Video Game Overuse May Be an Addiction

Millions of U.S. children and adults obsessed with video games may suffer from a real addiction, according to a proposal up for debate by top U.S. doctors.

Delegates attending the American Medical Association conference in Chicago, which starts Saturday, will discuss the proposed addition of video game addiction to a list of "formal disorders," where it would join other problem behaviors such as pathological gambling.

Dr. Martin Wasserman, executive director of MedChi, the Maryland State Medical Society, helped spearhead the new proposal, which has resulted in a 10-page report submitted to the AMA by the group's Council on Science and Public Health.

"The concern came up because one of our psychiatrists here in Maryland was seeing older people who were losing their social contacts," specifically because of their overuse of video games, Wasserman said. "It was ruining their family life. So, it was not unlike gambling addictions or alcohol, where it was having a profound impact on the lives of individuals."

According to the AMA report, one soon-to-be-released British study polled 7,000 "gamers" and found that 12 percent of them met World Health Organization criteria for addictive behaviors.

Statistics released in 2005 by the Entertainment Software Association (ESA), an industry group, estimated that 70 percent to 90 percent of American children play video games. The typical gamer is a 30-year-old male who spends about seven or eight hours a week gaming.

The ESA survey also found that video game overuse was most prevalent among the approximately 9 percent of video game users who play against others online in Internet-based "massive multiplayer online role playing games."

The new AMA report defines "heavy game use" as two or more hours a day, but Wasserman, a pediatrician, said addictions are best defined by their impact on an individual's life and psyche.

"Basically, you're using a disproportionate amount of time on the video game, and it's what you are thinking about even when you're not on the video game," he said. "And even though it's having negative consequences for you in school or your family situation, or it's taking a disproportionate amount of your money, you still continue to do it. You spend less time with your friends or in other social things."

One theory why certain individuals spend so much time on online games is that they prefer the experience to real-world interaction. According to the report's authors, the "current theory is that these individuals achieve more control of their social relationships and more success in social relationships in the virtual reality realm than in real relationships."

But that sense of control may come at a price, Wasserman said, especially for children and adults obsessed with games loaded with violent imagery.

"The violent aspects of this, in particular, have got to be a threat to the normal growth and development that we'd like to see in young people," he said. "People have observed more aggressive behaviors [linked to gaming], and if you do subjective testing, there are studies which have shown aggressive behaviors in young people and less supportive behaviors."

Wasserman wonders, as well, about the sedentary aspects of hours of video game use. "I can't tell you if this is associated with our current epidemic of child obesity," he said, "but too much time in front of a video tube -- and much of that time spent watching violent interactions -- can't be good for our kids."

That's a sentiment shared by a majority of the American public, according to a survey of more than 1,000 parents of children aged 2 to 17 that was released Tuesday by the nonprofit Kaiser Family Foundation. According to the Associated Press, two-thirds of parents responding to the survey said they were "very concerned" about the amount of sex and violence their children are exposed to in various media.

But the AMA report remains merely a starting point for discussion among doctors gathering in Chicago. It is far from certain that the physicians' group will, in fact, move to label excessive gaming an addiction.

The report's authors are urging that the AMA pressure the American Psychiatric Association (APA) to include "Internet/video game addiction" in the next edition of the Diagnostic and Statistical Manual of Mental Disorders, the standard diagnostic text used by psychiatrists worldwide.

But Dr. James Scully, medical director at the APA, said any decision on the matter is a long way off.

Right now, "we don't agree or disagree" with the idea, he said. "As a diagnostic issue, it is going to be several years before we make a determination of that. It's clearly something that we want to consider."

In the meantime, he said, it's up to parents to limit their child's exposure to video games, especially the more violent ones. Both the AMA and the APA support current recommendations from the American Academy of Pediatrics that limit children's exposure to all "screen time" -- TV, computers and video games -- to a total of two hours a day.

Wasserman believes this simple rule can minimize media's potentially harmful effects. Media, in itself, isn't always bad, he said, but "everything needs to be done in moderation."

"That's what we taught our kids -- if they didn't do it in moderation in our home, we moderated it for them," he said. "It didn't hurt them."
Source :http://www.forbes.com

Patient's death jeopardizes hospital

When Edith Isabel Rodriguez showed up in the emergency room of an inner-city hospital complaining of severe stomach pain, the staff was already familiar with her.

It was at least her third visit to Los Angeles County's public Martin Luther King Jr.-Harbor Hospital in as many days. "You have already been seen, and there is nothing we can do," a nurse told her.

Minutes later, the 43-year-old mother of three collapsed on the floor screaming in pain and began vomiting blood. Employees ignored her, and she was soon dead.

Now state and federal regulators are threatening to close the hospital or pull its funding unless it can be improved, and Rodriguez has become a symbol of everything wrong with the facility derisively known as "Killer King."

After she collapsed, surveillance cameras show that Rodriguez was left for dead on the floor.

Nurses walked past her. A janitor cleaned up around her. No one did anything until police were called to cart her away. They didn't get far before she went into cardiac arrest and died.

"This needs to stop," state Health Services Director Sandra Shewry said Thursday as the agency moved to revoke the hospital's license. "We're doing this in response to the egregious incidents that have come to light in the last six weeks."

The hospital, formerly known as Martin Luther King Jr.-Drew Medical Center, was built after the 1965 Watts riot to bring health care to poor, minority communities in south Los Angeles.

But it had been plagued by patient deaths blamed on sloppy nursing care, among other things. The county attempted over the last few years to correct the problems with a multimillion dollar rescue effort, disciplining workers, reorganizing management, closing the trauma unit and reducing the number of beds from 200 to 48.

After Rodriguez's death, federal reports showed those efforts were failing and patients were in "immediate jeopardy." Of the 60 cases reviewed between February and June, more than a quarter received substandard care, according to the U.S. Centers for Medicare and Medicaid Services.

In February, a brain tumor patient languished in the emergency room for four days before his family drove him to another hospital for emergency surgery. A pregnant woman who complained of bleeding was given a pregnancy test and left, only to return three days later and have a miscarriage after waiting more than four hours to see a doctor.

The findings have sent county officials scrambling to improve care before a federal inspection due by Aug. 15 that could determine whether the hospital keeps its federal funding. The county might close the facility without that money.

The hospital, meanwhile, could contest the state allegations in a hearing before a Department of Health Services administrative law judge.

"I'm losing hope," Zev Yaroslavsky, member of the county Board of Supervisors that oversees King-Harbor, told hospital managers earlier this week. "We need to be prepared for the worst-case scenario."

On Friday, the county's Department of Health Services released a contingency plan to deal with closing hospital departments and relocating patients if they must. The plan, which also lays out how the hospital could eventually be reopened if a private partner is found, will be presented to the Board of Supervisors on Tuesday, said Bruce Chernof, director of the department.

Even though hospitals nationwide struggle with too many patients and not enough staff, the scope and severity of King-Harbor's problems are rare.

"Most hospitals in America have long waits, they have crowded ERs," said Dr. Bruce Siegel, former chief of New York City's public hospitals and a George Washington University professor. "But they don't let people die in the waiting room after they call 911. This is a whole new level here."

Rodriguez, who struggled with drug addiction over the years, had visited King-Harbor several times for stomach pain in the days before she died. Each time, she was sent home, in some cases with pain medication, after doctors said she suffered from gallstones.

"They discharged me, but I don't feel good. I feel sick," she told her sister, Marcela Sanchez.

At the urging of her sister, Rodriguez returned to the hospital.

Early on May 9, she was wheeled into the ER by county police officers.

"Thanks a lot, officers, she's a regular here," a nurse said. "She has already been seen and was discharged."

