The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
September 23, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 June 14-27

Friday, June 27, 2003

  1. Like the Rest of Us, Doctors Need to Get Moving
  2. Men Can Benefit from Kegel Exercises, Too
  3. Nitric Oxide Governs Fever
  4. Too Much Shark, Swordfish May Pose Health Hazard
  5. Bone Strength
  6. Serious Spousal Spats Spike Blood Pressure
  7. Calcium Correctness
  8. Study: Sugary Drinks Help Children Get Fat
  9. Calcium Can Be Critical Before Menopause
  10. Diabetes Tied to Increased Risk of Breast Cancer
  11. Could a Plant Discovery Improve Chemotherapy?
  12. Canada Won't Ban Brains, Spines from Feed Now
  13. CPR May Work in Prone Position

    Thursday, June 26, 2003

  14. Dam in Brain May Halt Chronic Pain
  15. New Cavity-Fighting Agent Shows Promise
  16. In Alzheimer's, Plaques May Alter Memory Genes
  17. Low-Cost Steps May Save Millions of Kids
  18. Bad Bosses Do Make Your Blood Boil
  19. Men Have Biological Clocks Too, Study Finds
  20. The Bald Truth
  21. Kaopectate Maker Will Reduce Lead Levels
  22. Medical Screenings
  23. Many U.S. Adults Visit the ER for Toothaches: Study
  24. The Biology of Distance Perception
  25. Malpractice Woes Frustrate Fla. Doctors
  26. Envy Eats Away at Everyone
  27. Antibody Discovery Could Lead to HIV Vaccine: Study
  28. Dust Monitor May Stop Black Lung Disease
  29. New Approach to HIV Vaccine Needed: Experts
  30. Stroke Care Estimated at $51 Billion
  31. Knowing Smoking Has Hurt Your Lungs Helps You Quit
  32. AIDS Toll Could Reach 70 Million by 2020
  33. Cardiac Arrest Survivors Do Fairly Well: Study
  34. Scientists Say Pill May Prevent Strokes
  35. Nail Polish Not a No-No During Blood Oxygen Test
  36. Study: Cholesterol Test at 50 Most Efficient Heart Tracker

    Tuesday, June 24, 2003

  37. Scanning for Heart Disease
  38. Hormone Pills May Spur Breast Cancer
  39. Dip in Hormone Use Follows Discouraging Study
  40. Tropical Oils Beat Fat
  41. Drowning Alert
  42. Drug Promises to Prevent Prostate Cancer
  43. Does Insulin Contribute to Alzheimer's?
  44. Smallpox Shots Linked to Heart Problem
  45. More Bad News for Hormone Drugs in U.S. Study
  46. WHO Lifts SARS Travel Warning in Beijing
  47. U.S. Studies Weigh Safety of Smallpox Vaccinations
  48. Brain Study Examines How People Feel Pain
  49. Don't Take Blood Pressure Drug with Red Wine: Study
  50. Too Much Soda May Cause Caffeine Headaches in Kids
  51. Arts, Technology May Help Dementia Patients
  52. Rheumatoid Arthritis Ups Overall Death Risk: Study
  53. Long Plane Rides Raise Risk of Rare Stroke
  54. Baldness Drug Prevents Cancer in Men, Study Finds
  55. Blood Test Can Detect Threat of Kidney Disease
  56. Two-Minute Brush Helps Achieve Cleaner Teeth: Study
  57. What's Behind Teen Beverage Choices
  58. Die, Cancer Cells, Die

    Monday, June 23, 2003

  59. Beta Blocker Coreg Excels in Heart Study
  60. Diabetics Can Walk for Life
  61. Results Mixed for Post-Lyme Disease Antibiotics
  62. More Education Buys Alzheimer's Protection
  63. Brain Study Examines How People Feel Pain
  64. Blood Test May Predict HIV-Related Dementia
  65. Lower Tamoxifen Dosage May Be Healthier
  66. Don't Forget That Rx for Exercise, Docs
  67. Woman Impaled While Pregnant Recovers
  68. Inflammatory Marker Further Implicated in Stroke
  69. What's Behind Teen Beverage Choices
  70. Hole in Heart Ups Stroke Risk on Long Flight
  71. Bowed Legs Among Newborns
  72. Most Stroller Head Injuries Result of Child Falls
  73. Camping Caution
  74. FDA Approves OTC Version of Prilosec
  75. Die, Cancer Cells, Die
  76. Meningitis a Concern in Kids with Cochlear Implants
  77. Scanning for Heart Disease
  78. FDA Warns Consumers About Dietary Supplements
  79. Can Tea Lower Cholesterol?

    Sunday, June 22, 2003

  80. Scoliosis: The Health Threat That Starts in Childhood
  81. Working Out, Indoors or Out

    Saturday, June 21, 2003

  82. Coping with Multiple Sclerosis Fatigue

FRIDAY, JUNE 27, 2003

Like the Rest of Us, Doctors Need to Get Moving

By Steven Reinberg
HealthDay Reporter
HealthDayNews
Friday, June 27, 2003

FRIDAY, June 27 (HealthDayNews) -- Don't be surprised if the person on the treadmill next to you at the gym turns out to be your doctor.

To emphasize how critical exercise can be in preventing and treating heart disease, doctors are being urged by the American Heart Association (news - web sites) (AHA) to be more of a role model for their patients. That means becoming more physically active, working to make community fitness facilities more available, and the like.

Doctors also ought to actually prescribe fitness more often, the heart association says.

Simply put, data show that people with heart disease who exercise have a lower death rate, says Dr. Paul D. Thompson, director of Cardiovascular Research at Hartford Hospital, in Connecticut, and the lead author of a new AHA statement on the benefits of exercise on the heart, which appears in this week's issue of Circulation.

Today there's a tendency to treat heart disease with medication or invasive procedures alone, Thompson says. "But, we should not forget some of the simple things we can do to benefit cardiac patients," he says. "A lot of physicians underestimate the value of exercise."

People need to be physically active: "You should exercise at least 30 minutes a day until you are moderately short of breath," Thompson says. People with heart problems should check with their doctor before starting a vigorous exercise program, he stresses, "but there is no problem with everyone getting out and walking or doing yard work, etcetera."

"We consistently engineer exercise out of our environment," Thompson says. "More exercise needs to be engineered back into daily living."

And that applies to doctors and other health care workers as well, says the AHA. The new recommendations urge doctors to become more active themselves and to consistently ask patients about their exercise and recommend exercise more often. The statement is the first update of the association's recommendations since 1992.

Additionally, the AHA statement cites the need for further research on the best ways to make exercise a lifelong activity. More research also is needed on the amount of exercise that is most effective in reducing the risk of heart disease.

Dr. JoAnne Foody, a cardiologist and assistant professor at Yale University, says the AHA recommendation "tells us what we already know, but probably don't practice."

"Physical activity is essential in reducing the risk of heart disease," Foody adds. Exercise also helps in reducing blood pressure, reducing weight and cholesterol and improving diabetes, she says. In fact, she adds, doctors should emphasize to patients that, in many cases, exercise can be as beneficial as medication.

"Despite all the medical advances we have made, lifestyle changes, including exercise, are an important step in reducing the risk of heart disease," Foody says.

The first step for patients, she says, is to ask their doctors about specific lifestyle changes they could make, including exercise and diet, to improve their health.

More information

To learn more about heart disease and prevention, visit the National Heart, Lung and Blood Institute or the American Heart Association

Back to the Top

Men Can Benefit from Kegel Exercises, Too

Reuters
Friday, June 27, 2003

WASHINGTON (Reuters) - Men can benefit from Kegel exercises, which women often do to regain continence after childbirth, U.S. researchers said on Friday.

Women are advised to do the exercises to strengthen the pelvic floor to counter the occasional incontinence that can follow childbirth or come after menopause. But some men, it seems, can benefit from them as well.

A team at the Kaiser Permanente Medical Center in Los Angeles studied 38 men who had cancerous prostate glands removed.

The procedure, a radical prostatectomy, can cause at least temporary incontinence in up to 87 percent of men who have the surgery, said Dr. Sherif Aboseif, who led the study.

Half the men got instructions on how to do Kegels and were advised to do them twice a day after surgery. Half got no special instructions, Aboseif wrote in the July issue of the journal Urology.

"Overall 66 percent of the patients were continent at 16 weeks," Aboseif's team wrote.

But those given Kegel training regained control earlier, they added. They measured this by counting how many incontinence pads a man used.

After a year 82 percent of patients had regained control, whether they did the Kegels or not, his team added.

A Kegel exercise is done by contracting the pelvic muscles as if the patient was trying to hold in urine.

Prostate surgery is not the only cause of incontinence in men -- prostate enlargement that comes with normal aging can also cause incontinence, as can a range of other conditions, although the researchers did not test the efficacy of Kegels in men suffering from other conditions.

Back to the Top

Nitric Oxide Governs Fever

HealthDayNews
Friday, June 27, 2003

FRIDAY, June 27 (HealthDayNews) -- Nitric oxide plays an important role in regulating fever, says a Medical College of Georgia study.

Previous studies have offered conflicting conclusions about the role of nitric oxide, including that it induces fever, suppresses fever or plays no role in fever.

But the latest study found nitric oxide does play a role in fever regulation -- a complicated and surprising role, according to lead researcher Dr. Wieslaw E. Kozak, physiologist and biochemist.

Nitric oxide is produced by at least three enzymes in different tissues throughout the body. In experiments with mice, Kozak found each enzyme has a role.

His research to better understand the process of inflammation and resulting fever could help in the development of better ways to treat a wide range of problems, such as major infections and chronic inflammation.

The research appears in the April, May and June issues of the journal Genetic Models in Applied Physiology.

More information

Here's where you can learn more about fever.

Back to the Top

Too Much Shark, Swordfish May Pose Health Hazard

Reuters
Friday, June 27, 2003

GENEVA (Reuters) - Pregnant women concerned about the health of their unborn children should be careful about how much shark and swordfish they eat, food and health watchdog groups said on Friday.

The World Health Organization (news - web sites) in Geneva and the Food and Agricultural Organization in Rome cut by half the recommended intake limits for expectant mothers of methylmercury, a toxic chemical found especially in predator fish.

A group of experts, known by its initials JECFA, cut the provisional tolerable weekly intake, or PTWI, of methylmercury from 3.3 micrograms per kilo of body weight to 1.6 micrograms on the basis of new information on the effects of the chemical, the most toxic form of mercury.

WHO and FAO said in a joint statement that the reduction would ensure protection of the developing fetus, which absorbs the contaminant from food eaten by the pregnant woman.

WHO officials said all fish have low levels of methylmercury but predators have more because they eat smaller species. The nutrient value of all fish as a food for humans normally outweighs the possible danger.

Although not widely consumed in central and northern Europe and North America, swordfish and some varieties of shark are an important source of food around the Mediterranean and in coastal areas of Africa, Asia and Latin America.

Back to the Top

Bone Strength

HealthDayNews
Friday, June 27, 2003

(HealthDayNews) -- If you have osteoporosis or are at risk of developing it, you have good reason to exercise.

Strong back muscles are the best way to prevent spinal fractures, according to the Mayo Clinic. And the most effective way to strengthen the back is to do exercises that target your back muscles.

A Mayo Clinic study found that women who completed two years of supervised back-strengthening exercise were almost three times less likely to get a compression fracture, and the effect lasted up to eight years.

So keep your back strong and ask your doctor about specific exercises that could help prevent bone loss.

Back to the Top

Serious Spousal Spats Spike Blood Pressure

By Alison McCook
Reuters Health
Friday, June 27, 2003

NEW YORK (Reuters Health) - Although talking things through is generally a good idea in marriage, new research suggests that serious conflicts between partners can be hazardous to their health.

Investigators at Miami University in Oxford, Ohio, found that, during discussions between couples with a somewhat turbulent relationship in which one partner wanted the other to make certain changes in their marriage, the change-desiring spouse often experienced a marked increase in blood pressure, which lasted as long as the conversation.

A sustained and repeated increase in blood pressure can affect a spouse's health, perhaps eventually leading to cardiovascular disease, the study's lead author told Reuters Health.

"There may be some type of physical toll that is taken on a person," said Dr. Tamara L. Newton.

During the study, Newton and her co-author monitored changes in heart rate and blood pressure in both members of married couples as they discussed topics of conflict.

In one discussion, the partners talked about changes the husband wished the wife would make, while the other talk focused on things the wife wished the husband would change about himself.

In an interview, Newton said that the changes sought by husbands and wives ranged in importance, and included wishing the partner would spend more or less time with in-laws, participate more in housework or childcare, spend less money or make changes in their sex life.

In general, people who experienced the highest increases in blood pressure during the tense discussions were those who also showed the most negative behaviors during the discussions, Newton said. Negative behaviors included being critical or antagonistic, or dominating partners by cutting them off and being dogmatic.

And among couples who adopted those negative behaviors, blood pressure tended to increase more while discussing points in which they wanted their partners to change than when talking about something their partner wanted to change about them.

The discussions lasted for 15 minutes, and this increase in blood pressure continued throughout the entire conversation, Newton noted.

These findings suggest that the person who desires change is more likely to feel the health effects of arguments, she added.

The other partner, who is representing the way things currently are, is "in a more secure position, I think," she said. "They have more control, more security, there's less effort involved."

Research has shown that women typically desire more changes from their partners than men do, Newton said.

Studies have also shown that women may experience increases in blood pressure during conflict not seen in men -- but, according to this newest research, Newton said this increase could stem from the fact that women are more likely to desire change, and not from gender itself.

Source: Health Psychology 2003;22:270-278.

Back to the Top

Calcium Correctness

HealthDayNews
Friday, June 27, 2003

(HealthDayNews) -- While women often take calcium supplements to reduce their risk of osteoporosis, the bone-building mineral seems to inhibit the effectiveness of bisphosphonates, such as alendronate (Fosomax) or risedronate (Acetonel), which are prescribed to prevent osteoporosis, according to the John Hopkins Medical Letter.

To prevent calcium supplements from undermining the efficiency of bisphosphonates, do not take the two within 30 minutes of each other.

Back to the Top

Study: Sugary Drinks Help Children Get Fat

Reuters
Friday, June 27, 2003

WASHINGTON (Reuters) - The proof's in the calories: those sweet sodas, bottled teas and fruit drinks can make your children fat, U.S. researchers said on Friday.

Children who drank more than 12 ounces of sweetened drinks a day gained significantly more weight over two months than children who drank less than 6 ounces a day, the team of nutritionists at Cornell University in New York found.

The soft drink industry has long argued that a lack of exercise and not the availability of drinks is responsible for the rise of obesity in the United States.

But the Cornell team's study of 30 children aged 6 to 12 found that on days when they drank sweetened drinks, they took in, on average, 244 more calories a day.

The children did not eat any less food to compensate for the extra calories in the sodas, lemonades and other drink treats, the researchers said.

Children who drank more than 16 ounces a day of sweetened beverages gained an average of 2.5 pounds, compared with a 0.7- to 1-pound gain in children who consumed on average 6 to 16 ounces of sweetened drinks a day, they found.

"These findings suggest that sweetened drinks may be a significant factor in the increase in obesity among children in the United States," said David Levitsky, a professor of nutritional sciences and of psychology who oversaw the study.

Writing in the Journal of Pediatrics, Levitsky and Ph.D. candidate Gordana Mrdjenovic defined sweetened drinks as soda, fruit punch, bottled tea or drinks made from fruit-flavored powders, such as grape and lemonade.

They also found that children tended to pass up milk when they were offered a sweet drink, and that caregivers tended to offer either milk, or a sweet drink, but not both.

Children getting 12 ounces of more of soft drinks got 20 percent less phosphorus, 19 percent less protein and magnesium, 16 percent less calcium and 10 percent less vitamin A per day than recommended by the U.S. government.

The World Health organization (news - web sites) estimates that there are 17.6 million overweight children under age 5, with 20 percent of children in European countries obese or overweight. Fifteen percent of U.S. children aged 6 to 11 are overweight.

The Center for Science in the Public Interest, a non-profit health interest group has lobbied for a tax on soft drinks, calling them "liquid candy."

"Soda pop is Americans' single biggest source of refined sugars, providing the average person with one-third of that sugar," the CSPI said in a statement.

"Twelve- to 19-year-old boys get 44 percent of their 34 teaspoons of sugar a day from soft drinks."

Back to the Top

Calcium Can Be Critical Before Menopause

HealthDayNews
Friday, June 27, 2003

FRIDAY, June 27 (HealthDayNews) -- Many women start taking calcium supplements during menopause, but calcium deficiency increasingly is being seen in younger women, says the June issue of the Mayo Clinic Women's HealthSource.

Women who aren't getting enough calcium in their diets should take a supplement, regardless of their age. Ask your doctor how much calcium you need because the amount required changes based on age and health factors.

A doctor also can recommend which kind of calcium supplement should be taken, when to take it for best absorption, and if it should be combined with vitamin D or other minerals.

If dietary intake of calcium is insufficient, calcium supplements can provide special benefit to the bones at certain times in life, such as puberty or in early menopause. But at any age, calcium benefits a woman's bones as well as muscles and nerves.

A well-balanced diet can provide all the calcium you need. Good sources of calcium include: dairy products; vegetables such as broccoli, spinach, brussels sprouts and kale; tofu; calcium-fortified juices, cereals and breads; and canned fish such as salmon.

More information

Here's where you can learn more about calcium.

Back to the Top

Diabetes Tied to Increased Risk of Breast Cancer

By Jacqueline Stenson
Reuters Health
Friday, June 27, 2003

NEW YORK (Reuters Health) - Women with diabetes may have a slightly elevated risk of developing breast cancer (news - web sites), new study findings suggest.

"We found there is a small but statistically significant association," said study author Dr. Karin B. Michels, an associate professor of epidemiology at Harvard Medical School (news - web sites) in Boston.

The results, drawn from the ongoing Nurses' Health Study, showed that women with type 2 diabetes were 17 percent more likely to develop breast cancer than those without diabetes. Type 2 diabetes, the most common form of the disease, usually develops in adulthood though it is on the rise in children, who are increasingly becoming overweight.

In their analysis, Michels and colleagues accounted for various factors that may have influenced the results, such as heavy alcohol consumption, obesity and a family history of breast cancer.

The research involved 116,488 female nurses who were ages 30 to 55 when the study began in 1976. They were followed for the next two decades, during which time there were 6,120 cases of type 2 diabetes and 5,605 cases of breast cancer. Of those who developed breast cancer, 202 had diabetes.

The link between diabetes and breast cancer was apparent in postmenopausal but not premenopausal women, according to findings reported in the June issue of the journal Diabetes Care.

Michels said the explanation for the association between the two diseases is not clear. "How all of this works mechanistically we're not entirely sure," she told Reuters Health.

Some investigators have speculated that elevated levels of insulin in the blood of diabetics (news - web sites) may somehow promote breast cancer, the study authors note in the report.

Insulin is a hormone produced by the pancreas that allows glucose, or blood sugar, to enter cells to be converted into energy. This process is impaired during insulin resistance, when the body becomes less sensitive to the effects of insulin, prompting the pancreas to pump out more insulin to try to compensate.

Efforts to prevent diabetes by encouraging people to exercise regularly, control their weight and eat a healthful diet may have a new, added benefit for women, according to Michels.

"Maybe we can prevent some breast cancers as well," she said.

Source: Diabetes Care 2003;26:1752-1758.

Back to the Top


Could a Plant Discovery Improve Chemotherapy?

By Steven Reinberg
HealthDay Reporter
HealthDayNews
Friday, June 27, 2003

FRIDAY, June 27 (HealthDayNews) -- In experiments with plants, researchers have discovered a mechanism by which auxin, an important plant growth hormone, moves into cells.

The finding could have important implications in making chemotherapy more effective, the researchers believe, because proteins similar to human multidrug resistant (MDR) proteins control this movement.

Lead researcher Angus Murphy, an assistant professor of horticulture at Purdue University, says that auxin has a lot to do with the shape of a plant and also controls how plants bend in response to light and gravity.

Although the proteins that transport auxin from cell to cell in plants have been identified, how they work has remained a mystery, Murphy says.

"We found that one group of proteins controls the movement of auxin," he explains. Murphy and his colleagues discovered that plant proteins, similar to human MDR proteins, become depleted, allowing auxin to move into cells. The findings appear in the June 26 issue of Nature.

In humans, MDR proteins protect cells from toxins and are the proteins responsible for removing chemotherapy drugs from cells. To bypass MDR proteins, chemotherapy doses need to be high, causing the severe side effects associated with the treatment.

The latest finding has direct implications in agriculture and horticulture, by allowing for the regulation of plant growth. Using these findings, plant size, bushiness, fruit production and root structure can be manipulated, Murphy says.

But the discovery also might lead to ways to control and restrict human MDR proteins, making lower doses of chemotherapy more effective with fewer side effects, he adds.

Northeastern University biology professor Kim Lewis says the finding that genetic manipulation of hormones can affect a plant's growth rate, intensity of growth and root system growth is very interesting.

"What I am less enthusiastic about is the possible connection to human multidrug resistant cancer," Lewis says. "There are a number of molecules that work directly against human MDR proteins that have already been identified. Adding yet another member to this already large family of proteins will be not be helpful."

Lewis also disputes the claim that the finding will help in understanding the function of human MDR proteins. "The function of human MDR proteins is well understood," he notes.

More information

To learn more about cancer treatment, including chemotherapy, visit the National Cancer Institute or the American Cancer Society.

Back to the Top

Canada Won't Ban Brains, Spines from Feed Now

Reuters
Friday, June 27, 2003

WINNIPEG, Manitoba (Reuters) - Canada said on Friday it would closely study an international report urging a ban on the use of brain and spines in animal feed and food for human consumption, but said it would not immediately follow the recommendations.

The report was made in response to a single case of mad cow disease in Alberta last month which prompted a crippling international ban on Canadian beef exports.

Agriculture Minister Lyle Vanclief said that if Canada decided to follow the recommendations, it would take time to make the necessary changes to legislation and regulations.

"In general we agree with the direction of these recommendations... We are determined to review and if necessary revise these policies as quickly as possible," he told reporters on a conference call.

"However we must realize that many of these changes are complex and require coordination and in some cases even harmonization of course with the provinces and with the industry and with our trading partners."

Vanclief said the government would act "very quickly" in some areas, but not until he had met with his provincial counterparts in early July.

In the report, international veterinary experts told Canada to keep the brains and spines of cattle out of the meat-processing system and from being rendered into animal feed. BSE (news - web sites) is thought to be spread when brains, spines and other "specified risk materials" are fed to other cattle.

Removing specified risk materials from the food and feed chain would protect food safety, the panel said.

"Some measures -- such as tighter controls on non-ruminant feed -- require regulatory change," Vanclief said.

Back to the Top

CPR May Work in Prone Position

By Janice Billingsley
HealthDay Reporter
HealthDayNews
Friday, June 27, 2003

FRIDAY, June 27 (HealthDayNews) -- A small, preliminary study has found that performing cardiopulmonary resuscitation (CPR) on a person who's lying on his stomach rather than on his back improves blood flow.

