FRIDAY, SEPTEMBER 13, 2002  

1. Gymnastics Strengthens Girls' Bones: Study
2. Advocates Argue Over Genetic Privacy
3. Artificial Heart Patient Celebrates Anniversary
4. Court: Drug Discrepancies Overlooked
5. Chemical Contents of 'Glow Sticks' Appear Non-Toxic
6. Red Clover Can Help Hot Flashes
7. Getting Drugs a Struggle for Safety Net Providers
8. Hey, Doc, My Wrist Hurts!
9. Take Time to Relax, Bank Tells Bosses
10. Migraines a Pain For Kids, Too
11. Fifty Percent of Stalkers Are Ex-Partners
12. Hospitals No Less Safe on Weekends
13. Twins Born to Older Moms at No Greater Health Risk
14. Survey Finds 'Denial Gap' on Drug Abuse
15. Class Action Denied in Rezulin Suit Against Pfizer
16. Young Widowers at High Suicide Risk
17. Bike Handlebars Can Injure Kids' Internal Organs
18. Travel Can Trigger Asthma Symptoms
19. Pig Farmers Found to Carry Swine Flu Virus
20. Child-Resistant Packaging on Aspirin Works: Study
21. Cutting Copper to Combat Cancer
22. Miniature Genetic Test Set to Give Quick Results
23. Internet Sold Cipro, Questionable Anthrax Info
24. Tailored Education Helps Autistic Kids Mainstream
    
    THURSDAY, SEPTEMBER 12, 2002  
    
    
25. Experts Outline Cancer, Diet Evidence
26. Body Piercing Plus Heart Defect May Spell Trouble
27. Deaths Prompt FDA Dialysis Warning
28. HRT May Not Interfere with Mammograms: Study
29. Study Looks at Hormone-Cancer Link
30. TV Viewing Time Linked to Kids' Behavior Problems
31. An Unhappy Christmas Story
32. Plaque-Forming Enzyme Rises in Alzheimer's Brains
33. Hey, Don't Just Stand There!
34. Normal Breast Cancer Gene Type Is DNA Fixer: Study
35. Parkinson's Disease Scrambles Brain's Switchboard
36. Genes Key to Stem Cells' 'Stemness' Identified
37. Gene Therapy Creates Natural Pacemaker
38. More Women Getting Adequate Folic Acid: CDC
39. Motorcycle Helmets Save More Than Lives
40. Peanut Allergy from Playing Cards a Losing Hand
41. Tamoxifen Study Raises Risk-Benefit Questions
42. FDA Offers Guidance on Livestock Antibiotic Safety
43. Ex-FDA Consultant Says Agency Too Tight With Drug Companies
44. Ibuprofen Syrup Helps Kids with Hip Inflammation
45. Clot-Busting Drugs Save Heart Attack Victims
46. 'Big Picture' Health Improvements for Americans
47. Gulf War Illness Not Stress-Linked
48. Nonsmokers Respond Better to Crohn's Disease Drug
49. Pregnancy Hormone Levels May Affect Coffee Craving
50. Prostate Cancer Therapies About Equal
    
    WEDNESDAY, SEPTEMBER 11, 2002
    
    
51. One a day may protect infants from cancer
52. Many Sex Offenders Had Bad Fathering During Youth
53. CPR of Hospital Patients Rarely Successful: Report
54. Flaxseed May Cut Cholesterol Slightly in Women
55. Animal Drug Guidelines Proposed
56. Vitamins C, E May Prevent Artery Damage: Study
57. AIDS Virus Lurks in Fat Cells, French Study Finds
58. Anthrax Treatment in Development by Dutch Firm
59. Overuse of Anthrax Drug May Prove Deadly: Scientist
60. Regular Exercise Tied to Longer Menstrual Cycles
61. 'Biological Pacemaker' Created
62. Early Surgery Shown to Cut Prostate Cancer Deaths
63. Many Italians Have Unhealthy Habits: Survey
64. Smoking Up Among Firefighters Since 9/11 
65. Gene in Rare Disorder May Boost, Cut Cancer Risk
66. Depression Screening Day Set
67. Blood Pressure Test May Signal Diabetic Kidney Risk
68. About Fetal Ultrasound
69. Sell 'Morning-After' Pill over the Counter: Expert
70. Kidneys Are Incredible
    
    TUESDAY, SEPTEMBER 10, 2002
    
    
71. British Scientists Develop Quick Test for TB
72. Plant Compounds Keep Disease Away: Study
73. Woman's Dislodged Filling Causes Cluster Headaches
74. Acupuncture as Stroke Medicine?
75. Even Cooked Sausages Can Harbor Salmonella
76. Mixed Reviews for Medical Reporting
77. Correcting Infant Vision Can Stop Further Problems
78. Genetic defects found in cloned animals
79. Routine Smallpox Vaccine Risky for Eczema Patients
80. Surgery Best for Carpal Tunnel
81. Record Number of Japanese Live to 100 or More
82. Tea for Two
83. HRT, Drinking Milk Tied to Cancer Hormone in Women
84. Teens Who Eat Less Meat No Healthier Than Others
85. Use of Drug Khat Up in Some Cities
86. Vaginal Infections Linked to Preterm Birth
87. Study Bursts Nicotine Gum's Bubble
88. Tissue-Seeking Molecules Could Be Drug Vehicle
    
    MONDAY, SEPTEMBER 9, 2002
    
    
89. Experts Discuss Better Germ Control
90. Gene-Altered Follicles Grow Glowing Green Hair
91. Doctors Freezing Away Tumors
92. Drugged Out
93. Weight-Surgery Death Sparks Debate
94. Mouse Study Gives Clues to Nicotine-SIDS Link
95. Late Artery-Clearing Procedure May Not Help
96. Docs Use Varying Criteria to Determine Brain Death
97. Test Quickly IDs Fetal Heart Rhythm Abnormalities
98. Anger, Stress Can Trigger Irregular Heartbeat
99. Gender Impacts HIV Blood Levels, Report Says
100. Dogs, Day Care Linked to Kids' Ulcer Bug Risk
101. Vitamin E May Help Keep Arteries Clear in Women
102. Obesity Threatens to Reverse Gains in Longevity
     
     SUNDAY, SEPTEMBER 8, 2002
     
     
103. AbioCor Heart Patient Nears a Year
104. FDA Calls Botox Ads Misleading, Asks for Fix
105. Check Your Cholesterol
106. Heartburn Woes
107. Hundreds Get Radiation Pills
     
     SATURDAY, SEPTEMBER 7, 2002
     
     
108. Don't Have a Beef With Your Teens
109. Fighting Foot Ulcers

FRIDAY, SEPTEMBER 13, 2002

Gymnastics Strengthens Girls' Bones: Study

Reuters Health

Friday, September 13, 2002

NEW YORK (Reuters Health) - Supporting the notion that weight-bearing exercise throughout life can cut the risk of brittle bones later on, a small study shows that young female gymnasts build bone mass at a higher-than-average rate.

Researchers found that girls in competitive gymnastics gained more bone density over 3 years than their non-gymnast peers did. They also put on more lean body mass, which comes mainly in the form of muscle.

Higher-than-average bone mass has also been found in adult gymnasts, and the new findings suggest they may owe this to gains made throughout childhood and adolescence, according to the study authors.

More importantly, such early accumulation of bone density may protect against fractures later in life, they reported in a recent issue of the Journal of Pediatrics.

In the US, it is estimated that half of women older than 50 will sustain a fracture due to the brittle-bone disease osteoporosis. Experts believe that one way to prevent osteoporosis is to build bone mass at a young age through regular exercise, particularly so-called "high-load" activities that put more pressure on the bones to work. Gymnastics is one such activity.

In the new study, Emma M. Laing of the University of Georgia, Athens, and her colleagues followed 7 female gymnasts and 10 non-gymnasts over 3 years. At the start of the study, girls in both groups were around 11 years old, on average, and were of a similar weight and height overall. The non-gymnasts were active in other ways, with some regularly participating in basketball, softball, soccer or tennis.

The gymnasts, however, had a higher bone density in the hip, lower spine and thigh, as well as a lower percentage of body fat. And over the 3 years, gymnasts accumulated bone density in several areas at a higher rate than the other girls.

There was no difference between the groups in calcium intake, another important factor in bone mass, the researchers note.

They also point out that previous studies have suggested that female gymnasts have a higher-than-average bone density despite the fact that zealous dieting, delayed growth and irregular menstruation--all of which can signal trouble for the bones--are problems in the sport.

Laing and colleagues suggest that gymnasts' greater accumulation of muscle, which exerts a force on bone during contraction, may explain their sturdier bones.

Source: Journal of Pediatrics 2002;141:211-216.

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Advocates Argue Over Genetic Privacy

By Jesse J. Holland

Associated Press Writer

The Associated Press

Friday, September 13, 2002

WASHINGTON (AP) - As scientists make daily advances with the human genetic code, Congress should act now to prevent Americans from facing genetic discrimination from employers and insurers, privacy advocates say.

Genetic research could make it possible to identify an individual's lifetime risk of cancer, heart attack and other diseases.

But that same information also could be used by employers for hiring, firing or promotions, or by insurance companies to determine how much to charge for their services or to deny coverage completely, privacy advocates said Thursday.

But health and insurance advocates say there is no proof that anyone would do this, and lawmakers would be moving far ahead of reality by banning the use of genetic information.

"There is a difference between the perception of how medical information is used and reality," said Dr. John Rowe, chairman and CEO of Aetna Inc., which sells health insurance. "The record does not appear to include any identifiable cases in which people have been discriminated against in health insurance because of genetic information."

Rep. Steve Chabot ( news, bio, voting record), R-Ohio, chairman of the House Judiciary subcommittee on the Constitution, acknowledged that discrimination based on genetic information is "highly speculative."

But "if an employer could access information about an individual's susceptibility to disease, that employer might misuse the data to avoid expenses associated with absenteeism, health benefits and risky occupational exposures," he said.

Thirty-one states already have laws against genetic discrimination in the workplace, and 41 states have laws against insurers using genetic information to discriminate, Chabot said.

There's no telling what would happen if patients lose control of their genetic information, said Dr. Deborah Peel of Austin, Texas, representing the American Psychoanalytic Association.

Using a woman going through a divorce as an example, "should the risk of her having breast cancer ( news - web sites) or a mental disorder in the future keep her from having custody of her children?" Peel said. After the divorce, "should genetic testing of the children be used to assess their potential health problems and alter the amount of financial support their mother receives?"

And later, when she needs somewhere to live, "should a mortgage company be allowed to access the results of her genetic testing to assess her life expectancy before deciding to offer a loan?" she asked.

The answer is a federal law that would require people's permission before genetic information is released, said Joanne Hustead, lawyer for the Health Privacy Project and professor at Georgetown University's Institute for Health Care Research and Policy.

Politicians should be especially concerned about how available genetic information is to businesses and the public, because that information could easily be used against them in public elections, Peel said.

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Artificial Heart Patient Celebrates Anniversary

By Susan Nadeau

Reuters

Friday, September 13, 2002

CHICAGO (Reuters) - For Thomas Christerson, the only person living with a self-contained artificial heart, just "taking it easy" is really living.

"I get up, go to coffee, then I come back and just do whatever," he said. "It's so much easier to live, to breathe," he added. "I'm living through great things in life."

Christerson, 71, on Friday celebrated the first anniversary of his new heart. He is the only surviving patient of seven who have had the heart replacement surgery.

The mechanical heart, called AbioCor and 20 years in development by Abiomed Inc. of Danvers, Massachusetts, gave Christerson not only a chest full of titanium and plastic but a new lease on life and a certain place in history.

"I might have been dead by now. I would have," Christerson said in an interview taped last week by the hospital where the surgery was performed. "I'm no hero. I just want to live."

Christerson looked healthy and was in good spirits as he celebrated on Friday, eating cake and ice cream with the doctors and nurses at Jewish Hospital in Louisville, Kentucky. He spent months there recovering after the ground-breaking procedure.

Heavy Heart That Whirs

The AbioCor heart is battery-operated and must be recharged often, makes a constant whirring sound, weighs four times as much as a normal heart and is the size of a grapefruit. Yet for all of the inconveniences, it has kept Christerson alive for a year, which meant countless hours with loved ones and the chance to cuddle his first great-grandchild and namesake, Ellen Thomas.

"I didn't have any idea it would last this long. I thought it would give me another 6 months. But I got a year so far," Christerson said in another interview made public by Jewish Hospital. "I'm tickled to death with it."

In the last year Christerson had his share of hurdles--including a fever of 107 degrees Fahrenheit that threatened to push his other organs into failure--but he survived milestone after milestone.

Dr. Robert Dowling, one of the surgeons who performed the surgery, was clearly moved on Friday, calling the accomplishment "mind-boggling."

"This is a huge milestone not only for Tom but for medicine in general," he added.

Others Not As Lucky

Still, six other patients died after receiving the fully implanted heart, some shortly after surgery, with the other longest survivor living nearly 10 months.

The US Food and Drug Administration ( news - web sites) has granted Abiomed permission to implant a total of 15 replacement hearts as part of the initial human trial, but finding the appropriate patients has proven difficult.

The AbioCor is too large to fit in the chests of many men and most women, though a smaller version is expected to enter trials in 2004. Just to be considered for the experimental surgery, patients must be in late-stage heart failure, must have exhausted all other treatment options, and must be nearly certain to die within 30 days. That makes tolerating the necessary drugs or even the surgery itself next to impossible.

"I think you have to realize that everything we are doing is a new experience for all of us, and we are all learning," said Dr. Laman Gray Jr., another of Christerson's surgeons.

While the AbioCor is not approved in this trial to take the place of a human heart transplant, in the long run, the company's goal is to make it another viable option.

Some 50,000 Americans could benefit from a heart transplant, but only about 2,000 donor hearts become available each year. About 3,000 to 5,000 people are on waiting lists at any given time. In addition, an estimated 5 million Americans suffer from some stage of heart failure.

"What this opens up for the future is to have people who currently have no therapy, go and be treated with a support device, and get out and live normal lives, and get out and do what they want to do for a prolonged period of time," Gray said.

The events of the past year have had a profound effect on Christerson and his family, as well as his small Kentucky town of Central City. Last April, people lined the streets to welcome him as he was brought home in a fire engine, sirens blaring.

"The second chance on life has been an awakening for all of us," said Christerson's daughter, Patti Pryor. "It has given us time to gather together and have special moments."

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Court: Drug Discrepancies Overlooked

By Josh Freed

Associated Press Writer

The Associated Press

Friday, September 13, 2002

KANSAS CITY, Mo. (AP) - A drug company salesman decided not to bother investigating discrepancies connected with a pharmacist later found to have diluted drugs prescribed to cancer patients, according to court documents released Thursday.

"I decided that I'm tired of monkeying around with missing data and having to find it and all of this," Eli Lilly & Co. salesman Darryl Ashley said in a deposition.

Ashley said he made "a conscious decision" to spend his time telling doctors about Lilly's drugs, "not to go around and try to find invoices, not to find who's doing what."

The deposition was among a foot-thick stack of documents unsealed by a judge Thursday in litigation against Lilly and Bristol-Myers Squibb. Information contained in most of the other documents had already been released in one form or another.

"We actually are happy now to have our documents out so the public can see that in fact there is not one single piece of evidence that Lilly knew about Courtney's actions," Lilly attorney Marie Woodbury said Thursday.

Several hundred cancer patients have sued the companies, which they claim knew or should have known that Robert Courtney was diluting their medications. One of the suits is scheduled to go to trial Oct. 7.

Courtney pleaded guilty in February to charges of diluting cancer medications at a pharmacy he owned. He awaits sentencing.

Court documents show that in 1998, Lilly and Bristol-Myers Squibb noticed discrepancies between the amount of drugs sold to Courtney and the amount of drugs prescribed to cancer patients.

The drug companies say the discrepancy was just a problem with the collection of drug sales data.

Ashley said he did not confront Courtney about the discrepancy because he had avoided dealing with the pharmacist, whom he considered unethical. Ashley said Courtney had lied to him to get prices he then used to negotiate with another company, according to an earlier motion filed by the plaintiffs.

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Chemical Contents of 'Glow Sticks' Appear Non-Toxic

Reuters Health

Friday, September 13, 2002

NEW YORK (Reuters Health) - Children or adults who inadvertently ingest or otherwise come in contact with the glow-in-the-dark chemicals inside "glow sticks" or "light sticks" are not likely to be harmed, according to two doctors at the New York City Poison Control Center.

Although the material inside the glowing plastic rods, which are also sold as jewelry and are popular at festivals, sporting events and dance parties, is typically considered to be minimally toxic or non-toxic, there is a dearth of scientific evidence to support this view.

To investigate, Drs. Robert J. Hoffman and Lewis S. Nelson evaluated reports of pediatric and young adult exposure to the chemiluminescent products at their poison control center between January 2000 and April 2001. Their findings are published in the September issue of the Archives of Pediatrics and Adolescent Medicine.

During that time, 118 cases were reported: 108 included ingestion, 9 involved eye exposure, and 1 case involved skin exposure. Most exposures were among kids under age 13, but the group included 18 teens and 4 young adults between the ages of 18 and 25.

In all, only 27 patients exposed to an open container that leaked the glowing chemicals developed symptoms, which included irritation at the site of exposure. Four of the children experienced other symptoms such as nausea, vomiting and an impaired ability to taste.

A total of 12 reported swallowing intact glow sticks but none reported symptoms when they visited the poison control center or when contacted later. Also, no patient in the study required laboratory evaluation or hospital admission, the researchers add.

"Although we cannot declare that exposure to chemiluminescent products is free of potentially serious consequences, our data demonstrate that reported exposure to such products is unlikely to result in significant morbidity or mortality," the authors conclude.

Source:: Archives of Pediatrics and Adolescent Medicine 2002;156:901-904.

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Red Clover Can Help Hot Flashes

HealthScoutNews

Friday, September 13, 2002

FRIDAY, Sept. 13 (HealthScoutNews) -- A dietary supplement made from red clover provides relief for women with hot flashes, claims a new study.

Promensil, a standardized red clover supplement, reduces the frequency and severity of hot flashes, say the research, which appears in the current issue of The Female Patient.

The study found that 40 milligrams a day of Promensil reduced hot flashes by 48.5 percent, while a placebo offered a 10.5 percent reduction.

The study included 30 healthy, non-vegetarian women who had been post-menopausal for more than a year. None of them had used hormone replacement therapy (HRT), soy or other estrogen-active plant products for at least 16 weeks.

Non-vegetarian women were used in the study to avoid potential biasing. Vegetarian women eat more soy and legumes, which contain isoflavones that help control hot flashes.

"This study demonstrates that dietary supplementation with red-clover derived isoflavones is an effective alternative for symptomatic relief of vasomotor symptoms in post-menopausal women, reducing both the average daily frequency and severity of hot flushes," says study author Dr. Arturo Jeri, director of the climacteric unit at the Institute of Gynaecology and Reproduction in Peru.

More information

Here's more on red clover.

