Appears to Have 'Daydreaming' Mode
Drinking Predicts Kids' Disruptive Behavior
Out on Antioxidant, Eye Condition: Study
Chided for Neglecting Heart Risk
Dye May Worsen Lung Inflammation: Study
Outbreak a Century Ago Holds Clues for Today
Technique to Treat Congenital Heart Defects
Vaccine for Kids
Office Lights Eases Workers' Eyestrain
Drug Stalls Parkinson's Progress
May Have Slightly Higher Cancer Risk
DECEMBER 15, 2002
Not to Look Your Age
the Fat When Dining Out
Persist in Many WTC Rescuers
DECEMBER 14, 2002
the Gym Before You Hit the Slopes
Medicines Not Perfect, But Useful
Red Cross May Have
Released Unsafe Blood
By Lauran Neergaard
WASHINGTON - The American Red Cross (news
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
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
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
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
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
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
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.
Press Medical Writer Lauran Neergaard contributed to this
Culture May Be Culprit Behind Acne: Theory
By Jacqueline Stenson
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
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
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
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
However, this remains to be proven, note the authors of an
"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."
Archives of Dermatology 2002;138:1584-1592.
States Require Contraceptive Coverage
By Liz Sidoti
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
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
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
a Man's 'Ouch' Is Different Than a Woman's
By Alison McCook
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
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 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.
Herpes Vaccine on the Horizon
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
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
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
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
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.
The U.S. Centers for Disease Control and Prevention (news
sites) has more about genital
Study Reveals Why Pregnant Women
By Pat Hagan
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
"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,"
"Snoring may have a peripheral impact but it's unlikely
to cause preeclampsia because it will already be there,"
Some Respite From Breast Cancer
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
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
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.
The National Cancer Institute (news
sites) has more about breast
Lead in Bones Linked to Pregnancy
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
"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
Source: American Journal of Epidemiology 2002;156:1079-1087.
(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.
brown rice, whole wheat couscous, bulgur, barley, and other
grains on a regular basis.
Blood Sausage May Hinder Colon
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
"Participants then eagerly ate a locally produced 7-ounce
black pudding and then had a further Haemoccult test,"
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,
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
"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.
Studies: Widespread Smallpox Shots
By Gene Emery
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
The release of the findings came nearly a week after President
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
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."
(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
- 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
- Plan activities related
to books they enjoy, like a trip to the zoo if they like
- Children love hearing the same story over and over,
so share their enthusiasm. Avoid saying something like,
"Oh no, not this book again."
Pigeon Breeders at Risk of Long-Term
By Pat Hagan
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
"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
Herbal Treatment Shows Promise
Against Prostate Cancer
By Serena Gordon
FRIDAY, Dec. 20 (HealthScoutNews) -- An herbal formula sold
under the brand name Zyflamend may offer new treatment and
prevention options for prostate cancer (news
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
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)
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
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
New Transplant Rules to Protect
By Martin F. Downs
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
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.
New Study Debunks Value of HRT
By Felicity Stone
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
"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,"
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
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,
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
What To Do
For more on hormone replacement therapy, visit the National
Cancer Institute or the National
Institutes of Health.
FDA: Danger for Those with Deep
NEW YORK (Reuters Health) - The US Food and Drug Administration
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
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.
Treats Suicidal Behavior
FRIDAY, Dec. 20 (HealthScoutNews) -- The U.S. Food and Drug
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
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.
DECEMBER 19, 2002
Treating Tourette Syndrome
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
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
Here's where you can learn more about Tourette
Marijuana Shopping for Sick Canadians
By Robert Melnbardis
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
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
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
The Canadian government is working on the cultivation of a
safe and standardized supply of marijuana for use as a medical
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
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.
Anemia's Side Effects
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.
Here's where you can learn more about iron
Patients Often Ignore Warning Signs
By Michael Leidig
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
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.
Parents Ignore Heft and Contents
of Kids' Backpacks
By Nancy Deutsch
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
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
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
- 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
- And S is a reminder to
Search for updates about safe backpack carrying from a family
doctor or on the Internet.
What To Do
or the American
Academy of Orthopaedic Surgeons to learn more about carrying
the load safely.
Exposure Cuts Babies' Ability to Wake Up
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
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.
Studies of Herbal Medicine Found
By Janice Billingsley
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
"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
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
"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
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
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
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
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.
Shows Pacing Defibrillators May Damage Hearts
By Andrew Stern
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
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
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
"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
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
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.
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.
Teens Struggling With Depression
By Ed Edelson
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
Parents should be alert for the signs of depression, Koplewicz
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
DECEMBER 18, 2002
Fact Sheet Not Promoting Condom Use
By Laura Meckler
WASHINGTON - A government fact sheet that long promoted condoms
as "highly effective" in preventing HIV (news
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
sites) concerning the link between abortion and breast
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,
record), D-Calif., and 13 other Democrats said in a letter
Wednesday to Health and Human Services (news
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
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
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
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/
Cancer Institute: http://www.nci.nih.gov/
'Signature' Predicts Breast Cancer Outcome
By Alison McCook
NEW YORK (Reuters Health) - Women who carry a particular genetic
"signature" in their breast cancer (news
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
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
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
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
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,
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.
Premature Births Up, Teenage Births
By Laura Meckler
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
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
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
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
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
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
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
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.
Day in Hospital May Not Help Moms, Newborns
By Alison McCook
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,
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
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
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.
Artificial Heart Testing Misses
By Justin Pop
AP Business Writer
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
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:
Cracks Down on Supplements, Eases Up on Food
By Todd Zwillich
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
Food and Drug Administration (news
sites) (FDA) officials also announced that they would
step up enforcement against several categories of dietary
supplements where misleading claims about health benefits
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
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
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,
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
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
"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
sites) and lupus--as well as weight loss products and
Supplements claiming to treat mental retardation, to prevent
Alzheimer's disease (news
sites) and to prevent hangovers could also be targeted,
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.
The American Academy of Dermatology has more about fighting
dry skin during winter.
Surgeons Remove Liver to Treat Cancer
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
(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
- 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.
Rigorous Dialysis Won't Boost Survival: Study
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
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.
(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.
Credits Little Help for Low-Income Women: Study
By Julie Rovner
WASHINGTON (Reuters Health) - President Bush (news
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
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
Extra Help With Diet Makes the
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
So says a study in the December issue of the Annals of Internal
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
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.
The National Heart, Lung, and Blood Institute has more about
May Spread Ebola Virus, Research Suggests
WASHINGTON (Reuters) - Birds may be able to carry and spread
the Ebola (news
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
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,
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
Inhaled Steroids Can Lead to Falls
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
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.
Here's more about corticosteroids
Panel Backs Nasal Mist Flu Vaccine
By Lisa Richwine
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
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
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
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
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
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
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.
New Antibody Buys Time for Brain
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
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.
The U.S. National Cancer Institute (news
sites) has more about brain
Housing Boosts Poor Youngsters' IQ: Study
By Charnicia E.
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
"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
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
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
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,"
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
"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.
Infant Hair Sample Betrays Maternal
Drinking During Pregnancy
By Adam Marcus
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
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
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
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
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.
Drug Linked with Heart Valve Trouble
By Keith Mulvihill
NEW YORK (Reuters Health) - Researchers from the Mayo Clinic
say that in some cases, patients taking a Parkinson's disease
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
"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
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.
New Drug Holds Hope for Deadly
By Randy Dotinga
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
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
The study found that caspofungin treated candidiasis as well
as amphotericin B but without as many side effects, Perfect
"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
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
Oily Fish May Reduce Risk of Asthma
By Pat Hagan
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
More than 12% of the healthy volunteers reported eating oily
fish at least twice a week, compared with just 7.5% of the
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
"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
More Women Receiving Prenatal Care
By Adam Marcus
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
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
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
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.
Chemical Could Suppress Cough
By Pat Hagan
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.
May Be Healthier Choice Than HRT
By Kathleen Doheny
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
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
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,"
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
What To Do
For more information on SERMS, see breastcancer.org
or the American
Girls, Older Partners Leads to High STD Risk
By Alison McCook
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
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
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
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.
DECEMBER 17, 2002
Cheaper Drugs Best for Hypertension
By Ed Edelson
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
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
"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
sites)'s representative to the National Institutes of
sites) high blood pressure education program coordinating
"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
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.
Women, Men Benefit Equally from
By Suzanne Rostler
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
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
"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
Panel Clears Flu Spray for Some
By Lauran Neergaard
AP Medical Writer
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
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
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
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
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.
Consumers Blame Drugs for Higher
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
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
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
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.
Ultrasound Can Detect Down Syndrome
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
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.
Here's where you can learn more about Down
Birth Linked with Celiac Disease: Study
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
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
"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
Use Lung Scans With Care
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 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.
Here's more about lung
health and diseases.
Some Women Advised Against Cancer
By Daniel Yee
ATLANTA - Hoping to spare women from unnecessary, invasive
medical procedures, the American Cancer Society (news
sites) is saying for the first time that those who run
a low risk of developing cervical cancer do not need to get
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
Newer types of Pap tests allow women to be tested every two
years instead of yearly with the traditional Pap test, the
Dr. Daron Ferris of the Medical College of Georgia said the
society's guidelines are reasonable, but he said he will still
"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
Spate of Thyroid Cases Baffles
By Adam Marcus
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
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
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,
"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
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
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
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.
Phil Kraft, program director of the National Veterans Services
Fund says he's not expecting any mutiny with the smallpox
"It's not an experimental vaccine like the anthrax vaccine
was, so that has the soldiers feeling somewhat comfortable
about it," says Kraft, who received a smallpox booster
before he was sent to Vietnam to fight. "It's not that
they're experimenting on the troops without their permission."
Turner says soldiers with conditions such as eczema that would
leave them vulnerable to a smallpox vaccine won't be forced
to take it.
Turner vehemently rejected the notion that the anthrax vaccine
is experimental. Indeed, the shot was approved in 1970. However,
at that time it was limited to people who worked with animals
or animal products. They are prone to skin anthrax but not
the more deadly lung form that is feared in a bioterror attack
such as the one that killed five people in this country last
Last March, a government panel concluded the anthrax vaccine
was "reasonably safe" for people and that it worked
against inhaled infections.
What To Do
For more on Graves disease, visit the American
Thyroid Association or the National
Graves Disease Foundation.
Underused in Oldest Cancer Patients
By Suzanne Rostler
NEW YORK (Reuters Health) - Very elderly breast cancer (news
sites) patients are less likely to receive the anti-cancer
drug tamoxifen, possibly putting them at increased risk of
death and cancer recurrence, according to a study.
The report found that breast cancer patients aged 85 to 92
years were about 25% less likely than their counterparts aged
80 to 84 years to receive a prescription for the potentially
However, these women were also more likely to have other medical
problems. While several studies have demonstrated that tamoxifen
can help women with "estrogen receptor-positive"
tumors, the drug has serious side effects such as blood clots.
Estrogen receptor-positive tumors are those that grow in response
to the hormone estrogen, which is blocked by tamoxifen.
But the findings suggest that tamoxifen remains underutilized
in older women with estrogen receptor-positive tumors, conclude
Dr. Rebecca Silliman from Boston Medical Center in Massachusetts,
According to their report, the risk of being diagnosed with
and dying from breast cancer increases with age. For instance,
women aged 80 to 84 years are twice as likely to be diagnosed
and more than 3 times more likely to die of breast cancer
compared with women in their 50s.
"Given the increasing longevity of the oldest old, undertreatment
with adjuvant tamoxifen may put older breast carcinoma patients
at an increased risk of disease recurrence and breast carcinoma
mortality," they conclude.
Silliman added in an interview that " until there are
better strategies for more accurately predicting who will
benefit most...adjuvant tamoxifen will continue to offer older
women with estrogen-positive tumors their best chance for
The findings are published in the December 15th issue of Cancer,
a journal of the American Cancer Society (news
Tamoxifen, produced under the name Nolvadex by AstraZeneca,
is the most widely prescribed drug for breast cancer treatment.
It is recommended for women with estrogen-receptor positive
tumors, regardless of age.
The drug's role in prevention got a huge boost several years
ago when a large US trial showed that tamoxifen halved the
incidence of breast cancer among high-risk women over a 5-year
period. That trial was cut short so that women in the comparison
group, who were receiving an inactive placebo, would be allowed
to take tamoxifen.
To investigate whether a woman's age played a role in the likelihood
that she received a prescription for the drug, researchers
interviewed and reviewed the medical records of 92 patients
at four US medical centers. All women had been diagnosed with
early-stage breast cancer.
After taking into account other medical conditions such as
heart disease, diabetes, high blood pressure, and stroke,
the oldest women were found to be 26% less likely to receive
Prescriptions were not related to medical problems that raise
the risk of stroke caused by blood clots. In fact, the sickest
women, or those with the greatest number of additional medical
problems, all received prescriptions for the drug, the study
Women who did not receive a prescription for tamoxifen were
also less likely to be married or have living children, a
marker of their level of family support. There was no association
between tamoxifen prescription and race, education level,
or financial resources, according to the report.
It is not clear from the study why older women are less likely
to receive the drug. The findings may reflect some doctors'
belief that the risks and side effects of the drug, which
can include night sweats, hot flashes, blood clots and stroke,
rise in tandem with age. Alternatively, doctors may think
that some women won't live long enough to experience any benefit
from the drug, the researchers suggest.
The study was funded by the National Cancer Institute (news
sites) and the National Institutes of Health (news
Source: Cancer 2002;95:2465-2472.
Study Questions Drinking-Lung Cancer
By Paul Recer
AP Science Writer
WASHINGTON - Light to moderate drinking of alcoholic beverages
does not increase the risk of lung cancer, according to a
study that involved more than 9,000 people over two generations.
The study, appearing this week in the Journal of the National
Cancer Institute (news
sites), found that people who consume one to two alcoholic
drinks a day have no greater chance of developing lung cancer
than do nondrinkers.
Data from the study was adjusted so that the effects of smoking,
known to be the major cause of lung cancer, were statistically
eliminated as a factor in the conclusion, the researchers
Alcohol drinking has been associated with lung cancer in some
past studies, but the findings are considered by some experts
to be uncertain because drinking and tobacco smoke exposure
often go together. The new study attempts to avoid this problem
by removing the confounding effects of smoking, the researchers
Dr. Luc Djousse of Boston University School of Medicine, the
first author of the study, said his group used data from the
famed Framingham, Mass., study that followed the health of
thousands of participants since 1948. The research also includes
data from the Framingham Offspring Study, which started in
1971 and involves children of the original study participants.
For the lung cancer study, Djousse and his co-authors examined
health and survey data from 4,265 subjects in the original
Framingham study, and 4,973 from the offspring study.
The alcohol study was funded by the National Heart, Lung and
Blood Institute. Djousse and a co-author received grants from
research organizations supported by the beer and the wine
Researchers found 269 cases of lung cancer among the study
participants. They were matched by age, gender and smoking
history with participants who were not diagnosed with lung
cancer. The researchers then compared the drinking habits
of the group and concluded that light to moderate alcohol
consumption was not a factor in the cancers.
Djousse said that only one subcategory offspring who drank
more than two drinks a day showed an increased risk of lung
cancer. The incidence of cancer in this group was double that
of the nondrinkers of the same age, smoking history and gender.
However, Djousse said the numbers in this subcategory are too
small to draw a valid statistical conclusion.
Dr. Mary C. Dufour, deputy director of the National Institute
on Alcohol Abuse and Alcoholism, said the researchers doing
the study make up "a highly respected team using an extensive
data base," but that the results do not eliminate alcohol
drinking as a risk for lung cancer.
Dufour said that the Djousse study analyzed only the effects
of one to two drinks a day on lung cancer rates. She said
other studies that looked at heavy drinkers five drinks
or more a day found a direct link between alcohol and lung
"The jury is still out on the heavy drinkers," said
On the Net:
Journal of the National Cancer Institute: http://jncicancerspectrum.oupjournals.org/jnci/
Not Lethal, Experts Say
NEW YORK (Reuters Health) - The notion that poinsettia plants
are poisonous--even deadly--to humans and animals is nothing
more than an urban legend, according to experts.
