Scientists Struggle to Understand Swine Flu Virus
American health officials believe they are getting closer to answering those questions, or, at least, to ruling out wrong-headed theories.
“Weve begun to knock off hypotheses,” said Dr. Scott F. Dowell, director of global disease detection with the U.S. Centers for Disease Control and Prevention.
Among the factors disease detectives have discounted are Mexicos air pollution, secondary infections and poor health care. But they still do not know why so many Mexicans have died, although it could be because many more people actually have had the virus than health officials realize.
In Mexico, the virus is suspected of killing more than 150 people and sickening more than 2,400. Recent information suggests swine flu-related hospital admissions and deaths may have peaked and are declining, but no other country has shown any numbers close to those seen in Mexico.
The only other country to report a swine flu death is the United States, and that involved a toddler from Mexico who was visiting Texas with his family.
The leading theory remains that the virus itself is not significantly different in Mexico, but that the outbreak has for some reason just hit harder there, infecting more people overall. The more people who are infected, the more likely there will be severe cases and even deaths.
When the Mexican health secretary spoke this week about a 6 or 7 percent death rate, his figures were based on the number of deaths divided by the number of suspected infections. But authorities cannot be certain how many people have been infected, especially those who suffered only mild symptoms.
Mexican authorities have not tried to count mild cases, focusing instead on the severely ill and the dead. So the death rate may be much lower than 6 or 7 percent - and probably is, according to some experts.
A 6 to 7 percent death rate would make the Mexican swine flu nearly three times deadlier than the worst flu pandemic in the last 100 years - the 1918 Spanish flu, which killed an estimated 20 million to 50 million people worldwide.
That seems unbelievably high for this new virus, said Richard Webby, a flu researcher at St. Jude Childrens Research Hospital in Memphis.
Webby and others do not believe the swine flu in Mexico is different from whats been seen in U.S. patients. The virus samples in both countries match.
The CDC sent four epidemiologists and one lab scientist to Mexico over the weekend to investigate the disease there, and the agency expects to send a half-dozen more people this week, said Dowell, of the CDC.
- A second infection complicating the flu cases. A common danger in flu is that the patient is co-infected with pneumonia or other bacteria, which can lead to death. But lab tests of 33 Mexican patients, including seven who died, did not find that problem.
- Low-quality health care. CDC investigators have not seen any obvious problem. They have found capable doctors and well-equipped, high-quality hospitals, Dowell said.
- A medicine is compounding the problem. Investigators have looked into whether patients who got sick had taken some over-the-counter medicine or folk remedy that actually made things worse.
Such a problem has sometimes occurs in children recovering from flu who are given aspirin - a severe illness called Reyes syndrome, which causes vomiting, lethargy and even seizures. But theres no evidence of something like that in Mexico, Dowell said.
- Altitude or air pollution: Mexico Citys altitude and its infamous air pollution have raised speculation that those factors may have made people more susceptible to the virus. But severe cases are being reported over much of Mexico, including coastal communities and places with cleaner air, making that theory unlikely.
Studies: Drug Shows Guarantee Against Hepatitis C
Still, telaprevir and similar drugs that other companies are testing offer hope of a major advance against the disease, which afflicts about 3.2 million Americans and 180 million people worldwide. It is caused by a bloodborne virus that can lead to liver scarring or liver cancer.
Treatment is aimed at helping the immune system eliminate the virus. Current therapy combines the drugs peginterferon and ribavirin, but less than half on it are cured. Telaprevir and similar drugs under development are a potential game-changer because they specifically attack the hepatitis C virus.
In the two studies, roughly two-thirds given telaprevir with standard therapy for six months showed no signs of the virus after six months, which doctors considered being cured of the disease. Thats compared to 40 to 50 percent on standard treatment alone.
“We can now sit down with our patients and tell them that 2 of 3 patients can be cured with a 24-week course of therapy,” said Dr. John McHutchison, a Duke University doctor who led one study and has consulted for Vertex, based in Cambridge, Mass.
