Health Articles Blogs: August 2011

Wednesday, August 31, 2011

CDC: Half of Americans have a sugary drink daily (AP)

ATLANTA � Health officials say half of Americans drink a soda or sugary beverage each day � and some are downing an awful lot.

A new study found that one in 20 drinks the equivalent of more than four cans of soda each day. The Centers for Disease Control and Prevention research also showed teenage boys drink the most soda, sports drinks and other sugary liquids.

Sweetened drinks have been linked to the U.S. explosion in obesity, and health officials have been urging people to cut back. Many schools have stopped selling soda or artificial juices.

The CDC report released Wednesday is said to be the first to offer national statistics for adults and kids. Past studies have focused on certain groups, particularly school kids.

Monday, August 29, 2011

Need a C-section? Protection from blood clot urged (AP)

WASHINGTON � New advice for pregnant women: If you're getting a C-section, special inflating boots strapped on your legs may lower the risk of a blood clot.

Hospitals already use these compression devices for other major operations, such as hip replacements, and a growing number have begun offering them for at least some of their cesarean deliveries, too.

Now guidelines for the nation's obstetricians say it's time to make the step routine for most C-sections, which account for nearly a third of U.S. births.

The new recommendations promise to raise awareness of what is a silent threat not just for pregnant women but for thousands of other people, too: Blood clots in veins that can masquerade as simple leg pain.

Called a DVT, for deep vein thrombosis, this kind of clot usually starts in the leg or groin. But it can kill if it moves up to the lungs, where it's called a pulmonary embolism.

These clots make headlines every few years when seemingly healthy people collapse after long airplane flights or similar prolonged inactivity. Certain surgeries also can trigger a DVT. Earlier this year, tennis star Serena Williams was treated for clots in her lungs discovered after foot surgery and cross-country travel.

Obesity, some types of injuries, even some birth control pills can increase the risk, too.

A woman's risk of a DVT jumps during pregnancy and the six weeks afterward. That's partly because of slower blood flow from the weight gain, and because mom is less active in the last trimester and during those first few weeks of recovery from childbirth.

It's also because pregnancy temporarily changes blood to make it clot more easily.

"This is a consequence of nature's protecting women against the bleeding challenges of childbirth," explains Dr. Andra James of Duke University, who co-authored the new guidelines from the American College of Obstetricians and Gynecologists.

Add a C-section and, like any major surgery, it further increases that risk.

As many as two of every 1,000 pregnant women will experience a DVT, James says. Fortunately, pregnancy-related deaths are very rare in this country, but when they happen, those clots are one of the leading reasons.

Yet too few people even know the warning signs, she says: Pain or swelling in one leg, especially the calf or thigh. Redness or warmth in one spot on the leg. If the clot has reached the lung, shortness of breath or chest pain.

The new guidelines urge obstetricians to closely monitor their patients for DVTs � and to check if they have additional factors that would put them at extra risk. Women who've had a DVT earlier in life, or whose close relatives had one � or who have certain inherited clotting disorders � may need anti-clotting medicines throughout the pregnancy, say the recommendations, published in the September issue of the journal Obstetrics & Gynecology.

Then there are those compression devices, which slip over each leg and regularly inflate and deflate, sort of like a massage, to help blood flow more briskly.

The obstetricians' group acknowledges that there haven't been large studies with C-sections to prove how much difference the gadgets could make. But it decided to recommend them anyway because in other types of surgery, the devices can cut the clot risk by two-thirds, James says.

The guidelines recommend strapping them on before the C-section begins, unless there's no time before an emergency operation or the woman is taking anti-clotting medication.

Mount Sinai Medical Center in New York began using the devices for C-sections a few years ago, and deputy chief medical officer Dr. Erin DuPree says they add $14 to the cost of care. Women typically remove and replace them as they ease out of bed throughout the first day after surgery, and no longer need them by the second day, she says.

"It's an easy thing to do that really does not cause harm and could potentially help," she says.

James stresses that leg compression shouldn't lull a woman into thinking she can rest in bed rather than push herself to walk � and a new mom should remain alert to symptoms when she goes home because half of pregnancy-related DVTs occur in those weeks after childbirth.

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

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Online:

DVT info: http://www.cdc.gov/ncbddd/dvt/index.html

New HIV case causes LA porn industry shutdown (AP)

LOS ANGELES � A porn industry group says an adult film performer has tested positive for HIV, resulting in a production moratorium in Southern California while the organization investigates to see if the virus has spread.

Free Speech Coalition executive director Diane Duke told The Los Angeles Times ( http://lat.ms/mX0vin) on Monday that her group became aware of the HIV case Saturday.

Duke declined to release the performer's name, age or gender. She also declined to tell the Times how her group learned of the case.

According to Duke, the case was found in an out-of-state clinic that doesn't report to California state officials. Duke says the performer is being retested to confirm the HIV.

The group is working to identify others who had sex with the performer.

UN warns of bird flu resurgence, new Asian strain (AP)

ROME � The United Nations warned Monday of a possible resurgence of the deadly bird flu virus, saying wild bird migrations had brought it back to previously virus-free countries and that a mutant strain was spreading in Asia.

A mutant strain of H5N1, which can apparently sidestep defenses of existing vaccines, is spreading in China and Vietnam, Tthe U.N. Food and Agriculture Organization said in a statement Monday. It urged greater surveillance to ensure that any outbreaks are contained.

Last week, the World Health Organization reported that a 6-year-old Cambodian girl had died Aug. 14 from bird flu, the eighth person to die from H5N1 avian influenza this year in Cambodia.

Vietnam suspended its springtime poultry vaccination this year, FAO said. Most of the northern and central parts of the country where the virus is endemic have been invaded by the new strain.

Elsewhere, FAO says bird migrations over the past two years have brought H5N1 to countries that had been virus-free for several years, including Israel, the Palestinian territories, Bulgaria, Romania, Nepal and Mongolia.

"Wild birds may introduce the virus, but people's actions in poultry production and marketing spread it," said FAO's chief veterinary office Juan Lubroth in urging greater preparedness and surveillance.

WHO says globally there have been 331 human deaths from 565 confirmed bird flu cases since 2003 when it was first detected.

The virus was eliminated from most of the 63 countries infected at its peak in 2006, but it remained endemic in six countries: Bangladesh, China, Egypt, India, Indonesia and Vietnam.

The number of outbreaks in poultry and wild bird populations shrank from a high of 4000 to 302 in mid-2008, but outbreaks have risen progressively since, with almost 800 cases reported in 2010-2011, FAO said.

"The general departure from the progressive decline in 2004-2008 could mean that there will be a flare-up of H5N1 this fall and winter, with people unexpectedly finding the virus in their backyard," Lubroth said in a statement.

Taiwan hospital transplants 5 HIV-infected organs (AP)

TAIPEI, Taiwan � One of Taiwan's best regarded hospitals transplanted organs from an HIV carrier into five patients, a hospital official said Monday, in what appears to be one of the most egregious examples of medical negligence in the island's modern history.

The five are now being treated with anti-AIDS drugs, said the official at National Taiwan University Hospital in Taipei.

The official spoke on condition of anonymity because she is not authorized to deal with the media.

In a posting on its website over the weekend, the hospital said the mistake occurred because a transplant staffer believed he heard the English word "non-reactive" on the donor's standard HIV test, which means negative, while the word "reactive" was actually given.

The hospital added that the information on the test result was given over the telephone and was not double-checked, as required by standard operating procedures.

"We deeply apologize for the mistake," the hospital said.

Shih Chung-liang, a Health Department official, said a department team will look into the mistaken transplants and decide on possible penalties for NTUH.

The donor was a 37-year-old man who fell into a coma on Aug. 24 and his heart, liver, lungs and two kidneys were transplanted to five patients on the same day. The heart transplant was conducted at another hospital, while the four other transplants were conducted at NTUH, according to NTUH.

The donor's mother, who was not identified, told cable news stations that she felt terrible about the transplants and had not been aware of her son's ailment. She said he died after "falling from a high spot," without providing details.

Yao Ke-wu, who heads the health department of Hsinchu city, where the donor resided, decried the NTUH transplants as "appalling negligence."

He said NTUH staffers could have avoided the mistake by asking his department about the donor's medical history in advance, and deplored that such inquiries were not mandatory in Taiwan.

Yao said the five organ receivers will very likely contract HIV, and their anti-AIDS treatment will be further complicated because they also have to take medication to modify rejection of the new organs.

