Health-Medical-Fitness-Diet-zz: august 2012

duminică, 5 august 2012

Allergies May Plague Renters More Than Homeowners

In a survey of people with indoor allergies, 91 percent of those who owned their home were willing to keep pets out of the bedroom to eliminate dust mites, mold and pet dander, and adjust their home humidity to below 60 percent to prevent the growth of mold, according to a new study from the American College of Allergy, Asthma and Immunology (ACAAI).

"Allergy season lasts all year long for people who suffer from common household allergens," Dr. James Sublett, an allergist and chairman of the ACAAI Indoor Environment Committee, said in a college news release. "When environmental changes aren't made indoors, the home becomes a breeding ground for symptoms rather than a place to escape allergens."

In contrast, the researchers found that just 63 percent of renters make these types of changes to control their allergy symptoms.

"By making recommended environmental changes around the home, people with allergies can substantially reduce their symptoms," the study's lead author, Dr. Michael Schatz, an allergist and fellow at the ACAAI, said in the news release. "While some changes are related to owning a home, other changes, such as encasing your mattress with a dust-proof cover, can and should be done no matter your real estate status."

The ACAAI recommends that people with indoor allergies make the following changes at home to ease their symptoms:

Wrap pillows, mattresses and upholstered furniture with dust-proof covers. These covers should be washed routinely in hot water. Remove carpeting. Reduce home humidity to 60 percent. Use a vacuum cleaner with a HEPA filter once a week, or wear a dust mask while vacuuming. Remove visible mold. Install an air purifier. Don't allow pets in the bedroom. Wash pets every week to reduce exposure to dander.

The study was published in the August issue of the journal Annals of Allergy, Asthma & Immunology.

More information

The U.S. National Library of Medicine has more about indoor allergies.

Asthma Common Among Olympic Athletes

The Australian researcher suggested the conditions may be linked to the athletes' intense training, particularly those who participate in endurance sports or winter sports. The inhalation of cold air contributes to airway damage.

Airway hyper-responsiveness involves marked narrowing of the airways in response to some kind of outside trigger.

"Inhaling polluted or cold air is considered an important factor which might explain the cause in some sports, but not in all," explained study author Kenneth Fitch, of the University of Western Australia, in a university news release. "The quality of inhaled air could be harmful to the airways, but does not cause the same effect in all sports."

Fitch counted the number of athletes with asthma and airway hyper-responsiveness from the five Olympic games between 2002 and 2010. He identified the athletes by tracking the use of inhaled beta-2 agonists, an anti-asthma drug commonly used by top athletes.

In 2001, the International Olympic Committee recognized the increased use of the drug between 1996 and 2000, and issued a new rule requiring athletes to provide proof of their condition to safeguard the health of Olympic athletes, not as an anti-doping measure, according to the news release.

Fitch noted that athletes with asthma have routinely beaten their opponents. He added, however, there is no proof that treatments for the condition improved their performance. He suggested that training harder than other athletes could help explain why many athletes develop asthma or airway hyper-responsiveness as adults.

The study was published online in the British Journal of Sports Medicine.

More information

The U.S. National Heart, Lung, and Blood Institute provides more information on asthma.

FDA to review Medivation, Astellas' prostate cancer drug in November

The relentless, weather-gone-crazy type of heat that has blistered the United States and other parts of the world in recent years is so rare that it can't be anything but man-made global warming, says a new statistical analysis from a top government scientist.

Common Skin Cancer a Chronic Condition, Study Says

That's because once most people have a single occurrence, they are at risk of getting another.

"Basal cell carcinoma has generally been viewed as something that comes up, is treated and cured," said Dr. Martin Weinstock, a study co-author and professor of dermatology at the Warren Alpert Medical School at Brown University in Providence, R.I. "For someone with an isolated lesion, that's a reasonable way of looking at it. But most people are constantly at risk of this and will be getting more."

The study confirmed what was commonly understood about the disease: a prior history of basal cell carcinoma is the greatest risk for another lesion. But the research found that eczema may also predict a recurrence among those at high risk for the disease. Those with a family history of eczema had a 1.54 times greater risk than those without.

Older age, sun sensitivity, intense sun exposure before age 30, and use of certain blood pressure-lowering medications (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) were also associated with increased risk.

Why would eczema, a chronic skin disorder that involves scaly and itchy rashes, be associated with basal cell carcinoma? Weinstock said it's unclear. "There may be some differences in these people's immune systems compared to people without eczema," he said, noting that other investigators need to confirm the findings.

Having other types of skin cancer or actinic keratoses (scaly or crusty growths caused by sun damage) did not appear to raise the chances for basal cell carcinoma.

The study was published online July 19 in the Journal of Investigative Dermatology and funded by the U.S. Department of Veterans Affairs. It involved more than 1,100 people, nearly all men, all veterans, with a median age of 72.

On average, each participant had more than three instances of basal cell cancer or squamous cell cancer (another type of skin cancer) before participating in the research. During the study period, 44 percent developed new basal cell cancers, and those with the most basal cell cancers in the five years before the study had the most recurrences.

Study participants with more than five prior basal cell cancers were nearly four times as likely to develop a new one as those with one or no prior skin cancers. And their risk was twice as high as those with three previous skin cancers, the study found.

Now the most common cancer in the United States, basal cell carcinoma begins in the outer layer of the skin, often as a small white or flesh-colored bump that grows slowly and sometimes bleeds. While these cancers rarely spread, they must be removed or treated, usually in a physician's office with local anesthetic.

Weinstock said researchers are eager to find a preventive medication to guard against the recurrence of basal cell carcinoma. Last year a team he led concluded that topical tretinoin did not prevent new basal cell cancers in high-risk patients. Now he is involved in a study looking at whether 5-Fluorouracil, a compound used to treat actinic keratoses, may prevent basal cell cancer when given intravenously.