Telaprevir is in late-stage testing and is not available commercially; the company plans to seek government approval next year.
Results were published in Thursdays New England Journal of Medicine.
Hepatitis C is a huge and growing problem because for years there was no way to screen the blood supply for the virus. Infection often doesnt produce symptoms for many years, so many of these cases are just now being recognized even though they may stem from transfusions a decade or more ago.
The virus is mainly spread through contact with the blood of an infected person. It can be contracted by sharing dirty drug needles, getting pricked with a hospital needle with infected blood or being born to an infected mother.
About a quarter of people exposed to hepatitis C clear it out of their bodies without treatment. But the rest develop a lifelong infection that attacks their livers. There is no vaccine against hepatitis C.
In one study of 250 people with chronic hepatitis C in the United States, 61 percent who took telaprevir with standard therapy for six months cleared the virus, compared with 41 percent on standard therapy alone. Among those who took the drug and standard therapy for a year, 67 percent had no signs of infection.
However, twice as many on telaprevir stopped treatment because of side effects.
In another study of 334 people in Europe, 69 percent on telaprevir and standard therapy for six months had undetectable virus levels compared with 46 percent on standard treatment alone.
Testing of even shorter treatment times did not show benefit in either study.
“Telaprevir appears to be a material advance in the therapy of hepatitis C, beginning a new era of treatment,” Dr. Jay H. Hoofnagle of the National Institute of Diabetes and Digestive and Kidney Diseases wrote in an accompanying editorial.
Other doctors were more cautious.
“The new drug does show promise. However, its side effects remain a concern,” said Dr. James Ou, a hepatitis expert at the University of Southern Californias Keck School of Medicine.
Other companies developing similar drugs include Idenix Pharmaceuticals, Schering-Plough Corp. and InterMune Inc.
Mexico Raises Swine Flu Demise Toll to 159 as Businesses Hurt
About 2,498 people have been diagnosed with symptoms related to swine flu, while 1,300 of those are hospitalized, Health Minister Jose Cordova told reporters late yesterday. Hospitalizations have declined over the past few days, he said.
Mexicos swine flu outbreak is punishing businesses in the capital, which generates 22 percent of the countrys gross domestic product, according to Credit Suisse. Mexico Citys government yesterday ordered all 35,000 restaurants shut, after saying that economic activity has fallen 60 percent since schools were first closed on April 24.
As retail shoppers stay home to avoid crowds and foreign tourists stay away, the flu is threatening to further shrink an economy already battered by the global financial crisis and drug cartel violence. Wal-Mart de Mexico SAB said its 118 Vips and Porton restaurants in Mexico City are open for take-out only, which is allowed under the capitals rules.
“The government needs to compensate us for closing,” said Floriberto Riveros, 60, who said hed keep his seafood restaurant, Mariscos El Guero, open until officials come to tell him to shut it. “Even now, all I can cover is my staffs wages with the reduced amount of customers.”
The number of worldwide cases of the virus confirmed by laboratory tests reached 79 yesterday. The World Health Organization, acknowledging the growing threat of swine flu, raised its global pandemic alert to 4 from 3 on April 27, saying the disease is no longer containable.
School Cancellation
In Mexico, the cases have been concentrated in Mexico City, the state of Mexico, and San Luis Potosi state, Cordova said.
Mexicos federal government has canceled classes for all students through May 6 and urged places where crowds gather, such as night clubs and theaters, to shut their doors. The city is mandating that all movie theaters, convention centers and gyms shut down, Mayor Marcelo Ebrard said.
French travel agents have stopped booking any trips to Mexico, U.K. tour company Thomas Cook canceled trips to Cancun, Cuba suspended flights to and from Mexico and Canadian airline Air Transat said it would suspend trips to Mexico, Agence France-Presse reported. Argentinas government said yesterday it will suspend direct flights from Mexico City until May 4.
