Personal Health for the Week of December 14-20

FRIDAY, DECEMBER 20, 2002  

1. Red Cross May Have Released Unsafe Blood
2. Western Culture May Be Culprit Behind Acne: Theory
3. 19 States Require Contraceptive Coverage
4. Why a Man's 'Ouch' Is Different Than a Woman's
5. Herpes Vaccine on the Horizon
6. Study Reveals Why Pregnant Women Snore
7. Some Respite From Breast Cancer Treatments
8. Lead in Bones Linked to Pregnancy Blood Pressure
9. Preventing Cancer
10. Blood Sausage May Hinder Colon Cancer Testing
11. Studies: Widespread Smallpox Shots Unwarranted
12. Child Bookworms
13. Pigeon Breeders at Risk of Long-Term Lung Damage
14. Herbal Treatment Shows Promise Against Prostate Cancer
15. New Transplant Rules to Protect Living Donors
16. New Study Debunks Value of HRT
17. FDA: Danger for Those with Deep Brain Stimulator
18. Clozaril Treats Suicidal Behavior
    
    THURSDAY, DECEMBER 19, 2002 
    
    
19. Treating Tourette Syndrome
20. One-Click Marijuana Shopping for Sick Canadians
21. Fighting Anemia's Side Effects
22. Stroke Patients Often Ignore Warning Signs
23. Parents Ignore Heft and Contents of Kids' Backpacks
24. Smoke Exposure Cuts Babies' Ability to Wake Up
25. Studies of Herbal Medicine Found Inadequate
26. Study Shows Pacing Defibrillators May Damage Hearts
27. More Teens Struggling With Depression
    
    WEDNESDAY, DECEMBER 18, 2002 
    
    
28. CDC Fact Sheet Not Promoting Condom Use
29. Genetic 'Signature' Predicts Breast Cancer Outcome
30. Premature Births Up, Teenage Births Down
31. Extra Day in Hospital May Not Help Moms, Newborns
32. Artificial Heart Testing Misses a Beat
33. FDA Cracks Down on Supplements, Eases Up on Food
34. Weathering Winter
35. Italian Surgeons Remove Liver to Treat Cancer
36. Treating Corns
37. More Rigorous Dialysis Won't Boost Survival: Study
38. Chocoholic
39. Tax Credits Little Help for Low-Income Women: Study
40. Extra Help With Diet Makes the Difference
41. Birds May Spread Ebola Virus, Research Suggests
42. Inhaled Steroids Can Lead to Falls Among Elderly
43. FDA Panel Backs Nasal Mist Flu Vaccine
44. New Antibody Buys Time for Brain Cancer Victims
45. Better Housing Boosts Poor Youngsters' IQ: Study
46. Infant Hair Sample Betrays Maternal Drinking During Pregnancy
47. Parkinson's Drug Linked with Heart Valve Trouble
48. New Drug Holds Hope for Deadly Fungus
49. Eating Oily Fish May Reduce Risk of Asthma
50. More Women Receiving Prenatal Care
51. Chocolate-Derived Chemical Could Suppress Cough
52. SERMs May Be Healthier Choice Than HRT
53. Young Girls, Older Partners Leads to High STD Risk
    
    TUESDAY, DECEMBER 17, 2002 
    
    
54. Older, Cheaper Drugs Best for Hypertension
55. Women, Men Benefit Equally from Angioplasty
56. FDA Panel Clears Flu Spray for Some
57. Consumers Blame Drugs for Higher Healthcare Costs
58. Ultrasound Can Detect Down Syndrome
59. Summertime Birth Linked with Celiac Disease: Study
60. Use Lung Scans With Care
61. Some Women Advised Against Cancer Test
62. Spate of Thyroid Cases Baffles Army
63. Tamoxifen Underused in Oldest Cancer Patients
64. Study Questions Drinking-Lung Cancer Link
65. Poinsettia Not Lethal, Experts Say
66. Diplomats Prod U.S. on Affordable Drugs
67. Diuretic as Good as Newer Drugs for Blood Pressure
68. U.S. Joins Suits on Cardiac Devices
69. Study Finds Cholesterol Drug Does Not Cut Deaths
70. California Inmate Who Got New Heart Dies
71. Early Joint Replacement Better for Osteoarthritis
72. Pint-Size Pimples
73. US Seeks Law to Confirm FDA's Child Drug Authority
74. Stress-Busters
75. Experimental Drug Eases Early Parkinson's Symptoms
76. Platelets Found to Play Role in Atherosclerosis
77. IBM Takes Heart Monitor a Step Further
78. Cipro XR Treats Urinary Tract Infections
79. Groups to Appeal Ruling on Drug Tests in Children
80. Cancer Trials: Whom Do They Help?
81. Doctors promote acupuncture for children
82. Statins Work, If You Take Them
    
    MONDAY, DECEMBER 16, 2002 
    
    
83. Faster Care for Stroke Victims Sought
84. Nuts for Nuts
85. Osteoporosis
86. Legislation Sought on Child Drug Research
87. Check Your Heart Condition Online
88. Court Upholds Medicaid Prescription Plan
89. Want a Better Memory? Practice, Practice, Practice
90. Radiation May Help With Brain Defect
91. Eating Your Way to Acne
92. Acetaminophen Overdose Leading Liver Failure Cause
93. Echinacea Has No Effect on Colds
94. Study Zeros in on Smoking's Bone Thinning Link
95. Pain Isn't the Same Between the Sexes
96. Overnight Lenses Correct Kids' Daytime Vision
97. Ex-Heavy Drinkers Show Metabolic Changes
98. Brain Appears to Have 'Daydreaming' Mode
99. Father's Drinking Predicts Kids' Disruptive Behavior
100. Jury Out on Antioxidant, Eye Condition: Study
101. Doctors Chided for Neglecting Heart Risk
102. Scan Dye May Worsen Lung Inflammation: Study
103. Smallpox Outbreak a Century Ago Holds Clues for Today
104. New Technique to Treat Congenital Heart Defects
105. Combination Vaccine for Kids
106. Filtering Office Lights Eases Workers' Eyestrain
107. New Drug Stalls Parkinson's Progress
108. Firefighters May Have Slightly Higher Cancer Risk
     
     SUNDAY, DECEMBER 15, 2002 
     
     
109. How Not to Look Your Age
110. Dodge the Fat When Dining Out
111. Ailments Persist in Many WTC Rescuers
     
     SATURDAY, DECEMBER 14, 2002 
     
     
112. Hit the Gym Before You Hit the Slopes
113. Flu Medicines Not Perfect, But Useful

FRIDAY, DECEMBER 20, 2002

Red Cross May Have Released Unsafe Blood 

By Lauran Neergaard

Associated Press Writer

The Associated Press

Friday, December 20, 2002

WASHINGTON - The American Red Cross (news - web sites) may have released tainted blood to hospitals, the government said Friday, reporting more than 200 violations of federal blood safety rules in its battle to get the Red Cross to improve the quality of its blood operation.

The Food and Drug Administration (news - web sites) said it was investigating further to determine whether patients received bad blood.

"The blood supply is not as safe as it should be," said FDA Commissioner Mark McClellan. "I am troubled by apparent lapses in blood safety."

The Red Cross, which provides 45 percent of the nation's blood supply, said it is working hard to improve safety.

A year ago, the FDA went to court seeking contempt charges for 10 years of Red Cross safety violations. Friday's preliminary report on safety at the Red Cross biomedical headquarters suggests the problems have not been fixed, McClellan said, suggesting they point to "a culture willing to accept noncompliance."

Specifically, the FDA alleges that some Red Cross employees were instructed to skip required safety steps, and others altered records, to allow release of blood that had failed safety testing.

In addition, the Red Cross failed to screen out some people who were not supposed to give blood, the FDA said. It was unclear what happened to the units these people donated, the agency said.

More than 1,000 units of blood were unaccounted for, it said.

The FDA emphasized that anyone who needs a blood transfusion should get one, because the risk of forgoing a medical procedure is much higher than the risk of getting bad blood. The agency also noted that people who donate blood face no risk.

The Red Cross acknowledged problems and promised to fix them.

"The Red Cross understands more work needs to be done to further strengthen our processes and procedures, and we are fully committed to working collaboratively with the FDA to enhance our systems," Remesh Thadani, who heads biomedical services, said a statement Friday.

More than 200 individual violations were identified, the FDA said. Among them:

_Lack of management control and quality assurance oversight. Required testing steps were not always documented, and some employees reported being told to skip required steps.

_Data integrity: Employees were alleged to have changed records to indicate that flagged blood was safe.

_Failure to correct deviations from previous inspections, including failure to follow standard operating procedures.

_Release of unsuitable products. Donors in one Red Cross region who are found unsuitable are supposed to be listed in a donor deferral registry. They were not, and some went on to donate in other regions. In some cases, the FDA does not know what happened to their donated blood.

It was the first inspection of the Red Cross headquarters since last December, when the government asked a federal judge to hold the Red Cross in contempt for repeated violations of blood safety regulations, including shipment of contaminated blood.

In court, the FDA charged cited "persistent and serious violations" dating back 16 years and continuing despite a 1993 federal court order requiring improvements.

A year ago, the Red Cross vowed to fight the FDA. After getting a new director this summer, however, the two sides entered negotiations toward a settlement. The Red Cross said Friday it is making substantial progress; the FDA would not characterize the status of the talks.

The Red Cross refused to respond to specific allegations. But in a pre-emptive move, Red Cross officials had gathered reporters early this week to explain improvements made in recent months.

They said they have hired 175 people to work on quality and vowed better training for employees and improved computer systems that would be less prone to human error.

The Red Cross also has moved to an electronic blood donor record. In the past, some blood banks accepted blood from people who had not answered questions about the risk of HIV (news - web sites) infection or who had answered "yes" to questions about high-risk behavior. Under the new system, people who leave these questions blank or answer "yes" will not be allowed to donate.

The Red Cross also displayed a chart demonstrating that the number of FDA violations had fallen over the past several years to about 100 in 2001. With the most recent inspection, more than 200 violations have been identified for 2002.

Associated Press Medical Writer Lauran Neergaard contributed to this report.

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Western Culture May Be Culprit Behind Acne: Theory

 

By Jacqueline Stenson

Reuters Health

Friday, December 20, 2002

NEW YORK (Reuters Health) - Calling into question the current medical belief that diet does not affect acne, a new report suggests that regularly eating breads, cakes, chips and other staples of Western culture may promote the skin condition.

Dr. Loren Cordain, a professor of health and exercise science at Colorado State University in Fort Collins, and colleagues arrived at their conclusion after studying two non-Westernized populations: the Kitavan Islanders of Papua New Guinea and the Ache hunter-gatherers of Paraguay.

In the December issue of the Archives of Dermatology (news - web sites), the study authors report that they found no evidence of acne among 1,200 Kitavan Islanders aged 10 or older, including 300 of them between 15 and 25. They ate primarily fruit, fish, tubers and coconut but almost no cereals or refined sugars.

The researchers also saw no acne among 115 Ache hunter-gatherers, including 15 aged 15 to 25. Their diet consisted mostly of the root vegetable sweet manioc, peanuts, maize and rice, as well as some wild game. About 8% of their diet was made up of Western foods such as pasta, sugar and bread. Previous studies also have found that acne is rare or nonexistent in people living in non-industrialized cultures but tends to appear when they transition to a Western way of life, the report indicates.

In Western cultures, studies have indicated that acne affects 79% to 95% of adolescents and persists into middle age in 12% of women and 3% of men.

While genetic factors are known to play a role in acne, the authors point out that other groups of Pacific Islanders and South American Indians who live in more Westernized settings have higher rates of acne.

So the investigators turned their focus to environmental differences that might contribute to acne. "The most likely environmental factor that can elicit the hormonal cascade underlying acne is dietary in nature," Cordain told Reuters Health. "High-glycemic-load carbohydrates have been demonstrated to cause the exact hormonal changes known to occur with acne."

He said there is evidence to suggest that high-glycemic carbohydrates--those that substantially boost blood sugar levels--"set off a series of hormonal changes known to underlie the development of acne."

Elevated blood sugar leads to increases in insulin production, Cordain explained. This affects other hormones that ultimately can cause excess oil in the skin to be produced, pores to be clogged and bacteria that cause acne to thrive, he said.

High-glycemic foods include cereals, bagels and other breads, doughnuts and cakes, crackers, chips and candy.

Low-glycemic diets, including plenty of fruits and vegetables, might offer a new treatment option for people with acne, Cordain suggested.

However, this remains to be proven, note the authors of an accompanying editorial.

"Whether adherence to a diet with a low glycemic load can alter acne in other populations is unknown," write Dr. Diane Thiboutot of Hershey, Pennsylvania, and Dr. John Strauss of Iowa City, Iowa.

And while observations suggest that acne can develop in groups such as Eskimos who didn't have the skin condition until they started eating more high-glycemic foods, the editorialists add, "no systematic studies are available to fully support or refute these observations."

Source: Archives of Dermatology 2002;138:1584-1592.

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19 States Require Contraceptive Coverage

 

By Liz Sidoti

Associated Press Writer

The Associated Press

Friday, December 20, 2002

COLUMBUS, Ohio - Beth Taggart pays $35 a month out of her own pocket because her insurance does not cover birth control pills. That doesn't seem quite fair to her, considering the sort of things her health plan does cover.

"When I think that Viagra is covered, and the consequence of Viagra is not covered, it's hard to believe," said the 40-year-old former state employee and mother of a baby daughter. "Plus, it's a health concern, especially for people who just had babies and don't want to get pregnant again within the first year."

Lawmakers are listening: The debate over whether health plans should be required to include contraceptive coverage has moved into nearly all state legislatures

This year alone, in at least 19 states, including Ohio, more than 60 bills regarding insurance for birth control pills and devices have been introduced. Three of those states, New York, Arizona and Massachusetts, enacted laws, bringing to 20 the number of states that have passed such measures over the past five years.

Most of the laws require health insurance policies that cover prescription drugs to cover prescription contraceptives, too. Some states include an exemption for employers who object to such coverage for religious reasons.

"This momentum underscores that failure to cover contraceptives is illegal sex discrimination, and people now are recognizing that," said Elizabeth Cavendish, legal director of the National Abortion and Reproductive Rights Action League (news - web sites) in Washington.

The debate is only a few years old, having taken a back seat for decades to abortion rights. Pressure for contraception coverage grew sharply in the late 1990s when Viagra went on the market and insurers quickly covered it, but not such things as birth control pills, diaphragms, intrauterine devices or Norplant.

Two years ago, the U.S. Equal Employment Opportunity Commission issued an opinion that said not providing insurance for contraceptives amounts to sex discrimination. And two federal court rulings last year cited the opinion.

Federal legislation to force insurance companies to offer contraception coverage has languished in Congress since 1997. As a result, most of the action is taking place at the state level.

Ohio state Sen. Priscilla Mead, a Republican, introduced a bill last fall that went nowhere.

"Birth control is a basic part of women's health care that is used during much of a woman's life. I have spent about 4 1/2 years of my life bearing children and over 30 years of my life trying not to have children," said Mead, a 58-year-old mother of four.

Women's groups, gynecologists and obstetricians argue that affordable pregnancy prevention is a medical necessity and that it can ultimately save employers money by reducing the number of unwanted pregnancies.

Opponents of the bills — mainly insurance companies and some employers — say that what to insure is a decision best left to employers. They say that forcing the issue could lead some employers not to offer insurance at all.

"Employers shouldn't be told what type of coverage they have to purchase," said Larry Akey, spokesman of the Health Insurance Association of America. "The problem is that when you force an employer to do something, everything comes with a cost. As mandates pile one on top of the other, it pretty much reaches a breaking point."

Susan Pisano, a spokeswoman for the American Association of Health Plans, said such laws are unnecessary because most employers voluntarily offer such coverage already.

An August survey of more than 3,200 public and private employers by the Henry J. Kaiser Family Foundation, a nonprofit health group, found that 78 percent of workers who have employer-offered health insurance have coverage for oral contraceptives, up from 64 percent in 2001.

On the Net:

National Abortion and Reproductive Rights Action League: http://www.naral.org

American Association of Health Plans: http://www.aahp.org

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Why a Man's 'Ouch' Is Different Than a Woman's

 

By Alison McCook

Reuters Health

Friday, December 20, 2002

NEW YORK (Reuters Health) - Men generally tolerate intense pain better than women, but painkillers tend to do a better job at masking pain in women than in men--and new research in mice offers an explanation why.

Two new studies demonstrate that a type of protein known as a GIRK may answer the question of why men have higher pain tolerances but lower sensitivity to painkillers than women. These results may one day help design painkillers that are tailored to the needs of each gender, according to the researchers.

In one report, the authors demonstrate that GIRK provides the only means by which male mice can wipe out pain via analgesics. While GIRK also appears to play an important role in how analgesics work in females, the research shows that females have additional means by which painkillers can mask their pain.

This finding may explain why analgesics, which can act on all of these painkilling pathways found only in women, can stomp out pain better in one sex than the other.

Another study demonstrates that GIRK2--a type of GIRK--may provide the means by which men increase their tolerance to pain relative to women.

Both of the reports appear in the online Early Edition of the Proceedings of the National Academy of Sciences (news - web sites).

In one of the studies, Dr. R. Adron Harris of the University of Texas at Austin and his colleagues performed experiments in mice that had been genetically modified so that they lacked GIRK2.

GIRK2 is a protein located on the surface of nerve cells. Pain results when potassium ions enter a cell via GIRK2; when a painkiller attaches to GIRK2, however, the entrance for potassium ions into the cell becomes closed off, thereby averting pain.

During the study, Harris and his team gave mice with or without GIRK2 a number of painkillers, such as alcohol and the active ingredient in marijuana. The mice were then placed on a hot plate that was warm, and the researchers measured whether the mice moved their paws because of the heat.

The investigators discovered that, in most cases, mice who received an analgesic but lacked GIRK2 appeared to feel pain more quickly than those with the protein, indicating that knocking out that protein blocked the effects of the painkillers.

However, female mice given a painkiller who lacked GIRK2 waited longer to react to the pain than male mice without GIRK2, suggesting that painkillers could quell some of the pain in females without GIRK2, perhaps by acting on other pain-quelling pathways besides those that use GIRK2.

"In males, (GIRK2) accounts for essentially all the pain relief," Harris told Reuters Health. "In females, it accounts for a fraction of the pain relief."

During the second study, Dr. Igor Mitrovic of the University of California at San Francisco and colleagues knocked out GIRK2 in male and female mice, and found that males had lower pain tolerances than males who carried GIRK2, while females with and without GIRK2 had similar responses to pain.

Deleting GIRK2 from the mice, consequently, deleted the differences in pain thresholds between males and females, suggesting that GIRK2 enables males to boost their thresholds for pain.

Source: Proceedings of the National Academy of Sciences 2002;10.1073/pnas.0136823100, 0136822100.

