I See the Failure of the Health-Care System Every Day

By Dena Rifkin, MD
For the past three weeks, each issue of The New England Journal of Medicine has featured viewpoints on the pressing health-care policy issues facing the next administration. These topics (in case you haven’t heard) include health insurance and rising health-care costs, and how to balance them economically, ethically, and politically.
I see the insanity of the current “system” pretty much every day. Read More

Still Pregnant: My Miscarriage Was Misdiagnosed

By Erica Kain
“What exactly is that?” I asked, propping up on my elbows on the examining table, scrutinizing the ultrasound monitor.
“That is a seven-week-old embryo with a heartbeat,” my doctor said.
“No, wait, is it human?” I asked, gasping for air, staring at the flickering heartbeat pulsing through the little body.
I couldn’t believe it. Two weeks before, I’d been diagnosed with a miscarriage—specifically, a chemical pregnancy. I’d raced to the doctor’s office after experiencing heavy cramping and bleeding, and an ultrasound seemed to confirm my gut feeling that my pregnancy was ending. There wasn’t an embryo where there should have been one. And yet, here I was, two weeks later, finding out that I was still pregnant. Read More

Doctors Lack Smoking Cessation Training

(HealthDay News) -- Few doctors or other health-care providers have enough smoking cessation training to help their patients quit smoking, a U.S. study suggests.

It found that 87 percent to 93 percent of doctors and other health-care workers receive less than five hours of training on tobacco dependence, and less than 6 percent know the U.S. Agency for Healthcare Research and Quality (AHRQ) treatment guidelines for tobacco dependence, including the signs of nicotine withdrawal. This lack of knowledge about treating tobacco dependence may affect quit rates among smokers, suggested lead researcher Virginia Reichert and colleagues at the North Shore-LIJ Health System Center for Tobacco Control in Great Neck, N.Y.

They surveyed 322 prescribers (physicians, nurse practitioners, or physician assistants) and 278 nonprescribers (pharmacists, registered nurses, social workers, counselors, respiratory therapists, and students).

The researchers found that 87 percent of prescribers and 93 percent of nonprescribers received less than five hours of tobacco-dependence training. Only 6 percent of prescribers and 5 percent of nonprescribers knew the AHRQ treatment guidelines for tobacco dependence.

The study also found only 16 percent of prescribers and 8 percent of nonprescribers knew which U.S. Food and Drug Administration-approved medications were over-the-counter and which required a prescription.

The findings were to be presented Monday at the American College of Chest Physicians (ACCP) annual meeting, in Philadelphia.

"Without appropriate training in tobacco dependence treatment, health- care providers may lack the knowledge and confidence to help their patients quit smoking," Reichert said in an ACCP news release. "Furthermore, providers may not recognize that tobacco dependence is a chronic relapsing condition and become frustrated when patients do not quit when advised to do so."

Previous studies have found that about 70 percent of smokers want to quit but believe it will be too difficult without assistance, and that smokers are 30 percent more likely to kick the habit if they receive help from their health-care provider.

More information
The American Cancer Society offers advice about quitting smoking.

ADHD Might Raise Kids' Obesity Risk

(HealthDay News) -- Children with Attention-deficit hyperactivity disorder (ADHD) are at a 50 percent higher risk for being overweight if they are not taking medication for the condition, a new study finds.

On the other hand, youngsters who were medicated for ADHD had a raised risk of being underweight, the same researchers found.

"In light of these findings, children and adolescents with ADD/ADHD should be monitored for overweight and underweight/weight loss. By monitoring weight status of these youth, clinicians will be better prepared to prevent the development of childhood obesity and the negative physical health and psychosocial consequences," the researchers concluded.

The report is published in the July issue of Pediatrics.

In the study, researchers Molly E. Waring and Kate L. Lapane, from the department of community health at Brown Medical School in Providence, R.I., collected data on almost 63,000 children and adolescents, aged 5 to 17. The data came from the 2003-2004 U.S. National Survey of Children's Health.

The researchers found that children with ADHD who were not taking medication for the condition had a 1.5 times higher risk of being overweight, compared with children, who did not have ADHD. Conversely, children with ADHD who were on medication for the condition had a 1.6 times greater risk of being underweight, the study found.

But some experts don't find the ADHD-weight connection all that convincing.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, notes that because childhood obesity and ADHD are both widespread, it is to be expected that some ADHD children will be obese.

"Both ADHD and obesity are highly prevalent among children and adolescent in the U.S. One would expect considerable overlap between the two conditions, even if they had little to do with one another," Katz said.

