World News

AMA president speaks of pancreatic cancer struggle

 CHICAGO - As a doctor, Ron Davis knew what it meant when he got a diagnosis of advanced pancreatic cancer earlier this year.
So did his audience on Saturday, the American Medical Association. Davis, a doctor of preventive medicine, is the group’s president and he got the bad news eight months into his one-year term.

Like most of those diagnosed with the disease, Davis’ cancer has spread beyond the pancreas, reducing chances for recovery. Surgery wasn’t an option.

“As a physician, I know the survival statistics for someone with stage 4 pancreatic cancer,” he said. But if the five-year survival is 5 percent, that’s not zero… So, never take away someone’s hope.”

In an upbeat, sometimes funny and at moments poignant, emotional 45-minute speech, Davis talked about his life and how it has changed, both good and bad since his diagnosis. He spoke of his hopes for the future, his own and that of his fellow doctors and their patients. And he talked about legacy — his and that of everyone listening to him.

“So, whether we are ill or well, we should not waste any of that time before figuring out how to leave our mark on this planet,” he said.

Davis urged his fellow doctors, gathered in Chicago for their annual meeting, to help patients live healthier lives. He applauded the AMA for supporting stronger regulation of tobacco and for raising awareness about people who don’t have health insurance. And he urged the group to press for even more, raising federal taxes on tobacco and working to avoid Medicare doctor payment cuts.

These are familiar issues for Davis. A native of Chicago who now lives in East Lansing, Mich., he has spent his career working to prevent disease and raise awareness about the risks of tobacco. His agenda as AMA president has included coverage for the uninsured and promoting health quality and safety.

After his diagnosis, he has still managed to keep a dizzying pace of meetings and speeches. During one lecture, he walked on a treadmill to “walk the talk” on prevention of chronic illness through fitness.

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Report: Worrisome rise in underweight babies

 NEW YORK - The percentage of underweight babies born in the U.S. has increased to its highest rate in 40 years, according to a new report that also documents a recent rise in the number of children living in poverty.
The data on low birth weights is worrisome because such babies — those born at less than 5.5 pounds — are at greater risk of dying in infancy or experiencing long-term disabilities.

The findings were released Thursday in the annual Kids Count report on the health and well-being of America’s youth, which measures the states in 10 categories. Overall, the report found progress, as well as some setbacks.

“Well-being indicators have largely gotten better for teens, and they’ve gotten worse for babies,” said Laura Beavers, coordinator of the Kids Count project for the Baltimore-based Annie E. Casey Foundation.

The report documented improvements in the child death rate, teen death rate, teen birth rate, high school dropout rate, and teens not in school and not working. There was no change in the infant mortality rate, while four areas worsened: low-birthweight babies, children living in with jobless or underemployed parents, children in poverty, and children in single-parent families.

In composite rankings for all 10 indicators, New Hampshire, Minnesota, Massachusetts, Connecticut and Utah ranked the highest, while Mississippi, Louisiana, New Mexico, Alabama and South Carolina ranked the lowest.

Beavers noted that in many categories, the United States compares poorly to other developed countries. A recent study released by UNICEF ranked the U.S. second worst out of 33 industrialized nations in a composite index on child well-being, and it was 29th in regard to the percentage of babies with low birth weights.

According to Kids Count, the latest available federal data, from 2005, showed that 8.2 percent of U.S. babies were born at low birth weight, a level not seen since 1968.

The worst rate — 11.8 percent in Mississippi — was nearly twice the 6.1 percent rate in the best states — Alaska, Oregon and Washington.

Beavers said part of the overall increase in low-birthweight babies was due to a rise in multiple births as more older women use fertility treatments to conceive. But she said the birth-weight problem also has been worsening for single-baby deliveries.

The rate of low-weight births is sharply higher for blacks (13.6 percent) than for whites (7.3 percent) or Hispanics (6.9 percent). One important factor, Beavers said, is the mother’s overall health at the time of pregnancy and her access to good prenatal care.

Dr. Alan Fleischman, medical director of the March of Dimes, said the increase in underweight newborns is closely linked to a rise in premature births.

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AMA to consider endorsing undercover patients

 CHICAGO - Lori Erickson-Trump has faked headaches and back pain. She’s had physicals and MRIs she didn’t need and she gets paid for it — all to evaluate the performance of doctors and their staffs.
Hospitals and health clinics are increasingly turning to these undercover patients to grade the health care experience being offered.

Now the ethics council of the American Medical Association is pressing the doctors group to endorse such practices. AMA delegates are expected to vote on the proposal, along with dozens of others, during their five-day meeting beginning Saturday.

Some doctors are outraged at the idea.

Dr. Richard Frederick, of the University of Illinois College of Medicine in Peoria, called it “official deceit” that could have disastrous consequences. He wrote a commentary in May’s edition of Virtual Mentor, the AMA’s online ethics journal.

