Heavy exercise miscarriage link

UK Government advice is to stay active in pregnancy
Strenuous exercise early in pregnancy could triple the risk of miscarriage, according to Danish researchers.
The research found jogging, ball games and racket sports all increased the risk - as did more than seven hours of exercise a week.

However, current government advice is to continue exercise, where possible, throughout pregnancy.

And one UK expert took issue with the research, highlighted in New Scientist magazine, arguing running was safe.


While I would say that getting a hockey ball in the stomach is not a good idea, I can't think of any reason why jogging would be harmful
Alison Merry, Blooming Fit

The study was carried out at the University of Southern Denmark, who quizzed more than 90,000 women on their exercise regime, then linked the answers to the outcome of their pregnancies.

Compared with those who did no exercise at all, women who played "high-impact" sports or who exercised for more than seven hours a week were approximately three-and-a-half times more likely to miscarry.

Miscarriage is far rarer later in pregnancy, and after the 18-week mark, the link between exercise and miscarriage disappeared.

The study was originally published in the British Journal of Obstetrics and Gynaecology, and the authors wrote: "The results of this study suggest that leisure time exercise during pregnancy, and particularly high-impact exercise, is associated with an increased risk of miscarriage in the early stage of pregnancy."

They did concede, however, that the format of the research - asking women to recall what exercise they did during pregnancy - was imperfect.

It also did not allow for the fact that women who later miscarry are far less likely to experience morning sickness, which might be a reason they were able to exercise early in pregnancy.

Keep going

Some forms of exercise did not appear to increase the risk - including swimming, one of the most popular among pregnant women.

The government's official advice is for women to keep up their normal daily physical exercise routine for as long as they feel comfortable.

It suggests that women who were inactive before pregnancy shouldn't embark on a new strenuous fitness regime, but should aim for a little moderate exercise every day.

Alison Merry, a former midwife, runs a firm, Blooming Fit, which designs exercise programmes for pregnant women.

She said that while she would not normally recommend any sport which involved the risk of an impact to the abdomen of a pregnant woman, she was comfortable with the idea of pregnant women continuing to jog or run during early pregnancy.

She said: "The benefits of exercising during pregnancy are clear - it improves the cardiovascular system, and maintains muscle tone.

"While I would say that getting a hockey ball in the stomach is not a good idea, I can't think of any reason why jogging would be harmful."

'Proof still needed' for flu jab

The flu jab is usually available from about October each year
There is not enough evidence to support the effectiveness of immunising older people against flu, fresh research in the US has concluded.
Researchers from George Washington University, Washington DC, say the benefits in reducing deaths among over 70s have been "greatly exaggerated".

The findings echo a controversial 2006 British Medical Journal study.

But the latest study, in The Lancet Infectious Diseases, nonetheless urges vaccination to continue for the moment.

Most rich countries recommend vaccinating the old and the weak against flu annually in time for the winter.

As well as preventing flu, it is also thought to prevent deaths from other underlying chronic conditions.

In many studies, flu-related deaths are considered to be all those above the expected winter baseline. This is known as winter excess mortality.

Researchers from George Washington University, led by Dr Lone Simonson, say that in the US - despite an increase in vaccination coverage from 15% to 65% since 1980 - excess mortality among elderly people actually increased during the 1980s and 1990s.


The effectiveness of this strategy is under debate
Dr Lone Simonson

They also cited an Italian study, which found no decline in flu-related mortality rates, even as vaccine coverage rose from 5% to 65%.

The study also deplored what it saw as a lack of placebo-controlled randomised clinical trials (RCTs) among those over the age of 70.

They accepted that such trials were, however, unlikely as they would involve denying some participants access to a treatment which it is recommended they receive, and as such would not pass ethical review.

As an alternative, the team recommended that future studies should use "more specific endpoints" than just overall winter deaths.

This should include "vaccine effectiveness against the highly-specific outcome of laboratory-confirmed influenza virus, which although labour intensive and expensive, is more likely to obtain more realistic estimates of vaccine efficacy".

