New study firmly ties hormone use to breast cancer

By MARILYNN MARCHIONE

SAN ANTONIO (AP) — Taking menopause hormones for five years doubles the risk for breast cancer, according to a new analysis of a big federal study that reveals the most dramatic evidence yet of the dangers of these still-popular pills.
Even women who took estrogen and progestin pills for as little as a couple of years had a greater chance of getting cancer. And when they stopped taking them, their odds quickly improved, returning to a normal risk level roughly two years after quitting.

Collectively, these new findings are likely to end any doubt that the risks outweigh the benefits for most women.
It is clear that breast cancer rates plunged in recent years mainly because millions of women quit hormone therapy and fewer newly menopausal women started on it, said the study's leader, Dr. Rowan Chlebowski of Harbor-UCLA Medical Center in Los Angeles.

"It's an excellent message for women: You can still diminish risk (by quitting), even if you've been on hormones for a long time," said Dr. Claudine Isaacs of Georgetown University's Lombardi Comprehensive Cancer Center. "It's not like smoking where you have to wait 10 or 15 years for the risk to come down."

Study results were given Saturday at the San Antonio Breast Cancer Symposium.
They are from the Women's Health Initiative, which tested estrogen and progestin pills that doctors long believed would prevent heart disease, bone loss and many other problems in women after menopause. The main part of the study was stopped in 2002 when researchers saw surprisingly higher risks of heart problems and breast cancer in hormone users.
Since then, experts have debated whether these risks apply to women who start on hormones when they enter menopause, usually in their 50s, and take them for shorter periods of time. Most of the women in the federal study were in their 60s and well past menopause.

So the advice has been to use hormones only if symptoms like hot flashes are severe, and at the lowest dose and shortest time possible. The new study sharpens that message, Chlebowski said.

"It does change the balance" on whether to start on treatment at all, he said.

Even so, most women will not get breast cancer by taking the pills short-term. The increased cancer risk from a couple of years of hormone use translates to a few extra cases of breast cancer a year for every 1,000 women on hormones. This risk accumulates with each year of use, though.

The Women's Health Initiative study had two parts. In one, 16,608 women closely matched for age, weight and other health factors were randomly assigned to take either Wyeth Pharmaceuticals' Prempro — estrogen and progestin — or dummy pills.
This part was halted when researchers saw a 26 percent higher risk of breast cancer in those on Prempro.

But that was an average over the 5 1/2 years women were on the pills. For the new study, researchers tracked 15,387 of these women through July 2005, and plotted breast cancer cases as they occurred over time.

They saw a clear trend: Risk rose with the start of use, peaked when the study ended and fell as nearly all hormone users stopped taking their pills. At the peak, the breast cancer risk for pill takers was twice that of the others.

Think of it as President Bush's public approval rating, said another study leader, Dr. Peter Ravdin of the University of Texas M.D. Anderson Cancer Center in Houston. "Bush's popularity may be 50 percent on average, but it might have been descending the whole time he was president," Ravdin said.

In the second part of the federal study, researchers observed just 16,121 women who had already been on hormones for an average of seven years and another group of 25,328 women who had never used them. No results on breast cancer risk in these women have been given until now.

Plotting cases over time, researchers saw in retrospect that hormone users had started out with twice the risk of breast cancer as the others, and it fell as use declined. Among those taking hormones at the start of the study, use dropped to 41 percent in 2003, the year after the main results made news.

In the general population, use of hormone products has dropped 70 percent since the study, said another of its leaders, Dr. JoAnn Manson, preventive medicine chief at Harvard's Brigham and Women's Hospital in Boston.
That corresponds with big drops in breast cancer cases, but some scientists have said this could be due to a fall-off in mammograms, which would mean fewer cancers were being detected, not necessarily that fewer were occurring.
The new study puts that theory to rest. Mammography rates were virtually the same among those taking hormones and those not.

"It is clear that changing mammography patterns cannot explain the dramatic reductions in breast cancer risk," Manson said.
"The data are getting stronger," said Dr. C. Kent Osborne, a breast cancer specialist at Baylor College of Medicine in Houston.
Women who do need the pills should not panic, though the doubling of risk — a 100 percent increase — for long-term users is quite worrisome, cancer specialists say. Although the new study does not calculate risks in terms of actual cases, previous research showed that the average increased risk of 26 percent meant a difference of a few extra cases a year for every 1,000 women on hormone pills, compared with nonusers.

"Hormone therapy remains a good health care choice to relieve moderate to severe menopausal symptoms," says a statement from Wyeth, which made the pills used in the study.

"Most women should be able to discontinue hormones in three to four years," or at least reduce their dose, Manson said.
A future analysis will look at other women in the study who took only estrogen, generally women who have had hysterectomies.

On the Net:
Cancer conference: http://www.sabcs.org
Hormone study: http://www.nhlbi.nih.gov/whi/estro_pro.htm

Stress hits even before pregnancy

Premature birth can cause long-term health problems

Stress in the six months before conception increases the risk of giving birth prematurely, research suggests.
Mothers who experience a death or serious illness in the family before falling pregnant are more likely to have a preterm baby, a study found.

The link was particularly strong in mothers who had experienced "severe life events" in older children, the Human Reproduction journal reported.

Effects of stress hormones in the womb, may explain the findings, experts said.
Records from 1.35m mothers in Denmark were analysed in the study, which comes on the back of earlier research suggesting stress during pregnancy is a risk factor for premature birth.

Serious illness or death in older children in the six months prior to conception, increased the risk of birth before 37 weeks by 23% and the risk of birth before 33 weeks by 59%.

Death or illness in close relatives, such as parents, siblings or a partner in the last six months before becoming pregnant increased the risk of birth before 37 weeks by 16%.

Mothers who had experience stress and were also missing a parent or who did not have a partner were significantly more likely to have a premature birth, the study showed.

Hormones
The researchers suggested several possible explanations for the findings including increased levels of stress hormones or lifestyle changes in response to stress, such as increased consumption of tobacco or alcohol.

Study leader, Professor Philip Baker, from the Maternal and Fetal Health Research Group at the University of Manchester said most research to date had focused on stress during pregnancy.
"Yet these results suggest that the impact could be greater in the period preceding conception.
"Although relatively subtle its still a real effect."
He added they had chosen to look at death and serious illness in close relatives as they were undoubtedly very stressful events for anyone.

"This should help our understanding of the causes of premature birth," he added.
Tommy's, the baby charity, who funded the research said around 50,000 babies are born prematurely each year in the UK, putting them at risk of long-term health problems such as chronic lung disease, learning difficulties and blindness.
Ronald Lamont, consultant obstetrician at North West London Hospitals NHS Trust and spokesman for the Royal College of Obstetricians and Gynaecologists, said the results were a "little surprising".

"It's quite interesting and fits with what we knew about stress during pregnancy.
"The fact that the risk of pre-term birth was increased if pregnant women were missing a parent or partner shows the importance of close support."

Stem cell cure hope for back pain

Millions suffer debilitating back pain

A patient's own stem cells could soon be used to cure chronic back pain, say researchers.
The team from the University of Manchester hope their treatment will be available within three years.

They are perfecting a way to rebuild the soft shock-absorbing discs which separate the vertebrae in the spine.

Damage to these intervertebral discs (IVDs) is a common cause of debilitating low back pain which affects around 12 million in the UK.

BackCare
A treatment which effectively cured the problem could potentially save the UK economy as much as £5 billion a year.

The new therapy, developed by Dr Stephen Richardson, uses mesenchymal stem cells (MSCs) from adult bone marrow to regenerate spinal discs.

MSCs are a class of stem cell which can grow into many different cell types, including bone, cartilage, fat and muscle.

Dr Richardson has succeeded in turning MSCs into the cells which make up the gel-like nucleus pulposus (NP) tissue separating the vertebrae.

He plans to begin pre-clinical trials next year, with full patient trials to follow on.

Dr Richardson said: "Once we have extracted the bone marrow from the patient and have purified the MSCs, they will be grown in culture and our patented method of differentiation will be applied.

"They will then be embedded within a gel which can be implanted back into the patient."

No rejection

Since the stem cells are taken from the patient's own body, there is no chance of them being rejected by the immune system.

The gel is based on a natural collagen similar to one already used for the treatment of cartilage defects.

It is implanted using an arthroscope, a thin tube device slipped through a small incision in the back.

Dr Richardson said there was no reason why a patient should not return home on the same day as the procedure, or the day after.

He said: "Once implanted, the differentiated MSCs would produce a new NP tissue with the same properties as the original and would both treat the underlying cause of the disease and remove the painful symptoms."

Currently, low back pain is treated with a combination of painkillers, physiotherapy or surgery.

In severe cases tissue is removed to relieve the pain, or vertebrae fused together.

However, success is limited, and these techniques do not solve the root cause of the problem.

Dries Hettinga, research and information manager at the charity BackCare, said: "This is a really exciting area of research and although it is still early days, the initial results look very promising."

