Rehab-first promising for ACL tear, says study HEALTH

Gluten allergy culprits identified
Rehab-first promising
for ACL tear, says study
NEW YORK, July 22, (Agencies): Attention, weekend athletes: Don’t be too quick
to agree to surgery for a common type of knee ligament tear.
A study of Swedish amateur athletes — mostly soccer players — found that
those who got an ACL reconstruction right away plus physical therapy fared no
better than athletes who started out with rehab and got the surgery later if they still
needed it.
Of those in the rehab-first program, fewer than half went on to get the surgery
within two years, researchers reported in Thursday’s issue of the New England
Journal of Medicine.
“It seems that if you start out with rehabilitation only ... you have a good chance
of ending up with an equally good outcome as if you had early ACL surgery,” said
Richard Frobell of Lund University
Hospital in Sweden, an author of the
Pregnant women
“Maybe we will be surprised that a
lot of people actually do not need an
ACL reconstruction.”
Frobell stressed that the study did
not include professional athletes. They
usually seek surgery to get back into
action quickly rather than waiting to
NEW YORK, July 22, (RTRS):
see if rehabilitation works.
Pregnant women need no
About 200,000 Americans each year
longer give up their morning cup
have surgery to replace the anterior
of coffee.
cruciate ligament, or ACL, which is
A research review by The
crucial for knee stability. It can get torn
in sports like football and soccer that
require planting the foot and pivoting.
Gynecologists had found that
Doctors already knew that not every
moderate caffeine consumption
patient with a torn ACL needs surgery;
probably won’t increase the risk
of a miscarriage or premature
a middle-aged jogger or cyclist can
often get by with a knee brace and
Until recently, studies have
rehabilitation, experts say. Frobell said
had conflicting findings about
his work suggests that the same stratethe effect of moderate caffeine
gy might work for athletes who want to
consumption on pregnancy
return to more strenuous sports like
complications but a College
soccer, at least on lower competitive
committee has reviewed the evilevels.
Some patients with a damaged ACL
“I think it’s time to comfortably
can cope well at a high level. But docsay that it’s OK to have a cup of
tors can’t reliably predict which ACL
coffee during pregnancy,” Dr
patients will turn out to be “copers,”
William Barth, the chair of the
College committee, told Reuters
and Frobell acknowledged his work
doesn’t help with that.
The College’s Committee on
Doctors and patients currently
Obstetric Practice said that 200
decide on whether to do the surgery
milligrams of caffeine a day —
depending on individual factors like
about the amount in a 12-ounce
just what physical activities the patient
cup of coffee — doesn’t signifiplans to pursue and the overall health
cantly contribute to miscarof the knee, said Dr Bruce Levy, a
riages or premature births.
Mayo Clinic surgeon.
That definition of “moderate
The operation is an outpatient procecaffeine consumption” would
dure that involves replacing the ACL
also include drinking about four
with tissue from the patient or a cadav8-ounce cups of tea or more
er. Risks include infection and stiffness
than five 12-ounce cans of soda
a day, or eating six or seven
that may require more surgery. The surdark chocolate bars.
gery costs $10,000 or more, depending
The committee said the evion whether cadaver tissue is needed.
dence was not clear on whether
The new study focused on 121
consuming more than 200 mg of
Swedish amateur athletes, ages 18 to
caffeine a day might increase
35, mostly soccer players with some
pregnancy risks.
volleyball players. They had new, comThe group considered two
plete ACL ruptures. Half were randomrecent studies, each of which
ly assigned to get surgery right away
followed more than 1,000 pregplus physical therapy, and the other
nant women.
half to start with the rehab to improve
One study, led by Dr David
the knee. The rehabilitation required
Savitz of The Mount Sinai
about 60 sessions on average, two or
Medical Center in New York,
found no increased rate of misthree times a week, Frobell said. That
carriage for women who conworks out to about five to seven
sumed low, moderate, or high
levels of caffeine at different
Two years later, both groups reported
points in their pregnancy. In the
about the same amount of improveother, Dr De-Kun Li and his colment in ratings for things like pain, perleagues at Kaiser Permanente’s
formance in sports and how much their
Division of Research in Oakland
knee interfered with their lives. And
found a higher risk of miscarabout 40 percent of each group had
riage in women who consumed
returned to their previous level of
more than 200 mg of caffeine
sports intensity, as measured by that
per day, but no extra risk at
activity’s stress on the knee.
lower levels.
Among those treated with physical
The committee also pointed
to two other studies that found
therapy first, those who eventually got
that a mother’s moderate cafthe surgery turned out no better than
feine intake did not make it any
those who didn’t.
more likely she would deliver a
baby prematurely.
Research has shown that cafGluten allergy: Researchers have
feine is able to cross the placenidentified three fragments in gluten that
ta, which led to worries that it
appear to trigger a disorder in people
could cause miscarriage or prewho are allergic to the wheat protein.
mature birth.
