Curbs on youngest drivers may have bad side effect (AP)

CHICAGO � Strong driver's license laws have led to fewer fatal crashes among 16-year-olds but with a disturbing side effect � more fatal accidents among 18-year-olds, a nationwide study found.

Many states require young drivers to get extensive experience, including driving with an adult, before getting a full license. But in most states those laws only apply to those younger than 18. The new study suggests some teens are just putting off getting a license until they turn 18 � meaning they have little experience and higher odds for a deadly crash.

"There's an incentive right now to skip out and just wait until you're 18," said Scott Masten, the study's lead author and a researcher with California's Department of Motor Vehicles. "In most states you don't even need to have driver education or driver training" if you obtain a license at 18, he said.

"I was actually bummed by my own findings � to find out we're offsetting the benefits" in young drivers so much, he said. "It was quite unexpected."

The study examined fatal crashes from 1986 to 2007 involving 16- to 19-year-olds. Results appear in Wednesday's Journal of the American Medical Association.

Most previous studies have also linked graduated licensing programs with a decline in fatal crash rates among young teens, but evidence on effects in older teens is mixed.

A journal editorial by researchers with the Insurance Institute for Highway Safety said the potential effects in older teens "is a serious issue deserving attention by researchers and policymakers." The editorial noted that New Jersey is one of the few states where graduated driver's licensing restrictions apply to all first-time applicants younger than 21. That has led to lower crash rates among 17- and 18-year-olds.

Whether these programs should be extended to include older teens merits further study, the editorial said.

Every state has some type of graduated driver's licensing program. These typically allow full, unrestricted licenses to kids younger than 18 only after several months of learning while driving with an adult, followed by unsupervised driving with limits on things like night driving and the number of passengers.

The study authors analyzed fatal crash data from the National Highway Traffic Safety Administration and information on each state's licensing programs.

Comparing states with the most restrictions versus those with the weakest laws or no restrictions, there were 26 percent fewer fatal crashes involving 16-year-old drivers; but among 18-year-old drivers, there were 12 percent more fatal crashes. The differences are estimates, taking into account factors that would also influence fatal crash rates, including seatbelt laws, changes in minimum speed limits, and the fact that 18-year-old drivers outnumber 16-year-old drivers..

The programs appeared to have no effect on fatal crash rates for drivers aged 17 and 19.

Researchers estimate that since the first graduated licensing program began in 1996, the programs have been associated with 1,348 fewer fatal crashes involving 16-year-old drivers but with 1,086 more fatal crashes involving 18-year-old drivers.

During the 1986-2007 study, there were nearly 132,000 fatal crashes of drivers aged 16 to 19. Nearly 20 percent involved 16-year-old drivers, while almost 30 percent involved 18-year-olds.

Evidence suggests that many teens are waiting until they're older to get their licenses; in California for example, only 13 percent of 16-year-olds have driver's licenses, Masten said.

In a nationwide survey of almost 1,400 teens published last month in the journal Traffic Injury Prevention, 1 in 4 who were 18 and hadn't obtained a license cited the hassle of licensing requirements as a reason.

Masten said more research is needed to determine why the fatal crash rate among 18-year-olds rose and whether an increase also occurred in nonfatal crashes.

The study confirms that graduated licensing "is doing what it was intended to do � prevent novice drivers from being in high-risk conditions before they're ready for it," said Dr. Flaura Winston, a pediatrician and traffic injury expert at the Children's Hospital of Philadelphia. But the results also show there's a need for strategies for the novice independent driver at any age, she said.

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Online:

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

National Highway Traffic Safety Administration: http://www.nhtsa.gov

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

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Inhaler overuse may have killed Colorado student (AP)

FORT COLLINS, Colo. � Doctors say a 19-year-old student at Colorado State University might have died because she inadvertently used her asthma inhaler too much.

A roommate found Sascha Franzel, of Honolulu, on Saturday night and she was pronounced dead at a hospital.

