Methodist Healthcare Ministries

4507 Medical Drive
San Antonio, TX 78229
P 210.692.0234 | Toll-Free 1.800.959.6673


Methodist Healthcare Ministries Overview

Methodist Healthcare Ministries (MHM) is a private, faith-based, not-for-profit organization dedicated to providing medical, dental and health-related human services to low-income families and the uninsured in South Texas. The mission of the organization is “Serving Humanity to Honor God” by improving the physical, mental and spiritual health of those least served in the Southwest Texas Conference area of The United Methodist Church. MHM is one-half owner of the Methodist Healthcare System – the largest healthcare system in South Texas.

These services include primary care medical and dental clinics, support services like counseling, case management and social services, family wellness and parenting programs, and church-based community nursing programs.

MHM also works with similarly-focused organizations and state government in developing more socially conscious public policy. The purpose is to change legislative perspectives and policies so that the root of the problems of the underserved are addressed for the long term. In addition, MHM provides financial support to established organizations that are already effectively fulfilling the needs of the underserved in local communities through programs and services that they already operate.

MHM Featured Video

Neuroscience Articles

  • U.S. pediatricians reaffirm opposition to legalized pot

    By Andrew M. Seaman

    (Reuters Health) - Despite moves by some states to allow recreational and medical use of marijuana, a large group of U.S. pediatricians says in a new statement that the substance should remain - for the most part - illegal.

    In an update to its 2004 position statement on the matter, the American Academy of Pediatrics also calls for decriminalization of marijuana to lessen the lasting effects of criminal charges brought against youths - especially minorities.

    While it doesn't support legalization, the Academy says the penalties for being caught with the substance should be reduced because a criminal record can have a lasting impact on people's lives, causing them to have trouble getting jobs, housing and loans for education.

    Decriminalization of marijuana "takes this whole issue out of the criminal justice system and puts it into the health system, where it really should be," said Dr. Seth Ammerman, the statement's lead author from Stanford University in California.

    "What that would look like - we hope - (is) if you're found to be in possession of marijuana as a kid, instead of going to jail, juvenile hall or getting some sort of record, you'd be put in some sort of diversion or treatment program," Ammerman told Reuters Health.

    But while people often say marijuana is as benign as alcohol for adults, Ammerman said it's the Academy's position that the same is not true for children and adolescents.

    "It's not benign for youth," he said. "It may be benign for adults, but the Academy feels strongly that alcohol is not benign for youths either."

    The statement says the negative effects of marijuana on adolescents are well documented, including impaired short-term memory and decreased concentration and problem solving.

    Marijuana also affects motor control, which may contribute to deaths or injuries through traffic and other accidents. There are also more recent questions as to whether early use of the substance affects the brain.

    "There has been some interesting brain development research that shows the brain continues to develop into the mid-20s, and there is some research in regular to heavy users that their brain development is not normal," Ammerman said.

    While the organization is opposed to the legalization of marijuana because of the potential harm to children and adolescents, it supports studies of the effects of legalization, in states where sale and possession are allowed, in order to inform future policies and reduce use among youth.

    So far, Washington, Colorado, Oregon, Alaska and the District of Columbia allow recreational sale and/or possession of marijuana by adults. Twenty-three states and the District of Columbia allow medical use of marijuana.

    The Academy also opposes the legalization of marijuana for medical uses that haven't been evaluated through proper regulatory channels, such as the U.S. Food and Drug Administration.

    One sticking point, according to Ammerman, is that many of the ingredients in marijuana - known as cannabinoids - have not been studied.

    "There are over 200 - minimum if not more than that - and we know very little about them," he said. "These cannabinoids can have therapeutic value, but there have been no studies in children or adolescents."

    The statement does make an exception for children with a terminal illness or debilitating disease, saying marijuana should remain an option for them.

    Ammerman said the Academy also recommends that parents not use marijuana around their children.

    "They really need to be careful about their use especially around their kids and understand that kids' brains are different than adults and be good role models," he said.

    SOURCE: Pediatrics, online January 26, 2015.

  • Could flu vaccination protect your sense of smell?

    By Shereen Lehman

    (Reuters Health) - In a small new study, skipping the flu vaccine was associated with a higher risk for trouble with a sense of smell or taste.

    Researchers say the results are preliminary, but since respiratory viruses are a common cause of a lost ability to smell, it's possible that the flu could be a contributing factor.

    Respiratory viruses can damage olfactory nerves directly and indirectly by causing inflammation. Sometimes the effect is temporary, but not always, Dr. Zara Patel and colleagues at the Emory University School of Medicine in Atlanta, Georgia write in JAMA Otolaryngology-Head and Neck Surgery.

    "Patients who suffer from decreased or total loss of smell, called 'hyposmia' or 'anosmia' are deeply affected by this problem," Patel told Reuters Health by email.

    "Compared to the other special senses, for example, loss of vision or hearing, the loss of smell is often thought of as relatively inconsequential, but this is far from the truth," Patel said.

    People who can't smell may lose important safety mechanisms, such as the ability to smell smoke or spoiled food, Patel said. And 80 percent of taste is linked to smell, so a total loss of smell could ruin a person's ability to enjoy food and beverages and have a negative effect on their social life.

    "This can (and often does) lead to deep depression and a drastic reduction in quality of life," Patel said, adding there is currently no established cure for the problem.

    Patel said hundreds of different respiratory viruses might have an effect like this, including some 200 viruses that cause the common cold. But the influenza virus may be preventable with vaccines.

    "I saw this as a potential opportunity to (look for) any association between rate of vaccination and rate of (olfactory) loss, and see if there's a way to eventually use this information," she said.

    Patel and colleagues identified 36 patients with olfactory problems that started after upper respiratory infections. The average duration of loss of smell was about 19 months but ranged from three to 48 months.

    They compared those patients to 38 patients of the same race, age and gender, but without olfactory problems.

    Overall, only 19 percent of the group with smell problems had been vaccinated against the flu, compared to 42 percent of the group who had no loss of smell.

    It's important to note this is a small study, and more research needs to be done, Patel cautioned.

    Now her team needs to look at this same subject with more rigorously designed studies, she said.

    Patel said viruses aren't the only cause of smell dysfunction - sinus disease, trauma and tumors are other potential causes.

    She said a few people will spontaneously recover their sense of smell after losing it, but this chance decreases as time passes from the first month after the loss.

    "If people realize they are not able to smell or taste as well as they used to, they should seek care from an otolaryngologist as soon as possible," Patel said. "Because the longer the amount of time that passes before they are able to start treatment, the less chance they have for recovery."

    SOURCE: JAMA Otolaryngology-Head and Neck Surgery, online January 15, 2015.

  • Superbug spread through contaminated scopes sickened dozens in Seattle

    By Victoria Cavaliere

    SEATTLE (Reuters) - A drug-resistant superbug infected 32 people at a Seattle hospital over a two-year period, with the bacteria spreading through contaminated medical scopes that had been cleaned to the manufacturer's recommendation, officials said on Thursday.

    Eleven of the patients infected at Virginia Mason Medical Center between 2012 and 2014 eventually died, the hospital and city health officials said. But those patients were critically ill before being infected and it was unclear what role, if any, the bacteria played in their deaths.

