Smoking linked to earlier menopause

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By Genevra Pittman

NEW YORK | Fri Oct 14, 2011 12:38pm EDT

NEW YORK (Reuters Health) - Women who smoke may hit menopause about a year earlier than those who don't light up, according to a new look at past research.

That's important because the age at which women stop getting their periods may influence their risk of bone and heart diseases as well as breast cancer.

Study author Volodymyr Dvornyk, from the University of Hong Kong, said that women "should be aware of this effect and possible health consequences" of smoking, in addition to its other known risks.

He and his colleagues scanned the literature and found that women who were current smokers hit menopause a year earlier, on average, than non-smokers.

That data came from six studies including about 6,000 women in the U.S., Poland, Turkey and Iran. Non-smokers hit menopause between age 46 and 51, on average, depending on the study population. In all but two of the studies, smokers were younger -- between 43 and 50, overall.

Dvornyk and his colleagues also analyzed five other studies that used a cut-off age of 50 or 51 to group women into "early" and "late" menopause. Out of more than 43,000 women in that analysis, women who smoked were 43 percent more likely than nonsmokers to have early menopause.

"Our results give further evidence that smoking is significantly associated with earlier (age at menopause) and provide yet another justification for women to avoid this habit," the researchers wrote in the journal Menopause.

Both early and late menopause have been linked to health risks. Women who hit menopause late, for instance, are thought to be at higher risk of breast cancer because one risk factor for the disease is more time exposed to estrogen.

However, the "general consensus is that earlier menopause is likely to be associated with the larger number and higher risk of postmenopausal health problems, such as osteoporosis, cardiovascular diseases, diabetes mellitus, obesity, Alzheimer's disease, and the others," Dvornyk told Reuters Health in an email.

Overall, he added, early menopause is also thought to slightly raise a woman's risk of death in the years following.

Jennie Kline, an epidemiologist from Columbia University's Mailman School of Public Health in New York, said there are two theories for why smoking might mean earlier menopause.

Smoking may have an effect on how women's bodies make, or get rid of, estrogen, she said. Alternatively, some researchers believe certain components of cigarette smoke might kill eggs.

Dvornyk's team didn't have information on how long women had been smoking or how many cigarettes they smoked each day, so the researchers couldn't determine how either of those factors may have affected age at menopause.

For that reason, and a lack of data on other health and lifestyle factors linked to menopause, this analysis may not be enough to resolve lingering questions on the link between smoking and menopause, they added.

Alcohol, weight and whether or not women have given birth may each also play a role in when they hit menopause -- but the evidence for everything other than smoking has been mixed, Kline, who was not involved in the new study, told Reuters Health.

She said it's possible the same factors that influence age at menopause may determine whether or not women are still able to get pregnant when they hit their late thirties, or whether they have trouble with infertility.

Still, Kline said, "There are way better reasons to stop smoking than worrying about menopause," such as reducing the risk of heart disease and lung cancer.

SOURCE: bit.ly/nM27LT Menopause, online September 19, 2011.

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'Refer more for epilepsy surgery'

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14 October 2011 Last updated at 00:44 GMT Surgical treatment for epilepsy is being used more and more People who cannot control their epilepsy with medication should be referred sooner for surgery, suggests a study in The Lancet.

The University College London study found that 47% of patients who had surgery were free of seizures after 10 years.

It tracked 615 adults annually over an average of eight years.

But experts say people should be realistic about the risks and benefits of this kind of surgery.

Surgical treatment for epilepsy is being used more and more.

Two-thirds of people with epilepsy have the condition well controlled with medication and experience no side-effects.

The other third, for whom medication does not work, could be eligible for surgery.

The most common type of surgery undertaken on people in the study was temporal lobe surgery, which focuses on the area of the brain behind the forehead between the ear and the eye, where most seizures originate.

Researchers who carried out the study, published in The Lancet, reported that 63% of all patients were free of seizures two years after surgery (excluding simple partial seizures), 52% after five years and 47% after 10 years.

Those with simple partial seizures (SPS) in the first two years after temporal lobe surgery were two-and-a-half times more likely to experience subsequent seizures than those who experienced no SPS.

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Clinical practice needs to change with the early referral of appropriate patients”

End Quote Dr Ahmed-Ramadan Sadek and Professor William Peter Gray This has implications for decisions to stop taking anti-epileptic medication, say the authors.

They found that a relapse was less likely the longer a person was free of seizures after surgery, and more likely the longer seizures continued after surgery.

Realistic about risks

Most patients who were seizure-free after surgery still chose to remain on an anti-epileptic drug of some kind.

John Duncan, medical director at the Epilepsy Society and professor of neurology at University College London's Institute of Neurology, which carried out the study, said the study gave a realistic view of the long-term outcomes of surgery for epilepsy.

"It means people should consider surgery sooner rather than later, while being realistic about the risks too."

The study says that the selection process for surgery and surgical methods need to improve to increase success rates and to more accurately identify those who will not benefit from surgery.

Prof Duncan said the threshold for surgery had come down over the past 20 years.

"Surgery used to be offered to someone having three or four seizures a month. Now it could be offered to someone having one seizure a month, who is in employment but who is experiencing side-effects from the drugs.

"So the stakes are higher. The balance of risk and benefit has changed as surgery is offered to those less severely affected."

Commenting on the findings of the study in The Lancet, Dr Ahmed-Ramadan Sadek and Professor William Peter Gray from the Wessex Neurological Centre at the University of Southampton said the study validated the long-term effectiveness of epilepsy surgery.

But there were still hurdles to be overcome, they said.

"The median duration of epilepsy before surgery in this study was 20 years. In view of the long-term results of surgery shown, clinical practice needs to change with the early referral of appropriate patients."

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Why It's So Hard to Tell If Your Kid Is Being Bullied

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It's National Bullying Prevention Month, and until really recently, I was feeling pretty smug that my kids — ages 4, 6 and 8 — had largely escaped either being a bully or being bullied.

To be a bully, it seemed you had to torment your peers. To be bullied, it seemed you had to be the tormentee. But what I've learned is that the definitions are not always so clear-cut. Moreover, they're almost beside the point: if a kid — or his mom — feels like another child is being mean for the sake of being mean, it's time to pay attention.

A few weeks ago, my son, a third-grader, came home complaining about the boy who sat next to him in class. They'd been paired to work on a project, and the boy had yelled at him, my son said.

“Really?” I said, surprised. “In the middle of class?”

Yes, insisted my son. They'd disagreed, and the boy delivered a verbal dressing-down, very loudly. My son was mortified.

He'd told his classmate not to yell at him. Or so he said. Although he has no problem telling his squabbling sisters where to get off, he turns meek when it comes to speaking up for himself outside his family circle. And aren't meek kids a bully's prey of choice?

MORE: What You Need to Know About Bullying

In many school districts across the country, children learn from kindergarten onward about standing up to bullies. In my children's schools in Seattle, there are anti-bullying posters on the walls and anti-bullying speakers who address the kids in schoolwide assemblies. Mothers tote their babies into classrooms as part of a campaign to instill empathy in schoolchildren. Kids bring home brochures in their backpacks.

Traditionally, bullying evokes images of a hulking kid roughing up a beanpole in the boys' bathroom. It seems insidious and obvious, like you'd know it when you see it.

Was my son being bullied or was I being a reactionary Mama Bear? I wasn't sure.

I delivered an impromptu pep talk about the importance of being assertive and not letting others treat you badly. Then I promptly forgot all about it.

Until the next week, when he shared that this same boy had humiliated him in the school-bus queue, throwing this barb: You're the worst tablemate in the whole world. It would almost have been laughable had I not heard the hurt in my son's voice.

Was this bullying? It had happened twice, so there was repetition, which is a critical element of bullying.

Megan Moreno, an assistant professor of pediatrics at University of Wisconsin-Madison and author of a recent “Advice for Patients” column about school bullying published in the Archives of Pediatrics & Adolescent Medicine, says the definition of bullying has evolved.

“In the old days, bullying was getting pushed around on the playground,” she says. “Now we've realized that both verbal and physical abuse have consequences.

“The thing about it,” acknowledges Moreno, “is it's still hard on a day-to-day basis when it's your kid to know what counts.”

She recommends coaching beleaguered children to say something as simple and direct as, Hey, you need to stop it. Resist the temptation as a parent to fling yourself into the conflict; many times, children can resolve the problem on their own. If they can't, of course, it's appropriate to loop in teachers or other adults.

