Woman misdiagnosed with HIV gets 362.5M
Thu, 13 Dec 2007 05:54:37 GMTBy RODRIQUE NGOWI, Associated Press Writer
BOSTON - A jury awarded $2.5 million in damages Wednesday to a woman who received HIV treatments for almost nine years before discovering she never actually had the virus that causes AIDS.
In her lawsuit against a doctor who treated her, Audrey Serrano said the powerful combination of drugs she took triggered a string of ailments, including depression, chronic fatigue, loss of weight and appetite and inflammation of the intestine.
Serrano, 45, said she cried after hearing the verdict in Worcester Superior Court and was gratified that the jury believed her.
"I'm going to finish my school and I am going to continue to help others," Serrano said in a telephone interview from her Fitchburg home. "I am going to find another doctor that will help me."
Serrano's attorney, David Angueira, said Dr. Kwan Lai, who treated his client at the University of Massachusetts Medical Center in Worcester's HIV clinic, repeatedly failed to order definitive tests even after monitoring of Serrano's treatment did not show the presence of HIV in her blood.
"It is one of the clearest cases of misdiagnosis that I have ever seen and it's based in part on a presumption that people who engage in certain types of conduct are more likely to have HIV and AIDS than other people without really listening to the patient," Angueira said after the verdict.
Lai testified last week that Serrano told her she had worked as a prostitute, her partner had AIDS, and that she had suffered three bouts of a type of pneumonia typically associated with those infected by the virus.
Serrano has denied she had ever been a prostitute. She confirmed that her former boyfriend tested positive for HIV/AIDS, but disputed the claim that she told the doctor that she had suffered bouts of Pneumocystis pneumonia.
Lai's attorney, Joannie Gulliford Hoban, did not return a call for comment Wednesday night.
Lai testified that she had no reason to question Serrano's original diagnosis at another clinic because Serrano convinced her she had HIV when she took her personal history, and her blood had abnormal amounts of cells used to fight infections.
Hoban argued during the trial that Lai had provided standard care to Serrano.
"Audrey's case clearly demonstrates how inadequate that procedure was," Angueira said. He said his client "is responsible for changing thousands of lives in the future."
The medical center, which was not named in the lawsuit, did not immediately return a message for comment Wednesday night. The institution has denied wrongdoing in the case.
The jury reached its verdict after two days of deliberations, Serrano's attorney said. He said the damages could total about $3.7 million including prejudgment interest.
Serrano filed the lawsuit in 2003 after she became suspicious of her diagnosis and had herself tested at another hospital.
___
Associated Press writer Sylvia Lee Wingfield contributed to this report.
Panel urges end to incontinence stigma
Thu, 13 Dec 2007 02:23:10 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - One in four U.S. adults will experience incontinence at some point, a surprisingly high toll, and the condition is so embarrassing that many suffer silently, a government panel said Wednesday.
Women are most prone to incontinence, which is the inability to control urination or bowel movements. But everyone's risk rises as they get older. Being overweight and a couch potato adds to the risk.
With the population rapidly graying and fattening, scientists convened by the National Institutes of Health issued an urgent call for research to find better ways to prevent incontinence and to remove the stigma so more people will seek help.
"We as a society need to get over our discomfort with this subject so that incontinence sufferers receive the compassion, acceptance and care they need, and our aging population can take steps to prevent incontinence in the future," said Dr. C. Seth Landefeld, geriatrics chief at the University of California, San Francisco, who led the panel.
Today, fewer than half of the people with incontinence volunteer their symptoms to a doctor, the panel found. That is the case despite a variety of effective treatments, from exercises to medications and surgery.
Prevention is better, but the panel found major gaps in the understanding of the biology of incontinence that hinder that effort. For now, the panel's best advice is for people to seek help.
And for those without the problem, exercise and dropping extra pounds are recommended as protection.
"All of us are walking around with a bag of water and a bag of stool in our pelvis," Landefeld said. "Anything that exerts increased pressure on those, tends to push them out, is potentially leading to incontinence."
Among other suggestions are:
_Women especially should try exercises of their pelvic floor muscles, popularly termed "Kegels," to keep them strong enough for good bladder control. But ask at a checkup if they are being done correctly. Too many women wind up squeezing the wrong muscles.