Dr. Jean Tang, an assistant professor in the department of dermatology at Stanford University School of Medicine who is familiar with the study, said the most important thing for patients to know is that if you have had a basal cell carcinoma, you have a 44 percent chance of getting another.

"This study doesn't change any clinical guidelines or recommendations," she added. Current advice still stands: "Get an annual skin assessment by your dermatologist," she said.

More information

To learn more about skin cancer, visit the U.S. National Cancer Institute.

Covenant to offer Parkinson's disease support group

FDA approves Sanofi/Regeneron colon cancer drug

The infused medicine, to be taken in combination with standard chemotherapy, will compete with Roche Holding AG's Avastin and Bristol-Myers Squibb Co's Erbitux.

Industry analysts say they expect Zaltrap to win peak annual sales of perhaps $300 million to $400 million, well below the widely used older treatments.

Patients taking Zaltrap in a large clinical trial, in combination with a standard chemotherapy combination regimen called FOLFIRI, lived an average of 13.5 months, compared with 12 months for those receiving only FOLFIRI. Also, patients receiving Zaltrap went an average 6.9 months before their symptoms got worse, compared with 4.7 months for those on chemotherapy alone.

Zaltrap, like Avastin but through a different approach, blocks a protein called VEGF that tumors employ to create blood vessels that provide them nutrients. Erbitux blocks receptors to a different protein, called epidermal growth factor.

"This is a very solid new opportunity" for Regeneron," said RW Baird analyst Christopher Raymond, who predicted the medicine would garner sales of $205 million in 2015. But Raymond said most proceeds in the next few years will likely go to partner Sanofi, which is entitled not only to a half share of profits from Zaltrap but also to reimbursement from Regeneron for half the drug's development costs funded by Sanofi.

Regeneron is far better known for Eylea, a treatment approved late last year for treating macular degeneration, the leading cause of blindness in the elderly. The eye medicine has the same active ingredient as Zaltrap, called aflibercept, and is already achieving blockbuster sales and stealing market share from Roche's Lucentis treatment for the eye condition. Lucentis is derived from Avastin.

"While near-term we expect (Regeneron's) stock will continue to trade primarily on the Eylea launch which remains impressive, we view Zaltrap's approval as a nice complement to what is rapidly becoming one of biotech's best commercial stories," Raymond said.

The company, based in Tarrytown, New York, has a promising array of other drugs in development with Sanofi to treat cancer, cholesterol and inflammatory diseases.

Adnan Butt, an analyst with RBC Capital Markets, said he has particularly high hopes for REGN727, which slashed levels of "bad" LDL cholesterol by more than 60 percent in a mid-stage study and is now being tested in far larger Phase III studies. It blocks a protein called PCSK9, a new approach.

He also cited REGN88, a treatment being tested against rheumatoid arthritis that works by blocking a protein called IL-6.

"They are both potential blockbuster medicines," Butt said.

Regeneron shares, which rose 0.4 percent to $136.96 on Friday, have soared 250 percent since the FDA approved Eylea on November 18.

Regeneron research chief George Yancopoulos said anti-angiogenesis drugs, like Zaltrap and Avastin, have not been able to slow down tumor growth nearly as well as researchers had originally hoped.

"We thought if you could choke off the blood supply you could, if not kill the tumor, keep it from growing. But (targeting) VEGF may not be enough, we may have to combine different types of anti-angiogenesis drugs."

Toward that end, Yancopoulos said Regeneron and Sanofi are testing two such medicines, which instead block proteins DLL4 and angiopoietin 2, that could someday be used in combination with anti-VEGF therapies to more fully cut off blood supply to tumors.

Zaltrap, like Avastin, was shown to be ineffective in treating prostate cancer. It also failed in other studies to improve outcomes in patients with lung and pancreatic cancers.

Colorectal cancer is the fourth most commonly diagnosed cancer in the United States, and the fourth leading cause of cancer death, the FDA said. Almost 145,000 Americans are expected to be diagnosed with the disease this year, and almost 52,000 will die from the cancer, according to the National Institutes of Health.

(Reporting by Ransdell Pierson in New York and David Morgan in Washington; Editing by Lisa Von Ahn, Marguerita Choy and Bernard Orr)

US officials warn of swine flu outbreak at fairs

The virus does not appear to have evolved to the point where it spreads easily among humans, but it does contain a gene from the pandemic H1N1 flu that sickened millions worldwide in 2009 and 2010.

"We are concerned that... may confer the potential for the virus to infect or spread among humans to a greater extent," said Joseph Bresee, an influenza epidemiologist at the Centers for Disease Control and Prevention.

The virus was first detected in July 2011 and there have since been a total of 29 known cases -- 16 of them in the past three weeks -- in the United States.

It is a relatively mild flu -- everyone recovered and only three people were hospitalized. As a result, many more cases have likely occurred without being reported to health officials.

The bulk of the reported cases were among children, who are more susceptible to swine flu.

With county fair season in full swing, health officials expect more people will get sick.

"We also expect some of the cases may be severe," Bresee cautioned.

Bresee urged people to go to the doctor if they feel flu symptoms after coming into contact with pigs so that public health officials can better track the outbreak.

"What we're really going to be looking for is evidence that the virus has made that change to spread efficiently among humans," he explained. "So far we haven't seen that."

Simple hygiene -- hand washing after contact with animals and not eating, drinking or putting things like cigarettes in your mouth while in animal areas -- can prevent the flu's transmission.

Pregnant women, children younger than five, the elderly and those with chronic illnesses should avoid exposure to pigs and swine barns.

