The American Voice Institute of Public Policy presents

Personal Health

Joel P. Rutkowski, Ph. D., editor
September 6, 2004

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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



















PERSONAL HEALTH for the week of May 15-21


  1. Sodas Raise Cancer Risk, U.S. Study Finds
  2. People With MS Are 'Satisfied' With Life
  3. Ear Implants Work Best When Started Young
  4. Alzheimer's Risk Higher in Diabetics
  5. Low-Carb Diets Work Better in Short Term Reports
  6. Technology Takes New Look at Color Blindness
  7. CDC Watching for Next Worrisome Outbreak
  8. Blow Fish Poison Makes Powerful Painkiller
  9. Spending Soars for Kids' Behavior Drugs
  10. Migraines Can Be a Financial Headache
  11. Home Exercise Program May Not Improve Osteoarthritis
  12. Busy Consumers Eat on the Go
  13. Blood Test Could Improve Ovarian Cancer Survival
  14. Worrying About Health Costs Raises Death Rate
  15. A New Look to Heart Failure Treatment


Monday, May 17, 2004


Sodas Raise Cancer Risk, U.S. Study Finds



Monday, May 17, 2004

WASHINGTON (Reuters) - Carbonated drinks may raise the risk of esophageal cancer, a usually fatal disease, researchers reported on Monday.

Several studies presented at a meeting of cancer and gastrointestinal experts in New Orleans showed that what people eat and drink could affect a range of cancers.

"This research supports the widespread medical recommendations for healthy eating," said Dr. Lee Kaplan of Massachusetts General Hospital and Harvard Medical School (news - web sites) in Boston.

A team at Tata Memorial Hospital in India found a strong correlation between the rise in per capita consumption of carbonated soft drinks in the past 50 years and a documented increase in rates of esophageal cancer in the United States.

Team members studied U.S. Department of Agriculture (news - web sites) data to find that per capita consumption of carbonated drinks rose by more than 450 percent, from 10.8 gallons on average in 1946 to 49.2 gallons in 2000.

And over the past 25 years, the incidence rates of esophageal cancer have risen by more than 570 percent in white American men. Esophageal cancer affected 13,900 U.S. men and women in 2003 -- more than 10,000 men -- and killed almost all of them, according to the American Cancer Society (news - web sites).

The number of esophageal cancer cases clearly followed the rise in intake of carbonated soft drinks, the researchers found.

That could be coincidence, but they also found research that showed a possible biological basis for the effect. Carbonated soft drinks cause the stomach to distend, which in turn causes the gastric reflux associated with esophageal cancer.

The researchers found similar trends worldwide. Countries with per capita annual consumption of more than 20 gallons of fizzy soft drinks also had rising rates of esophageal cancer.

"The surprisingly strong correlation demonstrates the impact of diet patterns on health trends," Dr. Mohandas Mallath, who led the study, said in a statement.

But another study showed a potential benefit from drinking coffee and other caffeinated beverages.

A team at the National Institute of Diabetes and Digestive and Kidney Disease studied people with a high risk of liver problems and found those who drank more caffeine had fewer liver abnormalities.

They surveyed 5,944 adults at high risk for liver damage because of heavy drinking, hepatitis infection, iron overload or obesity.

The more coffee they drank, the more likely they were to have normal liver function, the researchers found.

"These results warrant further study," said Dr. James Everhart, who helped lead the study.

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People With MS Are 'Satisfied' With Life


By Amanda Gardner
HealthDay Reporter


Monday, May 17, 2004

MONDAY, May 17 (HealthDayNews) -- More than three-quarters of people with multiple sclerosis say they are "mostly satisfied" or "delighted" with their quality of life, a new study finds.

The research, appearing in the May issue of the Archives of Neurology, complements an earlier study also done by Mayo Clinic researchers that found MS patients were not as physically disabled as previously thought. More than half (52 percent) were fully ambulatory, while only 14 percent were confined to a wheelchair, the first study found.

The two studies combined should give hope to patients diagnosed with the disease, the study authors said.

"Getting a diagnosis of multiple sclerosis is not a death sentence," said lead researcher Dr. Sean J. Pittock, a research fellow at the Mayo Clinic. "It doesn't mean you'll have to stay in a wheelchair. Most patients have reasonably good quality of life, most stay ambulatory, most keep working."

Other experts noted, however, that the new findings should not diminish the impact of the disease for some people.

"We recognize that MS can be a very devastating illness for people," said Nicholas LaRocca, director of health-care delivery and policy research at the National Multiple Sclerosis Society. "On the other hand, I think it is also true that many people who live with MS live very productive lives and are able to carry on with their lives in spite of the illness."

Multiple sclerosis is an autoimmune disease that affects the central nervous system. The disease damages myelin, a fatty tissue surrounding and protecting the system's nerve fibers, resulting in an array of symptoms. These symptoms vary greatly from one person to the next, but can include fatigue, balance problems, vision problems, tremors and slurred speech. The progression of the disease is also highly variable from one person to the next.

For the new study, the Mayo researchers asked 201 people with MS living in Olmstead County, Minn., to fill out questionnaires on their quality of life.

This particular group of people represents all cases of MS in the county; they had already participated in several studies led by the nearby Mayo Clinic.

The questionnaire included sections on pain, vitality, fatigue, social functioning, emotional well-being, mental health and the ability to perform daily activities. The scores were compared to those of people without MS. The questionnaire that was used, LaRocca said, "is the gold standard in terms of health-related quality of life."