As for Ritalin and other medications used for ADHD, their association with weight is well-established, Katz said. "The answer here is to identify root causes of ADHD, so fewer children wind up needing medical treatment in the first place," he said.

Dr. David W. Goodman, an assistant professor in the department of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, Baltimore, agreed that, "the study confirms what has been known before."

Goodman contends that there is an association between obesity and ADHD, but whether it's one of cause-and-effect is unclear. "You don't have any causal link, but you can say it's a strong statistical correlation," he said.

That about one in five ADHD children are overweight is interesting but not necessarily clinically relevant, Goodman added. "We are talking about a 1.5 [times] increased risk. That's eyebrow-raising but not heart-stopping," he said.

However, Goodman believes that parents of children with ADHD should be concerned about their diet and understand that these youngsters are at higher risk of becoming obese.

"Pediatricians of newly diagnosed children with ADHD should advise parents of the risk factors for weight gain and obesity," Goodman said. "This is not simply an educational disorder, this is a disorder that affects a broad range of domains in one's life."

More information
For more information on ADHD, visit the U.S. National Institute of Mental Health.

Doctors Often Prescribe Placebo Treatments

(HealthDay News) -- American doctors regularly prescribe placebo pills that are intended to have a psychological effect, a new survey finds.

However, the placebos reported by the 679 physicians in the survey often aren't the inactive substances used in controlled clinical trials, said Dr. Farr A. Curlin, an assistant professor of medicine at the University of Chicago, and a member of the team reporting the finding in the Oct. 24 issue of the BMJ.

"Most people when they say 'placebo' think of something like a sugar pill," Curlin said. "But doctors can use a treatment that may have some effects but that they think will not have a direct effect on the patient except by the placebo effect."

The placebo effect, well-established in countless studies, is a benefit produced by assuring someone that whatever is being given will benefit whatever the problem happens to be -- "optimism or confidence that something is being done," as Curlin phrased it.

Only 3 percent of the doctors responding in the survey reported prescribing sugar pills. But 41 percent said they used over-the-counter painkillers as placebos, 38 percent used vitamins, 13 percent used antibiotics, and 13 percent used sedatives.

The survey also found that only 5 percent of the doctors who prescribe a placebo treatment describe it as such. The great majority, 68 percent, describe it as a potentially beneficial medicine or treatment not typically used for the condition.

And almost two-thirds of the doctors in the survey said they believed the practice to be ethically permissible.

"It's a gray zone," Curlin said. "It is not ethical to actively deceive patients. But when doctors give something which they think will help but don't think it helpful to explain the full reasoning about why it will help, that's a gray zone."

Placebo treatment "is pretty common in the practice of medicine," said Curlin, who acknowledged using it. "I give people the information I think a reasonable person would want to know, trying to be as candid as possible," he said. "There are times when I have said, 'Yes, I think it might be helpful, why don't you give it a try,' when I don't have confidence it will help their condition."

What matters is that the treatment can help, Curlin added. "The placebo effect is a real effect," he said. "People do feel better. To the extent that it can be mobilized in a way that is restful and not actively deceiving patients, I think it is acceptable."

Placebo treatment "is part of an old but good medical tradition," said Dr. David Spiegel, an assistant chair of psychiatry and behavioral sciences at Stanford University. "The basic rule is: First, do no harm. If there is no toxicity, and it does some good, evidence supports its use," Spiegel said.

But straightforward lying about a prescription is wrong, said Dr. Andrew Leuchter, associate dean of the school of medicine at the University of California, Los Angeles.

"The cornerstone of what treatment is acceptable is full disclosure for the patient," Leuchter said. "If you explain to the patient what you are doing, and why you are doing it, that is right. If you mislead a patient, there is a serious problem with that."

The appropriate way to explain a placebo treatment, Leuchter added, is to say, "There is no reasonable medical evidence that this pill is effective for your condition, but some people who take this pill say it makes them feel better."

It is important to note that "deception is not a necessary part of the placebo effect," Spiegel said. "You can tell people that the treatment might benefit them, and that is not a lie."

And the placebo effect is often at work in medical practice, Spiegel noted. "A lot of factors go into the effect of therapy, some of which are specifically pharmaceutical, and some are not. You might feel better, because you feel you are doing something actively to treat the problem."

The argument about the ethics of placebo treatment can also be turned around, he added. "There are ways to present placebo treatment that do not involve deception," he said. "You are doing it because it can help a patient, and a certain percentage of patients will respond. Especially in conditions where we do not have a lot of treatments, is it ethical to withhold it?"

More information
The history of placebo treatments is described in the Skeptics Dictionary.