Three Patients of Colorado Dentist Test Positive for Diseases

The Colorado Dept. of Public Health and Environment issued a statement this week about the infections after reaching out to thousands of patients who saw the dentist from 1999 through 2011 and telling them they’re potentially at risk for the diseases. The department said instruments were apparently re-used for multiple patients repeatedly, and often days at a time.

MORE: My Story: Taking Stock of Life Six Months After HIV Diagnosis

Due to patient confidentiality, the department didn’t say with which diseases the patients were infected. And good luck to those who want to pin their diagnosis on the dentist. Both the Centers for Disease Control and the health department said it would be “difficult, if not impossible to conclude definitively whether the dental practice was the actual source of transmission for any of these positive test results.”

CBS News quoted attorney Chad Hemmat as saying, “Everyone can sue.” When asked what the victims’ chances are of collecting damages he replied, “From the circumstances, as I understand them, somewhere between slim and none.”

Stein had his medical license suspended in 2011 for an unrelated and undisclosed reason. He’s not currently practicing dentistry.

Do you think the infected patients have a prayer in winning a case against the dentist? Let us know in the comments.

Related Stores on TakePart:

• New Tuberculosis Drug Combo Knocks Out Disease

• FDA Approves Truvada as First HIV Prevention Drug

• HPV Vaccine Benefits Those Who Do and Don't Get the Shots

Jeannine Stein, a California native, wrote about health for the Los Angeles Times. In her pursuit of a healthy lifestyle she has taken countless fitness classes, hiked in Nepal, and has gotten in a boxing ring. Email Jeannine | TakePart.com

Most Americans With Celiac Disease Don't Realize It: Study

The findings, which estimate that 1.8 million Americans have celiac disease -- an autoimmune condition -- suggest that a whopping 78 percent of sufferers don't realize they have the condition.

"This provides proof that the disease is common in the United States," said study co-author Dr. Joseph Murray, a gastroenterologist at the Mayo Clinic, in a clinic news release. "If you detect one person for every five or six [who have it], we aren't doing a very good job detecting celiac disease."

People with celiac disease have trouble digesting wheat, rye and barley. A gluten-free diet can help, but about 80 percent of people on such a diet haven't been diagnosed with celiac disease.

"There are a lot of people on a gluten-free diet, and it's not clear what the medical need for that is," Murray said. "It is important if someone thinks they have celiac disease that they be tested first before they go on the diet."

The researchers came to their conclusions by examining blood-test results and the findings of a national survey.

Celiac disease appears to be especially common in white people.

"Virtually all the individuals we found were non-Hispanic Caucasians," said study co-author Dr. Alberto Rubio-Tapia, a Mayo Clinic gastroenterologist, in the news release. But, he said, the results are head-scratching because research in Mexico has suggested celiac disease is common there.

The research was funded in part by the U.S. National Institutes of Health and the U.S. Centers for Disease Control and Prevention.

The study appears July 31 in the American Journal of Gastroenterology.

More information:

For more about celiac disease, try the U.S. National Library of Medicine.

Zaltrap Approved for Advanced Colorectal Cancer

FOLFIRI stands for a regimen that includes folinic acid, fluorouracil and irinotecan. Zaltrap, among a class of drugs called angiogenesis inhibitors, restricts tumor growth by inhibiting their blood supply. The drug was approved for people whose tumors are resistant to or have progressed after oxaliplatin-based chemotherapy, the FDA said in a news release.

Colorectal cancer, the 4th-leading cause of cancer and cancer deaths in the United States, will be diagnosed in an estimated 143,460 Americans this year, and about 51,690 will die from it, the agency said.

In clinical testing, people who received the Zaltrap-FOLFIRI combination lived an average of 13.5 months, compared to 12 months with a combination of FOLFIRI and a placebo, the FDA said.

The most common side effects of the Zaltrap-FOLFIRI combination included decreased white blood cells, diarrhea, mouth ulcers, fatigue, high blood pressure, weight loss, loss of appetite, abdominal pain and headache.

Zaltrap is produced by Sanofi-Aventis, based in Bridgewater, N.J.

More information

To learn more about colorectal cancer, visit the U.S. National Cancer Institute.

Barbecue Yes, Petting Zoos No: Pigs May Be Spreading Flu to Humans, CDC Says

The Centers for Disease Control and Prevention are warning people to refrain from having direct contact with pigs. The agency reported this week that out of 29 flu cases reported in eight states since July 2011, 19 of them were linked with fairs that featured pigs.

In a statement the CDC said that late summer is prime time for contact between swine and the public, since that’s when local fairs are in swing—fairs that typically feature farm animal exhibits and petting zoos.

MORE: Bird Flu Strain Kills Harbor Seals: Are Humans Next?

Twelve H3N2v infections were reported in Hawaii, Ohio and Indiana this week by the CDC, and ten of those were traced back to the Butler County Fair in Ohio.The virus carries the M gene from the H1N1 flu that makes it more transmissible from animals to humans.

However, it’s not so adept at spreading from human to human, the CDC’s Joseph Bresee told USA Today: “Because influenza viruses are always evolving, we'll watch closely to see if the virus has gained the capacity for efficient human to human transmission. So far we haven't seen that.”

No deaths have been reported from the virus, but three people with high-risk conditions were hospitalized. Symptoms are typical of the flu: fever, runny nose, sore throat, cough, aches.

The CDC has a few tips for those headed for county fair or other swine-centric events: If you do touch a pig, wash your hands before and after contact, and never eat, drink or put things in your mouth in an animal area.

Those who should be especially careful around animals include pregnant women, people 65 and older, those with compromised immune systems and young children.

MORE: Bird Flu Transmission: How Many Mutations Away?

