The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
July 31, 2003




Important Medical Disclaimer: The content displayed in Personal Health is designed to educate and inform. Under no circumstances is it meant to replace the expert care and advice of a qualified physician. Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate. Accuracy cannot be guaranteed. Personal Health assumes no responsibility for how information presented is used.

Personal Health for the Week of May 17-23


FRIDAY, MAY 23, 2003

  1. Oxygen Bars Not a Breath of Fresh Air
  2. Smoking May Speed Lung Cancer Patients' Death
  3. Gene Mutation Behind Hemochromatosis
  4. Mental Decline After Heart Bypass Not Permanent
  5. The Virus Behind the Bacteria
  6. Fungal Advice
  7. Concussion Recovery Longer for Younger Athletes

    THURSDAY, MAY 22, 2003

  8. Adderall Improves Life for Those With ADHD
  9. Lyme Disease: A Seasonal Scourge
  10. WHO Says More Money Needed to Fight Measles
  11. Chew Aspirin if You're Having a Heart Attack
  12. Laughter at Dinner Cuts Blood Sugar in Diabetics
  13. Lower Steroid Doses Effective in Severe Asthma
  14. Among Young with Breast Cancer, Blacks Fare Worse
  15. New Insights into Preventing Deadly Strokes
  16. Milk-Based Baby Formula Linked to Blood Pressure
  17. Blacks More Susceptible to Colorectal Cancer
  18. Scientist Warns Against Cancer 'Breakthrough' Hype
  19. DASH Diet Halts Hypertension
  20. Kids Who Live with Smokers Miss School More Often
  21. How Infants Say 'Ouch'

    WEDNESDAY, MAY 21, 2003

  22. Potent Pneumonia Drug Treats TB, Too
  23. Lithium Inhibits Enzyme Involved in Alzheimer's
  24. Dogs Are Pet Peeve to Asthmatic Lungs
  25. Atkins Diet Bolstered by Two New Studies
  26. More Meals Per Day May Up Men's Colon Cancer Risk
  27. Interleukin an Ally to Chemotherapy
  28. Study Links Asthma to Infants' Cockroach Exposure
  29. Backpacks Getting Bad Rap
  30. Ulcer Bug May Protect Against Cancer of Esophagus
  31. Antibacterials Not the Best Germ Fighters
  32. More Evidence Alzheimer's Vaccine May One Day Work
  33. Can a Capsule Reduce Damage From a High-Fat Meal?

    TUESDAY, MAY 20, 2003

  34. Study Doubts Risks for Children of Alcoholics
  35. Sitting for Meals May Aid Dieting, Study Finds
  36. Expectant Moms Battle Depression More Than Thought
  37. Fish May Fight Pregnancy Depression Risks
  38. Environment May Be Culprit in Childhood Asthma
  39. Exercise May Help Women's Nagging Neck Pain –Study
  40. Improving the Odds Against Rectal Cancer
  41. Colon Cancer Drug Shows Some Good Results
  42. Some Addicts' Wives May Be at AIDS Risk
  43. Smallpox Immunity Lasts Decades, Study Shows
  44. Artificial Back Discs May Come to U.S.
  45. Study: Surgery May Help Some Emphysema Patients
  46. Hormone-Drug Combo May Help Bone Density
  47. Study: Beta-Carotene Pills May Promote Colon Polyps
  48. Lung Surgery May Help Some With Emphysema
  49. Tea Compounds May Fight Bad Breath
  50. Finding Clues to Rheumatic Diseases
  51. Office Rectal Exam for Colorectal Cancer Doubted
  52. Chocolate May Extend Your Life
  53. 'Fantastic Voyage' Into Gut Nearer to Reality
  54. Hearing Aides

    MONDAY, MAY 19, 2003

  55. 'Electronic Nose' Sniffs Out Lung Cancer: Study
  56. New Back Discs Move Closer to U.S. Use
  57. Scientists Develop First 'Knock-Out' Rat
  58. Physical Therapy Can Help Reset Brain
  59. New Treatment Option for Advanced Breast Cancer
  60. Eat As I Eat
  61. Couric's Group Launches Free CD-ROM on Colon Health
  62. Uncovering Clues to Cancer
  63. Head Injuries May Hike Risk of Parkinson's Disease
  64. In Need of TLC
  65. Asian Americans at High Risk for Hep C Liver Cancer
  66. Tracking Down Endometrial Cancer
  67. Light Drinking May Keep Colon Polyps at Bay: Study
  68. Farm Kids Less Likely to Have Allergies
  69. Exercise Linked to Lowered Risk of Gallstones
  70. Racial Disparity Shown in Breast Cancer Treatment
  71. Study: Defibrillators Need Not Cause Painful Shocks
  72. Cancer Drug's Heart Risk Underestimated
  73. Snoring Kids at Risk for Learning Problems
  74. Depression Can Forewarn of Alzheimer's Disease
  75. Flatulence Test Sniffs Out Gut Bugs
  76. Prescription Arthritis Painkillers Not Worth Price
  77. Listerine Strips Don't Kill All Mouth Germs: Study
  78. Genentech Colon Cancer Drug Extends Life

    SUNDAY, MAY 18, 2003

  79. How to Prevent Tennis Elbow

    SATURDAY, MAY 17, 2003

  80. Take the Offense Against Lyme Disease
  81. Joint Efforts


FRIDAY, MAY 23, 2003

Oxygen Bars Not a Breath of Fresh Air

By Jennifer Thomas
HealthScoutNews Reporter
Friday, May 23, 2003

FRIDAY, May 23 (HealthScoutNews) -- Oxygen bars made their big-city debut during the flash and sizzle of the Clinton administration.

Now, customers pay through the nose to breathe scented, purified, highly oxygenated air in nightclubs and day spas in cities big and small, from Sacramento, Calif., to Ann Arbor, Mich., from Las Vegas to Asheville, N.C. The average price per minute of air: about $1.

But critics -- and there are many -- wish oxygen bars would go the way of the Y2K bug and 21-year-old dot-com millionaires.

They say there are no medical studies that show breathing oxygen in the manner it's dispensed at oxygen bars has any health benefits whatsoever. And too much oxygen, especially for people with certain medical conditions, can be harmful.

"Based on our understanding of the science, it's very hard to believe that the oxygen used in oxygen bars can be of any benefit," says Dr. Norman Edelman, consultant for scientific affairs with the American Lung Association and vice president for health sciences at Stony Brook University in New York.

"And we also want to caution people that breathing pure oxygen for extended periods of time can cause respiratory problems," Edelman adds.

But oxygen bar proprietors such as Lisa Hinchey shrug off the criticism.

She runs the 2202 Oxygen Bar and Organic Cafe in San Francisco. "Doctors don't want you to do it because it takes money away from them. It detoxifies your blood cells, it gives you more stamina, it gives you pure, fresh energy, not like caffeine energy," she says.

Hinchey says she breathes the oxygen at her bar for 40 minutes, three times a week.

"I feel really good and relaxed," she says. "I sleep more soundly. I wake up more happy, it lifts up my spirit, it rejuvenates me. I'm more at peace with oxygen in my bloodstream."

She says her clients include marathon runners, students preparing for their SATs, even older couples before they have sex.

Oxygen bars first appeared in Japan, Mexico and South America, where concerns about air pollution lead to an interest in breathing purified air, says Dr. Ron Balkissoon, a pulmonologist at the National Jewish Medical and Research Center in Denver.

By the late 90s, oxygen bars began appearing in major U.S. cities. Actor Woody Harrelson, best known for his role as the dim-witted bartender on the sitcom Cheers, opened one of the first on the Sunset Strip in Los Angeles.

Then the U.S. Food and Drug Administration (news - web sites) got wind of what was going on. Under the Federal Food, Drug and Cosmetic Act, any type of oxygen that's "used for breathing and administered by another person is a prescription drug," according to a recent article in the FDA Consumer magazine.

That means oxygen bars violate FDA regulations. Still, the agency leaves enforcement up to each state licensing board. "Many states choose to allow oxygen bars; others discourage the businesses by requiring strict compliance with the law," according to the article.

No matter if those rules are enforced or not, there's one thing oxygen bar owners can't do in any state -- make claims that oxygen can treat or cure illnesses.

To stay out of trouble, most oxygen bar owners avoid those claims, Balkissoon says. Instead, they say oxygen helps you relax, reduces stress, increases energy or alertness, and promotes general feelings of well-being.

But there's no medical evidence that says any of this is true, Balkissoon says.

Besides, all the oxygen that healthy people need is right under their nose.

Air normally contains about 21 percent oxygen. At an oxygen bar, customers typically breathe the oxygen through a cannula, a two-pronged tube that fits loosely in the nostrils.

While the air coming out of the cannula might be nearly 100 percent oxygen, the person inhaling it will probably breathe from 50 percent to 75 percent oxygen because they're still inhaling some room air, Balkissoon says.

If that sounds super healthy, think again.

In a healthy person, the hemoglobin in blood that transports oxygen is already 98 to 99 percent saturated with oxygen. Upping it another percentage point by breathing highly oxygenated air will have "absolutely no physiological effect," says Balkissoon. "Any extra oxygen gets exhaled right back out. Your body can't hold onto it."

And while it probably would not happen in an oxygen bar, too much oxygen can be toxic. Excess oxygen can increase the production of free radicals, which can damage tissues and kill cells, he says. Over time, this can hinder brain, heart, lung, muscle and memory function.

Complications of excessive oxygen can also include pulmonary edema, or fluid on the lungs.

There are other concerns. Some oxygen bars used scented air in flavors ranging from eucalyptus to raspberry to mint.

If the scent is oil-based, it's possible that tiny droplets of oil can be inhaled into the lungs, leading to a type of pneumonia called lipoid pneumonia, Edelman says.

People with emphysema or other chronic pulmonary obstructive disease should definitely stay away. For people already oxygen-compromised, breathing in too much oxygen can actually suppress their drive to breathe, Balkissoon says.

This can cause a buildup of carbon dioxide in their lungs, he says.

Finally, if you see an oxygen bar in a nightclub where people smoke, stay away, Balkissoon says. Oxygen feeds fires. "If you have any kind of a flame, and it comes into contact with pure oxygen, the flame will get bigger and bigger," he says. "They could blow up the bar."

More information

Read more about oxygen bars at the National Jewish Medical and Research Center. The American Lung Association has more on how oxygen supplementation is used for people with certain lung diseases.

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Smoking May Speed Lung Cancer Patients' Death

Reuters Health
Friday, May 23, 2003

NEW YORK (Reuters Health) - Smokers who continue to puff away even after a lung cancer diagnosis seem to die more quickly than smokers who quit during cancer treatment, new study findings suggest.

The study looked at patients with small cell lung cancer, which accounts for about one quarter of all newly diagnosed lung cancers. Most cases are only identified after the cancer has spread to distant sites such as the brain and liver. Patients typically live for only a matter of months after diagnosis, and few survive two years or more.

It is well known that smoking causes cancer, and previous research has suggested that people with cancer who continue to smoke during treatment tend to do more poorly, according to a team led by Dr. Gregory M.M. Videtic of Brigham and Women's Hospital in Boston, Massachusetts.

However, the effect of continued smoking on people being treated for small cell lung cancer is less certain, the researchers point out in a report in the Journal of Clinical Oncology.

To investigate, Videtic's team reviewed the medical records of 186 people with small cell lung cancer who underwent chemotherapy.

The researchers found that the average survival for former smokers was 18 months compared to 13.6 months for those who smoked during their treatment.

The researchers ruled out other characteristics, such as age and sex, or differences in treatment, as a cause of the survival difference.

"We conclude that (small cell lung cancer) patients who are offered (chemotherapy) as definitive management of their disease are at risk if they continue to smoke while receiving treatment," the authors write.

As such, the authors recommend that physicians ask their patients about their smoking status before beginning treatment and make suggestions about how they can kick their habit.

Source: Journal of Clinical Oncology 2003;21:1544-1549.

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Gene Mutation Behind Hemochromatosis

Friday, May 23, 2003

FRIDAY, May 23 (HealthScoutNews) -- German and American researchers have linked a gene mutation in the liver to hemochromatosis, a disease that causes a person's intestine to absorb too much iron.

If left untreated, the condition can lead to an overload of iron in the body, which can result in heart disease, liver cancer or other fatal conditions.

This study offers new information about how hemochromatosis develops.

"The mutation that causes the disease was thought to have its major effects in the intestine, where cells absorb iron from food. Our current study has changed that picture," researcher Martina Muckenthaler, of the European Molecular Biology Laboratory in Heidelberg, says in a news release.

People with hemochromatosis have inherited a defective copy of a gene called Hfe from each parent. This gene mutation can be traced back several centuries in Celtic history, where it originated in a single person who passed it down to descendents.

The disease has now spread to become the most common inherited disease in the Western world, affecting about one in every 250 people.

The study appears in a recent issue of Nature Genetics.

More information

Here's where you can learn more about hemochromatosis.

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Mental Decline After Heart Bypass Not Permanent

Friday, May 23, 2003

FRIDAY, May 23 (HealthScoutNews) -- Cognitive problems experienced by many people after they have coronary artery bypass surgery are mostly temporary, says a study by researchers at Johns Hopkins Medical Institutions.

More than two thirds of people who have coronary artery bypass surgery suffer a decline in their ability to think, remember and learn. They may also be slower at such tasks as writing and drawing immediately after the surgery.

The Johns Hopkins researchers found these mental effects are mostly reversible and generally last for no more than three months. The study appears in the May issue of The Annals of Thoracic Surgery.

The study compared 140 people who had coronary artery bypass surgery with 92 people with coronary artery disease who didn't have the surgery. The researchers found no differences in cognitive function between the groups when the surgery patients were tested three months and a year after their surgery.

The tests included measures of attention, learning and memory, spatial abilities and speed of processing.

The researchers plan to follow the study volunteers for three to five years to determine whether the people who had coronary artery bypass surgery suffer any long-term cognitive effects compared to those who didn't have the surgery.

More information

Here's where you can learn more about heart bypass surgery.

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The Virus Behind the Bacteria

Friday, May 23, 2003

FRIDAY, May 23 (HealthScoutNews) -- A virus that infects and destroys bacteria may be responsible for spreading strep and some other infectious diseases.

That's the conclusion of a Rockefeller University study in the June issue of the journal Infection and Immunity.

This bacteria-eating virus, called a bacteriophage, causes disease by transferring toxins and other disease-causing genes between bacteria, the study found.

It's the first research to show that bacteriophage -- previously believed to not be infectious to humans -- could offer a new target for scientists trying to develop ways to combat certain bacteria that produce toxins.

The study author suggest that controlling the bacteriophage, also known as phage, may be as important as controlling the bacteria.

"It's possible that phage present in the saliva of a child or another individual can cause the conversion of an existing non-toxigenic organism to a toxigenic one. We always believed that phage were not infectious to humans, but in a sense they are," senior author Vincent A. Fischetti says in a news release.

Humans are able to carry colonies of bacteria -- such as strep -- without becoming sick as long as the microbe doesn't carry a toxin-encoded phage. But a harmless microbe can be converted into a virulent bug when a toxin-producing phage moves into the previously benign microbe.

More information

Here's where you can learn more about strep infections.

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Fungal Advice

Friday, May 23, 2003

(HealthScoutNews) -- Foot fungus isn't very serious, but it can be annoying.

So here are some general recommendations from the dermatology department at the Tokyo Medical and Dental University for avoiding athlete's foot:

  • Since most cases of foot fungal infections come from public showers, the first thing you should do is wipe the soles of your feet carefully with a towel. Then wash your feet with soap and water.
  • Next, take 100 steps on a clean mat.
  • Finally, hold your feet in the air for one hour (yes, you're allowed to sit down while you do this).

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Concussion Recovery Longer for Younger Athletes

Friday, May 23, 2003

FRIDAY, May 23 (HealthScoutNews) -- Younger athletes take longer to recover from a sports-related concussion, says a University of Pittsburgh study in the May 19 issue of the Journal of Pediatrics.

The study, the first to examine age as a factor in sports concussion recovery, found high school athletes with concussions suffered prolonged memory problems that required longer recovery times compared to college athletes.

The finding supports the idea that high school athletes with concussions need more conservative management and comprehensive assessment. The study may also have important implications for guidelines about when high school athletes who've suffered a concussion can return to play.

The researchers compared post-concussion recovery of high school and college athletes at 24 hours, three days, five days and seven days after the concussion. In tests of self-reported symptoms and neurocognitive function, the high school athletes had much worse memory performance at seven days after concussion than age-matched control subjects.

Despite sustaining more severe injuries, concussed college athletes at three days after injury showed memory performance similar to age-matched control subjects.

"Our finding that high school athletes did not recover from concussion as quickly as college athletes is a cause for concern because the largest majority of at-risk athletes are at the high school level or below," principal investigator Dr. Melvin Field says in a news release.

"Furthermore, existing return-to-play guidelines assume a standard use for all age groups and levels of play, from school-age to professional. Our study is the first to suggest that there may be differing vulnerabilities to concussion at different ages and that current guidelines may not be appropriate for all age groups," Field says.

Recent studies show more than 62,000 concussions occur each year in high school sports in the United States. Football accounts for 63 percent of those concussions.

More information

Here's where you can learn more about concussion.

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THURSDAY, MAY 22, 2003

Adderall Improves Life for Those With ADHD

Thursday, May 22, 2003

THURSDAY, May 22 (HealthScoutNews) -- The quality of life for children with attention-deficit/hyperactivity disorder (ADHD) improves with long-term use of a once-daily stimulant called Adderall XR.

The results of this, the largest ADHD clinical trial to date, were presented May 21 at the American Psychiatric Association annual meeting in San Francisco.

The seven-week, open-label study included 2,900 children previously treated with a stable dose of ADHD medication, either methylphenidate HC1 or another methylphenidate product or a mixed salts amphetamine product.

After they were switched to once-daily Adderall XR, the children showed better symptom management and significant improvement in their quality of life as measured on the 23-item Pediatric Quality of Life Inventory, the study says.

"This largest study ever of ADHD patients establishes the significant improvements that treatment with the once-daily mixed salts amphetamine medication brings in decreasing symptoms. Such symptom control allows children to functionally improve and participate in life, such as engage in sports, get along with other kids, or help with chores," lead investigator Dr. Paul J. Ambrosini, a professor of psychiatry at Drexel University College of Medicine in Philadelphia, says in a news release.

In a separate study, researchers at the University of North Carolina at Chapel Hill found adults with ADHD treated long-term with an extended-release mixed-salts amphetamine medication maintained significant symptom improvement.

The study of 248 adults with ADHD was also presented May 21 at the American Psychiatric Association annual meeting.

"ADHD is not just a childhood disorder. While hyperactivity may sometimes diminish by adulthood, inattention and impulsivity often remain," researcher Dr. Richard Weisler, adjunct professor of psychiatry, says in a news release.

"Our findings suggest that, as in children with ADHD, adults who have this condition can benefit from treatment with this product. This medication can significantly improve adults' ADHD symptoms and, subsequently, their ability to work, socialize and be more productive in everyday activities," Weisler says.

More information

Here's where you can learn more about ADHD.

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Lyme Disease: A Seasonal Scourge

By Dennis Thompson Jr.
HealthScoutNews Reporter
Thursday, May 22, 2003

THURSDAY, May 22 (HealthScoutNews) -- It's been more than 30 years since scientists first identified the tick-borne illness now known as Lyme disease.

While much has been learned about this rarely fatal condition that can cause chronic physical pain and mental distress, questions remain.

And because May is Lyme Disease Awareness Month, doctors and medical activists are spreading the word about the disease and how people can avoid it.

Lyme disease is caused by the bacterium Borrelia burgdorferi, according to the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC). These bacteria are transmitted to humans through the bite of infected deer ticks and cause more than 16,000 infections in the United States each year.

Lyme disease was discovered in 1977 when arthritis was observed in children in and around Lyme, Conn.

People with Lyme generally have a rash in the shape of a bulls-eye at the site of infection, and they also can suffer from such symptoms as fever, malaise, fatigue, headache, muscle aches and joint aches, the CDC says. The incubation period from infection to the onset of the rash is typically seven to 14 days but may be as short as three days and as long as 30 days.

If left untreated, more dire symptoms can arise: arthritis, including intermittent episodes of swelling and pain in the large joints; neurologic abnormalities, such as aseptic meningitis, facial palsy, motor and sensory nerve inflammation and inflammation of the brain; and, rarely, cardiac problems, such as an enlarged heart or acute inflammation of the tissues surrounding the heart, federal health officials say.

Some doctors believe the disease also can affect people's rational mind.

"If people have neurologic Lyme, it directly affects their emotions and moods," says Dr. Lesley Ann Fein,a New Jersey doctor who specializes in the disease.

Because there are so many symptoms, and because only 60 percent to 80 percent of sufferers develop the telltale "bulls-eye" rash, Fein believes many people are infected with Lyme but remain undiagnosed. She says efforts are under way to establish a national committee that would set up clearer guidelines for diagnosis and treatment of the disease.

Antibiotics provide the only effective treatment for Lyme disease, says Fein and Tom Forschner, executive director of the non-profit Lyme Disease Foundation. Other drugs can be used to treat related symptoms, but antibiotics kill off the bacterium that causes Lyme.

However, there's disagreement among doctors regarding how long antibiotic treatment should last.

"There is no definitive test to tell us the bacteria is gone, so there's no end point for treatment everyone can agree on," Forschner explains. Some doctors believe antibiotic treatment should last two to four weeks, while others will extend it for several months, he says.

Early stage Lyme disease is typically treated with the antibiotics doxycycline or amoxicillin for three to four weeks. Later-stage Lyme, particularly with "neurologic manifestations," may require intravenous treatment with ceftriaxone or penicillin for four weeks or more, depending on the severity of the symptoms, the CDC says.

Lyme disease is mostly found in northeastern and mid-Atlantic states; states in the upper north-central region of the country; and several counties in northwestern California. Ninety-two percent of cases reported to the CDC in 1999 -- the most recent numbers available -- came from Connecticut, Delaware, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island and Wisconsin.

Forschner says that since Lyme disease can be spread by ticks that cling to birds, migration patterns provide a clue to what areas are at risk. "Basically the ticks go the same place birds go during migration," Forschner says.

The best way to avoid Lyme disease is to avoid areas likely to be infested with ticks, particularly in spring and summer. Ticks favor a moist, shaded environment, especially wooded, brushy or overgrown grassy habitats.

If you're going to be in an area that's likely infested with ticks, wear light-colored clothing so ticks can be spotted more easily and removed before becoming attached. Wear long-sleeved shirts and tuck your pants into socks or boot tops to keep ticks from reaching your skin.

When you come in from outside, perform a tick check on yourself. Run your hands through your hair, and thoroughly inspect your body. Since transmission of the disease is not immediate, removing an attached tick as soon as possible will more than likely keep you from contracting Lyme.

"If you find an attached tick that's engorged, call your doctor so you can get treated," Forschner says. "If it's had a chance to feed, it's had a chance to infect."

