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Health Headlines - August 26

Posted Oct 23 2008 2:24pm
Researcher Stands by Fetal Pain Findings

A controversial new research article questioning whether early-term fetuses feel pain has triggered a heated debate on how the research might influence the flash-point realm of abortion politics.

But a neuroscientist who helped write the paper, published Wednesday, said there's no doubt about the conclusion: Humans only feel pain if they have a properly functioning brain, and fetuses in the early stages of development don't.

"The circuitry is not there," at least in the first 20 weeks, said Dr. Henry Ralston, a professor of anatomy and neuroscience at the University of California, San Francisco. "Without the connections, the sensation can't take place."

The report, a review of known research by four doctors and a researcher at UCSF, goes even further: In examining the effectiveness of giving anesthesia to a fetus for therapuetic procedures or abortion, the researchers concluded that fetal perception of pain is unlikely before the third trimester, at 29 to 30 weeks.

Other doctors disagree, however, as do anti-abortion activists who criticized the findings, which appear in the Aug. 24/31 issue of the Journal of the American Medical Association.

Dr. K. S. Anand, a pediatrician at the University of Arkansas for Medical Sciences, told The New York Times, "There is circumstantial evidence to suggest that pain occurs in the fetus."

Anand said premature babies only 23 or 24 weeks old cry when their heels are pricked for blood tests and become conditioned to cry when someone nears their feet.

"In the first trimester, there is very likely no pain perception," Anand said. "By the second trimester, all bets are off, and I would argue that in the absence of absolute proof we should give the fetus the benefit of the doubt if we are going to call ourselves compassionate and humane physicians."

The study is also raising eyebrows, according to a Philadelphia Inquirer report, because one of its authors is the head of an abortion clinic. Her affiliation was not disclosed in the study, nor was that of the lead author, a medical student who once worked for an abortion-rights organization, the newspaper said.

The researcher, UCSF obstetrician-gynecologist Eleanor A. Drey, is medical director of the abortion clinic at San Francisco General Hospital. She told the Inquirer: "We thought it was critical to include an expert in abortion among the authors. I think my presence ... should not serve to politicize a scholarly report."

JAMA editor-in-chief Catherine D. DeAngelis told the newspaper she had been unaware of that.

"This is the first I've heard about it," she said. "We ask them to reveal any conflict of interest. I would have published" the disclosure if it had been made.

The issue of fetal pain, once fairly obscure, has taken an increasingly prominent position in the public consciousness in recent months. More than a dozen state legislatures -- including those in New York and California -- have debated whether to require doctors to tell women getting abortions about the potential pain felt by fetuses during the procedures. The proposed laws would require doctors to offer anesthesia for the fetus.

Arkansas, Georgia and Minnesota have already passed such laws.

And Congress is considering whether to require doctors to provide anesthesia to fetuses in all cases of abortion after 22 weeks of gestational age. (The new study noted that only 1.2 percent of abortions in the United States are performed at or after 21 weeks.)

Ralston said he and his colleagues launched their study, an analysis of previous research, to provide some perspective on the debate.

The researchers examined studies that looked at feelings of fetal pain before the age of 30 weeks. They found that while there hasn't been much research, the evidence suggests that fetuses aren't able to sense pain before the third trimester. They also report that "little or no" research provides guidance about the use of anesthesia on fetuses.

Advocates of anesthesia legislation have pointed to medical reports that fetuses shy away from painful stimuli, like the stick of a needle, in operations during pregnancy. Some doctors argue that infants between 20 and 30 weeks actually suffer pain more intensely than older fetuses and babies because their neural systems aren't set up to adequately process the sensations.

But Ralston said early fetal reactions are simply reflexes stemming from the spinal cord, not a matter of brain response to pain. The spinal cord develops earlier than the brain, as early as eight weeks, he said.

So when do fetuses actually start feeling pain? Ralston said it's not clear, but the lack of feeling before 20 to 22 weeks is "open and shut."

However, Dr. David A. Grimes, a former head of abortion surveillance at the U.S. Centers for Disease Control and Prevention who now delivers babies and also performs abortions in Chapel Hill, N.C., told the Times, "This is an unknowable question."

"All we can do in medicine is to infer," he added.

Still, he said, the new research makes a compelling case that fetuses younger than 29 weeks have no perception of pain.

Health Tip: Making Your Bathroom Fall-Proof

Slippery tubs and water-splashed bathroom floors are common reasons for senior spills.

The Canadian city of Ottawa suggests you take these steps to skid-proof your bathroom:

Make sure the bathtub plug is easy to reach and to use.
Use a rubber mat every time you take a bath or shower.
Make sure anti-slip decals on the bottom of the bathtub are no more than two inches apart.
Install at least two grab bars in the tub area.
Check that portable grab bars don't move when used for climbing out of the tub.
Use a rug with a rubber backing outside the tub.