"When patients were asked to describe how they felt about their life as a whole, 142 (77 percent) were mostly satisfied or delighted."

Not surprisingly, those men and women with MS had lower scores for physical functioning, vitality and general health.

What was surprising was that both groups had similar scores on pain, mental health and social functioning.

"You were more likely to have a worse quality of life if you have more disability, but it's not as strong as you might think," Pittock said. "Some very, very disabled people appeared to have very good quality of life."

There may be several reasons why people with a chronic and potentially disabling illness such as MS report such a positive quality of life. "People with a chronic illness go through a coping process in which they adjust to whatever the disease has thrown at them," LaRocca explained. "Although initially they have to face particular losses and disabilities, most people learn to live with those and go on to have much less distress."

There may also be a difference in the way people with MS rate their quality of life. "The other thing that seems to happen with people is that when they have lived with a certain level of interference in their health for a certain period of time, they seem to recalibrate their expectations," LaRocca said.

Finally, about 25 percent of the Olmstead group was taking disease-modifying drugs for MS, compared with 40 percent to 50 percent of Americans with the disease, LaRocca said. This may indicate a lower level of disability.

Pittock feels that because the study subjects included everyone in the county with MS, the findings are representative of people with the disease.

"We think we're getting the full picture," he said.

More information

The National Multiple Sclerosis Society has more on living with MS and on treatments.

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Ear Implants Work Best When Started Young


By Lindsey Tanner

AP Medical Writer

The Associated Press

Monday, May 17, 2004

CHICAGO - The earlier deaf children get cochlear implants, the more likely they are to speak and comprehend language normally later in life, new research suggests. In fact, some doctors say doing the surgery in infancy may produce the best results.

In one study, children ages 12 months to 3 years showed rapid improvement in understanding speech during the first year after receiving one of the electronic devices, with the best results in the youngest children.

In another study, 43 percent of children who got implants at age 2 had normal oral language abilities at ages 8 to 9, compared with just 16 percent of youngsters who got implants at age 4, University of Texas Southwestern Medical School researcher Ann Geers found.

Geers said the longer implant use by the youngest children studied does not explain her results. Instead, she and other researchers say that very early childhood is an especially critical period in the development of language skills, during which children hear and imitate sounds around them.

Both studies appear in May's Archives of Otolaryngology-Head & Neck Surgery, released Monday. This month's issue focuses entirely on cochlear implants in children. The studies are among the few to examine the use of the implants in children so young.

Cochlear implants, typically implanted in one ear, use electrodes to transmit sounds to the auditory nerve and brain, bypassing nonfunctioning parts of the ear. The electronic devices are approved for use in children as young as 12 months, but some doctors have begun implanting them in even younger children.

"Babies spend quite a bit of time hearing and experiencing all kinds of sounds and speech in order to learn to talk," said Dr. Nancy Young, an ear specialist at Chicago's Children's Memorial Hospital. "It certainly makes sense to think that giving children the opportunity to hear as soon as possible would be beneficial."

The latest research did not look at whether putting implants in infants under a year yields better results than doing so at, say, 12 months or 18 months. And neither study looked at youngsters past age 9.

But Geers said she believes waiting until after age 2 may decrease the chances that a child will ever develop normal speech skills.

Of the 50 or so children who get cochlear implants yearly at the Chicago hospital where Young works, the youngest was a 7-month-old Chesterton, Ind., boy with inherited hearing loss who had the surgery in December.

The boy, Kevin Johnston, is now a babbling, cooing 1-year-old year old and tests show his speech skills are "right on target" for a child his age, said his mother, Cindy Johnston.

Johnston said it was "a no-brainer" to have Kevin's surgery so young. In the three-hour outpatient operation, a cochlear implant was installed in the baby's right ear.

The same inherited condition affects her two older children, including a 4-year-old daughter who got an implant at 2 1/2. "She's just about a year behind in language," Johnston said, a delay she said she thinks would not have occurred if her daughter had had the surgery earlier.

About 3 out of every 1,000 U.S. infants are born deaf. Deafness and hearing problems also can occur after birth from ailments including meningitis. Many such children are candidates for cochlear implants, as are some adults with age-related hearing loss.

Dr. Michael M.E. Johns, Archives editor, said tremendous advances have been made in dealing with hearing loss in children over the past decade, with better implant technology and improved hearing tests.

Newborn hearing tests, now performed in most states, mean most children born deaf are diagnosed shortly after birth. In the early 1990s, children born deaf were typically identified after age 3, Johns said.

An estimated 23,000 people nationwide have the implants, including some 10,000 children. The devices do not restore normal hearing, and users usually work with specialists to improve their communication skills. Many wear hearing aids in the non-implant ear; some also use sign language.

Some activists for the deaf have complained that the devices stigmatize deafness and a repudiation of sign language, but the implants are becoming more accepted.

"Opposition is giving way to the perception that it is one of a continuum of possibilities for parents to consider," said researchers John Christiansen and Irene Leigh of Gallaudet University, a college for the deaf in Washington.

On the Net:


Deafness Research Foundation:

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Alzheimer's Risk Higher in Diabetics


By Amanda Gardner
HealthDay Reporter


Monday, May 17, 2004

MONDAY, May 17 (HealthDayNews) -- Having diabetes appears to be linked to a 65 percent higher risk of developing Alzheimer's disease (news - web sites).

While previous research has looked at the association between dementia and diabetes, results were often inconclusive.

The current study, appearing in the May issue of the Archives of Neurology, not only looks specifically at Alzheimer's, but it is also the first to look at how different cognitive "systems" might be affected differently in people with diabetes.