MORE: Why Kids Bully

Earlier this month, TIME put together a mongo package on bullying. In one piece, about re-thinking anti-bullying strategies, I found a clue that seemed to offer a realistic window into my son's experience:

… An emerging area of psychological study is looking at the formation of enemies — the adversarial and antipathetic relationships that are prevalent in classrooms (and, most likely, in the faculty lounge too) ... The problem is that without a clear definition of what constitutes bullying, children who exhibit any type of unfriendly, negative or exclusionary behavior are punished as bullies ...

"It's easy to take it a step further to think of dislike and bullying as the same, but they're not the same," says Melissa Witkow, an assistant professor of psychology at Willamette University and author of a landmark study that found an association between mutual antipathies and a higher level of social development. "As adults, there are people we don't like, but we're not beating them up. We're not harassing them. A lot of adults think that kids should only have positive relationships, but that's not possible."

According to Witkow's interpretation, my son had merely had a couple run-ins with a kid who just didn't like him (this, despite my boy's reigning stature as the 2010-11 winner of his grade's “humanitarian award”). Suck it up, Mom, Witkow seemed to say, and move on.

So I did. But not without first chatting with the boy's mother — actually my husband did that, with far more finesse and studied casualness than I could have mustered — and again reinforcing to my son the importance of standing up for himself.

Without a word from me, his teacher also helped smooth things over, switching up the assigned seating. My son's now got three new seatmates. As far as I know, they haven't proclaimed him the best tablemate in the world — he's got a tendency to be kind of messy — but neither have they dubbed him the worst.

Bonnie Rochman is a reporter at TIME. Find her on Twitter at @brochman. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.

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Do hospitals do enough to help smokers quit?

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A man smokes next to a ''No Smoking'' sign in downtown Shanghai April 27, 2011.

Credit: Reuters/Carlos Barria

By Kerry Grens

NEW YORK | Thu Oct 13, 2011 1:19pm EDT

NEW YORK (Reuters Health) - Nearly every smoker hospitalized in the United States is given advice or counseling on how to quit, according to a new study of hospital records.

But that finding belies what researchers consider a failed attempt, initiated nine years ago, at getting hospitals to actually help people stop smoking. The next version of the program needs to do better, experts say.

"There was no requirement, other than a box to check off that any substantive counseling was given to help smokers to quit," Dr. Michael Fiore, director of the Center for Tobacco Research and Intervention at the University of Wisconsin, told Reuters Health. He was not involved in the current study but chairs a panel working to revise the hospital rules on smokers.

In 2002, the Centers for Medicare and Medicaid Services and The Joint Commission, which sets hospital standards, required that smokers discharged after having pneumonia, heart attack or heart failure be given quitting advice.

It was almost too simple a request, said Douglas Levy, lead author of the new study and a professor at Harvard Medical School and the Mongan Institute for Health Policy at Massachusetts General Hospital.

"There are anecdotal reports of hospitals putting a postcard in the patient's room saying, 'you should quit smoking' and checking off the box that they've provided smoking cessation advice or counseling," Levy told Reuters Health.

Levy and his colleagues collected information from the Centers for Medicare and Medicaid Services on how often hospitals provided quitting advice to patients.

Their study, published in the Archives of Internal Medicine, shows how readily hospitals adopted the new measure.

In 2002, just 67 percent of smokers hospitalized because of a heart attack received advice on quitting smoking.

By 2008, that number jumped to 99 percent of heart attack patients.

For heart failure patients, 42 percent admitted to the hospital in 2002 received smoking cessation information, compared to 97 percent of patients in 2008.

Similarly for pneumonia patients, 37 percent of them were advised to quit smoking in 2002, compared to 95 percent in 2008.

The numbers show that hospitals paid attention to the rules, but the rules were too easy to satisfy, Levy said.

The Joint Commission recognized that the requirements were not strict enough, and they put together an advisory panel in 2009 to revise the rules. One of the study's authors sits on the panel.

Fiore, the panel's chairman, said one of the changes coming out in 2012 is that hospitals will have to follow up with people 30 days after they are discharged to check whether the patients were able to quit smoking.

In this way, hospitals can better gauge how well their efforts are paying off.

Levy's results don't show whether the higher rates of quitting advice resulted in more people quitting smoking.

Take-home advice from hospitals doesn't always change outcomes. Another recent study showed that hospitals that set up children and their families with a plan for managing asthma did not reduce later hospital visits for the condition (see Reuters Health story of October 4, 2011).

Fiore said he expects the new rules to be more effective at helping hospitals seize the opportunity to get smokers to quit.

Hospitals will also be required to document their efforts in more detail.

But Levy said some of his results left him concerned that certain hospitals may struggle under the stricter requirements.

The small numbers of patients who did not receive any advice on how to quit smoking were clustered at hospitals that serve a greater proportion of poor, minority or frail patients.

If these hospitals are not meeting the standards "when the bar is set low, it's going to be harder for them when the bar is set higher," Levy said.

He added that it will be important to make sure the most vulnerable hospitals don't fall behind.

SOURCE: bit.ly/rp6ipt, Archives of Internal Medicine, October 10, 2011.

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Naked Mole Rat's Genetic Code Laid Bare

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Researchers hope the naked mole rat's newly sequenced genome may offer insights not only into aging but also cancer and other diseases.

Lists of the world's ugliest animals sometimes include the naked mole rat. But scientists who have just analyzed its entire genetic code say this bizarre little creature has an inner beauty — unique traits that could aid research on cancer and aging.

Naked mole rats are neither moles nor rats, although they are naked. They have tiny eyes and piggy noses and have been described as looking like sausages with teeth.

"I think when you get to know them, or if you see them in real life, they take on a very cute quality," says biologist Thomas Park, who has a couple of hundred scampering through tunnels at his lab at the University of Illinois, Chicago.

Normally, these rodents live underground in eastern Africa, tunneling in search of tasty roots that they share with their colony. Like social insects such as bees, naked mole rats live in cooperative groups with one queen who has all the babies.

And if you pick one up, says Park, your hands will immediately feel another of the naked mole rat's distinctive features: Despite being a mammal, they are cold-blooded.

"They take on the temperature of the room, so at room temperature, it feels like you're holding something that's not alive," says Park. "It's very extraordinary."

What's more, Park adds, "they don't feel certain types of pain. And they don't get cancer." And because they evolved to exist in crowded, cramped tunnels with little air, they're able to survive on remarkably low levels of oxygen.

Plus, they also can live for around 30 years, far longer than mice or rats.

Understanding The Genes

So naked mole rats would seem ideal for biomedical scientists who want to learn how to do things like prevent cancer, or slow down aging, or protect the brain from oxygen deprivation during strokes.

This is why researcher Vadim Gladyshev of Harvard Medical School became so fascinated when he first heard of these animals a few years ago at a dinner party. He realized that for the science of naked mole rats to really move forward, biologists would first need to know all of its genes, so he put together an international team to quickly do it.

"We decided, 'OK, let's go full force and just sequence the genome,' " says Gladyshev. "Because the genome is really critical in order to understand the biology of that animal."

They used the DNA of a 4-year-old male from the Chicago lab. The job took about a year and a half.

"At this point, we have a genome and we have done a preliminary analysis. The findings are very interesting — a number of interesting leads — and we will continue working on them," says Gladyshev.

For example, since naked mole rats are cold-blooded, he says they looked at genes that help regulate body temperature. "We found a gene which changed specifically in naked mole rats, not in other mammals," he explains.

They found other changes in genes possibly linked to life span, body hair and cancer, according to their report in the journal Nature.

Now that there's a list of intriguing genes, scientists can try to figure out exactly what they do.

"It's up to the labs to take these findings and to take these analyses and go to the lab and test them experimentally," says Joao Pedro de Magalhaes, a biologist at the University of Liverpool in England who is part of another team that has been working to decode the naked mole rat's genes.

He called the new analysis "an excellent and hugely important work" for establishing the naked mole rat as "the first model of resistance to chronic diseases of aging."

And he says having the full genetic code should get more scientists interested in studying naked mole rats. "It certainly makes things much easier for researchers to work on the naked mole rat," he says.

For example, he says they could study genes in isolated cells or even put them into mice — a lab animal that's a lot more familiar to scientists than these odd, buck-toothed creatures.

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One pound of farm-raised salmon takes about three pounds of feeder fish — a losing equation.

In some people, a fruit and vegetable-filled diet can lower heart attack risk.

Those drumlike sounds some of the fish can make mean they're about to chow down, researchers say.

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Rare transplant gives quadruple amputee two new hands

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1 of 4. Doctors perform a double-hand transplant at Boston's Brigham and Women's Hospital Plastic Surgery Transplantation Program last week, in a photo released to Reuters on October 14, 2011.

