Payment for stem cell eggs debated

Sat, 20 Jan 2007 23:54:58 GMT
By MALCOLM RITTER, AP Science Writer
Say you're a woman who wants to have fertility treatment but can't afford the $5,000 to $6,000 cost.
What if you could get it for half-price, by agreeing to donate half the eggs you produce for stem cell research?

Interested?

British women may get a crack at that deal in a few months, under a plan pursued by Dr. Alison Murdoch of Newcastle University.

This concept, which resembles a strategy sometimes used to get eggs for fertility treatment, is just one of several new efforts to boost the supply of human eggs needed for research. The shortage has triggered an ethical debate on both sides of the Atlantic: Should women be paid for supplying eggs?

Scientists need eggs for a process called therapeutic cloning, which creates stem cells genetically matched to an individual. It may be used someday to create tissue to treat illnesses like diabetes and Parkinson's disease, providing transplant material that's genetically matched to the patient so that it won't be rejected. Therapeutic cloning may also help scientists develop better drug treatments.

The process involves transferring DNA into human eggs and growing them into 5-day-old embryos, from which stem cells are harvested.

It's not clear just how many eggs scientists need for this research. But it is clear that for a woman, donating eggs is a significant undertaking.

By various estimates, a woman can spend 40 to 56 hours in medical offices, being interviewed, counseled and subjected to a surgical procedure, under sedation, that retrieves eggs from her body. Before that procedure, she takes hormone injections daily for more than a week to stimulate egg development.

Women donate thousands of eggs in the United States every year to help other women have babies. They are paid. The American Society of Reproductive Medicine doesn't recommend a figure but says $5,000 or more requires some justification and that $10,000 is too much. .

The medical group also says it's fine to pay women for producing eggs for stem cell research. But other guidelines and laws on that topic favor just reimbursing women for expenses. That's the word from the law books of California and Massachusetts and a committee of the National Research Council, a congressionally chartered nonprofit organization that advises the federal government.

In fact, the compensation question has split American feminists and advocates for reproductive health and rights, said Marcy Darnovsky, associate executive director of the Center for Genetics and Society. One side says offering money beyond reimbursement risks exploiting disadvantaged women by offering undue inducement to participate, while the other side calls that stance paternalistic, she said.

Darnovsky said her center has no position on paying women to provide eggs for fertility clinics, but holds that if women give eggs for stem cell research, they should only be reimbursed for expenses, including lost wages.

Why the difference? It's a matter of a woman's gauging the risks and benefits of donating her eggs, Darnovsky said.

On the risk side, there's been too little follow-up of women to know for sure how safe the egg-retrieval process is, she said.

On the benefit side, while donating eggs to a fertility clinic often produces a baby, the potential payoff in stem cell research is promising but only speculative at the moment, Darnovsky said. But women, like society, have so bought into the expectation of "miracle cures" from stem cells that they overestimate the benefit from donating eggs, she said.

The result? If stem cell researchers offer the kind of money that fertility clinics do, "I think any woman who's trying to pay the rent and put food on the table, and people who don't have a lot of money to spare, are going to be tempted to discount the risks and overvalue the benefits," she said.

