The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
February 4, 2004

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 January 10-16

Friday, January 16, 2004

  1. Study: Cancer Treatment Increasingly Aggressive
  2. Bush Challenges U.N. Report on Obesity
  3. Nearly Half of Crib Deaths Tied to Sleep Position
  4. Glaucoma: The Silent Thief of Sight
  5. Activists Say U.S. Tries to Sap World Obesity Fight
  6. Over-the-Counter Doesn't Mean Risk-Free
  7. Having More Babies May Mean Lower Stroke Risk
  8. Fitness Pays Big Dividends as People Age
  9. Anti-Smoking Program Helps Expecting Fathers Quit
  10. Another Canker Sore?
  11. Methadone Not Great for Cancer Pain
  12. Different Prostate Cancer Treatments Not That Different
  13. People with Heart Failure Who Exercise Live Longer
  14. A Boost for Pain Relief
  15. Heel Ultrasound Predicts Broken Bones
  16. Time Matters With Pulmonary Embolisms
  17. Fish Oil for Mom May Prevent Allergies in Baby
  18. Arm Position Is Key to Blood Pressure Reading
  19. Food Groups Propose Voluntary Labeling
  20. That Tooth Can Be Saved

    Thursday, January 15, 2004

  21. Study Suggests Flu Vaccine Didn't Work Well
  22. Study Links Leukemia, Gene Combination
  23. Ebola May Come from 'Bush Meat,' Study Finds
  24. Experts: Halt HIV Vaccine Trial
  25. Stroke Risk Linked to Decline in Mental Powers
  26. Couch Potatoes Can Start Young
  27. Thick Waist Predicts Blood Pressure Risk: Study
  28. Ecstasy and Pot: Double the Memory Damage
  29. Injuries Cost Billions Every Year in U.S. - Report
  30. Ecstasy and Pot: Double the Memory Damage
  31. Hormone Imbalance Fuels Rheumatoid Arthritis
  32. Monkey Hear, But Monkey Not Comprehend
  33. Genes Make Some People More Prone to SARS, Scientist Says
  34. New Study Reinforces SIDS Prevention Guidelines
  35. FDA Places Six Canadian Feed Plants on Import Alert
  36. Caesareans Cut Chances of Future Vaginal Delivery
  37. Tai Chi Might Help Elderly Avoid Falls
  38. Pharmacists decry NDakota plan to use Internet to help by Canadian drugs
  39. Consumer Groups Ask More Info on Mad Cow Probe

    Wednesday, January 14, 2004

  40. Cancer Deaths to Decline in 2004
  41. New Clues to Genesis of Alzheimer's
  42. Wine's Health Benefits Mimicked in a Pill
  43. U.S. Urged on Universal Health Insurance
  44. Odor Receptor Helps Mosquitoes Target People
  45. Burger King Unveils Bunless Burgers
  46. Frito-Lay Introduces Low-Carb Chips
  47. Antibiotics May Help Stop Stomach Cancer
  48. For Chest Pain, Call EMS for Faster Treatment
  49. Kids' Immune Systems Unfamiliar With Flu Strain
  50. New Gene Therapy Targets Advanced Skin Cancer
  51. The Worm Turns on Parasite Treatment
  52. Problems Seen with New Coronary Bypass Device
  53. Stent With Cancer Drug Shines in Trial
  54. Factors Predict Worsening Rheumatoid Arthritis
  55. New Ways to Catch Heart Defect
  56. LASIK Eye Surgery OK for a Few Kids
  57. Water Workouts
  58. Tests Planned for Genetically Engineered TB Vaccine
  59. Dry Hands?

    Tuesday, January 13, 2004

  60. Exercise Ups Fitness in Women with Arthritis
  61. Veggies May Offer Cancer Cure
  62. Breast Cancer Survival Has Improved in Last Decades
  63. Sizing Up the Risks of Outpatient Surgery
  64. Calcium Not Useful for Lead Poisoning if Diet Good
  65. Informed Consent Doesn't Change Choice to Have Cataract Surgery
  66. Big Hospitals May Not Be Best for Heart Surgery
  67. Massachusetts to examine risks of obesity surgery after 3rd death in a year
  68. Ephedra, Though Banned, Still Under Attack
  69. Antibiotic Helps After Stroke, at Least in Mice
  70. Rhode Island official proposes buying prescription drugs from Canada
  71. New Fungus Compounds Halt Hardening of Arteries
  72. Some CoQ10 Supplement Labels Misleading: Report
  73. U.S. announces ban on import of civets because of SARS concerns
  74. Many with Migraines Prefer Root Canal to Headache
  75. Another Ontario hospital warns of improperly sterilized equipment

    Monday, January 12, 2004

  76. School and Work Call on Same Mental Skills
  77. Dieters Seek Alternatives to Ephedra
  78. Diabetes and Oral Health
  79. Vitamin D May Help Prevent MS, Rheumatoid Arthritis
  80. Morning Headache a Widespread Problem
  81. Study Tells Overweight Adults to Walk
  82. Ethnicity May Be Risk Factor for Asthmatic Kids' Allergies
  83. Breast Cancer Drug Herceptin Fails in Lung Trial
  84. Hispanic Teens Face High Chances of Heart Disease, Diabetes
  85. Dance From Brazil Latest Exercise Trend
  86. Research Raises Cancer Concerns Over Deodorants
  87. Cervical Cancer Screening: New Guidelines, More Options
  88. EU Commission Dampens Scottish Salmon Safety Fears
  89. Screening Saved Her Life
  90. Study: HMO Policy Not Tied to Newborn Problems
  91. Social Network Key to Teen Suicide Risk

    Sunday, January 11, 2004

  92. Poll: Smokers Unaware of Danger of Persistent Cough
  93. Compound May Improve Treatment for Asthma
  94. Report: Gulf War Syndrome Linked to Vaccines
  95. Organic Beef Tries to Benefit From Scare

Friday, January 16, 2004

Study: Cancer Treatment Increasingly Aggressive

By Merritt McKinney
Reuters Health
Friday, January 16, 2004

NEW YORK (Reuters Health) - The care of cancer patients near the end of life may be getting more aggressive -- perhaps overly aggressive -- researchers report.

In a new study covering the period 1993 to 1996, there was a small but steady increase in the proportion of cancer patients who were admitted to emergency rooms and intensive care units shortly before dying.

The trend toward more aggressive care may be related to the availability of new types of chemotherapy, the study's lead author told Reuters Health.

"Over this time period, as more and more chemotherapy drugs became available, we oncologists used them," said Dr. Craig C. Earle of the Dana-Farber Cancer Center in Boston.

"That's not a bad thing as long as it doesn't interfere with appropriate end-of-life care," Earle said.

But it may be a good idea to expand access to hospice services, which are designed to meet the needs of terminally ill patients and their families during the last weeks or months of life.

"It appears that patients who live in an area where hospice is more available are less likely to experience what some might call overly aggressive treatment," Earle said.

When hospice is not as easily available, Earle said, "we oncologists do what we know how to do -- keep giving chemotherapy."

One way to improve the quality of care for cancer patients may be to reduce barriers to hospice care, according to the Boston researcher.

Earle and his colleagues reviewed the cases of more than 28,000 people age 65 and older who died within a year of being diagnosed with lung, breast, colorectal or other gastrointestinal type of cancer.

Several indicators of more aggressive care increased during the study period, according to a report in the Journal of Clinical Oncology.

Compared to patients treated in 1993, those treated in 1996 were more likely to receive chemotherapy, including during the last two weeks of life. Over time, admissions to emergency rooms and intensive care units became more common near the end of life.

The percentage of patients seen in an emergency room more than once during the last month of life increased from 7.2 percent in 1993 to 9.2 percent in 1996. Similarly, 7.1 percent of patients in 1993 were admitted to an intensive care unit compared to 9.4 percent in 1996.

Although the increases were small, they were consistent, the researchers point out.

Despite the increase in aggressive treatment, over time cancer patients were more likely to receive hospice care and less likely to die in a hospital, according to the report. In fact, people who lived in an area where hospice services were more readily available were more likely to receive this type of care.

Source: Journal of Clinical Oncology, January 15, 2004.

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Bush Challenges U.N. Report on Obesity

By Jonathan D. Salant
Associated Press Writer
The Associated Press
Friday, January 16, 2004

WASHINGTON - The Bush administration is challenging a World Health Organization (news - web sites) report that outlines steps for nations to take to reduce obesity.

Administration officials questioned the science behind some of the recommendations, such as limiting food advertising aimed at children and limiting fats, salt and sugary sodas. But consumer groups on Friday accused President Bush (news - web sites) of kowtowing to the food industry, some of whose executives are among his biggest fund raisers.

The International Obesity Task Force estimates that 300 million people worldwide are obese and 750 million more are overweight, including 22 million children under age 5. The obesity problem has expanded like people's waistlines from the industrial nations to developing countries.

Objections to the 160-page report were laid out in a letter sent this month to the United Nations (news - web sites) agency by William Steiger, a special assistant for international affairs at the U.S. Department of Health and Human Services (news - web sites).

He said that the WHO report did not adequately address an individual's responsibility to balance one's diet with one's physical activities, and objected to singling out specific types of foods, such as those high in fat and sugar.

"The (U.S. government) favors dietary guidance that focuses on the total diet, promotes the view that all foods can be part of a healthy and balanced diet, and supports personal responsibility to choose a diet conducive to individual energy balance, weight control and health," Steiger wrote.

Dr. William Dietz, director of the division of nutrition and physical ability at the Centers for Disease Control and Prevention (news - web sites), said many of the report's recommendations were not backed by hard evidence.

For example, the rise in obesity mirrored an increase in lowfat products being sold in stores, Dietz said.

"Consumers thought that if all they had to do was reduce fat, they could eat anything they wanted," Dietz said. "We know that fat reduction alone is not sufficient. Calories are calories, whether they come from fat or carbohydrates."

Consumer advocates have criticized the administration's stance, saying it makes a mockery of HHS Secretary Tommy Thompson's anti-obesity efforts.

"We doubt the secretary's commitment to fighting obesity on any serious level," said Bruce Silverglade, legal affairs director for the Center for Science in the Public Interest. "Government is part of the problem and government needs to be part of the solution."

Concerns about the WHO report have been brought to the Bush administration by the Grocery Manufacturers of America, a trade group representing food companies such as PepsiCo Inc. and Hershey Foods Corp.

"One of the things we didn't see in the document was a recognition that it ultimately comes down to what individuals choose to do," spokesman Michael Diegel said. "You can't solve the problem by government fiat."

Executives of two member companies of the trade group David Murdock of Dole Food Co. Inc., and August Busch III of Anheuser-Busch Cos. Inc. have raised at least $100,000 for Bush's re-election campaign, giving them the status of "pioneers." The food industry has contributed $512,000 to the president's campaign.

"Why would this administration, or any administration, invoke the moral authority of the United States of America on behalf of the junk food and the obesity lobby?" said Gary Ruskin, executive director of Consumer Alert, an advocacy group affiliated with Ralph Nader (news - web sites).

HHS spokesman Bill Pierce said the administration's concerns are based on science, not on the views of industry.

On the Net:

Health and Human Services (news - web sites): http://www.hhs.gov

World Health Organization: http://www.who.int

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Nearly Half of Crib Deaths Tied to Sleep Position

Reuters Health
Friday, January 16, 2004

NEW YORK (Reuters Health) - Findings from a European study suggest that about 48 percent of crib deaths are attributable to the baby sleeping on its front or side. Sleeping in a room other than the parent's room was linked to 36 percent of cases, and 16 percent were linked to bed sharing.

Sudden infant death syndrome (SIDS), also called crib death or cot death, is the leading cause of death in babies less than a year old. Most SIDS deaths occur when babies are between two and four months of age, and more often in boys.

To better understand the risk factors for SIDS, Dr. R. G. Carpenter, from the London School of Hygiene and Tropical Medicine, and colleagues conducted studies in 20 regions in Europe. Data from 745 SIDS cases and 2411 living babies were included in the analysis.

The researchers' findings are reported in this week's issue of the medical journal The Lancet.

Consistent with previous reports, sleeping in the prone position or turning from the side to the prone position were major risk factors for SIDS. Compared with infants who slept in other positions, those that slept prone or turned from the side to the prone position were 13- and 45-times more likely, respectively, to experience SIDS.

Unless the mother smoked, bedsharing had little effect on the risk of SIDS and the association was only apparent during the first 8 weeks of life. In contrast, if the mother smoked, bedsharing raised the risk of SIDS by 13-fold during the first weeks of life.

Maternal alcohol use was identified as a significant SIDS risk factor, but only when the infant shared the bed all night, the researchers report.

"Avoidable risk factors such as those associated with inappropriate infants' sleeping position, type of bedding used, and sleeping arrangements strongly suggest a basis for further substantial reductions in SIDS incidence rates," the investigators conclude.

Source: The Lancet, January 16, 2004.

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Glaucoma: The Silent Thief of Sight

By Kathleen Doheny
HealthDay Reporter
HealthDayNews
Friday, January 16, 2004

FRIDAY, Jan. 16 (HealthDayNews) -- It's called the silent thief of sight, and for good reason.

Glaucoma has few if any early symptoms. And when they do appear, the disease has already robbed its victims of some sight. About 3 million Americans have glaucoma, but many do not know it yet.

Regular, routine eye exams, including special tests, can improve the odds of early detection, experts say. And, once detected, the disease can be controlled -- and remaining vision preserved -- with improved medicine and surgery techniques.

"The key is to get checked before the disease becomes symptomatic, " says Dr. Andrew Iwach, an ophthalmologist and assistant professor at the University of California, San Francisco.

That's a message that bears repeating during January, National Glaucoma Awareness Month.

Since glaucoma risk rises with age, eyes should be tested at about age 35 and 40, then every two to four years after age 40 and every one to two years after age 60, suggests the Glaucoma Research Foundation. Those at high risk due to family history should get exams every one to two years after age 35.

Glaucoma is actually a group of eye diseases, but all types damage the optic nerve, causing vision loss and, sometimes, blindness. The optic nerve connects the retina to the brain and it houses more than 1 million nerve fibers. For good vision, you need a healthy optic nerve.

What goes wrong in glaucoma? In the front of the eye, clear fluid flows in and out of a space called the anterior chamber. When the fluid passes out too slowly and builds up, pressure can increase and this intraocular pressure can rise to the point where it damages the optic nerve. This form of the disease, the most common, is called open angle glaucoma. It's so named because the fluid leaves the anterior chamber at the open angle where the cornea and the iris meet.

Some people have glaucoma, and optic nerve damage, even without the pressure within the eye rising -- a type called low-tension or normal-tension glaucoma.

And, in recent years, Iwach says, experts have discovered the thickness of the cornea somehow plays a role in who gets glaucoma.

"We may have a patient who has a higher than normal pressure, but the optic nerve looks fine," he says. Odds are, the patient has a thick cornea, somehow possibly protecting against damage to the nerve.

During an exam for glaucoma, doctors will also look at the optic nerve, measure the intraocular pressure and evaluate peripheral vision -- often affected first in glaucoma.

To lower the pressure inside the eye, drops are commonly prescribed.

"Twenty years ago, in order to control glaucoma, we needed to use drops four times a day," says Dr. Michael Berlin, a professor of clinical ophthalmology at the Jules Stein Eye Institute at the UCLA David Geffen School of Medicine.

Some of the newer eye drop medicines only need to be taken once or twice a day. Drops work either by causing the eye to make less fluid or helping the fluid drain.

If surgery is deemed the best treatment, a doctor may do a procedure called a laser trabeculoplasty, in which the laser is aimed at the lens of the eye and makes several evenly spaced burns, stretching the drainage holes inside the eye and allowing the fluid to escape better.

While the traditional approach has been to use medicine first, then surgery if the glaucoma still progresses, Iwach says the latest thinking has it that some patients may benefit most from having surgery first.

Compliance with medication is a problem among patients, Berlin and Iwach agree. "Most patients are not compliant," Berlin says. Part of the reason, he suspects, is the patient can tell little difference in vision during the short term, whether he takes the medicine or not.

Good patient-doctor communication is the key, say Berlin and Iwach. All the latest information -- whether medicine or laser therapy is best; which eye drops are preferred -- "has to be customized to the individual patient," Iwach says.

More information

To find out more about glaucoma, visit the Glaucoma Research Foundation. The foundation also has details on diagnostic tests for glaucoma.

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Activists Say U.S. Tries to Sap World Obesity Fight

By Stephanie Nebehay
Reuters Health
Friday, January 16, 2004

GENEVA (Reuters) - Consumer groups accused the United States on Friday of trying to sabotage a global fight against obesity targeting junk food and soft drinks.

The World Health Organization (news - web sites) (WHO) executive, which includes the United States and 31 other countries, will debate on Tuesday a plan drawn up by the U.N. agency after talks with member states, nutritional experts and the food industry.

The Global Strategy on Diet, Physical Activity and Health says poor diets and lack of exercise are the leading cause of illnesses including heart disease, type 2 diabetes and certain cancers. These account for nearly 60 percent of 56.5 million deaths a year deemed preventable.

As well as recommending lower intake of sugar, sodium and artery-clogging trans-fatty acids, the WHO plan urges countries to restrict food and beverage advertisements aimed at children. It also suggests that governments gear their taxation and subsidy policies to encourage healthy eating habits.

But activist groups charged that the U.S. administration, under pressure from the domestic food industry, aims to weaken the plan when it comes before the executive board, which meets from January 19-24.

Senior U.S. health department official William Steiger, who sits on the board, has challenged some of the findings of a nutrition study carried out with the U.N. Food and Agriculture Organization (news - web sites), which forms the basis for the strategy.

In an interview with the Washington Post on Friday, he said: "We have a whole series of potential changes we'd like to see... What's lacking is the notion of personal responsibility as opposed to what the government can do."

Leaked To Activists

In a letter to WHO chief Lee Jong-Wook, which was leaked to activists, Steiger said the WHO-FAO report did not meet U.S. scientific standards, including peer review criteria.

"The assertion that heavy marketing of energy-dense foods or fast food outlets increases the risk of obesity is supported by almost no data," his letter said.

"No data have yet clearly demonstrated that the advertising on children's television causes obesity."

Steiger also said the WHO/FAO Report exceeded the two U.N. agencies' mandates by addressing "broad areas of trade, agricultural subsidies and advertising."

"The Bush Administration is putting the interests of the junk food industry ahead of the health of people -- including children -- on a global scale," Commercial Alert, a non-profit group based in Portland, Oregon, said in a statement.

WHO officials said they expected a significant number of lobbyists representing the Grocery Manufacturers of America and the Sugar Association as well as food interests from other countries to be in Geneva for the meeting.

"These tactics are reminiscent of the tobacco industry's sinister efforts to oppose global anti-smoking initiatives," said the Washington-based Center for Science in the Public Interest.

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Over-the-Counter Doesn't Mean Risk-Free

By Dennis Thompson Jr.
HealthDay Reporter
HealthDayNews
Friday, January 16, 2004

FRIDAY, Jan. 16 (HealthDayNews) -- New and powerful over-the-counter medicines hit the shelves all the time, and many people think these drugs pose no risks because you don't need a prescription to get them.

They're wrong.

Over-the-counter drugs can be as potentially dangerous as prescription medicines, according to the "Be MedWise" public education campaign.

The campaign -- spearheaded by the National Council on Patient Information and Education and recently endorsed by U.S. Surgeon General Richard H. Carmona -- is designed to promote the safe and appropriate use of nonprescription medicines.

"There are a lot of medicines that not too long ago were available only by prescription," says Magaly Rodriguez de Bittner, a pharmacy professor at the University of Maryland, Baltimore. "These are powerful medicines, and because they are powerful people should read the label carefully. Like any other medications, they do have side effects that would come with their overuse or misuse."

Part of the problem, health experts say, is that people often serve as their own doctor and pharmacist when treating ailments.

Americans buy about 5 billion over-the-counter drug products each year to treat routine health problems, according to the U.S. Food and Drug Administration (news - web sites). And consumers "self-treat" four times more often when suffering a health problem than seek out a doctor.

The "Be MedWise" campaign urges consumers to read and follow the label and, when confused, to seek out a pharmacist who can answer questions.

Over-the-counter "doesn't mean throw caution to the wind in terms of your responsibility as a safe drug user," says Lee Rucker, senior vice president at the National Council on Patient Information and Education.

The label will tell you exactly how to take these medicines, and you should be prepared to follow those instructions to the letter, he says.

"We forget these are medicines, too," Rucker says. "We need to regard them with a dose of caution, recognizing that because they are medicines they must be taken exactly as directed."

The "Drug Facts" label included on each medication can help consumers figure out if a particular drug will "interact" with other remedies they are taking.

Drug interactions happen when a drug interferes with another drug. This can alter the way one or both of the drugs act in the body, or cause unexpected side effects. The drugs involved can be prescription medications, over-the-counter medicines, even vitamins and herbal products, according to the National Council on Patient Information and Education.

For instance, both aspirin and blood-thinners such as warfarin -- which is used to protect against a heart attack -- help to prevent blood clots from forming. Taking these drugs together, however, could cause excessive bleeding.

"If they are taking an over-the-counter medicine and prescription medication or dietary or herbal supplement, the easiest way to avoid interactions and replications is by reading the Drug Facts label," Rucker says.

Rodriguez de Bittner offers an example involving new nonprescription antacids that have hit the market like Pepcid or Zantac.

"Because they alter the acidity in your stomach, they may hamper other oral medications from entering your bloodstream," Rodriguez de Bittner says.

Those medications can include antibiotics, blood thinners and heart medications. If that were to happen, the medicine might not work as well -- if at all, the council notes.

An over-the-counter drug could even cause an overdose if taken with other medications that share the same active ingredient. Rucker points out that the very first thing on the Drug Facts label is the active ingredient, and that information should be used to protect your health.

The label also tells you the symptoms the product is supposed to treat, when to stop taking it or see a doctor, and how to store the drug.

If you're still confused after examining the label, you should seek out the help of a pharmacist.

"Here you have in the pharmacist a health-care provider who has been trained about over-the-counter medicines," Rodriguez de Bittner says. "If in doubt, consult the pharmacist. They are a great resource for you."

Pharmacists can be particularly helpful if you're already taking prescription medications. They can compare the over-the-counter drug to what you are currently prescribed and tell you whether it will be safe.

The "Be MedWise" campaign provides a list of questions for pharmacists, including:

  • Is this medication safe for me?
  • How much should I take and how often?
  • How soon should I expect results?
  • What possible side effects should I look out for?
  • What other medicines should I avoid while taking this?
  • How long can I safely use this?
  • Can I continue my normal activities while using this?

More information

To learn more about the "Be MedWise" campaign, click here. For more on the safe use of over-the-counter drugs, visit this State of North Carolina Web site.

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Having More Babies May Mean Lower Stroke Risk

By Megan Rauscher
Reuters Health
Friday, January 16, 2004

NEW YORK (Reuters Health) - Having several children may protect women against a form of stroke that involves bleeding at the base of the brain called subarachnoid hemorrhage (SAH), results of a population-based study suggest.

"It appears from our study that the more children a woman gives birth to the lower her risk of SAH later on in life," Dr. David Gaist from the University of Southern Denmark in Odense told Reuters Health.

SAH is the only type of stroke that afflicts women more than men, "suggesting that reproductive factors may play a role in the etiology," he and his colleagues note in the American Heart Association (news - web sites)'s medical journal Stroke.

Using data from three national Swedish registries, the team identified 887 women hospitalized with a first SAH. Of these, 70 percent had the stroke five years or more after the birth of their last child.

Data analysis revealed that the odds of SAH declined with increasing numbers of children. For women bearing two, three, four, or five or more children the odds of having SAH were reduced by 17 percent, 28 percent, 28 percent and 33 percent.

The underlying biological mechanism responsible for this apparent association is currently unknown, Gaist emphasized. "The nature of this link - whether (number of children) truly protects against SAH or is simply just negatively associated with it - deserves further study."

Source: Stroke, January 2004.

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Fitness Pays Big Dividends as People Age

By Janice Billingsley
HealthDay Reporter
HealthDayNews
Friday, January 16, 2004

FRIDAY, Jan. 16 (HealthDayNews) -- It's one thing to have stomach muscles that resemble a six-pack when you're younger, but how about being able to carry a six-pack from the car to the house when you're 75?

The latter is the goal of exercise for older people, says an exercise professional who specializes in fitness for seniors.

"The image of fitness is a ripped bodybuilder, but when you're talking about older adults, they just want to be active and physically healthy," says Colin Milner, head of the International Council on Active Aging, a trade association of more than 3,500 organizations that specializes in senior fitness.

And regular exercise can keep them that way long into old age, he says.

"Many of the chronic health conditions we experience as we age come from disuse rather than aging, and exercise can retard the onset of many of those conditions," he says.

For example, consider this: Beginning at age 50, people begin to lose 12 percent of their muscle strength and 6 percent of their muscle mass every decade, says University of Maryland kinesiologist Ben Hurley.

But weight training can reverse these effects significantly -- two to three months of thrice-weekly weight training can increase muscle strength and mass by a third, making up for up to three decades of loss of muscle strength and muscle mass, he says.

"You can't completely do away with aging effects, but you can delay the onset of the loss of muscle strength and mass by exercise," he says.

Milner says it can be difficult for older people interested in exercise to find a way to start a program because most exercise facilities and programs are aimed at younger people.

"While many organizations are trying -- like YMCAs, hospital wellness centers and retirement communities with trained staffs -- the vast majority of health centers are still very youth-oriented," he says. "The fitness industry has portrayed exercise as an activity for younger people, and the message turns off the elderly."

With that in mind, Milner's organization recommends some guidelines to help seniors increase their physical activity.

  • Get a checkup to find out any physical modifications you have to incorporate into an exercise plan.
  • Find your baseline of activity by keeping a diary of your physical movement, tracking how much time you are sedentary -- watching television, sitting at a desk -- and active -- walking to your car, cooking a meal, doing chores around the house. At the end of the day, you'll have a good idea of how physically active you are.
  • Think about the most comfortable way for you to exercise. Do you like to be alone, or would you prefer to have an exercise buddy? Are you a morning or night person? Do you like indoor or outdoor activities? How much time can you spend in an activity and do you like longer, less frequent workouts or shorter, more frequent ones?
  • Check out any facility before you join. If you want to join a gym, visit it to see if it feels comfortable, if the staff is friendly or trained in exercise that accommodates your needs. Do the staff members have a college degree in health? Do they offer pre-exercise fitness assessments? Can they work with your physical limitations?
  • Make a date to exercise. Once you've figured out what you'd like to do, put it into a set time in your schedule. Whether it's joining a friend, or having a trainer at a gym, or just setting aside a certain time to do some activity, this will make it more likely that you'll do it.
  • Set specific short- and long-term goals. Decide how many times a week you will do your activity. Over the long term, think of something to work toward that will give you satisfaction and pleasure -- a new level of fitness, say, or gaining the ability to participate in a new activity.
  • Increase your activity in your daily life. Move around when you're talking on the phone, stand up and move during television commercials, do your own yard and house work, and walk as much as possible to local stores by parking your car in the back of the parking lot.
  • Don't quit.

