Haiti group demands UN pay for cholera outbreak (AP)

PORT-AU-PRINCE, Haiti � A human rights group said Tuesday it has filed claims with the United Nations seeking damages on behalf of more than 5,000 Haitian cholera victims and their families.

The claims filed by the Boston-based Institute for Justice and Democracy in Haiti argue that the U.N. and its peacekeeping force are liable for hundreds of millions of dollars for failing to adequately screen peacekeeping soldiers.

They cite a range of studies that indicate the infected soldiers caused the outbreak when untreated waste from a U.N. base was dumped into a tributary of Haiti's most important river.

"The sickness, death and ongoing harm from cholera suffered by Haiti's citizens are a product of the U.N.'s multiple failures," the complaint reads. "These failures constitute negligence, gross negligence, recklessness, and deliberate indifference for the lives of Haitians."

Cholera has sickened nearly 500,000 people and killed more than 6,500 others since it surfaced in Haiti in October 2010, according to the Haitian Health Ministry. Evidence suggests that the disease was inadvertently brought to Haiti by a U.N. battalion from Nepal, where cholera is endemic. A local contractor failed to properly sanitize the waste of a U.N. base, and the bacteria leaked into a tributary of one of Haiti's biggest rivers, according to a study by a U.N. appointed panel.

The disease spread throughout Haiti because of poor sanitation, and the country now has the highest cholera infection rate in the world.

There had been no documented cases of the disease prior to its arrival, and medical workers say the disease is likely to become endemic.

Cholera is caused by a bacteria found in contaminated water or food, and can kill people within hours through dehydration. It is easily treatable if caught in time.

The Institute filed the petition on Thursday with the Office of the Secretary General in New York and with the claims unit for the mission in Port-au-Prince, said Brian Concannon, an attorney who is director of the Institute.

Concannon said he hoped the U.N. mission would set up a tribunal to evaluate the claims. He also said he hoped the U.N. force would create a lifesaving program that would provide sanitation, potable water and medical treatment. He also said he wants a public apology.

"We're obviously hoping that the U.N. will step up and do the right thing," he said by telephone.

If that doesn't happen, the group plans to file the claims in a Haitian court, he said.

The petitioners include families who saw breadwinners die from cholera, and the Institute said some families spent their life savings and went into debt to pay for funerals.

The Institute is also seeking a minimum of $100,000 for each bereaved family and $50,000 for each cholera survivor.

U.N. spokeswoman Sylvie Van Den Wildenberg said she was aware that a group was planning to file the complaint, but couldn't confirm that a claim presented to her was the same one officially received by the United Nations.

"In any case, the petition, when it is received, should be transferred to the legal office and headquarters," Van Den Wildenberg said.

Moving forward on the case could be tricky.

The U.N. has immunity from national courts but "one would hope that the Secretary General would address this with great moral seriousness," Ruth Wedgwood, a professor of international law and diplomacy at Johns Hopkins' School of Advanced International Studies, said after reading the petition. "It's a lot of money but if the facts as alleged as true it's a serious harm."

The U.N. force, known by its French acronym Minustah, arrived in 2004 following the ouster of then-President Jean-Bertrand Aristide. The mission's mandate was renewed last month for another year, though troop numbers are being reduced from almost 13,000 to 11,500.

The renewal coincided with anti-U.N. protests in Haiti. Demonstrators accused the world body of doing more harm than good, citing the cholera outbreak and an unrelated abuse scandal involving Uruguayan sailors.

The peacekeeping mission has helped keep order in the country and ensured two peaceful transfers of power but some Haitians view the force as an affront to national sovereignty.

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Babies on obesity path? New sign may offer answer (AP)

CHICAGO � Researchers say there's a new way to tell if infants are likely to become obese later on: Check to see if they've passed two key milestones on doctors' growth charts by age 2.

Babies who grew that quickly face double the risk of being obese at age 5, compared with peers who grew more slowly, their study found. Rapid growers were also more likely to be obese at age 10, and infants whose chart numbers climbed that much during their first 6 months faced the greatest risks.

