FRIDAY, OCTOBER 11, 2002

FRIDAY, OCTOBER 11, 2002 

Teething Can Gum Up the Right Diagnosis 

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Friday, October 11, 2002

FRIDAY, Oct. 11 (HealthScoutNews) -- Teething in infants usually causes nothing more than a bit of discomfort and perhaps a low-grade fever or diarrhea, pediatricians say.

However, an Australian survey of doctors and nurses found that many still adhere to an outdated notion that teething can lead to a variety of ills.

As a result, health professionals could be misdiagnosing more serious problems -- such as viral infections -- by blaming the symptoms on teething, the survey's authors contend.

An American pediatrician says some of his colleagues in the United States could be making the same mistake.

"It's easy to pacify parents by saying, 'Oh yeah, it's teething.' But if doctors attribute [high] fever and extreme irritability to teething, they're likely to miss something important," says Dr. Joel Steinberg, a professor of pediatrics at the University of Texas Southwestern Medical Center in Dallas.

Most babies' teeth typically break through the gums when the infant is about 5 months old, Steinberg says. Teething may continue until a baby is 15 or 16 months old.

"Teething certainly causes discomfort in some children," adds Dr. Dennis A. Clements, chief of primary child care at Duke University. "Teeth erupt overnight, and some children grind their gums and teeth and cry out in pain for no apparent reason.?

"Some children have a greenish stool when teething due to the stress. But there are plenty of children who get all their teeth without a whimper. It is variable," Clements says.

In the past, parents and doctors blamed a variety of symptoms on teething, from severe fevers to even death, says Steinberg, a spokesman for the American Academy of Pediatrics.

But in the last couple of decades, doctors have learned that many of the symptoms previously attributed to teething are really caused by viruses, which can strike infants as often as four to eight times in the first year of life, Steinberg says.

And those viruses can trigger health problems ranging from colds to ear infections, he says.

"I tell patients anything with a temperature above 100 is not teething," Steinberg says. "But teething can make you fussy, can make you drool a little more, and can make you sleep poorly."

The Australian researchers aimed to find out if health workers in the state of Victoria (home to Melbourne) had gotten the message about the harmlessness of teething. They surveyed 464 general practitioners, pediatricians, dentists, pharmacists and nurses.

Their report appears in tomorrow's issue of the British Medical Journal.

Nearly 75 percent of the nurses thought that all or most children suffered from symptoms of teething, while about 25 percent of the pediatricians did. Nurses and pharmacists were most likely to say that teething causes a variety of symptoms, and dozens of pharmacists said they had prescribed sedatives for teething infants.

Steinberg says he opposes the use of sedatives -- like Phenobarbital -- by teething infants, although painkillers like ibuprofen (Motrin or Advil) and acetaminophen (Tylenol) are appropriate. So is advising parents to give their teething babies something cool to chew on or drink.

"Topical anesthetics probably help little," adds Duke University's Clements. "They also anesthetize the tongue and throat, which may be a problem."

What To Do

Learn more about teething from the American Academy of Pediatrics or KidsHealth.

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More SIDS Cases May Be Due to Heart Problems 

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Heart problems could play a role in one in 10 cases of sudden infant death, Canadian researchers report.

Sudden infant death syndrome, or SIDS, is the leading cause of death for babies between 1 month and 1 year old, and the risk is greatest between 2 and 4 months of age. It is diagnosed when the cause of death remains unexplained and all other possibilities have been eliminated--such as infection, asphyxia, dehydration or child abuse.

In the study, Dr. Adrian Dancea of The Montreal Children's Hospital and colleagues reviewed 848 autopsy records of infants and young children who died suddenly and unexpectedly in Quebec between 1987 and 1999.

The researchers found that 82 of the children had some sort of heart problem, representing 10% of the total number of sudden infant deaths, the authors report in the September issue of The Journal of Pediatrics.

In about half of the 82 cases, a structural defect of the heart was found. The remaining children had structurally normal hearts but some other heart condition.

"We found that heart disease is present in a significant percentage of autopsies of infants dying suddenly and unexpectedly," write the authors.

Dancea and colleagues note that structural heart problems are often picked up in the first few weeks of life. However, half of the SIDS infants with a specific type of malformation were not diagnosed with the problem before they died.

Most autopsies were performed by a pediatric pathologist, according to the report. However, if the autopsy was performed outside a pediatric center, a close examination of the heart's anatomy was not performed in a third of cases.

This suggests, according to the researchers, that heart problems may be underreported in cases of SIDS.

Dancea's team has "shown that a significant number of unexpected deaths in the young are the result of cardiovascular diseases, some of which are heritable," according to Dr. Roger W. Byard of the Forensic Science Center in Adelaide, Australia.

"Given the recent criticisms of infant death investigations, both in the media and in the literature, there are many reasons why we have an obligation to get it right," Byard writes in an editorial accompanying the study.

Source: The Journal of Pediatrics 2002;141:336-342.

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Insurer OKs Foreign Drugs Via AARP  

By Theresa Agovino

AP Business Writer

The Associated Press

Friday, October 11, 2002

NEW YORK (AP) - The country's biggest health insurer has informed members of the senior citizens lobbying group AARP that it will reimburse them for prescriptions filled in Canada and elsewhere abroad.

UnitedHealth Group Inc. sent a letter to the 97,000 people who purchased insurance with a drug benefit through AARP telling them about the coverage.

Buying prescription drugs outside the country for use at home violates federal regulations but is a growing practice among some older Americans seeking relief from high prices. Insurance policies generally cover drugs purchased abroad if a person is traveling there and has forgotten their medicine or becomes ill.

Both UnitedHealth and AARP appeared to want to keep the measure low-key, but it was certain to meet with approval from both AARP plan members and others of the many thousands of senior citizens who purchase their drugs in Canada and Mexico, where they are drastically cheaper than in local pharmacies.

Viola Qurion, 76, a retired garment worker who lives in Waterville, Maine, on $1,027 a month, makes an annual pilgrimage to Canada to buy medicine. She said otherwise she would have to choose between drugs and food.

"We don't like to go," she said in a telephone interview. "It is hard for a lot of us to get around, but what choice do we have?"

She said she saved about $500 on the medicines for allergies and indigestion she bought in her most recent trip, made earlier this week. And she doesn't feel bad if that cost U.S. companies some income.

"The pharmaceutical companies spend millions keeping drug prices high. It is shameful," she said.

AARP said it is not advocating purchasing drugs from abroad. It described the letter as a reminder of policy, and called its timing "unfortunate," coming so soon after a failed effort at legislation to allow people to import prescription drugs for their own use. Currently, U.S. law prohibits Americans from importing medicines that are available in the United States.

"The letter was just an informational letter to members letting them know that we would be paying claims for all drug purchases," said Julie Alexis, manager of member health products at the AARP.

Alexis added that the policies covered by the letter are designed to fill gaps in Medicare, the government health plan for the elderly, and are consequently scrutinized by both federal and state regulators. Neither has expressed any concern over covering drugs purchased abroad, she said.

UnitedHealth said its letter did not reflect a change in coverage but was meant to clarify a misunderstanding. It also said it was not trying to encourage anyone to violate Food and Drug Administration (news - web sites) regulations.

"If someone is driving at a high rate of speed and they get in accident we cover them, but it not like we advocate such behavior," said UnitedHealth spokesman Mark Lindsay.

Lindsay says the insurer doesn't know how many of the 97,000 individuals get their drugs from abroad to save money.

An FDA official said the agency couldn't comment on the coverage because it doesn't know the details.

The AARP, formerly known as the American Association of Retired Persons, is critical of the pharmaceutical industry. It also has supported bills, so far unsuccessfully, to create a Medicare drug benefit and to make it easier for generic drugs to reach the market.

Experts said it was unlikely that either the drug makers or government officials would take issue with UnitedHealth or AARP over the drug reimbursements.

"No one wants to be seen like they are going after grandmothers," said Jonathan Wiener, professor of health policy and management at the Johns Hopkins School of Public Health in Baltimore.

He called the reimbursement policy "a warning shot at the pharmaceutical industry and Congress. I think they want to add to the outcry about drug prices and hit the pharmaceutical industry in the pocketbook."

The 97,000 members of the seniors group represent a negligible amount of the pharmaceutical industry's sales. The industry would likely see profits threatened only if the reimbursement policy spread to other insured groups such as company employees, which wasn't seen as likely.

"A local tool and dye shop is not the AARP," Wiener said.

AP reporter Karren Mills in Minneapolis contributed to this report.

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Low Weight at Birth May Impair Man's Fertility

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Low birth weight may affect testicle size--and perhaps fertility--later in life, results of a preliminary study from Italy suggest.

The researchers found that teenage boys who are born small for their gestational age, meaning they were smaller than average but were not born prematurely, tended to have smaller testes and lower levels of testosterone, according to a report in the September issue of the Journal of Pediatrics.

Whether this finding could explain some cases of infertility in adult men needs to be further investigated, the researchers say.

Previous research findings have linked low birth weight to a number of health conditions in adults, including high blood pressure. And a recent study in girls found that low birth weight was associated with impaired ovarian development, which may in turn lead to poor fertility.

In the new study, Dr. Alessandro Cicognani of the Universita degli Studi di Bologna evaluated 24 teenaged boys who had completed puberty and were born at average weights and 25 who had been small for their gestational age. The average birthweight for the control group was 7.1 pounds; for the small-at-birth group it was 3.7 pounds.

The low birthweight teens were found to have smaller testicles, on average, and lower levels of testosterone compared to those born at a normal weight. And the teens who were born at low weights who had the smallest testicles also had low levels of inhibin B, a hormone that has been linked to sperm production.

In addition, low birth weight teens with smaller testes tended to be shorter in stature compared to what would have been expected.

"There is a disruption of the exocrine function in subjects with smaller testicular size who failed to show a complete height catch-up growth," the authors write.

"This study supports a link between low birth weight and lower fertility in adult males," they conclude.

Source: Journal of Pediatrics 2002;141:376-379.

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Feds Nix Menopause Treatment Patch  

The Associated Press

Friday, October 11, 2002

BERLIN (AP) - Schering AG, the No.1 maker of birth-control pills, said Friday the U.S. Food and Drug Administration (news - web sites) has rejected its application for approval of a patch to treat menopause symptoms.

The German company didn't say why application for the estradiol/levonorgestrel transdermal combination patch was rejected. However, Schering said it is in discussions with the FDA to address technical aspects of one of the clinical studies submitted as part of its application for the once-a-week therapy.

"We regard our discussions with the FDA about this new drug application to be an ongoing process, and we will continue to examine all options for the approval of this application," Werner-Karl Raff, the head of Schering's Fertility Control & Hormone Therapy unit, said in a statement.

Schering said the rejection wouldn't affect this year's sales or profits.

Berlin-based Schering's shares closed down 3.5 percent at 48.09 euros ($47.42) in Frankfurt.

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Light Therapy Helps Treat Prostate Cancer, Too 

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Researchers may have added prostate cancer (news - web sites) to the list of cancers that can benefit from photodynamic therapy (PDT), which combines drugs and light to treat cancer and other conditions.

Timothy R. Nathan of the University College London Hospital in the UK and his colleagues report that most patients treated with PDT, whose prostate cancer had returned following radiation treatment, appear to benefit from the new therapy.

Specifically, the authors report, more than half of treated patients experienced a decrease in their blood levels of PSA, a protein produced by the prostate gland that is often elevated in the presence of prostate cancer. In addition, more than one third of PDT-treated men showed no trace of cancer from a post-treatment biopsy.

"Photodynamic therapy is a new option that could be suitable for organ confined prostate cancer recurrence after radiotherapy," Nathan and his team write.

"These results suggest that photodynamic therapy merits further investigation," they add.

PDT is a two-step therapy that is already being used to treat head and neck cancers, especially esophageal cancers. The first step is to give the patient a light-activated drug such as Photofrin, which tends to collect in tumors. The drug makes the abnormal tissue particularly sensitive to light. The second step is to shine a laser light on the drug-saturated tumors for a brief period of time. There are several PDT drugs available, and each is activated by different wavelengths of light.

Recent reports have suggested that PDT may also help treat cancers of the pancreas, lung and breast.

During the current study, Nathan and his team administered PDT to 14 men. All patients had prostate cancer that had returned following treatment with radiation, as indicated by an increase in PSA and results from a biopsy.

After the procedure, the researchers noted that PSA levels decreased in 9 patients, reaching undetectable levels in 2 patients. Biopsies of 5 patients showed that they were tumor-free. Scans showed that PDT had destroyed up to 91% of the prostate tissue.

A few of the patients experienced side effects after the treatment, Nathan and his team note. Four of the men reported stress incontinence, meaning they leaked urine as a result of laughing, coughing, sneezing or exercise, which began to gradually improve over time. Seven of the participants were able to have intercourse before PDT, and 4 reported a decrease in their abilities after receiving light therapy. This side effect did not appear to diminish over time, the authors report in the October issue of the Journal of Urology.

Complications were no worse among the patients than among studies of patients given surgery or cryotherapy to treat prostate tumors that had returned after treatment. And, the researchers note, complications could be reduced by dosage adjustments.

Nathan and other researchers involved in the study have a financial interest in or other financial relationship with Scotia Pharmaceuticals, the company that makes the drug used in the study.

Source: Journal of Urology 2002;168:1427-1432.

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Waist Circumference Helps Predict Cardiovascular Risk

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Friday, October 11, 2002

FRIDAY, Oct. 11 (HealthScoutNews) -- If you want to determine your risk for cardiovascular disease, maybe you should throw out your scale and grab the measuring tape.

A study appearing in a recent issue of the American Journal of Clinical Nutrition (news - web sites) suggests waist circumference is more strongly associated with cardiovascular risk factors than body mass index (BMI).

"There's been some research that shows that it may not be the total amount of fat in your body but where it is stored. In other words, fat distribution," says Stanley Heshka, a co-author of the study and a research associate at the New York Obesity Research Center at St. Luke's Roosevelt Hospital in New York City.

Body mass index (the measure of body fat based on height and weight) is the most widely used gauge to tell if adults are overweight or obese. The problem is that it doesn't take into account the wide range of fat distribution found in people.

Meanwhile, various studies have found body fat distribution is a better predictor for many diseases.

In the new study, the researchers looked at information on white men and women gathered for NHANES III, the National Health and Nutrition Examination Survey, which collected data on the health and nutrition of 9,019 Americans. Then the researchers correlated BMI values of 25 and 30 (which indicate overweight and obese, respectively) with cardiovascular and diabetes risk factors. They set out to determine what waist circumferences have the same degree of risk for cardiovascular disease and diabetes as the BMI guidelines.

To minimize the risk of heart disease, men should not go above a 35-inch waist and women should not go above 33 inches, Heshka says. Men whose waists are 39 inches or more and women whose waists are 37 inches or more should lose weight -- and inches, he says.

Though the study data involved exquisitely precise measurements (taken just above the top of the hip bone and at the end of a normal exhalation), regular folks don't need to be quite that exact.

If you come close to the recommended cutoff points, though, you need to take them seriously, Heshka cautions.

The researchers are still working to figure out why girth may be a better predictor of risk for cardiovascular disease. It may be because the amount of fat around the waist reflects more fat inside the abdominal cavity, something that has been associated with coronary vascular disease, Heshka says.

Some people have hypothesized that the fat drains into the portal vein and is then distributed to areas most sensitive to the development of cardiovascular disease.

"No one really knows how the fat works," Heshka says.

Heshka is quick to add that waist circumference alone may not be the best measure to determine cardiovascular disease risk.

Heshka and other researchers are now trying to see what combination of measures (for example, height, weight, waist circumference, body frame size…) are the best predictors for the development of cardiovascular disease.

"We may find that waist circumference and BMI in combination have an even stronger association," Heshka says. "That's what the goal is now: To find optimal predictors so we can find those people at risk."

More data is also needed to confirm that people with large waists are also the ones who eventually develop cardiovascular disease.

What To Do

To learn more about cardiovascular disease, visit the U.S. Centers for Disease Control and Prevention (CDC). To calculate your body mass index, visit this CDC site.

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Wart Virus May Contribute to Esophageal Cancer 

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Certain strains of the wart-causing human papillomavirus (HPV) may raise the risk of esophageal cancer, at least in parts of the world where the cancer is common, researchers report.

There are more than 100 types of HPV, with some causing the common warts of the hands and feet, others causing oral or genital warts and some causing no obvious symptoms at all. Certain sexually transmitted HPV strains are already believed to be the major cause of cervical cancer, but there is also evidence that HPVs may contribute to several other cancers, including vaginal and penile cancers and some cancers of the head and neck.

Esophageal cancer, which affects the tube through which food passes to the stomach, is relatively rare in many parts of the world. But certain regions, such as parts of China, have unusually high rates of the disease.

The new study looked at one Chinese region, Eastern Guangdong, where esophageal cancer is common. Researchers found that among the 55 esophageal cancer patients they studied, certain strains of HPV were commonly found in tumor samples.

Dr. Zhong-Ying Shen of Shantou University Medical College and colleagues report the findings in the November issue of the Journal of Medical Virology.

Overall, HPV was found in more than 60% of both cancerous and normal tissue samples taken from the patients. But two "high-risk" strains tied to cancer, HPV 16 and 18, were found mainly in tumor samples, Shen's team reports.

"Our results," the researchers write, "suggest that the high incidence of esophageal carcinoma in this particular region may be associated with the high infection rate with HPV, and HPV may be one of the major risk factors in the development of this tumor."

They note that in past studies in areas with low rates of esophageal cancer, HPV has either not been detected or has shown up far less often in esophageal tumor samples.

According to the researchers, the role of HPV in the development of esophageal cancer "might be more pronounced" in areas of the world where the disease is common.

Other factors believed to raise the risk of esophageal cancer include smoking and heavy drinking.

Source: Journal of Medical Virology 2002;68:412-416.

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Real Oven Better Than Microwave for Killing Germs 

HealthScoutNews

Friday, October 11, 2002

(HealthScoutNews) -- Before you heat up that doggie-bag full of the leftovers from last night's barbecue at Bill's house, be warned.

