Doctors: Pap remains best test for cervical cancer (AP)

There's more news on cancer screening tests � this time for women.

Scientists advising the government say a Pap test is a good way to screen young and middle-aged women for cervical cancer, and it's only needed once every three years. But they say there is not enough evidence yet to back testing for HPV, the virus that causes the disease.

That's at odds with the American Cancer Society and other groups, which have long said that using both tests can be an option for women over 30.

Those groups and the government advisory task force separately plan to release proposed new guidelines for cervical cancer screening on Wednesday and invite public comment. The task force is the same group that recommended against routine PSA tests to screen for prostate cancer, saying they were doing more harm than good for men at average risk.

Cervical cancer screening is a success story. In the United States, cases and death rates have been cut more than in half since the 1970s because of Pap smears � lab exams of cells scraped from the cervix, the gateway to the uterus. The test can find early signs of this slow-growing cancer and treat them before a tumor has a chance to develop.

So "the bar is set pretty high" for a test to replace or supplement Paps, said Dr. Evelyn Whitlock of Kaiser Permanente Northwest's Center for Health Research in Portland, Ore.

Not enough is known about the benefits and especially the harms of HPV testing, concludes the scientific review she led that was published on Monday. The task force that asked for the review voted unanimously in March that there was insufficient evidence to recommend for or against HPV testing, but has continued to discuss the issue and will give its advice on Wednesday.

Here's the dilemma: Infections with HPV, the human papillomavirus, are very common especially in young women. They usually go away on their own and only pose a cancer risk when they last a year or more.

Tests that find these infections might lead many women to more invasive follow-up tests that can weaken the cervix and cause problems having children later. No big studies measure these harms, and a test that flags more potential cancers might not be better.

"A lot of people use the word `superior' to mean it catches more cancer. But the other side of it is, does it catch more things that are not cancer? You have to weigh benefits versus harms for any screening test," said Debbie Saslow, the cancer society's director of breast and gynecologic cancer.

The evidence review finds little risk of cervical cancer in women under 21 and says screening below that age may be harmful. It also says screening can stop at age 65 if a woman has had adequate screening in the past and is not otherwise at high risk.

The review was published Monday in the Annals of Internal Medicine.

The same journal also published a study on another women's cancer issue � breast cancer screening. That research supports having mammograms every other year instead of annually. Over time, there are more false alarms with annual screening, and going every two years does not significantly raise the risk of a late-stage cancer being found, researchers report.

Breast cancer screening has been an emotional issue since 2009 when the government task force said women at average risk of the disease don't need mammograms until age 50 and then just every other year to age 74. The cancer society and others still advise annual tests starting at age 40.

The federally funded study gives a real-world view of the downside of screening � the worry, expense and medical risks of biopsies and other tests that ultimately prove unnecessary. It looked at false alarms at various intervals of screening for nearly 170,000 women ages 40 to 59 in ordinary community settings, plus nearly 4,500 other women with invasive breast cancer.

About 61 percent of women who get a mammogram every year for a decade will be called back at least once for extra tests that turn out not to show breast cancer, the study found.

Screening every other year drops this false alarm rate to 42 percent without a big risk of cancer being discovered at a late stage. And a tip for women: If you changed where you go for mammograms, bringing or having doctors send your last one to be compared to the new one cuts in half the chance of a false alarm.

Women who started having mammograms in their 40s versus their 50s were more likely to have a false alarm just because they were having more tests � not because mammography is less accurate in that age group.

False alarms "are part of the price to pay for early detection," said study leader Rebecca Hubbard of Group Health Research Institute, part of a Seattle-based managed care system. Women need to know how common they are, and "if it happens to them they will feel less anxiety," she said.

Dr. Robert Smith, the cancer society's director of cancer screening, said the study should have more precisely defined intervals � it called annual screening an interval of 9 to 18 months, and biennial screening, 19 to 30 months.

"A false positive is commonly discussed as if it were a catastrophic event. For the large majority of women, it isn't," and surveys say women will accept the risk in return for finding cancer early, he said.

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Online:

Journal studies: http://www.annals.org

Cervical cancer science review: http://tinyurl.com/6lc2rzg

Task force advice: http://www.ahrq.gov/clinic/pocketgd1011/gcp10s2.htm

CDC on HPV tests: http://www.cdc.gov/hpv/Screening.html

Cancer Society: http://tinyurl.com/44gnadx

and http://tinyurl.com/257mnge

___

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

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CDC: Add $2 per drink for US excessive drinking (AP)

ATLANTA � The toll of excessive drinking works out to about $2 per drink, in terms of medical expenses and other costs to society, according to a new federal research.

The Centers for Disease Control and Prevention study calculated societal costs from binge and heavy drinking beyond what consumers pay at the bar or liquor store. It's the first such federal estimate in more than a dozen years.

