Experts say cellphones are possibly carcinogenic (AP)

LONDON � A respected international panel of experts says cellphones are possible cancer-causing agents, putting them in the same category as the pesticide DDT, gasoline engine exhaust and coffee.

The classification was issued Tuesday in Lyon, France, by the International Agency for Research on Cancer after a review of dozens of published studies. The agency is an arm of the World Health Organization and its assessment now goes to WHO and national health agencies for possible guidance on cellphone use.

Classifying agents as "possibly carcinogenic" doesn't mean they automatically cause cancer and some experts said the ruling shouldn't change people's cellphone habits.

"Anything is a possible carcinogen," said Donald Berry, a professor of biostatistics at the M.D. Anderson Cancer Center at the University of Texas. He was not linked to the WHO cancer group. "This is not something I worry about and it will not in any way change how I use my cellphone," he said � from his cellphone.

After a week-long meeting, the expert panel said there was limited evidence cellphone use was linked to two types of brain tumors and inadequate evidence to draw conclusions for other cancers.

"We found some threads of evidence telling us how cancers might occur, but there were acknowledged gaps and uncertainties," said Jonathan Samet, the panel's chairman.

"The WHO's verdict means there is some evidence linking mobile phones to cancer but it is too weak to draw strong conclusions from," said Ed Yong, head of health information at Cancer Research U.K. "If such a link exists, it is unlikely to be a large one."

Last year, results of a large study found no clear link between cellphones and cancer. But some advocacy groups contend the study raised serious concerns because it showed a hint of a possible connection between very heavy phone use and glioma, a rare but often deadly form of brain tumor. However, the numbers in that subgroup weren't sufficient to make the case.

The study was controversial because it began with people who already had cancer and asked them to recall how often they used their cellphones more than a decade ago.

In about 30 other studies done in Europe, New Zealand and the U.S., patients with brain tumors have not reported using their cellphones more often than unaffected people.

Because cellphones are so popular, it may be impossible for experts to compare cellphone users who develop brain tumors with people who don't use the devices. According to a survey last year, the number of cellphone subscribers worldwide has hit 5 billion, or nearly three-quarters of the global population.

People's cellphone habits have also changed dramatically since the first studies began years ago and it's unclear if the results of previous research would still apply today.

Since many cancerous tumors take decades to develop, experts say it's impossible to conclude cellphones have no long-term health risks. The studies conducted so far haven't tracked people for longer than about a decade.

Cellphones send signals to nearby towers via radio frequency waves, a form of energy similar to FM radio waves and microwaves. But the radiation produced by cellphones cannot directly damage DNA and is different from stronger types of radiation like X-rays or ultraviolet light. At very high levels, radio frequency waves from cellphones can heat up body tissue, but that is not believed to damage human cells.

Some experts recommended people use a headset or earpiece if they are worried about the possible health dangers of cellphones. "If there is a risk, most of it goes away with a wireless earpiece," said Otis Brawley, chief medical officer of the American Cancer Society.

Brawley said people should focus on the real health hazards of cellphones. "Cellphones may cause brain tumors but they kill far more people through automobile accidents," he said. Brawley added it was also reasonable to limit children's use of cellphones since their brains are still developing.

Earlier this year, a U.S. National Institutes of Health study found that cellphone use can speed up brain activity, but it is unknown whether that has any dangerous health effects.

In the U.S., the Food and Drug Administration and the Federal Communications Commission have found no evidence cellphones are linked to cancer.

___

Online:

http://www.iarc.fr

http://www.cancer.org

http://www.cancerresearchuk.org

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More illnesses reported in E. coli outbreak (AP)

BERLIN � Germany's national disease control center says the number of people falling ill in connection with a mysterious bacterial outbreak linked to tainted vegetables continues to rise.

Robert Koch Institute said Tuesday that more than 1,150 people have been affected by the bacteria and that it has confirmed nine deaths.

German media has reported a total of 14 people are suspected to have died from the enterohaemorrhagic E.coli, also known as EHEC, bacteria, which has been found on cucumbers imported from Spain though the exact source is unknown.

Hundreds of people also have been sickened in other European countries, and Russia's chief sanitary agency on Monday banned the imports of cucumbers, tomatoes and fresh salad from Spain and Germany, pending further notice.

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Europeans trade blame over E.coli outbreak (AP)

BRUSSELS � Europeans traded blame Monday over the source of a mysterious bacterial outbreak that has killed 14 people and sickened hundreds across the continent and forced Russia to ban imports of some fresh vegetables from Spain and Germany out of fear they could be contaminated.

Austrian authorities sent inspectors to supermarkets to make sure Spanish vegetables suspected of contamination have been taken off shelves, while in Italy the country's paramilitary Carabinieri has been on the lookout since Saturday for suspected contaminated imports from Spain, the Netherlands and other European countries.

Pia Ahrenkilde Hansen, a European Union spokeswoman, said German authorities had identified cucumbers from the Spanish cities of Almeria and Malaga as possible sources of contamination and that a third suspect batch, originating either in the Netherlands or in Denmark and traded in Germany, is also under investigation.

In Germany, which has recorded the most infections and all known deaths, officials said they know that at least some Spanish cucumbers tainted with enterohaemorrhagic E.coli, also known as EHEC, have carried the bacteria, although they still have not been able to determine the exact source.

An EU official who spoke on condition of anonymity due to standing regulations, said the transport chain was long, and the cucumbers from Spain could have been contaminated at any point along the route.

Spain, meanwhile, went on the defensive, saying there was no proof that the E. coli outbreak has been caused by Spanish vegetables.

"You can't attribute the origin of this sickness to Spain," Spain's Secretary of State for European Affairs, Diego Lopez Garrido told reporters in Brussels. "There is no proof and that's why we are going to demand accountability from those who have blamed Spain for this matter."

The World Health Organization described the outbreak as "very large and very severe," and urged countries to work together to get to the root of the problem.

"Almost all cases being reported in other countries have a link to travel or residence in Germany," WHO food safety expert Hilde Kruse said, noting that cases of bloody diarrhea caused by EHEC have also been reported in Denmark, Sweden, France, the UK, the Netherlands and Switzerland.

Andreas Hensel, president of Germany's Federal Institute for Risk Assessment, told ZDF television that "we have found the so-called EHEC pathogens on cucumbers, but that does not mean that they are responsible for the whole outbreak."

Spanish Health Minister Leire Pajin stressed there were no Spanish cases reported and urged Germany to speed up its probe and establish proof of what has caused the outbreak. Germany's allegations "create alarm and affect the producers of a country without any evidence," she said.

The Danish Veterinary and Food Administration said there was "great uncertainty" about the suspicion that Danish cucumbers may be involved but carried out a lab test to reassure consumers. Results are expected Tuesday.

In the Netherlands, which exports more than half of the 1.6 billion cucumbers it produces each year to Germany, panicked growers went into damage control mode after all shipments were stopped.

While the National Agricultural Association met with the deputy agriculture secretary to discuss the situation, a group of cucumber growers invited an independent German institute to carry out tests in hopes it would prove their produce is safe.

Marian Bestelink, spokeswoman for the Dutch Food and Wares Authority, said investigations of a Dutch cucumber grower and Dutch warehouse did not uncover any traces of the bacteria.

"So we can definitely cross this Dutch wholesaler and this Dutch grower off the list of possible sources for the infection," she said.

With the cause of the outbreak still unclear, some countries have taken precautionary measures.

Russia's chief sanitary agency on Monday banned the imports of cucumbers, tomatoes and fresh salad from Spain and Germany pending further notice. It said in a statement that it may even ban the imports of fresh vegetables from all European Union member states due to the lack of information about the source of infection.

Austrian authorities sent inspectors to 33 organic supermarkets Monday to make sure Spanish vegetables suspected of contamination have been removed. The move came after a recall and ban on sales of cucumbers, tomatoes and eggplants that originated in Spain and were delivered to stores in Austria by German companies.

Italy's agriculture lobby, Coldiretti, used the outbreak to urge Italians to support their local growers and avoid imports.

Currently, Italian supermarkets are full of peaches, apricots, cherries and plums from Spain. As for pickles and cucumbers, Italy imported some 8 million kilograms (17 million pounds) from Spain last year.

Czech officials said tests on 120 potentially tainted Spanish cucumbers pulled off shelves on Sunday are expected to be concluded in two days. No illnesses have been reported.

In Poland, officials said Monday that a woman has been hospitalized in serious condition after returning from a trip to the northern German city of Hamburg, where at least 467 cases of intestinal infection have been recorded.

On Sunday, authorities said those included 91 cases of the more severe hemolytic uremic syndrome, known as HUS, but the officials noted on Monday that the number of new diarrhea cases was declining. HUS is a rare complication arising from infection associated with the E. coli bacterium.