According to the American Journal of Epidemiology, nuking them is not as good as reheating in the oven or a frying pan.

That information comes from the Epidemic Intelligence Service of the Centers for Disease Control and Prevention (news - web sites) in Atlanta, which was tracing an outbreak of Salmonella typhimurium in Juneau, Alaska.

Researchers found that all the people who became sick had been to the same picnic, and they all had taken home leftovers. But while 30 people had taken home doggie bags, only 10 became sick. What protected the others?

According to the CDC, all who became sick had reheated their food in a microwave oven. Those who didn't become sick had used a conventional oven or frying pan.

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Teens' Sexual Orientation Affects Body Image-Study 

By Alison McCook

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Teen boys who are gay are more likely than their heterosexual peers to diet and exhibit certain symptoms of eating disorders, while lesbian teens appear to be somewhat protected from the unhealthy body concerns that often plague heterosexual girls, US researchers report.

In addition, Dr. Sydney Bryn Austin of Children's Hospital and Harvard University in Boston and her colleagues found that teen girls and boys who believe themselves to be heterosexual, but are sometimes attracted to the same sex, are more likely than heterosexuals without same-sex feelings to diet and be unhappy with their bodies.

One of the most important aspects of these findings is the discovery of teens who consider their sexual orientation to be "mostly heterosexual"--choosing this category from a list of 6 descriptors, including "not sure"--and their tendency to adopt unhealthy behaviors, Austin told Reuters Health.

But just who these teens are and why they seem to worry more than others about their appearance remains unclear, she admitted.

"We're really at the beginning of figuring out who these adolescents are, and why are they at increased risk of eating disorders, and other unhealthy behaviors," Austin said.

The current findings are based on surveys completed by 10,136 girls and boys between the ages of 12 and 17. The surveys questioned teens about their sexual orientation, weight concerns, tendency to diet and how satisfied they were with their bodies. In addition, the respondents indicated if they had any symptoms of an eating disorder like eating while feeling out of control ("bingeing") or throwing up and using laxatives to rid their bodies of food ("purging").

The authors presented their findings at the recent National Lesbian Health Conference held in Washington, DC.

Austin and her team discovered that lesbian or bisexual girls were half as likely to have dieted within the last year as heterosexuals, while mostly heterosexual girls said they were 30% more likely to do so than heterosexual girls. Although mostly heterosexual boys were more likely to diet than heterosexuals, boys who considered themselves gay or bisexual were twice as likely as heterosexuals to admit to recently trying to shed pounds.

The symptoms of eating disorders also appeared more commonly in "mostly heterosexuals" than in heterosexuals. Most notably, gay and bisexual boys were 15 times more likely to report binge eating than heterosexual boys.

In an interview with Reuters Health, Austin said that lesbian and bisexual girls may be less likely than heterosexuals to have body concerns because previous research has suggested that men, in general, place a higher priority on their partners' physical attractiveness. This trend would also explain why gay and bisexual boys were more likely than others to have weight concerns, she noted.

Austin added that these results suggest that teens with infrequent same-sex thoughts may not be receiving enough social support. They may also lack the psychological security that comes with knowing your feelings fit into an acknowledged category such as "gay," "straight" or "bisexual."

These findings "suggest that this group is hidden, and needs help," Austin said.

The current study findings also suggest that qualities and feelings that accompany sexual orientation become apparent early on after puberty, given that these teens displayed such varying qualities so soon after becoming sexually mature, the researcher said. So whatever is happening, it happens fast, Austin noted, suggesting that it may be possible to modify some influencing factors and prevent sexual orientation from leading to unhealthy behaviors.

"What is it that's protecting lesbian and bisexual girls?" she asked. "If we find out, maybe we can protect heterosexual girls."

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Skateboarding Riskier Than Ever 

By Lisa Girard
HealthScoutNews Reporter

HealthScoutNews

Friday, October 11, 2002

FRIDAY, Oct. 11 (HealthScoutNews) -- Skateboarders who have taken it to the streets are taking it on the chin.

A new study in the October issue of the Journal of Trauma found skateboard injuries doubled between 1993 and 1998 as the sport underwent a radical change. It shifted from the 1980s style of skateboarding known as "vert," which uses 10-foot-high ramps, to "street skating," which encourages cruising through city streets. Even when supervised, street skating uses lower ramps and involves increasingly complex stunts and tricks.

Many of these injuries could have been prevented, researchers say, by using basic safety equipment -- helmets, wrist guards and elbow and knee pads.

The purpose of the study was to assess the risks of skateboarding compared to other youth sports such as basketball and football, says co-author Dr. Michael Nance, associate director of trauma at Children's Hospital of Philadelphia. As part of their research, the authors looked at data from the U.S. Consumer Product Safety Commission (news - web sites)'s National Electronic Injury Surveillance System (NEISS), which collects data on consumer product-related injuries. They also examined data from annual surveys from the National Sporting Goods Association, which reports on sports participation among people aged 7 and older.

What the scientists found was a significant decline in the rate of skateboard injuries from 1987 to 1993, followed by a significant increase in injuries over the next five years -? a trend they associate with the rising popularity of "street skating" during that period. This shift can be traced, in part, to the introduction in 1995 of the eXtreme Games, televised on ESPN each summer. Millions of kids now watch professional skaters, and many try to copy their more dangerous moves on curbs, stair railings and all sorts or construction equipment found in the streets.

This has caused a continued average annual increase of 16,500 skateboard injuries since 1998, according to NEISS statistics. Almost 30 percent of these involved children under 11. More than 53 percent of the victims were between 12 and 17. The most common types of injuries were wrist fractures, ankle strains and sprains, face lacerations, lower arm fractures, and wrist strains and sprains.

That said, the researchers conclude that, compared with other sports, skateboarding is relatively safe. For instance, the 1998 rate of skateboard injuries treated at emergency departments was only half as high as basketball injuries. And most skateboard-related injuries are relatively minor and can be treated on an outpatient basis, Nance says.

Currently, there are no standards for skateboarding equipment, except a voluntary standard for helmets set by the American Society for Testing and Materials. To reduce the chance of injury, Nance recommends skaters use a full range of equipment, including helmet, wrist guards, elbow and kneepads, and gloves.

"You tend to find that the kids who go to the parks wear the equipment," he said. "They're doing things in a safer setting, whereas the kids on the street tend to be tooling around. They tend to be a little more cavalier, or casual, about it and are more likely to be injured."

What To Do

Children's Healthcare of Atlanta has a number of good tips to increase safety among young skateboarders.

The National Safety Council also has some good advice for skateboarders.

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Choke Fears Spur U.S. Recall of 590,000 Kids' Toys 

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Over 310,000 stuffed polyester "pool animals" and another 280,000 animal-shaped toy sponges, both made by Dollar Tree Stores, Inc., are being recalled because they may pose a choking hazard to toddlers.

According to statements issued Thursday by the US Consumer Product Safety Commission (news - web sites) (CPSC), reports of foam-bead stuffing coming loose from the polyester pool animals, and an eye detaching from the sponge animals, have prompted the voluntary recall. No injuries to children have yet been reported, the CPSC say.

In the "pool animals" recall, all eight types of the small, brightly colored toys--crab, duck, frog, octopus, seahorse, shark, turtle and whale--are under recall. Each toy has a sewn-in label that reads, "DOLLAR TREE DISTRIBUTION, INC.," "MADE IN CHINA," and "RN#87254." The pool animals sold for $1 at Dollar Tree, Only One Dollar, Only $1, Dollar Express and Dollar Bills stores nationwide from April 2002 through August 2002.

The second recall includes whale, turtle and fish toy sponges made of terry cloth with suction cups designed to allow attachment to smooth surfaces such as bathtubs. The sponges--which also sold for $1 at the same stores across the US--have labels identical to those found on the pool animals.

Detailed photos of all of the Dollar Tree toys under recall are on view at www.cpsc.gov.

According to the CPSC, consumers should take all of these toys away from small children "and return them to the store where purchased for a full refund." Consumers who would like more information on the recalls can contact Dollar Tree at (800) 876-8077 between 9 AM-5 PM Monday through Friday, Eastern time.

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Troubled Slumber Can Hike Blood Pressure 

HealthScoutNews

Friday, October 11, 2002

FRIDAY, Oct. 11 (HealthScoutNews) -- Sleep-disordered breathing increases blood pressure in people with untreated hypertension, but their nighttime blood pressure can be lowered using nasal continuous airway pressure treatment.

That's the finding of a study in the October issue of CHEST.

People with sleep-disordered breathing (SDB) experience repeated episodes of breathing pauses lasting 10 seconds or longer while they sleep. Those breathing pauses are caused by the complete or partial collapse of the upper airway passage or an abnormal decrease in depth of respiration associated with lowering of blood oxygen levels.

This study by University of Wisconsin researchers included 24 men, ages 30 to 60, with mild to moderate hypertension. Fourteen of them had SDB. The aim of the study was to determine if SDB had an effect on blood pressure.

The men in the study were given nasal continuous airway pressure (CPAP) treatment for 14 days. CPAP, a machine that provides a constant flow of air to the user, is the usual treatment for SDB.

Each of the men in the study had blood pressure readings taken before, during and after the CPAP treatment. The researchers found the men without SDB showed no significant change in their blood pressure. That showed that CPAP itself didn't alter blood pressure.

But nighttime blood pressure decreased in the men with SDB as a result of the CPAP treatment. The researchers say that shows that there is a connection between SDB and increased nighttime blood pressure levels in people with hypertension.

"Considering that sleep-disordered breathing is a very common problem yet often not diagnosed, it could be an unrecognized contributor to hypertension in some patients," says Dr. Udaya B.S. Prakash, president-elect of the American College of Chest Physicians.

More information

Learn more about sleep disorders at the National Sleep Foundation.

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Doctors Switching Drugs Due to Cost Decisions 

By Karen Pallarito

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Doctors across America sometimes switch patients off of popular brand-name prescription drugs for reasons that have little to do with how their patients are responding to particular products, survey data suggest.

At least some of the time, switches are made for cost or formulary reasons, physicians report. A formulary is a list of drugs approved for reimbursement by an insurance company, government agency or other organization.

A survey of high-volume prescribers across America reveals the top-switched drugs and the percentage of time doctors say they switch to another medication because of cost or formulary considerations. The list of 14 drugs, compiled by Impact Rx, a Mount Laurel, New Jersey-based research outfit, reflects switches made from January through August 23.

Switching occurs an average of 2% to 7% of the time when cost or formularies are the "predominant reasons" for changing medications, said Timothy Margraf, president and CEO of Impact Rx. The company's drug-switching list, provided exclusively to Reuters Health, draws on data collected daily from a proprietary network of high-prescribing primary care physicians.

For each drug on the list, cost or formularies drive at least a quarter--and sometimes more--of the switching activity.

Avalide, a hypertension treatment marketed by Bristol-Myers Squibb Co. and Sanofi-Synthelabo, tops the list. Fifty percent of the time that patients taking Avalide are switched to alternative medications, it's for cost or formulary reasons.

Bristol-Myers' Pravachol and Merck & Co. Inc.'s Zocor, rival cholesterol-lowering medications, also rank high on the list. Forty-three percent of Pravachol switches reflect cost or formulary considerations. Those issues explain 38% of Zocor switches.

The list reflects classes of drugs for which there is at least one competing brand-name drug or a generic alternative. Included, for example, are rival products for lowering cholesterol, keeping blood pressure in check and treating ulcers and heartburn.

"I think part of what you're seeing here is that there are drugs within these categories...that have the same pharmacodynamic effect," said Jon Maesner, vice president of pharmacy policy at Cigna HealthCare in Hartford.

The proton pump inhibitors (PPI (news - web sites)), for example, while not chemically identical, work in a similar fashion to control gastric acid. AstraZeneca's Prilosec, which is going off patent, and Nexium, the company's replacement drug, are both on the list of top-switched drugs. Wyeth-Ayerst's Protonix, which came on the market at a lower cost to grab market share, is not.

"I'm not surprised that there would be switching activity," Maesner said.

What's behind those switches? A patient's health plan may not cover the drug initially prescribed or the health plan formulary may have changed. Patients might even request a different drug to lower their out-of-pocket costs.

If the patient's formulary doesn't cover a particular medication or requires a higher co-payment, the pharmacist might call the doctor to ask about switching. Sometimes a pharmacy benefits manager (PBM) may intervene to boost formulary compliance or encourage generic substitution.

MedcoHealth Solutions, one of the nation's largest PBMs, runs a big generic sampling program and does alert physicians to the availability of lower-cost alternatives with the same mechanism of action. The Franklin Lakes, New Jersey-based company tries to show physicians the difference from a cost perspective to the patient and the health plan.

"In most cases when we bring it to the physician's attention, the physician is saying, 'Okay, I'll pick the other one,"' said Dr. Glen Stettin, Medco's vice president of clinical products.

Drug switching remains a controversial practice, though, particularly when it happens because a particular pharmaceutical company has cut a better deal with a health plan or PBM to get its drug on the formulary.

Several health plans contacted by Reuters Health did not wish to comment on this story or failed to respond to repeated requests for comment. One health plan, through a spokeswoman, acknowledged that it could not comment because of the political sensitivity of the issue.

Part of the controversy stems from a concern that doctors may be unduly influenced by drug marketers to favor a particular product. A Kaiser Family Foundation survey released earlier this year found that 61% of doctors reported receiving meals, tickets to events or free travel--practices that have been severely curtailed or banned under a new industry code of ethics.

Kaiser also reports that $13.2 billion of the $15.7 billion drug companies spent promoting drugs in 2000 went to promotions targeting physicians. A growing chunk--nearly $2.5 billion in 2000--went to direct-to-consumer advertising.

"The reason the drug companies are throwing billions and billions into this kind of marketing and advertising is because they know it will reap even greater revenues as people are induced to purchase the most expensive and least cost-effective drugs," said Ron Pollack, executive director of Families USA.

"Once a physician has become comfortable prescribing a particular drug, it's not easy to get them to switch. That's why to the extent there are programs that promote generic drugs, I think that's good," he said.

"On the other hand," Pollack added, "in those situations where a consumer is being pushed from one drug to another which is not therapeutically equivalent, a cautionary flag needs to be raised."

Stettin, the MedcoHealth executive, agrees that switches shouldn't be made if there's a quality of care issue. But as for the top-switched drugs identified by Impact Rx, that's not a concern. Not one of the products jumps out as "a terrible drug" or "a drug you should avoid," he said.

"Physicians are saying it's not really a quality issue. These drugs work the same...and cost is a reason to make a change."

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Poor Children at Higher Heart Risk 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Friday, October 11, 2002

FRIDAY, Oct. 11 (HealthScoutNews) -- Children in lower-income families are more likely to grow up overweight and with high blood pressure, high cholesterol and insulin resistance, all of which make them more vulnerable to heart disease and stroke, a British study finds.

The risk factors picked up in childhood continue to dog those people, even if they grow up to be economically successful adults, says a report in tomorrow's issue of the British Medical Journal.

The finding accentuates the need to intervene decades before the first indicators of heart disease or stroke appear, says Debbie A. Lawlor, a lecturer in epidemiology at the University of Bristol and lead author of the report.

"There is cumulative evidence from this and other studies about early lifestyle factors to point to the need for affecting heart disease risk factors early in life, rather than taking adults who are at risk and doing the same thing with them," she says.

The results come from analysis of data about 4,286 older women in England, Scotland and Wales. They were asked about their social class in childhood and the present, and the information was correlated with tests for common cardiovascular risk factors.

Women who grew up in what the study called the "manual social class" were 23 percent more likely to have high blood pressure, 44 percent more likely to have elevated blood cholesterol, 68 percent more likely to be obese, and 33 percent more likely to have high insulin resistance, the researchers report. Moving up the socioeconomic ladder had only a slight effect on those numbers, they say.

"Animal studies show that environmental circumstances early in life affect development because many organs are still developing," Lawlor says. "So things that affect growth and development early in life have a long-term effect."

The study results come as no surprise to Barbara V. Howard, who chairs the American Heart Association (news - web sites) nutrition committee.

"It is well known that lack of education and lack of economic means leads to poor eating habits and a less healthy lifestyle, and that this affects children as well as adults," says Howard, who is president of the MedStar Research Institute, which is part of the largest nonprofit health-care organization in the Baltimore area. "These children will be learning bad eating habits and will not be taught good health habits. There is more and more evidence that the effects of behavior in childhood extend into adulthood."

Bad early habits can be changed by some adults, Howard says. "A person may diet and exercise and not go on to have diabetes or heart disease," she says. "But it is frustrating to try to change 40- and 50-year-old adults after the bad habits become so ingrained. We have a much better chance if we start with children, teenagers and young adults."

What To Do

The elements of a healthy lifestyle for children and adults are outlined by the American Heart Association. October is Children's Health Month. Learn more about it from the National Institutes of Health.

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Swaddling Infants for Sleep May Reduce SIDS Risk 

By Charnicia E. Huggins

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Reintroducing the ancient practice of swaddling, or tightly wrapping babies in cloth before putting them to sleep, may be one way to reduce an infant's risk of sudden infant death syndrome (SIDS), recent study findings suggest.

In the study, "babies who weren't used to swaddling...did go to sleep on their backs," study author Dr. Bradley T. Thach of Washington University School of Medicine in St. Louis, Missouri told Reuters Health. "And the back position is the preferred position for reducing the risk of SIDS," he added.

Swaddling, as a form of restraining infants' movement, was used almost universally before the 18th century, according to Thach and his colleagues. But recent studies suggested the practice might lead to breathing problems and even death because of the pressure of the swaddling cloths against the infant's chest wall. There has also been concern that the practice can cause problems in hip joint development, or lead to overheating.

Thach and his colleagues investigated the legitimacy of these concerns in a study of 37 infants, who ranged in age from 19 days to about 6 months. The infants were observed as they took short naps in a laboratory setting.

Overall, 33 of the infants, including seven who usually slept on their stomachs, were able to fall asleep within 30 minutes of their swaddling, the investigators report in the September issue of The Journal of Pediatrics. The infants who resisted the swaddle, meaning they did not fall asleep within a half hour, were about one month older, on average, than those who accepted the swaddle.