    The patients were infected with drug-resistant bacteria, including the rare Carbapenem-resistant enterobacteriaceae, which are difficult to treat because they have high levels of resistance to antibiotics, said Dr. Jeffrey Duchin, a senior official at Public Health - Seattle & King County.

    The report follows similar incidents in Pittsburgh in 2012 and Chicago in 2014, where contaminated endoscopes infected dozens of patients, health officials said. No fatalities were directly linked to the infections.

    In the Seattle case, public health officials said the germs apparently spread from patient to patient by endoscopes used to treat liver and pancreatic illnesses. Duchin said the scopes are typically used for thousands of procedures each year in U.S. hospitals.

    The scopes at Virginia Mason Medical Center were sterilized to existing standards before each use, public health officials and the hospital said.

    "This is a national problem," Virginia Mason Medical Center said in a statement. "We determined that the endoscope manufacturer's, as well as the federal government's, recommended guidelines for processing the scopes are inadequate."

    Duchin said it took investigators many months to pinpoint the contamination, and the hospital has since instituted a rigorous decontamination process that exceeds national standards.

    There are three major manufacturers of the scopes, called duodenoscopes: Olympus, Fujifilm and Pentax. Their disinfection recommendations were approved by the U.S. Food and Drug Administration.

    The FDA did not immediately comment on whether new standards were being pursued. Olympus, which supplies many of the Seattle hospital's scopes, was not immediately available for comment.

    It was unclear how many people were exposed to the superbug, officials said. The bacteria can cause serious infections such as pneumonia, bloodstream infections, urinary tract infections, and meningitis. The infections typically occur in ill patients.

    Neither Virginia Mason nor Public Health - Seattle & King County notified the public about the outbreak because "there was not a strong rationale for doing so," Duchin said.

  • Mobile game may have lasting benefit for "lazy" eye

    By Andrew M. Seaman

    (Reuters Health) - Children who had their "lazy" eye treated with an experimental mobile game continued to benefit for an entire year, according to a new study.

    "Lazy" eye, known medically as amblyopia, occurs when the eye cannot clearly focus. Sometimes it's caused by a person's eyes being misaligned.

    The usual treatment is to wear a patch over the "strong" eye, "to force the use of the amblyopic or weak eye," said Eileen Birch, the study's senior author. Patching the strong eye forces the brain to rely on the weak eye.

    "That does work, but there's been some research lately (suggesting) that's not really the right approach," said Birch, who is senior scientist at the Retina Foundation of the Southwest in Dallas. She said the condition often recurs after patching.

    Additionally, Birch said, the treatment for amblyopia should also teach both eyes to work together.

    For the new study, the researchers continued to follow children who were treated for amblyopia in an earlier study using an experimental game on an iPad. The game required the children to stack falling blocks while wearing glasses with lenses that are different colors.

    By playing with the color and contrast settings for the game, researchers were able to require each eye to work toward stacking the blocks. Additionally, they were able to require the children's eyes to work together.

    After a few weeks, the researchers found children who used the game had improved visual acuity, which is how much detail they're able to see. Another research team also found improvements in visual acuity among adults.

    During the first study, the researchers found that the children's improved vision remained stable for three months after they finished treatment. The new study, reported in JAMA Ophthalmology, found the improvement lasted for an entire year.

    In the new study, the researchers found the improvement in vision among kids who used the game did not differ between children who used an eye patch in an attempt to make the benefits last and those who didn't.

    "The kids who had no patching afterwards did just as well as the kids who tried the maintenance patching," Birch said.

    While the app is not available to the average person, she said there is a new trial underway to test the game's effectiveness in a much larger group of children.

    "There is a lot of interest in it," Birch said. "We'll find out in a clinical setting whether it's helpful for children to have this."

    SOURCE: JAMA Ophthalmology, online January 22, 2015.

  • REFILE-Costly, complex headache treatment on the rise

    (Corrects They to The in 10th paragraph)

    By Shereen Lehman

    (Reuters Health) - Contrary to most treatment guidelines for uncomplicated headaches, doctors are ordering expensive scans and referring patients to specialists more often, racking up unnecessary healthcare costs, a new study finds.

    "In U.S. healthcare we have a general overtreatment problem and headache is no different except that with headaches a lot of the overtreatment is potentially low value and high cost," said lead author Dr. John Mafi, an internal medicine fellow at Beth Israel Deaconess Medical Center in Boston.

    The great majority of people will experience a headache at some point in life, and about one in four Americans have recurrent severe headaches such as migraines. About 12 million Americans visit their doctors complaining of headaches each year at an annual cost of about $31 billion, Mafi and his colleagues write in the Journal of General Internal Medicine.

    Most evidence-based guidelines for headaches advise conservative treatments such as counseling about stress reduction or avoiding dietary triggers for headaches, and reserve imaging or specialty referrals for "red flag" headaches that stem from neurologic problems, cancer, trauma or human immunodeficiency virus (HIV), the authors note.

    "Oftentimes less can be more, particularly for things like uncomplicated headache where the vast majority of times they'll go away on their own with very conservative treatment and by listening to your body and really paying attention to the triggers," Mafi told Reuters Health.

    Mafi thinks many people have a misconception that more referrals and tests equal better care than simple, but often effective, lifestyle counseling.

    To analyze trends in headache treatment from 1999 to 2010, Mafi and colleagues looked at national healthcare databases. They examined more than 9,000 physician visits that were representative of the 144 million total visits for headache during that time period. The study team omitted visits for headaches associated with red flag conditions.

    The researchers discovered that use of advanced imaging procedures such as CT scans and MRIs rose from less than 7 percent of visits in 1999-2000 to almost 14 percent in 2009-2010. Referrals to other physicians increased from about 7 percent to 13 percent.

    The use of over-the-counter medications remained stable at approximately 16 percent, but use of anti-migraine medications such as triptans and ergot alkaloids rose from about 10 percent to more than 15 percent. Opioid and barbiturate use remained unchanged.

    The study team also found that clinician counseling for lifestyle changes dropped from almost 24 percent of visits to less than 19 percent.

    Mafi doesn't blame primary care providers, saying they're overworked, and there are financial and medico-legal pressures to order excessive testing procedures.

    He thinks the current "20-minute model" of healthcare is broken and suggests moving toward one that reimburses electronic communications and secure messaging, along with patients' ability to enter their information online.

    "There's less time than ever in the primary care visits because the doctors are increasingly hurried, it's just that much easier to click a button, order the test and move on because it takes so much more effort and time to actually counsel the patient and to explain to the patient why a test is unnecessary," he said.

    In their report, Mafi's team notes that the increase in the use of scans such as CT and MRI is "of particular concern" because of the added costs and potential harms of the scans themselves. In addition to the anxiety provoked in patients, scans may lead to unnecessary follow-up tests and incidental findings.

    Moreover, contrast dyes used for some kinds of scans can provoke allergies or kidney problems, they note. Finally, they write, the unnecessary exposure to radiation is also a hazard, pointing to an estimate that 4,000 additional cancers were created by the 18 million head CT scans performed in the U.S. in 2007.

    For busy clinicians, Mafi said, "One of the most important things that primary care can do is to stress nonpharmacological therapies, so just going over common dietary triggers like caffeine, chocolate and alcohol."