"This is very experimental, and we are not recommending anyone to start doing this," says Dr. Myron Weisfeldt, the lead author who did the study when he was chairman of medicine at Columbia Presbyterian Medical Center. But Weisfeldt, who is now chairman of the Johns Hopkins department of medicine, adds that the results are promising enough to conduct further research into the procedure.

The results of the study appear in the June issue of the journal Resuscitation.

Weisfeldt says that the study, which took four years to arrange because of the ethical considerations involved in trying a new technique on patients suffering from heart failure, is an effort to improve techniques for resuscitation.

"We know that the amount of blood flow in CPR is very modest, and for some years have been trying to develop new ways to improve blood flow using mechanical devices," he says.

"This is an effort to use the principles that we had been using for mechanical devices to instead devise something for people in the field to do with their hands," he adds.

The benefits of performing CPR on a person in the prone position seem to be clear: Because it is easier to apply pressure to the back than to the chest -- there's more room to maneuver and not worry about damaging the rib cage -- more force can be applied, which increases blood pressure.

The problem, Weisfeldt points out, is making sure a person can breathe when lying on his stomach. In the hospital study, the patients were given oxygen, though that wouldn't be true in a normal setting.

"We do not know how good or bad the ventilation would be on subjects [outside a hospital setting]," he says.

"This is a very small, early study on a very select population, but it shows a potential physiologic benefit in looking at blood pressure and blood flow, and gives some hope that in a certain population, prone CPR might increase blood flow," says Dr. Vinay Nadkarni, chairman of the emergency cardiovascular care committee of the American Heart Association (news - web sites) and an associate professor of anesthesiology and critical care at the University of Pennyslyvania.

Another benefit, he says, could be the fact that in supine CPR, the tongue tends to fall back in the throat, blocking the airway, and in a prone position, the tongue might stick out, keeping the passage clearer.

Nadkarni adds that CPR originally was performed on patients in a prone position, when people were rescued from drowning and the aim was to push water out of their lungs.

"So this is sort of an exciting new look at an old technique," he says, "a first building block to look at CPR a little differently, but it isn't enough to make the American Heart Association change its recommendations."

These recommendations including performing CPR in the supine position, Nadkarni says.

For the study, CPR was tested on six critically ill patients already in Columbia Presbyterian's critical care unit because their hearts had stopped. They had failed to respond to standard CPR for at least a half-hour.

Toward the end of this period, an additional 15 minutes of standard CPR was performed on the patients while their blood pressure was monitored, and then the patients were turned over and given another 15 minutes of CPR while on their stomachs.

While prone, the doctors were able to increase the systolic blood pressure, which measures heartbeats, on the patients by an average of 34 millimeters of mercury, a statistically significant improvement. Also statistically improved was the average arterial blood flow pressure, by an average 14 mm.

The diastolic blood pressure, the resting rate of the heart, improved by an average of 10 mm, which was not statistically significant.

Each patient given reverse CPR in the study also had a 10-pound sandbag placed underneath his lower chest to stabilize his body while pressure was applied to his back. His head was turned to one side to allow him to breathe with oxygen supplied by a nurse.

None of the patients in the study survived, because of their condition before the reverse CPR was attempted.

But Weisfeldt says the statistical improvement in blood pressure and blood flow between the two CPR positions demonstrates the value of pursuing research into the optimal position for CPR.

More information

The National Heart, Lung and Blood Institute has an informative site on blood pressure. For an explanation of CPR, you can visit Amherst College.

Back to the Top

THURSDAY, JUNE 26, 2003

Dam in Brain May Halt Chronic Pain

By Kathleen Doheny
HealthDay Reporter
HealthDayNews
Thursday, June 26, 2003

THURSDAY, June 26 (HealthDayNews) -- Scientists have long been interested in a substance called nocistatin, a brain peptide that could play a role in stopping the chronic pain that plagues about 86 million Americans.

German researchers have discovered more clues about how nocistatin might stop the pain process, and how it might act as a kind of natural analgesic by inhibiting the release of a neurotransmitter that's crucial for the pain process to kick in.

"Our main finding is very much related to basic research and questions of communication between nerve cells," says Dr. Hanns Ulrich Zeilhofer, a professor of molecular neuropharmacology at Erlangen-Nurnberg University. He and his colleagues report their findings in the June 27 issue of Science.

The team focused on receptors in the spinal cord called NMDA (N-methyl-D-aspartate), which play a key role in the processing of pain. The receptors require two neurotransmitters, glutamine and glycine, to be fully activated. It is thought that special "transporters" sweep up most of the glycine before it reaches the receptors, so the receptors remain subdued and pain does not become chronic.

But when Zeilhofer's team induced acute pain in laboratory rats, the rats' neurons released enough glycine to overwhelm these transporters. Then the glycine spilled over to the receptors, setting into motion the neurological "cascade" that leads to chronic pain.

"This process is called spillover," says Zeilhofer. "It has long been thought that synaptically released glycine [released from the synapses, or junctions between cells] only acts on inhibitory glycine receptors located directly in the glycinergic synapses. We have shown, under certain conditions, synaptically released glycine can escape these synapses to act on neighboring excitatory NMDA receptors."

Then came the finding that nocistatin can act as an analgesic by inhibiting this spillover release of glycine.

"We do not know yet whether it really can prevent chronic pain, but it reduces NMDA receptor activation and NMDA receptors are believed to be important for the induction of chronic pain," Zeilhofer says.

"We have previously shown that nocistatin inhibits glycine release," he says. "Others have already shown that nocistatin can be analgesic," he says.

"We are the first to provide a cellular and molecular mechanism for the analgesic action of nocistatin," he adds.

"It's an interesting mechanism to help understand how chronic pain can be perpetuated and amplified," says Dr. Daniel B. Carr, a pain expert at Tufts-New England Medical Center in Boston. "It adds to existing knowledge," he adds, noting that the progression of pain from acute -- considered normal, as when the body warns of danger -- to chronic is complicated.

Acute pain is considered a normal sensation, triggering the nervous system to alert you to potential injury and the need to take action (such as removing your hand from a hot stove). But chronic pain can persist for weeks, months or years. It can involve headache, backache, arthritis pain, and other ailments.

The chronic pain that plagues about 86 million Americans leads to losses of about $90 billion a year, the American Chronic Pain Association estimates. Treatments currently include medication, electrical stimulation, surgery, acupuncture and a variety of other methods.

More information

For more information on chronic pain, try the National Institute of Neurological Disorders and Stroke or the American Chronic Pain Association.

Back to the Top

New Cavity-Fighting Agent Shows Promise

By Keith Mulvihill
Reuters Health
Thursday, June 26, 2003

NEW YORK (Reuters Health) - An experimental cavity-fighting toothpaste may be better at preventing tooth decay and cavities than traditional fluoride toothpaste, according to a study.

The new agent does not contain any fluoride, which has been the cornerstone of cavity prevention for decades.

The product, called CaviStat, contains the amino acid arginine as well as calcium carbonate. The toothpaste may help fight cavities by promoting a higher pH in the mouth, according to Mitchell Goldberg, president of Ortek Therapeutics Inc., the company granted the licensing rights to the product by the Research Foundation of the State University of New York.

After eating food, the bacteria trapped in sticky plaque inside the mouth metabolize sugars and release acid. Over time, this process can eat away at the enamel of the tooth and promote decay.

The study, which is due to be presented at the International Association of Dental Research in Sweden later this week, suggests the calcium carbonate portion of the CaviStat might also remineralize teeth at a higher rate than fluoride, explained Goldberg in an interview.

Dr. Dan Meyer, director of science at the American Dental Association characterized his reaction to the study as "guardedly optimistic." He said he hasn't actually evaluated the product.

"Normally, you like to have several studies that find similar results," he said, adding that the current study "shows promise," but more research is needed to validate the anti-cavity findings.

In the study, Dr. Israel Kleinberg, of Stony Brook University in New York, and colleagues evaluated the efficacy of CaviStat among 726 Venezuelan children who were between 10 and 11 years old.

Half of the youngsters were instructed to brush their teeth three times a day for one minute with CaviStat toothpaste, and the other used traditional fluoride toothpaste.

After one year, CaviStat appeared to reduce the signs of early tooth decay, according to Goldberg.

At the end of two years, kids who used CaviStat had fewer cavities compared to the ones in the fluoride group, said Goldberg.

Although this is the first large clinical trial of the product to be conducted, Goldberg said he is confident that future trials will show similar results.

Back to the Top

In Alzheimer's, Plaques May Alter Memory Genes

By Adam Marcus
HealthDay Reporter
HealthDayNews
Thursday, June 26, 2003

THURSDAY, June 26 (HealthDayNews) -- The buildup of toxic proteins in the brains of Alzheimer's patients is accompanied by changes in several genes linked to memory and learning, a new study has found.

The study, which looked at both mice and humans, found that brain cell genes known to regulate memory and learning were significantly suppressed in the presence of plaques composed of a renegade protein called beta-amyloid. Many Alzheimer's researchers believe these plaques cause the dementia and other mental decline that mark the condition.

Dave Morgan, an Alzheimer's expert at the University of South Florida in Tampa, and the leader of the study, says the work could open a new frontier in the search for therapies to fight the disease.

So far, scientists have come at Alzheimer's from three directions: drugs that block the buildup of protein deposits, "plaque-busting" drugs that break up the protein clusters and allow the brain to clear them away and vaccines that encourage the immune system to destroy the plaques.

The fourth way, Morgan says, would be to use the latest information and subsequent research to design drugs that could reverse the effects of beta-amyloid on brain genes.

"I don't know that these drugs would ever be useful by themselves," he says, but they could augment some or all of the other treatments. No such compounds are in development yet, Morgan adds.

A report on the findings appears in the latest issue of the Journal of Neuroscience.

An estimated four million Americans have Alzheimer's disease (news - web sites), a brain-wasting condition that has no cure. Treatments for the disorder can briefly delay, but not halt, its progression.

The researchers studied mice engineered with two genes that cause them to accumulate beta-amyloid plaques in their brain. These animals ultimately develop some of the neurological problems consistent with the human Alzheimer's disease.

Using a "gene chip," which identifies increases or decreases in the genetic activity of cells, the scientists discovered six genes in the brain tissue of the sick mice that were significantly suppressed in the presence of plaques.

The genes -- called Arc, Zif268, NR2B, GluR1, Homer-1a and Nur77/TR3 -- play key roles in learning and memory. Animals missing the first two "cannot remember anything," Morgan says. "With other research we've found 10 genes that are affected," including one for a vital enzyme that controls the electrical "heartbeat" of neurons, he adds.

Interestingly, the scientists say, the six genes reported in the current paper appeared to function normally in areas of the brain that weren't infiltrated by the protein deposits.

After confirming their results with a different gene-measuring technique, the group turned to tissue samples from the brains of people who'd died with Alzheimer's disease.

Again, the six learning and memory genes were muted in cells affected by beta-amyloid plaques. But unlike in the mice, a host of other brain genes also were suppressed.

Morgan says that's not a surprise because people who die with advanced Alzheimer's have suffered widespread death of neurons. As a result, all of the genes in their brain cells are likely to be affected.

The mice his group used don't experience neuron death. "We suspect that if we had obtained brain tissue of patients who had died very early in Alzheimer's disease, then the picture would have been much more similar" to what occurred in the animals, he says.

D. Stephen Snyder, who studies Alzheimer's at the National Institute on Aging, which funded the research, agrees that the findings could lead to new treatments for the disease.

"I think that's a reasonable, hoped-for outcome down the road," Snyder says. However, he adds, trying to control the individual genes affected by plaques would perhaps be "more difficult to manage" than other approaches.

More information

Try the Alzheimer's Association or the National Institute on Aging for more on Alzheimer's disease.

Back to the Top

Low-Cost Steps May Save Millions of Kids

By Emma Ross
AP Medical Writer
The Associated Press
Thursday, June 26, 2003

LONDON - The lives of 6 million children under 5 could be saved every year if flu shots and other low-cost measures to prevent or treat disease were more widely used, global health experts say.

Every year, nearly 11 million children worldwide die before their fifth birthday, most from preventable causes such as diarrhea, pneumonia, neonatal problems and malaria. Malnutrition is a major factor in more than half those deaths, researchers estimate.

In a series of articles this week in The Lancet medical journal, experts say inexpensive lifesaving measures such as breast feeding, insecticide-treated bed nets, flu shots, antibiotics, newborn resuscitation and clean childbirth are not reaching the mothers and children who need them most.

Scaling up those interventions to a level that would save 6 million lives a year would cost about $7.5 billion annually, the experts say.

In the 1980s, the world made great progress in reducing unnecessary child deaths through a UNICEF (news - web sites) campaign called the child survival revolution. But the momentum was lost in the 1990s.

"We have dropped the ball," said one of the experts, Cesar Victora, professor of epidemiology at the Federal University of Pelotas in Brazil. "Child survival has fallen off the international agenda ... we need now a second revolution to finish this job."

The number of deaths among children under 5 fell from 117 per 1,000 live births in 1980 to 93 per 1,000 in 1990. Today, the death rate is still declining but not as fast in 2000, it was 83 per 1,000 live births.

Experts stressed two main reasons why progress appears to have stalled.

One is the realization in the 1990s that HIV (news - web sites)/AIDS (news - web sites) was decimating populations in Africa, which shifted the world's attention and resources toward fighting specific diseases, such as AIDS, malaria and tuberculosis.

"I'm not saying that it was wrong, but child health lost out in that," said Hans Troedsson, director of child and adolescent health and development at the World Health Organization (news - web sites).

The experts noted that the total number of child deaths each year is greater than those due to HIV, malaria and tuberculosis combined.

The other major factor was complacency, experts say.

"We were doing really well," Troedsson said. "There was a kind of attitude that the job was more or less finished. That kind of perception meant that a lot of investments and commitments to keep the steam in child survival was actually lost."

Other experts said the death of former UNICEF leader Jim Grant, who spearheaded the child survival revolution of the 1980s, left a void in global leadership as UNICEF's focus later shifted toward children's rights and education.

The U.N. children's agency said it still spends most of its money on child survival programs and many of its newer strategies addressing children's rights and education translate in the long-term to better child survival.

"The easy gains have been made," said UNICEF spokeswoman Marjorie Newman-Williams. "We have now plateaued because the strategies we have to put in place are more difficult."

Whereas earlier strategies were focused on delivering vaccines and medicines to clinics, future progress does not necessarily depend on that, she said. The benefits of that approach have been mostly mined, she said.

Many of the actions that will reduce the deaths now are those that have to be taken into the home, such as breast-feeding, bed nets and proper infant nutrition after weaning.

"Those three heavily depend on women's time, women's knowledge and availability," Newman-Williams said. "And to reduce neonatal mortality, you have to focus on women's health. This is not a child health intervention."

On the Net:

The Lancet: http://www.thelancet.com

UNICEF: http://www.unicef.org

Back to the Top

Bad Bosses Do Make Your Blood Boil

HealthDayNews
Thursday, June 26, 2003

THURSDAY, June 26 (HealthDayNews) -- Got high blood pressure? You could blame it on your boss.

A new British study contends that working for a boss who's considered unreasonable and unfair can make an employee's blood pressure rise. That, in turn, increases the employee's risk of heart attack and stroke.

Researchers surveyed and monitored the blood pressure of 28 female health-care assistants, 18 to 45 years of age, with one group working for fair bosses and the other working for unfair bosses. The workers were followed for three days, with readings taken every 30 minutes for a 12-hour period each day.

Those in the "unfair" group registered an increase of 15 mm Hg in systolic and 7 mm Hg in diastolic blood pressure. An increase of 10 mm Hg in systolic and 5 mm Hg in diastolic blood pressure has been associated with a 16 percent increased risk of coronary heart disease and a 38 percent increased risk of stroke, according to the study.

On the other hand, those working for a good boss -- one deemed reasonable and fair -- registered a slight decrease in blood pressure.

This shows that a workplace "characterized by fairness, empowerment and consideration is likely to provide one inexpensive strategy for reducing the risk of cardiovascular disorders," the researchers write in a news release.

Their findings appear in the current issue of Occupational and Environmental Medicine.

More information

Here's where you can learn more about lowering your blood pressure.

Back to the Top

Men Have Biological Clocks Too, Study Finds

Reuters
Thursday, June 26, 2003

WASHINGTON (Reuters) - It's not just women who have biological clocks, British researchers reported on Wednesday.

As men get older, it takes them longer to father a child, the team at the University of Hull reported.

Doctors have long known that the older a woman is, the more trouble she will have conceiving. Men can, at least theoretically, father children until they die.

But a study of more than 1,200 pregnant women shows it is not always easy.

Mohamed Hassan and Dr. Stephen Killick questioned the women about everything from whether they smoked to how long it took them to become pregnant. The time it took them to get pregnant, they found, became noticeably longer when their partners were 45 or older.

"As with women's age, increasing men's age was associated with significantly rising time to pregnancy and declining conception rates," they write in their report, published in the journal Fertility and Sterility.

"Half the couples trying for pregnancy succeed within three months," they write. Eighty-five percent succeed within a year.

One in six couples has trouble conceiving within a year, although 70 percent finally succeed after two years.

Even adjusting for factors like frequency of intercourse and the age of the woman, it took a man five times longer to father a child if he was older than 45, the researchers report.

"Age is not only a female problem," Dr. Marian Damewood, president-elect of the American Society of Reproductive Medicine, which published the report, said in a statement.

"Many patients are frustrated by the length of time that it takes them to conceive," she added.

"This study is valuable because it provides a broader view of the bottom-line effects of male aging on fertility."

Back to the Top

The Bald Truth

HealthDayNews
Thursday, June 26, 2003

(HealthDayNews) -- Baldness is not just a man's problem. As women age they, too, can have thinning hair. But unlike men who have receding hairlines, women's hair usually thins on the top and sides of the scalp, says the Medical College of Wisconsin.

After menopause, the ovaries may produce more male than female hormones, which can lead to hair loss. Other causes include some medications, severe stress, malnutrition, and iron deficiency.

While some products for women can lead to some hair growth, when you stop using the products, the hair you gain may fall out again within six months.

Back to the Top

Kaopectate Maker Will Reduce Lead Levels

By Beth Fouhy
Associated Press Writer
The Associated Press
Thursday, June 26, 2003

SAN FRANCISCO - Addressing a potential health threat in a product millions of parents have given their children, the maker of the anti-diarrhea medicine Kaopectate agreed to slash its lead levels in a settlement with the state approved Thursday.

The medicine's older formula no longer on pharmacy shelves as liquid but still sold in caplet form contains 25 micrograms of lead in every adult dose, or 50 times the level at which California requires a warning label.

Environmentalists, consumer groups and state Attorney General Bill Lockyer called the settlement a victory for children, who can suffer brain damage even from low levels of lead.

"Hundreds of thousands of consumers in California and across the country, including pregnant women and children, ingested Kaopectate and generic versions for years without knowing the product contained enough lead to pose a health risk," Lockyer said.

Pharmacia, the maker of Kaopectate, said in a written statement that its product "has been used safely and effectively for close to 50 years," and that it entered into the settlement "in the interest of avoiding costly and unnecessary litigation."

Pharmacia which was bought in April by New York-based Pfizer Inc. owes $1 million in civil penalties under the settlement, approved Thursday by San Francisco Superior Court Judge Richard Kramer. It will end up paying much less if it moves quickly to remove as much as 95 percent of the lead from Kaopectate, the nation's largest-selling diarrhea remedy.

Pharmacia began reformulating Kaopectate when California sued in 2001. About 80 percent of the lead has been removed from Kaopectate liquid, now sold in an hourglass-shaped bottle with a label that boasts it as "new and improved." Kaopectate caplets have not yet been reformulated.

The key ingredient in Kaopectate had been a substance called attapulgite clay that contains large amounts of lead. Pharmacia has agreed to completely remove the attapulgite from its product and replace it with bizmuth subsalicylate, found in the competing product Pepto-Bismol.

Even in relatively small doses, lead has been found to cause brain damage and other problems in children and neurological damage to fetuses.

A study published in April in the New England Journal of Medicine (news - web sites) found a 7.4-point IQ difference between children with just a slightly elevated level of lead in their blood and children with almost none.

"Numerous, small, little tiny doses of lead are much more important than we once thought," said Rick Maas, director of the Environmental Quality Institute at University of North Carolina, Asheville. "Over the last 15 years, we have been gradually uncovering the truth that lower and lower levels of lead exposure can cause irreversible damage, particularly to children and infants."

Lockyer and the Center for Environmental Health sued Pharmacia under a state law that requires manufacturers to provide "clear and reasonable" warning if their products contain certain toxic material.

The law requires a warning label if it exposes a consumer to more than 1/2 micrograms of lead per day. The older Kaopectate formula sold without a warning label contains 25 micrograms in each adult dose and six to 12 micrograms in each child dose.

On the Net:

California Attorney General's office: http://caag.state.ca.us

Pfizer: http://www.pfizer.com

Back to the Top

Medical Screenings

HealthDayNews
Thursday, June 26, 2003

(HealthDayNews) -- If you're between the ages of 40 and 60, John Hopkins Medical Center recommends you have the following medical screenings:

  • Blood Pressure -- You should be checked yearly, and more often if your reading is higher than 140/85.
  • Breast Cancer (news - web sites) -- Women should have mammograms and clinical exams every one to two years.
  • Cervical Cancer -- Women should have a Pap test every one to two years.
  • Cholesterol -- All people over age 40 should have a total blood cholesterol test every three years.
  • Colorectal Cancer -- All adults over age 50 should have an annual fecal occult blood test and a sigmoidoscopy every five years.
  • Prostate Cancer (news - web sites) -- Men over age 50 should have both a prostate-specific antigen (PSA) blood test and a digital rectum exam every year.

If you have a family history or other risk factors for any of these conditions, your doctor may recommend more frequent screenings.

Back to the Top

Many U.S. Adults Visit the ER for Toothaches: Study

By Charnicia E. Huggins
Reuters Health
Thursday, June 26, 2003

NEW YORK (Reuters Health) - Many American adults with tooth pain or injuries seek dental care in hospital emergency rooms, according to new study findings.

In fact, researchers report, from 1997 to 2000 nearly 3 million visits to emergency rooms in the U.S. were due to such dental-related complaints, and many of these patients were either uninsured or relied on public Medicaid insurance.

"Emergency departments are an important point of care for dental-related complaints, particularly for individuals who are publicly insured or uninsured," lead study author Dr. Charlotte Lewis, of the University of Washington in Seattle, told Reuters Health.

"The large number of uninsured and publicly insured individuals that come to emergency rooms for dental complaints suggests that they rely on emergency rooms because they have no other place to go for dental care," she added.

In a previously published study, a team of Boston University researchers reported that some children and adolescents also get their dental care in hospital emergency departments rather than their dentists' offices.

The current study's findings are based on 1997 to 2000 data from the National Hospital Ambulatory Medical Care Survey on all emergency department visits in which the patient's primary reason for seeking care was toothache or tooth injury.

During the study period, there were about 2.95 million such visits to emergency departments in the U.S., corresponding to an average 738,000 visits per year, the researchers report in the July issue of the Annals of Emergency Medicine.

Most of these visits were made by 19- to 50-year-old adults, who accounted for 77 percent of dental-related visits to emergency departments, but only 47 percent of other ER visits, the authors note.

