New Study Reaffirms HRT Link to Breast Cancer Rate Decline

TUESDAY, July 24 (HealthDay News) -- Scientists have once again linked a drop in breast cancer rates from 2003 to 2004 to a parallel decrease in women's use of hormone therapy beginning in 2002.
The decline in breast cancer rates persisted even though mammography screening rates remained stable, said researchers at Kaiser Permanente, reporting in the August issue of the Journal of the National Cancer Institute.
"The message is pretty straightforward," said study lead author Dr. Andrew Glass, senior investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. "If you need to take hormone therapy to block menopausal symptoms, do it for the shortest duration and the lowest dose."
"We now have a second observation that when we discontinue or decrease hormone therapy, we have a very significant drop in breast cancer incidence," added Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "This is another piece of information that I think women should use in determining whether or not they want to take hormone therapy. To me, it shows that combination therapy [estrogen plus progestin] does increase the incidence of breast cancer. Women need to take this into consideration."
Last December, a different set of researchers reported a precipitous drop in the incidence of breast cancer in 2003 and suggested that the downward trend was the result of millions of women discontinuing use of hormone replacement therapy.
The decline in the number of U.S. women taking hormone replacement therapy came after publication of the results of the landmark Women's Health Initiative (WHI) trial in 2002. That study, involving 16,608 participants, was halted after researchers found elevated health risks among HRT users, most notably for breast cancer and stroke.
Since then, a debate has continued over the utility and safety of hormone therapy, with health officials advising women to take HRT only when needed and for as short a period as possible.
The authors of the new study reviewed the medical histories of 7,386 women diagnosed with invasive breast cancer and treated at Kaiser Permanente Northwest between 1980 and 2006. The records were available through Kaiser Permanente's computerized database, which includes a tumor registry and clinical, pathology, radiology and pharmacy data systems.
From the early 1980s to the early 1990s, breast cancer rates rose 26 percent, then an additional 15 percent through 2001. From 2003 to 2006, rates dropped by 18 percent.
The 26 percent increase paralleled increases in the rates of mammograms as well as increases in the use of hormone therapy, especially combination therapy, the researchers said.
The 15 percent increase -- from 1992 to 2002 -- echoed a continued rise in the use of hormone therapy, although mammogram rates remained stable from 1991 rates.
The drop in breast cancer rates starting in 2003 coincided with a 75 percent drop in hormone therapy rates, although mammography rates remained the same.
"When HRT went down, breast cancer rates went down and mammography rates remained the same," Glass said. "This was an important finding, because others had suggested maybe the drop in breast cancer rates was because mammograms had gone down, but it didn't happen in the Kaiser numbers. The only thing we can figure out is, it's probably related to HRT, that fluctuations in HRT are the most likely explanation for fluctuations in breast cancer rates."
The increase in breast cancer rates occurred primarily in women over the age of 45 who had estrogen receptor-positive breast cancer.
According to Glass, this study is the first to document all these different factors -- mammography, hormone therapy, breast cancer and estrogen-receptor status -- in one study.
But one expert found the study's conclusions lacking.
"This is an interesting look at the picture but really is not evidence-based medicine," said Dr. Lila Nachtigall, director of the women's wellness program at New York University Medical Center and professor of obstetrics and gynecology at New York University School of Medicine. The study did not correlate individual cases of breast cancer with hormone use, therefore issues of causality cannot be decided, she added.

Glucosamine Trials Show Little Benefit Against Arthritis

FRIDAY, June 29 (HealthDay News) -- Although millions of arthritis sufferers buy glucosamine supplements to ease their joint pain, there's still no convincing proof the product works, according to a major new analysis.
In fact, the results of 15 trials of over-the-counter glucosamine vary so widely that industry bias may be a factor influencing the more positive outcomes, concludes a team writing in the July issue of Arthritis & Rheumatism.
"There's a big difference between trials, much more than you would expect by chance," explained lead investigator Dr. Steven Vlad, a fellow in rheumatology at Boston University Medical Center.
But an editorialist in the journal refutes those claims.
Dr. Jean-Yves Reginster, of the World Health Organization's Collaborating Center for Public Health Aspects of Rheumatic Disease, in Liege, Belgium, counters that industry trials are typically more stringent than independent academic research. He also believes that Vlad's group included trials in their analysis that were very unalike in terms of timeframes and methodology, confusing the results.
So, the years-long scientific debate on glucosamine continues. The popular supplement did take a major hit earlier this year, when a major U.S. study published in the New England Journal of Medicine found glucosamine hydrochloride to be of little help for knee osteoarthritis.
But Vlad also knew that other studies had found a real benefit to regular glucosamine use. Why the differences between trials?
To find out, he and his team combed through the available literature and selected 15 double-blind, placebo-controlled, randomized clinical trials that looked at the use of glucosamine for more than four weeks to help fight hip or knee osteoarthritis pain.
Trials involved either of the two major glucosamine preparations: glucosamine hydrochloride or glucosamine sulfate. Each delivers glucosamine bound to a different chemical salt.
First of all, the team determined one of the preparations to be useless.
"I think we have shown pretty conclusively that glucosamine hydrochloride doesn't work," Vlad said. "The data there is all consistent, it goes together -- there's just no evidence that it works."
But that wasn't the story with the other preparation, glucosamine sulfate.
In that case, results varied widely between the randomized trials. However, that variance went far beyond random chance. In fact, according to Vlad, the spread in results among various trials was four times that which would be normally expected.
No particular feature of the studies' design helped explain this disparity, except for differences among trials in what's known as "allocation concealment" -- the fact that some trials were more lax than others at concealing from the researchers involved which patients would get the drug and which would get a placebo.
One factor did appear to play a role in the variance between the glucosamine sulfate trial results: industry involvement.
"It's really hard to know just how big a factor that is," Vlad said, "whether it's manufacturing the whole effect or just exaggerating an effect that's there." He also stressed that, "If there is a bias from industry, I doubt very much that it is intentional. People want to sell their product, but I think that they rarely go into a study with the intention of twisting the results."
But Reginster, in his editorial, believes Vlad's own analysis is flawed. He agreed with the Boston group that industry involvement can, and often does, influence trial results. But he also notes that many of the industry studies included in the Boston analysis had to pass muster with the European League Against Rheumatism, the expert body which vouched for many of the trials' high quality.
That's important, he said, because -- unlike in the United States -- glucosamine sulfate is approved for sale as a prescription drug by regulatory agencies in Europe. To gain approval, industry-funded trials must conform to regulatory oversight and are often better designed than independent studies, he noted.
But Vlad doesn't buy that argument. "I would agree with [Reginster] that, in general, drug manufacturers do produce better trials," he said. "But I also believe it is too simplistic to say that academic researchers aren't as good at weeding out confounding factors and things that would influence the results. They can produce trials that are every bit as good."
Another expert weighed in on the issue.
"I have worked on both sides [industry and independent]," said Malachy McHugh, director of research at the Nicholas Institute of Sports Medicine and Athletic Trauma, at Lenox Hill Hospital, in New York City. He said one issue at play is the dire lack of quality independent studies.
"In the nutritional supplement area, the bigger problem is that there is a disincentive for companies to have their products tested," he said. "If they can convince people that their product works, why run the risk of proving otherwise? There are also many negative studies that never see the light of day."
Reginster lobbed another major criticism at the Vlad study. In his opinion, the Boston group mixed together trials with widely varying timeframes (four-week studies and three-year trials), glucosamine delivered in both injections and pills, and studies of greatly differing quality. This type of heterogeneity was bound to lead to variety in results, he wrote.
Vlad agreed that his team's analysis did cast a wide net, but he said that's the way meta-analyses are typically performed. "You try and capture all the trials that may be relevant to your question," he said. Select too few trials, he said, and you lose statistical power.
The system is "never going to be perfect," Vlad said.
He stressed that the new analysis does not close the book on glucosamine. And given the supplement's good safety profile, patients who really believe they are reaping a benefit from the glucosamine sulfate should feel free to continue to take it.
Vlad and McHugh remain dubious, however, that the pricey supplement does ease osteoarthritis pain.
"From my perspective," McHugh said, "the New England Journal of Medicine paper provides the most objective take on the efficacy. The bottom line is that there is limited efficacy."
In a related study in the same issue of the journal, U.S. researchers surveyed more than 6,000 people with rheumatoid arthritis and found that most are reluctant to switch to a new medication as long as their condition does not worsen.
The team from the National Data Bank for Rheumatic Diseases in Wichita, Kan., found three-quarters of respondents were happy with their current medications, and almost two-thirds (64 percent) said they wouldn't try a new drug unless their symptoms deteriorated. The findings may explain why many patients hold off trying promising new medications, the researchers said.

