KKANOTES GENERAL MEDICAL

More Isn’t Always Better in Coronary Care

2009-01-18T19:27:00.000-08:00

Personal Health
More Isn’t Always Better in Coronary Care

new_york_times:http://www.nytimes.com/2009/01/06/health/06brod.html

By JANE E. BRODY
Published: January 5, 2009
Ira’s story is a classic example of invasive cardiology run amok.

Ira, of Hewlett, N.Y., was 53 when he had an exercise stress test as part of an insurance policy application. Though he lasted the full 12 minutes on the treadmill with no chest pain, an abnormality on the EKG led to an angiogram, which prompted the cardiologist to suggest that a coronary artery narrowed by atherosclerosis be widened by balloon angioplasty, with a wire-mesh tube called a stent inserted to keep the artery open.
The goal, he was told, was to prevent a clot from blocking the artery and causing a heart attack or sudden cardiac death.
Wanting to avoid an invasive procedure, Ira decided to pursue a less drastic course of dieting, weight loss and cholesterol-lowering medication. But three years later, the specter of a stent arose again. An abnormal reading on a presurgical EKG led to another angiogram, which indicated that the original narrowing had worsened. Cowed by the stature of the cardiologist, Ira finally agreed to have not one but three coronary arteries treated with angioplasty and drug-coated stents, making him one of about a million Americans who last year underwent angioplasties, most of whom had stents inserted.
Being Treated While Healthy
For patients in the throes of a heart attack and those with crippling chest pain from even minor exertion, angioplasty and stents can be lifesaving, says Dr. Michael Ozner, a Miami cardiologist and the author of “The Great American Heart Hoax” (Benbella Books, $24.95). But, Dr. Ozner said in an interview, such “unstable” patients represent only a minority of those undergoing these costly and sometimes risky procedures.
Most stent patients are healthy like Ira, who was experiencing no chest pain or cardiac symptoms of any sort. Yet Ira was afraid not to follow the doctor’s advice, despite the fact that no study has shown that these procedures in otherwise healthy patients can reduce the risk of heart attacks, crippling angina or sudden cardiac death. “We’ve extended the indications for surgical angioplasty and stent placement without any data to support the procedures in the vast majority of patients — stable patients with blockages in their arteries,” Dr. Ozner said.
What the studies do show, Dr. Ozner said, is that putting stents in such patients is no more protective than following a heart-healthy lifestyle and taking medication and, if necessary, nutritional supplements to reduce cardiac risk. The studies have also shown that stents sometimes make matters worse by increasing the chance that a dangerous clot will form in a coronary artery, as noted in 2006 by an advisory panel to the Food and Drug Administration.
Dr. Ozner, medical director of the Cardiovascular Prevention Institute of South Florida, is one of many prevention-oriented cardiologists vocal about the overuse of “interventional cardiology,” a specialty involving invasive coronary treatments that have become lucrative for the hospitals and doctors who perform them.
Even some interventional cardiologists have expressed concern about the many patients without symptoms who are treated surgically. “The only justification for these procedures is to prolong life or improve the quality of life,” said Dr. David L. Brown, an interventional cardiologist and chief of cardiology at Stony Brook University Medical Center, “and there are plenty of patients undergoing them who fit into neither category.”
Mistaken Assumptions
The treatments — coronary artery bypass surgery, angioplasty and the placement of drug-coated stents — cost about $60 billion a year in the United States. Though they are not known to prevent heart attacks or coronary mortality in most patients, they are covered by insurance. Counseling patients about diet, exercise and stress management — which is relatively inexpensive and has been proved to be life-extending — is rarely reimbursed. In other words, procedure-oriented modern cardiology is pound wise and penny foolish. And in these economic times, it makes great sense to reconsider the approaches to reducing morbidity and mortality from the nation’s leading killer.
Most people mistakenly think of coronary artery disease as a plumbing problem. Influenced by genetics, diet, diabetes, hypertension, smoking and other factors, major arteries through which oxygen-rich blood flows to the heart gradually become narrowed by deposits of cholesterol-rich plaques until blood can no longer pass through, resulting in a heart attack.
In coronary bypass surgery, a blood vessel taken from elsewhere in the body is reattached to a clogged coronary artery to bypass the narrowed part.
However, as Dr. Ozner points out in his book, “three major studies performed in the late 1970s and early 1980s clearly proved that for the majority of patients, bypass surgery is no more effective than conservative medical treatment.” The exceptions — patients whose health and lives could be saved — were those with advanced disease of the left main coronary artery and those with severe crippling, or unstable, angina.
Bypass surgery does relieve the pain of angina, though recent studies suggest this may happen because pain receptors around the heart are destroyed during surgery.
“The studies on angioplasty delivered even worse news,” Dr. Ozner wrote. “Unless the patient was in the midst of a heart attack, the opening of a blocked coronary artery with a balloon catheter resulted in a worse outcome compared to management through medication.” In fact, one trial, published in 2003 in The Journal of the American College of Cardiology, found that balloon angioplasty, which flattens plaque against arterial walls, actually raised the risk of a heart attack or death.
Stents were designed to keep the flattened plaque in place. But studies of stable patients found no greater protection against heart attacks from stents than from treatments like making lifestyle changes and taking drugs to lower cholesterol and blood pressure.
A Small Culprit
A new understanding of how most heart attacks occur suggests why these procedures have not lived up to their promise. According to current evidence, most heart attacks do not occur because an artery is closed by a large plaque. Rather, a relatively small, unstable plaque ruptures and attracts inflammatory cells and coagulating agents, leading to an artery-blocking clot.
In most Americans middle age and older, small plaques are ubiquitous in coronary arteries and there is no surgical way to treat them all.
“Interventional cardiology is doing cosmetic surgery on the coronary arteries, making them look pretty, but it’s not treating the underlying biology of these arteries,” said Dr. Ozner, who received the 2008 American Heart Association Humanitarian Award. “If some of the billions spent on intervention were put into prevention, we’d have a much healthier America at a lower cost.”
Dr. Ozner advises patients who are told they need surgery to get an independent second opinion from a specialist.
This is the first of two columns on preventing heart attacks. Next week: Noninvasive remedies that work.

101 Free, Useful, and Striking Sites to Learn About Human Anatomy

2009-01-16T16:21:00.000-08:00

101 Free, Useful, and Striking Sites to Learn About Human Anatomy
By Holly McCarthy

Whether you’re a biology student, interested in studying medicine someday, or just curious about how the human body works, these anatomy sites can teach you whatever you want to know about the nervous system, your skeleton, reproductive systems and more. You’ll find games, diagrams and even glossaries devoted to revealing the intricate systems and parts that make the human body tick.
Overviews
For a general overview of human anatomy, visit these sites.
Human Anatomy Online: This website has all kinds of photos of skeletal anatomy and more.
Human anatomy: This Wikipedia entry explains the study of human anatomy and what it represents, including the brain, organ systems and more.
Human Anatomy: Look up anatomy terms and get an introduction to the digestive system and skeletal system on the Minnesota State University–Mankato website.
Human Anatomy Printouts: Test your knowledge of the arm, the body, and the brain here.
Biology 129 Human Anatomy: Penn State’s biology class offers up a course syllabus and links to helpful anatomy resources.
Human-Anatomy.net: This website is devoted to “accurate, interactive 3D anatomy” systems and software representations.
Anatomy of the Human Body: Read Henry Gray’s illustrated publication about human anatomy at Bartleby.com.
Human Anatomy Learning Modules: Dartmouth’s excellent website lets you see photos and learn about everything from the pelvis to the head and neck to the thorax and abdomen.
The Visible Human Project: If you qualify to be a part of this project, you’ll be able to see all kinds of photos and images of the human body.
Human Anatomy Table of Contents: Click on an anatomy subject, like the heart, leg, lower extremity or thoracic wall, to learn more.
Skeletal
Here you can learn about bones, how the skeleton fits together, and its function.
The Skeletal System: Read about the divisions of the skeleton, like the axial skeleton and appendicular skeleton, here.
Skeleton: Find out where the ribs, spine, coccyx, femur, tarsals and metacarpals are with this diagram.
Skeletal System: View the front and back of a human skeleton here to learn terms and placement for the humerus, cuboid bone and more.
The Human Skeleton: Listen to a guided tour of the human skeleton, then test your understanding of the diagram.
List of bones of the human skeleton: Here you can get definitions and find out where certain bones are located, including the ethmoid bone, zygomatic bone and vomer bone.
The Human Skeletal System: Click on a section of the skeleton–like skull, spine and vertebrae, or extremities and joints–to learn more about each.
Skeletal System: Penn State’s skeletal system page offers up-close photos of everything from the sternum to the fetal skull.
The eSkeletons Project: Compare the skeletal anatomy of a human against a chimpanzee, gorilla, baboon or other mammal.
BioEd Online: Skeleton: Access slides that help teachers explain the skeletal system to their students, using drawings, key words and more.
The Skeleton: Learn about the functions of the skeleton and each group of bones here.
Muscular
Read about and view photos of muscles, tendons and more from these websites.
Muscles: This diagram shows you where a human’s quadriceps, frontalis, pectorals, deltoids and more lie under the skin.
Muscular System: This highly detailed diagram shows you where to find the Vastus Lateralis Muscle, Tibialis Anterior Muscle and a lot more.
The Hosford Muscle Tables: Get details about the body’s muscles, from the masseter to the extensor indicis.
Muscular and Skeletal Systems: Get zoomed-in diagrams of skeletal muscle systems and muscle fibers and more from this site.
Human Body Muscle Diagram: Find out where major muscles are located here.
Organs
From the skin to the lymphatic system, you’ll learn about organs here.
Human Anatomy - Organs: The BBC’s diagram points to the brain, voice box, bladder, appendix, gallbladder and more.
Organ Anatomy: Follow the links to find out more about the human organ systems, including the lymphatic system, urinary system and more.
Basic Anatomy - Tissues and Organs: View diagrams of the epidermis, circulatory system, muscular system and more.
Organs of the human body: Learn more about human organs by region. Included are vertebra, heart, lung, nose, scalp and more.
Human Skin: View basic and advanced models of the human skin here.
The Brain and Nervous System
Learn about the anatomy of your nervous system and how your brain operates with these guides.
The Brain: Read about the nervous system, how the brain receives nourishment and more from this site.
Nervous System: Here you’ll find out which part of the brain controls sight, smell, hearing, balance and taste.
The Human Nervous System: Learn about the Central Nervous System and view a diagram of the nerve cell here.
Nervous System: View a diagram and discover terms like neurons, peripheral nervous system and brain stem.
Nervous System: Find out where the plantar digital nerve, radial nerve and others are found here.
The Human Central Nervous System: Learn about the difference between white matter and gray matter, the spinal cord and more.
Human Nervous System: On this site, you can explore the cerebral cortex, view brain anatomy pictures and learn more about the senses.
The Whole Brain Atlas: Harvard Medical School’s resource has information about the normal brain, a brain that has suffered a stroke, has a brain tumor, inflammatory or infectious disease, or a degenerative disease.
Anatomy of the Brain: Each division of the brain is explained here.
About Brain Injury: A Guide to Brain Anatomy: View diagrams, read terms and definitions, and learn about the brain for the purpose of understanding treatments and brain injury.
Sexual Anatomy
Better understand your reproductive parts by studying glossaries and diagrams here.
Pink Parts - Female Sexual Anatomy: Scarleteen’s diagram and guide to female anatomy explains the function and appearance of the uterus, vulva, and more.
Man’s Best Friend: Male Sexual Anatomy: Scarleteen also explains the male sexual anatomy in this guide.
Sexual Anatomy, Reproduction and the Menstrual Cycle: Women can learn about their anatomy here.
Illustrated Human Body: View photographs the male and female body, accompanied by a guide to each.
Female External Genital Anatomy: This graphic photograph shows where the clitoris, labia majora, hymen, perinerum and more are located.
Female Reproductive Anatomy: Here you’ll find another diagram for the interior and exterior female anatomy.
Male Reproductive Anatomy: Vind out where the epididymis, pubic bone and urinary bladder are located.
Basics of the Female Sexual Anatomy: This less graphic diagram explains the function and location of labia minora, labia majora and more.
Overview of the Male Anatomy: Yale Medical Group’s diagram and guide explains terms like scrotum, prostate gland and more.
Understanding the Male Anatomy Glossary of Terms: Get medical definitions for BPG, antigen, bladder and more.
Interactive Sites and Games
Play games and view 3D animations to learn about anatomy in more creative ways.
Get Body Smart: These Flash animations provide an interactive way of studying muscle tissue, the skeletal system and more.
Visible Body: This 3D visual animation tool gives you up-close views of the human body from all angles.
Teen Species: This game shows you what happens to teenage boys and girls during puberty.
The Virtual Body: Listen to narrated tours, take a test and zoom in to learn more about the brain, skeleton, heart and digestive system of humans.
Anatomy.tv: Subscribe to this site to watch demos and interactive anatomy diagrams.
Interactive Body: BBC’s website features games for learning about the skeletal system, organs, muscles, nervous system and more.
Anatomy and Physiology I Interactive Tutorials: Find movies and interactive tutorials for the Central Nervous System, cellular respiration and more.
WebAnatomy: Take tests and play games to learn about human anatomy here.
Activities Index: These interactive activities teach you about facial bones, skin structure, cell structure, body planes and more.
eAnatomy: This very cool site has full-screen displays, pictures and 3D reconstructions of the ear, face and neck, brain and more.
For Kids
These kids-friendly sites teach students and children about the human body, without getting too graphic.
Neuroscience for Kids: Get trivia answers, view the brain structure and more on this kid-friendly site.
Anatomy Arcade: Here, kids can “poke a muscle,” “whack a bone,” or play the muscular jigsaw puzzle.
BAM! Your Body: The Centers for Disease Control and Prevention hosts this kid site that teaches health, anatomy and more.
Kid Info: These links and games are great for slightly older kids.
Bone Links: This website has bone games and information about “bone careers.”
Anatomy Lesson Plans: Help your kids learn about anatomy using these lesson plans.
Ask a Scientist: Kids with an understanding of basic anatomy can ask questions or review the archive to learn more about biology, evolution and anatomy.
Brains Rule!: All kids can play around on this colorful, interactive site that explains the brain through games and more.
The Magic School Bus Human Body Tour: Scholastic’s children’s book comes to life with this game.
Probe the Brain: Shock the brain to learn how it works.
Digestive System
Find out exactly how your digestive system operates here.
Your Digestive System and How it Works: Find out why digestion is important, how food is digested and where key organs are located here.
Digestion: Learn about the stomach, small and large intestines, and fat digestion here.
Pathophysiology of the Digestive System: On this website, you can take “a voyage through the digestive tract” and learn about the liver and biliary system, pancreas and more.
AMA Digestive System: AMA offers up a diagram and helpful guide to explain how your digestive system works.
How Stuff Works: This Shockwave representation is all about the digestive system.
Digestive System Topics: View a diagram and look up symptoms or digestive problems here.
Your Gross and Cool Body — Digestive System: Follow your food as it travels through your body. This guide explains it all.
Cell Anatomy
Learn about the construction of your cells from these sites.
Cells Alive!: Find diagrams, puzzles and cell cams here.
The Anatomy of a Cell: This guide explains cell function and the different types of cells, prokaryotes and eukaryotes.
The Structure of a Human Red Blood Cell: Learn about red blood cells here.
Pregnancy and Infancy
Study how the female body changes during pregnancy and learn about the anatomy of a fetus in this list.
Pregnancy Anatomy and Physiology: Understand how the uterus and cervix change during pregnancy, and all about the placenta and umbilical cord.
Pregnancy: MedlinePlus offers up plenty of information about pregnancy anatomy and more.
Anatomy During Pregnancy: ProHealth Care’s diagram shows amniotic fluids and placenta, as well as fetal development from 10 weeks to 30 weeks.
Anatomy: Fetus in Utero: The Ohio State Medical Center explains terms like uterine wall and amniotic sac and also includes a diagram.
Anatomy of a Fetus: Circulation and Breathing: Learn about the development of a fetus’ circulatory and respiratory systems here.
Heart
Here you can learn all about the construction and function of the heart.
Heart Anatomy: This glossary gives definitions for terms like left atrium, aorta, mitral valve and others.
Heart Anatomy: Find out where the right ventricle, left atrium and more are located.
Heart Anatomy: The Texas Heart Institute offers a diagram and basic stats of the human heart here.
The Anatomy of the Heart: Click through the slides to view the chambers of the heart, learn about the valves and more.
Anatomy of the Heart: Find out how the human heart works when you read this guide.
Miscellaneous
From the anatomy of the ear to the anatomy of your foot and ankle, this list contains even more educational sites and diagrams.
Ear Anatomy: Learn terms and view a diagram of the ear here.
Lungs: This rough sketch asks you to match the parts of the lung–larynx, cardiac notch, or bronchial tree–to the appropriate spot.
Skin Anatomy: Learn where the Pacinian corpuscle, sweat gland and sebaceous gland are situated.
Anatomy References for Artists: Artists can access anatomy resources and games here to help them with their work.
Respiratory System: View a diagram of the human respiratory system and learn how it compares to the respiratory systems of birds, fish and reptiles.
3D Female and Male Anatomy: Find out how men and women’s anatomy differs, from the respiratory system to the urinary system.
Anatomical Dictionary: Refer to this dictionary to look up terms like angular bone, sternal plate and more.
Liver: MamasHealth.com explains the liver’s function, body location and even which medications can negatively affect the liver.
Anatomy of the Eye: Watch videos and view pictures of the retina and eye.
Anatomy of the Food and Ankle: Learn about the bones, joints, muscles and tendons that make up your foot and ankle.
The Anatomy of Teeth and Jaws: Get a look inside and around your teeth here.

http://www.geriatricnursingcertification.com/blog/2009/101-free-useful-and-striking-sites-to-learn-about-human-anatomy/

Jobs’s Pancreas May Be Removed After Complications

2009-01-15T19:15:00.001-08:00

Jobs’s Pancreas May Be Removed After Complications (Update1)

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By John Lauerman and Jason Gale
Jan. 15 (Bloomberg) --

Surgery that Apple Inc.’s Steve Jobs may be having to remove his pancreas could be the result of painful side effects from a cancer procedure, or the return of tumors he said were removed five years ago, doctors say.

If Jobs had a so-called Whipple procedure to excise the cancer, parts of his pancreas and other organs were removed. Sometimes, damage from cancer and the surgery can spur side effects, including enzyme leaks, that worsen in time, spurring a decision to remove the entire pancreas, said Robert Thomas, head of surgery at the Peter MacCallum Cancer Centre in Melbourne.
Most often, the pancreas is removed because the cancer has returned, said Andrew Lowy, head of the division of surgical oncology at Moores Cancer Center at the University of California, San Diego. In either case, patients must take insulin, a hormone produced in the organ, for the rest of their lives, along with enzymes to help digestion, the doctors said.
“We have to assume it’s quite likely that his disease may be harder to control, or coming back in a bigger way than we’d like to see,” said Simon Lo, director of the pancreas disease program at Cedars Sinai Medical Center in Los Angeles, in a telephone interview yesterday. “Speculation is dangerous without knowing all the facts, but if I were to guess I’d say this is not a good sign.”
Jobs hasn’t said whether the cancer has returned or spread. Last week Jobs, Apple’s chief executive officer, said he was getting “simple and straightforward” treatment for a hormone imbalance. Yesterday, the computer company said he was taking five months of leave because his “health-related issues” were more complex than he thought.

2004 Surgery
In 2004 Jobs said he underwent surgery to remove a neuroendocrine islet-cell tumor, a type of pancreatic cancer that can spur production of abnormal levels of hormones. The Whipple procedure can remove the cancer, but sometimes can result in dangerous leakage from the organ, Thomas said.
“Even with excellent surgery, there is an inexorable decline in survival of patients over the years and most patients end up dying of their pancreatic cancer despite having what seems to be effective surgery,” said Thomas, 66, who first performed the Whipple procedure more than 20 years ago.
When enzymes leak from the pancreas, they become toxic for other organs, Thomas said, and “you might have to take the rest of the pancreas out.”
Pancreatic leakage “is the most feared risk and it’s the most common issue” after Whipple operations, said Neil Collier, head of the hepatobiliary pancreatic unit at the Royal Melbourne Hospital in Melbourne. Collier has done about 200 Whipple procedures over 24 years. He wasn’t familiar with Jobs’s case.
Odds of Complications
“You are looking at something like a 40-to-45 percent chance of complications after the operation, so there are certainly reasons why further surgery could be necessary,” Collier said.
Once the pancreas is removed entirely, “you’re on significant doses of insulin, and it’s not easy to manage,” said Thomas, of the McCallum Center. “The person has the risk of severe diabetes.”
Neuroendocrine tumors can affect levels of hormones produced in the pancreas, including insulin and glucagon that help control blood sugar levels, and somatostatin and gastrin that are involved in digestion and other functions.

Tumor Recurrence
“The main reason to remove the rest of the pancreas” after a Whipple procedure “would be if the tumor recurred there,” Lowy said. “In garden-variety pancreas cancer that almost never happens. There are rare instances where the tumor could recur locally, and you could go in and try to remove the rest of the pancreas to get rid of the cancer.”
David Metz, associate chief for clinical affairs in the school’s division of gastroenterology at the University of Pennsylvania in Philadelphia, said a return of the cancer isn’t necessarily an early death sentence for Jobs. Some patients with neuroendocrine tumors live 20 years or longer, he said.
“Generally these tumors are slow growing, and occasionally they can be more aggressive and unpredictable,” Metz said in a telephone interview yesterday. He said he has no knowledge of Jobs’s case.
Apple yesterday announced Jobs will take a leave of absence from his job through June. Chief Operating Officer Tim Cook, who filled in for Jobs in 2004, has taken over Apple’s day-to-day operations, the Cupertino, California-based company said in a statement.
‘More Complex’
“During the past week I have learned that my health- related issues are more complex than I originally thought,” Jobs said in the statement.
The type of pancreatic cancer Jobs has said he had can cause symptoms that include weight loss, low blood sugar, and blood pressure changes, said Raji Annaswamy, an endocrinologist at Harvard Medical School in Boston, in a Jan. 5 telephone interview. Annaswamy hasn’t treated Jobs, and said she has no specific knowledge of his case.
Even if the cancer was defeated, the procedure can lead to a digestive condition known as dumping syndrome that causes people to lose weight, Lo, of Cedars Sinai Medical Center, said in a Jan. 5 telephone interview.
“It’s considered one of the most complicated surgeries in the abdomen,” said Lo, who hasn’t treated Jobs and doesn’t know details of his condition. “You’re creating a big hole in that area, and then trying to connect everything back together.”

Thousands of Patients
Neuroendocrine islet-cell tumors are found in about 2,000 to 3,000 people in the U.S. annually, making them about 10 times less common than other pancreatic cancer, according to pancreatica.org, a cancer information Web site maintained by the Lorenzen Cancer Foundation in Monterey, California.
An Apple spokesman, Steve Dowling, declined to comment, citing Jobs’s statement yesterday as the company’s response.
Speculation about Jobs’s health surfaced in June after he appeared thinner at Apple’s conference for developers. The company said at the time that he was suffering from a “common bug” and declined to elaborate. The speculation persisted as he continued to appear frail at company events. Investors punished the company’s shares with each report of Jobs’s ill health.

‘A Mystery’
On Jan. 5, Jobs, who turns 54 in February, said the reason for his weight loss “has been a mystery to me and my doctors.”
“After further testing, my doctors think they have found the cause -- a hormone imbalance that has been ‘robbing’ me of the proteins my body needs to be healthy,” he said in the Jan. 5 statement. The remedy “is relatively simple and straightforward,” he wrote.
Jobs is a vegetarian and is skeptical of mainstream medicine, Fortune reported last year. He delayed cancer surgery for nine months while he followed alternative treatments, the magazine reported in March.
Jobs, who co-founded Apple in 1976, said in his Jan. 5 statement that he lost weight throughout 2008.