Avoid sick pigs. How can you tell if a pig is not feeling well? Look for a runny nose and eye goop, and steer clear of animals that have separated from others, Lisa Ferguson, a veterinarian with the Department of Agriculture's National Animal Health Policy Program told USA Today.

It’s probably OK to chow down on barbecue and hot dogs, however, since properly cooked pork products don’t seem to spread the disease.

Will you avoid fairs this summer because of a flu threat? Tell us in the comments.

Related Stories on TakePart:

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For Colorado Family, It's Allergies All Around

What the Vail, Colo., mom didn't know at the time was just how serious those allergies would be.

Kloser's son, Christian, ended up developing life-threatening allergies to eggs, milk, soy, wheat, peanuts, seeds and tree nuts. The first significant sign of an allergy came the first time he had an egg and he broke out in hives.

"It was obvious that he had lots of food allergies," Kloser said. "He'd often have a runny nose and blotchy skin."

Once Kloser and her husband, Mike, learned just how many things Christian was allergic to, the real challenge began. "I had to relearn how to cook," Emily Kloser said. "I now read every label, every time. Even though you have a brand you trust, sometimes they change how they make things."

Because her son developed allergies at such a young age, Kloser said he didn't really know what he was missing and seemed to deal with it just fine. In fact, she said, when she'd make rice cereal treats for him to have at other children's birthday parties, the other children would often ask if they could have what Christian was having instead of the birthday cake.

At about age 5, she said, Christian outgrew his allergy to wheat, and a short time later he was able to eat eggs again. Around age 7 or 8, he was able to start drinking milk and eating dairy foods. Perhaps not surprisingly, one of the first foods he wanted to try was that ubiquitous kids' meal: pizza.

Now 18, he's still allergic to peanuts, seeds and tree nuts and, possibly, shellfish.

But just about the time Christian was outgrowing some of his allergies, his older sister Heidi had an allergic reaction after eating an avocado. Soon after that, they learned that she was also allergic to walnuts.

Both of the Kloser children are competitive skiers, and the family has traveled the world, despite the challenges of living with such serious food allergies. Emily Kloser said she learned to pack certain foods that her kids would need, and she learned how to ask about how foods were prepared in different languages so she'd be ready when they were away from the United States.

She said that living with the kids' food allergies "really made us all healthier" because it was easier to eat in than to eat at restaurants.

But it isn't always smooth sailing. Just a couple of years ago, Christian was traveling with a coach to a competitive ski event and was inadvertently exposed to something he was allergic to. They suspect it was a peanut exposure. He was back on the mountain, skiing downhill, when he started to feel badly. He didn't have antihistamine medication or an epinephrine injection with him to counteract his allergies, like he usually does, but his coach got him quickly to a hospital, though it took hours for Christian to get back to normal.

Still, Kloser said the family tries to live a normal life. "When I first found out, I sobbed," she said. "I wondered how he'd go to college, or even how he'd go to a friend's house. But you just have to educate the people your children come into contact with, and trust your children and the other adults in their lives. Have a plan and stick to the plan if something happens. But, don't get so in a panic over it that you start making your kid anxious."

More information

A companion article gives more detail on kids' food allergies.

CDC Preparing Vaccine for New Swine Flu

"This virus is still principally a swine virus, but it doesn't seem to have onward spread. It's still not a human virus," Dr. Joseph Bresee, from the CDC's influenza division, stressed during a noon press conference Friday.

"Even so, a H3N2 candidate vaccine has been prepared and clinical trials are being planned for this year," he said.

The reason the CDC is concerned about this particular virus is that it contains an element seen in the pandemic 2009 swine flu strain, H1N1, which may make it more likely for the virus to spread from person-to-person.

All 29 cases were infected with strains of H3N2 "that contained the matrix (m) gene from the influenza A H1N1 pandemic virus," Bresee explained. "This 'm' gene may confer increased transmissibility to and among humans, compared with other variant influenzas viruses."

In addition, the virus appears to have become more active recently, the CDC said. "The virus was first detected in humans in July 2011, and since then there have been 29 total cases of H3N2 variant virus detected, including the 16 cases occurring in the last three weeks," Bresee said.

Of the 12 cases reported this week, 10 were from Ohio and one each came from Hawaii and Indiana, the CDC said.

According to Bresee, "29 cases of infection with this H3N2 virus since 2011 is a significant increase for these types of viruses that we have seen in recent years."

Flu viruses commonly circulate in pigs, Bresee noted. But they are generally different from those that spread to people. Sometimes these viruses can spread to people, however, which happens most often when someone comes into close contact with an infected animal, he explained.

"Swine influenza viruses have not been shown to be transmissible to people through eating, or handling pork or other products derived from pigs. It is not a food-borne disease," Bresee said.

Each of the recent 16 cases were among people who had direct contact with pigs. In 15 cases, contact happened at a county fair, he added.

It may yet be possible, however, to transmit this virus from one infected person to another, Bresee said.

No human-to-human transfer of the virus occurred in the more recent cases, Bresee said, although scientists did find evidence of limited human-to-human transmission in three cases in 2011.

Fortunately, sustained person-to-person transmission of the virus hasn't happened yet, he added.

Of the 16 new cases, 13 arose in children, according to the CDC. Studies indicate that children may be more susceptible to the infection than adults, as occurred during the 2009-2010 pandemic H1N1 flu outbreak, Bresee said.

Right now, there is no cause for alarm, the CDC said. Symptoms of this flu are similar to seasonal flu, none of the recent 16 cases required hospitalization and there were no deaths. This flu did hospitalize three people with underlying disease last year, he noted.

"We expect more cases from contact with pigs and through limited human-to-human spread," Bresee said. "We also suspect that some of the cases might be severe."

Reported cases usually represent a small number of actual cases, since most people don't see a doctor and many doctors don't report flu cases.

