US among worst in world for infant death
Sun, 11 Nov 2007 07:35:55 GMTBy The Associated Press
The rate at which infants die in the United States has dropped substantially over the past half-century, but broad disparities remain among racial groups, and the country stacks up poorly next to other industrialized nations.
In 2004, the most recent year for which statistics are available, roughly seven babies died for every 1,000 live births before reaching their first birthday, the Centers for Disease Control and Prevention says. That was down from about 26 in 1960.
Babies born to black mothers died at two and a half times the rate of those born to white mothers, according to the CDC figures.
The United States ranks near the bottom for infant survival rates among modernized nations. A Save the Children report last year placed the United States ahead of only Latvia, and tied with Hungary, Malta, Poland and Slovakia.
The same report noted the United States had more neonatologists and newborn intensive care beds per person than Australia, Canada and the United Kingdom — but still had a higher rate of infant mortality than any of those nations.
Doctors and analysts blame broad disparities in access to health care among racial and income groups in the United States.
Not surprisingly, the picture is far bleaker in poorer countries, particularly in Africa. A 2005 World Health Organization report found infant mortality rates as high as 144 per 1,000 births — more than 20 times the U.S. rate — in Liberia.
Memphis fights its infant mortality rate
Sat, 10 Nov 2007 20:43:26 GMTBy ERIN McCLAM, AP National Writer
MEMPHIS, Tenn. - The first thing you notice is how tiny they are: Row upon row of babies, some no older than this day, hooked to grotesque jumbles of tubes. Press your palm against the incubator wall and the infant inside disappears from view.
It takes a while for something much sadder to occur to you: In a room full of newborns, dozens of them, there is no crying. The sound of beeping heart monitors, the rustle and murmur of observing doctors, but no crying.
"They're too small and too sick to cry," explains a passing nurse.
This is the newborn intensive care unit of the Regional Medical Center of Memphis, universally known around this city as The Med, perhaps two miles from the blues clubs and rib joints of Beale Street.
And these are the children with a fighting chance.
Some of them, a small fraction, will join the sparse field of little corpses buried in wooden boxes at the county cemetery, distinguished only by little metal plates and identification numbers, perhaps remembered with a stray and shriveled balloon.
Others will go home with mothers in a few days, a week, a year, and they will begin a life fighting impossible odds in this city's worst neighborhoods, forging a struggle against poverty entrenched for generations.
A 2002 federal report put this city at the top of the list for infant deaths in American cities: 692 dead babies over a four-year span, a rate of more than 15 deaths for every 1,000 births, more than twice the U.S. average.
Broken down by ZIP code, centering on the poorest places in this very poor city, there are spots where babies die at a higher rate than they do in some Third World countries.
Some health officials object to that characterization because the figures are small enough to call their statistical significance into question. But no one denies that there is an epidemic of dead babies here.
It is difficult to explain exactly why. It is even more difficult to say whether it will get significantly better any time soon.
Ask people here about their city and they are quick to acknowledge the problems — particularly poverty and racial disharmony, the one exacerbating the other for decades.
They also will physically grab your arm and insist that this is a place with a lot of people pulling for it. And trying very hard, desperately, to figure out a way to save more of the smallest among them.
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Infant mortality gets reported and tracked and scoured for trends in the agate box scores of medical journals, right along with lung cancer and tuberculosis and heart disease. But it is a different animal entirely.
It is not something you catch. There is no vaccine. There is no prescription to make it better. It is not really even something you can describe, beyond the umbrella definition: Infant mortality is a child who never turns 1.
It includes babies born after just five- or six-month pregnancies, children who enter the world with holes in their hearts or devastated lungs and who die in their mothers' arms.
It includes babies born to mothers who simply do not know about sudden infant death syndrome — "crib death" — and who suffocate from being placed on their stomachs to sleep.
It includes babies born into poor homes with unguarded space heaters or chemicals within easy reach under the sink, children who are fed potato chips and Coca-Cola and die of malnutrition.
The U.S. infant mortality rate is just under seven for every 1,000 live births, according to the most recent figures from the Centers for Disease Control and Prevention.
Global reports consistently place the United States near the worst among industrialized nations; analysts have blamed extreme disparity in the health-care quality depending on race and income level.