To contact the reporter on this story: John Lauerman in Boston at jlauerman@bloomberg.net; Jason Gale in Singapore at j.gale@bloomberg.net Last Updated: January 15, 2009 10:02 EST

http://www.bloomberg.com/apps/news?pid=20601170&refer=home&sid=aVFw9xGqpxkE

Child's Death Is First of Flu Season

2009-01-09T15:43:00.000-08:00

Child's Death Is First of Flu Season
CDC Reports Flu-Related Death of Minnesota Child
By Daniel J. DeNoonWebMD Health News
Reviewed by Louise Chang, MD
Jan. 7, 2009 - A Minnesota child was the first flu-related pediatric death of the 2008-2009 flu season, the CDC reports.
The death occurred during the week ending Dec. 20, 2008.
As of the end of 2008, flu cases had begun to trend upward. Thirty states, including Minnesota and the District of Columbia, report only sporadic flu cases. Three states -- Massachusetts, New Jersey, and Virginia -- reported region-wide flu activity; 10 states reported localized flu outbreaks.
No state has reported widespread flu. That's likely to change. Peak flu season usually occurs in January or February.
Hospitals report that cases of flu-like illnesses have begun to rise, although they hadn't yet increased beyond what is normal for this time of year. A trend of increasing flu-like illnesses is the first sign that flu season has arrived.
That's good news if you haven't yet got around to getting flu shots (or sniffs of the nasal flu vaccine) for your family. There's still plenty of time for protection, especially as flu cases pop up throughout the winter and spring.
Flu vaccination is even more important this year, as one of the flu bugs in circulation is resistant to the flu drug Tamiflu. Fortunately, this year's vaccine is an excellent match for the flu bugs circulating in the U.S.
Last year's flu vaccine was not a good match for the H3N2 flu bug that caused the most flu over the course of the season. However, even mismatched flu vaccine offers significant protection.
In terms of deaths and hospitalizations, the 2007-2008 flu season was the most severe season of the past three seasons. There's no way to predict how severe this year's flu season will be.

http://www.webmd.com/cold-and-flu/news/20090107/childs-death-is-first-of-flu-season?ecd=wnl_epi_010909

Kanye West's mother's plastic surgeon jailed for one year

2009-01-09T15:38:00.000-08:00

Kanye West's mother's plastic surgeon jailed for one year
01/08/2009 5:00 PM, Yahoo!

Dr. Jan Adams--the man who performed plastic surgery on Kanye West's mother Donda, shortly before she died--has been jailed for a year for drunken driving.

Adams pleaded guilty to the charge last year, after he drove his car the wrong way on Interstate 680. His blood alcohol level was .20 percent, reports the Associated Press.

When he performed West's surgery, the Medical Board Of California were seeking to remove his license to practice because of multiple alcohol-related arrests. There were also two malpractice judgments against him.

West died a day after having surgery for a breast reduction, tummy tuck, and liposuction. The autopsy cited heart disease and complications that arose from the surgery as the cause of death.

http://music.yahoo.com/read/news/61960621

Lisa Rinna: "I Look Like a Freak" After Too Much Plastic Surgery

2009-01-08T15:29:00.001-08:00

Lisa Rinna: "I Look Like a Freak" After Too Much Plastic Surgery

By Us MagazineJanuary 7, 2009 11:37 AM PST
celebs:
Lisa Rinna
topics:
Makeovers

Lisa Rinna arrives at the P.S. Arts "Express Yourself 2008" at Barker Hanger on November 16, 2008 in Santa Monica, CA.Us Magazine Lisa Rinna says she has one major plastic surgery regret."My cheeks. I had Juvederm put in my cheeks. That's what I overdid -- big time," Rinna, 45, tells the Web site momlogic.com in a new interview.

See photos of celebs who underwent drastic makeovers.

"I tried it because my girlfriends did it," she says. "I thought, 'I'll do it! I saw a photo and I was like, 'Oh Jesus. That's no good. That's NOT good.'"When you change your face, you don't look like yourself," she goes on. "Looking fresher is one thing. I look like a freak! I always said I wouldn't change my face, but I did it.

See which star vows to never get plastic surgery.

"I can't not be honest about it. I'd look like a fool. It's so obvious," she goes on. "But when this happened, I realized I couldn't hide it."

Can you believe these stars are in their 40s?

Although she still likes Botox ("it doesn't change the shape of my face," she says), she has learned she doesn't need so much surgery."You get older and insecure and you think you need it, and you don't," she says. "I learned less is more. Keep your skin good."

http://omg.yahoo.com/news/lisa-rinna-i-look-like-a-freak-after-too-much-plastic-surgery/17290?nc

GPs to receive dementia training

2009-01-07T05:06:00.000-08:00

GPs to receive dementia training
Monday, December 22 02:45 pm
Print Story
Every GP is to be trained to spot the first signs of dementia under a new Government scheme.

A total of 700,000 people in the UK have a form of dementia and the number of sufferers is set to double or triple.
Care Services Minister Phil Hope has said that "memory clinics" will be set up in every town as places where patients can get treatment and support to live their lives as normally as possible.
A national dementia strategy will be launched next month which could save nearly £1 billion while providing better care, Mr Hope said.
He said: "We want to see every GP trained to recognise the symptoms of early dementia and patients referred to specialist services in every area where they would get a proper diagnosis.
"As well as national training for GPs, we'd like to see memory clinics in every town where people can go for treatment and support to help them live their life as normally as possible."
He added: "This could be provided by a range of different people, from geriatricians and psychiatrists to local GPs with a specialist interest, working in partnership and possibly involving the voluntary sector."
A Department of Health spokeswoman said: "We want to make sure that every GP is trained to spot the first signs of dementia, and to refer patients on to specialists.
"The Department of Health will work with all relevant medical and nursing organisations - including the Royal College of GPs, Skills for Care and the NHS - to make sure that appropriate training is provided for medical students, and we will create opportunities for post-graduate education and training in dementia."

http://uk.news.yahoo.com/4/20081222/tuk-gps-to-receive-dementia-training-dba1618_1.html

Branson demands MRSA clean-up

2009-01-07T05:02:00.000-08:00

Branson demands MRSA clean-up
Tuesday, December 23 07:19 am

Virgin boss Sir Richard Branson has accused politicians and health bosses of "tinkering" with the problem of superbugs.

Sir Richard, recently appointed as vice-president of the Patients Association, is calling for all hospital staff to be screened for MRSA and receive immediate treatment if infected.
He also wants managers at failing NHS trusts to be fired.
Infection rates for MRSA are falling across the UK with the most recent quarterly figures showing a 33 per cent drop year on year, but Sir Richard is calling for more to be done.
The entrepreneur - whose daughter Holly is a doctor - said: "There have been some improvements, but the facts speak for themselves - and the facts are still horrific.
"It feels like they have tinkered with the problem rather than really got to the heart of the problem. The hospitals are there to cure people. They are not there to kill people."
He said the NHS could learn from the airline industry about how to avoid mistakes and improve.
"In the airline industry if we had that kind of track record we would have been grounded years ago," he said.
"In the airline industry if there is an adverse event that information is sent out to every airline in the world.
"And every airline makes absolutely certain that that adverse event doesn't happen twice."
A spokesman for the Department of Health in England said: "The government is taking tough actions in the fight against infections.
"These include stringent hand-washing across the NHS, doubling the number of matrons and giving them greater powers to enforce cleanliness standards, and screening admitted patients for MRSA.
"These are clearly making an impact as we have halved MRSA infections since 2003/04 and C difficile infections are down 35 per cent on the same quarter last year."

http://uk.news.yahoo.com/4/20081223/tuk-branson-demands-mrsa-clean-up-dba1618_1.html

Hospitals 'losing their compassion'

2009-01-07T04:59:00.000-08:00

Hospitals 'losing their compassion'
Tuesday, December 30 09:06 am
Print Story
NHS hospitals are losing their compassion, the head of a health thinktank has warned.

Niall Dickson, chief executive of the King's Fund, blamed work pressures, shorter stays in hospital and the greater complexity of medical challenges for staff behaving in a less feeling way.
He said compassion should be a key priority for the boards of every NHS hospital.
The draft constitution of the NHS identifies compassion as one of the six values of the service, explaining: "We find the time to listen and talk when it is needed, make the effort to understand, and get on and do the small things that mean so much - not because we are asked to but because we care."
The King's Fund is piloting a project in a number of hospitals to try to encourage staff to focus on being compassionate.
Under the "Schwartz round" scheme, staff from different disciplines get together once a month to discuss areas where they have experienced difficulties.
Mr Dickson said: "I have very little doubt that we've seen a deterioration in the level of compassion that is shown by staff to patients.
"The board of every hospital should be looking at this as one of their top priorities - what is it like for someone who's coming in to be treated, and how can we improve that experience?
"It's to do with staff facing very difficult situations - because patients are sicker and hospital stays are shorter - rather than them all turning into nasty people.
"If we can't get compassion into our healthcare, the system is failing. It's as fundamental as that."

http://uk.news.yahoo.com/4/20081230/tuk-hospitals-losing-their-compassion-dba1618_1.html

NHS agency staff 'get £200 an hour'

2009-01-07T04:53:00.000-08:00

NHS agency staff 'get £200 an hour'
Saturday, January 3 12:37 pm

NHS hospitals are paying agency staff almost £200 an hour to cover shifts, the Tories have said.

Figures obtained under the Freedom of Information Act showed some staff are paid hourly rates equivalent to salaries worth hundreds of thousands a year and agencies are taking large "cuts" in return for supplying workers.
The Tories said NHS organisations across England were paying agency staff "hugely inflated" hourly rates to cover gaps in normal cover.
The Party asked all NHS trusts to provide details of the highest amount they paid to an agency worker between May and October 2008 and received a response rate of more than 70 per cent.
Whipps Cross University Hospitals NHS Trust said it paid £188 an hour for an anaesthetics medical consultant - equivalent to an annual salary of £366,000.
Trafford Healthcare NHS Trust paid £167 for an A&E doctor, equivalent to £326,000 a year, and Dorset Primary Care Trust paid £158 an hour for a prison GP, which would amount to £307,000 a year.
Most organisations were unable to say how the hourly rate was split between the worker and the agency, but some agencies were found to be taking large cuts.
Somerset Partnership NHS Foundation Trust paid £116 per hour for a nurse but the agency took £50 (43 per cent), and Oxfordshire Primary Care Trust paid £94 per hour for a nurse but the agency took £40 (43 per cent).
Shadow health secretary Andrew Lansley, said: "It's incredible that agency staff can be paid such high hourly rates when jobs are being cut at the same time. This is typical of the waste that's occurred under this Labour Government."
A spokeswoman for the Department of Health said the Government was spending less on agency staff year on year.

http://uk.news.yahoo.com/4/20090103/tuk-nhs-agency-staff-get-200-an-hour-dba1618_1.html

Boy died after being refused visit

2009-01-07T04:49:00.000-08:00

Boy died after being refused visit
1 hour 16 mins ago

A 12-year-old boy who died of a mystery illness would have lived if a doctor had visited him, his mother claims.

Daniel Farr, from Tilehurst, Reading, was pronounced dead on arrival at the Royal Berkshire Hospital on Sunday.
The Year 8 pupil at Prospect School in Tilehurst was taken ill after a friend's birthday party on Friday evening and the sickness continued into Saturday morning, with Daniel vomiting and complaining of side and chest pains.
His mother Rosemary Farr, 51, called her GP practice but the surgery was closed for the weekend and her call was transferred to the Westcall Operations Centre at Wokingham Hospital, Berkshire.
She told a newspaper: "They said he had probably pulled a small muscle and advised me to give him paracetamol. I just trusted that they would know best so I followed their advice."
When Daniel's symptoms failed to improve, Mrs Farr contacted the centre again and was called back by a doctor.
Mrs Farr said: "I told him Daniel was no better and asked him to visit. He said they did not do home visits and told me if I was that concerned I should take him to the hospital myself."
Daniel was eventually taken to the Royal Berkshire Hospital by paramedics, where he was pronounced dead.
His mother added: "Daniel could still be alive if one of the doctors had come out to see him."
In a statement, Berkshire West Primary Care Trust said: "We are all extremely saddened by this very tragic event and our thoughts are primarily with the family at this time. We are currently undertaking a thorough investigation of all the circumstances."
A post-mortem examination is to be carried out to find out how Daniel died.

http://uk.news.yahoo.com/4/20090107/tuk-boy-died-after-being-refused-visit-dba1618_1.html

'More drugs' for cancer treatments

2009-01-07T04:32:00.000-08:00

'More drugs' for cancer treatments
Friday, December 26 11:57 am

The NHS drugs watchdog is to take a more flexible approach to the issuing of treatments which can prolong the life of people with terminal illnesses, it was has been announced.

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Professor Sir Michael Rawlins, chairman of the National Institute for Clinical Excellence (Nice), said that new guidelines to be published next week would extend the range of cancer treatments available on the NHS.
Nice has come under fire in recent months for refusing to allow some cancer treatments - which can extend the lives of sufferers for weeks or months - on the grounds that they are not cost-effective.
Sir Michael said that Nice had been consulting on proposals which recognised the particular importance people attached to the extra time such drugs could give them.
"We appreciate these extra weeks and months can be very special," he said.
"We are proposing to provide our advisory bodies with supplementary advice in these sort of circumstances which will have the effect of extending the threshold range of what we would normally regard as being cost-effective."
He said that the new guidance, which will be issued on January 2 with immediate effect, would concentrate on treatments for less common cancers.
"We are not proposing to extend this to all conditions. Frankly, it would cost the Health Service hundreds of millions of pounds if we were to do that," he said.
"We believe that the pharmaceutical industry should be prepared, in some circumstances, to lower the cost for common conditions where the volume of patients is greater so that the returns on their investment can be met by a large number of people.
"That is why were are concentrating on less common cancers because we recognise that with the less common cancers and less common conditions, the development costs are about the same as they are for common ones but because the population is smaller they need to charge more for each patient."
Sir Michael said that Nice was taking steps to speed up the approval process for new treatments, but he warned that they would take time to implement.
"What our ambition is, is to make sure that guidance is available to the Health Service within three to six months of a new product going on the market," he said.
"We are putting these arrangements in hand. It won't happen immediately, I'm afraid, because there is a backlog but we will be getting there within the next 12 to 18 months."

http://uk.news.yahoo.com/4/20081226/tuk-more-drugs-for-cancer-treatments-dba1618.html

Study backs deep brain stimulation for Parkinson's

2009-01-07T04:10:00.000-08:00

Study backs deep brain stimulation for Parkinson's
Yesterday, 09:02 pm Will Dunham
Print Story
Deep brain stimulation dramatically improves Parkinson's disease symptoms such as trembling and slowness of movement, offering hope to many with the incurable ailment, researchers said on Tuesday. Skip related content
Six months of deep brain stimulation with a device made by Minneapolis-based Medtronic Inc led to better quality of life and 4-1/2 additional hours per day of good motor functioning for Parkinson's patients, but did not come without risks, the researchers said.
The small electrical device is implanted surgically in the chest, with wires leading to electrodes in the brain. It sends electrical signals to brain areas that control movement.
One of the 121 Parkinson's patients in the study who got deep brain stimulation, or DBS, died from bleeding in the brain caused by a ruptured blood vessel after the surgery.
And compared to the 134 patients in the study who received only standard medical treatment, those getting DBS were 3.8 times more likely to have a "serious adverse event" such as a post-surgical infection. Most were quickly resolved, the researchers said.
But motor functioning improved for 71 percent of the DBS patients. Their quality of life -- like carrying out daily activities, mobility and emotional well-being -- also rose.
"The study provides the medical community with the highest class of evidence for the benefits of deep brain stimulation for properly selected patients," Dr. William Marks, a University of California, San Francisco neurologist who helped lead the study, said in a telephone interview.
DBS may help patients whose symptoms are not well controlled by drugs, Marks said.
The study was published in the Journal of the American Medical Association.
"MAGNIFICENT BENEFITS"
Parkinson's disease is a brain disorder in which nerve cells in the brain that control muscle movement die, causing trembling, stiffness of the limbs and trunk, slowness of movement and impaired balance and coordination.
There is no cure and drugs used to control symptoms can lose their effectiveness over time or cause bad side effects, often leaving patients desperate to find a new approach.
Sharon Pederson, 51, a Northern California woman who got DBS in the study, said it restored her quality of life. "The bottom line for me is that without hope, you have nothing to go for with Parkinson's," Pederson said in a telephone interview arranged by Medtronic.
Deep brain stimulation was approved in 2002 by the U.S. Food and Drug Administration to treat Parkinson's, but only a small percentage of patients get it.
Marks, who has worked as a consultant to Medtronic, said DBS does not cure the disease or prevent it from worsening over time, and does not improve non-motor symptoms such as thinking, memory or speech problems. In fact, those who got DBS in the study had slightly lower performance on cognitive tests.
While the treatment is not appropriate for everyone with Parkinson's disease, "a surgery done on the right patient by the right team can have magnificent benefits that extend beyond what can be achieved with medicines alone," said Dr. Michael Okun of the National Parkinson Foundation.
The study was funded by the U.S. Department of Veterans Affairs and National Institutes of Health, with some additional funding from Medtronic.

http://uk.news.yahoo.com/22/20090106/thl-uk-parkinsons-brain-top-acc9995.html

Australian researchers claim breakthrough on dengue fever

2009-01-07T03:53:00.000-08:00

Australian researchers funded by US billionaire Bill Gates Friday claimed a breakthrough which could help in the fight against dengue fever by stopping the often deadly disease in its tracks.

University of Queensland researchers said they have successfully infected the mosquito which spreads the tropical disease with a bacterium which halves its 30-day lifespan, thereby reducing its ability to transmit dengue to humans.
Scientists hope their work will help halt the spread of the painful and debilitating disease which affects millions of people each year.
"The key is that really only very old mosquitos are the only ones that are able to transmit the disease," said researcher Professor Scott O'Neill.

http://uk.news.yahoo.com/18/20090102/thl-australian-researchers-claim-breakth-edb91f1.html

Bush has scan and injection for painful shoulder

2009-01-07T03:49:00.000-08:00

Bush has scan and injection for painful shoulder
Monday, December 22 09:46 pm
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U.S. President George W. Bush had a scan done on his painful left shoulder and was given a cortisone injection on Monday but said he was in "good shape" and could still hurl a baseball at high speed. Skip related content
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Bush had a magnetic resonance imaging (MRI) check while he was at Walter Reed Army Medical Centre in Washington visiting patients who served in the wars in Iraq and Afghanistan.
"Following a review of the results of the MRI, President Bush received a cortisone shot for his left shoulder," White House spokesman Gordon Johndroe said. "No further medical action is expected to be necessary at this time."
Bush, 62, had been "experiencing some pain," Johndroe said.
Cortisone shots are generally given to reduce inflammation.
Johndroe quoted Dr. Richard Tubb, the president's physician, as saying it was "probably just a little bit of wear and tear of an active individual."
Asked by reporters how his shoulder was doing, Bush insisted he was in "good shape" and joked that he could pitch about an "80 mile-an-hour fastball."
Johndroe said the shoulder pain had not affected Bush's ability to do his job and that the president had gone biking over the weekend.
(Reporting by Tabassum Zakaria; editing by John O'Callaghan)

http://uk.news.yahoo.com/22/20081222/thl-uk-bush-shoulder-b2e59e8.html

Swayze: 'I May Not Beat Cancer'

2009-01-07T03:41:00.000-08:00

Swayze: 'I May Not Beat Cancer'
Sky News

Hollywood actor Patrick Swayze has described his fight against cancer as "hell". Skip related content
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Swayze: 'I May Not Beat Cancer'

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The 56-year-old said he believes he may only have two years to live as he battles pancreatic cancer.
Despite gruelling treatment, he has only missed one-and-a-half days of work in five months.
"You can bet that I'm going through hell," the Dirty Dancing star said. "And I've only seen the beginning of it."
In his first television interview since the diagnosis, Swayze acknowledged he may not beat the disease.
"I'd say five years is pretty wishful thinking. Two years seems likely if you're going to believe statistics.
"I want to last until they find a cure, which means I'd better get a fire under it," he said.
Swayze went ahead with filming for police drama The Beast, fitting chemotherapy sessions in at weekends.
Shunning painkillers during 12-hour shoots so as not to dampen his performance, he explained: "I've never been one to run from a challenge."
The actor was diagnosed with stage four pancreatic cancer in January 2008. The cancer has spread to his liver.
In Patrick Swayze: The Truth, he told Barbara Walters: "Yeah, I'm scared. Yeah, I'm angry. Yeah, I'm (asking), 'Why me?'"
He spoke to the ABC interviewer at his California ranch alongside his wife, Lisa Niemi.

http://uk.news.yahoo.com/5/20090107/twl-swayze-i-may-not-beat-cancer-3fd0ae9.html

NHS: Flu season kicks off early

2009-01-07T03:30:00.000-08:00

NHS: Flu season kicks off early
Monday, December 15 11:58 am
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The flu season has started a month earlier than expected, the NHS has said. Skip related content
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NHS Direct has seen the number of calls about symptoms more than double over the last three months and doctors are being urged to start prescribing ant-viral drugs.
Last year the virus began affecting people from mid-January but schools and hospitals are already reporting outbreaks, with children and the elderly the most vulnerable.
NHS is urging people to check their symptoms online as increasing numbers are expected to be struck down in the coming months.
For most people, the flu is nothing more than a week of feeling under the weather, but for those such as the elderly, and patients with lung problems and diabetes it can be far more dangerous - even life threatening.
The most at-risk groups are encouraged to get the flu jab each year.
The Department of Health along with the Health Protection Agency have written to doctors in England to recommend they prescribe ant-viral drugs to the most vulnerable groups.

http://uk.news.yahoo.com/4/20081215/tuk-nhs-flu-season-kicks-off-early-dba1618.html

Hospitals Braced For Flu Outbreak
Wednesday, December 24 04:35 am Sky News
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Hospitals across the country are braced for an influx of flu patients as doctors' surgeries close for Christmas. Skip related content
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Health experts have predicted the biggest outbreak of flu for nine years could be on its way.
The Royal College of GPs says the number of people seeing their doctor with the symptoms shot up 73% in a week.
The biggest rise was in the 65-plus age group which saw a huge increase of 151%.
The Department of Health's director of immunisation, Professor David Salisbury, said: "We have had very little flu over the last few years and this year may be like 1999/2000 when figures were quite high.
"The best protection against flu is to have the flu jab."
Prof Salisbury added: "There are simple steps that everyone can take to help prevent catching colds and flu.
"Always use a tissue to catch your sneezes, throw away used tissues where germs can linger and regularly wash your hands.
"If you think you have flu, stay at home, drink plenty of fluids and take medicines like aspirin or paracetamol for your symptoms."

http://uk.news.yahoo.com/5/20081224/tuk-hospitals-braced-for-flu-outbreak-45dbed5.html

Measles On Rise As MMR Shunned

2009-01-07T03:24:00.000-08:00

Measles On Rise As MMR Shunned
Sky News

The chances of making measles a disease of the past in Europe by 2010 are declining because of a fall in the number of vaccinations in just five countries, including England and Wales.

