Boston hospital performs double hand transplant (AP)

BOSTON � A quadruple amputee who received new hands through a transplant operation says he is looking forward to doing ordinary things again: getting dressed, taking a shower, making coffee and, sweetest of all, touching the faces of his two grandsons.

Richard Mangino, 65, of Revere, lost his arms below the elbows and his legs below the knees after he had a kidney stone in 2002 and contracted a severe bloodstream infection.

Last week, a team of more than 40 surgeons, nurses and support staff at Boston's Brigham and Women's Hospital worked for more than 12 hours performing a hand transplant.

Mangino said at a news conference Friday that he had adjusted to his life as a quadruple amputee. The former director of the ground crew for United Airlines at Boston's Logan airport, Mangino taught himself to do daily activities with his prostheses, mowing the lawn, shoveling snow and painting. He said people kept telling him what a "miracle" he was.

"But the one miracle I have prayed for, since my oldest grandson Trevor was born, was to be able to feel the sense of touch again ... to touch his and Nicky's little faces, and stroke their hair, and to teach them to throw a ball," he said. "To me, that would be a miracle. And today, my miracle has come true."

Doctors said it will take six to nine months for Mangino to regain sensory function in his hands, but days after surgery he began independently moving his fingers.

The donor's name was not made public.

In a statement, the wife of the donor said her husband, in talking about donation, always said, "It's just a body."

"I didn't have to struggle with the decision," she said of donating her husband's hands. "After I digested what it entailed, I thought, if it can help someone else out � I felt strongly that my husband would feel the same way," she said in her statement.

Dr. Bohdan Pomahac, director of plastic surgery transplantation at Brigham and Women's, said there have been approximately 50 hands transplanted worldwide, about a dozen of them in the United States. He said Mangino's surgery was only the fourth bilateral hand transplant in the U.S.

Mangino's procedure was the second bilateral hand transplant by surgeons at Brigham and Women's, which has performed four face transplants.

In May, a Connecticut woman who was mauled by a chimpanzee received a new face and two hands at the hospital, but the hand transplant failed after Charla Nash developed pneumonia and other complications after surgery.

Mangino's surgery involved multiple tissues, including skin, tendons, muscles, ligaments, bones and blood vessels on his forearms and hands.

He said he is looking forward to being able to do everyday things without having to struggle.

"I won't have to perform a miracle anymore to just get up in the morning," he said.

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Obama pulls plug on part of health overhaul law (AP)

WASHINGTON � The Obama administration Friday pulled the plug on a major program in the president's signature health overhaul law � a long-term care insurance plan dogged from the beginning by doubts over its financial solvency.

Targeted by congressional Republicans for repeal, the program became the first casualty in the political and policy wars over the health care law. It had been expected to launch in 2013.

"This is a victory for the American taxpayer and future generations," said Sen. John Thune, R-S.D., spearheading opposition in the Senate. "The administration is finally admitting (the long-term care plan) is unsustainable and cannot be implemented."

Proponents, including many groups that fought to pass the health care law, have vowed a vigorous effort to rescue the program, insisting that Congress gave the administration broad authority to make changes. Long-term care includes not only nursing homes, but such services as home health aides for disabled people.

Known as CLASS, the Community Living Assistance Services and Supports program was a longstanding priority of the late Massachusetts Democratic Sen. Edward M. Kennedy.

Although sponsored by the government, it was supposed to function as a self-sustaining voluntary insurance plan, open to working adults regardless of age or health. Workers would pay an affordable monthly premium during their careers, and could collect a modest daily cash benefit of at least $50 if they became disabled later in life. The money could go for services at home, or to help with nursing home bills.

But a central design flaw dogged CLASS. Unless large numbers of healthy people willingly sign up during their working years, soaring premiums driven by the needs of disabled beneficiaries would destabilize it, eventually requiring a taxpayer bailout.

After months insisting that could be fixed, Health and Human Services Secretary Kathleen Sebelius, finally admitted Friday she doesn't see how.

"Despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time," Sebelius said in a letter to congressional leaders.

The law required the administration to certify that CLASS would remain financially solvent for 75 years before it could be put into place.

But officials said they discovered they could not make CLASS both affordable and financially solvent while keeping it a voluntary program open to virtually all workers, as the law also required.

Monthly premiums would have ranged from $235 to $391, even as high as $3,000 under some scenarios, the administration said. At those prices, healthy people were unlikely to sign up. Suggested changes aimed at discouraging enrollment by people in poor health could have opened the program to court challenges, officials said.