New MS Therapies Show Promise

(HealthDay News) -- Two medications may prove to be advances in the treatment of multiple sclerosis, researchers say.

In one study, an experimental drug called oral fumarate (BG00012) substantially reduced symptoms in patients with relapsing-remitting multiple sclerosis, according to a phase II clinical trial by European and North American researchers.

And in a second trial, researchers found that the leukemia drug alemtuzumab (Campath) was about 70 percent more effective than another drug already widely used to treat MS. However, alemtuzumab also had significant side effects, including bleeding disorders, a greater risk of thyroid disease, and infections. This prompted experts to say that much more research is needed before alemtuzumab can be prescribed to treat multiple sclerosis.

Multiple sclerosis is a nervous system disease that affects the brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects nerve cells. This damage slows or blocks messages between the brain and the body, according to the U.S. National Library of Medicine.

Symptoms of the disease can include visual disturbances; muscle weakness; trouble with coordination and balance; sensations such as numbness, prickling, or "pins and needles;" and thinking and memory problems.

It's not known what causes multiple sclerosis. It may be an autoimmune disease, which happens when the body attacks itself. MS affects women more than men, and it often begins between the ages of 20 and 40. An estimated 400,000 Americans have the disease. Usually, the disease is mild, but some people lose the ability to write, speak or walk. There's no cure for MS, but medicines may slow it down and help control symptoms, according to the National Library of Medicine.

The 24-week study of BG00012 included 257 patients, ages 18 to 55, who were randomly assigned to receive either 120 milligrams of BG00012 once a day (64 patients), 120 milligrams three times a day (64 patients), 240 milligrams three times a day (64 patients), or a placebo (65 patients). The patients were assessed at weeks 12, 16, 20 and 24.

MRI brain scans showed that patients treated with 240 milligrams of BG00012 three times a day had 69 percent fewer new gadolinium enhancing (GdE) lesions -- a marker of MS-related inflammatory activity -- from week 12 to 24 than those who received the placebo. They also had fewer new or enlarging T2-hyperintense and T1-hypointense lesions at week 24.

The study also found that BG00012 reduced the annual relapse rate by 32 percent, but this finding wasn't statistically significant. Patients who received the drug were more likely than those in the placebo group to suffer adverse events such as abdominal pain and hot flush. Dose-related adverse events in patients taking the drug included headache, fatigue and feeling hot, the researchers said.

"Longer-term (phase III) studies of BG00012 in larger patient populations are underway to define its place in the future of relapsing-remitting multiple sclerosis treatment. If these studies show similar relapse rate reductions with BG00012, interferon beta, and glatiramer acetate, BG00012 could be a suitable initial treatment for relapsing-remitting multiple sclerosis," wrote Professor Ludwig Kappos, of University Hospital Basel, in Switzerland, and colleagues.

The study was published in the Oct. 24 issue of the The Lancet.

In an accompanying comment in the journal, Professor Per Soelberg Sorensen and Dr. Finn Sellebjerg of the Danish Multiple Sclerosis Research Center, noted that "BG00012 might have a favorable benefit-to-risk ratio profile compared with its oral competitors and the currently available first-line injectable drugs. However, we will have to await the results from the ongoing large phase III trials to establish the place of BG00012 and of other oral drugs in the treatment of relapsing-remitting multiple sclerosis."

The study of the leukemia drug alemtuzumab, which temporarily depletes white blood cells and is part of a class of drugs called monoclonal antibodies, included 334 patients. Patients were randomly assigned to get either alemtuzumab or interferon beta, a standard MS therapy, for three years.

Alemtuzumab reduced by 74 percent the risk of MS relapse, the researchers reported in the Oct. 23 issue of the New England Journal of Medicine.

"The ability of an MS drug to promote brain repair is unprecedented," Alasdair Coles, of Cambridge University in England, and one of the study's leaders, told the AFP news service. "We are witnessing a drug which, if given early enough, might effectively stop the advancement of the disease and also restore lost function by promoting repair of the damaged brain tissue."

However, in an accompanying journal editorial, Dr. Stephen L. Hauser, a neurologist at the University of California, San Francisco, said the "toxic effects associated with alemtuzumab considerably dampen any enthusiasm for its routine use in patients with multiple sclerosis until more is known about its long-term safety and sustained efficacy."

More information
The U.S. National Institute of Neurological Disorders and Stroke has more about multiple sclerosis.

NeuroStar Depression Therapy Cleared

(HealthDay News) -- The NeuroStar TMS (Transcranial Magnetic Stimulation) Therapy system has been approved by the U.S. Food and Drug Administration for people with major depressive disorder who haven't seen satisfactory improvement from at least one prior antidepressant medication, device maker Neuronetics said in a news release.