EU spokesman Frederic Vincent said Sunday that two greenhouses in Spain that were identified as the source of the contaminated cucumbers had ceased activities. The water and soil there are being analyzed to see whether they were the problem, and the results are expected Tuesday or Wednesday, Vincent said.

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Oleksyn reported from Vienna. Karel Janicek in Prague, Monika Scislowska in Warsaw, Poland, Frances D'Emilio in Rome, Ciaran Giles in Madrid, David Rising and Geir Moulson in Berlin, Frank Jordans in Geneva, Jan M. Olsen in Copenhagen, Denmark, Vladimir Isachenkov in Moscow and Toby Sterling in Amsterdam contributed.

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Hospitals hunt substitutes as drug shortages rise (AP)

WASHINGTON � A growing shortage of medications for a host of illnesses � from cancer to cystic fibrosis to cardiac arrest � has hospitals scrambling for substitutes to avoid patient harm, and sometimes even delaying treatment.

"It's just a matter of time now before we call for a drug that we need to save a patient's life and we find out there isn't any," says Dr. Eric Lavonas of the American College of Emergency Physicians.

The problem of scarce supplies or even completely unavailable medications isn't a new one but it's getting markedly worse. The number listed in short supply has tripled over the past five years, to a record 211 medications last year. While some of those have been resolved, another 89 drug shortages have occurred in the first three months of this year, according to the University of Utah's Drug Information Service. It tracks shortages for the American Society of Health-System Pharmacists.

The vast majority involve injectable medications used mostly by medical centers � in emergency rooms, ICUs and cancer wards. Particular shortages can last for weeks or for many months, and there aren't always good alternatives. Nor is it just a U.S. problem, as other countries report some of the same supply disruptions.

It's frightening for families.

At Miami Children's Hospital, doctors had to postpone for a month the last round of chemotherapy for 14-year-old Caroline Pallidine, because of a months-long nationwide shortage of cytarabine, a drug considered key to curing a type of leukemia.

"There's always a fear, if she's going so long without chemo, is there a chance this cancer's going to come back?" says her mother, Marta Pallidine, who says she'll be nervous until Caroline finishes her final treatments scheduled for this week.

"In this day and age, we really shouldn't be having this kind of problem and putting our children's lives at risk," she adds.

There are lots of causes, from recalls of contaminated vials, to trouble importing raw ingredients, to spikes in demand, to factories that temporarily shut down for quality upgrades.

Some experts pointedly note that pricier brand-name drugs seldom are in short supply. The Food and Drug Administration agrees that the overarching problem is that fewer and fewer manufacturers produce these older, cheaper generic drugs, especially the harder-to-make injectable ones. So if one company has trouble � or decides to quit making a particular drug � there are few others able to ramp up their own production to fill the gap, says Valerie Jensen, who heads FDA's shortage office.

The shortage that's made the most headlines is a sedative used on death row. But on the health-care front, shortages are wide-ranging, including:

_Thiotepa, used with bone marrow transplants.

_A whole list of electrolytes, injectable nutrients crucial for certain premature infants and tube-feeding of the critically ill.

_Norepinephrine injections for septic shock.

_A cystic fibrosis drug named acetylcysteine.

_Injections used in the ER for certain types of cardiac arrest.

_Certain versions of pills for ADHD, attention deficit hyperactivity disorder.

_Some leuprolide hormone injections used in fertility treatment.

No one is tracking patient harm. But last fall, the nonprofit Institute for Safe Medication Practices said it had two reports of people who died from the wrong dose of a substitute painkiller during a morphine shortage.

"Every pharmacist in every hospital across the country is working to make sure those things don't happen, but shortages create the perfect storm for a medication error to happen," says University of Utah pharmacist Erin Fox, who oversees the shortage-tracking program.

What can be done?

The FDA has taken an unusual step, asking some foreign companies to temporarily ship to the U.S. their own versions of some scarce drugs that aren't normally sold here. That eased shortages of propofol, a key anesthesia drug, and the transplant drug thiotepa.

Affected companies say they're working hard to eliminate backlogs. For instance, Hospira Inc., the largest maker of those injectable drugs, says it is increasing production capacity and working with FDA "to address shortage situations as quickly as possible and to help prevent recurrence."

But the Generic Pharmaceutical Association says some shortages are beyond industry control, such as FDA inspections or stockpiling that can exacerbate a shortage.

"Drug shortages of any kind are a complex problem that require broad-based solutions from all stakeholders," adds the Pharmaceutical Research and Manufacturers of America, a fellow trade group.

Lawmakers are getting involved. Sen. Herb Kohl, D-Wis., is urging the Federal Trade Commission to consider if any pending drug-company mergers would create or exacerbate shortages.

Also, pending legislation would require manufacturers to give FDA advance notice of problems such as manufacturing delays that might trigger a shortage. The FDA cannot force a company to make a drug, but was able to prevent 38 close calls from turning into shortages last year by speeding approval of manufacturing changes or urging competing companies to get ready to meet a shortfall.

"No patient's life should have to be at risk when there is a drug somewhere" that could be used, says Sen. Amy Klobuchar, D-Minn., who introduced the bill.

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EDITOR'S NOTE � Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Man celebrates 85 years of living with diabetes (AP)

LOS ANGELES � When Bob Krause turned 90 last week, it was by virtue of an unflagging determination and a mentality of precision that kept his body humming after being diagnosed with diabetes as a boy.

A leading diabetes research center named the San Diego resident the first American known to live 85 years with the disease, a life that has paralleled � and benefited from � the evolution in treatment.

Krause's wife of 56 years, his family and friends celebrated his longevity Sunday with a party and a medal from the Joslin Diabetes Center to commemorate his 85-year milestone.

"Bob has outlived the life expectation of a normal healthy person born in 1921," said his physician, Dr. Patricia Wu, attributing Krause's success to his strong character. "He knows that he has to deal with this and he sees this as a part of his life, he doesn't let this get him down."

The trim, white-haired Krause puts it more succinctly: "I'm a stubborn old man. I refuse to give up."

That trait certainly plays into how closely he has tracked his body's chemistry and become expert in the life-saving math that has kept his diabetes under control.

About 18.8 million Americans have been diagnosed with diabetes and an estimated 7 million more live with the disease unwittingly. Krause's form of diabetes, type 1, was once known more commonly as juvenile diabetes, and the more common form of diabetes often tied to obesity is type 2.

About 3 million Americans live with type 1 diabetes, a chronic illness in which their bodies don't make enough insulin, which is needed to convert blood sugar into energy. The exact cause is unknown, though genetics and autoimmune problems are thought to play a role.

Life expectancy is diminished for many diabetics because they face a higher risk of serious health complications, including heart disease, stroke, blindness, kidney damage and limb amputations. Many struggle to manage blood pressure.

The former University of Washington mechanical engineering professor says he's succeeded because he treats his body like a car and he only eats enough food to fuel the machine.

"To keep your diabetes under control you only eat the food you need to before you have activities to perform," Krause said. "I eat to keep me alive instead of eating all the time, or for pleasure."

He says he's not as active as he once was, so he doesn't need a lot of fuel � or variation in diet. For breakfast every day, he eats a bowl of nuts and five pitted prunes. He usually skips lunch and eats a salad with some lean meat for dinner.

"I was surprised when they told me I was the oldest, because I knew there were others out there. I certainly didn't think I was a loner," Krause said after being presented the medal.

The first time Krause met Dr. Wu at Kaiser Permanente San Diego, he came into the endocrinologist's office with a briefcase full of meticulous hand-drawn graphs charting months of his blood sugar levels, caloric intake and insulin doses.

He tests his blood up to a dozen times a day and he brings in updated charts every visit, Wu said.

"I think that's a testament of why he is successful in living with this very difficult to live with condition," she said. "Because of his persistence, his consistency, his hard work."

Krause's careful attention is not unlike many others who have been awarded by Joslin for successfully living with the illness for decades, according to researcher Stephanie Hastings.

The Boston-based center has honored long-time diabetes survivors since 1948, and 34 have earned 75-year medals.

Hastings said Krause is like many longtime successful diabetics, who "always have more information than we need."

If anything, Wu has worked with Krause over the past three years to be a little less rigid so that he doesn't overdose himself with insulin and push his blood sugar too low.

It can be tough to change the patterns of a patient who has dealt with an illness for so long.

Krause was lucky to be diagnosed with diabetes not long after the commercial production of insulin made it widely available. It was 1926, and he was 5 years old and living in Detroit where his father worked for the U.S. Rubber Co.

Krause's younger brother Jackie died of diabetes after being diagnosed a year earlier because insulin wasn't yet available.

Before the discovery of insulin, a diabetes diagnosis was a death sentence, with an expected survival of a couple years at most if patients undertook starvation diets to buy more time.

"I watched Jackie die by starving to death," Krause said. "Before insulin, diabetics would just die because eating doesn't make any difference: anything that you ate couldn't be converted and you literally starved to death because your body couldn't absorb anything."