After the nurse again refused to help, Rodriguez slid off her wheelchair and onto her knees in a fetal position, screaming in pain, according to a federal report based in part on surveillance videotape.

Over the next half hour, hospital staff walked past her. Soon, her boyfriend, Jose Prado, who had left for about an hour, returned to the hospital.

"When I came back, I found her lying on the floor with blood coming out of her mouth," Prado said. "She said, 'Honey, help me! Nobody will help me here!'"

He pleaded with medical staff and then a county police sergeant to intervene, but no one did.

"I told him she had blood in her mouth," Prado says he told the sergeant. "But he told me, 'Don't worry, she just has chocolate in her mouth."

Then he called 911.

"My wife is dying and the nurses don't want to help her out," he said in Spanish through an interpreter

"What's wrong with her?" a dispatcher asked.

"She's vomiting blood," Prado said.

When the dispatcher refused assistance, he hung up and frantically ran back to Rodriguez.

"I just hugged her. I didn't know what else to do. I couldn't think of anything else," he said.

Eventually, officers arrested her on a parole violation.

Police wheeled her out of the ER, then returned minutes later after Rodriguez's heart had stopped. Autopsy results revealed she died of a perforated bowel that probably developed in the previous 24 hours, a condition that is often treatable if caught early enough.

"They took her outside to die like an animal," Prado said.

After her death, a triage nurse was put on leave, resigned and was reported to the state Nursing Board for investigation. Six others — a nurse, two nursing assistants, and three hospital finance workers — were disciplined. Sheriff's detectives, meanwhile, have opened a homicide investigation.

Rodriguez's family said little will ease their grief. They plan to sue and are seeking copies of the video surveillance tapes, which are being held as part of a criminal investigation.

"They took my sister," Sanchez said. "It wasn't time for her to go."
Source :http://www.chron.com

U.S. posts hospital death rates for heart ailments

The U.S. government posted mortality data on Thursday for the nation's thousands of hospitals for heart attacks and heart failure, in an effort to shed light on which hospitals provide the best care.

Health care in the United States is notorious for its lack of transparency -- for both the price of goods and services, as well as the quality of care provided by doctors and hospitals.

The new mortality data updates a year-old project by the U.S. Department of Health and Human Services, contrasting prices and experience at the nation's 4,500 acute-care hospitals. The government's Web site compares 31 elective hospital procedures such as heart valve operations, gallbladder removal and hernia operations.

"We don't yet have the Formula One version. We have the go cart version," Secretary Mike Leavitt said during a briefing on the government's efforts to make hospitals -- which get a large portion of their revenue from government health programs -- more accountable.

The new measures track 30-day mortality following a heart attack and heart failure and make risk adjustments for a patient's health, age and other factors.

Hospitals are rated in-line with the national average, above average, or below average for the two heart conditions. Just seven hospitals were rated worse-than-average for death rates following a heart attack, while 17 were rated better-than- average.

In heart failure, 38 hospitals scored a top rating, while 35 scored a worse-than-average for that measure.

The small numbers reflect a conservative approach taken by the consortium, which developed the measures, and included researchers from Harvard and Yale Universities.

During the 1980s, the government tried releasing hospital quality data, but the industry revolted and they were eventually scrapped.
Source :http://www.reuters.com

FDA Issues Dietary Supplement Rules

The U.S. Food and Drug Administration announced Friday that manufacturers of vitamins, herbal pills and other dietary supplements would have to test the ingredients of all their products for safety and purity.

The new standards follow concerns that existing regulations are too weak in that they allow supplements on the market that were contaminated or whose ingredients didn't match claims made on the label.

But while the rules may strengthen enforcement in these areas, some experts say that the real question is the effectiveness of these products.

"This final rule establishes industrywide standards," said Robert Brackett, director of the center for food safety and applied nutrition at the FDA, in a press conference this morning. "Consumers should have increased confidence that the dietary products that they purchase are safe."

Published in an 800-plus page report, the regulations set so-called good manufacturing processes for the 29,000 dietary supplement products currently on the market -- including vitamins, minerals, botanicals, sports nutrition supplements, weight management products and specialty supplements.

The supplement makers will have to test the ingredients of all their products for purity, and accurately report ingredients on their labels.

Before his, supplements fell under the same regulatory guidelines used for food. But according to the FDA, regulating supplements in this way missed some critical problems.

"[The final rule] tries to be more specific about regulating the processes used to make diet supplements, which are quite different from the way you process food," said Vasilios Frankos, division director of the office of dietary supplements at the FDA.

The requirements also apply to imported supplements manufactured outside the U.S. Enforcement of the new guidelines begins Aug. 24.

"The aim is to prevent the wrong ingredients getting into supplements," said Frankos. The regulations also try to prevent contamination of supplements as well as the accidental inclusion of pesticides, glass or heavy metals like lead.

Fable-Free Labels

"These new regulations will at least take the quality issue off the table," says Dr. Brent Bauer, director of the complementary and integrative medicine program at the Mayo Clinic. "If a patient wants to try ginseng, they can be assured that when they purchase a ginseng brand that claims to have 5 percent ginsenosides, they will know that is what they are getting."
Source :http://www.abcnews.go.com

The Brains of the Family?

Given the choice, 9-year-old Carlyle Quinn would spend all day with his microscope, while younger brother Max would opt for the electric guitar.

There's no telling how these brothers living in Brooklyn, N.Y., will grow up. But according to groundbreaking new research, it is very likely Carlyle will have the highest IQ.

The study, published in the current issue of the journal Science, involved more than 240,000 Norwegian men who took intelligence tests when they entered the military. In most families, the scores of the firstborn were three points higher than the second child, and four points higher than a third.

It's not a huge difference, but it might be enough to divide an A student from a B student.

"It is a breakthrough study that is very difficult to dispute methodologically," Frank Sulloway, a University of California psychologist who wrote an accompanying editorial to the study, told ABC News correspondent Bill Weir.

Lead study author Petter Kristensen, an epidemiologist at the University of Oslo, doesn't think the results apply only to Norwegians, but he added that it would be interesting to examine if family patterns are different in some way in Norway.

As for the reasons behind the apparent intelligence gap, Kristensen and other researchers insist it is not due to nature but nurture, with the firstborn enjoying the fruits of undivided attention early in life.

Intelligence Through Teaching

Experts believe that when older children tutor their siblings, it may help their brains grow.

Add to this the fact that in many families, if the eldest is organized and studious, the younger finds more creative ways to get attention.

Sulloway said such differences are not necessarily bad; in fact, such an arrangement might allow younger children to shine in different ways.

"Younger siblings may have three points of something else that doesn't show up on an IQ test," he said.

Exceptions to the Rule

Examine certain sets of famous siblings, and a tantalizing dynamic emerges that seems to support these findings. Studious Prince William and his playful brother Harry, for example. Or Bill and Roger Clinton.
Source :http://www.abcnews.go.com

Health insurers to halt ad effort

Government officials said seven of the country's largest insurers will cease marketing some plans to seniors amid allegations of misleading and aggressive sales practices.

The companies agreeing to the suspension include Humana, WellCare Health Plans and UnitedHealth. Under the voluntary agreement, the companies will not promote their so-called private-fee-for-service plans until Medicare officials certify the companies use accurate and understandable marketing communication.

Medicare is the government-run health benefit that covers 43 million seniors. Roughly 20 percent of those seniors receive their benefits through privately run Medicare Advantage plans.

Last month, state insurance officials told lawmakers they have received hundreds of complaints from seniors who thought they were signing up for the traditional government program, only to learn they had been enrolled in a for-profit corporate plan.