"If healthy purchasers are not attracted ... then premiums will increase, which will make it even more unattractive to purchasers who could also obtain policies in the private market," Kathy Greenlee, the lead official on CLASS, said in a memo to Sebelius. That "would cause the program to quickly collapse."

That's the same conclusion a top government expert reached in 2009. Nearly a year before the health care law passed, Richard Foster, head of long-range economic forecasts for Medicare warned administration and congressional officials that CLASS would be unworkable. His warnings were disregarded, as Obama declared his support for adding the long-term care plan to his health care bill.

The demise of CLASS immediately touched off speculation about its impact on the federal budget. Although no premiums are likely to be collected, the program still counts as reducing the federal deficit by about $80 billion over the next ten years. That's because of a rule that would have required workers to pay in for at least five years before they could collect any benefits.

"The CLASS Act was a budget gimmick that might enhance the numbers on a Washington bureaucrat's spreadsheet but was destined to fail in the real world," said Senate Republican Leader Mitch McConnell of Kentucky.

Administration officials said Obama's next budget would reflect the decision not to go forward. Even without CLASS premiums, they said the health care law will still reduce the deficit by more than $120 billion over 10 years.

Kennedy's original idea was to give families some financial breathing room. Most families cannot afford to hire a home health aide for a frail elder, let alone pay nursing home bills. Care is usually provided by family members, often a spouse who may also have health problems.

"We're disappointed that (Sebelius) has prematurely stated she does not see a path forward," AARP, the seniors' lobby, said in a statement. "The need for long-term care will only continue to grow."

Sebelius said the administration wants to work with Congress and supporters of the program to find a solution. But in a polarized political climate, it appears unlikely that CLASS can be salvaged. Congressional Republicans remain committed to its repeal.

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Worried about vitamin safety? Experts offer advice (AP)

Two studies this week raised gnawing worries about the safety of vitamin supplements and a host of questions. Should anyone be taking them? Which ones are most risky? And if you do take them, how can you pick the safest ones?

Vitamins have long had a "health halo." Many people think they're good for you and at worst might simply be unnecessary. The industry calls them an insurance policy against bad eating.

But our foods are increasingly pumped full of them already. Even junk foods and drinks often are fortified with nutrients to give them a healthier profile, so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit.

"We're finding out they're not as harmless as the industry might have us believe," said David Schardt, a nutritionist at the consumer group Center for Science in the Public Interest.

This week, a study of nearly 40,000 older women found a slightly higher risk of death among those taking dietary supplements, including multivitamins, folic acid, iron and copper. It was just an observational study, though, not a rigorous test.

Another study found that men taking high doses of vitamin E � 400 units a day � for five years had a slightly increased risk of prostate cancer.

As many as one-third of Americans take vitamins and nearly half of people 50 and older take multivitamins, surveys suggest. Americans spent $9.6 billion on vitamins last year, up from $7.2 billion in 2005, according to the Nutrition Business Journal. Multivitamins top the list, at nearly $5 billion in sales.

Yet there is no clear evidence that multivitamins lower the risk of cancer, heart disease or any other chronic health problems. No government agency recommends them "regardless of the quality of a person's diet," says a fact sheet from the federal Office of Dietary Supplements. And vitamins aren't required to undergo the strict testing required of U.S.-approved prescription medicines.

Some fads, such as the antioxidant craze over vitamins A and E and beta-carotene, backfired when studies found more health risk, not less. And studies that find more disease in people with too little of a certain vitamin can be misleading: Correcting a deficiency so you have the right daily amount is different from supplementing beyond recommended levels.

The best way to get vitamins is to eat foods that naturally contain them, said Jody Engel, a nutritionist with Office of Dietary Supplements. "Foods provide more than just vitamins and minerals, such as fiber and other ingredients that may have positive health effects."

Schardt adds: "It's virtually impossible to overdose on the nutrients in food."

Some folks may need more of certain nutrients and should talk with their doctors about supplements:

� Postmenopausal women regarding calcium and vitamin D to protect bones.

� Women planning on pregnancy regarding folate, or folic acid, to prevent birth defects.

� People over age 50 and vegans who may need vitamin B12. "As we get older, a number of us no longer produce enough acid in the stomach to extract the B12 in food," Schardt explained.

� Pregnant women, who may need extra iron.

� Breastfed infants and possibly other infants concerning vitamin D.

Vitamin D is a nutrient many of us may need to supplement. Last fall, the Institute of Medicine, a panel of scientists who advise the government, raised the recommended amount but also warned against overdoing it. People ages 1 to 70 should get 600 international units a day, older folks 800 units.

