Some therapies may hurt pregnancy chance
Wed, 04 Jul 2007 12:54:06 GMTBy MARIA CHENG, AP Medical Writer
LYON, France - Alternative therapies such as reflexology and herbal supplements may reduce a woman's chance of getting pregnant, experts said Wednesday.
Research presented Wednesday at a Lyon meeting of the European Society of Human Reproduction and Embryology examined the impact of alternative therapies on women receiving in-vitro fertilization over a year.
Of 800 Danish women followed for the study, 261 tried treatments including reflexology, herbal supplements, homeopathy, kinesiology and acupuncture.
The women using such treatments overall were 20 percent less likely to get pregnant than those who did not, according to researchers Dr. Jacky Boivin, of Cardiff University, and Dr. Lone Schmidt, from the University of Copenhagen.
"Doctors tend to think that these kinds of therapies are benign," said Boivin, who was surprised by the results. "But maybe they're not as benign as we think they are."
While the study does not provide any definitive answers about the value of alternative therapies, experts say it raises an important issue.
"We cannot start with the assumption that these therapies do no harm," said Dr. Andrea Braverman, director of psychological and complementary care at Reproductive Medicine Associates in New Jersey. Braverman was not connected to Boivin's study and is currently running a study to see if acupuncture helps or hinders pregnancy.
To date, no large-scale, randomized studies have been done looking at the value of alternative remedies.
In the Danish study, the women most likely to try complementary therapies also tended to have a worse prognosis. But even after adjusting for this difference, Boivin said, a discrepancy in the pregnancy rates remained. All of the women in the study were from a similar socio-economic background.
"There still seems to be an association between the use of complementary therapies and the reduced chances for pregnancy," Boivin said.
Because Boivin and Schmidt were unable to disentangle the various alternative therapies tried — they measured all therapies tried, not individually — they could not explain why such treatments might decrease the pregnancy rate. "We have no idea why pressing on your feet could be bad for getting pregnant," Boivin said.
Some experts worried the study might be skewed. "The important question is whether the chicken or the egg came first," said Edzard Ernst, professor of complementary medicine at Exeter University, who was not connected to Boivin's work.
"Those women who are more prone to stress and have more health problems are more likely to try complementary medicine," he said. "So complementary medicine could only be a marker, and not the cause, of stress or lower success rates." Ernst said similar results had been found in looking at the use of alternative therapies in cancer patients.
Experts agreed the lack of data remained a problem. "Anything could have a positive or negative effect," Braverman said. "But without the evidence, we have to be cautious."
CDC defends TB patients quarantine
Wed, 04 Jul 2007 11:01:29 GMTBy COLLEEN SLEVIN and MIKE STOBBE, Associated Press Writers
DENVER - Federal health officials stand by their quarantine of an Atlanta lawyer they believed had a dangerous form of tuberculosis, even though new tests show he has a less severe form of the disease.
"The public health actions that CDC took in this case, and are continuing to take, are sound and appropriate," said Dr. Mitchell Cohen of the Centers for Disease Control and Prevention.
The lawyer, Andrew Speaker, said the CDC's actions were anything but appropriate when he became the center of an international health scare in May, when officials said he had traveled to Europe and back with an extremely drug-resistant form of TB.
The announcement Tuesday from Speaker's doctors raised immediate questions about the accuracy of the diagnosis by U.S. government health officials who had made Speaker the subject of the first federal quarantine order since 1963.
Cohen, speaking at a news conference here, said the public health response should be the same to both forms of drug-resistant TB.
Speaker said in a statement that the new diagnosis relieved him.
"The truth is that my condition is just the same as it was back in early May, long before there was a huge health scare, and back when I was allowed to carry on my daily life and was told I was not a threat to anyone," said Speaker, who was first told two weeks ago that he didn't have extensively drug resistant TB, or XDR-TB, as testing continued.
He also gave a harsh critique of the government's handling of the case: "In the future, I hope they realize the terribly chilling effect they can have when they come after someone and their family on a personal level. They can in a few days destroy an entire family's reputation, ability to make a living and good name."
In an interview with CNN's Anderson Cooper Tuesday night, he said he believed the CDC needed to apologize.
"I think they owe apologies to the people that they scared," he said.
