'I was treated by insulin pioneer'

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23 January 2012 Last updated at 08:26 GMT Frederick Banting discovered insulin by keeping a diabetic dog alive with pancreas extract Insulin has saved the lives of countless people with Type 1 diabetes.

In 1921, when the hormone was first discovered by a young Canadian surgeon named Frederick Banting, most children diagnosed with diabetes were expected to die within a year.

Ninety years on and Banting's breakthrough is being hailed a one of the twentieth century's most important medical advances.

Insulin in all its forms continues to ease and prolong the lives of diabetics by keeping blood glucose levels under control.

Sheila Thorn was lucky enough to be treated by Banting in Toronto in 1930 when she was diagnosed as diabetic at just a few months old.

The insulin he prescribed for Sheila has kept her alive for 80 years, making her probably the longest surviving insulin-dependent diabetic in the world.

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I've seen a lot of changes in the way people use insulin and these days I use an insulin pump to control my own condition. ”

End Quote Sheila Thorn Lucky "I've got a picture of me in mother's arms when we were in Canada. When I was a baby, insulin still wasn't widely available.

"I was lucky enough to be treated by the pioneers of insulin and that's why I'm still here."

Now living in Kent, Sheila remembers being on a very strict diet growing up and her mother injecting her two or three times a day.

"Since then, I've seen a lot of changes in the way people use insulin and these days I use an insulin pump to control my own condition. It makes a world of difference."

Millions of people like Sheila have used various types of synthetically produced insulin to replace the natural insulin that is not produced in people with Type 1 diabetes.

In Toronto in 1921, a severely diabetic dog was the key to Banting's discovery.

Leonard Thompson was the first patient to receive insulin in 1922

Assisted by Charles Best, he kept the dog alive for 70 days by injecting it with a canine pancreas extract.

'Life-saving drug'

The first human to benefit from the extract was a 14-year-old boy called Leonard Thompson, who was dying of starvation with diabetes.

Within days his dangerously high blood sugar levels had dropped to near normal levels, and his life was saved.

News of the miracle extract, insulin, spread and soon scientists had clear evidence that it was a life-saving drug.

How insulin can be administered and managed has changed dramatically over the years.

Blood tests, insulin pumps and the many kinds of human and animal insulin now available make it easier to control how much is required by an individual diabetic.

Karen Addington, chief executive of medical research charity, JDRF, says it is still a fine balance.

"Before I got an insulin pump, I had to take a precise dose of insulin and calculate the carbs I was eating and also things like exercise and stress, which can also have an impact. I was always juggling things around."

With an insulin pump delivering a varied dose of insulin continually throughout the day and night, Karen says it mimics the working of the pancreas in someone who does not have diabetes.

But it still doesn't test blood glucose levels or work out how much insulin to deliver.

'Mechanical cure'

The future promises two ways of getting round these problems, which could revolutionise life for diabetics.

The first is an 'artificial pancreas', essentially an insulin pump linked to a blood sugar monitor which is worn externally and is the size of a thumbnail.

"It will mean no hypos and hypers and no complications for people with Type 1 like strokes, amputations or blindness.

"It's a mechanical cure."

The second product being invested in by JDRF is a molecule which sits on the fingertips of the patient, releasing insulin into the blood whenever it is needed.

"The pace of development in Type 1 diabetes is really amazing," say Addington, who hopes that trials of both devices will lead to general use in a few years or so.

But Barbara Young, from Diabetes UK, still believes more should and could be done to manage both Type 1 and Type 2 diabetes.

"Diabetes is seen as a less serious disease than cancers and strokes, but you can die from it too.

"Perhaps because it's a long-term condition, there's a lack of political will to properly manage and educate patients so that complications and hospital admissions are avoided."

Young cites the example of insulin pumps, which only 3.9% of people with Type 1 diabetes have access to in the UK because of "a postcode lottery and a lack of funding".

Amy Turner, who is 28, knows what it is like to have Type 1 diabetes but no pump to help her, especially since she is a keen runner.

"It is not easy but I have to adapt and plan ahead. I never go out with a bag full of extra sugar if I need it.

"I am sadly not eligible for an insulin pump, although the doctors can see how it would benefit me."

Yet, Amy is determined that her diabetes will not get in the way of her life.

"I would have died it it hadn't been for insulin. With the different types of insulin now, I can do what I want to do. I want to prove I can do physical things like half marathons."

Frederick Banting would be proud. But Amy has the final word.

"Insulin is a life-saver, but it's not a cure, just a treatment."

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Studies: Avastin may fight early breast cancers

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Surprising results from two new studies may reopen debate about the value of Avastin for breast cancer. The drug helped make tumors disappear in certain women with early-stage disease, researchers found.

Avastin recently lost approval for treating advanced breast cancer, but the new studies suggest it might help women whose disease has not spread so widely. These were the first big tests of the drug for early breast cancer, and doctors were cautiously excited that it showed potential to help.

In one study, just over one third of women given Avastin plus chemotherapy for a few months before surgery had no sign of cancer in their breasts when doctors went to operate, versus 28 percent of women given chemo alone. In the other study, more than 18 percent on Avastin plus chemo had no cancer in their breasts or lymph nodes at surgery versus 15 percent of those on chemo alone.

A big caveat, though: The true test is whether Avastin improves survival, and it's too soon to know that — both studies are still tracking the women's health. The drug also has serious side effects.

"I don't think it's clear yet whether this is going to be a winner," Dr. Harry Bear of Virginia Commonwealth University said of Avastin. But he added, "I don't think we're done with it."

Bear led one study, in the United States. Dr. Gunter von Minckwitz of the University of Frankfurt led the other in Germany. Results are in Thursday's New England Journal of Medicine.

Avastin (uh-VAS'-tihn) is still on the market for some colon, lung, kidney and brain tumors. In 2008, it won conditional U.S. approval for advanced breast cancer because it seemed to slow the disease. Further research showed it didn't meaningfully extend life and could cause heart problems, bleeding and other problems. The government revoked its approval for breast cancer in November.

Now doctors can prescribe Avastin for breast cancer but insurers may not pay. Treatment can cost $10,000 a month. The drug is made by California-based Genentech, part of the Swiss company Roche. It is still approved for treating advanced breast cancer in Europe and Japan.

The new studies tested it in a relatively novel way — before surgery. This is sometimes done to shrink tumors that seem inoperable, or to enable women to have just a lump removed instead of the whole breast.

The women in the studies had tumors that were large enough to warrant treatment besides surgery. Their cancers were not the type that can be treated by Herceptin, another widely used drug.

In the U.S. study, 1,200 women were given chemo or chemo plus infusions of Avastin. By the time of their surgery, no cancer could be found in the breasts of more than 34 percent of those given Avastin versus 28 percent of the others. (Surgeons still have to operate because they don't know the tumor is gone until they check tissue samples.)

The German study involved 1,900 women including some with larger tumors. It used a stricter definition of cancer-free at surgery: no sign of disease in the breast or lymph nodes rather than just the breast. No cancer was seen in 18 percent of women on Avastin versus 15 percent of those given only chemo. Different chemo drugs were used — a factor that might change Avastin's effectiveness.

The U.S. study was paid for by the National Cancer Institute with some support from drug companies. The German study was sponsored by drug companies. Some researchers consult for Genentech or other makers of cancer drugs.

If even one of these studies shows a survival advantage for Avastin "that would be a game changer" although side effects remain a concern, said Dr. Gary Lyman. He is a Duke University researcher who was on the federal advisory panel that recommended revoking Avastin's approval.

However, von Minckwitz said side effects are more justifiable in early breast cancer patients because "the intention is cure" rather than in late-stage disease where cure isn't usually possible.

Of the more than 200,000 women in the U.S. diagnosed each year with breast cancer, about 30,000 are like those in the new studies, Lyman estimated.