"We're all looking for the fountain of youth," says Milner, "But the closest thing may be physical activity."

More information

The American Academy of Family Physicians offers some tips for exercise for older people, as does the Mayo Clinic.

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Anti-Smoking Program Helps Expecting Fathers Quit

By Alison McCook
Reuters Health
Friday, January 16, 2004

NEW YORK (Reuters Health) - Men whose partners are pregnant are more likely to quit smoking if they participate in a structured anti-smoking program, according to new research.

Australian investigators found that men who did not participate in such a program - which included nicotine patches and information about why smoking harms newborns - were half as likely to quit smoking within six months as those who did participate.

Kathleen Gilley, a respiratory therapist and professional counselor for smoking intervention at Respiratory Specialists, Inc. in Ohio, who reviewed the study for Reuters Health, explained that smoking interventions are often helpful because quitting smoking is extremely difficult, and because many people need help to understand that smoking is an addiction, not simply a habit.

However, some expecting fathers were able to quit without the intervention, likely because the prospect of becoming a father provides some men with enough motivation to "butt out" for good, she said.

Expecting fathers "want to be around for that baby growing up," said Gilley, who is also a member of the American Association for Respiratory Care. "And they don't want their children to smoke."

During the current study, reported in the journal Preventive Medicine, Dr. Warren Stanton of the University of Queensland and his colleagues identified 561 smokers whose partners were expecting a baby, and asked half to participate in a smoking cessation program.

As part of the program, participants watched a short video describing the health risks of smoking to a newborn, and received nicotine patches and materials that contained tips and motivations to quit smoking.

Six months after the study began, almost 17 percent of the men assigned to the intervention program were no longer smoking, compared with only 9 percent of the men who did not participate in the program.

Men who worked in a skilled profession, those who had tried to quit more times in the last year, and those who had their first cigarette relatively late in the day were more likely to have kicked the habit.

In an interview, Gilley explained that previous research has suggested that people working in skilled occupations may have more resources and less stress, and therefore may be less likely to smoke in order to alleviate that stress.

More frequent quitters may have been more successful because they knew what to expect when they stopped smoking, while late-in-the-day smokers may find it easier to stop for good because they are less addicted than people who need to smoke as soon as they wake up, she added.

Although many men who participated in the program did not quit, research shows that these smoking intervention programs prevent future smoking-related illnesses, and are therefore worth the time and money it takes to make them happen, Gilley noted.

"For every dollar that is spent on stopping smoking, two more dollars are saved in medical treatments, eventually," she said.

Source: Preventive Medicine, January 2004.

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Another Canker Sore?

HealthDayNews
Friday, January 16, 2004

(HealthDayNews) -- If you're prone to canker sores, you can ease the pain and help prevent them from returning with these tips from the Nemours Foundation:

  • Avoid eating abrasive foods, such as potato chips and nuts. These can irritate gums and other delicate mouth tissue.
  • Use only soft bristle toothbrushes, and brush your teeth and gums gently.
  • Avoid spicy, salty and acidic foods, which can aggravate tender mouth sores.

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Methadone Not Great for Cancer Pain

Reuters Health
Friday, January 16, 2004

NEW YORK (Reuters Health) - In a new study, methadone failed to displace morphine as the "gold standard" for controlling severe cancer pain.

This is disappointing news for pain sufferers in developing countries because morphine is often prohibitively expensive in such areas. Methadone, by contrast, is much cheaper because it is synthetic and not derived from poppies.

The results, which are published in the Journal of Clinical Oncology, are based on a study of 103 patients with cancer pain who received methadone or morphine pills for 4 weeks. Both drugs were given on a scheduled basis and as needed.

More patients in the methadone group stopped the drug due to side effects than in the morphine group, lead author Dr. Eduardo Bruera, from the M. D. Anderson Cancer Center in Houston, and colleagues report.

In terms of pain control, there were no clear-cut differences between the two treatments. However, because the researchers weren't able to recruit as many study participants as they had hoped, it was impossible to conclude that methadone was equivalent to morphine.

"Additional research is needed to explore other doses and/or schedules of methadone that may produce better results, and a properly planned equivalence trial is worth considering," the investigators conclude.

Source: Journal of Clinical Oncology, January 2004.

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Different Prostate Cancer Treatments Not That Different

HealthDayNews
Friday, January 16, 2004

FRIDAY, Jan. 16 (HealthDayNews) -- Cure rates are about the same for a number of the most common prostate cancer treatments, says a study in the January issue of the International Journal of Radiation Oncology.

The study of 2,991 men with prostate cancer found similar cure rates after treatment with surgery, radiation, permanent seed implants and permanent seed implants combined with radiation therapy. Outcomes for patients treated with low-dose external beam radiotherapy were significantly worse.

"This study represents the largest published series comparing the most frequently used therapies for patients with clinically localized prostate cancer," study author Dr. Patrick A. Kupelian, of the Anderson Cancer Center Orlando in Florida, says in a prepared statement.

"The results show that survival rates are pretty much the same for patients treated with surgery, high dose-external beam radiation therapy, permanent seed implants and a combination of permanent seeds implants and external beam radiation therapy. We hope that this study will help men newly diagnosed with prostate cancer and their families evaluate the treatment options to make the best treatment choice for their cancer and lifestyle," Kupelian says.

More information

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

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People with Heart Failure Who Exercise Live Longer

Reuters Health
Friday, January 16, 2004

NEW YORK (Reuters Health) - Among people with chronic heart failure, exercise training prolongs the time before they have to be admitted to hospital and improves their survival, according by UK researchers.

Dr. Massimo F. Piepoli of Royal Brompton Hospital, London, and colleagues identified nine clinical trials that included 801 stable heart failure patients and which involved exercise programs lasting at least 8 weeks. Exercise training was undertaken by 395 of the participants, while the other 406 subjects acted as controls.

During average follow-up periods of 159 to 2284 days, there were 88 deaths in the exercise groups, and these occurred after an average of 618 days. Among the control subjects, there were 105 deaths occurring after an average of 421 days.

Thus, the death rate was significantly decreased by exercise, the researchers say in their article in the British Medical Journal.

The combination of death or hospital admission also occurred in significantly fewer exercise patients (127) than control patients (173). Average times to hospital admission were 426 days and 371 days in the two groups.

The benefits of exercise applied equally to men and women and across age groups, Piepoli's team found

The investigators conclude that there is no evidence that properly supervised exercise programs for patients with heart failure "might be dangerous and indeed there is clear evidence for an overall reduction in mortality."

Source: British Medical Journal, "online first" January 16, 2004.

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A Boost for Pain Relief

HealthDayNews
Friday, January 16, 2004

FRIDAY, Jan. 16 (HealthDayNews) -- The nutritional supplement glucosamine helps increase the pain-relieving power of ibuprofen, according to a Temple University study.

This combination may let patients take lower doses of ibuoprofen to get the same amount of pain relief with fewer side effects.

Glucosamine occurs naturally in the body. A synthetic version is used to treat osteoarthritis, a painful, degenerative joint disorder. While glucosamine is believed to prevent and repair bone and cartilage damage, it hasn't yet been proven to block pain.

In this study, the Temple researchers confirmed that glucosamine on its own does not block pain. The researchers believe that any pain relief offered by glucosamine is a side effect of its ability to repair damage to bone and cartilage.

They also tested glucosamine in combination with a variety of non-steroidal anti-inflammatory drugs (NSAIDS) to determine if glucosamine improved the drugs' ability to relieve pain. They found that glucosamine did increase the pain-relieving powers of ibuprofen.

"The next step will be to study this drug combination in clinical trials to see whether it can enhance pain relief or offer pain relief using a lower dose of ibuprofen and therefore a lower risk of side effects," researcher Alan Cowan says in a prepared statement.

The study appeared in a recent issue of the Journal of Pharmacology and Experimental Therapeutics.

More information

Here's where you can learn more about glucosamine.

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Heel Ultrasound Predicts Broken Bones

Reuters Health
Friday, January 16, 2004

NEW YORK (Reuters Health) - Ultrasound of the heel -- to measure the density of bone -- can predict a person's chances of breaking their hip or other bones in the body, new research shows.

Although ultrasound has proven useful in assessing fracture risk in women, it was unclear if this imaging method could also predict fractures in men.

As reported in The Lancet, Dr. Kay-Tee Khaw, from Addenbrooke's Hospital in Cambridge, UK, and colleagues measured heel bone density by ultrasound in 6485 men and 8339 women between 42 and 82 years of age.

During a follow-up period of almost two years, 121 fractures needing hospital admission were observed, the authors note. Of these fractures, 31 were broken hips.

Heel ultrasound was able to predict total and hip fracture risk, the authors note. As ultrasound suggested more bone thinning, the person's chances of fracture rose. Moreover, this held true regardless of age, gender, height and weight, smoking, and whether the patient had any previous fractures.

"Simple and safe (heel) ultrasound measurements are strong predictors of hip and total fracture risk in men and women," the researchers state.

"Our findings emphasize the importance of bone health in determining fracture risk, and in view of the continuum of risk, the challenge of identifying interventions to improve bone health in the population," Khaw's team concludes.

Source: The Lancet, January 17, 2004.

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Time Matters With Pulmonary Embolisms

HealthDayNews
Friday, January 16, 2004

FRIDAY, Jan. 16 (HealthDayNews) -- The symptoms of a pulmonary embolism may resemble a heart attack -- shortness of breath and sharp chest pain -- and it can be just as deadly.

Pulmonary embolism occurs when one or more blood clots lodge in lung arteries and cut off blood flow to lung tissue. Prompt treatment is essential to prevent death.

The signs and symptoms of pulmonary embolism vary with the size, number, and location of clots in the lungs and the size of the area affected by lack of blood flow, says an article in the January issue of the Mayo Clinic Health Letter.

Some people experience no symptoms. Others suffer gradual shortness of breath for no apparent reason, sharp chest pain when they inhale, sudden breathlessness, dizziness, fainting, or they may cough up blood.

Treatment for pulmonary embolism usually requires hospitalization for several days. Patients typically receive blood-thinning drugs to stop the growth of existing clots and to prevent new clots.

The first step in preventing pulmonary embolism is to be aware of the risk factors and avoid them. Long periods of inactivity, such as during car or plane travel, can increase the risk. When you travel you should take breaks and walk when possible. Flex and stretch your feet and legs frequently.

People who are bedridden due to illness or surgery are at increased risk. Ask your doctor what can be done to prevent clotting in that situation.

Lifestyle can also affect your risk of pulmonary embolism. Stop smoking and lose weight.

More information

Here's where you can learn more about pulmonary embolism.

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Fish Oil for Mom May Prevent Allergies in Baby

By Amy Norton
Reuters Health
Friday, January 16, 2004

NEW YORK (Reuters Health) - Fish-oil supplements taken during pregnancy might help prevent allergies in babies at high risk for them, preliminary research suggests.

A study in Australia found that babies whose mothers took fish oil had weaker immune reactions to common allergy triggers and, at 1 year of age, showed signs of being less allergy-prone.

It's too soon to recommend the supplements for some pregnant women, but investigators say their findings lay the groundwork for larger, longer-term studies of whether fish oil can reduce childhood allergies.

In general, pregnant women are advised against taking any medication or supplement unless the benefit is known to outweigh any potential risk to the fetus. Pregnant women should always consult their doctor before taking drugs or supplements.

The new study looked at whether fish-oil capsules -- rich in healthful omega-3 fatty acids -- might help prevent the development of allergies in babies born to women with a history of hay fever or asthma. Children with a family history of allergies are at increased risk of developing them.

The theory is that because omega-3 fatty acids have anti-inflammatory properties, they may affect the developing immune system in a way that makes it less prone to allergic reaction, according to study author Dr. Susan L. Prescott of the University of Western Australia in Perth.

However, she told Reuters Health, "This is the first study to look at this in very early life, so more work is clearly needed."

The findings are published in the Journal of Allergy and Clinical Immunology.

According to the study authors, it's possible that the rise in allergic disease over the past few decades could be related, in part, to a decline in omega-3 fats in the Western diet. Fatty fish like salmon, tuna and sardines are a prime source of omega-3s; the fats are also found in certain vegetable sources, such as canola oil and flaxseed.

Prescott's team had 98 pregnant women take either fish-oil capsules or, for comparison, capsules containing olive oil. The women took four capsules per day from the 20th week of pregnancy until delivery.

Analyzing cells taken from the babies' umbilical cord blood, the researchers found greater amounts of omega-3 fats in the cell membranes of newborns whose mothers took fish-oil supplements. In addition, their immune cells tended to have a weaker reaction to allergy-producing substances like cat dander, compared with babies in the comparison group.

At the age of 1, infants whose mothers took fish oil were three times less likely to show sensitivity to egg during skin tests used to detect allergies. Babies in the fish-oil group were more likely to develop the allergic skin condition eczema; but among infants with eczema, those in the fish-oil group were much less likely to have a severe case.

Past studies in which fish-oil supplements were given to adults with allergies have yielded mixed results. According to Prescott's team, omega-3 supplementation may have to take place when the immune system is developing in order to have a benefit.

The next step, Prescott said, is to do larger studies looking at whether children exposed to fish-oil capsules in the womb actually do develop allergies at a lower rate over time.

Source: Journal of Allergy and Clinical Immunology, December 2003.

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Arm Position Is Key to Blood Pressure Reading

By Randy Dotinga
HealthDay Reporter
HealthDayNews
Friday, January 16, 2004

FRIDAY, Jan. 16 (HealthDayNews) -- Blood pressure readings taken on an arm that is slack can be up to 10 percent higher than those taken on an arm that is at a right angle to the body, new research shows.

The surprising study warns that this disparity can throw off treatment choices. Unfortunately, the researchers could not say which kind of reading was more accurate, although the American Heart Association (news - web sites) (AHA) recommends bending your elbow at a 45-degree angle during a blood pressure reading.

Regardless of whether patients sat, stood or lay down, blood pressure numbers rose when their arms were slack and dipped when their lower arms were at right angles to their upper bodies. In the first position, 41 percent of patients appeared to have high blood pressure levels; in the second position, only two in every 10 did.

"Arm position is important, and it should be consistent from measurement to measurement," says study co-author Dr. David Guss, director of emergency medicine at the University of California at San Diego Medical Center.

Doctors consider blood pressure to be one of the best gauges of a person's cardiovascular health. The top and bottom numbers of a blood pressure reading -- such as 115 over 75 -- measure how hard the heart has to work to push oxygenated blood into the circulation system and pull it back for recycling.

Higher numbers show that the heart is working harder because it's fighting greater resistance, typically because arteries have lost their flexibility, explains Dr. Dennis Goodman, chief of cardiology at Scripps Memorial Hospital-La Jolla in San Diego. "It's as if you put fluid in a pipe that can't stretch."

In the worst cases, high blood pressure can lead to heart attack or stroke by contributing to ruptured or blocked blood vessels.

In recent years, heart experts have revised their estimates of ideal blood pressure levels. While the cutoff used to be 140/90, cardiologists now consider rates higher than 115/75 to be unhealthy. Someone who has a blood pressure reading of 135/85 will double his or her risk of heart attack compared to someone at the 115/75 level, Goodman says.

Guss says he first became interested in the issue of arm position and blood pressure levels while measuring his own pressure as a medical student. He noticed the readings went up and down depending on where he put his arm.

In the study, Guss and two medical students checked the blood pressure levels of 100 patients, from age 18 to 88, at the medical center's emergency room. All of the patients were visiting the hospital for reasons not directly related to heart problems, such as colds and headaches. The findings appear in a recent issue of the Annals of Internal Medicine.

The researchers measured each patient's blood pressure a total of six times, testing two arm positions (with the lower arm jutting out at a right angle to the body, as if they were pointing forward, or simply parallel to the upper body) while they were sitting, standing and lying down.

Among seated patients with their arms at right angles, the blood pressure readings suggested that 22 percent suffered from hypertension. But nearly twice as many patients got that diagnosis when their levels were measured while their arms were slack, parallel to their upper bodies.

So which measurement is the correct one? The study authors didn't explore that issue, and Guss says he isn't certain why the difference exists. However, he notes the AHA recommends placing your arm in a 45-degree position, in the middle of the two positions explored in the study.

In more bad news for patients, other research has suggested medical professionals don't even follow the AHA guidelines rigorously.

Goodman says the study findings are surprising and important. Patients should pay attention when their blood pressure is measured and make sure their arms are in the recommended position, he says. If they're not, he says, patients shouldn't be afraid to speak up.

More information

You can learn about hypertension and what to do about it from the American Heart Association or the National Heart, Lung, and Blood Institute.

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Food Groups Propose Voluntary Labeling

Reuters
Friday, January 16, 2004

WASHINGTON (Reuters) - U.S. food retailers and the meat industry on Friday agreed to create a voluntary country-of-origin labeling program if Congress repeals a law mandating it.

Congress is considering a two-year delay of a law requiring country-of-origin labels on meat, seafood and fruits and vegetables after Sept. 30.

The U.S. Agriculture Department has estimated the labeling program would cost American food makers up to $3.9 billion in its first year.

"There is widespread agreement that the mandatory program is too costly and unworkable in the real world," said Tom Stenzel, president of the United Fresh Fruit and Vegetable Association.

"What is needed is an industry-driven framework for providing country-of-origin information that is market-driven and does not increase the cost of food," he added.

Industry groups said they hoped to finalize a voluntary labeling program by this spring.

The USDA already has a voluntary labeling program in place, but foodmakers have not signed on. "The current law is so burdensome that no one wanted, even on a voluntary basis, to try to implement it in its current form," said Tim Hammonds, president of the Food Marketing Institute.

With support from consumers and farm groups, Congress in 2002 passed the labeling law as a way to distinguish U.S.-grown food from competitors at the grocery store.

On Thursday, Senate Democratic Leader Tom Daschle and Sen. Mike Enzi, a Wyoming Republican, urged the Bush administration to issue emergency country-of-origin labeling requirements for beef products due to last month's discovery of mad cow disease in a Washington state dairy cow.

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That Tooth Can Be Saved

HealthDayNews
Friday, January 16, 2004

FRIDAY, Jan. 16 (HealthDayNews) -- If you're unlucky enough to have a tooth knocked out while playing sports or because of an accident, you may still be able to save it.

If the tooth is knocked out of its socket, but not broken, it's possible that a dentist or doctor can reimplant the tooth if you act quickly, says an article in the January issue of the Mayo Clinic Health Letter.

Here's some advice on what you can do to increase the chances of successful tooth reimplantation:

  • Don't touch the root of the tooth. You may damage the ligament.
  • Remove dirt and debris by rinsing the tooth in a container of clean water. Don't rub or scrape the tooth.
  • Try to replace the tooth in its socket and bite down gently on gauze or a moistened tea bag to keep it in place. If you can't replace the tooth in its socket, put it in milk, your own saliva, warm salt water or between your gum and cheek.
  • Head straight for the dentist or emergency room. There's a better chance of successful reimplantation if the tooth is back in its socket within 30 minutes.

Even if the tooth is successfully reimplanted, tissue inside the tooth eventually dies. A root canal will be necessary to keep the tooth functioning properly.

More information

Here's where you can learn more about dental injuries and emergencies.

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Thursday, January 15, 2004

Study Suggests Flu Vaccine Didn't Work Well

By Maggie Fox, Health and Science Correspondent
Reuters
Thursday, January 15, 2004

WASHINGTON (Reuters) - The influenza vaccine that many Americans clamored for this year was not very good at protecting people against influenza, colds and similar viruses, a preliminary report published on Thursday shows.

The study is the first attempt to show whether the vaccine that many sought after a flu scare this autumn and winter actually worked.

The study of hospital workers in Colorado, a state that was hit early and hard by influenza, showed the vaccine had "no or low effectiveness against influenza-like illness," the U.S. Centers for Disease Control and Prevention (news - web sites) said in its report.

Many experts did not expect the vaccine to work well, although the CDC had hoped it would at least prevent some of the worst illnesses caused by this year's strain of influenza.

The vaccine is only meant to protect against true influenza. Without a test, it is often difficult to distinguish between influenza and other, similar viruses.

CDC spokesman Tom Skinner said that for this reason the report only shows part of the story.

"This is the first of a number of studies that we are going to do to try to answer the question, 'did this year's vaccine offer protection against flu?' This study in and of itself does not answer this question," he said in a telephone interview.

However, the study shows that people who were vaccinated against influenza came down with colds, flu and similar viruses at the same rate as people who were not vaccinated. This would presumably include true influenza.

The vaccine is formulated each year in February or March, at the end of the northern hemisphere's flu season, and did not include the Fujian strain of influenza, a new, mutated strain that turned out to be the predominant type of flu in the United States and several other countries this year.

The epidemic appears to be on the wane -- this past week only 2.8 percent of hospital visits were for influenza-like illnesses, compared to 5.5 percent the week before.

News coverage of the early start to the flu season sent many people rushing to get vaccinated. There were shortages in some places and the U.S. government bought 625,000 doses of flu vaccine from makers Chiron and Aventis .

It also negotiated a discount price for states to buy up to 3 million unsold doses of Wyeth and MedImmune's FluMist vaccine, which is given nasally.

Experts knew the vaccines did not include the Fujian strain, but they did contain the related Panama strain, which they hoped would provide at least some protection.

The study, done among hospital workers at the Children's Hospital in Denver, suggests it did not.

Of the 1,000 people vaccinated before Nov. 1, 149 developed influenza-like illness, or just under 15 percent. Of the 402 people who were not vaccinated, 68 got a flu-like illness, or just under 17 percent.

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Study Links Leukemia, Gene Combination

By Paul Recer
AP Science Writer
The Associated Press
Thursday, January 15, 2004

WASHINGTON - Two children who developed leukemia after receiving gene therapy for an inherited disease may have been victims of a rare combination of genes that is unlikely to happen in gene therapy for other disorders, a study says.

Researchers at the National Cancer Institute (news - web sites) in Frederick, Md., discovered that a gene in a virus used to treat the children, who had an inherited immune system disorder, can combine with another gene to cause leukemia in mice.

Dr. Utpal P. Dave, first author of a study appearing this week in the journal Science, said that he and his team found that in mice a gene called Lmo2 can combine with another gene, called IL2RG, to cause leukemia.

Ten children in France who suffered from severe combined immune deficiency, or SCIDS, were treated with a gene therapy that used a virus to transfer the IL2RG gene to their bone marrow. This gene can correct SCIDS, causing the bone marrow to make normal immune system cells.

The therapy worked against SCIDS in the children, but two of them developed leukemia, which was blamed on the gene therapy. As a precaution, the Food and Drug Administration (news - web sites) in January last year suspended 27 gene therapy trials in the United States.

Dave said the study by his team showed that the leukemia was caused by a rare combination of genes. This means that other forms of gene therapy would not face the same risk, he said.

He also said that by studying cancer-causing gene combinations in mice, researchers may be able to identify those that would cause cancer in humans.

"The mouse can serve as a tool to identify genes that cause leukemia, for instance," he said.

Dr. Phil Nouguchi of the FDA said the work of Dave and his team is important in helping to advance gene therapy as a valuable medical tool. But he said that even though the authors showed that the leukemia in the children was a rare event, each proposed gene therapy treatment needs to be examined "on a case by case basis."

Nouguchi said some of the 27 gene therapy trials suspended last year have resumed, but that the FDA is still being cautious about tests of gene therapy techniques.

Science: www.sciencemag.org

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Ebola May Come from 'Bush Meat,' Study Finds

By Maggie Fox, Health and Science Correspondent
Reuters Health
Thursday, January 15, 2004

WASHINGTON (Reuters) - The deadly Ebola (news - web sites) virus, which emerged mysteriously from African forests, probably attacks people who butcher and eat infected animals, researchers said on Thursday.

The virus, which most recently killed 29 people in the Congo Republic, seems to break out when people slaughter chimpanzees, gorillas and small antelopes called duikers, the scientists said.

"Humans and duikers scavenging for meat probably became infected by contact with dead apes," they wrote in their report, published in Friday's issue of the journal Science.

"Almost all human Ebola outbreaks in Gabon and the Republic of Congo have been linked to the handling of dead animals by villagers or hunters, and increased animal mortality always preceded the first human cases," added the international team of researchers, led by Eric Leroy of the Development Research Institute in Gabon.

They said health workers may be able to get a warning of Ebola outbreaks when large numbers of dead animals start appearing in forests.

Ebola first appeared in 1976 and causes a particularly frightening and deadly form of hemorrhagic fever. Patients die of shock but may bleed internally and externally.

Depending on the strain of virus, it kills between 50 and 90 percent of patients.

Leroy and colleagues studied several outbreaks in central Africa and said villagers, and they themselves, found many dead animals just around the time of an outbreak.

They also found that great apes such as chimps and gorillas could be infected, although the original source of the virus remains unknown.

"The human outbreaks consisted of multiple simultaneous epidemics caused by different viral strains, and each epidemic resulted from the handling of a distinct gorilla, chimpanzee or duiker carcass," they wrote.

"These animal populations declined markedly during human Ebola outbreaks, apparently as a result of Ebola infection. Recovered carcasses were infected by a variety of Ebola strains, suggesting that Ebola outbreaks in great apes result from multiple virus introductions from the natural host."

This natural host, or reservoir, is likely to be an animal that is not made ill by the virus, scientists say.

Ebola Another Blow To Endangered Gorillas

Gorillas in particular have been hard-hit by Ebola, the researchers noted. Along with poaching and habitat loss, this could lead to their extinction in western Central Africa, they said.

Many people in Africa depend on apes and monkeys -- known as bush meat -- for food. But some governments are trying to discourage the practice because many apes are endangered.

And other viruses, including the HIV virus (news - web sites) that causes AIDS (news - web sites), are believed to have come from chimps and other close relatives of humans.

"Now we know that the virus doesn't 'spread' as much as it spills over from many sources in the forest," said Dr. William Karesh of the New York-based Wildlife Conservation Society, who worked on the study.

Karesh, Leroy and colleagues found that one outbreak between October 2001 and May 2003 was caused by eight viral strains originating from different areas.

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Experts: Halt HIV Vaccine Trial

By Steven Reinberg
HealthDay Reporter
HealthDayNews
Thursday, January 15, 2004

THURSDAY, Jan. 15 (HealthDayNews) -- Continuing a U.S. government-sponsored, large-scale trial of an HIV (news - web sites) vaccine in Thailand is throwing good money after bad, a team of leading experts claims.