Bressee said, however, it's too early to hazard a guess about how many cases of this flu there might actually be.

"Because influenza viruses are always evolving, we will watch closely for signs that the virus has gained capacity for efficient and sustained human-to human transmission," Bresee said.

"Thus far, we have not seen this type of transmission and therefore are not seeing features consistent with an influenza pandemic."

To prevent contracting this flu, the CDC advises people to limit their contact with swine and avoid contact with sick swine. People who have contact with these animals should take precautions such as washing their hands, not eating or drinking in areas with swine and controlling their cough.

More information

For more on H3N2 flu, visit the U.S. Centers for Disease Control and Prevention.

Alzheimer's Progression Slower After 80: Study

The risk of developing Alzheimer's disease increases with age, and by 85, the risk is about 50 percent. But those who develop the progressive brain disorder that late in life will experience a less aggressive disease than those whose symptoms appear at 60 or 70 years, according to investigators at the University of California, San Diego.

Lead researcher Dominic Holland from the university's neurosciences department said doctors will need to consider these findings when assessing older patients for Alzheimer's disease.

"Methods for early detection, which will rely on biomarkers as well as mental ability, will need to take into account the age of the individuals being assessed," he said. Because the "old" elderly may deteriorate at a slower pace than younger patients, doctors may not realize these people are suffering from Alzheimer's disease.

The findings also have implications for clinical trials evaluating potential Alzheimer's treatments and cost-of-care projections for different Alzheimer's patients, Holland and other experts say.

Currently, no effective treatments exist to slow or cure Alzheimer's disease, which gradually destroys brain cells and robs people of memory, and their ability to communicate and carry out everyday tasks.

The report was published Aug. 2 in the online journal PLoS One.

To study Alzheimer's disease progression, Holland and colleagues used data from the Alzheimer's Disease Neuroimaging Initiative study. They looked at more than 700 people aged 65 to 90, some with normal mental functioning, some with mild signs of dementia and others suffering from Alzheimer's.

Participants were tested every 6 or 12 months.

The researchers found that younger Alzheimer's patients lost their mental abilities faster than older patients.

These declines among younger patients paralleled the accelerated rate of brain tissue loss and the increase in a spinal-fluid indicator of Alzheimer's seen among the younger age group, compared with older patients, the study authors added.

The researchers aren't sure why Alzheimer's is more aggressive in younger patients. One explanation might be that the older patients have been declining at that slower rate over a longer time, with some unknown factor keeping symptoms at bay, they suggest.

Another possibility is that the older patients have dementia plus Alzheimer's, which might stall the full effect of Alzheimer's on the brain. But such a diagnosis must be made with an autopsy, which is the only way Alzheimer's is accurately diagnosed, Holland noted.

Alzheimer's disease currently affects an estimated 5.6 million Americans, and that number is expected to triple by 2050 as the baby boom generation ages.

The finding that the earlier one develops the disease, the more aggressive it is isn't good news for those younger elderly patients who will suffer the worsening loss of their mental abilities for a long time, Holland said.

Another expert said the findings may affect both health cost projections and clinical trials.

"This is an extremely important paper with implications for both the projections of cost of care for Alzheimer's disease and for planning clinical trials," said Dr. Sam Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center at the Mount Sinai School of Medicine in New York City.

If the clinical picture in the over-85 population is milder than what is typical in younger populations, those older patients would remain independent longer, and the projections for the economic burden to the health care system should be adjusted, he said.

"The annual cost now is $200 billion in the U.S.; the projection is $1 trillion annually by 2050," Gandy said.

"Maybe that $1 trillion is really only $500 to $750 billion. Still catastrophic, but it is worth considering this in projection," he added.

Equally important, if the rate of decline is slower in 85-year-olds than in 65-year-olds, that must be taken into account when recruiting for clinical trials, Gandy said.

For example, if all the patients receiving a drug were over 85 and all the patients receiving an inactive placebo were much younger, it might appear the drug was working when, in fact, the populations were improperly matched, Gandy pointed out.

"We have known that we wanted populations to be as identical as possible, but we didn't really know of this specific phenomenon before," he said.

More information

For more information on Alzheimer's disease, visit the Alzheimer's Association.

Komen cancer foundation 'oversells mammograms'

The Susan G. Komen for the Cure foundation uses misleading statistics in its pro-screening campaigns, two doctors from The Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire wrote in the BMJ medical journal.

"Unfortunately, there is a big mismatch between the strength of evidence in support of screening and the strength of Komen's advocacy for it," professors Steven Woloshin and Lisa Schwartz wrote.

They take issue with a Komen poster comparing the 98-percent five-year survival rate for breast cancer when caught early, with a 23-percent rate for later diagnosis.

Comparing the two figures did not say anything about the benefits of screening, they argued, and in reality a mammogram only narrowly decreases the chances that a 50-year-old woman will die from breast cancer within 10 years from 0.53 percent to 0.46 percent.

Breast cancer treatments are more effective today, and some question whether screening mammography has any benefit whatsoever, wrote the pair.

They accused Komen of overlooking the potential harms, with up to half of women screened annually over 10 years experiencing at least one false alarm that requires a biopsy.

Screening also results in overdiagnosis -- detecting cancers that would never have killed or even caused symptoms in a person's lifetime, and unnecessary treatment.

"The Komen advertisement campaign failed to provide the facts," said the piece. "Worse, it undermined decision making by misusing statistics to generate false hope about the benefit of mammography screening."

In 2010, a report in the New England Journal of Medicine said mammograms have only a "modest" impact on reducing breast cancer deaths.

Komen, in a response to the BMJ comment, insisted that early detection enables early treatment, which gives the best shot at survival.

"Everyone agrees that mammography isn't perfect, but it's the best widely available detection tool that we have today," said Chandini Portteus, the foundation's vice president of research, evaluation and scientific programmes.