According to the Fort Collins Coloradoan (http://bit.ly/qG67T9), the official cause of death won't be available for several weeks.

Franzel's mother told the newspaper that Sascha suffered from severe asthma and nearly died last November.

More than 200 people turned Monday for a candlelight vigil for Franzel that lasted for more than two hours.

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Information from: Fort Collins Coloradoan, http://www.coloradoan.com

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Experts: 366 million people now have diabetes (AP)

LONDON � An estimated 366 million people worldwide now suffer from diabetes and the global epidemic is getting worse, health officials said Tuesday.

The International Diabetes Federation described the number of cases as "staggering," with one person dying from diabetes every seven seconds.

The federation called for concrete measures to stop the epidemic, urging officials focusing on chronic diseases at a United Nations meeting next week to commit to specific targets to prevent cases and to invest in more research. Experts also said diabetes care should be integrated into local health clinics.

"The clock is ticking for the world's leaders," Jean Claude Mbanya, the group's president, said in a statement. "We expect action from their meeting next week at the United Nations that will halt diabetes' relentlessly upwards trajectory."

The figures were announced in Lisbon, Portugal, during the European meeting of the group, an umbrella organization that represents associations from more than 160 countries.

It estimated that diabetes causes 4.6 million deaths every year and that health systems spend $465 billion annually fighting the disease. That includes both Type 1 and Type 2 diabetes.

Type 1 diabetes mainly affects children and young adults, who are unable to make insulin. Type 2 diabetes is more common and is often tied to obesity. It develops when the body doesn't produce enough insulin to break down glucose, inflating blood sugar levels.

The disease can be managed with diet, exercise and medication but chronically high blood sugar levels causes nerve damage, which can result in kidney disease, blindness and amputation.

In June, a study published in the medical journal Lancet estimated the global number of diabetes had more than doubled in the last three decades and put the figure at 347 million.

Experts said much of the rise in diabetes cases was due to aging populations � since diabetes typically hits in middle age � and population growth, but that obesity rates had also fueled the disease's spread.

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Online:

http://www.easd.org

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Bionic ear maker Cochlear recalls hearing implants (AP)

SYDNEY � Bionic ear maker Cochlear has been forced to begin a global recall of the world's thinnest hearing implants after some stopped working.

The Sydney-based company, which dominates the world's bionic ear market, said Monday it was mystified as to why some of its award-winning Nucleus CI500 devices were suddenly shutting down.

The company has begun recalling its entire Nucleus CI500 range, which makes up the bulk of its sales, from shelves after a rise in the number of faults with the CI512 model.

While Cochlear believes the faults are unlikely to cause any health problems for people with defective implants, they are offering replacement models for re-implantation.

The news sent Cochlear's shares into a tailspin, with the stock dropping more than 25 percent at one stage amid worries about the financial impact and potential damage to the company's reputation the recall could cause.

Shares in Cochlear fell 14.68 Australian dollars ($15.21), or 20 percent, to close Monday at AU$57.50 ($59.58), the lowest in over two years.

Cochlear chief executive Chris Roberts said he was unable to say how many of the "very reliable" titanium-based devices were faulty.

While less than 1 percent of the Nucleus CI500 devices had failed since they hit the market in 2009, there had been a steady rise in faults being reported in recent weeks.

"We don't know what the cause is," Roberts told analysts on a conference call.

"That's exactly what we need to evaluate. We want to avoid saying it's 'a' or 'b' or 'c' when we have to up every stone and examine every possibility," he added.

People fitted with CI500 units but who have not experienced any problems are being advised to continue using the devices.

The voluntary recall of the Nucleus CI500 range includes the CI512 model as well as the CI513, CI551 double array implant and ABI 541 auditory brainstem implant.

It does not affect its earlier Nucleus Freedom range or its Nucleus 5 external hearing devices.

Production of the CI500 devices has stopped and patients needing bionic ear implants are being offered the Nucleus Freedom model, which has been on the market for seven years.

Roberts said Cochlear was better off halting manufacture until the cause of the faults was uncovered.

