst tobacco habits and those that grow the plant spend the least on programs to reduce smoking, says a new study that shows most of the billions pried from Big Tobacco in 1998 aren't being spent as intended.

In the 1998 Master Settlement Agreement, tobacco companies agreed to pay states $206 billion over 25 years. Much, though not most, of that money was implicitly earmarked to support antismoking campaigns. However, as many skeptics predicted, states have been using those dollars to pay for everything but that purpose. Some have even "securitized" the money, receiving lump sums up front to patch holes in their budgets.

"As of now, from a public health perspective, the [agreement] seems to be in critical condition," says Dr. Cary Gross, a Yale University physician and lead author of the study. "When states are not investing their tobacco settlement funds in their tobacco control programs, the program funding suffers."

Previous studies have pointed out the failure of states to apply their share of the settlement to tobacco control. Gross and his colleagues showed that tobacco control programs aren't drawing much from other sources of funding either. Their findings appear in tomorrow's issue of The New England Journal of Medicine ( news - web sites).

Forty-six states and the District of Columbia signed the settlement, while the rest made separate arrangements. In 2001, states took in an average of $28.35 per resident from the agreement. Yet, they spent only 6 percent of that money on tobacco control programs.

Including other funds, states spent an average of $3.49 per capita on anti-tobacco initiatives, well less than the range of $5 to $15 per head recommended by the U.S. Centers for Disease Control and Prevention ( news - web sites) (CDC). That figure depends on the state's smoking rate and its age distribution, and on average works out to about $7 per person.

Pennsylvania was the nation's anti-tobacco laggard in 2001, spending just a dime per resident on tobacco control. That has since changed, and the state is now putting about $50 million toward such programs. Maine spent the most, nearly $15.50 per inhabitant.

Tobacco-growing states, such as North Carolina, Kentucky and Tennessee, spent an average of $1.20 per head on tobacco control programs, less than a third of the average among non-growing states. Similarly, states with more smokers spent less on such programs, likely because their pro-smoking culture discouraged efforts to promote quitting, Gross says. State spending on health care linked to smoking was unrelated to how much money they devoted to tobacco control.

"It's sad, because it shows that the states with the greatest public health need are really doing the least to address that need," Gross adds.

The new study relies on data from 2001. However, the situation has only deteriorated since then, experts say. A report issued this summer found that states, struggling with budget shortfalls, have slashed this year's tobacco control programs by more than $102 million, or about 13 percent, from fiscal 2002 levels.

The report, from the American Lung Association, the American Cancer Society ( news - web sites), the American Heart Association ( news - web sites) and the Campaign for Tobacco-Free Kids, showed that Missouri, Michigan, Tennessee and Washington, D.C. have allocated no money this fiscal year for tobacco control. Michigan has allocated a chunk of its share to lure biotechnology firms.

"In each case, the dollars are being used for other programs. They simply have failed to address very serious problems associated with tobacco," says William V. Corr, executive vice president of the Campaign for Tobacco-Free Kids.

Corr says states this year will spend close to 4 percent of their settlement funding on tobacco control. "There's no question that states have failed to keep their promise, they have failed to seize a golden opportunity to reduce tobacco use with proven methods that have now been used in many states around the country," he says.

Still, while 15 states cut their tobacco control programs this year, 18 are spending more money than they did in 2001, Corr says. "That's a very important indicator that there is some leadership being exerted, and some recognition of the importance of these programs."

As a second study in the journal shows, telephone "quitlines" recommended by the U.S. Public Health Service can help people trying to quit stay off tobacco for extended periods of time.

A research team led by Shu-Hong Zhu of the University of California at San Diego evaluated California's Smoker's Hotline. The service, established in 1992, has been the model for scores of quitlines in other states. How well these programs work hasn't been clear.

Zhu's group found that callers who received counseling were nearly twice as likely as those who didn't to stay off cigarettes throughout the year. By 12 months, the number not smoking was low, about 8 percent, compared with about 4 percent of those who called into the line for self-help materials but didn't do more. The one-year abstinence rate was highest -- 12 percent -- for people who called in and received counseling on the spot.

Zhu says the counseling is "very tailored" to individual smokers, helping them understand what needs the habit satisfies and what quitting strategies are most likely to succeed. The initial, lengthiest session is followed up by at least two shorter calls, he says.

"Quitlines really do work in the real world ( news - Y! TV)," says Dr. Steven Schroeder, president and chief executive officer of the Robert Wood Johnson Foundation in Princeton, N.J., and author of an editorial accompanying the journal articles. "There are very few public health interventions that can save as many lives."

Applying the California model nationally could encourage 900,000 smokers a year to quit and over the long run save 300,000 lives annually, he says. The CDC estimates that 440,000 Americans die each year from smoking-related illnesses such as lung cancer and heart disease.

What To Do

To find out more about smoking cessation, try the American Legacy Foundation or the Campaign for Tobacco-Free Kids.

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Anti-Tumor Drug Safe in Humans 

By Merritt McKinney

Reuters Health

Wednesday, October 2, 2002

NEW YORK (Reuters Health) - An experimental cancer drug that made headlines a few years ago for dramatically shrinking tumors in mice appears to be safe in humans, according to results of two small studies. Although neither trial was designed to test the effectiveness of the drug, endostatin, against human cancer, tumors in a few patients seemed to respond well to the medication. Still, additional studies are needed to determine whether the drug will live up to its initial hype.

Tumors depend on an adequate blood supply to grow, so in recent years scientists have been trying to find ways to stop cancer by cutting off the formation of new blood vessels, a process called angiogenesis. Endostatin is one of several experimental drugs that target angiogenesis. When given to mice with cancer, tumors shrank to microscopic lesions.

What works in mice does not always work in people, however, and new drugs are first tested to make sure they are safe. In the September 15th issue of the Journal of Clinical Oncology, researchers report the results of two such safety trials of endostatin.

In one study, Dr. Joseph P. Eder Jr., of the Dana-Farber Cancer Institute in Boston, Massachusetts, and colleagues tested endostatin in 15 patients with tumors that had either relapsed or failed to respond to conventional therapies. Patients received a daily 20-minute intravenous dose of the drug. The length of treatment varied from patient to patient, ranging from 5 to 16 month-long cycles.

Treatment with endostatin did not seem to cause major side effects, Eder and his colleagues report. A couple of patients developed a mild rash, but it cleared up on its own. Two patients did develop a potentially dangerous infection called sepsis, but these infections were thought to be caused not by the drug but by the intravenous ports used to deliver it.

Though the study was not designed to evaluate the effectiveness of endostatin, cancer improved or stabilized in a few patients. One patient experienced a 17% tumor reduction that lasted for almost a year. In two other patients, tumors stabilized for several months.

The results of the other trial, led by Dr. Roy S. Herbst at the University of Texas M.D. Anderson Cancer Center in Houston, also suggest that endostatin is safe. In the study, which included 25 patients with a variety of tumors, treatment consisted of a daily dose of endostatin for at least 2 months.

For the most part, side effects in this study were also mild. Several patients did develop more serious complications, but in several cases, these effects were traced to infected catheters used to deliver the drug.

Herbst and his colleagues detected "minor antitumor activity" in two patients, though none of the patients experienced substantial improvements.

"The results of this phase I study demonstrate that endostatin is safe," Herbst's team concludes in the report. But they state that "further studies will be required" to see how well endostatin fights cancer, either alone or in combination with other drugs.

According to Dr. Frank A. Scappaticci, of Stanford University in Stanford, California, targeting the blood vessels that supply tumors "represents a very promising strategy to treat cancer."

In comments to Reuters Health, Scappaticci said that "this approach will likely deliver new drugs and biological agents for cancer treatment in the future." But he added that "this will take time to develop."

Scappaticci, who is the author of an article in the same issue of the journal that reviews the research to date on angiogenesis-based cancer therapies, explained that tumor blood vessels are a varied lot. A single drug may not be able to stop all such vessels from growing, he said.

"Multiple antiangiogenic drugs in combination may be necessary to effectively inhibit their growth," Scappaticci said.

In good news to patients who may one day be treated with anti-angiogenic medications, the California physician said that for the most part, the drugs "appear to be very well tolerated" and may avoid the side effects that conventional cancer drugs often cause in bone marrow, the gastrointestinal tract or hair follicles. He cautioned, however, that additional studies are needed to look for potential long-term side effects.

Though drugs that starve tumors of their blood supply may not turn out to be a magic bullet against cancer, Scappaticci said that "the hope is that these agents can convert cancer into a chronic disease with minimal toxicity similar to how high blood pressure or diabetes may be controlled chronically."

The study led by Eder was sponsored by EntreMed, Inc., the Rockville, Maryland, the company that makes endostatin.

Source: Journal of Clinical Oncology 2002;20:3772-3784, 3792-3803, 3906-3927.

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Pa. Doctors Rally Over Insurance  

By Bill Bergstrom

Associated Press Writer

The Associated Press

Wednesday, October 2, 2002

PHILADELPHIA (AP) - Doctors rallied Thursday in two Pennsylvania cities, saying soaring malpractice insurance rates threaten emergency room service around the state.

Doctors and patients demonstrated in Scranton, where a medical center is trying to line up coverage for 10 emergency room doctors who were notified last week their current policy was being canceled.

At a similar rally in Philadelphia, physicians called for a state law to limit damage awards in malpractice cases as a way of reducing rates. Speakers urged tort reform modeled on a California law that caps jury awards for pain and suffering in medical cases at $250,000.

Orthopedic surgeons, neurosurgeons, obstetricians and others have said rising malpractice rates may force them to stop performing surgery or leave the region.

"It now costs me more to practice in the city of Philadelphia than I can possibly hope to get paid," said Dr. Adrienne Cresswell, a plastic surgeon.

Pennsylvania lawmakers passed legislation in March that required malpractice lawsuits to be filed within seven years after the alleged error. But the law lacked limits on damages for pain and suffering and other non-economic damages in malpractice lawsuits, and doctors at the Philadelphia rally said the measure wasn't helping.

Steve Miskin, a spokesman for Pennsylvania House Majority Leader John M. Perzel, said damage limits would require an amendment to the state constitution.

On the Net:

Politically Active Physicians Association: www.fightingdocs.com

Pennsylvania Medical Society: http://www.pamedsoc.org

Pennsylvania Trial Lawyers Association: http://www.patla.org/

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Pill Prevents Rabbit Stents from Re-Blocking 

By Holly VanScoy
HealthScoutNews Reporter

HealthScoutNews

Wednesday, October 2, 2002

WEDNESDAY, Oct. 2 (HealthScoutNews) -- While researchers studying rabbits' response to an experimental drug aren't exactly hopping with excitement, they are cautiously optimistic that a pill containing the medication will let stents restore blood flow in clogged arteries without complications.

A stent is a wire mesh tube that cardiac specialists use to prop open a clogged artery after angioplasty has removed arterial blockage. It works like a permanent scaffold and keeps the artery walls spread apart. In as many as a third of patients who undergo the procedure, however, the artery narrows again because of scar tissue accumulating at the stent site, a re-narrowing known as restenosis. The condition typically requires at least one more angioplasty, and sometimes even more aggressive medical interventions.

Vice President Dick Cheney ( news - web sites)'s experience with restenosis elevated the condition to headline news briefly last year.

A new study from researchers at the Armed Forces Institute of Pathology suggests that orally administered everolimus, one of a class of drugs known as proliferation inhibitors, may prevent new blockage at stent sites.

"Depending on the dose of the medication administered to the animals in our study, the growth of scar tissue was reduced between 40 to 46 percent," says research leader Dr. Renu Virmani, head of cardiovascular pathology at the institute. "Although there have been other promising advances in treating restenosis that use radiation or stents that slowly release a medication, I believe an orally administered drug like everolimus provides a better, more cost-effective long-term solution."

The study appears in the current issue of Circulation.

Virmani and her colleagues gave six white rabbits everolimus orally for three days before and 28 days after stent surgery. Six other rabbits were given a lower dose of everolimus for one day before and 28 days after surgery, and six were used as controls for each experimental group.

The rabbits given the higher dose of everolimus experienced loss of appetite and weight loss, but they also had a reduction of 46 percent in the thickness of their artery walls compared to rabbits that received no medication, Virmani says. Rabbits on the lower dose of everolimus had fewer side effects and a reduction of 40 percent in artery thickness compared to the control group.

"Although I would like to study everolimus in individuals who undergo stent procedures, there are presently no plans for clinical trials with human patients," says Virmani. "Most of the interest now is in pursuing solutions that I believe will be more expensive in the long run."

Novartis Pharmaceuticals Corp., which funded Virmani's research, has completed human clinical trials evaluating the safety and efficacy of an orally administered drug containing everolimus for the prevention of organ rejection in renal and heart transplant recipients. In March 2002, Novartis granted Guidant Corp. the rights to use everolimus in manufacturing stents for the treatment of coronary and peripheral vascular diseases, including stenosis. Early next year, Guidant expects to start clinical trials of the device -- which will be among the class generically referred to as drug-eluting coronary stents.

Dr. David P. Faxon, cardiology section chief at the University of Chicago and former president of the American Heart Association ( news - web sites), acknowledges in an accompanying editorial that a pill to help prevent restenosis would have a wide range of uses in coronary artery disease treatment. However, he warns, there's no way to know yet if everolimus is the pill to do it or whether any oral medication will work.

"Successful animal studies are one thing," Faxon says, "but they don't always translate into successful treatments for humans. The very first attempts at treating restenosis focused on oral medications, too. But despite some promising first results, these medications eventually proved unsuccessful."

What To Do

Learn more about stents from the Heart Information Network or the American Heart Association.

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Latex Allergy May Be More Common Than Thought 

Reuters Health

Wednesday, October 2, 2002

NEW YORK (Reuters Health) - As many as 8% of people in the general population may be sensitized to latex, meaning they are at increased risk for an allergic reaction during medical treatment, according to an analysis of patients heading to the emergency department.

Latex is found in tens of thousands of consumer products, including condoms, balloons, athletic shoe soles, tires, underwear, rubber toys and pacifiers. Many medical supplies--such as disposable gloves, intravenous tubes, syringes, stethoscopes and bandages--also contain the material.

According to experts, the first sign of latex allergy is usually a poison ivy-like rash that appears 12 to 36 hours after contact with latex. Itching, redness, swelling, sneezing and wheezing and coughing may also occur.

"There are few scientific studies regarding the prevalence of latex allergy in the general population," Dr. Mary Grzybowski of Wayne State University in Detroit, Michigan, and colleagues report in the October issue of the Annals of Emergency Medicine.

"In 1987, it was believed that less than 1% of the general population was allergic to latex, but more recent data have shown an increase in latex sensitization," the authors add.

To investigate current rates of latex allergy, Grzybowski's team tested blood samples for latex-specific antibodies in 1,027 patients who had visited the emergency department for various reasons unrelated to latex allergy.

Of the group, 84 (8.2%) had positive results and of these, 20 "were classified as having strongly positive results." While people can have such antibodies and not have a reaction to latex, they are at greater risk for hypersensitivity after contact with medical products. Hypersensitive reactions can range from mild hives to a potentially-life threatening condition known as anaphylaxis.

Further analysis revealed that nonwhites were 4.7 times more likely to have latex sensitivity, while people who were allergic to any of 10 of the most common inhaled allergens--such as ragweed or dust mites--were 7.4 times more likely to be sensitive to latex.

"The prevalence of latex sensitization in our sampling is substantial and higher than previously estimated in the general adult population," Grzybowski and colleagues write.

"Latex allergy might be a larger public health problem than we once anticipated, and our findings suggest that emergency physicians will increasingly be caring for patients who are latex sensitive," the authors conclude.

Source: Annals of Emergency Medicine 2002;40:411-419.

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Quitlines Help Smokers Kick the Habit: Study 

By Suzanne Rostler

Reuters Health

Wednesday, October 2, 2002

NEW YORK (Reuters Health) - Telephone counseling can help smokers who are trying to kick their habit, study findings suggest.

The support, motivation and information offered through these so-called "quitlines" contributed to a quit rate of nearly 8% among a group of smokers, compared with 4% among smokers who did not have telephone counseling, after 1 year.

And more than twice as many smokers who received counseling had not smoked after 1, 3, 6, and 12 months, compared with the smokers who had not received counseling, according to the report in the October 3rd issue of The New England Journal of Medicine ( news - web sites).

The number of free telephone services aimed at helping smokers to quit has increased in recent years. Currently, 33 US states offer quitlines and many other states are gearing up to provide them to residents. The programs' success outside of carefully controlled studies, however, had not been shown.

"Our study shows that the help lines work in the real world ( news - Y! TV)," Dr. Shu-Hong Zhu, the study's lead author, told Reuters Health.

He said that the counseling motivates smokers to stay the course and helps them to map out a strategy for quitting. Motivation ebbs and flows, he said, and a situation can arise that tests the commitment of the smoker.

"The counselor makes a game plan...so that there is a coping strategy in place," said Zhu, from the University of California, San Diego.

In the study, more than 3,200 callers to the California Smokers' Helpline received written material on quitting and were told to call back when the service was less busy. They were then randomly assigned either to a control group, meaning they did not receive counseling unless they called back and requested it, or to a treatment group. All callers in the treatment group were assigned to a counselor whether or not they called back.

Treatment consisted of seven telephone counseling sessions. About 72% of those in the treatment group received counseling, while 32% of people in the control group did. On average, study participants who received counseling had three sessions.

The results suggest that quitlines could help lower rates of smoking. However, further research will need to evaluate how effective they are in other states. California, Dr. Steven A. Schroeder notes in an accompanying editorial, has a stronger anti-tobacco culture than other areas.

"Callers may have been particularly motivated to quit and may have been more supported to do so than they would have been elsewhere," writes Schroeder from the Robert Wood Johnson Foundation in Princeton, New Jersey.

Still, the study has important implications for the 46 million smokers in the US, about one third of whom will die prematurely, he adds.

Source: The New England Journal of Medicine 2002;347:1087-1093, 1106-1108.

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High-Pressure O2 Best After Carbon Monoxide Poison 

By Alison McCook

Reuters Health

Wednesday, October 2, 2002

NEW YORK (Reuters Health) - Patients with carbon monoxide poisoning are less likely to have neurological problems if they are quickly treated with high-pressure oxygen therapy rather than traditional oxygen treatment given at normal pressure, according to new study results released Wednesday.

Although previous studies have pointed to the benefits of high-pressure--or hyperbaric--oxygen therapy, the results have not been conclusive, and some doctors continue to hesitate to administer the treatment to patients with carbon monoxide (CO) poisoning.

Dr. Stephen R. Thom of the University of Pennsylvania in Philadelphia, who wrote an accompanying editorial, told Reuters Health that he hopes the current study findings will allay practitioners' fears in administering the high-pressure treatment.

"There should no longer be any hesitancy for doctors to refer patients to hyperbaric treatment for acute CO poisoning," Thom said.

Carbon monoxide poisoning occurs when people inhale high levels of the odorless gas, which is a byproduct of fuel combustion and can be generated by certain engines, furnaces and fires. The most common cause of accidental poisoning, carbon monoxide kills 800 people a year in the US.