    He added that counseling patients on good sleep hygiene and stress reduction are also important. "And most important (counseling on) just leading an overall healthy lifestyle with a balanced diet rich in fruits and vegetables, and getting plenty of exercise."

    Mafi said that having patients keep a daily diary of the events leading up to a headache is critical in helping to identify the patient's personal triggers.

    "And when they can identify all the different triggers in their life, they can make active changes that actually prevent headaches from starting, which could actually lessen the need for more tests, medications and even doctor visits," he said.

    SOURCE: Journal of General Internal Medicine, online January 8, 2015.

Oncology Articles

  • Breast cancer patients lack knowledge of their tumors

    By Andrew M. Seaman

    (Reuters Health) - Women with breast cancer often don't know what kind of tumors they have, a new study found.

    Not knowing one's tumor features isn't necessarily tied to worse outcomes, but better knowledge might help women understand treatment decisions and take medications as directed, said Dr. Rachel Freedman, the study's lead author from the Dana-Farber Cancer Institute in Boston.

    Also, she said, cancer patients who understand the basis for their treatment are generally more satisfied with that treatment.

    "Nobody to my knowledge has asked how much knowledge someone had of their own disease," she added.

    For the new study, published in the journal Cancer, Freedman and her colleagues asked 500 women from northern California about their breast cancers, which had been diagnosed between 2010 and 2011.

    Participants were asked about their tumor grade, tumor stage and whether or not their cancer feeds off the hormone estrogen or a protein called human epidermal growth factor receptor 2 (HER2).

    Fifty-five percent of women said they knew if their tumor fed off estrogen, and about a third said they knew their HER2 status. About a third said they knew their tumor's grade, which is the cancer's aggressiveness. And 82 percent of women said they knew their tumor's stage, which is how advanced the cancer is.

    Based on their medical records, only 56 percent of women reported the correct estrogen status, 58 percent reported the correct HER2 status and 57 percent reported the correct stage. Only about one in five women reported the correct grade.

    Overall, only 8 percent of women correctly answered all four questions, but the lack of knowledge was more pronounced among minority women, the researchers report.

    "Even though all these questions were low for all women, we did see difference by race and ethnicity," Freedman said.

    "What's really nice about finding something like this is that it's a modifiable problem," Freedman said. "If you can improve education and provider awareness of this, you can do something about this in the clinic."

    Dr. Michelle Shayne of the James P. Wilmot Cancer Center at the University of Rochester School of Medicine and Dentistry in Rochester, New York, who was not involved in the study, told Reuters Health, "Breast cancer patients in general are a very savvy group of individuals."

    They "tend to read a lot and bring a lot of clippings in to their oncologist and ask a lot of questions," she said, so the study findings surprised her.

    The results show that oncologists need to tailor their discussions about cancer to individual patients as much as they tailor the treatments, she said.

    Also, she said, cancer survivors should receive detailed treatment histories and information about their tumors for future medical care.

    Freedman said that in her own practice, she's been trying to explain patients' cancers in more detail, writing down the specifics and making sure they understand the information.

    "I think this raises awareness of the issue," she said. "This may be a more important issue than we previously appreciated."

    SOURCE: Cancer, online January 26, 2015.

  • Heeding musicians, New Orleans moves to ban smoking in bars

    By Jonathan Kaminsky

    NEW ORLEANS (Reuters) - The New Orleans City Council voted on Thursday to ban smoking in the city's bars, a move supported by several prominent local musicians who said the issue was for them a matter of workplace health.

    Most large U.S. cities already have such restrictions in place, anti-smoking advocates said, though smoking is still permitted in bars in cities including Las Vegas, Atlanta and Miami, and across much of the southeastern United States.

    The measure initially proposed in New Orleans included a ban on smoking in many outdoor areas, including parks and at city-sponsored festivals, but council members removed those restrictions before their unanimous vote to bar people from lighting up in bars and casinos.

    Smoking has been banned in Louisiana restaurants since 2007.

    The measure, which has the support of New Orleans Mayor Mitch Landrieu, is expected to take effect in April.

    "In the same way that government is responsible to make sure that there are guards on dangerous machinery, we are responsible to protect the workers in our city, including the workers in bars and casinos," said Councilwoman Susan Guidry before casting her vote.

    The ban received backing from prominent local musicians, including Kermit Ruffins, Irvin Mayfield and Deacon John Moore. Some bar owners and the casino industry opposed it, warning that it will harm business.

    The ban also covers the use of e-cigarettes, angering those who view the metal tubes that heat liquid into an inhalable vapor as less harmful than traditional cigarettes, both to their users and to those inhaling their contents secondhand.

    It exempts existing hookah bars, cigar bars, and businesses catering specifically to e-cigarettes, known as vape shops.

  • California lawmakers introduce Oregon-style assisted suicide bill

    By Alex Dobuzinskis

    (Reuters) - California lawmakers introduced a bill on Wednesday to legalize assisted suicide in the most populous U.S. state, an effort tearfully welcomed by a woman whose daughter moved to Oregon last year to avail herself of a death-with-dignity law there.

    The bill proposed by two Democratic state senators is similar to the physician-assisted suicide statute approved by Oregon voters in 1994. As in Oregon, it would require a determination from two doctors that a patient has six months or less to live before a drug to hasten death could be prescribed.

    The California bill also would emulate Oregon's law by requiring a patient seeking life-ending medical assistance to present two separate requests to an attending physician and for two witnesses to attest to the patient's wish to die.

    Sponsors of the legislation were joined at a news conference in Sacramento by Debbie Ziegler, whose daughter, Brittany Maynard, moved from the San Francisco Bay Area to Portland, Oregon, after she was diagnosed with terminal brain cancer.

    Maynard, 29, became the face of the right-to-die movement as she shared her feelings about her impending death on the Internet and was featured on the cover of People magazine before she ended her life on Nov. 1.

    Maynard's death gave increased momentum to legalizing assisted suicide, which is opposed by some advocates for the elderly and the disabled. They say making that option available could lead vulnerable people to end their lives prematurely.

    Critics cite concerns that some patients might end up being "steered" toward assisted suicide if insurers deny or even delay coverage for costly life-sustaining medical treatments.

    Since Maynard went public with her diagnosis in October, lawmakers have pledged to introduce assisted suicide legislation in 13 states, according to the office of California Senator Bill Monning, who co-authored the bill in Sacramento. In addition to Oregon, such laws are on the books in Washington state, Vermont and Montana.

    "Stand up and make your voice heard, even if it shakes like mine. Please help me carry out my daughter's legacy," Ziegler said, adding that her daughter gained a measure of peace from knowing she could end her life on her own terms.

    She recalled taking an Alaska cruise with her daughter and gazing into tide pools.

    "For those minutes of time, she forgot that she was dying and she just lived," Ziegler said.

  • The smoke around e-cig science

    By Sara Ledwith

    LONDON (Reuters) - From Apple Pie to Bubbly Bubble Gum, Irish Car Bomb or Martian bar - from Mars!, the flavors of electronic cigarette offer something for every taste.

