Could nervesnipping spur weight loss
Mon, 02 Jul 2007 20:00:43 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - An old ulcer operation is getting new attention as a possible alternative obesity surgery: a quick snip of a nerve that helps control hunger.
It's far from clear if cutting the vagus nerve really helps — initial pilot studies in a few dozen patients have just begun. Skeptics abound, and even proponents say it wouldn't lead to nearly as much weight loss as more traumatic operations that shrink the stomach and reroute intestines.
It's part of a hunt for middle-ground options for people scared of today's surgery, or those not quite fat enough to qualify for it.
"By no means do I think this is a panacea," cautions Dr. Robert Lustig of the University of California, San Francisco, who is studying the method along with University of Rochester surgeons.
"But I think this will be a rational alternative for a cadre of patients that are sort of in the middle there. With as much obesity as we have in this country, that's a big middle."
More than 177,000 people underwent obesity surgery last year, according to the American Society for Metabolic and Bariatric Surgery. The most popular method is gastric bypass, stapling the stomach to create a tiny pouch. Options include placing an adjustable band around the stomach, or cutting off the stomach's side and rerouting the intestines.
Surgery can produce life-altering weight loss, if recipients adhere to diet and exercise advice, but each method comes with varying degrees of pain and risk, including a rare chance of death. So doctors are searching for alternatives.
Enter the vagus nerve, which snakes from the brain to the abdomen, with fibers reaching into multiple organs with different effects. Among them: The nerve spurs gastric acid production, and in the 1970s, surgery to cut where it attaches to the front and back of the stomach brought ulcer sufferers great relief — after they recovered from open-abdominal surgery. Once better acid-reducing medications came along, this arduous operation was abandoned.
Yet surgeons at the time noticed, and subsequent animal studies confirmed, that these vagotomies could trigger weight loss. In addition to a less acidic stomach's slower digestion, the vagus helps control appetite-stimulating brain hormones and signals our bodies to store more fat, Lustig explains.
Since doctors today can snip the nerve far less invasively, through just five pencil-sized cuts in the abdomen, it was time to test in the obese.
Thirty patients had a vagus snip at UCSF or the University of Rochester. The study isn't complete. But of the 11 who are a year past surgery, all but one are shedding pounds, losing an average of 18 percent of excess weight so far, Lustig and Rochester's Dr. Thad Boss reported at last month's bariatric society meeting.
They suffered no serious side effects, and went home hours later with little pain.
"Every patient who had the vagus nerve cut says they're not hungry," adds Lustig — although the one who didn't respond got hungry again six weeks after surgery, perhaps because the nerve healed.
That's less than half the weight loss of standard surgeries, warns Dr. Neil Hutcher of Bon Secour St. Mary's Hospital in Richmond, Va., and a past president of the bariatric society.
"I have my doubts that vagotomy alone is going to be a significant weapon," says Hutcher, who often cuts the nerve during standard gastric bypasses for a different reason — to help those patients avoid the side effect of heartburn-causing acid buildup.
But, when Greensboro, N.C., surgeons added a vagotomy to 25 patients getting bands on their stomachs, the nerve-snip seemed to make that usually more modest operation about as effective as a gastric bypass — with 43 percent loss of excess weight at six months, and counting.
For a more rigorous study, Rochester's Boss is about to recruit 60 more patients headed for band surgery, giving half a vagotomy as well.
The pilot studies were funded by a startup medical device company called EndoVx Inc. that hopes one day to further simplify vagotomies, cutting the nerve by beaming high-intensity ultrasound waves down the throat.
Other doctors are testing if implants that treat epilepsy by stimulating the vagus nerve also might trigger weight loss, with mixed results so far.
For now, Boss stresses that vagus nerve-snipping remains highly experimental. He and Lustig will track their 30 patients for 18 months to check if ultimate weight loss is enough to warrant further study, and who responds best.
The goal is to help people like Garth Michaels of Walnut Creek, Calif., who twice backed out of standard obesity surgery, fearful of side effects and a long recovery. Thirteen months after he volunteered for the vagotomy experiment, he has dropped 66 pounds, to 246.