Once inside the body, CO competes with oxygen, potentially reducing the amount of oxygen distributed to tissues. Patients experiencing CO poisoning can first appear dizzy and confused, and about 15% of those with severe poisoning develop lingering neurological problems--such as memory loss--that first appear 2 to 28 days later.

In order to prevent these and other effects of CO poisoning, doctors often administer supplemental oxygen to out-compete the carbon monoxide swimming inside a patient's body. When patients experience acute poisoning, some doctors will opt for hyperbaric oxygen therapy, in which patients breathe pure oxygen in a chamber with a higher-than-normal atmospheric pressure.

In the current study, Dr. Lindell K. Weaver of the University of Utah School of Medicine and his colleagues compared high-pressure oxygen treatment to normally pressurized oxygen. A total of 152 patients experiencing acute carbon monoxide poisoning received either three sessions of high-pressure oxygen or three sessions of oxygen and air administered at atmospheric pressures, all within a 24-hour period.

Reporting in the October 3rd issue of The New England Journal of Medicine ( news - web sites), Weaver and his team found that only 25% of patients who received the high-pressure oxygen treatment experienced neurological problems 6 weeks later, relative to 46% of those whose treatment was administered at atmospheric pressure.

In an interview with Reuters Health, Weaver explained that the benefit of high-pressure oxygen therapy may lie in its dosing, with high-pressure treatment administering a more effective dose of oxygen than normally pressurized treatment.

"If oxygen is a drug, you have to give it at the right dose to have the benefit," editorialist Thom explained.

Weaver noted that high-pressurized treatment is not a viable option for all patients. For example, when patients live far away from the necessary equipment, doctors have to factor in the costs and risks of transportation. If a patient is not experiencing severe CO poisoning, it is not clear if the trip is always necessary.

"I think that's one of the major questions we need to tease out," Weaver noted.

Source: The New England Journal of Medicine 2002;347:1054-1055, 1057-1067, 1105-1106.

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TUESDAY, OCTOBER 1, 2002 

Breast Self-Exam Won't Cut Cancer Death Risk: Study 

Reuters Health

Tuesday, October 1, 2002

NEW YORK (Reuters Health) - Teaching women to perform breast self-exams does not lower their risk of death from cancer and may lead to unnecessary biopsies, according to the results of a decade-long investigation.

Therefore, women 40 and older with access to mammography should continue to get checked annually, the researchers conclude. The American Cancer Society ( news - web sites) recommends that these women receive annual mammography screening, in addition to examining their breasts monthly beginning at age 20.

"Programs to encourage breast self-exam in the absence of mammography would be unlikely to reduce mortality from breast cancer ( news - web sites)," write Dr. David B. Thomas from the Fred Hutchinson Cancer Research Center in Seattle, Washington, and colleagues.

The results, published in the October 2nd issue of the Journal of the National Cancer Institute ( news - web sites), should not discourage women from checking their breasts for tumors, the authors stress. Rather, women who do self-exams should practice regularly and understand that they may have a higher risk of having a breast biopsy for a benign tumor should they detect a lump, Thomas and co-authors explain.

Their study included more than 266,000 factory workers in Shanghai. Some women participated in an intensive program of instruction, including lessons on performing self-exams, monthly reminders to practice the exam and supervised practice sessions with doctors. Another group of women received no information on breast screening.

Rates of breast cancer and death from breast cancer were the same in both groups of women 10 to 11 years later, the investigators found. And contrary to some previous reports, women who performed self-exams did not detect cancers at an earlier stage, when they tend to be smaller and less likely to spread to other parts of the body.

Women who regularly performed self-exams found more benign tumors, which can lead to more biopsies and higher healthcare costs. On the other hand, these benign tumors were slightly smaller, suggesting that the exams helped women to detect lumps in their own breasts.

Drs. Russell Harris and Linda S. Kinsinger of the University of North Carolina at Chapel Hill note that teaching women to perform these exams is actually more expensive than it seems and difficult to do well. Compliance over the long term is also rare.

Therefore, educating women about the symptoms of breast cancer and spending more time on the clinical exam might be a better investment of healthcare resources, they note in an editorial accompanying the study.

"Routinely teaching breast self-exam may be dead, but giving women information--and continuing research on the effectiveness of excellent physical examination--should live on," the editorialists conclude.

Source: Journal of the National Cancer Institute 2002;94:1420-1421, 1445-1457.

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3 Developed Meningitis From Bad Drug  

By Doug Johnson

Associated Press Writer

The Associated Press

Tuesday, October 1, 2002

RALEIGH, N.C. (AP) - An elderly woman died and two others were sickened with meningitis after being injected with a contaminated painkiller at separate health clinics, state health officials said.

The three patients received spinal injections of the drug methylprednisolone — a steroid used to treat joint pain — between April and July, and later contracted meningitis, the state Department of Health and Human Services ( news - web sites) said.

A 77-year-old woman died in August after being transferred to a hospital when she became ill. Her name was not released.

Two others were treated for fungal meningitis; no other cases have been detected.

"The first thing I needed to do was make sure it wasn't a galloping problem," state epidemiologist Dr. Jeffrey Engel said Tuesday. "We can say it's not widespread."

Engel said 870 people in North Carolina received the drug, which was contaminated with Wangiella dermatitidis, a common soil mold but an uncommon cause of meningitis.

State health officials and investigators from the national Centers for Disease Control and Prevention ( news - web sites) are trying to determine how the contamination occurred.

"As it is now, we just don't know how this happened," Engel said.

The clinics where the drug was disseminated are FirstHealth Moore Regional Hospital Pain Clinic in Pinehurst, Wayne Memorial Hospital in Goldsboro and Johnston Pain Management in Jacksonville, officials said.

Vials of the drug were distributed by South Carolina Urgent Care Pharmacy in Spartanburg, S.C. Company founder and pharmacist Ray Burns said tests of returned vials of the drug showed no contamination.

"We are committed to doing everything within our means to help in the discovery of what went wrong and how it can be prevented in the future," Burns said in a statement.

The drug was shipped to clinics in four other states: Virginia, Connecticut, South Carolina and Massachusetts. North Carolina received 95 percent — or about 800 vials — of the contaminated batch, Engel said.

No other states had reported problems with the drug, which was recalled by the supplier Sept. 17 and is no longer being distributed. Health officials in Massachusetts said the entire supply was sent back before it was used, Engel said.

Meningitis is an infection of the lining of the brain and spinal cord. Symptoms include severe headache, fever, stiff neck, vomiting and worsening back pain.

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Alcohol Can Hurt Legs as Well as Liver, Study Shows 

By Richard Woodman

Reuters Health

Tuesday, October 1, 2002

LONDON (Reuters Health) - Long-term drinking can damage muscles in the legs and elsewhere in the body, as well as hurting the liver, according to a report released Tuesday.

"It is a common misconception that the brain and the liver are the two organs most affected by chronic alcohol misuse, which results in psychosocial abnormalities and cirrhosis," said Victor Preedy and Peter Emery of King's College London.

"Arguably, alcoholic myopathy (muscle damage) represents the most prevalent skeletal muscle myopathy in the Western Hemisphere," they added in an article published in The Biochemist by Britain's Biochemical Society.

Also, the authors note, this muscle damage could be just part of a disease process that affects the entire body, including the heart muscle and the smooth muscle of the gastrointestinal system.

In alcoholics, they explain, damage to the heart muscle makes it function less efficiently, while smooth muscle problems can disturb digestion and impair the ability to absorb nutrients.

The researchers, both nutritionists, expressed surprise that medical textbooks devote so little attention to alcoholic myopathy even though the condition was common, preventable and largely curable.

There are a number of mechanisms by which alcoholism damages muscles, they add, including slowed muscle protein formation, changes in calcium regulation and the production of cell-damaging molecules called free radicals.

Source: The Biochemist 2002;11-14.

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Brain Defect Study Finds Mutation  

By Lara Jakes Jordan

Associated Press Writer

The Associated Press

Tuesday, October 1, 2002

WASHINGTON (AP) - A newly discovered fatal gene mutation, found only in Amish newborns, could be a major first step toward preventing brain defects in babies worldwide, scientists said Tuesday.

The genetic disorder, known as Amish microcephaly, is specific to the Old Order Amish community in Lancaster County, Pa., where it has been traced back nine generations to one couple. It amounts to a breakdown in DNA creation that causes abnormally small heads and brains in fetuses and, eventually, death.

New information on the disorder — the result of a 2 1/2-year study by the National Genome Research Institute in Bethesda, Md. — could help doctors find ways to stop the DNA breakdown in other kinds of brain defects in newborns.

The study is the first of its kind to link problems with DNA production to fetal brain development, said Dr. Leslie Biesecker, the report's lead author, a senior investigator at the Institute's Genetic Disease Research Branch. It was first reported in the September issue of "Nature Genetics."

"What this disease appears to be is the inability to move those (DNA) building blocks into a particular place of the cell where they need to be," Biesecker said. "What we have to do is see if we can manipulate that, and supplement or do other medical tricks to get around that problem."

In Lancaster County, where about 20,000 Amish people descend from only a few dozen who settled there in the 1700s from Germany, 61 babies from 23 families have had the disorder in the last 40 years. Most of the babies died in their first six months; none survived more than 14 months.

There is no known treatment or cure.

Dr. D. Holmes Morton, who heads the Clinic for Special Children in Strasburg, Pa., and helped write the study, said he has cared for more than 20 Amish babies with the disorder since 1988. He sees as many as three new cases every year.

"It's a disorder that has shown up in the community for many, many generations," Morton said. "The Amish people knew about it, but very few other people had seen it."

Interestingly, Morton said, the DNA breakdown does not affect development in other parts of the fetus, which means that babies born with the defect have normal and healthy hearts, livers, kidneys, and other vital organs. That suggests that the DNA building blocks — specifically, a nucleic acid — are being received in developing cells in other parts of the body.

"It's precisely that kind of thinking about a mutation and about a mechanism of a disease like this that lets us think of possibilities about how you get around it," Morton said.

Dr. Victor A. McKusick, a professor of medical genetics at Johns Hopkins University in Baltimore and one of the nation's top genome experts, praised the study and said its release would likely result in more physicians testing for the disorder.

"This will be described in other ethnic groups," said McKusick, who also has researched Amish genetic disorders for years. "To my knowledge, it has not been as of yet."

McKusick said "as soon as these papers are published, people will be looking for it and testing for it."

On the Net: National Human Genome ( news - web sites) Research Institute: http://genome.gov/

The Clinic For Special Children: http://www.clinicforspecialchildren.org/

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US Docs More Apt to Look for Abuse in Minority Kids 

By Charnicia E. Huggins

Reuters Health

Tuesday, October 1, 2002

NEW YORK (Reuters Health) - Black, Hispanic and other minority children are more likely to be evaluated and reported for suspected abuse than white children are, according to the results of a new US study.

"Our study suggests that there are racial differences in the medical evaluation and reporting of children with fractures for suspected abuse," study author Dr. Wendy G. Lane of the University of Maryland School of Medicine in Baltimore told Reuters Health.

"We feel that there is both over-evaluation and reporting of minority children and under-evaluation and reporting of white children," Lane added.

While past research has found rates of verified maltreatment are higher among minority children, it is not clear whether these children are actually abused more often, or whether such abuse is more likely to be reported or substantiated. To investigate, Lane and her colleagues reviewed the records of 388 toddlers and infants treated for a skull or long-bone fracture between 1994 and 2000.

Nearly 30% of minority children and 12.5% of white children had bone fractures resulting from physical abuse, the researchers report in the October 2nd issue of The Journal of the American Medical Association ( news - web sites).

But reports of suspected abuse were filed for over half (53%) of the injured minority children overall in comparison to less than a quarter (22.5%) of white children, study findings indicate. In fact, minority toddlers aged one year and above who had accidental injuries were three times more likely to be reported for suspected abuse than their white counterparts.

Finally, minority children aged 1 to 3 years were also nearly nine times more likely to have their entire bodies x-rayed to identify signs of physical abuse, a test known as a skeletal survey. This remained true even when insurance status, socioeconomic class, likelihood of abuse and the appropriateness of the screening were taken into consideration, the researchers report.

Altogether, though these findings may be "concerning," they are "not surprising," the report indicates. "Earlier literature in child abuse and other fields of medicine has also identified racial differences in evaluation and management of illness," Lane said.

The study was conducted at the Children's Hospital of Philadelphia in Pennsylvania, but the results are likely to be similar to those seen in hospitals around the country, according to the researcher.

"We believe that our findings are reflective of medical practice throughout the US, as previous studies have shown racial differences in the evaluation of suspected abuse and differences in medical management in other fields of medicine," Lane said.

Source: The Journal of the American Medical Association 2002;288:1603-1609.

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Smelly Plant Could Offer Brain Cancer Treatment 

Reuters Health

Tuesday, October 1, 2002

LONDON (Reuters Health) - A protein from a highly poisonous, foul-smelling plant known as jimson weed could one day be used to help fight a type of brain cancer called glioma, Japanese researchers reported on Tuesday.

The protein, Datura stramonium agglutinin, or DSA, caused glioma cells with cancerous characteristics to begin developing normally, or differentiating, in lab studies, they report in the British Journal of Cancer for October.

The differentiation DSA induced was irreversible, being sustained once the protein was removed, the researchers report.

"DSA controls glioma cells as a result of glial differentiation rather than actually killing cells," said lead researcher Dr. Tasuku Sasaki, from the Tokyo Metropolitan Institute of Gerontology. "Any drug based on this concept would help patients suffering with tumors that are difficult to remove such as gliomas."

Glioma cells were also inhibited from growing and dividing out of control, or proliferating, by the presence of DSA, Sasaki's team reports.

"Taken together, these observations suggest that Datura stramonium agglutinin may be useful as a new therapy for treating glioma without side effects," they write.

Professor John Double, head of the Cancer Research UK Unit at Bradford University, said the discovery was exciting, but extremely preliminary.

"More needs to be done before we have enough evidence to commit to trials. Potential treatment, based on DSA, for this form of brain cancer is still a long way off."

Cancer Research UK's chief executive, Sir Paul Nurse, agreed, noting "there is much work to be done on the journey from the laboratory bench to the patient's bedside."

Source: British Journal of Cancer 2002;87:918-923.

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Report: Child Pedestrian Deaths Down  

By Nedra Pickler

Associated Press Writer

The Associated Press

Tuesday, October 1, 2002

WASHINGTON (AP) - The number of children hit and killed by automobiles was cut nearly in half during the 1990s, according to a report released Tuesday that said the decline is due to fewer kids walking to school and better traffic safety.

According to the National Safe Kids Campaign, 475 pedestrians under 15 years old were killed while walking in public roadways in 2000, compared to 861 in 1990.

The campaign's report on child pedestrian safety found that parents worried about safety, long distances, time and crime are driving their children to school more often or putting them on the bus instead of allowing them to walk.

In 1969, about half of elementary school children walked or biked to school, the study said. By 1995, the government's Nationwide Personal Transportation Survey of 5- to 9-year-olds found that 10 percent of kids walked to school, 53 percent traveled by car and about 30 percent rode school buses.

Heather Paul, executive director of the National Safe Kids Campaign, said it's important to make it safer for children to walk to school.

"We know obesity numbers are growing, and part of it is based on sedentary trends for children," Paul said. "Walking to school should be the first step, literally and figuratively, toward a really healthy day."

Paul also attributed the drop in deaths to better traffic safety, including more crossing guards and flashing lights and increased ticketing of speeders.

Children are most likely to be hit and killed between 4 p.m. and 8 p.m., the study found. Of those children killed while walking along roadways, only 29 percent were struck at intersections.

The pedestrian death rate also changes significantly by age, race and sex, according to the report. Children under 9 have a rate 20 percent higher than 10- to 14-year-olds. The death rate for black children is more than twice that of whites, and boys die 57 percent more often than girls.

Wednesday is International Walk to School Day, and Safe Kids and FedEx Express volunteers will visit schools across the country to teach children how to be safe when walking to school.

On the Net:

National Safe Kids Campaign: http://www.safekids.org/

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Mouth Problems Can Worsen With Age 

HealthScoutNews

Tuesday, October 1, 2002

(HealthScoutNews) -- As you age, you may be more prone to problems of the teeth and gums.

Teeth are often lost by people over 35 to periodontal or gingival gum disease. Caused by infections and plaque, gum disease can contribute to receding gums and the loss of supporting bone. Receding gums can contribute to a cavity problem, because as gums pull back from the teeth, pockets are created where cavity-causing bacteria can dwell and do their nasty thing.

Removing plaque, thorough brushing and daily flossing can help keep gum disease at bay. Regular dental check-ups -- every 6-12 months -- are strongly recommended.

Beyond taking care of your teeth and gums, by avoiding heavy drinking and smoking, you'll dramatically reduce the likelihood you'll have badly-stained, plaque-ridden teeth. Overindulging in either tobacco or alcohol can lead to loose gums, cavities, oral cancer, and dry mouth.

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Drug May Help After Prostate Cancer Spreads to Bone 

Reuters Health

Tuesday, October 1, 2002

NEW YORK (Reuters Health) - A new drug may help fight the pain and skeletal damage that occurs when prostate cancer ( news - web sites) spreads to the bone, according to the results of a new study.

The drug, zoledronic acid, is a member of a family of medications called bisphosphonates that help regulate the process of bone renewal.

More than 80% of men with advanced prostate cancer develop bone metastases, note Dr. Fred Saad of the Hopital Notre-Dame in Montreal, Quebec, Canada and colleagues. The metastases can lead to spinal cord compression, fractures, pain and abnormal calcium levels in the blood. And the hormonal treatment often given to prostate cancer patients can further weaken bones.

To investigate whether zoledronic acid might help prevent these complications, Saad and his team studied more than 600 men with prostate cancer that had spread to the bone who were not responding to hormone treatment. Their findings are published in the October 2nd issue of the Journal of the National Cancer Institute ( news - web sites).

In the study, 214 patients received intravenous zoledronic acid at 4 milligrams (mg) and 221 received zoledronic acid at 8 mg (later reduced to 4 mg due to kidney toxicity in one patient), while another 208 patients were given an inactive placebo.

The researchers found that 44% of men on placebo had "skeletal-related events" compared with 33% of men on 4 mg of zoledronic acid. Pain increased more in the men on placebo, but there were no differences between the drug and placebo groups in terms of quality of life or disease progression.

Commenting on the study, Drs. Christina M. Canil and Ian F. Tannock of the University of Toronto write that "this study with zoledronic acid has not provided a clear demonstration of net therapeutic benefit."

The study "adds to the evidence that bisphosphonates have some activity in reducing the incidence of skeletal-related events in men with metastatic prostate cancer but with some added toxicity."

The two editorialists note that zoledronic acid may be of particular benefit to men who have failed to respond to alternative treatments and who are at high risk of bone fractures or spinal cord compression.

Still, Canil and Tannock write that "zoledronic acid cannot be recommended as a standard therapy for men with prostate cancer (that has spread) to bone."