Credit: Reuters/Brigham and Women's Hospital

By Lauren Keiper

BOSTON | Fri Oct 14, 2011 2:44pm EDT

BOSTON (Reuters) - A 65-year-old quadruple amputee has received two new hands in a rare double transplant operation, Boston's Brigham and Women's Hospital said on Friday.

Richard Mangino got the two hands last week in a 12-hour transplant procedure by a team of more than 40 doctors, nurses and other medical staff, the hospital said.

Mangino said he's adjusting to the new hands gradually and said now he won't have to "perform a miracle" every day to do simple things like make coffee and get dressed.

Speaking at a news conference seated in a wheel chair with his arms and hands propped on stack of pillows, Mangino said he prayed for the ability to touch his grandsons' faces, stroke their hair and teach them to throw a ball

Mangino, from Revere, Massachusetts, lost his arms below the elbows and legs below the knees after contracting sepsis, a bloodstream infection, in 2002.

The complicated surgery included transplanting skin, tendons, muscles, ligaments, bones and blood vessels on both forearms and hands, the hospital said.

Doctors said Mangino independently moved fingers just days after surgery and called the results a "resounding success."

His recovery will take many months and doctors expect him to regain sense of touch in six to nine months with ongoing therapy to help him learn to grasp and pick things up.

The double-hand transplant is the second performed by Brigham and Women's, a teaching affiliate of Harvard Medical School.

In May, a team performed a full face transplant and its first double-hand transplant on Charla Nash, a Connecticut woman who was mauled by a chimpanzee in 2009.

The hospital said the hand transplant was successful, but the hands did not thrive after complications from pneumonia and were removed.

There are a few other programs around the country that perform hand transplants.

The first hand transplant was performed in France in 1998, and the first in the United States was completed a year later.

Doctors said about a dozen hand transplants have been done in the U.S. and believe just four of those have been bilateral.

(Editing by Ellen Wulfhorst and Jerry Norton)

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Imagined smells can precede migraines

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By Amy Norton

NEW YORK | Fri Oct 14, 2011 1:17pm EDT

NEW YORK (Reuters Health) - Hallucinated scents can, rarely, be a part of the "aura" that some people perceive before a migraine attack, a new study finds.

About 30 percent of people with recurrent migraines have sensory disturbances shortly before their headache hits.

Those disturbances, known as aura, are usually visual -- such as seeing flashes of light or blind spots. They can also include problems like tingling sensations or numbness, or difficulty speaking or understanding language.

But disturbances in the sense of smell -- so-called olfactory hallucinations -- have not been generally recognized as a part of migraine aura. They are not, for example, listed as an aura symptom in the international criteria doctors use to diagnose migraine.

"I think that's just because (olfactory hallucinations) have not been commonly reported," said Dr. Matthew S. Robbins, senior researcher on the new study.

But no one had done a systematic review of the medical literature on the subject until now, he told Reuters Health,

Robbins and his colleagues at the Montefiore Headache Center in New York reviewed 25 reported cases of patients with headaches (migraine in most cases) and olfactory hallucinations.

They also examined records from more than 2,100 patients seen at their center over 30 months. They found that 14 -- or just under 0.7 percent -- had described smelling scents in conjunction with their headaches.

"It's uncommon," Robbins said, "but it is distinctive."

Usually, the pre-migraine scents are not sweet. "The most common was of the burning or smoke variety," Robbins said.

Some headache sufferers described a general burning smell, while others said they smelled cigar smoke, wood smoke or burned popcorn.

After those burning scents, "decomposition" odors -- like garbage or sewage -- were the next most common.

A few people did describe pleasant odors, including the scent of oranges, coffee or, in one case, foie gras.

It's not clear why the hallucinated odors are most often unpleasant -- or why they are only rarely part of migraine aura.

But Robbins noted that, in general, aura symptoms are thought to involve a phenomenon called "cortical spreading depression" -- where a wave of increased electrical activity in nerve cells of the brain is followed by a wave of depressed activity.

That same phenomenon might underlie olfactory hallucinations, Robbins said. Since the brain's smell centers occupy much less real estate than its vision centers, that could, in theory, explain why phantom scents are so much less common than visual disturbances.

It's also possible that some people with migraines and olfactory hallucinations simply don't recognize the phenomenon, according to Robbins. You know something is wrong when you are seeing zigzag lines, for instance, whereas it's easy to assume that an odor is actually coming from somewhere.

A number of disorders, including Parkinson's disease, some epileptic seizures and brain tumors, can cause a person to smell scents that aren't there.

Knowing that migraines can be preceded by olfactory hallucinations might allow some headache sufferers to forgo "exhaustive medical workups" for other conditions, Robbins noted.

He stressed, however, that when those hallucinations arise without an accompanying headache, they should be thoroughly checked out.

It's estimated that about 11 percent of the world's population suffers from migraines. So even though olfactory hallucinations are an uncommon part of aura, there could still be a fairly large number of people who experience them, according to Robbins.

SOURCE: bit.ly/psoVEy Cephalalgia, online September 23, 2011.

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Osamu recalls frozen tuna over decomposition and histamine

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WASHINGTON | Fri Oct 14, 2011 10:38am EDT

WASHINGTON (Reuters) - Osamu Corp is recalling up to 1,800 cases of frozen ground tuna because of histamine that has sickened three people who ate tainted sushi, the Gardena, California, company said.

The Food and Drug Administration (FDA) found decomposition in several samples of the product as well as high levels of histamine in samples at one retail location, the company said in a statement dated October 12 and circulated by the FDA on Friday.

Decomposition can promote formation of histamine, which can cause tingling or burning sensation in the mouth, facial swelling, rash, hives and itchy skin, nausea, vomiting or diarrhea.

The frozen ground tuna was shipped from August 18 to September 8 to distributors AFC Corp, Red Shell Foods and Pacific Fresh Fish Co.

"The distributors have removed the product from the marketplace and are destroying any remaining product," the statement said.

Three illnesses due to elevated histamine levels have been reported, all involving sushi purchased at a single location, the statement said.

Red Shell has sushi franchises in grocery stores in California. AFC has grocery store sushi franchises in nearly every state.

Pacific Fresh Fish is a cash and carry establishment.

(Reporting by Ian Simpson; Editing by Jerry Norton)

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More Reasons To Eat Your Fruits And Veggies

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October 14, 2011

Audio for this story from Talk of the Nation will be available at approx. 6:00 p.m. ET

In a new study, researchers from McMaster University found that in people with a certain gene that elevates heart attack risk, a diet high in fruits and vegetables can help lower the risk. Dr. Sonia Anand explains the study, and what still needs to be learned about the gene.

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Using Magnets Aimed at the Brain to Influence Whether People Lie

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Zap one part of the brain with a magnetic pulse and people become more likely to lie. Stimulate the opposite side of the region and truth-telling increases, according to new research.

In the study, 16 participants were asked to view red or blue colored disks on a computer monitor and, at their own discretion, to sometimes lie about the color and identify red as blue, or vice versa.

While the volunteers made these choices, researchers applied repetitive transcranial magnetic stimulation (rTMS) to their brains. The small rTMS device uses magnets to generate weak electrical fields, and researchers place it near the head to administer the non-invasive pulses. This affects communication between brain cells in targeted regions.

Doctors use rTMS as a treatment for depression that fails to respond to drugs or therapy, and it is also being studied for other psychiatric and neurological disorders. Side effects can include some twitching, but the treatment is not generally reported to be painful.

In the new study, researchers administered rTMS to the dorsolateral prefrontal cortex — a region involved in planning, memory and self-control — either in the right or left hemisphere of the brain. When rTMS was used on the right hemisphere, participants were more likely to tell the truth. When the stimulation was applied to the left side of that region, the probability of lying increased. Stimulation applied to other brain regions in the study's control participants had no effect on their honesty.

MORE: The Criminal Mind: How Drugs and Violence May Affect the Brain

Because the number of participants was so small, it's hard to draw firm conclusions from the research. Even if the study were replicated in a much larger group, however, it might not translate directly to the real world. Stimulation of the brain could have a different effect when the stakes of lying — say, to avoid being sent to prison — are higher than simply participating in an experiment. The brain's responses to experience are different depending on the person's emotional state.

