NJ warns nearly 3,000 to get tested for hep B

TRENTON, N.J. – New Jersey officials have advised nearly 3,000 people who share a doctor to get tested after five cancer patients who visited the physician were found to have hepatitis B.
Two cases of hepatitis B were confirmed in late February as connected with the office of Dr. Parvez Dara, an oncologist with offices in Toms River and Manchester, near the Jersey Shore, Marilyn Riley, spokeswoman for the state Health Department, said Thursday.
Health officials recently learned of three more cases, all in Toms River, in which the patients were also under Dara's care.
"These were older adults who didn't have other risk factors, so that is what raised a red flag," Riley said.
Ocean County decided to send a letter to all Dara's patients dating to 2002. The March 28 letter warns them of the risk and suggests they be tested for the liver diseases hepatitis B and hepatitis C and for HIV, the virus that causes AIDS.
Linda Bradford of Bayville said she's worried about her husband's health after hearing news of the outbreak.
"The first thing I did was call my husband," Bradford told WCBS-TV. "I was terrified. Oh my God, what's going on here?"
Hepatitis B is transmitted through exposure to infected blood, often by sexual contact or infected needles. Dara's office treats patients with blood disorders and cancer, some of whom receive chemotherapy there.
"The evidence that's available suggests the infections could be linked to the method the clinical staff used to administer injectable medications," such as chemotherapy, Riley said. "There's no evidence to suggest the medications were a problem."
Dara faces suspension of his medical license in connection with the outbreak and for other alleged health code violations. A hearing is scheduled for Friday before the state Board of Medical Examiners.
Until then, he is performing only patient consultations, not procedures, said his lawyer, Robert Conroy. Neither of Dara's offices were open Thursday.
According to a report by the state epidemiology division, Dara has infection control violations dating to 2002, including violations of standards of the federal Occupational Safety and Health Administration.
Conroy said that there is no proof the patients got the disease from Dara's office and that other factors aren't being considered. All five patients were also seen at Community Medical Center in Toms River, he said.
Health officials said they ruled the hospital out as a possible source of the infection.
Hepatitis B is transmitted through exposure to infected blood, often by sexual contact or infected needles.
Conroy said three patients were found to have dormant hepatitis infections that might have been noticed only after they started cancer treatments, which can suppress the body's immune system.
Because the patients live in the same area, he said, there could be another possible source.
"Absent any evidence, it is just as likely that those patients were infected (at) ... a common eatery," he wrote in a letter to the Medical Examiners Board.
Meanwhile, Conroy said Dara has received only support from his patients.
"The doctor has never felt more appreciated by his patients than he does right now," he said.
Ocean County Health Department spokesman Edward Rumen said no new cases have been reported since the alert was issued.
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Associated Press writer Bruce Shipkowski in Toms River contributed to this report.

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House approves FDA regulation of tobacco products