Surgery beneficial in heartburn

By Emma Wilkinson
BBC News health reporter

Proton pump inhibitors are the standard treatment for reflux
People with persistent heartburn should be considered for early surgery to prevent a lifetime of popping pills, NHS research suggests.

A year after keyhole surgery, only 14% of patients were still taking medication, compared with 90% of those treated with drugs alone.

The £1m trial of 800 patients suggests surgery should be done more routinely in patients with chronic acid reflux.
Experts said there was a view among GPs that surgery was "too extreme".
Researchers at the University of Aberdeen co-ordinated the trial of laparoscopic fundoplication at 21 hospitals around the UK.

For some people, it is a serious problem which could potentially mean a lifetime of tablet taking
Professor Roger Jones, King's College London

The results so far suggest the procedure, although expensive at £2000 per patient, is cost-effective because reflux sufferers no longer have to take medication and their quality of life improves.

But they are following the patients for five years to check the benefits are long-term.

The operation involves wrapping a piece of the stomach around the oesophagus to create a new valve to prevent acid backing up from the stomach.

It used to be done by opening up the chest cavity, but with the advent of keyhole surgery is now a lot safer.
Common problem

Reflux is a very common condition with 20% of the population experiencing it at some point in their lives.
Those at the more severe end of the spectrum end up taking tablets for the rest of their lives - potentially for 20 to 30 years in younger patients - and few currently receive surgery.

Study leader, Professor Adrian Grant, said: "It looks pretty promising.
"I think these results will mean that surgeons will be suggesting the operation in those patients who are not quite so bad."
He added: "Like all surgery, fundoplication has some risks, but the more troublesome the symptoms, the greater the potential benefit from the operation."

Professor Roger Jones, head of general practice at King's College London and chair of the Primary Care Gastroenterology Society said surgery was often regarded as "too extreme" for something which is not a serious problem.

"But for some people, it is a serious problem which could potentially mean a lifetime of tablet taking."

Diabetes aspirin use questioned

Aspirin makes it harder for blood clots to form
Aspirin should not routinely be used to prevent heart attacks in people with diabetes, Scottish research suggests.

The British Medical Journal reported that in 1,300 adults with no symptoms of heart disease the drug, which can cause stomach bleeds, had no benefit.

The findings contradict many guidelines which advocate people with diabetes use aspirin to counter the underlying high risk of heart attack and stroke.

But there are key high-risk groups who still need the drug, experts said.
Patients with concerns are advised to consult their GP before changing medication.
In people who have already had a heart attack or stroke, or have been diagnosed with coronary artery disease, aspirin has been shown to reduce the risk of future "events" by around 25%.

However, in recent years doctors have begun to focus on people who have not yet developed so-called cardiovascular disease, but are at high-risk of having it in the future - such as people with diabetes.
There are around two million people over 40 with diabetes in the UK.
Around 80% of people with diabetes die of cardiovascular disease including strokes and heart attacks.
A daily dose of aspirin is recommended by several UK guidelines as a "preventive" treatment in these groups.

No benefit
But in the latest study in adults over 40 years with type 1 or type 2 diabetes and no symptoms of cardiovascular disease, there was no difference over seven years in heart attacks or strokes between those given aspirin and those given a dummy pill.

ASPIRIN USE
It can reduce the risk of people who have had strokes or heart attacks being ill again
But this study shows no benefit for people with diabetes who have no signs of heart disease
There is a known risk that taking the drug can cause stomach bleeds
People should talk to their GP before they stop taking the drug

Study leader Professor Jill Belch, from the University of Dundee, said aspirin was one of the most common causes of hospital admission for gastrointestinal bleeding.
"We have got a bit ahead of ourselves with aspirin.
"We need to think again about using it for primary prevention."
However she stressed the drug was beneficial in people who had already had a heart attack or stroke.

Professor Peter Sever, an expert in clinical pharmacology and therapeutics at Imperial College London, said the study was "extremely important".
"It confirms many concerns we have that aspirin is very widely used in the general population without an evidence base to support its overall benefits.
"Thousands of people buy aspirin over the counter - I'm forever saying to patients you shouldn't be taking this.
"I have had a couple of patients admitted to hospital with major gastrointestinal bleeding when there was no evidence it was doing any good."

The number of people diagnosed with diabetes and as having a high risk of cardiovascular disease is set to increase, with government plans in England to introduce a national screening programme for the over-40s next year.
Professor Steve Field, chair of the Royal College of GPs, said it would be worth revisiting the guidelines.
"But patients shouldn't panic or stop taking aspirin," he said.

Judy O'Sullivan, cardiac nurse at the British Heart Foundation, said: "This study adds weight to the evidence that aspirin should not be prescribed to prevent disease of the heart and circulation to people with diabetes, and other high risk groups, who do not already have symptoms of the disease."

Fatty acids clue to Alzheimer's

Scientists want to know more about the brain changes that lead to Alzheimer's

Controlling the level of a fatty acid in the brain could help treat Alzheimer's disease, an American study has suggested.
Tests on mice showed that reducing excess levels of the acid lessened animals' memory problems and behavioural changes.
Writing in Nature Neuroscience, the team said fatty acid levels could be controlled through diet or drugs.
A UK Alzheimer's expert called the work "robust and exciting".

There are currently 700,000 people living with dementia in the UK, but that number is forecast to double within a generation.

Over-stimulation
Scientists from Gladstone Institute of Neurological Disease and the University of California looked at fatty acids in the brains of normal mice and compared them with those in mice genetically engineered to have an Alzheimer's-like condition.
They identified raised levels of a fatty acid called arachidonic acid in the brains of the Alzheimer's mice.

This is cause for cautious optimism, as fatty acid levels can be controlled to some extent by diet and drugs
Rebecca Wood, Alzheimer's Research Trust

Its release is controlled by the PLA2 enzyme.
The scientists again used genetic engineering to lower PLA2 levels in the animals, and found that even a partial reduction halted memory deterioration and other impairments.

Dr Rene Sanchez-Mejia, who worked on the study, said: "The most striking change we discovered in the Alzheimer's mice was an increase in arachidonic acid and related metabolites [products] in the hippocampus, a memory centre that is affected early and severely by Alzheimer's disease."

He suggested too much arachidonic acid might over-stimulate brain cells, and that lowering levels allowed them to function normally.

Dr Lennart Mucke, who led the research, added: "In general, fatty acid levels can be regulated by diet or drugs.
"Our results have important therapeutic implications because they suggest that inhibition of PLA2 activity might help prevent neurological impairments in Alzheimer's disease.

"But a lot more work needs to be done before this novel therapeutic strategy can be tested on humans."
'Cautious optimism'

Rebecca Wood, chief executive of the UK's Alzheimer's Research Trust, said: "This research on mice suggests a connection between fatty acids and the abnormal brain activity that exists in Alzheimer's disease.
"This is cause for cautious optimism, as fatty acid levels can be controlled to some extent by diet and drugs.
"However, it is not yet clear if these findings are applicable to humans, and a lot more research is needed before any human trials can be conducted."

Professor Clive Ballard, director of Research at the Alzheimer's Society, said the work was "robust and exciting".
He added: "This is a novel and potentially exciting area of research, but it is still at a very early stage.
"Much more research is needed to see if fatty acids could lead to a treatment for those living with the devastating effects of Alzheimer's disease."

Antibiotic 'cerebral palsy link'

By Michelle Roberts Health reporter, BBC News

Antibiotics appeared to treble the risk of cerebral palsy
A study has linked a small number of cases of cerebral palsy to antibiotics given to women in premature labour.
The UK study found 35 cases of cerebral palsy in 769 children of women without early broken waters given antibiotics.
This compared with 12 cases among 735 children of women not given the drugs. Advice is being sent to the study's 4,148 mothers and a helpline set up.

Medical experts stressed pregnant women should not feel concerned about taking antibiotics to treat infections.

The Oracle study was the largest trial in the world into premature labour and was set up to investigate whether giving antibiotics - which might tackle an underlying symptomless infection - to women with signs of premature labour would improve outcomes for babies.

One in eight babies in the UK is born prematurely and prematurity is the leading cause of disability and of infant death in the first month after birth.

Premature labour
In 2001, ORACLE found the antibiotic erythromycin had immediate benefits for women in premature labour (before 37 weeks gestation) whose waters had broken. It delayed onset of labour and reduced the risk of infections and breathing problems in babies.

Erythromycin and the other antibiotic studied - co-amoxiclav - showed no benefit or harm for the women whose waters were still intact, however, and doctors were advised not to routinely prescribe them in such circumstances.
To study the longer-term outcomes, the Medical Research Council-funded scientists followed up the children seven years later.

Unexpectedly, both antibiotics appeared to increase the risk of functional impairment - such as difficulty walking or problems with day to day problem solving - and treble the chance of cerebral palsy in the children of the women whose waters had not broken.