"There is a very weak scientific rationale for going ahead and spending some $119 million and involving thousands of volunteers in this particular vaccine trial," says one of the letter's authors, Dr. Robert W. Doms, chairman of the department of microbiology at the University of Pennsylvania.

The letter from 22 HIV experts, including Dr. Robert Gallo, the co-discoverer of the AIDS (news - web sites) virus, appears in the Jan. 16 issue of Science.

The trial is now in what is known as phase III, which tests if a drug works in large groups of several hundred to several thousand people. The trial is designed to compare the test drug to other standard or experimental drugs. During the trial, adverse events and data on safe uses are also collected. A phase III trial is the last step before a drug can be approved for regular use.

One of the components of the vaccine called gp120, which has completed phase III trials, "failed completely in providing any degree of protection to HIV infection," Doms says.

The other component, called ALVAC, has had unimpressive results in trials, he adds. "Combining something that's failed with something that has not been terribly impressive doesn't seem to provide a good rationale for proceeding with such a large and costly trial," Doms says.

Gp120 is made by VaxGen, and ALVAC is a product of the pharmaceutical giant Aventis Pasteur.

The U.S. government defends the trial, saying this combination has not been tested on humans before now and it should at least be attempted. In a statement, the National Institute of Allergy and Infectious Diseases (news - web sites) (NIAID), an arm of the National Institutes of Health (news - web sites) (NIH), says the scientists have provided "no evidentiary data" that the trial will fail.

The NIAID and the U.S. Army Medical Research and Materiel Command, which are co-sponsoring the trial, say they plan to publish a rebuttal to the letter in an upcoming issue of Science.

Doms believes that money for this trial would be better spent on other vaccines that are in early development, but that show greater promise.

Another of the letter's authors, Dr. Dennis R. Burton, a professor of immunology at The Scripps Research Institute, agrees that other trials being planned show more promise.

The failed gp120 trials were based on the vaccine creating antibodies to HIV, but the vaccine did not create these antibodies, Burton says.

Burton believes that vaccines that create T-cell responses may be a better approach to creating an effective HIV vaccine. "A T-cell vaccine might not be enough, but the concept should be tested," he adds.

It is particularly difficult to develop an HIV vaccine, since the virus mutates very quickly, Burton says.

"Every time you come up with some way of containing it, the virus finds a way round the protective mechanism you have come up with. There are more different strains of HIV in a single person than there are strains of flu in the whole world," he says.

Burton says that the ultimate answer to an HIV vaccine will probably be a combination vaccine that creates antigens and T-cell responses. But this is a slow process, and such a vaccine will probably take years to develop and test.

Last year, the HIV Vaccine Trials Network (HVTN), which represents the largest group of doctors and researchers, canceled a similar trial, because the earlier phase I and phase II trials had found ALVEC to be ineffective, Doms notes.

Doms adds that NIH is directing more of its budget to purchasing anthrax vaccine and into bio-defense. "Money for HIV research has become tighter, and many of us have seen our own research grants being cut."

When the trial was first planned it may have been reasonable, but the "scientific landscape has changed, and I do not feel it is reasonable now," Doms says.

Dr. Paul Spearman, the co-principal investigator of the Vanderbilt HIV Vaccine Program at Vanderbilt University, did not sign the letter but agrees with it.

"The bulk of scientific data in the field strongly argues against a chance for efficacy of this vaccine combination, and an informed decision to halt the progression to phase III testing should be made," Spearman says.

"Instead, we should await the newer generations of vaccines that are currently in phase I and phase II testing which have a much greater potential for efficacy," he adds.

That isn't true, according to the sponsors. "In combination, these vaccines induce a repertoire of immune responses quantitatively and qualitatively different from those induced by either component alone," the NIAID statement says.

Dr. Jonathan N. Weber, a clinical professor of medicine and principal investigator of the HIV Research Group at Imperial College in London, says that he shares "the view that the ALVAC/gp120 phase III trial in Thailand is not justified on scientific grounds. I disagree that the previous phase III trials of gp120 was fully predicable, and hence not justified."

The negative results of the previous trial, "while miserable for the field and for global public health, nonetheless have moved the science forward with confidence," Weber says. "The result is what allows us to state that the ALVAC/gp120 trial is doomed to failure because of poor immunogenicity of ALVAC, and proven lack of activity of gp120," he adds.

The first two phases "determined that the strategy was safe and induced immune responses meeting pre-defined and thoroughly-vetted milestones," the NIAID statement says. "No laboratory tests or animal models have been demonstrated to predict HIV vaccine efficacy in humans. Thus, only human trials can determine efficacy."

Officials with VaxGen declined to comment. Lisabeth Bull, a spokeswoman for HVTN, also declined to comment.

More information

For more on HIV/AIDS, check the National Institutes of Health or UNAIDS.

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Stroke Risk Linked to Decline in Mental Powers

By Karla Gale
Reuters Health
Thursday, January 15, 2004

NEW YORK (Reuters Health) - A high risk for stroke predicts a deterioration in mental functioning, even when dementia and clinical stroke do not occur, investigators reported here today at a media briefing by the American Medical Association.

"Factors that increase the risk of stroke affect planning and organizational abilities," lead researcher Dr. Merrill F. Elias told the attendees. Such risk factors include type 2 diabetes, abnormal heart rhythms, heart enlargement, high blood pressure, and smoking.

The Framingham Stroke Risk Profile (FSRP) is a validated score that measures the risk of having a stroke, based on a variety of factors such as blood pressure, smoking, having diabetes, and so on.

Dr. Elias, at Boston University, and his colleagues examined FSRP scores in 2,175 members of the Framingham Offspring Cohort, none of whom had a history of stroke or dementia. The participants also underwent a battery of mental tests

The researchers found that as stroke risk increased, performance went down on tests of abstract reasoning, visual-spatial memory, tracking and organization, and attention. Functions not associated with FSRP were verbal learning and memory, Dr. Elias said.

He explained that the decline in mental powers may be related to the occurrence of small strokes "that haven't reached clinical significance, which still end up in dead brain tissue."

Since stroke risk profile factors play a role in dementia, "it is very likely that they play a role in Alzheimer's disease (news - web sites)," he added.

"The importance of our work is that it establishes a relationship between high risk for stroke and early cognitive deficit," the investigator explained. "The greatest opportunity to intervene is at the beginning when the cognitive deficit is mild. As the deficit increases, our opportunity to intervene decreases significantly."

Behavioral interventions and medications to treat risk factors such as hypertension and hypercholesterolemia "are both essential," he told Reuters Health.

This report will be published in the February issue of the medical journal Stroke. Dr. Vladimir Hachinski, editor-in-chief of Stroke and neurologist at the University of Western Ontario in Canada, told the group: "These findings suggest that in those who are prone, stroke can precipitate Alzheimer's disease."

He continued: "We know that stroke is preventable. In principle, since stroke is treatable, Alzheimer's disease too may be treatable."

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Couch Potatoes Can Start Young

HealthDayNews
Thursday, January 15, 2004

THURSDAY, Jan. 15 (HealthDayNews) -- Some children as young as 3 display a sedentary lifestyle that increases their risk of obesity later in life, says a study in the Jan. 17 issue of The Lancet.

Researchers measured the total energy expenditure (TEE), physical activity, and sedentary behavior of 78 3-year-old children and followed up with 72 of the children two years later.

The children's average physical activity levels indicated these young children had a sedentary lifestyle and, because of that, an increased risk of obesity. At 3 and 5 years, the children's TEE was much lower than the British estimated average requirement for energy, by about 200 calories per day.

The children in this study typically did only 20 to 25 minutes a day of moderate to vigorous physical activity. Present recommendations suggest that children need at least 60 minutes of moderate to vigorous exercise each day.

"We have provided objective evidence that present recommendations for physical activity are not being met by many young children. Low levels of physical activity might have been predicted, but directly measured objective data have not been available, and there is a widespread perception among parents and health and educational professionals that young children are spontaneously active," lead researcher John J. Reilly, a specialist in developmental medicine at the University of Glasgow and Yorkhill Hospital, says in a prepared statement.

"Public health interventions are needed urgently, and these must involve population-based strategies that increase physical activity, reduce sedentary behavior, or both, in early life," Reilly says.

More information

Here's where you can learn more about childhood obesity.

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Thick Waist Predicts Blood Pressure Risk: Study

Reuters Health
Thursday, January 15, 2004

NEW YORK (Reuters Health) - A measuring tape seems to be a powerful tool for identifying people at risk of developing high blood pressure, researchers from Brazil report.

In a new study, people who were obese based on their waist circumference were most likely to develop high blood pressure during the next few years.

Obesity is well known to increase the risk of high blood pressure, but there is more than one way to measure obesity.

Body mass index (BMI) is a measure of weight in relation to height. A BMI from 25 to 29.9 is considered overweight, and 30 and above is considered obese.

Another way to tell whether a person is overweight or obese is to measure waist circumference. The cut-off points for obesity are 40 inches for men and 35 inches for women, according to National Institutes of Health (news - web sites) guidelines.

Despite the link between obesity and an increased risk of high blood pressure, it is uncertain whether BMI or waist circumference is a better tool for predicting how likely a person is to develop high blood pressure. Research has shown that some people with a normal BMI but a high waist circumference have an increased risk of high blood pressure.

A team led by Dr. Flavio D. Fuchs of the Universidade Federal do Rio Grande do Sul compared the predictive powers of BMI and waist circumference in almost 600 Brazilians who did not have high blood pressure. During an average follow-up of more than 5 years, 127 people developed high blood pressure.

Based on BMI, obesity tended to predict the development of high blood pressure in women, but not in men.

But obesity based on waist circumference was an accurate predictor of future high blood pressure in both women and men, the researchers report in the January issue of the American Journal of Hypertension. The results in men were not quite statistically significant, but this might have been due to the small size of the study, according to the researchers.

"Considering its simplicity, waist circumference may provide more information about health risks and should be the preferential method to define obesity, particularly in relation to the prevention of," Fuchs's team concludes.

Although the cardiovascular risk of obesity sometimes declines with age, abdominal obesity - carrying extra pounds around the waist - is a persistent risk factor for heart disease. Abdominal obesity has also been linked to an increased risk of other health problems, including diabetes.

Source:American Journal of Hypertension, January 2004.

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Ecstasy and Pot: Double the Memory Damage

By Steven Reinberg
HealthDay Reporter
HealthDayNews
Thursday, January 15, 2004

THURSDAY, Jan. 15 (HealthDayNews) -- Adding to an already hefty body of evidence, a new study finds ecstasy users suffer from long-term memory problems while marijuana smokers struggle with short-term memory lapses.

The study found those who regularly took the popular club drug ecstasy were 23 percent more likely to report problems with remembering things than people who are drug-free. And marijuana smokers reported up to 20 percent more memory problems than nonusers.

"There is a lot of evidence that ecstasy users are likely to use other drugs, including cannabis [marijuana]. Users of both substances may therefore be vulnerable to a myriad of memory afflictions, which may represent a time bomb of cognitive problems for later life," says lead researcher Jacqui Rodgers.

Rodgers is with the School of Neurology, Neurobiology and Psychiatry at the University of Newcastle in England. The findings appear in the January issue of the Journal of Psychopharmacology.

Collecting data through a Web site, Rodgers and her colleagues used a standard questionnaire to assess drug use among the 763 individuals who responded. They also looked closely at a subgroup of 81 "typical" ecstasy users who had taken the drug at least 10 times.

The people were asked about their short-term and long-term memory. They were also asked to rank the probability of scenarios such as finding a television story difficult to follow, or forgetting to pass a message onto someone.

The group of "typical" ecstasy users reported their long-term memory to be 14 percent worse than the 480 people who had never taken ecstasy, and 23 percent worse than the 242 non-drug users.

"We found that people who regularly take ecstasy report experiencing long-term memory difficulties, and are 23 percent more likely to report problems with remembering things than nonusers," she says.

"We also found that people who use cannabis regularly report up to 20 percent more memory problems than nonusers, in terms of short-term memory performance," Rodgers adds.

Rodgers' team also noted the number of mistakes the people made when filling out the questionnaire.

Users of ecstasy -- also known as MDMA -- made 21 percent more mistakes on the questionnaire compared with non-ecstasy users and 29 percent more mistakes than people who did not take drugs at all.

These differences were the same for men and women.

"Our findings may help drug services in the U.K. and elsewhere explain the potential consequences of use so that people can make an informed decision as to whether to take ecstasy or not," Rodgers says.

"Users may think that ecstasy is fun and that it feels fairly harmless at the time. However, our results show slight but measurable impairments to memory as a result of use, which is worrying," she notes.

"It's equally concerning that we don't really know what the long-term effects of ecstasy use will be, as it is still a poorly understood drug," Rodgers adds. "The findings also suggest that ecstasy users who take cannabis are suffering from a double whammy, where both their long-term and short-term memory is being impaired."

Rodger's team is planning to launch a Web site within the next two months that will include memory tests that may determine whether self-reported memory impairment is actually detectable by objective measurement.

Dr. Stephen Koesters, a clinical assistant professor at the College of Medicine and Public Health at Ohio State University, says, "The study has a number of limitations, but does seem to support other studies that have been released in the past."

"While the specific effects of MDMA are difficult to pinpoint in light of multiple drug use by many patients, self-reporting of the amount and the frequency of drug use, there is certainly a trend in the available literature that suggests memory impairment is a real side effect of MDMA use," he adds.

Whether these effects are cumulative is difficult to determine, Koesters adds.

"Current evidence does suggest that MDMA can be dangerous, both with acute ingestion and to longer-term memory impairment," Koesters says. "With the current rate that MDMA is being abused, it is not safe to wait 30 or 40 years to see if we have a true epidemic," he adds.

Dr. Stephen Kish, a professor of psychiatry and pharmacology at the Human Neurochemical Pathology Section at the Centre for Addiction and Mental Health in Toronto, says the study doesn't break new ground.

"The real question is whether memory problems persist long after the ecstasy user has stopped taking the drug," Kish says. "We know the short-term effects, but what we don't know is if ecstasy causes permanent long-term changes."

This study offers no indication of whether memory problems are permanent, which might indicate brain damage, he adds.

More information

For more on drug addiction, check with the National Institute on Drug Abuse. For more on ecstasy, see the Partnership for a Drug-Free America.

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Injuries Cost Billions Every Year in U.S. - Report

By Maggie Fox, Health and Science Correspondent
Reuters
Thursday, January 15, 2004

WASHINGTON (Reuters) - Injuries caused by falling down, car wrecks and other accidents cost the U.S. economy $117 billion every year, the U.S. Centers for Disease Control and Prevention (news - web sites) reported on Thursday.

This represents 10 percent of all medical spending and much of it could be prevented, the CDC said.

The report, published in the CDC's weekly report on death and sickness, combines the results of two different surveys to come up with the costs.

"In the United States, injuries are the leading cause of death among persons aged under 35 years and the fourth leading cause of death among persons of all ages," the report reads.

"The medical costs associated with injuries are staggering but it's just the tip of the iceberg," CDC Director Dr. Julie Gerberding said in a statement.

"When we add in productivity losses, decreased quality of life and the emotional toil that injuries and disabilities have on families, the problem is enormous."

The report looked first at the Medical Expenditure Panel Survey, a survey of 25,000 people who got medical care in 2000.

It tallies up insurance costs and out-of-pocket spending for all medical services, including inpatient hospitalizations, emergency department visits, ambulatory care, prescription drugs, home health care, mental health care, dental visits, and medical devices.

It projected that 44.7 million people or 16 percent of the population needed treatment in 2000 for at least one injury .

Then the National Health Accounts survey, which looks at spending for the military and people in institutions, was factored in, too.

Falls accounted for at least 33 percent of the total medical cost of injuries and motor vehicle crashes accounted for at least 18 percent, the CDC said.

"Motor vehicle crashes, homicides, suicide, and debilitating falls are so common that unfortunately many have accepted that injury is inevitable," Gerberding said. "This is tragic because so many injuries are preventable."

The solutions are often easy and obvious, said Dr. Sue Binder, director of the CDC Injury Prevention Center.

"We know that seat belts and child safety seats and smoke alarms are effective. And we can prevent falls among older adults through exercise programs that include balance training, vision correction, and reduction of medications to the fewest number and doses, and environmental changes."

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Ecstasy and Pot: Double the Memory Damage

By Steven Reinberg
HealthDay Reporter
HealthDayNews
Thursday, January 15, 2004

THURSDAY, Jan. 15 (HealthDayNews) -- Adding to an already hefty body of evidence, a new study finds ecstasy users suffer from long-term memory problems while marijuana smokers struggle with short-term memory lapses.

The study found those who regularly took the popular club drug ecstasy were 23 percent more likely to report problems with remembering things than people who are drug-free. And marijuana smokers reported up to 20 percent more memory problems than nonusers.

"There is a lot of evidence that ecstasy users are likely to use other drugs, including cannabis [marijuana]. Users of both substances may therefore be vulnerable to a myriad of memory afflictions, which may represent a time bomb of cognitive problems for later life," says lead researcher Jacqui Rodgers.

Rodgers is with the School of Neurology, Neurobiology and Psychiatry at the University of Newcastle in England. The findings appear in the January issue of the Journal of Psychopharmacology.

Collecting data through a Web site, Rodgers and her colleagues used a standard questionnaire to assess drug use among the 763 individuals who responded. They also looked closely at a subgroup of 81 "typical" ecstasy users who had taken the drug at least 10 times.

The people were asked about their short-term and long-term memory. They were also asked to rank the probability of scenarios such as finding a television story difficult to follow, or forgetting to pass a message onto someone.

The group of "typical" ecstasy users reported their long-term memory to be 14 percent worse than the 480 people who had never taken ecstasy, and 23 percent worse than the 242 non-drug users.

"We found that people who regularly take ecstasy report experiencing long-term memory difficulties, and are 23 percent more likely to report problems with remembering things than nonusers," she says.

"We also found that people who use cannabis regularly report up to 20 percent more memory problems than nonusers, in terms of short-term memory performance," Rodgers adds.

Rodgers' team also noted the number of mistakes the people made when filling out the questionnaire.

Users of ecstasy -- also known as MDMA -- made 21 percent more mistakes on the questionnaire compared with non-ecstasy users and 29 percent more mistakes than people who did not take drugs at all.

These differences were the same for men and women.

"Our findings may help drug services in the U.K. and elsewhere explain the potential consequences of use so that people can make an informed decision as to whether to take ecstasy or not," Rodgers says.

"Users may think that ecstasy is fun and that it feels fairly harmless at the time. However, our results show slight but measurable impairments to memory as a result of use, which is worrying," she notes.

"It's equally concerning that we don't really know what the long-term effects of ecstasy use will be, as it is still a poorly understood drug," Rodgers adds. "The findings also suggest that ecstasy users who take cannabis are suffering from a double whammy, where both their long-term and short-term memory is being impaired."

Rodger's team is planning to launch a Web site within the next two months that will include memory tests that may determine whether self-reported memory impairment is actually detectable by objective measurement.

Dr. Stephen Koesters, a clinical assistant professor at the College of Medicine and Public Health at Ohio State University, says, "The study has a number of limitations, but does seem to support other studies that have been released in the past."

"While the specific effects of MDMA are difficult to pinpoint in light of multiple drug use by many patients, self-reporting of the amount and the frequency of drug use, there is certainly a trend in the available literature that suggests memory impairment is a real side effect of MDMA use," he adds.

Whether these effects are cumulative is difficult to determine, Koesters adds.

"Current evidence does suggest that MDMA can be dangerous, both with acute ingestion and to longer-term memory impairment," Koesters says. "With the current rate that MDMA is being abused, it is not safe to wait 30 or 40 years to see if we have a true epidemic," he adds.

Dr. Stephen Kish, a professor of psychiatry and pharmacology at the Human Neurochemical Pathology Section at the Centre for Addiction and Mental Health in Toronto, says the study doesn't break new ground.

"The real question is whether memory problems persist long after the ecstasy user has stopped taking the drug," Kish says. "We know the short-term effects, but what we don't know is if ecstasy causes permanent long-term changes."

This study offers no indication of whether memory problems are permanent, which might indicate brain damage, he adds.

More information

For more on drug addiction, check with the National Institute on Drug Abuse. For more on ecstasy, see the Partnership for a Drug-Free America.

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Hormone Imbalance Fuels Rheumatoid Arthritis

By Megan Rauscher
Reuters Health
Thursday, January 15, 2004

NEW YORK (Reuters Health) - The joint inflammation that is a hallmark of rheumatoid arthritis apparently results from out-of-kilter hormone levels in the joints, European researchers report.

They found that in patients with rheumatoid arthritis (RA), joint fluid levels of estrogens, which tend to promote inflammation, are elevated relative to androgens, which damp down inflammation.

Determining the ratio of estrogens to androgens in joint fluid "may be a helpful diagnostic tool for the assessment of the local inflammatory situation," say the researchers.

"The observed shift in the direction of estrogens in relation to androgens is a supporter of the inflammatory process in arthritis," lead author Dr. Rainer H. Straub from University Medical Center in Regensburg, Germany, told Reuters Health.

In the study, the overall concentration of free estrogens in joint fluid tended to be higher in 12 people with RA than in 8 patients with traumatic knee injury, who served as a comparison control group. The ratio of free estrogens to free androgens was also elevated in RA subjects compared to control subjects, the investigators report in the December issue of The Journal of Rheumatology.

The team also found, in lab experiments, that the sex-hormone precursor dehydroepiandrosterone (DHEA) is rapidly converted to estrogens in cells that line the joints.

The evidence from this study "may provide a basis to develop an alternative hormonal therapy for RA patients, using strategies designed to achieve a reduction in estrogen formation," the researchers conclude.

Source: Journal of Rheumatology, December 2003.

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Monkey Hear, But Monkey Not Comprehend

By Randy Dotinga
HealthDay Reporter
HealthDayNews
Thursday, January 15, 2004

THURSDAY, Jan. 15 (HealthDayNews) -- Researchers say they've come closer than ever to figuring out why humans can string sentences together and our hairy cousins can't.

One of the major barriers to a simian Shakespeare appears to be the inability of primates to comprehend anything other than the simplest rules of grammar, according to a new study.

Monkeys who listened to alternating male and female voices couldn't pick up on complex patterns designed to mimic those of human speech, researchers found. This lack of understanding could be a "fundamental bottleneck on animal thought," says study co-author Marc D. Hauser, a professor of psychology at Harvard University.

While monkey grammar skills may seem like a pretty arcane topic harkening back to diagrammed sentences on chalkboards, it's actually at the center of a major mystery: How did human speech evolve? How does the way humans talk to each other differ from the way animals communicate?

"Grammar may be the defining feature of human language, what makes our language different from other forms of animal communication," says Keith R. Kluender, a professor of psychology who studies speech perception at the University of Wisconsin. "It's a pretty big deal."

It's no secret that animals can communicate with each other in simple ways -- think of those midnight neighborhood symphonies of howling dogs or cats in heat. And humans have managed to teach sign language to apes and dolphins.

But Hauser says the top number of words they have learned is in the 300-to-400 range, which doesn't even compare to the 60,000-word vocabulary of a typical high school graduate.

Apes "have learned signs that refer to things in their world, like food and actions," Hauser says. "They could label things and could sign 'apple' or 'pond.' But what they couldn't say is, 'My apple is in the pond' or 'on the chair.' "

But is that because they truly can't handle that kind of grammar?

To explore that issue, Hauser and a British colleague developed a way to analyze grammar abilities in cotton-top tamarins, an endangered monkey found in South America.

The results of the study appear in the Jan. 16 issue of the journal Science.

Using male and female voices, the researchers let the monkeys listen to specific orders of several syllable-type sounds. In the most simple test, the monkeys looked at the loudspeaker whenever the voices broke the patterns.

The researchers increased the complexity of the patterns, using a system similar to that used by scientists who study the language development of human infants. But the monkeys couldn't keep up.

According to Hauser, this suggests the monkeys could possibly understand a simple pattern of grammar -- that an adjective typically precedes a noun, for example -- but be baffled by a more complex pattern, like an "if-then" statement with words in between.

This limitation makes sense, he adds. "The paradox is that many animals have rich conceptual systems and ways of thinking about the world, and rich social relationships. What they lack is a system that can convey that to each other," he says.

Kluender agrees with the finding that the monkeys can't process complex language patterns, but he says he's not sure that the researchers truly replicated human grammar in their study.

Both Kluender and Hauser do agree that it's very unlikely that scientists will stumble across advanced grammar skills in any non-human animal species.

"But it's hard to argue that it can't possibly exist," Kluender says.

More information

For more on cotton-top tamarins, visit the Brevard Zoo. You can explore the evolution of language at the Science Museum.

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Genes Make Some People More Prone to SARS, Scientist Says

Reuters
Thursday, January 15, 2004

HONG KONG (Reuters) - Scientists in Hong Kong have discovered people with a certain pattern of genes have a much higher risk of getting SARS (news - web sites), a finding that could help diagnose and prevent the spread of the deadly disease.

A study of SARS patients in Hong Kong showed individuals with a pattern known as HLA-B*0703 were four times as likely to contract the respiratory disease, said Paul Chan, an associate professor in microbiology at the Chinese University of Hong Kong.

Those with a pattern labeled HLA-DRBI*0301 had a much lower risk, indicating genetic make-up may play a key role in determining if some people are more susceptible to the virus than others.

"Our findings from this study will help us more accurately diagnose the disease and design effective prevention programs," Chan said on Thursday.

"For example, we could test an unproven vaccine or prevention method on the high-risk group. Hospitals may also consider sending only low-risk health workers to take care of SARS patients," he said.

The Hong Kong researchers examined the blood samples of 90 SARS patients and studied the patterns of their human leucocyte antigen (HLA) genes, which influence the activity of cells that are responsible for the immune system's response during infections.

The results were then compared with samples from people who did not have Severe Acute Respiratory Syndrome.

More than 1,700 people in Hong Kong contracted SARS last year after it spread from southern China and nearly 300 of them died. Worldwide, more than 8,000 people were infected and more than 800 died.

China recently announced its first confirmed SARS case in months and two suspected SARS cases in the southern city of Guangzhou. The government is still awaiting definitive test results on the suspected cases.

Another Hong Kong scientist said on Wednesday it was a new variety of the SARS virus that had emerged in China and it appeared to be less contagious than the strain last year.

Both are believed to be from the same family of coronaviruses, which also cause the common cold.

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New Study Reinforces SIDS Prevention Guidelines

By Ed Edelson
HealthDay Reporter
HealthDayNews
Thursday, January 15, 2004

THURSDAY, Jan. 15 (HealthDayNews) -- A large European study supports existing guidelines for protecting babies from sudden infant death syndrome (SIDS).

