28 October 2010

Patient, Heal Thyself

The Wall Street Journal

After Shorter Hospital Stays, Doctors Raise Demands and Time for Recovery

For Michael Noonan, knee surgery in April was practically a breeze—an outpatient procedure that had the 41-year-old investment banker hobbling home on crutches in a matter of hours after surgeon David Altchek replaced his anterior cruciate ligament using small incisions.

But recovery was another matter. He needed the crutches for three weeks, had 12 weeks of physical therapy three times a week, then six weeks of exercises at home. He rented a strap-on ice compression device to reduce swelling, and wore a brace for about five weeks. Though fully healed now, being responsible for so much of his own rehabilitation, he says, "was like taking a new baby home for the first time—you don't really feel like you're licensed to do it."

Surgery is easier and faster than ever before: Nearly 65% of all surgeries don't require an overnight hospital stay, compared to 16% in 1980. Hospitals that once kept patients for three weeks after some major operations now discharge them within a matter of days. But the body still heals at its own pace, and reduced time in hospital care means patients are assuming more responsibility for their own recovery—and more risks. Patients not only have to perform rehabilitation regimens at home, but they are more often caring for their own incision wounds and dressings and having to watch for signs of infections and blood clots. They also may be managing drains, implanted IV ports and pumps, all of which can be difficult and stressful.

The move to speedier surgeries is largely the result of new minimally invasive techniques, improvements in anesthesia and cost-cutting by insurance companies and hospitals. Surgical procedures now often use smaller incisions, cut less muscle, and result in less blood loss. Newer anesthetics allow patients to regain consciousness quickly or not go to sleep at all. Pain medications are more effective.

At the same time, concern about rising health care costs has led to changes in Medicare and insurance plans that have encouraged the development of outpatient surgical centers and created financial incentives for hospitals to shift less complex surgery to their own outpatient facilities. So, many types of surgeries previously performed in hospitals with overnight stays are now being done on an outpatient basis: The number of freestanding surgery centers grew from about 240 in 1983 to more than 5,000 now.

The mean charge for outpatient surgery was $6,100 versus $39,000 for inpatient surgery in 2007, according to the most recent report on surgical costs from the federal government. Insurance companies are also less likely to pay for stays at rehabilitation centers, places where surgical patients were often sent after hospital discharge to recuperate.

With patients going home so quickly, more are having to grapple with complications on their own. Of all the complications that occur in the 30 days after surgery, such as infection and blood clots, almost half will surface after a patient leaves the hospital, according to data from one million patients in a surgical quality improvement program sponsored by the American College of Surgeons.

"The onus is really on patients to recognize if something is a problem," says Clifford Ko, a colorectal surgeon at the University of California, Los Angeles, and director of research and optimal patient care for the American College of Surgeons. "The recovery period is often as important as the procedure itself, and patients who don't follow their discharge instructions could have longer recovery times, greater risk of a complication, and potentially more pain."

Knee surgery patients, for example, are counseled to maintain their weight after surgery. But a recent study shows that most patients gain weight, which can jeopardize the health of the other knee. Depression, another common after-surgery occurrence, also can inhibit healing, if patients don't seek treatment.

Efforts are underway to improve follow-up for patients, particularly those who have surgery in doctor's offices, which don't have the same regulation as outpatient surgery centers. The Institute for Safety in Office-Based Surgery has developed a checklist that includes assuring that discharge instructions are provided and a plan for follow-up care is clear. "Patients need to be asked things like if there is redness at the incision site, do you know what to do?" says Fred Shapiro, a Harvard anesthesiologist and president of the group. (Redness at an incision site can be a sign of infection.)

Infections that can occur after any surgery can lead to a severe bloodstream infection that can be fatal. A study published in July in the Journal of Hospital Infection of 84,000 patients who developed a surgical site infection found that more than half occurred after discharge, increasing the risks of an emergency room visit, readmission to the hospital, and another surgery.

For months after a procedure, surgical patients are also at high risk of developing blood clots which can travel to the lung and cause death from a pulmonary embolism. After joint replacement, for example, though the risk is greatest within two to five days, a second peak development period occurs about 10 days after surgery when most patients have been discharged from the hospital. In knee surgery patients, a clot can form in the calf if the patient fails to elevate the leg and perform specific movement exercises. Blood clots and subsequent pulmonary embolisms remain the most common cause for emergency readmission and death following joint replacement, according to the American Academy of Orthopaedic Surgeons.

The American Academy of Orthopaedic Surgeons sponsors workshops to teach its members better communications skills to help patients understand procedures and to stress the importance of follow-up care, such as providing clear written instructions and monitoring patients after surgery. "We can have a perfect total knee replacement but then have a poor outcome if we don't convince surgeons that explaining the post-operative care is in everyone's best interest," says John Tongue, a Portland, Ore.-area orthopedic surgeon and clinical associate professor at Oregon Health & Science University who teaches the workshops.

Insurers have become stricter about paying for inpatient rehabilitation programs where Detroit knee surgery patients were once transferred to recover. The move has been spurred partly by studies that show that cheaper at-home visits from therapists are effective.

But Nina Reznick, a 63-year old patient who had both hips replaced last July, says the home therapist her insurance paid for did not have the equipment or time to really help, so she did extra exercises on her own. She believes that effort enabled her to walk a week after surgery. "You are really on your own, and you have to be very motivated," she says.

Some doctors say that the changing demographics of their patients also can contribute to bumpy recoveries. Dr. Altchek, who performs knee and rotator cuff surgery at the Hospital for Special Surgery in New York, says that more younger patients are opting to replace troublesome knees and hips so they can resume athletic activities such as tennis and skiing; close to 42% of all knee replacements in 2008 were for patients aged 45 to 65, compared to less than 35% in 2002, and studies show that waiting too long once a joint starts to deteriorate before having surgery can make recovery more difficult.

But younger patients may also be impatient and assume they are healed, and then quit rehabilitation too early, Dr. Altchek says.

Andrew Minko, a 41-year-old patient of Dr. Altchek's who plays tennis and surfs, has had two surgeries to repair joints on his left shoulder and now needs surgery on his right shoulder. Though he healed well, he admits he was somewhat lax about doing his exercises at home and may have rushed into some activities too quickly after the previous procedures. For the upcoming surgery, he says, "I will be more diligent about the recovery."

25 October 2010

Mayo Clinic guide: Home Remedies can do the Trick

USA Today

In this age of rising medical costs and growing demands on our time, a trip to the doctor is something we hope to avoid.

But how do you keep yourself healthy enough to stay away? And how do you know what illnesses you can treat at home and which need professional attention?

Enter the Mayo Clinic's Book of Home Remedies, a 200-page guide for treating more than 100 common conditions. Savvy parents looking for quick advice and good bedside manner get both from author Philip Hagen, who discusses alternative and conventional approaches to healing, cautions about when to seek medical help and offers advice about how to stay healthy.

"This book reflects our experience in working with people who come to the doctor when there may be something that they can do at home," says Hagen, who specializes in internal and preventive medicine.

"We looked at conditions that had a broad impact on the population for which there seemed to be some reasonable home remedies. Then we asked the experts at Mayo to see if there might be reasonable scientific explanations for them and to determine that they're safe."

The need for families to stretch dollars wasn't overlooked by Hagen and his colleagues at Mayo. "The timeliness of this book is in no small part brought about by increasing medical costs," Hagen says.

The kinds of remedies addressed are as diverse as gentle stretching for back pain, swallowing a teaspoon of sugar for hiccups, trying ginger for morning sickness and using Tylenol for teething. And there are instructions for performing lifesaving moves such as CPR and the Heimlich maneuver.


"The best way to approach managing allergies is to know and avoid your allergy triggers," Hagen says.

The most common allergens are inhaled — such as pollen, dust, mold and pet dander. At this time of year, when weed pollen is at its worst, people sensitive to pollen can be particularly miserable. He advises:

•Close windows and doors.

•Don't hang laundry outdoors.

•Use an allergy-grade filter on your heating system.

•Rinse out your sinuses with a nasal lavage.


Insomnia disturbs more than one-third of adults at some point, Hagen says. He suggests lifestyle changes — including getting exercise and taking a warm bath one to two hours before bedtime — before resolving to find other ways (antihistamines, sleeping pills) to improve sleep.

•Try gentle exercise like stretching to relax.

•Take a warm bath one to two hours before bedtime.

•Limit naps to 20 or 30 minutes.


Prevention is the key. If you can follow the drill, you won't need a remedy. Still get hit with heartburn? Over-the-counter remedies such as antacids and Pepcid will help.

•Maintain a healthy weight.