But here in Memphis, a few other statistics drive home both the severity and the intractability of the problem:
_In 1990, about 20 black babies died for every 1,000 born in Shelby County, and about seven white. In 2006, the numbers were little changed: 19 black, seven white.
_Premature birth and low birth weight are by far the biggest causes of infant death. In 2002, they accounted for about a quarter of infant deaths in Shelby County; in 2006 the figure was more than 31 percent.
_Shelby County lost 209 babies in 2006, according to state Health Department data. No other Tennessee County lost more than 93.
And it is a problem with yawning demographic disparities. In Shelby County, which includes Memphis, about 17 black babies died for every 1,000 born in 2004. For whites, it was about six. Statistical maps that track infant mortality in the county darken ominously in Memphis' poorest neighborhoods.
"It touches on every inequality and unfairness you can think of in our day-to-day life," says Dr. Sheldon Korones, who started The Med's newborn intensive care unit in 1968 and still roams it day and night.
Korones, who is 83 years old, speaks in a whisper and literally laughs off the question of retirement, is still this city's foremost expert on infant deaths, and he seems haunted by the problem's intractability.
He filled out a psychiatric questionnaire once. One of the questions was: What gives you the most pleasure?
His answer was: Turning blue babies pink.
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There are foot soldiers in Memphis' war on its infant death problem — medical, governmental, religious. And then there are people like Rosanna Stepney, an AmeriCorps volunteer.
She was assigned to Porter-Leath, a Memphis nonprofit children's center. And now she is holding the hand — figuratively and, once in a while, literally — of a 19-year-old named Crystal Owens, steering her through her first year as a mother.
Today Stepney is driving through the streets of Hollywood in north Memphis, a place with all the telltale pockmarks of poverty in an American city — graffiti and closed shops, cracked roads with leaning street signs, glares at the unfamiliar.
The topics today are stress management and nutrition — the former for Crystal and the latter for Jaquarius Butler, her 4-month old son, who is smiling up and giggling from an infant seat on the floor of the sparse home where Crystal lives.
Things are improving: Crystal has found a job, as a cashier at Burger King, and has begun taking night classes. She had no job, no classes and no prenatal care when Stepney approached her, two months pregnant, at their church.
They navigated the pregnancy together, and now they are navigating Jaquarius' first year. On this visit, Stepney is concerned about Crystal's newly packed schedule. "Exercise is good for you," she says. "Or relax in the bathtub."
For Jaquarius, Stepney recommends Peek-a-boo and baby push-ups.
"And start him on the cereal," she says. "That's a four- to six-months food. Make sure he gets his proper vegetables and fruits. If he doesn't want to eat it, you know, just put a little applesauce on there."
These are the basics. Many young mothers in Memphis are lacking prenatal care, and with it they are lacking some of the most basic dos and don'ts about carrying a child to term.
Margaret Taylor, a nurse midwife who works at a Christ Community Health Services on a particularly gloomy section of Broad Avenue in Memphis, can tick off what she hears:
If you raise your hands over your head your baby will become wrapped in the umbilical cord. If you feel sick, open the medicine cabinet, any bottle will do. Or just as bad: Stay away from everything in the medicine cabinet.
"I've been in health care for 28 years," Taylor says. "There have been so many programs over time. But you still have women that don't take advantage of it. So you have to look at the culture. What makes people believe things that have no medical basis? It's been passed down."
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A pickup truck and a backhoe show up on the days, usually Tuesdays and Thursdays with good weather, when babies are buried at the county cemetery. The first carries the little wooden coffins, and the second digs the hole, maybe three feet wide, where they are placed a foot apart.
The caretaker is an ordained minister named Robert Savage who has done the job for three decades, and some days before or after driving in the takes to mark the numbered plates above the coffins, he will offer humble comfort to families who show up there. The mothers are often missing, still in the hospital.
In 2005, the local newspaper here, The Commercial Appeal, published an award-winning series called Born to Die that all but forced the people of Memphis and Shelby County and their leaders to confront the ghastly infant mortality figures.
It told the heartbreaking story of a 19-year-old mother named Fredesha Bradley who gave birth to twins; one who died of seizures in intensive care and one who survived and slept face-down in a bed, with a baseball bat nearby for safety.
Nine babies in the family's last three generations had failed to turn 1.
The newspaper series landed on this town like a lead safe.
"Folks had no idea it was this bad," says Yvonne Madlock, who heads the city and county health department.