TMS is a non-invasive therapy that involves stimulation of nerve cells in the brain that have been linked to depression. This is done by delivering MRI-strength magnetic pulses during a 40-minute outpatient procedure, in which patients do not require anesthesia or sedation, the company said. The daily treatment typically is given for four-to-six weeks.

In clinical studies involving 164 people with major depressive disorder, significant improvement was recorded for symptoms of core depression, anxiety, and other forms of psychological distress, Neuronetics said.

The most common side effect was mild-to-moderate scalp pain or discomfort at the treatment area, which declined "markedly after the first week," the company said. Fewer than 5 percent of patients stopped treatment due to adverse effects.

Initially, the therapy will only be available at a limited number of treatment centers across the United States, Neuronetics said.

More information
To learn more about depression, visit the U.S. National Institute of Mental Health.

Head-First Slide a Heads-Up Play

(HealthDay News) -- As base runners weigh whether to slide head first or feet first during Wednesday's first game of the World Series, they might want to talk to a physicist instead of a coach.

The effectiveness of either approach is closely tied to the principles of physics and factors like a baseball player's center of gravity, explained David A. Peters, a professor of engineering at Washington University in St. Louis.

"If it's just down to speed, and you want to get to the bag as fast as you can, there's a slight edge to head first," he said.

Peters estimates that sliding into a base head first could shave 1/200ths of a second off the body's travel time, the equivalent of about five inches, compared to going feet first.

"Your brain tells your body what to do, but after that, physics takes over," said Peters, an aircraft engineer and longtime baseball fan who's become the St. Louis media's go-to guy for questions about the mechanics of baseball.

"Whenever I watch baseball, I think of physics all the time," he said. "That's the way my brain works."

According to Peters, statistics suggest that about 60 percent of base runners are faster when they slide head first.

But head-first slides can be dangerous, because players are exposing their heads and hands to injury. "A lot of people aren't willing to give up their body that way," Peters said.

Feet-first slides can be hazardous to the opposing team. Baseball legend Ty Cobb was reputed to have sharpened the spikes on his cleats to intimidate anyone who dared to try to tag him out during a slide.

Peters said a player's center of gravity is the key to determining which sliding approach is faster. The center of gravity is the point where half of a player's weight is above that point and half is below. Typically, the point is above the body's actual halfway point, he said.

When a player slides head first, he gains more momentum if his center of gravity is above the body's midpoint, Peters said.

The mechanics of sliding head first give players another boost by allowing them to continue pumping their legs as they start falling to the ground, he said.

There's another option, of course: Run to the base -- particularly first base -- and don't slide at all. It turns out that physics offers contradictory advice on whether to slide or stand, said Alan M. Nathan, a professor of physics at the University of Illinois at Urbana-Champaign.

"On the one hand, a head-first slide gets the fingertips to the bag before the center of mass gets there," said Nathan. "On the other hand, sliding reduces your forward velocity. As with many things in physics, it is not so obvious which effect wins out."

So, should baseball players consult physicists for advice?

"I suspect they do not give much thought to the laws of physics. Nor should they," Nathan said. "In the end, the physics governing the game of baseball is often quite complex and is a highly empirical science. That is, we learn about the science of the game by watching the players play. They don't learn about playing the game by listening to us."

More information
For baseball safety tips, visit Safe USA.

For Diabetics, Flu Shot Is a Must

By Sean Kelley

Even if you take insulin every day (as I do), plunging a needle into your skin never gets comfortable—which is why I try to avoid additional, unnecessary pokes.
Until this year, I’ve always put the flu vaccine in that category.

I don’t get the flu and I seldom get colds. Plus, the few times I’ve had the vaccine I’ve felt miserable, something I have in common with other people who get the flu shot. (Read this before you get the flu shot.)

But avoiding the flu vaccine because I don’t like extra sticks or because I feel bad for a few days may be irresponsible. Diabetics need to get the flu shot, says Dr. Tony Fiore, an epidemiologist and flu expert with the Centers for Disease Control. Read More

With Peanut Allergy, Knowledge Is Power…for Bullies?

By Sean Kelley

In junior high, I was every bully’s fantasy: awkward, short, pudgy, and dressed in ill-fitting hand-me-downs with a curly perm, braces, and glasses. I was the butt of jokes—routinely cuffed, tripped, and otherwise humiliated in between classes and after school. (If you’re looking for the part where I stood up for myself, it’s missing; I eventually transferred to another school where I apparently appeared less geeky.)