Similarly, ethicist Laurie Zoloth of Northwestern University believes that paying compensation could exploit some women. Women who give eggs to fertility clinics are doing it for the money, she said, and as a society, "we don't ... want the bodies of the poor used for the needs of the wealthy."
"You do not see many full professors or CEOs selling eggs to secretaries or housecleaners," she said in an e-mail.
Zoloth, who emphasized that she strongly supports stem cell research that would use the eggs, said she believes women donating eggs for such research should only be reimbursed for expenses. Giving up eggs, like donating organs, should be an altruistic act, she said.
But others believe women should be paid.
Participants in other kinds of biomedical research are compensated for their time, inconvenience and rigors of participating, says Kathy Hudson, director of the Genetics and Public Policy Center at Johns Hopkins University. So why, she asks, should egg donors be treated any differently?
There are ways to guard against exploitation of vulnerable women, she said. One would be for local boards that oversee research to make sure that donors are recruited from a wide variety of groups rather than just the economically disadvantaged, she said. And limits can be set on the number of times any one woman can participate, she said.
So far, the track record for altruistic donations is mixed. On one hand, hundreds of women volunteered to donate eggs in South Korea for research by the now-disgraced scientist Hwang Woo-suk, who fraudulently claimed success in therapeutic cloning.
But Dr. Robert Lanza, vice president of research and scientific development at Advanced Cell Technology Inc. of Alameda, Calif., said he has given up trying to get donations without compensation. After more than a year of pursuing that strategy and about 100 advertisements, ACT was able to get only one woman to donate eggs, he said in an e-mail.
And Kevin Eggan of the Harvard Stem Cell Institute, who's been seeking eggs since May in return for reimbursing out-of-pocket expenses, said recently that the effort had generated some calls but no donors yet. The approach must be given more time to work, he said.
Murdoch, who also directs a fertility treatment center in Newcastle upon Tyne, said that when her lab asked fertility-clinic patients to donate eggs, it received only 66 over seven months. That's just not enough, she said.
In contrast, if her new plan attracts two women a week — chosen because they appear likely to produce lots of eggs — it would provide 20 eggs each week. That's still not a lot, but the supply should be steady, she said.
Her "egg-sharing" plan resembles an arrangement that's used occasionally at fertility clinics. In that plan, a woman shares her eggs and treatment costs with another woman who wants a baby.
Murdoch's group has permission from Britain's Human Fertilization and Embryology Authority to set up the arrangement for stem cell research. Now it's a question of raising money to finance it. Murdoch said she hopes to start offering the deal to British women in a few months, and that she has already heard from dozens of women eager to participate.
Though the HFEA approved Murdoch's plans in July, it has since started gathering public and expert opinions on whether egg sharing should be permitted. "If the consensus is that this is not a good idea, we can change the policy, and rescind the license," said John Paul Maytum, an HFEA spokesman.
The idea has drawn some opposition.
"I think it smacks of offering financial inducement to women to donate eggs specifically for research," said Dr. Stephen Minger, director of the stem cell biology laboratory at King's College in London. "You will be exploiting women for money," said Minger, who says that participants would be convinced to undergo the treatments for financial gain.
Hudson agreed, saying it would appeal to women of limited means who are "desperately trying to get pregnant" and offers the possibility of a baby in return for eggs. "How is that not undue influence?" she asked. "How can that possibly be OK, and it's not OK to compensate a normal, healthy volunteer?"
Murdoch says that as long as women provide informed consent, she believes that egg-sharing is no different from standard medical practices, such as giving blood or participating in drug trials.
"It almost becomes a feminist issue," said Murdoch. "I would take exception to the fact that society feels that women need to be protected from themselves."
Some stem cell scientists are skirting the debate by finding other sources of eggs. Dr. George Daley of Harvard's stem cell institute announced in June that he would use eggs originally produced for fertility treatment but which failed to become fertilized. Usually, such eggs are discarded, but women in the fertility program Daley works with must agree to their use in research.
Renee Reijo Pera of the University of California, San Francisco, is also working with eggs originally produced for a fertility clinic, but which turn out to be immature. Such eggs are not routinely used in clinics, though they can be matured in a lab.
Reijo Pera noted such lab-matured eggs can produce babies, so "the egg is not going to be the problem" in her stem cell work, she said.
Lanza said ACT is also working with fertility clinics to get immature eggs.
In any case, the need for eggs may only be temporary.
They are, in fact, only a tool to reprogram the inserted DNA so that it will drive the development of an early embryo. Scientists hope to learn enough about that reprogramming process to let them take an ordinary cell from a person and use it to produce other kinds of cells, perhaps without going through an embryo stage. That might happen in 10 years, Murdoch estimated.
And then they wouldn't need eggs any more.
___
Medical Writer Maria Cheng in London contributed to this story.