Nonetheless, the potential ability to detect or even control people's deceitfulness would be of tremendous interest to those working in professions like law or national security—as well as having terrifying civil liberties implications. Study co-author Talis Bachmann of the University of Tartu in Estonia spoke with the U.K.'s Guardian about the potential legal repercussions of using rTMS to get people to tell the truth:

Provided that the method is validated and legal norms are established, it could perhaps be allowed and justified ... but this should not become a routinely used technique. Basic human rights include cognitive privacy and this would be a clear infringement. If a subject freely agrees, maybe it would make sense, but I foresee heated debates on whether 'knocking truth out of the fellow' can be legalized in principle.

Quite an understatement, I'd say! Let's hope the ethicists keep close tabs on this technology.

The study was published in Behavioral Brain Research.

[h/t: Mo Costandi of the Guardian's excellent Neurophilosophy blog]

MORE: Mind Reading: When You Go Hunting for Psychopaths, They Turn Up Everywhere

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.

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When Politics Meets Science

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October 14, 2011

Audio for this story from Talk of the Nation will be available at approx. 6:00 p.m. ET

In his new book, Fool Me Twice, writer Shawn Otto tells why he thinks science is under assault in America. Otto, CEO and co-founder of Science Debate 2008, also explains why his "American Science Pledge" for candidates might bring more science into political decision making.

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NHS trust facing £38m funding gap

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13 October 2011 Last updated at 13:02 GMT A Surrey hospital trust is facing a spending gap of £38m this year which is predicted to get worse, it has emerged.

Epsom and St Helier NHS has balanced its books for the past four years but is facing a future shortfall.

Spokesman Antony Tiernan said the trust was facing two challenges - increased care costs and fewer people being treated in hospital.

The National Audit Office (NAO) has named the trust as one of 20 not able to achieve foundation status.

'Other options' needed

Mr Tiernan, director of communications and corporate affairs, said: "There is an ageing population. The cost of drugs and technology is increasing and people have more complex conditions so obviously that's increasing the price of NHS care.

Continue reading the main story

This is the year where it starts. The gap between our income and expenditure this year is £38m”

End Quote Antony Tiernan Epsom and St Helier NHS "More people are being treated in the community, so out of hospital, in their local GP centres and in local care centres, which means that money isn't coming into the hospital.

"When we looked forward over the next five, 10, 15 years for the future income for Epsom and St Helier hospitals the money wouldn't be there."

Mr Tiernan added: "Our existing situation shows this is the year where it starts.

"The gap between our income and expenditure this year is £38m because of those challenges and that would get worse year on year."

He said the trust had to find "other options" for running its hospitals to meet its financial challenges.

Epsom and St Helier NHS has said it is not viable to become a foundation trust in its present form and is seeking to merge with another trust.

An NAO study has said 80% of trusts in England yet to achieve foundation status are facing financial issues.

The government has scrapped a deadline for trusts to achieve foundation trust status by April 2014, but still expects the majority to become foundation trusts either on their own or through merger "as soon as clinically feasible".

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The digested Health Bill debate

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One hundred peers lined up to speak in this week's two-day debate on the government's plans to reform the NHS in England. If for some reason you were unable to find time to watch it all, fear not: Democracy Live has compiled this selection of highlights.

Watch the unedited first part of the Health and Social Care Bill debate above or click on the links in the text below to go directly to each peer's speech

Opening the debate, Lord Howe sought to pre-empt criticism that the responsibility of the secretary of state for health for the NHS would be watered down by the bill.

"Managing the range of healthcare needs for our diverse population is now so complex that no one would argue that it is a task best carried out from Whitehall," he argued.

The bill sought to bring about a "fundamental shift in the balance of power" from politicians to patients and doctors, the minister asserted, which would raise standards.

"The case for change is clear and compelling, and I am personally in no doubt that the changes set out in this bill are right for our NHS and, more importantly, right for patients," he concluded.

Labour peer and former GP Lord Rea

But the government's staunchest critic in the Lords was not soothed. Labour's Lord Rea set out to persuade his colleagues that the government had no democratic mandate to introduce the reforms and back his amendment to throw them out altogether - a highly unusual move for legislation that has already been approved by MPs.

Former Labour cabinet minister and founder of the SDP Lord Owen, who now sits as an independent peer, did not want to block the bill but he argued that the changes in it were so significant that a special committee should be established to look at them in detail.

After the health secretary's role had changed, he wondered, who would be in charge during a pandemic? "Adversarial debates across the floor of this House" were not the right medium for making judgements of such profound importance, he averred.

Labour frontbencher Baroness Thornton

Opposition health minister, Baroness Thornton, declared: "People did not expect, did not vote for and do not want these changes."

Focusing on the structural changes to NHS administration, she claimed that the new NHS Commissioning Board would be the "biggest quango in the world" and complained that Monitor was being transformed into a "huge bureaucratic economic regulator".

"The Liberal Party was in at the birth of the NHS," she noted, pleading with Lib Dem peers not to put that "legacy... in jeopardy".

Senior Lib Dem peer Baroness Williams

Baroness Williams told peers that extremely high levels of satisfaction with the current system were being overlooked, and that there was a pervasive fear that the NHS would be "essentially market based" under the changes.

She warned of the "frightening" consequences of mixing medicine and profit, suggesting that some US doctors were reluctant to cut down on carrying out lucrative prostate cancer tests despite warnings that they might cause incontinence and impotence.

Former Conservative Health Secretary Baroness Bottomley

Lady Bottomley suggested that some campaigning material she had received prior to the debate had been wide of the mark.

It exhorted her to "ensure my grandchildren can have the same benefits that you and I have received from the NHS since 1948", she revealed.

"I do not want my grandchildren to have the same benefits; my grandchildren have high standards. Like everybody else in this House, I want my grandchildren to have a better, more responsive, more effective and cost-effective NHS. Only through this bill will we achieve that."

Surgeon and former Labour health minister Lord Darzi

Lord Darzi, who conducted his own review of the NHS three years ago, said the "right competition for the right reasons" could drive up standards by "sparking creativity and lighting the fire of innovation" among clinicians.

But he criticised the complexity of the proposed new lines of accountability in the NHS.

Historian and broadcaster Lord Hennessy

Crossbencher Lord Hennessy, a co-signatory to Lord Owen's amendment, said the day the NHS was created was the "closest we have ever come to institutionalising altruism".

A way had to be found that did not involve the health secretary "abandoning" his role as the guarantor of a comprehensive service, free at the point of delivery, he said, and the special committee envisaged by his amendment would be able to do just that.

Fertility expert and broadcaster Lord Winston

Labour's Lord Winston spelled out why he believed "the legacy of the previous government which we keep hearing about might be a bit better than has been suggested by the present government".

The changes were "unnecessary" and "irresponsible", he lamented.

Lady Hussein Ece agreed the legislation was not perfect.

But she added: "I think most of us would agree that the status quo is not really an option." The bill could improve patient care and accountability, she predicted, if amended appropriately during its passage through the upper chamber.

Conservative former Health Secretary Lord Fowler

Lord Fowler lambasted a "dreary" misconception: "The use of the private sector does not mean that one is privatising the service."

He also dismissed the Owen-Hennessy bid to refer the bill to a special committee, telling peers that "the normal committee processes of the House would be sufficient" scrutiny for the legislation.

Finally, Lord Howe faced the daunting task of responding to the marathon debate. Peers agreed to give the bill a second reading, and then let it proceed with normal committee-stage scrutiny without establishing the special committee envisaged by Lord Owen and Lord Hennessy.

Compiled by Democracy Live's Ed Lowther

democracylive@bbc.co.uk

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Camouflaged Cuttlefish: Don't Mind Me; I'm Not Here

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This is Camo Week at this blog, when we celebrate varieties (hunting, eating) of camouflage, so I can't not mention the champs: cuttlefish. Here's why: Take this cuttlefish, who lives in a lab in Porto, Portugal...

He's a little odd-looking, for those of you who aren't familiar with this animal. A relative of the octopus and the squid, cuttlefish have tentacles, squishy bodies, no bones and a remarkable talent for mime. Place this guy next to a plastic underwater "plant," and in no time, he will assume the guise of his neighbor. He will pucker his skin, splay his body, hold his tentacles, and adjust his coloration in a Marcel Marceau-like attempt to blend in. Cuttlefish can hold an attitude for 20 minutes or so. Like so:

They are so good at this, in part because they don't have bones, but also because they've got big brains and a distributed intelligence that allows them to pucker, stretch and sculpt themselves in ways we can't even remotely copy. Our skin? We do goose bumps. They choose these attitudes. This is their art. Next to them, we're pathetic. When I was at ABC News, I got marine biologist Roger Hanlon to introduce me to one of his lab cuttlefish, who matter-of-factly disappeared before my eyes. Or tried to.