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Herpes Vaccine on the Horizon

HealthScoutNews

Friday, December 20, 2002

FRIDAY, Dec. 20 (HealthScoutNews) -- A national, four-year herpes vaccine study involving 7,550 American women will begin within the next few weeks.

St. Louis University will lead the U.S. National Institutes of Health (news - web sites) research into the investigational vaccine to prevent genital herpes in women. The vaccine was developed by GlaxoSmithKline.

The study will be conducted at 16 sites across the United States, with about 500 people enrolled at St. Louis University's Vaccine Center.

Herpes is one of the most common of human infections and a serious health problem. Many people infected with the herpes simplex virus have no symptoms. However, herpes infections can cause major stress and discomfort. It's also a serious health threat to newborn babies who are infected with herpes at birth.

Herpes causes small, painful, fluid-filled blisters on the skin and mucous membranes of infected people. These symptoms usually last one to two weeks. However, the herpes virus stays in the body and may continue to cause outbreaks.

Such outbreaks can happen many times each year. They sometimes happen after an illness, or can be triggered by emotional or physical stress, sunlight exposure, or some kinds of foods or medications.

Previous clinical trials with this investigational herpes vaccine included more than 2,700 people aged 18 to 45. Those studies found that about 73 percent of women who were free of herpes infection at the start of the trials and who received the vaccine were protected against genital herpes.

More information

The U.S. Centers for Disease Control and Prevention (news - web sites) has more about genital herpes.

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Study Reveals Why Pregnant Women Snore

By Pat Hagan

Reuters Health

Friday, December 20, 2002

LONDON (Reuters Health) - Pregnant women have narrower upper airways than other women, which might explain why they are more likely to snore, a new study reveals.

The investigation of 137 women was carried out by doctors at the Edinburgh Sleep Center. They found that the upper airways narrow when women are in their third trimester of pregnancy. Women with preeclampsia, a potentially life-threatening pregnancy complication, had even narrower airways.

The researchers, led by Professor Neil Douglas, said at a recent British Thoracic Society meeting that changes in the upper airway could contribute to increased blood pressure for women with preeclampsia.

"Snoring is common in pregnancy and snoring pregnant women have increased rates of preeclampsia," they noted.

Preeclampsia affects up to 5% of first-time pregnancies and is a major cause of maternal and fetal illness and death. Risk factors include age, a previous history of the condition, diabetes and kidney disease.

A pregnant woman with the condition may develop dangerously high blood pressure and begin excreting protein in the urine.

To assess the significance of snoring in the development of preeclampsia, researchers recruited 50 women in the third trimester of pregnancy, 50 non-pregnant women and 37 women already diagnosed with preeclampsia.

Using a technique called acoustic reflection, the investigators measured the dimensions of each patient's upper airway.

The results showed airways were narrower in pregnant women than in those not expecting babies and narrower yet in women with preeclampsia. They also showed that three out of four women affected by the condition snored in their sleep, compared with 28% of pregnant women and 14% of non-pregnant women.

"These changes could contribute to the increased snoring in pregnancy and to the upper airways resistance episodes during sleep in preeclampsia, which may further increase blood pressure," the researchers report.

Mike Rich, spokesman for the lobby group Action on Preeclampsia, said the results were interesting but stressed that snoring alone was not the cause of preeclampsia.

"Preeclampsia is caused by a restriction in the development of the arteries and veins between the placenta and the mother's body. This develops in the first trimester of pregnancy," Rich said.

"Snoring may have a peripheral impact but it's unlikely to cause preeclampsia because it will already be there," he added.

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Some Respite From Breast Cancer Treatments

HealthScoutNews

Friday, December 20, 2002

FRIDAY, Dec. 20 (HealthScoutNews) -- Stanford University Medical Center researchers are testing a new kind of radiation treatment that may significantly reduce treatment time for women with breast cancer (news - web sites).

Women taking part in the study will receive a single dose of radiation at the time of their surgery for breast cancer instead of the usual six-week course of radiation therapy.

People are currently being recruited for the clinical trial, which is meant to determine if this accelerated form of radiotherapy is safe, feasible and effective in controlling breast cancer recurrence in women who have a lumpectomy.

Many women with a breast tumor have a lumpectomy, in which surgeons remove the area of the breast with cancer and leave the rest of the breast intact. The lumpectomy is followed by six weeks of almost daily doses of radiation to the entire breast. That's meant to reduce the risk that the cancer will return.

The idea behind the six-week course of radiation treatments was to break the total radiation dose into smaller segments to reduce side effects. However, this lengthy course of treatment can be difficult for women because it interferes with their work and family lives.

In recent years, American and European doctors have started to examine ways to shorten the length of radiation treatment while still protecting women against the return of cancer.

A previous Italian study found that a single dose of radiation after lumpectomy seemed to be safe and effective. The Stanford researchers are doing the first U.S. trial of this technique.

They want to recruit 50 women, aged 40 and older, who have a single breast tumor smaller than 2.5 centimeters and who have a low likelihood of tumors elsewhere in the breast.

For information about taking part in this trial, call Janelle Maxwell at 650-498-7740.

More information

The National Cancer Institute (news - web sites) has more about breast cancer.

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Lead in Bones Linked to Pregnancy Blood Pressure

Reuters Health

Friday, December 20, 2002

NEW YORK (Reuters Health) - Women with higher-than-normal amounts of lead in their bones seem to have higher blood pressure in late pregnancy than other women, researchers report.

Although most women experience a rise in blood pressure late in pregnancy, levels that are too high are linked to the dangerous pregnancy complication, preeclampsia.

Preeclampsia can strike without warning, causing blood pressure to rise to dangerously high levels. The condition may progress to eclampsia, in which high blood pressure and convulsions could be fatal to the mother or child. Preeclampsia is a leading cause of maternal death. It strikes about 5% of first-time mothers and 1% to 2% of mothers during subsequent pregnancies.

Previous research in both men and women has shown that blood lead levels can contribute to an increase in blood pressure.

According to the report in the December issue of the American Journal of Epidemiology, Dr. Stephen J. Rothenberg and colleagues tested lead levels in the heel and shin bones of more than 1,000 women in the final trimester of pregnancy. They found that for each incremental increase in lead in the heel bone, the risk for elevated blood pressure went up.

Levels of lead in bone are a measure of past exposure to the toxic substance. However, they note that the lead did not seem to pose a major risk to the pregnant women.

"The increased risk of hypertension associated with increased bone lead in pregnant women is small," write Rothenberg and colleagues.

"However, given the prevalence of hypertension during pregnancy, the past lead exposure of a population will significantly increase the underlying rate of hypertension," they conclude.

The authors note that even women with low levels of lead in the blood--a sign of current exposure--may still be at risk for high blood pressure due to past lead exposure. During pregnancy, bone is broken down to contribute calcium to the developing fetus, a situation that can release stored lead into the blood.

"Controlling blood pressure may require reduction of lead exposure long before pregnancy," they conclude.

"Clearly this work gives additional urgency to worldwide efforts to reduce and prevent lead exposure in the workplace and community," according to a commentary by Howard Hu and Mauricio Hernandez-Avila, of the Department of Environmental Health at Harvard School of Public Health in Boston, Massachusetts. In addition, it gives added incentive to find ways--such as nutritional supplements--to try to reduce lead in the body after exposure.

Source: American Journal of Epidemiology 2002;156:1079-1087.

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Preventing Cancer

HealthScoutNews

Friday, December 20, 2002

(HealthScoutNews) -- Although there is no sure way to prevent cancer, there are certain ways to reduce your risk.

The first way is to stick to a fiber-rich diet, says the Memorial Sloane-Kettering Cancer Center in New York. Here are some tips for increasing your fiber intake:

·  Eat whole-grain breads, pastas and cereals.

·  Eat high-fiber breakfast cereals, such as wheat bran and oat bran.

·  Eat lots of fruits and vegetables, and leave the skin on whenever possible.

·  Reduce the amount of meat you eat, and build meals around beans, lentils, peas, grains, and other legumes.

·  Eat brown rice, whole wheat couscous, bulgur, barley, and other grains on a regular basis.

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Blood Sausage May Hinder Colon Cancer Testing

Reuters Health

Friday, December 20, 2002

LONDON (Reuters Health) - People with a hankering for black pudding should abstain while they're being screened for colorectal cancer, British researchers advise, as the congealed pig's blood in the British delicacy can interfere with screening tests used to identify blood in the stool.

In the British Medical Journal's holiday issue, traditionally a repository of the more entertaining sort of evidence-based medicine, Dr. Neil Haslam and colleagues conducted a rigorous study into the effect of eating blood sausage on fecal occult blood testing, also called Haemoccult testing.

They conducted their study in Bury, "black pudding capital of the world," although they note that variations on the blood sausage theme are also served in Germany, France and Spain. The British version is made of congealed pigs' blood, fat, and rusks, or sweetened bread crusts, contained in a piece of intestine.

The 10 participants under the age of 35 completed a Haemoccult test, requiring six stool samples taken over three consecutive days.

"Participants then eagerly ate a locally produced 7-ounce black pudding and then had a further Haemoccult test," they write.

A positive test result was defined as the occurrence of one or more positive specimens from the six provided. Initially all volunteers returned negative tests, but after consumption of black pudding, four people tested positive.

The researchers then questioned 100 people about their black pudding consumption and found that 63% succumbed on occasions, 8% weekly.

In Bury, the numbers eating the "almost irresistible" delicacy would mean a doubling of the proportion of people who would test positive for fecal occult blood, the researchers calculate.

"Gourmets should be advised to avoid black pudding during screening for fecal occult blood," they conclude.

The research team reports no external funding, however they do note under the heading of competing interests: "NH is extremely fond of black pudding."

Source: British Medical Journal 2002;325:1444-1445.

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Studies: Widespread Smallpox Shots Unwarranted

By Gene Emery

Reuters

Friday, December 20, 2002

BOSTON (Reuters) - Widespread public vaccination against smallpox is dangerous and probably unnecessary, according to two reports released on Thursday with a survey that shows most Americans are ready to be inoculated against a disease they know little about.

The release of the findings came nearly a week after President Bush (news - web sites) announced plans to vaccinate soldiers, health care workers and other emergency personnel who might respond to a biological attack using the smallpox virus.

Bush also said the vaccine would be made available to anyone who demanded it, but he and other officials have sought to discourage this. In the event of an attack, the entire US population could be vaccinated if necessary, they said.

The new survey of 1,006 Americans by the Harvard School of Public Health found that 61% said they want the vaccine as a precaution if offered to the public. Sixty-four percent believed terrorists would use smallpox against the United States in retaliation for any attack against Iraq.

The New England Journal of Medicine (news - web sites) originally planned to publish the survey in its Jan. 30 edition, but decided to release it on Thursday on its Web site, http://www.nejm.org, amid a widening public debate over smallpox vaccinations.

It shows large gaps in the public's knowledge of a disease that was last reported in the United States in 1949 and wiped out worldwide in 1977.

Sixty-three percent thought smallpox infections have been around as recently as five years ago, and 67% believed incorrectly that you can get smallpox by coming within a few feet of an infected person. Only 42% knew that the disease could be prevented by getting the vaccine within a few days of being exposed to the virus.

Two reports released by the Journal in conjunction with the survey suggested that a smallpox attack would be easily contained because the disease is so easy to recognize and isolate.

A research team led by Samuel Bozzette of the RAND Center for Domestic and International Health Security in Santa Monica, California, evaluated several bioterrorism scenarios and concluded that although it may be wise to vaccinate health care workers and emergency personnel, it was probably not a good idea to vaccinate everyone against the disease.

"We cannot endorse a public vaccination campaign at this time, because the certainty of harm outweighs the small chance of a net benefit," the Bozzette team wrote.

The vaccination makes some people very ill and can kill one to two out of every million vaccinated.

Thomas Mack of the University of Southern California in Los Angeles, who studied smallpox transmission 30 years ago in Pakistan, said most people head for bed as soon as they become infectious because they feel so ill. In addition, the disease is hard to miss and "transmission would not be expected to occur over more than very short distances," he said.

Isolating the victim and quickly vaccinating the people providing care should stop the spread, Mack said.

He estimated that no more than 15,000 people need to be vaccinated if the United States sets up a system of National Guard field hospitals where people with smallpox, and the people who have come in direct contact with them, can be isolated and treated.

"A terrorist introduction of smallpox could produce a short outbreak of cases and deaths, but the current vaccination policy will provide little protection and the cost in deaths from vaccine complications will outweigh any benefit," Mack wrote. "Only if evidence suggests that a massive attack or sustained biological warfare is probable can such a vaccination policy be justified."

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Child Bookworms

HealthScoutNews

Friday, December 20, 2002

(HealthScoutNews) -- Are you struggling to get your video-game-playing kids to read more?

New York University suggests these strategies:

• Fill your home with lots of different reading materials, including books, newspapers and magazines.
• Show -- rather than tell -- your kids what they can learn from what they read. For example, bake cookies using a recipe from a magazine.
• Read aloud to your children every day, even after they've learned to read by themselves.
• Encourage your toddlers to tell you stories based on pictures they see in books.
• Make frequent trips to the library with your kids and let them choose their own reading materials.
• Plan activities related to books they enjoy, like a trip to the zoo if they like animal stories.
• Children love hearing the same story over and over, so share their enthusiasm. Avoid saying something like, "Oh no, not this book again."

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Pigeon Breeders at Risk of Long-Term Lung Damage

By Pat Hagan

Reuters Health

Friday, December 20, 2002

LONDON (Reuters Health) - Pigeon breeders are at risk of developing long-term lung damage caused by exposure to feathers and feces, according to new research. But the 5-year study also shows this rarely results in symptoms obvious enough to damage quality of life.

"Although there was a significant deterioration in lung function, this did not appear to translate into clinical symptoms," lead researcher Dr. Tengku Ismail from North Glasgow University Hospitals Trust in Scotland told Reuters Health. The results were presented at a recent meeting of the British Thoracic Society in London.

Pigeon breeding is a popular pastime in some parts of the UK but can lead to a condition called allergic alveolitis, more commonly known bird fancier's lung. Prolonged exposure to birds triggers an allergic response within the airways.

It is estimated that about 10% to 15% of pigeon fanciers develop the lung complaint. However, little is known about the long-term consequences of the condition.

Ismail and colleagues tracked the health of 40 pigeon fanciers between 1997 and 2002, regularly checking lung function, symptoms and the level of antibodies in the blood to the allergy-stimulating molecules picked up from pigeons.

The results showed that there was a significant decline in forced expiratory volume--a measurement used to show how much air can be expelled from the lungs in one second--as well as forced vital capacity, which measures how much air the lungs can hold.

At the beginning of the study, 21 of the 40 subjects tested positive for immune system sensitization to pigeons. Five years later, this had risen to 25. The findings also revealed that as lung function went down, the level of antibodies in the blood went up.

"Their airways were slightly more narrow but this did not mean they were any more breathless compared to 5 years ago," Ismail said.

Despite this, the number of volunteers actually displaying symptoms of allergic alveolitis at the end of the study was only 11--two less than when the study began.

"This is good news for pigeon breeders," Ismail said. "But in future we need bigger epidemiological studies to see if there is further damage to their lungs over 10 or 15 years."

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Herbal Treatment Shows Promise Against Prostate Cancer

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Friday, December 20, 2002

FRIDAY, Dec. 20 (HealthScoutNews) -- An herbal formula sold under the brand name Zyflamend may offer new treatment and prevention options for prostate cancer (news - web sites) patients, say Columbia University researchers.

The formula, a combination of 10 different herbs, suppressed the growth of prostate cancer cells and caused many cells to self-destruct in lab experiments, report the researchers. They presented their findings at a recent meeting of the Society of Urologic Oncology at the National Institutes of Health (news - web sites) in Bethesda, Md.

"This is a natural product that contains herbs and spices and in our lab studies seems to have an effect on the cancer we looked at," says one of the study's authors, Dr. Aaron Katz, director of the Center for Holistic Urology at Columbia-Presbyterian Medical Center in New York City. "The compound needs future research on the clinical side, but it holds the potential for prevention and reducing PSA (prostate-specific antigen) levels."

Prostate cancer is the most common cancer in men, except for skin cancer. More than 189,000 men are diagnosed with this form of cancer every year, according to the American Cancer Society (news - web sites).

Zyflamend is made with a combination of turmeric, ginger, holy basil, hu zhang, Chinese goldthread, barberry, oregano, rosemary, green tea and Scutellaria baicalensis.

The researchers added Zyflamend to prostate cancer cells in lab cultures. They also tested the effects of curcumin, a compound from the spice turmeric. Curcumin is believed to have an anti-inflammatory effect that could reduce the growth of prostate cancer.

They found Zyflamend reduced the growth of prostate cancer cells and induced cell death, and that curcumin alone did not produce these effects.

Dr. Howard Korman, a urologist and prostate cancer specialist at William Beaumont Hospital in Royal Oak, Mich., says the results of this new study are exciting.

"Some of our most effective medicines come from plants," says Korman, "and these results are interesting and hopeful."

However, he cautions, "it's a big step to go from the lab to people."

Katz says the researchers are hopeful the therapy will be as effective in people as it is in the lab, and they plan on conducting clinical trials in the future.

If it proves as effective as they hope, Katz says the herbal formula could be used as preventative therapy because it has no significant side effects. He says it could also, perhaps, be used as a treatment for men with small tumors who don't want to undergo surgery or radiation if the trials go well.

What To Do

For more information on prostate cancer, visit the National Cancer Institute. The American Cancer Society offers tips that may help to prevent prostate cancer.

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New Transplant Rules to Protect Living Donors

By Martin F. Downs

Reuters Health

Friday, December 20, 2002

NEW YORK (Reuters Health) - A panel of experts has approved new rules for live-donor liver transplants in New York state, aimed at improving safety for donors.

The panel, convened to advise New York State Department of Health Commissioner Antonia Novello, unanimously approved the guidelines on Thursday. A spokesman for the health department, Robert Kenny, told Reuters Health that it will be "a top priority of Commissioner Novello to begin implementation."

Drafting of the guidelines was prompted by the death of Michael Hurewitz, 57, earlier this year at New York City's Mount Sinai Medical Center, after he donated a piece of his liver to his brother. An investigation found that poor care following the surgery was to blame for Hurewitz's death.

"The after-care was woefully inadequate," Kenny said.

One issue in Hurewitz's case was a shortage of medical staff in the ward where he had been recovering. The new rules mandate that during the first 24 hours after a transplant, one nurse must be on duty for every two patients. Later on, there must be one nurse available to care for every four patients. Also, doctors must be notified of any problems with a patient within 30 minutes, and doctors must be available to respond to emergencies at all times.

The guidelines also call for independent teams to act on behalf of living donors. The teams should be made up of at least a physician who specializes in internal medicine, a nurse clinician to act as transplant coordinator, and a medical social worker, who may seek advice from a psychiatrist or a medical ethicist. This team will explain the risks of transplantation to the potential donor; and they may, if they see fit, deny the donor's wishes after evaluating the case. There will be a mandatory 2-week "reflection and reaffirmation period" before the donor can finally agree to the operation.