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Getting Drugs a Struggle for Safety Net Providers

By Karen Pallarito

Reuters Health

Friday, September 13, 2002

NEW YORK (Reuters Health) - In large cities across America, "safety net" providers are leaning heavily on free samples and manufacturer-sponsored charity programs to get the prescription drugs that patients need, a new study finds.

Even with those options, community health centers (CHCs) and others that provide care to the uninsured find that obtaining necessary medications for their patients remains a struggle, researchers report in the September/October issue of the journal Health Affairs.

"The way that the uninsured are getting access to pharmaceuticals is extremely patchwork and full of potential holes," said Suzanne Felt-Lisk, lead author of the study and senior health researcher at Mathematica Policy Research in Washington. "Given the critical nature of pharmaceuticals to health, we ought to have a better way of doing that."

Providers in the five-city study complained that the process of qualifying patients for drugmakers' charity programs is administratively "cumbersome" and that those programs generally limit the amount of medication provided to a 1- to 3-month supply before requiring additional documentation.

Safety-net hospitals "are increasingly dependent on pharmaceutical company patient assistance programs," agreed Ted Slafsky, director of the Public Hospital Pharmacy Coalition in Washington. While the programs are "often very helpful," they typically require a tremendous amount of paperwork and are very difficult to access, he said.

Felt-Lisk and colleagues at Mathematica and the Urban Institute Health Policy Center initially set out to examine changes in safety-net providers' capacity to serve uninsured, low-income patients in their communities. "And pharmaceuticals just kept popping up as an issue," she said.

"People over and over said it's not enough to even have access to see the doctor.... If you can't get the medication to help your condition, you're not even halfway there," she told Reuters Health.

Through telephone interviews and site visits, the research team gleaned some of the ways that safety-net providers lay their hands on outpatient medications or funding for pharmaceuticals and the stumbling blocks encountered along the way.

Almost all providers indicated that they rely heavily on pharmaceutical assistance programs, and many said they take advantage of free samples. "One provider noted that his son in private practice sends all samples he receives to a CHC in Kansas City," the research team writes.

Another source of funding for outpatient drugs is the federal 340B program. Named for a section of the Public Health Service Act, it requires pharmaceutical manufacturers, as a condition of participation in the Medicaid program, to provide discounts on drugs purchased by public hospitals and clinics. Several providers in the study said they rely on grants and government assistance to buy drugs for their patients.

To keep costs down, many said they prescribe older medications and generics. Some safety-net providers worried that patients were going without needed medicines or using drugs sparingly. Others said their patients take "suboptimal" medications for cost reasons.

Unable to compete with the more generous salaries offered in the private sector, several safety-net providers also reported difficulty recruiting pharmacists. A CHC in Detroit temporarily closed its pharmacy until it could fill the post.

Felt-Lisk and colleagues worry about the long-term implications of providers' heavy reliance on drugmakers' voluntary prescription assistance programs. If market conditions turn up the financial heat on drugmakers, companies could decide to cut those programs, she said. "There's no legal obligations for them to be doing this."

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Hey, Doc, My Wrist Hurts!

HealthScoutNews

Friday, September 13, 2002

(HealthScoutNews) -- An old joke: "Hey, Doc, when I bend my wrist like this, it hurts." Doc: "Well, don't bend it like that!"

That's a simplistic -- but realistic -- answer to the question "How do I prevent Carpal Tunnel Syndrome?"

CTS, a painful, sometimes crippling result of too much repetitive stretching of tendons and ligaments in your wrist, has spurred an enormous amount of research over the past 25 years.

Government statistics show that complaints of CTS have increased rapidly since the 1980s.

According to the Bureau of Labor Statistics, "disorders associated with repeated trauma" account for about 60 percent of all occupational illnesses. Of these disorders, carpal tunnel syndrome is the condition most often reported.

Computer typists are probably most often associated with CTS. But butchers, dental hygienists, electronic assembly workers and cooks also are frequently treated for symptoms.

Since CTS is caused by repetitively making the same motions of the wrist, avoiding precisely the same motions time after time can help to ward off the problem.

Once it's been diagnosed, a broad assortment of treatments are available, ranging from medications to surgery.

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Take Time to Relax, Bank Tells Bosses

Reuters

Friday, September 13, 2002

LONDON (Reuters) - Stressed British bosses should eat more fruit, drink more water and play squash with clients to resist the ravages of long working hours, Abbey National bank suggested on Thursday.

The recommendations, which also included cutting out chocolate and crisps and learning to delegate, were part of a 10-step plan the bank issued to help bosses relax and improve their health.

The move followed a survey that found 56% of bosses felt stress was making their personal or family life difficult, while more than 1 in 10 said their health was deteriorating.

"We found that senior staff often work 70-hour weeks and are then too stressed to unwind properly. This is taking a heavy toll--our work is being put before our health," said Gary Hockey-Morley, director of Abbey National business.

Only 1% of top staff take regular exercise and 58% feel the best way to relax is to eat out, the survey of 500 companies with up to 250 employees found.

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Migraines a Pain For Kids, Too

HealthScoutNews

Friday, September 13, 2002

(HealthScoutNews) -- A surprising number of children -- more than eight million, or 15 percent of all children by age 15 -- suffer from migraine headaches, according to the American Medical Association.

For many, these severe headaches often stop as their young sufferers grow into adulthood. But they often return in middle age.

Before puberty, migraines hit boys as often as they do girls. But as with adults, girls are the main victims among adolescents. And 70 percent of all youthful sufferers have a family history of migraines.

Physicians believe the cause of migraines is the same in children and adults, but the former often exhibit different symptoms. Lacking is the visual aura adults often report. Most common symptoms among kids include nausea and vomiting, diarrhea, increased urination, sweating, thirst, and swelling and tearing.

Children often stop having migraines within a year, even without treatment. But to reduce their impact, doctors usually recommend maintaining regular bedtime and mealtime schedules. Also important, doctors say, is identifying and avoiding the "triggers" that spur a migraine's onset.

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Fifty Percent of Stalkers Are Ex-Partners

Reuters

Friday, September 13, 2002

LEICESTER (Reuters) - Fifty percent of stalkers are former partners who harbor a bitterness or hatred for their victims and are likely to use violence and threats, a British psychologist said on Thursday.

They tend to be hostile, hot-headed and impulsive and may recruit friends and families in their campaign, Dr. Lorraine Sheridan said in a report presented at a science conference.

The professor of psychology at the University of Leicester in central England compiled personality profiles of stalkers, who fall into four types, for law enforcement officials after studying 124 stalking cases.

"It can help investigators to prioritize from the large number of potentially important factors present in any given case," she said in the report.

Sheridan found that 50% of stalkers are ex-partners, 18.5% are infatuated with their target, 15.3% are delusional and do not respond to reason or rejection, and 12.9% are sadistic and obsessed with their victim.

The popular perception of stalkers is of mentally ill people following celebrities, royalty or strangers. But research has shown that many stalkers know their victims.

Sheridan said the profiles are important because they can enable police and legal officials to understand the motivations behind various stalking activities.

"This is especially important given that the same behaviors may present different levels of danger when perpetrated by different stalker types," she explained.

An infatuated stalker and a sadistic stalker may both send flowers and letters to get information about their victims.

"However, the motivations for these acts differ markedly," Sheridan added.

A US study estimated that 8% of women and 2% of men have been stalked at some time during their lives.

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Hospitals No Less Safe on Weekends

HealthScoutNews

Friday, September 13, 2002

FRIDAY, Sept. 13 (HealthScoutNews) -- If you end up in a hospital intensive care unit (ICU) on a weekend, there's no need to worry about the level of care you'll receive because there are fewer hospital staff on duty.

Researchers at the University of Iowa and the Veterans Affairs Medical Center in Iowa City found the risk of death for people admitted to ICUs from Friday to Monday was 9 percent higher than the risk for people admitted from Tuesday to Thursday.

They also found the hospital stays of people admitted to the ICU Friday through Monday were about 4 percent longer than the hospital stays of people admitted mid-week.

However, those differences probably have more to do with the condition of the patients than with hospital staffing levels, the researchers say.

Their study, published in a recent issue of Medical Care, tracked 156,136 people admitted to 38 ICUs in 28 northeast Ohio-area hospitals from 1991 to 1997.

"It turned out that most of the differences were relatively small with respect to mortality and length of stay. We believe those differences were due to the acuity, or severity, of patients' illnesses, not to staffing," says study co-author Dr. Gary Rosenthal, a professor of internal medicine at the University of Iowa.

This finding challenges the results of a Canadian study published last year that said people were more at risk if they were admitted to hospital on a weekend.

More information

The Ohio Hospital Association has more on workforce issues.

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Twins Born to Older Moms at No Greater Health Risk

By Alison McCook

Reuters Health

Friday, September 13, 2002

NEW YORK (Reuters Health) - Although babies born to women at least 35 years old are at increased risk of certain complications of pregnancy, new study findings show that twins born to older mothers have no greater risk of health problems than those both to younger moms.

In fact, Dr. Jun Zhang of the National Institutes of Health ( news - web sites) and colleagues found that triplets actually fare better when born to older, rather than younger, mothers.

So why the paradox? Zhang told Reuters Health that the finding may relate less to the health effects of being older, and more to what older women do during pregnancy.

Zhang explained that most of the older women who give birth to triplets or twins do so because they relied on fertility treatments to become pregnant, such as assisted reproductive technology, or ovulation-inducing drugs. In contrast, most younger women who give birth to more than one baby at a time conceived spontaneously, Zhang noted.

People who use fertility treatments are "generally much better off" financially than those who conceive spontaneously, Zhang said, noting the cost of the treatment. As such, these older women may have better healthcare coverage, and receive better prenatal and neonatal care, the researcher noted.

"It is well known that high socioeconomic status is associated with low infant mortality. Therefore, it is not surprising that these women, in general, have a better pregnancy outcome," Zhang said.

The researchers base their findings on a review of information collected from 147,400 twin and 5,015 triplet pregnancies, all of which occurred between 1995 and 1997 in the US. Reporting in the recent issue of Fertility and Sterility, the authors also reviewed 3.7 million births of single babies during 1996.

The investigators specifically examined the risk of prematurity, low birth weight, and death of the fetus or the infant soon after the pregnancy.

Zhang and colleagues found that, indeed, as women age, the risk to single-born children increases. However, when the babies are born as twins, those belonging to older mothers are not more likely to develop complications than those born to younger mothers, and triplets born to older mothers actually fared better than those with young moms.

Other factors that could influence the health of multiple babies born to older mothers include the fact that babies conceived using fertility treatments are less likely than spontaneous multiples to be identical twins, which have a higher risk of birth complications, the authors note.

In an interview with Reuters Health, Zhang emphasized that these findings are not intended to promote fertility treatment. Although most multiple births in older women stem from these assistance techniques, most older women still give birth to single children, the researcher added. Most of these pregnancies occur spontaneously, and so do not have the benefits associated with fertility treatments, Zhang noted, which explains why single children born to older mothers have relatively high risks of complications.

"This leads to an important message to the public: The vast majority of pregnancies, even in older women, are singleton and conceived spontaneously. Therefore, if a woman has a choice, there is no good medical reason to delay childbearing," Zhang said.

Source: Fertility and Sterility 2002 September.

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Survey Finds 'Denial Gap' on Drug Abuse

By Felicity Stone
HealthScoutNews Reporter

HealthScoutNews

Friday, September 13, 2002

FRIDAY, Sept. 13 (HealthScoutNews) -- Millions of Americans habitually smoke pot, snort cocaine and swallow prescription drugs -- yet many of them deny they might be addicts in need of help.

So say the findings of a new U.S. government report on drug abuse, which finds a surprising number of people are unaware that they have a serious problem.

Based on a survey of 70,000 people, researchers at the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the Department of Health and Human Services ( news - web sites), concluded that an estimated 15.9 million Americans had used an illicit drug in the month before the survey questionnaire.

The results also indicate that around 4.6 million people who meet the criteria for needing treatment do not recognize they have a problem. This figure is significantly higher than previously thought.

Participants were asked questions concerning run-ins with the law, drunken driving, difficulties at school or work, as well as details of their drug use. Many users who said they'd encountered trouble in most areas still believed they were in control of their habit.

"We have a large and growing denial gap when it comes to drug abuse and dependency in this country," says John Walters, director of the White House National Drug Control Policy. "We have a responsibility -- as family members, employers, physicians, educators, religious leaders, neighbors, colleagues and friends -- to reach out to help these people."

SAMHSA's report, released to coincide with the kickoff for the 13th annual National Drug and Alcohol Addiction Recovery Month observance, also highlights the facts that roughly 11 percent of youth aged 12 to 17 and about 19 percent of young adults aged 18 to 25 used drugs in 2001.

SAMHSA Administrator Charles G. Curie says the prevalence of drug use and abuse is partly due to a drop in the amount of people who see certain substances, such as marijuana, as harmful.

Seventy-five percent of illicit drug users smoke marijuana. Of that, 56 percent use it exclusively and about 25 percent use it in combination with other drugs such as ecstasy, cocaine and the prescription painkiller OxyContin.

According to the survey, the perceived risk of lighting up once or twice a week decreased to 53.3 percent in 2001 from 56.4 percent in 2000. "Naturally, perceptions about whether marijuana is harmful or not influences someone's decision to initiate in the first place, especially among teenagers," Curie says.

Curie believes the ongoing campaigns to legalize marijuana are likely contributing to more laissez-faire attitudes. Efforts to portray the drug as harmless are misleading, he says. "The one message we'd like to convey out of this study is that marijuana is a dangerous drug, and we want to assure that if initiation does occur it doesn't occur in as early an age as we've been seeing."

The research supports SAMHSA's position, Curie says. "It continues to show that marijuana harms perception, distorts judgment, can lead to severe anxiety, and heavy use impairs young people's ability to retain information during their peak learning years."

Moreover, he says, adolescents who use marijuana are six times more likely to use other drugs in their early adulthood.

Even though drug users often resist help or shun advice, people close to them should never abandon their efforts to get them into treatment, Curie says. "When you talk to people in recovery and ask them what got them to the point of seeking help, there's usually two things they say: 'I got in trouble with the law,' or 'I had a friend or family member who kept on confronting me and never gave up on me.'"

What To Do

For more information on the harmful effects of different drugs, visit the National Institute on Drug Abuse. If you need help in finding a treatment program, go to the Substance Abuse and Mental Health Services Administration.

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Class Action Denied in Rezulin Suit Against Pfizer

Reuters

Friday, September 13, 2002

LOS ANGELES (Reuters) - A US judge on Thursday denied a nationwide class-action lawsuit against Pfizer Inc. over the diabetes drug Rezulin, which was withdrawn from the market, because the claims do not have enough in common, the company said on Thursday.

New York-based Pfizer has been hit with thousands of lawsuits alleging that Warner-Lambert, which Pfizer acquired in June 2000, failed to inform the public of the drug's health risks. Rezulin was supplied by Warner-Lambert.

Plaintiffs sought to combine into one case claims from around 2 million people who took Rezulin, which was withdrawn from the market in March 2000 after about a hundred people taking the drug either died from acute liver failure or had to have liver transplants.

Judge Lewis Kaplan of the US Southern District of New York ruled that the claims did not meet federal standards of commonality necessary for class certification, Pfizer said.

The ruling applies to certain Federal lawsuits transferred since June 2000 into a single multi-district litigation that now involves more than 4,000 patients.

The judge found that controlled clinical studies of Rezulin demonstrate that the vast majority of patients who were treated with it tolerated the drug well and did not have elevated liver enzymes or liver injury, the company said.

The judge also rejected the plaintiffs' claims calling for medical monitoring of past Rezulin users.

In March, an Oklahoma jury ordered Pfizer to pay $11.55 million in damages to the family of a man who died after taking Rezulin, but the company said it would appeal the verdict.

In January, a Texas jury ordered Pfizer to pay $1.5 million in punitive damages and $23.46 million in compensatory damages to the family of a woman who died after taking Rezulin. The company is also appealing that verdict.

In December, the company settled two other lawsuits brought by Rezulin patients. One settlement came after a Texas jury awarded the plaintiff compensatory damages of $43 million.

According to the US Food and Drug Administration ( news - web sites), an estimated 1.9 million patients with diabetes were prescribed Rezulin, with fewer than 100 reporting acute liver failures that led to death or transplant, as of the drug's withdrawal from the market in March 2000.

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Young Widowers at High Suicide Risk

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Friday, September 13, 2002

FRIDAY, Sept. 13 (HealthScoutNews) -- The death of a wife hits young white men especially hard, raising their likelihood of suicide by 17 times, says a new study.

Young black men are also more likely to commit suicide after losing their wives, but women seem to adjust much better to widowhood, researchers found.

"If we add up all the young men, we're talking about a couple thousand men who would be at higher risk for suicide if they're recently widowed," says study co-author Jane Pearson, chairwoman of the National Institute of Mental Health's suicide research consortium. "Can we alert people who work with men in this situation? That's the question."

Suicide remains a major killer in the United States, more so than homicide. An estimated 28,000 people killed themselves in 2000, making suicide the 11th leading cause of death.

Men and women look at suicide differently, however. Men are less likely to make suicide attempts, but more likely to actually kill themselves. Women often try to commit suicide with drugs and are more frequently rescued, Pearson says.

In her study, Pearson and a colleague examined federal statistics about suicide from 1991-1996. The results appear in the September issue of the American Journal of Public Health.

White widowers aged 20 to 34 were 17 times more likely to commit suicide than their married counterparts, and black widowers were nine times more likely to kill themselves. Widows were much less likely to commit suicide.

The researchers report that as many as one in 400 black and white young widowers will die by suicide in any given year, compared with one in 9,000 American married men. The researchers estimate that at least one in 100 young widowers would try to commit suicide in the years after the loss of a wife.

Pearson suggests men may be less likely than women to seek help while suffering from bereavement and depression. Men are seen as "macho," she says. "They don't like to go to the doctor generally."

Studies also suggest women may do worse immediately after a spouse's death but recuperate better over time, Pearson says.

Daniel Romer, a suicide expert and research director for the Institute for Adolescent Risk Communication at the University of Pennsylvania, echoes Pearson's theories.

"Men seem to have more difficulty adjusting to loss of a spouse at any age," he says. "They are more prone to depression following spousal loss and this could be a factor. In addition, losing a spouse at an early age could be especially risky to young men because they are not seen as much by doctors and may find it uncomfortable to seek help for their depression. They are also more likely than older men to use drugs, and this might also increase the risk."

Both Pearson and Romer suggest that mental-health professionals should be aware of the special risks facing young widowers. Funeral directors and hospital workers could receive special training, Pearson says.

Counselors typically "try to get the person over the extreme unhappiness and desire to end his or her pain by thinking more positively about the future," Romer says.

What To Do

For suicide prevention resources, try the American Association of Suicidology, the American Foundation for Suicide Prevention or the National Center for Injury Prevention and Control.