"I think it strengthens the link," said Dr. Sam Gandy, vice president of the Medical and Scientific Advisory Council of the Alzheimer's Association.

It also means there may be things people can do to stave off Alzheimer's. "This strengthens the evidence that tight control of diabetes may be important not only to manage vascular complications but to lower your risk for Alzheimer's," Gandy added. "It's now possible with oral agents and insulin and relatively painless glucometers to monitor and maintain your blood sugar in a very tight range."

The issue of an association between diabetes and Alzheimer's is an important one as the prevalence of type 2 diabetes increases dramatically throughout the world. Currently, about 20 percent of Americans over the age of 65 have the disease. If left unchecked, diabetes can lead to heart problems, kidney problems, cognitive impairment and more.

This study used data from the Religious Orders Study, an ongoing study of Catholic nuns, priests and brothers, to analyze the relationship between Alzheimer's and diabetes. Some 824 participants were followed for about five and a half years, undergoing periodic neuropsychological testing of five cognitive "systems." Those systems were general knowledge, working memory, perceptual speed (the speed with which simple comparisons can be made, such as whether two groups of numbers are the same), and the ability to recognize spatial patterns.

Over the study period, 151 of the participants developed Alzheimer's, including 31 who had diabetes. This amounted to a 65 percent increase in the risk of developing Alzheimer's among people who had diabetes compared with people who did not.

People with Alzheimer's and diabetes had an increased rate of decline in their perceptual speed (44 percent lower) compared to people who had Alzheimer's but not diabetes. The other systems declined at a similar rate.

The difference in perceptual speed may be due to strokes, which are more common in people with diabetes.

Other underlying mechanisms are still not clear, nor were they specifically addressed in this study.

"One of the first thoughts that comes to mind is that it would be through a vascular process, because we know that diabetes is associated with vascular diseases that affect the brain and thinking ability," said study author Dr. Zoe Arvanitakis, a neurologist with the Alzheimer's Disease Center at Rush University Medical Center in Chicago.

It's also not certain whether this is a cause-and-effect relationship or simply an association, although a cause-and-effect scenario would make a certain amount of sense. "We know, for example, that diabetes increases atherosclerosis and high cholesterol, and high cholesterol can aggravate Alzheimer's," Gandy said. "The other thing is it appears the same enzyme that degrades insulin also decreases amyloid peptide [which is important in Alzheimer's]." In a person with diabetes, different systems may be competing for the same enzyme.

All the study participants have agreed to donate their organs after they die, so researchers will have an opportunity to explore some of these hypotheses at that time.

More information means more hope for prevention and treatment of Alzheimer's. "The overall goal of this and other studies is to better understand the factors that either increase or decrease the risk of Alzheimer's disease," Arvanitakis said. "If we can identify those factors and understand what mechanisms underlie the relationship, we might be able to influence a person's risk of having Alzheimer's disease."

More information

For more on Alzheimer's, visit the Alzheimer's Research Trust. The National Institute on Diabetes and Digestive and Kidney Diseases has more on the blood-sugar disorder.

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Low-Carb Diets Work Better in Short Term Reports



Monday, May 17, 2004

WASHINGTON (Reuters) - Low-carbohydrate diets help people lose weight in the short term but work no better than other diets after a year, researchers reported on Monday.

Two studies of the popular diets that limit sugar and processed starches show they can work faster than some low-fat diets.

Both studies published in the Annals of Internal Medicine showed that after six months, the low-carb dieters lost more weight than the low-fat group. And one study showed that after 12 months, both groups had lost about the same amount of weight.

In one study, a team at the Veterans Affairs Medical Center in Philadelphia followed 132 obese adults who were assigned randomly either to a low-carbohydrate diet with intake of less than 30 grams of carbs a day, or a low-calorie diet that kept fat intake at a moderate 30 percent of calories from fat.

Volunteers with diabetes had better control of blood sugar on the low-carb diet, the researchers reported.

The low-carb group lost weight faster, but the low-fat dieters caught up.

A year later, both groups had lost about the same amount of weight -- 11 to 19 pounds for the low-carb group and 7 to 19 pounds for the low-fat group.

Dr. Linda Stern, who led the study, said it confirmed that any diet that cuts calories will work.

"Americans are overweight because we're eating too much food and ingesting too many calories," she said in a statement.

But most people tend to overindulge in high-carbohydrate foods. "I think a low-carbohydrate diet is a good choice because much of our overeating has to do with consumption of too many carbohydrates," she added.

In the second study, a team from Duke University followed 120 overweight people and found those on the low-carb diet who also took a variety of vitamins and supplements lost an average of 26 pounds, compared to an average of 14 pounds on a low-fat diet after six months.

However, the low-fat dieters lowered their cholesterol levels more, reducing their risk of heart disease.

"We can no longer dismiss very-low-carbohydrate diets," Dr. Walter Willett of the Harvard School of Public Health wrote in a commentary. But researchers said more study was needed to show whether low-carb diets are safe in the long term.

"Patients should focus on finding ways to eat that they can maintain indefinitely rather than seeking diets that promote rapid weight loss," Willet added.

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Technology Takes New Look at Color Blindness


By Ed Edelson
HealthDay Reporter


Monday, May 17, 2004

MONDAY, May 17 (HealthDayNews) -- A technology originally developed for military space purposes has helped solve a puzzle about color blindness and holds promise for diagnosis and treatment of a number of eye disorders, new research says.