Further, people on Medicaid and those with no insurance were nearly twice as likely as those with private insurance to have their toothaches and injuries treated in the emergency department.

Currently, 44 percent of Americans lack any dental insurance, Lewis noted.

"In these difficult economic times," she said, "emergency departments may even face increasing numbers of patients with dental complaints if the number of uninsured patients increases and the barriers to accessing dental care are not addressed."

She added: "Emergency departments and their providers should be prepared and equipped to triage, diagnose, provide basic treatment, and ensure appropriate follow-up care for dental problems."

Source: Annals of Emergency Medicine 2003;42:93-99.

Back to the Top

The Biology of Distance Perception

HealthDayNews
Thursday, June 26, 2003

THURSDAY, June 26 (HealthDayNews) -- In a study using laser measurement, Duke University Medical Center neurobiologists uncovered the biological basis of distance perception in humans.

The scientists used a laser range finder to scan real-life scenes and gather millions of distance measurements in each scene. They used that data to explain a number of long-known but little understood quirks in how people judge distance.

For example, the scientists concluded that people tend to estimate the distance of isolated objects as being six to 12 feet away because that's the average distance of actual objects and surfaces in the visual scenes encountered by people.

The Duke researchers say that supports their theory that the human visual system evolved to make the best statistical guess, based on past experience, about distances and other visual features.

Their findings appear in the June issue of Nature Neuroscience.

"All the characteristics of the visual world that we take for granted -- for example, the diminution of size with distance -- are a result of perception. So, a question for centuries has been 'What is the biological reason we see space in the peculiar way that we do?'" researcher Dr. Dale Purves says in a news release.

In previous research on perception of geometry, color, brightness and motion, Purves and his colleagues found evidence that visual processing isn't the result of logical calculations about the image information gathered by the eyes. Rather, it's mostly an empirical process driven by connections between nerve cells in the visual system that evolved as a result of the success of organisms that correctly interpreted the ambiguous visual world.

That visual ambiguity arises because photons striking the eyes' retinas don't carry any information about their origins. That means the visual system has to process information from the retina statistically to correctly interpret a visual world that can't be known directly.

More information

Here's where you can learn more about eyes and vision.

Back to the Top

Malpractice Woes Frustrate Fla. Doctors

By David Royse
The Associated Press
Thursday, June 26, 2003

TALLAHASSEE, Fla. - With the Legislature having quit a special session this week unable to agree on how to make malpractice insurance more affordable for doctors, many lawmakers and physicians are in the same frustrated frame of mind.

Doctors say they can't continue to practice and with the Legislature so far unable to help lower their insurance rates, they are renewing warnings that many may simply close their offices and move out of state.

While critics say it's a veiled threat meant to intimidate legislators, doctors say they're weary of legislative inaction and can't promise they'll all still be here at the end of the year.

"Doctors are very exasperated and what's going to happen I have no idea," Florida Medical Association CEO Sandra Mortham said Wednesday.

Patrick Hinton, executive director of a much smaller group, the Jacksonville Orthopedic Institute, also doesn't know what will happen if the 22 doctors there don't get relief on their rates, which are scheduled to go up by more than half in September.

"We know we can't tolerate those kinds of increases," said Hinton. "What we will do ultimately if we don't get anything done, I have no idea, but I will tell you it's not an issue we can continue to deal with."

The Legislature gave up Tuesday after a week in special session trying to fix the crisis. Both the Senate and House propose to try to lower rates in part by limiting lawsuit damages, which the insurance industry blames for high premiums. But they can't agree on how to cap damages.

Two physicians at the Jacksonville Orthopedic Institute are talking about leaving, Hinton said, echoing a refrain heard around the state for nearly a year now: If something isn't done, access to health care is in jeopardy for many patients.

State Sen. Dennis Jones said he isn't buying the threat. Jones is a chiropractor in St. Petersburg, and just down the street a new ophthalmology practice has opened with several doctors.

Jones said it seems to him that there are lots of new doctors looking for patients, and he said the numbers bear that out.

"Last year 1,249 medical doctors passed the state board," said Jones. "These new people aren't coming to Florida to take the Florida board and then go practice in Wyoming."

There aren't any firm estimates of how many doctors have left Florida because of higher insurance rates.

"The doctors are not taking out a full page ad saying, 'I'm leaving the state,'" said Mortham. "They're very quietly closing their offices."

Florida Hospital Association lobbyist Bill Bell said hospitals are having a hard time keeping doctors too. Most are trying to hold out as long as possible, he said.

"(To leave) goes against their natural grain," Bell said. "They're trying to do the best they can and provide the community with as much care as they can give."

Back to the Top

Envy Eats Away at Everyone

HealthDayNews
Thursday, June 26, 2003

THURSDAY, June 26 (HealthDayNews) -- Whether their partner commits sexual or emotional infidelity, men and women have much the same jealous reaction.

That's according to a University of California, San Diego study recently published in Personality and Social Psychology Review.

It's long been contended that men react more strongly to a partner's sexual infidelity while women have a stronger reaction to emotional betrayal by a partner. Those gender differences were attributed to natural selection, which evolutionary psychologists said encouraged men and women to develop different emotional reactions to jealousy.

That line of reasoning suggests that men developed sexual jealousy as a mechanism to prevent cuckoldry and women developed emotional jealousy as a way to prevent the loss of resources.

Men would give priority to sexual jealousy because it would prevent them from having to expend energy on providing and caring for a child that wasn't their own. Women were shaped by evolution to be more jealous of a partner's emotional betrayal, which could result in the male no longer supplying food, shelter and other important resources to a woman and her children.

But this new study contradicts that idea. It challenges the view of gender differences on jealously and contends that men and women seem to regard sexual and emotional jealousy in the same light.

"This research has found that the evolutionary theory of jealousy just does not hold up to rigorous academic scrutiny. A thorough analysis of the different lines of research which espoused this point of view raises serous doubts about how much of a sex difference actually exists. It is entirely possible that natural selection shaped the two sexes to be more similar rather than different," study author Christine Harris says in a news release.

She reviewed a number of studies that seemed to support the theory of a gender difference in jealousy and concluded that many of the studies contained numerous flaws and discrepancies.

More information

Here's where you can learn more about infidelity and other family issues.

Back to the Top

Antibody Discovery Could Lead to HIV Vaccine: Study

By Maggie Fox
Reuters
Thursday, June 26, 2003

WASHINGTON (Reuters) - Researchers said on Thursday they had figured out how a rare antibody sees past the disguises of the AIDS (news - web sites) virus -- a finding that may lead to a vaccine that will finally work against the killer microbe.

The antibody, taken from an unusual patient whose body can resist the virus, recognizes and attacks the human immunodeficiency virus, unlike most of the body's defenses.

"Nothing like this has ever been seen before," Ian Wilson of The Scripps Research Institute in La Jolla, California, who led the research, said in a statement.

AIDS has killed 25 million people around the world and is projected to kill 80 million by 2010. The only real hope of fighting the incurable virus is a vaccine, but efforts so far have flopped although dozens of vaccines are being tested.

Antibodies are an important arm of the body's defenses against germs. They are usually able to recognize an invader by structures on its surface, called antigens, and can either call in help, or neutralize the invader themselves by pasting themselves against it.

Most vaccines in use today stimulate the production of neutralizing antibodies.

The human body makes plenty of antibodies against HIV (news - web sites), but the virus disguises itself with human sugars.

One antibody seems to be able to see past this ruse. Called 2G12, it was found by Austrian researchers a decade ago in a patient who seemed to resist AIDS -- the condition caused as HIV destroys the immune system over time.

Writing in the journal Science, Wilson and colleagues said they had figured out how 2G12 does it.

It recognizes that while HIV is covered up with human sugars, they are not arranged in a human-like way.

The antibody does this with a special structure of its own, which Wilson and colleagues, including a team at Oxford University in Britain, have crystallized and imaged.

"The Fab (antigen-recognition) arms are interlocked," said Scripps researcher Dennis Burton, who worked on the study. "That is a unique arrangement, and it is good for recognizing a cluster of shapes like sugars on a virus."

Now what needs to be done is to use the structure of the antibody as a template to design an antigen to stimulate the production of 2G12 or another antibody that will neutralize HIV, the researchers said.

The approach might also work for making vaccines against other germs, said Wilson.

"Can we now use this to engineer antibodies with higher affinity against other antigens or clusters of antigens?" he asked.

Back to the Top

Dust Monitor May Stop Black Lung Disease

By Nancy Zuckerbrod
Associated Press Writer
The Associated Press
Thursday, June 26, 2003

WASHINGTON - Coal miners appear to have support from the Bush administration for a dust-detecting monitor, worn on belts, that they hope can help to eradicate black lung disease.

Under pressure from miners and operators, the administration decided this week to delay a final rule to regulate coal dust in mines until the device is tested further. A new rule could direct the use of the device.

The monitor provides continuous, real-time information about how much dust a miner is breathing in.

Under the current system, bulky monitors that check for dust in the mines have to be mailed to a government lab for analysis. Often a miner does not know how dusty his work environment was on a given shift for weeks too late to fix the problem.

"It's going to empower them to do something about their dust exposure," said Ed Thimons, a branch chief with the government's National Institute for Occupational Safety Health. "It will be the first major advance in dust sampling technology in over 30 years."

Thimons is part of the team that this month took the dust monitors, made by Albany, N.Y.-based Rupprecht and Patashnick Co. Inc., out of the lab and into a West Virginia coal mine for testing. Further tests are continuing this week and are said to be going well.

"I am totally convinced it will change the way miners are exposed to coal dust in this country," said Joe Main, the top safety expert at the United Mine Workers of America.

Miners who use the monitors will be able to insist on better ventilation or other dust controls, he said.

Breathable dust in underground mines is the primary cause of black lung, a debilitating respiratory disease that from 1968 through 1990 killed more than 55,000 miners and still kills about 1,000 miners annually.

Coal operators also appear enthusiastic and, along with the union, had urged the administration to write regulations governing the monitor's use.

The operators believe the monitors could cut their worker compensation costs by improving miners' health, help them avoid getting cited by the government for too much dust and reduce the need to sample dust levels and test dust-control measures.

The administration issued its proposed rule concerning mine dust this spring. Had it been finalized in the coming months, as originally planned, it would have taken away the coal operator's responsibility for inspecting mines for dust and left that to the Labor Department (news - web sites)'s Mine Safety and Health Administration. But the proposal still would have required coal companies to conduct regular checks of their dust-control technologies and plans.

Both industry and union officials had criticized the administration for putting forth its rule regarding the dust sampling program without waiting for complete tests on the monitors.

"There's the potential of them to become the core element of a new dust sampling program," said Bruce Watzman, vice president for safety and health at the industry-backed National Mining Association.

David Lauriski, the assistant secretary in charge of the Mine Safety and Health Administration, said the agency initially went ahead with its proposal because of delays in the monitor's development. But he said the success of the recent tests helped change his mind.

The monitors, he said, "appear to hold the key to achieving renewed progress in the battle against black lung."

The United Mine Workers of America wants the agency to require the constant use of the monitors in highly dusty areas of a mine or for miners who already have been diagnosed with black lung disease.

Lauriski has been cautious, saying he is worried the monitors may be too expensive to mandate. They are estimated to cost at least $7,000 each, compared with about $1,000 for existing sampling technology.

On the Net:

Mine Safety Health Administration: http://www.msha.gov/

United Mine Workers of America: http://www.umwa.org/homepage.shtml

National Mining Association: http://www.nma.org/

Back to the Top

New Approach to HIV Vaccine Needed: Experts

By Alison McCook
Reuters Health
Thursday, June 26, 2003

NEW YORK (Reuters Health) - All researchers investigating potential vaccines to prevent HIV (news - web sites) need to work together to speed up the process, according to a report released Thursday by an international group of AIDS (news - web sites) experts.

In the journal Science, the authors urge all HIV vaccine investigators to form a network of worldwide HIV vaccine development centers, each of which would help coordinate activities in one aspect of the research.

In that way, researchers can work together, sharing information and learning from each other's experiences, a report author told Reuters Health.

"There's an urgent need to accelerate the pace of HIV vaccine development," said Dr. Helene Gayle of the Bill and Melinda Gates Foundation (news - web sites) in Seattle.

"A more collaborative approach to research would very likely help to accelerate the speed and also the efficiency," Gayle added.

Problems in efficiency are likely one of the main reasons why years of worldwide research have not yet yielded a viable HIV vaccine, Gayle said, along with the fact that the virus itself is biologically complex.

If this new proposed model for vaccine development works, Gayle noted that the lessons learned could be applied to other vaccine efforts, such as those aimed at fighting major killers like tuberculosis and malaria.

Currently, she said, researchers working toward an HIV vaccine share information with each other, but not to the extent recommended by the new report, which urges researchers to pool all of their results and work together.

She noted that she and her colleagues do not envision the vaccine network as a "superstructure," but instead use the Human Genome Project (news - web sites) as a model -- in which researchers worked individually on different aspects of the project, and shared their results.

Obstacles to this include the very nature of research itself, which is often competitive, Gayle noted.

In addition, companies often invest in research with the plan of making money off of the fruits of their efforts, and consequently prefer to keep some results secret in order to protect their proprietary information.

In order to overcome these barriers and establish a collaborative global network to develop an HIV vaccine, researchers will need to come up with new ways to conduct their work so that sharing and working together does not crush scientific creativity and the potential for profits, Gayle said.

Other obstacles to such a collaborative effort include the fact that many vaccine researchers are working on opposite sides of the globe, and do not have many resources, according to Gayle.

"Greater resources will be needed to do this more efficiently, more effectively," she said.

She noted that the additional money could come from the public and private sector, as well as foundations.

In the report, Gayle and her colleagues also recommend that most of the advanced trials of vaccine candidates be conducted in developing countries in Africa and Asia, which have been hardest hit by the HIV pandemic.

"In this case, the benefit is greatest for the countries in which the trials will eventually be done," Gayle said.

Source: Science 2003;300.

Back to the Top

Stroke Care Estimated at $51 Billion

The Associated Press
Thursday, June 26, 2003

ATLANTA - Treating stroke patients will cost an estimated $51 billion this year in the United States, and the expense is likely to rise as the baby boom generation grows old, the government reported Thursday.

The estimate for 2003 includes $12 billion in nursing home costs, the Centers for Disease Control and Prevention (news - web sites) said.

Overall costs will probably increase as baby boomers swell the ranks of the elderly, it said.

Strokes are the third leading cause of death in the United States, killing almost 168,000 people in 2000 and accounting for about one of every 14 deaths.

On the Net:

CDC stroke study: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5225a3.htm

Back to the Top

Knowing Smoking Has Hurt Your Lungs Helps You Quit

By Alison McCook
Reuters Health
Thursday, June 26, 2003

NEW YORK (Reuters Health) - Telling long-time smokers they have puffed their way into lung disease helps provide many with enough motivation to kick the habit for good, new research suggests.

Researchers based in Poland found that people who were told their breathing had become moderately to severely limited by long-term smoking were more likely to quit during the following year than people who were told their lungs were only mildly affected, or not at all, by their habit.

Dr. Dorota Gorecka, of the Institute of Tuberculosis and Lung Diseases in Warsaw, and her colleagues obtained their findings by measuring lung function -- using a test called spirometry -- in 659 middle-aged smokers wanting to quit. All participants also received advice on how to stop smoking.

The researchers then surveyed participants one year later to determine whether, in the interim, they had managed to kick the habit for good.

The spirometric screening revealed that around half of smokers had breathing problems associated with smoking -- a sign they had chronic obstructive pulmonary disease (COPD), a group of diseases that includes emphysema.

Among those diagnosed with reduced lung function, 60 percent had moderate-to-severe breathing problems.

COPD is marked by progressively worsening shortness of breath and coughing. It is currently the fourth-leading cause of death in the world, after heart disease, cancer and stroke.

More than 80 percent of cases of COPD are the result of smoking, and research suggests that people who stop smoking early in the course of the disease can prevent further decline in lung function.

One year later, all participants said they had tried to quit, but those who proved most successful were people who showed the worst lung function during the initial screening, the authors report in the journal Chest.

Specifically, almost 17 percent of people with moderate-to-severe breathing problems diagnosed one year previously managed to quit, relative to only six percent of people with mild problems and eight percent of participants with normal lung function.

"I believe that spirometry enhances the motivation of smokers to quit," Gorecka told Reuters Health.

Success in quitting was also seen more often among older smokers, people who started the habit relatively late in life and those who lit up relatively infrequently.

These findings add further evidence to support the idea that all long-term smokers should be screened for COPD, Gorecka added.

"Spirometry is the only way to diagnose COPD, so it should be offered to every middle-aged smoker," she said.

Source: Chest 2003;123:1916-1923.

Back to the Top


AIDS Toll Could Reach 70 Million by 2020

By Paul Recer
AP Science Writer
The Associated Press
Thursday, June 26, 2003

WASHINGTON - A crash program to develop an AIDS (news - web sites) vaccine may be the only way to reduce a worldwide death toll that could reach 70 million by 2020, some of the world's leading researchers say.

Twenty-four scientific leaders advanced a formal proposal in the journal Science on Thursday calling for a network of coordinated research centers dedicated to the sole purpose of developing and testing an AIDS vaccine.

Co-authors of the proposal include two Nobel prize winners, the heads of major public health departments of the U.S. government, and AIDS researchers from France, South Africa, England, Switzerland, China, India and the United Nations (news - web sites).

In concept, said co-author Dr. David Baltimore, the proposal is rather like a Manhattan Project against AIDS.

"In the sense it is a commitment to use the skills of the scientific community to solve a problem, it is like the Manhattan Project," said Baltimore, a Nobel laureate. "But the Manhattan Project depended on secrecy and we're doing the exact opposite."

Baltimore said the research would be conducted openly, with information and discoveries shared quickly and completely between labs.

Despite more than 20 years of effort, researchers have yet to find the ideal approach against AIDS. The human immunodeficiency virus, or HIV (news - web sites), that causes AIDS attacks the very cells in the body's immune system that play a key role in protecting against infection.

Most vaccines cause the production of antibodies that neutralize an invading microbe, but HIV attacks the immune system itself and antibodies made against HIV are ineffective.

Vaccines that have been tested have failed to trigger the immune system response needed to kill or control HIV, and researchers are still uncertain exactly how to prompt a vaccine-induced defense against the virus.

As a result, the plan calls for each of the labs to take a different approach in an effort to find the best route to a vaccine defense.

"Increasing the diversity of approaches and coordinating the types of vaccines entering clinical trials are fundamental to speeding global HIV vaccine development," the authors write.

Vaccines usually are developed by private pharmaceutical companies, but Baltimore said the problems and expense of developing an HIV vaccine make the traditional ways impractical.

"The pharmaceutical industry is involved, but not with the intensity that we would like," he said. "There are only a few companies that have put out an intense effort. I think part of the reason is that it is not seen as a potentially profitable enterprise (news - web sites)."

A crash program to develop and test an AIDS vaccine, the experts said, could cost billions of dollars and take five to 10 years.

But it is an effort that humanity cannot ignore, said the experts.

AIDS now kills more people than any other infectious disease. By 2010, it's estimated there will be 45 million new infections. HIV kills people in the prime of life, causing a serve impact on a nation's economy and leaving behind millions of orphaned children.

The entire continent of Africa has been crippled by AIDS, said Baltimore, and the disease is now becoming a major health threat in Asia.

"AIDS has decimated Africa and if it spreads to the same percentage of people in India or China, it will decimate those countries," he said.

The lead author of the study is Dr. Richard D. Klausner, the former director of the National Cancer Institute (news - web sites).

Co-authors include Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases (news - web sites), the chief federal AIDS research agency; Dr. Julie L. Gerberding, director of the U.S. Centers for Disease Control and Prevention (news - web sites); Dr. Gary J. Nabel, head of the Vaccine Research Center at NIAID; and Harold Varmus, a Nobel prize winner, former head of the National Institutes of Health (news - web sites) and current president of the Memorial Sloan Kettering Cancer Center in New York.

Back to the Top

Cardiac Arrest Survivors Do Fairly Well: Study

Reuters Health
Thursday, June 26, 2003

NEW YORK (Reuters Health) - Cardiac arrest patients who survive having their heart shocked with a portable defibrillator can go on to lead lives that are just as long and as full as people with similar heart conditions who've never had a cardiac arrest, a new study suggests.

The findings support the idea of equipping police and paramedics with cardiac defibrillators and training them to use them, according to Dr. Roger D. White and colleagues from the Mayo Clinic in Rochester, Minnesota.

Cardiac defibrillators are portable "shock boxes" that can deliver a jolt to restore the heartbeat. Easy enough for novices to use, such defibrillators are increasingly showing up in local malls, airports and other public places.

According to the report in Thursday's issue of The New England Journal of Medicine (news - web sites), even a minute's delay in getting defibrillation can make a big difference in whether a person lives long enough to make it home from the hospital.

In the study, the researchers look at survival and quality of life issues for 200 patients who underwent prompt defibrillation after undergoing cardiac arrest outside a hospital sometime between 1990 and 2000.

In 1990, Olmsted County implemented an early defibrillation program through the police department. The group of patients was compared to others who had heart disease but had not suffered a cardiac arrest and to the general population.

Of the 200 original patients, 42 percent lived long enough to leave the hospital, and almost all of those patients (79 out of 84) were free of disabling neurological problems.

While that might not sound too encouraging, the traditional survival rate for people who go into cardiac arrest outside a hospital is three percent to 10 percent -- although that is improving with increasing availability of defibrillators.

Before the Minnesota police program was initiated, the survival rate was 28 percent.

When the researchers looked at patients who survived to hospital discharge, they found that the five-year survival rate after that point was 79 percent, which was lower than the 86 percent seen in the general population, but identical to those with heart disease, the report indicates.

"We have known for some time that our program produces dramatically better short-term results, with 40 percent living to be discharged from the hospital," White said in a statement.

"This study shows rapid defibrillation not only saves lives, but most survivors are able to resume normal activities," he added.

In addition, the researchers also found that time from initial emergency call to first shock was critical -- 5.7 minutes for survivors, and 6.6 minutes for those who died in the hospital.

"Clearly, saving just a few seconds in administering the shock can make a tremendous difference in saving lives," White said.

Studies indicate that each day, about 1,000 adults in the U.S. go into cardiac arrest. About 60 percent of cases are due to ventricular fibrillation, in which the heart muscle suddenly stops beating rhythmically and is unable to properly contract and pump blood. It can be caused by heart disease, trauma, or drug overdose.

Without a shock to the heart to restore normal rhythm, cardiac arrest patients have little to no chance of survival.

Source: The New England Journal of Medicine 2003;348:2626-2633

Back to the Top


Scientists Say Pill May Prevent Strokes

By Emma Ross
AP Medical Writer
The Associated Press
Thursday, June 26, 2003

LONDON - A single pill combining six medications could prevent more than 80 percent of heart attacks and strokes if heart patients, most diabetics (news - web sites) and everyone over 55 took it, British scientists said Thursday.

However, the American Heart Association (news - web sites) cautioned such a pill might be dangerous for healthy people and not strong enough for those with heart trouble. It could also lull some people into persisting with life-threatening habits.