More than 12,000 cases of measles were reported in Europe in the two years spanning 2006 and 2007, a new study published in the Lancet has revealed.
All but 15% occurred in just five countries - the UK, Germany, Switzerland, Italy and Romania - and most were infections of unvaccinated or partially vaccinated children.
A slump in vaccine take-up in England - but not Scotland, which has a good vaccination rate - has been blamed on unfounded fears about the possible side effects of the triple measles, mumps and rubella (MMR) jab.
The first measles death in the UK for 15 years was reported in 2006.
The now-discredited 1998 study linking the MMR jab and autism had a direct impact on vaccination rates in the UK with the findings from Dr Andrew Wakefield at London's Royal Free Hospital sparking a major scare and causing vaccination numbers to fall.
In the UK, fewer than 90% of two-year-old children were vaccinated between 1999 and 2006, and between 2002 and 2005 the rate fell to below 85%.
The Department of Health launched a campaign last year to improve MMR take-up rates in England and made extra supplies of the vaccine available.
A spokesman for the Health Protection Agency said: "Recent months have seen improvements in vaccination coverage for children up to five years of age, probably linked to local efforts to increase MMR uptake in all unvaccinated children following the widely reported increase in measles cases across England and Wales during 2008."
Dr Mark Muscat, from the Statens Serum Institute in Copenhagen, Denmark, and colleagues evaluated data from 32 countries in Europe.
They found that, of a total of 12,132 cases in 2006 and 2007, the vast majority involved children but almost a fifth of cases were adults aged 20 or over.
They concluded that, unless the situation can be changed, the World Health Organisation's stated goal of eliminating measles from Europe by 2010 will not be achieved.
"Since imported cases are a potential source of outbreaks, countries should be aware of possible transmission within Europe and from other continents to ensure that appropriate control measures are implemented in a timely manner," the report's authors wrote.

http://uk.news.yahoo.com/5/20090107/tuk-measles-on-rise-as-mmr-shunned-45dbed5.html

Travolta son's death caused by "seizure disorder"

2009-01-06T04:37:00.000-08:00

Tuesday January 6, 8:47 AM
Travolta son's death caused by "seizure disorder"
Photo: ReutersClick to enlarge

NASSAU (Reuters) - Actor John Travolta's son, Jett, died from "seizure disorder," a Bahamas funeral home official said on Monday after pathologists performed an autopsy on the body of the teenager who suffered a seizure last week at his family's holiday home.
Bahamian authorities did not make public the results of the autopsy, which was observed by Travolta's family doctor. Police Commissioner Reginald Ferguson said the findings would not be released because "there is nothing criminal about the situation."
Keith McSweeney, funeral director for the Restview Memorial Mortuary in Freeport, where the boy's body was sent after the autopsy, said the death certificate listed "seizure disorder" as the cause of death.
Jett, 16, had a history of seizures and was found unconscious in a bathroom at his family's home in the Old Bahama Bay resort on Grand Bahama Island on Friday morning. He was pronounced dead after being taken by ambulance to Rand Memorial Hospital in Freeport.
Dozens of relatives flew to Grand Bahama to comfort John Travolta and his wife, actress Kelly Preston, said Obie Wilchcombe, a member of parliament for western Grand Bahama.
The couple, who also have an 8-year-old daughter, Ella, issued a statement on Sunday saying they were heartbroken by the loss of their son.
"Jett was the most wonderful son that two parents could ever ask for and lit up the lives of everyone he encountered," Travolta said in the statement. "We are heartbroken that our time with him was so brief. We will cherish the time that we had with him for the rest of our lives."
John Travolta and paramedics tried without success to resuscitate the boy.
The family's statement did not refer to Jett's medical history or possible cause of death. But Travolta's lawyers, Michael Ossi and Michael McDermott, were quoted on Sunday as saying Jett apparently suffered from grand mal seizures, which can cause loss of consciousness.
He was on an anti-seizure medication called Depakote for several years, Ossi and McDermott told the celebrity website TMZ.
They said the drug's use was suspended after it lost its effectiveness amid concern about side effects, however, and that Jett had been suffering about one extremely serious seizure a week.
Travolta and his wife have said that Jett was sick when he was a toddler and was diagnosed with Kawasaki disease, which leads to inflammation of the blood vessels in young children.
(Editing by Jim Loney and Eric Walsh)

http://asia.news.yahoo.com/090106/3/3ud73.html

Dengue fever

2009-01-03T16:35:00.000-08:00

High risk: Dengue fever may spread throughout the tropics, an expert has warned.

http://www.cairns.com.au/article/2009/01/03/22035_local-news.html

Esomeprazole Prevents Aspirin-Induced Ulcers

2009-01-02T15:58:00.000-08:00

Esomeprazole Prevents Aspirin-Induced Ulcers
Posted 12/18/2008

Long-term low-dose aspirin is commonly used to prevent cardiovascular events, but it produces its own risks, gastroduodenal ulcers, and esophagitis. Twelve investigators from Australia report in The American Journal of Gastroenterology in 2008[1] the results of a randomized, placebo-controlled trial of 20 mg daily of esomeprazole in 991 such patients at risk. Endpoints were recognition of gastric and duodenal ulcers, esophageal lesions, and associated symptoms. Over a 26-week period of study, 5.4% of the placebo group and only 1.6% of the treatment group developed ulcer disease while 18.3% and only 4.4%, respectively, developed erosive esophagitis and related symptoms. These differences are significant. Daily esomeprazole does help prevent these adverse GI effects in a population of long-term takers of low-dose aspirin.

http://www.medscape.com/viewarticle/585189

Economic Blues Trickle Down to Physicians

2009-01-02T15:31:00.000-08:00

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Economic Blues Trickle Down to Physicians
Robert Lowes
Medscape Medical News 2008. © 2008 Medscape
December 28, 2008 — Although most physicians are not losing their jobs or homes, they're nonetheless feeling the repercussions of the recession that began in December 2007 and deepened during the financial crisis in the fall of 2008. Symptoms large and small abound of a financial slump in medicine:
Fifty-six percent of hospitals told the American Hospital Association in November that physicians were seeking more financial support, ranging from reimbursement for on-call duty to outright employment.
Roughly 1 in 2 physicians plan to attend fewer continuing medical education conferences in 2009 that require overnight travel, according to a September survey by the publication Medical Meetings.
Some physicians may be receiving fewer holiday gifts, a sure sign of belt tightening among patients. Internist Sheree Lipkis, MD, in Glenview, Illinois, has noticed a decline in such gifts from previous years from her patients. "Some of them have lost their jobs," Dr. Lipkis told Medscape Medical News.
Physicians like Dr. Lipkis might expect that rising unemployment and curtailed consumer spending would reduce patient volume, but that's not a universal pattern. To be sure, elective surgery has tailed off. Six in 10 plastic surgeons, for example, report a decrease in cosmetic procedures during the first 8 months of 2008, according to the American Society of Plastic Surgeons. Yet most primary-care physicians interviewed by Medscape Medical News say they haven't slowed down. "Patient numbers are stable," said internist C. B. Dehlin, DO, in Lansing, Michigan. "Maybe we're just caring for the 90% of Michiganders that have jobs."
Patients Postponing Care, Skipping Tests and Treatments
Full schedules for primary-care physicians may be misleading, though. Thirty-six percent of Americans are postponing needed care, while another 30% are skipping tests and treatments outright, according to a survey in October 2008 by the Henry J. Kaiser Family Foundation, and both categories are up 7 percentage points since April 2008. However, with many primary-care physicians ordinarily drowning in patients, reduced demand may simply translate into a shorter waiting time for an appointment slot as opposed to an open slot.
Also, the payment cycles of commercial insurers may have temporarily softened the effect of the recession for physicians who enjoyed crowded waiting rooms in late 2008. By that time, many if not most insured patients had met their annual deductible, motivating them to load up on needed care before year's end while it was less expensive. Dr. Lipkis said that's the reason why the last few months of 2008 were busier than usual for her. Come January 2009, the prospect of shouldering the entire cost of an office visit or procedure may discourage insured patients from making an appointment.
If patients — insured or not — do book an appointment, there's also the possibility that they may not pay up afterward. The Kaiser Family Foundation found that one third of Americans were struggling to pay their medical bills in fall 2008, up from one quarter in 2006. Not surprisingly, a St. Louis collection agency called Account Resolution has seen the dollar volume of delinquent accounts received from physicians increase by roughly 25% in the last half of 2008, says company president James Hill, Jr. "These trends are happening all across the country," Mr. Hill said. And they only stand to worsen with unemployment expected to hit 8.3% by the end of 2009, according to financial research firm Standard & Poor's.
One component of the current recession — the credit crunch — has made it harder for some physicians to borrow money to start a practice or expand an existing one. "Automatic loans for anyone with a medical degree are a thing of the past," practice management consultant Michael LaPenna in Kentwood, Michigan, told Medscape Medical News. Besides requiring physicians to put up security for term loans, cautious banks are asking physicians with an existing line of credit to prove that they have enough accounts receivable to justify the amount of money made available.
Bolstered Medicaid, Medicare Spending May Help
Prognosticators such as Standard and Poor's expect the recession to last well into 2009. How physicians fare will depend partly on the success of federal bailout efforts enacted under the Bush administration — bankrolling banks to loosen up credit, for example — as well as the economic stimulants that President-elect Barack Obama has said he will administer. Mr. Obama has contemplated pouring billions of dollars into state Medicaid programs that have experienced budget cuts in the face of higher demand (the Kaiser Family Foundation estimates that every 1% increase in unemployment adds 1 million people to Medicaid and the State Children's Health Insurance Program). For many physicians, bolstered Medicaid spending could mean the difference between poor compensation versus none at all.
The American College of Physicians (ACP) is asking the federal government to be just as generous with Medicare. It is recommending that for 18 months, Congress fund a 10% bonus for all Medicare services performed by primary-care physicians. "Without funding to stabilize primary-care practices, many will go under and have to close" in light of the credit crunch, investment losses, slower collections, and uncompensated care, the ACP states in a letter to the incoming Obama administration.
While everybody, it seems, is waiting for federal largesse, physicians can act on their own to cope with the forlorn economy. For starters, tune up your billing and collection operation. With patients losing insurance coverage or switching to a spouse's policy after a job loss, it's imperative to verify insurance eligibility and benefits at the front desk so you know whom to bill, said practice management consultant Mr. LaPenna. Collecting copays and patient balances at the front desk is another must for the sake of maximizing revenue. If patients are short on money, offer them an installment plan. It can be as simple as keeping their credit card number on file — with the patient's authorization — and automatically charging it over a set number of months.
Improve Marketing to Current and New Patients
Practices with openings in their schedules should try to make it easier for patients to make appointments, suggested Hobie Collins, a practice management consultant with the Medical Group Management Association in Louisville, Kentucky. Extended weekday hours, for example, cater to employed patients who might find it hard to come in otherwise. "Eliminate as many barriers as you can," said Mr. Collins.
Stepped up marketing can also help fill up the waiting room. Target your existing patients first, advises practice management consultant Jeff Denning in La Jolla, California. "Go through your charts and see who's overdue for preventive or follow-up care, and give them a call," Mr. Denning said. A practice Web site may help a surgical specialist attract new cases.
Cost control is an indispensable virtue during a recession. "Remember the motto from the Great Depression," Mr. LaPenna said. "Use it up, wear it out, make it do, or do without." To achieve the right economy of scale, Mr. LaPenna said, physicians may have to go beyond mere downsizing and consider merging with another practice.
How drastic the solution needs to be, of course, depends on the length and severity of the recession. Dr. Lipkis, for one, will be watching how many tins of popcorn and bottles of wine she receives from patients when the winter holidays come around in 2009. In the meantime, she's giving thanks.
Dr. Lipkis said: "We remind our staff during stressful days how lucky we are to have jobs and be financially afloat."

Electronic Health Record

2008-12-31T18:45:00.000-08:00

Dr. Theodore A. Praxel, Marshfield’s director of quality improvement and care management.

Darren Hauck for The New York Times
Claire Critelli, 6, and her mother, Marilee, left, with Dr. Edna O. DeVries at the Marshfield Clinic in Wisconsin.

December 27, 2008
The Evidence Gap
Health Care That Puts a Computer on the Team
By STEVE LOHR
MARSHFIELD, Wis. — Joseph Calderaro, 67, is one of health care’s quiet success stories. Over the last four years, he has carefully managed his diabetes by lowering his blood sugar, blood pressure and cholesterol with diet, exercise and medication.
To keep on track, Mr. Calderaro visits his doctor, attends meetings for diabetes patients and gets frequent calls from a health counselor. It is a team effort, orchestrated by the Marshfield Clinic here. And it is animated by technology, starting with Mr. Calderaro’s computerized patient record — a continuously updated document that includes his health history, medications, lab tests, treatment guidelines and doctors’ and nurses’ notes.
To visit the Marshfield Clinic, a longtime innovator in health information technology, is to glimpse medicine’s digital future. Across the national spectrum of health care politics there is broad agreement that moving patient records into the computer age, the way Marshfield and some other health systems have already done, is essential to improving care and curbing costs.
A paper record is a passive, historical document. An electronic health record can be a vibrant tool that reminds and advises doctors. It can hold information on a patient’s visits, treatments and conditions, going back years, even decades. It can be summoned with a mouse click, not hidden in a file drawer in a remote location and thus useless in medical emergencies.
Modern computerized systems have links to online information on best practices, treatment recommendations and harmful drug interactions. The potential benefits include fewer unnecessary tests, reduced medical errors and better care so patients are less likely to require costly treatment in hospitals.
The widespread adoption of electronic health records might also greatly increase evidence-based medicine. Each patient’s records add to a real-time, ever-growing database of evidence showing what works and what does not. The goal is to harness health information from individuals and populations, share it across networks, sift it and analyze it to make the practice of medicine more of a science and less an art.
The Bush administration has left it mainly to advocacy and the private sector to introduce digital medicine. But President-elect Barack Obama apparently plans to make a sizable government commitment. During the campaign, Mr. Obama vowed to spend $50 billion over five years to spur the adoption of electronic health records and said recently that a program to accelerate their use would be part of his stimulus package.
The Marshfield Clinic, a large doctors’ group in Wisconsin, shows that computerized records can indeed improve the quality and efficiency of medicine. Yet the Marshfield experience suggests that the digital record becomes truly useful only when patient information is mined to find patterns and answer questions: What treatments work best for particular categories of patients? What practices or procedures yield the best outcome?
The Marshfield Clinic “understands that it’s a system of improvement that technology makes possible that really matters, and the electronic health record itself is no silver bullet,” said Dr. Carolyn M. Clancy, director of the federal Agency for Healthcare Research and Quality.
For the Obama presidency and the administrations that follow it, the challenge will be to somehow link electronic medical islands into a network that begins to approach on a national scale what organizations like Marshfield have achieved regionally. Ideally, a lone physician in a rural community could tap into the national health information network and be as well informed on treatments and research for patients with certain conditions as a specialist at Marshfield.
Some experts caution that such a broad capacity for record-sharing could take decades to achieve — if it is even possible in the decentralized American marketplace of medical competitors.
Marshfield Clinic, a nonprofit organization founded in 1916, has a long history of using information technology to further research and improve care. In the 1960s, the clinic bought the digital breakthrough of its day — a mainframe computer — and used punched cards to feed it information on diagnoses and procedures. In 1985, the clinic introduced its first basic electronic health records, kept refining them and by 1994 mandated that its doctors all use them. In 2003, it introduced wireless tablet computers, whose screen can written on like digital paper or flipped up, exposing a keyboard, and used as a conventional laptop PC.
Today, Marshfield’s 790 doctors and their support staff at 43 locations in Wisconsin all use the tablet PCs. At the end of last year, the group eliminated paper charts for the more than 365,000 patients its doctors see each year, freeing up storage space the size of a football field at the main clinic in Marshfield. At each step toward a fully digital system, physicians were consulted and involved in the design process.
“It’s been a fabulous journey from physicians being reluctant to now being unable to live without this technology,” observed Dr. Karl J. Ulrich, the clinic’s chief executive. Marshfield is one of a few dozen medical groups across the country that are aggressively embracing information technology. The organizations tend to be big — ranging from providers with thousands of physicians like Kaiser Permanente and the Department of Veterans Affairs to ones with hundreds like Marshfield and Geisinger Health Systems in central Pennsylvania. They are typically responsible for most or all aspects of a patient’s care. They are often insurers, as well.
Those groups, in other words, have the scale and economic incentives to invest in information technology to capture the gains from improved quality and efficiency. In that regard, they lie outside the mainstream of America’s health care economy, a fee-for-service system in which providers are typically paid for doing more, not necessarily doing better. It is a system that encourages more doctor visits, more tests, more surgical procedures, more pills.
For most doctors, who work in small practices, an investment in electronic health records looks simply like a cost for which they will not be reimbursed. That is why policy experts say any government financial incentives to use electronic records — matching grants or other subsidies — should be focused on practices with 10 or fewer doctors, which still account for three-fourths of all doctors in this country. Only about 17 percent of the nation’s physicians are using computerized patient records, according to a government-sponsored survey published in The New England Journal of Medicine.
Even for the large doctor groups, there is no crisp, conclusive cost-benefit arithmetic. Marshfield can point to various measurable savings, but has scant proof they outweigh the millions spent in the past and the $50 million-a-year technology budget.
“People ask about return on investment, but that’s the wrong question,” said Dr. John W. Melski, the medical director of clinical informatics at Marshfield. “This requires the usual leap of faith that knowledge will yield good things — better care, doing things smarter and, yes, saving money in the long run.”
Aided by their growing database, Marshfield’s physician-researchers are working on ambitious projects in personalized medicine that use genetic markers to tailor drug dosages. For example, the clinic recently began a clinical test on 250 patients that uses three gene markers to personalize their doses of Coumadin, or warfarin as the generic drug is known. The blood-thinning drug is widely prescribed for heart patients. But it is often difficult to calibrate the right dose for individuals, and the consequences of internal bleeding or blood clots can be life-threatening. In this case, the electronic health record is the starting point for research, feeding information into the database from which the clinic’s scientists appropriate patients. The digital record holds the patient-specific information used in the Coumadin calculation of tailored doses for individuals.
Marshfield is also researching “predictive” medicine that combines genetics, family histories and lab tests to warn patients about looming health risks. It has a voluntary DNA database on nearly 20,000 people, whose health care information goes back 30 years on average — and the electronic record is the vehicle for collecting and conveying that information. The researchers are looking for patterns in family history, lifestyle, environmental factors, lab test results and selected genetic markers that might predict the onset of conditions like diabetes and Alzheimer’s disease years in advance.
“Better health information technology is needed every step of the way,” said Catherine A. McCarty, director of Marshfield’s center for human genetics and principal investigator for its personalized medicine research project. “We could not do this without the electronic health record.”
The more immediate target, though, is harnessing the digital technology to help manage chronic illnesses like diabetes, heart disease, cancer and asthma. Seventy-five percent of America’s health care spending goes to people with one or more chronic conditions. And as the population ages that percentage is rising.
Marshfield’s progress in recent years with its more than 18,000 diabetes patients, including Mr. Calderaro, points to the potential. The gains are a byproduct of being able to constantly measure and manage health outcomes, a process of efficiently gathering and monitoring patient information that is made possible by the electronic health record. Besides the doctor visits, group meetings and monthly calls from a diabetes counselor, Mr. Calderaro has used all the information to take responsibility for controlling his diabetes. He not only monitors his blood sugar and blood pressure readings, but he could recite the carbohydrate grams in each of the foods he ate one day recently. A three-mile walk is often part of his daily regimen. He was never really heavy, but he has a sister with diabetes and had a maternal grandmother who suffered from the disease.
“If I had known when I was 40 years old what I know now, I would have done things differently,” Mr. Calderaro said.
From mid-2004 through the third quarter of this year, the percentage of the clinic’s diabetic patients with blood cholesterol at or below the recommended level rose to 61 percent, from 40 percent earlier. The percentage with satisfactory blood pressure increased to 52 percent, up from 32 percent.
Over the same span, hospital admissions among Marshfield’s diabetic population fell — to 311 per 1,000 patients a year, from 360. Because a hospital stay for a diabetes patient ranges from $8,000 to $22,500, according to national statistics, Marshfield’s results translate into an annual cost saving of $7.3 million to $20.5 million.
More important may be the suffering avoided. Complications from diabetes include kidney failure, blindness and amputations. “Those are the things that really scare you,” Mr. Calderaro, the patient, said. “But it doesn’t have to be. You can manage it.”
Marshfield is striving to help more of its diabetes patients to do as well as Mr. Calderaro, and the federal Medicare agency has recognized Marshfield’s progress.
In a continuing pilot project, Medicare has selected the clinic and nine other large doctor groups and arranged to pay them for the quality of care they deliver. Last year, on the basis of how well diabetes patients had fared, by various measures, Marshfield was one of only two groups that did well enough to earn bonus payments.
The Medicare pilot prompted Marshfield to take a fresh look at how it cares for various chronic conditions, including heart disease and hypertension. That led to a new software tool, called the iList, which has proved a big help, said Dr. Theodore A. Praxel, Marshfield’s medical director of quality improvement and care management.
The iList (for “intervention list”) culls the patient records of a primary care physician, and ranks and flags patients by conditions not met, including uncontrolled blood pressure and cholesterol, overdue lab tests and vaccinations missed. Nurses and medical assistants then “work the iList,” calling patients with reminders and scheduling them for exams and lab work.
In medicine, the computer is to memory what the X-ray machine is to vision — a technology that vastly surpasses human limitations. The benefits of a computer-helper, doctors say, become quickly evident in everyday practice.
When a doctor electronically prescribes a new drug, for example, an on-screen warning appears if the medication is on the patient’s allergy list or could cause a potentially dangerous interaction with another drug the person is taking. In the New England Journal of Medicine survey, 71 percent of physicians using electronic health records with that feature said they had received a computer alert that helped them avoid a harmful prescription mistake.
“It absolutely happens,” said Dr. Edna O. DeVries, a pediatrician at Marshfield. “You’re distracted and talking to the parents. You’re on autopilot.”
Dr. DeVries, who joined the clinic in 1989, was the medical director nearly a decade ago on a database, created by Marshfield, to track early childhood immunizations in central Wisconsin. Over the next two years, the immunization rates for children in the area rose to 93 percent, from 67 percent, as a result of the tracking and follow-up reminders.
“The quality of care goes up dramatically just by having information instantly,” Dr. DeVries said. Yet, as her colleague and veteran of computer medicine Dr. Melski notes, there is no payoff to technology alone — only in people using technology wisely.
“We have to restructure our medical culture,” he said. “We have to promote a culture that believes in the evidence and is trained in analyzing the evidence. It’s the only long-run answer to the challenges we face in health care — evidence-based medicine.”

http://www.nytimes.com/2008/12/27/business/27record.html

Past Coverage
A Towering To-Do List (November 6, 2008)
Most Doctors Aren't Using Electronic Health Records (June 19, 2008)
Kaiser Endorses Microsoft's Health Records Plan (June 10, 2008)
New York City to Help Doctors Track Patients' Records Electronically (February 26, 2008)
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No Mug? Drug Makers Cut Out Goodies for Doctors

2008-12-31T18:21:00.001-08:00

Just a few of the free pens in Dr. Jeffrey F. Caren’s collection.

Dr. Jeffrey F. Caren, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, has collected more than 1,200 pens and mounted them on a pillar in his office.

December 31, 2008
No Mug? Drug Makers Cut Out Goodies for Doctors
By NATASHA SINGER
To Lehman Brothers, Linens ’n Things and the blank VHS tape, add another American institution that expired in 2008: drug company trinkets.
Starting Jan. 1, the pharmaceutical industry has agreed to a voluntary moratorium on the kind of branded goodies — Viagra pens, Zoloft soap dispensers, Lipitor mugs — that were meant to foster good will and, some would say, encourage doctors to prescribe more of the drugs.
No longer will Merck furnish doctors with purplish adhesive bandages advertising Gardasil, a vaccine against the human papillomavirus. Banished, too, are black T-shirts from Allergan adorned with rhinestones that spell out B-O-T-O-X. So are pens advertising the Sepracor sleep drug Lunesta, in whose barrel floats the brand’s mascot, a somnolent moth.
Some skeptics deride the voluntary ban as a superficial measure that does nothing to curb the far larger amounts drug companies spend each year on various other efforts to influence physicians. But proponents welcome it as a step toward ending the barrage of drug brands and logos that surround, and may subliminally influence, doctors and patients.
“It’s not just the pens — it’s the paper on the exam table, the tongue depressor, the stethoscope tags, medical calipers that might be used to interpret an EKG, penlights,” said Dr. Robert Goodman, a physician in internal medicine at Montefiore Medical Center in the Bronx.
In 1999, Dr. Goodman started No Free Lunch, a nonprofit group that encourages doctors to reject drug company giveaways. “Practically anything you can put a name on is branded in a doctor’s office, short of branding, like a Nascar driver, on the doctor’s white coat,” Dr. Goodman said.
The new voluntary industry guidelines try to counter the impression that gifts to doctors are intended to unduly influence medicine. The code, drawn up by Pharmaceutical Research and Manufacturers of America, an industry group in Washington, bars drug companies from giving doctors branded pens, staplers, flash drives, paperweights, calculators and the like.
The guidelines also reiterate the group’s 2002 code, which prohibited more expensive goods and services like tickets to professional sports games and junkets to resorts. And it asks companies that finance medical courses, conferences or scholarships to leave the selection of study material and scholarship recipients to outside program coordinators.
Diane Bieri, the executive vice president of Pharmaceutical Research and Manufacturers of America, said the updated guidelines were not an admission that gifts could influence doctors’ prescribing habits. Instead, she said, they were meant to emphasize the educational nature of the relationship between industry and doctors.
“We have never said and would never say that a pharmaceutical pen or notebook has influenced any prescription,” Ms. Bieri said.
But some critics said the code did not go far enough to address the influence of drug marketing on the practice of medicine. The guidelines, for example, still permit drug makers to underwrite free lunches for doctors and their staffs or to sponsor dinners for doctors at restaurants, as long as the meals are accompanied by educational presentations.
“Pens or no pens, their influence is not going to be diminished,” said Dr. Larry M. Greenbaum, a rheumatologist in Greenwood, Ind. He has made a point of collecting ballpoint pens advertising formerly heavily promoted medications, like the painkiller Vioxx, that were later withdrawn after reports of dangerous side effects.
Last year, besides giving away nearly $16 billion in free drug samples to doctors, pharmaceutical companies spent more than $6 billion on “detailing” — an industry term for the sales activities of drug representatives including office visits to doctors, meal-time presentations and branded pens and other handouts, according to IMS Health, a health care information company.
The industry code also permits drug makers to pay doctors as consultants “based on fair market value” — which critics say means that companies can continue to pay individual doctors tens of thousands of dollars or more a year.
“We have arrived at a point in the history of medicine in America where doctors have deep, deep financial ties with the drug makers and marketers,” said Allan Coukell, the director of policy for the Prescription Project, a nonprofit group in Boston working to promote evidence-based medicine. “Financial entanglements at all the levels have the potential to influence prescribing in a way that is not good.”
About 40 drug makers, including Eli Lilly & Company, Johnson & Johnson and Pfizer, have signed on to the code. Representatives of several pharmaceutical makers said their companies intended to comply with the guidelines, but they declined to discuss past marketing programs involving branded gifts.
The restrictions come as a blow to the makers and distributors of promotional products, an industry with an annual turnover of about $19 billion, according to Promotional Products Association International, a trade group. Such companies, accustomed to orders of up to a million pens a drug, stand to lose around $1 billion a year in sales as a result of the drug industry’s voluntary ban, the group said.
The sudden scarcity of free goodies, though, could enhance the cachet of collections that some doctors have assembled over the years as a mocking countermeasure to drug marketing. Dr. Nathan Anderson, a resident in internal medicine at a hospital in Texas, has posted photographs of the various items he has received on his blog, drugreptoys.blogspot.com.
Dr. Jeffrey F. Caren, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, has collected more than 1,200 pens and mounted them on a pillar in his office.
While some doctors applaud the gift ban, others seem offended by the insinuation that a ballpoint pen could turn their heads. “It seems goofy to us; we like getting our pens,” Dr. Susan B. Hurson, an obstetrician and gynecologist in Washington, said in a telephone interview.
Dr. Hurson said she paid no attention to the logos on the pens she carries around in her doctor’s coat.
Prompted by a reporter’s question, she pulled out a handful of pens from her pocket and read off the drugs advertised: Clindesse, a cream for vaginal infection; Halo, a system for detecting breast cancer, and Evamist, an estrogen spray. “It’s hard for me to believe it influences what you prescribe.”
But Dr. Phillip Freeman, a psychiatrist in Boston, said that physicians who contended that the giveaways were benign might be suffering from denial.
“The need to deny influence is damaging to the soul,” Dr. Freeman said. He suggested that doctors would feel less conflicted if they simply wore drug company patches on their white coats.

http://www.nytimes.com/2008/12/31/business/31drug.html?em

Living Better With Rheumatoid Arthritis

2008-12-31T18:03:00.000-08:00

Personal Health
Living Better With Rheumatoid Arthritis

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By JANE E. BRODY
Published: August 11, 2008

Alan Moore was 52 years old, teaching statistics at the University of Wyoming, playing the violin in the university’s symphony and accompanying soloists on the piano when his health took a nosedive in April 2001.