We were really hard on this cuttlefish, sticking him in an environment he'd never find at sea. Football players are used to this, but what cuttlefish has tried to blend into black and white lines arranged in parallels? None, I figure.

But look at this guy! When our lines went straight up, he gamely stuck a bunch of his tentacles right up there with them. (left image) When we angled, he angled too, using different tentacles to cover different stripes (right image).

While this is all pretty good, on their best days, cuttlefish are simply astounding. The best thing they do — and I don't think Roger Hanlon has quite figured out how — is on sunny days when light is flickering on the shallow ocean bottom, occasionally interrupted by clouds, cuttlefish can mimic the weather!

When the light around them is changing, they don't want to be a dark, noticeable clump, so they turn their skin into a billboard — like those screens you see around Times Square — and they pulsate lights and shadows in tune with the weather so their enemies don't notice they're there.

How they time their skin cells to mime the movement of sunrays through water, angle changes, passing clouds, how they can split their displays in two, broadcasting one message to the right, a different message to the left, I have no idea. But they can. Watch.

I guess if you've spent the last 100 million years as an unprotected, unshelled, naked lump of delicious protein surrounded by predators, you learn a thing or two about camouflage.

For more details see, Barbosa, Allen, Mathger and Hanlon, "Cuttlefish use visual cues to determine arm postures for camouflage" and Ed Yong's excellent summary, Will all Camouflaged Cuttlefish Please Raise Their Tentacles? at Ed's blog, Not Exactly Rocket Science.

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Contest Seeks To Launch Student Space Projects

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October 14, 2011

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The YouTube Space Lab competition is asking high school students to submit video proposals for space-based science experiments. Zahaan Bharmal, a Google executive who envisioned the competition, says that the winning entry will be performed on the International Space Station and streamed live on YouTube to the world.

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New tests for cosmetic surgery

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By Adina Campbell
Newsbeat reporter Sian Welsh says she was too young when she had breast implants at 18

New assessments are being introduced at some private clinics to try to stop people having cosmetic surgery they may later regret.

The test has been developed by psychologists who say patients are being put at risk by firms who don't carry out enough checks.

They are also being backed by the UK's biggest plastic surgery group.

Some clinics in The British Association of Aesthetic Plastic Surgeons (Baaps) have already started using the form.

Nigel Mercer, a consultant plastic surgeon and member of Baaps, says the questionnaires are easy to use and have a scoring system to help identify those who aren't suitable for cosmetic surgery or treatments.

"It's important we are aware of those patients who are vulnerable and that they are appropriately counselled. They need to be fully aware of what they're letting themselves in for if they go for surgery."

"These assessments should act as an aid for surgeons who have a responsibility to ask the right questions. Too many private clinics are more concerned about their bank balance and not their patients."

The test asks questions like how long a person spends looking in the mirror and how much the feature they want to change bothers them.

Nichola Rumsey, a psychologist in Bristol, helped develop the assessment.

"We've worked on this for a number of years. We thought there was a need to provide surgeons with a screening instrument to find out who looks like they will do well from cosmetic surgery and those that may go on to suffer psychological problems."

'Flat chest'

Twenty-two-year-old Sian Welsh from Oldham had breast implants when she was 18. Looking back she says the surgeon didn't give her enough time to think about whether she needed surgery.

"Before my boob job I was a double A cup and it always bothered me having a flat chest. I was really excited about having implants when I turned 18 because I thought it would give me more confidence."

"But looking back, I was definitely too young and probably needed counselling to make me feel better about myself."

The patient must complete 11 questions on body image

"I don't regret the surgery but I should have waited. My surgeon didn't get to know me and never found out where I was psychologically."

The questionnaire takes up two sides of A4 and patients will need to answer the 10 questions before their first consultation with a surgeon.

There is a separate guide for surgeons which helps flag up those who aren't suitable for surgery and may need counselling instead.

It's claimed some patients who are desperate for surgery will able to cheat the test and give false answers.

Newsbeat gave Sian a copy of the questionnaire and she had mixed views.

"I think these assessments are a good idea and if it was around when I had surgery, the outcome may have been different for me.

"However, looking at these questions they're not very detailed and I think some people will put scores down that will guarantee they have surgery."

Nigel Mercer says the questionnaire is only supposed to be an aid for surgeons.

"Good surgeons will be able to tell when someone is lying and we are trained to pick out those who have deeper underlying issues."

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Seeing A Cephalopod In Ancient Bones

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October 14, 2011

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The origins of a stash of 220-million-year-old, 40-plus-foot-long ichthyosaur bones at a Nevada site have long puzzled paleontologists. Paleontologist Mark McMenamin explains his controversial theory that the bones were put there by a giant, ancient octopus-like creature.

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No Excuses! A Brief Guide to the Flu Shot

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We got our flu shots at TIME Healthland HQ this week, which reminds us to remind you to do the same. A few flu shot basics to follow.

What it is: The seasonal influenza vaccine is formulated to protect against the three strains of flu that public health researchers believe will be the most common during the upcoming season. That calculation is based on flu trends observed in the previous year and usually includes two influenza A subtypes and one influenza B subtype.

The 2011-12 flu vaccine protects against two influenza A strains: H1N1, the infamous "swine flu," and H3N2, a similar subtype that sickened many last year. The influenza B virus included in the current flu vaccine is the "Brisbane" strain.

Some critics say the flu vaccine isn't worth getting because it doesn't guarantee protection if, for instance, you become infected with a strain of flu that isn't included in the shot. That's true, but it does protect against the three strains you're most likely to get and, additionally, it can help make illness from other strains of flu milder.

What's new this year: This season's flu vaccine comes in a new package, with a much shorter and finer needle than the standard shot — which should make it more attractive to those with a fear of needles. It also contains fewer antigens than the traditional vaccine. The new vaccine began shipping last month. Reported Alice Park:

While the typical flu vaccine uses a 1-in. to 1.5-in. needle, the new Fluzone Intradermal influenza vaccine comes with an ultrafine needle that's 90% smaller, at just 0.06 in. Both vaccines contain the same antigens, which help the immune system to protect against the three commonly circulating influenza strains this season.

But because of its formulation, the new vaccine contains 40% less antigen material than the regular flu vaccine. That means the same amount of antigen can be used to make more doses of the intradermal vaccine, a useful feature if a flu-shot shortage were to occur this season.

The standard flu vaccine is still on offer, of course, but the new vaccine should be available wherever the usual injection is. Unfortunately for kids, though, the new shot is approved only for adults aged 18 to 64.

Who should get it: Everyone over 6 months of age should get the flu vaccine, provided they don't suffer from allergies to eggs, chicken feathers or the preservative thimerosal; also, if you've ever had a serious reaction to a flu shot in the past or had Guillain-Barré syndrome, talk to your doctor first.

The Centers for Disease Control and Prevention (CDC) strongly urges people at high risk of developing flu complications to get vaccinated, including: children younger than 5 (and especially younger than 2); adults aged 65 or older; pregnant women; the morbidly obese; those with underlying disease, such as asthma, diabetes, neurological problems, lung disease, or chronic conditions affecting the blood, kidney or liver; and those with weakened immune systems.

The CDC also recommends a flu shot for health-care workers and caregivers to small children or the elderly.

For specific info about the nasal-spray flu vaccine, which contains weakened live viruses, see the CDC's webpage here.

Why getting a flu shot is a good deed: If you're on the fence about getting inoculated because, let's face it, you're a healthy, young person for whom the flu would be more inconvenience than tragedy, here's another reason to do it: herd immunity. Babies under 6 months, who are very vulnerable to flu complications, are not able to have a vaccination. By protecting yourself, you'll lower the risk of passing infection on to them.

Meredith Melnick is a reporter at TIME. Find her on Twitter at @MeredithCM. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.

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Searching For Meaning In A Cheap Toaster

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October 14, 2011

Audio for this story from Talk of the Nation will be available at approx. 6:00 p.m. ET

Carl Sagan once said that if you want to make an apple pie from scratch, you must first invent the universe. In his book The Toaster Project, author and artist Thomas Thwaites describes his effort to build a cheap plastic toaster from scratch, and what the project taught him about material goods, self-reliance, international commerce, and globalization.

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In African Cave, An Early Human Paint Shop

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Enlarge Science/AAAS

This abalone shell was found with ocher and a grinding stone. The iron oxide was used as a pigment to paint bodies and walls, as well as to thicken glue.

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This abalone shell was found with ocher and a grinding stone. The iron oxide was used as a pigment to paint bodies and walls, as well as to thicken glue.