Canadian scientists Frederick Banting and John Macleod made the discovery in 1921 through experiments with a mixture of ground cow pancreas water and salts that eventually became insulin.

When experimenting with the mixture in humans began in 1922, scientists found they were literally injecting life into people who were wasting away. The discovery led to a Nobel Prize in 1923.

When Krause began taking insulin, diabetics had to boil glass syringes with long needles, sharpening the point when it would go blunt with wear.

Krause remembers how his mother, having lost one child to diabetes, weighed every piece of food Krause ate and kept him on a strict diet. By the time he was 6, he was giving himself injections in the arms or legs at every meal.

Back then, blood sugar testing was imprecise, messy and inconvenient. Krause would boil his urine in a test tube and drop a tablet into it that would turn different colors based on how much blood sugar was in the sample.

Since 1978, Krause has relied on his insulin pump to administer his dosages into his stomach, though he enters the amount of the dose himself rather than relying on automated doses of insulin that pumps can give throughout the day.

Krause's son, Tom Krause, said his engineer father has always been precise, measured and calculated � down to the box of sugar cubes he always kept next to his bed in case he felt faint.

"Having a sugar cube is a precise measurement � that's how much he kept track, down to the cube of sugar," said Tom Krause, 50.

And though Tom Krause inherited his father's diabetes, he doesn't share his father's regimented control of the illness.

"My dad, he is just a machine in how well he cares and manages his diabetes, with his willpower and how long he's been doing it," Tom Krause said.

Krause praises the advent of blood testing as one of the most life-changing moments in diabetes medicine, since it allows him to get a more precise reading of his blood sugar levels by pricking his finger for a test strip that is read by a machine.

"It's easier to control things today than it was back then. Back then you just ate a meal and that's all you ate all day long, you didn't eat anything in between and if your blood sugar got low, you would feel faint and drink orange juice and wait," Krause said.

Though they've worked together to make sure his treatment keeps up with the times, Krause reminds Wu of the same thing each time he leaves her office.

"He'll say, `I've been doing this for 80-number of years and it has gotten me this far and I'm still here, so who are you to tell me how to do this? I've been doing this since before you were born,'" Wu recalls with a laugh.

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Shaya Tayefe Mohajer can be reached at http://twitter.com/APShaya.

___

Online:

Joslin Diabetes Center: http://www.joslin.org

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UNICEF discloses vaccine prices for 1st time (AP)

UNICEF is for the first time publicizing what drugmakers charge it for vaccines, as the world's biggest buyer of lifesaving immunizations aims to spark price competition in the face of rising costs.

On Friday, UNICEF posted on its website the actual prices that it has paid individual drugmakers for 16 vaccines purchased over the last decade. It's a move that a few Western pharmaceutical companies don't support. Novartis AG and Merck & Co., which only sells one of its many children's vaccines to UNICEF, both declined to have their prices published.

UNICEF said it will continue to disclose pricing of future vaccine deals, with the hope that the transparency will push drugmakers to cut prices and thus allow the organization to vaccinate more children and save more lives.

"Transparency will also help foster a competitive, diverse supplier base," said Shanelle Hall, director of UNICEF's supply division. She noted that it also will help UNICEF's partners and those governments that buy vaccines on their own to make more informed decisions in price negotiations with drugmakers.

UNICEF last year spent $757 million to provide 2.5 billion doses of vaccines to 99 countries, reaching an estimated 58 percent of the world's children.

Its price list shows significant disparity, with Western drugmakers often charging UNICEF double what companies in India and Indonesia do. Just as striking is the steady rise in prices in the last decade, with the cost of vaccines against measles, polio and tetanus roughly doubling between 2001 and 2010. Prices of a few vaccines have remained flat or declined as additional competitors entered the market.

There's also a huge spread in prices among various vaccines.

As might be expected, shots that have been around for some time and those vaccines made by multiple companies cost just pennies per dose, such as tetanus and tuberculosis shots and oral polio vaccine. But a combination shot for immunization against diptheria, tetanus, whooping cough, hepatitis B and haemophilus influenza can run UNICEF $3 or more per dose. The dual vaccine against 10 or more strains of pneumococcal disease, which causes ear infections and meningitis, costs $3.50 a shot. And some of the vaccines require more than one booster shot, adding to the cost.

The cost is partly justified by the complex manufacturing process used to make combination vaccines. And UNICEF still pays far less than the $71 and $114 per dose, respectively, that is charged in the U.S. for those two vaccines. But given that the organization's mission is to immunize entire populations of at-risk children, any savings means more can be vaccinated.

British drugmaker GlaxoSmithKline PLC said in a statement that it "always offers UNICEF our vaccines at our lowest price as they are targeted at the people who need them the most, but are least able to pay. We welcome UNICEF's move to publish retrospective prices for tenders and hope that this will help inform decisions for future vaccine procurement." Messages left with other Western vaccine makers seeking comment weren't immediately returned Saturday afternoon.

Daniel Berman, deputy director of the Doctors Without Borders Campaign for Essential Medicines, called the new price disclosures "a real step forward."

"By getting access to these prices, buyers will be able to take advantage of the increasing capacity of emerging countries to develop and produce quality vaccines at significantly lower costs," he said in a statement.

He added that GAVI, the Global Alliance for Vaccines and Immunization, "should flex its purchasing muscles to encourage manufacturers" to produce vaccines that don't require refrigeration and can be administered through patches or liquids, rather than needles.

GAVI, which is supported by contributions from developed nations and the Bill & Melinda Gates Foundation, is the primary funder of vaccines purchased by UNICEF. Helen Evans, interim CEO of the GAVI Alliance, said in a joint statement with UNICEF that GAVI "strongly believes in timely, transparent and accurate information on pricing."

Many of the largest global pharmaceutical companies � most recently Johnson & Johnson � have jumped into the vaccine business in recent years to diversify revenue as many of their blockbuster pills are facing generic competition. Vaccines are all but immune from generic competition in developed countries, and some newer shots, such as Pfizer Inc.'s Prevnar pneumococcal vaccine, now bring in billions of dollars in revenue each year.

Those big companies are looking to less-developed countries for future sales growth, and vaccines against crippling and deadly childhood diseases are cost-effective purchases for countries with small health budgets.

AIDS groups and advocates for affordable health care in developing countries have campaigned for years for big pharmaceutical companies to sell their patented medicines to those countries at drastically reduced prices, or to allow generic drug makers in countries such as India to do so. They've had some success, so UNICEF's new price plan is a logical strategy.

UNICEF's Hall said the organization hopes to expand the transparency initiative to other essential products that it buys for children. UNICEF supports child health and nutrition, good water and sanitation, and quality basic education for boys and girls across the globe.

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UNAIDS to Vatican: Pope's HIV-condom view helpful (AP)

VATICAN CITY � The head of the U.N. AIDS agency told a Vatican conference on AIDS Saturday that Pope Benedict XVI's comments about the use of condoms in preventing HIV transmission had opened new prospects for dialogue with the U.N.

Dr. Michel Sidibe, executive director of UNAIDS, said it will help strengthen the fight for greater access to treatment for those afflicted. Sidibe said Benedict's views were important, even if differences remain between the U.N. and Catholic Church.

The U.N. says condoms should be an integral part of HIV prevention programs; the Vatican opposes condoms as part of its overall opposition to artificial contraception.

But Benedict said last year that a male prostitute who intends to use a condom might be taking a first step toward greater responsibility by looking out for the welfare of his partner, even if condoms aren't a moral solution.

"This is very important," Sidibe told the conference. "This has helped me to understand his position better and has opened up a new space for dialogue."

While Benedict's comments in the book "Light of the World" drew near-universal praise within the AIDS community, conservative Catholics insisted he wasn't altering church teaching and that the church's ban on condoms remained. After three attempts at clarification, the Vatican eventually issued a definitive ruling from the Congregation for the Doctrine of the Faith saying the pope in no way was changing church teaching.

Nevertheless, the impression left at least within the AIDS community was that he had made an opening � and Sidibe latched onto that in his comments Saturday.

Sidibe said previously the AIDS community and Catholic Church were "talking over" one another and often held opposing views about how to deal with the AIDS crisis. But he said Benedict's words had opened a new possibility for working together, particularly in agitating for greater access to anti-retroviral treatments for the world's poorest patients.

"Yes, there are areas where we disagree and we must continue to listen, to reflect and to talk together about them. But there are many more areas where we share common cause," Sidibe said.

Increasing access to treatment has become an even greater rallying call following the recently published results of a nine-nation study showing that HIV-positive patients who received early treatment were 96 percent less likely to spread the virus to their uninfected partners.

Sidibe called the research a "game-changer" in the fight against AIDS and Vatican officials said it gave new hope to couples where one partner is HIV-positive and want to have children.

