Transfer delays common for heart attack patients (AP)

CHICAGO � New research suggests hospitals are taking too long to move heart attack patients who need treatment elsewhere. And it says that delay might increase their chances of dying.

Patients with major heart attacks often need emergency procedures to clear clogged arteries. But most U.S. hospitals aren't equipped for that treatment. Guidelines recommend moving those patients to another hospital within a half-hour.

But in the study of more than 14,000 patients, only one in 10 were moved that fast. More deaths occurred in patients who weren't moved within a half-hour. These patients were generally sicker, and the researchers say that might partly explain the results.

The study appears in Wednesday's Journal of the American Medical Association.

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Cigarettes will carry grisly new warning labels (AP)

RICHMOND, Va. � Rotting teeth and gums. Diseased lungs. A sewn-up corpse of a smoker. Cigarette smoke coming out of the tracheotomy hole in a man's neck. Cigarette packs in the U.S. will have to carry these macabre images in nine new warning labels that are part of a campaign by the Food and Drug Administration to use fear and disgust to discourage Americans from lighting up.

The labels, announced on Tuesday, represent the biggest change in cigarette packs in the U.S. in 25 years.

At a time when the drop in the nation's smoking rate has come to a standstill, the government is hoping the in-your-face labels will go further than the current surgeon general warnings toward curbing tobacco use, which is responsible for about 443,000 deaths a year in the U.S.

"These labels are frank, honest and powerful depictions of the health risks of smoking," Health and Human Services Secretary Kathleen Sebelius said in a statement.

The FDA estimates the labels will cut the number of smokers by 213,000 in 2013, with smaller additional reductions through 2031.

Other countries such as Canada and Uruguay have used graphic, even grisly, warnings for years, and various studies suggest they spur people to quit. But exactly how effective they are is a matter of debate, since the warnings are usually accompanied by other government efforts to stamp out smoking.

"I think it's a great deterrent for kids," said Kristen Polland, 24, of Prattville, Ala. "If you start there, you have won half of the battle."

Rhonda Vanover, 43, of Cincinnati, on the other hand, said: "No one is going to stop me __ unless they make it illegal. Cigarettes get me through the day. They are part of my life."

The labels also include images of a smoker wearing an oxygen mask and a mother and baby with smoke swirling nearby. Some images are not graphic at all; one shows a man wearing an "I Quit" T-shirt.

The warnings will take up the entire top half � both front and back � of a pack of cigarettes. They must also appear in advertisements and constitute 20 percent of each ad. Cigarette makers will have to run all nine labels on a rotating basis. They have until the fall of 2012 to comply.

The legality of the new labels is already being challenged in a federal lawsuit bought by some of the major tobacco companies, which argue that the warnings will relegate the brand name to the bottom half of the cigarette package, making it difficult or impossible to see.

A spokesman for Richmond-based Altria Group Inc., parent company of the nation's largest cigarette maker, Philip Morris USA, said the company was looking at the final labels and had no further comment. Altria Group is not a party in the federal lawsuit.

A pack-a-day smoker would see the graphic warnings more than 7,000 times per year.

American Cancer Society CEO John R. Seffrin said the labels have the potential to "encourage adults to give up their deadly addiction to cigarettes and deter children from starting in the first place."

The introduction of graphic warning labels was required in a 2009 law that, for the first time, gave the federal government authority to regulate tobacco. Tuesday's announcement follows reviews of scientific literature, public comments and results from an FDA-contracted study of 36 labels proposed last November.

The U.S. first mandated the use of warning labels stating, "Cigarettes may be hazardous to your health" in 1965. The current warning labels � put on cigarette packs in the mid-1980s � say more explicitly that smoking can cause lung cancer, heart disease and other illnesses. But the warnings contain no pictures; they consist only of text in a small box.

The share of Americans who smoke has fallen dramatically since 1970, from nearly 40 percent to about 20 percent. But the rate has stalled since about 2004, with about 46 million adults in the U.S. smoking cigarettes. It's unclear why it hasn't budged, but some experts have cited tobacco company discount coupons on cigarettes and lack of funding for programs to discourage smoking or to help smokers quit.

In recent years, more than 30 countries or jurisdictions have introduced labels similar to those created by the FDA. The World Health Organization said in a survey done in countries with graphic labels that a majority of smokers noticed the warnings and more than 25 percent said the warnings led them to consider quitting.

In 2000, Canada introduced blunt warning labels that included images of a pregnant woman smoking, a child and parent puffing away, and a drooping cigarette to illustrate the risk of impotence from smoking. Since then, the county's smoking rate has declined from about 26 percent to about 20 percent. How much the warnings contributed is unclear because the country took other steps to reduce smoking.

