W.Va. unveils tool to help fight obesity
Tue, 30 Oct 2007 20:36:47 GMTBy TOM BREEN, Associated Press Writer
CHARLESTON, W.Va. - West Virginia is hoping that a little wheel can make a big difference in the state's obesity problem. The wheel is a body mass index calculator, a low-tech tool that will be distributed to doctors across the state as part of a new effort to get physicians to recognize obesity early in their patients.
The largest provider of Medicaid coverage in the state, the health benefits group UniCare, began offering training Tuesday to doctors and their staffs in obesity prevention and body mass index measurement.
UniCare's parent company, Indiana-based WellPoint Inc., currently offers the training only in California. But it hopes to use West Virginia as the starting point for an expansion into the 13 other states where it provides benefits.
"We all know somebody that would have given everything to have their health," Gov. Joe Manchin said at a news conference last week announcing the UniCare plan. "And they could have, if they had taken the right precautions."
West Virginia is the third-heaviest state in the nation. According to the state Bureau for Public Health, more than 30 percent of adults in West Virginia are obese. A national study earlier this year by the Trust For America's Health ranked West Virginia second in the percentage of children who are obese.
Manchin has made improving the health of residents one of his primary goals. The governor has been lobbying federal officials to allow West Virginia to use some of its state Children's Health Insurance Program money to do obesity screening for children in kindergarten and the second, fifth and eighth grades.
"That way, we can track them across a number of years and measure their progress, and our progress," Manchin said.
The body mass index test that doctors will be trained to use is a simple calculation based on a person's height and weight.
Joking that the small paper wheel used to make the calculation is a "miracle of modern technology," West Virginia University pediatrician Dr. Stephen Sondike said the test is especially crucial for young people.
It can be hard to tell if a child's weight is a sign of early obesity or normal growth, said Sondike, who attended the program's announcement.
"Kids can grow into their weight," he said. "But if there is a risk of obesity, it's a lot easier to stop it when they're children than when they're adults."
At the training sessions, doctors will be given calculation wheels along with charts from the federal Centers for Disease Control and Prevention to help interpret the results.
Sondike said that while many doctors are aware of BMI calculations, one goal of the training is to make physicians think of it as a standard measurement for patients, like weight or blood pressure.
For state government, the concern is the health of its residents, but it also a matter of dollars and cents. The state's Medicaid agency spends about $100 million on obesity-related costs annually, while obesity cost the state Public Employees Health Insurance agency $93 million last year, about 18 percent of its budget.
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On the Net:
State Office of Healthy Lifestyles: http://www.wvohl.org/
Vitamin D may not reduce cancer deaths
Tue, 30 Oct 2007 20:39:34 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - A large new study found no sign that vitamin D lowers the overall risk of dying from cancer, injecting a note of caution to the latest vitamin craze. The exception: People with more vitamin D in their blood did have a significantly lower risk of death from colorectal cancer, supporting earlier findings.
Getting enough of the so-called sunshine vitamin — the skin makes it from ultraviolet rays — is vital for strong bones. But vitamin D has made headlines in recent years because of research saying it may be a powerful cancer fighter, sparking a push for people to get more than currently recommended amounts, either through diet or sun exposure.
The first-of-a-kind government study released Tuesday shows the issue is far from settled.
National Cancer Institute researchers analyzed vitamin D levels measured in almost 17,000 people as part of a national study that tracked their health. About a decade after enrolling, 536 of those people had died of cancer. Whether people had low or high vitamin D levels played no role in their risk of dying from cancer in general, they reported Tuesday in the Journal of the National Cancer Institute.
Then the researchers examined different types of cancer. There were just 66 deaths from colorectal cancer. Still, people with high levels of vitamin D appeared 72 percent less likely to die of colorectal cancer than people with the lowest vitamin D levels.
"While vitamin D may well have multiple benefits beyond bone, health professionals and the public should not, in a rush to judgment, assume that vitamin D is a magic bullet and consume high amounts," Johanna Dwyer, a dietary supplement specialist at the National Institutes of Health, cautioned in an accompanying editorial.
Indeed, there are numerous risk factors for colorectal cancer, including obesity and low physical activity, and it's unclear if low vitamin D levels play an independent role or are just a marker for those other risks, she said.
Scientists have been interested in vitamin D's effects for decades, since noticing that cancer rates between similar groups of people were lower in sunny southern latitudes than in northern ones. A handful of studies since then have found people given vitamin D supplements have less risk of developing certain cancers, but much of the evidence is circumstantial.
Experts are cautious because other vitamins and nutrient supplements once widely thought to prevent cancer didn't pan out when put to rigorous testing.
