Surgeon general: Retarded people often denied care

Too many doctors and dentists refuse to treat mentally retarded patients or fail to understand their medical needs, Surgeon General David Satcher said Thursday.

Satcher called on medical schools to better train doctors about the care of the mentally retarded.

"People with mental retardation are stigmatized," Satcher said. "Sometimes they are stigmatized by the professionals charged to serve them. This stigma is real, it is painful, it is pervasive and it is unfair."

Satcher called for more government studies to assess the severity of the problem but said this report discloses a major weakness in the health system in this country.

He said part of the problem was weaknesses in the Medicaid health program for the poor. Children with mental retardation are nearly three times more likely than other children to rely on public health programs, he said.

Satcher brought together doctors, social service providers and mentally disabled people and their families for a two-day conference on disparities in the health care system.

He said a surgeon general's conference report would be issued soon, with more recommendations.

At a news conference, marathon runner Loretta Claiborne told how doctors had often failed to take her medical complaints seriously.

Claiborne, who has finished more than 26 marathons, said as a child she walked awkwardly and saw many doctors who offered no hope until one doctor paid for X-rays that discovered she needed foot surgery.

"If it wasn't for that doctor I would probably be still at home, walking awkwardly," she said.

She also explained that she suffered two tumors that were initially overlooked by doctors until she pressed for more tests.

"I still today have to fight not only for me, but many, many people like me," said Claiborne, 48.

New research clarifies red wine's benefits

Researchers are homing in on how a glass of red wine can offer more than just holiday cheer, but also protection against heart disease, according to a study out today.

That report, which appears in the journal Nature, shines light on a natural chemical in red wine that may protect against clogged arteries.

The findings may help explain a scientific mystery dubbed the "French paradox." Scientists had always wondered why the French have had a relatively low rate of heart disease, despite a diet that often includes rich foods laden with artery-clogging fat.

Roger Corder of the Queen Mary School of Medicine in London focused on flavor compounds in red wine called polyphenols, which had previously been credited with red wine's heart benefit.

In this study, the team doused cow cells growing in lab dishes with polyphenols taken from popular merlots, cabernet sauvignons and other red wines. The team found that polyphenols taken from all of the red wines tested slowed the test-tube production of endothelin-1. This natural chemical may help clog arteries by triggering the growth of smooth muscle cells in the artery wall, a process that leads to fatty deposits.

The findings suggest that people who drink a glass or two of red wine a day get less production of endothelin-1, Corder says.

The researchers found that all the red wines offered the endothelin-1 benefit, but cabernet sauvignon appeared to provide a slight edge.

Red grape juice also slowed the production of endothelin-1, but it wasn't as potent as the red wines, Corder says.

The white and rosé wines the team tested had no effect.

Other studies have shown that drinking red wine may boost the blood levels of HDL cholesterol, the good cholesterol. This is the first study suggesting that red wine's benefit may have something to do with endothelin-1, Corder says.

People who already drink wine might want to consider switching to red wine to get some of the heart benefits, Corder says. Others agree with that, but add a warning about alcohol's downside.

Ira Goldberg, a spokesman for the American Heart Association, says it's easy for people to go overboard on alcohol consumption, which can cause many problems, including liver disease.

Machine may be organ transplant breakthrough

 A machine that simulates a warm human body kept a kidney functioning for almost 24 hours in a test of a technique researchers say could longer preserve donated organs.

The team at the University of Chicago Hospitals announced Saturday that the kidney, the first human organ to be connected to the machine, functioned just as it would inside a human body after they connected it Friday at 5:30 p.m.

It survived until researchers disconnected it later for study.

Researcher Dr. David Cronin said the technique could also be used to test organs deemed questionable for transplantation to see if they're acceptable.

Dr. Alan Langnas, chief of transplantation at the University of Nebraska Medical Center in Omaha, called the discovery exciting.

"If we can apply it to humans then I think it will have important implications in the practice of kidney transplanting in the United States," said Langnas, who was not involved in the research.