Of the 769 children born to mothers without early broken waters and given both antibiotics, 35 had cerebral palsy, compared with 12 out of 735 whose mothers did not receive antibiotics in the same circumstances.
The reasons behind this link are unclear, particularly as there was no increased risk of cerebral palsy in women whose waters had broken.

Hostile environment
The researchers believe cerebral palsy is unlikely to be a direct effect of the antibiotic but rather due to factors involved in prolonging a pregnancy that might otherwise have delivered early.
Researcher Professor Peter Brocklehurst of Oxford University said: "We have a suspicion that infection is implicated in premature labour.

"Antibiotics may merely suppress levels of infection to stop preterm labour, but the baby remains in a hostile environment."
Infections during pregnancy or infancy are known to cause cerebral palsy.

In a letter to doctors and midwives advising them about the findings, Chief Medical Officer Sir Liam Donaldson says: "Pregnant women should not feel concerned about taking antibiotics to treat infections.

"It is important to note that these women had no evidence of infection and would not routinely be given antibiotics."
Where there is obvious infection, antibiotics can be life-saving for both mother and baby, the CMO says.

The Royal College of Obstetricians and Gynaecologists said: "These findings do not mean that antibiotics are unsafe for use in pregnancy. Pregnant women showing signs of infection should be treated promptly with antibiotics."
Cerebral palsy can cause physical impairments and mobility problems.

It results from the failure of a part of the brain to develop before birth or in early childhood or brain damage and affects one in 400 births.

Arthritis knee op 'does not work'

The surgery is not recommended in the UK
An operation offered to ease the symptoms of osteoarthritis makes no difference, say Canadian doctors.
Patients given knee arthroscopy showed no improvement beyond that provided by physiotherapy and painkillers.
Arthritis experts in the UK said some surgeons were still carrying out the operation, against national guidance.
They said New England Journal of Medicine study showed doctors still relying on the technique to treat osteoarthritis were misguided.

Thousands of people in the UK suffer from osteoarthritis in the knee, which can be painful and limit movement.
The operation involves inserting instruments through small incisions to try to flush out loose fragments of cartilage, and to smooth the surfaces of the joints, in the hope that this will relieve symptoms.
A group of 178 men and women, with an average age of 60, were enrolled in the trial at the University of Western Ontario.
All of them were given physiotherapy and painkilling drugs such as ibuprofen, but half of the volunteers were also given the "lavage and debridement" procedure.

When their symptoms were compared at various points afterwards, the group who had the operation were faring no better than those who had not received it.

Guidelines breached
Dr Brian Feagan, one of the researchers, said: "This is definitive evidence that arthroscopic surgery provides no additional therapeutic value when added to physical therapy and medication for patients with moderate osteoarthritis of the knee."
This type of surgery is still recommended for some other knee conditions, including more severe osteoarthritis where the knee is "locked" in position, but is not recommended for moderate osteoarthritis by the National Institute for Health and Clinical Excellence, which formulates UK guidelines.

A spokesman for the Arthritis Research Campaign said there was no longer any excuse for performing it in patients with less severe arthritis.

"Arthroscopic lavage and debridement is still commonly performed in the US but more rarely in the UK over the past ten years, and is no longer accepted as an effective treatment for osteoarthritis of the knee in this country.
"Surgeons still performing this operation need to ask themselves why they are doing it."

Lead, mercury and arsenic were found in the traditionally Indian herbal mixtures at levels that would surpass California safety guidelines, says a researcher who is calling for FDA curbs.
By Alan Zarembo, Los Angeles Times Staff Writer
August 27, 2008
Ayurvedic medicines -- herbal mixtures dating back thousands of years in India and increasingly popular in the West -- are frequently contaminated with lead, mercury or arsenic, according to a study published today.

A fifth of the nearly 200 concoctions tested contained levels of the toxic metals that, if taken at the maximum recommended doses, would surpass California's safety guidelines.

Dr. Robert Saper, a Boston University professor of family medicine who led the study, said the findings should spur the Food and Drug Administration to start clamping down on the largely unregulated world of pills, herbs and powders classified as dietary supplements.

"It shouldn't be me trying to figure this out," Saper said.

Ayurveda is a traditional Indian practice that takes a holistic approach to wellness, employing herbal medicine, meditation and exercise to promote good health. It exists alongside modern medicine in India, with its own network of clinics, hospitals and colleges serving hundreds of millions of patients.

It has spread to the U.S. and Europe with the migration of South Asians around the world and been popularized by figures such as bestselling author Deepak Chopra.

There are about two dozen ayurvedic training programs in the United States. A 2002 survey estimated that 750,000 U.S. residents have used the herbal preparations, sold under both traditional Indian names and more marketable labels such as GlucoRite and Ezi Slim.

Saper got interested in the supplements in 2003 after a man of Indian origin showed up at a Boston-area emergency room with seizures. The culprit turned out to be lead in the man's ayurvedic medicines. In an initial study published in 2004, Saper bought 70 ayurvedic herbal products imported from India and found that toxic metals were common components.

It was an unsettling finding, because most of the preparations are intended to be taken as part of a daily regimen to improve health.

"Many, many studies are showing that even small levels of lead in the blood can increase the risk of high blood pressure, kidney dysfunction and decreased IQ," Saper said.

Ayurvedic practitioners lashed out at the research as alarmist, saying that it only showed there were problems with mixtures from India, not with U.S.-made products.

They pointed out that in India, many of these metals are purposely blended with herbs as part of the medicinal recipe. Those metallic mixtures are rarely used in the United States, they said.

In the new study, published in the Journal of the American Medical Assn., Saper and his team analyzed 193 products purchased from 25 websites for Indian and U.S. manufacturers. The vast majority supposedly contained only herbs and no metals.

About 80% of the samples showed no detectable metal content.

But among the remaining samples, the toxic metals showed up at similar rates in both U.S. and Indian-made products.

Of the U.S. products, 21% contained lead, 3% contained mercury and 3% had arsenic. Among the Indian-made medicines, 17% had lead, 7% had mercury and none contained arsenic.

The researchers and other experts surmised that the contamination had less to do with the manufacturing process than with the soils in which the herbs were grown.

"The raw material is all coming from India," said Kush Khanna, who runs Bazaar of India in Berkeley, a manufacturer of ayurvedic medicines started by his father in 1971.

Heavy metals showed up in 17 of the products the researchers ordered from his company.

Khanna said two labs in India routinely tested the 80 or so ingredients he imported.

The problem is that there are no unified standards for what is considered safe.

Lead levels allowed by the World Health Organization are 500 times the California limits.

"Based on WHO standards, our products are perfect," Khanna said. "They have not exceeded any limits."

The researchers found only two products that exceeded the WHO standards for lead content. Both mixtures were from India and purposely prepared with metals as ingredients.

In California, the Safe Drinking Water and Toxic Enforcement Act of 1986 requires that products containing certain levels of toxic metals carry warning labels. But the act has no power to ban products, and companies with fewer than 10 employees, such as Khanna's, are exempt from the labeling requirements.

The FDA does not specify any limits for metal content in dietary supplements, leaving it to the manufacturers to ensure that their products are safe.

Jennifer Rioux, a medical anthropologist who runs the Integral Ayurveda clinic in Chapel Hill, N.C., said the research underscored the need for consumers to consult with ayurvedic experts instead of buying and taking products on their own.

She noted that the study showed many medicines to be perfectly safe, but she worried that its conclusions would tar her profession.

"All people need is one study to provoke fear about an entire system of medicine," she said.

Anaesthetics 'could worsen pain'

Some anaesthetics are irritant chemicals
Some general anaesthetics could actually worsen the pain following surgery, say scientists.

So-called "noxious" anaesthesia drugs - used commonly worldwide - stimulate nerves to cause irritation long after the operation is over. The US research, published in Proceedings of the National Academy of Sciences journal, could prompt the choice of different drugs. A UK expert said solving post-surgical pain was a priority for anaesthetists.

Anaesthetists have known for some time that certain drugs, such as the gas isoflurane, while very effective at rendering and keeping patients unconscious, are actually irritant chemicals. Some already use a painkilling drug to lessen this effect before delivering the anaesthetic itself. The latest finding, by research staff at Georgetown University Medical Center however, suggests that effects of the irritant is not just short-lived, but lingers on long after both the painkiller and the anaesthetic have worn off.

The drugs act on the same receptors on nerve cells which are activated by contact with other irritants, such as garlic, mustard or chilli.

Mice bred without these receptors were unaffected by the "noxious" anaesthetic gases.
If strongly activated, these can lead not just to an immediate sensation of pain, but also a longer oversensitisation of pain pathways in the nervous system.

In patients, this might mean that the pain they feel after an operation is significantly increased.

Switching drugs
Dr Gerard Ahern, who led the study, said: "It was not really recognised that use of these drugs results in the release of lots of chemicals that recruit immune cells to the nerves, which causes more pain of inflammation.
"The choice of anaesthetic appears to be an important determinant of post-operative pain."

