Scientists Seek Origins Of Obesity In The Womb
She went on to have two daughters, and she may have boosted their chances of avoiding becoming obese, like her two older children are.
Thats the implication of research suggesting that something in an obese womans womb can program her fetus toward becoming a fat child and adult. Its not about simply passing along genes that promote obesity; its some sort of still-mysterious signal.
The idea has only recently entered conversations between doctors and female patients, and scientists are scrambling to track down a biological explanation. That knowledge, in turn, may provide new ways to block obesity from crossing generations.
While theres some disagreement on how important the womb signal is, “the evidence is building and building that it is a substantial issue,” said Dr. Matthew Gillman of Harvard Medical School, who studies prevention of obesity.
Others agree. “I think it could be a hugely significant factor,” said Robert Waterland of the Baylor College of Medicine in Houston, who studies the effect in mice.
Dr. Rudy Leibel, an obesity expert at Columbia University, says he doubts it plays a huge role, but still believes its worth studying. If scientists can uncover its biological underpinnings, he said, they may be able to use that knowledge to prevent or treat obesity from other causes.
Perusse, 39, of Three Rivers, Quebec, knows the effects of being very fat. Before her weight-loss surgery in 1995, she packed 284 pounds on her 5-foot-2 frame. She could not ride a bike or climb stairs to her second-floor home without stopping to rest.
Now, although shes still overweight, those limitations are history, she said through an interpreter.
But her older children struggle with their weight. At 5-foot-3 and 300 pounds, her 22-year-old daughter cant bathe her own two children, Perusse said. Her 16-year-old son weighs 230 pounds and stands 5-foot-6.
They were born before she had the weight-loss surgery. Her two younger daughters, ages 4 and 7, came along afterward. Their weights are normal so far, though Perusse said her older children werent overweight at those ages either.
So shes using diet and exercise to try to protect them against what she called rotten genes, including those from their 400-pound father. She said she isnt optimistic.
But Dr. John Kral of the SUNY Downstate Medical Center in New York says his research suggests that obese women who lose weight before pregnancy may be helping the next generation keep off excess pounds – even if fat-promoting genes run in the family.
In addition, those born afterward showed lower levels of blood fats and indicators of future diabetes.
Kral says families typically dont change lifestyle or diet after surgery, so that doesnt explain the outcome.
Instead, he says, the surgical bypass operation made the womens bodies less efficient at digesting and absorbing food, and lowered levels of sugar and fat in the blood. That, in turn, would reduce the number of calories delivered to the fetus to levels like those provided by a normal-weight mother, he said.
And the womens shedding of pounds before the pregnancy would also help, he said.
While scientists are still trying to explain just how obesity could be transmitted from the womb, it makes sense that a mothers obesity could affect her childrens long-term weight, Waterland said. Cues in early life, including some in the womb, guide the development of a persons brain circuitry for controlling the balance between calories consumed and those burned away, he said. So a signal there could have a long-lasting impact.
Michelle Obama Highlights Breast Cancer Awareness
But thats where the Rockford, Ill., woman was Friday as she stood in a White House flower garden and shared her story of being repeatedly denied health insurance because of the cancer in her past.
In less than four minutes at the microphone, Lownsdale helped the Obama administration mark Breast Cancer Awareness Month and, more importantly, provide a flesh-and-blood illustration for why President Barack Obama wants to overhaul the system.
First lady Michelle Obama said the U.S. has come a long way from the days when people thought breast cancer was something to be ashamed of and kept a secret, when it was treated as something not discussed in polite company.
More women are getting mammograms, the five-year survival rate is above 90 percent and research spending is at $900 million – 30 times the amount spent in 1982. But 1 in 8 women will still be diagnosed with breast cancer in her lifetime and 40,000 women a year still die from the disease, she said, and the current health care system doesnt work for many women who are living with the cancer.
“Its a system that only adds to the fear and stress that already comes with the disease,” the first lady said.