"There are massive caveats. We are quite concerned about this," said Heart Association president Dr. Robert Bonow.

The concept, outlined Thursday on the Web site of the British Medical Journal, is the brainchild of two University of London doctors, Nicholas Wald and Malcolm Law.

Called the "polypill," it would contain aspirin to reduce the stickiness of blood cells involved in clotting; a statin drug to lower cholesterol and folic acid to reduce levels of homocysteine, an amino acid that promotes hardening of the arteries.

Three types of blood pressure drugs an ACE inhibitor, a beta-blocker and a diuretic would be included at half the standard dose enough, the doctors say, to lower blood pressure without causing as many side effects as when the drugs are used individually at higher doses.

The scientists based their finding on evidence from more than 750 existing studies involving 400,000 participants taking heart medications. By multiplying risk reductions for individual drugs, they estimated the pill would prevent about 88 percent of heart attacks and 80 percent of strokes if taken by people over 55, as well as many people with high blood pressure, heart disease or diabetes.

For example, Wald and Law calculated that if 100 people would have had a heart attack without treatment, cholesterol drugs would prevent 61 of the 100 attacks, leaving 39. About 46 percent of those would be prevented with blood pressure drugs, leaving 21 heart attacks. About 16 percent of these would be prevented with folic acid, leaving 18, and 34 percent of the remaining attacks would be averted with aspirin, leaving 12 heart attacks out of the original 100.

They estimated that one-third of people over 55 taking the pill would benefit, gaining on average about 11 years of life free from a heart attack or stroke. Side effects, mostly from aspirin, would occur in between 8 and 15 percent of people who take the pill, depending on the formulation, the scientists estimated.

"The polypill represents a radical departure from current practice in the prevention of cardiovascular disease. Undoubtedly there will be debate over it, and so there should be," Wald said.

Bonow from the American Heart Association urged caution.

"There are data already on aspirin that if you give aspirin to a general population, you do not save lives because the people you save by preventing heart disease and stroke is offset by the number of people you kill by causing bleeding," he said.

While the risk of a heart attack or stroke increases after the age of 55, age alone is not a strong enough risk factor to warrant treatment, he said.

"My concern is one pill may not fit all," he said.

Dr. Eric Topol, cardiology chief at the Cleveland Clinic, said the polypill idea runs counter to the way medicine is headed in the future, which is toward personalized medication based on an individual's genetic profile.

"There is tremendous promise for the individualization of care in the years ahead," he said.

Studies of the "Polypill" are planned to see if the combination is safe and effective. Results are not expected for a few years. Law and Wald have filed a patent application on the formulation of the combined pill they described.

On the Net:

British Medical Journal: http://www.bmj.com

Back to the Top

Nail Polish Not a No-No During Blood Oxygen Test

By Alison McCook
Reuters Health
Thursday, June 26, 2003

NEW YORK (Reuters Health) - Despite previous concerns, wearing nail polish during a test that measures oxygen in the blood need not interfere with the results, new research shows.

Earlier reports have suggested that wearing nail polish can affect the results of pulse oximetry, a monitoring technique in which a probe attached to a finger measures blood oxygen levels using red and infrared light.

Checking oxygen levels in the blood has become a standard technique in emergency rooms and when measuring a patient's vital signs, study author Dr. Edward M. Chan of the National Jewish Medical and Research Center in Denver told Reuters Health.

However, when Chan and his team placed the probe of a pulse oximetry sensor in a different orientation on the finger -- so that light is emitted parallel to the nail as opposed to the traditional method of light emitted perpendicular to the nail -- they found that nail polish had no effect on the readings.

"From our study, we found that (fingernail polish) didn't really make much of a difference," Chan said.

During the study, Chan and his co-authors -- his children Mallory and Michael, students in high school and junior high, respectively -- measured how well pulse oximetry measured blood oxygen levels in seven healthy people.

In each experiment, the participants' left hands were painted with one of 10 colors of nail polish: red, yellow, dark blue, green, black, purple, fuchsia, light blue, brown or white.

The researchers took three readings from each finger, trying two different positions -- with the light emitted from the sensor passing either parallel or perpendicular to the fingernail.

They found that polished nails produced slightly lower oxygen readings than unpolished nails on the same person when measured in the perpendicular form -- an effect that was particularly pronounced with black and brown polish.

However, when the researchers measured blood oxygen in the parallel form, nail polish had no effect on the results -- regardless of color.

The findings appear in the June issue of the journal Chest.

In an interview, Chan said that black and brown nail polish may absorb the light emitted during pulse oximetry. However, after changing the orientation to the parallel form, light no longer passes through the nail, preventing polish from affecting the results.

Chan recommended that doctors stick with the standard pulse oximetry technique, but try changing the orientation if tests of a person with polished nails show relatively little oxygen in the blood.

Source: Chest 2003;123:2163-2164.

Back to the Top


Study: Cholesterol Test at 50 Most Efficient Heart Tracker

By Ed Edelson
HealthDay Reporter
HealthDayNews
Thursday, June 26, 2003

THURSDAY, June 26 (HealthDayNews) -- If you want to save money in screenings for those most likely to have a heart attack or stroke in the next few years, a blood test at age 50 seems to be the most cost-effective method, a British study says.

Testing everyone for high levels of blood cholesterol is an expensive proposition, says a report in the June 28 British Medical Journal, maybe too expensive for society to afford.

Money can be saved by reserving those tests for people at high risk because of other factors, so a group led by Dr. Sarah Wilson, a senior research fellow at the William Harvey Research Institute in London ran a study on 6,307 people ages 30 to 74 to see which of four criteria works best.

This was a purely hypothetical study, not one of those trials in which people are followed for years to see who develops heart disease. Instead, the researchers picked out those people who met the criteria of the widely accepted Framingham 10-year coronary heart disease risk equation, based on results of the classic Framingham Heart Study in the United States, which has been found to be extremely accurate in predicting risk.

All the participants were first tested to see which ones met the Framingham criteria. Then, knowing those who were at high risk, the researchers used a screen within a screen, four different times.

First they applied the guidelines of the British National Health Service to pick out those most likely to need a cholesterol test. Those guidelines selected 43.4 percent of the people in the group as needing a cholesterol test; that test then identified 81.2 percent of those who meet the Framingham criteria for a 15 percent greater likelihood of a coronary incident in those 10 years.

A second preliminary screen was the Sheffield table, a British set of rules. It selected 73.1 percent of the group as needing a cholesterol test; that test identified better than 99 percent of those who met the Framingham criteria for high risk.

The worst results came from using fixed values of blood cholesterol; it required blood tests for only 17.8 percent of the group, with a cholesterol test showing 75.9 percent of them meeting the Framingham high-risk criteria.

Using age 50 as the criterion proved that tests were required for 46.3 percent of the group and identified 92.8 percent of them as high-risk people -- not as good as the Sheffield criterion, but almost as good and a lot less expensive because fewer tests are needed.

The age-50 screen "has been shown to be a simple and efficient method of identifying those at risk of heart disease and enables limited resources to be targeted to those in greatest need," Wilson says. "In addition, it ensures accessibility to care across all ethnic groups, creeds, and social classes."

In the real world (news - Y! TV), those people will be followed for years "to test the predictive performance of the Framingham equation," she adds.

It's an interesting venture into the hypothetical, says Dr. Richard Pasternak, director of preventive cardiology at Massachusetts General Hospital and a spokesman for the American Heart Association (news - web sites) (AHA), but one that is highly unlikely to be put into action here, or anywhere else.

"We have such inexpensive ways to screen patients, given all the things that are done these days, that I can't see why any country would not consider testing everyone who reaches adulthood," he adds.

And by leaving out younger people, the method might be pound-foolish, Pasternak says. "If we identify those young adults who have premature heart disease, the progression of the disease might be halted."

Pasternak stands by the AHA's updated recommendations, which call for thorough risk factor assessment at age 20 and comprehensive testing every five years for those 40 and over who have at least two risk factors, such as smoking or diabetes.

More information

You can get all the current guidelines for prevention of heart disease from the American Heart Association. Also, try the National Heart, Lung and Blood Institute to learn about cholesterol.

Back to the Top

TUESDAY, JUNE 24, 2003

Scanning for Heart Disease

HealthDayNews
Tuesday, June 24, 2003

MONDAY, June 23 (HealthDayNews) -- A combination of imaging provides the most complete noninvasive diagnosis of coronary artery disease, says a study presented Monday at the Society of Nuclear Medicine's annual meeting in New Orleans.

The study of 51 patients by researchers at the Medical Imaging Center of Southern California found functional information about tissue blood flow is provided by SPECT myocardial perfusion imaging (MPI), but it doesn't offer full anatomical detail.

On the other hand, CT scans can locate coronary calcium deposits and intracoronary lesions (CCTA), but don't provide as much functional information as the MPI.

In this study, all the patients had SPECT MPI and CT coronary calcium scanning, and 39 of the 51 also had CCTA scans. The researchers compared myocardial perfusion defects identified by MPI with the locations of calcium deposits and plaque identified by CCTA.

"Examining the scans together provided valuable information. For instance, we observed a strong link between severe myocardial perfusion defects and both heavy (calcium) deposits and intracoronary lesions found by CCTA," researcher Edwin C. Glass says in a news release.

"However, in more than half the cases, additional information was gleaned from the ensemble of tests that could not be discerned from any single test alone," he says.

He and his colleagues concluded that combining the results of both the functional MPI and anatomic CT scans benefits patients by offering a more comprehensive assessment of coronary artery disease and better treatment and diagnosis.

More information

Here's where you can learn more about coronary disease.

Back to the Top

Hormone Pills May Spur Breast Cancer

By Lindsey Tanner
AP Medical Writer
The Associated Press
Tuesday, June 24, 2003

CHICAGO - Estrogen-progestin pills may cause an aggressive form of breast cancer (news - web sites) and make it harder to find tumors until they have reached a later, less-curable stage, according to one of the biggest, most authoritative analyses yet.

The study is part of a run of bad news recently about the hormones routinely taken by millions of women after menopause.

"Hopefully, it will convince women to reconsider," said Dr. Susan Hendrix of Wayne State University in Detroit, a co-author of the new analysis. "We've got to find a better way to help women with their menopausal symptoms."

Some previous studies suggested breast tumors might be less aggressive in hormone users; other studies indicated the opposite. Previous research also suggested that hormones might make breast tissue more dense, hindering the detection of tumors.

To try to answer the questions more definitively, the researchers took a closer look at data from the government's landmark Women's Health Initiative study, which was halted last summer after it was found that estrogen-progestin pills raise the risk of heart attack, strokes and breast cancer.

While last summer's findings led many women to stop taking hormones, an estimated 3 million women still use them, primarily to relieve hot flashes and other symptoms of menopause.

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

The analysis involved 16,608 women ages 50 to 79 who used either combined hormone treatment or dummy pills for an average of five years.

As of January, breast cancer had developed in 245 women who used the combined hormone treatment and in 185 women who had taken dummy pills.

Hormone users' tumors were larger at diagnosis, 1.7 centimeters on average versus 1.5 centimeters in placebo women. Tumors had begun to spread in 25.4 percent of hormone users, compared with 16 percent of placebo women.

The researchers said this appears to mean that in women on estrogen-progestin, the tumors both grow faster that is, they are more aggressive and escape detection longer.

Overall, women on both hormones faced a 24 percent increased risk of breast cancer equal to eight extra cases of cancer per year for every 10,000 women taking the pills.

The increased risk did not appear in the first two years of treatment. But Hendrix said the tumors may have been present early on but were not detected until later because of hormone-induced breast density.

The new analysis did not examine breast density. But researchers think progestin may be the culprit because it can cause breast cells both normal and abnormal to proliferate, an effect that may be accentuated when the hormone is combined with estrogen.

Wyeth Pharmaceuticals, maker of the Prempro pills used in the study, said hormones remain an appropriate therapy when used at the lowest possible dose for the shortest possible time.

The latest analysis is by far the most conclusive, said Dr. Peter Gann, an associate professor of preventive medicine at Northwestern University who was not involved in the study.

It "further worsens the news for long-term hormone replacement therapy. It suggests the excess breast cancer risk is not trivial," Gann said.

Last summer's Women's Health Initiative findings shattered long-held beliefs that hormones are good for women's hearts. Last month, another analysis of data from the study found that instead of sharpening the mind, hormones may double the risk of Alzheimer's and other forms of dementia.

A second, smaller study in Wednesday's journal also confirmed a link between combined hormone treatments and breast cancer and suggested estrogen-only treatment may be safer.

The study involved 975 Seattle-area women ages 65 to 79. The greatest breast cancer risk was in women who used estrogen-progestin for at least five years, even if they took the progestin component only some days a month.

Those who used estrogen alone, even for 25 years or longer, showed no appreciable increased risk, according to the study, led by Dr. Christopher Li of Fred Hutchinson Cancer Research Center in Seattle.

Estrogen alone is recommended only for women with hysterectomies because it can cause uterine cancer unless balanced by progestin.

The researchers said more definitive answers will come from the continuing estrogen-only part of the Women's Health Initiative study.

On the Net:

JAMA: http://jama.ama-assn.org

Back to the Top

Dip in Hormone Use Follows Discouraging Study

By Alison McCook
Reuters Health
Tuesday, June 24, 2003

NEW YORK (Reuters Health) - Last year's study suggesting hormone replacement therapy could do more harm than good triggered a sharp drop in the number of older women using the drugs, Canadian researchers said Tuesday.

The study in question is the Women's Health Initiative (WHI), a U.S. government-sponsored trial of 16,000 women taking combined hormone replacement therapy (HRT) made up of estrogen and progestin. The trial was stopped in July 2002 after early analysis showed the therapy raised the risk of stroke, heart attack and breast cancer (news - web sites).

While the risk to the individual user was small, researchers estimated the treatment would cause eight additional cases of breast cancer, seven heart attacks, eight strokes, and 18 blood clots in every 10,000 women taking the combined form of HRT for one year, compared with non-users.

In the new study, Dr. Peter C. Austin and his colleagues discovered that in the period immediately following the release of the WHI findings, the number of women older than 65 taking HRT, both old and new users, dropped significantly in Ontario.

This finding "confirmed what we had heard about anecdotally," Austin, who is based at the Institute for Clinical Evaluative Studies in Toronto, told Reuters Health. "Two of the authors are family physicians, and had observed this phenomenon in their practices," Austin added.

Hormone replacement therapy is often used to alleviate the symptoms of menopause, but Austin noted that women older than 65 -- who are many years past menopause -- have also been given HRT to ward off diseases, primarily cardiovascular disease.

Austin and his colleagues obtained their findings by tracking claims for hormone replacement therapy submitted to a universal drug program for seniors in the province of Ontario between 1992 and 2002. This program records the use of medications by all Ontario residents older than 65, totaling 1.3 million people.

The analysis, reported in the Journal of the American Medical Association (news - web sites), looked at the use of combined HRT and the estrogen-only form of the medication, which is prescribed to women who have undergone hysterectomy.

Austin and his team discovered that use of HRT among older women increased until 1999, when it hit a plateau. After the results of the WHI study appeared, however, prescriptions for hormone replacement dropped dramatically, and in the last quarter of 2002, use was 32 percent lower than during the same period a year before.

Austin said he would expect to find the same results among older women in the U.S., given the large amount of publicity the WHI study results received.

Source: Journal of the American Medical Association 2003;289:3241-3242.

Back to the Top


Tropical Oils Beat Fat

HealthDayNews
Tuesday, June 24, 2003

TUESDAY, June 24 (HealthDayNews) -- A blend of tropical oils used for cooking can actually fight fat and cholesterol, say researchers at McGill University in Montreal.

They've completed two studies on the cooking oil blend that includes 67 percent tropical oils, 13 percent olive oil, 6 percent coconut oil and 5 percent flaxseed oil. It's called Functional Oil, and it was developed by McGill scientists.

The Functional Oil is composed of medium-chain triglycerides while vegetable cooking oils have long-chain triglycerides. When a person consumes Functional Oil, it's directed towards the liver, where it's burned for energy. It heightens a person's metabolism. The oil isn't stored in the body as fat.

The McGill researchers say there's even some data that suggests Functional Oil may reduce appetite.

The two studies included men and women about 25 pounds overweight. They ate a normal diet, but used Functional Oil instead of other cooking oils.

The studies found that men using Functional Oil lost an average of a pound over a month. Women in the studies didn't lose weight but did experience heightened metabolic rates. Cholesterol levels in both the men and women dropped by an average of 13 percent.

More information

Here's where you can learn more about cholesterol.

Back to the Top

Drowning Alert

HealthDayNews
Tuesday, June 24, 2003

(HealthDayNews) -- Every year, hundreds of children under age five drown in swimming pools, according to Fayette Hospital in Atlanta.

Many of these accidents can be prevented by practicing pool safety.

Here are some guidelines:

  • Never leave your child unsupervised when he's anywhere near a pool.
  • Leave a phone by the pool, not only for emergencies, but also to avoid stepping inside to answer a call.
  • Always accompany a toddler in the water.
  • Don't rely on floats, rafts or water wings.
  • If you have a pool in your backyard, make sure it's fenced and the entry latch is childproof.
  • When you're not using the pool, take all toys away so kids aren't tempted to go near the water and get them.
  • Learn CPR and emergency rescue techniques.
  • If a child is missing, always look in the pool first. Seconds count in preventing death.

Back to the Top

Drug Promises to Prevent Prostate Cancer

By Lauran Neergaard
AP Medical Writer
The Associated Press
Tuesday, June 24, 2003

WASHINGTON - Scientists have discovered that a drug that shrinks enlarged prostates and fights baldness also cuts men's chances of getting prostate cancer (news - web sites), the first success in a long quest to prevent the No. 2 cancer killer of men.

But not every man will want to use the drug, called finasteride: Sexual side effects aside, it may actually increase aggressive tumors in some.

Finasteride is sold under the brand name Proscar to treat the benign prostate enlargement so common with aging and, in a much lower dose, as Propecia to fight baldness.

"Finasteride may not be right for all men," cautioned Dr. Leslie Ford of the National Cancer Institute (news - web sites), which paid for the research. Men and their doctors should "take the time to review this data and make informed choices."

Prostate cancer strikes 220,000 U.S. men annually and kills almost 29,000; so even limited use of Proscar promises "extraordinary public health potential," said Dr. Ian Thompson of the University of Texas Health Sciences Center in San Antonio, who led the research.

Proscar alters levels of a male hormone, the testosterone relative DHT. Men with naturally low levels of DHT have less prostate cancer and black Americans, who have a very high risk of prostate cancer, have high DHT levels.

Researchers tested whether reducing DHT could prevent cancer. The results: Men who took Proscar daily for seven years had 25 percent fewer prostate cancers than men given a dummy pill.

The study of 18,000 older men, originally scheduled to run for another year, was abruptly stopped this month, and the New England Journal of Medicine (news - web sites) rushed the results onto its Web site Tuesday.

"This trial proves prostate cancer, at least in part, is preventable," said Dr. Peter Greenwald, NCI's cancer prevention chief, who participated in the study himself and so far is cancer-free. "It's a huge step forward."

But some troubling findings have critics questioning just how often Proscar should be used: Men who developed prostate cancer while taking Proscar were more likely to have tumors that appear to be aggressive, what doctors term "high grade." Some 6.4 percent of Proscar patients were diagnosed with high-grade tumors, compared with 5.1 percent of men given dummy pills.

No one knows if Proscar alters the prostate's hormone environment in a way that favors growth of more aggressive tumors or if that was a fluke. Some hormonal treatments can make prostate cancer cells initially appear more aggressive than they are. Researchers are tracking how those men fare.

Another quirk questions the true value of Proscar's benefit. Researchers diagnosed prostate cancer in four times more placebo patients than expected, partly because every study participant got a prostate biopsy even if blood tests for cancer-signaling PSA were normal. Those biopsies often found small, early-stage tumors and in the real world (news - Y! TV), wouldn't have been done.

"It looks like Proscar prevented little tiny, insignificant cancers, but did nothing for high-grade cancers or maybe even allowed them to become more common," said Dr. Peter Scardino of New York's Memorial Sloan-Kettering Cancer Center, who wrote a cautionary editorial accompanying the research. "That doesn't sound like a very good trade-off to me."

The study didn't test whether taking Proscar helped men live longer, added Dr. Herman Kattlove of the American Cancer Society (news - web sites), who predicted a huge debate about its usefulness.

Proscar's other effects: Sexual problems were 5 percent to 13 percent more common among Proscar users. However, Proscar users had slightly fewer of the urinary problems that often accompany aging.

"There are very few prevention strategies that are not trade-offs," said Thompson, urging men to weigh their individual cancer risk and side-effect tolerance.

Proscar aside, the massive study could shed much-needed new light on other problems with prostate cancer. Today, there's no good way to predict who needs aggressive

therapy and who has a slow-growing, unthreatening tumor. Scientists will use blood, biopsy and even some DNA samples given by study participants in hopes of solving that dilemma.

Back to the Top

Does Insulin Contribute to Alzheimer's?

Amanda Gardner
HealthDay Reporter
HealthDayNews
Tuesday, June 24, 2003

TUESDAY, June 24 (HealthDayNews) -- Insulin might be involved in the build-up of protein plaques in the brains of people with Alzheimer's disease (news - web sites), according to a preliminary study.

If true, the finding might one day lead to new treatments to combat plaques in the brain, a hallmark of the disease.

"We looked at the effects of raising insulin on beta amyloid, the protein that collects in brains of patients with Alzheimer's disease," says Suzanne Craft, lead author of the study appearing in the June 24 issue of Neurology.

"We found that insulin increased levels of protein in the spinal fluid and, particularly, the older the participant was, the more likely the protein levels were increased," she says.

Although the study was a small one, involving only 16 people, there are some important implications, adds Craft, associate director at the geriatric research center at Veterans Affairs Puget Sound, in Seattle.

In the past several years, research has shown that people with any of several disorders characterized by high levels of insulin also have an increased risk for Alzheimer's disease. Those high-insulin disorders include type 2 diabetes, hypertension and metabolic syndrome.

"For some time there has been an association between diabetes and dementia, [but] we do not know the exact pathway by which such an association comes about," says Zaven Khachaturian, senior advisor to the Alzheimer's Association on medical and scientific affairs.

"If it can be established that it is a causal factor, then prevention measures or therapies that are being developed for these other disorders could also help Alzheimer's. But that needs to be proven. This is very preliminary," Khachaturian adds.

It's also known that people with Alzheimer's have a build-up of beta amyloid proteins in the brain, although it's not clear yet whether the proteins actually cause the illness. It is, however, considered a good possibility.

The reason: People with early onset Alzheimer's have gene mutations that lead to an increase in beta amyloid production -- in particular, the longer forms of the protein, such as beta amyloid 42, says Dr. Douglas Galasko. He's the author of an editorial in the same issue of Neurology, and a professor of neurosciences at the University of California, San Diego.

But what might explain the cause of early onset Alzheimer's may not explain the far more prevalent late-life version of the disease.

"One of the nagging questions is what does this have to do with late-life Alzheimer's disease, which really accounts for 95 percent or more of everybody we will see with Alzheimer's?" Galasko says. "We don't have clear evidence from anywhere that beta amyloid is overproduced in late-onset Alzheimer's."

