Come With Major Risks
By Randy Dotinga
FRIDAY, Aug. 23 (HealthScoutNews) -- As medicine enters a new
era of pain treatment, a researcher reminded thousands of
doctors yesterday that popular painkillers are not without
Even a modern generation of drugs known as COX-2 inhibitors
are anything but harmless, said Henry J. McQuay, a professor
of pain relief at the University of Oxford, in a speech
before the 10th World Congress on Pain in San Diego.
"It's incredible how casual and careless the doctors are,
all of us," when it comes to prescribing proper doses
of mediations known as non-steroidal anti-inflammatory drugs,
he said. "We just forget doses... and it matters."
The International Association for the Study of Pain holds a
conference every three years in a different country. The
main topics at the 2002 conference, which ended yesterday,
included new medications, treatment of pain in the elderly,
the psychology of pain and the use of medical marijuana.
After decades of neglect, pain has become one of the hottest
topics in medicine over the last five years. Many doctors,
nurses and hospitals are responding to criticism that they
don't do enough to relieve pain, a notoriously difficult
symptom to understand and treat.
Among other things, many hospitals now routinely measure the
self-described pain level of patients -- the so-called "fifth
vital sign" -- along with pulse, respiration rate,
blood pressure and body temperature.
However, painkillers still have side effects. Opium-based drugs,
like morphine and OxyContin, are powerful but can cause
addiction. And non-steroidal anti-inflammatory drugs such
as aspirin, ibuprofen and naproxen can cause gastrointestinal
bleeding, a potentially fatal condition in fragile patients.
Some doctors fail to realize the drugs can also hurt the hearts
and kidneys of patients, McQuay added. "We have this
kind of blinkered approach in our medical teaching and training.
You could ask any health-care professional what the non-steroidals
do, and they'll say they make your guts bleed. But the cardiac
effects may be just as important."
The COX-2 inhibitors appear to be less risky, but they can
spell trouble, McQuay said.
In an interview, another pain specialist said some doctors
do indeed neglect the risks of non-steroidal painkillers.
However, like McQuay, he said doctors shouldn't abandon
the drugs but instead use them with care.
"It's generally perceived that the non-steroidals are
very safe given the fact that you can even buy them over
the counter without a prescription," said Dr. Bill
McCarberg, director of the chronic pain management program
for the Kaiser Permanente health plan in San Diego. "But
in reality, there are risks related to their use."
Patients should be especially vigilant about letting their
doctors know when they take over-the-counter painkillers,
McCarberg said. Otherwise, doctors may inadvertently cause
a potentially serious drug interaction.
Doctors must take special care when prescribing drugs for the
elderly, McQuay said at the pain conference.
"As the population ages, we're going to have a lot more
older people," he said. "And older people have
other medical problems, too. Many of our pain patients are
taking eight medications on average. So, if we put in another
medicine, we're likely to be causing ripples in the pond."
But McQuay also acknowledged that his advice is only based
on current medical knowledge. "I'm acutely aware that
everything I say will have to be changed in two or three
years' time," he said.
What To Do
Learn more about other topics discussed at the 10th
World Congress on Pain.
To learn more about potential painkiller side effects, read
this piece about drugs
and peptic ulcers from the National Institute of Diabetes
and Digestive and Kidney Diseases.
on Paxil TV Ads Delayed
By Paul Wilborn
LOS ANGELES (AP) - A court-ordered deadline to pull national
TV commercials that claim the anti-depressant Paxil is not
habit-forming was delayed from Sept. 1 to Sept. 12, an attorney
involved in the case said Friday.
The postponement will give the U.S. Food and Drug Administration
sites) time to file a brief supporting the ads.
The stay came in response to a "statement of interest"
brief from the FDA asking U.S. District Judge Mariana Pfaelzer
to rescind a decision that grew out of a civil lawsuit.
FDA officials said they were worried the ruling improperly
interferes with the way the agency regulates drugs and drug
The judge's decision to delay the ban came during a conference
call with the parties involved, said Karen Barth, an attorney's
for plaintiffs suing the makers of Paxil.
A new brief from the FDA is due Sept. 5. The plaintiffs then
have until Sept. 12 to file a response, Barth said.
Lawrence Bachorik, a spokesman for the FDA, confirmed that
the judge had issued a stay but did not elaborate.
The civil lawsuit against Paxil producer GlaxoSmithKline was
filed on behalf of 35 patients who claimed they suffered
withdrawal symptoms such as nausea, fever, and "electric
zaps" to their bodies.
In a filing Tuesday, the FDA said there were often side effects
when patients stop taking certain medications "abruptly,"
but the agency labels drugs as habit-forming only when such
drugs "cause drug-seeking behavior, often with the
user escalating the dose for psychological or physical gratification."
Pfaelzer found that in other countries, labels on the drug
warn of adverse reactions when use of the drug is discontinued.
The commercials were "misleading and created inaccurate
expectations about the ease of withdrawal from the drug,"
Pfaelzer ruled Monday.
The judge's ruling was preliminary and comes at an early stage
of the court proceedings. A hearing is set for Oct. 7 to
decide whether the lawsuit should be converted to a nationwide
class-action, Barth said.
Surging U.S. sales of Paxil and the asthma drug Advair led
to a 15 percent increase in second-quarter profits for London-based
GlaxoSmithKline PLC. Global sales of Paxil grew 29 percent.
Disease a Bigger Problem for Women
FRIDAY, Aug. 23 (HealthScoutNews) -- No one is happy to learn
that he or she has cardiac disease. But the quality of life
for women with heart disease is considerably worse than
a man's, according to a new study.
Researchers from Ohio State University say they found that
women had a significantly worse time than men, regardless
of the kind of cardiac disease, age, race, or cardiac risk
factors. The quality of life remains lower for women a year
after their diagnosis or initial treatment for heart problems.
The study included 536 people (35 percent women) with a mean
age of 59.5 years. All the people in the study filled out
a survey questionnaire and were interviewed at three-month
intervals over the following year.
The survey measured psychological functioning and quality of
life, including activity levels, emotional state, sadness
and anxiety, and the person's perception of available social
Women scored lower on both mental and physical composite indicators
of quality of life at every survey point in the study.
The authors say the study supports the theory that social support
is an important factor in the reduced quality of life for
women with cardiac disease.
The study was presented yesterday at the annual convention
of the American Psychological Association.
This information from the National Heart, Lung, and Blood Institute
can help women determine how
high their risk might be in developing cardiovascular
Injury, Brain May Repair Itself -- with Help
By Linda Carroll
NEW YORK (Reuters Health) - Scientists have discovered that
certain immature cells in the brain can be coaxed to mature
into functioning nerve cells, replacing damaged ones, new
study findings show.
By injecting growth factors into rat brains, Japanese researchers
were able to stimulate "progenitor" cells to grow
into mature neurons, according to the report published in
the August 23rd issue of Cell.
"This is a way to allow the brain to use its own tools
to make repairs," Ramesh Raghupathi, a research assistant
professor in the department of neurosurgery at the University
of Pennsylvania, told Reuters Health in an interview. "What
is interesting about this study is that it is one of the
first to show that endogenous progenitor cells can actually
become fully mature neurons."
Other studies have used transplants of stem cells from the
blood or fetal stem cells to try to repair brain damage,
For years, researchers have assumed that brain and spinal cells
can't repair themselves. But the Japanese researchers suspected
that progenitor cells, a kind of cell that can develop into
at least three different types of nerve cell, could be coaxed
to mature into neurons in a brain-injured animal.
"It has long been believed that the adult mammalian central
nervous system (CNS) is incapable of significant self-repair
or regeneration," the study's lead author Hirofumi
Nakatomi, a researcher in the departments of neurobiology
and neurosurgery at the University of Tokyo Graduate School
of Medicine, wrote. "Many lines of recent evidence
have revealed, however, that progenitors with the ability
to produce new neurons...remain in the adult CNS."
Nakatomi and his colleagues studied rats with damage to the
hippocampus, the part of the brain responsible for laying
down new memories. The scientists damaged the hippocampus
by briefly interrupting blood and oxygen flow to this part
of the brain.
Other studies have shown that after a brain injury in rats,
progenitor cells migrate to the damaged area, Nakatomi noted.
So, shortly after the rats' brains were injured, Nakatomi
and his colleagues infused growth factors into the some
of the rats' brains.
When the researchers examined the rats days later, they found
new hippocampal nerve cells in the rats treated with growth
To test whether these cells had grown proper connections with
the rest of the hippocampus, Nakatomi and his colleagues
tested uninjured rats, injured rats with no treatment, and
treated injured rats in a water maze. Normal rats quickly
learn--and then remember--that there is a hidden platform
they can climb onto to get out of the water.
Rats that had hippocampal damage had trouble finding the platform
and remembering where it was shortly after the brain injury.
But later, after the regrowth of neurons in rats that received
growth factor, treated rats were able to remember where
the platform was placed.
These results don't mean that we have an immediate cure for
brain and spinal injuries, Raghupathi said. But, he added,
"This is a good first step. Now we need to see if it
works in higher animals, such a primates."
Source: Cell 2002;110:429-441.
of Oxygen at Birth Not the Cause of Most Newborns' Seizures
By Adam Marcus
FRIDAY, Aug. 23 (HealthScoutNews) -- Most newborn seizures
aren't the result of oxygen starvation during birth, according
to a new study.
Johns Hopkins University researchers found that only one of
12 cases of infant seizures out of 22,000 deliveries at
that hospital over an 11-year period had brain damage that
likely resulted from the birthing process. And 70 percent
of seizure patients showed no signs of oxygen deprivation,
a leading cause of birth-related neurological injuries.
"We don't know" what's causing the seizures, says
Dr. Ernest Graham, a Johns Hopkins ob/gyn and leader of
the research team. "It could be a family history of
seizures or malformations" of the brain that lead to
most of the attacks. But in the vast majority of cases,
an oxygen bottleneck -- like a constricting umbilical cord
or too much time in the birth canal -- isn't to blame.
A report on the findings appears in the August issue of the
Journal of Maternal-Fetal and Neonatal Medicine.
Seizures are the most common sign of brain trouble in early
infancy. They affect up to 6 percent of newborns born weighing
3.3 pounds or less, but only 0.2 percent of infants born
between 5.5 and 8.8 pounds, or full-term size.
Seizures raise the odds of brain damage in newborns two-to-five
times, compared with infants who haven't had the episodes,
according to the study. That damage can include cerebral
palsy, a devastating neurological disorder.
Some evidence has suggested that as many as half of all newborn
seizures are the result of oxygen starvation during labor,
Graham said. But another study by the National Institutes
of Health ( news
sites) found the number to be only 10 percent.
In the latest look at the issue, Graham and his colleagues
analyzed roughly 22,000 deliveries at their hospital between
1988 and 1999, of which 13 involved newborns who'd suffered
seizures shortly after birth. One was excluded because the
child had a chromosome anomaly.
Graham's group compared the 12 infants who'd had seizures with
24 babies of similar gestational age, birth weight and delivery
method. They also looked at key measures of newborn health
and vigor for both sets of children, including the acid
content of the umbilical cord blood and so-called Apgar
scores at one minute and five minutes after delivery. The
Apgar test is a gauge of how active or lethargic a baby
is at birth. A high blood acid content can indicate a lack
Seizure-suffering infants were more likely than the other babies
to have poor Apgar scores. Yet, only 30 percent of them
had clinically significant blood acid buildup, and only
one of the 12 met the American College of Obstetricians
and Gynecologists (ACOG) criteria for delivery-related oxygen
deprivation and brain injury.
However, Graham noted that the ACOG criteria for labor-related
trauma have been criticized as being so strict that they
exclude many potential cases.
"They're a little tougher than in the past has been thought"
appropriate, agreed Dick Leavitt, director of science information
at the March of Dimes, a birth defects group based in White
Plains, N.Y. One likely reason, Leavitt said, is professional
Still, Leavitt said the new findings agree with the current
consensus among neonatologists that most cases of cerebral
palsy and related defects have their roots far earlier than
What To Do
While this study didn't find a cause for most infantile seizures,
it did narrow the possibilities by placing oxygen deprivation
For more information on birth defects, try the March
of Dimes or United
To Probe Health Issues in Slay
By Robert Burns
AP Military Writer
WASHINGTON (AP) - Alarmed by a series of domestic killings
and suicides at Fort Bragg, N.C., the Army is sending in
a team of health specialists to study a range of possible
explanations, officials said Friday.
The Army disputed reports that it is focusing mainly on the
possibility of a link to use of the anti-malarial drug,
Lariam, although officials said this was among the issues
to be examined.
Lariam was prescribed to troops who fought in Afghanistan (
sites). Three of the four soldiers involved in the killings
had recently returned from duty there, although the Army
will not say how many of them took Lariam.
"Contrary to news reports speculating that the team will
focus primarily on anti-malaria prophylaxis/medications
taken by soldiers, the team will consult with local medical
and unit/installation leadership at Fort Bragg on a wide
variety of possible contributing factors," an Army
The team will consider factors related to how the Army prepares
soldiers and their families to deal with personal and other
problems before an overseas deployment and supports them
upon their return.
The Army said it would look into "behavioral health issues"
related to overseas deployments that are not unique to Fort
Bragg, home of the Army Special Operations Command and the
18th Airborne Corps. Soldiers from those units featured
prominently in U.S. ground operations in Afghanistan.
The inquiry at Fort Bragg will last most of next week, the
Army said. Consultants in psychology, social work and psychiatry
will join Army epidemiologists and chaplains as well as
officials from the government's Centers for Disease Control
and Prevention ( news
"Members will also look at specific data associated with
recent cases looking for patterns, organizational dynamics
and medical issues that may have contributing significance,"
the Army statement said.
The Fort Bragg killings began June 11.
That day, Sgt. 1st Class Rigoberto Nieves, 32, a Special Forces
soldier, fatally shot his wife and then himself, two days
after he had returned from Afghanistan. Later that month,
according to police investigators, another Special Forces
soldier, Master Sgt. William Wright, 36, killed his wife
and weeks later led authorities to her body.
On July 19, Sgt. 1st Class Brandon Floyd, reportedly a member
of the secret Delta Force, shot his wife and then killed
Also in July, Marilyn Griffin, who had separated from her husband
in May, was stabbed to death and her body set on fire in
her home. Sgt. Cedric Griffin, 28, who is with the 18th
Airborne Corps and had never been to Afghanistan, was charged.
Local police said all the couples had reportedly had marital
problems. Army officials say there is no evidence that Lariam,
the anti-malarial medication, played any role. Yet questions
about the drug persist.
The manufacturer of Lariam, Roche Laboratories, acknowledges
reports of suicide and suicidal thoughts attributed to Lariam,
also known as mefloquine. But company spokesman Terence
Hurley said they are extremely rare, "only a small
percentage of the more than 25 million people that have
successfully used Lariam."
Roche says some cases of severe neuropsychiatric disorders
have been reported in connection with Lariam use. These
include anxiety, depression, panic attacks, hallucinations,
aggression and psychotic reactions.
The World Health Organization ( news
sites) puts the incidence of serious neuropsychiatric
effects from the drug at 5 in 100,000. Of the millions of
travelers given mefloquine each year, one in 6,000 to one
in about 10,000 will experience some kind of serious adverse
reaction, the WHO says.
On the Net:
Fort Bragg at http://www.bragg.army.mil/
Centers for Disease Control and Prevention at http://www.cdc.gov/
Lariam at http://www.rocheusa.com/products/lariam/
Finds Momentum for Radical Healthcare Reform
NEW YORK (Reuters Health) - With many different groups expressing
dissatisfaction with the US healthcare system, sentiment
for "radical reform" is growing, a new poll suggests.
In the past, the public has been more dissatisfied with the
healthcare system than have physicians, employers and health
administrators, according to nationwide surveys by Harris
Interactive ( news
web site). But now a new Harris poll finds significant
narrowing in the differences among those groups' points
Doctors soured on healthcare beginning in 1999 and have remained
less satisfied than they have been in the past. Harris believes
doctors' negative views reflect lingering anger about managed
With health plans loosening restrictions on doctors, physician
attitudes have perked up a bit in the past two years, the
poll found. Still, doctors' sentiments are more negative
now than at any time between 1984 and 1997, Harris noted.
Health plan managers also have grown notably more dour than
they were three years ago, the poll found. And while employers
are more satisfied than the public, they expressed more
hostility this year than in any previous survey, Harris
Public support for a major overhaul of the healthcare system
remains strong. While 17% think the system works pretty
well, almost twice as many (31%) think it needs to be rebuilt.
Harris calculated a "radical change" score for each
group based on its "overall view" of the country's
healthcare system. Respondents were asked to indicate whether
they believe that the nation's healthcare system works pretty
well and requires only minor changes, that it has "good
things" about it but needs fundamental change; or that
so much is wrong that it needs to be completely rebuilt.
The public's radical change was highest, at 56, followed by
hospital managers (51), employers (48) and health plans
(50). Physicians scored lowest, at 46.
The poll was conducted between April and June with separate
samples of 1,013 adults, 406 physicians, 301 employers,
101 health plan managers and 301 hospital managers. Data
for previous years were derived from similar surveys.
Butter as Health Food
(HealthScoutNews) -- Good news about a convenient, tasty kid
food: peanut butter. It can help protect against two serious
health threats -- heart disease and obesity -- reports Clarian
Health Partners, an affiliate of Indiana University.
Recent studies show that diets rich in peanuts and peanut butter
appear to protect against heart disease by lowering levels
of bad LDL cholesterol and controlling body weight, benefits
that older children and teens need more than ever. Just
don't let the kids overdo it.
And remember to follow this important caveat: The American
Academy of Pediatrics suggests that parents wait until their
children are at least 2 years old before introducing them
to peanut butter. Hold off until age 3 if either parent
has any type of allergy.
Start with just a little bit, spread thin on a cracker. And
wait until age 4 before serving chunky peanut butter, to
guard against choking.
Discourage eating peanut butter right from the spoon. It can
cause choking in both children and adults.
Moms' Diet Can Help Newborns Sleep Better
By Alison McCook
NEW YORK (Reuters Health) - Newborns whose mothers consumed
adequate amounts of a particular fatty acid during the last
3 months of pregnancy exhibit healthier sleep patterns than
others, US researchers report.
The amount of time babies spend in different stages of sleep
may indicate whether they are experiencing normal brain
development. Consequently, mothers who get enough of the
fatty acid docosahexaenoic acid (DHA) in their diets may
also be helping their babies' mental functioning, according
to Dr. Sunita R. Cheruku and her colleagues at the University
of Connecticut in Storrs.
"The results of this study are strongly suggestive of
the importance of DHA levels during the last trimester,"
study author Dr. Evelyn Thoman told Reuters Health.
Thoman cautioned that even if newborns appear to show disrupted
sleep patterns, they may only have a higher risk of--and
are not doomed to--less than optimal development. "Risk
factors do not mean certainty of outcome," she noted.
DHA is a long-chain polyunsaturated acid that appears to boost
brain development. Infants accumulate fatty acids in their
brains during the last 3 months in the womb and the first
few months outside it. The fatty acids are found in cold
water fish and fish oils.
The current study, published in the American Journal of Clinical
Nutrition ( news
sites), is not the first to suggest a link between babies'
DHA intake and their brain development. Previous research
demonstrated that babies who receive breast milk, which
contains DHA, exhibit more mature brain development than
their formula-fed peers.
Other studies have also suggested that infants who get enough
DHA early in life may have a reduced risk of later heart
disease. When levels of DHA are reduced in animal studies,
the animals develop high blood pressure as adults. There
is also evidence that when these fatty acids are given to
adults with mild to moderate hypertension, their blood pressure
returns to normal.
During the study, Thoman and her colleagues measured the levels
of DHA in the blood of 17 women when they delivered their
babies. The investigators then monitored the sleeping patterns
of the babies during their first 2 days of life, using a
sensor pad to record how the baby was breathing and moving
The researchers found that more babies of mothers with high
levels of DHA in their blood showed mature sleeping patterns--defined
as a shorter sleep-to-wake transition time, relatively high
amounts of wakefulness, and a lower ratio of active to quiet
sleep--than those whose mothers consumed less of the fatty
In an interview with Reuters Health, Thoman said that previous
research has indicated that less-than-optimal development
in babies--as exhibited by their sleeping patterns--may
predict brain function later in life. However, she noted,
many different factors influence a child's development.
"Many aspects of life during a child's development are
significant for mental, motor and physiological maturation,"
The study was funded by grants from the National Institutes
of Health ( news
sites), the US Department of Agriculture, the Donaghue
Medical Research Foundation and the University of Connecticut
Source: American Journal of Clinical Nutrition 2002;76:608-613.
Condition Difficult to Diagnose
(HealthScoutNews) -- It's always a painful when your doctor
can't tie your pain to a specific cause. A common
example is interstitial cystitis (IC), a chronic pelvic
pain disorder for which diagnosis is difficult and there's
no known cure.
IC affects some 700,000 Americans, 90% of whom are women. Their
recurring discomfort or pain in the bladder and surrounding
pelvic region is accompanied by an urgent or frequent need
to urinate. In severe cases, that need recurs up to 60 times
Because IC varies so much in symptoms and severity, most researchers
believe that it is not one, but several, diseases. One of
the steps in diagnosing IC involves eliminating the possibility
the patient could be suffering from another ailment.
Current treatments -- including bladder distension, bladder
instillation, oral drugs, exercise and diet -- are aimed
at relieving symptoms. And various types of surgery are
being tested with unpredictable results.
In 1998, the National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK), a part of the National Institutes
of Health ( news
sites) (NIH), initiated the IC Clinical Trials Group,
a project designed to develop and test new treatment strategies
for patients with IC. The first trial focuses on two oral
drugs Elmiron and Atarax.
The second trial will test whether the bacterium Bacillus
Calmette-Gurin (BCG) will relieve the pelvic pain and
frequent urination that are hallmarks of IC.
Suggests Early Screen for 'Lazy Eye' Is Best
By Keith Mulvihill
NEW YORK (Reuters Health) - People with amblyopia--commonly
known as "lazy eye"--can go on to injure their
healthy eye later in life, putting them at risk for severe
vision impairment or even blindness, researchers report.
The research findings emphasize the importance of screening
and treating children with the condition, according to Dr.
Jugnoo S. Rahi of the Institute of Child Health in London,
UK. Treatment at an early age can ward off the vision loss
that can occur if the condition is untreated.
While many industrialized nations promote screening for lazy
eye among school-age children, the value of such programs
has recently come under question, Rahi told Reuters Health.
In amblyopia, one eye is weaker than the other, usually due
to a misalignment or crossed eyes. Without treatment--which
can include wearing a patch over the stronger eye or using
eyedrops to blur vision in the eye--the weaker eye gets
progressively worse. The degree of visual impairment varies
from person to person and the condition is believed to afflict
about 1% of the population.
In the current investigation, Rahi and colleagues surveyed
the UK population over a 2-year period. They looked for
people with one amblyopic eye who had recently suffered
vision loss in their good eye severe enough to prevent them
The team identified 370 people with a broad range of visual
impairment, including blindness, according to the report
in the August 24th issue of The Lancet.
"Our findings revealed that the risk of ending up visually
impaired by losing sight in your better eye is much higher
than people previously thought," Rahi told Reuters
Health. "One previous report suggested the risk was
1 in 1,000. We are suggesting that it is 1 in a 100."
The most common reason for loss of sight in the good eye was
an accident, such as a car accident, sports injury, or on-the-job
mishap, the report indicates.
It's not that people with lazy eye are necessarily more prone
to accidents, "it's just that when accidents happen
you are more likely to get injured in your dominant (or
better) eye," Rahi explained.
Aside from the severely diminished quality of life that these
people experience, Rahi noted that the consequences of people
with lazy eye suffering additional visual loss also "has
large economic impacts."
"If you could prevent this, that would be good,"
she said, "and the findings support screening of children
for lazy eye."
According to Rahi, the policy implications of her team's findings
are important in the UK where screening is very seriously
being questioned. "This study now very strongly supports
(the continuation) of screening," she said.
Source: The Lancet 2002;360:597-602.
Fight Head Lice With ... Lice
FRIDAY, Aug. 23 (HealthScoutNews) -- An attack of the mutant
head lice may sound like a shoddy 1950s horror flick, but
it's a serious problem for schoolchildren.
About 6 million to 12 million American youngsters contract
head lice each year. The most common way to treat them is
with products that contain the insecticide permethrin. However,
mutant strains of head lice have appeared that are resistant
to the insecticide.
Now, University of Massachusetts scientists say they've taken
the first step towards finding a way to defeat that resistance.
They've discovered a way to grow colonies of mutated head
lice. That will let scientists study the little critters
and develop new ways to kill them.
A report about the research was presented at this week's annual
meeting of the American Chemical Society in Boston.
The University of Massachusetts scientists are the first to
create an artificial feeding system that lets them raise
mutant head lice for study.
"We have a membrane and automatic blood feeding system
that allows us to rear these things on little hair tufts.
We just cut little hair tufts and make teepees out of them,
and the head lice kind of sit on this membrane and they
think they're on a scalp and they wander down and take a
blood meal and go back up," says entomology professor
School of Public Health has more information on head
Treatment Eases Kids' Emotional Problems
NEW YORK (Reuters Health) - It is not necessary to treat children
who wet the bed for any emotional or behavioral problems
they may have prior to treating them for bedwetting, new
study findings suggest.
In fact, treating kids for bedwetting may reduce such problems,
according to lead author R. A. HiraSing of Free University
in Amsterdam, the Netherlands, and colleagues. And, they
found, children with emotional problems do just as well
with bedwetting treatment as those without such problems.
Bedwetting is so common among preschool children it is not
considered a concern. By school-age, it becomes much less
prevalent, with about 5% of 7-year-olds still wetting the
The causes of bedwetting are unclear, but experts note that
a significant physical condition such as kidney infection
or diabetes is only rarely involved. Genetics may be important,
however, as the problem tends to run in families.
In some cases, emotional difficulties such as anxiety also
may play a role. Some children who wet the bed may be treated
for emotional problems prior to bedwetting treatment, based
on the rationale that these problems could be the cause
But few studies have looked at whether curing bedwetting could
actually help resolve a child's emotional problems. To investigate,
HiraSing and colleagues monitored the effects of bedwetting
treatments and parent-reported emotional and behavioral
problems of 91 bedwetting children between the ages of 6
and 15 years. At the start of the 6-month study period,
the children wet their bed an average of 5.4 times each
The children were treated with the Dry Bed Training program,
which involves a behavior modification approach, for example
waking a child frequently during the night and helping him
or her to wake up with "mild prompts."
At the end of the study period, bedwetting had decreased among
the children to an average of 1 episode per week, according
to the report in a recent issue of the journal Acta Paediatrica.
Of the children who scored just below or in the clinical range
of having emotional or behavioral problems meriting treatment,
58% decreased their bedwetting frequency down to a level
considered normal, the authors report.
What's more, the investigators found that children who wet
their bed less often or not at all after treatment also
saw a reduction in the overall number of behavioral and
emotional problems that had been recorded by their parents.
"The children seemed to have less internal distress, fewer
problems with other people, and were less anxious and/or
depressed," HiraSing and colleagues write. "The
behavioral/emotional problems of children who wet their
beds need not be treated first," they add.
"Children who have relatively many behavioral/emotional
problems, according to parental reports, become dry just
as often as children with problem scores in the normal range,"
the researchers conclude.
Source: Acta Paediatrica 2002;91:960-964.
With Attention-Deficit Disorder Need Attention
By Janice Billingsley
FRIDAY, Aug. 23 (HealthScoutNews) -- Young girls are often
ignored when it comes to a proper diagnosis for attention-deficit/hyperactivity
disorder (ADHD), claims a new survey of gender differences
in the treatment of ADHD.
That's especially troubling because their suffering, particularly
in terms of self-esteem and socializing, is more pronounced
than that of boys with ADHD, and the disorder hits girls
as often as it does boys, says a doctor who specializes
"This is the first national survey that confirms what
we've seen clinically, that we've missed diagnosing about
50 percent of the girls who have ADHD," says Dr. Patricia
Quinn, director of the National Center for Gender Issues
and ADHD and an independent advisor on the survey. "The
diagnosis ratio of male to female with this disorder should
be 1:1. We're way behind the curve."
ADHD affects 3 percent to 5 percent of all children, perhaps
as many as 2 million American children. However, at least
twice as many boys are diagnosed with the disorder, according
the National Institute of Mental Health.