If you do need a supplement, beware: Quality varies. Consumerlab.com, a company that tests supplements and publishes ratings for subscribers, has found a high rate of problems in the 3,000 products it has tested since 1999.

"One out of 4 either doesn't contain what it claims or has some other problems such as contamination or the pills won't break apart properly," said company president Dr. Tod Cooperman.

For example, one gummy bear calcium product had 250 percent of the amount of vitamin D claimed on the label. Another liquid product made with rose hips had just over half the amount of vitamin C listed.

"You don't have to pay a lot. Price is not necessarily linked to quality," he said. "The quality doesn't really relate to where you're buying it. I know many people are surprised by that or don't want to believe it, but that is the case. We find good and bad products in every venue."

Mark Blumenthal, executive director of the American Botanical Council, suggests looking for "seals of approval" or certifications of quality from groups that spot-test supplements such as the USP, or United States Pharmacopeia; NSF International and NPA, the Natural Products Association.

Experts offered this advice:

� Keep it simple. The more ingredients there are in a supplement combo, the more chance that one of them will not be the right amount, Cooperman said.

� Consider a supplement combo tailored to your gender and age, the Office of Dietary Supplements suggests. Multivitamins often contain little iron, and ones for seniors give more calcium and vitamin D than products aimed at younger adults.

� Take vitamin D with dinner. A study found significantly more absorption of that nutrient when it was consumed at the largest meal, which tends to have more fat, than at breakfast, Cooperman said.

� Watch out for vitamin K � it promotes clotting and can interfere with common heart medicines and blood thinners such as warfarin, sold as Coumadin and other brands.

� Current and former smokers are advised to avoid multivitamins with lots of beta-carotene or vitamin A; two studies have tied them to increased risk of lung cancer.

� For cancer patients, "vitamins C and E might reduce the effectiveness of certain types of chemotherapy," Engel said.

� People having surgery should know that some vitamins can affect bleeding and response to anesthesia.

With any supplement � ask your doctor.

__

Online:

Vitamin facts: http://ods.od.nih.gov/factsheets/list-VitaminsMinerals

and http://ods.od.nih.gov/factsheets/MVMS-HealthProfessional

FAQs: http://ods.od.nih.gov/Health_Information/ODS_Frequently_Asked_Questions.aspx

Dietary advice: http://www.dietaryguidelines.gov

Vitamin E and prostate study: http://jama.ama-assn.org/content/306/14/1549

Video interview with author: http://jama.ama-assn.org/content/306/14/1549/suppl/DC1

___

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

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UK says Britons need to cut 5 billion calories (AP)

LONDON � British health officials say the country needs to slash 5 billion calories from its collective daily diet to slow the obesity epidemic.

In a report issued Thursday, the department of health said most adults in the nation of about 60 million people are already eating far more than they need. The average Briton eats about 10 percent more calories than necessary, the report said.

The U.K. has one of Europe's fattest populations: more than 60 percent of adults and one third of children aged 10-11 are overweight or obese. The new report aims to change diet and exercise habits enough so that the number of heavy Britons begins to fall by 2020.

Britain's chief medical officer, Sally Davies, said people need to be more honest with themselves about just how much food they're eating every day. "We are still too heavy as a nation," she said at a press conference. "Not enough of us are getting it right."

Obesity raises the risk of health problems including heart disease, diabetes, and cancer. Experts said treating fat patients costs the national health service 5.1 billion pounds (US$8 billion) every year.

Health Minister Andrew Lansley said Britain will continue working with the food and beverage industry in a deal to reduce the amount of salt and fat from their products and to post calorie content where possible. The deal was previously slammed by health charities and leading medical organizations who argued the food and drink industry were dictating government policies.

Lansley said the government would consider whether a 'fat tax' could help, but said he would prefer a voluntary and cooperative approach.

The government will also introduce various initiatives to encourage people to exercise, including several linked to the London Olympics next year.

Though London 2012 officials promised they would get 2 million more people exercising by the time the Olympic torch is lit, that goal looks increasingly unlikely. Only about five percent of Britons currently meet the recommended guidelines to get 150 minutes of physical exercise every week.

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Prostate testing's dark side: Men who were harmed (AP)

Terry Dyroff's PSA blood test led to a prostate biopsy that didn't find cancer but gave him a life-threatening infection.

In the emergency room, "I didn't sit, I just laid on the floor, I felt so bad," said Dyroff, 65, a retired professor from Silver Spring, Md. "I honestly thought I might be dying."

Donald Weaver was a healthy 74-year-old Kansas farmer until doctors went looking for prostate cancer. A PSA test led to a biopsy and surgery, then a heart attack, organ failure and a coma. His grief-stricken wife took him off life support.