Attached ticks should be removed using fine-tipped tweezers. Grasp the tick firmly at its mouthparts, as close to your skin as possible. With a steady motion, pull the tick's body away from the skin. If the tick's mouthparts remain in the skin, don't be alarmed. The bacterium that causes Lyme is contained in the tick's midgut or salivary glands. Then cleanse the area with an antiseptic, health experts advise.

More information

To learn more about Lyme disease, visit the Centers for Disease Control and Prevention or the National Institutes of Health.

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WHO Says More Money Needed to Fight Measles

Reuters Health
Thursday, May 22, 2003

NEW YORK (Reuters Health) - More than 770,000 children died from measles in 2000, international health experts said Thursday, and the World Health Organization (news - web sites) (WHO) is asking for more money to fight the disease in developing nations.

Inadequate vaccination in the regions where most of these deaths occur, the new report suggests, is due to insufficient internal and international investment in the health infrastructures and vaccination programs of poorer countries.

As such, a resolution to the World Health Assembly, on Saturday, will ask countries to "contribute actively" to achieve United Nations (news - web sites) goals for cutting childhood measles deaths worldwide, the WHO said in a press release.

The WHO and the U.N. Children's Fund estimate that an additional $200 million will be needed to implement a comprehensive measles strategy over the next three years in the 45 countries that account for nearly all measles deaths globally.

Measles is a respiratory disease caused by a virus, with symptoms including rash, fever, cough and a runny nose. In some cases, the infection causes serious complications such as pneumonia or brain inflammation, and is sometimes fatal. However, measles vaccination -- given routinely in developed nations -- usually provides lifelong immunity against the disease.

A dose of measles vaccine costs only 25 cents, which includes the equipment to provide a safe injection, according to the WHO.

Nevertheless, about 777,000 children died from measles worldwide in 2000, researchers from the WHO and elsewhere report in the May 23rd issue of the Morbidity and Mortality Weekly Report.

Of these deaths, 58 percent occurred in Africa and 26 percent in Southeast Asia.

"The measles deaths occurred overwhelmingly among children living in poor countries with inadequate vaccination services," the researchers write.

"To prevent these deaths, stronger political commitment is needed to provide all children worldwide with two opportunities for measles immunization."

In 2000, measles was the fifth-leading cause of death worldwide among children younger than 5, according to the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC).

"Like human immunodeficiency virus (HIV (news - web sites)), malaria, and tuberculosis, measles can be considered a disease of poverty," the CDC notes in an editorial published with the report.

"However," the agency adds, "unlike these diseases, measles can be prevented through vaccination."

Source: Morbidity and Mortality Weekly Report 2003;52;471-475.

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Chew Aspirin if You're Having a Heart Attack

Thursday, May 22, 2003

(HealthScoutNews) -- Experts advise that if you think you're having a heart attack, the first thing you should do is chew an aspirin tablet.

But because aspirin starts to break up as soon as it touches your tongue, why chew it instead of swallowing it?

Here's why, according to the American Journal of Cardiology. Researchers at the University of Texas Southwestern Medical School recruited 12 volunteers and measured the length of time it took for the aspirin to inhibit blood clotting, which is the reason to take it after a heart attack.

They found that swallowing a whole aspirin takes 12 minutes to have any effect on your blood's clotting time; drinking a liquid remedy containing aspirin takes seven minutes to work, but chewing a regular aspirin tablet begins showing benefits in only five minutes.

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Laughter at Dinner Cuts Blood Sugar in Diabetics

By Alison McCook
Reuters Health
Thursday, May 22, 2003

NEW YORK (Reuters Health) - A small study shows that diabetics (news - web sites) may be better able to process the sugar they consume during meals if they order a side of laughter with their food.

Laugh if you will, but a group of researchers in Japan found that people with type 2 diabetes -- the most common form of the disease -- had a smaller rise in post-meal blood glucose (sugar) when they watched a comedy show than when they listened to a humorless lecture.

The researchers, led by Dr. Keiko Hayashi from the University of Tsukuba, also found the same results in people without diabetes.

Poorly controlled blood sugar can increase the risk of diabetes complications such as heart disease, kidney failure and blindness.

Hayashi told Reuters Health that people with diabetes have a lot to worry about -- diet, exercise and keeping their glucose and insulin levels in check. And stress is known to increase the risk of elevated blood glucose, the researcher noted.

"If positive emotion such as laughter reduced blood glucose, both patients and medical providers would recognize the importance of it, and it would improve their mental health" and quality of life, Hayashi said.

"We should laugh more," the researcher added.

Plenty of studies have shown that laughter can combat many common ills. For instance, research suggests that humor may lower blood pressure and release endorphins.

Laughter is also thought to improve circulation, stimulate the nervous system, heighten the immune system and make the heart stronger.

All of the diabetic patients included in the study had type 2 diabetes, which occurs when the body fails to respond to insulin, the hormone that clears the blood of sugar after a meal and deposits it into cells to use for energy.

During the study, reported in the May issue of the journal Diabetes Care, Hayashi and colleagues measured the blood glucose levels of 19 diabetics and five non-diabetics before and after they ate the same meal, on two separate days.

On one day, participants listened to a 40-minute lecture, which the researchers describe as "monotonous" and "without humorous content." On the second day, participants were included in an audience of 1,000 people who watched a Japanese comedy show.

At the end of the show, "most" participants "considered that they laughed well," the authors note.

The researchers found that post-meal blood glucose levels were higher after the boring lecture than after the comedy show, in diabetics and non-diabetics alike.

Hayashi noted that the reasons why laughter might reduce blood glucose are not clear, but suggested that laughter could increase energy consumption by working the abdominal muscles.

Alternatively, the researcher said, laughter might affect the neuroendocrine system, which controls glucose levels in the blood.

Source: Diabetes Care 2003;26:1651-1652.

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Lower Steroid Doses Effective in Severe Asthma

By Ed Edelson
HealthScoutNews Reporter
Thursday, May 22, 2003

THURSDAY, May 22 (HealthScoutNews) -- Doses of inhaled steroids for patients with chronic, severe asthma can be reduced sharply to cut the risk of side effects while still keeping the condition under control, a Scottish study shows.

This is the first carefully controlled trial to show that this "stepdown" approach works in chronic, severe cases of asthma, says a report in the British Medical Journal.

"Patients with more severe asthma who require high doses of inhaled steroids account for approximately 15 percent of all asthmatics," says Dr. Neil Thomson, professor of respiratory medicine at the University of Glasgow, leader of the study. "This is the group we studied."

Inhaled steroids are the recommended treatment for chronic asthma, but they are accompanied by a number of side effects, including weakened bones and eye problems, such as cataracts and glaucoma. Obviously, doctors prefer to keep dosage at a minimum.

The study included 259 adult asthma patients with symptoms severe enough to require high steroid doses, an average of 1,400 micrograms a day of beclomethasone, a commonly used drug, or equivalent amounts of other steroids. After a month of data gathering, 130 patients began taking half the previous dose, while 129 continued their old dosage. As is common in such controlled studies, none of the patients knew what they were taking.

After a year, the researchers say, the treatment results were essentially the same for the two groups, with 109 of the 130 reduced-dose patients and 105 of the 129 higher-dose patients meeting the criteria for good control.

"It should therefore be possible for a substantial proportion of patients receiving inhaled corticosteriods at high dose to reduce their doses, thereby reducing the risk of side effects while maintaining control," the researchers write. No record was kept of side effects.

The study is a welcome reminder that doctors treating asthma patients should look toward reducing steroid dosage, says Dr. John J. Costa, assistant clinical professor of medicine at Harvard Medical School (news - web sites), and a spokesman for the American Academy of Allergy, Asthma and Immunology.

Often, asthma patients go to their doctors when the disease flares up, and doses are prescribed to bring things back to normal, he says.

"The importance of this paper is to remind practitioners that when they see asthmatics and decide that a certain amount of medicine is needed to address what is going on at that moment, once stability is achieved, it may not be the amount of medicine needed when the patient in not in the middle of a flare-up," Costa says.

Asthma specialists usually ask a patient to make a follow-up appointment, but patients often don't, he says. "So many patients might be treated on the assumption that if you don't hear from them, they are doing OK," Costa says. "The doctor should follow up to see if it is possible to reduce the dosage."

More information

You can learn almost anything you need to know about asthma from the National Institute of Allergy and Infectious Diseases or the American Academy of Allergy, Asthma and Immunology.

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Among Young with Breast Cancer, Blacks Fare Worse

Reuters Health
Thursday, May 22, 2003

NEW YORK (Reuters Health) - Among women with breast cancer (news - web sites) who are younger than 65, black women do not survive as long as whites, researchers report.

In contrast, their study found race had little bearing on survival among older women with the disease.

Taken together, these findings suggest that a racial gap in treatment exists for younger U.S. women with breast cancer that is narrowed among older patients, possibly due to Medicare coverage, according to the study's authors.

Their findings add to a growing body of evidence that suggests breast cancer treatment, and possibly outcomes, are inferior for African-American women.

To assess the effect of race on breast cancer outcomes, Dr. Kenneth C. Chu, from the National Cancer Institute (news - web sites) (NCI) in Bethesda, Maryland, and colleagues analyzed data from a registry of breast cancer cases in 11 U.S. regions from 1992 to 1999.

Overall, six-year survival rates were lower for black women than for white women, the investigators report in the June 1st issue of Cancer.

However, the results were somewhat different when the researchers took into account a couple of factors -- the type of treatment women received and whether their tumors were dependent on estrogen to grow.

In this analysis, only black women younger than 50 whose tumors were responsive to estrogen and black women younger than 65 whose tumors were not estrogen-dependent had significantly lower survival rates than their white counterparts.

But in every age group, black women were less likely to be diagnosed with early, stage I cancer, the authors report.

The results suggest there is a need for "more early diagnosis of breast (cancer) for black females," and for a "focus on racial differences in treatments for younger black females," Chu's team writes.

"In addition, the racial differences in stage (at diagnosis) indicate that black females of every age need to focus more on early diagnosis."

Experts recommend that women have a yearly mammogram to detect early breast cancer, starting at age 40. Women at higher-than-average risk due to factors like family history should talk to their doctors about when and how often they should be screened for the disease.

Source:Cancer 2003;97:2853-2860.

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New Insights into Preventing Deadly Strokes

By Ed Edelson
HealthScoutNews Reporter
Thursday, May 22, 2003

THURSDAY, May 22 (HealthScoutNews) -- They're called subarachnoid strokes, and they're about as deadly as strokes come.

They also tend to strike young and middle-aged adults. Yet, new research shows they can be prevented.

Fifty-five thousand to 60,000 Americans suffer a subarachnoid hemorrhage each year, and 40 percent to 50 percent of them die, half within two days of the attack.

"Most subarachnoid hemorrhages in young and middle-aged people are preventable," says Dr. Joseph P. Broderick, chairman of the department of neurology at the University of Cincinnati. He's also leader of the study that appears in the May 23 issue of Stroke.

The key to prevention: "People have to change their behavior," Broderick says.

To determine which behavior changes are most important, Broderick and his colleagues questioned 312 young and middle-aged men and women who had suffered these hemorrhages between 1994 and 1999. They asked about lifestyle and other factors that could be related to the risk of such strokes. Then the researchers compared the answers with those of 618 similar people who had not had such strokes.

One risk factor that stood out was family history. The risk was 3.8 times higher for people with a close relative who had had a subarachnoid stroke, compared to those without such a family history.

Another culprit, to no one's surprise, was smoking. Two-thirds of the stroke patients were smokers, compared to 30 percent of the healthy people.

"It should be emphasized that current cigarette smoking is the most important modifiable risk factor," says Dr. Thomas Brott, a professor of medicine at the Mayo Medical School in Jacksonville, Fla., and a member of the research team.

Another common risk factor was one that's behind most cardiovascular disease: high blood pressure. People with the condition had 2.39 times the normal risk of subarachnoid hemorrhage.

Diabetes and high blood cholesterol, two other familiar cardiovascular risk factors, don't seem to play a role in subarachnoid hemorrhage, the study indicates.

But drug use might. The numbers are small, but it's significant that three of the stroke patients reported cocaine use, while none of the healthy people did, Broderick says.

One unexpected finding was that the stroke risk was higher for thin people -- a low body mass index (23 or lower) was associated with a 50 percent higher risk of subarachnoid hemorrhage. "The association was strongest among four-pack-a-day smokers, so this might be an indirect effect of smoking," says Brott, noting that heavy smoking can keep people thin.

You can't change family history, the leading risk factor, Broderick says. So for those with such a history, he says, "it becomes more critical and more important to make lifestyle changes."

Those changes should include controlling blood pressure, Brott says. Just last week, the American Heart Association (news - web sites) issued new guidelines that say any reading between 120/80 and 139/89 is now considered "prehypertensive;" previously that was considered within the normal range.

Broderick says a genetic-based effort to identify people who might be at especially high risk of subarachnoid stroke has begun. "We're trying to identify genes that are related to high risk," he says. "Any results are probably a couple of years away."

More information

To learn more about preventing a stroke, visit the American Heart Association or the National Institute of Neurological Disorders and Stroke.

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Milk-Based Baby Formula Linked to Blood Pressure

By Maggie Fox
Thursday, May 22, 2003

WASHINGTON (Reuters) - Babies fed a dairy-based formula grew up to have higher blood pressure than babies who were breast-fed, British researchers reported on Thursday.

Their study, published in the American Journal of Clinical Nutrition (news - web sites), supports several others that show substituting cow's milk for breast milk might promote heart disease later in life.

The American Academy of Pediatrics says mothers should breast-feed babies for at least a year and longer if possible, while the World Health Organization (news - web sites) says two years should be the minimum.

Babies who get breast milk are healthier, less likely to become obese and may have better brain function, studies have shown. Infant formula manufacturers have taken note and regularly adjust their formulas to more closely resemble human milk.

But in the 1970s, formulas were based on dried cow's milk, and breastfeeding was out of fashion in countries such as the United States and Britain. Richard Martin of the University of Bristol and colleagues followed up on babies first studied between 1972 and 1974.

Now in their 20s, those who were fed the most cow's-milk formula were taller but had the highest blood pressure, Martin's team found. High blood pressure can lead to heart disease and stroke.

It could be that the high sodium content of cow's milk affects the development of young babies, the researchers said. It might also be that cow's milk is higher in fat and calories overall, and overfed babies -- especially those who gain weight too rapidly early in life -- are prone to obesity and heart disease later in life.

More-subtle factors could also be at work, they said.

"Mothers in the United Kingdom who breastfeed are likely to be better educated and to encourage healthier eating habits for their children than are mothers who do not breastfeed," the researchers write in the report.

Fortified cow's milk is an important source of calcium and vitamin D -- key to preventing rickets and osteoporosis -- but a second study in the same journal suggests that, at least for adults, orange juice could substitute.

Dr. Michael Holick and colleagues at Boston University School of Medicine found that adults who drank orange juice fortified with vitamin D absorbed it just as well as from milk.

Orange juice is already available fortified with calcium.

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Blacks More Susceptible to Colorectal Cancer

Thursday, May 22, 2003

THURSDAY, May 22 (HealthScoutNews) -- Blacks who live in Pennsylvania, West Virginia and Kentucky have a greater risk of developing and dying from colorectal cancer than whites who live in those states.

So claims a study by researchers at Penn State Milton S. Hershey Medical Center.

The scientists analyzed data from more than 62,000 cases of colorectal cancer in the three largely rural states from 1994-98. The authors say the study findings confirm that unexplained health disparities exist for blacks in those areas.

The study was presented May 21 at the 2003 Digestive Diseases Week meeting in Orlando, Fla.

The researchers found blacks were 18 percent more likely to have proximal, or upper, colon cancer than whites. They were also 56 percent more likely to have proximal colon cancer diagnosed at a later stage, when there is only a 9 percent survival rate.

Overall, the study found that blacks living in the three states were 33 percent more likely to die from colon cancer.

There may be a number of reasons for this disparity, including differences in diet, lifestyle, education, environment and access to cancer screenings.

Blacks are more likely to develop all cancers than people in other racial or ethnic groups, and blacks are more frequently diagnosed after the cancer has spread to other areas of the body. Colorectal cancer is the third leading cause of cancer death in black Americans.

The researchers say their study indicates the importance of regular colon screenings for everyone. They also believe it heightens awareness about potential health disparities that exist for blacks and may lead to recommendations about improving access to colon screenings for blacks.

More information

Here's where you can learn more about colorectal cancer.

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Scientist Warns Against Cancer 'Breakthrough' Hype

By Richard Woodman
Reuters Health
Thursday, May 22, 2003

LONDON (Reuters Health) - So many "breakthroughs" are being reported in the battle against cancer that skepticism may set in and research funding dry up, a British scientist said on Thursday.

Professor Rob Newbold, dean of the Faculty of Life Sciences and head of the Institute of Cancer Genetics and Pharmacogenomics at Brunel University, near London, called for a halt to "breakthrough fever" in cancer research.

"A new cancer gene is discovered almost every month. This is great progress; however it does raise the question of when these discoveries could translate into treatments," he said in a statement.

Newbold pointed out that genetic discoveries could take years to translate into benefits and that if clinical trials failed, the drugs designed as cures might never appear.

"Despite responsible reporting by cancer research organizations, this can create a public perception that discoveries seldom amount to action -- resulting in widespread skepticism about the true value of cancer 'breakthroughs."'

Reports of research studies into dietary, environmental and other factors on cancer are also increasing, are often conflicting, and could cause confusion over what exactly constitutes a serious cancer risk, he added.

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DASH Diet Halts Hypertension

Thursday, May 22, 2003

THURSDAY, May 22 (HealthScoutNews) -- You may be able to DASH your way to lower blood pressure.

The good news comes from a study just released online in the journal Hypertension.

The study says a diet that stresses vegetables, fruits and low-fat dairy products may act as a natural diuretic that could let people lower their blood pressure without the use of medication.

Previous research found this Dietary Approaches to Stop Hypertension (DASH) diet significantly reduced blood pressure, but it was unclear how it did it.

This new study says the DASH diet promotes salt excretion, similar to that of diuretic drugs, resulting in increased urine production. The benefits of the DASH diet seem to be most noticeable in people sensitive to the blood pressure effects of salt.

The study included 375 adults with normal to moderately elevated blood pressure. They were randomly assigned to consume a DASH diet or a control diet for three consecutive 30-day periods. During each of those 30-day periods, they had different levels of salt intake.

People on the DASH diet excreted salt easier and in greater amounts and also had reduced blood pressure. The study also found the impact of the DASH diet decreased as the level of salt intake decreased.

Diuretic drugs can cause side effects, so the DASH diet may offer a safer alternative.

"I think the DASH diet acts as a natural diuretic without the adverse effects. The DASH diet provides healthy food for people of all ages. I think the diet should be recommended for everyone, regardless of age, not only for reducing blood pressure but also to prevent heart disease and cancer," the study's author, Dr. Genjiro Kimura of the Nagoya City University Graduate School of Medical Sciences in Japan, says in a news release.

More information

Here's where you can learn more about the DASH diet.

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Kids Who Live with Smokers Miss School More Often

Reuters Health
Thursday, May 22, 2003

NEW YORK (Reuters Health) - New study findings show that fourth-graders who live with at least one smoker are more likely than those who don't to miss school because of a respiratory illness.

Living with more than one smoker further increased the likelihood that kids would call in sick, especially if the child had asthma, according to the report.

These findings indicate that even kids who are old enough to attend school full-time, and therefore spend every weekday away from home, still feel the effects of secondhand smoke, write Dr. Frank Gilliland and colleagues at the University of Southern California in Los Angeles.

"Thus, although (secondhand smoke) exposure among school-aged children is likely to be substantially lower than that among preschool children, the adverse effects appear to be substantial," they write in the May 15th issue of the American Journal of Epidemiology.

While missing a day of school here and there may appear somewhat harmless, absences can be markers of much larger problems, according to editorialists led by Dr. Anthony J. Alberg of the Johns Hopkins Bloomberg School of Public Health in Baltimore.

"Lurking behind a school absence may lie sleepless nights, physician visits, emergency department visits, hypersomnolence (excessive sleepiness), poor concentration, parents missing work, and poor asthma-specific quality of life," Alberg and his colleagues write.

The current study "adds to the importance of promoting smoking cessation among parents who smoke cigarettes," they add.

Gilliland and his team obtained their findings from information about illness-related absences among 1,932 California fourth-graders during 1996.

Parents or guardians reported whether a doctor had ever diagnosed their children with asthma, and how many smokers lived in their households.

Children who lived with at least one smoker were 27 percent more likely to have been absent from school due to respiratory illness than children whose homes were smoke-free.

And the more smokers in the house, the worse off children were, the authors note. Children who lived with at least two smokers were 75 percent more likely than those from non-smoking homes to miss school due to respiratory illness.

Having asthma also made the situation worse, Gilliland and his team write. Children with asthma who lived with smokers were more than twice as likely to stay home because of respiratory illness than non-asthmatic kids from smoke-free households.

In asthmatic kids who lived with at least two smokers, the risk of such absences shot up by more than four-fold.

Gilliland and his colleagues point out that secondhand smoke may help cause or aggravate respiratory infections, or worsen pre-existing asthma.

In the editorial, Alberg and his colleagues suggest that school officials could interpret repeated absences as a sign that a child has undiagnosed asthma, or, if already diagnosed, needs better treatment.

Source: American Journal of Epidemiology 2003;157:861-869,873.

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How Infants Say 'Ouch'

Thursday, May 22, 2003

(HealthScoutNews) -- Infants -- particularly tiny ones born with a low birth weight -- don't have many ways to communicate distress. But there are some clues.

Members of the British Columbia Research Institute for Children's and Women's Health in Vancouver observed 64 preterm babies to see how they responded to pain. Among other factors, they monitored the babies' heart rate, which is a good indicator of pain.

As reported in the Clinical Journal of Pain, when a preemie jumps, twitches or squirms, that's usually not a sign of discomfort. It's just normal movement. On the other hand, when a preemie spreads his fingers or extends his legs, that's a sign of pain.

And when a preemie raises his eyebrows, it doesn't indicate immediate pain -- but it does suggest that the infant has been in pain within the past 24 hours, and that he's still recovering from it.

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Potent Pneumonia Drug Treats TB, Too

WEDNESDAY, May 21 (HealthScoutNews) -- A potent new antibiotic approved to fight tough cases of pneumonia also appears to work against tuberculosis, researchers say.

Linezolid, which goes by the brand name Zyvox, is the first in a new class of synthetic drugs called oxazolidinones to be approved for use in the United States. The drug, which won the nod from the U.S. Food and Drug Administration (news - web sites) in 2000, works by stopping bacterial growth.

In one study, Richard Wunderink compared the use of linezolid with vancomycin (Vancocin), the traditional antibiotic of last resort, in patients with a form of hospital-acquired pneumonia called MRSA, for methicillin-resistant Staphylococcus aureus.