•Avoid food and drink that can trigger heartburn. These include fatty foods, alcohol, peppermint and tomato products.

•Don't eat two to three hours before bed.


If you get the flu, rest, drink plenty of fluids, try chicken soup — which the authors say helps break up sinus congestion — and consider pain relievers, "but remember, they only make you feel better and can have side effects." Best to take preventive steps:

•Get a flu shot in October or November.

•Wash your hands.

•Eat right and sleep tight.

Brain's Pleasure Chemical May Explain Men's Higher Alcoholism Rate

Bloomberg / BusinessWeek

Drinking-related dopamine release is greater in males, study finds

Differences in the release of the neurotransmitter dopamine may help explain why men are up to twice as likely as women to develop alcoholism, a new study says.

Dopamine, which plays a number of roles in the brain, provides a feeling of pleasure when it's released by experiences such as having sex or taking drugs.

The study included male and female college-age volunteers who underwent brain scans after consuming an alcoholic or non-alcoholic drink. After consuming similar amounts of alcohol, men showed greater dopamine release than women. The increased release occurred in a part of the brain called the ventral striatum, which is strongly associated with pleasure, reinforcement and addiction formation, according to the researchers, from Columbia and Yale universities.

Their findings were published in the Oct. 15 issue of Biological Psychiatry.

"In men, increased dopamine release also had a stronger association with subjective positive effects of alcohol intoxication," Dr. Nina Urban, a study co-author, said in a news release from the journal's publisher. "This may contribute to the initial reinforcing properties of alcohol and the risk for habit formation."

The study also found that repeated heavy drinking episodes resulted in a decline in alcohol-induced dopamine release. This may be a factor in developing tolerance or becoming an alcoholic, the researchers said.

24 October 2010

New Crop of Elderly Outsmart Their Predecessors

Scientific American

A Swedish study finds that 70-year-olds in 2000 did better on intelligence tests than 70-year-olds had done in 1971.

If 50 is the new 40 and 60 is the new 50, what’s the new 70? Well, it seems safe to at least say that 70 isn’t what it used to be. And that’s good. Because a new study finds that 70-year-olds did better on intelligence tests than 70 year olds used to do. In Sweden, anyway. The research was published in the journal Neurology. [Simona Sacuiu et al, Secular changes in cognitive predictors of dementia and mortality in 70-year-olds]

The study compared a group of people born in 1901 and 1902 and tested in 1971 with another group born in 1930 and tested in 2000. And the newer crop of 70 years old performed far better than the previous generation did.

The researchers say the newer seniors had numerous advantages. They had better pre and postnatal care than their predecessors. They also had better nutrition, a higher quality education, and better treatment of high blood pressure and cholesterol. And, the researchers say, today’s high-tech life also helps keep you sharp. Because all of those factors come into play in many other parts of the world, there’s reason to be optimistic that it’s not just old Swedes who are smarter.

22 October 2010

Diabetes may affect as many as 1 in 3 Americans by 2050

USA Today

The future of diabetes in America looks bleak, according to a new Centers for Disease Control and Prevention report out today, with cases projected to double, even triple, by 2050.

According to the report, one in 10 U.S. adults have diabetes now. The prevalence is expected to rise sharply over the next 40 years with as many as one in three having the disease, primarily type 2 diabetes, according to the report, published in the journal Population Health Metrics.

"There are some positive reasons why we see prevalence going up. People are living longer with diabetes due to good control of blood sugar and diabetes medications, and we're also diagnosing people earlier now," says Ann Albright, director of the CDC's Division of Diabetes Translation.

A more diverse America — including growing populations of minority groups such as African Americans and Hispanics, who are more at risk for the disease — factors into the increase as well, Albright says. But an increasing number of overweight Americans also is fueling the stark predictions for diabetes, which should be taken seriously, Albright says.

Diabetes is the No. 1 reason for adult blindness, kidney failure and limb amputation, and it's a large contributor to heart attacks and strokes, she says. "It's also now linked to a form of dementia, some forms of cancer and some forms of lung disease. Diabetes impacts so many systems in the body," Albright says.

Programs and policies to prevent obesity and diabetes need to be put in place at every level, says Duke University Medical Center endocrinologist Susan Spratt, who says schools are a good place to start. Healthful food options in schools and daily physical education classes should be a priority, she says.

"Vending machines should not sell sugar soda or candy bars. School fundraisers should not revolve around unhealthy food," says Spratt, who adds that cities need to be pedestrian-friendly, bike-friendly and safe.

A price will be paid if the projections go unheeded, experts say. The CDC estimates the current cost of diabetes at $174 billion annually — $116 billion of which is in direct medical costs.

Previous research has suggested that the financial burden may easily double in the next 20 years, says David Kendall, chief scientific and medical officer of the American Diabetes Association.

"The financial burden is potentially a very, very troublesome one," Kendall says.

"There's a dual message here: prevention where it's feasible, and critical and early intervention for those already diagnosed," he says.

Study: Soy may reduce Breast Cancer Recurrence

USA Today

For women past menopause who have had breast cancer, a higher intake of soy may help reduce the risk of the disease's recurrence, a new study of Chinese women suggests.

The same link was not found in premenopausal women with breast cancer, whatever their soy intake, the study authors said.

The study, while called intriguing by U.S. experts, was not large and included only women with breast cancer receiving care in China. It's not known if the results would apply to other groups of women, said Marji McCullough, a spokeswoman for the American Cancer Society.

"Chinese women may have been likely to have a lifelong high consumption of soy," she said. "We don't know whether starting on a diet high in soy after a breast cancer diagnosis would have the same effect as eating a lifelong diet high in soy."

For the study, Dr. Qingyuan Zhang of the Cancer Hospital of Harbin Medical University in Harbin, China, evaluated 524 women who had undergone breast cancer surgery between August 2002 and July 2003. They were receiving endocrine therapy such as anastrozole (Arimidex) or tamoxifen to reduce cancer recurrence risk.

The researchers measured the women's dietary intake of soy isoflavones at the start of the study, and then followed them for about five years to see if breast cancer recurred.

For the premenopausal women, soy had no apparent effect on the risk of subsequent breast cancer.

But postmenopausal women with the highest intake of soy — more than 42.3 milligrams of soy isoflavones a day — had a 33% reduced risk of cancer recurrence. For patients receiving anastrozole and whose breast cancer was estrogen receptor-positive and progesterone receptor-positive, the risk reduction link was even stronger.

The study findings were published Oct. 18 in CMAJ (the Canadian Medical Association Journal).

A serving of soy milk has about 30 or 40 milligrams of isoflavones.

But Zhang cautioned that larger studies with women from many medical centers are needed before scientists can say that soy may help reduce the risk of breast cancer's return.

McCullough agreed. "It's still possible that other lifestyle differences in women in China who were eating less soy" might explain their higher likelihood of getting breast cancer again, she said.

There have been concerns about the effect of soy consumption on women with estrogen receptor-positive and progesterone receptor-positive breast cancer because soy isoflavones are similar to estrogen in chemical structure, and because tumor growth is dependent on estrogen, the study authors said in a news release.

Dr. Joanne Mortimer, director of the women's cancers programs at the City of Hope Comprehensive Cancer Center in Duarte, Calif., said some doctors tell women to avoid soy, concerned that too much might be hazardous. "I think this is yet another study that confirms that soy products do not cause an increased risk of breast cancer or even recurrence," she said.

But, it's not a reason to go overboard on soy, Mortimer said. "I wouldn't tell people they should eat a lot of soy," she said. Rather, "they should eat a healthy diet and if they eat soy, this study suggests there is not harm in it."

According to current American Cancer Society guidelines, which are under review, up to three servings a day of soy foods is considered safe, McCullough said. But women are advised to avoid the high soy dose found in more concentrated sources such as soy powders and isoflavone supplements, she said.

20 October 2010

W Virginia Hospitals brace for Costs of new Health Care Law

Bloomberg / BusinessWeek

West Virginia hospitals face uncertainty and hefty upfront spending as the federal health care overhaul begins to unfold, the head of their state association told lawmakers Monday.

Joseph Letnaunchyn, president of the hospital group, also warned of short-term drops in government reimbursement payments to hospitals, as scheduled under the new law. The chair of the state Health Care Authority, Sonia Chambers, echoed those concerns during the interim committee meeting Monday.

"It will be difficult for many West Virginia hospitals to sustain those reductions," said Chambers, whose agency regulates health care spending in the state.

But she and Letnaunchyn also sought to strike optimistic tones about the sweeping changes. Chambers cited its attempts to curb hospital readmissions forced by preventable infections. Letnaunchyn noted the more than 100,000 West Virginians who will eventually gain coverage, easing the hospitals' charity care costs.