Apparently one of the earliest human instincts was to paint things, including bodies and cave walls. That's the conclusion from scientists who have discovered something remarkable in a South African cave — a tool kit for making paint. It looks to be the oldest evidence of paint-making.

Over in southern Africa 100,000 years ago, Homo sapiens was pretty new on the scene. A favorite hangout was a cave named Blombos near the Southern ocean.

Archaeologists like Christopher Henshilwood have spent decades finding stuff there that our ancestors left behind. Recently, Henshilwood uncovered two abalone shells with ocher ground into the shell. "Above and below each shell and to the side of each shell was a complete kit that was used for producing a pigmented mixture," he says.

In addition to the shells were stone flakes, grinding stones and bits of bone with reddish ocher on them. Ocher is a kind of iron oxide dug from the ground that early humans used as a pigment and to thicken glue.

I think we're going to find that these early people were smarter than we think.

- Alison Brooks, anthropologist, The George Washington University

Henshilwood, a professor with the University of the Witwatersrand in South Africa and the University of Bergen in Norway, says his discovery points to decoration.

"I think the most likely explanation for this is that they were producing paint," he says. "This really was the smoking gun."

Henshilwood says for a short time, the cave was a paint shop — the earliest ever seen. The makers added bone and charcoal to a liquid mixture to make it oily and viscous so it would stick. The ocher provided color and a matrix. It was complex chemistry but stirred by hand.

"We can see where the small quartz grains that had adhered to the finger had left a very tiny trace in the shell," Henshilwood says.

Enlarge Science/AAAS

Archaeologist Christopher Henshilwood excavates at the 100,000-year-old levels of the Blombos cave in South Africa.

Science/AAAS

Archaeologist Christopher Henshilwood excavates at the 100,000-year-old levels of the Blombos cave in South Africa.

Higher-Order Thinking

In a laboratory at George Washington University, anthropology student Andrew Zipkin opens a bag of ocher and puts it into a mortar, where he grinds it with a pestle.

"You need to sort of tap it and break it up first," he explains. "The finer-grain material here is quite powdery now. This is ready to use. I can mix this with water and I'll have a pretty nice paint out of this."

Zipkin's Ph.D. work focuses on ocher and how to make stuff with it the way ancient humans did.

Lately, he has been exploring the other ancient use for ocher: He's gluing stone points onto arrowheads. Then he tests how well the glue works.

"I went to an Ethiopian butcher in Falls Church, Va., and tracked down a goat carcass they had there," he says. Then he shot the arrows into the carcass. He found that the arrowheads with ocher stayed on better than those without.

Enlarge Magnus Haaland

Researchers found paint and tools in the Blombos cave, marked with the white arrow on the left side of the image, on the southern coast of South Africa.

Magnus Haaland

Researchers found paint and tools in the Blombos cave, marked with the white arrow on the left side of the image, on the southern coast of South Africa.

Zipkin makes a lot of ocher mixtures — you can tell by looking at his hands and his clothes. He says the recipe has to be followed exactly right, a process that takes planning.

"I think we're going to find that these early people were smarter than we think," says Alison Brooks, an anthropologist at George Washington University. She says working with ocher reflects higher-order thinking, and using it as paint probably represents an early form of symbolic thinking as well.

"The ultimate purpose of putting something on yourself, your house, your walls is to make a statement about who you are," she says. "So it would have been important to identify yourself as a friend."

Whoever these people were — primitive Picassos or house painters — their handiwork lasted 100,000 years, and is described in the journal Science.

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Author Thomas Thwaites discusses his quest to build a toaster from scratch, starting with iron ore.

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House debates abortion-funding bill

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Rep. Joe Pitts, R-Pennsylvania, sponsored the Protect Life Act, which would bar federal subsidies for health plans that provide abortion services.Bill passes with overwhelming Republican supportHouse Democratic Leader Nancy Pelosi condemns measureAmendment would bar funding for health plans providing abortion servicesSenate unlikely to take up measure; Obama promises veto

Washington (CNN) -- The U.S. House passed a bill Thursday that would amend the health care law to bar federal funding for health plans that provide abortion services.

The vote was 251 in favor and 170 against.

The bill, the Protect Life Act, was sponsored by Pennsylvania Republican Joe Pitts and gathered overwhelming Republican support. Only two Republicans voted against it, along with all but 15 Democrats.

House Democratic Leader Nancy Pelosi condemned the bill during earlier debate, arguing that if it passed, "women can die on the floor and health care providers do not have to intervene."

Democrats opposed to the bill charged that the GOP majority was ignoring the nation's top priority and instead spending time on a bitterly divisive issue.

"Instead of focusing on jobs, Republicans are continuing to wage their war on women," California Democrat Barbara Lee said on the House floor.

But GOP leaders emphasized the House spent the bulk of the week on proposals like the three free trade agreements that passed Wednesday aimed at boosting job creation. They explained Thursday's vote was simply following through on a campaign promise that House Republicans made when they outlined their agenda in the run-up to the 2010 elections.

"We've done four or five solid job-creation bills this week and this bill was part of our Pledge to America. We are keeping our word to the American people, and we are going to do it," House Speaker John Boehner said.

Supporters of the measure argued that the health care law contains a loophole that allows those receiving federal subsidies to use the money to enroll in health care plans that allow abortion services.

Abortion rights advocates maintain the bill is unnecessary because existing laws already bar any taxpayer money from underwriting abortion procedures. During the health care debate, President Barack Obama signed an executive order stating no federal funds could be used in the new health care exchanges created in the law.

Pro-abortion-rights groups like Planned Parenthood also maintain the bill adds a new restriction. Currently, hospitals that receive federal funds but don't have facilities to treat women who may need emergency abortion services are directed to transfer those patients to a health care facility that can treat them. The Pitts bill removes that requirement.

A day after the House passed the three trade agreements with Colombia, Panama, and South Korea with sizable bipartisan votes, debate in the House chamber on the abortion bill Thursday was heated and at times became personal.

Rep. Jackie Speier, D-California, who revealed last year that she suffered a miscarriage and required a procedure to end her pregnancy, accused Republicans of being "absolutely misogynist" for bringing up the bill.

But Rep. Virginia Foxx, R-North Carolina, responded, "The misogyny comes from those who promote the killing of unborn babies."

Foxx said the bill was not about taking away any existing rights, but restricting the use of federal money. She cited opinion polls showing that more than three-quarters of Americans oppose taxpayer funding of abortions.

Rep. Ileana Ros-Lehtinen, R-Florida, disputed Democrats who repeatedly argued that Obama's 2010 executive order made it clear women would have to use private funds to pay for any abortion services.

"It is flawed because executive orders can disappear as quickly as they are issued. But the Protect Life Act will create a solid framework that will safeguard taxpayer dollars," Ros-Lehtinen said.

The Senate is not expected to take up the bill and the White House issued a veto threat on the Protect Life Act on Wednesday.

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Guidelines of the ultrasound can diagnose wrongly miscarriage

As if anxiety about potential error were not quite stressful for newly pregnant women, research published Friday shows that the current guidelines for using ultrasound to determine that a pregnancy is completed can not always be accurate.

Four new studies looked at ultrasound U.K. specifications, but when the results are extrapolated to the guidelines of the U.S., researchers suggest that 1 in 23 women diagnosed with error could still have a viable pregnancy.

That could mean for the future of such incorrectly doomed pregnancies is not known. Researchers analyzed not if women in the studies that have been informed that their pregnancies had ended then has to have surgery to remove their uterus.

But just the possibility that a pregnant woman unintentionally would end a pregnancy viable is intolerable, said Tom Bourne, Professor of Gynecology at Imperial College London and principal author of three related studies published in the journal ultrasound in obstetrics and Gynecology. "We are concerned that the current guidelines can lead to a misdiagnosis," said Bourne. "The current thresholds for error are not appropriate."

More: Women Grieve error for years, even after having a healthy baby

Ultrasound is the gold standard used to determine the error. It is assumed - at least by pregnant women - exceptionally precise. Yet, studies, who analysed the existence or the size of the gestational sac, concluded that the presence or absence of a gestational sac, as well as its size, were not infallible indicators of spontaneous abortion.

The researchers followed 1,060 women who complained of slight bleeding or pain - the two potential signs that a pregnancy is distressed - between five and eight weeks of pregnancy and had an initial ultrasound. As is practical, they returned seven to ten days later for a further analysis measure the growth of the bag. Those who were still pregnant were followed again between 11 and 14 weeks.