Having firsthand knowledge of how cruel kids can be, I cringe when I look at my son, Graeme, whose allergies to food—peanuts in particular—make him vulnerable to horrible pranks. He doesn’t turn 2 for a couple of weeks, but I’m already picturing the teenage angst and middle-school high jinks he could fall victim to. Why? I keep reading about it in the news.
Read More

Why moms get jealous of dads

Moms say they want their spouses to be do-it-all dads. After all they ARE forward-thinking women of the 21st century. Besides, if they did less, we couldn't possibly juggle our busy lives without going nuts. "But we don't want them to take over," says Pyper Davis, a mother of two in Washington, D.C. "We don't ever want to be pushed off that throne of being Mommy." Read on for more on the struggle. full story

Health Tip: Choose a Safe Halloween Costume

(HealthDay News) -- Before you and your child head out for a night of trick or treat, make sure you choose a Halloween costume that will keep your child safe.

The U.S. National Safety Council offers these suggestions:

• Only choose costumes that are flame-retardant.


• Choose loose-fitting costumes so your child can wear warm clothes underneath.


• Make sure your child's costume is the right length. Costumes that are too long can cause your child to trip and fall.


• If your child will be out after dark, make sure the costume is reflective, or you can add strips of reflective tape.


• Use makeup instead of a mask, which could obstruct your child's vision.


• If your child does wear a mask, make sure that it has large holes around the eyes, mouth and nose.


• If your child is carrying an accessory such as a sword or knife, make sure it is made of a soft, flexible material.

Cancer Screenings for Medicaid Patients Miss Targets

(HealthDay News) -- Screening rates for colorectal, breast and cervical cancer among older Medicaid patients are below national objectives, a new study suggests.

The researchers looked at 1,951 North Carolina Medicaid recipients aged 50 and older. "Documentation that colorectal, breast and cervical cancer screening was recommended by the primary-care provider was found for only 52.7 percent, 60.4 percent and 51.5 percent of eligible patients, respectively," wrote Dr. C. Annette DuBard, of the North Carolina Department of Health and Human Services and the University of North Carolina at Chapel Hill, and colleagues.

"Documented rates of adequate screening were 28.2 percent for colorectal cancer, 31.7 percent for mammography within two years and 31.6 percent for Papanicolaou [cervical cancer] test within three years. When medical record and claims data were combined, approximately half of eligible patients had evidence of screening."

These rates are substantially lower than in the general population.

"Lack of screening recommendation by the physician, rather than patient refusal of recommended tests, accounted for most instances of screening delinquency," the researchers concluded. "Efforts to increase cancer screening rates among Medicaid recipients must address patient, physician and organizational barriers to the routine identification and delivery of preventive services."

The study was published in the Oct. 13 issue of the Archives of Internal Medicine.

The researchers noted that colorectal, breast and cervical cancer are potentially curable when treated early, and that eliminating disparities in screening is part of the U.S. government's Healthy People 2010 Plan.

"State Medicaid agencies are in a unique position to monitor and improve the quality of care received by some of the nation's most vulnerable citizens," the study authors wrote.

More information
The American Cancer Society has more about cancer screening.

Health Tip: Having a Baby After Age 35

(HealthDay News) -- While many women have successful pregnancies after age 35, certain complications can occur more frequently in women of that age group.

If you're 35 or older, before you try to conceive, consider this information provided by the American Pregnancy Association:

• Make an appointment with your doctor to address your questions and concerns.
• Don't get discouraged if you don't get pregnant right away. On average, it takes women 35 and older one to two years to conceive.
• Get yourself in good physical, emotional and mental health. Avoid alcohol, smoking and caffeine.
• Learn when you are most fertile. Watch for signs that you are ovulating.
• Take an at-home fertility test that screens for fertility elements in both men and women.
• If you haven't been able to conceive after six months of trying, talk to your doctor about the possibility of fertility testing.

Health Tip: Bonding With Your Premature Baby

(HealthDay News) -- Premature babies -- those born earlier than 37 weeks -- are at higher risk of complications and may need to spend time in the hospital's neonatal intensive care until they are healthy enough to go home.

The American Pregnancy Association offers these suggestions to help you bond with your premature newborn:

• Gently touch or stroke your baby as often as possible.
• Try talking, reading or singing to your baby, who is used to the comforting sound of your voice.
• If allowed, change your baby's diaper yourself.
• Take your baby's temperature when it's time.
• Participate in giving your baby the first bath.

Getting My Diabetic Day Off on the Wrong Foot

By Sean Kelley

If someone gave awards to diabetics for smart lunchroom choices, I’d win every one in my company’s meager cafeteria: Two or three servings of veggies and a 2- to 4-ounce serving of meat, skip the bread. Just what this diabetic needs to manage his blood sugar.