But the studies' impact could be far greater: The participants' tissue samples are being analyzed for genes and biomarkers to predict which women are most likely to respond to Avastin. That could lead to a relook of using the drug for certain women with advanced disease, too.

Three other studies are under way testing Avastin in early breast cancer; one is expected to have results by the end of this year, said Dr. Sandra Horning, global development chief of cancer drugs for Roche and Genentech. The company does not plan to seek any change in Avastin's use until more results are available, she said.

___

Online:

Studies: http://www.nejm.org

Avastin: http://www.avastin.com

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

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Study of disease inhuman mystery found no cause

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FILE - In this Aug. 1, 2006 file photo, Verna Gallagher, who claims to be suffering from a rare infliction called Morgellons, points to a sore on her skin that she believes bugs related to the condition emerged from, at her Roseville, Calif., home. Like others with the condition, Gallagher, 48, said she has a crawling sensation on her skin that is caused by bugs that emerge from the skin purpose do not act like they are alive. Results of Centers for Disease Control study released Wednesday, Jan. 25, 2012 conclude that Morgellons exists only in the patients' minds. (AP Photo/Rich Pedroncelli, File) FILE - In this Aug. 1, 2006 file photo, Verna Gallagher, who claims to be suffering from a rare infliction called Morgellons, points to a sore on her skin that she believes bugs related to the condition emerged from, at her Roseville, Calif., home. Like others with the condition, Gallagher, 48, said she has a crawling sensation on her skin that is caused by bugs that emerge from the skin purpose do not act like they are alive. Results of Centers for Disease Control study released Wednesday, Jan. 25, 2012 conclude that Morgellons exists only in the patients' minds. (AP Photo/Rich Pedroncelli, leader) eval ("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval ("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval ("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); ATLANTA (AP)--Imagine having the feeling that tiny bugs are crawling on your body, that you have oozing sores and mysterious fibers sprouting from your skin. Sound like a horror movie? Well, at one point several years ago, government doctors were getting up to 20 calls a day from people saying they had such symptoms.

Many of these people were in California and one of that state's U.S. senators, Dianne Feinstein, asked for a scientific study. In 2008, federal health officials began to study people saying they were affected by this freakish condition called Morgellons.

The study cost nearly $600,000. Its long-awaited results, released Wednesday, conclude that Morgellons exists only in the patients' minds.

"We found no. infectious cause," said Mark Eberhard, a Centers for Disease Control and Prevention official who was part of the 15-member study team.

The study appears in PLoS One, one of the Public Library of Science journals.

Sufferers of Morgellons (mor-GELL-one) describe a variety of symptoms, including fatigue, erupting sori, crawling sensations on their skin and - perhaps worst of all — mysterious red, blue or black fibers that sprout from their skin. Some say they've suffered for decades, but the syndrome wasn't named until 2002, when "Morgellons" was chosen from a 1674 medical paper describing similar symptoms.

Afflicted patients have documented their suffering on websites and many have vainly searched for a doctor who believed them. Some doctors believe the condition is a form of delusional parasitosis, a psychosis in which people believe they are infected with parasites.

Last May, Mayo Clinic researchers published a study of 108 Morgellons patients and found none of them suffered from any unusual physical ailment. The study concluded that the sores are many of them were caused by their own scratching and picking at their skin.

The CDC study was meant to be broader, starting with a large population and then went looking for cases within the group. The intent was to give scientists a better idea of how common Morgellons actually is.

They focused on more than 3 million people who lived in 13 counties in Northern California, a location chosen in part because all had health insurance through Kaiser Permanente of Northern California, which had a research arm that could assist in the project. Also, many of the anecdotal reports of Morgellons came from the area.

Culling through Kaiser patient records from July 2006 through June 2008, the team found - and was able to reach — 115 who had what sounded like Morgellons. Most were middle-aged white women. They were not clustered in any one spot.

That led to the finding that Morgellons occurred in roughly 4 out of every 100,000 Kaiser enrollees. "So it's rare," said Eberhard.

Roughly 100 agreed to at least answer survey questions, and about 40 consented to a battery of physical and psychological tests that clay over several days.

Blood and urine tests and skin biopsies checked for dozens of infectious diseases, including fungus and bacteria that could cause some of the symptoms. The researchers found none that would explain the cases.

There was no sign of an environmental cause, either, although researchers did not go to each person's house to look around.

They took fibers from 12 people, which were tested at the Armed Forces Institute of Pathology. Nothing unusual there, either. Cotton and nylon, mainly - not some kind of organism wriggling out of a patient's body.

Skin lesions were common, but researchers concluded most of them were from scratching.

What stood out was how the patients did on the psychological exams. Though normal in most respects, they had more depression than the general public and were more obsessive about physical branch, the study found.

However, they did not have an unusual history of psychiatric problems, according to their medical records. And the testing gave no clear indication of a delusional disorder.

So what do they have? The researchers don't know. They don't even know what to call it, opting for the label "unexplained dermopathy" in their paper.

Purpose clearly, something made them miserable. "The absence of evidence is not evidence of absence," said Felicia Goldstein, an Emory University neurology professor and study co-author.

She said perhaps the patients could be helped by cognitive behavioral therapy that might help them deal with possible contributing psychological issues.

The study is not expected to be the last word on the subject.

Among those with additional questions is Randy Wymore, an Oklahoma State University pharmacologist who for years was the most reputable scientist to look into it and who has concluded Morgellons is not a psychiatric disorder.

On Wednesday, Wymore said he had not seen the CDC paper and was unable to how we it. But when the study began, he questioned whether Kaiser patients with Morgellons would participate, especially if they were unhappy with how they were previously handled by their Kaiser doctors.

"There is always the question: How many of the participating study actually have Morgellons Disease?" he said, in an email.

The CDC is not planning additional study, however. The agency's expertise is in infectious diseases and environmental health problems, and the researchers saw no. evidence of that.

"We're not mental health experts," one CDC spokeswoman said.

___

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PLoS One: http://www.plosone.org/home.action

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Study: Many women can skip frequent bone scans

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ATLANTA (AP) — New research could mean millions of older women can skip frequent screening tests for osteoporosis: If an initial bone scan shows no big problems, many can safely wait 15 years to have another one, the study suggests.

Government advisers and leading doctor groups urge osteoporosis screening, but no one has known how often that should happen. The findings offer the best information to date on that question, experts said.

"This is landmark, in the sense that it could allow us to move on to more precise guidelines," said Dr. Heidi Nelson, a researcher at the Oregon Health & Science University who is an expert on the topic.

At issues are bone mineral density tests, which usually are done through X-rays and cost around $250. It takes about 10 minutes and involves less radiation than what's emitted during a chest X-ray. Medicare pays for testing every two years.

The new study feeds concerns that the tests are done too often, at least for some women.

"It's an expenditure of time, it's exposure to radiation, and it's cost. And there's no reason to expose yourself to any risks if there's going to be no benefit," explained Dr. Virginia Moyer, who heads the U.S. Preventive Services Task Force, a government panel that issues testing guidelines.

The test measures how thick bones are in certain spots, usually focusing on the hip and lower spine. Doctors use it to gain early warning of osteoporosis, a bone-thinning disease that can be staved off with better diet and exercise and treated with bone-building drugs. Nearly half of all women older than 50 will break a bone because of osteoporosis, according to the National Osteoporosis Foundation.

The government task force recommends that all women over 65 get a scan. The panel also recommends testing for younger postmenopausal women who seem at higher risk for fractures. But the task force has not said how often follow-up tests should be done, just that a couple years between tests are needed.

There are no immediate plans to update the task force's advice for osteoporosis screenings, but the new study will be an important consideration when the panel acts again, Moyer said.

The new, government-funded research involves nearly 5,000 women aged 67 years and older in a national health study that began in the 1980s. None had osteoporosis at the outset.