He said a warm blood pumping system could help reduce the number of kidneys that don't work immediately after transplantation because kidneys are kept in cold storage before they are transplanted.

Organs can become less effective the longer they are kept on ice, Cronin said. He said that puts tremendous pressure on transplant teams.

Cronin would not disclose where the donor kidney came from, but he said it wasn't one that could have been used for a transplant.

The warm blood preservation machine was developed by TransMedics Inc. of Woburn, Mass. The company is sponsoring the research.

The machine works with a heart-like pump that pushes blood through tubes into the kidney, which was kept at about body temperature. The kidney filtered the blood and produced urine that was collected in a bag. The kidney was also being fed with oxygen and nutrients.

"That organ is happy," Cronin said of the kidney, which was placed in a plastic container next to the electronic equipment that runs the machine.

Dr. Waleed Hassanein, president and CEO of TransMedics, said the company will submit its trials to the FDA in the fall and hopes to market its machine by next year. The machine is being tested at nine U.S. and British hospitals.

Cronin said the next step is to test other organs on the machine. More than 500 animal organs, including hearts, lungs and livers, have already been tested.

Lawmakers: OxyContin maker failing to curb abuse

The company that makes OxyContin is partly to blame for growing abuse of the prescription painkiller, says the head of the Drug Enforcement Administration.

DEA blames the drug for 117 deaths in 31 states in the past two years, and the agency believes it is the likely cause in 179 other deaths, DEA Administrator Asa Hutchinson said Tuesday.

He told a House Appropriations subcommittee that the "aggressive marketing practices" of Purdue Pharma L.P. have made the drug more readily available. The number of OxyContin prescriptions has grown steadily and reached 5.8 million last year.

He said Purdue Pharma gave its sales representatives incentives to sell large quantities of the drug and said the company took doctors on expense-paid retreats to encourage them to prescribe it.

Purdue Pharma executive vice president Paul Goldenheim rejected claims its marketing has been improper. "That is simply not the case," he said.

Goldenheim said the company spends significant time educating doctors about proper use of the drug.

He noted that the company worked with the Food and Drug Administration to strengthen warnings on OxyContin package inserts and helped law enforcement officials develop placebo tablets used in sting operations.

OxyContin is a slow-release narcotic painkiller. It is widely prescribed for victims of moderate to severe chronic pain resulting from such problems as arthritis, back trouble and cancer.

One pill is designed to last 12 hours, but those who abuse OxyContin usually crush the medicine and then snort or inject it, producing a quick, heroin-like high.

Hutchinson said the problem was most severe in Eastern and Southern states, but is spreading elsewhere. "I do not believe we've reached the peak of this problem yet," he said.

Rep. Hal Rogers, R-Ky., said the company ignored complaints from local pharmacists in Myrtle Beach, S.C., who said a pain clinic in town was prescribing too much OxyContin. Five people died of overdoses, according to government investigators.

The clinic closed in June after the DEA suspended the licenses of doctors there.

"People were dying, and your company did nothing," said Rogers, who represents an eastern Kentucky district where OxyContin abuse is widespread.

In a testy exchange, Goldenheim said his company "can't stop them from providing our product." To which Rogers responded, "We can."

Rep. Frank Wolf, chairman of the Commerce, Justice, State and Judiciary Appropriations Subcommittee, said he would ask congressional auditors to investigate Purdue Pharma's marketing practices. Wolf, R-Va., said he doesn't want to ban the drug, but believes it can more closely regulated. Wolf's parents both died of cancer.

The hearing also featured testimony from law enforcement officials and families affected by the drug. The officials were united in their belief that greater controls are needed.

"I think certainly the supply has to be tightened up," said Tammy McElyea, a prosecutor in Lee County, Va. "I don't think I should get this drug because I have a tooth pulled."

She and other officials said they would support a national prescription monitoring plan to track who gives out OxyContin and who receives it.

FDA to bar blood from more European travelers

Thousands more people who have lived or traveled in Europe will be barred from donating blood, beginning next spring, as a new precaution against mad cow disease.