I do a good job at dinner, too, which I cook for my family most nights. But my Achilles’ heel is breakfast: I hate it.
I’m really busy in the morning, I don’t feel hungry, and my blood sugar is usually high, a common diabetic problem. So I often skip that early meal. Read More

Tennis Forehand - Forehand Step 1 - Pivot and Shoulder Turn

The first step of the tennis forehand is the pivot and shoulder turn. You execute this step as soon as you realize that you are hitting a tennis forehand. This step also starts your tennis racket take back. It's important to note that your arms DO NOT DO ANYTHING during this step.

It's the shoulders that start the racket take back on your tennis forehand. Simply put, your body turns sideways and the racket comes along for the ride. If you watch the video, when Frank demonstrates the pivot and shoulder turn during his tennis forehand, both hands stay on the racket.For more FREE tennis videos on how to hit a tennis forehand, as well as the other shots, please visit http://www.fuzzyyellowballs.com/ !

Is Human Growth Hormone a Key to Longevity?

(HealthDay News) -- Adults who long for the vitality of their younger days may be curious about trying injections of human growth hormone, the same substance allegedly used by some Major League Baseball players to boost their athletic performance.

But can it really turn back the hands of time?

Studies of human growth hormone in healthy adults are limited. And what rigorous scientific evidence there is suggests that the risks -- and they can be substantial -- outweigh the benefits.

"I think people are looking for a pill or an injection or something that will cause them magically to become younger," said Dr. Hau Liu, associate chief of endocrinology and co-director of chronic care management at Valley Medical Center in San Jose, Calif. "At least from our view of the data, our conclusion is that it's not the fountain of youth."

Liu was lead author of an analysis of data culled from randomized, controlled trials of growth hormone use in healthy older adults. His team's study, published last year in the Annals of Internal Medicine, found an association between growth hormone use and slight changes in body composition, but no changes in other important health outcomes.

What's more, users of growth hormone had high rates of soft tissue swelling and joint pain, compared to people who didn't get these injections. There was also an increased risk of impaired blood sugar control or diabetes. Although this finding was not statistically significant, Liu suggests that it is "worrisome" given the epidemic rise of type 2 diabetes in the United States.

Human growth hormone is a protein made by the pituitary gland. It's important for normal development and maintenance of tissues and organs, and is especially important for normal growth during childhood, according to the U.S. National Institute on Aging.

As people enter their 40s, the amount of growth hormone produced starts to decline. And, despite a lack of solid evidence, some people believe that bolstering levels of the hormone through injections will help stave off the effects of aging.

In the United States, the U.S. Food and Drug Administration has approved the use of synthetic human growth hormone to treat children with short stature and some other growth problems caused by childhood diseases.

The FDA, however, prohibits drug companies from marketing growth hormone for "off-label" uses such as anti-aging. But that hasn't stopped some physicians from prescribing growth hormone to patients willing to pay the price.

It's estimated that some patients spend as much as $1,000 to $2,000 a month on growth hormone for anti-aging purposes, says the American College of Physicians.

"I suspect that the threat of legal action will be the only way this inappropriate use of growth hormone will be curbed," said Dr. Mary Lee Vance, a professor of internal medicine and neurosurgery at the University of Virginia Health System, who specializes in pituitary diseases.

Vance is concerned about the potential harm to patients. She once corresponded with a patient who took growth hormone ostensibly "to prevent aging." He died from a heart attack six months after starting the therapy, which someone else had prescribed, she said.

The American Association of Clinical Endocrinologists says there's currently no place for the use of growth hormone (GH) as an anti-aging agent. "The future role of GH therapy in various clinical conditions should be explored through appropriate scientific investigation and clinical verification," the association writes on its Web site.

Still, proponents of growth hormone therapy remain resolved. In April, a worldwide coalition of physicians and scientists in anti-aging medicine called on the U.S. Congress to reject proposed legislation that would classify human growth hormone as a Schedule III controlled substance, which would tighten restrictions on how it's dispensed.

Meanwhile, scientific investigation continues. Liu intends to expand his research to examine a combination of growth hormone with other agents. "There's some evidence that multiple agents somehow may have some synergistic effect on outcomes, and that's what we're trying to investigate further," he said.

But until those results are in, he suggests that the best life-extending advice comes from our mothers. "Exercise, eat well, don't smoke: Those are the therapies, really, that will help enhance your quality of life and increase your probability of living a long, healthy life," he said.

More information
For more on hormones and aging, visit the U.S. National Institutes of Health.