“In some instances sham patients have presented to overcrowded emergency rooms with chest pain,” he wrote. “How could the hospital administration defend this exercise to someone who suffers an adverse outcome while waiting his turn behind the person who is only pretending to be sick?”

The proposal to the AMA does include restrictions that address that and other concerns. The recommendation is to have a system that: makes sure fake patients don’t interfere with treating real ones; gives doctors a heads-up that undercover patients might be visiting; and ensures that bad reviews aren’t used to punish doctors.

And Dr. James Loden, writing an opposing view in the online journal, says undercover patients are neither “devious” nor “spying.”

“Employees, including doctors, are paid to do specific tasks; if they choose to perform at a level that is less than acceptable, they need to improve or find other jobs,” he wrote.

Loden, an ophthalmologist at Nashville, Tenn.-based Loden Vision Centers, started using undercover patients to evaluate his business two years ago.

The sham patients showed “that I consistently left the examining room without asking clients whether they had any questions,” Loden wrote. He also learned that some employees didn’t always introduce themselves or explain why tests were being performed.

The idea was to help the centers compete with others offering similar services including Lasik surgery. The centers have worked to eliminate the revealed shortcomings and Andy Patrick, Loden’s chief operating officer, said client-to-client referrals have since increased.

“We don’t always like what we hear, but it makes us get better and better,” Patrick said.

Erickson-Trump, 37, works for Perception Strategies, an Indianapolis-based company that provides undercover patients to health systems in about 25 states. Her preferred job title is “mystery shopper,” a service more familiar in the retail and food industries.

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CDC: Hospitals do poorly on breast-feeding support

 ATLANTA - Most U.S. hospitals don’t do very well when it comes to promoting breast-feeding, according to the first national report to look at the issue. The average hospital scored 63 out of 100, the Centers for Disease Control and Prevention reported Thursday.
The researchers did not attach letter grades to the scores, but the results were clearly disappointing, said Deborah Dee, a CDC epidemiologist who co-authored the report.

“There is a lot of room for improvement,” said Dee.

States in New England and on the West Coast scored highest, and the South did the worst. Vermont and New Hampshire topped the list, tied with a score of 81. Arkansas had the poorest score, 48.

But practices unfriendly to breast-feeding were common throughout the country, the survey found.

About a quarter of hospitals reported giving formula or some other supplement to more than half of their healthy, full-term newborns. The practice was common even when mothers were able and willing to breast-feed, Dee said.

Of hospitals who gave supplements, 30 percent gave sugar water and 15 percent gave water.

Experts say there are no good nutritional reasons to use those, but it is commonly done to quiet crying babies separated from their mother. Sometimes it’s done to test a baby’s ability to feed — even though such a test is usually not necessary, Dee said.

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FDA issues precautionary note on silver fillings

 WASHINGTON - Silver dental fillings contain mercury, and the government for the first time is warning that they may pose a safety concern for pregnant women and young children. The Food and Drug Administration posted the precaution on its Web site earlier this month, to settle a lawsuit — making the move a victory for anti-mercury activists.
The warning is not aimed at the general population, only at two groups already urged to limit mercury from another source — seafood — because too much can harm a developing brain.

The fillings, formally known as dental amalgams, “contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses,” reads the FDA Web posting.

That doesn’t mean it truly harms, and the FDA advises against removing existing fillings.

The agency still is studying whether the small amount of mercury vapor released by chewing and brushing is enough to cause neurologic disorders or other problems in youngsters. There have been only a handful of rigorous studies comparing children given either amalgam fillings or tooth-colored resin composite fillings that are mercury-free — and those studies haven’t detected any brain problems.

Nor has that research settled the long-simmering scientific controversy. Two years ago, the FDA’s own independent scientific advisers said that while amalgam fillings were safe for most people, more research was needed about potential effects on fetuses and children under 6.

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CDC: Salmonella-tainted tomato illnesses reach 228

 WASHINGTON - The toll from salmonella-tainted tomatoes jumped to 228 illnesses Thursday as the government learned of five dozen previously unknown cases and said it is possible the food poisoning contributed to a cancer patient’s death.
Six more states — Florida, Georgia, Missouri, New York, Tennessee and Vermont — reported illnesses related to the outbreak, bringing the number of affected states to 23.

The Food and Drug Administration has not pinpointed the source of the outbreak. With the latest known illness striking on June 1, officials also are not sure if all the tainted tomatoes are off the market.

“As long as we are continuing to see new cases come on board, it is a concern that there are still contaminated tomatoes out there,” said the agency’s food safety chief, Dr. David Acheson.

Government officials have said all week they were close to cracking the case, but “maybe we were being too optimistic,” Acheson acknowledged.