But despite its reservations about the quality of the available evidence, the team nonetheless recommended that people over the age of 70 should continue to be vaccinated until better data could be collected.

Trials call

Dr Tom Jefferson, of the Cochrane Library - a body that determines the relative effectiveness of health interventions - welcomed the study, which repeated many of his own assertions made in a paper published a year ago.

Writing in an editorial, he said it was time to carry out a placebo-based trial in which some participants are denied the jab.

"Head-to-head comparisons with other types of influenza vaccine will not allow direct assessment of absolute vaccine effectiveness," he wrote.

"Could governments be courageous and honest enough to reassess their cherished policies?"

It costs about £115m to vaccine the vulnerable against flu in the UK each year.


This study acknowledges that, whilst waiting for an improved evidence base, vaccination with flu vaccine in this group should continue
Department of Health

"The aim of our influenza policy is to protect those who are most at risk of serious illness or death should they develop influenza," a spokesperson for the Department of Health said.

"UK policy is constantly under review to take into consideration all available evidence. This study acknowledges that, whilst waiting for an improved evidence base, vaccination with flu vaccine in this group should continue."

The Royal College of GPs said it endorsed current policy and suggested that the study was lacking.

"There is a widely-held view that many respiratory virus infections cause mild, self-limiting disease and this is true," it said in a statement.

"But it is equally true that the relatively infrequent serious outcomes from this apparently minor illness add up to a major public health problem.

"Routine annual influenza vaccination of the elderly and persons with co-morbidity remains a vital element in this attack."

Fatty liver can be a sign of serious problems to come

Starchy diet 'may damage liver'


A diet rich in potatoes, white bread and white rice may be contributing to a "silent epidemic" of a dangerous liver condition.
"High-glycaemic" foods - rapidly digested by the body - could be causing "fatty liver", increasing the risk of serious illness.

Boston-based researchers, writing in the journal Obesity, found mice fed starchy foods developed the disease.

Those those fed a similar quantity of other foods did not.

One obesity expert said fatty liver in today's children was "a tragedy of the future".

High GI foods:
Mashed potato
White bread
Chips
Some breakfast cereals (eg Cornflakes, Rice Krispies, Coco Pops)
Steamed white rice


Fatty liver is exactly as it sounds - a build-up over time of fat deposits around the organ.

At the time, no ill-effects are felt, but it has been linked with a higher risk of potentially fatal liver failure later in life.

The study, carried out at Boston Children's Hospital, looked at the effect of diets with precisely the same calorific content, but very different ingredients when measured using the glycaemic index (GI).

This is a measure of how quickly the energy in the food is absorbed by the body, producing a rise in blood sugar levels - high GI foods lead to sharper rises in blood sugar, and similar rises in insulin levels, as the body releases the chemical in response.

High GI foods include many breakfast cereals and processed foods such as white bread and white rice.

Low GI foods include unprocessed fruit, nuts, pulses and grains, including rye or granary bread, spaghetti, apples and oranges.

Silent and deadly

After six months on the diet, the mice weighed the same, but those on the high GI diet had twice the normal amount of fat in their bodies, blood and livers.

Fatty liver is going to be one of the tragedies of the future unless we do something about it
Tam Fry, National Obesity Forum

The researchers say that because the processed carbohydrates are absorbed so quickly, they trigger the release of more of the chemical insulin, which tells the body to lay down more fat.

Dr David Ludwig, who led the research, said that the results would also apply to humans, and even children, in whom fatty liver is becoming far more common.

Between a quarter and half of all overweight American children are thought to have the condition, he said.

"This is a silent but dangerous epidemic," he said.

"Just as type 2 diabetes exploded into our consciousness in the 1990s, so we think fatty liver will in the coming decade."

Tam Fry, National Obesity Forum board member and chairman of the Child Growth Foundation, said it was clear that eating a diet rich in high-glycaemic food led to increased fat.

He said: "Fatty liver is going to be one of the tragedies of the future unless we do something about it."