8 Ways to Save on Health Care, No Matter Who Wins the Election

By Amy O'Connor

If you’re hoping a new administration will bring you health-care security, don’t hold your breath. With the country reeling from the banking debacle, and the markets in a free fall, even the most optimistic Americans question whether the next president will be able fulfill his health-care promises.

Senator Barack Obama, for example, may have a hard time passing costly reforms outlined in his plan, which calls for mandatory coverage of preexisting conditions, tax credits for families, and the expansion of Medicaid and the State Children’s Health Insurance Program (SCHIP), which would cover all children without private insurance.
Senator John McCain’s plan aims to cut tax breaks for companies that offer health insurance to employees, and replace them with a refundable tax credit of $2,500 for individuals or $5,000 for families—a promise that may be hard to make a top priority.

But no matter who wins, and what they are able to accomplish, there is a lot you can do to save on medical costs and plan for a healthier future. Read More

Does Drinking Really Make You Warmer?

Alcohol may seem like the perfect cold-weather beverage, because it creates a sensation of warmth. But it actually decreases core body temperature and increases your risk of hypothermia.

In cold weather, blood flows away from your skin and into your organs, causing a sensation of coldness but increasing core body temperature. Alcohol reverses this process, increasing the flow of blood to your skin. This causes a sensation of warmth, but sets off a sharp drop in body temperature.

Alcohol also reduces your ability to shiver, which is one of your body’s way of creating warmth, and increases sweating, which further decreases body temperature.

Several studies have found that alcohol often plays a role in hypothermia-related injuries and deaths.

Sources:
New York Times January 1, 2008

Health Tip: Biking Safely

(HealthDay News) -- Proper supervision and wearing protective gear, especially a helmet, are critical to biking safely.

The Nemours Foundation offers these safety tips for children to prevent biking accidents:

• Wear fluorescent, brightly-colored or reflective clothing when biking, especially at night or in the evening. Avoid dark clothes.
• Wear lightweight clothing to keep cool.
• Wear pants with tight-fitting legs -- no flared or wide leg pants that can get caught in gears or spokes.
• If biking with a backpack, make sure the straps are tied up and out of the way.
• Wear sturdy shoes that can grip bike pedals. Never wear cleats, heeled shoes, or flip flops, and never bike barefoot.

Health Tip: Parenting a Child With ADHD

(HealthDay News) -- Children with Attention-deficit-hyperactivity-disorder (ADHD) often require special attention to help manage their behavior.
The University of Michigan Health System offers these suggestions for parents of a child with ADHD:

• Pay attention to the good qualities your child has, and tell him or her when you notice good behavior.
• When offering praise, tell your child specifically what was done well and what you liked about it.
• Offer direction in a positive way. Tell the child what you want done, instead of what shouldn't be done.
• Offer immediate and constant feedback throughout the day, keeping it simple and clear.
  Because medications for ADHD can affect appetite, make sure your child has plenty of healthy meals and snacks throughout the day.
• Keep a close eye on your child during play and exercise to prevent injury caused by active, impulsive behavior.

Book Offers Novel Approach to Weight Loss

(HealthDay News) -- Could a novel with an embedded message about good health help overweight girls develop the motivation to lose a few pounds? New research suggests that it just might, but the results weren't dramatic.

Duke University researchers found that obese girls who read a book featuring a weight-management storyline were slightly more likely to control their weight than two comparison groups.

The research is the first "to show a relationship between reading and making positive, healthy lifestyle changes," said study author Alexandra C. Russell, a fourth-year medical student at Duke University School of Medicine.

The findings were expected to be presented Oct. 4 at the Obesity Society's annual meeting, in Phoenix.

According to federal statistics, 16 percent of American children ages 6 to 19 are either obese or overweight.

"Childhood obesity is becoming an epidemic problem in this country," Russell said. "We need to find ways to appeal to a large population in an effective way."

In the study, the researchers assigned 31 severely overweight girls in a weight-management program to read a book called Lake Rescue, part of a series called Beacon Street Girls. The girls were all aged 9 to 13.

The book deals with an overweight girl who worries about going on an outdoor school trip. She ends up making friends, improving her self-esteem and learning about appropriate levels of physical activity, Russell said.

"Kids really enjoyed the book, I think, because the message doesn't hit them over the head," Russell said. "Because there are so many female characters, I think every girl reading it has someone to identify with if they didn't identify with the overweight character. We got only positive feedback."

Another 33 girls in the weight-management program read another book that had no storyline about being overweight; instead it told the story of a girl who searches for a missing cat in Paris. A third group of 17 girls in the weight-management program wasn't assigned to read any books, Russell said.