At the end of her treatment for a pea-sized tumor, Lownsdale said her doctor said she had a 94 percent chance of remaining cancer free, “very similar to a woman whos never had breast cancer.” Then in 2005, her insurer notified her that her health care premiums would more than double.
The married, 40-something graphic designer shopped around for new coverage and repeatedly was denied. She ended up with coverage through Illinois high-risk pool, and currently pays $600 a month for her coverage alone.
Despite her good health, she said the diagnosis “left a target on my back.”
“I will most likely be cancer free for the rest of my life, but having the word cancer written on my medical chart is enough to generate an automatic rejection from insurance coverage,” Lownsdale told a gathering of breast cancer survivors, advocates, members of Congress and Jill Biden, the vice presidents wife. Mrs. Biden started a breast cancer education program in Delaware after some close friends were diagnosed.
Mrs. Obama said health care changes the president is pushing Congress to pass would help consumers by barring insurers from denying coverage because of pre-existing conditions, like breast cancer, and require coverage for preventive screenings like mammograms.
“Perhaps most heartbreaking of all is the fact that right now, today in America, there are people in this country who have breast cancer but dont even know it because they cant afford a mammogram,” said Mrs. Obama, a former hospital administrator in Chicago.
One in five women age 50 or older havent had a mammogram in the past two years, she said, citing a Health and Human Services Department report.
Snowe Rejects Public Option as Senate Democrats Weigh Measure
“A public option at the forefront really does put the government in a disproportionate position with respect to the industry,” Snowe, the only Republican to vote for a health plan so far, said in an interview with Bloomberg Televisions “Political Capital With Al Hunt,” airing this weekend.
Snowes stance is crucial because Democrats such as Nebraska Senator Ben Nelson say a bill has to have Republican support to win his vote. She might also bring along more Republicans, such as fellow Maine Senator Susan Collins.
While the establishment of a so-called public option to compete with private insurers is opposed by all Republicans and has divided Democrats, the idea is getting fresh attention from Senate Democratic leaders, lawmakers say. It was the main topic of discussion all day on Capitol Hill and was brought up at a meeting that Majority Leader Harry Reid and other lawmakers had later with President Barack Obama at the White House.
Senator Kent Conrad, a North Dakota Democrat whos played a leading role in seeking a bipartisan compromise, said Reid and Obama administration officials are tilting in favor of including a version in a Senate bill.
States would be free to opt out of the insurance program and the plan would pay health-care providers at higher rates than does the Medicare insurance system for the elderly, Conrad, a member of the finance committee, told reporters.
“What Im hearing is this is the direction of the conversation,” he said, adding that no decision had been made.
Reids spokesman, Jim Manley, declined to comment.
60 Votes Needed
A Democratic aide familiar with the discussions said while a public option is being considered, it wont be included in legislation unless Reid can get 60 votes, the number needed to avoid Republican stalling tactics. Another possibility is Snowes plan to start a government plan only if there isnt enough competition for private insurers to keep rates low, said the aide, who requested anonymity.
Meanwhile, House Democratic leaders are trying to gain consensus among the partys rank and file for a public option that would peg doctor reimbursements to lower Medicare rates, which would present a stronger challenge to private insurers.
In the Senate, Democrats including Charles Schumer of New York and Jay Rockefeller of West Virginia say a public option is vital to bringing costs down. Snowe and some Democrats such as Nelson say theyre worried about undermining the market.
Biggest Changes
Lawmakers are considering the biggest health-care changes since the creation of Medicare in 1965. The legislation, Obamas top domestic priority, attempts to curb medical costs while covering tens of millions of uninsured Americans.
Obama has told Congress he wants to sign legislation this year, a goal that may slip, Snowe said.
“Christmas might be too soon,” she said in the Bloomberg interview. “We should give it the time it deserves.”
Reid is combining a measure passed by the Senate health committee in July with an $829 billion proposal approved by the Senate finance panel on Oct. 13 with Snowes vote. The Senate has to debate and vote on a plan before it can be merged with a bill from the House, which is going through the same process.