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Bike Handlebars Can Injure Kids' Internal Organs

Reuters Health

Friday, September 13, 2002

NEW YORK (Reuters Health) - Bicycle handlebars may be behind hundreds of abdominal organ injuries in US children each year, according to new estimates.

Researchers say such injuries could be prevented by better awareness of the danger and better design of handlebars--which in an accident, they explain, can act as "blunt-ended spears."

According to their report in the September issue of the Archives of Pediatrics & Adolescent Medicine, in 1997 more than 1,100 US children and teens were hospitalized for bike-related injuries to their abdominal or pelvic organs. None of these accidents involved a car, and in most injuries, the bike handlebars were "likely" to blame, the researchers report.

Dr. Flaura K. Winston of the Children's Hospital of Philadelphia, in Pennsylvania, led the study.

The potential for bike handlebars to injure internal organs has been known for 30 years, the authors note. Reports have documented injuries to the intestines, liver, spleen, pancreas and abdominal wall, among other sites. But just how prevalent and serious the problem is in the US has been unclear.

To investigate, Winston's team looked at hospital records from 19 US states, estimating the percentage of abdominal and pelvic injuries associated with bike handlebars, as well as the cost of these injuries.

They estimate that in 1997, nearly 900 people aged 19 and younger were hospitalized for such handlebar injuries, at a cost of almost $10 million in hospital charges.

"These estimates indicate that handlebar-related injuries pose a serious health risk to children at a substantial healthcare cost," Winston and her colleagues write.

They point out that children's bikes typically have handlebars that are small in diameter, meaning they pack a concentrated force when they hit the torso. Handlebars are also often made from steel or aluminum tubing, and if the bar-end caps come off in an accident, the rider is exposed to bare metal.

The researchers suggest that safer handlebar designs that lessen the force of impact on the torso could reduce organ injuries. Giving children the proper bike size and type for their age and keeping the bike in good shape may also cut the risk of accidents, they note.

Winston has a patent pending for a new handlebar design.

Source:Archives of Pediatrics & Adolescent Medicine 2002;156:922-928.

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Travel Can Trigger Asthma Symptoms

HealthScoutNews

Friday, September 13, 2002

FRIDAY, Sept. 13 (HealthScoutNews) -- Travel may expand your mind, but it can be hazardous for your lungs.

A study in the September issue of Chest says travel is the main source of secondhand smoke for many adults with asthma. That exposure can lead to asthma symptoms and breathing problems.

The study by researchers at the University of California, San Francisco, included 374 nonsmoking adults with asthma who lived in California. That state prohibits smoking in the workplace and most other public places. That means travel is the main source of environmental tobacco exposure (ETS) for nonsmokers who don't live with a smoker, the study authors say.

They examined the prevalence and short-term health effects of ETS on the study subjects. That included symptoms attributed to ETS, respiratory problems, and extra use of inhalers experienced by the people when they traveled outside California within the previous year.

The study found 30 percent of the people reported ETS exposure when they traveled. The most common complaint was ETS-related coughing, wheezing or chest tightness.

"The health impact of intermittent ETS exposure during travel has not been previously examined," says study author Dr. Mark D. Eisner.

"As smoking has become quite restricted in California, ETS exposure during travel has become a more important source of exposure. Our findings tell us that this vulnerable group -- people with asthma -- were frequently exposed to ETS during travel. Those who were exposed had a high prevalence of sensory irritation symptoms and respiratory problems," Eisner says.

More information

Here are more tips on traveling and asthma.

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Pig Farmers Found to Carry Swine Flu Virus

Reuters Health

Friday, September 13, 2002

NEW YORK (Reuters Health) - Influenza viruses that normally infect pigs may infect pig farm workers much more often than has been thought, according to the results of a US study.

The finding is important because pigs could potentially serve as the "hosts" from which mutant flu strains with epidemic potential arise, the researchers point out.

Their study of pig farm workers and residents in Wisconsin found that 17 of 74 had antibodies to swine flu viruses in their blood, indicating they'd been infected. In contrast, only 1 of 114 blood samples taken from the general population harbored such antibodies.

This antibody rate "strongly" supports the theory that people involved in pig farming are infected with swine influenza more often than sporadic reports have suggested, according to a report in a recent issue of the journal Emerging Infectious Diseases.

The potential danger of species-jumping flu viruses became evident in Hong Kong during the 1997-1998 flu season, when six people died of a flu strain that had previously infected only birds. However, the authors of the new study note, it appears that bird-to-human transmission of these avian flu viruses is rare.

In contrast, Dr. Christopher W. Olsen and his colleagues explain, the species barrier between people and pigs "appears to be less stringent." What's more, the pig respiratory tract is receptive to both human and bird flu viruses, making the animal a potential "mixing vessel" in which a mutant human-bird flu virus might be created--and possibly transmitted to people.

To see how often pigs might pass flu viruses to humans, Olsen, a researcher at the University of Wisconsin-Madison, and his associates tested blood samples from pig farm owners, their families, their employees, their employees' spouses and farm veterinarians.

Compared with samples from the nearby urban population, people involved in pig farming were far more likely to have antibodies to swine influenza--particularly farm owners and their families, the report indicates.

Only 3 of the 17, however, had particularly high antibody levels to either of two swine flu viruses, and there was no sign that infection had made them--or their pigs--ill.

According to Olsen's team, it is unclear whether infection with a swine flu virus could produce an illness any different from the everyday flu. They say it would be "valuable" to test pig farm workers with flu symptoms to see if they, in fact, have a pig virus.

Moreover, they conclude, it may become "prudent" to monitor pig farm workers and residents as potential "sentinels" for the emergence of new flu strains.

Source:Emerging Infectious Diseases 2002;8:814-819.

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Child-Resistant Packaging on Aspirin Works: Study

By Alison McCook

Reuters Health

Friday, September 13, 2002

NEW YORK (Reuters Health) - Child-resistant packaging on aspirin bottles has reduced the rate of childhood deaths from aspirin poisoning by 34%, according to one US researcher.

That benefit translates into 90 lives saved between 1973 and 1990, writes Dr. Gregory B. Rodgers of the US Consumer Product Safety Commission ( news - web sites) in Washington, DC.

In the 1950s and 1960s, prior to the development of child-resistant packaging, around 120 children died each year from an overdose of aspirin--representing almost two thirds of all cases of fatal drug poisonings in children.

In response, bottles of aspirin and other toxic products started to be sold with packaging designed to be difficult for children to open, such as tops that need to pressed down and twisted simultaneously.

Although early reports suggested that the new packaging was saving lives, later studies began to question whether child-resistant (CR) packaging works.

To better inform the debate, Rodgers reviewed data on how many children under 5 years of age died from aspirin poisoning between 1958 and 1990. Using statistics, the researcher removed the influence of factors besides packaging that could influence death rates from aspirin poisoning, such as how much aspirin was produced, the changing awareness of parents about safety in the home, and improvements in emergency healthcare.

Reporting in the September issue of the Archives of Pediatrics and Adolescent Medicine, Rodgers found that child-resistant packaging on aspirin bottles, alone, may have reduced the risk of childhood poisoning from aspirin by 34% during the study period.

In an interview with Reuters Health, Rodgers cautioned that child-resistant packaging is not foolproof, and many children still die from aspirin poisoning. Parents or grandparents may leave off caps inadvertently, or may not store the bottles where they are out of reach of young hands. He added that the packaging may not be complicated enough to thwart all children.

"There are always some kids who are able to get into it," Rodgers said. "Child-resistant packaging isn't the whole answer, and it's not foolproof."

However, the current findings demonstrate that child-resistant packaging does deter many kids from ingesting aspirin, Rodgers noted. As such, perhaps other potentially toxic household products that don't have child-resistant packaging should consider adding it to help keep children safe, he added.

Source:Archives of Pediatrics and Adolescent Medicine 2002;156:929-933.

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Cutting Copper to Combat Cancer

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Friday, September 13, 2002

FRIDAY, Sept. 13 (HealthScoutNews) -- Researchers at the University of Michigan have unraveled some of the cellular mechanisms that explain why a particular drug is able to slow the growth of some cancerous tumors.

The drug, tetrathiomolybdate or TM, was originally developed to reduce excess copper levels in patients with Wilson's disease, a rare and potentially lethal genetic disorder.

Scientists had noticed in other research that blood vessels didn't grow well when copper levels were depleted.

Dr. Sofia D. Merajver, senior author of the study appearing in the current issue of Cancer Research, and her colleagues wondered if using the drug to lower copper levels in cancer patients would reduce the uncontrolled growth of blood vessels that fuel tumors.

"We surmised that perhaps the copper requirement for angiogenesis was higher than for very fundamental single cell processes that depend on copper," says Merajver, an associate professor of internal medicine and director of the University of Michigan Breast and Ovarian Cancer Risk Evaluation Program.

Angiogenesis refers to the growth of blood vessels, a normal and essential process. Uncontrolled angiogenesis, however, is an important factor contributing to the growth of cancerous tumors.

When the researchers gave TM to mice that had been programmed to develop cancer, no cancer growths appeared. In fact, lab mice given TM on a regular and long-term basis thrived, though their mammary glands harbored tiny cancers that were not acquiring blood vessels.

The next -- giant -- step was to see what would happen in humans.

"Nobody had intentionally made humans copper deficient. This wasn't a joke," Merajver says. "Here we were taking people walking and talking. It was not completely obvious that this was an OK thing to do."

But it soon became obvious. In 1997, Merajver opened clinical trials involving humans with end-stage cancer, people who had exhausted all other options. Among 42 patients, almost half (45 percent) experienced stabilization or some regression of their disease, an effect that lasted for six months or more. This was among a group of patients with a typical life expectancy of about three months. One patient from that trial is still alive and has been on TM for four years.

Throughout the last six years of research, Merajver and her colleagues have been searching for the magic "why." Why do low copper levels have this effect on tumors?

As it turns out, the explanation is deceptively simple. A master switch that controls many different molecules that promote angiogenesis and inflammation is inhibited by a copper deficient environment.

"It's a very efficient way to turn things off," Merajver explains. "It's a brand new concept that copper plays any role at all in the master switch. This was completely unknown."

The drug is unlikely to play a role in advanced cancer but could be promising for early stage cancer, she says.

"We are very excited about the practical applications and we are also very excited about perhaps opening the door to new avenues of basic science investigation," says Merajver.

While the findings may be cause for quiet celebration, experts caution that the results are extremely preliminary.

"It's obviously very interesting. But I think one of the problems is that [people develop] great expectations and, unfortunately, in the world of angiogenesis, there has been a lot of tremendous enthusiasm with very little proof that any of the agents have an effect in terms of the clinical care of patients," says Dr. Jay Brooks, chief of hematology/oncology at the Ochsner Clinic Foundation in Baton Rouge, La.

"That does not mean that this research should not go on but to actually translate this into clinical practice will take time," he says.

What To Do

For more information on the field of angiogenesis, visit the Angiogenesis Foundation, or the Angiogenesis Research Center.

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Miniature Genetic Test Set to Give Quick Results

By Patricia Reaney

Reuters

Friday, September 13, 2002

LEICESTER (Reuters) - A new genetic testing device, the size of a shoebox, could soon be available in surgeries and pharmacies to determine whether a person has a particular type of infection, a scientist said on Friday.

Dr. Paul Debenham, of LGC Ltd., formerly Britain's Laboratory of the Government Chemist which was privatized in 1996, said the test would be capable of analyzing DNA from saliva, blood or urine samples to give a result in 15 to 25 minutes.

"We've discovered a relatively constraint-free way of doing genetic tests that we think could be applied pretty much to anything," he told the British Association science conference.

The company is now working with London-based Agile Technologies to roll out a shoebox-size version of the technology that can be used in doctors' offices and chemists.

Agile Technologies is building a prototype of the device. After clinical validations of the technology, the device, which would cost about 4,000 (US$6,000), could be commercially available within a year.

Debenham said the test could be used to detect particular infections or strains of viruses and individual genetic variations that make some people more sensitive than others to certain drugs.

"In terms of inherited genetics, one of the initial focuses was on the genes involved with a process called pharmacogenetics (personalized medicine) because one of the things you would want to know about yourself is your ability to metabolize medicines," he added.

Because of their genetic make-up, some people cannot metabolize and detoxify drugs. One application of the test would be to identify these people to avoid prescribing the wrong type or dose of drug to avoid an adverse reaction. Debenham said he is one of 7% of the population who are poor metabolizers of drugs due to an enzyme called CYP2D6, a liver enzyme that metabolizes about 100 currently prescribed drugs.

"Effectively we have different enzyme activity, so those drugs hang around until they are filtered out or removed by secondary pathways," said Debenham.

The genetic test could also be used to detect people who are susceptible to deep vein thrombosis (DVT), or blood clotting in the legs, so they can exercise or wear compression socks or take other measures to avoid the condition during long flights.

Debenham believes the initial application for the test would be to diagnose infections.

"What we are doing is moving the genetics technology, enabling it to be available and functional for the health professional closer to the individual," said Debenham.

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Internet Sold Cipro, Questionable Anthrax Info

By Alison McCook

Reuters Health

Friday, September 13, 2002

NEW YORK (Reuters Health) - Just two weeks after last year's anthrax outbreak, numerous Web sites sprung up selling the antibiotic ciprofloxacin to people without a prescription, according to a new report.

Moreover, Alexander C. Tsai of Case Western Reserve University in Cleveland, Ohio and his colleagues report, many of the sites featured "poor quality of information, inadequate consumer safeguards, and high prices."

These Web sites contained numerous "potential harms to consumers," Tsai told Reuters Health. For instance, he said that many people are allergic or overly sensitive to the class of antibiotics to which ciprofloxacin, brand name Cipro, belongs. More than one quarter of the sites examined in the report did not mention the dangers associated with allergic reactions to these antibiotics, thereby putting many people at risk, he said.

The study could not assess how many people purchased ciprofloxacin from these Web sites, nor whether any consumers experienced adverse effects from the product. However, Tsai speculated that if people freely purchased unlimited amounts of the drugs from these sites and there was a widespread anthrax outbreak, there suddenly might not have been enough of the drug to go around. "We might not have enough when we really need them," he said.

In addition, if people are freely purchasing the drug and taking it incorrectly--for example if they don't need to--this could add to the ever-increasing problem of antibiotic resistance, Tsai added.

During the study, Tsai and his co-authors, Dr. Peter Luri of the Public Citizen's Health Research Group in Washington, DC, and Dr. Ashwini Sehgal of the MetroHealth Medical Center in Cleveland reviewed 59 Web sites that sold ciprofloxacin without a prescription between October 28 and 31, 2001. The research was conducted only weeks after the first reported case of anthrax, which occurred on October 4.

The investigators located the Web sites by performing Internet searches using 11 top search engines. They entered the terms "cipro," "cipro AND buy," "anthrax AND cipro" and "anthrax AND antibiotics."

Reporting in a recent issue of the American Journal of Medicine, the authors found that 39% of the sites they examined first appeared during the 2 weeks after October 4. In addition, many did not include standard cautionary information about the treatment: almost one-third did not include any information about side effects of ciprofloxacin, and more than one-quarter did not mention that people allergic to the class of antibiotics could have a life-threatening reaction to Cipro.

Shortly after the study was conducted, the researchers note, almost one half of the reviewed sites had stopped selling ciprofloxacin.

In an interview with Reuters Health, Tsai added that many of the sites included false information about anthrax. For example, he said, one site said that half of all people exposed to anthrax die between 24 and 48 hours--an overblown estimate, the researcher noted.

Many of the sites avoided the requirement of a prescription before selling prescription-only drugs by asking customers to complete a questionnaire, and then employing physicians to review the information and write a prescription, Tsai added. However, 19% of the sites did not require a questionnaire--meaning "no questions asked, you could purchase the drug," he said.

Tsai added that he and his colleagues believe coordinating how the government responds to these Web sites and issuing stronger guidelines on selling prescription drugs over the Internet could help control this type of questionably legal activity.

"Our report makes clear that Web site operators selling prescription medications can act rapidly to capitalize on emerging opportunities and recede, evading apprehension, with equal swiftness," the authors write.

"Regulatory authorities must have the resources and adequate legal authority to act with similar urgency," they add.

Source:American Journal of Medicine 2002 September.

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Tailored Education Helps Autistic Kids Mainstream

By John Griffiths

Reuters Health

Friday, September 13, 2002

LONDON (Reuters Health) - A novel program of tailored therapy for young children with autism can help youngsters attend a mainstream school, according to UK researchers.

The results were "dramatic," said Professor Alec Webster, who directs the South West Autism Project (SWAP) at Bristol University. The program boosted academic skills, but more importantly, helped children acquire "the social skills to take part in group activities and follow everyday school routines," Webster said.

"When I first started in this profession, all autistic children went to special schools," he added.

He noted that recent figures suggest as many as 1 in 100 children are affected by autism spectrum disorder, a broad definition of autism, which is a neurological disorder that affects a child's behavior and ability to communicate and interact with others.

The study included children aged from 2 to 4 years from 26 families who were enrolled when the program began 2 years ago.

The researchers assessed the children's developmental quotient (DQ)--a measurement that ranged from 24 (severe learning disorders with autism) to 100 (normal learning functioning with autistic features) in the study, compared with 80-120 in normal school settings.

A tailor-made educational plan was then developed for each child and trained tutors spent an average of 10 hours per week with a child at home and in playgroups. His team used techniques such as picture exchange, where picture symbols are used to communicate words, and visual timetables where symbols depicting what a child is going to do on that day are represented by symbols.

Webster explained that many autistic children have behavioral problems such as obsessions and irrational fears.

"We devised games responsive to the needs of the child. For example, children with no eye contact and poor social skills were introduced to a bubble-blowing game, which depended on eye contact and required turn-taking," he told Reuters Health.

All children on the program made progress regardless of their original abilities.

"In the best case we had a child with severe learning difficulties and a DQ of 24, who gained more than 60 points over an 18-month period. One third of the group showed gains of more than 45 points and half showed DQ gains of 20 points or more," Webster said.

To date, 16 of the 17 children who completed the SWAP program have gone to mainstream schools.

"What's unique about this program is that we work in family context and are adaptable to their needs. Because it is a service run in conjunction with the (local education authority), we can manage transition into early year settings," Webster said.

Ross Fisher, age 4, was one of the children involved in the study. His mother Lisa told Reuters Health when he was diagnosed "there was a lot of head banging, he could not concentrate, or even hold a pen." Ross did SWAP four afternoons a week for 2 hours.

"Twelve months later, he is a different child. Now he knows the entire alphabet and his speech has come on fantastically. Ross has always been a bright child, but now he is reading more like a 6 or 7 year old, even though he is only 4 years old." He started in infants' school this week, and has coped extremely well, said Lisa.

When Ross went to nursery he had a SWAP tutor, an educational psychologist, a nursery teacher and a speech therapist.

"It was the multi-professional approach we valued, where we were all working together. We all met regularly to see how he progressed, and I was involved when the tutor wasn't."