Health Tip: Building Strong Bones

It's widely known that calcium helps build strong bones. But according to Tufts University Health & Nutrition Letter, iron is another important nutrient associated with bone health because it helps produce an integral component of bone called collagen.

However, iron is only effective in bone building when the recommended 800-1200 milligrams of calcium are consumed as well.

A recent study of menopausal women found that those who consumed about 18 milligrams of iron a day, along with adequate calcium, had the greatest bone mineral density.

Doubts over "metabolic syndrome" weigh on Sanofi

The world's top two diabetes organizations have questioned the existence of a medical condition widely cited by drug firms, in a move that could hamper prospects for Sanofi-Aventis's new drug Acomplia.

The American Diabetes Association and European Association for the Study of Diabetes said in a joint statement on Thursday that "metabolic syndrome" -- which has come to be seen as a predictor of cardiovascular disease -- was poorly defined, inconsistently used and in need of further research.

Doctors should not diagnose people with the "syndrome" or treat it as a separate condition until the science behind it is clear, according to a paper to be published in the September issue of Diabetes Care and Diabetologia.

"There is no combination of risk factors that boosts a person's cardiovascular risk beyond the sum of the parts, or constitutes a separate disease," said Dr Ele Ferrannini, president of the European diabetes association.

Industry analysts said the strongly worded warning was a setback for Sanofi, which is keen to position its anti-obesity drug Acomplia as a medicine to treat "metabolic syndrome," because it also helps with risk factors such as lipid levels.

Shares in Sanofi were 1.2 percent lower at 69.45 euros by 1100 GMT, underperforming the European drug sector, which was off 0.5 percent.

Acomplia, which Sanofi hopes to launch next year once it has received regulatory approval, is viewed as a potential multibillion-dollar-a-year seller for the French company.

Sanofi had no immediate comment on the statement by the two groups.

"Metabolic syndrome" is often defined as applying to anyone with three or more of the following conditions -- a large waist circumference, high triglyceride levels, high blood pressure, low levels of HDL "good" cholesterol and high blood glucose.

A large and growing section of the population in North America and Europe are covered by such a definition, reflecting the increasing problem of obesity in developed countries.

Taken individually, all of the above conditions can be considered a risk factor for heart disease, the two associations said. But they should each be treated separately, and doctors should not try to prescribe treatments for the "syndrome" until new, solid evidence is obtained.

Their experts' concerns over "metabolic syndrome" follow similar controversies surrounding other new disorders that the pharmaceutical industry stands accused of inventing.

Conditions such as "generalized anxiety disorder" and "female sexual dysfunction" have been cited in the past as examples of so-called disease-mongering by drug companies eager to carve out new markets for their products.

The drug makers say they are addressing serious, chronic medical conditions.

Acupuncture Effective for Fibromyalgia

A brief regimen of acupuncture appears to offer more than a month of relief from some of the most debilitating symptoms of moderate-to-severe fibromyalgia, a new study suggests.

The findings are to be presented Thursday by Mayo Clinic researchers at the 11th World Congress on Pain, the meeting of the International Association for the Study of Pain, in Sydney, Australia.

The scientists cautioned that while acupuncture seems to alleviate some of the pain, chronic fatigue and anxiety that many fibromyalgia patients experience, the treatment should not be viewed as a cure.

They further stressed that even with improved energy levels and reduced stress, patients did not demonstrate improvements in either short-term or long-term physical functions after treatment.

Nonetheless, the Mayo team expressed hope that further studies will demonstrate that a sustained regimen of acupuncture treatments may offer fibromyalgia patients a shot at significant quality-of-life benefits over the long-term.

"We found that acupuncture helps with the symptoms, and might be particularly attractive to patients that might not be able to take a range of medications because of side effects," said study lead author Dr. David P. Martin, of the department of anesthesiology at the Mayo Clinic's division of pain medicine.

Fibromyalgia, which has no known cause, can provoke pain, fatigue, stiffness, headaches, numbness, tingling, sleep disturbances, sensitivity to heat and cold, and cognitive and memory problems, according to the National Institutes of Health.

The NIH estimates that between 3 percent and 6 percent of Americans suffer from the often-disabling disorder. While 80 percent to 90 percent of all victims are women, fibromyalgia can strike men, women and children of any age or race.

Doctors typically treat the condition with a combination of symptom-based approaches that offer piecemeal pain management, such as stress and sleep counseling, aerobic exercise, and the tricyclic family of antidepressants.

But, antidepressants are only partially effective and can sometimes provoke side effects, such as excessive sleepiness, dry mouth, constipation and weight gain, Martin said.

Seeking to expand treatment options, the Mayo team tested the benefit of acupuncture on 50 fibromyalgia patients who were described as "moderately debilitated."

The patients -- all of whom had failed to achieve symptom relief with traditional treatments -- were divided into two groups. The first group received six sessions of acupuncture over a two- to three-week period. The second group received six sessions of simulated acupuncture in the same time frame.