Legislative Timeline
House Speaker Nancy Pelosi said Democrats hope to introduce their combined legislation next week. Senate Finance Committee Chairman Max Baucus said he doesnt expect a Senate bill to be ready for floor debate in his chamber.
Novo Nordisk Drug Helps Healthy Lose Weight, Axe Blood Pressure
The study involving 564 people found just five months of liraglutide injections shaved 4.8 kilograms (10.6 pounds) to 7.2 kilograms from their frames, compared with 4.1 kilograms for those on Xenical and 2.8 kilograms for those given placebo.
The research suggests that liraglutide may be more effective than currently available treatments for obesity. About half of Europeans and two-thirds of Americans are overweight, and 30 percent are considered obese, studies show. Few treatments are available. Novo Nordisk, based in Bagsvaerd, Denmark, funded the research that appears in the journal Lancet and has another trial under way.
“Overall, the results of this study indicate the potential benefit of liraglutide, in conjunction with an energy-deficit diet, in the treatment of obesity and associated risk factors,” said the researchers, led by Arne Astrup, from the University of Copenhagens department of human nutrition. “Liraglutide offers a new mode of action for the treatment of obesity and improved efficacy compared with currently available therapies.”
The research is the second of three phases of trials generally needed to win regulatory approval. Novo Nordisk said it is waiting to hear from U.S. regulators this quarter about the use of the drug for diabetes before it starts additional weight loss trials. Liraglutide is already approved for diabetics in Europe, where its marketed under the name Victoza.
Lower Blood Pressure
Blood pressure levels dropped in all patients taking liraglutide, while signs of impending diabetes, marked by slightly elevated blood sugar levels, fell by as much as 96 percent, the study found.
“Liraglutide improved several factors associated with cardiovascular events over 20 weeks, which are regarded as more clinically relevant than weight loss per se,” the researchers said. “The long-term risk-benefit profile for liraglutide, as well as its weight maintenance capabilities, remain to be established.”
The most common side effects were nausea and vomiting, which generally occurred within the first month. There were no signs of other serious side effects, including pancreatitis, psychiatric complications or thyroid cancer. Participants in the study also followed a calorie-restricted diet and increased their physical activity.
Increased Obesity
The rising rates of obesity during the past two decades have coincided with a dramatic increase in diabetes, leading many public health officials to declare that epidemics are under way with both conditions.
Healthy patients in Astrups study lost more weight than diabetics in earlier studies who were taking the same doses of the drug, said George Bray, from Louisiana State Universitys division of clinical obesity and metabolism in Baton Rouge, in an editorial. It may be that people without diabetes are more responsive to the drug, which stimulates insulin production, slows the emptying of the stomach, and decreases food intake, he said.
“Whether long-term use of an injectable drug is palatable as a treatment for obesity is yet to be established,” Bray wrote. “From what we do know about GLP-1 agonists and their mechanisms, we can be optimistic that their promise for the treatment of obesity will be fulfilled.”
Past Setbacks
Efforts to develop obesity drugs have suffered setbacks. Sanofi-Aventis SA pulled Acomplia off European shelves last year after regulators recommended suspension of sales. The medicine failed to win the backing of a U.S. advisory panel in 2007 after it was linked to suicide.
Merck & Co. last year stopped development of taranabant, in the same class of medicine as Acomplia, because it made people depressed and irritable. Pfizer Inc., the worlds biggest drugmaker, also ended early-stage work on obesity treatments as part of a research overhaul last year.
GlaxoSmithKline Plc sells a form of Xenical, known chemically as orlistat, in a lower-dose, over-the-counter formulation known as Alli.
— Editors: Phil Serafino, Kristen Hallam
Ny Officials Rescind Mandatory H1n1 Flu Shot Order
New York will be getting only about 23 percent of its anticipated supply of the vaccine for the swine flu virus – also called H1N1 – by the end of the month, and that should be reserved for those most at risk for serious illness and death, according to Gov. David Patersons office.
“New evidence is showing that H1N1 can be especially virulent to pregnant women and young people – so they should get vaccinated first,” said Dr. Richard Daines, the state health commissioner.