"I wouldn't suggest eating them or using them to garnish
a holiday meal--but eating the plant won't kill you,"
Dr. Frank McGeorge, an emergency room physician at Beaumont
Hospital in Royal Oak, Michigan, told Reuters Health in an
Still, the doctor warned that eating the plant would likely
cause an upset stomach and possibly nausea and vomiting.
So how did the pretty red plant that has come to symbolize
the holiday season get such a bad rap?
There was a single case report back in 1919 that attributed
a child's death to eating some of a poinsettia plant, but
some other factor was probably responsible, McGeorge explained.
Since then, there have been numerous reports of poinsettia
ingestion over the years but no case of death by poinsettia
plant poisoning has ever been recorded. In fact, McGeorge
points out that several years ago, a study of the plant's
toxicity completely refuted its lethal reputation.
Probably the biggest danger posed by holiday foliage is the
choking hazard holly berries and mistletoe berries pose to
curious infants and toddlers, noted McGeorge.
Like the poinsettia, ingesting mistletoe or holly is not fatal
but may cause nausea, cramps or vomiting, McGeorge said.
Pet owners may be relieved to learn that poinsettias are not
likely to kill dogs or cats that nibble on the plants, explained
Ruth First, a spokesperson for the American Society for the
Prevention of Cruelty to Animals (ASPCA) in New York City.
"The poinsettia is not toxic to dogs or cats but they
could get an upset stomach if they ate some of the plant,"
she told Reuters Health.
Both McGeorge and First recommend a "better safe than
sorry" approach during the holidays, keeping poinsettia
and other holiday plants out of reach of infants, small children
Diplomats Prod U.S. on Affordable
By Naomi Koppel
GENEVA - The success or failure of talks on trade rules to
ensure better access to cheap medicines for poor countries
is now entirely in the hands of the Bush Administration, diplomats
"It's up to the United States now," European Union
sites) Ambassador Carlo Trojan told reporters at the end
of a renewed negotiating session at the World Trade Organization
At stake is a draft agreement which would allow some developing
countries to ignore patents on branded medicines and use cheaper
generic drugs to treat diseases such as HIV (news
sites) and malaria. But the draft could also allow for
developing countries to circumvent drug patents for other
diseases and conditions.
The United States says it generally supports the proposal,
but maintains the agreement must be limited in scope to drugs
that treat infectious disease epidemics and not to gain access
to cheap medicines for asthma, diabetes or smoking-related
"We remain committed to both the intention and the spirit
and we will work with other delegations," U.S. Ambassador
Linnet Deily told reporters. She declined to comment on diplomats'
claims that the United States is alone in blocking agreement.
Switzerland, which like the United States has a large pharmaceutical
industry, has yet to announce its support for the text. However,
diplomats expect that Switzerland will fall in line if the
United States accepts the agreement.
The meeting was adjourned until Friday. If members are to meet
their self-imposed time limit of the end of the year to settle
the issue, that meeting will be their last chance. The WTO
is closed throughout the Christmas and New Year period.
Antonio de Aguiar Patriota of Brazil said the United States
had to accept the compromise proposal on the table or risk
wrecking the whole agreement, drawn up after many months of
"The predominant view is that if we change anything in
this text, it is a very delicate balance and it will unravel
the entire process," he said.
A ministerial meeting in Qatar in November last year recognized
the right of WTO members to override patents on expensive
Western drugs and make the products themselves when public
health is at stake.
However, drugs made under such "compulsory licensing"
were to be used only domestically and not exported. That meant
a country without a drug industry was no better off because
it could neither make the drugs nor buy them from another
Developing countries, led by South Africa and Brazil, reluctantly
accepted the declaration rather than cause the collapse of
the bid to launch a wider trade round. In return, the WTO
was instructed to solve the problem by the end of this year.
Trojan said that, like most of the WTO's 144 members, the 15-nation
EU had problems with the agreement but would accept it.
"I think we have gone so far that we need to go the last
mile. It isn't a trade negotiation issue, it's a humanitarian
issue," he said.
Kenyan Ambassador Amina Chawahir Mohamed, speaking on behalf
of all the African WTO members, said the African nations
who were wavering after Monday's meeting also had decided
to accept the agreement "as imperfect as it is."
Developing countries had been clamoring for more liberal measures.
as Good as Newer Drugs for Blood Pressure
By Joyce Frieden
WASHINGTON (Reuters Health) - Old-fashioned diuretics are cheaper
and just as good-if not better--at controlling blood pressure
as newer hypertension drugs, such as calcium channel blockers
and angiotensin converting enzyme (ACE) inhibitors, researchers
The results are from the Antihypertensive and Lipid-Lowering
Treatment to Prevent Heart Attack Trial (ALLHAT) published
in Wednesday's issue of the Journal of the American Medical
"The ALLHAT results indicate that thiazide-type diuretics
should be considered first for those starting or already on
drug therapy for hypertension," said Dr. Jackson T. Wright
Jr., vice-chair of the ALLHAT steering committee, at a press
conference here Tuesday.
"They are unsurpassed at lowering blood pressure and reducing
the clinical complications of hypertension. Furthermore, they
are well tolerated by patients and they cost less." said
Wright, a professor of medicine at Case Western Reserve University
in Cleveland, Ohio.
The researchers studied 33,357 men and women aged 55 or older
with hypertension and at least one other risk factor for coronary
In the study, participants were randomly assigned to receive
chlorthalidone (a diuretic), amlodipine (a calcium channel
blocker) or lisinopril (an ACE inhibitor). The study also
included a fourth arm involving an alpha-adrenergic blocker,
but that part of the trial was stopped in March 2000 because
those on the drug were more likely to be hospitalized for
heart failure than patients treated with chlorthalidone.
During the eight-year study, the researchers found no differences
between amlodipine and chlorthalidone for fatal heart disease
or non-fatal heart attack. There were no significant differences
in mortality due to any cause, stroke, kidney failure or other
outcomes. The chlorthalidone group had a lower risk of heart
failure than the amlodipine group.
Similarly, no differences were observed between lisinopril
and chlorthalidone for fatal heart disease or non-fatal heart
attack, or other problems. The lisinopril group, however,
had a slightly higher rate of cardiovascular disease problems
than those taking chlorthalidone.
The study is the largest hypertension trial ever conducted,
noted Dr. Claude Lenfant, director of the National Heart,
Lung, and Blood Institute, which coordinated the study.
The authors noted that it was not surprising that no differences
in heart disease and stroke rates were found between chlorthalidone
and amlodipine, since previous studies resulted in similar
findings. Previous studies also shown that those on a diuretic
are less likely to have heart failure than those taking amlodipine.
In an accompanying editorial, Dr. Lawrence J. Appel of Johns
Hopkins University in Baltimore said that "the ALLHAT
results...are particularly noteworthy, because there is no
cost-quality tradeoff; the most effective therapy was also
the least expensive."
Given these results, he wrote, "it is unclear why physicians
should implement an ACE inhibitor-based strategy that commonly
leads to use of 2 drugs (ACE inhibitor and diuretic) when
monotherapy with a thiazide diuretic can effectively reduce
blood pressure and prevent blood pressure-related cardiovascular
The study was supported by the National Heart, Lung and Blood
Institute and Pfizer. The investigators received study medications
from Pfizer (amlodipine and doxazosin), AstraZeneca (atenolol
and lisinopril) and Bristol-Myers Squibb (pravastatin).
U.S. Joins Suits on Cardiac Devices
WASHINGTON - The Justice Department (news
sites) said Tuesday it was joining lawsuits against 27
hospitals for improperly billing Medicare for medical procedures
involving experimental cardiac devices.
The hospitals are located in 15 states and the District of
Columbia, and are part of a case originally filed by a whistle-blower
against more than 100 facilities. The government previously
sued 13 hospitals, reached settlements worth $42 million with
31 others, and said it was close to settling two other cases.
The Medicare charges involved cardiac devices, including pacemakers
and defibrillators, that had not been proven safe and effective
by the Food and Drug Administration (news
sites) when the procedures were performed between 1986
and 1995, the agency said.
List of hospitals available at http://www.usdoj.gov
Finds Cholesterol Drug Does Not Cut Deaths
By Merritt McKinney
NEW YORK (Reuters Health) - Study after study has shown that
cholesterol-lowering drugs called statins can prevent heart
attacks, but in a new trial the statin pravastatin (Pravachol)
did not reduce the risk of death and heart disease in people
with moderately high cholesterol and high blood pressure.
But the results of the study do not mean that pravastatin or
other statins cannot prevent heart disease, the study's lead
author told Reuters Health.
In an interview, Dr. Barry R. Davis explained that pravastatin
was effective at lowering cholesterol in a wide range of people
in the study. But participants who did not take the statin
but who instead received "usual care"--which could
also include cholesterol-lowering medication--also experienced
a drop in cholesterol, said Davis, who is at the University
of Texas-Houston Health Science Center. The differences in
how much cholesterol dropped in each group "were not
big enough" to show an effect on heart disease and other
clinical outcomes, Davis said.
Statins' record in clinical trials is impressive, but many
groups of people, including women, older people, racial and
ethnic minorities and people with diabetes, were not adequately
represented in earlier studies. The new study, which drew
participants from a larger study of treatments for high blood
pressure, was designed to see how well a statin could prevent
deaths in a wide variety of people.
The study included more than 10,000 people who were at least
55 years old and who had moderately high cholesterol and high
blood pressure. Participants were randomly assigned to take
pravastatin or to receive the "usual care" recommended
by their physician. This care could include cholesterol-lowering
drugs, but this was discouraged unless a person's health took
a turn for the worse.
For lowering cholesterol, pravastatin was a success, according
to a report in the December 18th issue of the Journal of the
American Medical Association (news
sites). Four years after the study began, total cholesterol
had dropped 17% in people taking the statin and about 8% in
the usual care group. And at the same time, testing of a random
sample of participants showed that levels of LDL, the "bad"
type of cholesterol, had dropped nearly 28% in the pravastatin
group and 11% in the usual care group.
In a bit of encouraging news, Davis said, pravastatin lowered
cholesterol in a wide range of people, regardless of age,
sex, race or history of diabetes.
It is well known that lowering LDL cholesterol can reduce the
risk of heart attack and stroke, but the study showed that
people taking pravastatin were no less likely to die or develop
heart disease than people receiving usual care.
These results do not mean that pravastatin does not provide
clinical benefits, though, Davis said. He explained that during
the course of the study, several other research teams reported
studies demonstrating the powerful cholesterol-lowering effects
of statins. Because of the increased awareness of statins,
people in the usual care group were prescribed the cholesterol-lowering
drugs "much more than we anticipated," Davis said.
The Houston researcher pointed out that cholesterol levels
also dropped in the usual care group, although not as much
as in people specifically assigned to take statins. Unlike
in other statin trials, many of which compared the drugs to
an inactive placebo, the difference may not have been big
enough to detect any clinical benefits, Davis said.
The study was sponsored by the National Heart, Lung, and Blood
Institute, but it also received funding from Pfizer. AstraZeneca,
Pfizer and Bristol-Myers Squibb, which makes pravastatin,
donated medications used in the study.
"Physicians might be tempted to conclude that this large
study demonstrates that statins do not work," according
to Dr. Richard C. Pasternak, of Harvard Medical School (news
sites) in Boston, Massachusetts. "However, it is
well known that they do," he concludes in an editorial
that accompanies the study.
What may have happened, according to Pasternak, is that the
drugs may not be as effective in ordinary settings as they
are in clinical trials where participants are carefully selected
and followed closely.
Pasternak has served as a consultant to or on the advisory
boards of several pharmaceutical companies, including Bristol-Myers
Squibb. In addition, he has received funding from Merck-Medco
and has served on the speakers bureau for several drug makers.
Bristol-Myers Squibb was not available for comment at press
Source: Journal of the American Medical Association
California Inmate Who Got New Heart
By Jim Wasserman
SACRAMENTO, Calif. - An inmate who received a new heart in
an operation that touched off a nationwide debate over the
ethics of organ transplants for convicts has died at age 32,
11 months after the surgery.
The prisoner, whose name was never released, died Monday at
Stanford Medical Center after entering the hospital Nov. 23
with signs that he was rejecting the organ.
He was believed by state officials to be the nation's first
state prison inmate to receive a heart transplant.
He had been serving a 14-year sentence for a 1996 Los Angeles
robbery and was up for parole in 2008.
Prison officials said that the prisoner had failed to follow
doctors' recommendations for maintaining his health after
"I can tell you he has not been a model patient,"
said Corrections Department spokesman Russ Heimerich.
The transplant, performed on a day when more than 500 Californians
were on waiting lists for new hearts, triggered an angry reaction
among talk radio listeners and others who said criminals should
not be eligible.
Medical professionals defended the transplant, saying that
the inmate met all medical criteria and that doctors do not
have the right to make such public-policy decisions. Prison
officials also cited court rulings that require them to give
inmates the same medical care due other Californians.
They said the transplant itself cost $850,000, while follow-up
care pushed the cost to more than $1 million.
The prisoner's own heart had been damaged by a viral infection.
Joint Replacement Better for Osteoarthritis
NEW YORK (Reuters Health) - People with osteoarthritis might
do well to undergo knee and hip replacement surgery before
their pain becomes very severe and they have lost a great
deal of joint function, the results of a study suggest.
Osteoarthritis is a degenerative joint disease that affects
an estimated 21 million Americans, according to the report.
The disease is marked by a progressive loss of cartilage and
the development of bony overgrowths that can lead to inflammation
and severe joint pain.
Typically, patients postpone having joint replacement surgery
as long as possible. But delaying surgery can lower a patient's
quality of life not only before the operation but for up to
two years afterwards, conclude researchers.
The findings in the December 5th issue of Arthritis and Rheumatism
indicate that joint replacement surgery should not be considered
a "last-resort sort of procedure," Dr. Jeffrey Katz,
the study's lead author, said in a prepared statement.
"We found that patients could have a positive impact on
their quality of life by having this surgery before their
arthritis became severe," said Katz, from Harvard University
in Boston, Massachusetts.
Prostheses used in joint replacement surgery today can last
up to 20 years, Katz and colleagues note.
In the study, 165 patients undergoing elective knee or hip
replacement surgery were divided into two groups according
to their level of pain and physical functioning.
Patients who experienced the most pain prior to surgery reported
feeling the worst two years later, the researchers found.
Additionally, five times as many patients who delayed their
surgery required help with daily activities such as bathing
"Although there are no validated indications for when
a patient should optimally have total joint replacement, this
data suggest that timing of surgery may be more important
than previously realized," they conclude.
Source: Arthritis and Rheumatism 2002.
(HealthScoutNews) -- If your infant is only a month old and
has already broken out in acne, don't panic. According to
St. Louis Children's Hospital, infant acne is merely how the
skin responds as your newborn's hormones adapt to life outside
the womb. There's no need to treat it, other than to keep
your baby's skin clean. The condition should clear up in a
And don't think that your child's acne is a harbinger of an
acne-ridden adolescence. There is no link between the two.
Seeks Law to Confirm FDA's Child Drug Authority
WASHINGTON (Reuters) - The US government said on Monday it
would ask Congress to give the Food and Drug Administration
sites) clear authority to require studies on whether medicines
are safe and effective in children.
Health and Human Services (news
sites) Secretary Tommy Thompson announced the request
as the government decided not to appeal a court decision that
struck down a rule finalized by the FDA in late 1998 requiring
"The fastest and most decisive route for establishing
clear authority in this area is to work with Congress for
new legislation," Thompson said in a statement.
Legislation signed into law early this year provided patent-extension
incentives for drug makers to study medicines in children
but its effectiveness is limited to drugs with existing patents
"Children are a special population that need to have access
to drugs that can benefit them, and these drugs need to be
properly tested for pediatric use, not prescribed and sold
without testing," Thompson said.
In October, the US District Court for the District of Columbia
had ruled that the FDA overstepped its authority by imposing
its pediatric rule.
The Association of American Physicians and Surgeons had argued
the rule was unfounded because it required testing drugs on
children even if those drugs were not labeled for use by children.
The association said the tests subjected children to unnecessary
risk and delayed introduction of new drugs that could help
FDA Commissioner Mark McClellan said continued litigation was
likely to take years with the risk of an uncertain outcome.