He said that while this effect could be reduced by using other types of anaesthetic, these might not perform as well in other ways.

Professor Ian Power, from the University of Edinburgh, said that post-operative pain remained a serious problem, despite advances in anaesthesia over the decades.
"We are very aware that acute post-operative pain can persist and become chronic and long-lasting, and we have been looking for reasons for that - perhaps this research may provide those.
"If this research were to be validated and proved correct, it would be fairly easy for anaesthetists to move from one type to another."

Professor Richard Langford, a consultant in anaesthesia and pain management at Bart's and The London NHS Trust, said that while the findings were interesting, there was no guarantee a similar effect would be detected in humans undergoing surgery.
"There are a myriad of different factors that combine to produce the experience of pain, including the degree and size of the surgery, and the mood or level of anxiety in the patient."

Pregnant Women, Children Cautioned on Dental Mercury (Update1)
By Avram Goldstein

June 5 (Bloomberg) -- The mercury in dental fillings may have toxic effects on fetuses and young children, U.S. regulators said for the first time as part of a legal settlement.

After decades of debate about the safety of mercury amalgam dental fillings, the Food and Drug Administration added the statement on ``safety concerns'' to its Web site this week, said agency spokeswoman Peper Long in a telephone interview today. The FDA agreed to post the warning about the dangers for developing human brains to settle a lawsuit by a collection of environmental groups, consumers and state officials.

In the settlement, the FDA agreed to bring to a conclusion by July 2009 a regulatory review of mercury in fillings that began in 2002. The process could result in a requirement that prescribing information warn dentists and pregnant women of nervous system dangers to fetuses and young children with developing brains, Long said.

``Gone are all of FDA's claims that no science exists that amalgam is unsafe,'' said Michael Bender of Vermont, a plaintiff in the lawsuit, in a statement today on PR Newswire. ``The FDA has moved to a more neutral course, while still recognizing the serious health risks posed by amalgam in particular for children and unborn children, for pregnant women, and for those with mercury immuno-sensitivity.''

Mercury is a neurotoxin that can interfere with brain growth and has been shown to affect cognitive and motor-skill development, according to the Environmental Protection Agency.

Dental Association

The American Dental Association, the largest group of U.S. dentists, said the settlement amounts to little because it doesn't change the current use of mercury. Cavities are filled with the amalgam, made of mercury and a powder containing silver, tin, copper, zinc and other metals. Dentists have used it for more than 100 years.

``Dental amalgam remains a safe, affordable and durable cavity-filling choice for dental patients,'' the dental group said in a statement today on PR Newswire. That belief, the group said, is based on ``extensive studies and scientific reviews of dental amalgam by government and independent organizations worldwide.''

An FDA panel of independent advisers voted 13 to 7 in 2006 to reject the agency's conclusion that the available literature supports continued use of mercury in fillings. The agency had said it reviewed 34 studies and found no evidence the metal releases harmful mercury vapors in the mouth from chewing or during dental procedures.

Data Sought

Many members of the panel, which included doctors and dentists, said the risks associated with mercury fillings can't be quantified without better data on short-term exposure and certain patient groups. About 30 percent of the more than 150 million fillings placed in the U.S. each year are made of amalgam.

Patient advocates urged the panel to recommend that the FDA ban amalgam in favor of tooth-colored composite resins, which they said are safer and just as effective.

Dentists argued that fillings containing mercury are stronger, cheaper and more durable, and said the amount of mercury exposure from fillings is minuscule when compared with fish and other dietary sources.

The lawsuit was filed in December in U.S. District Court in Washington and then assigned by a federal trial judge to a magistrate who served as a mediator, Long said. FDA officials added the cautionary language to the agency Web site on June 3 with ``uncharacteristic speed,'' Bender said.

The case is: Moms Against Mercury v. Eschenbach, 07cv2332, U.S. District Court for the District of Columbia.

Sitting straight 'bad for backs

Sitting up straight is not the best position for office workers, a study has suggested.

Scottish and Canadian researchers used a new form of magnetic resonance imaging (MRI) to show it places an unnecessary strain on your back.

They told the Radiological Society of North America that the best position in which to sit at your desk is leaning slightly back, at about 135 degrees.

Experts said sitting was known to contribute to lower back pain.

Data from the British Chiropractic Association says 32% of the population spends more than 10 hours a day seated.

Half do not leave their desks, even to have lunch.

Two thirds of people also sit down at home when they get home from work.

Spinal angles

The research was carried out at Woodend Hospital in Aberdeen, Scotland.

Twenty two volunteers with healthy backs were scanned using a positional MRI machine, which allows patients the freedom to move - so they can sit or stand - during the test.

Traditional scanners mean patients have to lie flat, which may mask causes of pain that stem from different movements or postures.

In this study, the patients assumed three different sitting positions: a slouching position, in which the body is hunched forward as if they were leaning over a desk or a video game console, an upright 90-degree sitting position; and a "relaxed" position where they leaned back at 135 degrees while their feet remained on the floor.

The researchers then took measurements of spinal angles and spinal disk height and movement across the different positions.

Spinal disk movement occurs when weight-bearing strain is placed on the spine, causing the disk to move out of place.

Disk movement was found to be most pronounced with a 90-degree upright sitting posture.

It was least pronounced with the 135-degree posture, suggesting less strain is placed on the spinal disks and associated muscles and tendons in a more relaxed sitting position.

The "slouch" position revealed a reduction in spinal disk height, signifying a high rate of wear and tear on the lowest two spinal levels.

When they looked at all test results, the researchers said the 135-degree position was the best for backs, and say this is how people should sit.

'Tendency to slide'

Dr Waseem Bashir of the Department of Radiology and Diagnostic Imaging at the University of Alberta Hospital, Canada, who led the study, said: "Sitting in a sound anatomic position is essential, since the strain put on the spine and its associated ligaments over time can lead to pain, deformity and chronic illness."

Rishi Loatey of the British Chiropractic Association said: "One in three people suffer from lower back pain and to sit for long periods of time certainly contributes to this, as our bodies are not designed to be so sedentary."

Levent Caglar from the charity BackCare, added: "In general, opening up the angle between the trunk and the thighs in a seated posture is a good idea and it will improve the shape of the spine, making it more like the natural S-shape in a standing posture.

"As to what is the best angle between thigh and torso when seated, reclining at 135 degrees can make sitting more difficult as there is a tendency to slide off the seat: 120 degrees or less may be better."

Breastfeeding 'helps to boost IQ'

The government advises breastfeeding for first six months
More evidence is being put forward that breastfed babies eventually become more intelligent than those who are fed with formula milk.

Canada's McGill University found breastfed babies ended up performing better in IQ tests by the age of six.
But the researchers were unsure whether it was related to the breast milk itself or the bond from breastfeeding.
The study of nearly 14,000 children is the latest in a series of reports to have found such a positive link.

However, one problem has been that some of the research has struggled to identify whether the findings were related to the fact that mothers from more affluent backgrounds were more likely to breastfeed and it was factors related to the family circumstances that was really influencing intelligence.

But the latest study attempted to take this into account by following the progress of children born in hospitals in Belarus, some of which ran breastfeeding promotion schemes to boost rates across all groups.
They found that those who breastfed exclusively for the first three months - with many also continuing to 12 months - scored an average of 5.9 points higher on IQ tests in childhood.

Teachers also rated these children significantly higher academically than control children in both reading and writing, the Archives of General Psychiatry reported.

Lead researcher Professor Michael Kramer said: "Long-term, exclusive breastfeeding appears to improve children's cognitive development."

But he added: "Even though the treatment difference appears causal, it remains unclear whether the observed cognitive benefits of breastfeeding are due to some constituents of breast milk or are related to the physical and social interactions inherent in breastfeeding."

Changes
Fatty acids found in breast milk are thought to boost intelligence, but the report said the physical and emotional aspect of breastfeeding may lead to permanent changes to brain development.
The researchers also suggested breastfeeding may increase verbal interaction between mother and child, which in turn could aid their development.

Nonetheless Professor Kramer said more efforts should be made to promote breastfeeding.
In England, the government recommends mothers breastfeed exclusively for the first six months.
But research shows while three quarters start off breastfeeding, just one in four are still doing it by six months.

Rosie Dodds, of the National Childbirth Trust, said: "This research certainly increases the evidence about the impact of breastfeeding. "And I think what we now need is more effort put into supporting it."

Breastfeeding benefits 'instant'

Breastfeeding has many health benefits for mother and child
The benefits of breastfeeding for mother and baby start from day one, say campaigners.
Yet more than half of 500 women did not realise this, the National Childbirth Trust found.

The findings come as the NCT boosts efforts to encourage more breastfeeding.

A government poll of 427 men found 79% would want their baby to be breastfed, contrary to popular belief that they might not.

Breast or bottle?

The UK has one of the lowest breastfeeding rates in Europe - almost a third of women in England and Wales never try to breastfeed, compared with just 2% in Sweden.