The researchers then compared the body mass indexes of girls in the three groups up to six months later. On average, the girls who read Lake Rescue gained better control of their weight, moving from the 98th to the 97th percentile in a range of weights, Russell said.

"The book helped," she said. "It either helped them stay at the same weight while they were growing or even helped them lose their weight."

While the difference in percentiles was statistically significant, it's hard to know if it meant much to the girls from a health perspective, Russell said. "These girls need to be followed up to see if there's a difference over a long term, compared to just one to three months," she said.

Dr. David Katz, director of the Yale University School of Medicine Prevention Research Center, said embedding weight-management messages in a book is a "very promising idea," but more research is needed.

"Could a cottage industry sprout up in publishing for novels that are ostensibly about some diverting plot, but really about eating well, being active, or losing weight?" he asked. "It's too soon to tell. We don't know how strongly, consistently, or enduringly such books might contribute to weight loss and control, or other health benefits."

More information
Learn more about childhood obesity from the U.S. Centers for Disease Control and Prevention.

Health Tip: Controlling Hot Flashes

(HealthDay News) -- Hot flashes are a common side effect of hormonal changes that occur during menopause.

Here are suggestions from the University of California San Francisco Medical Center on how to prepare for hot flashes, especially at bedtime:

• Keep your bedroom cool, and keep a nearby fan on while you sleep.
• Wear light, cotton pajamas.
• Put cotton or "t-shirt" sheets on the bed to help absorb sweat.
• Have an extra clean pair of pajamas and sheets near the bed, so you can quickly change them if they get too damp
• Before heading to bed, take a warm bath or shower.

Connection Between ED and Heart Disease and BP

Connection Between ED and Heart Disease and BP

Health Tip: Stretch Your Hamstrings

(HealthDay News) -- The hamstring is a muscle that runs along the back of the thigh. Pulling this muscle can be quite painful.

A simple stretch can help prevent a pulled hamstring if done before and after exercise, according to the American Academy of Orthopaedic Surgeons:

• Sit down on the floor and straighten out one leg, and bend your other leg.
• Place the sole of your foot of your bent leg against the inside of your straight leg.
• Leaning forward a little bit, extend your arms and touch the toes of your straight leg.
• Keep your toes pointing upward and your foot and ankle relaxed.
• Hold that position for 30 seconds.
• Switch and perform the stretch on the other leg.

Birth Size Linked to Breast Cancer Risk

(HealthDay News) -- Women who are heavier and longer at birth are at increased risk of developing breast cancer later in life, British researchers report.

In fact, as birth weight and length increases, so does the risk for breast cancer, according to the results of a study published in the Sept. 30 online edition of PLoS Medicine.

"These researchers have documented in unequivocal terms that larger birth size is associated with increased breast cancer risk several decades later," said Dr. Dimitrios Trichopoulos, the Vincent L. Gregory Professor of Cancer Prevention at Harvard University School of Public Health Department of Epidemiology and author of an accompanying journal editorial.

Birth size reflects, to a considerable extent, the effects of the intrauterine environment on the fetus, Trichopoulos noted. "To this day, they had not been sufficiently appreciated by the scientific community, because each individual study could not provide conclusive evidence. We are facing now a new reality: that breast cancer has its origins several decades before its clinical appearance," he said.

For the study, a research team led by Dr. Isabel dos Santos Silva, a professor of epidemiology at the London School of Hygiene and Tropical Medicine, collected data on more than 600,000 women, 22,058 of whom had breast cancer. The data came from 32 studies.

The researchers found that women who were heavier and longer at birth had increased risk for breast cancer as adults. An analysis of birth records, among these women, found that for every 17.6 ounces of birth weight, the risk for breast cancer increased 7 percent.

In addition, birth length and head circumference were also associated with an increased risk of breast cancer. The strongest association between size at birth and an increased risk for breast cancer was seen for birth length, the researchers reported.

"Recognition of early life influences are critical in the etiology of breast cancer and helps to explain why several adult life primary prevention practices -- as distinct to secondary prevention ones focusing on early detection -- have been of limited effectiveness," Trichopoulos said.

"Prevention of breast cancer needs to take into account the very long natural history of the disease," he added.

Expert reaction to the new research was fairly guarded.

"There's good evidence for these findings, but there is really no clinical relevance for them," said Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society.

"There is nothing that women should do differently to try to have smaller babies, or women who were born with a longer length or larger head circumference should do anything differently when they grow up or get screened differently, or consider themselves at high risk -- it's really just a research issue," Saslow said.

More information
For more on breast cancer, visit the American Cancer Society.