The study was funded by Novartis, the maker of zoledronic acid.

Source: Journal of the National Cancer Institute 2002;94:1422-1423, 1458-1468.

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Dry Mouth Condition Has Many Causes 

HealthScoutNews

Tuesday, October 1, 2002

(HealthScoutNews) -- The name may not be familiar, but xerostomia -- more commonly referred to as dry mouth -- is a common problem among adults. While it has several causes, it is not a normal by-product of aging. Research has shown that adults and children produce similar amounts of saliva, a shortage of which causes this dry, unpleasant-tasting effect.

A problem for individuals with Sjogren's syndrome, systemic lupus, diabetes and other immune diseases, dry mouth also can be caused by any of 400 or more medications -- some prescription, some available over the counter. Many of these meds are intended to treat high blood pressure or depression. Others are antihistamines -- for treating asthma and allergies. When two or more such medications are taken together, the dry mouth effect can be compounded.

The condition can be further aggravated if, while taking "drying" medications, you drink caffeinated, sweet or alcoholic beverages or you smoke, or eat salty or sugary snacks.

Some cancer treatments, including chemotherapy, or radiation to the head or neck, can cause dry mouth, too.

As well as making your mouth feel and taste unpleasant, dry mouth can contribute to tooth decay because with too little saliva circulating in the mouth, bacteria and food particles are left where they can be troublesome.

The condition could possibly be relieved by taking small, frequent sips of water, sucking sugarless candies or chewing gum.

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Illegal Organ Sales Leave Sellers Sicker, Poorer 

By Merritt McKinney

Reuters Health

Tuesday, October 1, 2002

NEW YORK (Reuters Health) - Though poor people in India and other countries sometimes sell their kidneys in hopes of climbing out of debt, in a new study, three out of four people in India who had sold a kidney were still in debt an average of 6 years later and many reported being in worse health than before. And almost 80% said that they would not recommend selling a kidney.

In an interview with Reuters Health, Dr. Madhav Goyal of the Geisinger Health System in State College, Pennsylvania, said that some proponents of permitting the sale of kidneys believe that the practice is acceptable as long as people "are doing it voluntarily and of their own free will."

Based on the results of the study, Goyal said, "I don't think that it's as simple as that."

He noted that two of the women interviewed said their husbands had forced them to sell a kidney. Other women could have been forced to sell an organ, according to Goyal, but they might have been reluctant to admit it in interviews, which were often conducted in the presence of other family members.

According to the Pennsylvania researcher, many of the people in the study were in debt to money lenders who "viewed their kidneys as collateral." In some cases, Goyal said, when people could not pay their debts, the money-lenders harassed them to sell a kidney until the pressure "just got to be too much. This was their only option."

Goyal noted that in the study, which is reported in the October 2nd issue of The Journal of the American Medical Association ( news - web sites), "overall, selling a kidney did not lead to any tangible long-term benefit and appeared to be associated with a decline in their financial status as well as health status, and most would not recommend that another person sell."

In most of the world, the demand for kidney transplants far exceeds the supply. In the US, for example, 50,000 people await a kidney transplant, but only 15,000 kidneys are transplanted each year. In India, with four times the population of the US, only 4,000 kidney transplants are performed each year, and some of these donated organs go to foreign patients.

Paying for a donated kidney is illegal in the US and India, but in India, poor people have been selling their kidneys for more than a decade, Goyal and his colleagues note in the report. Supporters of allowing people to sell kidneys, according to the report, claim that besides helping the transplant recipient, the practice allows poor people to emerge from extreme poverty at little health risk.

The results of a study of 305 Indians who sold a kidney question the accuracy of these arguments, according to Goyal and his colleagues.

Nearly all of the respondents, more than two thirds of whom were women, said that they had sold a kidney to pay off debts, including food and household expenses as well as rent, marriage expenses and medical bills. Ninety-five percent said that the desire to help a person in need was not a major factor in their decision.

On average, people who sold a kidney were promised $1,410, but actually received $1,070.

Though the desire to pay off debts was the main reason people sold kidneys, the percentage of people below the poverty line actually increased, rising from 54% before selling a kidney to 71% afterwards. After selling a kidney, participants' family income declined by about a third, even though per capita income in the state where the study was conducted increased during the period. At the time of the survey, 74% were still in debt.

Even though a person can live a healthy life with only one kidney, more than 75% of the participants reported a decline in health after selling a kidney, according to the report. Half of the participants said they felt persistent pain at the site where their kidney had been removed and one-third reported long-term back pain.

Most participants, 79%, said they would not advise others in similar situations to sell a kidney.

Since Goyal and his colleagues had no problem finding several hundred people who had sold kidneys in India, the study highlights the need for the Indian government to clamp down on this illegal practice and to consider setting up a nationwide system of donor organs from cadavers, he said.

Goyal said that the study also raises questions for people in the US, where several organizations have proposed paying people or family members for organs.

"This sets us up for a situation similar to India where only the poor are likely to respond to such incentives," Goyal said. "We can see from the Indian experience just how they can be exploited."

He added that there have been several reports of kidneys being sold in the US.

Goyal added that there is no guarantee that paying people for their kidneys will increase the supply of organs. "In fact, in one transplant center in Iran, the total supply of kidneys has not gone up, but rather has just shifted from relatives to paid donors."

Though the study will not be the last word in the debate, "by demonstrating that the sale of organs does not serve as an escape route from poverty, indeed, that its aftereffects may even make escape more difficult, Goyal et al. explode the proposition that sale is a win-win situation that benefits buyer and seller," Dr. David J. Rothman of Columbia University in New York states in an accompanying editorial.

Source: The Journal of the American Medical Association 2002;288:1589-1593, 1640-1641.

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Another Reason to Order Tofu Burgers 

HealthScoutNews

Tuesday, October 1, 2002

TUESDAY, Oct. 1 (HealthScoutNews) -- Tofu and other soy-based foods greatly reduce levels of a class of estrogens linked with breast cancer ( news - web sites) in post-menopausal women.

So says a study in the September issue of Cancer Epidemiology, Biomarkers and Prevention.

"Results from this study support the hypothesis that high soy intake may reduce the risk of breast cancer by lowering endogenous estrogen levels, particularly estrone," says lead investigator Anna. H. Wu, a professor of preventive medicine at the Keck School of Medicine, University of Southern California, Los Angeles.

In their study of 144 post-menopausal Asian women, aged 50-74, in Singapore, Wu and her colleagues found a link between soy-rich diets and lower levels of estrone, the predominant type of estrogen in women following menopause.

Estrone levels in women who consumed the most soy protein were about 15 percent lower than other women. The researchers could not find any other easily changeable lifestyle factor that could produce that much of an estrone reduction.

It's been shown that high estrogen levels increase the risk of breast cancer among post-menopausal women.

More information

The U.S. Food and Drug Administration has a discussion on soy.

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Colon Cancer Screening Rates Slowly Improving 

By Dana Frisch

Reuters Health

Tuesday, October 1, 2002

NEW YORK (Reuters Health) - Despite evidence that screening for colorectal cancer helps detect the disease early on, making it easier to treat or in some cases preventing it entirely, a new study shows that use of screening tests increased only slightly from 1997 to 1999.

Cancer of the colon or rectum is the fourth most common cancer among both men and women in the US. This year alone, almost 150,000 Americans will be diagnosed with the disease and approximately 56,000 will die as a consequence.

"I think people have only been on board and have known that screening is effective for the last 5 years or so, and it certainly takes time to trickle out to the general community," said lead author Dr. Laura Seeff, a medical officer at the Centers for Disease Control and Prevention ( news - web sites) in Atlanta, Georgia.

In addition to lack of awareness, Seeff cited patient embarrassment, a low rate of reimbursement for physicians doing screening procedures and the fact that many health plans don't cover screening tests as other reasons for why many people are still not being tested.

A smaller percentage of people at risk are screened for colorectal cancer than are screened for breast or cervical cancers, Seeff and her colleagues note.

Colorectal cancer screening methods include fecal occult blood testing, to identify blood in the stool; and colonoscopy and sigmoidoscopy, in which a physician inserts a tube into the colon to identify any polyps, or small growths, that can develop into cancer. CDC guidelines suggest everyone over 50 have a fecal occult blood test once a year, a colonoscopy once every 5 years and a full x-ray of the colon every 10 years.

To investigate whether rates of colorectal cancer screening had changed, Seeff and her colleagues analyzed data from the Behavioral Risk Factor Surveillance System, a telephone survey of over 60,000 Americans over 50 years of age. Survey participants were asked four questions regarding their use of one of the two screening methods. Data were compared for 1997 and 1999, and the findings are published in the September issue of The Journal of Family Practice.

In 1999, almost 21% reported having a fecal occult blood test in the last 5 years, and about 33% reported having had a colonoscopy during that same time. These are slight increases from 1997 when 19% and 30% responded affirmatively.

"I am heartened by the fact that it is slowly improving," Seeff said. "It is definitely gaining more and more attention." She anticipates that data from 2001 will show that the numbers being screened continue to rise.

Seeff recommends that patients speak to their physician to decide on a screening method best suited to them.

For more see http://www.cdc.gov/cancer/colorctl/index.htm

Source: The Journal of Family Practice 2002;51:761-766.

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Promising New Stroke Therapy 

HealthScoutNews

Tuesday, October 1, 2002

TUESDAY, Oct. 1 (HealthScoutNews) -- A synthetic antioxidant that can reduce brain damage by more than 40 percent in animal models of stroke may be a promising candidate for human stroke therapy.

That's the finding of a study in the October issue of Free Radical Biology and Medicine.

In this study by researchers at National Jewish Medical and Research Center and Duke University Medical Center, the synthetic antioxidant called AEOL 10150 proved effective when given 7.5 hours after the start of a stroke. That's a significant point.

"Because the onset of stroke can be difficult to detect, many patients do not get treatment for several hours," says study co-author Dr. James Crapo, chairman of the department of medicine at National Jewish. "Our findings suggest that the antioxidant is a promising candidate for stroke therapy because it can prevent damage so many hours after the stroke begins."

A stroke occurs when blood vessels in the brain are blocked or leak, causing an interruption of blood flow to the brain. That deprives brain cells of oxygen and they start to die. Even after blood flow to the brain is restored, brain cells injured by the oxygen deprivation continue to die for hours after the stroke.

Those injured brain cells are killed by highly reactive molecules called free radicals.

In this study, researchers used the synthetic antioxidant AEOL 10150 to neutralize those damaging free radicals and reduce brain cell death in mice who had their cerebral arteries blocked for 90 minutes. Six hours after their cerebral arteries were reopened, the mice had either AEOL 10150 or a placebo injected into their brains.

When the mice were evaluated a week later, the mice who received the synthetic antioxidant had 92 cubic millimeters of brain tissue destroyed by the stroke, 43 percent less than the 160 cubic millimeters of brain tissue destroyed in the mice who received the placebo.

"There is a significant arc of potentially salvageable tissues surrounding the cells that are killed by the initial stroke," says Dr. David S. Warner, professor of anesthesiology, Duke University Medical Center. "The antioxidant appears to protect this tissue."

More information

Learn more about stroke at the American Stroke Association.

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Hot-Headed Guys? It's All in the Brain 

By Holly VanScoy
HealthScoutNews Reporter

HealthScoutNews

Tuesday, October 1, 2002

TUESDAY, Oct. 1 (HealthScoutNews) -- Just when Viagra took care of one concern of men, another matter seems problematic.

Brain matter.

A husband-and-wife research team from the University of Pennsylvania School of Medicine reports that the relative size of the sections of the brain that constrain aggression and monitor behavior are larger in women than in men.

Conversely, the researchers say they also found that the sections of the brain that promote aggression are smaller in women than in men.

Ruben C. Gur and Raquel E. Gur, reporting in the September issue of Cerebral Cortex, say these are biological characteristics that translate into important behavioral distinctions between the sexes.

"Perhaps the greatest emotional difference between men and women is their expression of aggression," says Ruben Gur, a professor at the school's department of psychiatry, neurology and radiology.

"This study provides neurobiological evidence that women have more of the brain tissue that's used censoring aggressive and angry responses, while men have more brain tissue of the type that initiates aggression and impulsive, angry responses," he adds.

The Gurs say their research was based on established scientific knowledge that emotional control and expression are linked to specific regions of the human brain. The so-called limbic system, particularly the amygdala, for instance, is involved in the emotional behavior associated with arousal and excitement, and the orbital frontal region is involved in the modulation or control of aggression.

When their team performed MRI scans on the brains of 116 healthy men and women, they found the 59 women in their study had a significantly higher volume of brain tissue in the orbital frontal region in proportion to amygdala brain tissue volume than did the 57 men they examined.

This, they conclude, gives women an advantage when it comes to controlling their aggressive behaviors. Men, it would seem, are biologically fated to be more hot-headed than women.

Kenneth Goldberg, a clinical assistant professor of neuropsychology at Widener University in Pennsylvania, says research findings like these can be helpful in understanding differences between male and female behavior.

"Some people don't want to admit that men's and women's brains are different," says Goldberg. "Even though research studies like this one show that such differences do exist and are quantifiable, there are those who insist that biology doesn't play a role in human behavior. Obviously, brain-size differences between males and females do exist and may prove to be very important."

Goldberg points out that understanding what goes into the expression of aggression at the biological level is also relevant and valuable.

"The Gurs' results provide us with a way to conceptualize the physiological mechanisms that play a role in specific human behaviors, such as violence and aggression," Goldberg says. "Although the field of science isn't there yet, one day information of this type can help in the development of treatment and prevention approaches."

According to Ruben Gur, the next step in the research is to examine the role of individual differences in the context of the male-female brain biology the research team documented.

"We will now be looking at how the proportion of brain tissue promoting aggression to that modulating aggression relates to the way specific men and women express aggression," he says. "We are hoping to determine whether it is feasible to use MRI scans as an anatomic index to predict the risk of aggression in certain individuals."

"If high-risk individuals can be identified based on the relative size of some of these parts of their brains, it may be possible to develop means for them to enhance the brain tissue that inhibits or controls these aggressive emotions and their expression," he says.

What To Do

To read the abstract of the Gurs' study in Cerebral Cortex, click here. For a wide-ranging look at aggressive behavior in humans, visit the University of Plymouth, in the United Kingdom.

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Hospitals Washing Hands Of Water
Research Shows Alcohol Gels Kill More Germs

By Daniel Q. Haney
The Associated Press
Tuesday, October 1, 2002

SAN DIEGO -- Soap and water may be all washed up. Many hospitals are switching to quick-drying alcohol gels as evidence builds that they stop dangerous germs faster and better than traditional hand-washing.

The spread of microbes in hospitals is a huge health problem, making sick people sicker and resulting in an estimated 20,000 deaths in the United States each year. One of the chief ways germs spread is on the hands of nurses, doctors, technicians and others who move from patient to patient.

Although hospital workers are routinely urged to wash up between patients, a thorough job can take a full minute, results in dry skin and is often skipped to save time, especially in hectic intensive care wards -- where the risk can be the greatest.

The latest research, presented last Saturday at a meeting of the American Society for Microbiology, suggests the alcohol-based rinses are surprisingly effective at reducing hospital germs because they are quicker, require no water or sink and kill more microbes.

"You go up to a dispenser, go, 'Click!' and it's there. The time saving is amazing. It's something people actually do use rather than walking by the sink," said Barbara E. Murray, director of the division of infectious diseases at the University of Texas Medical School at Houston.

Over the past two years, some hospitals have installed alcohol gel dispensers beside every bed, and many more are planning to make the switch. New guidelines from the Centers for Disease Control and Prevention, to be released later this fall, are expected to recommend hospitals use the alcohol gels exclusively except when workers' hands are visibly soiled.

"This will represent a revolution in hand hygiene," said Elaine Larson, a registered nurse and professor of pharmaceutical and therapeutic research at Columbia University. "No longer is the best way to clean your hands washing them. Can you imagine telling surgeons you no longer need to scrub? This is news, and it's very exciting."

The alcohol rinses, available as foam, gel or lotion, are simple to use: Pour a dime-sized blob on one palm, then rub the hands together until it dries, which takes about 15 seconds. The solutions also contain moisturizers, so they do not dry the skin. Identical products are available in grocery stores.

"One of the real barriers to hand hygiene is how busy health care workers are," said David C. Hooper, associate director of the infection control unit of Massachusetts General Hospital. "The ability to very rapidly kill bacteria on your hands is a great advantage."

Researchers at the Veterans Administration Medical Center in the District measured the effects of switching to the alcohol rinses two years ago. Dispensers were put in all patient rooms and outpatient clinics. New cases of drug-resistant staph infections decreased 21 percent, while resistant enterococcus dropped 43 percent; both are serious, hospital-acquired infections.

Among the first to study the gel's advantages was Didier Pittet of the University of Geneva Hospitals in Switzerland. Four years of use there cut hospital-spread infections by half.

Some hospitals have been reluctant to adopt the new cleaners because they cost more than soap. However, a new analysis by Pittet suggests they actually save money because they reduce infections, which are expensive to treat.

At his hospital, he found the gels cost an extra $1.62 for each patient admitted, or $82,000 per year. But from 1999 to 2001, the hospital saved more than $12 million in treatment costs.

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Pharmacy-Assisted Health Care Backfires 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Tuesday, October 1, 2002

TUESDAY, Oct. 1 (HealthScoutNews) -- A program designed to involve pharmacists in the health care of customers with certain respiratory illnesses did not have better outcomes than having the patients manage their own care.

The pharmacist-care program did lead to increased satisfaction among customers, but it also led to more medical visits, according to a study appearing in tomorrow's issue of the Journal of the American Medical Association ( news - web sites).

"The original intent was to see if pharmacists in the community could use patient-specific information about customers to interact effectively with them and improve outcomes," explains Morris Weinberger, lead author of the study and a professor of health policy and administration at the University of North Carolina.

Breathing disorders such as asthma and chronic obstructive pulmonary disease (COPD) can be managed with drugs, but patients often have trouble following the prescribed regimen.

According to the study, pharmacies may be helpful because people often have several doctors but just one pharmacist, whom they're inclined to trust. The pharmacist is also the last health-care professional patients see before they take their medications.

To see if pharmacists could help compliance and therefore outcomes, the study authors conducted a randomized trial at 36 CVS community drugstores in Indianapolis. The trial enrolled 1,113 participants with asthma or active COPD, a condition usually associated with emphysema and chronic bronchitis.

The drugstores were divided into three groups of 12 stores each. One group followed the pharmacy care program, which involved training the pharmacist and using patient-care materials. Patients visiting the second group of pharmacies measured their own peak expiratory flow rate (PEFR), a gauge of exhalation and lung function, with peak flow meters at home. The third group did not receive peak flow meters or individualized care from the pharmacist.

After one year, patients in the pharmacy care group had similar PEFRs to those in the peak flow group and both were higher than patients in the usual-care component. "The results were that, basically, intervention looked a lot like the peak flow monitoring group," Weinberger says.