Webster pointed out that the next step is to pursue these children into their new schools, "so we can determine the most effective environment for their progress. These children will need support and specialized help for much of their school careers, and probably for the rest of their lives. We are hopeful that because of this early start their inclusion in society will be facilitated."

THURSDAY, SEPTEMBER 12, 2002

Experts Outline Cancer, Diet Evidence

 

By Emma Ross

AP Medical Writer

The Associated Press

Thursday, September 12, 2002

LONDON (AP) - Wading through 30 years of confusing and sometimes contradictory studies on cancer and diet, experts have summarized the state of scientific knowledge: alcohol is bad, obesity is bad and lots of fruits and vegetables are good.

Poor diet is thought to account for about 30 percent of cancer in the developed world and about 20 percent in poor countries, and scientists have long sought to determine what foods cause or ward off cancer. A review of the evidence, published this week in The Lancet medical journal, concludes that studies so far have confirmed little.

"Because the public is so bombarded and confused by stories that broccoli is the answer, or whatever, we wanted to get away from that and report what we know is really important," said the study's lead investigator, Dr. Tim Key, a diet expert at Oxford University's cancer epidemiology unit. "The problem is you keep getting stories, and the more bizarre the connection, the more press coverage it gets."

There have been few studies that have tested the link between cancer and specific foods by randomly giving some people specific foods and comparing their cancer rates with people who got no intervention. A positive result in such a study is considered real proof.

The few such studies show a diet rich in fruits and vegetables reduces the chance of cancer, while alcohol and obesity increase the risk.

"The results ... that have been published have been important in suggesting that some previous observations were misleading," the study said.

Two prominent examples are beta-carotene and vitamin E. Both looked promising as anti-cancer nutrients, but showed no effect on lung cancer rates when tested in rigorous experiments.

Studies have suggested that such dietary components as red meat, broccoli, garlic, fiber, folic acid, vitamin C and soya can either encourage or prevent certain cancers, but the links have not been proven.

The study also identified aspects of nutrition where further research might soon clarify the issues.

For red meat, it looks as though the important thing could be how the meat is prepared. Recent studies have suggested that preserved meats such as cured ham, bacon and sausages could increase cancer risk, but that fresh red meat may not.

The idea that high intake of calcium and vitamin D might reduce the chance of colorectal cancer looks promising, the study said.

However, the evidence does not support the theory that dietary fat increases the risk of breast cancer ( news - web sites), and findings on other foods such as dairy products and meat are inconclusive, the study said.

"This is a good update of the situation," said Dr. Elio Riboli, chief of the nutrition and cancer unit at the World Health Organization ( news - web sites)'s cancer research agency, the International Agency for Research on Cancer. Riboli was not involved with the study.

Riboli said emerging evidence suggests many of the factors that contribute to heart disease are also involved in cancer, such as lack of exercise, being even moderately overweight and problems with insulin, the hormone that goes wrong in diabetes.

"I think it's possible that we will realize that some of the benefits which were in the past attributed to the diet in itself should actually be attributed to the global balance between how we eat, how we move and our body shape, where we are actually pointing more to the energy balance," Riboli said.

"This is a major change in the intellectual view of the problem," he said. "Within the World Health Organization there's been a clear understanding that obesity is the real worrying epidemic around the world. There is a strong movement in the direction of 'yes, we have to do something.'"

Earlier this year, WHO officials said obesity has reached such epidemic proportions worldwide that a more aggressive approach is needed to try to head off a global explosion of fat-related diseases.

Experts are also starting to advocate a tougher strategy. "The individual awareness approach has been shown repeatedly to have failed," experts said in a report presented Wednesday at a European Union ( news - web sites) summit on obesity.

In its report, the International Obesity Task Force called for European restrictions on the advertising of junk food.

Other measures mentioned in the report were: redesigning roads to accommodate networks of bicycle tracks, removing junk food vending machines from schools, reintroducing cooking skills into the school curriculum and the establishment of a new medical specialty that takes a comprehensive approach to obesity.

On the Net:

International Obesity Task Force, http://www.iotf.org

International Agency for Research on Cancer, http://www.iarc.fr

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Body Piercing Plus Heart Defect May Spell Trouble

Reuters Health

Thursday, September 12, 2002

NEW YORK (Reuters Health) - People with certain congenital heart disorders may want to think twice before getting a body piercing, researchers suggest.

Writing in the August issue of the journal Emerging Infectious Diseases, Drs. Hossein Akhondi and Ali R. Rahimi of the Mercer University School of Medicine in Savannah, Georgia report on one 25-year-old man who became seriously ill soon after having his tongue pierced.

The man had a heart defect known as congenital aortic stenosis, a condition in which the valve to the aorta--the largest artery in the body--is abnormally narrow. People with heart-related abnormalities such as this one are advised to take antibiotics whenever they are having invasive procedures, such as surgery or dental work.

Dental work--and possibly body piercing--poses a risk of infection to such individuals because bacteria in the mouth can gain access to the bloodstream. Once inside the body, the bacteria can take hold in the heart, causing a potentially life-threatening infection.

Akhondi and Rahimi report that 2 months after his tongue was pierced, the man was hospitalized with fever, chills and shortness of breath. Blood tests revealed that the man's heart was infected with a type of mouth bacteria known as H. aphrophilus. The stud of the piercing also tested positive for the presence of the same bacteria. The man received a 6-week course of antibiotics via a catheter and recovered, although he did not return for heart valve replacement surgery as doctors recommended.

Although he usually took antibiotics before a trip to the dentist, the man did not take antibiotics prior to the piercing.

The researchers recommend more study of the subject and suggest that people with structural heart diseases take antibiotics before they get a body piercing.

Source: Emerging Infectious Diseases 2002;8:850-851.

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Deaths Prompt FDA Dialysis Warning

The Associated Press

Thursday, September 12, 2002

WASHINGTON (AP) - Dialysis centers are being warned not to use certain blood tubing because it may be linked with five deaths and two injuries, the Food and Drug Administration ( news - web sites) said Thursday.

The deaths occurred in late August in dialysis centers in Indiana and Michigan using certain Medisystems tubing in connection with Baxter Healthcare Corp.'s Meridian dialysis machine, the FDA said.

The FDA said it is working with Baxter, based in Roundtop, Ill., and Medisystems Corp. of Seattle to determine the cause of the problem.

Meanwhile, Baxter has notified dialysis centers to stop using the tubing in question and use other available blood tubing instead. Blood tubing that may be associated with the deaths or injuries is Medisystems product code D3-9694/9793 or K3-9694/9793, Baxter product code 5M9694, the agency said.

The FDA said the incidents occurred at Nephrology Inc. in Mishawaka, Ind., and Physicians Dialysis Inc. in Grand Rapids, Mich.

"FDA is alerting the public and the medical community to this problem in an effort to prevent other deaths and injuries," FDA Deputy Commissioner Lester M. Crawford said in a statement.

On the Net:

Food and Drug Administration: http://www.fda.gov

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HRT May Not Interfere with Mammograms: Study

Reuters Health

Thursday, September 12, 2002

NEW YORK (Reuters Health) - Despite concerns that hormone replacement therapy (HRT) might make breast tumors more difficult to spot on mammograms, new study findings suggest this is not the case.

HRT has received much attention of late, with new evidence showing that the therapy does not protect older women's cardiovascular health as once hoped. In fact, the large US Women's Health Initiative (WHI) study was halted this summer due to evidence that HRT with an estrogen/progestin combo may actually increase a woman's risk of heart attack and stroke, as well as breast cancer ( news - web sites). While the risk to the individual user was small, the treatment could cause eight additional cases of breastcancer among 10,000 women taking the therapy for one year, WHI researchers estimated.

Another concern with HRT has been that women on the therapy may have denser breast tissue, making mammographic detection of small tumors more difficult--and, by extension, long-term survival less likely.

In the new study, researchers found that HRT did not seem to hinder mammography and women taking the hormones at the time of diagnosis survived just as long or longer than women not taking HRT. The results are published in the September issue of the Archives of Surgery.

A number of studies have linked long-term HRT use to a small increase in the odds of developing breast cancer. But several, like the current one, have suggested that while their risk of the disease may be higher, HRT users also tend to develop smaller, slower-growing breast tumors compared with non-users.

Many researchers have attributed this to more frequent mammography among HRT users, but the authors of the new study argue that HRT may have favorable biological effects on breast tumors.

In the study, Dr. Rodney Pommier of Oregon Health and Sciences University (OHSU) in Portland and his team reviewed the cases of nearly 300 postmenopausal breast cancer patients treated at OHSU since 1994. Half had received HRT at the time of diagnosis. On average, they had been on replacement hormones for 16 years.

They found that among HRT users, 84 had their breast cancer detected by mammography screening, while 60 had their disease diagnosed after lumps were felt. Among women who didn't use HRT, 63 cancers were caught by mammography and 85 not until lumps were palpable--despite the fact that, overall, they went for mammograms as often as HRT users did.

Cancer survival was also better among HRT users, with 92% still alive 6 years after diagnosis, compared with 80% of non-users. And among women whose cancer was caught by mammography, all HRT users were alive 6 years later, compared with 87% of non-users.

The investigators also found that HRT users had some other things in their favor, including more early, stage 1 tumors and fewer cancers that had spread to the lymph nodes.

These women essentially had "better-behaved tumors," said study co-author Dr. SuEllen Toth-Fejel, also of OHSU. Finding out why they did is the goal of future research.

"If HRT does inhibit tumor growth," she told Reuters Health, "we'd like to know how."

The study authors acknowledged that, based on WHI and other studies, HRT may indeed cause a small increase in the incidence of breast cancer.

But, Pommier said, the evidence also suggests that when women do get breast cancer, those who used HRT may be more likely to "get a more favorable tumor."

Source: Archives of Surgery 2002;137:1015-1021.

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Study Looks at Hormone-Cancer Link

By Lindsey Tanner

AP Medical Writer

The Associated Press

Thursday, September 12, 2002

CHICAGO (AP) - A new study suggests that while long-term hormone therapy may raise the risk of breast cancer ( news - web sites), users who develop the disease may survive longer than those who never took supplements.

The reason may be that hormone users' tumors are less aggressive, said Dr. Rodney Pommier, who led the study at the Oregon Health and Science University.

Among participants whose tumors were detected by mammogram, all hormone users survived at least six years after diagnosis, compared with 87 percent of nonusers.

The research, published in September's Archives of Surgery, comes two months after a big hormone-replacement therapy study was abruptly halted because it found that women who took estrogen and progestin for about five years had a 26 percent higher risk of developing breast cancer.

Some doctors said the Oregon study is flawed and does not let hormones off the hook.

"The results should be interpreted very cautiously," said Dr. JoAnn Manson, who is chief of preventive medicine at Harvard's Brigham and Women's Hospital and took part in the halted research.

Rather than showing that hormone treatment overall is beneficial, the study "shows that if you have breast cancer, you are better off if you've had a long history of hormone replacement therapy," said Dr. John Butler, an Orange, Calif., physician who was not involved in the research.

The Oregon researchers reviewed medical records of 292 postmenopausal women diagnosed with breast cancer at the Oregon center. On average, hormone users had taken supplements for 16 years before diagnosis and developed breast cancer at age 66.

However, the researchers did not randomly assign women to receive hormones or a placebo and follow them to learn the consequences — the method considered the gold standard of medical research.

They also did not differentiate between women who had used estrogen plus progestin and those who took estrogen alone. Manson said there is mounting evidence that the combination raises the risk of breast cancer more than estrogen alone.

Users of hormone supplements were no more likely than nonusers to get mammograms.

Hormone supplements have been found to make breast tissue denser and potentially more likely to hide tumors on mammograms. But the hormone users in the Oregon study were actually more likely than nonusers to have their tumors detected by mammograms.

On the Net:

Archives of Surgery: http://archsurg.com

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TV Viewing Time Linked to Kids' Behavior Problems

Reuters Health

Thursday, September 12, 2002

NEW YORK (Reuters Health) - Kids who spend more time watching TV--regardless of the content of the programming--are more likely to behave aggressively and have other types of social problems, a study has found.

"Prolonged television watching may be considered to be one of the new symptoms of this era of technology, and it deserves more attention and evaluation in every aspect," write study author Dr. Elif Ozmert of Hacettepe University in Ankara, Turkey and colleagues.

"Families should be advised to restrict the television viewing hours of their children and to encourage them to participate in active peer relationships," they add.

To investigate whether television viewing might have effects on children's behavior, the researchers surveyed the parents of 689 students in the second and third grades.

They found that the children watched about 2.5 hours of television each day, on average, with their viewing time increasing during the weekend, according to the report in the September issue of Archives of Pediatrics and Adolescent Medicine.

The more television a child watched, the more likely he or she was to exhibit social problems and delinquent and aggressive behavior, the report indicates.

For example, children who watched more than 4 hours of television daily showed more delinquent and aggressive behavior than those who watched 2 hours or less per day. And this aggressive behavior was seen regardless of the content of the television programming, the researchers note.

"Thus, it was speculated that not only the prolonged television viewing but perhaps the inactivity and social isolation while watching television may have contributed to increased aggressive behavior scores," the authors write.

The children's age and sex were also associated with their likelihood of watching more than 2 hours of television daily, study findings indicate.

With every one-year increase in age, kids were 33% more likely to watch more than 2 hours of television per day. And boys were nearly twice as likely as girls to watch more than two hours of television daily.

It is not known, however, whether television viewing puts children at risk of behavior problems, or if children with behavior problems are just more likely to watch television, the researchers note.

"In either direction, it deserves further consideration," they write.

Commenting on the study, Dr. Flaura Koplin Winston of Children's Hospital of Philadelphia, Pennsylvania told Reuters Health that it gives "more evidence we need to be watching what the children are watching."

"Television is a very powerful influence on children on everything from what they should be eating...to how they should behave," she said. Yet, while great importance is often placed on other issues, such as "who will be our child's babysitter, sometimes we don't look at this television thing," she said.

Source: Archives of Pediatrics and Adolescent Medicine 2002;156:910-914.

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An Unhappy Christmas Story

HealthScoutNews

Thursday, September 12, 2002

(HealthScoutNews) -- In 1952, a 5-year-old British boy was found to have a little known 'bleeding disease'. It came to be formally known as 'hemophilia B'. Informally, this relatively rare affliction is called 'the Christmas disease' after Stephen Christmas, the youngster whose case was studied at Oxford University.

Today, in the United States, the Christmas disease strikes one in every 30,000 males. All share the absence in the blood of a factor that causes blood to clot. Without this factor, minor bumps and scrapes can be life-threatening.

About one in 5,000 U.S. males -- roughly 13,500 people -- is affected by Type A hemophilia. A far smaller number -- about 100,000 people, or 200 overall in the U.S. -- is affected by Type C hemophilia. Women are affected only by this type, which strikes men and women equally.

Each of the three hemophilias is caused by the absence of a different blood factor. It is important, for treatment purposes, that each type be properly diagnosed.

Hematologists are the medical specialists best trained for diagnosing and treating hemophilia and other types of blood disorders.

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Plaque-Forming Enzyme Rises in Alzheimer's Brains

Reuters Health

Thursday, September 12, 2002

NEW YORK (Reuters Health) - An enzyme involved in making Alzheimer's-related brain deposits is present in higher levels and is more active in parts of the brain where the disease takes the heaviest toll, researchers have found.

The findings raise the possibility that a drug that blocks the enzyme could reduce the formation of the deposits in the brain even when Alzheimer's has already reached an advanced stage, the investigators suggest.

Neurological deposits called plaques--made of substances called amyloid-beta proteins--are hallmarks of Alzheimer's disease ( news - web sites). In an interview with Reuters Health, the study's senior author, Dr. Michael C. Irizarry of Massachusetts General Hospital in Boston, explained that amyloid-beta proteins are formed when two types of enzymes--beta-secretase and gamma-secretase--chop off different parts of a protein called amyloid precursor protein.

Researchers have known, Irizarry said, that the production of amyloid-beta protein is increased in hereditary forms of Alzheimer's, in which symptoms tend to start decades earlier than in the much more common types of Alzheimer's that are not passed down a family tree. Whether the same is true in the more common forms of Alzheimer's "hasn't been clear," Irizarry said.

An issue that has perplexed Alzheimer's researchers, Irizarry added, is whether plaques form because too much amyloid-beta is made or because the protein is not properly metabolized or "cleaned up" in the brain. He noted that there are some signs that the cleaning up of amyloid-beta proteins is not as efficient as it should be in Alzheimer's disease.

But Irizarry and his colleagues suspected that levels of a protein called BACE--the primary form of the protein-clipping beta-secretase--would be elevated in parts of the brain where plaques usually form.

To test the hypothesis, the researchers developed screens to detect beta-secretase and to measure its activity--how efficiently it clips proteins. They applied the tests to 61 brains from people who had died with Alzheimer's and a "control" group of 31 brains from people who did not have the disease when they died.

The BACE form of beta-secretase was more abundant and more active in the brains of Alzheimer's patients, but only in the parts of the brain where plaques usually develop, the researchers report in the September issue of the journal Archives of Neurology.

In the temporal neocortex and the frontal neocortex--both regions where plaques accumulate--BASE activity was 63% and 13% higher, respectively, in the Alzheimer's group than in the control group. Similarly, levels of the protein in these parts of the brain were higher in Alzheimer's brains than in the control group.

In a brain region called the cerebellar cortex, which Alzheimer's usually spares, BACE was neither more active nor more abundant in the Alzheimer's brains.

The study "points out that this particular enzyme, beta-secretase, is a good target for treatment," Irizarry said. He noted that in the temporal section of the brain, levels of beta-secretase were highest in patients who had had Alzheimer's the longest, suggesting that beta-secretase "might be a target even late in the disease."

He cautioned, however, that even if a drug were developed to block beta-secretase in advanced Alzheimer's, it might be too late to replace many of the nerve cells already destroyed by the disease.

In an accompanying editorial, Dr. Roger N. Rosenberg of the University of Texas Southwestern Medical Center in Dallas concludes, "These observations provide a direct and compelling reason to develop therapies directed at inhibiting beta-secretase activities."

However, the report does raise "a cautionary note," according to Rosenberg, who is the editor of the journal, since the study found that the increase in BACE activity did not correspond to an increase in amyloid-beta levels.

In the interview, Irizarry noted that despite the findings, the increase in beta-secretase in the Alzheimer's brain "doesn't explain this whole process all by itself."

One of the study's authors receives financial support from Takeda Chemical Industries in Osaka, Japan.

Source: Archives of Neurology 2002;59:1367-1368, 1381-1389.

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Hey, Don't Just Stand There!

HealthScoutNews

Thursday, September 12, 2002

(HealthScoutNews) -- Ceremonial military guards, at places such as Arlington National Cemetery or Buckingham Palace, aren't always as "motionless" as their reputations suggest. Every so often, two guards will turn sharply, march toward and past each other, then resume a fixed stance where their counterpart stood a short while earlier.

There's a reason: Unless the legs are exercised, their muscles can't help push blood upward through the veins and toward the heart. If a soldier stands stiffly for too long -- more than 15 minutes is the rule of thumb -- the blood flow from veins is so affected that he could faint.