More than 3,000 people responded to the survey, which was conducted
by Harris Interactive ( news
web site): 346 adolescents who had been diagnosed with
ADHD; 541 parents of children with ADHD; 550 elementary
and high school teachers, and 1,797 adults in the general
Among the findings with the ADHD children, aged 12 to 17, were
that more girls than boys reported it was "very difficult"
to make friends (27 percent versus 18 percent), to get along
with their parents (39 percent versus 25 percent), to get
things done in general (57 percent versus 39 percent), and
to focus on schoolwork (77 percent versus 66 percent).
The girls were also more likely to report it was "very
or somewhat difficult" to feel good about themselves
before treatment compared to the boys -- 68 percent compared
to 57 percent.
Further, before diagnoses, the girls were three times as likely
as the boys to have been treated for depression, the survey
The parents of the ADHD children concurred with the children's
assessments: 55 percent of the girls' parents reported their
daughter's ADHD affected her self-esteem a great deal, compared
to 46 percent of the boys' parents; 78 percent of the girls'
parents said, if left untreated, the disorder negatively
affected relationships with peers and classmates, compared
to 64 percent of the boys' parents.
"Girls tend to internalize their problems and withdraw,"
which lowers their self-esteem, says Quinn, who is a pediatrician
at Georgetown University.
Teachers, too, seem to be aware that girls are under-diagnosed,
the survey found.
Eighty five percent of the teachers thought that girls with
ADHD are less likely to be diagnosed than boys, with 92
percent reporting it was because girls don't "act out."
Quinn agrees, explaining there are three subsets of ADHD: inattentive;
hyperactive/impulsive; and a combination of the two.
While most boys with ADHD fall into the latter two categories,
most girls with ADHD exhibit the less noticeable symptoms
of inattentive behavior.
"A boy will often manifest ADHD by getting up to go to
the pencil sharpener and being disruptive in the classroom,
while a girl will be sitting quietly staring at the teacher
praying she won't call on her," Quinn says.
Girls will often exhibit forgetfulness, a lack of organization
or daydreaming, she says, all things a teacher might not
It's a problem," says Nadine Kaslow, chief psychologist
at Emory University School of Medicine. "Girls have
more of the attentional difference, and might be considered
not as smart or not hard-working, rather than suffering
from a disorder."
Quinn says recent research shows the disorder is a neuro-biochemical
one, meaning that parts of the brain that help with concentration
and organization are not activated in patients with ADHD.
Medications can stimulate those areas of the brain and improve
"The drugs stimulate the areas that aren't 'turned on,'"
It is important that other treatments be used as well, Kaslow
"Patients need a thorough evaluation and treatment that
can include parent training, remedial help for the child
in school, and patients may also need therapy," she
The survey was funded by Novartis Pharmaceuticals, which manufactures
Ritalin ( news
sites), a drug used to treat ADHD. It was conducted
over the Internet, using Harris' standard polling techniques,
and the data was weighted to reflect age, gender, race,
region, income and education in the general population.
What To Do
To see if your daughter might be suffering from ADHD, you can
look at the self-report questionnaire at Addvance,
a Web site focusing on women with ADHD. A fact sheet about
ADHD can be found at The
Center for Children and Youth with Disabilities.
Particles Found in Schizophrenia Patients
By Stephen Pincock
STOCKHOLM (Reuters Health) - Swedish scientists have found
a tiny particle in the spinal fluid of people with schizophrenia
that could be a marker for the disease, or even play some
part in causing it.
"The micrometer-sized particles may serve as biological
disease markers in schizophrenia," the researchers
report in a study published on Friday. "Hyopthetically,
they may be involved in the development of the disease or
may result from the disease process in brains of schizophrenic
Schizophrenia is a widespread and debilitating form of mental
disease with symptoms ranging from delusions and an altered
sense of self, to apathy and social withdrawal. It affects
around 1% of people, but how it develops is poorly understood.
Dr. Lennart Wetterberg, professor of psychiatry at Stockholm's
St. Goran Hospital and one of the co-authors of the study,
said the full significance of the finding was not yet clear
and more research was needed.
"It could be anything, and we're open to all possibilities.
It's not a quiz game and we're not gambling with bookmakers,"
he told Reuters Health. "We have to do more work."
Wetterberg said he hoped the publication of the study would
stimulate other researchers to conduct research.
"If it's hopeful or discouraging only the next step will
tell," he said.
The researchers took spinal fluid from 22 schizophrenic patients
and 38 healthy "control" patients. In the journal
Neuroscience Letters, they report finding spherical particles
in the spinal fluid of 20 of the 22 patients with schizophrenia
but only 2 of the 38 controls.
One theory could be that it is a new form of life, although
it is still uncertain what the micrometer-sized particles,
which are bigger than viruses but smaller than bacteria,
The particles did not include bacterial DNA material and so
far have not replicated in culture.
"They are not any of the usual viruses or bacteria that
have been found," Wetterberg said. "They are more
like something like the prion which is causing mad cow disease--but
it took 15 years until it was found out what that really
"And of course there are still many open questions there,
so we should be quite humble," he said.
More of a Culprit in Asthma
FRIDAY, Aug. 23 (HealthScoutNews) -- Sensitivity to airborne
molds can increase asthma severity.
That's the claim of a European study in this week's British
The study used data from 1,132 people with asthma from the
European Community respiratory health survey. The researchers
found a strong connection between a person's sensitization
to molds and the severity of their asthma, but found no
such connection with pollen or cats.
The researchers suggest the small size of fungal spores of
airborne molds let the spores enter a person's lower airways.
Also, while pollen is present only at certain times, molds
are present throughout the year and their spore counts just
increase during autumn.
Mold exposure levels are probably greater than those of pollen
because mold exposure occurs indoors, where people spend
most of their time.
The study authors say people with asthma who are sensitized
to airborne molds must pay close attention to their asthma
symptoms and adhere to their treatment programs, especially
during the fall when mold spore counts increase.
Improving the ventilation and decreasing the dampness in your
house can also help decrease your exposure to molds, the
Lung Association has more information about asthma.
Going for the Grains May Cut Diabetes Risk
NEW YORK (Reuters Health) - In the long run, men who chow down
on a diet rich in whole-grains may reduce their risk of
type 2 diabetes, researchers report.
According to a study in the August issue of the American Journal
of Clinical Nutrition ( news
sites), whole-grain products--such as brown rice, oats,
corn and barley--were protective against diabetes. Men who
ate the most whole-grain products were less likely to be
diagnosed with type 2 diabetes than men who consumed mostly
refined grains--like those found in cookies, doughnuts,
pasta or white rice, the study results show.
Because whole grain results in lower levels of blood glucose
(sugar), the body does not have to produce as much insulin
to process the food. Refined grains, on the other hand,
result in more than double the amount of sugar in the blood
and cause more insulin to be secreted than whole-grain products.
And experts point out that whole grains contain vitamins and
nutrients that may be important in modifying the risk of
Type 2 diabetes occurs when the body fails to respond to insulin,
the hormone that clears the blood of sugar after a meal
and deposits it into cells to use for energy. High blood
sugar can increase the risk of complications from diabetes
such as heart disease, kidney failure and blindness.
"Efforts should be made to replace refined-grain with
whole-grain foods," writes Teresa T. Fung of Simmons
College in Boston, Massachusetts and colleagues.
The team of researchers looked at the eating and lifestyle
habits of nearly 43,000 healthy men and followed them for
roughly 12 years.
At the end of the study period, 1,197 men had developed type
2 diabetes. Men who consumed the least amount of whole grains,
about 0.4 servings per day, were nearly 60% more likely
to develop type 2 diabetes compared with men who consumed
the most--about 3.2 servings of whole-grains per day.
In other findings, Fung's team discovered that the benefit
of eating whole grains wasn't just limited to lean men.
Obese men who were getting exercise and consuming whole
grains were 52% less likely to develop type 2 diabetes,
the authors report.
"Given the current overall low intake of whole grains,
efforts should be made to decrease the cost and increase
the availability and consumption of whole-grain products,"
Fung and colleagues conclude. "This has the potential
to reduce substantially the incidence of type 2 diabetes
and possibly other chronic diseases when sustained over
The National Institutes of Health ( news
sites) and the American Diabetes Association funded
Source: American Journal of Clinical Nutrition 2002;76:535-540.
Is Anything But
By Serena Gordon
FRIDAY, Aug. 23 (HealthScoutNews) -- Ecstasy, the popular dance
party drug, is often used by those who feel socially isolated
and need help coping with their loneliness.
That's the conclusion of a new study presented yesterday at
the American Psychological Association's Annual Convention
"Ecstasy users may choose this drug to help mediate the
negative effects of loneliness," says Tricia Orzeck,
the co-researcher on the paper from York University in Toronto.
While turning to drugs to cope with psychological problems
isn't a new phenomenon, using ecstasy to feel better may
be even more troublesome than using other drugs. Ecstasy
can cause confusion, depression, sleep problems, drug craving,
severe anxiety and paranoia, according to the National Institute
for Drug Abuse, and recent studies have indicated it may
cause permanent, long-term brain damage.
Orzeck and her colleague, Ami Rokach, recruited 818 people
for their study. One hundred and six were regular users
of ecstasy, 88 used other drugs, such as marijuana or alcohol,
and 624 reported no drug use. The average age of the volunteers
was 22. Of the total, 543 were women and 275 were men.
Each participant completed a questionnaire on how they had
coped with loneliness in the past. The answers fell into
six broad coping strategies: reflection and acceptance,
self-development and understanding, social support network,
distancing and denial, religion and faith, or increased
The researchers found drug users coped with loneliness differently
than non-drug users, and ecstasy users coped differently
than other drug users did.
Ecstasy users were at least three times more likely to deny
that they were feeling lonely than non-drug users, and almost
twice as likely as other drug users. People who used ecstasy
were also the most likely to seek out social support and
to increase their daily activities.
By contrast, non-drug users most often turned to reflection
and acceptance, meaning they spent time alone, reflecting
on their fears and accepted the pain of their loneliness.
Non-drug users were also much more likely to turn to religion
and faith to help them cope with loneliness than either
ecstasy or other drug users.
Dr. Kenneth Skodnek, chair of the department of psychiatry
and psychology at Nassau University Medical Center in East
Meadow, N.Y., says the findings make sense.
"Alcohol has been labeled a social lubricant in the past,
because people who didn't feel comfortable at social gatherings
would drink to loosen up," says Skodnek. "Perhaps
ecstasy is the newest version of the social lubricant."
However, he says ecstasy use should be avoided: "There
can be severe physical consequences and lingering effects
on brain function. This is not a benign substance."
He says there are effective prescription medications that can
help people with social phobias or anxiety, but adds that
teens and young adults often don't seek help from their
parents or health-care professionals.
The researchers suggest that by understanding the coping strategies
used by different groups, counselors can come up with more
effective and healthier options when counseling lonely young
What to Do
For more information on the detrimental effects of ecstasy,
visit the Drug
Policy Alliance or the National
Institute on Drug Abuse.
Warns of Possible Cryolife Heart-Valve Risk
WASHINGTON (Reuters) - U.S. regulators this week urged doctors
to consider alternatives to heart valves from Cryolife Inc.,
the company subject to a major recall of its human tissue
Cryolife's heart valves were not part of the recall and are
still available, but the Food and Drug Administration (
sites) said the valves may carry an infection risk.
The FDA has "serious concerns" regarding Cryolife
heart valves "because patients who receive these devices
may be at increased risk for infection," the agency
said in a notice posted on its Web site on Wednesday. The
FDA sent e-mails to alert doctors and others to the notice.
The notice advises surgeons thinking of implanting a Cryolife
heart valve to "consider using processed allografts
from alternative manufacturers/processors."
On Aug. 14, the FDA told Cryolife to recall soft tissue products
processed after Oct. 3 and halt sales because the firm cannot
ensure the products are free of bacterial or fungal contaminants.
The FDA said Cryolife tissue was linked to the Nov. 7 death
of a 23-year-old knee-surgery patient.
The heart valves were not included in the recall because they
are essential for correcting certain heart problems in children,
the FDA said. "Under these circumstances, the benefit
of these devices outweighs the risk," the FDA said.
The agency urged doctors to monitor patients who have had a
Cryolife heart valve implanted recently and inform them
of the FDA's concerns.
Cryolife officials were not immediately available for comment.
The company has said it is appealing the FDA's recall order
and has confidence in the safety of its processed tissue.
Shares of Cryolife, based in Kennesaw, Georgia, fell 12.5 percent
to close at $3.22 on Friday. The shares have traded as high
as $43 in the past year.
Early for Gestational Diabetes
FRIDAY, Aug. 23 (HealthScoutNews) -- It's more efficient to
screen pregnant women for gestational diabetes at 16 weeks
rather than the current practice of screening in the third
That what a new study in the August issue of the Journal
of Reproductive Medicine suggests.
The earlier tests mean earlier detection and treatment of gestational
diabetes in women at highest risk, possibly reducing complications
to both mothers and babies, says study author Dr. Gerard
Nahum, an associate clinical professor in the department
of obstetrics and gynecology at Duke University Medical
He and researchers from the University of Hawaii and California
State University studied 255 pregnant women who came to
a private obstetrics practice in Honolulu. The women were
given a glucose screening test between 14 and 18 weeks of
In that initial screening, 14 of the women had blood plasma
glucose levels higher than 135 milligrams of glucose per
deciliter of blood (mg/dL). They were sent for more testing
to confirm whether they had gestational diabetes.
The other 241 women were screened again at between 24 and 32
weeks of pregnancy. Any who had a blood plasma glucose level
higher than 135 mg/dL were sent for more testing.
"Women who had a 16-week glucose screening test result
of less than 110 mg/dL had a 99.4 percent chance of not
developing gestational diabetes," Nahum says.
"None of the women who had a result of less than 104 mg/dL
developed gestational diabetes. This gives us a cutoff point.
Women who test in this range at 16 weeks are almost guaranteed
not to develop gestational diabetes," he says.
More studies are needed to confirm that earlier screening for
gestational diabetes can benefit mothers and their babies,
Gestational diabetes occurs in 2 percent to 7 percent of all
pregnancies in the United States.
Institute of Child Health & Human Development has
more information on gestational diabetes.
Says Malarone Safer Than Other Malaria Drugs
WASHINGTON (Reuters Health) - The US Food Administration has
allowed drugmaker GlaxoSmithKline to boost safety claims
for its malaria drug Malarone, Glaxo said Friday.
The company said the FDA ( news
sites) approved the addition of favorable new safety
data that showed it has fewer overall adverse events than
two competitors, chloroquine/proguanil and Roche's Lariam
Several marketed malaria treatments are labeled with possible
serious side effects including seizures, psychotic episodes
and depression. Glaxo said the comparative safety study
showed that patients receiving Malarone (atovaquone and
proguanil hydrochloride) suffered fewer adverse events overall,
compared to travelers who used Lariam and chloroquine/proguanil.
The announcement followed reports that an Army epidemiological
team had been dispatched to Fort Bragg, North Carolina,
to investigate the recent killings of four women there,
and what role, if any, Lariam may have played.
Specifically, the company said the study showed that 14% of
travelers using Malarone had neuropsychiatric side effects
such as strange or vivid dreams, insomnia, dizziness or
vertigo, anxiety and depression, compared to 29% on Lariam.
The studies also showed that those on Malarone experienced
fewer gastrointestinal side effects than those who used
chloroquine/proguanil (12% vs. 20%), Glaxo said.
"We are hopeful that the addition of this new safety data
to Malarone's label will assure physicians they can prescribe
an antimalarial that is both effective and well tolerated,"
said Jo LeCouillard, vice president of GlaxoSmithKline's
Vaccine Business Unit, in a statement. "On the strength
of these study results, Malarone may well become the preferred
option for malaria prevention for both travelers and physicians."
The FDA approved Malarone in July 2000 for the prevention and
treatment of acute, uncomplicated malaria in adults and
children. The drug is taken orally one to two days before
travel, every day during the trip and for seven days after
GlaxoSmithKline said that malaria poses a serious threat to
an estimated seven million Americans who travel to malaria-endemic
countries each year. Each year, about 1,000 to 1,500 will
contract the disease, the company added.
A corporate spokeswoman told Reuters Health that the timing
of the Malarone safety data being announced following the
news of the Army investigation was coincidental.
Bones About It -- Milk Helps Kids' Growth
By Nancy A. Melville
FRIDAY, Aug. 23 (HealthScoutNews) -- With cartoon-character
juices and sodas lining the lower level of store shelves,
it has never been harder for parents to sell kids on the
virtues of good old-fashioned milk.
However, according to new research, failure to get enough milk
in childhood could keep those higher shelves out of reach
for kids much longer than expected.
In comparing a group of 50 children who had avoided milk between
the ages of 1 to about 6 with 200 habitual milk consumers
in the same age group, researchers in New Zealand found
the milk-avoiders were not only substantially shorter in
stature, but had worse bone health and much higher rates
of bone fractures.
Evaluations of calcium intake and bone mineral density showed
that only four of the non-milk drinking children had adequate
intakes of calcium, and in general, children in that group
had a lower total-body bone mineral content than the control
In addition, the annual incidence of forearm fractures was
3.5 percent in milk-avoiding children, compared with an
expected rate of about 1 percent in regular milk consumers.
Interestingly, while the milk-avoiding children were found
to be in generally good health, about 30 percent were overweight
or obese, a problem the researchers attribute to the likely
substitution of sugary juices or sodas for their liquid
"Milk and dairy products generally provide about 75 percent
of the dietary calcium in Western diets," explains
co-author Ailsa Goulding, a professorial research fellow
at Otago University in New Zealand.
"But milk consumption is falling today in the U.S. and
other countries, as many youngsters (are given) excessive
fizzy drinks and fruit juices instead of milk because they
are cheaper," she adds.
The findings appear in the August issue of the American
Journal of Clinical Nutrition ( news
While other studies have shown lower calcium levels in children
who have low milk consumption, Goulding says this is the
first study to measure bone density throughout the skeleton
of a group of young children who have chronically avoided
cow milk; to ask about bone fractures; and to look at height
and levels of obesity accurately.
"We were surprised not just by the severity of the low
density in the children we studied, but also by the high
number of young children we saw who had already broken bones
and by their shortness and (excessive weight)," she
Goulding notes that only about half the participants had ever
experienced any unpleasant physical symptoms from milk consumption.
Many instead avoided milk simply because they disliked the
taste or because family members chose not to offer it to
"One child refused milk merely because she didn't like
cows," Goulding says.
The American Academy of Pediatrics (AAP) recommends 800 milligrams
of calcium each day for children, and 1,200 to 1,500 milligrams
per day for preteens and adolescents, or three servings
of low-fat dairy products per day. Exercise is also important
in enhancing bone mass.
Experts stress that fat-reduced dairy products such as skim
milk are not less nutritious for older children than whole
milk, and they say there are plenty of creative -- and appetizing
-- alternatives to regular milk that parents can use to
satisfy the calcium requirements.
Yogurts, cheeses and fruit smoothies containing milk, yogurt
or ice cream are good choices, says Dr. Marc Jacobson, co-chair
of the AAP's committee on nutrition and a professor of pediatrics
at Schneider Children's Hospital in New Hyde Park, N.Y.
"Even chocolate milk is fine, " he adds.
Calcium supplements may help, but doctors say the nutritional
mix provided in milk is much more valuable.
"Milk is a complex and well-balanced nutrient -- it's
also a major source of protein, for example," Goulding
says. "And in addition to the calcium, milk offers
plenty of the vitamin D that's necessary to absorb the calcium
While getting enough calcium is important throughout life,
there's no time when it's more critical than in the developing
years, when the bones are still growing, Jacobson adds.
"A good way to look at it is like making deposits in your
bone bank, realizing that once you get to a certain age,
usually in your 20s, that bank is no longer going to accept
deposits and you just have to live with what you've got,"
"You can prevent loss in later years with good calcium
intake, but you can't add new bone mineral. The skeletal
structure is finished developing," he adds.
What To Do
You can read more about the American Academy of Pediatric's
recommendations on calcium intake in its policy statement
Requirements of Infants, Children, and Adolescents.
And the American Dietetic Association offers helpful information
on how Calcium
Intake Increases When Milk Takes a Flavor and Getting Kids to Drink Milk.
AUGUST 22, 2002
The Lead Out!
(HealthScoutNews) -- More than 80 percent of the U.S. homes
built before 1978 still have lead-based paint in them. And
the older the house is, the more likely it is to contain
a higher concentration of lead in the paint, according to
the Centers for Disease Control and Prevention ( news
Lead, a highly toxic metal, may cause a range of health woes,
from behavioral problems and learning disabilities to seizures
and death. Children 6 years old and under are most at risk,
because their bodies are growing quickly.
Research suggests that the primary sources of lead exposure
for most children are, in addition to deteriorating lead-based
paint, lead-contaminated dust and lead-contaminated residential
According to recent CDC estimates, 890,000 U.S. children ages
1-5 have elevated blood lead levels, and more than one-fifth
of African-American children living in housing built before
1946 have elevated blood lead levels. Children between 12
months and 36 months old have a lot of hand to mouth activity,
so if there is lead in their homes, they are more likely
to ingest it than are older children.
Children at risk for lead exposure should have a blood test.
If treatment is deemed necessary, it can prevent irreversible
damage caused by lead poisoning.
AIDS Drug Raises Hopes, Fears
By Theresa Agovino
AP Business Writer
NEW YORK (AP) - The federal government has approved tests of
an experimental and potentially expensive AIDS ( news
sites) drug that could prolong the lives of patients
with drug-resistant strains of HIV ( news
Dubbed Fuzeon by its developers, Roche Group and Trimeris Inc.,
the drug won a priority, six-month review from the Food
and Drug Administration ( news
sites). The companies hope to put Fuzeon on the market
"Everyone is so pleased about the drug itself," said
Martin Delaney, founding director of Project Inform, an
advocacy organization. "It is such a significant development.
But we are terribly apprehensive about the cost."
Roche, based in Switzerland, and Trimeris, of Durham, N.C.,
won't discuss pricing details until the drug is approved,
but say Fuzeon is complicated to produce and will be expensive.
Experts predict a cost of $10,000 to $15,000 a year per
The most expensive AIDS drugs now available cost about $7,500
a year, although some combination treatments approach $15,000
in annual costs.
Fuzeon's cost should be kept in perspective, said Dr. James
Thommes, the drug's medical director at Roche, saying that
it keeps people from expensive hospital stays and prolongs
"No one wants drug companies to stop looking at ways to
treat AIDS" because of expense issues, he said.
Cash-strapped AIDS assistance programs are already worried
they might not be able to afford Fuzeon. Roche and Trimeris
also have said they may not be able to make enough Fuzeon
to meet initial demand.
The drug is the first in a class known as fusion inhibitors,
which are designed to block HIV from entering blood cells.
It acts on the third stage of that entry process, known
Fuzeon's journey to the marketplace exemplifies the challenges
of transforming innovative science into a drug that fits
into a complex web of production, pricing and patient demands.
Roche began outfitting a plant to produce Fuzeon two years
ago, when only one 28-patient study on its effectiveness
was completed. The companies knew Fuzeon had promise but
couldn't know how it would perform in large trials.
The plant was set up to produce enough Fuzeon for 25,000 patients
by the end of 2003 and 40,000 patients by 2004.
Now, it looks like demand will be greater.
It is unclear how many of the 850,000 to 950,000 Americans
infected with the virus have a drug-resistant form. Resistance
often becomes a problem after people start taking AIDS medicines.
A recent study in the New England Journal of Medicine ( news
sites) found that the number of newly infected people
with resistance to one drug increased threefold from 1995
to 2000, to 12.4 percent. A study by the Department of Veterans
Affairs ( news
sites) released last December found that 78 percent
of the 1,647 people they tested showed resistance to one
or more AIDS drugs.
Clinical tests showed that when Fuzeon was added to the regimen
of patients with drug resistance, they were twice as likely
to have virus concentrations decrease below detectable levels
than those who didn't add the medicine.
Fuzeon was discovered by two researchers at Duke University,
Dani Bolognesi and Tom Matthews, who then founded Trimeris.
Fuzeon is a large, complex peptide, or string of amino acids,
that is difficult to manufacture and must be taken by injection
twice daily. Most drugs are small molecules that are easier
to produce and can be taken orally.
"We knew we'd have challenges in cost and production,
but what was the alternative?" Bolognesi said. "The
important thing is there is a new AIDS drug."
As they struggle with the already high cost of existing drugs,
AIDS assistance programs in 11 states have closed enrollment
or limited access because of budget constraints. The programs
provide care to those who can't afford it using state and
federal money, and illustrate how cost is a factor not just
in poor countries, where pharmaceutical firms have been
pressured to reduce prices.
When Fuzeon becomes available, "no one knows how they
are going to afford to pay for this," said Bill Arnold,
chairman of the ADAP Working Group, an advocacy organization
for the programs.
Activists are seeking an accounting of costs from the manufacturers.
They are concerned the makers might try to make as much
profit as possible before other drugs arrive. Merck and
Schering-Plough are developing another class of AIDS drugs
that can be taken orally.
Bolognesi thinks activists' concerns about Fuzeon's price are
premature because it is still unclear how the drug will
fit into the current treatment mix. It may wind up replacing
one or two drugs in a patient's regimen, so the total treatment
cost might not jump significantly, he said.
On the Net:
News on Vitamin E
THURSDAY, Aug. 22 (HealthScoutNews) -- If you are a woman who
doesn't get enough vitamin E, you could increase your risk
of cardiovascular disease.
A study in the September issue of the American Journal of
Clinical Nutrition ( news
sites) found that low vitamin E intake in middle-aged
women is a risk factor for early atherosclerosis.
The study included 307 southern Italian women, average age
56, with no clinical history of cardiovascular disease.
The women did not take any vitamin supplements containing
the antioxidant vitamins A, C or E.
Their average daily intakes and plasma concentrations of antioxidants
were assessed, using questionnaires and blood samples. They
were also given ultrasound examinations of the carotid arteries
The researchers found that 66 percent of the women had atherosclerotic
plaques at one or more sites in the carotid arteries. Women
with the lowest vitamin E intake were more than twice as
likely to have plaque in their carotid branches.
There was no connection between such plaque in the women's
carotid arteries or branches and their intake of vitamins
A and C, the study found.
The women in the study reported their main sources of dietary
vitamin E were legumes, vegetables and olive oil.
The study authors say only people with low intakes of vitamin
E could benefit from increasing their intake of the vitamin.
Before anyone alters their diet or takes antioxidant supplements,
they need to assess their daily vitamin E intake with their
doctor, the authors say.
Institutes of Health has an extensive overview on vitamin
Will Be What We Eat
THURSDAY, Aug. 22 (HealthScoutNews) -- Here's an inner child
you might not want to carry into adulthood.
A child with a high body mass index (BMI) is more likely to
be obese or overweight as an adult, says a study in the
September issue of the American Journal of Clinical Nutrition
The researchers used newly revised BMI-for-age charts from
the Centers for Disease Control and Prevention ( news
sites) to estimate the probability that an overweight
or obese child will be that way when they grow up.
The new charts that say a BMI of 25 or more (26 for men and
28 for women on the previous chart) is considered overweight
for both males and females aged 2 to 20 years.
The study found the higher a child's or adolescent's BMI and
the older the child, the more likely they would be an overweight
or obese adult.
The study included 166 white males and 31 white females who
were enrolled in the study soon after they were born. A
comparison was done between their weight and stature when
they were 3 to 20 years old and when they were 30 to 39
Young males with high BMI-for-age were more likely to be overweight
adults than young females with high BMI-for-age.
Here's an example of what the researchers found: A 12-year-old
girl with a BMI of more than 25 would be in the 95th percentile
of BMI for her age, the researchers say, and would have
an 80 percent probability of being an overweight adult.
That would increase to a 90 percent probability if she remained
in the 95th percentile for BMI when she was 20.2 years old.
The researchers say the findings mean that adolescence is a
critical period in terms of lifetime weight management.
They recommend this predictive approach be used to evaluate
and monitor children and adolescents who are in the 85th
or higher percentile of BMI for their age.
Calculate and learn more about your BMI
at the Centers for Disease Control and Prevention.
Zoos: Steer Clear of Dirty Hands
By Adam Marcus
THURSDAY, Aug. 22 (HealthScoutNews) -- The Escherichia coli
0157:H7 that poisoned 51 people, mostly children, at a Pennsylvania
petting zoo two years ago was likely caused by contact with
calves and young cattle contaminated with the bacteria.
That's the conclusion of a new post-mortem of the outbreak,
which helped spur the Centers for Disease Control and Prevention
sites) (CDC) to issue new guidelines for proper sanitation
at petting farms.
Although no visitor who fell ill during the episode died, the
newborn baby of the farm's owners died four days after birth
from a mix of infections that included E. coli, officials
said at the time. However, the subsequent investigation
eliminated the 0157 strain as a culprit in the infant's
Petting zoos have long been known, among microbe hunters if
not the public, to be infection risks. Children touch animals,
pick up germs that live in their feces, and ingest those
organisms by bringing their unclean hands to their mouths.