"They're the most comprehensive regulations in the country," said Dr. Lewis Teperman, director of transplantation at New York University Medical Center, in an interview with Reuters Health. Teperman served on the panel that drafted the rules. "I believe this will be the blueprint that the rest of the country follows," he said.

Kenny said the regulations could be enacted as early as April 2003.

Shortly after Hurewitz died on January 13, Mount Sinai voluntarily ceased live-donor transplants, before the state forced them to do so. "They're working toward improving," Kenny said. Officials will visit the hospital for an unannounced inspection sometime in January 2003, and if improvements are deemed satisfactory, the ban may be lifted. "If there are issues, it will not be lifted," Kenny said.

"We're hopeful," said Dr. Leona Kim, director of Mount Sinai's Recanti-Miller Transplantation Institute, in an interview with Reuters Health.

She said she wholly supports the rules proposed in the Department of Health's document. "It should be put into place," she said. She was especially enthusiastic about creating teams of donor advocates. "That is one of the best things to come out of the document," she said.

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New Study Debunks Value of HRT

By Felicity Stone
HealthScoutNews Reporter

HealthScoutNews

Friday, December 20, 2002

FRIDAY, Dec. 20 (HealthScoutNews) -- Hormone therapy doesn't prevent a heart attack in postmenopausal women who've previously suffered one, a new British study says.

Researchers based at the University of Manchester in England found that women taking estrogen were just as likely to have a second heart attack as women taking a placebo.

Dr. Nicola Cherry, the study's lead investigator, says the findings reinforce current thinking regarding hormone replacement therapy (HRT).

"At the moment, the U.S. guidelines are that hormone replacement is not recommended for secondary prevention of heart disease and nothing we found in this study would change that," Cherry says.

The results, published in tomorrow's issue of The Lancet, contradict findings from some observational studies that have suggested HRT may protect women from coronary disease.

However, earlier investigators had compared the heart attack rate in women who'd opted to take estrogen with those who decided against taking the hormone, Cherry explains. "So, if the people who chose to take estrogen tended to have less heart attacks, it may be because they also chose not to do other things that might increase their risk, like smoking, for example," she says.

In this latest research, participants were randomly given either estrogen or a placebo, so "all those other factors [in the earlier studies] that might explain why they were doing better or not disappeared," Cherry says.

The researchers recruited 1,017 postmenopausal women, aged 50 to 69, from 35 hospitals in England and Wales. All had recently suffered a heart attack.

Half of them were given a daily dose of oestradiol valerate, an estrogen therapy, and the others were given a placebo for two years.

During the first three months of the study, there were four heart attack-related deaths among women taking estrogen, compared to 12 deaths among those taking the placebo. But by the end of the two years, the difference between the two groups was reduced substantially -- 21 taking estrogen had died of a second heart attack, versus 30 who had been taking the placebo, Cherry says.

Other recent research has indicated that women taking a combination of estrogen and progestin have a slightly increased risk of heart disease. In July, part of the Women's Health Initiative (WHI), a major U.S. study into the long-term effects of HRT, was halted early because of health risks to study participants.

The new study is the first to examine whether taking estrogen alone can cause harm. The results are significant, Cherry says, because while "we didn't find any increased risk, we can't say estrogen had a beneficial effect on the outcome of cardiac deaths either." The evidence adds further weight to the view that HRT should not be prescribed to postmenopausal women solely to protect against heart attacks, she says.

Dr. Margery Gass, a professor of obstetrics and gynecology at the University of Cincinnati and the principal investigator for the WHI's estrogen/progestin trial, says the Manchester study's high attrition rate "could make the benefit of estrogen look less, but it could also make the risk appear lower because fewer people were taking the active treatment." Within three months of the start of the trial, 30 percent of the participants had dropped out of the study; after a year, 50 percent had dropped out.

Gass says when the WHI estrogen/progestin trial was stopped prematurely, some researchers wondered whether the health problems experienced by study participants lay in the mix of the two hormones.

"This [Manchester] study answers the question that taking estrogen alone doesn't offer any cardiac benefit," she says.

What To Do

For more on hormone replacement therapy, visit the National Cancer Institute or the National Institutes of Health.

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FDA: Danger for Those with Deep Brain Stimulator

Reuters Health

Friday, December 20, 2002

NEW YORK (Reuters Health) - The US Food and Drug Administration (news - web sites) (FDA) issued an alert on Friday stating that it has received reports of deaths of patients with implanted deep brain stimulators who received diathermy therapy.

Diathermy therapy uses shortwave, microwave or therapeutic ultrasound to deliver "deep heat" to body structures. It is used by physical therapists, chiropractors, nurses, dentists and others to promote wound healing after surgery or to relieve swelling, pain and stiffness in muscles or joints.

This treatment can be hazardous to patients with deep brain stimulators, which involve the implantation of electrodes into the brain to treat neurological ailments such as Parkinson's disease (news - web sites). Diathermy may cause implanted electrodes to heat up excessively, damaging brain tissue.

"Laboratory testing has shown that patients with any sort of implanted metallic lead are at risk of serious injury when exposed to shortwave or microwave diathermy therapy," the agency cautioned. "This is true even if the implanted device is not turned on, and even if the lead is no longer connected to an implanted system."

The FDA urged doctors who implant or monitor the leads or systems with leads to caution their patients against receiving shortwave or microwave diathermy therapy. The agency also stressed that healthcare professionals who use such therapy should ask patients about whether they have implants.

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Clozaril Treats Suicidal Behavior

 

HealthScoutNews

Friday, December 20, 2002

FRIDAY, Dec. 20 (HealthScoutNews) -- The U.S. Food and Drug Administration (news - web sites) has approved the anti-psychotic drug Clozaril (clozapine) to treat recurrent suicidal behavior among schizophrenics.

The drug, produced by Novartis, was first approved as a treatment for schizophrenia in 1989. The new approval allows the drug to be marketed and prescribed specifically to treat suicidal tendencies among those with the disease.

The brain disorder affects about 1 of every 100 Americans, the FDA says. Some 20 percent to 40 percent of schizophrenic patients attempt suicide.

The approval follows two years of clinical trials that compared patients on Clozaril with those on a drug from the same family, olanzapine. Among the 980 participants, those on Clozaril made fewer suicide attempts and required fewer hospitalizations for suicidal tendencies.

Clozaril does have a dangerous side effect -- it puts those who take it at risk of a dangerous blood disorder called agranulocytosis. The FDA says frequent blood tests are necessary to check for the condition.

About 3,600 suicides each year in the United States are associated with schizophrenia, the FDA says.

Here is the FDA Talk Paper describing the new approval. For more information about schizophrenia, check the National Institute of Mental Health.

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THURSDAY, DECEMBER 19, 2002

Treating Tourette Syndrome

HealthScoutNews

Thursday, December 19, 2002

THURSDAY, Dec. 19 (HealthScoutNews) -- The drug mecamylamine, which blocks nicotine receptors in the brain, seems to relieve mood instability and depression in adolescents and children with Tourette Syndrome.

So says a preliminary study in the latest issue of Depression and Anxiety.

The national randomized study by University of South Florida College of Medicine researchers included 50 children and adolescents with Tourette Syndrome and at least one of several mood disorders, including depression, attention-deficit disorder, oppositional defiance disorder, obsessive compulsive disorder and hypomania.

Of the 50 study participants, 38 completed the eight-week trial -- 21 taking a placebo pill and 17 receiving mecamylamine, a drug originally used to treat hypertension.

The study found the greatest mecamylamine-related improvements in the behavioral and emotional symptoms of four Tourette's patients who also had major depression. They had significant decreases in sudden mood changes, irritability, inattention, anxiety, restlessness, impulsiveness and demanding attention.

The study participants with Tourette's and depression who received the placebo showed no improvement.

The researchers recently began a controlled study of mecamylamine in children and adolescents with bipolar disorder, also called manic depression.

More information

Here's where you can learn more about Tourette Syndrome.

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One-Click Marijuana Shopping for Sick Canadians

 

By Robert Melnbardis

Reuters

Thursday, December 19, 2002

MONTREAL (Reuters) - Canadian activists for the medicinal use of marijuana celebrated a court victory on Thursday by launching an Internet site offering home delivery of cannabis for seriously ill people.

Saying it would even offer tax deductions for orders, the Marijuana Party Foundation took the unprecedented step after Quebec Superior Court Judge Gilles Cadieux stopped the drug-trafficking trial of two volunteers from Compassion Club of Montreal, a group that provides marijuana for medicinal purposes.

In his long-awaited decision, Judge Cadieux agreed that the pair, Marc-Boris St-Maurice, 33, and Alexandre Neron, 22, had planned to sell marijuana when they were arrested almost three years ago. But the judge noted that it was unconstitutional to deny patients access to the drug.

Judge Cadieux said he did not have the authority to rule on the constitutionality of Canada's marijuana laws. Prosecutors did not indicate whether they would appeal his decision.

Earlier this month, a parliamentary committee urged the Canadian government to relax its laws on possession of marijuana. The committee on the nonmedical use of drugs said marijuana should be decriminalized, but not legalized, an idea US drug control officials quickly condemned.

Home Delivery Of Marijuana

Elated by Judge Cadieux's decision, St-Maurice hailed it as both a moral and legal victory. The Marijuana Party Foundation, operated by the federally chartered Marijuana Party, reacted to the ruling by immediately launching a Web Site offering to dispense therapeutic cannabis.

The Web Site, www.marijuanahomedelivery.ca, offers two formats of "highest quality therapeutic cannabis" with a THC content of 8% or more. A two-gram package sells for C$30 ($19) while Internet surfers can order a 10 gram shipment for C$120.

"You are not contributing to organized crime. All revenues raised from our service go to advance efforts to end cannabis prohibition," the organization promises on its Web Site.

Those wishing to order marijuana via the Web Site must be Canadian citizens residing in Canada, 18 years of age, and provide a doctor's diagnosis of an illness known to be treatable or alleviated through the use of cannabis.

"It's an online Compassion Club to serve all Canadians who would have a need for medical marijuana," St-Maurice told Reuters.

Medicinal Cannabis Legal In Canada

Canadian law allows access to medical marijuana for a certain patients. Canada's Office of Cannabis Medical Access oversees regulations brought down in July 2001 that allow marijuana use by people suffering from grave and debilitating illnesses.

Applicants include those who have a terminal illness or serious medical conditions such as multiple sclerosis, spinal cord disease, cancer or AIDS (news - web sites)/HIV (news - web sites) infection.

The Canadian government is working on the cultivation of a safe and standardized supply of marijuana for use as a medical treatment.

But that supply is not yet available and those seeking medicinal marijuana must turn elsewhere for access to the drug. Often, they must apply for a license to grow the marijuana themselves or seek it on the street.

St-Maurice said the Marijuana Party Foundation does not have permits from the Canadian government allowing the group to sell cannabis online. Its Internet initiative also does not have the consent of the Canadian Medical Association or other professional groups.

But St-Maurice said those hurdles will not prevent the Web Site from taking orders and shipping marijuana.

"In January, we'll be starting to offer tax deductions for the marijuana we sell online," he said.

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Fighting Anemia's Side Effects

 

HealthScoutNews

Thursday, December 19, 2002

THURSDAY, Dec. 19 (HealthScoutNews) -- A new form of oral iron chelation therapy removes excess iron in people with anemia who have had multiple blood transfusions.

That's the finding of a study presented recently at the annual meeting of the American Society of Hematology in Philadelphia.

The study found the oral compound ICL670 is as effective as the standard treatment with the drug deferoxamine, which requires continuous infusion of the drug many hours each day.

A multi-center phase II study on ICL670 was led by researchers at Turin University in Italy. The study included 71 people with anemia who had transfusional iron overload. They were given either oral doses of ICL670 or deferoxamine.

The researchers measured the iron content in the study subjects' livers every three months using a non-invasive technique.

After nine months of treatment, the people taking various amounts of ICL670 had reductions in their iron liver content.

ICL670 cause some abdominal pain and other gastrointestinal side effects in most of the people taking it.

People with anemia who receive multiple blood transfusions suffer iron overload, which slows oxidation and damages their cells, tissues and organs. After years of transfusions, some people with anemia develop serious complications such as heart disease, liver disease and other health problems.

Human bodies have no natural mechanism to remove excess iron.

More information

Here's where you can learn more about iron chelators.

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Stroke Patients Often Ignore Warning Signs

 

By Michael Leidig

Reuters Health

Thursday, December 19, 2002

BERLIN (Reuters Health) - Stroke outcomes could be improved if at-risk individuals were more aware of warning signs and called for emergency medical help sooner, according to a new study from the University of Cologne's neurology department.

The study by Dr. Sebastian Kiock and colleagues, carried out as part of the Cologne Stroke Project, looked at 2,400 stroke patients between 1997 and 1998.

Kiock found that stroke patients often put their lives at risk by going to bed or opting to wait until they could visit their family doctor rather than calling an ambulance. The patients in the study had the most common type of stroke, which is due to a blockage in blood flow to the brain. Such strokes, known as ischemic strokes, can be treated with clot-dissolving drugs-but only if a patient gets treatment within three hours of experiencing symptoms.

Ischemic stroke patients treated with such drugs have a better chance of surviving without major complications, Kiock told Reuters Health. But all too often victims failed to recognize the symptoms of a stroke, which can include partial paralysis, difficulty in speaking and vision problems.

On average, only 30% to 40% of the patients grasped the seriousness of their condition and phoned an ambulance, according to the study.

Half of those who phoned an ambulance were in an emergency room within three hours. In contrast, only a quarter of those who contacted their family doctor got help in the critical 3-hour period. One in four stroke patients failed to take any action at all when the symptoms appeared, Kiock found.

The study also found that the younger a stroke patient was, the more likely he or she was to ignore symptoms. Half of those under 40 years of age went to bed believing they would be better in the morning.

Kiock found overall survival rates were in line with the 30% estimate of the National Institute of New Disease Study (NINDS), published in 1996.

Strokes are the third most common cause of death in Western Europe after cardiac arrest and cancer, and clot-dissolving drugs are considered one of the most effective treatments.

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Parents Ignore Heft and Contents of Kids' Backpacks

By Nancy Deutsch
HealthScoutNews Reporter

HealthScoutNews

Thursday, December 19, 2002

THURSDAY, Dec. 19 (HealthScoutNews) -- If you know of a child who appears to carry the weight of the world on her shoulders, you may need to look no further than her backpack to help relieve some of the burden.

Many youngsters carry a surprisingly hefty physical load on those tiny backs and shoulders, researchers say. And not only do very few parents actually know the weight of their child's backpack, but few ever look at the contents, Texas researchers report in a new study.

"Parents, look in your kid's backpacks. I think you'll be surprised," says Dr. Bryan Lane, a family physician at Scott and White Memorial Hospital in Temple, Tex., and one of the authors of the report, which appears in the January issue of Archives of Disease in Childhood.

The authors surveyed 745 students in elementary schools in Texas, from kindergarten through grade five, whose backpacks weighed 10 percent or more of their body weight. The children reported that only 4 percent of their parents had ever weighed their backpack, and 34 percent of parents had never checked their child's backpack's contents.

Those whose parents had never surveyed the contents carried significantly heavier burdens and more textbooks than those whose parents did check the contents. The most common item carried was a reading book, but students also carried textbooks, folders, extra clothing, lunch boxes, and electrical devices.

Although many physicians and parents will anecdotally report that children are hurt by the heavy weight they force onto their shoulders or backs, there are relatively few studies in this area, Lane admits. In another study as yet unpublished, Lane and others report that children carrying 10 percent or more of their weight in a backpack frequently complain of shoulder, back, neck, and other musculoskeletal discomfort.

Long-term studies are needed to discern whether problems later in life can be traced to consistently carrying heavy loads to school in younger years, and Lane hopes this study will prompt that research, he says.

Dr. Arya Shamie, an assistant professor in the department of orthopedic surgery at the University of California in Los Angeles, says the study "puts some attention to a potentially damaging activity we do as kids."

He says that if he sees a man at 40 with worn-out discs, he doesn't know if the damage results from having carried a heavy backpack for too long or incorrectly, but he thinks that "could be" the cause.

Lane says that many kids today carry more items than when their parents attended school, and may even be carrying band instruments and gym clothes to boot. He says that a child will start to feel sore if she is carrying more than one-tenth of her own weight. "That seems to be the line that triggered the discomfort."

Dr. Leonard Pollack, head of pediatrics at Henry Ford Health System in Detroit, has never thought to weigh his own children's backpacks, but thinks it's a good idea. He also thinks parents should talk to their child's teacher or school and find out why children are carrying so much.

"Some of the lockers are very small," Pollack suggests. Or maybe "the child is afraid something will be stolen." He says schools need to look at where lockers are placed and whether heavy textbooks need to be brought home and back to school regularly.

Pollack was surprised to find so few parents go through their child's backpack. "I think parents need to be cognizant of what is coming home in the backpack. Parents ought to be keeping track of what the kid brings home from school, whether it's a weight issue or not," he says.

Aside from suggesting that parents look in their child's backpack and remove unnecessary items, Lane's group has developed an acronym to help students remember some rules about carrying a backpack properly. It's called SKILLS, and it goes thusly:

·         S stands for Selecting the right backpack that is full-sized with adequate back padding and wide straps;

• K is to Know the limit of the weight that should be carried, and that the recommendation is that it be less than 10 to 15 percent of the child's weight;
• I is to Inspect what is inside the bag and make sure only necessary items are there and packed properly;
• L represents Lifting the backpack correctly by bending knees and facing the backpack when lifting it;
• L is so students will Learn to adjust the straps on the back and check that the backpack rests on the back, as it should, and not below the waist;
• And S is a reminder to Search for updates about safe backpack carrying from a family doctor or on the Internet.

What To Do

Visit KidsHealth or the American Academy of Orthopaedic Surgeons to learn more about carrying the load safely.

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Smoke Exposure Cuts Babies' Ability to Wake Up

 

Reuters

Thursday, December 19, 2002

LONDON (Reuters) - Babies exposed to tobacco smoke have a weaker arousal response than other infants, which could partly explain why children whose parents smoke have a higher risk of cot death, researchers said Thursday.

Exactly what causes cot death, or sudden infant death syndrome (SIDS), in which babies die mysteriously in their sleep, is unknown. However, lying a baby down on its stomach to sleep and parental smoking are risk factors.

Scientists at the Royal Children's Hospital in Queensland, Australia found that children who had been exposed to tobacco smoke while still in the womb were not as easily aroused from sleep as babies of mothers who had not smoked during pregnancy.

"At an age when the incidence of SIDS is at its peak, infants of smoking mothers are less rousable than those of non-smoking mothers...this may partly explain why such infants are more at risk of SIDS," Anne Chang, an associate professor at the hospital, said in a report in the journal Archives of Disease in Childhood.