He was unable to say how long it would take before the devices were back on sale but said if any changes had to be made, the company would need to get regulatory approval from the countries where the units are sold.

Cochlear was also unable to say what the cost of the product recall would be.

Cochlear sold more than 17,000 of its Nucleus 5 range of devices in the 2010/11 financial year, representing 70 percent of its total bionic ear sales in 100 different countries.

The Nucleus 5 range includes the thinnest hearing implants on the market at just 3.9 millimeters (0.15 of an inch) thick.

Cochlear has promoted them as "a new design that is built to last a lifetime."

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Families urge action as US drafts Alzheimer's plan (AP)

WASHINGTON � As her mother's Alzheimer's worsened over eight long years, so did Doreen Alfaro's bills: The walker, then the wheelchair, then the hospital bed, then the diapers � and the caregivers hired for more and more hours a day so Alfaro could go to work and her elderly father could get some rest.

Alfaro and her husband sold their California house to raise money for her mother's final at-home care. Six years later, the 58-year-old Alfaro wonders if she eventually develops Alzheimer's, too, "what happens to my care? Where will I go?"

Dementia is poised to become a defining disease of the rapidly aging population � and a budget-busting one for Medicare, Medicaid and families. Now the Obama administration is developing the first National Alzheimer's Plan, to combine research aimed at fighting the mind-destroying disease with help that caregivers need to stay afloat.

"This is a unique opportunity, maybe an opportunity of a lifetime in a sense, to really have an impact on this disease," says Dr. Ronald Petersen of the Mayo Clinic, who chairs a committee that later this month begins advising the government on what that plan should include.

An estimated 5.4 million Americans have Alzheimer's or similar dementias. It's the sixth-leading killer. There is no cure; treatments only temporarily ease some symptoms. Barring a research breakthrough, those numbers will worsen steadily as the baby boomers gray: By 2050, anywhere from 13 million to 16 million Americans are projected to have Alzheimer's, costing a $1 trillion in medical and nursing home expenditures.

But that's not the full toll. Sufferers lose the ability to do the simplest activities of daily life and can survive that way for a decade or more, requiring years of care from family, friends or paid caregivers. Already a recent report finds that nearly 15 million people, mostly family members, are providing more than $200 billion worth of unpaid care.

Thousands of those caregivers have turned out at public meetings since early August � and at a "telephone town meeting" organized by the Alzheimer's Association that drew 32,000 people � pleading for a national Alzheimer's strategy to bring changes.

They want primary care doctors trained to diagnose dementia earlier, describing how years of missed symptoms cost them precious time to make plans or seek treatment.

They demand to know why the National Institutes of Health spends about six times more on AIDS research than on Alzheimer's, when there are good drugs to battle back the HIV virus but nothing comparable for dementia.

Overwhelmingly, they ask for resources to help Alzheimer's patients live their last years at home without ruining their caregivers' own health and finances.

"Either you're rich and can afford $25 an hour for care at home, or you send him to a facility. We're in the middle of the road," says Shirley Rexrode of suburban San Francisco, whose 85-year-old father, Hsien-Wen Li, was diagnosed with Alzheimer's nearly three years ago.

Adult day care didn't work out � even at $90 a day, the only place with an opening couldn't handle the behaviors of Alzheimer's. Rexrode's mother, Li's primary caregiver, already has suffered some depression.

"We just have to muddle through, but we don't know how long we can," Rexrode says.

And while Medicare will pay for doctor bills and medications, even getting to the doctor can be a hurdle. When her 89-year-old mother with advanced Alzheimer's developed a urinary tract infection, Susan Lynch couldn't find a doctor willing to come to her parents' home in Fall River, Mass. Lynch flew there from her Gaithersburg, Md., home but couldn't carry her mother down the stairs. A private ambulance service didn't have an opening for weeks. Lynch wound up calling the town ambulance for a costly but Medicare-covered trip to the emergency room.

Federal health officials, who promise a first draft of the national plan by December, say they're getting the message.