Talk of universal health care grows

Sat, 20 Jan 2007 19:18:07 GMT
By ROBERT TANNER, AP National Writer
Health care for all — an elusive goal that has tantalized presidents and governors for decades — is roaring back this year with ambitious proposals in a handful of prominent states.
The promise: Cover millions of uninsured adults and children. Improve the quality of care at hospitals and doctor's offices. Rein in rising costs that are eating up workers' wages, company profits and state budgets.

The problem: Someone's got to pay. And getting those with a stake in health care — doctors, insurers, hospitals, workers, employers, government — to agree on who and how much won't be easy.

The most influential effort is undoubtedly in California, the nation's most populous state, where GOP Gov. Arnold Schwarzenegger this month introduced a bold plan that would provide health care coverage for 6.5 million residents without insurance.

With less fanfare, Pennsylvania has proposed a similar step and a half-dozen more states are actively debating the idea. All are building on a Massachusetts program that began this year — it likens health insurance to car insurance, making it a requirement for everyone.

If successful, the states could carve out a long-sought path for universal health care, a goal that's been politically dead since the Clinton administration. But that's a big "if" — passage won't be easy and the programs aren't cheap.

The Associated Press looked at proposals in front of state legislatures to break down the contentious issue.

___

WHY HEALTH CARE IS HOT NOW: It's been talked about and debated for years, but wide agreement is emerging over the problem of health care's rising costs, which swallow wage increases and have threatened to overtake state spending on primary education. Businesses say they're at a disadvantage with global competitors.

The system can't survive another few years on the same track without collapsing, said Pennsylvania Gov. Ed Rendell, a Democrat.

"If California, Pennsylvania and Massachusetts prove it's doable — and Maine has already to some extent — it will create an unstoppable momentum," he said.

Maine brought the issue back in 2003, with a law seeking to provide universal coverage.

Massachusetts' law last year — guaranteeing universal coverage — jump-started the action in state capitols.

In the last month, governors, legislative leaders and blue-ribbon commissions have declared universal coverage an attainable goal in Iowa, Kansas, Minnesota, New Mexico, Oregon, Washington state and Wisconsin. Massachusetts and Vermont are to put their programs into effect this year, while Maine is tweaking its existing system. Many more are considering significant expansions.

___

HOW UNIVERSAL HEALTH CARE COVERAGE WOULD WORK: The overall goal is to get everyone, or nearly everyone, health insurance. The plans also aim to cut costs by improving efficiency, and to improve the quality of care. The plans being discussed would accomplish that in the following ways.

• All would build on the existing public and private insurance system to provide insurance and health care access to most or all the uninsured in their states — now some 46 million people nationwide.