The researchers looked at how the women did on bone density tests, and watched for who got osteoporosis and when. They were followed for 15 years.

Based on that, the researchers concluded that women with a healthy initial test could wait as long as 15 years before getting a second screening. But women deemed at moderate risk should get tested about every five years. And women at high risk should get tested more often, perhaps even annually.

The research, published in Thursday's New England Journal of Medicine, was led by Dr. Margaret Gourlay of the University of North Carolina. She worries that her findings might be misinterpreted and cause some women to wait longer than they should for their next test. She cited earlier research suggesting not enough women get the recommended initial scan.

The 15-year interval applies only to postmenopausal women judged to be at low risk for osteoporosis from the first screening, she noted, and perhaps fewer than half of U.S. women over 65 fall into that category.

But she said even for those women, other risk factors have to be considered: smoking, slim build, prior broken bones and taking medication that has an eroding effect on bones.

She also noted that osteoporosis becomes a greater risk in the oldest patients, so a woman with a moderate risk who is 85 or older might be better off getting tested every three years instead of every five.

___

Online:

New England Journal: http://www.nejm.org

Osteoporosis information: http://www.bones.nih.gov

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FDA clears safety test to screen Tysabri patients

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WASHINGTON (AP) — The Food and Drug Administration on Friday approved a new diagnostic test to help identify patients who have an increased risk of developing a rare brain infection while taking Biogen Idec's multiple sclerosis drug Tysabri.

Tysabri is one of a handful of drugs used to control multiple sclerosis, a debilitating disease in which the body attacks its own nervous system. Prescribing of the drug has been tightly controlled by the FDA because of a rare infection that causes inflammation of the brain, known as multifocal leukoencephalopathy, or PML. Currently there is no treatment or cure for PML, which usually causes death or severe disability.

The newly approved Stratify JCV test is designed to detect a common virus that increases the likelihood of developing the brain infection. The John Cunningham virus is harmless in most people, but can become dangerous in patients taking immune system-suppressing drugs like Tysabri.

Doctors can use the results of the blood-based test, combined with facts about the patient's medical history, to determine whether they are at risk of developing the brain infection. Other factors that influence a patient's risk include how long they've been taking Tysabri and whether they've previously taken other medications that weaken the immune system.

The test was developed by Quest Diagnostics.

The FDA also updated Tysabri's label to specify that patients who test positive for the virus have a higher risk of developing PML.

"This label change marks an important advance in assisting people with MS and their physicians to make better-informed decisions concerning the challenges of balancing effectiveness with safety," said Dr. Nicholas LaRocca, vice president of the National MS Society.

Tysabri was temporarily pulled from the market shortly after its launch in 2005 after three patients taking the drug developed PML. FDA allowed the drug back on the market the following year but under a restricted distribution program. Only doctors and pharmacies registered with the company's distribution program are permitted to prescribe and dispense the drug.

Biogen, based in Weston, Mass., sells Tysabri through a partnership with Elan Corp., an Irish drugmaker.

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Meals at the school to have more vegetables, whole grains

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First lady Michelle Obama visits the cafeteria as she has lunch with school children at Parklawn elementary school in Alexandria, Va., Wednesday, Jan., 25, 2012. (AP Photo/Pablo Martinez Monsivais) First lady Michelle Obama visits the cafeteria as she has lunch with school children at Parklawn elementary school in Alexandria, Va., Wednesday, Jan., 25, 2012. (AP Photo/Pablo Martinez Monsivais) First lady Michelle Obama takes a bit of her turkey taco as she has lunch with school children at Parklawn Elementary School in Alexandria, Va. (AP Photo/Pablo Martinez Monsivais) Celebrity cook Rachael Ray has lunch with school children at Parklawn Elementary School in Alexandria, Va., Wednesday, Jan., 25, 2012. She joined first lady Michelle Obama and Agriculture Secretary Tom Vilsack at the luncheon. (AP Photo/Pablo Martinez Monsivais) First lady Michelle Obama visits the cafeteria as she has lunch with school children at Parklawn elementary school in Alexandria, Va., Wednesday, Jan., 25, 2012. (AP Photo/Pablo Martinez Monsivais) First lady Michelle Obama has lunch with school children at Parklawn elementary school in Alexandria, Va., Wednesday,Jan., 25, 2012. (AP Photo/Pablo Martinez Monsivais)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); ALEXANDRIA, Va. (AP) — The first major nutritional overhaul of school meals in more than 15 years means most offerings — including the always popular pizza — will come with less sodium, more whole grains and a wider selection of fruits and vegetables on the side.

First lady Michelle Obama and Agriculture Secretary Tom Vilsack announced the new guidelines during a visit Wednesday with elementary students. Mrs. Obama, also joined by celebrity chef Rachael Ray, said youngsters will learn better if they don't have growling stomachs at school.

"As parents, we try to prepare decent meals, limit how much junk food our kids eat, and ensure they have a reasonably balanced diet," Mrs. Obama said. "And when we're putting in all that effort the last thing we want is for our hard work to be undone each day in the school cafeteria."

After the announcement, the three went through the line with students and ate turkey tacos with brown rice, black bean and corn salad and fruit — all Ray's recipes — with the children in the Parklawn Elementary lunchroom.

Under the new rules, pizza won't disappear from lunch lines, but will be made with healthier ingredients. Entire meals will have calorie caps for the first time and most trans fats will be banned. Sodium will gradually decrease over a 10 year period. Milk will have to be low in fat and flavored milks will have to be nonfat.

Despite the improvements, the new rules aren't as aggressive as the Obama administration had hoped. Congress last year blocked the Agriculture Department from making some of the desired changes, including limiting french fries and pizzas.

A bill passed in November would require the department to allow tomato paste on pizzas to be counted as a vegetable, as it is now. The initial draft of the department's guidelines, released a year ago, would have prevented that. Congress also blocked the department from limiting servings of potatoes to two servings a week. The final rules have incorporated those directions from Congress.

Among those who had sought the changes were potato growers and food companies that produce frozen pizzas for schools. Conservatives in Congress called the guidelines an overreach and said the government shouldn't tell children what to eat. School districts also objected to some of the requirements, saying they go too far and would cost too much.

The guidelines apply to lunches subsidized by the federal government. A child nutrition bill signed by President Barack Obama in 2010 will help school districts pay for some of the increased costs. Some of the changes will take place as soon as this September; others will be phased in over time.

While many schools are improving meals already, others still serve children meals high in fat, salt and calories. The guidelines are designed to combat childhood obesity and are based on 2009 recommendations by the Institute of Medicine, the health arm of the National Academy of Sciences.

Vilsack said food companies are reformulating many of the foods they sell to schools in anticipation of the changes.

"The food industry is already responding," he said. "This is a movement that has started, it's gaining momentum."

Diane Pratt-Heavner of the School Nutrition Association, which represents school lunch workers, said that many schools won't count pizza as a vegetable even though they can. Students qualifying for subsidized meals must have a certain number of vegetables and other nutritious foods on their lunch trays.

"Most schools are serving fruit or vegetables next to their pizza and some schools are even allowing unlimited servings of fruit or vegetables," Pratt-Heavner said.

Celebrity chef Ray said she thinks too much has been made of the availability of pizza and French fries. The new rules will make kids' lunch plates much more nutrient dense, she said.

"The overall picture is really good," she said. "This is a big deal."

The subsidized meals that would fall under the guidelines are served as free and low-cost meals to low-income children and long have been subject to government nutrition standards. The 2010 law will extend, for the first time, nutrition standards to other foods sold in schools that aren't subsidized by the federal government. That includes "a la carte" foods on the lunch line and snacks in vending machines.

Those standards, while expected to be similar, will be written separately and have not yet been proposed by the department.