That kind of rapid growth should be a red flag to doctors, and a sign to parents that babies might be overfed or spending too much time in strollers and not enough crawling around, said pediatrician Dr. Elsie Taveras, the study's lead author and an obesity researcher at Harvard Medical School.

Contrary to the idea that chubby babies are the picture of health, the study bolsters evidence that "bigger is not better" in infants, she said.

But skeptics say not so fast. Babies often grow in spurts and flagging the speediest growers could lead to putting infants on diets � a bad idea that could backfire in the long run, said Dr. Michelle Lampl, director of Emory University's Center for the Study of Human Health.

"It reads like a very handy rule and sounds like it would be very useful � and that's my concern," Lampl said. The guide would be easy to use to justify feeding infants less and to unfairly label them as fat. It could also prompt feeding patterns that could lead to obesity later, she said.

Lampl noted that many infants studied crossed at least two key points on growth charts; yet only 12 percent were obese at age 5 and slightly more at age 10. Nationally, about 10 percent of preschool-aged children are obese, versus about 19 percent of those aged 6 to 11.

Lampl and Edward Frongillo, an infant growth specialist at the University of South Carolina, voiced concern in an editorial accompanying the study in the journal Archives of Pediatrics & Adolescent Medicine, released online Monday. They argue that more research is needed to confirm whether the study's recommendation is really a useful way to flag infants for obesity.

"The potential to do more harm than good is actually very high," Frongillo said.

Taveras said the kind of rapid growth noted in the study should be used to raise awareness about potential risks but is not a reason to put babies on a diet.

The study involved 45,000 infants and children younger than age 11 who had routine growth measurements during doctor checkups in the Boston area from 1980 through 2008.

Growth charts help pediatricians plot weight, length in babies and height in older kids in relation to other children their same age and sex. Pediatricians sometimes combine an infant's measures to calculate weight-for-length � the equivalent of body-mass index, or BMI, a height-to-weight ratio used in older children and adults.

The charts are organized into percentiles. For example, infants at the 75th percentile for weight are heavier than 75 percent of their peers.

The study authors used seven major cutoffs on the charts � the 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles � to calculate growth pace. An infant whose weight-for-length jumped from the 19th percentile at 1 month to the 77th at 6 months crossed three major percentiles � the 25th, 50th and 75th � and would be at risk for obesity later in childhood, the authors said.

Larger infants were most at risk for obesity later on, but even smaller babies whose growth crossed at least two percentiles were at greater risk than those who grew more slowly.

About 40 percent of infants crossed at least two percentiles by age 6 months. An analysis of more than one-third of the study children found that 64 percent grew that rapidly by age 2.

Dr. Joanna Lewis, a pediatrician at Advocate Lutheran General Hospital in Park Ridge, Ill., said she supports the idea that infancy is not too young to start thinking about obesity.

Still, she emphasized that rapid growth in infancy doesn't mean babies are doomed to become obese. "It's not a life sentence," and there are steps parents can take to keep their babies at a healthy weight without restrictive diets, she said.

Lewis said many of her patients are large babies whose parents feed them juice or solid food despite guidelines recommending nothing but breast milk or formula in the first six months.

"The study reinforces what we try to tell parents already: Delay starting solids and don't put juice in a bottle," Lewis said.

Lewis also advises parents that when starting infants on solid food, have the whole family sit down and eat together. Research has shown that obesity is less common in children raised in families that have frequent meals together at home.

___

Online:

Journal: http://www.archpediatrics.com

Growth charts: http://www.cdc.gov/growthcharts

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

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Hit reset on cancer screening: 'Tests not perfect' (AP)

WASHINGTON � It turns out that catching cancer early isn't always as important as we thought.

Some tumors are too slow-growing to ever threaten your life. Some are so aggressive that finding them early doesn't make much difference. And today's treatments are much better for those somewhere in the middle.

Those complexities are changing the longtime mantra that cancer screening will save your life. In reality, it depends on the type of cancer, the test and who gets checked when.

"We can find cancer early. We can reduce the burden of the disease. But along the way, we're learning our tests are not as perfect as we'd like," says the American Cancer Society's Dr. Len Lichtenfeld, a longtime screening proponent. "We're learning that we're now finding cancer that would in fact never cause harm."

