The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
September 30 , 2002

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

Personal Health for the Week of SEPTEMBER 7 - 13

  1. Many Sex Offenders Had Bad Fathering During Youth
  2. Blood Pressure Test May Signal Diabetic Kidney Risk
  3. Dogs, Day Care Linked to Kids' Ulcer Bug Risk
  4. Vitamin E May Help Keep Arteries Clear in Women
  5. Obesity Threatens to Reverse Gains in Longevity

    SUNDAY, SEPTEMBER 8, 2002

  6. AbioCor Heart Patient Nears a Year
  7. FDA Calls Botox Ads Misleading, Asks for Fix
  8. Check Your Cholesterol
  9. Heartburn Woes
  10. Hundreds Get Radiation Pills

    SATURDAY, SEPTEMBER 7, 2002

  11. Don't Have a Beef With Your Teens
  12. 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 Marbαn, 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.

Marbαn 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. Marbαn 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 found.

"We now have more secure information that (surgery) diminishes the risk of dying from prostate cancer, and we know more about the pattern of side effects both for watchful waiting and surgery," Holmberg said.

Walsh pointed out that men in the Scandinavian trial did not routinely receive so-called nerve-sparing surgery, a more recent advance in radical prostatectomy that can save the nerves that control erection in some men. More men might have avoided impotence had the technique been more widely used.

But Walsh also emphasized that there are men for whom watchful waiting is the best course, including more-elderly men and those with serious co-existing illnesses--in general, he explained, men whose life expectancy is less than 10 years. Some men with very early cancer caught through PSA screening may also want to opt for watchful waiting.

According to Holmberg, much depends on where a patient's priorities rest--whether survival rates or the risk of certain treatment side effects weigh more heavily.

"The doctor has to probe the patient's preferences really carefully and discuss the options openly," he said.

Source: The New England Journal of Medicine 2002;347:781-796, 839-840.

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Many Italians Have Unhealthy Habits: Survey

Reuters Health

Wednesday, September 11, 2002

FLORENCE (Reuters Health) - Too much salami, too much wine and too little exercise--that's the verdict on the health of Italians from a survey released by the national statistics bureau Istat at a meeting in Rome.

The report assessed the state of Italy's health and healthcare in 1999-2000. People with more education and more economically advantaged individuals tended to enjoy better health, the survey found.

One in four of Italy's 58 million citizens lead a sedentary life, the survey revealed, while 16 million are overweight and 4 million are obese.

Smoking is still a big problem in the country: there are 12 million smokers, 32.2% of men and 18.2% of women. The growing number of young smokers is a particular concern, according to the report. Twenty-two percent of 14- to 24-year-olds smoke, an increase of nearly 9% since 1993.

Adolescents are also bad eaters, preferring meat and salami to rice, pasta, vegetables and fruit, the survey found.

Almost 3 million men and 500,000 women drink more than half a liter of wine every day, and 400,000 young people reportedly abuse alcohol.

Overall, the survey recorded a marked disadvantage in the south when it comes to healthcare, lifestyle and disability.

"The poor people of the south are in worse health condition compared to the poor people of the north. We can't explain why this is happening," the report said.

More than 8% of the population, mostly women and old people, take daily doses of analgesics, sleeping pills, laxatives, nasal sprays or digestives, the survey found. Tranquilizers are used daily by 3.3% of the population, in particular old women.

The report comes on the eve of the presentation of a new drug reimbursement scheme. Health minister Girolamo Sirchia will introduce it on Thursday to the pharmaceutical trade organization Farmindustria, the pharmacist association Federfarma and the patients' rights group Tribunal of the Sick.

Under the new plan, which the government hopes will trim spending by at least 750 million euros in 2003, reimbursement eligibility for a drug will be established focusing on cost-effectiveness.

Changes in the list of reimbursable drugs will have to be made by the CUF (Pharmaceutical Commission) by 30 September. The new reimbursement scheme is expected to be effective by November.

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Smoking Up Among Firefighters Since 9/11

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 11, 2002

WEDNESDAY, Sept. 11 (HealthScoutNews) -- Martin Merrick, a 56-year-old New York City firefighter, has been smoking cigarettes since his early teens, but in all those years his strongest urge to smoke came right after the attacks on the World Trade Center.

 In the city's tightly knit team of firefighters, Merrick knew 83 of the 343 firefighters who died in the disaster.

"My smoking went up. I'm sure of it," he says nearly a year later. "You don't realize it at first because you're busy, but then it hits you. I talked to another firefighter I know, and he said he started smoking like crazy after September."

The two men aren't alone. To deal with the stress and grief following the terrorist attacks, 29 percent of the smokers in the 11,000-person Fire Department of New York City admitted smoking more cigarettes; 23 percent of the ex-smokers said they had started again, according to data collected by the department's medical office.

The figures dovetail with estimates released this week by the New York City Department of Health that 75,000 people may have taken up the habit for the first time as a result of 9/11.

The disturbing trend didn't stop at the city line. Another survey found 21 percent of smokers increased their smoking in New York, New Jersey and Connecticut. One percent of nonsmokers started smoking and 3 percent of drinkers increased their alcohol intake, according to the Centers for Disease Control and Prevention ( news - web sites).

However, among the firefighters, who are often exposed to carcinogens that can become much more damaging when coupled with smoking, the risks are extreme, says Dr. David J. Prezant, the fire department's deputy medical officer.

"Firefighting is one of the most stressful jobs in America. You come across death on a regular basis, unfortunately too regular," he says. "Most of these people who smoke want to stop smoking, now more than ever."

To help firefighters kick the habit, the department last month began offering a free stop-smoking course designed for firefighters. Merrick, who works in the medical examiner's office, is one of the 160 firefighters who have already started the weekly course.

"I've tried it before. I must have tried it 10 times or more, but it only lasts a week or so," Merrick says about his efforts to quit. This time, because of help from his comrades and his daughter's ultimatum that he can't visit his grandson if he smokes, the 30-year firefighter has held on longer than ever before.

"The first week was a little tough. I had a few cigarettes," he says. "But it's been about three weeks since I had a cigarette. It feels good."

The program relies on nicotine replacement therapies such as inhalers and patches; small group sessions to discuss cravings other aspects of quitting smoking, and medical monitoring of all participants. The department is also offering the program to spouses of the firefighters to root the behavior change in the family.

Prezant helped design the program after examining other smoking cessation initiatives. Other sponsors are the Chest Foundation and Pharmacia Corp., makers of the Nicotrol line of smoking cessation products.

"I can't take away their exposure from 9/11. I don't have a magic wand," Prezant says. "But I want to look forward the next 20 years for their health, and one of the most major modifiable behaviors is smoking."

Besides preventing the long-term dangers of smoking, there are other reasons for addressing the smoking trend by New York City firefighters and nearby residents, says David Vlahov, director of the New York Academy of Medicine's Center for Urban Epidemiological Studies. Smoking is just one sign of a panic attack that can also lead to depression and drug and alcohol abuse, which should also be treated.

"The World Trade Centers were a symbol for the city. To what extent did this affect the general attitude of the city?" Vlahov says. "We were wondering if there were going to be ripple effects to the disaster that continue to affect us."

For the New York City firefighters, the cessation program is so successful the fire department plans to expand it to bring in more of the 1,500 firefighters who smoke.

"Right now we have more people than we can handle. That's still only 10 percent of what we want to get, but every week we're starting a new program," Prezant says.

What To Do

For tips on stopping smoking, visit the Centers for Disease Control and Prevention. For a list of groups that run smoking cessation programs in your area, go here.

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Gene in Rare Disorder May Boost, Cut Cancer Risk

Reuters Health

Wednesday, September 11, 2002

NEW YORK (Reuters Health) - Scientists studying a rare disease that makes people prone to multiple types of cancer have discovered a gene with an unusual characteristic--it seems to protect against cancer in some circumstances, but promote the disease in others.

The gene is called LKB1, and it is mutated in people with Peutz-Jeghers syndrome, a rare inherited disorder that causes ink-like spots on the lips or hands, benign polyps of the intestines and malignant tumors of the pancreas, intestine, stomach or breast later in life.

In a new study, Dr. Ronald A. DePinho of Harvard Medical School ( news - web sites) in Boston, Massachusetts and colleagues developed mice that lacked their version of the gene, known as Lkb1. They found that, like humans with the disease, the mice developed benign polyps in the stomach and intestine as they aged.

However, when they studied the Lkb1-deficient cells in laboratory culture dishes, they made a surprising finding. The Lkb-1 deficient cells grew rapidly and perpetually--characteristics of cancer cells. But when the researchers introduced cancer-promoting genes into the Lkb1-deficient cells--a step that typically turns normal cells into cancer--they were remarkably resistant to the transformation.

"At first glance, these features appeared paradoxical," according to lead author Nabeel Bardeesy, of the Dana-Farber Cancer Institute and Harvard Medical School. However, the finding may explain the puzzling symptoms seen in patients with Peutz-Jeghers syndrome.

Patients who lack the gene tend to get many types of cancer, suggesting LKB-1 is a tumor suppressor gene. However, patients also have cells that grow out of control in the intestines--causing unusual polyps--that never become cancerous.

Because many cellular mistakes must occur before a cell can become cancerous, the researchers believe timing is the key to LKB1. An early mutation in LKB1 may cause rapid cell growth, but make cells resistant to further cancer-causing changes. However, if a cell already has undergone several cancer-causing changes, a defect in LKB1 may push it into the cancer zone, according to Bardeesy.

The findings are published in the September 12th issue of Nature.

"Although we need to investigate the matter further, our work suggests that LKB1 mutations might affect the cells in a context-dependent manner," according to Bardeesy.

"Our ultimate goal is to understand exactly what cellular processes go awry when LKB1 is mutated," the researcher added.

Source: Nature 2002;419:162-167.

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Depression Screening Day Set

HealthScoutNews

Wednesday, September 11, 2002

WEDNESDAY, Sept. 11 (HealthScoutNews) -- Today brings a strong reminder of how difficult the past year has been -- and many people may be overwhelmed by sadness, anger, fear and helplessness.

To address those feelings and issues, free mental health screenings will be offered at almost 2,000 locations across the United States for National Depression Screening Day on Oct. 10.

The screenings will include educational presentations on mood and anxiety disorders, written screening tests and personal discussions with mental health professionals. People judged to require further mental health evaluation will be given referrals to local treatment services.

Along with screening for depression and manic depression, screening for anxiety and post-traumatic stress disorder will be offered.

"The events of the past year have affected us all. It is understandable, and even normal, for people to feel sad, angry, tense or irritable; to have difficulty sleeping or nightmares, but these symptoms should resolve over time," says Dr. Douglas G. Jacobs, executive director of National Depression Screening Day.

"If these symptoms persist or interfere with the person's ability to function normally, professional help should be sought," he adds.

More information

To find the nearest screening site, go to the National Depression Screening Day Web site or phone 1-800-520-NDSD.

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Blood Pressure Test May Signal Diabetic Kidney Risk

Reuters Health

Wednesday, September 11, 2002

NEW YORK (Reuters Health) - Nighttime blood pressure could serve as an early warning of kidney damage in people with type 1 diabetes, preliminary research suggests.

Investigators found that diabetics ( news - web sites) who did not show the dip in blood pressure that normally occurs overnight were more likely than others to develop a condition called microalbuminuria--a build-up of the blood protein albumin in the urine that can signal kidney disease.

They suggest that an increase in nighttime blood pressure may play a key role in the development of diabetes-related kidney damage known as diabetic nephropathy.

Moreover, it may serve as the earliest indicator of which type 1 diabetics are at risk, according to a report in the September 12th issue of The New England Journal of Medicine ( news - web sites).

Diabetic nephropathy is a serious complication of diabetes in which the kidneys lose their ability to function over time. High blood pressure increases the kidney risk further.

However, when type 1 diabetics are found to have microalbuminuria, they typically do not yet have overt high blood pressure, according to the authors of the new study. But recent research suggests that they do have higher-than-normal nighttime blood pressure.

To see whether this overnight blood-pressure jump occurs before microalbuminuria sets in, Dr. Empar Lurbe of the University of Valencia in Spain and colleagues studied 75 teenagers and young adults with type 1 diabetes. None had high blood pressure or abnormal albumin levels in the urine at the start of the study.

At the outset, participants had their blood pressure measured at the doctor's office. They were also given a portable device that measured their blood-pressure changes over a 24-hour period. These measures were taken again 2 years later, and patients were followed for an average of about 5 years to detect the development of microalbuminuria.

Lurbe's team found that those whose blood pressure rose overnight during the 24-hour measurements were more likely to develop microalbuminuria. Those who showed the normal nighttime dip had a 70%-lower risk of the condition, the report indicates.

Right now, urine microalbumin tests can detect early kidney disease. But if microalbuminuria is present, that means there is already "substantial" kidney damage, according to Dr. Julie R. Ingelfinger, an editor of the journal.

A simple, early test that spots diabetics at the highest and lowest risks of kidney disease would be "invaluable," she writes in an accompanying editorial.

If these new findings are confirmed in larger studies, Ingelfinger notes, they "could argue" for giving blood pressure drugs like ACE inhibitors to type 1 diabetics with nighttime blood pressure jumps. ACE inhibitors are believed to protect the kidneys in addition to lowering blood pressure.

Source: The New England Journal of Medicine 2002;347:778-779, 797-805.

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About Fetal Ultrasound

HealthScoutNews

Wednesday, September 11, 2002

(HealthScoutNews) -- If your doctor suspects you or your unborn baby may be having a problem, he or she can use fetal ultrasound to help diagnose the problem.