"He died of unnecessary preventive medicine," said his nephew, Dr. Jay Siwek, vice chairman of family medicine at Georgetown University. "Blood tests can kill you."

Since Friday, when a task force of independent scientists said routine PSA testing does more harm than good, urologists who make a living treating prostate cancer have rushed to defend the test, as have patients who believe it saved their lives.

Less visible are men who have been harmed by testing, as Dyroff and Weaver were. The harm is not so much from the test itself but from everything it triggers � biopsies that usually are false alarms, and treatments that leave many men incontinent or impotent for cancers that in most cases were not a threat.

Once a PSA test suggests a problem, many men can't live with the worry that they might have cancer. And once cancer is found, most men feel they have to treat it, usually at the urging of their urologist.

"There are many men who have had serious consequences from treatment. Those stories don't get told and they are not uncommon," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, which thinks the task force reached "an appropriate conclusion" about the PSA test.

"I'm not going to criticize men who believe that their lives have been saved by this test," because that's what doctors have told them, Lichtenfeld said. "If you're sitting there and you wet your pants three times a day, you've got to believe it's worth it, that it saved your life."

Many men who agree to a PSA test do not understand what it is. Some common misconceptions:

� It shows cancer. In fact, PSA is just a measure of inflammation, and it can be elevated for many reasons besides cancer: normal enlargement of the prostate with age, an infection, even recent sex, a strenuous bike ride or horseback riding.

� It's been proven to save lives. Only two large, well-done studies have looked at this, the task force says. The American study found annual screening did not lower the chances of dying of prostate cancer. However, cancer fear is so great, and belief in the value of screening so ingrained, that half the men assigned to the group not offered PSA tests got one anyway. That made comparisons to the group given annual screening difficult. For that reason, some doctors don't believe the study's conclusion.

The other study, conducted in Europe, found a small benefit for certain age groups screened every two to seven years � not annually. However, one Swedish center had such rosy results that scientists think it may have biased the whole study. If that center is excluded, no benefit from the PSA test is seen.

� The task force's stance goes against past advice. Routine PSA testing has been supported by some advocacy groups and by urologists, the doctors who do the tests and treatments. But it has not been pushed by major scientific groups, the American Cancer Society or the government.

� It finds cancer early so you're more likely to survive. About 90 percent of prostate cancers found through screening are early-stage. Most will grow so slowly they will never threaten a man's life, but there's no good way to tell which ones will. Research suggests that tumors causing symptoms are more likely to warrant treatment than those that are not. Also, finding aggressive prostate tumors early may not affect how lethal they prove to be; the PSA test may just let men learn of them sooner than they otherwise would.

The task force said that in the European study, the rate of overdiagnosis from PSA screening � finding cancers that do not need to be treated � was estimated to be as high as 50 percent. Based on that study, 1,410 men would have to be screened, and 48 patients would have to be treated, just to save one life from prostate cancer.

Yet the public perception is that if PSA testing finds a cancer early, it must be good.

"Most people tend to think `if it may help, I'm all for it.' But we don't know if it will help," said Siwek, the Georgetown doctor whose uncle died.

Once a PSA test suggests a problem, "it's hard to stop the conveyor belt or the cascade effect" that leads to more testing and treatment, said Siwek, who also is editor of the journal American Family Physician. "The inclination is, `I've got to do something about it.'"

Dyroff, the retired professor, agreed to a biopsy after a blip in his PSA. Several days later, he ran a high fever, felt weak and faint, and spent three days in the hospital fighting a bloodstream infection. A week later he relapsed and required a combination of intravenous antibiotics to finally recover.

A recent Johns Hopkins University study found surprisingly high rates of hospitalization after prostate biopsies and a 12-fold greater risk of death in those who develop infections.

Tony Masraff, a Houston restaurant owner, reluctantly agreed to a biopsy and then was diagnosed with prostate cancer in 1999. His urologist pushed surgery and balked when Masraff asked about other options such as radiation. After some research, Masraff decided just to monitor his tumor, and has seen his PSA rise very slowly over more than a decade.

Now 74, he hasn't had treatment "and I never will," he said. "I'm not concerned because I don't want the debilitative effects � I don't want to wear a diaper, and I like women."

"There's a huge number of people that are being operated on that don't need treatment," said Masraff, who formed a foundation for research into less invasive options.

The need to find a better screening tool is the real message from the task force, said Dr. Christopher Logothetis, prostate cancer research chief at the University of Texas M.D. Anderson Cancer Center in Houston. It may even be that there are better ways to use the PSA � employing it as a baseline test and tracking its rise over time � that might prove better than annual testing.