WASHINGTON – Anti-smoking forces won a long-awaited victory Thursday as the House passed legislation that would give the federal government key controls over the tobacco industry for the first time.
The measure, passed 298-112, gives the Food and Drug Administration authority to regulate — but not ban — cigarettes and other tobacco products.
The Senate could take up its version of the bill later this month, and supporters are confident they can overcome opposition from tobacco-state senators. The White House supports the legislation, a shift from the Bush administration which threatened to veto a House-passed measure last year.
President Barack Obama has spoken publicly about his own struggles to kick a smoking habit.
"This is truly a historic day in the fight against tobacco, and I am proud that we have taken such decisive action," said Energy and Commerce Committee Chairman Henry Waxman, D-Calif., the bill's sponsor. "Today we have moved to place the regulation of tobacco under FDA in order to protect the public health, and now we all can breathe a little easier."
Waxman and his Senate counterpart, Sen. Edward Kennedy, D-Mass., have promoted legislation giving the FDA regulatory powers over tobacco products since the Supreme Court in 2000 ruled that the agency did not have that authority.
That ruling came after years of lawsuits and debate on the issue, including Waxman's memorable 1994 hearing where the heads of big tobacco companies testified that nicotine was not addictive.
Waxman's Family Smoking Prevention and Tobacco Control Act wouldn't let the FDA ban nicotine or tobacco outright, but the agency would be able to regulate the contents of tobacco products, make their ingredients public, prohibit flavoring, require much larger warning labels and strictly control or prohibit marketing campaigns, especially those geared toward children.
Kennedy plans to introduce his version of the bill after Congress returns from its April recess. Sen. Richard Burr, R-N.C., is expected to lead the opposition, but supporters are confident they can clear the 60-vote threshold needed to break a filibuster.
"FDA regulation of cigarettes — the most lethal of all consumer products — is long overdue," Kennedy said Thursday. "I am confident that the Senate will approve it expeditiously."
Opponents from tobacco-growing states such as top-producing North Carolina argued that the FDA had proven through food safety failures that it's not up to the job. They also said that instead of unrealistically trying to get smokers to quit or prevent them from starting, lawmakers should ensure they have other options, like smokeless tobacco.
That was the aim of an alternate bill offered by Rep. Steve Buyer, R-Ind., who would leave the FDA out and create a different agency within the Health and Human Services Department. His proposal failed on a 284-142 vote.
"Effectively giving FDA stamp of approval on cigarettes will improperly lead people to believe that these products are safe, and they really aren't," Buyer said. "We want to move people from smoking down the continuum of risk to eventually quitting."
Major public health groups, including the American Lung Association and the American Medical Association, wrote to lawmakers asking them to oppose Buyer's bill, contending it would leave tobacco companies without meaningful regulation and able to make untested claims about the health effects of their products.
Buyer pointed out that Waxman's bill is supported by the nation's largest tobacco company, Marlboro maker Philip Morris USA. Officials at rival tobacco companies contend the Waxman bill could cement Philip Morris' market advantage.
Lorillard Tobacco Co. said in a statement that among other problems, Waxman's bill "leads to an industry monopoly by locking in the huge market share of our largest competitor while eliminating our ability to communicate with our adult smokers."
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The bill is H.R. 1256.
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NY county ban on baby bottle chemical is official

NEW YORK – A suburban New York county has adopted the nation's first ban on the chemical found in plastic baby bottles and sippy cups.
The measure banning the sale of baby bottles containing BPA was signed by Suffolk County Executive Steve Levy on Thursday after county legislators passed it last month.
Several states including California, Oregon and Hawaii are considering bans the chemical formally known as bisphenol A, but Suffolk County, on Long Island, is the first place in the nation to enact one.
Canada announced in October it was banning BPA in baby bottles, becoming the first country to restrict sale of the chemical, which is commonly used in the lining of food cans, eyeglass lenses and hundreds of household items.
The Suffolk County ban will take effect within 90 days of being filed with New York's secretary of state and applies to empty beverage containers used by children ages 3 and younger.
Baby bottles frequently contain BPA, which is used to harden plastic and make it shatterproof.
Some scientists believe that long-term exposure to BPA is harmful to humans, but the European Union and the U.S. Food and Drug Administration say the chemical is safe.
"While the U.S. Food and Drug Administration stands by, Suffolk County is taking measures to protect their most vulnerable population from the potential harm of BPA exposure," said Urvashi Rangan, a senior scientist and policy analyst at Consumers Union, the nonprofit that publishes Consumer Reports magazine.
Levy, the Suffolk County executive, said children's exposure to potentially harmful products should be minimized.
"Of all the things a parent must worry about," he said, "whether or not their child is being harmed by a baby bottle should not be one of them."

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1 in 5 Medicare patients readmitted within month