There are also concerns among the physicians and nurses who conducted the transplants that they too may contract HIV.

Lee Nan-yao, a physician with the National Chengkung University Hospital, which performed the heart transplant, told the United Daily News that some physicians and nurses who had conducted the transplant "were depressed, and on the verge of panic."

(This version CORRECTS Adds details, byline. Updates with authorities investigating transplants. Corrects how mistake was made.)

Saturday, August 27, 2011

FDA approves gene-targeting lung cancer drug (AP)

WASHINGTON � The Food and Drug Administration has approved a new Pfizer drug for a subset of lung cancer patients with a particular genetic mutation.

The twice-a-day pill, called Xalkori, is part of a new wave of personalized medications that fight disease by targeting specific genes found in certain patients. Last week, the FDA approved another drug that uses similar gene targeting technology to treat two rare forms of lymph node cancer.

Xalkori is approved to treat a small subset of non-small cell lung cancer patients, less than 7 percent, who have an abnormal gene that stimulates cancer cells and causes tumor growth. It works by blocking proteins produced by the gene.

"It's another example of how we're using molecular medicine to subtype lung cancer into more specific and treatable diseases," said Dr. Roy Herbst, a lung cancer expert who is chief of medical oncology at Yale University.

Including previously approved targeted therapies, "we have specific therapies now that we can offer for about 18 percent of lung cancer patients that are far superior to chemotherapy and that in many cases can cause their tumors to melt away with few side effects," Herbst said.

The FDA said it also approved a genetic test to screen for the mutation, known as an abnormal anaplastic lymphoma kinase gene. The test is made by Abbott Laboratories.

About 187,000, or 85 percent, of the 220,000 lung cancer cases diagnosed each year are non-small cell lung cancer. Roughly three-fourths of patients aren't diagnosed until tumors have spread, and only 6 percent of those patients live five years.

"It's pretty exciting," said Dr. David Carbone, a lung cancer specialist at Vanderbilt University, one of the sites that tested the drug. Only a small share of lung cancer patients have the gene mutation this drug targets, "but for those people it makes a huge difference," he said.

Analysts predict Xalkori could be a blockbuster product for Pfizer, eventually reaping more than $2 billion in annual sales by 2021.

The FDA approved the drug under its accelerated approval program, which speeds up the clearance of therapies that show promising early results.

Pfizer released follow-up data on the drug in June, reporting that 88 percent of patients in one study saw their tumors shrink at least somewhat after one year on Xalkori. In a second study, 54 percent of patients had their tumors shrink by about a third or more and 83 percent had tumors shrink somewhat. Most patients had only mild side effects, but two of the nine patient deaths during that study were considered treatment-related.

The most common side effects of the drug include vision disorders, nausea, diarrhea and inflammation.

The FDA's accelerated approval program has come under criticism in the last year after follow-up studies showed the best-selling cancer drug Avastin did not extend the lives of patients with breast cancer. The FDA granted the drug accelerated approval because a single study suggesting it slowed tumor growth. The FDA is now in the process of trying to remove the drug's indication, though the drug maker, Roche, has appealed the decision.

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AP Medical Writer Marilyn Marchione contributed reporting from Milwaukee.

Thursday, August 25, 2011

Report: Vaccines generally safe, some side effects (AP)

WASHINGTON � Vaccines can cause certain side effects but serious ones appear very rare � and there's no link with autism and Type 1 diabetes, the Institute of Medicine says in the first comprehensive safety review in 17 years.

The report released Thursday isn't aimed at nervous parents. And the side effects it lists as proven are some that doctors long have known about, such as fever-caused seizures and occasional brain inflammation.

Instead, the review comes at the request of the government's Vaccine Injury Compensation Program, which as the name implies, pays damages to people who are injured by vaccines. Federal law requires this type of independent review as officials update side effects on that list to be sure they agree with the latest science.

"Vaccines are important tools in preventing serious infectious disease across the lifespan, from infancy through adulthood. All health care interventions, however, carry the possibility of risk and vaccines are no exception," said pediatrician and bioethicist Dr. Ellen Wright Clayton of Vanderbilt University, who chaired the institute panel.

Still, the report stresses that vaccines generally are safe, and it may help doctors address worries from a small but vocal anti-vaccine movement. Some vaccine-preventable diseases, including measles, are on the rise.

"I am hopeful that it will allay some people's concerns," Clayton said.

The review echoed numerous other scientific reports that dismiss an autism link.

But it found convincing evidence of 14 side effects:

_Fever-triggered seizures, which seldom cause long-term consequences, from the measles-mumps-rubella, or MMR, vaccine.

_MMR also can cause a rare form of brain inflammation in some people with immune problems.

_The varicella vaccine against chickenpox sometimes triggers that viral infection, resulting in widespread chickenpox or a painful relative called shingles. It also occasionally can lead to pneumonia, hepatitis or meningitis.

_Six vaccines � MMR and the chickenpox, hepatitis B, meningococcal and tetanus-containing vaccines � can cause severe allergic reactions known as anaphylaxis.

_Vaccines in general sometimes trigger fainting or a type of shoulder inflammation.

There's suggestive evidence but not proof of a few other side effects, including anaphylaxis from the human papillomavirus, or HPV, vaccine and short-term joint pain in some women and children from the MMR vaccine.

On the other hand, the report cleared flu shots of blame for two long-suspected side effects: Bell's palsy and worsening of asthma.

That doesn't mean there aren't other side effects � the review couldn't find enough evidence to decide about more than 100 other possibilities. Some vaccines are just too new to link to something really rare. Another example: Flu shots have long come with a caution about rare, paralyzing Guillain-Barre syndrome, but Clayton said research hasn't settled if that's a coincidence since the disorder is more common during the winter.

The Health Resources and Services Administration, which runs the vaccine compensation program, is reviewing the report but said it's too early to predict if it will prompt changes to the injury list.

Wednesday, August 24, 2011

Specialized mosquitoes may fight tropical disease (AP)

NEW YORK � Scientists have made a promising advance for controlling dengue fever, a tropical disease spread by mosquito bites. They've rapidly replaced mosquitoes in the wild with skeeters that don't spread the dengue virus.

More than 50 million people a year get the dengue virus from being bitten by infected mosquitoes in tropical and subtropical areas, including Southeast Asia. It can cause debilitating high fever, severe headaches, and pain in the muscles and joints, and lead to a potentially fatal complication. There's no vaccine or specific treatment.

Some scientists have been trying to fight dengue by limiting mosquito populations. That was the goal in releasing genetically modified mosquitoes last year at sites in Malaysia and the Cayman Islands.

Australian scientists took a different tack, they report in Thursday's issue of the journal Nature.

First, they showed that Aedes aegypti mosquitoes, the chief carriers of the dengue virus, resist spreading that virus if they are infected with a particular kind of bacteria. Then they tested whether these resistant mosquitoes could displace their ordinary cousins in the wild, thus reducing the number of dengue-spreading mosquitoes.

The resistant mosquitoes have an advantage in reproduction. Resistant females can mate with either resistant or ordinary mosquitoes, and all their offspring will be resistant. But when ordinary females mate with a resistant male, none of the offspring survive.

For the experiment, scientists released more than 140,000 resistant mosquitoes over 10 weeks in each of two isolated communities near Cairns in northeastern Australia, starting last January. By mid-April, monitoring found that resistant mosquitoes made up 90 percent to 100 percent of the wild population.

The result is a "groundbreaking first step," Jason Rasgon of the Johns Hopkins Bloomberg School of Public Health in Baltimore wrote in a commentary accompanying the paper. Rasgon, who did not participate in the study, said the next hurdle is to test the idea in areas where dengue is spread constantly, rather than sporadically as in Australia. Researchers will also have to show it works against varied strains of the dengue virus, he said.

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Online:

Journal: www.nature.com/nature

Disease information: http://bit.ly/r0i8Lq

FDA warns of heart risks with high doses of Celexa (AP)

WASHINGTON � Federal health regulators are warning doctors not to prescribe high doses of the antidepressant Celexa, because of the risk of fatal heart complications.

The Food and Drug Administration said in an online posting that the drug can interfere with the heart's electrical activity at doses above 40 milligrams.

The label for Celexa previously stated that some patients should receive 60 milligrams, but the FDA has eliminated that language. "Studies did not show a benefit in treatment of depression at doses higher than 40 mg per day," the FDA states.

The new label will emphasize that Celexa should not be used in patients with congestive heart failure and other conditions that affect the heart's pumping action.