In other cases, agents misled seniors into leaving the government program for a privately run Medicare Advantage plan.

While nearly all the major health insurers offer the plans, nearly half of all patients enrolled are in Humana plans, Medicare officials said.

The plans are popular among seniors -- over 1 million are enrolled -- because of the benefits, which often include dental and vision care. However, they often carry unexpected costs and limited access to physicians.
Source :http://www.suntimes.com

Race May Color Heart Doctors' Choices

When you roll into the ER with crushing chest pain, does your skin color determine the care you get?

A new study in this week's Journal of the American Medical Association suggests it very well might, though experts continue to be at odds over the impact of race in heart disease treatment.

Lead study author Dr. Ioana Popescu and colleagues at the University of Iowa Medical School reported on a five-year study of what happened to more than 1 million elderly black and white Medicare patients after they had heart attacks.

What Popescu found was that that black patients were less likely to receive invasive, aggressive treatments following a heart attack -- procedures like bypass surgery or receiving an artery-opening stent.

Though the study did not examine certain other factors that could influence death rates -- such as obesity and smoking -- Popescu cited consistently higher death rates for black patients between one month and one year after their episode.

The importance of the findings was echoed by other cardiologists and heart surgeons not affiliated with the study.

Dr. Carl Pepine, chief of cardiology at the University of Florida, noted, "These are very important findings that emphasize that we have much important work remaining in the battle against heart disease that is not linked simply to insurance status."

Fewer Aggressive Treatments

When dealing with a patient who has suffered heart problems, doctors have an array of options, some more aggressive than others.

A stent is a sort of scaffolding that props a clogged artery open. In a bypass surgery, a nonessential vein (like one from the leg) is cut out and used to reroute blood away from the blocked artery that caused the heart attack.

Both can be done on an emergency basis, or can be scheduled if an artery is dangerously close to closing off.

Heart patients who do not receive these treatments instead take medications, such as beta-blockers and aspirin, to prevent another heart attack.
Source :http://abcnews.go.com

Children with autism get day in court

The parents of 12-year-old Michelle Cedillo asked a federal court Monday to find that their child's autism was caused by common childhood vaccines, a precedent-setting case that could pave the way for thousands of autistic children to receive compensation from a government fund set up to help people injured by the shots.

Wearing noise-canceling headphones, Michelle, of Yuma, Ariz., was brought into the courtroom in a wheelchair at the start of the proceedings before the U.S. Court of Federal Claims. She stayed only a short time.

Her parents, Theresa and Michael Cedillo, allege a preservative called thimerosal that had been used in vaccines weakened their daughter's immune system and prevented her body from clearing the measles virus after she was immunized for the disease at age 15 months.

Today, Michelle suffers from a litany of health problems, including severe autism, inflammatory bowel disease, glaucoma and epilepsy.

"We hope to find out what happened and hopefully get the help she needs," said Theresa Cedillo, who takes care of her daughter full time at home.

Special Master George Hastings Jr. thanked the family for allowing theirs to be the first of nine test cases that will help guide the resolution of some of the nearly 5,000 similar claims lodged with the government.

"Clearly the story of Michelle's life is a tragic one," Hastings said in pledging to listen carefully to the evidence presented during the three-week hearing.

The burden of proof is easier than in a traditional court. Plaintiffs only have to prove that a link between autism and the shots is more likely than not, based on a preponderance of evidence.

Large scientific studies have found no association between autism and vaccines containing thimerosal.

But many parents say their children's symptoms did not show up until after their children received the vaccines, required by many states for admission to school.

"These are families who followed the rules. These are families who brought children in for vaccines. These are families who immunized their children," said the Cedillos' attorney, Thomas Powers.

Powers said that the science regarding a possible vaccine-autism link is in dispute.

Government attorney Vincent Matanoski dismissed much of what the plaintiffs are expected to present as conjecture or speculation.

"You'll find their hypotheses untested or, when tested, have been found false," Matanoski said.

Since 1999, more than 4,800 families have filed claims with the government alleging their children developed autism as a result of routine vaccinations. Most contend that a preservative called thimerosal is to blame for the impaired social interaction typical of the disorder.

The court is being asked to decide whether there is a link between autism and childhood vaccines. If it finds one exists, the families could be eligible for compensation under the Vaccine Injury Compensation Fund, a program established by Congress to ensure an adequate supply of vaccines by safeguarding manufacturers from lawsuits. Under the program, people injured by vaccines receive compensation through a special trust fund.

Autism is characterized by impaired social interaction. Those affected often have trouble communicating, and they exhibit unusual or severely limited activities and interests. Classic symptoms of mercury poisoning include anxiety, fatigue and abnormal irritation, as well as cognitive and motor dysfunction.

Monday's case addresses the theory that the cause of autism is the measles, mumps and rubella vaccine in combination with other vaccines containing thimerosal. The preservative, about 50 percent mercury by weight, is no longer found in routine childhood vaccines but is used in some flu shots.

In July 1999, the U.S. government asked vaccine manufacturers to eliminate or reduce, as expeditiously as possible, the mercury content of their vaccines to avoid any possibility of infants who receive vaccines being exposed to more mercury than is recommended by federal guidelines.
Source :http://www.chron.com

FDA Steps Up Oversight of Body Parts Companies

U.S. health officials said Tuesday that they're stepping up inspections of companies that use cadavers to harvest body parts for tissue transplants.

The increased vigilance comes after scandal shook the transplant industry last year when it was discovered that funeral homes were harvesting body parts and selling them without consent, including body parts from Alistair Cooke, the 90-year-old former host of PBS' Masterpiece Theater.

f not screened properly, transplanted tissues can cause serious infections, including HIV, hepatitis -- even death. Harvested tissues are used in some 1 million medical procedures in the United States each year, many of them for knee and back surgeries. Up to 100 recipients may receive tissue from a single donor, the FDA said.

In response to the scandal, the U.S. Food and Drug Administration formed the Human Tissue Task Force, which issued its first report Tuesday.

"Today's report finds no significant industry-wide problem in the recovery of human tissues," Dr. Celia Witten, director of FDA's Office of Cellular, Tissue and Gene Therapies, said during an afternoon teleconference. "This provides our belief that the risk of disease transmission is very low for patients who receive these products."

Still, the task force is calling for still more inspections. "There is reason to be ever vigilant because the tissue industry is growing," Witten said.

There are more than 2,000 cell and tissue establishments registered with FDA, the agency said.

Originally, the task force recommended targeted inspections -- or a "blitz" -- of U.S. companies that recover human tissues, including tendons, ligaments, bone and other musculoskeletal tissues, said David Elder, director of the FDA's Office of Enforcement, Office of Regulatory Affairs.

To date the FDA has inspected 153 major human tissue recovery firms and plans on inspecting an additional 300 companies, Elder said. "What our investigators found was encouraging for tissue safety," he said during the teleconference. "Although we identified some deviations from regulations, we generally saw no unsafe or deceptive practices that could put tissue recipients at risk for disease."

The biggest company involved in illegally harvesting body parts was Biomedical Tissue Services of New Jersey. The company faces trial, along with a former New York state funeral home director, on charges they stole bodies and dissected them unlawfully, the Associated Press reported.

In addition, seven funeral home directors have already pleaded guilty and tens of thousands of body parts removed by the company have been recalled. About 10,000 people are believed to have received tissues from the company, according to the AP.

The FDA task force is also recommending:

* Increased education and outreach. The FDA should sponsor a workshop on tissue processing and microbiology for industry, surgeons and academics, to develop and share best practices for reducing the risk of disease transmission.
* Research regulations and guidance. In September 2006, the FDA issued a "guidance document" that emphasized responsibilities for ensuring tissue safety between establishments and their contractors. The FDA will issue guidance on "current good tissue practices" to encourage tissue manufacturers to seek the best methods to further reduce the risk of infection transmission.