The flus impact on Mexicos economy will be short-term if the number of cases falls and schools reopen next week, similar to the effect of severe acute respiratory syndrome, or SARS, on Asias economy in 2003, said Gabriel Casillas, an economist at UBS AG. An increase in the pace of deaths or the WHOs pandemic alert level may cause a greater economic impact, he said.
SARS Comparison
The economic impact of SARS, which killed more than 700 people in China, Hong Kong, Taiwan and Singapore, was short- lived because containment measures were implemented quickly, Barclays Capital said in a report. Retail sales, services, exports and tourism were particularly hard hit, the report said.
Economists shied away from making concrete forecasts for the economic impact of the swine flu outbreak, saying it was too early to determine.
“Its premature to make an assessment,” said Paulo Leme, chief Latin America economist at Goldman Sachs in Miami. The outbreak “affects retail services and economic activity more broadly. It temporarily undermines confidence.”
Victor Villegas, marketing chief in Mexico for Cinepolis, the largest movie-theater chain in Latin America with 216 locations, said the government hasnt said when theater doors can open again.
No Indication
“We have no idea,” he said. “Weve been given no indication.”
For Flavia Chavez, a 30-year-old teacher, the swine flu outbreak, a 5.6-magnitude earthquake in Mexico City on April 27 and forecasts for an economic contraction this year are a warning from above that society has gone astray.
Us Wants Ingredient In Swine Flu Vaccine By May
Even if all goes well, it still will take a few months before any shots are available for the first required safety testing, in volunteers.
“Were working together at 100 miles an hour to get material that will be useful,” Dr. Jesse Goodman, who oversees the Food and Drug Administrations swine flu work, told The Associated Press.
Using samples of the new swine flu, taken from people who fell ill in Mexico and the U.S., scientists are engineering a strain that could trigger the immune system without causing illness.
“Were about a third of the way” to that goal, Dr. Ruben Donis of the Centers for Disease Control and Prevention said in an interview Tuesday.
The hope is to have that ingredient - called a “reference strain” in vaccine jargon - to manufacturers around the second week of May, so that they can begin their own laborious production work, Donis said.
But, “this is biology, not mathematics,” he cautioned.
To further speed the vaccine hunt, the CDC has shipped a raw sample of the new virus to one manufacturer - Gaithersburg, Md.-based MedImmune LLC, which sells the only flu vaccine given via a nasal spray instead of a shot. MedImmune thus uses a slightly different approach to creating influenza strains suitable for that spray, Donis explained.
Health authorities are struggling to rein in the swine flu epidemic that has sparked a global crisis since discovery of the never-before-seen strain just last week - and the world learned that travelers to Mexico, where dozens may have died, were carrying the bug home.
Standard anti-flu drugs can treat the illness. But the world has no vaccine that prevents this new strain, a mix of pig, human and bird viruses that people presumably have little natural immunity to. And if the virus ultimately spreads enough to spark a pandemic - which hasnt happened yet and may not - a vaccine would be key to mitigating the disaster.
Vaccine manufacturers are just beginning production for next winters regular influenza vaccine, which protects against three human flu strains. Monday, the World Health Organization said factories should stay with that course for now - it wont call for mass production of a swine flu vaccine unless the outbreak worsens globally.
Think of flu viruses as wearing coats, changeable proteins on their surface that trigger the immune system to mount an attack. Those proteins give flu strains their main identity: This new swine flu is part of the Type A/H1N1 family - the “H” being a version of the protein hemagglutinin and the “N” is the protein neuraminidase. Matching those H and N components forms the basis of a vaccine.
First researchers had to grow enough virus samples, culled from a handful of patients, to work with. Influenza virus traditionally is grown by injecting it into fertilized chicken eggs, but this novel virus didnt grow easily there. Theres an alternative, growing it in vats of cells instead, but most flu vaccine manufacturers today still rely on eggs.
Next, using a technique called reverse genetics, scientists are selecting genes for the swine flus H and N antigens to create a customized strain and look for signs that it will prompt a good immune response. Then manufacturers would get the strain to start their own production supply, which could take another two months.
