Panel: Boys should get HPV vaccine given to girls (AP)

ATLANTA � A vaccine against cervical cancer hasn't been all that popular for girls. It may be even a harder sell for boys now that it's been recommended for them too.

A government advisory panel on Tuesday decided that the vaccine should also be given to boys, in part to help prevent the cancer-causing virus through sex.

Public health officials have tried since 2006 to get parents to have their daughters vaccinated against the human papillomavirus, or HPV, which causes most of the cervical cancer in women.

They have had limited success, hitting a number of hurdles. Some parents distrust the safety of vaccines, especially newer products. Others don't want to think about their daughters having sex one day, or worry that the vaccine essentially promotes promiscuous behavior.

Tuesday's vote by the Advisory Committee on Immunization Practices' was the first to strongly recommend routine vaccination for boys since the vaccine was first approved for them two years ago. Officials acknowledged the low rate in girls encouraged them to take a new, hard look.

Experts say a key benefit of routinely vaccinating boys could be preventing the spread of the virus to others through sex � making up somewhat for the disappointing vaccination rate in girls. But the recommendation is being framed as an important new measure against cancer in males.

"Today is another milestone in the nation's battle against cancer," said Dr. Anne Schuchat, a U.S. Centers for Disease Control and Prevention administrator who oversees the agency's immunization programs.

Federal health officials usually adopt the panel's recommendations and ask doctors and patients to follow them.

The vaccine has been advised for girls since 2006. Just 49 percent of adolescent girls have gotten at least the first of the three HPV shots. Only a third had gotten all three doses by last year.

"Pretty terrible," Schuchat said.

Schuchat attributed the low rates for girls to confusion or misunderstanding by parents that they can wait until their daughter becomes sexually active. It works best if the shots are given before a girl or boy begins having sex.

Some conservatives argue the vaccine could promote promiscuous behavior. It has come up in the GOP presidential campaign. Texas Gov. Rick Perry came under attack for a 2007 executive order requiring adolescent girls to get the vaccine (with an opt-out clause). When conservative lawmakers rebelled, he backed down.

An estimated 75 to 80 percent of men and women are infected with HPV during their life, but most don't develop symptoms or get sick, according to the CDC. Some infections lead to genital warts, cervical cancer and other cancers, including of the head and neck.

The HPV vaccine is approved for use in males and females ages 9 to 26; it is usually given to 11- and 12-year olds when they get other vaccines. The committee also recommended that males 13 to 21 years get vaccinated.

Tuesday's vote follows recent studies that show the vaccine prevents anal cancer in males, and may work against a type of throat cancer. A study that focused on gay men found it to be 75 percent effective against anal cancer.

While anal cancer has been increasing, it's still fairly rare. Only about 7,000 U.S. cases in men each year are tied to the strains targeted in the HPV vaccine. In contrast, about 15,000 vaccine-preventable cervical cancers in women occur annually.

Preventing a cancer that's primarily associated with gay men may not be much of a selling point, said Dr. Ranit Mishori, a family practice doctor in Washington, D.C. and an assistant professor at the Georgetown University School of Medicine.

Some parents may say "`Why are you vaccinating my son against anal cancer? He's not gay! He's not ever going to be gay!' I can see that will come up," said Mishori, who supports the panel's recommendation.

Schuchat indicated the CDC is ready for that kind of argument: "There's no data suggesting that offering a vaccine against HPV will change people's subsequent sexual behavior," she said.

So far, the threat of genital warts hasn't been persuasive: Some data suggest that less than 1.5 percent of adolescent males have gotten the vaccine over the past two years.

Meanwhile, some feel it's unlikely that most parents will agree to get their sons vaccinated primarily to protect girls. A survey of 600 pediatricians last year found that nearly 70 percent of doctors thought families would deem vaccination of their boys as unnecessary.

Experts at the committee meeting noted an earlier analysis that showed vaccinating boys would not be cost-effective if the female vaccination were high.

"If you do reach high coverage of females, will you stop vaccinating males?" asked Dr. David Salisbury, director immunization for the United Kingdom's Department of Health.

There are two vaccines against HPV, but Tuesday's vote applies only to Merck & Co.'s Gardasil, which costs $130 a dose. The other vaccine wasn't tested for males.

The committee's recommendation � and the greater insurance coverage of the vaccine that is expected to follow � will make it easier for more boys to get the shots, said Dr. Mark Feinberg, chief public health and science officer for Merck Vaccines.

Merck officials bristled at the idea that males would see the vaccine as mainly meant for gay men, noting that HPV-caused anal cancers can occur in heterosexual men.

Maura Robbins of Chicago said she's likely to have her 12-year-old son, Cole, vaccinated against HPV � but probably not until he's a little older. "I would just like to see some long-term testing and long-term results," she said.