Now cancer specialists are struggling to find a new balance: to quit over-promising the power of early detection and to help people understand that the tests themselves have risks � while not scaring away those who really need it.

Least controversial are cervical and colorectal cancer screenings. They can spot pre-cancerous growths that are fairly easy to remove, although even some of those tests can be used too frequently. More serious questions surround other cancers � like which men, if any, should get a PSA blood test to check for prostate cancer, and whether women should start mammograms in their 40s or wait until they're 50.

Also in question is whether doctors will be able to head off another looming controversy: Just which smokers and ex-smokers should get a pricey CT scan that can detect lung cancer but also is prone to false alarms? A recent study found the scans could save some lives. But guidelines aren't due out until early next year that would decide who is at enough risk to outweigh the test's potential harm � such as a risky, invasive biopsy to tell if a suspicious spot is cancer or just an old smoking scar.

Yet already people like 80-year-old Fred Voss of Sunderland, Md., are seeking out the tests.

"It was a big relief, and it gave me something to watch," says Voss, who participated in the CT study but wanted to get tested again to make sure nothing had changed.

Today, guidelines for how to handle some of the most common cancer screenings conflict. And, they're written for the average patient when many people may need a more customized decision, says Dr. Jeanne Mandelblatt of Georgetown University. She has studied breast cancer risk for a government panel that recommends most women not begin screening for the disease until age 50.

Consider this, she says: The average woman has a 3 percent lifetime risk of dying of breast cancer, a low risk for a disease that women find so scary. But the chances of getting breast cancer do gradually increase with age and other circumstances.

So if you're 40 and have several risk factors � like dense breasts and close relatives with the disease � then you have the same risk as an average 50-year-old, not an average 40-year-old, and might consider earlier mammograms, Mandelblatt says. Few primary-care doctors have the time to go into that kind of detail.

Adding to the confusion are testimonials from cancer survivors that a screening saved their lives. Dartmouth researchers recently studied how often that's true for mammograms, and estimated that about 13 percent of women in their 50s whose breast cancer is detected by the tests survive as a result.

What else plays a role? Treatments have dramatically improved in recent years, saving more lives. Also, increasingly powerful mammograms are detecting more low-risk tumors, the kind that probably wouldn't have threatened a woman's life in the first place.

Still, mammograms are "not perfect, but they're the best we have," cautions Mandelblatt. She thinks the Dartmouth estimate is somewhat low.

PSA tests for prostate cancer are a much tougher call. Last month, a government panel recommended an end to routine PSA screenings, a step further than other major medical groups that urge men to weigh the pros and cons and decide for themselves. But the U.S. Preventive Services Task Force found limited, if any, evidence that screening average men improves survival. That's largely because so many men are diagnosed with slow-growing tumors that never would have killed them; still, they have treatments that can cause incontinence, impotence or even lead to death.

"We really � underline the word `really' � have to pull back the messaging on prostate cancer," says the cancer society's Lichtenfeld, who himself isn't sure of the test's net worth. PSA testing took off on the basis of "blind faith" that they would work, not science, he says.

What really worries Lichtenfeld is that ever more powerful cancer screenings are being developed, before doctors have a way to tell exactly which early tumors should be removed.

"We have cells in our body that are abnormal all the time, and our bodies deal with it," he says. "Our technology takes us further and further down the early-detection path, and we need to sort through all this."

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

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Too posh to push? More C-sections on demand in UK (AP)

LONDON � Pregnant women in Britain, where the government provides free health care, may soon be able to get a cesarean section on demand thanks to a rule change that critics describe as the health system caving into the "too posh to push" crowd.

Currently, British women who can't afford to pay private doctors for their baby's delivery have been allowed to have planned C-sections only if there are health concerns for mother or baby. Emergency C-sections are done when the situation demands it.

But new guidelines set to take effect later this month say pregnant women "with no identifiable reason" should be allowed a cesarean if they still want it following a discussion with mental health experts.

"It's about time women who have no desire to view labor as a rite of passage into motherhood be able to choose how they want to have their baby," said Pauline Hull, who has had two children by cesarean because of medical reasons. "The important thing to me was meeting my baby, not the experience of labor."