Incidents similar to that in Pennsylvania have been reported
in England, Canada and other parts of the United States
-- including one in 2000 in Washington that sickened five
children, three of whom required hospitalization.
In response to the Pennsylvania and Washington outbreaks, the
CDC issued voluntary guidelines for petting zoos. The agency
called on farms to locate hand-washing stations close to
animal pens, post signs stressing the importance of clean
hands in preventing E. coli infection, and take other
steps to reduce transmission of the bacteria.
"The single most important thing that people can do to
avoid [E. coli] from farm animals is to wash their
hands immediately after touching an animal," says Dr.
John Crump, a CDC medical epidemiologist and lead author
of the latest report.
"We have learned of some farms that have implemented changes,"
Crump adds, but he notes the agency has no enforcement powers.
The analysis of the outbreak appears in tomorrow's issue
of The New England Journal of Medicine ( news
The outbreak, at Merrymead Farms in Montgomery County, Pa.,
seems to have occurred between September and November. Of
the 51 people sickened, 47, or 92 percent, were 10 years
old or younger. Their symptoms included bloody diarrhea,
fever, vomiting and other signs of gastric infection. None
died, although 16 were hospitalized.
Thirty-three, or 15 percent, of the farm's 216 cows were found
to be contaminated with E. coli0157:H7. However,
none of the 43 other animals at the petting farm tested
positive for the germs.
Of the 33 cows with the 0157 strain, 28, or 85 percent, had
the same molecular profile as the bugs isolated from patients.
Not surprisingly, investigators learned, the petting zoo's
youngest attractions were the source of the disease. "We
know from the animal literature that it's the young animals
that are most often colonized with E.coli. What we
found with the herd at the farm was consistent with that,"
E. coli poisons roughly 73,000 Americans a year,
killing 60. Most contract the infection through tainted
food and water.
"You're more likely to come down with a diarrheal illness
from a food product then you are from a petting zoo. But
if you die from visiting a zoo, you're just as dead,"
says Philip Tierno Jr., a pathogen expert at New York University
Medical Center in New York City.
"Of all of the things that expose children to pathogens,
petting zoos are easiest to control," adds Tierno,
author of The Secret Life of Germs.
What To Do
To learn more about E. coli, try the CDC
or the U.S.
Food and Drug Administration.
No '90s Health Coverage Boom
By Laura Meckler
WASHINGTON (AP) - The booming economy of the late 1990s did
not lead to an increase in the percentage of American workers
covered by employer-sponsored health insurance, a study
The number of uninsured children in working families dropped,
but only because of a new government program.
Overall, about three in four people under age 65 in working
families got health insurance from an employer in 2001,
statistically unchanged from 1997, according to the report
released Wednesday by the Center for Studying Health System
During most of those years, health costs were relatively stable.
That, combined with the strong economy and demand for workers,
should have helped increase health insurance coverage in
the private sector but it didn't, analysts said.
"These findings tell us that relying on economic growth
to reduce the number of uninsured won't work," said
Paul B. Ginsburg, president of the research center. "Short
of a major public investment ... significantly reducing
the number of uninsured Americans in working families isn't
In 2001, there were 189 million people under age 65 in working
families. Of them, 75.6 percent had insurance through an
employer. Another 8.4 percent were offered insurance but
didn't take it, typically because their share of the premium
was too expensive. Sixteen percent were not offered health
insurance at all.
Kate Sullivan, director of health policy for the U.S. Chamber
of Commerce ( news
sites), said the numbers didn't increase more because
so many of the new jobs were created by cash-strapped small
businesses, who traditionally have trouble affording coverage
for their workers. She added that in raw numbers, rather
than percentages, the number of people with employer-sponsored
coverage rose, as the total number of workers rose.
Still, she agreed with the report's conclusion. "I don't
think you can count on employers to solve the problem of
the uninsured," she said.
The increase in coverage came thanks to the State Children's
Health Insurance Program, CHIP, which was created in 1997
and now covers more than 3 million children. It typically
offers insurance on a sliding scale, with parents who earn
more money paying a higher portion of the premium.
The portion of uninsured children in working families fell
from 20.4 percent in 1997 to 15.5 percent in 2001.
Some of those kids were eligible for coverage from their parents'
employers a problem that lawmakers worried about when
creating CHIP. The program was designed to minimize this,
to avoid spending taxpayer money to cover kids who have
access to insurance in the private sector.
The study found that about a third to half of the children
who signed up for CHIP otherwise would have had access to
private coverage, though it might have been too expensive
for their parents to buy.
The results are based on a telephone survey conducted in 1996-97
and again in 1998-99 and 2000-01. Each survey gathered information
concerning about 60,000 people.
in Moms' Diets Fuel Growth of Newborn Brains
By Adam Marcus
THURSDAY, Aug. 22 (HealthScoutNews) -- Pregnant women who eat
more of a key fatty acid found in fish have babies who show
signs of more mature brain development, a new study has
Those newborns whose mothers had more of it in their blood
had heartier sleep patterns in the first 48 hours after
delivery compared to those whose mothers consumed less of
the compound, known as docosahexaenoic acid (DHA).
Infant sleep patterns are thought to reflect the maturity of
their nervous system, and have been correlated with more
rapid development in their first year of life. A report
on the findings appears in the September issue of the American
Journal of Clinical Nutrition ( news
An omega-3 fatty acid, DHA, along with another substance, arachidonic
acid (AA), are key building blocks in breast milk that contribute
to healthy brain and eye development. Indeed, acknowledging
the advantages of these compounds, two of the nation's largest
formula makers, Ross Products and Mead Johnson Nutritionals,
announced earlier this year that they would begin adding
them to select brands.
The two substances are also passed from mother to fetus across
the placenta. Some 70 percent of brain cell development
takes place during gestation.
In the new study, Carol Lammi-Keefe and her colleagues at the
University of Connecticut compared DHA levels and newborn
sleep patterns in 17 women and their babies. Ten of the
women had high blood concentrations of DHA -- considered
to be more than 3 percent of their total circulating fatty
acids -- while seven had less than that amount.
Lammi-Keefe's group didn't ask the women about their diets.
None of the subjects in the study had DHA levels that reflect
eating three or more fish meals a week, what many experts
recommend. Other foods, like eggs and red meat, contain
modest amounts of the nutrient, but cold-water fish such
as tuna and mackerel are considered the best source.
Women with low DHA were more likely to be minorities and to
have received fewer years of education. They were also five
years younger, on average, than those in the high DHA category
-- 24 versus 29 years.
All the babies were delivered vaginally, and none of the women
had been given drugs known to make newborns lethargic, the
Using a motion-sensing pad to measure breathing and movement
during sleep cycles, the researchers found babies of women
in the low-DHA group had less advanced sleeping patterns
than the other infants. They had a greater ratio of "active"
to "quiet" sleep, spent more time transitioning
between sleeping and waking, and spent less time fully awake
than those of women with higher blood levels of the fatty
"As an infant matures, normally you would see the infant
spending more time in a wakeful state," Lammi-Keefe
says. "Infants born to mothers with more DHA have sleep
characteristics of a more mature central nervous system
compared with the infants of mothers with lower DHA levels."
The researchers are now organizing a study that will look at
dietary intake of DHA in pregnant women. It will follow
their children over the course of a year to assess the substance's
impact on development. Lammi-Keefe says she hopes to enroll
between 140 and 160 women in the project.
June Machover Reinisch, director emerita of the Kinsey Institute
and a child development expert, says the findings seem to
echo the importance of breast feeding for optimal infant
growth. However, she notes it's difficult to draw meaningful
conclusions from the research.
After all, many factors, from method of delivery and the use
of anesthesia during labor to the infant's gender, can influence
a newborn's wakefulness.
"We have to be flexible in our definition of development,"
Machover Reinisch says. "With the child who sleeps
not as well at two days, it may be related to the DHA, but
it doesn't necessarily mean that there's going to be a problem
with that child."
Researchers have correlated newborn sleep states with performance
on mental and motor developmental tests at 9 months of age.
However, both Lammi-Keefe and Reinisch say there's no way
to predict whether a child with less mature sleeping habits
in the first week of life will be anything other than healthy.
What To Do
more on fatty acids and infant development, try Infant Canada. For more on infant
sleep states, try Lamaze.com
Stem Cells May Be Less Versatile Than Thought
By Amy Norton
NEW YORK (Reuters Health) - Although past animal research has
suggested stem cells in adult bone marrow can develop into
brain cells, the results of a new study in mice indicate
that this is not a universal phenomenon.
The finding may take some air out of the hope that a person's
own bone marrow cells could one day be used to replace brain
cells damaged by diseases such as stroke--a possibility
raised by some previous animal work.
"That was the promise, but our study suggests it's not
that simple," lead author Dr. H. David Shine of Baylor
College of Medicine in Houston, Texas, told Reuters Health.
However, that's not to say that adult bone marrow cells will
not someday turn out to be a useful source of new brain
cells, according to the researcher. Instead, the new findings
indicate that the transformation of bone marrow cells into
brain cells is "probably not a general phenomenon,"
He and his colleagues report their findings in the August 23rd
issue of Science.
In the study, the researchers transplanted bone marrow stem
cells from one type of lab mouse into another. The mice
used as "donors" carry a gene called LacZ in most
of their cells, which allowed the scientists to weed out
which cells in the recipient mice were derived from the
Some of the mice were given brain injuries to see if the donor
bone marrow cells would develop into replacement brain cells.
However, Shine's team found no evidence of this--nor did
they find any donor-derived neural cells in the uninjured
"Of course, we were disappointed," Shine said.
However, these results are far from the final word on the potential
of adult bone marrow cells in treating brain injury, according
to the researcher. Instead, he noted, it emphasizes that
there is much more work to be done.
Source: Science 2002;297:1299.
Reviews Novartis Cancer Drug
Thursday, August 22, 2002
BASEL, Switzerland (AP) - Novartis said Thursday that its anti-cancer
drug Gleevec is receiving a priority review from the U.S.
Food and Drug Administration ( news
sites) for use by a wider range of sufferers.
The FDA took only three months to approve the drug for the
treatment of adults in the late-stages of chronic myeloid
leukemia, or CML, and stomach cancer.
Now the Swiss pharmaceutical company has applied for approval
of Gleevec known as Glivec outside the United States
for the treatment of children and of newly diagnosed CML
The FDA grants priority reviews to products for serious or
life-threatening diseases that may offer a significant improvement
compared with existing therapies.
"The current labeling represents around 25 to 30 percent
of patients suffering from chronic myeloid cancer,"
said David Epstein, head of Novartis' oncology unit.
He said research and trial data show that the earlier CML patients
are treated with Gleevec, the more likely they are to respond
positively to the drug.
Currently, a bone marrow transplant is the only known cure
for CML. The standard treatment is with interferon, which
can extend a leukemia patient's life by up to two years
but can have side effects that cause about 20 percent of
patients to stop using it.
Initial data showed that the treatment with Gleevec is about
three times more effective than today's standard treatment
with interferon, Epstein said.
Novartis is developing a number of drugs that work similarly
to treat solid tumors found in colon, ovary or breast cancer
sites), metastatic colorectal cancer and iron overload,
Early Mobiles Reportedly Pose Brain Tumor Risk
By Anna Peltola
STOCKHOLM (Reuters) - Long-term users of some first generation
cell phones face up to 80 percent greater risk of developing
brain tumors than those who did not use the phones, a new
Swedish study shows.
The study, published in the European Journal of Cancer Prevention,
looked at 1,617 Swedish patients diagnosed with brain tumors
between 1997 and 2000, comparing them with a similar control
group without brain tumors.
Researchers found that those who had used Nordic Mobile Telephone
handsets had a 30 percent higher risk of developing brain
tumors than people who had not used that type of phone,
particularly on the side of the brain used during calls.
For people using the phones for more than 10 years, the
risk was 80 percent greater.
"Our present study showed an increased risk for brain
tumors among users of analog cellular telephones. For digital
cellular phones and cordless phones the results showed no
increased risk overall within a five-year latency period,"
the study said.
Two major mobile phone manufacturers disputed the findings
of an increased risk of cancer.
The world's biggest mobile producer, Finland's Nokia ( news
sites) Oyj, which still produces two models of phones
working in the Nordic Mobile Telephone standard, said scores
of other studies conducted on the health effects of cell
phones showed no evidence of health hazards for users.
"There have been close to 200 studies done on different
areas of mobile phones and in the light of those and the
way the scientific evidence is, there is no health risk
in using mobile phones," Marianne Holmlund, communications
manager at Nokia Phones, told Reuters Thursday.
Mikael Westmark, a spokesman for Sweden's Telefon AB LM Ericsson
sites), which used to make Nordic Mobile Telephone handsets,
said: "The study and the conclusions it reaches differs
from at least three other studies in the past in several
highly regarded scientific journals. None of these studies
found a connection between mobile phones and cancer."
Developed To Serve Nordic Countries
The Nordic Mobile Telephone network was initially developed
to serve the Nordic countries, starting operations in the
early 1980s, but then became popular in Russia and the Baltic
It is still used in more than 40 countries, but has been overtaken
in several countries by the Global System for Mobile Communications,
which is due to be gradually replaced by rapid third-generation
Analog Nordic Mobile Telephone phones have been in operation
for 20 years, making it possible to study the longer-term
impact of microwave exposure to their users, but researcher
Kjell Hansson Mild said it was too early to draw conclusions
on the currently widely used digital Global System for Mobile
"Nothing can be said about GSM at this stage," said
Hansson Mild, professor at the National Institute for Working
Life and co-leader of the study.
"These are tumors that develop very slowly, and GSM does
not have users who have been using it for 10 years,"
he told Reuters. (Additional reporting by Jan Strupczewski)
(HealthScoutNews) -- Lice, small insects that live on humans,
survive by feeding on blood. They are spread easily from
one host to another through close bodily contact or through
shared clothing or personal items (such as hair brushes).
They can not jump or fly but they can itch like crazy.
Outbreaks of head lice are common in children in school and
day care centers, reports Clarian Health Partners, an affiliate
of Indiana University. Girls are slightly more likely to
be infested than boys. People from all income and social
levels can be affected by head and pubic lice, as can people
who bathe, shampoo their hair, and wash their clothing regularly.
By comparison, body lice are more common among people
who do not bathe regularly or who do not wash their clothes
Both nonprescription and prescription products are available
to treat head and pubic lice. An oral prescription medication
(ivermectin) may be used to treat them when two or more
approved topical medications have not been effective. Itching
may persist even after successful treatment.
Medicines generally are not needed to treat body lice, since
they live in clothing, not on your body. Washing the clothing
in hot (130 degree F/54.4 C) water usually is sufficient
to eliminate the problem.
Injuries Send 4.3 Million to ERs Each Year
By Alison McCook
NEW YORK (Reuters Health) - Summer is a great time to run around
outdoors, but sporting aficionados may not be taking enough
precautions to avoid potentially life-threatening injuries,
according to US government researchers.
From the summer of 2000 to the following year, 4.3 million
people sought emergency care after being injured while engaged
in sports or recreational exercise, representing 16% of
all "unintentional injury-related emergency department
visits" in the US.
These types of injuries are more common than those involving
passengers in motor vehicles, which total only 3.5 million
annually, according to Dr. Julie Gilchrist and her colleagues
at the Centers for Disease Control and Prevention ( news
"This happens a lot," Gilchrist told Reuters Health.
"People end up in the emergency department as a result
of activities that are considered healthy."
In order to prevent such injuries, Gilchrist and colleagues
urge people engaged in sports or play to use safety gear,
make sure they are fit enough for the activity, and use
only safe equipment. It's time to "remind people who
are participating to take precautions that are known to
work," she said.
Injury rates were obtained from a national surveillance program
that monitors injuries treated in emergency departments
across the US.
The rate of injuries varied by age and gender, with the highest
incidence of these accidents occurring in boys aged 10 to
14, and the lowest in women at least 45 years old.
In young children, injuries were most likely to result from
frolicking on playgrounds or riding bicycles, while teens
tended to be injured most often during organized sporting
activities such as basketball and football. Adults often
injured themselves when engaged in exercises including weight
lifting, aerobics and jogging.
The most common injuries were sprains or strains--representing
almost 30% of all reported sports-related injuries--fractures,
and bruises or abrasions, the authors note in the August
23rd issue of the CDC's Morbidity and Mortality Weekly Report.
In an interview with Reuters Health, Gilchrist said that this
report does not include injuries that people treat at home,
nor those they choose to bring to a primary care physician
or sports medicine clinic rather than the emergency department.
"There are a lot of sports-related injuries that don't
end up in the emergency department," she said.
And although the study does not examine which prevention strategies
would best reduce these injuries, Gilchrist noted that knowing
which sports pose the most danger to different age groups
helps point researchers in the right direction.
"You need to know what's going on before you know what
sports to target," she said.
Source: Morbidity and Mortality Weekly Report 2002;51:736-740.
Prilosec Needs Clearer Label
CINCINNATI (AP) - The Food and Drug Administration ( news
sites) has told Procter & Gamble Co. to provide
a clearer label for Prilosec before the consumer products
concern can sell the heartburn drug in stores.
The agency also told P&G in a letter earlier this month
that the company would have to conduct a study to prove
that patients can understand the label for an over-the-counter
version of Prilosec.
The letter is standard procedure and usually indicates the
agency expects to approve a drug once any remaining issues
Cincinnati-based P&G had hoped to have the over-the-counter
Prilosec on the market by early next year, but that was
before the company had received the specific FDA requirements,
Greg Allgood, associate director of P&G Health Sciences
Institute, said Thursday.
"We always expected to do a label study and included that
in our timeline projections, but we couldn't proceed until
we got the specifics from the FDA," he said. "Now
that we have those, we hope to have the drug on the market
in the first half of 2003, pending FDA approval."
Allgood said P&G expects to keep the Prilosec name for
its over-the-counter heartburn drug. The prescription version
of Prilosec, which is used to treat a variety of acid-related
diseases, is expected to remain on the market, he said.
Allgood said the requirements stated in the FDA letter were
not any different from what an FDA advisory committee told
P&G in June.
He said the company has no concerns that generic over-the-counter
versions of Prilosec will make it to the market before P&G's
"Once you get FDA approval, which is still pending, you
normally have about three years of exclusivity before any
generic over-the-counter drugs could get on the market,"
In afternoon trading on the New York Stock Exchange ( news
sites), P&G shares were down 55 cents at $90.34.
Considers Dietary Supplements
WASHINGTON (AP) - The National Institutes of Health ( news
sites) is bringing together researchers this week to
assess whether the dietary supplements garlic, ginkgo, hawthorn
and phytoestrogens help the heart, as touted.
Understanding the possible mechanism of the biological action
of widely used herbal supplements is important in designing
clinical trials to see if they really help, or if they cause
side effects or merely are a waste of money.
Herbs can contain numerous natural chemicals. If they do have
a medicinal effect, the pills and other supplement products
made from them must contain the responsible ingredient or
a user won't get the hoped-for benefit, explained Dr. Michael
Lin of the NIH's National Heart, Lung and Blood Institute,
who organized the meeting.
There is no federal regulation of supplements to ensure that
Consider garlic. Eating one or two fresh cloves a day has been
associated, in some studies, with a lower risk of heart
disease. But clinical trials of less smelly garlic pills
and powders have produced mixed results, with some finding
no effect from garlic at all.
It turns out that some of those dietary supplements studied
contained parts of garlic that are inactive, so "no
wonder it didn't work," Lin said.
While the effects of garlic's other, presumably active, ingredients
on the heart have yet to be proved, the example shows that
before designing more clinical trials of supplements, "we
want to be sure we know what we're dealing with," Lin
In addition to garlic, NIH will hear research about ginkgo,
mostly touted as a memory booster, although a major study
this week concluded it failed to help healthy people; hawthorn,
touted for heart failure; and phytoestrogens, plant-based
estrogens, mostly from soy.
Variant Linked to Higher Arrhythmia Risk
By Merritt McKinney
NEW YORK (Reuters Health) - A gene variation found in more
than 1 out of 10 African Americans increases the risk of
potentially fatal heart rhythm abnormalities called cardiac
arrhythmias, new research suggests.
But the risk of experiencing cardiac arrhythmia is still very
low in people who carry the genetic variant, according to
one of the study's authors, Dr. Mark T. Keating of Harvard
Medical School ( news
sites) in Boston, Massachusetts.
Each year, roughly 450,000 Americans die from cardiac arrhythmia.
There are several risk factors for the heart rhythm abnormalities,
including heart attacks, reduced blood flow to the heart
and certain medications, but not everyone who is at high
risk experiences an arrhythmia. One possibility is that
genetic factors may influence a person's risk.
In comments to Reuters Health, Keating explained that everyone
carries genetic variants, or polymorphisms, that subtly
increase the risk of disease. To identify genetic variants
that might raise the risk of arrhythmia, Keating and his
colleagues screened DNA samples from individuals with cardiac
arrhythmia. They identified Y1102, a variant form of a gene
called SCN5A. In additional DNA screening, the risk of cardiac
arrhythmia turned out to be 8 times higher than normal in
individuals who carried the Y1102 variant.
The researchers estimate that this variant occurs in roughly
13% of African Americans. No one in a sample of several
hundred whites and Asians carried the variant and it was
present in just 1 out of more than 100 Hispanics screened,
according to a report on the findings published in the August
23rd issue of the journal Science.
Despite the increased risk associated with having the variant
gene, Keating said, "it is important to note...that
most people carrying the variant will never have an arrhythmia."
The information will be most useful, he noted, for people
who are already at higher risk of arrhythmia, such as those
with a heart condition called cardiomyopathy or those who
take certain medications, such as diuretics used to treat
high blood pressure.
"Once this and other genetic tests are generally available,
Y1102 will be another tool in a physician's medical bag,"
Keating said. "Clinicians will be able to use genetic
information for predicting risk and preventing disease."
Since the risk of arrhythmia remains very low in people who
carry the variant form of the gene, Keating explained, "there
is no urgent need to obtain a test. It will be of greatest
use for individuals who are already known to be at risk
for arrhythmia for other reasons."
If a person is found to be at high risk for arrhythmia, there
are several ways to prevent the heart rhythm abnormalities.
Avoiding certain medications that increase the risk of arrhythmias,
such as diuretics, maintaining adequate levels of potassium
in the blood, and treatment with drugs called beta-blockers
may minimize the risk of arrhythmias.
Source: Science 2002;297:1333-1336.
on Rheumatoid Arthritis Found
BOSTON (AP) - A study in mice raises the possibility that carbohydrates
in human tissue may be a target of the misguided immune
system attack that results in rheumatoid arthritis.
The case, however, is still far from proven, and much more
research will be necessary to show how these essential components
of cells might be involved in this crippling autoimmune
disease, which affects about 2.1 million Americans.
The research, conducted by Dr. Julia Wang and colleagues from
Boston's Brigham and Women's Hospital, was presented Wednesday
at a meeting of the American Chemical Society.
Experts have long known that rheumatoid arthritis results when
the body's own disease-fighting cells attack the cartilage
and joints. The new work suggests that the specific target
of this onslaught is essential carbohydrates in the tissue.
"This is potentially of enormous importance," said
Dr. John H. Klippel, medical director of the Arthritis Foundation.
If the theory proves true, it could eventually lead to new
medicines for protecting the joints from this destruction.
The researchers believe the target of the disease is carbohydrates
called glycosaminoglycans, which are naturally present in
joint cartilage and fluid, among other places.
In the experiment, the researchers injected glycosaminoglycans
into mice and found that it triggered arthritis symptoms,
including swelling, inflammation and joint damage.
"This study shows that rheumatoid arthritis may result
from the body's mishandling of its own carbohydrates that,
under normal circumstances, would not be interpreted as
a threat," Wang said.
On the Net:
Drug Linked to High Rate of Eye Problems
NEW YORK (Reuters Health) - More than 40% of people with epilepsy
who take a particular drug to treat their symptoms may develop
eye problems as a result, UK researchers report.
The drug is called gamma-vinyl GABA (GVG), also known as vigabatrin
or Sabril. The treatment has been used for years to treat
epilepsy in Europe, and is also available in Canada. It
is currently awaiting approval by the US Food and Drug Administration
Previous reports have suggested that patients who take vigabatrin
may have an increased risk of developing visual problems.
In the present study, Dr. Andrew Nicolson of the University
of Liverpool in the UK and his colleagues found that 43%
of 98 patients tested had visual field defects that could
only be attributed to their use of the drug. None of the
patients tested had obvious symptoms of visual problems.
"This study confirms the previously reported high incidence
of asymptomatic visual field defects associated with vigabatrin.
Many patients taking vigabatrin may not have been counseled
about the risks," the authors write.
In epilepsy, abnormal electrical activity in the brain leads
to seizures. Some patients with the condition have partial
seizures, which occur in only one area of the brain, and
can range from sudden, unexplained feelings or sensations
to total loss of consciousness.
Vigabatrin reduces the number of seizures by altering how brain
cells communicate--specifically, by increasing the amount
of a messenger chemical in the brain called GABA. This process
allows brain cells to transmit messages to each other more
smoothly, preventing the uncontrolled releases of chemicals
into the brain that can lead to seizures.
In 1997, reports began to emerge that the treatment may cause
some patients to experience a narrowing of their field of
vision, which appeared to be irreversible, and became worse
as the treatment continued.
In the current study, published in the Journal of Neurology
Neurosurgery and Psychiatry, Nicolson and his colleagues
tested eye functioning in 98 patients with epilepsy who
had been given vigabatrin. Of these patients, 42 had problems
with their field of vision that could not be explained by
other events, such as stroke, trauma or brain damage. Men
were more likely to have vision problems than women.
Although there was no clear relationship between dose of vigabatrin
and the risk of visual problems, patients who received the
largest overall dose did appear to have a slightly higher
incidence of eye abnormalities.
During the study, which included 583 patients, a total of 445
patients stopped taking vigabatrin, and the vast majority--93%--did
not experience any increase in their symptoms as a result,
casting doubt on claims that stopping the drug can cause
patients to lose control over their seizures.
"Our study provides information from large numbers of
patients that the seizure outcome is generally good on cessation
of vigabatrin," Nicolson and his team write.
Despite the high prevalence of side effects, the authors stressed
that "there are clearly some circumstances in which
patients would elect to continue taking vigabatrin,"
and that they should balance the drug's benefits against
Aventis, the manufacturer of the drug, declined to comment
on the findings.
Source: Journal of Neurology, Neurosurgery and Psychiatry
Device Cuts Pain, Lengthens Injection Time
By Melissa Schorr
NEW YORK (Reuters Health) - A computerized injection device
can lessen the pain children endure at the dentist's office,
but it takes longer to administer than the traditional anesthetic
jab, which may mean kids who receive it will spend more
time squirming in the dentist's chair.
"We found that it actually helps reduce the discomfort
during the initial injection (of anesthesia)," study
lead author Dr. Keith D. Allen, a professor of pediatrics
and psychology at the University of Nebraska Medical Center
in Omaha, told Reuters Health.
The computerized device, called the Wand and made by Milestone
Scientific, Inc., injects the numbing solution into the
gums at the slowest possible rate. The device is available
to dentists, but little research has been conducted on whether
it is useful for reducing pain among young children.
To investigate, Allen and his colleagues conducted a study
comparing the Wand to a traditional anesthetic injection.
Milestone Scientific helped fund the research, which is
published in the August issue of the journal Pediatric Dentistry.
Forty children requiring local anesthesia for dental procedures
were randomly assigned to receive Wand injections or traditional
injections. The children ranged in age from 2 to 5.
The investigators measured signals of pain such as moaning,
crying and moving.
Children given the Wand injection cried less and were less
disruptive, the researchers found. For example, none of
the children using the Wand required some kind of restraint
during the first 15 seconds of the shot, while nearly half
the children receiving a traditional shot did.
But Allen noted that the Wand injection takes an average of
3 minutes to administer. A traditional shot may hurt more,
but takes only around 15 seconds.
"With preschoolers, because the Wand takes so much longer,
by the time you're done, those kids are becoming a little
fidgety," he said. "It's faster to get a shot--but
it hurts more. It takes a little longer to do a Wand injection,
but you end up with a kid who is less disruptive and in
However, this lengthy injection time may outweigh the benefits
of reduced pain, noted Dr. Joel Weaver, a spokesperson for
the American Dental Association and the director of anesthesiology
at Ohio State University's College of Dentistry. "This
Wand can be beneficial in some children, but the advantages
seemed to go away as the injection continued for a long
period of time," he told Reuters Health.