Fetal ultrasound, an imaging examination that uses sound waves to examine a fetus before birth, is a painless procedure that is not harmful to the mother or her unborn baby. Different body tissues reflect specific amounts of sound that can be measured and converted into a picture. When viewed on a monitor, this picture can help establish the accurate age of the fetus, identify fetal abnormalities, assess the size and position of the fetus in the uterus and detect multiple pregnancy.

Ultrasound also is recommended when there is vaginal bleeding or unusual pain during pregnancy.

If you are more than six weeks pregnant, you can see the baby's heartbeat. If the procedure is performed after 20 weeks, the sex of the baby can sometimes be determined.

To prepare for the procedure, if you are less than 14 weeks' pregnant, you should arrive with a full bladder, because a full bladder helps to transmit the sound waves of the ultrasound and produces a better image. Drink about 32 ounces of water one hour before the exam.

If you are more than 14 weeks' pregnant, you do not need a full bladder.

The ultrasound procedure can take from 15 minutes to half an hour.

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Sell 'Morning-After' Pill over the Counter: Expert

Reuters Health

Wednesday, September 11, 2002

NEW YORK (Reuters Health) - Women would not be at risk if emergency contraception went from being available only by prescription to being sold over the counter in pharmacies, according to one expert.

The US has one of the highest rates of unplanned pregnancy among all industrialized countries, writes Dr. David A. Grimes of Family Health International in Research Triangle Park, North Carolina. Allowing women to obtain the treatment without their doctors' permission could have a significant impact on the public health burden from unwanted pregnancies, he adds.

"If access to emergency contraception remains limited, the consequence is clear: more unintended pregnancies," Grimes argues in the September 12th issue of The New England Journal of Medicine ( news - web sites).

Emergency contraception is also called the "morning-after" pill because women take it after unprotected sex. The treatment consists of higher-than-usual doses of ordinary oral contraceptives. The pills work by interrupting fertilization or by preventing a fertilized egg from implanting in the uterus. Because of the latter effect, emergency contraception is controversial. While doctors define pregnancy as beginning with implantation, religious groups and others often see things differently.

A number of other arguments against prescription-free distribution also exist, including the fear that couples would stop using condoms, thereby increasing their risk of acquiring sexually transmitted diseases. However, Grimes argues, emergency contraception is often used once a condom, or other so-called "barrier" contraceptive, has failed. "Thus, emergency contraception supplements rather than supplants barrier contraception," he writes.

In the report, Grimes also responds to the criticism that over-the-counter emergency contraceptives would be available to children without the permission of their parents. "At present, condoms and spermicides are widely available to minors without parental notification or consent," he writes. "Should a double standard prevail for emergency contraceptives?"

Rather, Grimes argues, the Food and Drug Administration ( news - web sites) (FDA) should follow the recommendations issued by more than 70 organizations on February 14, 2001, and make emergency contraception available to women without a prescription.

The US would not be the first to make this transition, according to Grimes: Israel, South Africa, parts of Canada and a number of European countries have all begun to sell the treatment over the counter.

The earlier women receive emergency contraception, the better it works, Grimes notes, so restricting access to the treatment only increases the risk women will not be able to prevent an unwanted pregnancy.

Furthermore, he writes, the treatment is safe and easy to follow without a physician's instructions.

"The prescription requirement for emergency hormonal contraception jeopardizes women's health by decreasing or delaying use of this safe, effective prophylaxis," Grimes concludes.

Source: The New England Journal of Medicine 2002;347:846-849.

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Kidneys Are Incredible

HealthScoutNews

Wednesday, September 11, 2002

(HealthScoutNews) -- If you're lucky, you were born with two functioning kidneys. Between them, they process around 200 quarts of blood daily. In metric terms, that's around 189.3 liters.

Adults normally have a blood volume of about five to six liters (5.3-6.3 quarts). That entire volume is pumped through the fist-sized kidneys roughly 35 times a day. Of that total volume, roughly one percent (2 quarts, or 1.9 liters), is waste that is converted by the kidneys into urine.

That waste is filtered out by a million tiny blood vessel-units called nephrons, which also measure out chemicals like sodium, phosphorus, and potassium and release them back to the blood to return to the body. In this way, your kidneys regulate the body's level of these substances. The right balance is necessary for life, but excess levels can be harmful.

Most kidney diseases attack the nephrons, causing them to lose their filtering capacity. Damage to the nephrons may happen quickly, often as the result of injury or poisoning. But most kidney diseases destroy the nephrons slowly and silently. It may take years or even decades for the damage to become apparent.

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TUESDAY, SEPTEMBER 10, 2002

British Scientists Develop Quick Test for TB

Reuters

Tuesday, September 10, 2002

LEICESTER (Reuters) - British scientists have developed a quick test that can detect tuberculosis in two or three hours instead of weeks.

It uses DNA fingerprinting techniques to confirm new outbreaks of the highly infectious disease within hours of receiving a sample.

"We have already used the test many times to confirm that an outbreak has been controlled," Professor Mike Barer of the University of Leicester said on Tuesday.

The professor of microbiology, who presented his research at a British science conference, used DNA microarray technology to take fingerprints of strains of the Mycobacterum tuberculosis (Mtb) bacterium that causes TB.

The 400 genes that make up the genome of the bacterium were mapped in 1998. Barer and his team used the test during an outbreak of TB in the central English town of Leicester last year when 24 cases of the virulent infection, which was centered on a school, were confirmed.

"The emerging DNA technology we have applied here has compressed the time scale between fundamental and applied research. Not only do we have a potentially valuable tool for outbreak management but we can now start tracking and understanding the evolution of a major pathogen in near real time," Barer said.

The disease was once a major killer in Britain but it declined in the 20th century with improvements in living standards.

Tuberculosis, which is spread by coughing and sneezing, destroys the lungs and causes death through asphyxiation. Despite effective treatment, 1.5 million people worldwide still die from it each year.

The World Health Organization ( news - web sites) is attempting to eradicate the disease but it is still rampant in many countries, particularly in Asia and Africa.

An increase in air travel and more foreign visitors have caused a rise in the number of TB cases in Britain.

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Plant Compounds Keep Disease Away: Study

By Merritt McKinney

Reuters Health

Tuesday, September 10, 2002

NEW YORK (Reuters Health) - An apple a day may indeed keep the doctor away, new findings from Finland suggest.

In a study of more than 10,000 men and women, individuals who consumed more of plant compounds called flavonoids--especially one type that is most abundant in apples--were less likely to die from heart disease or develop a variety of chronic diseases, including lung cancer, asthma, stroke and diabetes.

"The message of our study is that individuals consuming fruits and vegetables rich in different flavonoids have a reduced risk of overall mortality and of several chronic diseases," Dr. Paul Knekt of the National Public Health Institute in Helsinki told Reuters Health.

Compared to other fruits and vegetables, apples "showed the strongest and most consistent effects," Knekt said. He added, "This study underlines the suggestion that a healthy diet should include plenty of fruits and vegetables," including apples.

Flavonoids, which are found in a variety of fruits and vegetables as well as in tea and red wine, are thought to boost health in part by combating oxidation, a process in which cell-damaging substances called free radicals accumulate. Oxidative damage can be caused by outside factors, such as cigarette smoking, or by factors on the cellular level. Oxidation is suspected of increasing the risk of heart disease, stroke and several other diseases.

Some studies have shown that the risk of cardiovascular disease and cancer decline as consumption of flavonoids rises, but other studies have failed to show a protective effect of the plant compounds.

In the current study, participants filled out a questionnaire and completed an interview to find out what they had eaten during the previous year. Based on average flavonoid contents of foods available in Finland, the researchers estimated each person's flavonoid intake. Through national prescription and disease registries, the researchers tracked the development of disease in the participants for up to 28 years after the initial interview.

The results of the study suggest that the risk of several chronic diseases--including heart disease, stroke, lung and prostate cancer ( news - web sites), type 2 diabetes and asthma--drops as the consumption of flavonoids rises, Knekt and his colleagues conclude in a report in the American Journal of Clinical Nutrition ( news - web sites). Most of the benefits seemed to stem from quercetin, a powerful antioxidant that is plentiful in apples, although several other flavonoids seemed to be protective as well.

For instance, greater consumption of apples, which are the main source of quercetin in Finland, and onions, which contain a flavonoid called kaempferol, were both linked to a reduced risk of dying from heart disease.

Likewise, the risk of stroke was 30% lower in people who ate the most kaempferol than in those who ate the least. And in men, higher levels of quercetin were linked to lower risks of lung cancer and prostate cancer. Eating lots of foods rich in quercetin also seemed to provide some protection against type 2 diabetes, although the risk reduction was small enough that it could have resulted from chance.

Although the researchers suspect that the antioxidant properties of flavonoids account for some of the benefits of the compounds, they call for additional research in other groups of people who consume different varieties of flavonoid-rich foods. They suggest that such studies, which should take into account factors that might influence the connection between flavonoids and good health--such as lifestyle--may help draw conclusions about the antioxidant compounds.

Source: American Journal of Clinical Nutrition 2002;76:560-568.

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Woman's Dislodged Filling Causes Cluster Headaches

Reuters Health

Tuesday, September 10, 2002

NEW YORK (Reuters Health) - The source of a woman's 8-year bout with excruciating headaches was a dislodged tooth filling that found its way into one of her sinuses, according to a report in a recent issue of the journal Neurology.

The woman suffered from cluster headaches, sudden episodes of pain that can center on one eye or one side of the head. The pain is perhaps one of the most severe known to human beings, lead author Maria Clara Scorticati of the Hospital de Clinicas "Jose de San Martin" in Buenos Aires, Argentina and colleagues explain in their report.

About a year after suffering head injuries during an explosion on a ship, the woman began having piercing headaches once or twice a day for 20 days, every 6 to 8 months. She sought treatment and took various medications, with little success.

When Scorticati and colleagues saw the woman, they diagnosed her with a sinus infection. They performed an x-ray of the infected region, and identified a metallic foreign body in her sinus, findings confirmed by a computerized tomography (CT) scan. The team removed the object, which turned out to be a dental filling, likely forced into the sinus during the accident.

The woman was treated with antibiotics for her infection, and 3 years after the surgery remains pain-free, the report indicates.

The researchers note that while the woman's symptoms seemed to match the criteria for a cluster headache, the fact that the headaches didn't respond to treatment and other factors suggested an underlying cause. About 3% to 5% of cluster headaches, they note, are secondary to "diverse lesions" like the misplaced filling.

"Each case of cluster headache thus should be carefully evaluated on its own merits, and the diagnosis of primary forms should only be made after ruling out secondary forms by means of complementary exams," the researchers conclude.

Source: Neurology 2002;59:643-644.

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Acupuncture as Stroke Medicine?

HealthScoutNews

Tuesday, September 10, 2002

TUESDAY, Sept. 10 (HealthScoutNews) -- Researchers are trying to see if acupuncture can poke away at the debilitating effects of stroke.

A pilot study to compare the effects of real acupuncture to sham acupuncture in treating stroke patients is being conducted by researchers at the New England School of Acupuncture, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School ( news - web sites) and Harvard School of Public Health.

Computerized imaging of gait and limb movements and magnetic resonance imaging (MRI) of the brain will be among the methods used to evaluate potential acupuncture benefits.

"This study will look at a number of clinically driven questions about how effective acupuncture can be in reducing some physical impairments, removing functional limitations and enhancing the quality of life in patients with chronic hemiparesis," says principal investigator Dr. Peter Wayne, director of the acupuncture school.

Hemiparesis is weakness or paralysis on one side of the body, and is the most significant chronic effect of stroke.

For the study, researchers are looking for people who have had a stroke at least six months earlier, and still experience weakness on one side of their body. Participants are being recruited through Spaulding Rehabilitation Hospital.

This year, an estimated 750,000 Americans will suffer a first or recurrent stroke. That works out to a stroke every 45 seconds. Stroke is the leading cause of adult disability.

More information

Here's more on acupuncture treatments for stroke.

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Even Cooked Sausages Can Harbor Salmonella

By Stephen Pincock

Reuters Health

Tuesday, September 10, 2002

LONDON (Reuters Health) - Salmonella bacteria are found in a significant proportion of cheap sausages and might not be killed even if the links seem fully cooked, British researchers warned on Tuesday.

Food cooked too quickly can seem done but may not have reached the temperature needed to kill the bugs, explained Dr. Frida Jorgensen from Public Health Laboratory Service (PHLS) food microbiology laboratories in Bristol.

Salmonella food poisoning causes diarrhea, vomiting and fever, and can sometimes be fatal for elderly or chronically ill people.

"If you cook a frozen sausage for 6 minutes on your barbecue, although it looks cooked it's definitely not enough to destroy the Salmonella if they're there," she told Reuters Health from the PHLS annual scientific meeting in Warwick.

"Also if you were frying them on a pan for 10 minutes instead of 12 minutes. Twelve minutes would ensure that you eliminated Salmonella but 10 minutes wouldn't," she said.

Jorgensen and colleagues looked for the bacteria in 162 packs of uncooked "economy" or catering sausages and found the bacterium in 7.5% of frozen sausages and 9.1% of chilled sausages.

This was a significant drop from the rate of 17% seen in 1995. Jorgensen said the decline could be partly because chicken meat, which is thought to be a leading source of Salmonella, has increased in price relative to other meats.

"Maybe they're using more pork," she said.

Separately, the researchers injected Salmonella into frozen sausages, barbecued or pan-fried them until they seemed cooked, and tested for the presence of the bug.

Although the sausages seemed thoroughly cooked, "barbecuing and frying sometimes allowed Salmonella cells to survive," they reported.