The technology is adaptive optics, which uses a constantly changing mirror to give clear pictures of images that would otherwise be blurred because they are passing through a constantly changing medium -- the earth's atmosphere in astronomy, the fluid of the eye in optometry.

Adaptive optics has become a powerful tool of ground-based astronomy. Its potential medical uses are illustrated by this latest report.

Researchers at the University of Rochester in New York, where much work on adaptive optics has been done, report in this week's issue of the Proceedings of the National Academy of Sciences (news - web sites) that they have used the technology to compare the light-receiving molecules in the eyes of two color-blind individuals.

The eye has two kinds of light receptors -- cones, which are sensitive to light but not colors, and rods, which come in three varieties sensitive to red, blue and green.

"This is the first time we have been able to see rods and cones on a single-cell level," said study author Joseph Carroll, a postdoctoral fellow in the Rochester Center for Visual Science.

What they saw in one color-blind person was the normal number of cones, but all the red cones had been replaced by green cones. In the second individual, all the green cones were missing. Remarkably, this loss of one-third of all the cones did not reduce visual acuity.

"This person had no idea that there was anything wrong with his vision other than color blindness," Carroll said.

That finding has no immediate medical application, but Carroll said "it opens the door to the study of many more common retinal diseases that cause loss of vision." One such condition is retinitis pigmentosa, in which rods and cones begin to die in the peripheral part of the visual field, with the loss moving inward to eventually destroy central vision.

What is needed for medical use of adaptive optics is a low-cost mirror, Carroll says. An adaptive technology mirror now costs upwards of $100,000. The goal is to bring that down to about $1,000. Work toward that goal is part of the mission of the Center for Adaptive Optics, funded by the National Science Foundation (news - web sites), which includes 13 institutions across the country.

One of those Institutions is the University of Indiana School of Optometry. Donald T. Miller, an associate professor of optometry there, said "we are working to combine adaptive optics with other technologies to get a better view of the eye."

Adaptive optics gives an image of the surface of the retina, Miller said, but it cannot look into the three layers of cells that make up the retina.

"The push here is to combine adaptive optics with optical coherent tomography, which would give a direct indication of the health of the retina, particularly related to glaucoma," Miller said.

Glaucoma causes vision loss by steadily destroying retinal cells as pressure builds up in the eye. The condition can be treated with drugs that reduce pressure, but "the problem is that we have a difficult time diagnosing whether a patient has glaucoma, and so we tend to err on the conservative side," Miller said. Better images could prevent unnecessary use of drugs, he added.

For retinitis pigmentosa, "we need to be able to image rods and cones as well, and no one has been able to do that yet," he said. Recent reports indicate that adaptive optics may be able to achieve that goal, Miller said.

More information

An overview of the varied uses of this technology is given by the Center for Adaptive Optics. Go to MedlinePlus to find an example of a color blindness test.

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CDC Watching for Next Worrisome Outbreak


By Daniel Yee

Associated Press Writer

The Associated Press

Monday, May 17, 2004

ATLANTA - SARS (news - web sites). West Nile. HIV (news - web sites). Bird flu. Once-obscure and unknown diseases have caused some of the most worrisome outbreaks in recent years, and health officials can only guess what disease will strike next.

Despite having the best medical and science know-how in history, today's health experts are struggling to predict the next outbreak as even the rarest diseases can be easily and quickly spread around the globe because of air travel and international commerce.

Some of last year's outbreaks including SARS worldwide and monkeypox's first presence in the United States emerged with little warning.

"We know we need to continue to expect the unexpected," said Dr. James Hughes, director of the National Center for Infectious Diseases at the Centers for Disease Control and Prevention (news - web sites) based in Atlanta.

While health officials including those at the CDC say it's impossible to determine exactly what disease will appear next, they are constantly preparing for the world's next outbreak.

"We always say that the most important disease is the next one unfortunately there is no crystal ball to look into," said Dr. Corrie Brown, a University of Georgia professor and member of the Secretary of Agriculture's advisory committee for animal and poultry diseases.

Health officials say there's no evidence yet of any new outbreaks threatening humans, but they are closely watching a few likely suspects.

At the top of the list is influenza. Up to 50 million people died in the flu pandemic of 1918-1919, the worst flu outbreak in recent history. Because flu strains mutate and swap genes with other flu viruses, health officials fear that another powerful strain could strike at any time.

"Most of us in infectious diseases are waiting for an influenza pandemic," said Dr. Mark Smolinski, a former CDC official who helped investigate hantavirus when that disease first appeared in 1993 in the United States.

The avian influenza outbreak earlier this year in Asia scared health officials, as it hit eight Asian countries, killing 24 people in Vietnam and Thailand. About 100 million chickens in Asia either died from the illness or were slaughtered to prevent its spread.

"It's the first time we've ever had an avian flu epidemic in multiple countries at one time of a highly pathogenic strain," said Smolinski, now acting vice president of biological programs at the nonprofit Nuclear Threat Institute.

Another concern are diseases transmitted by insects. The mosquito-borne West Nile virus (news - web sites) came to the United States in 1999 and has spread across the continental United States.

That experience has made health officials wary of Rift Valley fever, another mosquito-borne disease, but one that is much deadlier than West Nile. Rift Valley fever has a mortality rate of up to 26 percent, compared to West Nile, which kills up to 10 percent of those it infects.

"If we get Rift Valley fever in the United States, it would make West Nile look like a hiccup," Brown said. "It was heavily investigated during the Cold War as a good way to immobilize troops."