___

Online:

USDA school lunch rules: http://www.fns.usda.gov/cnd/Governance/Legislation/nutritionstandards.htm

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Find Mary Clare Jalonick on Twitter at http://twitter.com/mcjalonick

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Scientists pause research with lab-bred bird flu

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WASHINGTON (AP) — Scientists who created easier-to-spread versions of the deadly bird flu said Friday they are temporarily halting more research, as international specialists debate what should happen next.

Researchers from leading flu laboratories around the world signed onto the voluntary moratorium, published Friday in the journals Science and Nature.

What the scientists called a "pause" comes amid fierce controversy over how to handle research that is high-risk but potentially could bring a big payoff. Two labs — at Erasmus University in the Netherlands and the University of Wisconsin-Madison — created the new viruses while studying how bird flu might mutate to become a bigger threat to people.

The U.S. government funded the work but last month urged the teams not to publicly reveal the exact formula so that would-be bioterrorists couldn't copy it. Critics also worried a lab accident might allow the strains to escape. The researchers reluctantly agreed not to publish all the details as long as the government set up a system to provide them to legitimate scientists who really need to know. The National Institutes of Health is creating such a system.

"We recognize that we and the rest of the scientific community need to clearly explain the benefits of this important research and the measures taken to minimize its possible risks," lead researchers Ron Fouchier of Erasmus and Yoshihiro Kawaoka of Wisconsin wrote Friday in the letter. They were joined by nearly three dozen other flu researchers.

They called for a public international meeting to debate how to learn from the work, safely. And they agreed to hold off on additional research with the existing lab-bred strains or that leads to any new ones for 60 days.

A U.S. official praised the development.

The moratorium "is a really good idea, because a lot of very important issues are at hand," said Dr. Anthony Fauci, director of the NIH's National Institute of Allergy and Infectious Diseases, who expects most flu researchers doing such work to sign on. "There aren't a lot of people who are doing that, I can assure you."

The U.S. also wants international input; researchers are talking with the World Health Organization.

Today, the so-called H5N1 bird flu only occasionally infects people, mostly those who have close contact with sick poultry. But when it does, it is highly lethal. The lab-bred H5N1 strains were a surprise because they showed it was easier than previously thought for the virus to mutate in a way that lets it spread easily between at least some mammals — in this case, ferrets.

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Tiny baby leaves Los Angeles hospital amid fanfare

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Haydee Ibarra looks at her 14-week-old daughter, Melinda Star Guido, at the Los Angeles County-USC Medical Center in Los Angeles, Wednesday, Dec. 14, 2011. At birth, Melinda Star Guido tipped the scales at only 9 1/2 ounces, less than a can of soda. After spending her early months in the neonatal intensive care unit, a team of doctors and nurses will gather Friday Jan. 20, 2012 to see her off as she heads home. She is the world's third smallest baby and the second smallest in the U.S. (AP Photo/Jae C. Hong) Haydee Ibarra looks at her 14-week-old daughter, Melinda Star Guido, at the Los Angeles County-USC Medical Center in Los Angeles, Wednesday, Dec. 14, 2011. At birth, Melinda Star Guido tipped the scales at only 9 1/2 ounces, less than a can of soda. After spending her early months in the neonatal intensive care unit, a team of doctors and nurses will gather Friday Jan. 20, 2012 to see her off as she heads home. She is the world's third smallest baby and the second smallest in the U.S. (AP Photo/Jae C. Hong) Melinda Star Guido, who weighed only 9 ½ ounces at birth— less than a can of soda, is shown Friday Jan. 20, 2012 as she is released from Los Angeles County-USC Medical Center in Los Angeles. Guido spent her early months in the neonatal intensive care unit. Guido now weighs 4 pounds, 17 ounces. (AP Photo/Damian Dovarganes) Baby Melinda Star Guido is hugged by her mother Haydee Ibarra, 22, as her father Yovani Guido, 25, looks on after being discharged from Los Angeles County-USC Medical Center five months after her birth, Friday, Jan. 20, 2012 in Los Angeles. Guido was born 16 weeks early, weighing 9.5 ounces, and was the third smallest baby born in the world. (AP Photo/Damian Dovarganes) Baby Melinda Star Guido is passed by nurses to her mother Haydee Ibarra, right, after being discharged from Los Angeles County-USC Medical Center five months after her birth, Friday, Jan. 20, 2012 in Los Angeles. Guido was born 16 weeks early, weighing 9.5 ounces, and was the third smallest baby born in the world. (AP Photo/Damian Dovarganes)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); LOS ANGELES (AP) — One of the world's smallest surviving babies was discharged Friday from the hospital where she spent nearly five months in an incubator — but not before getting the Hollywood treatment.

Wearing a pink knit hat and wrapped in a pink princess blanket, Melinda Star Guido was greeted by a mob of television cameras and news photographers outside the Los Angeles County-USC Medical Center.

"I'm just happy that she's doing well," said her 22-year-old mother Haydee Ibarra. "I'm happy that I'm finally going to take her home ... I'm just grateful."

Melinda was born on August 30 weighing just 9 1/2 ounces, less than a can of soda. She was so tiny that she fit into her doctor's hand. Melinda is believed to be the world's third-smallest surviving baby and second smallest in the U.S.

Now weighing 4½ pounds and breathing through an oxygen tube as a precaution, doctors said Melinda has made enough progress to go home. Her brain scan was normal and her eyes were developing well. She also passed a hearing test and a car seat test that's required of premature babies before discharge.

It's too early to know how she will do developmentally and physically, but doctors planned to monitor her for the next six years.

"I am cautiously optimistic that the baby will do well, but again there is no guarantee," said Dr. Rangasamy Ramanathan, who oversees preemies at the hospital.

Most babies as small don't survive even with advanced medical care. About 7,500 babies are born each year in the U.S. weighing less than 1 pound, and about 10 percent survive.

Melinda has come a long way since being delivered by cesarean section at 24 weeks after her mother developed high blood pressure during pregnancy, which can be dangerous for mother and fetus.

She was whisked to the neonatal intensive care unit where she breathed with the help of a machine and received nutrition through a feeding tube. Infants born before 37 weeks are considered premature.

Even after discharge, such extremely premature babies require constant care at home. Their lungs are not fully developed and they may need oxygen at home. Parents also need to watch out for risk of infections that could send infants back to the hospital. Even basic activities like feeding can be challenging.

"They may need extra help and patience while they learn to eat," Dr. Edward Bell, a pediatrician of the University of Iowa who runs an online database of the world's smallest surviving babies born weighing less than a pound.

The list features 130 babies dating back to 1936 and does not represent all survivors since submission is voluntary. Melinda was not eligible to be included until she was discharged.

Two years ago, Bell published a study in the journal Pediatrics that found many survivors have ongoing health and learning concerns. Most also remain short and underweight for their age.

There are some rare success stories. The smallest surviving baby born weighing 9.2 ounces is now a healthy 7-year-old and another who weighed 9.9 ounces at birth is an honors college student studying psychology, according to doctors at Loyola University Medical Center in Illinois where the girls were born.

Soon after birth, Melinda was treated for an eye disorder that's common in premature babies and underwent surgery to close an artery. Ibarra held Melinda for the first time after the operation in November. Her parents said the toughest part was battling traffic after work every day to see their daughter.

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Registry: http://www.healthcare.uiowa.edu/tiniestbabies

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No pertussis in California last year deaths

LOS ANGELES (AP)--California has not been a single death of whooping cough in 2011, the first year since 1991, that is there were no deaths in the State of the highly contagious disease, health officials said Tuesday.

The news comes after the State has experienced an outbreak of whooping cough in 2010 when the 9 000 have been infected. Too young to be fully immunized children are most vulnerable to the disease. Ten babies died after exposure of adults or older children.