Workers had protested Daines earlier order that health care workers receive the vaccine, arguing it was unfair to force them to put a substance into their body. Unions and health workers sued the state, and a judge issued a temporary restraining order last week.
“This is welcome news,” said Carl Korn, a spokesman for the New York State United Teachers union. “This suit was never about the safety of the vaccine, or the merits of it. The suit was always about giving individuals the choice, as adults, as to whether or not they wanted to be vaccinated without the threat of termination.”
Its unclear what will happen with the lawsuits. Thursdays action was a suspension of the order, and the Health Department plans to pursue making the order permanent in 2010, as long as theres enough vaccine for that flu season, said Diane Mathis, an agency spokeswoman.
The Health Department initially had said the workers must be vaccinated by November 30. Institutions had to determine how to enforce the mandate, leaving some workers concerned about possible disciplinary action, including dismissal.
“This was the proper and appropriate action for the state to take,” said Kenneth Brynien, president of the Public Employees Federation, one of the unions that sued. “This was an extremely passionate issue for many of our members.”
PEF said it encourages members to get flu vaccinations, but opposes the emergency regulation requiring the vaccine as a condition of employment.
This week the Centers for Disease Control and Prevention allowed the state to order 146,300 doses of vaccine, but health care providers across the state have requested more than 1.4 million doses.
Fda Warns: Swine Flu Scams Lurk On The Internet
These and other products making bogus claims to prevent or treat swine flu are flooding the Internet as scam artists prey on the publics fears while the vaccine is delayed and real Tamiflu – made by Switzerlands Roche Group – is rationed.
Every problem, it would seem, is a sales opportunity. Some of the products appear to have been pitched for other emergencies, such as one called “Quake Kare” and masks and purifiers sold during the SARS scare.
Federal officials have sent warning letters to promoters of more than 140 swine flu-related products, including well-known alternative medicine advocate Dr. Andrew Weil for his “Immune Support Formula.”
Consumer Reports also has warned subscribers to be wary.
“Its harmful, disappointing, frustrating to see folks take advantage of the public like this,” said Dr. John Santa, who evaluates health claims for Consumer Reports.
Fraudulent products emerged shortly after swine flu did last spring – about 10 a day, said Alyson Saben, head of a swine flu consumer fraud team formed by the Food and Drug Administration. The pace slowed over the summer as the flu abated, but “its picked up” in recent weeks, she said. “We are seeing new sites pop up.”
Most worrisome: sites that claim to sell Tamiflu without a prescription. The FDA bought and tested five such products. One contained powdered talc and generic Tylenol – no Tamiflu. Several others contained some Tamiflu but were not approved for sale in the U.S.
“We have no idea of the conditions under which they were manufactured. They could contain contaminated, counterfeit, impure or subpotent or superpotent ingredients,” Saben said.
Tamiflu and GlaxoSmithKlines Relenza are the only drugs recommended for treating swine flu.
Rogue Web sites are not the only ones trying to cash in on flu fears. Makers of some well-established products are making claims that may be close to the line, the FDA says.
This week, the makers of Dial Soap, Kleenex, Clorox and other big brands launched a joint promotional campaign costing up to $1 million. The FDA is reviewing the campaign, which includes a video that says:
“Germs are tiny organisms that can cause disease. According to the CDC, up to 80 percent of infectious diseases, like the flu, are spread by your hands. Thats why frequent, proper handwashing is so important in preventing spread of the flu, other viruses and germs. An antibacterial soap like Dial Complete foaming hand wash kills 99.9 percent of germs.”
The campaign is “not being specific down to swine flu,” said Scott Moffitt, an official with Dial Corp.s parent company, Germany-based Henkel AG. He also contends the video is not misleading, even though the germ-killing claim follows a sentence about flu and other viruses.
One product that drew a warning letter from the FDA is the Photon Genie, a gadget that delivers “energy waves.” Its Web site claimed it “helps strengthen the immune system, and a strong immune system is KEY to preventing swine flu symptoms and KEY to treating swine flu.”