In 2003, the government set a target to increase the number of women starting to breastfeed by 2% a year.

But experts acknowledge that breastfeeding is not suitable or the best option for all women and that individual choice is important.

The NCT surveyed women about their breastfeeding knowledge.

Nine out of 10 did not know that breastfeeding for just one month has a lasting impact on health during the first 14 years of a baby's life.

Although formula milk does not negate all the protection offered by breastfeeding, only a third knew that feeding babies under six months on both breast and bottle milk still provides them with a certain amount of protection from infections.

Health benefits

Almost half of respondents did not know that breastfeeding also reduces the risk of osteoporosis and cancer of the ovary for the mother.

Belinda Phipps of the NCT said: "Because the benefits start right from the first feed, any amount of breastfeeding is a reason to feel proud.

"This is especially important for the nine out of 10 women who stop breastfeeding before they want to, generally because of a lack of good information or support from those around them.

"It's encouraging that the majority of men are supportive of breastfeeding.

"However, with over a fifth of men not showing support, there is still more to be done."

Christine Carson, the Department of Health's National Infant Feeding Advisor, said: "We encourage every new mum to try breastfeeding.

"Sometimes it may not be easy, but with the right advice, support and encouragement, particularly from those closest to them, we hope to see a marked increased in the amount of mothers and their babies experiencing the many benefits that breastfeeding brings."

Type of body fat 'boosts health'

Body fat found under the skin - and particularly on the buttocks - may help reduce the risk of developing type 2 diabetes, research suggests

The study contrasts this subcutaneous fat with visceral fat, which is wrapped around the organs, and raises the risk of ill health.

It is thought subcutaneous fat may produce hormones known as adipokines which boost the metabolism.
The Harvard Medical School study appears in the journal Cell Metabolism.

The researchers, who worked on mice, transplanted fat from one part of the animals' body to the other.
When subcutaneous fat was moved to the abdominal area, there was a decrease in body weight, fat mass, and blood sugar levels.

The animals also became more responsive to the hormone insulin, which controls the way the body uses sugar. A lack of response to insulin is often the first stage on the path to type 2 diabetes.
In contrast, moving abdominal visceral fat to other parts of the body had no effect.
Lead researcher Professor Ronald Khan said: "The surprising thing was that it wasn't where the fat was located, it was the kind of fat that was the most important variable.

"Even more surprising, it wasn't that abdominal fat was exerting negative effects, but that subcutaneous fat was producing a good effect."

Previous research has suggested that obese people with high levels of both abdominal and subcutaneous fat are more insulin-sensitive than those with only high levels of abdominal fat.

Professor Khan said it was possible that subcutaneous fat offset the effects of visceral fat.

Dr David Haslam, of the National Obesity Forum, said the finding cast new doubt on the merits of Body Mass Index (BMI) as a way to assess whether somebody was unhealthily overweight, as it did not differentiate between different types of fat.
He said it was still important that people tried to control their weight, as healthy lifestyle choices like a balanced diet and taking exercise would overwhelmingly impact on visceral, and not subcutaneous fat levels.

Women have a tendancy to lay down more subcutaneous fat, particularly on their legs and buttocks than men.
Dr Ian Campbell, medical director of the charity Weight Concern, said: "If there is something about subcutaneous fat which is protective, and actually decreases insulin resistance, this could help open up a whole new debate on the precise role fat has on our metabolism."

Playgroups 'cut leukaemia risk'

Childhood leukaemia is linked to infection

Children who attend daycare or playgroups cut their risk of the most common type of childhood leukaemia by around 30%, a study estimates.

Researchers reviewed 14 studies involving nearly 20,000 children, of which 6,000 developed acute lymphoblastic leukaemia (ALL).

It is thought early infections may help the body fight off the disease.
The University of California, Berkeley study will be presented to a leukaemia conference in London.

Leukaemia is the most common cancer found in children in the industrialised world, affecting about one in 2,000 youngsters.

ALL accounts for more than 80% of leukaemia cases among children, and most often occurs in those aged between two and five. Scientists believe that for most types of childhood leukaemia to develop, there must first be a genetic mutation in the womb, followed by a second trigger - such as an infection - during childhood.

However, it is also thought that contracting some childhood infections - which are often readily spread in environments such as playgroups where children are in close contact with each other - may prime the immune system against leukemia.

Conversely, if the immune system is not challenged in early life, this is thought to raise the risk of an inappropriate response to subsequent infections, making the development of leukaemia more likely.

Fosamax drug 'risks heart'

Women who take the drug Fosamax for osteoporosis may be at an increased risk of developing an irregular heartbeat, a US study suggests.

Researchers have linked the drug - widely prescribed in the UK to stop bone-thinning in older women - to a condition known as atrial fibrillation.

This is not necessarily serious, but can in some cases lead to a stroke.

But the Archives of Internal Medicine study concluded for most women the drug's benefits outweighed the risks.
It is not the first research to examine a link between Merck's Fosamax - whose generic name is alendronate - and atrial fibrillation, but its suggestion that the drug may increase the risk by 86% is higher than previous findings - although it is a smaller study.

In the UK, about one in 200 people aged 50-60 have atrial fibrillation, and the risk increases to about one in ten people by the age of 90.

In many cases it has no symptoms, but it can make the blood clot - which can in turn cause an embolic stroke.

Blind Man Suddenly Sees Again

by Katie Wiedemann, Reporter

DUBUQUE - Doctors aren't quite sure how it happened, but a Dubuque man can see clearly after being blind in one eye for more than a decade.

It happened after a trip to the chiropractor.

Twelve years ago Doug Harkey's left eye suddenly stopped working. "I woke up one day and I didn't have vision in one eye."

And as quickly as he lost sight, he got it back.

Harkey said, "he just did his normal adjustment and, voila!

After a routine visit to Chiropractor Tim Stackis, Harkey says a miracle happened.

"My blind eye starting watering after I left there and it watered for 45 minutes straight. It started making my good eye water. I went to wipe my right eye and I could see out my left again."

Doctor Stackis said the bones in the Harkey's neck were out of alignment.

Stackis said, "That interferes with the messages and energy the brain sends down to the rest of the body."

Harkey now has the depth perception he'd been missing, just what he needs as he's about to walk down the aisle with his fiancée next month.

Harkey’s Fiancée, Gina Connolly said, "I'm not use to him not running into things or stepping on our feet."

Doctor Stackis and Harkey were both surprised by what happened.
Harkey said, "He has miracle hands, I guess."

Was it a miracle? Harkey’s not sure how to explain it, he’s just glad it happened.

Harkey says his eye doctor says with the help of corrective lenses he will be able to almost perfectly out of both eyes.

It's Chiropractic - It's SAFE!!

Usage of paracetamol and development of allergy and asthma

A number of studies have suggested that intake of paracetamol during pregnancy and during the first months of life is associated with an increased risk of childhood asthma.

We aimed to determine the association between paracetamol usage during pregnancy and the first 6 months of life, and childhood allergy (i.e. positive skin prick tests), allergic asthma, and asthma, using a matched patient-sibling study comparing patients with allergic asthma with their healthy siblings without any symptoms of allergic diseases.

Usage of paracetamol during pregnancy was associated with allergic asthma.

Usage of paracetamol between birth and 6 months of age, and between 4 and 6 months of age, was also found to be associated with non-allergic asthma.

Usage of paracetamol during pregnancy and during the early months of life may play a role in the development of allergic and non-allergic asthma in children.

Omega 3 - How Our Food Manufacturers Distort Omega 3 Labeling

Food Manufacturers’ Misleading Labeling

It is incredibly disturbing our food manufacturers disregard the harm caused to American health and what is more disturbing, they seek permission to and it is given. The medical discovery is specific - our need for Omega 3 fish oil, not more Omega 3 ALA. And the trusting, unsuspecting American who hasn't the time to delve into the research rushes to purchase Omega 3 products believing they are helping their health. From Omega 3 eggs, Omega 3 bread, and now Omega 3 meats, the addition of Omega 3 in their product is more plant derived ALA, the undisputed culprit. Little did they know they just added harmful Omega 3 ALA.

Center for Science In The Public Interest (CSPI)

Research shows that omega-3s found only in fish and some plants are "good" fatty acids, and help prevent heart disease. But the Center for Science in the Public Interest (CSPI) says consumers are being hoodwinked when it comes to omega-3 eggs. These egg producers, egged on by their trade association, is brazenly putting omega-3 claims in big print on the front of the labels, knowing that that is a buzzword that will attract people” says Michael Jacobson of the CSPI.

On Thursday the organization called on the FDA to enforce its own regulations and stop the egg industry from using what it calls misleading labels and advertising. "It's like using filtered cigarettes to prevent cancer. It ain't gonna happen. These eggs are loaded with cholesterol, which promotes heart disease," Jacobson claims.