Data on 745 cases of SIDS and 2,400 control cases was gathered from 20 European centers. And the finding "strongly suggests a basis for further substantial reductions in SIDS incidence rates," says study author Robert G. Carpenter, a medical statistician at the London School of Hygiene and Tropical Medicine. The research appears in the Jan. 17 issue of The Lancet.

The risk is greatest for babies who sleep on their stomach; whose mothers smoke; who are covered with bedding; and who sleep in the same bed as the mother. The researchers found six of 10 SIDS cases were attributable to babies lying on their stomachs or their sides. As for sleeping in the same bed as the mother, 77 percent of those SIDS cases involved a mom who was a smoker.

These are all risk factors that have previously been identified, says Betty McEntire, executive director of the American SIDS Institute, but the apparent lack of news is actually good news.

"One good thing is that looking at all these different countries, putting all their data together in one data set, confirms what we've known before," McEntire says. "Parents can do a lot of things to make a baby safer and reduce the risk of SIDS quite a bit."

The advice that has evolved over the years already has lowered the incidence of SIDS substantially. From 1983 to 1992, there was an average of 5,000 to 6,000 SIDS deaths a year, according to the U.S. Centers for Disease Control and Prevention (news - web sites).

This year, that number is predicted to be under 2,500, McEntire says, and it could be even lower if parents followed all the advice.

"The safest thing you can do is to put a baby in bed with nothing but the baby and what it wears, except a pacifier," she says. "The baby should be on its back, warm but not too warm, in bed in the mother's room but not in the mother's bed. It should not be exposed to cigarette smoke..."

Why the advice works is not exactly known, Carpenter says. "As with so many of these things, we don't know why sleeping with the face down increases risk," he says. "Why sleeping in the mother's bed and the mother smoking increases risk is not clear."

A theory that is gaining attention holds that vulnerable children are born with a subtle defect in the autonomic nervous system, which governs such basic functions as breathing, McEntire says.

"Most babies born with the defect may never be known to have it and will outgrow it," she says. "But if during the early time of life the baby suffers some other problem, physical insult or stress, that might be enough to push it over the top."

For example, the problem for a baby with that subtle autonomic disorder who sleeps face down might be that he or she is breathing in exhaled air, which contains a slightly higher-than-normal level of carbon monoxide, McEntire explains.

For another baby, the slight degree of over-warming caused by bed clothes that are too heavy might be lethal, she says.

"The more we know about it, the more we are able to give advice about preventing SIDS," McEntire says.

More information

To learn more about SIDS, visit the American SIDS Institute and the National SIDS/Infant Death Resource Center.

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FDA Places Six Canadian Feed Plants on Import Alert

By Randy Fabi
Reuters
Thursday, January 15, 2004

WASHINGTON (Reuters) - Since the discovery of mad cow disease in the United States, the Food and Drug Administration (news - web sites) has placed six Canadian animal feed plants on "import alert" after finding prohibited meat material in its shipments, a spokeswoman said on Thursday.

Canadian feed plants owned by Bunge Ltd., Louis Dreyfus, and Saskatchewan Wheat Pool were among those listed by the FDA that must test all feed shipments bound for the United States for traces of animal tissue, the FDA said.

The United States has banned meat and bone meal in all animal feed from Canada since its northern neighbor found a case of mad cow disease in an Alberta cow last May.

"The firms listed ... have attempted to import feed products containing animal material of indeterminate origin," the FDA said.

Experts believe mad cow disease is spread when cattle eat feed infected with the remains of diseased animals. A Washington state dairy cow was diagnosed on Dec. 23 with the first U.S. case of mad cow disease.

Since then, the FDA has placed six Canadian feed plants on "import alert." A total of 14 plants are on the list.

The United States and Canada are trying to track down the feed sources that caused the two mad cow cases.

Bunge, the world's top oilseed processor, said on Tuesday that the FDA stopped a canola meal shipment from its CanAmera Foods crushing plant in Nipawin, Saskatchewan, from entering the United States on Dec. 23 or 24 because of suspected contamination.

"Future shipments from Bunge are subject to action until the company establishes that its feed complies with applicable regulatory standards," said FDA spokeswoman Rae Jones.

The company has requested the FDA conduct a DNA analysis of the canola meal sample to determine what type of animal the meat came from.

Louis Dreyfus Canada was placed on import alert on Dec. 30 after meat was found in a feed shipment from its Calgary plant. Company officials were not immediately available for comment.

The Saskatchewan Wheat Pool feed plant under FDA surveillance was located in Vancouver.

Other Canadian plants listed after the U.S. mad cow discovery were Agricore United's, Macleod Feed Mill and New Life Feeds. All of these are located in Alberta, which is the birthplace of the two animals with mad cow disease in North America.

Saskatchewan Wheat Pool and Agricore were not immediately for comment.

DNA tests have confirmed that the infected dairy cow in Washington state was imported from Canada and born in Alberta.

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Caesareans Cut Chances of Future Vaginal Delivery

HealthDayNews
Thursday, January 15, 2004

THURSDAY, Jan. 15 (HealthDayNews) -- Women whose first child is delivered by Caesarian section are much less likely to have a subsequent vaginal delivery, says new research.

The study, published online Jan. 14 by the British Medical Journal, included 283 women who were surveyed three years after they had vaginal delivery (with use of ventouse or forceps) or Caesarian section. Of those women, 140 had become pregnant again during the intervening three years.

Women who had an instrumental vaginal delivery were less likely to report difficulty conceiving and were more likely to have achieved a further pregnancy than those who had a Caesarian section. Women who had a previous instrumental delivery were also more likely to desire a vaginal delivery and more likely to have a vaginal delivery.

Women in both groups (51 percent after vaginal delivery and 42 percent after Caesarian section) cited fear of childbirth as a reason for avoiding another pregnancy.

The study authors conclude that vaginal delivery offers advantages for future pregnancies over Caesarian section. They say the increasing use of Caesarian section instead of vaginal delivery when there are difficulties during labor may have far-reaching consequences.

They suggest more work is necessary to address the psychological impact on women in these circumstances.

More information

Here's where you can learn more about birth and labor.

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Tai Chi Might Help Elderly Avoid Falls

By Amy Norton
Reuters Health
Thursday, January 15, 2004

NEW YORK (Reuters Health) - The ancient Chinese practice of tai chi might help reduce the risk of falls even among relatively frail elderly adults, new study findings suggest.

Researchers found that among adults in their 70s, 80s and 90s -- many of whom relied on assistive devices to get around -- tai chi exercises over a 48-weeek period reduced the risk of falling by 25 percent.

In research terms, this risk reduction was not significant statistically, but could still be important in real life, according to the study's lead author, Dr. Steven L. Wolf of Emory University School of Medicine in Atlanta.

In an interview, Wolf pointed out that in the early months of the study, many of the elderly participants had to get comfortable simply with giving up the support of their assistive devices, let alone getting the full benefit of a tai chi class.

When his team looked only at months four through 12 of the study, tai chi participants were almost half as likely to fall as those in a comparison group given wellness education classes.

Given past studies of healthier older adults in which tai chi nearly halved the risk of falls, the practice should continue to be studied among high-risk elderly, the researchers advise in the Journal of the American Geriatrics Society.

Tai chi focuses on building strength, balance and flexibility through slow, fluid movements combined with mental imagery and deep breathing. Studies have suggested that the elderly can reduce their risk of falls, lower their blood pressure and ease arthritis symptoms through the practice.

Last month, Great Britain's national health service announced a new program offering older adults free tai chi classes, as part of a government campaign to cut the number of elderly who fall and break a hip.

However, past tai chi research has focused on "robust" older adults. Whether the practice can benefit less healthy individuals has been unclear.

In the new study, 311 older adults -- mostly women -- were randomly assigned to either tai chi instruction or wellness education, for 48 weeks. All of the participants were living in facilities for the elderly and were considered to be "transitioning to frailty."

Over the 48 weeks, participants who practiced tai chi were less likely to fall than those in the education group. Overall, about 52 percent in the tai chi group had no falls, compared with just fewer than 40 percent in the comparison group.

An editorial published with the report echoes Wolf's conclusion that the risk reduction in this study was "substantive," if not statistically significant.

"It is certainly a mistake to conclude that tai chi has failed to demonstrate benefit because of these new findings," write Drs. Laurie L. Lavery and Stephanie A. Studenski.

They agree that the difference in fall risk between the two groups may be a "clinically important" one.

According to Wolf, older adults who are living independently and want to try a tai chi class should first make sure the instructor has experience teaching older students. People with medical conditions, such as osteoarthritis, should also ask the instructor whether he or she knows how to modify movements for their particular limitations.

Source: Journal of the American Geriatrics Society, December 2003.

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Pharmacists decry NDakota plan to use Internet to help by Canadian drugs

By Dale Wetzel
The Associated Press
Thursday, January 15, 2004

BISMARCK, N.D. (AP) - Helping North Dakotans use the Internet to buy prescription drugs from Canada - an idea Gov. John Hoeven is exploring - would encourage illegal purchases, the state pharmacy board's director believes.

"We shouldn't be bypassing the pharmacies that we have, the patient care system, and putting our people at risk," said Howard Anderson Jr., director of the North Dakota board that licenses pharmacists. Hoeven and Minnesota Gov. Tim Pawlenty recently discussed Minnesota's plans to establish a website to help that state's residents buy prescription drugs from Canadian pharmacies.

Many widely used U.S.-made drugs are less expensive in Canada than they are in the United States, in part because of Canadian drug price controls.

Minnesota's website is scheduled to begin operating late next month. Pawlenty and Illinois Gov. Rod Blagojevich are holding a meeting for governors in Washington, D.C., on Feb. 24 to discuss ways to lower prescription drug costs.

A number of state and local governments are exploring the option of importing Canadian drugs. The city of Springfield, Mass., is already doing so, despite warnings from U.S. federal regulators.

Several private initiatives are operating, including a website established by a group of Vermont doctors to help their patients buy drugs from Canada.

Hoeven is no longer considering a state role in buying Canadian prescription drugs for use in the state's Medicaid program, or for the health insurance plan for North Dakota government employees, said Duane Houdek, Hoeven's staff attorney.

Medicaid is a medical assistance program for the poor, which is financed by the federal and state government.

However, North Dakota may establish its own website with links to Canadian pharmacies that state officials have checked and consider to be safe drug suppliers, Houdek said.

"This would be where individuals would choose to participate, would pay for it by themselves," Houdek said. "There's nothing wrong with providing these kinds of assurances about (Canadian) pharmacies . . . That certainly would be a plus."

Anderson said a North Dakota government Web site with links to Canadian pharmacies would be tantamount to encouraging people to break federal drug importation laws.

"I don't think it's a good idea for us as public employees or politicians to encourage that," Anderson said.

"We need to work on changing the law. That's what we ought to do, if we want to get those drugs imported more cheaply."

The U.S. Food and Drug Administration (news - web sites) has said prosecuting individuals who import drugs from Canada and other foreign countries for personal use is a low enforcement priority for the agency.

"Although we must concede that FDA has not often prosecuted those importing illegal drugs into the United States from Canada, FDA reserves the right to do so in the appropriate circumstance," agency official William Hubbard said in a February 2003 letter on Canadian drug imports.

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Consumer Groups Ask More Info on Mad Cow Probe

By Randy Fabi
Reuters
Thursday, January 15, 2004

WASHINGTON (Reuters) - U.S. consumer groups on Thursday demanded the federal government release the names of the grocery stores and restaurants that may have purchased meat from a Washington state cow infected with mad cow disease.

Consumers on the West Coast may have unknowingly purchased beef products from the infected cow because the U.S. Agriculture Department has refused to disclose the retail outlets that purchased them, the consumer groups said.

The USDA last month recalled about 10,000 pounds of beef from Vern's of Moses Lake Meats, a small plant in Washington that slaughtered the cow diagnosed on Dec. 23 with the first U.S. case of mad cow disease.

The beef was sent to food stores in Washington, Oregon, California, Nevada, Idaho and Montana, the USDA said.

"Worse, because of the slow pace and secrecy of the recall, there may well be consumers who purchased and ate meat from the BSE (news - web sites)-positive animal in the days leading up to and following the Christmas holidays," the coalition said in a letter to Agriculture Secretary Ann Veneman.

The group, which met with Veneman on Thursday, includes the American Public Health Association (news - web sites), Center for Science in the Public Interest and the Consumer Federation of America.

The USDA said there was an "extremely low likelihood" that the beef contained any infectious material since the cow's brains and spinal cord were removed at slaughter.

Experts say the greatest risk for spreading mad cow disease lay in cattle brain, spinal cord and meat containing these products. About 140 people, mostly in Europe, were killed by a human variant of mad cow associated with eating meat from diseased bovines.

The coalition said the USDA only shares information with states if they agree not to publicly identify the locations where potentially tainted meat has been distributed and sold.

"We think this is wrong and that it endangers public health," it said.

USDA said it has alerted all companies that purchased the recalled beef and necessary precautions were taken.

Days after the mad cow announcement, Safeway Inc., Kroger's Fred Meyer stores and Albertsons Inc. voluntarily asked customers to return beef products purchased in some of its West Coast stores.

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Wednesday, January 14, 2004

Cancer Deaths to Decline in 2004

American Cancer News
Wednesday, January 14, 2004

Death rates from some of the most common cancers are dropping, according to the latest projections compiled by the American Cancer Society (news - web sites). Fewer Americans this year are expected to die from lung, colon, breast, and prostate cancer, ACS experts report in Cancer Facts & Figures 2004, an annual estimate of cancer incidence and death rates in the United States.

The decline in deaths is due to new treatments and wider use of tools for finding cancer early, when it is most treatable, the report says.

Nevertheless, cancer remains the second leading cause of death in the US, killing more than 1,500 people a day. Only heart disease claims more lives. More than 1.3 million people are expected to be diagnosed with some form of cancer in 2004, and about 563,700 people are expected to die from this disease, according to the report.

Many of those cases and deaths could be prevented with lifestyle changes. More than 180,000 cancer deaths in 2004 will be caused by tobacco use, the report says, while about one-third of cancer deaths are related to poor nutrition, lack of physical activity, and excess weight.

"Cancer is not an inescapable fact of life," said Michael Thun, MD, vice president of epidemiology and surveillance research for ACS. "Things we do, and social policies, make a huge difference."

Public health officials face a particularly great challenge in addressing the problem of physical inactivity and obesity, Thun said.

"The pieces that are missing in terms of prevention are effective ways by which communities and social policies can help people maintain a healthy body weight and get regular physical activity," he said. "The big thing to tackle is, What are the interventions that will actually begin to turn it around?"

Lung Cancer Deadliest

Lung cancer is the second most common cancer, and it's the top cancer killer of both men and women. Although it accounts for just 13% of cancer cases, lung cancer is responsible for nearly one-third of cancer deaths in men (32%) and one-quarter of those in women (25%). About 173,770 new cases and 160,440 deaths are expected in 2004. Smoking will be the direct cause of about 87% of those deaths.

Tobacco control efforts have had a dramatic impact, however, particularly in men. The lung cancer death rate among men has been decreasing significantly, by nearly 2% per year, since the early 1990s. This drop is mostly due to reductions in smoking among men, which has led to fewer cases of the disease.

But the same is not true of women. Lung cancer deaths in women, which had been rising until the 1990s, have reached a plateau; they have not yet started to decline.

Progress Against Breast, Prostate Cancer

Early detection and better drugs are credited with reducing deaths from breast cancer, the most common cancer among American women (other than skin cancer). More women were diagnosed with breast cancer in the 1990s, but this increase was seen only among women age 50 and older. In spite of this, death rates dropped by more than 2% per year among women overall, while women under age 50 saw even greater declines. Today, about 97% of women with localized breast cancer survive 5 years after their diagnosis.

About 215,990 new cases of invasive breast cancer and 59,390 cases of in situ breast cancer are expected to be diagnosed in women in 2004; about 40,110 women are expected to die from this disease. Breast cancer can also strike men, though it is rare. About 1,450 new cases and 470 deaths are expected among men in 2004.

Prostate cancer is the most common cancer among men, and detection rates for this disease have been on the rise, most likely because of wider use of the PSA screening test. About 230,110 new cases of prostate cancer, and 29,900 deaths, are expected in 2004. African-American men are more likely than white men to develop prostate cancer and die from it. However, deaths from prostate cancer in both races have been declining since the early 1990s. Today, around 86% of prostate cancer cases are discovered at an early stage, when 5-year survival is 100%.

Despite these positive findings, Thun said there is a lot of room for improvement.

"For both breast and prostate cancer, there are tests that effectively diagnose the disease early, but in the clinical management of people who have those early cancers, we have a lot to do in sorting out the appropriate level and aggressiveness of treatment," he said.

More needs to be done to find genetic markers that can help doctors decide which cancers need to be treated aggressively and which can be safely be watched carefully but left untreated, he said. Developing better treatments is also important. Researchers have made great progress in developing more effective, less toxic medications for some of the less common cancers, such as Gleevec for chronic myelogenous leukemia. Similar drugs that target more common cancers are needed, Thun said.

Colon Cancer Screening Having an Impact

Public health officials also need to do more to increase screening rates for colorectal cancer, the third most common cancer among both men and women in the US and the third deadliest in both groups. About 146,940 new diagnoses and 56,730 deaths are expected in 2004.

In recent years, fewer people have been getting this disease and fewer have been dying from it, likely due to increased screening, which can find and remove precancerous polyps before they become deadly tumors. Still, Thun pointed out, fewer than half of Americans who should get screened actually do so.

Finding colorectal cancer early makes a big difference. About 90% of patients with localized disease survive 5 years beyond their diagnosis, but once the cancer has spread to nearby lymph nodes or organs, that number decreases to 66%. Unfortunately, just 38% of colorectal cancers are discovered at the earliest, most curable stage.

Addressing Disparities

This year's Facts & Figures report also addresses how cancer differently impacts minority racial/ethnic and low socioeconomic groups. For instance, racial minorities have substantially lower survival rates from cancer than do whites. African Americans fare the worst. Death from cancer is 40% higher among African American men than white men, and 20% higher among African American women compared with white women.

Poverty, which disproportionately affects racial and ethnic minority groups, plays a big role in this gap, Thun explained. People with no health insurance may be unable to get important cancer screening tests that find the disease early, for instance. Or if they are diagnosed, people with low incomes may be unable to complete treatment because they can't afford to take time off work, or because they work more than one job. Poor communities may have fewer healthful fruits and vegetables in their local supermarkets, and residents may be unable to afford these foods.

"Many of these things are difficult to turn around," Thun acknowledged, "but the thing that is really important is to keep pointing out the problems and keep pressure on to find things that can be modified."

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New Clues to Genesis of Alzheimer's

HealthDayNews
Wednesday, January 14, 2004

WEDNESDAY, Jan. 14 (HealthDayNews) -- German scientists say they may have found a missing link in the chain of events that trigger Alzheimer's disease (news - web sites).

University of Bonn researchers are pointing the finger at a protein called abeta, which often shows up in large quantities in the cerebral cortex of patients with Alzheimer's. Their study appears in the February issue of Traffic.

Despite the presence of abeta in the brains of Alzheimer's patients, scientists weren't certain whether the protein could enter the cell plasma and cause damage.

In this new study, Bonn University scientists say they discovered abeta can enter the cell plasma but, as a rule, decomposes once it's in the cell plasma. But the scientists suggest that if this decomposition does not occur properly, abeta can accumulate and destroy cells.

More information

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

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Wine's Health Benefits Mimicked in a Pill

Reuters
Wednesday, January 14, 2004

LONDON (Reuters) - Italian scientists are working on a pill that replicates all the health benefits of drinking a glass of red wine.

The research, by scientists at the Pavese Pharma Biochemical Institute in Pavia, Italy, could allow teetotallers to enjoy the health advantages of wine, long seen as beneficial for the heart in moderate consumption.

The pill will include a mixture of sugar, amino acids, polyphenols and other healthy ingredients in wine, but none of the alcohol.

Polyphenols are antioxidants that destroy harmful substances called free radicals that can cause cancer. They may also help to keep arteries clear and reduce heart disease.

"Freeze-drying and compacting the mix leaves a tablet with all the benefits of a glass of wine, say the inventors," New Scientist magazine reported Wednesday.

Researchers have also shown that people who drink a glass of wine a day have a lower risk of dementia than individuals who do not drink.

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U.S. Urged on Universal Health Insurance

By Mark Sherman
Associated Press Writer
The Associated Press
Wednesday, January 14, 2004

WASHINGTON - The Institute of Medicine (news - web sites) on Wednesday recommended for the first time that the government provide universal health insurance, attempting to spark an election-year debate on a decades-old problem that keeps getting worse.

The president and Congress should set 2010 as the deadline for providing coverage to all, according to the institute, part of the National Academy of Sciences (news - web sites), a private organization chartered by Congress to provide scientific advice to the government.

The report endorsed no proposal and provided no estimate of cost, except to say it would be expensive.

It said that rising costs, increasing numbers of uninsured and growing financial pressures on health care providers have created the right conditions for major reform at the federal level, a decade after Congress rejected President Clinton (news - web sites)'s proposed overhaul. The report was the last of six studies over three years that explored aspects of the lack of health insurance.

"I believe we're reaching the point where the system is unsustainable," said one of the report's authors, Dr. Arthur L. Kellermann of the Emory University School of Medicine in Atlanta.

Mary Sue Coleman, president of the University of Michigan and head of the committee that prepared the report, said the problem "is not going away. It will only get worse."

The Census Bureau (news - web sites) reported that 43.6 million people lacked health insurance at some point in 2002, compared with 39.8 million in 2000.

The study said that strong, bipartisan support is necessary for any proposal to move forward. The report got a boost former Republican Sen. Bob Dole, who praised the goal of universal coverage but said a partisan effort tied to one approach would be doomed to failure.

"If properly framed, the lack of coverage ... can be one of the big, big issues in this election," said Dole, who attended a news conference on the report.

Separately, a survey by two pollsters, a Republican and a Democrat, for the American Hospital Association found that a majority of Americans, including a majority of Republicans, are willing to pay higher taxes to "assure every American citizen receives health care coverage."

Yet reaction to the study showed the partisan divide that has marked the issue. Democrats were overwhelmingly supportive, while Republicans were skeptical.

Health and Human Services (news - web sites) Secretary Tommy Thompson said universal coverage by 2010 is "not realistic."

In a meeting with reporters this week, Thompson said, "I just don't think it's in the cards. I don't think that administratively or that legislatively it's feasible."

The Bush administration last year proposed spending up to $89 billion in health care tax credits to help those who do not have employer-based coverage. The Republican-led Congress took no action.

Thompson said the president would have more to say about the uninsured in next week's State of the Union address.

Senate Majority Leader Bill Frist of Tennessee said he was concerned that the report "may not focus enough on the reasons why health care costs continue to rise and how to pay for any reform."

Senate Democratic leader Tom Daschle of South Dakota said the lack of insurance is the leading domestic issue today. He said the report's goal could be met. "I think it's essential," he said.

The institute said the lack of health insurance was deadly, costly and a cause of insecurity even among the insured. Rejecting incremental expansions, it said only major reform at the federal level would make universal coverage a reality.

In previous reports, the institute has estimated that the lack of health insurance causes 18,000 unnecessary deaths in the United States and costs the nation $65 billion to $130 billion annually.

Layoffs and cutbacks in health benefits by employers have led even those with insurance to worry that they could lose it. Lack of adequate health insurance "creates insecurity for everyone, because losing that coverage tomorrow is so easy," the report said.

The Census Bureau said a decline in workplace-based coverage was the main reason for the increase in uninsured between 2001 and 2002.

On the Net:

Institute of Medicine: http://www.iom.edu

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Odor Receptor Helps Mosquitoes Target People

By Merritt McKinney
Reuters Health
Wednesday, January 14, 2004

NEW YORK (Reuters Health) - Scientists have identified a specialized receptor on mosquitoes that seems to help the blood-sucking insects zero in on their human targets.

The identification of this smell receptor raises the possibility of developing better insect repellents or mosquito traps, the study's lead author told Reuters Health.

"We found that a particular mosquito smell receptor is exquisitely sensitive to a human sweat odor," said Dr. John R. Carlson of Yale University in New Haven, Connecticut. This receptor, he explained, may help mosquitoes locate their next meal.

"This finding could be used in designing new insect repellents or in identifying strong attractants for use in insect traps," Carlson said. The next step, according to the Yale researcher, will be to find other chemicals that block this receptor or activate it strongly.

The prospect of a better bug repellent may sound like a good idea to fans of backyard barbecues everywhere, but mosquitoes are more than a minor irritation in many parts of the world. Malaria-carrying Anopheles mosquitoes are to blame for more than one million deaths per year.

Carlson and his colleagues developed a method of identifying odors that activate mosquito smell receptors. Through a little genetic tinkering, the researchers caused fruit fly neurons on the insects' antennae to produce mosquito smell receptors.

These altered bugs did not respond to most odors, because the fruit flies normal smell receptors had been removed. But a mosquito smell receptor called AgOr1 had a strong response to a component of human sweat, the researchers report in Thursday's issue of the journal Nature.

Carlson and his team suspect that AgOr1 may help mosquitoes home in on their human targets, because this receptor is expressed only in female mosquitoes, which need blood for producing offspring. Levels of the receptor diminish after a female mosquito has had a meal of blood.

Carlson told Reuters Health that he and his colleagues are continuing to examine other mosquito odor receptors to see what triggers them. Although the current research involved mosquitoes, he noted that "the method could also be used to design new ways of controlling other insect pests."

Source: Nature, January 15, 2004.

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Burger King Unveils Bunless Burgers

By Dave Carpenter
AP Business Writer
The Associated Press
Wednesday, January 14, 2004

CHICAGO - It has come to this in America: Burgers are losing their buns. Some of them, at least. Burger King's rollout of breadless Whoppers this week is a nod to the low-carb craze that's sweeping the nation and the latest evidence that the burger wars are taking a turn for the healthy.

Smaller chains Hardee's and Carl's Jr. dumped the bread from some hamburgers last month, going lettuce-wrapped instead, and TGI Friday's restaurant has started serving a bunless cheeseburger, too.

But hold the bun odes, please. Burger-lovers will have the last say, and experts say the bun shouldn't be written off from restaurants' regular fare, much less from its place in modern American food lore.

"This won't be a big segment of the (burger) market," predicted Jerry McVety, a foodservice industry consultant based in Farmington Hills, Mich. "I don't see it lasting very long."

Besides, he noted, a Whopper without a bun is almost an oxymoron. "The bun is almost the least of my worries," he chuckled.

McDonald's and Wendy's, the other two largest burger purveyors, aren't biting on bunless for now. Spokesmen for both those chains, which have added entree salads and taken other steps to assuage customers' diet concerns, said Wednesday they have no plans to include bunless burgers on their menus.