Up to 100,000 persons are hospitalized each year with MRSA infections, according to Wunderink, citing CDC statistics. This type of pneumonia typically develops in hospitalized patients who are elderly or very sick, but also it also occurs in nursing home patients admitted to the hospital.

In Wunderink's study, those getting linezolid were twice as likely to survive as those on vancomycin. The drugs were given intravenously every 12 hours for seven to 21 days.

"MRSA is the cause of up to 30 percent of hospital-acquired pneumonias," says Wunderink, a physician at Methodist Health Care Memphis and a clinical associate professor of medicine at the University of Tennessee in Memphis.

He predicts linezolid will begin to be used more with the news of a survival difference, although he points out that linezolid is much more expensive. "It's at least 50 percent more than vancomycin," he says. Pharmacia, manufacturer of Zyvox, funded the study.

In another study, linezolid proved promising for multi-drug resistant tuberculosis treatment. Dr. Nicos Hadjiangelis and his colleagues from the New York School of Medicine/Bellevue Chest Service in New York City reported it was well tolerated and safe for a small group of five patients, all diagnosed with what doctors call multi-drug resistant tuberculosis.

Tuberculosis, a bacterial infection that typically attacks the lungs, can also affect other organs. In 2001, 15,898 new cases of TB were reported n the United States, according to the American Lung Association.

Multi-drug resistant TB, defined as a strain resistant to treatment by two commonly used drugs, isoniazid and rifampin, is a major health problem worldwide.

When the researchers added linezolid to other drugs that weren't working well enough, the sputum cultures in all five turned negative for TB. "It means the treatment is effective," Hadjiangelis says.

Another expert says that while the pneumonia study is "not very newsworthy," the TB study is "of interest for several reasons." Multi-drug resistant tuberculosis occurs all over the world, says Dr. David N. Gilbert, a physician at Providence-Portland Medical Center in Oregon and immediate past president of the Infectious Diseases Society of America. While scientists know linezolid appears to work in the laboratory test tube, "it's nice to get some clinical data," he says.

But he does think giving all the credit to the linezolid for the TB patients may be overstatement. "With the combination of drugs used, it's difficult to say linezolid did it. It may have contributed."

What is needed next, he says, is a controlled study of linezolid in an area where the drug-resistant TB is a problem.

The presentations were made this week at the 99th International Conference of the American Thoracic Society this week in Seattle.

More information

To find out more about tuberculosis, click on the American Lung Association, which also has a primer on pneumonia.

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Lithium Inhibits Enzyme Involved in Alzheimer's

By Stephanie Riesenman
Reuters Health
Wednesday, May 21, 2003

NEW YORK (Reuters Health) - Lithium, a manic depression drug first used in the 1960s, blocks an Alzheimer's disease (news - web sites)-related enzyme in the brains of mice, according to new research.

The findings could lead to more effective treatments for Alzheimer's patients, investigators say.

"What our work shows is that lithium can reduce production of amyloid ... in tissue culture cells and in mice that have mutations that are the same as mutations that cause inherited Alzheimer's disease," Dr. Peter Klein, an assistant professor of medicine at the University of Pennsylvania in Philadelphia, said in an interview with Reuters Health.

Klein and his colleagues have identified the point where lithium works in the brain. The drug affects an enzyme called glycogen synthase kinase-3, or GSK-3. The enzyme is involved in the production of amyloid plaques, which accumulate in the brains of people with Alzheimer's disease.

After being exposed to standard doses of lithium for three weeks, the drug reduced the presence of amyloid plaques in the brains of mice by 40 to 50 percent. The mice, a special genetically engineered strain, are used as a model of Alzheimer's disease.

The findings are published in Thursday's issue of Nature.

However, the findings do not mean that everyone with Alzheimer's should now be given lithium, Klein said. The drug, which is most often used in patients with bipolar disorder, or manic depression, can have side effects, he said. Side effects can include increased urine output, excessive thirst, nausea and trembling hands.

"This is early data, and you can't just run out and give lithium to old people and people with Alzheimer's. Lithium does have side effects, which are more common in older people," he said.

People who are already taking lithium for bipolar disorder or manic depression will probably be the first patients studied. Klein says researchers will look to see if these people are less likely to get Alzheimer's disease than peers not taking the drug.

He says clinical trials using lithium in relatively young people who are showing early signs of Alzheimer's disease would also be worth looking into.

Also, researchers will try to find more specific drugs that target GSK-3. Lithium inhibits two forms of GSK-3 present in the human body -- alpha and beta. Only alpha is involved in Alzheimer's-related plaques, Klein said.

"Since we identified alpha -- and this was a surprise that only alpha is involved -- this is very important because now we can try to develop drugs that can inhibit alpha without affecting beta, and that will get around the global side effects," said Klein.

He says drug companies have been focusing on GSK-3 for some time, but the results of this study will probably encourage them to "redouble their efforts."

"I think it will be hard to ... focus on GSK-3 alpha specifically, because the two of them are so similar," said Klein. "It's going to take some clever ideas to do that, but it's worth trying."

Source: Nature 2003; 423:435-439.

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Dogs Are Pet Peeve to Asthmatic Lungs

By Adam Marcus
HealthScoutNews Reporter
Wednesday, May 21, 2003

WEDNESDAY, May 21 (HealthScoutNews) -- Rex may be your best pal, but if you've got asthma he is your lungs' worst enemy.

More people are allergic to cats than dogs. However, a new study shows dog allergens are more ferocious irritants to asthmatics than cat dander, cockroaches, mold and dust mites.

The researchers presented their findings May 20 at a meeting of the American Thoracic Society in Seattle.

The study included 809 men and women with mild to moderate asthma who underwent skin tests for various irritants.

To measure their sensitivity to an allergen, the researchers tested subjects in four areas: their ability to exhale while exposed to an irritant (weaker is worse); the amount of nitric oxide gas in their breath (more signals inflammation); and the nature of the phlegm, if any, they coughed up (cells called eosinophils present in mucus reflect inflammation). They also provoked their lungs with a drug that simulates constricted airways.

Cat allergens were most likely to trigger at least one of these reactions, doing so in nearly three-quarters of the volunteers, the most of any irritant. Dog dander, by comparison, did so only about half as frequently.

However, dog dander was the irritant most likely to decrease lung function, constrict the airways and provoke inflammation.

Recent research has suggested cats in the home can protect infants from early-childhood asthma. However, the new study shows that both dogs and cats are a problem for adults with the breathing problem.

"Once you have asthma, both of the critters can increase inflammation and decrease the stability of asthma," says Dr. Tim Craig, a pediatrician at Pennsylvania State University College of Medicine and a collaborator on the work.

Interestingly, the researchers say, pollens didn't seem to exacerbate the lungs as much as dog and cat dander and other indoor irritants. "Though they cause significant symptoms, like runny noses and itchy eyes, they may not be as important triggers of asthma as indoor allergens are," Craig says.

Dr. Clifford Bassett, a New York City allergy specialist, says the new findings run counter to what most asthma experts have believed. "Normally we think cat dander is most provocative," says Bassett, who sits on the public education committee of the American Academy of Allergy, Asthma and Immunology.

Some doctors say pets are a no-go for asthma patients. Bassett says it's possible to keep animals around, as long as you take steps to reduce your exposure to their allergens. Using special air filters to intercept the particles is one way, while lower-tech measures such as wearing cotton (wool's a magnet for pet dander) and keeping your animal out of the bedroom help, too. "Keeping your pet out of the bedroom can reduce your allergy symptoms by 30 percent," Bassett says.

Also important, Bassett adds, is that everyone with asthma should be tested for allergies. "Certain allergies can be modified" with lifestyle changes, prevention or medication, he says.

More information

An estimated 4 million to 5 million children in this country have asthma. For more on the breathing disorder, try the American Academy of Allergy, Asthma and Immunology or the U.S. Environmental Protection Agency.

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Atkins Diet Bolstered by Two New Studies

By Janet McConnaughey
Associated Press Writer
The Associated Press
Wednesday, May 21, 2003

A month after Dr. Robert C. Atkins' death, his much-ridiculed diet has received its most powerful scientific support yet: Two studies in one of medicine's most distinguished journals show it really does help people lose weight faster without raising their cholesterol.

The research, in Thursday's New England Journal of Medicine (news - web sites), found that people on the high-protein, high-fat, low-carbohydrate Atkins diet lose twice as much weight over six months as those on the standard low-fat diet recommended by most major health organizations.

However, one of the studies found that the Atkins dieters regain much of the weight by the end of one year.

Atkins, who died April 17 at age 72 after falling and hitting his head on an icy sidewalk, lived to see several shorter studies that found, to researchers' great surprise, that his diet is effective and healthy in the short run.

Although those reports have been presented at medical conferences, none until now has been published in a top-tier journal. And one of the studies in the journal lasted a year, making it the longest one yet.

"For the last 20 years that I've been helping people lose weight, I've been trashing the Atkins diet — without any real data to rely on," said Dr. Michael Hamilton, an obesity researcher who was not part of either study. "Now we have some data to give us some guidance."

Now, he said, he would neither trash it nor endorse it. "I'm going to say I don't know. The evidence isn't in," he said.

One study ran six months and was conducted by the Veterans Affairs Department; the yearlong study was led by Gary D. Foster, who runs the weight-loss program at the University of Pennsylvania School of Medicine.

Atkins' diet books have sold 15 million copies since the first one was published in 1972. From the start, doctors branded the Atkins diet foolish and dangerous, warning that the large amounts of beef and fat would lead to sky-high cholesterol levels.

In both studies, the Atkins dieters generally had better levels of "good" cholesterol and triglycerides, or fats in the blood. There was no difference in "bad" cholesterol or blood pressure.

Dr. Frederick F. Samaha of the Philadelphia Veterans Affairs Medical Center, who led the VA study, said both studies indicate that people do lose more weight on Atkins, "but the difference is not great."

The 132 men and women in the VA study started out weighing an average of 286 pounds. After six months, those on the Atkins diet had lost an average of 12.8 pounds, those on the low-fat diet 4.2.

The other study involved 63 participants who weighed an average of 217 pounds at the start. After six months, the Atkins group lost 15.4 pounds, the group on the standard diet 7.

But at the end of a year, the Atkins dieters had regained about a third of the weight. Their net loss averaged 9.7 pounds. The low-fat dieters had regained about one-fifth of the weight, for a net loss of 5.5 pounds.

The year-end difference was not big enough to tell whether it was caused by the diets, Foster said.

About 40 percent of the patients dropped out of each study. And while supporters of the Atkins diet say it is easier to stick with, people on the Atkins regimen were just as likely to drop out as people on the standard diets.

The important finding, Foster said, is that the Atkins diet appears to be a healthy short-term way to lose weight. Nobody has studied it long enough to tell whether it is a healthy way to maintain that loss, he said.

Collette Heimowitz, director of education and research at Atkins Health and Medical Information Services, said people there were not surprised by the weight loss and improved cholesterol.

"But I'm thrilled that serious researchers are taking a hard look at the program, so that health care professionals and physicians would find comfort in offering Atkins as an alternative to the one-size-fits-all hypothesis of low-fat, low-calorie," she said.

The studies did not convince Kathleen Zelman, a spokeswoman for the American Dietetic Association.

"There's never been any denying that low-carbohydrate, high-protein diets such as Atkins do, absolutely, cause weight loss," she said. "But do they hold up over time and can you stay on them over time?"

From Foster's study, it does not look like it, she said.

On the Net:

American Dietetic Association:

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More Meals Per Day May Up Men's Colon Cancer Risk

By E. J. Mundell
Reuters Health
Wednesday, May 21, 2003

ORLANDO (Reuters Health) - For reasons that remain unclear, men -- but not women -- who eat more frequently during the day are at higher risk of colon cancer compared with men who eat less frequently, researchers report.

The results held even when total daily food energy intake between frequent-eaters and those who sat down for fewer meals each day was roughly the same.

"Those who ate less than three times per day had about half the odds of colon cancer compared to those who ate three to four times per day," concluded researcher Dr. Jeffrey T. Wei, of the University of North Carolina.

He presented his findings here Tuesday at Digestive Disease Week, the largest annual gathering of gastroenterologists in the world.

Previous studies have noted a trend between an increasing number of daily meals and snacks and higher rates of colon cancers, especially in men. But these studies were either small in scale or failed to factor out important variables such as body weight or total daily food energy intake.

In their study, Wei's team had 643 North Carolina colon cancer patients and 1048 healthy "controls" fill out a questionnaire on the average number of meals and snacks consumed per day over the previous year. Study subjects averaged 65 years of age.

After adjusting for age, gender, family history of colon cancer, coffee intake, weight and total daily energy, Wei found that men in the highest-frequency group -- those eating more than four meals per day -- were at 2.3 times the risk of developing colon cancer compared with those eating less than three meals per day. These results were not found in women however.

"The magnitude of this finding was consistent with results of previous studies," Wei told conference attendees, and he speculated that "the differences between men and women might be explained by sex differences in bile acid metabolism."

Bile acid secretion and metabolism is thought to play a role in the genesis of colon cancer, and gender may exert an influence on bile acid activity.

While the findings appear interesting, Wei admitted that, for most men, eating habits developed over a lifetime may be "difficult to alter." And he said there may be a downside to restricting our daily intake of calories to just two meals per day, since bigger meals tend to cause a surge in post-meal insulin levels that can raise blood cholesterol levels.

"So the benefits of decreasing eating frequency for cancer risk might be offset by an increase in cardiovascular risk," he pointed out.

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Interleukin an Ally to Chemotherapy

Wednesday, May 21, 2003

WEDNESDAY, May 21 (HealthScoutNews) -- A protein fragment in the cancer immunotherapy drug interleukin 2 (IL-2) seems to improve the effectiveness of chemotherapy against tumors.

A study by researchers at the Keck School of Medicine, University of Southern California, says when the protein fragment called PEP (permeability-enhancing peptide) is attached to a tumor-targeting antibody, it can prompt tumors to soak up more than 300 percent of the normal amount of chemotherapy drugs.

The research appears in the May 21 issue of the Journal of the National Cancer Institute (news - web sites).

PEP increases tumor uptake of chemotherapy drugs by making the tumor's blood vessel walls more permeable to the drugs. PEP acts on epithelial cells that form the blood vessel walls. These cells are usually tightly joined together. PEP loosens up the junctions between the epithelial cells, making it easier for molecules to enter or leave.

The Keck researchers isolated PEP and determined it enhanced blood vessel permeability while they were doing research on IL-2, which can help fight cancer by revving up the body's immune system.

However, IL-2 can only be used in small doses. At the higher doses necessary to provide therapeutic benefit to cancer patients, IL-2 causes widespread edema (excessive accumulation of tissue fluid) and other problems caused by blood vessel leakiness.

When the Keck scientists investigated why this happened, they identified PEP. Once they found PEP, they did further research with mice that revealed PEP's ability to increase tumor uptake of drugs.

More information

Here's where you can learn more about interleukin 2.

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Study Links Asthma to Infants' Cockroach Exposure

Wednesday, May 21, 2003

WASHINGTON (Reuters) - Babies exposed to cockroaches, pesticides and a range of other substances in the first year of life appear to have a higher risk of developing asthma later in childhood, according to a study released on Tuesday.

Presented at the American Thoracic Society International Conference in Seattle, the study found that children exposed to cockroaches within the first 12 months of life were twice as likely as those not exposed to cockroaches to develop asthma.

Herbicide exposure in the first year of life was associated with a 4.6-fold increased risk of asthma, while pesticide exposure was associated with a 2.4-fold increased risk, the study found.

"We also found that exposure to wood or oil smoke in the home from heating and exposures to the farming environment increased the risk of asthma, but the risk was strongest if the exposures occurred in the first year of life," said lead researcher Dr. Frank Gilliland of the University of California Los Angeles.

"If the exposure occurred when the child was older, it didn't have as large an effect."

Gilliland's study looked at 700 children, half of whom had developed asthma by age 5. Parents provided information on the children's early-life environmental exposures.

During infancy, the lungs are growing rapidly and the immune system is developing, so the child is particularly vulnerable, Gilliland said.

"The increased risk for asthma that we noted from environmental exposures during the first year may reflect that sensitive window in development," he said.

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Backpacks Getting Bad Rap

Wednesday, May 21, 2003

WEDNESDAY, May 21 (HealthScoutNews) -- While they may be crammed with everything but the kitchen sink, those heavy backpacks your children lug to school don't cause back pain.

That surprising finding comes from a new University of Michigan Health System study.

For years, experts have warned that children need to lighten their backpack loads, wear the packs on both shoulders to evenly distribute the load, and put down that burden whenever possible.

But a study by researcher Dr. Andrew Haig says those heavy backpacks don't actually inflict stress and strain on young backs. Haig is medical director of the university's Spine Program and an associate professor of physical medicine and rehabilitation and surgery at the the university's medical school.

"There is no good scientific evidence to support the claim that schoolbag load is a contributing factor to the development of low back pain in growing children," Haig says in a news release.

Instead, his study indicates a child's activity level and body weight may have more impact on whether they suffer back pain.

The study was presented May 21 at the World Congress of the International Society for Physical and Rehabilitation Medicine in Prague, Czech Republic.

For this study, students aged 7 to 15 were asked about their backpack use, back pain, activity levels and transportation to school. The children and their backpacks were weighed and the children's heights recorded. Those numbers were used to determine the backpack weight as a percentage of body weight.

Nearly all the students said they used a backpack every day. Third grade students carried an average of 5.7 percent of their body weight in their packs, while middle school students carried backpacks equal to 11.4 percent of their body weight.

Most children ignored warnings about putting both backpack straps over their shoulders and, instead, carried their packs over one shoulder.

More than a third of the children said they had at least one indicator of back pain. However, the study found those students didn't carry heavier backpacks than children with no indicators of back pain.

The study also found there was no relationship between back pain and whether students wore their backpacks on one or both shoulders.

Middle school children were more likely than younger children (45 percent versus 15 percent) to report back pain. That could be the result of the children's declining activity levels and physical condition.

"The students' body mass index, an indicator of obesity, increased from the third graders to middle schoolers, so the middle schoolers were more fat. Also, the percent of students who walked or biked to school dropped dramatically in the older kids, so they're much less active. At the same time, they reported watching much more TV and spending more time playing video games," Haig says in the news release.

"Frankly, I think that might be more of a factor in back pain than the backpacks," he says.

He says exercise squeezes and stretches spinal discs, which act as shock absorbers for the back. This exercise-generated motion pumps in nutrients and oxygen, which help keep the discs healthy. Without that movement, spinal discs may lack nutrition and that may lead to back pain.

More information

Here's where you can learn more about back pain.

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Ulcer Bug May Protect Against Cancer of Esophagus

By E. J. Mundell
Reuters Health
Wednesday, May 21, 2003

ORLANDO (Reuters Health) - By lowering levels of stomach acid, a common bacterium responsible for ulcers and many stomach cancers may, conversely, cut the risk of another killer -- cancer of the esophagus.

What's more, the finding may explain why cases of esophageal cancer have increased in white males in recent years, researchers say.

A large percentage of adults worldwide carry Helicobacter pylori bacteria in their gut. In recent decades, science has pinpointed H. pylori as the main cause of stomach ulcers, prompting doctors to recommend antibiotic eradication of the bug for patients with ulcers.

But now a study led by Dr. Catherine de Martel, of Stanford University in California, suggests that eradicating H. pylori may leave patients more vulnerable to a leading form of esophageal cancer.

Individuals carrying the ulcer bug "were significantly less likely than uninfected subjects to get esophageal adenocarcinoma," according to de Martel. She spoke to reporters here Tuesday at Digestive Disease Week, the largest annual gathering of gastroenterologists in the world.

In the study, the Stanford team pored over the medical records of about 130,000 California patients followed since the 1960s. Fifty-two of the patients went on to develop adenocarcinoma of the esophagus. The researchers looked for signs of H. pylori in blood samples collected from each of those patients in decades past, and compared the results to those of 551 "controls" who had never developed the cancer.

According to de Martel, individuals infected with H. pylori had about a 70 percent lower risk of developing the cancer, compared with uninfected individuals. This finding held even after researchers adjusted for other risk factors such as age, gender, obesity and history of smoking.

How might H. pylori reduce esophageal cancer risk -- even as it raises risks of ulcers and stomach cancer? De Martel noted that esophageal adenocarcinoma is almost always related to acid reflux disease, otherwise known as gastroesophageal reflux disease, or GERD.

Over time, acid washing up because of GERD can damage the esophagus until a condition called Barrett's esophagus arises. Almost all patients with esophagheal adenocarcinoma have a previous history of GERD and Barrett's esophagus, she said.

But H. pylori may damage the acid-secretion abilities of the stomach. This means that people with H. pylori may have less acid reflux, greatly reducing their esophageal cancer risk.

However, these findings may leave patients and physicians in a bind as to whether they should eradicate H. pylori.

Because the bacteria are responsible for both ulcers and stomach cancer, de Martel said: "I can't say 'don't eradicate H.pylori."' But she said doctors should become more aware of the possible heightened risk of esophageal cancer among patients with GERD who also test negative for the ulcer bug.

The absolute risk for adenocarcinoma of the esophagus remains very low -- about 10 cases in every 100,000 individuals per year. But rates for the illness are rising.

"In the 25 last years, there has been an almost 10-fold increase of this cancer in white males," de Martel pointed out. She believes that the increasing use of antibiotics to eradicate H. pylori in Western populations may be behind this trend.

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Antibacterials Not the Best Germ Fighters

Wednesday, May 21, 2003

WEDNESDAY, May 21 (HealthScoutNews) -- Your wallet may be the main thing getting cleaned by household antibacterial cleaning products.

A Tufts University School of Medicine microbiological survey of homes found little difference in levels of bacteria or antibiotic resistance between homes that used antibacterial cleaning products and those that didn't.

The findings were presented May 21 at the general meeting of the American Society for Microbiology in Washington, D.C.

The Tufts researchers checked for aerobic bacteria in the bathrooms and kitchens of 38 homes in the Boston and Cincinnati areas. They also evaluated the frequency of bacterial resistance to six different antibiotics.

They found large variations among identical sites in different homes and determined that significant amounts of bacteria could be recovered, even from sites in homes where antibacterial products were used for cleaning.

The highest numbers of bacteria were found on kitchen sponges and in sink and bathtub drains.

More information

Here's where you can learn more about antibacterial cleaners.

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More Evidence Alzheimer's Vaccine May One Day Work

By Alison McCook
Reuters Health
Wednesday, May 21, 2003

NEW YORK (Reuters Health) - One year after receiving a new vaccine against Alzheimer's disease (news - web sites) as part of an experiment halted due to the vaccine's side effects, some patients showed an improvement in their symptoms of the memory-robbing disease, according to study results released Wednesday.

These findings suggest that, in the future, a vaccine against Alzheimer's disease may one day help stop the disease in its tracks, study author Dr. Roger N. Nitsch of the University of Zurich told Reuters Health.

"This is the first step toward a cure (for) Alzheimer's disease," he said.

Nitsch cautioned, however, that many hurdles must be overcome before any vaccine against Alzheimer's will be available to patients.