_Obestricians should end routine use of episiotomies, an incision that enlarges the vaginal opening for childbirth. Obstetric groups long have issued the same advice, saying episiotomies are useful only if the baby is in distress. But Wednesday's panel cited estimates that 1 million women a year still receive a routine one, leading to perhaps 1,000 of them suffering fecal incontinence directly after birth or later in life.
Urinary incontinence is the more common type; previous estimates have put the number of people with this condition at around 13 million. Actually, more than 20 million women and 6 million men have experienced urinary incontinence at some point, the NIH panel concluded.
The two most prevalent subtype are stress incontinence and urge incontinence.
Stress incontinence is leakage caused by physical pressure to the abdomen, such as coughing, sneezing, laughing, jogging or lifting a heavy object. Urge incontinence is a sudden, uncontrollable urge to urinate, sometimes called overactive bladder.
Fecal incontinence is harder to measure, even more stigmatized and thus hardly ever studied. The best estimates suggest it affects up to 5 percent of the general population and up to 39 percent of nursing home residents.
Pregnancy and childbirth can trigger incontinence that can be either temporary or lasting. So can menopause, when the loss of estrogen is thought to weaken some bladder-control muscles.
But other risk factors are myriad and poorly understood: radiation therapy, pelvic injury or surgery, urinary tract infections, neurological diseases, the panel found.
The severity of incontinence varies widely, from a few drops to a major impairment that requires wearing diapers and may strand people in their homes.
It is a huge trigger of nursing home admissions, particularly with dementia patients whose caregivers cannot handle the added stress and physical toll of diapering an uncooperative adult.
Disturbingly, much incontinence in nondemented nursing home patients is not due to biology but lack of staff to help the frail get to the bathroom in time, the panel noted.
Merck recalls common childrens vaccine
Thu, 13 Dec 2007 05:12:40 GMTBy LINDA A. JOHNSON, AP Business Writer
TRENTON, N.J. - The recall of a routine vaccine for babies due to contamination risks could trigger a shortage and likely will alarm parents, but officials said there is no known health threat.
The recall announced Wednesday covers roughly 1.2 million doses of the vaccine against Hib, which causes meningitis, pneumonia and other serious infections, and a combination vaccine for Hib and hepatitis B. The Hib vaccine is recommended for all children under 5 and is usually given in a three-shot series, starting at 2 months old.
Drugmaker Merck & Co. produces about half of the nation's annual supply of 14 million doses of Hib vaccine.
Merck recalled the lots after this week identifying a sterility problem in a Pennsylvania factory. It said sample vials from the recalled lots, tested before shipment, were not contaminated but the company could not assure sterility of the entire lots.
"The potential for contamination of any individual vaccine is low," said Kelley Dougherty, a spokeswoman for the Whitehouse Station-based company.
Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention, echoed that in a news conference.
"This is not a health threat in the short run, but it is an inconvenience," she said.
Barbara Kuter, Merck's head of pediatric medical affairs, told The Associated Press that the company will not be able to supply any vaccine for at least nine months.
"Manufacture of vaccines is pretty complicated, and we have to basically make some changes in the process," then get approval from the Food and Drug Administration before resuming production and shipments, Kuter said. Merck hopes to restart production next fall, she said.
"It's likely that there's going to be a shortage of this product," Kuter said, adding that the impact on the public is unclear.
Donna Cary, spokeswoman for Sanofi Pasteur, the only other company making the vaccine for the U.S., said it was too soon to say whether it can boost production. The company, a unit of Paris-based drugmaker Sanofi-Aventis SA, makes an Hib vaccine in France that is distributed both to the U.S. and other countries.
"We're looking at what we can add and we're working closely with the CDC on this," to see whether some vaccine could be shifted to the U.S. from other countries, Cary said.
Health officials said they already are talking about prioritizing shots for American Indian and Alaska Native children, who are considered at higher risk for Hib-caused illnesses, said Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.
It was unclear how many of the 1.2 million doses were administered to children.
The recalled doses, distributed beginning in April, are considered potent, so revaccinations won't be needed, Schuchat said.