He continued: "They created a huge international panic. They scared, you know, millions of people around the world."
The news that he has a more treatable form of TB means he may avoid surgery and has a much better chance for a cure.
"These new test results are good news for Mr. Speaker. His prognosis has improved," said Dr. Charles Daley, who is treating Speaker at National Jewish Medical and Research Center. "We now have more effective medications available to fight his disease and may be able to treat him successfully without surgery."
It was also good news for any airline passengers who were alarmed to find that Speaker was on their trans-Atlantic flights when he flew to Europe for his wedding and honeymoon even though health officials in Atlanta had advised him not to do so.
The CDC won't know until late July or August whether anyone may have contracted the disease from the 31-year-old Speaker, Daley said. But if they did, they would be easier to treat.
For the past month, Speaker has been isolated at the Denver hospital, which specializes in treating TB and other respiratory diseases. His bride, Sarah, has paid regular visits.
Speaker was found in May to have XDR, based on an analysis of a sample taken in March by the CDC. The strain is rare, extremely difficult to treat and is a growing public health threat.
But later tests in Denver indicate Speaker's TB is a more treatable form of the disease, called multidrug-resistant TB. And the CDC's own retesting of its original sample from Speaker now matches the results in Denver. Multidrug-resistant TB can be treated with some antibiotics that the more severe form resists.
"I don't think we'll ever know why this happened," Daley said.
The CDC's Cohen explained that reading the test results is not black and white.
It's possible for a couple of types of TB to be in one sample, and in one patient, he said. That is one of several possible explanations for why CDC might have found XDR, while subsequent test results show MDR, Cohen said. The sample could have been contaminated or two specimens could have become mixed, he said.
The CDC's diagnosis of XDR-TB was a key factor cited by CDC chief Dr. Julie Gerberding in issuing a quarantine order against Speaker.
When he flew to Greece to be married in May, he was believed to have only MDR-TB. Speaker ignored federal health officials' warnings to get medical help in Europe and not to get on an airplane. Instead, he and his wife flew to Canada and crossed the border into the United States even though his name was on a no-fly list given to border guards.
He was briefly placed under federal quarantine and later sent to the hospital in Denver. The case prompted a hunt for passengers on the cross-Atlantic flights taken by Speaker so they could be tested for the disease.
___
AP Medical Writer Mike Stobbe reported from Atlanta.
Egypt attempts to curb smoking in public
Wed, 04 Jul 2007 08:15:08 GMTBy ANNA JOHNSON, Associated Press Writer
CAIRO, Egypt - In a country where perhaps the most popular national past-time is puffing on a water pipe or chain smoking while drinking tea, new laws designed to curb smoking are receiving a skeptical response.
Egypt's 76 million people smoke billions of cigarettes a year — one of the highest rates in the Middle East. Smoke-filled offices are the norm here along with taxi drivers who light one cigarette after another while stuck in Cairo's treacherous traffic. Nonsmoking sections in restaurants are unheard of and water-pipe filled cafes often overflow onto sidewalks, leaving the sweet smell of fruit-flavored tobacco lingering on the streets.
But some doctors and lawmakers here want to change Egypt's smoking culture. The country's parliament recently passed laws banning tobacco advertising and smoking in some public places including government buildings, schools and hospitals.
The law also calls for health warning labels to be put on cigarette packs and allows the government to increase the price of tobacco, according to parliament member Hamdi el-Sayyed, who proposed the new laws. The national cigarette brand, Cleopatra, sells for about 50 cents a pack.
If individuals break the law, they could be fined up $17. Establishments could be forced to pay about $3,500, if they don't follow the law, said el-Sayyed, who also head's Egypt's Doctor's Syndicate.
Egypt's laws are modest and by no means trendsetting compared to other countries including Britain, Ireland, Italy and some U.S. cities where smoking in all indoor public places — including most restaurants and cafes — is banned. But they are start, especially for a country where 80 billion cigarettes are smoked a year, el-Sayyed said.
"Part of the objective is to keep children and young people from becoming smoking addicts," he said.
But in a country where a massive government bureaucracy often keeps reform moving at snail's pace and bribing officials is common, there is much doubt that the laws will be enforced.