But the pharmacy-assisted patients were also 2.16 times likelier to end up in an emergency room or a doctor's office with a breathing-related problem than were those in the usual-care group.

The study also found that pharmacists accessed computerized data on patients only half the time, which Weinberger feels was not frequently enough. "We found that it was too clunky for the pharmacists. We need a simpler way. We have been working with CVS on how to do that more effectively."

It's not clear why those helped by a pharmacist landed in the hospital more often. Increased education may lead to seeking more medical care, postulates Dr. Marianne Frieri, director of the Allergy Immunology Program at Nassau University Medical Center in East Meadow, N.Y. "It's good that the patient has another person to interact with rather than just take a pill and go home. Maybe it's because when they had increased education they decided to go back to their doctor. It might be increased attention to their disease state."

Some experts feel the design of the study may have weeded out non-compliant patients, which resulted in the similar outcomes. "I'm not surprised that they didn't find much difference with pharmacy intervention," says Dr. Richard Honsinger. "They picked the most compliant patients anyway. If a pharmacy program is going to make a difference, it's probably going to make a difference in compliance." The study results reflected only those patients who had responded to questionnaires, not those who had not responded.

The larger question still remains: Should pharmacists assume a larger role in health care? "I still think the idea is how do we get pharmacists involved as members of the care team in an effective way," Weinberger says. "We've made a dent on that road, but we need to get them more engaged."

Others are not so sure.

"We have a limited health-care budget in the United States. We have more and more people getting into the health-care field who all want an income: We need to keep doing these studies to see if intervention is worth the money we put into it," Honsinger says. "We want to take care of people. We want them to do well, but we want to know that our money is being well spent."

What To Do

For information on a variety of respiratory conditions including asthma, visit the American Academy of Asthma, Allergy and Immunology. The National Heart, Lung and Blood Institute has a page devoted to COPD.

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Chinese herbs may help treat hepatitis B  

From the Science & Technology Desk
United Press International

Tuesday, October 1, 2002

 BERKELEY, Calif., Oct. 1 (UPI) -- Treating chronic hepatitis B infection with Chinese herbal medicine may be as effective as the western approach of interferon alpha injections, researchers said Tuesday after analyzing 27 studies done mostly in China.

When the two approaches are used in combination, they said, the results are more effective than interferon alpha alone.

"What we found was that the use of Chinese herbal medicine significantly enhanced the effect of interferon when used together or was equivalent to interferon when herbal medicine was used alone," lead author Michael McCulloch told United Press International

"Research really ought to focus on investigating herbal medicines as potential substitutes for interferon treatment where interferon isn't working or side effects are not tolerated," said McCulloch, who is an epidemiology researcher at the University of California at Berkeley and an acupuncturist and researcher at the Pine Street Research Group in San Anselmo, Calif.

Although Chinese herbal medicine would be much cheaper to administer than interferon alpha shots, which cost thousands of dollars, several experts -- as well as the authors of the analysis themselves -- expressed concern about the qualities of the original studies.

For example, the authors pointed out many of the studies reviewed probably would not meet the standards of most research published in western medical journals. The study subjects, as well as the investigators, usually knew who was receiving the Chinese herbal medicine or interferon alpha, or both. In addition, subjects appeared not to have been randomly assigned by conventional methods to the groups receiving different treatments.

Study design issues aside, patients receiving Chinese herbal medicine formulations plus interferon alpha were about 1.8 times more likely to show a beneficial response than patients receiving only interferon alpha, if three standard measures of benefit are averaged. Chinese herbal medicine alone, by one measure, showed twice the effectiveness of interferon alpha. By two other standard tests, it showed about the same benefit.

Some of the formulations, such as bufotoxin, which is derived from toads, and kurorinone, made from the root of flavescent sophora, a deciduous shrub, "appear to be targets for further investigation ... in well-designed trials," the authors wrote in the Oct. 1 issue of the American Journal of Public Health.

"Until this is studied in a randomized, controlled, double-blind clinical trail with investigators that are doing it the right way you really can't draw any conclusions," Howard J. Worman, associate professor of medicine and cell biology at the College of Physicians and Surgeons of Columbia University in New York told UPI.

"More clinical research needs to be done on these medications before they find their way into clinical practice in the west, said Anna Sasaki, a gastroenterologist and liver specialist at Oregon Health and Science University in Portland. "Because of the potential toxicity of some herbal medication, people should seek advice before trying any of these medications," Sasaki, who also is with and the Portland Veterans Administration Medical Center, told UPI.

Many patients with hepatitis B have jaundice, fatigue abdominal pain, loss of appetite, nausea vomiting and joint pain. Patients often develop scarring of the liver tissue or liver cancer. About 15 to 25 percent of those infected die of hepatitis B. Hepatitis B and C are both transmitted by blood or body fluids. Hepatitis C is fatal less than 3 percent of the time. Hepatitis A is most often transmitted from unwashed hands to food.

The World Heath Organization estimates 350 million chronic hepatitis B infection cases worldwide.

(Reported by Joe Grossman, UPI Science News, in Santa Cruz, Calif.)

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MONDAY, SEPTEMBER 30, 2002 

Lifelong Exercise May Cut Breast Cancer Risk 

By Peggy Peck

Reuters Health

Monday, September 30, 2002

ORLANDO (Reuters Health) - Even moderate physical activity--for example brisk walking for at least 2 miles three times a week--over the course of a lifetime can reduce a young woman's risk of developing breast cancer ( news - web sites) by 33%, and the risk of breast cancer after menopause by 26%, according to results of a study of women living in the San Francisco Bay area.

The results were presented Friday at the Department of Defense ( news - web sites) Breast Cancer Research Program.

Dr. Esther M. John, an epidemiologist at the Northern California Cancer Center in Union City, California, told Reuters Health that the study confirms earlier reports that "exercise can reduce the risk for breast cancer."

But, she added, "this study also points out two important factors: it is total physical activity over the course of a lifetime that confers a benefit, and this activity is not limited to vigorous exercise. Even moderate activity has real benefits."

John and colleagues based their findings on interviews with 1,249 women aged 35 to 79 who were newly diagnosed with breast cancer between 1995 and 1998, and 1,547 similar women who were cancer-free.

Of the women with breast cancer. 402 were diagnosed before menopause and 847 were diagnosed after menopause. The risk of breast cancer increases with age, John noted.

The women agreed to detailed interviews that assessed total physical activity "beginning in the teen years and then continuing through every decade thereafter. We asked about all types of activity including traditional exercise like biking, running, walking and weight lifting and so on, as well as nontraditional exercise such as housework and yard work," she said. The women were asked, for example, if they walked to school as teens or if they rode bikes for pleasure or to run errands. Women were also asked to rate their jobs for exercise content.

The researchers then divided the women into three groups based on their activity level.

Those premenopausal women in the most active group had a 26% lower risk of breast cancer compared with the least active women. Postmenopausal women in the most active group had a 19% lower risk than the least active women.

Breast cancer risk was cut by 33% in premenopausal women who were moderately active and 26% in postmenopausal women who were moderately active compared with the least active women.

The benefits were greater for women with a lower body mass index (BMI), which "probably indicated greater overall fitness," said John. Women with a BMI of 25 or less who were in the most active group were 47% less likely to develop premenopausal breast cancer and 31% less likely to develop breast cancer after menopause than the most sedentary women. Anyone with a BMI 25 or more is considered overweight, while a BMI of 30 or more is considered to be obese.

In the San Francisco Bay area, the incidence of breast cancer is lowest among Latinas (90 cases per 100,000 population aged 35-49) followed by African Americans (105 per 100,000 aged 35-49), and highest among white women (135 per 100,000 aged 35-49).

John said lifetime physical activity was highest among Latinas followed by African Americans and whites. She estimated that physical activity explained "13% of the difference observed between Latinas and whites but does not explain the difference between African Americans and whites."

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Assisted-Living Planning 

HealthScoutNews

Monday, September 30, 2002

(HealthScoutNews) -- Would you choose to move into an assisted living facility? If you had no choice, would you be prepared to do so? If you've done your homework -- helped, perhaps, by a family member or friend -- you're more likely to make the right move.

 Assisted living facilities offer various services and accommodations. Some offer around-the-clock nursing services, while others offer a minimum of nursing support -- or something between the full- and minimum-care levels.

Some facilities monitor and adjust residents' personal service and medical needs more often than do others. Some offer greater ranges of recreational and social activities. The cost of these facilities ranges from as little as $1,000 per month to more than $4000 monthly.

Assisted living experts recommend that you find out the facts now, before being self-sufficient is no longer an option.

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Scientists Test Blood Sterilization  

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, September 30, 2002

Several hundred transfusion recipients around the country — adults undergoing heart surgery and children with certain inherited anemias — are being enrolled in a bold experiment: They'll receive donated blood that has essentially been sterilized.

Today's blood supply is very safe because it undergoes numerous tests to ensure that donated pints containing infections like the AIDS ( news - web sites) virus are thrown out.

Testing isn't perfect, however, and a few tainted pints slip by. Last month's discovery that West Nile virus ( news - web sites) apparently can be spread through transfusions highlights another problem: Blood banks can't prevent what they can't test for, and there's no test yet for West Nile in donated blood.

A technology called "pathogen inactivation" is being promoted as the solution. A chemical added to a donated bag of blood is supposed to break up the genetic material of any viruses or bacteria lurking inside so they can't infect, essentially offering the first way to sterilize blood.

"This is a paradigm shift in the way we deal with protecting the safety of the blood supply," says Dr. Laurence Corash of Cerus Corp., one of several companies developing the technology. "In the past we have relied upon testing. Testing will never put you in front of a new pathogen like West Nile virus when it first occurs."

Now Cerus and a competitor, V.I. Technologies, are beginning the first major U.S. studies, in 520 patients, to see if it's safe to give people pathogen-inactivated red blood cells.

Cerus has won European approval to sterilize platelets, one component of blood, and marketing should begin there late this month.

But don't expect sterilization of red blood cells — the typical transfusion — for at least several more years, as researchers study some serious questions: Does the cleaning alter blood so it doesn't function normally? Does the leftover cleanser residue pose any risk, or alter any cells in a way that might encourage cancer formation?

The Food and Drug Administration ( news - web sites) calls pathogen inactivation highly promising. It even took the unusual step of asking Cerus and Vitex to turn over evidence that their technologies could destroy West Nile virus in transfusions, raising the prospect of additional clinical trials if the mosquito-borne virus renews its threat next summer before a blood test, expected by then, is working.

"The promise is somewhat in the future," cautions FDA's Dr. Jesse Goodman. The FDA will demand stringent proof that altering blood to eliminate a bug found in, say, one of every 5,000 donated pints won't pose a new and different risk to the other 4,999.

Cerus and Vitex use different compounds, but the end result is the same: the molecules target and break up the genetic DNA and RNA that viruses and bacteria use to multiply, so the pathogens are no longer infectious.

Both companies cite success in killing a variety of bugs, from the HIV virus ( news - web sites) to the malaria parasite. Vitex, working with the Agriculture Department, recently proved it can kill the West Nile virus; Cerus is doing similar experiments.

Red blood cells, plasma and platelets, blood's major components, contain no nuclear DNA or RNA and so are not destroyed. White blood cells contain the genetic material, but as they're not needed in transfusions, destroying them does no harm.

Both companies say what little cleanser residue is left isn't harmful.

But blood banks cite the cautionary tale of an earlier attempt to scrub infections out of plasma that won FDA approval only to have doctors discover later that it could cause a serious side effect in certain patients. That and marketing problems caused this "solvent detergent plasma" to fail.

So blood banks are closely watching Cerus and Vitex. The companies' clinical trials aren't large enough to prove the technology reduces infections, but they're crucial to see if sterilized blood causes side effects that blood tested in the regular way wouldn't.

Participating in Cerus' study are Yale University, the University of Minnesota, the University of Virginia, Boston's Brigham & Women's Hospital, and the University of Florida. Vitex is now picking study sites.

If the studies go well, both companies hope to seek FDA approval for sterilized red blood cells in 2004.

Editor’s Note: Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Animal Testing: Exploring Alternatives 

United Press International

HealthScoutNews

Monday, September 30, 2002

(HealthScoutNews) -- Using animals to test products for humans is considered cruel and inhumane by many people. Scientists are sensitive to that, and are struggling to find alternative ways of ensuring items that we eat, drink and use are safe for us, our unborn children and our environment.

 Ironically, animals -- as well as people -- benefit from antibiotics, vaccines, blood thinners, cardiovascular therapies, pain-killers, and many surgical procedures developed through animal-related research.

Research that focuses on reducing or eliminating the use of animal subjects in research studies undergo peer reviews by members of the Interagency Coordinating Committee on the Validation of Alternative Methods. The group explores the use of other-than-animal testing procedures.

Since it's first action, in 1998, the committee has declared itself in favor of:

  • The "Murine Local Lymph Node Assay" test to determine if allergy- or dermatitis-risks exist in industrial chemicals, cleansers, cosmetics and various household products. This test actually takes one-third the time than the old animal-intense testing procedure, and involves one-half to one-third as many animals;
  • The "Corrositex" test, using a synthetic skin rather than rabbits, tests the corrosiveness of chemicals to human skin;
  • The use of rodents whose genes have been altered in a way that makes them respond faster and more accurately to tests -- resulting in fewer animals being used, and;
  • The use of fish and frogs and their tissues, rather than warm-blooded animals, for some tests.

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FDA Launches Plan to Reduce Acrylamides in Foods 

By Alicia Ault

Reuters Health

Monday, September 30, 2002

COLLEGE PARK (Reuters Health) - The US Food and Drug Administration ( news - web sites) (FDA) on Monday set in motion a plan to identify how the chemical acrylamide is getting into food and what can be done to reduce or eliminate it, since it can cause cancer, neurological damage and infertility.

In the first of many meetings, the FDA plans over the next year to conduct research and form a consensus with international scientists on how to eliminate acrylamide, said Lester Crawford, deputy FDA commissioner.

"It's alarming--nobody wants it in the food supply," Crawford said in an interview with Reuters Health. He added that the FDA aims to make final recommendations in conjunction with the World Health Organization ( news - web sites) (WHO) in early 2004.

"We're trying to do it in as few months as we possibly can," said Crawford.

Acrylamide first came to light in April, when the Swedish National Food Administration and Stockholm University reported they had found the chemical in fried and oven-baked foods, especially potato chips and French fries. The Swedes said high-temperature cooking caused acrylamide formation and suggested that the chemical might cause several hundred cases of cancer each year in Sweden alone.

Many initially doubted the findings, but scientists in Norway, the United Kingdom and Switzerland have come up with similar results.

"The Swedes did not go over the top," Crawford said.

Acrylamide's discovery was new, but the chemical has likely been in food for thousands of years, said Bernard Schwetz, FDA's senior science adviser.

Scientists agreed at a June WHO meeting to work together to determine how acrylamide is formed, how to measure it in food, and whether it stays in the body or is metabolized and excreted. The scientists also hope to find out if known non-food acrylamide sources, such as cigarette smoke, are a greater or equal threat compared to food exposure.

Finally, they hope to figure out if any acrylamide consumption is safe. The FDA will be helping in all of these efforts, especially focusing on foods that Americans consume most.

In international studies, potato chips, French fries, baked goods like crackers and pastries, breakfast cereals and coffee powder had the highest acrylamide levels. Lower amounts were found in fried fish and fried chicken, chocolate powder and instant malt drinks.

Preliminary FDA tests of American grocery and restaurant foods also found the highest levels in French fries and potato chips, but the range of acrylamides within food categories and among brands was quite large in some cases, said Dr. Lauren Posnick of the FDA's Center for Food Safety and Nutrition. That gives hope that there may be ways to minimize or eliminate acrylamide, Posnick said.

There are some clues to why acrylamide forms. Recent studies by FDA researchers and several papers in this week's issue of Nature show that when the amino acid asparagine is heated in combination with glucose, acrylamide is more likely to form. Asparagine is found in many plant-based foods.

Low water content and high-temperature cooking also seem to play a role.

But given foods' chemical complexity, "we'll likely find multiple mechanisms involved in the formation of acrylamide," said Schwetz.

Until there are more answers, Americans should strive to eat a balanced diet heavy on fruits and vegetables and limit fried and fatty foods, Crawford said.

The National Food Processors Association said it agreed with FDA that more needs to be learned about acrylamides and commended the agency's plan. But the group added, "we do not believe we are faced with a public health emergency."

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Time to Get Serious About Seasonal Allergies 

By Dennis Thompson Jr.
HealthScoutNews Reporter

HealthScoutNews

Monday, September 30, 2002

MONDAY, Sept. 30 (HealthScoutNews) -- Think allergies are little more than a runny nose?

Guess again.

The watery eyes, sneezing, congestion and itchy throat that are hallmarks of allergies take a lot more out of sufferers than most people think.

A new survey by the American College of Allergy, Asthma and Immunology (ACAAI) found that 94 percent of people said that when their allergies act up, their quality of life deteriorates. Their work, sleep, concentration -- even their sex lives -- suffer.

"Allergies and their symptoms not only cause quality of life consequences such as fatigue, impaired work performance and general malaise, but also, insufficiently treated allergies often lead to serious conditions such as sinus or ear infections, asthma and sleep problems," says ACAAI President Dr. Bobby Lanier.

Despite these disruptions to their lives, only about 50 percent of sufferers said they considered their allergies to be a serious medical condition. And nearly two-thirds did not see a physician the last time their symptoms kicked up, the survey found.

Given that awareness gap and the approaching height of the fall allergy season, the ACAAI has issued a "call to action" for allergy sufferers to take their health problems seriously, and see an allergist or personal physician to get the treatments that can manage their ills.

"We're trying to tell people, 'Hey, recognize this chronic problem and take care of it,'" Lanier says. "Pay this thing some respect, because it will eat you up if you don't."

About 50 million Americans are expected to suffer from allergic symptoms this fall, either from seasonal allergies caused by mold spores or plant pollens, or from year-round allergies caused by indoor allergens like dust mites.

Ragweed is the plant most responsible for fall allergy symptoms. It's most prevalent throughout the Northeast, South and Midwest, although forms of ragweed allergens can be found in all areas of the United States, the ACAAI says.

Other common fall allergens include outdoor molds found in soil, vegetation and rotting wood. Some molds peak in late summer or early autumn, while leaf molds peak after the leaves have fallen. They are most common in the North during the fall and year-round in the South and West Coast.

"Unfortunately, most people think that anyone who suffers from allergies are a bunch of wimps, because they're complaining about a runny nose," says Dr. Jay Portnoy, an allergist from Kansas City, Mo. "Many people don't recognize how much of an impairment they're having from their allergies."

For the survey, telephone interviews were conducted last month with 300 allergy sufferers nationwide. Among the key findings:

·         More than two-thirds of the respondents said their allergies kept them from getting a good night's sleep.

  • About half said allergies interfered with outdoor activities and with their ability to concentrate.
  • 43 percent said their work productivity suffered due to their allergies, and
  • 13 percent said their sex life was disrupted by allergies.