"Folks desperately, desperately want to be able to provide the care themselves," says Donald Moulds, a deputy assistant secretary at the Department of Health and Human Services who oversees the project. "It's very, very hard work. Figuring out better mechanisms for supporting people who are trying to do that work is, one, the right thing to do."

It also may be cheaper for taxpayers. Nursing homes not only are pricier than at-home care, but many families only can afford them through Medicaid, the health care program for the poor. Another key, Moulds says, is better care coordination as Alzheimer's complicates the many other health problems of aging.

But given the budget crisis, the big question is whether any anti-Alzheimer's strategy can come with enough dollars and other incentives attached to spur true change.

"That's a concern, a very real one," says Mayo's Petersen.

The law that requires a national Alzheimer's plan didn't set funding, and Moulds is mum on a possible price tag. Almost complete is an inventory of all Alzheimer's-related research and care reimbursement paid for by the U.S. government, to look for gaps that need filling and possible savings to help pay for them.

Other countries including England and Australia � and 25 U.S. states, by Moulds' count � have developed their own Alzheimer's plans. But the U.S. is taking a special look at France, where President Nicolas Sarkozy in 2008 pledged to invest 1.6 billion euros, about $2.2 billion, over five years for better diagnosis, research and caregiver support and training.

Sarkozy told an international Alzheimer's Association meeting in July that he wants to guarantee "that no French family is left without support."

Moulds says it's too early to know what's working in France. But U.S. families are telling him that any Alzheimer's plan must bring better understanding of a disease too often suffered in isolation.

"What I want to see is mainly awareness, awareness of this disease and what it does not only to the individual but also to the network of family and friends that are going to care for the person," says Alfaro, of Aptos, Calif.

"It should be as understood as diabetes, and as treatable," adds Audrey Wiggins of Triangle, Va., whose father has and grandmother died of Alzheimer's.

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Medical prize honors discoverer of malarial drug (AP)

NEW YORK � A scientist who discovered a powerful malaria drug and two others who illuminated how proteins fold within cells have won prestigious medical awards.

The Albert and Mary Lasker Foundation announced the $250,000 prizes Monday and will present them Sept. 23 in New York.

Tu Youyou, 81, of the China Academy of Chinese Medical Sciences in Beijing, won the clinical research award for discovering the malaria drug artemisinin (ar-tuh-MIHS'-ihn-ihn), which the foundation said has saved millions of lives.

In the late 1960s, as part of a Chinese government project, Tu began combing ancient texts and folk remedies to find a treatment for malaria. She collected 2,000 potential recipes, from which her team made 380 extracts. One extract, from sweet wormwood, showed promise in mouse studies. Following a clue from an ancient document, Tu redesigned the extraction process to make the extract more potent. In the early 1970s, she and her colleagues isolated the active ingredient, artemisinin.

The Lasker award for basic research is shared by Dr. Franz-Ulrich Hartl, 54, of the Max Planck Institute of Biochemistry in Martinsried, Germany, and Dr. Arthur Horwich, 60, of Yale University. Their key discoveries about how proteins fold within cells may someday help scientists find new treatments for such illnesses as Alzheimer's, Huntington's and Lou Gehrig's diseases, the foundation said.

Before their work, scientists thought that proteins needed no help to fold into their proper shapes. But in the late 1980s, the two men discovered that the folding happens within a cage-like structure that promotes the process.

"They gave the medical world a key understanding of how proteins reach their biological potential," the foundation said.

A third Lasker prize, for public service, was awarded to the Clinical Center of the National Institutes of Health. Since 1953, the center has been "a model research hospital, providing innovative therapy and high-quality patient care, treating rare and severe diseases and producing outstanding physician-scientists," the foundation said.

The Lasker foundation was established in 1942. Albert Lasker was an advertising executive who died in 1952. His wife Mary was a longtime champion of medical research before her death in 1994.

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Online:

Lasker Foundation: http://www.laskerfoundation.org

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