"The better course now is to work with the committees
in Congress and enact new, specific legislation rapidly,"
Thompson said new legislation should provide for early consultation
between manufacturers and the FDA regarding pediatric plans
during the drug development process.
Pediatric data should also be provided by a manufacturer at
the time of new drug approval application, or a timeline provided
for pediatric data if a delay is appropriate.
Thompson said the government also wanted pediatric studies
of existing products and the creation of a new FDA Pediatric
(HealthScoutNews) -- Is your stress-laden life wearing you
down? Are there too many occasions when you feel your mind
or body is racing out of control?
Here are some stress-busting techniques suggested by the University
of Illinois McKinley Health Center:
- Slow down your breathing
to a 10-second cycle, six breaths a minute. Inhale for five
seconds, then exhale for five seconds. Do this for 2-5 minutes
or until your pace slows down.
- Close your eyes and take
a deep breath. Visualize yourself lounging on a white, sandy
beach, or watching the sunset, or relaxing in the shower.
- Focus on something peaceful
and beautiful in your immediate surroundings. It can be
a blade of grass, a painting, a color or anything that soothes
you. Concentrate on the beauty and allow it to slow you
Drug Eases Early Parkinson's Symptoms
By Merritt McKinney
NEW YORK (Reuters Health) - A once-a-day drug helps relieve
symptoms of Parkinson's disease (news
sites) in people who are in the early stages of the progressive
neurological disease, a new study shows.
The medication, rasagiline, still awaits approval in the US,
but eventually it could be a reasonable option for people
with early Parkinson's, according to the study's authors.
Parkinson's disease causes tremor, muscle rigidity and movement
problems. The underlying cause is the slow loss of neurons
that produce dopamine, a brain chemical involved in movement.
Treatment with levodopa, a precursor of dopamine that the
brain can use to produce dopamine, can alleviate Parkinson's
symptoms. However, levodopa does not slow the progression
of the disease.
Rasagiline blocks the activity of an enzyme called MAO-B. This
action is thought to slow the destruction of dopamine in the
The new study included 404 people with early Parkinson's who
had not yet started taking levodopa or other treatments for
Parkinson's. The participants were randomly assigned to take
a daily dose of rasagiline--either 1 or 2 milligrams--or a
placebo that did not contain any medication.
At the end of the 26-week study, people taking rasagiline had
better scores on a scale used to evaluate Parkinson's disease
symptoms, according to a report in the December issue of the
journal Archives of Neurology.
The medication "was significantly better than placebo
in treating symptoms of early Parkinson's disease," the
study's lead author, Dr. Andrew Siderowf, of the University
of Pennsylvania in Philadelphia, told Reuters Health. Benefits
were similar with the 1- and 2-mg doses of the drug.
Although rasagiline relieved symptoms of Parkinson's disease,
the drug did not postpone the need for dopamine-boosting therapy
such as levodopa. But the authors suggest that the study was
not big enough or long enough to detect this difference.
The benefits provided by rasagiline were more modest than those
provided by other Parkinson's drugs, although the difference
was not large.
"An important point about rasagiline," Siderowf said,
"is that it is a once-a-day drug, which makes it easy
for patients." He noted that it was as well tolerated
as placebo in the study.
There have been some concerns that rasagiline and drugs that
act in the same way may have harmful cardiovascular effects.
But in the study, the only cardiovascular difference between
the groups was slightly higher blood pressure in people taking
the higher dose of rasagiline.
People with Parkinson's disease should not expect to get a
prescription for rasagiline the next time they go to the doctor.
Siderowf noted that the drug has not yet been approved by
the Food and Drug Administration (news
The study was funded by Teva Pharmaceutical Industries, Ltd.,
the company that is developing rasagiline.
Source: Archives of Neurology 2002;59:1937-1943.
Platelets Found to Play Role in
TUESDAY, Dec. 17 (HealthScoutNews) -- University of Virginia
School of Medicine researchers have identified a new factor
in the development of atherosclerosis, the most common form
of hardening of the arteries.
Atherosclerosis, characterized by cholesterol-calcium-lipid
deposits, is the main cause of heart attacks, which is the
leading killer of Americans.
The University of Virginia scientists' research with mice found
that activated platelets circulating in the blood act as participants
in the process that eventually leads to atherosclerosis. These
activated platelets have long been identified as markers for
The scientists injected activated platelets into mice that
were engineered to have high cholesterol levels. They then
studied the interaction with human endothelial cells.
The scientists found that activated platelets deposited pro-inflammatory
factors, called chemokines, on monocytes and blood vessel
walls, an important factor in the formation of atherosclerosis
The study also found that a protein called platelet P-selectin
is vital for the interaction of the platelets in the formation
of atherosclerosis lesions.
Identifying the role of these platelets is the first step.
The next step is to develop drugs to limit their activation,
which could prove an effective preventive measure against
Platelets are round or oval discs routinely found in blood
and they play an important role in clotting. They're activated
as part of the blood-clotting response to an injury or as
part of the body's inflammatory response.
The findings of the two-year study were just published in the
online issue of Nature Medicine.
The American Heart Association (news
sites) has more information about atherosclerosis.
Takes Heart Monitor a Step Further
By Bill Berkrot
NEW YORK (Reuters) - A tiny device that reads a heart rate
monitor and automatically sends a warning call to a predetermined
cell phone number if the user is in distress could soon aid
people at high risk of cardiac problems.
A team from IBM Engineering and Technology Services has successfully
tested the relay device and is actively seeking a customer
to turn it into a consumer product, the company said.
It remains to be seen whether the instrument will be produced
and marketed by a medical device company, a cell phone network
provider or an athletic equipment manufacturer. But the designers
see a variety of uses for it and are busy working on variations
on the theme.
While portable heart rate monitors have been available to joggers,
cyclists, heart patients and assorted weekend warriors for
some time, this device goes a couple of steps further, explained
Bryan Striemer, a development engineer for IBM and one of
"Suddenly we were able to send heart rate information
over cell phone networks," Striemer told Reuters in a
telephone interview from Rochester, Minnesota.
The device uses radio frequency wireless technology, such as
short-range Bluetooth technology, to read a heart monitor.
When a predetermined heart rate that signals possible cardiac
distress is reached, the device automatically sends a text
message alert via cell phone to any pre-programmed cell phone
number, such as a physician, care-giver or the emergency services.
Striemer said the developers initially focused on uses for
the elderly--"somebody who wanted to be independent and
live alone but they have a heart condition that they wanted
to have monitored all the time.
"Then pretty quickly we got into the issue of athletes
as well," he added.
In addition to its potential life-saving function for those
who want to continue a vigorous exercise regimen but are at
risk for heart problems, the device could send heart rate
information from runners or cyclists to coaches or conditioning
trainers for reference.
Its convenient size should make it attractive to runners or
other athletes who are not willing to take on extra weight
or carry around cumbersome devices. "Our device is the
size and shape of a few sticks of chewing gum," Striemer
Of course, the user must have a cell phone and it must be turned
on to automatically transmit the crucial information.
Striemer is working on incorporating global positioning technology
into a version of the device that would enable an elderly
person or someone suffering from Alzheimer's disease (news
sites) who became lost or confused to send their whereabouts
to their children or a designated care-giver's cell phone.
He also has a pedometer version in the works to allow athletes
to send distance information to coaches or to a training database.
No price structure has been determined for the device, but
a spokesman for IBM Engineering and Technology Services said
they were determined to make it affordable for the average
"It will not be overboard pricewise, nothing prohibitive,"
promised Cary Ziter.
"What I would love to see in next coming months is that
this would be available in your local athletic store and be
in a price range of similar gadgets," Striemer said.
Cipro XR Treats Urinary Tract Infections
TUESDAY, Dec. 17 (HealthScoutNews) -- The U.S. Food and Drug
sites) has approved an extended-release version of the
antibiotic Cipro (ciprofloxacin) to treat uncomplicated urinary
tract infections (UTIs).
The recommended dose for the 500-mg. Cipro XR tablet is once
daily for three days, Bayer Corp. said in announcing the FDA
action. Regular-strength Cipro is normally taken in 250-mg
strength twice daily.
UTIs are caused by bacteria that enter the urethra and travel
up the urinary tract. Affecting millions of Americans annually,
they are the second most common infection, behind those of
the respiratory tract. Women are especially prone to UTIs,
and their risk increases with age.
FDA approval of Cipro XR followed clinical trials among 891
adult women who had clinical signs of UTI. The study compared
the once-daily medication with its older twice-daily counterpart.
The company says 95 percent of UTI patients were cured with
Cipro XR, versus 93 percent of patients who used regular-strength
Cipro XR will begin shipping to U.S. pharmacies on January
2, the company said. Side effects include nausea and headache.
The drug should not be taken concurrently with the asthma
Here is the Bayer
Press Release announcing the approval. For more information
about urinary tract infections, visit the U.S. National
Kidney and Urologic Diseases Information Clearinghouse.
to Appeal Ruling on Drug Tests in Children
By Julie Rovner
WASHINGTON (Reuters Health) - While the Bush administration
has declined to appeal a court case that struck down a Food
and Drug Administration (news
sites) rule requiring drug companies to test their products
on children, two children's health groups are going to continue
the case on their own.
On Friday, US Federal District Court Judge Henry H. Kennedy
Jr. said that the American Academy of Pediatrics and the Elizabeth
Glaser Pediatric AIDS (news
sites) Foundation were sufficiently involved in the case
to allow them to appeal the decision even if the FDA declined
to do so. The judge noted that the groups have been "directly
harmed" by the loss of the rule and that they have "championed
this policy from its inception."
Kennedy in October struck down the so-called "pediatric
rule," saying the FDA overstepped its authority in issuing
it in 1998.
The groups filed their "notice to appeal" on Monday,
just hours before the FDA announced it would not join them.
Bush administration officials said they will instead pursue
legislation in Congress to give the FDA explicit authority
to order pediatric drug testing when the agency feels is it
In a statement issued late Monday, FDA Commissioner Mark McClellan
said that "continued litigation is likely to take years,
and its outcome is uncertain. The better course now is to
work with the committees in Congress and enact new, specific
legislation rapidly." The Bush administration did not
work to pass a bipartisan bill approved by the Senate Health,
Education, Labor and Pensions Committee last fall. That bill
died at the end of the Congress.
The two children's health groups, which also support a legislative
solution to the problem, said it is nevertheless important
to continue the lawsuit.
"Currently three quarters of the drugs prescribed to children
haven't been tested for their use," said Kate Carr, president
and CEO of the Glaser Foundation. "We will continue to
vigorously protect this crucial regulation that is improving
the health and well-being of children."
Said Dr. Stephen Edwards, president of the American Academy
of Pediatrics: "Each day that passes without the Pediatric
Rule puts children senselessly at risk. We must act now, before
the rule's absence compromises the health of our next generation."
Cancer Trials: Whom Do They Help?
By Amanda Gardner
TUESDAY, Dec. 17 (HealthScoutNews) -- Do you do it to benefit
a patient today, or to benefit humanity at some unspecified
time in the future?
That's the question physicians ask -- or should ask -- every
time they recommend a patient for a clinical trial.
However, even though the stated purpose of clinical trials
is to advance science and come up with better treatments for
future generations, many cancer specialists believe the primary
purpose is actually to benefit the patients in the trial,
says a study in tomorrow's issue of the Journal of the
National Cancer Institute (news
"Up until now, we have really focused on designing clinical
trials to help answer scientific questions about what the
best interventions are," says Dr. Ruth Oratz, an associate
professor of medicine at New York University School of Medicine
and chairwoman of the ethics committee at NYU's Tisch Hospital.
"This study highlights a very important fact, which is
that clinicians who participate in trials continue to make
therapeutic benefits for patients a very high priority. I'm
not sure that that is bad," she says.
The study authors mailed surveys to 1,120 oncologists around
the United States to find out why they enrolled patients in
clinical trials for cancer treatments and what they viewed
as the main societal purpose of the trials.
Different cancer specialists had vastly different views on
the topic. For instance, 64.1 percent of pediatric oncologists
said they enrolled patients in trials to provide state-of-the-art
treatment for them. Only 42.8 percent of medical oncologists
and 25.2 percent of other cancer subspecialists reported the
On the flip side of the coin, 40.5 percent of medical oncologists,
32.3 percent of pediatric oncologists and 62.6 percent of
the other oncology subspecialists reported enrolling patients
in clinical trials to improve future therapy.
More pediatric oncologists (38.2 percent) thought the societal
purpose of clinical trials was to ensure state-of-the-art
treatment for participants. Only 19.5 percent of medical oncologists
and 13.1 percent of other cancer specialists felt this way.
Almost three-quarters (72.7 percent) of medical oncologists,
59.4 percent of pediatric oncologists and 81.9 percent of
the other subspecialists reported enrolling patients to benefit
"The most surprising thing was the differences among the
specialties," says study author Dr. Steven Joffe, an
instructor in pediatrics at the Dana-Farber Cancer Institute
and Boston Children's Hospital in Boston. "We sort of
theorized that that might be there, but to actually see it
come back and be as distinct as it was took me a little bit
The authors stress this study should not be taken as an indictment
of clinical studies, or that trials have to be an either/or
situation. Sometimes you can advance medicine and provide
good care for trial participants.
"I don't come away from this with a negative opinion.
I think trials are a very good thing for patients to consider,"
Joffe says. "You can make treatment and research line
up quite well or line up very poorly. I think the cancer field
has done quite a good job of designing things in a way that
people get good care in trials. For that reason, I think trials
are to be encouraged but there remains the danger of forgetting
that there are two different things going on."
Physicians need to be aware that there is a potential for friction
between the clinical and research objectives and to make sure
patients are aware of the distinction, Joffe says.
"I think the wrong thing to do would be to recruit somebody
to a trial by saying this is the best thing for you, leaving
out discussion of the uncertainties," he adds. "The
most important thing is for physician-investigators to be
conscious of the fact that they are playing these two roles."
Some doctors feel the discussion is one of splitting hairs
when there might not even be a hair to split.
"I'm a practicing oncologist for 17 years and have probably
put over 700 patients in clinical research trials, and I have
never felt conflicted about the two questions here,"
says Dr. Jay Brooks, chief of hematology/oncology at the Ochsner
Clinic Foundation in New Orleans. "I don't look at this
as a one-two and if it's one way it's unethical. If I don't
feel the study is a good study, then I don't put my patient
in the study."
If there are existing treatments available for a particular
condition, clinical trials compare the experimental treatment
against the best existing treatment. This means that all trial
participants will not be left out in the cold: They will get
either the best available treatment or a possibly cutting-edge
"I think we're doing an excellent job in this country
in trying to conduct well-designed and ethically appropriate
clinical trials," Oratz says. "But we can do better."
What To Do
For more on clinical trials, visit the National
Institutes of Health or CenterWatch.
For more on clinical trials involving cancer research, check
with the National
promote acupuncture for children
By Bruce Sylvester
UPI Science News
the Science & Technology
United Press International
Mass., Dec. 17 (UPI) -- Acupuncture should be used more routinely
to treat children with chronic pain or nausea, results of
a study released Tuesday recommend.
can work for kids as well as adults," lead investigator
and study co-author Dr. Kathi Kemper, instructor of medicine
at Harvard University Medical School, told United Press International.
kids may initially be afraid of needles, we found that most
kids, over two-thirds, found acupuncture actually pleasant,
also found that even for kids who had pain that hadn't responded
to the best pain treatments mainstream medicine could offer,
over 50 percent had significant pain relief with acupuncture."
the study, published in the December issue of the journal
Contemporary Pediatrics, Kemper and co-author Ellen Silver
Highfield, licensed acupuncturist at the Center for Holistic
Pediatric Education and Research at Children's Hospital in
Boston, summarized results of adult acupuncture studies from
the past three decades, highlighting implications for the
treatment of children. They also presented case studies from
their own clinical work with children.
most common reasons we recommend acupuncture for kids are
chronic or severe pain such as migraine headaches, chronic
abdominal pain, cancer, endometriosis, nausea and vomiting
associated with surgery or chemotherapy," Kemper told
few insurance companies pay for acupuncture, so parents must
be prepared to pay out of pocket for treatment. The good news
is that most acupuncturists take sliding scale fees and do
not turn patients away, and you usually know it's going to
work within three to five treatments," Kemper said.
to acupuncture services for most children remains limited
in the United States because few acupuncturists treat children
and few insurance companies provide full coverage.
many pediatricians rarely think of acupuncture as a therapeutic
option due in part to the lack of training in and familiarity
with acupuncture," Kemper noted.
number of licensed acupuncturists in the United States doubled
between 1990 and 2000. Numbers are expected to rise dramatically
as U.S. acupuncture schools increase enrollments.
than 40 states have provisions to license or register acupuncturists.