    Researchers have counted 7,764 varieties of "vape." That adds up to one of many challenges - from practical constraints to conflicts of interest - in working out how safe e-cigs are, and whether they help smokers quit.

    Most scientists agree e-cigs have potential as a stop-smoking aid. They can be used with or without nicotine and are free of the thousands of toxins in conventional cigarettes. But e-cigs also throw up some unusual obstacles.

    Drug firms usually test one treatment against another. With e-cigarettes, the huge variety of constantly evolving products means it would be prohibitively expensive to test every flavor and vaporizer.

    "E-cigs are really the first product I'm aware of that have challenged pharma in this way," said Chris Bullen, an associate professor at the University of Auckland and author of one of two randomized trials of e-cigs in a recent major review of the science. "I guess many alternative 'natural' products raise similar issues when they start to make health claims."

    E-cigarettes can look like ordinary smokes but are metal and plastic battery-powered gadgets that heat flavored liquids into a cloud which users suck in, then exhale as dense white plumes. Invented in their present form in China about a decade ago, e-cigarettes generated $4 billion to $5 billion in sales in 2014, according to Euromonitor, a market research firm.

    The gadgets themselves come in hundreds of brands and are constantly morphing, at the hands of both users and the small-scale distributors who sell them online.

    Because they are a strange hybrid between smoking - which kills nearly 6 million people a year - and stop-smoking medications, e-cigs rival both tobacco and pharma. Tobacco companies have responded to that threat by buying up e-cig businesses, and are now funding research. Pharma firms have kept their distance.

    The products have also opened a rift between researchers who see their goal as eliminating nicotine in all its forms, and others who believe it makes more sense to reduce the harm of smoking.

    "You've got people who've taken a position and they're looking at the evidence only in relation to the position they've got," David Sweanor, an e-cig enthusiast and law professor at the University of Ottawa, told an e-cigarette symposium in London in November.


    There are more than 2,000 papers on e-cigarettes in the scholarly journals covered by the Web of Science, a database. Of those in the highest impact journals, most have been funded by public bodies. Only a few contain original research; methodological problems or potential bias are common, scientists have found.

    Last month, in an attempt to clear matters up, Bullen and other scientists in Britain and New Zealand published their assessment of the most impartial studies. Known as a Cochrane Review - a study of the best science on a subject - it aimed to see if e-cigs can help people stop smoking.

    The review concluded that e-cigs may help smokers quit, and that there is little sign that they hurt users.

    But it found the evidence thin and data poor. Of almost 600 studies analyzed, only 13 published papers were up to the Cochrane standard. Just two were randomized controlled trials, the most rigorous test.

    Big Pharma is not helping. The pharmaceutical industry has backed efforts to restrict e-cigarettes and is not sponsoring a single current e-cigarette trial in the U.S. National Institutes of Health database.

    For drugs firms, smoking cessation is a small business, generating $2.4 billion in sales in 2013, according to Euromonitor. That's just a fraction of the $206 billion the industry generated in global consumer health products.

    "We've decided we're not going to play (in e-cigs)," GlaxoSmithKline Chief Executive Andrew Witty told Reuters. "We've consciously had a think about it but we're not going to play."


    This leaves e-cigarette companies to fund their own research, giving rise to concerns over conflicts of interest.

    In 2010 one European e-cig distributor, Italian firm Arbi Group Srl, sponsored a significant body of work by a team at Catania University in Sicily. Catania researchers are among the most prolific, records in the Web of Science show; they conducted the second of the two randomized trials included in the Cochrane Review and are working on nine of the 48 trials on e-cigarettes logged with the U.S. National Institutes of Health (NIH).

    The Catania randomized trial took 300 smokers who did not intend to quit and found that, with or without nicotine, e-cigarettes cut cigarette consumption and helped some people stop completely, without significant adverse effects. That supported claims e-cigarettes had a role reducing the harm of smoking.

    "At the end of the day we were stuck accepting money from e-cigarette owners because there was no other way to carry out research," said Catania professor Riccardo Polosa, who designed the trial. He said he had also received funding from pharma.

    That, says Charlotta Pisinger, a Danish doctor who runs stop-smoking clinics, is a problem. Last October she published a review which found one in three e-cigarette studies had a conflict of interest because they were funded by e-cig manufacturers, pharma or tobacco, or a combination. She saw evidence of bias: "We must exercise the utmost caution in trusting their conclusions," she wrote.

    Experienced medical researchers say industry funding to test new products is the norm.

    "The majority of clinical research is sponsored by the manufacturers," said David Tovey, editor in chief of the Cochrane Library, which vets Cochrane Reviews. Another Cochrane study has found that scientific studies sponsored by private industry generally reported greater benefits and fewer harmful side effects than studies industry did not sponsor.


    E-cigarette opponents are also being scrutinized for bias.

    A 2014 U.S. review of the literature, carried out for the World Health Organization at the University of California, San Francisco (UCSF), said that the two randomized trials had shown e-cigarettes were no better than other nicotine replacement therapies at helping people quit.

    In August, the World Health Organization recommended that smokers should be encouraged to try already approved treatments, rather than e-cigs.

    Stanton Glantz, a veteran campaigner in the war against Big Tobacco and professor at UCSF, was one author of the U.S. review. But some researchers say activists like Glantz may have been prejudiced against e-cigarettes by their past battles with the tobacco industry.

    Robert West, a professor at University College London, is an e-cigarette enthusiast who has been funded by pharma, but not by e-cig makers. He says some opponents present themselves as unbiased, but "their professional and moral stance represents a substantial vested interest."

    Glantz says he started his review "completely agnostic."


    To add to the controversy, Big Tobacco is getting more deeply involved. E-cigarettes are a threat to the $722 billion retail sales of conventional cigarettes globally in 2013, but they are also an opportunity. Fewer people are smoking in the rich world. Shane MacGuill, senior tobacco analyst at Euromonitor, calls tobacco a "terminally sick" industry. E-cigarettes may offset the decline.

    Firms including Reynolds American Inc. and Imperial Tobacco Group PLC have sponsored seven of the e-cig trials in the NIH trials database.

    Tobacco executives mingled with researchers and anti-smoking activists at the London symposium last November. The conference was held at the Royal Society, an association of scientists whose fellows include around 80 Nobel Laureates. Beneath portraits of such illustrious figures as Stephen Hawking, delegates puffed on vaporizers.

    Some delegates said they found being in the same room as tobacco firms discomfiting. The industry's history of suppressing the truth about tobacco's risks still prompts some universities and academic journals to shun tobacco, and the World Health Organization is forbidden from collaborating with it.

    E-cigs are helping tobacco companies transform their image. Firms that for years denied tobacco's harms now emphasize that nicotine itself is not harmful, we just need safer ways to administer it. Some are stepping into smoking cessation: British American Tobacco already has a medical license for a medicinal nicotine inhaler. A Reynolds subsidiary sells nicotine gum.

    Big Tobacco has some support among those in public health who think it won't be necessary to eliminate nicotine, so we should reduce the harm of smoking. But as universities ban association with tobacco firms, it will become even harder for independent researchers to study vaping.

  • Ramping up e-cigarette voltage produces more formaldehyde -study

    By Toni Clarke

    WASHINGTON (Reuters) - People who smoke high-voltage e-cigarettes have greater exposure to formaldehyde, a suspected carcinogen, than those who keep the voltage low, according to a study published in the New England Journal of Medicine on Wednesday.