Hull runs a website about elective C-sections from her home in Surrey, south of London. She said doctors tend to overexaggerate the risks of C-sections and underestimate those of vaginal births.

The new draft guidelines come from the National Institute for Health and Clinical Excellence, or NICE. The agency's guidelines are usually accepted by the government and determine what will be paid for by its health system.

"In general, a C-section is a safe operation, especially when performed as a planned procedure," the new guidance says.

The agency says it routinely updates guidance every few years and denies there was any pressure to change its more restrictive C-section advice. But in recent years, advocates and some doctors have slammed the U.K. health system for not giving women a greater say in childbirth.

The change comes at a price for Britain's cash-strapped health system. NICE estimates C-sections cost about 800 pounds ($1,280) more than a vaginal birth, although that doesn't include the price of treating possible long-term complications like urinary incontinence from vaginal births.

The report notes that for every percentage point the C-section rate falls, the health system could save 5.6 billion pounds ($8.9 billion).

In the U.K., about 25 percent of women have C-sections, versus about 30 percent in the U.S. In both countries, rates have doubled in recent years, though doctors say that's not just due to demand, but because pregnant women increasingly have other problems like obesity and diabetes.

About 10 percent of all U.K. births are planned C-sections while about 15 percent are emergency procedures, according to NHS figures.

The World Health Organization says wealthy countries should aim for a C-section rate of about 15 percent.

The National Health Service estimates that about 15 percent of British births take place in private hospitals, which tend to have higher cesarean rates. At Portland Hospital in London, where many celebrities check in, the C-section rate ranges from 35 to 40 percent.

The issue of women having C-sections on demand has long been a hot button issue in the U.K., with celebrities like Madonna and former Spice Girl Victoria Beckham having scheduled procedures at upscale hospitals. Criticism for the wealthy getting these elective surgeries led to the phrase "too posh to push."

But some experts say the new British guidance won't dramatically change how pregnant women are treated.

"It's only a small percentage of women who ask for a C-section," said Cathy Warwick, chief executive of the Royal College of Midwives.

Warwick said doctors and midwives regularly talk to women who have concerns about childbirth and after addressing their fears, most women agree to skip a planned C-section.

"As long as it's safe for both mother and baby, a vaginal birth is absolutely the best way for anyone to deliver," said Dr. Daghni Rajasingham, an obstetrician and spokeswoman for the Royal College of Obstetricians and Gynaecologists. She said the physical stress put on a baby's lungs during labor helps them adapt to breathing after being born.

Rajasingham also said while C-sections are safe, the operation comes with risks including infections, bleeding, and the potential for problems with future pregnancies.

"As an obstetrician working with limited resources, I want to make sure we have safe and high-quality health care for all women and not be skewed by a few women who want something specifically," Rajasingham said.

For women like Hull, however, the policy shift is long overdue.

"Women shouldn't think a C-section is going to be a walk in the park, but they should have all the information they need to help them make an informed choice," she said.

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Texas board mulls stem cell therapy used on Perry (AP)

AUSTIN, Texas � The experimental stem cell procedure that Texas Gov. Rick Perry underwent this summer could be restricted or even blocked under new rules being considered Friday by the state's Medical Board.

Some top scientists are questioning the safety and wisdom of the procedure, and doctors say it may run up against federal rules. It also carries potential health threats, ranging from blood clots to increased cancer risk.

The Republican presidential candidate had stem cells taken from fat in his own body, which were then grown in a lab. They were injected into his back and his bloodstream during an operation in July to fuse part of his spine.

Adult stem cells have long been used to treat leukemia, lymphoma and other cancers. While the cells are being studied to treat other ailments, from heart disease to diabetes, experts say it's too soon to know if the approaches are safe or effective. The Food and Drug Administration hasn't approved using adult stem cells to help people heal from surgery � but experimentation is common.

Perry opposes greater oversight in Texas, and he sent a letter to the board urging members to recognize the "revolutionary potential" of adult stem cell research and therapies.

"Texas is a leader in innovation in many fields," Perry wrote after his surgery. "It is critical that we continue to foster an environment that encourages technological advancement in the health care arena."