That's so because blood in your veins is under low pressure -- so low that veins in your legs have special one-way valves that can only be opened from the bottom, so gravity-influenced blood from the upper body doesn't drain downward and accumulate in the legs or feet.

Arteries, which carry blood away from the heart, have a significantly different structure than veins, in part because they are designed to transport the blood under much higher pressure than veins do.

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Normal Breast Cancer Gene Type Is DNA Fixer: Study

Reuters Health

Thursday, September 12, 2002

NEW YORK (Reuters Health) - Scientists have known for several years that mutations in two genes, BRCA1 and BRCA2, increase the risk of breast and ovarian cancers, but the purpose of the normal versions of these genes has been unclear.

Now, New York researchers have uncovered evidence showing that the protein expressed by the unmutated version of one of these genes, BRCA2, helps make genetic repairs that prevent cancer from developing.

Last month, Stanford University researchers reported that the healthy version of BRCA1 plays a similar role, helping to identify and fix DNA damage.

BRCA1 and BRCA2 mutations, which occur in about 1 out of every 40 women of Ashkenazi Jewish descent, have been linked to an increased lifetime risk of both breast and ovarian cancers.

When a mutation is present in BRCA2, chromosomes become unstable because of defects in a process called homologous recombination, which repairs damaged spots in the double strands of DNA. How BRCA2 is involved in this process has been uncertain, however.

By zooming in on the structure of BRCA2, a team led by Dr. Nikola P. Pavletich at Memorial Sloan-Kettering Cancer Center in New York, were able to show that BRCA2 plays a direct role in the process of homologous recombination.

Though there have been hints suggesting that BRCA1 and BRCA2 play a role in DNA repair, the findings "place these hints on solid ground by providing structural and biochemical evidence that BRCA2 is directly involved in the repair of DNA double-strand breaks," according to Drs. John H. Wilson and Stephen J. Elledge of Baylor College of Medicine in Houston, Texas, who are the authors of an accompanying editorial.

Even though Wilson and Elledge call the findings "profound," it remains a mystery why mutations in BRCA2 cause tumors in a well-defined set of human tissues, according to the editorialists.

"Are breast and ovary exposed to higher rates of DNA damage?" they ask. "Do other tissues have a better back-up DNA repair system and, if so, what might it be? Are these tissues less efficient at eliminating BRCA-deficient cells, enabling survival mutations to arise and tumors to form?"

Source: Science 2002;297:1837-1848.

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Parkinson's Disease Scrambles Brain's Switchboard

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 12, 2002

THURSDAY, Sept. 12 (HealthScoutNews) -- One of the hallmarks of Parkinson's disease ( news - web sites) is slow movement, and a researcher from Rutgers University believes he's discovered why this occurs.

By studying rats with chemically induced Parkinson's, the researcher was able to see that the disease caused connections in the brain to reorganize and send signals to different parts of the body than they were originally programmed to control. Results of the study appear in the October issue of The Journal of Comparative Neurology.

The researcher, Mark West, a behavioral neuroscientist at Rutgers, likens this area of the brain to a switchboard, and says Parkinson's disease changes the switchboard wires around.

"If the wires are switched, information isn't getting to the right area," he explains, which makes it difficult for the body to respond.

The bad news, he says, is it's not likely that medications would ever be able to reverse these new connections.

However, neurologist Dr. Christina Drafta, of New York University Medical Center, points out that slow movement is only one symptom of Parkinson's, and there are still many other aspects of the disease that may eventually be more treatable. "I don't think there is no hope," she adds.

Parkinson's disease affects as many as 1.5 million Americans, according to the Parkinson's Disease Foundation. The main symptoms include rigidity, tremor, slow movement, poor balance and problems walking. The exact cause of Parkinson's remains a mystery, but researchers do know that many of the symptoms occur because of a severe shortage of a brain chemical known as dopamine. There is no cure for the disease, but there are medications that can help control some of the symptoms.

For this study, West and his colleagues chemically induced Parkinson's disease in rats on one side of their brain so they could compare the changes to the normal side of the brain.

They then concentrated their study on the part of the brain affected by Parkinson's -- the basal ganglia. In a normal brain, neurons -- the cells that conduct electrical messages -- cluster together by body type. For example, several clusters might correspond to an arm and other clusters are responsible for a leg.

In the Parkinson's brain, these clusters are smaller because the neurons on the edges of the clusters have broken away, West says. When these neurons break away, they change their function and start responding to different input. So, a cluster that originally was programmed to respond to a touch on the arm might learn to react to a poke in the back. Interestingly, West says these renegade neurons can actually learn to respond to more than one area of the body, which normal neurons don't do.

The problem is, the connections in the body parts don't change. So, when the neuron that has broken off from the arm now responds to a touch on the leg, it fires off its message to respond, but the leg doesn't "hear" that message; the arm does.

West says his findings explain why the commonly used treatment, a dopamine-replacement drug, doesn't help with slow movement. Once these new connections are made, he says, they can't be "taken back."

He says more research should be done on prevention so these changes don't have the chance to occur.

Drafta says patients shouldn't be discouraged by these findings. It's important to remember that these results come from a study of rats that did not get Parkinson's naturally, she explains. While that doesn't mean the results are not valuable, it does mean it's not necessarily what happens in the human brain, Drafta says.

Also, these findings don't explain the other symptoms of Parkinson's, Drafta adds.

"There are still a lot of ifs here," she says.

What To Do

For more information on Parkinson's disease, go to the Parkinson's Disease Foundation or to the Parkinson's Disease Society.

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Genes Key to Stem Cells' 'Stemness' Identified

Reuters Health

Thursday, September 12, 2002

NEW YORK (Reuters Health) - In findings that could lead to a better understanding of how stem cells work as well as help scientists to identify new types of stem cells, two sets of researchers have identified sets of genes that are shared by several types of stem cells.

Stem cells are immature "master" cells capable of maturing into different types of body tissue. These cells are most abundant in embryos, but there are also stem cells in some adult tissues, such as bone marrow.

Despite great interest in using stem cells to treat disease, very little is known about the genetics of the cells.

To find out more, Dr. Douglas A. Melton of the Howard Hughes Medical Institute and Harvard University in Cambridge, Massachusetts and colleagues "profiled" the genes of several types of mouse stem cells. They selected the three varieties of stem cells that have been studied the most: embryonic stem cells, neural stem cells and hematopoietic cells, which give rise to blood cells.

Melton's team identified 216 genes that were expressed, or "turned on," in high levels in all three types of stem cells. According to a report the September 12th issue of Sciencexpress, the online edition of the journal Science, this set of genes is "likely to reveal core stem cell properties or 'stemness"' that give stem cells their special properties, including self-renewal.

"The study shows that a set of genes, not one gene, but a set of about 200 genes, gives stem cells their special properties," Melton told Reuters Health. He said that the genes identified in the study "are likely to be important for an organism's ability to maintain itself (and) regenerate tissues."

According to Melton, the newly identified genes "should help scientists identify and purify stem cells from other tissues." Pointing out that the study involved blood, brain and embryonic stem cells, he said that the new information can now be used to find stem cells in the pancreas, bone, heart and other tissues.

The results of a second study, also published in Sciencexpress, suggest that the genetic similarity of stem cells applies to human cells as well. When a group of researchers at Princeton University in New Jersey compared mouse and human hematopoietic stem cells, they found that the cells expressed a number of the same genes.

The similarities between the mouse and human stem cells, according to the researchers, may represent a "molecular signature" that governs the properties shared by various types of stem cells. The team also found that mouse hematopoietic stem cells shared some of the same molecular signature as mouse embryonic and neural stem cells.

In an interview with Reuters Health, the study's lead author, Dr. Ihor R. Lemischka, compared the molecular signature to a "parts list." As is the case with a computer or any other machine, "you need to know what the parts are," he said. Now that researchers have identified the components of several types of stem cells, he said, the next step is to figure out "how they fit together."

ImClone Systems Inc. provided some funding for the Princeton study.

Source: Sciencexpress 2002;10.1126/science.1072530, 1073823.

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Gene Therapy Creates Natural Pacemaker

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 12, 2002

THURSDAY, Sept. 12 (HealthScoutNews) -- With the help of gene therapy, researchers have re-programmed guinea pig heart cells to do a pacemaker's job, and they hope to one day be able to do the same for humans.

 A team from the Johns Hopkins School of Medicine got the rodents' hearts beating properly by changing the function of less than 1 percent of their heart cells. The researchers report on what they call the first "biopacemaker" in today's issue of Nature.

Dr. Eduardo Marbán, the lead researcher, says scientists can envision a day when doctors can recreate a human's pacemaker cells rather than having to implant an electronic pacemaker. He adds, though, that such a possibility is years away.

Normally, the heart's pacemaker cells, which are found in the blood-receiving chamber called the atrium, generate electrical impulses that spread through the organ and make it contract. With age or illness, natural human pacemaker cells die off, making a pacemaker necessary.

More than 600,000 pacemakers are implanted every year, according to the American Heart Association ( news - web sites). These battery-operated devices work by artificially replacing the heart's natural electrical impulses.

Most heart cells are set to maintain a level of potassium that makes it difficult for them to send electrical signals, or "fire." That means they can't generate an electrical signal on their own; they must wait to be triggered by pacemaker cells.

The Hopkins researchers suspected that if they could alter the potassium balance in the heart cells, the cells might be able to fire without being triggered. To do so, they needed to block the usual potassium "channel" that keeps potassium levels in check.

They did this by altering the gene that controls the potassium channel, inserting it into a virus, and then injecting it directly into the guinea pig heart cells. Three to four days later, the animals' heart cells started producing the defective potassium channel, according to the study. Then, those cells started firing electrical impulses on their own.

Marbán says the researchers saw no evidence of adverse effects from the gene therapy.

He says the researchers plan on testing the gene therapy on larger animals and, if all goes well, they hope to start human trials in as little as four years.

"This is exciting work," says Dr. Freddy Abi-Samra, director of the electrophysiology lab at Ochsner Clinic Foundation in New Orleans. However, he cautions that many steps have to occur before these findings will be useful to humans, and further warns that while guinea pigs provide a good model for human heart function, they are not exactly the same.

Plus, he says the researchers changed only ventricle cells in the heart into pacemaking cells, but would need to be able to change atrial cells for the finding to be of use. Marbán says he suspects that atrial cells will show a similar pacemaking ability once the potassium channel is blocked in those cells.

What To Do

To learn more about the anatomy of the heart and how it works, go to HowStuffWorks. For more information on pacemakers, visit the American Heart Association.

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More Women Getting Adequate Folic Acid: CDC

Reuters Health

Thursday, September 12, 2002

NEW YORK (Reuters Health) - A national campaign to help ensure that all US women of childbearing age get enough folic acid to prevent certain birth defects appears to have paid off, according to a report released Thursday.

In September 1992, the US Public Health Service recommended that women of childbearing age consume 400 micrograms of folic acid daily to reduce the incidence of spina bifida or other neural tube defects. A US-wide effort to help women achieve that goal, which included food fortification and educational efforts, was launched soon afterwards.

Researchers from the Centers for Disease Control and Prevention ( news - web sites) (CDC) compared folate concentrations in women of childbearing age who participated in the National Health and Nutrition Examination Survey (NHANES) during 1988-1994 and 1999-2000.

In the Morbidity and Mortality Weekly Report for September 13th, the agency reports that all three racial/ethnic populations studied--non-Hispanic white women, non-Hispanic black women and Mexican-American women--posted "substantial" increases in blood folate concentrations over the study period.

But the CDC cautions that racial disparities in blood folate concentrations remain. While blood folate levels among white and Mexican-American women reached goals set for 2010, those for black women did not, they report.

"For the number of pregnancies affected by neural tube defects to be reduced further, all women of childbearing age capable of becoming pregnant should consume the Public Health Service-recommended level of folic acid daily," the authors conclude.

Source: Morbidity and Mortality Weekly Report 2002;51:808-810.

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Motorcycle Helmets Save More Than Lives

HealthScoutNews

Thursday, September 12, 2002

THURSDAY, Sept. 12 (HealthScoutNews) -- Revved-up hospital costs are another reason why motorcyclists should wear helmets in the event of a crash.

 Along with higher health-care costs, longer hospital stays are in store for injured riders who don't don helmets, says a University of Michigan study in the September issue of the Journal of Trauma.

The study also found motorcyclists injured while riding without a helmet were less likely than their helmet-wearing colleagues to be covered by insurance to pay for their care. Riders without helmets were more likely to be younger, have more severe injuries, and suffer more head and neck injuries.

The study looked at the cases of 216 motorcycle crash victims at the university's Health System's Trauma Burn Center between 1996 and 2000. In 42 of those cases (19 percent), the riders weren't wearing helmets.

The average hospital costs for riders wearing helmets when they crashed were about 20 percent less (about $6,000) than for riders who weren't wearing helmets. The average costs were $31,158 and $37,317, respectively.

The researchers also looked at the costs for 23 motorcycle accident victims who received inpatient rehabilitation after leaving the trauma unit. The average rehabilitation cost for riders without helmets was $43,053, compared to $23,201 for helmeted riders.

"This adds further evidence to the argument that we need helmet laws for every rider in every state, not to infringe personal freedom, but to improve safety and reduce costs for everyone," says study co-author Dr. Mary Margaret Brandt, an assistant professor at the Medical School's department of surgery and a trauma surgeon at the Trauma Burn Center.

"Until that happens, it shows that those who ride without helmets should pay higher insurance premiums, as smokers and other high-risk groups do," Brandt says.

Three states have no helmet laws, and 27 have helmet laws that require helmets only for certain riders, such as minors.

The National Highway Traffic Safety Administration ( news - web sites) (NHTSA) says that 2,862 motorcyclists died and about 58,000 were injured in 2000. Riders not wearing helmets are 40 percent more likely to suffer a fatal injury and 15 percent more likely to suffer a non-fatal injury than riders who wear helmets, the NHTSA says.

More information

Here's more on motorcycle helmet safety.

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Peanut Allergy from Playing Cards a Losing Hand

Reuters Health

Thursday, September 12, 2002

NEW YORK (Reuters Health) - The case of a man allergic to peanuts who suffered a reaction after playing cards highlights the fact that there are many hidden sources of peanut allergens, according to a new report.

Dr. Ute Lepp of Foschungszentrum Borstel in Germany and colleagues describe the experience of a man who needed treatment after experiencing swelling in his lips and tongue and shortness of breath.

The man was allergic to peanuts, but said he had not eaten any peanuts. His companions also knew of his allergy and said they had not eaten any peanuts in front of him, and the nuts had been stashed out of his way.

However, once the patient said he had licked his thumb to help separate the cards, doctors got a clue as to how the patient was exposed.

In the journal AllergyNet, Lepp and colleagues propose that the cards contained traces of peanut protein from the fingers of the patient's opponents, which then reached the patient's mouth when he tried to separate the cards. Even trace amounts of the protein can trigger a reaction, the authors note, and clearly enough was present on the cards to cause symptoms.

In an interview with Reuters Health, Lepp said that the investigators were surprised to see someone develop an allergic reaction from cards. However, Lepp noted, this is not the first time a patient allergic to peanuts has reacted to a seemingly harmless source.

Previous reports have described allergic reactions to peanuts after a kiss on the cheek or mouth that were severe enough to require a trip to the emergency department. Patients have also reacted after playing sports, suggesting that balls used in play can transfer traces of the peanut protein between players.

"One of my patients reacted after a meal which was prepared in a pan which was used for a peanut-containing meal before," Lepp added.

Although the patient featured in this case report was quite sensitive to peanuts--the breath of a person who had eaten peanuts could trigger a reaction--Lepp noted that even people with previously mild allergies can experience severe symptoms from their next exposure.

These past experiences illustrate that even those who try to avoid obvious sources of peanuts may still be inadvertently exposed. Lepp's advice to someone trying to protect a loved one from an allergic reaction: "Avoid all peanut-containing food."

Source: AllergyNet 2002:864-865.

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Tamoxifen Study Raises Risk-Benefit Questions

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 12, 2002

THURSDAY, Sept. 12 (HealthScoutNews) -- The drug tamoxifen can reduce the risk of breast cancer ( news - web sites) in women with higher odds of getting the disease, but a new study says it's not clear if the benefits of the drug outweigh its side effects.

 Researchers in Britain, Australia and New Zealand found a 32 percent reduction in the risk of breast cancer in 3,578 women taking the hormone therapy. However, it turned up a doubling in potentially life-threatening blood clots, especially in women undergoing surgery or prolonged immobilization. And it found more than a doubling in the risk of death -- related to clots after surgery -- compared with 3,566 women receiving dummy treatment.

Dr. Jack Cuzick, the leader of the IBIS-I (International Breast Cancer Intervention) study, said in a statement: "Although when used as adjuvant therapy for breast cancer, tamoxifen can clearly reduce the risk of recurrence and death, at present the overall risk-to-benefit ratio in the preventive setting is still unclear. Further long-term follow-up to study breast-cancer incidence and mortality, other causes of death, and side effects in the current trials remains essential."

However, some American doctors disagree that tamoxifen was on a bubble. Dr. D. L. Wickerham, associate chairman of the National Surgical Adjuvant Breast and Bowel Project (NSABP), a major cancer research effort in the United States, says the results "confirm that tamoxifen is an effective drug." As for the clotting risk, Wickerham says that's "not news. Tamoxifen has been around since the 1960s," and doctors have long known about the elevated incidence of blood cots.

Wickerham, a breast cancer expert at Allegheny General Hospital in Pittsburgh, adds the risk is the same as that of estrogen in hormone replacement therapy for postmenopausal women: not negligible, but not so great to prevent them from taking it.

The researchers report their findings in this week's issue of The Lancet.

Tamoxifen is sold as Nolvadex by AstraZeneca. Many take it for the treatment of existing breast tumors, and a smaller fraction use it to prevent cancer from occurring.

The drug is a selective estrogen receptor modulator, or SERM. It binds to estrogen receptors and alters how cells react to the hormone. In the breast, it restrains estrogen activity, reducing the growth of cells. In the endometrium, it increases estrogen activity, pushing cell growth.

Three previous clinical trials of tamoxifen have shown it can cut the risk of breast cancer in high-risk women, such as those with a close relative with the disease, by about 50 percent over five years. That's in the ballpark of the latest study, which included more than 7,100 women between the ages of 35 and 70.

The researchers did see more uterine cancers in the women taking tamoxifen, 11 versus five, but the difference wasn't statistically significant and the tumors were easily removed by hysterectomy.

However, the clotting risk may be more troublesome, the scientists say. While some of the clots -- roughly half of which were in the leg veins -- occurred after leg surgery or a fracture, many others were spontaneous.

All of the excess deaths in the tamoxifen group occurred after surgery, the researchers say. As a result, "a wise precaution would be to discontinue" the drug before any operation and use anti-clotting therapy during the procedure. Tamoxifen should be resumed only when the woman is able to move around well.