    The study, which critics say is misleading and lacks context, is the latest contribution to a debate on the safety of e-cigarettes that has so far has yielded little long-term data, though most experts believe they are less toxic than combustible cigarettes.

    Researchers from Portland State University took flavored nicotine liquid made by Halo Cigs, a private company, and tested it in a personal vaporizer from Innokin. The vaporizer allows consumers to adjust the voltage from 3.3V to 5.0V. The higher the voltage the greater the nicotine kick, but also the greater the amount of formaldehyde.

    E-cigarette liquids typically contain propylene glycol, which when heated is known to release formaldehyde gas. "Vaping" at high voltage also produced formaldehyde-containing compounds known as hemiacetals, the researchers found.

    Formaldehyde inhaled as a gas has been associated with an increased risk of leukemia and nasopharyngeal cancer, which affects the upper part of the throat behind the nose.

    It is not known exactly where formaldehyde contained in hemiacetals gets deposited in the body or whether it is similarly toxic, said James Pankow, one of the study's authors.

    "There has never been a cancer study with hemiacetals," Pankow said in an interview.

    Absent such a study, the authors estimated the formaldehyde-related cancer risk associated with e-cigarettes by extrapolating from data on formaldehyde in cigarettes.

    They concluded that the life-time risk of developing formaldehyde-related cancer at roughly 1 in 200 for high-voltage e-cigarettes versus 1 in 1,000 for cigarettes - at least five times higher. They found no increased risk for people vaping at a low voltage.

    Dr. Neal Benowitz, a nicotine expert at the University of California, San Francisco, said the study could prove useful to the U.S. Food and Drug Administration as it prepares to regulate e-cigarettes, potentially including limits on formaldehyde.

    But he questioned the legitimacy of comparing the effect of formaldehyde delivered in a cigarette to that delivered via hemiacetal, in droplet form, in an e-cigarette. The effect on organs could be entirely different, he said.

    Other critics said that in the real world most "vapers" do not push the voltage to the levels seen in the study as the taste would become unpalatable. They also noted that the overall health risk of conventional cigarettes, which contain 70,000 toxins in addition to formaldehyde, is far greater than any formaldehyde risk associated with e-cigarettes.

    "Lifelong smokers face a greater than 1 in 2 chance of dying from smoking-related diseases, including a roughly 1 in 10 chance of dying from lung cancer," said Jed Rose, director of the Center for Smoking Cessation at Duke University Medical Center.

    Pankow conceded that the study could have contained more context about overall relative risk, but said the authors "just wanted to get it out."

    They submitted it to the NEJM in the form of a letter, which a spokeswoman for the journal said was peer-reviewed. Pankow said letters tend to be less detailed than other studies.

    David Abrams, executive director of the Schroeder Institute for Tobacco Research and Policy Studies at the anti-tobacco group Legacy, said he was concerned the study would be taken out of context "in the worst possible way."

    For most vapers who use e-cigarettes as intended, he said, the findings show "there are non-detectable levels of formaldehyde ... which means people can use them to help them quit smoking lethal cigarettes."

    SOURCE: NEJM, online January 21, 2015.

Orthopedic Articles

  • Portable X-ray services becoming more common

    By Daniel Gaitan

    (Reuters Health) - Portable X-ray services are becoming more popular as patients seek medical care in familiar surroundings.

    Proponents say-home X-ray services help frail patients avoid difficult and potentially hazardous trips to hospitals. Other patients seek in-home providers out of convenience, as an ankle or chest X-ray can take less than 20 minutes.

    "We go to the patient and take the X-ray, rather than having the patient go to the doctor's office," said Paul Fowler, founder of Specialty Portable X-Ray, Inc. in New York.

    "Usually, in about an hour after we take an X-ray we give these results directly to the doctor," he told Reuters Health. "With the digital X-rays, we are using probably less exposure than you would at the hospital."

    Patients must have a doctor's prescription for an x-ray, or for an ultrasound exam, which can also be done at home. Fowler's company charges about $300 for a visit for patients without health insurance, he said. Some celebrities seek his services to avoid paparazzi and unwanted attention.

    "The very wealthy who don't want to go to the emergency room, they feel like they're above that, they'll call us and say, 'I twisted my ankle, can you come over and take an X-ray of my ankle,' " he added. "I've been doing it for 35 years, it's just gotten bigger and better over the years."

    Jacob R. Wuerstle, president of Diagnostic X-ray Service, Inc. in Pennsylvania, said portable X-rays are also used in assisted living facilities and prisons.

    "We keep the patients in a setting that they're familiar with, that they're comfortable with," he told Reuters Health. The option for home X-rays is especially helpful for elderly patients in snowy parts of the country.

    His technicians scan more than 30,000 patients per year. Sessions cost about $200. "We use state-of-the-art equipment and we transmit right from the patient's bedside to the radiologist," he said.

    Wuerstle said baby boomers are the fastest growing segment of clients.

    Dr. James C. Carr, a professor of radiology at Northwestern University's Feinberg School of Medicine in Chicago, believes trained technicians using portable machines can provide quality scans for patients in rural areas or unable to move.

    "As long as the equipment is being regulated and the technologists are satisfactorily trained, concerns can be mitigated," he told Reuters Health.

    But portable X-ray machines, while convenient, may be less accurate.

    Dr. David Levin, professor and chairman emeritus of the Department of Radiology at Thomas Jefferson University Hospital in Philadelphia said he would not recommend in-home X-rays for mobile patients.

    "The quality of those images is usually not very good. If you compare the quality of those kinds of studies with the quality of a study that was performed in a hospital in a radiology department or in a private radiology office, there is going to be no comparison," he told Reuters Health. "If a portable X-ray is absolutely necessary because of the patient's clinical condition, then it's justifiable."

    As the portable X-ray market grows, state and federal regulations for radiation protection must be followed, said Dr. William Thorwarth, Jr., chief executive officer of the American College of Radiology in Virginia.

    "You want to be very certain that the technologist who's acquiring the images is appropriately trained and qualified," he told Reuters Health. "There needs to be appropriate precautions so that other people in the house are not exposed."

  • Heavy soccer playing before age 12 tied to later hip deformities

    By Kathryn Doyle

    (Reuters Heath) - In a study of Dutch professional footballers, a bone deformity at the hip was much more common among men who started playing the sport at least four times a week before age twelve.

    If the bones of the hip don't develop normally during childhood, a so-called cam deformity can occur, with extra bone growing near the ball-shaped top of the femur, potentially leading to joint damage and pain, according to the American Academy of Orthopedic Surgeons (AAOS).

    Cam deformities begin to show up on X-rays in early adolescence, and tend to be more common among males and athletes in high-impact sports, the authors of the new study note in the British Journal of Sports Medicine.

    "It is in youth, during growth, that bone activity is high and bone is very responsive to loading," said lead author Igor Tak of the Sports Rehabilitation and Manual Therapy Department at Physiotherapy Utrecht Oost in The Netherlands.