While there had never been an official Vatican policy about condoms and HIV, some Vatican officials had previously insisted that condoms not only don't help fight HIV transmission but make it worse because they gave users a false sense of security. Some claimed the HIV virus could easily pass through the condom's latex barrier.

Benedict himself drew the wrath of UNAIDS and several European countries when, en route to Africa in 2009, he told reporters that the AIDS problem couldn't be resolved by distributing condoms. "On the contrary, it increases the problem," he said then.

The comments drew fierce criticism in Africa, where an estimated 22.4 million people are infected with HIV, two-thirds of the global total.

With his revised comments, the Vatican debate seems to have changed ever so slightly. The fact that Sidibe was even invited to speak at the Vatican was significant; usually only like-minded outsiders are invited to speak at Holy See conferences.

That said, the Vatican officials present made clear that condoms weren't the answer to fighting AIDS and that changing sexual behavior to emphasize marital fidelity was the best answer. Monsignor Zygmunt Zimowski, head of the Pontifical Council for Health Care Workers which hosted the meeting, didn't even refer to Benedict in his keynote speech.

Rather, he cited Pope John Paul II on three separate occasions, quoting him as speaking about the "crisis of values" that was behind the AIDS crisis.

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Is a repeat flu shot needed? This fall, maybe not (AP)

ATLANTA � Vaccine makers said this month they plan to make a record amount of flu vaccine for this fall and winter � enough for more than half the population. It's just not clear all those people will need it.

This year's flu shot will be a duplicate of last year's because the same flu strains are still circulating. So some experts say young, healthy people may have enough protection from last season's vaccine to skip getting it again this fall.

"For healthy people, it can't be said to be necessary," said Dr. Robert Couch, a flu vaccine expert at the Baylor College of Medicine.

Still, government health officials are urging nearly everyone to get this fall's flu shot. They say a vaccine's protection can fade significantly after several months � especially for those who are frail and elderly.

Two weeks ago, five vaccine manufacturers announced plans to make between 166 million and 173 million doses for the coming season. That's at least 6 million more than the maximum ever produced.

It's quite a bet, considering the flu season that just ended was somewhat mild. But vaccine makers think it's a good one.

"We are confident in our 2011 projections for the U.S. market. They are based on ordering patterns as well as what's known about the epidemiology of the flu," said Liz Power, spokeswoman for Novartis Vaccines, one of the main manufacturers of flu shots for the United States.

Demand for vaccine has been growing in the U.S. More than 40 percent of the population was vaccinated against the flu in the last 10 months, the second year in a row vaccinations were at so high a level. Previously, only about a third of Americans were getting vaccinated, according to government figures.

The Centers for Disease Control and Prevention had something to do with that. Last year, the CDC began recommending an annual flu vaccination for everyone except babies younger than 6 months and those with egg allergies or other unusual conditions. That probably helped boost vaccination rates, along with the appearance in 2009 of swine flu, which was more dangerous than other strains to young people.

The CDC also is buying about 18 million of the 2011-2012 doses, primarily for government vaccine programs for children.

Other countries, even in Europe, do not promote flu shots as aggressively as the United States. Seasonal flu can be deadly, especially for the elderly and people with weak immune systems.

The biggest selling point for an annual shot, usually, is that flu strains are usually different each year. But this year, that argument goes out the window. The last time flu strains didn't change was during the winters of 2002-2004.

But there are other arguments for getting a flu shot. For one thing, the vaccine is only about 70 percent effective to begin with � and that's in a good year, when the vaccine is well-calibrated to circulating strains. That's not good enough to protect the U.S. population for one year, let alone two, CDC officials say.

But the main argument now is one of waning immunity. CDC officials believe that a year after someone gets the flu shot, antibody levels � an indicator of immunity � can fall by two-thirds or more. Some key studies indicate the resulting levels are not strong enough to be protective, said Nancy Cox, head of the CDC's chief of the CDC's flu division.

However, other studies are less clear. Some have suggested that a flu vaccination can provide sufficient protection for more than a year in adults, and perhaps two or three years in children.

Cox said some of those conflicting studies are outdated and flawed, and noted more recent U.S. studies that found large drops in children's immunity in just one year.

Other researchers sound less decided about which studies were right and which were wrong on this question.

"Nobody really, really knows," said Dr. John Treanor, a flu vaccine researcher at the University of Rochester School of Medicine.

But even if the question is unsettled, Treanor and other experts said the CDC's position is probably the wisest course.

"The bottom line is, with our current knowledge, we believe it is better to be re-vaccinated. And getting another shot is certainly not going to harm you," said Dr. Arnold Monto, an esteemed University of Michigan flu expert.

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NIH stops study of niacin to prevent heart attacks (AP)

WASHINGTON � A drug that boosts people's good cholesterol didn't go on to prevent heart attacks or strokes, leading U.S. officials to abruptly halt a major study Thursday.

The disappointing findings involve super-strength niacin, a type of B vitamin that many doctors already prescribe as potential heart protection. The failed study marks the latest setback in the quest to harness good cholesterol to fight the bad kind.

"This sends us a bit back to the drawing board," said Dr. Susan Shurin, cardiovascular chief at the National Institutes of Health.

The bad kind of cholesterol, called LDL, is the main source of artery clogs. Popular statin drugs, sold under such names as Zocor and Lipitor, plus generic forms, are mainstays in lowering LDL. Yet many statin users still have heart attacks, because LDL isn't the whole story.

HDL cholesterol, the good kind, helps fight artery build-up by carrying fats to the liver to be disposed of. That's one reason that people with too little HDL also are at risk of heart disease. So scientists are testing whether giving HDL-boosting drugs in addition to statins could offer heart patients extra protection.

The newest study tested Abbott Laboratories' Niaspan, an extended-release form of niacin that is a far higher dose than is found in dietary supplements. The drug has been sold for years, and previous studies have shown it does boost HDL levels. But no one knew if that translated into fewer heart attacks.

Researchers enrolled more than 3,400 statin users in the U.S. and Canada who had stable heart disease and well-controlled LDL, but were at risk because of low HDL levels and too much of a different bad fat, triglycerides. They were given either Niaspan or a dummy pill to add to their daily medicine.

As expected, the Niaspan users saw their HDL levels rise and their levels of risky triglycerides drop more than people who took a statin alone. But the combination treatment didn't reduce heart attacks, strokes or the need for artery-clearing procedures such as angioplasty, the NIH said.

That finding "is unexpected and a striking contrast to the results of previous trials," said Dr. Jeffrey Probstfield of the University of Washington, who helped lead the study.

But it led the NIH to stop the study 18 months ahead of schedule.

Adding to the decision was a small increase in strokes in the high-dose niacin users � 28 among those 1,718 people given Niaspan, compared with 12 among the 1,696 placebo users. The NIH said it wasn't clear if that small difference was merely a coincidence; previous studies have shown no stroke risk from niacin. In fact, some of the strokes occurred after the Niaspan users quit taking that drug.

What's the message for heart patients?

Statin users who have very low LDL levels, like those in this study, don't need an extra prescription for niacin, said Dr. Robert Eckel, a University of Colorado cardiologist and American Heart Association spokesman who wasn't involved with the study.

But it's not clear if niacin would have any effect on people at higher risk or those who don't have a diagnosis of heart disease yet but take niacin as a preventive, said study co-leader Dr. William Boden of the University at Buffalo.

"We can't generalize these findings ... to patients that we didn't study," he said.

Eckel said it's "really hard to envision exactly what's going to happen in physicians' offices" in coming weeks as they discuss niacin with patients. The NIH urged people not to stop high-dose niacin without consulting a doctor.

Nor do the findings end hope that raising HDL eventually will pan out, Eckel said. While two other drugs have failed as well, he is closely watching some much stronger HDL-boosters, including a Merck & Co. drug named anacetrapib, that are under development.

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Online:

Background on niacin: http://tinyurl.com/3vgablq

Niaspan: http://www.niaspan.com/

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UN puts off destroying last smallpox viruses (AP)

GENEVA � Health ministers from around the world agreed Tuesday to put off setting a deadline to destroy the last known stockpiles of the smallpox virus for three more years, rejecting a U.S. plan that had called for a five-year delay.

After two days of heated debate, the 193-nation World Health Assembly agreed by consensus to a compromise that calls for another review in 2014.

The United States had proposed a five-year extension to destroying the U.S. and Russian stockpiles, arguing that more research is needed and the stockpiles could help prevent one of the world's deadliest diseases from being used as a biological weapon.

But other ministers at the decision-making assembly of the World Health Organization said they saw little reason to retain the stockpiles, and objected to the delay in destroying them.

Dr. Nils Daulaire, head of the U.S. Office of Global Health Affairs and the chief American delegate to the assembly, expressed some disappointment but said the compromise was satisfactory.

"Three years is a reasonable time period in terms of the next review," he told reporters. "Obviously during that time period, we expect there will be meaningful progress in the research on anti-virals and vaccines and diagnostics."