• All aim to expand existing Medicaid programs to cover more of the poor and working poor who don't have insurance. They would require employers who don't provide insurance to do so. They seek some financial contributions or savings from doctors and insurers.
• They would establish a state mechanism that creates an insurance product, or sets up a marketplace, so that small businesses and individuals can get reasonably priced insurance.
• Some plans mandate that every individual must have insurance — not unlike mandatory auto insurance for every driver — with financial help for those too poor to buy it outright.
___
THE BIGGEST BARRIER: The biggest stumbling block is money. Who pays?
In California, doctors and hospitals are already unhappy with Schwarzenegger's plan to levy a 2 percent fee on doctors and a 4 percent fee on hospitals. He would cap profits for insurers by requiring that 85 percent of revenue be devoted to treating patients: That idea alone sent the stock of health insurer Wellpoint Inc., with 34 million members, down 3.5 percent.
"He made enemies of every doctor and hospital in California when he did that," said Helen Darling, president of the National Business Group on Health, a consortium of companies trying to lower health costs.
In California, Pennsylvania, Massachusetts and Maine, state leaders said they were spreading the pain to every player, so every critic should stay on board.
"That's always been the biggest challenge in health care reform. There is no pain-free solution," said Drew Altman, president of the Henry J. Kaiser Family Foundation, a Washington-based health group.
___
CHANCE OF SUCCESS: The next few months will determine whether enthusiasts like Rendell or Schwarzenegger win the argument.
In Minnesota, GOP Gov. Tim Pawlenty warns that simply focusing on getting everyone insurance ignores deeper problems, even as some leaders of the Legislature's new Democratic majority say this is the year for universal health care.
"Many policymakers around the country are so fixated on more access, they're losing sight of the need to simultaneously focus on cost and quality," Pawlenty said. "Expanding access to a broken system is no solution. ... In the long run, that will be a failure."
He wants universal coverage, he insisted, but warns that government can't end up with the bill. His plan would broaden coverage to more uninsured children and have the state create a marketplace where insurers can provide a more affordable product. It wouldn't mandate that everyone get coverage.
There are even deeper philosophical differences in other parts of the country, particularly more conservative states which have emphasized cutting Medicaid costs rather than expanding coverage.
But the new ideas are even getting an airing there.
In Florida, where the biggest health care change under former Gov. Jeb Bush emphasized cutting costs of Medicaid, the new surgeon general talked enthusiastically of Massachusetts' universal health coverage law — and new GOP Gov. Charlie Crist said he wouldn't rule out considering something along those lines.
___
FLASH IN THE PAN? How the Massachusetts program and high-profile proposals do also will decide the staying power of health care as a political issue. After President Clinton's health care reform attempt failed in the 1990s, the issue went dormant for years.
"Once you pass these programs and start the implementing, it only gets harder," said Maine Gov. John Baldacci, a Democrat. "Because then you're talking about real dollars and real decisions."
Maine hasn't met its ambitious goals, with fewer businesses signing on to the state program. But Baldacci and state leaders are trying to fix the flaws.
"Hopefully," he said, "the chambers of commerce, the unions, the businesses will recognize we need a solution."

Activists continue smokefree push

Sat, 20 Jan 2007 23:03:31 GMT
By MARTIN GRIFFITH, Associated Press Writer
RENO, Nev. - Thirty years after it began as just another quirky movement in Berkeley, Calif., the push to ban smoking in restaurants, bars and other public places has reached a national milestone.
For the first time in the nation's history, more than half of Americans live in a city or state with laws mandating that workplaces, restaurants or bars be smoke-free, according to Americans for Nonsmokers' Rights.

"The movement for smoke-free air has gone from being a California oddity to the nationwide norm," said Bronson Frick, the group's associate director. "We think 100 percent of Americans will live in smoke-free jurisdictions within a few years."

Seven states and 116 communities enacted tough smoke-free laws last year, bringing the total number to 22 states and 577 municipalities, according to the group. Nevada's ban, which went into effect Dec. 8, increased the total U.S. population covered by any type of smoke-free law to 50.2 percent.

It was the most successful year for anti-smoking advocates in the U.S., said Frick, and advocates are now working with local and state officials from across the nation on how to bring the other half of the country around.

In a sign of the changing climate, new U.S. House Speaker Nancy Pelosi banned smoking in the ornate Speaker's Lobby just off the House floor this month, and the District of Columbia recently barred it in public areas. Arizona, Colorado, Hawaii, Louisiana, New Jersey and Ohio also passed sweeping anti-smoking measures last year.

"That's how life is now. They're banning smoking everywhere," said Rep. Devin Nunes , R-Calif., an occasional smoker.

Susan Burgess, the mayor pro tem of Charlotte, N.C., said what's fueling the push is a U.S. Surgeon General's report released last June that found just a few minutes inhaling someone else's smoke harms nonsmokers, and separate smoking sections don't offer enough protection.

She said the report gave momentum to the anti-smoking front even in North Carolina — the nation's No. 1 tobacco state — and influenced Nevada voters to approve a ballot measure banning smoking at restaurants, bars that serve food, and around slot machines at supermarkets, gas stations and convenience stores. Nevada, where gambling and smoking had been assumed to go hand in hand, previously had one of the nation's least restrictive smoking laws.