For example, at 45 seconds into the injections, 80% of patients
receiving injections from both the Wand and the regular
injection became disruptive.
However, Allen contended that reducing the extreme pain of
the traditional shot and adding a period of only modest
discomfort may help prevent children from developing a fear
of the dentist. "You try to avoid experiences that
are really discomforting for kids," he said, "because
you want them to associate going to the dentist with good
Source: Pediatric Dentistry 2002;24:315-320.
Thermometers Not So Hot
By Adam Marcus
THURSDAY, Aug. 22 (HealthScoutNews) -- The popular use of the
ear thermometer is being challenged.
Despite what you may have heard, the new-age aural gauges aren't
as accurate as the old-fashioned rectal types when it comes
to taking a child's temperature.
So say British researchers who reviewed a passel of studies
comparing the two gauges. They found the ear thermometers
come close, but perhaps not close enough, to rectal readings.
The researchers stress that doctors, hospitals and parents
don't need to throw out their ear thermometers -- they miss
the mark from rectal thermometers by an average of only
a fraction of a degree centigrade.
However, says Dr. Rosalind L. Smyth, a pediatrician at the
University of Liverpool and leader of the research group,
when clinical decisions hinge on an accurate temperature
reading, rectal is the way to go. Because while the average
variation from rectal temperature with the ear devices was
.29° centigrade, some studies found that the range of error
might be three times as great, or nearly 2° Fahrenheit.
"There are specific clinical situations where one reading
would perhaps change a patient's management," Smyth
says. For example, children with compromised immunity may
require intravenous antibiotics at the first sign of a fever.
So, underestimating body temperature might have disastrous
An accurate measure of fever is also crucial for very young
infants, experts say.
Smyth and her colleagues report their findings this week in
The ear thermometer technology works by reading the infrared
radiation -- a reflection of heat -- in the ear canal. A
computer then converts that information into body temperature.
Ear thermometers have obvious appeal. They can take readings
in seconds and present doctors, nurses and parents with
a less embarrassing route of temperature measurement. Not
surprisingly, nearly two-thirds of pediatricians and family
doctors in the United States report using the technology
Smyth's group reviewed 31 studies, involving 4,441 children,
comparing rectal and ear thermometers. The ear devices can
be programmed to simulate temperatures at various sites
in the body, giving readings for the ear canal and the rectum,
arm pit and a core figure. So the researchers included studies
that included these simulations.
When taken together, the studies showed that ear thermometers
consistently varied from rectal readings. They even did
so when simulating rectal temperature, though not by as
much as the average discrepancy. While the average difference
was only .29° centigrade, the highs and lows swung well
above and below the average difference.
"We're not saying that people should stop using [ear thermometers].
We feel that in the majority of situations people should
continue with the practice they find most comfortable,"
Smyth says. However, when the most accurate reading possible
is needed, rectal thermometers are best, she stresses.
Richard Harbin, a pediatric nurse practitioner at the Indian
River County Health Department in Vero Beach, Fla., says
he's not surprised by the latest report. "I would agree
with the findings," says Harbin, who called the reading
differences "a big problem" for health practitioners.
"The manufacturers say that these things are accurate,
but most people in practice" prefer rectal thermometers,
Harbin says. "If I saw a sick kid come in here and
thought he had a fever, I'd use a rectal thermometer"
to make sure.
What To Do
For more on ear thermometers, try HowStuffWorks,
AUGUST 21, 2002
to Revamp Drug Making Rules
By Lauran Neergaard
AP Medical Writer
WASHINGTON (AP) - The Food and Drug Administration ( news
sites) is poised to revamp rules for safe drug manufacturing
for the first time in 25 years, reacting in part to companies'
desire to automate pill production and the government's
own inability to inspect factories as rigorously as it once
The FDA's planned update comes even as numerous major medical
factories have repeatedly failed to meet current standards
of quality manufacturing.
Just last week, the FDA ordered a Georgia tissue bank to recall
soft tissue grafts because it couldn't guarantee they were
free of bacterial contamination. Drug maker Schering Plough
recently agreed to a $500 million FDA fine for quality-control
violations; Eli Lilly & Co. last month said factory
problems could delay as many as five drugs under FDA review;
and Abbott Laboratories in 1999 paid a $100 million fine
in agreeing to clean up its plants.
The FDA said its changes will modernize the way it inspects
medical factories ultimately focusing most on those that
make the riskiest products and allow pharmaceutical companies
to make better use of new technology that could improve
"There's a tremendous scientific and technological opportunity
here, and we need to embrace that and help the industry
embrace it," FDA drug chief Dr. Janet Woodcock said
For example, she cited fully automated manufacturing systems
that some U.S. drug makers use in factories in Europe and
other countries but not here that contain sensors embedded
in different steps. Those sensors could tell if a batch
of pills or powders has an ingredient wrong, for example.
So can FDA-required laboratory testing of a few pills here
and a few pills there, but a sensor may provide continuous,
immediate quality control, Woodcock said.
The FDA likes the promise of that technology, but drug makers
recently told agency officials that they believed the government's
25-year-old manufacturing rules made it too hard for them
to adopt it in their U.S. factories. As a first step in
its planned update of "good manufacturing practices,"
the FDA already has begun streamlining how companies can
adopt such technology, Woodcock said.
The Pharmaceutical Research and Manufacturers of America, the
industry's trade group, welcomed Wednesday's announcement,
saying FDA's development of new manufacturing standards
"will help ensure that patients continue to benefit
from timely access to high-quality" drugs.
But Larry Sasich of the consumer advocacy group Public Citizen
called the plans "very, very troubling."
He questioned whether FDA was loosening some standards simply
because it has run out of money to inspect medical factories
frequently, and asked how technology could really be transforming
the industry when so many factories have recently run into
trouble. "It just doesn't add up."
Last year the FDA inspected 1,600 factories for compliance
with good manufacturing practices, down from 4,300 in 1980,
Woodcock said. The reason: Even as the number of drugs FDA
oversees has increased, Congress has not increased funding
for regular inspections to ensure those medications aren't
contaminated and contain the proper, safe level of ingredients
in each batch.
The FDA's update won't loosen standards but strengthen them
so "we'll be able to allocate inspections better based
on risk," said enforcement chief John Taylor.
The update is expected to take several years to complete; companies
must follow the old rules until then.
On the Net:
Food and Drug Administration: http://www.fda.gov/
Chocolate Compounds Potential Cancer Drug
By Stephen Pincock
LONDON (Reuters Health) - Compounds found in coffee and chocolate
could form the basis of new drugs for cancer, heart disease
and inflammation, British scientists said on Wednesday.
Professor Peter Shepherd and colleagues from University College
London and elsewhere found that caffeine and a related molecule
called theophylline block an enzyme that is crucial for
They warned that the study did not mean people should overdose
on caffeine in an effort to avoid cancer, but said modified
forms of caffeine might one day be used to stop uncontrolled
cell growth in cancer or prevent blood clots that cause
heart attack and stroke.
In their study, the researchers used genetically engineered
insect cells to produce an enzyme called p110 delta. Caffeine
and theophylline both blocked the enzyme's function, according
to their report in the Journal of Biological Chemistry.
"Alongside possible advances in cancer treatment, this
research suggests that caffeine type drugs could be used
to treat heart disease and inflammatory illnesses,"
Shepherd said in a statement.
P110 delta is found mostly in white blood cells, meaning it
could be particularly useful in treating cancers like leukemia
and for inhibiting white blood cells that cause inflammation,
Shepherd told Reuters Health. In fact, theophylline has
been used for years as an asthma drug, but nobody really
knew how it worked, he added.
The enzyme is one of a group of molecules known as PI 3-kinases
that have become a focus of interest for major pharmaceutical
"Many drug companies around the world are looking for
inhibitors of these molecules at the moment," Shepherd
told Reuters Health. "This one was sitting there under
their noses all the time."
But the researcher stressed that chocolate and coffee were
not cures for cancer.
"The message to the general public is not to overdose
on chocolate or coffee. Caffeine has well-known side effects
that make it inappropriate for drug use," he said.
An Australian company called Kinacia has begun human studies
with a molecule that blocks another enzyme in the PI 3-kinase
family. It is hoping to develop anti-clotting medicines
that lack the side effects of drugs like aspirin.
Dr. Shaun Jackson, the founder and principal scientist of the
company, told Reuters Health that the British research would
speed the development of PI 3-kinase blockers.
"What it tells us is that we can modify the structure
of caffeine and come up with more potent inhibitors that
could ultimately become new therapies. It's exciting in
that respect," he said.
Source: Journal of Biological Chemistry 2002.
May Destroy Anthrax
By William McCall
A bacteria-killing enzyme can detect and destroy anthrax, and
should work even if terrorists create antibiotic-resistant
strains, researchers say.
The enzyme was isolated from a virus that attacks bacterial
"Essentially, it cracks them open and releases all the
cell contents, so the bacterial cell explodes," said
Raymond Schuch of The Rockefeller University in New York,
co-author of a study published Thursday in the journal Nature.
Ordinary anthrax responds to antibiotics, but there is concern
that terrorists might develop resistant strains. The researchers
suggested it would be difficult to create strains that resist
the enzyme because it acts on a vital part of the bacterial
wall, one that can't easily be modified.
Schuch and colleagues reported that the enzyme, called PlyG
lysin, kills anthrax bacteria in the laboratory. What's
more, when they infected mice with a related kind of bacteria
that can kill the animals within five hours, prompt treatment
with PlyG saved 13 of 19 animals.
They also found that spores of this anthrax-related bacteria
could be quickly detected using PlyG and a hand-held device.
"I think this is a very clever piece of work," said
Stephen Morse, a Columbia University molecular biologist
and former program manager of the advanced diagnostics program
at the Defense Advanced Research Projects Agency.
The PlyG enzyme possibly could be made into a drug that would
hunt down anthrax bacteria as they begin to infect a person
or an animal, Morse said.
"As always, it will take some time to fully develop and
validate this approach to make sure it has therapeutic value,
but it's very promising," Morse said.
Phil Hanna, a University of Michigan microbiologist who specializes
in anthrax, said the next step will be further animal tests
to see if the enzyme can halt an anthrax infection.
The key, Hanna said, as with conventional antibiotics used
against anthrax, is early treatment before the bacteria
produce enough toxin to kill healthy cells and tissue.
"If you wait too long, until serious symptoms appear,
even if you use antibiotics to kill all the anthrax bacteria,
the animal is doomed because of the toxin levels,"
Calvin Chue of the John Hopkins Center for Civilian Biodefense
Studies in Baltimore, Md., said the enzyme likely will have
more value as an alternative treatment for anthrax than
for detecting anthrax bacteria.
"There are detection methods coming down the line that
are more useful," Chue said, including equipment that
can identify bacterial DNA.
On the Net:
Nature magazine: http://www.nature.com
Carbohydrates Contribute to Arthritis
By Amanda Gardner
WEDNESDAY, Aug. 21 (HealthScoutNews) -- Carbohydrates that
are naturally present in the human body may help cause rheumatoid
arthritis, a debilitating, painful disease that has no cure
and no clear cause.
"Basically, we found that altered recognition and handling
of glycosaminoglycans (GAGs) in your body by the immune
system can cause rheumatoid arthritis," says Julia
Ying Wang, lead author of the new study and an assistant
professor of medicine at Brigham and Women's Hospital and
Harvard Medical School ( news
sites). "It affects primarily the joints, but also
skin and other connective tissues such as tendons."
The findings, which are being presented today at the American
Chemical Society's annual meeting in Boston, are in keeping
with what is already known about this disease, other experts
"Even though it may not be the cause, it may be an important
component in the cascade that leads to the damage,"
says Dr. Mark Jarrett, a rheumatologist and chief medical
officer at Staten Island University in New York City. "We
certainly feel rheumatoid arthritis is a disease that's
immune-mediated. One of the problems is that we've never
known what sets off the immune system that promotes the
disease. It certainly could be some natural carbohydrates
in our body, which, for some reason, are altered or recognized
as looking like they're altered by the immune system, and
trigger the cascade of inflammation that results in the
GAGs are sugars that are already present in joint cartilage,
joint fluid, connective tissue and skin. They do not come
from outside the body. "That's why it's called an autoimmune
disease. The body attacks itself," Wang explains.
When Wang and her colleagues injected large amounts of GAGs
into lab mice, the mice developed symptoms of arthritis,
including swelling, inflammation and joint damage.
The same type of GAG-binding cells were also found in tissue
taken from people with rheumatoid arthritis. In both mice
and humans, the cells which experienced inflammation had
receptors that bonded with the GAGs.
Wang suspects rheumatoid arthritis may be initiated by microorganisms
either because they present GAGs very similar to our own
on their surfaces or because they secrete enzymes that liberate
GAGs from the connective tissue.
"This is definitely a very nice target for drugs because
we found the same type of cells in humans already,"
Wang says. "To design inhibitors that block this interaction
would be a good drug target."
"It is an important step, even though it may not be the
critical step. If you can block that, it certainly might
lead to a treatment," Jarrett says.
Drugs developed to attack this mechanism would be classified
as biological agents, which target specific parts of the
immune system. Biological agents have become more and more
important in the treatment of rheumatoid arthritis.
"This complements the work that's ongoing," Jarrett
What To Do
For more information on rheumatoid arthritis, visit the Arthritis
Foundation or the National
Institute of Arthritis and Musculoskeletal and Skin Diseases.
Ear Fixes Noise Damage in 48-Hour Cycle
By Alison McCook
NEW YORK (Reuters Health) - The short-lived hearing loss that
follows a burst of noise such as a gunshot or loud concert
may result--and be reversed by--the damage and repair of
tiny structures in the inner ear, according to researchers
from the National Institutes of Health ( news
Tiny hair bundles found inside the inner ear, which enable
humans to hear, regenerate themselves every 48 hours--the
amount of time needed to recover from a temporary loss of
hearing, according to a new study by Dr. Bechara Kachar
The study was published in the August 22 issue of the journal
In an interview with Reuters Health, Kachar likened the process
to renovating a building, in which workers repair the structure
without tearing any part down. "You keep the building
in place, but you change 1 brick at a time, starting at
the top, and going to the bottom," he said.
However, these findings are not a call to concert-lovers to
abandon their earplugs, Kachar told Reuters Health. Permanent
hearing loss can occur from a single exposure to one very
loud noise, Kachar warned. Furthermore, just because researchers
have uncovered the means by which the ear may regain hearing
after temporary loss, "that doesn't mean we have a
way to prevent noise-related hearing loss" in the first
place, he added.
The researcher added that when people experience permanent
hearing loss, the tiny hair bundles may become "overwhelmed"
by the excessive noise and stop functioning, causing the
hair cells in the ear to die. As such, there are "limits
to what this machinery can stand," Kachar noted.
These findings may also shed light on some inherited hearing
abnormalities, Kachar added, which may result from problems
in the processes responsible for the formation and maintenance
of the tiny hair bundles.
Source: Nature 2002;418:837.
Admin. to Push Embryo Adoption
By Laura Meckler
WASHINGTON (AP) - Pushed by Congress, the Bush administration
is set to promote "embryo adoption," in which
one infertile couple donates leftover embryos to another.
It's the latest move in the heated debate over the moral
and legal status of an embryo.
The administration plans to distribute nearly $1 million for
public awareness campaigns promoting donation of embryos,
one of several options available to couples who create more
than they need for in vitro fertilization. Another option:
Donate them for stem cell research that has generated controversy
because the embryo must be destroyed to get the stem cells.
The Department of Health and Human Services ( news
sites) says it has no political agenda and is simply
following orders from Congress. The grant program was inserted
into an HHS spending bill by Sen. Arlen Specter ( news,
record), who supports both abortion rights and embryonic
stem cell research.
Specter, R-Pa., said the embryos should be available for research,
but only if they are going to be thrown away otherwise.
"If any of those embryos could produce life, I think they
ought to produce life," he said in a statement.
The public awareness campaign, he said, is "sort of a
test program" for embryo adoption. "Let us try
to find people who will adopt embryos and take the necessary
steps on implanting them in a woman to produce life,"
Still, the program is making some people nervous. Officials
at the American Society for Reproductive Medicine are considering
applying for a grant but fear it will suggest that donating
embryos to another couple is preferable to donating them
for research or discarding them altogether.
"Our biggest concern is to protect all of the options
for the patients, not to make any one thing the designated
best option," said Eleanor Nicoll, spokeswoman for
the fertility clinic trade group. "Some patients are
extremely uncomfortable about the idea of other people bearing
and raising their genetic offspring."
Abortion rights advocates worry that the program lays the legal
groundwork for considering embryos human beings with full
legal rights. Using the term "adoption" rather
than "donation" makes it appear that the program
views embryos as children, said Kate Michelman, president
of the National Abortion and Reproductive Rights Action
League ( news
If an embryo were a person with equal rights, abortion could
be more easily declared illegal, she said. "It can
be used to support their effort to roll back Roe vs. Wade."
Fertility clinics that offer clients the option of giving embryos
to other couples use the term "embryo donation."
The phrase "embryo adoption" comes from a Christian
adoption agency, which uses the same procedures to place
embryos as it uses to place babies.
That agency, Nightlight Christian Adoptions, plans to apply
for one of the grants. Its embryo program, called Snowflakes,
has produced 18 babies, with five women pregnant now.
Officials there are thrilled by the opportunity to promote
their philosophy with federal dollars.
"I believe every embryo is a child that deserves a chance
to be born," said JoAnn Eiman, a spokeswoman for Snowflakes.
"This is more than mere tissue. They need an option
they haven't had in the past."
She added that it should be up to each family to decide what
to do with its leftover embryos and hopes the education
campaign will inform more people about the adoption option.
The embryos are a byproduct of in vitro fertilization, in which
an egg is fertilized in the lab and then implanted into
a woman's uterus a few days later. Typically, couples fertilize
about a dozen eggs, in hopes that they will have enough
healthy embryos to produce the children they want. Those
that are not implanted are frozen for future use or discarded.
But after a couple has all the children it wants, there are
often embryos leftover. And tens of thousands of embryos
are now frozen in fertility clinics, often because couples
don't know what to do with them.
Their options are limited. They can throw them away. They can
leave them in the freezer. They can donate them for research
though research using newly destroyed embryos is not eligible
for federal funding under a decision made by President Bush
sites) last year. They can also give them to another
woman hoping to get pregnant.
The grants being offered by HHS are intended to boost interest
in the latter. A total of about $900,000 will be distributed,
and federal officials anticipate awarding three to four
grants of $200,000 to $250,000 each.
HHS officials said they don't know what programs will be proposed.
Snowflakes plans to suggest a video promoting adoption,
particularly at IVF clinics that don't offer it already,
a Web site, a public relations campaign and mailings to
obstetricians. Applicants must have experience with embryo
adoption and be prepared to evaluate their programs.
Applications are due next week.
Surgery May Cut Older Drivers' Crash Risk
By Alison McCook
NEW YORK (Reuters Health) - Older adults who have surgery to
repair their cataracts may be less likely to have a car
accident than cataract patients who opt out of surgery,
new study findings suggest.
However, there is only a small reduction in risk--about 5 crashes
per million miles of travel--and experts caution against
assuming the surgery can make people better drivers.
Although people over 60 are some of the safest drivers on the
road, previous research has demonstrated that older adults
with cataracts are more likely to be involved in a car crash
than their cataract-free peers. The current research suggests
that surgery may help decrease that gap. This added benefit
of surgery may be something patients and their doctors should
consider when deciding whether to undergo an operation,
according to the study's lead author, Dr. Cynthia Owsley
of the University of Alabama at Birmingham.
"These are benefits that those who have cataract surgery
can appreciate, but are also benefits that may not be explicitly
discussed at the time one is thinking about surgery,"
she told Reuters Health.
Cataracts occur when proteins in the eye's lens begin to clump
together and cloud vision. All people, if they live long
enough, will experience some clouding in the eye lens, which
can increase the effects of glare while driving and reduce
During cataract surgery, doctors remove the cloudy lens, which
is usually replaced with an intraocular lens, after which
vision can be close to normal.
Currently, half of white adults between the ages of 65 and
74 are estimated to have cataracts, while the condition
may affect up to 60% of black Americans in that age group.
Owsley and her colleagues obtained their findings from surveys
of 277 patients ages 55 to 84 with cataracts, 174 of whom
decided to undergo surgery. The researchers followed the
patients for 4 to 6 years, and noted how many experienced
According to the report in the August 21st issue of the Journal
of the American Medical Association ( news
sites), the authors found that people who underwent
surgery were 53% less likely to be involved in a car crash
than those who did not have surgery. All-told, patients
who had surgery experienced an average of 5 fewer crashes
per million miles traveled.
"We have identified a way that crash risk can be reduced,
at least for a certain segment of the population,"
Owsley said in an interview.
People over 60 have the lowest crash rate of licensed drivers,
about 40 crashes per 1,000 licensed drivers, compared with
140 per 1,000 for those under 25.
She added, however, that the purpose of the study was not to
increase the rate of cataract surgeries among older adults,
but rather to help doctors and patients make decisions about
whether the procedure is appropriate.
"Medical decision-making between patient and doctor will
be a more effective process as patient and doctor have as
much information as possible about the impact of the procedure
on the patient's quality of life," she said.
In an accompanying editorial, however, Dr. Barbara E. K. Klein
of the University of Wisconsin-Madison urges caution in
interpreting the study results.
The decrease in crashes between the two groups was relatively
small, Klein noted, and patients who opted out of surgery
may have had other medical risk factors that influenced
both their decision to avoid the procedure and their risk
of car crashes.
"The limited potential benefit of cataract surgery reported
in the study...should, therefore, be weighed against the
risks of cataract surgery, which may include patients' fear
of surgery, the inconvenience of surgery, and its cost,"
Source: Journal of the American Medical Association
More Is Not Better
By Amanda Gardner
Wednesday, August 21, 2002
WEDNESDAY, Aug. 21 (HealthScoutNews) -- When it comes to mastectomies,
new research shows that more is not better.
A 25-year update of the first randomized clinical trial to
ever look at this issue finds that a radical mastectomy
is not more effective than a simple mastectomy, in which
lymph nodes and muscles are left in place. In this latest
follow-up, both procedures produced essentially the same
The findings appear in tomorrow's issue of The New England
Journal of Medicine ( news
The "B-04" trial, as it is called, launched the trend
towards less surgery to treat breast cancer ( news
"This was one of the most important trials ever in breast
cancer," says Dr. Alan J. Stolier, medical director
of the Lieselotte Tansey Breast Center at the Ochsner Clinic
Foundation in New Orleans. "It told us that what we
thought might be true intuitively was not true, that more
was not better. The cure was the same whether we did a more
simple procedure versus a more radical procedure. This trial
was one that was given credit for doing away with most radical
"This opened the door for what we are now doing,"
says Dr. Bernard Fisher, the study's author and scientific
director of the National Surgical Adjuvant Breast and Bowel
Project (NSABP), which conducted the trial. "This was
the turning point in the story of the surgical management
of breast cancer, plus it led to the understanding that
you weren't going to cure more people by bigger operations,
and that you needed systemic therapy in order to do that.
And that opened the door for chemotherapy."
In 1971, when the study first started enrolling women, radical
mastectomy -- in which the entire breast, muscles of the
chest wall and nearby lymph nodes are all removed -- was
However, not all doctors agreed and they pushed for less invasive
procedures. To resolve the controversy, the NSABP started
the B-04 trial.
The study involved 1,765 women who were randomly assigned to
one of three groups. The first group received a radical
mastectomy. The second got a simple mastectomy, plus radiation.
The third received a simple mastectomy without radiation.
"There was no difference in the outcome by any of the
three methods," Fisher says.
Twenty-five years later, the survival rate for all three groups
was 14 percent if their lymph nodes tested positive for
cancer at the time of surgery. The survival rate for all
three groups was 23 percent, on average, if the lymph nodes
tested negative for cancer at the time of surgery.
At the time the trial started, biopsies and mastectomies were
done at the same time, while the woman was under general
Stolier, then a resident, operated on some of the women in
the trial and remembers waiting in the operating room with
the whole surgical team for the biopsy results to come back.
If the diagnosis was cancer, Stolier was handed a white
envelope that contained which of the three procedures he
was to perform on the woman, still asleep on the operating
Part of the significance of the trial is its sheer length.
"I don't know of anything else that long," Fisher
says. "It provides the first real solid natural-history
information to what happens to these women."
A substantial proportion of women had recurrences of breast
cancer after the watershed five-year mark, indicating the
need for long-term follow-up, even when the patient has
a good prognosis.
Because none of the women in the study received chemotherapy,
the trial also serves as a good baseline for what is accomplished
with the addition of chemotherapy, Fisher says.
"I don't know of any other studies that really have that
information," he adds.
What To Do
For more information on cancer trials, visit the National
Surgical Adjuvant Breast and Bowel Project.
Here is a primer
on the different
types of mastectomies.
Monitor Biotech Animal Food
By Emily Gersema
WEDNESDAY, August 21(The Associated Press) - A report by a
panel of scientists is feeding consumer groups' claims that
federal regulators should work to ensure food safety by
tightening oversight of animal cloning and genetic modification.
The National Research Council ( news
sites) released a report Tuesday that evaluated risks
of animal biotechnology, including food safety. The Food
and Drug Administration ( news
sites) commissioned the report in response to questions
about whether dairy and other food products from cloned
animals might be unsafe to eat or drink.
While foods made from cloned animals probably are safe, the
committee said, products from transgenic animals those
altered with genes from other species or from drugs might
The panel believes the federal government needs to balance
addressing people's concerns with allowing the technology
to advance, said council chairman John Vandenbergh, zoology
professor at North Carolina State University.
"By identifying these concerns, we hope we can help this
technology be applied as safely as possible without denying
the public its potential benefits," he said in a written
The panel wasn't asked to recommend policy changes, but it
said the three agencies monitoring biotechnology the FDA,
the Department of Agriculture and the Environmental Protection
Agency ( news
sites) need to toughen guidelines and clearly define
The report also questioned "the legal and technical capacity
of the agencies to address potential hazards, particularly
in the environmental area."
Genetically engineered animals could become an environmental
problem should they escape, squeezing out their relatives
in the wild by taking control of the food supply and wiping
out weaker animals, the group said.
Rebecca Goldburg, a spokeswoman for Environmental Defense,
said the report underscores the need for stronger federal
oversight, especially in the case of altered fish.
The population of farmed Atlantic salmon is quickly growing,
she said, and it has escaped the fish farms, taking control
of territory where wild salmon spawn.
"The few remaining wild Atlantic salmon in the U.S. are
on the endangered species list," Goldburg said. "Genetically
engineered Atlantic salmon ... could further imperil wild
The Center for Food Safety said the report demonstrated that
the government shouldn't allow modified animals to be used
in food production.
"You don't rectify the regulatory inadequacies by letting
it come on the market," said Joseph Mendelson, legal
director for the Center. "That is potentially going
to lead to terrible results for human health and the environment."
The industry, however, believes the benefits of transgenics
and cloning outweigh the risks.
Scientists have worked mostly with cows, introducing genes
to produce drugs or plasma in large quantities in milk.
People should realize that scientists aren't trying to play
with nature, said Lisa Dry, spokeswoman for the Washington-based
Biotechnology Industry Organization. Rather, they are trying
to develop drug therapies through transgenics and cloning.
Citing Hematech Inc.'s research as an example, Dry noted that
the Sioux Falls, S.D., company and its partner, Kirin Brewing
Co., are harvesting disease-fighting human antibodies in
cow's milk. The proteins will be used to treat illnesses
ranging from tetanus to earache-causing viruses.
"These are important treatments that you just can't get
any other way," Dry said.
The FDA is considering whether cloned animals will require
government approval before they can be sold for food. Farmers
and companies owning cloned animals aren't allowed to sell
the animals until the debate is resolved.
On the Net:
National Research Council: http://www.nas.edu/nrc/
Food and Drug Administration: http://www.fda.gov/
Department of Agriculture: http://www.usda.gov/
Environmental Protection Agency: http://www.epa.gov
Biotechnology Industry Organization: http://www.bio.org
Center for Food Safety: http://www.centerforfoodsafety.org/
Pain Costs Employers $80 Billion Annually
Wednesday, August 21, 2002
WEDNESDAY, August 21 (Reuters Health) - Pain from common conditions
such as headaches and back ache costs US employers about
$80 billion a year in lost productivity, according to a
report presented here at the 10th World Congress on Pain.
But the bulk of the loss, or about $64 billion, is largely
invisible to employers because it occurs not when workers
take sick days but rather when they are on the job but in
too much pain to perform up to par.
The survey is "the first to really measure the cost of
pain," lead author Walter Stewart, a researcher at
the Center for Work and Health at AdvancePCS in Hunt Valley,
Maryland, told Reuters Health. AdvancePCS provides information
on health improvement services.