Cases of pertussis, also known as pertussis, dropped to 3,000 last year, and authorities expected to see how this year is before declaring the epidemic to the course.

"Everything which seems to indicate we'll position in this direction," said epidemiologist State Dr. Gil Chavez.

Public health officials credited the decline of greater awareness, more rapid diagnosis and a new State law requiring that middle and high school students get a booster shot before starting school.

At the peak of the epidemic, doctors have been encouraged to identify pertussis in the beginning, to send babies infected at the hospital and quickly treat those diagnosed.

"We worked very hard on that and I believe that it has been successful, said pediatrician Dr. James Cherry, of the University of California at Los Angeles."

The California Department of Public Health has also given free vaccines to hospitals and broadcast public service announcements in English and Spanish.

"People rallies and got vaccinated and it makes a huge difference, Chavez has."

Cases of pertussis tend to run in cycles, with a peak of all five years. It is a highly infectious bacterial disease which, in rare cases, can be fatal. Pertussis begins like a cold but leads to cough severe which may last for weeks.

A study in the journal Pediatrics 2009 revealed that the children to be vaccinated against whooping cough are 23 times more likely to get the disease than vaccinated children.

Among vaccinees, authorities recommend a vaccine booster in children older and adolescents to protect themselves against vaccine to offshore.

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http://www.DHS.ca.gov/

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CDC: Diabetes amputations falling dramatically

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ATLANTA (AP) — Foot and leg amputations were once a fairly common fate for diabetics, but new government research shows a dramatic decline in limbs lost to the disease, probably due to better treatments.

The rate has fallen by more than half since the mid-1990s, according to what is being called the most comprehensive study of the trend.

For older diabetics, amputations dropped from more than 11 to about 4 per 1,000 people, the Centers for Disease Control and Prevention reported Tuesday.

Other diabetes studies have shown declines in lost toes, feet and legs, but not as dramatic.

"What jumped out to me was the scale of the improvement," said Dr. John Buse, a University of North Carolina diabetes expert who was not involved in the new study.

The study was released Tuesday by the medical journal Diabetes Care.

Diabetes is a disease in which sugar builds up in the blood. Roughly 1 in 10 U.S. adults has it, and it is the seventh leading cause of death, the CDC says.

Complications include poor circulation and nerve damage in the lower limbs, resulting in numbness and slow healing of sores and infections. That's most common in elderly patients and those with diabetes for at least 10 years.

While diabetes has been growing more common in the United States — driven by obesity-related Type 2 — researchers have noted recent declines in some of the other most dreaded complications, including blindness and kidney failure.

Buse recalled seeing such problems constantly when he first became director of UNC's Diabetes Care Center in the mid-1990s.

"Pretty much every minute of every day in the waiting room, there would be somebody missing a limb, or with a seeing eye dog or white cane," he said.

But he hasn't seen a patient like that in his waiting room for a few years, he added.

In the CDC study, the researchers checked national hospital discharge records for 1988 through 2008, looking for patients aged 40 and older who had lost a toe, foot or leg to diabetes.

They found that though the number of people with the disease more than tripled over those two decades, foot and leg amputations fell after 1996.

The researchers also looked at people who did not have diabetes, and found the rates of amputation were flat.

It's not clear what happened to start the drop among diabetics, said Nilka Rios Burrows, a CDC epidemiologist who co-authored the study.

But experts note that was a decade in which studies clearly demonstrated the value of close monitoring and stepped-up patient education. It's also when Medicare began paying for blood sugar monitoring and for protective shoes and other medical devices for elderly diabetics.

CDC officials saw increases in the proportion of diabetics who got annual foot exams, and believe the enhanced care is the main reason for the decline in amputations.

But another element may be that larger numbers of diabetics are being diagnosed earlier and with milder disease, Burrows said.

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Diabetes Care: http://care.diabetesjournals.org/

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Turkish hospital performs triple limb transplant

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ANKARA, Turkey (AP) — A hospital in southern Turkey on Saturday was attempting the world's first triple limb transplant, attaching two arms and one leg to a 34-year-old man, the country's state-run news agency reported.

A team of doctors at Akdeniz University Hospital, in the Mediterranean coastal city of Antalya, was at the same time transplanting the face of the same donor onto another patient — a 19-year-old man. It would be Turkey's first face transplant.

"Today could be a day of many firsts for the medical world," the Anadolu Agency quoted Dr. Zafer Aydin as saying.

"We are hoping that the operation is a success and that it is a world first," said Aydin, who heads the organ transplant unit at the hospital in western Turkey where the donor's limbs were removed. "Two arms and a leg have never been transplanted on one patient until today."

The hospital in Antalya said an announcement would be made after the surgery.

Anadolu said Atilla Kavdir, the 34-year-old receiving the limbs, lost his arms and right leg when he was 11 after he hit power lines outside his home with an iron rod to scare away pigeons and received an electric shock.

The teenage face transplant recipient was burned in a house fire when he was a baby.

The limbs and the face became available early on Saturday and the hospital began the operation at 3:15 a.m., Anadolu said.

The world's first double arm transplant was in Germany in 2008, while the first double leg transplant took place in Spain in July 2011.

More than a dozen face transplants have been carried out around the world, starting in November 2005 with a French woman who was mauled by her dog. The first face transplant in the U.S. was in December 2008.

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Mexico enacts rules against 'miracle cure' ads

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MEXICO CITY (AP) — Mexico enacted tough new rules Thursday to ban advertising of "miracle cures" for weight loss, sagging body parts and more serious illnesses like prostate ailments, chronic fatigue and even cancer.

Mexico has a long history of faith healers and home remedies, but the problem has come to a head in the last few years with a constant stream of ads on television for more "scientific" sounding creams that supposedly lift or enlarge breast and buttocks, magnets that help users lose weight, or pills and powders that cure gastric problems or diabetes.

In a country with levels of diabetes and obesity among the highest in the world, the combination of a sick population and fake cures can be deadly.

"This is a fraud," said regulator Mikel Arriola, whose Federal Commission for Protection against Health Risks is the agency in charge of regulating pharmaceuticals in Mexico. "It is a very serious public health problem, because people take these things instead of going to the doctor ... they lose time in getting treatment or getting cured."

Under the new rules, which take effect in 30 days, authorities can order media outlets to remove such advertising within 24 hours, and it steeply raises fines that can be levied on manufacturers and distributors that advertise the products.

The rules require that any product making a therapeutic claim will first have to prove it is listed in Mexico's pharmaceutical register. The register requires scientific proof of effectiveness and a scientific description of how the medicine or medical apparatus achieves its claimed effects.

That is probably not going to be possible for products like "Acu-Mag." Its advertising purports that when the tiny pad with eight bumps is placed in the outer ear and massaged a few minutes each day, it helps customers lose weight through what ads call "auricular therapy" — an alternative medicine supposedly derived from acupuncture.

According to the manufacturer's published claims, the pad "helps you lose weight ten times faster than any other (method) ... eliminates anxiety, burns the fat on your body, improves digestion."

Arriola said the ad should no longer be able to air because it makes claims of medical treatment.

Nor should ads for an herbal supplement called Prostaliv, which promises to reduce prostate enlargement and urinary problems in two to four weeks. Similar claims are made for Mulunggay, another herbal extract that is touted as being able to "combat 300 diseases" and control diabetes.

Anyone with real health issues who relies on such non-working treatments could wind up getting worse, "and that represents a cost for the government," Arriola said, because public hospitals have to treat sicker people.

But he added that supposed "miracle cures" are seldom outright dangerous. "Mainly what these companies are doing is selling a placebo, and spending a lot of money on advertising to promote it."

Executives at two of Mexico's largest vendors of such cure-alls could not be reached for comment. An employee at one of the companies appeared not to have heard of the new rules, and the other firm had an incorrect phone number listed with the Mexican stock exchange.

Companies do appear to have been taking note of the government's plan.