The FDA's Center for Biologics Evaluation and Research has strengthened its collaboration with the U.S. Centers for Disease Control and Prevention, to oversee tissue-safety surveillance and adverse reaction investigations, according to the report.
Source :http://www.forbes.com

Autism test cases against US begin

Lawyers began arguments yesterday in the first of several test cases that may help decide whether the government should pay millions of dollars to parents of children with autism.

Nearly 5,000 parents say that vaccinations caused their children to develop autism and many of their claims have been pending for five years. The hearing was held at the "federal vaccine court" set up by Congress 20 years ago when a series of vaccine scares nearly crippled the industry.

Every major study and scientific organization examining this issue has found no link between vaccination and autism, but the parents and their advocates have persisted. Their frustration was evident in the opening statement of the parents' lawyer, Thomas Powers of Portland, Ore.

"Numerous obstacles have been placed in the path of the petitioners seeking that fair and generous compensation that they are entitled to," Powers said.

Powers gave his statement with his back to the three judges who will decide the case, addressing instead a few dozen audience members, many of them lawyers.

"I felt it was important to address the families and the public," he said during a break in the hearing.

The vaccine court has gone to unusual lengths to convince parents that it will fairly adjudicate their claims, even setting up a conference call where parents can listen in to the hearings, which are expected to run for three weeks.

At the opening of the hearing, Special Master George Hastings expressed his sympathy to the parents of children with autism.

He pointed to Michelle Cedillo and her parents, Theresa and Michael, whose claim for compensation is serving as the first test case. Hastings said the Cedillos were "the most important people in the courtroom."

"To all such family members, as to the Cedillo family, we special masters pledge to you that we will listen very carefully to the evidence presented at this hearing," Hastings said. "We realize what an important task . . . has been assigned to us in this hearing."

Michelle Cedillo, 12, was brought into the courtroom in a wheelchair at the start of the hearing. She wore hearing protection similar to that worn by heavy-machinery operators. She hit herself repeatedly and made loud grunting noises. Her parents soon took her out of the courtroom.

Many parents who say that vaccines gave their children autism are deeply suspicious of what they see as the government's role in their children's illness. Most have dismissed the many government-sponsored studies and panels that found no link between vaccination and autism. A few have even physically threatened some government scientists.

Parents' lawyers said this case would probably affect only a few of the other claims. A test hearing for the other claims will be heard next year, said Mike Williams, chairman of a committee of parents' lawyers.
Source :http://www.boston.com

Home-based care program also benefits the insurer

Every year, about 1.5 million Americans are diagnosed with cancer. Every year, they run up a medical tab estimated at $100 billion.

Some of that money is spent on unnecessary hospitalizations and emergency room visits, which is why Blue Shield of California sends a nurse to Pamela Sprott's home in Valencia several days a week.

"I am not in the hospital because she makes sure I am taken care of," Sprott, 56, said of the care coordinator who keeps track of her mind-boggling regimen of chemotherapy treatments and drug prescriptions and the appointments with specialists who treat her leiomyosarcoma, a rare form of cancer that started in her uterus.

Supplying care coordinators is one of Blue Shield's strategies to prevent patients' conditions from worsening while containing the costs of treatment. By vigilantly managing Sprott's treatment, the insurer lowers her risk of developing complications, such as dehydration or anemia, that could land her in an emergency room or hospital bed.

"What we are saying is, let's just keep the bad stuff from happening in the first place," said Andrew Halpert, Blue Shield's senior medical director.

A Blue Shield study published in the American Journal of Managed Care found that patients like Sprott had 30% fewer emergency room visits and 38% fewer hospital admissions than Blue Shield cancer patients who didn't receive the intensive care coordination.

The study, co-authored by Halpert, concluded that the care-coordination program, launched on a trial basis in 2003, saved more than $18,000 per patient on average in an 18-month period. Survival rates remained virtually the same.

Blue Shield, which with 3.2 million members is the third-largest health plan in California, rolled out the patient-centered management program statewide this year to about 800 patients with late-stage cancer and other serious diseases. The insurer hasn't disclosed the cost of the program, but the study concluded that the trial had a return-on-investment ratio of 2 to 1.

Most health plans have call centers with customer service representatives who answer members' questions about their coverage and help them find specialists, among other things. But the service isn't personalized.

At Blue Shield, each coordinator handles no more than two dozen patients, and they are regularly visited at home.

A chief goal of the program is to keep people out of hospitals, and especially emergency rooms. Patients who land in the ER are likely to be seen by a doctor with little or no background in oncology, said Thomas B. Strouse, the director of pain management at the Cedars-Sinai Outpatient Cancer Center in Los Angeles. That is no good for the patient or the insurance company paying most of the bill.

The idea of decreasing hospitalization to rein in healthcare costs isn't new. For a decade, Kaiser Permanente, the state's largest health maintenance organization, has offered intensive home-based treatment to some of its sickest patients, including cancer sufferers.

The end-of-life care saved about half the costs of treating such patients without the program, according to Kaiser, which plans to double the number of Southern California patients who receive care at home to 2,000 this year.

Avoiding costly hospitalizations is increasingly important for insurers, said Michael Burcham, president of ParadigmHealth Inc. of Upper Saddle River, N.J., which specializes in care coordination for complex cases that include cancer, neo-natal and spinal cord patients. The company, whose clients include Blue Shield, has seen its business grow 20% to 25% a year since 2002.

"If you look at the elderly population, hospitalization is a significant piece of the cost," Burcham said. "As the baby boomers age, we will be facing more of these cases."

Beyond that, patients who remain at home tend to feel more comfortable with their treatment regimen than patients in hospitals.

Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, welcomes the trend. But echoing many patients' advocates, he cautions that such decisions should be based on medical evidence, not cost concerns.

Blue Shield executives said their program was designed to avoid unnecessary treatment rather than withhold what's needed.

Health insurers' attempts to cut costs have often met with accusations that the savings come at the expense of care. Denial of requested treatment is one of the most common complaints that clients lodge, according to the California Department of Managed Health Care. The state received 1,080 such complaints last year, 524 of them against San Francisco-based Blue Shield. The nonprofit health plan is also among a handful of California insurers to be sued by patients saying they were dropped once they became ill and accumulated large medical bills. Blue Shield and the others have denied wrongdoing. Sprott, a former teacher who's married to Robert Sprott, a Superior Court judge, is undergoing chemotherapy and trying not to think about her life ending. The couple have a 15-year-old son.

A few years ago, before she learned she had cancer, she was in a serious car accident.

"The car rolled over three times," she said. "I thought I was going to die then. I don't know that I'll die of cancer. It might be something else, but you just have to take one day at a time and enjoy the day."
Source :http://www.latimes.com

TB threat for 200 Calgarians

Calgary health officials are testing 200 people who may have been exposed to tuberculosis while visiting a city hospital.

But the Calgary Health Region's Dr. Robert Cowie yesterday stressed the risk of contracting the disease is low and the measures are being taken as a precaution.

"It is not highly infectious -- we're just being ultra careful," said the director of the region's tuberculosis clinic.

"This particular situation is a low-risk environment."

Cowie said 200 people who visited the emergency department at the Peter Lougheed hospital March 27 may have been exposed to a patient with pulmonary tuberculosis.

Letters were sent this month to those people requesting they contact the health region to be tested for possible infection, said Cowie.

"It takes eight to 12 weeks before the test for tuberculosis infection becomes positive after someone has been exposed," he said.