It's not just economic fraud, which it is, but it is a serious health problem," Jacobson argues”. (cbsnewshealthwatch)

The egg industry isn’t the only culprit of economic fraud. It is rampant throughout the food manufacturing industry and we’re being hood-winked. And the FDA and the USDA, the watch dogs for American health, tightly bound to the food manufacturers allows this to continue. Michael Jacobson calls it economic fraud – my feelings run more to injustice, unethical, and the single most damaging mislabeling of foods ever in American history. And now it’s meats, too.

To see the complete article: http://www.americanchronicle.com/articles/37763

Daily caffeine 'protects brain'

The easy way to neutralise cholesterol?

Coffee may cut the risk of dementia by blocking the damage cholesterol can inflict on the body, research suggests.
The drink has already been linked to a lower risk of Alzheimer's Disease, and a study by a US team for the Journal of Neuroinflammation may explain why.

A vital barrier between the brain and the main blood supply of rabbits fed a fat-rich diet was protected in those given a caffeine supplement.

UK experts said it was the "best evidence yet" of coffee's benefits.

"Caffeine is a safe and readily available drug and its ability to stabilise the blood brain barrier means it could have an important part to play in therapies against neurological disorders"
Dr Jonathan Geiger, University of North Dakota

The "blood brain barrier" is a filter which protects the central nervous system from potentially harmful chemicals carried around in the rest of the bloodstream.

Other studies have shown that high levels of cholesterol in the blood can make this barrier "leaky".

Alzheimer's researchers suggest this makes the brain vulnerable to damage which can trigger or contribute to the condition.
The University of North Dakota study used the equivalent to just one daily cup of coffee in their experiments on rabbits.
After 12 weeks of a high-cholesterol diet, the blood brain barrier in those given caffeine was far more intact than in those given no caffeine.

'Safe drug'
"Caffeine appears to block several of the disruptive effects of cholesterol that make the blood-brain barrier leaky," said Dr Jonathan Geiger, who led the study.

"High levels of cholesterol are a risk factor for Alzheimer's disease, perhaps by compromising the protective nature of the blood brain barrier.

"Caffeine is a safe and readily available drug and its ability to stabilise the blood brain barrier means it could have an important part to play in therapies against neurological disorders."

A spokesman for the Alzheimer's Disease Society said that the study shed "important light" on why previous research had showed benefits for drinking coffee.

"This is the best evidence yet that caffeine equivalent to one cup of coffee a day can help protect the brain against cholesterol.
"In addition to its effect on the vascular system, elevated cholesterol levels also cause problems with the blood brain barrier.

"This barrier, which protects the brain from toxins and infections, is less efficient prior to brain damage caused by Alzheimer's disease or strokes."

She called for more research into whether the same effect could be seen in humans.

Medication 'worsens Alzheimer's

Medication 'worsens Alzheimer's'

Anti-psychotic drugs commonly given to Alzheimer's patients often make their condition worse, a UK study suggests.
Neuroleptics provided no benefit for patients with mild behavioural problems, but were associated with a marked deterioration in verbal skills.

The research focused on 165 people with advanced Alzheimer's who were living in nursing homes in four British cities.
Up to 60% of Alzheimer's patients in nursing homes are given the drugs to control behaviour such as aggression.
The study appears in the journal Public Libary of Science Medicine.

CASE STUDY
Rita Clark's husband was diagnosed with Alzheimer's seven years ago.
Rita, from Cleveland, said: "My husband developed a range of side effects while receiving anti-psychotic drugs.
"Since the drugs have been withdrawn, the side effects have gone and he generally seems much better and more settled.
"I'm not saying it's the same for everyone, but in my husband's case, withdrawing the drugs has led to a clear improvement in his quality of life."

The researchers, from Kings College London and the Universities of Oxford and Newcastle, found the drugs offered no long-term benefit for most patients with mild symptoms of disturbed behaviour.
But just six months of treatment was enough for patients to show a marked deterioration in their verbal fluency.
Further preliminary analysis already under way on the data suggests the use of neuroleptics may also increase death rates.
The research focused on patients living in nursing homes in Oxfordshire, Newcastle, Edinburgh and London.
All patients had been taking neuroleptics for three months. They either continued on the same medication for a further 12 months, or took a dummy pill.

Lead researcher Professor Clive Ballard, said: "It is very clear that even over a six-month period of treatment, there is no benefit from neuroleptics in treating the behaviour in people with Alzheimer's disease when the symptoms are mild.
"For people with more severe behavioural symptoms, balancing the potential benefits against adverse effects is more difficult."
Rebecca Wood, of the Alzheimer's Research Trust, said: "These results are deeply troubling and highlight the urgent need to develop better treatments."

The trust says that neuroleptics should only continue to be prescribed long-term to dementia patients with severe behavioural problems, and then only as a last resort when non-drug methods have been tried and have failed.
Stroke risk

Neil Hunt, of the Alzheimer's Society, said previous research had also shown that anti-psychotic drugs raised the risk of stroke and death for people with dementia.

"This widespread overprescription to people with dementia must stop," he said.

"It is time we stop wasting money giving people drug treatments with no benefit and start investing in good quality dementia care."

It is estimated that 700,000 people are affected by dementia in the UK, a figure that will double in the next 30 years.
A report into the use of anti-psychotics in care homes is due to be published by the All-Party Parliamentary Group on Dementia this month.

The neuroleptics which came under analysis in the study were thioridazine (Melleril), chlorpromazine (Largactil), haloperidol (Serenace), trifluoperazine (Stelazine) and risperidone (Risperdal).

Inexpensive Drug Found Best for Renoprotection from Contrast Agent

By John Gever, Staff Writer, MedPage Today
Published: February 26, 2008

ANN ARBOR, Mich., Feb. 26 -- For patients at a high risk of contrast-induced
kidney failure, an inexpensive and widely available pill is the most
renoprotective agent of all, including hydration, found a meta-analysis
here.

A 25-cent N-acetylcysteine pill appeared to provide the most consistent
protection against nephropathy caused by iodine-based imaging contrast
agents, beating out hydration, theophylline, fenoldopam, iloprost, statins,
dopamine, trimetazidine, bicarbonate, ascorbic acid, furosemide, and
mannitol.

So showed the analysis of 41 randomized trials, reported by Aine M.
Kelly, M.D., and colleagues at the University of Michigan in the Feb. 19
issue of Annals of Internal Medicine. This analysis found that
N-acetylcysteine with IV saline hydration showed the most consistent benefit
in preventing contrast-induced nephropathy, as measured by serum creatinine levels when compared with saline hydration alone.

"This drug, which is quick, convenient, inexpensive, and widely available,
with no major side effects, appears to be the best choice to protect those
whose kidneys are most at risk," said Dr. Kelly. N-acetylcysteine is carried
in most pharmacies and costs about 25 cents for a 500-mg tablet, the
researchers said.

The trials involved a total of 6,379 patients and they all compared various
protective drugs with periprocedural hydration. Most patients in the studies
had chronic renal impairment.

Up to 10% of patients with normal renal function suffer kidney injury after
receiving iodine-containing contrast agents, with even higher rates in
patients with pre-existing kidney dysfunction or other risk factors, Dr.
Kelly and colleagues said. These agents are the third most common cause of
acute renal failure.

Those statistics were derived mainly from an earlier generation of
high-osmolar contrast agents. Saline hydration and the introduction of
iso-osmolar or low-osmolar contrast agents such as iodixanol have reduced
the rate of contrast-induced nephropathy, but not totally abolished it, Dr.
Kelly and colleagues said.

"Thus, protective agents must still be considered for patients with severe
renal impairment who are to receive large volumes of contrast agents," they
wrote.

Most of the studies were in the context of coronary angiography or CT scans
where the contrast agent was delivered intra-arterially.

The meta-analysis identified N-acetylcysteine as showing the best results
across 26 studies. The aggregated relative risk of nephropathy with this
agent was 0.62 (95% CI 0.44 to 0.48).

On the flip side, furosemide turned out to significantly increase risk of
nephropathy (RR 3.27, 95% CI 1.48 to 7.26) on the basis of two studies.

Fenoldopam, mannitol, and a combination including furosemide, dopamine, and mannitol all showed no sign of benefit, with nonsignificant increases in
risk of nephropathy.

What Is the Total Cost of Low Back Pain?

Abillion here, a billion there, and pretty soon you're talking about real money," quipped U.S. Senator Everett Dirksen.

Nowhere is this observation more relevant that in the study of low back pain-and its costs. Everyone acknowledges that low back pain is enormously expensive but there is substantial disagreement about its total costs-and discord about how to estimate them accurately.

Simon Dagenais, DC, PhD, and colleagues recently performed a systematic review of low back pain cost-of-illness studies published from 1997 to 2007. They found 21 relevant investigations. (See Dagenais et al., 2008.) These employed a variety of different methods and arrived at substantially different conclusions. "Estimates of the economic costs in different countries vary greatly depending on study methodology but by any standards they must be considered a substantial burden on society," these researchers observed.