The message for consumers is to ensure that sausages are cooked for 12 minutes at a medium heat when frying and 10 minutes on the barbecue, the researcher said.

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Mixed Reviews for Medical Reporting

By Melissa B. Robinson

Associated Press Writer

The Associated Press

Tuesday, September 10, 2002

WASHINGTON (AP) - The Bush administration on Tuesday threw its support behind a proposal for a voluntary, confidential system for reporting medical errors. Critics said it was too weak to be effective.

A bill by Rep. Nancy Johnson ( news, bio, voting record), R-Conn., the chairwoman of the Ways and Means health subcommittee who is in a tight re-election race against Rep. Jim Maloney, D-Conn., would create new procedures for health care providers to report errors. Doctors, nursing homes, hospitals, home health care agencies and hospices would be covered.

The information could not be used in medical malpractice lawsuits, unless it is otherwise available from other sources.

A 1999 Institute of Medicine ( news - web sites) report found that preventable medical errors are the eighth leading cause of death in America, ahead of breast cancer ( news - web sites), AIDS ( news - web sites) and traffic accidents. It said medical errors contribute to more than 1 million injuries and up to 98,000 deaths annually.

U.S. Health and Human Services ( news - web sites) Secretary Tommy Thompson said the bill would remove the barrier of "fear professionals have that if they report some event or some condition that is less than perfect, their report will be used to stir up litigation rather than fix the problem."

The National Academy for State Health Policy, a research organization that works with state governments, said the bill fails to include both types of reporting systems recommended by the Institute of Medicine as a way of reducing errors: a mandatory system for serious mistakes, and a voluntary, confidential one for lesser errors.

Without a mandatory system that provides accountability, "there will be no check and balance and Congress will have no mechanism to know that voluntary reporting is working," said Jill Rosenthal, the organization's project manager.

Critics are also concerned that the bill could prevent victims of medical errors from filing legitimate claims — an important deterrent to medical malpractice — and that the voluntary, national system would pre-empt states with stricter reporting requirements.

Since the Institute of Medicine's report was issued, 20 states have created mandatory reporting systems.

Under the bill, new, independent private entities called Patient Safety Organizations would receive information from providers, analyze it and provide feedback.

They would also report it to a new HHS Center for Patient Safety for inclusion in a database to be used by researchers in identifying trends and recommending improvements.

The bill is H.R. 4889

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Correcting Infant Vision Can Stop Further Problems

By Patricia Reaney

Reuters

Tuesday, September 10, 2002

LEICESTER (Reuters) - Babies as young as nine months old could benefit from wearing spectacles to correct their vision, scientists said on Tuesday.

Researchers from University College London, who have developed a device that takes pictures of babies' eyes to identify visual defects, said correcting vision can reduce the risk of other problems later.

"There is a group of babies of around nine months of age who are long-sighted and they are most at risk of lazy eye or a squint or of an eye turning in," Professor Jan Atkinson told a science conference.

"We've also found from a randomized controlled trial that if we treat these children with spectacle correction and they wear the spectacles in infancy they can have a much improved visual outcome," she added.

Squinting, crossed-eyes and lazy eye, when one eye does not work properly, are the most common visual problems in children.

Atkinson and her colleagues said long-sightedness in infants should be corrected because it seems to be correlated with eye problems and pre-school delays. Short-sightedness is less common and does not cause a problem.

"We think there is a link between their visual problems that show up in the first year of life and these normal delays in visual motor development and skills--things like putting a letter in an envelope or walking along a straight line," Atkinson added.

When the scientists conducted large screening programs using a device called a videorefractor on a large number of babies, they found that between two and five percent of them could benefit from corrective spectacles.

The scientists have also conducted a large study of children who have suffered brain damage around the time of birth due to a lack of oxygen. They used magnetic resonance imaging, a scanning technique, to study their brains and visual development.

They discovered that the dorsal pathway or stream in the brain, which is used for action and motions, is more vulnerable in the children than the ventral pathway, which is linked to recognizing objects and faces.

"It is particularly important in terms of thinking of treatment that we recognize that not all of the brain is as plastic and recoverable as other parts," Atkinson told the British Association for the Advancement of Science ( news - web sites) conference.

The scientists have also discovered that children with Williams Syndrome, which causes them to have difficulty with tasks involving spatial relationships, show problems with the dorsal stream system.

But Atkinson added that many of the children who have extensive brain damage on the MRI images make a good recovery. She emphasized the importance of finding new strategies to help children with dorsal stream problems to overcome their difficulties.

"The brain is very plastic early in life and we should definitely think about treatment," she said.

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Genetic defects found in cloned animals

From the Science & Technology Desk
United Press International

Tuesday, September 10, 2002

 BOSTON, Sept. 10 (UPI) -- Scientists have found further evidence that cloned animals tend to harbor genetic defects that will disrupt their development and lead to abnormalities, strengthening the rational that reproductive cloning of humans should be banned.

However, the researchers noted the technology still could be used safely for therapeutic cloning techniques, such as producing embryonic stem cells to treat diseases ranging from Parkinson's to diabetes.

"Cloned animals have major dysregulation of multiple genes so they are not normal at all," principal investigator of the study Rudolf Jaenisch, a biologist at the Whitehead Institute for Biomedical Research, told United Press International.

Jaenisch's team looked at 10,000 genes in cloned mice and found hundreds of genes important to development were not correctly expressed in the animals, he said. Overall, about one out of every 25 genes was not expressed correctly in the placenta. Abnormal gene expression also was observed in the liver but at a lower rate.

This ultimately impacts the animal's development and causes all kinds of malformations, he said, and it probably explains why many clones die early, are obese or have other problems.

Hans Scholer, director of University of Pennsylvania's Center for Animal Transgenesis and Germ Cell Research in Philadelphia, agreed the research "supports the notion that you shouldn't clone humans." Scholer himself reported research in May that found a single gene was vital to cloning success.

Because the animals appeared normal yet exhibited genetic defects, it should send a message to Severino Antinori, the controversial Italian physician who claims to have impregnated three women with cloned human embryos, Scholer told UPI. "It says, 'even if you show us the face of a beautiful baby, behind the face there might be a terrible problem,'" Scholer said.

"If Antinori claims he has a healthy clone, I would think he lied." Jaenisch said. Antinori has claimed the cloned babies are expected to be born in December and January.

Robert Lanza, vice president of medical and scientific development at Advanced Cell Technology of Worcester, Mass., which conducts reproductive cloning in animals, also concurred.

The new study is "further scientific grounds to ban all human reproductive cloning," he told UPI. "This definitely raises a red flag for anybody who would want to use cloning for reproducing humans."

The cloning process -- which involves transferring DNA from a single cell of an animal into an egg cell and creating a relatively exact copy of that animal -- does not adequately reprogram the genes for proper development. In other words, the cloned animals showed genetic defects because the procedure does not replicate normal reproduction, Jaenisch said, although it is not yet understood how cloning interferes with the reprogramming process.

Jaenisch pointed out the research has no bearing on therapeutic cloning, which appears to pose no safety risks. Therapeutic cloning takes tissue derived from embryonic stem cells and places it in a fully-grown animal to treat disease. The inserted cells function normally and there does not appear to be any problem, he said. His group reported earlier this year they had used therapeutic cloning to cure a mouse of an immunodeficiency disease.

"I agree 100 percent with (Jaenisch) on that," Scholer said. Embryonic stem cells derived from therapeutic cloning would be grown into specific types of cells such as heart or brain cells, he said. If a tissue sample turns out to be faulty or have defects, "you just throw it away. But you can't do this with entire organisms" that have arisen from cloning.

"This is pretty much in favor still of therapeutic cloning but at the same time it is closing the door on reproductive cloning," Scholer said.

The research will be published this week in the online edition of the Proceedings of the National Academies of Science.

(Reported by Steve Mitchell, UPI Medical Correspondent, in Washington)

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Routine Smallpox Vaccine Risky for Eczema Patients

Reuters Health

Tuesday, September 10, 2002

NEW YORK (Reuters Health) - As health experts and government officials debate the merits of widespread smallpox vaccination amid renewed concerns of bioterrorism, a report cautions that the vaccines can trigger severe skin reactions among susceptible individuals.

People with immune deficiency diseases such as AIDS ( news - web sites), those on immune system-suppressing drugs, such as transplant patients, and people with eczema are all vulnerable to vaccinia, a virus related to the smallpox virus that is used in vaccines.

In people with eczema, exposure to vaccinia through the vaccine or by contact with someone who was recently vaccinated can cause a condition that can lead to scarring, blindness and even death.

The US Centers for Disease Control and Prevention ( news - web sites) (CDC) recommends that all laboratory technicians who have contact with the smallpox virus get immunized. It is not recommended that individuals with eczema or a history of the skin disorder, also known as atopic dermatitis, be "vaccinated under routine circumstances," according to Dr. Renata J.M. Engler from the Walter Reed Army Medical Center in Washington, DC, and colleagues.

Given the rise in the number of people who suffer from eczema, up to one-half of the US population may be ineligible for routine smallpox vaccination, the researchers estimate in a report in the September issue of the Journal of Allergy and Clinical Immunology.

"A major challenge lies in the ability to protect the population from the disease while minimizing the considerable side effects from the vaccine," the researchers conclude.

They call for more research into clinical markers to identify people who are prone to side effects, and into how people with asthma, an allergic disorder, respond to vaccinia vaccination.

Doctors should also screen individuals for eczema if a smallpox vaccination campaign is launched in the US, although in some cases, such as after a bioterrorist attack, the benefit of vaccine could outweigh the risk. If an exposed individual is vaccinated within 4 days, the vaccine can reduce symptoms or prevent the disease, whose initial signs include headache, vomiting and fever. Subsequently, pus-filled lesions form on the head, face, and in some cases, on other parts of the body.

Prior to 1972, all Americans were vaccinated against smallpox, a viral infection that is fatal in 20% to 40% of unvaccinated individuals. The eradication of the disease was declared in 1980 and over the next several years, all countries stopped their national vaccination campaigns.

Officially, smallpox exists only in two laboratories--one in the US and the other in Russia. However, reports that other governments or terrorist groups may have samples of the deadly virus have sparked fear of bioterrorist attacks.

Source: Journal of Allergy and Clinical Immunology 2002;110:357-365.

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Surgery Best for Carpal Tunnel

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, September 10, 2002

CHICAGO (AP) - Surgery for carpal tunnel syndrome produces better long-term results in most patients than the more common treatment of putting a splint on the wrist, Dutch research suggests.

The findings "suggest that surgery should be the first rather than last option" for most patients, said researcher Annette Gerritsen of Vrije University in Amsterdam.

The syndrome, often associated with use of computer keyboards, can cause numbness, tingling and pain in the fingers, hands and wrists. It occurs when tendons leading from the hand become swollen and press on a nerve in a region of the wrist called the carpal tunnel.

It affects an estimated 5 million Americans and is a significant cause of missed work days.

Well over 200,000 carpal tunnel operations are done in the United States each year, but splinting is thought to be the most common treatment and is generally tried before surgery is considered. Splints work by keeping the wrist from bending, easing pressure on a nerve.

In the study, 176 patients underwent surgery or wore wrist splints for at least six weeks; they were then evaluated periodically.

After three months, significant improvement was seen in 80 percent of surgery patients, compared with 54 percent of splint patients. At 18 months, the success rate remained significantly higher for the surgery group.

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

The study excluded patients with very mild or severe cases, and thus does not prove that surgery is best for everyone, said Dr. Shaw Wilgis, research director at Curtis National Hand Center in Baltimore and an associate professor at Johns Hopkins University.

Surgery involves making a small incision in the wrist and cutting the carpal ligament away from the median nerve to relieve pressure. Surgery generally takes less than an hour and is done on an outpatient basis under local anesthesia.

The study did not examine anti-inflammatory drugs, which also are sometimes prescribed.

On the Net:

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

National Institutes of Health ( news - web sites): http://www.ninds.nih.gov/health_and_medical/disorders/carpal_doc.htm

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Record Number of Japanese Live to 100 or More

Reuters

Tuesday, September 10, 2002

TOKYO (Reuters) - Hitting the age of 100 need not mean you quit work or stop pacing the fairway, according to a Japanese government survey released on Tuesday.

A 100-year-old woman farmer who modeled in an advertisement and a 99-year-old man who plays golf regularly are picked as examples of active old age in a Health Ministry report on the country's centenarians.

The report also says the number of people aged 100 or over hit a record high this year--a sharp reminder of the graying of Japan's population. Birthrates are tumbling, raising concerns that pension obligations could become unmanageable.

The number of centenarians rose by 2,459 to reach 17,934 this year, compared with just 153 in 1963, the survey said. More than 80% of the centenarians are women.

Included in their number are the world's oldest person, Kamato Hongo, who turns 115 on September 16, and the oldest man in the world, Yukichi Chuganji, who is 113.

Both live on the southwestern Japanese island of Kyushu, but the even more southerly Okinawan chain of islands boasts the largest proportion of centenarians, with an average of 39.5 of every 10,000 people aged at least 100.

Researchers have said the warm climate, healthy diet and tight-knit social networks in southern Japan may contribute to longevity in the area.

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Tea for Two

HealthScoutNews

Tuesday, September 10, 2002

(HealthScoutNews) -- Both men and women can benefit by drinking tea, according to two studies published in medical journals.

First, Oncogene reported that regular tea drinking can help men with prostate cancer ( news - web sites). The disease can be stimulated by androgens, the male sex hormones. Some components of tea appear to bind to androgen receptors in the prostate gland, slowing the growth of the cancer.