Study to Assess Hormone Therapy Before Menopause

FRIDAY, June 22 (HealthDay News) -- Researchers at eight locations across the United States plan to examine the safety and effectiveness of estrogen therapy during perimenopause, the few years just prior to menopause.
The KEEPS (Kronos Early Estrogen Prevention Study), led by researchers at the University of Wisconsin (UW) School of Medicine and Public Health, will evaluate the effect that four years of estrogen therapy has on mood and cognition in 720 healthy perimenopausal women.
"There has been a tremendous amount of important and valuable research done on the positive and negative health effects of therapy using estrogen in menopausal women," study leader Sanjay Asthana, head of the UW Section of Geriatrics and Gerontology and director of the Geriatric Research, Education and Clinical Center, said in a prepared statement.
"It is my belief that this study will go a long way in helping us understand the complexity of estrogen and related hormones in humans. It is critical that we continue to systematically address all of the clinical issues concerning estrogen treatment and its effects on diseases like Alzheimer's," Asthana said.
The $3.4 million study will be funded by the U.S. National Institutes of Health.
Among its objectives, KEEPS will compare an arm patch that delivers a natural, human form of estrogen to the commonly used oral form of estrogen synthesized from animal sources.
Other goals include determining the best way to counteract the adverse effects of estrogen on the lining of the uterus and investigating which hormone therapy best mimics the menstrual cycle.

Girls Who Like Dad Favor Partners Who Look Like Him

The study, published in the July issue of the journal Evolution and Human Behavior by British and Polish psychologists, also found that women who had a negative/less positive childhood relationship with their father weren't attracted to men who looked like their father.
The researchers had 49 Polish women (eldest daughters) look at pictures of 15 faces and choose the one they found most attractive. Their selections were compared to their fathers' faces. The women were also asked to rate their childhood relationship with their father.
The findings offer new insight into how people select partners and the effect that parents have on the process, the researchers said. Until recently, it was believed that this parental influence was a passive process. But this study adds to growing evidence that it's actually an active process.
The results of this study "show for certain that the quality of a daughter's relationship with her father has an impact on whom she finds attractive. It shows our human brains don't simply build prototypes of the ideal face based on those we see around us, rather they build them based on those to whom we have a strongly positive relationship. We can now say that daughters who have very positive childhood relationships with their fathers choose men with similar facial characteristics to their fathers," study author Dr. Lynda Boothroyd of Durham University said in a prepared statement

Vitamin D Cuts Cancer Risk: Study

FRIDAY, June 8 (HealthDay News) -- Boosting your vitamin D intake can dramatically reduce your risk of breast and other cancers, a new study found.
The research adds to growing evidence that vitamin D can help protect against many forms of cancer as well as other diseases, Creighton University researchers said.
But an American Cancer Society spokeswoman urged caution in interpreting the findings, saying it was premature to recommend taking vitamins to reduce cancer risk.
Joan Lappe, a Creighton University professor of medicine and nursing and lead author of the study, said, "What we can say from our study is that 1,100 international units (IUs) a day of vitamin D definitely decreased the incidence of cancer."
That amount of the vitamin is nearly triple the recommended intake for the age group studied -- women who were 55 and older when the four-year study started.
Lappe's team followed 1,179 study participants who were all postmenopausal and lived in rural Nebraska. The women were free of known cancers for the 10 years before entering the study. They were assigned to one of three groups and followed for four years.
One group took 1,400 to 1,500 milligrams of supplementary calcium a day, another group took that same amount of calcium plus 1,100 IUs of vitamin D daily, while the third group took placebo pills every day.
After four years, those in the combination vitamin D and calcium group had a 60 percent lower risk of developing cancer, compared to the placebo group. The calcium-only group had a 47 percent reduced risk.
Then the researchers eliminated data from the first year of the study, figuring some women may have entered the study with cancer that had not yet been diagnosed. The results were more dramatic, Lappe said.
When the researchers looked at results from just the last three years of the trial, they found the combination calcium-and-vitamin D group had a 77 percent reduced risk of cancers, compared to the placebo group. The risk for the calcium-only group was essentially unchanged.
In all, a total of 50 women got non-skin cancers during the study, with breast cancer the most common. The other cancers included lung and colon tumors.
The findings are published in the June edition of the American Journal of Clinical Nutrition.
In May, Harvard Medical School researchers reported in the Archives of Internal Medicine that high intakes of vitamin D and calcium cut the risk of breast cancer by nearly one-third in premenopausal women, but not women past menopause.
Dr. Michael Holick, professor of medicine, physiology and biophysics at the Boston University School of Medicine and a long-time vitamin D researcher, said the Lappe study adds to growing evidence of the health and disease-fighting effects of vitamin D.
"It's very clear the data are significant," he said of the Lappe study.
Vitamin D is thought to act through the immune system to help prevent the formation of abnormal cells, Lappe said.
To date, both Lappe and Holick said, high intake of vitamin D has been found to reduce the risk of many forms of cancer as well as type 1 diabetes, multiple sclerosis, rheumatoid arthritis and high blood pressure.
Both researchers think the current recommendations for daily vitamin D intake should be boosted. The U.S. Institute of Medicine, which makes recommendations on vitamin and mineral requirements, considers 200 IUs of vitamin D adequate for children and adults up to age 50; 400 IUs adequate for adults 51 to 70, and 600 for those 71 and older. The levels aren't Recommended Dietary Allowances, or RDAs, because the institute doesn't think there's enough evidence to establish an RDA for vitamin D.
"I think it's safe to say the current recommendations are much too low," Lappe said, adding that postmenopausal women should "probably be taking 1,100 IUs a day."
She recommends vitamin D3 supplements, the type used in the study, over D2, because D3 is more active, she said.
But Marji McCullough, strategic director of nutritional epidemiology for the American Cancer Society, who is familiar with the new study and other similar research, said in a prepared statement that the society doesn't currently recommend taking vitamin or mineral supplements to reduce cancer risk. But it has joined other health organization to weigh the evidence of vitamin D, and a joint panel recommends supplementation and small amounts of ultraviolet exposure "as the best way to achieve proper vitamin D status."
While she called the new study "intriguing,'' she said the number of participants was small and the research needs to be replicated before firmer conclusions can be drawn.
Discuss vitamin D intake with your doctor. And be aware that the Institute of Medicine has declared that 2,000 IUs is the upper tolerable, or safe, level for most people. For babies up to 1 year old, the limit is 1,000 IUs, McCullough said.
Vitamin D, which is important for strong bones, is found in salmon and other fish, and fortified milk and fortified cereals, among other foods.
Supplements aren't the only potential way to fight disease. In the same issue of the journal, another report found that a high intake of whole grain foods reduced the risk of atherosclerosis, or hardening of the blood vessels, which can lead to heart disease.
U.S. researchers tracked 1,178 men and women, from 40 to 69 years old at the start of the study, and found that eating more whole grains was associated with a lower risk of atherosclerosis.

Breakthrough Liver Cancer Treatment Found

MONDAY, June 4 (HealthDay News) -- Researchers have announced the first drug to make major inroads against liver cancer, one of the more voracious forms of the disease.
Nexavar, made by Bayer, gave patients with advanced liver cancer 44 percent more time to live, compared to patients who did not receive the drug, according to results presented Monday at the annual meeting of the American Society of Clinical Oncology, in Chicago.
Results of a major clinical trial with Nexavar (sorafenib) were, in fact, so successful that the trial was halted early, the researchers announced.
"This is the first systemic therapy to prolong survival in [liver cancer] patients," said Dr. Joseph Llovet, lead author of the study and director of research in liver cancer at Mount Sinai School of Medicine in New York City. "This is a new reference standard for systemic therapy of [liver cancer] patients after 30 years of research and more than 100 randomized controlled trials performed."
Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, added, "This is going to change the standard of practice."
Liver cancer is the third leading cause of cancer death in the world and often causes death within a year of diagnosis. About 40 percent of liver cancers (up to 80 percent in Asia and sub-Saharan Africa) are diagnosed at an advanced stage. Surgery is sometimes possible, and radiation and chemotherapy can also be options. But there is no systemic treatment, meaning a medication that enters the bloodstream.
"There is no established standard of care for liver cancer even though it is one of the leading causes of death," said Dr. A. William Blackstock, a Wake Forest University radiation oncology professor who moderated a Monday news conference to announce the study results.
Nexavar, which is taken in tablet form, is already approved in the United States for treating advanced kidney cancer. It is being studied for various other cancers; results of some of those studies are also being presented at ASCO annual meeting.
In this study, 602 patients with advanced liver cancer were randomly assigned to receive either 400 milligrams of Nexavar twice a day or a placebo for six months.
Patients receiving the drug lived a median of 10.7 months, compared with only 7.9 months for those on a placebo. Time to cancer progression was 5.5 months in the Nexavar group, versus only 2.8 months in the placebo group. The findings were so positive that the study was terminated early.
"We recommended ending the trial early because of survival advantages favoring the sorafenib group," said Llovet.
Side effects were similar in the two groups, the most common being diarrhea, skin reactions, fatigue and bleeding.
"Sorafenib was well tolerated with manageable side effects," Llovet said.
A second study presented Monday at the cancer meeting offered a bit of good news for colorectal cancer patients.
When chemotherapy was given both before and after surgery to remove liver metastases in colorectal cancer patients, the risk of the liver tumor recurring was reduced almost 30 percent.
"A few years ago, we had only palliation to offer these patients and survival lasted no longer than six months," said Dr. Bernard Nordlinger, lead author of the study and chairman of surgery and oncology at Ambroise Pare Hospital in Paris. "This treatment should be proposed as a new standard for these patients."
One million people are diagnosed with colorectal cancer each year; up to half will see their cancer spread to the liver. Liver tumors are removed when possible, but only 30 percent to 35 percent of patients who have liver metastases survive five years after surgery.
Adding the targeted therapy Erbitux (cetuximab) to chemotherapy reduced the risk of metastatic colorectal cancer spread by 15 percent. The drug is currently approved as a second-line or third-line therapy, not as the first option.
These new results indicate that Erbitux has promise as a first-line treatment, the researchers said.