This suggests that "early introduction of swaddling may ensure greater success," the researchers speculate.

Also, when the swaddle was progressively tightened to the tightness of traditional swaddles, the infants did not show any great increases or decreases in their heart rate, or their number of grunts or sighs, study findings indicate. Their oxygen levels also remained unchanged during the tightening.

Yet, infants did have slight increases in their breathing during the swaddle tightening experiment, the researchers note. "This suggests that the infant may be compensating for some degree of chest wall restriction and/or decreased lung volume," they write.

Finally, the infants were able to spontaneously flex their hips from 45 to 60 degrees while swaddled, and they only experienced a two-degree increase in skin temperature.

The infants were wrapped in swaddling cloths that were "looser on the hips than the traditional swaddle," Thach explained. Also, the swaddle cloth was thin so "overheating doesn't seem to be a problem," he said.

Swaddling during the first year of life is still common in Eastern Europe, the Middle East, Asia, South America and among Native Americans in North America, but it is rarely used outside of hospital nurseries in the United States, the researchers note. Cultures that practice swaddling, with infants normally sleeping on their backs, have a lower incidence of SIDS.

Source: The Journal of Pediatrics 2002;141:398-404.

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Herpes Rates Could Explode by 2025 

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Friday, October 11, 2002

FRIDAY, Oct. 11 (HealthScoutNews) -- Nearly half of all young American women could suffer from genital herpes by the year 2025 if nothing more is done to stem the disease's spread, a new study contends.

As for young men, a group of U.S. and Canadian epidemiologists is estimating they won't be much better off than their female counterparts. In less than three decades, 39 percent of males aged 15 to 39 could have herpes, the researchers predict.

Besides the costs in medical care and personal suffering, such an increase in herpes could also exacerbate other health threats, says Dr. Michael Horberg, an authority on sexually transmitted diseases (STD).

"The presence of herpes causes inflammation, and increases your risk of contracting other STDs like HIV (news - web sites)," he says.

While herpes gets only a fraction of the attention of potentially deadly STDs such as AIDS (news - web sites) and syphilis, it is much more common. An estimated 22 percent of adult Americans are infected with a genital strain known as herpes simplex virus type 2.

In the most serious cases, the disease can cause spinal problems and brain swelling. "Needless to say, it's very painful," Horberg adds.

Herpes can be especially risky for women. "The big concern is if they have active herpes during pregnancy," Horberg says. "They can pass it to the baby during delivery, and it can cause blindness and other defects."

Drugs usually can suppress the herpes virus during outbreaks, but those infected can become contagious before they notice the lesions that come during outbreaks, he says.

In the new study, the epidemiologists developed a mathematical formula to estimate how the herpes epidemic among heterosexuals will evolve over the next few decades.

The findings appear in the October issue of the journal Sexually Transmitted Diseases.

The researchers estimate that 49 percent of women aged 15 to 39 will be infected with herpes simplex virus type 2 by 2025 if present trends continue. The associated medical costs would rise to $2.7 billion in 2025, from $1.8 billion in 2000.

The researchers' predictions could indeed come to pass, but figuring out the trajectory of a disease is tricky business, says Frank Myers, an epidemiologist at Scripps Mercy Hospital in San Diego who was not involved in the study.

For example, some health experts in the 1980s predicted the rates of tuberculosis in the United States would level off or increase slightly if prevention budgets were cut. However, tuberculosis rates actually skyrocketed as HIV entered the picture and made thousands of people more vulnerable to the disease, Myers says.

In another example, experts predicted the HIV epidemic would keep growing rapidly, but they didn't anticipate that gay men would adopt safer sex practices, he says.

Herpes can't be cured, so it seems logical that it would keep increasing, Myers says, "but the authors and I could be wrong."

Regardless of the trends in herpes infection, sexually active Americans can prevent getting the disease by wearing condoms or insisting on their use and by avoiding sex with people who have active lesions, Horberg says. He adds that people with herpes should avoid sex during outbreaks to prevent spreading their infection.

What To Do

Learn more about herpes from the National Institute of Allergy and Infectious Diseases. The American Herpes Foundation, supported by drug companies, has information for doctors.

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THURSDAY, OCTOBER 10, 2002 

All's Fair in Middle Age 

HealthScoutNews

Thursday, October 10, 2002

(HealthScoutNews) -- Life really does begin after 45, it seems.

If you want proof, here's a report from the Journal of Advanced Nursing, in which researchers from the College of Nursing at Arizona State University measured the stress levels and personality traits of 299 women of various ages.

Here's what they found:

• Women between ages 18 and 29 were under high stress, and had poor personality traits. Result: poor health, both physically and emotionally.
• Between ages 30 and 45, stress levels generally went up, but women with strong personality traits saw their way through it all, and they were healthier than when they were younger.
• Once past 45, emotional stress levels declined, while the healthy personalities became better still.

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Receiving an Apology Does a Body Good, Study Finds 

By Charnicia E. Huggins

Reuters Health

Thursday, October 10, 2002

NEW YORK (Reuters Health) - Most individuals who have been wronged would agree that they feel better after receiving an apology. Now researchers have found scientific proof to back up that claim.

"The data suggest that apologies and restitution can have an immediate, positive impact on physiological and subjective responses to transgressions," according to Dr. Everett L. Worthington, Jr., of Virginia Commonwealth University in Richmond and his colleagues.

For their study, 61 college undergraduates--32 men and 29 women--were told to imagine that they had been robbed, and that the robber had afterwards either apologized, restored to them the things he or she had stolen, apologized and made restitution, or did neither.

Overall, the students had lower heart rates when they imagined that the robber had given them a strong, guilt-ridden apology and made restitution to compensate for the stolen items and trouble he or she had caused, study findings indicate. Further, the students also showed less muscle tension in their face--such as less wrinkling of the brow--and had less stress and lower blood pressures.

In other findings, when the students imagined that they had received a strong apology and had been compensated, they experienced a reduction in their level of unforgiveness that was twice as great as when they imagined themselves to have just received a strong apology, according to Worthington.

The students also said they felt more forgiveness, gratitude and empathy and less anger, fear and sadness, study findings indicate. Finally, the undergraduates also said they felt more in control.

"If someone apologizes it makes it easier to give some measure of forgiveness because it reduces the gap of injustice," Worthington told Reuters Health. "Justice can only take you so far, but if you forgive--that can take you all the way to closure."

The findings were presented in Washington, DC during the recent annual meeting of the Society for Psychophysiological Research.

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Study Finds New Seat of Anxiety in Brain 

HealthScoutNews

Thursday, October 10, 2002

THURSDAY, Oct. 10 (HealthScoutNews) -- American researchers have identified a new target area in the brain for anti-anxiety drugs.

They report their findings in the October issue of The Journal of Clinical Investigation.

The discovery may lead to new kinds of non-addictive anti-anxiety drugs with fewer side effects.

Mice missing an enzyme called protein kinase Ce (PKCe) had significantly lower anxiety and stress compared to normal mice, the study says.

The researchers believe this finding can be applied to humans and help in creating better drugs to treat anxiety disorders.

"To conduct this study, we used a strain of mouse that lacks an enzyme called protein kinase Ce (PKCe). Earlier work showed that this enzyme interacts with GABA A receptors in the brain. As activation of GABA A receptors reduces anxiety, we tested whether PKCe deficiency reduces anxiety. This research demonstrated that a complete absence of the enzyme greatly reduces anxiety," says study co-author Jacob Raber, an assistant professor of behavioral neuroscience at the Oregon Health and Science University School of Medicine.

"While there are anxiety medications such as Valium currently on the market, these pharmaceuticals often act as a sedative. Even more concerning, many anxiety medications are addictive in nature. We believe this enzyme may be an ideal drug target for medications without serious side effects," Raber says.

He and his colleagues compared the responses of mice bred to lack PKCe and normal mice to various settings and conditions. Mice lacking PKCe were less timid about being in open, lighted areas and showed less stress when place in a confined space for a limited period.

An estimated 30 million Americans suffer from anxiety severe enough to require treatment. Anxiety disorders are the most common mental illness in the United States. People with anxiety disorders are three to five times more likely to see their doctor and six times more likely to be hospitalized for psychiatric disorders than other people.

More information

For more about anxiety disorders, go to the U.S. National Institute of Mental Health.

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Contraceptive Being Recalled  

The Associated Press

Thursday, October 10, 2002

WASHINGTON (AP) - A type of contraceptive injected once a month is being recalled because some doses may not be potent enough, the manufacturer announced Thursday.

A subpotent dose may not be effective in preventing pregnancy.

Pharmacia Corporation of Peapack, N.J., said the recall covers Lunelle monthly contraceptive in prefilled syringes.

As many as 100,000 women could be affected by the recall, covering products distributed between January and October of this year, the Food and Drug Administration (news - web sites) reported.

The recall does not include the form of Lunelle packed in vials, the company said, but only the prefilled syringes which constitute the majority of the market.

When the drug won approval in 2000, the company said it was 99 percent effective.

Pharmacia spokeswoman Caroline Bullock said the company has not seen any increase in unintended pregnancies among users of the drug.

Women who used the contraceptive may not be aware if they received the prepacked form or that drawn from a vial. Pharmacia urged women who have been using Lunelle to contact their physician about another form of contraception and begin using an additional barrier form of contraception in the meantime.

Lunelle is an alternative to another injectible contraceptive, called Depo-Provera, that lasts three months. Like many birth-control pills, it works through a combination of the hormones progestin and estrogen.

Women taking the contraceptive injection still have monthly menstrual cycles.

Pharmacia said patients can call 1-888-691-6813 for more information. Healthcare professionals can call 1-800-323-4204.

On the Net: http://www.lunelle.com

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Helping Those Who Help Alzheimer's Patients 

HealthScoutNews

Thursday, October 10, 2002

WEDNESDAY, Oct. 9 (HealthScoutNews) -- An interactive (news - external web site) program to help people caring for a family member with Alzheimer's disease (news - web sites) is now available from the University of Florida.

Alzheimer's Caregiver Support Online, the first program of its kind, is staffed by university psychology professionals who do live, interactive classes on topics such as stress management, understanding and dealing with memory loss, and managing difficult caregiver tasks.

There's also a message board and regular telephone conferences with Alzheimer's experts so that caregivers from around the world can exchange comments and ask questions.

The program is available online here, or you can call toll-free at 1-866-260-2466.

Alzheimer's Caregiver Support Online was actually launched a year ago and promoted mainly to Florida residents. It proved a huge success. More than 2,400 people used the program's Web and phone services each month.

Based on that success, the university recently created a Spanish version of the program, also available here. It's the only exclusively Spanish site of its kind in the United States.

About 4 million Americans have Alzheimer's disease, and more than seven out of 10 of them live at home. Almost 75 percent of home care for people with Alzheimer's disease is provided by family and friends.

"Taking care of an older person with Alzheimer's typically includes managing potentially injurious behavior to self or others, issuing frequent reminders, and monitoring hygiene and self-care activities," says Robert Glueckauf, a professor of clinical and health psychology at the university.

"Unfortunately, such intensive activities are performed at a high cost to caregivers in terms of physical, financial and psychological resources. Caregivers typically experience reduced social activities, disrupted household routine and relationships, and deterioration of physical and mental health," Glueckauf says.

He designed the program to fill the large gap between caregivers' needs and the resources available to help them look after a family member with Alzheimer's.

More information

There's more about Alzheimer's disease at the U.S. National Institute on Aging.

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Old Age, Illness Up Urination Frequency at Night 

Reuters Health

Thursday, October 10, 2002

NEW YORK (Reuters Health) - Findings from a new study in elderly people suggest that frequent nocturia--waking up at night to urinate--can be related to age as well as a variety of health complications such as diabetes, poor sleep or irregular heartbeat.

"The aim of the present study was to investigate the possible relationship between some common diseases, medications and nocturia in the elderly," writes study author Dr. Ragnar Asplund of the Karolinska Institute in Ostersund, Sweden.

Asplund surveyed 6,143 men and women over the age of 65 about their overall health, including how many times they awoke during the night to urinate.

Those over age 70 were nearly twice as likely as younger people to report that they got up to urinate three or more times during the night, according to the report in the British Journal of Urology International.

Other health-related outcomes associated with nocturia were poor sleep, irregular heartbeat, diabetes and stroke, Asplund found.

"It has been well-known since long ago that congestive heart failure is associated with nocturia," Asplund told Reuters Health. "One finding in my study is that irregular heartbeats, but not angina (news - web sites) pectoris, was associated with increased nocturia."

Angina pectoris is severe chest pain linked to heart disease.

Asplund noted that people with nocturia who take diuretics--drugs used to boost fluid excretion--in the morning may want to take them later in the day or evening, "if there is no reason against such a change." Those that took diuretics 6 hours before going to bed had a "substantial reduction" in nocturia, he noted.

Source: British Journal of Urology International 2002;90:533-536.

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Scientists Find How Painkiller Damages Liver 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Thursday, October 10, 2002

THURSDAY, Oct. 10 (HealthScoutNews) -- Researchers say they have found a surprising mechanism by which acetaminophen causes liver damage and they are close to a better treatment for the overdoses that are the leading cause of liver failure.

Until now, the accepted picture has been that an overdose of the widely used painkiller sets off a series of molecular events that cause overproduction of a molecule called NAPQI that attacks liver cells, says David D. Moore, a professor of molecular and cell biology at Baylor College of Medicine. He is the leader of the group reporting the finding in tomorrow's issue of Science.

"What we add is that acetaminophen induces its own toxicity," Moore says. His research centers on a molecule called CAR, which regulates the response of the liver to a number of drugs. Working with mice, Moore and his colleagues show that high doses of acetaminophen activate CAR, increasing production of toxic substances.

The Baylor researchers have found a molecule, androstanol, which can block CAR activity if given within an hour of an acetaminophen overdose -- but only in mice. "CAR is different in mouse and humans," Moore says, different enough so that the treatment that works in rodents doesn't affect human liver cells. Research for an androstanol-like molecule that will be effective in humans is under way, he says.

"We haven't found anything very strong yet, but we are confident that we will be able to identify something," Moore says.

Acetaminophen overdoses now are treated with a compound that increases the body's production of glutathione, a naturally occurring molecule that neutralizes NAPQ1. Blocking CAR "would provide a completely different approach to acetaminophen toxicity and possibly to the toxicity of other agents for which no drug treatment is available," Moore says.

The discovery "provides a very clear and very elegant mechanism for how this damage occurs," says Steven Kliewer, a professor of molecular biology at the University of Texas Southwestern Medical Center who has done research in the field. "The more we understand about the mechanism, the better people will be able to treat it."

Until now, Kliewer says, "I don't think anybody has had a very good handle on how this happens."

The background to the research is concern about the possible dangers of acetaminophen, which is best known by the brand name Tylenol but which is found in more than 100 over-the-counter products. Last month, an advisory committee to the U. S. Food and Drug Administration (news - web sites) (FDA) recommended a stronger warning on products containing acetaminophen, and there have been some calls for changing its over-the-counter status. The FDA has not yet acted.

"An important part of the debate is that acetaminophen never received regulatory approval, since it was already on the market when the FDA began to give approvals," Moore says. "Some people think it would be reasonable for it to go through the approval process."

If acetaminophen is taken in the recommended dose, there is no danger, Moore says. One problem is that many people are not aware that a specific product they are using contains acetaminophen, he says.

What To Do

Detailed information about acetaminophen is available from the National Library of Medicine. Learn about its potential dangers from eMedicine.

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Youth Tobacco Limits May Prompt Thefts: U.S. Study

 

By Paul Simao

Reuters Health

Thursday, October 10, 2002

ATLANTA (Reuters) - Restrictions on the sale of tobacco to minors may be prompting more teen-age smokers to steal cigarettes or get them from parents and older friends, according to a US study of student smoking habits in Texas.

The study, published on Thursday by the US Centers for Disease Control and Prevention (news - web sites), found that the number of middle school students who smoked and reported stealing cigarettes rose more than 48% between 1998 and 1999.

Those who obtained cigarettes illegally in other ways jumped about 40%, according to the study, which surveyed thousands of students in 214 public schools in Texas.

The percentage of high school students who obtained cigarettes from an older person also increased.

At the time of the survey, Texas had tough laws that imposed fines on retailers caught selling cigarettes to minors, limited cigarette vending machines to adult-only locations and required proof of identification from youths attempting to buy tobacco. The laws were passed by the Texas Legislature in 1997.

The rate of illegal cigarette sales to minors fell to 13% in 1999 from 24% in the previous year.

"Stricter enforcement decreases sales in vending machines and stores, but particularly in middle school students results in a shift to other sources," said Terry Pechacek, associate director of science in the CDC's Office on Smoking and Health.

"This is a typical reaction," said Pechacek, who noted that states like Texas needed to combine strict anti-tobacco laws for minors with intensified community education programs involving youth, retailers and parents.

The CDC, which hopes to cut smoking by students in half to 16% by 2010, said smoking prevalence among middle school students in Texas dipped to 14.8% in 1999 from 20% the previous year. The rate for high school students, however, remained largely unchanged at just under 33%.

Nearly half a million Americans die each year from smoking-related lung cancer, heart disease and other illnesses, making smoking the No. 1 preventable cause of death in the United States.

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Bubble Boy Disease Baffles Doctors

By Lauran Neergaard

AP Medical Writer

The Associated Press

Thursday, October 10, 2002

GAITHERSBURG, MD. (AP) - A French toddler suffering a leukemia-like side effect from gene therapy that was used to cure an immune disorder called "bubble boy disease" is doing well, but scientists said Thursday they still haven't pinpointed what caused his illness.

There are clues, however, that a virus used in the treatment may be to blame, by accidentally causing a gene responsible for the formation of certain blood cells to become overactive.

No other children given gene therapy for the disease — severe combined immunodeficiancy, or SCID — have shown such a side effect. Still, scientists in France and the United States last week suspended studies of the gene therapy until they could decide whether additional safety steps are needed.

SCID is the only disease ever cured by gene therapy.