How much longer? “That’s impossible to say.”

On the do-not-eat list are raw red plum, red Roma or red round tomatoes, unless they were grown in specific states or countries that the FDA has cleared because they were not harvesting when the outbreak began or were not selling their tomatoes in places where people got sick.

The FDA is directing consumers to its Web site — http://www.fda.gov — for updated lists of the safe regions.

Also safe are grape tomatoes, cherry tomatoes and tomatoes sold with the vine still attached. That is not because there is anything biologically safer about those with a vine but because the sick have assured investigators that is not the kind of tomato they ate.

What if you did not go to the store armed with a list, or the store or restaurant manager cannot assure that any plum, Roma or round tomatoes came from safe regions?

“If you don’t know, don’t take the risk,” Acheson said.

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Disclosing drug makers payments to docs gets boost

By KEVIN FREKING, Associated Press Writer
Tue May 13, 5:02 PM ET
 
WASHINGTON - Legislation that would require prescription drug makers to disclose payments to doctors got a boost Tuesday when Eli Lilly and Co. broke ranks with the industry and endorsed the bill.
 
Lawmakers gained Eli Lilly’s support after they agreed to raise the payment limit requiring disclosure from $25 to $500. The lawmakers also agreed to apply the legislation to all drug and medical device makers. Previously, the proposed disclosures would have applied only to companies with more than $100 million in annual revenue.

The legislation addresses concerns that payments, such as picking up the tab for dinner or paying travel expenses for a conference at an exotic locale, can influence a doctor’s prescribing habits. The legislation doesn’t ban the payments, but it does require that companies report them, beginning March 31, 2011.

The legislation would pre-empt laws in the few states that already require drug makers to disclose their payments to doctors.

John C. Lechleiter, Eli Lilly’s president and CEO, said the pre-emption was an important addition to the bill.

“This helps patients, businesses and doctors alike by setting expectations and creating a more efficient system for gathering, reporting and understanding such data,” Lechleiter said.

Last year, the company was the first drug maker to publicly report all of its educational grants and charitable contributions.

The bill’s sponsor, Sen. Charles Grassley, R-Iowa, and top Democratic co-sponsor, Sen. Herb Kohl of Wisconsin, said Eli Lilly’s endorsement shows “transparency’s time has come.”

“Transparency brings about accountability and benefits everyone, consumers most of all,” Grassley said.

The lawmakers are pressing to get provisions of The Physician Payments Sunshine Act into a bill later this year that would prevent payment cuts to doctors caring for Medicare patients.

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Beijing reports first child virus death

By CARA ANNA, Associated Press Writer
2 hours, 35 minutes ago
 
BEIJING - China’s capital reported Wednesday its first death from the hand, foot and mouth disease virus that has sickened tens of thousands of children across the country and killed at least 42 people.
 
The child died Sunday on the way to a hospital, the state-run Xinhua News Agency said, citing Beijing Health Bureau spokeswoman Deng Xiaohong.

The director of the health bureau’s publicity office, contacted by telephone, declined to comment on the death.

The health bureau also told Xinhua that another child died of the illness in Beijing, but the death was counted in the victim’s home province of Hebei, which neighbors Beijing. A 21-month-old boy also died of the virus Monday in Hubei province, Xinhua reported.

The three newly reported deaths raise the countrywide death toll to 42 since late March. Hand, foot and mouth disease has sickened more than 24,934 children in seven Chinese provinces plus Beijing, Xinhua reported.

It said 3,606 hand, foot and mouth infections had been reported in Beijing as of Monday. It also said 32 patients remained in Beijing hospitals, with eight in serious condition.

“It is likely that the figures may be fluctuating greatly in the next few weeks” because the Health Ministry last week ordered care providers to report cases within 24 hours, ministry spokesman Mao Qunan said, according to the ministry’s Web site.

China has also been struggling to handle the magnitude-7.9 earthquake that struck Monday and killed more than 12,000 people.

The hand, foot and mouth virus has been yet another major concern for Chinese authorities as they prepare for the Beijing Olympics in August. Cases have been reported from Guangdong province in the south to Jilin province in the northeast, and in major cities including Beijing and Shanghai.

“What I know is the death rate has gone down drastically since early May,” World Health Organization China representative Hans Troedsson said Wednesday. “There are very, very few cases with complications — 99 percent of these are mild cases.”

U.S. Health and Human Services Secretary Mike Leavitt was visiting China this week and said the U.S. was willing to help China battle the illness.

Most cases of hand, foot and mouth disease in China this year have been blamed on enterovirus 71.

The virus spreads through contact with saliva, feces, nose and throat mucus or fluid secreted from blisters. There is no vaccine or specific treatment, but most children with mild forms of the illness recover quickly after suffering little more than a fever and rash.