TB Patient Apologizes to Fellow Passengers but Defends Actions

FRIDAY, June 1 (HealthDay News) -- The Georgia man infected with a dangerous form of tuberculosis insisted in a televised interview Friday that he was never told by health officials that he was contagious, and apologized to passengers who shared a series of airline flights with him last month.
"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. It's awful," Andrew Speaker told ABC's Diane Sawyer on Good Morning America from his room in a Denver hospital that specializes in infectious diseases.
Dressed in street clothes but wearing a face mask, Speaker, a 31-year-old personal injury lawyer from Atlanta, apologized repeatedly to the dozens of airline passengers and crew members now awaiting their own test results because they had been exposed to him, the Associated Press reported.
"I don't expect for people to ever forgive me. I just hope that they understand that I truly never meant to put them in harm," said Speaker, whose new father-in-law, Robert C. Cooksey, is a research microbiologist with the U.S. Centers for Disease Control and Prevention's division of tuberculosis elimination.
Speaker said he, his doctors and officials from the CDC all knew he had been diagnosed with "extensively drug-resistant" TB, also called XDR-TB, before he flew to Europe for his wedding and honeymoon last month. But he said he was told he wasn't infectious and did not pose a health risk to others. Health officials said they'd prefer he didn't fly, but no one ordered him not to, he said.
He said his father, also a lawyer, taped that meeting, the AP reported.
"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 said, the AP reported.
Dr. Steven Katkowsky, director of the Fulton County (Georgia) Department of Health and Wellness, said Speaker was told in early May not to travel to Europe.
"He was told traveling is against medical advice," agreed Dr. Martin Cetron, director of the CDC's division of global migration and quarantine. Once Speaker was in Europe, "He was told in no uncertain terms not to take a flight back," Cetron added.
Speaker said the CDC called him in Rome and informed him he had the drug-resistant form of TB and told him to cancel his commercial fight plans. But the CDC didn't offer him any help, he said, other than to meet with health officials in Italy. He contended in Friday's interview that the CDC was effectively abandoning him in Rome and eliminating his best chances for saving his life -- treatment at the TB facility at Denver's National Jewish Medical Center.
Meanwhile, Speaker continued to receive treatment Friday at the Denver hospital. He was flown to Denver from Atlanta, accompanied by federal marshals, on Thursday after being quarantined at Grady Memorial Hospital in Atlanta for two days.
Dr. Charles Daley, chief of the National Jewish Hospital's infectious-disease division, said he was optimistic Speaker could be cured because he appears to be in the early stages of the disease, the AP said.
Daley's colleague, Dr. Gwen Huitt, said Thursday that Speaker is "a young, healthy individual" who is "doing extremely well."
"By conventional methods that we traditionally use in the public health arena ... he would be considered low infectivity at this point in time," she said. "He is not coughing, he is healthy, he does not have a fever."
The hospital is testing other antibiotics and developing a drug regimen that could include as many as five antibiotics, Huitt said.
Speaker's new wife, Sarah, has tested negative for the respiratory disease.
Speaker had taken two trans-Atlantic flights last month for his wedding and honeymoon, possibly infecting fellow passengers in the process.
Speaker's father-in-law, Robert C. Cooksey, the CDC research microbiologist, issued a terse statement Thursday afternoon through the CDC, denying that he knew of his new son-in-law's travel plans.
"As part of my job, I am regularly tested for TB. I do not have TB, nor have I ever had TB. My son-in-law's TB did not originate from myself or the CDC's labs, which operate under the highest levels of biosecurity," said Cooksey, who has worked at the CDC for 32 years.
He added, "First and foremost, I am concerned about the health and well-being of my son-in-law and family, as well as the passengers on the affected flights."
Speaker flew on May 12 from Atlanta to Paris on Air France Flight 385, continued on to Prague, then took a return flight aboard Czech Air Flight 0104 to Montreal, Canada, on May 24, before driving back into the United States at Champlain, N.Y.
On Tuesday, CDC officials issued the first federal isolation order since 1963 to quarantine Speaker.
The agency has advised passengers who were on both flights to get tested for tuberculosis, although they are thought to be at low risk of infection from the disease, agency officials said Wednesday.
The CDC's Cetron noted that on the flight from Atlanta to Paris, some 40 to 50 passengers who sat near Speaker were those most likely at risk. Speaker probably sat in row 51. The same is true for the 30 passengers who sat near him on the flight from Prague to Montreal. On that flight, he sat in seat 12C.

Eye-Protecting Sunglasses Are Cool Again This Summer

MONDAY, May 28 (HealthDay News) -- The official start of summer this Memorial Day weekend is a great time to remember the danger to eyes from the sun's ultraviolet rays, say experts at Prevent Blindness America.
"Most of us wouldn't dream of staying outside in the sun without putting on sunscreen lotion. But we also have to remember to wear both UV-blocking lenses and a brimmed hat to protect our eyes as well," Daniel G. Garrett, senior vice president of Prevent Blindness America, said in a prepared statement.
But a recent survey found that only nine percent of respondents were aware that extended sun exposure can damage vision, and only about 16 percent said they wear sunglasses when they're outdoors for long periods of time, according to the Chicago-based organization.
Only about a third of respondents said they wear a hat when they're out in the sun.
UV damage to eyes is cumulative, and the harmful effects may not be evident for years. Extended UV exposure has been linked with a number of eye problems including cataract, age-related macular degeneration, pterygium (a corneal disorder), and photokeratitis.
As part of UV Awareness Month in May, Prevent Blindness America is launching a new Web site to educate people about what they can do to protect their eyes. The site includes a variety of features, ranging from information about risk factors to tips for buying sunglasses.
Sunglasses don't have to be expensive to be effective, which means they block out 99 percent to 100 percent of both UV-A and UV-B radiation.

Trial of Blood Pressure Drug Offers Hopeful Early Results

MONDAY, May 21 (HealthDay News) -- Researchers are reporting what they call promising early results from a major trial that they say may change the basic tactics for controlling high blood pressure in the most vulnerable people.
Over a six-month period, successful blood pressure control was achieved in 73 percent of the more than 11,500 participants in the ACCOMPLISH (Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension) trial, the researchers said.
That rate was achieved by use of Lotrel, the most prescribed combination brand for high blood pressure, which currently is not indicated for the initial treatment of high blood pressure. The hope of Novartis, the company that sells Lotrel and sponsored the trial, is that the medication will become an accepted first-line treatment.
There are major health implications linked to the study. Some 72 million Americans have high blood pressure, also known as hypertension, a major risk factor for heart attack, stroke and other cardiovascular problems. But blood pressure is not under control in 70 percent of those people, including the nearly 40 percent taking medication.
Early results of the ACCOMPLISH trial, led by Dr. Kenneth Jamerson of the University of Michigan Health System, were to be reported Monday at the American Society of Hypertension annual meeting, in Chicago.
"There are millions on millions of people whose blood pressure is not controlled," said Jamerson, who is professor of internal medicine at Michigan. "Using this strategy, we can expect to double the amount of cases under control. Since the estimated risk of getting high blood pressure at some time in life is 80 to 90 percent, we expect our society will embrace this strategy."
Traditionally, the approach to high blood pressure has been to start with one medication, increase the dose if necessary and then add a second drug, according to a statement issued by Novartis. "We now have significant data which demonstrate the value of treating high-risk hypertensive patients with a fixed-dose combination from the start," the statement said. "This data has the potential to change the current treatment guidelines."
Lotrel combines a calcium channel blocker, amlodipine besylate, with an ACE inhibitor, benazepril. In the trial, the drug was compared with a different combination medication that combined benazepril with a diuretic, which makes the body lose water. Various groups of patients were given different doses of the drugs.
The control rate achieved with Lotrel was lower for people with conditions that put them at higher risk of cardiovascular disease -- 43 percent for those with diabetes and 40 percent for those with kidney disease. But, the report noted, "Of the patients uncontrolled, 61 percent were not on maximum medications, suggesting potential increases in control rates."
Some skepticism has been expressed about the goals of the ACCOMPLISH trial. Those voicing concerns include Dr. Alan B. Weder, a professor of internal medicine at the University of Michigan.
But, in a recent interview, Weder said his criticism, published two years ago in Expert Opinion on Pharmacotherapy, wasn't directed so much at ACCOMPLISH as at clinical trials in general. "In the world of clinical trials, ACCOMPLISH is probably one of the better ones," he said.
Still, Weder said, "without doubt, these trials are done to further the interests of the pharmaceutical industry. But I don't see anything wrong with that."