In 1999, a survey of academic pediatric pain treatment programs
in North America indicated that more than one-third offered
many children's hospitals do not offer acupuncture services,
Kemper said she hopes pediatric access will grow as more acupuncturists
become available in more mainstream clinical settings and
insurance plans are encouraged to cover the treatment.
its safety record," Kemper noted, "we routinely
recommend acupuncture as an adjunctive (add-on) therapy for
patients suffering from chronic, recurrent or severe pain
and those with chronic or predictable vomiting. In specific
circumstances in which patients hold values and world views
consistent with acupuncture and are eager to try it, we support
their decisions, acknowledging the limitations of our current
scientific knowledge regarding its effectiveness."
expert Dr. Larrie Greenberg said that she thought "the
article by Kemper and Highfield makes an important contribution
to the practice of pediatrics in that it reviews what is currently
known and the theories of how acupuncture works."
director of the Creative Medical Education center in Potomac,
Md., told UPI, "the fact is that this centuries old Chinese
technique is being offered by practitioners for many problems
that are not being resolved with traditional Western medicine,
such as pain.
health care providers need to be aware of the possibilities
and limitations of this therapy, and as the authors state,
be able to identify competent practitioners in their communities
who can provide quality integrative care for their patients."
research was supported by a grant from National Institutes
of Health through the National Center for Complementary and
Alternative Medicine in Bethesda, Md.
(Reported by Bruce Sylvester, UPI Science News,
Work, If You Take Them
By Adam Marcus
TUESDAY, Dec. 17 (HealthScoutNews) -- Statins work as advertised
to lower cholesterol.
However, that doesn't automatically translate into a reduction
in their risk of heart problems or death compared with conventional
therapy to lower blood fat, a new study has found.
Still, experts say the results don't undermine the broad utility
of statins, which are among the most widely prescribed drugs
on the planet. Rather, the study suggests doctors need to
do a better job of keeping patients on the medications if
they expect the same performance produced by rigorous clinical
"This is not in any way a blemish on statins or pravastatin
[the drug used in the study]," says Dr. Richard C. Pasternak,
a Harvard University cardiologist. "It's more a blemish
on our ability to maintain best practice."
Pasternak wrote an editorial accompanying the study, which
appears in tomorrow's issue of the Journal of the American
Medical Association (news
Statins have shined in previous studies, leading to marked
reductions in total cholesterol and the LDL, or the "bad"
form of blood fat. However, those trials have been in tightly
controlled settings that don't necessarily reflect the real
TV). They also typically involved people with high or
extremely high cholesterol.
The latest study, called ALLHAT, was the second-largest cholesterol-lowering
trial yet conducted, involving 10,355 people treated at 513
clinics in North America. Volunteers had moderately high cholesterol
and elevated blood pressure that was under control with medication.
They also had at least one risk factor for heart disease,
such as Type II diabetes.
Half the patients -- men and women aged 55 and older -- received
40 milligrams a day of pravastatin, sold as Pravachol by Bristol-Myers
Squibb. The rest received "usual care," which consisted
of lifestyle changes such as a low-fat diet and exercise.
Nearly a third of those in this group switched to pravastatin
during the eight-year study.
After four years, patients on the statin drug saw their total
cholesterol drop by about twice as much as those in the other
group, 17 percent versus 8 percent. And in a subset from whose
LDL cholesterol was sampled, the drop was even better: 28
percent versus 11 percent.
However, the gap between the two groups for total cholesterol
was less than half the average of eight other large studies
comparing statins with other therapies.
The number of people in either group who died was essentially
identical, with a six-year death rate of about 15 percent.
Rates of coronary heart disease -- defined as non-fatal heart
attacks and deadly artery trouble -- were also close, at 9.3
percent in the statin group versus 10.4 percent in the usual
care group, a difference that wasn't statistically significant.
Even so, Dr. Barry Davis, a co-author of the paper, says the
benefits of statins are clear and probably understated in
"Statins are very useful at lowering cholesterol and,
in the big picture, at lowering cardiovascular morbidity and
mortality, especially from heart attacks," he says.
Davis, who ran the ALLHAT center at the University of Texas-Houston
Health Science Center, explains that the benefits of the drug
were obscured by patients hopping out of the usual care group
into the statin arm of the study. That migration was prompted
by new evidence of the drug's ability to prevent cardiovascular
deaths made public during the late 1990s. "If none had
switched, it's highly likely that we would have seen a difference"
in mortality, he says.
"The [clinical] trials provide a compelling case for statin
use, but in the real world it doesn't appear that patients
are getting the full benefit that the trials suggest,"
says Joshua S. Benner, director of health economics at Epinomics
Research, a Virginia-based consulting firm.
The reason: Only one in four people who start taking the drugs
are still on them as intended five years later, according
to a study Benner helped conduct while a researcher at Harvard
Medical School (news
That disappointing compliance rate comes despite the fact that
statins are relatively easy to take, with few side effects.
And in Benner's study, patients received the drugs for free
or paid only a few dollars to fill each prescription.
What To Do
To learn more about high cholesterol and how to keep it in
check, visit the American
Heart Association. You can also try the Heart
DECEMBER 16, 2002
Care for Stroke Victims Sought
By Lauran Neergaard
AP Medical Writer
The Associated Press
Monday, December 16, 2002
WASHINGTON - They jokingly call themselves commandos, but instead
of camouflage gear they wear white coats doctors whose mission
is to get more stroke victims a clot-busting drug that can
mean the difference between permanent brain damage or recovery.
In the handful of cities where these specialists race to emergency
rooms at whatever hour stroke victims arrive, patients are
up to 10 times more likely to get that drug.
"Usually when we arrive, there's a great sigh of relief"
from overworked ER doctors who are unsure how to treat a stroke,
says Dr. Edward Jauch of the University of Cincinnati's stroke
More than 700,000 Americans will suffer strokes this year.
It is the nation's leading cause of disability and No. 3 killer.
Some strokes are caused by the bleeding in the brain, but
most are ischemic strokes, caused when arteries feeding the
brain are blocked. That's the type that the clot-busting TPA
Yet six years after TPA was named crucial to the treatment
of strokes, only two of every 100 ischemic stroke victims
But in Houston, San Diego, Cincinnati and other cities, the
so-called stroke commandos are getting TPA to significantly
more patients in time, from 10 percent to beyond 20 percent
of patients in some hospitals.
Now the National Institutes of Health (news
sites) wants to spread that success and turned to the
commandos for advice. Their recommendation: Within the next
year, all hospitals should designate whether they have the
facilities for proper stroke care. Then ambulances should
begin immediately to carry possible stroke victims to those
hospitals that promise state-of-the-art care, even if it requires
bypassing a closer ER, just as paramedics now take accident
victims to trauma centers.
"Hospitals are not created equally," Dr. Anthony
Furlan of the Cleveland Clinic Foundation told 400 stroke
experts at a meeting convened by NIH last week. "Either
they have to get up to speed, or they shouldn't be doing stroke
Why is it so hard to give TPA?
Partly it's a matter of time. TPA must be given within three
hours of the first symptoms, and roughly a quarter of patients
get to hospitals fast enough.
But too often the hospital plays a role. Patients arrive in
time, only to be cared for by nonspecialists confused about
how and when to give TPA, stroke experts told the NIH meeting.
Because TPA can cause bleeding in the brain, a CT scan to ensure
the patient isn't already bleeding is crucial. Not every hospital
offers 24-hour CT scans.
And the scans can be confusing. For example, one study found
32 percent of patients initially deemed to have a stroke too
mild for TPA wound up dead or disabled. Yet stroke "is
a slowly gathering steam engine" as brain damage builds
for hours, so don't rule out TPA just because of an early
CT scan, warns Dr. J.P. Mohr of New York's Columbia-Presbyterian
The stroke commandos fight such barriers in different ways.
In Houston, for example, University of Texas experts signed
up six of 29 area hospitals to offer proper stroke care, with
specialists on duty 24 hours a day, and taught paramedics
stroke symptoms. Ambulances now are supposed to bring possible
stroke victims only to those six hospitals.
In Cincinnati, Jauch assembled a team of experts that 15 area
hospitals page for help whenever a stroke victim arrives.
San Diego's system is similar.
In Nevada, where patients can be 300 miles from the nearest
stroke specialist, a commando team advises rural hospitals
on TPA by phone and computer, and flies patients to bigger
hospitals for follow-up care.
There are no national guidelines urging hospitals to adopt
such programs. But the NIH's National Institute of Neurologic
Disorders and Stroke will post the new recommendations on
its Web site in hopes communities will follow them.
Meanwhile, patients and families can help themselves by knowing
stroke symptoms weakness or numbness on one side of the
body, slurred speech and loss of balance and seeking help
immediately. Call 911, as arriving by ambulance guarantees
a faster hospital exam.
Women often have some different symptoms, including confusion,
disorientation and pain. Don't focus just on those unusual
signs mention any other symptoms like one-sided weakness,
too, because those buzz words speed a correct diagnosis, advises
Dr. Lewis Morgenstern of the University of Michigan.
And don't be reluctant to ask the ER doctor if you or a relative
is a TPA candidate, the specialists say. The answer might
be no, but asking can help ensure the right tests are done.
Editors Note Lauran Neergaard
covers health and medical issues for The Associated Press
Monday, December 16, 2002
(HealthScoutNews) -- Have you stopped snacking on nuts because
you've heard they're too fatty, caloric, and salty? Well,
According to the University of California, Berkley, recent
studies have shown that nuts can help prevent coronary disease.
They're rich in unsaturated fats, vitamin E, fiber, folic acid,
and other B vitamins. And walnuts are especially rich in heart-healthy
So dig in, but choose the unsalted variety and, as with any
food, enjoy them in moderation.
Monday, December 16, 2002
(HealthScoutNews) -- Post-menopausal women, and men with low
testosterone, are most at risk for osteoporosis, a disease
that causes bones to become brittle and weak.
The Osteoporosis Society of Canada offers these preventive
tips for over-50-year-olds:
- Include 1,500 milligrams
of dietary calcium and 800 international units of vitamin
D in your daily diet.
- Do weight-bearing exercises
-- like walking, jogging, dancing or aerobics -- at least
three times a week.
- Add resistance training
to your workout routine: lift free weights, use weight-training
machines, play racquet or impact sports.
- Practice proper lifting
techniques -- bend from your knees, not your back.
- Have an annual physical
exam and ask your doctor to order a bone density test.
Sought on Child Drug Research
By Lauran Neergaard
AP Medical Writer
The Associated Press
Monday, December 16, 2002
WASHINGTON - The Bush administration won't appeal a court decision
that threw out rules that required drug companies to test
in children adult medicines commonly given to kids.
Instead, federal health officials announced Monday they will
work to get Congress to write those child-testing rules into
law this year. Congress could settle the long-simmering dispute
much faster than a court fight, said Food and Drug Administration
sites) Commissioner Mark McClellan.
The move does not mean the FDA is backing away from the so-called
"pediatric rule," he stressed.
"We want legislation that gives us the authority to require
pediatric testing," McClellan said. "This is an
important public health issue."
Adult medications commonly are prescribed for children despite
a lack of studies proving if the drugs work in youngsters,
are safe for them and if so, what dose to use. Researching
medications in children can be difficult because of ethical
issues and because it's difficult to find enough sick children
to test. Drug companies often have little incentive to do
the work if they expect desperate doctors will use the medications
anyway because they have no other option.
In 1998, the FDA issued a regulation, known as the "pediatric
rule," allowing the agency to require tests for those
adult drugs used most often in children.
A conservative think tank and a private doctors' group challenged
the rule, arguing the FDA cannot force drug makers to conduct
tests of kids if they are not seeking FDA approval for use
In October, a federal judge agreed, ruling that Congress had
specifically refused to require drug testing in children but
instead passed legislation giving drug companies financial
incentives to conduct such research.
Monday was the deadline for the FDA to appeal that ruling,
and it decided not to, instead pursuing Congress.
Conversations with committees in the House and Senate that
oversee medications give McClellan "some confidence"
that legislation specifically authorizing the pediatric rule
will move fairly quickly, he said.
Rep. Billy Tauzin, R-La., and Sen. Judd Gregg, R-N.H., who
head those committees, could not be immediately reached for
Two child health groups that support the pediatric rule the
American Academy of Pediatrics and Elizabeth Glaser Pediatric
sites) Foundation did file a motion Monday to appeal
in U.S. District Court in Washington, pledging to continue
the legal battle.
The groups expressed disappointment that the FDA didn't pursue
a pediatric rule in the courts as well as in Congress.
"But we are encouraged by the strong statement of support"
from the FDA, said AIDS Foundation public policy director
Mark Isaac. He urged McClellan to ensure the legislation's
details back "the strongest possible protection for children."
The suit challenging the rule was filed by the Association
of American Physicians and Surgeons and the Competitive Enterprise
Institute. The law generally allows the FDA to require testing
only for medication uses for which a drug maker is seeking
formal approval, even though doctors can later prescribe the
drugs "off label" for different uses. The groups
argued that the pediatric rule could set a precedent for FDA
to require testing of other off-label drugs.
Your Heart Condition Online
Monday, December 16, 2002
MONDAY, Dec. 16 (HealthScoutNews) -- The American Heart Association
sites) has created two new online tools to provide the
public with personalized information about cardiovascular
The tools, "Know Your Heart Attack Risk Assessment"
and "Heart Profilers," are free and include the
latest and scientifically accurate research.
"Know Your Heart Attack Risk Assessment" allows you
to find out your risk of suffering a heart attack within the
next 10 years, even if you don't currently have CVD. The risk
assessment is based on your age and gender, along with health
conditions and habits such as high blood pressure, cholesterol,
smoking and prior heart attack and stroke.
The heart attack risk assessment tool will be launched this
"Heart Profilers" offers you a personalized, confidential
report of scientifically accurate treatment options, along
with the most recent articles and research, key questions
to ask your doctor, and other information that lets you be
involved in your treatment for cardiovascular disease.
The first two Heart Profilers were released earlier this year
and focused on heart failure and coronary artery disease,
followed by Heart Profiler tools for high blood pressure,
high cholesterol and atrial fibrillation.
To access the tools, go to the American
Court Upholds Medicaid Prescription
By Dee-Ann Durbin
The Associated Press
Monday, December 16, 2002
LANSING, Mich. - Michigan acted legally when it attempted to
cut costs by limiting the drugs doctors can prescribe to low-income
patients, the state appeals court said in a decision released
The unanimous decision was a victory for the Michigan Department
of Community Health. It also sent a clear signal to other
states, who have been waiting to see if courts would approve
Michigan's unique approach.
"This allows us to continue to offer high quality health
care to low-income Michigan citizens and prudently manage
costs," Community Health Director James Haveman said
Drug companies and mental health advocates, who sued to stop
the plan, said they were disappointed with the decision.
"Patients in Michigan are being denied the medicines their
doctors want them to have," said Bruce Lott, a spokesman
for the Washington-based trade group Pharmaceutical Research
and Manufacturers of America, or PhRMA.
Michigan's plan, which went into effect in February, requires
doctors to use a state-developed list when prescribing medications
to patients who rely on state aid, including Medicaid fee-for-service
patients and programs for infants and the elderly. The program
will eventually cover around 1.6 million patients.
Doctors must get state authorization for medications not on
the list, which was developed by a committee of physicians
and pharmacists selected by Republican Gov. John Engler.
Some drugs were allowed on the list because they were considered
medically necessary. In other cases, drug companies were told
to give discounts or risk being left off the list.