"We've said for years that science has to do better, which is why Komen is putting millions of dollars into research to detect breast cancer before symptoms start, through biomarkers, for example."

In February, Komen was embroiled in a controversy over its decision to stop funding for an abortion clinic group in the United States.

Exercise May Ease Depression Tied to Heart Failure

Researchers randomly assigned more than 2,300 heart failure patients in the United States to receive either education and usual care or supervised aerobic exercise for 90 minutes a week for the first three months followed by at-home aerobic exercise 120 minutes a week for the next nine months.

The patients in the exercise group had modest reductions in symptoms of depression after one year, compared with those in the usual care group, according to the study published in the Aug. 1 issue of the Journal of the American Medical Association.

Patients in the exercise group who most faithfully followed the aerobic workout program had the greatest decreases in depressive symptoms, but the absolute reduction was small, James Blumenthal, of Duke University Medical Center, and colleagues said in a journal news release.

The researchers also found that higher levels of depression symptoms were associated with a more than 20 percent increased risk for all-cause death and hospitalizations among the heart failure patients. This increased risk was independent of antidepressant use and known risk factors in heart failure patients, including age and disease severity.

Heart failure means the heart isn't pumping blood the way it should, which can cause fatigue, shortness of breath and fluid buildup in the lungs. About 5 million people in the United States have heart failure, and more than 500,000 new cases are diagnosed each year, according to background information in the study.

Depression affects as many as 40 percent of heart failure patients.

More information

The Heart Failure Society of America offers advice for managing feelings about heart failure.

Pigs under scrutiny at Midwest state fairs after flu outbreak

Ten new cases of influenza A (H3N2) variant were reported in Ohio and one in Indiana associated with attendance at agricultural fairs. Another case was reported from Hawaii.

"All of this week's reported cases occurred in people who had direct or indirect contact with swine prior to their illness," the Centers for Disease Control and Prevention in Atlanta said in a statement.

The reports had veterinarians at the Ohio and Indiana state fairs testing the animals for infections. Two hogs tested positive and were sent home from the Ohio State Fair, which ends on Sunday. No swine were found to be infected at the Indiana State Fair, which started on Friday and runs through August 19.

Missouri, Iowa and Illinois state fairs start next week. Minnesota's fair starts later in August.

In Butler County, Ohio, 10 human cases have been confirmed and 10 more people are being tested, said Patricia Burg, director of the county's health department. There have been no hospitalizations so far.

The hogs exhibition remained open Friday at the Ohio State Fair in Columbus, where veterinarians were checking the remaining animals as the fair winds down, said Erica Pitchford, spokeswoman for the Ohio agriculture department.

The focus on people was mainly on exhibitors who spend more time in the area than the general public, she said.

"The chances of the virus infecting anyone walking through the barn is very low," Pitchford said.

Swine influenza A viruses rarely infect humans, but can be spread when people are standing near an infected pig which coughs or sneezes. Humans also can get the virus by touching an infected pig or a surface that has been infected, and then touching their own mouth or nose.

The CDC officially has 29 U.S. reported human cases of influenza A variant H3N2 infections since July 2011. Ohio led with 10 cases, Indiana had 7, Iowa 3, Pennsylvania 3, Maine 2, West Virginia 2, Utah 1 and Hawaii 1.

Nineteen cases were associated with fairs where swine were present. Three people with high risk conditions have been hospitalized, but all have recovered.

Health officials in Indiana said on Friday they had confirmed 11 cases statewide of influenza A variant infections, all linked to swine, some of which were exhibited at local fairs, since July 2012.

"As Hoosiers visit fairs around the state this summer, they should take extra care to practice thorough hand washing and avoid eating when around animals," said Dr. Greg Larkin, Indiana's state health commissioner.

In Wisconsin, the state fair opened Thursday and agriculture officials are monitoring the situation, but have not considered canceling events involving swine, said Brian Bolan, the fair's director of agriculture and youth programs.

Dr. John Schiltz, Iowa's state veterinarian, said on Friday that livestock are examined first on the farm by private veterinarians and then at the fair where a veterinarian is available 24 hours a day to examine animals that show signs of illness.

"People are very conscientious and take the proper precautions to make sure their animals are healthy when they come in," Schiltz said.

Children under 5 and adults over 65, pregnant women, and people with chronic medical conditions such as asthma, diabetes or heart disease, are at high risk for serious complications from influenza and should consider avoiding exposure to pigs and swine barns this summer, the CDC said.

(Reporting by Allen Bernard in Columbus, Brendan O'Brien in Milwaukee, Kay Henderson in Des Moines, Kevin Murphy in Kansas City and David Dawson in New York; writing by David Bailey; Editing by Bob Burgdorfer)

PSA Screening Could Prevent Prostate Cancer Spread, but Would It Save Lives?

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Forgoing a test to detect prostate cancer could mean that three times as many men would fail to have the disease detected before it spreads to other organs, according to a paper in Cancer on July 30. This new finding arrives just months after the U.S. Preventative Service Task Force issued a recommendation against using PSA screening. The task force gave PSA screening a grade of "D," meaning it does more harm than good for most men.

The FDA approved PSA screening in 1986 as a diagnostic test to detect prostate cancer, and it has been controversial from the beginning. The screening has a high false positive rate because PSA levels rise from nonmalignant prostate growth. Additionally, many prostate cancers grow so slowly that they will never cause problems, and it is nearly impossible to tell which cancers need to be treated and which can be left alone.

Surgery or radiation used in treatment can produce incontinence or impotence. As with any surgery, there is a small risk of death or other serious complications, and it's painful, even under the best of circumstances. The task force analyzed several large studies and determined that the benefits of screening and treatment did not outweigh the risks.