Drugmaker Forest Laboratories sells Celexa in doses of 10, 20 and 40 milligrams

APNewsBreak: Global Fund lifts China grant freeze (AP)

BEIJING � A high-profile global health fund that has come under pressure to clean up corruption has ended its dispute with China and will resume hundreds of millions of dollars in funding for programs to fight AIDS and other diseases, thereby removing a source of embarrassment for Beijing.

The Global Fund to Fight AIDS, Tuberculosis and Malaria froze disbursements of its AIDS grant to China in November and then all other grants in May over suspected misuse of the money and the government's reluctance to involve community groups. The move was seen as a rebuke to the authoritarian government over its customary suspicion of independent groups.

The Geneva-based Global Fund said Tuesday it is lifting the freeze on funding to China to ensure AIDS work in the country continues while it works with government officials, representatives from United Nations' agencies and private groups to resolve the dispute.

"During these discussions, the parties agreed to resume funding flows to ensure that the Chinese AIDS program would not be impeded by the ongoing efforts to strengthen fiduciary controls and to ensure sufficient civil society engagement in The Global Fund-supported programs," Global Fund spokesman Jon Liden emailed in response to an Associated Press query.

"China and The Global Fund will continue to work closely together to tighten fiduciary controls and ensure that programs are as effective as possible in combatting the three diseases," Liden said. He said the lifting was effective immediately.

The Global Fund froze payments of a $283 million AIDS grant in November after finding that Chinese government agencies had breached an agreement by channeling too small a share of the funds to grass-roots groups. Then in May, it stopped payments of all other grants in China after concerns about how the money was being used by the thousands of counties that receive grant payments.

Earlier this year, the $22 billion Global Fund faced a backlash among major donors over reports of corruption. It has said it will make public more detailed information about money it has lost to fraud and mismanagement.

Resolving the China dispute could mean China will continue to receive payments of $300 million in funding over the next several years for programs to prevent and treat HIV and AIDS in prostitutes, injecting drug users and others and for malaria and tuberculosis � unless the recent talks resulted in a reduction of the funding.

Beijing already funds the majority of its efforts to fight AIDS, TB and malaria, the fund added in its statement.

The dispute comes amid a larger debate among international aid donors and groups about whether China should continue to receive foreign aid, considering its relative prosperity resulting from decades of high economic growth. Critics point to the government's ability to fund a manned space program and extravaganzas like the 2008 Beijing Olympics, while proponents say China still has hundreds of millions of poor and needs international know-how.

Critics have said that by competing with poorer developing countries for Global Fund grants, China is effectively robbing the poor. Since 2003, the Global Fund has disbursed $570 million in grants to China.

The Global Fund did not provide details about what the Chinese government has done to meet the demands of the fund before the decision to lift the freeze was made.

But in the months since the freeze, China's Health Ministry has issued statements acknowledging the contributions of China's independent health groups. Health Minister Chen Zhu attended a meeting with community AIDS groups in late June in the southwestern city of Kunming and pledged that his ministry would try to help facilitate the work of private groups.

The government has also agreed to allocate 25 percent of the Global Fund budget to community organizations, and to set up a separate entity to manage all funding that is allocated to civil society groups, according to a public tender notice issued late last month by the Chinese Center for Disease Control and Prevention, or China CDC, the Global Fund's main recipient in China.

The China CDC's moves were welcomed by the leader of a network of more than 130 groups working to help people with HIV across in China.

"To community groups, this is a really good thing, because it has pushed the government to change its attitude toward us," said Wang Long, who heads the China National Network of AIDS Community-Based Organizations. "It has made the government value the contribution of civil society groups."

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Follow Gillian Wong on Twitter at http://twitter.com/gillianwong

Monday, August 22, 2011

Hospitals are giving faster heart care, study says (AP)

In a spectacular turnabout, hospitals are treating almost all major heart attack patients within the recommended 90 minutes of arrival, a new study finds. Just five years ago, less than half of them got their clogged arteries opened that fast.

The time it took to treat such patients plunged from a median of 96 minutes in 2005 to only 64 minutes last year, researchers found.

Some hospitals are moving at warp speed: Linda Tisch was treated in a mere 16 minutes after she was stricken while visiting relatives near Yale-New Haven Hospital in Connecticut this month. Emergency responders called ahead to mobilize a team of heart specialists.

Once she arrived, "they had a brief conversation and I went straight into the OR. My family was absolutely flabbergasted," said Tisch, 58, who went home to Westerly, R.I., two days later.

Tisch wasn't a fluke. The hospital took 26 minutes on another case on Thursday.

"Americans who have heart attacks can now be confident that they're going to be treated rapidly in virtually every hospital of the country," said Yale cardiologist Dr. Harlan Krumholz. He led the study, published online Monday by an American Heart Association journal, Circulation.

What is remarkable about this improvement, Krumholz said, is that it occurred without money incentives or threat of punishment. Instead, the government and a host of private groups led research on how to shorten treatment times and started campaigns to persuade hospitals that this was the right thing to do.

"It's amazing and it's very gratifying. I'm surprised that we were able to achieve that type of dramatic improvement" so quickly, said Dr. John Brush, a cardiologist at Eastern Virginia Medical School in Norfolk, Va., who helped the American College of Cardiology design its campaign, which involved more than 1,000 hospitals.

Heart attacks are caused by clogged arteries that prevent enough oxygen and blood from reaching the heart. Each year, about 250,000 people in the United States and more than 3 million worldwide suffer a major one, where a main artery is completely blocked.

The best remedy is angioplasty, in which doctors push a tube through an artery to the clog, inflate a tiny balloon to flatten it, and place a mesh prop called a stent to keep the artery open.

The period from hospital arrival to angioplasty is called "door-to-balloon" time, and guidelines say this should be 90 minutes or less. Any delay means more heart damage, and the risk of dying goes up 42 percent if care is delayed even half an hour.

Not all hospitals have the capability to do angioplasty around the clock, so part of the effort to speed care involved setting rules for who has to be consulted before deciding to do the procedure.

The study involved more than 300,000 patients who had an emergency angioplasty at hospitals that get Medicare reimbursements. The researchers looked at records from 2005, just before campaigns to shorten treatment times were launched, through September 2010.

Only 44 percent were treated in the recommended time in 2005, but by last year it was 91 percent.

The National Heart, Lung and Blood Institute and the Centers for Medicare and Medicaid Services paid for the study.

"It's not an exaggeration to say that care of heart attacks in the United States has been transformed by this improvement," said Dr. Christopher Granger, a Duke University Medical Center cardiologist who led a Heart Association program to improve care.

"We've made very important progress but there still is a lot of unfinished work in improving heart attack care," such as what happens before people get to a hospital where angioplasty is done, he said.

Patients also need to do their part, by knowing the warning signs of a heart attack:

� Discomfort in the center of the chest lasting more than a few minutes, or that goes away and comes back. It can feel like pressure, squeezing, fullness or pain.

� Pain or discomfort in one or both arms, the back, neck, jaw or stomach.

� Shortness of breath, which might include breaking out in a cold sweat, or feelings of nausea or lightheadedness.

What to do is simple, doctors say: Call 911.

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Online:

How hospitals rate: http://www.hospitalcompare.hhs.gov/ Heart association: http://www.americanheart.org/ College of Cardiology: http://www%h%href_on(http://www.acc.org/%)ref_off(%).acc.org/ __%href_on(http://www.acc.org/%)_

Marilynn March%href_off(%)ione can be followed at http://twitter.com/MMarchioneAP

5,000 kids injured in falls from windows each year (AP)

CHICAGO � More than 5,000 U.S. children and teens are injured each year in falls from windows, according to a study that suggests the problem stretches beyond urban high-rises.

The research found many children fall from first- and second-story windows.

"This is more than just a big-city problem," said senior author Dr. Gary Smith of Nationwide Children's Hospital in Columbus, Ohio.

Suburban mother, Beth Harlan, knows that to be true.

Two years ago, her daughter, Sidney Dillon, then age 6, fell from a second-story window in their home in Galloway, just west of Columbus. The girl was sitting on the sill and leaned against the window screen. Harlan walked into the room as the screen gave way.

"I came upstairs just in time to see her falling out the window," Harlan said. Luckily, Sidney fell into a bush and fresh landscaping mulch. An X-ray ruled out broken bones. Still, the accident frightened both mother and daughter.

"Don't ever think that kind of thing can't happen to you," Harlan said. "Never in a million years, when I opened up the window, did I think my kid would decide to sit in a windowsill."