She and her colleagues tested arousal responses in 20 babies between eight and 12 weeks old, the age when cot deaths are most common. All the babies were healthy and had been born at full term but half the mothers had smoked during pregnancy and half had not.

Using tests that measure physiological and behavioral changes, including opening eyes and physical movements, they found fewer reactions among the babies exposed to smoke before birth.

The scientists suspect nicotine in tobacco smoke may have an affect on the developing nervous system that can alter arousal responses.

SIDS is the leading cause of death in babies under a year old. Most SIDS deaths occur between two to four months of age and are more prevalent in boys than girls.

A campaign to encourage parents to put their babies to sleep on their backs has lead to a decrease in cot deaths. Doctors also believe that 30% of the infant deaths could be prevented by not exposing infants to smoke.

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Studies of Herbal Medicine Found Inadequate

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Thursday, December 19, 2002

THURSDAY, Dec. 19 (HealthScoutNews) -- In a wide-ranging critique of herbal medicines, a Dutch scientist reports that a lack of regulation and scientifically rigorous research damages the safety and efficacy of the alternative remedies that are taking up increasing space in the nation's medicine cabinets.

Faced with the popularity of herbal remedies like St. John's wort, ginkgo and saw palmetto, it is incumbent upon doctors to take a more active role in advising patients about the non-regulated substances, says pharmacist Peter A.G.M. DeSmet of the Scientific Institute Dutch Pharmacists in The Hague (news - web sites).

"It is imperative to ask patients whether they are taking herbal products, particularly when they present with an unexplained health problem. Clinicians must be informed about the potential effects of herbal preparations and must be able to discuss this subject in a non-judgmental way," DeSmet writes in today's issue of The New England Journal of Medicine (news - web sites).

His review article was accompanied by two essays in the journal calling for more research and regulation of the exploding herbal medicine market. About 10 percent of Americans now take them, according to the U.S. Centers for Disease Control and Prevention (news - web sites).

"The sale of herbal medicines ought to be based on reasonable evidence that they do something and that they're safe, but the information people now have to guide them ranges from misleading to wrong," says Dr. Donald Marcus, an immunologist at Texas' Baylor College of Medicine and author of one of the essays.

Other serious problems, he says, are that many herbal products contain undisclosed and possibly dangerous prescription or over-the-counter drugs, and that the labels on herbal medicines offer little information about possible adverse effects.

"The adulteration issue is a very real one," he says, citing as an example a 1998 California Department of Health report that found that 32 percent of Asian patent medicines sold in the state contained undeclared drugs such as ephedrine, lead, mercury and arsenic.

"Also, accurate labeling including real warnings should be on herbal products," he says.

Ginkgo is a very popular herbal product that is supposed to improve memory. However, he says, the herb can affect blood platelets and can be dangerous for people who are already taking anticoagulants to thin their blood. Yet the labeling on most ginkgo pill bottles recommends only that people check with their doctors.

While prescription drugs must undergo rigorous testing before being approved for sale by the U.S. Food and Drug Administration (news - web sites) (FDA), herbal products must only conform to the much less onerous 1994 Dietary Supplement and Health Education Act, which defines herbs as dietary supplements. As such, while holding herbal manufacturers responsible for the truthfulness of the claims they make about their product, the law requires no evidence to back up those claims.

For the past five years, the FDA has been working with the herbal industry to set up more stringent, mandatory manufacturing guidelines for herbal products, the authors report, but the guidelines are not yet completed.

Marcus, in his essay, blames the delay on the botanical industry, claiming that it has "consistently blocked" such a proposal. An industry spokesman denies the charge.

"It is untrue," says John Hathcock, vice president for nutrition and regulatory science for the Council for Responsible Nutrition, stating it is in the interests of reputable herbal medicine manufacturers to have recognized quality standards.

"The industry has asked for regulations for the past five years, especially in the area of good manufacturing practices," he says, and he commends the Netherlands study as being "pretty well-balanced and the reviews of the studies pretty much on target."

In the Netherlands study, DeSmet discusses the problems of measuring the quality and efficacy of herbal medicines as well as insuring their safety in the unregulated marketplace. He then reviews several dozen studies of four popular herbs: ginkgo biloba, used to treat dementia; hawthorn, recommended in cases of heart failure; saw palmetto, used to treat swelling in the prostate; and St. John's wort, recommended for depression.

He reports that a number of the studies reported scientifically significant improvements in symptoms for these illnesses, but criticizes the methodology of many of the studies as having too few participants, being too short in duration, failing to use standardized symptom scores to rate results, or reporting only positive results.

In discussing the data used to support the use the St. John's wort to treat mild or moderate depression, for instance, DeSmet points to one review that stated the rates of response to St. John's wort were 23 percent to 55 percent higher than response rates to a placebo. However, the authors write, the review identified only one of the randomized, controlled trials used as a basis for the conclusion as without methodological flaws, and "even that trial has raised some questions."

Marcus, who teaches medical students about alternative medicine by having acupuncturists, herbal medicine specialists and homeopathic doctors speak in his classes, is personally skeptical about the benefits of herbal medicines. However, he believes strongly that doctors need to be informed enough about herbal medicines and open enough so that their patients will discuss the subject with them.

"I think the evidence is very clear that using herbs has considerable potential danger and very little upside," he says, especially when FDA-approved prescription drugs are available to treat the same illnesses.

"But doctors do need to inform themselves about popular therapies so they can provide help to patients. People aren't asking their doctors about herbal medicines. They're just taking them," he says, yet it is their doctors who, in the face of poor regulation, are the ones who can help patients avoid the pitfalls of poor combinations of drugs and the dangers of certain herbal products.

What To Do

The American Academy of Family Physicians and the National Institutes of Health have helpful fact sheets on what you should know about the risks of mixing herbal medications with certain medical conditions. An explanation of the different kinds of alternative medicine can be found at Alternative Medicine Foundation Inc.

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Study Shows Pacing Defibrillators May Damage Hearts

 

By Andrew Stern

Reuters

Thursday, December 19, 2002

CHICAGO (Reuters) - The common practice of "pacing" the heartbeat may damage patients' hearts, researchers said on Tuesday in a study of heart devices that was terminated early because too many patients died.

The Cleveland Clinic cardiologist who led the study concluded that physicians should switch off the pacemaker function on dual-chamber implantable defibrillators--the type implanted last year in Vice President Dick Cheney (news - web sites)--as it may knock the heart out of rhythm and hasten heart failure. The pacemaker uses a mild electrical impulse to continuously control the heartbeat.

Defibrillators are implanted in about 100,000 people annually to control an irregular heartbeat, which is often a precursor of a heart attack. A defibrillator is designed to deliver a powerful shock to the heart if it falls out of rhythm or speeds up too much.

Many of the battery-powered defibrillators currently in use can deliver electric shocks to both chambers in the heart's right side, which pumps blood to the lungs. The left side of the heart pumps re-oxygenated blood returning from the lungs back into the body.

The advantage of delivering electric impulses to both the heart's right atrial and right ventricle chambers is that it helps coordinate the signal to the heart and is useful for diagnostic purposes.

In a majority of patients with the implanted dual-chamber defibrillator, the device's pacemaking function is also activated.

But activating the pacemaker function in the right side of a patient's heart may be throwing off synchronization with the left side, causing the heart to lose efficiency and deteriorate, said the report published in the Journal of the American Medical Association (news - web sites).

"It's easily conceivable that, with the number of defibrillators going in, if three-quarters are being programmed the wrong way, we could be hurting patients," study author Dr. Bruce Wilkoff said in an interview with Reuters.

Out of 506 patients implanted with defibrillators in the study, roughly half had defibrillators programmed to pace their heart at 70 beats per minute as well as to shock both right-side chambers in the event of an arrhythmia. The other half had devices programmed to shock the right ventricle in the case of an arrhythmia but only to activate the pacemaker function if the heartbeat fell below 40 beats per minute.

A normal heartbeat ranges roughly between 50 and 75 beats a minute.

In the study group whose pacemaker function was activated, and who were expected to be healthier, 23 died and 43 became ill enough to require hospitalization. In the other group, 15 died and 30 were hospitalized.

That was enough for a committee overseeing the study to call a halt a few months early before any more patients were enrolled.

A spokesman for device-maker Medtronic Inc., which makes defibrillators and pacemakers, said the study was flawed because the patients who participated did not need their hearts paced for them.

"Physicians know when the patient should have pacing and when they shouldn't," Medtronic spokesman Scott Papillon said.

Cheney, who has suffered four heart attacks since 1978 and was diagnosed as being at risk of an irregular heartbeat, was implanted with Medtronic's dual-chamber defibrillator last year, but the company spokesman said Cheney's device was not set to automatically pace his heart.

The devices used in the 506-patient study were made by St. Jude Medical, which provided funding, Wilkoff said.

Wilkoff said pacemakers, which have been around for half a century, still have an important use for patients with ailments that dangerously slow down their heartbeats.

But patients with defibrillators who do not need the pacemaking function should probably not use it, Wilkoff said. The problem, he said, is that many patients who have the devices also take medications that slow their heartbeats, making them sluggish and making them candidates for the pacemaking function.

The next generation of heart devices delivers impulses to both sides of the heart to ensure synchronization, he said, though implanting electric leads on the left side was more difficult.

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More Teens Struggling With Depression

 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Thursday, December 19, 2002

THURSDAY, Dec. 19 (HealthScoutNews) -- More young Americans seem to be suffering from depression this holiday season, a new survey finds.

The survey, done for the New York University Child Study Center, reports that 43 percent of adolescent girls and 28 percent of adolescent boys say they have experienced recent periods of depression lasting at least two weeks.

Approximately 400 teens were interviewed for the survey, which was conducted Dec. 3-6.

Previous studies have indicated that only 19 percent of adolescents experience such periods of depression, says Dr. Harold S. Koplewicz, director of the center. He attributes the high rates found by the survey, in part, to the enforced gaiety of the holiday season.

"The holidays can be a stressful time for all of us," Koplewicz says. "It's possible that the holiday season always does this to children and we haven't known about it until now. There might also be lingering effects of the terrorist destruction of the World Trade Center."

One effect of depression is to increase the likelihood of high-risk behavior, Koplewicz says. "Girls are more likely to have sex, use drugs and drink," he says. "Boys are more likely to drive dangerously and drink."

The holiday effect heightens year-round stresses on young people, says Linda Lebelle, executive director of Focus Adolescent Services, a recently founded advisory service for parents.

"Children get mixed messages these days," she says. "The family says one thing and the world behaves in a different way. The most blatant example is the issue of sexuality and sexual relations. The family says that sex is an expression of love, but the media are not saying that. And the family says not to use drugs, but that is not what they see on television."

A high incidence of youthful depression at this time of the year is unusual, Lebelle says.

"This is not the time of year when you see the most suicides and suicide attempts," she says. "That is usually the spring." However, her organization has been getting a high volume of calls from parents worried their children may be depressed, Lebelle says.

A day or two of depression is normal -- 90 percent of adolescents report experiencing them -- but prolonged depressive behavior requires action.

Parents should be alert for the signs of depression, Koplewicz says.

Warning signs include a prolonged shift in behaviors -- a change in sleeping habits, a change in appetite, social isolation (being alone more than two or three hours a day), and losing interest in the things that usually are of interest, he says.

"Don't wait, don't think it is just a phase," Koplewicz says. "Call an expert in adolescent depression, rather than the family doctor."

Usually this advice goes unheeded, he acknowledges.

The new poll duplicated findings in the 1999 Mental Health Report of the Surgeon General: only one in five children with a psychiatric problem receives treatment.

What To Do

You can get detailed information about teen suicide and depression from the American Psychiatric Association. One place to turn for help is Focus Adolescent Services.

WEDNESDAY, DECEMBER 18, 2002

CDC Fact Sheet Not Promoting Condom Use

 

By Laura Meckler

Associated Press Writer

The Associated Press

Wednesday, December 18, 2002

WASHINGTON - A government fact sheet that long promoted condoms as "highly effective" in preventing HIV (news - web sites) and other sexually transmitted diseases now offers a more neutral summary of the pros and cons of condom use.

Congressional Democrats charge that politics are trumping science.

They also point to a fact sheet produced by the National Cancer Institute (news - web sites) concerning the link between abortion and breast cancer (news - web sites). Until this summer, it said that women who had abortions face no increased risk of breast cancer; now it says the evidence is not clear.

"We are extremely concerned about these alterations and deletions of important scientific information," Rep. Henry Waxman (news, bio, voting record), D-Calif., and 13 other Democrats said in a letter Wednesday to Health and Human Services (news - web sites) Secretary Tommy Thompson.

"They appear to be part of an Orewellian trend at HHS. Simply put, information that used to be based on science is being systematically removed from the public when it conflicts with the administration's political agenda."

HHS officials say the revisions are consistent with the science. They deny any political interference.

On the Centers for Disease Control and Prevention (news - web sites) Web site, the condom fact sheet had said that refraining from sex was the best way to prevent transmission of HIV, the virus that causes AIDS (news - web sites), and other sexually transmitted diseases. The old version went on to say: "But for those who have sexual intercourse, latex condoms are highly effective when used consistently and correctly."

The recently posted version focuses on HIV along with other sexually transmitted diseases. In its introduction, the fact sheet now says that condoms "can reduce the risk of STD transmission. However, no protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD."

The fact sheet goes on to analyze the effectiveness of condoms versus a variety of sexually transmitted diseases.

It says that condoms are highly effective in preventing HIV, an incurable disease that is often fatal and requires extensive treatment. There is no evidence that condoms prevent the transmission of the human papillomavirus, which causes no disease in 99 percent of cases, but will cause cervical cancer in 1 percent of its female victims.

Given the mixed evidence, the CDC opted for a more neutral introduction to the fact sheet, said Dr. David Fleming, the CDC's deputy director for science.

"This fact sheet is designed to be as scientifically accurate as possible," he said. "We specifically tried not to nuance it in the direction either of encouraging or discouraging use of condoms. The interpretation really is in the eyes of the beholder."

He said that the fact sheet was written with the help of people at HHS headquarters, but said he stands by it from a scientific point of view.

In the case of breast cancer and abortion, the National Cancer Institute removed a fact sheet from its Web site that said "the current body of scientific evidence suggests that women who have had either induced or spontaneous abortions have the same risk as other women for developing breast cancer."

The posting specifically dismissed studies to the contrary, citing methodological problems.

In its place, there is now a neutral rendering that says some studies find a link and others do not. The fact sheet promises to convene a conference on the issue early next year.

NCI spokeswoman Nicole Gottlieb said Wednesday that the institute had no further comment.

On the Net:

Centers for Disease Control and Prevention: http://www.cdc.gov/

National Cancer Institute: http://www.nci.nih.gov/

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Genetic 'Signature' Predicts Breast Cancer Outcome

 

By Alison McCook

Reuters Health

Wednesday, December 18, 2002

NEW YORK (Reuters Health) - Women who carry a particular genetic "signature" in their breast cancer (news - web sites) cells are more than five times as likely as those without that genetic pattern to see their cancer spread to other parts of their bodies after the tumor is removed, researchers report.

Although this method to predict cancer prognosis is more accurate than currently used techniques, study author Dr. Rene Bernards of the Netherlands Cancer Institute in Amsterdam told Reuters Health that this and similar techniques "can never be totally accurate."

He added that the genetic signature method also will likely not be available to women in the US for a few years, but may shortly become an option for women diagnosed with breast cancer in Holland.

Current methods to predict the path of a tumor include a woman's age, the size of her tumor, and whether the disease has spread to her lymph nodes, often a sign that the cancer will soon infiltrate other body regions.

That said, adding this genetic technique to classical methods will undoubtedly improve the accuracy with which doctors can predict how a patient's cancer will progress, which would enable patients to "make informed decisions" about which treatments they should add onto surgery, Bernards added.

The current study, published in the December 19th issue of The New England Journal of Medicine (news - web sites), validate a previously devised technique that examines genetic patterns in breast cancer.

In January, the same group of authors published preliminary findings that described a "pattern of gene activity" that appeared to distinguish between more and less aggressive forms of the disease. The researchers developed the pattern after scanning 25,000 genes in samples of breast cancer tumors, and identifying 70 that were only active in very aggressive breast cancer tumors.

During a previous interview with Reuters Health, current study author Dr. Laura J. van't Veer, also of the Netherlands Cancer Institute, explained that almost all women with breast cancer are treated as if they have an aggressive form of the disease, which is likely to spread throughout their bodies. However, she noted, only up to one third of patients develop distant metastases, or cancer that has infiltrated other body regions.

As a result, van't Veer explained, the majority of women may be given unnecessary treatments like chemotherapy and hormonal therapy, both of which carry significant side effects.

In the current study, Bernards, van't Veer and colleagues tested the previously developed genetic pattern on 295 breast cancer patients with early forms of the disease.

The test predicted that 180 women had a poor prognosis, and 115 were likely to fare well from their disease. The test results did not match whether or not the cancer had spread to a woman's lymph nodes, for those with positive lymph nodes were equally likely to be given either prognosis.

Most of the women whose cancer had spread to their lymph nodes, and only a fraction of those with cancer-free lymph nodes, were treated with either chemotherapy or hormonal therapy, or both.

Ten years later, only 55% of women with a poor prognosis were alive, relative to 95% of those given a good prognosis by the test, the report indicates.

Bernards added that the genetic profile used in the current test could also one day provide researchers with new drug targets for treatment, and also help doctors design therapies that are better tailored to a patient's specific genetic profile. Consequently, the choice may change from whether to use chemotherapy or not, to what type of chemotherapy would best suit each woman, he noted.

In an accompanying editorial, Dr. Anne Kallioniemi of the University of Tampere in Finland writes that the test remains an "excellent starting point for work aiming to predict the behavior of a tumor." However, further study is needed before the test can be routinely available to patients, she points out.

In addition, Kallioniemi notes that patients were given additional treatment according to the status of their lymph nodes, and not on whether the test predicted they would fare well or poorly. Future studies should try to tease out the effect of treatment on patient outcomes, she noted.

Source:The New England Journal of Medicine 2002;347:1995-1996, 1999-2009, 2067-2068.

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Premature Births Up, Teenage Births Down

By Laura Meckler

Associated Press Writer

The Associated Press

Wednesday, December 18, 2002

WASHINGTON - The percentage of babies born prematurely in the United States reached a two-decade high last year, driven by an increase in twins and triplets. The government also found a rise in prenatal care and a drop in smoking during pregnancy.

Births to teenagers fell for the 10th year in a row, with abortion on the decline, too. At the same time, births to women in their 30s and 40s continued a steady climb, according to an annual review of birth statistics that was released Wednesday.

Overall, 4,025,933 babies were born in the United States in 2001, a small drop from 2000.

There were more boys than girls, though only by a tiny margin, and more births on Tuesdays than any other day. The most popular month to have a baby was August.