"The Nevada vote shows that when people are given accurate information about the dangers of secondhand smoke, it's almost a no-brainer" they'll support smoking controls, said Burgess, founder of the anti-smoking group Smokefree Charlotte.

Not all elected officials and business owners embrace the cause. They maintain such laws drive away smoking customers and cut profits.

"There's a fear that we would lose restaurant business to nearby towns if we passed a smoking ordinance," Moline, Ill., Mayor Don Welvaert said. "Before acting, we would need real proof that cities have not experienced business losses because of smoking regulations."

Nevada's smoking restrictions have been challenged in state court by a coalition of businesses. Opponents say the ban, which does not apply to the gambling floors of casinos on and off the Las Vegas Strip, is unconstitutional, vague and unenforceable.

In Columbia, Mo., one business owner displayed his displeasure at a new local ordinance banning smoking with a sign: "Smoking allowed until Jan. 9, City Council banning beer next, and hopefully, karaoke!"

R.J. Reynolds Tobacco Co. plans to continue to fight smoking bans at adult-only businesses because it thinks such restrictions infringe on the rights of owners and adversely affect business, spokesman David Howard said from the company's headquarters in Winston-Salem, N.C.

But Columbia Mayor Darwin Hindman said studies show bans will not force smoking customers to go elsewhere. The Surgeon General's report reached a similar conclusion.

"I don't think it's a legitimate fear that bars and restaurants will lose business," Hindman said. "From what I've read, smokers keep going to bars and restaurants even after smoking is banned. Smoking restrictions should be based on health issues anyway."

Amy Winterfeld, health policy analyst for the National Conference of State Legislatures based in Washington, D.C., said smoke-free legislation is pending in at least seven states.
"When you see an issue like this passing in a number of states it does give it momentum in other states," Winterfeld said. "It's certainly possible that a number of states will take it up this year."
___
On the Net:
Americans for Nonsmokers' Rights: http://www.no-smoke.org
R.J. Reynolds Tobacco Co.: http://www.rjrt.com

Implant factory adjusts to silicone rule

Sun, 21 Jan 2007 00:56:31 GMT
By JEFF CARLTON, Associated Press Writer
IRVING, Texas - In many spots, the factory looks like an especially clean industrial kitchen. Workers are covered from head to toe in surgical scrubs. Stacked on stainless steel rolling trays are mounds of various sizes and shapes, all resembling risen pizza dough.
Mentor Corp. has its global manufacturing operations at this 145,000 square-foot factory that is home to the nation's only breast implant manufacturing facility and anecdotally known as one of the augmentation capitals of the United States.

The recent FDA approval of silicone-gel implants — ending a 14-year virtual ban — has far-reaching ramifications in Texas. All made-in-the-U.S.A. breast implants begin here, the starting point for nearly a quarter million breast augmentation surgeries a year.

The daily grind of making implants might not change much — but what workers are doing here will affect hundreds of thousands of women a year.

A combination of factory workers, machines and robots produce about 2,100 saline implants a day and more than half a million a year in a process that Mentor protects as if it were nuclear missile launch codes. The implants come in a variety of sizes and two main shapes: round and teardrop.

The factory is located in an industrial office park near the Dallas/Fort Worth International Airport. But the California-based company prohibits photographs of most parts of the manufacturing process and declined to identify certain employees lest any rivals divine trade secrets.

This reticence comes at a time when implant manufacturers stand to make additional millions of dollars, thanks to the FDA approval in November. In a jubilant conference call with shareholders and analysts after the FDA announcement, Mentor President and CEO Josh Levine referred to the FDA approval as a "historic moment."

When silicone implants were banned in 1992, saline became the only option, unless women agreed to be part of a clinical study or were undergoing breast reconstruction. Under the new ruling, the FDA allows women 22 and older to choose silicone for augmentation.