NEW YORK – One in five Medicare patients end up back in the hospital within a month of discharge, a large study found, and that practice costs billions of dollars a year. The findings suggest patients aren't told enough about how to take care of themselves and stay healthy before they go home, the researchers said. A few simple things — like making a doctor's appointment for departing patients — can help, they said.
The study found that a surprising half of the non-surgery patients who returned within a month hadn't even seen a doctor between hospital stays.
"Hospitals put more effort into the admission process than they do into the discharge process," said Dr. Eric Coleman, one of the study's authors from the University of Colorado in Denver.
Coleman, who runs a program to improve "hand-offs" between health care systems, said patients often have a honeymoon notion about how things will be once they're home. Then when they become confused about how to take their medicine or run into other problems, they head back to the hospital because they don't know where to turn, he said.
The issue of hospital readmissions and their cost has come under scrutiny in recent years. And it's getting attention now because President Barack Obama's budget calls for reducing spending on Medicare readmissions to pay for health care reform.
For their study, reported in Thursday's New England Journal of Medicine, the researchers looked at Medicare records from late 2003 through 2004. They found that about 20 percent of 11.9 million patients were readmitted to the hospital within a month of discharge; about a third were back in the hospital within three months.
About half of the patients hospitalized for ailments didn't see a doctor before they landed back in the hospital within a month.
Patients with heart failure and pneumonia had the most readmissions overall; among surgical procedures, heart stents and major hip and knee surgery had the highest returns.
About 10 percent of all readmissions were probably planned, such as putting in a stent, the researchers said. They estimated that the cost of unplanned return visits in 2004 was $17.4 billion.
"It's a big hunk of money and it's a big hunk of misery," said another study author, Dr. Stephen Jencks, an independent consultant who worked for the Centers for Medicare and Medicaid Services.
Besides making follow-up doctor appointments, Jencks said hospitals should give patients a list of all their medications, explain what to do at home and where to call if they run into problems. He said the hospitals should also call the patient within two days and make sure that the patient's doctor knows they were in the hospital.
He said the goal is to keep patients from getting really sick again, not to keep them out of the hospital if they do.
The differences in readmission rates among states suggests that improvements can be made, he said. Iowa had the lowest rate with 13 percent, while Washington, D.C., had the highest at 23 percent.
Dr. Brian Jack at Boston Medical Center tells the story of a patient who didn't understand that the blood pressure medicine that the hospital told her to take was the same as the one she had at home — just with different names. She took both and returned to the hospital with kidney failure. Jack and his colleagues tested a new checklist that nurses used when they sent patients home. The patients who used the checklist had 30 percent fewer visits to the emergency room or return hospital stays over the next month, compared to patients who didn't use it, they found.
"There are not too many things that improve health and save money," said Jack, who was not involved in the new research.
In 2007, a panel that advises Congress on Medicare suggested ways to cut hospital readmissions. One recommendation was to change how Medicare pays hospitals and to cut payments to those with high rates — an approach included in Obama's budget proposal.
Currently, hospitals get the same payment for each hospital stay and critics say there's no incentive to reduce readmissions.
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On the Net:
New England Journal: http://www.nejm.org
Care Transitions: http://www.caretransitions.org/
Project Red: http://www.bu.edu/fammed/projectred

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Pistachio warning could signal food safety shift