"I contend that the glass is half-full rather than half-empty," Letnaunchyn told lawmakers. "We're just trying to tell you what the facts are from where we see them. We supported (health care reform) going in."

Those facts, he explained, include the price of required upgrades to health information technology systems. While the aim is long-term savings and improved patient care, some hospitals face devoting 35 to 40 percent of coming capital budgets to meeting that provision, Letnaunchyn said. Available federal funds will help, but only some, he said.

The impact of other provisions will depend on how officials write the rules that will carry them out, Letnaunchyn said. Awaiting those regulations, he said, creates a sense of uncertainty among hospitals that he likened to driving through fog.

Senate Minority Leader Mike Hall, R-Putnam, suggested that the overhaul will increase hospital costs by requiring them to hire additional staff to ensure they follow its many provisions.

"I'm speculating that it will cost millions and millions of dollars," Hall said.

Chambers said hospitals are already reporting information to regulators. But she noted that the overhaul could change. Among other factors, Republicans have vowed to seek the overhaul's repeal if they win control of Congress next month.

"I wouldn't be surprised if some of these provisions change year to year," Chambers said. "We're really going to have to wait and see."

19 October 2010

FDA Clears Addiction Drug to treat Narcotic Abuse

Associated Press

Drugmaker Alkermes Inc. says it has received U.S. approval to market its addiction medication for use in heroin addiction treatment and with other narcotics.

The Food and Drug Administration approved the company's drug Vivitrol as a monthly injection to treat addiction to opioids, highly addictive drugs often abused for their euphoric effects. Vivitrol is already approved for alcohol addiction treatment.

The drug is designed to block brain receptors that deliver the pleasurable sensations associated with alcohol and drug abuse.

The FDA approved the drug based on company studies that showed patients taking Vivitrol were more likely to be free of opioids than those taking a dummy injection. The typical Vivitrol patient reported opioid-free urine samples 90 percent of the time, compared with 35 percent for those not taking the drug.

Walker wants UW to Focus on Adult Stem Cell Research

Milwaukee Journal-Sentinel

Milwaukee County Executive Scott Walker said Tuesday if elected governor he would shift funding from embryonic stem cell research to adult stem cell research at the University of Wisconsin-Madison.

"I'm going to put the money behind adult stem cells - not embryonic," the Republican told reporters. "The money the state's involved (with), the money that comes from the federal government, should be focused on the greatest potential for success, and that's adult stem cell research."

David Gamm, a stem cell researcher at UW-Madison, called Walker's position "ridiculous" and "not practical" because it would mean researchers would lose millions in federal grants.

"This is basically ignorance," Gamm said. "I would pick up my funding and go somewhere else. I can't give up (nearly) $2 million in grants to stay in Wisconsin."

Walker, who opposes embryonic stem cell research because it destroys embryos, repeatedly refused Tuesday to say whether he supported an outright ban on embryonic stem cell research.

Walker has been endorsed by Pro-Life Wisconsin, however, and that group endorses only candidates who support a ban on embryonic stem cell research.

The university conducts research on both embryonic and adult stem cells and is known internationally as the place where embryonic stem cells were grown for the first time.

About $5 million a year in federal money goes toward embryonic stem cell research at UW.

Adult stem cells are cells that can turn into different cell types but have more limited potential than embryonic stem cells.

Embryonic stem cells have shown promise for curing diseases because they can become all cell types. Reprogrammed adult stem cells also have shown potential as a possible alternative to embryonic stem cells, but there have been some indications that they may not be equivalent. For example, the reprogrammed cells appear to retain a memory of their original cell type.

Walker's Democratic opponent, Milwaukee Mayor Tom Barrett, said in a statement Tuesday that Walker's "ideological views threaten scientific research in our state that can save and improve lives, and they jeopardize significant business opportunities and thousands of jobs in Wisconsin's growing tech economy."

18 October 2010

McDonald's Happy Meal shows no Sign of decomposing after Six Months

Daily Mail

Looking almost as fresh as the day it was bought, this McDonald's Happy Meal is in fact a staggering six months old.

Photographed every day for the past half a year by Manhattan artist Sally Davies the kids meal of fries and burger is without a hint of mould or decay.

In a work entitled The Happy Meal Project, Mrs Davies, 54, has charted the seemingly indestructible fast food meals progress as it refuses to yield to the forces of nature.

Sitting on a shelf in her apartment, Sally has watched the Happy Meal with increasing shock and even her dogs have resisted the urge to try and steal a free tasty snack.

'I bought the meal on April 10 of this year and brought it home with the express intention of leaving it out to see how it fared,' she said.

'I chose McDonald's because it was nearest to my house, but the project could have been about any other of the myriad of fast food joints in New York.

'The first thing that struck me on day two of the experiment was that it no longer emitted any smell.

'And then the second point of note was that on the second day, my dogs stopped circling the shelf it was sitting on trying to see what was up there.'

Expecting the food to begin moulding after a few days, Mrs Davies' surprise turned to shock as the fries and burger still had not shown any signs of decomposition after two weeks.

'It was then that I realised that something strange might be going on with this food that I had bought,' she explained.

'The fries shrivelled slightly as did the burger patty, but the overall appearance of the food did not change as the weeks turned to months.

'And now, at six months old, the food is plastic to the touch and has an acrylic sheen to it.

'The only change that I can see is that it has become hard as a rock.'

Even though she is a vegan, Mrs Davies' experiment has brought her amusement rather than fear.  

'I don't really see this experiment as scary, I see it almost as an amusement,' she said.

'Although, I would be frightened at seeing this if I was a meat eater. Why hasn't even the bun become speckled with mould? It is odd.'

When asked if their food was not biodegradable, McDonald's spokeswoman Danya Proud said: 'This is nothing more than an outlandish claim and is completely false.'

It comes after Denver grandmother Joann Bruso left a Happy Meal to decay for a year until March to highlight the nutritional dangers of fast food.

Morgan Spurlock also made the film Super Size Me in 2004 charting the changes to his body eating just fast food for 28 days had.

17 October 2010

Brain-Injury Studies open to Youth, Adults


Medical studies that make the news usually involve large numbers of patients. But research can focus on rarer events, such as traumatic brain injuries.

Dr. Brenna McDonald, an assistant professor of radiology and Indianapolis neurologist at the Indiana University School of Medicine, is enrolling patients for two trials that delve into the aftermath of traumatic brain injuries.

One study focuses on children who have sustained a mild brain injury, such as a concussion. The other compares treatments for adults who had a traumatic brain injury of any severity.

People interested in participating in either trial can call (317) 274-6633.

Question: Please tell me about the study on children.

Answer: It targets children 8 to 15 years old who had a mild traumatic brain injury or concussion six to 12 months ago. What we're looking at are any residual or lasting problems that we can detect with structural brain imaging or cognitive tests.

We don't really know if there are meaningful or lasting results in this population. There has been a lot of worry about risk. We know for kids who are severely injured there are likely to be lasting consequences.

Q: Is much known about the effect of a brain injury?

A: Not for mild injury. We don't have a really good sense if there's a reason to be concerned about lasting effects. We don't know in younger kids what we should be worried about, if we should be worried at all, and how worried we should be.

For moderately to severely injured kids, a program of rehabilitation may be recommended that typically includes speech, physical and occupational therapy. Depending on the level of cognitive problems, we may make recommendations in terms of academic intervention. That can run the whole range of possible educational interventions.

Q: How many do you hope to enroll?

A: We're looking for between 15 and 30 kids over the next year or two. Participation in the study is about six hours, and it can be done over one or two days.

Q: What about the other study?

A: We're recruiting adults who have sustained a traumatic brain injury of any severity at least four months but no more than five years ago. The study includes medication treatment and therapeutic treatment. . . . The goal of all treatments is to try to improve memory or attention complaints.

It's a relatively brief time commitment of about seven weeks. This is designed by a colleague who designed the treatment program initially to address similar cognitive complaints after cancer chemotherapy. We have some preliminary data suggesting it can be effective for this.

16 October 2010

Hope for Seniors arrives in 'Memory Pill'

Daily Mail

A pill that prevents so-called ‘senior moments’ is being developed by British doctors.

Taken later in life, it could put an end to forgetting where the car keys are, or not being able to remember names.

The drug, which is aimed principally at absent-mindedness rather than brain diseases, has already been tested on animals.

It could go to human trials next year and, if these are successful, be on the market within five years.

Jonathan Seckl, who led the research at Edinburgh University, said: ‘A third of older people have what is euphemistically called mild cognitive impairment.