The findings, published on Thursday
In the United States, about 16
in the journal Science Translational
percent of all pregnancies end
Medicine, may lead to a more targeted
in miscarriage and about 12
cure instead of what sufferers practice
percent of babies are born prenow — life-long abstinence from food
containing gluten, such as cereal, pasta,
Barth said previous studies
cookies and beer.
were mixed and unclear about
“If you can (narrow down) the toxicthe link between caffeine and
pregnancy risks. It was the new
ity of an allergen to a few components,
findings from large groups of
that enables you to make a highly tarwomen that allowed the commitgeted therapy in a way that you no
tee to feel confident that moderlonger need to target the whole immune
ate caffeine intake was safe.
system,” said researcher Robert
Anderson of The Walter and Eliza Hall
Institute of Medical Research in
Without a bone marrow transplant,
Victoria, Australia.
For people with the allergy, gluten which works best with a matching
causes an overreaction in the immune donor, such “bubble babies” have to
system that damages the lining of the live in germ-free environments and
small intestine, leaving it unable to usually die within a year. Doctors hope
absorb vitamins, minerals and other gene therapy will work when no donor
is available.
nutrients from food.
But its success has been limited by
The sufferer is subject to chronic
fatigue and risks osteoporosis, infertili- the threat of leukemia, and the new
ty, miscarriage and even cancers of the study looks at the long-term impact of
digestive tract — symptoms of what is a treatment that the researchers last
used in 2002.
called celiac disease.
The team, led by Salima HaceinIn the study, 244 people with celiac
disease in Australia and Britain ate Bey-Abina of the Paris Descartes
food with gluten over three days and University, reported in the New
researchers then analysed the immune England Journal of Medicine that the
treatment provided a long-term cure for
cells in their blood samples.
SCID, in most cases.
“All children except one, including
‘Bubble boy’ treatment: A 10-year the three survivors of T-cell acute
study of nine boys born without the leukemia, could live normally in a nonability to ward off germs has found that protected environment and cope with
gene therapy is an effective long-term microorganisms without harmful contreatment, but it carries a price: four of sequences while growing normally,”
them developed leukemia.
they concluded.
The technique is designed to help
The median age of the boys when
boys with X-linked severe combined they got the gene therapy was seven
immunodeficiency disease, or SCID, a months. The one death was from
rare mutation that prevents the body leukemia.
from making mature T cells or natural
Leukemia is much easier to treat in
killer cells, which are vital tools for young children than SCID. The success
fighting infections.
rate is usually 90 percent or more.
‘Okay to have
a cup of coffee’
Maurice Leroux, a former employee of Ferodo-Valeo holds a piece of asbestos in this Oct 24, 2007 file photo, in Condé-sur-Noireau. Despite proven links to cancer, a ban in the
European Union and four other countries, and reams of damning scientific tests, asbestos is still selling like hotcakes in the developing world, a report said July 21, 2010. (AFP)
Asbestos trade thriving in developing world: report
Despite proven links to cancer, a ban in
the European Union and restrictions in
the United States, industry lobbyists have
ensured that asbestos is still selling like
hotcakes in the developing world, a report
said Wednesday.
An investigation conducted by the
Investigative Journalists and the BBC
found that the asbestos industry has
ignored waves of asbestos-related disease around the world that have led to
bans or restrictions in 52 countries, and
continues to ply the mineral in developing nations.
More than half of the two million metric
tonnes of asbestos that were mined
worldwide in 2009 was exported to developing countries like India and Mexico,
where demand is high for cheap building
materials, the report said.
Most of the asbestos sold in those
countries is used in cement for corrugated roofing, in water pipes and for home
The asbestos industry’s growth has
been fueled by “a marketing campaign
involving a global network of industry
groups led by the Canadian-governmentbacked Chrysotile Institute,” said David
Kaplan, director of the ICIJ.
Chrysotile is another name for white
asbestos, the most common form of the
The asbestos industry has spent “nearly 100 million dollars US in public and private monies since the mid-1980s to keep
asbestos in commerce,” said Kaplan.
Enrolment of new patients not allowed
US issues ‘hold’ on Avandia study
In this file photo, a pharmacist holds a
bottle of Avandia pills at Maximart
Pharmacy in Palo Alto, Calif. Federal
health officials say new patients should
not be enrolled in a study of
GlaxoSmithKline’s controversial diabetes
pill Avandia, after experts last week said
the drug increase heart risks. (AP)
‘Umbrella may offer less protection’:
Hiding out under a beach umbrella may offer
you far less protection from the sun’s harmful
ultraviolet radiation than you expect, according
to a new study by Spanish researchers.