Health warning over 'dangerous' Crocs

By Tom Leonard in New York
http://www.telegraph.co.uk/;jsessionid=GYOQIPSCDMG3VQFIQMGCFFWAVCBQUIV0

Crocs, the popular plastic shoes that are reputedly as comfortable as they are ugly, may not be quite so “go-anywhere” as they seem.


Reports are increasing of wearers getting their toes caught in escalators
Reports are increasing around the world of Croc wearers, invariably young children, getting their toes caught in escalators - sometimes with drastic results.

Made of a soft, synthetic resin, Crocs were designed as a boating shoe because of their non-marking, slip-resistant soles.

Their soaring popularity has been fuelled by their appearance on the feet of the likes of George Bush, Jack Nicholson and Kate Middleton.

The Colorado-based company, which only started five years ago, last month reported sales had jumped by 162 per cent, to pounds 110 million, from April to June this year.

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But in Washington DC, the Metro, one of the largest American subway systems, has now put up warning notices about wearing such shoes on its moving stairways.

The posters don’t mention Crocs by name but feature a photo of a crocodile.

A Metro spokesman said that, in the past two years, so-called “shoe entrapments” had gone from being relatively rare to occurring four or five times a week.

In American Girl, an upmarket US toy store chain owned by Mattel, signs warn customers wearing Crocs or flip-flops to use the lifts instead of escalators.

There have also been Croc-related escalator incidents in Singapore and Japan as well as in malls and railway stations across America.

The Japanese government warned its public last week that it had received 39 reports of sandals - mostly Crocs or similar products - getting stuck in escalators between late August and early September.

Most of the reports involved small children, some as young as two.

In Singapore, a two-year-old girl wearing rubber clogs - the brand is unclear - reportedly had her big toe ripped off in an escalator accident last year.

A common pattern is that the accidents occurred because of the brightly-coloured, clog-like shoes’ flexibility and grip, supposedly two of their main selling points.

Some accidents reportedly occurred because the shoes got caught in the “teeth” at the bottom or top of the escalator, or in the crack between the steps and the side of the escalator.

In the US, a three-year-old boy wearing Crocs suffered a deep gash across the top of his toes on an escalator at Atlanta Airport in June.

A spokesman for the airport terminal said it was one of seven shoe entrapments since May, all but two of which involved Crocs.

During the past two years, shoe entrapments in the Washington subway system have gone from being relatively rare to happening four or five times a week during warm months, although none has caused serious injuries, said Dave Lacosse, who oversees the subway’s 588 escalators, the most of any US transit system.

Rory McDermott, four, caught a Croc in an escalator in a suburban Washington shopping mall last month.

His mother, Jodi, managed to yank him free, but the nail on his big toe was almost completely ripped off, causing heavy bleeding.

Mrs McDermott said she initially had no idea what caused the accident until someone at the hospital remarked on Rory’s shoes, prompting her to do an internet search.

She said: “I came home and typed in ’Croc’ and ’escalator,’ and all these stories came up. If I had known, those would never have been worn.”

Kazuo Motoya of Japan’s National Institute of Technology and Evaluation said children may have more escalator accidents because they “bounce around when they stand on escalators, instead of watching where they place their feet".

Crocs says its shoes are “completely safe” and has suggested the accidents are instead due to badly-maintained escalators or people not behaving safely on them.

It said in a statement: “Escalator safety is an issue we take very seriously. In order to stay safe while riding escalators or moving walkways, it’s important to pay attention, especially when stepping onto or off of the escalator or walkway. It’s also important for parents to help young children ride escalators and moving walkways safely."

Crocs said it was working in the US with the Elevator Escalator Safety Foundation on public education initiatives.

However, Barbara Allen, the foundation’s executive director, said that after a Crocs official rang her a year ago about possible cooperation, there had been no further contact and the company had not returned her calls.

Poor quality care for people suffering fractures

The NHS is wasting millions of pounds on poor quality care for people suffering fractures, said a study.

Staff are failing to identify and treat osteoporosis in patients who have had a previous fracture and a postcode lottery exists in accessing care, it said.

It is known that the number of people suffering hip fractures is expected to double by 2050 as the population ages.