“Its worth taking that time at the very beginning to really make sure youve got exactly what you want,” said MedImmune senior director Dr. Kathleen Coelingh. “Weve got to get this right.”
But those initial pilot lots will go straight into human safety tests already being planned, Goodman said. Flu vaccine in general is very safe. But in 1976, thousands claimed side effects from a swine flu vaccine administered after an outbreak at Fort Dix, N.J., that never spread.
For now, manufacturers are studying production options. Sanofi Pasteur, the worlds largest flu vaccine maker, just opened a new U.S. factory but if necessary could keep its older one open as well just for swine flu vaccine production, said spokesman Len Lavenda. It also produces vaccine at a factory in France.
At Novartis AG, spokesman Eric Althoff said the company is studying which of its two technologies for vaccine-making would be better. The Swiss drugmaker can make vaccines both in eggs and in cell culture.
Glaxo, Roche Meet Swine-flu Drug Needs; Vaccine Is Months Away
Glaxo increased output of its flu remedy Relenza during the weekend, the London-based company said. Roche is also making more of its medicine Tamiflu, said Martina Rupp, a spokeswoman for the Basel, Switzerland-based drugmaker.
Swine flus spread in Mexico, the U.S. and Canada is heightening concern that the virus may spark the worlds first influenza pandemic since the 1968-1969 Hong Kong flu, according to the World Health Organization. That outbreak killed an estimated 1 million people worldwide, according to U.K. researchers. Seasonal flu shots typically take three to six months to make, not counting lab time needed to develop a version tailored to specific strains.
“The vaccine wont be available for quite some time, at least four months, and then it wont be in huge numbers,” said Othmar Engelhardt, a virologist at the U.K.s National Institute for Biological Standards and Control, in Potters Bar, England, north of London.
Sanofi-Aventis SAs vaccine unit is “ready to work” with world health authorities if they ask, said Pascal Barollier, a spokesman for the Paris-based drugmaker. Developing a swine-flu vaccine would take about four months, he said.
Baxter International Inc., which makes both seasonal and pandemic vaccines, has requested samples of the swine virus to do laboratory testing and potentially make shots, said Christopher Bona, a spokesman for the Deerfield, Illinois-based company. Baxters Vero-cell technology can produce flu vaccine in about half the time required by traditional egg-based manufacturing, which takes about 24 weeks, Bona said in a telephone interview.
Baxter Expertise
“Baxter has the expertise to develop vaccines against potential pandemic flu viruses,” Bona said. He declined to say how quickly after receipt of the swine virus the company might have a vaccine ready to enter production.
Homeland Security Secretary Janet Napolitano said 25 percent of “courses of treatments” of antiviral drugs were being released from U.S. stockpiles. In all, there are 50 million courses, she said. Among those are Tamiflu and Relenza.
“Tamiflu, made by Gilead and Roche, and Relenza, made by GlaxoSmithKline Plc, will be natural beneficiaries as stockpiles of these medicines should need replacing,” Les Funtleyder, an analyst with Miller Tabak & Co. in New York, said in a note to clients. “Flu vaccine makers Glaxo and Sanofi Aventis SA could also see some upside as we would expect vaccination rates going into the fall would be significantly higher than in years past.”
400 Million Treatments
Roche can produce 400 million treatments of Tamiflu over a 12-month period, said James Smith, the drugmakers medical leader for Tamiflu, in an interview. “Production capacity now basically outstrips demand.”
How much vaccine makers benefit from swine flu may depend on how fast they can get samples of the swine virus from public- health officials and develop an inoculation in their labs.
“We dont think that any of the existing vaccines are effective,” said Richard Besser, the acting head of the U.S. Centers for Disease and Prevention, based in Atlanta. “There are discussions ongoing about whether to make a vaccine and whether that should be undertaken. Its not an easy decision.”
Developing a flu vaccine can take weeks. Then it takes at least six months to make the vaccine in quantity, according to the CDC. Makers generally start work in January each year on the vaccines that will be used in the flu season that begins in October, the CDC said.