As of this week, he said about 30 people have been tested and none are positive.

Cowie said the CHR calls for public testing for possible tuberculosis infection as often as 10 times each year.

"There's probably no time in the year when we aren't following up with someone who's been exposed to tuberculosis," he said.

He said anyone who tests positive for infection would be placed on a four-month course of treatment to ward off the disease.

The patient with pulmonary tuberculosis who attended the emergency department in March was unaware they had the disease, said Cowie.

The patient is receiving treatment, which takes up to nine months, he added.

Tuberculosis is an infectious disease spread through close contact over an extended period of time and is not easily spread to others, said Cowie.

In 2006, there were 56 confirmed cases in the region.
Source :http://calsun.canoe.ca

Lack of funding putting Ontario's water at risk

TORONTO — Ontario risks compromising the safety of its tap water because many small towns and cities lack the resources to meet proposed stringent new standards for operating drinking water systems, says the head of a task force that two years ago called for a sweeping overhaul of the province's water systems.

“I'm suggesting specifically they're running higher risks on public health than we should be willing to tolerate,” Harry Swain, chairman of the Water Strategy Expert Panel, said in an interview.

Seven years after the Walkerton tainted-water tragedy claimed seven lives and left thousands ill, many Ontario residents have something new to worry about – lead in their tap water.

Last week, the province's Environment Ministry ordered 36 cities and towns to test older homes – typically those built before 1955 – for possible lead contamination in their drinking water. The order went out after high levels of lead were found in one in four homes tested in London.

The lead levels were detected even after flushing, which typically replaces water that has come in contact with lead pipes. Lead poses a health risk for pregnant women and young children. The order says excessive corrosion of pipes may be causing lead to leach into the water in other municipalities, including Toronto.

Opposition members have criticized the government's response as woefully inadequate because the testing is confined to 20 single-family homes in each municipality. Progressive Conservative MPP Laurie Scott asked in Question Period this week why the government was not testing the water in more homes and also in schools and hospitals.

“It's as if the Keystone Cops are running the Ministry of the Environment,” Ms. Scott said.

Environment Minister Laurel Broten said she wasn't going to accept advice from the Tories, which left the province with the Walkerton legacy.

New Democrat MPP Peter Tabuns criticized the government for not moving faster.

“You've got a big problem with lead and you've got a bigger looming problem with water quality because the infrastructure is not getting funding that's needed,” he said.

The problem has hit close to home. This week, politicians and staff in the Ontario legislature were told not to drink the water because lead has been detected in the 114-year-old building's tap water.

Worried homeowners in Toronto have inundated city hall with calls. Lou Di Gironimo, general manager of Toronto Water, said 500 homeowners have requested water tests since the order went out, up from 50 in the first four months of this year. The city plans to meet every one of those requests, he said.

About nine per cent of the 500,000 houses in Toronto have water pipes made of lead, according to an internal briefing prepared by Mr. Di Gironimo's office. Six of 86 homes tested this year had elevated lead levels in their tap water.

Mr. Swain said he is troubled the Ontario government has not acted on a key recommendation of the panel that water utilities be consolidated. A water utility ideally should have at least 30,000 customers to give it the economies of scale to provide safe and affordable water. However, Ontario had about 640 water utilities serving fewer than 10,000 customers, according to a 2002 tally done by the Environment Ministry.

Under the government's proposal to ensure that drinking water is safe, municipal drinking water systems will need to meet quality management standards, including enhanced training for operators, before they can obtain an operating licence.

Pat Vanini, executive director of the Association of Municipalities of Ontario, said it does not make sense to amalgamate water utilities that are geographically isolated. Many municipalities are strapped for funding because the previous Progressive Conservative government shifted responsibility for many services to them, she said.

“If we could resolve the $3-billion-plus in downloading, that would add some financial capacity for municipalities to invest in services,” she said.

Amy Tang, a spokeswoman for Infrastructure Renewal Minister David Caplan, said the government needs to be flexible in implementing the panel's recommendations. “Some municipalities have been very good at investing in their water systems, others have not,” she said.
Source :http://www.theglobeandmail.com

Vietnam confirms second bird flu case in two weeks

Hanoi - Vietnam has confirmed its second human case of the H5N1 avian flu virus in two weeks, after reporting no human cases in the previous 18 months, local press reported Saturday.

In addition, a Vietnamese health official said at least two other patients are suspected of having the disease, the reports said.

Vietnamese media Saturday quoted Dr. Tran Duc Hien, director of the Hospital for Tropical Diseases in Hanoi, as saying that an employee at a slaughterhouse in the city had tested positive for the avian flu virus.

The man, whom authorities are referring to only by his first initial, T., had reported to a health station on May 19, complaining of breathing difficulties, a runny nose and a persistent chill.

Hien said T. remains in treatment at the Hospital for Tropical Diseases. Vietnam's other confirmed case, a 30-year-old man from Vinh Phuc province who tested positive for H5N1 on May 20 after killing the chickens for a friend's wedding, is being treated at Hanoi's Bach Mai Hospital.

That patient has recovered and will be released soon, according to doctors.

'He's now much better,' Dr. Tran Thuy Hanh, acting director of Bach Mai, said Saturday. 'Tests have shown that he's negative to H5N1.'

Hanh also said that besides the two confirmed cases, at least one other patient currently in treatment, and one who died Friday, are suspected of having the disease.

Hanh said the patient who died was admitted Thursday night for complications related to gout. After he died the next morning, she said, 'the hospital X-rayed him as a precaution, and found that his lungs were completely white.' Results of his H5N1 test were not yet available.

The second suspected case was also admitted on Thursday. He is a 29-year-old policeman who had taken part in the culling of sick chickens.

The latest confirmed case brings the total number of confirmed human cases in Vietnam to 94 since the disease emerged here in late 2003. International health authorities generally regard Vietnam as a success story because of its aggressive efforts to control the disease in animals and to test and treat human cases.
Source :http://news.monstersandcritics.com

Still in the shade

Sunscreen is the snake oil of the 21st-century,” said Samuel Rudman, a lawyer at Lerach Coughlin, announcing that the firm was filing a class-action lawsuit in the Los Angeles Superior Court against five leading sunscreen manufacturers. Rudman’s allegation – that the companies behind household names such as Hawaiian Tropic and Neutrogena were misleading consumers about the cancer-protective powers of their products – was based on the evidence of consumers who had worn sunscreen, but still contracted skin cancer. It sent tremors across the sun-kissed beaches of the Californian coastline.

The outcome of this case is still pending, but it’s not just our sun-spoilt friends on Santa Monica beach who should be sweating. With Britons set to bask in another scorching summer, even the more sun-savvy tanners, who slather on a high SPF, may not be as protected as they think. Why? Because the SPF rating on the average sunscreen relates only to UVB rays that cause sunburn and are associated with the development of skin cancer, not the wrinkle-causing UVA rays, which, until recently, were thought to be relatively harmless.

However, it is now believed that UVA rays penetrate the skin, distorting the structure of cells, elastin and collagen. The cumulative damage is irreversible and can go undetected for years. A growing number of scientists think that prolonged exposure to UVA rays greatly contributes to melanoma, the deadliest skin cancer. Brian Diffey, professor of photobiology at Newcastle University, warns: “By 2035, there could be 21,000 new cases of melanoma a year in the UK, as those who sunburnt badly in the 1980s and 1990s suffer the long-term effects.” Yet millions of people are oblivious to this time bomb and will still spend hours in the sun, striving for a perfect bronze glow.