The site has since removed the swine flu claim but “other claims remain,” Saben said.
The group behind the Web site, the Skilling Institute of Phoenix, “is not marketing, and will not market in the future, any product that is intended to diagnose, mitigate, prevent, treat or cure the H1N1 flu virus,” its director, Warren Starnes, wrote in an e-mail.
Some products the FDA warned about contain silver, such as “Swine Flu…Gone,” made by Secrets of Eden.
House Targets Insurers With Antitrust Challenge, Public Option
The House Judiciary Committee yesterday voted 20-9 to approve legislation that would ban insurers from engaging in price fixing, bid-rigging and market allocation. The measure may be added to broader health-care overhaul legislation.
At the same time, Democratic leaders said they can win passage for a government program to compete with private insurers and drive down prices, one of the most contentious issues dividing Democrats and Republicans.
“We have the votes to pass a robust public option,” said Connecticut Representative John Larson, chairman of the House Democratic Caucus. A Congressional Budget Office estimate that the House measure would cut the deficit over 20 years “has placed us in a good spot with the caucus,” he said.
Democratic leaders in the Senate had a tougher time yesterday, when they lost a bid to stave off Medicare-payment cuts to doctors because Republicans and even some Democrats objected to the $247 billion cost. Democrats have been courting the doctors to support the revamp of the medical system.
Lawmakers are considering the biggest changes to U.S. health care since the creation of Medicare in 1965. The legislation, President Barack Obamas top domestic priority, attempts to curb health-care costs while covering tens of millions of uninsured Americans.
Showdown With Senate
The proposal to create a public option is dividing House and Senate Democrats. While the idea has met resistance in the Senate, House Speaker Nancy Pelosi has insisted on keeping it in her version, setting up a clash between the two chambers later when they must reconcile their legislation.
Under one House plan, the public option would peg rates to 5 percent above those paid by Medicare, the government program for the elderly.
An alternative plan would negotiate rates, as private insurers do. A group of fiscally conservative Democrats known as Blue Dogs supports that idea, saying it would provide fairer competition for insurers such as Indianapolis-based WellPoint Inc.
Preliminary Congressional Budget Office estimates show that the legislation with a public option pegged to Medicare rates would cost $871 billion over 10 years, while a bill requiring negotiated reimbursements would be $895 billion, a House leadership aide said on condition of anonymity.
To raise money, House Democratic leaders are considering an annual fee for medical-device manufacturers that would bring in $20 billion over 10 years, the aide said.
“We have a couple of good options,” Pelosi said in a Bloomberg Television interview yesterday. “I dont think we have a bad option in the mix.”
Pelosi and Senate Majority Leader Harry Reid are blending versions passed by three House committees and two Senate panels. In all the measures, Americans would be required to buy insurance, helped by purchasing exchanges and government aid. Insurers would face new rules and have to accept all clients.
While House Democrats are nearing agreement, lawmakers in the Senate are debating other issues. Chief among them are whether to require that employers cover workers, and how to pay for legislation that will cost more than $800 billion over 10 years, as well as the public option.
Senator Ben Nelson, a Nebraska Democrat, said he met with Reid on Oct. 20 and pushed him to drop a “robust public option.” He and Maine Senator Olympia Snowe, the only Republican to support any measure so far, talked with Reid again yesterday about the employer requirement.
“There are a number of our colleagues who have concerns about the employer mandate,” Nelson said.
Biggest Hits
Insurers have taken some of the biggest hits in the debate. The industry opposes the public option, and Americas Health Insurance Plans, a Washington trade group, said action on the antitrust exemption isnt needed and might create “increased regulatory and legal uncertainty.”
Production Of Swine Flu Vaccine Is Way Behind
As nervous Americans clamor for the vaccine, production is running several weeks behind schedule, and health officials blame the pressure on pharmaceutical companies to crank it out along with the ordinary flu vaccine, and a slow and antiquated process that relies on millions of chicken eggs.