Mutating Virus
Fears of a lethal pandemic lie in the nature of flu germs, which mutate readily and can become virulent by exchanging genes with related influenza viruses. While the H5N1 bird flu that has killed more than 250 people hasnt gained genes to spread easily among humans, the Mexican swine flu already may have done so, said Malik Peiris, a microbiologist from the University of Hong Kong.
“The concern is that this virus has the ability to transmit from humans to humans because a number of the cases who got infection have had no direct exposure to swine,” said Peiris, who has studied the virus behind severe acute respiratory syndrome, or SARS, and avian flu. There is no vaccine for the strain, he said.
Flu Similarities
How Who Measures A Pandemic
- Phase 1. There are no viruses circulating in animals that have been reported to cause infections in humans.
- Phase 2. An animal flu virus has caused infections in humans in the past and is considered to be a potential pandemic threat.
- Phase 3. An animal or mixed animal-human virus has caused occasional cases or small clusters of disease, but the virus does not spread easily. The world is currently in phase 3, with H5N1 bird flu viruses sporadically infecting humans and occasionally spreading from human to human.
- Phase 4. The new virus can cause sustained outbreaks and is adapting itself to human spread.
- Phase 5. The virus has spread into at least two countries and is causing even bigger outbreaks.
- Phase 6. More outbreaks in at least two regions of the world; the pandemic is under way.
If the World Health Organization raises its pandemic alert level to 4 or 5, that signals that the swine flu virus is becoming increasingly adept at spreading between humans. That would signal to governments they should ready their pandemic preparedness plans and increase detection systems for potential cases.
With an elevated pandemic alert level, WHO might also issue travel advisories, warning against nonessential travel to regions battling outbreaks, trade restrictions, the cancellation of public events or border closures.
During the SARS outbreak in 2003, WHO travel advisories drastically slashed travel to affected regions, curtailing the outbreak.
Novartis Drug Heralds Era Of New Multiple Sclerosis Therapies
In Seattle this week, the two companies will present results from late-stage trials of two oral drugs. If the products go on to win regulatory clearance, patients for the first time will be able to take pills, rather than shots or transfusions, to slow the muscle-wasting condition. Five more pills and two new infusion therapies may join the now $7.5 billion a year MS market by 2014, according to the National Multiple Sclerosis Society in New York.
Progress against MS is coming on three fronts, said John Richert, a doctor who leads research at the society. The new drugs may reduce the frequent relapses most patients face. Improved detection may allow earlier treatment before symptoms emerge. Stem-cell therapies now being tested may go even further, reversing disability in patients with advanced disease.
“In terms of stopping disease activity, there are more therapies coming onstream than ever before and many of these also appear to be more potent,” Richert said in a telephone interview. “While the whole idea of repairing the nervous system really seemed like science fiction five to six years ago, advances in the last year suggest this may well be within our grasp.”
First described 140 years ago, multiple sclerosis causes the body to attack itself through the immune system. Rogue immune cells travel to the brain and spinal cord and enter the nervous system. There the cells assault and destroy myelin, the fatty substance that surrounds nerve-cell fibers. That interferes with the nerve cells ability to transmit electrical impulses and move muscles.
Taking a Fall
MS generally starts in early adulthood, disrupting peoples coordination and balance and sometimes leading to damaged vision and paralysis. For Rhonda McHenry, a fall in 1994 while chasing her then 9-month-old son, and the resulting nerve pain, led to an MS diagnosis.
McHenry, now 44, was diagnosed with the “relapsing- remitting” form of MS that makes symptoms flare and recede and that 85 percent of patients have initially, according to the MS Society.
In one way, she was fortunate. Around the time of her diagnosis, three new drugs made from proteins called beta interferons were approved to prevent MS relapses.