TERRA BELLA, Calif. – It could take weeks before health officials know exactly which pistachio products may be tainted with salmonella, but they've already issued a sweeping warning to avoid eating the nuts or foods containing them.
The move appears to indicate a shift in how the government handles food safety issues — from waiting until contaminated foods surface one-by-one and risking that more people fall ill to jumping on the problem right away, even if the message is vague.
Officials wouldn't say if the approach was in response to any perceived mishandling of the massive peanut recall that started last year, only that they're trying to keep people from getting sick as new details surface about the California plant at the center of the pistachio scare.
"What's different here is that we are being very proactive and are putting out a broad message with the goal of trying to minimize the likelihood of consumer exposure," said Dr. David Acheson, FDA's assistant commissioner for food safety. "The only logical advice to consumers is to say 'OK consumers, put pistachios on hold while we work this out. We don't want you exposed, we don't want you getting salmonella.'"
Dr. Joshua Sharfstein, the president's new acting commissioner who started Monday, made it clear staff needed to move quickly, Acheson said.
The agency announced Monday that Setton Pistachio of Terra Bella Inc., the second-largest pistachio processor in the nation, recalled more than 2 million pounds of its roasted pistachios.
Suspect nuts were shipped as far away as Norway and Mexico, Acheson said Tuesday. One week after authorities first learned of the problem, they still had little idea what products were at risk, he said.
As federal health inspectors take swabs inside the plant to try to identify a salmonella source, a whole range of products from nut bars to ice cream and cake mixes remain in limbo on grocery shelves.
Company officials said Tuesday they suspected their roasted pistachios may have been contaminated by salmonella-tainted raw nuts they were processed with at the hulking facility.
Roasting is supposed to kill the bacteria in nuts. But problems can occur if the roasting is not done correctly or if roasted nuts are re-exposed to bacteria.
The firm sells its California-grown pistachios to giants of the food industry such as Kraft Foods Inc., as well as 36 wholesalers across the country.
"We care about our business and our customers greatly," said Lee Cohen, the production manager for Setton International Foods Inc., a sister company to Setton Pistachios. "We've never had an illness complaint before but obviously this affects the whole industry. It's not good."
California supplies 99.99 percent of the U.S. pistachio market, according to the California Pistachio Board.
"What's scary is that it's after the nuts have been processed that this stuff is getting into it, so it really makes you wonder," said Marcia Rowland, an avid pistachio eater in Apopka, Fla.
The FDA learned about the problem March 24, when Kraft notified the agency that routine product testing had detected salmonella in roasted pistachios. Kraft and the Georgia Nut Co. recalled their Back to Nature Nantucket Blend trail mix the next day and expanded the recall to include any Planters and Back to Nature products that contain pistachios Tuesday.
Kraft spokeswoman Laurie Guzzinati said her company's auditors visited the plant early last week, and "observed employee practices where raw and roasted nuts were not adequately segregated and that could explain the sporadic contamination."
She said she didn't know specifically what they saw.
Federal inspectors last visited the plant in 2003, and the California Department of Public Health was there last year, Acheson said. Federal officials made note of several problems — an open door into one of the nut rooms, and an employee wearing street clothes that weren't adequately covered — but nothing that posed a food safety threat, he said.
Acheson said management corrected the problems that day, and said he did not have access to California inspectors' records.
Cohen said the plant had never had an illness complaint, followed industry health guidelines and had its huge metal silos and warehouse inspected regularly, but refused to provide additional details or records. Several plaques on the firm's office walls showed the firm won industry awards for food safety excellence.
No illness have been tied to contaminated pistachios. Two people called the FDA complaining of gastrointestinal illness that could be associated with the nuts, but the link hasn't been confirmed, Acheson said.
While consumer advocates praised the government's swift action, they said the pistachio recall illustrated that more oversight was needed.
"It is encouraging that this response was so quick, but we need to move to a system that focuses on prevention through the entire food production process," said Jeff Levi, executive director of Trust for America's Health.
Two California legislators introduced a bill Tuesday that would require periodic testing of food at food processing facilities and mandate processors to report to state authorities within 24 hours any positive test result for a dangerous contaminant.
"We shouldn't be reacting to the next crisis, we should be preventing the next crisis," said Assemblyman Mike Feuer, D-Los Angeles.
___
Associated Press writers Tracie Cone in Fresno and Samantha Young in Sacramento contributed to this report.
___
On the Net:
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FDA cracks down on unapproved narcotic painkillers

WASHINGTON – The government ordered 14 unapproved narcotic painkillers off the market Tuesday, prescription versions of potent morphine, hydromorphone and oxycodone. The Food and Drug Administration told nine manufacturers to quit distributing the drugs within 90 days — but insisted there are plenty of legal versions of the painkillers being sold for patients who need relief.
"There will be no shortage for consumers," said Deborah Autor, director of FDA's drug compliance office.
The move is part of the FDA's years-long attempt to weed out thousands of prescription drugs that sell despite never being formally approved by the health regulatory agency. Many entered the market decades ago, before federal law required such approval. The FDA estimates that unapproved drugs account for 2 percent of all prescriptions filled.
Tuesday, the FDA targeted unapproved versions of high-concentrate liquid morphine sulfate and unapproved immediate-release tablets containing morphine sulfate, hydromorphone and oxycodone. Most are generic.
To help consumers tell if they have an approved or unapproved version, the FDA posted both lists on its Web site: http://www.fda.gov/cder/drug/unapproved_drugs/narcoticsQA.htm.
Manufacturers receiving warning letters Tuesday are: Boehringer Ingelheim Roxane Inc. of Columbus, Ohio; Cody Laboratories Inc. of Cody, Wyo.; Glenmark Pharmaceuticals Inc. of Mahwah, N.J.; Lannett Co. Inc. of Philadelphia; Lehigh Valley Technologies Inc. of Allentown, Pa.; Mallinckrodt Inc. Pharmaceuticals Group of St. Louis; Physicians Total Care inc. of Tulsa; Roxane Laboratories Inc. of Columbus, Ohio; and Xanodyne Pharmaceutical Inc. of Newport, Ky.
The largest, Boehringer, didn't immediately return a call seeking comment.
Even FDA-approved versions of these painkillers pose a risk of serious side effects, but the unapproved products add an extra problem: Regulators haven't checked that those versions work as well and are as pure as their approved competitors.
Companies that don't heed the FDA's deadline could face big penalties: The government once seized $24 million worth of unapproved drugs from a company that ignored a stop-selling order, Autor noted.