Dr. Clifford Hudis, chief of the breast cancer medicine service at Memorial Sloan-Kettering Cancer Center in New York City, says the latest research would be concerning had other studies not found no increased risk of death from tamoxifen. But "all the other studies show that you lower your breast cancer risk and the risk of death is neutral or better."

Still, Hudis says it's true that doctors need to refine their risk-benefit profile for the drug, especially in determining which women are the best candidates for therapy. Hudis considers tamoxifen most appropriate as a preventive in women at high risk of breast cancer. The IBIS study, he notes, included many women at moderately elevated risk of the disease.

What To Do

For more on tamoxifen and other ways of preventing breast cancer, visit the National Surgical Adjuvant Breast and Bowel Project or AstraZeneca.

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FDA Offers Guidance on Livestock Antibiotic Safety

Reuters Health

Thursday, September 12, 2002

WASHINGTON (Reuters Health) - The US Food and Drug Administration ( news - web sites) (FDA) has issued guidelines on how to determine whether new antibiotic drugs used in animals are likely to lead to drug-resistant disease in the humans who eat them.

The FDA's draft guidance document lays out an approach for investigating the potential for causing drug resistance as part of the pre-approval evaluation of these drugs.

According to the FDA, national and international health organizations have seen evidence that use of antimicrobial drugs in food-producing animals could lead to the emergence of drug-resistant bacteria that can harm humans.

For instance, the FDA noted, Salmonella and Campylobacter can exist in the digestive tract of food-producing animals without causing illness, but people can suffer severe illness after consuming these bacteria in meat, milk or eggs.

"FDA's main concern is that use of antimicrobial drugs in food-producing animals may lead to the emergence of bacterial pathogens that are resistant to drugs used to treat human illness, potentially making human illnesses more difficult to treat," the agency said.

In January 1999, the FDA also issued a proposed framework for managing the potential risk.

According to the FDA, this risk assessment process will produce an estimate of the potential risk posed to human health by the proposed new antimicrobial animal drug.

"FDA believes that the potential human health consequences of exposure to the defined hazardous agent may be estimated qualitatively by considering the human medical importance of the antimicrobial drug in question," the agency states in the guidance document.

FDA guidance documents are not legally binding, but they reflect the agency's preferred approach for dealing with specific issues.

Specific comments on the proposed methodology will be accepted for 75 days following publication of the draft guidance document in the September 13 issue of the Federal Register, the agency said. The agency added that it would also accept general comments at any time.

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Ex-FDA Consultant Says Agency Too Tight With Drug Companies

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 12, 2002

THURSDAY, Sept. 12 (HealthScoutNews) -- A doctor consulting for the U.S. Food and Drug Administration ( news - web sites) on a controversial bowel pill claims the pressure of big money prompted the agency to let the drug back on the market after it was initially withdrawn over safety fears.

Dr. Paul Stolley, a retired professor from the University of Maryland, says he believes the FDA is too close to the drug companies it regulates. Under a 1992 law, pharmaceutical firms actually help pay the bill for regulators to review product applications. His experience with the bowel drug Lotronex, or alosetron, "is a perfect example" of how tightly industry and the agency are now linked, and how companies can use fiscal muscle to have their way over sound science.

"The FDA was in partnership with industry" in the Lotronex affair, Stolley says in this week's British Medical Journal (BMJ). "It should have been negotiating, not in partnership. Why was it in partnership? Because it's financially supported by industry."

The author of the BMJ article is Ray Moynihan, a journalist with the Australian Financial Review. In a previous issue of the journal, Moynihan co-authored an article accusing drug companies of "disease mongering," marketing generally minor problems into full-blown illnesses in order to sell medication.

One of these conditions, he said then, was irritable bowel syndrome, or IBS. IBS causes varying degrees of constipation, bloating, diarrhea and cramps in as many as 20 percent of American women.

In February 2000, the FDA approved Lotronex, from then-GlaxoWellcome, for the treatment of IBS marked by diarrhea. But over the course of a year, the agency began receiving reports of serious -- and even fatal -- bowel trouble in some patients.

By November, the company withdrew Lotronex from pharmacies. As of last spring, the FDA said it had linked 84 cases of bowel damage and 113 cases of serious constipation to the pill, 137 of which required hospitalization. At least four, and possibly several more, proved fatal.

Patient groups -- with financial ties to industry, Moynihan argues -- were upset by the decision to withdraw the drug and pushed hard for its return. In December of last year, the company, now GlaxoSmithKline, asked the FDA to allow the drug back, which it did in June of this year.

The FDA stipulated that the company could sell Lotronex only under strict oversight to a select group of women with severe IBS marked by diarrhea who have failed to respond to other treatments. Of the 18.5 million people with IBS, about 185,000, or fewer than 5 percent, would qualify for the therapy, officials said at the time.

To prescribe the drug, doctors would have to notify the company that they were familiar with its risks and with the disease and would receive stickers in return. Pharmacies would be discouraged from filling prescriptions without first seeing a sticker.

Lotronex was also to carry a "black box" warning, the agency's most stringent caution, and GlaxoSmithKline promised not to market the drug directly to consumers. [Officials said doctors could offer the drug to men with IBS, although it is not specifically approved for them.]

Yet, these precautions weren't as stringent as those an FDA advisory panel recommended to regulators. The panel had in April 2002 urged the agency to narrow the physicians eligible to prescribe the drug to people with demonstrated -- and not merely avowed -- expertise with IBS.

And that is the guts of Stolley's and Moynihan's complaint.

"The FDA is not bound to take all the advice of its committees, but in this case several panel members were furious," wrote Moynihan, who added that critics of the agency consider the outcome a "case study in regulatory capture."

According to Moynihan, Stolley, who could not be reached to verify the account, felt that FDA officials turned a deaf ear to his concerns about Lotronex's safety. Stolley also works for the advocacy group Public Citizen, which called on the FDA to withdraw Lotronex and keep it off the market. He alleges that an FDA official, Dr. Janet Woodcock, accused him of "brow-beating" other reviewers and that the pill was safe enough to return to market.

Woodcock, head of the Center for Drug Evaluation and Research, which was handling the Lotronex matter, in an interview Thursday denied Stolley's charge. She said she remembers meeting with the consultant, but that the discussion didn't involve his opinion of Lotronex.

Woodcock also rejected the notion that the 1992 user fee law has compromised the agency's ability to review drugs objectively. "The FDA is not influenced by user fees in any individual decision about a drug. Period," Woodcock said.

Dr. Brian Strom, a University of Pennsylvania epidemiologist who sits on the advisory panel whose advice was spurned, said he was angered by the FDA's decision. Yet, he acknowledges that the agency was well within its rights to act as it did.

"We did think [Lotronex] should be back on the market, but under very strict limited conditions," Strom said. The group felt that only IBS experts --some even said only bowel specialists -- should be allowed to prescribe the pill. They also believed that giving patients a consent form to fill out before receiving a prescription absolved both doctors and the company of responsibility for the harm that might ensue.

Strom, who is quoted in Moynihan's article, said that perhaps just 2 percent of women with IBS would respond well to Lotronex. For this group, "it's a good drug," and the FDA should focus on serving these patients. The rest, he said, should probably not have access to the pill. "If [IBS] is sufficiently mild that they don't need a gastroenterologist, they don't need a drug that has a chance of killing them," he said.

Woodcock defended the agency's choice of risk plans, saying the panel was asked merely to consider a range of elements in such a system and recommend those it felt would be effective. Taken together, the litany of measures would have been "overwhelming as far as the burden on the health care system," she said. The final version, she added, while somewhat looser than everything each of the panelists may have wanted, still provides more restrictions than govern the typical prescription drug.

In fact, some people familiar with the Lotronex debate said the drug might not be such a perfect case study in cash-over-conscience after all. Ramona DuBose, a spokeswoman for GlaxoSmithKline, in Research Triangle Park, N.C., noted that patient groups, not the pharmaceutical company, were the engine behind the pill's return.

"When we took it off the market in November of 2000, it was our intention never to bring it back," DuBose said. "But the outcry was so compelling" that the company decided to reconsider. DuBose said the firm then approached the FDA for help crafting a plan to give Lotronex a second, closely monitored chance.

DuBose said the company doesn't expect Lotronex to make it much money, and that the cost of implementing and running the risk management system will be "substantial." The pill will be available to patients by the end of the year.

What To Do

For more on Lotronex and its return, try the U.S. Food and Drug Administration.

To learn more about irritable bowel syndrome, try the National Institutes of Health or the IBS Self Help and Support Group.

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Ibuprofen Syrup Helps Kids with Hip Inflammation

Reuters Health

Thursday, September 12, 2002

NEW YORK (Reuters Health) - Children diagnosed with a temporary condition known as "irritable hip" get better more quickly if they take an anti-inflammatory syrup, according to the results of a small trial.

Irritable hip, also known as transient synovitis of the hip, is caused by inflammation of the hip joint and sometimes occurs in youngsters after a bout of flu-like illness. A child tends to complain of hip pain, and usually the condition resolves within a week even without treatment.

In a new study, Dr. Susan Kermond and colleagues from the Royal Children's Hospital in Melbourne, Australia, randomly assigned 40 children with transient synovitis of the hip to ibuprofen syrup three times daily for 5 days or to an inactive placebo. Thirty-six patients completed the trial.

All the youngsters had resolution of symptoms within 7 days. However, the median duration of symptoms was about 2 days in the ibuprofen group compared with 4.5 days in the placebo group, according to the report in the September issue of the Annals of Emergency Medicine.

Ibuprofen is a type of drug known as a nonsteroidal anti-inflammatory drug (NSAID), a class of medication that does not include drugs such as acetaminophen, the active ingredient in Tylenol.

Kermond and colleagues conclude that "treatment of transient synovitis of the hip in the emergency department with ibuprofen may shorten the duration of symptoms. In our small (study group), it was safe and well tolerated."

They add that, while a large study should be done to confirm these results, "we have changed the practice in our emergency department, and we do recommend that patients with transient synovitis of the hip be discharged with an NSAID."

Source: Annals of Emergency Medicine 2002;40:294-299.

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Clot-Busting Drugs Save Heart Attack Victims

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 12, 2002

THURSDAY, Sept. 12 (HealthScoutNews) -- Giving on-the-spot clot-dissolving treatment to heart attack patients is as effective in saving lives as waiting to give artery-opening angioplasty in the hospital, a French study finds.

 It's a study that adds a new element, time, to an ongoing discussion of the best emergency treatment for a heart attack. Several American studies have found that angioplasty -- using a balloon to open a blocked heart artery -- is better than giving a drug to dissolve the clot blocking that artery. But in those studies, clot-dissolving treatment didn't begin until the patient got to the hospital.

Now cardiologists at University Hospital in Lyon, France, report almost identical survival rates in a trial in which some patients got clot-dissolving therapy even before they got to the hospital, while others waited an hour longer and got angioplasty.

The results aren't as clear-cut as could be desired, says Dr. Eric Bonnefoy, a senior physician in the university's coronary care unit and lead author of a study appearing in the Sept. 14 issue of The Lancet. The study didn't enroll as many patients as planned, because money ran out, and 25 percent of the patients who got clot-dissolving therapy ended up undergoing "rescue angioplasty" when it was suspected the initial treatment had failed.

Even so, the death rate for patients who got the early clot-dissolver treatment was 3.8 percent, compared to 4.8 percent for those who waited for angioplasty. The overall incidence of adverse effects, such as a second heart attack, was 8.2 percent for the clot-dissolving group vs. 6.2 percent for the angioplasty group, a difference that is not statistically significant.

The French medical system, which includes doctors in the emergency response team, makes early clot-dissolving treatment "already standard therapy," Bonnefoy. It's not possible just now in the United States, for several reasons, American cardiologists say.

"It's fantastic and I wish we could do it," says Dr. Donald W. LaVan, clinical associate professor of medicine at the University of Pennsylvania and a spokesman for the American Heart Association ( news - web sites). "Unfortunately, we have problems with trial lawyers. It carries a certain risk, and someone will complain about it possibly causing harm. But most important, licensing requirements don't permit folks to start it. They [the French} had the luxury of having doctors on board. I wish we could do that."

There have been U.S. trials in which clot-dissolving treatment was administered to heart attack patients before they got to the hospital, says Dr. Judith S. Hochman, director of the cardiac care unit at St Luke's-Roosevelt Hospital in New York. In those trials, emergency technicians transmitted real-time medical data to hospital-based doctors, who could order the treatment. Those trials have not led to general use.

"This reopens the discussion about which is superior, primary angioplasty with inherent delays or very early, pre-hospital fibrinolysis [clot-dissolving treatment]," Hochman says. "The answer may be that if treatment is started very early, fibrinolysis is best, but if the patient is further along, it is best to go to the catheter laboratory for angioplasty."

The French results add more support to the belief that when a heart attack occurs, "time is muscle and the earlier you open the artery the better," Hochman says. As to the method of opening the artery, "we ought to be looking more at early fibrinolysis," she says.

What To Do

Early recognition of a heart attack is essential, and you can learn about the warning signs and symptoms and what should be done from the American Heart Association, which also has a page on heart attack treatments.

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'Big Picture' Health Improvements for Americans

Reuters Health

Thursday, September 12, 2002

WASHINGTON (Reuters Health) - Americans' average life expectancy and infant mortality rates are at their best ever, though large gaps in health still exist between races, according to a report released by federal health officials Thursday.

According to the report, the average American infant born in 1999 is expected to live 76.7 years, with females enjoying a 5.5-year longer average than men. Still, white Americans have a life expectancy of 77.3 years on average, while African Americans could expect to live just 71.4 years.

Average life expectancy for white females ticked down slightly, from 79.5 years in 1998 to 79.4 years in 1999. Black males born in 1999 have an average life expectancy of 67.8 years, nearly 7 years shorter than for white males.

Experts credit improved hygiene, advancing health technology, and lower smoking rates with steady improvements in overall life expectancy during the 1900s. End-of-the-century average life expectancy was nearly double what it was in 1900 and 8.5 years longer than it was in 1950, according to the report.

Diane Maykuc, a statistician and co-author of the report from the federal Centers for Disease Control and Prevention ( news - web sites) (CDC), said that the study clearly shows "big picture improvements" in Americans' health since the middle of the century.

Overall annual death rates dropped in all age categories since 1950, while common causes of death, such as infectious disease and stroke, are all less prevalent than they once were.

Heart disease remains the nation's number-one killer, claiming the lives of 725,000 Americans in 1999. The figure is down slightly from 20 years ago. Meanwhile, deaths from cancer increased by 32% between 1980 and 1999, reaching nearly 550,000 in that year.

Infant mortality rates remained at 7.2 infant deaths per 1,000 live births in 1998, the last year for which data were available. The figure was unchanged from the previous year but is the lowest of the 20th century.

The US ranks 28th in the world in infant mortality, down from 12th in 1960. "Our ranking isn't great, but overall rates are declining," Maykuc said. Hong Kong was ranked first, with an overall infant mortality rate of 3.2 deaths per 1,000 live births.

Officials said that they were encouraged by continued improvements in life expectancy, a crude measure of Americans' overall health. But along with the improvements come challenges, Maykuc said. The number of Americans over 65 has nearly tripled since 1950, now comprising 13% of the US population. In 1950, seniors accounted for just 8% of the population.

"The aging of the population is one of the great challenges the country will face," she said.

The exploding elderly population is already taking heavy tolls on the nation's finances. Americans spent $1.3 trillion on healthcare in 1999, a figure that is expected to rise as the population ages and requires more care.

The US already spends 13.1% of its gross domestic product on healthcare, far more than any other nation, according to the report. More than 40 million Americans were without any form of health insurance in 2000.

Officials also remain concerned about exploding rates of obesity among Americans. As many as 61% of Americans are now considered overweight or obese, including 13% to 14% of children. The percentage of overweight children and adolescents has nearly tripled since the 1960s.

Experts are beginning to see the effects of obesity on the nation's health, Maykuc said. Deaths from diabetes, a leading consequence of obesity, doubled between 1980 and 1999, according to the report.

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Gulf War Illness Not Stress-Linked

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 12, 2002

THURSDAY, Sept. 12 (HealthScoutNews) -- As the United States readies for a potential second round of war in Iraq, British scientists say Gulf War ( news - web sites) illness from the first conflict isn't fallout from stress or other psychological trouble.

In a finding that some American veterans groups suspected all along, a new study says that U.K. veterans of the 1991 Persian Gulf War who still complain of physical ailments aren't significantly more likely to have psychiatric diagnoses than those without such symptoms or other vets in Britain's armed services.

"Ill health in Gulf War veterans cannot be fully accounted for by clinical psychological problems, such as depression, anxiety, alcohol problems and post traumatic stress disorder (PTSD)," said Dr. Khalida Ismail, a scientist at the Gulf War Illnesses Research Unit at Guy's, King's and St. Thomas's School of Medicine in London.

Ismail acknowledged that her study, in the Sept. 14 issue of the British Medical Journal, doesn't make inroads into the cause or causes of Gulf War syndrome ( news - web sites). Some American scientists have argued that the illness resulted from exposure to a jumbled cocktail of chemicals including nerve gas, insecticides and other substances. But Ismail won't endorse that explanation without concrete evidence -- proof that doesn't yet exist.

Most Gulf War complaints involve chronic pain, fatigue, rashes and other relatively mild symptoms. Yet some are far more serious.

After years of denying any health risk associated with service in the Persian Gulf, the U.S. government in 2001 acknowledged that vets had double the normal risk of developing Lou Gehrig's disease ( news - web sites). More than half the soldiers who contracted the rare and always fatal muscle-melting disorder as a result of their military service have since died.

Unproven, but under investigation, are links to multiple sclerosis and certain cancers. Conflicting evidence also exists for an increase in birth defects among the children of Persian Gulf vets.

In a previous study, Ismail and her colleagues sent a health questionnaire to three groups of British soldiers: some who served in the Gulf War theater, others who were stationed away from the area at the same time, and a group sent as peacekeepers to Bosnia. Some of the vets had chronic physical complaints.

The survey seemed to show a higher prevalence of emotional disorders in the Gulf combat soldiers with persistent bodily ailments, she said. To investigate further, the researchers examined in person a subset of their original population, consisting of about 340 vets in all.

This time, Ismail's group found that about a quarter of the Gulf War vets with physical symptoms also had clinically diagnosable emotional disorders. That rate was roughly equal to the prevalence of these conditions in the other soldiers. The rate of PTSD ran about 1 to 3 percent across the three groups surveyed.

"Some Gulf War veterans have got more psychological problems," Ismail said. "But it's not enough to explain" Gulf War illness.

Phil Kraft, a counselor with the National Veterans Services Fund in Darien, Conn., said the latest study confirms what his constituents have been claiming. "This puts it all exactly in the court that Gulf War vets want it. That way it's not all in your head, it's not imagined," Kraft said.

Steve Robinson, a Gulf War vet who is now executive director of the National Gulf War Resource Center, said the British study and related American research show that PTSD rates of soldiers in the region were lower than for any other conflict analyzed.