The new treatments included Avonex, made by Biogen Idec Inc. of Cambridge, Massachusetts; Betaferon, made by Bayer AG of Levrkusen, Germany; and Copaxone, a product from Teva Pharmaceutical Industries Ltd., of Petah Tikva, Israel.
Inhibit Immune Response
These products, along with Rebif, made by Merck KGaA, of Darmstadt, Germany, inhibit the overactive immune response found in MS, reducing damage to nerves and slowing disability, Richert said. Rebif was approved by the U.S. Food and Drug Administration in 2002.
As researchers have learned more about how the immune system attacks nerves, they have been able to design drugs that interfere with that process, Richert said.
Blocks Cell Movement
The newest MS treatment on the market, Biogens Tysabri, blocks the movement of immune cells from the bloodstream into the nervous system.
The experimental Novartis drug FTY720 disrupts the movement of immune cells at an earlier stage than Tysabri, keeping them from leaving lymph nodes and entering the bloodstream, according to Richert.
German Merck is attempting to turn a cancer drug, cladribine, into an MS medicine because it suppresses the immune system, blunting its attack on nerve cells. The product was approved to treat leukemia more than a decade ago.
Novartis, based in Basel, Switzerland, and Merck will release results this week at a Seattle meeting of the American Academy of Neurology, a professional association based in St. Paul, Minnesota. Preliminary findings already released by both companies suggest that the drugs limit relapses.
Side Effects Key
Pediatricians Adopt New Term For Shaken Baby Abuse
The nations largest pediatricians group recommends “abusive head trauma,” calling it a more comprehensive diagnosis for brain, skull and spinal injuries associated with shaking and other head injuries inflicted on infants.
The academy says the new diagnostic term should be used in medical records and that it may provide more clarity in the courtroom.
Some defense attorneys and doctors believe shaken baby syndrome doesnt exist, arguing that its impossible to shake babies hard enough to cause brain injuries without breaking their necks. But that argument is based on faulty evidence and is not shared by most physicians who specialize in treating child abuse, said Dr. Robert Block, former chairman of an academy committee on child abuse.
The National Institutes of Health says shaking can cause bruising, swelling, and bleeding, “which can lead to permanent, severe brain damage or death.”
Block said legal challenges to the term “shaken baby syndrome” can detract from more important questions about whether abuse occurred. The new term can avoid that problem, he said.
“In no way does this change the position of the academy” about the potentially fatal risks of shaking an infant, said Block, a pediatrics professor at the University of Oklahomas community medicine school in Tulsa.
The pediatrics academy recommends the new terminology in a policy statement being published in the May issue of its journal, Pediatrics.
Dr. Cindy Christian, a co-author of the policy statement and a child abuse researcher at Childrens Hospital of Philadelphia, said evidence shows babies can be injured by severe shaking alone but sometimes they have head injuries caused by other abuse as well.
The National Center on Shaken Baby Syndrome says an estimated 1,200 to 1,400 U.S. children are injured or killed by shaking each year, but that the number may be much higher since many cases likely are not detected.
The advocacy group also uses the umbrella term “abusive head trauma,” but says shaking is the leading cause of death in these cases.
The pediatricians new policy says doctors should be alert to signs of head trauma that could include abusive shaking. Doctors also should teach parents safe ways to calm fussy babies and how to avoid the dangers of shaking, the policy advises.
Marilyn Barr, executive director of the center on shaken baby syndrome, praised the academy for “trying to clear murky waters.”
On the Net:
Academy of Pediatrics: http://www.aap.org/
NIH: http://tinyurl.com/38d8vd
Doctors Urge Baseline Test For Prostate Cancer
“Many men do not need yearly screening,” but each mans risk should be individually assessed, said Dr. Peter Carroll, who led the panel that wrote the American Urological Associations new guidelines. They are being issued Monday at the groups annual meeting in Chicago.
The new stance brings the group more in line with advice from other experts, who say annual screening is leading to unnecessary biopsies and treatment with little proof that it saves lives. Screening involves a physical exam and a blood test for a substance called PSA.