David Hammond, a health behavior researcher at the University of Waterloo in Canada, who worked with the firm designing the labels for the FDA, said that while the images are graphic, they are necessary.

"This isn't about doing what's pleasant for people," he said.

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Associated Press Writers Lisa Cornwell in Cincinnati and Anna McFall in Montgomery, Ala., contributed to this report.

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Michael Felberbaum can be reached at http://www.twitter.com/MLFelberbaum.

Online:

New Cigarette Warning Labels: http://1.usa.gov/j2DI5f.

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Sotomayor tells how she deals with diabetes (AP)

WASHINGTON � Supreme Court Justice Sonia Sotomayor was seven years old and living in the South Bronx when she found she was thirsty all the time. Soon after, she started wetting her bed at night.

"I was ashamed," the 56-year-old justice said, as she related how she came to learn that she has diabetes. The audience for the unusually personal glimpse at a justice's life was children who are diabetics, like Sotomayor. And the reason she met with them Tuesday in a Washington ballroom was to assure them that their common affliction is no bar to doing anything they want.

"It's a disease you have to deal with, but you can," she said, as she sat in an armchair with 150 children seated in a semicircle on the carpet in front of her.

Sotomayor said she has the job of her dreams and that coping with it has become second nature. She injects herself with insulin four to six times a day, including often before she takes the bench with her colleagues to hear arguments in Supreme Court cases.

Sotomayor's condition has long been known, but she has not previously spoken so openly about managing diabetes. The appearance was part of the Juvenile Diabetes Research Foundation's Children's Congress.

To one little girl who asked whether having Type 1 diabetes gets easier as an adult, Sotomayor replied, "Absolutely."

Advances in technology have made dealing with diabetes so much easier since she was diagnosed in the early 1960s, she said.

She held her hands about a foot apart to indicate, perhaps with a bit of exaggeration, how big the needle was that a lab technician used to draw blood. Whatever its size, Sotomayor said it was large enough that she ran from the hospital where she was being tested and hid under a car outside.

Instead of the pin pricks used today to check a diabetic's blood sugar levels, Sotomayor recounted using the edge of a razor blade. "It was horrible," she said.

Without disposable needles for insulin injections, Sotomayor had to sterilize a needle every morning, requiring her to climb on a chair to reach the stove. She would fill a pot with water and then wait for it to boil. "It takes forever to get water to boil," she said, recalling how long it seemed to her as a child.

When another child asked her to say something positive about having diabetes, Sotomayor said it taught her discipline, which has helped her as a student and beyond.

"Figuring out how I felt all the time," she said. "All of that taught me discipline."

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APNewsBreak: FDA issues graphic cigarette labels (AP)

RICHMOND, Va. � In the most significant change to U.S. cigarette packs in 25 years, the Food and Drug Administration on Tuesday released nine new warning labels that depict in graphic detail the negative health effects of tobacco use.

Among the images to appear on cigarette packs are rotting and diseased teeth and gums and a man with a tracheotomy smoking.

Also included among the labels are: the corpse of a smoker, diseased lungs, and a mother holding her baby with smoke swirling around them. They include phrases like "Smoking can kill you" and "Cigarettes cause cancer" and feature graphic images to convey the dangers of tobacco, which is responsible for about 443,000 deaths in the U.S. a year.

Each label includes a national quit smoking hotline number.

The labels will take up the top half � both front and back � of a pack of cigarette packs. Warning labels also must appear in advertisements and constitute 20 percent of an ad. Cigarette makers have until the fall of 2012 to comply.

Mandates to introduce new graphic warning labels were part of a law passed in 2009 that, for the first time, gave the federal government authority to regulate tobacco, including setting guidelines for marketing and labeling, banning certain products and limiting nicotine.

The announcement follows reviews of scientific literature, public comments and results from an FDA-contracted study of 36 labels proposed last November.

In recent years, more than 30 countries or jurisdictions have introduced labels similar to those being introduced by the FDA. The U.S. first mandated the use of warning labels stating "Cigarettes may be hazardous to your health" in 1965. Current warning labels � a small box with black and white text � were put on cigarette packs in the mid-1980s.

The FDA says the new labels will "clearly and effectively convey the health risks of smoking" aimed at encouraging current smokers to quit and discourage nonsmokers and youth from starting to use cigarettes.

"These labels are frank, honest and powerful depictions of the health risks of smoking," Health and Human Services Secretary Kathleen Sebelius said in a statement.

American Cancer Society CEO John R. Seffrin applauded the new labels in a statement, saying they have the potential to "encourage adults to give up their deadly addiction to cigarettes and deter children from starting in the first place."