Within a year, the state of Tennessee — ranked 48th in the nation for infant mortality — had launched a program called 1 For All that took aim at all sides of the problem, encouraging healthier pregnancies and preaching how to care for children.
Still, Madlock acknowledges, the obstacles can seem daunting.
Maybe a young mother-to-be can't get sick leave to see her doctor. Time off is money lost for rent. Maybe she's in denial, and doesn't even have the pregnancy confirmed until the baby has already been harmed. Maybe she is ashamed to visit a clinic. Maybe she has no insurance.
"I'm not crazy. I'm not Pollyanna," Madlock says. "Change isn't immediate. Certain things just take sustained effort."
While devoted health officials here have been working quietly on the problem for years, only in the past two years did Memphis and Shelby County launch a broad, coordinated attack.
The governor's office committed more than $3 million in grants to boost grass-roots programs that try to keep women of childbearing age healthy and to pay for better equipment and add workers at city health clinics.
At the moment, health leaders in Memphis are placing their faith in a relatively new idea called "centering pregnancy," which gathers about a dozen women with similar due dates and coaches them through their pregnancies. They take their own measurement at each meeting, call each other with questions.
The idea: Solve the medical problem by getting vital prenatal care to women who otherwise might not have it, and chip away at the social problem by building a community who women who trust and rely on each other, and perhaps as well at some of the shame and inaccurate information that may have been passed down in families.
Two studies in the journal Obstetrics & Gynecology, including one that came out this August, have found the models led women to be better prepared to handle their pregnancies. One of the two studies also found the model led to higher birth weight, especially for premature babies.
The county has the program up and running at one of its clinics, with plans for two more soon. And Christ Community, where Taylor works, is expecting a state grant soon to start one of its own.
Taylor, who wears earrings depicting babies in the womb — head down, the optimal way, she points out when a guest inquires about them — can barely contain her excitement.
"They are acknowledged. They are heard," she says. "They interact with each other. It produces a community support for each other. You're actually growing a community and teaching women to take care of themselves."
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Sheldon Korones grew up on the Lower East Side of Manhattan, and his grandfather, a Russian Jewish immigrant, was a wainwright, a powerful man who fixed wagons.
The grandfather observed the Sabbath on Saturday, and closed his shop then and worked instead on Sunday, in violation of city blue laws. One Sunday he was working on a wagon, chained to an anvil to keep it in place, when the cops showed up and ordered him to stop.
The police picked up a sledgehammer and went for the chain. The man puts his fists there and said, "You break the hands first."
That is, at 83, how Korones sees his work. You would have to break his hands to stop him from trying to save the babies who keep turning up at the intensive care unit he started 40 years ago.
And yet it is difficult to spend much time talking with him and come away feeling anything but despair for the babies in this city where babies die at such an alarming rate.
"We have treated 48,000 babies here," he says. "Infant mortality is still a problem, and the reason for that, my friend, is we are after the fact. We're a Band-Aid. As soon as a premature baby is born, society has failed."
But the statistics: When the intensive care unit was started, about a quarter of the babies who arrived there died. Last year, the unit admitted 1,200 and lost just 35, about 2 percent. Twenty of the 35 weighed less than 2 pounds.
"I've watched this problem since the days of LBJ," he says. "I've gone to meeting after meeting and we're saying the same damn thing we said back there. I started as a man possessed. And I remain a man possessed."
Confusion on US growth hormone rules
Sat, 10 Nov 2007 16:51:36 GMTBy DAVID B. CARUSO, Associated Press Writer
NEW YORK - Jeffrey George had no background in health care when he founded his business to sell human growth hormone on the Internet.
But even though most uses of the drug are illegal, he is absolutely certain that selling HGH isn't against the law, as long as customers have a prescription.
"It's the same thing as getting antibiotics," the 26-year-old bodybuilder said in a recent interview.
His confidence is understandable. Seventeen years after Congress made it a felony to distribute synthetic HGH improperly, there is still confusion about who may legally get the drug.
Doctors, pharmacists and even law enforcement agents disagree about the meaning of the law that, at least on paper, appears to ban prescriptions for HGH for anything other than a handful of rare illnesses.
The Food and Drug Administration has warned that anyone who distributes HGH for athletic enhancement or as an anti-aging remedy faces up to five years in prison, but that threat is rarely enforced.