"Stress has been the main object of everyone's focus. Although there are some vets with that problem, the majority of them are complaining about things unrelated to" PTSD, Robinson said.

Robinson, who sits on a Veterans Affairs committee looking into Gulf War ailments, said more than 350,000 of the 700,000 combat vets from the mission have sought treatment at VA hospitals for service-related complaints. "That's staggering," he added.

So are there lessons from the first Iraq attack that might protect soldiers in a future assault?

Robinson believes there are, but he accused the Pentagon ( news - web sites) of ignoring them. Perhaps most important, he said, the government has failed to fully implement a law that requires screening of soldiers before, during and after the mission. Doing so would help identify emerging illness trends, he said.

Robinson also said even today's high-tech armed forces are ill-equipped to deal with chemical and biological agents they might face in Iraq. "Our detectors don't detect, our alarms don't work properly. And we've told Saddam [Hussein, Iraq's leader] that we're coming in the front door."

When attacking an enemy known to harbor chemical and biological weaponry, such advanced notice is "bad policy," Robinson said.

"All of [the scientific evidence] points to the fact that there's a problem," Robinson added. "If we're getting ready to go back, we need to address the veterans that were there 11 years ago because they have significant health concerns that are still not being addressed today, even though science has shown that it's more than stress."

Military officials were not available for comment today.

What To Do

For more on Gulf War illness, try the military's GulfLink web site or the National Gulf War Resource Center.

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Nonsmokers Respond Better to Crohn's Disease Drug

Reuters Health

Thursday, September 12, 2002

NEW YORK (Reuters Health) - Crohn's disease patients who don't smoke, and those who already take immune-system suppressing drugs, show a better response to the drug infliximab, research shows.

Crohn's disease is a digestive disorder caused by intestinal inflammation that leads to abdominal pain, diarrhea and weight loss. Infliximab blocks tumor necrosis factor alpha, a protein believed to be key in the inflammation involved in Crohn's. While the drug is effective for patients who don't respond to other therapies, it is expensive, must be given intravenously and has been linked to some complications, the researchers note.

Because of the drug's expense and possible toxicities, it would make sense to limit its use to those patients who are likely to experience a therapeutic response, study author Dr. Jean-Paul Achkar from The Cleveland Clinic Foundation and colleagues note.

To determine which patients might respond best to infliximab, Achkar's team analyzed data from 100 patients with Crohn's disease who were treated with infliximab and followed them for at least 3 months. Some had inflammatory disease only. Others had fistulas, which are abnormal tube-like openings from a body cavity to the body surface or to another body cavity. Patients with inflammatory disease received at least one infliximab infusion, while those with fistulous disease received at leastthree.

In patients with inflammatory disease, those who didn't smoke and used immunosuppressive therapy were more likely to respond to treatment, the researchers found.

Seventy-three percent of nonsmokers showed a clinical response to the drug, compared with only 22% of smokers, the authors note. Furthermore, a response lasting longer than 2 months was much more common among nonsmokers. Concurrent immunosuppressive use was associated with both the likelihood of achieving a response and the duration of response.

In the fistulous disease group, smoking was associated with a reduced duration of response but did not affect the likelihood of response, the researchers report. Concurrent immunosuppressive use did not appear to have an effect on either of these variables.

It is unclear why smoking reduces the likelihood of a response to infliximab, Achkar's team states. One possible explanation is that smoking alters some immune system components, making patients more resistant to the anti-inflammatory effects of the drug.

"While awaiting further validation, we recommend concurrent immunosuppressive therapy in patients with inflammatory Crohn's disease and strongly encourage smoking cessation in all Crohn's disease patients and especially those who are being considered for infliximab therapy," the investigators conclude.

Source: Gastroenterology 2002;123:707-713.

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Pregnancy Hormone Levels May Affect Coffee Craving

Reuters Health

Thursday, September 12, 2002

NEW YORK (Reuters Health) - Although previous studies have suggested that drinking coffee early in pregnancy can increase the risk of miscarriage, a new study suggests that it is the health of a woman's pregnancy that influences her taste for coffee--not vice versa.

Dr. Christina C. Lawson of the National Institute for Occupational Safety and Health in Cincinnati, Ohio and her colleagues found that the surge of hormones that comes with a healthy pregnancy may cause some women to lose their taste for coffee.

"A healthy pregnancy will produce a surge of pregnancy hormones that in some women will result in a strong aversion to the smell or taste of coffee," Lawson told Reuters Health. "Conversely, unchanged coffee or caffeine consumption could be indicative of a vulnerable pregnancy that produces lower hormone levels."

Previous studies have tried to eliminate the influence of "coffee aversion" from their results, Lawson noted, but have done so by using nausea to represent how a woman's hormones were affecting her taste for coffee. This may not be good enough, she said.

Her study found that on average, a woman's level of nausea or appetite loss was not related to how much coffee she drank.

"Our study showed that nausea was not a good surrogate for coffee consumption as it related to pregnancy hormones. Therefore, we feel strongly that future studies need to correct for coffee aversion as a pregnancy symptom," Lawson said.

During the study, Lawson and her team followed 92 women during the beginning of their pregnancies, recording how much coffee they drank, including decaffeinated. All of the women drank coffee during their last menstrual period, and most stopped or decreased the amount they consumed during the first trimester of pregnancy.

The investigators also noted the women's symptoms of nausea and vomiting, and measured levels of pregnancy hormones in their urine. In general, higher levels of pregnancy hormones during early pregnancy indicate that the fetus is more likely to be healthy, they point out in the report published in the American Journal of Epidemiology.

Lawson's team found that most women cited coffee aversion as the reason they decreased the amount of coffee they drank during early pregnancy. In addition, women who decreased how much coffee they drank during early pregnancy also tended to have higher levels of pregnancy hormones, they note. Coffee drinking also appeared linked to how much a woman was vomiting, but not how much nausea she felt, or whether her appetite decreased.

"Our study showed that coffee consumption decreased significantly as hormone levels rose," Lawson said, suggesting that healthy increases in hormones can cause women to cut back on coffee.

The researchers also found that the women who drank more coffee tended to have lower levels of one particular pregnancy hormone. While these lower levels were still enough to maintain pregnancy, the authors add, they could be of concern to women with fertility problems.

As to how coffee affects pregnancy, the current study shows that, in regard to that question, the jury is still out.

"There have been no clear studies to date that show whether drinking moderate amounts of coffee during pregnancy has detrimental effects," Lawson said. "If a woman has a question about coffee consumption during pregnancy, she should consult with her healthcare professional."

Source: American Journal of Epidemiology 2002;156:428-437.

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Prostate Cancer Therapies About Equal
Having Surgery May Extend Patient's Life

By David Brown
Washington Post Staff Writer

The Washington Post
Thursday, September 12, 2002

Men with prostate cancer who decide not to undergo surgery and instead opt to treat only the symptoms of their disease do just about as well as men who are operated on, at least in the initial six or seven years after diagnosis.

Neither strategy shields a man from serious side effects, such as impotence or urinary problems, although the spectrum of problems differs, depending on which therapy is chosen.

Those are the main conclusions of two studies, published in yesterday's New England Journal of Medicine, that examined one of the most controversial issues in medicine -- how to treat prostate cancer. While the research produced no clear winner between therapies, it adds important details to the complicated picture of risks and benefits each patient must confront.

"The decision will still be difficult," said Lars Holmberg, a Swedish physician at Uppsala University, who helped lead the experiment. "But at least now we have a chance for better-informed guesses about a man's future than we did before."

Prostate cancer is one of the slowest-growing human cancers, and also one of the commonest. Small prostate tumors can be found in a majority of men who die in their eighties of other causes.

Some doctors oppose routine surgery in elderly men, and argue that a cure is unlikely, complications are common, and a patient is more likely to die of other causes before the tumor spreads and becomes fatal. Others argue that surgery is better, largely because doctors believe it extends life.

The debate was made more complicated in the last decade by the huge popularity of prostate specific antigen (PSA) testing, which measures the blood level of a protein made by growing prostate tissue, including tumors. PSA testing caused a spike of cancer diagnoses -- and operations -- in the early 1990s, especially in men who had no symptoms and were younger than the age at which prostate cancer had traditionally been found.

The Scandinavian study, which enrolled men from 1989 to 1999, straddled that period. Slightly more than half of patients had symptoms of prostate or urinary tract disease. In the rest, the cancer was found as the result of rectal examinations, PSA measurements and other tests.

In the experiment, nearly 700 Scandinavian men with prostate cancer were randomly assigned to either undergo potentially curative surgery or to use "watchful waiting" as the main approach to their disease.

Some of the men in the watchful-waiting group had surgery if they developed problems urinating. Many also received hormone or radiation treatments to shrink the size of their tumors (as did some of the surgery patients). None of those treatments was intended to cure them, however.

After about six years, 62 people in the watchful-waiting group had died, compared with 53 of those assigned to undergo an operation called a radical prostatectomy. Statistically, this outcome was a draw.

Men getting surgery, however, had only half the risk of dying of prostate cancer. This showed that radical prostatectomy appears to be curative in a substantial number of cases.

Furthermore, the cancer had spread to distant organs in only half as many men in the surgery group as in the watchful-waiting group. Because the average patient lives only two years once the disease gets to that stage, that observation suggests the surgery group may ultimately survive longer.

In the second study, the Swedish researchers asked the men about the complications of their disease and how much the problems bothered them.

Problems with sexual function were more common in the surgery group (80 percent) than in the watchful-waiting group (45 percent), as were problems of urine leakage (49 percent compared with 21 percent). Difficulty urinating was more common in the watchful-waiting patients (44 percent compared with 28 percent). Most of the surgery patients did not get "nerve-sparing" operations, which appear to reduce the risk of those complications.

Overall, about 35 percent of men in both groups reported "low or moderate" psychological well-being, and about 40 percent in both reported "low or moderate" quality of life.

Gunnar Steineck, an oncologist and epidemiologist at the Karolinska Institute in Stockholm, said that previously, the assumption was that if a patient chose surgery, he "had to trade quality of life to win length of life. The results [of the study] do not support that."

Overall, Steineck said, "I think doctors are going to be on much safer ground depicting the alternative [treatment] scenarios."

There may be debate among American physicians "about what does it mean in the real world," said Martin I. Resnick, a urologist at Case Western Reserve University, and president-elect of the American Urological Association.

The average age of men in the Scandinavian study was 65. In the United States, the average age of men diagnosed with prostate cancer has been falling steadily and is now about 60. Furthermore, most cases are found through PSA testing and before the patients have any symptoms.

"It is not uncommon to find men in their early fifties who have prostate cancer, while that was highly unusual a decade ago," he said.

How watchful waiting performs in that group is unknown, but a clinical trial is underway in Veterans Affairs hospitals here trying to answer the question.

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WEDNESDAY, SEPTEMBER 11, 2002

One a day may protect infants from cancer

Reuters
Wednesday, September 11, 2002

WASHINGTON -- Pregnant women, already urged to take multivitamins to prevent birth defects such as spina bifida, may also be protecting their babies against cancer, researchers said recently.

They found that women who took vitamins during pregnancy cut their children's risk of neuroblastoma, a kind of nervous system tumor, by 30 to 40 percent.

The U.S. and Canadian researchers could not pinpoint which vitamin was responsible, but said other studies have suggested vitamin use during pregnancy may protect against childhood leukemias and brain tumors.

"Neuroblastoma ... is the most common tumor diagnosed in infants and is usually diagnosed in children under age 3," Dr. Andrew Olshan, a professor of epidemiology at the Univeristy of North Carolina who led the study, said in a statement. "Typically, fewer than 50 percent of affected patients live five years following diagnosis."

In the United States, 9.1 out of every 1 million children develop neuroblastoma.

Olshan's team, working with colleagues at the M.D. Anderson Cancer Center at the University of Texas in Houston, the U.T. Health Science Center in San Antonio and the University of Minnesota, looked at 538 children with neuroblastoma in 139 U.S. and Canadian hospitals.

They compared them with 504 comparable children without neuroblastoma, and asked the mothers whether they took vitamins before, during and after pregnancy, and looked at other possible health-related factors.

Olshan said the findings clearly suggest women who took vitamins were less likely to have children who developed neuroblastoma. He said more study needs to be done, especially to pinpoint which vitamins may be responsible.

Pregnant women or women who may conceive are advised to take a daily vitamin containing folic acid, which can protect against spina bifida and related defects of the spinal cord.

Many multivitamins contain high levels of vitamin A which, if too much is taken, can cause birth defects, so women are advised to study labels carefully and consult their doctors.

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Many Sex Offenders Had Bad Fathering During Youth

Reuters Health

Wednesday, September 11, 2002

NEW YORK (Reuters Health) - Many incarcerated rapists and other violent offenders may have had fathers who were unresponsive to their needs during their early years, recent study findings suggest.

While this does not mean that the early father-son relationship determines whether young boys grow up to become criminals, it may have "major implications for the prevention of crime, particularly the early detection and treatment of individuals who are at risk of developing antisocial lifestyles and attitudes," write study author Dr. Tony Ward of the University of Melbourne in Australia and his colleagues.

To investigate, the researchers interviewed 55 men incarcerated for child molestation and 30 men in prison for rape to determine their perceptions of their early relationships with their mothers and fathers. For comparison the study also included 32 men who were incarcerated for violent crimes and 30 men in jail for non-violent, non-sex-related crimes.

In general, study findings indicate that the fathers of the rapists and violent offenders were less responsive to their needs than the fathers of the other offenders, the investigators report in a recent issue of The Journal of Sex Research. The mothers and fathers of the rapists and violent offenders also did not seem to be as strict in supervision and discipline as did the parents of the other offenders.

Further, rapists and child molesters, to a lesser extent, rated their fathers as more rejecting, and all of the offenders rated their fathers as less consistent than their mothers.

"Clearly the behavior of fathers had more impact on specific types of offenders than did that of mothers, at least within an incarcerated group of offenders," the authors write.

Commenting on the study, Dr. Jules Burstein, a psychologist in private practice in Berkeley, California, told Reuters Health that although the research was "very responsible and very well done...it ought not to be taken as all kids with bad fathers are doomed to become moral monsters."

For these children--similar to those from other disadvantaged circumstances--it may just be "harder to carve out a decent life," he said.

Yet mothers who are concerned about their child's lack of a good father, particularly those with boys--who are much more at risk of becoming sexual offenders than girls--need not feel helpless, according to Burstein.

He advises that they "make really concerted, concrete efforts from the time boys are really young to develop a relationship with a responsible...surrogate male figure."

"It's much, much harder to have a good life if you don't have a good start," he added.

Source: The Journal of Sex Research 2002;39:85-93.

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CPR of Hospital Patients Rarely Successful: Report

By Alison McCook

Reuters Health

Wednesday, September 11, 2002

NEW YORK (Reuters Health) - Despite how well resuscitation works on television medical dramas, most adults who experience a cardiac or respiratory arrest while in the hospital do not survive, new study findings show.

In the study, researchers reviewed medical records of patients who experienced either cardiac or respiratory arrest and were treated with CPR, the insertion of a breathing tube or a defibrillator to shock the heart.

CPR is short for cardiopulmonary resuscitation, a procedure used to circulate oxygenated blood in the body of someone in cardiac arrest. In cardiac arrest--which is different from a heart attack--the heart stops beating, often due to an electrical or rhythm disturbance. CPR can be performed until the heart is shocked back into a normal rhythm using a defibrillator.

The researchers found that 22% of those for whom a healthcare worker was present during their arrest survived and were discharged from the hospital. In contrast, only one person who experienced an arrest while alone in the hospital survived and was able to return home, representing less than 1% of all unwitnessed cardiac or breathing arrests.

Lead author Dr. Peter G. Brindley of the University of Alberta in Edmonton, Canada, told Reuters Health that while these statistics appear grim, it is important for family members whose loved one has suffered an arrest to not be "unrealistically optimistic."

Doctors will work hard to revive a person whose heart or lungs have stopped working, he said, but family members deserve to know the truth: "Despite everybody's best efforts, there's a very good risk you will still be unsuccessful," he noted.

Brindley and his team base their findings on a review of medical records of 247 arrests that occurred between 1997 and 1999 at three hospitals in Edmonton. Of the total number of arrests, slightly more than half took place in front of a healthcare worker.

Of those arrests for which others were present, almost half of the patients were eventually resuscitated. Twenty-two percent lived long enough to leave the hospital, and less than 19% made it home, with the rest being enrolled in a long-term care facility.

People who suffered their arrests while alone fared much worse, Brindley and his team report in a recent issue of the Canadian Medical Association Journal. Only 21% of these patients were successfully resuscitated, and only one survived long enough to leave the hospital and go home.

On a similar note, people were more likely to survive a respiratory arrest than a cardiac arrest--probably because respiratory arrests were almost twice as likely as cardiac arrests to occur in front of a healthcare worker, Brindley told Reuters Health in an interview.

As to why patients who experience arrest have a slim chance of full recovery, Brindley explained that resuscitation consists of trying to revive someone who would certainly die without any intervention.

"If someone is sick enough to require hospital admission, and in addition, despite all of the resources of a major hospital, still deteriorates to the point that the heart and lungs fail, this person is just that sick, and has unfortunately possibly reached the end," Brindley said.

Source: Canadian Medical Association Journal 2002;167:343-348.

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Flaxseed May Cut Cholesterol Slightly in Women

Reuters Health

Wednesday, September 11, 2002

NEW YORK (Reuters Health) - Flaxseed may help to reduce levels of cholesterol in the blood of postmenopausal women, researchers report.

Overall, total cholesterol fell in the women by an average of 6%, according to the report in the Journal of Clinical Endocrinology and Metabolism. While LDL cholesterol fell, so did HDL ("good") cholesterol, resulting in only a minor reduction in the ratio of "bad" to "good" cholesterol.

Flaxseed is a whole grain that can be found in health food stores and some supermarkets. It can be sprinkled on food, or is sometimes used in baked goods, such as muffins or bread. Flaxseed is rich in lignans, a group of phytoestrogens. These plant-based estrogen-like compounds are associated with lower levels of total cholesterol and LDL ("bad") cholesterol, possibly due to their fiber and omega-3 fatty acid content.

In the study, volunteers consumed 40 grams of either ground flaxseed or wheat daily for 3 months. All 36 women who completed the study took a supplement containing 1,000 milligrams of calcium and 400 international units of vitamin D, which helps the body to absorb calcium.

Apolipoprotein B (apo B), a cholesterol-carrying molecule that may be a more sensitive indicator of heart disease risk than cholesterol alone, fell by nearly 8% among women who consumed flaxseed.

There was no reduction in cholesterol among women who took the wheat supplement, report researchers, and neither the flaxseed nor the wheat had any affect on bone metabolism.

"The findings of the present study suggest that flaxseed consumption by postmenopausal women is effective in reducing...known risk factors of coronary heart disease," Dr. Bahram H. Arjmandi from Oklahoma State University in Stillwater and colleagues conclude.

But more research is needed into the mechanisms, they add.