The urology groups new advice says men should be offered a baseline PSA test at age 40, and follow-ups at intervals based on each mans situation. A high PSA at age 40 greatly predicts a risk of prostate cancer, said Carroll, a urologist at the University of California at San Francisco.
Doing a baseline test “makes a lot of sense to me,” said Dr. Eric Klein, prostate cancer chief at the Cleveland Clinic.
Others disagreed. There is no proof that a baseline test will save lives, said Dr. Barnett Kramer, a National Institutes of Health scientist.
“The same issue of harm comes up - overdiagnosis. A baseline PSA, just like regular PSA screening, can lead to the diagnosis of cancers that would not have harmed a man had they not been detected,” Kramer said.
Prostate cancer is the most common non-skin cancer in American men. An estimated 186,000 new cases and 28,660 deaths from it occurred last year.
Cases rose in the late 1980s with the start of testing for prostate-specific antigen, or PSA, a substance the prostate produces when it is inflamed. Despite its name, PSA isnt very specific. It can rise for many reasons besides cancer, such as normal prostate enlargement as men age, use of certain medicines - even things like a hard bike ride or recent sex.
Two big studies last month concluded that annual PSA tests do little to prevent deaths from prostate cancer. But many doctors believe the test may still have value - if researchers can figure out better ways to use it.
New studies at the urology meeting suggest ways. One found that a mans PSA at age 60 can strongly predict whether he ultimately will die of the disease.
Dr. Hans Lilja of Memorial Sloan-Kettering Cancer Center in New York tested stored blood samples from nearly 1,200 Swedish men from the early 1980s and checked cancer registries to see how many later developed or died of prostate cancer.
If PSA was 1 or less at age 60, the risk of dying of prostate cancer by age 85 was very low - less than 1 percent - even if men had the disease for many years. About 90 percent of cancer deaths occurred in men whose PSAs at age 60 were in the top one-fourth of the group.
“The bottom line is if youve got a PSA of less than one in your initial screen, you can wait to get another PSA for five years and not really be at increased risk of missing a cancer,” he said. “If your PSA is between 1 and 2, its also a small risk.”
Crawford is the unpaid chairman of the Prostate Conditions Education Council, an industry-supported group that promotes screening.
Dr. Robert Uzzo, a prostate surgeon at Fox Chase Cancer Center in Philadelphia, said many doctors are already advising longer testing intervals.
“Everybody has to get screened at least at some baseline” to sort out future testing needs, he said. “If the baseline is quite low then I dont insist on yearly screening.”
Dr. Otis Brawley, the American Cancer Societys chief medical officer, believes there is still some value to PSA testing, but added: “I am very concerned that the urology community and the American public may think theres more value in PSA than there actually is.”
Doctors Warn About Camphor Poisoning In Children
The alert is in a report in the May issue of the journal Pediatrics about three toddlers who suffered seizures in January 2008. They had either eaten camphor products, inhaled camphor or had it rubbed on them as a cold remedy. The products included folk remedies, pesticides and air fresheners. The children were treated at a Bronx hospital and recovered.
Several other children developed similar symptoms but authorities were unable to confirm if camphor was the culprit, said Dr. Hnin Khine. She is an emergency room physician at Childrens Hospital at Montefiore in the Bronx who treated the three youngsters described in Pediatrics.
The products are made from the wood of evergreen camphor trees that are native to Japan and China, or from synthetics.
Camphor has a strong odor and is used in mothballs. Vicks VapoRub also contains camphor, in low, government-approved doses, although the label advises against use in children younger than 2.
The products implicated in the poisonings were imported white cubes or tablets and contained doses higher than U.S. regulations allow, Khine said.
Theyre widely available in ethnic pharmacies and discount stores, sometimes labeled “alcanfor,” the Spanish word for camphor.
Camphor is easily absorbed by the skin and nose. Young children are especially vulnerable. Poisoning symptoms can include stomach aches, nausea, vomiting and irritability.
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On the Net:
Pediatrics: http://www.aap.org/