Lanier says he wasn't surprised to learn that so many people find that allergies have a profound affect on their lives. Nor was he surprised to hear that half still don't consider allergies a serious problem.

"I think a lot of people who don't deal with an allergy may be surprised by it," Lanier says. "I would just say, 'Aha! I told you so.' It's a chronic problem that doesn't produce any visible scars, so it's hard for people to take it seriously."

Forty-one percent of those surveyed said they first thought they had a cold or virus when they began suffering from allergies. The reason: Many of the signs of a cold -- watery eyes, runny nose, congestion, itchy throat -- are also symptoms of allergies.

The survey also found that when people relied on over-the counter medications for relief, 67 percent reported drowsiness as a side effect. More troubling, two-thirds of those experiencing drowsiness said they drove a car shortly after taking such medicine.

Portnoy says allergy sufferers should see a doctor or allergist to receive treatment specific to their symptoms. It's particularly helpful if you do so at the start of the season.

An allergist can prescribe appropriate medicines, help identify the substance causing the allergies, or even offer allergy shots if other remedies fail, Portnoy says.

"They can be a collaborator with you in controlling your disease," Portnoy says. "You've got somebody to work with, a sympathetic ear."

What To Do

To learn more about allergies and treatments, visit the American College of Allergy, Asthma and Immunology, or the American Osteopathic Association.

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HIV Groups: Bush Fights Prevention  

By Laura Meckler

Associated Press Writer

The Associated Press

Monday, September 30, 2002

WASHINGTON (AP) - The Bush administration has pulled information about the effectiveness of condoms from a government Web site and is engaged in a "witch hunt" against those who promote condoms in the fight against AIDS ( news - web sites), several groups charged Monday.

They argue that the administration is hostile to HIV ( news - web sites) prevention and sex education that is not based on "abstinence-only," which discourages all sex before marriage and bars discussion of the benefits of birth control or condom use.

The advocacy groups said they are particularly concerned about federal agency audits of AIDS groups now under way, examining their finances and programming.

"It's a campaign to censor science and research, and it's a campaign to use government auditors to intimidate opponents of the administration on key policy issues," said James Wagoner, president of Advocates for Youth, a group that promotes education about birth control and condom use.

The administration says it is simply making sure that tax dollars are properly spent.

"We're looking at ourselves to see what we need to do to be efficient and effective," said Claude Allen, deputy secretary at the Department of Health and Human Services ( news - web sites). He called any suggestion of a witch hunt laughable.

Advocates point to a series of actions in the last year:

_Information explaining the effectiveness of condoms in preventing HIV transmission has been pulled from the Centers for Disease Control and Prevention ( news - web sites) Web site. Also gone: a section called "programs that work," which focused on HIV and highlighted several proven programs that involve condom use.

_HHS is conducting a broad management review its AIDS spending, ordered by HHS Secretary Tommy Thompson. That includes grants to outside groups and includes prevention, treatment and research.

Allen said he did not know of any other HHS-funded programs that are undergoing similar scrutiny.

_The HHS inspector general is investigating at least eight AIDS programs to see if their content is too sexually explicit or promotes sexual activity. Several of those reports are expected by year's end.

The inspector general already issued one report highly critical of Stop AIDS in San Francisco, saying their programs aimed at gay men were promoting sex and were possibly obscene. For instance, it pointed to program called "Great Sex Workshop," which examined ways of reducing the spread of HIV but also explored sex that was "safe, erotic, fun and satisfying."

A follow-up report on Stop AIDS is expected soon, and an administration official said it is expected it to find that the group made several positive changes to its programming.

Many fear there is more to come, said Martin Algaze, of the New York-based Gay Men's Health Crisis, an AIDS service group. "We think this is just the beginning of this witch hunt," he said.

Members of Congress also have twice asked HHS to further investigate AIDS groups.

In July, a group of Republicans asked HHS to examine whether the protesters at the international AIDS conference in Barcelona had used tax dollars to finance their trips. They also complained that the conference did not focus sufficiently on the role of religious groups in HIV prevention.

Thompson responded that his staff has brought concerns about religious groups to the conference organizers. But he said it would be too difficult to unravel the funding that various AIDS groups used absent a more specific complaint.

This month, a second group of House Republicans asked Thompson whether organizations lobbying against additional money for abstinence-only programs were using federal funds for such lobbying.

Thompson has yet to respond, but the groups say their lobbying activities are kept strictly separate from their federally funded work.

On Wednesday, one of those groups, the Sexuality Information and Education Council of the United States, plans to release a poll showing overwhelming support among parents for comprehensive sexuality education.

AIDS groups say the administration's focus on abstinence is having a chilling effect on other AIDS programming.

"There is a fear out in the community that if they produce something or say something inappropriate, or what is deemed as inappropriate, they will lose their funding," said Mary Ann Green of Florida AIDS Action.

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Arithmetic Beats Technology in Predicting Birth Weight 

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews

Monday, September 30, 2002

MONDAY, Sept. 30 (HealthScout News) -- A simple, six-step formula is more accurate than ultrasound in predicting the birth weight of an unborn baby, says new Duke University research.

The study, published in the September issue of the Journal of Reproductive Medicine, used the formula to estimate birth weights for 244 babies. On average, the predictions were accurate to within 8 percent. By contrast, ultrasound predictions vary from 8 percent to 16 percent, says study author Dr. Gerard Nahum, an associate clinical professor in the department of obstetrics and gynecology at Duke University Medical Center.

"It's amazing that until the turn of the 21st century, no such formula was developed," he says. "You don't need a calculator. You need a pencil and paper. It's low-tech, but it's more accurate. It's the most accurate method."

Doctors agree that estimating a child's birth weight is an important step in preparing for possible delivery complications, such as the need for a cesarean section. However, they don't appear to be jumping at the chance to trade in their pricey ultrasound machines for Nahum's equation and a pad of paper.

"A dartboard isn't too bad to begin with," says Dr. Rosemary Reiss, co-director of obstetric ultrasound at Brigham and Women's Hospital in Boston.

By simply predicting the birth weight for all babies at eight pounds, most of them will fall within about 10 percent, she says. And other methods -- merely looking at the mother's size or asking her how big she thinks the baby is, for example -- are nearly as accurate.

"People have been trying and trying for 20 years to get a better model, and they all come out about the same," Reiss says.

The problem with ultrasound is that it estimates a baby's birth weight based on only a few measurements, such as the circumference of her head or the length of her femur. While a number of formulas are used to translate the measurements into birth-weight estimates, none of them work well.

"Ultrasounds are limited by what they can see," Nahum says. "If a mother is overweight or the fetus is in an awkward position, this can throw off the accuracy of such a test. We don't encounter those problems with our equation."

His formula is based on six variables: gestational age, maternal height, maternal weight, third-trimester weight gain rate, number of prior children and fetal gender. In a previous study in California, Nahum used the formula to achieve similarly accurate results.

Still, the equation has significant drawbacks. For example, the 244 babies included in the study were picked from 398 babies born between 1998 and 2000 at the Duke University Medical Center. The researchers eliminated cases of non-white babies, twins, babies with diabetes or birth defects and those born before 37 weeks gestation.

To Dr. Terry J. DuBose, director of the sonography at the University of Arkansas for Medical Sciences, those exclusions make the formula useless in practice.

"This works as long as the baby is normal," he says. "The problem is that it's going to miss the abnormalities."

Besides estimating birth weight, ultrasound is used to detect twins, birth defects or complications, such as if the placenta is in the wrong place. And one of the six factors in Nahum's formula is the sex of the baby. This is significant since male babies are heavier than females. However, Nahum would need ultrasound to find that out, or lose 1 percent to 2 percent of his accuracy.

"I am not in any way saying ultrasound isn't useful," Nahum says. "You would be hard-pressed to point to anything that has changed obstetrics as much as ultrasound in the last three decades. But there's a huge amount of infrastructure invested in it. There's been kind of a vested interest in not accepting this formula."

With a patent riding on the equation, Nahum still contends that it's more accurate than ultrasound. Since reporting these findings, he has developed 60 more variations of the formula to account for different ethnicities and birth factors, such as whether the mother smokes.

He intends to create a computer program that would work with ultrasound machinery to "get the best of both."

What To Do

For tips about having a healthy pregnancy, visit the U.S. Centers for Disease Control and Prevention. Or to find an obstetrician or gynecologist in your area, visit the American College of Obstetricians and Gynecologists.

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Antibacterial Products May Fuel Growth of Superbugs 

By Jacqueline Stenson

Reuters Health

Monday, September 30, 2002

SAN DIEGO (Reuters Health) - New study findings add to growing concerns that widespread use of products containing the antibacterial agent triclosan may be promoting the growth of dangerous superbugs.

Triclosan is found in a variety of soaps, household cleaners, toothpastes, baby toys, sponges and other products.

But questions have emerged as to whether these products are doing more harm than good.

In the latest research, Stanford University investigators conducted laboratory studies involving triclosan and a variety of strains of the E. coli bacterium. They found that some E. coli strains that were resistant to triclosan became increasingly hardy over time.

"The results from the experiment indicate that constant exposure to triclosan can cause bacteria to tolerate it better and become more and more resistant," said study author Clara Davis, a PhD student.

"This increased level of resistance can also be accompanied by an increased (bacterial) growth rate," said Davis, whose findings were released here Saturday at a meeting of the American Society for Microbiology.

This latter finding is unusual, she said, because bacteria that develop resistance to an antibiotic or other antibacterial agent generally grow more slowly than bacteria that are sensitive to the agent, she explained. From a public-health standpoint, this is beneficial because when the antibacterial agent is not present, the drug-sensitive strain may grow to dominate the drug-resistant strain.

But the new research suggests that E. coli bacteria ( news - web sites) that are resistant to triclosan may continue to persist, even thrive, whether triclosan is present or not.

The results raise questions of how well triclosan may continue to work in the future, Davis said.

"Just as the antibiotics used to treat infections do not always work due to bacterial resistance, our results imply that resistance (to triclosan) could arise in a bacterial population and persist," she said.

Studies are needed to understand how these laboratory findings apply to a home environment where triclosan products are used, Davis added.

One industry representative agreed that bacterial resistance to triclosan in the lab may not reflect that occurring in the home.

"Although a few laboratory studies have found evidence of bacterial resistance under very specific experimental conditions, review of the available information leads to the conclusion that triclosan does not induce nor selects for resistance against antibiotics used for the therapy of human diseases under actual use or "real-life" conditions," according to Keith A. Hostetler, a spokesperson from Ciba Specialty Chemicals, a manufacturer of triclosan.

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Food Cos. Refine Marketing of Fats  

By David Koenig

AP Business Writer

The Associated Press

Monday, September 30, 2002

Sarah Blumenschein sees a pattern in the overweight children who come to her clinic. They snack more often and they eat out more often — especially at fast-food restaurants.

"The kids don't realize the high calorie and fat levels in fast food," said Blumenschein, a pediatric cardiologist at the University of Texas Southwestern Medical Center at Dallas. "The marketing of fast food has been very clever."

She applauds the recent announcements by McDonald's Corp. and Frito-Lay Inc. that they will reduce a particularly suspect form of fat in making french fries and chips. But she and other medical experts said the move was overdue, and they plan to keep pressing the U.S. food industry to do more to reduce fat, not just substitute one for another.

"Trans fat is a no-brainer. They should have done this a long time ago. We've known about trans fat for 30 years," said Marion Nestle, a professor of nutrition at New York University and author of "Food Politics," a critical look at the food industry's influence.

McDonald's says its fried foods will contain half as much trans fatty acids as before, while Frito-Lay plans by early next year to switch cooking oils to eliminate trans fats, which have been linked to raised levels of bad cholesterol and risk of heart disease.

Nestle expects other food companies to follow the lead of McDonald's and Frito-Lay because of a proposal by the Food and Drug Administration ( news - web sites) to require warning labels on food containing trans fats.

An FDA spokeswoman said the agency expects to issue a final rule requiring the labels early next year. Companies would likely have a year or more to comply.

"Once those labels go on, trans fats are history," Nestle said. And the fight would likely switch to overall fat levels.

The food industry's critics blame fatty snacks and fast food for an increase in obesity — 60 percent of Americans are overweight, and 300,000 die each year from related illnesses, according to the surgeon general. They say fat-rich diets have led to children developing a type of diabetes that used to be associated only with adults.

Food makers say they offer products for people who want less fat, and it's up to individuals to watch what they eat.

"There are no good foods and bad foods. It's about the totality of what you eat," said Rocco Papalia, Frito-Lay's senior vice president of technology.

Frito-Lay is also expanding its lineup of reduced-fat chips, and has hired a Dallas doctor and fitness advocate to develop nutrition and exercise messages on packages.

Walt Riker, a spokesman for McDonald's, said the chain's average customer visits only two or three times a month. He said it would be unfair to blame the restaurants if some customers are overweight.

"There are a lot of choices on the menu. ... We have salads," Riker said. "It's very basic food. It's quality food."

McDonald's had a flop with its lower-calorie McLean burger a few years ago but says fruit yogurt is a hit now. About 20 percent of Frito-Lay's sales come from pretzels and baked and reduced-fat chips, and Papalia said that could rise to one-third of sales in a few years.

John Faucher, an analyst with J.P. Morgan, said Frito-Lay would, at best, enjoy a brief increase in sales from the new lines of lower-fat chips.

"The problem is, people tell you they want healthier food," he said, "and then they go out and order a plate of cheese fries with gravy."

Both McDonald's and Frito-Lay say the timing of their decisions to reduce or eliminate trans fatty acids had nothing to do with fear of lawsuits or the FDA's proposal on labeling trans fats. They compared it to switching from animal fats to vegetable oil for cooking more than a decade ago once the health benefits became clear.

The lawsuits against McDonald's, Burger King, Wendy's and KFC have drawn a fair amount of derision from those who say fat people have only themselves to blame. The first lawsuit was filed in July by a 56-year-old, 5-foot-10, 272-pound New Yorker with a history of heart attacks, diabetes and high blood pressure.

"It's easy to argue that Caesar Barber is responsible for his own obesity. It's harder to argue that with 8- or 9-year-old kids," said John Banzhaf, a law professor at George Washington University who is advising Barber's lawyer. The lawyer's other plaintiffs are two teen-agers.

Banzhaf, an anti-tobacco crusader who is turning his gaze to the food industry, proposes requiring fast-food restaurants to post calories and fat content of menu items on the big signs above the counter. He also hints at lawsuits against schools that continue to sell soft drinks and junk food in vending machines for, in his view, failing to look out for the welfare of students.

Analysts generally don't see the lawsuits yet as a threat to the companies.

"The idea of suing McDonald's because you're obese is absolutely ridiculous. Just don't eat the stuff," said Jeff Kanter, an analyst who tracks food companies for Prudential Securities.

"I don't think this is going to be that big a deal until people stop eating chips altogether," Kanter said. "People like chips. Maybe they'll go to slightly better-for-you chips."

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Play Fair If You Play Favorites 

HealthScoutNews

Monday, September 30, 2002

MONDAY, Sept. 30 (HealthScoutNews) -- Mom may like you best, but that doesn't necessarily mean you're going to like yourself.

A favored child's self-esteem may actually suffer if the child doesn't think she deserves preferential parental treatment, says a study in the September issue of Family Psychology.

The study found that when siblings judge preferential treatment to be fair, each child is less likely to have such problems as depression and anxiety and they're more likely to have higher feelings of self-worth.

The study examined several aspects of favored treatment from parents, including being less strict with, or showing more interest or enjoyment in, one child over another. It included interviews with 135 children, about 12 years old, and their older siblings, about 15 years old.

The children were asked to rate the degree to which their parents gave preferential or equal treatment to themselves and their siblings. The children rated whether instances of preferential treatment were fair or unfair. They also filled out a self-worth questionnaire.

The children agreed that younger siblings are more likely to get more affection from their mothers and be dealt with less strictly by mothers and fathers.

The children judged 78 percent of the instances of preferential treatment to be fair. They didn't simply consider preferential treatment in their favor as fair and preferential treatment for siblings as unfair, the study notes.

"The key idea is that -- contrary to the common assumption that children and adolescents suffer when they receive poorer treatment from a parent than a sibling and thrive when they receive preferred treatment -- what's really important is whether children believe the parental treatment is fair or not," says study investigator Laurie Kramer, a professor in the department of human and community development at the University of Illinois.

"Children receiving better treatment than a sibling may have difficulties if they don't believe they are entitled to it," Kramer says.

Parents need to seriously consider how their children view the legitimacy of preferential treatment and need to make their reasoning clear to their children, Kramer says.

More information

For more about sibling interaction, go to this North Dakota State University site about sibling rivalry.

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Soy Cuts Insulin, Cholesterol in Diabetic Women 

By Suzanne Rostler

Reuters Health

Monday, September 30, 2002

NEW YORK (Reuters Health) - Older women with type 2 diabetes who take a daily soy supplement show improvements in cholesterol and insulin levels, according to preliminary study findings.

Although the women took the supplements for only 12 weeks, the finding suggests that soy may reduce the risk of cardiovascular disease, such as heart attack and stroke, in women after menopause. There were no side effects associated with the supplements, researchers report in the October issue of Diabetes Care.

While larger and longer-term studies are needed, the results offer some hope to postmenopausal women with type 2 diabetes, who are up to four times more likely to die of heart disease than their healthy peers.

Recent study findings showing that the long-term risk of hormone replacement therapy (HRT) outweighs the benefits in postmenopausal women left many wondering where to turn for help.

For women with diabetes, the findings were all the more disappointing, Vijay Jayagopal, the study's lead author and a researchers at Hull Royal Infirmary in Hull, UK, told Reuters Health. Type 2 diabetes, the most common form of the disease, typically occurs in adulthood and is often associated with obesity.

"This fall from grace of HRT makes it even more important to focus on alternatives and the use of soy or soy-derived products therefore requires more urgent scrutiny," Jayagopal said in an interview. However, it is too soon to make any recommendations, since it is not clear how much soy is needed to provide cardiovascular protection and in what form it is most effective.

To investigate whether soy protein and isoflavones affected blood glucose (sugar), insulin, and other markers of heart disease risk, the researchers assigned 32 postmenopausal women with type 2 diabetes to take a soy supplement or an inactive pill (placebo) for 12 weeks. The dose of isoflavones--the antioxidant component of soy--was greater than amounts typically consumed in Asian countries, where rates of heart disease are lower and soy is a staple in the diet.

After 2 weeks in which all women consumed their regular diet, the study volunteers switched treatments for the next 12 weeks.

The women took a daily supplement containing 30 grams of soy protein plus 132 milligrams of isoflavones.

The soy supplement was associated with an 8% reduction in fasting insulin and an improvement in long-term blood glucose control, probably through its effect on total and LDL cholesterol, Jayagopal and colleagues conclude. Total cholesterol fell by about 4% and LDL cholesterol fell by 7%, 12 weeks after taking the daily soy supplement.

Chronically elevated levels of insulin, the body's key blood sugar-regulating hormone, raise the risk of both heart disease and exacerbate the effect of diabetes.