With good reason, according to Carl Sibilski, an analyst for Chicago-based Morningstar and frequent fast-food patron. "Bunless burgers don't sound so appealing," he said.

The price of the new product risks being unappealing to customers, too: It's the same with or without bun, per Burger King's recommendation to its 8,000 restaurants.

The surge in popularity for the high-protein, high-fat, low-carbohydrate Atkins diet is what prompted a move that once would have been unthinkable in the hamburger business. Customers who used to ask "Hold the pickle" now are saying "Hold the bun"; can "Hold the burger" be far behind?

Burger King took out a full-page advertisement in USA Today on Wednesday to tout its unlikely new product, showing a giant Whopper with dotted lines marking the outlines of where a bun would normally be. The Miami-based chain is selling them in plastic salad bowls, with knife and fork, after reporting an increasing number of such requests over the past year.

It also is introducing Whopper meals that substitute salads for French fries and bottled water for soft drinks and promising a new line of salads, so company officials aren't staking their future on a bunless trend.

"A large majority of our customer base still enjoy fully loaded, high-quality cheeseburgers, so we don't see this as some kind of sea change," said Russ Klein, Burger King's chief marketing officer. "But it's a change that we felt was warranted in order to give all our customers options they feel comfortable with in terms of diet."

The bunless Whopper has 3 grams of carbohydrates, compared with 52 for a regular Whopper.

No matter how you slice it, though, such "gimmicks" as bunless burgers don't impress dietitians like Connie Diekman.

"The issue is we need to burn more carbohydrates more physical activity and eat less," said Diekman, director of university nutrition at Washington University in St. Louis. "The better option would be a smaller burger, maybe less often, and still have it on a bun so you control the calories and the fat."

Ricardo Real, a tourist from Mexico who lunched at a Burger King in downtown Chicago on Wednesday, was unimpressed when informed about the bunless burger and chose a regular hamburger instead. "A burger without bread? That's crazy," he said. "That's not a burger."

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Frito-Lay Introduces Low-Carb Chips

Reuters
Wednesday, January 14, 2004

NEW YORK (Reuters) - Snack foods company Frito-Lay said Wednesday it is introducing two new types of chips to capitalize on the popularity of low-carbohydrate diets.

The two new products, called Doritos Edge and Tostitos Edge, will cut out 60 percent of the carbohydrates that are in regular Doritos and Tostitos.

Frito-Lay, a unit of PepsiCo Inc., has already eliminated trans fats from its brands. Trans fats, which give products a longer shelf life, have been linked to heart disease.

The new chips will use soy proteins and fiber as substitute ingredients, the company said in a statement. Both Tostitos Edge and Doritos Edge will have six net carbohydrates, 10 grams of protein, and three grams of fiber.

The low-carb craze, popularized by the high-protein Atkins diet, has food companies rolling out new products to jump on the bandwagon.

Anglo-Dutch food group Unilever said on Wednesday it has launched a variety of low-carb products in the U.S. markets under existing brand names such as Ragu, Wish-Bone, Skippy, Lipton and Lawry's.

Fast food chains McDonald's Corp. and Burger King revamped their menus to cater to customers counting their carbs.

The alcohol industry is also taking notice. Anheuser-Busch Cos. Inc.'s low-carb Michelob Ultra beer has been a big profit driver for the past year and Adolph Coors Co. is rolling out Aspen Edge beer to take a part of the health-conscious market.

Spirits companies such as Diageo Plc. are using their advertising to point out that many of their drinks have always been low carbohydrate offerings.

Doritos Edge is currently being tested in Phoenix, and both products will be available across the United States in May.

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Antibiotics May Help Stop Stomach Cancer

By Lindsey Tanner
AP Medical Writer
The Associated Press
Wednesday, January 14, 2004

CHICAGO - Antibiotics can help prevent stomach cancer in people who carry a common strain of bacteria known to cause ulcers, a study found.

The Chinese study adds to the already strong evidence that Helicobacter pylori bacteria can cause stomach cancer, a disease especially prevalent in Asia but far less common in the United States.

Still, experts said the findings do not solve the dilemma of whether and how to treat carriers of the bacteria.

The study involved 1,630 men and women from Fujian Province in southern China. All were carriers of H. pylori; hundreds of them already had precancerous lesions at the outset of the study.

Patients were randomly assigned to receive two weeks of treatment with antibiotics and an anti-ulcer drug, or a dummy medicine, and were followed for 7 1/2 years after that.

Among the 988 patients without precancerous lesions at the outset, none on the treatment got stomach cancer, compared with six in the placebo group.

The findings among those with precancerous lesions were not as clear-cut: Seven in the treatment group developed stomach cancer, versus 11 in the placebo group.

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

H. pylori is estimated to affect as many as 90 percent of people in some developing nations and up to 50 percent of people in some industrialized countries, according to the World Health Organization (news - web sites). Chronic H. pylori is thought to cause stomach cancer, and doctors have come to believe since the early 1980s that it is the No. 1 cause of ulcers.

Stomach cancer is the fourth most common type of cancer worldwide and is diagnosed in about 870,000 people annually, according to the World Health Organization. The highest rates are in East Asia, including China, perhaps because of genetic reasons or a diet high in salt-cured foods.

In the United States, about 23,000 new cases are expected this year, according to the American Cancer Society (news - web sites).

The findings suggest that doctors should consider routine screening for such lesions in H. pylori patients in high-incidence areas, and treating the infections in patients with no precancerous lesions, said the authors, led by Benjamin Chun-Yu Wong of the University of Hong Kong.

But a JAMA editorial said the study does not resolve whether to employ widespread screening for the bacteria or for precancerous lesions.

While simple breath, blood and stool tests can identify whether someone has H. pylori, diagnosing precancerous lesions is more tricky and would probably require invasive and costly tests and biopsies, said the editorial by Dr. Julie Parsonnet, a Stanford University infectious-disease specialist, and David Forman of the University of Leeds in England.

Dr. Michael Brown, a gastroenterologist at Rush University Medical Center in Chicago, said routine H. pylori screening would not be cost-effective in the United States because the rates of infection and cancer are so low.

On the Net:

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

American Cancer Society: http://www.cancer.org

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For Chest Pain, Call EMS for Faster Treatment

By Alison McCook
Reuters Health
Wednesday, January 14, 2004

NEW YORK (Reuters Health) - People with chest pain will likely reach the hospital faster if they get someone to drive them, but they may receive treatment sooner if they call for an ambulance, new research shows.

The investigators found that people who relied on private transportation reached the emergency department 4 minutes faster than those who waited for emergency medical services (EMS). However, people who opted for EMS received treatment for their chest pain nearly 26 minutes earlier than people who drove themselves to the hospital.

Although people using private transportation technically reach the emergency department faster, the point of reaching the hospital faster is to get help sooner, which is more likely to occur if people call 911, study author Dr. Mohamud Daya said.

Paramedics can administer certain treatments en route to the hospital, so when you call 911, "you bring part of the hospital to your home, and your care starts sooner," Daya, of Oregon Health and Science University in Portland, told Reuters Health.

Chest pain is often a symptom of heart attack, which occurs when a blockage in an artery halts blood flow to the heart. If patients arrive at the hospital early enough, doctors can try to restore blood flow with clot-busting drugs or angioplasty.

During the study, Daya and his colleagues interviewed 5581 people who had gone to an emergency room as a result of chest pain, and reviewed their charts to determine how long it took before they received treatment.

Approximately one quarter of respondents said they called 911 when they developed chest pain, and the majority drove themselves to the hospital.

Although people who drove to the hospital got there quicker, people who called 911 received treatment for their chest pain within 6 minutes, compared to 32 minutes for people who opted for private transportation.

Furthermore, among those who needed clot-busting drugs, people who called an ambulance received the treatment 17 minutes sooner than people who decided to drive themselves to the hospital, Daya and his team write American Heart Journal.

In an interview, Daya explained that paramedics can take steps to help identify the cause of chest pain, alert doctors that they are about to receive a person experiencing a heart attack, for example, and speed up the process once patients arrive, Daya noted.

Calling 911 helps "trigger the system" of health care, he said.

Although it may be tempting to jump in a car at the first sign of chest pain, if you wait for EMS, "the hospital is more ready to take care of you, and you get faster care once you get to the hospital," Daya added.

Source: American Heart Journal, January 2004.

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Kids' Immune Systems Unfamiliar With Flu Strain

By Ed Edelson
HealthDay Reporter
HealthDayNews
Wednesday, January 14, 2004

WEDNESDAY, Jan. 14 (HealthDayNews) -- A leading influenza expert speculates that this winter's deadly outbreak has been hard on young children because it contains a strain their immature immune systems haven't encountered before.

At last count, the flu had killed 93 children, and the expert suspects many of them fell victim to a strain that was last seen in this country before they were born.

But this season also may have one good effect, says another researcher trying to keep a step ahead of the influenza virus's shifting nature: increased awareness of the need to get flu shots.

Influenza kills an average of 51,000 Americans and makes many more ill each year, Dr. John Treanor, director of the University of Rochester Medical Center Vaccine Evaluation Unit, writes in the Jan. 15 issue of the New England Journal of Medicine (news - web sites). It hits old people and children the hardest, he notes.

"What is perhaps more noteworthy than this year's epidemic is the extent to which we routinely accept these vaccine-preventable deaths without much comment," Treanor says.

The effort to produce effective vaccines is endless, Treanor writes, because new versions of the virus emerge continuously from waterfowl to infect humans.

These viruses contain differing forms of two essential proteins -- hemagglutinin, which attaches the virus to cells, and neuraminidase, which lets the virus spread from cell to cell. Scientists have identified 15 forms of hemagglutinin and nine forms of neuraminidase in waterfowl.

To complicate matters, the flu virus comes in two versions, type A and type B. Type A has been the dominant form in this year's outbreak. More specifically, this season's dominant strain is A/Fujian/411/2002 (H3N2), and viruses of what Treanor calls the H3 subtype are "often accompanied by the relatively early onset of a more severe influenza epidemic," he writes.

"There has been relatively little H3 virus activity in the United States for the past three years," Treanor continues. "There is therefore a relatively large cohort of susceptible children, which is probably playing an important role in transmission. In fact, the most dramatic reports of severe disease this year have been those of influenza in young children."

Each year, the U.S. Centers for Disease Control and Prevention (news - web sites) alters the vaccine slightly, using knowledge about the probable evolution of the virus.

"You look at the evolutionary tree, then ask how the virus migrates from one pool to the next," explains Walter Finch, a professor of ecology and evolutionary biology at the University of California at Irvine who is working on the type B virus.

"I am looking at type B to see if we could predict its evolutionary course as well as is possible for the A virus," Finch says. "It requires a lot of data to do that."

While there are "lots of caveats," Finch says, "there are lots of things to be hopeful about."

The best vaccine is of no use if vulnerable people don't get it, Treanor says, so the current outbreak "may help us deal with influenza outbreaks more effectively."

Reports of the toll flu is taking on children have increased the demand for flu shots, he says, and "increased demand for vaccine will encourage manufacturers to continue producing it, possible in greater quantities."

"Vaccination coverage in this country has improved, but we still have a long way to go," Treanor says. He hopes for a cycle in which "we see increased demand for flu shots stimulate manufacturers to make more for next year."

It can be a tricky issue for pharmaceutical companies, Treanor acknowledges. "They don't want to make so much that a lot will be left over. Someone has to make some very educated guesses."

Ongoing research and large-scale production are needed because sooner or later there will be a major change in the virus that will cause a worldwide epidemic affecting many millions of people all over the world, Treanor says. New strains of the type A virus caused the influenza pandemics of the past century, most notably the Spanish flu in 1918, Asian flu in 1957, and Hong Kong flu in 1968.

More information

The whys and wherefores of influenza and the flu vaccine can be found at the U.S. Centers for Disease Control and Prevention or the American Lung Association.

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New Gene Therapy Targets Advanced Skin Cancer

By Karla Gale
Reuters Health
Wednesday, January 14, 2004

NEW YORK (Reuters Health) - By improving the delivery method, an international research team has developed a new gene therapy for advanced skin cancer that spares normal tissue.

Gene therapy combats disease by delivering various genes to the affected cells. Once in the cell, the genes produce proteins that, it's hoped, arrest or slow the disease process. Typically, the genes are delivered to the cells by harmless viruses.

As a treatment for cancer, gene therapy has been plagued with delivery problems, Dr. David T. Curiel, at the University of Alabama at Birmingham, and colleagues note in the International Journal of Cancer.

Although such therapy can deliver genes to the cancer cells, normal surrounding tissues are often harmed by the treatment. In addition, the therapy is rather inefficient -- only a small percentage of genes actually get delivered to the target cells.

In the new study, the researchers took a standard delivery virus and modified it to seek out cells with advanced melanoma, a potentially fatal type of skin cancer. This change improved the virus' ability to target the melanoma cells, resulting in greater gene delivery with fewer side effects to surrounding tissues.

Curiel told Reuters Health that his team has tested the new gene therapy in mice with early melanoma. Once again, the results were promising: genes were delivered in high numbers to primarily only those cells with cancer. He noted that his team is currently evaluating the method in mice with more advanced melanoma.

With National Cancer Institute (news - web sites) support, Curiel hopes to see human trials as early as 12 to 18 months from now.

"(Advanced) melanoma has been a particularly difficult context, and we're hopeful this new agent will provide a possible treatment modality," he concluded.

Source: International Journal of Cancer, January 1, 2004.

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The Worm Turns on Parasite Treatment

By Adam Marcus
HealthDay Reporter
HealthDayNews
Wednesday, January 14, 2004

WEDNESDAY, Jan. 14 (HealthDayNews) -- Pork tapeworm infection is a leading cause of epileptic seizures in developing countries, and in some immigrants to the developed world as well.

What to do about the microbes has been a matter of considerable debate among disease-control experts, many of whom have feared that killing the worms in infected patients could worsen their symptoms by triggering inflammation in the brain.

Not so, says a new study that found wiping out the parasitic worms reduced seizures more than leaving them alone.

"Some people were saying that we should not be killing this parasite because it would do more harm than good," says study leader Dr. Hector Garcia, a worm expert at the Universidad Peruana Cayetano Heredia, in Lima, Peru. "We are doing more good than harm. People who receive the anti-parasitic treatment did better and it's very obvious that they didn't do worse."

A report on the findings appears in the Jan. 15 issue of the New England Journal of Medicine (news - web sites).

Pork tapeworm infection, or cysticercosis, is rampant in many parts of the world -- particularly in Latin America, where pig farming is common. Larvae of the organisms, which live in both pigs and humans and are called Taenia solium, are passed from person to person through contact with infested human feces. Worms travel to the brain, where they can cause small cysts that spark seizures.

Tapeworms also enter people via infected pig meat, where they dwell as larvae. The eggs mature into adults in the gut, and the adults shed more eggs into feces, perpetuating the transmission of the worms.

Drugs that kill the parasites have been available since the late 1970s, but not all doctors have embraced them. Opponents of the treatment argue that many of the cysts disappear on their own over time and drug therapy may lead to permanent seizures by damaging the brain. Advocates of the treatment claim that eradicating the worms prevents seizures from recurring and makes managing the cysts easier.

To test this question, Garcia and his colleagues gave a combination of the worm-killing drug albendazole and the powerful anti-inflammatory drug prednisone to 60 men and women with worm-induced seizures. They gave sugar pills to 60 others with the condition. Patients were watched for 30 months, or until they'd been free of seizures for at least six months.

The rate of partial seizures -- attacks on one side of the brain -- were the same in each group. However, patients who received albendazole had a 63 percent reduction in their chances of suffering "generalized" seizures across their whole brain. What's more, treatment with the drug increased the odds that cysts would heal compared with doing nothing, the study found.

Of the 75 million people in Latin America at risk of the disease, 10 percent develop symptoms, says study co-author Dr. Robert Gilman, a researcher at the Johns Hopkins University Bloomberg School of Public Health.

To best prevent cysticercosis, countries need to make pig husbandry cleaner, Gilman says. Economic development is a proven remedy, eradicating the disease in the United States and other industrialized nations. But development hasn't been quick enough elsewhere.

Although albendazole is often subsidized, Gilman says the therapy isn't meant for widespread control of worm infection: "You're not treating everybody, only those with seizures."

But Dr. James Maguire, chief of parasitic diseases at the U.S. Centers for Disease Control and Prevention (news - web sites), says the bigger costs of treating cysticercosis involve diagnosing the condition, which requires sophisticated brain scans. "It's the unfortunate reality of a lot of modern medicine. Poor people don't have access to it because of the cost," says Maguire, author of a commentary on the journal article.

Tapeworms are vulnerable at various points in their lifecycle, Maguire says. Adult worms can be safely destroyed in humans and pigs with drugs, and a porcine vaccine is, in theory, possible. However, none has yet been developed, he says.

More information

For more on cysticercosis, try the Centers for Disease Control and Prevention. For more on tapeworms, visit the U.S. Department of Agriculture.

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Problems Seen with New Coronary Bypass Device

Reuters Health
Wednesday, January 14, 2004

NEW YORK (Reuters Health) - Newest isn't always best. A recently introduced surgical device intended to improve coronary artery bypass surgery seems to be linked to a high rate of heart attacks or severe angina in the six months after the procedure.

The findings are reported in an expedited review in the Journal of the American College of Cardiology for January 7.

Based on this and additional reports describing high rates of failure of veins used to bypass clogged coronary arteries, Dr. Sotirios Tsimikas and colleagues advise close monitoring of patients in whom the device has been implanted.

The Symmetry Bypass Connector was designed to connect the bypass veins to the aorta without sutures, explain the authors, who are based at the University of California-San Diego in La Jolla. The team had used 320 of the devices in 121 patients during 263 coronary bypass surgeries.

Subsequently, five patients had a heart attack or developed severe angina within 6 months.

Eleven of the vein grafts were either totally blocked or severely compromised, and the team found these blockages were extremely difficult to clear with angioplasty.

Tsimikas' team points out that since their paper was submitted, two additional studies and an abstract presentation revealed similar high rates of short-term failure.

"Up to 10 percent of patients develop clinical symptoms and up to 38 percent may have evidence of some extent of (graft narrowing) in the first six months following coronary artery bypass grafting," they write.

In addition to carefully checking patients undergoing coronary bypass with the device, the authors recommend that patients should be treated with anti-thrombosis agents for at least six months.

Source: Journal of the American College of Cardiology, January 7, 2004.

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Stent With Cancer Drug Shines in Trial

By Adam Marcus
HealthDay Reporter
HealthDayNews
Wednesday, January 14, 2004

WEDNESDAY, Jan. 14 (HealthDayNews) -- Stents coated with a cancer drug sharply reduce the risk that the vessels they widen will narrow again, but only if the drug is released slowly and carefully, a new study suggests.

Stents are metal scaffolds that prop open narrowed blood vessels and restore healthy blood flow to the heart. Coating stents with drugs is all the rage among cardiologists, and advocates of the technology claim it prevents re-narrowing and chest symptoms. They argue that while coated stents cost much more than conventional devices, they pay for themselves in the long run by reducing the need for additional procedures to reopen vessels.

Just how much of a difference drug-coated stents make, however, isn't clear.

Researchers reported last spring that stents coated with paclitaxel reduced return narrowing better than stents without the drug. But that study was small, only 176 patients, and a larger trial failed to confirm the effect.

One explanation, scientists reasoned, was the drug was coming off the stents too haphazardly, without adequate timing or dosing. Modifying the stent with a plastic matrix that slows the release of the drug might improve its ability to prevent narrowing, they thought.

In the new study, the largest yet to test a drug-coated stent, researchers pitted a new stent with slow-release paclitaxel -- the active ingredient in the breast and ovarian cancer drug Taxol -- against a bare metal model in 1,314 men and women with coronary artery disease. After nine months, 732 patients had an X-ray video scan -- called angiography -- of their stented artery to see how well the device was functioning.

At the nine-month mark, the advantage of the drug-coated stents was clear. Only 7.9 percent of the people who received them had narrowing in the treated vessel, compared with 26.6 percent in the group that got the uncoated stent -- a 70 percent reduction.

Patients with coated stents had about a quarter the rate of additional procedures to open their ailing vessels, 3 percent versus 11.3 percent. They also were about 60 percent less likely to have significantly reduced blood flow in the treated artery.

"We found there was a very profound and robust reduction" in return narrowing, or restenosis, says study leader Dr. Gregg Stone, a heart specialist with the Cardiovascular Research Foundation in New York City.

Rates of heart attacks and deaths were similar in the two groups of patients. But that's not surprising, says Stone, whose group reports the findings in the Jan. 15 issue of the New England Journal of Medicine (news - web sites). "We don't expect a drug-eluting stent to reduce death or [heart attacks]. All we expect it to do is to reduce scar tissue growth at the site of the stent," he explains.

The new stent is being developed by Boston Scientific Corp., a leading stent maker. It has yet to be approved for use in the United States, says Stone, who has been a paid consultant for the company.

Despite their great promise, drug-coated stents aren't without problems. The U.S. Food and Drug Administration (news - web sites) recently said it had received reports of more than 360 clotting cases and 70 deaths associated with the device, made by Cordis Corp., a division of Johnson & Johnson. However, experts stress the clots were no more likely in drug-coated stents than in normal ones, and that many thousands of other patients had no problems.

The Cordis stents are coated with the antibiotic sirolimus, which is intended to decrease inflammation and scarring around the scaffolding and prevent re-blockage of the artery.

The latest study did not see a high rate of clots in patients who received those drug-coated stents, the researchers say.

Dr. Thomas Lee, a cardiologist at Harvard Medical School (news - web sites) in Boston and author of an editorial accompanying the journal article, says heart specialists have "some worry" about the clotting potentially tied to drug-coated stents. But, he adds, "I don't really see that there's any reason to believe they're more dangerous than regular stents."

A bigger fear, adds Lee, who is also medical director for Partners Community HealthCare Inc., a health system affiliated with Harvard hospitals, is that doctors will rush to embrace the new stents. "I worry that people will throw them around and overuse them" because of the hype that attends the devices.

More information

To learn more about angioplasty and stenting, visit the CardiologyChannel or HeartCenterOnline.

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Factors Predict Worsening Rheumatoid Arthritis

Reuters Health
Wednesday, January 14, 2004

NEW YORK (Reuters Health) - US researchers have identified several factors that predict which patients with early rheumatoid arthritis will experience worsening of their disease.

Predictors of worsening joint damage seen on an x-ray, include older age, certain gene mutations, the presence of a protein called "rheumatoid factor," and certain markers for old immune cells.

The findings, published in the medical journal Arthritis and Rheumatism, are based on a study of 111 consecutive patients who had rheumatoid arthritis for less than a year. Ninety-four of the patients completed a 2-year follow-up.

During the study period, 52 percent of patients were able to control their disease with standard drugs and did not need steroids, lead author Dr. Jorg J. Goronzy, from the Mayo Clinic in Rochester, Minnesota, and colleagues note. Forty-eight percent of subjects had no evidence of joint erosions throughout the study.

Joint erosions present when the study began were also identified as a predictor of disease worsening on x-ray, the investigators note. A high frequency of older immune cells was directly associated with the risk of worsening.

Although certain gene mutations seemed to raise the risk of deterioration, a mutation in a gene called uteroglobin actually seemed to lower the risk, the authors found.

"Our study documents the need to identify prognostic markers in order to make early treatment decisions in rheumatoid arthritis," the researchers state. "New markers, such as the uteroglobin gene, and biologic markers of (aging cells) show promise and warrant further investigation."

Source: Arthritis and Rheumatism, January 2004.

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New Ways to Catch Heart Defect

HealthDayNews
Wednesday, January 14, 2004

WEDNESDAY, Jan. 14 (HealthDayNews) -- Mayo Clinic researchers have developed improved ways to treat people with a potentially dangerous heart defect, say two studies in the January issue of Mayo Clinic Proceedings.

The studies outline the successful use of new procedures to observe and treat a heart defect called patent foramen ovale (PFO), an opening in the heart that fails to close after birth.

This opening or flap in the wall of the heart may let blood cross from the right (venous) side of the heart to the left (arterial) side and allow blood clots to get into the arterial circulation. These clots may travel to the brain and cause a stroke.

In the first study, researchers outline the use of a new ultrasound probe developed at the Mayo Clinic. This probe provides doctors with important visual information about the location and size of defects in heart walls. The procedure can be used in place of other ultrasound techniques that may be more uncomfortable for patients.

The second study outlines follow-up research on 103 people whose PFO was closed with a catheter device. The results indicate a 93 percent success rate in completely closing the PFO, with few complications. This catheter device may offer an alternative to long-term medication to treat PFO.

An editorial in the same issue of Mayo Clinic Proceedings says further studies are needed into the best treatments for people with PFO.

"We cannot assume that all patients with patent foramen ovale and neurologic symptoms need to have the cardiac abnormality corrected," Dr. Harold Adams Jr., of the department of neurology at the University of Iowa's Carver College of Medicine, says in a prepared statement.

"Some patients might benefit substantially from closure of their patent foramen ovale; however, the procedure might be unnecessary in other patients. The neurology and cardiology communities need to collaborate in clinical studies to prospectively test the safety and efficacy of patent foramen ovale closure devices," Adams says.

More information

Here's where you can learn more about heart defects.

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LASIK Eye Surgery OK for a Few Kids

By Amy Norton
Reuters Health
Wednesday, January 14, 2004

NEW YORK (Reuters Health) - LASIK eye surgery, commonly used to correct blurry vision in adults, may be a safe option for some children with nearsightedness, according to researchers.

Investigators in Ireland found that the laser procedure improved visual acuity in six children who were significantly nearsighted. Five of the children had amblyopia, or "lazy eye," a condition in which the brain favors one eye, leaving the other with much poorer vision.

LASIK, which uses a laser to reshape the eye's cornea, is an increasingly common way to correct common vision problems in adults. However, it is usually not considered suitable for children.

An exception may be made when a young child has one highly nearsighted eye, and the goal of LASIK is to give the child symmetric vision, according to Dr. Robert Maloney, director of the Maloney Vision Institute in Los Angeles and a leading LASIK expert.

Otherwise, it is generally considered inappropriate to perform LASIK in children and teenagers, in large part because their vision is still changing, Maloney explained in an interview.

Though adults usually opt for LASIK for the sake of convenience or cosmetics, these are "never reasons we do it in children," Maloney said.

Reporting in the January issue of the British Journal of Ophthalmology, doctors at Mater Private Hospital and Children's University Hospital in Dublin describe the cases of six children they treated with LASIK.

The children were selected for the procedure because conventional treatments for lazy eye -- glasses, contact lenses and patching the strong eye to force the weak one to do the work -- had all failed.

Two years after the surgery, five of the children had greater visual acuity, report Drs. M. O'Keefe and L. Nolan. One patient showed no improvement because the child did not comply with post-operative patching of the eye, they add.