And the American Journal of Clinical Nutrition ( news - web sites) reported that in a study of 1,256 women, tea drinkers had a higher bone-mineral density than those who didn't drink tea. In other words, tea may protect against osteoporosis.

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HRT, Drinking Milk Tied to Cancer Hormone in Women

By Suzanne Rostler

Reuters Health

Tuesday, September 10, 2002

NEW YORK (Reuters Health) - Drinking milk may raise blood levels of a cancer-promoting hormone in women, according to two recent studies. What's more, taking hormone replacement therapy (HRT) or having multiple children appears to reduce levels of the hormone.

But it is too soon to recommend that women avoid milk products, since it is not clear whether milk, or a particular component of milk, is the culprit, the study authors point out. Similarly, more research is needed into the effects of HRT on cancer risk, since a large study recently found that taking HRT increased the risk of breast cancer ( news - web sites), they note.

"We cannot yet make the leap to say that higher levels of milk intake will increase the risk of cancer," Dr. Michelle D. Holmes, the primary investigator of both reports, told Reuters Health. "Foods are complicated, with many components, and they may have many different actions on the body."

The data on more than 1,000 women analyzed in both reports was drawn from the Nurses' Health Study, the longest national health study conducted in women. The findings are published in the September issue of Cancer Epidemiology Biomarkers and Prevention.

One report found that levels of insulin-like growth factor-1 (IGF-1), a hormone that can raise cancer risk when levels are too high, fell as the number of pregnancies increased. Women who had been through at least four pregnancies had IGF-1 levels that were 14% lower on average than their peers who had fewer children.

Pregnancy is known to decrease a woman's risk of breast and colon cancer, and the study--the first to report an association between parity (the number of times a woman has given birth) and IGF-1 levels--suggests a possible mechanism behind this effect.

However, more research is needed, cautioned Holmes, from Brigham and Women's Hospital in Boston, Massachusetts.

"If this connection between parity and IGF levels should turn out to be consistent in other similar studies, it would be interesting to know something about how parity affects IGF levels over time," she said in an interview.

Her study also reported a link between HRT, especially oral estrogen, and lower IGF-1 levels among postmenopausal women, a finding that supports the results of other studies. Women using oral estrogen had lower levels than those using the estrogen skin patch and women who did not use any hormones.

A second study found that IGF-1 levels rose in tandem with women's intake of protein, especially from milk. There was no association between IGF-1 levels and vegetable protein intake. Yogurt, cheese and ice cream also had no association with the hormone.

Taken together, the study findings suggest a link between lifestyle factors and levels of a hormone associated with cancer risk.

"For something like milk intake, it means we have a potential mechanism, but we do not yet know whether there is a connection between milk intake and cancer risk," Holmes explained.

"For something like parity...this may represent a mechanism by which parity helps prevent cancer. As scientists, it is always more reassuring if we know how something works rather than just knowing that it works," she added.

Source: Cancer Epidemiology Biomarkers and Prevention 2002.

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Teens Who Eat Less Meat No Healthier Than Others

Reuters Health

Tuesday, September 10, 2002

NEW YORK (Reuters Health) - Despite their healthy diets, vegetarian youth in Sweden and Norway do not practice other healthy lifestyle behaviors such as exercising more or using alcohol or tobacco less frequently than do their peers, according to recent study findings.

"Contrary to findings from other studies, adherence to a low-meat diet may not correlate with other health promotion practices among adolescents in Sweden and Norway," write lead study author Dr. Christel L. Larsson of Umea University in Sweden and her colleagues.

This finding is based on a survey of 2,041 Swedish and Norwegian 15- to 16-year-old students, 149 of whom said they were low-meat consumers--a category that included vegetarians. Nearly three-quarters of the low-meat eaters were female.

Altogether, the low-meat eaters did not differ from their omnivore, or meat and vegetable eating, peers in their weight, body mass index or their opinion about their weight, Larsson and her colleagues report in the August issue of the Journal of Adolescent Health.

"This may indicate that concern about weight is not a major reason among adolescents for becoming low-meat consumers," the authors write.

Young women also did not seem to choose the low-meat diet for health-related reasons. In fact, being healthy seemed to be more important for the omnivores, who tended to be healthier than the low-meat eaters, study findings indicate.

Female low-meat eaters reported being sick more often than did their peers, while male low-meat eaters reported being tired and having headaches more often than their peers. Both the male and female low-meat eaters reported being depressed more often than the omnivores.

Low-meat eaters may be less healthy because their health was poorer initially, leading them to choose a vegetarian lifestyle for health reasons, or they may choose a low-meat diet for ethical reasons rather than health concerns, so they "do not have the same interest in practicing a healthy lifestyle as do more health-oriented vegetarians," the researchers speculate.

The researchers also found no difference in exercise habits, alcohol use or smoking practices between the low-meat eaters and the omnivores.

Source: Journal of Adolescent Health 2002;31:190-198.

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Use of Drug Khat Up in Some Cities

By Stephanie V. Siek

Associated Press Writer

The Associated Press

Tuesday, September 10, 2002

COLUMBUS, Ohio (AP) - An influx of immigrants from Somalia and other African and Middle Eastern countries has led to increased use in some U.S. cities of the illegal drug khat, a leaf that is chewed for its amphetamine-like high, authorities say.

Khat has been seen in cities such as Detroit and New York since the 1980s. But it was virtually unknown in Columbus and Minneapolis until the late 1990s, law enforcement authorities say.

Use of the drug appears to be confined largely to immigrant communities, police in Columbus and Minneapolis say.

Khat has been illegal since 1993 in the United States. According to the Drug Enforcement Administration, chronic use can cause violence and suicidal depression similar to amphetamine addiction, though the agency said it was unaware of any examples.

Khat has increased in prevalence in the past several years with an influx of immigrants from countries such as Somalia, Ethiopia, Kenya and Yemen where khat is widely used, authorities say.

"What coffee is to Americans is what khat is for Somalis," said Omar Jamal, executive manager of the Somali Justice Advocacy Center in St. Paul, Minn. "The whole thing about khat being addictive is very strange for Somalis. It's a completely different frame of thinking."

Community groups say their people are being targeted and are not aware they are breaking the law. Police say they are confident immigrants know khat is illegal.

Khat leaves contain cathinone, which is chemically similar to amphetamine. The shiny, bright green or reddish-green leaves are sold attached to thin, rhubarblike stems. A bundle of 15 to 35 sticks costs about $40 in Columbus. Users often brew the leaves or stuff them into their cheeks like chewing tobacco.

"Like what you would get from two or three beers _that little feeling that lets people forget problems and troubles," said Ali Sharrif of Toronto, who is from Somalia and said he used to chew khat in his homeland. "It makes talking and communicating a lot more easier somehow. You feel like you are suddenly very, very alert."

Most khat that makes its way to the United States comes from East Africa, where it is a major export. Because khat's potency dramatically drops after 48 hours, it usually is delivered by air express or by courier, law enforcement officials say.

According to the DEA, the only known case of khat cultivation in the United States was in 1998 in Salinas, Calif., where authorities seized 1,076 of the plants.

In Hennepin County, which includes the Minneapolis area, khat-related charges have been filed against 10 to 20 people in the past year, said Dan Rogan, spokesman for the county attorney's office. St. Paul-Minneapolis has the nation's biggest Somali community, estimated at up to 50,000 members.

In Columbus, where community groups estimate there are more than 30,000 Somalis in the second-biggest concentration in the United States, police have seized 860 pounds of khat so far this year. Sgt. Ben Casuccio said that in all of 2001, Columbus police seized 633 pounds. In 2000, they confiscated about 8 1/2 pounds.

The number of khat-related charges in Columbus was not available because authorities do not classify charges by drug.

Nationally, DEA and Customs officials said they seized around 40 tons in 2001, more than double the amount confiscated in 1996.

Under federal sentencing guidelines, possession of more than about 45 pounds of khat is punishable by up 16 months in prison.

New York police have made no arrests related to khat, Detective Walter Burnes said. Police in Detroit did not immediately respond to a request for numbers of khat arrests and seizures.

Jamal said Minneapolis police have pulled over young Somalis in search of khat, which he considers racial profiling. DEA spokesman David Jacobson in Detroit said no ethnic community is targeted.

"We need to take a proactive stance on khat because there's a negative effect on the user and the family around them," he said.

Maryam Warsame, leader of the Somali Women's Association in Columbus, said khat is to blame for the breakup of many marriages.

Men go off to use khat, and "it is the woman who has to stay with the children, take care of the house," Warsame said. "And sometimes the paycheck does not come home. They have to pay whoever is selling the khat, instead of giving it to their family, to their children."

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Vaginal Infections Linked to Preterm Birth

By Hannah Cleaver

Reuters Health

Tuesday, September 10, 2002

BERLIN (Reuters Health) - New research has reinforced the theory that even less-severe infections during pregnancy can increase the risk that an infant will be born early and at a low birth weight.

Preliminary results from a study in Vienna, Austria are so convincing, the author says, that if final figures back them up the results should lead to a new screening program for all pregnant women.

Professor Herbert Kiss of the University of Vienna investigated the relationship between a variety of vaginal infections, known as common genital tract infections, during pregnancy and underweight birth. The findings are published in the journal Geburtsh Frauenheilk.

Initial results show a significant effect, he said, telling Reuters Health, "If these end results support what the initial results point to, I would recommend a screening and treatment program for all pregnant women. It is very simple and cost-effective, costing less than an ultrasound."

He and his team screened more than 4,000 women between their 16th and 20th month of pregnancy for vaginal bacterial and yeast infections.

He said 20% of those screened had an infection, including such common ones as trichomonas vaginalis and bacterial vaginosis, even though none of them had complained of symptoms.

"We wanted to look for connection between very low-weight babies and the infections," he said. "So rather than taking a preterm definition of a baby being born before the 37th week of pregnancy or the European definition of the baby being pre-37th week and less than 2,500 grams at birth, we decided to look at babies born at less than 1,900 grams. These always need neonatal care, often in an incubator."

He stressed that his study is looking at the matter from an economic perspective as well as from a health standpoint. Very early babies tend to run up major health expenses after birth, as well as during later life when disabilities or general poor health may emerge, he explained.

Of the 4,160 women tested, 1,112 have given birth and the initial results for women whose babies weighed less than 1,900 grams were significant, he said.

Among those with infections who received treatment, five women, or less than 1% of the group, had babies weighing less than 1,900 grams, while the figure for those whose infections were not treated was 14, or 2.5%.

"We need to wait for the finalized results," he said. "If they bear out these results then there has to be a screening and treatment program set up for all pregnant patients."

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Study Bursts Nicotine Gum's Bubble

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 10, 2002

TUESDAY, Sept. 10 (HealthScoutNews) -- A new survey suggests nicotine patches and gum alone have become virtually useless for quitting smoking for good, apparently because doctors no longer supervise their use.

 "Nicotine addiction isn't just a physiological addiction. It's a psychological one, too," says study co-author John P. Pierce, director of the Cancer Prevention and Control Program at the University of California at San Diego Cancer Center.

"Unless you handle the problems and the issues that are behind why you're using smoking as a crutch, sooner or later the patch isn't going to work," he says.

However, the maker of the NicoDerm and Nicorette brands of anti-smoking patches and gum says the findings conflict with earlier studies. In smokers who don't take part in behavioral therapy, use of nicotine-based products appears to double the chances smokers will be able to quit, GlaxoSmithKline says in a written response to the study.

The results of the study appear in tomorrow's issue of the Journal of the American Medical Association ( news - web sites).

Nicotine gums and patches have been available over the counter since 1996. The products let smokers slowly wean themselves off their addiction by getting doses of nicotine without having to light up.

In the new study, researchers examined data from the California Tobacco Surveys of 15,000 adult smokers taken in 1992, 1996 and 1999. "We took the smokers and looked at their quitting behavior, whether they used anything to help them quit, and how effective it was," Pierce says.

In 1992 and 1996, smokers who used nicotine patches or gum were more likely than other smokers to be able to quit for long periods of time. However, in 1999, users were no more likely than other smokers to remain cigarette-free after three months.

Pierce suspects more light smokers -- those who smoke fewer than 15 cigarettes a day -- are incorrectly using the products because they no longer require a doctor's prescription.

"The patch has never been shown to be helpful to them," he says.

On the positive side, Pierce says smokers who are trying to quit can indeed get benefits from the patch, whether or not they enter behavior-modification programs. They just must find some way to deal with the psychological cravings, he adds.

"People associate a lot of things with smoking. They can't relax without it," he says. "In those situations, you've got to replace smoking with something else and feel that you're getting the same benefit."

For example, if a writer can't write without puffing away on a cigarette, "you've got to come up with some other way of handling that problem," he says.

In its statement, GlaxoSmithKline pointed out the U.S. Public Health Service has recommended nicotine patches and gum for nearly all smokers, even light ones who smoke 10 or fewer cigarettes a day. Light smokers should simply start with lower doses, the company says.

The California study shouldn't "discourage smokers from striving to escape their tobacco dependence and using clinically proven cessation aids ( news - web sites) and behavioral support to increase their chances of success," the company states.

What To Do

For more stop-smoking strategies, visit QuitNet. For a fact sheet on nicotine-replacement products, go to The American Lung Association.

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Tissue-Seeking Molecules Could Be Drug Vehicle

Reuters Health

Tuesday, September 10, 2002

NEW YORK (Reuters Health) - In an advance that eventually may have implications for the development of drug therapies and diagnostic tests, scientists have succeeded in getting "nanocrystals"--molecules so small that they are measured in billionths of a meter--to zero in on specific tissues without accumulating in other tissues.