The study looked at costs that included � among other things � lost work productivity, property damage from car crashes, expenditures for liver cirrhosis and other alcohol-associated medical problems, and money spent on incarceration of drunk drivers and criminals using alcohol.

The CDC estimated excessive drinking cost society nearly $224 billion in 2006, the most recent year for which all necessary statistics were available. That worked out to about $1.90 per drink, 80 cents of which was spent by federal, state or local governments, the researchers estimated. The rest came from drinkers, their families, private health insurers, employers, crime victims and others.

Most of that was related to binge drinking, in which four or five alcoholic beverages are consumed on one occasion.

"Binge drinking results in binge spending," said CDC Director Dr. Thomas Frieden.

CDC officials noted that while some health benefits have been associated with, say, a glass of wine each day, there are no health benefits linked to excessive drinking. They also said the new study likely represents an underestimate of the total cost.

Smoking has been estimated to cost society about $193 billion annually. An older study estimated the cost of not exercising to be around $150 billion.

The study was released Monday by the American Journal of Preventive Medicine.

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No cupcakes here! Gold-medal school fights obesity (AP)

DANVILLE, Ill. � Five-year-olds dance hip-hop to the alphabet. Third-graders learn math by twisting into geometric shapes, fifth-graders by calculating calories. And everyone goes to the gym � every day.

In the middle of America's heartland, a small public school, Northeast Elementary Magnet School, has taken on a hefty task � reversing obesity.

And it's won a gold medal for it, becoming the first elementary school in the country to receive that award from the Alliance for a Healthier Generation. The Alliance was founded by the American Heart Association and the William J. Clinton Foundation to reduce childhood obesity. Only two other schools have taken the gold.

The cafeteria here serves fresh fruit and veggies, low-fat or no-fat milk, no sodas or fried foods and no gooey desserts. There are no sweets on kids' birthdays and food is never used as a reward. Teachers wear pedometers and parents have to sign a contract committing to the school's healthy approach.

Northeast Elementary is not in some posh, progressive suburb. It's in Danville, Ill., an economically struggling city of 30,000 in farm country some 150 miles south of Chicago. But teachers, parents and students have embraced the rigorous curriculum and kids even call it "fun."

From the outside, it's a drab 50's-era yellow brick building in a blue-collar neighborhood of modest frame homes, a few blocks from a homeless shelter and a Salvation Army donation center. Inside, it's a cheerful oasis for almost 300 kids and has caught the attention of some of the nation's biggest obesity-fighting advocates.

Former President Bill Clinton says the steps Northeast has taken are an exemplary way to tackle "a terrible public health problem."

"We will never change it by telling people how bad it is. We've got to show people how good it can be," Clinton said, paraphrasing a colleague at the Alliance's June awards ceremony in Little Rock, Ark.

Northeast's strict, no-goodies program might sound extreme, but students seem to have bought it.

During a recent nutrition lesson, first-graders sat raptly on the hallway floor as a teacher read "The Very Hungry Caterpillar," a classic kids' story about a caterpillar that can't seem to stop eating � all kinds of fruit at first. But when the bug moved on to chocolate cake and ice cream, the youngsters gasped and said in hushed tones, "junk food," as if it were poison.

"We're a healthy school," says 10-year-old Naomi Woods, a shy, slim fifth-grader. "We're not allowed to eat junk food or stuff like that."

Sandy-haired Timothy Mills, a fourth-grader, says the focus "just keeps us more fit, plus we have a lot more fun."

Like Mills, an earnest, heavy-set 9-year-old, Northeast kids aren't all skinny. Even some kindergartners are clearly overweight. But they still jump enthusiastically to the alphabet song, and though chubbier kids struggle to run around the football field during gym class, there doesn't seem to be much grumbling.

Physical education teacher Becky Burgoyne said it's sometimes tough to get kids of "all different shapes and sizes" to be physically active.

"I just ask that students do their best and improve on what they can already do," Burgoyne said.

Some schools "may have physical education twice a week, once a week, and that's not acceptable. Children need to move," she said. "To have a healthy body is to have a healthy brain and therefore they become better at reading and math and science. It all works together."

The students mostly mirror Danville and surrounding Vermilion County � generally poorer, less healthy than the state average, with many families struggling with obesity and related problems.

The percentage of overweight kids at Northeast increased in 2009, the program's third year, but dropped slightly last year, to 32 percent; 17 percent are obese. Those are similar to national figures, Principal Cheryl McIntire said. With only three years of data, it's too soon to call the slight dip in the percentage of overweight children a trend. But she considers it a promising sign, and there's no question that the children are learning healthy habits.