The goal of the Cancer study was to determine how many cases of prostate cancer might be missed until they metastasized if PSA testing were eliminated. Metastatic prostate cancer, a malignancy that has spread to distant organs, is usually symptomatic, leading men to seek treatment. It's generally fatal within a few years. Researchers analyzed data from the Surveillance, Epidemiology, and End Results (SEER) Program to determine the prevalence of men who were diagnosed with metastatic prostate cancer as their initial prostate cancer diagnosis, rather than a less invasive form.

The researchers used data from 1983 to 1985, the three years immediately preceding the PSA screening test, to determine the rate of metastatic prostate cancer cases without screening and used the rate to extrapolate the number of cases in 2008, the latest year for which data are available.

They then compared the expected rates to the actual rates for that year and calculated that approximately 25,000 men would have been given an initial diagnosis of metastatic prostate cancer in 2008 without screening, as opposed to the approximately 8,000 who did.

Edward Messing, the senior author of the study, says that PSA is capable of detecting the disease earlier, which could, in theory lead to fewer deaths from prostate cancer. Marc Garnick, a prostate cancer expert at Harvard Medical School, points out, "this would have been a much more powerful study if they had mortality outcomes, not the incidence of metastatic disease."

In fact, Garnick says the clinical trials that have addressed mortality rates have already been done, and they indicate no difference in overall survival or prostate cancer survival in men who underwent screening. Studies like Messing's, he says, are trying to poke holes in the research. "Every single time these studies come out, the backlash is that the studies were flawed. I'm not aware of any program in medicine where randomized studies posed in prestigious journals come out with these negative conclusions, and everyone is trying to data mine the conclusions. It's unprecedented."

Garnick says that PSA screening is based on the faulty assumption that cancer starts small, becomes localized in the prostate, advances to nearby regions of the body, becomes metastatic, and then kills. If this were the case, screening studies should have showed that more lives were saved. "The screening studies show that there's no difference in mortality. The biology of the cancer trumps the stage of the cancer."

In addition, the largest difference between expected and observed metastatic cancer is in older age groups. "The headline seems to be coming from patients who are greater than 80 years old," Garnick says. But those patients often have many other health problems that lead to death before even aggressive prostate cancer.

Otis Brawley, a medical oncologist and chief medical officer of the American Cancer Society who was not involved with the study, says, "It certainly adds to the body of evidence, but it's by no means definitive." One problem is that many men whose initial diagnosis is localized, not metastasized, prostate cancer, end up relapsing even after having their prostate is removed. This means that the cancer had already metastasized by the time of the first diagnosis, but it could not be detected at that time. Those patients already had metastatic disease when screened, but they were not diagnosed at the time, and so they are not counted in Messing's study.

Another problem is that modeling studies, like this one, are inherently less powerful than other kinds of medical research: randomized clinical trials, the gold standard in medical research, in which patients are randomly assigned different treatments or no treatment; case-control studies, which compare patients who have a condition with those who do not; or cohort studies, which determine the risk of contracting a disease by studying a group of people with similar demographics. So the results from a modeling study, no matter how compelling, are not definitive. They should lead to other studies, and eventually clinical trials.

On both sides of the debate researchers agree that men should be informed of the risks and possible benefits of PSA screening and subsequent treatment before they start the process, a challenge when contradictory reports abound. Garnick says, "My heart goes out to both patients and physicians because the whole concept of screening, diagnosing and offering treatments is among the most complicated in medicine."

"What we need is a better biomarker that not only tells us that the patient has cancer but what the behavior of that cancer is likely to be," Garnick continues. "It becomes a circular argument until we get better biomarkers." For now, men and their families have to make tough choices about whether knowledge is power or ignorance is bliss.

Breast Cancer Charity Overstates Value of Mammograms: Researchers

The organization in question is the Susan G. Komen for the Cure, which stated in a 2011 advertisement that the five-year survival rate for breast cancer when caught early is 98 percent, while it is only 23 percent if not caught early.

"The survival statistics they present are eye-catching and compelling. They imply that a woman would be crazy and irresponsible if they didn't go for screening," said Dr. Steve Woloshin, co-author of the article challenging the charity. "But the statistics are deceptive."

According to Woloshin's commentary, which appears online Aug. 2 in the BMJ, a woman in her 50s who goes for regular mammograms for 10 years will only cut her chance of dying by a fraction of a percentage point -- for every 10,000 women who are screened 7 deaths will be prevented.

The reason for the discrepancy?

Survival statistics calculate how long a woman lives only after diagnosis, the researchers explained.

If 100 women were diagnosed with breast cancer after feeling a lump at age 67 and all died three years later at the age of 70, the five-year survival rate would be 0 percent.

But, if the cancers were detected by mammography when the women were 64 and they still died at the age of 70, the five-year survival would be 100 percent.

Komen also minimizes the harms that can come from over-screening, according to the article.

For every woman whose life is saved by mammography, between two and 10 women are overdiagnosed, meaning they are told they have cancer when they do not and end up going through unnecessary treatment.

And up to half of women who are screened every year for a decade receive at least one false positive, meaning they have to undergo a biopsy and experience the fear of thinking they have breast cancer, if only temporarily.

The article comes at a time when there has been increasing furor over the value of breast cancer screening. The U.S. Preventive Services Task Force now recommends that women in their 40s do not get regular mammograms.

In contrast, the American Cancer Society recommends that all women aged 40 and over get annual mammograms.

In the end, women need to get reliable information from their physicians or other sources about the risks and benefits of mammography. One problem is that not all primary care physicians know the right numbers to convey to their patients, according to a recent survey.

Overall, few doctors would argue that there isn't some benefit to mammography.

Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, supports the charity's push for cancer screening.