Should the vaccine later prove contaminated, health officials believe most children will experience, at worst, skin irritation around the shot site. Problems could be worse for children with weakened immune systems.
Any problems would have appeared within a week of vaccination, Schuchat said, and there have been no such reports.
The contamination was on unspecified equipment used in making the vaccine. Kuter said a sterility test during a routine evaluation of Merck's West Point, Pa., vaccine plant determined that the equipment was contaminated with a common bacterium called Bacillus cereus, or B. cereus.
It is a spore-making microorganism commonly associated with food poisoning and causes diarrhea and vomiting in people who eat contaminated foods.
The recall is likely to heighten a debate over childhood vaccines, their safety and whether too many are required. Some parents are distrustful and suspect some vaccines of being linked to autism, although scientific studies have not shown a connection.
This week, New Jersey took a controversial step toward becoming the first state to require flu shots for preschoolers after a health advisory board backed new vaccine requirements over opposition from some worried parents.
Merck is one of the few drugmakers that make vaccines. Company representatives could not immediately say how much revenue the Hib vaccine produces.
While the company took a black eye with its September 2004 withdrawal of painkiller Vioxx due to increased heart attack risk, it has been performing well recently. It gave an upbeat assessment Tuesday in its annual briefing for analysts.
Five weeks ago, Merck reached a deal to settle up to 50,000 Vioxx lawsuits for $4.85 billion, an amount expected to save the company millions in trial costs.
Its stock price has more than recovered from its post-Vioxx slump, a two-year-old restructuring plan is going well, and profits are up. Merck posted a 62 percent increase in its third-quarter profit as revenues jumped 12 percent.
The company also has had an impressive seven new products approved for U.S. sale in the last two years, including three vaccines.
Merck shares fell 68 cents Wednesday to close at $59.72 before the recall announcement. The shares fell 12 cents in after-hours trading.
___
AP Medical Writer Mike Stobbe in Atlanta contributed to this report.
Study Why pregnant women dont topple
Thu, 13 Dec 2007 03:30:38 GMTBy SETH BORENSTEIN, AP Science Writer
WASHINGTON - Scientists think they have figured out why pregnant women don't lose their balance and topple over despite ever-growing weight up front. Evolution provided them with slight differences from men in their lower backs and hip joints, allowing them to adjust their center of gravity, new research shows.
This elegant engineering is seen only in female humans and our immediate ancestors who walked on two feet, but not in chimps and apes, according to a study published in Thursday's journal Nature.
"That's a big load that's pulling you forward," said Liza Shapiro, an anthropology professor at the University of Texas and the only one of the study's three authors who has actually been pregnant. "You experience discomfort. Maybe it would be a lot worse if were not there."
Harvard anthropology researcher Katherine Whitcome found two physical differences in male and female backs that until now had gone unnoticed: One lower lumbar vertebra is wedged-shaped in women and more square in men; and a key hip joint is 14 percent larger in women than men when body size is taken into account.
The researchers did engineering tests that show how those slight changes allow women to carry the additional and growing load without toppling over — and typically without disabling back pain.
"When you think about it, women make it look so very damn easy," Whitcome said. "They are experiencing a pretty impressive challenge. Evolution has tinkered ... to the point where they can deal with the challenge.
"It's absolutely beautiful," she said. "A little bit of tinkering can have a profound effect."
Walking on two feet separates humans from most other animals. And while anthropologists still debate the evolutionary benefit of walking on two feet, there are notable costs, such as pain for pregnant females. Animals on all fours can better handle the extra belly weight.
The back changes appear to have evolved to overcome the cost of walking on two feet, said Harvard anthropology professor Daniel Lieberman.
When the researchers looked back at fossil records of human ancestors, including the oldest spines that go back 2 million years to our predecessor, Australopithecus, they found a male without the lower-back changes and a female with them.
But what about men with stomachs the size of babies or bigger? What keeps them from toppling over?
Their back muscles are used to compensate, but that probably means more back pain, theorized Shapiro, who added: "It would be a fun study to do to look at men with beer bellies to see if they shift their loads."
___
On the Net:
Nature: http://www.nature.com/nature