If it's not overproduction that's the culprit, then it might be something else, possibly decreased breakdown or "clearance" of the protein, Craft and Galasko say.

Beta amyloid is created and broken down in healthy people all the time, although scientists aren't sure what its role is in the body. It's possible that the longer forms of the protein, such as amyloid 42, have no real function at all.

Craft and her colleagues focused specifically on the clearance -- the breaking down and purging -- of beta amyloid 42 from the brain to the spinal fluid in 16 healthy, older adults.

Ten women and six men each underwent, at separate times, two infusions either of a placebo or insulin plus dextrose, a sugar. Then they had their blood, spinal fluid and cognitive abilities measured.

Not surprisingly, the insulin infusion produced an increase in insulin concentration in the spinal fluid sample. More notably, it also led to an increase in amyloid 42, especially in older participants.

Interestingly, insulin infusion improved memory performance in the younger participants. But older participants who had an increase in beta amyloid 42 levels in their spinal fluid showed a decline in memory skills.

"It's possible that higher amyloid in their spinal fluid reflected a problem with clearing insulin in the brain," Craft suggests.

Galasko says it's unclear why the protein was found in the spinal fluid. One leading theory is that both insulin and beta amyloid 42 are competing for the attention of IDE, or insulin-degrading enzyme. This is one of the main enzymes that clear both beta amyloid and insulin. If IDE is showing a preference for insulin when both substances are present, then the beta amyloid will lose out, the theory goes.

Still, the new study is potentially significant, researchers agree. "It is the first demonstration in humans that levels of this protein can be affected by an acute challenge of any sort," Craft says.

Adds Galasko: "[Another] part of the study which is of interest is the general concept that we can do something, give some kind of substance [for example, insulin] that alters levels of beta amyloid in the spinal fluid and this has not been an easy thing to prove. At present, we don't have any available treatment for Alzheimer's disease that alters beta amyloid, so it's encouraging."

The findings could eventually open up a new class of therapies for Alzheimer's, experts say.

"What's happening is a bit of a paradigm shift within the field," Craft says. "Different areas within Alzheimer's disease that are now coming to the forefront have to do more with metabolic processes, with inflammation. We're looking at agents that reduce insulin levels. Insulin sensitizers that have been brought to use for diabetes in the past three to four years may actually benefit patients with Alzheimer's."

However, Khachaturian cautions, "drug development is a long, tedious process and many, many promising leads [get] derailed. We hope it doesn't happen here."

More information

For more on Alzheimer's disease, visit the Alzheimer's Association. For more on insulin and diabetes, visit the National Institute of Diabetes & Digestive & Kidney Diseases.

Back to the Top

Smallpox Shots Linked to Heart Problem

By Lindsey Tanner
AP Medical Writer
The Associated Press
Tuesday, June 24, 2003

CHICAGO - Heart muscle inflammation should be added to the list of serious but uncommon side effects linked to smallpox shots, a U.S. military study found.

The study details 18 cases of probable myopericarditis out of 230,734 military personnel vaccinated between December 2002 and mid-March. The rate is more than triple the expected rate in nonvaccinated people and translates to at least 78 cases per million people.

Updated figures show 37 cases out of 450,293 military people vaccinated through May 28, a similar rate.

All patients recovered and are being evaluated to see whether there are any lasting effects on the heart.

The other known side effects from smallpox shots may include soreness at the injection site, fever and muscle aches. Less common but more serious reactions include a widespread skin rash, and rarely encephalitis, an inflammation of the brain. Government data show only one civilian and one military case of encephalitis were reported through May.

A federal advisory panel last week recommended against expanding the civilian smallpox program to millions of emergency workers because of concerns about heart inflammation. The panel cited at least 18 suspected cases among some 37,000 civilian health care workers vaccinated so far.

The military study appears in Wednesday's Journal of the American Medical Association (news - web sites).

It is one of several published in JAMA detailing otherwise generally positive results from the military and civilian smallpox immunization programs.

The studies found that serious side effects are uncommon; one suggests they are rare even in some people with immune system problems.

"The really important news is that it is possible to conduct a mass smallpox vaccination in a safe and effective manner," said Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs.

A JAMA editorial says the studies help alleviate concerns that surfaced when the government began smallpox programs for the military and some health care workers as part of terrorism preparedness efforts. Routine smallpox immunization in the United States ended in 1972.

Some experts had worried that the current U.S. population might be more vulnerable to side effects from the vaccine than people before 1972 because of increases in immune-compromising conditions such as AIDS (news - web sites).

"The observation that this smallpox vaccine can be administered safely in a 21st century population with a very low adverse-event rate is a critically important piece of new information," Drs. Anthony Fauci and Mary Wright of the National Institute of Allergy and Infectious Diseases (news - web sites) said in the editorial.

The overall rate of side effects in the military was largely below the rates reported before 1972, one of the studies found.

Myopericarditis causes inflammation of the heart muscle and the fibrous tissue that envelops the heart. The ailment probably occurred during smallpox vaccination in the 1960s, too, but was underrecognized because diagnostic technology was less sophisticated, military officials say.

Eight other heart-related events occurred shortly after vaccination in the military program, including four heart attacks, one of them fatal.

While military doctors think those were not related to the vaccine, the risk prompted government officials to recommend against giving the shots to people with heart conditions or strong risks of heart disease.

On the Net:

JAMA: http://jama.ama-assn.org

Centers for Disease Control and Prevention (news - web sites): http://www.cdc.gov

Back to the Top

More Bad News for Hormone Drugs in U.S. Study

By Michael Conlon
Reuters Health
Tuesday, June 24, 2003

CHICAGO (Reuters) - The most common hormone replacement drug therapy not only increases the risk of breast cancer (news - web sites) in post-menopausal women but also makes cancer harder to detect with mammography, a report said on Tuesday.

The finding is the latest in a continuing stream of bad news for preparations that combine estrogen and progestin.

The hormones have been shown to halt or reverse osteoporosis, lessen the risk of hip fractures and prevent colorectal cancer. But a major government study on long-term use was halted in the summer of 2002 after it showed the estrogen-progestin combination sold as Wyeth's Prempro carried an increased risk of breast cancer, heart attack and stroke.

Wyeth has won government approval to market lower dose versions of its drug which it says address the risk problems.

Tuesday's study was a closer analysis of findings in the study halted a year ago. Published in the Journal of the American Medical Association (news - web sites), the new research affirmed the breast cancer problem, finding a 26 percent increase in the risk of that cancer for women taking estrogen plus progestin.

But the report, from Harbor-UCLA Research and Education Institute, Torrance, California, also found that the cancers tend to be diagnosed at more advanced stages and result in substantial increases in abnormal mammograms.

In an editorial in the same issue commenting on the study Peter Gann and Monica Morrow, physicians at the Feinberg School of Medicine at Northwestern University in Chicago, said:

"The ability of combined hormone therapy to decrease mammographic sensitivity creates an almost unique situation in which an agent increases the risk of developing a disease while simultaneously delaying its detection.

"It strongly suggests that the breast cancers related to estrogen plus progestin use are not 'good' (easily treatable) ones, that they occur earlier than expected based on some previous studies, that there are no easily identified subgroups at higher risk and that, to top it off, women using estrogen plus progestin experience a much higher rate of mammographic abnormalities leading to anxiety and further costly work-ups."

The study findings came from the now-halted Women's Health Initiative, which involved 16,608 post-menopausal women some of whom received combination hormone treatment, others an inert placebo.

It said that there was "am "absolute increase in abnormal mammograms of about 4 percent per year in women receiving estrogen plus progestin" that translates into "approximately 120,000 otherwise avoidable abnormal mammograms annually for the estimated 3 million U.S. post-menopausal women currently using this hormone regimen."

The study was paid for by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health (news - web sites).

In a second study published in the same journal, researchers at the Fred Hutchinson Cancer Research Center in Seattle said they found there was a breast cancer risk even when progestin is not taken every day in combination with estrogen -- so-called sequential treatment.

The conclusion came from a look at 51 other previously published studies.

Back to the Top

WHO Lifts SARS Travel Warning in Beijing

By Joe MacDonald
Associated Press Writer
The Associated Press
Tuesday, June 24, 2003

BEIJING - The World Health Organization (news - web sites) lifted its last SARS (news - web sites) travel warning Tuesday, declaring the disease under control in Beijing, the hard-hit capital of the nation where the outbreak began.

Toronto has experienced the largest SARS outbreak outside Asia, with health officials reporting 38 deaths since the illness first appeared there in early March. The city had 24 active probable cases hospitalized Monday.

Canadian health officials reported one more fatality on Monday but said the 88-year-old man had died April 29. They said Canada's death toll was unchanged at 38 because an earlier fatality turned out not to be SARS-related.

Also in Canada, promoters announced that the Rolling Stones would headline an outdoor concert on July 30 in Toronto to boost tourism after the SARS outbreak. In early April, the Stones canceled what would have been their first concerts in China because of SARS.

In a videotaped appearance from Europe, Mick Jagger said the event is meant to "help bring back the energy to our favorite city."

Representatives from several Asian countries met Tuesday with WHO experts in Bangkok, Thailand, to discuss strategies for preventing a recurrence of the SARS outbreak.

Beijing also was removed from a WHO list of places with recent local transmissions of severe acute respiratory syndrome, leaving only Toronto and Taiwan on that list. Travel advisories for Toronto and Taiwan were lifted earlier.

But the WHO called for the international community to remain vigilant against the disease, which has killed more than 800 people worldwide and infected over 8,400.

The end of the advisory against nonessential travel to Beijing followed the gradual end to anti-SARS measures in the Chinese capital that had closed schools, cinemas and other public facilities since late April.

Chinese airlines, hotels and other businesses welcomed the WHO announcement, hoping for a quick economic revival after months of heavy losses as travelers avoided Beijing and other SARS-affected areas.

"Things are definitely going to improve," said Eggert Muss, executive assistant manager of the Swissotel Beijing. He said that after weeks of disruption to business travel, the WHO announcement was "just what the clients wanted to hear."

The U.S. Centers for Disease Control and Prevention (news - web sites), however, still has a travel advisory in effect for Beijing and Taiwan that recommends that all but essential travel be postponed.

The CDC also recommends that travelers take precautions when visiting the rest of mainland China, Hong Kong and Taiwan.

The world's first known SARS case occurred in November in China's southern province of Guangdong, where experts suspect the virus jumped to humans from animals.

The crisis peaked in March and April before ebbing worldwide as officials began quarantining patients and screening travelers.

Beijing accounted for just over half of China's 347 deaths and 5,300 cases. The number of new cases reported daily in Beijing fell to the single digits in early June, down from more than 150 a day a month earlier.

Shigeru Omi, WHO director for the western Pacific, said the decision to lift the Beijing travel advisory was based on factors including the number of current SARS cases, quality of surveillance and the effectiveness of prevention measures.

"After careful analysis, WHO has concluded that the risk to travelers to Beijing is now minimal," Omi told reporters in Beijing.

Beijing had just 46 people hospitalized on Tuesday, according to the Health Ministry. That was down from more than 1,000 at the height of the epidemic, which prompted the hurried construction of a SARS isolation facility for patients from overflowing hospitals.

A senior Chinese health official said authorities will temporarily keep checking travelers for fevers a possible symptom of SARS at airports and bus stations.

"We must not let down our vigilance," Gao Qiang, the executive deputy health minister, said at the news conference with Omi.

Hours after the WHO announcement, Japan's government lifted its own advisory against travel to Beijing.

Back to the Top

U.S. Studies Weigh Safety of Smallpox Vaccinations

Reuters Health
Tuesday, June 24, 2003

CHICAGO (Reuters) - The Pentagon (news - web sites)'s campaign to vaccinate half a million military personnel against smallpox has produced few serious adverse reactions and is basically safe, according to a military study published Tuesday.

Over five-and-a-half months beginning in mid-December, the Defense Department administered 450,293 smallpox vaccinations, many to soldiers before the U.S.-led war on Iraq (news - web sites), to protect against a feared biological warfare attack.

"Most adverse events occurred at rates below historical rates," study authors John Grabenstein, of the Military Vaccine Agency, and William Winkenwerder, assistant secretary of defense, write in the report, published in the Journal of the American Medical Association (news - web sites).

"In two settings, 0.5 percent and 3 percent of vaccine recipients needed short-term sick leave ... One case of encephalitis (brain inflammation) and 37 cases of acute myopericarditis (an inflammation of the heart or the sac surrounding the heart) developed after vaccination; all cases recovered," they report.

"Our experience suggests that broad smallpox vaccination programs may be implemented with fewer serious adverse events than previously believed," they conclude.

The program exempted pregnant women, people with weakened immune systems and those with chronic skin diseases.

People at risk of heart disease were also excluded after the myopericarditis cases, and following the deaths of two female health care workers and a 55-year-old male soldier from heart attacks shortly after their vaccinations.

SAFETY CONCERNS

Safety concerns about the vaccine -- which in the past killed one or two out of a million recipients -- have been partly responsible for slow progress in the U.S. government's effort to inoculate 500,000 health care workers.

President Bush (news - web sites) said late last year he had decided to make smallpox vaccine available to all Americans to protect against a possible attack with the virus. Last month, he signed into law a compensation program for those sickened by a shot.

Smallpox, which the World Health Organization (news - web sites) declared eradicated in 1980, kills roughly 30 percent of its victims.

Three other reports published in the journal addressed safety issues related to the vaccine, which can cause such reactions as a benign rash called folliculitis, fever and scarring lesions.

One study by Sharon Frey of Saint Louis University School of Medicine indicated that the estimated 90 percent of U.S. adults older than 30 previously inoculated have retained some immunity and could be safely revaccinated with a diluted form of the vaccine -- possibly resulting in less severe reactions.

Even so, more than half of people revaccinated with a diluted form still suffered what Frey called "major reactions," involving lesions.

Another study, by the Pentagon's Smallpox Vaccination Clinical Evaluation Team, said myopericarditis following vaccination was uncommon but not unexpected, and may be diagnosed if chest pains occur within a month of the shot.

The heart condition could be expected to strike 7.8 out of 100,000 people within 30 days, according to the report.

Back to the Top

Brain Study Examines How People Feel Pain

By Randolph E. Schmid
Associated Press Writer
The Associated Press
Tuesday, June 24, 2003

WASHINGTON - Pain that brings tears to one person's eyes may be barely noticed by someone else, and that can be a problem for doctors deciding on treatment.

The answer: Listen to the patient, a new study says. Some people really do feel more pain than others.

"We have all met people who seem very sensitive to pain as well as those who appear to tolerate pain very well," said Robert C. Coghill of Wake Forest University Baptist Medical Center.

"Until now, there was no objective evidence that could confirm that these individual differences in pain sensitivity are, in fact, real," said Coghill, lead investigator on the paper published Monday in the online edition of Proceedings of the National Academy of Sciences (news - web sites).

The study of brain activity showed that some people respond more strongly to pain.

"One of the critical things is, it provides physicians with the evidence they need to have confidence in patients' reports of pain and use that to guide treatment," Coghill said.

The researchers used magnetic resonance imaging to study the brains of 17 volunteers. The skin of each volunteer's lower right leg was heated with a heating pad.

After each heating the participants gave their estimate of how painful it was and the two sessions were averaged. On a one-to-10 scale various individuals rated the heating pain from a low of one to a high of "almost nine."

When the researchers compared the brain scans to the pain ratings of the volunteers they found that parts of the brain known to be involved in experiencing pain were more active in people who said they felt more pain.

In particular, they found increased activity in the primary somatosensory cortex, which deals with pain location and intensity, and the anterior cingulate cortex, which handles unpleasant feelings caused by pain.

But they found little difference between people in the activity of the thalamus, which helps transmit pain signals from the spinal cord to brain regions.

That may indicate that incoming pain signals are being delivered by the spinal cord in a similar way for different people, but once they arrive in the brain they are handled differently.

Coghill said the study found no difference in response to heat pain between men and women.

His paper comes six months after researchers at the University of Michigan reported finding a gene that can make people more or less sensitive to pain, depending on the form they inherit.

In that study, brain scans showed that painkilling chemicals called endorphins were much more active in the brains of people who reported less sensitivity to pain.

On the Net: http://www.pnas.org

Back to the Top

Don't Take Blood Pressure Drug with Red Wine: Study

By Alison McCook
Reuters Health
Tuesday, June 24, 2003

NEW YORK (Reuters Health) - People who take an extended-release form of the blood pressure drug felodipine with a glass of red wine on an empty stomach may run into problems, according to findings from a new small study.

Canadian researchers discovered that when eight healthy people took extended-release felodipine (Plendil) -- a form of the drug intended to release an entire day's dose slowly and constantly -- on an empty stomach and with a glass of red wine, only traces of the drug filtered into their blood.

However, four hours later, when the participants ate lunch, blood levels of felodipine spiked, filling people's bodies with a huge dose of the drug.

"You go from no effect to toxicity," study author Dr. David G. Bailey, of London Health Sciences Center in Ontario, told Reuters Health.

"It was like taking an overdose," he said.

Felodipine helps alleviate high blood pressure by opening up blood vessels. In healthy people like those in this study, a burst of the drug into the bloodstream is unlikely to be harmful. But a similar spike in a person with high blood pressure could be dangerous, Bailey explained.

For these people, who often have other cardiovascular conditions as well, too large a drop in blood pressure can cause chest pain or possibly a heart attack, Bailey said. In addition, a sharp decline in blood pressure can result in fainting, he added.

Based on these findings, which appear in the June issue of the journal Clinical Pharmacology & Therapeutics, Bailey recommended that people taking the extended-release form of felodipine not do so on an empty stomach, with a glass of red wine.

He added that extended-release forms of other drugs might also interact badly with red wine, but more research is needed to answer that question.

During the study, Bailey and his colleagues asked eight people to take extended-release felodipine on an empty stomach with either a glass of red wine or water, and measured levels of the drug in participants' blood for eight hours. Participants ate a meal four hours after taking the drug.

The researchers found that people who took the drug with red wine showed much lower early levels of the drug in their blood, relative to when they downed the pill with a glass of water. After lunch, however, red wine drinkers saw a spike in levels of felodipine that was much higher than when they drank water.

The person with the highest peak blood levels of felodipine also experienced a rapid heart rate, palpitations and flushing, the authors report.

Bailey said that the extended-release form of felodipine, when taken on an empty stomach with red wine, is likely undergoing a process of "dose dumping."

He explained that drugs are absorbed into the bloodstream when they pass into the intestine. However, when taken with red wine without food, the extended-release form of felodipine may be getting stuck in the stomach, and not passing into the intestine until a few hours later, when it dumps a large dose of the drug into the blood.

Bailey said he and his colleagues don't know whether red wine consumed with a meal might cause a problem if combined with the drug.

He noted that patients are also cautioned against taking some drugs with grapefruit juice, for compounds in the juice inactivate the enzymes that normally break down drugs, causing patients to get a higher-than-expected dose.

Source: Clinical Pharmacology & Therapeutics 2003;73:529-537.

Back to the Top


Too Much Soda May Cause Caffeine Headaches in Kids

Reuters Health
Tuesday, June 24, 2003

NEW YORK (Reuters Health) - Parents who are mystified about the cause of their son's or daughter's daily headaches might want to check their child's soda-drinking habits.

Results of a five-year study suggest that children who drink too much cola may experience "caffeine-induced" headaches on a daily basis.

This finding should serve as an "alert" for pediatricians and other health professionals, researchers report in the journal Cephalalgia, since soft drinks account for more than half of the caffeine intake among U.S. schoolchildren.

"Although cola drinks are regarded as a harmless soft drink, this might not be the case," write Drs. Rachel Hering-Hanit of Sapir Medical Center in Israel and N. Gadoth of Tel Aviv University.

"Its popularity and extensive consumption may be accounted for by its caffeine content, which at high doses may probably lead to daily or nearly daily headache," they add.

A high caffeine intake may also rob children of much-needed sleep, according to previously published research. Two Ohio researchers found that children with higher intakes of caffeine slept fewer hours, were more likely to wake during the night and tended to be sleepier during the day than their peers.

The current study involved 36 children and teens, ages 6 to 18, who visited a hospital with complaints of daily or near-daily headaches and were deemed "excessive caffeine consumers."

All reported drinking at least 1.5 liters of cola each day and an average 11 liters of cola each week -- a caffeine intake roughly equivalent to two large cups of instant coffee or small cups of ground coffee per day, and 17 such servings per week. None reported drinking coffee.

After gradually discontinuing their daily cola-drinking habit over a one- to two-week period, 33 of the 36 patients experienced a "complete cessation of all headaches," which lasted throughout the 24-week follow-up period.

And they did so without any side effects, such as any type of caffeine "withdrawal" headache, the researchers note.

The remaining three patients began experiencing occasional migraines in place of the daily headaches. But these three, along with four of their formerly "heavy" cola-drinking peers also had a family history of headaches or migraine, the researchers note.

The study also included a comparison group of 69 children and teenagers who reported frequent headache, but consumed only low amounts of daily caffeine.

For 26 of these kids, the use of analgesic medications appeared to be behind the headaches. Nearly all got relief once they stopped overusing the painkillers.

Taking too many headache remedies too often can cause a rebound headache, which can only be relieved by stopping the medication completely, according to the National Headache Foundation (news - web sites).

Some over-the-counter headache remedies do contain caffeine, but caffeine-containing brands seem to be no more likely to trigger rebound headaches than other brands, according to the foundation.

While excessive caffeine can be a headache trigger, small doses have been shown to be helpful when given with pain relievers such as aspirin and acetaminophen, according to the group's Web site.

Source: Cephalalgia 2003;23:332-335.

Back to the Top


Arts, Technology May Help Dementia Patients

By Patricia Reaney
Reuters Health
Tuesday, June 24, 2003

LONDON (Reuters) - Artistic pursuits and a hand-held computer could help people suffering from dementia to express themselves and remember appointments and events, British researchers said Tuesday.

An estimated 37 million people worldwide suffer from dementia which is characterised by memory loss and a progressive decline in thinking, comprehension and judgment. Alzheimer's disease (news - web sites) is the leading type of the disorder in the elderly.

But scientists who presented new research at the British Psychological Society meeting at the University of East Anglia in eastern England said patients can express themselves and communicate through art and the latest technology.

"We've run a number of pilot projects in different art forms and found extraordinary things happening," said John Killick, of the University of Stirling in Scotland.

Patients who had difficulty communicating through speech displayed an amazing ability to express themselves through photography, collage and sculpture.

Although it did not improve their cognitive ability, patients conveyed what they were feeling in ways they had never done before.

"We need to do far more research and give far more opportunities to people with dementia to express themselves in alternative ways," Killick added in an interview.

By contrast, scientists at the Oliver Zangwill Center for Neuropsychological Rehabilitation in Ely, eastern England and the University of Dundee in Scotland have turned to technology and adapted a tiny computer called the MemoJog to help patients and their carers remember dates, appointments, when to take medicines or even what day it is.

About the size of personal digital assistants (PDAs), the device is easy to program and can improve the quality of life and independence for people with memory problems, Dr Jonathan Evans told the meeting.