Dr Des Fernandes, a plastic surgeon and founder of Environ skincare, claims that 60% of UVA rays penetrate even the best sunblock. If this is the case, why are we no clearer on what UVA protection sunscreens offer? The problem is that the men in white coats and beauty corporations have failed to establish a universal, SPF-type rating system for UVA, because they have yet to agree on a method of measuring the effectiveness of UVA-blocking products. So, while protection against UVB rays is indicated with a number, such as SPF 15, UVA protection is denoted in many different ways, including broad-spectrum, broad-band protection, numbers and stars.

Boots has been commended for attempting to bring clarity to the issue by introducing the star-rating system for UVA protection as early as 1991. However, Cancer Research UK describes it as “vague” and “confusing” in the way it measures UVA protection only in relation to UVB: for example, a high-SPF sunscreen with two stars may give better overall protection than a low SPF with three stars. And other critics point out that the star system does not account for photostability (the ability of the product to remain on the skin during sun exposure).

Faced with the challenge of creating a standardised guide to UVA protection, beauty companies argue that as long as there is no universal method to objectively measure the long-term effects of UVA on the skin, such a system seems a long way off. Animal testing has proved inconclusive: tests on mice suggest that UVB rays cause melanoma; tests on fish found UVA rays incubated the disease. As Chris Flower of the Cosmetic, Toiletry and Perfumery Association (CTPA), a group that promotes the interests of companies such as Estée Lauder, Johnson & Johnson and Procter & Gamble, says: “It takes time to prove a scientific theory. If UVA takes years to lead to premature ageing, how are you going to test the product’s benefit if it won’t show for years?”

Various companies claim to have discovered their own “ground-breaking” products to protect against UVA rays. L’Oréal says its patented filters, Mexoryl SX and Mexoryl XL, contained in brands such as Ambre Solaire, form the most effective UVA filtering system available. Other companies suggest that mineral filters – the zinc oxide and titanium dioxide contained in Z01 Body Protection Lotion, for example – provide the best broad-band UVA and UVB protection. Fernandes believes his Environ range of antioxidant-rich products will fight the free radicals caused by sun exposure, and that this is crucial to preventing skin cancer. The New York dermatologist Dr Dennis Gross, the man behind MD Skincare, says the answer lies in chelators, a group of metal-binding molecules. He believes chelator-rich products counteract iron, an aggressive free radical found on the skin that generates other free radicals, which, in turn, are a trigger for skin cancer.

However, many scientists say that nobody can lay claim to the ultimate UVA protection. “Skincare companies are not the founts of all knowledge. Their primary objective is to sell products,” says Diffey. “There are active ingredients that can provide equal, if not broader, UVA screening than Mexoryl. The protection provided by antioxidants is small; as for chelators, reducing free-radical damage can help, but shade and clothing can provide you with 10 times the protection of these ingredients.” His only advice to people wanting to protect themselves from harmful rays is: “Stay indoors with the curtains closed.” But, as we head into the holiday season, that is not going to happen.

However, there is hope on the horizon. The European Cosmetic Toiletry and Perfumery Association (Colipa) has developed a test-tube (in vitro) method of assessing UVA protection that meets European commission recommendations. This could form the basis for a universal system, but initially it would apply only to Europe. The CTPA has indicated that it plans to adopt Colipa’s standardised system, but due to product cycles, sunscreens featuring the Colipa logo will not appear until next year.
Source :http://women.timesonline.co.uk

Time for Universal Coverage?

Sen. Barack Obama became the latest presidential candidate to call for universal health coverage this past week.

It's been 13 years since First Lady Hillary Clinton's effort at creating universal health care helped cause Democrats to lose control of Congress. Nevertheless, Democratic presidential hopefuls are once again embracing the proposition, following the lead of some Republican governors.

Earlier this year, California Gov. Arnold Schwarzenegger unveiled a plan to cover all of the state's uninsured and Massachusetts next month implements the nation's first comprehensive coverage plan, requiring residents to buy health insurance or face tax penalties. That plan was signed into law by then-Gov. Mitt Romney, now a Republican candidate for president.

Here's a closer look at the issue:

Why the new focus on health care?

Rising public support for health-care reform reflects increasing costs for employees and employers. Health-care costs per capita will reach $7,500 this year, an $800 increase over the past two years and more than double the $3,470-per-person figure in 1993.

Meanwhile, the ranks of the uninsured have grown to 45 million from 37 million since 1993, and those costs are passed onto the government, taxpayers and insurance holders. In 2005, those with insurance paid a "hidden tax" of about $922 on their insurance premiums to cover unpaid health-care costs of the uninsured, according to a study by Families USA, a consumer advocacy group. The rising costs of the uninsured could raise premiums by an additional $1,500 by 2010.

While employers are leery of mandates that require them to insure employees or face fines, big businesses have increasingly called for government action because rising health costs put them at a competitive disadvantage with foreign companies.

How do the parties differ? Republicans support measures that minimize costs to the government and encourage greater consumer choice. Earlier this year, President Bush proposed taxing employer-provided health insurance, which is currently tax-exempt. He argues that the current system encourages workers to choose more expensive coverage in order to get a bigger tax break.

The plan, which wouldn't increase costs for the government, would give all individuals -- those who purchase their own coverage and those who have employer-sponsored coverage -- tax breaks of $15,000 for families and $7,500 for individuals. The proposal received a cool response on Capitol Hill.

Congressional Democrats tried to pass a bill earlier this year that would have allowed the government to negotiate directly with drug makers to lower drug prices for Medicare. But a Congressional Budget Office report said that allowing negotiations would have a "negligible effect" on federal spending, saving about $2 million in its first year, unless the government was willing to restrict formularies, or the lists of drugs available to beneficiaries.

Democrats also favor an expansion of the State Children's Health Insurance Program. But few advocate as ambitious an approach as the 1993 Clinton plan, which included an employer insurance mandate and would have created competitive but highly regulated HMOs.

How would candidates pay for their reforms? Both John Edwards and Mr. Obama would fund their plans by ending President Bush's tax cuts for the wealthy, effectively raising taxes on those who make more than $250,000. Mr. Obama would repeal the Bush tax cuts on capital gains and dividends and Mr. Edwards advocates increased efforts to collect capital gains taxes by requiring brokerage houses to report capital gains from stock sales.

Would Americans support higher taxes to pay for reforms? Polls show that they might. According to a March NBC News/Wall Street Journal poll, 52% of respondents would pay higher taxes in order to provide universal health insurance, compared with 41% that opposed.

Americans cited health care as the top domestic priority, and the second-most important priority overall after the Iraq war in an April poll, topping issues such as illegal immigration, energy and the economy.

Does either party have an edge among voters? A March survey by Harris Interactive and The Wall Street Journal Online showed that more Americans trust Democrats to improve health-care policies, at 50% and up from 45% last year, than Republicans, whose support fell to 28% from 31% last year.
Source :http://online.wsj.com

Medical biller accused of scamming $300G from GHI

The accused brains behind a medical billing scam for phony neurosurgeries proved to be no brain surgeon himself, federal prosecutors said.

A Mount Vernon man who worked as a medical biller for a Hawthorne company concocted a scheme to submit bogus claims and post-operative reports to the insurer Group Health Inc. for 20 brain surgeries for three New York City municipal workers and their family members, federal authorities said. The scheme netted more than $300,000 for Charles Pritchett and his three alleged co-conspirators, according to federal prosecutors.

The scam fell apart when an internal audit by Manhattan-based GHI found so many brain operations clustered among three subscribers. GHI received claims for nine brain surgeries from one family and nine from another.

The third alleged co-conspirator submitted claims for brain surgeries for himself and his wife.

"We picked it up through the audit process," said Ilene Margolin, GHI's senior vice president for corporate affairs, "It raised red flags."