Maloney stressed that only a small number of children are appropriate candidates for LASIK, and that the procedure should be an option only if conventional treatments for lazy eye have failed. He noted that of the roughly 30,000 LASIK procedures he's done, about four have been in children.

"The last thing we want to do," he said, "is to have parents thinking they're getting their kids LASIK for Christmas."

Source: British Journal of Ophthalmology, January 2004.

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Water Workouts

HealthDayNews
Wednesday, January 14, 2004

HealthDayNews) -- Water workouts are great ways to improve your fitness. The body's natural buoyancy in water also decreases the strain on joints and muscles, according to the American Physical Therapy Association.

But before you jump in, take note of these safety tips:

  • If you're alone in a pool, make sure someone is nearby in case of an emergency.
  • Wait 45 minutes after eating before you enter the pool.
  • If the water is cool, walk several laps to warm up.
  • If you have diabetes or difficulty with your feet, wear an old pair of sneakers or special water shoes.

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Tests Planned for Genetically Engineered TB Vaccine

Reuters
Wednesday, January 14, 2004

LONDON (Reuters) - GlaxoSmithKline Plc., Europe's leading drugmaker, and U.S. biotech firm Corixa Corp. said on Wednesday they planned to start the first human tests of a genetically engineered tuberculosis vaccine.

The new vaccine contains a fusion of proteins from the bacteria that causes TB and the developers hope it will offer improved protection against the killer disease. It has already produced good results in tests on mice, guinea pigs and monkeys.

There is a long-established vaccine against TB, known as BCG, which is one of the most widely-used vaccines in the world. But the product was developed 80 years ago and is only about 50 percent effective, according to some scientists.

Twenty volunteers will be enrolled into the U.S. Phase I trial of the new vaccine which will assess the product's safety and the immune response it generates.

TB bacteria infect some two billion people worldwide. The bacteria are infectious and can be passed on by sneezing.

Each year some eight million people become sick as a result of TB and an estimated two million die annually from the disease, according to the World Health Organization (news - web sites).

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Dry Hands?

HealthDayNews
Wednesday, January 14, 2004

(HealthDayNews) -- Is the cold winter air causing your hands to become dry and flaky?

If so, the National Jewish Medical and Research Center in Denver offers these suggestions:

  • Soak your hands in warm water for 15 to 20 minutes. This gives your skin time to absorb the water.
  • Pat your hands dry and immediately apply a thick layer of an occlusive moisturizer to seal in the water.
  • If your hands still feel dry, wear a pair of light cotton gloves to bed at night. This will further reduce water loss.

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Tuesday, January 13, 2004

Exercise Ups Fitness in Women with Arthritis

By Amy Norton
Reuters Health
Tuesday, January 13, 2004

NEW YORK (Reuters Health) - An exercise plan combining strength training and aerobic conditioning can help women with even long-standing rheumatoid arthritis boost their fitness, a small study in Finland suggests.

Keeping the muscles and heart in shape, researchers say, could allow people with rheumatoid arthritis to better maintain their ability to perform day-to-day tasks.

Unlike the more common osteoarthritis that is often associated with aging, rheumatoid arthritis -- or RA -- arises when the immune system mistakenly attacks tissue in the joints, leading to inflammation, pain and progressive joint damage. The condition, which is seen much more commonly in women than men, is often marked by flare-ups in which there is active inflammation and worsening symptoms, followed by "stable" periods in which symptoms improve.

Because muscle weakness and lower cardiovascular fitness can accompany the joint damage of RA, the new study looked at whether a combination of supervised strength conditioning and endurance training could safely improve fitness among women the disease.

The study, reported in the journal Arthritis & Rheumatism, included 23 women with RA, of whom half were in the early stages of the disease, while the other half had long-standing symptoms. All were in a stable period of the condition and had no active inflammation.

The researchers found that 21 weeks of aerobic activity -- riding a stationary bike or walking -- plus resistance exercises to work the major muscles improved the women's cardiovascular fitness and strength.

What's more, the women did not have to exercise a lot to see these benefits, the study's lead author, Dr. Arja Hakkinen of Central Hospital in Jyvaskyla, told Reuters Health.

The exercise plan called for three aerobic workouts over a two-week period, and the same frequency of strengthening exercises.

What is vital, Hakkinen said, is that each woman's exercise plan was supervised by health professionals. This not only ensured safety, but also allowed each woman's workout to be adjusted over time to most effectively boost her endurance and muscle strength, according to the researcher.

All of the women in the study were on standard RA drugs, but Hakkinen stressed that supervised physical activity is an important component of overall therapy that should begin in the early stages of the disease.

Many people with RA, the researcher said, "live just above the muscle strength threshold" for performing such essential tasks as getting up from a chair or climbing stairs. Improving their strength and endurance could help them preserve their capacity for these daily activities, according to Hakkinen.

Arthritis & Rheumatism, December 15, 2003.

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Veggies May Offer Cancer Cure

HealthDayNews
Tuesday, January 13, 2004

TUESDAY, Jan. 13 (HealthDayNews) -- Another round of healthy applause may soon be due for the likes of broccoli, cabbage, turnips and mustard greens.

It's already recognized that these humble vegetables may help prevent some cancers. Now, researchers at Texas A&M University say they may have found a way to derive a cancer cure from these foods.

The researchers have patented a new use for derivatives of diindolylmethane (DIM), a natural compound derived from certain vegetables, to treat cancer.

"We took advantage of a natural chemical, that research has shown will prevent cancer, and developed several more analogs," chemist Steve Safe says in a prepared statement.

"DIM is a potent substance. But we made it even more potent against various tumors," Safe says.

In laboratory tests, this chemically altered DIM proved effective in inhibiting the growth of breast, pancreatic, colon, bladder and ovarian cancer cells. Limited trials on rats and mice yielded similar results.

"One of the best parts is that this treatment appears to have minimal or no side effects; in the mice trials it just stops tumor growth. The hope now is that the patented chemicals can be developed into useful drugs for clinical trials and then be used for cancer treatment," Safe says.

More information

Here's where you can learn more about eating vegetables and fruits to prevent cancer.

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Breast Cancer Survival Has Improved in Last Decades

Reuters Health
Tuesday, January 13, 2004

NEW YORK (Reuters Health) - Between 1974 and 2000, women with repeat bouts of breast cancer have experienced a significant improvement in survival, new research shows.

Previous reports have shown that overall breast cancer death rates have declined in recent years. However, it was unclear if this trend was due to a greater proportion of patients being diagnosed at an earlier, more treatable stage or to actual improvements in treatment.

In the current study, Dr. Sharon H. Giordano and colleagues, from M. D. Anderson Cancer Center in Houston, assessed the survival outcomes of 834 women who had a recurrence of breast cancer between 1974 and 2000. The findings are reported in the medical journal Cancer.

The patients were all initially treated with chemotherapy protocols approved by the review board at the authors' institution. Based on when their cancer returned, the patients were divided into five groups: 1974-1979, 1980-1984, 1985-1989, 1990-1994, and 1995-2000. The patients were followed for around 9 years after recurrence.

The authors found that survival improved steadily with each more recent recurrence group. With each 1-year increase in the recurrence date, the risk of death fell by 1 percent.

Other factors associated with increased survival after recurrence included smaller initial tumor size, less severe disease, and limited spread to lymph nodes. Also, survival was better for cancers that tested positive for hormone binders called estrogen receptors.

"These findings, although not conclusive, suggest that breast cancer survival has been improving," the researchers state. "We present these data to encourage further research to clarify whether advances in therapy have translated into improvements in survival for women with recurrent breast cancer."

Source: Cancer, January 1, 2004.

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Sizing Up the Risks of Outpatient Surgery

HealthDayNews
Tuesday, January 13, 2004

TUESDAY, Jan. 13 (HealthDayNews) -- A patient's health status and where outpatient surgery takes place play a part in the outcome, claims a U.S. study in the January issue of the Archives of Surgery.

Currently, about 60 percent to 70 percent of all surgical procedures are performed in an outpatient setting such as a doctor's office or a specialized surgery center. More and more high-risk patients, including elderly people, are having outpatient surgeries.

This study examined the risk associated with 16 outpatient surgical procedures -- such as cataract removal, hernia repair, knee arthroscopy, prostate resection -- done on people aged 65 and older.

The researchers examined 564,267 outpatient surgeries. Of these, 360,780 were done at a hospital-based outpatient center, 175,288 were done at ambulatory surgery centers (ASCs), and 28,199 were done in a doctor's office.

The study found there no deaths on the day of surgery at a doctor's office, four deaths the day of surgery at an ASC (2.3 deaths per 100,000 procedures), and nine deaths on the day of surgery at an outpatient hospital (2.5 deaths per 100,000 procedures).

The rate of death for seven days following outpatient surgery was 35 per 100,000 for procedures done at a doctor's office, 25 per 100,000 for surgeries at an ASC, and 50 per 100,000 for procedures at a hospital-based outpatient center.

Hospitalization rates following outpatient surgery also varied by surgical setting. Hospital admission within seven days of surgery was 9.08 per 1,000 outpatient procedures at a doctor's office, 8.41 per 1,000 outpatient procedures at an ASC, and 21 per 1,000 procedures at a hospital-based outpatient center.

The study also found older age, prior hospital stays within the previous six months and invasiveness of the surgical procedure increased the risk of death or hospitalization within seven days of outpatient surgery.

More information

Here's where you can learn more about outpatient surgery.

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Calcium Not Useful for Lead Poisoning if Diet Good

By Anthony J. Brown, MD
Reuters Health
Tuesday, January 13, 2004

NEW YORK (Reuters Health) - Contrary to what researchers expected, calcium supplements do not seem to reduce levels of lead in the blood of children with adequate dietary levels of calcium, new research shows.

Whether this approach works in kids with low calcium levels remains to be seen.

Lead is a toxic molecule that can cause serious illness, according to the report in the medical journal Pediatrics. Children can be exposed to lead by eating certain types of paint found in older homes.

In theory, calcium can lower blood levels of lead by preventing the molecule from binding to various entry sites into the body, lead author Dr. Morri E. Markowitz, from Children's Hospital at Montefiore in the Bronx, New York, told Reuters Health.

"We were disappointed by the results," Markowitz said. "However, one thing we hadn't counted on was that dietary calcium intake would increase from when we planned the study to when it was actually performed. Therefore, we now had a population that was calcium-sufficient at baseline."

What about children with low calcium levels? "We plan on investigating this in a future study, but to obtain this type of population we will probably have to go outside of the U.S.," he explained.

The current study involved 67 young children with moderate lead poisoning. The subjects were given calcium supplements or an inactive "placebo."

During the 3-month treatment period, lead levels decreased in both groups and this change was not influenced by calcium supplementation.

For doctors and parents caring for children with lead poisoning, reducing blood lead levels with calcium or other agents is only a secondary approach, Markowitz emphasized. The main focus is to reduce environmental exposure to lead through measures such as removing lead-based paint, he added.

Source: Pediatrics, January 2004.

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Informed Consent Doesn't Change Choice to Have Cataract Surgery

HealthDayNews
Tuesday, January 13, 2004

TUESDAY, Jan. 13 (HealthDayNews) -- Explaining the risks of cataract surgery as part of an informed consent procedure a day before surgery doesn't seem to influence patients' decisions to have the surgery.

So says an Austrian study in the January issue of the Archives of Ophthalmology.

The study included 70 people, with an average age of 70, about to undergo cataract surgery. On the day before the surgery, the patients received a standardized informed consent procedure. They also answered 15 questions developed by clinical psychologists, lawyers and ophthalmologists.

Of the 70 patients, 16 (23 percent) who arrived for surgery believed there were surgical procedures without any risks; and 53 (76 percent) believed there were no risks for their cataract surgery.

The study found that 31 patients (44 percent) said they preferred that their doctor make the decision for surgery, while 16 patients (26 percent) said they wanted to make the decision together with their ophthalmologist.

It also found the risk of a complication that could compromise sight didn't influence the decisions of 54 patients (77 percent) to go ahead with the surgery, and 55 patients (78 percent) said they weren't influenced by the informed consent procedure.

Fifteen of the patients (22 percent) said the informed consent process helped confirm their decision to go ahead with the cataract surgery.

More information

Here's where you can learn more about informed consent.

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Big Hospitals May Not Be Best for Heart Surgery

By Anthony J. Brown, MD
Reuters Health
Tuesday, January 13, 2004

NEW YORK (Reuters Health) - Unless you're over 65 years of age or very sick, there is no reason to select a hospital for heart surgery based solely on the number of operations performed there each year, new research suggests.

Hospital procedural volume is only modestly linked to the outcomes of heart bypass surgery, also known as coronary artery bypass grafting (CABG), and only in patients over 65 years of age or those who are very sick, the findings show.

"The belief by some groups that limiting CABG to high volume centers will dramatically reduce mortality rates in the US is a fallacy," lead author Dr. Eric D. Peterson, from Duke Clinical Research Institute in Durham, North Carolina, told Reuters Health.

Numerous studies have examined the relationship between hospital volume and surgical outcomes. Although many studies have concluded that outcomes are better at high-volume centers, a report in November found that this was largely due to the caseload of the operative surgeon. In other words, the more experience they had, the better their performance.

The current findings, however, refute the argument that higher procedural volumes mean better CABG outcomes. The results suggest that procedural volume may not be a suitable marker of quality for CABG surgery, according to the report published in the Journal of the American Medical Association (news - web sites).

"We found that the effect of hospital volume on CABG outcomes is somewhat less than what researchers have reported previously," Peterson noted. Moreover, "the benefits of large procedural volumes are confined to older and sicker patients," he added.

In more than 250,000 procedures performed in 2000 and 2001, the overall death rate from the operation was 3 percent. Of the 439 hospitals represented in the database, 82 percent performed fewer than 500 CABG procedures per year.

Operative death rates fell as hospital CABG volume rose, but the effect was mild. For every additional 100 CABG surgeries, operative mortality decreased by just 0.07 percent, the authors found. Moreover, prohibiting 100 of the lowest-volume centers from performing CABG surgery would prevent less than 1 percent of all CABG-related deaths.

Consistent with the report released in November, the hospital volume-outcome link seen in older and sicker patients was mainly affected by the caseload of the individual surgeon, the researchers note.

If volume is not an adequate quality measure, what should patients and providers look for when considering a hospital for CABG? "I would want to know whether the hospital was systematically tracking their outcomes, whether they were benchmarking those outcomes relative to their peers, whether they sought to improve their care over time, and what obviously their outcomes were," Peterson said.

Source: Journal of the American Medical Association, January 14, 2004.

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Massachusetts to examine risks of obesity surgery after 3rd death in a year

The Associated Press
Tuesday, January 13, 2004

BOSTON (AP) - Massachusetts health officials announced plans Tuesday to assemble a panel of experts to examine the dangers of obesity surgery, less than a week after the state's third death in a year linked to weight loss operations.

Separately, officials are investigating the death last Thursday of 37-year-old Howard Reid, who went into cardiac arrest after surgery in which a silicone band was placed around his stomach to restrict his food intake. The inquiry is intended to determine whether Beth Israel Deaconess Medical Center made mistakes during Reid's surgery two days before that contributed to his death.

"The news of yet another death has raised some concerns," said Roseanne Pawelec, a spokeswoman for the Department of Public Health (news - web sites). "This is a surgery that is growing quickly in popularity. We're not necessarily saying we have a problem here. We don't know. The goal is to reduce errors and to improve patient safety."

Dr. Michael Epstein, Beth Israel's chief operating officer, said the hospital is conducting an internal investigation, but declined to comment further.

State officials said the expert panel, which has not been named, will focus on the outcomes of weight loss surgery. The panel will have access to medical reports and details of the Massachusetts deaths, with the goal of offering recommendations within three months, Pawelec said.

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Ephedra, Though Banned, Still Under Attack

By Amanda Gardner
HealthDay Reporter
HealthDayNews
Tuesday, January 13, 2004

TUESDAY, Jan. 13 (HealthDayNews) -- Half the recommended dose of Metabolife 356, a dietary supplement which contains ephedra and caffeine, increased blood pressure as well as one measure of the time between heart contractions, new research shows.

Over time, increased blood pressure can increase the risk of having a heart attack while the change in heart contractions could increase the risk of developing a certain type of arrhythmia, or abnormal heart rhythm.

The findings would add fuel to the anti-ephedra fire, had the U.S. Food and Drug Administration (news - web sites) (FDA) not already announced it was banning products containing ephedra.

According to the researchers, the FDA did, in fact, see the report before its current publication in the Jan. 14 issue of the Journal of the American Medical Association (news - web sites).

"[The FDA] got an advance copy in December," says senior study author C. Michael White, an associate professor of pharmacy at the University of Connecticut School of Pharmacy in Storrs. "I think it definitely did play a part in their decisions."

David Cohen, national science counsel for Metabolife, says the study is flawed for a number of reasons. For starters, the researchers did not acknowledge previous data, which showed no prolongation of the QT interval, Cohen says. Prolonged QT intervals are potentially problematic because they can lead to a dangerously irregular heartbeat called torsade de pointes. Nowhere in this study or in the clinical literature, Cohen adds, is there any record of ephedra being linked to torsade de pointes.

"It's not clear what is the clinical significance of this study," Cohen says. "At the very least, honest researchers acknowledge inconsistent data. That has been the running theme in a lot of what's been going on about ephedra. Nobody, including the FDA, wants to acknowledge all the data that's been out there for years that does not demonstrate that this is a dangerous product and this is just another piece of that."

Weight-loss supplements containing ephedra have been linked to more than 100 deaths, including that of Baltimore Orioles pitcher Steve Bechler last year. The exact physiological mechanism behind these tragedies has not been well understood.

"We have known for a very long time that stimulants like caffeine or ephedra have the potential to create arrhythmia [but] we never really understood the frequency or exactly how it was occurring," says Dr. Larry Chinitz, director of clinical cardiac electrophysiology at New York University Medical Center. "The study documents what we've always had an idea about and suggests that it may be more frequent than we suspected in the past."

Metabolife 356 contains a total of 19 ingredients, including ephedra and caffeine, and is one of the top sellers in its category. The study authors were specifically interested in the product's effect on corrected QT (QTc) interval duration and systolic blood pressure. QTc interval duration is a measure of the time intervals that occur during the electrical impulses that cause the heart to contract. Longer intervals can increase the risk of developing arrhythmia, or abnormal heart rhythms. Systolic blood pressure is the upper number on a blood pressure reading.

Fifteen young, healthy men and women were randomized to receive either the Metabolife product or a placebo. After a one-week break between sessions, the groups switched to receive the other treatment. Heart rates and blood pressure were measured right before taking the pill as well as one, three and five hours after.

Individuals taking Metabolife 356 had longer QTc intervals and higher systolic blood pressure compared with people taking the placebo. The average QTc interval for Metabolife takers was 419.5 milliseconds versus 396.1 milliseconds in the placebo group. The mean systolic blood pressure reading was 123.5 in the Metabolife group versus 118.93 in the placebo group.

Some 53 percent of participants had QTc intervals increases of at least 30 seconds while taking Metabolife 356. Thirty seconds is considered the threshold for possible concern by the European Center for Proprietary Medicinal Products. While the FDA has no similar guideline, it has removed products that induce smaller increases, say the study authors.

Which ingredient is responsible for the changes is not known, but the authors suspect ephedra is the culprit. "It has become very, very hard to find only ephedra-containing products on the U.S. market because of litigation and other things," White says. "We looked at adrenaline, which is a close cousin to ephedra, and we found that, by itself, it can also increase QTc interval, and people know that it can increase blood pressure. Since a close cousin can increase QTc, we're pretty sure that ephedra does also."

The study involved administering only half a dose (one pill versus the two recommended on the package label). "The manufacturers have contended that most of the cases of patient harm involved larger-than-average doses," White says. "We gave the equivalent of one tablet. There's the possibility that, had we given them two, the results may have been worse in terms of blood pressure or QTc interval increases."

It will be easy enough to avoid ephedra once these products are taken off the market. Whether or not to avoid caffeine is an entirely different issue. "In patients who have heart disease, this should be avoided at all costs," Chinitz says. "In the absence of heart disease, one would recommend moderation and recognize that anybody could be affected, but the risk would be smaller."

More information

The American Heart Association (news - web sites) has more on blood pressure testing and on arrhythmias.

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Antibiotic Helps After Stroke, at Least in Mice

By David Douglas
Reuters Health
Tuesday, January 13, 2004

NEW YORK (Reuters Health) - Patients who suffer a stroke are abnormally prone to develop serious infections. Now, German and Russian researchers have shown in animal experiments that antibiotic treatment to prevent such infections leads to a significant reduction in post-stroke deaths and brain damage.

This strategy may become "an important new therapeutical approach to improve outcome in patients with severe stroke," they say in the January issue of the American Heart Association (news - web sites)'s medical journal Stroke

As lead investigator Dr. Christian Meisel told Reuters Health, "stroke victims suffer from a surprisingly high risk of developing severe bacterial infections. These infections, in particular pneumonia, have enormous impact on morbidity, mortality, and rehabilitation of these patients."

Dr. Meisel of Humboldt University Berlin and colleagues point to evidence that a stroke suppresses the immune system, and this underlies the high rate of infection.

To investigate the value of trying to prevent infections in this situation, the researchers gave the antibiotic moxifloxacin to mice after one of their arteries supplying blood to the brain was blocked to induce a stroke. The drug was started either immediately after 60 minutes of blockage, or 12 hours later.

"Moxifloxacin prevented the development of infections and fever," the researchers report, and reduced mortality by 40 percent compared with untreated mice. In addition, 80 percent of treated animals had very little or no brain impairment compared to 43 percent of controls.

As Dr. Meisel pointed out, these improvements occurred with antibiotic treatment "even when started 12 hours after stroke onset." He said, "Several studies worldwide are currently evaluating preventive anti-infective therapy as a novel form of treatment in stroke patients."

Stroke 2003;35:2-6.

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Rhode Island official proposes buying prescription drugs from Canada

The Associated Press
Tuesday, January 13, 2004

PROVIDENCE, R.I. (AP) - The secretary of state urged Rhode Island on Tuesday to join several cities and states that have plans to buy prescription drugs from Canada, despite a federal prohibition on importing them.

Matt Brown said a prescription program for state employees and retirees could save millions of dollars for Rhode Island, which faces a projected $37 million US deficit for the fiscal year that ends June 30. Brown also said he will set up a website to help Rhode Island residents buy medications from Canada, where prescription drugs are substantially cheaper.

"Americans pay the highest prescription drug prices in the world," Brown said in a statement. "This program will help Rhode Islanders get access to quality, affordable prescription drugs."

Boston Mayor Thomas Menino plans to begin allowing the city's employees and retirees to buy drugs from Canada this year, despite pressure from the Food and Drug Administration (news - web sites), which says buying drugs from Canada is risky because U.S. officials cannot guarantee the safety and dosages of the imported medicines.

New Hampshire and Illinois are among the group of states and municipalities developing various plans for purchasing drugs from Canada.

The city of Springfield, Mass., already imports Canadian drugs.

A message left for an FDA spokeswoman for comments on Brown's planned website was not immediately returned.

An aide to Lt.-Gov. Charles Fogarty said the lieutenant governor appreciates Brown's interest in health-care reform.

"Any effort to help people pay for the prescription drugs they need at prices they can afford is worthy of strong consideration," spokesman Ray Sullivan said.

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New Fungus Compounds Halt Hardening of Arteries

By Kathleen Doheny
HealthDay Reporter
HealthDayNews
Tuesday, January 13, 2004

TUESDAY, Jan. 13 (HealthDayNews) -- Two compounds derived from a fungus and tested in mice seem to prevent the accumulation of lipids in cells where hardening of the arteries begins, a Japanese study finds.

If the research bears out, it could help scientists develop new drugs for treating atherosclerosis. The report appears in this week's issue of the Proceedings of the National Academy of Sciences (news - web sites).

In the early stages of atherosclerosis, which boosts the risk of heart attack and stroke, cells called macrophages store cholesterol and fatty acids, setting the stage for hardening of the arteries.

The Japanese team isolated the compounds from the Beauveria fungus and called them beauveriolides. They tested the activity of the compounds in macrophage cells and found the compounds stop the formation of lipid droplets and the activity of an enzyme called acyl-CoA:cholesterol acyltransferase (ACAT), thus preventing the cascade of events that eventually lead to hardening of the arteries.

When tested in mice bred to develop atherosclerosis, these compounds reduced the atherosclerotic lesion formation by about 50 percent in the treated mice, compared to controls. And they did so without causing side effects such as damage to adrenal tissue, which has been found with similar compounds used to inhibit ACAT.

"We first reported that beauveriolides inhibit lipid droplet accumulation in macrophages in 1999," says study author Hiroshi Tomoda, a professor at the Kitasato Institute for Life Sciences & Graduate School of Infection Control Sciences at Kitasato University in Tokyo.

In this study, the team showed the beauveriolides inhibit ACAT enzyme activity directly.

The study reports "an interesting and new finding of a novel compound," says Dr. Gregg Fonarow, a professor of cardiology and a researcher at the UCLA David Geffen School of Medicine in Los Angeles. Eventually, Fonarow says, the compounds may have a therapeutic use.

A variety of such inhibitors have been developed previously, Fonarow says, but when they were tested in small human clinical trials to assess safety some problems surfaced, including toxicity to adrenal tissue and other side effects.

The new compounds, Fonarow adds, "are significantly different. They target the macrophages specifically."

As exciting as the new discovery is, Fonarow notes, therapeutic use is probably five or 10 years away, and that's if the research bears out.

But he notes the statin drugs now commonly used to lower cholesterol were originally derived from fungal compounds, too.

Tomoda's team has already synthesized a number of the fungal compound derivatives and the researchers are searching for more. Hopefully, he says, there will be many such fungal derivatives to test for eventual use in humans.

More information

For more information on hardening of the arteries, see the American Heart Association or the National Library of Medicine.

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Some CoQ10 Supplement Labels Misleading: Report

By Merritt McKinney
Reuters Health
Tuesday, January 13, 2004

NEW YORK (Reuters Health) - People who purchase the antioxidant supplement coenzyme Q10 (CoQ10) may not be getting what they pay for, according to a report released Tuesday by ConsumerLab.com.

In a review of 32 CoQ10 products on the market, several supplements did not contain the claimed amount of the micronutrient. They contained either too much, too little or none at all.

"Anyone using CoQ10 in managing a disease needs to be aware that with the wrong brands they may be getting anywhere from zero to 175 percent of the dose they are trying to take," said ConsumerLab president Dr. Tod Cooperman, "And this can affect their health."

Unfortunately, "There is no way to tell by looking at a product whether it contains what it claims," Cooperman told Reuters Health.