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AP Medical Writer Lindsey Tanner in Chicago contributed to this report.

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Online:

HPV info: http://www.cdc.gov/hpv/

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Boys should get HPV vaccine too, panel says (AP)

ATLANTA � A government panel is recommending that young boys also get the controversial HPV shot. That's the vaccine now given to girls to prevent cervical cancer.

Doctors argue that it could protect boys against genital warts and some kinds of cancers. But they also say vaccinating 11- and 12-year old boys could also help prevent the spread of the sexually transmitted virus to girls.

The HPV vaccine has been controversial since it was recommended for girls five years ago. And only about a third of adolescent girls have been fully vaccinated against the virus.

The Advisory Committee on Immunization Practices made the recommendation Tuesday. Federal health officials usually adopt what the panel says and asks doctors and patients to follow the recommendations.

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Divide over when to use in-depth cholesterol tests (AP)

WASHINGTON � For heart health, you're supposed to know your numbers: Total cholesterol, the bad LDL kind and the good HDL kind. But your next checkup might add a new number to the mix.

More doctors are going beyond standard cholesterol counts, using another test to take a closer look at the bad fats � a count of particles that carry LDL through the blood.

Cardiologists are divided over the usefulness of that approach. Proponents contend it might help them spot at-risk patients that regular checks might miss, or get more information about how aggressively to treat them.

But so far, guidelines from major heart organizations don't recommend these extra tests. They're pricier than regular cholesterol exams, although Medicare and many other insurers pay for them. And it's not always clear what the results mean.

"I see a lot of people being confused," says Dr. Nieca Goldberg of New York University Langone Medical Center and the American Heart Association. Especially when they're used on lower-risk people, "you don't know how to make sense of the information."

Yet up to half of patients diagnosed with heart disease apparently had normal levels of LDL cholesterol, and some doctors say particle testing might help find some of them sooner.

"For most people, the standard lipid profile is fine," says Dr. Michael Davidson of the University of Chicago. But "I get referred people who said, `My cholesterol was fine, why do I have heart disease?' We're showing them, well, because your particle number's sky high and they were not aware that was a problem."

Davidson chaired a committee of the National Lipid Association which this month called the extra tests reasonable to assess which at-risk patients might need to start or intensify cholesterol treatment. That committee's meeting was paid for by a grant from eight pharmaceutical companies, including some makers of particle tests.

Cholesterol isn't the only factor behind heart disease. High blood pressure, smoking, obesity, diabetes or a strong family history of the disease can put someone in the high-risk category even if their cholesterol isn't a red flag. Some doctors also are testing for inflammation in arteries that may play a role, too.

On the cholesterol front, doctors have long focused on three key numbers:

_Total cholesterol should be below 200.

_An LDL or "bad" cholesterol level below 130 is good for healthy people, but someone with heart disease or diabetes should aim for under 100.

_For HDL, the "good" cholesterol that helps control the bad kind, higher numbers are better � 60 is protective while below 40 is a risk.

Where do particles come in? Scientists have long known that small, dense LDL particles sneak into the artery wall to build up and narrow blood vessels more easily than larger, fluffier particles. While overall LDL levels usually correlate with the amount of particles in blood, they don't always, just as a beach bucket of sand may weigh the same as a bucket of pebbles but contain more particles.

Only in recent years have commercial tests made particle checks more feasible � although there's no standard method, and different tests measure in different ways. The tests add another $100 to $150 to regular cholesterol checks.

But is knowing about your particles really useful, and if so when? That's where doctors are split.

A study published last spring used one particle test, from Raleigh, N.C.-based LipoScience, to analyze a database of more than 5,000 middle-aged people whose heart health was tracked for five years. Most people's overall LDL and particle counts correlated pretty well. But people had a higher risk of heart disease when their particle count was much higher than their LDL predicted � and, conversely, a lower risk if their particle count was lower than expected, says lead researcher Dr. David Goff Jr. of Wake Forest University.

"We could be treating some people who don't need to be treated ... and we may be missing some people who should be treated," Goff says. "But I'd also say that we haven't done all the research that needs to be done to prove that this will lead to better patient outcomes."

Many of those higher-risk patients could be caught by a closer look at standard tests "for no additional charge," says Dr. Roger Blumenthal of Johns Hopkins University and the American College of Cardiology.

Triglycerides, another harmful fat, are a good indicator, Blumenthal says. You're at risk despite a low LDL if your triglycerides are over 130, not to mention a low HDL, he said. People who are obese, diabetic of borderline diabetic also are at greater risk, because they often have higher LDL particle counts.