The current study, reported in the journal Neuron, included only 30 patients, and with such a small number, it is difficult to say whether any vaccine will benefit Alzheimer's patients overall.

In an accompanying editorial, Bengt Winblad of Huddinge University Hospital in Stockholm, Sweden, and Kenneth I. Blum, deputy editor of Neuron, agree "the results should be regarded as preliminary."

Winblad and Blum write that the original experiment involving the vaccine featured in the current study was halted because six percent of vaccinated patients developed brain inflammation.

"Thus, while there are hopes that it can be mitigated or eliminated, this potentially fatal side effect remains an overriding concern," they note.

Alzheimer's disease is characterized by brain-clogging plaques made up of a protein called beta-amyloid.

Nitsch told Reuters Health that the vaccine his team used consists of synthetic beta-amyloid proteins. Injecting patients with the vaccine causes their bodies to generate antibodies that target those beta-amyloid proteins, he said.

In addition, if a small fraction of the antibodies infiltrate the brain, Nitsch said, they might bind to the beta-amyloid plaques, perhaps slowing Alzheimer's progression.

The current study findings suggest that this process could very well occur.

Among the 30 patients, 24 of whom received the vaccine, 20 appeared to have developed antibodies against the beta-amyloid proteins, the authors note. Furthermore, those who carried beta-amyloid antibodies showed less mental decline one year after vaccination than patients who did not have antibodies against beta-amyloid.

Differences between the two groups were seen in many different areas of mental functioning, including attention, memory, language and the ability to carry out day-to-day activities.

A similar slowing of the progression of Alzheimer's was seen in two of the three patients who developed brain inflammation as a result of the vaccine, Nitsch and his colleagues report.

Whether these improvements last more than one year after being vaccinated is not clear, Nitsch said. "We are currently evaluating the second year," he noted. "Long-term follow up is one of our major objectives for the future."

Nitsch added that the vaccine is currently unavailable to patients, due to the side effects reported in the previous experiment.

Source: Neuron 2003;38:547-554.

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Can a Capsule Reduce Damage From a High-Fat Meal?

By Gary Gately
HealthScoutNews Reporter
Wednesday, May 21, 2003

WEDNESDAY, May 21 (HealthScoutNews) -- Taking capsules containing fruit and vegetable concentrates could lessen damage to arteries caused by a high-fat meal, a new study suggests.

The study, published in the May 21 issue of the Journal of the American College of Cardiology, focused on three dozen volunteers, each of whom ate a 900-calorie McDonald's meal containing 50 grams of fat: an Egg McMuffin, a Sausage McMuffin, two hash browns and a non-caffeinated drink.

"I think it sort of confirms what people have known for a while -- that is, eating fruits and vegetables long-term is beneficial in decreasing the risk of cardiovascular disease," says study co-author Dr. Gary D. Plotnick, a professor of medicine at the University of Maryland School of Medicine.

Plotnick cautions, however, that the study results are preliminary and need to be confirmed by a much larger study. And he warns against assuming you can take a capsule concentrate containing fruit and vegetables, then eat high-fat meals without worry.

"What I don't want to get across is you can take pills and eat anything you want because there are detrimental effects of high-fat meals independent of what we looked at," he says. For example, Plotnick says, the study did not examine the high-fat meal's effect on cholesterol.

Before the meal, researchers divided the volunteers into three groups. For four weeks, one group received the capsule concentrate; one group, the capsule concentrate and an herbal supplement; the third group, a placebo.

The fruit-and-vegetable supplements appeared to help arteries retain much of their ability to expand in response to a sudden increase in blood flow, the study found.

Among those who took only placebos, however, the high-fat meal significantly reduced the blood vessels' ability to expand with an increase in blood flow. (Addition of the herbal supplement had no significant effect on the vessels.)

The researchers measured blood vessel response three hours after the meal by using a blood-pressure cuff to stop blood flow in the arm for five minutes, then releasing the cuff, causing a sudden surge in blood flow. After a high-fat meal, the inner lining of blood vessels -- called the endothelium -- does not expand as well in response to an increase in blood flow because the endothelium doesn't release as much nitric oxide, Plotnick says.

The researchers received support for the study from Natural Alternatives International, the manufacturer of the fruit-and-vegetable capsules used in the research.

The researchers suggest the antioxidants in fruits and vegetables may have helped endothelium function among those who took the concentrate. Diminished function of the endothelium can be an early sign of atherosclerosis, the gradual blocking of arteries that can lead to heart attack and stroke, the study says.

Researchers not involved in the study say they wouldn't read too much into its results.

In an editorial in the journal accompanying the study, Dr. Jane E. Freedman, associate professor of medicine at Boston University School of Medicine, says the study presents a possible reason for protective benefits of compounds in fruits and vegetables. But, she writes, further research is needed to determine the possible benefits of the fruit-and-vegetable concentrate.

"This is a very limited study that should not be over-interpreted," Freedman says.

She also says the study results can't be extended to other fatty foods, and adds that endothelium function has not been proved to correlate with cardiovascular disease.

Alice H. Lichtenstein, a professor of nutrition, science and policy at Tufts University School of Medicine, points out that ingredients in the concentrate -- but not found in fruits and vegetables -- could have affected the study's outcome.

Lichtenstein, vice chairwoman of the American Heart Association (news - web sites)'s Nutrition Committee, says the study focused on a "very narrow question asked under very controlled and extreme experimental conditions."

"It would be premature to make a recommendation based on this study," she says.

More information

Check out the American Heart Association's recommendation for fruit and vegetable consumption. For more on atherosclerosis, visit the National Center for Biotechnology Information.

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TUESDAY, MAY 20, 2003

Study Doubts Risks for Children of Alcoholics

By K.L. Capozza
HealthScoutNews Reporter
Tuesday, May 20, 2003

TUESDAY, May 20 (HealthScoutNews) -- A new study disputes conventional wisdom that children of alcoholics have certain risk factors that predispose them to follow in the footsteps of their addicted parents.

The study, which tries to zero on those factors, suggests that performance on psychological tests in early adulthood does not predict alcoholism later in life. The finding debunks a prevailing theory that neuropsychological performance can foretell the future alcoholic tendencies of children.

University of Kansas researchers used data collected in a large retrospective Danish study during the 1960s to examine potential markers for future alcoholics. The Danish study identified 223 high-risk sons of alcoholic fathers and 107 low-risk sons of nonalcoholic fathers.

At age 19, before the boys had started drinking alcohol, they were evaluated using a series of cognitive and behavioral tests. Those who scored poorly were considered high risk, while those who scored well were labeled low risk.

"When these subjects were tested at 18 and 19 [years old] we found shocking differences between them. We thought that these differences would predict them becoming alcoholics," says Elizabeth Penick, a professor of psychiatry at the University of Kansas Medical Center.

Back then, "it was considered a powerful research paradigm to find early markers of alcoholism," Penick says. "People even talked about making a vaccine."

To determine if the children who were considered high risk actually became alcoholics, Penick's team tracked down the subjects 10 years later and determined how many of them had developed a drinking problem.

The researchers were surprised to find that performance on the neuropsychological tests at age 19 did not predict later alcohol dependence.

"We found that intellectual and cognitive risk factors are not good predictors of later disease," Penick says.

However, the researchers were able to isolate four factors that appear to predict future alcoholism: childhood unhappiness, life stress, low birth weight and antisocial behavior.

"There are things which predict alcoholism, but these [tests] are not one of them," Penick says.

The results, while interesting, are not particularly surprising, says Dr. Kirk Wilhelmsen, a behavioral geneticist at University of California at San Francisco.

"If you think about it, there's lots of people who are smart who are alcoholics and lots of people who aren't particularly smart who aren't," he says. "What this study suggests is that a lot of the observational data that indicates that cognitive function plays a role in alcoholism has to be viewed skeptically."

Robert Zucker, director of the University of Michigan's Addiction Research Center, says the study design may have biased the results.

"What has been established is that the particular battery of neuropsychological tests this team used was not able to differentiate those who became alcohol dependent versus those who did not. This may or may not be an indictment of the high-risk paradigm," he says.

The findings were presented May 19 at the annual meeting of the American Psychiatric Association in San Francisco.

More information

Learn about families and alcohol problems from the National Institute on Alcohol Abuse and Alcoholism or Adult Children of Alcoholics.

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Sitting for Meals May Aid Dieting, Study Finds

By E. J. Mundell
Reuters Health
Tuesday, May 20, 2003

ORLANDO (Reuters Health) - Diet-conscious couch potatoes, beware: a new study finds that eating while lying down might leave you hungry for more.

Ultrasound stomach scans and post-meal interviews suggest that people feel full sooner when seated for a meal, as opposed to reclining.

"When you are in the seated position, as opposed to lying flat, you are going to have more of your meal retained in the lower part of the stomach," explained Australian researcher Dr. Deirdre O'Donovan. "And you're going to feel, as a result of that, less hungry and more full."

O'Donovan, a researcher at the University of Adelaide, presented her team's findings here Tuesday at Digestive Disease Week, the largest annual gathering of gastroenterologists in the world.

While previous studies have examined the effect of eating posture on the movement of food from the stomach into the small intestine, O'Donovan's team says its study is the first to examine the relationship between body position and the distribution of a meal inside the stomach.

The researchers had eight healthy volunteers consume a sugary drink laced with a harmless radioactive tracer. Each volunteer drank the liquid twice -- once while sitting and once while lying flat with his or her head propped on a pillow.

With the tracer as a marker, the researchers used ultrasound and another scanning technique called scintigraphy to examine the distribution of food in the stomach, following its passage into the small intestine for an hour-and-a-half after consumption. Participants were also asked periodically how hungry or full they felt.

"Posture didn't affect the overall rate at which food left your stomach and went into the small intestine," O'Donovan said in an interview with Reuters Health.

But it did have an impact on "whether it was in the top part of your stomach -- which it was in the lying-down posture -- or in the lower part of your stomach, as it was in the sitting posture."

People who ate while sitting up tended to feel fuller, sooner. This makes sense, O'Donovan said, because that sense of fullness is increased when food collects in the lower portion of the stomach.

So breakfast in bed might not be the best idea for those hoping to slim down for the summer.

Instead, dieters "might want to have their meals while in the upright, seated posture," O'Donovan advised. "That would give them the greatest chance of feeling full immediately after their meals."

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Expectant Moms Battle Depression More Than Thought

Tuesday, May 20, 2003

TUESDAY, May 20 (HealthScoutNews) -- One in five pregnant women may suffer symptoms of depression, but few get treatment for it.

That's the finding of a University of Michigan study in the May 22 issue of the Journal of Women's Health.

The study also found women with a history of depression at any time before their pregnancy -- about one in every four women -- are about twice as likely as other women to experience symptoms of depression while they're pregnant.

Pregnant women who don't receive treatment for their depression symptoms may be at greater risk of postpartum depression and their condition could pose a risk to their unborn babies.

The study included 3,472 pregnant women from 10 Michigan obstetrics clinics. The findings reveal a troubling under-diagnosis and under-treatment of depression during pregnancy.

Of the women in the study, 20 percent scored high on a standard survey of depression symptoms. Of those, only 13.8 percent were receiving any mental health counseling, drugs or other treatment for depression.

The study also found that 24 percent of women who had depression in the previous six months were receiving treatment for depression while they were pregnant.

There's scientific evidence to suggest that hormone imbalances associate with depression can affect the fetus or increase a woman's risk of postpartum depression, the study notes.

More information

Here's where you can learn more about depression.

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Fish May Fight Pregnancy Depression Risks

By Malcolm Ritter
AP Science Writer
The Associated Press
Tuesday, May 20, 2003

SAN FRANCISCO - Pregnant women might be able to lower their risk of becoming depressed before or after giving birth by eating fish, a study suggests.

That is because they will get a nutrient called omega-3 fatty acids, which are found in seafood and are also available in fish oil supplements, researchers say.

Oily fish such as salmon, tuna, sardines and herring are especially rich in omega-3. These particular fish are not on the federal list of fish pregnant women should avoid because of high levels of mercury, although some consumer activists believe tuna should be included in the list.

In an analysis of 11,721 British women, researchers found that the more omega-3 fatty acids a woman consumed in seafood during the third trimester, the less likely she was to show signs of major depression at that time and up to eight months after the birth.

In fact, the rate of depression in the women with the highest intakes was only about half that of women with the lowest intakes, said one of the researchers, psychiatrist Dr. Joseph R. Hibbeln. Eating fish two or three times a week was typical of the highest-intake group, Hibbeln said.

The federal government says that because of mercury contamination, pregnant women should limit themselves to an average of 12 ounces a week of a variety of fish, an amount Hibbeln said corresponds to about two servings. He also said that federal data show very little mercury in salmon, catfish, scallops and tilapia, and that fish-oil supplements are supposed to be free of mercury.

As for why would omega-3 fatty acids reduce the risk of depression, Hibbeln said they are key building blocks of the brain, and studies show that low levels in the diet are associated with low levels of a brain chemical called serotonin. Low levels of serotonin, in turn, are implicated in depression.

About 10 percent of pregnant women develop depression severe enough to interfere with their functioning, and the figure jumps to 13 percent to 15 percent in new mothers.

Pregnant women could be particularly vulnerable to low levels of omega-3 fatty acids because the developing fetus draws on supplies stored in the mother's body, Hibbeln said. "If mothers don't eat enough, they're likely to become depleted," he said.

In the depression study, the results held up even after researchers accounted for other factors that influence risk of the illness.

Still, more definitive studies should be done before omega-3 fatty acids are recommended to pregnant women for avoiding or easing depression, said Hibbeln, chief of the outpatient clinic at the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Md.

The study, which Hibbeln said received no funding from the fishing or nutritional-supplement industries, was released Tuesday at the annual meeting of the American Psychiatric Association.

Research suggests that giving antidepressants to pregnant women and nursing mothers appears to pose little risk to the fetus and newborn. But there have been few studies of the long-term effects, said Dr. Katherine Wisner of the University of Pittsburgh, who studies depression during and after pregnancy.

The new study shows a strong statistical relationship between low levels of omega-3 fatty acids and symptoms of depression, Wisner said.

Now researchers have to show that the fatty acid levels really are responsible for that relationship, and that boosting the levels will combat depression, she said. That would be "a major finding," she said.

The government has warned pregnant women to avoid eating shark, swordfish, king mackerel and tilefish because they can contain high levels of mercury, which might harm the developing nervous system of the fetus.

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Environment May Be Culprit in Childhood Asthma

Tuesday, May 20, 2003

TUESDAY, May 20 (HealthScoutNews) -- Children exposed to certain chemicals, pollutants and irritants such as cockroaches, dust and farm crops during their first year of life may face a greater risk of developing asthma.

Weed killers, pesticides, fuel oil, soot, exhaust and farm crops, cockroaches, dust and animals all seemed to be linked to early asthma in children, a study from researchers at the Keck School of Medicine, University of Southern California, found.

Babies who first attended day care before they were 4 months old were also more likely to be diagnosed with asthma.

The study was presented May 20 at the annual international conference of the American Thoracic Society.

The researchers looked at 338 children diagnosed with asthma before they were 5 years old. They were compared to 570 asthma-free children of the same age who lived in the same communities.

The risk of developing asthma before age 5 was:

  • More than four times greater for children exposed to herbicides before age 1.
  • Nearly two-and-a-half times greater for children exposed to pesticides before age 1.
  • Also nearly two-and-a-half times greater for children who attended day care before 4 months of age.
  • More than two times greater for children exposed to cockroaches in the home before age 1.
  • Nearly two times greater for children exposed to dust, animals or farm crops before age 1.
  • More than 50 percent greater for children exposed to wood or oil smoke, soot or exhaust anytime between birth and the age of 5.

This study didn't look at the specific reasons why these exposures increased the risk of asthma in children.

"The first year of life seems uniquely important in terms of susceptibility to environmental triggers of asthma," study author Dr. Frank G. Gilliland, Keck professor of preventive medicine, says in a news release.

"The first year of life is a critical time period of lung development -- both for immunity and airway structure. Others have shown that certain early life exposures are important for asthma development," Gilliland says.

More information

Here's where you can learn more about asthma.

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Exercise May Help Women's Nagging Neck Pain –Study

Reuters Health
Tuesday, May 20, 2003

NEW YORK (Reuters Health) - Women with chronic neck pain may find relief by doing neck-muscle exercises as little as two times a week, Finnish researchers reported Tuesday

Seven percent of women and five percent of men in Finland have reported chronic neck pain, according to the report in the Journal of the American Medical Association (news - web sites).

Such patients use up to twice as many health care services as the general population, on average.

In the new study, Dr. Jari Ylinen of the Jyvaskyla Central Hospital looked at 180 female office workers who reported constant or frequent neck pain.

The women underwent either endurance training or strength training, or were placed in a control group.

The endurance-training group performed neck exercises such as lifting the head while lying on the back or stomach. The strength-training group performed high-intensity neck strengthening exercises using an elastic band. Both groups also used weights to strengthen the muscles of the shoulder, back and arms.

Those in the control group did not receive any specific weight-training regimen and were only encouraged to do aerobic activity for 20 minutes three times per week. Those in the endurance and strength-training groups were also encouraged to do aerobic exercise.

After 12 months all of the women were re-evaluated.

"Our study showed that participation in 1-year endurance and strength training programs led to a considerable reduction in average neck pain and disability compared to the control group," the authors write.

"Neck function, including neck strength and range of motion, was improved significantly in both training groups compared to the control group," they add.

Women received a benefit even if they only did the exercises two times a week, the authors found.

Source: Journal of the American Medical Association 2003;289:2509-2516.

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Improving the Odds Against Rectal Cancer

Tuesday, May 20, 2003

TUESDAY, May 20 (HealthScoutNews) -- People with rectal cancer have higher survival rates and less chance of permanent colostomy when they're treated at hospitals that deal with many more cases of rectal cancer than other hospitals.

So says a study in the May 21 issue of the Journal of the National Cancer Institute (news - web sites).

Researchers from the University of Toronto and Harvard Medical School (news - web sites) compared the outcomes of 7,257 people who had surgery for rectal cancer.

The study found rectal cancer patients treated at low-volume hospitals (those performing less than seven rectal cancer operations a year) had a post-surgery death rate of 4.8 percent and a two-year survival rate of 76.6 percent.

Patients treated in high-volume hospitals (more than 20 rectal cancer operations a year) had a post-surgery death rate of 1.6 percent and a two-year survival rate of 83.7 percent.

The rectal cancer patients treated at the low-volume hospitals had a 7 percent increase in absolute risk of permanent colostomy compared to those treated in high-volume hospitals. A permanent colostomy is a procedure to permanently reroute the passage of waste materials from the body.

Previous studies have found a person's quality of life is substantially reduced after having a colostomy.

The differences between rectal cancer patient outcomes in high-volume and low-volume hospitals may be due to surgeon-related factors, such as experience, training or attitudes about colostomy, the study authors suggest.

More information

Here's where you can learn more about rectal cancer.

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Colon Cancer Drug Shows Some Good Results

By Paul Elias
AP Biotechnology Writer
The Associated Press
Tuesday, May 20, 2003

SAN FRANCISCO - An experimental drug that had essentially been written off as a failure dramatically extended the lives of some of the sickest colon cancer patients, its maker, Genentech Inc., said Monday.

The news sent the biotechnology company's stock soaring nearly 45 percent and boosted the spirits of researchers working with similar drugs in a field plagued by recent setbacks.

Genentech's Avastin is the most advanced drug in this new class of medicines, which are intended to choke off the blood supply to cancer tumors. The work was pioneered by Dr. Judah Folkman some 30 years ago.

"The fact that this extended life is a very major medical breakthrough," said Folkman, a researcher at Boston's Children's Hospital. "You can't do any better than that. This will set the standard."

The company's stock was up $16.95 to close at $54.85 on the New York Stock Exchange (news - web sites).

Genentech said patients with late-stage colon cancer who received Avastin with chemotherapy drugs lived longer than expected.

"The magnitude of the benefit observed far exceeded what the study was designed to demonstrate," the company said in a statement.

The company, based in South San Francisco, offered few details, saying it would release the results of its experiment on more than 900 colon cancer patients at the American Society of Clinical Oncology (news - web sites) meeting in Chicago next month.

Genentech's drug and others that are based on Folkman's research are designed to stop angiogenesis, the formation of new blood vessels that are necessary for tumors to grow.

The new medicines have "the potential to change the practice of treating cancer," Dr. Susan Hellmann, a Genentech executive vice president.

Hellmann said Genentech plans to start discussion with the Food and Drug Administration (news - web sites) about filing for marketing approval. Hellmann said few side effects occurred in those treated with Avastin.

Genentech is also testing Avastin in patients with kidney, breast and other cancers.

"This will be a very significant drug for the company," said Adam Walsh, an analyst with Jeffries & Co. "This has the potential of being a blockbuster."

Walsh said if regulators approve Avastin, it has a good chance of becoming a $1 billion-a-year seller for Genentech.

As recently as September, Genentech said that Avastin had failed to help breast cancer (news - web sites) patients. That news caused the company's stock to plummet and added to growing skepticism about the angiogenesis approach.

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Some Addicts' Wives May Be at AIDS Risk

By Randy Dotinga
HealthScoutNews Reporter
Tuesday, May 20, 2003

TUESDAY, May 20 (HealthScoutNews) -- New research suggests that countless wives of drug users may be in danger of AIDS (news - web sites) infection because their husbands are living secret lives.

In a survey, 71 percent of wives of at-risk addicts didn't know their spouses were having extramarital sex and using dirty needles.

"We actually blown away by the number of wives who reported that they had no idea what their husbands were up to," says study co-author William Fals-Stewart, a clinical psychologist at the University of Buffalo in New York. "It was surprising and disturbing."

It's not clear if the wives are truly in the dark or living in some sort of denial, Fals-Stewart says. But the research does suggest that many American women face potential AIDS infection without knowing they're at risk.

Fals-Stewart is an expert in couples counseling as a treatment for drug and alcohol use. He and his colleagues launched the study to help them understand what wives know about the high-risk behaviors of their husbands.

The researchers interviewed 362 men, mostly white, who were entering drug addiction recovery programs in upstate New York. They also separately interviewed the men's wives.

"We kept a firewall between the husband's report and the wife's report," Fals-Stewart says. "We told them we weren't going to share any information."

The findings of the study appear in the May issue of Drug and Alcohol Dependence.

Forty percent -- or 144 -- of the men admitted to engaging in activities within the past year that could have put them at risk of AIDS infection. They acknowledged having unprotected sex outside marriage (usually with a woman), using dirty needles during drug use or sharing needles, or all of the above.

Of the wives of the men at risk, 108 reported they didn't usually use condoms during intercourse with their husbands. Of that group, 77 (71 percent) said they didn't think their husbands engaged in risky activities. The rest said they did know they were at risk but didn't bother to protect themselves by insisting on condom use.

Fals-Stewart says it seems likely the men were telling the truth. It would be "bizarre" if they were to lie about drug use and extramarital sex, he says.