Once confined to Africa, Rift Valley fever entered the Arabian peninsula for the first time four years ago. It's believed to have spread through exported livestock. About 95 people died from it in Saudi Arabia in 2000.

The concern in the United States over the Rift Valley fever is that about 25 different kinds of domestic mosquitoes could carry the virus if it reaches North America.

The pig-borne Nipah virus, discovered in 1998 in Malaysia, "has surfaced periodically in the swine populations," said Dr. Nina Marano, acting associate director for veterinary medicine and public health for the CDC. Nearly 900,000 hogs were killed and 265 people died before the Malaysian outbreak was controlled.

Both of these viruses have manmade dangers: Federal officials warn that terrorists could try to spread them both as bioweapons.

Those new threats come on top of long-standing diseases that have been difficult to contain. About a quarter of the 57 million deaths in the world in 2002 were from infectious diseases. About 2.8 million people died that year from HIV and AIDS (news - web sites), the globe's leading killers, Hughes said.

"Malaria, tuberculosis and HIV still are wiping out large portions of the population," Smolinski said. "We're very concerned about the global pandemic of HIV the horse is out of the barn on that it's just starting to be seen in some of these very heavily populated countries like India, China, Thailand."

Avian influenza and SARS have led to unprecedented collaboration between international medical and veterinary experts. The U.N. Food and Agriculture Organization (news - web sites), the World Health Organization (news - web sites) and the Paris-based World Organization for Animal Health have been working on ways to better trade information and expertise on dangerous animal diseases that can harm humans.

In the United States, human and animal health experts are combining their talents to fight emerging diseases. The CDC is working to merge surveillance systems of state diagnostic labs, veterinary labs, wildlife health agencies and zoos. Travel medicine clinics also can provide early warning for U.S. health officials, as doctors spot cases in Americans who travel abroad.

"People have said for a long time 'It's a global village' and it really, very much is," said Dr. Phyllis Kozarsky, director of the Travel Clinic of Emory University School of Medicine. "As people travel, so do microbes."

On the Net:

CDC info:

World Health Organization:

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Blow Fish Poison Makes Powerful Painkiller


Monday, May 17, 2004

MONDAY, May 17 (HealthDayNews) -- A drug made from blow fish poison is being tested to see if it can dull cancer pain.

Early results show the drug, Tectin, is well tolerated and can relieve cancer pain for up to two weeks in some patients, says a study presented recently at a joint meeting of the American Pain Society and the Canadian Pain Society in Vancouver, British Columbia.

The blow fish, also known as the puffer fish or Fugu, has long been a rather risky delicacy for dedicated sushi lovers. Only the most expert of sushi chefs prepare blow fish for customers, since consumption of the animal's natural toxin can cause paralysis and even death.

However, according to the Canadian team, blow fish toxin might someday become a source of safe, effective pain control. Almost three-quarters of cancer patients experienced good results from the toxin-based drug, said lead researcher Dr. Neil Hagan, of the University of Calgary.

Doctors now have embarked on follow-up trials of the drug. Interim results are expected in 2005.

The company that created Tectin, International Wex Technologies Inc., originally intended it for the treatment of drug withdrawal. But when researchers found it mainly helped by reducing pain, the company pursued testing for pain relief in cancer patients.

More information

The University of Wisconsin Medical School has more about cancer pain relief.

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Spending Soars for Kids' Behavior Drugs


By Linda A. Johnson

AP Business Writer

The Associated Press

Monday, May 17, 2004

TRENTON, N.J. - As more children pop pills for attention deficit and other behavior disorders, new figures show spending on those drugs has for the first time edged out the cost of antibiotics and asthma medications for kids.

A 49 percent rise in the use of attention deficit/hyperactivity disorder drugs by children under 5 in the last three years contributed to a 23 percent increase in usage for all children, according to an annual analysis of drug use trends by Medco Health Solutions Inc.

"Behavioral medicines have eclipsed the other categories this year," said Dr. Robert Epstein, Medco's chief medical officer. "It certainly reflects the concern of parents that their children do as well as they can."

Antibiotics still top the list of the most commonly used children's drugs, but parents are paying more for behavioral drugs, such as stimulants or antidepressants, according to the analysis of drug use among 300,000 children under 19.

Medco, the nation's largest prescription benefit manager, was to release the data culled from its customers' usage on Monday.

The most startling change was a 369 percent increase in spending on attention deficit drugs for children under five. That's in part because of the popularity of newer, long-acting medicines under patent, compared with twice-a-day Ritalin (news - web sites) and generic versions available for years.

But the use of other behavioral drugs also jumped in the last three years. Antidepressant use rose 21 percent and drugs for autism and other conduct disorders jumped 71 percent, compared to a 4.3 percent rise in antibiotics.

Epstein said 17 percent of total drug spending last year for the group of children under 19 was for behavioral medicines, compared with 16 percent each for antibiotics and asthma drugs, 11 percent for skin conditions and 6 percent for allergy medicines.

Use of such behavior medicines has been controversial, with some experts questioning whether parents and school officials are too eager to medicate disruptive children.

Some experts say no.

"It's not necessarily a bad thing that these medicines are being used more," said Dr. James McGough, associate professor of clinical psychiatry at the UCLA Neuropsychiatric Institute.

McGough said kids on attention deficit drugs tend to avoid substance abuse and other problems and do better in school.

However, McGough said increasing adolescent use of antidepressants is a concern, because there's little proof they work in young people and evidence they may increase suicidal tendencies.