"Our initial findings suggest that the MemoJog device may be useful for at least some people with memory impairment, including older users. Most of participants reported that it was easy to learn how to use MemoJog and that it was of benefit to them in remembering their day-to-day activities," he said.

Back to the Top

Rheumatoid Arthritis Ups Overall Death Risk: Study

Reuters Health
Tuesday, June 24, 2003

NEW YORK (Reuters Health) - Rheumatoid arthritis appears to raise the risk of death from any cause in men and women older than 40, a large study of UK patients has found.

People with rheumatoid arthritis were 60 to 70 percent more likely to die from any cause during the study period than either healthy men and women or people with osteoarthritis, the common form of arthritis that typically strikes at an older age.

Those with rheumatoid arthritis were also 30 to 60 percent more likely to suffer a cardiovascular complication such as a heart attack or stroke, researchers report in The Journal of Rheumatology.

For the study, Dr. Douglas J. Watson and colleagues at Merck Research Laboratories in Pennsylvania, analyzed a database containing patient records from several hundred UK general practices dating back to 1987. They looked at more than 8,000 women and 3,500 men diagnosed with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory condition in which the body's own immune system attacks the tissue lining the joints. It can also damage other parts of the body, such as the heart, lungs and kidneys.

The cause of rheumatoid arthritis is not well understood, but research suggests that age, smoking, obesity and genetic factors may play a role in the development of the disease.

Osteoarthritis is a progressive deterioration in the cartilage of joints, and can be a byproduct of strenuous sports, obesity or aging.

Past research has shown that death risk -- whether from any cause, or from cardiovascular disease -- is higher among people with rheumatoid arthritis than in the general population.

According to the study authors, the reasons are not fully clear, but certain aspects of rheumatoid arthritis -- chronic inflammation, the medications used to treat it, and the degree of functional disability -- may be factors.

Chronic inflammation, for example, is believed to contribute to artery disease.

"The results of this and other studies suggest that physicians should consider the potential risk of vascular events in patients with rheumatoid arthritis and counsel and treat such patients accordingly," Watson's team concludes.

Drugmaker Merck & Co. funded the study.

Source: The Journal of Rheumatology 2003:30:1196-1202.

Back to the Top


Long Plane Rides Raise Risk of Rare Stroke

Kathleen Doheny
HealthDay Reporter
HealthDayNews
Tuesday, June 24, 2003

TUESDAY, June 24 (HealthDayNews) -- A long airplane flight can increase the risk of having a rare type of stroke, a new study says.

The stroke type occurs in those who have a deformity called a patent foramen ovale, an opening between two of the heart's chambers. While up to 30 percent of the general population has this condition, most are unaware they do. And long-term air travel boosts the risk of getting this type of stroke when the abnormality is present, the authors say.

While the link between air travel and blood clots in the lungs has been widely studied and publicized, a connection between flying and strokes has not been fully explored till now.

The new study, appearing in the June 24 issue of Neurology, may be the first to report on it, the researchers say.

But the study's co-author says the findings should not alarm most passengers.

"It's a real problem but a small one," says Dr. Stephen W. Borron, an associate clinical professor of emergency medicine and medicine at George Washington University School of Medicine in Washington, D.C.. "There are millions of passenger miles [logged] without any problems."

Borron and his colleagues from Avicenne Hospital in Bobigny, France, examined passengers arriving at Paris' Charles de Gaulle Airport over an eight-year period, from 1993 to 2000. Of the 155 million passengers, 65 were tended by a medical team for lung blood clots. And of those, four passengers, or 6 percent of those with lung blood clots, had strokes.

All four of those had the patent foramen ovale, the researchers say.

What happens, the researchers say, is that air travel can increase the risk of developing blood clots in the legs, which can then travel to the lungs and block an artery. Sometimes, the heart openings can allow the blood clot to enter the brain blood vessels and cause a stroke.

Putting the risk in perspective, Borron says, "Passengers traveling long distances, over 3,500 miles, appear to be at some increased risk, albeit small, of having a blood clot travel to the lungs. If they have patent foramen ovale, there is also a risk that the clot could travel to the brain. It must be emphasized that the number of people who have blood clots during air travel is low."

At greater risk, he says, is anyone who has had surgery within the previous month, those with cancer or previous blood clots, pregnant women, and anyone who has been immobile longer than three days.

"The results of this study are not surprising," says another expert, Dr. Cathy Helgason, director of the cerebrovascular service at the University of Illinois College of Medicine in Chicago.

Most people with the heart abnormality would not know they have it, Borron says, unless they have had an echocardiogram of the heart or cardiac catheterization.

Both Borron and Helgason advise passengers flying more than 3,500 miles to take precautions.

"Anyone traveling long distances should be aware of the findings of this study," Helgason says. "Frequent walks up and down aisle, exercise of the lower extremities and arms, as well as maintenance of good hydration under such circumstances, should play a role in prevention."

"If you are taking a long flight, make sure you get a little exercise on the plane," Borron agrees.

If you can't walk up and down the aisle, he adds, do in-seat exercises, moving your ankles to keep the blood flowing.

In an earlier study of lung blood clots, Borron found that 85 percent of those affected had not moved around during the lengthy flight.

More information

For more information on stroke risk factors, click on the National Institute of Neurological Disorders and Stroke or the American Heart Association.

Back to the Top

Baldness Drug Prevents Cancer in Men, Study Finds

By Maggie Fox
Reuters Health
Tuesday, June 24, 2003

WASHINGTON (Reuters) - A popular baldness drug that works by lowering male hormone levels also seems to prevent prostate cancer (news - web sites), a major killer of men, U.S. researchers said Tuesday.

The drug, finasteride, worked so well that the researchers stopped their trial so that all the men could take the drug. It seemed to reduce prostate cancer by 25 percent.

The drug used in the study is sold as Proscar, made by Merck & Co., Inc. Finasteride was at first developed to stop the benign enlargement of the prostate that comes with normal aging.

It became best-selling baldness drug when it was also found to stop the thinning of the hair that many men see with age.

Prostate cancer is the most common cancer in men, after skin cancer, and will affect nearly 221,000 men in the United States this year. About 29,000 men will die of the disease.

"Millions of men may benefit from finasteride's ability to reduce prostate cancer risk," Dr. Leslie Ford of the National Cancer Institute (news - web sites), who helped lead the study, said in a statement.

Writing in the New England Journal of Medicine (news - web sites), Ford and colleagues said they gave 9,000 men either finasteride or a placebo. The study was supposed to last for 10 years or until 2004.

They found that 18 percent of the men who took finasteride, or 803 men, developed prostate cancer. About 24 percent of men who took placebo, or 1,147 men, developed prostate cancer.

Many of the men with cancer had normal prostate specific antigen levels -- a standard blood test for prostate cancer, and also seemed normal with a standard digital rectal exam, the NCI said.

But the men who got the drug who did develop cancer developed a more aggressive form, the study found.

They found that 6.4 percent of men on finasteride -- 280 men out of 4,368 in the study -- had high-grade tumors. For men on placebo, 5.1 percent had high-grade cancers.

It was not clear if this would mean the cancer would be harder to treat, the NCI said.

"The reason men on finasteride had more high-grade tumors is currently unknown, but the researchers are studying several possibilities," the institute said in a statement.

"The drug affects the appearance of prostate cancer cells, and this may lead to a false estimate of tumor grade, which is determined visually by a pathologist."

Back to the Top

Blood Test Can Detect Threat of Kidney Disease

Janice Billingsley
HealthDay Reporter
HealthDayNews
Tuesday, June 24, 2003

TUESDAY, June 24 (HealthDayNews) -- Current screening tests for kidney disease miss an estimated 300,000 Americans who have the illness.

But adding a simple blood test to routine exams could go a long way toward detecting most cases of kidney disease, a particular problem for diabetics (news - web sites), a new study says.

The research appears in the June 25 issue of the Journal of the American Medical Association (news - web sites).

"By estimating the glomerular filtration rate (GFR) using a simple blood test, we can detect kidney disease and implement intervention early," says Dr. Holly J. Kramer, a nephrologist at Loyola University Medical Center in Maywood, Ill., and lead author of the study.

A decrease in a person's glomerular filtration rate, which is a measure of the kidneys' filtering capacity, always occurs before kidney failure, Kramer explains. In addition to diabetics, others at risk of kidney disease include people with a family history of kidney failure or hypertension.

Currently, doctors screening patients at high risk for kidney disease monitor them for the eye disease called retinopathy. Or they check for too much of the protein albuminuria in the urine. Albuminuria can indicate the onset of kidney disease.

These tests pick up the majority of cases of kidney failure, but they miss an estimated one-third of patients, Kramer says. "We need to alert doctors that 30 percent of patients do not have the classic signs of kidney disease," she says.

When untreated, kidney disease leads eventually to kidney failure and the need for dialysis, a procedure that costs the U.S. government $15 billion annually through its Medicare program. Almost 40 percent of kidney failure, called end-stage renal disease, is attributed to type 2 diabetes.

"This is a really important study and point to make," says Dr. Kathy Tuttle, chairwoman of the National Kidney Foundation's work group on Diabetes in Chronic Kidney Disease. "It's another step in the direction of more complete evaluation and better information about kidney disease in diabetes."

"If you know people have kidney damage and can pick it up this way, you can intervene in a way to prevent or delay dialysis, which, in addition to its cost, is a quality-of-life issue," she says.

Intervention treatments include reducing blood pressure, blood sugar levels and proscribing a healthy lifestyle for patients, Kramer says.

For the study, Kramer and her colleagues examined data from 1,197 people, aged 40 or older, who had type 2 diabetes. Thirteen percent of them had chronic renal insufficiency, or kidney disease.

Of that group, 28 percent had retinopathy, and 45 percent had high levels of albuminuria in their urine.

But 30 percent of those with chronic renal insufficiency had neither warning sign. Extrapolating out, Kramer estimates that approximately 300,000 Americans are at risk of undetected kidney disease.

More information

The National Kidney and Urologic Diseases Information Clearinghouse provides extensive information on kidney disease and diabetes. Additional advice on monitoring kidney disease can be found at The National Diabetes Information Clearinghouse.

Back to the Top

Two-Minute Brush Helps Achieve Cleaner Teeth: Study

By Alison McCook
Reuters Health
Tuesday, June 24, 2003

NEW YORK (Reuters Health) - Although hard work tends to pay off in other areas of life, forceful toothbrushing appears to be no better at ridding the mouth of plaque than a medium effort.

A group of European researchers discovered that the most efficient means of reducing plaque appears to be brushing for about two minutes at a medium force.

More vigorous teeth cleaning may actually do more harm than good, said Dr. Peter A. Heasman of the University of Newcastle upon Tyne, UK. Research suggests that heavy brushing can damage gums and wear down teeth, both potentially serious oral health problems, he said.

"Although we found that you have to brush your teeth reasonably long and hard to get rid of the harmful plaque which causes dental diseases, our research shows that once you go beyond a certain point you aren't being any more effective," Heasman said in a statement.

"You could actually be harming your gums and possibly your teeth," he added.

Heasman and his colleagues designed the study, published in the Journal of Clinical Periodontology, to determine the most efficient way to brush away plaque. Plaque is a sticky substance that can contain more than 300 species of bacteria, which adhere to tooth surfaces and produce cavity-causing acid. Plaque is a leading cause of gum disease.

During the study, Heasman and his colleagues measured plaque levels in the mouths of 12 people after they brushed their teeth using four different forces and for four periods of time -- 30 seconds, 60 seconds, 120 seconds, and 180 seconds.

The study participants brushed using a power toothbrush, which exerted set forces of between 75 grams and 300 grams. All spent 24 hours without cleaning their teeth before testing how well each technique stripped their mouths of plaque.

Heasman said that a force of 75 grams feels much lighter than one of 300 grams. However, he recommended that people visit their dentist to determine how different brushing forces feel.

"It is very difficult for a lay person to differentiate between brushing forces," Heasman told Reuters Health.

Longer brushing generally appeared better, but the researchers found that 120 seconds of brushing was roughly just as effective at removing plaque as longer brushing. And during those longer sessions, people removed about the same amount of plaque using a force of 150 grams as when they employed forces of 225 and 300 grams.

Although different people may require more or less time to get at all the plaque-ridden nooks and crannies in their mouth, spending around two minutes brushing your teeth seems "about right," Heasman said.

And applying a force beyond 150 grams -- somewhere in between light and forceful brushing -- "offered little benefit to plaque removal," Heasman added.

Furthermore, in toothbrushing, it is possible to have too much of a good thing, the researcher said.

"In the short term, gum changes may become apparent, but in the longer term, tooth wear or toothbrush abrasion is likely with too abrasive a technique, toothpaste, brush or force," Heasman said.

Source: Journal of Clinical Periodontology 2003;30:409-413.

Back to the Top


What's Behind Teen Beverage Choices

HealthDayNews
Tuesday, June 24, 2003

MONDAY, June 23 (HealthDayNews) -- The age, race and gender of American teenagers influence what they drink, says a new study in the International Journal of Food Sciences and Nutrition.

The study by researchers at Virginia Tech's Center for Food and Nutrition Policy found that, overall, white children and teens drink more beverages than their black counterparts. The researchers say the reason for that isn't clear and needs to be explored further, especially with regard to proper hydration for everyday and strenuous physical activity.

Young boys and girls in all ethnic groups drink more milk than any other beverage, but black children drink less milk than white or Hispanic children. The study found that young white boys and girls drink about 1.4 and 1.2 servings of milk a day, compared to 1 and 0.8 servings a day for black boys and girls.

Only 7.4 percent of young Hispanic girls reported drinking no milk, compared to 13 percent to 14 percent of young black children.

The researchers were surprised by their finding that black adolescent girls drank few beverages, and particularly little milk. That could put them at future risk of poor bone health and increased risk of high blood pressure, a common condition among black Americans. Previous research has shown that calcium-rich dairy products may help reduce the risk of high blood pressure.

Among younger children, soft drinks are the second or third most popular choice. During adolescence, soft drinks are the first choice and milk falls to second. Older teens tend to drink more carbonated beverages, citrus juice and fruit drinks and less milk and non-citrus juice.

The study, which also concluded there was no link between soda consumption and overweight children, was supported by an unrestricted research grant from the National Soft Drink Association.

More information

Here's where you can learn more about children and milk.

Back to the Top

Die, Cancer Cells, Die

HealthDayNews
Tuesday, June 24, 2003

MONDAY, June 23 (HealthDayNews) -- A new way of forcing cancer cells to self-destruct has been discovered by researchers at St. Jude Children's Research Hospital.

The Memphis institution reports its finding in the June 20 issue of Molecular Cell.

The research suggests drugs designed to activate this form of cell suicide -- called apoptosis -- may help fight cancer. Such a strategy would target specific molecules in cancer cells rather than relying on chemotherapy, which can cause serious side effects and drastically degrade quality of life for cancer patients.

The St. Jude researchers triggered apoptosis in cancer cells using a drug called rapamycin, which blocks the action of a protein called mTOR.

The mTOR protein stimulates a biochemical pathway that increases production of proteins that are essential for cancer cell proliferation. By blocking mTOR, rapamycin prevents the cancer cells from making these critical proteins and eventually causes the cells to self-destruct.

"Right now, we don't know exactly what sends the cell into crisis after rapamycin blocks mTOR. Further study is needed to determine what the link is between shutting down production of specific proteins and the cellular crisis that prompts cells to undergo apoptosis," researcher Peter Houghton, chairman of the St. Jude department of molecular pharmacology, said in a news release.

More information

Here's where you can learn more about apoptosis.

Back to the Top

MONDAY, JUNE 23, 2003

Beta Blocker Coreg Excels in Heart Study

By Emma Ross
AP Medical Writer
The Associated Press
Monday, June 23, 2003

LONDON - A large head-to-head comparison of two widely used heart drugs known as beta blockers found one significantly superior in prolonging the lives of people with chronic heart failure.

Some experts, however, said the results might be different depending on the formulation of one of the drugs used.

Prognosis for chronic heart failure is poor, with around half of patients dying within three to five years a death rate similar to that of lung cancer.

In the largest such study to date, scientists estimated that those taking carvedilol, also known as Coreg in the United States or Dilatrend elsewhere, lived nearly 18 months longer than those taking metroprolol, another beta blocker.

The study, paid for by F. Hoffmann-La Roche and GlaxoSmithKline, marketers of carvedilol, and conducted by a committee of European heart failure experts, was presented Monday at a European heart failure conference in Strasbourg, France.

"Carvedilol's significant survival benefit could mean thousands of lives saved each year. The results will have a major impact on clinical practice," said lead investigator Dr. Philip Poole-Wilson, professor of cardiology at Imperial College in London.

However, Dr. Michal Tendera, European Society of Cardiology heart failure spokesman, gave a cautious interpretation of the results.

"This is most probably related to the drug, but it may also be due to the different formulation of the metroprolol used in this study compared to other studies of metroprolol," said Tendera, a professor of cardiology at Silesian School of Medicine in Katowice, Poland, who was not connected with the study.

The study used a short-acting generic metroprolol. Key research that established metroprolol as an effective beta blocker used the long-acting version known as Toprol XL and that research indicated the drug was as effective as carvedilol or other beta blockers, although there has never been a head-to-head comparison, Tendera noted.

Heart failure is a condition in which the heart is weak and cannot pump enough blood. The heart tries to compensate for its weakened pumping action by beating faster, which puts more strain on it.

Drugs known as beta blockers are commonly prescribed for the condition. They reduce the heart's tendency to beat faster.

Experts suggest there may be more than 10 million people with chronic heart failure in Europe alone and another 4.8 million in the United States, where the American Heart Association (news - web sites) estimates that about 550,000 new cases are diagnosed every year.

The study, conducted in 15 European countries, involved 3,029 patients with all degrees of chronic heart failure. A total, of 1,511 people were given carvedilol and 1,518 got metroprolol, a generic drug. The patients were followed for almost five years.

By the end of the study, 512, or 34 percent of the carvedilol patients had died, compared with 600, or 40 percent, of the patients in the metroprolol group. The researchers estimated that the average survival was 1.4 years longer in the carvedilol group.

"There will be arguments about dose and formulation," Poole-Wilson said. "But the bottom line is we have compared two drugs and shown one is better than another."

The study could not determine why carvedilol was better, but scientists believe it could be because it works slightly differently.

Beta blockers block specific receptors beta receptors located on the heart cells, reducing the effects of chemical messengers that increase heart rate.

The body has two main beta receptors: beta 1 and beta 2. Some beta-blockers, such as metroprolol, block beta 1 receptors. Others, such as carvedilol, block both beta 1 and beta 2 receptors. Carvedilol is believed to block other activities that cause heart trouble.

On the Net:

European Society of Cardiology: http://www.escardio.org/

Back to the Top

Diabetics Can Walk for Life

By Janice Billingsley
HealthDay Reporter
HealthDayNews
Monday, June 23, 2003

MONDAY, June 23 (HealthDayNews) -- If you're diabetic, a new study finds that you'll probably live longer simply by strolling.

An analysis of 2,900 adults who had diabetes for an average of 11 years found that even two hours of walking weekly reduced the risk of death by 39 percent.

Included in that reduction was a 34 percent decrease in risk of death from cardiovascular disease, to which diabetics (news - web sites) are particularly prone.

"This is the first study to look at a nationally representative sample of people with diabetes," says Edward Gregg, an epidemiologist with the U.S. Centers for Disease Control and Prevention (news - web sites), who did the analysis and wrote the results in a study published in the June 23 issue of the Archives of Internal Medicine (news - web sites).

"Other studies have found that people are less likely to get new diseases if they walk, but we found that walking will increase the length of life once people have diabetes," he says.

This is particularly important, Gregg adds, because of the incidence of the disease.

"Diabetes is one of the most common chronic illnesses; the ratio in people 60 and older is one out of five or one out of six. But even though the disease increases the risk for death, most people with diabetes will go on to live for a long time. So one of the key things to do is improve the quality of life, and walking will increase the length of life once people have diabetes."

For the analysis, Gregg and his colleagues at the CDC's Division of Diabetes Translation used data from the 1990-1991 National Health Interview Survey (NHIS) to look at the mortality rates for 2,896 diabetics who'd been sick for an average of 11 years. Their average age was 59. In an eight-year follow up, 671 of the participants died, 316 of heart disease.

Looking at the health interviews that were conducted in the early 1990s, including self-reports of exercise among all the participants, the scientists found that those diabetics who walked for at least two hours weekly had a 39 percent lower all-cause death rate and a 34 percent lower death rate from heart disease compared to those who did not walk.

Among those who walked between three and four hours a week, the benefit was even higher, a 53 percent lower death rate from cardiovascular disease. Walking any longer than that didn't result in further benefit, however, the study points out.

Dr. Frank Hu, a diabetes specialist at the Harvard School of Public Health who wrote an editorial that accompanied the study, says the CDC study confirms that walking is an important part of treating diabetes.

"Lifestyle modifications remain a cornerstone for diabetic management," Hu says. "We have very strong evidence that walking and other types of activity can go a long way in reducing mortality and cardiovascular complications from diabetes. Walking is as effective as medicines -- probably more effective, because walking has no side effects."

Brisk walking is the best, Gregg recommends.

"People should be able to carry on a conversation but know that their breathing is elevated," he says.

More information

Facts about diabetes can be found at the American Academy of Family Physicians. Exercise and diet recommendations for people with diabetes are available at the Juvenile Diabetes Research Foundation International.

Back to the Top

Results Mixed for Post-Lyme Disease Antibiotics

By Linda Carroll
Reuters Health
Monday, June 23, 2003

NEW YORK (Reuters Health) - When it comes to lingering Lyme disease symptoms, intravenous antibiotics may not improve impaired thinking, two newly released studies suggest.

But one study found the treatment may help ease the debilitating fatigue experienced by many with post-Lyme syndrome, a condition in which symptoms continue even after initial treatment with antibiotics.

In an interview with Reuters Health, a co-author of that study cautioned that it was too soon to say that IV antibiotics should be prescribed to treat fatigue in patients who continue to experience symptoms after initial treatment for the tick-borne disease.

Even though the improvement in fatigue experienced by people receiving IV antibiotics "is provocative, this benefit needs to be weighed against the side effects of the treatment," said Dr. Leslie G. Hyman, a researcher in the department of preventive medicine at Stony Brook University Medical Center in Stony Brook, New York.

She also noted that "since fatigue is a non-specific symptom that can have a wide variety of causes, it is difficult to be sure that improvement in this symptom is due to persistent infection" with the Lyme disease bacteria.

Lyme disease is most common in the Northeast, parts of Wisconsin and Minnesota and northern California, although cases have been reported in other areas.

Besides developing a rash, a person bitten by an infected tick may develop flu-like symptoms. The illness is treatable with antibiotics, but if left untreated, people with the disease can develop serious complications, including arthritis and heart problems.

Some patients continue to have symptoms of Lyme disease after treatment with antibiotics, and researchers are divided over whether this represents continuing infection or a new illness, often called post-Lyme syndrome or chronic Lyme disease.

The two studies, which were published in the journal Neurology, were designed to test whether antibiotics beyond the initial course prescribed for Lyme disease could help knock back the long-term symptoms that a small percentage of people experience.