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St. Louis hospital to study birth defect

ST. LOUIS – A top children's hospital wants to improve the survival rate of infants born with a birth defect that many families have never heard of until their child is diagnosed.
Dr. Brad Warner, surgeon-in-chief of St. Louis Children's Hospital, said Tuesday that he and others plan research to better understand the condition, known as CDH, or Congenital Diaphragmatic Hernia. One in 2,000 babies is diagnosed with the disease, doctors say. Half of those don't live to their first birthday.
The condition occurs when the diaphragm, which separates the chest cavity from the abdomen, does not completely form in the womb. The contents of the belly migrate to the chest, which keeps the lungs from developing properly.
Eight babies at the St. Louis hospital died last year from the condition.
Doctors at St. Louis Children's Hospital say they're part of a national database registry to collect and track information on children with the condition. They plan to recruit faculty candidates that are able to explore fetal surgery intervention and are working to collect DNA for analysis.
Treatment for the birth defect varies.
Many are stillborn. Babies who die from the birth defect usually have insufficient lung tissue to survive, or develop hypertension in the blood vessels of the lungs. Medications to lower blood pressure in the lungs lower the baby's overall blood pressure, which can be problematic.
Of those who live, some are in distress from the moment the umbilical cord is clamped; others are OK for their initial hours of life, then get worse. A third group, which is the most uncommon, initially looks good, but later exhibits signs, such as bowel sounds in the chest, that reveal the condition.
In some cases, doctors have performed surgery on pregnant women and their fetuses to try to address problems before a baby is born, but those procedures have risks. Children with CDH can grow up to be healthy adults.
Doctors say they hope to better understand predictors of good and bad outcomes for babies with the condition, as well as how to address the many complications that can arise.
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Breath of Hope: http://www.breathofhopeinc.com/

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Study: Plavix plus aspirin helps prevent strokes

ORLANDO, Fla. – Taking the blood thinner Plavix along with aspirin helped prevent strokes and heart attacks in people with a common heartbeat abnormality that puts them at high risk of these problems, doctors reported Tuesday.
The treatment is for atrial fibrillation, a rhythm disorder that 2.2 million Americans have. It occurs when the upper parts of the heart quiver instead of beating properly. This allows blood to pool and form clots that can travel to the brain, causing a stroke.
The usual treatment is the blood thinner warfarin, sold as Coumadin and in generic form. But finding the right dose is tricky — too little and patients can have a stroke; too much and they can have life-threatening bleeding. Patients on the drug must go to the doctor often for blood tests to monitor their dose.
For these reasons, as many as half of patients take aspirin instead of warfarin, even though aspirin is much less effective at preventing strokes.
Dr. Stuart Connolly of McMaster University in Hamilton, Ontario, led a study testing whether adding clopidogrel, sold as Plavix by French-based Sanofi-Aventis SA, could help.
The study involved 7,554 patients in the United States and 32 other countries who were not able or chose not to take warfarin. All were treated with aspirin; half also were given Plavix.
After nearly four years of followup, the dual drug treatment lowered a combined measure — heart attacks, heart-related deaths, strokes and blood clots — by 11 percent. There were 924 of these problems in patients on aspirin alone but only 832 in those also getting Plavix.
However, the combination treatment raised the risk of serious bleeding — 251 cases versus 162 for those on aspirin alone.
Doing the math, patients still come out ahead on the combination, Connolly said. For every 1,000 patients treated for three years, it would prevent 28 strokes and six heart attacks, and lead to 20 bleeding cases. Bleeding often is treated with transfusions and is not as likely to prove fatal.
"For the first time in 20 years, there's a new treatment for atrial fibrillation," Connolly said.
Results were presented Tuesday at an American College of Cardiology conference and published online by the New England Journal of Medicine.
The study was sponsored by Sanofi, and Connolly and other authors have consulted for the company. Plavix costs about $4 a day.
"Warfarin was, and remains, first-line therapy — this does not change that," said Dr. Richard Page, cardiology chief at the University of Washington School of Medicine in Seattle and an American Heart Association spokesman.
But for those who can't tolerate it, the Plavix-aspirin combo gives a better option than aspirin alone, he said. Page has consulted for Sanofi in the past.
On Saturday, other doctors at the cardiology conference reported on another potential treatment for atrial fibrillation — an experimental heart device called the Watchman aimed at preventing clots from reaching the brain. A federal Food and Drug Administration panel meets to consider it on April 23.
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On the Net:
Cardiology meeting: http://www.acc.org
Medical journal: http://www.nejm.org