The NCI's study is the first to compare blood levels of vitamin D to cancer mortality, and "it's the best research we have on this topic," said Dr. Len Lichtenfeld of the American Cancer Society.
But a big weakness: It measured vitamin D at just one point in participants' lives, when levels can vary widely with dietary changes and especially the seasons.
Overall, most research "seems to be pointing in the direction that there is a role of vitamin D," Lichtenfeld said. Tuesday's study "puts a note of caution in there that says with all the explosion of information and advocacy on behalf of vitamin D, we need to be cautious. ... We really need some further studies that are well done to answer the question."
More young adults on cholesterol drugs
Tue, 30 Oct 2007 11:40:22 GMTBy LINDA A. JOHNSON, AP Business Writer
TRENTON, N.J. - Use of cholesterol and blood pressure medicines by young adults appears to be rising rapidly — at a faster pace than among senior citizens, according to an industry report being released Tuesday.
Experts point to higher rates of obesity, high blood pressure and high cholesterol problems among young people. Also, doctors are getting more aggressive with preventive treatments.
"This is good news, that more people in this age range are taking these medicines," said Dr. Daniel W. Jones, president of the American Heart Association.
Still, he said many more people should be on the drugs that lower cholesterol or blood pressure and which have been shown to reduce risks for heart attack and stroke.
The new data, from prescription benefit manager Medco Health Solutions Inc., indicate use of cholesterol-lowering drugs among people aged 20 to 44, while still low, jumped 68 percent over a six-year period.
The rate rose from 2.5 percent in 2001 to just over 4 percent in 2006 among Medco customers. That means roughly 4.2 million Americans in that age group are now taking cholesterol medicines.
Meanwhile, use of blood pressure medicines increased 21 percent, from about 7 percent of 20- to 44-year-olds in 2001 to over 8 percent in 2006. That translates into about 8.5 million Americans in that age group taking drugs to lower their blood pressure.
"It was a surprise to us," said Dr. Robert Epstein, chief medical officer at Franklin Lakes, N.J.-based Medco. "Maybe the fact that we're seeing more young people with high cholesterol and blood pressure is indicative of the epidemic of obesity and overweight that we're seeing in this country."
Among people 65 and older, use of blood pressure drugs increased only 9.5 percent and use of cholesterol drugs by 52 percent. That's because half the seniors were already taking blood pressure drugs and more than one in four were taking cholesterol drugs in 2001.
Jones, dean of the University of Mississippi School of Medicine, said he has seen some increase in young adults with blood pressure or cholesterol problems, but not of the magnitude suggested by Medco's data.
Dr. Howard Weintraub, the heart disease prevention expert at the American College of Cardiology, said he's "thrilled" by the dramatic increase, which he says is tied to requests from patients with "a brand new sense of urgency" and referrals from other doctors to his private practice.
"If you wait until a heart attack or stroke, it's a little bit late," Weintraub said.
He and Epstein both said patients with problems should first work with their doctors on lifestyle changes — more exercise, a better diet and weight loss. But Weintraub said many people need medication to achieve and maintain the ever-lower levels of blood pressure and cholesterol that experts now recommend.
However, Dr. John LaRosa, president of SUNY Downstate Medical Center, said, "particularly for young people, lifestyle change is worth a try."
Once patients start taking these medicines, they usually stay with them and there are some side effects, LaRosa said.
"It's amazing what five or 10 pounds will do" to reduce blood pressure and cholesterol levels, he said.
Federal health statistics show that while the percentage of people with high cholesterol has dropped overall in recent years, it has risen among younger people, especially those 20 to 34 years old.
Meanwhile, the prevalence of high blood pressure was flat or up slightly among those age groups; among women in the 35 to 44 age group, the rate of high blood pressure rose significantly.
Medco processes prescription claims for about 60 million insured Americans. The report's findings are based on a representative sample of data from 2.5 million members.
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On the Net: http://www.medco.com
Doctors test hot sauce for pain relief
Tue, 30 Oct 2007 10:41:01 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Devil's Revenge. Spontaneous Combustion. Hot sauces have names like that for a reason. Now scientists are testing if the stuff that makes the sauces so savage can tame the pain of surgery.
Doctors are dripping the chemical that gives chili peppers their fire directly into open wounds during knee replacement and a few other highly painful operations.
Don't try this at home: These experiments use an ultra-purified version of capsaicin to avoid infection — and the volunteers are under anesthesia so they don't scream at the initial burn.
How could something searing possibly soothe? Bite a hot pepper, and after the burn your tongue goes numb. The hope is that bathing surgically exposed nerves in a high enough dose will numb them for weeks, so that patients suffer less pain and require fewer narcotic painkillers as they heal.