Harlan's daughter was older than the typical child who falls. Preschoolers are at the highest risk and they suffer more head injuries than older children.

"Two-thirds of these injuries occurred among children younger than 5. This is the age group that's mobile, curious and does not recognize the danger of falling from a window," Smith said.

The study, appearing Monday in the journal Pediatrics, is the first nationally representative study of such injuries. Researchers analyzed data from emergency departments from 1990 through 2008. An estimated 98,415 children were hurt during that time.

Fewer than 1 percent of the cases led to deaths, but the researchers said the tally likely underestimated fatalities because not all children who die from their injuries are brought to the hospital.

Summer months, when windows are left open, saw the highest number of injuries. One- and two-story falls made up 94 percent of the cases where the height of the fall was recorded.

Injury rates declined slightly over the 19 years, about 4 percent, almost entirely in the under-5 age group. The average yearly injury rate was about 7 injuries per 100,000 children.

Increased awareness of the danger, improved window construction and the use of window guards � bars that allow windows to open but keep children from falling � could explain the decrease, Smith said.

New York and Boston have been able to achieve even greater decreases in injury rates through public awareness campaigns, Smith said. New York City requires window guards in apartments with children 10 and younger.

"The public awareness campaign is an important first step in building consensus. But not until you get the mandatory regulations in place are you going to see the kind of impact you're trying to achieve," said Dr. Andrew D. Racine of Children's Hospital at Montefiore in New York's Bronx borough, where window fall injuries now are seen only rarely.

Window guards cost about $20 to $40 per window. A quick release feature allows escape from a fire or other emergency. Parents also should move furniture away from windows and open windows from the top, if possible.

"We know what works and yet we still have over 5,000 children a year being rushed to emergency departments because of falls from windows. That's 14 kids a day," Smith said.

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Online:

American Academy of Pediatrics: http://www.aap.org

Window falls facts: http://injuryresearch.net/windowfallswhatsnew.aspx

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AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson

Saturday, August 20, 2011

Boomers will be spending billions to counter aging (AP)

NEW YORK � Baby boomers heading into what used to be called retirement age are providing a 70 million-member strong market for legions of companies, entrepreneurs and cosmetic surgeons eager to capitalize on their "forever young" mindset, whether it's through wrinkle creams, face-lifts or workout regimens.

It adds up to potential bonanza. The market research firm Global Industry Analysts projects that a boomer-fueled consumer base, "seeking to keep the dreaded signs of aging at bay," will push the U.S. market for anti-aging products from about $80 billion now to more than $114 billion by 2015.

The boomers, who grew up in a culture glamorizing youth, face an array of choices as to whether and how to be a part of that market.

Anti-aging enthusiasts contend that life spans can be prolonged through interventions such as hormone replacement therapy and dietary supplements. Critics, including much of the medical establishment, say many anti-aging interventions are ineffective or harmful.

From mainstream organizations such as the National Institute on Aging, the general advice is to be a skeptical consumer on guard for possible scams involving purported anti-aging products.

"Our culture places great value on staying young, but aging is normal," the institute says. "Despite claims about pills or treatments that lead to endless youth, no treatments have been proven to slow or reverse the aging process."

Its advice for aging well is basic: Eat a healthy diet, exercise regularly, don't smoke.

"If someone is promising you today that you can slow, stop or reverse aging, they're likely trying hard to separate you from your money," said S. Jay Olshansky, a professor at the University of Illinois-Chicago's School of Public Health who has written extensively about aging.

"It's always the same message: `Aging is your fault and we've got the cure,'" Olshansky said. "Invest in yourself, in the simple things we know work. Get a good pair of running or walking shoes and a health club membership, and eat more fruits and vegetables."

But such advice hasn't curtailed the demand for anti-aging products, including many with hefty price tags that aren't covered by health insurance. These include cosmetic surgery procedures at $10,000 or more, human growth hormone treatment at $15,000 per year and a skin-care product called Peau Magnifique that costs $1,500 for a 28-day supply.

Another challenge for consumers is that many dietary supplements and cosmetics, unlike prescription drugs and over-the-counter medicines, aren't required to undergo government testing or review before they are marketed. The Food and Drug Administration and the Federal Trade Commission do crack down at times on egregiously false anti-aging claims, but generally there's little protection for people who don't get hoped-for results.

Mary Engle, director of the FTC's division of advertising practices, said her agency focuses on the cases that could cause serious harm, such as bogus cancer treatments that might prompt an ill person to forgo proper care.

She said the agency lacks the resources to crack down comprehensively on ads with exaggerated claims that exploit customers' hopes for better looks or more energy.

"Often it doesn't rise to the level of fraud," she said. "There are so many problematic ads out there and we really have to pick and choose what we focus on."

In contrast to the caution of mainstream organizations, there are many vocal promoters of anti-aging products and procedures, including the American Academy of Anti-Aging Medicine. It hosts annual conferences in the U.S. and abroad, and claims 22,000 members, mostly physicians.

In its mission statement, the academy says the disabilities associated with normal aging "are caused by physiological dysfunction which in many cases are ameliorable to medical treatment, such that the human life span can be increased."

One of the academy's co-founders is Robert Goldman, a doctor of osteopathic medicine. He contends that much of the resistance to the anti-aging movement comes from sectors of the health and pharmaceutical industries that feel threatened financially � for example by the surging use of over-the-counter nutritional supplements.

"It all has to do with who's controlling the dollars," he said.

Though many anti-aging interventions are expensive, Goldman said people on tight budgets still can take useful steps such as drinking purified water, taking vitamins and using sun screen.

"People should be healthy and strong well into 100 to 120 years of age," Goldman says in a biographical video. "That's what's really exciting � to live in a time period when the impossible is truly possible."

Olshansky, who over the years has been among Goldman's harshest critics, believes there will be scientific breakthroughs eventually, perhaps based on studies of the genes of long-lived people, that will help slow the rate of aging.

In the meantime, Olshansky says, "I understand the need for personal freedom, the freedom to make bad decisions."

A look at some of the major sectors in the anti-aging industry:

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Hormone replacement therapy:

Numerous companies and clinics promote hormone replacement drugs, including testosterone for men and custom-mixed "bioidentical" hormones for women, as a way to slow the aging process.

Many consumers have seen ads featuring muscle-bound Dr. Jeffry Life, now 72. He used testosterone and human growth hormone in his own bodybuilding regimen and recommends hormonal therapy for some of the patients patronizing his age-management practice in Las Vegas.

The FDA has approved hormone replacement drugs for some specific purposes related to diseases and deficiencies, but not to combat aging.

"Finding a `fountain of youth' is a captivating story," says the National Institute on Aging. "The truth is that, to date, no research has shown that hormone replacement drugs add years to life or prevent age-related frailty."

Dr. Evan Hadley, director of the institute's Division of Geriatrics, says hormone replacement drugs can have harmful side effects. He said there is a need for more research, such as an institute study of testosterone therapy, to identify the potential risks and benefits.

"There is indeed potential that people can be healthier in old age," Hadley said. "But it still requires evidence about what's going to help and what's not."

Hormone drugs can be expensive. HGH shots can cost more than $15,000 a year, according to the institute. A hormone-based dietary supplement known as DHEA (dehydroepiandrosterone), a precursor of estrogen and testosterone, is marketed online for $12.95 per capsule by Utah-based NutraScriptives.

Some proponents say over-the-counter DHEA supplements can improve energy and strength, boost immunity and decrease fat. The institute says there's no conclusive scientific evidence of any such benefits.

Life says he's a staunch advocate of exercise and healthy eating, but insists that hormone replacement therapy, under a doctor's supervision, is a crucial addition for some men, and that includes him.

"There's no way I could look and feel the way I do if all I had done the last 13 years was exercise and eat right," he said. "Even if you do everything right, if you have a deficiency in testosterone, you will lose the fight."

Life acknowledged that the cost of testosterone replacement, probably more than $5,000 year and not covered by insurance, could be daunting for some. But he contends the investment pays off in more vitality.

"It's hard to put on price on good health," he says.

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Cosmetic Surgery:

According to the American Society of Plastic Surgeons, there were 13.1 million cosmetic plastic surgery procedures performed in the U.S. in 2010, a 77 percent increase over a decade.

One notable trend is increased preference for less invasive procedures that enable patients to get back to work and social settings without a long leave of absence.

The most popular of these is treatment with the wrinkle-smoothing drugs Botox or Dysport. They account for 5.4 million procedures, averaging about $400 per treatment. Other popular noninvasive procedures include soft-tissue facial fillers, chemical peels and microdermabrasion.