"It's the winter months when people are holed up inside by a fire," said Joyce Martin, the report's lead author, offering one of several theories.

Not all the trends were positive. The percentage of Cesarean sections continued to climb, reaching nearly one-quarter of all births, the highest rate since data became available more than a decade ago. The rate has been on the rise for five years now.

Health officials have hoped to reduce the C-section rate to 15 percent, contending that vaginal births carry a lower risk of medical complications for mothers. But the rates are climbing both for mothers who have never had a C-section before and for those who have.

Also disturbing: the rise in babies born prematurely, which is defined as less than 37 full weeks of gestation. The percentage of babies born that early rose to nearly 12 percent, the highest level since officials began tracking this category 20 years ago.

In a related finding, the portion of babies born dangerously little also rose, to 7.7 percent in 2001, an increase of 13 percent since the mid-1980s.

Some of the rise for both factors can be traced to the increased number of multiple births; in these cases, babies tend to be born before their due date and are smaller than other babies. Older mothers and women who use certain fertility treatments — both of which are on the rise — are more likely to have twins, triplets and even higher multiples.

Analysts at the National Center for Health Statistics, which produced the report, said the increase could be a function of doctors opting to induce birth early because of complications with mother or fetus. Sometimes the mother has high blood pressure, which restricts blood flow to vital organs. The fetus may not be growing inside the uterus, usually because it is not getting needed oxygen and nutrients.

Both conditions can prompt a doctor to induce birth early, said Dr. Fredric Frigoletto, chief of obstetrics at Massachusetts General Hospital in Boston. He added that the decision is not always the right one.

"It's a very tense situation for both mother and doctor," he said. "You're walking a narrow line, and if your judgment is off or the tests are misleading, it's easy to make the wrong decision."

Overall, the rate of induced births, both early and on time, continued to climb, reaching one in five births last year. This rate has nearly doubled since 1989. The reasons are not always medical, Frigoletto said.

"Their parents or their in-laws are coming from far away, and if you can put this on a fixed timeline it seems to work well for everybody," he said. "They often don't know what the downside is to having everything so structured and sounding so neat."

The rise in prenatal care during the first trimester has been steady for a decade, particularly among Hispanic and black women.

In 2001, 83 percent of women got timely prenatal care, up from 76 percent in 1990. Black and Hispanic rates each rose from about 60 percent in 1985 to about 75 percent in 2001.

Martin said the rise is due in large part to expanded Medicaid eligibility in the late 1980s, which meant that more poor pregnant women could get government-funded health insurance. Health and Human Services (news - web sites) Secretary Tommy Thompson singled out this achievement and said he hoped it would continue to rise.

"Timely prenatal care is one of the best ways to ensure the health of mothers and their infants, and we will continue working to expand access to this essential care for all Americans," he said in a statement.

More good news: the portion of women who smoked while pregnant continued a decline that began more than 10 years ago, reaching 12 percent in 2001. The teenage birth rate hit another record low, the 10th year running it has fallen. Last year, there were 45.8 births for every 1,000 women age 15 to 19. Data reported separately show that the teenage abortion rate has fallen, too.

Fewer teenage births and more older women having babies combined to raise the median age of childbirth. The typical first-time mother is now 24.8 years old, up from 22.1 years old in 1970.

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Extra Day in Hospital May Not Help Moms, Newborns 

By Alison McCook

Reuters Health

Wednesday, December 18, 2002

NEW YORK (Reuters Health) - Although public outcry about "drive-by-deliveries" led to laws ensuring a 2-day hospital stay after childbirth, researchers suggest that mothers and newborns who stay just 1 night after an uncomplicated delivery fare as well as those who stay longer.

In the new study, babies who left the hospital with their mothers after only 1 night were no more likely than those who stayed 2 nights to visit the emergency department or be rehospitalized during the first 10 days of life.

However, the results may not apply to all women with all types of insurance. The hospitals involved in the study erred on the side of caution when it came to allowing women to leave after 1 night, Dr. Jeanne M. Madden told Reuters Health.

The study was designed to compare the policy of early discharge--in which mothers and their newborns left the hospital after 1 night and received a home visit within 2 days--to a state law that guaranteed they could extend their stay to 48 hours, Madden said.

Early discharge was standard during the early 1990s, Madden explained. However, babies are especially vulnerable to certain health problems during the first days of life, she noted. Public outcry about "drive-by-deliveries" prompted legislators in 41 states and Congress to establish many laws that required insurance companies to cover a 2-day hospital stay.

But the current study, which compares the two policies in Massachusetts, reveals that a longer stay may offer no benefit to mothers and their babies, Madden said.

"In this setting, it looks like the (early discharge) program was safe...and the legislation didn't benefit them in any particular way," according to the researcher who is at Harvard University and Harvard Pilgrim Health Care, the health management organization (HMO) that insured the women in the study.

The findings, published in the December 19th issue of The New England Journal of Medicine (news - web sites), are based on analyzes of 20,366 pairs of mothers and newborns in hospitals between 1990 and 1998.

In terms of why an extra hospital day appeared to offer no benefit, Madden said that some experts believe that the second day of life is often uneventful, and health risks like jaundice and breast-feeding problems are more likely to pop up when the baby is 3 or 4 days old.

In addition, she said, the decision of whether or not to let a woman leave the hospital after 1 night was made very carefully at the hospitals participating in this study. The results may not apply to other women with other insurers, Madden cautioned.

Madden and her colleagues also discovered that the costs of caring for mothers and their infants only dropped by $90 per delivery after the HMO implemented its early discharge program. After the state law mandated a 48-hour minimum stay, those costs increased by $100 per delivery.

Madden explained that the lack of difference in cost between the two programs likely stems from the fact that substituting a home visit from a nurse for an extra day in the hospital did not do much to reduce costs. In addition, prices of a 1-night stay in hospital rapidly increased when the HMO installed its early discharge policy--likely an attempt on the part of the hospital to recoup some of their losses in profits from the HMO cutting the days spent in hospital, Madden suggested.

Source: The New England Journal of Medicine 2002;347:2031-2038.

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Artificial Heart Testing Misses a Beat

By Justin Pop

AP Business Writer

The Associated Press

Wednesday, December 18, 2002

BOSTON - With its clinical trial seemingly ground to a halt, Abiomed Inc. tried to reassure nervous investors about the progress of its self-contained artificial heart.

The company gained worldwide attention last year by implanting six of its AbioCor hearts into critically ill patients. But surgeons have tried the procedure just once this year, and not since ending a moratorium on recruiting three months ago.

The slowdown of the trial has dispirited investors. Abiomed shares, which traded at $17 last December, opened below $4 Wednesday on the Nasdaq Stock Market.

In a conference call Tuesday, executives said the company continues to push to complete the first round of 15 implants. They said Abiomed simply hasn't found enough patients who meet its stringent criteria, which include a life expectancy of 30 or fewer days without the device.

"I think the trick is they want to make sure the patients are healthy enough to live a long life under the implant, and yet the patient has to be in pretty dire straights to be considered," said Banc of America Securities senior analyst Kurt Kruger.

But some say Abiomed has raised its eligibility standards and is playing it too safe.

"I think they're being overly ethical," said Bill Frain, a large investor in the company. "They're being so cautious that they're hurting themselves."

The company also faces a lawsuit by the widow of one patient who died. Abiomed officials say the lawsuit hasn't affected their decisions.

The firm's leaders also are declining — at least for now — to make one change that could broaden the pool of candidates: allowing family members to give proxy approval for the procedure. Currently, patients must give their own consent, which limits the pool to patients who are responsive.

"It's troubling, frankly, very troubling," Kruger said. "We're frustrated. In our view, this should prompt a reassessment of the entrance criteria. (They've) made the entrance requirements so strict, they'll never see any patients."

Abiomed has said the device could someday break into an enormous market and help the 100,000 Americans who need heart transplants each year. Only about 2,000 get them.

The company says the trial has met its limited goals: helping patients live 60 days, double the expectation, with an improved quality of life. Of seven people implanted with the device so far, one is still alive.

The company says the device was not to blame for the deaths of any of the patients, all of whom were critically ill with a variety of health problems when they received the AbioCor.

But it faces competing incentives. Like any manufacturer, it is eager to complete tests so it can start selling the product. On the other hand, it has no interest in seeing the product's average survival rate decline.

Frain said he's been told Abiomed has even raised its standards for candidate health, and that none of the patients who received the device last year would qualify today.

"They don't want to take a chance of them dying immediately," said Frain. "We've been told that at any given moment they've been monitoring from three to seven patients. But those patients die before they go ahead and implant the AbioCor."

Abiomed spokeswoman Sara Goldstein denied that standards have changed, saying it's up to doctors to screen patients.

According to Abiomed, candidates must suffer from bi-ventricular heart failure, be older than 18, unresponsive to existing therapies and ineligible for a natural heart transplant.

"These aren't things that are flexible," she said. "These are very concrete criteria."

Goldstein said the company continues to monitor candidates and is eager for the next implant to take place. She said it could happen at any time.

On the Net:

Abiomed: http://www.abiomed.com

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FDA Cracks Down on Supplements, Eases Up on Food
 

By Todd Zwillich

Reuters Health

Wednesday, December 18, 2002

WASHINGTON (Reuters Health) - Food manufacturers will for the first time be allowed to tout the health benefits of their products even if there is no scientific consensus as to the foods' benefit, under a plan announced Wednesday by Bush administration officials.

Food and Drug Administration (news - web sites) (FDA) officials also announced that they would step up enforcement against several categories of dietary supplements where misleading claims about health benefits are rampant.

The change in food labels allows manufacturers to make health claims as long as the "weight of scientific evidence" supports the claim. Until now, such claims were barred unless manufacturers could show that they were supported by complete agreement among scientists. For example, oatmeal makers could advertise the cholesterol-lowering properties of their product because there was scientific consensus on the subject.

Administration officials said that the plan would promote public health by attracting consumers to healthier foods when most of the science supports their benefits.

"Our goal is to help consumers make sound decisions," said Dr. Mark B. McClellan, commissioner of the Food and Drug Administration.

McClellan said that the program would also spur competition among manufacturers to produce more nutritious products.

Food manufacturers praised the move, saying that it would give shoppers better information about which foods are best for their health. But the plan drew harsh criticism from one consumer group, which argued that it would only serve to encourage food companies to produce junk science in support of the claims.

Under the plan, food manufacturers will submit a proposed health claim and scientific data supporting it to FDA for a food ingredient such as omega-3 fatty acids. The compound, found in oily deep-sea fish like salmon, has been shown in some studies to reduce the risk of heart disease.

FDA regulators will review the science supporting the claim and will approve its use on product labeling if the "weight of the scientific evidence" supports it, according to FDA documents.

McClellan said that the lower scientific burden would allow consumers to benefit from healthier foods even when "it's not a completely settled scientific issue."

FDA has yet to finalize the process it will use to review the claims, or exactly how it will define the amount of scientific evidence needed to make a claim legal, officials said. The agency has set up a task force to establish a review process and recommend final regulation that will govern the process, they said.

McClellan said that most health claims would be "qualified," meaning that statement connecting the product's use to health benefits would be qualified with a disclaimer alerting consumers that evidence is strong but not conclusive.

"It's scientific evidence that determines whether or not we're going to allow these claims," McClellan said.

Rhona S. Applebaum, vice president of the National Food Processors Association, an industry group, said that the new program frees up manufacturers to alert consumers to the health benefits of many foods for which at least some scientific debate is ongoing.

She cited studies supporting the role of high-fiber foods in reducing the risk of colon cancer, and a growing body of scientific research showing that a diet rich in fresh fruits and vegetables lowers cancer risk.

"To wait until there is essentially a firm conclusion...science rarely comes to a firm conclusion on anything. It can take decades," she said.

But Larry Sasich, a research analyst with the Public Citizen health research group, attacked the program, saying it would allow companies to plant low-quality studies in research journals and then submit them as scientific proof of a food's health benefits.

"What is going to be fostered is spurious and unreliable studies," Sasich said. "No matter how bad the science is, if the guys that wrote it are persistent enough, they're going to get it published somewhere in the medical literature."

Officials also announced a move to crack down on unsubstantiated health claims made by dietary supplements makers. Regulators at both FDA and the Federal Trade Commission have become increasingly concerned about supplements makers who claim health benefits on product labels without scientific backup.

McClellan said that FDA planned to step up scrutiny of supplements in nine major categories, including supplements that claim to treat life-threatening diseases--such as cancer, HIV (news - web sites)/AIDS (news - web sites) and lupus--as well as weight loss products and autism treatments.

Supplements claiming to treat mental retardation, to prevent Alzheimer's disease (news - web sites) and to prevent hangovers could also be targeted, he said.

BACK TO TOP

Weathering Winter

HealthScoutNews

Wednesday, December 18, 2002

WEDNESDAY, Dec. 18 (HealthScoutNews) -- Chapped hands and lips, dry, itchy skin and colds are common problems during winter.

The Medical College of Wisconsin offers some tips on how you can deal with these daily issues caused by cold weather.

Winter's dry air can lead to dry, flaky and irritated skin, as well as chapped lips. One way to counter the dry air is to increase your fluid intake by drinking six to eight glasses of water or other kinds of non-caffeinated beverages.

Moisturizing creams can help your skin. If you have sensitive skin, use skin creams without perfumes. Apply skin creams generously and regularly.

A portable home humidifier or one attached to your furnace will put moisture into the air inside your home and help prevent your skin and nasal passages from drying out. Be sure to properly clean your humidifier regularly.

You can also use saline nasal sprays to moisten your nasal passages and lip balms to help your chapped lips.

The common cold is another winter annoyance. While there is no cure, there are things you can do to prevent colds. The best form of prevention is frequent handwashing, especially before meals. You might also want to take 500 to 1,000 milligrams of vitamin C each day.

If you do catch a cold, you can reduce the symptoms by getting rest, drinking fluids and taking decongestants/antihistamines.

If you develop cold sores, you can get prescription anti-viral medications that will shorten the length of the outbreak. Remember that cold sores can be contagious if the fluid they contain comes into contact with an open sore or the lining of a person's mouth, nose or genital tract.

Remember to stay active this winter. Whether you walk, swim, ski, snowshoe or skate, just make sure you don't spend the entire winter on the couch.

More information

The American Academy of Dermatology has more about fighting dry skin during winter.

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Italian Surgeons Remove Liver to Treat Cancer

 

Reuters

Wednesday, December 18, 2002

LONDON (Reuters) - Italian scientists have taken a new approach to treating liver cancer by removing the organ, dosing it with radiation and then replacing it in the patient.

A 48-year-old man who was the first patient to have the innovative treatment at the San Matteo Hospital in Pavia, Italy is cancer-free a year after he was treated during the 21-hour operation for more than 14 tumors in his liver.

"The out-of-body operation allows doctors to administer high doses of radiation to widespread tumors without affecting other organs," New Scientist magazine said Wednesday.

Surgeon Aris Zonta and physicist Tazio Pinelli of the National Institute of Nuclear Physics in Italy, who co-ordinated the procedure, are awaiting approval to treat six other patients with multiple tumors.

The original patient had cancer of the colon, which had spread to the liver. The cancer did not respond to chemotherapy and was so widespread that conventional radiotherapy would have destroyed the liver.

The Italian scientists decided to try boron neutron capture therapy which they have been working on since 1987 and which was first attempted in the 1950s.

It involves injecting a fluid containing boron atoms into the patient and using a low-energy neutron beam to split the boron into particles that kill the cancerous cells.

But an even dose of neutrons is needed to treat the entire organ and bones in the body can block the beam so the surgeons removed the liver, treated it and then replaced in the body.

"By explanting the organ, we could give a high and uniform dose to all the liver, which is impossible to obtain inside the body without serious risk to the patient," Pinelli told the magazine.

Although the treatment, which has been dubbed TAORMINA, was successful and could give new hope to seriously ill patients it would only be suitable for patients whose cancer has spread to only one other organ and if they are strong to survive the operation. "The technique is currently being tested on patients with otherwise untreatable brain tumors -- obviously without removing the organ in question," the magazine added.

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Treating Corns

HealthScoutNews

Wednesday, December 18, 2002

(HealthScoutNews) -- Corns can be so painful that you'd rather walk barefoot than have them rub against the inside of your shoe. They usually develop from pressure created by tight-fitting shoes or from repeated friction between your toes. The American Academy of Orthopedic Surgeons suggests some corn healing tips:

• Buy special doughnut-shaped pads that allow the corn to slot into the hole. This relieves pain and pressure.
• Some pads contain salicylic acid that removes the dead skin. This will help get rid of the corn.
• If nothing helps and the corn looks like it's there to stay, see a podiatrist. A foot specialist's treatment should hasten the healing process.

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More Rigorous Dialysis Won't Boost Survival: Study

 

Reuters Health

Wednesday, December 18, 2002

NEW YORK (Reuters Health) - A dialysis treatment that cleanses more toxins from the blood is no better than currently recommended dialysis when it comes to the health and survival of patients with kidney failure, according to a large, well-designed comparison of the treatments.

"This will be welcome news to the hundreds of thousands of people who are on dialysis in the United States, since our findings support the National Kidney Foundation's current practice guidelines," said lead author Dr. Garabed Eknoyan of Baylor College of Medicine in Houston, Texas.

"It is reassuring that the dose now recommended is adequate," Eknoyan noted in a prepared statement.

The study included 1,846 men and women undergoing dialysis three times each week. Participants received either standard treatment or a high-dose dialysis with or without the use of special "high-flux" filters that remove more waste molecules from the blood in a shorter period of time.

There were no major differences between the groups when it came to hospitalizations or survival, according to the report in the December 19th issue of The New England Journal of Medicine (news - web sites).

Patients require dialysis because their kidneys can no longer filter toxins from the blood. In the study, patients went to a hospital or clinic to have their blood pumped through a dialyzer--a type of "artificial kidney"--for about 3 hours at a stretch. About 96% of patients had hypertension, 45% had diabetes, and 80% had a history of heart disease.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, with additional support from Baxter Healthcare, Fresenius Medical Care, R&D Laboratories and Ross Laboratories.

Source: The New England Journal of Medicine 2002;347:2010-2019.

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Chocoholic

HealthScoutNews

Wednesday, December 18, 2002

(HealthScoutNews) -- Frequent chocolate feasts will undoubtedly expand your waistline, but you should treat yourself to a bar once in a while. It can actually be good for you.

The mouth-watering treat contains large amounts of beneficial chemicals that may reduce the risk of many cancers.

According to the University of California, Berkley, one large ongoing study exploring the benefits of exercise found that men who eat one to three bars of chocolate a month live longer than those who eat none. No one knows why, but who cares. If you're a chocolate lover, this is good news.

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Tax Credits Little Help for Low-Income Women: Study

 

By Julie Rovner

Reuters Health

Wednesday, December 18, 2002

WASHINGTON (Reuters Health) - President Bush (news - web sites)'s proposed tax credits to help those with low incomes purchase health insurance coverage would not be large enough to help most uninsured women, according to a study released Wednesday by the Commonwealth Fund.