"People are at work but not performing as well as they
would were they pain-free," said Judith Ricci, another
member of the research team.
To arrive at the estimate, the researchers conducted an ongoing
telephone survey, from July 2001 to July 2002, including
more than 29,000 employed and more than 1600 unemployed
people ranging from 18 to 65 years old. They described pain
complaints from headache, arthritis, backache and other
musculoskeletal conditions as well as work absences and
reduced work performance.
The researchers converted the subjects' lost productive time
to dollars per worker per week, using self-reported annual
"I was surprised at how pervasive pain is," Ricci
says. "Over half the people we interviewed who were
working reporting being in pain at least once in the past
two weeks," Ricci says. Even more pain reports were
received from the unemployed respondents.
The researchers conclude that pain is the most prevalent health
condition in the US work force and the most costly in terms
of productive work time. Headache and back pain account
for the majority of on-the-job pain complaints. Pain has
the most impact on the job for men, those 35 to 40 years,
those with less education, African Americans and workers
with high demand jobs over which they have little control
"The critical finding here is that pain is common in the
workforce," Stewart says. "People bring it to
work and they don't function well. And it's invisible to
Bypass Surgery Makes a Difference
By Ed Edelson
Heatlh Scout News
Wednesday, August 21, 2002
WEDNESDAY, Aug. 21 (HealthScoutNews) -- The increasing availability
of a surgical technique that uses a small incision for bypass
surgery is making a difference.
The technique, minimally invasive bypass surgery, now is preferable
for many patients who otherwise would be treated with the
artery-opening procedure called angioplasty, says a report
in tomorrow?s issue of The New England Journal of Medicine
sites). Angioplasty is when thin balloons and other
devices are threaded into a coronary artery and inflated
to remove plaque that has blocked blood flow.
With the minimally invasive technique, the surgeon can do a
bypass procedure through an incision as small as 4 inches,
rather than sawing open the breastbone, as is done in conventional
bypass surgery. Minimally invasive surgery can be done on
the beating heart; conventional surgery requires the heart
be stopped and the patient put on a heart-lung machine.
In the latest study, cardiologists at the University of Leipzig
Heart Center in Germany compared the outcome of the minimally
invasive technique to angioplasty followed by the implantation
of a stent, a tube designed to keep the blood vessel open.
Included in the study were 220 patients with blockage of
a major heart vessel, the left anterior descending coronary
This is "a very important coronary artery, and one that
is at high risk for restenosis," says lead author Dr.
Gerhard Schuler, a professor of medicine at Leipzig. Restenosis
is a potentially life-threatening closing of the artery
after its blood flow has been restored by angioplasty or
The study was done because balloon angioplasty followed by
stenting has become the standard procedure for the condition,
but no studies have compared stenting with minimally invasive
bypass, Schuler says. In the study, half the patients had
stenting, the other half had minimally invasive bypass surgery.
Overall, the results favored bypass surgery, Schuler says.
The incidence of complications immediately after the procedure
was higher for the surgery patients, but after six months
only 21 percent of the bypass patients had angina ( news
sites) -- chest pain caused by artery blockage -- compared
to 38 percent of the angioplasty-stent patients. Restenosis
occurred in 29 percent of the stent patients, compared to
5 percent of the bypass patients. And 31 percent of the
stent patients had a major cardiac event such as a heart
attack, compared to 16 percent of the bypass patients.
Those results indicate that bypass surgery is a preferable
treatment, but only if it is done with the minimally invasive
method, in which "surgical trauma is much less severe
and the hospital stay is shorter," Schuler says.
Other medical conditions influence the decision, he adds: "For
patients at high risk of stenosis, such as those with diabetes,
we feel that they should undergo bypass surgery, conventional
or minimally invasive."
Also, the arrival of a new generation of stents that are coated
with drugs designed to prevent the artery from closing might
make a difference, says an accompanying editorial by Dr.
Thomas E. MacGillivray and Dr. Gus J. Vlahakas, both of
Massachusetts General Hospital.
"Recent studies using drug-coated stents suggest that
these devices reduce...recurrent stenosis, although long-term
data are not yet available," they write.
What To Do
You can learn more about minimally invasive bypass surgery
from the American
Find out who is a candidate
Test Supposedly Easier
The Associated Press
Wednesday, August 21, 2002
WEDNESDAY, August 21 (AP) - Even if President Bush ( news
sites) and Katie Couric might make it seem that way,
getting screened for colorectal cancer isn't easy. But that
may be about to change.
The most accurate screening procedure colonoscopy is uncomfortable
and embarrassing, meaning many people who need it never
Other procedures like flexible sigmoidoscopy and fecal occult
blood testing, though not as invasive, are no less embarrassing
and require the patient to alter his or her diet. Worse,
they frequently yield false positive results or fail to
find existing cancers.
Don Hardison, president and chief executive of Exact Sciences
Corp., once received a positive result for colon cancer
after having such a test, only to find after further testing
that he was cancer free.
Now his Maynard, Mass. applied genomics company has developed
a test for colorectal cancer that taps into the science
of the human genome ( news
sites), promising ease of use, better detection and
less need for a red face.
The PreGen-Plus, which Exact hopes to introduce next year,
features proprietary technology that can detect cancer-indicating
mutations in human DNA extracted from the stool. The test
requires no dietary changes and causes no discomfort. A
user just produces a sample and mails it to the laboratory
in a sealed container.
"There's no diet modification, no bowel preparation,"
Hardison said in an interview. "You can do the test
in the privacy of your own home and it's shipped back to
the lab. You just do something you probably do every day
Colon cancer kills 57,000 Americans a year and is the deadliest
cancer among non-smoking men and women. But if it's caught
early, the five-year survival rate is more than 90 percent.
The problem is persuading people to get tested. About 80
million Americans over age 50 are at risk, but only 12 million
to 14 million actually get screened, said Anthony Shuber,
chief technology officer at Exact.
The problem is persuading people to get tested. In an attempt
to coax people into getting a colonoscopy, journalist Couric
had one performed live on television in March 2000 after
her husband died of colon cancer. President Bush also had
a colonoscopy performed this summer.
A non-invasive test like PreGen-Plus, which analysts think
will cost around $500 to $700 and may be able to detect
cancer 65 percent to 70 percent of the time, could have
a market worth hundreds of millions of dollars, Hardison
Based on early studies, accuracy will be about equal to a Pap
smear test and compares well with 50 percent sensitivity
for sigmoidoscopy and around 30 percent for a single fecal
occult blood test, Shuber said.
If the Exact test indicates cancer, 95 percent of the time
cancer is there, so the rate of false positives appears
Colonoscopy is better than any other test, including PreGen-Plus,
with sensitivity of around 90 percent. But the test, which
probes the entire colon and requires advance preparation
by the patient, can't detect very early changes in DNA that
might lead to colon cancer. Some patients have been injured
by the procedure.
"Colonoscopy is an expensive test," Hardison said,
noting it can cost up to $2,000. "You have to do a
bowel preparation that's not a lot of fun, and you miss
a day of work. A huge market of people will never do it."
Exact is conducting two U.S. trials of approximately 10,000
patients for PreGen-Plus. The question is whether Exact
can have equal success detecting cancer in the general population,
as its data to date is based on smaller studies of patients
who were, for the most part, symptomatic. The first results,
on a study of 5,000 patients, are due by the second half
of next year, and will go a long way toward determining
whether the product will be a success.
For many years, scientists thought it would be impossible to
isolate human DNA from the stool. Some said it simply didn't
exist there. But Shuber found a way to do so. The technology
can detect various gene mutations, including one in the
APC gene that is evident in almost all cases of colon cancer.
Because these mutations can occur before there's any other
evidence of disease, the test can lead to an earlier diagnosis,
raising the survival rate.
Wednesday, August 21, 2002
WEDNESDAY, August 21 (HealthScoutNews) -- While nothing can
be done to prevent tornadoes, having a Tornado Emergency
Plan can reduce your risk of injury.
Here are some tips from the Centers for Disease Control and
Prevention ( news
- Sketch a floor plan of
your home, or walk with family members through each room
and discuss where and how to seek shelter.
- Show a second way to exit
from each room or area. If you need special equipment,
such as a rope ladder, mark where it is located.
- Make sure everyone understands
the siren warning system, if your area has one.
- Mark where your first-aid
kit and fire extinguishers are located.
- Mark where the utility
switches or valves are located so they can be turned off
in an emergency.
- Teach your family how
to administer basic first aid, how to use a fire extinguisher,
and how and when to turn off water, gas, and electricity.
- Learn the emergency dismissal
policy for your child's school.
- Be sure to conduct drills
and ask questions to make sure your family remembers information
on tornado safety, particularly how to recognize hazardous
weather conditions and how to take shelter.
Cancer Gene Study Questioned
AP Science Writer
The Associated Press
Wednesday, August 21, 2002
WEDNESDAY, August 21 (AP) - Some women with gene mutations
have had their breasts removed after studies showed they
were at a high risk of cancer. A new analysis suggests the
studies may have exaggerated the breast cancer ( news
Precautionary breast removal, called prophylactic mastectomy,
has been performed for many women who have a high frequency
of breast cancer in their families and who have mutations
in the BRCA1 and BRCA2 genes. Such women are thought to
have lifetime breast cancer risks of 80 percent or more.
But Colin B. Begg of Memorial Sloan-Kettering Cancer Center
in New York said this high risk rate cannot be applied to
every woman with mutations of the BRCA genes.
"It is likely that the typical mutation carrier would
have risks lower than that," said Begg, who wrote an
analysis published this week in the Journal of the National
Cancer Institute ( news
sites). "Relatively few mutation carriers would
have risks that high."
Some experts acknowledge there probably have been women who
chose to have their breasts removed based on data now known
to be exaggerated.
Begg said early studies that evaluated breast cancer risk among
gene mutation carriers selected women in families where
sisters, mothers and grandmothers had breast cancer. This
created a statistical bias that skewed risk estimates for
women in the general population, he said.
"The risks that have been quoted are among the highest
because they have been based on studies using high-risk
families," Begg said in a telephone interview from
France, where he was on vacation.
Later studies showed the breast cancer risk among mutation
carriers "is highly variable," he said. "The
average risks are lower than what has been quoted."
"We don't know at the moment how to predict risks well
for the individual," he said.
Dr. Kathy J. Helzlsouer, an epidemiology professor and medical
oncologist at Johns Hopkins University in Baltimore, said
she and most other doctors and genetic counselors have realized
in recent years that a lot of uncertainty remains in computing
cancer risks among women with the BRCA gene mutations.
Yet some women probably chose to have their breasts removed
based on exaggerated data "because that is all we had."
"We've all been concerned about the numbers," Helzlsouer
said. "Big decisions are being made based on the estimates
of risk, so we need to keep doing research on it."
Helzlsouer said medical counselors face the challenge of advising
patients on what option to follow if they discover they
have a BRCA gene mutation. Some may choose a mastectomy,
while others may decide to take medicine, such as tamoxifen,
to lower the risk. Still others may decide to do nothing.
"If you say to everybody who comes in with the mutation
that their breast cancer risk is up to 75 to 80 percent
(based on the early studies), we know that is way too high,"
said Helzlsouer. "So what is the real risk (for the
individual woman)? The answer is, we don't know."
But clearly women with BRCA gene mutations have a breast cancer
risk much higher than the lifetime risk of 11 percent to
12 percent for the general female population in the United
States, said Helzlsouer. She said a study of mutation carriers
in Iceland found a 20 percent risk, while a similar study
among Ashkenazi Jews found a 56 percent lifetime risk.
"Some women will look at that and say, `Well, since it's
about 50-50, I will try other means and not remove parts
of my body,'" said Helzlsouer. "But others will
say, `That's too high for me' and choose mastectomy."
Both Begg and Helzlsouer see an urgent need to determine precisely
the breast cancer risk for women with specific types of
BRCA mutations. There is a genetic revolution under way
in medicine and many experts believe genetic profiles of
patients will eventually become routine.
Begg said when it becomes common to identify women whose only
breast cancer risk factor is gene mutation, "We need
to know how to advise them."
On the Net: Journal of the National Cancer Institute: http://jncicancerspectrum.oupjournals.org/
Choice Said a Control Issue
Associated Press Writer
The Associated Press
Wednesday, August 21, 2002
WEDNESDAY, August 21 (AP) - Hospice patients who request physician-assisted
suicide under a landmark Oregon law want control over their
death and generally don't show signs of depression or worry
that they could become a burden to their families, according
to a survey of nurses and social workers.
The Oregon Death With Dignity Act was approved by voters in
1994 and went into effect three years later after voters
overwhelmingly rejected an effort to repeal it and the U.S.
Supreme Court ( news
sites) ruled that states have the authority to pass
laws regulating assisted suicide.
In a study published Thursday in the New England Journal of
Medicine ( news
sites), Oregon researchers surveyed 306 nurses and 91
social workers who have treated hospice patients since 1997.
Nearly half 45 percent said they had cared for a terminally
ill patient who had requested a lethal prescription, and
30 percent had cared for a patient who received one.
Control over the timing and manner of death was repeatedly
the most important reason that dying patients cited for
their request, while depression was rated the least important
by hospice workers, said Dr. Linda Ganzini, an Oregon Health
& Science University psychiatry professor who led the
"It's surprising how we found so little variation with
regard to this characteristic, almost as if the nurses and
social workers were all seeing the same patient," Ganzini
The study also suggests that lack of social support or fear
of being a financial drain on family members are the least
important factors in the decision to request assisted suicide,
contrary to the criticism from opponents of the law, Ganzini
Supporters of the law say the study is further evidence it
is working well and limited only to terminally ill patients
who at least want the option.
"It should quiet the fears of people who believe that
choice at the end of life is bad for patients or bad for
medical care," said Barbara Coombs Lee, who heads Compassion
in Dying and helped draft the Oregon law.
The survey was conducted in 2001, when the Oregon Health Division
had recorded that 91 people had died by assisted suicide
since the law went into effect late in 1997.
A questionnaire was mailed to 545 hospice nurses and social
workers at all 50 Medicare-certified hospices in Oregon,
and 397 workers responded.
There were 82 terminally ill patients at the hospices who requested
lethal prescriptions, evenly divided between men and women
with a mean age of 63.6 years. Eighty-three percent had
Dr. Susan Tolle, director of the Center for Ethics in Health
Care at Oregon Health & Science University, said the
study may reflect some bias by hospice workers who may be
less opposed to assisted suicide.
The survey found 59 percent of the nurses and social workers
supported the Oregon law, 26 percent opposed it, and 14
percent said they were neutral.
Ryan Ross, spokesman for the Denver-based Hemlock Society,
said the survey shows the law works.
"All of the fears about what could happen if physician-assisted
suicide was legalized have not happened," Ross said.
"We can approach the end of life without undercutting
the social fabric or pressuring people into doing what they
don't want to do."
On the Net:
New England Journal of Medicine: http://www.nejm.org
Oregon Health & Science
Probe Nev. Cancer Cluster
Associated Press Writer
The Associated Press
WEDNESDAY, August 21 (AP) - High levels of arsenic and tungsten
were found in residents of this northern Nevada town during
an investigation of a mysterious cancer cluster, government
scientists reported Tuesday.
There's no known correlation, however, between high levels
of the minerals and acute lymphocytic leukemia, the Centers
for Disease Control and Prevention ( news
sites) said. Of the 16 confirmed childhood leukemia
victims linked to Fallon since 1997, three have died.
Eight of 10 residents showed high levels of tungsten, compared
to the national average of one in 10, according to the CDC's
Dr. Carol Rubin. A third of the residents had arsenic levels
above 50 parts per billion, high enough to cause a wide
range of health problems.
Tungsten was mined for years in Fallon, about 60 miles southeast
of Reno, before the mines were shut down, and arsenic occurs
naturally in the area.
Rubin said studies have linked arsenic to some adult cancers,
but not to acute lymphocytic leukemia. She said there have
been no studies on possible links between tungsten and acute
State epidemiologist Randall Todd said the latest research
opens a new area of inquiry.
"This was on nobody's radar screen as something to consider,"
he said of the tungsten data. "This opens a door to
another room that we didn't know existed."
The CDC study is not expected to be completed until this fall,
but health officials had promised worried residents that
any unusual findings would be released immediately.
Some officials suspect an environmental cause for the cancer
Fallon's water supply for decades has contained naturally occurring
arsenic at 100 parts per billion, 10 times the federal standard,
and the city is building a new water treatment plant.
Another focus of attention has been a jet fuel pipeline that
serves Fallon Naval Air Station. In May, two federal agencies
investigating the cancer cluster ruled the pipeline out
as a public health hazard.
Wednesday, August 21, 2002
WEDNESDAY, August 21 (HealthScoutNews) -- Tetanus, a potentially
fatal disease, is less common now than it ever was in the
United States. But it is more common, lately, among those
under 40 than it is among their elders.
The percentage of young victims of tetanus -- the result of
a tiny organism, clostridium tetani, entering the
body through a wound -- rose from 28% in the 1991-95 period
to 42% between 1996-2000. This shift coincided with an increase
in the intravenous use of drugs and from the increase in
puncture wounds related to a rise in self-performed body-piercing
The best way to avoid contracting tetanus: Get vaccinated against
the disease, and get booster shots at intervals suggested
by your doctor, advises the Centers for Disease Control
and Prevention ( news
Ginkgo Doesn't Aid Memory
AP Medical Writer
The Associated Press
WEDNESDAY, August 21 (AP) - A new study suggests ginkgo supplements
do nothing to quickly improve memory in healthy people,
a finding that goes against years of well-publicized claims
that helped turn the supplements into a multimillion-dollar
The over-the-counter supplements are made using extract from
the fan-shaped leaves of the ginkgo biloba tree.
Early studies suggested the supplements could boost mental
function in people with and without mild dementia, however,
those studies had methodological flaws and were too short
to measure a true effect, according to the authors of the
The new study, reported in Wednesday's Journal of the American
Medical Association ( news
sites), involved 230 people over age 60 who had no signs
of memory impairment and found that the ginko supplements
worked no better to improve memory than dummy pills over
a six-week period. Some of the supplements are advertised
to have a noticeable benefit in four weeks.
"We don't see any benefit," said lead author Paul
Solomon, a psychology professor at Williams College.
Solomon said his study involved the same type of rigorous testing
required by the Food and Drug Administration ( news
sites) for pharmaceutical drugs, though supplements
like gingko are not FDA-regulated. The same battery of mental
tests was given at the beginning and end of the study.
While both groups' scores improved slightly, that likely was
because they'd taken the tests before, and the placebo and
ginkgo patients performed equally well the second time around,
Ginkgo has been thought to improve blood flow to small veins
and capillaries, ostensibly helping deliver oxygen to the
brain. It also contains antioxidants, substances that absorb
chemicals called free radicals produced during metabolism
that are thought to damage cells.
Dr. Steven DeKosky, chairman of the University of Pittsburgh's
neurology department, said the study doesn't address whether
larger doses taken for a longer duration or taken by people
who already have memory problems would be beneficial.
DeKosky is the lead researcher in a government-funded study
examining whether ginkgo in doses equal or double those
in the JAMA study can help prevent Alzheimer's disease (
sites). Participants in his study are older than 75,
have normal mental function or slight memory problems and
are taking ginkgo for five years.
Solomon said it's possible ginkgo pills would show some mental
benefits in healthy people if taken longer than six weeks,
the study's duration. But he noted that the tablets used
in the study, Pharmaton Natural Health Products' Ginkoba,
are marketed as producing noticeable benefits after just
four weeks at the study's dose, 120 milligrams daily.
Pharmaton's David Morrison said the findings are from a single
study that doesn't "negate the vast body of evidence
showing that ginkgo biloba is effective."
On the Net:
Angry With Preventable Deaths
By Ravi Nessman
Wednesday, August 21, 2002
WEDNESDAY, August 21 (AP) - AIDS ( news
sites) killed 3 million people last year. The year before,
tuberculosis killed 1.7 million and malaria more than a
million others. Millions more died from diarrhea and other
easily preventable diseases.
A decade ago, world leaders at the Earth Summit in Rio promised
to tackle diseases of the poor. But with so many of the
world's most vulnerable still dying in droves, many health
activists are furious that more has not been done to save
"We are losing 6 million people every year to AIDS, TB
and malaria alone, 14 million to communicable disease. This
is not progress," said Rachel Cohen, spokeswoman with
Medecins Sans Frontieres, the medical aid group known in
English as Doctors Without Borders ( news
"You really have to think twice about whether this health
revolution that is being talked about in the West is any
way benefiting the people that need it the most," she
Leaders meeting at the World Summit for Sustainable Development
starting Monday in Johannesburg will again discuss ways
to fight preventable diseases in the developing world.
In recent years, there have been some stunning successes.
In 1988, when the world launched its drive to eradicate polio
sites), 350,000 new cases of the deadly disease were
reported. Last year, following massive immunization campaigns,
the World Health Organization ( news
sites) said just 480 new cases were reported.
It also said a campaign against leprosy has cut new cases by
85 percent over the past 15 years and eliminated it from
But other diseases have gotten far worse.
Between 1990 and 2000, the number of people infected with tuberculosis
in Africa and Eastern Europe, regions highly vulnerable
to the disease, jumped from 200 million to 450 million.
HIV ( news
sites) infections jumped from 8-10 million people to
Meanwhile, resistant strains of malaria have spread across
the world, forcing many poor African countries to exchange
their cheap and increasingly ineffective drugs for more
potent medicine that can cost 10 times as much.
The Global Fund to Fight AIDS, Tuberculosis and Malaria was
created last year with hopes of distributing $7 billion
a year of the estimated $10 billion in aid needed to tackle
these diseases. But only $2 billion have been pledged to
"The amount that is needed is just four days' global military
spending. So the 10 billion is not an unreasonable demand,"
said Jo Nickolls, a policy adviser at Oxfam GB.
In some cases, rich countries have damaged the already weak
health care systems in many poor countries, activists said.
Countries including Canada, Great Britain and the United States
have tried to solve their nursing shortages by recruiting
health workers from countries such as South Africa, which
have shortages of their own.
Efforts to enforce patent rights for HIV medicines have also
kept available but expensive treatments away from those
too impoverished to pay, Nickolls said.
For many other diseases, there are no new drugs and no plans
to make any, she said.
According to Oxfam, global drug research and development spending
is about $70 billion, but only 10 percent of that money
goes to research on diseases that account for 90 percent
of the world's infections.
"There's very little interest in creating medicines that
can cure people who are poor in a poor country," Nickolls
Many of the poor countries themselves have shown a lack of
political will to tackle many of these diseases, Cohen said,
The disease, which disproportionately affects people of working
age, has killed the main breadwinners in many families,
decimated the ranks of skilled workers and left tens of
millions of children orphaned in the most vulnerable countries.
Many of Africa's scarce teachers will die and millions of
children, forced to help support their families, will no
longer attend school.
The economies of the hardest hit countries could fall by 8
percent by 2010, according to UNAIDS ( news
"Sustainable development is great. But if we can't bring
AIDS under control, forget about development at all, much
less sustainable development," said Dr. Peter Piot,
director of UNAIDS.
Many health activists cautiously hope the summit might help
spark a true war against these diseases.
"All we can do is continue to make the case that it is
not acceptable to let millions of people die," Cohen
August 21, 2002
WEDNESDAY, August 21 (HealthScoutNews) -- HIV ( news
sites)-positive men are more likely to have unprotected
sex if they love a good thrill and believe alcohol enhances
their sexual enjoyment.
So says a new study in the August issue of the Annals of
The study found that HIV-positive men described as "sensation
seekers" were more likely to have unprotected sex,
whether or not they drank alcohol. It also found alcohol
use predicted unsafe sex independently.
Alcohol was a factor in HIV-positive men having risky sex if
the men believed it would improve their sexual experience,
the study found.
The researchers collected information from 197 HIV-positive
men in Atlanta. Most of them were black, and 66 percent
said they were gay.
Statements such as "I would like to try bungee jumping"
or "I get bored seeing the same old faces" were
used to assess whether the men were sensation seekers. Statements
such as "sex is better after I have been drinking"
and "drinking helps me relax about having sex"
were used to evaluate the men's attitudes about alcohol
The study found that 28 percent of the men had unprotected
sex during the previous three months, and 11 percent had
unprotected sex with multiple partners over that time.
Lead author Seth C. Kalichman did the study while at the Medical
College of Wisconsin. He's now a professor of psychology
at the University of Connecticut.
He says the finding could offer insight into ways to reduce
risky sexual behavior in HIV-positive men.
"Cognitive approaches to challenging beliefs about the
effects of alcohol on sexual performance and arousal can
be incorporated into existing risk-reduction interventions,"
the researchers say.
Read more about HIV
risks among black men.
Finds Exception to Cell Rules
AP Medical Editor
The Associated Press
Wednesday, August 21, 2002
WEDNESDAY, August 21 (AP) - Every biologist knows that people
inherit their cellular power plants, called mitochondria,
only from their mothers, not their dads. Now a surprising
new discovery suggests there can be exceptions to this carved-in-stone
Cells employ mitochondria microscopic creatures captured
eons ago to extract energy from food. Mitochondria have
their own genes, separate from the usual human blueprints,
and scientists long believed that only mothers passed them
on to the next generation.
But now, Danish scientists have documented the first known
exception to the rule, a man whose muscle cells contain
mitochondria that came mainly from his father.
The discovery was so unexpected that the researchers repeated
their experiments several times to make sure they hadn't
mixed up samples or made other mistakes.
"The only explanation for our results is that it is a
case of paternal inheritance of mitochondria. It was a very
big surprise to us," said Marianne Schwartz, a geneticist
at Copenhagen University Hospital.
Some rare diseases are caused by mutations in mitochondrial
genes. However, it makes no difference whether or not the
bad gene came from the mother, so the latest discovery has
little practical importance to patients.
However, some wonder whether it might throw off the study of
human evolution, since mutations in mitochondrial genes
are used to calculate how long ago humanity dispersed from
a single individual or small group. The estimates are based
on the assumption that only females pass on this DNA through
Schwartz's study, published in Thursday's issue of the New
England Journal of Medicine ( news
sites), involved a 28-year-old man with a severe, lifelong
inability to exercise or run more than a few steps. His
problem was traced to a deletion in one of the genes that
controls his mitochondria.
However, the researchers found that only his muscle, the tissue
that uses the most energy, had mitochondria with the genetic
defect. Cells in his blood, skin, hair and elsewhere contained
mitochondria with a different genetic pattern. Further genetic
testing revealed that mitochondria in his muscle were identical
to his father's, while those elsewhere in his body came
from his mother.
No one knows how often something like this happens, although
Schwartz and others believe it's quite rare. "Maybe
we will never see it again, but I think it could happen
more than we think," she said.
Both the sperm and the egg that come together to make an embryo
carry mitochondria. However, the sperm packs only about
100 copies, while the egg has 100,000.
According to one theory, the male's mitochondria are simply
swamped by the far larger number from the female. However,
even highly sensitive genetic tests have routinely failed
to find any trace of fathers' mitochondria after the early
days of development in the womb. Another theory suggests
some surveillance system in the embryo weeds out the father's
Evolutionary biologists have assumed that each person's mitochondrial
DNA is a copy of their mother's, their grandmother's and
so on, back to the dawn of the species. The genes acquire
mutations more quickly than ordinary genes, so in theory
it is possible to estimate how long two groups of people
have been separated by looking at how much their mitochondrial
This led to the theory that all humans descended from an African
Eve more than 100,000 years ago. However, Dr. R. Sanders
Williams, dean of Duke University's medical school, said
the possibility of male DNA oozing in could throw off these
"This will generate new debate about the validity of the
Eve hypothesis," he said. "Are we all derived
from a single female or a small group in Africa, or are
our origins a bit broader than that?"
But evolutionary biologist Alan Templeton of Washington University
doubts the occasional bit of male genetic material will
make much difference.
"It is so rare that it won't affect the overall patterns
over long periods of time," he said. "It's not
something I'm overly concerned about."
EDITOR'S NOTE: Medical Editor Daniel Q. Haney is a special
correspondent for The Associated Press.
On the Net:
Linked to Delayed Brain Development
Wednesday, August 21, 2002
WEDNESDAY, August 21 (HealthScoutNews) -- Delayed neurological
development, which can be predicted by a drawing test, may
explain bedwetting in some children.
That's the finding of a new British study that appears in the
September issue of the Archives of Disease in Childhood.
The study included 34 children, aged 7 to 13. They all wet
the bed at least four times a week and had been treated
with a synthetic form of the hormone vasopressin. The natural
hormone vasopressin is produced by the pituitary gland and
reduces urine production.