PhRMA and mental health advocates said the state program endangers
patients' lives and is unconstitutional because it was never
considered by the full Legislature. A lower court agreed and
halted the program with a temporary injunction.
The Michigan Court of Appeals lifted that injunction while
it heard the case. On Monday, the appeals court permanently
lifted the injunction, saying the drug companies and mental
health advocates failed to show their case was likely to succeed.
The appeals court said the Legislature has given the Department
of Community Health the authority to administer health care
"In the absence of a specific directive limiting the DCH's
discretion as to the precise manner in which to accomplish
its duty, the DCH is, and must be, permitted to formulate
policies that promote the program's continued viability,"
the court said.
The Department of Community Health, which now spends around
$1 billion per year on prescription drugs, said it is saving
$850,000 each week with the program. Haveman said other health
programs will have to be cut if courts rule against the prescription
Lott and Susan McParland, an attorney for the Michigan Association
of Children with Emotional Disorders, said Monday that they
didn't yet know if they would appeal to the Michigan Supreme
"I'm disappointed because of what's at stake here. We
know so many of the consumers are being injured because of
these policies," McParland said.
PhRMA also has filed a lawsuit in federal court to stop Michigan's
program. A decision in that case is expected early next year,
On the Net:
Michigan Department of Community Health, http://www.michigan.gov/mdch
Pharmaceutical Research and Manufacturers of America, http://www.phrma.org
Want a Better Memory? Practice,
By Nancy Deutsch
Monday, December 16, 2002
MONDAY, Dec. 16 (HealthScoutNews) -- Ever been envious of a
friend who knows everyone's telephone number by heart? Or
of your partner's ability to never forget a name?
Having an excellent memory may not be as elusive as you think.
People with superior memories don't have brains different from
those less successful at remembering, a new study by British
researchers has found. Rather, people renown for their memory
have trained certain parts of their brain to store and retrieve
information, a feat that others with less proficient memories
have not yet mastered.
"Although more research is needed, it may be that we all
have the potential and neural capacity to improve our memories,"
says Eleanor Maguire, a neuropsychologist at the Institute
of Neurology in London, and the lead author of the study.
In their study, which appears in the new issue of Nature
Neuroscience, the researchers examined eight people who
had placed at the top in the World Memory Championships, as
well as two other people who had been studied before for their
remarkable ability to remember things.
Then the researchers found 10 people of comparable educational
and occupational backgrounds, but who were not celebrated
for their memories.
All participants underwent two to three hours of testing, including
general intelligence exams, as well as structural brain imaging
and functional brain imaging.
The researchers found that those with superior memories weren't
more intelligent than those with average memories. Nor did
they have any obvious brain differences, such as more gray
matter from years spent challenging themselves mentally.
Using magnetic resonance imaging, the researchers discovered
that those with superior memories used the right posterior
hippocampus, medial parietal cortex, and the retrosplenial
cortex areas of their brain more than the control subjects
These areas are critical for spatial memory, Maguire says.
"Events that happen to us invariably occur at a certain
time and in a certain place. The 'where' an event occurs is
its spatial context."
The participants with great memories didn't perform exceptionally
well in all areas of memory, however.
When it came to remembering snowflake patterns, for instance,
both groups performed equally. And when it came to remembering
faces, those with superior memory did slightly better than
the control group. It was only in the area of remembering
numbers that those known for their memory skills excelled.
They reported using mnemonic techniques -- specific memory
strategies -- to remember things. The three areas of the brain
that were used more often by the memory experts may reflect
their use of these techniques, specifically "route strategies,"
the researchers report.
One common mnemonic technique is the "method of loci,"
in which specific objects to be remembered are placed along
an imaginary path through which a person can mentally walk.
Michael Stadler is an associate professor of psychology at
the University of Missouri-Columbia who teaches the method
of loci to students. When he teaches students to remember
a list of grocery items, for example, he has them mentally
walk through their home and place grocery items along the
"They step through locations and imagine each thing in
those places. They're very simple techniques," he says.
There are a variety of mnemonic techniques that you can employ,
Maguire says. "Even something as simple as tying a knot
in a handkerchief is a memory aid, in that it helps you to
remember something," she says. "Many of the most
effective mnemonics involve imagery or involve processing
something more deeply so that it forms associations and has
a better chance of being remembered."
Learning to use a mnemonic technique may help anyone who wishes
to have a better memory, particularly when it comes to numbers,
Stadler says. "It's kind of encouraging for all of us,"
he says. "We've all got the hard drive, but we need the
What To Do
To learn how "sleeping on it" can help you to remember
something, visit the American
Psychological Association. For tips on improving your
study habits and memory, check with Middle
Tennessee State University.
Radiation May Help With Brain Defect
By Katherine Vogt
The Associated Press
Monday, December 16, 2002
DENVER - With the zap of a beam, 5-year-old Whitney Boyce took
a leap toward possible recovery from a brain defect that has
tyrannically worked to deprive other parts of her body of
blood since she was born.
Doctors at the University of Colorado Health Sciences Center
used a relatively new surgical device to precisely focus a
high concentration of radiation on the congenital birth defect
made up of a tangle of veins and arteries in a small portion
of Whitney's brain.
With the procedure, Whitney joined a handful of patients in
Colorado treated with the Novalis Shaped Beam Surgery device,
which uses beams of photon energy aimed from several directions
to target tumors or other growths that can be stopped with
With help from computer-generated images and a system that
precisely positions the patient using grids, the radiation
beams are molded to mirror the shape and size of the growth.
"In your mind, when you hear it's radiation, it's scary.
But I think this was the best option," Theresa Boyce
The device slightly larger than a refrigerator with a giant
arm gave doctors the best tool available to treat Whitney's
life-threatening brain defect as well as a host of other ailments,
including brain tumors.
It could be two years before they know if the procedure worked.
Success would dramatically alter the life of the plucky kindergartner
and ultimately may even save it.
Whitney underwent the procedure at the university's Health
Sciences Center in November.
As a newborn, she was diagnosed with an arteriovenous malformation,
a golfball-sized cluster of veins and arteries. The engorged
knot hogged blood from parts of her body, turning her blue
and sending her into congestive heart failure.
Doctors ultimately were able to pull Whitney out of heart failure,
but a new problem emerged: She went through a brief spell
of suffering seizures. The next several years were punctuated
by frequent trips to doctors and specialists who helped Whitney
escape major developmental problems. Many times it meant traveling
100 miles to Denver from the family's home in Akron.
Much of the medical work was done by Dr. David Kumpe, director
of interventional radiology and interventional neuroradiology
at the Health Sciences Center. Kumpe, Whitney's longtime physician,
has treated the malformation with a series of non-invasive
procedures in which glue and coils were used to stem blood
flow into the knot of veins and arteries.
The work helped reduce the influence of the mass, but Kumpe
said there was a small kidney-bean sized portion remaining
in a very sensitive area. He didn't want to risk another procedure
in that part of the brain so he turned to Shaped Beam surgery.
It is designed to focus radiation and destroy blood vessels
in diseased tissue while leaving surrounding healthy tissue
untouched a critical factor when treating the brain or other
sensitive parts of the body.
Unlike traditional open skull surgery, no incisions are made
for the Shaped Beam procedure and the treatment can be administered
in just one dose for many patients.
Experts say similar radiosurgery devices have been available
for years, but the Shaped Beam system may provide the most
"It's the best, the newest and most accurate and applicable
to the most treatment sites (on the body)," said Timothy
Solberg, director of the medical physics division at the David
Geffen School of Medicine at the University of California
at Los Angeles, where the first patient was treated with the
system in 1998.
"Up until the point of the Novalis, we couldn't shape
the radiation beam. You had to make some compromises, all
of which were less than ideal."
"It's the first time that I've come across something in
the medical environment that's actually easier to use, but
most importantly is also better for the patient," he
Eighteen hospitals nationwide already use the device. Solberg
said UCLA alone has used the system to treat more than 1,400
brain tumor cases.
Unlike the older Gamma Knife which uses a super-concentrated
beam of radiation the Shaped Beam system does not have a
radioactive source that has to be replaced. It uses electricity.
"I think it's the future for radiosurgery because it can
be used for many purposes," said Dr. Laurie Gaspar, chair
of the department of radiation oncology at the Health Sciences
If left untreated, the malformation afflicting Whitney has
a 95 percent mortality rate.
With the Shaped Beam surgery, Whitney's prognosis is very good,
Kumpe said, adding that he hoped most of the mass had dried
"If we do an angiogram in two years, it may show that
she may need to get more treatment," he said.
Within two days of the procedure, Whitney was home, demanding
to be allowed to attend her kindergarten, insisting her presence
was required because it was her day to bring classmates a
On the Net:
Your Way to Acne
By Serena Gordon
Monday, December 16, 2002
MONDAY, Dec. 16 (HealthScoutNews) -- The standard Western diet
of refined sugars and starches may be more to blame for the
high rates of acne than you'd think.
That's the belief of an international team of researchers who
suspect that highly processed foods, such as breads, cereals,
chocolate and pizza, cause the body to produce high levels
of insulin, which in turn leads to an excess of male hormones.
Excess male hormones cause an overproduction of sebum -- the
greasy stuff that blocks your pores -- and acne results.
"Acne can be psychologically devastating to a teen,"
says study author Loren Cordain, a professor of health and
exercise science at Colorado State University.
More important, he adds, "acne is just one small part
of a larger health problem." The typical Western diet
likely also contributes to heart disease and other ailments.
According to the study, published in the December issue of
the Archives of Dermatology (news
sites), 79 percent to 95 percent of teens in Western
societies have acne. Forty percent to 54 percent of those
over 25 have it, and for Westerners in middle age, 12 percent
of women and 3 percent of men still suffer from acne.
Cordain says he became interested in the acne-food connection
after reading an article about a tribe living in a non-developed
part of the world whose members had no pimples until they
were introduced to a Western diet.
So, the researchers set out to study two pimple-free populations
-- one from Papua New Guinea and the other from Paraguay.
These primitive people live without electricity or running
water and eat a decidedly non-Western diet. They eat only
foods they can hunt, gather or grow.
The researchers examined 1,200 (including 300 teens) Kitavan
Islanders from Papua New Guinea and 115 (including 15 teens)
Ache hunter-gatherers from Paraguay. They found no cases of
acne in either population. In fact, the study says they found
no pimples on any of those people studied.
"There was a startling lack of acne," Cordain says,
and it wasn't a one-time effect. The researchers studied the
Ache people for two years and never saw a single case of acne.
Previous research had shown that when tribespeople such as
those studied adopt a Western lifestyle, acne follows. So
genetics couldn't be protecting the subjects of Cordain's
That meant, he says, the lack of acne had something to do with
their environment, and the only known environmental factor
that could cause the excess of insulin, male hormones and
overproduction of sebum seen in Western civilization is diet.
Others, however, aren't so sure.
"If processed foods cause acne, why don't little kids
and the elderly have acne?" asks Dr. Ted Daly, a dermatologist
at Nassau University Medical Center in East Meadow, N.Y. Daly
says he also finds it hard to believe that of the 1,200 people
studied by Cordain's group, the researchers couldn't find
one pimple or blackhead. If that's the case, Daly says, there
is no proof that there isn't a genetic basis, or something
else in the environment that accounts for their clear skin.
Dr. Harry Saperstein, director of pediatric dermatology at
Cedars-Sinai Medical Center in Los Angeles, says the Cordain
theory is "an interesting starting point," but still
hasn't been scientifically proven.
Cordain, however, is convinced that the Western diet is at
fault and recommends changing your diet to reduce acne and
to improve overall health. He is quick to point out, though,
that he's not advocating any of the popular high-protein diets,
because they're often high in saturated fat.
What he does recommend is a low-glycemic load diet. The glycemic
index predicts how much a particular food will raise insulin
levels. Bread, potatoes, many cereals and candy all have high
glycemic indexes, while fruits, vegetables and bran products
have lower glycemic indexes. He advocates a diet that's about
one third protein (from lean meat and fish), one third fat
and one third complex carbohydrates such as fruits and vegetables.
Daly says if you want to reduce acne outbreaks, keep your skin
clean and use a benzoyl peroxide wash or cream daily. He says
while he doesn't know of any studies that scientifically link
food and acne, if you feel a particular food makes you break
out, you might want to avoid it.
What To Do
For more information on acne and its treatment, visit the National
Institute of Arthritis and Musculoskeletal and Skin Diseases
or the American
Academy of Dermatology.
Acetaminophen Overdose Leading
Liver Failure Cause
By Merritt McKinney
NEW YORK (Reuters Health) - Overdoses of acetaminophen, the
active ingredient in Tylenol and other over-the-counter pain
and fever relievers, are now the leading cause of acute liver
failure in the US, researchers report.
But there is scant evidence that the recommended dose of acetaminophen
can harm the liver, according to the investigators. On average,
people in the study who went into acute liver failure were
taking three times the maximum daily dose of acetaminophen.
Unlike chronic liver failure, which develops gradually, acute
liver failure occurs when a person with no apparent liver
disease suddenly experiences a severe deterioration in liver
function. Each year an estimated 2,000 people in the US go
into acute liver failure. During the past three decades, the
leading cause of acute liver failure has been hepatitis infection,
particularly hepatitis B.
That no longer seems to be the case, according to a study of
308 people who experienced acute liver failure from 1998 through
2001 in the US.
"Drug-induced liver injury makes up more than 50% of cases,
and viral hepatitis appears on the decline as a cause of this
acute liver function," the study's lead author, Dr. William
M. Lee of the University of Texas Southwestern Medical Center
in Dallas, told Reuters Health.
"More importantly," Lee said, "acetaminophen
constitutes nearly 40% of all cases, and this appears to be
increasing over the past two decades."
Acetaminophen overdoses were responsible for 39% of the acute
liver failure cases in the study. Another 13% of cases were
thought to be caused by the effects of other medications.
About 12% of cases stemmed from hepatitis A or B infections,
and another 17% were of uncertain cause. The findings are
published in Tuesday's edition of the journal Annals of Internal
The results of the study do not mean that acetaminophen, which
is the most popular over-the-counter pain reliever in the
US, is unsafe. Eighty-three percent of patients who went into
liver failure after taking acetaminophen had exceeded the
maximum daily dose. Taking more than 4,000 milligrams per
day (4 g/d) of acetaminophen is not recommended.
According to Lee, acetaminophen overdose has been the leading
cause of acute liver failure in the UK, where it is known
as paracetamol and is implicated in 73% of cases of acute
liver failure. "The study shows, Lee said, that "US
numbers are beginning to approach those in the UK."
The difference between the US and the UK, however, Lee pointed
out, is that most acetaminophen overdoses are unintentional
in the US. In the UK, cases of acetaminophen overdose are
"largely suicidal," the Texas physician said.
According to the US Food and Drug Administration (news
sites), common causes of acetaminophen overdose include
inadvertent use of multiple acetaminophen-containing products
at the same time and the misinformed belief that larger doses
will lead to faster relief.
One of the researchers received a Schering Research Fellowship
from the American Association for the Study of Liver Diseases.
Source: Annals of Internal Medicine 2002;137:947-954.
Has No Effect on Colds
By Kathleen Doheny
Monday, December 16, 2002
MONDAY, Dec. 16 (HealthScoutNews) -- Echinacea (news
sites), a well-known herb popular as a cold treatment,
is no better than a placebo for shortening the duration of
the common cold or the severity of its symptoms. So say researchers
from the University of Wisconsin-Madison whose study appears
in tomorrow's Annals of Internal Medicine.
But they acknowledge that more research is needed before they
can recommend that cold sufferers shelve their echinacea.
The researchers gave the herb in capsule form or a placebo
in capsule form to 142 otherwise healthy college students
who had just come down with colds. Without knowing if they
were getting the herb or the placebo, the students took six
grams on the first day and three grams on each subsequent
day, for a maximum of 10 days.
No differences between the groups were found in severity of
such symptoms as cough, nasal congestion, fever and aches.
There was also no significant difference in the duration of
the cold between the groups. In each, the cold symptoms lasted
two to 10 days. And, in fact, the mean duration in the placebo
group was 5.75 days, while in the herb group it was 6.27 days.