Calcium Some Help in Preventing Postmenopausal Weight Gain

WEDNESDAY, May 16 (HealthDay News) -- Postmenopausal women who take supplements with calcium and vitamin D gain slightly less weight than women not taking the supplements, researchers report.
While the effect on weight was small, it's another reason women should be taking calcium and vitamin D, which can help prevent osteoporosis, the study authors said.
"There was a small effect in the prevention of weight gain, approximately 5 percent," said lead researcher Bette Caan, a senior research scientist at Kaiser Permanente Northern California, in Oakland. "The effect was greatest at three years among women who had been taking less than the daily recommend amount [of calcium] before the trial. They were also more likely to stay stable or lose weight," she said.
For the study, Caan's team collected data on 36,282 postmenopausal women, ages 50 to 79. The women were part of the Women's Health Initiative clinical trial. In the trial, 18,176 women were randomly selected to receive a daily dose of 1,000 milligrams of calcium plus 400 international units of vitamin D, while 18,106 women were given a placebo once a day. Then, their weight was checked each year for seven years.
By the end of the trial, the researchers found that women who took the supplements weighed an average of 0.28 pounds less than those who did not.
Women who received the supplements and were getting less than the recommended amount of calcium daily before the start of the study weighed an average of 0.42 pounds less than those who did not. In addition, these women had a lower risk of putting on weight in both small amounts (2.2 pounds to 6.6 pounds) and moderate amounts (more than 6.6 pounds). And they were more likely to maintain a stable weight (within 2.2 pounds of their starting weight) or losing weight (more than 2.2 pounds), the researchers said.
Caan does not recommend taking calcium and vitamin D for the purpose of slowing weight gain. "However, since 1,200 milligrams of calcium is already recommended for postmenopausal women for bone health, they should continue with that recommendation, and it may be an extra benefit if it also helps reduce the risk of weight gain," she said. "They should not rely on calcium to prevent weight gain. It's not a magic bullet."
The study was published in the May 14 issue of the Archives of Internal Medicine.
One expert thinks calcium's small effect on weight gain is not really an effective part of fighting obesity.
"The beneficial effects on weight gain peaked after just three years, and then plateaued," said Dr. David Katz, director of the Yale University School of Medicine Prevention Research Center. The benefits of supplementation were reduced weight gain, not weight loss. Roughly 70 percent of the women in this trial were overweight at the start, and almost all gained weight throughout, he said.
"Calcium and vitamin D did not cause weight loss, or even prevent weight gain -- they just slowed its relentless march a bit," he said. "In the battle to control obesity and its adverse effects, this has contributed the equivalent of a pea shooter."

11 Featured Nutrients: Why You Need Them

Beta Carotene

What it does:
In the body, beta carotene is converted to vitamin A, a nutrient essential for healthy vision, immune function and cell growth. It also acts as an antioxidant that neutralizes free radicals.

How much you need:
There's no RDA for beta carotene.

Food Sources of Beta Carotene:
Eat plenty of dark green vegetables and orange vegetables and fruits (papaya, mango) weekly to meet your vitamin A needs and reap beta carotene's potential antioxidant benefits.

Is 1 Pill Better Than 2 for Heart-Disease Protection?

FRIDAY, May 11 (HealthDay News) -- When it comes to daily drug therapy for heart patients, less may be more, a new study suggests.
Researchers developed a computer model to predict the cost and benefits of administering two drugs -- one to lower blood pressure and one to lower cholesterol -- either separately, or in a single-pill formulation, to two, 100,000-member groups with hypertension plus other cardiovascular risk factors.
The two medications were amlodipine, a blood pressure medication sold under the brand name Norvasc, and atorvastatin, a cholesterol-lowering medication branded as Lipitor. The combined formulation is called Caduet, and all three are available from Pfizer Inc., which provided funding for the study.
Under idealized, clinical trial conditions, where each individual was presumed to take his or her medication exactly as directed, both groups had the same number of cardiovascular events over four years -- 3,520. But the four-year medical costs were lower in the single pill group ($6,471 vs. $7,665), because the single pill formulation costs less.
When the two groups were "modeled" in "real-world" conditions, in which adherence to medication regimens isn't 100 percent, the number of predicted cardiovascular events jumped to 6,990 for the two-pill group, and to 6,859 for the single pill, with associated four-year medical costs of $6,543 and $4,993, respectively.
In other words, outside of a clinical trial setting, users of the single-pill formulation could expect slightly fewer cardiovascular incidents, and lower associated medical costs, than users of the two pills, said study author Timothy Smith, senior director of health economics and outcomes research at IMS Consulting in Falls Church, Va.
"In the language of cost-effectiveness analysis, this is a case where the two-pill therapy is dominated by the one-pill therapy," Smith said, "because the single pill costs less, and it is more effective because of improved compliance."
The study was expected to be presented May 11 at the American Heart Association's Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, in Washington, D.C.
According to Smith, the findings reflect the anecdotal understanding that the more medications a patient must take, the less likely he or she is to take them all correctly. "It is fairly well accepted that there is a pill burden," he said. "The more medications you take, the worse the compliance."
But, Smith added, the conclusions also are based on a computer model that used data from a former study using slightly different medications. So, the new findings must be validated, he said.
Dr. Paul S. Chan, a cardiovascular fellow at the University of Michigan Medical School, who has published several papers on cost effectiveness in medicine, called the new study "interesting." But, he noted, that besides not having been peer-reviewed, the study's primary conclusion -- that one pill is better than two -- has one "huge caveat."
Even if one pill saves money over two pills at the present time, that would not likely be true once one or both drugs lost patent protection.
"It's a very ingenious marketing ploy," Chan said. "Even though it saves money up front, it also ensures that patients will stay on the combination pill when, in the future, it might be cheaper to buy the meds separately."

Hepatitis C Infection Ups Lymphoma Risk

TUESDAY, May 8 (HealthDay News) -- People with the liver disease hepatitis C face a higher risk of developing lymphoma, a cancer of the immune system, new research suggests.
Overall, the risk is almost 30 percent higher, but for a certain type of lymphoma called Waldenstrom's macroglobulinemia, the risk is almost 300 percent higher, according to the study.
"If I had hepatitis C, this would be one more piece of evidence that might make me consider treatment, though hepatitis C treatment can be difficult and is often unsuccessful," said the study's lead author, Dr. Thomas Giordano, an assistant professor of medicine at Baylor College of Medicine in Houston.
"On the other hand," he added, "the risk of these cancers is so small, I wouldn't panic if wasn't getting treatment either. The overall risk is low."
More than 4 million Americans have hepatitis C, and about 26,000 new cases are diagnosed each year, according to the U.S. Centers for Disease Control and Prevention. Lymphomas are cancers that originate in the lymphatic system, a part of the body's immune system. The two most common forms of lymphoma are Hodgkin's and non-Hodgkin's lymphoma. About 8,000 Americans develop Hodgkin's lymphoma and more than 56,000 develop non-Hodgkin's lymphoma each year, according to the Leukemia and Lymphoma Society.
"At least five agents -- four viruses and one bacterium -- are associated with an increased risk of lymphoma, said Dr. Marshall Lichtman, executive vice president for research and medical programs at the Leukemia and Lymphoma Society.
But, Lichtman said he couldn't speculate as to why hepatitis C might increase the risk of lymphoma.
Giordano suspects that the chronic stimulation of the immune system caused by hepatitis C might be contributing to the development of certain lymphomas.
For the new study, Giordano and his colleagues reviewed data from the Veterans Administration. First, they found almost 150,000 veterans with a diagnosis of hepatitis C, and then they matched by age and sex four healthy veterans for each person infected with hepatitis C. Nearly all of the veterans included in the study were male, and the average age was 52.
The researchers found that just under 1,400 people included in the study developed non-Hodgkin's lymphoma and 165 developed Waldenstrom's lymphoma.
The risk of non-Hodgkin's lymphoma was 28 percent higher for those with hepatitis C, and the risk of Waldenstrom's was 276 percent higher, according to the study.
While women only comprised 3 percent of the study population, both Giordano and Lichtman think the results would probably apply to women as well.
The findings are published in the May 9 issue of the Journal of the American Medical Association.
Giordano said there aren't any immediate practical implications from the findings, because there's no standard screening tool for lymphoma. He said the findings may help researchers, and they may alert physicians to think of the possibility of lymphoma in their hepatitis C patients.
Lichtman agreed that lymphoma screening isn't feasible at this point. "Lymphoma is not a disease that can be detected early," he said. "Once it's clinically apparent, it's usually advanced."
Another important point, Lichtman added, is that no one yet knows if the treatments for hepatitis C would reduce the risk of lymphoma, too.