None of the children in the study had any known neurological
or urinary problems, or special educational needs.
The children were given a neuro-psychological test called the
Rey-Osterrieth test. It uses a linear figure that tests
the ability to copy and redraw from memory. The test measures
planning and organizational skills, problem-solving and
perceptual, motor and memory functions.
Scoring of the children was done according to the number of
boundary errors they made by spacing incorrectly or leaving
out lines and shapes in the linear figure.
The researchers found that significantly more boundary errors
were made by the children who didn't respond well to the
synthetic vasopressin. In the test, 11 children made three
or more mistakes. All of them were children who had no response
to synthetic vasopressin.
The Rey-Osterrieth test may let doctors better predict how
children will respond to treatment with synthetic vasopressin,
the authors say.
To avoid wetting the bed at night, you need appropriate nerve
signaling between the visual cortex, the hypothalamus, the
pituitary gland in the brain and the bladder, the researchers
say. This nerve signaling results in the release of vasopressin
from the pituitary gland, and the ability to wake up if
your bladder is full.
The researchers say the appropriate growth of nerves that regulate
nighttime urine production are affected by unknown factors
before and after birth.
Here's more information about bedwetting.
AUGUST 20, 2002
in Soaps, Lotions Don't Help: AMA
NEW YORK (Reuters Health) - Consumer products such as soaps
and lotions often contain germ-killing antimicrobials, but
there is scant evidence they are helpful in preventing infections,
according to an American Medical Association (AMA) committee.
What's more, they may actually be harmful in terms of promoting
bacterial resistance to germ-killers, according to a report
from the AMA's Council on Scientific Affairs published in
the August issue of the journal Archives of Dermatology
Indiscriminate, widespread use of antimicrobial products is
discouraged by the medical community because it is believed
to promote the growth of bacteria resistant to chemicals
used as hospital disinfectants.
Still, the use of antimicrobial-laden products, such as disinfecting
hand soaps and lotions, have skyrocketed in recent decades.
Indeed, 45% of consumer soaps contain an antimicrobial,
even though there is no proof the products can prevent infections
better than regular soap, the report indicates.
In the study, Dr. Litjen Tan and colleagues reviewed scientific
papers published between 1966 and 2001 in an effort to learn
if antimicrobial consumer products may be a "significant
source of antimicrobial resistance."
The authors report that "a growing number of studies"
suggest that bacteria are gaining resistance to the antimicrobials
used in these products. It is even possible that bacteria
that become resistant to such antimicrobials may also be
harder to treat with therapeutic antibiotics, but more study
is needed to determine if this is true, Tan and colleagues
"Considering the available data and the critical nature
of the antibiotic resistance problem, it is prudent to avoid
the use of antimicrobial agents in consumer products,"
While antimicrobial-containing soap and other products can
help prevent the spread of infection in hospitals, nursing
homes and newborn nurseries, they are used in a "dramatically
different" way than the consumer products, the authors
"These same surface chemicals have been used effectively
for several decades in hospitals under stringent guidelines
that require, among other precautions, minutes--not seconds--of
exposure," according to an editorial by Dr. Stuart
Levy of Tufts University School of Medicine in Boston, Massachusetts.
A high concentration of the chemicals is left on surfaces
"long enough to do the antimicrobial job required."
In the home, however, the products leave a residue on the skin,
kitchen or bathroom in a less-than-effective dose, setting
up the "perfect condition for the selection of microbes
resistant to their action," Levy notes.
There is no "evidence that additional cleaning or disinfecting
power is needed (in the home) beyond that provided by normal
cleansers, soap and water," Levy writes. "Instead
the negative consequences stemming from the residues of
these compounds present an unacceptable risk to the household."
In 2000, the AMA urged the US Food and Drug Administration
sites) to closely monitor and possibly regulate the
use of such substances in private homes, a decision Levy
said is a good one.
However, the manufacturers of such products feel differently.
In a statement to Reuters Health, the Cosmetic, Toiletry
and Fragrance Association (CTFA) noted that "antimicrobial
products kill germs, and that is a benefit to consumers
and their families. Removing these products would deprive
consumers of effective hygiene products and would not help
in eliminating antibiotic resistance."
The CTFA added that "the AMA should focus efforts on preventing
misuse and over-prescription of antibiotic medicines by
doctors and their patients, factors that are known to contribute
to an increase in antibiotic resistance."
The Washington, DC-based CTFA is a trade association for the
personal care products industry.
of Dermatology 2002;138:1082-1086.
Say Buying Marijuana Is Easy
By Greg Toppo
AP Education Writer
Teenagers say marijuana is easier to buy than cigarettes or
beer one in three say they can find it in a matter of
hours but only 25 percent admit trying it, a national
When the National Center on Addiction and Substance Abuse polled
1,000 teens last winter, 27 percent said they could buy
marijuana in an hour or less; another 8 percent said it
would take a few hours. But for the first time since the
study began in 1996, teenagers said it was easier to buy
marijuana than cigarettes or beer.
The annual survey didn't specify whether drugs are easy or
difficult to buy at school, but 63 percent of students said
their schools are "drug-free," nearly double the
number who said the same in 1998. It's the highest percentage
While many have criticized nationally used anti-drug programs
such as D.A.R.E., educators said years of using such programs
seem to be paying off.
"I think we're starting to see the fruition of some of
those programs," said Gerald Tirozzi, executive director
of the National Association of Secondary School Principals.
He said student drug use has been dropping for the past four
or five years as communities began financing anti-drug programs.
"There has been a sense that the drug problem, while
not solved, has been improving," he said.
More than half of students said they don't drink alcohol in
a typical week, and about as many said they have never had
While one in four pupils said at least one parent smokes cigarettes,
69 percent said they have never smoked.
Joel Willen, principal of Pershing Middle School in Houston,
said teachers and administrators are seeing less drug activity
at school. "I think the kids are not bringing whatever
it is they're doing, if they're doing it, to school,"
Pershing's drug-prevention programs are paired with a get-tough
policy on drugs that includes twice-yearly, random locker
and backpack searches by drug-sniffing dogs, Willen said.
Students caught using or selling drugs can be sent to an
alternative school or even expelled.
"They know we take a real hard line on drugs," he
The survey also found that:
8 percent of students believe there's a teacher at their school
who uses illegal drugs.
25 percent said they have seen illegal drugs being sold at
55 percent said they'd report someone they saw using drugs
56 percent said they'd report someone they saw selling drugs
at school, the highest level since 1996.
24 percent said drugs are "the most important problem
facing people your age," highest among several problems
such as crime, peer pressure, sexuality and the environment.
The National Center on Addiction and Substance Abuse, based
at Columbia University, polls teenagers on drug use and
the presence of drugs in schools. This year's random telephone
survey of students age 12-17 was conducted Dec. 27, 2001-Feb.
6, 2002, by QEV Analytics. It has a margin of error of plus
or minus 3.1 percent age points.
An accompanying survey of parents found them equally divided
on their children's drug habits: 44 percent said it's "not
very likely" their child will ever try illegal drugs,
but 43 percent it's "very likely" or "somewhat
likely" that their kids will try them.
The federal Centers for Disease Control and Prevention ( news
sites) estimates that, by the time they complete high
school, 47 percent of teenagers have smoked marijuana, 24
percent have used another illicit drug and 81 percent have
drunk alcohol. The agency also estimates that 70 percent
have smoked cigarettes.
On the Net:
National Center: http://www.casacolumbia.org
Seek National ATV Standards
By Laurie Kellman
WASHINGTON (AP) - Advocacy groups say the government should
ban children from riding all-terrain vehicles and force
other riders to obey new safety standards, contending a
surge in deaths and injuries show the ATV industry has failed
to protect and educate riders.
Representatives from consumer, children's and environmental
groups cited statistics showing injuries to ATV riders under
16 have nearly doubled in the last eight years.
"Self-regulation by the ATV industry has led to larger
and faster ATVs and more children being killed and injured,"
said Rachel Weintraub, assistant general counsel to the
Consumer Federation of America.
Children, she said, are being disproportionately hurt and killed
by ATVs. According to government statistics, those under
16 represent about 14 percent of ATV riders but suffer 37
percent of ATV-related injuries and 38 percent of ATV-related
Grown-ups, not the government, bear responsibility for keeping
their kids safe and riding only on child-sized machines,
say ATV proponents.
"Unfortunately, some people ride these things stupidly,"
said Bill Ford, owner of a West Virginia company that offers
ATV tours. He recalls seeing a mother and two kids riding
an ATV down a highway without helmets. "There's a lot
we should be doing with education."
ATVs are motorized machines that can traverse off-road terrain.
While popular for recreation, they are also used extensively
by farmers, police and others who find them less expensive
than trucks and tractors and easier to maneuver in regions
with few roads.
Rules for operating the vehicles vary widely by state. Some
have no restrictions, while others require licenses for
owners and operators and bar children under 16 from riding
The ATV industry has opposed some efforts to restrict the vehicles'
use, saying it will hurt those who depend on ATVs for their
livelihood and unfairly penalize safe operators.
In West Virginia for example, it's still legal to drive an
ATV on a highway without a helmet. Critics have tried and
failed for years to inspire the state legislature to pass
new rules governing ATV use. The efforts have been blocked
in part by farmers and coal industry workers, who say they
need to use the vehicles to do their jobs.
"ATVs have been a way of life for certain parts of West
Virginia for some time. And from a tourism perspective,
it's doing wonders for the economy," said Ford, an
attorney and owner of Charles Town-based Mountain Thunder.
In response to a rising fatality rate, particularly among children,
the government and the industry entered a court-approved
consent decree in 1988 banning the manufacture of three-wheel
ATVs. It also ordered ATV distributors to use their "best
efforts" to assure that dealers do not sell adult-size
ATVs to children under 16.
The advocacy groups said rising death and injury rates indicate
the voluntary guidelines are not working.
Annual injuries for four-wheel ATVs have increased more than
200 percent from about 36,000 in 1993 to about 100,000
in 2001, according to the Consumer Product Safety Commission
Annual injuries from all ATVs some three-wheel vehicles made
before the ban took effect still are in use more than
doubled during that period, from about 50,000 to about 111,700,
the commission said.
And ATV injuries to children under 16 increased from about
17,000 in 1993 to about 34,800 in 2001.
The Consumer Federation of America, the Bluewater Network,
the National Trails and Waters Coalition and various emergency
medical professionals say they want Congress and federal
agencies to bar children under 16 from riding ATVs. The
coalition also wants every state to adopt legislation to
license, train and require safety rules for ATV owners and
Separately Tuesday, Arctic Cat Inc. of Thief River Falls, Minn.,
recalled about 45,000 all-terrain vehicles because a mechanical
problem can cause them to overturn, resulting in injuries.
On the Net:
Consumer Products Safety Commission: http://www.cpsc.gov
Consumer Federation of America: http://www.consumerfed.org
AUGUST 19, 2002
Patch May Heat Up Women's Desires
MONDAY, Aug. 19 (HealthScoutNews) -- A skin patch that may
help restore sexual desire in post-menopausal women is being
tested in clinical trials at more than 150 sites in the
United States and Canada.
The thin, nearly transparent hormone patch is worn on the abdomen.
It's main ingredient is testosterone, a hormone long-associated
with sexual desire and aggresiveness in men.
Millions of women have decreased sexual desire because of lower
hormone levels following menopause or hysterectomy. That
can lead to frustration, unhappiness and relationship problems.
"More than 40 million women suffer from the lack of sexual
desire, which often leads to personal distress or relationship
issues," says Sheryl Kingsberg, a clinical psychologist
at MacDonald Women's Hospital at University Hospitals of
Cleveland, one of the study sites.
"Since no medications currently are approved by the U.S.
Food and Drug Administration ( news
sites) for the treatment of diminished sexual desire,
these clinical studies are an important step in the development
of new therapeutic options to help many women and their
partners regain a satisfactory sex life," Kingsberg
It's estimated that about 43 percent of women have experienced
some form of difficulty in their sexual function, compared
to about 31 percent of men.
This isn't the first trial involving testosterone and women.
John Hopkins researchers conducted similar experiments last
year, and a trial is also being conducted at New Hyork uniersity
The decline in a woman's sexual desire can be accompanied by
other problems, such as inability to achieve orgasm.
Physicians, researchers and post-menopausal women continue
to search for ways to deal with some of the problems that
come along after menopause. Lately, there's been debate
over when and if a woman should have hormone replacement
This report from the National Institutes of Health ( news
sites), called The
Women's Health Initiative, sums up all the new information
about HRT's risks since a major July 2002 report was issued.
Gene May Up West Nile Risk
By Paul Recer
AP Science Writer
WASHINGTON (AP) - Only about one in five people infected with
the West Nile virus ( news
sites) develop a severe, life-threatening illness. A
study in mice suggests a gene variation may be the reason
some become very sick from the mosquito-borne virus, while
others recover easily.
Experts said the research is an important step toward finding
a drug to treat West Nile, a virus that has caused 11 deaths
in the United States this year. The Centers for Disease
Control and Prevention ( news
sites) reported Saturday there have been at least 251
human cases of the disease this year.
West Nile is carried by mosquitos whose bite can spread the
virus to birds, horses and humans. So far this year, the
virus has been found in dead birds, in horses, in humans
or in mosquito pools in at least 39 states, New York City
and the District of Columbia. Human cases have occurred
in 11 states and the District of Columbia.
For most people, West Nile causes only flu-like symptoms. But
for some patients, particularly the young and the elderly,
West Nile can be a killer, causing a swelling of the brain
that can be lethal.
Just why some people are more susceptible to serious illness
from the virus has intrigued researchers and prompted scientists
at the Pasteur Institute in France to search for a gene
variation that might explain the difference.
The French first tested a series of laboratory mouse strains
to find a genetic type that was most likely to die after
being exposed to the West Nile virus.
They found that animals in the mouse strain called BALB/c all
died within 13 days when injected with the West Nile virus.
When these animals were mated with other mouse strains,
some of the offspring died from the virus, while others
were little affected.
By analyzing the genes of both the BALB/c mice and the mixed
strains with a high rate of West Nile deaths, the researchers
isolated a specific gene variation that increased the susceptibility
to the virus, the researchers report. They called the variation
the West Nile gene.
Dr. Jean-Louis Guenet of Pasteur, a co-author of the study
appearing this week in the Proceedings of the National Academy
of Sciences ( news
sites), said the West Nile gene allows the virus to
cause disease by blocking production of a group of proteins
that normally prevent viruses from reproducing inside a
"The variation ... stops the action of the gene prematurely,
making it nonfunctional," said Guenet. "It is
the absence of some proteins made by this gene that leads
He said the flawed gene contains a "stop codon,"
an arrangement that prevents the full expression of the
gene. Without the full expression, some virus-fighting proteins
are not made.
"All of the susceptible mice have the stop codon. All
of the other mice do not have this stop codon," said
the Pasteur researcher.
Guenet said the missing proteins participate in a network of
proteins that normally degrade viral genes inside a cell.
The exact gene variation has not been found yet in humans,
Guenet said, but researchers at the National Institutes
of Health ( news
sites) said the finding by the Pasteur scientists is
important because it moves research closer to finding a
drug for West Nile virus.
"The most promising thing about this study is that it
could help lead to a drug" that would restore the missing
protein and give patients protection against replication
of the virus, said Catherine A. Laughlin of the National
Institute of Allergy and Infectious Diseases ( news
sites) at the NIH.
"The possibility of developing a drug is why we are excited
about this finding," said James M. Meegan, a virology
research program leader at NIAID.
Meegan said that NIAID is funding research on three West Nile
virus vaccines and one may be ready for human trials next
On the Net:
Proceedings of the National Academy of Sciences www.pnas.org
West Nile virus: http://www.cdc.gov/ncidod/dvbid/westnile/
Let Worms Dog You
(HealthScoutNews) -- Roundworms, a parasite (Toxocara) commonly
found in the intestines of dogs and cats, can be passed
from pets to humans and cause an infectious disease called
toxocariasis. It sickens some 10,000 people yearly in the
United States. More than 700 of them experience total or
partial loss of vision.
Heavy or repeated Toxocara infections, while rare, can initiate
a disease that causes swelling of the body's organs or central
Though hard to pronounce, toxocariasis can easily be prevented:
- Have your veterinarian treat your dogs and cats, especially young
animals, regularly for worms.
- Wash your hands well with soap and water after playing with your pets
and after outdoor activities, especially before you eat.
- Teach children to always wash their hands after playing with dogs
and cats and after playing outdoors.
- Do not allow children to play in areas that are soiled with pet or
other animal stools.
- Clean your pets' living area at least once a week. Feces should be
either buried or bagged and disposed of in the trash.
- Teach children that it is dangerous to eat dirt or soil.
U. Named Top 'Party School'
By Shannon Dininny
BLOOMINGTON, Ind. (AP) - Indiana University was crowned the
nation's No. 1 "party school" Monday in an annual
Princeton Review survey that school leaders and medical
experts derided as irresponsible and unscientific.
Following IU in the rankings were Clemson University, the University
of Alabama-Tuscaloosa, Pennsylvania State University and
the University of Florida.
IU officials questioned the No. 1 ranking. The school, which
didn't appear on the list last year, has toughened its stance
on student drinking since the 1998 alcohol-related death
of a student.
In the past year, five IU fraternities have been suspended
or expelled for violations of alcohol policies, said Bill
Stephan, the university's vice president for public affairs.
"I think there are some serious questions about the methodology
of the study and it really calls into question the credibility
of the ranking," Stephan said.
IU freshman Anya Simonova said her school may be perceived
as a party school, but noted that "it's getting quieter
because they're cracking down more." Junior Erin Pritchard
"I'd be surprised to hear we're number one," she
said. "Even though most people party three or four
times a week, this past year they've been a lot more strict."
The survey, conducted since 1992, ranks schools in 63 categories
based on in-person or computer interviews with 100,000 students.
The party school designation is based on student reports
on alcohol and marijuana use, the amount of time spent studying
outside of class and the popularity of fraternities and
sororities on campus.
Princeton Review, a test-preparation and college admissions
company with no connection to Princeton University, defended
"We simply are reporting on the conditions that exist
on those particular campuses, and if social life continues
to be an aspect that students comment on, then I will continue
to include that list in the book," said Robert Franek,
the company's editorial director.
Franek noted that the survey also lists the top-20 "Stone-Cold
Sober Schools," where students say there is little
drinking. Brigham Young University topped that list for
the third straight year.
The American Medical Association has repeatedly criticized
the "party school" rankings, saying they irresponsibly
legitimize high-risk drinking and portray alcohol as central
to college life.
On Monday, Richard Yoast of the AMA's Office of Alcohol and
Other Drug Abuse called the survey "a marketing gimmick"
and said it does a disservice to quality universities.
Following Florida, the rest of the top 10 party schools were
the State University of New York-Buffalo; the University
of New Hampshire; the University of Colorado-Boulder; Florida
State University; and the University of Wisconsin-Madison.
(Beware Of) Water, Water Everywhere
(HealthScoutNews) -- Many a vacation in the U.S. and abroad
has been ruined by intestinal illness brought on by the
consumption of contaminated food or drink. Water is the
most frequent carrier of infectious agents.
In areas with poor sanitation, you may be able to safely drink
only boiled water, hot beverages (such as coffee or tea)
made with boiled water, canned or bottled carbonated beverages,
beer, and wine. Ice may be made from unsafe water and should
Boiling is the most reliable method to make water safe to drink.
Bring water to a vigorous boil, then allow it to cool; do
not add ice. At high altitudes, allow water to boil vigorously
for a few minutes. Adding a pinch of salt or pouring water
from one container to another will improve the taste.
As a last resort, water that is uncomfortably hot to touch
may be safe for drinking and brushing teeth after it is
allowed to cool. However, many disease-causing organisms
can survive the usual temperature reached by the hot water
in overseas hotels.
heart disease indicator identified
From the Science & Technology
United Press International
Monday, August 19, 2002
Mass., Aug. 19 (UPI) -- The presence of an easily detectable
protein in the blood can help predict the onset of heart
disease before any symptoms appear, new research from the
Framingham Heart Study suggests.
Framingham study, which was begun in 1948 by the organization
that is now the National Heart, Lung, and Blood Institute
in Bethesda, Md., has attempted to identify common factors
or characteristics that contribute to diseases of the heart
and cardiovascular system by tracking a large group of subjects
-- all residents of the town -- who had not yet developed
symptoms or suffered a heart attack or stroke.
the latest research, investigators examined 2506 men and
women with no apparent symptoms of cardiovascular disease.
Using computed tomography or CAT scans, they found increased
levels of a protein called C-reactive indicate higher levels
of calcium in the coronary arteries of the heart. Higher
calcium levels, which cause the buildup of fatty deposits
called atherosclerotic plaques, are associated with heart
disease and are predictors of heart attack.
found that the majority of men and women in the study had
calcium in their arteries. But we also found that the more
C-reative protein they had, the more calcium they had,"
Dr. Thomas Wang, lead author of the study and a research
fellow at the institute, told United Press International.
the first time since the inception of the Framingham study
more than 50 years ago, investigators have the ability to
study what is happening in the arteries of the heart with
CT scans," Wang said. "Using CT scanning, we have
found that many (individuals showing no symptoms) with elevated
C-reative protein levels appear to have objective evidence
of atherosclerosis in their coronary arteries," he
two previous studies had failed to find a link between increased
C-reactive protein and calcium deposits, the groups in those
studies consisted of post-menopausal women and male Army
personnel aged 40 to 45. The authors of the new research
said the use of Framingham subjects, representing a broader
segment of the population -- men and women aged 35 to 84
with an average age of 60 -- might be responsible for the
difference in the results.
acknowledged the new research does not address certain questions
about an individual patient's condition.
or not a physician would send a person with an elevated
C-reactive protein for more advanced testing needs to be
studied further," said Wang, who also is a fellow in
the cardiology division at Massachusetts General Hospital
protein, which plays an important role in the body's immune
defenses, indicates that there is inflammation somewhere
in the body. Earlier work has shown a correlation between
elevated C-reactive protein and heart attack and a number
of studies have associated inflammation with increased heart
diseases also need to be ruled out, however. Increased C-reactive
protein levels can indicate rheumatoid arthritis, rheumatic
fever, cancer, tuberculosis and pneumococcal pneumonia,
as well as cardiovascular disease.
the current research, investigators drew blood from the
subjects between 1991 and 1995 to analyze for C-reactive
protein. They then divided the subjects into five groups
based on their protein scores.
to 8 years after taking the original samples, the researchers
gave each subject a type of CAT scan called electron beam
computed tomography or EBCT, a procedure that can detect
calcification of the arteries. They found calcification
scores increased uniformly with increasing levels of C-reative
protein among both males and females.
again the investigators from the Framingham Study have provided
us with valuable information, which should give us more
insight about how to identify even earlier persons at risk
for cardiac events, "Dr. Sidney Smith, chief science
officer for the American Heart Association, told UPI.
experts urged caution in jumping to conclusions, however.
Michele Hamilton, associate clinical professor of cardiology
at the David Geffen School of Medicine at the University
of California at Los Angeles, and co-director of the UCLA
heart failure program, told UPI, "Right now, I would
not recommend that everyone go out and have their C-reactive
protein level checked because our therapy for protection
against coronary artery disease is directed by the other
known risk factors." Hamilton specified cholesterol
levels, blood pressure, diabetes and smoking as the usual
targets of therapy.
P. Cooke, associate professor and director of vascular medicine
at Stanford University Medical School in Palo Alto, Calif.,
told UPI, "It's not terribly surprising that C-reactive
protein is correlated with coronary calcium because C-reactive
protein is associated with coronary events (and) I think
it's really a modest extension of the data we already have."
agreed. "Clearly, we need further research to tell
us how to accurately integrate and use these two sources
of information to better predict cardiovascular events,"
research is reported in the Aug. 20 in the journal Circulation
and on the American Heart Association's rapid access Web
for UPI Science News by Joe Grossman in Santa Cruz, Calif.,
and Bruce Sylvester in West Palm Beach, Fla.)
Potential Drugs for AIDS Discovered
Monday, August 19, 2002
MONDAY, Aug. 19 (HealthScoutNews) -- American and Belgian scientists
apparently have discovered several new potential drugs to
treat AIDS ( news
sites), including compounds that block all known drug-resistant
strains of the virus.
According to a report being presented today at the American
Chemical Society's annual meeting in Boston, two of the
new drugs, Dapivirine and R165335, have shown promise in
Phase I and Phase II clinical trials.
Because it's easy to manufacture and has a low cost, Dapivirine
may prove useful for treating AIDS in developing countries.
The drug is also being tested as a microbicide to prevent
HIV ( news
A third drug called R278474 is scheduled for Phase I trials.
The researchers say it's even more active against common
and mutant HIV strains.
The emergence of drug-resistant HIV strains has been a major
obstacle to long-term treatment, the researchers say.
The U.S. Food and Drug Administration ( news
sites) offers a history of the AIDS
Approves Light Therapy for Acne
Monday, August 19, 2002
WASHINGTON (AP) - Patients with a certain type of acne can
soon opt for light therapy to try to clear it up.
The Food and Drug Administration ( news
sites) approved a device Monday that emits high-intensity
light to help clear up moderate inflammatory acne.
The ClearLight system doesn't work on severe acne or mild cases
of pimples but works only on inflammatory acne, which is
caused by bacteria, said Neil Ogden, FDA's director of general-surgery
The theory is that the light kills the bacteria inside the
It's blue light, a different wavelength than skin-damaging
ultraviolet light, and thus is thought to cause no side
effects, he said.
Israel-based Lumenis Inc. studied about 48 patients with moderate
inflammatory acne, treating half the face with the ClearLight
and comparing the result with the untreated other side of
the face, Ogden said.
The treatment consisted of eight twice-a-week, 15-minute light
Not everyone responded. If the acne does not seem better after
two or three sessions, there's only a 10 percent chance
it will respond to the treatment at all, Ogden said. About
half of the patients who finished all eight treatments saw
at least 50 percent decreases in the number of pimples,
Acne patients have a range of options, from topical ointments
to antibiotics and, for the most severe cases, drugs like
Accutane. That drug can cause severe birth defects, however,
so it's used under very strict precautions to treat young
women. ClearLight would offer a subset of acne sufferers
Lumenis estimates up to 13 million a nondrug alternative.
The company estimates patients would pay about $50 a session,
or $400 for a full course of treatment. It's not clear how
often recurrent acne sufferers could undergo light therapy.
Lumenis said it would begin shipping the light device to dermatologists
immediately. The company would not disclose how much the
machines will cost doctors.
May Do More Than Soothe Your Spirit
By Randy Dotinga
Monday, August 19, 2002
MONDAY, Aug. 19 (HealthScoutNews) -- Imagine inhaling a certain
scent that would help protect your lungs from damage if
you found yourself in a smoke-filled room.
A California scientist says his research into the healthy properties
of aromas could make that a possiblity one day.
Kwang-Geun Lee, of the University of California at Davis, released
findings at the annual meeting of the American Chemical
Society yesterday in Boston that suggest some smells could
act as antioxidants, the healthful agents found in fruits
"Exposure to these aromas may help to prevent (oxygen)
damages, which are a factor in many diseases," Lee
Humans have known about the positive effects of smell for thousands
of years, and "aromatherapy" has become a household
word. Scientists have a good understanding of how smell
works, from the sensors in the nose that take in information
to the areas of the brain that process the data, says George
Preti, a researcher at Monell Chemical Senses Center in
However, Lee says, scientists still aren't sure why odors seem
to have healthy effects on the body.
At his laboratory, Lee distilled and extracted 30 chemicals
that produce aroma from 10 plants. Then, he tested them
for the presence of antioxidants.
In initial research, Lee found levels of antioxidants -- similar
to those in Vitamin E -- in soybeans, mungbeans, kidney
beans, eucalyptus leaves and several types of spices, including
basil, thyme, rosemary, chamomile and cinnamon.
Experts believe antioxidants block certain types of cell damage
caused by molecules called free radicals, which are caused
by exposure to tobacco smoke and some chemicals.
Foods rich in antioxidants help destroy free radicals, and
scientists think they reduce the risk of diseases such as
cancer, heart disease and stroke. However, more research
will be needed to figure out if the antioxidants in the
aromas actually affect the body, Lee says.
If they do, he says, it's possible they could be released in
a room full of smokers to counteract the damaging effects
Preti notes that some body creams have antioxidant properties,
and it's not "too far-fetched" to believe that
odors could do the same.
However, if researchers do try to put aromas to work to protect
a person's health, they'll need to use a lot of them, Preti
"Most of the things you smell are at very low quantities.