The assembly declared smallpox officially eradicated in 1980, and the U.N. health agency has been discussing whether to destroy the virus since 1986.

Then in 2007, the assembly asked WHO's director-general to oversee a major review of the situation so that the 2011 assembly could agree on when to destroy the last known stockpiles.

WHO officials said in a statement that the assembly "strongly reaffirmed the decision of previous assemblies that the remaining stock of smallpox (variola) virus should be destroyed when crucial research based on the virus has been completed."

But the assembly won't again have to grapple with a decision over exactly when to do that until three years from now.

The assembly, like the U.N. General Assembly, is a world forum whose decisions aren't legally binding but do carry moral weight. So even if the assembly finally sets a date for destroying the stockpiles, it can't force the United States and Russia to comply.

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Teen bond overcomes girl's heart transplant fear (AP)

WASHINGTON � Courtney Montgomery's heart was failing fast, but the 16-year-old furiously refused when her doctors, and her mother, urged a transplant.

Previous surgeries hadn't helped and the North Carolina girl didn't believe this scarier operation would either. It would take another teen who's thriving with a new heart to change her mind.

"I was like, `No, I don't want this. If I'm going to die, I'm going to die,'" Courtney recalls. "Now I look back, I realize I wasn't thinking the way I should have been."

Teenagers can add complex psychology to organ transplantation: Even though they're minors, they need to be on board with a transplant because it's up to them to take care of their new organ. Depression, anger and normal adolescent pangs � that tug-of-war with parents, trying to fit in � can interfere. It's not just a question of having the transplant, but how motivated they are to stick with anti-rejection treatment for years to come.

"The decision-making process that we go through, in terms of our ability to weigh factors in a rational sense, probably doesn't mature until you're in your late 20s," says Dr. Robert Jaquiss, pediatric heart surgery chief at Duke University Medical Center, where Courtney eventually was transplanted. "It introduces an enormous level of complexity to caring for these kids."

Then there's the sense of isolation. Far fewer adolescents than older adults undergo an organ transplant, making it unlikely that a teen has ever seen how fast their peers can bounce back.

Between 700 and 800 adolescents, ages 11 to 17, have some type of organ transplant each year. That's nearly 40 percent of the roughly 2,000 annual pediatric transplants. Teens fare better than any other age � child or adult � the first year after surgery. But long-term, adolescents do a bit worse than younger children, and the reason isn't biological, Jaquiss says. It's that teens, and young adults as well, tend to start slipping on all the required follow-up care.

One study found up to 40 percent of adolescent liver recipients eventually miss medication doses or checkups. It can be normal development, as teens start sleeping late and simply forgetting morning doses, or sometimes it's rebelliousness. Then there are medication side effects that Jaquiss says can be especially troubling to this image-conscious age group: weight gain, acne and unwanted hair growth.

And at the Children's Hospital of Pittsburgh, separate research with heart recipients has found chronological age is unrelated to "medical maturity." Young patients who had a hard time accepting a transplant as normal and who avoided family discussion of problems, for example, were less likely to stick with care.

Courtney's mother, Michelle Mescall, said that when the medical center advised that her daughter needed to agree to go on the transplant waiting list, "I said, `Well she's a minor, what do you mean? I'm going to make this decision.' I was just floored that it was now her decision."

Legally, the hospital could have proceeded with mom's OK. But clinical social worker Shani Foy-Watson says if that happened, Courtney's resentment could have torpedoed her recovery, setting up just those kinds of problems with follow-up care.

Foy-Watson says it's not unusual for kids who've lived with serious illness for years to have a hard time imagining normalcy � at the same age when it's normal to seek more independence from their terrified parents.

Courtney, of Asheville, N.C., was diagnosed at age 8 with hypertrophic cardiomyopathy, a thickened and hard-to-pump heart that's the leading cause of sudden death in young athletes. Her mother tried to shield her from doctors' death warnings, but says Courtney became anxious and depressed early on.

She had a defibrillator implanted and later heart surgery that offered only temporary relief, fueling resentment of her mother's medical choices. Courtney eventually had to give up her beloved cheerleading, and last year required home-schooling.

As a few weeks passed with Courtney still resisting a transplant, the social worker tried a new tack: A 17-year-old football player had received a new heart at Duke a few months earlier because of the same condition, and already was back at school in Raleigh. Would he meet with Courtney?

It was a gamble. No one told Josh Winstead, now 18, the reason for the meeting, and they might not have hit it off. But they did, and Courtney immediately changed her mind.

"I guess me doing what I do, being a kid, helped out the most," says Winstead, who took Courtney to his prom a week before her surgery. "It was more just showing her how normal my life is."

You hear all the advice from friends and doctors, Courtney says, "but it doesn't hit home like when Josh would tell me, `I have the same scars you do and this is how it felt and this is how I feel now.'"

She got her new heart last month. She's recovering well and exercising in hopes of getting back to the cheerleading squad.

Her mother's helping Courtney learn to handle a whopping 33 pills a day, and is proud of how her daughter has rallied: "I'm just dealing with how to let go and let her fly, but also be the parent of a 16-year-old."

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EDITOR'S NOTE � Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Baby boomers fueling boom in knee, hip surgeries (AP)

SAN DIEGO � We're becoming a nation of bum knees, worn-out hips and sore shoulders, and it's not just the Medicare set. Baby boomer bones and joints also are taking a pounding, spawning a boom in operations to fix them.

Knee replacement surgeries have doubled over the last decade and more than tripled in the 45-to-64 age group, new research shows. Hips are trending that way, too.

And here's a surprise: It's not all due to obesity. Ironically, trying to stay fit and avoid extra pounds is taking a toll on a generation that expects bad joints can be swapped out like old tires on a car.

"Boomeritis" or "fix-me-itis" is what Dr. Nicholas DiNubile, a suburban Philadelphia surgeon, calls it.

"It's this mindset of `fix me at any cost, turn back the clock,'" said DiNubile, an adviser to several pro athletic groups and a spokesman for the American Academy of Orthopaedic Surgeons. "The boomers are the first generation trying to stay active in droves on an aging frame" and are less willing to use a cane or put up with pain or stiffness as their grandparents did, he said.

A huge industry says they don't have to. TV ads show people water skiing with new hips. Ads tout "the athletic knee," "the custom knee," "the male knee," "the female knee." Tennis great Billie Jean King, 67, is promoting the "30-year" Smith & Nephew knees she got last year.

"I wanted to make sure whatever they put in me was going to last," she said. "I'm not trying to win Wimbledon anymore. I'm trying to get my exercise in," play a little tennis on the clay courts in Central Park, and walk to a movie or a restaurant. "If I'd known what I know now, I would have had it 10 years ago."

Joint replacements have enabled millions of people like King to lead better lives, and surgeons are increasingly comfortable offering them to younger people.

But here's the rub: No one really knows how well these implants will perform in the active baby boomers getting them now. Most studies were done in older folks whose expectations were to be able to go watch a grandchild's soccer game � not play the sport themselves, as one researcher put it.

Even the studies presented at a recent orthopedics conference that found knee replacements are lasting 20 years come with the caveat that this is in older people who were not stressing their new joints by running marathons, skiing or playing tennis.

Besides the usual risks of surgery � infection, blood clots, anesthesia problems � replacing joints in younger people increases the odds they'll need future operations when these wear out, specialists say.

"We think very carefully about patients under 50" and talk many of them out of replacing joints, said Dr. William Robb, orthopedics chief at NorthShore University HealthSystem in suburban Chicago.

But many don't want to wait, even if they're not much beyond that:

_Karen Guffey, a 55-year-old retired civilian police worker in San Diego, plans to have a hip replaced in September. "I can't exercise the way I want to. I have to go slow, which is really aggravating. I want to go full force," she said. "I'm not worried about how I'm going to feel when I'm 75. I want to feel good now."

_Karen Cornwall, a Havertown, Pa., nurse who played a slew of sports since childhood, had both knees replaced last year when she was 54. "I just felt like I was too young and too active to be in pain all the time," she explained.

_Bill McMullen, a former Marine and construction worker from suburban Philadelphia, had seven knee repair surgeries before finally getting a knee replacement at age 55 a decade ago. He took up weightlifting to spare his knees but damaged a shoulder and had it replaced two years ago. "People ask me if I'm happy and I say, `If you have pain, go and get it done,'" he said of joint replacement. "It was the best thing for me. I have no pain."

People are urged to exercise because it's so important for health, but there are "too many wannabes" who overdo it by trying to imitate elite athletes, said Dr. Norman Schachar, a surgeon and assistant dean at the University of Calgary in Alberta, Canada.

"They think if they've got a sore knee they're entitled to having it replaced," he said. "I think surgeons are overdoing it too, to try to meet that expectation."

Dr. Ronald Hillock, an orthopedic surgeon in a large practice in Las Vegas that does about 4,000 joint replacements a year, sees the demand from patients.