The Food and Drug Administration already bans blood donations from people who have spent at least six cumulative months in Britain between 1980 and 1996, the worst period of that country's mad cow outbreak.

The FDA said Monday it would tighten its restrictions, barring donors who have spent at least three cumulative months in Britain during that time and, eventually, travelers to other parts of Europe.

The new precautions will be phased in between spring and fall 2002, giving blood banks months to hunt for new donors and keep the nation's already tight blood supply from becoming tighter.

Blood donors may find Monday's announcement confusing. That's because the American Red Cross next month will begin turning away donors under even tighter restrictions — people who have spent three months in Britain or six months anywhere in Europe since 1980.

The FDA allows blood banks to adopt stricter precautions than it recommends. But FDA officials insist that because mad cow disease is only a theoretical risk to the blood supply, a more gradual nationwide change will provide comparable safety without causing shortages in parts of the country that rely heavily on blood from travelers and military personnel, or even blood imported directly from Europe.

"There is a need to strike a careful balance between increasing the safety of the blood supply while at the same time ensuring that blood products are available," said FDA blood chief Dr. Jay Epstein.

Mad cow disease is a brain-destroying illness that first surfaced in British cattle but now has spread to cattle in much of Europe. A human form, called "new variant Creutzfeldt-Jakob disease," apparently spread by eating infected beef, has claimed more than 90 lives in Britain and parts of Europe.

Mad cow disease has never been found in U.S. cattle, and the new CJD has never been diagnosed here, although Americans can get a similar disease, regular CJD. There is no evidence the human form can spread through blood transfusions, but donors are restricted just in case.

Under the FDA's proposal, by May 31 blood banks would have to bar donors who have:

Spent three cumulative months or more in Britain from 1980 through 1996.
Spent five cumulative years or more in France from 1980 to the present.
Spent six months or more, as American military personnel or dependents, on bases in Northern Europe from 1980 through 1990, and elsewhere in Europe from 1980 through 1996. That's when British beef was sold on those U.S. bases.
Received a blood transfusion in Britain since 1980.
In fall 2002, FDA would bar donors who spent a cumulative five years or more anywhere in Europe since 1980, and end New York's imports of blood from Europe, which accounts for more than 25% of that city's supply.

The FDA estimates the new restrictions will bar 5% of blood donors. The FDA has estimated that the Red Cross' stricter rules could cut blood donors by 9%. But the Red Cross, which supplies half the nation's blood supply, argues the impact won't be that big — and that it already is replacing lost donors with a major recruitment campaign.

America's Blood Centers, which provides the other half of the nation's blood supply, praised the FDA for gradually implementing the new restrictions.

As for donors who are barred, regardless of which blood bank turns them away: Don't worry about your own health, Epstein stressed.

"We would expect the vast, vast majority ... are in fact uninfected," he said. "But there is no screening test that could be used on donors. The only available tool we can apply to improve blood safety is to avoid the use of blood from people who may have had these exposures."

The FDA's proposal is open for public comment for 30 days; the agency expects to finalize the rules by year's end.

Stem cell treatment eases Parkinson's symptoms

WASHINGTON (AP) — Researchers used embryonic stem cells to relieve symptoms of Parkinson's disease in rats, demonstrating the cells can be turned into neurons that make dopamine, a key brain chemical.

The researchers at Harvard Medical School and McLean Hospital in Belmont, Mass., showed in tests that the cells injected into rats whose brains had been chemically damaged would spontaneously convert to correct the Parkinson's symptoms.

Some experts said the study, appearing Tuesday in the Proceedings of the National Academy of Sciences, was significant because it showed embryonic stem cells could be used to treat brain disorders, but they cautioned that the cells also could cause tumors.

Dr. Ole Isacson, senior author of the study, said that if further experiments are successful, there could be human trials of the technique in about five years.

Federally funded research on human embryonic stem cells is limited because producing such cells requires the death of human embryos. President Bush last summer approved some such research, but limited it to cell colonies that already exist — about 60 cell lines.

In the current study, researchers first developed rats that had Parkinson's disease symptoms by injecting into their brains a toxin that killed neurons.