Your olfactory abilities are fairly sensitive. Most things
aren't in high enough quantities to cause any physiological
or unhealthy sensations," he says.
What To Do
To learn about research on antioxidant therapy for heart disease
and other conditions, visit the Linus
For more on Vitamin E, a major source of antioxidants, visit
Institutes of Health.
Not Always to Blame for Kids' Back Pain
By Kathleen Doheny
Monday, August 19, 2002
SAN DIEGO (Reuters Health) - Parents often warn their school-age
children not to carry heavy backpacks, worried that they'll
get backaches. But a new study has found that the load on
the back is often not the culprit when youngsters develop
low back pain.
Children with emotional or behavioral problems, as well as
those who frequently complain of stomachaches or headaches,
are more likely to have low back pain than those who tote
around a heavy backpack, researchers reported Sunday at
the 10th World Congress on Pain.
Like most experts, a research team from the University of Manchester
in the UK figured that heavy backpacks would take a toll
on children's back health. "Our hypothesis was that
the greater the load, the more low back pain," said
Gary Macfarlane, an epidemiologist at the University of
Manchester and the lead researcher.
"But we found there is very little difference in risk
of low back pain no matter how much you carry," he
said. The heaviest backpack in the study weighed about 39
pounds, but most were about 13 pounds. And the kids who
carried the heaviest packs, walked to school with them on,
and carried them around all day did have a slightly increased
risk of back pain.
But the real predictor of back pain was whether the children
had emotional or behavior problems, or frequently reported
stomachaches or headaches, according to Macfarlane.
"Those with conduct problems were at three times the risk
of developing low back pain," he said, compared with
those who carried heavy backpacks. "We know that psychological
factors can predict the onset of low back pain in adults,"
Macfarlane said, and this might be true in children as well.
The team went to 39 schools, recruiting children ages 11 to
16. The investigators weighed students' backpacks on 5 consecutive
days and asked the students questions about how well they
got along with others and other psychosocial issues.
In all, 18.6% of the 903 children surveyed had low back pain.
As for backpack weight, Macfarlane stressed that it is not
a good idea to load backpacks to any weight. "We're
not saying carry whatever you want," he said. But a
backpack weighing up to about 25 pounds, depending on the
age and size of the child, is probably fine, he noted.
The American Academy of Pediatrics recommends that backpack
weights not exceed 10% or 20% of a student's body weight
and recommends wheeled backpacks if possible.
When Macfarlane's research team reviewed medical records of
the children with low back pain, they often saw notes advising
the parents to caution children about not overloading their
The message, Macfarlane said, might also be to keep in mind
that the pain may be related to emotional and behavioral
Value of Water Studied
By Lauran Neergaard
AP Medical Writer
"Drink at least eight glasses of water a day" is
an adage some obsessively follow, judging by the people
sucking on water bottles at every street corner but the
need for so much water may be a myth.
Fear that once you're thirsty you're already dehydrated? For
many of us, another myth. Caffeinated drinks don't count
because they dehydrate? Probably wrong, too.
So says a scientist who undertook an exhaustive hunt for evidence
backing all this water advice and came up mostly, well,
dry. Now the group that sets the nation's nutrition standards
is studying the issue, too, to see if it's time to declare
a daily fluid level needed for good health and how much
leaves you waterlogged.
Until then, "obey your thirst" is good advice, says
Dr. Heinz Valtin, professor emeritus at Dartmouth Medical
School, whose review of the eight-glass theory appears in
this month's American Journal of Physiology.
It's about time for all the attention, says Pennsylvania State
University nutritionist Barbara Rolls, a well-known expert
on thirst. "There's so much confusion out there."
Much of it centers on where you should get your daily water.
"There's this conception it can only come out of a bottle,"
and that's wrong, notes Paula Trumbo of the Institute of
Medicine ( news
sites)'s Food and Nutrition Board, which hopes to decide
by March whether to issue the first official water-intake
In fact, people absorb much water from the food they eat. Fruits
and vegetables are 80 to 95 percent water; meats contain
a fair amount; even dry bread and cheese are about 35 percent
water, says Rolls. That's in addition to juices, milk and
And many of us drink when we don't really need to, spurred
by marketing, salty foods and dry environments, Rolls says.
"For most of us, that's not going to matter you're just
going to need to go to the bathroom more," she says.
But for people with certain medical conditions, chugging too
much can be harmful, sometimes fatal, Valtin warns. Even
healthy people such as teenagers taking the party drug
Ecstasy, which induces abnormal thirst can occasionally
drink too much. So-called water intoxication dilutes sodium
in the blood until the body can't function properly.
Conversely, no one disputes that getting enough water is crucial.
Indeed, the elderly often have a diminished sensation of
thirst and can become dangerously dehydrated without realizing
it. People with kidney stones, for example, require lots
of water, as does anyone doing strenuous exercise.
But the question remains: How much water does the typical,
mostly sedentary American truly need? And what's the origin
of the theory, heavily promoted by water sellers and various
nutrition groups, that the magic number is at least 64 ounces?
Valtin, who has spent 40 years researching how the body maintains
a healthy fluid balance, determined the advice probably
stems from muddled interpretation of a 1945 Food and Nutrition
Board report. That report said the body needs about 1 milliliter
of water for each calorie consumed almost 8 cups for a
typical 2,000-calorie diet but that "most of this
quantity is contained in prepared foods."
That language somehow has morphed into "at least"
64 ounces daily, Valtin says. (One Web site's "hydration
calculator" even recommends a startling 125 ounces
for a 250-pound couch potato.) And aside from the American
Dietetic Association's advice, few of the "drink more
water" campaigns targeted to consumers mention how
much comes from food.
Valtin couldn't find any research proving the average person
needs to drink a full 64 ounces of water daily.
Also, contrary to popular opinion, he cites a University of
Nebraska study that found coffee, tea and sodas are hydrating
for people used to caffeine and thus should count toward
their daily fluid total.
That thirst means you're already dehydrated. That can be true of
the elderly, and studies of marathon runners and military
recruits in training have found that some focus so intently
on strenuous exercise that they block thirst sensations
until they're in trouble. But Rolls did hourly hydration
tests to prove that drinking when thirsty is good advice
for the rest of us.
That water blocks dieters' hunger. Studies show water with food can
help you feel full faster, but that just drinking water
between meals has little effect, Rolls says.
So how much do we need? Until the Institute of Medicine sets
a level, "if people obey their thirst and they are
producing urine of a normal yellow color, that's a safe
sign," Valtin concludes.
Editors Note Lauran Neergaard covers health and medical issues
for The Associated Press in Washington.
and dads differ on kid's pain
By Peggy Peck
UPI Science News
the Science & Technology
United Press International
Monday, August 19, 2002
DIEGO, Aug. 19 (UPI) -- A study from Finland suggests mothers
and fathers react differently to a child in pain -- dads
are more likely to think the child should suffer in silence,
while moms tend to reach for the baby aspirin.
Paivi Kankkunen based her findings on a survey of parents
whose children had undergone outpatient surgery. Just over
200 mothers and a little more than 100 fathers filled out
the survey forms.
fathers were more likely to think that children could be
faking pain and they were also more likely to think that
children should learn to live with the pain," Kankkunen
said in an interview with United Press International. She
added that both mothers and fathers also thought "boys
should be encouraged to tolerate the pain without pain medication."
Parents also said it was more acceptable for boys to engage
in risk-taking play that might result in injury, but were
less likely to support such activities by girls.
her survey detected gender-based differences, Kankkunen
said she found mothers and fathers are similar because they
generally are very reluctant to give children any pain medication.
who presented her findings Monday at the 10th World Congress
on Pain, said a few days of watching American television
have convinced her this reluctance to use pain medicines
sets Finnish parents apart from their American counterparts.
"Here, you advertise analgesics for children! That
would never be done in Finland," she said.
Sandra Chaplan, a clinical professor of anesthesiology at
the University of California at San Diego and a member of
the organizing committee for the pain meeting, told UPI
physicians often see "this in our offices -- a mother
may be more empathetic than the father. Often, for example,
a father is less willing to give a Tylenol to the child
who is complaining about a headache."
said she does not think Kankkunen's findings "can really
be applied to North American parents. There have been several
hallway conversations about this particular paper and the
feeling among the people that I've talked to is that this
probably doesn't reflect the attitudes of American parents."
of Cancer Drug Disappointing
LONDON (AP) - Anglo-Swedish drug company AstraZeneca PLC said
Monday a key trial of its new cancer drug Iressa was disappointing.
The setback sent the company's shares tumbling to $32.24 in
late morning trading on the New York Stock Exchange ( news
sites), down $4.76, or 13 percent.
AstraZeneca said the late-stage trials showed Iressa didn't
improve survival rates for patients with advanced non-small
cell lung cancer when used with existing chemotherapy drugs.
Iressa, a new type of treatment known as Epidermal Growth Factor
Receptors, is a tablet taken once daily.
Iressa had shown better results in an earlier trial, where
it was used alone, said Brent Vose, AstraZeneca's vice-president
AstraZeneca used the earlier trial to make submissions to regulators.
Japan has already approved the drug and the U.S. Food &
Drug Administration will consider this submission in September.
The latest results cast doubt on the drug's potential sales.
Some analysts had expected Iressa to reap as much as $2
billion a year at its peak, but those estimates took account
of Iressa used by itself and in combination with chemo drugs
for various cancers.
The setback with Iressa comes just weeks after the company
said its other promising up-and-coming drug Crestor, for
cholesterol, will be delayed.
Iressa and Crestor are key to the company's future earnings
growth as AstraZeneca prepares for the possible loss of
patent coverage on Losec/Prilosec, once the world's biggest
selling drug and cornerstone of the company's profit.
AstraZeneca said Monday its full-year earnings guidance remains
Better Fever Reducer for Kids: Report
By Kathleen Doheny
SAN DIEGO (Reuters Health) - The drug ibuprofen, the active
ingredient in Motrin, Advil and other over-the-counter drugs,
is better at reducing fever in children than acetaminophen,
another often-used fever reducer found in Tylenol and other
medications, Australian researchers reported Sunday at the
10th World Congress on Pain.
To reach that conclusion, Tiina Piira, a clinical psychologist,
and Dr. G. David Champion, director of the pain research
unit at Sydney Children's Hospital, Randwick, and their
colleagues conducted a comprehensive analysis of both published
and unpublished data.
The team performed a meta-analysis of studies in the medical
literature and solicited unpublished data. In all, they
evaluated 28 studies, with more than 4,000 children, that
looked at the use of ibuprofen and acetaminophen for pain
and fever, and for their potential for side effects. The
children ranged in age from about 18 months to 16 years,
The general feeling among many doctors as well as parents,
Champion said, is that acetaminophen is the better choice
for fever reduction in children.
But the investigators found that a single dose of ibuprofen
was more effective at reducing fever than a single dose
of acetaminophen at 2 to 6 hours after the treatment.
When it comes to reducing pain, both medicines were fairly
equal, the researchers reported. And they are equally safe.
However, "you have to conclude that at the doses tested,
ibuprofen comes out better for fever," Champion said.
In the studies, fever was defined by each research team, Champion
said, but normally is considered a temperature of about
101 degrees Fahrenheit (38.3 Celsius) or above.
The study was partially funded by Boots Healthcare Australia,
a pharmaceutical company. The company makes ibuprofen, among
other drugs. But Piira said great care was taken when evaluating
the studies to ensure that the investigators did not know
details such as the researchers' names or the funding for
the studies. "We looked at the scientific merits of
each paper," she said.
device aims to limit heart damage
From the Science & Technology
United Press International
Monday, August 19, 2002
Minn., Aug. 19 (UPI) -- Doctors in Minnesota announced Monday
that they have treated the first patient ever with a device
designed to cool the body rapidly and thereby reduce irreversible
damage that can occur during a heart attack.
patient, a 50-year-old man who suffered a heart attack,
"left the hospital with basically normal heart function,"
Kenneth Baran, a cardiologist at the St. Paul Heart Clinic,
told United Press International.
noted, "it's hard to say" whether the patient
would have the same result had he not been treated with
the device, called the Celsius Control System. The patient
will be examined again in 30 days to look for signs of heart
than 1 million people will suffer a heart attack in the
United States this year and two-thirds will not make a complete
is not yet known if the principle of cooling down the body
will spare damage to the heart, but it has looked promising
in studies in animals, said Robin L. Allgren, vice president
of clinical research and medical affairs at Innercool Therapies
of San Diego, the company developing the device.
heart attack deprives the heart of oxygen, which can result
in the death of heart tissue. If the damage is large enough,
it can impair heart function, Allgren said. The hope is
that lowering the body temperature will prevent some of
the damage from occurring in the first place, she said.
Celsius system consists of a cooling catheter inserted in
a vein in the thigh. As blood passes over the catheter,
it is rapidly cooled. As a result, the body's temperature
drops 7 degrees, from 98.6 Fahrenheit to 91.4 F in one hour,
and maintains that level for 6 hours.
advantage of the device is it can cool down the body very
rapidly, Baran said. Ice baths can take hours to achieve
similar body cooling and often will induce shivering in
the patient, which interferes with rapid cooling.
patient is the first of 400 patients Innercool intends to
enroll in the study, which is taking place at more than
25 clinical centers in the United States. The study will
be ongoing for the next 2 years.
company also is developing the device for use in brain surgery
or conditions such as stroke, where cooling the body can
help prevent brain damage.
noted the device also could prove useful for treating heat
stroke. For example, if it had been available last year
when Minnesota Vikings football player Corey Stringer died
from heat stroke, "it probably could have saved his
life," he said.
by Steve Mitchell, UPI Medical Correspondent, in Washington)
Side of Brain Important for 'Self-Memory'
NEW YORK (Reuters Health) - Most of the time, the right side
of the brain is better at identifying familiar faces, but
when it comes to recognizing one's own face, the left side
of the brain is tops, new research suggests.
A man who had undergone surgery to treat epilepsy provided
Dr. David J. Turk and colleagues at Dartmouth College in
Hanover, New Hampshire, with an opportunity to evaluate
separately the ability of each side of the brain to recognize
To treat epilepsy that did not respond to other therapies,
fibers in the man's brain that connect the left and right
brain hemispheres had been cut. Therefore, the two brain
hemispheres could no longer communicate with one another,
which allowed the researchers to investigate their individual
Using computer technology, the researchers altered a pair of
photos, one of the patient himself and the other of "Mike,"
a doctor the patient knew well. Some of the altered photos
looked more like the patient while others resembled the
doctor more. When shown the photos, the man had to decide
whether the picture looked more like himself or Mike. The
same exercise was repeated with photos of other easily recognized
faces, including President Bush ( news
sites) and former President Clinton ( news
The right hemisphere of his brain did a better job at recognizing
faces, with one exception, according to a report in the
advance online edition of the journal Nature Neuroscience
for September. The left side of the man's brain was more
accurate at recognizing his own face.
"Our results support the view that, although both hemispheres
are capable of self-recognition, cortical networks in the
left hemisphere have an important role in the execution
of this process," Turk and his colleagues write.
According to the researchers, the brain is thought to possess
a "self-memory system" made up of each person's
conception of himself or herself. The fact that the left
hemisphere is better able to recognize photos of the self
suggests that this side of the brain plays a dominant role
in the self-memory system, the authors report.
Source: Nature Neuroscience 2002;10.1038/nn907.
lower heart re-hospitalization
From the Science & Technology
United Press International
Monday, August 19, 2002
Aug. 19 (UPI) -- British researchers have found giving certain
antibiotics to patients hospitalized for heart attack or
severe chest pain reduces re-hospitalization for these problems.
receiving the antibiotics were 39 percent less likely to
be hospitalized or to die from heart problems for one year
compared with patients who did not receive the medications.
Short-term effects were also seen, researchers said. Within
the first three months of receiving antibiotics, 27 percent
of patients who had taken no medication were re-hospitalized
for heart problems or died from a heart attack, compared
with only 17 percent in the antibiotic group.
acute heart disease episodes probably are associated with
inflammation of the fatty deposits in the coronary arteries,
the study's co-author, Michael A. Mendall, told United Press
question's always been, what causes that acute inflamation?
... Is it infection or is it something else?" asked
Mendall, a gastroenterologist at Mayday Hospital and senior
lecturer at St. Georges Medical School.
researchers wanted to see if two different classes antibiotics
-- called macrolides and non-macrolides -- would affects
heart patients differently. This was the first time the
two classes have been compared in a heart disease study.
found although the macrolides and non-macrolides both reduced
re-hospitalization, taking the antibiotics had no effect
on the 5 percent rate of fatal heart attacks suffered by
the patients. Instead, most of the benefit was in the reduction
of hospital readmissions for unstable angina, a condition
that creates pain or discomfort in the upper body and can
occur whether the patient is resting or active. It is caused
by blockages in blood vessels that supply the heart.
researchers randomly created three groups from 325 patients
admitted to the hospital for acute myocardial infarction
-- heart attack -- or unstable angina. Two of the groups
received antibiotics while a third received identical-looking
placebos. The patients took antibiotics or placebos for
groups treated with antibiotics received both metronidazole
and omeprazole, but one group also received azithromycin,
a macrolide and a known anti-inflammatory agent. The other
group received amoxicillin, a non-macrolide with no known
researchers said it might have been the action of the metronidazole
or the omeprazole, given to both antibiotic treatment groups,
that was responsible for the lower heart incident rates
in the treated group.
original hypothesis was that inflammation may be due to
infections with either Chlamydia pneumoniae or Helicobacter
pylori (bacteria), but the study suggested that the antibiotics
weren't working that way -- that they were working in a
different way," Mendall said.
said he believes the antibiotics may work against other
infections in the body or against a general infection. "One
possibility is that the antibiotics lighten the load on
the immune system or have a direct anti-inflammatory action,"
P. Cooke, associate professor and director of vascular medicine
at Stanford University Medical School in Palo Alto, Calif.,
suggested one possibility for what happened: "Maybe
those bacteria weren't the factor. Maybe there's another
bacteria that's being treated that hasn't been recognized,"
he told UPI.
hypothesis has been tested in two large-scale, well-designed
trials involving more than 20 times the number of patients
reported in this trial and have shown no benefit of the
antibiotic treatment in patients with acute coronary symptoms
syndromes," Gregg Fonarow, associate professor of medicine
at the University of California at Los Angeles and director
of the Ahmanson-UCLA Cardiomyopathy Center, told UPI.
acknowledged, however, that previous trials did not use
some of the antibiotics included in the current study.
research appears in the Aug. 20 issue of the journal Circulation
and on the rapid-response Web site of the American Heart
by Joe Grossman, UPI Science News, Santa Cruz, Calif.)
Swap Distinguishes One Blood Type from Another
By Alison McCook
NEW YORK (Reuters Health) - Although getting the wrong type
of blood during a transfusion can possibly kill you, researchers
have determined that only a tiny change in an enzyme can
make the difference between type A and type B blood.
These findings demonstrate that relatively minor tweakings
of body chemicals can produce widely varying results, study
author Dr. Stephen V. Evans told Reuters Health.
"If you have blood group A, blood group B, it's a difference
in one amino acid," Evans said. Amino acids are the
building blocks of protein, and the enzyme that constructs
blood types contains a total of 354 amino acids.
"Actually, it's quite an amazing story," he noted.
A person's blood type results from the structure of certain
sugars present on the surface of red blood cells. Enzymes
called transferases assemble the sugars that make up the
different blood types.
Researchers have known that the sugar structures present in
A and B blood types differ in only one respect--one small
chemical group present on one of the sugars.
Similarly, researchers know the sequences of the A and B blood
type transferases differ in only four amino acids, out of
a chain of 354. In the new study, Evans and his colleagues
discovered that of the four amino acids, only one appears
to be able to contact both the sugar chain being built and
the chemical that needs to be donated to the chain in order
to distinguish A and B blood types.
"There's only one amino acid, and that amino acid makes
all the difference," Evans said.
The researchers made the discovery by using x-ray crystallography
to generate highly detailed, three-dimensional images of
the structures of the A and B blood type transferases. They
report their findings in the advance online publication
of the journal Nature Structural Biology for September.
That single difference becomes "very important,"
the researcher noted. For example, if a person with type
A blood is given type B blood, that one chemical that distinguishes
the two types will trigger the immune system to attack the
new blood as a foreign substance, perhaps ultimately killing
Source: Nature Structural Biology 2002;10.1038/nsb832.
Aspirin Not Recommended for Everyone
By Alison McCook
NEW YORK (Reuters Health) - Research into the benefits of daily
aspirin for preventing heart attacks have not adequately
measured the effects of the drug in people at low risk of
cardiovascular disease, according to US researchers.
Although current research suggests that those at risk of heart
attack can benefit from daily aspirin, this does not mean
that the drug is right for everyone, lead author Dr. John
M. Boltri of Mercer University School of Medicine in Macon,
Georgia, told Reuters Health.
"Right now, there is just insufficient evidence to justify
recommending aspirin therapy to low-risk individuals,"
In fact, given the risk of aspirin's side effects, such as
bleeding, people who have a low risk of heart attack might
be better off without a daily dose, Boltri noted. If they
would never experience heart attacks anyway, their risk
of side effects outweighs the treatment's ability to save
their lives, he added.
However, Boltri cautioned that patients should rely on their
doctors to help them determine their risk of heart attack,
because many adults have so-called "silent" conditions
that place them unknowingly in a higher risk category.
"It really should be something they are talking to their
physicians about," Boltri noted.
Researchers have suggested that aspirin may help prevent heart
attacks by reducing the "stickiness" of platelets,
substances in the blood that can form a life-threatening
blood clot within the blood vessels.
Reporting in the August issue of The Journal of Family Practice,
Boltri and his colleagues reviewed previous research into
the benefits of daily aspirin for preventing heart disease
and heart attacks in people at low risk of these events.
Low-risk individuals were defined as having no more than one
of the common risk factors, including high blood pressure,
family history of the disease, or diabetes. In men, a risk
factor for cardiovascular disease includes being older than
45, and for women being over 55.
The researchers restricted their search to studies that measured
death rates in patients from all causes, because only reporting
deaths from cardiovascular disease might miss those who
die from side effects of aspirin, which include gastrointestinal
bleeding and bleeding in the brain.
The investigators ended up with three studies that met their
criteria, which included more than 110,000 patients.
Boltri's team found that two of the studies showed that people
who were at low risk of cardiovascular disease had no lower
risk of death when they took aspirin regularly than when
they didn't. Moreover, the other study included in the analysis
suggested that low-risk patients who take aspirin might
have an even higher risk of dying than those without a daily
"There is insufficient evidence for or against recommending
aspirin to low-risk individuals," the authors conclude.
Source: The Journal of Family Practice 2002;51:700-704.
May Help Old Folks Keep Their Smarts
By Anne Harding
BOSTON (Reuters Health) - A cup of blueberries a day may keep
"senior moments" away, new findings suggest.
A team of Massachusetts and Florida researchers has shown that
the fruit reduces aging-related damage in rat brains, and
can also prevent mental decline in mice genetically engineered
to develop Alzheimer's-like plaques in their brains.
The findings, along with early results from a human study,
suggest a healthy diet can go a long way toward preventing
the mental decline that often accompanies aging, Dr. James
A. Joseph of the Center on Aging at Tufts University in
Boston and USDA Human Nutrition Research told Reuters Health.
Joseph presented his findings here Monday at the American Chemical
Society's annual meeting.
Cell-damaging products of normal metabolism known as free radicals
can injure tissue, an effect known as oxidative damage.
Antioxidants -- found in several fruits and vegetables,
including blueberries -- help prevent this damage, which
has been implicated in a number of conditions including
cancer, Alzheimer's and heart disease. Oxidative damage
is also a factor in aging.
Aged rodents that consumed the human equivalent of one cup
of blueberries a day showed less oxidative damage in tissue
from two distinct brain regions, Joseph and his team found.
To evaluate whether this effect might extend to behavior, Joseph
and colleagues David Morgan, Gary Arrendash and David Diamond
from the University of South Florida, put mice through a
Half of the mice were genetically engineered to develop Alzheimer's-like
plaques in their brains, while the rest were not. In each
group, half of the animals were given blueberry-based pellets.
Testing began when the mice were young, before the genetically
modified animals had developed plaques. The study lasted
The mice with pseudo-Alzheimer's that didn't eat blueberries
performed worse and worse on the maze over time. But the
genetically modified animals given blueberries showed no
decline; they performed just as well as normal mice, even
though they still developed plaques.
Joseph said he believes the berries' brain-protecting power
goes beyond its known antioxidant and anti-inflammatory
effects. Blueberries seem to "directly influence the
way neurons communicate," he told Reuters Health.
Preliminary results from a new study, he added, show that people
who ate a cup of blueberries a day appeared to be protected
from aging-related mental decline. Joseph expects the study
will be published late this fall.
The next steps, the Boston researcher said, will be to do more
tests in transgenic animals, evaluate which chemicals in
blueberries find their way into the brain, and study how
the fruit might be protecting the brain.
Shown to Boost Antioxidants in Blood
By Anne Harding
BOSTON (Reuters Health) - If findings from preliminary research
pan out, honey could offer a sweet way to get a serving
Dr. Nicki Engeseth from the University of Illinois at Urbana-Champaign
reported on her research, the first to look at blood levels
of antioxidants in humans after honey consumption, at the
American Chemical Society's annual meeting here Monday.
Engeseth and her colleagues demonstrated in previous studies
that the darker the honey, the richer it is in antioxidants.
The color and composition of honey depends on the blooms.
Buckwheat is the darkest honey the researchers have tested,
and it's "higher in just about everything," Engeseth
noted, including protein and chemicals called phenolics.
On a per-weight basis, she and her colleagues have shown, the
darkest honey contains antioxidant levels similar to those
found in spinach and garlic. While it wouldn't be advisable
to consume the weight equivalent of a vegetable serving
in honey, Engeseth noted that it's easy for people to slip
honey into their diets in place of sugar and other sweeteners.
Engeseth's team decided to test the effect of honey on antioxidant
blood levels in a group of 25 men aged 18 to 68 years. After
they had fasted for 12 hours, the researchers gave the men
water, black tea, water and honey, tea and honey or tea
with a sugar-like sweetener. The men were given about four
tablespoons of honey in a 16-ounce glass of water or tea,
and tested once a week for 5 weeks.
Their blood was tested 60 and 90 minutes after they drank the
beverage. Surprisingly, the researchers found that water
mixed with honey was the only drink that increased levels
of antioxidants in the blood, even though tea itself is
known to contain antioxidants.
She and her colleagues are now conducting a longer-term experiment
in rabbits with high cholesterol, to see if honey has any
effect on blood vessel and heart health. Engeseth's research
is funded by the National Honey Board, as well as the Functional
Foods for Health Program.
Pill May Help Ward Off Cancer
By Anne Harding
BOSTON (Reuters Health) - A new molecule based on the cancer-fighting
chemical found in broccoli, cabbage and other pungent vegetables
(called sulforaphane) is safer than the original and much
cheaper, Chicago researchers reported here Monday. And it
appears, so far, to be equally effective in building the
body's defenses against cancer.
Dr. Jerry Kosmeder of the University of Illinois reported on
an animal study of the new chemical, oxomate, at the American
Chemical Society's annual meeting.
Sulforaphane, found in broccoli, Brussels sprouts and other
cruciferous vegetables, strengthens the body's defenses
against cancer by promoting the activity of detoxifying
chemicals known as phase II enzymes.
But sulforaphane can be toxic, and is very expensive to produce.
The going rate for synthesizing 50 grams of sulforaphane,
Kosmeder told Reuters Health, is $50,000. Kosmeder and his
colleagues "tweaked" the original molecule to
come up with oxomate, which also boosts phase II enzyme
activity but is 7 to 10times less toxic than sulforaphane.
And for $50,000, he told Reuters Health, it's possible to
synthesize hundreds of kilograms of oxomate.
The Chicago researchers tested oxomate in female rats that
had been given cancer-promoting chemicals. Oxomate produced
a 50% reduction in breast tumors in the animals. The team
is now investigating whether oxomate can prevent skin cancer
in ultraviolet-irradiated mice. They are planning a similar
study of colon cancer in the "near future." All
research is being funded by the National Cancer Institute
The goal of the research, Kosmeder said, is a pill people could
take every day, like a vitamin, to help prevent cancer.
"For people who are at risk, like cigarette smokers, this
would be very advantageous," he added.
Kosmeder filed for a provisional patent on oxomate last week,
with the intention of drawing interest from pharmaceutical
companies. Funding from industry, he explained, could speed
the development of a nutritional supplement based on the
Kosmeder anticipates that human studies could begin in 5 years.
as Part of Healthy Diet, Cut Cholesterol
By Suzanne Rostler
NEW YORK (Reuters Health) - Including almonds in an overall
healthy diet may help to reduce cholesterol levels, the
results of a small study suggest.