Advisers to the Food and Drug Administration (news - web sites) began a daylong meeting Thursday to evaluate what evidence there is that the treatment itself caused the 3-year-old to develop a leukemia-like illness.

The boy's physician, Dr. Alain Fischer, told the group by telephone from Paris that blood tests show the toddler's immune cell counts have returned to normal. He will do more tests soon to see if the child is in full remission, or whether he may need additional leukemia treatment.

SCID is a very rare inherited disease, occurring in about 1 in 75,000 births, in which patients' bodies don't make 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 is a good match. When those without a good match undergo a transplant anyway, a quarter die — although Duke University scientists told the FDA panel Thursday that they achieve a far better success rate when they can transplant into newborns instead of older babies.

Gene therapy however has worked in nine of the 11 X-SCID patients treated so far in Paris, thus creating great excitement until last week's announcement of the first side effect.

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

Scientists long theorized that cancer might occur if the therapy's virus lodged near certain genes that control cell growth and effected them too.

Painstaking analysis of the ill toddler's DNA, taken at different points after his gene therapy three years ago, shows that the SCID-correcting gene landed backward inside a cancer-promoting gene called LMO-2. It happened sometime after the SCID-correcting gene also landed in the right place, curing the boy's immune disorder. He appeared healthy until August, when scientists found leukemia-like overproduction of white blood cells. But the LMO-2 overactivation may have been occurring 17 months earlier, Fischer and Dr. Christof Calle of the University of Cincinnati told the panel.

However, it's still not clear if that alone is to blame. Cancer runs in the boy's family, something else under investigation.

The FDA panel will decide if more research is needed on this safety question before three U.S. studies of gene therapy for SCID patients will be allowed to restart.

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Second 'Superbug' Staph Infection Appears

By Adam Marcus

HealthScoutNews

Health Scoutnews Reporter

Thursday, October 10, 2002

THURSDAY, Oct. 10 (HealthScoutNews) -- Three months after the first case of "superbug" staphylococcus appeared in the United States, a second person has been diagnosed with the drug-resistant infection, health officials say.

Disease detectives in Pennsylvania say they identified a patient with vancomycin-resistant Staphylococcus aureus, or VRSA, last month. Vancomycin is one of the most powerful drugs to treat staph aureus infections, which are picked up by more than 200,000 hospital patients a year in this country alone.

S. aureus had already gained resistance to the earlier front-line therapy against it, methicillin, leaving vancomycin as the drug to kill it without fail. However, in recent years hardier strains of staph have cropped up in Europe, Japan and the United States that can withstand vancomycin to some degree before succumbing.

In another ominous sign, in 1988 scientists saw the emergency of vancomycin-resistant enterococcus, another bacterium. That event suggested it was only a matter of time before VRSA emerged -- and it did.

The new case is the second recorded incidence of VRSA in this country, following the discovery in June of a 40-year-old kidney failure patient in Michigan who also developed the infection. In both cases, the germ proved sensitive to other antibiotics.

Dr. Andre Weltman, of the Pennsylvania Department of Health, declined discussing details of the case, which officials are still investigating. However, Weltman says the patient, who was not identified, had been "in and out" of hospitals for several years and had also taken vancomycin in the past.

"What's of concern, but what's unanswered right now, is was this created clearly as a result of vancomycin exposure" or was the resistant bug a genetic cross between vancomycin-resistant enterococcus and methicillin-resistant staph.

"That's very likely what happened," says Dr. Scott Fridkin, a Centers for Disease Control and Prevention (news - web sites) medical epidemiologist working on the case. If so, it would mark only the second time such a mixed strain of S. aureus has been discovered worldwide, the other incident being the patient in Michigan, Fridkin says.

Staph infections can spread from person to person or by contact with fomites. These are inanimate objects, like a catheter or blood pressure cuff, contaminated with the germs. "We're looking to find out where this has spread," Weltman says. "We're optimistic it hasn't."

Methicillin-resistant staph infections (MRSA) now occur in as many as 80,000 hospital patients in this country each year, so VRSA is still only a budding problem. But it could spiral out of control without more careful prescribing from doctors and better hand washing by everyone, Fridkin says.

"Our hope is that through a concerted public health response to the emergence of VRSA, not only will we prevent continued emergence but we will reduce both [vancomycin-resistant enterococcus] and MRSA in the United States and worldwide," Fridkin says.

The Netherlands, Denmark and Belgium have been "very impressive success stories" in their efforts to reverse MRSA, he adds. "The battle is not lost."

What To Do

For more on S. aureus, try the U.S. Food and Drug Administration or the Centers for Disease Control and Prevention.

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Suicide Risk Runs in Families

By Kathleen Doheny

HealthScoutNews

Health ScoutNews Reporter

Thursday, October 10, 2002

THURSDAY, Oct. 10 (HealthScoutNews) -- A person is more likely to commit suicide if a family member has taken his or her own life or has a history of psychiatric illness, a new study suggests.

Danish researchers tracked 4,262 people between the ages of 9 and 45 who had committed suicide and compared them to more than 80,000 controls. They evaluated the suicide history of parents and siblings, history of psychiatric illness among parents and siblings and other data.

Those with a family history of suicide were two and a half times more likely to take their own life than were those without such a history. And a family history of psychiatric illness requiring hospital admission increased suicide risk by about 50 percent for those who did not have a history of psychiatric problems themselves.

Both types of family history boosted risk, but the effect was strongest for individuals whose family history included both suicide and psychiatric illness, the researchers report in this week's issue of The Lancet.

In previous research, experts have found that clustering of suicides within families occurs and that suicidal behavior in part might be genetically transmitted.

"To our knowledge, this is the first study demonstrating that the two familial factors [suicide and psychiatric illness] act independently on increasing the risk of suicide," says Dr. Ping Qin, lead author and a researcher at the National Centre for Register-based Research at Aarhus University in Denmark.

"Though we cannot conclude that there is a genetic factor associated with suicide, the findings from this large population-based study do suggest that the aggregation of suicide in families is likely due to a genetic factor rather than other non-genetic factors," Qin says. "And this genetic susceptibility is likely to act independently of mental illness."

More study is needed, she says, to find out exactly why a family history of suicide or psychiatric illness raises the risk of an individual taking his own life.

Lanny Berman, executive director of the American Association of Suicidology, says the study simply reinforces "what we have long known. With regard to family history of suicide, the pathway may be genetic, biochemical, and/or psychological. With regard to a family history of mental disorder requiring hospitalization, the same explanation might describe increased risk for similar mental disorder in offspring, and these mental disorders, in turn, are risk factors for suicide."

Another expert, Dr. Andrew Leuchter, a professor and vice chairman of the Department of Psychiatry at the David Geffen School of Medicine at UCLA, says the new study "confirms findings we have known for some time: that suicide does tend to run in families. We have known for some time that if you have a first-degree relative -- mother, father, sister, brother -- you are at higher risk for committing suicide." But "the significant addition of this study suggests there are independent and significant contributions both of a family history of suicide and a family history of psychiatric illness."

He adds a caveat, though: If you have a family history of both, you are not doomed. "Both family history of suicide and family psychiatric history are important risk factors, but they still account for only a minority of all suicides."

Qin agrees. In her study, she says, family suicide history accounted for 2.25 percent and family psychiatric history for 6.8 percent of the more than 4,000 suicides.

Regardless, she says health professionals should evaluate both suicide history and psychiatric illness history when they are assessing a person's suicide risk.

What To Do

For information on helping the suicidal person, try the American Association of Suicidology or Suicide Awareness Voices of Education.

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Iron Deficiency Still Common in Some Groups: CDC

Reuters Health

Thursday, October 10, 2002

NEW YORK (Reuters Health) - Mild degrees of iron deficiency are common in US toddlers, teenage girls and women of childbearing age, although full-fledged iron deficiency anemia remains rare, according to a new report from the Centers for Disease Control and Prevention (news - web sites) (CDC).

Anemia occurs when a person has insufficient stores of iron in the body. This can result in the blood becoming unable to supply the body with enough oxygen, which can lead to fatigue, and heart and gastrointestinal problems.

"One of the national health objectives for 2010 is to reduce iron deficiency in these vulnerable populations by 3 to 4 percentage points," Dr. Anne Looker, CDC senior research epidemiologist at the National Center for Health Statistics in Hyattsville, Maryland, and colleagues explain in the CDC's Morbidity and Mortality Weekly Report for October 11. Specifically, the goals are iron deficiency levels of 5%, 1% and 7% for toddlers, preschool children and females aged 12 to 49 years, respectively.

Looker's team compared national health and nutritional data from 1999-2000 with similar data from 1988-1994.

They found that the prevalence of iron deficiency was similar in both surveys for most age and sex groups. Iron deficiency remains 2 to 5 percentage points above the 2010 national health objectives, they note.

The estimated prevalence of iron deficiency was greatest among 1- to 2-year-old toddlers (7%) and 12- to 49-year-old women (9%-16%). Among minority women aged 12 to 49, the prevalence was two times higher than the 2010 national goals (19%-22%).

"We had hoped that there might have been more evidence of progress," Looker said. "While there is still time remaining until 2010, it would be nice to start to see a clearer picture that we were going down to those goals."

Physicians have a crucial role in helping the US meet 2010 goals, she said. The CDC is recommending that teenage girls and women of childbearing age be screened for anemia every 5 to 10 years, Looker noted, and that high-risk infants should also be checked. "Doctors can really play an important role in deciding who needs to be screened and look for it," she explained.

SOURCE: Morbidity and Mortality Weekly Report 2002;51:897-899.

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Botox Maker Seeks Approval to Treat Strokes

By Janice Billingsley

HealthScoutNews

Health ScoutNews Reporter

Thursday, October 10, 2002

WEDNESDAY, Oct. 9 (HealthScoutNews) -- Banishing the furrowed brow is not the only use for Botox.

It received approval for cosmetic use last April. But before that, the U.S. Food and Drug Administration (news - web sites) (FDA) had approved Botox -- the brand name for a purified form of a protein called botulism toxin type A -- to relieve patients' suffering from eye and neck disorders.

Now its manufacturer, Allergan Inc., is seeking FDA approval to use Botox to reduce spasticity in patients suffering from stroke.

In the same way that Botox temporarily paralyzes the muscles that contract to form frowns in the forehead, it can relax the muscles of patients whose involuntary muscle contractions hinder their movement and cause them pain. This is called spasticity. Neurologists have been using the drug for this purpose for the last decade, despite the fact that it hasn't received the FDA's blessing for this use.

The FDA approves drugs for specific purposes, which are outlined on the labels, but doctors can legally use the drugs for other purposes if they think they are useful.

"It is an excellent drug because it can be used very specifically -- you can pinpoint the exact muscle as well as the exact dose -- and because it doesn't have side effects like dizziness, drowsiness and constipation that can come with other drugs, like valium," says Dr. Susan Pierson, a Cincinnati neurologist.

She has been using Botox to treat spasticity in patients for 12 years: "Most of the major insurers pay for it, including Medicare," she says.

Indiana University neurologist Dr. Allison Brasher is lead author of the most recent study on the benefits of Botox in reducing spasticity. The study, published in a recent issue of The New England Journal of Medicine (news - web sites), found that people with severe problems using their hands and fingers after a stroke were twice as likely to get relief from Botox injections than if they did not have Botox treatments.

"As a physician and investigator on the study, I hope the FDA will consider The New England Journal of Medicine study strong evidence that Botox should be approved for spasticity," she says. "It clearly has clinical meaningfulness, improving the quality of life for these patients."

In the study, half of the 126 stroke patients received injections of 240 units of Botox, 12 times more than the standard dose for wrinkles, and half received injections of a placebo.

Over the next 12 weeks, they were then asked to rate their improvement on one of four self-selected criteria: improvement in personal hygiene, dressing, limb position or pain. Sixty-two percent of those who were given Botox injections found relief of their symptoms, while only 27 percent of the patients taking the placebo reported improvement.

The study, which was funded by Allergan, is being included as part of the company's Phase II trials for approval by the FDA.

"We are just in the planning process to begin Phase III trials," says Nancy Grondhuis, of Allergan's scientific information and medical compliance department. She adds that FDA approval is at least several years away.

At the Drake Center, a rehabilitation and post-acute care hospital in Cincinnati, Pierson and her colleagues have successfully used Botox to reduce spasticity not only in stroke victims, but in patients with multiple sclerosis and in a man who was paralyzed from the neck down following a car accident.

Key to successful Botox therapy, however, Pierson says, is that the doctor be knowledgeable about which muscles to inject.

"The more complicated the clinical problem -- which means where the muscles are located in the body -- the more you need an experienced injector," she says.

What To Do

An explanation of Botox, what it does and its FDA-approved uses can be found at FDA. More information about Brashear's study can be found at Indiana University School of Medicine.

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Arthritis More Common in Smokers, Divorced

By Alison McCook

Reuters Health

Thursday, October 10, 2002

NEW YORK (Reuters Health) - Researchers have long known that people with arthritis are more likely than others to be obese, older and less physically active. Now, new research shows that certain other factors may also be associated with the risk of arthritis.

According to Dr. Fatima Mili and colleagues from the Centers for Disease Control and Prevention (news - web sites) in Atlanta, Georgia, arthritis appears to occur more commonly in people who are separated or divorced, and in those who have ever smoked cigarettes.

In an interview with Reuters Health, study author Dr. Charles G. Helmick explained that identifying arthritis early helps treat the condition, because it enables patients to begin to ease their symptoms sooner rather than later. As such, along with asking patients about traditional risk factors for arthritis, Helmick suggested that healthcare providers try to detect early symptoms of the condition in smokers and divorcees.

"So if you're a healthcare provider, you may want to ask such people if they're having joint problems," Helmick noted.

The findings are based on telephone surveys of more than 54,000 people living in 15 states and Puerto Rico. The surveys questioned people about their behaviors and diagnosed them with arthritis if a doctor had ever done so, or if they complained of ongoing joint pain during the past year.

The study did not differentiate between osteoarthritis, which usually occurs in older people, and rheumatoid arthritis, an autoimmune disease that is more common in women than men and is most commonly diagnosed between the ages of 40 and 60, although it can occur at any age.

The investigators found that 17,556 of the people that responded to the survey had arthritis. As reported in previous studies, women and people who were older, obese, inactive or had low education and incomes were more likely than others to be diagnosed with the condition.

However, the researchers also spotted some new, previously unreported characteristics linked with arthritis: people who were divorced or separated, and those with a history of smoking cigarettes.

Specifically, people who were divorced were 30% more likely than similarly-aged married people to have arthritis, while smoking everyday was associated with a 60% increased risk of arthritis, relatively to those with no history of smoking, according to the report in a recent issue of the Journal of Rheumatology.

Previous studies have produced results that suggest a link between smoking and arthritis, the authors write, while others have refuted this relationship.

However, in this study, when the researchers eliminated the effects of other factors that can influence arthritis risk, past or present smoking was clearly associated with a higher risk of arthritis.

"When you combine all the types of arthritis, smoking seems to have an effect," Helmick told Reuters Health. "We really don't have a good reason for that," he added.

In terms of why arthritis could be linked to a disrupted homelife, the researcher suggested that severe types of the condition may put stress on a marriage, possibly leading to separation and divorce. Alternatively, Helmick suggested that the stress of a breakup could also aggravate the beginning stages of arthritis, which might induce people to seek medical advice about the condition for the first time, leading to a formal diagnosis of arthritis.

SOURCE: Journal of Rheumatology 2002;29:1981-1989.

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Did You Wash Your Hands?

HealthScoutNews

Thursday, October 10, 2002

(HealthScoutNews) -- Hand washing, correctly done, can easily prevent the spread of communicable disease. The better you wash, the more likely you are to remove even tiny particles that, if allowed to get into your mouth, could make you seriously ill.

Wisconsin's Department of Health and Human Services (news - web sites) has published a four-point guide to hand washing. The steps are:

• Wet your hands, ideally with very warm water.
• Add soap, then rub your hands together to make a soapy lather. Vigorously scrub the front and back of your hands, between your fingers and under your nails, for no less than 10 seconds before you ...
• Rinse the lather off your hands, letting the water run into the sink, not down your arms. In public restrooms, use a paper towel to turn off the water so you don't touch a potentially-dirty handle, then ...
• Dry your hands thoroughly with a clean towel.

The soap's job is to suspend dirt and germs so they can be washed away. Using very warm water is important because its warmth opens your pores, allowing you to clear out more dirt and germs.

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Warning Issued on Reuse of Needles

By Nick Trougakos

The Associated Press

Thursday, October 10, 2002

OKLAHOMA CITY (AP) - A hepatitis C outbreak that has infected 52 people in Oklahoma has led to a national warning to nurse anesthetists against reusing needles in intravenous tubes.

James C. Hill, a nurse anesthetist in Oklahoma City, told health officials he reused needles and syringes up to 25 times a day to inject pain medication through intravenous tubes at a pain management clinic in Norman and two surgical centers in Oklahoma City. Such reuse of needles can spread the disease, which can lead to serious liver damage, cancer and even death.

Hill is under investigation by the state Department of Health and the Oklahoma Board of Nursing.

Health officials have sent letters to 1,220 patients treated by Hill, telling them to get tested for hepatitis C, and 52 of the patients have tested positive since late August.

Last year, 19 patients of a Brooklyn, N.Y., clinic contracted hepatitis C when an anesthesiologist reused needles and a vial of medication.

The American Association of Nurse Anesthetists has sent 33,000 letters to hospital administrators, nurse anesthetists and nursing students nationwide, citing the Oklahoma outbreak and telling them not to reuse needles. Experts say some health practitioners may not be aware that reusing needles is dangerous because the needles are inserted into tubes rather than under the skin.

"After discussion with infection control experts, we have concerns there may be a widespread misunderstanding by health care practitioners of the dangers associated with the reuse of needles and syringes," the letter said.

Dr. Elliot Greene, associate professor of anesthesiology at Albany Medical College in Albany, N.Y., said studies done in the 1990s documented that health care professionals sometimes reused needles when injecting drugs into intravenous tubes.