Dagenais and colleagues could not find any studies that accurately estimated the total costs of low back pain in the United States. And they noted that it won't be possible to come up with cost-effective solutions in the management of low back pain without these data. "Cost of illness studies summarizing the economic burden of a particular disease must be considered by all stakeholders, including patients, clinicians, and third-party payers, when deciding on the allocation of scarce healthcare resources," they pointed out.

Those seeking to develop miracle cures for low back pain need to look well beyond the clinic in gauging the impact of new treatments and management strategies. "From studies conducted outside the United States, it appears that direct medical costs represent only a small proportion of the total costs of low back pain..." according to Dagenais et al. Indirect costs from work absence, long-term disability claims, and lost productivity account for the lion's share of back pain's economic burden. And the prevention of long-term disability is likely to be the most important goal in reducing the economic burden of low back pain.

Reference: Dagenais S et al., A systematic review of low back pain costs of illness studies in the United States and internationally, The Spine Journal, 2008; 8:8-20.

Georgia Girl Helps Link Autism to Childhood Vaccines

By ALISON YOUNG
The Atlanta Journal-Constitution
Published on: 03/06/08

In a move autism family advocates call unprecedented,
federal health officials have concluded that childhood
vaccines contributed to symptoms of the disorder in a
9-year-old Georgia girl.

While government officials continue to maintain that
vaccines don't cause autism, advocates say the recent
settlement of the girl's injury case in a secretive
federal vaccine court shows otherwise.

The U.S. Department of Health and Human Services has
concluded the family of Hannah Poling of Athens is
entitled to compensation from a federal vaccine injury
fund, according to the text of a court document in the
case. The amount of the family's award is still being
determined.

The language in the document does not establish a
clear-cut vaccine-autism link. But it does say the
government concluded that vaccines aggravated a rare
underlying metabolic condition that resulted in a
brain disorder "with features of autism spectrum
disorder."

In an interview Wednesday with The Atlanta
Journal-Constitution, Hannah's parents, Jon and Terry
Poling, said the government's concession in the case
will help pay for the numerous therapists and other
medical experts their autistic child needs — now and
for the rest of her life.

"At least we have some commitment from the government
to take care of Hannah when we're gone," said Dr. Jon
Poling, a neurologist.

But the case also thrusts the family into a national
spotlight in the controversial public debate over
whether vaccines have played some role in the growing
number of U.S. children diagnosed with autism. Of
particular concern to some families is the
mercury-based preservative thimerosal, not used in
child vaccines (except for some flu shots) since 2001.

Hannah's case was one of three vaccine-court test
cases alleging that thimerosal caused the children's
autism. The other cases go to trial in May.

Suspicion of vaccines is fueled in part by vocal
advocates — including radio shock jock Don Imus and
actress Jenny McCarthy — speaking out on radio and TV
shows such as "Oprah" and "Larry King Live."

Even Republican presidential candidate Sen. John
McCain said on the campaign trail that "there's strong
evidence" that a preservative in vaccines is fueling
the dramatic rise in autism cases across the country.

As many as 1 in 150 children in some communities have
autism disorders, says the Centers for Disease Control
and Prevention.

"We need to recognize this is a national crisis," Jon
Poling said.

Autism is a lifelong neurological disorder that causes
problems with communication and the ability to have
normal social interactions. Autism and related autism
spectrum disorders cover a range of symptoms that can
vary from mild to severe. The cause is unknown, but
scientists believe genes may play a role.

Pediatricians and public health officials worry that
this case may cause fear among some parents and prompt
them to refuse to vaccinate their children, and put
them in real danger from measles, whooping cough and
other diseases.

The risks of diseases are real risks," said Dr.
Melinda Wharton, deputy director of CDC's National
Center for Immunization and Respiratory Diseases.
Numerous large studies don't support a relationship
between vaccines and autism, according to the CDC and
the Institutes of Medicine.

The Georgia girl's case – and its implications in the
vaccine-autism debate – raise more questions than it
answers, experts say.

Some medical experts say it's difficult to fully
assess the case because the federal vaccine-court
documents are sealed from public view.

"It raised a lot of questions for us," said Dr. David
Tayloe Jr., president-elect of the American Academy of
Pediatrics. The national medical group's leadership
has been seeking more information about Hannah's
vaccine-court case since last week when a sealed
vaccine-court document detailing the government's
settlement was posted on the Internet by an autism
book author, then circulated widely among autism
groups.

The pediatrics association has been trying to get
access to official documents in the case so medical
experts can delve into the science, assess whether
there are implications for other children and answer
questions from doctors and families.

"Our responsibility is to make sure the public is
given good information and make sure the hype doesn't
distract from public health," Tayloe said. "I still
would not think that we're going to have evidence
showing a role of vaccines actually causing autism."

According to the leaked document posted online, the
government's Division of Vaccine Injury Compensation
concluded that five shots Hannah received in July
2000, when she was 19 months old, "significantly
aggravated an underlying mitochondrial disorder" and
resulted in a brain disorder "with features of autism
spectrum disorder."

Sallie Bernard, executive director of the national
autism advocacy group SafeMinds, called the case
"unprecedented" in that a link between vaccines and
autism is being made public. Federal health officials
"have insisted there is no link at all between
vaccines and vaccine components and autism. And
apparently that is not true," she said.

The case also is significant because other autistic
children have mitochondrial disorders, Bernard said.
"The question is: What is the proportion?"

Robert Krakow, a New York attorney representing other
autistic children in vaccine court, said the
significance of the case is "potentially explosive."
He said he has several clients with similar histories.

Hannah requires one-on-one care at all times, said her
mother, Terry Poling, a nurse and lawyer. The Polings
described how Hannah was a normal, verbal toddler
until she received several vaccines during a well-baby
visit. Within 48 hours of the shots, she developed a
high fever and inconsolable crying and refused to
walk. She stopped sleeping through the night. Within
three months after receiving the vaccine, she began
showing signs of autism, including spinning and
staring at lights and fans. For a while, she lost her
ability to speak.

Then, within six months after the shots, as the family
came to grips with the likelihood that she was
autistic, they turned to leading experts in neurology.
"I had to know. My daughter didn't just suddenly
develop autism for no reason," Terry Poling said.

Hannah's father co-authored an article about her case,
which was published in the Journal of Child Neurology
in 2006.

Hannah, who has two older brothers, continues to have
mild to moderate symptoms of autism. The family says
early and ongoing intensive therapy has been critical
for her.

"The biggest question right now for the public is: How
unique is Hannah's case?" said Jon Poling. Poling said
he suspects there are other children like Hannah.

Cliff Shoemaker, the Polings' attorney, said the
family has filed a petition with the vaccine court to
unseal all of Hannah's records and allow both the
family and the government to fully discuss the case.

Despite this, a spokesman for the U.S. Department of
Justice, which reprersents the government in court
cases, would not grant interviews or explain to the
AJC why it isn't releasing the records. HHS officials,
who administer the vaccine compensation fund, also
declined to be interviewed, citing the court's
confidentiality requirements.

Shoemaker said the government's November concession in
the case is public, but the government's reasons
aren't. "I'm not aware of any other conceded autism
cases," he said.

Congress created the National Vaccine Injury
Compensation Program in 1988 after widespread lawsuits
against manufacturers and health-care providers
stemming from reports of side-effects of a version of
the diphtheria-tetanus-pertussis vaccine used in the
1980s.

With companies getting out of the vaccine business for
liability reasons, Congress established the program
and a trust fund to serve as a no-fault alternative
for resolving certain vaccine injury claims.

The average injury compensation to an individual in
vaccine court has been about $1 million. In fiscal
year 2007, more than $91 million was awarded to people
harmed by vaccines.

A Rip-Off by Health Insurers?

IF THIS KIND OF CHEATING IS HAPPENING IN THE USA, CAN HERE BE ANY BETTER?

Have health insurers been systematically cheating patients and doctors of fair reimbursement for medical services? That is the disturbing possibility raised by an investigation of the industry's arcane procedures for calculating "reasonable and customary" rates.

The investigation, by the New York State attorney general, Andrew Cuomo, and his staff, suggests that these procedures - used by major insurance companies to determine what they will pay when patients visit a doctor who is not in the company's network - may be rigged to shortchange the beneficiaries.

When patients visit an out-of-network doctor, insurers typically agree to pay 80 percent of the reasonable and customary rate charged by doctors in the same geographic area. The patient is stuck with the rest, and as any patient knows, that rate always seems to fall short of what their own doctor is charging. If the attorney general's investigators are right, we can understand why.

The numbers are mainly compiled by an obscure company known as Ingenix, which - as it turns out - is owned by UnitedHealth Group, one of the nation's largest health insurers. Ingenix collects billing information from UnitedHealth and other health care payers to compile a database that is then used by the insurers to determine out-of-network reimbursement rates.