    "For girls this is between 10-14 and for boys this on the average 1.5 years later," Tak told Reuters Health by email. "This suits our findings that when the threshold of loading with a high and low frequency is set at 12 years or 13 years of age, differences are visible between hip morphology of these boys later in life when being an elite player."

    For the new study, Tak and his coauthors studied X-rays of the hips of 63 players from two Dutch football clubs. The players' average age was 23.

    The researchers also used preseason player questionnaires, which include questions about their the men's age when they started playing football and the age when they transitioned from playing three or fewer times per week to playing four or more times per week.

    On average, the players had started practicing soccer at an amateur level around age six, and entered a professional football club, which would require four or more sessions per week, between ages 12 and 13.

    The study team found that 40 of the 63 footballers had some type of cam deformity in one or both hips, while 18 had a "pathological deformity" at an angle severe enough to be associated with developing hip osteoarthritis at an older age.

    Considering the 63 players' total of 126 hips individually, 40 percent of those who had started playing in a professional club after age 12 had a cam deformity, compared to 64 percent of those who started before age 12. There was a similar difference in the number of pathological deformities.

    Cam deformities make the "ball" part of the hip's ball-and-socket less round, which can increase the risk of osteoarthritis later, Tak said. People who play ice hockey, football and basketball often have cam deformities, he said.

    Athletes may work their hip joints more and begin to experience hip pain earlier, but exercise does not cause cam deformities, according to the AAOS.

    Regular people who do not become elite athletes may experience the same thing if they play high-impact sports frequently during bone development, Tak said. Young people should moderate their high-impact sport participation around the age of the "growth spurt," and it would be helpful to more exactly define when that is, but more information is needed on this topic, he said.

    Almost a third of white males develop a cam deformity, and only a small number will develop clinical complaints of restricted range of motion or osteoarthritis pain, even at an older age, said Dr. Emmanuel Audenaert, an orthopedic surgeon at Ghent University in Belgium, who was not involved in the new study.

    For the hips, growth plates stay open until age 16 to 18, which is relatively late, Audenaert said.

    "During puberty and as a result of changing testosterone hormone balance, the growth plate weakens around the age of 12-13, making it even more sensitive to displacement or deformity," Audenaert told Reuters Health by email.

    "Severe muscular training and high loading activities should be restricted until skeletal maturity for any joint and sport," he said. "At young age sportsmen should train on endurance, and maybe most of all technique."

    The results would likely be similar for non-elite athletes, but they would not have the same close medical follow-up and their hip problems may not be detected until middle age, he said.

    The results of other investigations have been mixed and the new study only looks back at the pasts of current adult players, said Dr. Kasper Gosvig of Hvidovre Hospital in Denmark, who was not involved in the Dutch report. Another study following kids as they play sports and their cam deformities emerge is needed, he told Reuters Health by email.

    SOURCE: British Journal of Sports Medicine, online January 7, 2015.

  • U.S. insurance study charts huge price gaps for hip, knee surgery

    By David Morgan

    WASHINGTON (Reuters) - Hip and knee replacements, two of the fastest-growing U.S. medical procedures, are subject to huge - and apparently random - price variations within the same geographical areas, a new insurance industry study said on Wednesday.

    The study by Blue Cross Blue Shield health insurers adds to the evidence of massive disparities between what different hospitals and medical practices charge in the world's most expensive healthcare system.

    It examined claims in 64 healthcare markets over three years and found the biggest price swings for hip surgery in Massachusetts, where the same type of care varied by more than 313 percent, from a low of $17,910 to a high of $73,987.

    The biggest gaps in total knee replacement surgery appeared in Dallas, Texas, where prices varied 267 percent from $16,772 to $61,584, according to researchers.

    Nationwide, typical knee and hip replacements cost an average of just over $30,000, the study found. Both procedures ranged as low as $11,300 in Alabama. But while the price of knee replacements soared to more than $69,000 in New York City, hip surgery climbed even further, to nearly $74,000, in Boston.

    The study, which looked at claims for more than 53,000 procedures from 2010 to 2013, underscores the inconsistencies in medical pricing at a time when employers are increasingly shifting healthcare costs to workers through high-deductible insurance plans.

    Researchers described the variations as "seemingly random" and said the data demonstrated the need for transparent pricing in medicine.

    "Extreme price variation in healthcare can have obvious financial consequences for individuals and employers," the study's authors said. "And from a macroeconomic perspective, it can have serious implications for the sustainability of (the) U.S. healthcare system."

    Researchers also noted that a lack of price variation can penalize consumers in markets where prices are consistently high, such as Fort Collins, Colorado, where knee replacements exceeded the national average by nearly $25,000 but varied locally by less than 1 percent.

    Data contained in the study reflects money that insurers and patients paid to hospitals, doctors, labs, physical therapists and others involved in procedures that are expected to increase as the U.S. population continues to age.

    The study cited independent research estimating that knee replacements tripled and hip replacements doubled between 1993 and 2009. General spending on healthcare is expected to grow 5.7 percent annually over the next decade as health coverage expands under the Affordable Care Act, according to government forecasters.

    SOURCE: Blue Cross Blue Shield Association, January 21, 2015.

  • Older minds need physical and mental activity

    By Ronnie Cohen

    (Reuters Health) - Exercising the body and mind may be the best way to keep an older brain sharp, suggests a new study.

    "The best medicine is physical activity," lead researcher Ralph Martins told Reuters Health.

    "At the end of the day, the two together - physical activity and cognitive training - gave us an additional benefit," said Martins, who directs the Center of Excellence for Alzheimer's Disease Research and Care at Edith Cowan University in Perth, Australia.

    Martins and his colleagues studied 172 people from ages 60 to 85 years, assigning them randomly into four groups.

    One group walked three days a week for an hour and did 40 minutes of resistance training twice a week for 16 weeks. Another group did hour-long computer brain-training exercises five days a week, also for 16 weeks. A third group did both the physical exercise and the computer activities. A fourth group maintained their regular routines.

    The researchers write in Translational Psychiatry that only the group that engaged in both physical activity and computerized brain training showed significantly improved verbal memory, which helps people remember words and language.

    The researchers note that the study failed to show benefits for executive functions that control focus, attention to details and goal setting. They also didn't find benefits for visual memory, processing speed or attention.

    Martins said physical exercise had the most profound and constant effect.

    Dr. David Merrill also sees physical activity as the most useful aid to maintaining memory and cognitive ability as people age, but the combination of physical and mental exercise may offer "synergistic" benefits.

    "What's good for the muscular-skeletal system is good for the cardiovascular system, and it's also good for the brain," said Merrill, who is a geriatric psychiatrist at the David Geffen School of Medicine at the University of California, Los Angeles.

    "Physical exercise sets the stage for the brain to be responsive to new information," said Merrill, who was not involved with the new study. "You're all ready to build new synapses, new connections."

    Both Martins and Merrill recommend that older people exercise regularly and stay intellectually involved. Both favor real-life challenges over computerized brain exercises.

    Martins urges retirees to join service organizations, like the Rotary Club, and to dance for the physical exercise and mental acuity.

    "Full retirement doesn't make sense for graceful aging," Merrill said. "People should try to keep working not only to maintain their self-identity but to challenge their brain."

    Merrill said the new research is the most recent of a handful of studies showing that a combination of interventions can help seniors remain mentally alert.