The new labels come as the share of Americans who smoke has fallen dramatically since 1970, from nearly 40 percent to about 20 percent. The rate has stalled since about 2004. About 46 million adults in the U.S. smoke cigarettes.

It's unclear why declines in smoking have stalled. Some experts have cited tobacco company discount coupons on cigarettes or lack of funding for programs to discourage smoking or to help smokers quit.

While it is impossible to say how many people quit because of the labels, various studies suggest the labels do spur people to quit. The new labels offer the opportunity for a pack-a-day smoker to see graphic warnings on the dangers of cigarettes more than 7,000 times per year.

The FDA estimates the new labels will reduce the number of smokers by 213,000 in 2013, with smaller additional reductions through 2031.

Tobacco use costs the U.S. economy nearly $200 billion annually in medical costs and lost productivity, the FDA said. Tobacco companies spend about $12.5 billion annually on cigarette advertising and promotion, according to the latest data from the Federal Trade Commission.

The World Health Organization said in a survey done in countries with graphic warning labels that a majority of smokers noticed the warnings and more than 25 percent said the warnings led them to consider quitting.

While some have voiced concerns over the hard-hitting nature of some of the labels, those concerns should be trumped by the government's responsibility to warn people about the dangers of smoking, said David Hammond, a health behavior researcher at the University of Waterloo in Canada, who worked with the firm designing the labels for the FDA.

"This isn't about doing what's pleasant for people. It's about fulfilling the government's mandate if they're going to allow these things to be sold," Hammond said. "What's bothering people is the risk associated with their behavior, not the warnings themselves,"

In places like Canada, Hammond said smokers offended by some of the images on cigarettes packs there started asking for different packs when they received ones with certain gory images, or used a case to cover them up. But smokers said those warnings still had an effect on them.

Canada introduced similar warning labels in 2000. Since then, its smoking rates have declined from about 26 percent to about 20 percent. How much the warnings contributed to the decline is unclear because the country also implemented other tobacco control efforts.

The legality of the new labels also is part of a pending federal lawsuit filed by Winston-Salem, N.C.-based Reynolds American Inc., parent company of America's second-largest cigarette maker, R.J. Reynolds; No. 3 cigarette maker, Greensboro, N.C.-based Lorillard Inc.; and others.

Tobacco makers in the lawsuit have argued the warnings would relegate the companies' brands to the bottom half of the cigarette packaging, making them "difficult, if not impossible, to see."

A spokesman for Richmond, Va.-based Altria Group Inc., parent company of the nation's largest cigarette maker, Philip Morris USA, said the company was looking at the final labels but would not comment further.

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Online:

New Cigarette Warning Labels: http://1.usa.gov/j2DI5f

___

Michael Felberbaum can be reached at http://www.twitter.com/MLFelberbaum

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Study: Docs overtesting for cervical cancer virus (AP)

WASHINGTON � Too many doctors are testing the wrong women, or using the wrong test, for a virus that causes cervical cancer.

The days of one-size-fits-all screening for cervical cancer are long gone. How often to get a Pap smear � and whether to be tested for the cancer-causing HPV virus at the same time � now depend on your age and other circumstances.

But a government study reports Monday that a surprising number of doctors and clinics aren't following guidelines from major medical groups on how to perform HPV checks, suggesting a lot of women are getting unnecessary tests.

That wastes money and could harm women who wind up getting extra medical care they didn't need, says Dr. Mona Saraiya of the Centers for Disease Control and Prevention, who led the research.

Even she wasn't protected from the confusion. Saraiya was stunned to get a bill showing that her own doctor had ordered testing for HPV strains not connected to cervical cancer.

The findings, reported in the journal Obstetrics & Gynecology, show women have to be savvy to ensure they're getting the right checkups � enough, but not too much.

"It's extremely discouraging," says Debbie Saslow, gynecologic cancer director at the American Cancer Society, who's had to argue with her doctor against testing too often. "We have not been able to get that message across."

Cervical cancer grows so slowly that Pap smears � which examine cells scraped from the cervix � usually find it in time to treat, or even to prevent when precancerous cells are spotted and removed.

For decades, Paps were the only way to screen for cervical cancer. Now doctors know that certain strains of HPV, the human papillomavirus, cause most cervical cancer. HPV testing isn't a replacement for the Pap. But it can provide extra information to help determine if a woman is at higher or lower risk and thus guide her ongoing care � if it's used correctly.

The new CDC study, part of a national survey of medical practices that included 600 providers of cervical cancer screening, examined how doctors are using it.