The findings raise the possibility that there is a large population of women at risk for AIDS who don't know it, Fals-Stewart says. To make matters worse, public health workers don't target these women for prevention, he adds. "It kind of raises the specter of extramarital sexual relationships as a public health issue," he adds.

Fals-Stewart says researchers are already testing whether it would be helpful to let couples in drug counseling know about the study findings. "We raise the specter to the wife that maybe her husband is engaging in high-risk behavior," he says.

However, the study findings make it clear that knowing about the risks they face doesn't always lead to protected sex.

The wives "may be in relationships where they feel that they can't negotiate that," says Charles J. Neighbors, an associate professor of psychiatry and human behavior at Brown Medical School in Providence, R.I.

Couples may also fear that condoms will reduce the emotional connection they feel during sex, he adds.

More information

Learn more about HIV (news - web sites) from the U.S. Centers for Disease Control and Prevention (news - web sites)'s Divisions of HIV/AIDS Prevention or AIDS Action.

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Smallpox Immunity Lasts Decades, Study Shows

By Maggie Fox, Health and Science Correspondent
Tuesday, May 20, 2003

WASHINGTON (Reuters) - Immunity to smallpox lasts virtually a lifetime, researchers said on Tuesday in a report that suggests anyone vaccinated in the past still has some protection if the virus is used in a bioterrorism attack.

Tests of people who were vaccinated as long as 75 years ago showed everyone had at least some immunity to the deadly virus, a team at Oregon Health and Science University (OHSU) found.

The finding may offer comfort to those older than 30, who assumed their immunity was long gone.

The United States stopped routine vaccination against smallpox in 1972, and the World Health Organization (news - web sites) announced the disease was eradicated in 1980.

Ninety percent of Americans older than 30 have been vaccinated against smallpox at least once, which means as many as 150 million people have at least some immunity to the virus, said OHSU microbiologist and immunologist Mark Slifka.

But U.S. officials and bioterrorism experts say several groups and governments may possess smallpox weapons and could be more likely than ever before to use them.

To defend against such an attack and to help discourage it, the United States has begun a vaccination campaign. The U.S. Centers for Disease Control and Prevention (news - web sites) (CDC) says 36,000 health care and emergency workers have been vaccinated, so they will be ready to vaccinate others in case of attack.

The military is vaccinating 500,000 personnel.

In designing a smallpox plan, officials have assumed that no one has much immunity after about five years.

Slifka, Erika Hammarlund and others at OHSU are among the teams testing this premise, by looking at the blood of 306 people vaccinated in the past.

Everyone Had Immunity

Everyone who had ever been vaccinated against smallpox had some degree of immunity, Slifka told a meeting of the American Society for Microbiology.

The people came from 40 different states and 34 countries. "There isn't any difference, whether you are vaccinated in Oregon or Florida or France," Hammarlund told a news conference.

The smallpox vaccine uses a related virus called vaccinia. Various forms have been used in the past, but all gave good immunity, Slifka said.

"We specifically recruited people who were vaccinated ... several times," Slifka said. "It had very little effect." While there is a "burst" of immunity right after getting a vaccination, a person's overall immunity seems to return to a set point even after multiple immunizations.

But Slifka said it still makes sense to vaccinate health care workers, who, along with family members of victims, are the most likely to become infected in an outbreak. "There is a range of immunity out there," he said.

People with some immunity can still become ill, even if they are less likely to die of smallpox, and can pass the disease to others.

Hammarlund said at least half of those tested had high levels of antibodies that, in past studies done when smallpox was still around, protected them from serious infection.

"The CDC design right now is very rational," Slifka said.

But he said his team's findings suggest that, were there to be a smallpox attack, it would not be necessary to mass-vaccinate the population -- although the U.S. Health and Human Services (news - web sites) Department is stockpiling enough vaccine to do just that.

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Artificial Back Discs May Come to U.S.

By Lauran Neergaard
AP Medical Writer
The Associated Press
Tuesday, May 20, 2003

WASHINGTON - Russ Rice's back pain was so intense he could hardly walk. Two surgeries had failed to offer lasting help for his damaged spinal disc, and only large doses of painkillers got him through each day.

Then, as part of a study, doctors implanted an artificial disc in Rice's back. Just four days later, the California man returned to work, pain-free for the first time in over a year.

Artificial discs have long been used in Europe but remain experimental in this country. Two major studies nearing completion could change that: For the first time, scientists will know just how such implants compare to the only other alternative patients like Rice have had — major surgery to fuse together two vertebrae in the lower back.

Preliminary results are promising enough that doctors expect one artificial back disc to be on the U.S. market as early as next year.

Researchers aren't stopping there: Studies recently began of artificial discs designed for the more delicate neck, which don't bear as heavy a load but must be more moveable. And scientists hope to begin studies within a year of injections of collagen-like material to prop up a collapsing disc, buying time before more surgery is needed.

The bones of the spine have spongy discs between them — tough collagen rings surrounding a fluid-filled cushion — that act as shock absorbers, keeping verterbrae properly separated, cushioned and flexible.

But a disc damaged from injury or aging can cause intense pain, especially if nearby nerves are crunched or the disc degenerates enough that bone grinds on bone.

Back pain affects millions of Americans, and a degenerating disc is one of the main reasons. Time to heal and painkillers help most recover; some need special exercises.

But a small percentage need surgery, called a microdiscectomy, to remove damaged pieces.

When even that doesn't help, more than 200,000 Americans a year undergo spinal fusion — completely removing the degenerated disc and grafting the bones on either side together. It eases pain, but causes a problem: Freezing proper spinal motion puts more pressure on other discs below that spot. As many as 20 percent of fusion recipients need surgery for another disc problem in the next 10 years, says Dr. John Regan of Los Angeles' Cedars-Sinai Medical Center.

The hope is that an artificial disc, by allowing more movement, won't have that problem.

The earliest artificial discs failed miserably, says Dr. David Bradford of the University of the University of California, San Francisco. They could become dangerously loose in the spine.

Then in the late 1980s, European scientists developed different materials that stayed in place until they grew into the bone — and tracking of European patients suggests those discs offer significant pain relief with few side effects.

Two European models — the SB Charite and Prodisc — are the furthest in U.S. studies that, unlike the European research, directly compare the implants to spinal fusion to prove whether the artificial disc is as effective and safe as standard treatment.

Results of the Charite study — comparing how 300 patients fared two years after surgery — are due in December, and the Food and Drug Administration (news - web sites) is expected to evaluate that disc next year, Regan says.

Prodisc is still under study at about a dozen U.S. hospitals.

The discs are similar — metal plates pressed into the surrounding vertebrae that hold in place a soft plastic cushion. Preliminary results from both are promising, say Regan, who is studying the Charite (pronounced shar-ee-TEH) disc, and Prodisc investigator Bradford.

Another company, Medtronic Sofamor Danek, recently began U.S. studies of its own artificial disc.

However those studies turn out, doctors already know recovery from disc implantation is faster: Implant recipients are encouraged to start moving around the same day, while fusion patients are put in a back brace for three months while their bones meld.

"I'm only 40, so I didn't want a fusion — really, you're never the same after that," said Rice, a Santa Clarita, Calif., business executive who was dreading a plane trip abroad to get an artificial disc when he learned Regan had an opening.

He needed a midday nap for about a week after returning to work, but otherwise rapidly recovered. "Every day I wake up and I just thank the Lord because I'm like a new guy," he says.

Editor’s Note — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Study: Surgery May Help Some Emphysema Patients

By Gene Emery
Tuesday, May 20, 2003

BOSTON (Reuters) - A controversial treatment for emphysema may help some people with the disease breathe easier, but may do more harm than good for those with extensive lung damage, doctors reported on Tuesday.

The operation, known as lung volume reduction surgery, involves removing part of the lung in hopes of easing the breathing of people with emphysema, which affects two million U.S. smokers and ex-smokers and is linked to the death of 100,000 people each year.

The new study, presented on Tuesday at a Seattle meeting of the American Thoracic Society, showed that when diseased tissue was in the upper lobes of the lungs and a patient had little ability to exercise, surgery produced a significant improvement and cut the risk of death nearly in half.

Yet among patients who could still exercise, even though the emphysema had spread throughout their lungs, surgery doubled the risk of death.

"The findings provide critical new information for weighing the benefits and risks of lung volume reduction surgery for the treatment of severe emphysema," said researcher Steven Piantadosi of Johns Hopkins.

Co-author Dr. Robert Wise of Johns Hopkins said the findings can also determine which patients will respond well to surgery and which are at risk of complications.

Supporters of the operation said the new study validates their belief that it is an important treatment.

"The surgery improves patients' quality of life, which we believe is the most meaningful outcome for people with severe emphysema," said Joel Cooper of the Washington University School of Medicine in St. Louis. "In addition, the study confirms our more limited evidence that may add to life expectancy."

However, statistician James Ware sounded a note of caution in a commentary in the New England Journal of Medicine (news - web sites), where the study will be published on Thursday.

He said that among the 538 volunteers who underwent surgery, the benefits only lasted for two years and the overall death rate was not significantly lower than the 540 patients who did not.

The benefits for people with upper-lobe disease came to light only in an after-the-fact analysis of the data, which can be misleading, he said.

"The evidence does not meet the highest standard of proof," Ware said.

In an editorial in the journal, Jeffrey Drazen and Arnold Epstein said 30 percent of emphysema patients fall into a category where the risks of the surgery are clearly too high.

Among the other patients, they said, lung volume reduction surgery appears to have a benefit.

Source: The New England Journal of Medicine 2003;348:2055-2056,2059-2073,2092-2102,2134-2136.

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Hormone-Drug Combo May Help Bone Density

By Lindsey Tanner
AP Medical Writer
The Associated Press
Tuesday, May 20, 2003

CHICAGO - Hormone supplements plus a bone-building drug work better at increasing bone density than either treatment alone in older women, a study suggests.

The study involved 373 women ages 65 to 90 who had either thinning bones or full-blown osteoporosis and took one of four treatments for three years: hormones combined with alendronate, sold as Fosamax; hormones alone; Fosamax alone; or dummy pills.

Last summer, a study was published linking hormone supplements with heart attacks, strokes and breast cancer (news - web sites).

But the incidence of those problems was extremely low in the new study, said lead author Dr. Susan Greenspan, professor of medicine at the University of Pittsburgh. The hormones-Fosamax treatment "was safe and well-tolerated," said Greenspan, who has worked as a consultant for Fosamax maker Merck Research Laboratories.

Greenspan said her study suggests the hormones-Fosamax treatment may be an option for older women who face a severe risk of osteoporosis and bone fractures.

The findings appear in Wednesday's Journal of the American Medical Association (news - web sites).

The hormone study released last summer, the Women's Health Initiative, led many doctors to recommend against using hormone supplements for any reason other than relief of short-term menopause symptoms. And a WHI researcher, Jennifer Hays, said the new findings are not convincing enough to recommend hormones for osteoporosis prevention even in older women.

Hays, a Baylor College of Medicine psychologist, said the bone-enhancing benefits from estrogen come only after long-term use — which also carries the highest risk of breast cancer or heart disease.

The hormones used in the Fosamax study contained estrogen alone or estrogen-progestin.

After three years, hip bone density had increased nearly 6 percent in women on hormones plus Fosamax, 4 percent in those on Fosamax, and 3 percent in the hormones-only group. Increases also were seen in spinal bone density.

Higher bone density is usually associated with fewer fractures.

On the Net:



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Study: Beta-Carotene Pills May Promote Colon Polyps

By Jacqueline Stenson
Reuters Health
Tuesday, May 20, 2003

NEW YORK (Reuters Health) - Beta-carotene supplements appear to promote the recurrence of potentially pre-cancerous colon polyps in people who smoke and drink regularly, researchers reported Tuesday.

Their study is the latest to raise concerns about beta-carotene supplements in some people. Previous research found the pills might also increase the risk of lung cancer among those who smoke and drink.

"Beta-carotene supplements seem to work in an adverse way with regard to cancer when they're combined with smoking and/or alcohol," said study author Dr. John A. Baron, a professor of medicine at Dartmouth Medical School in Lebanon, New Hampshire.

The reason, however, is unclear. "We really don't understand what beta-carotene does," Baron told Reuters Health.

Beta-carotene is converted by the body into vitamin A. Researchers have thought beta-carotene acts as an antioxidant, mopping up cell-damaging substances called free radicals that may promote cancer.

And, in fact, Baron's team found that among patients who neither smoked nor drank, beta-carotene supplements were associated with a lower risk of polyp recurrence.

But the study, along with others, suggests beta-carotene might actually fuel cancer in some situations, such as when it is taken in high supplemental doses by people who also smoke and drink, Baron said.

His study involved 864 people who had colon polyps removed. Colon polyps are benign growths that can become cancerous.

In an effort to determine whether antioxidants help prevent polyps from recurring, the researchers divided the participants into four groups. They received either beta-carotene supplements, vitamins C and E, beta-carotene plus vitamins C and E, or placebo pills.

By the end of four years, complete study data, including information on smoking and drinking habits, was available for 707 participants.

None of the supplements had an overall impact on polyp recurrence. But when the researchers divided people into groups according to whether they smoked or drank, they did find effects for beta-carotene, according to results published in the May 21st issue of the Journal of the National Cancer Institute (news - web sites).

People who took 25-milligram beta-carotene supplements and also smoked and drank more than one alcoholic beverage a day were twice as likely to have a colon polyp recurrence as those who took placebo pills.

Smoking and drinking, individually, also appeared to promote recurrences among those taking beta-carotene, but not as much as when combined.

On the other hand, beta-carotene supplements seemed to benefit those who did not smoke or drink, reducing their risk by 44 percent.

But Baron said the findings do not provide strong enough evidence to recommend that these people should be taking supplements to ward off colon polyps or cancer.

"If anything, this study is an indictment of beta-carotene," he said.

In an accompanying editorial, Dr. Bernard Levin of the University of Texas M.D. Anderson Cancer Center in Houston pointed out that while beta-carotene supplements were linked to a greater risk of polyp recurrence in some study participants, that doesn't necessarily mean the pills actually promote colon cancer.

Source: Journal of the National Cancer Institute 2003;95:697-699,717-722.

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Lung Surgery May Help Some With Emphysema

By Mark Bryant
Associated Press Writer
The Associated Press
Tuesday, May 20, 2003

SEATTLE - Cutting out the diseased parts of the lungs in patients with severe emphysema can modestly improve their capacity to exercise and their overall quality of life, a landmark study shows.

The surgery was first done in the 1950s and became popular in the 1990s as a way of restoring breathing power to victims of emphysema, which is otherwise irreversible and contributes to 100,000 deaths annually in the United States.

However, without a carefully controlled study, there was little clear proof that the operation actually improves people's lives. As a result, Medicare imposed a moratorium on paying for the surgery in the mid-1990s and sponsored a large study to examine its benefits.

The results, released Tuesday, show that fewer than one in five have meaningful improvement in their symptoms, and the operation has no effect on long-term survival. Nevertheless, the approach does help some patients, especially those with emphysema damage in the upper portion of the lungs.

The operation involves cutting away diseased portions of the lungs. Typically doctors take out about one-quarter to one-third of their total lung tissue, hoping to help the good parts of the lung work more freely and efficiently by removing the damaged bulk around them.

Lung reduction surgery "will likely be remade in the context of this trial and come back stronger than ever," said Dr. Keith Naunheim, chief of thoracic surgery at St. Louis University and a principal investigator of the National Emphysema Treatment Trial.

"The conclusions are rock solid. This is a very well-done trial," said Dr. Robert Cerfolio, chief of thoracic surgery at University of Alabama at Birmingham and one of the reviewers of the study.

However, he estimated that only about 10 percent of those with emphysema are suitable for the operation. Several doctors involved in the study said the number may be as low as 5 percent.

The study results were released at a meeting in Seattle of the American Thoracic Society and also will be published in Thursday's issue of the New England Journal of Medicine (news - web sites).

Researchers said their results will help doctors determine the best candidates for surgery — what Dr. Malcolm DeCamp of the Cleveland Clinic Foundation called the "green-light group."

The study, begun in 1996, was conducted on 1,218 men and women at 17 hospitals around the country. They were randomly assigned either to get the operation or standard medical therapy.

After one year, 16 percent of the patients getting the surgery had significantly increased their exercise capacity as measured on an exercise bike, compared with 3 percent on medical treatment. On questionnaires, they also rated their quality of life as better. However, after two years, their conditions had returned to about the same levels as before the procedure.

The procedure was pioneered decades ago by Dr. Otto Brantigan, a Baltimore surgeon, but it quickly fell out of favor because of the high mortality rate — about one in five. In the early 1990s, Dr. Joel Cooper, a St. Louis surgeon, began doing the operation on emphysema sufferers too sick or old for lung transplants. Changes in surgical techniques had improved survival rates, and other doctors quickly began doing lung-volume reduction surgery.

"It spread across the country to other medical centers like wildfire," said Dr. Joshua Benditt, director of respiratory care services at the University of Washington Medical Center, who also was involved in the study.

Anecdotal evidence suggested the surgery was effective, but there were no studies of its worthiness. There also was the question of cost for the operation, which averages $35,000 and offers no cure, just relief for some patients.

"We know it's expensive and have to be careful about who gets the procedure," said Dr. Scott Ramsey of Fred Hutchinson Cancer Research Center, who directed an analysis of the operation's cost effectiveness.

Dr. Sean Tunis, a Medicare official, said the agency will reassess coverage for the operation and make new recommendations based largely on the latest study.

The study found that the surgery was most likely to help people whose emphysema was mostly in the upper lobes of their lungs and whose exercise capacity was low. Researchers said one contribution of the study is identifying those for whom the operation is especially risky.

On the Net:

New England Journal of Medicine:

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Tea Compounds May Fight Bad Breath

By Linda Carroll
Reuters Health
Tuesday, May 20, 2003

NEW YORK (Reuters Health) - Compounds found in tea can slow the growth of bacteria linked to bad breath, according to a study released Tuesday -- though researchers say you shouldn't throw out your mouthwash yet.

Antioxidants called polyphenols, which are found in both green and black tea, can block bacteria from producing foul-smelling compounds such as hydrogen sulfide, researchers reported at the annual meeting of the American Society for Microbiology in Washington, D.C.

Bad breath, or halitosis, is caused by anaerobic bacteria that live on the back surface of the tongue and in the gum pockets -- deep spaces between the gums and the teeth, according to the study's lead author, Christine D. Wu of the College of Dentistry at the University of Illinois at Chicago.

The bacteria "make horrible, smelly stuff," Wu said in an interview with Reuters Health. "That's why we get bad breath."

Earlier studies by Wu and her colleagues showed that black tea could slow dental plaque formation.

The researchers suspected that certain compounds in the tea might be affecting the growth of bacteria and thus the production of bad-smelling compounds.

In a laboratory study, Wu and her colleagues incubated tea polyphenols with three species of halitosis-causing bacteria for 48 hours. At concentrations that were lower than what is normally found in tea, the polyphenols inhibited the growth of these bacteria, Wu said.

At even lower concentrations, polyphenols hindered an enzyme that spurs the formation of the malodorous hydrogen sulfide.

The researchers tested two types of polyphenols: catechins and theaflavins. Catechins are found in both green and black tea, while theaflavins are found mostly in black tea.

The results don't prove that tea sweetens breath, Wu allowed.

"All we can say is that a cup of tea will produce more than enough of these active materials to affect the bacteria," she said. "Remember, this is a lab study. In the mouth, bacteria are protected by all sorts of things."

Wu hopes to look at the effects of tea on bad breath in future studies.

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Finding Clues to Rheumatic Diseases

Tuesday, May 20, 2003

TUESDAY, May 20 (HealthScoutNews) -- Four hundred families with twins or pairs of close brothers or sisters are being sought to take part in a study examining the causes of rheumatic diseases.

Specifically, the study by the U.S. National Institute of Environmental Health Sciences is looking for volunteer families in which one twin or one of a pair of close siblings has rheumatoid arthritis, polyarticular juvenile rheumatoid arthritis, lupus, systemic sclerosis or idiopathic inflammatory myopathy.

The other same-gender twin or sibling must be free of these diseases. Both children and adults are eligible to take part in the study, along with their parents.

The researchers note that, even in identical twins, the chances are more than 50 percent that one twin will have a rheumatic disease and the other will not.

That leads scientists to suspect that a combination of genetic variations and environmental exposures may be involved in the development of these rheumatic diseases.

This study will examine a number of environmental exposures such as drugs, vaccines, bacteria, viruses, dietary supplements, stress, occupational exposure and ultraviolet light.

Study volunteers will be followed for five years and be required to give blood and urine samples that the researchers will use to test for environmental exposures and minor gene variations that may increase susceptibility to rheumatic diseases.

To quality for the study, brother and sister pairs must be within 47 months of age of each other. For more about the study, you can call 1-800-411-1222 (TTY: 1-866-411-1010) or you can go to this Web site.

More information

Here's where you can learn more about rheumatic diseases.

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Office Rectal Exam for Colorectal Cancer Doubted

By E. J. Mundell
Reuters Health
Tuesday, May 20, 2003

ORLANDO (Reuters Health) - It's an unpopular procedure for patients and doctors alike, and new research suggests that office-based digital rectal exams aimed at detecting colorectal cancers may not even be useful in spotting disease.

Instead, researchers advise skipping the in-office rectal examination, waiting instead for a more thorough exam at the time of colonoscopy.

"Now that colonoscopy is routinely available, I think it's reasonable -- and I think many doctors are actually already doing this -- not to stick with routine rectal examination in the office," said Dr. Louise Langmead of the University of Sydney Concord Hospital in Australia.

She presented the findings here Monday at Digestive Disease Week, the largest annual gathering of gastroenterologists in the world.

In a digital rectal exam, a gloved physician uses a finger to try to detect suspicious growths in a non-sedated patient. While the procedure is usually painless, for most patients "it's not a comfortable procedure -- it's undignified," Langmead said in an interview with Reuters Health.

Usually, patients with symptoms suggestive of colorectal cancer will also receive a digital rectal exam at the time of their colonoscopy, when they are under sedation. When questioned, most of the patients in Langmead's study said that, if given a choice, they would much prefer undergoing the digital exam at that time, rather than while wide awake in their doctor's office.

So how useful is the in-office rectal exam? In their study, Langmead and her colleagues looked at the location of tumors in 68 patients with colonoscopy-confirmed rectal cancers.

One limitation of the digital rectal exam is that "it is dependent on the length of the person's finger who performs it," Langmead said. Her team judged the length of the average index finger to be roughly 7 centimeters (about 2.75 inches).

Looking over the medical records of the 68 patients, the researchers found that cancers in a full 45 were located beyond that 7-centimeter range, meaning they would most likely have been missed during a digital exam.

Furthermore, factors such as the presence of stool in the rectum mean that the test is generally assumed to have about a 75 percent detection rate.

All this means that, according to the researchers' calculations, physicians would have to perform "280 rectal examinations to detect one cancer," Langmead said. "And this is in patients who are going to have a rectal examination at the time of their colonoscopy anyway."