Advocates of the herb suspect it increases the activity of
the immune system, helping it to fight off a cold.
Despite the study results showing no benefit to the herbal
treatment, the lead author, Dr. Bruce Barrett, an assistant
professor of family medicine, says he's not ready to give
up on echinacea -- a favorite of North American Plains Indians
who used it often for medicinal purposes.
"We definitely have to wait and see," says Barrett,
whose study was funded by the U.S. Department of Health and
Human Services (news
sites), the National Institutes of Health (news
sites), and Shaklee Technica, which sells the herb preparations.
The company had no role in the study's design, conduct, reporting
of data or the decision to submit the manuscript for publication,
the authors note in the paper.
Among the limitations of his study, says Barrett, was the type
of herb used. He used a mixture of herb and root, and the
mixture has not previously been tested, he says. He says it
may be ineffective due to "bioavailability" or other
And healthy undergraduates might not gain as much benefit from
the herb as older people, because their immune systems are
presumably healthier than those of older adults, Barrett says.
Also, the study was relatively small.
"There's too much evidence [from other studies] that it
might work," Barrett says. "I don't think we've
proven it doesn't work."
So, to take the herb or not for a cold?
"It's a tricky question because there are not good treatments
for the common cold," says Barrett. "If people are
going to treat with something, I would prefer echinacea to
a decongestant, for instance. Decongestants work like a stimulant
and may have harmful effects. And if you believe in echinacea,
it would be a good thing to take."
Barrett advises other measures to combat colds, too. "Handwashing
to prevent the spread of colds, fluids and rest are all good
Dr. Ronald B. Turner, a professor of pediatrics at the University
of Virginia School of Medicine, praises the study but he's
not ready to write off echinacea.
"This study was really quite well done," says Turner,
who wrote an editorial to accompany the study report. "I
don't think it will be a final word on echinacea." He
expects more studies to be released in the future.
The problem, he says, is there are so many variables with the
herb. Turner notes there are three different species of the
herb that are used for medicinal purposes. "And it is
hard to make a recommendation just based on this study,"
Turner's advice, for now: "Withhold your judgment on the
use of echinacea. I would not use it right now [for colds]."
And it's crucial to remember, he adds, that nothing available
cures a cold, but rather treats the symptoms.
What To Do
more information on echinacea, see the Herb Research Foundation. To learn
more about the common cold, check with the National Institute of Allergy and Infectious
Study Zeros in on Smoking's Bone
NEW YORK (Reuters Health) - Scientists have identified two
bone loss-related factors that drop in postmenopausal women
after they quit smoking. The finding may help explain why
smoking increases a woman's risk of developing the bone-thinning
While experts have long known of the link, it has never been
clear exactly how smoking adversely affects bone strength.
In the current investigation, Dr. Cheryl Oncken and colleagues
from the University of Connecticut Health Center in Farmington
looked at levels of sex hormones and other factors in 38 women
who smoked at least 10 cigarettes a day. Roughly, half of
the women underwent smoking cessation counseling to quit or
reduce the number of cigarettes that they smoked. The rest
of the women, the "control" group, did not undergo
smoking cessation therapy, according to Oncken's team.
They found that two markers associated with bone loss--sex
hormone-binding globulin (SHBG) and N-terminal collagen crosslinks
(NTx)--dropped in women who quit smoking. Levels of SHBG and
NTx decreased by 5% and 8%, respectively, in the women who
The discovery may partly explain how smoking contributes to
osteoporosis in postmenopausal women, according to the report
published in the December issue of the journal Nicotine and
"Further research should be done to evaluate whether the
observed changes in SHBG and NTx after smoking cessation result
in long-term increases in bone mineral density or decreases
in fractures," the authors conclude.
Source: Nicotine and Tobacco 2002 December.
Isn't the Same Between the Sexes
Monday, December 16, 2002
MONDAY, Dec. 16 (HealthScoutNews) -- Proteins called GIRKS
play a major role in male and female differences in sensitivity
to pain and painkillers, say two new studies.
The information may help scientists develop pain treatments
specifically designed for each gender, say researchers from
the University of Texas at Austin.
Men typically can endure more pain than women, and painkillers
seem to affect men and women differently. However, the biological
reasons for those differences isn't clear.
In the first study, researchers studied pain sensitivity and
responses to analgesic drugs in mutant mice that lacked a
protein called GIRK2. This protein plays an important role
in electrical communication between neurons.
The study found that the male mutant mice, but not the females,
had lower pain thresholds than a control group of normal mice.
That showed that the removal of the GIRK2 protein eliminated
gender differences in baseline pain sensitivity.
The study also found that both types of analgesic tested --
clonidine and morphine -- were less effective in treating
pain in mice that lacked the GIRK2 protein.
The second study used the same kind of GIRK2-deficient mice
and tested their response to the analgesic effects of several
kinds of drugs, including alcohol, nicotine and cannabinoids,
which is the active ingredient in marijuana.
The researchers found the lack of GIRK2 eliminated the analgesic
effects of some of these drugs in the mutant male mice, but
not in the mutant female mice.
The combined findings of these studies indicates that the GIRK2
protein may be a critical part of the pain pathway that accounts
for gender differences in pain sensitivity and response to
analgesics. The protein may also offer a promising new target
for pain treatment.
The U.S. National Institutes of Health (news
sites) has more about pain
and pain control.
Overnight Lenses Correct Kids'
By Kathleen Doheny
NEW YORK (Reuters Health)
- Special contact lenses worn during sleep can correct vision
enough to allow nearsighted children to function during the
day without wearing either glasses or contact lenses, an Ohio
researcher reported last week at the American Academy of Optometry
meeting in San Diego.
The approach uses a rigid, gas-permeable contact lens to flatten
the cornea, temporarily correcting nearsightedness. The concept,
called orthokeratology, has been around for decades, said
Dr. Jeffrey J. Walline, a research scientist at Ohio State
University, Columbus, who led the children's orthokeratology
But the US Food and Drug Administration (news
sites) (FDA) approved an overnight lens for the temporary
reduction of nearsightedness in June 2002, granting the approval
to Paragon Vision Sciences in Mesa, Arizona for its CRT (corneal
refractive therapy) and Quadra RG lenses. The lens can be
used in both adults and children, under the device approval
granted by the FDA.
Previously, lenses for orthokeratology treatment were only
approved for daytime wear, an approach considered to be not
as convenient as overnight wear, Walline said.
Walline's study was conducted prior to the FDA approval, in
an effort to determine the safety and effectiveness of the
special lens use in children. He fit 25 children, aged 8 to
11, with the lenses and instructed them to wear the lenses
each night while sleeping. Their vision was measured regularly
for 6 months after they began the overnight wearing regimen.
Before the children started the study, they all wore glasses
to correct their vision, and all were mildly to moderately
nearsighted. "We fit them with the overnight orthokeratology
contact lenses so they would have clear vision throughout
the entire day without contact lenses or glasses," Walline
"In about 2 weeks, after wearing these lenses overnight
every night during sleeping hours, they could do without their
glasses during the day. Their vision might decline a little
at the end of the day," he added.
At the meeting, Walline reported that the 10 children who have
thus far completed 6 months of the study can make it through
the day without eyeglasses or contact lenses.
The lenses used for orthokeratology are shaped differently
than conventional contact lenses, Walline explained, allowing
them to change the shape of the cornea more quickly. The lenses
flatten the cornea so light rays focus on the retina as they
should, thus sharpening vision.
The best candidates for the approach, Walline noted, are children
with moderate nearsightedness, less than five diopters, or
roughly 20/400 vision. The FDA approval is for those with
up to six diopters, however. Nearsighted children who also
have low amounts of astigmatism (an abnormality of the eye
that results in blurred images) can also be fitted.
The first-year cost, including lenses and fittings, is about
$1,000, Walline estimates. Walline pointed out that the approach
is not a permanent remedy for nearsightedness. "We're
treating it but not curing it."
Support for the study was received from Paragon Vision Sciences,
the maker of the lenses, and a grant from the American Optometric
Association. The overnight contacts carry the same risks as
other rigid gas-permeable lenses, including a chance of corneal
swelling and corneal staining, according to the company.
Dr. Robert Davis, a practicing optometrist in Oak Lawn, Illinois
and former chair of the American Optometric Association's
contact lens and cornea section, thinks the approach will
take off, particularly for children.
"For kids involved in sports, it will be a significant
advantage," said Davis, who is studying the approach
for another manufacturer. Wearing the rigid gas-permeable
lenses, typically not as comfortable as conventional soft
lenses, poses less of a comfort problem if worn at night rather
than during the day, he said.
Recent improvements in rigid contact lens materials have made
them more comfortable and also makes the orthokeratology approach
more feasible, added Dr. Glenda Secor, a Huntington Beach,
California-based optometrist who is also studying the approach
for another manufacturer. Like Davis, she said the approach
is worth a try if children are willing to wear the lenses
"The good news is, it's not permanent," she told
Reuters Health. "The bad news is, it's not permanent."
Ex-Heavy Drinkers Show Metabolic
Monday, December 16, 2002
MONDAY, Dec. 16 (HealthScoutNews) -- Heavy drinkers who put
a cap on their boozing may actually upset their body's sodium
metabolism, which could increase their sodium sensitivity
and lead to higher blood pressure.
That odd finding comes from a study in the December issue of
Alcoholism: Clinical and Experimental Research.
Researchers studied 18 alcoholics (6 women, 12 men) who entered
in-hospital detoxification at the University of Parma in Italy.
The alcoholics' blood pressure and sodium levels were monitored
during their first eight days in hospital. During that time,
each person was on a hospital diet that provided them with
150 mM of sodium per day. That level is considered normal.
After a year of carefully monitored abstinence from alcohol,
the people in the study were given four weeks of physical
examination. That included measuring their blood pressure
levels on three different occasions.
They were then asked to stick to a diet of 55 mM of sodium
per day, which is considered a low level of sodium intake.
That was later supplemented with 205 mM of sodium per day,
for a total of 260 mM per day.
During their first eight days of withdrawal from alcohol when
they were on a normal diet, the people in the study had high
sodium levels, weight gain and an increase in blood pressure.
When checked a year later and during the subsequent changes
to their sodium intake, the people in the study had significant
changes in blood pressure and greater sodium sensitivity compared
to a group of teetotalers.
The findings indicate that salt sensitivity plays an important
role in regulation of blood pressure.
The U. S. National Institute on Aging has more about how you
can control your blood
Brain Appears to Have 'Daydreaming'
By Alison McCook
NEW YORK (Reuters Health) - Much as a car's engine hums along
even when it's parked in neutral, the brain seems to contain
a "default mode" in which certain regions become
more active at rest, US researchers report.
"During rest, these regions appear to be interacting,
because they change at similar rates," lead author Dr.
Michael D. Greicius of Stanford University in California told
Intriguingly, the behavior of these brain regions bears a certain
resemblance to what one would expect from brain areas that
make up human consciousness, Greicius added.
The default mode network supported in the current study generally
increases its activity when the brain is at rest, then drops
in activity once people are called to a certain task. In a
similar way, Greicius said, a person could be daydreaming
or following a stream of consciousness, but those activities
would be zapped away as soon as the person was called to action,
perhaps by a ringing telephone.
In addition, some of the brain regions that may form parts
of the so-called default mode network have shown in previous
studies to be involved in certain aspects of consciousness,
Greicius added. For instance, one of the brain regions looked
at in the current study, the posterior cingulate cortex (PCC),
has been shown to play a role in the brain processes by which
people recall memories. In addition, PCC activity tends to
peter out as people lose consciousness when sedated.
Given that PCC forms a part of the theoretical default mode
network, Greicius and his colleagues suggest that this network
may serve similar functions, such as involving itself in remembering
past events, mulling over information, and thinking about
Greicius cautioned in an interview, however, that the results
of the current study do not demonstrate that the default mode
does, in fact, represent the brain network involved in consciousness,
nor is it involved in any specific activity related to consciousness.
"All of this stuff is supportive, but none of it is definitive,"
During the study, Greicius and his colleagues measured brain
activity in a handful of people during different activities:
performing a mental task, passively watching a pattern on
a screen, or resting with their eyes closed. They report their
findings in the online Early Edition of Proceedings of the
National Academy of Sciences (news
The authors found that PCC and at least one other brain region
known as the ventral anterior cingulate cortex seem to show
similar rates of increase and decrease in activity in response
to what people are doing.
Greicius noted that the default mode regions continued to show
high activity while people passively watched the screen pattern--a
finding that makes sense, he said, for just because you are
looking at something, doesn't mean you can't daydream.
The current findings also demonstrate that the brain may need
to be active even when the mind is at rest, he added. "When
the car is running, the engine is still purring," Greicius
Source: Proceedings of the National Academy
of Sciences 2002;10.1073/pnas.0135058100.
Father's Drinking Predicts Kids'
By Serena Gordon
Monday, December 16, 2002
MONDAY, Dec. 16 (HealthScoutNews) -- Fathers who report consuming
a large amount of alcohol at one time are more likely to have
children who have behavioral problems and substance or alcohol
In a recent study, Minnesota researchers asked almost 2,500
dads what the maximum number of alcoholic drinks they had
ever consumed in one day was. The more the fathers reported
drinking, the greater the chance their youngsters had behavioral
problems such as attention deficit disorder or oppositional
defiant disorder, and the greater the risk the children would
become dependent on alcohol or drugs themselves.
"As the number of drinks per day went up, the likelihood
of problems increased," says Stephen Malone, lead author
of the study and a research associate with the Minnesota Twin
Family Study at the University of Minnesota.
"To some extent, the maximum number of drinks is an indicator
of the severity of dad's problems," says Malone. He explains
that while some of the fathers who reported high maximums
didn't meet the criteria for a diagnosis of alcohol dependence,
a history of having had 40, 50 or even 80 drinks in one day
certainly indicated a greater risk for dependency. Such a
high number in one day suggested a history of excessive drinking
because it's difficult to consume that much alcohol in a day
unless you have built up a tolerance for it.
The information for this study came from the Minnesota Twin
Family Study, a large study following the entire population
of twins and their parents in Minnesota. Malone and his colleagues
questioned both male and female twins and their parents for
the current study. The twins were either 11 years old (1,350
total) or 17 years old (1,076 total) at the start of the study.
They were questioned again by researchers after three years.
The researchers found the number of drinks a father reported
having in one day was associated with their children's behavioral
problems and substance-related problems for both age groups.
In the younger set of twins, the more a father reported drinking
in a day, the greater the likelihood of their children starting
to use drugs or alcohol early in life. These results were
similar for both males and females, and held true whether
the father was diagnosed as alcohol dependent or not.
Results of the study appear in the December issue of Alcoholism:
Clinical and Experimental Research.
Michael Nuccitelli, a psychologist and director of SLS Health,
a psychiatric and drug treatment facility for young adults
in Brewster, N.Y., says much of what this study says is common
sense, but it's helpful for clinicians to have it quantified.
"The higher the blood alcohol level, the more the brain
is impacted. Alcohol can make people more violent and abusive
and verbally abusive, saying things they don't mean,"
says Nuccitelli. "That would naturally increase childhood
Nuccitelli says the study proves again the impact of alcohol
abuse and consumption on child development.
"Ninety percent of all parenting is indirect. For the
first 12 years, that's where most children learn about how
to interface with the environment," he explains. "So,
if at home children see poor conflict resolution, alcohol
use and abuse, et cetera, it will have a detrimental effect."
For people who treat children and alcoholics, he says this
study gives them another good measure for identifying adults
and youngsters that are most at risk.
Malone says he suspects the results would hold true for mothers
as well; they just weren't studied this time.
What To Do
This article from Dr.Spock.com
discusses parental alcoholism and its effects on kids. Kid'sHealth
offers this article for teens on coping
with an alcoholic parent.
Jury Out on Antioxidant, Eye Condition:
By Kathleen Doheny
NEW YORK (Reuters Health) - The antioxidant lutein, promoted
by some as a way to ward off the sight-robbing condition macular
degeneration, had no more effect than a placebo in a recent
study, an Oregon researcher reported recently at the American
Academy of Optometry meeting in San Diego, California.