In the second study, researchers led by Dr. Richard F. Kaplan, a professor of psychiatry at the University of Connecticut School of Medicine in Farmington, followed 129 patients with a history of Lyme disease.

All patients also reported suffering one or more of the following symptoms: wide-spread musculoskeletal pain, impaired thinking, numbness, tingling, aching or burning sensations, as well as severe fatigue.

The patients were randomly assigned to receive either intravenous ceftriaxone for 30 days followed by 60 days of oral doxycycline or placebo intravenous treatment followed by 60 days of sugar pills.

When researchers compared the antibiotic-treated patients to the placebo-treated patients at 90 and 180 days, they found no difference in terms of cognitive function.

Researchers from Stony Brook also found little difference between antibiotic-treated and placebo-treated patients when it came to cognitive function.

In that study, researchers followed a total of 55 patients who had previously been treated for Lyme disease. At the outset, all 55 still suffered persistent, severe fatigue, according to Hyman. The patients were randomly assigned to receive either 28 days of intravenous ceftriaxone or an intravenous placebo.

When the researchers rechecked the patients six months after treatment, they found that 64 percent of people who had been treated with antibiotics felt less fatigued compared to 19 percent of those treated with placebo.

"This is an encouraging finding and further research should be done," Hyman said. "Since we don't know whether the benefit we observed for fatigue in our study is due to antibacterial actions or some other mechanism, other potential treatment approaches may go beyond antibiotics."

In an editorial accompanying the two articles, Dr. Israel Steiner suggests that neither could be expected to give a final answer on the subject of antibiotics and post-Lyme syndrome because there is no definitive test for the syndrome.

Without a clear test to make sure studies are including only patients with post-Lyme syndrome, "every attempt to address clinical questions in the realm of (post-Lyme syndrome) is doomed, almost by definition, to leave these questions unsettled," according to Steiner, who is at Hadassah University Hospital in Jerusalem.

Roche Laboratories provided the antibiotics and the placebo for the Stony Brook study.

Source: Neurology 2003;60:1888-1889,1916-1930.

Back to the Top


More Education Buys Alzheimer's Protection

By Ed Edelson
HealthDay Reporter
HealthDayNews
Monday, June 23, 2003

MONDAY, June 23 (HealthDayNews) -- Autopsies of the brains of monks and nuns shows more years of schooling can protect against the ravages of Alzheimer's disease (news - web sites).

Matching brain against brain, researchers found men and women with more years of education have less decline in cognitive function, even when the physical signs of Alzheimer's disease are identical.

"There is fairly good evidence that education and things related to education protect against getting the clinical signs of Alzheimer' disease," says Dr. David A Bennett, director of the Alzheimer's disease center at Rush Presbyterian-St. Luke's Medical Center in Chicago and lead author of the report in the June 24 issue of Neurology.

Indeed, any mental activity seems to be good for the aging brain, Bennett says. He cites a study, reported just last week, showing that reading books, playing cards, doing crossword puzzle puzzles and playing board games reduces the risk of developing Alzheimer's disease.

"It's a question of information processing, and even playing games is information processing," he says. "Even playing video games is information processing, and having conversations with people is another kind of information processing."

The new report involves 130 participants in the long-running Religious Orders Study -- not only Roman Catholic monks and nuns but also priests and lay brothers. All agreed to take tests of 19 measures of cognitive function, on average eight months before they died. After death, the researchers autopsied their brains, measuring the number and extent of amyloidal plaques, the tangles of protein seen in Alzheimer's disease.

Using a complex mode of analysis, the researchers say that on a scale where the average participant scores 100, the presence of 18 plaques -- more than enough for a diagnosis of Alzheimer's disease -- lowered the score of someone with just a bit of college attendance to 82, the study finds. For someone with postgraduate college education and the same number of plaques, the score was 96.2.

There are a couple of cautions in applying the results to everyone, Bennett says. The people in the study were highly educated, compared to the general population, and the mental activity that was measured took place decades before Alzheimer's disease would be expected to develop.

Nevertheless, he says, the study shows "there is something about education that allows the brain to tolerate a much larger burden of Alzheimer's disease without depressing cognitive functions."

"It's interesting to see that within this fairly limited range of high education we see this effect," says Neil Buckholtz, chief of the dementias of aging branch at the National Institute on Aging, which funded the study. "What we have to do now is look at a greater range of education, as well as try to figure out what the mechanisms are."

One hypothesis is that education may somehow increase the number of synapses, connections between nerve cells, in the brain, Buckholtz says.

"These researchers have brain tissue and potentially could look at these kinds of things in the brain," he says."

Whatever the mechanism, Bennett says, the findings create "a win-win situation. By getting educated, you protect against Alzheimer's disease."

More information

You can keep abreast of the latest developments in Alzheimer's research by consulting the Alzheimer's Association or the National Institute on Aging.

Back to the Top

Brain Study Examines How People Feel Pain

By Randolph E. Schmid
Associated Press Writer
The Associated Press
Monday, June 23, 2003

WASHINGTON - Pain that brings tears to one person's eyes may be barely noticed by someone else, and that can be a problem for doctors deciding on treatment.

The answer: Listen to the patient, a new study says. Some people really do feel more pain than others.

"We have all met people who seem very sensitive to pain as well as those who appear to tolerate pain very well," said Robert C. Coghill of Wake Forest University Baptist Medical Center.

"Until now, there was no objective evidence that could confirm that these individual differences in pain sensitivity are, in fact, real," said Coghill, lead investigator on the paper published Monday in the online edition of Proceedings of the National Academy of Sciences (news - web sites).

The study of brain activity showed that some people respond more strongly to pain.

"One of the critical things is, it provides physicians with the evidence they need to have confidence in patients' reports of pain and use that to guide treatment," Coghill said.

The researchers used magnetic resonance imaging to study the brains of 17 volunteers. The skin of each volunteer's lower right leg was heated with a heating pad.

After each heating the participants gave their estimate of how painful it was and the two sessions were averaged. On a one-to-10 scale various individuals rated the heating pain from a low of one to a high of "almost nine."

When the researchers compared the brain scans to the pain ratings of the volunteers they found that parts of the brain known to be involved in experiencing pain were more active in people who said they felt more pain.

In particular, they found increased activity in the primary somatosensory cortex, which deals with pain location and intensity, and the anterior cingulate cortex, which handles unpleasant feelings caused by pain.

But they found little difference between people in the activity of the thalamus, which helps transmit pain signals from the spinal cord to brain regions.

That may indicate that incoming pain signals are being delivered by the spinal cord in a similar way for different people, but once they arrive in the brain they are handled differently.

Coghill said the study found no difference in response to heat pain between men and women.

His paper comes six months after researchers at the University of Michigan reported finding a gene that can make people more or less sensitive to pain, depending on the form they inherit.

In that study, brain scans showed that painkilling chemicals called endorphins were much more active in the brains of people who reported less sensitivity to pain.

On the Net: http://www.pnas.org

Back to the Top

Blood Test May Predict HIV-Related Dementia

By Keith Mulvihill
Reuters Health
Monday, June 23, 2003

NEW YORK (Reuters Health) - Preliminary research is zeroing in on certain protein patterns in blood cells that may be a sign an HIV (news - web sites)-infected patient is at risk of dementia, according to a study released Monday.

"This study is a first and early work to determine if specific protein fingerprints can be obtained from blood cells that would predict cognitive dysfunction in HIV-1 infected people," said lead investigator Dr. Howard E. Gendelman.

The findings are exciting, according to Gendelman, because they open up new areas of research into neurological diseases. Until now, doctors have relied on clinical examinations and brain-imaging techniques to diagnose brain disease, including HIV-associated dementia. The new study offers the hope that a blood test may one day help spot early disease.

Late-stage AIDS (news - web sites) patients often suffer from HIV-associated dementia, a progressive degeneration of the brain, which occurs as HIV invades the central nervous system. The condition induces steady, incremental losses in both mental and motor function, explained Gendelman, who is with the University of Nebraska Medical Center in Omaha.

About ten percent of HIV-infected individuals have severe cognitive disease, Gendelman said, although a higher percentage experience other neurological complications, including a condition called neuropathy.

In the study, the team of researchers used a relatively new technique called "proteomics protein fingerprinting" to evaluate protein activity in infection-fighting white blood cells. The researchers looked at blood samples from 21 HIV-positive Hispanic women, some with and some without dementia. Their findings were compared to similar blood samples collected from 10 healthy Hispanic women without HIV.

In all, the team of researchers, which included co-investigator Dr. Loyda M. Melendez of the University of Puerto Rico Medical Sciences Campus in San Juan, evaluated 177 proteins. Of that group, 38 proteins exhibited different activity levels in women with dementia and those without dementia, according to the report.

"The idea that a blood test can be used with some precision to aid more conventional testing is quite novel and may prove to be important if further defined," Gendelman told Reuters Health.

Still, protein patterns may change over time so patients need to be followed, he said.

"Groups of proteins may be predictive but others may actually be involved in the disease process," said Gendelman. "Differentiating these groups of proteins is important."

"The data is preliminary and much more need be done before it can be used in any clinical setting," he added.

Gendelman pointed out that there is another part of this research that is equally important in a different way.

"It shows that circulating blood cells of the monocyte-macrophage lineage -- the blood's scavenger cells -- are involved in the pathogenic process of disease," he told Reuters Health.

"So why is this important? Unlike other types of (brain inflammation) where virus infects nerve cells -- like herpes, and rabies for example -- HIV-1 infects immune cells that enter into the brain and, once inside, cause considerable injury through indirect mechanisms," said Gendelman.

If the researchers can gain a better understanding of how these indirect mechanisms work, better ways may be found to treat the disease process, he said.

Source: Neurology 2003;60:1931-1937.

Back to the Top

Lower Tamoxifen Dosage May Be Healthier

By Lauran Neergaard
AP Medical Writer
The Associated Press
Monday, June 23, 2003

WASHINGTON - Tamoxifen is the top choice of doctors worldwide for preventing breast cancer (news - web sites) from coming back and, in high-risk women, for keeping it from striking in the first place.

Yet the drug causes some lifethreatening side effects, and now scientists wonder if dramatically lowering the dose could give women the benefits with fewer risks.

There is some tantalizing new evidence, albeit preliminary, that suggests it might. The question is how to prove it: Who would dare test a lower dose instead of the proven one? Besides, most U.S. research involves testing newer, more expensive alternatives in the quest for a next-generation tamoxifen.

But a small group of scientists in several countries hopes to revamp tamoxifen, citing the appeal of a time-tested medicine available in cheaper generic form.

"In many underdeveloped countries, being able to give a cheap, safe medicine to cut your risk of breast cancer in half for pennies this has such a worldwide impact," says Dr. V. Craig Jordan of Northwestern University, who developed the drug 30 years ago.

Tamoxifen is a multiple-personality drug: It acts like the estrogen hormone in some tissues and like an anti-estrogen in others.

In women with estrogen-sensitive breast cancer, it fends off cancer by blocking estrogen's growth-spurring effects. For the same reason, women at high risk of developing breast cancer can cut that risk by 44 percent if they take tamoxifen pills daily.

But tamoxifen acts like estrogen in the uterus and bloodstream, doubling users' risk of getting uterine cancer and tripling the risk of a potentially fatal blood clot.

When tamoxifen first debuted, it was hailed for having none of chemotherapy's immediate toxic effects so few questioned if the daily dose of 20 milligrams was too high until several years ago, when thousands of still-healthy women started taking it for cancer prevention.

"Drugs have often been marketed at what were later recognized as excessive doses," notes Dr. Andrea Decensi of the European Institute of Oncology in Milan, Italy, who is leading the safer-dose hunt. "Our results suggest that tamoxifen does not escape this rule."

Decensi gave 120 women with breast cancer either the standard 20 mg of tamoxifen or radically lower doses 5 mg or 1 mg for four weeks before tumor-removing surgery.

A key measure of cancer cell growth showed decreases of the same amount, 15 percent, regardless of tamoxifen dose, Decensi reported in the Journal of the National Cancer Institute (news - web sites) this month. Regarding side effects, women taking less tamoxifen also had lower levels of key clotting substances in their blood.

A similar study from Brazil, published in the European Journal of Cancer and co-authored by Jordan, also found low-dose tamoxifen can stop cell growth.

Decensi has begun additional studies of whether lower-dose tamoxifen is safer for the uterus.

The preliminary research is intriguing, but no woman should lower her tamoxifen dose unless and until far larger and stricter studies prove that really works, cautions Dr. Powel Brown of Houston's Baylor College of Medicine.

For many scientists, the emphasis is on finding a tamoxifen alternative:

  • Some 16,000 women are taking either tamoxifen or another estrogen-modifying drug, raloxifene, to see if they prevent breast cancer equally well. Raloxifene today is sold to treat osteoporosis, but seems to block estrogen's breast effects like tamoxifen does. Although it has its own side effects, including questions about blood clots, it doesn't seem to cause uterine cancer. Results of the research are due in a few years.
  • A new family of drugs, called aromatase inhibitors, are challenging tamoxifen for treatment of late-stage breast cancer. A study in Europe recently was begun to see whether they might work as well or better than tamoxifen for preventing cancer, too; similar research is planned here. But aromatase inhibitors can be used only by postmenopausal women and can increase the risk of bone-thinning osteoporosis, drawbacks tamoxifen doesn't have, Brown notes.

"These are all pieces of a jigsaw," says Jordan, who wants equal interest in researching cheaper, low-dose tamoxifen.

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

Back to the Top

Don't Forget That Rx for Exercise, Docs

By Alison McCook
Reuters Health
Monday, June 23, 2003

NEW YORK (Reuters Health) - Doctors should always recommend regular physical exercise to their patients to prevent and treat cardiovascular disease, according to a new report from the American Heart Association (news - web sites).

Writing in the journal Circulation, a group of experts led by Dr. Paul D. Thompson of the Hartford Hospital in Connecticut note that people who get a lot of regular exercise appear to have half the risk of blood vessel disease as sedentary people.

In addition, regular exercise appears to lower the chances of a host of other chronic conditions, such as diabetes, depression and certain types of cancer.

Consequently, Thompson and his team suggest that doctors follow recommendations issued by the U.S. Centers for Disease Control and Prevention (news - web sites), which support at least 30 minutes of moderate exercise, such as a brisk walk, on most or all days of the week.

In an interview, report co-author Dr. Barry Franklin of William Beaumont Hospital in Royal Oak, Michigan, told Reuters Health that, despite the obvious benefits of exercise, he suspected that its value in protecting the heart and blood vessels has been "woefully underestimated," even among doctors.

"I think the medical community needs further education about the value of physical exercise," Franklin said.

Citing some of the evidence in favor of regular activity, Franklin described recent research that found that regular exercise appeared to reduce the risk of death as much as commonly used drugs, such as beta-blockers and aspirin.

As a result, exercise -- which is cheaper and causes fewer side effects than medication -- "seems to convey the same magnitude of cardioprotection," Franklin said.

And combining drugs and exercise appears to reduce the risk even further, he noted.

In the report, the authors also recommend that doctors themselves get regular exercise, to "set a positive example" for their patients and the outside world.

As community members and health experts, doctors can also counsel schools and local businesses to encourage physical activity within the community, the report notes.

Franklin said that the American Heart Association has issued recommendations to doctors in the past and has written earlier reports about the importance of exercise. The organization decided to issue another report in light of new and growing information about the benefits of exercise in treating and preventing heart disease, he added.

The new report has been endorsed by the American College of Sports Medicine.

Source: Circulation 2003;10.1161/01.CIR.0000075572.40158.77.

Back to the Top


Woman Impaled While Pregnant Recovers

The Associated Press
Monday, June 23, 2003

ANN ARBOR, Mich. - A woman who was 8 1/2 months pregnant when she was impaled on a microphone stand has only minor aches and a 3-inch scar two weeks later, and her newborn son is perfectly healthy.

Jessie Wickham, 34, lost her balance and fell from the second floor of a loft onto the 3-foot microphone stand. The pole went through the upper chest just millimeters from her heart, penetrating the upper left lobe of her lung and hitting one of her shoulder bones.

"I made it out all right and we are both alive. I am really happy about that," Wickham said Monday at the University of Michigan Hospital, where she has been recovering since the June 11 fall.

Her son, Ryan, was delivered just days after the accident. The boy went home from the hospital last week.

"He's beautiful. He's been healthy from the beginning," Wickham said. "I miss him so bad."

Wickham is expected to make a full recovery from a ruptured lung and soon could join her son at their Livingston County home 40 miles west of Detroit.

Fellow musicians Wickham plays bass are raising money to help pay her bills.

Wickham said she remembers waiting for paramedics after the fall, the helicopter ride to Ann Arbor and talking to doctors when she arrived. But the early part of her hospital stay is a blank. Ryan was delivered by Cesarean section a few days later.

"It was amazing that falling face down hard enough to drive that pole through her chest, that there was no injury to the baby," Dr. Stewart Wang, a surgeon at the hospital, said Monday.

Back to the Top

Inflammatory Marker Further Implicated in Stroke

By Jacqueline Stenson
Reuters Health
Monday, June 23, 2003

NEW YORK (Reuters Health) - High blood levels of a protein linked to inflammation are associated with an increased risk of stroke in the elderly, even in those who don't have extensive plaque buildup in arteries that lead to the brain, researchers report.

The reason may be that C-reactive protein (CRP) is a marker for more unstable plaques, said Dr. Mary Cushman, an associate professor of medicine at the University of Vermont in Burlington.

Those plaques can rupture and cause a blood clot that can travel to the brain, block an artery and cause a stroke, she told Reuters Health.

While previous research has implicated CRP in an increased risk of stroke and heart attack, there is not enough evidence to date for doctors to routinely test patients, according to Cushman. It's also not clear what to do about high CRP levels, though losing excess weight and stopping smoking may help, she said.

Her findings are published in the rapid access issue of Circulation: Journal of the American Heart Association (news - web sites).

"Each new study, as it is evaluated, will allow us to gradually refine the patients most likely to benefit from CRP testing," Dr. Augustus Grant, president-elect of the American Heart Association, said in a statement. "Thus far, we believe CRP testing may be useful as a discretionary tool for evaluating people with moderate cardiovascular risk."

The study involved 5,417 adults ages 65 and older who were divided into four groups based on their CRP levels. Doctors also used an ultrasound test to gauge the thickness, or narrowing, of arteries in the neck.

During the next 10 years, 469 of the participants experienced an ischemic stroke, which is the most common type of stroke and is caused by a blocked blood vessel.

After taking into account other risk factors for stroke such as high blood pressure, Cushman and colleagues found that participants in the highest CRP quartile were 60 percent more likely to have a stroke than those in the lowest quartile.

Those in the third highest quartile were 5 percent more likely to have a stroke than those in the lowest quartile, while those in the second highest quartile were 19 percent more likely.

The results were almost the same when the researchers took into account the presence of atherosclerosis, or clogging of the arteries.

However, the link between CRP levels and stroke was strongest in patients with greater artery narrowing.

"We found that while C-reactive protein is an independent risk factor for stroke, it is even more closely related to stroke in people with thicker artery walls than in people with thinner walls," Cushman said in a statement.

Source: Circulation 2003;108.

Back to the Top


What's Behind Teen Beverage Choices

HealthDayNews
Monday, June 23, 2003

MONDAY, June 23 (HealthDayNews) -- The age, race and gender of American teenagers influence what they drink, says a new study in the International Journal of Food Sciences and Nutrition.

The study by researchers at Virginia Tech's Center for Food and Nutrition Policy found that, overall, white children and teens drink more beverages than their black counterparts. The researchers say the reason for that isn't clear and needs to be explored further, especially with regard to proper hydration for everyday and strenuous physical activity.

Young boys and girls in all ethnic groups drink more milk than any other beverage, but black children drink less milk than white or Hispanic children. The study found that young white boys and girls drink about 1.4 and 1.2 servings of milk a day, compared to 1 and 0.8 servings a day for black boys and girls.

Only 7.4 percent of young Hispanic girls reported drinking no milk, compared to 13 percent to 14 percent of young black children.

The researchers were surprised by their finding that black adolescent girls drank few beverages, and particularly little milk. That could put them at future risk of poor bone health and increased risk of high blood pressure, a common condition among black Americans. Previous research has shown that calcium-rich dairy products may help reduce the risk of high blood pressure.

Among younger children, soft drinks are the second or third most popular choice. During adolescence, soft drinks are the first choice and milk falls to second. Older teens tend to drink more carbonated beverages, citrus juice and fruit drinks and less milk and non-citrus juice.

The study, which also concluded there was no link between soda consumption and overweight children, was supported by an unrestricted research grant from the National Soft Drink Association.

More information

Here's where you can learn more about children and milk.

Back to the Top

Hole in Heart Ups Stroke Risk on Long Flight

Reuters Health
Monday, June 23, 2003

NEW YORK (Reuters Health) - Long airplane flights may increase the risk of stroke in people with a relatively common heart defect called patent foramen ovale, although such strokes are rare, French doctors announced Monday.

In patent foramen ovale, a tiny opening between the heart's two upper chambers that normally closes during fetal development remains open. Up to 30 percent of the population may have the heart defect.

Long flights are also thought to increase the risk of developing blood clots in the legs, or deep vein thrombosis (DVT). These clots can break free and travel to the lungs, leading to a potentially life-threatening condition called pulmonary embolism. These conditions are sometimes called "economy class syndrome," although any type of immobility -- such as bedrest after an operation -- can increase the risk of clot formation.

Previous research has suggested that people with a patent foramen ovale may be at greater risk of stroke after many hours spent in an airplane. The opening between their heart's two chambers may, in some cases, allow a blood clot to enter the arteries of the brain, thereby causing stroke.

In the new study, reported in the June 24th issue of the journal Neurology, Dr. Frederic Lapostolle of the Hopital Avicenne in Bobigny and colleagues looked at air travelers with a pulmonary embolism who arrived at Roissy Charles de Gaulle Airport in Paris over an eight-year period. Sixty-five individuals with the blood clots were transported to a hospital in that time.

Four of these airplane travelers experienced a stroke during or immediately following a flight lasting between eight and 12 hours. All the patients were in their 50s or 60s. Two of the individuals had no previous medical history of heart problems, another was a very heavy smoker and the fourth had a history of blood clots.

Further analysis revealed that all four had a patent foramen ovale, according to the report.

Although stroke after a long flight is rare, a considerable percentage of people who experience a pulmonary embolism and have patent foramen ovale may be at risk of a stroke, according to Lapostolle and his colleagues.

"If the patent foramen ovale was the key for the development of stroke in the four patients, as seems reasonable, the risk for stroke in the patients with pulmonary embolism and patent foramen ovale would be ... approximately 15 percent to 21 percent," the authors write.

"Although this figure is based on speculation, it is a substantial percentage," they add.

Physicians must be aware of this association, the authors conclude.

To reduce risk of blood clots during flight, experts advise passengers to drink fluids, avoid alcohol, wear loose clothing, avoid crossing their legs, wear elastic support stockings and engage in minor physical activity during flight, such as walking or moving their legs.

Source: Neurology 2003;60:1983-1985.