A list of CoQ10 supplements that met the group's standards is available at www.consumerlab.com.

CoQ10, also known as ubiquinone, is a fatty substance found in cell membranes. This substance is involved in transporting electrons during the cellular respiration process, which is how cells get their energy from oxygen.

The micronutrient is an antioxidant, meaning it can counteract the effects of byproducts of the oxidation process.

Although CoQ10 is produced in the body, there is preliminary evidence that it may be helpful to people with Parkinson's disease (news - web sites). Some people with other health conditions, including congestive heart failure and AIDS (news - web sites), also take the supplement.

In the U.S., CoQ10 is classified as a dietary supplement rather than a drug, so it is not regulated by the Food and Drug Administration (news - web sites).

In November 2000, ConsumerLab.com found that one product contained only 17 percent of the CoQ10 claimed on its label. Following up on this discovery, the group reviewed 32 CoQ10 products.

Most supplements met ConsumerLab.com's standards, but one product did not contain any detectable CoQ10. Another product contained only 71 percent of the amount listed on its label, while another product contained 75 percent more than its claimed amount.

ConsumerLab.com is a privately held company based in White Plains, New York. According to the company, it is neither owned by nor has a financial interest in any companies that make, distribute or sell consumer products.

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U.S. announces ban on import of civets because of SARS concerns

The Associated Press
Tuesday, January 13, 2004

WASHINGTON (AP) - The United States has imposed an immediate embargo on the import of civet cats because of suspicions that the mongoose-like animal has spread the SARS (news - web sites) virus to humans in China.

"This embargo will help us protect the American public and prevent introduction of SARS in the United States," Health and Human Services (news - web sites) Secretary Tommy Thompson said Tuesday.

While scientists have not found unequivocal evidence that the small tree-dwelling mammal is responsible for transmitting severe acute respiratory syndrome to humans, they have found the SARS virus in civets and China has ordered the killing of thousands of the animals.

It wasn't clear how many civets, regarded as a delicacy in southern China, are imported into the United States.

Thompson said non-infectious civet products, such as taxidermied animals and civets imported for educational or scientific purposes, would not be affected by the ban.

SARS emerged in Guangdong, southern China, in late 2002 and sickened more than 8,000 people worldwide before subsiding in June. The disease has killed nearly 800 people, including 44 in Canada.

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Many with Migraines Prefer Root Canal to Headache

By Alison McCook
Reuters Health
Tuesday, January 13, 2004

NEW YORK (Reuters Health) - Nearly one-third of people who suffer from migraines have never been formally diagnosed by a doctor, and many attribute their crippling pain to simply sinus pain or tension, according to a new survey.

Indeed, it seems many sufferers would rather visit the dentist than a doctor -- almost one out of three people with migraines said they would prefer to have a root canal than another headache.

Dr. Merle Diamond, spokesperson for the National Headache Foundation (news - web sites), which commissioned the study, said many people with migraines may not receive a proper diagnosis because they attribute their headaches to something else, or because they are reluctant to seek help.

"I think there's still a certain amount of embarrassment about" having migraines, Diamond, of the Diamond Headache Clinic in Chicago, told Reuters Health.

Approximately 28 million people in the U.S. suffer from migraines, severe headaches that can cause people to miss work and disrupt their routines. Symptoms of migraines include severe head pain lasting up to 72 hours, nausea, vomiting and sensitivity to light and sound.

As part of the survey, conducted by Harris Interactive, researchers asked 1,020 adults if they ever suffer from migraines or other types of headaches, and how they typically respond to the pain.

Six percent of the sampled adults said they experience migraines, and another six percent said they suffered from severe headaches.

However, upon further questioning, it became apparent that most of the people who claimed to have severe headaches actually suffered from migraines, and had failed to recognize the classic symptoms, according to Diamond.

Indeed, the vast majority of people who appeared to experience migraines said they attributed their headaches to a variety of factors, including sinus pressure, hormones or a menstrual cycle, or stress.

As a basic rule, Diamond said that stress and sinus headaches "tend not to be disabling," whereas migraines can have a severe impact on your ability to function.

In fact, the majority of people with migraines said their headaches had an impact on many aspects of their lives, including social activities, work, exercise and time with family.

Along with root canals, other painful activities respondents would prefer over a migraine included a broken nose and childbirth.

Approximately 59 percent of migraine sufferers popped a prescription medication when a headache kicked in. Other remedies included over-the-counter medicines, rest and avoiding known triggers like chocolate or wine.

In an interview, Diamond said these results should encourage people who think they may have a migraine to seek help from their doctors, and to find a therapy that helps them conquer the pain.

Effective treatments for migraine include lifestyle changes, such as diet, sleep and exercise, or prescription medications. "Getting a good therapy can really help you to function normally," Diamond said.

To conduct the survey, the National Headache Foundation received a grant from GlaxoSmithKline, which makes Imitrex, a prescription medication for migraines.

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Another Ontario hospital warns of improperly sterilized equipment

By Keith Leslie
Canadian Press
Tuesday, January 13, 2004

TORONTO (CP) - Another southern Ontario hospital admitted using improperly sterilized equipment Tuesday even as Health Minister George Smitherman gave a clean bill of health to disinfection procedures at hospitals across the province.

Tuesday's warning makes the Grand River Hospital in Kitchener, Ont., the ninth in the province to alert former patients to the possibility they may have been exposed to equipment that wasn't properly sterilized.

A probe used to treat women with a cervical condition was cleaned and sanitized, but "not sterilized in accordance with Health Canada guidelines," said Dr. Chris Steingart, medical director of infection control.

As a result, patients who were treated with the probe between May 1990 and November 2003 - probably fewer than 100, Steingart said - may have been exposed to a virus which causes genital warts.

"We hope to start notifying our patients this evening," Steingart said.

"We're just trying to do what we can in our community to make sure the people that need to have this information have it as soon as they can."

Steingart said the risk to patient health is low, but added it will likely take time to track everyone down because the hospital's electronic database only dates back to 1997.

Word of the alert came as Smitherman announced that the provincewide audit of hospital sterilization techniques - ordered in November after hospitals in Toronto and nearby Oshawa reported similar breaches - had uncovered no new problems.

"Ontario citizens should have confidence that infection control in Ontario hospitals has been strengthened because of this audit," he told a news conference.

Smitherman ordered the audits last fall after Sunnybrook hospital in Toronto and Oshawa's Lakeridge facility reported having used improperly sterilized equipment.

Six more facilities discovered problems with their sterilization techniques as a result of the audits. Some 1,300 patients had to be tested for possible exposure to HIV (news - web sites) and hepatitis.

Smitherman noted that Grand River had asked for more time to review one of its procedures "to see if there is a patient safety risk."He later said the timing of the alert was probably just a coincidence.

"The minute that they figured out that the problem was such that it warranted notification of people, the obligation on their part was to go public with that, and that's what they did," he said in a telephone interview.

"I believe that the audits were a very worthwhile exercise because they indicated that we could do better, and we are now doing better."

Other Ontario hospitals reporting similar problems last fall included York Central north of Toronto, Brantford General, Cambridge Memorial, Hotel Dieu in St. Catharines, St. Mary's in Kitchener and Winchester District Memorial in eastern Ontario.

The scare also prompted health officials in neighbouring Manitoba to order similar audits of their own sterilization procedures.

In Ontario, at least two class-action suits have been filed against the hospitals on behalf of the patients.

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Monday, January 12, 2004

School and Work Call on Same Mental Skills

HealthDayNews
Monday, January 12, 2004

MONDAY, Jan. 12 (HealthDayNews) -- If you're successful in school, there's a good chance that pattern will repeat itself in the work world.

An analysis of 127 studies involving 20,352 people concluded that the intelligence needed to make it in the workplace is similar to the intelligence necessary for academic achievement.

The findings, published in the January issue of the Journal of Personality and Social Psychology (news - web sites), contradict the popular idea that there's a great difference between the general cognitive ability required to excel in the classroom and those needed to succeed on the job.

General cognitive ability (g), a concept introduced nearly a century ago, is believed to predict a broad range of a person's behaviors and performances. This includes academic success, job performance, creativity and health-related behaviors.

However, not all experts accept this idea. They believe there's a difference in the abilities needed to achieve success in school and abilities required to make it in the workplace.

In this study, researchers at the University of Illinois at Urbana-Champaign and the University of Minnesota say their analysis offers evidence that g is related to a person's success in many areas, including work and school.

"Although the academic setting places a greater emphasis on the acquisition of knowledge, performance in both academic and work settings is predicted by g," the researchers write.

"Both situations involve learning and contain complex or practical tasks, and performance in both situations is partially determined by previously acquired levels of knowledge and skill. General cognitive ability is related to all three of these, which is why it should come as no surprise that the same cognitive ability test is a valid predictor of performance in both settings," the authors write.

More information

Here's where you can find more on g.

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Dieters Seek Alternatives to Ephedra

By Lauran Neergaard
AP Medical Writer
The Associated Press
Monday, January 12, 2004

WASHINGTON - People who think ephedra helped them lose weight are looking to new ingredients with names like guarana, bitter orange and green tea extract to replace the soon-to-be-banned dietary supplement.

There's little proof yet that ephedra alternatives actually burn pounds, and scientists warn that some come with health considerations of their own including an ephedra mimic that might interact dangerously with medicines the dieter also swallows.

"There are a number of, quote-unquote, `ephedra substitutes' on the market now where even less is known about potential side effects," Food and Drug Administration (news - web sites) Commissioner Mark McClellan cautioned in an interview last week.

The FDA will pull ephedra off the market soon and wants consumers to stop immediately using the herbal stimulant, which is linked to 155 deaths and dozens more heart attacks and strokes.

Many consumers are ignoring that advice. There has been a run on remaining ephedra supplements since FDA's warning two weeks ago, even though studies show ephedra helps people lose only a few pounds more than dieting alone.

Still, as January ushers in postholiday diets, Americans are turning to the burgeoning ephedra-free market, too. Topping the lists of new ingredients are caffeine-containing supplements, some that deliver the buzz of at least three cups of coffee in one dose. Not all mention caffeine on the label; consumers may have to learn herbal aliases such as guarana and green tea to ensure they don't get caffeine jitters by taking multiple supplements.

The ingredient drawing the most attention is bitter orange, which McClellan says the FDA is monitoring closely because it contains synephrine, a stimulant chemically similar to ephedra.

Also called citrus aurantium, the peel of this very sour "Seville orange" is found in some foods like orange marmalade.

"It's not as potent as ephedra unless you take it in much higher doses," says Mark Blumenthal of the American Botanical Council.

But some scientists note that synephrine can increase blood pressure and constrict blood vessels, as ephedra does, and question whether using it with caffeine could worsen those effects the way taking ephedra with caffeine does.

"There's not really a reason to think citrus aurantium will be safer," says Dr. Adriane Fugh-Berman of Georgetown University, an expert on herbal supplements.

More worrisome, she says, is that bitter orange could interact dangerously with prescription or over-the-counter drugs.

Why? It's related to a longtime warning against taking medications with grapefruit juice. Grapefruit contains a natural chemical that inhibits one of the body's drug-metabolism routes so that some medicines build up to dangerous levels, and bitter orange contains even more of that drug-boosting substance, says Fugh-Berman.

Studies to date show bitter orange inhibits metabolism of at least two drugs, the popular over-the-counter cough medicine dextromethorphan and the prescription blood-pressure drug Plendil.

As for shedding pounds, there's no evidence in people yet that it works.

Other ephedra alternatives:

  • Green tea extract. Green tea typically contains less caffeine per cup than coffee, plus many antioxidant vitamins.

Caffeine itself can be a mild appetite suppressant, and proponents say there may be other substances in green tea that could slightly speed calorie burning. There's no evidence yet that green tea causes weight loss, but Fugh-Berman calls the possibility interesting and says the substance probably is harmless.

  • Guarana, used in a popular Brazilian (news - web sites) soft drink, contains two to three times as much caffeine as coffee, Blumenthal says. Other caffeine-containing supplements are kola and mate.
  • Garcinia, also called hydroxycitric acid. A Journal of the American Medical Association (news - web sites) research review found no good evidence of weight loss.
  • "Starch-blocking" pills promise to help starchy foods pass through the body with less calorie absorption. Most are made with kidney-bean extracts not thought to be harmful. Supplement giant Metabolife International cites a small study that found users dropped slightly more weight than regular dieters, but the research has not been published.

Old-fashioned fiber works on the same principle and can fill people up so they eat less, notes Fugh-Berman. But she says it's impossible to get as much fiber in a pill as from a glass of Metamucil, made with the soluble fiber psyllium.

  • Bladderwrack, an herb that contains a lot of iodine, which could cause or worsen thyroid disease, notes a recent supplement review by University of Montana pharmacists. Germany, which strictly regulates herbal medicines, lists bladderwrack as unapproved, citing the health risk and lack of evidence that it burns pounds.

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

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Diabetes and Oral Health

HealthDayNews
Monday, January 12, 2004

HealthDayNews) -- If you have diabetes, you should pay extra attention to oral health. Diabetics are prone to mouth infections, dry mouth, and oral thrush.

The National Institute of Dental and Craniofacial Research suggests these steps for keeping your mouth healthy:

  • Control your blood glucose.
  • Brush and floss daily.
  • See your dentist regularly, and make sure you tell him or her that you have diabetes.
  • Tell your dentist if your dentures don't fit properly, or if your gums are sore.
  • If you smoke, quit. Smoking makes gum disease worse.

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Vitamin D May Help Prevent MS, Rheumatoid Arthritis

Reuters Health
Monday, January 12, 2004

WASHINGTON (Reuters) - Vitamin D -- which the body makes when exposed to sunlight -- may help prevent multiple sclerosis and rheumatoid arthritis, two studies suggest.

The findings may help explain why the two autoimmune diseases are more common in northern climes, where sunlight is often scarce, the researchers said.

In a study released Monday for the Jan. 13 issue of Neurology, the researchers found women who take multivitamins containing vitamin D are 40 percent less likely to develop multiple sclerosis than women who do not take supplements.

"Because the number of cases of MS increases the farther you get from the equator, one hypothesis has been that sunlight exposure and high levels of vitamin D may reduce the risk of MS," said Kassandra Munger of the Harvard School of Public Health in Boston, who led the study.

"These results need to be confirmed with additional research, but it's exciting to think that something as simple as taking a multivitamin could reduce your risk of developing MS."

Multiple sclerosis is a crippling disease caused when the immune system, for unknown reasons, mistakenly damages the myelin, the protective fatty sheath around nerves.

Symptoms range from tremors to paralysis to memory loss and vary from person to person. There are treatments that help, but no cure.

Munger's team looked at two studies of 187,000 nurses that followed what the women eat and do in their lives, then chronicled their health. Out of all the women, 173 developed MS over a 20-year period.

The nurses with the highest intake of vitamin D from supplements -- 400 IU or more a day -- were 40 percent less likely to develop MS than those who used no supplements. The women who only got vitamin D from food such as fortified milk did not lower their risk of MS.

A second study, published in the journal Arthritis & Rheumatism, showed that vitamin D may prevent rheumatoid arthritis, another autoimmune disease in which the joints are attacked and destroyed.

The 11-year study of 29,368 women aged 55 to 69 involved detailed questions about eating habits, use of vitamin pills and other lifestyle choices. In this group, 152 women developed rheumatoid arthritis.

The women whose diets were highest in vitamin D had the lowest occurrence of the disease, the researchers at the University of Iowa, the University of Alabama at Birmingham and elsewhere found. Again, supplements seemed to be a better source than food, they reported.

The vitamin may somehow affect the immune system, the researchers said.

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Morning Headache a Widespread Problem

By Ed Edelson
HealthDay Reporter
HealthDayNews
Monday, January 12, 2004

MONDAY, Jan. 12 (HealthDayNews) -- A morning headache is a common experience for one of every 13 persons, a new survey finds, and these painful awakenings are closely associated with depression and anxiety.

The survey included 18,980 residents of five European countries, and the incidence of morning headaches is almost certainly similar in the United States, says Dr. Maurice M. Ohayon, an associate professor of psychiatry and behavioral sciences at Stanford University School of Medicine.

He reports his results in the Jan. 12 issue of The Archives of Internal Medicine (news - web sites).

The high incidence of morning headache "is very surprising," Ohayon says. "It means that a lot of people are suffering."

"With a population of 300 million in America, it means that 27 million people are suffering," he says. These are people who do not sleep well, who wake up with pain. There are probably a lot of consequences, in their work and their personal relationships."

Heavy drinkers, people with high blood pressure and those with conditions affecting muscle and skeletal function are among those most likely to start the day with a throbbing head, the survey finds. But the highest incidence was among people with depression and anxiety disorders.

In all, 1,442 people, 7.6 percent of those who were questioned, said they have chronic morning headaches -- 1.3 percent every day, 4.4 percent "often" and 1.9 percent "sometimes."

Women are slightly more likely to have chronic morning headaches (8.4 percent vs. 6.7 percent of men) and one of every 11 middle-aged persons, aged 45 to 65, is a persistent sufferer.

The survey produces one "do" and one "don't" for people with chronic morning headaches, says Dr. Seymour Diamond, executive chairman of the National Headache Foundation (news - web sites) and director of the Diamond Headache Center in Chicago.

"If you wake up with a headache every morning, you should check your blood pressure," Diamond says, because of the link between high blood pressure and morning headaches found in the survey.

But don't think surgery to correct a breathing disorder will do much for the headache problem, Diamond says.

"There is a lot of literature about morning headaches are due to obstructive nose disease and other types of obstructed breathing," he says. "This survey does not validate that opinion."

Mainly, Diamond adds, "this survey solidifies the fact that depressive disorders can cause frequent early morning headaches."

The best medications for chronic headache sufferers are the older tricyclic antidepressants such as amitryptyline (Elavil) and amoxapine (Asendin), Diamond says. They are available in less expensive generic versions and have been "more effective in my clinical practice" in preventing headaches than newer SSRI antidepressants such as fluoxetine (Prozac), he says.

More information

A summary of the morning headache problem is offered by the National Headache Foundation. Here's more on depression.

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Study Tells Overweight Adults to Walk

By Lindsey Tanner
AP Medical Writer
The Associated Press
Monday, January 12, 2004

CHICAGO - Overweight adults who are not on a diet need only a small amount of exercise the equivalent of a half-hour of brisk walking per day to prevent further weight gain, a study found.

Participants who got no exercise during the eight-month study gained an average of almost 2.5 pounds. But 73 percent of those who briskly walked 11 miles a week, or about 30 minutes a day, were able to maintain their weight or even lose a few pounds.

The most noticeable weight loss occurred in those who did the most vigorous exercise jogging about 17 miles weekly. They lost an average of nearly eight pounds over eight months, and also shed more than 10 pounds of body fat and gained about 3 pounds of lean body mass on average.

The study was led by Duke University researchers and involved 120 overweight or mildly obese adults who were instructed not to diet during the research. The findings appear in Monday's Archives of Internal Medicine (news - web sites).

The study confirms that exercise without cutting calories is not the most effective way to lose weight, said Dr. Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis.

But demonstrating that small amounts of exercise alone can prevent weight gain is significant, given the nation's growing obesity epidemic, Klein said.

"That's important because on average we gain about a pound of fat a year from age 25 to 55 in this country," he said. "Preventing that would be very important."

The men and women studied were ages 40 to 65. They had an average body-mass index of 29.7; anything between 25 and 29 is considered overweight, while 30 and above is obese. The index is a height-weight ratio.

Government estimates suggest more than 60 percent of American adults are overweight.

The study may help settle confusion over conflicting recommendations from the Institute of Medicine (news - web sites) and the federal Centers for Disease Control and Prevention (news - web sites).

The institute, a private group that advises the government, has recommended adults get at least an hour of moderate-intensity exercise daily. The study's findings suggest that may be unrealistic and unnecessary for weight maintenance; they are more in line with the CDC's recommendations for a half-hour of moderate exercise per day, said Duke researcher Cris Slentz, the study's lead author.

On the Net:

Archives: http://archinternmed.com

CDC: http://www.cdc.gov/nccdphp/dnpa/obesity/

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Ethnicity May Be Risk Factor for Asthmatic Kids' Allergies

HealthDayNews
Monday, January 12, 2004

MONDAY, Jan. 12 (HealthDayNews) -- Ethnicity may influence the risk of developing multiple allergies in children with asthma, says a U.S. study in the January issue of Chest.

The study of 791 children, aged 4 to 18, in Hartford, Conn., found Puerto Rican children with asthma were up to three times more likely to suffer indoor and outdoor allergies than white children with asthma. Black children with asthma were two to three times more likely to suffer outdoor allergies than white children with asthma.

"Asthma is a significant public health problem among Puerto Ricans, but the extent to which this population is affected by allergies is not completely understood," study author Dr. Juan Celedon, of Brigham and Women's Hospital in Boston, says in a prepared statement.

"Puerto Rican and African-American children are more likely to live in poor housing conditions and, consequently, have an increased risk of exposure to certain allergens. Not knowing a child is allergic to certain allergens may result in the child being continuously exposed to these allergens, which can ultimately make asthma management more difficult," Celedon says.

The high frequency of positive allergy test results in Puerto Rican and black children with asthma in this study suggests that children in these groups need to be tested for allergies more often. However, these children often have limited access to allergy skin tests.

"Parents of Puerto Rican or African-American children with asthma should be aware that allergy skin testing may be helpful in managing their child's asthma, particularly if the child has asthma that is difficult to treat," Celedon says.

More information

Here's where you can learn more about allergies.

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Breast Cancer Drug Herceptin Fails in Lung Trial

By Ben Hirschler
European Pharmaceuticals Correspondent
Reuters
Monday, January 12, 2004

LONDON (Reuters) - Herceptin, a novel breast cancer drug that has extended the lives of many women, has failed to produce similar benefits for lung cancer patients, German researchers said on Tuesday.

Results of an intermediate Phase II trial, involving more than 100 patients, found that those given the drug alongside traditional chemotherapy did no better than patients treated with chemotherapy alone.

Lead investigator Ulrich Gatzemeier of Krankenhaus Grosshansdorf, Germany, said the findings were disappointing since test-tube experiments had suggested Herceptin might work in lung cancer patients with a specific gene defect.

In the event, his team found very few patients with non-small-cell lung cancer (NSCLC), the commonest form of the disease, had the right genetic profile to benefit.

Herceptin, a monoclonal antibody approved in 1998, is designed to treat cancers in patients whose tumors over-express the growth-promoting HER-2 gene.

It is marketed by U.S. group Genentech Inc and Switzerland's Roche Holding AG.

In breast cancer, it is suitable for around a quarter of patients -- enough to generate estimated worldwide revenue of around $850 million in 2003, according to industry analysts.

But while over-expression is also common among many lung cancer patients, the German research team found less than two percent had sufficiently high HER-2 for Herceptin to make a difference.

"The main reason for the negative result is the very low level of strongly HER-2 positive patients," Gatzemeier told Reuters.

Gatzemeier, whose research was supported by Roche and published in the Annals of Oncology journal, said it made no sense to look further at Herceptin in combination with chemotherapy, since the tiny percentage of patients who might benefit made clinical trials impractical.

The drug might, however, have a role to play if given in combination with other so-called targeted therapies which attack different biological pathways, he added.

Tumor cells use a number of parallel signaling pathways to promote growth and blocking more than one at a time is increasingly viewed as a promising way forward.

Other targeted therapies include drugs like AstraZeneca Plc's Iressa, which was approved last year as a last-resort lung cancer treatment and works by blocking a target called EGFR.

Lung cancer, the biggest of all cancer killers in North America and Europe, has proved notoriously hard to treat and 90 percent of patients die within five years. NSCLC accounts for around 75 percent of all lung cancer cases.

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Hispanic Teens Face High Chances of Heart Disease, Diabetes

HealthDayNews
Monday, January 12, 2004

MONDAY, Jan. 12 (HealthDayNews) -- An alarming number of Hispanic pre-teens have at least one risk factor for cardiovascular disease or type 2 diabetes.

That's what two University of Southern California (USC) studies say in the January issue of the Journal of Clinical Endocrinology & Metabolism.

One study found three in 10 Hispanic pre-teens have metabolic syndrome, which comprises numerous risk factors for type 2 diabetes and cardiovascular disease. The risk factors associated with metabolic syndrome include: high blood pressure; low levels of HDL ("good") cholesterol; central obesity; elevated triglycerides (a fat linked to heart disease); and impaired glucose tolerance (abnormally high blood sugar levels, also called pre-diabetes).

This high rate of metabolic syndrome may be due to the fact that obesity is particularly common among Hispanics, the researchers suggest. They note that 35 percent of young Hispanics are overweight, about twice as many as a decade ago. Obesity is linked with insulin resistance, which is linked to metabolic changes and increased risk of disease.

The second study found that nearly three of 10 Hispanic pre-teens (28 percent) already have impaired glucose tolerance (pre-diabetes), putting them at a heightened risk of developing type 2 diabetes.

"Obesity is now a critical, common nutritional problem in children," researcher Michael I. Goran, a professor of preventive medicine and physiology and biophysics at USC's Keck School of Medicine, says in a prepared statement.

"These studies show that the likely common pathway linking obesity to increased risk for type 2 diabetes and cardiovascular disease is insulin resistance. Our results show that this link is established early in life," Goran says.

More information

Here's where you can learn more about metabolic syndrome.

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Dance From Brazil Latest Exercise Trend

By Holly Hickman
Associated Press Writer
The Associated Press
Monday, January 12, 2004

DURHAM, N.C. - A centuries-old Brazilian (news - web sites) dance that combines martial arts with the pulse and energy of a Carnival party is sweeping U.S. fitness centers, challenging gym rats constantly looking for new trends.

It's called "capoeira" (cap-WAY-rah), and membership has tripled in North Carolina's Research Triangle. It's popping up in gyms from the trendy Crunch in New York City to the public the Parks and Rec in Provo, Utah. And cities such as Nashville, San Diego, London and Vancouver brim with burgeoning capoeira communities.

Brian Donnelly, who does capoeira in New York, says it's impossible to be bored in class.

"You trim the fat. You play a cool instrument. You learn a new language. ... And that's just the first 20 minutes," Donnelly said.

Those first 20 minutes typically consist of calisthenics to raise the heart rate. The teacher, called the "mestre," then demonstrates a new skill, such as a kick-and-duck or a cartwheel. The movements have foreign names, but most teachers conduct class in English.

After a half-hour or so of practice, the class transforms the energy of the aerobics room into a vibrant and stirring pulse.

The class forms a circle, called the roda (HO-da), and beats drums native to Brazil. The teacher plays a stringed instrument called the berimbau and belts out songs in Portuguese that have easy-to-imitate refrains. The lyrics give verbal directions, praise and reprimands to two people who then spar inside the circle.