Dr. Diane P. Yolton, a professor of optometry at Pacific University
in Forest Grove, Oregon, and her research team randomly assigned
45 healthy young adults to take either lutein supplements
or an inactive placebo for 6 months.
Lutein is given to increase the pigment in the macula, located
in the center of the eye's retina, Yolton said.
"When you lose macular pigment, macular degeneration sets
in, is the theory," said Yolton, describing what is thought
to happen in so-called "dry" macular degeneration,
the most common type of the disease. The condition causes
a loss of central vision, making it difficult to read, drive
or perform other activities that require sharp vision.
The Oregon researchers measured pigment density in the eye
before the study and at one-month intervals throughout the
study period. But after 6 months of daily supplementation
with lutein, Yolton's team found no increase in pigment density
in the group that took supplements compared to the group that
took a placebo. However, the results may differ in those who
have the disease. It's possible that lutein may not increase
the pigment in those who have adequate amounts, but may help
those with a deficiency.
Macular degeneration can occur during middle age, according
to the National Eye Institute, but the risk increases with
age. Age-related macular degeneration (AMD) is the leading
cause of blindness in the industrialized world. Women are
thought to be at higher risk than are men, and smoking, a
family history and high cholesterol levels also increase the
risk of macular degeneration.
Yolton acknowledges that other studies have found that lutein
does boost macular pigment. "Basically, there are mixed
results out there," she said. "It looks like different
people metabolize lutein differently. When we looked at males
versus females in our study, we didn't find any differences."
But other studies have, she noted, so it is possible that men
may get more benefit from lutein than women do.
In part, Yolton said, how well lutein works to boost pigment
in the macula may depend on how much fat tissue a person has.
"Lutein is fat-soluble, so some of it gets deposited
in the fat. And so maybe in that case, there is not as much
available to the eye."
Even though her study showed no benefit to the supplements,
Yolton said she doesn't think taking the supplements would
be harmful. "Macular degeneration usually starts over
age 60," she stated. "If I had concern about macular
degeneration or a family member who had it, I would probably
start taking (lutein supplements) earlier, probably at age
Lutein is also found naturally in foods, such as spinach and
other leafy green vegetables.
Doctors Chided for Neglecting
By Ed Edelson
Monday, December 16, 2002
MONDAY, Dec. 16 (HealthScoutNews) -- The president of the American
Heart Association (news
sites) has a message for physicians:
You're not doing a good enough job of using existing tools
that can help you single out people at high risk of cardiovascular
disease and treat them appropriately.
The message is delivered in an editorial in tomorrow's edition
of Circulation. The issue is devoted to printing a
report on those tools, listed in the National Cholesterol
Education Program's Adult Treatment III Final Report.
Despite its name, the report is not limited to cholesterol
as a risk factor for cardiovascular disease. It also discusses
other major contributors -- high blood pressure, high blood
triglycerides and obesity. A combination of all of these factors
can place a person at high risk of heart disease, even if
no single one reaches a dangerous level.
"Although the formulas have been out there for a while,
very few physicians are using them to calculate them,"
says Dr. Robert O. Bonow, a professor of medicine at Northwestern
University School of Medicine and president of the heart association.
"A lot of people have a considerable risk of bad events
occurring, even though no one major risk factor is extremely
elevated. They have multiple elevations that together put
them at risk," he says.
A useful assessment tool for overall risk of cardiovascular
disease has been developed using data from the Framingham
Heart Study, Bonow says. It calculates the 10-year risk of
heart disease for men and women on the basis of age, total
cholesterol, high density cholesterol (the "good"
kind that does not clot arteries), blood pressure and cigarette
"Although the simple tool is readily available on pocket-sized
nomograms or can be downloaded onto a handheld PDA (personal
digital assistant), and takes only 30 seconds to use, many
primary-care physicians and subspecialists have yet to integrate
it into their practice," the editorial says.
Worse, Bonow says, "even some specialists are sometimes
not using this kind of approach. If they are not doing it,
a lot of primary-care physicians are not doing it."
It's not possible to calculate how many lives would be saved,
but the potential is considerable, since cardiovascular disease
is the leading cause of death in the United States. Nearly
960,000 Americans die each year of heart disease and stroke,
"Using this tool can enable a physician to determine which
people are at low risk and to stratify other people very well
to determine how aggressively they should be treated,"
The rules for calculating cardiovascular disease also can be
used by anyone to adopt a better lifestyle, he says. Among
the recommended features are reducing intake of saturated
fats to less than 7 percent of total calories, limiting dietary
cholesterol to no more than 200 milligrams a day, increasing
intake of fruits and vegetables, avoiding obesity and exercising
One problem is that American medicine focuses too much on treating
disease, rather than preventing it, Bonow says.
"We do a great job of treating patients with cardiovascular
disease; now we need to do a better job of preventing it,"
What To Do
Learn more about the risk factors for cardiovascular disease
from the American
Heart disease is the leading cause of death among American
women. The heart association has information on how
women can protect themselves.
Scan Dye May Worsen Lung Inflammation:
By Stephen Pincock
LONDON (Reuters Health) - French researchers have urged physicians
to be cautious in their use of a scanning dye in patients
with acute lung injury, as the contrast material can worsen
the condition of some critically ill patients.
Acute lung injury is a serious condition where inflammation
of the lungs causes fluid build-up, making breathing harder.
It can be triggered by a range of things, including blood
transfusion, and a severe version is called acute respiratory
distress syndrome. Doctors use CT scans to quickly assess
the lungs, often adding injecting a contrast material, or
dye, that allows better visualization of some lung problems.
Researchers from Hospital Pitie-Salpetriere in Paris performed
CT scans on 14 patients with acute lung injury--before and
after injection of contrast material.
Professor Jean-Jacques Rouby and colleagues from the hospital
found that injecting the contrast material increased the amount
of extravascular lung water, which is an indication of lung
They released their findings Monday in an online report from
the journal Critical Care.
Professor Rouby stressed in an interview with Reuters Health
that the technique has been performed safely in thousands
of critically ill patients.
"I think that in a vast majority of patients with moderate
forms of acute lung injury, the increase in extravascular
lung water resulting from the injection of contrast material
is limited and therefore not really harmful to the lungs,"
"However, it cannot be excluded that in a minority of
patients with extremely severe acute respiratory distress
syndrome, it can really deteriorate the patient's condition,"
Rouby pointed out.
"As such, the physicians should be aware of his potential
deleterious effect and limit their indications of contrast
material to what is absolutely required in patients with acute
lung injury undergoing lung CT for diagnostic purposes,"
Source: Critical Care http://ccforum.com/inpress/cc1852.
Smallpox Outbreak a Century Ago
Holds Clues for Today
By Amanda Gardner
Monday, December 16, 2002
MONDAY, Dec. 16 (HealthScoutNews) -- A bit of history has just
entered the current debate over President Bush (news
sites)'s smallpox vaccination plan. And the page from
the past could well provide a lesson for the future, experts
Even though smallpox was eradicated worldwide in 1977, there
is plenty of concern that this viral killer could come back
to haunt us in the form of a biological weapon. Knowledge
of the disease, then, is as essential now as it ever was.
With this in mind, researchers at the National Institutes of
sites) used historical records to revisit the smallpox
epidemic in Boston a century ago, in which 1,596 people fell
ill and 270 people died. Their analysis, presented in tomorrow's
issue of the Annals of Internal Medicine, found survival
was strongly related to age, vaccination status and severity
of the disease.
Specifically, in the 1901-1903 Boston epidemic, those younger
than 5 and older than 45 were less likely to live, those who
had been vaccinated, even if it was after exposure, were more
likely to survive, and those with less severe infections were
also more likely to live.
According to the article, the vast majority -- 95 percent --
of smallpox cases in the United States in the 20th century
were caused by a mild variety of the disease. The Boston epidemic,
however, was the result of a more virulent form and, consequently,
had a much higher mortality rate.
Except for patients considered too sick to be moved, all victims
of the Boston epidemic were taken to the Southampton Street
or Gallop's Island hospitals and held in isolation. The authors
of anaylsis pored through handwritten records of 243 smallpox
patients who were admitted to the Southampton Street facility
between Jan. 23 and April 2, 1902.
These records, the only surviving ones from the epidemic, were
all meticulously recorded by Dr. Irving Reed Bancroft, a 1900
graduate of Harvard Medical School (news
sites) who trained as the resident physician at the hospital
during the epidemic. The records were donated to Boston Medical
Library in 1974.
The record-keeping was an event in itself. "He did every
single one of 243 records. It's absolutely astounding,"
says Dr. Joel Breman, senior author of the study and senior
scientific advisor at the NIH's Fogarty International Center
"Plus, he was sitting in the middle of hundreds of smallpox
patients who were presenting in the most horrific way possible."
The current-day researchers based their analysis on 206 patients
for whom survival information was available. Of those, 36,
or 17.5 percent, died.
The results, Breman says, were less surprising than they were
a reinforcement of what is already known today.
Perhaps the most comforting lesson is that those who got vaccinated,
even within three weeks of being exposed to smallpox, either
did not get sick or had a much milder version.
"If you get the vaccine usually up to four to five days
after being exposed, you may not have any symptoms at all
or a very reduced case," says Gigi Kwik, a fellow at
the Center for Civilian Biodefense Strategies at Johns Hopkins
University in Baltimore. "That's the basis of the current
plan in that you would have some time to vaccinate the population."
According to the study authors, management of an outbreak today
would be much the same as it was 100 years ago, with isolation
of patients, treatment of symptoms, and selective vaccination
of medical staff, patients and anyone with whom they had come
Certainly, the modern day offers several advantages, including
improvements in treatments, regulated production and quality
of the vaccine and a more robust public health infrastructure.
And presumably a stronger concern for civil liberties.
When the Boston epidemic first started, health authorities,
in their zest to vaccinate as many people as possible, stormed
into homeless shelters and transient hotels, wrestled people
to the ground, rolled up their sleeves and jabbed them forcefully
with a needle, Breman says.
"A few people had bloodied heads," he adds.
What To Do
For more on smallpox, visit the U.S. Centers
for Disease Control and Prevention, or for information
on the President's vaccination program, check out the just-launched
New Technique to Treat Congenital
LONDON (Reuters) - British scientists said Monday they have
devised a new technique to diagnose and treat children born
with heart defects.
Called XMR, it combines magnetic resonance imaging (MRI) scans
and conventional X-rays to help treat the problem, which affects
about 25,000 babies each year in the US alone. "The new
XMR system gives us three-dimensional imaging, a way of measuring
blood flow and tells us how the heart is beating--all extremely
useful clinical information that helps us treat patients with
greater accuracy and efficiency," said Dr. Reza Razavi
of Guy's & St Thomas' Hospital in London.
Razavi is one of a team of researchers who developed and tested
the new method on 12 children with congenital heart defects.
To diagnose and treat children with the problem, doctors use
a technique called cardiac catheterisation, which involves
inserting a catheter, or tube, into an artery or vein in the
neck or leg and channeling it to the heart.
"At the moment, X-rays alone are used to guide the catheters
into and around the heart. Doctors can get a reasonable idea
of the catheter's position, but have little idea about the
shape of the inner surface of the heart where they might want
to place the catheter or other device," team member Dr.
Derek Hill said in a statement.
XMR gives doctors a three-dimensional picture of the heart
and shows how the blood is pumped through it.
"It's like being able to see a model of the house rather
than a floor plan," Hill added.
Although X-rays and MRI are used together, the scientists believe
new technology and increased expertise will enable them to
use MRI without X-rays, which have harmful side effects that
can lead to later problems.
"It's all about creating a better picture of what's going
on inside the child's heart," Hill added.
Scientists do not know exactly what causes congenital heart
defects but genetics and environment are involved. Rubella,
or German measles, and certain drugs for acne and for psychological
problems can also increase the risk of heart defects.
Combination Vaccine for Kids
Monday, December 16, 2002
MONDAY, Dec. 16 (HealthScoutNews) -- A combination vaccine
that protects children against diphtheria, tetanus, whooping
cough, polio (news
sites) and diseases that stem from the Hepatitis B virus
has been approved by the U.S. Food and Drug Administration
The Pediatrix vaccine, produced by SmithKline Beecham, includes
inoculations that are already available in the United States
as separate vaccines, the agency says. But Pediatrix cuts
down the number of shots needed in some cases from 9 to 3.
The doses are recommended for infants at ages 2 months, 4
months and 6 months.
Side effects were similar to those from the separate vaccines,
including pain, redness, swelling and fever. In clinical trials,
incidence of fever was greater among those who received the
combination vaccine than among recipients of the individual
Pediatrix should not be given to infants less than 6 weeks
old, the FDA says.
Here is the FDA Talk Paper
announcing the approval. For more information about childhood
vaccination, visit the U.S. Centers
for Disease Control and Prevention.
Filtering Office Lights Eases
By Kathleen Doheny
SAN DIEGO (Reuters Health) - Filtering fluorescent lights in
offices to produce light similar to natural sunlight reduces
workers' eyestrain, a California optometrist reported here
Thursday at an American Academy of Optometry meeting.
Eyestrain, or asthenopia, is widespread among computer users,
noted Dr. James LaMotte, an optometrist on faculty at the
Southern California College of Optometry in Fullerton, citing
information from the US National Institute for Occupational
Safety and Health.
His research team evaluated the effect of filtered light on
49 data entry workers at California State University-Fullerton,
who worked under traditional fluorescent light. They first
asked the workers to answer questions about eyestrain, then
replaced the traditional panels over the fluorescent tubes
with acrylic panels tinted to give off a more natural light.
After 2 weeks working under the filtered lights, the researchers
surveyed the workers again.
After working under the filtered lights, the study participants
reported a significant decease in eyestrain, eye fatigue,
sensitivity to light, blur with computer use, and glare or
reflections from the computer screen. There were no differences
found between the two lighting methods in workers' reports
of eye burning, itching or pain, nor headaches or energy levels.
Nearly 75% of the workers said they preferred the filtered
light to the unfiltered. "We used a prismatic panel that
is colored or dyed to absorb ultraviolet light and it changes
it to a more natural light like sunlight," LaMotte explained.
The filtering panels are available commercially, he added.
In addition to working under filtered light, computer users
who want to reduce eyestrain may also consider reducing reflection
off the computer screen by placing special deflecting shields
over the monitor, LaMotte said.
New Drug Stalls Parkinson's Progress
By Adam Marcus
Monday, December 16, 2002
MONDAY, Dec. 16 (HealthScoutNews) -- An experimental drug for
Parkinson's disease (news
sites) may buy time for people whose condition isn't severe
enough to demand more serious treatment, a new study has found.
The drug, rasagiline mesylate, can improve mood, motor control
and overall daily functioning in people in the early stages
of the degenerative condition. It frees up the production
of dopamine, a key signaling molecule that dwindles in Parkinson's
People who took rasagiline for six weeks showed significant
improvement in their scores on standard neurological tests
compared with those who took sugar pills. However, a double
dose of the drug proved no more effective than a single, one
milligram pill per day.
Between 700,000 and 1 million Americans have Parkinson's. The
disorder results from the gradual deterioration of brain cells
that respond to dopamine, which is linked to a sweeping range
of functions including motor control and cognition. Parkinson's
patients typically develop stiff movement, tremors and weakness,
and they can also become profoundly confused about even the
most trivial tasks.
The typical Parkinson's patient goes about a year after diagnosis
before needing treatment for symptoms of the disease. Until
then, experts say, simply stalling progression of the disorder
would be a significant step. A report on the findings appears
in the December issue of the Archives of Neurology.
Rasagiline is made by Teva Pharmaceutical Industries, an Israeli
company that paid for the study, which was done in the United
States and Canada. The drug, which has not yet been approved
for use in the United States, inhibits a brain enzyme called
monoamine oxidase type B (MAO-B), leading to an increase in
A previous study showed patients seem to tolerate the drug.
In the new study, researchers gave one or two milligrams a
day of rasagiline for 26 weeks to 266 men and women recently
diagnosed with Parkinson's. Another 138 received placebo tablets.