She points out there are no official guidelines dictating that doctors perform these exams when looking for colorectal cancers -- just "conventional wisdom" stemming from a period before the advent of colonoscopy and other high-tech diagnostic tools.

"I think patients could be asked their opinion on it -- would they like to have it now or would they like to wait until colonoscopy?," she said. "So my recommendation would really be 'ask the patient'."

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Chocolate May Extend Your Life

Tuesday, May 20, 2003

(HealthScoutNews) -- Here's one for all you candy lovers out there.

A study reported in the prestigious British Medical Journal suggests that people who regularly eat candy live up to a year longer than those who deprive themselves.

The study looked at the 1998 health records of 7,841 men, who entered Harvard as undergraduates between 1916 and 1950. And it found that people who ate modest amounts of candy bars, from one to three a month, had a 36 percent lower risk of death than those who abstained.

The researchers say that antioxidant phenols in the chocolate portion of the candy probably are responsible for the added longevity. They say the amount of phenols in a 1.5-ounce chocolate bar is about the same as in a glass of red wine.

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'Fantastic Voyage' Into Gut Nearer to Reality

By E. J. Mundell
Reuters Health
Tuesday, May 20, 2003

ORLANDO (Reuters Health) - Once the stuff of science fiction, tiny, remote-controlled capsules could soon be used to diagnose and even treat illnesses anywhere in the human gut, according to researchers.

Such a wireless (news - web sites), video-equipped capsule -- about half the size of a grape -- has been swallowed and tested in the first human volunteer, they reported here Monday at the annual Digestive Disease Week conference.

Using a radio-guided control box, the researchers were able to "move the capsule, go backwards and look at something again," said Dr. Annette Fritscher-Ravens of the University of London.

"It's the future of wireless capsule therapy," she said.

Until recently, patients with unexplained gastrointestinal illness had only a few options when it came to diagnosis -- CT scans or MRI, endoscopy, or surgical interventions. Each has its limitations, and researchers have long sought a method of clearly viewing the inside of the entire length of the gastrointestinal tract without having to resort to surgery.

Within the last decade, researchers developed tiny, video-equipped capsules that are swallowed and then passed through the body via the normal movement of the gut.

But relying on the gut to propel the capsule forward has had its problems.

"Sometimes it runs quickly or runs very little," Fritscher-Ravens said, which can keep the capsule sitting for hours in an area of little interest, while speeding it past areas doctors want to linger on.

What was needed was a method of controlling the capsule from the outside.

Fritscher-Ravens and her colleagues say they have patented just such a method. Using technology very similar to that found in TV remotes or electronic car-keys, they attached tiny electrodes to the front and rear portions of the video capsule, along with a tiny antenna. Using a drive/reverse switch, they have been able to steer and propel the capsule through the gut, lingering wherever a lesion or other suspicious formation occurs.

After first testing the device in pigs, "we were able, in man, to steer the capsule backwards and forwards and stop it," Fritscher-Ravens told reporters at the meeting.

Safety was always a concern, but the device only requires 5 milli-amps of power. "This is very, very little power -- much less power than would interfere with a heart rate or anything," the researcher said.

The capsule, which is meant to be disposable, safely passes through the gut and is flushed away with a regular bowel movement.

Speaking with Reuters Health, Fritscher-Ravens and co-researcher Dr. C. Paul Swain (who was the first human test subject) said they expect the device to go through further trials and then be submitted for approval by the U.S. Food and Drug Administration (news - web sites) within the next two to three years.

They have high hopes for the capsule. Someday, the device might be made to travel through the gut and grab tiny pieces of tissue for biopsy. It might even be used to treat disease, possibly eliminating the need for surgery, according to the researchers.

"Right now, with this capsule we can see (a lesion), but we can't treat it," Fritscher-Ravens said. However, she envisages a future where "you can swallow two capsules that come together, and then you can just fire a laser at the lesion."

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Hearing Aides

Tuesday, May 20, 2003

(HealthScoutNews) -- If you're talking on the telephone in a noisy room, you're apt to hear specific words better if you put the receiver to your right ear.

That's because your right ear is wired more directly to the part of the brain that processes language (even though, ironically, that part is on the left side of your brain), says author David Bodanis in his book, The Secret Family.

Tests have shown that if two words are broadcast to someone wearing earphones, the word coming from the right will be better understood, writes Bodanis.

To prove the point, he suggests you try tapping your right finger while you repeat the words someone is saying to you. Because using your right finger uses up some of the language-processing area on the left side of your brain, Bodanis says you'll do better by tapping your left finger while doing the experiment.

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MONDAY, MAY 19, 2003

'Electronic Nose' Sniffs Out Lung Cancer: Study

By Charlene Laino
Reuters Health
Monday, May 19, 2003

SEATTLE (Reuters Health) - A novel "electronic nose" shows promise for sniffing out lung cancer, a new study suggests.

If the biosensor pans out in future trials, it could offer a fast, non-invasive way of detecting the number-one cancer killer in the United States, researchers said.

Known as the Cyranose, the device picks up the scent of certain compounds exhaled in the breath of lung cancer patients, according to the team led by Dr. Roberto F. Machado, a fellow at the Cleveland Clinic in Ohio.

In a study of 59 people, the electronic nose was able to distinguish between those who had lung cancer and those who did not, Machado reported here at the American Thoracic Society International Conference.

Cyranose takes advantage of the fact that human breath contains a mixture of hundreds of volatile chemicals. In a person with lung cancer, there is a distinct mixture of these chemicals that is high in alkanes and benzene derivatives.

When a person breathes into the device, dozens of sensors go to work, hunting down any chemicals that are present and generating a "smellprint" that can be seen on a video display monitor.

Machado tested whether the device could detect lung cancer on the basis of its smellprint in 14 people with lung cancer, 25 with other lung disorders and 20 healthy people.

"The person just blows out and the device analyzes their breath," Machado said.

The pattern produced by the lung cancer patients showed a distinct pattern that was different from that produced by either the other lung disease patients or healthy people, he reported.

But the differences were small, the researchers said, and further refinement to improve the sensitivity of the nose for sniffing out lung cancer is needed before proceeding to larger trials.

Nevertheless, the Cyranose is a "promising, exciting technology," said Dr. Constance Jennings of the Cleveland Clinic, who was not involved with the study.

"It might allow for earlier diagnosis of lung cancer patients," she told Reuters Health. "And it's well established that the earlier you find a lung cancer, the more treatable it is."

The device could also potentially be used to monitor lung cancer patients undergoing treatment for disease recurrence, Machado said.

Cyranose is made by Cyrano Sciences of Pasadena, Calif., which helped fund the trial.

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New Back Discs Move Closer to U.S. Use

By Lauran Neergaard
AP Medical Writer
The Associated Press
Monday, May 19, 2003

WASHINGTON - Russ Rice's back pain was so intense he could hardly walk. Two surgeries had failed to offer lasting help for his damaged spinal disc, and only large doses of painkillers got him through each day.

Then, as part of a study, doctors implanted an artificial disc in Rice's back. Just four days later, the California man returned to work, pain-free for the first time in over a year.

Artificial discs have long been used in Europe but remain experimental in this country. Two major studies nearing completion could change that: For the first time, scientists will know just how such implants compare to the only other alternative patients like Rice have had — major surgery to fuse together two vertebrae in the lower back.

Preliminary results are promising enough that doctors expect one artificial back disc to be on the U.S. market as early as next year.

Researchers aren't stopping there: Studies recently began of artificial discs designed for the more delicate neck, which don't bear as heavy a load but must be more moveable. And scientists hope to begin studies within a year of injections of collagen-like material to prop up a collapsing disc, buying time before more surgery is needed.

The bones of the spine have spongy discs between them — tough collagen rings surrounding a fluid-filled cushion — that act as shock absorbers, keeping verterbrae properly separated, cushioned and flexible.

But a disc damaged from injury or aging can cause intense pain, especially if nearby nerves are crunched or the disc degenerates enough that bone grinds on bone.

Back pain affects millions of Americans, and a degenerating disc is one of the main reasons. Time to heal and painkillers help most recover; some need special exercises.

But a small percentage need surgery, called a microdiscectomy, to remove damaged pieces.

When even that doesn't help, more than 200,000 Americans a year undergo spinal fusion — completely removing the degenerated disc and grafting the bones on either side together. It eases pain, but causes a problem: Freezing proper spinal motion puts more pressure on other discs below that spot. As many as 20 percent of fusion recipients need surgery for another disc problem in the next 10 years, says Dr. John Regan of Los Angeles' Cedars-Sinai Medical Center.

The hope is that an artificial disc, by allowing more movement, won't have that problem.

The earliest artificial discs failed miserably, says Dr. David Bradford of the University of the University of California, San Francisco. They could become dangerously loose in the spine.

Then in the late 1980s, European scientists developed different materials that stayed in place until they grew into the bone — and tracking of European patients suggests those discs offer significant pain relief with few side effects.

Two European models — the SB Charite and Prodisc — are the furthest in U.S. studies that, unlike the European research, directly compare the implants to spinal fusion to prove whether the artificial disc is as effective and safe as standard treatment.

Results of the Charite study — comparing how 300 patients fared two years after surgery — are due in December, and the Food and Drug Administration (news - web sites) is expected to evaluate that disc next year, Regan says.

Prodisc is still under study at about a dozen U.S. hospitals.

The discs are similar — metal plates pressed into the surrounding vertebrae that hold in place a soft plastic cushion. Preliminary results from both are promising, say Regan, who is studying the Charite (pronounced shar-ee-TEH) disc, and Prodisc investigator Bradford.

Another company, Medtronic Sofamor Danek, recently began U.S. studies of its own artificial disc.

However those studies turn out, doctors already know recovery from disc implantation is faster: Implant recipients are encouraged to start moving around the same day, while fusion patients are put in a back brace for three months while their bones meld.

"I'm only 40, so I didn't want a fusion — really, you're never the same after that," said Rice, a Santa Clarita, Calif., business executive who was dreading a plane trip abroad to get an artificial disc when he learned Regan had an opening.

He needed a midday nap for about a week after returning to work, but otherwise rapidly recovered. "Every day I wake up and I just thank the Lord because I'm like a new guy," he says.

Editor’s Note — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Scientists Develop First 'Knock-Out' Rat

By Linda Carroll
Reuters Health
Monday, May 19, 2003

NEW YORK (Reuters Health) - For years, scientists have tried to find a way to delete certain genes from a rat so they could learn more about the functions of those genes.

Now, Wisconsin researchers have found a way to create "knock-out" rats that lack two breast cancer (news - web sites) genes, according to a study published in the advance online edition of the journal Nature Biotechnology.

Knock-out mice have been available for research for the past 10 years, according to study co-author Michael N. Gould, a professor of oncology at the University of Wisconsin in Madison.

But, while the rat is a better model for certain diseases, such as breast cancer, the technology to produce a rat with knocked-out genes has eluded researchers -- until now, Gould said in an interview with Reuters Health.

"We came up with an alternate procedure that allowed us to knock out specific genes -- BRCA-1 and BRCA-2 -- in the rat," Gould said.

These two genes are thought to suppress the growth of breast cancer. Mutations in BRCA1 and BRCA2 are linked to an increased risk of breast and ovarian cancer.

Rats are a better model for breast cancer than mice, Gould said, because their tumors are more similar to human tumors. For example, breast cancers in rats, unlike mice, are sometimes responsive to hormones.

"Tamoxifen, for example, was found in rat experiments," Gould said. "This wouldn't have been found in mouse experiments because mouse tumors aren't responsive to hormones."

Tamoxifen is a drug used to treat breast cancer that is sensitive to the effects of estrogen.

To produce knock-out mice, researchers simply need to collect embryonic stem cells, remove the gene of choice and then allow the stem cells to develop into a mouse, Gould explained.

This technique doesn't work with rats, he explained.

To create knock-out rats, Gould and his colleagues injected male rats with a chemical that causes mutations in the stem cells of the testes, Gould said. Sperm that are formed after the injections will be missing a variety of genes, he added.

When the injected rats are bred with normal rats, their offspring end up with multiple genes knocked out, Gould said. "Each one of these offspring will have about 20 to 30 out of about 30,000 genes knocked out."

Gould and his colleagues next devised a test to figure out which genes are knocked out in the offspring.

"So if you screen a thousand rats, maybe one will be the mutation you're looking for," Gould said. "Then this rat can be used for biomedical research."

Source: Nature Biotechnology advance online publication 2003;10.1038/nbt830.

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Physical Therapy Can Help Reset Brain

Reuters Health
Monday, May 19, 2003

WASHINGTON - Physical therapy changes the way body parts are represented in the brain, a finding researchers hope will lead to improved therapies.

A team of researchers in Germany and the United States studied 10 musicians suffering from focal hand dystonia, which causes the hands to cramp into abnormal positions and make uncoordinated movements.

The musicians underwent therapy in which parts of their hands were immobilized with a splint while they exercised. The magnetic currents in the patients' brains were measured before therapy and after it had been under way for eight days.

Before the therapy the brains had an abnormal representation of the hand, according to the team led by Victor Candia of the University of Konstanz, Germany.

After treatment of the hand, manual dexterity was improved and the brain representation of the affected hand became more like that of the normal hand.

The study "demonstrates that in the case of motor disorders, but also for other brain disorders — for example after brain injury — highly specific therapeutic plans have to be developed," Candia said.

Such research, he said, combined with other studies under way, can help in the development of new therapies and improve rehabilitation of motor and sensory disorders.

Working with Candia were other researchers at Konstanz and at Pennsylvania State University.

On the Net:

Proceedings of the National Academy of Sciences (news - web sites):

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New Treatment Option for Advanced Breast Cancer

By Patricia Reaney
Monday, May 19, 2003

LONDON (Reuters) - A drug that works in a different way from other hormone therapies may offer women with advanced breast cancer (news - web sites) a new treatment option, doctors said on Monday.

Trilostane, which is marketed by biotechnology company Bioenvision under the brand name Modrenal, has two mechanisms that slow down the disease in post-menopausal women with hormone-sensitive cancer that has spread beyond the breast.

"Modrenal certainly inhibits breast cancer cell proliferation," said Professor Gavin Vinson, a biochemist at the University of London.

In clinical trials of the drug in more than 700 women who no longer responded to other hormone therapies, 35 percent responded to Modrenal.

"It acts in a way that no other drug does," Vinson told a breast cancer symposium.

In hormone-sensitive breast cancer, the female hormone estrogen drives cancer cell growth by acting on two receptors in the cell. ER alpha acts like an accelerator for the cancer and ER beta is the brake to slow it down.

Modrenal increases oestrogen binding to ER beta and decreases its impact on ER alpha. It also acts on another site in cell DNA called AP1 to reduce cell proliferation.

Tamoxifen, the most widely prescribed drug for breast cancer, has been credited with improving survival of women with the illness, by neutralizing the action of oestrogen. Another class of drugs called aromatase inhibitors suppresses the production of oestrogen in post-menopausal women.

Modrenal was tested in post-menopausal women whose tumors failed to respond to the other treatments.

"These results underline the significance of Modrenal as a breast cancer treatment, and explain why the drug can provide doctors with a therapeutic option when choices for the patients are fast running out," said Dr. Chris Wood, the chief executive of Bioenvision.

When asked about side effects, Wood said the drug is well tolerated but can cause stomach upset and diarrhea.

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Eat As I Eat

Monday, May 19, 2003

MONDAY, May 19 (HealthScoutNews) -- Parents need to remember they're important role models for their children's eating habits, says the American Dietetic Association (ADA).

A survey of 1,230 parents and children by the ADA Foundation found parents have more potential to influence their children's eating habits than anyone else. The Family Nutrition and Physical Activity Survey asked about the parents' and children's attitudes and behavior regarding weight, eating habits and physical activity.

Children aged 8 to 12 said their top role models were:

  • Mother - 23 percent.
  • Father - 17.4 percent.
  • No role model or unsure - 13.2 percent.
  • Sports celebrity - 8.3 percent.

For children aged 13 to 17 years old, the top responses were:

  • Mother - 13.8 percent.
  • No role model or unsure - 13.4 percent.
  • Sports celebrity - 11.9 percent.
  • Father - 11.3 percent.

The survey found girls were more likely to identify their mother as a role model, while boys more often selected their father. Actresses, actors and music celebrities were also named as role models by the children.

"These findings underscore the importance of a parent's involvement in helping their children make good choices in life, including dietary choices," ADA spokesperson Sheah Rarback says in a news release.

"Research has found strong links especially between the food mothers eat and the choices made by their children. And children's eating behaviors are influenced by such family-related factors as the number of meals eaten together. By eating healthy foods themselves and making sure to offer them to their children, parents can give their kids opportunities to learn to like a variety of nutritious foods," Rarback says in the release.

She also notes the survey found that the role of parents as role models decreased children grew older. That offers more evidence that parents have to positively influence their children at an early age.

More information

Here's where you can learn more about healthy eating.

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Couric's Group Launches Free CD-ROM on Colon Health

By E J. Mundell
Reuters Health
Monday, May 19, 2003

ORLANDO (Reuters Health) - Five years after losing her husband to colon cancer, NBC Today show host Katie Couric is launching another salvo against the disease.

On Monday, The National Colorectal Cancer Research Alliance, a nonprofit group Couric helped create in 2000, announced the launch of a free, 3-hour CD-ROM aimed at encouraging routine colon screening.

"There's a lot of really solid information on there and our goal is to take the fear factor out for patients," said Judi Ketcik, vice president of communications at the Entertainment Industry Foundation, which is partnering with the NCCRA to produce and distribute the CD-ROMs.

Ketcik spoke here Monday at Digestive Disease Week, the largest annual gathering of gastroenterologists in the world.

Colon cancer is the second leading cause of cancer death in the U.S., but it is also 90 percent curable when spotted early. The key to early detection is regular colon screening to look for cancer or suspicious growths called polyps.

To catch cancer early, the American Cancer Society (news - web sites) advises men and women to undergo regular screening for colorectal cancer beginning at age 50. There are several types of screens, including flexible sigmoidoscopy, barium enema, colonoscopy and a test that looks for blood in the stool.

According to Ketcik, the CD-ROM is designed to take the mystery out of a screening procedure called a colonoscopy.

"There are about 3 hours of video and you can learn about prevention, all about the test -- you actually see how a colonoscopy is done," Ketcik said.

Besides Couric's award-winning Today show segment -- where millions of viewers looked on as the newscaster underwent live colonoscopy -- footage of two other colonoscopy procedures are featured. Users can also access a list of important Web sites, medical articles and other information resources.

"This is just one more step in just really fully understanding what the colon cancer test is and why you shouldn't be afraid of it," Ketcik said in an interview with Reuters Health.

"Hopefully it will help patients be more able to talk more about their symptoms, ask questions about why I should have one test over another -- whatever it takes to get them in to get tested for colon cancer."

NCCRA intends to distribute the CD-ROMS in doctors' offices nationwide. For a "sneak peek" at the product, go to

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Uncovering Clues to Cancer

Monday, May 19, 2003

MONDAY, May 19 (HealthScoutNews) -- A new gene-profiling technique that can define complex patterns of gene activity in tumors that have different genetic origins has been developed by researchers at Duke and Georgetown universities.

The technique provides more detailed information about the subtle differences in gene activity associated with cancer-causing pathways. In future, that may let doctors tailor cancer treatments to individual patients and better predict disease outcomes.

The research was published May 19 in Nature Genetics.

Mutations in individual cancer-causing genes, called oncogenes, result in reduced or increased activity in hundreds of other interacting genes. Rather than focusing on single genes, this new technique uses a wider view of the many shifts in gene activity that's characteristic of cancers that have a specific genetic cause.

"The gene profiles allow us to be much more precise. Now, we can find subtleties among tumors that we can't see under the microscope and also uncover the biology to better understand the basis of the disease," study co-author Joseph Nevins, a professor of molecular genetics and microbiology at Duke University, says in a news release.

Nevins says this new gene-profiling technique is an example of the power of genomics and statistics in helping develop a personalized approach to medicine.

More information

Here's where you can learn more about cancer genetics.

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Head Injuries May Hike Risk of Parkinson's Disease

By Jacqueline Stenson
Reuters Health
Monday, May 19, 2003

NEW YORK (Reuters Health) - People who sustain substantial head injuries may face an increased risk of developing Parkinson's disease (news - web sites) years later, new study findings suggest.

Overall, those who had experienced head trauma were about four times more likely to develop the neurological disease than those who never had such injuries, results showed.

But only the more severe forms of head trauma appeared to raise the odds of developing Parkinson's. People with mild head injuries who did not lose consciousness or experience memory loss lasting at least 30 minutes faced no increased risk, according to findings published in the journal Neurology.

However, those who had experienced head trauma involving a loss of consciousness, skull fracture, prolonged memory loss or more severe complications were 11 times more likely to develop Parkinson's disease than those who had never sustained head trauma.

"I was surprised by the strength of the association," said study author Dr. James H. Bower, a neurologist at the Mayo Clinic in Rochester, Minnesota.

An average person's lifetime risk of developing Parkinson's is 1.7 percent, so those with the more severe head trauma may face almost a 20 percent risk, Bower explained.

Parkinson's is a progressive brain disease characterized by tremors, muscle stiffness, a shuffling walk and difficulty with balance and coordination.

Previous studies have reached conflicting conclusions about whether head trauma is associated with Parkinson's. One of the reasons researchers have suspected a link is that boxers are known to be at risk for a condition called dementia pugilistica that has some Parkinson's-like symptoms.

A strength of the new study is that it is the first to rely on medical records of head trauma rather than on patient recall of such events, the researchers noted.

The study involved 196 patients who developed Parkinson's disease from 1976 to 1995. Patients' medical records were compared with those of another 196 people who did not have the disease.

A total of 16 head traumas of any kind were identified, 13 (6.6 percent) among those who later developed Parkinson's disease and three (1.5 percent) among those who did not.

Among those who developed Parkinson's, the lag time between head trauma and the onset of the disease ranged from three to 55 years, according to the report.

Doctors don't know exactly what causes Parkinson's disease though they have identified genetic underpinnings and suspect pesticides and other factors may play a role.

"We are by no means saying we have found the cause of Parkinson's disease," Bower said. "This is potentially one cause of this disease. There are probably many different causes."

In the report, the researchers raise a few theories about how head trauma might promote Parkinson's disease.

One possibility, according to Bower's team, is that the blood-brain barrier becomes disrupted during head trauma, allowing damaging proteins or other substances in blood to enter the brain.

Another potential explanation is that head trauma causes the brain to make destructive proteins. And a third possibility, the researchers suggest, is that head trauma kills brain cells immediately, and over time further brain cell loss from natural aging fuels the disease.

While there's no proven way to prevent Parkinson's disease, Bower said, everyone should take precautions to avoid head injuries.

"People in contact sports really need to wear protective head gear," he advised. The same goes for bikers, skiers, skateboarders and others who might be at risk, he added.

Source: Neurology 2003;60.