Another way to measure without an added test: Just subtract HDL from your total cholesterol number. The resulting bad-fat total should be no higher than 30 points above your recommended LDL level � and if they are, it's time for serious diet and exercise, adds Dr. Allen Taylor of Washington Hospital Center.

Still, even some doctors who don't think particle testing is for the masses say they use it sometimes to tip the scales on a borderline patient.

Others use it to guide therapy. Consider Denny Fongheiser of Santa Monica, Calif. At 52, his usual 3-mile-a-day walk suddenly left him panting, but his insurer wouldn't pay for a stress test because his cholesterol was normal.

A month later, chest pain sent Fongheiser to the hospital where he needed a stent to unclog an artery. It turned out he had high particle levels, which his cardiologist now aims to get below the LipoScience-recommended level of 1,000 with cholesterol-lowering drugs.

"I was basically a time bomb," Fongheiser says. He welcomes "being able to test this and know what's going on."

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Demise of Obama long-term care plan leaves gap (AP)

WASHINGTON � It's the one major health expense for which nearly all Americans are uninsured. The dilemma of paying for long-term care is likely to worsen now that the Obama administration pulled the plug on a program seen as a first step.

The Community Living Assistance Services and Supports program, or CLASS, was included in the health overhaul law to provide basic long-term care insurance at an affordable cost. But financial problems dogged it from the outset.

Those concerns prompted the administration to announce that CLASS would not go forward. Yet it could take a decade or longer for lawmakers to tackle the issue again, and by then the retirement of the Baby Boomers will be in full swing.

Most families don't plan for long-term care. Often the need comes unexpectedly: an elder takes a bad fall, a teen is calamitously injured in a car crash or a middle-aged worker suffers a debilitating stroke.

Nursing home charges can run more than $200 a day and a home health aide averages $450 a week, usually part-time. Yet Medicare doesn't cover long-term care, and only about 3 percent of adults have a private policy.

"Long-term care is a critical issue, and people are in total denial about it," said Bill Novelli, former CEO of AARP. "I am very sorry the administration did what they finally did, although I understand it. It is going to take a long time to get this back � and fixed."

The irony, experts say, is that paying for long-term care is the kind of problem insurance should be able to solve. It has to do with the mathematics of risk.

Most drivers will have some kind of accident during their years behind the wheel, but few will be involved in a catastrophic wreck. And some very careful drivers will not experience any accidents. The risks of long-term care are not all that different, says economist Harriet Komisar of the Georgetown University Public Policy Institute.

"A small percentage of people are going to need a year, two years, five years or more in a nursing home, but for those who do, it's huge," Komisar said. "Insurance makes sense when the odds are small but the financial risk is potentially high and unaffordable."

Komisar and her colleagues estimate that nearly 7 in 10 people will need some level of long-term care after turning 65. That's defined as help with personal tasks such as getting dressed, going to the toilet, eating, or taking a bath.

Many of those who need help will get it from a family member. Only 5 percent will need five years or more in a nursing home. And 3 in 10 will not need any long-term care assistance at all.

For those who do need extended nursing home care, Medicaid has become the default provider, since Medicare only covers short-term stays for rehab. But Medicaid is for low-income people, so the disabled literally have to impoverish themselves to qualify, a wrenching experience for families.

Liberals say the answer is government-sponsored insurance, like the CLASS plan the Obama administration included in the health overhaul law, only to find it wouldn't work financially.

The administration was unable to reconcile twin goals of CLASS: financial solvency and affordable coverage easily accessible to all working adults, regardless of health.

Conservatives have called for private coverage, perhaps with tax credits to make it more affordable.

Some experts say it will take a combination of both approaches.

"It almost has to be," said Robert Yee, a financial actuary hired by the Obama administration to try to make CLASS work.

Lower-income workers probably would never be able to afford private insurance, Yee explained. And a lavish public plan is out of the question.

"Anytime people talk about a social program, you are talking about a basic layer," he said.

Indeed, Yee had proposed to keep CLASS afloat by using some of the techniques of private insurers to attract the healthy and discourage the frail. The administration rejected that hybrid approach as incompatible with the law's intent to cover all regardless of health.

"Despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time," Health and Human Services Secretary Kathleen Sebelius told congressional leaders.

Although CLASS would have come too late to help his disabled mother, Jacob Bockser of Walnut Creek, Calif., says he is disappointed.

Bockser, 29, is a former emergency medical technician studying to become a respiratory therapist. His mother Elizabeth, 58, is struggling with an aggressive form of multiple sclerosis.

She had moved to lower-cost Washington state to save money, but as her condition worsens her son is trying to find a way to bring her back to California. She can still live in her own home, with help to keep safe.

"She did a lot of good saving. But because she did good, it disqualifies her from some kinds of public assistance," said the son. "When you are only 58 and looking at hopefully living another 20 or 25 years, it's scary to think the money just won't last."