TV Use Pervasive Among Tiniest Tots

MONDAY, May 7 (HealthDay News) -- Parents don't seem to be heeding expert pediatrician guidelines that urge a ban on TV watching for their very youngest children.
The American Academy of Pediatrics currently recommends that children 2 and under watch no TV at all.
However, a new study finds that on a typical day, only 37 percent of children between zero and 2 years old watch no television, and as many as one in five youngsters under 2 even have a television placed in their bedrooms. More than half (54 percent) of these tiny tots could turn on the TV themselves.
"I understand the AAP's stance, because we don't yet know the neurological implications of screen time in young children," said the study's author, Elizabeth Vandewater, associate director of the population research center and an associate professor of human development and family sciences at the University of Texas in Austin.
On the other hand, she said, "I don't think the guidelines are realistic."
The study's findings weren't all bad. Vandewater found that just over half of 3- to 4-year-olds and 70 percent of 5- and 6-year-olds watched no more than the recommended limit of two hours daily. In the 3 to 6 age group, TV in the bedroom became more common, with about one-third having a set in the bedroom.
The findings were published in the May issue of Pediatrics.
To learn more about actual viewing habits in young children, Vandewater and her colleagues surveyed 1,051 parents of young children during 2005. They asked about media use, whether or not there was a TV in the bedroom, and also about other activities, such as reading and playing outdoors, to see if TV use was supplanting other pursuits.
On an average day, three-quarters of children watched at least some television, and about one-third watched videos or DVDs, the study found. The average viewing time was one hour and 20 minutes, which falls within the AAP guideline of no more than one to two hours for children over 3.
The researchers didn't find that TV typically displaced other activities, such as reading or outdoor play. However, Vandewater said that in previous research she's conducted, she has found that TV may replace time spent interacting with parents.
"It's important to remember that if you turn off the TV, the assumption is that the family will spend time together, but that's not always true. They might find other things to do separately," she said. "It's also important that we don't assume all time spent with parents is good, quality time. If parents are under stress, that's not necessarily a good time to be together, and it might not be so bad to pop in a video for a half an hour," Vandewater said.
She also commiserated with parents who might find the "no TV" rule tough to adhere to. "Media and technology are not going away," Vandewater said. "They're part of the backdrop of our everyday lives -- TV stands are now standard living room furniture. So, we need to figure out how to give advice that's workable."
Dr. Christopher Lucas, director of the early childhood service at the New York University Child Study Center in New York City, agreed that it's difficult to keep children under 2 from watching any TV, because TV has become so ubiquitous in American life.
"The guidelines seem out of sync with what the reality is," said Lucas.
Neither Vandewater or Lucas is specifically advocating TV watching for young children. Instead, they're just acknowledging that it does occur and that there's currently no evidence to prove that it's harmful.
Lucas said to be helpful, TV needs to be put into context for children. "Unsupervised, passive watching probably isn't helpful, but educational media -- when watched with parents or another caregiver -- could be helpful," he said.
Both Vandewater and Lucas were concerned about the growing trend of TVs in children's bedrooms. Most often, parents interviewed in the study said they put a TV set in their kid's room because it freed up other TVs in the house for parental use.
"There is a growing body of literature showing that TV in the bedroom is related to a host of negative outcomes. I would strongly urge parents not to put TV in a child's bedroom," said Vandewater.
"There's this belief that TV is helpful to children and may soothe them, but TV activates the brain and actually makes it more difficult to sleep," explained Lucas.
Vandewater's final advice? "Media is a treat. Like any other treat, it's best in moderation."

Too Much on Your Plate?

The moment I hear Law & Order's distinctive two-beat intro, my salivary glands flood. I watch this week's corpse discovery, then take the first commercial break to hustle out to the Sub-Zero. Two huge scoops of Vanilla Swiss Almond Häagen-Dazs in an oversize bowl later, I'm back in the company of police who investigate crime and the district attorneys who prosecute the offenders. Over the next 15 minutes, those voluptuous mounds of ice cream, along with their bustier of chocolate sauce and Reddi-wip, disappear someplace.
Under cross-examination by Jack McCoy, I could probably be witness-badgered into specifying where this someplace is. Right now, however, I'm too distracted to remember or care. Another commercial comes on, and I feel a sudden vague sense that my life needs balance. Something crunchy, perhaps something with salt. Oh, and add something that will make this first combo of somethings easier to swallow.
By the time the jury finds the perp-o'-the-week guilty, an 8-inch stack of Zesta saltines and a 16-ounce Coke have slurried off together, crunch by crunch, sip by sip, in search of the missing Häagen-Dazs. Most men think, if we think about it at all, that the urge to eat is simple. We become hungry, we seek food, we shovel same into our maws, we feel full, we stop. After a suitable interlude, the cycle starts anew.
But hunger (appetite's physiological accelerator) and satiety (its brakes) are not the only reasons we start and stop eating. Researchers in the burgeoning field of food psychology have pinpointed a complex web of cues in the modern environment that all but overwhelm our once-adaptive systems: societal shifts in what constitutes appropriate portion sizes; the colors, embedded scents, and promotional language used in food packaging; the distracting effects of TV viewing during meals. These are just a few of the ubiquitous hidden persuaders that have converted eating from a natural human need into a national hobby.
Part of the problem is the sheer number of times we're confronted with food decisions. According to a University of Illinois study, the average American makes more than 200 choices each day, most executed on a quasi-conscious level. Yogurt or a sticky bun for breakfast? A garden salad or Double Whopper for lunch? Celery sticks or pork rinds with a pilsner or pale ale after work?
Psychologists in labs around the world, to be sure, have an interest in understanding what motivates such decisions and perhaps nowhere more so than in the labs at major food corporations. Whether it's Frito-Lay or Burger King, Dannon or Pillsbury, they're all in business to optimize profits. If tweaking the minutiae of consumer psychology will make their products more tempting than the competition's, you can bet they'll do so.
"Nowadays, companies are investing a lot of money to figure out this kind of information," says Leslie Harrington, Ph.D., founder of LH Color, a Connecticut-based company that advises food manufacturers on ways to leverage color's psychological effects. "You can't change behavior by cognition alone," she says. "You need to engage a consumer's emotions, and color is just one of many ways to do this."
The Science of Appetite
University and government researchers, for their part, approach food psychology from a different perspective. Most here are seeking strategies to steer us willingly, that is toward healthier diets, hoping in the process to not only save lives but also avoid a fortune in future medical costs from today's obesity epidemic.
For Brian Wansink, Ph.D., director of the Cornell University food and brand lab, part of the answer lies in a "know the enemy" approach. In his book, Mindless Eating: Why We Eat More Than We Think, Wansink condenses years of research into practical lessons for recognizing and circumventing the myriad influences that promote autopilot eating. "The goal," he says, "is to re-engineer your food life so you can enjoy eating without obsessing."
This doesn't just mean eating less junk. The same techniques that push Ho Hos and Häagen-Dazs can also help us eat better-quality fare, from five-a-day fruits and vegetables to soluble fiber and omega-3 fats. By better understanding how food psychology influences us, we can avoid being blinded by a false glow, and simultaneously add more luster to the foods our bodies really need.

The Atmospheres of AppetiteThough it doesn't appear on a list of ingredients, one of a food's most seductive additives is the setting in which it's served.
Restaurateurs from McDonald's to Ruth's Chris Steak House have long understood how critical ambience is to sales. Not surprisingly, the choice of atmosphere will differ dramatically, depending on how an establishment wants to make those sales. In the case of fast-food emporia, profits depend on speed eating, whereas at high-end restaurants, the goal is to keep diners ensconced long enough to "up-sell" them drinks, appetizers, and desserts.
One of the most common techniques used to achieve both ends is color. "Bright red, for example, is the color to stimulate your appetite," says color expert Harrington. "It also increases adrenaline and blood pressure and makes you physically want to move." It's no accident that the benches at every McDonald's are not only bright red but also bruisingly hard on the buttocks. The last thing you want en route to selling 80 billion burgers are loitering customers.
Contrast this approach with a high-end steak house. Managers here want you ravenous, too but they also want you to linger long enough to run up a drink tab and other expenses. "These places still use red to stimulate appetite," says Harrington, "but they tone it down to a softer burgundy or wine color." The soft seating here could be endorsed by post-op hemorrhoid patients.
To further encourage leisurely dining, upscale restaurants also frequently use muted lights and soothing music. Of course, you'll never find candelabra and Chopin anywhere near a bucket of chicken. If such places can't lure clientele onto the drive-thru conveyer belt, they'll at least make their interiors as energizing to the senses as possible.
For reasons that aren't completely understood, men seem particularly vulnerable to such manipulations. "Bright lights, loud noises, and reflective surfaces cause most everyone to eat faster," says Lenny R. Vartanian, Ph.D., lead author of a recent study in Appetite that examined factors influencing food consumption. "But environmental stimulation causes men to really speed up their eating it has a much more exaggerated influence."
Another highly provocative sense is smell. A mere whiff of something delicious increases salivation and the release of pancreatic enzymes, readying our bodies to be fed. Wansink has dubbed this the "Cinnabon Effect" after an aroma credited with generating $200 million in annual sticky-bun sales.
"I've been in food courts where it seems like restaurants are battling," says Armand V. Cardello, Ph.D., a food psychologist at the U.S. Army Natick Labs. "Every 5 feet you walk, you're hit with a different smell."
Short of wearing nose clips, earplugs, and welder's glasses when dining out, there's not much we can do to eliminate this assault on our senses. Still, knowing what we're up against can move such marketing ploys from unconsciousness to awareness, where we have at least a fighting chance of resisting or avoiding them.
At home, where we do have some control over our eating environment, we can use these same marketing strategies to our benefit. For example, "even broccoli tastes better by candlelight," says Wansink. He recommends a few guy-specific tactics, as well. For at least 30 minutes of your meal, turn off the TV and instead play your favorite slow music softly in the background. Use decent china, which sends the message "fine dining ahead!" as opposed to plastic plates and bowls, which proclaim "time to spork down some biomass." Perhaps most important, serve food at a table where you've previously enjoyed celebratory meals not on a TV tray where you've previously celebrated sports victories.
If your goal is simply to eat less, try a more radical approach to ambience. "Blue is the color most associated with mold and decay in food," says Harrington. "The greatest diet tip I know is simply to put a blue lightbulb in your refrigerator."