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In Need of TLC

Monday, May 19, 2003

(HealthScoutNews) -- Loneliness is a major contributor to a bad diet among elderly Americans.

Studies have found that both elderly men and women who live alone get significantly fewer dietary vitamins and minerals than married people, according to a report in the Washington Post.

"It's not that older people who lived alone chose food that was less nutritious than foods chosen by those who lived with a spouse. They simply were eating less of it, missing meals more often," says the article.

"There perhaps is no greater deterrent to eating well than having to sit down to meals alone," particularly for people who have lost a loved one, writes reporter Lawrence Linder. "They simply may not have the heart to prepare wholesome repasts that will be eaten while they stare at the four walls."

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Asian Americans at High Risk for Hep C Liver Cancer

By E. J. Mundell
Reuters Health
Monday, May 19, 2003

ORLANDO (Reuters Health) - Asian Americans infected with the hepatitis C virus have four times the risk of developing liver cancer compared with U.S. whites at a similar stage of infection, according to a new study.

Hepatitis C, which can be passed through tainted blood transfusions, dirty needles or sexual contact, is a leading cause of liver cancer, accounting for 50 percent of new liver cases in the U.S., according to Dr. Mindie Nguyen of the University of California, San Francisco.

Nguyen, who presented her findings here Sunday at the Digestive Disease Week conference, said other studies have shown especially high rates of liver cancer in minority populations, especially Asians and blacks.

Her team focused specifically on 496 San Francisco-area patients with hepatitis C whose infection had resulted in cirrhosis, a disease characterized by scarring of the liver.

Taking ethnicity into account, the researchers looked back at each patient's medical records, comparing the race of those who developed liver cancer with those who did not.

According to Nguyen, Asian Americans "had significantly higher risk for liver cancer as compared to the Caucasian group."

Asian Americans infected with hepatitis C had four times the risk of developing cancer compared to white patients, even after factoring in age, gender, and severity of liver disease, she said.

The reason for this disparity remains unclear. One reason could be overall duration of hepatitis C infection. Hepatitis C can be a "silent killer," causing little or no symptoms for years while it begins its slow assault on the liver.

According to Nguyen, "many Asian patients may have been infected during childhood, so at a similar age as a Caucasian patient they may have been infected for 20 or 30 years longer."

Other factors, such as co-infection with hepatitis B (another liver cancer risk factor), drinking and smoking rates, and access to health care, may also play a role. Nguyen said a new study, one that follows patients over time, is already underway to investigate these factors.

Finally, genetics could be key in rendering Asian American more vulnerable to hepatitis C-linked liver cancer. Nguyen said she believes "a comparative genetics study of liver cancer in an ethnically and racially diverse population is also needed."

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Tracking Down Endometrial Cancer

Monday, May 19, 2003

MONDAY, May 19 (HealthScoutNews) -- Checking for mutations in a certain gene in younger women who have endometrial cancer may help identify families who are at risk for inherited cancers.

That's the claim of researchers at Washington University School of Medicine in St. Louis.

Their study of 441 women with endometrial cancer found that at least 1.6 percent of women with endometrial cancer have mutations in a gene called MSH6. That frequency is comparable to that for the most common inherited form of colon cancer.

Further research suggests that mutations in the MSH6 gene may be associated with a higher chance that the women and members of her family will develop certain kinds of cancer later in life.

The study appears in a recent issue of the Proceedings of the National Academy of Sciences (news - web sites).

The findings suggest more women than previously believed have mutations that indicate they have an inherited susceptibility to cancer. The findings may also explain why cancer seems to run in families that don't have mutations in other genes associated with cancer susceptibility.

Endometrial cancer is the most common gynecologic cancer and the fourth most common cancer in women. About 39,300 women in the United States were diagnosed with endometrial cancer last year, and 6,600 died from it.

More information

Here's where you can learn more about endometriosis.

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Light Drinking May Keep Colon Polyps at Bay: Study

By E. J. Mundell
Reuters Health
Monday, May 19, 2003

ORLANDO (Reuters Health) - Raise a glass or two to your colon's health: new research suggests moderate drinking may help prevent the growth of cancer-linked polyps.

"It didn't matter what type of alcohol it was -- beer, wine, distilled spirits -- we found the same relationship," explained researcher Dr. Rajeev Jayadevan, of Our Lady of Mercy Medical Center in New York City.

Colon cancer remains a leading cause of cancer death. However, experts now recommend routine colon cancer screening for every adult over 50 years of age, to help spot suspicious growths called polyps.

"If they're left alone for long enough, some of them will grow to become cancers," Jayadevan explained.

He and his team of researchers wondered if specific lifestyle factors might influence the risk of polyp development. They asked over 600 healthy, older adult patients coming into their hospital's endoscopy unit to fill out questionnaires detailing diet, smoking, drinking and medical histories prior to undergoing a screening test called colonoscopy. Polyps were found in 30 percent of patients.

According to Jayadevan, "the main findings were that if you are a mild-to-moderate drinker, you're less likely to have a colon polyp than if you're not a drinker."

In fact, risk for polyps dropped a full 80 percent in the light-drinking group compared with teetotalers, the researchers found. They defined mild-to-moderate drinking as about one or two drinks daily.

How might a glass or two of beer or wine a day help prevent polyps? Jayadevan speculated that alcohol may help suppress the activity of oncogenes, specific genes that are thought to spur the growth of both benign polyps and malignant tumors.

He stressed that only light drinking appears to benefit colon health. In fact, "as the amount of alcohol consumption increases, the heavy drinkers ... tend to have a high risk of colon polyps," Jayadevan said.

And he cautioned that more research needs to be done to confirm these results in larger and more varied populations.

"No dietary recommendations can be made from this study," he said. "It's accepted that a healthy, balanced diet rich in fruits and vegetables is excellent for overall health and also for (preventing) colon cancer. But this study per se doesn't make any changes in the current recommendations. More study is needed."

The findings were presented here Sunday at Digestive Diseases Week, the largest annual gathering of gastroenterologists in the world.

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Farm Kids Less Likely to Have Allergies

By Kathleen Doheny
HealthScoutNews Reporter
Monday, May 19, 2003

MONDAY, May 19 (HealthScoutNews) -- Growing up on a farm may protect children from getting allergies and asthma, yet another study suggests.

Canadian researchers surveyed 1,158 4-H Club members, aged 8 to 20, asking about current and previous residences and residential exposure to livestock, as well as any problems with allergies and asthma.

Allergic symptoms were lower among those youth who lived on a farm when the survey was taken or had lived on a farm previously, says Helen Dimich-Ward, an associate professor at the University of British Columbia in Vancouver. She presented her findings May 18 at the American Thoracic Society's conference in Seattle.

The highest prevalence of allergic symptoms was found in urban or rural residents without livestock. Diagnosed asthma was lowest among those who currently lived on a farm, while past farm dwellers had the lowest prevalence of ever having wheezing.

Like other researchers, Dimich-Ward says the "protective farm factor" may be the reason -- that is, kids who grow up on farms are less likely to suffer asthma and allergies because they have more frequent, higher exposures to endotoxins. Endotoxins, a piece of the bacterial cell wall, are generally found at higher levels on farms. They are present in livestock feces, barn and house dust and mattresses, researchers have found.

Researchers also call this the hygiene hypothesis -- that high levels of these endotoxins early in life toughen up the immune system and the child does not tend to get allergies or asthma. But exposure to high endotoxin levels in someone who already has asthma or allergies can aggravate the condition.

"Endotoxin exposure is an appealing explanation," Dimich-Ward says. That's true, she adds, both for reduced allergic symptoms among farm children and for the results of some studies that found fewer allergic conditions for children exposed to dogs or cats at an early age.

However, she says, it is not yet absolutely clear that endotoxins are the protective mechanism. And it was not just having contact with farm animals in her study that appeared to have a protective effect.

"Rather, lower risks for allergic symptoms were associated with living on a farm or rural area and having livestock currently and at an early age," she says.

Dimich-Ward's findings echo those of earlier research. In a study published last year in the New England Journal of Medicine (news - web sites), researchers who evaluated more than 800 Swiss, German and Austrian children found asthma and allergy rates lower among the 319 who grew up on farms.

And a study published in the American Journal of Respiratory and Critical Care Medicine in 2000 found that a lower prevalence of asthma persists in farm children even after accounting for the fact that they smoke less than their urban counterparts.

Every year, more than 50 million Americans suffer from allergic diseases, according to the National Institute of Allergy and Infectious Diseases (news - web sites), part of the National Institutes of Health (news - web sites).

Dimich-Ward points out other factors may explain the finding. One possibility is that children who live on a farm may have parents who are not allergic, suggesting that families who may be prone to allergies would leave the farm environment. Relatively few parents of the farm children she surveyed had a history of allergies, she notes.

Another expert in the field calls the new research an interesting part of the puzzle, but agrees with Dimich-Ward that more research is needed.

"What's really needed is a longitudinal study going from birth," says Dr. Alex Marotta, a fellow at the National Jewish Medical and Research Center in Denver who has researched the topic.

Whether endotoxins are truly the reason these children on the farm have fewer asthma and allergy problems remains to be proven, he adds.

Meanwhile, there's not much urban parents can do, he says.

What about buying a cat or a dog to boost endotoxin exposure? "That needs to be studied more," he says. One thing is known, he adds: "Once you have developed asthma and allergies, having a cat in the house is bad."

More information

To find out more about kids and asthma, see the American Academy of Allergy, Asthma & Immunology. Resources for those with allergies can be found at the National Institute of Allergy and Infectious Diseases.

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Exercise Linked to Lowered Risk of Gallstones

By E.J. Mundell
Reuters Health
Monday, May 19, 2003

ORLANDO (Reuters Health) - A daily run or swim could put real distance between you and painful, debilitating gallstones, according to a new study.

"We think that a very active lifestyle -- doing more than an hour of physical activity a day, with an active job -- can reduce your risk of gallstones by about 60 percent," concluded Dr. Andrew R. Hart of the University of Bristol in the UK.

About 15 percent of us will be affected by gallstones at some point in our lives, with the risk of stone formation increasing with age. While most gallstones produce no symptoms and dissolve naturally, others can cause painful blockages that require surgical intervention.

In an interview with Reuters Health, Hart explained that gallstones arise when bile lying within the gall bladder collects and settles. Over time, cholesterol found in the bile can crystallize and form stones.

Exercise may literally "shake up" this pooled bile, discouraging crystallization.

"The theory would be that if you do a lot of physical activity, your bile doesn't get time to aggregate and form cholesterol crystals to form a lot of stone," Hart said.

Testing this theory, the UK researchers compared rates of daily physical activity and occurrence of gallstones in over 25,000 adults between 45 and 79 years of age. About 175 of those questioned went on to develop gallstones.

"We found that the more physical activity you do, the less your risk of developing gallstones in the future," Hart said, with the most-active group exhibiting a 60 percent drop in gallstone risk compared with inactive, "couch potato" types.

The findings held even after the researchers accounted for other factors known to affect gallstone risk, such as obesity, alcohol consumption and reproductive history.

Hart said it's still too early to issue firm recommendations, however.

"Basically we need a lot more studies looking at physical activity and gallstones to see if the results are consistent," he said. For now, Hart recommends eating a sensible, low-fat, low-sugar diet and keeping trim.

The findings were presented here Sunday as part of Digestive Disease Week, the largest annual gathering of gastroenterologists in the world.

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Racial Disparity Shown in Breast Cancer Treatment

By Amanda Gardner
HealthScoutNews Reporter
Monday, May 19, 2003

MONDAY, May 19 (HealthScoutNews) -- Differences in how black women are treated for breast cancer (news - web sites) may explain why they have lower survival rates than white women even when the cancer is discovered at the same stage.

A study in the June 1 issue of Cancer found significantly lower stage-specific survival rates for black women under the age of 50 even when the type and stage of the breast cancer were identical. On the other hand, there were no significant differences in women over the age of 65, suggesting the universal availability of Medicare might iron out earlier disparities.

"If you have a high percentage of people covered with Medicare, the differences that you see in the younger age groups need to be thought of not only in the parameters of biology and aggressiveness, but also in the parameters of the health-care system," says study author Kenneth C. Chu, program director of the Center to Reduce Cancer Health Disparities at the National Cancer Institute (news - web sites). "We're trying to open up that door so that discussion can begin."

The issue of racial disparities in health care has been a subject of increased interest and scrutiny, and the picture emerging is an incredibly complex one.

According to Barbara Krimgold, director of the health disparities project at the Center for the Advancement of Health, there appear to be four broad reasons why black women have higher mortality rates from breast cancer, even though white women have a higher incidence. Those areas are socioeconomic status, racism, access to insurance and health care and treatment.

Previous studies have shown black women are less likely to get mammograms and are therefore diagnosed later than white women. They are also less likely to receive the same treatments.

"As the Institute of Medicine (news - web sites) reported, even where African-Americans have equal incomes or equal insurance, the treatment is different and the outcomes are different. So you frequently get less aggressive treatment, and it's sometimes less awareness on the part of the patients and probably unconscious discrimination in most cases on the part of providers, who don't seem to act as quickly or as aggressively in treating their black patients," Krimgold says.

Clinical trials, however, have shown that when black and white women receive equal treatment for their particular type of breast cancer, they have similar survival rates.

Using breast cancer data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program, Chu and his colleagues compared survival rates in black and white women at specific stages of breast cancer and according to ER status. In other words, a white woman with stage 3 ER-positive breast cancer would be compared only to a black woman with stage 3 ER-positive breast cancer.

"The ER status is related to the types of treatment you have," Chu explains. ""What I tried to do was remove the fact that black women present at a later stage from their actual survival."

In general, black women had lower six-year survival rates for each stage of breast cancer. The differences were more pronounced in younger groups, however. Black women under the age of 50 with ER-positive cancers, for instance, had significantly lower six-year survival rates. In the over-65 group, there were no real differences.

Most other researchers have used the age of 50 as a cut-off point, to coincide roughly with the beginning of menopause. "When you look at that break, you'll see differences in both age groups," Chu says. "We looked at the older age group because we were interested in knowing not the biology, but whether or not Medicare may in fact have some potential impact."

This study suggests an association, but it doesn't prove a cause-and-effect link.

And the association has been noted before. "When we compare the U.S. to other countries, we see the U.S. hovering around 20th among all industrialized nations for almost all health status indicators: infant mortality, life expectancy and potential years of life lost prematurely," Krimgold says. "But once people in the U.S. make it to age 65, the U.S. rises near the top of the health indicator tables. With universal health care and income support through Medicare and Social Security (news - web sites), elderly people in the U.S. have better prospects for health and life expectancy compared with their counterparts in other countries than do younger Americans."

But the prospects of middle-age black women shown in this study were troubling to Dr. Alfred R. Ashford, a professor of clinical medicine at Columbia University College of Physicians and Surgeons and director of the department of medicine at Harlem Hospital, both in New York City.

"I think that's very tragic in our society that all the pieces of a modern treatment package are not always there for women of various backgrounds but perhaps, in particular, the poor and ethnic minority groups. It has to be corrected," Ashford says. "We call this an access-to-care problem. We have public safety net hospitals, which usually can provide this care."

People are probably not accessing this safety net because they are not aware they exist, adds Ashford, who is also director of the cancer center for Lincoln, Metropolitan and Harlem hospitals, all of which are part of the New York City public hospital network.

More information

The Institute of Medicine has a report on racial and ethnic disparities in health care. The Office of Minority Health Resource Center has a "Breast Cancer Resource Guide for Minority Women."

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Study: Defibrillators Need Not Cause Painful Shocks

By Julie Steenhuysen
Monday, May 19, 2003

CHICAGO (Reuters) - When an implantable defibrillator jump-starts a heart, it feels like a kick in the chest.

The treatment is a lifesaver for thousands of patients whose hearts have stopped, but unnecessarily painful for those whose hearts are racing in the danger zone, according to a study of 637 patients released on Saturday.

Doctors at a key cardiology meeting in Washington said minor programming changes can reduce by two-thirds the instances in which patients with the devices receive a shock, without compromising safety.

Implantable cardioverter defibrillators (ICDs) -- stopwatch-sized devices like the one implanted in Vice President Dick Cheney (news - web sites) -- treat dangerously fast heartbeats that can lead to sudden cardiac arrest, in which the heart stops pumping blood. The condition is the second-leading cause of death in the United States, killing about 450,000 U.S. residents a year.

Most ICDs typically are programmed to deliver shocks to correct heart rhythms in the dangerous range of 188 to 250 beats-per-minute, known as the fast VT range. But a study showed that painless, low-power electrical pacing was able to restore most patients to normal heart rhythms without the need for a massive jolt.

In a multicenter clinical trial of patients with heartbeats in the fast VT range, half of the patients received standard defibrillator treatment and half were treated with defibrillators using the new technique, called antitachycardia pacing.

The study, sponsored by medical technology giant Medtronic Inc., showed patients in the pacing group received 70 percent fewer shocks for fast VT than patients in the group with traditional ICD programming.

The pacing patients were at no increased risk for fainting, rising heart rhythms or death and both treatments took about the same amount of time to end the dangerous rhythm, the doctors said.

"The biggest benefit for patients is that they have a lifesaving device that is painless," Dr. Mark Wathen, principal investigator in the study, said in a statement.

Wathen, director of electrophysiology labs at Vanderbilt University Medical Center in Nashville, Tennessee, said the study should lead to a major change in the way doctors use ICDs.

"What we've shown is that most fast rhythms can be pace-terminated and that shocks are a last resort, although ICD patients need the protection of both therapies," he said.

Wathen presented results of the study at the 24th annual scientific sessions of the North American Society of Pacing and Electrophysiology, the country's largest meeting of physicians specializing in heart rhythm disorders.

According to Medtronic, about 250,000 to 270,000 patients in the United States have implantable defibrillators, and most of those are capable of being reprogrammed to deliver the low-powered pacing pulse without the need for surgery.

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Cancer Drug's Heart Risk Underestimated

By Adam Marcus
HealthScoutNews Reporter
Monday, May 19, 2003

MONDAY, May 19 (HealthScoutNews) -- Doctors have known a common cancer drug causes heart failure in some patients, forcing them to stop treatment and in rare cases requiring an organ transplant, but a new study says that risk may be significantly greater than previously believed.

The drug, doxorubicin, is used in the treatment of many cancers, from leukemia and breast tumors to lung and testicular cancers. The new research doesn't second-guess the therapy. However, experts say it should prompt cancer specialists to be especially vigilant about budding congestive heart failure, particularly in patients most vulnerable to the problem, such as children, the elderly and those who've had radiation therapy.

"What this paper has demonstrated is that while we thought we had a pretty good idea of exactly what the risks are of doxorubicin, we have to be a little more cautious" in using it, says study co-author Dr. Michael Ewer, a heart expert at the University of Texas' M.D. Anderson Cancer Center. "If you have signs of decreasing function then you do need to stop the drug right away, but that's usually a little later than you wished you would have stopped it."

A report on the findings appears in the June 1 issue of Cancer. The work was funded by Pharmacia, which makes a version of doxorubicin called Adriamycin.

Ewer's group, led by Dr. Sandra Swain of the National Cancer Institute (news - web sites), reviewed three earlier studies of doxorubicin, also known as Rubex, and heart failure in patients with lung and breast cancer (news - web sites). Of the 630 subjects, 32 were diagnosed with congestive heart failure.

The risk of the complication rose with the cumulative dose of the drug. Heart failure occurred in 1.7 percent of patients taking a low dose -- measured in milligrams per meters squared -- but it occurred in 26 percent of people on a moderate to high regimen. Nearly half of patients on the highest doses developed the condition.

The overall rate of heart failure in people on doxorubicin was roughly 5 percent at a medium dose, higher than the rate reported in the most recent study to examine the effect.

In addition to the greater prevalence of heart problems, Ewer's group noted two other areas of concern with the cancer drug. People over age 65 were about 20 percent more likely than younger patients to suffer the complication. And a heart output test doctors have been using to monitor heart function in people taking doxorubicin doesn't seem to be of much use. Some patients with no problems have abnormal test results, while others with failing pumps go undetected. "It's just an imperfect test," Ewer says.

More information

For more on doxorubicin, visit the M.D. Anderson Cancer Center. To learn more about congestive heart failure, try the University of California at Davis.

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Snoring Kids at Risk for Learning Problems

By Charlene Laino
Reuters Health
Monday, May 19, 2003

SEATTLE (Reuters Health) - Children who snore are at heightened risk for a host of learning and psychological problems, including poor verbal skills, anxiety and depression, Kentucky researchers report.

Snoring in youngsters is already known to be a sign of an illness known as obstructive sleep apnea that causes people to stop breathing dozens of time each night. If left untreated sleep apnea can increase the risk of several health problems, including high blood pressure and cardiovascular disease.

But the new study shows that snoring presents a health risk even in children who don't have sleep apnea, said study author Dr. Louise O'Brien, a research fellow at the University of Louisville.

"Even a condition that we all think of as benign -- snoring -- can have an effect on a child's daytime functioning," she told Reuters Health.

"If your child snores regularly and also has some behavioral or learning issues, it may be wise to seek out the help of a sleep specialist," O'Brien said.

About 10 percent of children snore, and three percent have sleep apnea, she said.

The new study, reported here Sunday at the American Thoracic Society International Conference, enrolled 87 youngsters, ages 5 to 7, who snored but did not have sleep apnea and 31 children in the same age group who slept quietly through the night.

Parents of the children filled out standard behavior questionnaires that gauge such factors as hyperactivity, depression and attention span. The children took a cognitive test that measures reasoning skills and a neuropsychology test that measures the ability to plan and execute tasks.

The children who snored performed worse on just about every measure than those who didn't, O'Brien reported.

"While their scores were still within the normal range, they were more hyperactive, more impulsive, and had more social problems. And they were more anxious and depressed than children who didn't snore," she said.

The biggest differences were seen on the cognitive test scores, she said, with children who snored having worse verbal, language and spatial skills than the non-snorers.

While the study was not designed to determine why snoring leads to psychological problems and learning deficiencies, the researchers speculated that snoring may interfere with breathing, causing a child to get too little oxygen. Plus, snoring may jerk a child awake, thus interrupting a good night's sleep.

The right prescription for healthy ZZZs, according to O'Brien, includes instituting a bedtime routine, such as story-time each night, and keeping fluids to a minimum in the evening.

The Kentucky researcher also recommended restricting children's consumption of sugar and caffeine. "You'd be surprised how many kids drink cola with their dinner," she said.

The findings suggests that current guidelines for the management of snoring may need to be re-evaluated, said O'Brien, noting that the American Academy of Pediatrics says that snoring in the absence of sleep apnea should be considered a benign condition.

"Right now, you can't find guidance on how to manage the child who snores," she said. "We need to find a way to determine which kids who snore are vulnerable to neuropsychological problems."

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Depression Can Forewarn of Alzheimer's Disease

By Ed Edelson
HealthScoutNews Reporter
Monday, May 19, 2003

MONDAY, May 19 (HealthScoutNews) -- Depression in the early years of life can be a warning sign that Alzheimer's disease (news - web sites) will develop decades later, new research claims.