"We wanted to exploit this numbness," is how Dr. Eske Aasvang, a pain specialist in Denmark who is testing the substance, puts it.
Chili peppers have been part of folk remedy for centuries, and heat-inducing capsaicin creams are a drugstore staple for aching muscles. But today the spice is hot because of research showing capsaicin targets key pain-sensing cells in a unique way.
California-based Anesiva Inc.'s operating-room experiments aren't the only attempt to harness that burn for more focused pain relief. Harvard University researchers are mixing capsaicin with another anesthetic in hopes of developing epidurals that wouldn't confine women to bed during childbirth, or dental injections that don't numb the whole mouth.
And at the National Institutes of Health, scientists hope early next year to begin testing in advanced cancer patients a capsaicin cousin that is 1,000 times more potent, to see if it can zap their intractable pain.
Nerve cells that sense a type of long-term throbbing pain bear a receptor, or gate, called TRPV1. Capsaicin binds to that receptor and opens it to enter only those pain fibers — and not other nerves responsible for other kinds of pain or other functions such as movement.
These so-called C neurons also sense heat; thus capsaicin's burn. But when TRPV1 opens, it lets extra calcium inside the cells until the nerves become overloaded and shut down. That's the numbness.
"It just required a new outlook about ... stimulation of this receptor" to turn those cellular discoveries into a therapy hunt, says NIH's Dr. Michael Iadarola.
Enter Anesiva's specially purified capsaicin, called Adlea. Experiments are under way involving several hundred patients undergoing various surgeries, including knee and hip replacements. Surgeons drip either Adlea or a dummy solution into the cut muscle and tissue and wait five minutes for it to soak in before stitching up the wound.
Among early results: In a test of 41 men undergoing open hernia repair, capsaicin recipients reported significantly less pain in the first three days after surgery, Aasvang reported this month at a meeting of the American Society of Anesthesiologists.
In a pilot U.S. study of 50 knee replacements, the half treated with capsaicin used less morphine in the 48 hours after surgery and reported less pain for two weeks. Ongoing studies are testing larger doses in more patients to see if the effect is real.
There's a huge need for better surgical pain relief, says Dr. Eugene Viscusi, director of acute pain management at Thomas Jefferson University in Philadelphia, one of the test sites. Morphine and its relatives, so-called opioid painkillers, are surgery's standby. While they're crucial drugs, they have serious side effects that limit their use.
Specialists are watching the capsaicin research because it promises a one-time dose that works inside the wound, not body-wide, and wouldn't tether patients to an IV when they're starting physical therapy.
"It's in and it's done," Viscusi explains. "You can't abuse it. You can't misuse it."
"There's been an enormous effort to try and develop alternatives to opioids with the same strength but not too much success," adds Dr. Clifford Woolf of Harvard and Massachusetts General Hospital. "We think we're moving toward it."
His team is trying a different approach: Standard lidocaine injections numb all the surrounding tissue. Woolf and colleagues slipped lidocaine inside just pain-sensing neurons, by opening them with a tiny dose of capsaicin. Rats given the injections ran around normally while not noticing heat applied to their paws, they reported in the journal Nature this month.
That's years away from trying in people, and would have to be done in a way to avoid even a quick capsaicin burn.
In a third approach, Iadarola and NIH colleagues hope to soon test a capsaicin cousin called resiniferatoxin in advanced cancer patients whose pain no longer is relieved by opioids. Injections into the spinal columns of cancer-riddled dogs did more than temporarily numb — it severed some nerve connections.
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EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
TV raises blood pressure in obese kids study
Tue, 30 Oct 2007 04:34:12 GMTCHICAGO - Watching too much television may not only help make children fat, it may also raise their blood pressure, U.S. researchers said on Tuesday.
They found obese children who watched four or more hours of TV a day were three times more likely to have high blood pressure than children who watched less than two hours a day.
&;There is a significant association between hours of television watched and both the severity of obesity and the presence of hypertension in obese children,&; Dr. Jeffrey Schwimmer of the University of California, San Diego and colleagues wrote in the American Journal of Preventive Medicine.
Many studies have found a strong link between watching TV and obesity, but this is the first study to show a link between TV and blood pressure in obese children and teens, the researchers wrote.
Obesity in children is on the rise, increasing the risk of heart disease and diabetes. And high blood pressure in children has been rising in right along with obesity rates.
The problem is often undiagnosed in children, and if undetected, high blood pressure can quietly damage the organs, especially the kidneys.
Schwimmer worked with researchers at the University of California, San Francisco, and the University of South Alabama. They studied 546 children and teens aged 4 to 17 seen at weight management clinics from 2003 to 2005.
Height and weight were measured to determine a body mass index, or BMI, and blood pressure was recorded.