El-Sayyed said Egypt is trying to address the lack of enforcement by calling for the creation of a tobacco control agency and giving the Ministry of Health jurisdiction. He hopes the laws will be implemented by the end of the summer.
"We are determined to get this through. We are anxious to get this implemented," el-Sayyed said.
But skepticism over how Egypt — a country burdened by poverty and high unemployment — would be able to force people not to smoke remains high.
Soliman Mahmoud said he quit smoking 20 years ago but others have not followed his example.
"People here have been trying for a long time to get people not to smoke, but people here don't follow," said Mahmoud while standing on the corner of a congested downtown Cairo street.
Mustafa Ahmed, 25, said laws to curb smoking are a good idea in principle but are not realistic.
"Smoking is popular in Egypt. There is a lot of pressure on people here, especially because the economy is bad. People smoke because they think it will relax them," said Ahmed as he sat on a chair holding a cigarette outside the downtown travel agency where he works.
Sherif Omar, parliament member and professor emeritus with Cairo University's National Cancer Institute, also has doubt over the new laws. He said education was the only way to get young people to put down the water pipe and cigarettes, but anti-smoking education is not part of school curriculum here.
"Law by themselves do not work well unless you have education in schools and in the media," he said.
Screening may affect embryos viability
Wed, 04 Jul 2007 07:04:53 GMTBy MARIA CHENG, AP Medical Writer
LYON, France - An older woman's slim chances of getting pregnant could be made worse if embryos are screened for defects before being implanted into the womb, doctors said Wednesday.
Pregnancy and live birth rates were substantially lower among women whose embryos were screened compared with those whose were not, according to a study presented Wednesday at a Lyon meeting of the European Society of Human Reproduction and Embryology.
The findings, which were questioned by some experts, suggest genetic screening should not be a routine part of fertility treatment for women over 35.
"Based on our research, I would say skip the pre-genetic screening and stick with regular in-vitro fertilization," said Dr. Sebastiaan Mastenbroek from the Center for Reproductive Medicine at the University of Amsterdam.
In the study, also published Wednesday in the New England Journal of Medicine, Mastenbroek and colleagues were trying to determine the value of pre-genetic screening, a process that involves taking a single cell from a developing embryo to look for chromosomal defects that could lead to problems such as Down's syndrome. Doctors have generally thought selecting the most promising embryos will give older women a better chance of getting pregnant.
But some experts have expressed concern that fertility centers promote the genetic tests because they generate profit — with a single test costing up to $5,000.
"This is the first study that has tried to determine for patients, if they put their money down, whether they will take a baby home," said Dr. Peter Braude, professor of obstetrics and gynecology at King's college. The answer, Braude said, was not necessarily.
The study involved 408 women, aged 35-41 and undergoing three cycles of in-vitro fertilization. The Dutch researchers tested embryos from half of those women.
Roughly half were assigned to have their embryos screened. Those who received the screening had a substantially lower pregnancy rate than those who did not: 25 percent versus 37 percent. More than 60 percent of the embryos implanted into women who had them screened were abnormal, a clear indication of the difficulties older women face getting pregnant. And in this study, having their embryos screened did not help.
Mastenbroek and colleagues had several hypotheses to explain the discrepancy between women who received screening and those who did not.
"It could be that the biopsy of one cell needed for pre-genetic screening is more harmful to the ultimate development of the embryo than we had previously thought," Mastenbroek said.
They also suggested that the cell examined might not be representative of the entire embryo. Even if the biopsied cell appeared normal, the rest of the embryo might be abnormal, leading to a problematic pregnancy.
Other experts had reservations about the researchers' methodology.
"The way they performed this process tells us that they did not have a lot of expertise in this," said Dr. Anna Ferraretti, scientific director of the Italian Society for the Study of Reproductive Medicine.
Ferraretti and others said that sometimes the researchers took one cell to biopsy from a four-cell embryo, earlier than is standard procedure for pre-genetic testing.
Some practicing doctors said they were not surprised by Mastenbroek's results. "We have not seen that doing pre-genetic screening increases pregnancy rates," said Dr. Paul Devroey, of the Center for Reproductive Medicine in Brussels. "There is still a big question mark over whether the screening of embryos helps."