Generally, an embryo enjoyed 6 mm with no increase in the size of the gestational sac between detectable scans or without a heartbeart is supposed to indicate the spontaneous abortion, but Bourne concluded that it is possible that a pregnancy may not grow measurable in a week. In fact, half a percentage point for women in the study - or 1 in 183 - still could be pregnant even if scanning guidelines technically would have classified their pregnancies in the end.

To the United Kingdom, ultrasounds which reveal an empty gestational sac over 20 mm in size lead to a diagnosis of spontaneous abortion. In the United States, the standard established by the American College of Radiology is 16 mm. based on the findings of researchers, 8 in 183 U.S. women - or 1 to 23 - would have a miscarriage diagnosed incorrectly.

More: The common use Painkiller may be linked to the risk of miscarriage

Another study concluded that a gestational sac can vary up to 20% according to the who made the measure; different clinicians obtain different results. Imagine, for example, that a Sonographer overstates size of CCS, and then a second ultrasound later underestimates it. The confusion which could lead to a women being falsely that she had failed.

To increase the precision, Bourne recommends ultrasound guidelines be updated and increased standards for the determination of miscarriage.

Jonathan Schaffir, Associate Professor of obstetrics and Gynecology at the Ohio State University, who was not involved in the research, said that the British studies are important, even if it is likely that most of the doctors who suspect miscarriage at early stages of pregnancy would adopt a wait-and-see approach. "It is important of Miss not even a viable pregnancy, but it is rather unusual to determine the error based on an analysis of these measures at the beginning, at the beginning," he said. "From a practical point of view, the results of these studies will not change clinical practice."

Bonnie Rochman is a journalist in time. Find him on Twitter at @ brochman. You can also continue the discussion on the time Facebook page and Twitter time @.

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Worried about vitamin safety? Experts offer advice

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In this Thursday, Oct. 13, 2011 photo illustration, multivitamins are poured from a bottle in Philadelphia. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke) In this Thursday, Oct. 13, 2011 photo illustration, multivitamins are poured from a bottle in Philadelphia. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke) The nutritional label of a box of multivitamins is photographed in Philadelphia on Thursday, Oct. 13, 2011. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke) The nutritional label of a box of multivitamins is photographed in Philadelphia on Thursday, Oct. 13, 2011. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); Two studies this week raised gnawing worries about the safety of vitamin supplements and a host of questions. Should anyone be taking them? Which ones are most risky? And if you do take them, how can you pick the safest ones?

Vitamins have long had a "health halo." Many people think they're good for you and at worst might simply be unnecessary. The industry calls them an insurance policy against bad eating.

But our foods are increasingly pumped full of them already. Even junk foods and drinks often are fortified with nutrients to give them a healthier profile, so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit.

"We're finding out they're not as harmless as the industry might have us believe," said David Schardt, a nutritionist at the consumer group Center for Science in the Public Interest.

This week, a study of nearly 40,000 older women found a slightly higher risk of death among those taking dietary supplements, including multivitamins, folic acid, iron and copper. It was just an observational study, though, not a rigorous test.

Another study found that men taking high doses of vitamin E — 400 units a day — for five years had a slightly increased risk of prostate cancer.

As many as one-third of Americans take vitamins and nearly half of people 50 and older take multivitamins, surveys suggest. Americans spent $9.6 billion on vitamins last year, up from $7.2 billion in 2005, according to the Nutrition Business Journal. Multivitamins top the list, at nearly $5 billion in sales.

Yet there is no clear evidence that multivitamins lower the risk of cancer, heart disease or any other chronic health problems. No government agency recommends them "regardless of the quality of a person's diet," says a fact sheet from the federal Office of Dietary Supplements. And vitamins aren't required to undergo the strict testing required of U.S.-approved prescription medicines.

Some fads, such as the antioxidant craze over vitamins A and E and beta-carotene, backfired when studies found more health risk, not less. And studies that find more disease in people with too little of a certain vitamin can be misleading: Correcting a deficiency so you have the right daily amount is different from supplementing beyond recommended levels.

The best way to get vitamins is to eat foods that naturally contain them, said Jody Engel, a nutritionist with Office of Dietary Supplements. "Foods provide more than just vitamins and minerals, such as fiber and other ingredients that may have positive health effects."

Schardt adds: "It's virtually impossible to overdose on the nutrients in food."

Some folks may need more of certain nutrients and should talk with their doctors about supplements:

— Postmenopausal women regarding calcium and vitamin D to protect bones.

— Women planning on pregnancy regarding folate, or folic acid, to prevent birth defects.

— People over age 50 and vegans who may need vitamin B12. "As we get older, a number of us no longer produce enough acid in the stomach to extract the B12 in food," Schardt explained.

— Pregnant women, who may need extra iron.

— Breastfed infants and possibly other infants concerning vitamin D.

Vitamin D is a nutrient many of us may need to supplement. Last fall, the Institute of Medicine, a panel of scientists who advise the government, raised the recommended amount but also warned against overdoing it. People ages 1 to 70 should get 600 international units a day, older folks 800 units.

If you do need a supplement, beware: Quality varies. Consumerlab.com, a company that tests supplements and publishes ratings for subscribers, has found a high rate of problems in the 3,000 products it has tested since 1999.

"One out of 4 either doesn't contain what it claims or has some other problems such as contamination or the pills won't break apart properly," said company president Dr. Tod Cooperman.

For example, one gummy bear calcium product had 250 percent of the amount of vitamin D claimed on the label. Another liquid product made with rose hips had just over half the amount of vitamin C listed.

"You don't have to pay a lot. Price is not necessarily linked to quality," he said. "The quality doesn't really relate to where you're buying it. I know many people are surprised by that or don't want to believe it, but that is the case. We find good and bad products in every venue."

Mark Blumenthal, executive director of the American Botanical Council, suggests looking for "seals of approval" or certifications of quality from groups that spot-test supplements such as the USP, or United States Pharmacopeia; NSF International and NPA, the Natural Products Association.

Experts offered this advice:

— Keep it simple. The more ingredients there are in a supplement combo, the more chance that one of them will not be the right amount, Cooperman said.

— Consider a supplement combo tailored to your gender and age, the Office of Dietary Supplements suggests. Multivitamins often contain little iron, and ones for seniors give more calcium and vitamin D than products aimed at younger adults.

— Take vitamin D with dinner. A study found significantly more absorption of that nutrient when it was consumed at the largest meal, which tends to have more fat, than at breakfast, Cooperman said.

— Watch out for vitamin K — it promotes clotting and can interfere with common heart medicines and blood thinners such as warfarin, sold as Coumadin and other brands.

— Current and former smokers are advised to avoid multivitamins with lots of beta-carotene or vitamin A; two studies have tied them to increased risk of lung cancer.

— For cancer patients, "vitamins C and E might reduce the effectiveness of certain types of chemotherapy," Engel said.

— People having surgery should know that some vitamins can affect bleeding and response to anesthesia.

With any supplement — ask your doctor.

__

Online:

Vitamin facts: http://ods.od.nih.gov/factsheets/list-VitaminsMinerals

and http://ods.od.nih.gov/factsheets/MVMS-HealthProfessional

FAQs: http://ods.od.nih.gov/Health_Information/ODS_Frequently_Asked_Questions.aspx

Dietary advice: www.dietaryguidelines.gov

Vitamin E and prostate study: http://jama.ama-assn.org/content/306/14/1549

Video interview with author: http://jama.ama-assn.org/content/306/14/1549/suppl/DC1

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Now wash your hands - and your mobile

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14 October 2011 Last updated at 00:55 GMT Often not as clean as it looks... It is the sort of news story that will have left many feeling queasy over their breakfast cereal - a study which suggests one in six mobile phones is contaminated with faecal matter.

Researchers at the London School of Hygiene and Tropical Medicine and Queen Mary, University of London took nearly 400 samples from mobile phones and hands in 12 British cities.

They found 16% of phones and 16% of hands harboured E. coli (Escherichia coli), bacteria which inhabit the human intestines.

The largest proportion of contaminated phones was in Birmingham (41%) while Londoners were caught with the highest proportion of E. coli present on hands (28%).

Why do so many people clearly not wash their hands with soap after a visit to the toilet? Perhaps they do, but are simply doing it wrong.”

End Quote Fergus Walsh

But the sample size in each city was small, so the variations between them could be a statistical anomaly.

However Dr Val Curtis, from the London School of Hygiene says the study showed clear differences between north and south.

"We found the further north we went the more hands and phones were likely to be contaminated. It could be the bugs survive better in colder and wetter conditions or it might be that people wash their hands less."

I explained to Dr Curtis that such comments were unlikely to win her friends in Glasgow and Liverpool - two of the cities where samples were taken.