"It was a shocking thing to see," said Greene, who serves on the task force for infection control in the American Society of Anesthesiologists. He said the problem has to do with a lack of education.

"There are a lot of people who started their practice before this was an issue," Greene said. "They got into certain practice patterns that are now considered bad technique."

Jeff Beutler, executive director of the nurse anesthetists association, said that when a shot is given into an intravenous line, a needle can easily come into contact with a patient's blood. Blood-to-blood contact spreads hepatitis C.

Beth Bell, chief of the epidemiology branch in the division of viral hepatitis at the Centers for Disease Control and Prevention (news - web sites), said research clearly shows the danger of reusing needles.

"The way that these kind of intravenous tubes are placed, what often occurs is that there is a back-flow of blood into the intravenous tube," she said.

State Epidemiologist Dr. Mike Crutcher said Hill believed he was practicing safe medicine.

"He didn't think it was abnormal procedure," Crutcher said. "It's hard to imagine that he would think it was normal."

Messages left on Hill's telephone answering machine were not returned.

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Survival Up Slightly for Some Lung Cancer Patients

Reuters Health

Thursday, October 10, 2002

NEW YORK (Reuters Health) - Survival rates for patients diagnosed with early-stage small cell lung cancer have seen modest improvements over the last 25 years, new study findings show.

Small cell lung cancer accounts for about one quarter of all newly diagnosed lung cancers. But most cases are only identified after the cancer has spread to distant sites such as the brain and liver. Patients typically live for only a matter of months after diagnosis, and few survive 2 years or more.

In the current investigation, Dr. Bruce E. Johnson of the Dana Farber Cancer Institute in Boston, Massachusetts, and colleagues evaluated the survival of 6,564 patients diagnosed with small cell lung cancer who participated in clinical trials between 1972 and 1992. All of the patients had limited-stage cancer, meaning it had not spread beyond the lung.

Half of the patients who participated in the trial between 1972 and 1981 survived for at least 12 months, the authors report in the October 1st issue of the journal Cancer. Survival improved by roughly 5 months for patients treated between 1982 and 1992, so that half of patients lived for at least 17 months.

Johnson and colleagues also analyzed data from the National Cancer Institute (news - web sites)'s Surveillance Epidemiology and End Results (SEER) cancer registry.

Over a similar time period, the SEER data showed that survival for people with limited-stage small cell lung cancer was extended by a median of 6.4 months. The SEER data also showed that the number of patients surviving for 5 years after diagnosis has doubled over the last 25 years, from 5.2% of patients to 12.1%.

Currently, the usual treatment for people with this type of lung cancer is a combination of chemotherapy and radiation therapy, Johnson and colleagues note.

Further research will be needed, they conclude, to determine the factors--such as better treatment or supportive care--that contributed to the improvement in survival.

SOURCE: Cancer 2002;95:1528-1538.

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Which Mammography Works Best?

HealthScoutNews

Thursday, October 10, 2002

THURSDAY, Oct. 10 (HealthScoutNews) -- Thousands of women are needed for a national study comparing the effectiveness of digital mammography to standard mammography in detecting breast cancer (news - web sites).

The Digital Mammographic Imaging Screening Trial (DMIST) is being coordinated by the National Cancer Institute (news - web sites) and the American College of Radiology. About 49,500 women are expected to take part in the study.

One of the study centers is the Jonsson Cancer Center at the University of California, Los Angeles (UCLA), which is working to recruit 2,475 women for its part of the study.

"This study is the next step in the digital revolution," says breast imaging expert Dr. Lawrence Bassett, principal investigator for the UCLA arm of the study and director of the Iris Cantor Breast Imaging Center at UCLA.

"Digital mammography holds promise to improve earlier detection of breast cancer, but a large study is necessary to see whether digital mammography really is better than, or as effective as, standard mammography," Bassett says.

"Despite some limitations, mammography remains the most effective way to detect breast cancer. It is the only detection method that has been studied in large trials and proven to reduce deaths from breast cancer. So working to improve mammographic images is critical to improving accuracy in breast cancer detection," he says.

Digital mammography uses computers and specially designed detectors to provide a digital image of the breast. This image can be displayed and enlarged, magnified, lightened or darkened on high-resolution monitors. The digital images can also be printed on X-ray film.

"One possible advantage of digital mammography is that it may be more effective in detecting cancers in women with dense breasts because the digital mammogram images have a wider contrast range than images on standard mammograms," Bassett says.

"With standard mammography, radiologists have a more limited ability to spot abnormalities in dense breast tissue or recognize tumors with subtle or faint borders," he says.

For more information about enrolling in the UCLA DMIST study, phone the Jonsson Cancer Center clinical trials hotline toll-free at 1-888-798-0719. For information about study sites across the United States, go to the DMIST Web site.

More information

To find out more about breast cancer detection, go to the U.S. National Cancer Institute.

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Gene Therapy Likely Caused Cancer in Child-Experts

By Maggie Fox

Reuters Health

Thursday, October 10, 2002

GAITHERSBURG (Reuters) - A gene therapy treatment that cured a baby in France of a deadly immune deficiency probably caused him to develop leukemia later on, US experts said on Thursday.

The US Food and Drug Administration (news - web sites) is reviewing all gene therapy experiments in the United States to decide whether they should be halted while the danger is assessed, said Dr. Philip Noguchi of the FDA's Center for Biologics Evaluation and Research.

"This clearly is not a coincidence," Noguchi told reporters at a meeting of a panel of experts advising the FDA on the issue.

The FDA is trying to decide whether to stop similar trials on children with immune deficiencies, or whether their risk of dying from immune defects outweighs any risk of leukemia.

Noguchi said there was no evidence anyone else had developed cancer from gene therapy. He said 150 different gene therapy experiments in the United States had used retroviruses--the same kind of virus used in the French trial and the virus blamed for causing the boy's cancer.

"We are actively reviewing not just (new) reports that come in, but we are re-reviewing reports for all other trials," he said. "So far we have not seen anything yet of a leukemia or a lymphoma in a person that was not present before being treated."

But experts at the meeting said it was possible other gene therapy experiments could cause cancers because many different genes can cause cancer when disrupted during the therapy.

The FDA said last week it had halted three gene therapy trials upon learning that the French boy had developed leukemia after being treated for X-linked severe combined immunodeficiency or X-linked SCID, also known as "bubble boy" disease.

SCID patients are born without any working immune system. Without treatment, they once lived out their short lives in sterile "bubbles" because any infection would kill them. A single genetic defect causes the syndrome.

The condition can be treated with bone marrow transplants, which are highly successful if done very early and with bone marrow from a relative whose tissue matches closely. But babies with no healthy matched relatives have fewer options.

The gene therapy, which reinforces the children's bone marrow with genetically engineered immune cells, had worked well in the children. Ten boys in France treated using gene therapy were living normal lives.

The French researchers, led by Dr. Alain Fischer of Necker Hospital in Paris, used a retrovirus to carry normal copies of a gene to correct the defect in bone marrow stem cells, and then infused the cells back into the boys.

Retroviruses insert their own genetic material into the DNA of the cells they infect. The corrected bone marrow cells grow and proliferate to replace defective cells.

For gene therapy, the virus is crippled so it cannot reproduce. But researchers cannot yet control where the virus puts its genetic material.

During gene therapy, tens and even hundreds of millions of cells are infected with the genetically engineered virus. The retrovirus integrates into random parts of the genome--the entire collection of genetic material.

It seems that when Fischer's team infected the boy's bone marrow cells with the virus, one virus integrated itself into a sensitive point on chromosome 11 in a single cell.

This was near a gene called LMO-2, which controls the replication of cells.

LMO-2 causes embryos to grow many of their blood cells, Dr. Christof Kalle of the University of Cincinnati, who analyzed the French child's blood cells, told the meeting. The virus probably reactivated this process, which caused leukemia.

Fischer said the boy was doing well on chemotherapy. He said the family had a history of cancer--the boy's sister had a brain tumor. And the boy had recovered from two viral infections, including chickenpox, which may have made him more susceptible to leukemia.

The other boys in the trial have been checked and do not have a similar overgrowth of blood cells.

The only gene therapy-linked death was in the US in 1999, when Jesse Gelsinger, age 18, died in an experiment for a rare genetic liver condition. Researchers say the uproar that followed Gelsinger's death has caused them to be extra-careful in this case.

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Cell Phone Pluses

HealthScoutNews

Thursday, October 10, 2002

(HealthScoutNews) -- With all the bad news about cellular phones, here's some positive information to talk about.

According to the journal Neuroreport, the psychology department at the University of Turku in Finland measured the effects of cellular phone use on 48 healthy volunteers. The researchers gave the subjects 12 tests to take, both before and after a long conversation on a cellular phone.

According to their report, talking on the cell phone resulted in faster reaction times and better results on mental arithmetic problems. Overall, the subjects' brains seemed to work faster and better after using the cell phone.

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WEDNESDAY, OCTOBER 9, 2002

New Drug May Help Break Cocaine Habit

HealthScoutNews

Wednesday, October 9, 2002

WEDNESDAY, Oct. 9 (HealthScoutNews) -- A new drug called Nocaine may help recovering cocaine addicts beat their habit in much the same way that methadone helps heroin addicts.

So says a study in the October issue of the Journal of Pharmacology and Experimental Therapeutics.

Nocaine was developed through Georgetown University Medical Center's Drug Discovery Program. The study was done by Georgetown University researchers, along with colleagues at the University of Mississippi and the University of Texas.

This study examined Nocaine's cocaine-like properties. The researchers found laboratory animals worked harder to get doses of Nocaine than they did to receive a placebo saline solution. However, the researchers also found the animals expended much less effort to get Nocaine than they did to get doses of cocaine.

"Our study results imply that Nocaine is a weak reinforcer -- meaning that it provides some of cocaine's effects, but at a much lower level," says William L. Woolverton, a professor of psychiatry at the University of Mississippi Medical Center.

Weak reinforcers are less likely to be abused than strong reinforcers such as heroin or cocaine, and that means the weak reinforcers are less likely to have abuse-related toxicity.

Earlier studies on Nocaine showed it may act to reverse the neurologic effects linked to cocaine withdrawal, and that Nocaine blocks cocaine's stimulant effect.

"Our studies have shown that Nocaine would likely blunt the aversive effects associated with cocaine abstinence, enabling addicts to gradually and safely withdraw from the drug," says Alan P. Kozikowski, a professor of neurology and director of Georgetown's Drug Discovery Program.

Phase I clinical trials of Nocaine are expected to start in early 2003.

More information

The National Institute on Drug Abuse has more on cocaine addiction.

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Skin, Natural-Antibiotics Studied

By Janet McConnaughey

The Associated Press

Reuters Health

HealthScoutNews

Wednesday, October 9, 2002

Scientists say they have found evidence that some people are vulnerable to infections because they lack certain germ-fighting chemicals naturally present in the skin.

The chemicals themselves were discovered a few years ago, and scientists have long known that they help protect animals from infection.

In a new study, researchers offered evidence that a lack of these natural antibiotics may explain why people with the most common form of eczema are highly prone to staph infections of the skin.

The skin has long been regarded as simply a protective barrier that separates us from our environment. But more recently, scientists have come to suspect that it plays a more active role, producing its own chemical defenses against microbes.

In Thursday's issue of the New England Journal of Medicine (news - web sites), researchers report that eczema sufferers typically make too little of two of these germ killers.

The discovery suggests that staph infections can be fought off by replacing these chemicals or by stimulating their production.

One of the researchers, Dr. Tomas Ganz of UCLA's medical school, cautioned that more research is needed to prove beyond a doubt that a lack of these chemicals contributes to eczema victims' infections.

The study involves a type of eczema called atopic dermatitis, an itchy allergic condition that often causes scratching that leaves the skin inflamed. It affects about 15 million people in the United States. About 90 percent of them wind up with long-term staph infections on their skin, though the germs do not always cause symptoms.

This study looked at two kinds of antibiotic proteins, called beta-defensins and cathelicidins. Both usually are found in large numbers in inflamed skin. Several years ago, large amounts also were found in the skin of people who have psoriasis, explaining why they get fewer skin infections than most people.

But when researchers looked at eight eczema patients' infected patches, they found none or nearly none of the chemicals.

"I think it is the beginning of a new type of thinking in medicine," said Dr. Enno Christianson, a scientist at the University of Kiel in Germany who discovered a number of human defensins.

Christianson said the study opens a new way to look at the body's defenses, since it does not involve the immune system but the epithelium, the body's surface tissue. Other defensins are created in mucous membranes and tissues lining the gut and the bronchial system.

Dr. Jon Hanifin of Oregon Health Sciences University, a member of the National Eczema Association's scientific advisory committee, said the researchers may have gone too far with their conclusions.

He said it is not at all clear whether the lack of the antibiotic proteins is a cause or effect: "It could be there's so much staph on the skin that it soaks up these defensins."

The study suggests that the body's allergic response suppresses production of these antibiotics. That means drugs already being tested against allergies and asthma might also help eczema sufferers get rid of skin infections, said the lead researcher, Dr. Donald Leung of the National Jewish Medical and Research Center in Denver.

Another researcher who worked on the study, Dr. Richard L. Gallo of the Veterans Affairs San Diego Healthcare System and the University of California at San Diego, said protein antibiotic creams now under development might also help.

On the Net:

New England Journal: http://www.nejm.org

National Jewish Medical and Research Center: http://www.njc.org

American Academy of Dermatology's eczema site: http://www.skincarephysicians.com/eczemanet/index.htm

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IV Drug Users with Hepatitis C Don't Play It Safe

Reuters Health

Wednesday, October 9, 2002

NEW YORK (Reuters Health) - Even after educational counseling, injection drug users who are infected with hepatitis C virus (HCV) do not heed safer drug use advice, a new report suggests.

The findings do not bode well for public health officials who hope to stem the spread of the viral infection among this high-risk group, according to lead author Danielle C. Ompad of Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

HCV is an infection of the liver that can lead to cirrhosis and liver cancer. It currently affects around 1.8% of the US population and can be spread via contaminated blood products or by injection drug use.

In the current investigation, the researchers aimed to learn how injection drug users responded to HCV testing and educational counseling regarding the virus.

In all, 46 injection drug users who tested positive for HCV were interviewed and given educational counseling about their drug behaviors at the beginning of the study and again 6 months later. Their responses were compared with those from a group of 60 similar injection drug users who were not infected with HCV, or did not know their HCV status.

"No significant differences were detected between the two groups," according to the report published in the October issue of the journal Clinical Infectious Diseases.

"Reductions in direct sharing of needles were observed for fewer than one fifth of the study subjects, suggesting that risk reduction counseling is of limited benefit," Ompad and colleagues write.

"We observed that many HCV-infected persons failed to reduce the frequencies of high-risk behaviors, such as direct sharing of needles and/or syringes and indirect sharing of injection equipment," the authors add.

The findings suggest that routine counseling "may not be enough" to change injection drug users' potentially HCV-spreading behavior, the investigators conclude.

SOURCE: Clinical Infectious Diseases 2002;35:783-788.

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Botox Maker Seeks Approval to Treat Strokes

By Janice Billingsley

Health ScotuNews Reporter

HealthScoutNews

Wednesday, October 9, 2002

WEDNESDAY, Oct. 9 (HealthScoutNews) -- Banishing the furrowed brow is not the only use for Botox.

It received approval for cosmetic use last April. But before that, the U.S. Food and Drug Administration (news - web sites) (FDA) had approved Botox -- the brand name for a purified form of a protein called botulism toxin type A -- to relieve patients' suffering from eye and neck disorders.

Now its manufacturer, Allergan Inc., is seeking FDA approval to use Botox to reduce spasticity in patients suffering from stroke.

In the same way that Botox temporarily paralyzes the muscles that contract to form frowns in the forehead, it can relax the muscles of patients whose involuntary muscle contractions hinder their movement and cause them pain. This is called spasticity. Neurologists have been using the drug for this purpose for the last decade, despite the fact that it hasn't received the FDA's blessing for this use.

The FDA approves drugs for specific purposes, which are outlined on the labels, but doctors can legally use the drugs for other purposes if they think they are useful.

"It is an excellent drug because it can be used very specifically -- you can pinpoint the exact muscle as well as the exact dose -- and because it doesn't have side effects like dizziness, drowsiness and constipation that can come with other drugs, like valium," says Dr. Susan Pierson, a Cincinnati neurologist.

She has been using Botox to treat spasticity in patients for 12 years: "Most of the major insurers pay for it, including Medicare," she says.

Indiana University neurologist Dr. Allison Brasher is lead author of the most recent study on the benefits of Botox in reducing spasticity. The study, published in a recent issue of The New England Journal of Medicine (news - web sites), found that people with severe problems using their hands and fingers after a stroke were twice as likely to get relief from Botox injections than if they did not have Botox treatments.

"As a physician and investigator on the study, I hope the FDA will consider The New England Journal of Medicine study strong evidence that Botox should be approved for spasticity," she says. "It clearly has clinical meaningfulness, improving the quality of life for these patients."

In the study, half of the 126 stroke patients received injections of 240 units of Botox, 12 times more than the standard dose for wrinkles, and half received injections of a placebo.

Over the next 12 weeks, they were then asked to rate their improvement on one of four self-selected criteria: improvement in personal hygiene, dressing, limb position or pain. Sixty-two percent of those who were given Botox injections found relief of their symptoms, while only 27 percent of the patients taking the placebo reported improvement.

The study, which was funded by Allergan, is being included as part of the company's Phase II trials for approval by the FDA.

"We are just in the planning process to begin Phase III trials," says Nancy Grondhuis, of Allergan's scientific information and medical compliance department. She adds that FDA approval is at least several years away.

At the Drake Center, a rehabilitation and post-acute care hospital in Cincinnati, Pierson and her colleagues have successfully used Botox to reduce spasticity not only in stroke victims, but in patients with multiple sclerosis and in a man who was paralyzed from the neck down following a car accident.

Key to successful Botox therapy, however, Pierson says, is that the doctor be knowledgeable about which muscles to inject.

"The more complicated the clinical problem -- which means where the muscles are located in the body -- the more you need an experienced injector," she says.