Pritchett, 39, of South Ninth Avenue, was arrested Thursday along with Dorothy L. Smith, 42, of Manhattan, and Michael Biscotti, 37, of Staten Island. A fourth suspect, Stanley Cannella, 36, of Manhattan, has not yet been arrested. It is unclear how Pritchett knew the other defendants. They were all charged with health care fraud and mail fraud in a six-count indictment unsealed in U.S. District Court in Manhattan.

Pritchett's lawyer Edward D. Wilford did not return calls seeking comment. Lawyers for the other defendants could not be reached for comment. Cannella's home number has been disconnected.

The scheme began in 2003 when Pritchett used his access to the medical billing company's computer to download legitimate insurance claim forms and post-operative reports from a Manhattan neurosurgeon, federal prosecutors said. Those forms provided the templates he would use for the next three years, federal authorities and GHI said.

Pritchett swapped out the two patients' identifying information for that of two of his alleged co-conspirators, Cannella and Smith, and started submitting bogus claims. On May 30, 2003, the first of the bogus claims was paid by GHI. The insurance provider cut a check for $14,142 to Cannella, who deposited it in his bank account, federal prosecutors said.

Between April 2003 and September 2006, Pritchett and Cannella submitted nine claims for reimbursement for brain surgeries on Cannella, his wife and his two sons. None of those procedures ever occurred, federal authorities said. But all of them were paid, to the tune of $142,268.

Smith and Pritchett submitted nine claims for Smith, her husband and their two daughters between June 2003 and December 2005. All nine claims were paid, including three for the same bogus operation. In all, GHI paid Smith $131,397 in phony claims, federal authorities said.

Biscotti and Pritchett submitted bogus claims for his and hers brain surgeries on Biscotti and his wife in March and June 2004, according to federal authorities. GHI paid Biscotti $31,041 for the two bogus claims.

After GHI did the internal audit, it launched its own investigation and then contacted the U.S. postal inspector and the U.S. Attorney's Office, Margolin said.
Source :http://www.thejournalnews.com

6 Billion Bits of Data About Me, Me, Me!

JAMES D. WATSON, who helped crack the DNA code half a century ago, last week became the first person handed the full text of his own DNA on a small computer disk. But he won’t be the last.

Soon enough, scientists say, we will all be able to decipher our own genomes — the six billion letters of genetic code containing the complete inventory of the traits we inherited from our parents — for as little as $1,000.

Just what we will do with the essence of who we are once we bottle it, however, is likely to be as much a social experiment as a scientific one.

As thousands of people decode their DNA over the next few years, they are likely to find themselves facing a genetic mirror whose reflection changes on an almost daily basis.

The more genomes that scientists have to work with, the more they can learn about them. So staying on top of your own health outlook may begin to resemble checking the performance of your stock portfolio. One day you find you have a gene that puts you at risk for diabetes; the next it’s one that may make you live longer.

“Nobody quite knows how to manage expectations in such a rapidly changing and deeply personal field,” said George M. Church, a Harvard Medical School geneticist who directs the Personal Genome Project. “The picture is getting more and more complete, but along the way there’s going to be a lot of, ‘You told us this last week and now you’re telling us this!’ ”

By the end of the summer, Dr. Church’s research project promises to deliver sequences to its first 10 volunteers. Unlike Dr. Watson, whose complete genome cost $1 million, the project’s volunteers will receive the one percent of their genome currently deemed most useful at a cost of $1,000.

One start-up company, 23andme, recently announced plans to provide affordable chunks of their DNA to individual consumers, along with tools to help them keep track of and understand their genetic information.

And technology companies like Illumina, Applied Biosystems and 454 Life Sciences, which solicited Dr. Watson’s DNA to prove its abilities, say the price of a complete human genome has already dropped to $100,000. They are competing for a $10 million “X prize” to sequence 100 human genomes within 10 days. (Dr. Watson’s took about two months.)

Those who have signed up to be sequenced as part of the competition include Paul Allen, co-founder of Microsoft; the astrophysicist Stephen Hawking; the television interviewer Larry King; and the financier Michael Milken.

“It’s the start of an era of comparative individual genomics,” said J. Craig Venter, who as president of the Celera Corporation sequenced much of his own genome in 2000 and recently completed it. “Hopefully we’ll have tens of thousands to compare in the next year or two.”

Dr. Venter said he consulted his genetic profile every time a new announcement of a gene discovery came out. Just last month, having read a report in this newspaper about a gene that raises the risk of heart disease, he found that he indeed carried the mutation.

He might have guessed that from his family history, but knowing his individual risk, rather than a statistical average, is a stronger motivator to change, Dr. Venter said. Because of another risk gene he carries for heart disease, he altered his diet and has been taking a cholesterol-lowering drug for several years.

“Now we can do something to alter what might have been our genetic destiny,” he added.

Beyond heart disease, there are a growing number of genes already known to influence predispositions to common diseases like breast and colon cancer, depression and dementia.

There are other reasons to unravel your genome. Embracers of nature over nurture may sift through their 20,000 genes to find an explanation for personality traits thought to have a partial genetic basis — like early rising, risk-taking, shyness and addiction.

And the curiosity is unlikely to be restricted to our own genetic code. A generation of personally motivated amateur geneticists may seek out others who have similar traits and similar quirks in their genetic code, hoping to deduce a connection.

Friends and families, too, may begin to compare notes.

“You can imagine a family who won’t let someone marry their daughter until they examined her prospective husband’s genome,” Dr. Watson suggested at a news conference on Thursday. “You’ll want to know what your mate is going to have.”

The mate, of course, may not want to know himself. Dr. Watson told the company that sequenced his genome not to reveal to him the status of one gene known to predispose people to Alzheimer’s disease. “Who wants to know that?” he said.

But Dr. Watson, 79, may yet learn that his genome contains Alzheimer’s risk genes that may be discovered tomorrow or next month or next year. On the other hand, he may find that he carries genes that offset the risk. Or both.

Moreover, because the way genes influence health and behavior depends heavily on their interaction with the environment, what our genome can tell us may change depending on lifestyle choices.

People who learn they carry a higher genetic risk of Type II diabetes, for instance, may see that risk increase if they start to gain weight. A gene that makes it difficult for some people to sweat in extreme heat might not matter to you if you live in Seattle. But if you are thinking of moving to Miami, knowing it exists in your genome could prove useful.

The lack of established medical authorities to interpret or filter such information could cause deep discomfort, some experts caution. And the technology is quickly outpacing social debate over how it should be handled.

“Some people are going to have information that they don’t know what to do with,” said Angela Trepanier, president elect of the National Society of Genetic Counselors. “And that can do more harm than good.”

Still, the early boosters of the personal genome say the best bet for improving individual health care is not only to embrace genetic knowledge about ourselves, but to share it with others.

If hundreds of thousands of people make their genomes public — along with personal information about their ancestry, their health history, what they look like, what they do and where they live — they argue, scientists will finally be able to draw meaningful correlations between variations in DNA sequence and any trait that has even a partial genetic basis, from what drugs we should take to what foods we like to eat.

As that happens, everyone with a sequenced genome will learn how the new findings affect them.

“Let’s sequence prominent Texans,” Dr. Watson said at the press conference in Houston last week. “What we really want now is a lot of data.”

Until then, even Dr. Watson, who posted his genome on the Internet last week, has to wait. At a ceremony marking the occasion, he stared at the disk containing his genome for a few seconds, then stuck it in his pocket.
Source :http://www.nytimes.com/

New Treatments for Tough Cancers Show Promise

Advances in treating lung and head/neck cancers could have immediate implications for patients, new research suggests.