Last year, nearly 300,000 patients underwent breast augmentation surgery, according to the American Society of Plastic Surgeons. Industry experts say that women around the world choose silicone over saline between 80 percent and 90 percent of the time. The reason is simple:

"Silicone looks more natural and it feels more natural, and that's it," said Dr. Robert Schwartz, a Dallas plastic surgeon. "But that's huge."

Schwartz said he is seeing an increase in two kinds of patients: women with saline implants who want to switch to silicone and women who were waiting for FDA approval to get silicone.

Since the FDA approval "we haven't had to put up velvet ropes, but definitely there's an uptick in calls and people scheduling appointments to get it done," Schwartz said.

Holly Brooks' first pair of implants were saline and "looked fake and felt terrible, like a balloon filled up with water," she said.

The 41-year-old suburban Dallas massage therapist eventually switched to silicone implants, a choice she expects more women will soon be making.

Mentor officials, predicting that 40 percent of American women will choose silicone over saline within the first year of approval, already have adjusted their revenue projections for 2007 by as much as $25 million. With silicone, Mentor stands to make twice as much on a per-implant basis, company officials said.

A pair of saline implants retail for about $800 to $900 and double that for silicone, Schwartz said. Including the costs for the surgery, breast augmentation procedures typically cost patients between $5,000 and $7,000 for saline implants and another $1,000 for silicone, Schwartz said.

The impact of FDA approval at the implant factory has been minimal. The plant has been cutting saline implant production and boosting silicone implant production to meet the expected market shifts, said plant manager Andrew G. Tymkiw, Mentor's vice president of global manufacturing operations.

So it remains business as usual for the plant's 350 employees. During the manufacturing process, employees help cure, vacuum seal, wash, heat, package, sterilize and store the implants. They take careful thickness measurements, working under signs that read "Stuffing Area" and "Gel Fill Area."
Throughout the process, workers closely inspect the implants for air pockets, tears and other imperfections — looking very much like Florida elections officials scrutinizing ballots for hanging chads.

Obesity may reduce risk of heart failure death

Sat, 20 Jan 2007 04:48:56 GMT
By David Douglas
NEW YORK - Obese patients hospitalized with heart failure tend to fare better than their lean counterparts, new research suggests.
The report, which appears in the American Heart Journal, indicates that this "obesity paradox," which was previously described in patients with chronic heart failure, may also apply to patients with rapidly worsening or "decompensated" heart failure.

"This study suggests that overweight and obese patients may have a greater metabolic reserve to call upon during an acute heart failure episode," lead investigator Dr. Gregg Fonarow told Reuters Health, "which may lessen in-hospital risk"

Fonarow of the University of California, Los Angeles and colleagues came to this conclusion after studying data on almost 109,000 heart failure episodes in more than 80,000 patients.

Patients were grouped by body mass index , a measure of weight relative to height. A normal BMI is between 20 and 25 and subjects in the present study had ones ranging from 16 to 60 .

Those with the highest BMI were younger, were more likely to have diabetes and had higher left ventricular ejection fraction, meaning that the heart was able to pump more blood out with each contraction.

The team found that in-hospital deaths fell as BMI rose, even after accounting for factors including age, gender, blood pressure, and heart rate.

For example, the overall in-hospital death rate was 5 percent in those with the lowest BMI versus 2.2 percent in those with the highest. For every 5 unit increase in BMI, the death risk fell by 10 percent.

The team calls for further study to investigate underlying factors. "These findings," Fonarow noted, "raise the possibility that nutritional/metabolic support may have therapeutic benefit in specific patients hospitalized with heart failure"

SOURCE: American Heart Journal, January 2007.

Tough pregnancy may raise wheeze risk in child

Sat, 20 Jan 2007 04:55:22 GMT
By Will Boggs, MD
NEW YORK - Children born to women who experience certain complications during pregnancy and delivery are at increased risk for developing specific patterns of wheezing, according to a new report.
"This study adds weight to the epidemiological data which suggest that early development has significant consequences in disease risk not only in childhood , but also throughout life," Dr. Franca Rusconi told Reuters Health.