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“I felt like I had the flu,” Mr. Moore recalled in an interview last month. “I was very weak and fatigued. I had extreme pain and swelling in a lot of my joints. I was in agony when I got up in the morning, so stiff I had to shuffle to the bathroom. I couldn’t peel a banana, turn the key in the ignition or even pull the tab of a tea bag. My wife, Cindy, had to help me with the simplest of tasks. Needless to say, I couldn’t play the violin or piano or use the computer.”
Doctors diagnosed it as rheumatoid arthritis.
“And I thought that my life as I knew it was over,” said Mr. Moore, now 59, of Laramie, Wyo.
But by enrolling in a clinical trial of one of the drugs and drug combinations that are revolutionizing the treatment of the disease, Mr. Moore got his life back.
Rheumatoid arthritis is the world’s most common autoimmune disease, striking up to 1 in 100 in the course of a lifetime. It is most often diagnosed in people ages 30 to 60 but it can occur at any time, including childhood.
As with other autoimmune diseases, women are three to four times likelier than men to develop rheumatoid arthritis. About 80 percent of Caucasians with the disease have a genetic marker, a gene sequence in the HLA-D region of chromosome 6 that is found in only about 35 percent of the general population.
The disease causes chronic joint inflammation and progressive destruction of the cartilage at the ends of bones, which can result in an inability to use the affected joints. Other effects include fatigue, malaise, anemia and damage to organs throughout the body, including the cardiovascular system.
Untreated, 20 to 30 percent of people become permanently disabled within three to five years of diagnosis. Life expectancy may be reduced by as much as 15 years, with half of patients succumbing to cardiovascular disease.

A Therapeutic Revolution
Doctors traditionally treated the symptoms of rheumatoid arthritis, usually with anti-inflammatory and pain-relieving medications. But the underlying destruction of tissues continued, leading to chronic disability and premature death.
The goal today is suppression of the disease and prevention of progressive joint destruction by treating patients early with synthetic or biologic agents called disease-modifying antirheumatic drugs.
Though he did not know it at the time, Mr. Moore was randomly assigned to the study group that every two weeks self-injected a biologically derived drug called Humira, which acts to block a protein involved in the inflammation associated with rheumatoid arthritis. Humira is one of six federally approved biologic treatments for the disease. Three other biologic remedies are nearing approval by the Food and Drug Administration.
“Within days my symptoms declined to nearly zero,” Mr. Moore said, “and I’ve had no symptoms since.” He has continued the injections of Humira and participates in a registry of patients to help assess the drug’s long-term benefits and potential risks.

Combining Treatments
The costly biologic drugs are often used in combination with much cheaper synthetic disease-modifying drugs taken orally, like methotrexate. In some cases, oral medications are all that patients need to keep symptoms and joint destruction under control.
But well-designed clinical trials have typically shown that in patients facing moderate to severe disease, combining the treatments often results in fewer symptoms and less destruction of joints, especially if therapy begins early.
In a study published July 16 in The Lancet, researchers in Leeds, England, reported that among 542 patients randomly assigned to receive either methotrexate alone or in combination with Enbrel, another biologic agent, those receiving the combination were almost twice as likely to become symptom free and more likely to show no X-ray signs of progressive joint destruction a year later.
In a commentary with the Lancet report, Dr. Joel M. Kremer, a rheumatologist at Albany Medical College, said it was important to consider the long-term consequences and costs of the disease when deciding how much to spend on therapy.
“Most of the biologic agents cost in the range of $16,000 to $18,000 a year, whereas the oral medications cost only about a tenth that,” Dr. Kremer said in an interview.
But, he added, inadequately treated rheumatoid arthritis typically leads to a need for multiple joint replacements, lost productivity, lost tax revenue and a greatly diminished quality of life, as well as an increased risk of life-threatening infections and cardiovascular disease.
“Most patients diagnosed at age 45 will be disabled in five or six years,” Dr. Kremer said. “You have to consider what it costs to fix a bridge against what it will cost when the bridge collapses.”
Before the use of disease-modifying drugs, direct medical costs from rheumatoid arthritis were estimated at $5.5 billion, and that did not include the indirect costs of lost wages and productivity, the need for custodial care and the emotional and social consequences of chronic disability.

A Tailored Approach
While not everyone with rheumatoid arthritis responds to the new treatments as vividly as Mr. Moore did, many large studies have shown there is no longer any reason for pessimism about the diagnosis. But it is vitally important to begin treatment early.
The recent therapeutic developments, Dr. Kremer said, mean doctors in general practice need to remain alert to symptoms of the disease in its early stages and quickly refer patients to rheumatologists who can confirm the diagnosis and prescribe up-to-date treatment before irreparable damage to joints occurs. Treatment is most effective if begun within one year after symptoms appear.
There is no one treatment approach that works for everyone. Rather, studies have indicated that treatment should be tailored to individual patients: the nature and extent of their disease, their other health issues and how they respond to various therapies.
Dr. Kremer said many patients could be started on a single, low-cost drug like methotrexate, as long as their condition was closely monitored and the treatment adjusted if there are signs of progressive disease.
Regular exercise and physical and occupational therapy, along with medication, can help patients maintain function. In addition to antirheumatic drugs to reduce inflammation, Dr. Kremer recommends fish oil at a daily dose of 2 grams of EPA and DHA — about six capsules as they are currently formulated.

http://www.nytimes.com/2008/08/12/health/12brod.html?_r=1&fta=y

More Articles in Health » A version of this article appeared in print on August 12, 2008, on page F7 of the New York edition.
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Patient’s DNA May Be Signal to Tailor Medication

2008-12-31T17:27:00.000-08:00

Jody Uslan, who took the drug Tamoxifan for two and a half years to prevent a recurrence of breast cancer, recently found out through newly available genetic testing that the drug had no effect on her.

Dr. David Flockhart discovered how the body converted the medication tamoxifen.

The Evidence Gap
Patient’s DNA May Be Signal to Tailor Medication

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By ANDREW POLLACK
Published: December 29, 2008

The Evidence GapThe Genetic Factor
Articles in this series are exploring medical treatments used despite scant proof that they work and are examining steps toward medicine based on evidence.

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For more than two years, Jody Uslan had been taking the drug tamoxifen in hopes of preventing a recurrence of breast cancer. Then a new test suggested that because of her genetic makeup, the drug was not doing her any good.
“I was devastated,” said Ms. Uslan, 52, who stopped taking tamoxifen and is now evaluating alternative treatments. “You find out you’ve been taking this medication for all of this time, and find out you are not getting benefit.”
Ms. Uslan’s situation is all too common — and not just among the hundreds of thousands of women in this country taking tamoxifen.
Experts say that most drugs, whatever the disease, work for only about half the people who take them. Not only is much of the nation’s approximately $300 billion annual drug spending wasted, but countless patients are being exposed unnecessarily to side effects.
No wonder so much hope is riding on the promise of “personalized medicine,” in which genetic screening and other tests give doctors more evidence for tailoring treatments to patients, potentially improving care and saving money.
Many policy experts are calling for more studies to compare the effectiveness of different treatments. One drawback is that such studies tend to be “one size fits all,” with the winning treatment recommended for everybody. Personalized medicine would go beyond that by determining which drug is best for which patient, rather than continuing to treat everyone the same in hopes of benefiting the fortunate few.
The colon cancer drugs Erbitux and Vectibix, for instance, do not work for the 40 percent of patients whose tumors have a particular genetic mutation. The Food and Drug Administration held a meeting this month to discuss whether patients should be tested to narrow use of the drugs, which cost $8,000 to $10,000 a month.
And a genetic test might help doctors determine the optimal dose of warfarin, a blood thinner used by millions of Americans. Tens of thousands of them are hospitalized each year because of internal bleeding from an overdose or a blood clot from an inadequate dose.
“If you save one hospitalization for every 100 new warfarin users, you more than offset the cost of testing all 100,” said Dr. Robert S. Epstein, the chief medical officer of Medco Health Solutions, which manages prescription plans for employers. The test typically costs $100 to $600.
For all the potential, experts see some formidable obstacles on the path to the promised land of personalized medicine.
“It’s going to take 20 to 30 years for all this to fall into place,” said Dr. Gregory Downing, who heads efforts by the Department of Health and Human Services to spur personalized health care.
The hurdles include

drug makers, which can be reluctant to develop or encourage tests that may limit the use of their drugs.

Insurers may not pay for tests, which can cost up to a few thousand dollars.

For makers of the tests, which hope their business becomes one of health care’s next big growth industries, a major obstacle is proving that their products are accurate and useful.

While drugs must prove themselves in clinical trials before they can be sold, there is no generally recognized process for evaluating genetic tests, many of which can be marketed by laboratories without F.D.A. approval.
Genentech, a developer of cancer drugs, petitioned the F.D.A. this month to regulate such tests. It warned of “safety risks for patients, as more treatment decisions are based in whole or in part on the claims made by such test makers.”
A cautionary case is Herceptin, a Genentech breast cancer drug that is considered the archetype of personalized medicine because it works only for women whose tumors have a particular genetic characteristic. But now, 10 years after Herceptin reached the market, scientists are finding that the various tests — some approved by the F.D.A., some not — can be inaccurate.
Moreover, doctors do not always conduct the tests or follow the results. The big insurer UnitedHealthcare found in 2005 that 8 percent of the women getting the drug had tested negative for the required genetic characteristic. An additional 4 percent had not been tested at all, or their test results could not be found.
Tamoxifen, the drug Ms. Uslan took, illustrates the promise and current limitations of genetic testing. In 2003, more than 25 years after tamoxifen was introduced, researchers led by Dr. David A. Flockhart at Indiana University School of Medicine figured out that the body coverts tamoxifen into another substance called endoxifen. It is endoxifen that actually exerts the cancer-fighting effect. The conversion is done by an enzyme in the body called CYP2D6, or 2D6 for short.
But variations in people’s 2D6 genes mean the enzymes have different levels of activity. Up to 7 percent of people, depending on their ethnic group, have an inactive enzyme, Dr. Flockhart said, while another 20 to 40 percent have an only modestly active enzyme.
The implications were “scary,” Dr. Flockhart said. Many women were apparently not being protected against cancer’s return because they could not convert tamoxifen to endoxifen.
The economic implications could be just as scary to big pharmaceutical companies.
Tamoxifen, now a generic drug, costs as little as $500 for the typical five-year treatment. But most patients in the United States are currently treated with a newer, much more expensive class of drugs, called aromatase inhibitors, that cost about $18,000 over five years. Those drugs — made by AstraZeneca, Novartis and Pfizer — performed better than tamoxifen in clinical trials before the role of 2D6 was generally understood.
If only women with active 2D6 had been assessed, tamoxifen might have worked as well or better than the newer drugs, according to researchers at the Dana-Farber Cancer Institute in Boston.
But proving these suppositions and having them incorporated into medical practice have not been easy.
The F.D.A., in its meeting this month, said clinical trials were the ideal way to validate a test. But many test developers argue that trials would be too costly and time-consuming, so many tests are validated by reanalyzing patient data from old trials.
In the case of tamoxifen, Dr. Matthew P. Goetz of the Mayo Clinic and colleagues went back to an old trial and used stored tumor samples to test the 2D6 genes of each patient. The researchers reported in 2005 that 32 percent of the women with inactive 2D6 enzyme had relapsed or died within two years, in contrast to only 2 percent of the other women.
But while some subsequent studies have backed those conclusions, two had contradictory results. That leaves many experts hesitant to use the test, which costs about $300.
There are other complications. Dozens of variants of the 2D6 gene exist, and laboratories can differ in their interpretation of test results. And it is not always clear how to act upon the information the test provides.
Ms. Uslan, who lives in the Woodland Hills neighborhood of Los Angeles, is in a predicament since she stopped taking tamoxifen. The newer alternative, aromatase inhibitors, work only for postmenopausal women and she has not yet completed menopause. To take an aromatase inhibitor, she must have her ovaries removed or take a drug to induce menopause. Because both options are unattractive, many experts say there is no point testing premenopausal women for 2D6.
Such complexities are not confined to tamoxifen testing. The labels of about 200 drugs now contain some information relating genes to drug response, said Lawrence J. Lesko, the F.D.A.’s head of clinical pharmacology. But in many cases, he said, doctors are not told specifically enough what to do with the test results, such as how much to change the dose.
Despite all the obstacles, personalized medicine is coming. Even the drug companies, which have been worried that testing would reduce their sales, are starting to realize that their medicines might not be approved or paid for without better evidence that they work.
Last year, for instance, European regulators said Amgen’s colon cancer drug Vectibix did not provide enough benefit to patients to be approved.
So Amgen reanalyzed the data from its clinical trial. After the results showed Vectibix worked better in patients whose tumors did not have a mutation in a gene called KRAS, the drug was approved for those patients only.
As for tamoxifen, an F.D.A. advisory panel recommended two years ago that the 2D6 test be mentioned in the drug’s label. But the agency itself was not persuaded there was enough evidence until just recently, Dr. Lesko said. “There’s no ‘one size fits all’ for evidence that everybody buys into.”
More Articles in Business » A version of this article appeared in print on December 30, 2008, on page A1 of the New York edition.

http://www.nytimes.com/2008/12/30/business/30gene.html?em=&pagewanted=all

Past Coverage
The Promise and Power of RNA (November 11, 2008)
PERSONAL HEALTH; Living Better With Rheumatoid Arthritis (August 12, 2008)
Couch Mouse to Mr. Mighty by Pills Alone (August 1, 2008)
Myriad Genetics Stops Work on an Alzheimer's Drug (July 1, 2008)

Cyberknife boost to cancer care

2008-12-30T07:03:00.000-08:00

Professor Eric Lartigau is impressed by the technology

The cyberknife minimises damage to healthy tissue

Page last updated at 06:00 GMT, Tuesday, 30 December 2008
Cyberknife boost to cancer care
By Fergus Walsh BBC News medical correspondent

Dr Nick Plowman says the cyberknife can target cancer cells with 'high exactitude'
A robot radiotherapy machine to treat cancer is to be available in the UK for the first time from February.
Called the Cyberknife, it moves with a patient's breathing so tumours can be targeted with greater accuracy, and damage to healthy tissue is reduced.
The machine will be at the private Harley Street Clinic in London.
More than a dozen countries worldwide already use the machine, including France, which has three under clinical trial.
At first sight the Cyberknife looks like one of those robots used in the TV car commercials.
It is a compact linear accelerator mounted on a robot arm.

The cyberknife minimises damage to healthy tissue
The cyberknife works by delivering multiple beams of high dose radiation from a wide variety of angles using a robotic arm.
X-ray cameras monitor the patient's breathing and re-position the radiotherapy beam in order to minimise damage to healthy tissue.
This accuracy enables tumours to be treated that are in difficult or dangerous to treat positions, such as near the spinal cord.
Good results
The French National Cancer Institute has paid for three Cyberknife machines to be trialled at hospitals in Nice, Nancy and Lille.
Professor Eric Lartigau from the Centre Oscar Lambret in Lille said he was very impressed.
He said: "We have treated just over 200 patients in 18 months and all couldn't have been treated with conventional radiotherapy so it is a big plus for our patients."
One of those patients is Helen O'Doherty from Limerick in Ireland.
She has liver cancer and was told by her doctors that conventional treatment, like surgery, was not possible, so she was referred to Lille for radiotherapy with the Cyberknife.

Professor Eric Lartigau is impressed by the technology

The Irish health service is paying for her treatment and she has made several trips to Lille with her husband.
She said: "I feel very privileged and excited to be here because I know it's the best and I'm so grateful to have another chance."
Conventional radiotherapy involves twenty or more short sessions with low-dose radiation.
But because the Cyberknife can deliver high dose beams with greater accuracy, it means Helen can have all her treatment in just three sessions.
Fifteen countries including the USA, Germany, Italy and Japan have the Cyberknife.
It is also installed in hospitals in Vietnam, Turkey and Greece.
In early February, the first Cyberknife in the UK will begin treating patients at the private Harley Street Clinic in London.
Clinical director Dr Nick Plowman, who is also a consultant oncologist at Barts Hospital, does not believe that Britain is lagging behind.
He said: "It is only in the past couple of years that the software has got to the stage where we believe it is right for introduction to our clinical service.
"So we don't believe we have been tardy; we have been waiting for the improvements to come and now they're here we are happy to introduce the machine."
Treatment will cost between £20,000 and £25,000.
Although most will be private, the clinic says it expects to treat some NHS patients.
Dr Plowman is keen to stress that conventional radiotherapy works well for most patients.
But for patients with some hard to treat tumours the Cyberknife will present another potential therapy.

http://news.bbc.co.uk/2/hi/health/7791315.stm

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Cholera deaths soar in Zimbabwe

2008-12-30T06:54:00.000-08:00

This is the reality of Zimbabwe’s cholera epidemic, aid workers say. Dehydrated patients lie motionless on makeshift beds. Nurses work day and night with barely any medical supplies.

This clinic had 15 cholera patients, a nearby clinic was said to have 600

The UN has warned the total number of cases could reach 60,000

Page last updated at 11:50 GMT, Monday, 29 December 2008
Cholera deaths soar in Zimbabwe

The UN has warned the total number of cases could reach 60,000
The latest figures from the UN and Zimbabwe's health ministry reveal that two-thirds of the victims of the cholera outbreak have died this month.
The death toll at the end of last week stood at 1,564, with 29,131 suspected cases since August, the UN said.
Figures from the health ministry on 1 December put cholera deaths at 484.
The UN has warned it could take six months to control the outbreak that has been fuelled by the collapse of the health, sanitation and water services.
No food
According to the World Health Organization, cases have been reported in all 10 of Zimbabwe's provinces.
CHOLERA FIGURES SINCE AUGUST
25 December

Deaths: 1,564

Cases: 29,131
1 December

Deaths: 484

Cases: 11, 735
Cases in December 68%
"The overall Case Fatality Rate (CFR) has risen to 5.7% - far above the 1% which is normal in large outbreaks - and in some rural areas it has reached as high as 50%," the WHO said in a statement.
Last Tuesday, Unicef put the number of cholera deaths at 1,174.
Aid agencies say so many clinics and hospitals have closed that large sections of the population have no access to medical care.
The suburb of Budiriro in Harare's capital, has been worst hit by the outbreak, followed by Beitbridge on the border with South Africa.
South Africa has recorded 1,279 cases and 12 deaths - the bulk of these in the border region, the WHO says.
Over the weekend, Save the Children said some five million people in Zimbabwe - or about 50% of the country's population - were now in need of food aid.
President Robert Mugabe has been facing intensified criticism over the dire economic and humanitarian situation in Zimbabwe.
He signed a power-sharing deal with his rival, Morgan Tsvangirai, in September, intended to rescue the collapsing economy but progress has since stalled over who should control key ministries.
Mr Tsvangirai has threatened to pull out of power-sharing talks unless abductions of his supporters stop.
According to his Movement for Democratic Change, about 40 human rights activists and opposition supporters have been abducted in the past two months.
Meanwhile, the US envoy to Africa, Jendayi Frazer, has warned that last week's military coup in Guinea should serve as a warning of what could happen in Zimbabwe, if Mr Mugabe is allowed to cling to power and die in office.

http://news.bbc.co.uk/2/hi/africa/7802943.stm

CHOLERA CRISIS

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Crisis in pictures
Cholera lays bare Zimbabwe's collapse
'Stench of death': Reporter round-up
Diary: 'Too much to take'
Hospital death throes
BACKGROUND
Victims demand justice
What's the lie of Zimbabwe's land?
Zimbabwe deal: Key points
Q&A: Zimbabwe crisis
VIDEO AND AUDIO
Zimbabwe's cholera crisis
Economic challenges

Blood pressure cases 'to top 1bn'

2008-12-30T06:50:00.000-08:00

Last Updated: Thursday, 16 August 2007, 23:16 GMT 00:16 UK
Blood pressure cases 'to top 1bn'

High blood pressure is generally accepted as a reading above 140/80mmHgHigh blood pressure is out of control around the world, with the number of sufferers expected to exceed a billion within 20 years, experts warn.
One in four adults already has the condition, which increases the risk of heart disease, stroke and death.
But unhealthy modern lifestyles mean the toll could hit 1.56 billion by 2025, up from 972 million in 2000, The Lancet medical journal reports.
The biggest problem is poor compliance with treatment, an editorial claims.
Time bomb
Despite very effective and cost-effective treatments, target blood pressure levels are very rarely reached, even in countries where cost of medication is not an issue, says the editorial.
"Many patients still believe that hypertension is a disease that can be cured, and stop or reduce medication when blood pressure levels fall.
"Physicians need to convey the message that hypertension is the first, and easily measurable, irreversible sign that many organs in the body are under attack.
"Perhaps this message will make people think more carefully about the consequences of an unhealthy lifestyle and give preventative measures a real chance," it says.
High blood pressure is a ticking time bomb and should be taken seriously
Professor Gareth Beevers of the Blood Pressure Association
Currently, a person in the Western world has a greater than 90% lifetime risk of developing high blood pressure or hypertension.
But lifestyle factors, such as physical inactivity, a salt-rich diet with high processed and fatty foods, and alcohol and tobacco use, mean the problem is spreading at an alarming rate from developed countries to emerging economies, such as India and China, says The Lancet.
Professor Gareth Beevers of the Blood Pressure Association said: "This shows that high blood pressure is a ticking time bomb and should be taken seriously.
"This is preventable, if people of all ages start looking at their lifestyles and start taking the right action to reduce their risk."
Prevention
Dr Isabel Lee, of The Stroke Association, said: "Every five minutes someone in the UK has a stroke - that's 150,000 every year. Yet, over 40% of these strokes could be prevented by the control of high blood pressure.
"Whilst it is important to get your blood pressure measured regularly, it is equally important that people who are prescribed blood pressure medication continue to take it even once their blood pressure is back under control.
"GPs need to ensure that patients are made fully aware of the importance of continuing with their blood pressure medication."
People can also take additional steps to help improve their lifestyles and reduce their risk of high blood pressure by stopping smoking, having a healthy diet and exercising regularly, she said.
A British Heart Foundation spokeswoman said high blood pressure often remained undiagnosed until a person encountered something as serious, and potentially fatal, as a heart attack or stroke.
"That's why it's vital that people know what their blood pressure is and how they can reduce it if it is high.
"Everyone over 40 years of age should talk to their GP or practice nurse about having a full risk assessment for heart and circulatory disease carried out."