Some already run small-print slogans with their ads stating that "this is not a medicine." Arriola called that "an evasive maneuver" and said such ads won't be exempt from the new rules if they still make medical claims.

And the marketing companies also appear to be moving into less-regulated areas, such as corsets in various forms that are "guaranteed" to give wearers a perfect figure instantly. Those ads could continue to run, in theory, as long as they don't make claims that the product is doing anything but hiding fat.

President Felipe Calderon announced the new rules as a sort of crusade against the power of deceitful advertising.

"Every day, at every hour, on radio, television and the Internet, in print media, the public is literally being bombarded with a huge quantity of ads for all sorts of products that supposedly have curative powers," Calderon said. "They put the health and economic well-being of the population at risk."

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Niche focus Spurs Pharma that we aid the antibiotics

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WASHINGTON (AP) - The pharmaceutical industry won approval to market a record number of new drugs for rare diseases last year, as a combination of scientific innovation and business opportunity spurred new treatments for diseases long-ignored by drug companies.

Drug companies are increasingly taking advantage of the extra benefits of developing so-called orphan drugs, which include commercial patent protections, higher pricing and a streamlined review process by FDA. Among the innovative treatments approved in the past year were the first new drug for lupus in 50 years and the first new drug for Hodgkin's lymphoma in 30 years.

But the focus is specialty drugs has put pressure on the U.S. government to ramp up its own spending on vaccines, antibiotics and drugs for more widespread health threats, which are less profitable for companies.

Since 2006, government spending on research for familiar diseases like staph infections, smallpox and botulism has increased more than 660 percent, from $54 million to $415 million last year

"Many of these are everyday, general diseases that we thought we had conquered decades ago, but we've seen some of them pop up again," said Dr. Robin Robinson, director of the Biomedical Advanced Research and Development Authority, which is tasked with acquiring vaccines, drugs and other necessities for public health emergencies.

Since 2005, women has awarded $3.5 trillion to outside companies to encourage research and production of antibiotics, flu vaccines and other products that are seen as less profitable than specialty drugs.

"We have pushed the envelope more toward diminishing the risk for companies so that they'll be more interested in getting involved with us and developing things like vaccines and antivirals," said Dr. Anthony Fauci, infectious diseases chief at the National Institutes of Health, which funds research into bird flu, tuberculosis and other potential pandemics. The government's role in developing new therapies goes beyond awarding contracts and includes offering assistance in designing trials and recruiting test subjects.

The need for such assistance stems in part from a new focus among pharmaceutical companies on drugs for rare diseases or unusual strains of common diseases.

Eleven of the 30 new drugs approved last year, or 37 percent, were for rare medical conditions, the highest percentage on record since the FDA began offering incentives to develop such therapies, known as orphan drugs, about 30 years ago. Additionally, nearly half of the 30 drugs were cleared under FDA's "fast track" program reserved for drugs that fill an unmet medical need.

"The companies are saying 'this is actually a viable model.'" "Whereas back in the nineties they were skeptical, now they seem convinced," said Mark Schoenebaum, an analyst with International Strategy & Investment.

Analysts credit scientific advances and looming patent Expiries with the spate of innovative products. Drugs worth a mammoth $255 billion in global annual sales are set to go off patent before 2016, according to EvaluatePharma Ltd., a London research firm.

The pharmaceutical industry reached its peak of profitability in the 1990s with heavily marketed drugs for common afflictions, like AstraZeneca PLC's Nexium pill for heart burn and Pfizer Inc.'s Lipitor for high cholesterol. In the last decade drugmakers managed to extend the patents on those drugs by tweaking their formulations, resulting in so-called ' follow - on' drugs. But with most of those products on the cusp of losing patent protection, drugmakers have finally been forced to innovate, often turning to hard-to-treat diseases for which there are few existing therapies.

The FDA grants companies seven years of exclusive, competition-free marketing for each newly approved orphan drug, as well as tax breaks on the costs of developing the drugs. Orphan drugs also typically command much higher prices than other drugs. Last year French drugmaker Sanofi paid $20 billion to acquire specialty drugmaker Genzyme, whose products range from $100,000 to $300,000 for one year's supply.

One side effect of the focus on developing drugs for rare diseases is increased investment by the government to spur research into more common public health threats with the potential to cause mass outbreaks of illness. One such threat comes from so-called superbugs, or bacteria that have grown resistant to antibiotic drugs.

Robinson says government support is needed to spur antibiotic development because of how the products are used sparingly in medical practice. After decades of routine use, many first-generation antibiotics like penicillin are no longer effective against common bacterial strains, such as the staphylococcus aureaus, which causes staph infections. Physicians are encouraged to use newer antibiotics only in critical situations so that superbugs have less chance to build a resistance to them. As a result, drugmakers do not see a large commercial market for new antibiotics. Now the federal government is providing an incentive.

BARDA has awarded a series of contracts to encourage development of new antibiotics that can be stockpiled for use in a natural outbreak or during a bioterrorism attack.

-The agency has allocated up to $64 million to Achaogen, a San Francisco startup, for development of a new antibiotic against tularemia, a bacterium that can cause pneumonia and urinary tract infections. Public health officials are especially focused on Tularemia because it could also be used in a potential bioterrorism attack. Robinson says the contract is an example a new strategy of encouraging companies to produce therapies with dual uses: as federal preparatory measures and as commercial medical products.

Achaogen has received $155 million in research contracts and has several antibiotics in early and mid-stage, though none are currently available for sale.

-Under a $38.5 million contract awarded in September, BARDA will help GlaxoSmithKline PLC test an experimental antibiotic against both bioterrorism agents and infections like hospital-acquired pneumonia.

The U.S. government has used a similar pump priming strategy to encourage investment in flu vaccines. The Department of Health and Human Services wants to be able to provide enough vaccine for the entire U.S. population within six months of a flu pandemic. To meet that goal the government has tried to boost vaccine production by encouraging more Americans to get the standard flu vaccine each year. The government's hope is that by making the shots routine for more Americans, companies will invest in larger vaccine that can ramp up production facilities in the event of a pandemic.

Last month Swiss drugmaker Novartis AG opened the first U.S. vaccine facility equipped with cell culture technology, a faster method for producing vaccines than the traditional technique using chicken eggs. The U.S. government provided half of the $1 billion investment for the facility, as part of its preparations for a potential flu pandemic.

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Too many tests? Routine checks getting second look

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FILE - In this Feb. 6, 2009 file photo, a man sits on an ergometer during an electrocardiogram in a doctor's surgical office in Stuttgart, Germany. Some of the nuts-and-bolts tests administered during check-ups and non-emergency visits are getting a second look. Think twice about a routine EKG if you have no heart symptoms, or a chest X-ray just because you’re going in for knee surgery. Increasingly, groups that represent the very doctors who order the most common medical tests say they do so way too often, wasting money and sometimes harming people when false alarms spur unneeded follow-up care. (AP Photo/Thomas Kienzle, File) FILE - In this Feb. 6, 2009 file photo, a man sits on an ergometer during an electrocardiogram in a doctor's surgical office in Stuttgart, Germany. Some of the nuts-and-bolts tests administered during check-ups and non-emergency visits are getting a second look. Think twice about a routine EKG if you have no heart symptoms, or a chest X-ray just because you’re going in for knee surgery. Increasingly, groups that represent the very doctors who order the most common medical tests say they do so way too often, wasting money and sometimes harming people when false alarms spur unneeded follow-up care. (AP Photo/Thomas Kienzle, File)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); WASHINGTON (AP) — Recent headlines offered a fresh example of how the health care system subjects people to too many medical tests — this time research showing millions of older women don't need their bones checked for osteoporosis nearly so often.