"The basic bottom line of this study is you need to make the tax credits more generous," Commonwealth Fund President Karen Davis told reporters at a briefing.

Women are disadvantaged compared to men when it comes to buying health insurance, the study noted. Women not only "on average have greater need for healthcare over their life span than men," the study said, but because insurance is more expensive for women, "tax credits (would) buy less coverage for young women than young men."

Researchers surveyed policies available in 25 cities to healthy, nonsmoking women aged 25, 35 and 50 for premiums of $1,000--the maximum tax credit available to individuals under the President's plan--and $1,500 annually.

The study found that even healthy young women could not necessarily obtain a policy for $1,000, and that most plans with low premiums had very high deductibles that could still act as barriers to needed care. The median deductible for 50-year-old women for plans with a $1,500 annual premium was $5,000.

The median sum of premiums and deductibles for women with incomes of $15,000 annually--the maximum income to be eligible for the full credit under the President's plan--would require 25-year-olds to pay 15% of their total income; this would rise to 26% of income for 50-year-olds.

At the same time, the study found, most of the plans had relatively spartan benefit packages. Most charged an extra fee for prescription drug coverage, which often did not take effect unless the plan's overall deductible had been met, offered no coverage of maternity care, and few if any mental health or substance abuse benefits.

Given the size of deductibles in low-premium plans, said Davis, "it's pretty clear that it isn't better than nothing," since having any coverage could jeopardize low-income women's eligibility for charity care.

The study also found that policies available represented what Commonwealth's Cathy Schoen called a "the best of the best-case scenarios," because the prices are for women in excellent health, which applies to only a quarter of women. For those with health problems, said Trudy Lieberman of Consumers' Union, policies may be as much as twice as expensive or not available at all.

Also, noted the study, the generosity of coverage varied widely by geographic area, meaning the same size tax credit could help people with the same income far more or less depending on where they live

Finally, the amount of the credit has not changed since President Bush was a candidate, while health costs have risen rapidly. The $1,000 proposed credit "has already lost 20% of its buying power," said Jeanne Lambrew of George Washington University.

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Extra Help With Diet Makes the Difference

HealthScoutNews

Wednesday, December 18, 2002

WEDNESDAY, Dec. 18 (HealthScoutNews) -- People who receive nutrition counseling to help them lower their cholesterol levels are more satisfied with their quality of life and health care than people who try to lower their cholesterol in other ways.

So says a study in the December issue of the Annals of Internal Medicine.

The six-month study included 90 people with high cholesterol. Half the group received special counseling from a registered dietitian or nutrition professional as part of the medical care for their high cholesterol.

The patients received personalized feedback on their diet changes, handwritten instructions and recipe suggestions, and educational brochures.

The other half of the group received the usual care for high cholesterol from their doctors. That consisted mostly of verbal advice and handouts on how to lower cholesterol levels.

The study found the people in the counseled group significantly lowered their cholesterol levels, improved dietary habits and activity levels, and lost more weight compared to the people who didn't receive counseling.

The counseled group also maintained or improved their quality of life, including their enjoyment of food and convenience of preparing a low-fat diet.

More information

The National Heart, Lung, and Blood Institute has more about healthy eating.

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Birds May Spread Ebola Virus, Research Suggests
 

Reuters

Wednesday, December 18, 2002

WASHINGTON (Reuters) - Birds may be able to carry and spread the Ebola (news - web sites) virus, a deadly African germ that has mystified doctors, US researchers said on Tuesday.

They said Ebola, which has killed several hundred people in Congo Republic, the neighboring Democratic Republic of Congo (news - web sites), and Gabon since it was first identified in 1976, resembled some bird viruses.

David Sanders and colleagues at Indiana's Purdue University found that the outer protein shell of Ebola is similar to those of several viruses carried by birds.

"We knew these viruses were inwardly similar, and now we see their outer similarity as well," Sanders, a biologist, said in a statement.

"While bird transmission of Ebola is by no means certain, the resemblance among all these viruses should encourage health officials to be on guard for it."

Ebola kills an estimated 70% of victims, depending on the strain. It is a hemorrhagic fever, causing widespread tissue destruction and bleeding. There is no cure.

Scientists believe it is passed from some animal to people but have not been able to find the animal "reservoir" for the virus. Contact with chimpanzees and gorillas have been associated with some outbreaks. The disease is also passed on through contact with body fluids.

Birds are known reservoirs of other viruses that infect people, including influenza.

Writing in the Journal of Virology, Sanders and colleagues said their findings suggest the bird viruses and Ebola have a common ancestor.

Understanding Ebola is key, not least because it is considered a possible biological warfare or bioterrorism agent.

"Ebola is one of the viruses with which the US agencies in charge of bio-defense are most concerned," Sanders said. "Identification of its natural hosts should be a priority."

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Inhaled Steroids Can Lead to Falls Among Elderly

HealthScoutNews

Wednesday, December 18, 2002

WEDNESDAY, Dec. 18 (HealthScoutNews) -- Inhaled corticosteroids increase the risk of hip fractures in older people, says a British study in the latest issue of the American Journal of Respiratory and Critical Care Medicine.

The researchers studied 16,341 hip fracture cases and 29,889 people without hip fractures in a control group. The median age of the people in the study was 79.

The study found the risk of hip fracture associated with use of inhaled corticosteroids had an odds ratio of 1.26.

The researchers suggest that people with asthma or chronic obstructive pulmonary disease should limit their doses of inhaled corticosteroids to what's needed to control their airflow obstruction.

About one in 10 people in the United Kingdom are prescribed inhaled corticosteroids to manage asthma or chronic obstructive pulmonary disease. Previous research found the use of 1,200 micrograms per day of inhaled corticosteroid led to a reduction in bone mineral density in the lower lumbar spine and femur.

More information

Here's more about corticosteroids and asthma.

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FDA Panel Backs Nasal Mist Flu Vaccine

 

By Lisa Richwine

Reuters

Wednesday, December 18, 2002

BETHESDA (Reuters) - An influenza vaccine that can be sprayed painlessly in the nose took a step toward the market on Tuesday as US advisers ruled it was safe and effective for healthy people aged 5 to 49.

But the Food and Drug Administration (news - web sites) advisory panel said there was not enough evidence to prove the vaccine, called FluMist and made by MedImmune Inc., works in people aged 50 to 64, a group that health officials urge to get vaccinated against influenza, commonly called the flu.

Millions of Americans each year experience the fever, aches and general misery the flu brings. About 20,000 of them die from the illness, and about 114,000 have to be hospitalized, according to the Centers for Disease Control and Prevention (news - web sites).

Only 30% of healthy US adults, and 10% of healthy US children, get flu shots, the only approved flu immunizations, MedImmune officials said. They hope the easy way of administering FluMist--spraying it into the nose--will persuade more people to become immunized.

"It is in this healthy population where we believe FluMist can fill an important public health need," James Young, MedImmune's president for research and development, told the panel.

The FDA usually follows its panels' advice, which means FluMist could be approved and on the market in time for the flu season that starts next fall. But excluding the older age group will restrict FluMist's sales, some industry analysts said. The vaccine would be co-marketed by Wyeth.

"The majority of flu vaccine users are older people, so it's bad news the vaccine is not deemed effective for that group," said Hemant Shah, an independent New Jersey-based analyst.

Shah estimated FluMist will post sales of $50 million to $100 million its first year on the market and will achieve eventual peak annual sales of no more than $300 million to $500 million.

After the panel meeting, MedImmune Chief Executive David Mott said the company was "thrilled with the significant step forward we've taken" in getting FluMist on the market.

In a study of 1,600 healthy children aged 15 months to six years, FluMist was 93% effective in preventing the flu, Young said.

A study of 4,561 adults failed to show that FluMist reduced illnesses with fever when compared with a placebo spray. Data did show FluMist cut rates of severe feverish illness and upper respiratory infections.

Just last year, the FDA panel ruled that it was not convinced FluMist was safe enough to be sold. MedImmune eased the panel's concerns, although several members encouraged further study of various issues after the vaccine hits the market.

That included a closer look at whether the live, weakened viruses used in the vaccine could spread and cause harm to unvaccinated people. Some panelists also suggested a head-to-head comparison of FluMist with a flu shot.

"We think this is favorable to MedImmune and hopefully will lead to an approval," Todd Nelson, an analyst at RBC Capital Markets, said of the panel vote. He added that "it might require some repositioning in the market" if the FDA excludes people over age 50 from the approval.

MedImmune had previously requested permission to sell FluMist for children as young as a year old. Concerns that FluMist might increase the risk of asthma attacks in young children partly led to the FDA panel's rejection of the product in July 2001. The company later amended its application to market FluMist for people aged 5 to 64.

The FluMist application was first submitted in October 2000 by Aviron, a California-based vaccines company acquired by MedImmune in January.

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New Antibody Buys Time for Brain Cancer Victims

HealthScoutNews

Wednesday, December 18, 2002

WEDNESDAY, Dec. 18 (HealthScoutNews) -- A specially designed antibody shows promise in extending survival for people with high-grade cancers of the brain, one of the most aggressive and deadly forms of cancer.

That's the claim of a study in the December issue of the American Journal of Clinical Oncology.

The published results are from the first 10 years of an ongoing study that started in 1987. It follows 180 people who, after receiving surgery and radiation therapy for their brain tumors, were given injections of a radioiodinated monoclonal antibody called MAb425.

The antibody was developed at the Wistar Institute in Philadelphia.

Of the 180 people who received the antibody injections, three with high-grade brain tumors were still alive after five years and longer. In the patients with less aggressive tumors, eight were alive after five years and longer and 50 percent of those patients were alive after 56 months.

Typically, people with lower-grade brain tumors die within 18 to 24 months and people with more aggressive brain tumors usually die within 12 to 18 months.

More information

The U.S. National Cancer Institute (news - web sites) has more about brain tumors.

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Better Housing Boosts Poor Youngsters' IQ: Study

 

By Charnicia E. Huggins

Reuters Health

Wednesday, December 18, 2002

NEW YORK (Reuters Health) - Children who live in brick and cement houses have higher IQs than those of the same socioeconomic status who live in nearby shanty houses, according to the results of a study conducted in India.

Yet, it is not the housing structure itself that influences a child's mental intelligence, the researchers note, but rather the difference in attitude among parents in lower versus higher quality housing.

"Living in better housing seemed to bring about the change in parental attitude that induced them to send their children for preschool and thus provide better opportunities for their children," study author Dr. Jacob M. Puliyel of St. Stephens Hospital in Delhi, India, told Reuters Health.

The children studied were grandchildren of adult migrant workers who formerly lived in urban slums clustered around construction sites.

Previous research has shown that children who live in poverty-stricken slums, which are known to have poor quality housing, tend to have lower IQs than their peers.

In the case of the migrant workers, however, the Government of Delhi intervened--as in other periodic instances--by relocating the workers and their children to areas that were then on the outskirts of the city and providing them with plots of land to build brick and cement houses. Yet, there was not enough land earmarked for the project, so the families that did not get their own plot were left to live in neighboring shanty houses.

Puliyel and his colleagues therefore investigated the influence of housing on IQ by studying 200 children who were raised in brick and cement houses on the government-issued plots of land and 173 children who were raised in shanty houses. The children ranged in age from 3 to 5.5 years.

Similar to previous studies, the children with the new homes had IQ scores that were, on average, slightly higher than their peers in the shanty houses, the researchers report in the December issue of Health Policy and Planning.

The two factors that had the biggest impact on the children's IQ scores was their nourishment during the first 6 months of life and their preschool attendance.

Children who were not adequately nourished during the first few months after birth had lower IQ scores than their peers, the report indicates. Still, the percentage of such children was similar among families who lived in plot areas and those who lived in adjoining shanty houses.

In contrast, preschool attendance, which was associated with higher IQ scores, was reported among more than half (53%) of the plot-area children but only 28% of the children who lived in shanty houses, study findings show.

This education was available to all of the children free-of-charge, according to Puliyel, so the discrepancy among the two groups "is interesting as it is consistent with an attitudinal change brought about by moving up the scale from living in a slum to a house of one's own," he and his team write.

Parents who live in slums "are likely to have less self-esteem, be less ambitious and have lower expectations of their children," but as they move outside the slums into better housing, their seeming change of attitude "would likely result in providing better opportunities, widened choices and optimal attainment of physical and mental potential of the child," they explain.

Thus the findings may offer a new way for the government to effectively address poverty, according to the researchers. "Aid, in this case simple houses, can assist in lifting the poor out of the cycle of poverty, slum-dwelling, low self-esteem, lowered IQ of children and poverty perpetuated into the next generation," they write.

"The provision of decent accommodation is essential if slum dwellers are to be motivated to improve their lot," Puliyel added.

Further, he said, the findings are not limited to India, but may extend to the United States and other nations as well.

"The problem of homelessness and slums exist in developed countries as it does in developing countries," Puliyel said. "The slum dweller in developed countries have a higher income than those in poorer countries, but the disparity and resultant feelings of hopelessness must be universal."

So what can poor families do to minimize any negative effects of their poor housing environment on their child's mental intelligence?

"Parents who don't live in proper housing can ensure their child's IQ does not suffer if they can keep up their morale and motivate their children to go to school and avail of the opportunities available to them," Puliyel said.

Source: Health Policy and Planning 2002;17:420-424.

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Infant Hair Sample Betrays Maternal Drinking During Pregnancy

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Wednesday, December 18, 2002

WEDNESDAY, Dec. 18 (HealthScoutNews) -- Testing infant hair could help doctors identify babies at risk for fetal alcohol syndrome because their mother drank during pregnancy.

Physicians who suspect a pregnant woman was drinking or using drugs now look for signs of those substances in the early feces, or meconium, of her newborn. However, meconium quickly passes through the body and is available for two or three days after birth at most.

The new test, first used on newborns by Canadian researchers, detects molecules called fatty acid ethyl esters. It can, in theory, pick up evidence of alcohol exposure for as long as three months after birth, the researchers say.

Little can be done for a child exposed to excessive alcohol in the womb. But knowing a child might be vulnerable to fetal alcohol syndrome could be of value to child welfare and law enforcement officials who might want to take action against the mother.

Of course, not all babies are born with hair, so for these infants the new test wouldn't be useful. But for the rest, it could significantly widen the window during which alcohol exposure screening is effective, says research leader Dr. Gideon Koren, of Toronto's Hospital for Sick Children.

"I think the fact that you can measure [alcohol exposure] in hair is very big news," says Koren, co-author of a research letter describing the technique in a woman and her baby girl who tested positive for both cocaine and alcohol. The letter appears in tomorrow's issue of The New England Journal of Medicine (news - web sites).

The test used mass spectroscopy to analyze the chemical makeup in small samples of hair. It found the baby girl's fatty acid ethyl ester concentrations -- which reflect maternal alcohol breakdown -- were about six times lower than her mother's but detectable nevertheless. The woman had said she was a "social" drinker during pregnancy, suggesting that newborns exposed to greater amounts of alcohol should have stronger signs of it in their hair.

Koren and his colleagues haven't looked yet for indications of alcohol in infant hair as far out as three months. However, they've done so successfully for other substances, including cocaine, nicotine and marijuana, he says.

The hair test is still "cumbersome," says Koren, director of the Motherisk program, a counseling and testing service for pregnant and nursing women. Once demand for the screening increases, he expects it will become quicker and less costly.

A larger concern is correlating levels of ethyl esters, either in hair or meconium, with the risk of fetal alcohol syndrome. No one has been able to do so to date.

Another potential problem: Every fetus is exposed to trace amounts of alcohol from the mother through the normal breakdown of sugars. However, at least in meconium testing, the amounts present in the newborns of women who drink during pregnancy are 10 to 100 times higher than the normal level, Koren says.

Fetal alcohol syndrome affects between 0.3 and 2.2 American babies per 1,000, or between 1,200 and 8,800 newborns a year, according to the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC). Alcohol exposure during pregnancy can lead to birth defects as well as severe mental and behavioral problems, including low IQ and attention-deficit disorder. These symptoms don't generally appear for several years -- long after any neonatal test would be helpful.

Fewer women drink during pregnancy than did in the past, the CDC says. However, the number who report consuming at least seven drinks a week and five or more drinks at a sitting jumped fourfold between 1991 and 1995.

Since fetal alcohol exposure during the first three to eight weeks of development is linked to birth defects, many women drink before they know they're pregnant.

Some states require hospitals to notify child welfare officials if a mother admits to drinking during pregnancy or if she tests positive for alcohol or drug use. None requires testing meconium for all newborns.

Dr. Cynthia Bearer, a neonatologist at Case Western Reserve University in Cleveland and an expert on fetal exposures to toxic substances, says she doesn't believe the hair test will replace meconium screening.

"Every baby has meconium and a lot of babies don't have hair. And a lot of moms don't like it if you cut their baby's hair off," she says.

Eventually, Bearer says, she'd like to see meconium testing be routine in delivery wards, not just for drugs and alcohol but other prenatal exposures as well, such as chemicals in the environment. "You'd get a picture of the exposures, and maybe have an intervention" to prevent or reverse harm to the infant, she says.

The only step that effectively discourages women from drinking during pregnancy is to educate those who've already done so before about the risks to their future pregnancies, Bearer says. Warning labels on alcohol and at bars and liquor stores don't seem to be more than a temporary deterrent, and only with more educated women, she says.

What To Do

For more on fetal alcohol syndrome, try the National Organization on Fetal Alcohol Syndrome or the U.S. Centers for Disease Control and Prevention.

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Parkinson's Drug Linked with Heart Valve Trouble

 

By Keith Mulvihill

Reuters Health

Wednesday, December 18, 2002

NEW YORK (Reuters Health) - Researchers from the Mayo Clinic say that in some cases, patients taking a Parkinson's disease (news - web sites) drug may experience damage to heart valves. They report three cases in which women in their 60s or 70s who were taking pergolide (Permax) developed severe, unexplained valvular heart disease.

"Pergolide appears capable of causing significant injury to the heart valves, potentially requiring valve replacement surgery," Dr. Raul E. Espinosa told Reuters Health.

Espinosa and colleagues from the Rochester, Minnesota-based Mayo Clinic, report on the three patients in the December issue of the Mayo Clinic Proceedings. Two were being treated with pergolide for Parkinson's disease and the third for sleep apnea and restless legs syndrome.

None of the patients--a 72-year-old, 74-year-old and 61-year-old--had used other drugs associated with heart valve problems.

The patients had symptoms such as fluid retention in the legs, breathing difficulties and heart murmurs that can be indicative of heart valve problems. The heart valves keep blood from flowing backwards in the organ, and are essential to the normal flow of blood.

Two of the patients underwent surgery to replace the defective valves. An analysis showed surface lesions on the damaged valves, the investigators report.