At present, more than 310,000 patients attend UK hospitals with "fragility fractures" each year, costing around £2 billion in social and health care.

Most of these people are elderly and around a quarter of the fractures - 75,000 - are hip fractures, typically caused by a fall.

The British Orthopaedic Association and the British Geriatrics Society published a study on fractures with the support of the Royal College of Nursing and the National Osteoporosis Society.

It comes as new research suggests that the once-a-year drug, Aclasta, cuts the number of deaths among patients with fractures caused by osteoporosis.

The drug is expected to receive its license for use in the UK before the end of the year.

The organisations published a guide on best practice and called for fracture patients over the age of 50 to be routinely tested for osteoporosis.

The condition is more common among women, with half of over-50s likely to suffer a related fracture.

Cardiology Kung-Fooie

A high-profile San Diego cardiologist is under CMS investigation for
allegedly hitting a patient several times during a cardiac
catheterization. The physician, Dr. Maurice Buchbinder, is a
controversial figure who's been up against federal authorities before,
last time for using an unapproved device developed by a company in which
he had a financial interest. Buchbinder practices within the Scripps
hospital system, which performs more heart procedures than any other in
the U.S.

Dr. Buchbinder was targeted after lab technicians filed complaints with
state licensing officials alleging that he had struck an unruly patient
several times during a cath procedure done on August 31st. The
complaints triggered the CMS investigation. Scripps has since announced
that Buchbinder has been suspended indefinitely from practicing at any
Scripps facility nationwide.

Tips for Relieving Dry Eyes Naturally

Dry eyes, often referred to as Dry Eye Syndrome, is the most frequent patient complaint to eye doctors. Like most eye conditions, Dry Eye Syndrome is often related to health conditions in the rest of the body. It is commonly associated with dryness of other mucous membranes, interior body surfaces such as joints and brittle nails. It can also be a sign of digestive imbalances or of more serious systemic autoimmune diseases, such as rheumatoid arthritis, Sjogrens syndrome or lupus erthematosus.

Here are some specific recommendations:

Make sure to eat lots of green leafy vegetables.
Avoid sugar and/or artificial sweeteners: Consumption of more than 11 teaspoons of sugar a day has been linked to dry eye syndrome (a single can of soda contains approximately 9 teaspoons of sugar. Sugar is hidden throughout processed and refined foods including cereals, ketchup, and salad dressings.

Avoid the toxic fats in commercial red meat, dairy products, fried foods and hydrogenated oils (such as margarine and shortening). These fats interfere with the proper metabolism of essential fatty acids in the body and are indirect causes of dry eye syndrome. Eat organic or free range whenever possible.

Avoid coffee and smoking.

Avoid hydrogenated and trans fatty acid containing foods (i.e.: margarine, most chips ... read labels).

Drink 8-10 glasses of water a day.

Avoid any foods you may be allergic to. ry cutting out categories of foods for a week at a time, and see how you feel, or visit an allergist for testing. Typical allergenic foods include nightshades (eggplant, peppers, tomatoes, white potatoes and cucumbers), milk, wheat, and corn (or products with corn in it).

Supplement your diet with a good vitamin that has omega 3 fatty acids in it.

Other Recommendations

Use a humidifier at home and/or at work to keep the air from drying out in the winter.
Remember to blink, especially while working at the computer.
Check your medications for any side effects that may cause dry eyes.
Gently massage upper and lower lids, a couple of times a day to stimulate the tear glands.

Nutritional Recommendations
Supplementing with specific nutrients can help with the tear production including omega-3 fatty acids (such as from flax seed and fish oils), specific omega-6 fatty acids (such as those from Black Current Seed and Borage oils), vitamins A, C, D, E, B6, magnesium. Other nutrients such as tumeric and lactoferrin may be helpful as well. There are formulas available on the market that contain these nutrients.

Natural eye drops without preservatives can be extremely helpful as well.