"If the debate gets reduced to `there's a right and a wrong,' we will lose what we are being told here, which is to search for the path forward," he said.

The cancer society's Lichtenfeld agreed. "Maybe it's time to listen to evidence instead of hope," he wrote in his blog.

___

Online:

Task force recommendations: http://www.uspreventiveservicestaskforce.org/tfcomment.htm

Task force evidence report: http://bit.ly/ovhKUW

PSA decision guide: http://bit.ly/cXq1QE

___

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

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80 percent of US boys use condoms the first time (AP)

CHICAGO � A surprising 80 percent of teenage boys say they are using condoms the first time they have sex, a government survey found in a powerful sign that decades of efforts to change young people's sexual behavior are taking hold.

But another promising trend � a drop since the 1980s in the number of teenagers having sex � has leveled off.

Boys' condom use may mean they are taking more responsibility for contraception or they are protecting themselves from sexually transmitted diseases, experts say. Or, as one young man said, girls may be drawing the line.

"I'm not sure how much of this is guys thinking they need to use a condom or girls insisting they use a condom," said 17-year-old Olivier Vanasse of Princeton, N.J. "I'd be hesitant to give guys credit for coming up with this on their own."

The study, released Wednesday, is based on interviews with about 4,700 teenagers, ages 15 to 19, conducted from 2006 through 2010. It shows the percentage of boys who said they used condoms the first time they had sex climbed from 71 percent in 2002 to 80 percent in the new survey. In 1988, 55 percent of boys said they used a condom during their first sexual intercourse.

"It comes as a general surprise to people that teenagers in general and teen boys in particular can behave responsibly when it comes to making decisions about sex," said Bill Albert, spokesman for the National Campaign to Prevent Teen and Unplanned Pregnancy. "I think it is surprising."

The survey suggests that condom use continues. Asked if they used a condom the last time they had sex in the previous three months, 75 percent said they did, an increase from 71 percent in 2002.

"We don't think it's a stupid thing to do anymore," said Vanasse, a high school senior and staff writer for http://www.sexetc.org, a project of Rutgers University's Answer, a national sex education organization. "It's just accepted as common sense that you should be using a condom if you're going to be having sex."

Overall, about 43 percent of girls and 42 percent of boys report ever having vaginal intercourse, a rate that is statistically unchanged since 2002. The rates had been declining steadily since 1988, when 51 percent of girls and 60 percent of boys reported that they had had sex.

Albert said those findings also explode myths about teen sex.

"There's the notion that all teenagers are doing it, and that's not the case. In fact, less than half said they've had sex," he said. "And there's no gender gap between the teen boys and the teen girls. There's a myth that guys are out on the prowl, and that's not supported by this data."

Less sex and more contraception are driving down teen births, he said. The U.S. teen birth rate in 2009 � 39 births per 1,000 females � was nearly 40 percent lower than the peak in 1991. It's still a dramatically higher birth rate than in Western Europe, where birth control is less expensive and more accessible to teens.

The new study contains more encouraging news. For the first time, there was no racial difference in the percentage of girls reporting they had had sex. In the past, black females were more likely than whites to be sexually experienced.

"That's due to a drop in black females who are sexually experienced," said the study's lead author, Gladys Martinez, a demographer for the government's National Center for Health Statistics.

Other findings:

� Teens were less likely to have had sex if they lived with both parents, if their mothers hadn't been teen moms themselves, or if their mothers were college graduates.

� Most teens � 70 percent of girls and 56 percent of boys � had their first sex with someone with whom they were "going steady."

� A minority � 16 percent of girls and 28 percent of boys � had their first sex with someone they just met or with whom they were "just friends."

Some teenage girls are trying newer contraceptive methods, even the first time they have sex. A small but growing proportion of girls � 6 percent in the new survey, compared with 2 percent in 2002 � reported using long-acting hormonal methods such as injectable birth control, contraceptive patches or the new contraceptive ring.

The finding on teenage boys' condom use heartened proponents of sex education.

"Boys have really stepped up to the plate in the last 20 years. We've included them in the conversation about teen sex and have seen them as able to be responsible actors, and they've done it for us," said Linda Lindberg, a senior research associate for the Guttmacher Institute. "There's been some shift from the double standard of teaching boys not to ask for sex and teaching girls to say no."

She said it was too soon to see any effect from the Obama administration's move away from abstinence-only sex education to programs that teach pregnancy prevention.

___

Online:

Report: http://www.cdc.gov/NCHS/

___

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

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