Pet Food Recall Widens Again on New Threat

THURSDAY, May 3 (HealthDay News) -- Two months after it triggered the largest pet food recall in U.S. history, a key Canadian manufacturer has widened its recall once again on the threat of cross-contamination in some products.
The latest action comes amid reports from U.S. health officials that more than 4,000 dogs and cats may have died from eating contaminated pet food.
And at the same time, U.S. regulators report that the Chinese company accused of exporting wheat gluten that included the toxic chemical melamine had intentionally labeled its shipments as nonfood to avoid inspections.
The newest recall involves any pet food processed at any Menu Food plant during the period in which contaminated wheat gluten was in that plant, according to the recall notice issued late Wednesday. The original recall by the company involved more than 60 million cans and pouches of moist dog and cat food. The new recall, the Streetsville, Ontario company said , includes cuts and gravy and select other products.
The company, which produces pet foods for more than 100 name brands, said the additional recall represents less than 5 per cent of the products that have already been recalled or withdrawn. It did not say what the cross-contamination involved. An updated list of all recalled products is available at the company's website at http://www.menufoods.com.
The news followed reports earlier this week that contaminated pet food leftovers had been fed to hogs and chickens, many of which have been processed for human consumption.
U.S. Food and Drug Administration and U.S. Department of Agriculture officials have downplayed any potential human health risk.
But the FDA, which has only ever confirmed the deaths of 16 pets from contaminated food since the recall began March 16, now says that pet owners have reported the deaths of about 1,950 cats and 2,200 dogs. It was not known how many of those were linked to the recalled pet food, the AP reported.
The New York Times reported that FDA officials also say the Xuzhou Anying Biologic Technology Development Company shipped more than 700 tons of wheat gluten labeled as nonfood products this year through a third-party Chinese textile company.
By listing the goods as nonfood items, the companys shipments were not subject to mandatory inspection by the Chinese government, the newspaper reported.
ChemNutra, the Las Vegas pet food supplier that bought the wheat gluten from Xuzhou and then resold it to pet food makers in North America, said it had received the shipments of wheat gluten through a third party, a company called Suzhou Textiles Silk Light and Industrial Products.
A spokesman for Suzhou Textiles denied that the company exported any wheat gluten to the United States, the Times reported.
The other supplier of contaminated protein is Binzhou Futian Biology Technology, which said that it supplies soy, corn and other proteins and has strong sales in the United States, Europe and Southeast Asia. The company also declined to comment, the newspaper said.
Meanwhile, the Senate voted Wednesday in favor of stricter production and labeling standards on pet foods so consumers are better informed about what they are feeding their pets, the Associated Press reported.
The 94-0 vote was on an amendment by Sen. Dick Durbin, D-Ill., which called for a national pet version of the system that now tracks food contamination and outbreaks of illness and death in people.
In a prepared statement, the Humane Society applauded the Senate action.
"The Humane Society of the United States commends Senator Durbin for his fast action to protect the food supply for people and their pets," said Wayne Pacelle, its president and CEO. "The last six weeks have exposed that the safety standards for pet foods are not in place in any significant way and the constant drumbeat, day after day, of recalls has shaken consumers' confidence in the pet food industry's adherence to food safety standards."
Earlier this week, U.S. health officials had reported that up to 3 million broiler chickens were fed tainted pet food and then sold on the U.S. market beginning in early February.
The contaminated pet product made its way into poultry feed at 38 Indiana farms, 30 of which produced broiler chickens destined for restaurants and supermarkets, said FDA and USDA officials.
Approximately 2.5 million to 3 million chickens fed contaminated pet food have already been sold, Kenneth Peterson, assistant administrator for field operations at the USDA's Food Safety and Inspection Service, said during a Tuesday teleconference. "That's out of a total of 9 billion broilers processed in the U.S. each year," he noted.
"We still have no evidence of harm to humans or to swine," added Dr. David Acheson, who began his tenure as the FDA's new assistant commissioner for food protection on Tuesday. Acheson said that the contaminated food constituted only about 5 percent of the total feed at the farms. "The risk to humans is small," he said.
The announcement came on the heels of similar discoveries at hog farms across the United States. The USDA first announced last week that meat from 345 hogs suspected of eating the contaminated feed had entered the U.S. food supply. Some 6,000 hogs suspected of eating the contaminated product have since been quarantined and meat from these animals will be withheld from the food supply, both agencies said.
Last week, China banned melamine from its food products, but rejected the charge that the substance caused the U.S. pet deaths, the AP reported.
U.S. regulators were continuing to investigate how -- or even if -- melamine becomes fatal for pets, because it's not believed to be particularly toxic. But U.S. law bans its presence in any form of food, the newspaper said.

Vets From First Gulf War Show Brain Differences

TUESDAY, May 1 (HealthDay News) -- Veterans of the first Gulf War who developed numerous health complaints have areas of the brain that are measurably smaller than those of healthier vets, a new study found.
The results of the U.S. government-funded study are preliminary but provide some of the first hard evidence that veterans from the 1990-1991 conflict are suffering from a real neurological illness, researchers say.
"Right now, for Gulf War veterans, there is a discounting of there being any physical basis for what might be wrong with them. But I think that what is really important about this brain imaging research is that it suggests that we really need to take their symptoms seriously, that there is a clear neurological basis for their complaints," said study lead researcher Roberta White of Boston University School of Public Health.
Another expert with a long history of research into so-called Gulf War syndrome was more cautious.
"These findings are intriguing, but they do not prove that veterans of the first Gulf War were harmed by wartime chemical exposure," said Dr. Daniel Clauw, professor of medicine and director of the Chronic Pain and Fatigue Research Center at the University of Michigan, in Ann Arbor.
The study was expected to be presented Tuesday at the annual meeting of the American Academy of Neurology, in Boston.
U.S. and British veterans of the first Gulf War have long complained of a wide array of physical and mental symptoms, which many blame on exposure to biowarfare agents such as toxic pesticides and sarin gas.
"Back when the vets first started returning from the war, they were complaining of symptoms that affected the central nervous symptom, or suggested effects on the central nervous system," White said. Those symptoms included mood swings, personality changes, disordered sleep, joint pain, headaches, skin conditions, chronic fatigue and other effects.
But, it has been tough for experts to pinpoint any "objective evidence" -- for example, anatomical anomalies -- supporting the existence of an identifiable neurological condition, White said.
But recent advances in brain imaging are helping that effort.
In its study, which is ongoing, White's team took detailed MRI images of the brains of 36 veterans of the first Iraq conflict. Half of the veterans have complained of five or more symptoms -- out of a list of 20 -- attributed to Gulf War syndrome, while the other half have listed less than five symptoms.
The brain scans revealed key differences between the two groups.
First, the cortex -- the covering of the brain, highly involved in learning -- was about 5 percent smaller in those veterans with a higher number of symptoms compared with those with a lower number of symptoms. And a second area of the brain, called the rostral anterior cingulated gyrus -- important to emotion, motivation and memory -- was 6 percent smaller on average in the more symptomatic vets, according to the study.
These finds are preliminary and do not confirm that wartime exposures changed the veterans' brains, only that differences exist, White said.
However, the brain differences may be relevant to reported symptoms "because [veterans] complain of fatigue, of changes in their cognitive efficiency, and memory problems," she noted. "We actually have objective evidence that memory performances were worse among the high-symptom complainers and that correlates with the findings in the cingulated gyrus," White added.
Those symptoms also correlate with exposures to a variety of toxins present in the first Iraq conflict, White said. "Things like pesticides, sarin -- chemical warfare agents of the kind that they used in the Gulf -- those kinds of substances do cause these kinds of effects on brain function," she said. However, she added that "much less is known about more subtle effects on brain structure of these chemicals, because they have not been studied in this way."
Another expert in Gulf War syndrome agreed that it's impossible at this point to conclude that wartime exposures led to changes in veterans' brains.
For example, "we know that many psychiatric disorders, such as depression and post-traumatic stress disorder, cause cognitive problems. And we know that these two can be associated with changes in brain function and metabolism," said Dr. Simon Wessely, a professor of psychiatry at the King's Center for Military Health Research at King's College London.
Until White's group can get a larger number of study subjects and tease out these possible confounding causes, scientists shouldn't get "too excited" about the findings, he said.
"The symptoms of Gulf War illness are very common in people who have not been to the Gulf," Wessely noted. "I would be more interested in comparing Gulf [veterans] vs. civilians with the same symptoms before I jumped to any conclusions about any relation to Gulf War exposures," he said.
Clauw seconded that thought.
"Recent, similar studies have shown decreases in brain volumes in individuals in the general population with chronic pain conditions such as low back pain and fibromyalgia," he said. "Future studies need to compare the results of brain scans of Gulf War veterans with individuals with chronic pain and other symptoms who were not deployed to the Gulf War, before concluding that any changes are due to wartime exposures."
White agreed that it's still too early to draw any definite conclusions. She said the study, which was funded by the U.S. Department of Veterans Affairs, should wrap up by this fall.
"These are preliminary findings, and, with more subjects, we might learn more about which parts of the brain are more affected," she said. Still, she added, "I think this is a very important next chapter in looking at the first Gulf War."
More information
There's more on Gulf War syndrome at the University of Chicago Medical Center.