That's a much more gradual loss than with regular surgery, but Michaels says having his hunger curbed help him finally learn to exercise. He spends a half-hour on an exercise bike most days. And he learned to avoid former diet saboteurs — french fries, sweets — that caused foul burping after his vagotomy, in favor of fruits and vegetables.
"I will lose more, there's no doubt about it," says Michaels, 56, whose goal is 175 pounds. "It has given me such hope."
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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Study Over 30 pct. report alcohol abuse
Mon, 02 Jul 2007 20:01:33 GMTBy CARLA K. JOHNSON, Associated Press Writer
CHICAGO - More than 30 percent of American adults have abused alcohol or suffered from alcoholism at some point in their lives, and few have received treatment, according to a new government study. Alcoholics who got treatment first received it, on average, at about age 30 — eight years after they developed dependence on drinking, researchers reported.
"That's a big lag," especially combined with the fact that only 24 percent of alcoholics reported receiving any treatment at all, said study co-author Bridget Grant of the National Institute on Alcohol Abuse and Alcoholism.
The treatment rate for alcoholics was slightly less than the rate found a decade earlier. The study did not look at reasons for the decline, but other research has revealed a belief among doctors and the public that treatment doesn't work.
However, Dr. Mark Willenbring, director of the institute's Division of Treatment and Recovery Research, said evidence indicates that substance-abuse treatment is more effective than treatments for many medical disorders.
Three common approaches to treating alcoholism are 12-step programs, cognitive behavioral therapy and motivational enhancement therapy. Medications such as Antabuse, naltrexone and Campral also can help in combination with counseling, he said.
"The important thing is to engage with treatment and stick with it," Willenbring said.
About 42 percent of men and about 19 percent of women reported a history of either alcohol abuse or alcoholism during their lives. Whites and Native Americans were more likely than other ethnic groups to report drinking problems.
Alcohol abuse was defined as drinking-related failure to fulfill major obligations at work, school or home; social or legal problems; and drinking in hazardous situations. Alcoholism was characterized by compulsive drinking; preoccupation with drinking; and tolerance to alcohol or withdrawal symptoms.
The definitions were based on the American Psychiatric Association's diagnostic manual.
Treatment, in the study's definition, could have been by a doctor or another health professional, in a 12-step program, at a crisis center or through an employee-assistance program.
The study, appearing in Monday's Archives of General Psychiatry, was based on a new analysis of the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. The survey involved more than 43,000 face-to-face interviews with a representative sample of Americans, ages 18 and older.
A previous report on the same data found that 4.7 percent of adults reported alcohol abuse in 2001-2002, and 3.8 percent reported alcoholism.
The new analysis was the first to report on the prevalence of alcohol problems over a lifetime.
The study was funded by the New York State Psychiatric Institute and the National Institute on Alcohol Abuse and Alcoholism, a division of the National Institutes of Health.
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On the Net:
Archives of General Psychiatry: http://archpsyc.ama-assn.org/
National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/
Leaving health plan harder than joining
Mon, 02 Jul 2007 19:42:00 GMTBy KEVIN FREKING, Associated Press Writer
WASHINGTON - The health insurance salesman who came to Gloria Young's house made a strong pitch. His company's private Medicare plan could meet her needs just as well as her current insurer, and much more cheaply.
Like many other people, however, after she signed up, she found her doctor wouldn't accept the plan — and she faced months of hurdles switching back.
When Young, 61, of Victory Mills, N.Y., went to her doctor a month after switching to the new insurance, a sign at the front desk said the doctor did not accept that plan.
The nurse then gave her even more alarming news. The new plan would not cover any of her medicine. Young would need to buy that insurance coverage separately.
When she got home, Young called the agent immediately to discuss what she had just seen and been told, and she let him know she needed to cancel before the insurance policy took effect Jan. 1.
"He all but called me a liar," she said.
Over the following months, Young was dogged in her efforts to not let her old insurance lapse and to not let the new insurance kick in. She called the company — American Progressive, a subsidiary of Universal American Financial Corp. — repeatedly. She mailed a premium check to her old plan. They returned it. She called lawmakers and scores of government agencies, she said.
The new policy kicked in anyway, and it would take another five months before she could switch back. Along the way, she missed physical therapy sessions and switched to cheaper, but less effective medications.
Officials at Universal American Financial Corp. did not have an immediate response to calls seeking comment.