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Stop-smoking lines flooded as tobacco tax rises

WASHINGTON – Calling your state stop-smoking hot line for help kicking the habit? Expect a wait: Smokers are flooding the lines in a panic over an increase in the tobacco tax.
Denver-based National Jewish Health received triple the usual number of calls Monday for a March day to quit lines it runs in six states: Colorado, Idaho, Iowa, Montana, New Mexico and Ohio.
The calls — 2,317 on Monday — had steadily increased all month as smokers began dealing with a big price hit in a sour economy. Not only does the per-pack federal tax climb from 39 cents to $1.01 on Wednesday, but the major cigarette makers raised prices several weeks ago in anticipation.
Quit lines around the country are feeling the surge, according to an informal survey by the Campaign for Tobacco-Free Kids that found a missed opportunity as cash-strapped states struggled to meet demand.
Michigan's quit line itself had to quit — working, that is. It ran out of money in mid-March after logging more than 65,000 callers in five days. Besides counseling and tips, Michigan's hot line offered free nicotine patches, gum or lozenges. The giveaway program in 2008 generated only about 20,000 calls in six weeks, the campaign noted.
Arkansas quit general advertising of the quit line to keep up with calls that rose from about 500 a week in January to more than 2,000 a week in mid-March, the campaign said. And Indiana and Oklahoma were receiving record-level weekly calls.
Price surges typically spur would-be quitters to take the plunge. Not all will be successful. The tobacco-free kids group estimates that about 1 million adults will quit as a result of the tax increase.
Consumers can dial 1-800-QUIT-NOW to be directed to their state hot lines.
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Campaign for Tobacco-Free Kids: http://www.tobaccofreekids.org/index.php

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German researchers testing veggie Viagra: reports

BERLIN (AFP) – German researchers are testing an impotency treatment for men made using only natural ingredients that in some cases works better than Viagra, newspapers reported Monday.
"In clinical trials, 50 men had much better sex afterwards, more fun in bed and just generally felt better about themselves," the Sueddeutsche Zeitung daily cited Olaf Schroeder from Berlin's Charite hospital as saying.
"Their libido was even higher than the control group taking Viagra," he said.
The potent cocktail includes tribulus terrestris, a herb already used in alternative medicine, a root vegetable found in the Andes called maca and grape juice extract, newspapers said.
The treatment, dubbed "Plantagrar", is due to be launched in early 2010, the Bild daily said.
But some of those tested had unwelcome side effects.
"Two of the subjects had bad diarrhoea," the Berliner Kurier quoted Schroeder as adding.

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Second-Generation Female Condom Approved

WEDNESDAY, March 11 (HealthDay News) -- The Female Health Co.'s FC2 Female Condom has been approved by the U.S. Food and Drug Administration, the company said Wednesday. The product helps protect women against pregnancy and sexually transmitted diseases.
The second-generation condom is similar in design and performance to the FC1, except that it is made of a synthetic rubber called nitrile and costs about 30 percent less, the company said. The FC1 was approved in 1993.
The FDA approval of the FC2 will allow the U.S. Agency for International Development to distribute the condoms via global HIV/AIDS programs, the Associated Press reported.
The first-generation FC1 has been distributed by United Nations agencies in 142 countries, the wire service said.
More information
To learn more about female condoms, visit the U.S. National Library of Medicine.