What To Do

An explanation of Botox, what it does and its FDA-approved uses can be found at FDA. More information about Brashear's study can be found at Indiana University School of Medicine.

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'Date-Rape' Drug Detectors Disputed

By Margie Mason

The Associated Press

Wednesday, October 9, 2002

SAN JOSE, Calif. (AP) - Colleges around the country are buying millions of coasters that test for "date-rape" drugs in drinks. But some experts say the coasters are ineffective and could lead to more assaults by creating a false sense of security.

The manufacturers — who also make fake snow and party foam — say the 40-cent paper coasters are 95 percent accurate. The coasters have test spots that are supposed to turn dark blue in about 30 seconds if a splash of alcohol contains drugs often used to incapacitate victims.

In tests at the Michigan State Police Crime Lab, however, the coasters failed to react clearly to drinks spiked with gamma hydroxybutyrate, a major date-rape drug known as GHB, said forensic scientist Anne Gierlowski.

"We tested red wine, cola, whiskey and orange juice and because three out of the four have color already, it was very hard to decipher a color change," she said. "It's a nice idea, but it's probably a nicer idea for the people selling them because they've probably made a lot of money."

Plantation, Fla.-based Drink Safe Technologies Inc. has sold about 50 million of the coasters since March, mostly to colleges and convenience stores, said president Francisco Guerra.

Guerra likens the coasters to condoms: While not 100 percent safe and effective, they are a good prevention tool.

"I've had 100 people say this saved them from getting raped," said Guerra, a former magician. "Before me, there was no way to detect it. It's nice to be able to do something about it."

A federal task force recently estimated that college drinking leads to an estimated 70,000 sexual assaults or rapes annually.

Yasmine Timberlake, a sophomore at San Jose State University, was grateful for the coasters handed out by the YWCA at a bar near campus.

"We're girls, and we've got to be careful," she said, putting a handful in her purse. "That's all we can do."

And students are now openly talking about date rape at St. Mary's University in Halifax, Nova Scotia, which bought 800 coasters to pass out to freshmen.

"That's the purpose: to educate them and to make them more aware," said Donnie Jeffrey, who runs St. Mary's alcohol-awareness program.

The coasters' labels promise they will help "identify the presence of illicit drugs in beverages." But in response to questions from The Associated Press, co-inventor Brian Glover, a New York dentist who dabbles in chemistry, acknowledged that the coasters can identify just two of the many date-rape drugs — GHB and ketamine.

There are 36 drugs on the street classified as date-rape drugs, too many for police field tests to detect, said Trinka Porrata, a retired Los Angeles detective who is an authority on GHB.

"I'm horrified to think people are actually buying it and passing it out. I think it will do more damage than it will ever do good," said Porrata, a board member of Project GHB, a prevention and education organization. "If it was that simple, we could shut down all of our crime labs."

Porrata tested different varieties of drugs on the coasters. Some test spots turned a slight shade of blue within 30 minutes; others did not change color until hours later, she said.

The Drug Enforcement Administration also advises against putting faith in tests that cannot keep up with the constantly changing chemistry of illegal drugs.

"In cases where there are scientific advances, the bad guys get around it faster than the good guys can," DEA spokeswoman Rogene Waite said. "I would urge people to be really, really, really careful. It's so dangerous, I wouldn't want them to rely on one thing."

On the Net:

Drink Safe Technologies: http://www.drinksafecoaster.com

Project GHB: http://www.projectghb.org

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Some Type 2 Diabetics Get Pancreas Transplants

By Amy Norton

Reuters Health

Wednesday, October 9, 2002

NEW YORK (Reuters Health) - As a treatment for diabetes, pancreas transplants are usually reserved for patients with the type 1 form of the disease. But a small number of people with type 2 diabetes-the most common form of the disease--are also considered good transplant candidates by US transplant centers.

In a survey of 44 such centers, researchers found that of all pancreatic transplant recipients in 1999, just under 2% were type 2 diabetics (news - web sites). Of these 16 patients, 14 were "intentionally selected"--meaning, the study's lead author told Reuters Health, they did not "sneak through" the patient-selection process, but were considered good transplant candidates.

In general, pancreatic transplants for diabetes are attempted only when the risks--such as organ rejection--are outweighed by the potential benefits of better diabetes management, noted Dr. Amy L. Friedman of Yale University in New Haven, Connecticut. The tactic, she said, is only rarely appropriate for type 2 diabetics.

That's why, according to the researcher, the results of the new study are "encouraging."

"Transplant centers are very restrictive in their patient selection...and have chosen only the most robust candidates who can, and do, thrive," she said.

Friedman and colleague Dr. Eli A. Friedman report the findings in the October issue of Diabetes Care.

Pancreas transplants are usually reserved for type 1, rather than type 2, diabetes because the two conditions have different underlying mechanisms. Type 1 diabetes arises-usually in childhood--from an aberrant immune system attack on the pancreatic cells that produce insulin. Insulin is an essential hormone that helps shuttle glucose (sugar) from the blood and into cells to be used as energy. In some cases, a new pancreas--or a transplant of insulin-producing pancreatic cells--can help control the disease.

In type 2 diabetes, by far the more common form, the pancreas is usually producing insulin, but the body cannot use it properly. The condition is closely associated with obesity and is most often seen in middle-aged and older adults.

In the current study, most transplant centers considered obesity and older age marks against potential pancreas recipients. For example, the researchers found, a 65-year-old candidate would make the waiting list at only 6 of the 44 centers. Nearly 88% of centers considered obesity a "relative" risk in pancreatic transplantation, while 18% considered it an "absolute contraindication" against the procedure.

It is unclear, Friedman said, why pancreas transplants work for a small number of type 2 diabetics, but it may be because these patients have become insulin-deficient, as type 1 diabetics are.

It is unlikely that more type 2 diabetics will be offered the treatment, she and her colleague note, in part because donor organs are in short supply.

SOURCE: Diabetes Care 2002;25:1896.

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Worms Need to Keep Their Wits in Place

HealthScoutNews

Wednesday, October 9, 2002

WEDNESDAY, Oct. 9 (HealthScoutNews) -- American and Japanese researchers are going "flat-out" in their efforts to better understand brain and nervous system development.

Working with flatworms, they've discovered a gene that makes certain the flatworm's brain develops in its head. When that gene is inactivated, the flatworm develops brain material throughout its body, including its tail.

The study, which appears in tomorrow's issue of Nature, "may help us to understand how we can rebuild organs and tissues after injury, disease or aging," the study authors write.

The flatworm gene is called ndk. That's short for "nou-darake", which is Japanese for "brains everywhere."

The researchers say the gene is present in humans. However, in humans this gene probably doesn't play a role in programming the brain to stay inside the skull. Instead, the gene likely has some other role in the development of the nervous system in human embryos, says study co-author Alejandro Sanchez Alvarado, a developmental biologist at the University of Utah School of Medicine.

Flatworms are simple organisms that live in fresh and ocean water and soil. Also known as planarians, they're about a quarter inch long. To reproduce, they attach their tail to a solid object and then swim away. The head and upper body detach from the tail.

The head and upper body grow a new tail, and the tail regrows a head. The same thing happens when a flatworm is chopped into pieces. Each piece grows into a new worm. Some of the processes involved in this kind of regeneration are similar to embryo development.

More information

Here's where to go to learn more about the brain and spinal cord.

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Drug Ads Spur 20 Percent of Consumers to Call Doc

Reuters Health

Wednesday, October 9, 2002

NEW YORK (Reuters Health) - One in five Americans say direct-to-consumer (DTC) advertising prompted them to call or visit their doctor to discuss an advertised drug, a new consumer tracking study finds.

The August PharmTrends survey by market research firm Ipsos-NPD also shows that 50% of consumers recalled seeing advertising for prescription products in the previous 12 months, up from 47% in the first survey conducted in February.

"The information is still telling us that consumers are accepting and actually eager to find information about prescription drugs," said Fariba Zamaniyan, director of Ipsos PharmTrends.

The percentage of consumers responding to a DTC ad by calling or visiting their doctors actually declined in August--to 20% from 25% six months earlier. Zamaniyan said the numbers might reflect seasonable fluctuation in drugmaker spending on DTC advertising.

"I wouldn't necessarily say it's a dip or a drop in the trend. I would say it's actually consistent," she told Reuters Health.

Considering that PharmTrends' DTC survey is based on a representative national sample of adults 18 and older, drugmakers have good reason to be encouraged by the 20% "call to action" their ads have provoked. "It's a good sign that they're getting a positive response from the general population," Zamaniyan said.

The latest survey also finds that 22% of consumers credit DTC ads with making them aware of potential drug options for their conditions, down from 25% in the February poll. Twelve percent said that they asked their doctor about a drug that they saw advertised, versus 15% in poll 6 months earlier.

These trends may become clearer once the firm has completed the third poll in the tracking series, Zamaniyan said. The February 2003 poll will provide a third snapshot-in-time of consumer behavior and enable year-over-year comparisons.

Ipsos NPD is a unit of the Paris, France-based global market research conglomerate Ipsos, which specializes in media, advertising and market research and conducts public opinion polling.

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Addiction Treatment to Be Available at Doc's Office

By Maggie Fox
Reuters Health
Wednesday, October 9, 2002

WASHINGTON (Reuters) - Drug addicts in the United States will soon be able to get medical treatment in the privacy of their own doctors' offices, thanks to the approval of two new drugs and a new piece of legislation, experts and lawmakers said on Wednesday.

Two formulations of the narcotic painkiller buprenorphine were approved by the US Food and Drug Administration (news - web sites) Tuesday night, and under legislation signed by US President Bill Clinton in 2000 they can be prescribed by specially licensed doctors and filled at a pharmacy.

The drugs, called Subutex and Suboxone, are the first two that can be prescribed under the legislation, aimed at getting drug addiction patients away from poorly attended clinics.

The new rules effectively give heroin and other opiate addicts more control over their treatment, and experts hope the combination of a new drug and easier availability will mean more addicts will seek help.

"We hope we have made a major impact on the reduction of heroin addiction," Sen. Carl Levin, a Michigan Democrat who helped sponsor the legislation, said at a news conference.

"Currently the available medications, methadone and ORLAAM (a relative of methadone), are extremely useful but ensnared in regulations that grossly limit their potential effectiveness," said Charles Schuster, a psychiatry professor at Wayne State University.

Fewer than 200,000 of an estimated 1 million opiate addicts in the United States are in treatment, added Dr. Harold Kleber, substance abuse director at Columbia University's medical school. This is in part because it is so difficult to get treatment at clinics, which tend to be in urban neighborhoods and often in crime-ridden districts.

At least half of those offered methadone treatment turn it down, according to the National Institute on Drug Abuse. Patients often dislike the atmosphere at clinics and want more of a say in their treatment than clinics offer.

New Drug

The new drugs, made by British pharmaceutical company Reckitt Benckiser Pharmaceuticals, not only block the effects of opiate drugs on the brain but also are considered less likely to themselves cause dependence and addiction.

Like methadone, buprenorphrine is related to morphine. It can be abused and it can kill if taken in an overdose.

Buprenorphine alone is sold under the brand name Subutex, while a second newly approved pill, Suboxone, also contains naloxone--another drug that interferes with the effects of opioids on the brain.

"Subutex and Suboxone are the first narcotic drugs available for the treatment of opiate dependence that can be prescribed in an office setting under the Drug Addiction Treatment Act (DATA) of 2000," the FDA said in a statement.

"Until recently, opiate dependence treatments...like methadone could be dispensed in a very limited number of clinics that specialize in addiction treatment. As a consequence, there have not been enough addiction treatment centers to accommodate all patients desiring therapy."

"I hope that FDA approval will help spur the private sector to redouble its efforts to find new cures for drug addiction," said Utah Sen. Orrin Hatch, a Republican who helped sponsor the legislation.

Hatch and others stressed that drug use should remain illegal, but said they hoped addicts would someday be treated as patients and not as criminals.

"Opioid dependence, as with other addictions, is a chronic relapsing disorder, not a character flaw, failure of will or lack of self-control. These drugs change our brains," Kleber said.

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Eczema Tied to Failure of Natural Antibiotic

By Ed Edelson
Health ScoutNews ReporterHealth ScoutNews
Wednesday, October 9, 2002

WEDNESDAY, Oct. 9 (HealthScoutNews) -- The recurrent infections suffered by people with the most common form of eczema are due to the failure of a newly discovered defense system that produces microbe-fighting molecules in the skin and other organs.

"We've known about these natural peptide antibiotics in lower animals, but there hadn't been any examples in humans that associated them with a disease," says Dr. Richard Gallo, chief of dermatology with the Veterans Affairs San Diego Healthcare System. Gallo is a member of the research team reporting the finding on this kind of eczema, known as atopic dermatitis, in tomorrow's issue of The New England Journal of Medicine (news - web sites).

"This gives us greater insight into the disease and might make clinicians more cognizant of the risk of infection for these patients," Gallo says. "We hope that within five years or so it will lead to a more rational design of antibiotic replacements for these patients."

However, the report has significance far beyond any skin condition, says Dr. Michael Zasloff, dean of research at Georgetown University Medical Center and author of an accompanying editorial. To him, it is an opening chapter of a medical story that ranks in significance with Pasteur's discovery of vaccination.

What Pasteur and others since then have regarded as the first line of defense, the system housed in the bone marrow that produces protective cells that fight invaders, is actually a backup for a "powerful, silent, innate" system that quietly manufactures molecules to fight microbes, viruses and fungi, Zasloff says.

"This becomes evident when you look at most of the animals on the planet," he says. "If you forget about vertebrates, you realize that most of the other creatures rely exclusively on the innate system for survival. We and other vertebrates have inherited a second system, above and beyond the innate system."

Acute dermatitis is an inherited disease that affects upwards of 3 percent of Americans, and is most common in childhood. The condition causes infections to occur again and again because skin cells do not produce natural antimicrobial compounds called cathelicidins and beta-defensins, the journal report says. Gallo first described those molecules in 1994.

As part of the study, researchers at the National Jewish Medical and Research Center in Denver showed the antimicrobial molecules work together to kill Staphylococcus aureus, a common cause of skin infections. When they compared skin samples from eight patients with atopic dermatitis, 11 patients with psoriasis and six healthy persons, they found elevated levels of the defense molecules in the psoriasis patients, a response to an infectious attack, but not in the atopic dermatitis patients, an indication that they were not responding properly to such an attack.

"The most frequent complication of atopic dermatitis is that the skin gets infected frequently," Gallo says. "Our finding that these natural peptide antibiotics are deficient in patients may explain why they get infections."

Similar defects in this innate system could explain many other human diseases, says Zasloff. A study to be published next week will show a link with periodontal disease, in which white cells fail to make the microbe-fighting molecules, he says.

"I am interested in disorders of the bowel," he says. "There is a fair amount of work going on in many laboratories that has not yet been published, which suggests that certain disorders, such as inflammatory bowel disease, are in fact problems with the innate immune system."

"This innate system keeps microbes at bay with very little energy and little tissue damage. When it fails us, the deeper second line of defense gets pulled in, and when that is mobilized all hell breaks loose."

Pharmaceutical companies are starting to get interested in these defensive molecules, Gallo says. "A number of companies have been looking at them," he says. "There are possible clinical applications, like diabetic ulcers and infections of the mouth."

And so, Zasloff says, "what seems to be a rather arcane finding touches upon the importance of the innate defenses system."

What To Do

Information about atopic dermatitis is given by the American Academy of Dermatology or the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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Genes, Environment May Shape Kids' Reading Ability

By Charnicia E. Huggins
Reuters Health
Wednesday, October 9, 2002

NEW YORK (Reuters Health) - When it comes to children's reading abilities, both their genes and their environment seem to play an important role, research findings suggest.

"As with most behavioral characteristics, differences between individuals' reading performance is influenced by both genes and environment. The influence of one does not preclude the influence of the other," lead study author Dr. Sally J. Wadsworth of the University of Colorado in Boulder told Reuters Health.

Her study included 245 adoptive and 245 non-adoptive parents and their children, all of whom were involved in the Colorado Adoption Project--a long-term study of genetic and environmental influences on behavioral development.

Overall, Wadsworth and colleagues found that the reading ability of the non-adopted children was similar to that of their biological parents, they report in the September issue of the Journal of Child Psychology and Psychiatry. There were no similarities in reading ability between the adoptive parents and their children.

Further, certain aspects of each child's environment seemed to greatly impact their reading performance, study findings indicate. Those environmental influences were found to be unique to each child. As such, they may be partly due to a child's schoolteachers and peers, and other differences in their school environments, the researchers speculate.

The investigators also found that the effect of an environmental influence, such as a parent reading to a child, on the child's reading skills did not vary based on whether the parent was an excellent or average reader. Parental reading ability, they observed, did not seem to change the impact of such environmental influences.

Altogether, Wadsworth and colleagues' findings support previous studies that compared the results of childhood versions of adult reading tests taken by 7- and 12-year olds to the results of their parents' reading tests. The new study also involved 16-year-olds, however, who completed the same adult-version reading tests that their parents took.

The Colorado Adoption Project is funded by grants from the National Institute of Child Health and Human Development and the National Institute of Mental Health.

SOURCE: Journal of Child Psychology and Psychiatry 2002;43:769-774.

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Rate of Hospital Errors in Prescribing Meds Up

By Alison McCook
Reuters Health
Wednesday, October 9, 2002

NEW YORK (Reuters Health) - Prescribers sometimes make mistakes when noting the physical form a prescription medication should take--such as a tablet, liquid or cream. However, these types of errors, known as dosage form errors, occur relatively often for hospitalized patients, and the rate at which they take place appears to have increased during the past 5 years, according to one US researcher.

Based on a review of dosage form errors at one hospital during that 5-year period, Dr. Timothy S. Lesar of the Albany Medical Center in Albany, New York, found that the rate of these errors increased from slightly higher than 0.6 for each 100 patients in 1996 to 1.3 per 100 patients in 2000.

Given these findings, Lesar writes that patients admitted to the hospital are "at risk for adverse outcomes due to prescribing errors."