"That live, interactive, fluid group energy is critical," Donnelly said.

On a December day at a Beyond Fitness gym in Durham, two people lock eyes and crouch at the opening of the roda. They clasp hands and stir under the infectious music. Then they release their arm-wrestle grip and hurtle themselves toward the center of the circle.

For the next few minutes, their limbs interweave and shadow. She cocoons her body and he lunges, sways and arcs his fists toward her. They do not make contact. They do not stop sweating.

"I have to say the reason I don't look 38 is because of capoeira," instructor Lua Fabbri said after her exchange in the roda. The Italian native teaches in Brazil, New York and North Carolina. Her student Scott Bailey said three months of capoeira has cultivated muscles he never knew he had.

"It increases agility and strength, and we're having more fun than those runners on the treadmill," Bailey said.

The Duke University freshman embraces capoeira's vibrant energy.

"It's called axe (ah-SHAY), or life force, because you leave here so revitalized," Bailey said after two hours of corkscrewing his body, singing and sparring with 11 classmates.

No, not sparring, corrected Fabbri.

"We don't fight capoeira, we play capoeira," she said. "The slaves in Bahia (a region of Brazil) who created it were forbidden to fight. It's a martial art that's disguised as a dance, so to fight capoeira would be to lose its essence."

As Bailey and Fabbri are in the circle, a more advanced student, Amani Redd, cuts in, and Bailey folds himself back into the surrounding group. The teacher speeds up the tempo, and Redd and Fabbri slash into each other's spaces. A shy beginner then takes Fabbri's place. Redd slows her powerful swooshing to accommodate her new partner

"I was a beginner once, too," Redd said. "But you catch the bug, and the others help you learn."

Fabbri teaches two classes a week here to up to 30 people. She says all age groups can play, and that people with less hardy bodies can tailor moves to suit their abilities.

"Some of our New York students are in their sixties and never exercised before," she said.

Shelby Braxton-Brooks remembers heeding the call of capoeira in Brazil's Bahia region, under beachside sunsets and above the sugar cane fields where 17th-century slaves created it.

"The energy was so infectious, the African influences so alive," the New York actress recalled. "The moves were so poetic. I loved that I couldn't tell if it was a dance or martial arts class. I just got sucked in."

On the Net:

Capoeira Online: http://www.capoeira.com/online/welcome/

Planet Capoeira: http://www.capoeira.com/planetcapoeira/

Lua Fabbri and Contra-Mestre Caxias online: http://nyccapoeira.com/

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Research Raises Cancer Concerns Over Deodorants

Reuters
Monday, January 12, 2004

LONDON (Reuters) - Chemicals found in underarm deodorants have been detected in the tumors of breast cancer sufferers, British scientists said Monday.

Researchers at the University of Reading found traces of the chemicals called parabens in tissue samples, proving that the preservatives can accumulate inside the body, although a direct link with breast cancer has not been proven.

"Their detection in human breast tumors is of concern since parabens have been shown to mimic the action of the female hormone estrogen, and estrogen can drive the growth of human breast tumors," Dr. Philippa Darbre, lead author of the study, said in a statement.

"It would therefore seem especially prudent to consider whether parabens should continue to be used in such a wide variety of cosmetics applied to the breast area," she added.

But Dr. Philip Harvey, European editor of the Journal of Applied Toxicology, which published the research, stressed the need for more investigation.

"Further work is required to examine any association between estrogenic, and other, chemicals in underarm cosmetics and breast cancer," he said.

Despite previous suggestions that chemicals in deodorants and anti-perspirants may be adding to a rising incidence of breast cancer, charities stress that no evidence exists to support any link.

"Breast cancer is a complex disease and we do not yet understand all its causes," said Delyth Morgan, Chief Executive of breast cancer charity Breakthrough.

"There has been a lot of discussion surrounding a link between anti-perspirants and the disease but there is still no scientific evidence of a causal link," she added.

Breast cancer is the most common cancer in women worldwide, with one in nine UK women likely to develop the disease at some time in their life.

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Cervical Cancer Screening: New Guidelines, More Options

By Amanda Gardner
HealthDay Reporter
HealthDayNews
Monday, January 12, 2004

MONDAY, Jan. 12 (HealthDayNews) -- Since the Pap smear was introduced more than half a century ago, the death rate from cervical cancer has plummeted.

The question now is not whether women should be screened for the highly treatable disease, but how often and with what test. Fortunately, new guidelines make that decision easier.

"Cervical cancer screening has been fantastically successful because we've had such a tremendous impact on mortality over the last 50 years," says Dr. Diane Solomon, a senior investigator in the breast and gynecologic cancer research group at the National Cancer Institute (news - web sites). "Cervical cancer is virtually 100 percent curable when it's in the precancerous stage."

Catching it early is critical; more than half of the deaths from this type of cancer occur in women who weren't adequately screened.

An estimated 12,200 new cases will be diagnosed in 2003, and approximately 4,100 women will die of the disease, according to the U.S. Centers for Disease Control and Prevention (news - web sites).

Today, women have more screening options than ever. That means more choices need to be made and what better time to start making them than in January, which is Cervical Health Awareness Month.

Cervical cancer is caused by the ubiquitous human papillomavirus (HPV). At some point in time, the majority of women will have the virus, which is sexually transmitted. However, most will get rid of it quietly and painlessly, often without realizing they're infected, experts say.

"Most women never know they have it and don't need to be concerned they have it," says Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society (news - web sites).

In the extreme minority of cases, however, the virus progresses to cancer. "Only a very small number of HPV infections that are persistent become a risk for cervical cancer," Solomon says. Because it probably takes decades for an HPV infection to become cancer, screening tests have ample time to stop the disease in its tracks.

A number of organizations have issued guidelines for cervical cancer screening, guidelines that were recently confirmed by a study in the New England Journal of Medicine (news - web sites).

The guidelines recommend women under 30 should have annual Pap smears. Those over 30 who have had three normal (or negative) Pap tests in a row can extend the interval between screenings to three years.

"Cervical cancer is so slow-growing that getting screened every year [for low-risk women] is really overkill," Saslow says. Women who get screened too often can end up with abnormal results that are medically meaningless but can cause huge amounts of anxiety and cost money.

Women should start screenings three years after becoming sexually active or when they turn 21. Previous guidelines had recommended starting at age 18, which is now considered too early.

Those 65 and older who have been screened and have been getting normal Pap results can stop if they want.

It's also not necessary to get screened if you had your cervix removed as part of a hysterectomy. Before you stop getting tested, however, make sure your cervix really was removed, as it is in 99 percent of these procedures.

The new recommendations don't specify that women must have a traditional Pap test. Although the Pap is "still a good test," Solomon says, there are now a range of choices.

The Pap smear, which is done as part of a routine pelvic exam, involves using a Q-tip or similar tool to take a sample from the cervix (the neck of the uterus and easily accessible through the vagina). The sample is smeared on a slide, then sent to a lab for analysis.

"The Pap has a high failure rate, but that hasn't been a big problem because cervical cancer is so slow you can get it the next year," Saslow says. "But people are still not comfortable with the fact that the Pap test misses a lot."

The newer liquid-based Pap test takes the sample in the same way but, instead of scraping it on a slide, dips it into liquid. The advantage of this test, Saslow says, is like shaking up a box of Raisin Bran. If the suspicious cells are the raisins, it's better to shake the box up. The liquid provides a more purified sample, a more representative sample and also eliminates mucus, blood and other obfuscating elements. On the downside: the cost is double and the sensitivity is increased, meaning the test may flag things that really aren't a cause for concern.

The HPV test looks specifically for the HPV virus, as opposed to the abnormal cells that are targeted in the above two tests. This means that women under the age of 30, most of whom will have the virus, should not take the test, health experts say.

"In young women, the cost-benefit balance of using the HPV test to augment screening is not beneficial," Solomon says. "Too many women are HPV-positive and the risk of cancer is so low, it's more an issue of overtreatment."

Even for those over 30, many more women are going to test positive than are going to develop cancer. The HPV test is done with a Pap test so if the Pap is normal and the HPV is positive, women will have to wait a year before deciding if they need to take another step.

On the other hand, if you test negative on the HPV and the Pap tests, your odds of developing cancer are virtually nil.

"If you get a negative HPV test, your chance of getting cervical cancer in the next few years is almost zero," Saslow says. "The reassurance is extremely high, but the problem is a lot of people are going to test positive and they don't need to be that worried."

More information

The American Cancer Society and the National Cancer Institute have more on HPV and cervical health.

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EU Commission Dampens Scottish Salmon Safety Fears

Reuters
Monday, January 12, 2004

BRUSSELS (Reuters) - The European Commission (news - web sites) played down consumer concern over high dioxin levels in Scottish farmed salmon on Monday but said it would soon propose new rules to limit the presence of other toxic chemicals in food.

Health and Consumer Protection Commission spokeswoman Beate Gminder said the farmed salmon was still safe for humans to eat -- though recent American research said it should be eaten sparingly because of its dangerously high dioxin content.

Dioxins are one of a number of toxic chemicals that originate in pesticides or industrial processes, leach into rivers and lakes and build up in the flesh of fish and animals.

Many such chemicals are known or suspected to cause cancer.

"The American research did not find dioxin levels above the EU's maximum threshold where the product would be banned from supermarket shelves," Gminder said.

The EU measures two levels of dioxin content in food. The lower level is an early warning signal which prompts the EU to call on countries to investigate the cause of the contamination, though it considers the food still safe to eat.

The second level measured is a maximum, which results in an EU ban on the sale of the product.

The EU Commission will launch a proposal before the end of the year to limit the presence in food of polychlorinated biphenyls (PCBs), another group of toxic chemicals, which are not covered by present EU food safety rules.

The 15-nation bloc would have to endorse the proposal for it to become law.

A team of U.S. researchers reported in the journal Science last week that farmed salmon taken from markets in Frankfurt, Edinburgh, Paris, London, Oslo, Boston, San Francisco and Toronto had levels of toxic chemicals such that consumers should eat no more than one-half to one eight-ounce (quarter-kilogram) portion of salmon per month.

Consumers could safely eat up to eight portions a month of wild salmon, they said, basing their findings on U.S. Environmental Protection Agency (news - web sites) standards.

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Screening Saved Her Life

By Amanda Gardner
HealthDay Reporter
HealthDayNews
Monday, January 12, 2004

MONDAY, Jan. 12 (HealthDayNews) -- It was an annual check-up just like any other check-up, or so Kim Villanueva thought.

The only difference, she assumed, was that it was August 1996 and she was six weeks pregnant with her second child.

But Villanueva's Pap smear came back abnormal. In January, her doctors performed a colposcopy, a way of examining the cervix and surrounding tissue. Again, the results were abnormal.

"I think at that point, I knew deep down that it was more serious than what everybody was saying," says Villanueva, a controller for a party rental company in Maryland and a volunteer for the American Cancer Society (news - web sites). "My family was saying it's no big deal, don't stress about it."

Villanueva's doctors felt a biopsy was called for but they had to wait until her baby was born in late May. Ten weeks after the birth of her son, a biopsy turned up cancer with glandular involvement. Even then, Villanueva did not quite believe it.

She was sitting in her doctor's office at the end of the day after everyone else had gone. When he said "cancer," she recalled, she replied, "Are you sure it's not just a severe infection?" The doctor turned the report around on his desk and showed her where it said "cancer" in black-and-white on the form.

Doctors at Johns Hopkins Medical Center in Baltimore performed a cone biopsy and were hoping to excise all the cancer cells that way, but they found tumors in the lymphatic channel. That meant Villanueva needed a hysterectomy and had to have her pelvic and aortic lymph nodes removed to make sure the cancer hadn't spread.

Here's when Villanueva's luck started to change: The cancer had not hit the lymph nodes so she did not have to endure chemotherapy. "I was clean as of the surgery," she says. That was September 1997. Villanueva was 27 years old.

The mystery is how the cancer managed to develop and progress when Villanueva reported religiously for her annual Pap smears. "I think part of the reason was because the Pap smears that were being done at the time were so hard to read that it might have been a false-negative," she says. "That's my own suspicion, but I don't know if that's the case."

Villanueva still goes for screening every year, an event that causes her no small amount of distress.

"When you first start going for those, there's so much anxiety associated with it that it's like a huge bookcase in the middle of the room and you can't get by it," she says. "I get very irritable with my family for the two to three weeks it takes to get the results back. I would always call the doctor and not wait for him to mail me something."

The process is a little easier each year. And this year marks the sixth year she's been cancer-free.

"It's just a regular check-up," she says. "Just like you go for your mammograms, you go for this too."

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Study: HMO Policy Not Tied to Newborn Problems

By Amy Norton
Reuters Health
Monday, January 12, 2004

NEW YORK (Reuters Health) - One HMO's former policy of sending most moms and newborns home less than two days after delivery does not appear to have caused a spike in infant jaundice and feeding problems, Harvard researchers report.

Such early discharges were common in the 1990s in the U.S., as managed care plans tried to curb costs. By the late 90s, however, public outcry had moved Congress and most states to pass minimum-stay laws guaranteeing that insurance plans would cover 48 hours of hospital care after delivery.

Still, whether early-discharge policies had ill effects on newborn health -- and whether minimum-stay laws have had health benefits -- remains unclear.

The new study, reported in the January issue of the medical journal Pediatrics, looked at nearly 20,400 mother-infant pairs covered by one large Massachusetts HMO between 1990 and 1998. In 1994, the health plan started a policy under which most women with uncomplicated deliveries were sent home with their babies after only one overnight hospital stay. The policy was ended in 1996 when Massachusetts passed its minimum-stay law.

Researchers found that although two common newborn problems, jaundice and feeding difficulties, rose during the HMO's early-discharge policy, they remained elevated after the state law was passed.

Feeding problems -- mainly difficulties with breastfeeding -- more than doubled after the policy was launched, then remained elevated after the law took hold.

Similarly, in the four years before the early-discharge policy, jaundice diagnoses remained steady at about 8 percent of newborns, then increased to 11 percent during the policy, and remained there after the law. Infant jaundice is a yellowing of the skin caused by excess blood levels of bilirubin, a byproduct of the breakdown of red blood cells. In most newborns, jaundice clears up on its own, but very high bilirubin levels can lead to serious complications such as brain damage if left untreated.

According to the study authors, better detection of these infant problems -- due, in part, to the design of the early-discharge policy -- seem to explain the increase. Under the HMO's policy, mothers and infants who were discharged less than two days after delivery received a home visit from a nurse when the baby was 3 or 4 days old.

It's this visit that was probably key, since jaundice and feeding problems peak around the third or fourth day of life, Dr. Jeanne M. Madden, the study's lead author, told Reuters Health.

"I suspect the most important thing...was the home visits," said Madden, of Harvard Medical School (news - web sites) and Harvard Pilgrim Health Care, the HMO that covered the women in the study.

Other likely contributing factors include two national guidelines on newborn care issued around the time of the HMO policy -- one on hospital stays after delivery, and one on jaundice management -- according to Madden's team. The researchers say these factors created lasting changes in newborn care that kept diagnoses of jaundice and feeding problems elevated after the minimum-stay law went into effect.

Madden noted that even after the law, many women in the HMO still received a home visit on day three or four, since the law mandated coverage of a home visit if a woman chose to stay in the hospital for less than 48 hours.

Madden said the new findings add to earlier evidence that this HMO early-discharge policy was instituted safely. Using the same study population, she and her colleagues had previously found that newborns who stayed in the hospital for one night were no more likely than those kept two nights to be rehospitalized or visit the emergency department in their first 10 days of life.

Source: Pediatrics, January 2004.

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Social Network Key to Teen Suicide Risk

By Randy Dotinga
HealthDay Reporter
HealthDayNews
Monday, January 12, 2004

MONDAY, Jan. 12 (HealthDayNews) -- When it comes to preventing teen suicide, understanding the social world of adolescent girls may provide a key to predicting potential risk, says a new study.

Researchers found girls were twice as likely to think about suicide if they had few friends. The risk of suicide attempts also rose among girls whose social life was fragmented among different groups of friends.

While one suicide expert says the research offers nothing new, study co-author Peter Bearman contends the findings should help guide communities as they try to prevent suicide. For teens, especially girls, "what is important is having social identity, friendships and feeling integrated," says Bearman, a professor of sociology at Columbia University.

Suicide is the third leading cause of death among children aged 10 to 14 in the United States, and continues to be a major killer among young and middle-aged people, according to 2001 federal statistics.

In the new study, researchers looked at 13,565 students in grades 7 to 12 who answered federal questionnaires in 1994 and 1995. The researchers report their findings in the January issue of the American Journal of Public Health.

Teens were 1.4 to 2.7 times more likely to think about suicide if someone they knew -- a family member or friend -- had killed himself or herself. Students of both genders were about 1.5 times more likely to think about suicide if they acknowledged homosexual feelings, and girls were nearly twice as likely to consider killing themselves if they'd been sexually assaulted.

The likelihood of considering suicide doubled among girls who had few friends. They were also more likely to be at risk if their friends were not friends with each other, Bearman says.

But the risk of suicidal thoughts actually dropped among boys with few friends. The researchers wrote that adolescent boys are "more impervious" to their social worlds than girls.

The study points to a link between social lives and mental health, Bearman says, adding it reveals how difficult it is to predict which suicidal students will move from thoughts to action.

However, one suicide expert is skeptical about whether the findings shed any new light on teen suicide. Researchers already knew that teens are prone to imitate each other and at higher risk if their friends committed suicide, says Daniel Romer, a suicide expert and research director for the University of Pennsylvania's Institute for Adolescent Risk Communication.

"The findings about the social networks of suicidal youth are interesting, but we really don't know what they mean," says Romer. "Measuring a person's social network characteristics is very hard, and the study really does not take us much further along [beyond] what we knew already."

More information

Get details about the warning signs of teen suicide from the American Academy of Pediatrics. You can also try the American Foundation for Suicide Prevention or the National Center for Injury Prevention and Control.

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Sunday, January 11, 2004

Poll: Smokers Unaware of Danger of Persistent Cough

Reuters
Sunday, January 11, 2004

LONDON (Reuters) - Nearly half of British smokers who have a persistent cough are unaware that it could be a warning sign of a serious lung disease, according to a poll published Monday.

A lingering cough is one of the early symptoms of COPD (chronic obstructive pulmonary disease), which includes smoking related illnesses such as chronic bronchitis and emphysema.

It is Britain's fifth biggest killer and causes more than 30,000 deaths each year.

"This new research highlights the lack of awareness and understanding of what is one of the UK's biggest killers," said Dr Michael Rudolph, the chairman of the British Thoracic Society Consortium on COPD which commissioned the MORI poll.

Forty-seven percent of the 1,006 people questioned had heard of COPD but did not know it was related to smoking although more than one in 10 smokers will develop the illness.

Forty-two percent of smokers who took part in the poll who had one or more symptoms of COPD had not seen their doctor.

In addition to a lingering cough, breathlessness, increased mucous and frequent colds in the winter are also warning signs of the disease.

COPD eventually leads to fatigue, shortness of breath and difficulty breathing as the lungs are destroyed. Deaths from the illness are more common than those from asthma and have been rising in most countries.

It afflicts people over 40 years old who have been smoking for many years and contributes to other illnesses such as pneumonia, heart disease and stroke.

There is no cure for COPD. The best way to avoid it is to stop smoking. Treatments can relieve the symptoms and researchers are conducting trials to determine whether therapies can slow down the progression of the illness.

"It is vital for middle-aged smokers in particular, to visit their GP or practice nurse for a simple breathing test if they have a persistent cough or one of the other early symptoms," Rudolph added.

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Compound May Improve Treatment for Asthma

By Randolph E. Schmid
Associated Press Writer
The Associated Press
Sunday, January 11, 2004

WASHINGTON - Researchers have found a compound that blocks the production of excessive mucus, which could point the way to better treatments for asthma, chronic bronchitis, cystic fibrosis and other diseases.

Mucus, a thick fluid produced by mucus membranes, moistens and protects areas such as the digestive and nasal canals. Excess production of mucus in diseases such as asthma can block airways.

Scientists working with asthmatic mice found that excess mucus production could be sharply reduced or eliminated using a peptide called MANS. It blocks the protein that causes the excess secretion.

The findings of the research team, led by Kenneth B. Adler of North Carolina State University, are reported in the February issue of the journal Nature Medicine. Their paper was published Sunday in the journal's online issue.

"These findings could be very important as far as providing direction to eventually lead to therapeutic treatment" of certain respiratory diseases, Adler said in an e-mail interview.

He said it could take time before such a treatment would be ready for testing in people.

Dr. Philip S. Norman, an asthma expert at Johns Hopkins University in Baltimore, noted that excess mucus is a major problem in asthma and that finding a safe way to limit it would be a help toward treatment.

It would not be a cure, however, because other symptoms of asthma occur, said Norman, who was not part of the research team.

No side effects were noted in the mice, Adler said, but they were treated for less than an hour. Longer-term studies would be needed to assess the safety of the compound, he said.

Nevertheless, depending on the dose, the chemical was effective in reducing excess mucus production in different types of mice.

In one group, excess mucus was reduced by 80 percent or more, with larger doses cutting the mucus to below normal flows.

In a different strain of mice, excess mucus was cut by between 50 percent and 100 percent, depending on dosage. A third group, using a different chemical to induce the allergy, saw a reduction in excess mucus by between 20 percent and 90 percent as doses were increased.

The researchers found that mucus production requires a protein called myristoylated, alanine-rich C-kinase substrate, or MARCKS.

In lab tests, they found that an amino acid fragment called myristoylated N-terminal sequence, or MANS, reduces mucus flow, possibly by inhibiting the attachment of MARCKS to membrane cells.

They then turned to the mouse experiments to see if the same would result would occur.

In addition to the researchers at North Carolina State, the team includes scientists at the Pasteur Institute, Paris; the University of Sao Paulo, Brazil; and the School of Veterinary Medicine, Hannover, Germany.

On the Net:

Nature Medicine: http://www.nature.com/nm/

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Report: Gulf War Syndrome Linked to Vaccines

Reuters
Sunday, January 11, 2004

LONDON (Reuters) - A leaked British Army medical report has provided the first official backing that vaccines given to British soldiers before the 1991 Gulf War (news - web sites) caused illnesses associated with Gulf War Syndrome (news - web sites), the Times reported on Monday.

It said Lieutenant-Colonel Graham Howe, clinical director of psychiatry with the British Forces Health Service in Germany, made the link after the War Pensions Agency asked him to look at the case of former Lance-Corporal Alex Izett, who now suffers from osteoporosis and acute depression, the paper said.

The Times quoted Howe as saying in his unpublished report, dated September 2001 and handed to the paper by Izett, that "secret" injections given to the soldier "most probably led to the development of autoimmune-induced osteoporosis."

Howe came to that conclusion because in the end Izett was never posted to Iraq (news - web sites), the Times said.

The paper added that Izett won a landmark ruling at a war pensions appeals tribunal last summer which awarded him a 50 percent disability pension.

The existence of Gulf War Syndrome and its possible causes have been hotly debated.

It has been linked variously to the inoculations the veterans received, pesticides they handled, smoke from oil-burning fires, stress and organophosphates -- chemicals that have been shown to affect the human nervous system.

U.S. and British veterans of the conflict have complained of symptoms such as respiratory and digestive problems, nerve damage, fatigue, pain, numbness and memory and psychological problems.

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Organic Beef Tries to Benefit From Scare

By Mark Sherman
Associated Press Writer
The Associated Press
Sunday, January 11, 2004

WASHINGTON - Discovery of a Holstein with mad cow disease has producers and sellers of organic and natural beef changing their marketing tactics to make the case sometimes starkly that their meat is free of the disease.

The largest natural-food grocery chain is taking the high road in a pitch on National Public Radio acknowledging its financial support of public radio. Whole Foods Market, based in Austin, Texas, describes itself as a "purveyor of natural beef from cattle raised without animal byproducts and monitored throughout the entire production process."

Others prefer the direct approach: "Organic Beef It's What's Safe for Dinner" was the headline on a New Year's Eve news release from the Organic Valley Meat Co. of La Farge, Wis.

Agriculture officials believe that contaminated feed containing protein or bone meal from infected cows or sheep is the most likely source of infection with mad cow disease, or bovine spongiform encephalopathy. They have spent the past three weeks tracking down the meat from the infected cow and others slaughtered with it, as well as other animals that might have eaten the same feed.

Mad cow disease eats holes in the brains of cattle. Humans can develop a similar fatal brain-wasting illness, variant Creutzfeldt-Jakob disease (news - web sites), by eating contaminated beef products.

To be certified as organic, beef must come from cattle fed vegetarian diets. The meat also must be able to be traced from the ranch to the dinner table. Government and industry experts say the likelihood that an American consumer might contract the disease is minuscule.

David Martosko, director of research for the industry-backed Center for Consumer Freedom, said he resents the organic advocates' "scaremongering" but understands the business decision.

"For the organic marketers, it's about capturing market share," he said. "They're in business to make money just like anybody else."

Several organic companies report increased sales since the Dec. 23 announcement that a cow in Washington state was diagnosed with mad cow disease. Conventional beef sellers complain that organic marketers and consumer advocates are trying to capitalize on public fear about the disease.

Michael Levine, president of Organic Valley Meat, said the situation facing the industry required an eye-catching statement of confidence in his product; hence his "It's What's Safe for Dinner." "In a circumstance like this, where consumers are fearful, truly nobody wins," Levine said. "To take advantage would be irresponsible. But not to be responsive would also be irresponsible."

Organic Valley also has distributed to its customers grocery stores and restaurants posters for display that lists the advantages of the company's meat.

The organic beef industry has a tiny, but growing share of the U.S. beef market. Of roughly 100 million cattle in the United States, about 65,000 were certified organic in 2001, according to Agriculture Department figures. Levine said Organic Valley would have sales of less than $10 million this year.

Organic beef typically is far more expensive than conventional beef.

Whole Foods is among Organic Valley's customers. Not all beef sold at Whole Foods is organic, but the company claims that it adheres to the same standards. Additionally, for ground beef the company buys only whole muscle cuts of beef, considered safe from mad cow infection, and grinds it at each store.

"We don't want to promote it at the expense of bad news, but we are trying to reassure our customers that they can buy with confidence," said Whole Foods spokeswoman Kate Lowery-Monteilh.

Yet that is much the same message being propounded throughout the U.S. beef industry.

"Conventional beef is perfectly safe to begin with," said the Center for Consumer Freedom's Martosko. "I have nothing against organic beef. It's a perfectly fine option for people who are willing to pay more for it."

The center and other beef trade groups insist, however, that organic beef is no safer than the conventional product. While cattle prices have dropped, the industry has reported no decrease in Americans' beef consumption.

On the Net:

Agriculture Department: http://www.usda.gov

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