    He advocates building up to more strenuous exercise than peple did in the study.

    "There's lots of data that shows that being physically active is good for the brain," he said. "It's almost so intuitive that it defies logic that so few people are active physically."

    The U.S. Centers for Disease Control and Prevention recommends that older adults perform moderate and vigorous aerobic and muscle-strengthening activities at least twice a week.

    SOURCE: Translational Psychiatry, online December 2, 2014.

Transplant Articles

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Women’s Health Articles

  • Breast cancer patients lack knowledge of their tumors

    By Andrew M. Seaman

    (Reuters Health) - Women with breast cancer often don't know what kind of tumors they have, a new study found.

    Not knowing one's tumor features isn't necessarily tied to worse outcomes, but better knowledge might help women understand treatment decisions and take medications as directed, said Dr. Rachel Freedman, the study's lead author from the Dana-Farber Cancer Institute in Boston.

    Also, she said, cancer patients who understand the basis for their treatment are generally more satisfied with that treatment.

    "Nobody to my knowledge has asked how much knowledge someone had of their own disease," she added.

    For the new study, published in the journal Cancer, Freedman and her colleagues asked 500 women from northern California about their breast cancers, which had been diagnosed between 2010 and 2011.

    Participants were asked about their tumor grade, tumor stage and whether or not their cancer feeds off the hormone estrogen or a protein called human epidermal growth factor receptor 2 (HER2).

    Fifty-five percent of women said they knew if their tumor fed off estrogen, and about a third said they knew their HER2 status. About a third said they knew their tumor's grade, which is the cancer's aggressiveness. And 82 percent of women said they knew their tumor's stage, which is how advanced the cancer is.

    Based on their medical records, only 56 percent of women reported the correct estrogen status, 58 percent reported the correct HER2 status and 57 percent reported the correct stage. Only about one in five women reported the correct grade.

    Overall, only 8 percent of women correctly answered all four questions, but the lack of knowledge was more pronounced among minority women, the researchers report.

    "Even though all these questions were low for all women, we did see difference by race and ethnicity," Freedman said.

    "What's really nice about finding something like this is that it's a modifiable problem," Freedman said. "If you can improve education and provider awareness of this, you can do something about this in the clinic."

    Dr. Michelle Shayne of the James P. Wilmot Cancer Center at the University of Rochester School of Medicine and Dentistry in Rochester, New York, who was not involved in the study, told Reuters Health, "Breast cancer patients in general are a very savvy group of individuals."

    They "tend to read a lot and bring a lot of clippings in to their oncologist and ask a lot of questions," she said, so the study findings surprised her.

    The results show that oncologists need to tailor their discussions about cancer to individual patients as much as they tailor the treatments, she said.

    Also, she said, cancer survivors should receive detailed treatment histories and information about their tumors for future medical care.

    Freedman said that in her own practice, she's been trying to explain patients' cancers in more detail, writing down the specifics and making sure they understand the information.

    "I think this raises awareness of the issue," she said. "This may be a more important issue than we previously appreciated."

    SOURCE: Cancer, online January 26, 2015.

  • Pain during sex more common after a C-section

    By Kathryn Doyle

    (Reuters Health) - A year and a half after giving birth, one in four women report pain during vaginal intercourse - and odds for the problem are higher in women who had a cesarean section, according to a new study.

    The researchers were surprised to find that almost all women experience pain the first time they have sex after childbirth, whether they resume sex in the first six weeks or wait several months, senior author Stephanie Brown told Reuters Health.

    "This is not generally known, and certainly not what most women and their partners would be told to expect," said Brown, from the Healthy Mothers Healthy Families Research Group at Murdoch Childrens Research Institute in Melbourne, Australia,

    Another surprise was that pain during intercourse was more likely after a C-section, she said.

    Brown and her coauthors studied just over 1,200 women at six maternity hospitals in Melbourne.

    Almost half had spontaneous vaginal deliveries, and most also required perineal stitches due to tearing or an episiotomy. About 11 percent gave birth vaginally with vacuum extraction or forceps, which usually caused some tearing.

    Before pregnancy, about 27 percent reported having pain during sex. By three months postpartum, when nearly 95 percent of the women had resumed vaginal intercourse, more than 44 percent were still reporting pain during sex.

    By a year and a half after childbirth almost 98 percent of women had resumed sex, and 24 percent reported pain.

    "For most women, pain gradually resolves over the course of the first year, but for about one in four women pain persists or recurs," Brown said.

    Women who delivered by emergency C-section or vacuum extraction were twice as likely to be having pain during sex at 18 months than women who had a spontaneous vaginal birth with no tearing, according to results in the British Journal of Obstetrics and Gynecology.

    The odds were also higher, but less so, for women who had planned C-sections.

    "Most people tend to assume that having a caesarean will protect the pelvic floor and therefore be associated with less problems after birth," but that doesn't appear to be the case, Brown said.

    A caesarean is a significant operation and recovery be slow, said Dr. Hannah Woolhouse, also of Murdoch Childrens Research Institute, who was not an author of the new study. "Just because a woman doesn't have a vaginal birth, doesn't mean she won't experience ongoing pelvic and abdominal pain," Woolhouse told Reuters Health by email.

    Fatigue, depression, younger age and having experienced pain with intercourse before giving birth were all associated with painful sex after childbirth, the authors found.

    Talking to a trusted, empathic health professional can be helpful for some women, Brown said.

    "When resuming a sexual relationship, taking things slowly and not feeling pressured to rush into it is important. Women taking part in our research say that knowing 'what's normal' and that what you are going through is not abnormal is also helpful," she said.

    It's important to wait until the mother is physically and emotionally ready to resume sex, said Dr. Mohammad Reza Safarinejad, a private practice urologist in Tehran, Iran, who was not involved in the study.

    "The intercourse should start with the positions she finds most comfortable," he told Reuters Health by email. "For example, side by side or spooning would be a good idea. This will put the least pressure on her abdomen, which is where the incision was done."

    Vacuum extractions and emergency C-sections are by nature unpredictable. The potential sexual consequences are unlikely to affect decision making, but for a planned cesarean with no medical cause, the mother should be informed ahead of time before she makes that choice, said Dr. Eyal Sheiner, a maternity expert at Ben-Gurion University of the Negev in Beer-Sheva, Israel, who was not part of the new study.

    The bigger issue the study raises is just how common pain during sex can be after delivery, Sheiner told Reuters Health by email.

    "Part of the reason this may be surprising is that women tend not to talk about this issue after birth," Woolhouse said. "It remains a relatively taboo topic that can be difficult to discuss with both partners and health professionals."

    SOURCE: British Journal of Obstetrics and Gynecology, online January 21, 2014.

  • Complacency after a heart attack is a bad idea

    By Lisa Rapaport

    (Reuters Health) - People who seem healthy after a heart attack remain at high risk for another one, but many don't take the drugs that can improve their survival odds, researchers say.

    Swedish investigators studied heart attack patients who remained stable for the first year after leaving the hospital. One in five had another heart attack, a stroke or died from cardiovascular causes during the next three years.