This system is an invitation for abuse. UnitedHealth owns the company whose database will affect its costs and profitability, so both have a strong financial interest in keeping reimbursement rates low. Even Ingenix seems unwilling to stand behind its numbers. In licensing its database to insurers, it stresses that the data is "for informational purposes only" and does not imply anything about "reasonable and customary" charges. Yet that is precisely what the health insurers use the data for, as Ingenix knows, according to investigators.

Mr. Cuomo and the American Medical Association, which has a long-standing suit filed against Ingenix and various UnitedHealth companies, claim that the data is manipulated. They claim that health insurers and Ingenix disproportionately eliminate high charges, thus skewing the numbers for customary charges downward.

Mr. Cuomo also says that Ingenix pools the charges for services performed by low-paid nurses and physician assistants with those performed by high-paid doctors. And he says the company fails to account for the patient's condition and type of facility where the service was provided - factors that can drive up costs. He also contends that Ingenix uses outdated information, which would guarantee that reimbursement rates will always lag behind medical inflation.

The A.M.A.'s more detailed legal complaint also charges that the database dilutes prices in high-cost locations by combining them with low-cost areas, and includes prices that reflect in-network discounts.

The attorney general's investigators did their own survey and concluded that $200 is the fair market rate in New York City and Nassau County for a 15-minute consultation with a doctor for an illness of low to moderate severity. Ingenix, the investigators said, calculated the rate as $77, of which United would pay $62, leaving the patient to pay $138. UnitedHealth disputes those numbers, so the attorney general will need to offer a fuller explanation of how they were derived.

Mr. Cuomo has announced his intention to sue UnitedHealth, Ingenix and three other subsidiaries, and has subpoenaed data from 16 other health insurers. Whatever that investigation unearths, it is already clear that the system for calculating "reasonable and customary" charges ought to be reformed by making it truly independent and objective. No consumer can reasonably trust numbers generated by a company whose loyalties and financial interests lie with the health insurers.

Jessica Vega After Gardasil

" The FDA adverse event reports on the HPV vaccine read like a catalog of horrors," stated Judicial Watch President Tom Fitton. "Any state or local government now beset by Merck's lobbying campaigns to mandate this HPV vaccine for young girls ought to take a look at these adverse health reports. It looks as if an unproven vaccine with dangerous side effects is being pushed as a miracle drug." Judicial Watch filed its request on May 9, 2007, and received the adverse event reports from the FDA on May 15, 2007. Judicial Watch has posted the adverse event reports on their Internet site at: http://www.JudicialWatch.org." - Judicial Watch, May 23 statement"


Student Natasha D'Souza said she collapsed and was left paralysed for six hours after being injected. "I couldn't move at all. There were girls dropping like flies, basically," she said. Ms D'Souza said she had been vaccinated in the past but her reaction to Gardasil was different. Fellow student Brooke Levy, who was taken to hospital, said she thought she might pass out or vomit after she was vaccinated. But authorities believed their reactions were likely to be related to having an injection not the vaccine itself." - Danialle Cronin, Canberra Times, Australia


"Her legs are paralyzed, her arms are affected. She is very weak in her arms," said Tondra Vees a family friend. "She has to use a walker. Even with that, she can't get to the bathroom. She can't stand up at all." Vees said the girl has been determined by her doctor to have Guillain-Barre syndrome, an acute, autoimmune condition that can lead to paralysis. The girl.....received her first booster shot of the cervical cancer prevention vaccine Gardasil on May 2....Vees cites a report on the National Vaccine Information Center Web site, nvic.org, in which NVIC president Barbara Loe Fisher states, "There are twice as many children collapsing and four times as many children experiencing tingling, numbness and loss of sensation after getting a Gardasil vaccination compared to those getting a TDAP (tetanus-diphtheria- acellular pertussis) vaccination. There have been reports of facial paralysis and Guillain-Barre syndrome..." - Jo Rafferty, May 17 Nevada Appeal


"Assembly Bill 16 would require pupils to receive shots recommended by the federal government's Advisory Committee on Immunization Practices -- a list that happens to include Gardasil -- after approval by the state health officer. Rick Rollens, a longtime Capitol staffer and lobbyist, pleaded with the Assembly Education Committee to hold up AB 16, saying his son "suffers from vaccine-induced regressive autism" and citing increasing evidence that childhood vaccines play a role in autism. He characterized AB 16 as "an outrageous and arrogant attempt" to shift vaccination mandates from the Legislature to a "non-accountable bureaucrat" and a remote federal committee. Nevertheless, the bill sailed through the Assembly's education and health committees...." - Dan Walters, May 17 Sacramento Bee


"In an editorial published in today's New England Journal of Medicine, the UCSF doctors suggest that there are still too many questions about both the efficacy and the long-term safety of the vaccine, called Gardasil, to warrant making it mandatory for all girls -- as has been suggested in several states, including California. "At this stage, vaccination can still be considered experimental," said Dr. Karen McCune, an associate professor of obstetrics and gynecology at UCSF, who co-authored the editorial. "To be discussing mandatory vaccination when the main clinical trials are still ongoing seems extremely premature. We're feeling like the enthusiasm is driving policy rather than data." - Erin Allday, May 10 San Francisco Chronicle

Barbara Loe Fisher Commentary:
In June 2006, NVIC issued its first press release providing evidence that Merck's GARDASIL vaccine had not been thoroughly tested for safety and efficacy in young girls. In February, NVIC released two detailed reports analyzing vaccine reaction reports filed with the federal Vaccine Adverse Events Reporting System (VAERS), which documented that many girls were suffering atypical collapse with seizure activity and subsequent brain dysfunction, including three cases of facial paralysis and five cases of Guillain Barre syndrome (http://www.nvic.org/Diseases/HPV/HPVHOME.htm).

NVIC has led the opposition to HPV vaccine mandates based on product safety concerns that there is inadequate scientific proof the vaccine is safe and effective for 11 year old girls, who are being targeted by the CDC and Merck for mass use.And it just keeps getting worse and worse. Now three deaths have been reported, along with more reports of paralysis in girls who have gotten the poorly tested HPV vaccine. As usual, the vaccine maker and public health officials are in denial mode, using the unscientific "coincidence" argument in an attempt to cover- up HPV vaccine-related death and neuroimmune dysfunction.

And, still, politicians in California, New York and other states press forward to get GARDASIL mandated even as politicians in many other states are wisely backing off from adding it to state vaccine mandates for school entry.

For those who have watched industry and government cover-up harm caused by DPT, DTaP, MMR, HIB, hepatitis B, chicken pox, pneumococcal, influenza, anthrax and other vaccines during the past quarter century, the HPV vaccine risk cover-up is just another deja vu experience. Same story, different vaccine.

When will it end? When will industry and government health officials, along with pediatricians and nurses injecting children with reactive vaccines, like GARDASIL, stop deluding themselves into believing the public is going to blindly trust and buy the "coincidence" argument forever?

For more information about GARDASIL and HPV infection, go to www.nvic.org. If you or a loved one has experienced a reaction to GARDASIL vaccine or any other vaccine, you can post your story (and a photo) on the International Memorial for Vaccine Victims at http://rs6.net/tn.jsp?t=q5ptjacab.0.od5855bab.oblmlwbab.12517&ts=S0251&p=http%3A%2F%2Fvaccinememorial.org%2F.


Jeffrey Dach MD said...
Gardasil Vaccine: So far 3 deaths and 1,637 Adverse Reaction Reports to FDA

Opponents to Gardasil say things like:

"This vaccine should not be mandated for 11-year-old girls.... It's not been tested in little girls for efficacy. At 11, these girls don't get cervical cancer—they won't know for 25 years if they will get cervical cancer. Giving it to 11-year-olds is a great big public health experiment." Dr. Diane Harper, lead researcher, HPV vaccine development

Objections Listed:

1. The vaccine is costly. ($360 for series of three shots)

2. Lack of testing in 9–13 yr olds.

3. Lack of evidence of duration of protection (estimated duration of 5 years).

4. Efficacy has not been demonstrated and is unknown. In fact, there's already been talk of the need for booster shots.

5. Benefit of Gardasil to 9–13 year olds is dubious. Cervical Cancer affects 45-55 year olds, 40 years later.

6. Questionable Safety when used in conjunction with other vaccines (Hep B and Meningitis ).

7. High rate of vaccine injury: the US Vaccine Adverse Event Reporting System is showing considerable serious injury from this vaccine, especially neurological and immune dysfunction. Included are reports of collapse, paralysis, Guillain-Barre syndrome, dizziness, vomiting, rash, syncope, seizures and headache.

8. Gardasil may actually cause an increase in cervical cancer due to a false feeling of security in the females who receive it and decline PAP smears.

9. Gardasil does not guarantee safety from HPV: Regular Pap screening tests with their incumbent costs will still be needed.

10. The incidence of cervical cancer is low, and it would cost $360 million to pay for vaccine to prevent only 1–2 deaths.

11. HPV is usually benign: The virus clears up on its own within 8–12 months.

12. Pap screening already works and has been very effective in reducing cervical cancer rates.