Overall, 5.3 percent of children took some type of behavioral medicine in 2003, including 3.4 percent on attention deficit medicines and 2.3 percent on antidepressants, according to the study. Some children are on both types of drugs. That compares with 44 percent who used antibiotics at some point, 13 percent on asthma medicines and 11 percent who used allergy drugs.

Use of asthma medicines increased 15 percent from 2000 to 2003 and use of medicines for gastrointestinal problems jumped 28 percent, mainly due to new drugs for the stomach gas that gives babies colic.

Dr. Richard L. Gorman, director of the American Academy of Pediatrics' drugs committee, said while there may be "initial overprescribing" of attention deficit disorders, the children are typically taken off the drugs if they don't work.

"Either it's better and everyone's relieved, or nothing happens, the kid's still wild and then the parents say to the school, `We tried this stuff and it didn't work,'" he said.

New attention deficit drugs such as Strattera, Adderall and Concerta require only one morning dose, which helps keep children on an even keel all day and eliminates having to line up to get an afternoon dose from busy school nurses or day-care officials.

The side effects are mainly reduced appetite and growth.

Estimates of how many American children have attention deficit problems vary, from 3 percent to 10 percent. According to the National Center for Health Statistics, the number of children aged 3 to 17 with the disorder rose from 3.3 million in 1997 to 4.4 million in 2002.

Franklin Lakes, N.J.-based Medco said average monthly spending per member was still lowest for those 19 and under, $12.31 a month, compared with $125.58 for those 65 and older.

However, the average cost of a daily dose for one medicine was much higher for children than for senior citizens $2.12 per day versus $1.29 per day because many more generic drugs are available for conditions of the elderly.

On the Net:

Medco Health Solutions:

Centers for Disease Control and Prevention (news - web sites) site on ADHD:

National Resource Center on AD/HD:

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Migraines Can Be a Financial Headache



Monday, May 17, 2004

MONDAY, May 17 (HealthDayNews) -- Migraines can drain your pocketbook, says an article in the current issue of the American Journal of Managed Care.

Families with at least one person suffering from migraines spend about 70 percent more each year on medical costs than other families.

Even family members without migraines have higher medical costs when they live with a migraine sufferer, which could mean the illness contributes to unhealthy stress levels in the home.

The differences in cost remained the same even after taking into account other health conditions that might have affected migraine patients. The number of lost workdays, short-term disability days and worker's compensation claims were also higher in migraine families.

Households with a juvenile migraine sufferer averaged about $4,400 a year in additional health-care costs, while those with an adult sufferer averaged about $4,700 a year. When both a child and a parent were diagnosed with migraines, annual costs averaged about $6,900 higher.

More information

The National Institutes of Health (news - web sites) has more about migraines.

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Home Exercise Program May Not Improve Osteoarthritis


Reuters Health

Monday, May 17, 2004

NEW YORK (Reuters Health) - Doctors often advise people with osteoarthritis to keep a diary of their symptoms and to perform exercises at home, but neither of these approaches seemed to improve symptoms in a new study.

However, people who were advised to exercise were the most likely to be satisfied with their medical care.

The results of the study do not mean that people with arthritis should not exercise, the study's authors caution.

Dr. Maxime Dougados at Hopital Cochin in Paris and colleagues point out that regular exercise has other benefits, such as preventing obesity. The researchers also note that other studies have shown that exercise reduces arthritis pain and disability.

The study included nearly 3,000 people with osteoarthritis of the knee or hip. Participants were told to keep a weekly diary of their arthritis symptoms, to perform a series of exercises at home or both. Another group of participants did not keep a diary or perform the special exercises.

Everyone in the study was taking the anti-inflammatory drug rofecoxib.

At the end of the 24-week study, arthritis symptoms improved in all groups. In fact, there was no statistically significant difference between the groups.

Despite the lack of difference between the groups, patients who had performed the exercises, either with or without keeping a diary, were more likely to be satisfied that their rheumatologist had done the best job possible to improve their function than people who were not assigned to exercise therapy.

The results appear in the June issue of the journal Annals of the Rheumatic Diseases.

One difference between this study and earlier research is that most other studies of exercise therapy and arthritis included supervised, not at-home, exercise programs. Many of the participants in the current study did not meet the goals of the exercise program.

Another factor is that everyone in the study was taking an anti-inflammatory drug to treat their arthritis.

It may be possible to improve exercise programs by simplifying them, according to the report. For instance, people with arthritis could be encouraged to walk for exercise rather than to perform specific exercises.

Another option, the researchers suggest, is to increase the supervision of exercise by nurses or other therapists.

The study was funded by Merck Sharp & Dohme, Chibret, France.

Source: Annals of the Rheumatic Diseases, June 2004.

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Busy Consumers Eat on the Go


By Connie Farrow

Associated Press Writer

The Associated Press

Monday, May 17, 2004

SPRINGFIELD, Mo. - Angela Muggenburg eats a Sausage McGriddle on her way to work, and then drives through McDonald's again for a grilled chicken sandwich sans mayo and french fries for lunch while running errands. The busy mom is one among many Americans whose chaotic schedules have them picking up more than an occasional meal to eat by the glow of their dashboard lights.

The National Restaurant Association says a survey of more than 1,000 consumers showed 67 percent view convenience as critical.

Muggenburg, 34, realized just how often her Lexus RX300 was hitting the Golden Arches when a drive-through worker predicted her order before she could say a word.

"I just feel like I don't have a lot of time, so I look for things that are fast and easy," Muggenburg said.

McDonald's might want to consider making her its poster child. She is the counterpoint to Morgan Spurlock, the filmmaker who gained 25 pounds eating at McDonald's for a month.