The researchers then injected embryonic stem cells, extracted from an early mouse embryo and capable of growing into any type of cell.

About nine weeks after the stem cells were in the rat brains, they converted to neurons that make dopamine, a brain chemical lacking in Parkinson's disease patients, Isacson said.

The injected stem cells, said Isacson, grew into the type of neurons that typically die in the brains of Parkinson's patients.

One of the symptoms the Parkinson's rats had was a tendency to turn aimlessly in their cages after they had been injected with amphetamine. Nine weeks after the stem cell injections, Isacson said, the rats' tendency to turn was stopped.

The researchers also conducted magnetic resonance imaging tests and found that blood flow was restored to parts of the brains that had died from the Parkinson's effect.

Dr. Arlene Y. Chiu of the National Institute of Neurological Disorders and Stroke said Isacson's study was an important advance because it showed that embryonic stem cells will grow into specific neurons in the brain.

But she noted that five of the 19 animals used in the study also developed tumors and cautioned that this was a problem that must be solved before the technique could be used on humans.

"One of the great fears about using undifferentiated stem cells is that they will develop tumors," said Chiu.

She said Isacson reduced this problem by injecting only about 1,000 stem cells into each of the test animals. In some earlier studies, researchers injected more than 100,000 cells and many test animals developed tumors.

Asthma treatment causes bone loss in young women

Inhaled steroids, widely used to treat asthma, cause bone loss in young women, researchers report.

Anti-inflammatory steroids taken in pill form are known to accelerate bone loss but it wasn't clear whether steroids inhaled directly into the lungs also thin bones.

Researchers at Boston's Brigham and Women's Hospital found a direct relation between the amount of inhaled steroids used and a decrease in bone density in the 109 women studied. Bone loss can lead to osteoporosis.

"The importance of this is that we know there's an effect, and the message really is we need to use inhaled corticosteroids at the lowest doses that we can," said Dr. Elliot Israel, one of the researchers.

The findings are reported in Thursday's New England Journal of Medicine. A second study in the journal shows an osteoporosis drug prevents bone loss in men getting hormone therapy for prostate cancer.

The studies provide further evidence that some medications promote bone loss, said Dr. Bess Dawson-Hughes of Tufts University, who wrote an accompanying editorial.

"There are ways — medical, nutritional and otherwise — to prevent some, if not all, of this medical therapy-induced bone loss," she said.

The inhaled steroids study looked at three groups of premenopausal women with asthma. One group did not use steroids to control their asthma. The two other groups used the same inhaled steroid, Azmacort, but at different doses.

Bone density was measured periodically over three years.

The researchers found small yearly decreases in bone density in the hip — but not the spine — in those who used inhaled steroids. Those who used higher doses had more bone loss.

Israel said inhaled steroids are effective in treating asthma, and their use shouldn't be discouraged. But patients should try to use low doses, get sufficient calcium and vitamin D, exercise and have their bone density checked, he said.

Israel and his colleagues only studied women but he said he would expect similar results in men who use inhaled steroids.

The second study was conducted at Boston's Massachusetts General Hospital and involved 47 men with advanced prostate cancer or a recurrence of the disease. It showed the drug Aredia, also known as pamidronate, prevented bone loss associated with hormone therapy for prostate cancer, which decreases testosterone levels.

One of the researchers, Dr. Matthew R. Smith, said hormone therapy is an overlooked cause of osteoporosis in men, who account for 20% of the 10 million cases of the brittle-bone disease.

In the study, half of the patients received intravenous treatments every three months of the hormone therapy Lupron Depot, also known as leuprolide, and Aredia. Half received only Lupron.

After nearly a year, those treated only with Lupron had a bone density decrease of 3% in the spine and nearly 2% in the hip. There was no significant change in bone density in those who were also given Aredia. The study was funded in part by Novartis Oncology, which makes the drug.

Dr. Felicia Cosman, clinical director of the National Osteoporosis Foundation, said more study is needed to see if the drug also reduces the risk of fractures or if easier-to-take oral osteoporosis drugs work in prostate cancer patients.