Common Treatments for Diabetes Destroy the Pancreas and Leads to Worsening

A class of drugs called thiazolidinediones (TZDs), and specifically the brand name drug Avandia, were found to drastically increase the rate of heart attack. Given that 70% of diabetics already die of heart-related complications, an increase in this risk is devastating. The next punch came from an article in the September issue of Diabetes Research and Clinical Practice. Researchers confirmed earlier findings that another popular class of diabetic drugs, the sulfonylureas (such as brand name Glyburide), actually kill off the cells in the pancreas that make insulin, virtually ensuring that these patients will end up worsening and needing to inject insulin!!

Article from: http://www.sciencedirect.com/

Sulfonylurea and glinide reduce insulin content, functional expression of KATP channels, and accelerate apoptotic β-cell death in the chronic phase

Abstract

We previously found that chronic exposure to glibenclamide inhibits acute glibenclamide-induced insulin secretion by reducing the number of functional ATP-sensitive K+ (KATP) channels on the plasma membrane of pancreatic β-cells. In the present study, we compared sulfonylurea-induced and glinide-induced insulin secretion in pancreatic β-cells chronically exposed to these widely used oral hypoglycemic agents. Chronic exposure of pancreatic β-cells to sulfonylureas (glibenclamide or tolbutamide) and glinide (nateglinide) similarly impaired their acute effectiveness by reducing the insulin content and the number of functional KATP channels on the plasma membrane. Functional expression of the voltage-dependent Ca2+ channels (VDCCs), ion channels that play a critical role in the KATP channel dependent insulin secretory pathway, was similar to that in drug-untreated cells. Chronic exposure to each of the three agents similarly accelerated apoptotic β-cell death. Thus, reduction of the insulin content, reduction of the number of functional KATP channels on the plasma membrane, and acceleration of apoptotic β-cell death all are involved in impaired insulinotropic agent-induced acute insulin secretion in the chronic phase of sulfonylurea and glinide treatment. These findings help to clarify the mechanism of secondary failure after long-term therapy by these hypoglycemic agents, and should have important clinical implications regarding pharmacotherapy for type 2 diabetes.


Abbreviations: KATP, ATP-sensitive K+; VDCCs, voltage-dependent Ca2+ channels; DMEM, Dulbecco's modified Eagle's medium; KRBB, Krebs–Ringer bicarbonate buffer; RIA, radioimmunoassay; TUNEL, TdT-mediated dUTP nick end labeling; PBS, phosphate buffered saline; DMSO, dimethylsulfoxide

Akira Takahashia, b, Kazuaki Nagashimaa, , , Akihiro Hamasakia, Naomitsu Kuwamuraa, Yukiko Kawasakia, Hiroki Ikedaa, Yuichiro Yamadaa, Nobuya Inagakia, c and Yutaka Seinoa, d
aDepartment of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
bNakamura Hospital, Osaka, Japan
cCREST of Japan Science and Technology Cooperation (JST), Kyoto, Japan
dKansai Denryoku Hospital, Osaka, Japan

Mahjong game 'can cause epilepsy'

By Vaudine England
BBC News, Hong Kong


The study said the syndrome affects more men than women
A study by doctors in Hong Kong has concluded that epilepsy can be induced by the Chinese tile game of mahjong.

The findings, published in the Hong Kong Medical Journal, are based on 23 cases of people who suffered mahjong-induced seizures.

The report's four authors, from Hong Kong's Queen Mary Hospital, said the best prevention - and cure - was to avoid playing mahjong.

The study led the doctors to define mahjong epilepsy as a unique syndrome.

Epileptic seizures can be provoked by a wide variety of triggers, but one cause increasingly evident to researchers is the playing - or even watching - of mahjong.

This Chinese tile game, played by four people around a table, can involve gambling and quickly becomes compulsive.

Demanding

The game, which is intensely social and is sometimes played in crowded mahjong parlours, involves the rapid movement of tiles in marathon sessions.

The doctors conclude that the syndrome affects far more men than women; that their average age is 54; and that it can hit sufferers anywhere between one to 11 hours into a mahjong game.

They say the attacks are not just caused by sleep deprivation or gambling stress.