"People come in and say `this is what I want, this is what I need,'" he said. "They could buy a cane or wear a brace," but most want a surgical fix.

The numbers tell the story. There were 288,471 total hip replacements in 2009, nearly half of them in people under 65, according to the federal Agency for Healthcare Research and Quality, which tracks hospitalizations.

Knee replacements soared from 264,311 in 1997 to 621,029 in 2009, and more than tripled in the 45-to-64-year-old age group.

"Five or 10 years ago, a very small number of people under 65 were receiving this surgery. Now we see more and more younger people getting it," said Elena Losina, co-director of the Orthopaedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital in Boston.

She analyzed how much of this rise was due to population growth and obesity, and presented results at an orthopedic meeting in San Diego in February.

From 1997 to 2007, the population of 45- to 64-year-olds grew by 36 percent, but knee replacements in this group more than tripled. Obesity rates didn't rise enough to explain the trend.

"At most, 23 percent of the 10-year growth in total knee replacement can be explained by increasing obesity and population size," Losina said.

"This is a very successful operation. The only caveat is, all the successes have been seen in the older population," who usually put less stress on their new joints than younger folks who want to return to sports. "It's unclear whether the artificial joint is designed to withstand this higher activity," she said.

If you have a good result from a joint replacement, don't spoil it by overdoing the activity afterward, experts warn. Better yet, try to prevent the need for one.

"Being active is the closest thing to the fountain of youth," but most people need to modify their exercise habits because they're overdoing one sport, not stretching, or doing something else that puts their joints at risk, said DiNubile, the "boomeritis" doctor.

Experts recommend:

_Cross training. People tend to find one thing they like and do it a lot, but multiple activities prevent overuse.

_Balance your routines to build strength, flexibility, core muscles and cardiovascular health.

_Lose weight. "Every extra pound you carry registers as five extra pounds on your knees," DiNubile said. "The good news is, you don't need to lose a lot of weight" to ease the burden.

_Spend more time warming up. Break a sweat and get the blood flowing before you go full blast.

_Let muscles and joints recover and rest in between workouts.

_If you've had a joint replacement, do the physical therapy that's recommended.

"I tell patients, 20 percent of the outcome is the technical stuff I do in the surgery, and 80 percent is them," said Hillock, the Las Vegas surgeon. "I can do a perfect surgery, but if they don't do the rehab they're not going to have a good outcome."

__

Online:

Consumer info: http://www.orthoinfo.org

and http://www.aaos.org/research/stats/patientstats.asp

__

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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'Jeopardy!'-winning computer delving into medicine (AP)

YORKTOWN, N.Y. � Some guy in his pajamas, home sick with bronchitis and complaining online about it, could soon be contributing to a digital collection of medical information designed to help speed diagnoses and treatments.

A doctor who is helping to prepare IBM's Watson computer system for work as a medical tool says such blog entries may be included in Watson's database.

Watson is best known for handily defeating the world's best "Jeopardy!" players on TV earlier this year. IBM says Watson, with its ability to understand plain language, can digest questions about a person's symptoms and medical history and quickly suggest diagnoses and treatments.

The company is still perhaps two years from marketing a medical Watson, and it says no prices have been established. But it envisions several uses, including a doctor simply speaking into a handheld device to get answers at a patient's bedside.

Watson won't be the first such product on the medical market, however, and one rival company says it isn't impressed.

At a recent demonstration for The Associated Press, Watson was gradually given information about a fictional patient with an eye problem. As more clues were unveiled � blurred vision, family history of arthritis, Connecticut residence � Watson's suggested diagnoses evolved from uveitis to Behcet's disease to Lyme disease. It gave the final diagnosis a 73 percent confidence rating.

"You do get eye problems in Lyme disease but it's not common," Dr. Herbert Chase said. "You can't fool Watson."

For "Jeopardy!" Watson was fed encyclopedias, dictionaries, books, news, and movie scripts. For health care, it's on a diet of medical textbooks and journals. It could also link to the electronic health records that the federal government wants hospitals to maintain. Medical students are peppering it with sample questions to help train it.

Chase, a Columbia University medical school professor, says anecdotal information � such as personal blogs from medical websites � may also be included.

"What people say about their treatment ... it's not to be ignored just because it's anecdotal," Chase said. "We certainly listen when our patients talk to us, and that's anecdotal."

Chase and other experts say cramming Watson with the latest medical information will help with a major problem in modern health care: information overload.

"For at least 30 years it's been clear that it's not possible for us to know everything," he said. "Every day, doctors have questions they can't find the answers to. Even if you sit down at a search engine, it's so labor intensive and it takes so long to find answers."

Carl Kesselman, director of the Health Informatics Center at the University of Southern California, says the "deluge of information" is a significant problem.

"Advances in medicine are increasing rapidly: genomics, specialized drugs, off-label uses, increasingly finer-grained classifications of disease," said Kesselman, who is not involved with the Watson project. "The ability to ask `Jeopardy!'-style questions and get that kind of information retrieval, to sort through all the stuff out there and point you to the latest literature, would be of potentially huge value."

Michael Yuan, chief scientist at Ringful Health, a medical consulting company in Austin, Texas, that has worked with IBM, cited a 1999 study of 103 doctors that found they fielded more than 1,100 questions a day, of which 64 percent were never answered.

"That's a huge potential for people to make mistakes," he said. "Watson is the type of solution that can really reduce that."

In "Jeopardy!" Watson was asked for one correct answer, whether it was answering questions about Sir Christopher Wren, the Lion of Nimrud or the Church Lady from "Saturday Night Live."

But in its medical guise, when presented a set of symptoms, Watson offers several possible diagnoses, ranked in order of its confidence.

"In medicine, we don't want one answer, we want a list of options," Chase said.

Kesselman said having options might help doctors accept a computer's findings.

"Will a physician ever blindly accept a diagnosis coming out of a computer? I don't think that will happen anytime soon," he said.

Chase said seeing more than one choice might also help doctors move away from what he called "anchoring," or getting too attached to a diagnosis.

"If a person has a 95 percent chance of having disease X, there's still a one-in-20 chance that they have something else," he said. "We often forget what's in that 5 percent. But Watson won't."

The treatment application works much like the diagnosis application. In the demonstration, Watson first suggested the antibiotic doxycycline for treating Lyme disease, then switched to cefuroxime when told the patient was pregnant and allergic to penicillin.

Chase said Watson will know the latest treatment guidelines � which are complex and often updated � "and can see if they're not being met."

"You have to match the right treatment with each unique patient," Chase said. "You can't treat everybody with high blood pressure the same way � a 75-year-old man with prostate cancer who felt dizzy last week and a 32-year-old woman."

Yuan said Watson's influence will depend on "how widely it is adopted."

"You have to wonder if a hospital is going to plunk down a couple of million dollars," he said.

IBM's Dan Pelino, general manager for global health care, said clients won't have to buy a complete Watson system. He said possible future uses include:

� Allowing a doctor to connect to Watson's database by speaking into a hand-held device, using speech-recognition technology and cloud computing;

� Serving as a repository for the most advanced research in cancer or other fields;

� Providing an always-available second opinion.

"You can imagine someone asking Watson a question on an iPad as they're walking down the hall," Chase said. "It might get updates like a GPS."

An existing private medical database known as Isabel is already used by some multi-hospital health systems. Co-founder Jason Maude of Isabel Healthcare said that from what he's heard about IBM's plans for Watson, "It's kind of what we've had for about 10 years."

An online demonstration of Isabel showed similarities to the Watson model � symptoms are entered, and the computer searches through a database for a possible diagnosis. Maude, who named Isabel for a daughter who escaped a serious misdiagnosis as a child, says Isabel's database has been "tuned and honed" over time.

He said prices for using Isabel range from a few thousand dollars a year for a family practice to as much as $400,000 for a health system.

Pelino said Watson is much faster and Chase said Watson is better at understanding non-medical terms.

"Watson knows that `difficulty swallowing' is `dysphagia,'" he said.

Isabel has been used at the Orlando Health hospital network in Florida since last fall, and "has had its successes," said Dr. Jay Falk, chief academic medical officer. He said less experienced doctors use it under the guidance of senior clinicians "who can make some judgments about the likelihood of what's given on the list of diagnoses."

"There's no question that there's a need for a tool that will help in this regard," Falk said. "Whether Isabel itself is the answer is unclear." Overall, he said, "We're enjoying learning with it."

IBM said Watson can answer some medical questions in the same few moments it took on "Jeopardy!" Yuan noted studies have shown that "If it takes more than two minutes, it won't get used."

As on "Jeopardy!" � where Watson identified Toronto as a U.S. city and Picasso as an art period � the computer occasionally bungles a medical question.

"I think once we were asking what type of drug we should use and the answer was a person's name," Chase said. "In fairness, I think it was a person associated with the drug."