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Suriname starts free circumcision project

PARAMARIBO (AFP) – Suriname has launched a three-month pilot project offering free circumcisions in a bid to cut sexually transmitted diseases, Health Minister Celsius Waterberg said Friday.

Circumcision "could also minimize the risk of HIV infection", he said, adding the project would run in the capital city, Paramaribo.

Some two percent of the Suriname population is HIV-infected, about 10,000 people, and the project aims to carry out the operations on 100 men aged between four and 21 years old over the next three months.

If successful then the project will spread nationwide, Waterberg said.

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Weight loss enhances obese men's sexual well-being

NEW YORK (Reuters Health) – Obese men who undergo gastric bypass surgery will not only lose weight; their sex lives are likely to improve, too, new research shows.
"We wanted to know if obesity was biologically associated with an unsatisfying sex life, and if so, could it be reversible," Dr. Ahmad Hammoud of the University of Utah in Salt Lake City, who led the study, said in a press release accompanying the new report. "Our results show that the answer to both questions may be yes."
While obesity in men has been linked to low testosterone levels, high levels of estrogen, impaired fertility, and worse sexual quality of life, Hammoud and his colleagues note in the Journal of Clinical Endocrinology and Metabolism, there is little information on what happens to these men's sex hormones and sexual function if they lose weight.
To investigate, Hammoud and his team looked at 22 men who had undergone gastric bypass surgery and 42 obese men who didn't have the operation. At the study's outset, participants weighed 330 pounds, on average, while the average BMI for the group was 46.2, what is considered to be .
The heavier the men were, the lower their testosterone, and the more likely they were to report dissatisfaction with their sex lives-especially avoiding sexual encounters and having difficulty performing sexually.
Two years later, the men who'd had weight loss surgery had dropped an average of nearly 17 points from their BMI. Their estrogen levels had fallen significantly, while their testosterone levels had gone up. And all showed improvements on each of the four measures of sexual quality of life the researchers looked at: they were less likely to avoid sexual encounters, have difficulty with sexual performance, have little sexual desire, or report not enjoying sex.
There were no significant changes in measures of sexual quality of life or hormone levels in the group of men who didn't have the surgery.
Because other both biological and psychological factors involved in obesity can affect both sexual health and hormone levels, Hammoud and his team conclude, more research is needed to determine whether there is a causal relationship between hormone changes and sexual quality of life.
SOURCE: Journal of Clinical Endocrinology and Metabolism, April 2009.

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Insurers offer to stop charging sick people more

WASHINGTON – The health insurance industry offered Tuesday for the first time to curb its controversial practice of charging higher premiums to people with a history of medical problems. The offer from America's Health Insurance Plans and the Blue Cross and Blue Shield Association is a potentially significant shift in the debate over reforming the nation's health care system to rein in costs and cover an estimated 48 million uninsured people. It was contained in a letter to key senators.
In the letter, the two insurance industry groups said their members are willing to "phase out the practice of varying premiums based on health status in the individual market" if all Americans are required to get coverage. Although the letter left open some loopholes, it was still seen as a major development.
"The offer here is to transition away from risk rating, which is one of the things that makes life hell for real people," said health economist Len Nichols of the New America Foundation public policy center. "They have never in their history offered to give up risk rating."
"This letter demonstrates that insurance companies are open to major insurance reform, and are even willing to accept broad consumer protections," said Sen. Jeff Bingaman, D-N.M., a moderate who could help bridge differences on a health care overhaul. "It represents a major shift from where the industry was in the 1990s during the last major health care debate."
Insurers are trying to head off the creation of a government insurance plan that would compete with them, something that liberals and many Democrats are pressing for. To try to win political support, the industry has already made a number of concessions. Last year, for example, insurers offered to end the practice of denying coverage to sick people. They also said they would support a national goal of restraining cost increases.
The latest offer goes beyond that.
Insurance companies now charge very high premiums to people who are trying to purchase coverage as individuals and have a history of medical problems, such as diabetes or skin cancer. Even if such a person is offered coverage, that individual is often unable to afford the high premiums. About 7 percent of Americans buy their coverage as individuals, while more than 60 percent have job-based insurance.
"When you have everyone in the system, and you can bring (financial) assistance to working families, then you can move away from health status rating," said Karen Ignagni, president of America's Health Insurance Plans, the leading trade group.
The companies left themselves several outs, however. The letter said they would still charge different premiums based on such factors as age, place of residence, family size and benefits package.
"If the goal is to make health care affordable, this concession does not go far enough," said Richard Kirsch, campaign manager for Health Care for America Now. "It still allows insurers to charge much more if you are old." His group, backed by unions and liberals, is trying to build support for sweeping health care changes.
Importantly, insurers did not extend to small businesses their offer to stop charging the sick higher premiums. Small employers who offer coverage can see their premiums zoom up from one year to the next, even if just one worker or family member gets seriously ill.
Ignagni said the industry is working on separate proposals for that problem.
"We are in the process of talking with small-business folks across the country," she said. "We are well on the way to proposing a series of strategies that could be implemented for them."
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On the Net:
America's Health Insurance Plans: http://us.rd.yahoo.com/dailynews/ap/ap_on_he_me/storytext/insurers_sick_people/31419391/SIG=10l8ksrl2/*http://www.ahip.org
Blue Cross and Blue Shield Association: http://www.bcbs.com/