At the beginning of the study, patients in all three groups
had an average score of roughly 25 on the Unified Parkinson's
Disease Rating scale. This test gauges a person's ability
to perform daily tasks such as dressing and walking, as well
as their emotional state.
By the end of the study, the untreated group scored about four
points worse than those on either one or two milligrams of
"A four-point difference over six months is definitely
a good improvement," says study co-author Dr. Raj Pahwa,
director of the Parkinson's Disease Clinical and Research
Center at the University of Kansas. "It's not a cure,
and it's not the biggest invention yet for Parkinson's. But
it's another small step in trying to slow the disease progression."
People taking the drug were more likely than those on sugar
pills to report dizziness and nausea. However, Pahwa says
those side effects are mild and wouldn't deter him from prescribing
rasagiline if it were approved by the U.S. Food and Drug Administration
A Teva spokesman says the company hasn't submitted a new drug
application for rasagiline and doesn't have a concrete timetable
for when it would do so.
Robin Elliott, executive director of the Parkinson's Disease
Foundation, in New York City, said his group was "not
terribly excited about" the latest study.
Rasagiline is a "mildly good product" that "really
doesn't advance things so far," he added.
What To Do
For more on Parkinson's disease, try the National
Parkinson Foundation or the National
Institutes of Health.
Firefighters May Have Slightly
Higher Cancer Risk
By Alison McCook
NEW YORK (Reuters Health) - Firefighters appear to have slightly
higher rates of cancer than others, providing more evidence
that their occupation may pose health hazards even after fires
have been put out, according to researchers.
The findings are based on almost 20 years of data from more
than 30,000 male firefighters certified in Florida--the largest
study ever conducted on cancer risks in this population, study
author Dr. Fangchao Ma of the University of Miami told Reuters
However, Ma cautioned that the current study does not show
that the firefighters developed cancer as a result of their
job, only that their risk seems somewhat higher than that
seen in the general population. It's possible that lifestyle-related
factors may be responsible for the higher risk.
Reporting at the recent annual meeting of the American Public
Health Association (news
sites) in Philadelphia, Ma and his colleagues found that
firefighters appear to be more likely than others to develop
cancer--and, specifically, respiratory system and skin cancers--than
the general population in Florida.
Similar results were found when the researchers combined results
from full-time firefighters with those from an additional
30,000 volunteer firefighters in Florida.
Previous studies have shown that firefighters have slightly
higher risks of certain types of cancers, such as in the brain,
bladder and kidney. In the current study, firefighters showed
slightly higher-than-average cases of those conditions, but
the differences between their rates and those in the rest
of Florida were so small, they could have resulted from chance.
Ma told Reuters Health in an interview that, theoretically,
firefighters could be exposed to more cancer-causing agents
than others because buildings are made of a wide variety of
materials. In the case of a fire, he said, all of those materials
are incinerated and released in the air.
Ma and his team base their findings from follow-ups of all
35,777 male firefighters who were certified between the years
1972 and 1999 in Florida, which included reviewing statewide
data to see if any of them had died of cancer.
During the study period, 364 firefighters died of cancer.
Ma explained that firefighters carry a breathing apparatus
that protects them from inhaling potentially dangerous fumes,
but the device is very heavy, so many firefighters remove
it once the fire has been put out. However, after the flames
are gone, firefighters often return to a building to see if
any stubborn fires are burning, and to review the damage--"that's
when they are exposed," Ma said.
Reducing firefighters' chances of inhaling harmful chemicals
will require educating them about the need to keep their breathing
device on at all times, as well as providing them with a breathing
device that is more comfortable to wear, Ma noted.
"So you have to design something that is easy to use,"
SUNDAY, DECEMBER 15, 2002
Not to Look Your Age
By Jennifer Thomas
SUNDAY, Dec. 15 (HealthScoutNews) -- When you were young, you
baked in the sun -- and now you're paying the price.
You've noticed wrinkles around your eyes, blotchiness in your
tone, a certain sagginess around the chin and mouth.
So what's a former sun god or goddess to do?
There's lots you can do, dermatologists say. Plenty of new
treatments -- from lasers to lotions laced with vitamins and
other skin-restoring substances -- are available to help repair
sun-damaged skin and keep you looking younger whether you're
in your 20s or your 60s.
But one thing bears repeating, again and again.
The most important the thing you can do for your skin is to
limit your sun exposure and wear sunscreen, or a lotion containing
sunscreen, every day, dermatologists say. The best have a
skin protection factor (SPF) of 15 or more and contain zinc
oxide, says Dr. Min-Wei Christine Lee, a dermatologic and
cosmetic laser surgeon in Walnut Creek, Calif.
There are two types of aging. The first is caused by genetics.
As time passes, biochemical changes in the cells cause a decrease
in production of the skin's collagen and a breakdown of elastin,
the connective tissues that give skin its firmness and elasticity.
Cigarettes, by the way, contribute to this type of aging by
causing biochemical changes in skin tissue. So if you want
to keep your skin supple looking, don't smoke.
The other type of skin aging is called photo aging, which is
the major source of skin damage in most people, dermatologists
Guess what causes it? You got it. The sun.
"The earlier you start to minimize sun exposure, the better
off you'll be," Lee says. "It's a lifetime project."
Here's a rundown of how you can expect your skin to change
throughout the decades -- and what you can do about it.
In Your 20s: So, you've finally bid goodbye to pimples.
Or have you?
Women, in particular, still struggle with hormone-related acne
breakouts, most often along the jaw line and on the chin.
A mild cleanser with acne-fighting ingredients, such as salicylic
acid or sulfur, can control outbreaks, says Dr. Marianne O'Donoghue,
a dermatologist at Rush-Presbyterian St. Luke's Medical Center
This is also the decade when you may first begin to see the
subtle signs of aging. Again, the best thing you can do for
your skin at this phase of life is protect it from the sun.
In Your 30s: This is the time when you'll most certainly
see some changes in you skin.
Skin in your 30s may appear to be confused, O'Donoghue says.
"Oily one minute, dry the next," she says. She recommends
using products that are non-comedogenic, meaning they don't
have acne-producing ingredients.
She also recommends creams and lotions that contain antioxidants
such as vitamins C, E and beta-carotene that can help repair
sun damage. Lee also recommends products that contain copper,
a nutrient that can stimulate collagen production, and green
In Your 40s: The relentless aging process continues.
The skin's oil production diminishes at this age, and wrinkles
around the mouth and eyes become more apparent.
O'Donoghue recommends consulting a dermatologist about alpha
hydroxy acid, a compound that removes the outer layer of skin,
leaving you with a fresher, younger appearance.
She also recommends tretinoin, a cream that contains vitamin
A and reduces the signs of fine lines, wrinkles and age spots.
A dermatologist can prescribe it.
How much difference do these products make?
"It's not like you're going to look dramatically different
in a week or a month," Lee says. "But if you had
a twin, and one used these products and the other didn't,
you'd see a big difference 10 years down the line."
In Your 50s: In this decade, your skin may begin to lose
its plumpness and tone. This is caused by a breakdown of collagen.
You may also notice more irregular pigmentation and "age
If you haven't already, this is a good time to have your skin
looked at by a dermatologist to screen for skin cancer or
actinic keratosis, a precursor to skin cancer.
To reduce wrinkles, you can consider Botox injections, O'Donoghue
and Lee say. It's a cosmetic procedure in which a purified
version of botulinum toxin is injected into key locations
on the face to paralyze the muscles and soften crow's feet
and other facial wrinkles.
You can also consider injectable collagen therapy, in which
bovine collagen, a tissue filler, is injected into the face
to soften wrinkles and lines, Lee says.
In your 60s and beyond: At this age, your
skin may have lots of wrinkles and a loose, saggy appearance.
Still, you've got options for improving matters, if you're
willing and able to pay for them and put up with the downtime
associated with many of these procedures.
Chemical peel. A chemical solution is applied to the skin, causing
it to blister and peel off over a period of days. As the treated
skin peels off, new, fresher-looking skin replaces it.
However, Lee notes, a chemical peel makes
your new skin more vulnerable to the sun, so you have to be
extra careful if you get one.
- Dermabrasion. A procedure
that uses a rapidly rotating brush to sand off the surface
layer of skin, diminishing scars and improving the appearance
of sun-damaged skin.
- Laser skin resurfacing.
High-energy lasers emit an intense beam of light that can
vaporize skin tissue to improve wrinkles or scars. There
are many types of lasers.
A carbon dioxide laser delivers short bursts
of very high-energy light, vaporizing the undesired skin tissue
one layer at a time. CO2 lasers work well on deep wrinkles,
Erbium lasers produce energy in a wavelength
that's readily absorbed by the water in tissue cells, and
scatters the heat effects for a more superficial treatment
of sun damage or irregular pigmentation, O'Donoghue says.
Non-ablative lasers work beneath the surface
skin layer and stimulate collagen growth to make the skin
look less wrinkled, fresher and more supple. There's almost
no healing or downtime, Lee says. They differ from the other
lasers, which heat and remove skin tissue.
What To Do
To learn more about skin, aging and what you can do about it,
visit the American
Academy of Dermatology's Aging Skin Net or the American
Society for Dermatologic Surgery.
Dodge the Fat When Dining Out
SUNDAY, Dec. 15 (HealthScoutNews) -- Many people go out for
restaurant meals over the holidays, but eating out doesn't
have to mean unhealthy eating.
Appetizers, large portions and decadent desserts in restaurants
can all pose tempting dangers to people trying to maintain
a healthy diet. Wake Forest University Baptist Medical Center
offers advice on how to eat healthy when you're dining out.
Call the restaurant to find out if it offers healthy food choices
on the menu, so that you don't have to wait until you get
there to learn what's available.
Learn the cooking terminology. You should know that poached,
roasted or steamed are low-fat cooking methods. If food is
buttered, fried, escalloped or au gratin, then it contains
higher amounts of fat.
Don't be afraid to ask questions or to ask if you can make
changes to menu selections. Waiters can provide information
about the food, such as the types of sauces, low-calorie dressing
choices, and side dish options. You should feel free to ask
that particular items, such as high-fat sauces, be left off
your meal or for the waiter to bring you sherbet for dessert
instead of cake.
If a restaurant refuses to accommodate your requests, go to
another restaurant the next time you dine out.
Watch your portion size. Even if it's an unbelievable deal,
don't get the super-sized meal. In fact, you might want to
order a children's meal to get smaller portions, fewer calories
and less fat.
If you go to a fast-food restaurant, select one that offers
healthier food selections such as plain baked potatoes, chili,
salads and vegetarian burgers.
The University of Illinois has more about healthy
holiday eating away from home.
Ailments Persist in Many WTC Rescuers
NEW YORK - More than half of the 2,500 World Trade Center rescue
workers who have been screened for health problems under a
federally funded program remain sick with a variety of illnesses.
Since last spring, doctors at Mount Sinai Hospital have been
seeking out ground zero workers whose health suffered because
of the Sept. 11 terrorist attacks.
More than half of the people screened so far have been diagnosed
with persistent upper respiratory inflammation. Post-traumautic
stress disorder has also been found in more than half of the
people tested, and about 20 percent have acid reflux, or heartburn,
"These rates of abnormality are striking a year and three
months after the event," Stephen Levin, head of the hospital's
center for occupational and environmental medicine, told the
Daily News in Sunday editions. "People are coming to
us with shortness of breath, wheezing, coughing, asthma. This
is an urgent public health matter."
There have been questions about health hazards at the trade
center site since the terror attacks last year, when the collapse
of the twin towers sent dust clouds rolling through lower
The project, which was announced last May, is being financed
by $12 million in federal funding.
SATURDAY, DECEMBER 14, 2002
the Gym Before You Hit the Slopes
SATURDAY, Dec. 14 (HealthScoutNews) -- Shaping up before you
start your ski season can help you ski better and avoid injuries.
There are four basic components to downhill ski fitness, says
information from the Medical College of Wisconsin.
The first is cardiovascular fitness. Rollerblading, sideboards,
tennis and soccer are all good activities to shape up for
ski season. Not only do they provide a good cardiovascular
workout, they also feature lateral movements similar to skiing.
Flexibility is another important fitness component for downhill
skiing. Increased flexibility reduces your risk of injury.
You should emphasize improving flexibility in your hips, thighs,
groin and lower back.
You also need to do strength training, focusing on quadricep
muscles to protect your knees. You should also build strength
in your hamstring muscles, shoulders, abdomen and lower back.
Suggested exercises for downhill ski conditioning include single
leg squat, lunges, shrugs and upright rows.
Balance and agility are also vital. You can help develop those
by doing lateral box jumps and tuck jumps.
Here's where to go to find much more about ski
Medicines Not Perfect, But Useful
By Kathleen Doheny
SATURDAY, Dec. 14 (HealthScoutNews) -- When influenza strikes,
you can expect at least a week of misery, with fever, shaking,
chills, body aches and headache.
But two relatively new antiviral medicines, approved by the
U.S. Food and Drug Administration (news
sites) (FDA) in the last three years, promise to minimize
The two drugs, which require a prescription, aren't for everyone,
and they don't work if the flu has progressed too far. They're
also expensive and aren't a substitute for getting a flu shot.
But in some patients, they're worth a try, doctors agree.
Relenza (zanamivir) arrived first, approved in the summer of
1999. Later that year, the FDA also approved Tamiflu (oseltamivir
phosphate). Both are known as neuraminidase inhibitors because
they block the activity of the enzyme, neuraminidase. If not
barricaded, this enzyme breaks the bonds that hold new flu
virus particles to the outside of infected cells, allowing
new virus to be set free to infect other cells and spread
Relenza is approved to treat flu once it has occurred, and
Tamiflu can be used to treat or prevent flu -- for instance,
if one member of the household already has flu and others
don't want to catch it.
When used to treat flu, there's a somewhat narrow window of
opportunity, a fact many patients don't seem to know. The
manufacturers of both treatments say the drugs should be taken
with two days of the onset of symptoms.
Patients tend to wait too long to come in and request the drugs,
says Dr. Thomas Weida, a family physician in Hershey, Pa.,
and an associate professor of family medicine at Hershey Medical
Center, Penn State College of Medicine.
"They come in usually day 3 or day 4," Weida adds.
Even if taken within the recommended time frame, patients can
expect the new drugs to shorten their misery by only a day
and a half, says Dr. Michael Herbst, a family practice doctor
at the Les Kelley Family Health Center in Santa Monica, Calif.,
and a staff physician at Santa Monica-UCLA Medical Center.
"That's not real impressive to me," he adds.
But he concedes that it may be important to some people to
shave off that much sick time, in order to get back to work
or family responsibilities. And, of course, the drugs may
help some people feel better more quickly than that.
The relief doesn't come cheaply. A course of treatment runs
about $50 or more, Herbst says.
And the drugs, like most drugs, aren't meant for everyone.
Roche Laboratories, which makes Tamiflu, warns that the drug's
safety and effectiveness haven't been determined in people
who have chronic heart or lung disease or kidney failure.
Among its reported side effects are nausea, vomiting, diarrhea,
stomach pain, dizziness, headache and bronchitis.
And Relenza, according to a warning by its manufacturer, GlaxoSmithKline,
has caused wheezing or serious breathing problems in some
who have used it. Many of those with these side effects had
asthma or lung disease already, but not all. As a result,
the drug is not generally recommended for use on those with
Among the side effects reported with Relenza use are headache,
diarrhea, nausea, vomiting, nasal irritation, bronchitis,
sinus inflammation, dizziness and ear, nose and throat infections.
The new anti-virals attack both influenza A and B, Weida points
out. The older anti-virals, including amantadine (Symmetrel)
and rimantadine (Flumadine) only wipe out influenza A.
But Weida says that if he knows influenza A is prevalent, he
sometimes prescribes the older anti-virals, which are generally
Even with the array of anti-viral choices, Weida encourages
patients suffering from the flu to take old-fashioned measures
as well, including chicken soup. "For some reason chicken
soup helps the immune system," he says. "Theoretically,
it helps promote anti-viral activity."
He also suggests drinking lots of fluids, getting lots of rest
and washing your hands often to minimize the spread of the
flu. And if you've got flu, and you're the family cook, delegate
that task to someone else until you're not contagious.
What To Do
The U.S. Food and Drug Administration has detailed information