The experiments were carried out in mice and are still in the early stages, but researchers hope that the tiny molecules one day may be used to deliver drugs to specific organs. And since the molecules, known as quantum dots, or qdots, are fluorescent, they may be useful in diagnostic imaging.

Dr. Erkki Ruoslahti of the Burnham Institute in La Jolla, California and colleagues worked with qdots that were smaller than 10 nanometers--10 billionths of a meter--in diameter. The molecules were coated with certain peptides, or protein snippets, designed to help guide the nanocrystals to particular tissues.

In one set of experiments, mice were injected with qdots that were coated with lung-targeting peptides. In other tests, the animals received injections of nanocrystals coated with peptides that sought out vessels found within tumors.

In both cases, according to a report in the early edition of the journal Proceedings of the National Academy of Sciences ( news - web sites), the qdots zeroed in on the targeted tissues. And what's more, adding a substance called polyethylene to the peptide coating prevented the tiny molecules from accumulating in non-targeted tissues.

One problem, however, was that even though qdots sought out targeted tissues, fluorescence did not accumulate within these tissues. The authors are not sure why this was the case, but one possibility is that the qdots "were not sufficiently stable to remain luminescent in living cells and tissues," the report notes.

"Although the current nanosystems are rather simple, in the future we envision the fabrication of multifunctional nanosystems, known as nanomachines," the researchers write. "Such devices may, as an example, sense the presence of disease, deliver a drug to the site of disease, and release the drug at that site."

Source: Proceedings of the National Academy of Sciences Early Edition 2002;10.1073/pnas.152463399.

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MONDAY, SEPTEMBER 9, 2002

Experts Discuss Better Germ Control

By Emma Ross

AP Medical Writer

The Associated Press

Monday,  September 9, 2002

WARWICK, England (AP) - People come into contact with others up to 1,000 times more frequently than they did a century ago and infectious disease experts say scientists need to better understand human behavior and movement in the global battle against germs.

Scientists gathering Monday at the annual meeting of Britain's infectious disease trackers heard that while great strides have been made in vaccine and antibiotic development, the importance of human behavior and the way humans interact with microbes has been largely neglected.

Humans are constantly giving opportunities to microbes — viruses, bacteria, fungi and other bugs.

An example is measles, which has been recognized since at least the early 10th century. The emergence of measles in the urban centers of the great civilizations did not occur because the measles virus changed. It occurred because human behavior changed, Dr. Mike Ryan, global outbreak and response coordinator at the World Health Organization ( news - web sites), told scientists at the conference of the Public Health Laboratory Service, Britain's equivalent of the U.S. Centers for Disease Control and Prevention ( news - web sites).

"We talk about the battle against infectious diseases; the war on AIDS ( news - web sites) — we have become very focused on a military approach to the microbe," Ryan said. "The microbe must be eradicated, eliminated, beaten back. We overfocus on the microbe itself and less on the way our society behaves, the way we live and interact and how we can provide fewer opportunities for the microbe, rather than attacking it."

But it isn't a battle to be finished and won, Ryan said. The success of the global eradication of smallpox in 1980 gave people a false sense of hope that such success could be repeated for every disease.

"HIV ( news - web sites) has shown us that it's a much more complicated disease than smallpox and it's not as easy to deal with," Ryan said. "You never win because microbes are part of nature. They will constantly emerge. If we come to terms with that and if we are smart and quick ... we'll be ahead of them."

The rate at which germs evolve is related to the rate of transmission of the bugs between humans, noted Dr. Roy Anderson, head of infectious disease epidemiology at Imperial College of Medicine in London.

"We understand very little about how the two are linked and about the forces that drive microbe evolution in particular settings," Anderson said.

"Coming up in the future, in part stimulated by Sept. 11, we need to understand a lot more about people's movements globally," he said.

While it's clear there has been a massive increase in international travel, scientists need to know more detail, such as the rate at which people move between countries and continents and how they move around within a country, Anderson said.

One facet of modern life that offers infectious disease trackers an opportunity to gain such insight is the technology used for mobile phones, he said.

"Mobile phones are connected by networks of receivers and transmitters and an individual phone can be tracked round the United Kingdom and internationally. That's a rich source about people's movements," he said. "I suspect in the coming years we are going to have the first studies of how people move and behave between particular localities."

Anderson presented new research in which he estimated that between 1918 and 2000, physical contact between people in different countries has increased by as much as 1,000 times.

Patterns of movement within countries have increased similarly in the last 100 years, he added.

Ryan said Anderson's research has important implications for the control of infectious diseases.

"It's the first time I've heard someone quantify it. It's quite telling," he said. "It's not that it makes the world a more dangerous place. It just creates more opportunities for infectious diseases to spread."

On the Net

Britain's Public Health Laboratory Service,

http://www.phls.co.uk

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Gene-Altered Follicles Grow Glowing Green Hair

By Keith Mulvihill

Reuters Health

Monday,  September 9, 2002

NEW YORK (Reuters Health) - Scientists have successfully inserted a foreign gene into the DNA of mice that was later incorporated into growing hair shafts.

"This will allow us to search for genes that will give a cosmetic benefit as well as potential therapeutic benefits when inserted into the hair follicle," said the study's lead author Dr. Robert M. Hoffman of AntiCancer Inc., a San Diego, California-based biotechnology company.

While the green fluorescent protein (GFP) gene, which comes from jellyfish, has no medical significance, the main goal was to determine if the researchers could make transgenic mouse hair.

The mouse genome did indeed take up the GFP gene, researchers report in the early edition of the Proceedings of the National Academy of Sciences ( news - web sites).

Hoffman and his colleagues began by inserting GFP into an inactivated virus. Then they removed small bits of skin from mice and treated their skin with the enzyme collagenase. The collagenase made the hair follicles in the skin accessible to the virus, which was used to "micro-inject" the DNA containing the GFP gene, Hoffman explained.

"This allowed the efficient transfer of the GFP gene to the hair follicles," he said. The treated fragments of skin were then transplanted onto other mice.

"The gene-modified hair follicles then produced modified hair shafts, which were easily detected by GFP fluorescence," Hoffman said.

Roughly 75% of the mice hair follicles contained the new gene, the report indicates.

With regard to cosmetic implications, Hoffman noted that patients undergoing hair transplants, where skin fragments could be treated in a similar fashion as in the mouse experiment, could use this technology. This would require that the researchers discover genes that confer cosmetic benefits, he pointed out.

In addition, the hair follicle "could also be used as a 'factory' to produce therapeutic products as well," Hoffman said.

The therapeutic gene could be chosen depending on the disease one wishes to treat. The hair follicle could express this gene and produce the therapeutic product, he noted.

"It must be emphasized that this early technology is now appropriate only in animal experiments and not for use in humans. We will exploit this technology to discover useful cosmetic and therapeutic genes that can be transferred in this manner or perhaps modifying the technology to transfer the genes directly without removal of the skin," Hoffman told Reuters Health.

"It also must be emphasized that any type of gene transfer in humans will be very carefully scrutinized by the FDA ( news - web sites) before approval," he added.

"It is difficult to speculate when such technology would be applicable to human trials," Hoffman stated. "A guess would be in the order of 5 years."

Source: Proceedings of the National Academy of Sciences 2002;10.1073/pnas.192453799.

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Doctors Freezing Away Tumors

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday,  September 9, 2002

Robin Imhof watched, fascinated, as her doctor stuck a needle into the dime-sized lump in her breast and pumped freezing gas through it. On a nearby ultrasound monitor, a round image gradually turned lighter and lighter — her noncancerous but extremely painful tumor being encased in a ball of ice.

It didn't hurt — the cold itself was anesthetic even as it froze the growth to death. No hospital stay, stitches or scar. An hour later, the Ferndale, Wash., woman headed home to wait for the lump to shrink over the next few months, her body slowly absorbing the destroyed cells.

Doctors have long attacked tumors with heat. Now a few clinics around the country are turning to cold.

Called cryoablation, it's being used to extend the lives of people dying from liver cancer, to treat prostate cancer ( news - web sites), and as the first nonsurgical alternative for the half-million women who have benign breast tumors removed each year. Doctors have just begun testing it as a possible scar-free way to remove early breast cancer ( news - web sites), and as an alternative to open surgery for kidney cancer.

It's catching on slowly — the delicate technique requires special training to avoid serious side effects from accidentally freezing healthy tissue, and it has a controversial history.

But "it made perfect sense," says Imhof, explaining why she chose cryoablation over standard breast surgery. "I thought, 'Yeah, the simple science of stuff in your freezer decaying ... that makes really good sense.'"

Cryoablation, which destroys cells by shattering their outer walls during freeze-and-thaw cycles, actually was first hailed in the 1960s. But it proved too risky for much deep-body use — doctors couldn't see what they were aiming to freeze and thus had high complication rates. Dermatologists and gynecologists continued to freeze away easy-to-see skin or cervical growths, but other uses of cryoablation faded away.

Today it's making a slow comeback thanks to improved medical imaging that allows doctors to see deep in the body while they work. They can place a needle that emits freezing gas — argon is used primarily — in a tumor or organ and literally watch until ice encases it.

"You could see it so exquisitely under ultrasound," said Dr. Gary Onik, who pioneered cryoablation's return.

The first approved use is in patients whose colorectal cancer had spread to the liver and become inoperable. Cryoablation offers the hope of buying them some time; Onik says about 20 percent of his patients survive five years.

For prostate cancer, cryoablation proved more difficult. Bad aim causes serious side effects in the bladder or rectum; inconsistent freezing can miss cancer. But after years of research — and bad publicity from what Onik says were poorly trained doctors and technology companies rushing the procedure — a recent study published in the journal Urology suggests a careful cryoablation technique may be as effective as a widely used treatment, radioactive seed implants.

Like other prostate treatments, however, cryoablation can cause impotence.

So Onik, at Florida Hospital/Celebration Health, is experimenting with a nerve-sparing version in hopes of reducing that risk.

On to the breast: Sanarus Medical Inc. recently won federal approval of its cryoablation system to destroy fibroadenomas, benign breast tumors like Imhof's.

Now the company is conducting two pilot studies to test whether cryoablation might treat breast cancer, too. In one study, 25 women will have small cancers frozen. Three weeks later, they'll undergo a lumpectomy — standard surgery — so scientists can examine the lump for any cancer cells left lurking around the edges. The hope is that cryoablation might someday replace lumpectomies for certain women.

In the second study, another 25 women will undergo cryo-assisted lumpectomy, as scientists test whether freezing tumors that are hard for surgeons to feel can help them remove all the cancer on the first try.

"There's tempered enthusiasm," said study investigator Dr. J. Stanley Smith of the Pennsylvania State College of Medicine, cautioning that it will take years to prove whether the technique works.

Other scientists are testing freezing for kidney cancer patients who are poor candidates for grueling open surgery.

Experiments aside, patients considering even approved uses of cryoablation should pick an experienced cryosurgeon, warns Dr. LaMar McGinnis of the American Cancer Society ( news - web sites): It takes lots of training and practice to avoid complications.

Editor’s Note: Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Drugged Out

HealthScoutNews

Monday,  September 9, 2002

MONDAY, Sept. 9 (HealthScoutNews) -- You might be getting a government-approved "high."

 More than 20 percent of the drugs approved in the United States are approved at too high a dosage level, and those dosages have to be subsequently lowered, say researchers at Georgetown University's Center for Drug Development Science.

Their findings appear in a recent issue of Pharmacoepidemiology and Drug Safety.

The dosage changes required after approval show there's a discrepancy between dosage data gathered from pre-marketing studies and data required for safe and effective clinical use, the study authors say. Reducing this kind of approved drug overdosing could reduce side effects and prescription drug costs, they add.

The Georgetown researchers examined label changes made for all new drugs approved in the United States between 1980 and 1999. They found dosage changes were made in 21 percent of the drugs. Of those changes, 79 percent were the result of safety concerns.

"This pattern may represent a systematic flaw in pre-marketing dosage evaluation," the authors write.

Ideally, the dosage of a drug should remain constant through its lifetime of use.

Another study by Dutch researchers found a similar rate of dosage changes in drugs approved in other countries, with the exception of antibiotics.

More information

The U.S. Food and Drug Administration ( news - web sites) has more on the safe use of medicines.

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Weight-Surgery Death Sparks Debate

By John Porretto

AP Business Writer

The Associated Press

Monday,  September 9, 2002

DETROIT (AP) - The death of a city councilwoman after weight-reduction surgery has focused attention on a newly available technique in which a noose is tightened around the stomach.

Councilwoman Brenda Scott, who weighed more than 300 pounds, died Sept. 2 from an infection caused by a stomach perforation, three days after surgery at Port Huron Hospital. The medical examiner ruled the death an accident.

Scott, 47, underwent a procedure called Lap-Band Adjustable Gastric Banding, which won approval from the Food and Drug Administration ( news - web sites) in June 2001. The procedure has been done on nearly 90,000 people in other countries, mostly in Europe, over the past nine years.

The procedure involves placing an adjustable silicone band around the upper part of the stomach, creating a small gastric pouch that limits food consumption and creates an earlier feeling of fullness.

Once in place, the device is inflated with saline and can be tightened or loosened. It is intended to remain in place permanently but can be removed if necessary. Surgeons use keyhole surgery to put it in place.

Other surgical treatments for obesity — such as stomach stapling and gastric bypass — are more invasive.

The FDA has said Lap-Banding is intended only for severely obese people — those who are at least 100 pounds overweight or twice their ideal body weight and have failed to lose weight by diet, exercise and other means.

Doug Trigg, spokesman for INAMED Corp. in Santa Barbara, Calif. — makers of the Lap-Band device — said the death rate worldwide has been extremely low — about 0.005 percent.