Muggenburg has actually lost 25 pounds in the past five months by eating fast food. Her trick is avoiding the french fries and high-calorie condiments, paying attention to portions and being on the go with her kids.

The alarm rings at 6:15 a.m. on weekdays at the Muggenburg home in Ozark. The priority is getting 2-year-old Keaton and 6-year-old Bailey dressed and fed. She takes Bailey to school on her way to work, while husband Steve drops Keaton off at grandma's house.

Bailey has gymnastics two nights a week. Steve Muggenburg co-owns a heating and cooling business and often works six-day weeks.

"There are nights when we will just pick up a salad or something on the way home, and we'll bake chicken strips," she said.

Terry Egan, nutrition specialist with University Outreach and Extension in Springfield, said those who eat on the go should remember the "five a day" rule for fruits and vegetables. She suggests packing cherry tomatoes, baby carrots or precut vegetables into small plastic bags. Apples, oranges, bananas and grapes also are easy choices for busy lifestyles.

"The key to healthy dashboard dining is to focus on foods that provide a big nutritional punch with few calories from sugar and fat," she said.

She also advises against super-sizing meals and sodas.

"Americans are so obsessed with value," she said "The trouble is that when we spend that extra quarter to super-size our meals, we also super-size ourselves."

Molly Plate keeps milk, vegetables and a variety of fruits on hand. But her family turns to fast food so often that she refers to her car as "our dining room."

"My mother was a home ec teacher," she said. "I can cook, but that's just not me."

Plate teaches piano lessons in her Springfield home and cares for her 4-year-old daughter during the day, while her husband commutes some 20 miles to a utility company. Her boys ages 11 and 8 are involved in after-school sports and church activities. All the running leaves little time to plan meals, she said.

"The kids wanted tacos on Sunday," Plate said. "I figured by the time I went to the store and bought all the things to make them and then did the cooking it was just easier to go to Taco Bell."

Not everyone believes eating while driving is efficient, or that automakers put cup-holders in vehicles to make sure motorists have easy access to soft drinks.

A study released last June by AAA Foundation For Traffic Safety showed eating and drinking is the No. 1 distraction for motorists.

The average person spends about one hour and 15 minutes in a vehicle each day, and 4.6 percent of that time is used to eat or drink, the study showed.

"The trouble is that if you're eating a hamburger, you may glance down to unwrap it or even block part of your field of vision as you eat it," said Fairley Washington, foundation spokeswoman. "Drinks can spill."

New Jersey's legislature last year proposed a penalty for eating while driving as part of a bill outlawing handheld cellular phones. It was deleted, however, because lawmakers feared it would be impossible to enforce.

Mike McQuerter, a 32-year-old fire safety inspector who is on the Body For Life diet, said he couldn't get the diet's six suggested meals each day if he didn't nosh while driving across southwest Missouri to customers' businesses.

McQuerter's father died of a heart attack at age 43. He's so determined to maintain a healthy weight that he equipped his Atlas Security van with a George Foreman minigrill and a portable cooler.

Two meals consist of protein shakes. Lunch, however, is chicken or salmon. McQuerter cooks it in foil (to ease cleanup) while he's at a job site.

"You should see people's faces when they walk by my van and smell chicken cooking," McQuerter said.

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Blood Test Could Improve Ovarian Cancer Survival



Monday, May 17, 2004

LONDON, England (Reuters) - A simple blood test may help to improve survival rates for ovarian cancer by revealing which patients are likely to develop a resistance to chemotherapy drugs.

Professor Robert Brown, of Glasgow University in Scotland, told a cancer conference Monday that he and his colleagues found that the body can switch off genes that enable chemotherapy to kill cancer cells if the tumor reappears after initial treatment.

The blood test would enable doctors to identify patients who are likely to respond to additional treatment following a recurrence, or those who could benefit from soon-to-be tested drugs that are designed to turn the genetic switch back on.

"It is the first time this test has been used in this manner," Brown said in an interview.

"We're using it in ovarian cancer patients to look at mechanisms of how tumors become resistant to chemotherapy and to show associations with patient survival following chemotherapy."

Blood tests have been used in other types of cancer to detect the genetic changes, known as gene methylation, that can occur in tumors. Patients who do not acquire methlyation of a particular gene survive longer.

About 190,000 cases of ovarian cancer and 114,000 deaths occur each year. Eastern Europe, Scandinavia, the United States and Canada have the highest rates of the disease, according to the International Agency for Research on Cancer (IARC) in Lyon, France.

The five-year survival rate is about 40 percent because the illness is often not diagnosed before it has spread.

In early results from 500 ovarian cancer patients in an international trial of the test, Brown and his team found signs of gene methylation.

"We are seeing acquisition of this mechanism that switches genes off, and secondly that acquisition of the mechanism that switches genes off is associated with poorer survival in the patients," said Brown, a molecular biologist who presented his findings at a meeting of senior researchers at the charity Cancer Research UK in Harrogate, northern England.

He added that it is important to identify patients who could benefit from new drugs, known as demethylating agents, which would be given in conjunction with chemotherapy after a relapse.

"By switching these genes back will sensitise the tumors to chemotherapy," said Brown.

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Worrying About Health Costs Raises Death Rate

By Ed Edelson
HealthDay Reporter


Monday, May 17, 2004

MONDAY, May 17 (HealthDayNews) -- Worrying about the cost of medical care appears to increase the risk of dying after a cardiac procedure, a study finds.