There was no effect on weight, blood pressure, HDL ("good") cholesterol, or triglycerides, a type of blood fat associated with heart disease. Similarly, the soy supplement did not appear to influence hormonal levels such as estrogen or testosterone.

"The findings of our study certainly provide an encouraging first step in answering some of the questions and provides hope for many postmenopausal women who are at risk of cardiovascular disease and at present have very few options in the way of therapeutic intervention to reduce this risk," Jayagopal said.

Source: Diabetes Care 2002;25:1709-1714.

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Food for Thought for Obesity Experts 

HealthScoutNews

Monday, September 30, 2002

MONDAY, Sept. 30 (HealthScoutNews) -- Experts attending a symposium on the American obesity epidemic are going to have the chance to eat what they preach.

A typical menu at an academic conference might include bagels with cream cheese for breakfast, tuna sandwiches, potato chips and soda at lunch, and an afternoon snack of cookies, brownies, and doughnuts.

However, the participants at today's obesity symposium at the University of Michigan will be offered menu choices that might be called food for thought.

The menu was developed by Anita Sandretto, director of the human nutrition program at the university's School of Public Health. She wanted to offer examples of foods Americans need to eat to combat obesity.

Low-fat, high-fiber muffins will replace doughnuts. Water, juices and low-fat milk will be offered in place of soda. She did make one concession by allowing coffee and tea.

When attendees make their lunch meal choices, they'll get detailed nutritional information about their selections. Their low-fat options include grilled herbed vegetables in flat, lavash bread, and foccacia, a pizza-style crusty bread topped with grilled chicken.

Sandretto said taste was as important in selecting these meals as the health benefits.

"We always need to realize that people eat with all their senses and their psyche as well. We have to balance our waistline concerns with taste. If it tastes like cardboard, it won't be consumed, even if it has a great nutrient profile," Sandretto says.

More information

To learn more about obesity and how to control your weight, visit the U.S. National Institutes of Health.

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Playing Sick May Help People Feel Unique, Important 

By Charnicia E. Huggins

Reuters Health

Monday, September 30, 2002

NEW YORK (Reuters Health) - New research findings suggest that people who fake or exaggerate illness or injuries may do so because of the favorable attention they get by doing so.

"It appears that there may be some social and psychological advantages to being sick, above and beyond the more obvious benefits like getting gifts and being allowed to miss work or school," Dr. Jim Hamilton of the University of Alabama in Tuscaloosa told Reuters Health.

"It may be that people who present themselves as having a fascinating medical problem, or who use the sick role as an opportunity show off prized medical knowledge, may actually be getting encouragement from their family and friends," he added.

Hamilton and his colleagues investigated the psychological advantages gained by individuals who seek opportunities to occupy the "sick role" by allowing groups of students to evaluate various versions of a 2-page report about a 22-year-old patient. In each version, the patient developed abdominal pains that later became a medical emergency.

Altogether, the students had a more favorable impression of the patient when he or she was described as having sophisticated medical knowledge, rather than as someone who was indifferent or disinterested in the details of their medical condition, the investigators report. In fact, students rated the patient who exhibited medical knowledge as much more intelligent and knowledgeable overall than the disinterested patient.

This was true even though both patients were described as having similar grades, as taking mostly mathematics and business courses, and as being of the same socioeconomic status, the researchers note.

The students also had more favorable impressions of the 22-year-old when his or her symptoms were described as resulting from a rare intestinal problem, rather than from a common case of appendicitis, study findings indicate. For example, when the patient had a rare medical condition, he or she was also assumed to have higher self-esteem.

The findings will be published in an upcoming issue of the Journal of Social and Clinical Psychology.

"One implication of this research is that our results may help to understand the process by which a person develops a chronic problem of exaggerating or feigning illness," Hamilton said. "It might be that people who feel undistinguished or unappreciated discover, more or less by accident, that the sick role provides a way for him or her to feel unique and important."

However, more study is needed, according to the researcher. "The results of our research are preliminary and they need to be replicated," Hamilton said.

Source:  Journal of Social and Clinical Psychology 2002; in press.

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Movement Afoot to Yank Yuck Factor From Medicine 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Monday, September 30, 2002

MONDAY, Sept. 30 (HealthScoutNews) -- If researchers from a New Jersey company are successful, parents won't need a spoonful of sugar to help the medicine go down anymore.

Scientists from Linguagen Corp recently received a $746,000 grant from the U.S. government to develop a compound that would block the bitter taste of many over-the-counter medications.

Currently, most medications are either placed in capsules or in a sugary liquid to mask the flavor, explains lead researcher Stephen Gravina.

Linguagen scientists have already pinpointed the genes that let humans perceive bitter taste.

"Now, we're looking for ways to block [the action of the genes] at the taste bud so the taste tissue doesn't recognize the bitter taste," Gravina says.

They hope to use a naturally occurring compound to accomplish this task. The compound would bind to the bitter-tasting molecules and short circuit the signal going back to the brain.

Gravina says they expect the compound will be safe and effective, and that it will probably not need to go through the same U.S. Food and Drug Administration ( news - web sites) (FDA) approval process as medications do. Gravina believes the compound will fall into the FDA's "generally recognized as safe" category because it is natural and only a taste modifier.

If all goes well, he says the compound could be commercially available in as little as two years.

"This sounds wonderful," says Michelle Kromelis, the pharmacy manager for investigational drugs at Children's Medical Center of Dallas. "It would be a godsend for us."

"We really struggle with getting kids to keep medicines down," she explains. "If they don't like it, the spit it right back out at you." She says you can't always mask the taste of some medications, and older children actually can't stand the syrupy sweetness of some drugs.

If you can get a child to take a drug once, but they don't like the taste or the texture, it's nearly impossible to get them to take it again, she adds.

The problem isn't limited to children, however. Many AIDS ( news - web sites) drugs are so bitter that they can leave a bad taste on the tongue long after they're ingested, and patients have been known to discontinue them for that reason.

The only concern Kromelis voiced about the compound is that researchers need to ensure that it doesn't interfere with the action of the medication.

What To Do

Here are some tips on giving youngsters medications from the American Academy of Pediatrics via Kids Healthworks and from the Nemours Foundation.

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Location of Breast Tumor May Influence Prognosis 

By Peggy Peck

Reuters Health

Monday, September 30, 2002

ORLANDO (Reuters Health) - An analysis of more than 35,000 breast cancer ( news - web sites) patients enrolled in a Danish breast cancer registry suggests that women may be more likely to survive depending on where the tumor is located in the breast.

Dr. Mads Melbye of the department of epidemiology research at Statens Serum Institute in Copenhagen, Denmark found that women who have breast tumors located on the upper lateral quadrant of the breast have a 15% to 20% better survival rate than women who have medial or central lesions.

Melbye presented the study results last week at the Department of Defense ( news - web sites) Breast Cancer Research meeting here.

He said that tumor location was an independent marker for survival regardless of how advanced the tumor was or whether or not it had metastasized, or spread to other parts of the body.

"We don't really know how to explain this difference. Except that we can say this: these findings tell us that for many women we should be able to do better," Melbye said in an interview with Reuters Health.

Dr. Dennis Slamon, chief of the division of hematology-oncology at UCLA Medical Center and director of the Revlon/UCLA Women's Cancer Research Program, said this is the first time that he has seen compelling data that suggest location is a factor in survival. "But here are the numbers. They are undeniable. This is a population study with huge numbers, so this is real."

Slamon cautioned that the study "needs to be replicated in another large population study --perhaps another study from one of the Scandinavian countries--before we can start guessing at the biology behind it."

It's possible that tumors in certain locations of the breast have a better prognosis due to differences in the circulation of lymph or tumor biology, Slamon said.

Women included in the registry are less than 70 years of age and the median follow-up is 5.3 years, but 25% of the women had more than 10 years of follow-up.

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Injections Kill Breast Cancer in Mice 

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Monday, September 30, 2002

MONDAY, Sept. 30 (HealthScoutNews) -- Injections designed to spur the body's immune system to attack tumors cured breast cancer ( news - web sites) in mice, a new study says.

Researchers inoculated six mice with genetically modified dentritic cells, an important immune system component. A single injection directly into breast cancer tumors in the mice destroyed the tumor in five mice and reduced the sixth's tumor to barely discernible size.

The researchers later injected the mice with more live breast cancer cells. None of the mice developed any new tumors.

"This suggests that the treatment not only fights tumors but generates a long-lasting immune system memory, which should protect the host in the same way that anti-infection vaccines do," says Zoya R. Yurkovetsky, the study's lead researcher and a doctoral candidate in the department of molecular genetics and biochemistry at the University of Pittsburgh School of Medicine.

The study was presented at this weekend's "Era of Hope" forum in Orlando, Fla. The forum was sponsored by the U.S. Department of Defense ( news - web sites)'s Breast Cancer Research Program.

However, Dr. Jay Brooks, chief of hematology and oncology at the Ochsner Clinic Foundation in New Orleans, cautions it's too early to get overly hopeful about a cancer vaccine.

"Research like this is very exciting and very encouraging to clinicians like myself," Brooks says. "The problem is that breast cancer in mice is not the same as breast cancer is in women. To translate this work in patients is a gigantic leap of faith at this time."

Breast cancer in women is far more complex, usually developing over a long period of time and affected by a variety of factors, from genetics to environmental contributors. The mice, in contrast, had artificially induced breast cancer caused by a specific agent, Brooks says.

"There's been many cases in the past where we found drugs that were very effective in mice, but in humans they didn't hold up," Brooks adds.

Still, Yurkovetsky says, the research is another step toward the glimmering hope of a vaccine against cancer.

In the study, Yurkovetsky and her colleagues created an adenovirus that can transport genes into cells.

The added gene caused the dentritic cells to produce a protein called CD40L, Yurkovetsky says.

Dentritic cells with this protein on their surface become even more powerful immune system weapons that activate the body's disease fighting T-cells to make cytokines, or chemicals, that fight tumors, she says.

"When you place the CD40L on the dentritic cells, it increases their function, making them more powerful for fighting the tumor," she says. "It's the T-cells which actually kill the tumor cells."

The researchers plan to try similar experiments on other types of cancer tumors. They also want to see if injecting mice with the genetically altered dentritic cells will work to prevent the growth of cancer. In this study, the injection was directly into a tumor site.

In similar experiments involving colon cancer in mice, the injections significantly reduced the size of tumors but did not eradicate them, suggesting that lots more research needs to be done.

What To Do

For more information about breast cancer, including treatments and how to cope, visit the Susan G. Komen Breast Cancer Foundation, or the American Cancer Society.

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Study Shows How Alcohol May Damage Fetal Brain 

By Keith Mulvihill

Reuters Health

Monday, September 30, 2002

NEW YORK (Reuters Health) - Scientists say that they have identified two different experimental compounds that block alcohol's adverse effects on the developing brain and nervous system cells of fetuses.

The findings shed light on fetal alcohol syndrome, which occurs when a pregnant woman drinks alcohol. Fetal alcohol syndrome leads to long-term mental, developmental and behavioral problems for her offspring.

What's more, according to lead investigator Dr. Michael E. Charness of the VA Boston Healthcare system, the research could one day help scientists develop a drug that prevents fetal alcohol syndrome.

"But that would be a long way off," he told Reuters Health during an interview.

Previous research has shown that a naturally occurring compound called the L1 adhesion molecule helps bring brain and nervous system cells together during fetal development and may play an important role in fetal alcohol syndrome. Specifically, researchers have speculated that somehow alcohol blocks the action, at least in part, of the L1 adhesion molecule.

In the current study, which appears in the October issue of the Journal of Pharmacology and Experimental Therapeutics, Charness and colleagues conducted experiments with cells to see if two different drugs would block ethanol from interfering with cell adhesion.

Charness explained that his team inserted the gene that makes L1 adhesion molecule into cells that do not normally produce this substance.

The team then showed that in the absence of ethanol, the cells stuck together, while when alcohol was present they did not. Charness and his team then tested two compounds, NAP and SAL, to see if they could interrupt alcohol's effect.

"Both appear to have a potent effect on blocking the action of alcohol on L1 adhesion molecule," Charness said.

"The findings increase the likelihood that L1 adhesion molecule really is important in the target of alcohol. We have now demonstrated that with two totally different classes of drugs," he added.

"Alcohol probably produces birth defects by multiple mechanisms and its interference with the L1 adhesion molecule is believed to be just one of several that leads to birth defects," he concluded.

Source: Journal of Pharmacology and Experimental Therapeutics 2002;303:110-116.

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Statins OK For Kids 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Monday, September 30, 2002

MONDAY, Sept. 30 (HealthScoutNews) -- Statins can lower high cholesterol levels in children as effectively as they do in adults, without affecting normal growth and development.

Statin treatment reduced every measure of heart-threatening blood cholesterol and lipid levels in children, says a report in tomorrow's issue of Circulation. After 48 weeks, total cholesterol dropped by 31 percent; LDL cholesterol, the "bad" kind that clots arteries, was down 41 percent, and triglycerides dropped by 9 percent.

The study included 173 young people aged 9 to 19 in seven countries on four continents, all with a genetic condition that gives them unusually high cholesterol levels. Some were given a placebo, while others got simvistatin, marketed as Zocor by Merck, with a starting dose of 10 milligrams a day that was gradually increased to 40 milligrams a day.

"No safety issues became evident," says the journal report. "…There was no evidence of any adverse effect from simvistatin on growth and pubertal development."

That last point is an important one, says Dr. Hugh D. Allen, a professor of pediatrics and internal medicine at Ohio State University and a spokesman for the American Heart Association ( news - web sites).

"The question has been the possible impact of statin treatment on growth and puberty," Allen says. "This shows no impact on growth or puberty, and thus allows us to use these drugs in children. I have been looking for something like this."

The study will help reduce a slight sense of unease about statin therapy for young people, says Dr. Stephen R. Daniels, a professor of pediatrics at Cincinnati Children's Hospital Medical Center.

"This class of medications has been used in pediatrics for a number of years without a lot of data to back it up," he says. "This study indicates that they are as effective in children in adults, with a safety profile similar in pediatrics to that in adults. It also gives us some sense of the correct dosage to use in young patients."

Some questions remain, Allen says. "The next question is whether statin therapy will be as effective in young people who simply have elevated cholesterol, rather than familial hypercholesterolemia," he says. "That remains to be seen, but I am cautiously optimistic."

There has been concern about use of statins in young women who might become pregnant, because of a fear of possible birth defects, Daniels says. Previous studies were mostly conducted in boys, he notes. "This study was beneficial because it included girls and did not show an effect on growth and maturation," he says. "But the issue of pregnancy in adolescent females remains to be concerned about."

Treatment of high cholesterol, in adults or children, starts with dietary measures, but those are not often effective, Daniels says. The U.S. National Cholesterol Education Program recommends drug therapy when dietary changes are not effective for children aged 10 and older who have LDL cholesterol readings of 160 if they have other risk factors, such as an existing cardiovascular condition, and 190 if there are no other risk factors.

What To Do

You can get much more information about the dangers of high cholesterol in children and its treatment from the American Heart Association.

The National Library of Medicine has more on familial hypercholesterolemia.

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DES Daughters Face Higher Breast Cancer Risk: Study 

By Richard Woodman

Reuters Health

Monday, September 30, 2002

LONDON (Reuters Health) - Thousands of women whose mothers were prescribed a synthetic hormone to prevent miscarriages face more than double the normal risk of breast cancer ( news - web sites), British newspapers said on Monday.

They said that an American study of 5,000 women due to be published this week had found that those over 40 whose mothers were give diethylstilboestrol (DES) were 2.5 times more likely to develop breast cancer.

Up to 6 million women worldwide have reportedly used DES, which was promoted by several manufacturers for preventing miscarriage and preterm births. It was introduced in the 1940s, but withdrawn in 1975 after an association was reported between in utero exposure to the drug and the subsequent development of cancer of the cervix and vagina.

The Daily Mail said that the latest study, by researchers at the US National Cancer Institute ( news - web sites), followed 5,000 women who were exposed to DES and compared them with a group who were not.

Overall, the DES daughters had a 40% increased risk of breast cancer but the risk was 250% higher in a subgroup of women over 40. The findings are due to be published in the journal Cancer Causes and Control.

Britain's Department of Health said in a statement it had received a letter from DES Action UK, a group representing past users of the drug, which wants the government to set up a register of those at risk so that they can be offered screening.

DES remains available in Britain for the treatment of prostate cancer ( news - web sites) and advanced breast cancer in postmenopausal women.

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Study: Cipro Overused for Pneumonia 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Monday, September 30, 2002

MONDAY, Sept. 30 (HealthScoutNews) -- Doctors are over-prescribing Cipro and its kin when more modest treatments would be equally effective, and in the process they're exacerbating the problem of drug-resistant germs.

So say U.S. researchers who found that roughly a third of pneumonia patients are discharged from the hospital with orders for Cipro and other fluoroquinolone antibiotics, even when the strain of lung bacteria they have would succumb to penicillin-like drugs.

Ironically, the overuse doesn't appear to be making Streptococcus pneumoniae, a major cause of pneumonia, tougher to treat. But the researchers say it is having a major impact on the hardiness of several unrelated bugs, including E. coli and Pseudomonas aeruginosa, a common source of respiratory infections in people with cystic fibrosis.

At the University of California-San Francisco Medical Center, for example, the incidence of fluoroquinolone susceptible E. coli linked to bladder infections plunged from 98 percent in 1997 to 79 percent last year. "That's an enormous drop," said Joseph Guglielmo, director of the hospital's antimicrobial review program and a member of the study team.

Similarly, the share of Pseudomonas aeruginosa strains that resist the drugs climbed from just 5 percent to roughly 40 percent between 1992 and 2001. These trends hold true in other parts of the United States, too, added Guglielmo. He presented the study this weekend at the annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in San Diego.

The study analyzed treatment of more than 13,000 Americans in the hospital for pneumonia they'd picked up in the community. For most people, the strain of germ causing their infection wasn't identified. In these cases, prescribing fluoroquinolones is appropriate, the researchers said.

But in the group with successful lab tests to identify the offending organism, between 30 percent and 35 percent were sent home with a fluoroquinolone drug even though the strain of bacteria they had would have responded well to penicillin.

Dr. Dale Bratzler, principal clinical coordinator of the Oklahoma Foundation for Medical Quality in Oklahoma City, who helped conduct the study, said in these cases doctors should know better. He said specialty group guidelines support the notion of "empiric" therapy -- doing what you know will work in the absence of more evidence in cases where the cause of pneumonia is a mystery.

"But once you do know what the organism is, you should switch them to the narrowest effective drug," he said. That, he added, clearly isn't happening as often as it should.

Dr. Peter Houck, of the Centers for Medicare and Medicaid Services in Seattle and a collaborator on the research project, said there are reasons doctors choose so-called "broad spectrum" drugs like fluoroquinolones that kill a wide range of bacteria. They can be taken once a day, compared with up to four times a day for narrower-acting compounds like penicillin and amoxicillin. That's more convenient for patients. And while Cipro and its relatives are more expensive per tablet than those other drugs, it may be cheaper in the long run because administration costs are lower.