‘But it is a major risk factor for Alzheimer’s disease and it is also pretty frustrating if you can’t remember what you left the house to do or where you put your keys.

‘It is soul-destroying and memory clinics are full of patients who are deeply frustrated by being unable to remember things.’

Such problems are at least partially due to high levels of stress hormones, including cortisol, damaging the brain’s ‘memory hub’.

Professor Seckl has shown that an enzyme called 11beta-HSD1 boosts levels of cortisol and he created the drug to stop that happening.

Known as UOE1961, it sharpened the minds of elderly mice to such an extent that they were as good as much younger creatures at performing tests of memory and learning.

What is more, the animals were treated for only two weeks, the Journal of Neuroscience reports.

Professor Seckl, who was funded by the Wellcome Trust, said: ‘They were coming toward the end of their lifespan and had profound deficits in their ability to learn things.

‘We turned them back to being as good as young animals, which was very exciting. What that teaches us is that that sort of memory loss is not irreversible.’

It is too early to know what side-effects UOE1961 will have.

But, on the plus side, reducing levels of stress hormones is likely to be good for the heart.

It is thought the drug will work only on the ageing brain – meaning it will not help young people cram for exams.

Insurers Denied Coverage to 1 in 7

The Wall Street Journal

The four largest U.S. for-profit health insurers on average denied policies to one out of every seven applicants based on their prior medical history, according to a congressional investigation released Tuesday.

Two top House Democrats said the findings covered 2007 to 2009 for Aetna Inc., Humana Inc., UnitedHealth Group Inc. and WellPoint Inc. In total, the carriers denied coverage to more than 651,000 people due to pre-existing medical conditions over the three-year period.

Under the health-care overhaul legislation, beginning in 2014 insurers can no longer deny coverage because of a pre-existing health condition.

Mohit Ghose, a spokesman for Aetna, said the findings "document what many health insurers, including Aetna, have been saying for years—that the individual market needs to be reformed so we can improve access for all consumers."

Robert Zirkelbach, a spokesman for the insurance trade group America's Health Insurance Plans, said that in the current market, insurers needed to have the option of factoring in health status. That discourages people from buying a policy only after they get sick, which increases costs for all consumers, he said.

Mr. Zirkelbach noted that insurers proposed eliminating denials based on pre-existing health conditions as part of the health overhaul, as long as everyone was required to have coverage.

Henry Waxman (D., Calif.), chairman of the House Energy and Commerce Committee, and Rep. Bart Stupak (D., Mich.) released the findings. Mr. Waxman's office wouldn't specify how many customers each carrier denied.

While most Americans have coverage through their employer or Medicare, an estimated 15.7 million adults under age 65 received coverage through an individual policy as of 2008, the congressional report said. Those are the customers who can be denied coverage because they have a past illness.

In some cases, customers can enroll in a policy but aren't covered for ailments that predate the enrollment. During the three-year period, the four carriers together declined to pay 212,800 medical claims for that reason, the report found.

In a separate report released Tuesday, the lawmakers found that women who are pregnant, fathers-to-be and those attempting to adopt children are generally unable to buy policies on the individual insurance market.

14 October 2010

Walking Now may give your Brain a Boost Later

LA Times

Walking promotes good physical health, but it may also help maintain memory and cognitive function for years, a study finds.

The research, published online Wednesday in the journal Neurology, is based on a study of 299 men and women, average age 78, who were followed for nine years. The study participants were asked about their physical activity, which was calculated as number of blocks walked per week (walking was the most common exercise). Study subjects walked from zero to 300 blocks over a one-week period. High-resolution brain scans were done on the participants nine years after the beginning of the study.

The more the participants walked at the beginning of the study, the greater their brain volume nine years later. This was still the case after researchers controlled for a number of factors, including age, gender, body mass index and education.

How many blocks of walking per week did it take to see improvement? The magic number was 72, or about six to nine miles. Walking more than that didn't further improve gray-matter volume.

Although all participants were deemed cognitively normal at the beginning of the study, 40% developed cognitive impairment or dementia four years in. However, those who walked the most reduced their risk of acquiring memory loss by half.

Lead author Kirk Erickson of the University of Pittsburgh said in a news release, "If regular exercise in midlife could improve brain health and improve thinking and memory in later life, it would be one more reason to make regular exercise in people of all ages a public health imperative."

13 October 2010

Half a Million Americans Denied Health Coverage

Financial Times

The four largest health insurance companies in the US denied coverage to more than half a million individuals because of their pre-existing conditions from 2007 to 2009, according to a congressional investigation.

On average, the four companies – Aetna, Humana, UnitedHealth Group and WellPoint – denied one out of seven applicants’ coverage based on conditions such as pregnancy, angina, diabetes and heart disease.

The investigation found that the number of people who were denied coverage increased about 49 per cent from 2007 to 2009. In that period, the groups refused to pay 212,800 claims for individuals who were already insured based on their previous medical conditions.

New revelations about the extent of denials based on pre-existing conditions comes at a crucial time for Democratic lawmakers.

Many of them have come under pressure in the lead up to the November mid-term elections because of their support for President Barack Obama’s healthcare reform law, which was passed by Democrats in Congress in March.

Polls show that roughly 50 per cent of voters disapprove of the wide-ranging new law.

But one of the most universally popular provisions – which will not take effect until 2014 – makes it illegal for insurance groups to deny an individual coverage based on a person’s health status or pre-existing condition.

Democrats have argued that the provision is economically feasible because the new law also includes a mandate forcing every individual to be covered, one of the least popular aspects of the bill.

Republican candidates for Congress have vowed to “repeal and replace” the healthcare law, but keep the new provision on pre-existing conditions. They have not, however, explained how they would extend coverage to those individuals with Michigan health plans without a broader mandate.

The congressional investigation by Democrats on the House energy and commerce committee was initiated shortly before the landmark vote on healthcare reform, when Congressman Henry Waxman, chairman of the committee, asked each of the companies for extensive information about their denial policies.

Each of the companies complied with the request. The congressional probe found that each company saw its policy on pre-existing conditions as a key area of growth.

For example, internal documents by a company that was not identified by the committee showed that executives were considering practices such as denying payments for drugs related to pre-existing conditions and linking additional claims to pre-existing condition exclusions as ways to limit the amount of money the company had to pay for claims.

Although the committee found that a total of 651,000 individuals were denied insurance coverage in the individual market between 2007 and 2009, investigators said the number was likely “significantly higher” because the figure did not include individuals who were discouraged from applying for coverage by insurance agents.

The four companies covered about 2.8m people in the individual market in 2009. In some cases, the denials were issued without review.

A memo circulated by one unidentified company in 2006 listed 14 medical categories that did not require review, including: any woman who was pregnant or had been treated for infertility within five years.

Baby Born From 20-Year-Old Frozen Embryo

Popular Science

Cryopreservation was once the domain of sci-fi novels and B-rate movies. (Think Encino Man.) But it’s increasingly real, as the recent birth of a healthy boy from a frozen embryo created 20 years earlier shows.

The birth, which is reported in a study in the online edition of the journal Fertility and Sterility, sets a record. Until now, no embryo frozen for this long has resulted in a live birth.

The 42-year-old mother of the boy, who is not named in the study, began trying to get pregnant using IVF ten years ago. At the time, she and her husband received embryos from a heterosexual couple who had themselves undergone IVF.

That couple had anonymously donated their leftover embryos after the woman successfully gave birth. Thing was, they did so in 1990 – meaning that the boy just born to the woman in the study has a sibling out there somewhere who was conceived at the same time but is 20 years younger.

Frozen embryos are something of a new ethical frontier in IVF -- one that was not foreseen back in 1978, when Nobel Prize in Physiology recipient Robert Edwards and colleague Patrick Steptoe announced the birth of Louise Brown, the world’s first test-tube baby. Because of improved fertility drugs and lab techniques, the average IVF cycle now yields more embryos than it once did. Many of those end up in the freezer, where they keep remarkably well.

But the ethical and practical implications of keeping potential humans on ice are now becoming abundantly clear. Increasingly, divorced couples fight over frozen embryos. And the preservation of genetic material – embryos, eggs, and sperm -- created by biological parents who may be well beyond their reproductive years gives others pause. In 2007, a mother froze eggs for use by her daughter, then seven years old, who was born with a condition that could make her infertile. If the daughter someday uses the embryos, she will give birth to her half-brother or half-sister.

And then there is the time lapse between conception and birth in this latest news item. Previously, the record-holder for longest time in the freezer was a baby born from an embryo that had been frozen for 13 years.