And of course there are things Watson cannot do. It won't know a patient's appetite for risk, for example, or feelings about end-of-life treatment.

"That's why you have to emphasize that the decisions aren't coming from the computer, they're coming from the patient," Chase said.

Chase's suggestion that medical blogs be included may have something to do with his own medical history.

Several years ago, fighting a cholesterol problem, he took Lipitor and was soon plagued with insomnia. He suspected a connection but found nothing in textbooks or journals.

"I go to the blogosphere, and it was like, `You moron, don't take Lipitor before you go to bed because you'll never sleep again!'

"Now it's five years later, and if you Google Lipitor and insomnia, it's all over the place," Chase said.

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CDC's 'zombie apocalypse' advice an Internet hit (AP)

ATLANTA � "Zombie apocalypse." That blog posting headline is all it took for a behind-the-scenes public health doctor to set off an Internet frenzy over tired old advice about keeping water and flashlights on hand in case of a hurricane.

"You may laugh now, but when it happens you'll be happy you read this, and hey, maybe you'll even learn a thing or two about how to prepare for a real emergency," wrote Dr. Ali Khan on the emergency preparedness blog of the federal Centers for Disease Control and Prevention.

Above the post is a photo of what appears to be a dirty-fingered female zombie.

Khan's postings usually draw 1,000 to 3,000 hits in a week. This one � posted Monday � got 30,000 within a day. By Friday, it had gotten 963,000 page views and was the top item viewed on the agency's Web site, thanks in part to media coverage that began mid-week.

As of Friday morning, the traffic showed no signs of abating.

"The response has been absolutely excellent. Most people have gotten the fact that this is tongue-and-cheek," Khan said.

More important, CDC officials said, it is drawing interest from teens and young adults who otherwise would not have read a federal agency's guidance on the importance of planning an evacuation route or how much water and what tools to store in case a major storm rolls in.

The idea evolved from a CDC Twitter session with the public earlier this year about planning for disasters. Activity spiked when dozens of tweets came in from people saying they were concerned about zombies.

Dave Daigle, a veteran communications specialist, proposed the idea of using a zombie hook to spice up the hurricane message. Khan, director of emergency preparedness, approved it immediately and wrote it himself.

"Most directors would have thrown me out of their office," Daigle laughed. "Ali has a good sense of humor."

In the blog, Khan discussed what fiction has said about flesh-eating zombies and the various infectious agents that different movies have fingered as the cause.

His favorite zombie flick is "Resident Evil," but his interest in unpredictable terrors is driven more by his decades of work tracking real-life infections like Ebola hemorrhagic fever, bird flu and SARS.

CDC officials said the feedback they've gotten is almost completely positive, including a nice note from the boss, Dr. Tom Frieden.

Almost as rewarding was a nice comment Daigle said he received from his 14-year-old daughter, who has shown little interest in her dad's work but saw the zombie post and said, "This is cool!"

There have been few comments asking whether this is the best way for the government to spend tax dollars. The agency is under a tight budget review at the moment and facing potentially serious budget cuts. But the zombie post involved no extra time or expenditure, CDC officials said.

"We have a critical message to get out and that is CDC saves lives while saving money. If it takes zombies to help us get that message out, then so be it," said agency spokesman Tom Skinner.

Whether the message sticks still has to be determined. The agency is planning a follow-up survey to see if people actually did prepare emergency kits or follow Khan's other advice.

CDC deserves credit for trying something like this, said Bill Gentry, director of the community preparedness and disaster management program at the University of North Carolina's school of public health.

But that doesn't mean the agency should start using vampires to promote vaccinations or space aliens to warn about the dangers of smoking.

"The CDC is the most credible source out there for public health information," he said. "You don't want to risk demeaning that."

___

Online:

CDC's emergency preparedness blog: http://bit.ly/ikth7k

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Kept in chains: Mental illness rampant in Somalia (AP)

MOGADISHU, Somalia � Hassan Qasim lies shackled to a wall in a hallway with 25 other patients at a clinic for the mentally ill. He whispers under his breath and spits at his neighbors. Torn and dirty clothes hang off his skinny frame.

Doctors say the 25-year-old's brother and sister were killed in front of him, and that he was abducted and tortured by gunmen. Soon after, Qasim began wandering the streets naked, lashing out at passers-by.

In this Horn of Africa nation that has been mired in anarchy and war for two decades, nearly all families have been touched by tragedy. The World Health Organization estimates that one in three Somalis have suffered from some kind of mental illness, a rate that is among the highest in the world.

Gunfire crackles every few seconds in Mogadishu at night, and mortars scream out of the sky.

"We believe every bullet or mortar will cause more people to become mentally ill," said Dr. Abdirahman Ali Awale, a Somali psychiatrist.

Somalia's civil war also has simultaneously destroyed health care infrastructure to treat the traumatized. A World Health Organization report found that the country has only three psychiatrists and no psychologists working at its five main mental health facilities.

As a result, some Somalis have been chained up in mental wards for as long as eight years, according to the WHO. At one mental health facility, almost 50 percent of patients were chained. At other clinics, doctors recite the Quran to patients, hoping it will improve their condition.

This year, WHO began giving medicine and other supplies to the Habeb mental hospital, the only facility that treats patients without detaining them.

"Our treatment is chain-free. We never restrain them," said Dr. Abdirahman Habeb. He says the facility has treated more than 9,000 psychiatric patients using a combination of medicine and counseling. Still, the majority of mentally ill people in Somalia face much grimmer prospects.

The Somali government, which is consumed by political infighting and battling an al-Qaida-linked insurgency, is unable to even assert control over all of Mogadishu much less help its traumatized population. It relies on 9,000 African Union peacekeepers to retain control of half the country's capital.

Dr. Rizwan Hamayun, who helped write a WHO study earlier this year examining mental health in Somalia, said the chaos has resulted in a loss of jobs, family, homes and property which in turns can contribute to mental illness. His latest new patient was a shepherd who attempted suicide after losing all his animals not to war but to a natural calamity � an ongoing drought.

While poverty and fear are the main triggers for mental illness, some also have been intimidated by continuous threats made by insurgents over mobile phones. Insurgents call and threaten people they suspect of collaborating with the government. As punishment for alleged crimes, insurgents saw off captives' hands and feet in public squares and stone people to death.

The insurgents accused Ibrahim Nuraddin of selling phone credit, bread, and other small items to Somali soldiers. The elderly former shopkeeper had a mental breakdown after receiving frequent death threats, relative Ibrahim Farabadn said.

Nuraddin had already spent one year imprisoned in his family's house or tied to a tree. Finally, relatives sought treatment after hearing that a Mogadishu clinic was taking patients. Three hefty men dragged Nuraddin into the clinic but he struggled to escape. They quickly chained him up.

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Home births up, driven by natural birth subculture (AP)

ATLANTA � Home births rose 20 percent over four years, government figures show, reflecting what experts say is a small subculture among white women toward natural birth.

Fewer than 1 percent of U.S. births occur at home. But the proportion is clearly going up, study by researchers at the Centers for Disease Control and Prevention found. The new figures are for 2004 to 2008. Home births had been declining from 1990 to 2004.

The increase was driven by white women � 1 in 98 had their babies at home in 2008, the most recent year for which the statistics were available.

Only about 1 in 357 black women give birth at home, and just 1 in 500 Hispanic women do.

"I think there's more of a natural birth subculture going on with white women � an interest in a low-intervention birth in a familiar setting," said the lead author, Marian MacDorman of the CDC's National Center for Health Statistics.

For all races combined, about 1 in 143 births were at home in 2008, up from 1 in 179 in 2004.

Geographically, 27 states had significant increases during those four years. Montana, Vermont and Oregon had the most home births � about 1 in 50 births were at home in those states.

Alaska's rate was nearly as high, and it's clear that some home births occur because women are in remote locations and are not able to get to hospitals in time for delivery.

The increase is notable because doctors groups have been increasingly vocal about opposing home births, The American College of Obstetricians and Gynecologists has for years warned against home births, arguing they can be unsafe, especially if the mother has high-risk medical conditions, if the attendant is inadequately trained or if there's no quick way to get mother and child to a hospital if something goes awry.

Doctor participation in home births declined by 38 percent from 2004 to 2008. The percentage of home births attended by certified midwives and nurse-midwives grew, meanwhile.

Home births increasing? "From our perspective, that's not the best thing for the overall health of babies and women," said Dr. George Macones, an obstetrician at Washington University in St. Louis who chairs ACOG's Committee on Obstetric Practice.

Exactly how unsafe home births are is a matter of medical controversy, with studies offering conflicting conclusions. And some argue that hospitals present their own dangers of infection and sometimes unnecessary medical interventions.

The CDC researchers did find that home births involving medical risks became less common from 2004 to 2008. Home births of infants born prematurely fell by 16 percent, so that by 2008 only 6 percent of all home births involved preterm births. That's less than half the percentage in hospitals.