Still, Houck said, those reasons ultimately fall short. "Why use the big gun [when you don't have to], particularly when we're so concerned about the emergence of drug resistance?"

What To Do

For more on fluoroquinolones, try MEDLINEplus. For more on the problem of drug resistance, visit the World Health Organization.

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Engineered Vitamin D May Help Strengthen Bone 

By Linda Carroll

Reuters Health

Monday, September 30, 2002

NEW YORK (Reuters Health) - Researchers have discovered a modified form of vitamin D that can help stimulate bone growth, a new study shows.

The compound may lead to new treatments for the brittle bone disease osteoporosis, according to the report published in the online early edition of the Proceedings of the National Academy of Sciences ( news - web sites).

Scientists have long known that vitamin D is needed for healthy bones. But the naturally occurring form of the vitamin does not appear to play a direct role in bone formation, study co-author Hector F. DeLuca, chairman of biochemistry at the University of Wisconsin in Madison, said in an interview with Reuters Health.

DeLuca and his colleagues are studying a form of vitamin D called 2MD. "We and other groups have been modifying the molecule to get selective or improved action," he explained. "This compound is modified in three ways from the natural vitamin D hormone."

With the modifications, 2MD appears to boost bone growth by stimulating bone-building cells.

Like the skin, bone is continuously being destroyed and rebuilt. Bone-destroying cells, called osteoclasts, chew holes in bone. These cavities are then filled in by bone-forming cells, osteoblasts, using calcium as the building blocks. Up to age 30, bone-forming cells continue to work faster than bone-destroying cells. After that, osteoblasts slow down and bones start to thin.

In women, the thinning process accelerates at menopause when the ovaries stop producing estrogen.

DeLuca and his colleagues looked at the effects of 2MD on a rat model for menopause-related osteoporosis. The female rats in the study had had their ovaries removed. With no ovaries, the rats produced no estrogen.

For the new study, the researchers fed some of the rats vegetable oil with 2MD and some vegetable oil alone.

DeLuca and his colleagues measured the rats' bone density at the beginning of the study, at 13 weeks and at 23 weeks. At the end of the study, rats fed oil and 2MD had 9% more bone than those fed oil alone, DeLuca said.

The researchers also tested 2MD on human bone cells in the test tube. Once again they found that the vitamin led to bone growth.

The Wisconsin researchers aren't sure exactly how 2MD works. But DeLuca said the vitamin appears to affect both osteoclasts and osteoblasts. "It just seems to stimulate bone synthesis more," he said. "We're very excited about it as a potential therapy for bone-loss diseases."

The study was supported by the Wisconsin Alumni Research Foundation, Deltanoid Pharmaceuticals and the National Institutes of Health ( news - web sites).

Source: Proceedings of the National Academy of Sciences Early Edition 2002;10.1073/pnas.202471299.

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Inhaled Steroids Cut Asthma Hospitalizations 

HealthScoutNews

Monday, September 30, 2002

MONDAY, Sept. 30 (HealthScoutNews) -- People with asthma who regularly use inhaled steroids reduce their hospital admissions for severe attacks by almost a third, says a new Canadian study in the journal Thorax.

Most previous research has focused on the short-term results of inhalers to prevent asthma attacks. However, this study looked at data collected over 22 years.

Researchers analyzed Saskatchewan provincial health insurance records for 30,569 people with asthma, aged 5 to 44 years, between 1975 and 1991.

That analysis included 3,894 hospital admissions and 1,886 re-admissions for asthma. About 42 in every 1,000 of the study subjects with asthma were admitted to hospital each year. However, the study found that regular use of inhaled steroids reduced overall hospital admission rates by 31 percent and re-admission rates by 39 percent.

The study authors calculated that for every 1,000 people with asthma, consistent use of inhalers could prevent five admissions and 27 re-admissions to hospital each year.

More information

There's more about asthma at the American Lung Association.

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Natural Radiation May Affect DNA 

By Merritt McKinney

Reuters Health

Monday, September 30, 2002

NEW YORK (Reuters Health) - Concerns about the harmful effects of radiation tend to focus on man-made sources, such as nuclear power plants and weapons, but scientists report that exposure to high levels of naturally occurring radiation can cause mutations in the genetic material DNA.

The findings do not mean that people living in places with naturally high radiation levels need to start packing; there is no conclusive evidence that they are at higher risk of cancer and other health problems. But the findings do suggest that it may be a good idea to reconsider limits for workers exposed to radiation, one of the study's authors, Dr. Peter Forster of the University of Cambridge in the UK, told Reuters Health.

Given that the naturally occurring radiation in a region in south India--10 times what is considered normal--produced a "measurable increase in hereditary DNA mutations," Forster said that "it might be sensible to reconsider legal safety limits for workers of reproductive age," which are currently allowed to be 50 times higher than normal radiation levels.

But Forster emphasized that his study and several recently published studies on the long-term effects of the Chernobyl disaster are the first in this field, so "more research is needed to obtain quantitative conclusions."

Everyone is exposed to radiation in the environment, but the amount varies from place to place. Along the coast of India, a small area in the state of Kerala has the highest level of natural radiation in a densely populated place. Because of a 10 kilometer by 1 kilometer strip of the radioactive mineral monazite, the radiation level in this area is about 10 times higher than the worldwide average.

Radiation is linked to cancer and chromosome damage, but its effects on the DNA sequence are less clear. To see whether high levels of natural radiation can trigger changes in DNA, Forster and his colleagues studied 988 Kerala residents from 248 families, including some that lived in the high-radiation area and others that lived in a low-radiation part of the state. They screened the participants for changes in mitochondrial DNA, a type of DNA that is passed on by the mother.

The researchers detected 22 mutations in the DNA sequences of high-radiation families but just a single mutation in the low-radiation families. The mutations tended to be located in DNA regions that are known as "evolutionary hot spots" because they undergo mutations more often than other areas. However, none of the mutations became "fixed" in later descendants, according to a report on the findings in the online early edition of the journal Proceedings of the National Academy of Sciences ( news - web sites).

Based on previous studies, there is no conclusive evidence that residents of this part of India are at increased risk of birth defects or another abnormalities because of radiation exposure, the report indicates.

But besides highlighting the need to take a second look at current radiation standards, the study could have implications for scientists who rely on genetic information to study prehistoric humans, according to Forster.

"Even the natural range of radiation encountered by humans is sufficient to influence the molecular clock with which geneticists date human genetic prehistory," Forster said. For example, he noted that this molecular clock is used to date the initial settlement of the continents, human migrations as well as prehistoric mutations that protect against diseases, such as malaria and HIV ( news - web sites).

In the future, according to Forster, "geneticists will have to check whether their age estimates might be skewed by differing levels of ionizing radiation."

Source: Proceedings of the National Academy of Sciences Early Edition 2002;10.1073/pnas.202400499.

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Belly Size Better Gauge of Heart Risk Than Obesity 

Reuters Health

Monday, September 30, 2002

NEW YORK (Reuters Health) - Although obesity is a risk factor for heart disease, the place where a person stores his or her excess weight may be a more important variable, two new studies suggest.

According to Italian researches, men with a "beer belly," known medically as central obesity, maybe more likely to develop high blood pressure than their peers who store their weight in other areas. Their study found that this pattern of weight gain was associated with elevated blood pressure regardless of body mass index (BMI) and insulin resistance, a condition in which a person loses his or her ability to respond to this key blood sugar-regulating hormone. BMI is a measure of weight in relation to height used to gauge obesity.

The findings may help to explain the link between obesity and metabolic syndrome, a cluster of conditions that include high blood pressure, cholesterol and insulin levels. Left untreated, the syndrome, also called insulin resistance syndrome or syndrome X, can progress to diabetes and heart disease.

"These results provide supportive evidence for the need to reduce overweight and ameliorate insulin sensitivity, both by caloric restriction and by increased physical exercise," Dr. Alfonso Siani from the National Research Council ( news - web sites) in Avellino, Italy, and colleagues write.

Their study included more than 700 men aged 25 to 75 who were not taking blood pressure-lowering medication. The researchers measured blood glucose and insulin levels after an overnight fast, calculated BMI and took three different blood pressure readings. Abdominal circumference, a marker of central obesity, was determined by measuring the waist in relation to the hips.

Blood pressure rose in tandem with BMI, age, and higher waist-to-hip ratios, report researchers in the September issue of the American Journal of Hypertension. Blood pressure was also associated with higher insulin levels after subjects consumed a sugar-filled drink.

"In middle-aged men, a central distribution of body fat is associated with increased blood pressure, independently of body mass index and insulin resistance, thus suggesting a key role of central adiposity in the full expression of the 'metabolic syndrome,"' the researchers conclude.

The findings are supported by the results of a second study published in the October issue of the American Journal of Clinical Nutrition ( news - web sites). In this report, researchers assessed the relationship between waist circumference and heart disease risk factors associated with obesity in more than 9,000 adults.

Waist circumference was found to be a more sensitive measure of heart disease risk factors than BMI, as it more closely correlated with elevated LDL ("bad") cholesterol, high blood pressure, elevated blood glucose (sugar) and lower levels of HDL ("good") cholesterol.

"Waist circumference...may be a stronger predictor than BMI for the identification of metabolic and cardiovascular disease-associated risk factors," Dr. Steven B. Heymsfield from Columbia University in New York City and colleagues conclude.

Source:  American Journal of Hypertension 2002;15:780-786; American Journal of Clinical Nutrition 2002;76:743-749.

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Blood Pressures Similar for Africans, U.S. Blacks 

By Peggy Peck

Reuters Health

Monday, September 30, 2002

ORLANDO (Reuters Health) - New research from an international team of epidemiologists has found that Africans living in Ghana and Uganda are just as likely to have high blood pressure as blacks living in the United States.

"Our findings suggest that there is more to hypertension in African-Americans than soul food and obesity," lead author Dr. Kevin J. Keen of Case Western Reserve University School of Medicine in Cleveland, Ohio, told Reuters Health. "Hypertension is an African phenomenon. The rate of high blood pressure among African populations is higher than rates in white Americans, even though people in Ghana and Uganda are less likely to be overweight than either white or black Americans."

He said that while African Americans tended to be heavier than their Ghanaian and Ugandan counterparts, "their systolic and diastolic blood pressures are similar." And he added that although African-American women generally have a higher body mass index (BMI) than white women in the US, there is no difference in the obesity rate between Caucasian men and African-American men, yet "African Americans are more likely to have hypertension." BMI is a measure of weight in relation to height used to gauge obesity.

Keen presented the research here Friday at the American Heart Association ( news - web sites)'s annual conference on hypertension research.

He and his colleagues analyzed data collected from surveys of 496 residents of Uganda, 4,733 residents of Ghana, and the Institutes of Health survey of 39,695 Americans (NHANES III) that included 4,508 African Americans. The data from Uganda was collected in 1999, the Ghana data was collected in 1988, and the US data comes from a 1988-1994 survey.

In general, Africans who live in urban areas are more likely to "be overweight and to exercise less than Africans living in rural areas. This impact of urban versus rural is bad for both men and women, but is more apparent among men. We think this reflects lower levels of daily physical exercise."

When Keen compared African populations to white and Hispanic Americans, he found there "was a higher prevalence of hypertension among Africans at every BMI compared to BMI-matched Caucasian and Mexican Americans."

Other research has indicated that an expanding waistline or "spare tire" is a marker for high blood pressure and Keen said the new research confirms this observation. "Regardless of race, blood pressure goes up with waist size," he said.

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Gum Disease May Harm the Heart, Too 

By Jacqueline Stenson

Reuters Health

Monday, September 30, 2002

SAN DIEGO (Reuters Health) - Gum disease may spell more than torturous hours in the dentist's chair.

The bacteria that cause it can travel through the bloodstream to the heart and contribute to artery-clogging plaque build-up, according to the results of a study in animals.

Researchers have observed that people with gum disease seem to also be at risk of heart disease. But the new findings offer "proof of the hypothesis" that the Porphyromonas gingivalis bacterium can actually migrate from the mouth to the heart and cause inflammation in arteries that promotes atherosclerosis, said study author Dr. Caroline Genco, an associate professor of medicine at Boston University in Massachusetts.

"These data demonstrate that there is a direct impact of the chronic oral disease periodontitis on the development and acceleration of cardiovascular disease," she told Reuters Health.

Gum disease often rears its head when people hit their 40s, but infection with P. gingivalis can occur decades earlier. Combined with years of inadequate oral hygiene, infection can result in gingivitis, an early form of gum disease characterized by red, swollen gums that often bleed easily. This form of the disease can usually be reversed with more careful brushing and flossing. But as the more aggressive periodontitis develops, the gums and bone surrounding the teeth can become seriouslydamaged, and teeth may loosen or fall out. Treatment with antibiotics can help prevent some of this destruction.

At a meeting of the American Society for Microbiology here Saturday, Genco presented results of a study in which mice bred to have a high risk of heart disease were orally infected with P. gingivalis or a mutant strain of the bacterium not linked to gum disease and then followed for 17 weeks.

While both types of bacteria were able to get into the bloodstream and travel to the heart, only P. gingivalis caused significant damage to bone in the mouth as well as inflammation in heart arteries that contributed to substantial plaque build-up, Genco reported. What's more, vaccination against P. gingivalis helped prevent atherosclerosis in a group of mice exposed to the bacteria.

A vaccine against P. gingivalis is not available for people, though researchers are working to develop one. Such a vaccine could possibly help reduce the incidence of heart disease, Genco said.

In addition, a multi-center study that began earlier this year is seeking to determine whether treating gum disease with antibiotics will help stave off heart disease, she noted.

For now, though, the new findings offer more reason to brush and floss diligently, according to Genco. "It is very important to practice good oral hygiene and to see a dentist regularly, especially if you have other risk factors for heart disease," she said.

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Bacteria Common in Foods, but Few Drug Resistant 

By Jacqueline Stenson

Reuters Health

Monday, September 30, 2002

SAN DIEGO (Reuters Health) - While many grocery store items may harbor enterococci bacteria, the presence of these microbes in the food supply does not pose a significant health threat to most people, according to a researcher from the US Department of Agriculture (USDA).

"Unless you're really, really sick, the enterococci is not going to harm you," said Dr. Charlene Hudson, a microbiologist at the USDA's Antimicrobial Resistance Research Unit in Athens, Georgia. "People generally don't get sick from eating enterococci in foods."

Particularly encouraging, she said, is that a new analysis of common food products did not find any strains of the bacterium that are resistant to the antibiotic of last resort in treating it--vancomycin. Vancomycin-resistant enterococci are a growing concern in hospitals, where they can be spread from patient to patient, possibly killing them.

"We were happy there was no vancomycin resistance," Hudson told Reuters Health.

Enterococci are commonly found in the gastrointestinal tracts of people and animals.

Experts have been concerned that the use of antibiotics in animals could contribute to the development of resistant strains of bacteria that are then passed on to people through consumption of meat or fruits and vegetables that are exposed to the bacteria in soil that is contaminated, often by animal excrement. There are also worries that harmful strains of bacteria might get into the food supply in other ways, for example through food handlers.

In the new study, Hudson and colleagues examined 19 different types of meats, vegetables and fruits purchased in six grocery stores in Georgia to see if the foods harbored enterococci, and if so, which strains.

Fifty-five percent of the food samples, or 186 out of 337, contained enterococci, Hudson reported Friday at a meeting of the American Society for Microbiology. Potatoes were most likely to carry the bacteria, which were also frequently found in chicken, beef, turkey and pork.

While most of the enterococci strains were resistant to the antibiotics bacitracin and lincomycin, few were resistant to newer antibiotics such as linezolid and nitrofurantoin. None was resistant to vancomycin.

In addition, Hudson noted, not many of the foods sampled contained other bacteria, including Salmonella, Campylobacter or E. coli, all of which can cause serious illness.

"This study is, to us, good news," she said.

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Blood Sugar Control May Be Linked to Birth Weight 

By Suzanne Rostler

Reuters Health

Monday, September 30, 2002

NEW YORK (Reuters Health) - Babies born weighing less than 5.5 pounds (2.5 kilograms) have a more difficult time processing glucose in their bodies than infants born at normal weight, a new study has found. This could put them at risk for a host of chronic disorders in adulthood.

Birth weight, which is influenced by the gestational age, is thought to reflect how well the baby was nourished in the womb. Low birth weight may be a risk factor for obesity, high blood pressure, diabetes and high cholesterol, among other conditions.

Glucose tolerance refers to how well the body is able to use sugar from food as energy. To investigate whether birth weight and gestational age might have an effect on glucose tolerance, the researchers studied 100 newborns weighing less than 5.5 pounds or born premature (before 38 weeks gestation). Blood sugar and insulin levels were measured before and after the babies were fed milk.

The study, published in the September issue of The Journal of Clinical Endocrinology & Metabolism, shows that higher birth weight correlated with better glucose tolerance regardless of gestational age.

Smaller infants and those who were the most sensitive to insulin, the key blood-sugar regulating hormone, also grew the fastest in the first days of life, a phenomenon known as "catch-up growth." The researchers cite at least one study showing that catch-up growth was associated with higher body mass index (BMI) in 5-year-olds and suggest that the phenomenon may be one mechanism by which low birth weight increases the risk of obesity and the chronic disorders associated with obesity.

The findings, the authors conclude, support the idea that the environment of the womb has a strong influence on a newborn's metabolism, an influence that could extend into childhood and even adulthood.

In an interview with Reuters Health, Dr. Nigel J. Crowther, the study's lead author, explained that low birth weight babies who become obese adults have one of the highest risks of developing type 2 diabetes and heart disease.

"Dietary intake for low birth weight children should not be in a form that leads to excessive weight gain in the form of fat. In other words, do not feed your children McDonald's and Coke because you think they are too thin," said Crowther, from the University of the Witwatersrand in Johannesburg, South Africa. "Follow a healthy diet that does not contain lots of fat and refined carbohydrate."

In other findings, babies born to mothers taking medication to control their blood pressure during pregnancy were also smaller and tended to secrete more insulin after eating, compared with their peers born to mothers who were not taking medication. Overall, 50% of the infants in the study were born to mothers taking blood pressure medication.

Source: The Journal of Clinical Endocrinology & Metabolism 2002;87:4252-4256.

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Grandparent Contact May Help Kids Adjust to Divorce 

By Charnicia E. Huggins

Reuters Health

Monday, September 30, 2002

NEW YORK (Reuters Health) - Children may be better able to adjust to their parents' divorce and remarriage if they stay in contact with their maternal grandparents, according to recent study findings.

"We know from decades of research on children's development that they benefit from stable and loving environments," study author Dr. Kirby Deater-Deckard of the University of Oregon in Eugene told Reuters Health. "It's important to remind ourselves that grandparents are an important part of the equation."

Deater-Deckard and his colleagues investigated children's closeness to grandparents after parental divorce and remarriage in a study of 155 British children and their parents.

Children who lived either with their biological mothers or with both biological parents were more likely to be in contact with their grandparents--particularly their maternal grandparents--than children who lived with stepparents, the investigators report in the September issue of the Journal of Family Psychology.