12 October 2010

IUD Proposed to Treat Uterine Cancer

Bloomberg / BusinessWeek

An intrauterine device that releases a progestin hormone may be an effective treatment for younger women with early-stage uterine cancer, Italian researchers report.

By delaying a total hysterectomy, which is the usual treatment for endometrial cancer, the IUD allows women to remain fertile and possibly to have families, according to the study published online Wednesday in Annals of Oncology, the monthly journal of the European Society for Medical Oncology.

"The study was done to see if this was a viable option for younger women who want to preserve fertility," said Dr. Jamie Bakkum-Gamez, senior associate consultant in the division of gynecologic surgery at the Mayo Clinic in Rochester, Minn. "We see it as buying more time to have a family and, once that's completed, to have a hysterectomy."

"It's a very important trial," added Dr. Angeles Alvarez Secord, associate professor of gynecologic oncology at Duke Comprehensive Cancer Center in Durham, N.C. "I've been using [the IUD] clinically for several years now for this purpose in patients who desire future fertility and some patients who cannot undergo surgery or who are at high risk for surgical complications. It's a fantastic alternative to treat patients with these diseases, and this study will help doctors when they discuss [treatment options] with patients."

Bakkum-Gomez has also used the method in her practice and is conducting a study of the IUD, which was originally designed as a contraceptive device, for this purpose.

About 3 percent to 5 percent of women who get endometrial cancer, which affects the womb lining, are under the age of 40 and will lose their fertility if they undergo a hysterectomy. The majority of these women have not yet had children, according to background information in the article.

Although the IUD is not yet approved to treat endometrial cancer, it is approved and widely used to treat endometriosis and abnormal uterine bleeding.

While hysterectomy or removal of the uterus is the accepted treatment for this kind of cancer, doctors have been using the hormone in oral form for the past 20 years, but only for "well-selected groups of women," said Dr. Elizabeth Poynor, a gynecologic oncologist and pelvic surgeon with Lenox Hill Hospital in New York City. "Well selected," in this case, means those with early-stage disease who want to maintain their fertility, much like the group in this trial.

Oral hormone treatment to slow down the cancer's growth is a systemic therapy, however, and can have adverse side effects such as skin rashes, nausea and vomiting, headaches and abnormal uterine bleeding, according to background material accompanying the study.

The theoretical -- but still unproven -- advantage to this new IUD method, Poynor said, is that "there is a lower risk of systemic side effects . . . and that you may be giving higher doses of the drug directly into the uterus."

The authors followed 20 Italian patients from January 1996 to June 2009 with atypical endometrial hyperplasia (AEH), which often precedes the cancer, and 14 women with early-stage endometrial cancer confined to the inner layer of the womb.

Participants -- all of whom were between ages 20 and 40 -- had an IUD known as Mirena, which released levonorgestrel, inserted for a year. They also received monthly injections of gonadotropin-releasing hormone (GnRH), which halts estrogen production, for six months.

The IUD was removed at the end of the year if there was no evidence of cancer.

Ninety-five percent of women with AEH initially saw their lesions disappear completely, while 57.1 percent of women with early-stage Indianapolis cancer treatment also responded completely to the treatment. (The disease progressed in one of the women with AEH and four of the women with early-stage cancer.)

Of the patients with AEH, four later relapsed and required further treatment; of the women with early-stage cancer, two who had an initial complete response relapsed. However, all the women were alive and seemingly cancer-free by the end of the study after further treatment (either the IUD and GnRH treatment or a hysterectomy), the study reported.

"They did show a higher recurrence or progression rate with endometrial cancer than with AEH and that is consistent with other data," said Bakkum-Gamez, who added that the IUD method would not be appropriate for later-stage cancers, which tend to be more aggressive.

No adverse effects from treatment were noted, according to the researchers, who declared no conflicts of interest.

In background material, the researchers stated the progestin-releasing IUD should be effective in treating AEH and also early endometrial cancer treatment in Detroit, as long as those patients were evaluated with laparoscopy, ultrasound and MRI to make sure their cancer had not spread and there was no simultaneous ovarian cancer.

Nine of the women in the study successfully delivered babies.

11 October 2010

What's Happening to your Health Plan

The Wall Street Journal

It's open-enrollment season, the annual rite of fall when health-care costs hit home for most people.

Companies typically allow employees to elect their benefit packages once a year. Making this season especially tricky: the health-care overhaul, which is leading to confusion—and sticker shock—for many employers and workers alike.

For the first time in years, your benefits could well be getting more lavish—but they could cost more, too.

Companies are scrambling to comply with early provisions of the Patient Protection and Affordable Care Act, such as a requirement that plans cover dependent children up to the age of 26. Many employees will be able to count on their companies paying all their bills for preventative care, and plans must eliminate lifetime limits on coverage.

But some companies, citing the new mandates, say costs are rising too fast: In a survey of more than 1,000 employers, Mercer, a human-resources consulting firm, found that corporate health-care costs would rise by 10% next year if firms made no changes to their plans. Many are finding that they have little choice but to switch a greater share of costs to employees.

Last year, when the outcome of the health-care overhaul was still uncertain, some employers held off on making any significant alterations in their plans. That is one of the reasons the number of changes this year is so great, says Tom Richards, senior vice president for U.S. products at health insurer Cigna Corp.

Some of these benefit expansions might not affect you. Dozens of companies, including McDonald's Corp. and Jack in the Box Inc., have been granted waivers by regulators from the new cap on annual payments. And many retirees are discovering that the new mandates don't apply to their plans

But those exceptions are small, and many employees are seeing new benefits and rising prices in the wake of the overhaul this fall.

Take Cathie Swem, 57 years old, of Jacksonville Beach, Fla. Her employer, Integrated Community Oncology Network, which runs cancer centers in Florida, changed insurers on Oct. 1 and raised the price of her coverage by about $65 per twice-monthly paycheck. The company also reduced the number of plans it offers from four to three, and implemented a slate of newly required benefits, including preventative services and dependent coverage of adult children.

Ms. Swem decided to switch to a high-deductible plan to save money. After making the change, she is spending just $8.22 more per paycheck—but now must contend with a $2,500 deductible, up from $250 with her traditional PPO plan, which offers a higher level of coverage.

She says she is happy to take advantage of the free preventative care. But since she is relatively healthy, she has trouble seeing the benefit of the other new benefits.

"All those things sound great, but if they don't affect you it's not as important as the cost," says Ms. Swem, who, as a billing specialist, deals with medical bills every day.

Mercer says the new benefits from the health overhaul add about 4% to premiums. The Obama administration says any impact on premiums will be minimal and in any event mitigated by provisions in the new law.

"Over the past decade, premiums for Americans who get their insurance at work have more than doubled," says Jessica Santillo, a spokeswoman at the Department of Health and Human Services. "The Affordable Care Act offers new benefits like preventive care with no out-of-pocket cost and tools to help fight unreasonable premium increases that will save money for consumers."

No one is sure how the changes will play out. But in the meantime, here is a look at what you can expect to see this open-enrollment season—and what you need to know about it.

One of the first things to ask is whether your plan is "grandfathered." The health-care overhaul stipulates that plans that remain substantially the same, with very few changes from last year, can avoid some of the new requirements.

Iroquois Title Co., a six-person firm in Watseka, Ill., faced a 20% price increase on its policy for next year. President Wayne Lehmann decided to swallow the increase and not make any changes to avoid having to cover things such as preventative services, which he worried would be too costly.

Mr. Lehmann said his employees were relieved not to have to pay more. One of them, Jeanette Reifel, 64, of Milford, Ill., says she told Mr. Lehmann "you made my day" when he delivered the news. "I'd been worried about changes to the plan," she says. "I need my paycheck."

About 50% of companies, though, are choosing to forgo grandfathered status, according to the Mercer survey. Costs are rising too fast, they say, and making changes to their current health plans is the only way to keep premiums lower.

Even grandfathered plans are required to offer certain newly mandated benefits. They must cover children with pre-existing health conditions and dependents up to the age of 26, and eliminate lifetime limits on coverage.
Dependent Coverage

The new dependent-children mandate could be a bonus for families like the Elkers, of Warminster, Pa. When Paul Jr. and Trish Elker's son Paul III, 23, graduated from college last December, Mr. Elker's corporate plan no longer covered his son.

The family bought Paul III an individual policy through online broker eHealthInsurance.com for $126 a month—and just in time. Paul broke his nose a few weeks later, requiring $28,000 worth of medical care.

The Elkers are eagerly awaiting the ability to re-enroll Paul III on his father's company's plan, for which they will pay no additional premiums. The open-enrollment period doesn't take place until early next year, though, says Ms. Elker. In the meantime, it is difficult to come up with the extra money to pay for Paul's coverage.