Source: The Journal of Clinical Endocrinology and Metabolism 2002;87:1527-1532.

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Animal Drug Guidelines Proposed

By Emily Gersema

Associated Press Writer

The Associated Press

Wednesday, September 11, 2002

WASHINGTON (AP) - Federal regulators are proposing guidelines to evaluate the safety of animal drugs amid concerns that the pharmaceuticals can end up in the food supply, enabling bacteria that can sicken humans to become resistant to drug treatment.

The Food and Drug Administration ( news - web sites) released the proposal Wednesday. It outlines strategies that manufacturers of animal drugs could use to determine if their new pharmaceuticals would contribute to the spread of resistant bacteria.

As more bacteria become immune to leading antibiotics, federal scientists are examining factors that may contribute to the problem, including the use of antibiotics on farm animals.

Many of the drugs fed to animals, such as penicillin, are also used to treat human illnesses.

The FDA said in the proposal that it believes humans are most likely exposed to resistant bacteria through food made from animals. Environmental groups, including Environmental Defense, said the agency is acknowledging that animal antibiotics are overused and are a health risk.

Larry Bachorik, an FDA spokesman, said the agency isn't making conclusions. It just wants to assess whether using drugs on farm animals is a health risk to humans, he said.

Environmental and health groups have criticized farmers for using antibiotics in animal feed when the animals aren't sick. The animal drug industry argues that feeding the antibiotics to farm animals actually makes food safer.

Karen Florini, a spokeswoman for Keep Antibiotics Working, said the draft proposal is a sign that federal regulators are recognizing antibiotics are overused in livestock farming. But she said the agency is failing to address the problem that farmers are using large quantities of the drugs.

"The elephant in the room is the vast quantity of antibiotics already being administered to farm animals," said Florini, who also works for Environmental Defense.

But the Animal Health Institute, a group representing drug manufacturers, said the draft merely provides a framework for manufacturers to use when identifying the risks involved with new drugs.

"The concept of risk assessment is a far better tool than legislative bans, which is what some groups have proposed," said Ronald Phillips, a spokesman for the group.

Sen. Edward Kennedy, D-Mass., and Rep. Sherrod Brown, D-Ohio, have proposed legislation that would restrict the use of some antibiotics for animal use. Florini said the proposal will probably be discussed next year.

The FDA is seeking comments from the public on its proposed guidelines.

On the Net:

Food and Drug Administration: http://www.fda.gov

Keep Antibiotics Working: http://www.keepantibioticsworking.com

Environmental Defense: http://www.environmentaldefense.org

Animal Health Institute: http://www.ahi.org

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Vitamins C, E May Prevent Artery Damage: Study

Reuters Health

Wednesday, September 11, 2002

NEW YORK (Reuters Health) - Both vitamins C and E, taken alone, may prevent a type of oxidative damage tied to cardiovascular disease. However, taking the two vitamins together doesn't seem to give an added benefit, according to researchers.

In a study of 184 non-smoking adults, investigators found that taking either vitamin C or E reduced the oxidation of blood fats called lipids. Oxidation is a normal chemical reaction in the body, but the process can also damage cells. Lipid oxidation is believed to play a key role in the development of the artery-clogging disease atherosclerosis, which can lead to heart attack or stroke.

A number of studies have suggested that antioxidant vitamins like C and E may help ward off oxidative damage--and that these two vitamins may enhance each others' protective powers. But much of this research has been in the lab rather than in people, the authors of the new study point out.

So the researchers, led by Dr. Han-Yao Huang of Johns Hopkins University in Baltimore, Maryland, looked at how vitamins C and E, alone or together, affected lipid oxidation in middle-aged and older adults.

Over 2 months, participants followed one of four daily regimens: 500 milligrams (mg) of vitamin C alone; 400 international units (IU) of vitamin E alone; both vitamins together; or placebo (inactive) pills. They were instructed to take no other vitamins during the study.

The researchers found that both vitamins C and E lowered urine levels of a particular substance that is a byproduct of lipid oxidation--a substance that has been found to be elevated in cigarette smokers and people with diabetes and high cholesterol. However, the vitamin combo was no more effective than either C or E alone.

The findings are published in the September issue of the American Journal of Clinical Nutrition ( news - web sites).

Past studies on the effects of antioxidant vitamins against cardiovascular disease have come up with conflicting results, particularly when it comes to treating established artery disease. According to Huang's team, antioxidants may be most effective in the earliest stages of atherosclerosis, when lipid oxidation is key.

They also note that the daily vitamin C dose used in this study is attainable through diet, while the vitamin E dose is "virtually impossible" to come by through food alone.

Food sources of vitamin E include wheat germ, nuts and vegetable oils. Citrus fruits, strawberries, tomatoes and broccoli are among the top sources of vitamin C.

Source: American Journal of Clinical Nutrition 2002;76:549-555.

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AIDS Virus Lurks in Fat Cells, French Study Finds

By Maggie Fox

Reuters

Wednesday, September 11, 2002

BALTIMORE (Reuters) - The AIDS ( news - web sites) virus, long known to infect immune system cells, also takes up residence in fat cells, French researchers report.

They found HIV ( news - web sites) in the fat tissue of patients with irregular fat deposits known as lipodystrophies--a side-effect of long-term drug treatment for the virus.

The finding could help explain why HIV has proven impossible to eradicate, and it may open a whole new window in understanding how the fatal and incurable virus works, experts told a conference.

France Pietri-Rouxel of the Institut Cochin in Paris and colleagues stumbled upon the finding by accident, when she was treating HIV patients whose body fat began to redistribute itself in odd ways--the condition known as lipodystrophy.

A specialist in fat tissue, she was removing fat from the abdomens of the patients and injecting it into their cheeks to fill out their faces. "The thin, gaunt face is one of the disturbing signs of an HIV patient," she said in an interview. Jacques Leibowich of Hospital Foch in Suresnes, France, asked her for samples of the fat tissue for an unrelated study he was doing. To his surprise, HIV genetic material turned up in the tissue.

The human immunodeficiency virus, discovered 20 years ago, is known to infect immune system cells. It favors CD4 T-cells, lymphocytes that respond to infection.

The virus grapples the cells, injects its genetic material in the form of RNA, and forces the cell to manufacture more copies of itself.

To do this it uses receptors, a kind of molecular doorway into the cell. The two main receptors HIV uses are called CD4 and CCR5--both found on T-cells.

But fat cells also have CCR5 receptors, and now it appears HIV must use these to infect fat cells, Leibowich and Pietri-Rouxel told a meeting of the Institute of Human Virology, part of the University of Maryland in Baltimore.

Robert Gallo, head of the Institute and one of the men who discovered HIV, said the finding could help explain why HIV lurks in the body for years despite treatment with drugs that can suppress its activity. Experts believe it must lie low in a pool of cells known as a reservoir.

"That could be a major contributor to the reservoir," Gallo said. "It could also be the reason that some people with HIV lose fat."

Pietri-Rouxel said all seven patients she treated had HIV in their fat. All were taking drug cocktails known as highly active antiretroviral treatment or HAART, which had knocked the virus in their body to levels that cannot be detected in blood tests.

"What we don't know is the relationship between the treatment and the infected cells," Pietri-Rouxel said.

"Could the treatment have caused it?" asked Leibowich.

Pietri-Rouxel said there was some evidence the virus was acting as it does in other cells and using them as little factories to make copies of itself, but she cautioned that this was not yet certain.

If all fat cells in an HIV patient are infected, the implications could be serious, Leibowich said. "A person has about a kilogram (two pounds) of lymphocytes," he said. "But someone like me has 15 kilograms (30 pounds) of fat. So fat cells could be the more important source."

The researchers now plan to look for infected fat cells in other HIV patients, especially those who have not developed lipodystrophies.

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Anthrax Treatment in Development by Dutch Firm

By Justin L'Anson Sparks

Reuters Health

Wednesday, September 11, 2002

LONDON (Reuters Health) - A drug that can treat advanced anthrax infections could be on the market within 3 years if laboratory results are verified in animal and human trials, a Dutch biotechnology company said on Wednesday.

Respiratory anthrax, the most lethal form of the disease, occurs when a person inhales spores of the Bacillus anthracis bacterium. The spores germinate to produce growing bacteria, which release a deadly toxin.

Five people died and 13 were taken ill after anthrax-tainted letters were sent to government officials and media outlets in Washington, DC, Florida and New York in the weeks following the September 11 attacks last year.

In early stages of the disease, the bacterial infection can be treated successfully with antibiotics, but antibiotics will not neutralize the toxin.

"We have succeeded in selecting and cloning the human cells which create antibodies to deal with that toxin," Dr. Roland Lageveen, managing director of IQ Corporation BV, told Reuters Health.

"By the time anthrax symptoms appear, such as black spots on the skin, it is normally too late to help a patient, but antibiotics in combination with these antibodies could be enough to cure patients even in acute stages of the disease," he said.

The human monoclonal antibodies developed by IQ Corporation prevent the deadly toxin from binding to cells. The company says they could be used as therapeutic agents to rescue victims exposed to anthrax, and also preventively to protect military personnel and bioweapons inspectors deployed on high-risk missions.

The details of the in vitro studies were presented on Wednesday at the Dangerous Pathogens 2002 conference in Bath, England.

The results are the fruition of a 3-year program carried out with the support of the Dutch, Italian and British ministries of defense and the US Naval Medical Research Center in Silver Spring, Maryland, the company said.

A spokeswoman for Britain's Defense Science and Technology Laboratory Porton Down, part of the Ministry of Defense, told Reuters Health the early results were promising.

"We are keen to pursue a technology such as this which, although still in its early stages, could lead to a highly specific protective therapy which could save lives in exposed individuals," she said.

The success of the laboratory trials has been verified by the US Food and Drug Administration ( news - web sites), and animal trials are set to begin next year, the company said. Assuming clinical studies are successful, Lageveen estimated that the drug will reach the market within 2 to 3 years.

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Overuse of Anthrax Drug May Prove Deadly: Scientist

By Patricia Reaney

Reuters

Wednesday, September 11, 2002

LEICESTER (Reuters) - Overuse of the drug that was widely taken during the US anthrax attacks last year could lead to more deaths from antibiotic-resistant infections than from the bacteria, a British scientist said on Wednesday.

More than 30,000 prescriptions for Bayer AG's Cipro were written last year after anthrax-tainted letters, which killed five people, were sent to US government officials and media outlets in three states in the weeks following the September 11 attacks.

Many more people self-prescribed the drug after obtaining it from the Internet or abroad, which increased the risk of drug resistance as well as complications from serious side effects.

"Here we have a situation where a very important broad-spectrum antibiotic is massively used and we have the risk that more people can develop drug-resistant complications, which could lead to death, than would have actually been killed in the anthrax attacks," Dr. Chris Willmott told a science conference.

The professor at Leicester University in central England cited research from scientists at Johns Hopkins University in the United States, who modeled the impact of 5,000 prescriptions of Cipro. The results suggested it would have prevented nine cases of anthrax.

"At the same time, about two people per hour in American hospitals are dying of complications of drug-resistant bacteria. That equates to around about 17,000 people a year," Willmott added.

Cipro, or ciprofloxacin, is an antibiotic that is used for a wide range of bacterial infections and life-threatening illnesses such as pneumonia, meningitis and septicaemia, which unlike anthrax can easily be transmitted to other people.

Willmott told the British Association for the Advancement of Science ( news - web sites) festival that overprescribing Cipro increases the threat of resistance and could make people vulnerable to other infections.

The US Centers for Disease Control and Prevention ( news - web sites) now recommends doxycycline, a member of a different class of antibiotics, instead of Cipro against anthrax.

"The frenzy whipped up regarding Cipro as the only cure for anthrax led to widespread and unnecessary self-prescription of ciprofloxacin," said Willmott.

"It remains to be seen if there is a significant increase in resistance-associated fatalities resulting from this unregulated misuse of a vital antibacterial drug," he added.

Last month, scientists at Rockefeller University in New York announced they may have found a new treatment that would make it impossible for anthrax to mutate into a resistant form.

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Regular Exercise Tied to Longer Menstrual Cycles

Reuters Health

Wednesday, September 11, 2002

NEW YORK (Reuters Health) - Regular, moderate exercise may stretch out the time a woman has between her menstrual periods, new study findings suggest.

The research supports one theory on why regular physical activity has been linked to a lower breast cancer ( news - web sites) risk, according to researchers. Some evidence suggests that hormonal changes brought on by exercise may help lower the chances of breast cancer developing.

However, the authors of the new study point out, this evidence comes largely from studies of highly athletic women who get few periods or have stopped menstruating altogether. Whether more-moderate exercise affects the menstrual cycle significantly is unclear, they note in the September 1st issue of the American Journal of Epidemiology.

To investigate, Dr. Barbara Sternfeld of Kaiser Permanente in Oakland, California, and her colleagues looked at two groups of women who had participated in separate US studies. The nearly 700 women in both studies had provided information on their exercise habits and menstrual cycles.

The researchers found that exercise, particularly vigorous activity, was associated with a somewhat longer menstrual cycle--or time between periods.

In one of the studies, both total physical activity and vigorous activities were tied to women's menstrual cycle length. But the effect was not seen among significantly overweight women.

In the other study, only daily vigorous exercise was tied to menstrual cycle length, and the add-on time was modest. The researchers estimate that, during a given menstrual cycle, an increase of 10 minutes per day of vigorous exercise would lengthen that cycle by about two-tenths of a day.

"These findings lend modest support to the hypothesis that moderate levels of physical activity can lengthen the menstrual cycle," Sternfeld and her colleagues conclude.

Relatively moderate activity, they add, "may have hormonal effects that may lengthen the menstrual cycle, resulting, over a lifetime, in lower levels or less cyclic fluctuations of estrogen and progesterone."

This could be a mechanism by which regular exercise may lower breast cancer risk, according to the researchers. They stress, however, that they do not know whether the possible hormonal effects seen in exercisers in this study may translate into any "meaningful" health effects.

Source: American Journal of Epidemiology 2002;156:402-409.

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'Biological Pacemaker' Created

By Mark Evans

Associated Press Writers

The Associated Press

Wednesday, September 11, 2002

Researchers have created a "biological pacemaker" in guinea pigs by slipping a gene into their hearts — a first step in what could lead to alternatives to the electronic devices now implanted in hundreds of thousands of people each year.

The healthy human heart already contains a small number of specialized "pacemaker" cells, which initiate the muscle's beat and determine its rate and rhythm of contraction. But old age or disease can cause the cells to malfunction, and mechanical pacemakers are needed to fix the trouble.

In their study, researchers at Johns Hopkins University used a virus to deliver genes to cells in the guinea pigs' ventricles — places in the heart where the animals have no natural "pacemaker" cells.

Three or four days later, some of the animals' ventricle cells had been converted into "pacemaker" cells — able to generate spontaneous, rhythmic electric activity on their own. Researchers speculated that this triggering capacity exists in all regions of the heart, but is suppressed in most cells.

"We effectively lifted the anchor, freeing muscle cells to re-establish ability they last held in the developing embryo," said Eduardo Marban, a molecular cardiologist and member of the research team. The study was published in Thursday's issue of the journal Nature.

The researchers said the added gene worked by blocking a mechanism that stifles a heart cell's ability to fire on its own.

Marban said the research marks a significant step toward new treatments for people who require electronic pacemakers. Roughly 250,000 Americans are implanted with the devices each year.

"We can now envision a day when it will be possible to recreate an individual's pacemaker cells or develop hybrid pacemakers, part electronic and part biologic," he said.

The study did not aim to find out the effect of the genetically altered cells on the guinea pigs' overall health or survival. Marban's team is conducting a study now on pigs to determine that. He said trials on humans are at least a few years away.

David Faxon, chief of cardiology at the University of Chicago, called the study interesting but said it would take further research to show whether the transformed cells would work properly without causing trouble, and give long-lasting help.

"There are lots and lots of things that would have to be done to show serious potential here," Faxon said, "but it's intriguing, no question."

On the Net:

Nature: http://www.nature.com

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Early Surgery Shown to Cut Prostate Cancer Deaths

Reuters Health

Wednesday, September 11, 2002

NEW YORK (Reuters Health) - In findings expected to help answer the long-debated question of how to treat early prostate cancer ( news - web sites), new research shows that prostate removal does cut men's risk of dying from the disease.

What's more, researchers say, although such surgery often carries significant side effects including impotence and incontinence, patients' overall quality of life after surgery may be no different from that of men who opt for "watchful waiting."

The question of whether to aggressively treat early prostate cancer is controversial, due to both the nature of the disease and the risks of treatment. It is estimated that by the time they reach age 75, at least half of men have some cancerous changes in their prostates, while up to one third of men may have microscopic signs of the disease at age 50. But far fewer will actually die of prostate cancer.

Watchful waiting means that when cancer is detected, no immediate treatment is given, and the patient is instead monitored for signs that his prostate cancer is progressing. The approach is based on the premise that early prostate cancer may grow so slowly that it will never become a serious health threat; studies have shown that men with early cancer confined to the prostate gland can live years without signs of disease.

But in the US, the past two decades have seen a sharp increase in surgery to remove the prostate gland--referred to as radical prostatectomy--despite the fact that it has been unclear whether it extends the lives of men with cancer confined to the prostate.

"There's been a lot of debate, a lot of doubt, about whether it's necessary to treat prostate cancer at its earliest, most curable stage," Dr. Patrick C. Walsh, a prostate cancer expert at Johns Hopkins Hospital in Baltimore, Maryland, said in an interview with Reuters Health.

But these new findings, from two studies of men in a long-range Scandinavian trial, provide "clear evidence" that surgery for localized prostate cancer cuts men's risk of dying from the disease, according to Walsh.

In fact, he said, he was "absolutely shocked" to see such a survival advantage emerge within the 8-year follow-up of the study patients. According to Walsh, the benefit should only grow over time.

Walsh wrote an editorial accompanying both reports in the September 12th issue of The New England Journal of Medicine ( news - web sites).

In one study, researchers found that men with localized prostate cancer who underwent radical prostatectomy were about half as likely to die of prostate cancer over 8 years than men in the watchful-waiting group. Overall, just under 9% of the 348 men in the watchful-waiting group died of prostate cancer, compared with 4.6% of the 347 men who received surgery.

However, the risk of death from any cause was comparable in both groups. The reason, for now, is unclear, the study's lead author told Reuters Health.

"Our main hypothesis is, so far, that this is a chance finding," said Dr. Lars Holmberg of the Regional Oncologic Center in Uppsala, Sweden.

The second study, also led by Holmberg, found that impotence and urinary incontinence were common problems after radical prostatectomy, but many men in the watchful-waiting group also reported these conditions.

Eighty percent of surgery patients had erectile dysfunction, as did 45% of watchful-waiting patients--which, according to Holmberg's team, could have been due to growing tumors in some cases. Watchful-waiting patients were also more likely to have an obstruction blocking urinary flow.

And despite their higher rate of impotence and urinary problems, patients who received surgery rated their well-being and quality of life as high as the other men did, the researchers