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WHO issues pessimistic global tuberculosis report

RIO DE JANEIRO – The number of people infected with both tuberculosis and HIV is twice what researchers previously thought, top health officials said Tuesday. The World Health Organization's annual report on TB, presented in Rio, indicates that there were 1.37 million cases of people with both TB and HIV in 2007, the latest year for which statistics are available. About 700,000 people were infected with both in 2006, according to a report released by WHO last year.
Researchers attribute the numbers mostly to more widespread testing and reporting. They say direct information on the HIV status among TB patients is now available from 64 nations — up from just 13 nations in recent years. More reporting is also coming from Africa, where 79 percent of the dual-infection cases were reported.
In 2007, 1.3 million people died from TB, while another 465,000 people who had both TB and HIV died. About 1.5 million people died in 2006 from TB, according to WHO's report last year. It was not clear how many of those who died also were infected with HIV.
WHO researchers said the new data means HIV-positive people are about 20 times more likely than HIV-negative people to develop TB in countries where HIV is at epidemic levels, and between 26 and 37 times more likely to develop TB where HIV prevalence is lower.
In a message to mark World TB Day, U.N. Secretary-General Ban Ki-moon said the epidemic is continuing to decline "but the rate of decline is far too slow, and TB still takes a life every 20 seconds."
"Millions of people are benefiting from treatment through coordinated national efforts, but millions more are still missing out," he said in the message released at U.N. headquarters in New York. "Unless we accelerate action, the numbers of those falling ill will continue to grow."
The WHO's annual report had other pessimistic points: an expected $1.6 billion gap in funding needed to fight the disease this year and an increase in the number of cases of drug-resistant TB.
"We have a situation with very little progress, particularly in Africa and Eastern and Central Europe," said Tido von Schoen-Angerer, the executive director of Doctors Without Borders, who was attending the TB conference. "There is no room anywhere in this report for congratulations."
The survey estimates that 9.27 million people around the globe had TB in 2007 — slightly up from 9.24 million in 2006.
That amounts to a per capita rate of 139 per 100,000 people globally, the report states. That pace, a drop of less than 1 percent a year, has continued for the past several years, said Mario Raviglione, director of the WHO's Stop TB program.
He said it would take millennia to wipe out the disease at that rate.
Multiple-drug-resistant cases of TB also rose in 2007 to 500,000. Such cases are more difficult to treat and have a higher rate of deaths.
Aggravating the fight against TB is the global financial crisis.
Michel Kazatchkine, executive director of the U.N.-backed Global Fund to Fight AIDS, Tuberculosis and Malaria, said funding for programs to fight TB will fall $1.6 billion short in 2009, a gap he estimates will reach at least $4 billion in 2010.
"The crisis is severely affecting developing nations," he said. "But countries should realize health costs are an investment for development and not just a strain on budgets."
Asia registered the most TB cases in 2007, with 55 percent, while Africa had 31 percent. Among nations, India had the most cases with 2 million, China had 1.3 million and Indonesia 530,000.
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Associated Press Writer Edith Lederer contributed to this story from the United Nations in New York.

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