Children were considered obese if their BMI measures were above the 95th percentile for age and gender. Children in the study had a mean BMI of 35.5. In adults, a BMI of 30 or higher is considered obese.
The children and their parents estimated how much time they spent watching TV, and a doctor reviewed and confirmed their estimates.
The researchers found children who watched two to four hours of TV were 2.5 times more likely to have high blood pressure compared with those who watched less than two hours of television a day. Those who watched more than 4 hours per day were 3.3 times more likely to have hypertension.
The authors said the study illustrates the need for parents to curb their children's TV time, especially for children who are already obese or have high blood pressure.
The American Academy of Pediatrics recommends children watch fewer than two hours of TV per day.
Some 17 percent of U.S. children are obese, according to the U.S. Centers for Disease Control and Prevention.
Professor observes kids face their fears
Tue, 30 Oct 2007 20:54:15 GMTBy SETH BORENSTEIN, AP Science Writer
In the lab, psychology professor David Zald studies how fast adults react to fear. At his home this time of year, he watches kids adjust to it.
Zald, a professor at Vanderbilt University, turns his house in Nashville, Tenn., into a Halloween fear lab — with a reward of candy for those who brave it. Skeletons hang from the tree, motion-activated sensors move objects around in a scary way and there's a creepy fog floating around the house. Zald decorates in classic horror motif for fun, but the shrink in him can't help but observe the classic fear response in children.
"They want the candy, but they're not sure they want to come up," says Zald, who in the past has dressed up as a devil but this year will be costumed as kitschy Disco Stu from the animated TV series, "The Simpsons."
By the end of the night, even the young children aren't fazed by ghouls and goblins. They control their fear to get the reward of candy, Zald said, and they learn a healthy lesson.
Fear is a negative emotion and for millions of Americans, it's disabling. Yet people love horror movies, and Halloween is a holiday that celebrates fear while rewarding children with sweets. There are scientific reasons for this odd mix.
"One of the odder aspects of human nature is our willingness to pay money to actually get scared," Zald said. "Essentially we get off on the excitement. We get a high arousal state and we actually find that appealing."
There are physical chemical rewards in our brain when we experience fear, yet cheat an anticipated painful threat, psychologists say. And fear-induced hormones, such as adrenaline, are pleasurable at times.
"Part of the fun of Halloween is that it's a way of experiencing fear in a pretty controlled setting," said University of Michigan psychology professor Stephen Maren. "People enjoy the fun and surprises, but they're putting themselves in situations where they are really not in danger."
Some people need that kind of excitement, which is similar to the rush felt when playing sports, said New York psychologist Linda Sapadin, author of the book "Master Your Fears."
"We do need some fear in our lives, otherwise things are too placid," she said.
On the other hand, she noted, people who live in war zones don't go to horror movies.
Smoking not linked to more advanced breast cancer
Tue, 30 Oct 2007 21:00:43 GMTBy Will Dunham
WASHINGTON - Women who develop breast cancer are no more likely to have aggressive or advanced tumors if they are cigarette smokers than if they do not smoke, researchers said on Sunday.
Whether cigarette smoking raises a woman's chances of ever developing breast cancer has remained a controversial question, with some research indicating a risk and other studies not.
Researchers at Fox Chase Cancer Center in Philadelphia investigated whether female smokers who got breast cancer were more likely to have a more serious form.
They analyzed data on 6,162 women with breast cancer evaluated at the facility from 1970 to 2006, and found that whether a woman smoked did not affect whether her tumor was more advanced or particularly aggressive at the time of diagnosis.
Nine percent of the breast cancer patients were smokers when they were first seen.
&;For patients who developed breast cancer, there did not appear to be a difference in the cancers that they presented with based on whether or not they had ever smoked,&; Dr. Matthew Abramowitz of Fox Chase Cancer Center, one of the researchers, said in a telephone interview.
&;In addition, there did not appear to be a difference in the type of treatment they were offered, whether or not they were smokers,&; added Abramowitz, whose findings were presented at a meeting of the American Society for Therapeutic Radiology and Oncology in Los Angeles.
Abramowitz said the study did not evaluate whether smokers were more likely than nonsmokers to have complications in treatment for breast cancer or die from the disease.
&;I was expecting that maybe there would be more advanced stage in patients who were smoking,&; Abramowitz said.
Abramowitz said the findings do that mean that smoking is any less hazardous than multitudes of studies have shown.
The National Cancer Institute said cigarette smoking causes 87 percent of lung cancer deaths and is responsible for most cancers of the larynx, mouth, esophagus and bladder. It said tobacco use, particularly cigarette smoking, is the most preventable cause of death in the United States.