"Patients receiving pergolide should contact their physician and undergo a careful cardiovascular examination, and perhaps an echocardiogram to visualize the structure and function of the heart valves," Espinosa advised. "If abnormal valve function is found, with no apparent alternative cause, consideration should be given to stopping pergolide."

He and his colleagues conclude in their paper that "more studies are necessary to determine the incidence of valvular disease and the spectrum of abnormalities seen with pergolide treatment."

"My hope is that a study done properly...would show that the three cases reported (by Espinosa and colleagues) are a rare occurrence; however, this must be proved," Dr. Shahbudin H. Rahimtoola, from the University of Southern California, Los Angeles, comments in a journal editorial.

"Patients currently taking or those who have taken pergolide surely want to know the whole truth as soon as possible," Rahimtoola adds. Whether patients need to undergo heart tests before taking the drug "is an important and perhaps controversial issue that needs to be resolved."

Speaking on behalf of Eli Lilly, the pharmaceutical company that developed the drug, spokeswomen Kindra Strupp noted that the company is aware of the valve disorder and that they have been in contact with the US Food and Drug Administration (news - web sites) (FDA). Amarin Pharmaceuticals Inc. markets the drug in the US.

"Reports of cardiac valvulopathy are very rare, " Strupp told Reuters Health. Less than 0.005% of patients have reported incidents of valvulopathy, she explained.

Since the product was approved for treatment of Parkinson's disease patients about 13 years ago, more than 500,000 people have taken the drug, according to Strupp.

Recently, the FDA contacted Eli Lilly about the latest heart valve reports and recommended that the company make a slight amendment to the labeling of pergolide in the warnings section of the label that denotes rare occurrences, she said.

Strupp said the company will amend the label shortly.

Source: Mayo Clinic Proceedings 2002;77:1280-1286.

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New Drug Holds Hope for Deadly Fungus

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Wednesday, December 18, 2002

WEDNESDAY, Dec. 18 (HealthScoutNews) -- For most of us, fungal infections are an annoying but mostly harmless fact of life. Athlete's foot and yeast infections are hardly killers.

But fungus is a different story for sick people whose bodies are too weak to put up a strong defense against attacks launched against their blood vessels and internal organs.

Now, there's a new medication on the market to help the most vulnerable patients, and research funded by a drug company suggests that it works as well as an existing product without the troublesome side effects.

The new drug, known as caspofungin, will help combat the "hidden plague" of serious fungal infections in hospitals, said study co-author Dr. John Perfect, an associate professor of medicine at Duke University.

"Fungal infections complicate modern medicine and without control of them, many lifesaving therapies for other serious diseases will be compromised," he said.

Various types of fungus live naturally in our bodies and occasionally cause infections in places like the toenails, the mouth (in a disease called thrush), and the vagina. In patients with weakened immune systems, however, fungi can travel into the body and cause a disease known as candidiasis.

The disease can kill 30 to 40 percent of those who are infected, Perfect said. The most vulnerable patients are HIV (news - web sites)-positive people, organ transplant recipients, chemotherapy patients, and those who have catheters inserted.

According to Perfect, doctors have mainly used two drugs to treat candidiasis. Amphotericin B, which has been available for about 45 years, works well but has serious side effects. Nurses call it a "beast of a drug," Perfect said.

The second drug, fluconazole, is safer but doesn't work against all strains of the disease, he said.

Perfect and colleagues tested new and old drugs in more than 200 patients from around the world. The study was funded by Merck, manufacturer of caspofungin.

The study findings appear in the Dec. 19 issue of the New England Journal of Medicine (news - web sites).

The study found that caspofungin treated candidiasis as well as amphotericin B but without as many side effects, Perfect said.

"The disadvantage is that this agent must be given through the veins and cannot be taken by mouth," he said. "This is not a problem in the hospital but becomes more difficult to give outside the hospital setting."

Another physician, Dr. Judith Feinberg of the University of Cincinnati College of Medicine, predicted that caspofungin will not become popular immediately.

"It's new and will therefore be expensive," said Feinberg, a professor of medicine who specializes in treating AIDS (news - web sites) patients. "It will be reserved for the sickest kinds of patients who are in the hospital and for one reason or another have not responded to fluconazole."

The federal government has not yet approved caspofungin for use in candidiasis patients, Perfect said. That means Merck cannot advertise the drug for use in those patients. However, doctors can still legally use the drug for "off-label" purposes such as treating candidiasis.

What To Do

Get a primer on candidiasis from Medline. And learn more about fungus from (who else?) Doctor Fungus.

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Eating Oily Fish May Reduce Risk of Asthma

 

By Pat Hagan

Reuters Health

Wednesday, December 18, 2002 

LONDON (Reuters Health) - Eating oily fish like salmon of mackerel regularly may reduce the risk of asthma symptoms, according to new British research.

A study by public health experts at the University of Cambridge suggests regular consumption of fish like salmon, mackerel and herring can have a protective effect. It is the latest evidence that diet is important in determining who is most at risk of developing asthma, and adds to the list of benefits ascribed to fish rich in omega-3 fatty acids.

"This study adds to existing evidence that a diet high in oily fish could protect against asthma," said the National Asthma Campaign in a statement released in response to the study.

"There have now been several studies suggesting an association between intake of certain foods and a lower incidence of asthma. These have shown a potential association between intake of oily fish, fresh fruit and magnesium--which is found in fresh fruit and vegetables and reduced by cooking--and a lower rate of asthma," the National Asthma Campaign statement notes.

The results add to the argument that lifestyle changes could be one reason that asthma rates are increasing.

A team of researchers from the university studied more than 750 volunteers who were already taking part in a much bigger investigation called the European Prospective Investigation of Cancer--a long-term study into the effects of diet on cancer.

They provided details of diet and lifestyles and were also asked if they had even been diagnosed with asthma.

The results revealed 333 patients had suffered wheezing in the 12 months before completing their questionnaire and 437 had not.

More than 12% of the healthy volunteers reported eating oily fish at least twice a week, compared with just 7.5% of the asthma sufferers.

After accounting for other asthma risk factors, such as body mass index, social class and smoking habits, the researchers found regular fish consumption roughly halved the risk of asthma attacks, wheezing or waking up with tightness in the chest.

"These data support the hypothesis that regular consumption of oily fish may be protective against symptomatic asthma," the researchers said in a report at the recent British Thoracic Society Winter meeting in London.

How the polyunsaturated fatty acids in these fish protect against asthma remains unknown, but scientists speculate it may to do with reducing production of prostaglandins linked with constriction of the airways.

Eating oily fish has also been linked to protection from heart disease, arthritis and other ailments, although the British government currently recommends limiting consumption of oily fish to one portion a week, as the flesh may contain high concentrations of heavy metals such as mercury, as well as dioxin pollutants.

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More Women Receiving Prenatal Care

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Wednesday, December 18, 2002

WEDNESDAY, Dec. 18 (HealthScoutNews) -- The share of American women who received prenatal care in the first three months of pregnancy rose 7 percent between 1991 and 2001, to 83 percent, according to new government figures released today.

But premature births were also up, dramatically, to their highest level in 20 years. And Caesarean deliveries reached an all-time high last year, the Centers for Disease Control and Prevention (news - web sites) (CDC) report on maternal and infant health found.

On the plus side, the report also found that only 1 percent of American mothers-to-be last year reported getting no prenatal care at all during pregnancy -- half as many as in 1990. Blacks and Hispanics, who historically haven't received prenatal care as frequently as whites, showed particularly strong gains, the report found.

Still, about a quarter of minority women aren't getting timely prenatal checkups, said Joyce Martin, a statistician with the National Center for Health Statistics, a division of the CDC and lead author of the report. Prenatal care is important for monitoring the health of both mother and fetus, and can catch conditions like diabetes or high blood pressure that might threaten the lives of both.

"It's very important that all women have timely, competent care," Martin said. "You don't want a woman starting prenatal care in her seventh or eighth month of pregnancy, when it's too late to control problems like diabetes or hypertension."

Health officials were enthusiastic about the prenatal findings in the report, which was based on birth certificates filed in state vital statistics offices and reported to CDC.

"We're continuing to make excellent progress in our efforts to have more women, particularly minority women, receive early prenatal care," Secretary of Health and Human Services (news - web sites) Tommy Thompson said in a statement today. "Timely prenatal care is one of the best ways to ensure the health of mothers and their infants, and we will continue working to expand access to this essential care for all Americans."

Another encouraging sign: The number of women who smoked during pregnancy fell to 12 percent in 2001, a drop of 38 percent from 1989. Exposure to tobacco in the womb significantly raises a baby's chances of being born underweight. Slight infants face higher risks of developmental delays.

But not all the news in the report was good. Premature births have hit their highest level in two decades, making up roughly 12 percent of the 4,025,933 newborns in 2001. Premature babies -- those born earlier than 37 weeks of gestation -- are often underweight. Not surprisingly, the incidence of low birth weight infants -- defined as weighing less than about 5.5 pounds -- rose to 7.7 percent of deliveries, up more than 13 percent since the mid-1980s.

Experts attributed some of the rise in prematurity and low birth weight to an increase in induced labor, which is now twice as common as it was in 1989 and makes up a fifth of all deliveries. Some probably is also due to a surge in multiple pregnancies, like twins and triplets, that has accompanied greater use of fertility-enhancing therapies and assisted reproduction.

The nation's twin birth rate topped 3 percent of all deliveries in 2001 for the first time, and the number of triplets and "higher-order multiples" climbed 3 percent between 2000 and 2001.

Caesarean section surgery accounted for about 24 percent of deliveries last year, up 5 percent from the year before and an all-time high, officials said. Similarly, the rate of vaginal delivery after a previous C-section plummeted 20 percent during the period. Caesarean section procedures aren't risky for infants, but like any operation, they can pose a threat to the health of the mother.

The reasons for the recent surge in C-section deliveries aren't fully understood, Martin said. Some of the increase probably reflects factors like maternal choice and physician habits.

The country's birth rate fell slightly between 2000 and 2001, from 14.7 per 1,000 people to 14.5 per 1,000. Births to single women constituted roughly a third of all deliveries last year, or 1.3 million children, the report found. Although that was a record high, the rate of births to unwed mothers fell fractionally.

Teen births fell to an all-time low of 45.8 per 1,000 girls age 15 to 19 in 2001, off 26 percent since 1991, officials said. Among black girls, the decline has been even sharper, with births tumbling 46 percent during the period.

What To Do

For more on the report, try the CDC's National Center for Health Statistics. To learn more about child health, go to the National Institute of Child Health and Human Development.

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Chocolate-Derived Chemical Could Suppress Cough

 

By Pat Hagan

Reuters Health

Wednesday, December 18, 2002

LONDON (Reuters Health) - A chemical found in cocoa and chocolate appears to suppress coughs and could potentially be developed into an effective treatment, according to the results of a small new study.

However, don't use the findings as an excuse to hit the candy store the next time you feel a cold coming on. The researchers note that a person would have to consume up to 25 candy bars to achieve the dose of the substance used in the study.

Researchers at the National Heart and Lung Institute in London did discover that the chemical, theobromine, was more effective than codeine, which is used in pharmacy cough remedies.

"It's too early to advise people suffering from cough to treat themselves with chocolate," Dr. John Harvey, chairman of the Communications Committee of the British Thoracic Society (BTS), said in a statement.

"But the number of people with undiagnosed chronic cough is increasing in this country and more effective treatments are needed. So I hope this research provides a clue for future treatments," Harvey said.

The findings were unveiled at the recent BTS winter meeting in London. The research team, led by Dr. Omar Sharif Usmani, recruited 10 healthy nonsmokers and exposed them to three different forms of treatment--1000 milligrams (mg) of theobromine, 60 mg of codeine, or an inactive placebo.

Two hours after taking each one separately, volunteers were then given capsaicin, a cough-inducing substance that puts the "hot" in hot peppers and is routinely used in cough medicine research.

The researchers wanted to measure how much capsaicin it took to induce five coughs. Their results showed that although there was little difference between the codeine and placebo, there was an increase in the amount of capsaicin needed when patients took the theobromine.

It's not clear why the compound might suppress coughs. But theories put forward by the research team include the possibility that it may have an affect on receptors for adenosine, a molecule that plays an important role in regulating the body's nervous systems. Another suggestion is that it inhibits the effects of phosphodiesterase, an enzyme that plays a wide role in many cellular processes.

Usmani said further studies of the effectiveness of theobromine are under way and although it is too early to recommend its use as a medicine, the findings highlight doubts over the effectiveness of existing remedies.

"Over-the-counter sales for acute cough medicines currently reach approximately 100 million a year in the UK--money that is being spent on remedies where evidence regarding their effectiveness is inconclusive," he said in the statement.

The study was not funded by any commercial companies.

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SERMs May Be Healthier Choice Than HRT 

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Wednesday, December 18, 2002

WEDNESDAY, Dec. 18 (HealthScoutNews) -- Physicians and women are showing renewed interest in medications known as selective estrogen receptor modulators, or SERMS.

That's especially true since conventional hormone replacement therapy has been linked to unacceptable health risks.

SERMS, also called designer estrogens, offer an alternative to HRT. And they can eliminate one of the side effects of HRT, an increased risk of breast cancer (news - web sites), according to an article on the medications in the January issue of Cancer.

The authors, from the University of Athens and the University of Patras in Greece, spell out the advantages of SERMS over HRT. One advantage is the ability to individualize treatments, depending on whether a woman needs to build bone, reduce breast cancer risk or other goals.

SERMS block the actions of estrogen in breast tissue and in certain other tissues by filling up the estrogen receptor cells. While the SERM medication fills in the receptor, it does not send messages to the cell to grow and divide, thus reducing cancer risk. However, the SERM medicines do send estrogen-like signals when they fill up receptors in bone cells, thus helping to slow or prevent osteoporosis, the researchers say.

Among the common SERMS are tamoxifen (Nolvadex), toremifene (Fareston) and raloxifene (Evista).

SERMS may be preferred over conventional HRT, the authors write, because they mitigate the breast cancer risk but maintain many of the therapeutic benefits of estrogen replacement therapy.

Earlier this year, a portion of the massive Women's Health Initiative, a study in which women were given estrogen and progestin, was halted when the overall health risks were found to exceed the benefits. Specifically, for every 10,000 women taking combined HRT for one year, there were seven more coronary heart disease events, eight more strokes, eight more lung embolism and eight more invasive breast cancers than in women taking a placebo. Those on HRT had six fewer colon cancers and five fewer hip fractures. The estrogen-only arm of the trial is continuing.

SERMs are a promising alternative to conventional HRT, the authors conclude. Taking a multidisciplinary approach will help doctors and women individualize therapy, depending on their needs and risks.

"This ultimately should provide women and their physicians with the ability to make safe and confident selections from a repertoire of medications that promise to expand the life span and improve the quality of life for women after menopause," they conclude.

Another expert, Dr. Victor G. Vogel, a professor of medicine and epidemiology at the University of Pittsburgh who studies SERMS, applauds the article and says attention to SERMs is past due. The medications, he says, "can lower breast cancer risk, sometimes by 40 or 50 percent." And they can reduce the risk of fractures and come without some of the other side effects found with combination HRT use. SERMs can also lower cholesterol, Vogel says.

"In light of the new data on hormone therapy," Vogel says, "physicians and women are wise to rethink their medication strategy for health-related problems that occur later in life, such as osteoporosis. What these Greek authors are saying is, there are some options here," Vogel says.

Like other experts, Vogel says women can take HRT on a short-term basis for relief of menopausal symptoms such as hot flashes. The SERMs, as Vogel and the authors of the paper point out, do not help hot flushes and can actually increase them.

"I am a somewhat biased observer, because I have written on the topic," says Vogel. He also served on the data and safety monitoring board for the Women's Health Initiative. "I was one of those folks who said, 'We have to halt this trial.'"

What To Do

For more information on SERMS, see breastcancer.org or the American Cancer Society.

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Young Girls, Older Partners Leads to High STD Risk

 

By Alison McCook

Reuters Health

Wednesday, December 18, 2002

NEW YORK (Reuters Health) - Teenage girls who have older partners are more likely than girls their same age with younger partners to report behaviors that place them at high risk of sexually transmitted diseases (STDs), new research demonstrates.

Specifically, Elin Begley of Emory University in Atlanta, Georgia discovered that teenage girls who said they were dating someone at least 2 years older were half as likely as girls with partners closer to their own age to say they had consistently used condoms during the past 30 days. In addition, girls with older boyfriends were more than twice as likely to report that their partners had had other partners during their relationship in the past 6 months.

Indeed, screening the girls for sexually transmitted diseases revealed that those with older partners were almost four times as likely as others to have chlamydia.

These trends persisted regardless of the woman's level of education and her knowledge about preventing HIV (news - web sites) and other STDs.

All of the girls in the current study were pregnant, Begley told Reuters Health. Chlamydia, if left untreated, can cause sterility in women, but can also pose health risks to their fetus if not treated before childbirth, Begley said, such as blindness or conjunctivitis. Presumably, she added, if these girls had not been screened for STDs, these health problems could have occurred.

"There's some pretty serious health outcomes that can be very detrimental," she said.

Begley obtained her results from surveys and screenings of 170 pregnant African-American girls between the ages of 14 and 20 who attended a prenatal clinic. She reported her findings at the recent 130th Annual Meeting of the American Public Health Association (news - web sites) in Philadelphia.

In an interview, Begley said that there could be many reasons why teens dating older men may take more risks in terms of their sexual health than young girls with younger partners. Older partners may be more interested in pregnancy, she said, and may simply be less willing to wear a condom than younger men.

Older men may also be more likely to give their young partners chlamydia by virtue of the fact that they may have had more partners than younger men, Begley noted. However, the finding that older partners have more extra affairs paints a more complex picture, she added.

"Obviously, there's some multiple partnering going on here, so that could be a factor," Begley noted.

She suggested that clinicians working with young women should educate them about protecting themselves from STDs, may even want to consider asking them about the age of their partners, and keep in mind that their responses could have implications for the girls' risk of diseases.

Begley added that women who say they have older partners may also benefit from repeated screening for STDs during their pregnancies, since they are less likely to use condoms, and therefore may become reinfected with certain diseases over the course of their pregnancies.

"Clinicians should inquire about the age of an adolescent woman's partner, so that they can kind of use that as a flag for screening," Begley said.

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TUESDAY, DECEMBER 17, 2002

Older, Cheaper Drugs Best for Hypertension

 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Tuesday, December 17, 2002

TUESDAY, Dec. 17 (HealthScoutNews) -- The older, less expensive blood pressure drugs called thiazide diuretics do a better job of saving lives than newer, costlier medications, a new study finds.

In an eight-year trial, the incidence of adverse events such as heart failure was lower and the risk of fatal heart disease or heart attacks was no greater for people who took a diuretic as for those who took a calcium channel blocker or an angiotensin-converting enzyme (ACE) inhibitor, says a report in tomorrow's issue of the Journal of the American Medical Association (news - web sites).