Adult stem cell therapy is different from using embryonic cells, a controversial technology that Perry opposes.

The medical board will meet Friday to discuss rules that would require an accredited body to review any procedures involving stem cells before they're carried out, to access research trials and ensure patient safety. The rules also would require that such therapies be done by physicians and in adherence to Texas and federal laws.

The 19 volunteer board members � all appointed by Perry, including a dozen physicians � could approve the proposed rules, make or seek changes, or scrap them altogether, board spokeswoman Leigh Hopper said.

If the board vote goes against him, the matter could become a campaign issue as Perry struggles to reinvigorate his White House bid. His polling numbers have tumbled in recent weeks. Perry has worn a back brace but maintained his work schedule since the surgery.

Some orthopedic surgeons are experimenting with stem cells to help bones heal, with the cells being taken from bone marrow and injected or implanted in the trouble spot. The theory is that such "master cells" will follow cues from cells around them and form bone or cartilage, though researchers worry they also might spur unwanted growth and cancer.

Perry's treatment, which involved using stem cells from fat, was even more experimental.

Perry said in his letter that he understood the need to protect patients, but added, "we need to ensure that physicians in this state can continue to pursue new technologies and treatments that will benefit all Texans."

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Study: Infant formula ads reduce breast-feeding (AP)

MANILA, Philippines � The World Health Organization said a study has found that Filipino mothers who have been influenced by advertisements or their doctors to use infant formula are two to four times more likely to feed their babies with those products.

The study appears to support the Philippines' decision to limit advertising for infant formula, which can discourage mothers from breast-feeding that provides health benefits for newborns.

Published by the Social Science and Medicine Journal in September and released this week, the study said those mothers were 6.4 times more likely to stop breast-feeding babies within one year of age � a step that raises risks of illness and death for the infant.

Breast milk significantly reduces infant mortality, according to international health experts, who recommend that mothers exclusively breast-feed for the first six months and continue breast-feeding, supplemented by solid foods, until their babies are 2 years old.

The International Code of Marketing of Breast-Milk Substitutes, sponsored by the World Health Organization and UNICEF, is not legally binding. It is up to individual countries to implement the code by enacting their own laws.

The Philippine study wanted to examine if marketing for breast milk substitutes was to blame for a drop in breast-feeding in the Southeast Asian country, one of several where multinational companies fought a legal battle for the right to aggressively sell baby formulas.

When the Philippine government tried to tighten its advertising laws for milk products, the companies took it to court.

The Supreme Court ruling in October 2007 upheld the Department of Health's mandate to regulate advertising of breast milk substitutes. It prohibited all health and nutrition claims but failed to support a full advertising ban, citing freedom of speech.

WHO data show exclusive breast-feeding rates for Filipino babies up to four months old dropped from 47.3 percent in 1998 to 40.1 percent in 2008.

Four of the six authors of the study are from the WHO, led by the organization's medical officer Howard Sobel. They conducted a household survey between April and December 2006 and focus groups in April-May 2007.

According to their findings, 59.1 percent of the mothers recalled an infant formula advertisement message and one-sixth reported a doctor recommended using formula. Those who recalled an ad message were twice as likely to feed their babies infant formula, while whose advised by a doctor where four times as likely to do so.

"Despite poverty and extra strain on household income associated with formula use, 41.1 percent of the infants and young children were fed formula," the authors said.

The WHO says addition of formula leads to decreased stimulation from suckling and its reflex for breast milk production. Not breast-feeding also was associated with a 5.8 times increased risk of all-cause deaths in the first two months of life, with risks elevated up to the second year, it says.

The authors said that despite the WHO's adoption in 1981 of the International Code of Marketing Breast Milk Substitutes to curtail unethical marketing promotions, few countries have fully implemented the code's ban on advertising or other forms of promotion.

Alex V. Castro III, executive director of the Infant Pediatric Nutrition Association of the Philippines that groups infant formula makers, said the association fully supports breast-feeding.

He said their members have been diligently complying with the Philippines' adaptation of the WHO's milk code, including prohibitions in advertising. He said no advertisement has been allowed without approval of an interagency headed by the Department of Health.

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