As to why the rate of these errors appears to be on the rise, the researcher told Reuters Health that more medications are now available in different forms, which increases the chance that mistakes will occur.

The increase in dosage form errors on prescriptions is "most likely due to the rapidly increasing availability of unique or special dosage forms of medications, both of newly introduced and older, established medications," Lesar said.

The findings, reported in the recent issue of the Journal of General Internal Medicine, are based on a review of all prescription errors stemming from mistakes in how the medication should be given to patients. The errors occurred at one 631 bed hospital in New York State between January 1, 1996 and December 31, 2000.

When medication is prescribed, Lesar writes, an order is sent to a pharmacist. If the pharmacist believes there may be a mistake in the order--such as the wrong route of administration, dosing frequency or dose--they contact the original prescriber. Errors were considered to be orders that both people believe contain an error that needs correcting.

During the study period, Lesar reports that a total of 1,115 errors involving dosage form took place, 52 of which were considered to be potentially fatal or have serious effects.

The most common types of errors involved those in which the prescriber did not specify that the drug needed to be given to the patient in a controlled release form, which ensures that the medication will exert its effects in the body over a protracted period.

Three of the instances of medication order errors, if not corrected, were considered to be potentially fatal or severe, while another 49 errors were classified as serious, Lesar reports.

More than half of the errors involved cardiovascular drugs.

In an interview with Reuters Health, Lesar recommended that patients try to protect themselves from becoming victims of dosage form errors by learning the complete name of their medications, and asking both the prescriber and pharmacist if there are any special characteristics about the medication form.

Another piece of advice Lesar offered to patients: "Always look at your medications when getting refills to be sure that they look like the previous ones you used--if not, ask the pharmacist to double check."

SOURCE: Journal of General Internal Medicine 2002;17:579-587.

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Gene Predicts Prostate Cancer's Virulence

By Adam Marcus
Health ScoutNews Reporter
Health ScoutNews
Wednesday, October 9, 2002

WEDNESDAY, Oct. 9 (HealthScoutNews) -- A gene that silences tumor-blocking proteins is a red flag for aggressive prostate cancer (news - web sites), new research says, and men having low levels of it could be spared unnecessary treatments.

The gene, EZH2, is much more active in aggressive prostate tumor cells than in either localized cancer or in healthy prostate tissue.

"This helps us distinguish between aggressive prostate cancer and slow-growing prostate cancer, and allows us to identify patients appropriate for watchful waiting and those who need radical [prostate removal surgery] or radiation," says Dr. Arul M. Chinnaiyan, a University of Michigan pathologist and leader of the research effort. The study appears as a research letter in tomorrow's issue of Nature.

Prostate cancer affects roughly 190,000 American men a year, killing 30,000. Metastatic prostate tumors are almost always lethal.

EZH2 belongs to a family of genes called transcription repressors, which prevent cells from copying and carrying out the instructions of other genes. It also belongs to a cluster of genes that help cells remember their specific function as they divide.

When Chinnaiyan's group boosted EZH2 protein levels in prostate cells in a dish, they saw that the activity of 163 other genes flagged -- yet no other genes revved up. Some of these genes that were shut down can help cells fight cancerous mutations.

In another experiment, when they disabled EZH2 with small bits of genetic material called RNA, cell division halted. "Not only is EZH2 likely involved in proliferation and progression, but it could serve as a therapeutic target, too," Chinnaiyan says. However, he adds, the researchers have yet to test that approach in lab animals or patients.

EZH2 is also present in certain forms of blood cancers such as lymphoma, though its utility as a marker for these diseases isn't clear.

Bruce Zetter, a cancer biologist at Children's Hospital in Boston who studies why tumors become metastatic, says EZH2 seems to behave like the first in a line of dominoes: Tipping it sends the whole array into a tumble.

Knowing which genes encourage the spread of cancer is valuable for all tumor types, but especially for prostate cancer, Zetter says, since the disease isn't deadly for most men.

"What we need in prostate cancer is a better prognostic marker. We don't need to improve the diagnosis so much," says Zetter, co-author of a commentary on the study. "That's what these latest developments are paving the way to do."

Doctors currently have little success at eradicating large tumors that have migrated from a main site, Zetter says. But in the future, thanks to early detection of smaller metastases, they will be able to use therapies like tumor vaccines and low doses of anti-cancer drugs to suppress these wanderers before they become deadly.

In earlier work, Chinnaiyan and his colleagues discovered a gene called AMACR, which could help solidify a diagnosis of prostate cancer in the event of a fuzzy biopsy. Such ambiguity occurs in about 15 percent to 20 percent of samples.

AMACR might also improve screening for prostate cancer, which is now done by a test for prostate-specific antigen, or PSA. This test picks up elevations in a blood protein shed by prostate tumors. Unfortunately, it's produced by benignly enlarged glands, too, leading to much unnecessary treatment.

AMACR, on the other hand, appears only to be elevated in the presence of cancer, so a positive result would signal a tumor.

Chinnaiyan is now working on combining AMACR and EZH2 into a single genetic test that would both identify the presence of prostate cancer and determine its virulence. The cost of such a test would not be exorbitant, he adds.

What To Do

For more on prostate cancer, try the University of Michigan or the Prostate Cancer Research Institute.

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New Bill Would Ban Steroid-Like Muscle Builders

By Todd Zwillich
Reuters Health
Wednesday, October 9, 2002

WASHINGTON (Reuters Health) - A bill introduced in the US Congress Wednesday seeks to ban over-the-counter sales of steroid-like performance enhancers available in many health-food stores.

The measure would reclassify steroid precursors like androstenedione (news - web sites) and androstenediol as schedule III controlled substances, making them available only with a doctor's prescription.

The compounds, collectively known in gyms and locker rooms as "andro," become indistinguishable from anabolic steroids once metabolized in the body. As many as one fifth of gym-going US men in a January survey conducted in Boston acknowledged using "andro" over the previous 3 years.

Lawmakers said they were moving to ban store sales of the compounds because of their widespread use among teens and the associated health risks. Anabolic steroid use is linked to an increased risk of heart disease, liver damage and stunted growth in children.

"What 16-year-old doesn't want to knock the ball out of the park just a little bit further," said Rep. John Sweeney (D-NY), who is sponsoring the bill with Rep. Tom Osborn (R-NE), a former coach of the University of Nebraska football team. "These drugs are obtained too easily by youngsters," Sweeney said.

The US Anti-Doping Agency already lists androstenedione as a banned substance for competing athletes. The US Olympic Committee (USOC) also endorsed the proposal, which is not expected to get a vote in Congress until next year.

"It's about the creation of fair play on the field of competition," said Lloyd Ward, the USOC's chairman.

By law, schedule III classification is reserved for substances with some medical applications but also the potential for abuse. Anabolic steroids, some barbiturates, and codeine are all listed under schedule III.

The Council on Responsible Nutrition, a dietary supplements industry group, had no comment on the substance of the new legislation. "We are reviewing the bill," lobbyist Mike Greene said.

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New Drugs for Heroin Dependence

Health ScoutNews
Wednesday, October 9, 2002

WEDNESDAY, Oct. 8 (HealthScoutNews) -- The U.S. Food and Drug Administration (news - web sites) has approved two new drugs for heroin addicts who are going through withdrawal. And the agency says it will allow doctors to prescribe the drugs themselves, rather than having to refer heroin users to a relatively small number of treatment clinics.

Subutex and Suboxone, manufactured by Britain's Reckitt Benckiser Pharmaceuticals, are two new formulations of the drug buprenorphine, which helps curb heroin cravings. Subutex, which contains only buprenorphine, is meant to be used at the beginning of treatment. Suboxone -- meant to maintain treatment -- contains both buprenorphine and the opiate antagonist naloxone, which is designed to guard against intravenous abuse of buprenorphine.

Both drugs come in 2 mg and 8 mg tablets that are placed under the tongue and must be allowed to dissolve. The medications were found to be safe and effective in clinical trials involving more than 2,000 people.

Side effects include cold or flu-like symptoms, headaches, sweating, insomnia, nausea and mood swings. Those symptoms usually peak at the beginning of treatment and usually last a few weeks, the FDA says.

Here is the FDA Talk Paper about the approval. And for more about heroin addiction, see the National Institute on Drug Abuse.

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Women's Cough Reflex More Sensitive Than Men's

By Keith Mulvihill
Reuters Health
Wednesday, October 9, 2002

NEW YORK (Reuters Health) - Women have a more sensitive cough reflex than men, which may explain why specialty clinics that treat people with chronic coughs routinely have more female than male patients, researchers report.

"Among patients attending specialist cough clinics there is an excess of females, but the reason for this sex difference is unknown," according to Dr. Jack A. Kastelik of the University of Hull in the UK and colleagues.

To date, researchers have found that healthy volunteers who undergo cough sensitivity tests will cough when exposed to certain substances like citric acid or capsaicin, the chemical that puts the "hot" in hot pepper. And, in general, women tend to be more sensitive than men.

But no studies have aimed to identify a sex-related difference in cough reflex sensitivity among people diagnosed with chronic cough, according to the report published in the October issue of the American Journal of Respiratory and Critical Care Medicine.

To investigate, Kastelik and colleagues evaluated cough reflex sensitivity among 118 men and women with chronic cough. Patients underwent cough tests with capsaicin or citric acid or both.

The investigators found that women had a heightened cough reflex when compared to men, co-author Alyn Morice told Reuters Health.

"It is approximately double that of a man--for a given stimulus, women will cough twice as much," said Morice. "Unsurprisingly, women outnumber men by 2:1 in cough clinics and we show that coughing women have an even greater sensitivity."

However, "there is no difference in causes or treatment," Morice noted.

SOURCE: American Journal of Respiratory and Critical Care Medicine 2002;166:961-964.

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Study Faults Data on Asthma Inhalers and Growth

By Serena Gordon
Health ScoutNews Reporter
Health ScoutNews
Wednesday, October 9, 2002

WEDNESDAY, Oct. 9 (HealthScoutNews) -- Several recent studies have reassured the parents of asthmatic children that their youngsters' growth will not be stunted by the use of inhaled steroids.

However, researchers in the United States and Denmark are wondering out loud how reassuring those studies should be. They question whether the results were truly definitive because they didn't account for compliance rates. The latest round in this volley appears as a research letter in tomorrow's issue of The New England Journal of Medicine (news - web sites).

In medicine, compliance is a measure of how often a patient takes a prescribed medication. If the prescription is to take two puffs of an inhaler twice a day, and a child only takes two puffs in the morning, he is only 50 percent compliant.

"Past research which did not include measures of compliance should be interpreted with caution," says one of the authors, Dr. Ole Wolthers from the Children's Clinic in Randers, Denmark.

Almost 5 million American children have asthma, according to the American Academy of Allergy, Asthma and Immunology. Asthma is responsible for 5,000 deaths in the United States every year and accounts for almost 2 million hospital visits annually. Each year, 14 million school days are missed because of asthma.

Inhaled steroids are one of the most effective preventive treatments available to control asthma. They help to reduce the underlying inflammation that makes it difficult to breathe. However, Wolthers says that few patients on these medications stay compliant over the long term.

In the letter, Wolthers and his co-author, Dr. David Allen from the University of Wisconsin Children's Hospital, cite a study on compliance that monitored the actual use of medications by implanting an electronic chip into the inhaler to record dosing information. That study found compliance was near 80 percent at three months, but dropped to 54 percent at nine months and fell even further, to 49 percent, at 27 months of use.

Since previous studies have found that growth rates are slowed during the first year of inhaled steroid use and then gradually level off back to normal, the authors theorize that in the beginning, when compliance is at its highest, children are receiving a high enough dose to affect their growth. Later, as compliance wanes, the dose they receive is not sufficient to alter their growth rate, suggest Wolthers and Allen.

Does this mean parents should take their children off inhaled corticosteroids? Absolutely not.

"Steroids are important drugs in asthma management," confirms Wolthers. "They maintain lung function in the long term and in many cases may be lifesaving."

What the authors do recommend is that future studies take into account the likely lack of compliance.

Dr. Susanna McColley, acting head of the division of pulmonary medicine at Children's Memorial Hospital in Chicago, agrees that compliance should be considered in studies of the long-term effects of inhaled corticosteroids, but says that parents shouldn't be unduly alarmed by this issue. First, she points out that the data from the studies reflect real-life usage of the medications. She adds that, even in the worst-case scenario, growth might only be affected by a centimeter or two.

"Clearly, inhaled corticosteroids save lives and improve children's ability to attend school and avoid illness," says McColley. "Don't toss out a very effective medication for a theoretical concern."

She does, however, recommend that children be on the lowest dose of steroid possible. She also says that if your child's asthma is stable -- no missed school, no coughing at night, and no visits to the emergency room -- you should talk a doctor about reducing the dose of inhaled steroids. Also, children who are on inhaled steroids long-term should be visiting their doctors periodically and they should have their growth monitored, McColley adds.

What To Do

For more information about asthma, go to Kid's Health. To learn more about asthma medications, including inhaled steroids, visit the American Academy of Allergy Asthma and Immunology.

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Pilgrim's Pride Recalls Meat Due to Listeria

By Randy Fabi
Reuters Health
Wednesday, October 9, 2002

WASHINGTON (Reuters) - Pilgrim's Pride Corp., the second largest US poultry producer, recalled about 295,000 pounds of turkey and chicken deli meat due to potential contamination with Listeria bacteria, the US Department of Agriculture (USDA) said on Wednesday.

The USDA said the recall was not related to a major Listeria outbreak in the northeast US that has caused at least 20 deaths and 120 illnesses.

Pilgrim's Pride, headquartered in Pittsburg, Texas, recalled some of its ready-to-eat turkey and chicken products made at its Pennsylvania plant. The products were produced under the Wampler Foods brand, the USDA said.

Food contaminated with Listeria monocytogenes can cause high fever, severe headaches and nausea. The bacteria are especially dangerous for pregnant women, the elderly and those with weakened immune systems from cancer or other diseases.

The USDA said all of the recalled products were produced on Aug. 14 and distributed to retail stores and other institutions nationwide. All products bear the establishment code "P-1351" inside the USDA seal of inspection.

"We want consumers to be aware of the recall because of the potential for foodborne illness," said Garry McKee, administrator for USDA's Food Safety and Inspection Service (FSIS). "Diners may also wish to ask if their meals contain the products."

Unrelated To Listeria Outbreak

The USDA discovered the problem while investigating the cause of 120 Listeria cases in eight northeastern states. A sample at the Pilgrim's Pride plant tested positive for Listeria on Oct. 2, the USDA said.

"There is no link between the recalled products and Listeria monocytogenes illnesses in northeast states," the department said. "However, FSIS is continuing its investigation."

In the Listeria outbreak involving 120 illnesses, the USDA and the Centers for Disease Control and Prevention (news - web sites) (CDC) have linked at least seven deaths, three miscarriages and 43 illnesses to the same Listeria strain. Illnesses from the northeast Listeria outbreak were reported in Pennsylvania, New York, New Jersey, Delaware, Maryland, Connecticut, Ohio and Michigan.

Federal officials have not yet been able to pinpoint the source of this Listeria outbreak.

The CDC said last week it believed turkey deli meat was one likely source for the outbreak. The USDA has conducted more than 400 tests on lunch meats and deli products following the illnesses.

Health officials have advised those most at risk to avoid eating uncooked hot dogs, luncheon meats or soft cheeses as these products have been associated with listeriosis outbreaks in the past.

About 2,500 cases of listeriosis occur each year in the United States. Listeria can be destroyed by cooking meat to a temperature of at least 160 degrees Fahrenheit.

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Melanoma Deaths Climb Among Older Men

By Adam Marcus
Health ScoutNews Reporter
Health ScoutNews
Wednesday, October 9, 2002

WEDNESDAY, Oct. 9 (HealthScoutNews) -- U.S. death rates from the most severe form of skin cancer rose nearly 160 percent for older men during the last three decades, bucking a trend of fewer such deaths among the younger crowd, a new study shows.

The surge in fatal melanoma cases in older and middle-age white men was largely responsible for the nation's overall death rate from melanoma climbing 50 percent between 1969 and 1999, from two per 100,000 people to three per 100,000.

Melanoma deaths fell for Americans ages 20 to 44 during the same period, dropping by 39 percent for women and 29 percent for men in this age group. The researchers attributed the decrease in deaths among younger people to skin cancer education efforts and more prudent sun-bathing habits.

"They are beginning to reap some of the positive messages from the sun protection campaigns," said Alan Geller, a skin cancer expert at Boston University and lead author of the study.

The study, which looked only at whites -- who have 10 to 15 times as much melanoma as blacks and Hispanics -- appears as a research letter in today's issue of the Journal of the American Medical Association (news - web sites).

Death rates from the disease in women ages 45 to 64 rose 19 percent, from 2.6 to 3.1 people per 100,000, during the study period. Men the same age saw a 66 percent increase in deaths, from 3.8 to 6.3 people per 100,000. The increase for men 65 and older was 157 percent, three times the rate for women in the same age group.

Trends in melanoma incidence mirrored the mortality rates, jumping three-fold and five-fold for middle age and older men, respectively, in the study -- from 19 to 92 per 100,000 in those 65 and up -- but not quite doubling for young men.

Geller said it's not entirely clear why seniors are suffering so much more melanoma now than they did 30 years ago, but the surge reflects more than simply increased diagnosis of the disease. One theory, he said, is that sun exposures during World War II and the Korean conflict might be driving the rise. Another is that bathing suit styles in the 1950s and '60s revealed more skin than before, boosting the risk of cancer.

Geller and his colleagues stressed the importance of looking for suspicious moles and lesions, particularly on the back, and bringing them to the attention of a doctor. Men are especially bad at policing their own skin, with two-thirds of their cases of melanoma discovered by their spouses or their doctors, he added.

Catherine Poole, executive director of the National Melanoma Foundation, in Philadelphia, disputed the notion that Americans are being more cautious about the sun than they were 30 years ago. "Our society still thinks it's pretty healthy to be out there on the beach at noon," she said. "Our kids are playing sports at high noon."

Until the country takes a much dimmer view of the sun, Poole said, public education efforts will continue to fizzle.