The study found 60 percent of doctors and clinics say they give a routine Pap-plus-HPV test to women who are too young for that combination. Guidelines stress that so-called co-testing is only for women 30 and older. If both tests are negative, they can wait three years before their next screening.

Why the age limit? Saslow says HPV is nearly as common as the common cold, especially in younger women � but their bodies usually clear the infection on their own and only a years-long infection is risky. Learning that a 20-something has HPV increases the odds of more invasive testing that in turn can leave her cervix less able to handle pregnancy later in life. Younger women are supposed to get HPV testing only if a Pap signals a possible problem and doctors really need the extra information.

Then there's the question of which test to use. Only a few so-called high-risk strains of HPV cause cervical cancer, the strains doctors are supposed to test for. Before scientists understood the different HPV types, a test already was on the market that detects strains that can cause genital warts, not cervical cancer. The CDC's Saraiya says there's no reason to use that old test because learning you have a probably transient warts-causing strain doesn't alter your care.

Yet her study found 28 percent of doctors and clinics say they order tests for both the cancer-causing and warts-causing strains, regardless of patient age. The study couldn't tell why, although Saraiya says some doctors don't know there's a difference and some order forms for the lab tests don't differentiate.

An HPV test costs $80 to $100, on top of a $40 Pap. Saraiya says labs can bill for two HPV tests when doctors order testing for both kinds of strains.

So what does a woman need to know before her next checkup? The CDC has developed a consumer-friendly brochure to help women understand their options for cervical cancer screening: http://tinyurl.com/6g8de6v

And guidelines from the American College of Obstetricians and Gynecologists recommend that:

_Routine Paps start at age 21.

_Most women in their 20s get a Pap every two years.

_Women 30 and older wait three years between screenings if they've had a negative Pap and negative HPV test, or three consecutive clear Paps.

_If a Pap is inconclusive at any age, HPV testing may help rule out who needs further examination and who can just repeat a Pap in a year.

_Anyone who's been vaccinated against HPV, a relatively new vaccine, still must follow Pap screening guidelines for their age group.

_Higher-risk women, such as those with HIV or previous cervical abnormalities, need more frequent screening.

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

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Study says 1 in 13 US children have food allergy (AP)

CHICAGO � Food allergies affect about one in 13 U.S. children, double the latest government estimate, a new study suggests.

The researchers say about 40 percent of them have severe reactions � a finding they hope will erase misconceptions that food allergies are just like hay fever and other seasonal allergies that are troublesome but not dangerous.

Overall, 8 percent of the children studied had food allergies; peanuts and milk were the most common sources. That translates to nearly 6 million U.S. children.

The most recent government estimate, from the Centers for Disease Control and Prevention, was based on in-home interviews and found that about 3 million children were affected, or about 4 percent. Other estimates based on different methods have ranged from 2 percent to 8 percent.

The new study, funded by an advocacy group, is based on online interviews with parents of kids younger than age 18 and involved 40,104 children. Research firm Knowledge Networks conducted the survey. Families were recruited through random telephone dialing.

Results were released online Monday in Pediatrics.

The findings suggest that food allergies affect two kids per classroom, said lead author Dr. Ruchi Gupta, a pediatrician and researcher with Chicago's Children's Memorial Hospital.

Dr. Calman Prussin, an investigator with the National Institute of Allergy and Infectious Diseases, said the study "confirms that food allergy is a substantial public health problem."

Prussin said differences in estimates are due to different survey methods and definitions of what constitutes a food allergy. He said the only way to know for sure how many kids are affected would be lab tests on scores of children, which isn't practical.

Because the new figure is within the range of previous estimates, he said the study doesn't mean prevalence has increased, although experts generally believe allergies including those to food are on the rise, Prussin noted.

He said some people mistake food intolerances for food allergies. For instance, many people are lactose intolerant, meaning they can't properly digest milk. That can cause bloating and digestive problems, but not an allergic reaction.

Typical signs of a true food allergy include skin rashes, wheezing, tightness in the throat or difficulty breathing.

The new survey asked parents whether their children had those symptoms � a big strength of the study, Prussin said.

Many children outgrow allergies to some foods, including eggs and wheat, but they're less likely to outgrow allergies to peanuts and other nuts.

The study was funded by the Food Allergy Initiative, a nonprofit advocacy group founded by parents of children with allergies.

Mary Jane Marchisotto, the group's executive director, said the study "paints a more comprehensive picture" of food allergies, and should help raise awareness.

The group, funded privately but without industry money, is working with the CDC on national guidelines on how to manage food allergies in schools, she said.

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Online:

Pediatrics: http://www.pediatrics.org

Food Allergy Initiative: http://www.faiusa.org

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

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