Employees should be aware of the rules governing who qualifies for the adult-child coverage, says Randy Abbott, a senior consultant at Towers Watson & Co., a benefits consulting firm. Adult children can be covered regardless of whether they live with their parents, are financially dependent on them or still go to school. But if that adult child gets married or has a child, the plan doesn't have to cover those dependents.

Think twice before you twist the truth to get an unqualified dependent coverage: Plans are increasingly conducting dependent audits. Benefitfocus Inc., a firm that provides open-enrollment software to more than 300,000 companies, said it has seen a 41% increase in customers requesting that it verify dependents' eligibility for next year. Penalties vary by state, says Benefitfocus, and include rescinding the policy and repaying the employer for claims.
New Benefits

Plans will have to cover preventative services at no cost to members. So employees who may have put off testing and preventive care in the past should be aware of what services they can now get free. This includes colonoscopies, cholesterol and blood-pressure tests, as well as adult vaccines. For children, vaccines, developmental screening and lead tests all should be covered.

What isn't covered? Prenatal screening is still being evaluated, and guidelines are expected to be issued next summer.

Beginning in 2014, your plan also will have to eliminate so-called lifetime limits on what it will pay out for your care. This can be important in the case of a long-term illness that results in numerous surgeries or hospital stays, for example. Leviton Manufacturing Co., a Melville, N.Y., manufacturer of electrical wiring with 2,700 workers, had a $5 million lifetime limit that it eliminated for 2011, for example.

Annual limits on coverage still will be permitted, though. In the coming year, plans will be allowed to set annual limits no lower than $750,000. On Sept. 23, 2011, that threshold moves to $1.25 million, and to $2 million a year later, as they gradually phase out.
'Cost Shifting'

Employers already are passing on a bigger share of their health-care costs to employees than they have over the previous decade, according to data from the Kaiser Family Foundation. The Menlo Park, Calif.-based nonprofit found this year that family premiums for firms went up 3% in 2010, but workers' share of those costs rose 14%.

This so-called cost-shifting trend appears to be intensifying. When Zurich Insurance Services Inc., a property and casualty firm in Jacksonville, Fla., conducted its open enrollment last month, it asked employees to pay 10% of their premiums for the first time. The company always has paid 100%, but "we reached the breaking point," says Ryan Schwartz, senior vice president of corporate affairs, citing higher costs generated by the new health-law provisions.

Tinsley English, a 33-year-old business analyst at Zurich, covers her husband and daughter through the company's plan, and says her premiums will be about $75 each twice-monthly pay period in 2011, up about 18% from this year. Still, she is grateful to have coverage and anticipates using the new free preventative services to take her daughter for doctor visits. She previously had to fork over a $20 co-pay for such visits.

"With a two-year-old, every penny counts," Ms. English says.

There isn't much that you can do about cost shifting, but you can cut costs in other ways. Helen Darling, who runs an employer coalition called the National Business Group on Health, advises employees to take advantage of the cost calculators on insurers and employers' websites to figure out how rich a plan they really need. "Most people are going to be better off taking less out of their paycheck," she says, than having gold-plated coverage.
Other Cost-Saving Tactics

Cost shifting isn't the only way employers are looking to curb the costs of their health plans.

BB&T Corp., a bank with 32,500 employees in Winston-Salem, N.C., is instituting mandatory mail order for prescription drugs starting next year. Steve Reeder, who runs benefits there, said he hopes to save 30 cents per employee each month by doing this. One reason to seek savings: Plan costs will go up 1% because of paying for preventative services, he says.

Another push is supplemental benefits. Mohawk Industries Inc., a flooring maker based in Calhoun, Ga., with 24,000 employees, is doubling the amount of critical-illness health insurance coverage employees can qualify for next year, from $10,000 to $20,000. (The company bought the voluntary benefit from insurer Unum Group.) That is in part to cover for employees who are facing higher deductibles in their traditional health plans: Mohawk is freezing new enrollment into its PPO plan and moving employees into two high-deductible plans next year and introducing health-savings accounts, in which employees can contribute tax-free to pay for medical expenses.

Finally, expect to be asked to work out and give your employer your body-mass index and cholesterol levels. Insurers say they are rolling out new wellness programs for employers this open-enrollment season that aim to reward employees who participate.

UnitedHealth Group Inc. is launching a personal rewards program that asks employees to keep a scorecard of their health in return for perks like discounted premiums or cash payouts. Humana Inc. is offering clients in some states a personal health allowance that reduces their co-payments if they take steps to improve their health.

1 in 4 U.S. Teens Binge Drink

USA Today

More than one in four U.S. teens and young adults admit they are binge drinkers, according to a report from the U.S. Centers for Disease Control and Prevention (CDC).

In the United States, binge drinking is defined as having four or more drinks for women, and five or more drinks for men, over a couple of hours — numbers that are different because men and women metabolize alcohol differently.

And it's not just teens who are affected, more than 33 million adults have reported binge drinking in the past year, according to the report.

"Binge drinking is a very large health and social problem" and one that has gone largely unnoticed, CDC director Dr. Thomas Frieden said during a noon press conference Tuesday. "Most people who binge drink are not alcoholic. It may be because binge drinking has not been recognized as a problem (that) it has not decreased in the past 15 years."

Nonetheless, the toll of binge drinking is enormous.

More than 79,000 deaths each year in the United States result from drinking too much, with about half of these attributable to binge drinking, according to Dr. Robert Brewer, alcohol program leader at CDC's National Center for Chronic Disease Prevention and Health Promotion.

Binge drinkers also put themselves and others at risk for alcohol-related car accidents, violence, HIV transmission and sexually transmitted diseases, drug rehab Florida, and unplanned pregnancy, according to the CDC.

Moreover, drinking too much can lead to liver disease, certain cancers, heart disease, stroke and other chronic diseases. Pregnant women who binge drink can also harm their developing fetus, resulting in permanent mental retardation and other birth defects, the CDC says.

And among teenagers, damage from regular binge drinking may far outlast a hangover the next morning. An earlier study found that in MRI scans, the brains of teens who drank heavily showed damaged nerve tissue compared to those who did not.

These findings are particularly worrisome in light of the current CDC report, which reveals that high school students tend to binge drink whenever they consume alcohol.

"Ninety percent of the alcohol consumed by high school students is consumed in the course of binge drinking, and more than half of the alcohol consumed by adults is consumed in the course of binge drinking," Frieden said.

Among drinkers, one-third of adults and two-thirds of high school kids binge drink, Frieden said.

"If excessive alcohol consumption every day is problem drinking, what is the occasional stint of up to five drinks at one sitting? The answer for many might be 'a party,' and that's just what makes binge drinking so dangerous," said Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine.

"While it resides in the realm of social acceptability, it is, in fact, a major cause of alcohol-related death, and the major cause of such deaths among adolescents and young adults. No party is worth the cost of a young life, full of promise," Katz added.

"Avoiding that cost starts with awareness. Adults need to know, and show, that a drink or two is fine — five or six is not. They need to pass on that awareness to their children. The tragic problem with not knowing when to say 'when' ... is that you may never get another chance," according to Katz.

Men are more than twice as likely to binge drink as women (21% compared with 10%). In addition, binge drinking is more common among whites (16%) than among blacks (10%).

While the report indicates that binge drinking is common, it is probably even more widespread than this report found.

"There really is a substantial under-reporting of binge drinking and alcohol consumption," said the CDC's Brewer. "Even though we are reporting high rates of binge drinking among adults and youth, there is good reason to believe it is significantly under-reported," he said.

Interestingly, binge drinking becomes more common as incomes rise. In fact, adults with incomes of $75,000 or more were more likely to be binge drinkers. About one in five reported binge drinking, Brewer said.

A possible reason that binge drinking increases with income is because it is not recognized as a risky health behavior, Frieden said. "Another possibility is simply with more money, people are able to afford more alcohol and do so," he said.

For the report, the CDC used the Behavioral Risk Factor Surveillance System and the National Youth Risk Behavior Survey to collect data on self reports of binge drinking during the past month for 412,000 adults aged 18 and older and over 16,000 high school students.

Binge drinking also varies from state to state, ranging from 6.8% of adults in Tennessee to 23.9% in Wisconsin and leading to alcohol rehab Florida. Binge drinking is most common in the Midwest, North Central Plains, lower New England, Delaware, Alaska, Nevada, and the District of Columbia, according to the report.

08 October 2010

New Method makes Adult Cells Act like Embryonic Cells

USA Today

Stem cell researchers on Thursday reported a new method for reprogramming adult cells into ones that act like more versatile embryonic stem cells, an advance that could open a new avenue for lab-grown transplant tissues.