Bockser says he doesn't expect the government to solve everything, but "even if there is the opportunity to try to piece together a couple of different programs that would be a start."

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BPA in pregnant women might affect kids' behavior (AP)

CHICAGO � Exposure to BPA before birth could affect girls' behavior at age 3, according to the latest study on potential health effects of the widespread chemical.

Preschool-aged girls whose mothers had relatively high urine levels of bisphenol-A during pregnancy scored worse but still within a normal range on behavior measures including anxiety and hyperactivity than other young girls.

The results are not conclusive and experts not involved in the study said factors other than BPA might explain the results. The researchers acknowledge that "considerable debate" remains about whether BPA is harmful, but say their findings should prompt additional research.

The researchers measured BPA in 244 Cincinnati-area mothers' urine twice during pregnancy and at childbirth. The women evaluated their children at age 3 using standard behavior questionnaires.

Nearly all women had measurable BPA levels, like most Americans. But increasingly high urine levels during pregnancy were linked with increasingly worse behavior in their daughters. Boys' behavior did not seem to be affected.

The researchers said if BPA can cause behavior changes that could pose academic and social problems for girls already at risk for those difficulties.

"These subtle shifts can actually have very dramatic implications at the population level," said Joe Braun, the lead author and a research fellow at Harvard's School of Public Health.

For every 10-fold increase in mothers' BPA levels, girls scored at least six points worse on the questionnaires.

The study was released online Monday in Pediatrics.

Linda Birnbaum, director of the National Institute of Environmental Health Sciences and the National Toxicology Program, said the study contributes important new evidence to "a growing database which suggests that BPA exposure can be associated with effects on human health."

Grants from that federal agency helped pay for the study.

The Food and Drug Administration has said that low-level BPA exposure appears to be safe. But the agency also says that because of recent scientific evidence, it has some concern about potential effects of BPA on the brain and behavior in fetuses, infants and small children. The FDA is continuing to study BPA exposure and supports efforts to minimize use in food containers.

BPA has many uses, and is found in some plastic bottles and coatings in metal food cans. It was widely used in plastic baby bottles and sippy cups but industry phased out that use.

Braun said it's possible that exposure to BPA during pregnancy interferes with fetal brain development, a theory suggested in other studies, and that could explain the behavior differences in his study. Why boys' behavior wasn't affected isn't clear. But BPA is thought to mimic the effects of estrogen, a female hormone.

The researchers evaluated other possible influences on children's behavior, including family income, education level and whether mothers were married, and still found an apparent link to BPA.

But Dr. Charles McKay, a BPA researcher and toxicologist with the Connecticut Poison Control Center, said the researchers failed to adequately measure factors other than BPA that could explain the results.

For example, there's no information on mothers' eating habits. That matters because mothers' higher BPA levels could have come from eating lots of canned foods instead of healthier less processed foods, which might have affected fetal brain development.

The American Chemistry Council, a trade group whose members include companies that use BPA, said the research "has significant shortcomings ... and the conclusions are of unknown relevance to public health."

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Online:

FDA: http://tinyurl.com/ya4d4ku

Info for parents: http://www.hhs.gov/safety/bpa/

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

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Russia parliament adopts law restricting abortions (AP)

MOSCOW � Russia's parliament adopted a law Friday limiting abortions but rejected even tougher restrictions backed by the country's conservative Orthodox Church.

Health officials say Russia's abortion rates are among the world's highest, contributing to a fertility rate of only 1.4 children per woman � far below the 2.1 needed to maintain the existing population. The country's birth rate has become a serious concern for Russia as it fights to stem a steep population decline.

The Health Ministry says more than a million pregnancies are terminated in Russia annually, although abortion critics say the statistics don't include private clinics and the real number amounts to six million a year.

The law passed Friday limits abortions to 12 weeks of pregnancy, except for women who say they can't afford a child, who may have an abortion up to 22 weeks. The law also stipulates a mandatory waiting period of two to seven days before the procedure to allow a woman to reconsider her decision.

The law does not include restrictions proposed by the Russian Orthodox Church, such as a requiring a husband's consent for married women, parents' consent for teenage girls or for a doctor's right to refuse an abortion.

During the Soviet era, abortion laws were liberal and unrestricted abortions became virtually the only effective method of family planning, as condoms were unreliable and seldom used.

The abortion debate in Russia has not become as divisive and heated as the abortion debate in the United States, but the effort to restrict them has strong backing from the Russian Orthodox Church, which has sought a more muscular role in society.

Russia's population, now at 143 million, has shrunk by 5.7 million since the 1991 fall of the Soviet Union, a plunge blamed on rampant alcoholism, bad diets and lack of exercise.

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