Mahjong is cognitively demanding, drawing on memory, fast calculations, concentration, reasoning and sequencing.

The distinctive design of mahjong tiles, and the sound of the tiles crashing onto the table, may contribute to the syndrome.

The propensity of Chinese people to play mahjong also deserves further study, the doctors say.

What is certain though, is that the only sure way to avoid mahjong epilepsy, is to avoid mahjong which, for many people, is easier said than done.

LIES!: Surgery for Money

Monte Sereno doctor accused of faking patients' need for surgery By Barbara Feder Ostrov Mercury News

On the day of his cancer treatment, 87-year-old Dung Le lay on a table, his frail body sedated as needles loaded with radioactive seeds were inserted into his prostate to destroy the malignant tissue his doctor told him was there.

But Dung Le never had cancer, and his doctor knew it.

Now that doctor, Ali Moayed of Monte Sereno, faces felony charges of battery, elder abuse and fraud for his treatment of Le, in a bizarre case that has deeply unsettled local physicians. Two other men in their 70s, their medical files falsified by Moayed, narrowly escaped the same unnecessary procedure, according to a state medical board investigator's report.

Santa Clara County prosecutors are also investigating whether Moayed - who has pleaded not guilty to the charges - may have harmed 13 other men in a similar scheme.

"He doctored the pathology reports to induce a patient to undergo a procedure that carried a significant risk," said Santa Clara County prosecutor Bill Butler. "The conduct was so egregious, it goes beyond simply medical malpractice."

Sparked by a colleague's discovery of altered lab reports, the unraveling of Moayed's alleged deceptions spanned two years of investigation by several agencies, leading to his arrest in late June.

But the question remains: Why would a prosperous doctor risk his career this way? Was it greed? A misguided sense that he was doing the right thing for his patients?

Free on $500,000 bail but currently barred from practicing medicine, the 41-year-old urologist faces more than seven years in prison and potential civil lawsuits that could bankrupt him.

Moayed did not return phone calls or e-mails from the Mercury News and his attorney declined to comment. Yet hints about Moayed's motivation are found in the normally confidential medical board investigator's report placed in his court file.

Missing report in '05 A missing pathology report proved to be Moayed's undoing. In May 2005, Dr. Abhinand Peddada, a Los Gatos radiation oncologist, was reviewing the medical files of one of Moayed's patients, identified only as "S.B.," 75, who was scheduled for a prostate cancer treatment known as brachytherapy.

The procedure isn't pleasant: It involves sedating the patient, then inserting radioactive seeds the size of rice grains into the prostate to shrink tumors.

As Peddada scrutinized the file to confirm the patient's post-surgery treatment plan, he noticed that a crucial lab report confirming the cancer diagnosis was missing.

He called Moayed's medical office in Los Gatos first, then the lab that had examined a sample of tissue taken from the patient's prostate. Two pathology reports came in. The first one, from the lab, said the patient was cancer-free. The second - from Moayed's office - said the opposite. Peddada suspected that the report from Moayed's office had been altered. S.B.'s procedure was immediately canceled.

Good Samaritan Hospital in San Jose, where both Peddada and Moayed were on staff, began to investigate. When Peddada, hospital administrators and other physicians reviewed the files of Moayed's other patients, they found that pathology reports for Dung Le and another patient, referred to in medical board documents as "B.T.," 75, were falsified. They were able to cancel B.T.'s upcoming brachytherapy.

But for Dung Le, it was too late.

Hospital findings Good Samaritan officials quickly reported their findings to the state medical board, law enforcement and Los Gatos Community Hospital, where Moayed also was on staff. The medical board and the Santa Clara County District Attorney's Office opened investigations.

By August 2005, Moayed, on the advice of his lawyer, had resigned from the medical staffs at both hospitals.

He relinquished his medical license the next month, and his practice was taken over by Dr. Farshad Nowzari, according to the investigator's report. Until this incident, Moayed had never been investigated or disciplined by the state medical board.

Once Moayed stopped practicing medicine, investigators could take their time to build a case. As Peddada dug deeper into Moayed's patients' files, his concerns grew. There were other aspects of Moayed's treatment of cancer patients that were difficult to fathom.