There have been other bottlenecks, too: Factories that put the precious liquid into syringes have become backed up. And the government itself ran into a delay in developing the tests required to assess each batch before it is cleared for use.
What effect the delays will have on the course of the outbreak is unclear, in part because scientists cannot say with any certainty just how dangerous the virus is, how easily it spreads, or whether it will mutate into a more lethal form.
Since April, swine flu has killed more than 800 people in the U.S., including 86 children, 39 of them in the past month and a half, according to the Centers for Disease Control and Prevention. More than half of all hospitalizations since the beginning of September were people 24 and under.
“Were in this race against the virus, and only Mother Nature knows how many cases are going to occur over the next six to 10 weeks,” said Michael Osterholm, a vaccine expert at the University of Minnesota.
In the meantime, many states have had to postpone mass vaccinations. Clinics around the country that managed to obtain doses of the vaccine have been swamped. And doctors are getting bombarded with calls from worried and angry parents.
“Nobody has it,” said AnnMarie OConnor, who waited more than four hours for the vaccine in Rockville, Md., standing in line with her two young children and about 1,000 other people. Health officials “said the shots would be here in early October. But where are they?”
Federal officials counsel patience, saying that eventually there should be enough of both vaccines for everyone who wants them.
“We wish we had better ways to produce vaccines perfectly predictably, but this is how influenza vaccine production often goes,” Dr. Anne Schuchat, who heads the CDCs immunization and respiratory disease section, said last week.
The delays have led to renewed demands for a quicker, more reliable way of producing vaccines than the chicken-egg method, which is 50-year-old technology and involves injecting the virus into eggs and allowing it to feed on the nutrients in the egg white.
Federal officials initially projected that as many as 120 million doses of the vaccine would be ready to dispense by mid-October. They later reduced their estimate to 45 million. As of Tuesday, only 12.8 million were available. (Health officials say a single dose will protect adults, while children under 10 will need two doses.)
In a sign of how rapidly the virus is spreading, education officials said 198 schools in 15 states were closed Wednesday because of swine flu, with more than 65,000 students affected. That was up from 88 school closings the day before.
The government now hopes to have about 50 million doses out by mid-November and 150 million in December, Dr. Nicole Lurie, assistant health and human services secretary for preparedness, told The Associated Press on Wednesday.
“By the end of November, I think were going to be pretty well back on track,” she said.
However, a study by Purdue University researchers said the vaccinations will probably come too late to significantly reduce the number of infections. The study, published last week, predicted that infections would peak in late October and that by the end of the year, 63 percent of the U.S. population will have caught the virus.
The blame for the delays has been placed in part on the chicken-egg technology. It is a slow process, and the pressure on manufacturers to produce two vaccines at the same time – for both swine flu and ordinary flu – has made it even slower.
Also, the virus on which the swine flu vaccine is based was found to reproduce very slowly in eggs – much more slowly than the ordinary flu virus. Health and Human Services Secretary Kathleen Sebelius, who on Wednesday was grilled about the delays by the Senate Homeland Security Committee, said the problem has been fixed.
Panel Backs Vaccine as Cervical Cancer Alternative
The panel gave a limited endorsement to GlaxoSmithKlines vaccine, Cervarix, which the government licensed last week. Merck & Co. has had the vaccine Gardasil on the market since 2006.
The Advisory Committee on Immunization Practices did not state a preference for one vaccine over the other. But officials noted that while both protect against cervical cancer, the older Merck vaccine also protects against genital warts.
The committee advises a federal public health agency, the Centers for Disease Control and Prevention. The CDC still has to adopt the new recommendation for it to become official advice for U.S. physicians.
Both shots are a three-dose series that target two types of human papillomavirus, believed to be responsible for about 70 percent of cervical cancer cases. HPV is spread through sex.
The vaccine is considered most effective when given to girls at around age 11 or 12, before they become sexually active.
The Merck series costs about $390 and Glaxos costs about $385.