Officials with an advocacy group that helped Young — the Medicare Rights Center — said she represents hundreds of seniors who have contacted them because they can't get out of insurance bought as a result of misleading sales tactics.
"We see only the tip of the iceberg," said Robert Hayes, the organization's president.
The problem is that the government failed to establish an effective, seamless process for those who opt out of private plans called Medicare Advantage, Hayes said.
Regional Medicare offices around the country are the first point of contact for his agency, Hayes said.
"Each office plays by different rules in helping people. Literally, different people in the same office play by different rules," Hayes said. "It can be weeks, it can be five or six months even when we are involved. And these are skilled, passionate advocates who take on these cases."
Jeff Nelligan, a spokesman for the Centers for Medicare and Medicaid Services, said the agency will let seniors enroll in another plan even after the open enrollment season has passed if they were misled or given incorrect information. They should call 1-800-Medicare to see if they qualify, he said.
However, Sen. Gordon Smith, R-Ore., said Friday that his staff found the Medicare hot line to be of limited use. He said they called the number several times on June 17 because of concerns about a backlog in disenrollment claims.
There, they were greeted with long wait times, and a "dizzying array" of responses about disenrolling. The average wait time for calls successfully completed by his staff to 1-800-Medicare was 12 minutes. Many others never got through, Smith said.
Nelligan said the average wait time for all calls made to 1-800-Medicare on June 17 was 32 seconds. He said the wait for speaking to an operator was shorter than usual. Calls that didn't get through may have been a result of local telephone network problems, not as a result of problems on CMS's end.
As to the "dizzying array" of responses that Smith said his staff received, Nelligan said the agency takes reports of problems very seriously and works quickly to resolve them.
"We are looking closely at the concerns of Senator Smith in the same manner," Nelligan said.
Smith, the ranking Republican on the Senate Aging Committee, said his staff is investigating reports of lengthy backlogs in the processing of disenrollment claims. He blamed part of the problem on Medicare officials not accepting some disenrollment files from the insurers.
"It is unacceptable for a Medicare beneficiary to wait up to three months to cancel their enrollment in an MA plan," Smith said.
Smith asked for copies of call center scripts relating to disenrollment from private Medicare plans, as well as all guidance, advisories and other instruction letters issued on the topic.
Nelligan said agency officials believe it's important to note that more than 8 million people are enrolled in Medicare Advantage plans, and the agency has logged just 2,700 complaints in the past four months about the plans, a strong track record.
In recent months, federal officials have said agents for some Medicare Advantage plans have used unscrupulous tactics to enroll seniors.
In Georgia, for example, the state insurance commissioner reports that one agent was arrested for fraud after allegedly signing up 10 residents at a home for the mentally disabled. Two other agents were arrested for conspiring to defraud seniors after they allegedly signed up people without their knowledge. They're also accused of signing up dead people.
Seven of the leading companies offering a particular type of managed care plan for seniors, called private fee-for-service, have agreed to suspend the advertising of their plans until they fully implement new marketing requirements.
Meanwhile, Young said she continues to get mail from her old insurer: Last week's letter started out "Dear Member." The letter requested some basic health information so that the insurer could better serve her. ___
On the Net:
Official Medicare site: http://www.medicare.gov
Medicare Rights Centers: http://www.medicarerights.org
Labs mature eggs from girls with cancer
Mon, 02 Jul 2007 18:32:36 GMTBy MARIA CHENG, AP Medical Writer
LYON, France - Doctors have removed eggs from young female cancer patients and — for the first time — brought the eggs to maturity before freezing them, giving the girls a better chance to one day have children.
Previously, scientists had thought viable eggs could only be obtained from girls who had undergone puberty.
"We didn't expect young girls to have eggs that could withstand the process of maturation," which involves adding hormones, said Dr. Ariel Revel, who led the research at the Hadassah Hospital in Israel.
The research will be presented Tuesday at the annual meeting of the European Society of Human Reproduction and Embryology in Lyon.
In related work, Canadian doctors on Monday announced the first birth of a baby from eggs matured in a laboratory, frozen, thawed and then fertilized — a key development that holds promise for infertile women.