http://news.bbc.co.uk/2/hi/health/6949526.stm

Blood pressure 'link to dementia'

2008-12-30T06:41:00.001-08:00

High blood pressure can be a warning of ill health

Blood pressure 'link to dementia'

High blood pressure can be a warning of ill health
Controlling blood pressure from middle-age onwards may dramatically reduce the chances of developing dementia, researchers have said.
Two studies support a link between high blood pressure and dementia risk - with one by an Imperial College London team suggesting treatment could cut this.
This study, by published in the Lancet Neurology journal, found blood pressure drugs reduce dementia by 13%.
The Alzheimer's Society said better control could save 15,000 lives a year.
Only half of people over 65 receive effective treatment, yet we know treatment works
Professor Clive BallardAlzheimer's Society
As many as one in four people has high blood pressure, in many cases undiagnosed or untreated.
The precise reasons why high blood pressure might increase the risk of dementia are not fully understood although many scientists believe that it can starve the brain of bloodflow and the oxygen it carries.
Patients suffering this restricted bloodflow are often described as having "vascular dementia", and account for approximately a quarter of dementia patients.
Other types of dementia, such as Alzheimer's disease, have no obvious link to bloodflow, but some experts think that blood pressure may still be somehow contributory in some cases.
The Lancet Neurology study looked at a trial of elderly patients with high blood pressure to see if those who were receiving treatment were less likely to develop any form of dementia compared with those left untreated.
Clear benefit
The trial was stopped early after the benefits of treatment in terms of reducing strokes and heart disease were so obvious it became unethical to deny them to everyone.
Although this meant that no benefits in terms of dementia could be found, when these results were combined with other similar studies in different age groups, the incidence of dementia was 13% lower in the treated groups.
Dr Ingmar Skoog, from the Institute of Neurosciences at Sweden's Goteburg University, said that the need to treat high blood pressure, reducing heart attacks and strokes, was clear, even without the additional results on dementia.
Rebecca Wood, from the Alzheimer's Research Trust, said the finding was an "exciting development", which, if repeated, could offer hope to the 700,000 people in the UK with dementia.
Healthy living
The Alzheimer's Society, however, stressed the need to try to prevent the disease.
Its own unpublished research suggested that vascular dementia was six times more likely to develop in people who had high blood pressure in their 40s and 50s.
If "best practice" in blood pressure treatment was applied to the UK population, it said, with every case detected and treated appropriately, this would save 15,000 lives a year.
Professor Clive Ballard, its director of research, said: "Only half of people over 65 receive effective treatment, yet we know treatment works."
The charity's chief executive, Neil Hunt, urged everyone, even those in middle age, to have regular blood pressure and cholesterol checks.

http://news.bbc.co.uk/2/hi/health/7492959.stm

Drug adherence poor in women with urinary trouble

2008-12-30T05:26:00.000-08:00

Drug adherence poor in women with urinary trouble

Thu Dec 25, 4:32 pm ET
NEW YORK (Reuters Health) – The odds are high that a woman who is prescribed an "anticholinergic" drug to relieve urinary incontinence or other lower urinary tract symptom will discontinue the medication not long after starting it, a study suggests. This is true regardless of the class of medication used.
Two examples of anticholinergic drugs that are often prescribed for urinary incontinence are oxybutynin (Ditropan) and tolterodine (Detrol).
"Our high discontinuation rates across all anticholinergic drug classes...highlight the need for more effective therapies for lower urinary tract symptoms," Dr. Manish Gopal from Saint Peter's University Hospital, New Brunswick, New Jersey and colleagues conclude.
Using a large database, Gopal and colleagues analyzed 29,369 women aged 18 and older who were initially prescribed an anticholinergic medication, such as Ditropan or Detrol, between 1991 and 2005.
They found that half of women prescribed an anticholinergic stopped taking it by 6 months, and 3 out of 4 women discontinued therapy by 1 year. The median time to discontinuation for all 9 different anticholinergic drugs was about 4 months after initial use.
In a report in the journal Obstetrics and Gynecology, the investigators note that rates of discontinuation increased with duration of use, and "very few women" switched to another drug after initial prescribed treatment before stopping the drug.
Because of the high discontinuation rates of anticholinergic therapy for lower urinary tract symptoms, health care providers "must be vigilant" regarding alternative forms of treatment, such as bladder training and pelvic floor rehabilitation, for overactive bladder "and increase our awareness that this group of women is being treated inadequately," the investigators conclude.
SOURCE: Obstetrics and Gynecology, December 2008.

http://news.yahoo.com/s/nm/20081225/hl_nm/us_drug_adherence_poor_women_with_urinary_tr;_ylt=Aq.VdxUGMew7lCQNa4w0qE7VJRIF
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Teens may not know risk factors for infertility

2008-12-30T05:23:00.000-08:00

Teens may not know risk factors for infertility

By Joene Hendry Joene Hendry – Mon Dec 29, 5:17 pm ET
NEW YORK (Reuters Health) – Canadian high school students may lack important knowledge about risk factors for infertility, survey findings suggest. For example, most students were unaware that some sexually transmitted infections can cause infertility.
"About 80 percent of students said they were familiar with the term infertility," Susan Quach, of Sunnybrook and Women's College Hospital Fertility Center in Toronto, told Reuters Health. But when asked more specific infertility-related questions, fewer students answered correctly, indicating a lack of knowledge that may increase their risk of infertility later in life, Quash said.
For example, more than 94 percent of the students did not know that sexually transmitted infections, such as chlamydia or gonorrhea can lead to infertility, Quash and co-investigator Dr. Clifford Librach at the University of Toronto report in the journal Fertility and Sterility.
The researchers asked 772 ethnically diverse high school students to complete a written questionnaire designed to determine their knowledge of and attitudes about infertility. The students were 17.5 years old, on average, and 49 percent were female.
A total of 608 students completed the questionnaire and, as noted, the vast majority did not know that chlamydia and gonorrhea can lead to infertility. About 25 percent thought fertility problems only occurred among women 40 years or older.
The researchers found that students from schools with low socioeconomic status more frequently gave incorrect answers and were significantly less aware of associations between sexually transmitted diseases and infertility.
Overall, about 73 percent of female and 67 percent of male respondents said protecting their fertility was important to them. Most also reported that their fertility was important to them. Fifty-five percent of the students said they were open to screening for sexually transmitted diseases as a means of protecting their fertility.
These findings highlight the importance of educating young people about modifiable risk factors for infertility, such as body fat, smoking, caffeine consumption, excessive exercise, drug use, and sexually transmitted infections, Quash and Librach note.
To assist the development of targeted and appropriate infertility prevention education, the investigators suggest that further infertility knowledge assessments should be conducted among students in rural or less ethnically diverse schools.
SOURCE: Fertility and Sterility, December 2008.

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Obese kids who snore more sleepy in the daytime

2008-12-30T05:16:00.000-08:00

Obese kids who snore more sleepy in the daytime
Mon Dec 29, 2:22 pm ET

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NEW YORK (Reuters Health) – Obese children who have difficulty breathing while they sleep have excessive daytime sleepiness compared with slimmer children who are also chronic snorers, new research in the journal Pediatrics shows.
The symptoms in heavy children are "strikingly reminiscent of excessive daytime sleepiness patterns in adults with obstructive sleep apnea," Drs. David Gozal and Leila Kheirandish-Gozal of the University of Louisville in Kentucky write. The findings suggest, they add, that obstructive sleep apnea looks different in obese children than it does in normal weight kids, which may have implications both for how the condition is treated and how it ultimately affects organ function.
The researchers previously observed that among children with sleep problems, daytime tiredness seemed to be the main symptom in obese kids, while sleepiness tended to manifest itself as inattention and hyperactivity for normal-weight children.
To investigate their hypothesis that kids with the same level of snoring severity would be more likely to be sleepy during the day if they were obese, they observed 50 healthy 6- to 9-year-old, normal-weight children who were habitual snorers and 50 obese children, also snorers, who had been matched by gender, age and ethnicity.
Children were observed for a full night of sleep in the lab, and then the researchers conducted a multiple sleep latency test, which assessed the degree of sleepiness by measuring the time it took the children to fall asleep during the day. The test involved giving the children a chance to nap for 30 minutes every 2 hours, beginning at 8 a.m. Each child had five nap opportunities.
On average, the obese children took 12.9 minutes to fall asleep, compared with 17.9 minutes for the non-obese children. Twenty-one of the obese kids had sleep latency times of 12 minutes or less, while just 5 of the normal-weight children did. Daytime sleepiness was most strongly associated with how many times a child woke up every hour due to respiratory disturbances.
This suggests, the researchers say, that sleep fragmentation my be more common in obese children and that a lack of oxygen during sleep may play a significant role in triggering the biological response that ultimately leads to increased daytime sleepiness.
While obstructive sleep apnea was more common among the obese children than the slimmer children, obese children without the condition were still more likely to have excessive daytime sleepiness than their slimmer counterparts.
Both obesity and obstructive sleep apnea are disorders related to low-level, system-wide inflammation, the researchers add. So both conditions could act together to further increase the levels of inflammation- and sleepiness-promoting substances in the body, the researchers suggest.
While the mechanism behind the link requires further study, they conclude, for now, children with symptoms of excessive daytime sleepiness who have trouble staying awake should be evaluated for obstructive sleep apnea.
SOURCE: Pediatrics, January 2009.

http://news.yahoo.com/s/nm/20081229/hl_nm/us_obese_daytime;_ylt=AsXhzjte2TopmEVY3jilZPzVJRIF
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Researchers Create Molecular Manual

2008-12-30T05:11:00.000-08:00

Researchers Create Molecular Manual

Mon Dec 29, 11:48 pm ET
MONDAY, Dec. 29 (HealthDay News) -- The first catalog of tissue-specific changes associated with hundreds of diseases has been compiled by an international research team, who said the information could help improve understanding and treatment of numerous conditions such as heart disease, breast cancer, autism and Parkinson's disease.
"Disease processes in humans are far from being exhaustively understood and characterized, in part because they are the result of complex interactions between many molecules that may take place only in specific tissues or organs," co-author Kasper Lage, of the Massachusetts General Hospital Pediatric Surgical Research Laboratories, said in a news release from the hospital.
"Experiments to directly study these interactions in human patients would not be possible, which limits our understanding of how diseases arise and which molecules and genes are involved," Lage said.
In the research, supercomputers were used to "model biological processes in tissues across the human organism, based on the knowledge from millions of already published articles," explained co-author Niclas Tue Hansen, of the Center for Biological Sequence Analysis, Technical University of Denmark. "In this way, we were able to create an extensive map of the interactions of molecules in many diseases -- a sort of molecular manual -- without carrying out experiments in patients."
The research was reported in Proceedings of the National Academy of Sciences.
"Our findings have the potential to advance the knowledge of pathways, genes and proteins involved in hundreds of human disorders and perhaps contribute to better treatment strategies for some of these serious diseases," co-corresponding author Dr. Patricia Donahoe, a professor of surgery at Harvard Medical School, said in the news release.

http://news.yahoo.com/s/hsn/20081230/hl_hsn/researcherscreatemolecularmanual;_ylt=ApurgbP.acgaEVGBzhlUSn_VJRIF
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The catalog is available at the Web site of the Center for Biological Sequence Analysis.
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British doctors could get Internet post reviews: minister

2008-12-30T05:08:00.000-08:00

British doctors could get Internet post reviews: minister
Mon Dec 29, 11:37 pm ET
AFP/File – British patients could soon rate their doctors by posting reviews on an official health service website, …

LONDON (AFP) – British patients could soon rate their doctors by posting reviews on an official health service website, Health Minister Ben Bradshaw said in comments published Tuesday.
By being able to read feedback from other patients, people would be better able to decide which doctor they wanted to consult, the junior minister told The Guardian newspaper.
The scheme would take its cue from the way people leave comments and ratings about books and music on Internet retail sites, Bradshaw said.
Posters would be able to leave positive and negative feedback, though the site would be moderated.
However, doctors' representatives voiced concern that it would descend into a meaningless popularity contest rather than providing accurate information about medical skills.
Officials have been told to get the necessary software ready in 2009, The Guardian said.
Since April, the National Health Service's Choices website has allowed people to post comments on hospitals. Bradshaw wants to extend the scheme to family doctors, called general practitioners (GPs).
"On NHS Choices there is already some useful information about whether a practice offers extended hours and how it performs on the quality indicators," Bradshaw said.
"But the quality scores look like the results of an east European election under the Soviet regime. Nearly all get 96 percent, 97 percent or 98 percent.
"That doesn't really give people an idea of whether the practice is better or worse than others in the area.
"I want people to be able to read comments. It may be that people think the GP is fantastic and they can always get an appointment within 48 hours. Or they may have terrible experiences and think the receptionist is really rude."
He added: "I would never think of going on holiday without cross-referencing at least two guide books and using Trip Adviser (a travel review website). We need to do something similar for the modern generation in healthcare.
"I can already learn a lot from the comments of people, both positive and negative, about a type of treatment or a hospital. We need to extend the service to cover GPs."
However, Laurence Buckman, chairman of the British Medical Association's GPs committee, accused the government of not thinking the plan through properly.
"A website on which people can slander or praise irresponsibly is the wrong approach," he said.
"Patients should be able to choose a doctor, but I don't think this is the way to do it.
"For example, if I don't give antibiotics for a viral infection because I don't think it is appropriate, the word will get out that I am a tough git. But making them happy is not what I am there for. I am there to make them healthy."

http://news.yahoo.com/s/afp/20081230/hl_afp/britainhealthinternetpolitics
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Liver transplants from elderly donors are safe

2008-12-30T04:55:00.000-08:00

Liver transplants from elderly donors are safe
Mon Dec 29, 5:16 pm ET

NEW YORK (Reuters Health) – Advanced donor age, per se, does not adversely affect the transplant recipient or the survival of the organ after liver transplantation, according to a report in the Journal of the American College of Surgeons.
Previous reports have indicated that the age of the donor -- older than 60 years - contributes to decreased organ and patient survival, as well as a poorer quality of life for the recipient, the authors explain. They hypothesized, however, "that proper selection of donors older than age 60 and even over age 70" can produce outcomes comparable to those obtained with younger donors.
Dr. William C. Chapman and colleagues from Washington University School of Medicine, St. Louis, Missouri, analyzed their experience with 741 adult-to-adult whole organ transplants -- 91 donors were 60 years or older and 650 were younger than 60 years.
There was no significant difference in the number of second transplants performed or signs that another transplant was going to be needed between patients who received organs from younger and older donors, the authors report.
Overall survival rates did not significantly differ between the two groups of patients, the researchers note. Five-year survival, for example, was 67.6 percent in the patients who received organs from older donors compared with 75.5 percent in those who received organs from younger donors.
Similarly, organ survival was not significantly different between recipients of organs from younger and older donors, even when the donors were separated into three age groups - younger than 60 years, 60 to 69 years and 70 years or older.
Time between organ removable and transplant was significantly shorter for organs from older donors than for organs from younger donors, the report indicates.
"Our analysis was not able to identify any significant disadvantage in graft or patient survival based on donor age," the authors noted.
Other donor risk factors, such as time from organ removal to transplant and variables associated with the recipient are all "important to ensure optimal outcomes" of transplants from older donors, they add.
Overall, the investigators conclude that "older donors represent an important and safe expansion of the donor pool."
SOURCE: Journal of the American College of Surgeons, December 2008.

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Degarelix Approved for Advanced Prostate Cancer

2008-12-30T04:50:00.000-08:00

Degarelix Approved for Advanced Prostate Cancer

MONDAY, Dec. 29 (HealthDay News) -- The injected drug degarelix has been approved by the U.S. Food and Drug Administration to treat advanced prostate cancer.
It belongs to a class of drugs called gonadotropin releasing hormone (GnRH) receptor inhibitors, which suppress the male hormone testosterone. Certain hormonal treatments for prostate cancer initiate a spurt in production of testosterone, which is believed to play a vital role in the growth of prostate cancer. Degarelix doesn't cause this, the agency said in a news release.
Prostate cancer is the second-leading cause of death among men in the United States, according to the American Cancer Society. For 2008, 186,320 men will be diagnosed with the disease and 28,660 will die from it, the ACS estimates.
In clinical testing, degarelix was compared to leuprolide, a drug used in hormonal treatment of prostate cancer. Degarelix suppressed testosterone production to levels seen in men who had had surgical removal of the testes, the agency said.
Frequently reported side effects of the drug included injection site reactions, hot flashes, weight gain, fatigue and an increase in certain liver enzymes.
Degarelix is produced for New Jersey-based Ferring Pharmaceuticals by the German drug maker Rentschler Biotechnologie.

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Hard to hear at holiday parties? Blame your brain

2008-12-30T04:15:00.000-08:00

Graphic shows the part of the ear where hearing loss occurs and how the auditory nerves travel to the brain; 2 c x 5 3/4 in; 96.3 mm x 146.05 mm

Hard to hear at holiday parties? Blame your brain

By MALCOLM RITTER, AP Science Writer Malcolm Ritter, Ap Science Writer – Mon Dec 29, 6:07 pm ET

NEW YORK – It's almost New Year's Eve, a time for plunging into boisterous crowds bathed in loud music. And for some of us, that means turning to an old friend and hearing things like this: "Did you know (BOOM-da-da-BOOM) went over (Bob! You look wonder-) so she said (clink-clink) and then I (Here, have another one) what would you do?" Huh? Too noisy to hear! But wait — how come these younger people understood what she said? What's wrong with your ears? Actually, part of the problem may be your brain.
In fact, it may lie in your brain's dimmer switch for controlling the input from your ears. That bit of brain circuitry appears to falter with age, and scientists are getting some clues about why.
If you have trouble understanding conversation in a noisy room, you're experiencing what's sometimes called the cocktail party problem.
That can be one of the first signs of an age-related hearing loss — a more general problem that can creep in during middle age, and affects one-third of adults ages 65 to 75.
Scientists are still trying to piece together why our hearing goes downhill with age, with the goal of trying to slow it or even reverse it.
When it comes to the cocktail party problem, the dimmer switch is a piece of that story, though it's not clear just how big a factor.
"I think it's a significant player," said Robert Frisina of the University of Rochester in New York, who is studying it.
Scientists have long known that the brain not only receives signals from the ears, but can also talk back to them. And when there's too much noise, this dimmer-switch brain circuitry tells the ears to reduce their flow of signals to the brain.
This helps the sensitive auditory system handle loud sounds that otherwise would overwhelm it and become distorted, as when a radio is turned up too loud for the speaker to handle. In addition, since background noise at a party tends to be lower-pitched than speech sounds, the dimmer switch probably can block out that distracting noise more than it does the speech, Frisina said.

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Researchers unlock secrets of 1918 flu pandemic

2008-12-30T04:01:00.000-08:00

Policemen in Seattle wearing masks made by the Red Cross, during the influenza epidemic in a National Archives photo dated December 1918.(National Archives/Handout/Reuters)

Researchers unlock secrets of 1918 flu pandemic
Mon Dec 29, 5:44 pm ET

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WASHINGTON (Reuters) – Researchers have found out what made the 1918 flu pandemic so deadly -- a group of three genes that lets the virus invade the lungs and cause pneumonia.
They mixed samples of the 1918 influenza strain with modern seasonal flu viruses to find the three genes and said their study might help in the development of new flu drugs.
The discovery, published in Tuesday's issue of the Proceedings of the National Academy of Sciences, could also point to mutations that might turn ordinary flu into a dangerous pandemic strain.
Yoshihiro Kawaoka of the University of Wisconsin and colleagues at the Universities of Kobe and Tokyo in Japan used ferrets, which develop flu in ways very similar to humans.
Usually flu causes an upper respiratory infection affecting the nose and throat, as well as so-called systemic illness causing fever, muscle aches and weakness.
But some people become seriously ill and develop pneumonia. Sometimes bacteria cause the pneumonia and sometimes flu does it directly.
During pandemics, such as in 1918, a new and more dangerous flu strain emerges.
"The 1918 influenza pandemic was the most devastating outbreak of infectious disease in human history, accounting for about 50 million deaths worldwide," Kawaoka's team wrote.
It killed 2.5 percent of victims, compared to fewer than 1 percent during most annual flu epidemics. Autopsies showed many of the victims, often otherwise healthy young adults, died of severe pneumonia.
"We wanted to know why the 1918 flu caused severe pneumonia," Kawaoka said in a statement.
They painstakingly substituted single genes from the 1918 virus into modern flu viruses and, one after another, they acted like garden-variety flu, infecting only the upper respiratory tract.
But a complex of three genes helped to make the virus live and reproduce deep in the lungs.
The three genes -- called PA, PB1, and PB2 -- along with a 1918 version of the nucleoprotein or NP gene, made modern seasonal flu kill ferrets in much the same way as the original 1918 flu, Kawaoka's team found.
Most flu experts agree that a pandemic of influenza will almost certainly strike again. No one knows when or what strain it will be but one big suspect now is the H5N1 avian influenza virus.
H5N1 is circulating among poultry in Asia, Europe and parts of Africa. It rarely affects humans but has killed 247 of the 391 people infected since 2003.
A few mutations would make it into a pandemic strain that could kill millions globally within a few months.
Four licensed drugs can fight flu but the viruses regularly mutate into resistant forms -- just as bacteria evolve into forms that evade antibiotics.
(Reporting by Maggie Fox, editing by Will Dunham and John O'Callaghan)

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Older people mixing drugs: study

2008-12-30T03:48:00.001-08:00

Pharmacist preparing a prescription. Potentially dangerous mixing of medications is common among older people and non-prescription drugs are the culprit more than half of the time, a new study has found.(AFP/File/Robert Sullivan)

Older people mixing drugs: study
Wed Dec 24, 2:27 pm ET

CHICAGO (AFP) – Potentially dangerous mixing of medications is common among older people and non-prescription drugs are the culprit more than half of the time, a new study has found.
US researchers found nearly one out of every 25 people aged 57 to 85 took dangerous combinations of drugs with the potential for serious interactions, the study found.
For men ages 75 to 85, it was as high as 1 in 10.
"The public has an awareness that two prescription medications used together might be dangerous," said study author Stacy Tessler Lindau of the University of Chicago Medical Center.
"But what people don't fully appreciate is that non-prescription drugs can interact with prescription drugs and even other non-prescription drugs."
About a third of older adults uses five or more prescriptions and about half use over the counter medications and dietary supplements, the study found.
More than half of older adults used five or more prescription medications, over-the-counter medications or dietary supplements while 29 percent took more than five prescription medications.
More than half of the dangerous drug combinations included the use of aspirin or blood thinners such as warfarin.
The most common dangerous combination of non-prescription drugs was ginkgo biloba and aspirin which can increase the risk of internal bleeding when taken together.
Researchers at the University of Chicago studied the medication use of 3,500 people aged 57 to 85 living independently across the United States to create a representative sample.
When extrapolated to the general population, the study found that some 2.2 million people were at risk from dangerous combinations of medications.
A recent report found that US adults over the age of 65 make are taken to the emergency room more than 175,000 times every year because of bad reactions to medication.
The study was published in this week's edition of the Journal of the American Medical Association.