Port Huron Hospital, which has performed the procedure more than 80 times since March, had had no major complications before Scott's death, medical director Dr. Kevin Sullivan said Thursday. Sullivan would not comment on Scott's case but said the hospital continues to offer the operation.

The American Society for Bariatric Surgery in Gainesville, Fla., estimates that 63,100 Americans will have stomach-reduction surgery this year. That is up from 23,100 in 1997.

"It used to be considered on the fringes of medicine, and now it's pretty mainstream," said Georgeann Mallory, the association's executive director. "More people know about it. More people have confidence in it."

Mallory said she had no statistics on complications related to Lap-Banding because the procedure is so new in the United States. She said the death rate for gastric bypass is three in every 1,000 patients.

"There's risk associated with any surgery," she said. She added: "Keep in mind that morbid obesity also carries risks."

In clinical trials of Lap-Band, most of the 299 patients — who also were required to diet and exercise — steadily lost weight over three years.

Lap-Band patients typically leave the hospital within 24 hours. Scott left Port Huron Hospital on Aug. 31. By the next night, she was complaining of abdominal pain and was taken to Detroit Receiving Hospital. She died of peritonitis, an infection of the abdominal lining often caused by a surgical mistake.

Her family has retained attorney Geoffrey Fieger, whose clients have included assisted-suicide advocate Jack Kevorkian ( news - web sites).

Fieger said two autopsies revealed perforations in Scott's stomach. He said there was no other way the holes could have occurred except in surgery.

"It's a no-brainer," Fieger said.

Jackie Viteri, spokeswoman for the Washington-based American Obesity Association, said she hopes the Scott death does not become an indictment of all weight-reduction operations.

"Each individual case is so different," Viteri said. "There are a lot of options for treatment — surgery being the most severe. But this shouldn't hinder someone from discussing that option with their surgeon."

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Mouse Study Gives Clues to Nicotine-SIDS Link

By Alison McCook

Reuters Health

Monday,  September 9, 2002

NEW YORK (Reuters Health) - Infants whose mothers smoked during pregnancy face a higher risk of sudden infant death syndrome (SIDS), and new research in mice provides an early glimpse into how nicotine might increase this risk.

Researchers have suggested that nicotine affects the functioning of certain proteins in the body. In the current study, published in the early edition of the Proceedings of the National Academy of Sciences ( news - web sites), a group of European researchers demonstrate that these proteins appear to help arouse baby mice during the brief pauses in breathing that often occur during sleep. Consequently, if nicotine affects these proteins, this may in turn increase the infants' risk of SIDS, the authors write.

Infants who stop breathing momentarily during sleep will experience a decrease in the delivery of oxygen to their tissues, from which they need to "escape" with a gasp in order to stay alive, study author Dr. Claude Gaultier from the Hopital Robert-Debre in Paris, France, told Reuters Health.

"If you don't gasp, you will die," Gaultier said.

Baby mice exposed to nicotine may have less functional forms of the proteins linked to the "gasping" recovery in their bodies, and therefore may not be able to snap out of a low-oxygen state, Gaultier explained.

During the study, Gaultier's team measured breathing patterns during sleep in normal mice and those that lacked proteins targeted by nicotine in the brain, known as nicotinic acetylcholine receptors, or nAChRs. When the two types of mice were forced to breathe in a low-oxygen environment, the researchers found that those with normal nAChRs were better able to snap themselves out of a pause in their breathing during sleep, known as a sleep apnea.

In an interview with Reuters Health, Gaultier explained that in a developing fetus, nicotine may cause changes in the body that result in a decrease in functioning of the nAChRs. Based on the current study findings, the researcher added, decreasing the functioning of nAChRs may prevent babies from breathing normally and snapping themselves out of apnea.

These findings concur with previous studies, in which other investigators linked exposure to cigarette smoke to a higher-than-average SIDS risk. In one report, infants born to mothers who smoked during pregnancy tended to be more difficult to rouse from sleep, and also had more episodes of sleep apnea.

Nicotine may not be the only ingredient of cigarette smoke that is dangerous to growing fetuses: in another report, investigators found that exposing rats to carbon monoxide, a component of cigarette smoke, can interfere with the maturation of heart cells in the developing fetus.

Gaultier said that SIDS does not likely have one cause, for babies never exposed to cigarette smoke can die suddenly in their sleep. However, smoking likely plays an important role.

"If we can suppress smoking during pregnancy, you should certainly decrease the number of SIDS (deaths) around the world," Gaultier said.

Source: Proceedings of the National Academy of Sciences 2002;10.1073/pnas.192463599.

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Late Artery-Clearing Procedure May Not Help

By Keith Mulvihill

Reuters Health

Monday,  September 9, 2002

NEW YORK (Reuters Health) - Getting artery-clearing angioplasty many days or weeks after a heart attack appears to have limited benefits, according to UK researchers.

While researchers are currently studying whether angioplasty within 12 to 24 hours of a heart attack can increase survival compared with clot-dissolving drugs, Dr. Michael S. Marber of Kings College London and colleagues conducted a small study looking at the usefulness of artery-clearing angioplasty 8 to 44 days after a heart attack.

During the procedure, a balloon-tipped catheter is threaded into a blocked artery and inflated, pushing aside blockages.

In the current study, Marber's team evaluated the outcomes of 66 heart attack patients who had persistent blockage in a coronary artery even though they weren't suffering from any chest pain or other symptoms after their initial heart attack treatment.

Thirty-two patients were given angioplasty 8 to 44 days after the heart attack and 34 patients were given drug treatment alone, according to the report in the September 4th issue of the Journal of the American College of Cardiology.

One year later, patients in the angioplasty group were more likely to have an enlarged left ventricle--a sign that the heart muscle had not fully recovered from the heart attack--than those in the non-angioplasty group. On the other hand, the angioplasty patients reported a higher quality of life and scored higher on exercise tests, the report indicates.

"The prediction is that opening an artery late after a heart attack would have a benefit through keeping the heart size more normal, but in fact what we found was the opposite," Marber explained in a prepared statement from the American College of Cardiology.

"We found that opening the artery in fact tended to make the remodeling process--those changes that occur after a heart attack--worse," he added. "However, it did tend to make patients feel better and it allowed them to exercise further."

Commenting on the study, Dr. Timothy Gardner, a spokesperson for the American Heart Association ( news - web sites), said that "this particular study is very unusual because they conducted the procedure many days or, in some cases, weeks after the heart attack."

"There has not been any good evidence to support this way of doing the procedure with such a delay," added Gardner, who is with the University of Pennsylvania in Philadelphia.

"The results suggest that (angioplasty many days later) didn't help much," Gardner told Reuters Health. "The patients that only had a drug intervention ended up with a more normal heart size."

In addition, Gardner pointed out that the study is not very powerful because the researchers only looked at 32 patients.

"There is currently an ongoing trial sponsored by the National Institute of Health that is looking at the efficacy of doing the artery opening procedure within the first 12 to 24 hours after a having a heart attack," Gardner noted.

Performing the angioplasty sooner rather than later "is a fairly commonly attempted procedure," said Gardner, "because, the thinking goes, if you reopen the artery early enough to preserve some of the heart cells that are dying as a result of the blocked blood flow, you can improve the patient's recovery."

Source: Journal of the American College of Cardiology 2002;40.

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Docs Use Varying Criteria to Determine Brain Death

By Alison McCook

Reuters Health

Monday,  September 9, 2002

NEW YORK (Reuters Health) - Different doctors use different standards when deciding if a patient is brain dead, and some may not perform all of the tests required to show that all parts of the brain are no longer functioning, US researchers report.

This is a critically important decision, study author Dr. J. Peter Gruen of the University of Southern California in Los Angeles told Reuters Health. When some doctors don't follow a set of standard criteria, the "great fear" is that a patient may be diagnosed as brain dead when he or she may not be, Gruen noted.

"Nobody wants to declare somebody dead who is not dead," Gruen said.

"Maybe we should consider having some kind of standard, because the stakes are so high," he added.

A patient is considered brain dead if he loses all functioning in his brain, with no chance of recovery. As a result, the brain can no longer control vital functions such as breathing, even though the heart may continue to beat for some time. To keep the patient breathing--which provides his organs with oxygen--doctors may connect him to a ventilator, during which time family members may donate his organs to patients awaiting transplants.

Gruen explained in an interview that a patient who is brain dead is not simply in a vegetative state; while people in the latter condition may no longer appear responsive, they are still very much alive.

Over the years, doctors have established criteria to help other doctors identify when someone is, indeed, brain dead, Gruen noted. These include a battery of tests that target different parts of the brain. For example, if a patient's pupils do not respond to a light, his midbrain is likely no longer functioning. However, that test alone does not show anything about the functioning of the rest of the patient's brain, Gruen cautioned, so doctors need to perform more tests "to establish thatevery part of the brain is not working."

However, not all doctors agree on how many criteria are required when diagnosing brain death, Gruen said. In addition, doctors disagree on how to proceed if a patient meets all but one or two of the criteria for brain death.

To determine what methods different doctors use when making these difficult decisions, Gruen and his colleagues reviewed 121 notes about brain death in 58 patients evaluated during 1 year at a major medical center. Their findings are published in the September issue of the journal Neurosurgery.

The investigators found that doctors were most likely to perform simple tests when diagnosing brain death, such as looking at pupil responses to light, and checking a patient's gag reflexes. However, they note, only 66% of patients' motor reactions were tested, and doctors checked their corneal reflexes only 57% of the time.

In all, the researchers found that some patients were declared brain dead when it appeared as if their doctors had not performed all the tests needed to examine the entire brain, Gruen said. "I was unpleasantly surprised to find that a significant number of people were declared brain dead when there were parts of the brain that were not evaluated," he noted.

Gruen explained that there is a lot of pressure on doctors to declare a patient brain dead. Many people are in desperate need of organs, and plenty of surgeons are standing by, ready to transplant them, Gruen said. "The concern is: a corner is going to be cut on the donor side of this," he added.

One way to overcome this concern is to rely solely on objective tests when diagnosing brain death, Gruen suggested. For example, if doctors inject radioactive material into a patient's bloodstream and it doesn't reach the brain, this indicates that the brain is dead. While those tests may be more expensive to perform, and involve logistical concerns such as transporting patients around the hospital, those obstacles are not insurmountable, Gruen said.

Source: Neurosurgery 2002;51:731-736.

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Test Quickly IDs Fetal Heart Rhythm Abnormalities

By Merritt McKinney

Reuters Health

Monday, September 9, 2002

NEW YORK (Reuters Health) - A new test quickly and accurately detects abnormalities in fetal heart rhythms as early as the 18th week of pregnancy, an international team of researchers reports.

The new screen, known as tissue velocity imaging, is "an extremely effective way of evaluating a variety of fetal heart rhythms," the study's lead author, Dr. David J. Sahn of Oregon Health and Science University in Portland, told Reuters Health in an interview.

Sahn explained that when a doctor suspects that a fetus's heart is beating too fast or too slow, a woman is referred to a specialist to determine whether the rhythm abnormality is serious. In most cases, Sahn said, these abnormal rhythms, known as cardiac arrhythmias, are temporary and correct themselves without any treatment. But other cases are more serious and may be caused by structural abnormalities in the heart, he said.

Unfortunately, the methods for looking at heart rhythms in the womb are "still a little crude," according to the Oregon researcher. It is possible to measure the electrical activity of the fetal heart, but Sahn said that it is very difficult. It is possible to use conventional ultrasound to measure the motion of the heart in the womb, but this process is "very laborious" and can take half an hour or longer to perform, Sahn said.

Tissue velocity imaging is "much more efficient," he said in the interview.

Sahn explained that the new test uses ultrasound imaging to measure the speed of the heart's chambers. "Even though the structures aren't moving very far, they are moving reasonably fast," he said.

Sahn, along with colleagues in Massachusetts and Israel, tested the accuracy of tissue velocity imaging in 31 fetuses whose mothers had been referred for echocardiography--a diagnostic test that uses ultrasound waves to produce an image of the heart--to evaluate cardiac arrhythmia. The women were 18 to 38 weeks along in pregnancy when they had the screen.

Using tissue velocity imaging, the researchers were able to diagnose cardiac arrhythmias quickly and accurately, according to a report published in the online edition of Circulation: Journal of the American Heart Association ( news - web sites). On average, it took researchers 4 minutes to perform the test and 8 minutes to analyze the results.

Eighty-seven percent of the fetuses had an abnormality called supraventricular arrhythmia, which starts in the heart's upper chambers, and 6% had an abnormality called ventricular ectopy. Another 3% had complete atrioventricular block, which causes a delay in the electrical impulses that move from the atria into the ventricles, and 3% had a slow heartbeat called sinus bradycardia.

The researchers point out that conventional screens usually miss one of the arrhythmias detected by the screen, atrioventricular block, except when it is more severe.

Source:Circulation 2002;10.1161/01.CIR.0000031571.92807.CC.

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Anger, Stress Can Trigger Irregular Heartbeat

By Suzanne Rostler

Reuters Health

Monday, September 9, 2002

NEW YORK (Reuters Health) - Keeping feelings of stress and anger at bay may lower the risk of sudden death in heart patients with an implantable defibrillator, new study findings suggest.

The medical device, also known as an implantable cardioverter-defibrillator (ICD), is placed in the heart of a patient with an abnormal heart rhythm. The device detects heart rhythm abnormalities, and releases an electric impulse to stabilize the heartbeat. These abnormalities can lead to sudden death if normal heart rhythm is not restored.