Both before and immediately after the acupuncture and simulated sessions, all the patients completed questionnaires regarding their specific symptoms, their level of related pain, and the impact of fibromyalgia on their daily routines. The surveys were also offered one and seven months after treatment.

Martin and his team found that symptoms -- particularly in terms of pain, fatigue and anxiety -- improved significantly and in larger measure among real acupuncture patients compared with the simulated acupuncture patients. The most dramatic symptom improvements were noted at one month after acupuncture.

Yet physical function did not improve. And seven months after acupuncture, pain, fatigue and anxiety symptoms had all returned to pretreatment levels.

Martin suggested that offering acupuncture to patients on an ongoing basis may provide more sustained benefit. And, he added, he would recommend acupuncture to fibromyalgia patients who are open to the notion.

"We need further studies with a larger population," he said. "But the kind of acupuncture we offered was not incredibly unique. You could probably get it at many locations across the country. So I'd recommend patients discuss it with their family physician, and get a referral because people come to acupuncture through all different courses of training."

Dr. Stuart L. Silverman, a professor of medicine and rheumatology, and the medical director of the Fibromyalgia Rehabilitation Program at Cedars-Sinai/University of California, Los Angeles, cautioned that the jury is still out on the potential benefit of acupuncture for fibromyalgia.

"While it's certainly possible and encouraging that in some hands acupuncture works, we have to wait for further study," Silverman said. "Fibromyalgia is a question of central pain -- not peripheral pain. It's as if a person's pain fuse in the brain is broken. They have a problem with the processing of sensory information. They perceive almost any sensation as being painful.

"So while we do know that acupuncture is helpful for peripheral pain, for tennis elbow, for example, it's much harder when we ask acupuncture to treat a pain in the brain -- to treat brain modulation of pain. I think it might be able to do it. But we don't yet know," he added.

Understanding, identifying and treating fibromyalgia can be challenging and confusing for both patients and physicians. NIH researchers point out, for example, that although fibromyalgia is a rheumatic condition -- causing the onset of chronic pain due to joint and soft tissue impairment -- it is not actually a disease of the joints, and is therefore not officially considered a form of arthritis.

An official fibromyalgia diagnosis is typically based solely on reported symptoms, medical exams and the patient's history, since no current lab test or X-ray can effectively screen for the disorder.

"These patients often have to leave their social obligations early and are not able to meet all the expectations of friends and family or be able to do their fair share of the housework," said Martin. "Yet when they go to the doctor, the doctor says that everything's normal -- and it's very frustrating for the patient. These people get pretty desperate."

Health Tip: Get Less Salt

If you've been advised to reduce the amount of salt in your diet, Harvard Medical School offers these tips:

Buy fresh, frozen or canned "no salt added" vegetables.
Use fresh poultry, fish, and lean meat, rather than canned or processed.
Use herbs, spices and salt-free seasoning blends in cooking, and at the table.
Rinse canned foods, such as tuna, to remove some sodium.
Cut back on frozen dinners, packaged mixes, canned soups, and salad dressings.
Cook rice, pasta, and hot cereals without salt.

Health Tip: The Impact of Divorce on Your Children

Divorce can wreak havoc in children's lives, and while there is no step-by-step manual for steering your kids through this traumatic time, there are some common sense guidelines that may make adjustments easier.

If you're going through a divorce, The Nemours Foundation suggests you:

Encourage your kids to talk as openly as they can about their feelings, positive or negative.
Don't bad mouth your estranged spouse in front of your children, no matter how angry you are.
Avoid using your kids as messengers or go-betweens.
If there's someone new in your life, expect resistance from your children.
Seek out support groups, counseling, and friends in similar situations.

Food Fact:
Miso hungry!

This fermented soybean paste packs a lot of flavor in a very small quantity. The Japanese staple is usually made from a combination of soybeans and rice, although additional soybeans or barley may be used in place of the rice. Miso is usually sold in pint-sized recloseable plastic tubs at large supermarkets, whole foods stores and Asian markets. Refrigerated miso will keep for several months. Miso is very high in sodium, so use it sparingly in soups, marinades and salad dressings.

Fitness Tip of the day:
Mirror, mirror...

Ever wonder why health clubs have all those mirrors? No, it's not for vanity's sake! The mirrors are there to assure you're maintaining proper form when exercising. You're not being a narcissist when you position yourself in front of the mirror; pay careful attention to see you're doing the exercise right. If you are uncertain as to how to perform an exercise, don't hesitate to ask for help.

FAQ of the day:
Do I really need a "cooldown" after a workout?

Cooling down after a workout is even more important than the preworkout warm-up. During a cooldown, blood slowly returns from the extremities to the heart, capillaries return to normal dilation, and your respiration and heart rate slow down. If you skip your cooldown, you risk light-headedness and muscle spasms. It's also harder on your heart to go suddenly from 60 to zero. Walk slowly at the end of a run, do a few slower minutes on the stair climber or bike, and remember to stretch.
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