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Study: Obesity surgery reverses diabetes in teens

2008-12-30T03:30:00.000-08:00

Study: Obesity surgery reverses diabetes in teens

By STEPHANIE NANO, Associated Press Writer Stephanie Nano, Associated Press Writer – Mon Dec 29, 12:07 am ET

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NEW YORK – Obesity surgery can reverse diabetes in teens, just as it does in adults, according to a small study.
All but one of the 11 extremely obese teens studied saw their diabetes disappear within a year after weight-loss surgery, the researchers reported. The 11th patient still had diabetes, but needed much less insulin and stopped taking diabetes pills.
Previous studies have shown the diabetes benefits of obesity surgery for adults. Dr. Thomas Inge, a pediatric surgeon at Cincinnati Children's Hospital Medical Center, and his colleagues wanted to find out if the same was true for adolescents.
Although more research is needed, Inge said the study "opens the door" to weight-loss surgery as a treatment option for severely obese teens with Type 2 diabetes.
The results are in the January issue of Pediatrics and are being released Monday.
About a third of U.S. youngsters are either overweight or obese. Increasing numbers of obese children are being diagnosed with Type 2 diabetes, the most common form of the disease and the one linked to obesity. It was seldom seen before in kids.
"It's marching south through the generations, which is very scary," said Dr. Larry Deeb, a former president of the American Diabetes Association and a spokesman for the group.
Teen candidates for weight-loss surgery need to be carefully selected, he said, since the long-term consequences of the operation for children aren't yet known.
The 11 patients in the study were 14 to 21 years old and all were extremely obese, ranging from 250 to 403 pounds. They were taking diabetes pills and one was on insulin. At five different medical centers, they had gastric bypass surgery, or stomach stapling, to reduce their stomach to a small pouch.
They were compared to 67 mostly obese teens with diabetes at Cincinnati Children's whose blood sugar was being controlled through diet or medication.
After one year, those who had surgery had lost between 72 and 218 pounds, although none had dropped to a normal weight. For 10 of them, their diabetes was in remission and they stopped taking diabetes medicine.
For the teens who didn't have surgery, they all still had diabetes after a year and there was no difference in their weight or their use of diabetes medication. Their blood sugar levels did improve, the researchers said.
As for the one surgery patient whose diabetes wasn't reversed, the researchers said the reason wasn't known, but they noted his mother and a younger sibling also had Type 2 diabetes. Three years after the surgery, the teen was no longer overweight but still needed to take insulin.
Another explanation could be that his diabetes was more advanced that the other teens, Inge said. Adult studies have indicated that the chances of diabetes reversal are better the sooner surgery is done after diagnosis, he said.
"We caught the others in early stage of disease," Inge said. "Did we miss the boat on this one?"

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Trying to prevent lymphedema after breast cancer

2008-12-30T03:25:00.000-08:00

Trying to prevent lymphedema after breast cancer

AP - Mon Dec 29, 9:12 PM ET
WASHINGTON - Hospitals in about a dozen states are testing whether some simple steps, such as arm-strengthening exercises, could reduce the risk of one of breast cancer's troubling legacies — the painful and sometimes severe arm swelling called lymphedema. Lymphedema has long been a neglected side effect of cancer surgery and radiation: Many women say they never were warned, even though spotting this problem early improves outcomes.

Rural Doc a Rare Find

2008-12-29T20:56:00.000-08:00

Dr. David Watson looks through patient files earlier this month in Yoakum, Texas. (David J. Phillip/AP Photo)

Dr. David Watson, left, drains the elbow of Dorothy Dean, 83, in Yoakum, Texas. Watson is the 2008 Country Doctor of the Year, presented by Staff Care. Like country doctors and house calls, family practitioners are a disappearing breed.(David J. Phillip/AP Photo)

Doc Watson Keeps Small Town Healthy With House Calls
Hospital CEO: '"He's Always Right There When You Need Him'
By MONICA RHOR
The Associated Press
YOAKUM, Texas
In this sleepy country town, which sprang up around a railroad junction and the start of the Chisholm trail, folks give out their phone numbers by the last four digits, the annual Tom-Tom festival culminates with the crowning of the Tomato King and Queen, and everybody knows Doc Watson.
Over the last 50 years, the tall and lanky family practitioner delivered a good many of the town's residents and doctored most of the others.
The night Janet Jaco's little girl had to be rushed to the hospital with a sudden hemorrhage, David Watson walked the four blocks from his house to the Yoakum Community Hospital every hour on the hour to check on his patient and offer a comforting shoulder to her worried mother.
The night the hospital urgently needed blood for an obstetrics patient, Watson rushed down from his office to donate some of his O-negative, then stayed to call in other townspeople with the right blood type. (He knew who they were.)
The day after a torrential rainfall, Bernice Watson remembers, her husband did not let flooded roads stop him from getting to an ailing neighbor. He just hopped aboard a tractor, one arm around the driver, the other clutching his battered leather doctor's bag.
This month, Watson received the Country Doctor of the Year award, which honors a primary care physician who best exemplifies the spirit of rural practitioners. The award is given out by Staff Care, the largest physician staffing service in the country, which hopes to attract more young doctors to family practice.
"I never wanted to be anything other than a family doctor," Watson said as he sat in the hospital cafeteria on a recent December day. Pork chops and chicken fried steak ("good home cooking," noted Watson) were on the menu, a reminder of the small-town atmosphere that drew the Baylor College of Medicine graduate to Yoakum in 1958.
The doctor's bag he brought with him is now frayed at the seams and tattooed with scratches and stains, the scars of countless moments of birth, death and recovery. In the process he has gotten to know several generations of patients in this town of 6,000 about 100 miles east of San Antonio.
"He's always right there when you need him," said Karen Barber, CEO of the Yoakum Community Hospital, where a wing is named after Watson. "There's never a second thought for him. He just does what needs to be done."
Like country doctors and house calls, family practitioners are a disappearing breed. In 1998, half of the medical graduates in the U.S. went into primary care. In 2006, that number had dropped to 38 percent. Most graduates now prefer to go into higher-paying specialties like dermatology or anesthesiology.
That never appealed to Watson, who grew up the son of a Methodist minister in eastern Texas.
He began his practice charging $3 for office visits and $5 for house calls, but he often accepted other kinds of payment including homemade pies, fresh vegetables, deer meat and sausages. One grateful patient gave Watson, a hardcore golfer, one of her husband's old 2-irons. It still sits in a corner of his office.
As a teenager, his oldest daughter, Debbie Austin, once chastised her father for letting patients pay with produce and baked goods. His response: "These people have paid me with what they could. As far as I'm concerned, they're paid in full."
"I remember feeling like I got a big lecture without being yelled at," Austin recalled. "My dad really is a doctor, a true doctor."
Like his doctor's satchel, Watson has been weathered by time, his hair gone to silver, his posture slightly stooped. But his commitment to the town of Yoakum, and the practice of family medicine remains undimmed.
At 78, he still sees up to 30 patients a day at the Yoakum Medical Clinic, the office where he has worked for half a century. He visits another 30 patients during daily rounds at the hospital and a local nursing home, treats children at the Bluebonnet Youth Ranch and continues to make house calls.
"He made me feel like I had a friend. He was so sweet and attentive," said Jaco, the director of the Youth Ranch, whose daughter recovered from her middle-of-the-night emergency and is now grown and married. "I remember thinking: What other doctor would do this?"
Inside the small brick medical clinic, furnished with old-fashioned mint-green metal medicine cabinets, Watson greets his patients like old friends, asking about their families and their hobbies as well as their health. He carefully reads through their medical files, still kept in brown folders. No computerized record-keeping here.
"Lou used to run the golf shop," Watson says, as he examines 80-year-old Lou Olsovsky, who suffers from diabetes and uses a walker. "He's on a bunch of pills, but he's still with us."
He places a stethoscope to Olsovsky's chest. "You lost your wife four years ago?" Watson asks. "You're ready to go meet her, aren't you? You're tired of pills."
"I was supposed to go first, but she wouldn't let me," says Olsovsky, who still wears his wedding ring.
Blood pressure good. Blood sugar good. No swelling in the legs. Olsovsky can come back in two months for his next checkup.
"If you ever want to come to the golf course, let me know," Watson says, patting his patient gently on the shoulder. "I'll come pick you up."
Watson drops Olsovsky's chart into a plastic slot and heads to the next examining room. He's doing what he loves, and has no plans to slow down.
"When I can't do crossword puzzles anymore, I'll know it's time to quit," he said. "But as long as I'm reasonably healthy, and have a little sense, I'll keep doing it."
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Cancer Medicine Advances on Many Fronts

2008-12-26T16:30:00.000-08:00

Cancer Medicine Advances on Many Fronts

By Amanda GardnerHealthDay Reporter by Amanda Gardnerhealthday Reporter – Tue Dec 23, 11:48 pm ET

TUESDAY, Dec. 23 (HealthDay News) -- The war against cancer gathered steam in 2008, as new drugs tackled the toughest cancers with some success, and advances were made in both disease prevention and risk factor identification.
A new report from the American Society of Clinical Oncology (ASCO) details 12 "major" advances and 19 "notable advances" across the gamut of cancer prevention, screening, treatment and survival in the past year.
"These specific advances . . . reflect a maturation, if you will, of the whole approach of personalized medicine to oncology care," said ASCO President Dr. Richard L. Schilsky, a professor of medicine at the University of Chicago Medical Center. "And some of the reports deal with targeted therapies being used in a broader array of diseases. We're beginning to see the utility of targeted therapies expand across many, many diseases, and we're increasingly able to identify those patients who are most likely to benefit from those targeted therapies."
The report was expected to be published online Dec. 22 in the Journal of Clinical Oncology.
One of the most impressive reports of the year serves as a backdrop to these advances, pointed out Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. That was a study showing the first reported decline in the number of U.S. men and women developing and dying from cancer.
Nevertheless, some 1.4 million people received the devastating diagnosis of cancer in 2008, and half a million people died from the disease.

Following are the 12 major advances of 2008 identified by ASCO, divided into six general areas and not ranked in order of importance.

In the area of hard-to-treat cancers:
Cetuximab (Erbitux), a monoclonal antibody, when added to chemotherapy, increased overall survival by as much as 21 percent in patients with non-small cell lung cancer which expressed the epidermal growth factor receptor (EGFR). Patients receiving Erbitux in a recent trial lived an average of 11.3 months vs. 10.1 months in those receiving a placebo. Lung cancer is the number-one cancer killer among men and women; only 5 percent of those diagnosed with this type of lung cancer survive five years.
The new chemotherapy drug Gemcitabine (Gemzar) doubled disease-free survival from 6.9 months to 13.4 months in pancreatic cancer patients, and increased overall survival from 20.2 months to 22.8 months in patients with early-stage pancreatic cancer who had undergone surgery. Again, only 5 percent of people receiving this diagnosis live five years.

In the area of new drug approvals:
Bendamustine (Treanda) "eliminated" chronic lymphocytic leukemia (CLL) in one-third of patients compared with 2 percent who went with current standard therapy, and extended survival without a recurrence to 21.7 months from 9.3 months. The drug was approved in March of 2008 and is now indicated as first-line treatment for the disease.
Bevacizumab (Avastin), another monoclonal antibody, was approved (in conjunction with the chemotherapy drug paclitaxel (Taxol) for women with previously untreated HER2-negative, metastatic breast cancer. A trial the year before had found the combination doubled disease-free survival compared with women receiving chemo alone. A second trial, this one from 2008, confirmed the findings.

In the area of reducing cancer recurrence:
Women with breast cancer who have already taken tamoxifen for five years and who take additional hormone therapy in the form of an aromatase inhibitor or more tamoxifen may reduce even further the chances of the cancer coming back.
Adding the osteoporosis drug zoledronic acid (Zometa) in premenopausal women with early-stage breast cancer also undergoing suppression of ovarian function and hormonal therapy with tamoxifen or an aromatase inhibitor reduced the risk of recurrence.
Giving one year of pegylated interferon treatment to people with stage III melanoma who had already undergone surgery reduced the risk of recurrence by 18 percent; the four-year recurrence-free survival rate for those on interferon was 45.6 percent vs. 38.9 percent for those not taking the treatment. Overall survival was the same.

In the area of personalized medicine:
Patients with newly diagnosed advanced colorectal cancer who have the normal version of the KRAS gene benefited from Erbitux, according to a study released last year. Those with a mutation in the gene did not benefit, a finding which will help guide treatment.

In the area of risk factors:
Women who take birth control pills reduce their risk for ovarian cancer by 20 percent for every five years they are on the pill.
Between 1973 and 2004, the incidence of head-and-neck cancers related to the HPV virus increased by 0.8 percent. The incidence of these cancers not associated with HPV stayed the same, then declined during the same period. The increase could be due to changes in sexual behavior, for example, an increase in oral sex.

In the area of access to care:
A significant shortage of oncologists in the United States (up to 4,000) is predicted by 2020, even as the number of cancer patients will continue to rise.
Childhood cancer survivors are up to 10 times more likely than their healthy siblings to develop heart disease 30 years after their initial cancer, although researchers emphasized that the absolute rates were still low.
The report also included two recommendations:

Increase funding for clinical cancer research and
boost the number of participants in clinical trials, which hovers at around 5 percent of all adult cancer patients who could be participating in such trials.

"The good news is that we continue to make great progress in cancer," Schilsky said. "All of that is based upon the strength of our research programs in this country, which are now really beginning to suffer. We've had five years of essentially flat funding to the National Cancer Institute, which really translates into an approximate 15 percent decrease in the budget. At a time when we have more opportunity and are making more progress than ever, the government is essentially pulling the rug out from under us."
"There have been significant advances, [but] if you're a patient out there or have a loved one who has cancer, the results are still not satisfying," said Dr. Otis Webb Brawley, chief medical officer for the American Cancer Society. "We have made definite positive steps, but they are steps. We haven't arrived. The problem is there are no home runs, just a bunch of bunt singles."

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Two Asthma Meds May Be Too Risky, FDA Panel Says

2008-12-26T16:21:00.000-08:00

Two Asthma Meds May Be Too Risky, FDA Panel Says

By Steven ReinbergHealthDay Reporter by Steven Reinberghealthday Reporter – Thu Dec 11, 11:48 pm ET
THURSDAY, Dec. 11 (HealthDay News) -- The risks of two widely used asthma drugs outweigh their benefits for both children and adults, a U.S. Food and Drug Administration advisory panel said Thursday.
The health panel targeted GlaxoSmithKline's Serevent and Foradil, made jointly by Novartis AG and Schering-Plough, for restrictions, but it excluded Advair, Glaxo's biggest-selling drug in the class of medications known as long-acting beta-agonists. It also left alone a fourth such drug, AstraZeneca's Symbicort.
The health experts did not say that the use of Serevent and Foradil should be abandoned altogether. Instead, they said the medications' labeling should be reworded to urge doctors to use the drugs along with an inhaled corticosteroid -- as guidelines already recommend.
That may help explain why Advair and Symbicort were spared. Serevent contains just one active ingredient, salmeterol, while Foradil contains only formoterol. Advair is a combination of both salmeterol and fluticasone (an inhaled cortocosteroid), while Symbicort contains formoterol and another steroid (budesonide). All of these drugs relax airway muscles, letting asthma patients breathe more easily.
The controversy over these drugs has been going on for several years, with two FDA officials recently calling for banning the use of these drugs for anyone under 17. The results of studies noting a rise in asthma-related deaths by people using the medications have already resulted in a black-box warning that use could "increase the risk of asthma-related death."
The advisory panel voted 10 to 17 on whether the benefits of Serevent outweighed its risk as maintenance therapy for adults, and voted 6 to 21 on the same question for adolescents ages 12 to 17, Dow Jones reported. Foradil received similar votes on the same questions: 9 to 18 for adults and 6 to 21 for adults.
The panelists were unanimous in voting that the benefits of the two drugs did not outweigh risks when used for children ages 11 and younger.
The announcement followed a two-day meeting on the issue by the expert advisory panel. The FDA is not obligated to follow the advice of its advisory panels but usually does so.
Speaking before Thursday's decision, one expert said the problem is not with the drugs, but with their misuse.
"This is an over-interpretation of the risk without adequate consideration of benefit," said Dr. Miles Weinberger, a professor of pediatrics at the University of Iowa. "However, there has been irresponsible marketing of the products, salmeterol and formoterol, and irresponsible prescribing by many physicians."
"Since most patients with chronic asthma can be controlled with inhaled steroids alone, using these more expensive combination formulations as first line is inappropriate but strongly encouraged by marketing practices" of drug makers, Weinberger said.
In the panel's first day of hearings on Wednesday, FDA officials themselves were split over the risks of the drugs.
One official told the panel members that more than 14,000 people may have died since 1994 after taking the drugs, while another suggested that an even greater number might have died without them, according to The New York Times.
Last week, two FDA officials, who work in the agency's safety division, posted an assessment on the agency Web site, saying asthma sufferers of all ages should not take the medicines. But a third FDA official concluded that Advair and Symbicort are safe for adults, but that all four drugs should no longer be used by children 17 and younger, the Times said.
The panel was reviewing an FDA study of 110 trials that included 60,954 people and found an increase in asthma-related hospitalization, asthma-related intubation, and asthma-related death in asthmatic patients with the use of these drugs. The risk varied, however, depending on the particular drug studied.
For example, there were 20 asthma-related deaths, 16 among people taking long-acting beta agonists compared with four patients not taking these drugs. All the deaths were in patients taking Serevent, the FDA notes.
The increased risk wasn't seen when a long-acting beta agonist was used along with an inhaled corticosteroid, the agency found.
The greatest risk appears to be among children aged 4 to 11; women also appeared to be at greater risk than men.
Weinberger thinks that long-acting beta agonists should be used only in combination with inhaled steroids.
"All trials of the combination of long-acting beta agonists and an inhaled steroid demonstrate substantial additive effect for patients not fully controlled on the inhaled steroid alone," Weinberger said. "The sensible approach is to use the combination products only after inadequate control is observed with an inhaled steroid alone."
For their part, the drugs' manufacturers said they believe there is adequate evidence that their products are safe and effective when used properly.
In a joint statement issued after the panel voted, Novartis and Schering-Plough said both companies "remain confident in the safety and efficacy of Foradil." The statement added, "Novartis and Schering-Plough strongly disagree with the Joint Advisory Committees view that the benefits of Foradil do not outweigh its risks in patients using it according to current product labeling for the maintenance treatment of asthma. We believe this opinion is inconsistent with clinical evidence supporting the benefit/risk profile of Foradil in patients not adequately controlled on other asthma-controller treatments."
In its statement before the vote, AstraZeneca said the company "believes that Symbicort exhibits a favorable benefit-risk profile in patients 6 years of age and older. Symbicort offers an important therapeutic option for asthma patients who cannot be adequately controlled on other asthma controller medications [low- to medium-dose inhaled corticosteroids] or whose disease severity clearly warrants initiation of treatment with two maintenance therapies."
And GlaxoSmithKline said in its statement before the vote: "The combination of salmeterol with an inhaled corticosteroid provides unsurpassed asthma control to patients by improving lung function, preventing daytime and night-time symptoms and decreasing the use of rescue medications. For Advair, there was no evidence of increased risk for asthma-related death, asthma-related hospitalization, asthma-related intubation and all-cause death in any database. Therefore, no regulatory action is necessary for this product."
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Health Tip: Why You May Have Erectile Dysfunction

2008-12-26T16:19:00.000-08:00

Health Tip: Why You May Have Erectile Dysfunction

(HealthDay News) -- Erectile dysfunction occurs when a man can't achieve or maintain an erection during sex.
The American Academy of Family Physicians says the condition doesn't have to be a natural part of getting older. ED often is attributed to physical or psychological causes. Physical reasons may include:

Having a side effect of surgery on the prostate or bladder, or radiation therapy to the testicles.
Having low testosterone levels, kidney failure, liver failure, multiple sclerosis or Parkinson's disease.
Having chronic conditions such as diabetes, high blood pressure, or hardening of the arteries.
Having had a stroke or an injury to the brain or spinal cord.
Using too much tobacco or alcohol.
Being tired.

School Program Helps Cut Asthma Risks

2008-12-26T16:15:00.000-08:00

School Program Helps Cut Asthma Risks

Wed Dec 17, 11:48 pm ET
WEDNESDAY, Dec. 17 (HealthDay News) -- A school-based asthma management program can help children and teens reduce their symptoms and the number of missed school days, a study conducted in a California school district shows.
Researchers analyzed the effectiveness of a program called Kickin' Asthma, a four-session curriculum developed by American Lung Association staff and nurses and peer educators from the Oakland Unified School District. The program provides students with information and tools to better manage their asthma, such as teaching them about triggers and telling them when and how to take their medication.
Program participation was voluntary, but students who completed the program during the first two years of the study were given a small incentive. About 990 students in grades 7 to 10 from 15 middle schools and three high schools took part in the program.
The program achieved measurable improvements in asthma symptoms and correct medication use and a reduction in the rate of asthma occurrence during the first three years.

Days for which participants had activity limited or missed school were reduced by a half-day for every four weeks of the program.
During the first two years of the program, there was a significant decline in the number of students who reported outpatient emergency care or hospitalization for asthma.
Frequency of daytime symptoms also declined during the program's first three years.

The study was published in the Journal of School Health.

"This study demonstrates how schools can play an important role in the health and safety of children and adolescents coping with asthma," study author Sheryl Magzamen, a Robert Wood Johnson Foundation Health & Society Scholar at the University of Wisconsin, said in a foundation news release. "We found that Kickin' Asthma is a good strategy for educating adolescents about their disease and helping them to take more control over it."
Almost 6.8 million (10 percent) of American children have asthma, according to the U.S. Centers for Disease Control and Prevention. Childhood asthma is most common in urban areas.
"The Kickin' Asthma program is specifically designed for an urban population and addresses the problem in children and adolescents during a potentially critical time, when they are starting to have more control over their own asthma care," Adam Davis, director of programs and research at the American Lung Association of California, said in the news release.
More information
The Asthma and Allergy Foundation of America has more about childhood asthma.
Related Searches:
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http://news.yahoo.com/s/hsn/20081218/hl_hsn/schoolprogramhelpscutasthmarisks;_ylt=ArKY5Dhfm9ZGvni8Nmfs.9GWSbYF

Avoiding the painkiller-overuse rut in migraines

2008-12-26T16:01:00.000-08:00

Rena Cerbone, 41, talks about medication on the counter that she currently takes to prevent migraines, at her home in Montclair, N.J., Friday, Dec. 19, 2008. Cerbone says she found relief after a period of rebound headaches provoked by the painkiller used to dull her frequent migraines.(AP Photo/Mike Derer)

Avoiding the painkiller-overuse rut in migraines

By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer – Mon Dec 22, 9:21 pm ET

WASHINGTON – Those pain pills you think help your migraines? Take too many and you could make them worse. Overusing painkillers can spin migraine patients into a rut, spurring more headaches that in turn require more pain medication. A very unlucky fraction even get what's called chronic migraine, where they're in pain more days than not, and new research suggests certain prescription painkillers, including narcotics, increase that risk.
Don't misunderstand: Treating migraines, properly, is important. The bigger message is to try migraine-preventing medicines if the tenacious headaches strike regularly — so that you don't fall into the painkiller rut like Rena Cerbone did.
"It was a double-edged sword," Cerbone, 41, of Montclair, N.J., says of a period when only one pain reliever dulled her migraines and then invariably triggered rebound headaches a day or so later. "I was taking Fiorinal on a daily basis just to function."
The caution is timely, as the estimated 30 million Americans who suffer migraines — migraineurs, they're called — often find the holiday season a time of increased pain. Lack of sleep, tempting treats and the stress of travel are common triggers.
The head throbs, usually on one side, anywhere from a few hours to three days. Nausea and sensitivity to light and sound are common. Moving makes it worse. Some people can sense them coming with visual disturbances like seeing pinpoints of light, although lacking that classic "aura" doesn't mean you don't have a migraine.
Fortunately for most patients, migraines are every-so-often miseries. Studies suggest that about a third of migraine sufferers have them often enough to be candidates for prevention medications that can cut the frequency in half. Yet only about 10 percent use them.
And depending on acute painkillers more than a few days a week can signal overuse.
"Most people outside the specialty community are not aware of the concept," said Dr. Stephen Silberstein of Thomas Jefferson University, a spokesman for the American Academy of Neurology. "I think there's an epidemic in the U.S. of patients having frequent headaches, taking their pain pills over and over again," and winding up in more pain.
Overusing any pain medication, over-the-counter or prescription, can cause a rebound headache once it's stopped.
But occasionally in frequent migraine sufferers, the brain gradually becomes more sensitive to pain so they worsen even more. When they're having pain a stunning 15 or more days a month, it's called chronic migraine or "transformed migraine." No one knows exactly how many people get that bad, although migraine specialist Dr. Richard Lipton of the Albert Einstein College of Medicine says some estimates suggest there could be as many as 5 million.
"Chronic migraine is a condition we should be trying to prevent," says Lipton, who also heads New York's Montefiore Headache Center and studied whether particular medicines are linked to this worst-case pain.
The study tracked 8,200 episodic migraine sufferers for a year, and found 2.5 percent worsened to a state of chronic migraine. Those who took two classes of prescription medications — drugs containing narcotics, such as Percocet, or drugs containing barbiturates, such as Fiorinal — were most likely to worsen, Lipton and colleagues reported in the journal Headache. Risk increased with higher doses.
Over-the-counter standbys, from plain acetaminophen to the anti-inflammatories called NSAIDS — ibuprofen, naproxen and their cousins — weren't linked to chronic migraine. The NSAIDS even showed a hint of protection. Migraine-specific painkillers called triptans likewise showed no risk at low to moderate use, becoming a risk factor only after 10 pain days a month.
Some patients will need the stronger narcotics or barbiturates, especially for severe attacks, Lipton acknowledges. But, "the reality is they're overused" in migraines, he says, advising that patients who truly need them limit weekly doses.
Chronic migraine aside, getting out of the medication-overuse rut is hard. In New Jersey, it took Cerbone several tries before she found a migraine specialist who cut her prescription painkiller cold turkey and found a daily prevention medication that has worked since August.
Headache specialists advise:
_Ask about migraine-prevention drugs. Choices range from blood pressure-lowering drugs called beta-blockers to epilepsy drugs and certain antidepressants, all of which have side effects to be considered. Some patients even try Botox injections, to quiet overactive nerve endings.
_Quit the overused medication, but brace for painful withdrawal. A doctor may advise different short-term medications to help.
_Use a headache diary to pinpoint migraine triggers and learn to minimize them.
___
EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Related Searches:
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http://news.yahoo.com/s/ap/20081223/ap_on_he_me/med_healthbeat_migraine_rut;_ylt=Aqb2.gN.IT8dZilZLwgqcXbVJRIF