Previous research has shown that emotional and physical stress can tax the hearts of both cardiac patients and healthy individuals. Working patients wearing ICDs are more likely to experience a rapid heartbeat on Mondays, for instance, and medical interns are more likely to have abnormal heart rhythms while they are on call.

To investigate emotional and physical triggers of abnormal heart rhythms, or arrhythmias, in a group of patients with ICDs, a team of researchers followed 240 people over 3 years. All patients kept diaries of their mood, activities and level of physical exercise rated on a 5-point intensity scale, with 5 indicating the most vigorous activity. Patients who had an arrhythmia over the course of the study also recorded their mood shortly beforehand, and again 1 week later at the same time.

Feelings of anger and any level of physical activity increased the risk of needing a shock to restore normal heart rhythm, according to the findings in the October 1st issue of Circulation: Journal of the American Heart Association ( news - web sites). Among patients who received a shock, anger was rated at 3 or higher in the 15 minutes preceding the shock in 15% of cases, compared with 3% of the time the following week. These patients reported that they had been arguing, gambling, driving or had just heardbad news when the shock was delivered.

Other emotions such as anxiety, sadness, happiness or feelings of being in control or challenged did not affect the risk of arrhythmia, however, the report indicates.

Patients were also more likely to receive a shock when they were walking, engaging in physical activity at work or exercising, according to the research team led by Dr. Diwakar Jain from Hahnemann University in Philadelphia, Pennsylvania.

Jain, in an interview with Reuters Health, stressed that these patients can exercise under medical supervision at a cardiovascular rehabilitation program.

"Low-level, carefully titrated physical exercise...is beneficial for these patients," he said.

And while it is not clear whether moderating feelings of anger would have any effect on patients who wear ICDs, some studies have shown that stress management and anger-reduction interventions can lower the risk of repeat cardiac events.

"I strongly think that comprehensive behavior modification therapy may have an important role in patients with ICDs or in those with ventricular arrhythmias and in patients with coronary artery disease in general," Jain told Reuters Health.

Source: Circulation 2002;106.

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Gender Impacts HIV Blood Levels, Report Says

By Jacqueline Stenson

Reuters Health

Monday, September 9, 2002

NEW YORK (Reuters Health) - At similar stages of HIV ( news - web sites) infection, women tend to have lower levels of the virus in their blood than men, according to a new report.

Previous studies have yielded conflicting findings on this issue. But the new report, which took a close look at 13 earlier studies involving more than 10,500 patients, concluded that the majority of the evidence shows a clear gender effect.

"The difference is real," said study author Dr. Monica Gandhi of the University of California, San Francisco. "But we have no idea of the significance of that difference."

Since doctors use blood levels of HIV to guide them in many of their treatment decisions, the difference could be an important one. Yet there is no good evidence to suggest that giving women medication at different times than men will confer benefit, especially since both men and women appear to develop full-blown AIDS ( news - web sites) at similar rates, Gandhi told Reuters Health. "If we treat women earlier, will they do better?"

Answers to that question will only come with more research involving women, Gandhi said. Most AIDS studies have been conducted with men, which is why doctors have little understanding of how gender affects HIV progression or treatment, she pointed out.

In a recent issue of Clinical Infectious Diseases, Gandhi and colleagues reported that more than three-quarters of the studies they reviewed showed that at similar stages of infection, women had blood levels of the AIDS virus that were twofold to sixfold lower than in men.

The researchers took into account various factors that could have affected the results, including patient age, race and how the virus was contracted.

The precise reason for the difference is unclear, according to Gandhi. But she said she's not surprised that it exists because female sex hormones, namely estrogen, have an impact on a variety of diseases.

"This study adds to the accumulating data that there are major differences between men and women in disease progression," Gandhi said.

Source:Clinical Infectious Diseases 2002;35:313-322.

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Dogs, Day Care Linked to Kids' Ulcer Bug Risk

Reuters Health

Monday, September 9, 2002

NEW YORK (Reuters Health) - Children in day care or who have pet dogs are more likely to carry Helicobacter pylori, the bacterium associated with stomach ulcers, new study findings from Italy suggest.

While the bacteria are common in the general population, researchers are not sure exactly when the organisms take up residence in the intestinal tract. Studies suggest that for most people this happens in early childhood.

Researchers are also still trying to determine who is most at risk of contracting the bug. Previous research has shown that children in less developed nations are more likely to be infected. However, even among kids living in industrialized nations, the risk of infection with H. pylori can vary widely among different ethnic groups.

People infected with H. pylori face an increased risk of developing ulcers, and in some cases, gastric cancers.

In the current study, Dr. Maria P. Dore of the University of Sassari and colleagues analyzed blood samples of 2,810 children attending primary or middle school in northern Sardinia.

Twenty-two percent of the children tested positive for H. pylori. Kids living in rural areas were more likely to be infected than urban children--37% versus 13%, respectively, according to the report in a recent issue of Clinical Infectious Diseases.

Among children living in the country, having a pet dog nearly doubled their chances of testing positive for the bacteria. No such association was seen among children living in cities, the investigators found.

Urban children were 1.5 times more likely to carry H. pylori if they attended nurseries or day care centers, but because such facilities are not common in rural villages, this information was not collected for that group.

"Our study showed that the epidemiology of H. pylori infection in childhood is influenced by environmental factors both inside and outside the home," Dore's team concludes.

Source: Clinical Infectious Diseases 2002;35:240-245.

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Vitamin E May Help Keep Arteries Clear in Women

Reuters Health

Monday, September 9, 2002

NEW YORK (Reuters Health) - Women who take in less vitamin E may be at greater risk of heart disease and stroke, even if they do not have other risk factors, Italian researchers report.

Their study found that women with the greatest intake of vitamin E had the least plaque at the carotid bifurcation--a Y-shaped branch in the arteries in the neck where plaque build-up usually begins. This build-up, known as atherosclerosis, is a major risk factor for heart disease and stroke.

The findings suggest that vitamin E--found in nuts, olive oil and some vegetables--may provide protection against the early stages of plaque build-up, according to Dr. Paolo Rubba from Federico II University in Naples, Italy, and colleagues.

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

Rubba and colleagues examined 310 women 30 to 69 years and measured their blood levels of vitamins A, C, E and other antioxidants. They also interviewed the study participants about their medical history, drug use and personal habits, and the frequency with which they consumed various foods. Women were then divided into three groups according to their intake of vitamin E-rich foods. None of the women were taking vitamin supplements.

Women who reported consuming the most vitamin E-rich food had the lowest build-up of plaque in their carotid bifurcation, the investigators found. Among postmenopausal women, those who consumed the least vitamin E were nearly three times more likely to have arterial plaque regardless of age, smoking habits, blood pressure, body mass index (BMI) and other heart disease risk factors.

Similarly, those with low blood levels of vitamin E relative to cholesterol were about twice as likely to have carotid plaques, the report indicates.

While the findings suggest an association between vitamin E intake and arterial plaque, it is still unclear exactly how vitamin E might prevent plaque build-up. Vitamin E is an antioxidant, meaning it neutralizes the effects of cell-damaging molecules called free radicals that may play a role in plaque formation. However, the study found no association between other antioxidant vitamins such as A, C and beta-carotene and arterial plaque.

More research is needed into vitamin E's potential plaque-fighting mechanisms, the researchers conclude.

Source: American Journal of Clinical Nutrition 2002;76:582-587.

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Obesity Threatens to Reverse Gains in Longevity

By Patricia Reaney

Reuters

Monday, September 9, 2002

LEICESTER (Reuters) - Obesity threatens to reverse gains in longevity made during the last 100 years and in some cases could result in parents outliving their children, a British nutritionist said on Monday.

An estimated 28% of people in the United States and 20% in Europe are obese and many more are overweight, making obesity the fastest growing health epidemic of the past two decades.

Professor Andrew Prentice of the London School of Hygiene and Tropical Medicine said the epidemic that has resulted from too much fatty food and a decrease in physical activity has caused a shift in human evolution and shape.

But unlike the last change, which occurred about two centuries ago following an improved diet and involved an increase in height, people are now getting fatter, not taller, and at a much younger age.

"We've spent 100 years doing marvelous work in terms of increasing longevity and improving human health and now there are a few things that threaten that," he said, citing obesity and smoking.

"Obesity is massively implicated and it is likely to tend to reverse all those gains we've been having."

Obesity Starting Younger

Adolescents are becoming obese and at a younger age and along with the younger onset of obesity, doctors are seeing Type II diabetes and other weight-related illnesses, which normally develop much later, in younger patients.

"Diabetes is a very serious, life-threatening disease. So if you put all those things together, these young people who are being ambushed by this change in the environment are storing up for themselves enormous ill health in the future," he said.

Prentice added that there have already been extreme cases where parents have outlived their children who have died of obesity.

The problem is compounded because obese children and adolescents are more likely to remain obese as adults and the younger obesity occurs, the more severe its long-lasting effects on health.

About 30,000 people in Britain die of obesity-related causes each year, cutting short their lives by about nine years, according to the National Audit Office.

"Obesity is a gradually evolving disease and the effects of it take time to accumulate. There is a time component to this. The longer you are obese the more likely you are to accrue all the damaging side effects of obesity," said Prentice.

Many children are brought up on fast food diets, high in fats, and are exercising less and spending more time in front of computers and televisions instead of exercising and playing outdoors.

"Obesity is a perfectly predictable biological response to our changing environment," he explained.

"The kids of today are not gluttonous or lazy. They have been ambushed by living in a environment that they know no different to."

Prentice said major changes in transport, food, advertising and education policies are needed to encourage people to exercise more, eat better and provide children with safer places to play are needed to change the trend.

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SUNDAY, SEPTEMBER 8, 2002

AbioCor Heart Patient Nears a Year

By Bruce Schreiner

Associated Press Writer

The Associated Press

Sunday, September 8, 2002

LOUISVILLE, Ky. (AP) - One year ago, Tom Christerson's life was ebbing away when he made the decision to let doctors take out his failing heart and put in a revolutionary mechanical pump.

Now, as he prepares to mark the first anniversary of his operation this week, the retired tire dealer has become a silver-haired symbol for the AbioCor artificial heart and its potential as a replacement for diseased hearts.

Of seven people implanted with the device, the 71-year-old Christerson is the lone survivor. He went home in April to Central City, Ky., resuming a quiet life with a close-knit circle of family and friends.

"I didn't have any idea it would last this long," Christerson said last week during a routine checkup at Jewish Hospital. "I thought it would give me another six months, but I've got a year so far."

The AbioCor has not skipped a beat since being inserted into Christerson's chest last Sept. 13, according to its manufacturer, Abiomed Inc. of Danvers, Mass.

The softball-sized pump, made of plastic and titanium, is powered by batteries. It is self-contained within the chest with no wires or tubes sticking through the skin, a technological leap from earlier mechanical hearts, like the Jarvik-7, that were attached by wires and tubes to machinery outside the body.

Among all artificial heart recipients, William Schroeder of Jasper, Ind., lived the longest, surviving 620 days with a Jarvik-7 until his death in 1986. The first artificial heart recipient, Barney Clark, a Seattle-area dentist, lived 112 days after receiving a Jarvik-7 in 1982.

Before Christerson's implant surgery at Jewish Hospital, he was so weak that a few steps would leave him gasping for breath. His doctors said he had only days to live. Now, Christerson strolls unassisted each morning from a parking lot to a cafe where he sips coffee and gossips with friends.

He has lived to see the birth of his first great-grandchild. Next month, he and his wife will celebrate their 55th wedding anniversary.

As the longest-living AbioCor recipient, Christerson advocates it for others.

"I'd say do it, if they were in the same shape I was in," Christerson said. "Of course, I didn't have too long to live. I wouldn't hesitate to tell them to go ahead and get it done."

For the manufacturer, Christerson is the model patient.

"Tom Christerson's experience demonstrates the great potential of the AbioCor to save lives and provide a good quality of life," said Dr. David Lederman, president and chief executive of Abiomed.

The fifth AbioCor recipient, James Quinn, died last month after suffering a stroke. He survived 10 months.

The AbioCor gave Quinn more time with his grandchildren. He also attended church, went shopping, dined out, went home for his wedding anniversary and visited a comedy club.

Quinn was the third AbioCor patient to suffer a stroke blamed as a contributing factor to their death.

The threat of stroke prompted Abiomed to refine the pump, but it hasn't hasn't been able to assess the change yet. The first patient to receive the altered device died in the operating room at Jewish Hospital in April, the only AbioCor implant this year. The pump wasn't a factor in the death, officials said.

The threat of stroke also has become a bigger factor in choosing patients.

Doctors are looking more closely at physical conditions in the screening process that might prevent patients from tolerating anti-clotting medication. Unlike many AbioCor patients so far, Christerson was able to take recommended doses of the blood-thinning medication. Many heart patients can't because they are malnourished and prone to bleeding.

Some prominent heart specialists say the clinical trial already has been a success, showing that the AbioCor works and that its patients can live for extended periods, but they caution that it needs more work.

Christerson's recovery is "a beacon of hope" for people with end-stage heart disease, said Dr. Robert Higgins, chairman of cardiac surgery at the Medical College of Virginia.

"The expectations are very high, probably unrealistically high, that we can replace the human heart at this juncture," he said. "It's still imperfect technology which requires modifications and improvements."

The Food and Drug Administration ( news - web sites) has approved eight more AbioCor implants.

The company wants to pick up the pace and possibly have the operations done this year, and its goal is to gain FDA approval to begin selling the AbioCor on a limited basis in 2004, said company spokesman Edward Berger.

"It's fair to say that there will be for probably a number of years continuing clinical trials of one level or another," he said.