    "We were surprised that the risk of future cardiovascular events in these patients was still high," said lead study author Dr. Tomas Jernberg, a cardiologist at Karolinska University Hospital in Stockholm. "We need to follow and support these patients more carefully."

    Jernberg's team analyzed outcomes for 97,254 patients who had heart attacks between 2006 and 2011 and survived for at least a week after leaving the hospital. A year later, 76,687 of those patients were considered "stable" because they hadn't had another heart attack or a stroke.

    Overall, the researchers found, the stable patients were likely to be younger, with fewer other serious health conditions, than the unstable patients. They were also slightly more likely to have had an aggressive intervention right after the first heart attack, such as angioplasty to clear a blocked artery.

    Yet in the three years following an initial stable year, 20 percent had another heart attack, stroke or other cardiovascular event. Of these, 41 percent died from a cardiovascular cause.

    The Swedish team also found that after the first year, stable patients were less likely to be on the standard medications used to manage heart patients.

    It's unclear whether doctors treating these seemingly healthier heart attack survivors were not prescribing the correct medications according to practice guidelines, or they were, and patients were not taking them.

    The research, published in the European Heart Journal, was supported by AstraZeneca PLC, which sells several medications for cardiovascular disease. Two co-authors are AstraZeneca employees.

    It's common for people to resist drugs when they don't understand the benefits, said Dr. Lisa Rosenbaum, a cardiologist at Brigham and Women's Hospital in Boston who recently published an essay in the New England Journal of Medicine about patients' feelings toward heart medications.

    "In the days immediately after a heart attack, so many people will look you right in the eye and say, 'Doctor, I'll do whatever you say and I'm going to change my life,' but the real question is what happens later," said Rosenbaum, who wasn't involved in the Swedish study.

    Some people may reject the notion of medications because if they don't take pills, they don't feel like they're sick, she said. Others may be scared of side effects. Still others may associate drugs with unhealthy lifestyle choices that contribute to heart disease and feel ashamed to take medication.

    "There isn't a silver bullet to fix this, but I think we need to focus on improving communication and removing any stigma that people may feel," Rosenbaum said. "We need to go old school and actually make time to talk to patients, which isn't something we can do in a five- or 10-minute appointment."

    Dr. Jeffrey Schussler, a cardiologist at Baylor Jack and Jane Hamilton Heart and Vascular Hospital in Dallas, agreed that most patients will stick to recommended treatment if they clearly understand the benefits.

    "In my experience, 95 percent of people are compliant, and then there will be 5 percent who smoke and drink and don't listen," said Schussler, who wasn't involved in the Swedish study.

    While medications certainly help patients remain stable after a heart attack, he said that for many, the outcome will depend on whether they continue to see a heart specialist after going home from the hospital.

    "Even if it's just once a year, you really need to see a cardiologist," Schussler said. "There can be a temptation after you're stable for a while to just see a primary care physician, but that's a mistake."

    SOURCE: European Heart Journal, online January 13, 2015 and, New England Journal of Medicine, January 8, 2015.

  • Laws deny leprosy sufferers right to work, travel, marry - study

    By Reuters Staff

    LONDON (Thomson Reuters Foundation) - Leprosy sufferers worldwide face discriminatory laws affecting their right to work, travel and marry, according to an advocacy group which called upon governments to follow U.N. guidelines and abolish such legislation.

    Around 20 countries, including India, Thailand and Nepal, have or continue to pass laws that discriminate against people with leprosy, the International Federation of Anti-Leprosy Associations (ILEP) said ahead of World Leprosy Day on Sunday.

    There were more than 200,000 new leprosy cases reported worldwide in 2013, yet this number has shrunk by 20 percent since 2006, according to the World Health Organization (WHO).

    The U.N adopted a resolution in 2010, urging governments to abolish all discriminatory laws against people affected by leprosy and their family, ILEP said.

    "Some countries have repealed their laws and started public education campaigns to stop stigma against men, women and children affected by leprosy... we applaud those which have taken such action," ILEP President Jan Van Berkel said in a statement.

    Millions of people and their families still suffer from the stigma associated with the disease, which is perpetuated by outdated laws and regulations, ILEP said.

    India has at least 15 laws discriminating against those with leprosy, prohibting them from standing for election or hold a driver's license, according to the anti-leprosy federation.

    People can also be forcibly removed from residential areas and segregated from society even if they have been cured.

    The study said India, home to 60 percent of the world's new leprosy cases in 2013, was reviewing its discriminatory laws.

    Thailand, Nepal and Singapore were among countries discriminating against leprosy sufferers when it came to marriage, divorce and employment, while Malaysia and South Africa have segregation and separation laws for those affected.

    The Philippines and Namibia can refuse entry visas to people with the disease, and people from Pakistan living in the Gulf states face immediate repatriation if diagnosed with leprosy.

    Dainius Pras, U.N. special rapporteur on the right to health, urged all governments to give consideration to the U.N. resolution and follow in the footsteps of Greece, China, Ethiopia, Oman, Ukraine, Estonia and Ecuador in repealing discriminatory laws, ILEP said.

    Leprosy is a chronic infectious disease causing disfiguring skin ulcers and nerve damage in the arms and legs.

    In the past leprosy, also known as Hansen's disease, was regarded as incurable, and patients often became social outcasts, but it can now be treated with antibiotics.

  • Wide use of prescription painkillers found in U.S. women of childbearing age: CDC

    By David Beasley

    ATLANTA (Reuters) - Prescription painkillers are used widely by U.S. women of childbearing age, a federal report released on Thursday found, and health officials said exposure to such drugs during pregnancy could increase the risk of birth defects.

    Of women aged 15-44, more than a third on Medicaid and a fourth on private insurance filled prescriptions for opioid pain medications each year between 2008-2012, a team from the Centers for Disease Control and Prevention said today in the Morbidity and Mortality Weekly Report.

    Opioids include medications such as hydrocodone, codeine and oxycodone that are taken to treat moderate to severe pain. The study was the first by the CDC to specifically examine their use by women of reproductive age.

    Taking the drugs during pregnancy, particularly in the early weeks, can increase the chances that babies will be born with birth defects, the CDC said.

    Given the popularity of the painkillers, a thorough health assessment of women of reproductive age is crucial before they are prescribed, officials said.

    "Many women of reproductive age are taking these medicines and may not know they are pregnant and therefore may be unknowingly exposing their unborn child," CDC Director Tom Frieden said in a statement.

    Prescription rates of opioids for reproductive-aged women were highest in the South and lowest in the Northeast, the CDC study said.

    The study did not address why more patients on Medicaid, the federal government's health insurance plan for the poor, use prescription painkillers. One reason could be that they have more health problems that require pain medication, said CDC epidemiologist Jennifer Lind, one of the study's authors.

    "There may be more women on Medicaid who are manual laborers, jobs that cause more chronic pain," Lind said in an interview.

    Half of all births in the United States are to mothers on Medicaid, according to the CDC.

    The federal health agency has launched a program called "Treating for Two" to increase awareness on the potential dangers of prescription painkillers to women of child-bearing age, Lind said.

    "What we're trying to do is expand research and also develop reliable guidance so that women and healthcare providers can have conversations and make informed decisions on what the safest options may be," she said.

    SOURCE: MMWR, online January 22, 2015.