The study was done by two CDC researchers and a Boston university professor. It was electronically published Friday by a medical journal called Birth: Issues in Perinatal Care.

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Paralyzed man freely moves after getting implant (AP)

LONDON � After Rob Summers was paralyzed below the chest in a car accident in 2006, his doctors told him he would never stand again. They were wrong.

Despite intensive physical therapy for three years, Summers' condition hadn't improved. So in 2009, doctors implanted an electrical stimulator onto the lining of his spinal cord to try waking up his damaged nervous system. Within days, Summers, 25, stood without help. Months later, he wiggled his toes, moved his knees, ankles and hips, and was able to take a few steps on a treadmill.

"It was the most incredible feeling," said Summers, of Portland, Oregon. "After not being able to move for four years, I thought things could finally change."

Still, despite his renewed optimism, Summers can't stand when he's not in a therapy session with the stimulator turned on, and he normally gets around in a wheelchair. Doctors are currently limiting his use of the device to several hours at a time.

His case is described in a paper published Friday in the journal, Lancet. The research was paid for by the U.S. National Institutes of Health and the Christopher and Dana Reeve Foundation.

For years, certain people with incomplete spinal cord injuries, who have some control of their limbs, have experienced some improvement after experiments to electrically stimulate their muscles. But such progress had not been seen before in someone with a complete spinal cord injury.

"This is not a cure, but it could lead to improved functionality in some patients," said Gregoire Courtine, head of experimental neurorehabilitation at the University of Zurich. He was not connected to Summers' case. Courtine cautioned Summers' recovery didn't make any difference to the patient's daily life and that more research was needed to help paralyzed people regain enough mobility to make a difference in their normal routines.

The electrical stimulator surgeons implanted onto Summers' spinal cord is usually used to relieve pain and can cost up to $20,000. Summers' doctors implanted it lower than normal, onto the very bottom of his vertebrae.

"The stimulator sends a general signal to the spinal cord to walk or stand," said Dr. Susan Harkema, rehabilitation research director at the Kentucky Spinal Cord Injury Research Center in Louisville and the Lancet study's lead author.

Harkema and her colleagues were surprised Summers was able to voluntarily move his legs. "That tells us we can access the circuitry of the nervous system, which opens up a whole new avenue for us to address paralysis," Harkema said. She said prescribing drugs might also speed recovery.

Dr. John McDonald, director of the International Center for Spinal Cord Injury at Kennedy Krieger Institute in Baltimore, said the strategy could be rapidly adopted for the 10 to 15 percent of paralyzed patients who might benefit. He was not connected to the Summers case.

"There is no question we will do this for our patients," he said. McDonald added that since the electrical stimulators are already approved for pain relief, it shouldn't be difficult to also study them to help some patients regain movement.

For now, Summers does about two hours a day of physical therapy.

"My ultimate goal is to walk and run again," he said. "I believe anything is possible and that I will get out of my wheelchair one day."

___

Online:

http://www.lancet.com

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Swimmer's ear medical costs total $500M a year (AP)

ATLANTA � The first national estimates of swimmer's ear say it causes about 2.4 million trips to doctors and hospitals in a year.

The Centers for Disease Control and Prevention also said swimmer's ear cases amounted to about $500 million in annual medical costs � or roughly $200 per visit.

Some people get the problem repeatedly, and the CDC didn't estimate how many Americans suffer swimmer's ear each year. But according to calculations by The Associated Press based on CDC statistics, more than 2 million get it.

Swimmer's ear is an itchy, painful, outer-ear infection that can occur when bacteria in swimming water get through breaks in the skin. It's commonly treated with antibiotic ear drops.

More than half the cases were in adults. The CDC released the statistics Thursday.

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HPV test beats Pap for cervical cancer screening (AP)

Two big studies suggest possible new ways to screen healthy people for cervical or prostate cancers, but a third disappointed those hoping for a way to detect early signs of deadly ovarian tumors.

Researchers found:

_For women 30 and over, a test for the virus, HPV, is better than a Pap smear for predicting cervical cancer risk, and those who test negative on both can safely wait three years to be screened again.

_A single PSA blood test at ages 44 to 50 might help predict a man's risk of developing advanced prostate cancer or dying of it up to 30 years later. The PSA test is notoriously unreliable, but using it this way separates men who need a close watch from those who are so low-risk that they can skip testing for five years or more.

_Screening women with no symptoms for ovarian cancer with a blood test and an ultrasound exam is harmful. It didn't prevent deaths and led to thousands of false alarms, unneeded surgeries and serious complications.

The last study is a warning to people who get screening tests that aren't recommended, or who question whether screening can ever hurt.

"The answer is, it could hurt a lot," said Dr. Allen Lichter, chief executive of the American Society of Clinical Oncology. The group published these and 4,000 other studies Wednesday, ahead of its annual meeting next month.

Cervical cancer is easy to prevent. It's very slow-growing and screening finds precancerous cells and allows early treatment. The new study was the first big one to examine a newer screening tool, HPV tests, with or without Pap smears in routine practice.

For a Pap test, cells scraped from the cervix, the gateway to the uterus, are checked under a microscope. But this can miss problems or raise false alarms.

HPV tests detect the human papillomavirus, which causes most cases of cervical cancer. But HPV is "the common cold" of the nether regions � most sexually active young people have been exposed to it, said Debbie Saslow, the American Cancer Society's director of breast and gynecologic cancer. Most infections go away on their own; they're only a cancer risk when they last a year or more.

Younger women tend to have short-term infections, so Pap tests are a better way to screen them. HPV tests are approved as an option along with Paps for women 30 and older, and the cancer society says that if a woman tests negative on both, she can wait three years to be screened again. Few take this advice, though.

"Women still want their annual Pap and doctors still want to give them," and think it's rationing care to test less often, Saslow said.

The new study gives "very, very solid support" for screening less often, Lichter said.

Hormuzd Katki of the National Cancer Institute studied more than 330,000 women getting HPV and Pap tests through Kaiser Permanente Northern California for five years.

Only about three out of 100,000 women each year developed cervical cancer after negative HPV and Pap tests. HPV tests were twice as good as Paps for predicting risk. Adding a Pap after a negative HPV test did little to improve risk prediction.

However, if an HPV test was positive, a Pap test helped confirm or rule out the need for follow-up.

The study didn't look at the downside of HPV testing � how many false alarms and needless procedures it triggered. HPV tests cost $80 to $100 compared to $20 to $40 for Paps.

The prostate study sought a better way to use PSA tests, which are troublesome because PSA can be high for many reasons besides cancer, and doctors don't know which cancers need treatment or whether screening saves lives. Most groups don't recommend PSA tests, but most men over 50 get them anyway.

The new study "is not going to end the controversy, but it suggests a very interesting middle ground," Lichter said.

Researchers at Memorial Sloan-Kettering Cancer Center in New York used stored blood samples that 12,000 Swedish men gave for a heart study decades ago, when most were 44 to 50 years old. They also had second samples from some of them six years later, and samples from other 60-year-old men.

Looking 27 years later, researchers saw that 44 percent of cancer deaths occurred in men whose initial PSAs had been in the top 10 percent when they were 44 to 50 years old.

Conversely, scoring below the median meant very little cancer risk years later.

"They're identifying a group of guys who don't need to be screened, or need to be screened less often," said Dr. Otis Brawley, the cancer society's chief medical officer.

The results are "provocative," but this type of study can't prove that screening prevents deaths, said Dr. Matthew R. Smith of the Massachusetts General Hospital Cancer Center. Few of the Swedish men were treated for prostate cancer as most men are today, which can affect survival.

The National Cancer Institute, the Swedish Cancer Society and several foundations paid for the work, and one researcher holds patents for two PSA-related tests.

Baseline PSA tests for men in their 40s can't be recommended yet, Brawley said. The cancer society says men should be informed of the risks and benefits of PSA tests starting at age 50, and sooner for blacks and those with family history of prostate cancer.

The government-funded ovarian cancer study involved nearly 80,000 women. Half were screened annually with an ultrasound for four years and a blood test for six years. The blood test looked for CA-125, a substance often elevated in ovarian cancer.

After 13 years, there were no major differences in ovarian cancers found or deaths from the disease. Screening found only 212 cancers while giving 3,285 false alarms that led to 1,080 unneeded biopsy surgeries and 163 serious complications.

"So many people say `how can cancer screening be harmful?' This thing documents it," Brawley said.

The results don't apply to using these tests on women with symptoms of ovarian cancer or abnormal physical exams. That's still the best way to check for ovarian cancer in those cases.

___

Online:

CDC on HPV tests: http://www.cdc.gov/hpv/Screening.html

Cancer Society on HPV: http://tinyurl.com/44gnadx

Cervical cancer science review: http://tinyurl.com/6lc2rzg

Oncology society: www.cancer.net

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