On the Net:

Abiomed: http://www.abiomed.com

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FDA Calls Botox Ads Misleading, Asks for Fix

Reuters

Sunday, September 8, 2002

LOS ANGELES (Reuters) - Print and television ads for the wrinkle-smoothing drug Botox are misleading and should be pulled until they are changed, the US Food and Drug Administration ( news - web sites) told the drug's maker Allergan Inc.

The ads fail to emphasize that Botox is a temporary fix for wrinkles, suggest incorrectly that it can be used to treat all kinds of wrinkles and do not mention that the drug is approved only for people between the ages of 18 and 65, the regulatory agency said in a Sept. 5 letter to the company and posted on the agency's Web site.

The FDA instructed the company to immediately stop all broadcast ads and other promotional activities that contain misleading claims.

Officials at Allergan, based in Irvine, California, could not be immediately reached for comment.

Botox, a purified form of the toxin that causes botulism food poisoning, smooths out wrinkles by interfering with neurotransmitters and relaxing muscles.

Approved since 1989 for eye muscle disorders, and used for years ""off-label" to freeze wrinkles, Botox was officially approved by the FDA in April for temporary improvement in the appearance of moderate to severe brow furrows.

The FDA said a brochure stating, ""It seems like everybody is talking about Botox Cosmetic, the highly effective, non-surgical procedure that can dramatically reduce your toughest wrinkle within 7 days," misleads because it does not state that the effect is temporary.

""Please immediately cease distribution of these, and similarly worded, materials and revise these statements to clearly emphasize the temporary duration of this product and to appropriately identify the approved indication for use, e.g. 'those tough lines between your eyebrows,"' Mary Malarkey, of the FDA's office of compliance and biologics quality, said in the letter.

The FDA also said Allergan was misleading consumers with statements like, ""If doing all you can to look your best is important to you, Botox Cosmetic may be for you," because they do not clearly define the age range it is approved for.

The agency singled out TV ads that focus attention on complexion and image, make repeated references to age and make the statement, ""Ask your dermatologist or plastic surgeon about Botox Cosmetic."

The FDA also warned Allergan that dilution instructions for doctors posted on a company Web site promote several dilutions and doses that are not approved for cosmetic procedures.

The FDA requested that the company respond by Sept. 15.

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Check Your Cholesterol

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Sunday, September 8, 2002

SUNDAY, Sept. 8 (HealthScoutNews) -- If the risk of heart disease isn't enough to convince you to check your cholesterol levels, here's another incentive:

September is Cholesterol Awareness Month, so now's the time to learn your cholesterol count.

Approximately 100 million Americans, roughly one-third of the population, have a combined cholesterol count over 200, which is considered a borderline-high risk marker for heart disease, according to the American Heart Association ( news - web sites). In that group, 41 million people are at high risk for heart disease because their cholesterol is over 240.

"High cholesterol is a major risk for atherosclerosis and stroke," says Dr. Roger Blumenthal, a cardiologist at Johns Hopkins School of Medicine. "But you can significantly reduce cholesterol by a combination of improving your lifestyle and appropriate use of medication."

Cholesterol is not always a bad thing. A waxy substance produced by the liver, it insulates the nerves, makes cell membranes and produces certain hormones. However, the body produces enough for its own needs. If, through a combination of poor diet or a genetic predisposition, you produce more cholesterol than needed, the excess stays in the blood, forming plaque that lines the arteries. Eventually, the arteries harden and put you at risk for heart disease.

So, you should first find out what your cholesterol levels are through a blood test at a doctor's office. There are two types: LDL cholesterol and HDL cholesterol.

LDL is often called the "bad" cholesterol because it stays in the blood, forming the plaque that lines the arteries. Eventually it hardens the artery walls, making them thicker and less flexible so that blood flow to the heart is restricted, which can cause heart attacks.

"Optimally, your LDL level should be less than 100 milligrams per deciliter of blood," Blumenthal says.

HDL is known as the "good" cholesterol because high levels are associated with less heart attack risk, and Blumenthal says a count above 40 milligrams per deciliter is considered healthy.

Together, the two counts should be under 200, Blumenthal says, which is considered "normal."

Also important is your level of triglycerides, which are fats present in the blood that are associated with the risk of heart disease. Blumenthal says they should not be higher than a count of 150 milligrams per deciliter of blood.

If your cholesterol counts are over 200 and/or your triglyceride count is over 150, the first thing to look at is changing your lifestyle.

"We look at food and physical activity," says Connie Diekman, a nutritionist and spokeswoman for the American Dietetic Association who works with people at risk for heart disease.

"We take a food history to get a snapshot of the whole diet, and then give a person feedback on basic nutrition and how to relate it to their goals of reducing their heart attack risk. Sometimes simple diet changes will naturally pull the cholesterol in line," Diekman says.

The most common problem with people's diets is that they are not eating enough servings of fruits and vegetables, which should be at least five a day.

Ironically, many people try to avoid fat in their foods, and wind up omitting healthier fats from their diets.

"Olive oil, canola oil, fatty fish and peanuts, for instance, are good fats that reduce cholesterol," Diekman says.

Diekman says improving your diet isn't easy: "We're very much creatures of habit and it takes some work." However, if you motivate people in the right way, it can be done, she adds.

"Fear, for instance, only works for about six months as a motivator," she says. "It's better to look at changing a diet as an opportunity to enjoy new things."

Diekman recommends working within your own dietary routines to find places to add good foods, rather than focusing on taking away foods. Adding fruit to your morning cereal, cooking vegetables along with the chicken you roast, sticking sliced tomatoes or red pepper strips into your sandwich are all ways to add nutrition without much strain.

"Also, you can shift the fat in your diet where you want it," she says. "If someone has a treat they really don't want to give up, I say, 'That's fine. We can work that in, but we have to shift something else to make room for it.' "

Exercise is equally important in reducing cholesterol, and Diekman recommends her clients try for 30 to 40 minutes of aerobic exercise most days of the week -- "walking, jogging, biking, dancing, whatever they like to do."

Diekman says it takes about six to eight weeks to see any decline in cholesterol after making changes. Even then, the most you can expect from improvements in your diet and increased exercise is a 5 percent to 10 percent drop in cholesterol.

If your cholesterol is still too high after lifestyle changes, then it's time to look at medications, Blumenthal says.

"Diet and exercise are the cornerstones of cholesterol management, but medication can be helpful," he says.

For people with high cholesterol who have never had a heart attack, doctors can decide whether drugs are appropriate using a score that assesses heart attack risk. Factoring in a person's age, total cholesterol count, HDL level, smoking history and blood pressure, doctors can predict the risk level for a heart attack within a decade. If the risk is more than 20 percent, they can prescribe a cholesterol-lowering medication.

A group of drugs called statins, which decrease the production of cholesterol in the liver, are the most common treatment for high cholesterol, Blumenthal says. They reduce the risk of subsequent heart attacks in people who have already had one, and are equally helpful for people who have never had a heart attack but who are at risk for one, he adds.

What To Do

An explanation of what cholesterol is and what it does can be found at the American Heart Association, which also offers a cholesterol test so you can see how much you know about cholesterol.

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Heartburn Woes

HealthScoutNews

Sunday, September 8, 2002

SUNDAY, Sept. 8 (HealthScoutNews) -- Despite what some heartburn medications ads imply, having chronic heartburn doesn't mean you're in imminent danger of developing esophageal cancer.

However, chronic heartburn may cause certain medical problems and you should talk to your doctor about it, says an article in the September issue of Mayo Clinic Women's HealthSource.

About 10 percent of Americans have heartburn each day. In most cases, it's mild and temporary.

However, some have chronic heartburn that hits them several times a week. That could indicate a condition called gastroesophageal reflux disease (GERD).

GERD can be treated several ways. That includes lifestyle changes such as exercise, weight loss and avoiding foods that cause heartburn. Surgery and medications are other options.

About 5 percent of people with GERD have Barrett's esophagus. That's a condition where cells that are similar to the stomach's lining develop in the lower esophagus. People with Barrett's esophagus are at increased risk of developing esophageal cancer.

If you do have chronic heartburn that isn't controlled by antacids, it's wise to see your doctor about it, the Mayo article says.

More information

Here's more about GERD.

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Hundreds Get Radiation Pills

By Jay Hughes

Associated Press Writer

The Associated Press

Sunday, September 8, 2002

CLINTON, Ill. - A year ago, Charles and Deborah Bateson may have disregarded a chance to stock up on pills that help block radiation in case of an accident at the nuclear plant near their home.

They were among the first to get the pills Saturday.

"The way the world is right now, you never know what's going to happen," Charles Bateson said.

Hundreds of residents within 10 miles of the Clinton nuclear power plant took advantage of a weekend giveaway of potassium iodide pills. The pills can block buildup of one type of radiation in the thyroid gland, but do not guard against other radiation.

Clinton-area residents are the first in Illinois to be offered the pills by the state Department of Nuclear Safety. The agency later plans to offer potassium iodide to residents near Illinois' five other working nuclear plants.

DNS spokeswoman Patti Thompson said the giveaway allows the department to address safety and emergency concerns.

Since Sept. 11, federal nuclear regulators have made potassium iodide available to the 33 states with nuclear plants; three other states have distributed pills to those who live in the shadow of nuclear plants. In those states, officials say, between 10 and 34 percent of those eligible chose to stockpile the medication.

On the Net:

Department of Nuclear Safety: http://www.state.il.us/idns/

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SATURDAY, SEPTEMBER 7, 2002

Don't Have a Beef With Your Teens

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Saturday, September 7, 2002

SATURDAY, Sept. 7 (HealthScoutNews) -- If your teenager has sworn off hamburgers and offers dinnertime soliloquies about how gross it is to eat cow, you don't need to worry.

Vegetarian diets for teens can be quite healthy, as long as parents help monitor the diets so the kids get the nutrients they need, new research has found.

"Parents are a bit too concerned about their teen's vegetarianism," says study author Cheryl Perry, a professor of epidemiology at the University of Minnesota. "If the adults could embrace it a bit and say, 'We'll have vegetarian meals twice a week and you can help me cook,' it might take some of the perceived rebellion out of it and be healthier for the whole family."

Perry and her colleagues studied 4,746 teenagers of various ethnic and racial backgrounds from 31 middle and high schools in the Minneapolis area. Of them, 262, or 6 percent, said they were vegetarian. The majority were girls.

Researchers then compared the diets of the vegetarian teens to dietary guidelines issued by the U.S. Department of Health and Human Services ( news - web sites).

The study, which appeared in a recent issue of the journal Archives of Pediatrics and Adolescent Medicine, found that:

·         Vegetarian teens were more than twice as likely to eat less than 30 percent of their calories from fat, compared to non-vegetarians. About 65 percent also consumed less than 10 percent of their calories from saturated fat, compared to 39 percent of meat-eaters.

  • Vegetarians were also more likely to eat at least five servings of fruits and vegetables daily -- 39 percent compared to 28 percent.
  • Vegetarians also ate less cholesterol-laden foods, more Vitamin A, more iron and less fast food and drank less regular soda. However, they consumed more caffeine and more diet soda.

Perry's previous research found the main reason teens gave for giving up meat was to lose weight. Other common reasons included compassion for animals and the environment, not liking the taste of meat, and wanting to eat healthier.

However, weight loss isn't a good reason for starting a vegetarian diet. The researchers found no difference in the average body mass index of the vegetarians versus the non-vegetarians.

The American Dietetic Association says a vegetarian diet can be healthy for a child of any age, including infants.

"A well-managed vegetarian diet can absolutely meet the needs of growing children, including teenagers," says Sheah Rarback, an American Dietetic Association spokeswoman. "The issue is making sure the child is getting all the nutrients they need from non-meat sources. It all comes down to eating a variety of allowed foods, and making sure you get all the nutrients for growth."

That said, both Rarback and Perry caution that some of those teens who proclaim they are vegetarians could also be trying to hide an eating disorder.

"Saying that you're vegetarian can help mask an eating disorder and take the pressure off," Rarback said. "A teen can say, 'I don't eat this because of my beliefs.' "

In earlier research, Perry found vegetarian teens were at higher risk of unhealthy weight-control practices, such as bingeing or taking laxatives. About 8.5 percent of vegetarian teens had been told by a doctor they had an eating disorder, compared to only 3.1 percent of meat-eating teens.

What To Do

Check out the American Dietetic Association's position paper on vegetarianism, which also includes a food guide for vegetarians and meal-planning ideas. Or visit the Vegetarian Resource Group for nutrition tips for teens.

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Fighting Foot Ulcers

HealthScoutNews

Saturday, September 7, 2002

SATURDAY, Sept. 7 (HealthScoutNews) -- A genetically engineered gel is being tested to see if it can heal diabetes-related foot ulcers.

This form of gene therapy is meant to cover such foot ulcers with substances the body normally produces to repair skin. It's being tested by University of Florida scientists, along with researchers from Selective Genetics Inc., the company that developed the gel.

The study will include at least 21 people with diabetes-related food ulcers. It's designed to determine whether this gene therapy approach is safe and what the ideal dose is. The researchers will also assess whether the gel improves wound healing.

The gel itself contains a common virus that's been engineered to carry copies of the gene that makes platelet-derived growth factor. That's something the body naturally produces to help heal wounds. The developers expect wound repair cells to migrate to the gel, take up the gene, and start producing the platelet-derived growth factor.

Each year in the United States, doctors treat about 3 million skin ulcers that refuse to heal, even months after the initial injury. About 400,000 of those skin ulcers afflict people with diabetes. For thousands of them, skin ulcers that won't heal lead to foot or limb amputation.

More information

The American Academy of Family Physicians ( news - web sites) has more about diabetic foot ulcers.

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