Moayed gave some of his patients hormone injections to prevent their prostate cancer from progressing, but according to their medical files, they didn't appear to show effects of the treatment - almost as if they had been given a placebo, Peddada told investigators.

He called Moayed to ask if he had received "a bad batch" of hormones, the report says. After Moayed got that call, Peddada told investigators, the patients began to show the response to the treatment that should have occurred all along. Peddada declined to speak with the Mercury News.

Much to lose Moayed had a great deal to lose from his apparent deceptions. A 1991 graduate from the University of Cincinnati Medical School, Moayed owns a medical building and lives in a Monte Sereno mansion with an estimated value of more than $3 million.

He admitted to the medical board investigator that he had falsified the reports for three cancer-free patients, inserting lab results from patients who did have cancer.

He said he didn't do it for the money. Each brachytherapy procedure would have netted him only $600 because they are performed alongside a radiation oncologist, he told investigators.

Why, then, would he lie to his patients? The investigative report isn't clear, but Moayed appears to claim that the brachytherapies would help them by preventing future cancers. At least one of his patients had displayed early warning signs, including an elevated PSA (prostate specific antigen) level. Moayed "felt the patients were on the brink of getting cancer and that he wanted to give them a definitive answer," the report says.

"He knows he messed up and that he will no longer be practicing medicine," the investigator wrote in the report. "He stated that there was no justification for what he did."

Moayed said "he was under a lot of stress," logging many after-work hours on his computer instead of spending time with his children, the investigator reported.

Treatment debated In medical circles, the best way to treat prostate cancer is fiercely debated.

The disease afflicts more than 218,000 American men each year, many of them elderly. An estimated 20 percent of American men will be diagnosed with the disease between the ages of 70 and 75, according to the National Cancer Institute.

Once cancer is detected, treatment options range from "watchful waiting" (in which patients are closely monitored but not treated) to hormone or radiation therapy, to surgery.

But an independent doctor who reviewed evidence in the case told medical board investigators that Moayed's apparent conviction that his patients ultimately would develop cancer, based on the early warning signs, simply wasn't valid. Nor should a doctor pursue cancer treatments for a patient whose cancer has not been confirmed, the independent doctor said.

Many doctors believe that elderly patients are more likely to die of other causes, such as heart disease, before they die of prostate cancer. Moayed told the investigator he had "messed up" with only three patients, but local prosecutors and the medical board investigator are examining his treatment of more than a dozen other patients from Los Gatos Community Hospital. Dr. Domenico Manzone, a Los Gatos urologist, told the medical board investigator that Moayed had performed 13 other brachytherapy procedures at the Silicon Valley Urology Center at Los Gatos Community Hospital. But when Manzone reviewed the patients' charts, he found no reports documenting their cancer - only a statement from Moayed that they had the disease, the investigator's report says.

Manzone declined to speak about Moayed. But in an e-mail, he said, "The dedicated and hardworking physicians" of the Silicon Valley Urology Center "deplore the apparent breaches by Ali Moayed of some of the most fundamental principles of our profession."

Hearing not set A date for Moayed's preliminary hearing hasn't been set yet, but the criminal charges against him are the only the start of his legal woes. He could face malpractice lawsuits that wouldn't be subject to California's $250,000 damages cap because of the age of the victims, said prominent San Jose attorney Dick Alexander. If a jury finds him guilty of willful misconduct, the doctor's malpractice insurance would not cover him.

It's unusual, but not unheard of, for prosecutors to file criminal charges against doctors over medical treatment, said David Magnus, a Stanford University medical ethicist. Such cases are typically handled by state medical boards, which can revoke a doctor's license, and in civil courts through malpractice lawsuits.

If the facts of Moayed's case are true, Magnus said, they represent a doctor out of control.

"That kind of blatant paternalism might have been common in this country in the 1940s and 1950s, but it's inappropriate and something that won't be countenanced today," Magnus said. "You can't knowingly, intentionally lie to patients to get them to do what you want."