Poor blood flow to brain may provoke Alzheimer's: study

2008-12-26T08:18:00.000-08:00

An Alzheimers patient at a psychiatric hospital. A gradual loss of blood flow to the brain over years or decades could be a major trigger for Alzheimer's disease, according to a study to be published Friday.(AFP/File/Jean-Philippe Ksiazek)

Poor blood flow to brain may provoke Alzheimer's: study

Wed Dec 24, 2:39 pm ET

PARIS (AFP) – A gradual loss of blood flow to the brain over years or decades could be a major trigger for Alzheimer's disease, according to a study to be published Friday.
Up to now, what provokes the debilitating disease has remained a mystery, even if the mechanism causing the damage is well understood.
The new research shows that an insufficient supply of sugar glucose, transported by blood, sets off a biochemical chain reaction resulting in the accumulation of the neuron-attacking proteins that cause Alzheimer's.
"This finding is significant because it suggests that improving blood flow to the brain might be an effective therapeutic approach to prevent or treat Alzheimer's," said Robert Vassar, a professor at Northwestern University's Feinberg School of Medicine, and lead author of the study.
Exercising, reducing cholesterol intake, and managing hypertension are all measures that could provide added protection, he said.
"If people start early enough, maybe they can dodge the bullet," Vassar said in a statement.
And for persons who already show symptoms of constricted arteries, taking vasodilators -- drugs that boost blood flow -- could help deliver nourishing oxygen and glucose to the brain.
Drawing from experiments with humans and mice, Vassar and colleagues showed that reduced blood flow alters a protein called elF2alpha.
In its changed form, elF2alpha increases the output of the enzyme that spurs production of the fiber-like knots of amyloid beta protein that form outside neurons and disrupt their ability to send messages.
Vassar discovered the key role of the enzyme, BACE1, in promoting Alzheimer's a decade ago.
The new study opens a path to the development of drugs designed to block elF2alpha, and thus the biochemical process leading to the disease, he said.
It also suggests that Alzheimer's may result from the same type of energy deprivation that occurs in a stroke.
Rather than dying, the brain cells react by increasing the BACE1 enzyme, which offers short-term protection but is harmful in the long run.
"A stroke is a blockage that prevents blood flow and produces cell death in an acute, dramatic event," he explained. "What we are talking about here is a slow, invidious process over many years where people have a low level of cardiovascular disease."
"It is so mild, they don't even notice it, but it has an effect over time because it is producing a chronic reduction in the blood flow," he added.
Alzheimer's is a degenerative disorder of the brain characterised by forgetfulness and dementia.
It is caused by a massive loss of cells in several regions of the brain, driven by a buildup of plaques of amyloid protein.
The disease occurs most frequently in old age, but some genetic variants have been shown to increase risk as well.
The number of people worldwide afflicted with the disease is set to rise from 24 million people today to 42 million in 2020 and 81 million in 2040, according to the World Health Organisation.
The study is to be published in the December 26 issue of Neuron, a journal based in Cambridge, Massachusetts.

http://news.yahoo.com/s/afp/20081224/hl_afp/healthdiseasealzheimerbrain;_ylt=Ar3YKa857QH7fYKjEntInZfVJRIF

Amateurs are trying genetic engineering at home

2008-12-26T08:11:00.000-08:00

Meredith L. Patterson, a computer programmer by day, conducts an experiment in the dining room of her San Francisco apartment on Thursday, Dec. 18, 2008. Patterson is among a new breed of techno rebels who want to put genetic engineering tools in the hands of anyone with a smart idea. Using homemade lab equipment and the wealth of scientific knowledge available online, these hobbyists are trying to create new life forms through genetic engineering - a field long dominated by Ph.D.s toiling in university and corporate laboratories.(AP Photo/Noah Berger)

Amateurs are trying genetic engineering at home

By MARCUS WOHLSEN, Associated Press Writer Marcus Wohlsen, Associated Press Writer – Thu Dec 25, 6:49 pm ET

SAN FRANCISCO – The Apple computer was invented in a garage. Same with the Google search engine. Now, tinkerers are working at home with the basic building blocks of life itself.
Using homemade lab equipment and the wealth of scientific knowledge available online, these hobbyists are trying to create new life forms through genetic engineering — a field long dominated by Ph.D.s toiling in university and corporate laboratories.
In her San Francisco dining room lab, for example, 31-year-old computer programmer Meredith L. Patterson is trying to develop genetically altered yogurt bacteria that will glow green to signal the presence of melamine, the chemical that turned Chinese-made baby formula and pet food deadly.
"People can really work on projects for the good of humanity while learning about something they want to learn about in the process," she said.
So far, no major gene-splicing discoveries have come out anybody's kitchen or garage.
But critics of the movement worry that these amateurs could one day unleash an environmental or medical disaster. Defenders say the future Bill Gates of biotech could be developing a cure for cancer in the garage.
Many of these amateurs may have studied biology in college but have no advanced degrees and are not earning a living in the biotechnology field. Some proudly call themselves "biohackers" — innovators who push technological boundaries and put the spread of knowledge before profits.
In Cambridge, Mass., a group called DIYbio is setting up a community lab where the public could use chemicals and lab equipment, including a used freezer, scored for free off Craigslist, that drops to 80 degrees below zero, the temperature needed to keep many kinds of bacteria alive.
Co-founder Mackenzie Cowell, a 24-year-old who majored in biology in college, said amateurs will probably pursue serious work such as new vaccines and super-efficient biofuels, but they might also try, for example, to use squid genes to create tattoos that glow.
Cowell said such unfettered creativity could produce important discoveries.
"We should try to make science more sexy and more fun and more like a game," he said.
Patterson, the computer programmer, wants to insert the gene for fluorescence into yogurt bacteria, applying techniques developed in the 1970s.
She learned about genetic engineering by reading scientific papers and getting tips from online forums. She ordered jellyfish DNA for a green fluorescent protein from a biological supply company for less than $100. And she built her own lab equipment, including a gel electrophoresis chamber, or DNA analyzer, which she constructed for less than $25, versus more than $200 for a low-end off-the-shelf model.
Jim Thomas of ETC Group, a biotechnology watchdog organization, warned that synthetic organisms in the hands of amateurs could escape and cause outbreaks of incurable diseases or unpredictable environmental damage.
"Once you move to people working in their garage or other informal location, there's no safety process in place," he said.
Some also fear that terrorists might attempt do-it-yourself genetic engineering. But Patterson said: "A terrorist doesn't need to go to the DIYbio community. They can just enroll in their local community college."

http://news.yahoo.com/s/ap/20081225/ap_on_sc/do_it_yourself_dna;_ylt=AkvcDXTHQzSSdOFUJ9UUj0XVJRIF

Convincing the Depressed to Seek Treatment

2008-12-26T07:58:00.000-08:00

Convincing the Depressed to Seek Treatment

Posted Fri, Dec 19, 2008, 11:24 am PST
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In my experience, it is sometimes hard to convince a patient that his or her symptoms are due to depression. Even more difficult, however, is getting a depressed person to do something about the problem.
I think of treatments for depression as falling into three broad categories—home remedies, counseling, and medication. I'll write more about each of these in the future, but for now let's concentrate on how a patient who is depressed makes the decision to deal with the problem. Perhaps you will recognize in yourself or a friend one or more of the following excuses for not seeking treatment:

Denial:
"Why should I do anything about a problem that doesn't exist?" Obviously, people who don't accept a diagnosis of depression, anxiety, or related mood disorder will resist treatment. Many cultures attach a lot of stigma to mental illness, so people naturally don't like to be labeled as depressed or anxious. Sometimes this issue can be solved with a different choice of words. Situational dysthymia (low mood in response to a stressful situation) may, for example, sound much less threatening to a patient than depression. Open communication between the patient, the health care provider(s), and friends and family members can be very important in reaching a mutually acceptable diagnosis, so that the conversation can move on to creating a treatment plan.

"I can take care of it myself."
Even after acknowledging that they are depressed or anxious, patients often tell me that they don't need any treatment—they'll just deal with it themselves, or wait for the stressful situation to resolve. In part, this is an extension of the stigma associated with depression. Admitting to needing help dealing with issues is often seen as a sign of weakness. This can also become a secondary form of denial, something akin to "Okay, maybe I'm a little depressed, but it isn't severe enough to need treatment."
In some cases, these feelings are correct. A temporary cause of depression may resolve, or the patient may eventually develop his or her own coping strategies and get back to a happier and healthier lifestyle. But frequently, one upsetting situation is followed by a new source of stress, or the depression is due to multiple other factors that aren't likely to change on their own in the near future, so the symptoms of depression continue for a prolonged period. And those who do get better without special assistance often could have improved sooner by dealing with the issue head-on.

"I don't have time to deal with it."
It's true that there are only 24 hours in a day, and we all must make decisions about how to spend those hours. Taking steps to deal with depression may very well mean that there is less time available to do something else. Like so many other things, this becomes a matter of setting priorities. If depression is causing bothersome symptoms or otherwise reducing the quality of life, spending some time working on solving the problem is probably worth it. In the end, the payoff is often more time to get other things done—and more enjoyment of those things—once the depression has lifted and the patient has more energy and motivation and improved mental sharpness.

"It costs too much."
While there are a few inexpensive ways of managing depression, many of the approaches to treatment do cost some money. Health insurance has been notoriously poor at covering many of these expenses. The Federal Mental Health Parity Act of 1996 attempted to require that mental health benefits be comparable to other health benefits, but the Act left many loopholes. The Mental Health Parity and Addiction Equity Act of 2008, which takes full effect in October 2009, is expected to bring coverage for mental health care more into line with insurance payments for mainly physical disorders.
There is also the problem that many people simply lack health insurance entirely. Clearly, there is no simple solution to these financial issues, but there are a variety of programs available to help cover the costs of counseling and/or medications for those with limited financial resources. The first step is to make a commitment to treat the depression. After that, the challenge is to choose the least expensive treatment methods and find the financial help to pay for them.

Preconceived notions.
Many people have strong negative feelings about counseling and medications. Most of the time, these fears and negative expectations far exceed the reality.

With a measure of patience and carefully monitored treatment, most patients who suffer from depression, low mood, and/or anxiety can get back to a normal life with few inconveniences or side effects. The key is to get past denial and fear of stigma, so that the healing can begin.

© 2007 Johns Hopkins University. All Rights Reserved. This article from Johns Hopkins University is provided as a service by Yahoo. All materials are produced independently by Johns Hopkins University, which is solely responsible for its content.

http://health.yahoo.com/experts/yourhealth/3080/convincing-the-depressed-to-seek-treatment/

The Chaos Inside a Cancer Cell

2008-12-26T07:50:00.000-08:00

Science Visuals
The Chaos Inside a Cancer Cell

new_york_times:http://www.nytimes.com/2008/12/25/science/25visual.html

By NICHOLAS WADE
Published: December 25, 2008

A striking feature of many cancer cells is that the DNA in their chromosomes is all jumbled up. Chunks of DNA containing one or more genes have been ripped out of their chromosome and reinserted in a different place. Other lengths of DNA have been transferred to a different chromosome altogether.

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These rearrangements may degrade the cell's regulatory systems, especially when a rearrangement cuts a gene in half, or separates it from the regions of DNA that control its activity.
Researchers led by Oliver A. Hampton and Aleksandar Milosavljevic at the Baylor College of Medicine in Houston have now compared the genome of a type of breast cancer cell with that of normal cells. They find 157 rearrangements, they report in the current issue of Genome Research.
The graphic summarizes their results. Round the outer ring are shown the 23 chromosomes of the human genome. The lines in blue, in the third ring, show internal rearrangements, in which a stretch of DNA has been moved from one site to another within the same chromosome. The red lines, in the bull's eye, designate switches of DNA from one chromosome to another.
One of the rearrangements disrupts a gene called RAD51C which is involved in mending serious chromosome breaks, those in which both strands in the DNA are disrupted. The impairment of double strand break repair could be a major cause of all the other rearrangements, the researchers suggest.

http://www.nytimes.com/2008/12/25/science/25visual.html

Too sick to work? Need health care? Take a number

2008-12-26T07:41:00.000-08:00

Shalonda Frederick poses at her apartment in Glen Burnie, Md., Tuesday, Dec. 9, 2008. Shalonda Frederick managed a bakery, where she decorated cakes for special occasions. One day her face and hands, and her arms and legs, started clenching up. Then she fell off a ladder at work. It turned out to be multiple sclerosis.(AP Photo/Rob Carr) AP

Too sick to work? Need health care? Take a number

By RICARDO ALONSO-ZALDIVAR, Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer – Tue Dec 23, 12:28 pm ET

WASHINGTON – Master toolmaker John McClain built machine parts with details so small they couldn't be seen with the naked eye. Then a lump on his neck turned out to be cancer.
Shalonda Frederick managed a bakery, and decorated cakes for special occasions. One day her face and hands, and her arms and legs, started clenching up. Then she fell off a ladder at work. It turned out to be multiple sclerosis.
McClain, 56, and Frederick, 33, are unlucky enough to have gotten seriously ill in their most productive years. Theirs is a daily struggle against life-changing circumstances.
As if that weren't enough, after years of counting on employer medical benefits, they are uninsured — and trapped in one of the most troubling gaps in the nation's health care system.
After reviewing their cases, the government declared McClain and Frederick too sick to work and started issuing them monthly Social Security disability checks. Then they found out they'd have to wait two years to get health care through Medicare. Even though workers and their employers pay the payroll taxes that fund Medicare, federal law requires disabled workers to wait 24-months before they can begin receiving benefits.
McClain and Frederick are far from alone. An estimated 1.8 million disabled workers are languishing in Medicare limbo at any given time. And about one out of eight dies waiting.
As many as one-third of those waiting are uninsured.
Frederick needs an expensive injection to control her symptoms; McClain, a scan of a new, and potentially problematic, spot. Neither can afford it. Instead, they fend off creditors, sink deeper into debt and fume that a system they paid into all those years isn't available when they need it.
"The government is the screwiest insurance company I ever saw," said McClain, of Allen, Texas. "What is it that I was paying for out of my check every pay period? They have taken the charge for Medicare out of my paycheck, and now that I need it, I can't have it."
With President-elect Barack Obama promising to guarantee health care coverage for all, advocates for the disabled are hoping that repeal of the Medicare waiting period is finally at hand.
"The current law is really indefensible," said Sen. Jeff Bingaman, D-N.M. "There is no logic behind requiring people who are determined to be disabled to wait two years before they become eligible for Medicare." Bingaman introduced a bill to phase out the waiting period, and as a senator Obama co-sponsored it.
It turns out there is a simple explanation for the waiting period: cost.
In 1972, Congress and President Richard Nixon agreed to expand Medicare to cover not only seniors but the disabled. They created a waiting period to minimize costs and discourage people from gaming the system.
Over time, the consequences of the waiting period — and the costs of repeal — have only grown.
In the 1970s, there wasn't a whole lot medical science could do for many cancer patients. Now cancer is thought of less as a death sentence, and more as a manageable disease.
But as drugs and treatments for serious illnesses have improved, the cost of closing the Medicare gap has ballooned. Estimates range up to $12 billion a year. And that gives lawmakers pause.
"When it comes to people dying of cancer, you can't help but be sympathetic," said Sen. Charles Grassley, R-Iowa. "But at a time when we have a big downturn in the economy, it may be questionable what can be done in a lot of these areas." Grassley, the senior Republican on the Senate committee that oversees Medicare, said he hasn't made up his mind about a repeal of the waiting period.
A possible compromise that could save taxpayers money would be to subsidize a continuation of employer coverage for disabled workers during the 24-month wait. Many can keep their benefits now, provided they pay the full premium, which not all can afford.
But that wouldn't help those without job-based coverage.
The government already exempts people who need kidney dialysis and those with Lou Gehrig's disease from the waiting period.
Economist Pamela Farley Short of Penn State University, who has researched the issue, said the waiting period should concern all workers.
"It's easy to think it's not going to happen to me," she said. "But when you follow people over time, just over 15 percent of those who are 55 are going to be on Medicare before they turn 65. That doesn't seem so trivial."
Nearly 7 million disabled people under age 65 are now covered through Medicare.
Of those still waiting for coverage, about 60 percent manage to hang on to private insurance. Many draw down their retirement savings to pay premiums through a previous employer's health plan. Others fall into poverty and are picked up by Medicaid. As many as one in three, like McClain and Frederick, wind up uninsured.
McClain was diagnosed with cancer a little more than two years ago. He was at work one night when he reached up to scratch his neck and felt a big lump. He hadn't been feeling particularly well for several months. The next day he started getting dizzy and went to the emergency room.
Eventually, the diagnosis came back: a tumor on his left tonsil.
McClain doesn't spare himself when it comes to blame. He started smoking cigarettes at 13, and, though he has cut down, has been unable to quit.
"I don't know how to say how stupid I am for still smoking," he said.
His cancer treatment has been arduous: Chemotherapy. Radiation. A feeding tube. Bouts of depression and anxiety. His weight dropped from about 150 pounds to 116. But the cancer seems to be retreating.
McClain has begun to feel his energy come back, and he yearns to go back to the machine shop. Yet he is worried about a small area in his throat. And he can't afford to pay for a scan because he lost his insurance at the end of October.
"I think I have around $22 in savings," he said. "After talking with my creditors and a debt management company, it sounds like bankruptcy. The funny part is, I have a perfect payment history to this day, and none of them can figure out how I made it this far."
Like McClain, Frederick, the former bakery manager, is spiraling toward bankruptcy.
Multiple sclerosis is a progressive disease in which the immune system attacks the protective covering around the nerves. It can lead to paralysis. Frederick was diagnosed in 2002.
"My MS affects my mobility," said Frederick, of Glen Burnie, Md. "I have shaky hands and legs. When I lay still at night, I can feel my muscles vibrate. It's like a dim humming and I can't sleep. I stretch my legs, and then I can't bend them."
Frederick had to leave the bakery because her hands shook too much to decorate cakes. Then, in the fall of 2007, she lost her fallback job as an event planner. Even with her disability check, she is behind on rent and utilities. Without health insurance, she can't afford an injection that costs around $3,000 each time and helps control her MS. She is supposed to get a treatment every three months. Her last was in July.
"They tell you to go to school and graduate and get a career," Frederick said. "I did all of that, so why is this happening now?
"I'm old enough to know that there are things in life that happen that aren't fair," she continued. "I was employed from when I was 15 to when I was 32. I worked my whole life and I paid into this fund."

http://news.yahoo.com/s/ap/20081223/ap_on_he_me/health_care_gap;_ylt=ApIGGxNv9bx9sw1Wt8LVuKV1_aF4

Low death rate after obesity surgery in Sweden

2008-12-26T07:33:00.000-08:00

Low death rate after obesity surgery in Sweden

Thu Dec 25, 4:40 pm ET
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NEW YORK (Reuters Health) – Death rates soon after anti-obesity or "bariatric" surgery in Sweden are low, statistics show.
"Most published series are from high-volume expert centers," according to lead investigator Dr. Richard Marsk from Danderyd Hospital, Stockholm. "We have shown that bariatric surgery can be performed with low mortality on a national level."
Marsk and colleagues assessed deaths from any cause after weight loss surgery in Sweden using data from 14,768 bariatric procedures conducted between 1980 and 2005.
The early post-surgery death rate ranged from 0.2 percent at 30 days to 0.3 percent at 90 days, they report, with a 1-year cumulative death rate of 0.5 percent.
The 1-year cumulative death rate adjusted for age was higher for men (1.1 percent) than for women (0.4 percent) and higher for patients older than age 50 (1.2 percent) than for patients younger than age 50 (0.4 percent).
Including the entire follow-up period, the age-adjusted death rate was twice as high for men (100 per 10,000 persons per year) than for women (50 per 10,000 persons per year).
"I believe that the increased mortality seen among men is due to increased preoperative co-morbid disease and also later referral to surgery, such that men to a greater extent have established cardiovascular disease at the time of surgery," Marsk said.
"Further studies are needed to explain this in full," he added.
Cumulative mortality did not differ between patients having primary surgery or "revisional" surgery, the researchers note.
The most common causes of death during the first year after weight loss surgery were non-heart related, the investigators report, whereas the most common causes of late death were heart attack and cancer.
SOURCE: Annals of Surgery, November 2008.

Cost of Health Insurance Rises Again, but at a Slightly Slower Rate

2008-12-26T07:24:00.000-08:00

Cost of Health Insurance Rises Again, but at a Slightly Slower Rate

new_york_times:http://www.nytimes.com/2007/09/12/business/12health.html

By MILT FREUDENHEIM
Published: September 12, 2007
The cost of employer-sponsored health insurance premiums has increased 6.1 percent this year, well ahead of wage trends and consumer price inflation, but below the 7.7 percent increase in 2006, the Kaiser Family Foundation reported yesterday.
Because doctor and hospital costs continue to rise at an even faster rate, the modest slowdown in insurance inflation mainly reflects cutbacks in coverage by many health plans, which have found ways to make employees pay more for their care. Industry experts said that without those measures, premium costs would have risen by 9 percent or more.
The total average annual cost for family coverage premiums rose this year to $12,106.
“For that kind of money, you could buy a compact car every year,” said Drew Altman, president of the Kaiser Foundation, a nonprofit group that produces the widely watched annual survey. He noted that health costs had increased 78 percent since 2001, more than four times the pace of prices and wages.
The 2007 increase was the smallest annual rise since 1999, when health premiums jumped 5.3 percent.
Kaiser did not try to project 2008 costs for health premiums. But research houses are forecasting increases for next year that include 6.7 percent by Mercer Health and Benefits; 9.9 percent by PricewaterhouseCoopers; 10.5 percent by the Segal Company; and 11 percent by AON Consulting.
The costs of hospital and doctor care seem to be “outpacing premium increases,” said Jon Gabel, a principal investigator for the Kaiser survey. That could squeeze insurance company profit margins, which have been running at 6 percent to 7 percent, he said.
Sixty percent of employers offer health benefits, including nearly all large companies with 200 or more workers. But fewer than half of small businesses with three to nine employees do so, the survey found.
The telephone survey, which ended in May and was conducted by Kaiser and the Health Research and Educational Trust, queried 3,078 public and private employers and was based on 1,997 that responded to the full survey.
It found that employers and workers are still slow to embrace the widely publicized high-deductible plans with savings options that have been promoted by the Bush administration and many insurance companies and banks. Such health savings account plans attained only a “modest enrollment” of 3.8 million workers, according to Kaiser. That was 5 percent of all covered employees, compared with 4 percent in 2006.
Almost one in five large employers currently offer some sort of health savings option, combined with high-deductible insurance. But that number may not grow much. Only 2 percent of employers that do not already offer health savings accounts said they were very likely to add them next year.
Under health savings plans, employees can set aside money in tax-sheltered accounts that roll over year to year and that workers can take with them if they change jobs. Employers also have the option of contributing to the accounts of workers to help cover potentially high out-of-pocket costs. But only about half of the employers that offer the plans make such contributions, according to the survey.
Other findings included a sign of growing awareness that preventive care can be cost effective: most preferred-provider organizations, or P.P.O.’s — the networks that cover 57 percent of all workers — now pay for services like immunizations and mammograms without charging the employee.
Also, nearly half of all employers that offer health benefits now cover unmarried domestic partners of the opposite sex, and about 37 percent cover same-sex partners.
As for drug plans, three in four covered employees are in them, with average out-of-pocket payments of $11 for generic drugs, $25 for the health plan’s preferred brand-name drugs and $43 for brands not on the preferred list.

http://www.nytimes.com/2007/09/12/business/12health.html?adxnnl=1&fta=y&adxnnlx=1230304011-Jzsjsv9+BnCnY4FwknSlig

Extreme Coughing: Whooping Cough Makes a Comeback

2008-12-26T07:00:00.000-08:00

Most parents are not aware that whooping cough remains a formidable health threat for young children.(Corbis Images)

Extreme Coughing: Whooping Cough Makes a Comeback
More cases in teens and adults; parents often unaware of new booster vaccine
By CARI NIERENBERGABC News Medical Unit
Dec. 26, 2008—
A young woman in her early 30s was the picture of health: She was fit and ran regularly but had this nagging cough that she couldn't seem to shake.
Because she didn't feel sick and had no fever, she figured it was a cold. Yet the coughing continued for weeks. So she went to her doctor, who suspected it was asthma because the hacking seemed to increase after she'd finished running. But asthma medications brought her no relief.
Frustrated that she couldn't run, the woman sought a second opinion from the Mayo Clinic in Rochester, Minn.
She learned the unexplained cough wasn't asthma. And it wasn't bronchitis or pneumonia either.
It was whooping cough.
In recent years, whooping cough has been diagnosed increasingly in teens and adults, although the disease typically had its most serious complications in infants.