People who answered "yes" when asked, "Have your medical costs been an economic burden over the past year?" were much more likely to die in the 12 months after angioplasty to open heart arteries or bypass surgery, said a May 16 report at an American Heart Association (news - web sites) scientific forum in Washington, D.C.

There have been "lots of other studies" showing that money and socioeconomic status have a strong influence on medical results, said report presenter Carole J. Decker, project manager of cardiovascular outcomes at the Mid America Heart Institute of Saint Luke's Hospital in Kansas City, Mo.

But this is the first study to ask the question about a patient's attitude toward medical costs, she said.

More than a quarter of the 2,097 patients asked the question described themselves as "slightly" to "severely" burdened, Decker said.

The one-year death rate for those people was 5.9 percent, compared to 3.5 percent for those who described themselves as unburdened, she said.

There was the inevitable correlation between economic status and poor outcomes that has been found in many other studies, Decker said, but also some surprises.

"For the most part, patients who had lower incomes reported themselves as burdened," she said. "But one patient had an income over $100,000 a year and said his medical costs were a burden."

Another part of the study not reported at the meeting found generally poorer outcomes in terms of frequency of symptoms and self-reported physical limitations among patients who described themselves as worried about medical costs, Decker said.

A next step in the study will be to get a clearer picture of the link between attitude toward medical costs and health, she said. Perhaps worries about money prevented people from seeking medical care or from taking medications they needed, she noted. Overall, the patients with money worries were in poorer health and more likely to have conditions such as diabetes, congestive heart failure and high blood pressure.

More studies at other hospitals are needed to verify the results, Decker added. If the relationship holds up, it could help identify patients who need special help, such as social services or more aggressive action by their doctors.

"We also need to better understand what the actual burden is," she said. "Is it medication, transportation to health care, time away from work? Only then can society take steps to decrease the burden and possibly impact these patients survival."

More information

A government report about socioeconomic effects on medicine is available from the U.S. Department of Health and Human Services. Meanwhile, the American Heart Association has several pages on a healthier heart lifestyle.

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Sunday, May 16, 2004


A New Look to Heart Failure Treatment


By Randy Dotinga
HealthDay Reporter


Sunday, May 16, 2004

SUNDAY, May 16 (HealthDayNews) -- In an unusual strategy in the battle against one of America's leading killers, cardiologists are turning to experimental operations that aim to treat heart failure by reshaping ailing hearts into stronger organs.

The procedure isn't for everyone, and experts say it may only help a small percentage of heart failure patients. But considering that an estimated 300,000 Americans die of heart failure or related complications each year, any change in the death rate could lead to survival for thousands.

"This is now a new tool in the armamentarium of treating end-stage heart disease," said Dr. John Conte, director of heart and lung transplantation at Johns Hopkins University, which has been testing the operation. "I think it's something we'll do more and more as time goes on."

While it doesn't get as much attention as heart attacks, heart failure is a major health problem in the United States, striking an estimated 550,000 people each year. Patients typically develop heart failure while suffering from clogged arteries that prevent proper blood flow in and out of the heart.

Normally, the heart is small and elliptical, like an acorn. But as stress on the heart goes up, it becomes larger and more rounded, Conte said.

As the heart begins to fail, the circulatory system ceases its effective distribution of blood throughout the body. "Most commonly, people will develop fluid overload and shortness of breath with fluid in the lungs, fluid in the legs," Conte said. "Actually it's an insidious process you don't notice, depending on how bad your heart is, until a certain point."

Cardiologists treat heart failure with a variety of approaches, including drugs and heart transplants. But transplants aren't the panacea they may seem, Conte said.

Artificial hearts are far from being ready for prime time, while the number of available human hearts is limited to about 3,000 a year. The elderly, in fact, may be entirely out of luck.

"Certainly no one's going to transplant someone in their 80s, and most won't transplant anyone in their 70s," Conte said.

The reshaping operations, which only appeared on the scene within the past few years, are geared to help the neediest patients. Surgeons at several U.S. hospitals are testing the procedure.

Using a patient's height and weight measurements, the surgeons calculate how big the heart should be and try to form it into a football shape, rather than the damaged volleyball appearance. Some cardiologists insert mannequin-like devices into the heart and use them as guides during the reshaping procedure, said Dr. John D. Puskas, an associate professor of surgery at Emory University. In other cases, cardiologists eyeball the heart and use their own judgment about how best to return the heart to its proper shape, he said.

Often, cardiologists must cut away dead tissue to change the heart's shape. "This is a relatively new area and the techniques are evolving," Puskas said. "The results differ between different groups [of surgeons] with different levels of experience."

"By reshaping the heart and making it smaller without taking out tissue which is alive or viable, you're allowing the heart to perform much better with the same effort," said Dr. Eric Eichhorn, medical director of the Cardiopulmonary Research Science and Technology Institute in Dallas.

It's not clear how many patients will be helped by the new procedure. Conte estimated 10 percent, and Eichhorn said it may be lower. Even so, the number of heart-failure cases is on the rise as the average age of Americans goes up.

"If you added up breast, colon, lung and pancreatic cancer combined, they don't equal the number who will die from heart failure this year," Conte said. "It doesn't get as much press as cancer, but certainly it's a far greater health-care problem."

Even those who live with the health threat often suffer from "miserable" lives of congestive heart disease and shortened breath, Puskas said. "This [reshaping technique] is a response to try to offer a therapy for people who really don't have an alternative."

More information

Learn more about heart failure from the American Heart Association and the National Heart, Lung, and Blood Institute.

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