More invasive procedures come at a higher price. Face-lifts can run from $6,000 to $15,000; the plastic surgeons' academy reported performing 112,000 of them in 2010.

Dr. Peter Schmid, who runs a cosmetic surgery practice in Longmont, Colo., says his field is flourishing because of evolving attitudes among appearance-conscious boomers. A recent Associated Press-LifeGoesStrong.com poll found that 1 in 5 boomers either have had or would consider cosmetic surgery.

"Cosmetic surgery has become table talk at home. There's a lot of satisfaction and acceptance from people who've had it, friend to friend, word of mouth," Schmid said.

While the noninvasive procedures cost less than a face-lift, the effects won't last as long and repeat treatments might be needed several times a year, Schmid said. He advised patients to calculate carefully which type of procedure makes the most sense for them financially.

Schmid, who is on the board of the American Academy of Cosmetic Surgery, cautioned against any rush to try new procedures that get a burst of publicity.

"There's a certain vulnerability because everybody's looking for that quick fix, that fountain of youth," he said. "Many people will shop emotionally instead of objectively, before something has been tried and tested."

Some critics of the anti-aging industry are supportive of cosmetic surgery, provided the patient can comfortably afford it.

Professor Robert Binstock, an expert on aging at Case Western Reserve University's School of Medicine, told of a recently widowed friend whose spirits lifted after getting the bags under her eyes removed. "If you feel better looking in the mirror in the morning, fine," he said. "I have no objection to people being narcissistic."

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Skin care:

One of the industry's booming sectors is anti-aging skin care, featuring wrinkle creams and facial serums. By some estimates, the U.S. market for cosmeceutical products � cosmetics with medicine-based ingredients � is approaching $20 billion a year.

The FDA, which oversees cosmetic safety and labeling, doesn't require manufacturers to prove the effectiveness of cosmetic products before they go on sale, and many ads make claims which critics say are exaggerated or unverifiable. The American Academy of Dermatology recommends consulting a dermatologist on what skin care products have been proved safe and effective in human studies.

Consumer Reports has ventured into the realm of anti-aging cosmetics several times recently, using high-tech optical devices and other scientific methods to assess the products.

Last year, the magazine tested nine face serums, available at drug stores for prices ranging from $20 to $65 and all claiming to reduce wrinkles.

"After six weeks of use, the effectiveness of even the best products was limited and varied from subject to subject," according to the review. "When we did see wrinkle reductions, they were at best slight, and they fell short of the miracles that manufacturers seemed to imply on product labels."

Earlier, the magazine tested wrinkle creams.

"Even the best performers reduced the average depth of wrinkles by less than 10 percent, a magnitude of change that was, alas, barely visible to the naked eye," it said.

Its top-rated product, Olay Regenerist, cost about $19 at the time of the testing. La Prairie Cellular, the most expensive at $335, was rated among the least effective.

Similar conclusions were reached in testing 16 over-the-counter eye creams.

"Even among the best-performing products, wrinkle reduction around the eyes was generally pretty subtle," the magazine said. "After six weeks of daily use, none came close to eliminating wrinkles."

It said the most expensive, Perricone MD at $95 a jar, was no better than cheaper drugstore brands.

One recent development in anti-aging skin care is the use of stem cell technology. ReVive's expensive Peau Magnifique is among the new products, claiming to "recruit adult stem cells into brand new stem cells."

Neither Consumer Reports nor the FDA has conducted any specific assessment of Peau Magnifique's effectiveness. On a Web site called Makeupalley.com, some customer reviews raved about it; others trashed it as a waste of money.

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Online:

National Institutes on Aging: http://www.nia.nih.gov

Federal Trade Commission: http://ftc.gov/bcp/menus/consumer/health.shtm

American Academy of Anti-Aging Medicine: http://www.worldhealth.net

Professor S. Jay Olshansky: http://web.mac.com/sjayo/SJayOlshansky/Background.html

Dr. Jeffry Life: http://www.drlife.com

American Society of Plastic Surgeons: http://www.plasticsurgery.org

American Academy of Cosmetic Surgery: http://www.cosmeticsurgery.org

Dr. Peter Schmid: http://www.theaestheticsurgeon.com

Professor Robert Binstock: http://www.case.edu/med/bioethics/facultystaff/rhb3.htm

American Academy of Dermatology: http://www.aad.org

Consumer Reports: http://tinyurl.com/3hby2sv

Makeupalley: http://www.makeupalley.com

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David Crary can be reached at http://twitter.com/CraryAP

Friday, August 19, 2011

Feds oppose ban on food stamps for sodas in NYC (AP)

NEW YORK � A plan by New York City to combat obesity by restricting the purchase of sugary drinks with foods stamps would be too large and complex, federal officials said Friday.

The U.S. Department of Agriculture rejected a waiver request that would have allowed the city to implement the plan, which would have barred food stamp recipients from using their benefits to buy sodas, teas, sports drinks and other sugar-sweetened drinks.

The ban would have applied to any sweetened beverage that contains more than 10 calories per 8 ounces.

Mayor Michael Bloomberg and Gov. David Paterson announced in October that they would seek a waiver from the USDA to start up a temporary program that would be evaluated before becoming permanent.

In a statement released Friday, Bloomberg said his administration was disappointed by the USDA's decision.

"We think our innovative pilot would have done more to protect people from the crippling effects of preventable illnesses like diabetes and obesity than anything being proposed anywhere else in this country � and at little or no cost to taxpayers," he said.

While sharing the goal of reducing obesity, an official with the nation's food stamp program said in a letter Friday addressed to the state Office of Temporary and Disability Assistance that the USDA had concerns about the plan's "potential viability and effectiveness."

Jessica Shahin, associate administrator of the program, wrote that the proposal lacked clear product eligibility guidelines, didn't take into account the burden that might be placed on city food retailers and failed to put forward a credible design for evaluating the effect on obesity and health.

The food stamp program was launched in the 1960s and serves more than 40 million Americans each month.

The city has been actively working to shape diet choices by New Yorkers, including with a public advertising campaign called "Pouring on the Pounds" that targets the excessive consumption of sugary drinks by linking it to obesity and diabetes.

Doctors question Perry's stem cell back treatment (AP)

He calls it innovative. Others call it a big risk. In any case, the stem cell procedure that Texas Gov. Rick Perry had last month was an unusual experiment to fix a common malady: a bad back.

Perry, the newest GOP presidential candidate, has access to the best possible care and advice. Yet he and his doctor chose a treatment beyond mainstream medicine: He had stem cells taken from fat in his own body, grown in a lab and then injected into his back and his bloodstream during a July 1 operation to fuse part of his spine.

The treatment carries potential risks ranging from blood clots to infection to cancer and may even run afoul of federal rules, doctors say. At least one patient died of a clot hours after an infusion of fat-derived stem cells outside the United States. It's not clear how much of this Perry might have known.

His doctor and friend, orthopedist Dr. Stanley Jones, could not be reached for comment despite repeated requests to the spokeswoman for his Houston-area hospital. Jones told the Texas Tribune that he went to Japan for a stem cell treatment that helped his arthritis and that he had never before tried the procedure he used on Perry. He also said it had no side effects or risks.

However, some top scientists are questioning the safety and wisdom of Perry's treatment, especially because it was not part of a clinical trial in which unproven therapies are tested in a way that helps protect patients and advances medical knowledge.

Perry "exercised poor judgment" to try it, said Dr. George Q. Daley, of Children's Hospital Boston and the Harvard Stem Cell Institute. "As a highly influential person of power, Perry's actions have the unfortunate potential to push desperate patients into the clinics of quacks," who are selling unproven treatments "for everything from Alzheimer's to autism."

Daley is past president of the International Society for Stem Cell Research, a group of 3,000 scientists and others in the field. He consults for several biotech companies and favors stem cell research. But of Perry's treatment he said: "I would never in a million years accept for one of my family members to undergo this."

On the campaign trail Thursday in New Hampshire, Ray Sullivan, Perry's chief of staff, said: "The governor consulted with his physician and decided the best course of action for him. He's very pleased with the results of the surgery, with the rapid recovery and with the procedure that he had. And he feels like that is certainly his right to determine the best course of treatment for him."

Perry's treatment was first reported by the Texas Tribune. The procedure was done by Jones, who works at Foundation Surgical Hospital � a private, doctor-owned orthopedics center in suburban Houston � but Perry spokesman Mark Miner would not say where it took place.