"As physicians, we feel that breast cancer screening is extremely beneficial," she said. "Screening does save lives, but it's probably not as dramatic as it's sometimes made out to be."

Adds Woloshin, who is professor of medicine and community and family medicine at Dartmouth School of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice: "There is some benefit but the magnitude is of a different order from what is implied by the ad. Women should make good decisions for themselves."

A representative of the Komen Foundation defended the organization's position.

"Everyone agrees that mammography isn't perfect, but it's the best widely available detection tool that we have today," said Chandini Portteus, Komen's vice president of research, evaluation and scientific programs. "We've said for years that science has to do better, which is why Komen is putting millions of dollars into research to detect breast cancer before symptoms start, through biomarkers, for example," she explained.

"Komen also is funding research to help accurately predict which tumors will spread and which won't," Portteus continued. "While we invest in getting those answers, we think it's simply irresponsible to effectively discourage women from taking steps to know what's going on with their health," she noted.

"The numbers are not in question," Portteus said. "Early detection allows for early treatment, which gives women the best chance of surviving breast cancer."

More information

The U.S. National Cancer Institute has more on breast cancer.

My Story: After Prostate Cancer Diagnosis, Finding the Mercy of the Angels Around Us

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Two years after having my diagnosis upgraded to Stage 4 metastatic disease, it happened. I finally had my SUPERSIZED come-apart last week. I suppose I shouldn’t have been too surprised. Working where I do, I’ve been able to keep a clinical and statistical lid on the simmering pot for quite a long time. Some who know me well, especially my wife, later told me they were waiting for the day when the volcano could no longer lay dormant and emotions would erupt unexpectedly.

My personal Vesuvius vs. Pompeii finally arrived last Monday. I will tell you, as the town lying in the shadow of the volcano, the siege came unexpectedly and with surprising force. The event was triggered by not one catalyst in particular, but by a series of smaller pre-quakes, which passed largely unnoticed.

An early morning meeting with a colleague took an unexpected turn when the discussion focused on me. What was I really feeling? Did I really believe that my outcome COULD be a bad one? How was my family dealing with it? What are my odds? These are questions and issues I have dealt with and answered freely for a while now. I wasn’t particularly shaken by the discussion. In fact, I went back to my desk and sent an email containing three entries from this blog with a note saying, …these might give you some more insights into my life… thanks for asking. Task done.

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Shortly after that, there was a phone call with a newly diagnosed patient who needed some fellow-patient insights on treatment and side effects. His case was very similar to mine. Within 15 minutes we bonded quickly, as members of this brotherhood do. I signed off wishing him well and asking him to keep me posted on his progress. Task done.

Then I read through a clinical study. It was the type that occasionally crops up and causes me to miss a heartbeat or two wondering which outcome group I would fall into. Task done.

Finally, there was another project that required me to check on some of my cancer brothers on Facebook…

As I stared into the screen, I was confronted by an entry from a fellow patient I have come to know quite well despite the distance. I knew he had been hospitalized the week before. His entry read…Countdown to chemo—T minus 5 hours. I slept well and am not really nervous to get this started. A few positive thoughts and prayers wouldn’t hurt however!! Here’s to the next chapter in the journey! As if that wasn’t enough, his photo, although he was smiling, was a far cry from the man I remembered.

Ground zero… eruption.

I was shocked. I couldn’t breathe. Within seconds, I found I was sobbing at my desk. At last, too much cancer had gotten to me.

No one wants to get teary-eyed at the office, no less be found sobbing at their desk. I turned my chair around to face the window and pretended to be reviewing some materials. I couldn’t tell you what I was looking at for the moment. Three times I tried dialing my wife who was away for the day. Three times I hung up. I knew I wouldn’t be able to coherently relay what was going on at the moment. I thought of my college friends in the South Bay and Orange County. I stopped mid-dial on both of those calls as well. My calls would only have caused them to wonder what was going on, and I would not be able to squeeze out an audible and comprehendible answer.

When the coast was clear, I plotted a course out the side door with a short recovery in the men’s room that was followed by a beeline to another colleague’s office. She, a double cancer survivor, took one look at me, and I started again. But I was at least in safer territory. She looked at me and said, “Dan, I know what you’re going through… you are thinking about coming off of treatment in several weeks…” She was right. My wife and I have spoken of this several times in the past few weeks. In fact, she was the first to spot that fear in me.

Although I recovered a bit, every five minutes brought on a new eruption. I knew I had to call it a day and hastily asked for “permission to escape cancer,” which was immediately granted.

Driving back to the South Bay, I took time to stop and look at the ocean. I was still in the throes of my meltdown, but the cool breezes at least provided some comfort. I knew I couldn’t go home yet and face my boys in this condition, so when I thought I had recovered sufficiently, I welcomed two stops I had to make.

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It was these stops that reminded me how compassionate others can be. At both places the sight of a familiar face caused me to lose it once again. At both stops I was taken in and given an opportunity to let my emotions out and breathe. They passed the tissues and just listened. They let me take the time I needed to recover. They found ways to make me laugh. I am grateful for their kindness. It’s remarkable given that I have just gotten to know them to any extent in the past few weeks.

By the time I arrived at home, I was finally calm enough to dial my wife and, among much gentler tears, relay what had happened to me that day and soak in her comfort.

If this journey has taught me nothing more than to acknowledge the mercy of the angels around us—those well known and those who present themselves when needed—it is beyond a doubt a journey worth taking.

Blessings to all our caretakers, loved ones, friends and acquaintances who catch us when we fall.

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Dan Zenka is senior vice president of the Prostate Cancer Foundation. In 2010 he was diagnosed with the disease and started the blog My New York Minute to share information and patient perspectives and to encourage men to talk about prostate cancer.