That finding is not astoundingly new, says Dr. Robert C. Green, an associate professor of neurology at Boston University School of Medicine who reports it in the May issue of the Archives of Neurology. However, it comes from a study that is much larger than earlier trials that found a similar link, and it confirms the need to find out why that link exists, he says.

"Does Alzheimer's disease start in a very subtle way in the 20s or 30s?" he asks. "Or could it be that people who are less prone to depression have more resistance to getting Alzheimer's disease? Or is there something about depression that is somehow toxic to the brain?"

All those questions remain unanswered, Green says. The real importance of the study, he says, is that it adds to a mosaic of possible risk factors that someday could be used to identify people at high risk of the mind-robbing condition who could be treated -- when treatments become available.

This study included 1,953 people with Alzheimer's disease who were matched with 2,093 of their close relatives who did not have the disease. The incidence of depression was found by questioning those relatives.

Overall, people with a history of depression symptoms were twice as likely to have Alzheimer's, the researchers report. If depression began a year before the onset of Alzheimer's, the association was almost five times stronger. And the incidence of Alzheimer's was 70 percent greater even if depression was reported to have begun more than two decades earlier.

Those numbers must be viewed with caution, says Jennie Ward-Robinson, director of medical and scientific affairs at the Alzheimer's Association. "They depend on recollection by caregivers, and those recollections are complicated by the relationship of the caregiver to the patient," she says.

But she agrees with Green on one point: "What is exciting is that we are beginning to learn more about Alzheimer's disease and are getting to the point where we can talk in terms of risk factors."

Head injuries increase the risk, Green explains, while taking antidepressants, vitamin E or statins -- cholesterol-lowering drugs -- appears to reduce the risk.

"The importance of this paper is not so much the individual finding as that it helps create profiles of people at higher and lower risk, and of protective factors," he says.

Already, there are tentative efforts to put some of that information to use, Ward-Robinson says, most notably in trials looking at the relationship of statin therapy to Alzheimer's disease.

"We are converging on a picture that will help us better understand the mechanistic process of Alzheimer's disease," Green says.

More information

The Alzheimer's Association monitors new developments in the fight against the disease. And read more about other possible causes of Alzheimer's.

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Flatulence Test Sniffs Out Gut Bugs

By E. J. Mundell
Reuters Health
Monday, May 19, 2003

ORLANDO (Reuters Health) - Some day, diagnosing that nasty stomach bug could be as easy as passing gas.

UK scientists say a hi-tech test focused on flatus -- the pungent gas emanating from stool -- is highly effective in quickly identifying tough-to-spot viral or bacterial infections of the gut.

"There are very specific (chemical) 'fingerprints' in the gas, so that you can make specific diagnoses very quickly," lead researcher Dr. Christopher Probert, of the University of Bristol, told Reuters Health.

Probert presented the findings here Sunday at Digestive Diseases Week, the largest annual gathering of gastroenterologists in the world.

While flatulence may be the stuff of jokes, the fight against dangerous gastrointestinal (GI) infections is no laughing matter.

Worldwide, over 600,000 children die each year from chronic diarrhea, most of them in poorer countries without ready access to sophisticated medical laboratories. Effective treatment relies on timely identification of the bacterium or virus behind the illness, and as each day goes by patients become more dehydrated, weak and malnourished. Even when available, conventional lab tests can take days to pinpoint the exact cause of infection.

What's needed, Probert said, is a cheap, portable and accurate means of diagnosing identifying specific infections, ideally within hours.

To perform the new test, the UK team collects a stool sample from an infected patient and places it in a vial with a rubber cap, allowing gases from the stool to rise and fill the vial.

Next, a 'smart needle' is passed through the rubber cap. Flatus molecules adhere to this 'smart needle,' which is then removed from the vial and placed in a special machine.

"The machine will analyze these molecules and tell you what the infection is," Probert explained.

So far the technology has displayed impressive accuracy, correctly identifying the potentially life-threatening bug, Clostridium difficile, 100 percent of the time and the Norwalk virus -- responsible for last year's highly publicized cruise-ship outbreaks -- 93 percent of the time. The test was also highly accurate in spotting rotavirus, a major cause of diarrhea in children.

"Whether this can be used for other infectious diseases in the bowel we have yet to determine," Probert said, "we've got a program ongoing to look at other things like cholera and typhoid and so forth."

Since the test can yield accurate results within an hour, Probert said the next step is to shrink the technology down to "something the size of a shoe box that could be used anywhere at a relatively low cost."

And yes, sometime in the future, your GI specialist might dispense with collecting stool samples altogether, asking you to simply emit a quick "flatus sample" instead.

"We did at one stage discuss the possibility of a 'smart lavatory,' so that you could have a device that could sample the gas in that way," Probert said with a smile. "There are a lot of things that we might want to do someday."

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Prescription Arthritis Painkillers Not Worth Price

By Randy Dotinga
HealthScoutNews Reporter
Monday, May 19, 2003

MONDAY, May 19 (HealthScoutNews) -- Which painkiller is best for older people with arthritis -- over-the-counter drugs that costs pennies or prescription drugs that can run more than 10 times as much?

Researchers crunched the numbers and reported Monday that the typical patient doesn't need the more expensive medications, even if they're a slight bit safer than the cheap ones.

Except in special cases, arthritis patients should avoid the costly drugs, which are selective cox-2 inhibitors commonly known by the brand names Celebrex and Vioxx, said study co-author Dr. Brennan Spiegel, a researcher at the University of California at Los Angeles.

"They need to know if they're paying out of pocket for this medicine, it's probably not worth it unless they've had a problem in the past," he said. "If they're not paying out of pocket, they have to know that ultimately their insurance company is paying too much money, and this will come back to haunt them."

Cox-2 inhibitors are commonly prescribed as alternatives to over-the-counter drugs like aspirin, ibuprofen (Motrin, Advil, Nuprin) and naproxen (Aleve).

"The main benefit those [cox-2 inhibiting] medications provide is that they're safer on the stomach," Spiegel said. "They appear to cause fewer ulcer complications, including ulcer bleeds, painful ulcers, and, very rarely, ulcer perforations."

But cox-2 inhibitors aren't cheap. They cost about $2.70 a tablet, and patients usually take one or two a day. Naproxen, by contrast, costs only about 18 cents a tablet, and ibuprofen is even cheaper, Spiegel said.

Some studies suggest that doctors are prescribing cox-2 inhibitors even more commonly than over-the-counter painkillers, he said.

Many doctors don't properly prescribe the cox-2 painkillers, said Dr. Daniel Solomon, a rheumatologist at Brigham and Women's Hospital in Boston. Some doctors prescribe them when over-the-counter painkillers would work fine, while others fail to turn to them when patients suffer from gastrointestinal problems, he said.

"The problem is not as simple as under- or over-use; it appears to be a problem of misuse," Solomon added.

Spiegel and his fellow researchers created a computer simulation of a group of arthritis patients with an average age of 60. They then compared the cost-effectiveness of prescribing cox-2 inhibitors vs. the over-the-counter painkillers.

The results of the analysis appear in the May 20 issue of the Annals of Internal Medicine.

The researchers found that patients and insurance companies would have to spend more than $275,000 for cox-2 drugs before a single average 60-year-old arthritis patient benefited by living an extra healthy year more than he would have otherwise.

Another way to look at it is that doctors would need to treat 125 patients with the cox-2 drugs before one would benefit by not having gastrointestinal problems, Spiegel said.

However, the researchers did discover that it would be much more cost-effective -- with the drugs costing about $55,000 before a patient would get a big benefit -- to prescribe cox-2 inhibitors to arthritis patients who had a history of severe gastrointestinal problems, like bleeding ulcers. In those cases, the over-the-counter drugs could have caused more bleeding.

According to the researchers, insurance companies don't consider certain kinds of drugs to be cost-effective unless extra years of life start kicking in when only about $50,000 is spent.

In general, Spiegel said, the cox-2 drugs "aren't worth the price. They cost too much and don't provide enough benefit."

More information

Learn about the variety of painkillers you can take and why some are better than others for specific conditions in this Mayo Clinic roundup. For an explanation of drugs to treat arthritis, go to the Arthritis Foundation .

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Listerine Strips Don't Kill All Mouth Germs: Study

By Alan Mozes
Reuters Health
Monday, May 19, 2003

NEW YORK (Reuters Health) - "Cool Mint Listerine PocketPaks" -- a popular over-the-counter bad breath remedy -- appear to kill germs in the laboratory, but the human mouth may be a different story, according to new research.

In tongue swabs taken before and after the strips were used, an undergraduate biology student and her advisors found no drop in tongue bacteria in volunteers who used the strips.

However, the manufacturer of the PocketPaks, Pfizer, Inc., said the researchers did not look at odor-causing bacteria, and that the product makes no claims to kill all types of germs.

On their Web site, Pfizer describes the PocketPak strip as a sugar-free, alcohol-free, and calorie-free product, which "kills 99.9% of odor-causing bacteria in 30 seconds!" ( highlights)

The manufacturer cautions, however, that the "micro-thin starch-based film" strips "have not been proven to kill germs that can cause plaque and gingivitis, or germs residing in areas other than the tongue."

In a study presented Monday at the American Society of Microbiology, Alice John, an undergraduate student at Felician College in Lodi, New Jersey and colleagues used 192 PocketPak strips in experiments with bacteria growing in laboratory culture dishes.

The lab tests focused on the strips' anti-bacterial effectiveness against bacteria commonly found in the human mouth, as well as against various forms of group A streptococcus, bacteria that can cause strep throat, tonsillitis, and blood, wound and skin infections.

John and her team found that the strips were 100 percent effective -- killing both normal bacteria and the group A streptococcus -- in the laboratory.

The researchers then took tongue swab samples from 34 healthy volunteers to test the strips' effectiveness in a human mouth. Swabs were taken before consuming a strip, followed by swabs one minute, 15 minutes, and 30 minutes after placing a single strip on the tongue.

In this case, the authors found that the strips had almost no anti-bacterial effects, reducing almost none of the germs commonly found in the human mouth. They noted that only in one person was there even a slight germ reduction -- observed one minute after consuming the strip -- and that this reduction disappeared by the 15-minute marker.

"It could be the feel and the sensation of the strips -- because it has a nice taste to it -- that makes you feel that something is happening, but in terms of killing germs in the mouth we did not find that," said study co-author Dr. Yvonne Lue.

Lue, who runs a microbiology lab for Quest Diagnostics in Teterboro, New Jersey, reviewed the data collected by John. Lue emphasized that her participation in the study was conducted independently of her position at Quest Diagnostics, a company that makes diagnostic tests for cancer and other ailments.

John initiated the project to fulfill course work requirements for an undergraduate degree in biology, under the supervision of Felician professor and microbiologist Anne LaGrange Loving.

The researchers suggested that the enzymes found in saliva -- absent in the laboratory dish -- might be responsible for blocking the strips' ability to kill germs.

"When the project started out it was to confirm that it actually did kill the bacteria in the mouth," said Lue. "I think we were all surprised by these findings really."

"We weren't setting out to nuke Pfizer," added Loving. "It was a student project ... (but) we found it pretty astounding that they didn't seem to do anything in the mouth even though they work perfectly in the Petri dish," she told Reuters Health.

Loving added that the research team unsuccessfully attempted to contact Pfizer on several occasions by calling the toll-free number on the product packaging in order to clarify how the company tests their strips.

Dr. Michael Lynch, Pfizer's director of clinical research in oral care research and development in the Consumer Health Care Division told Reuters Health that the company was not aware of the researcher's attempted phone calls.

After reviewing a brief outline of the study, Lynch said that the researchers appear to have focused on specific germ-killing abilities that lie outside the claims Pfizer makes on behalf of PocketPaks.

"They seem to be looking at the bugs that are implicated in causing certain diseases --often respiratory type diseases," he noted. "We have no desire to look at strep ... It's a cosmetic product. It helps control bad breath by killing the germs that cause bad breath ... And we have a number of good studies that support that."

"Pfizer is completely correct," responded Loving. "We were not testing for odor-causing bacteria, and we know they do not claim to kill strep."

However, she emphasized that their findings suggested that in the human mouth the strips failed to kill a broad range of normal bacteria, suggesting that they would similarly fail to hinder both odor- and disease-causing bacteria as well.

PocketPaks were first launched in the American market in October 2001, and are currently also available in Canada, Mexico, the UK, Greece, Australia, Ireland and Singapore. As of late 2002 more than 200 million PocketPaks had been sold in the US.

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Genentech Colon Cancer Drug Extends Life

By Toni Clarke
Monday, May 19, 2003

NEW YORK (Reuters) - Genentech Inc. said on Monday its experimental colon cancer drug, Avastin, extends life far longer than it had expected, marking one of the biggest recent breakthroughs in cancer research.

Results of a late-stage trial show that the drug, which slows tumor growth by cutting the supply of blood and oxygen, improved survival when used in combination with chemotherapy.

The news surprised analysts and scientists, who had become skeptical of the approach, known as anti-angiogenesis, after the drug had failed to prove effective in treating breast cancer (news - web sites).

If approved, the drug could generate as much as $2 billion in revenue, analysts said. Genentech in 2002 had total revenue of $2.7 million.

"Showing a survival benefit is very rare," said Meirav Chovav, an analyst at UBS Warburg. "This is going to transform the treatment of solid tumors, and it's obviously going to transform Genentech."

Avastin is the first of a new class of drugs to treat cancer by inhibiting a protein known as vascular endothelial growth factor, which plays an important role in stimulating the growth of new blood vessels to tumors.

By slowing the tumor's growth, Avastin appears to help chemotherapy do its work of destroying malignant cells.

"This will give a huge boost to the anti-angiogenisis field, which many scientific journals have been questioning lately," said Sapna Srivastava, an analyst at ThinkEquity Partners.

Genentech said the main side effect of Avastin is an increase in hypertension, or high blood pressure. The company said there is also an increase in tearing of the gastrointestinal tract. The company said this is uncommon.

Patients with colon cancer live on average 14 months from the time of diagnosis. Genentech said it met the main goal of its trial, which analysts said would likely be an extension of life by about two months.

Since the results are beyond Genentech's expectations, analysts said the drug could extend life by about four months.

Detailed results of Genentech's trial, the last before it applies for marketing approval, will be presented at the annual meeting of the American Society of Clinical Oncology (news - web sites) beginning May 31.

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SUNDAY, MAY 18, 2003

How to Prevent Tennis Elbow

Sunday, May 18, 2003

SUNDAY, May 18 (HealthScoutNews) -- A repetitive motion with just about any part of your body will typically backfire on you with stress-related pain, and the elbow is no exception. That's why you don't necessarily have to be a tennis player to get the condition known as tennis elbow -- but it probably helps.

The pain of tennis elbow centers on or around the bony prominence that's felt on the outside of the elbow, according to the American Academy of Orthopaedic Surgeons (AAOS). The pain may radiate down your arm, and the type of gripping or extending of the wrist associated with tennis can further increase the pain.

The pain, which is usually the result of muscle overuse, is specifically related to tiny tears in the tendons in your forearms. Continued overuse of those muscles can prevent the tears from healing and cause further pain as the tendons become inflamed.

In addition to tennis, other activities that can cause tennis elbow include everything from raking leaves and repetitive hammering to rowing or even painting.

The best advice, say experts, is to simply stop doing whatever activity you believe is causing the pain and give your tendons some time to heal.

Anti-inflammatory medications may help to reduce the pain and try applying ice to reduce swelling, advises the AAOS. In time, the pain should subside and you should be able to return to your normal activities. If, however, the pain persists after two to three weeks, you may want to consult a doctor.

More information

Learn about tennis elbow from the Nicholas Institute of Sports Medicine and Athletic Trauma.

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SATURDAY, MAY 17, 2003

Take the Offense Against Lyme Disease

Saturday, May 17, 2003

SATURDAY, May 17 (HealthScoutNews) -- Don't let ticks suck the fun out of your summer.

While deer ticks do carry bacteria that cause Lyme disease, you can protect yourself and your family by taking appropriate precautions.

Lyme disease can cause a variety of conditions, including heart disorders, meningitis, facial palsy and arthritis. Lyme disease in the United States is mostly limited to northeastern, mid-Atlantic and upper north-central states, as well as several counties in northwestern California.

In 1999, there were 16,273 cases of Lyme disease reported to the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC) and 92 percent of those cases were in Connecticut, Rhode Island, New York, Pennsylvania, Delaware, New Jersey, Maryland, Massachusetts and Wisconsin.

Ticks pass on the bacteria that cause Lyme disease when they attach to your skin and feed on your blood. They have to be attached for a long period of time (more than 36 hours) for a tick to transmit the Lyme disease organism into your bloodstream.

The CDC offers the following advice for people in areas where ticks may carry Lyme disease:

  • Avoid tick habitats. That means staying out of moist, shaded areas, especially those with leaf litter and low-lying vegetation in woody, brushy or overgrown grassy locations.
  • If you have to go into areas with potential tick infestation, wear light-colored clothing. That lets you spot ticks more easily and remove them before they attach to you. Wear long-sleeved shirts and pants and tuck your pants into your socks or boots. High rubber boots may offer added protection because ticks are usually located close to the ground.
  • Use insect repellants that contain DEET and apply them to your clothing and skin.
  • Do tick checks and remove any attached ticks. Remove attached ticks by using fine-tipped tweezers. Grasp the tick firmly and as closely to your skin as possible. With a steady motion, pull the tick's body away from the skin. The tick's mouthparts may remain in the skin, but they don't contain the bacteria that cause Lyme disease. Clean the area with an antiseptic. You may wish to consult with your doctor.
  • Eliminate tick habitat around your home. Get rid of leaf litter, brush and wood piles, and clear trees and brush to admit more sunlight.

More information

Here's where you can find out more about Lyme disease.

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Joint Efforts

By Colette Bouchez
HealthScoutNews Reporter
Saturday, May 17, 2003

SATURDAY, May 17 (HealthScoutNews) -- It can begin with stiffness in the joints you use most -- your hips, knees, lower back or fingers. Soon, however, you may start to experience real pain.

The problem is osteoarthritis and if you've just turned 50, you might be experiencing your first bout with this common problem.

"Age 50 is a transition point where the vast majority of people first start noticing symptoms," says Dr. John Klippel, medical director of the Arthritis Foundation.

As one of the most common of the more than 100 different types of arthritis, osteoarthritis is caused by a natural wearing away of cartilage, the cushion that lies between joints. As the cartilage breaks down, bones can rub against each other during even simple movement, leading to inflammation and, ultimately, pain and stiffness.

Currently, the Arthritis Foundation reports some 20 million Americans are facing the effects of osteoarthritis every day. With May designated as National Arthritis Month, officials are spreading the word that a battery of treatments exist to ease sufferers' pain.

While osteoarthritis may be a natural part of the aging process, not everyone is affected in the same way, Klippel says. For some, he says, osteoarthritis can cause extreme pain, while others may hardly feel a twinge. What can often make the difference: Weekend-warrior type injuries to the joints that occur years before symptoms develop.

"Any injury to your joints can set the stage for osteoarthritis later in life, which is one reason professional athletes seem to suffer the most with this problem," Klippel says.

If you're thinking "score one" for the couch potatoes, guess again. People who are inactive throughout their lifetime are also at increased risk, experts say. Other factors that play a role, says Klippel, include heredity and being overweight.

Once osteoarthritis sets in, and particularly once the pain begins, your natural instinct may be to limit movements. Ironically, studies show that staying sedentary can make you feel worse.

"When you don't move, over time you lose muscle mass, so the supporting structures around the affected joint grow weak, and in turn affect flexibility," Klippel says. As a result, pain can increase and movement can become even more difficult.

That's one reason it's important to "push through the pain" and continue as many activities as you can, Klippel says. The good news is there are a variety of medications that can help you do just that.

"If you have mild pain, the most common recommendation is to use Tylenol (acetaminophen) or, if the pain is moderate, an over-the-counter NSAID (non-steroidal anti-inflammatory drug) like Motrin (ibuprofen)," says Dr. Steven B. Abramson, director of rheumatology at New York University Medical Center and the Hospital for Joint Diseases.

Other medications that fall into the second category, says Klippel, include Advil (ibuprofen), and Aleve (naproxen), as well as aspirin.

Although all NSAIDs work similarly to reduce inflammation and pain, they may not work the same for you. Klippel says a little known fact about NSAIDs is that the response to each drug can be highly individual -- with one brand offering little or no relief while another is pure Nirvana. The message here, he says, is if you don't get relief from the first drug, try others in the category, including prescription NSAIDs.

As helpful as these drugs can be, however, they aren't always kind to your stomach. This is particularly true, says Abramson, if you already have gastrointestinal problems, such as ulcers, or you are at risk for internal bleeding. When this is the case, a relatively new class of NSAIDs -- drugs known as Cox 2 inhibitors -- might be the right choice, he says.

"These drugs are more target-specific, reducing joint pain and inflammation without affecting the stomach lining," Abramson says. Medications in this category include Celebrex (celecoxib), Vioxx (rofecoxib) and Bextra (valdecoxib).

The one caveat here: Although studies are still in progress, preliminary data shows Cox 2 inhibitors may not be right for those at increased risk for heart disease.

"In these instances, the older NSAIDs can be used in combination with medications known as proton pump inhibitors (PPI (news - web sites)) -- drugs which protect the stomach lining," Abramson says.

In addition to traditional medications, you may also be tempted to try two popular alternative remedies known as Glucosamine and Chondroitan Sulfate. These are substances found naturally in the body that may play a role in cartilage repair and elasticity, experts say.

Derived from animal tissue, some studies have shown these supplements offer pain relief equal to NSAID drugs, without the side effects. In addition, there is some evidence the compounds might slow cartilage damage in people with osteoarthritis, thus reducing disease progression.

The latest research, published in March 2003 journal Rheumatology, reveals that even topical creams containing a Glucosamine-Chondroitan compound may be helpful when applied externally to sore, aching joints.

Currently, a large National Institutes of Health (news - web sites) study is ongoing to assess the full value of these supplements, and in several years doctors may know for certain if they can really help. Abramson says most physicians accept them, at least as an adjunct treatment.

In addition to oral medications, there are several types of injections administered directly into the affected joints that, although costly, can prove helpful, particularly when pain involves the knee or hip. These include two forms of a substance known as hyaluronic acid (Synvisc or Hyalgan), as well as injections of anesthetic, which can be given alone or in combination with corticosteroid drugs to help extend pain relief and reduce inflammation, Abramson says.

So how do you know what treatment is right for you? Experts say talk to your doctor first to make certain you have the correct diagnosis before taking any medications.

"People should not automatically assume that because a joint hurts it's osteoarthritis," Klippel says. While often this is the problem, it's worth checking with your doctor before trying to self-treat joint pain or swelling, he says.

More information

To learn more about osteoarthritis, visit the Arthritis Foundation. Or you can check this advice from the National Institutes of Health.