Rusconi from the University of Florence, Italy and colleagues in the SIDRIA Collaborative Group evaluated the associations between maternal medical complications and procedures during pregnancy and at delivery and the risks of various wheezing disorders -- transient early wheezing, persistent wheezing and late-onset wheezing -- in 15,609 children between 6 and 7 years old.

The team found that 9.5 percent of the children had transient early wheezing, 5.4 percent had persistent wheezing, and 6.1 percent had late-onset wheezing. Preeclampsia or high blood pressure requiring therapy was associated with an increased risk of all three wheezing types, the investigators report, increasing the odds by 40 percent, 59 percent, and 47 percent, respectively. Maternal diabetes was associated with a 72 percent increased risk of persistent wheezing.

Prescription of antibiotics for urinary tract infections and antibiotics administered at delivery were associated with early-onset transient and persistent wheeze, the results indicate. Prescription of antibiotics for respiratory infections was strongly associated with both persistent and late-onset wheezing, the researchers note.

Amniocentesis or chorionic villus sampling, cesarean section, and weight gain during pregnancy were not significantly associated with childhood wheezing, the investigators report in the American Journal of Respiratory and Critical Care Medicine.

Although a maternal history of asthma and/or allergy was also associated with wheezing in childhood, this history did not modify the association between maternal complications or procedures in pregnancy and at birth and wheezing phenotypes, the report indicates.

"If these findings are causal, they are generally consistent with the concept of 'programming,' which occurs when an event in a critical early period of an organism's life permanently changes its structure or function," Rusconi and colleagues write.

In a related editorial, Drs. Andrew Bush from Royal Brompton Hospital, London, and Dr. Isabella Annesi-Maesano from Medical School Saint-Antoine, Paris, say the study "is observational and hypothesis generating," and that "its major service is to point to early life events as the source of lifelong problems."

The editorialists conclude: "Perhaps more attention needs to be paid by clinicians to what happened to a child at these crucial times, and researchers need to consider whether they are looking for answers or to test interventions long after the horse has left the stable, and disappeared over the horizon."

In a concluding comment, Rusconi added: "It is very important to follow up pregnancies carefully (and this could be a problem, at least in our settings for less educated women) and, possibly, to take into consideration also less severe forms of disease, such as gestational diabetes, mild gestational hypertension, asymptomatic bacteriuria, and chorioamnionitis."

Am J Respir Crit Care Med 2007;175:16-21,1-8.

Folic acid may boost brain power in the elderly

Fri, 19 Jan 2007 15:14:35 GMT
By Patricia Reaney
LONDON - Folic acid supplements may boost brain power in the elderly and could possibly help reduce the risk of dementia, scientists said on Friday.
Brain function, memory and the speed with which information is processed decline as people age but researchers in the Netherlands and Switzerland have found that taking folic acid can help.

"We have shown that three-year folic acid supplementation improves performance on tests that measure information processing speed and memory, domains that are known to decline with age," said Dr Jane Durga of the Nestle Research Center in Lausanne.

Folic acid is a synthetic compound of folate, a B vitamin found in green leafy vegetables, yeast, liver, beans and in some fruits. Women are advised to take folic acid before conceiving and during the early months of pregnancy to prevent disorders such as spina bifida.

British researchers have also shown that folic acid supplements decrease the risk of cardiovascular disease by lowering levels of the amino acid homocysteine, which is thought to damage the inner lining of arteries.

POOR MENTAL PERFORMANCE

"The functions that decrease most commonly with age are those that we see a beneficial effect through folic acid supplementation," Durga said in an interview.

"It seems a bit intuitive, although it is not proven, that if you can slow down age-related cognitive decline perhaps you can also affect the risk of dementia. But this is still a question that needs to be researched," she added.