Wasn't Whooping Cough Eliminated Long Ago?
Whooping cough is an illness caused by the bordetella pertussis bacteria. Health professionals tend to call this extremely contagious infection pertussis.
Reported cases of whooping cough have tripled in the United States since 2001, according to the Centers for Disease Control and Prevention, seen mainly in adolescents and adults, said Tami Skoff, a pertussis epidemiologist in the division of bacterial diseases at the CDC in Atlanta.
"But the jury is still out on whether it's a real increase in disease or an increase in reported disease due to improved diagnostic testing and more awareness among health professionals," she said.
Skoff suggested that there appears to be a shift in the epidemiology of the disease from infants to adolescents and adults. "From the data it looks like what's occurring is waning immunity."

Vaccine Causes Decline
A pertussis vaccine was first introduced in the United States in the 1940s, because whooping cough had been one of the most common diseases and a major cause of death in childhood.
The vaccine, known as DTaP, provides protection against pertussis along with diphtheria and tetanus. It's typically given as three shots at roughly 2, 4 and 6 months of age; a fourth shot is given between ages 15 and 18 months, and a fifth between ages 4 and 6, before children start school.
Although vaccination caused a sharp decline in the disease for more than 40 years, whooping cough never fully disappeared.

Whooping Cough Booster Vaccine Introduced in 2005
As more cases were reported, it became clear that the five-shot series was not providing lifelong protection. Immunity seemed to wear off five to 10 years after the last shot was received, making teens and adults vulnerable to infection once again.
In 2005, a new booster vaccine known as Tdap was approved by the FDA. This one-time booster dose is given to people between the ages of 11 and 64, assuming they have completed the childhood series.
But word of Tdap has not yet reached all parents of school-age children. While coverage rates for the childhood pertussis vaccine series hover around 90 percent of recommended recipients, rates for the Tdap booster are now around 30 percent, according to the CDC.
"It's still new," Skoff said. "With education campaigns, we expect this number to go up."
A growing awareness of the booster vaccine, which some middle schools require for entrance, could help stem the tide. In the meantime, both parents and patients still seem surprised when they find out they have whooping cough.
"I didn't think that disease existed anymore," is the response Dr. Judith Guzman-Cottrill, an assistant professor of pediatric infectious disease at Oregon Health and Science University in Portland, often gets when she tells a parent that their child has been diagnosed with pertussis.
And when she tells teenagers they have whooping cough, the typical reaction is "I thought that was a baby disease."

A Terrible Disease in Infants
The first stage of the illness typically starts out with a watery, runny nose, sneezing, redness of the eyes, a mild cough, and a low fever for the first week or two. To doctors and parents, it looks very much like the common cold.
The tricky thing about pertussis is that although it resembles a cold in this early stage, this is also when it's most contagious, pointed out Guzman-Cottrill.
But during the second stage, the cough worsens. An infant gets intense coughing fits and brings up thick phlegm. At the end of a severe coughing spell, the baby will try to catch its breath to recover and often takes a long inhalation, which sounds like a whoop. That's where the name whooping cough comes from.
Babies often "whoop," but teens and adults might not. And more than half of patients cough so severely that they vomit afterward.
"The forcefulness of the cough is really dramatic sometimes to the point of rib fracture," said Guzman-Cottrill. Or worse still. Some babies have such severe breathing difficulties that their tiny lungs and heart give out.

Infants With Whooping Cough Hospitalized
When they have whooping cough, infants are most always hospitalized, explained Robert Jacobson, chairman of the department of pediatric and adolescent medicine at the Mayo Clinic. "They look terrible." And infants with pertussis typically get it from adults, he noted.
Compared to younger children, teens and adults don't usually get the classic case of whooping cough and they might not look ill, Jacobson noted. He said they're likely to have an annoying cough that lasts for weeks and weeks.
"That's why it's sometimes called 'the 100-day cough,' which is a great name for it," he said.
Jacobson believes that pertussis is greatly underdiagnosed, and he said his best estimate is that there are about 600,000 cases of it in American adults a year.
Statistics from the CDC, however, paint a very different picture. The CDC reports 10,000 total U.S. cases in 2007, 15,000 cases in 2006 and 25,000 in both 2005 and 2004.
Jacobson also explained that the pertussis bacteria can live in dried mucus for three days, so whooping cough can be a real problem in adults who are undiagnosed and untreated. Adults could potentially pass it on to infants if they are exposed to them in their first few highly contagious weeks of illness, when the respiratory droplets from a cough can propel germs into the air.
According to Jacobson, antibiotics are the typical treatment if the disease is caught early. Antibiotics are also given to family members to reduce the possibility of spreading. He said it's less clear whether antibiotics help with patient symptoms when the disease is diagnosed late.

Making 'Whoopies' to Prevent Whooping Cough
When two twin girls in Phoenix were stuck at home with whooping cough this summer, they turned what could have been an unpleasant experience into a positive one.
The 11-year-olds, Ileyna and Flori, caught whooping cough in July while away at summer camp. They came home with very bad coughs, which at first were thought to be bronchitis but were later determined to be pertussis after an astute health professional decided to run one more test.
"It was a fluke that we found out what it was," said the twins' mother, Julie Witenstein.
"When I had to share the news with all the parents of the children the girls were exposed to, I realized that few of them knew about the pertussis booster vaccine."
The girls had had all their childhood vaccines but had just turned 11 and had not yet had the booster. While they were convalescing at home, a notice arrived from the middle school the girls would attend in August, explaining that the Tdap booster was required before enrolling.
The notice would arrive too late for the twins, but while indoors they kept themselves busy with a crafts kit a friend had given them. They started to decorate bottle caps with glitter, beads, buttons and glue.
The decorated bottle caps first started out as refrigerator magnets. But as the girls continued working on the caps, their creativity took hold and they put pins or tacks on the backs, or hooks to make necklaces or holiday ornaments. They made hundreds of decorated bottle caps and eventually started a business.
And that's how Whoopies was born, explained Witenstein.
Ileyna and Flori have been selling Whoopies at their parents' gymnastics studio and at a neighborhood art fair. With each sale they share their story about whooping cough, hand out a reminder on the importance of preteen vaccination, and give a portion of the proceeds to the Arizona Partnership for Immunization, a public health organization in the state that soon hopes to have a Web site to take orders for Whoopies.
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http://abcnews.go.com/Health/ColdandFluNews/story?id=6512732&page=1

British woman to deliver baby screened for breast cancer

2008-12-26T06:56:00.000-08:00

British woman to deliver baby screened for breast cancer
Tue Dec 23, 12:02 pm ET

LONDON (AFP) – A woman is to give birth this week to the first baby in Britain which has been selected to be free of a gene which greatly increases the risk of breast cancer, experts said.
The 27-year-old woman, who wants to remain anonymous, decided to take the step because several of her husband's close female relatives suffered from breast cancer.
But one campaign group warned that such selection takes science "further along the line which ultimately ends in designer babies".
The baby grew from an embryo screened to make sure it did not contain the faulty BRCA 1 gene, which would have given it a 50 to 80 percent change of developing breast cancer.
The mother said in June: "We felt that, if there was a possibility of eliminating this for our children, then that was a route we had to go down."
The procedure was carried out using a technique known as pre-implantation genetic diagnosis which has already been used here to screen embryoes for disorders like cystic fibrosis.
It was given the green light in Britain in 2006.
The procedure is still relatively rare but has been used to screen embryoes for breast cancer in the United States and Belgium.
Paul Serhal, who led the team which carried out the procedure, said last week that scientists had entered "a new era of being able to help people who have cancer genes."
Josephine Quintavalle, of campaign group Comment on Reproductive Ethics, raised concern about discarded embroyoes, telling the BBC: "What next? It is going further along the line which ultimately ends in designer babies."

http://news.yahoo.com/s/afp/20081223/hl_afp/britainhealthcancerchildethics_081223170238;_ylt=Antfc.DS9LMckTC3E0hv_c0p_aF4

Expansion of Clinics Shapes a Bush Legacy

2008-12-26T06:37:00.000-08:00

Dr. LaTonya D. Knott, right, treating Willie Mai Ridley.

Charmissa Johnson with patient files at the Southside Family Clinic, which last year moved into a new building in Nashville.

Dr. Keith E. Junior, medical director at the Cayce projects facility in Nashville, examining Toyashika Polk last month.

Providing Care

Maria Flores, center, who is pregnant, came to the Waverly Belmont clinic in Nashville for care for herself and for her 11-month-old daughter, Jausari Patron.

Expansion of Clinics Shapes a Bush Legacy

new_york_times:

http://www.nytimes.com/2008/12/26/health/policy/26clinics.html

By KEVIN SACK
Published: December 25, 2008

NASHVILLE — Although the number of uninsured and the cost of coverage have ballooned under his watch, President Bush leaves office with a health care legacy in bricks and mortar: he has doubled federal financing for community health centers, enabling the creation or expansion of 1,297 clinics in medically underserved areas.
For those in poor urban neighborhoods and isolated rural areas, including Indian reservations, the clinics are often the only dependable providers of basic services like prenatal care, childhood immunizations, asthma treatments, cancer screenings and tests for sexually transmitted diseases.
As a crucial component of the health safety net, they are lauded as a cost-effective alternative to hospital emergency rooms, where the uninsured and underinsured often seek care.
Despite the clinics’ unprecedented growth, wide swaths of the country remain without access to affordable primary care. The recession has only magnified the need as hundreds of thousands of Americans have lost their employer-sponsored health insurance along with their jobs.
In response, Democrats on Capitol Hill are proposing even more significant increases, making the centers a likely feature of any health care deal struck by Congress and the Obama administration.
In Nashville, United Neighborhood Health Services, a 32-year-old community health center, has seen its federal financing rise to $4.2 million, from $1.8 million in 2001. That has allowed the organization to add eight clinics to its base of six, and to increase its pool of patients to nearly 25,000 from 10,000.
Still, says Mary Bufwack, the center’s chief executive, the clinics satisfy only a third of the demand in Nashville’s pockets of urban poverty and immigrant need.
One of the group’s recent grants helped open the Southside Family Clinic, which moved last year from a pair of public housing apartments to a gleaming new building on a once derelict corner.
As she completed a breathing treatment one recent afternoon, Willie Mai Ridley, a 68-year-old beautician, said she would have sought care for her bronchitis in a hospital emergency room were it not for the new clinic. Instead, she took a short drive, waited 15 minutes without an appointment and left without paying a dime; the clinic would bill her later for her Medicare co-payment of $18.88.
Ms. Ridley said she appreciated both the dignity and the affordability of her care. “This place is really very, very important to me,” she said, “because you can go and feel like you’re being treated like a person and get the same medical care you would get somewhere else and have to pay $200 to $300.”
As governor of Texas, Mr. Bush came to admire the missionary zeal and cost-efficiency of the not-for-profit community health centers, which qualify for federal operating grants by being located in designated underserved areas and treating patients regardless of their ability to pay. He pledged support for the program while campaigning for president in 2000 on a platform of “compassionate conservatism.”
In Mr. Bush’s first year in office, he proposed to open or expand 1,200 clinics over five years (mission accomplished) and to double the number of patients served (the increase has ended up closer to 60 percent). With the health centers now serving more than 16 million patients at 7,354 sites, the expansion has been the largest since the program’s origins in President Lyndon B. Johnson’s war on poverty, federal officials said.
“They’re an integral part of a health care system because they provide care for the low-income, for the newly arrived, and they take the pressure off of our hospital emergency rooms,” Mr. Bush said last year while touring a clinic in Omaha.
With federal encouragement, the centers have made a major push this decade to expand dental and mental health services, open on-site pharmacies, extend hours to nights and weekends and accommodate recent immigrants — legal and otherwise — by employing bilingual staff. More than a third of patients are now Hispanic, according to the National Association of Community Health Centers.
The centers now serve one of every three people who live in poverty and one of every eight without insurance. But a study released in August by the Government Accountability Office found that 43 percent of the country’s medically underserved areas lack a health center site. The National Association of Community Health Centers and the American Academy of Family Physicians estimated last year that 56 million people were “medically disenfranchised” because they lived in areas with inadequate primary care.
President-elect Barack Obama has said little about how the centers may fit into his plans to remake American health care. But he was a sponsor of a Senate bill in August that would quadruple federal spending on the program — to $8 billion from $2.1 billion — and increase incentives for medical students to choose primary care. His wife, Michelle, worked closely with health centers in Chicago as vice president for community and external relations at the University of Chicago Medical Center.
And Mr. Obama’s choice to become secretary of health and human services, former Senator Tom Daschle of South Dakota, argues in his recent book on health care that financing should be increased, describing the health centers as “a godsend.”
The federal program, which was first championed in Congress by Senator Edward M. Kennedy, Democrat of Massachusetts, has earned considerable bipartisan support. Leading advocates, like Senator Bernie Sanders, independent of Vermont, and Representative James E. Clyburn, Democrat of South Carolina, the House majority whip, argue that any success Mr. Obama has in reducing the number of uninsured will be meaningless if the newly insured cannot find medical homes. In Massachusetts, health centers have seen increased demand since the state began mandating health coverage two years ago.
At $8 billion, the Senate measure may be considered a relative bargain compared with the more than $100 billion needed for Mr. Obama’s proposal to subsidize coverage for the uninsured. If his plan runs into fiscal obstacles, a vast expansion of community health centers may again serve as a stopgap while universal coverage waits for flusher times.
Recent job losses, meanwhile, are stoking demand for the clinics’ services, often from first-time users. The United Neighborhood Health Services clinics in Nashville have seen a 35 percent increase in patients this year, with much of the growth from the newly jobless.
“I’m seeing a lot of professionals that no longer have their insurance or they’re laid off from their jobs,” said Dr. Marshelya D. Wilson, a physician at the center’s Cayce clinic. “So they come here and get their health care.”
Studies have generally shown that the health centers — which must be governed by patient-dominated boards — are effective at reducing racial and ethnic disparities in medical treatment and save substantial sums by keeping patients out of hospitals. Their trade association estimates that they save the health care system $17.6 billion a year, and that an equivalent amount could be saved if avoidable emergency room visits were diverted to clinics. Some centers, including here in Nashville, have brokered agreements with hospitals to do exactly that.
Many centers are finding that federal support is not keeping pace with the growing cost of treating the uninsured. Government grants now account for 19 percent of community health center revenues, compared with 22 percent in 2001, according to the Health Resources and Services Administration, which oversees the program. The largest revenue sources are public insurance plans like Medicaid, Medicare and the State Children’s Health Insurance Program, making the centers vulnerable to government belt-tightening.
The centers are known for their efficiency. Though United Neighborhood Health Services has more than doubled in size this decade, Ms. Bufwack, its chief executive, manages to run five neighborhood clinics, five school clinics, a homeless clinic, two mobile clinics and a rural clinic, with 24,391 patients, on a budget of $8.1 million. Starting pay for her doctors is $120,000. Patients are charged on an income-based sliding scale, and the uninsured are expected to pay at least $20 for an office visit. One clinic is housed in a double-wide trailer.
Because of a nationwide shortage of primary care physicians, the clinics rely on federal programs like the National Health Service Corps that entice medical students with grants and loan write-offs in exchange for agreements to practice as generalists in underserved areas. Of the 16 doctors working for United Neighborhood, seven are current or former participants.
Dr. LaTonya D. Knott, 37, who treated Ms. Ridley for her bronchitis, is among them. Born to a 15-year-old mother in south Nashville, she herself had been a regular childhood patient at one of the center’s clinics. After graduating as her high school’s valedictorian, she went to college on scholarships and then to medical school on government grants, with an obligation to serve for two years.
She said she now felt a responsibility to be a role model. “I do a whole lot of social work,” she said, noting that it was not uncommon for children to drop by the clinic for help with homework, or for a peanut butter sandwich. “It’s not just that we provide the medical care. I’m trying to provide you with a future.”
Despite such commitment, national staffing shortages have reinforced concerns about the quality of care at health centers, notably the management of chronic diseases. This year, the government started collecting data at the centers on performance measures like cervical cancer screening and diabetes control.
“The question is not just, ‘Are you going to have more community health centers?’ ” said Dr. H. Jack Geiger, founder of the health centers movement and a professor emeritus at the City University of New York. “It’s, ‘Are you going to have adequate services?’ ”
A deeper frustration for health centers concerns their difficulty in securing follow-up appointments with specialists for patients who are uninsured or have Medicaid. All too often, said Ms. Bufwack, medical care ends at the clinic door, reinforcing the need to expand both primary care and health insurance coverage.
“That’s when our doctors feel they’re practicing third world medicine,” she said. “You will die if you have cancer or a heart condition or bad asthma or horrible diabetes. If you need a specialist and specialty tests and specialty meds and specialty surgery, those things are totally out of your reach.”
More Articles in Health » A version of this article appeared in print on December 26, 2008, on page A1 of the New York edition.

http://www.nytimes.com/2008/12/26/health/policy/26clinics.html?_r=1&pagewanted=all

Doctor autonomy linked to medical errors

2008-12-25T19:29:00.000-08:00

Medical students need to be fully socialized in their roles as patient agents rather than autonomous decision-makers.

Health News

Doctor autonomy linked to medical errors
Published: Dec. 25, 2008 at 1:31 PM

BALTIMORE, Dec. 25 (UPI) -- Despite increased emphasis on patient safety, little progress has been made in making U.S. hospitals safer, a researcher said.
Dr. Peter Pronovost, a critical care specialist at The Johns Hopkins University in Baltimore, identified physician autonomy and a lack of standardization of safety protocols as to why patient safety has not improved.
"It's been almost 10 years since the Institute of Medicine published 'To Err Is Human,' its treatise on the need for increased patient safety initiatives at hospitals," Pronovost said in a statement. "Yet we really haven't made much progress."
An average hospitalized adult will receive recommended therapy only 53 percent of the time and this accounts, in part, for the nearly 100,000 U.S. patients who die each year because of hospital error, Pronovost said.
"Imagine, America has some of the best doctors and medicine in the world, yet we are only getting it right half of the time," Pronovost said.
Pronovost said to improve patient safety medicine must realize:
-- Physicians must balance their autonomy with team-based standardized care therapies.
-- Medical students need to be fully socialized in their roles as patient agents rather than autonomous decision-makers.
-- Evidence-based therapy based on research including risks, benefits and costs should be made explicit.

Pronovost's article appears in the Journal of the American Medical Association.
© 2008 United Press International, Inc. All Rights Reserved.

http://www.upi.com/Health_News/2008/12/25/Doctor_autonomy_linked_to_medical_errors/UPI-86721230229905/

Hospital safety reports withheld

2008-12-25T16:18:00.000-08:00

Hospital safety reports withheld

Sean Parnell, FOI editor December 23, 2008
Article from: The Australian
REPORTS detailing the extent and economic impact of dangerous and sometimes fatal errors in hospitals are being withheld from the public.
The Rudd Government's hospital safety regulator, the Australian Commission on Safety and Quality in Health Care, earlier this year commissioned a series of reports from associate professor Terri Jackson.
But The Australian's bid to gain access to the reports using Freedom of Information laws has been blocked by the commission because it would damage relations between governments and potentially hinder reform efforts.
The commission's deputy chief executive Bill Lawrence yesterday said Professor Jackson obtained information from a state government "under the requirement that it would remain confidential unless and until the state approved its release".
While Professor Jackson -- who works at the Australian Centre for Economic Research on Health at the University of Queensland -- has used West Australian data in the past, it is understood for this project she is relying on Queensland and Victorian data.
The Australian understands Professor Jackson has found that, on average, about 12per cent of hospital procedures in those states encounter problems, the most costly being post-procedural and general maternity complications.
Mr Lawrence said while he considered the public interest in making the reports known to the broader community, he also needed to consider the need to preserve the efficient and proper function of government, its relationships and "the interest in promoting further research into the causes of patient safety risks and the economic effects of patient safety interventions".
"In my view, in relation to these documents, the factors against disclosure outweigh the factors in favour of disclosure, as the risk of damage to relations in regard to the safety and quality of healthcare is very high," Mr Lawrence said.
The reports included a draft paper titled Costs of Sentinel Events to Australia's Health Care System and a more recent draft paper entitled Setting Economic Priorities for Patient Safety Programs.
Mr Lawrence was unavailable for further comment.
A spokesman for Health Minister Nicola Roxon could not be contacted yesterday.
In a submission to the National Health and Hospitals Reform Commission this year, the commission identified a need for more readily available economic information, which it vowed to deliver for authorities to make informed policy decisions.

Ebola outbreak kills nine

2008-12-25T16:13:00.000-08:00

Ebola outbreak kills nine

From correspondents in Kinshasa, Democratic Republic of Congo December 26, 2008
Article from: Reuters
A MYSTERIOUS disease that has killed nine people in southern Democratic Republic of Congo has been identified as the deadly Ebola virus, the Congolese health minister said today.
The virus appeared in southern Western Kasai province on Nov. 27, and blood and stool samples were sent to laboratories in Gabon and South Africa for identification.
"Following the analysis of samples taken in (the village of) Kalwamba, it is now recognised that we are facing an epidemic of the viral haemorrhagic fever Ebola," said health minister Auguste Mopipi Mukulumanya.
There is no cure or treatment for Ebola, which kills 50 to 90 percent of its victims.

Tragic meningitis teen Terri buried

2008-12-25T06:39:00.000-08:00

Tragic meningitis teen Terri buried
By Brendan McDaid and Lisa SmythWednesday, 24 December 2008

This is the bright Strabane teenager who was laid to rest after her life was tragically cut short by meningitis.
Relatives, schoolfriends, neighbours and teachers gathered at St Joseph’s Chapel in Glenmornan to say an emotional farewell at the funeral of 16-year-old Terri Devine.
At the funeral Mass yesterday, mourners were told of how Terri had been a “bright, intelligent girl” who had ambitions to travel the world.
Terri died at Altnagelvin Hospital in Londonderry on Sunday.
The Western Health Board has sent letters to parents of her classmates urging them to check their children for symptoms of the virus.
The Meningitis Trust described Terri’s death as a tragedy and urged everyone to be aware of symptoms as the disease can strike in minutes and kill in hours.
A spokeswoman said: “If people are concerned about their own, or someone else's health, they must seek medical attention immediately.
“Recognising the symptoms can be difficult as many of its symptoms are similar to more common illnesses like the flu.
“The rash that is commonly associated with meningitis doesn't appear in all cases, so it is vital that people are aware of the other symptoms.”
She added: “Symptoms can appear together and some may not appear at all. They include fever (possibly with cold hands and feet), headache, stiff neck, dislike of bright lights, drowsiness, joint pain, vomiting, diarrhoea and confusion.
“In babies, an unusual cry, dislike of being handled and refusing feeds are also signs that can point to meningitis. If in doubt, always seek urgent medical advice.
“We produce and distribute free symptoms cards for people to keep in their wallets and purses. To request these, call our freephone 24-hour nurse-led helpline on 1800 523 196 or visit http://www.meningitis-trust.ie/.”

http://www.belfasttelegraph.co.uk/news/local-national/tragic-meningitis-teen-terri-buried-14119859.html

Read:
Haemophilus meningitis
Pneumococcal meningitis
Meningococcal meningitis