Web sites frequented by bodybuilders brazenly hawk mail-order growth hormone as a way of increasing strength and stamina.
George's company, South Beach Rejuvenation and Health, touts the drug as a "fountain of youth," capable of removing wrinkles and boosting sex drive.
"Rejuvenation" centers catering to aging Baby Boomers offer HGH injections as a remedy for everything from low energy to expanding waistlines.
Distributors, according to a recent FDA alert, have increasingly offered to fulfill demand by importing unapproved versions of the drug from China, even though all such shipments are flatly illegal.
After years of treating it as a minor problem, some law enforcement agencies have recently turned more attention to HGH.
In September, the founder of one of China's largest drug manufacturers, the GeneScience Pharmaceuticals Company, was indicted on federal charges that he smuggled huge amounts of HGH into the U.S.
Last month, state officials seized $7.5 million in Chinese-made growth hormone from a Brooklyn pharmacy that had been supplying anti-aging clinics in New York and Florida.
A St. Louis pharmacy company, Specialty Distribution Systems Inc., agreed to pay a $10.5 million fine for distributing HGH to athletes, entertainers and others who didn't qualify for treatment.
And since the spring, a long list of doctors, clinic owners and pharmacy operators from several states have faced charges in Albany that they distributed HGH and steroids to patients who had no medical need for the drugs.
However, authorities acknowledge that the crackdown has been limited.
Prosecutors have been especially reluctant to take on one of the largest sources of HGH: Doctors who prescribe the drug as part of an anti-aging regimen.
Under the law, physicians are allowed to prescribe HGH when a patient's pituitary gland stops producing normal amounts of hormone, usually because it has been damaged by a tumor or a cancer treatment like surgery or radiation therapy.
Since the early 1990s, however, a minority of doctors have claimed that millions of other adults also can be legitimately said to have a hormone deficiency because the pituitary gland naturally tapers off HGH production after a person reaches middle age.
The growth of that approach infuriates doctors like Thomas Perls, an aging expert at Boston University Medical School, who said that while HGH has legitimate benefits there is little evidence to back claims it can slow aging.
"It's the worst kind of quackery," he said.
It also may not be safe, he said. Some studies have suggested that people who take HGH supplements run a greater risk of getting cancer. HGH treatment can also have side effects like joint pain and diabetes.
Prosecuting doctors, however, isn't easy. Just last week, one of the FDA's few efforts to crack down on a doctor ended in failure. A federal jury acquitted Reno, Nev., physician James Forsythe, who was charged in 2005 with prescribing HGH to middle-aged patients who wanted to get into better shape. Forsythe denied doing anything wrong.
State medical boards also appear loath to discipline physicians.
New York's Board for Professional Medical Conduct has taken action against only a handful of doctors in the past two decades for writing unwarranted HGH prescriptions.
After Albany Country District Attorney P. David Soares complained last spring that legal loopholes had made it more difficult to target doctors selling the drug to bodybuilders, Sen. Charles Schumer proposed a bill that would put HGH in the same regulatory category as narcotics and steroids.
At least some people in the business agree that changes are needed.
"The industry is polluted with the wrong types of people," said Brian Cotugno, a Floridian who worked as a consultant to several hormone replacement clinics.
Like George, Cotugno's original background wasn't in medicine. As a young man, he served a 10-year prison sentence for cocaine trafficking.
After his release, he said, he became a consultant, telling clinics how to satisfy government regulations. But he said many of his clients ignored advice that might cut into their profits.
Cotugno said he recently stopped advising the clinics, and abandoned a small HGH marketing business of his own.
"It always ended with some sort of disastrous scenario," he said.
UN report Human cloning ban needed
Sat, 10 Nov 2007 19:52:19 GMTLONDON - The international community faces a stark choice: outlaw human cloning or prepare for the creation of cloned humans, U.N. researchers said Saturday.
Previous attempts to reach a binding worldwide treaty foundered over divisions on whether to outlaw all cloning or permit cloning of cells for research.
The best solution may be to ban human cloning, but to allow countries to conduct strictly controlled therapeutic research, including stem cell research, according to the report from the Japan-based United Nations University Institute for Advanced Studies.
Almost all countries oppose human cloning and more than 50 nations have introduced laws banning it. But lack of binding global legislation gives scientists an opening to create human clones in countries where bans do not exist.