Stem cells are the building blocks from which replacement cells, everything from blood to bone to brain, grow in early development and throughout life. Researchers consider embryonic stem cells the most useful type for generating replacement tissues, but obtaining them requires the controversial destruction of embryos. Then, in 2006, a Kyoto University team first reported adult skin cells can be "induced" into resembling embryonic stem cells.

That breakthrough relied on viruses infecting cells with four cancer-related genes to spur the transformation. But the new study pulls off the trick with ribonucleic acid (RNA) molecules, normally the workhorses that translate DNA-encoded genes into proteins and perform other housekeeping roles inside cells.

In the journal Cell Stem Cell, a team led by Derrick Rossi of Children's Hospital Boston unveils a cancer-mutation-free method, 40 to 100 times more productive than normal, to create induced stem cells. Induced stem cells are similar to embryonic stem cells in their potential to transform into every type of tissue in the body — but lack the controversy.

"This is very exciting," Rossi says. "We have a new experimental process that can efficiently give us patient cells in clinically useful types."

"RNA, if it works, sounds like a very realistic, promising alternative," says stem cell biologist Gary Stein of the University of Massachusetts Medical School in Worcester, who was not part of the study. Worries about virus contamination and cancer have dogged induced stem cells since their discovery, he notes, along with concerns about their low efficiency rate, with perhaps one cell in 1,000 transforming through the use of viruses.

Treating adult human cells with RNA engineered to overcome immune system defenses reliably creates induced stem cells, the study says. Moreover, the same RNA molecule cued to fire up different genes over three days' time can then be used to turn those induced stem cells into specific types of tissues, such as muscle.

For that reason, "this paper is a major advance in the field of regenerative medicine," says stem cell researcher Douglas Melton of Harvard, who was not part of the study team. Since the isolation of human embryonic stem cells in 1998, researchers have sought ways to turn early stem cells into heart, spine and other tissues needed by transplant patients. The RNA advance means labs can experiment on deriving these tissues in test tubes, he says, speeding progress in the field.

06 October 2010

Slims’ Transplant Inspires Push for Organ Donations


In 2008, Carlos Slim Domit watched his younger brother suffer progressive health troubles. Not yet 40, Patrick, chairman of Latin America’s largest wireless company, was often fatigued, his hands and feet swollen.

After doctors told Patrick his kidneys were beginning to fail, Carlos had himself tested to see if one of his could be used to save his brother. So did his father, the Mexican billionaire Carlos Slim. The younger Carlos turned out to be the best fit, and surgeons transplanted his kidney to Patrick.

“I wouldn’t have imagined how immediate the change would be,” Carlos said in an interview. “He had better color. He had another expression.”

The Slim family, led by the world’s richest man, has taken the experience as a call to action in their native Mexico. While the country’s rate of organ donation is one of the lowest in Latin America, the family is using its wealth and public profile to encourage people to embrace the practice.

On Oct. 1, the brothers Carlos and Patrick will unveil a campaign with the country’s Health Ministry to promote organ donation. Through print and television advertising, the effort will explain the need for donations and encourage Mexicans to talk with loved ones about contributing their bodies after death.

The younger Carlos said Mexicans may grow more comfortable with the idea of organ donations by hearing the brothers’ story.

“Learning and hearing about the experience from people who have been through the process can always help,” said Carlos, 43, the eldest of the six children of Carlos Slim and chairman of Telefonos de Mexico SAB.

Mother’s Legacy

The elder Slim, whose public holdings are worth about $60.3 billion, according to data compiled by Bloomberg, said last month he disagrees with Bill Gates and Warren Buffett that billionaires should donate half their wealth to charity. Slim has said he prefers to fight poverty by investing in projects that create jobs. Slim’s charities have a budget of 18.8 billion pesos ($1.49 billion) this year, according to an advertisement his companies placed in Mexico City newspapers in June.

The issue of organ transplants has the family’s financial and personal support. Their recent effort builds on the legacy of Soumaya Domit, the elder Slim’s wife, who also received a kidney transplant and died of kidney failure in 1999. Slim, 70, has never remarried. The family’s National Transplant Foundation has funded 6,500 transplants over the past decade.

More than two-thirds of the family’s wealth comes from stakes in America Movil, Latin America’s largest mobile-phone carrier, and Telefonos de Mexico, the nation’s biggest land-line phone company.

Long-Term Funding

Through his Carlos Slim Health Institute, the billionaire and his family spend about $20 million a year on research and administrative costs around organ transplants, or about 10 percent of its annual budget, said Roberto Tapia, chief executive officer of the organization.

The idea, Tapia said, is to move from simply funding transplants for Mexicans to improving the medical technology available to make operations safer and more successful. The group’s projects include funding genomic research at the Broad Institute of Massachusetts Institute of Technology and Harvard University to understand genetic factors in medical conditions including kidney failure.

“They prefer to see it as a social investment, instead of calling it philanthropic,” Tapia said of the Slim family.

The Slim Institute, founded in 2007, also is funding research at Harvard-affiliated Brigham and Women’s Hospital in Boston to increase the duration and health of a donated kidney awaiting a recipient, Tapia said.

Health Ministry

Mexico’s government has welcomed the Slims’ help as it seeks ways to fund more donations through its own health-care system and to train more medical experts to guide families through organ donations from patients who are near death, said Enrique Martinez, director of the National Transplant Registry at Mexico’s Health Ministry.

“Around the world these organizations are important, but in a country like Mexico they take up an even more important role,” Martinez said in a phone interview. “We always have problems in institutions with a lack of resources, and these organizations offer an opportunity to patients that, truthfully, would be very difficult for them to find through other means.”

Mexico’s kidney transplant rate from live donors last year was 16.6 per million people, about the same as the U.S. and ahead of Spain, Colombia and Uruguay, according to Martinez and to statistics from the International Registry of Organ Donation and Transplantation, compiled by Spanish and Italian researchers.

Drop-off After Death

The drop-off for Mexico came from deceased donors, with a rate of 4.6 kidney transplants per million. That compares to 18 in Colombia, 33 in Uruguay, 29 in the U.S. and 45 in Spain, the leader in organ donations after a years-long government effort. A lack of trained medical personnel and legal frameworks are some of the biggest obstacles to surmount, Slim Domit said.

“A big part of what’s going on is that there is very little information,” Carlos Slim Domit said. “The other part is all the infrastructure that is being created so that there are people specialized in organ donations in the different health centers, public and private, that know all the legal processes that are required so people can donate.”

Transplant Improvements

Doctors have been successfully performing kidney transplants since the 1950s, with success rates improving over the decades with advances in tissue-matching tests and drugs to suppress rejection of organs by the recipient’s immune system.

In the U.S., where the Slim Domit brothers had their operation to gain access to the latest immune system suppression therapies, kidney recipients between 35 and 49 years old had a survival rate of 93 percent after the first year and of 89 percent after five years, according to government statistics.

Two years after their transplant, the Slim Domit brothers are talking about the operation publicly to help Mexicans learn more. Carlos and Patrick, 41, recorded Web video testimonials to encourage more families to consider donations. While the Slim family cherishes its privacy, the decision to talk openly about the transplant was easy, Carlos Slim Domit said.

“Our aim is that the experience that Patrick and I had can help other people to sensitize themselves more to the subject of organ donations,” he said.

Searching for Breast Cancer Culprits in Chemicals

USA Today

When Heather Rogers was diagnosed with breast cancer three years ago, she asked herself, "Why me?"

Like 90% of women with the disease, Rogers had no family history of breast cancer. She was healthy, only 46, never considered herself at high risk.

And like many breast cancer survivors, she wonders if her disease was caused by chemicals in the environment.

Rogers says she's frustrated that doctors are unable to give her a clear answer.

"They've made a lot of progress, which I'm really grateful for," says Rogers, of Alexandria, Va. "But I was surprised that, after all these years, there are still so many unanswered questions."

Although the American Cancer Society estimates that environmental pollution causes 6% of all cancer deaths — or about 34,000 lost lives each year — the group doesn't offer specific advice on which chemicals to avoid to reduce breast cancer risk.

Difficult to ascertain

To some extent, scientists will never have "definitive" answers, says Julia Brody of Silent Spring Institute, an advocacy group that studies breast cancer and the environment.

People are exposed to a countless mix of chemicals over a lifetime. Since cancers usually take decades to develop, it can be hard to make clear connections. And since researchers can't test toxins on humans, they rely on studies in animals and lab dishes, as well as observations of population trends, Brody says.