In a recent math class, fifth grade teacher Lisa Unzicker explained how food labels can be misleading by listing only calories per serving, not per container. Pointing to an image of a pretzel bag label projected on a screen at the front of the classroom, she taught students to figure out how many calories are in a whole bag, based on the amount in each serving.

You have to be careful about potato chips and candy bars, she told the class. "This is why it pays to be a very conscious consumer."

Teachers and parents credit McIntire for the school's success. The principal joined Northeast in 2008, a year after the staff moved to adopt the healthy focus, and has made it her mission to instill that mantra.

McIntire literally "walks the walk." When students need a talking-to, she walks to their classrooms and escorts them to and from her office rather than just messaging for them. When it's her turn for recess duty, she walks with her pedometer around the school's big field instead of standing on the sidelines. She recalls a student recently calling out, "Hey, Mrs. McIntire, are you doing your steps?"

McIntire is closely involved with choosing school menus and secured money from the state and local school district that have paid for fresh produce, including things like kiwi fruit that many children have never seen before.

A recent lunch menu featured whole-grain, reduced-fat cheese pizza, broccoli and cauliflower buds, sweet corn, chilled pears, low-fat pudding, and 1 percent low-fat milk.

McIntire has changed her own eating habits, giving up potato chips and shedding 15 pounds since last year.

Tall, slender and a youthful 56, McIntire guides Northeast with a firm but loving hand. She greets students by name each morning, helps with untied shoelaces, and offers hugs. And she scolds kids who have messy uniforms or are rude to their classmates.

School hallways feature signs about good food choices and being healthy, and a poster about the Alliance's gold award is prominently displayed near the school office.

The Alliance established a Healthy Schools' program in 2006, with funding from the Robert Wood Johnson Foundation. It helps schools that want to become healthier and meet alliance criteria for winning medals. More than 500 schools have won bronze and silver awards. Those gold medals are tougher to come by. Memorial High School in West New York, N.J., was the first school in the country ever to win a gold. Last year, Northeast became the first elementary school to do that. Rio Hondo Elementary in suburban Los Angeles is the latest to win it.

Ginny Ehrlich, chief executive officer for the Alliance for a Healthier Generation says of Northeast, "They truly stand out." The school has done a remarkable job of making "healthy eating and activity the norm."

Since Northeast is a magnet school, students have to apply to attend, although they don't need to test in. Besides committing to the healthy mindset, parents must volunteer 26 hours at the school each year.

"There certainly are people who are much more invested than others, but we have gotten so much positive feedback from parents," McIntire said.

In her first year, McIntire recruited students by posting advertisements in the local newspaper. "I don't need to do that anymore," she said. For the current school year, there were more than 80 applications for 48 kindergarten slots.

"We have people calling everyday wondering if their child can get in," she said.

Shelbi Black says Northeast has had an "amazing, life-altering" influence on her kids, 10-year-old Kayla and Carter, 5. They've come home requesting fruits and vegetables they used to reject. Carter was thrilled to make frozen fruit shish kebobs in school, and Kayla "was so excited the other day because she made her goal in running the mile and she was so happy that she knocked down her time from last year," Black said.

Tim Mills' mom, Charlyn Hester, says since the school adopted the healthy program, her family has switched from eating lots of convenience foods to lean grass-fed beef and lots of fruits and vegetables. Her oldest daughter, a recent Northeast graduate, has slimmed down and Hester says she thinks Tim and his 11-year-old sister will, too. Hester herself has lost almost 100 pounds since 2009.

The family's grocery bills are higher, but Hester, a freelance writer, says she and her husband, a security officer, have decided it's worth spending more on food and forgoing things like a new car, for their kids' health.

"It's not necessarily a financial hardship, but it's certainly an investment," she said.

Health department officials say they have not calculated obesity rates for children in Danville and the county. Psychologist Richard Elghammer, who works with a large rural health clinic in Danville, says about one-third of the kids treated there are overweight or obese � similar to the national average. National data suggest that the county's obesity rate alone for adults, about 32 percent, is also similar to the national average. About two-thirds of adults are overweight.

But Vermilion County rates of obesity-related illness including heart disease are higher, and more than 80 percent of county residents don't eat government-recommended amounts of fruits and vegetables, according to national surveys.

Dr. Thomas Halloran, an internist who treats adults in Danville, has been working to provide financial support and resources to Northeast, through his medical group, Carle Clinic. Halloran says many of his patients have diabetes and other illnesses tied to a lifetime of obesity and poor health habits. By instilling healthy habits in kids starting in kindergarten, the school is making an important contribution to the community's health, Halloran said.

___

Online:

Alliance for a Healthier Generation: http://www.healthiergeneration.org

Northeast's Facebook page: http://on.fb.me/oAutYo

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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

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

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