"Failure to outlaw reproductive cloning means it is just a matter of time until cloned individuals share the planet," said Brendan Tobin, a human rights lawyer who co-authored the report.
"If failure to compromise continues, the world community must accept responsibility and ensure that any cloned individual receives full human rights protection," he said.
Cloning research proponents argue it offers great hope for producing replacement tissue and the potential for a cure for diseases such as cancer, Alzheimer's, Parkinson's and diabetes.
The report recommends permitting cloning cells for research — but not cloning aimed at duplicating a person or animal . It also calls for strict controls to prevent the uncontrolled production and destruction of embryos.
Dieting hardest for emotional eaters study
Fri, 09 Nov 2007 14:24:49 GMTCHICAGO - Emotional eaters -- people who eat when they are lonely or blue -- tend to lose the least amount of weight and have the hardest time keeping it off, U.S. researchers said on Thursday.
They said the study may explain why so many people who lose weight gain it all back.
&;We found that the more people report eating in response to thoughts and feelings, the less weight they lost,&; Heather Niemeier, an obesity researcher at The Miriam Hospital and The Warren Alpert Medical School of Brown University, said in a statement.
&;Amongst successful weight losers, those who report emotional eating are more likely to regain,&; said Niemeier, whose study appears in the journal Obesity.
The study included 286 overweight men and women who were participating in a behavioral weight loss program.
A second group consisted of more than 3,300 adults who have lost at least 30 pounds and kept it off for at least one year.
Niemeier and her team analyzed responses to an eating inventory questionnaire.
They focused on people who ate because of external influences, such as people who eat too much at parties, and people who ate because of internal influences, such as feeling lonely or as a reward.
What they found is that the more a person ate for internal reasons, the less weight they lost over time.
&;Our results suggest that we need to pay more attention to eating triggered by emotions or thoughts as they clearly play a significant role in weight loss,&; Niemeier said.
The study was funded by a grant from the National Institutes of Health.
EU Socialists petition for tax cut on condoms
Thu, 08 Nov 2007 18:54:37 GMTBRUSSELS - Aiming to combat AIDS by cutting the cost of safe sex, the European Parliament's Socialist group launched a campaign on Thursday to press EU governments to cut sales tax on condoms.
The 27 European Union member states are free to fix their own Value Added Tax rates on condoms, with a minimum level of five percent. It is as high as 25 percent in Sweden and Denmark.
&;Cutting VAT on condoms to the minimum rate would be both a practical step in tackling AIDS and a powerful symbolic gesture on World AIDS Day ,&; Socialist group vice-president Jan Marinus Wiersma said on launching an online petition at www.socialistgroup.eu.
World Health Organisation figures showed HIV infection rates were growing in Europe, with nearly 27,000 new cases reported in 2005, he said.
Macau doctors want vaccines against infant killer
Fri, 09 Nov 2007 11:00:38 GMTHONG KONG - Doctors in Macau are urging the government to introduce another vaccine to protect children against pneumococcal diseases, which kill more than a million children worldwide a year, mostly in poorer states.
Dubbed the &;infant killer,&; pneumococcal diseases are caused by the common bacteria, Streptococcus pneumoniae.
They cause pneumonia if they attack the lungs, bacteremia if they invade the bloodstream and meningitis if they end up in the brain. They can also cause middle ear infection and sinusitis.
Lui Kin Man, president of the Macau Paediatric Society, said childhood vaccination against the bacteria was important in southern China because treatment was especially difficult.
&;In our region, like Hong Kong, Macau and Taiwan, bacterial drug resistance is very high, and pneumococcal is resistant to drugs like penicillin and erythromycin,&; Lui said in a telephone interview.
The World Health Organization recommended in March that the pneumococcal conjugate vaccine be included in national childhood immunization programs, but it is out of reach for many in Asia at a cost of around $70 for each of the four doses.
Bacteria and viruses are hardy, crafty forms of life that mutate constantly to survive. Excessive and improper prescription of drugs will result in them becoming resistant, and victims would require ever stronger drugs.
The World Health Organization estimates that 49 children in Asia are killed by pneumococcal pneumonia every hour.
&;Mortalities are higher in developing countries and mostly from pneumonia. Of all pneumonia deaths, 40 percent of them are caused by this bacteria,&; Lui said.