Scientists sometimes disagree about how to interpret the results. Even more crucially, though, experts disagree about how to act in the face of uncertainty.

Some cancer experts, such as the American Cancer Society's Michael Thun, says it's important to make health recommendations only when doctors can be very sure about the science.

"The problem with sounding too many alarms is that people can't tell what's real," he says.

Exercise caution to reduce exposure

Other medical leaders, such as the President's Cancer Panel and the Endocrine Society, follow the "precautionary principle," arguing that it makes sense to reduce exposures to chemicals that appear harmful. In a May report, the cancer panel urged the country to act to protect people from "grievous harm" caused by toxins. And in a 2009 report, the Endocrine Society warned that hormone-disrupting chemicals in consumer products may contribute to cancer, infertility and other conditions.

Doctors expect to get many answers from the National Children's Study, launched this year, which will follow 100,000 children from birth — or earlier — through age 21. Researchers will study chemicals in blood, urine and even umbilical cords, looking for links to cancer, asthma, autism and other disorders.

But Brody says that Americans don't need to wait for that study's results to begin protecting themselves and their children. More than 200 chemicals have been linked to breast cancer in animals, she says.

A growing number of scientists are particularly concerned about chemicals that alter natural hormonal systems. These chemicals don't need to cause genetic mutations to cause breast cancer, says Janet Gray, a professor at New York's Vassar College.

Toxins could increase the number of new cancers by pushing girls into early puberty — a known risk factor for breast tumors, Gray says. Such "hormone-disrupting" chemicals are everywhere — plastics, pesticides, even perfumes.

"We believe there's enough science to act now," says Janet Nudelman of the Breast Cancer Fund.

05 October 2010

Researchers seek new Tools to flag Concussions

Philadelphia Inquirer

Four Eagles games, four concussions - the latest two suffered by wide receiver Riley Cooper and cornerback Asante Samuel on Sunday. Coach Andy Reid said Monday that their injuries "seem to be mild," but that word seem is telling.

From a scientific perspective, no one really knows. Physicians can see when someone's outward symptoms have returned to normal, as most do within a few weeks. But there is no lab test to measure internal damage from a concussion and no medicine to treat it.

"Absolutely nobody knows when it's safe to go back in," said Douglas H. Smith, director of the University of Pennsylvania's Center for Brain Injury and Repair. "If anyone says one week is good, three weeks is good, they're not basing it on facts."

The scientific study of concussions, sometimes called mild traumatic brain injuries (TBI), lags behind research on many other ailments - a failing attributed to a lack of funding and public pressure, among other reasons. Smith and a growing number of others are striving to change that, investigating techniques such as advanced brain scans, genetic screens, and the analysis of biomarkers - small amounts of certain proteins that may leak into the blood after a brain injury.

They want to know if there has been subtle damage inside brain cells - the sort of thing that might lead to chronic problems years later.

The quest has taken on new urgency with the prevalence of soldiers who suffer head injuries from the jolt of an explosion, experiencing cognitive deficits despite the lack of external wounds. Concern over the issue has filtered through to civilians as well, from professional athletes down to neighborhood leagues.

The sports world has paid particular attention to an ongoing study at Boston University, where researchers have analyzed the brains of deceased football players, identifying numerous cases of chronic traumatic encephalopathy - a degenerative disease marked by "tangles" in the brain.

But the goal is to peer inside the body while the patient is still alive. An ideal solution: a simple blood test that would allow the diagnosis of concussions within minutes, on the playing field or even in a war zone.

One biotech firm working to develop such a test is called Banyan Biomarkers, founded by scientists from the University of Florida. The Department of Defense plans to collaborate with the firm on a phase-three trial of its biomarkers, said Col. Dallas C. Hack, who is based at Fort Detrick, Md., and directs the Combat Casualty Care Research Program.

The key is to make sure that such proteins are specific to brain injury, and not something that turns up in the blood after injuries elsewhere in the body. Kevin Wang, a Banyan cofounder, said he and his colleagues had identified several good candidates, including one protein normally found in the cytoplasm of brain cells.

"We're just taking what Mother Nature gives us," Wang said.

Biomarkers are under scrutiny at Penn, too, as part of a joint study with the Baylor College of Medicine. That study also includes research on a kind of advanced MRI called diffusion tensor imaging (DTI), both in humans and pigs.

A traditional MRI does an excellent job of distinguishing among different kinds of tissue, in part by measuring the density of protons in bodily fluid. But it's not useful for looking at anomalies within a given type of tissue of uniform density, such as white matter - the fatty, insulating tissue that covers axons in brain cells.

The type of cellular injury that is thought to be associated with concussions, in other words, can't be seen in a regular MRI.

That's where DTI may be useful, allowing the measurement of protons contained in water molecules. Scientists can detect how these protons are moving inside an axon, the long, skinny portion of a neuron. In a healthy axon, the water protons are more free to travel along its length, said Elias Melhem, a neuroradiologist at Penn. In an axon that has been stretched, suffering internal damage and even swelling, the paths of the water protons are more random, he said - a quality that can be quantified with sophisticated mathematics.

Lots of work remains to determine how the results should be interpreted, said Alisa Gean, a neuroradiologist at the University of California, San Francisco. In theory, DTI measures the structural integrity of axons, but it's not clear yet how the measurements correspond to actual brain function, she said.

"While it does hold great promise, it's not ready for prime time," she said. Other kinds of advanced imaging are being studied as well, in some cases revealing internal abnormalities even after the patient reports feeling back to normal, Gean said.

To get a better look at individual axons, Smith's lab also puts rat brain cells on a silicon membrane and then stretches them by administering puffs of air. The amount of stretching, and the speed at which it occurs, is akin to what a human brain would suffer in a mild traumatic brain injury, Smith said, though he doesn't like the adjective mild because the consequences can be grave.

The results are not pretty. Looking at the stretched cells under a microscope, the scientists can see breakage in internal structures called microtubules, which Smith likens to train tracks that carry crucial proteins along the length of an axon. This can lead to a pileup of proteins, causing swelling and even disintegration of the cell.

Even if there is no internal breakage, stretching an axon too quickly leads to chemical changes that appear to make the cell more susceptible to damage from a repeat stretch a day later, he and colleagues have reported.

"These types of changes may underlie the suspected 'period of vulnerability' for athletes suffering concussion that is the center of debate about when they should return to the game," Smith said.

Another challenge is studying the sort of axonal stretching thought to occur during the blast wave from an explosion. The amount of stretching is much less than when a football player's head is slammed into the turf, but the rate of stretching is faster, due to the high frequency of the blast wave, Smith said.

Injuries can occur even when the soldier suffers no physical impact or external injury. But how to measure these unseen impacts?

With engineering colleagues Shu Yang and Kacy Cullen, Smith has developed a small, wearable sensor that will change color when subjected to strain at the high frequency of a blast wave. The sensor is made of a crystalline material, which responds by collapsing at a certain frequency - a little bit like an opera singer shattering a crystal glass. The color of the sensor changes because the collapsed structure refracts light differently.

These various lines of research are welcomed by neurologists, said Jeffrey S. Kutcher, chair of the American Academy of Neurology's Sports Neurology Section. Kutcher is involved in re-writing the academy's concussion guidelines to reflect some of the latest studies.

For example, it used to be considered medically acceptable for athletes to return to action if they had mild symptoms that cleared up within 15 minutes of being hit, said Kutcher, who is also director of Michigan NeuroSport, a medical and research team at the University of Michigan. But symptoms can arise or worsen up to several hours later, he said.

Much more science is needed, he and other brain-injury experts said. Obtaining consistent research data is difficult because an identical impact can cause a range of responses in different people, Kutcher said.

"Concussion is not like an ACL injury. Everybody's knee is essentially the same. We know what it does, we know what it should do," allowing for a standard treatment protocol, Kutcher said. "Brains are way too diverse for that."

Then there's the problem that concussions have historically been underreported, because of the old attitude that athletes should shake it off and get back on the field - an approach that neurologists say is dangerous. Estimates of the number of concussions vary widely, but tend to place it well above one million each year.

One of the biggest risk factors for concussion is having already had a concussion. But it is not entirely clear what that means.

The first concussion might have weakened those people and made them more susceptible to repeat injury. Or perhaps they were more prone to having concussions to begin with, either because of the nature of their brains or their occupation. Outward symptoms are meaningful, but Kutcher said indicators from inside the head are desperately needed. Hack, the head of the military research program, agreed.

"This is truly an under-addressed area of medicine, one of the last frontiers of medicine that we have not done a good job on as a medical community," Hack said. "We're going to change medicine with the work we're doing."