Overall, however, most children said they were close to their grandparents, and this closeness was associated with better adjustment to their parents' divorce and remarriage, the report indicates.

For example, among children who lived with both biological parents, or with biological mothers and stepfathers, closeness to maternal grandparents was associated with lower levels of anxiety, aggression and other internalizing and externalizing problems.

In some cases, however the closeness between grandchildren and grandparents may not have had such positive effects.

Children who lived with their stepmother and a biological father, for example, had more problems adjusting to their parents' divorce and remarriage if they maintained contact with both their maternal and stepmaternal grandparents, study findings indicate.

What's more, children who lived with single mothers had better adjustment if they were close to their maternal grandparents, but had more emotional and behavioral problems if they remained in close contact with their paternal grandparents.

In general, children's closeness with their maternal grandparents was related to higher levels of adjustment, while their closeness with their paternal grandparents was usually either unrelated to their adjustment or was related to poorer adjustment, the researchers note.

However, Deater-Deckard and his colleagues were unable to determine whether the children's closeness to their grandparents protected them from emotional or behavioral problems or if they were already well-adjusted children who were able to "elicit or facilitate closeness with grandparents," they write.

In addition, because the study involved only white families, it is not known if the findings extend to other cultural groups in which multigenerational households are common or divorce is rare.

Still, in light of the findings, "grandparents play an very important role as children and their parents navigate through the changes and challenges that arise following parental divorce and remarriage," Deater-Deckard said.

"When they can do it, the adults--parent and grandparents--who are affected by a divorce or remarriage, should strive to maintain and nurture this special relationship between children and their grandparents," he added.

Source: Journal of Family Psychology 2002;16:363-376.

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Key to Possible Carcinogen In Starchy Foods May Be Heat
Chemical Reaction Suspected in Potato Chips, French Fries

By Lauran Neergaard
The Associated Press
Monday, September 30, 2002

Scientists have found a clue to the chemical reaction that may cause potato chips, french fries and other fried or baked starchy foods to build up high levels of a possible cancer-causing substance.

The suspect is asparagine, a naturally occurring amino acid that, when heated with certain sugars such as glucose, leads to the formation of the worrisome substance acrylamide.

The Food and Drug Administration has made studying acrylamide's risk and determining how to lower its levels in food two of its highest research priorities, according to a plan that agency officials were to discuss today with consumer groups and food manufacturers.

Canada's government made the discovery about the chemical reaction and has ordered food manufacturers to look for ways to alter it and thus lower levels of acrylamide in food. Cincinnati-based manufacturer Procter & Gamble Co. says its scientists, too, have found the asparagine connection.

It is the first clue to emerge in the mystery of acrylamide since Swedish scientists announced that high levels of the possible carcinogen are in numerous everyday foods: french fries, potato chips, some types of breakfast cereals and breads -- plenty of high-carbohydrate foods that are fried or baked at high temperatures. The chemical was not found in boiled foods, which are cooked at lower temperatures.

Sweden's findings were confirmed in June by the governments of Norway, Britain and Switzerland, and preliminary testing of several hundred foods by the FDA suggests U.S. foods contain similar acrylamide levels, said Richard Canady, who is directing the agency's assessment of acrylamide's risk.

Acrylamide is used to produce plastics and dyes and to purify drinking water. Although traces have been found in water, no one expected high levels to be in basic foods.

It causes cancer in test animals, but it has not been shown to do so in people. Still, Swedish scientists have said the levels are high enough that foodborne acrylamide might be responsible for several hundred cases of cancer in that country each year.

In the United States, the FDA has been careful to caution that acrylamide is only a suspected carcinogen. The FDA has not yet advised consumers to alter their diets to avoid it.

Still uncertain is whether the FDA, once it finishes testing different foods next year, will publicly identify which brands contain the most acrylamide -- information that consumer advocates want.

For now, Canady said, "We want to reinforce . . . eating a balanced diet with plenty of fruits and vegetables. That's the best way to ensure that you're getting adequate nutrition."

The FDA has an impressive research plan but "should give the public better advice," said Michael Jacobsen of the consumer group Center for Science in the Public Interest.

"People should be consuming [fewer] french fries and potato chips for other reasons -- the salt, the calories, the fat -- and the government should have been urging that, anyway. Here's yet another reason," he said.

The food industry stresses that although fried potato products are getting most of the bad publicity -- most testing shows the highest levels in them -- acrylamide is in a variety of foods. Procter & Gamble said Friday that its testing found acrylamide in such previously unimplicated foods as roasted asparagus and banana chips.

"The other aspect people need to look at is while a french fry or a potato chip may be high . . . in concentration, it still comes down to what is the total contribution of that food to the diet," said Henry Chin of the National Food Processors Association.

Asparagine is in lots of vegetables, Chin noted.

Regardless, the asparagine clue is encouraging, Chin and Jacobsen said.

Different varieties of potatoes contain different levels of both asparagine and glucose. That might explain varying acrylamide levels among different brands; levels in french fries, for instance, vary widely among fast-food restaurants. Pick a different potato, and a brand's acrylamide level might drop.

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On Ecstasy, Consensus Is Elusive
Study Suggesting Risk of Brain Damage Questioned by Critics of Methodology

By Rick Weiss
Washington Post Staff Writer

The Washington Post
Monday, September 30, 2002

New research has escalated a decades-old scientific and political battle over the risks inherent in the popular street drug known as Ecstasy.

A synthetic chemical cousin of "speed," Ecstasy already had a rap sheet as long as its chemical name: 3,4-methylenedioxymethamphetamine, or MDMA. Studies in animals have suggested it may be toxic to brain cells that help regulate mood. It's been linked to memory impairment in some users. And rarely the drug triggers a mysterious reaction in which the body becomes radically overheated, causing sudden death.

If that weren't enough to make potential users think twice, Ecstasy is highly illegal. The Drug Enforcement Administration (DEA) has placed it in its most restrictive "schedule 1" category, meaning it has no medical value and carries serious risks.

Last week, researchers added to the agony of Ecstasy by reporting in the Sept. 27 issue of Science that, in monkeys, at least, even one night's indulgence in the drug may increase the odds of getting Parkinson's disease. Yet despite all the evidence against it, Ecstasy's popularity has only grown in recent years, with about 10 percent of U.S. high school students saying they've tried it in the past 12 months. That pattern is testimony to the profound sense of peace and open-heartedness that Ecstasy users say the drug delivers. But it is also the result of a deep distrust of the evidence of Ecstasy's harm -- not only by youthful partygoers but also by a cadre of scientists and others who have been arguing with increasing fervor that much of the work, including the latest study, is flawed.

A close look at the evidence presented by both sides shows how difficult it can be to judge the long-term significance of drug-induced changes in the brain.

Ecstasy produces its pleasurable effects largely by making neurons secrete massive amounts of serotonin, the same chemical that is the target of some antidepressants. Studies in monkeys -- and less definitive studies in people -- have suggested that Ecstasy can damage the tiny branching fibers that allow those neurons to communicate with nearby cells, perhaps permanently.

George Ricaurte, a Johns Hopkins University neurologist who has led many Ecstasy studies, said the evidence is overwhelming that the drug is dangerous. "My belief and the belief of the vast majority of others is that the [serotonin-producing] nerve endings are destroyed by the drug. It is a pruning, if you will."

Others, however, strongly disagree. They say results in animals have varied so much from species to species -- and the doses given the animals have been so high -- that extrapolation to humans is unreliable. Moreover, they say, human studies have rarely controlled for concomitant use of other drugs (some scientists think the small memory decline seen in some Ecstasy studies is actually due to participants' use of marijuana). And the few human brain scan studies that have been published used old and untrustworthy imaging technology.

"In my opinion . . . these studies are so flawed in terms of the technology used that one cannot derive any conclusion from them at all," said Stephen Kish, another leading Ecstasy researcher and chief of the human neurochemical pathology laboratory at the Center for Addiction and Mental Health in Toronto.

The newest study, led by Ricaurte and involving monkeys and baboons, sought to more closely mimic human Ecstasy use by giving three consecutive doses of the drug at three-hour intervals -- as if the animals were at an all-night "rave." In contrast to previous human studies, brain scans found evidence of damage not only to serotonin neurons but also to neurons that produce dopamine.

Dopamine levels were down about 65 percent six weeks after the test. If those reductions are permanent, Ricaurte said, users may be vulnerable to early-onset Parkinson's (which is caused by reductions of about 90 percent) when levels drop further as a natural result of aging. "The margin of safety for MDMA appears to be extremely small, if present at all," he said.

Alan Leshner, former director of the National Institute on Drug Abuse (NIDA) and chief executive of the American Association for the Advancement of Science, which publishes Science, agreed. "This says even a single evening's use is playing Russian roulette with your own brain," he said.

Critics, however, noted that the drug was given in human-equivalent doses but was injected into the animals, a route that Ricaurte himself has shown to be twice as potent as taking the drug orally. Adding to evidence that the test involved overdoses, two of the 10 animals in the experiment died quickly after their second or third dose and two others became so sick they could not take the third dose.

"How come 40 percent of people who are doing this drug are not dying or almost dying?" asked Rick Doblin, president of the Multidisciplinary Association for Psychedelic Studies, a Sarasota-based organization that funds research on therapeutic uses of mind-altering drugs.

Several experts said Parkinson's symptoms have never been associated with Ecstasy users -- even those who have been taking it regularly for years. Some called the new work the latest in a string of biased studies sponsored by the federal government.

Federally funded research on Ecstasy is "an egregious example of the politicization of science," said Charles Grob, a neuropsychiatrist at the University of California at Los Angeles School of Medicine, in testimony last year before the U.S. Sentencing Commission. "Much of the NIDA-promoted research record . . . suffers from serious flaws in methodological design, questionable manipulation of data, and misleading and deceptive reporting in the professional literature and to the media."

Kish of Toronto said the one serious risk clearly linked to Ecstasy is "malignant hyperthermia," an unpredictable onset of high fever and sudden death. He said New York, a city estimated to have thousands of users, experiences about one death a year linked to Ecstasy by itself and about seven a year involving Ecstasy with other drugs. Leshner's Russian roulette analogy only makes sense, he said, if one imagines a gun with one bullet and "thousands and thousands and thousands of chambers."

To be sure, Kish said, that risk is not zero and needs to be taken seriously. And the picture could get worse when definitive human brain imaging studies are completed in the next year or so. New, high-tech equipment being used in those studies should settle the question of neuronal damage.

But if the results amount to something less than an indictment, then scientists will have to consider whether the potential psychological benefits might in some cases be worth the risks. That will require a new batch of studies, looking not for damage but for evidence of healing.

Last fall, the Food and Drug Administration gave the green light to the first such study, which would test Ecstasy's usefulness as an adjunct to therapy for people with post-traumatic stress disorder as a result of sexual or other violent assaults.

That study, sponsored by Doblin's organization and set to take place in Charleston, S.C., is awaiting approval by the DEA.

Marsha Rosenbaum, a director at the New York-based Drug Policy Alliance, warned that anti-drug advocates could harm their own cause by just saying no to the possibility that some illicit drugs might be therapeutic.

"Like everyone, young people stop trusting you when you bend the truth to scare them," Rosenbaum said in a statement. "Good science, not misguided fear, is what helps us talk honestly and effectively with our teenagers about drug use and their safety."

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SUNDAY, OCTOBER 29, 2002

Proper Shoes Keep Your Kids' Feet Fit 

HealthScoutNews

Sunday, September 29, 2002

SUNDAY, Sept. 29 (HealthScoutNews) -- When buying shoes for your children, don't sacrifice proper fit and support for trendy styles.

Bunions, corns, calluses and hammertoes are among the foot problems caused by poor-fitting shoes, says the American Academy of Orthopaedic Surgeons (AAOS). Many foot problems experienced by adults begin with ill-fitting shoes they wore when they were children.

"Shoes should conform to the shape of the feet with plenty of room for toes to wiggle, and should fit well in the heel. Your child's feet should never be forced to conform to the shape of a pair of shoes. There is no 'breaking-in' period either; if they are not comfortable, don't buy them," says Dr. Vernon T. Tolo, AAOS president.

Here are some other shoe buying tips from the AAOS:

·         Shoes should be soft and pliable with enough length in the toe box for growth and enough width for the toes to wiggle. There should be a thumb's width space between toes and the end of the shoe. The shoe should bend at the ball of the foot, not the middle.

  • Get your children's feet measured every time you buy them shoes. When their feet are being measured, children should stand and place their full weight on their feet. Both feet should be measured and you should choose a shoe that fits the bigger foot.
  • Don't buy shoes that are tight. They can damage your children's feet.
  • When trying on shoes, children should wear their normal socks and walk around in both shoes.
  • Check the fit of the heels as well as the toes, and feel the inside of the shoe for rough spots, glue, staples and other things that can cause foot irritation.
  • For girls who want a high heel or platform shoe, choose a 1- to 2-inch chunky heel on shoes that have padded insoles and toe wiggle room. Limit the amount of time children wear such shoes. They should be alternated with flat-heeled shoes for part of the day.

More information

You can find out more about proper shoe fitting at the AAOS.

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Low, low blood pressure heals heart  

By Peggy Peck
UPI Science News
From the Science & Technology Desk
United Press International

Sunday, September 29, 2002

ORLANDO, Fla., Sept. 29 (UPI) -- Blood pressure experts say new research suggests doctors need to target lower goals for blood pressure to reverse heart damage caused by hypertension.

The lower-is-better approach to blood pressure treatment has been bandied about by physicians for years but recently several studies have provided evidence that only aggressive approaches to blood pressure lowering are really effective.

One such study, from a team of Japanese researchers, reinforces this growing sentiment, said Ernesto Schiffrin, who served as program chair at the recent American Heart Association's 56th Annual Conference on High Blood Pressure Research.

Atsuhiro Ichihara, of Keio University School of Medicine in Tokyo, said his study of 142 patients with high blood pressure or hypertension has convinced him the target for blood pressure treatment should be a pressure of less than 130/85 milligrams of mercury. Most physicians attempt to get blood pressure below 140/90 mmHg, the level designated as high blood pressure by the AHA and the National Heart Lung and Blood Institute.

Ichihara's study attempted to find out if lowering blood pressure could reverse or ease one of its dangerous effects -- stiffening of the arteries. He measured an indicator of arterial stiffness called pulse wave velocity or PWV. This measures, in centimeters per second, how fast blood rushes between the brachial artery in the arm and the tibial artery in the ankle.

As the PWV increases, arteries stiffen. When the blood slows, the walls relax.

He randomized half of 142 high blood pressure patients to a group in which the goal was a pressure below 130/85 and the other half to a group with the standard treatment goal of blood pressure less than 140/90.

After 12 months, patients who had the lower blood pressure goal had an average PWV decline from 1,779 cm/sec to 1,621 cm/sec.

"Healthy people with normal blood pressure have PWV in the 1,600 cm/sec range," Ichihara said. But patients in the normal treatment group had no difference in PWV. These patients, however, also had achieved very healthy blood pressures averaging 129/78 mmHg.

While physicians are moving toward general agreement about the need for aggressive lowering of blood pressure in people with hypertension, it is not so clear if they think healthy people need to take a few points off their blood pressure readings.

Schiffrin said he thinks it may be two different situations. People with a history of high blood pressure have "already damaged their blood vessels, so normal may be different for these people."

He said to "get back what one has damaged, it may require some extra help" such as really low blood pressure.

Schiffrin also said he believes the medical community is moving toward resetting blood pressure goals and he expects those changes to become official by late next year.

Blood pressure recommendations are made by a quasi-governmental body called the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure or JNC. It has reworked the blood pressure guidelines six times in the past 20 years, each time redefining normal blood pressure by lowering the recommended blood pressure.

Schiffrin said the JNC is expected to huddle early in 2003 to begin considering new recommendations, which he predicted would be issued by late next year. Before the JNC makes it recommendations, however, another group of blood pressure researchers will announce results of the largest blood pressure study to date -- a study most researchers think will not only provide a definite answer to the "how low should we go" question but also will name the type of drug effective at getting patients to that goal.

The massive study -- which is called the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial or ALLHAT -- enrolled more than 42,000 patients. Results of the study are expected in December.

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Massive Prostate Cancer Trial 

HealthScoutNews

Sunday, September 29, 2002

SUNDAY, Sept. 29 (HealthScoutNews) -- The Cancer Care Center at Advocate Lutheran General Hospital in Park Ridge, Ill. is seeking volunteers to be part of the largest-ever prostate cancer ( news - web sites) prevention clinical trial.

The international trial is called SELECT - Selenium and Vitamin E Cancer Prevention Trial. It's sponsored by the National Cancer Institute ( news - web sites) and will examine whether either vitamin E or selenium protects against prostate cancer. It's the second most common kind of cancer in men.

Previous research suggests selenium and vitamin E may reduce prostate cancer risk by 60 and 30 percent, respectively.

Advocate Lutheran General Hospital is one of the research sites across the United States, Canada and Puerto Rico that will enroll 32,000 men for SELECT. There are 13,951 men currently enrolled and the remainder of participants will be signed up over the next four years.

Healthy men aged 55 and older (50 and older for higher-risk black men) are eligible for the study.

Study participants will be followed for seven to 12 years, depending on when they enter the trial. They'll be assigned to one of four groups. One group will receive 200 micrograms of selenium daily, plus a placebo that looks like vitamin E. Another group will receive 400 milligrams of vitamin E daily, along with a placebo that looks like selenium. A third group will receive both selenium and vitamin E. The fourth group will receive two placebos.

The men will not have to change their diets, but they'll be required to stop taking any supplements they buy themselves that contain vitamin E or selenium.

If you'd like to join the study at Advocate Lutheran General Hospital, phone the clinical research department at 847-723-8252.

More information

For more information about SELECT, go to the National Cancer Institute.

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SATURDAY, SEPTEMBER 28, 2002

Help for the Housebound a Boon to Their Health 

HealthScoutNews

Saturday, September 28, 2002

SATURDAY, Sept. 28 (HealthScoutNews) -- Social care services provide a self-esteem and morale boost to housebound senior citizens, even when elderly people say they don't need such services and don't welcome them, a new British report says.

Researchers with the Growing Older program, funded by the Economic and Social Research Council, suggest that care services managers act as quickly as possible to provide help to elderly people who have recently experienced a loss of autonomy due to poor health or a fall or other kind of accident.

The targeting of home care services for people most in need has improved during the last 10 years, but some older, frail people still live alone with little or no help. Some newly housebound people find it difficult to welcome any kind of help and they're not always the best judges of their immediate needs, the researchers say.

They found that over a six-month period, housebound older people who received services had higher self-esteem than those who didn't get the services, which include such things as having a home help or care assistant, attending a day center, or moving to sheltered housing.

The study included 35 people (26 women, nine men) aged 75 and older who lived alone and had developed a physical disability within the previous three months that prevented them from going out of their home without help.

More information

To learn how to get more out of life in your later years, visit the National Institute on Aging.

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