The disease is expected to peak in the hot months of June and July.

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Exercise may protect girls from future breast cancer

By LAURAN NEERGAARD, AP Medical Writer
Tue May 13, 9:06 PM ET
 WASHINGTON - Get your daughters off the couch: New research shows exercise during the teen years — starting as young as age 12 — can help protect girls from breast cancer when they’re grown. Middle-aged women have long been advised to get active to lower their risk of breast cancer after menopause.
 
What’s new: That starting so young pays off, too.

“This really points to the benefit of sustained physical activity from adolescence through the adult years, to get the maximum benefit,” said Dr. Graham Colditz of Washington University School of Medicine in St. Louis, the study’s lead author.

Researchers tracked nearly 65,000 nurses ages 24 to 42 who enrolled in a major health study. They answered detailed questionnaires about their physical activity dating back to age 12. Within six years of enrolling, 550 were diagnosed with breast cancer before menopause. A quarter of all breast cancer is diagnosed at these younger ages, when it’s typically more aggressive.

Women who were physically active as teens and young adults were 23 percent less likely to develop premenopausal breast cancer than women who grew up sedentary, researchers report Wednesday in the Journal of the National Cancer Institute.

The biggest impact was regular exercise from ages 12 to 22.

“This is not the extreme athlete,” Colditz cautioned.

The women at lowest risk reported doing 3 hours and 15 minutes of running or other vigorous activity a week — or, for the less athletic, 13 hours a week of walking. Typically, the teens reported more strenuous exercise while during adulthood, walking was most common.

Why would it help? A big point of exercise in middle age and beyond is to keep off the pounds. After menopause, fat tissue is a chief source of estrogen.

In youth, however, the theory is that physical activity itself lowers estrogen levels. Studies of teen athletes show that very intense exercise can delay onset of menstrual cycles and cause irregular periods.

The moderate exercise reported in this study was nowhere near enough for those big changes. But it probably was enough to cause slight yet still helpful hormone changes, said Dr. Alpa Patel, a cancer prevention specialist at the American Cancer Society, who praised the new research.

And while the study examined only premenopausal breast cancer, “it’s certainly likely and possible” that the protection from youthful exercise will last long enough to affect more common postmenopausal breast cancer, too, Colditz added.

If you were a bookworm as a teen, it’s not too late, Patel said. Other research on the middle-age benefits of exercise shows mom should join her daughters for that bike ride or game of tennis or at least a daily walk around the block.

Many breast cancer risks a woman can’t change: How early she starts menstruating, how late menopause hits, family history of the disease.

Even though the exercise benefit is modest, physical activity and body weight are risk factors that women can control, Patel stressed.

“I’d say you and your daughter are getting off the couch,” she said. “Women who engage in physical activity not only during adolescence but during adulthood lower their risk.”

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Government to unveil fitness test for adults

By KEVIN FREKING, Associated Press Writer
Wed May 14, 12:12 AM ET
 
WASHINGTON - If you didn’t get a Presidential Physical Fitness Award in school, the government is giving you another chance to prove you’re in shape.
 
An adult fitness test is being introduced Wednesday by the President’s Council on Physical Fitness and Sports. It will incorporate several of the exercises that millions of students undertake each year as they aim for a certificate signed by the president.

“What were trying to do is inspire and motivate Americans to move their bodies more,” said Melissa Johnson, executive director of the council.

The test involves three basic components: aerobic fitness, muscular strength and flexibility. The test is for people 18 and older who are in good health. It was inspired by scores of baby boomers who kept asking council members whether there was a fitness test available today that was similar to the ones they took as students, Johnson said.

The aerobic component of the tests consists of a one-mile walk or 1.5-mile run. The run is not recommended for those who don’t run for at least 20 minutes, three times a week.

Push-ups and half sit-ups make up the strength test. The push-ups are done until failure. The sit-ups are done for one minute.

A stretching exercise called the “sit-and-reach” is used to measure flexibility.

The scores from all four of the fitness tests can be entered online. Other information, such as age, gender, height and weight are also part of the equation.

You won’t get a presidential certificate, but the results will then show where you rank among people of the same age. For example, if someone scores in the 75th percentile for push-ups, that means 75 percent of the scores fall below your score.

The fitness test incorporates height and weight to give participants their body mass index. Generally, a BMI score above 25 equates to being overweight. However, for people who do exercise a lot, the BMI score can be high because of their extra muscle mass, not because they have too much fat.

The test will allow people to easily record a baseline that they can work from through their exercise routine.

“The point is to do consistent, regular physical activity and these are good check-in points to see how fit people are,” Johnson said.

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On the Net:

Adult Fitness Challenge: http://www.adultfitnesstest.org/adultFitnesstestLanding.aspx

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