Durga and scientists at Wageningen University in the Netherlands, who reported their findings in The Lancet medical journal, compared the impact of folic acid supplements to a placebo in a study involving 818 men and women 50-70 years old.

Half of the volunteers were given 800 micrograms of folic acid each day for three years while the remainder received the dummy pill.

When the scientists tested the cognitive and memory functions at the end of the study, they found the three-year change was significantly better in the folic acid group.

In a commentary on the research, Martha Clare Morris and Christine Tangney of the Rush Institute for Healthy Aging in Chicago, Illinois said the study included volunteers with low folate levels compared to some countries. But it is not clear how much people with higher levels would benefit from the supplements.

Folate levels vary according to the diet of different populations. It is high in countries such as Greece, Italy, France and Spain where a Mediterranean diet high in fruits and vegetables is consumed and in the United States and Canada where grain is fortified with folic acid.

News confirms suspicions of breast cancer survivor

Sun, 21 Jan 2007 14:30:54 GMT
By Maggie Fox, Health and Science Editor
WASHINGTON - Diane Balma felt vindicated when she heard the news -- Canadian researchers had discovered that women with dense breasts, making their mammograms difficult to read, had a far higher risk of cancer.
They found that women with the densest breasts had four to six times the risk of breast cancer compared with women with the fattiest, and easiest-to-image, breasts.

Writing in the New England Journal of Medicine, Dr. Norman Boyd of the Ontario Cancer Institute in Toronto and colleagues said breast density itself could be a risk factor for breast cancer.

The other risk factors include having a close relative with breast cancer, carrying one of the known BRCA breast cancer genes and never having borne a child.

Balma had none of the other risk factors, but was worried when she felt a lump in her breast 11 years ago at age 30.

"I wasn't doing self-exams at the time," said Balma, who is now director of public policy at the non-profit Susan G. Komen Breast Cancer Foundation. "I just happened to come upon it. It was quite large and pretty deep."

She went immediately for a mammogram -- not a routine recommendation for women under 40, but Balma was worried.

"It did not show on the mammogram," said Balma in a telephone interview. She had dense breasts, which show up on an X-ray like a white mass of tissue. Tumors in fatty breasts usually show up more clearly.

Her radiologist, a doctor who specializes in reading X-rays such as mammograms and other scans, was not especially worried but ordered an ultrasound.

"I was relatively small-breasted. Even so, he was barely able to find it on the ultrasound," Balma said. "When he did see it, his words to me were, 'You know, you are too young. I wouldn't worry about this. I am sure it is not cancer."'

But it was.

LIFE-SAVING DECISION

"I decided to have it removed and it was a decision that saved my life," Balma said. Her surgeon discovered a very large tumor that turned out to be an aggressive type of cancer.

Balma eventually had both breasts removed and endured six rounds of chemotherapy. She has been cancer-free for 11 years.

"I have always known that dense breast tissue makes breast cancer harder to detect. But I also wondered if it brought a greater risk of breast cancer," Balma said.

The Canadian study, published on Thursday, appeared to confirm that.

Breast cancer will be found in 180,510 men and women in 2007 in the United States alone and will kill 40,900, according to the American Cancer Society. Globally, it affects 1.2 million people a year.

The deaths are almost exclusively in people whose cancer is found too late, and young women under 40 make up about 5 percent of that number. Most cases are in women past menopause.
Mammograms are only recommended for women who know they are at high risk, and for women over the age of 40. How would a younger women such as Balma even know she had dense breasts and thus perhaps have a higher risk?
"That is a question that has not been answered yet," said Dr. Cheryl Perkins, senior clinical adviser at the Foundation.
"We need more study of breast cancer in young women. We comprise far fewer breast cancers but our tumors tend to be more aggressive and more deadly," said Balma.
Perkins agreed. Younger women have fewer treatment options, she said. "Those types of breast cancer tend to metastasize early. They tend to metastasize to the brain," Perkins said.

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