Back to the Top


Bowed Legs Among Newborns

HealthDayNews
Monday, June 23, 2003

(HealthDayNews) -- Newborn infants often look like they have bowed legs, but according to Harvard Medical School (news - web sites), this is natural and usually corrects itself within a few weeks. The bow-shape is due a baby's curled up position in the uterus.

That's also why some infants have turned-in feet and turned-in toes.

If you can move your baby's feet into a normal position with your hands, these conditions are likely to correct themselves.

Back to the Top

Most Stroller Head Injuries Result of Child Falls

By Alison McCook
Reuters Health
Monday, June 23, 2003

NEW YORK (Reuters Health) - More than half of all stroller-related head and face injuries among children one year old and younger occur when children fall out of their strollers, new research shows.

While some of those falls occur when children lean out of or stand in the stroller, some head and face injuries have resulted from falls that took place when the child was simply sitting in the chair, according to a Canadian researcher.

These findings stress the importance of vigilance, even when a child appears securely strapped into a stroller, Steven McFaull of Health Canada in Ottawa told Reuters Health.

"A lot of (these injuries) are just related to supervision," he said. Parents and caretakers may believe a child is sleeping in the stroller, leave them alone for an extended period, "then something like this happens," he said.

A smaller proportion of stroller-related head and face injuries -- 13 percent -- happened when the stroller rolled down stairs or a sleep slope. A smaller percentage of accidents involved a motor vehicle.

The vast majority of the accidents were relatively minor, according to the report, and only four percent of children were admitted to the hospital as a result.

McFaull presented his findings last week during the 80th annual meeting of the Canadian Pediatric Society, held in Calgary.

McFaull obtained his findings from a review of surveys conducted with parents who brought their injured children into one of 15 emergency departments across Canada.

In an interview, the researcher explained that a preliminary look at the data suggests that children tended to receive many of their in stroller injuries when strapped into so-called "umbrella strollers," which are collapsible and tend to be more lightweight and less expensive than other models.

McFaull said that when the stroller is lighter than the child -- as is often the case with the umbrella strollers -- the chair can topple over after simple shifting or leaning, even when the child is sitting and strapped in.

Umbrella strollers tend to be very narrow, he said, and children are often squished in. In that case, when young infants -- who carry much of their weight in their heads -- lean out or get their shoulders out of the stroller, they are in danger of slipping out of the chair or causing it to topple over, he noted.

However, McFaull noted that not all accidents involved umbrella strollers, and children had similar accidents in many other stroller types, such as twin and triplet strollers, standard strollers, and those used for jogging.

Once children became older and more mobile, a larger proportion of falls were due to accidents that occurred when the child maneuvered out of the stroller, McFaull said.

Other tips McFaull offered parents to help avoid these accidents include not leaving the stroller close to stairs -- such as while getting ready to leave the house -- and keeping the wheels locked when not moving.

He described cases where a stroller was knocked over or down an incline when hit by a dog or sibling, accidents that could have been avoided if the wheels had been locked.

A small number of head and face injuries resulted from burns, he said, such as when caretakers using the cup holder on strollers spilled a hot beverage on the child, or when passersby accidentally hit the child with a lit cigarette.

Parents should also avoid attaching a leashed dog to a stroller, McFaull added, for the dog can easily pull the stroller over.

Back to the Top

Camping Caution

HealthDayNews
Monday, June 23, 2003

(HealthDayNews) -- If you've got any camping trips lined up for the summer, it's a good idea to brush up on some safety tips.

Health Canada offers this advice:

  • Include treatments for food and insect allergies in your first-aid kit.
  • Ensure your kids are always at a safe distance from campfires.
  • Keep sand or water near the campfire to put out unwieldy blazes.
  • Never leave the campsite alone, and let another adult know when you're leaving and when you'll be back.
  • Avoid wearing fragrances and bright colors. They can attract wasps.
  • Food attracts wild animals and insects. Store it in a cooler in your car, not inside your tent.

Back to the Top

FDA Approves OTC Version of Prilosec

Reuters
Monday, June 23, 2003

NEW YORK (Reuters) - Popular heartburn drug Prilosec received U.S. Food and Drug Administration (news - web sites) clearance on Friday to be sold without a prescription, opening the way for a planned fall launch of the blockbuster heartburn drug by Procter & Gamble Co., the company said.

The approval comes after P&G, which holds the over-the-counter rights to drug, made changes to the labeling on the box at the behest of the FDA, so consumers could better understand when and how to take the drug, which will be called Prilosec OTC.

Prilosec enters the $1.2 billion over-the-counter U.S. acid relief market where acid-reducer Pepcid is currently the market leader. It will come in the form of 20 mg tablets, the most commonly prescribed strength of the drug.

P&G has an agreement to market the drug over the counter with the drug's maker, AstraZeneca Plc, and has said it expects to sell $200 million to $400 million in the first year the drug is available over the counter. Greg Allgood, associate director of P&G Health Sciences Institute, said that level of sales would make Prilosec OTC the "market leader in the heartburn aisle" and one of the largest over-the-counter switches ever.

The consumer products maker, better known for its Tide laundry detergent and Crest toothpaste, hopes to start selling the drug in the fall for less than $1 per tablet, compared with more than the $4 per capsule AstraZeneca charges on a prescription basis.

For consumers, the approval of OTC Prilosec means they can get the heartburn drug without first going to the doctor. But Prilosec OTC could cost more for some people who once paid a small co-payment under their insurance plan.

Prilosec, which is the first proton pump inhibitor drug to go over-the-counter, was once the world's top-selling drug, regularly logging more than $6 billion in annual sales.

With the patent for Prilosec set to expire in late 2001, AstraZeneca devoted its marketing efforts to its new prescription "purple pill," Nexium, to preserve its franchise in prescription heartburn treatments.

AstraZeneca was able to fend off most generic competitors to Prilosec in court and now faces only Schwarz Pharma AG in the U.S. market. But as a result of the competition and the shift in marketing to Nexium, Prilosec sales slipped to $4.6 billion last year from $5.6 billion in 2001.

Pepcid, marketed by Johnson & Johnson and Merck, is likely to promote its ability to be taken every day versus Prilosec where consumers are advised not to take a 14-day course more often than every four months for frequent heartburn unless directed by a doctor.

An estimated 61 million Americans suffer heartburn at least once a month. "Consumers can safely treat themselves -- if they need to -- every day," Kathy Widmer, director of marketing for Johnson & Johnson, told Reuters.

Doctors have expressed concern that making Prilosec available without a prescription could be dangerous because patients may treat themselves for heartburn, not realizing they have more serious problems such as Barrett's esophagus, a constant irritation of the esophagus by gastric juices that can lead to cancer.

Dr. Charles Ganley, director of division of OTC drugs at FDA, noted that the drug is meant to be taken for a full two weeks, unlike current retail heartburn medications. Ganley said Procter & Gamble had to work on the Prilosec OTC's labeling so customers would understand that they should see a doctor if symptoms occur again after 14 days of using the drug.

While the prescription Prilosec pills are purple, the Prilosec OTC pills will be pink.

Back to the Top

Die, Cancer Cells, Die

HealthDayNews
Monday, June 23, 2003

MONDAY, June 23 (HealthDayNews) -- A new way of forcing cancer cells to self-destruct has been discovered by researchers at St. Jude Children's Research Hospital.

The Memphis institution reports its finding in the June 20 issue of Molecular Cell.

The research suggests drugs designed to activate this form of cell suicide -- called apoptosis -- may help fight cancer. Such a strategy would target specific molecules in cancer cells rather than relying on chemotherapy, which can cause serious side effects and drastically degrade quality of life for cancer patients.

The St. Jude researchers triggered apoptosis in cancer cells using a drug called rapamycin, which blocks the action of a protein called mTOR.

The mTOR protein stimulates a biochemical pathway that increases production of proteins that are essential for cancer cell proliferation. By blocking mTOR, rapamycin prevents the cancer cells from making these critical proteins and eventually causes the cells to self-destruct.

"Right now, we don't know exactly what sends the cell into crisis after rapamycin blocks mTOR. Further study is needed to determine what the link is between shutting down production of specific proteins and the cellular crisis that prompts cells to undergo apoptosis," researcher Peter Houghton, chairman of the St. Jude department of molecular pharmacology, said in a news release.

More information

Here's where you can learn more about apoptosis.

Back to the Top

Meningitis a Concern in Kids with Cochlear Implants

By Megan Rauscher
Reuters Health
Monday, June 23, 2003

NEW YORK (Reuters Health) - Preliminary results suggest a high rate of bacterial meningitis among Canadian children with surgically implanted hearing devices called cochlear implants.

Many of these cases could have been prevented, according to Dr. Samantha D. Wilson of Health Canada in Ottawa who reported the findings during the 80th annual meeting of the Canadian Pediatric Society in Calgary, which ended Sunday.

"All children should be up to date on their immunizations but especially children considered to be at risk for certain infections, such as those with cochlear implants who are at high risk for both Haemophilus influenzae type B and streptococcus pneumonia or invasive pneumococcal disease," she told Reuters Health.

Cochlear implants go beyond the sound amplification of traditional hearing aids (news - web sites) by translating sounds into electrical impulses that stimulate auditory nerves in the inner ear. The brain unscrambles the information, restoring some measure of hearing to the deaf.

Bacterial meningitis occurs when meningococcal or other bacteria cause an inflammation of the meninges, the protective membranes surrounding the brain and spinal cord. Symptoms such as headache, intolerance for light, a stiff neck and vomiting can develop rapidly. The infection can be life threatening, and urgent treatment with antibiotics is essential.

A possible link between cochlear implants and subsequent bacterial meningitis surfaced in Europe in July 2002 with a cluster of cases reported. To see whether such a link existed in Canadian cochlear implant recipients, Wilson and colleagues sent questionnaires to all 1,432 Canadian cochlear implant recipients who received implants between January 1995 and July 2002.

They identified four cases of bacterial meningitis (two were pneumococcal, 1 meningococcal and 1 unknown) among recipients who responded to the survey.

None of the three cases for which the causative agent was identified had been immunized against these agents. Overall, there was a "low" rate of immunization against pneumococcal and meningococcal disease, 46 percent and 52 percent, respectively, in the cochlear implant recipients surveyed.

Time between cochlear implant and bacterial meningitis ranged from 7 months to over 7 years. The researchers were unable to identify any risk factors for bacterial meningitis among cochlear recipients.

"Unfortunately, we don't have a baseline population to compare this specialized group with," Wilson said. "What's really important," she added, "is that some of these bacteria that cause meningitis could be prevented through immunization."

Back to the Top

Scanning for Heart Disease

HealthDayNews
Monday, June 23, 2003

MONDAY, June 23 (HealthDayNews) -- A combination of imaging provides the most complete noninvasive diagnosis of coronary artery disease, says a study presented Monday at the Society of Nuclear Medicine's annual meeting in New Orleans.

The study of 51 patients by researchers at the Medical Imaging Center of Southern California found functional information about tissue blood flow is provided by SPECT myocardial perfusion imaging (MPI), but it doesn't offer full anatomical detail.

On the other hand, CT scans can locate coronary calcium deposits and intracoronary lesions (CCTA), but don't provide as much functional information as the MPI.

In this study, all the patients had SPECT MPI and CT coronary calcium scanning, and 39 of the 51 also had CCTA scans. The researchers compared myocardial perfusion defects identified by MPI with the locations of calcium deposits and plaque identified by CCTA.

"Examining the scans together provided valuable information. For instance, we observed a strong link between severe myocardial perfusion defects and both heavy (calcium) deposits and intracoronary lesions found by CCTA," researcher Edwin C. Glass says in a news release.

"However, in more than half the cases, additional information was gleaned from the ensemble of tests that could not be discerned from any single test alone," he says.

He and his colleagues concluded that combining the results of both the functional MPI and anatomic CT scans benefits patients by offering a more comprehensive assessment of coronary artery disease and better treatment and diagnosis.

More information

Here's where you can learn more about coronary disease.

Back to the Top

FDA Warns Consumers About Dietary Supplements

Reuters
Monday, June 23, 2003

WASHINGTON (Reuters) - The U.S. Food and Drug Administration (news - web sites) on Friday warned consumers against taking certain dietary supplements containing a prescription drug ingredient that could cause a sharp loss in blood pressure.

The FDA said consumers should not purchase or consume SIGRA, STAMINA Rx and STAMINA Rx for Women, Y-Y, Spontane ES or Uroprin manufactured by NVE Inc., in Newton, New Jersey and distributed by Hi-Tech in Norcross, Georgia.

The agency said the products contain the prescription-strength ingredient, tadalafil, the active ingredient in Cialis, a product of Eli Lilly and Co. that is approved in Europe to treat male erectile dysfunction.

"An interaction between certain prescription drugs containing nitrates (such as nitroglycerin) and tadalafil may cause a drastic lowering of blood pressure," the FDA said in a statement.

The agency's Office of Criminal Investigations executed federal search warrants in Georgia and New Jersey after finding the dietary supplements.

Spokesmen for NVE Inc. and Hi-Tech could not be reached for comment.

Back to the Top

Can Tea Lower Cholesterol?

By K.L. Capozza
HealthDay Reporter
HealthDayNews
Monday, June 23, 2003

MONDAY, June 23 (HealthDayNews) -- Research has shown that tea can prevent a gamut of health problems, running from cancer to bad breath. The latest says it may also help fight heart disease by lowering cholesterol.

Researchers at Vanderbilt University studied the impact of a 375-milligram pill containing green and black tea extracts, enriched with the antioxidant theaflavin, on 240 men and women. The subjects, all of whom were on a low-fat diet, were randomly assigned to receive either the pill or a placebo for 12 weeks. Those receiving the tea extract pill were given a high-antioxidant dosage, equivalent to seven cups of black tea and 35 cups of green tea.

The study authors say they were surprised to find a robust reaction -- a 16 percent cholesterol drop among the subjects who took the tea extract pill.

Although this reduction is not as high as is typically found with cholesterol-lowering drugs, it is an impressive result when compared to other non-pharmaceutical medications, says lead author Dr. David Maron, an assistant professor of medicine at Vanderbilt.

"While I wouldn't want to see this taken instead of a drug that's been indicated, I would like to see if this has an additive or synergistic effect," says Maron, whose findings appear in the June 23 issue of the Archives of Internal Medicine (news - web sites).

But because the researchers used a pill containing a "cocktail" of antioxidants, the study doesn't reveal which particular agent -- or combination of agents -- caused the subjects' cholesterol to drop, says Joe Vinson, a professor of chemistry at the University of Scranton in Pennsylvania.

"Because it's a mixture of things, we just don't know what the active ingredient is," he says.

While pleased with these intriguing results, Maron says further testing is needed to determine the long-term safety, the effective dosing range, and how the extract interacts with other cholesterol-lowering drugs.

"This study needs to be replicated in a different population of subjects," he says.

The finding adds to the growing body of research illuminating the broad health benefits of tea drinking. Other studies have suggested green and black tea possess anti-microbial, anti-cancer, and anti-aging properties.

"Tea has the most antioxidants of any beverage you could drink, and now we have this great cholesterol-lowering effect," says Vinson. He agrees, however, that tea drinking alone isn't enough to lower cholesterol if other lifestyle habits counteract its effects.

This caveat may explain why tea-drinking people like the British don't have particularly low cholesterol, he says.

"If you have a terrible diet, drink a lot of beer, smoke, and are overweight, tea isn't going to help you," he says.

Maron's study was funded by Nashai Biotech, a Nashville, Tenn.-based manufacturer of tea extract.

More information

Go to the National Heart, Lung, and Blood Institute for tips on how to keep your cholesterol down. Learn more about tea from the Tea Association of the United States of America.

Back to the Top

SUNDAY, JUNE 22, 2003

Scoliosis: The Health Threat That Starts in Childhood

By Amanda Gardner
HealthDay Reporter
HealthDayNews
Sunday, June 22, 2003

SUNDAY, June 22 (HealthDayNews) -- Scoliosis -- better known as curvature of the spine -- isn't just a disease of crooked old women and men.

In fact, it more often strikes young girls and boys just as they hit adolescence.

Late-onset idiopathic scoliosis -- or LIS -- is the most common form of the disease and is generally diagnosed after the age of 10. The condition, which has no known cause other than genetics, affects 3 percent of children between the ages of 8 and 16, and about 60,000 teens in the United States.

It's more common in girls than boys, can appear in children as young as 5, but usually strikes during the adolescent growth spurt.

Scoliosis manifests itself as a side-to-side curvature of the spine. On an X-ray, the spine appears more as an "S" or "C" than a straight line. In some cases, the bones in the spine may also rotate so the person's waist or shoulders appear uneven.

"Before we had school screening, we used to see girls come in with their mothers complaining that they had to hem their skirts differently because of the asymmetry it causes, although there was no actual difference in leg lengths," says Dr. Stuart L. Weinstein, a professor of orthopaedic surgery at the University of Iowa.

The trick is to catch the disease when it first appears.

"It's important that primary-care physicians check for this and look for it on each annual exam," says Weinstein. "School check-ups, particularly when one gets to the adolescent growth spurt at 10 to 16 years of age, are also important. Doctors need to look for it, as do families."

The severity of the condition varies widely; some cases merit treatment, such as surgery or bracing, and others do not.

For children and teens with mild scoliosis, doctors frequently recommend a strategy of "watchful waiting" -- regular monitoring to make sure the curve doesn't worsen.

If a severe curve is left untreated, however, it can result in not only cosmetic deformities such as asymmetrical shoulders, hips and ribs, it can also push against body organs and lead to heart and breathing problems.

Fortunately, diagnosing LIS is simple.

"The most common way of diagnosing teenage idiopathic scoliosis is with a forward bending exam, in which the school nurse or nurse or pediatrician bends the patient forward and looks for asymmetries in the posterior lumbar spine or posterior chest," says Dr. Keith Bridwell, president of the Scoliosis Research Society.

"If there's any asymmetry of five degrees or more, then the patient is referred to an orthopedic surgeon, who orders a set of X-rays to see if it is or is not scoliosis."

Scoliosis is usually diagnosed when the curvature is 10 degrees or more. Still, the curve needs to reach 25 or 30 degrees for physicians to start worrying. "If it's under about 20 degrees, the probability of it getting worse or causing any health problems is very small," Weinstein says.

There are three basic categories of treatment, depending on the severity of the condition.

If the curve is mild -- say under about 25 degrees -- most doctors recommend "watchful waiting."

"If the child has growth left, it's observation and seeing the child back once in a while," Bridwell says. This category represents the majority of cases. Scoliosis in this mild category may or may not be visible and will not affect activities, including sports.

A smaller number of children have curves in the 25- to 40-degree range, which often require some kind of back brace to stop the curve from getting worse, but not reverse it. There is some controversy over whether bracing is really effective and which children really need it.

"You don't know if you have two equal children what the prognosis is going to be," Weinstein says. "Some feel very sure that bracing prevents progression and others are not so sure."

For severe curves (45 or 50 degrees or more), surgery is generally recommended. Traditionally, surgery has involved fusing the vertebrae of the spine. Today, there are new options, including one procedure that offers an alternative to bracing.

Stapling is a new procedure that seems to be particularly suited to children who are athletes, dancers, gymnasts, cheerleaders or are active in some other way and want to remain flexible, says Susan Porth, a pediatric nurse practitioner at Shriner's Hospital for Children in Philadelphia.

"Basically it involves using surgical staples along the convex or the outer side of the spine that's curving," Porth explains. "The stapling is designed to hold in check the progression of the scoliosis. It's not meant to correct it."

And stapling does not preclude vertebrae fusion in the future if the person needs it. "We haven't done anything that can't be undone," Porth says.

Still, experts say more research and advances are needed to make significant strides against advanced cases of scoliosis.

"We need a much more aggressive standard," says Joseph O'Brien, president of the National Scoliosis Foundation. "It is in the best interest of our adolescent patients to replace the generally accepted wait-and-see approach with an effective non-operative treatment intervention plan. There is a need for more multidisciplinary research and coordination to develop and validate a more effective late-onset treatment plan."

More information

For more on teenage scoliosis, visit the Virtual Children's Hospital, the National Scoliosis Foundation or the Scoliosis Research Society.

Back to the Top

Working Out, Indoors or Out

HealthDayNews
Sunday, June 22, 2003

SUNDAY, June 22 (HealthDayNews) -- Fitness clubs, home gyms and workout attire suitable for all seasons have limited the number of excuses you can think up for not exercising.

Whether you choose to sweat off the calories indoors or outdoors, it's a good idea to know what factors you should consider.

Indoor exercise requires little forethought about the weather, but choose an area that's well-ventilated and humidified. You'll breathe easier, especially if you're an asthmatic.

If you prefer to get your heart rate going in the great outdoors, weather extremes don't have to deter you. Just make some minor adjustments to your routine.

For instance, when it's hot or humid exercise in the early morning or evening. Wear light-colored, loose-fitting cotton clothing and go easy the first few times you pound the steamy sidewalks. Stop at any hint of muscle cramping or dizziness.

In cold weather, dress in layers. Choose gear that traps in warm air but lets sweat pass through, away from your skin. Avoid heavy cotton sweats; they suck in moisture and chill your body. Wear gloves and a hat -- 40 percent of body heat is lost through your neck and head. Warm up slowly and stop if you feel shivery, drowsy or disoriented, all signs your body's losing too much heat.

Before you head out, check the air temperature and wind chill factor. Skip the outdoors if the temperature falls at or below the danger zone for skin exposure.

Wherever and whenever you're exercising, consume lots of water. Try drinking six to eight ounces of fluid every 15 to 20 minutes during your workout. If you wait until you're thirsty before you drink, you've waited too long. So swig back that water, parched or not.

More information

These fitness facts from the American Council on Exercise can help you get the most out of your workouts, come rain or sunshine.

Back to the Top

SATURDAY, JUNE 21, 2003

Coping with Multiple Sclerosis Fatigue

HealthDayNews

Saturday, June 21, 2003

SATURDAY, June 21 (HealthDayNews) -- Living with multiple sclerosis often means fighting fatigue on a daily basis.

In fact, as many as 95 percent of those with multiple sclerosis (MS) report having a problem with fatigue, according to the National Multiple Sclerosis Society. More than just feeling shortchanged of a few hours of sleep, those with MS fatigue feel a pervasive tiredness that often interferes with the ability to complete daily activities.

The first step in getting help is to rule out other causes of fatigue, such as depression or sleep problems. If your physician determines that your fatigue is MS-related, there are several treatments that can help ease the constant feeling of exhaustion.

Occupational and physical therapy can help movement or breathing problems that might be causing fatigue. These therapists can design activity planning and exercise programs that may help reduce fatigue. Occupational therapists, in particular, can help you learn to pace your activities and use energy effectiveness strategies.

Medications such as amantadine, modafinil and pemoline may help, but the society cautions these drugs are not a cure and they don't work for every patient. Also, like all medications, they do have side effects.

Lifestyle changes can also be important. Stress management, relaxation exercises, aerobic exercise, sleep regulation or psychotherapy have all been used to treat fatigue. Additionally, feeling overheated is often a culprit in MS fatigue, so it's important to keep cool.

More information

To learn more about dealing with fatigue from multiple sclerosis, visit the National Multiple Sclerosis Society.

Back to the Top