"The governor chose this procedure to repair a reoccurring back ailment" and has confidence in the team that did it, Miner told The Associated Press. "The governor believed in this innovative approach."

It used Perry's own "adult" stem cells � not embryonic stem cells, a controversial technology that involves destroying an embryo, which the governor opposes. Adult stem cells have long been used to treat cancers such as leukemia and lymphoma � it's what doctors are using when they do bone marrow transplants. The cells are being studied for everything from heart disease to diabetes, but it's too soon to know if these approaches are safe or effective.

Some orthopedic surgeons, including Dr. Christoph Meyer at Jones' hospital, are experimenting with stem cells to help bones heal. The cells usually are taken from bone marrow and injected or implanted in the trouble spot, such as a knee or shoulder. The theory is that these "master cells" will follow cues from cells around them and form bone or cartilage, though scientists worry they also might spur unwanted growth and cancer.

Perry, however, had an even more experimental procedure: stem cells from fat removed by liposuction and grown in a lab for some time before they were put into his spine and bloodstream.

"It's a new technology that doesn't have the track record of the older ones," Meyer said. "Doctor Jones and Governor Perry made a bold move but that's how all advances in medicine have been made. I think it says a lot about Governor Perry that he was willing to try something like this that was new and untested. I mean that in a positive way."

However, Dr. George Muschler, an orthopedic surgeon at Cleveland Clinic, said fat-derived stem cells are "an unusual choice" because they don't form bone as readily as those from marrow.

Using them as was done for Perry is "quite experimental and it's quite controversial because there isn't good evidence yet, at least in the medical literature, that fat cells work better or even work at all in repairing bones," Muschler said. "It's out there, a little past the edge of what mainstream medicine would generally accept."

The Cleveland Clinic has three patents on cell-related technologies Muschler developed, and he has consulted for Medtronic Inc. and the federal Food and Drug Administration.

Dr. Thomas Einhorn, orthopedics chairman at Boston University, has tested some experimental stem cell therapies himself. He said one concern is that Perry's cells were grown in a lab dish with other ingredients where there is more of a risk they will transform into cancer and any breach in sterility could lead to an infection once they were put into a vein.

He also took issue with infusing the cells into Perry's bloodstream. "I can't think of any reason to do that. I wouldn't want to cause a blood clot."

It also enters a gray area with the FDA, which does not regulate how doctors practice medicine but does oversee medical products. Growing the cells in culture and possibly mixing them with other substances may make these modified cells a product. The FDA got an injunction barring a Colorado company from growing marrow-derived stem cells in this way; lawsuits over that are pending.

FDA spokeswoman Shelly Burgess said that the agency could not comment on Perry's treatment and that each case must be evaluated individually.

Besides safety concerns, little is known about whether such cell therapies work.

Patients may believe cells helped them, but there's no way to know they did unless a study is done comparing those who did and did not receive such treatment, said Dr. Scott Rodeo, an orthopedic surgeon at the Hospital for Special Surgery in New York. He was a physician to the USA Olympics Teams in 2004 and 2008 and is associate team physician for the New York Giants football team.

Perry still wears a back brace sometimes now on the campaign trail, but he wasn't available for an interview Thursday. On July 12, less than two weeks after his surgery, he told an AP reporter: "Every day has been better. Not quite ready to go run a marathon in July but I feel great, wear a little brace and good to go. Everything is awesome."

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Associated Press writers April Castro in Austin, Texas, and Steve Peoples in Dover, N.H., contributed to this report.

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

Thursday, August 18, 2011

US says Legionnaire's cases triple over decade (AP)

ATLANTA � Cases of Legionnaire's disease have tripled in the last decade, U.S. health officials said Thursday, but the risk of dying from it is lower because of more effective treatment.

Legionnaire's most often strikes the elderly and can cause deadly pneumonia. The germ spreads through mist or vapor from contaminated water or air conditioning systems.

The Centers for Disease Control and Prevention reports 3,522 cases in 2009, the most since Legionnaire's was first identified in 1976. There were only 1,110 cases in 2000. CDC officials think the increase may be partly because there are more old people.

To be sure, Legionnaire's remains uncommon. Just 8 percent of its victims died in the last decade, compared to 20 percent in the 1980s and 1990s. But it still kills hundreds of Americans each year, and leaves an estimated 8,000 to 18,000 hospitalized.

The increase in cases is worrisome, said study co-author Dr. Lee Hampton, a CDC epidemiologist. "We need to minimize the risk of people dying from this," he said.

The disease got its name from an outbreak at a Philadelphia convention of the American Legion in 1976 when more than 200 people were sickened and 34 died. The outbreak drew intense media coverage, and months later health investigators fingered the bacterial cause. The germ apparently had spread through the convention hotel's air-conditioning system.

Early signs of the disease can include high fever, chills and a cough. Fortunately, some of the drugs most commonly used against pneumonia are first-line treatments against Legionnaire's.

Cases of the disease held relatively steady in the 1980s-90s, but rose since 2000.

The CDC relies on doctors, hospitals and state health departments to report cases when they occur, and agency officials believe the national case count is an underestimate.

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Online:

Report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6032a3.htm?s_cidmm6032a3_w

Wednesday, August 17, 2011

Study: Only 1 in 5 medical malpractice cases pay (AP)

ATLANTA � Only 1 in 5 malpractice claims against doctors leads to a settlement or other payout, according to the most comprehensive study of these claims in two decades.

But while doctors and their insurers may be winning most of these challenges, that's still a lot of fighting. Each year about 1 in 14 doctors is the target of a claim, and most physicians and virtually every surgeon will face at least one in their careers, the study found.

Malpractice cases carry a significant emotional cost for doctors, said study co-author Amitabh Chandra, an economist and professor of public policy at the Harvard Kennedy School of Government

"They hate having their name dragged through the local newspaper and having to go to court," he said.

The study might seem to support a common opinion among doctors that most malpractice lawsuits are baseless, but the authors said the truth is more complicated than that.

They noted influential earlier research in New York state concluding that just a tiny fraction of the patients harmed by medical mistakes actually file claims.

Trial lawyers say cost is a barrier to bringing a claim to court. There are very high up-front costs for hiring expert witnesses and preparing a case. Doctors, hospitals and their insurers often have significant money and legal firepower. Some states also have caps on malpractice awards. So, usually, only very strong cases with high expected payouts are pursued.

Given the expense and other difficulties involved in winning, it's doubtful most claims are filed on a greedy whim, the researchers said.

"A lawyer would have to be an idiot to take a frivolous case to court," Chandra said.

The study was published online Wednesday by the New England Journal of Medicine.

The research team turned to one of the nation's largest national malpractice insurers, analyzing data for about 41,000 physicians who bought coverage from 1991-2005. The researchers could only get the data by signing an agreement not to identify the insurer, so they wouldn't disclose the name of the company.

The insurer represents only about 3 percent of the nation's doctors, but it operates in all 50 states. The average payouts were about the same as seen in the government-created National Practitioner Data Bank, which records payouts but doesn't record all claims filed.

The study found:

_About 7.5 percent of doctors have a claim filed against them each year. That finding is a little higher than a recent American Medical Association survey, in which 5 percent of doctors said they had dealt with a malpractice claim in the previous year.

_Fewer than 2 percent of doctors each year were the subject of a successful claim, in which the insurer had to pay a settlement or court judgment.

_Some types of doctors were sued more than others. About 19 percent of neurosurgeons and heart surgeons were sued every year, making them the most targeted specialties. Pediatricians and psychiatrists were sued the least, with only about 3 percent of them facing a claim each year.

_When pediatricians did pay a claim, it was much more than other doctors. The average pediatric claim was more than $520,000, while the average was about $275,000.

"Jurors' hearts cry out for injured patients, especially when kids are involved," Chandra said. The amount attached to a pediatric case also rises because many more years of suffering are involved than if the victim is middle-aged or elderly, experts said.

The study was funded by the RAND Institute for Civil Justice. Chandra also received funding from the National Institute on Aging, which has been interested in malpractice as a possible driver of health-care costs.

The study echoes earlier research on which specialists get sued most often, said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, a Washington, D.C.-based consumer advocacy group.

"The thing that's disappointing about their study is they don't focus on what can be done to prevent people from being injured," said Wolfe, who has pushed for more aggressive policing of doctors by state medical licensing boards.

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Online:

New England Journal: http://www.nejm.org

FDA approves gene-targeting skin cancer drug (AP)

WASHINGTON � The Food and Drug Administration has approved a first-of-a-kind drug to treat the deadliest form of skin cancer by targeting a particular genetic mutation found in about half of patients.