According to the report funded by The Almond Board of California
and the Canadian government, adults who substituted 74 grams
of almonds (about 2 ounces) for other foods reduced their
LDL ("bad") cholesterol by nearly 10% after 1
month. Adults who consumed fewer nuts also saw their cholesterol
levels fall, researchers report in the September 10 rapid
access issue of Circulation: Journal of the American Heart
Association ( news
However, adding nuts to a diet already sufficient in calories
and fat could lead to weight gain, a risk factor for heart
disease, cautions Julie Walsh, a spokesperson for the American
Dietetic Association. While nuts are rich in protein and
healthy monounsaturated fat, they are also high in calories.
"People have to remember when they eat nuts they have
to take out calories elsewhere," Walsh said in an interview
with Reuters Health.
The study included 27 adults with high cholesterol and an average
age of 64 years, who agreed to follow three diets with a
different snack of about 420 calories per day, for a month
The first diet included a snack of 74 grams of almonds, the
second diet included about 37 grams of almonds plus one-half
of a muffin, and the third diet substituted a whole-wheat
muffin, low in saturated fat, for the nuts. The muffin had
roughly the same amount of protein and saturated and polyunsaturated
fat as the nuts.
But almonds are higher in monounsaturated fat, found also in
avocados, olive oil and other types of nuts. When substituted
for saturated fat or trans fat, which is found in processed
foods and baked goods, monounsaturated fat has been shown
to lower cholesterol levels.
Indeed, adults eating the diet with more almonds reduced their
LDL cholesterol by 9.4% and lowered their ratio of LDL to
HDL ("good") cholesterol -- an important marker
of heart disease risk -- by 12%, after one month.
The diet with the half-portion of almonds was associated with
a more than 4% average reduction in LDL and a nearly 8%
reduction in the LDL to HDL ratio. Average cholesterol levels
did not fall in those on the diet that included just the
muffin. There was no change in body weight associated with
any of the snacks.
"Almonds (and nuts) may be included as part of a healthy
diet to reduce the risk of heart disease without weight
gain," Dr. Cyril W.C. Kendall, a study author from
the University of Toronto in Canada, told Reuters Health.
"The health benefits would be observed in individuals
with high cholesterol and in those with normal levels,"
Source: Circulation 2002;10.1161.01.CIR.0000028421.91733.20.
Help Predict Death Rate After Angioplasty
By Merritt McKinney
NEW YORK (Reuters Health) - Checking levels of a heart-related
enzyme may identify patients who are at the greatest risk
of dying after having balloon angioplasty to unclog blocked
blood vessels, according to the results of a new study.
The enzyme, known as creatine kinase-MB (CK-MB), rises after
a heart attack to signal that heart muscle has been damaged.
Measuring CK-MB levels is a standard test for diagnosing
heart attack. But levels of the enzyme also may rise after
angioplasty, during which a balloon-tipped catheter is threaded
into a blocked artery and inflated, flattening fatty plaques
against the artery wall.
Doctors often measure CK-MB levels in angioplasty patients,
but what to do with the results has been uncertain, the
study's lead author, Dr. Stephen G. Ellis, of the Cleveland
Clinic Foundation in Ohio, told Reuters Health in an interview.
The results of the study, he said, should help physicians
"better understand what to do with the results."
For most angioplasty patients, even those with elevated CK-MB
levels, reducing the risk of death does not require extra
time in the hospital, although they may benefit from cholesterol-lowering
drugs, Ellis and his colleagues suggest in a report on the
findings. The report, which is being published online, will
appear in the September 3rd issue of Circulation: Journal
of the American Heart Association ( news
Patients with CK-MB levels that are more than five times higher
than normal--who were found to have an increased risk of
dying--should probably only be kept in the hospital longer
if they have other risk factors, such as congestive heart
failure, kidney failure and older age, according to Ellis
and his colleagues.
The study included more than 8,000 patients whose CK-MB levels
were measured 6 to 8 hours after angioplasty as well as
on the morning after the procedure.
Patients with higher-than-normal CK-MB levels, especially those
whose enzyme levels were more than five times higher than
normal, were more likely to die during the 4 months after
angioplasty. During this time,1.2% of patients with normal
CK-MB levels died, compared with 1.9% of patients whose
levels were one to five times higher than normal, and 8.9%of
those with higher levels. The increased risk of dying was
most prominent during the first few months after angioplasty.
But among patients with CK-MB levels that were one to five
times above normal, the increase in death risk mostly occurred
more than 1 week after angioplasty, suggesting that keeping
these patients in the hospital for a few extra days would
do little to prevent deaths, the researchers report.
But because the study showed that patients who were not taking
cholesterol-lowering drugs called statins were more likely
to die after angioplasty, the authors conclude that high-risk
patients should be" strongly considered for statin
therapy." In the interview, Ellis recommended that
angioplasty patients ask their physicians whether they should
be taking statins. Although the drugs were developed to
lower cholesterol, Ellis speculated that the benefits to
angioplasty may stem from anti-inflammatory actions of the
Source: Circulation 2002;10.1161/01.CIR.0000028146.714162E.
Evidence HRT Doesn't Cut Heart Risk: Study
By Suzanne Rostler
NEW YORK (Reuters Health) - Hormone replacement therapy (HRT)
does not lower the risk of developing heart disease among
postmenopausal women, according to a review of more than
30 years of medical data.
The findings support those of a much-publicized trial halted
last month, which demonstrated that the risks of HRT outweigh
the benefits for the majority of postmenopausal women. In
that study, the Women's Health Initiative, women with an
intact uterus who took the combined estrogen plus progestin
therapy had a higher risk for breast cancer ( news
sites), heart attack, blood clots and stroke.
The current report found that HRT neither lowered nor increased
the risk of heart disease and coronary artery disease (CAD),
a type of heart disease that occurs when fatty deposits
narrow the arteries that supply blood to the heart. CAD
can lead to chest pain and heart attack.
A number of previous studies have linked hormone use with a
decreased risk of heart disease. But according to the current
analysis, other variables may have been responsible for
For instance, studies reporting a protective effect of HRT
did not account for women's socioeconomic status, and studies
that showed little or no protective effect took a woman's
social and economic class into account, Dr. Linda L. Humphrey
and colleagues note in the August 20th issue of the Annals
of Internal Medicine.
"Healthy women...tend to have more money, time, obtain
preventive healthcare, and have behaviors that may protect
them from heart disease," Humphrey explained in an
interview with Reuters Health.
"You can get a spurious relationship because healthy women
are the ones who decided to take hormones in the first place,"
added Humphrey, from the Veterans Affairs Medical Center
in Portland, Oregon.
The researchers reviewed observational studies on the relationship
between HRT, heart disease and coronary artery disease,
and included 20 studies in their final analysis. All of
the studies included data on potentially confounding factors
such as a woman's age, smoking and exercise habits, cholesterol
levels, family history of heart disease, socioeconomic status,
and other conditions such as high blood pressure or diabetes.
The results "support the findings of the Women's Health
Initiative that there is no current evidence to support
using hormones to prevent heart disease," Humphrey
said. "My personal belief is that you shouldn't take
hormones for cardiovascular disease protection."
She recommends that women who have been taking HRT review the
reasons why they are taking hormones with their physicians
and discuss the potential risks and benefits.
Source: Annals of Internal Medicine 2002;137:273-284.
Begin on New Type of Vaccine for Malaria
LONDON (Reuters) - British scientists have begun tests in Gambia
on a new type of vaccine for malaria that could one day
save millions of lives.
Some 360 Gambian adults will be given shots. Half will receive
the malaria vaccine, with the other half given a rabies
shot to compare the effects.
At present there is no effective, widely used vaccine for the
tropical disease spread by mosquitoes.
Professor Adrian Hill of Oxford University told Reuters the
vaccine being tested was the first of a new kind.
Unlike conventional vaccines, which "teach" the body's
immune system to recognize and destroy an organism that
causes an infection, the new vaccine would teach the body
to recognize its own infected cells.
"Kill the cell and the parasite at the same time. That's
the principle," he said. "This would be the first
(vaccine) that is explicitly designed to stimulate that
arm of the immune system."
Similar principles could one day be used to help prevent or
treat other diseases, such as cancer or HIV ( news
sites), he said.
Hill said his vaccine has already been shown to help curb the
spread of malaria in tests done in Britain, where volunteers
allowed themselves to be bitten by infected mosquitoes.
The Gambia trials will be the first large-scale test in the
field. The research is being funded by Britain's Wellcome
Trust, the world's largest medical research charity.
Hill said he hoped proving the vaccine was at least partially
effective in the field would attract investment from large
drugs companies, who have so far been reluctant to commit
resources to preventing a disease found mainly in poor countries.
"Nobody becomes a billionaire by making a malaria vaccine,"
Hill said. "It is extremely complicated research."
Each year, malaria sickens millions of people in tropical countries
and kills between one and two million children, Hill said.
U.S. Teens May Be Smoking, Using Drugs
NEW YORK (Reuters Health) - US high school students have an
easier time buying marijuana than cigarettes and beer, according
to a national survey of public school students. At the same
time, more public schools are drug free than in the past
The researchers found that the roughly one third of teenagers
surveyed who said they had an easier time buying marijuana
were 1.5 times more likely than their peers to use drugs.
Similarly, teens who said marijuana is not harmful were nearly
three times more likely to abuse pot than their peers who
believe the drug is dangerous, according to the report by
the National Center on Addiction and Substance Abuse (CASA)
at New York City-based Columbia University.
But availability and beliefs about drugs are not the only influences
on teens' decisions to use drugs, the survey found. At home,
younger siblings who believe that their older brother or
sister had tried illegal drugs were 1.5 times more likely
to report smoking, drinking or using illegal drugs.
And teens who live with a sibling who pushes drugs are twice
as likely to abuse substances, while teens who said their
older sibling would be "very angry" to learn they
were using marijuana were less likely to abuse substances,
the survey reports.
Overall, however, a majority of 12- to 17-year-old public school
students reported that their school is drug free for the
first time in the survey's 7-year history. About 62% of
the 1,000 students surveyed said drugs were not used, kept
or sold at their school, up from 42% in 2000.
Parochial school students reported a similar rise to 79% of
those surveyed from 65% in 2000.
The results may indicate that a smaller percentage of students
are abusing drugs than in the past, because studies have
shown that the risk of substance abuse is cut by half when
teens attend a drug-free school.
The findings also underscore the role parents can play, Joseph
A. Califano, Jr., CASA president, stressed in a prepared
statement. Studies have shown that parents who express strong
negative opinions about marijuana, for instance, can lower
the risk that their teen abuses pot.
"Parents must raise their voices and refuse to tolerate
drugs in their teens' schools to maintain this improvement,"
he said. "It's time all American parents get as angry
about drugs in schools as they are about asbestos in schools."
But many parents feel powerless when it comes to protecting
their children from drugs, according to the study. More
than one-third said they have little influence over whether
their teen tries drugs, alcohol or cigarettes. What's more,
43% of parents said their teen was likely to use drugs in
the future, compared with just 16% of teens.
To find out about drugs in schools, CASA recommends that parents
ask some key questions, including what steps are taken to
keep drugs and alcohol off school premises, whether teachers
are trained to spot signs of drug abuse, and what education
and prevention programs are offered and in what grades.
Indeed, the majority of teens who drink alcohol and smoke cigarettes
and marijuana begin between the ages of 12 and 16 years,
when the risk of substance abuse increases by 500%, according
to the report.
"Drug education efforts must begin as early as elementary
school," Califano said in a statement.
The survey was conducted by QEV Analytics, and included telephone
interviews with 1,000 teenagers and 541 parents between
December 2001 and February 2002.
Blood Sugar Test Inching Closer to Reality
By Anne Harding
BOSTON (Reuters Health) - Scientists are hard at work looking
for ways people with diabetes can measure their blood sugar
without the painful and scarring jabs now necessary for
Several researchers discussed the state of the art Sunday at
a symposium at the American Chemical Society's annual meeting.
Dr. Yizhong Yu, chief scientist at Animas Corporation in Frazer,
Pennsylvania, discussed his company's efforts to develop
a tiny, titanium-coated device that would communicate continuous
blood glucose readings to a monitor worn on the patient's
wrist. Sensors would poke through a blood vessel wall to
gauge the blood's absorption of near-infrared light. The
device, roughly the size of a pacemaker, would convert these
readings to blood glucose levels, and is intended to last
for at least 5years in the body.
One major hurdle in developing devices that use light to measure
blood glucose has been coming up with a formula to convert
light wavelength readings into glucose levels. Yu reported
that blood tests from more than 500 patients--far more than
other companies developing similar devices--have shown Animas's
formula is quite accurate.
Human tests will likely begin in a year or less, Yu said. But,
he added, "I do not want to paint a very rosy picture...there
is a lot for us to do to really get a sensor to the market."
He told Reuters Health he could not estimate the price of
the device, but said it would be a cost insurers would be
Animas's device, Yu and other panelists at the meeting said,
is the furthest along among other similar implantable devices
Researchers are also investigating a completely non-invasive
method: measuring wavelengths of near-infrared light after
it passes through the skin. Dr. Mark A. Arnold of the University
of Iowa in Iowa City reported on his efforts using this
After about 9 years, Arnold said, he and his colleagues are
ready to begin clinical tests of a system in which a beam
of light is passed through a roughly 2 millimeter pinch
of skin at the back of the hand. The experiments are being
funded by NASA ( news
sites), the National Institute of Diabetes and Digestive
and Kidney Diseases, and Inverness Medical Technology.
Dr. Gerard L. Cote of Texas A&M University and his colleague
Michael V. Pishko of Pennsylvania State University are developing
a sensor that would be implanted just under a patient's
skin. The implant would consist of tiny beads or a thin
slab of material that would glow under fluorescent light
to varying degrees depending on the glucose concentration
between skin cells.
In this method, a person would, theoretically, get the implant
at a doctor's office. Then he or she could shine fluorescent
light from a device about the size of a laser pointer on
the skin over the implant. The device could read the resulting
level of fluorescence and provide a blood glucose reading.
Tests in rats have shown the implants did not produce inflammation
in the animals or irritate them in any apparent way, and
that the beads did fluoresce under the skin under fluorescent
light. A sheet of the material would probably be most practical
for human use, Cote noted, as it would be easier to remove
and provide a larger area for readings. He predicts such
an implant could probably last a year in the body.
He predicted that human tests of the material could begin in
5 years. "A lot of it depends on funding," he
Dr. Vladimir Alexeev of the University of Pittsburgh and colleagues
are developing a material that, they hope, could be used
as an eye insert or contact lens that would monitor glucose
levels in the tear fluid covering the eye. The material,
called a hydrogel, changes color as glucose levels increase
Alexeev and colleagues are now working on their third generation
of the material, which shows a shift from red to blue as
glucose levels rise. Alexeev's team has received an NIH
grant to begin animal studies of the material.
Vaccine Guards Against Illness and Saves Money
By Charnicia E.
NEW YORK (Reuters Health) - Annual influenza vaccinations seem
to protect all adults--not just elderly and other at-risk
individuals--during flu season and may also be a money-saving
option for employers, new study findings suggest.
Each year, influenza reportedly affects as many as 2 out of
every 10 individuals in the United States.
"From this analysis it appears that vaccination of healthy
workers is cost saving (in) paying for itself and reducing
the frequency of flu," study author Dr. Eric D. Peterson
of Duke University Medical Center in Durham, North Carolina,
told Reuters Health.
He and his colleagues analyzed previously published data to
determine the most cost-effective strategy for preventing
and treating the flu in healthy adult workers aged 18 to
50 years. The economic value of the treatment was determined
by treatment costs and the number of workdays gained.
Overall, the health benefits of flu vaccination outweighed
its associated costs, the investigators report in the August
20th issue of Annals of Internal Medicine.
The best treatment strategy for individuals already infected
with the flu bug was vaccination combined with the antiviral
drug rimantadine, study findings indicate.
This treatment combination was associated with a cost savings
of $30.97 in health benefits, such as workdays gained, compared
with nonvaccination and no antiviral treatment, study findings
Peterson and his team also compared rimantadine with two newer
antiviral drugs, to determine if the newer drugs were worth
their higher cost.
They found that all of the drugs had health benefits that equaled
or exceeded their costs, the report indicates.
Rimantadine was slightly more cost-effective than the newer
drugs, yet it was also associated with more frequent nausea
and dizziness--side effects known to be more severe in elderly
individuals than among healthy workers, the researchers
Further, rimantadine is mainly effective against only one type
of influenza, according to Peterson.
Taking the newer drugs would require individuals to "trade
off a little more cost for newer drugs for their efficacy
and fewer side effects," Peterson said. But "if
feeling better leads to more days of work, you've more than
covered the cost of the drug," he said.
Peterson added that his study did not pit the drugs against
each other to determine which drug was the best treatment
"Head-to-head trials of various flu treatments need to
be done in order to decide which is the best overall,"
Source: Annals of Internal Medicine 2002;137:225-231.
SUNDAY, AUGUST 18, 2002
New Take on the Prescription Drug Flap
By Janice Billingsley
SUNDAY, Aug. 18 (HealthScoutNews) -- Amid the controversy surrounding
the high cost of prescription drugs, some health professionals
contend there's already a product in place that ensures
the fairest prices for consumers.
It's called the generic drug.
"The development of generics has been one of the best
success stories in the health-care field in the last 20
years," says Daniel Albrant, president of a Virginia-based
health-care consulting company, and a spokesman for the
American Pharmaceutical Association.
"And the present medications are probably one of the most
cost-effective parts of the health-care system," he
Others disagree, saying access to prescription drugs needs
tweaking -- at a minimum -- so it's more palatable to consumers.
"I'm fairly horrified by the cost of drugs -- they should
be available at a much lower cost," says Dr. Jean Barbey,
interim director of Georgetown University Hospital's division
of clinical pharmacology in Washington, D.C.
Generic drugs are copies of brand name drugs whose patents
have expired. A drug company that creates a new drug has
a 17-year patent on that drug, after which time it loses
the exclusive right to manufacture it. Then other companies
are free to produce the same drug, Albrant says.
Because those companies don't have to pay for the expensive
research and development that goes into the creation of
a drug, they can sell it at a much lower cost. The savings
to the consumer, or a third-party provider, are considerable
-- often half the price of the brand name drug, Albrant
Since 1984, when Congress passed a law to streamline the production
of safe generic drugs, the Food and Drug Administration
sites) has approved the sale of about 250 generic drugs
every year. The result has been a huge savings for consumers,
either directly or through health-care plans, says Albrant.
"It's difficult for consumers to see, but it's true that
all these new drugs have improved people's life spans and
the quality of their lives," he says.
But health-care experts like Barbey contend that not enough
is being done to keep prescription drugs within the reach
of all who need them.
"Money is spent on marketing and direct advertising to
potential customers that could constructively be used in
other ways," Barbey says. "Right now, no health
authority is trying to regulate this free-for-all market,
trying to limit it a little bit without stifling research."
Barbey, a Swiss native, says the more socialistic European
models are better able to control prices.
In France, for instance, a drug company seeking to develop
a drug must consult with the government about its plan.
Then the government, weighing the health benefits and cost-effectiveness
of the drug, sets the price at which the company can sell
In the United States, Barbey says, the free market also allows
drug companies to try to extend their patents by manufacturing
so-called "new" drugs that are simply variations
on the original. This often happens, he says, with drugs
that treat common ailments like allergies and depression.
And, Barbey adds, American drug companies seeking to boost
profits often manufacture too many of the same kind of drugs,
called "me-too" drugs. He points to the approximately
one dozen different ACE inhibitor drugs on the market, which
are designed to treat high blood pressure.
"This is an excellent class of drugs, and you could argue
that you need more than one drug from the class, but do
you need 12?" he asks.
But Albrant counters that the very free-market system that
Barbey criticizes has actually encouraged the development
of more and better drugs. Facing deadlines on their patents,
companies are always seeking to develop new products.
"The pharmaceutical industry has become more efficient,"
he says. "They can't sit back on their laurels. They
need to continue to produce more compounds."
This has meant that companies that would have been content
to produce drugs for large segments of the population --
such as those with cardiovascular disease or cancer -- have
had to target smaller groups of people, developing new drugs
for those with conditions like migraines, epilepsy or depression.
Despite their philosophical differences, Albrant and Barbey
agree that generic drugs are as effective and as safe as
brand name drugs.
"I have no hesitation in prescribing generic drugs,"
Adds Albrant: "I recommend them all the time, confident
that the products are equivalent in every way to the trade
name products, but at a reduced cost."
The testing for generics is quite thorough, Barbey says. In
a typical study to compare them to brand name drugs, study
participants are divided into two groups. One group takes
the brand name drug and the other takes the generic, and
both groups have blood samples taken.
Several weeks later, the test is repeated, only this time the
participants switch drugs, then give another blood sample.
All the blood samples are then examined to reveal how quickly
both drugs were absorbed into the blood, the maximum concentration
of the drug in the blood, and how long it stayed in the
If the results show that the generic drug comes close to matching
the performance of the brand name drug, it is approved as
"bio-equivalent" to the original drug.
What To Do
To look up any drug approved by the Food and Drug Administration,
check the agency's Orange
Book. For more on the difference between generic and
brand name drugs, visit this Federal
Trade Commission Web site.
Into the Swing of Things
SUNDAY, Aug. 18 (HealthScoutNews) -- Don't let tennis elbow
serve up a grand slam of trouble.
Overuse of your arm and forearm muscles can cause abrupt or
subtle tearing of the muscles and tendons around the outside
of the elbow, resulting in pain. That's tennis elbow.
Just because it's called that doesn't mean it's limited to
people who play tennis. It can affect other athletes and
people who do leisure or work activities that require repetitive
arm, elbow and wrist movement, says Dr. Stephen Silver,
an orthopedic surgeon at the Insall Scott Kelly Institute
for Orthopaedics and Sports Medicine at Beth Israel Medical
Center in New York City.
He offers the following tips to prevent tennis elbow:
Hit some soft shots with a partner before you start a tennis match.
- When hitting backhand,
begin the motion at the shoulder and avoid placing your
thumb behind the racket's grip. This reduces the amount
of vibration absorbed by your arm.
- Dust your racquet handle
with sawdust or chalk to reduce slippage.
Silver says the most common symptoms of tennis elbow include:
Pain slowly increasing around the outside of the elbow. Sudden development
of pain can occur, but is less common.
- Your pain is worse when
you shake hands or squeeze objects.
- The pain is made worse
when you stabilize or move your wrist by force. For example,
when lifting, using tools or handling simple utensils
such as a knife or fork.
Silver says 95 percent of people with tennis elbow improve
and recover with non-surgical treatment. However, such treatment
is most effective if it starts as soon as symptoms appear.
The longer you've had tennis elbow, the longer your rehabilitation
and the greater chance you'll need surgery.
Centre for Occupational Health and Safety has all the
facts about this condition.
SATURDAY, AUGUST 17,
Medicare Fails Elderly
WASHINGTON (AP) - Medicare limits the services available to
many elderly patients by failing to adequately reimburse
hospitals and health care professionals in dozens of states,
Rep. Leonard Boswell ( news,
record), D-Iowa, said Saturday.
"It must be fixed," Boswell said in the Democrats'
weekly radio address. "Despite the fact that everyone
pays the same Medicare taxes, the outdated Medicare formulas
do not equally reimburse for seniors' health care."
Hospitals, doctors and nurses across the country are "at
risk of being unable to provide the most up-to-date treatment
and the most effective care," he said.
Iowa ranks last in the nation in Medicare reimbursement, getting
$3,053 for each Medicare recipient, Boswell said. Louisiana
is the top-ranked state, getting $7,336 for each recipient.
"In states like Iowa, we are losing a billion dollars
for every year that we get reimbursed at less than the national
average," Boswell said. He added that 34 other states
are paid below that level.
Boswell said he has proposed legislation to bring Medicare
reimbursements in all states closer to the national average.
He called on President Bush ( news
sites) and members of Congress to pledge to "end
Boswell is one of several Iowa representatives fighting for
re-election this fall in redrawn voting districts. A third-term
congressman, he left his farm and a new majority-Republican
district and moved to Des Moines in hopes of saving his
place in the House.
Last month, Boswell accused the Bush administration of paying
close political attention to Iowa while ignoring its shabby
treatment in the health care system.
"Clearly, the administration views Iowa as a politically
important state," Boswell said then. "I am hopeful
we can leverage that into support for Medicare equity."
Fitting Fitness Back in
By Kathleen Doheny
SATURDAY, Aug. 17 (HealthScoutNews) -- In the good old days
before you were married, had kids, got the promotion, bought
the house and did the yard work, you really worked
Hard, fast, regularly. Back then, you could run a five-minute
mile. Or bench press your weight. Or sweat through that
90-minute advanced aerobics class.
These days, are you spending more time feeling guilty about
not working out than working out?
If so, you're probably the kind of lapsed boomer President
Bush ( news
sites) was talking to when he recently declared war
on being fat and sedentary. No wonder you weren't invited
along on that three-mile fun run with him and his staff.
But you have plenty of company. You've joined the 4-in-10 adult
Americans of all ages who admit they are not physically
active at all, according to the President's Council on Physical
Fitness and Sports.
Exercise experts like Richard Cotton and Cedric Bryant have
heard it all before -- busy boomers complaining that, between
carpools and van pools and making ends meet, they barely
have time for a movie, much less a regular exercise routine.
Cotton is an exercise physiologist and also a spokesman for
the American Council on Exercise in San Diego, Calif., an
organization that certifies instructors and oversees exercise
research. Bryant is the chief exercise physiologist for
They both specialize in motivating inactive people to become
involved in exercise programs. They inspire woefully out-of-shape,
middle age lapsed exercisers or never-exercisers to consider
the benefits of incorporating workouts into their however-hectic-or-sedentary
routine, convincing them that the stress-reduction and disease-risk
reduction benefits are worth the effort.
Here are some of their best tips.
Blot out that "hard body image" memory. It's normal to
have a mental image of yourself when you last exercised
regularly, says Cotton. If your image is from high school,
you could be in big trouble. Even if it was from last year,
forget it. "Try to have as little memory as possible
of what you used to look like and do," Cotton says.
"Be in the present."
- Start slowly. "Do much less than
you think you are able to," Cotton suggests. Take
a 10-minute stroll if you're newly back to workouts. Clients
tell Cotton, "It's not enough." No, he replies,
it's not, "but it's a start." Consider walking
as a good way to get back to exercise.
- Know the risks of too
much, too fast. "Go too fast and you're likely to get injured," Bryant
says. That could set you back to square one.
- Prepare. Plan your workout wardrobe
so you'll be comfortable. Consider the weather you will
be walking in and decide: long pants, long sleeves, shorts,
- Don't skimp on shoes. A good pair of shoes
should cost about $70, says Cotton, and they'll help ensure
good shock absorption and cushioning. Which type? "If
you are walking with the hope of jogging eventually, buy
running shoes," says Cotton. If you plan to walk
as your main exercise, get walking shoes.
- Don't overlook good socks.
Best for workouts: Socks with some synthetic fibers (rather
than all-cotton) because they wick away sweat better.
When you try on exercise shoes, wear your exercise socks.
- Increase your duration
of exercise in small increments. "Spend one week minimum at each phase,"
Cotton says. Exactly how long you will walk in each phase
will depend on your stamina and your doctor's advice.
But you might begin with as little as a 15- or 20-minute
walk, then work up, Cotton says. Add duration before speed.
You can increase the length of the walk each phase, by
perhaps five minutes a phase. Soon, you'll be at the recommended
30 minutes (or more) a day, five or more days a week.
"Accept yourself where you are," Cotton says.
- Do the talk test. If you can't talk with
ease as you walk or jog, you're going too fast and trying
to do too much, Bryant says.
- Remember to stay well-hydrated. "The thirst mechanism is less sensitive by age 50," Bryant
- Add strength training
to the cardiovascular routine. But only when you are ready, Cotton suggests.
- Consider getting an exercise
buddy. That could help increase your faithfulness to your new routine.
"An exercise buddy is always nice," Cotton says,
"especially if you can latch on to someone who already
has the habit. That's a free ride."
- Be realistic about the
You might notice looser waistbands but no difference on
the scale. "As you get up into the 35-, 40- or 45-minute
walks that are brisk, you can expect weight loss,"
Cotton says. "But figure it takes six to eight weeks
to transform your body. And even if you do not lose a
pound, you are healthier if you exercise."
And quite possibly, that might put you higher up on Bush's
invite list, should he host another run.
What To Do
For more information on exercise and age-related weight gain,
see the American
College of Sports Medicine. For information on staying
fit, see American
Council on Exercise.