But she brushed this aside explaining that after a similar survey three years ago she was advised not to hang around Newcastle.

Dr Ron Cutler of Queen Mary, University of London, explains the findings

Archers warning

Most strains of E. coli found on the hands and phones are not likely to cause major ill-health, although listeners of "The Archers" will know that Clarrie Grundy became an unwitting carrier of the bacteria, leading to a number of children being hospitalised in the fictional county of Borsetshire.

Dr Curtis explained that they were using E. coli as a marker for the presence of faecal matter.

She said: "Campylobacter and Salmonella bacteria are much more likely to cause a gastric infection and could easily be passed on through faecal contamination."

So we are talking about poo, excrement - on mobile phones and fingers.

Hand washing technique

Why do so many people clearly not wash their hands with soap after a visit to the toilet? Perhaps they do, but are simply doing it wrong.

I remember having correct hand-washing technique described to me by the virologist Professor John Oxford.

He thought people didn't wash thoroughly enough, or long enough - two verses of Happy Birthday to you were suggested.

Perhaps there is also a confusion in some people's minds about dirt and germs. After all, there is plenty of research suggesting dirt can be good for you.

Since the late 1980s the "hygiene hypothesis" has argued that the lack of early childhood exposure to some germs may be linked to the rise in allergic diseases, by suppressing the development of the immune system. It's a much-debated theory.

But while letting your children - or your husband - play in the dirt may well be ok, they still need to wash their hands after the toilet. Or after handling raw meat and poultry.

Big killer

You simply have to look to the developing world to see the devastating effects of poor hygiene. Diarrhoeal disease remains one of the world's biggest killers.

While hand-washing may help prevent a nasty stomach bug here, in poorer countries it can save lives.

The survey from the London School of Hygiene and Tropical Medicine is timed to publicise Global Handwashing Day on 15 October.

It is an annual event which promotes hand-hygiene, the cheapest and most effective way of preventing infection by bacteria and viruses.

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Authorities perplexed by drug shortage spike

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A customer leans against a pharmacy counter at a Sam's Club store in Arkansas, May 31, 2007.

Credit: Reuters/Jessica Rinaldi

By Anna Yukhananov

WASHINGTON | Fri Oct 14, 2011 1:17pm EDT

WASHINGTON (Reuters) - Two years into an escalating shortage of life-saving cancer drugs, regulators and lawmakers are still unable to identify why it is happening, let alone how to solve the problem.

Hospitals and doctors across the country are postponing care or using second-best or more costly alternatives. The shortages have also forced delays in clinical trials for cancer, which use these drugs as a baseline to test the effectiveness of novel therapies.

While work-arounds can help for a while, what is perhaps most worrying is that the officials in charge of addressing the problem are no closer to identifying the underlying causes.

In the balance are hundreds of thousands of patients, and potentially millions, who may not get the full care they need.

"Anybody who is sure they know the answer to this question is probably kidding themselves," said Peter Lurie, a senior adviser in the Food and Drug Administration (FDA) Office of the Commissioner, who works on public health issues, including drug shortages.

"There appear to be multiple factors that are playing in it and it's very difficult to identify which one is most important," Lurie told Reuters.

Drug shortages have been around for years in the United States, but they were previously intermittent and largely temporary, pharmacists and doctors say. They have shot up in a very short time, with a record of over 200 scarce medicines this year alone, up from 56 in 2006, according to FDA data.

Health providers say the companies who make these drugs, long sold in generic form, have a diminishing interest in ensuring a strong supply. After a wave of consolidation, only five to seven companies produce 80 percent of these medicines, and stricter reimbursement policies have cut into the profits.

But a group representing companies such as Watson Pharmaceuticals Inc and Sandoz, a division of Novartis AG, blames the FDA for introducing unnecessarily strict inspections and shutting down manufacturing facilities for minor issues.

The finger pointing and lack of answers is leaving health providers and patients exasperated.

"Something has to be done soon in order to try to alleviate this problem," said Dr. Michael Link, the current president of the American Society of Clinical Oncology (ASCO), a non-profit group of cancer doctors and other providers.. "Right now we're already seeing patient care suffering... I think you're seeing a groundswell of concern."

In the meantime, distributors in the so-called "gray market" are exploiting the situation to peddle the drugs at hundred-fold mark-ups, according to lawmakers investigating the situation.

Senator Chuck Schumer, a Democrat from New York, has called for an investigation by the Federal Trade Commission. And last week, Representative Elijah Cummings, the top Democrat in the House Committee on Oversight and Government Reform, asked five companies in the gray market to provide information on their sales and how they obtain the drugs.

PATIENTS IN THE BALANCE

In a July survey of 820 hospitals by the American Hospital Association, more than four-fifths of hospitals said they had to delay treatment and more than half could not provide patients with the recommended drug for their disease. Sixty-nine percent of patients had to settle for a less effective drug.

The non-profit Institute for Safe Medication Practices (ISMP) has reports of at least 15 patients dying from drug shortages since last September. In the most high-profile case, nine patients died from contaminated IV fluid in Alabama this past March, when the typical supply was unavailable.

Of the 140,000 patients diagnosed with colorectal cancer each year, about 80,000 are expected to rely on typical treatments such as fluorouracil or leucovorin, both currently in short supply, said Nancy Roach, a board member at the patient group Fight Colorectal Cancer.

The government is trying to create a better notification system for shortages, which could address some of the most immediate issues for patients.

Senator Amy Klobuchar, a Democrat from Minnesota, along with Robert Casey, a Democrat from Pennsylvania, introduced a bill in February that would force drug companies to inform the FDA about looming shortages. The FDA said early notification helped it prevent 99 shortages so far this year.

But the bill does little to prevent shortages in the long-term. "People aren't in agreement on how to solve it in the long term, and not a lot of bills are going through Congress," Klobuchar told Reuters.

MARKET PERFECT STORM

The FDA began tracking drug shortages closely in 1999. Over a decade later, they have only gotten worse. Sterile injectables such as the cancer drugs, make up the lion's share and accounted for 132 out of 178 shortages in 2010.

Most are generic and have been around for years, meaning profit margins are lower.

The FDA can explain the immediate causes of the shortages -- in 2010, over half of them came from product quality and "significant" manufacturing problems such as metal shavings found in vials or fungal contamination, said Sandra Kweder, deputy director of the FDA's Office of New Drugs.

But these reasons fail to address why these problems have gotten so much worse, officials and industry analysts said.

Industry consolidation and lower inventory levels could exacerbate the problem, leaving less slack in the system to deal with shortages when they arise, the FDA said.

The agency has also blamed an increasing number of production issues on older facilities that need to be renovated as manufacturers in the low-margin generic market avoid investments in maintenance. Makers of sterile injectables Teva, Hospira and Bedford Laboratories, part of privately-held Boehringer Ingelheim, have all had manufacturing issues in the past few years, shuttering production on multiple drug lines.

The FDA also acknowledges some manufacturers may have less financial incentive to make older, cheaper generic drugs. In 2010, 11 percent of shortages were due to companies that stopped making a certain drug, usually for business reasons.

Manufacturers are loathe to make a connection between the financial incentives and producing older medicines. Several, including Teva Pharmaceuticals and Hospira, say they are building new facilities as a back-up for future shortages.

The industry lays part of the blame with the FDA. The Generic Pharmaceutical Association (GPhA) said the agency has become more focused on enforcement in the past three years, shutting down factories for smaller problems that would have been dealt with less drastically in the past.

STALLED PROPOSALS

Various proposals to address the long-term problem have stalled, not least because of the disagreement over the cause.

They include creating a national stockpile for emergency injectables -- just like for vaccines -- or offering tax incentives for manufacturers of low-cost but life-saving products. But those are unlikely to gain favor as the U.S. government is scrambling to cut costs and reduce the national debt, lawmakers and industry players said.

The International Monetary Fund and the U.S. Department of Health and Human Services are both investigating the issue, and a Government Accountability Office report is due to come out in November, according to a congressional staffer.

In the meantime, doctors like Steven Abrams, at Texas Children's Hospital in Houston, work to make sure newborn infants with intestinal damage have enough calcium and phosphates.

These essential minerals - manufactured by APP Pharmaceuticals, a company in the Fresenius Kabi Group, and Hospira - have been in short supply since April, Dr. Abrams said, forcing him to ration treatment to those most in need.

"Our task is to continue to advocate for long-term solutions," he said. "And the second is to manage this problem day to day. That's just what we have to do, ... to make sure the babies get the medicine they need."

(Reporting by Ann Yukhananov; Editing by Michele Gershberg and Tim Dobbyn)

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