The pill called Zelboraf, made by Roche, is the first treatment for melanoma that targets a specific gene found in skin-cancer tumors. The FDA said Wednesday it also approved a test to screen patients for the mutation.

Melanoma is the fastest-growing form of cancer in terms of new diagnoses. Researchers attribute the acceleration to longer life expectancies among the elderly and increased indoor tanning by the young.

About 68,000 people in the U.S. were diagnosed last year and 8,700 died, according to the American Cancer Society.

Melanoma has long been considered one of the toughest cancers to treat, with few drug options. In March the FDA approved a Bristol-Myers Squibb drug that was the first drug shown to prolong survival in patients with advanced skin cancer.

Zelboraf will provide a second option for melanoma patients with a mutated form of a protein called BRAF that helps with cell growth when working normally. Zelboraf works by blocking the mutated form of the protein, slowing tumor growth.

The FDA approved the drug based on a 675-patient study in which patients received either Zelboraf or a chemotherapy drug. The study is ongoing, but 77 percent of people on Zelboraf are alive compared with 64 percent of those taking the older drug, according to the FDA.

Despite the higher survival rate, melanoma adapts quickly, and patients saw their tumors resume growth after seven months, on average.

A six-month course of Zelboraf will cost about $56,400.

Side effects with the drug included skin rashes, joint pain, fatigue, diarrhea and hair loss. About 26 percent of patients developed a less serious form of skin cancer.

Melanoma patient advocates praised the FDA for clearing the drug well ahead of an Oct. 28 target date to complete its review.

"The FDA's quick action on this drug approval is important because it gives melanoma patients a new way to fight this deadly disease," Timothy Turnham, director of the Melanoma Research Foundation, said in a statement.

In June, Roche's Genentech agreed to study Zelboraf in combination with Bristol-Myers' Yervoy, the only other melanoma drug shown to extend life.

Zelboraf was co-developed by Roche's Genentech unit, based in South San Francisco, Calif., and Daiichi Sankyo, a Japanese drugmaker. The companies will co-promote the drug in the U.S.

Roche said Wednesday the drug would be available within two weeks.

The drug is under review in the European Union and more than a half-dozen other countries around the world.

Monday, August 15, 2011

Studies show 15 minutes of daily exercise can help (AP)

LOS ANGELES � Don't despair if you can't fit in the recommended 30 minutes of daily exercise. Growing evidence suggests that even half that much can help.

It's still no excuse to slack off. Regular exercise strengthens muscles, reduces the risk of some diseases and promotes mental well-being. The more exercise, the better.

But not everyone has the time or willpower. So researchers set out to find the minimum amount of physical activity needed to reap health benefits. The findings by a study in Taiwan suggest just 15 minutes of moderate exercise a day can lead to a longer life.

This "may convince many individuals that they are able to incorporate physical activity into their busy lives," Dr. Anil Nigam of the University of Montreal said in an email. Nigam had no role in the research but wrote an editorial accompanying the Taiwan study published online Monday in The Lancet.

Fitness guidelines by the World Health Organization, the U.S. and other countries recommend that adults get at least a half-hour of moderate workout most days of the week. This can include brisk walking, bike riding and water aerobics.

Realizing that it might be difficult for some to break a sweat, health groups have suggested breaking it down into smaller, more manageable chunks of time such as three 10-minute spurts a day on weekdays.

The latest study, a large one led by researchers at the National Health Research Institutes in Taiwan, sought to determine if exercising less than the recommended half-hour was still helpful.

The researchers noted that east Asians � including China, Japan and Taiwan � are generally less physically active than their Western counterparts and their workouts tend to be less intense.

About 416,000 Taiwanese adults were asked how much exercise they did the previous month. Based on their answers, they were put into five groups of varying activity levels from inactive to highly active. Researchers kept track of their progress for eight years on average and calculated projected life expectancy.

The study found those who exercised just 15 minutes a day � or 90 minutes a week � cut their risk of death by 14 percent and extended their life expectancy by three years compared with those who did no exercise. Both men and women benefited equally from the minimum activity.

Each additional 15 minutes of exercise reduced the risk of death by another 4 percent compared with the inactive group. Researchers did not report how additional exercise affected life expectancy.

There were some limitations. Answers were self-reported. The study, though large, was observational, which means the health benefits may not be entirely due to exercise. But researchers said they took into account other factors that might affect health such as smoking and drinking. And outside scientists said the findings are in line with other studies.

For the sedentary, the key is this: Some exercise is better than none.

"Get off the couch and start moving," said I-Min Lee of the Harvard School of Public Health.

In a study published in Circulation earlier this month, Lee and colleagues found that people who engaged in 15 minutes a day of moderate physical activity had a 14 percent lower risk of heart disease compared with inactive people.

That research, combining the results of nearly three dozen studies of people from North America and Europe, also found that the benefit increased with more activity and may provide more motivation to the physically fit.

People should strive to do the recommended level of exercise, but should not be discouraged if they can't achieve it right away. Start slow and gradually build up.

"As inactive persons start moving, they may very well find that they become more fit" and reaching their exercise goal becomes easier, Lee said.

Until a year ago, Bernadette O'Brien, a retired principal who lives in northern New Jersey, did not make time for exercise. She would occasionally walk around her neighborhood and swim in the pool at her local gym, but she did little else.

After the 80-year-old was diagnosed with diabetes, she decided to change her habits. Now O'Brien exercises between 15 and 45 minutes a day, five days a week. She mixes up her routine with water aerobics and strength training so she won't get bored.

"I feel healthy and energetic. And my balance is pretty good," she said.

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Online:

Lancet journal: http://www.thelancet.com

U.S. guidelines: http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html

WHO guidelines: http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/index.html

Follow Alicia Chang's coverage at http://twitter.com/SciWriAlicia

Do-it-yourself battlefield medicine saves lives (AP)

CHICAGO � When Army Ranger Leroy Petry's hand was blown off by a grenade as he was saving his comrades in battle, he knew just what to do. He used his remaining hand to twist a tourniquet around his arm to avoid bleeding to death.

Sgt. 1st Class Petry, awarded the Medal of Honor last month, was with a regiment trained in do-it-yourself battlefield treatment. That kind of quick care on the field led to a 92 percent survival rate for the regiment over more than seven years, a study found.

Of the 32 deaths, just one had wounds considered potentially survivable, in this case massive bleeding. That Ranger died from post-surgery complications.

The study found a 3 percent death rate from potentially survivable causes in the 75th Regiment between October 2001 and April 2010. That compares with a 24 percent rate in a previously reported set of U.S. military deaths in Iraq and Afghanistan, which included troops who didn't have the Ranger-style training, the study authors said.

Petry "is a prime example of how this works," said lead author Dr. Russ Kotwal of the Special Operations Command at Fort Bragg, N.C. President Barack Obama awarded Petry his medal in a ceremony where he shook the Ranger's new robotic hand.

Historically, about 90 percent of combat-related deaths have occurred in the field, before troops reached a medical facility. Mindful of that, the Rangers adopted a new approach more than a decade ago, focusing on certain types of injuries, after a review of casualties in previous wars.

The idea is straightforward: There aren't enough doctors or medics to treat battlefield wounds, so Rangers must be equipped with their own first aid devices and trained to use them.

"If you can't do it to yourself, then you grab somebody to do it for you," Kotwal said.

The study, published Monday in Archives of Surgery, details the Rangers' approach, which also has been adopted in some other parts of the military.

The Rangers are part of the Army's Special Operations Command. They undergo training over a couple of days in how to treat battlefield wounds.

The focus is immediately treating the three main types of "potentially survivable" injuries: extreme bleeding from arms or legs, collapsed lungs from chest trauma, and airway blockage, including blood or tissue caught in the throat.

Soldiers are equipped with tourniquets, special wound dressings and needles used to treat major chest injuries. Their medical training is considered "as important as shooting," said Dr. John Holcomb, the study's senior author.

"To really inculcate this training and mentality into the entire regiment takes a couple of years," Holcomb said.

Master Sgt. Harold Montgomery, a medic, said he's "an absolute believer" in the approach.

He said he has seen non-medics administer treatment without qualms. "The one time you see them flustered" is treating severe chest wounds, which can cause air to fill the chest cavity and collapse the lungs. Treatment "is sticking a big needle into somebody's chest" to deflate the air build-up. "It can quickly save a life," but non-medics sometimes seek assurance from more medically experienced comrades about when it's really needed, Montgomery said.