Chances are you've heard that many expert groups say cancer screening is overused, too, from mammograms given too early or too often to prostate cancer tests that may not save lives. It's not just cancer. Now some of the nuts-and-bolts tests given during checkups or hospital visits are getting a second look, too — things like routine EKGs to check heart health, or chest X-rays before elective surgery. Next under the microscope may be women's dreaded yearly pelvic exams.

The worry: If given too often, these tests can waste time and money, and sometimes even do harm if false alarms spur unneeded follow-up care.

It begs the question: Just what should be part of my doctor's visit?

If you're 65 or older, Medicare offers a list of screenings to print out and discuss during the new annual wellness visit, a benefit that began last year. As of November, more than 1.9 million seniors had taken advantage of the free checkup.

For younger adults, figuring out what's necessary and what's overkill is tougher. Whatever your age, some major campaigns are under way to help. They're compiling lists of tests that your doctor might be ordering more out of habit, or fear of lawsuits, than based on scientific evidence that they are really needed.

"Too often, we order tests without stopping to think about how (if at all) the result will help the patient," wrote Dr. Christine Laine. She's editor of Annals of Internal Medicine, which this month published a list of 37 scenarios where testing is overused.

Not even physicians are immune when it comes to their own health care. Dr. Steven Weinberger of the American College of Physicians had minor elective surgery for torn knee cartilage about a year ago. The hospital required a pre-operative chest X-ray, an EKG to check his heart, and a full blood work-up — tests he says aren't recommended for an otherwise healthy person at low risk of complications.

Weinberger should know: He led the team that compiled that new list of overused tests. All three examples are on it.

"If anyone should have objected, I should have objected, but I took the easy way out. I didn't want to be raising a fuss, quite frankly," he says.

The college of physicians' push for what it calls "high-value, cost-conscious care" — and similar work being published in the Archives of Internal Medicine — aims to get more doctors to think twice so their patients won't be put in that uncomfortable position. Another group, the National Physicians Alliance, is studying whether training primary care doctors in parts of Connecticut, California and Washington about the most overused care will change their habits.

Medical groups have long urged patients not to be shy and to ask why they need a particular test, what its pros and cons are, and what would happen if they skip it. This spring, a campaign called Choosing Wisely promises to provide more specific advice. The group will publish a list of the top 5 overused tests and treatments from different specialties. Consumer Reports will publish a layman's translation, to help people with these awkward discussions.

For now, some recent publications offer this guidance:

—No annual EKGs or other cardiac screening for low-risk patients with no heart disease symptoms. That's been a recommendation of the U.S. Preventive Services Task Force for years. Yet a Consumer Reports survey of more than 8,000 people ages 40 to 60 found 44 percent of low-risk, people with no symptoms had undergone an EKG or similar screening. Simple blood pressure and cholesterol checks are considered far more valuable.

—Discuss how often you need a bone-density scan for osteoporosis. An initial test is recommended at 65, and Medicare pays for a repeat every two years. A study published last week found that a low-risk woman whose initial scan is healthy can wait up to 15 years for a repeat; those at moderate risk might need retesting in five years, high-risk women more often.

—Women under 65 need that first bone scan only if they have risk factors such as smoking or prior broken bones, say the two new overtesting lists.

—Most people with low back pain for less than six weeks shouldn't get X-rays or other scans, Weinberger's group stresses.

—Even those all-important cholesterol tests seldom are needed every year, unless yours is high, according to the college of physicians. Otherwise, guidelines generally advise every five years.

—Pap smears for a routine cervical cancer check are only needed once every three years by most women. So why must they return to the doctor every year to get a pelvic exam (minus the Pap)? For no good reason, the Centers for Disease Control and Prevention reported last month. Pelvic exams aren't a good screening tool for ovarian cancer, and shouldn't be required to get birth control pills, the report says.

Yes, simple tests can harm. Cleveland Clinic cardiology chief Dr. Steven Nissen cites a 52-year-old woman who wound up with a heart transplant after another doctor ordered an unneeded cardiac scan that triggered a false alarm and further testing that in turn punctured her aorta.

A close relationship with a primary care doctor who knows you well enough to personalize care maximizes your chances of getting only the tests you really need — without wondering if it's all just about saving money, says Dr. Glen Stream of the American Academy of Family Physicians.

"The issue is truly about what is best for patients," he says.

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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Medicare preventive services list: http://1.usa.gov/aiOTnS

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Sex poses surprisingly low risk to heart patients

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This Jan. 13, 2012 photo shows heart patient Tammy Collins who credits her recovery and confidence with her cardio rehabiltaion workouts at The Ohio State University CarePoint East facility in Columbus, Ohio. After suffering a heart attack and then healing she was apprehensive about how to safely return to her sex life. The American Heart Association says having sex only slightly increase the chance for having a heart attack. And that's true for patients with and without heart disease. (AP Photo/Mike Munden) This Jan. 13, 2012 photo shows heart patient Tammy Collins who credits her recovery and confidence with her cardio rehabiltaion workouts at The Ohio State University CarePoint East facility in Columbus, Ohio. After suffering a heart attack and then healing she was apprehensive about how to safely return to her sex life. The American Heart Association says having sex only slightly increase the chance for having a heart attack. And that's true for patients with and without heart disease. (AP Photo/Mike Munden) In this Jan. 13, 2012 photo, heart patient Tammy Collins, right, goes through her cardio rehabiltaion workout while being monitored by nurse Julie Walsh at The Ohio State University CarePoint East facility in Columbus, Ohio. After suffering a heart attack and then healing she was apprehensive about how to safely return to her sex life. The American Heart Association says having sex only slightly increase the chance for having a heart attack. And that's true for patients with and without heart disease. (AP Photo/Mike Munden) This Jan. 13, 2012 photo shows heart patient Tammy Collins who credits her recovery and confidence with her cardio rehabiltaion workouts at The Ohio State University CarePoint East facility in Columbus, Ohio. After suffering a heart attack and then healing she was apprehensive about how to safely return to her sex life. The American Heart Association says having sex only slightly increase the chance for having a heart attack. And that's true for patients with and without heart disease. (AP Photo/Mike Munden) This Jan. 13, 2012 photo shows heart patient Tammy Collins who credits her recovery and confidence with her cardio rehabiltaion workouts at The Ohio State University CarePoint East facility in Columbus, Ohio. After suffering a heart attack and then healing she was apprehensive about how to safely return to her sex life. The American Heart Association says having sex only slightly increase the chance for having a heart attack. And that's true for patients with and without heart disease. (AP Photo/Mike Munden)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); CHICAGO (AP) — Good news: Sex is safe for most heart patients. If you're healthy enough to walk up two flights of stairs without chest pain or gasping for breath, you can have a love life.

That advice from a leading doctors' group on Thursday addresses one of the most pressing, least discussed issues facing survivors of heart attacks and other heart patients.

In its first science-based recommendations on the subject, the American Heart Association says having sex only slightly raises the chance for a heart attack. And that's true for people with and without heart disease.

Surprisingly, despite the higher risk for a heart patient to have a second attack, there's no evidence that they have more sex-related heart attacks than people without cardiac disease.

Many heart patients don't think twice about climbing stairs, yet many worry that sexual activity will cause another heart attack, or even sudden death, said Dr. Glenn Levine, lead author of a report detailing the recommendations and a professor of medicine at Baylor College of Medicine in Houston.

The report says sex is something doctors should bring up with all heart patients. Yet few do because they're uncomfortable talking about it or they lack information, Levine said. The new guidance is designed to fill that gap.

Heart patients should get a doctor's OK before engaging in sexual activity. Many may be advised first to do cardiac rehab — exercise while being monitored for heart symptoms, to improve heart strength and increase physical fitness. But the heart association says most eventually will be cleared to resume sexual activity.