This year, almost 54,000 people will be diagnosed with melanoma, and 7,400 will die of the disease, according to the American Cancer Society (news - web sites).

What To Do

For more information on melanoma, try the Melanoma Patients' Information Page or the National Melanoma Foundation. You can also check with the American Cancer Society.

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Protein Level Predicts Prostate Cancer Prognosis

By Alison McCook
Reuters Health
Wednesday, October 9, 2002

NEW YORK (Reuters Health) - People with prostate cancer (news - web sites) who have relatively high levels of a particular protein may be at increased risk of their cancer metastasizing, or spreading throughout the body, new research shows.

However, study author Dr. Arul M. Chinnaiyan of the University of Michigan Medical School in Ann Arbor cautioned in an interview with Reuters Health that these results remain preliminary, and it will be some time before doctors can use them to predict the risk of a man's prostate cancer becoming deadly.

"If (these findings are) validated in the near future, however, we hope that measuring (protein) levels in prostate needle biopsies will help patients and physicians choose between 'watchful waiting' versus a more aggressive treatment for prostate cancer," Chinnaiyan noted.

The researchers report their findings in the October 10th issue of Nature.

The question of whether to aggressively treat early prostate cancer is controversial, due to both the nature of the disease and the risks of treatment. Watchful waiting means that when cancer is detected, no immediate treatment is given, and the patient is instead monitored for signs that his prostate cancer is progressing. The approach is based on the premise that early prostate cancer may grow so slowly that it will never become a serious health threat; studies have shown that some men with early cancer confined to the prostate gland can live years without signs of disease.

During the study, the researchers measured the levels of the EZH2 protein in more than 1,000 tissue samples from people with healthy prostates, and from those with prostate cancer of varying degrees of severity.

Chinnaiyan and colleagues found that EZH2 protein levels in the samples appeared to increase with the severity of the illness, showing the highest concentrations in samples from people whose cancer had spread throughout their bodies.

In an interview with Reuters Health, Chinnaiyan explained that the reasons why the more severe forms of prostate cancer contain higher levels of the protein remain unclear. However, the researcher noted, EZH2 is a member of a complex of proteins that influence cellular identity, and previous studies have suggested that when this pathway is perturbed, cancer can result. "In other words, cells 'forget their identity' and thus progress to cancer," Chinnaiyan said.

However, these remain very early findings, the researcher cautioned, and future studies are needed before they can be used to predict how aggressive a patient's tumor is. "I think it would be premature to make patient care decisions based on these findings," Chinnaiyan noted.

Since the current study findings suggest that EZH2 may be involved in prostate cancer cell proliferation, targeting the protein may also help treat the condition, Chinnaiyan suggested. Future studies need to determine how blocking EZH2 might hurt patients before this approach would be possible, the researcher added.

"What is needed is a way of distinguishing prostate cancers that are, or will become, metastatic from those that will remain localized to the prostate," write Drs. Bruce R. Zetter and Jacqueline Banyard of Children's Hospital in Boston in an accompanying analysis piece.

"The best prognostic indicators would be molecules whose levels fall or rise during the transition to metastasis--as is the case with EZH2," they add.

SOURCE: Nature 2002;419:624-628, 572-573.

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Help Your Child Make Sense of a Scary World

By Nancy Deutsch
Health ScouitNews Reporter
Health ScoutNews
Wednesday, October 9, 2002

WEDNESDAY, Oct. 9 (HealthScoutNews) -- Maybe they've heard the frightening news from a friend, glimpsed it on TV, or listened to a graphic radio report.

Children -- even little ones -- may be all too aware of the deadly sniper shootings that have stunned suburban Washington, D.C.

And specialists agree that parents should move quickly to address their children's concerns, to reduce their worries and restore their sense of security.

"If parents don't talk about it, the message is it's too scary to talk about," says Dr. Joseph F. Hagan, chairman of the American Academy of Pediatrics' committee on psychological aspects of child and family health.

"If you don't bring it up, you miss the opportunity to reassure," Hagan adds. "I think the first piece of advice is to frame it: 'It is horrible, but it won't happen to you.' "

The way you reassure your children is as important as what you say. "The effect of how you talk about it is very important," Hagan says. For instance, don't broach the subject when you're upset or worried, because those emotions will come through and can upset your child, he says.

Hagan says children of all ages, even older teenagers, shouldn't watch the evening news without their parents.

"We're bringing pretty horrendous stuff into out living rooms," he says.

Headline-grabbing events like the sniper shootings -- or the 9/11 attacks, the anthrax-by-mail terror campaign, or the string of school shootings -- are often rebroadcast over and over. While adults can intellectually process such information, children often assimilate images differently, he notes.

Seeing a violent act several times "makes it more real for children," Hagan says. But if you watch television with your children, you can put matters into a safer context for them.

James Maddux, a clinical psychologist at George Mason University in Virginia, says that when a child brings up the subject, a parent should ask what she understands about the situation, and then answer honestly. "Kids hear all kinds of strange things from other children," and what they fear may be much worse than reality, he says.

Maddux recalls being a seven-year-old and believing all kinds of frightening -- though false -- stories about the Cuban Missile Crisis in 1962. "I would have been better off knowing the truth," he says.

Even a child of four or five may be ready to talk about something as unsettling as the sniper attacks, but parents are the best experts to gauge what is healthy for their child. "Most parents know how much information a child is ready for," he says.

Maddux, echoing Hagan, says put the child's fear into perspective. The odds that a child will be hurt by sniper fire are "thousands of times less than being struck by lightning or being hit on the highway on the way home," he says.

Also, simply being present for your child will make him feel safe, he notes. A parent's presence "provides true physical safety and a sense of psychological safety in children," Maddux says.

Older children can benefit from discussing with their parents what they can actually do to be safe, such as being aware of their surroundings, says Lisa Opipari-Arrigan, a pediatric psychologist at the University of Michigan. "Help the child feel they have some control," she says.

Children today are exposed to more scenes of violence than ever before, Opipari-Arrigan says. "Help by keeping lines of communication open. Provide reassurance about their safety," she says.

Be observant and note if your child is particularly moody, seems excessively worried, has sleep problems, or is stressed about world events, Opipari-Arrigan says.

But perhaps the most reassuring words for parents come from Maddux: "I think sometimes adults exaggerate children's fears. Children are more psychologically resilient than we give them credit for."

What To Do

For more information on helping children deal with crisis, check the Rocky Mountain Region Disaster Mental Health Newsletter, or the American Psychological Association.

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Emotionally Mature Kids More Sensitive to Criticism

By Charnicia E. Huggins
Reuters Health
Wednesday, October 9, 2002

NEW YORK (Reuters Health) - Though there may be great advantages for precocious preschoolers who have a high level of mental, social and emotional understanding, there may be disadvantages as well, new study findings suggest. These youngsters may be more sensitive to criticism.

"Some 5-year-olds think everybody likes them, that they're doing terribly well in everything," Dr. Judy Dunn of Kings College London told Reuters Health. Those in the study who had great levels of understanding, however, were more sensitive to how others reacted to them and to people not liking them, she said.

"This is the first clear indication, to our knowledge, that there may be costs as well as benefits to understanding other people well, early in life," write Dunn and co-author Dr. Alexandra L. Cutting of the University of Reading in the UK.

Their findings are based on a study of 141 first-grade students, 113 of whom had also undergone tests of their understanding during preschool. Dunn and Cutting evaluated sensitivity to criticism using a puppet scenario in which a teacher criticized a child for making a mistake in his or her schoolwork.

Overall, all of the first-graders were sensitive to criticism and responded to failure more negatively when the failure was criticized than when it was not criticized, the investigators report in the October issue of the Journal of Child Psychology and Psychiatry.

The 5-year-olds who showed a high level of mental and emotional understanding in preschool and in first grade, however, were the most sensitive to the teacher's criticism, study findings indicate. They also rated their own ability to perform a particular task as lower after they had been criticized and were more likely to say "the criticism made them feel that they were 'not good' at the task," the researchers report.

Consequently, it may be possible that young children who have "greater social understanding may have more fragile self-esteem," Dunn said.

"Sometimes it's the children who are the most acute and mature who are more vulnerable to minor criticisms and failures," she added.

A grant from the National Institute of Child Health and Human Development funded the study.

SOURCE: Journal of Child Psychology and Psychiatry 2002;43:849-860.

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Study Finds That in U.S., 1 in 3 Are Obese

By Sally Squires
Washington Post Staff Writer
Wednesday, October 9, 2002; Page A18

Americans are not just fat, they're getting fatter, according to a new government study that finds about one in every three adults is now obese and nearly two-thirds are overweight in the United States.

The number of overweight and obese people continues to climb at a steady rate despite the fact that Americans spend $34 billion annually on diet products, from sugar-free sodas and weight-loss supplements to diet programs, the study indicated. From 1999 to 2000, the number of overweight adults rose from 56 percent to 65 percent of the population, according to the federal Centers for Disease Control and Prevention. (Overweight is defined as having a body mass index of 25 or higher -- for example, a 5-foot-6-inch person who weighs 160 pounds or more.)

While waistlines are expanding across the board, the study shows that some groups are getting fatter faster than others. For example, more than half of black women 40 and older are obese, and more than 80 percent are overweight.

The findings suggest that "we are totally losing the battle to prevent and treat obesity," said George L. Blackburn, chairman of nutrition medicine at Harvard Medical School.

Also troubling is the rise in extreme obesity, according to the study, which is one of three papers on obesity published today in the Journal of the American Medical Association. Obesity is defined as having a BMI of 30 or greater, while extreme obesity is defined as having a BMI of 40 or greater. The number of adults with extreme obesity -- equal to a 5-foot-10-inch person weighing 280 pounds or more -- rose from 3 percent to nearly 5 percent from 1999 to 2000, according to the CDC. That trend worries public health officials, because this group is at greatest risk for severe health problems, including diabetes, high blood pressure, heart disease and kidney failure.

"The greatest concern is about African American women," said William H. Dietz, director of the CDC's Division of Nutrition and Physical Activity and co-author of the JAMA paper on extreme obesity. "More than half are obese, and 15 percent have a BMI greater than 40."

The obesity epidemic is not limited to adults. A companion study of children and adolescents, led by Cynthia L. Ogden of the CDC's National Center for Health Statistics, found that in 1999 to 2000, nearly 16 percent of 12- to 19-year-olds were overweight, an increase of nearly 5 percentage points from 1988 to 1994. Among black and Mexican American adolescents, the rise was even greater, jumping 10 percentage points.

About 7 percent of youngsters 2 to 5 were overweight in 1988 to 1994, according to the CDC. But in 1999 to 2000, that number rose to 10 percent. Among those 6 to 11, the number of overweight children increased from 11 percent in 1988 to 1994 to 15 percent in 1999 to 2000.

"This is a stunning increase and a really scary thing," said Richard L. Atkinson, president of the American Obesity Association and director of the Medstar Research Institute's obesity research. "The public health costs of this are just really frightening if the disease acts as it has in adults. It certainly portends a grave public health problem. . . ."

What to do, however, is a matter of great debate. In an editorial that accompanies the obesity studies, JAMA's deputy editor, Phil B. Fontanarosa, noted that "during a time when the amount of research activity, knowledge and interest in obesity among the medical community as well as the level of public attention to the issues of weight, diet and exercise have never been greater, the epidemic of obesity continues virtually unabated with no sign of reversal."

To help focus attention on obesity, JAMA announced plans to publish a theme issue devoted to obesity research in spring 2003.

On Tuesday, first lady Laura Bush and former U.S. surgeon general David Satcher were hosts of the Healthy Schools Summit to help promote physical activity and better nutrition in schools. A bill designed to address obesity with more research was introduced last summer by Sen. Bill Frist (R-Tenn.). Rep. Mary Bono (R-Calif.) recently introduced similar legislation in the House.

Experts said that these latest findings simply underscore the extent of the obesity epidemic. "Even if we were able to do everything perfectly to halt the trend today, it probably won't change the prevalence much for a decade," said Van S. Hubbard, director of the National Institutes of Health's Division of Nutrition Research Coordination.

Yet without better means of prevention and treatment, obesity experts predict a grim future. "We must have the surgeon general and the CDC intensify their efforts for early identification and early prevention of overweight and obesity," said Harvard's Blackburn, "or we are going to have the first generation of children who are not going to live as long as their parents."

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Brain Size Tied to Attention Deficit Hyperactivity Disorder

By Erica Goode
Wednesday, October 9, 2002

The brains of children and adolescents in whom attention deficit hyperactivity disorder is diagnosed are on average 3 percent to 4 percent smaller in volume than those of children without the condition, according to a large-scale government study whose findings were reported today.

And the greater the severity of a child's symptoms, the greater the discrepancy in the size of various brain areas, as measured on brain scans, the researchers said.

Disparities in brain volume have been found before in children with the disorder, differences that some had speculated might be a result of the medications commonly used to treat such children.

But the new work, reported today in The Journal of the American Medical Association, found the difference was present even among children who had never taken medication.

"I've always been extremely cautious about overinterpreting results," said Dr. F. Xavier Castellanos, the lead author, who directed the study at the National Institute of Mental Health. "But I think this is a definitive finding and something that needs to be considered."

Still, Dr. Castellanos, now at New York University's Child Study Center, said the difference in overall brain size was "not huge."

While smaller, the brains of the children with attention deficit hyperactivity disorder, also referred to as A.D.H.D., followed the same progression of development as those of the normal children. And the size difference, Dr. Castellanos said, could not be used to diagnose the disorder, because the difference was calculated using group averages and did not necessarily apply in individual cases.

"There are some kids with A.D.H.D. that have the second largest brains in the whole distribution," Dr. Castellanos said. It is not clear whether the size difference between the groups was present at birth but it did appear before school age, he said.

Attention deficit hyperactivity disorder is characterized by distractibility, hyperactivity and/or impulsivity, the American Psychiatric Association diagnostic manual says.

Experts said the study, conducted between 1991 and 2001, was the largest of its kind and the first to follow children over time and to include a large sample of children who had not been medicated.

The researchers used magnetic resonance imaging to examine the brains of 152 children, aged 5 to 18, who had A.D.H.D. and 139 normal children in the same age range. Forty-nine of the children with the disorder were scanned before they had received any medication to treat it.

Critics have argued that Ritalin, Adderall and other drugs used to treat attention disorders were the cause of the size differences in brain areas reported in previous studies.

According to some estimates, 1.3 million children from 5 to 14 in the United States, most of them diagnosed with attention deficit hyperactivity disorder, take Ritalin.

But Dr. Castellanos and his colleagues found that, as in children who had taken medication, the total brain volume of children who had never been medicated was significantly smaller than that of children in the control group.

"This study is so timely," said Dr. B. J. Casey, director of the Sackler Institute for Developmental Biology at Weill Medical College of Cornell University and an expert on pediatric brain imaging. "We've all wanted to see a study like this." The study found that the unmedicated children's brains also showed a "strikingly smaller" volume of white matter, pale central nervous system tissue heavy with fibers.

White matter increases with age, and the unmedicated children tended to be younger than the other participants. But Dr. Castellanos said the finding also raised the possibility that medication might enhance the normal maturation of the brain in children with attention disorders.

The largest size difference the researchers found was in the cerebellum, a brain structure just above the brainstem, which is involved in muscle tone, balance, the synchronization of muscle activity and perhaps other functions. The caudate nucleus, an area deep in the brain that is believed to serve as a relay station for information important in regulating attention and activity level, was also significantly smaller in younger children with A.D.H.D.. But by the time the children were 15, the caudate did not differ in size between the two groups.

Dr. Bradley Peterson, a professor of child psychiatry at Columbia University who is also a brain imaging expert, called the study's methodology "elegant" and said its findings would become a landmark.

But he added, "Unfortunately, it doesn't give us a clear idea as to where, specifically in the brain, things are going wrong for kids with A.D.H.D.," he said.

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Groups Call for Bans or Limits on Diet Supplement

By Maggie Fox
Reuters Health
Wednesday, October 9, 2002

WASHINGTON (Reuters) - The American Medical Association called for a ban on the weight loss supplement ephedra on Tuesday, and a top maker of the supplements said the industry should be more closely regulated.

When misused, ephedra can cause heart attacks and can kill even strong, healthy people, witnesses told a hearing of the Senate Subcommittee on Oversight of Government Management, Restructuring, and the District of Columbia.

The hearing is one of several being held while the US government ponders whether to restrict the supplement, which can be sold freely over the counter under current laws.

But the government is at the same time cracking down on some makers. On Monday, the US Food and Drug Administration (news - web sites) said it had warned a Dutch-based Internet company about its web site selling Yellow Jackets, an ephedra-containing herbal product, as an alternative to illicit street drugs.

On Tuesday Health and Human Services (news - web sites) Secretary Tommy Thompson said he had asked the FDA to recommend the "strongest possible mandatory warning label" for ephedra products.

Ephedra, also known as ma huang, is virtually the same ingredient as the pseudoephedrine found in many over the counter decongestants.

Companies that promote its use as a weight loss supplement say it can speed metabolism, helping users burn off calories.

But these same qualities can cause heart rhythm defects, says the American Medical Association.

Not Recommended For Weight Loss

"Diet aids (news - web sites) containing ephedra are not recommended for weight loss," the AMA's Dr. Ron Davis told the Senate subcommittee hearing.

"And because of ephedra's effects on the cardiovascular and central nervous systems, it may cause cardiac arrhythmias, heart attacks, strokes, seizures and sudden death in both previously healthy people, as well as in those with risk factors for these conditions."

Davis said people assume the supplements are safe, because they are classified as foods.

"Dietary supplements containing ephedra have significant risks, which may be serious or fatal to people with preexisting illnesses, as well as those who were previously healthy. They should be removed from the market," he said.

Dr. Sidney Wolfe, of the consumer organization Public Citizen's Health Research Group, agreed.

"This is not and has never been a question of scientific or medical evidence. It is a question of politics, and the extraordinarily dangerous political cowardice of the FDA and HHS Secretary Thompson in the face of massive lobbying by ephedra-makers in Washington," Wolfe told the hearing.