The year-old baby girl was born to a woman in Canada, doctors told the conference. Three other women are pregnant from eggs that had been matured in a lab, frozen, thawed and then implanted, they said.
The 20 women involved in the study are infertile with an average age of about 30. None have a history of cancer. Until now, doctors did not know whether eggs matured in a lab could withstand the fertilization process, adding that the research is still in early stages.
"It has the potential to become one of the main options for fertility preservation," said Dr. Hananel Holzer, the study's lead author and an assistant professor in the department of obstetrics and gynecology at McGill University in Montreal.
In the study involving young girls with cancer, Revel surgically extracted the eggs and then artificially matured them in a laboratory, with the idea of re-implanting them one day should the patient wish to have children.
To obtain the eggs, Revel and his colleagues performed surgery on 18 patients ages 5 to 20. Of 167 eggs, 41 were successfully matured, including some from prepubescent donors. They were then indistinguishable from those of older women, Revel said.
"Any advance that enables young women to have children one day after having cancer is positive," said Simon Davies, head of Teenage Cancer Trust, a charity based in Britain. Davies was not linked to the research.
But as the extraction of eggs is an invasive operation, Davies said more information was needed about potential risks to young women fighting cancer. There might also be ethical concerns, as the decision to remove eggs from very young girls would likely be made by the parents, not the patient.
Experts think cancer treatments can affect female fertility. Chemotherapy usually affects all body cells, attacking not only the cancer, but other areas including the ovaries — for which it is often deadly.
Unlike men, who produce sperm throughout their lifetime, women only have a set number of eggs from their birth, which decreases as they age. Young girls who undergo aggressive chemotherapy treatments often experience a sharp drop in the number of their eggs, and some become completely infertile.
The cure rate for childhood cancer can be as high as 90 percent, and doctors are investigating options for preserving patients' fertility. Another experimental method involves removing a thin layer of ovarian tissue for re-implantation later, but trials so far have resulted in only a handful of pregnancies worldwide.
Immature eggs from adult women have previously been matured in the laboratory, but until now, no one had ever tried it with eggs from young girls.
The real test will come when the girls on whom the treatment was performed might be ready to have children. "We will only know the final chapter of this story in about 10 years, when we hope to close the circle of this research," Revel said.
None of the eggs has yet been thawed, and experts are unsure if the process of artificial insemination could result in other problems such as chromosomal abnormalities. Additional surveillance, such as amniocentesis screenings to check the baby's development, probably would be necessary.
Obesity drug has little effect on heart in teens
Mon, 02 Jul 2007 18:25:31 GMTNEW YORK - When the weight-loss drug sibutramine, marketed under the brand names Meridia or Reductil, is used to treat obesity in adolescents, it is associated with small decreases in blood pressure and pulse rate, according to a new study.
&;Overall there were only minor cardiovascular effects related to the treatment with sibutramine,&; Dr. Stephen R. Daniels from University of Colorado School of Medicine, Denver, told Reuters Health. &;However, it is important to recognize that this is only one study and that more data would be useful to more clearly define both the efficacy and the safety of sibutramine in young patients.&;
The study was prompted by previous reports that increases in blood pressure and pulse rate could occur in adults treated with sibutramine. Daniels and his associates investigated the cardiovascular effects of sibutramine in conjunction with behavioral therapy in nearly 500 obese adolescents.
At the start of the study, the participants' average body-mass index was about 36. A year later, the average BMI had dropped by 2.9 points in those given sibutramine compared with only 0.3 points among those who had been given an inactive &;placebo&; pill.
&;Small decreases in blood pressure and pulse rate were seen in both sibutramine and placebo groups,&; the researcher report in the medical journal Pediatrics, and these changes were greater in those who lost the most amount of weight.
&;It is not clear why blood pressure and heart rate respond differently to treatment with sibutramine in adolescents compared with adults,&; the investigators say.
&;I personally still see the use of sibutramine in adolescents more in the research realm than the clinical realm,&; Daniels commented.
&;Behavioral therapy is still the mainstay of treatment in younger patients,&; he said. If drug treatment is to be used, he advised, it should be reserved for those with more severe obesity and with disorders related to obesity &;in whom behavioral methods have been seriously tried and have failed.&;
SOURCE: Pediatrics, July 2007.