Committee members discussed whether it was appropriate or not to give a subtle nod to one vaccine over the other. To some, the fact that Gardasil also targets two other types of HPV that cause genital warts was an important consideration. Genital warts are not a serious condition, but there are a half million such infections a year, many of them in teens and young adults.
“It has an enormous impact on relationships and self esteem,” said Dr. James Turner, executive director of student health at the University of Virginia. Turner is not a voting member of the committee; he is a liaison to the committee on behalf of the American College Health Association.
Some cost-effectiveness studies have suggested the Glaxo vaccine series should be priced about $100 less than it is, since it doesnt protect against genital warts, said Harrell Chesson, a CDC economist.
But because its slightly less expensive than the Merck vaccine, some patients and doctors may still choose it instead, some experts said.
More women getting the Glaxo vaccine reported pain, redness and swelling at the injection site. Committee members said that could be due to the fact that the vaccine uses a new kind of adjuvant – a chemical compound used to boost the immune system and stretch the vaccines active ingredient, board members said.
CDC officials advised avoiding a statement on preference of one over the other. “We wanted to facilitate a market for both vaccines,” said Dr. Lauri Markowitz, a CDC HPV expert.
Neither vaccine is recommended for pregnant women – a precaution, because the effect of the vaccine on pregnant women and developing fetuses has not been thoroughly studied.
Last week, the Food and Drug Administration approved a new use for Gardasil, to prevent genital warts in boys.
The committee considered whether to recommend routine vaccination of boys against HPV, partly as a strategy to prevent the spread of HPV to girls. Fewer that 40 percent of the girls and young women recommended to get Gardasil have gotten a first shot, and fewer than 20 percent have had the whole three-dose series.
Some physicians who work with adolescents passionately endorsed such a step. But the committee decided not to do that, after hearing experts say such a strategy was not very cost effective, and female HPV vaccination rates are expected to rise without such a step.
But while doctors are not expected to prod families to get their boys vaccinated against HPV, the committee voted that for families who want it for their boys ages 9 to 18, it will be covered by a federal program that pays for vaccinations for children who are uninsured or on Medicaid or meet other criteria.
Sperm Donor Passed On Sudden Demise Heart Defect
Two children, both now teenagers, have developed symptoms and are at risk for sudden cardiac death, the report says. Its the second documented instance of a genetic condition being inherited through sperm donation.
The latest case highlights the importance of thoroughly screening sperm donors, according to the report and an editorial published with it in Wednesdays Journal of the American Medical Association.
The San Francisco sperm bank involved now gives all donors electrocardiogram tests to weed out men with genetic heart problems; the study authors recommend that other sperm banks follow suit.
Voluntary sperm bank guidelines say donors should be required to provide a complete medical history to rule out those with infectious diseases or a family history of inherited diseases. Many also do testing but for genetic diseases that are less common than the heart problem, according to co-author Dr. Barry Maron of the Minneapolis Heart Institute, a leading authority on the condition called hypertrophic cardiomyopathy.
Hypertrophic cardiomyopathy thickens the heart and makes it harder to pump blood. It affects about one in 500 people; many more likely have the genetic defect without symptoms, said study co-author Heidi Rehm of Harvard Medical School.
Symptoms can include an irregular heartbeat and shortness of breath but many cases go undetected until sudden death. The condition is often the culprit when young athletes collapse and die suddenly. Treatment includes medication and an implanted defibrillator to prevent sudden death.
Neither the sperm bank nor the donor were identified. The donor, now 42, had no symptoms of genetic heart disease and no obvious family history when he donated sperm in the early 1990s. His own condition wasnt diagnosed until after a child born through sperm donation was diagnosed. Maron declined to provide more details on the donors health, citing privacy concerns.
The children are now ages 7 to 16. Nine, including one born to the donors own wife, tested positive for the heart mutation. One born through sperm donation died; two others have developed symptoms, with one getting a defibrillator. The remaining children are at increased risk for problems, which often dont show up until adolescence, Maron said.
The only other documented case of a disease inherited through sperm donation involved a rare blood disease.
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