Laboratory study is called preliminary, but promising

MONDAY, April 30 (HealthDay News) -- Green tea, already touted for its cardiovascular and anticancer benefits, may also help ease the inflammation and pain of rheumatoid arthritis, a new study suggests.
The study was conducted in the laboratory, and its findings are preliminary, stressed lead researcher Salah-uddin Ahmed, an investigator at the University of Michigan Health System, in Ann Arbor.
"It's too early" to fully recommend green tea to ease rheumatoid arthritis, he said, but the study "is a starting point."
Ahmed was scheduled to present the research Sunday at the Experimental Biology meeting, in Washington, D.C.
For the study, Ahmed isolated cells called synovial fibroblasts from the joints of patients with rheumatoid arthritis. These cells form a lining of tissue surrounding the capsule of the joints.
In patients with rheumatoid arthritis, this lining is inflamed, leading to long-term joint damage and chronic pain. About 2.1 million Americans have rheumatoid arthritis, according to the Arthritis Foundation.
Ahmed's team next cultured these cells and exposed them to the active ingredient in green tea, a compound named epigallocatechin-3-gallate (EGCG). Next, the cells were stimulated with a protein of the immune system known to play a role in causing joint degradation in rheumatoid arthritis. The protein is called cytokine interleukin-1 beta or IL-1B.
"IL-1B is a major player in mediating cartilage degradation," Ahmed explained.
In an earlier study, Ahmed's team found that fibroblasts pretreated with EGCG and then stimulated with cytokine IL-1B were better able to block IL-1B's ability to produce damaging proteins and enzymes. Those proteins and enzymes can infiltrate the joints and cause the cartilage breakdown seen in people with rheumatoid arthritis.
In the more recent study, the researchers focused on whether EGCG had the ability to block the activity of two potent molecules, IL-6 and cyclooxygenase-2 (Cox-2), which also play a role in breaking down bone in an RA joint.
The two molecules were suppressed by the EGCG, Ahmed's team found. While he said it is difficult to quantify exactly the effect of the suppression, the EGCG "blocked them significantly," he said.
EGCG also blocked the production of prostaglandin E2, another compound that can cause joint inflammation.
One expert said the new green tea study was intriguing. "This study is very specific," said Stephen Hsu, an associate professor of dentistry, molecular medicine and genetics at the medical College of Georgia in Augusta.
In his own research, Hsu has found that green tea may help protect against certain autoimmune diseases, in which the body triggers an immune response, basically attacking its own cells. Hsu studied EGCG's effect in helping to inhibit an autoimmune disorder known as Sjogren's syndrome, in which the salivary glands are affected, and in lupus, in which the skin is affected.
The new research by Ahmed is one of the first to focus on rheumatoid arthritis and green tea, Hsu said. If it bears out, it could be good news for rheumatoid arthritis patients, perhaps offering them a non-drug option to keep pain under control, he said.
Ahmed cautioned that it's too soon to advise rheumatoid arthritis patients to drink green tea. On the other hand, drinking green tea certainly wouldn't hurt, he said, since it is known to have many health benefits and no known side effects.
He said people might want to try drinking three or four 8-ounce cups of green tea per day. "Try different brands," he suggested. The flavors may taste slightly different. "Drink it continuously throughout the day," he said, to keep blood levels more constant.
And you might want to consider popping some tart cherries along with that tea, according to another study presented at the same meeting.
In the study, conducted by another team of University of Michigan researchers, powdered tart cherries appeared to lower total cholesterol and blood sugar and help the body handle fat and sugar -- at least in animals.
More information
To learn more about rheumatoid arthritis, visit the Arthritis Foundation.

Is “Healthy Soda” an Oxymoron?

Soda is a multi-billion dollar industry in this country, but despite huge sales, its image has suffered in recent years. Diet offerings have been plagued by artificial sweetener woes—from myths of brain tumors to some legitimate health concerns. And the versions sweetened with high-fructose corn syrup have fared no better. In a report issued in 1998, the nutrition advocacy group Center for Science in the Public Interest famously dubbed soda “liquid candy.” Subsequently, protests by parents and nutrition advocates have lobbied to get soda machines banned from high-school cafeterias, and fast-food chains like McDonald’s have expanded their drink options to include healthier choices like bottled water or milk.
So what’s a soda manufacturer to do in order to stay in the game? Coke and Pepsi seem to think the answer lies in adding vitamins to soft drinks—turning your fizzy afternoon indulgence into a “health” food. This month, Coke is set to launch Diet Coke Plus, a zero-calorie cola with a sprinkling of nutrients mixed in. According to the company, one 8-ounce serving of the soda will provide 15 percent of the daily value (DV) of niacin, vitamins B6 and B12, and 10 percent of the DV for zinc and magnesium. And in the fall, Pepsi will roll out Tava, a line of zero-calorie sparkling beverages in flavors like Tropical Berry Blend and Passion Fruit Lime. Each 8-ounce serving of Tava will deliver 10 percent of the DV of vitamins B3, B6 and E.
“The biggest thing in every industry right now is health and wellness,” says Lynn Dornblaser, director of Mintel Custom Solutions, a market research firm. “Even companies that never had that as a primary focus are now trying to adapt their product lines to fit what’s important today.”
But can a soda ever really make the leap from junk food to health food? “Probably it’s just marketing,” says Kristine Clark, director of sports nutrition at Penn State University and a registered dietitian. The small amounts of nutrients in such sodas probably aren’t enough to make much difference in the average American diet. “Let’s hope no one is using these products to meet their nutritional needs,” says Clark.
The ever-growing category of natural sodas has been promoting health claims for several years, and has lured drinkers away from more conventional carbonated beverages or turned the health conscious into first-time soda drinkers. Brands like Izze, Santa Cruz Organics and Blue Sky contain real fruit juice, organic sugar as well as, in some case, vitamins. “The success of natural sodas—and especially of fortified bottled waters—may have spurred the more traditional companies to move in a similar direction,” says Dornblaser.
While trend-watchers speculate on whether or not consumers will swallow the health claims of Coke’s and Pepsi’s new sodas, nutritionists remain sanguine. “If you’re drinking these because of their nutrients, that’s not a valid reason, but if you’re going to be drinking soda anyway, you’re at least getting something extra,” says Clark. “Just don’t kid yourself that soda is a health drink.”