"Thiazide-type diuretics should be considered first for pharmacologic therapy in patients with hypertension [high blood pressure]," the report says. "They are unsurpassed in lowering blood pressure, reducing clinical events and tolerability, and they are less costly."

The drugs have different mechanisms of action. Diuretics lower blood pressure by increasing the excretion of water and sodium. Calcium channel blockers widen blood vessels by relaxing the muscles around them. ACE inhibitors block the activity of an enzyme that makes arteries constrict. Diuretics, by far the older drugs, generally are available as relatively inexpensive generics, while the calcium channel blockers and ACE inhibitors often are higher-priced, brand-name products.

The 50 million to 60 million Americans who have been diagnosed with high blood pressure now spend an estimated $15.5 billion a year on drugs to treat it, the report says. It does not estimate how much would be saved by wider use of diuretics, and it notes that a large proportion of patients need more than one drug. However, it adds that "it is reasonable to infer that a diuretic be included in all multi-drug regimens."

A preliminary cost analysis has been made, says study leader Dr. Jackson T. Wright Jr., a professor of medicine at Case Western Reserve University, and it shows that "if patients were switched from calcium channel blockers and ACE inhibitors to diuretics, the annual savings in direct costs would be between $250 and $600 per patient." There would be other savings from a reduced need for hospitalizations, Wright adds.

The study shows a diuretic is more effective than a calcium channel blocker in preventing heart failure and reducing the need for hospitalization, and that it is more effective than an ACE inhibitor in preventing stroke, heart failure and a number of other adverse events, Wright says.

The incidence of fatal heart disease or nonfatal heart attacks was virtually the same for all three drugs -- 11.3 percent for those taking the calcium channel blocker, 11.4 percent in those taking the ACE inhibitor, and 11.5 percent in those taking the diuretic.

The study "will lead physicians to rethink how they treat high blood pressure," says a statement by Dr. Daniel Jones, associate vice chancellor for health affairs at the University of Mississippi Medical Center and the American Heart Association (news - web sites)'s representative to the National Institutes of Health (news - web sites) high blood pressure education program coordinating committee.

"But we strongly urge patients to continue taking their current medication until they have talked with their physician to determine the best treatment," Jones says.

Diuretics have fallen out of favor with many doctors because they have potentially dangerous side effects such as raising blood cholesterol and sugar levels, says Dr. Lawrence J. Appel, a professor of medicine at Johns Hopkins University who wrote an accompanying editorial.

However, the new study "provides strong evidence that they should be first-line therapy," he says.

The new study probably is the most comprehensive effort ever made to compare the effectiveness of different blood pressure drugs, Appel says.

"There have been many trials, but few have compared so many agents and none have had clinical outcomes as their endpoints," he says, meaning that earlier studies looked at how well the drugs reduced blood pressure, rather than their ability to reduce heart attacks and fatal heart disease.

The study enrolled more than 33,000 people with high blood pressure and at least one other risk factor for heart disease at 623 medical centers in the United States, Canada, Puerto Rico and the U. S. Virgin Islands. Some took amlodipine, a calcium channel blocker marketed as Norvasc, some took lisinopril, an ACE inhibitor marketed as Zestril or Prinivil, and some took chlorthalidone, a diuretic marketed as Hygroton or Thalitone but also available in generic form.

Appel says the study results will not change the way he practices because he has been a fan of diuretics from the start. One reason why many doctors have prescribed newer, more expensive drugs is that pharmaceutical companies advertise them heavily, while "there is little marketing of generics," he says.

What To Do

You can learn more about high blood pressure and how it is treated from the American Heart Association and the National Heart, Lung, and Blood Institute.

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Women, Men Benefit Equally from Angioplasty

By Suzanne Rostler

Reuters Health

Tuesday, December 17, 2002

NEW YORK (Reuters Health) - Women with heart disease who undergo angioplasty fare as well as their male counterparts when it comes to survival after the procedure, researchers report.

The study may put to rest concerns that women fare worse after having angioplasty and other artery-clearing procedures. According to the new report on nearly 34,000 cases, the rate of emergency open-heart surgery, heart attack and death were roughly equal for both sexes.

What's more, the rate of emergency surgery and heart attack post surgery declined during the study period, a time during which more patients were being treated with angioplasty--even those who were generally sicker than the first patients treated with the technique.

"Regardless of sex, and despite intervening on a sicker patient population, outcomes for (artery-clearing procedures) are improving," Dr. David Malenka, the study's lead author, told Reuters Health.

The investigators reviewed data from patients admitted to US hospitals for artery-clearing procedures between 1994 and 1999. Overall, the need for emergency open-heart surgery, also known as coronary artery bypass grafting (CABG), and the rate of heart attack declined over the years. By the end of the study, the need for emergency CABG surgery was 0.06% for women and 0.05% for men. Similarly, the rate of heart attack was roughly equal for women and men, they report in the December 18th issue of the Journal of the American College of Cardiology.

The rate of death did not decline during the study and remained slightly higher for women, possibly because they tend to be sicker than men by the time they are referred for these procedures, the researchers write.

While it is not clear from the study why outcomes improved, the researchers suggest that the use of stents--metal scaffolding designed to prop open arteries after angioplasty--may play a role.

"It seems logical to assume that the use of stents allowed cardiologists to better cope with suboptimal results and thus, avoid acute closures which would necessitate open heart surgery," said Malenka, an associate professor at Dartmouth Medical School in Lebanon, New Hampshire.

However, improvements in other devices such as catheters and balloons used in the surgery, the availability of new devices, better drugs, and the cumulative experience of the doctors participating in the study may also have contributed, he added.

Source: Journal of the American College of Cardiology 2002;40:2092-2101.

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FDA Panel Clears Flu Spray for Some

 

By Lauran Neergaard

AP Medical Writer

The Associated Press

Tuesday, December 17, 2002

WASHINGTON - one squirted up noses instead of injected into arms — took a tentative step toward the market Tuesday even as government scientists said FluMist is safe enough for only some people to use.

But FluMist is not proved safe for the people who most need a flu vaccine or a pain-free option — toddlers, the elderly and anyone with asthma or other chronic diseases, advisers to the Food and Drug Administration (news - web sites) stressed.

Indeed, FluMist initially was created with the hope of giving toddlers a needle-free vaccine, but researchers discovered it seems to increase the risk of asthma attacks in children under age 5.

So in its second attempt at winning FDA approval in two years, the vaccine's maker withdrew its plans to sell FluMist for toddlers, saying it would instead target healthy people ages 5 to 64.

The FDA's advisers threw a monkey wrench into the new plan Tuesday — recommending approval only for those aged 5 to 49. They concluded there's too little evidence that FluMist protects people 50 and over, an age when the immune system begins to wane.

Now the question is whether the FDA, which isn't bound by its advisers' recommendations, will let a vaccine with so many restrictions sell. If so, the uncertainties would severely limit how often doctors offer FluMist instead of the flu shots that 70 million Americans get every year.

A big unanswered question: Is FluMist as good as that standard flu shot? After all, FluMist is made of a weakened but live flu virus, while today's flu shots are made of killed virus. Manufacturer MedImmune Inc. hasn't compared the two vaccines.

Calling that question "the elephant in the room," FDA adviser Dr. Julie Parsonnet of Stanford University complained that without such data, doctors won't know which product to offer which patient if FluMist does sell.

"They are issues that are going to be highly problematic," agreed Dr. Dixie Snider of the Centers for Disease Control and Prevention (news - web sites).

Flu kills 20,000 Americans each year and hospitalizes 100,000. Those most at risk of flu complications, and thus who most need vaccine, are those over age 65 and people with certain illnesses including asthma and heart disease. Also, this year for the first time, pediatricians are being encouraged to vaccinate babies and toddlers, who are hospitalized with flu as often as the elderly and are key spreaders of infection through day care and to elderly grandparents.

Flu experts have longed for a needle-free alternative as a way to persuade more people to get annual flu vaccinations.

The nasal vaccine works by stimulating the immune system through the same nose tissue where the flu virus attacks. But in July 2001, FDA's advisers blocked FluMist's sale by saying the vaccine wasn't yet proved safe for children.

Tuesday, MedImmune argued its case again.

The vaccine proved 93 percent effective in preventing the flu in a study of 1,600 healthy children ages 15 months to 6 years. Side effects primarily included runny nose, muscle aches and fever, expected from exposure to weakened flu virus.

But up to 1.5 percent of children under age 5 who received FluMist suffered asthma attacks or asthma-like wheezing, rates almost four times higher than children who received a dummy vaccine, the FDA said.

So MedImmune decided to target FluMist only to children over 5, who didn't seem to have that asthma risk — although if the FDA lets FluMist sell, some doctors might give it to younger children anyway.

In adults, the vaccine wasn't as promising. Some 4,561 healthy, working adults ages 18 to 64 were given either FluMist or a dummy spray, and then reported any symptoms to researchers.

FluMist recipients were just as likely as the unvaccinated to experience a flulike illness, although MedImmune said vaccination cut severe illness by about 17 percent, as well as cutting lost days of work and doctor visits.

But FDA said FluMist didn't protect people ages 50 to 64 from flulike illnesses. MedImmune argued that those people didn't get as sick as the unvaccinated, but FDA's advisers ultimately said the company hadn't proved FluMist should be given to that age group.

Another key concern: Sneezing children occasionally spread the FluMist virus, raising questions about whether the spray vaccine would endanger grandparents or asthmatic playmates who aren't inoculated against the flu.

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Consumers Blame Drugs for Higher Healthcare Costs

Reuters Health

Tuesday, December 17, 2002

NEW YORK (Reuters Health) - Many consumers are blaming higher prescription drug costs, hospital fees and medical malpractice and insurance costs for their increased out-of-pocket healthcare costs, according to a new Wall Street Journal/Harris Interactive poll.

The findings suggest Congress will face even greater pressure to do something about escalating healthcare costs in 2003, pollsters say. But the survey also shows Americans' perception of the real drivers of rising healthcare costs is somewhat skewed.

Economists would say the public is overestimating the impact of higher drug prices and malpractice insurance and underestimating the impact of new medical technology, new drugs and increased utilization, noted Humphrey Taylor, chairman of the Harris Poll.

While Americans have seen rapid increases in prescription drug co-payments, they are largely shielded from many other health insurance expenses, the pollster explains.

More than half of all Americans reported feeling the pinch of higher out-of-pocket healthcare costs this year, according to the survey. Those costs were 37% higher, on average, for those who reported an increase. Among Americans 65 and older, the average increase was 25%.

Seventy-four percent of Americans and 89% of senior citizens blamed the higher prices of prescription drugs for the higher costs they faced in 2002. Higher hospital fees ranked No. 2 in the poll (with 61% of US adults and 76% of seniors), followed by medical malpractice and insurance costs (61% of adults and 71% of seniors).

The results were based on a nationwide poll of 2,438 US adults.

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Ultrasound Can Detect Down Syndrome

HealthScoutNews

Tuesday, December 17, 2002

TUESDAY, Dec. 17 (HealthScoutNews) -- Examining the nasal bones of fetuses during the mid-trimester ultrasound scan may help doctors identify those with Down Syndrome, says new research.

Down Syndrome affects one in every 500 to 600 lives. Currently, the most effective way of testing for Down Syndrome is by amniocentesis, where doctors take a sample of amniotic fluid. However, the test carries the risk of miscarriage.

The ultrasound study, which appears in the January issue of Ultrasound in Obstetrics and Gynecology, found that the nasal bone was underdeveloped in 61.8 percent of fetuses with Down Syndrome. Only 1.2 per cent of normal fetuses had an underdeveloped nasal bone. That demonstrates that nasal bone underdevelopment is associated with high risk for Down Syndrome.

The researchers estimate that combining the detection of an underdeveloped nasal bone with other testing methods could raise the ability to detect Down Syndrome in fetuses to more than 90 percent. That would help reduce the need for amniocentesis.

More information

Here's where you can learn more about Down Syndrome.

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Summertime Birth Linked with Celiac Disease: Study

 

Reuters Health

Tuesday, December 17, 2002

NEW YORK (Reuters Health) - Children born in the summertime have a greater risk of developing celiac disease, new study findings from Sweden show, suggesting that the disease may be due to some sort of seasonal environmental exposure.

Celiac disease affects the small intestine, interfering with the absorption of nutrients from food. People with the disease can't tolerate a protein called gluten found in wheat, rye and barley. While genetics are believed to play a role in celiac disease, the specific genes involved have not been identified.

Experts don't know why some people develop celiac disease, which usually lasts a person's lifetime.

The illness is of concern because gluten-containing cereals "are an important part of the diet in many countries," lead author Dr. A. Ivarsson of Umea University and colleagues write in the current report in the December issue of the Journal of Epidemiology and Community Health.

In the current investigation, Ivarsson and colleagues studied 2,151 children 15 or younger who were diagnosed with celiac disease to determine if the risk of the disease varied with month of birth.

Compared to Swedish children without celiac disease, those diagnosed with celiac disease were 40% more likely to be born during a summer month. But this seasonal variation was only seen among children diagnosed with the disorder before they were 2 years old.

While more girls than boys had the disease, the seasonal risk pattern was more pronounced among boys, the researchers found.

The relative seasonal risk persisted throughout the 10-year study, although the incidence of the disease varied throughout that period.

"This suggests causal environmental exposure(s) with a seasonal pattern," the authors write, noting that the cause could be some type of infection, or perhaps the interaction of an infection with other exposures, although a non-infectious exposure could also be responsible. "Primary prevention might be possible if these causal exposure are identified."

Source: Journal of Epidemiology and Community Health 2003;57:36-39.

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Use Lung Scans With Care

HealthScoutNews

Tuesday, December 17, 2002

TUESDAY, Dec. 17 (HealthScoutNews) -- Needless lung scans may be a threat to people with acute lung injury.

That's the sobering finding of a new study in a recent issue of Critical Care.

It's common practice for people with acute lung injury (ALI) to be injected with a special dye before they have a computerized tomography (CT) scan of their lungs. The dye helps doctors get a better image of the lungs to evaluate their condition.

However, this study says the dye may worsen the condition of people with ALI because it causes the lungs to fill with fluid, making it more difficult for the patients to breathe.

ALI is a serious lung disorder featuring widespread destruction of lung tissue caused by a lack of oxygen in the bloodstream.

The study examined the effects of the dye on 14 people with ALI. They were divided into two groups. People in one group were given a CT scan both before and 30 seconds after being injected with the dye. People in the other group were given a CT scan before and 15 minutes after being injected with the dye.

The study found the dye increased lung tissue volume in both groups, with a larger increase seen after 15 minutes. The lung tissue volume increase is attributed to accumulation of fluid in the lungs caused by the injection of the dye.

The study authors conclude the injection of the dye makes it harder for people with ALI to breathe. They suggest the use of dye be avoided in critically ill people with ALI who are having a thoracic CT scan.

More information

Here's more about lung health and diseases.

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Some Women Advised Against Cancer Test

By Daniel Yee

Associated Press Writer

The Associated Press

Tuesday, December 17, 2002

ATLANTA - Hoping to spare women from unnecessary, invasive medical procedures, the American Cancer Society (news - web sites) is saying for the first time that those who run a low risk of developing cervical cancer do not need to get Pap tests.

The society's last guidelines, issued in 1987, recommended that all women at least 18 years old receive a Pap test and a pelvic exam yearly; the test could be performed less frequently if a woman had three consecutive, normal exams.

The new guidelines say testing isn't needed for young women who are not sexually active; women 70 or older who have had normal Pap tests in the past; and women who have had hysterectomies for non-cancer-related reasons.

The guidelines say sexually active women should begin getting Pap tests within three years of the start of sexual activity, but no later than age 21.

The problem with Pap tests, according to the experts who wrote the new guidelines, is that they detect non-cancerous lesions, causing doctors to perform additional tests that needlessly worry patients, cost money and sometimes have harmful effects, such as reduced fertility.

The goal is to "diminish the number of invasive procedures done to prove a woman doesn't have cancer," said Dr. Carmel Cohen, a professor of obstetrics and gynecology at New York's Mount Sinai Medical Center who led the society's review committee.

Newer types of Pap tests allow women to be tested every two years instead of yearly with the traditional Pap test, the guidelines said.

Dr. Daron Ferris of the Medical College of Georgia said the society's guidelines are reasonable, but he said he will still be careful.

"I think you still need to exercise good judgment," he said. "No woman wants to have cervical cancer and find the test didn't find it."

On the Net:

Cervical cancer guidelines: http://CAonline.AmCancerSoc.org

American Cancer Society: www.cancer.org

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Spate of Thyroid Cases Baffles Army

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Tuesday, December 17, 2002

TUESDAY, Dec. 17 (HealthScoutNews) -- A dramatic spike in cases of an overactive thyroid struck a U.S. Army Special Forces unit in the late 1990s, and Army doctors are at a loss to explain why.

Military physicians say the unit, based in Fort Campbell, Ky., had eight cases of apparent Graves disease over a 21-month period ending in 1999. That's 62 times the expected incidence of the condition in young men, who seldom contract the autoimmune disorder.

Severe stress or contact with thyroid-harming substances such as iodine can bring on Graves disease. Yet the soldiers didn't appear to have been contaminated with iodine and they didn't report excessive stress. Several had worked in the motor pool or with organic solvents, raising the possibility of contact with substances that might have triggered the disease. The researchers also wrote that it's possible an "infectious agent" could be the culprit. However, no particular agent or cause could be identified, says Dr. Henry Burch, a hormone specialist at Walter Reed Army Medical Center in Washington, D.C.

"This appeared to be an isolated incident," says Burch, who believes the cluster was probably a statistical glitch. Burch and his colleagues reported the investigation as a research letter appearing in tomorrow's issue of the Journal of the American Medical Association (news - web sites).

Graves disease might earn a potential recruit a medical rejection, but it's treatable and doesn't demand discharge for soldiers in the service, Burch says. All of the men who developed the disease were doing well at last report, he adds.

Dr. Leonard Wartofsky, a retired Army colonel and a leading thyroid expert, says he was aware of the Graves cluster and couldn't explain it. "It's an unusual cohort of people and it raises the question [of why]," he says. "It could be a total fluke, or it could be something that is precipitating the Graves disease."

Several of the men had a family history of thyroid problems, which is considered a risk factor for susceptibility to Graves. However, even in these people some kind of trigger is required to turn the body against the thyroid gland.

The revelations about Graves disease come on the heels of an order by President Bush (news - web sites) -- whose mother has the condition -- that roughly a half million military personnel receive the smallpox vaccine.

Smallpox vaccine is effective, but it causes deadly reactions in about one to two people per million who receive the inoculation.

So far, officials say, the demand has provoked no rebellion. However, a similar order in the late 1990s regarding the anthrax vaccine prompted many soldiers to reject the shot over safety concerns. Jim Turner, a Pentagon (news - web sites) spokesman, says the military disciplined 450 personnel who refused the vaccine between 1997 and August 2000. About 110 have been forced out of the armed forces as a result of their stance, including three last year.