Causes of injuries and deaths examined in the study included explosive devices and gunshot wounds, which accounted for half of the deaths. Most battlefield treatment focused on controlling bleeding and non-medical personnel applied 42 percent of the tourniquets.

The approach studied teaches soldiers "to take a deep breath" in the middle of combat and "fall back on a basic set of concepts and maneuvers shown by this study to increase survival of those wounded," said Dr. Todd Rasmussen, an Air Force surgeon who is the deputy commander of the U.S. Army Institute of Surgical Research in San Antonio, Texas.

It is being adopted in some military settings and by police in nonmilitary settings, "to overcome the chaos of these types of events, whether it is an explosion on the battlefield or a live shooter at a mall," Rasmussen said. He was not involved in the study.

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Online:

Archives of Surgery: http://www.archsurg.com

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Saturday, August 13, 2011

CDC looks for 15 passengers of flight with bat (AP)

ATLANTA � Health officials are still looking for 15 passengers who were on a flight in which a bat flew inside the airplane's cabin so they can protect them against the possibility of rabies.

Danielle Buttke (buht-KEE') of the Centers for Disease Control and Prevention said Saturday they have contacted 35 of the 50 passengers on the Aug. 5 Delta Air Lines flight 5121 that was operated by Atlantic Southeast Airlines.

She says none of the passengers they've spoken with required treatment.

The plane was flying from Madison, Wis., to Atlanta when the bat emerged. No one knows if the bat had rabies because it escaped. The CDC wants to talk to the plane's passengers to make sure they didn't have close contact with it, putting them at risk.

Friday, August 12, 2011

Bat on Wisconsin flight prompts rabies probe (AP)

ATLANTA � Health officials say a bat on a flight from Wisconsin to Atlanta last week has sparked a national search for passengers to protect them against possible rabies.

Officials don't know if the bat had rabies. It escaped. But they want to alert passengers of the risk just in case. The Centers for Disease Control and Prevention says it is trying to reach all 50 people who flew on Delta flight 5121, which departed from Madison, Wis., to Atlanta at 6:45 a.m. on Aug. 5.

If the animal was rabid, people could catch rabies from a bite or exposure to the bat's saliva.

CDC officials asked anyone on the flight to call 1-866-613-2683. The airline didn't retain the records for all the passengers.

The jet was in the air when the winged animal emerged and a passenger shot a video. Operators of the flight said it could have been a bird. But CDC says its rabies expert believes from the video that it was a bat.

UN says cholera epidemic in Somalia (AP)

GENEVA � World Health Organization officials said Friday that famine-hit Somalia faces a cholera epidemic as dirty water and poor sanitation are leading to an increase in outbreaks of the disease.

Officials say cases of acute watery diarrhea � an important indicator of the risk of cholera � are now at 4,272 in Somalia � an 11 percent rise on last week's WHO reported figure of 3,839.

WHO public health adviser Dr. Michel Yao told reporters in Geneva on Friday that the number of cholera cases has also risen sharply this year, with officials confirming 18 cases in the 30 lab samples taken in recent days from people living in the capital, Mogadishu.

Yao said the 60 percent infection rate confirms there is a "high risk" of the disease spreading quickly � "so we can say we have an epidemic."

The random samples, which were tested in a lab in the capital, were drawn from among 4,272 samples from people who have suffered the diarrhea, he said. So far, he said, there have been 181 acute watery diarrhea-related deaths.

WHO spokeswoman Fadela Chaib said last week that a few cases of cholera have been confirmed in Somalia and the diarrhea is also on the rise. She said of the 3,839 reported cases, 77 percent afflicted children younger than 5-years old in Mogadishu.

The World Health Organization has said it is very concerned about disease outbreaks in drought-hit East Africa, due to a lack of clean water for drinking and bathing, overcrowding in camps and the low tolerance to disease of starving young children.

The United States estimates drought and famine in Somalia have killed more than 29,000 children under the age of 5. Millions face the risk of starvation amid Somalia's worst drought in 60 years.

UNICEF spokeswoman Marixie Mercado said Friday that tens of thousands of children have died and countless more are particularly at risk of cholera and other diseases because of drought and violence in East Africa.

Thursday, August 11, 2011

'Amazing' normalcy for those with face transplants (AP)

They savor pizza and burgers, no longer frighten children, and many of them can walk the streets without people knowing they have someone else's cheeks, nose, lips and skin. People who have had face transplants increasingly are going public, helping to transform an operation that six years ago was daredevil theory into one that is widely accepted.

At least 18 face transplants have been done around the world, starting with a French woman mauled by her dog in November 2005, said Dr. Maria Siemionow, at Cleveland Clinic. She did the first face transplant in the U.S. in December 2008.

Brigham and Women's Hospital in Boston has done three this year alone. The U.S. Department of Defense is providing money for more of these surgeries in Cleveland and Boston in hopes of helping soldiers disfigured in battle. The University of Pittsburgh plans to offer face transplantation soon.

"It isn't mainstream yet. It's a last resort surgery," said Michael Cunningham, a psychologist at the University of Louisville, a pioneer in hand transplantation. But the face transplant experience so far shows that "there were a lot of naysayers and worries that just didn't seem to come to pass," he said.

On Thursday, the Boston hospital released a photo taken last month of Charla Nash, a Connecticut woman mauled by a chimpanzee. She had a face transplant in May.

"I will now be able to do things I once took for granted," Nash said in a statement. "I will be able to smell. I will be able to eat normally. I will no longer be disfigured. I will have lips and will speak clearly once again. I will be able to kiss and hug loved ones. I am tremendously grateful to the donor and her family."

Not all face transplant recipients have recovered hoped-for capabilities yet, and some have less than stellar aesthetic results although they are all vastly improved from how they looked before. The more recent ones in particular, where full rather than partial transplants have been performed, have fared especially well.

"They look from the very beginning quite natural and quite normal," said Dr. Bohdan Pomahac, who has performed four face transplants at Brigham. The most touching moment for him was a recipient texting him nine days after the operation, asking for a place to get good sushi in Boston.

"The level of normalcy," and to consider going out in public so soon, is "amazing," Pomahac said.

Here's how some others have fared:

_Dallas Wiens, a 25-year-old Texan severely disfigured in a power line accident, looked like a sock of flesh had been pulled over his face � no eyes or nose and barely a mouth. After his transplant earlier this year in Boston, he said the first thing his young daughter told him was "Daddy, you're so handsome." He said his new face felt "natural," and that right away he could smell the hospital's lasagna.

_Connie Culp, 48, an Ohio woman who was the first U.S. face transplant recipient, has made several television appearances and become an advocate for organ donation. Doctors have refined the droopy jowls and extra skin they purposely left to make checkup biopsies easier, and she now has "a normal face," Siemionow said. "She's smiling, she's perfect. When she jokes, she kind of flickers her eyes. Her face is vivid. You can see emotions."

_Mitch Hunter, 30, of Indiana, wore a prosthetic nose and had a distended, lopsided jaw after being disfigured in an accident. Now, he could pass you on the street and you wouldn't guess he has a new face, so good is his cosmetic result.

The successes have led more hospitals to approve face transplant protocols.

"We're currently screening patients," said Dr. Joseph Losee of the University of Pittsburgh. Carefully selecting appropriate patients "is the most important thing," he said.

So far, only two face transplant-related deaths have been reported, said Dr. John Barker, former director of plastic surgery research at the University of Louisville who is now a reconstructive medicine researcher at the University of Frankfurt in Germany.

One was a Chinese man who reportedly was not given or did not take medicines to prevent his body from rejecting his new face. The other was in Paris, a man who received a face and a double hand transplant. He suffered a heart attack during surgery to address a complication, Barker said.

Overall, "I think it's gone fabulously," he said of face transplantation. "It is a clinical alternative now, not experimental," he said. "It's been done and it works. For a select group of patients, it is a viable treatment."

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Online:

Chimp attack woman: http://bit.ly/kcxTfi

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

Wednesday, August 31, 2011

Monday, August 29, 2011

Saturday, August 27, 2011

Thursday, August 25, 2011

Wednesday, August 24, 2011

Monday, August 22, 2011

Saturday, August 20, 2011

Friday, August 19, 2011

Thursday, August 18, 2011

Wednesday, August 17, 2011

Monday, August 15, 2011

Saturday, August 13, 2011

Friday, August 12, 2011

Thursday, August 11, 2011

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