Health Highlights: April 26, 2007

Congress Should Limit TV Violence: FCC
Texas Governor's HPV Vaccine Order Rejected
Pull Shrek Exercise Ads for Children, Group Says
U.S. Army Testing Equipment to Check Soldiers for Brain Injuries
Texas Company Stops Illegal Production and Sale of Drugs
Primary-Care Doctor Visits Less Costly
Here are some of the latest health and medical news developments, compiled by editors of HealthDay:
Congress Should Limit TV Violence: FCC
The U.S. Congress should legislate limits on TV violence in order to better protect children since voluntary parental controls aren't working, the Federal Communications Commission (FCC) said in a report released Wednesday.
The FCC said this kind of regulation is needed because research shows that extended exposure to TV violence can lead to more aggressive behavior in kids, The Washington Post reported.
V-chip blocking technology is only partially effective in screening violent content, said the FCC, which produced the report at the request of 39 lawmakers. The report will be used as a basis to draft legislation, said Sen. Jay Rockefeller (D-W.Va.).
"Clearly, steps should be taken to protect children from excessively violent programming. Some might say such action is long overdue," FCC Chairman Kevin Martin said in a prepared statement.
Giving the government the power to determine what's acceptable for TV concerns some groups, however.
"The job of policing TV for children is one for parents, not the government," Caroline Fredrickson, director of the American Civil Liberty Union's legislative office in Washington, D.C., told the Post. "The government isn't capable of making distinctions about what's violent or gratuitous."
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Texas Governor's HPV Vaccine Order Rejected
Texas Governor Rick Perry's order requiring sixth-grade girls to get the human papillomavirus virus (HPV) vaccine was rejected Wednesday by Texas lawmakers, who sent the governor a bill that would block, for at least four years, officials from requiring girls to get the vaccine.
HPV is a sexually transmitted disease that causes cervical cancer.
After Perry issued his executive order in February, prominent legislators vowed to overturn the order because they said the vaccine was too new to force on Texas families, the Associated Press reported. The order was to have taken effect in September 2008.
Perry has 10 days to sign or veto the bill passed by the legislature. Even if he does veto it, lawmakers have the two-thirds majority vote in both chambers needed to override the veto.
The vaccine, which protects against four HPV strains, was recently approved by the U.S. Food and Drug Administration for use in girls and women ages 9 to 26.
To date, about 20 states have introduced bills to require girls to get the vaccine, the AP reported. Critics charge that making the vaccine mandatory promotes promiscuity and infringes on parents' rights.
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Pull Shrek Exercise Ads for Children, Group Says
The animated character Shrek should no longer be used in U.S. Health & Human Services (HHS) public service TV commercials that encourage children to get more exercise, says the Campaign for a Commercial-Free Childhood.
The Harvard University-based child advocacy group said the animated green ogre is no longer an appropriate spokesperson for healthier lifestyles for youngsters. That's because promotions tied to the May 18 release of the Shrek the Third film also include a number of high-calorie or high-sugar foods, USA Today reported.
"The food industry and the government can't have it both ways. Either (Shrek's) a pitchman for junk food or a spokesman for health and well-being. Those are mutually exclusive roles," said Susan Linn, co-founder of the Campaign for a Commercial-Free Childhood.
In the public service ads, which started airing in February, Shrek encourages children to: "Get up and play an hour a day." The ads are popular with children and it would be a mistake to drop them, said Penelope Royall, a deputy assistant secretary for health at HHS.
However, the ads will not air from early next month until 30 days after the end of the new film's run "because we're not in the business of promoting movies," HHS spokesman Bill Hall told USA Today.
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U.S. Army Testing Equipment to Check Soldiers for Brain Injuries
In an effort to better identify hard-to-diagnose brain injuries in soldiers, the U.S. Army says it will soon begin testing new neuroimaging equipment, the Associated Press reported.
A new scanning camera that uses gamma rays and radioisotopes is expected to arrive within two weeks, said Col. John Cho, commander of the Evans Army Community Hospital at Fort Carson, Colo.
Soldiers who've already been diagnosed with traumatic brain injury will be used to test the equipment and its effectiveness. The findings will be given to an Army review board, the AP reported.
Thousands of U.S. soldiers have suffered brain injuries in the Iraq War. A recent study at Fort Carson found that 2,932 (18 percent) of 13,400 troops who'd been to Iraq had suffered at least some degree of brain damage after being hit by blasts caused by improvised explosive devices.
Some critics have accused the Army of not doing enough to diagnose soldiers with brain damage.
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Texas Company Stops Illegal Production and Sale of Drugs
A Texas-based company has agreed to stop the illegal manufacture and distribution of prescription and over-the-counter drugs, the U.S. Food and Drug Administration said Wednesday.
The agreement applies to PharmaFab Inc., its subsidiary PFab LP, and two company officials -- Mark Tengler, PharmaFab's president, and Russ McMahen, PFab's vice president of scientific affairs.
The products made by the company are illegal because they aren't made according to the required current good manufacturing practice and they may lack FDA approval.
PharmaFab made and distributed more than 100 different prescription and over-the-counter drug products, including ulcer treatments, cough and cold products, and postpartum hemorrhage products, the FDA said.
The unapproved drugs made by the company included: De-Congestine Sustained Release Capsules; GFN 1200/DM 60/PSE 60 Extended-Release Tablets; Rhinacon A Tablets; Sudal 12 Chewable Tablets; Histex PD 12 Suspension; Atuss HX CIII; Ergotrate Tablets; and Hyoscyamine Sulfate Time-Release Capsules.
Consumers who have used any PharmaFab products should talk with their doctor, the FDA said.
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Primary-Care Doctor Visits Less Costly
In 2004, primary-care doctors (general practice, family medicine, internal medicine, and pediatricians) accounted for nearly half of all 967.3 million doctor visits in the United States, but totaled only 30 percent of the $152 billion spent on office-based doctor care.
The remaining 70 percent of the $152 billion was spent on specialty care, says the latest News and Numbers from the U.S. Agency for Healthcare Research and Quality.
The agency also found that the average cost of a visit to the doctor's office was $155, but there were wide variations depending on the type of doctor. The average cost for primary-care doctors was about $100, compared with $232 for a cardiologist, $210 for an orthopedist, and $206 for an ophthalmologist.
Other findings:
Private insurance paid for 48 percent of doctor office visits, Medicare paid for 21 percent, and 14 percent was paid out-of-pocket by patients and families.
On average, patients paid 20 percent of total expenses out-of-pocket when seeing a primary-care doctor, compared with 16 percent for an orthopedist visit, 13 percent for a cardiologist visit, and about 25 percent when seeing dermatologists, psychiatrists and ophthalmologists.

Tainted Pet Food Found in Hogs in Several States

TUESDAY, April 24 (HealthDay News) -- Contaminated pet food, the focus of a massive nationwide recall last month, has been fed to hogs in at least five states, the U.S. Food and Drug Administration announced Tuesday.
Ten pet food manufacturers sent unusable dog and cat food containing the toxic chemical melamine to hog producers in California, New York, North Carolina, South Carolina, Utah and possibly Ohio, FDA officials announced during a late afternoon press conference. Contaminated pet food was also sent to one chicken farm in Missouri, the officials added.
"Hogs that have been fed salvage pet food in North Carolina, South Carolina and California were tested, and levels of melamine were detected in their urine," Dr. Stephen F. Sundlof, FDA's director of the Center for Veterinary Medicine, told reporters at the teleconference.
Whether any of the contaminated meat has entered the U.S. food supply isn't known, Sundlof added. But all the hogs at the farms have been quarantined, he said.
In addition, he said, the FDA has begun to test several types of imported protein supplements used both in human and pet food for the presence of melamine, a chemical used to make plastics and fertilizers.
The imported melamine found in dog and cat food was apparently used to boost the protein content of the foods, and has sickened and killed an unknown number of animals.
"The FDA will begin testing a variety of protein ingredients in finished products commonly found in the U.S. food and feed supply for the presence of melamine," Sundlof said. The agency will focus on newly imported products as well as products already in the country, he added.
Products to be tested include wheat gluten, rice protein concentrate, corn gluten, corn meal, soy protein and rice bran, Sundlof said. Other products may be added to the list later.
These ingredients are used widely in human foods, Dr. David Acheson, FDA's chief medical officer at the Center for Food Safety and Applied Nutrition, told reporters. "Things like breads, pastas, cereals, pizza dough, energy bars and protein shakes," he added.
However, he said, "At this time there is no indication that melamine has been added to ingredients other than those used in the pet food."
Melamine was first found in pet foods manufactured by the Canadian company Menu Foods, which began its recall March 16 with moist dog and cat foods made with melamine-contaminated wheat gluten from China.
The recall has since expanded to other pet food manufacturers and other pet food ingredients, including the imported rice protein concentrate and corn gluten.
On Tuesday, however, Sundlof also announced that in addition to melamine, the FDA has now found cyanuric acid in the rice protein concentrate used for the pet food.
Like melamine, cyanuric acid is a chemical that can be used to boost the apparent protein content of foods but is normally used as a stabilizer in outdoor swimming pools and hot tubs.
"We are testing for that compound as well," Sundlof said.
The pet food recall has gotten the attention of the U.S. Congress, and two senators have asked the FDA to be more forthcoming in disclosing information about the companies involved in importing pet food ingredients.
In a letter to the FDA, Democratic Senators Richard Durbin of Illinois and Maria Cantwell of Washington state asked the agency to reveal the names of all importers of the contaminated rice protein concentrate, which was first recalled last week by Wilbur-Ellis Co. of San Francisco, and the names of the companies that received the shipments.
"We have learned that in addition to Wilbur-Ellis, a second United States company imported a shipment of rice protein from China that is also likely to be contaminated with melamine," the senators wrote. "We request the FDA identify this second importer as well as those manufacturers to which it may have sold the contaminated product."
The FDA confirmed at Tuesday afternoon's teleconference that another company also imported rice protein concentrate from the same Chinese company as Wilbur-Ellis, but the agency continued to refused to identify the U.S. company.
On Monday, however, China finally gave U.S. regulators permission to enter the country to investigate whether Chinese suppliers had exported contaminated pet food ingredients to the United States this year, The New York Times reported.
Previously, China had barred FDA representatives from entering the country despite evidence that the contaminant in the U.S. pet food supply came from Chinese exporters of wheat gluten and other animal feed ingredients, the Times said.
Meanwhile, another manufacturer, SmartPak of Plymouth, Mass., announced that it has recalled its LiveSmart Weight Management Chicken and Brown Rice Dog Food, which it said could contain contaminated rice protein concentrate.
More information
For more information on pet food, visit the U.S. Food and Drug Administration.