Three studies detailing the findings were presented at a press conference Saturday at the American Society of Clinical Oncology annual meeting, in Chicago.

These types of cancer are notoriously difficult to treat, and have extremely low survival rates. Lung cancer is currently the number one cancer killer in the world. Head and neck cancers rank sixth, with 500,000 new cases and 300,000 deaths worldwide each year. Progress, particularly with lung cancer, comes in small increments.

"These are two very difficult-to-treat cancers," said Dr. Roy S. Herbst, moderator of the press conference and a professor of medicine and cancer biology at the University of Texas M.D. Anderson Cancer Center in Houston.

One study found, for the first time, that giving Avastin (bevacizumab) to patients with advanced non-small cell lung cancer, along with the chemotherapy drugs cisplatin and gemcitabine, slowed the growth of the cancer by up to 25 percent. The data confirms earlier results.

"This cancer is very hard to treat. There have been some advances, but we have reached a treatment plateau and we need more agents which may help us to offer better treatment to patients," said study author Dr. Christian Manegold, a professor of medicine at the University of Heidelberg in Germany. "We were able to confirm that Avastin adds efficacy to standard chemotherapy and provides hope for patients suffering from a deadly disease."

The U.S. Food and Drug Administration approved Avastin in October to be used in combination with chemotherapy drugs carboplatin and paclitaxel. The new study looked at Avastin with chemotherapy drugs cisplatin and gemcitabine. The study was funded by Hoffman-La Roche, parent company of Genentech, which makes Avastin.

Thirty-four percent of patients in the low-dose Avastin group and 30 percent of those in the high-dose Avastin group saw their tumors shrink, compared with only 20 percent in the chemotherapy-alone group. The duration of response was 6.1 months in both Avastin groups vs. 4.7 months in the control group.

A second study found that radiation delivered directly to the head in patients who have advanced-stage small cell lung cancer cut the risk that the cancer would spread to the brain by about two-thirds.

This type of lung cancer represents about 15 percent of all lung cancer cases in the United States, and tends to be more aggressive. "At diagnosis, about two-thirds of patients already have disseminated disease," said study author Dr. Ben Slotman, professor and chairman of radiation oncology at VU University Medical Center in Amsterdam, the Netherlands.

"The prognosis is poor," agreed Dr. Corey Langer, a medical oncologist at Fox Chase Cancer Center in Philadelphia. "The first shot [of treatment] is the best shot."

In the study, 286 patients who had already responded to chemotherapy were randomly chosen to receive radiation to the head or no radiation.

One year later, 14.6 of patients in the radiation group had developed brain metastases, vs. 40.4 percent in the control group. Also, 27 percent in the radiation group were alive at one year, compared with only 13.3 percent in the control group.

"This study shows that prophylactic cranial radiation [PCI] significantly reduces the risk of brain metastases at one year and it also shows that PCI prolongs survival," Slotman said. "It was well-tolerated, and it didn't adversely influence quality of life. Based on these results, PCI should now routinely be offered to all patients responding with small cell lung cancer who respond to chemotherapy."

Other experts aren't so sure, however. For one thing, study participants in the control group had a shorter survival than usually seen, making it unclear if the participants were representative, Langer said. "I don't know if this will make a wholesale adoption of PCI possible, but it offers justification for giving PCI to certain patients."

In a third study, adding the targeted therapy Erbitux (cetuximab) to a first-line chemotherapy that included cisplatin or carboplatin extended survival for patients with head and neck cancer that had spread to other parts of the body.

"The worst category are patients who have recurrent or metastatic disease," said study author Dr. Jan B. Vermorken, a professor of oncology at the University of Antwerp, in Belgium. "These patients are being treated in general with chemotherapy but, over the last 25 years, not much has changed in outcome when we treat these patients with chemotherapy. The median survival is six to seven months."

But patients who received Erbitux plus chemotherapy lived a median of 10.1 months, compared to 7.4 months in the control group, which had received only chemotherapy.

"This is a very unique observation. We have never seen this before in the last 25 years -- that adding a drug to chemotherapy is giving a better survival for these patients," Vermorken said.

One side effect, a skin rash, is particularly problematic, however. "It's not a mild rash," Langer said. "It potentially compromises quality of life. This isn't a free ride."

Two additional studies presented at the press conference looked at markers of lung and head and neck cancers.

Researchers at Duke University identified molecular pathways that are altered in advanced non-small cell lung cancer that could offer a new target for treatment.

The final study, funded by Bristol-Myers-Squibb, showed that variations in genes involved with metabolizing chemotherapy drugs may help explain why American and Japanese patients with advanced non-small cell lung cancer respond differently to therapies.

"We looked at normal DNA within the host [patient] and how to exploit these molecular profiles to improve therapeutic outcome," explained study author Dr. David Gandara, director of clinical research at the University of California, Davis.
Source :http://www.forbes.com

TB patient: 'I hope they forgive me'

DENVER — An Atlanta attorney quarantined with a dangerous strain of tuberculosis apologized to his fellow plane passengers in an interview aired Friday, and said he was told he wasn't contagious or a threat to anyone.

"I feel awful," Andrew Speaker said, speaking through a mask with ABC's "Good Morning America" at his hospital room in Denver. "I've lived in this state of constant fear and anxiety and exhaustion for a week now, and to think that someone else is now feeling that, I wouldn't want anyone to feel that way.

"I don't expect those people to ever forgive me. I just hope they understand that I truly never meant them any harm."

Speaker, 31, said he, his doctors and the federal Centers for Disease Control and Prevention all knew he had TB before he flew to Europe for his wedding and honeymoon last month. But he said he was told that he wasn't contagious or a danger to anyone. Officials said they would rather he didn't fly but didn't forbid it, he said.

His father, also a lawyer, taped that meeting, he said.

"My father said, 'OK, now are you saying, prefer not to go on the trip because he's a risk to anybody, or are you simply saying that to cover yourself?' And they said, we have to tell you that to cover ourself, but he's not a risk."

Speaker, his new wife and her 8-year-old daughter were already in Europe when the CDC contacted him and told him to turn himself in immediately at a clinic there and not take another commercial flight.

Speaker said he felt as if the CDC had suddenly "abandoned him." He said he believed if he didn't get to the specialized clinic in Denver, he would die.

"Before I left, I knew that it was made clear to me, that in order to fight this, I had one shot, and that was going to be in Denver," he said. If doctors in Europe tried to treat him and it went wrong, he said, "it's very real that I could have died there."

Even though U.S. officials had put Speaker on a warning list, he caught a flight to Montreal and then drove across the U.S. border on May 24 at Champlain, N.Y. A border inspector who checked him disregarded a computer warning to stop Speaker, officials said Thursday.

The unidentified inspector later said the infected man seemed perfectly healthy and that he thought the warning was merely "discretionary," officials briefed on the case told The Associated Press. They spoke on condition of anonymity because the matter is still under investigation.

The inspector ran Speaker's passport through a computer, and a warning — including instructions to hold the traveler, don a protective mask in dealing with him, and telephone health authorities — popped up, officials said. About a minute later, Speaker was instead cleared to continue on his journey, according to officials familiar with the records. The inspector has since been removed from border duty.

Colleen Kelley, president of the union that represents customs and border agents, declined to comment on the specifics of the case, but said "public health issues were not receiving adequate attention and training" within the agency.

The next day, Speaker became the first infected person to be quarantined by the U.S. government since 1963.

He was flown by medical transport Thursday to National Jewish Medical and Research Center, where doctors put him in an isolation room where he will be treated with oral and intravenous antibiotics.
Source :http://www.chron.com