The doctors' group offers advice for heart patients based on scientific research involving sometimes provocative sex-related topics:

—Who's most at risk for sudden death related to sex? Married men having affairs, often with younger women in unfamiliar settings. Those circumstances can add to stress that may increase the risks, evidence from a handful of studies suggests.

—Sex may be OK as soon as one week after a relatively mild heart attack, if patients can walk up a few flights of stairs without discomfort.

—Viagra and other drugs for erectile dysfunction are generally safe for men with stable heart disease.

"The risk of having a heart attack during sexual activity is two to three times higher than when not having sexual activity. However, this increased risk of heart attack during sexual activity represents only a very small part of a person's overall risk of having a heart attack, and sexual activity is the cause of less than 1 percent of all heart attacks," Levine said.

Among heart attack survivors, average risks for another heart attack or sudden death are about 10 in 1 million per hour; having sex increases that to about 20 to 30 in 1 million per hour of sexual activity, the new report says. People without heart disease face lower overall risks for a heart attack, but similar risks for a sex-related attack.

The updated advice was released online Thursday in the heart association journal, Circulation.

Dr. Keith Churchwell, chief medical officer of Vanderbilt University's Heart and Vascular Institute, said the guidance is important for patients, and that questions about sex are the most common ones he hears from heart patients.

Ohio State University heart specialist Martha Gulati praised the recommendations for emphasizing that sexual counseling is important not just for patients but also their partners, who she says are often just as nervous about resuming sexual activity.

Day-care operator Tammy Collins of Reynoldsburg, Ohio, one of Gulati's patients, says the advice is reassuring.

She had a heart attack last year on Sept. 11, during a trip to Cincinnati to celebrate her wedding anniversary.

Collins' mother died of a heart attack at the same age, on her 51st birthday. With high blood pressure and high cholesterol, Collins knew she was at risk. She developed symptoms a few hours after having sex. She dismissed it at first, until she felt a sharp pain in her upper back and had trouble breathing. She was rushed to the hospital and doctors used stents to open blocked arteries.

Collins said she wasn't embarrassed to ask Gulati about sex, who told her it was unlikely that her night of romance had caused the heart attack. After several weeks of cardiac rehab, she was cleared to resume sexual activity — advice that surprised her friends. But Collins said the exercise sessions have made her feel fitter than ever.

"A heart attack does not have to be the end of living," Collins said.

Chicago cardiologist Dan Fintel, a professor of medicine at Northwestern University, said he routinely gives heart patients a sex talk on their last day in the hospital, knowing that it's likely on their minds.

"Resuming sexual activity is safe and emotionally part of the healing process, with a few caveats," he tells patients.

Those caveats elicit nervous chuckles when he explains that includes no philandering, given evidence about that causing extra stress.

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Online:

Circulation: http://bit.ly/1mt2UY

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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Novartis drug investigated after 11 deaths

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LONDON (AP) — A European agency is investigating a multiple sclerosis drug made by industry giant Novartis to determine whether the medicine played any role in the deaths at least 11 patients.

The drug, Gilenya, was licensed last year in the European Union to treat a severe type of multiple sclerosis. It can cause a slow heart rate when first taken and doctors closely monitor patients after the first dose.

The European Medicines Agency, which is now investigating the drug, said it isn't clear if it caused the deaths. One of the fatalities occurred in the United States, where a patient died within 24 hours of taking the first dose.

The European agency said it didn't know where the other 10 deaths occurred, but that they were reported to its drug database, which monitors side effects from medicines in the European Union.

Novartis said not all the deaths were heart related.

A spokeswoman at the U.S. Food and Drug Administration said it also is conducting a data analysis but has not made any definitive conclusions and does not know when its review will be complete.

More than 30,000 patients have taken Gilenya worldwide.

The European Medicines Agency advised doctors to increase their monitoring of patients after the first dose of the medicine. The agency said the risk of a slow heart rate after the first dose of Gilenya was known when it was approved.

Novartis AG said it was advising doctors of new recommendations on using Gilenya. They had previously said all patients should be monitored for six hours after their first dose, but are now tightening that to include continuous heart monitoring using electrocardiograms and measuring blood pressure and heart rate every hour. In certain patients, that monitoring should be extended, the drug maker said in a statement.

This new guidance applies only to patients taking their first dose, Novartis said in a statement.

The EU drug regulator hopes to finish its review of the drug by March.

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www.ema.europa.eu

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Common substance may fight food poisoning hazard

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NEW YORK (AP) — A substance found in nuts and whole grains may someday help doctors fight the kind of food poisoning that sickened thousands of people in Europe last summer, a study in mice suggests.

While a variety of germs can cause food poisoning, the European outbreak involved a dangerous strain of the bacterium E. coli. It infects people and pumps out a poison called Shiga toxin. Some other bacteria also produce this toxin, which overall causes more than 1 million deaths a year worldwide. The European food poisoning outbreak included about 4,000 people and 50 deaths.

There's no definitive treatment for Shiga toxin. But in Friday's issue of the journal Science, scientists report that they could protect mice against a lethal dose by injecting them with the mineral manganese.

The animals were injected daily, starting five days before they were exposed to the toxin. While untreated mice died within four days, the injected mice remained healthy. The manganese made the toxin vulnerable to being destroyed by cells.

Scientists still need to do more research before they can assess the usefulness of manganese in treating people. Manganese is already approved for medical use and it's inexpensive, they note. So that might make it especially useful in developing countries, where nearly all cases of Shiga toxin poisoning occur, wrote the researchers, from Carnegie Mellon University in Pittsburgh.

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Science: http://www.sciencemag.org

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CDC: Many teen moms didn't think it could happen

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ATLANTA (AP) — A new government study suggests a lot of teenage girls are clueless about their chances of getting pregnant.

In a survey of thousands of teenage mothers who had unintended pregnancies, about a third who didn't use birth control said the reason was they didn't believe they could pregnant.

Why they thought that isn't clear. The Centers for Disease Control and Prevention survey didn't ask teens to explain.

But other researchers have talked to teen moms who believed they couldn't get pregnant the first time they had sex, didn't think they could get pregnant at that time of the month or thought they were sterile.

"This report underscores how much misperception, ambivalence and magical thinking put teens at risk for unintended pregnancy," said Bill Albert, a spokesman for the Washington, D.C.-based National Campaign to Prevent Teen and Unplanned Pregnancy.

Other studies have asked teens about their contraception use and beliefs about pregnancy. But the CDC report released Thursday is the first to focus on teens who didn't want to get pregnant but did.

The researchers interviewed nearly 5,000 teenage girls in 19 states who gave birth after unplanned pregnancies in 2004 through 2008. The survey was done through mailed questionnaires with telephone follow-up.

About half of the girls in the survey said they were not using any birth control when they got pregnant. That's higher than surveys of teens in general, which have found that fewer than 20 percent said they didn't use contraception the last time they had sex.

"I think what surprised us was the extent to which they were not using contraception," said Lorrie Gavin, a CDC senior scientist who co-authored the report.

Some of the teen moms were asked what kind of birth control they used: Nearly 20 percent said they used the pill or a birth control patch. Another 24 percent said they used condoms.

CDC officials said they do not believe that the pill, condoms and other forms of birth control were faulty. Instead, they think the teens failed to use it correctly or consistently.

Only 13 percent of those not using contraception said they didn't because they had trouble getting it.

Another finding: Nearly a quarter of the teen moms who did not use contraception said they didn't because their partner did not want them to. That suggests that sex education must include not only information about anatomy and birth control, but also about how to deal with situations in which a girl feels pressured to do something she doesn't want to, Albert said.

The findings are sobering, he added. But it's important to remember that the overall teen birth rate has been falling for some time, and recently hit its lowest mark in about 70 years.

Albert said it would be a mistake to come away from the report saying, "They can't figure this out?" ''Most of them are figuring it out," he said.

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CDC report: http://www.cdc.gov/mmwr

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