As much as 34 percent of ultraviolet radiation, found to cause skin cancer and cataracts,
reaches the ground covered by a beach umbrella, the University of Valencia researchers
This is because the umbrellas catch almost
all of the direct rays but not the diffused radiation that penetrates through from the sides,
according to the research published in the journal Photochemistry and Photobiology this
To carry out the study, researchers placed an
ultraviolet ray sensor on the base of a blue and
white canvas umbrella with a radius of 80 centimetres (12 inches) and a height of 1.5 metres.
“The umbrella intercepts the direct radiation
that comes from the sun, but part of the diffused radiation, which makes up approximately
60 percent of the total, reaches the sensor from
the sky not covered by the umbrella,” study coauthor Jose Antonio Martinez-Lozano said.
‘Blue Cross reaps surpluses’: Blue
Cross Blue Shield’s nonprofit health plans
raised insurance premiums even as they set
aside millions of dollars in surpluses over the
past decade, according to a report published on
For example, Blue Cross Blue Shield of
Arizona policyholders faced double-digit rate
increases in recent years while the company’s
surplus grew to seven times the regulatory minimum.
The surpluses — mandated to ensure the
payment of all medical claims — were built up
partly to fund business expansion and new
products, said the report from Consumers
Union, the nonprofit watchdog and publisher of
Consumer Reports.
“These are nonprofit companies,” said
Sondra Roberto, a report co-author. “The priorities should be to provide affordable health care
coverage to the greatest extent possible.
“And so if these other priorities such as
product development or technology upgrades
are competing with that function of providing
affordable coverage, we want a light shined on
that,” said Roberto.
Blue Cross, a nonprofit association of independent, locally-run insurance companies, had
more than $32 billion in surplus in its plans in
2008, according to the report.
“To put these blunt caps, or bright line sort
of rules on, that limits the flexibility of the
company and really puts it at a greater risk of
being unable to do the things it needs to do,”
said Bob Kolodgy, the association’s chief
financial officer.
Blue Cross said the recent healthcare overhaul law will extend coverage to millions of
new individuals with unpredictable results.
“So when you look at requiring plans to
lower those reserves at this time, we think it
would be extremely dangerous given health
reform’s going to require plans to have
strong reserves going into this new era,” said
Alissa Fox, a senior vice-president at Blue
WASHINGTON, July 22, (AP): US government health officials are barring new
patients from enrolling in a safety study of
GlaxoSmithKline’s controversial diabetes
pill Avandia, a week after a panel of experts
ruled that the drug increases heart risks.
The Food and Drug Administration said
it issued a “partial clinical hold” on the
study to update researchers on the latest
concerns about Avandia, which has been
under scrutiny since 2007.
Last week a panel of experts voted that
the drug appears to increase heart risks, but
a majority ultimately voted to leave the
drug on the market because the evidence
was not definitive.
The FDA is currently reviewing the
panel’s opinions and deciding what action
to take.
GlaxoSmithKline said in a statement it
would halt recruitment for the so-called
TIDE trial and update the study’s chief
investigators on last week’s meeting.
Patients already in the study will be permitted to continue participating.
The London-based drugmaker agreed to
conduct the trial in 2007, after safety questions about Avandia were first publicized.
The TIDE study is designed to give a
definitive assessment of whether Avandia’s
heart risks are greater than its chief competitor Actos.
Last week, the FDA’s panel of outside
advisers voted 20-10 that the trial should
continue if Avandia stays on the market.
However, Avandia’s critics have argued
that the trial is unethical since current evidence already shows Avandia is riskier than
Actos, which is made by Japan-based
Takeda Pharmaceuticals.
“It’s the ethically correct thing to do,”
said Dr Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic.
“It was the only decision the FDA could
have made.”
Nissen first drew attention to Avandia’s
risks in a 2007 medical journal article estimating the drug increases heart attack risk
by 43 percent. He noted that the FDA’s
advisory panel specifically voted last week
that Avandia increased risk of heart attacks
more than Actos.
“I still think there’s a very good chance
that the FDA will decide to remove
Avandia from the market,” Nissen said.
The TIDE study is supposed to enroll
16,000 patients, though safety concerns
surrounding Avandia have slowed recruitment. Glaxo reported last week that just
1,100 patients have volunteered for the
The FDA said TIDE’s researchers should
update the informed consent forms used to
describe the risks of the study to potential
But Yale University cardiologist Dr
Cross. (RTRS)
No extra heart benefit seen
HDL may mean little for statin users
CHICAGO, July 22, (RTRS): People with
high levels of the so-called good cholesterol HDL tend to have fewer heart
attacks but HDL may offer little protective
benefit in people who take statins to lower
harmful LDL cholesterol, US researchers
said on Wednesday.
An analysis of a large study of healthy
people who took AstraZeneca’s statin
drug Crestor to prevent heart attacks
found having high HDL was not a good
predictor of heart attack risk.
“HDL is a very powerful predictor of
future risk” of heart disease, said Paul
Ridker of Brigham and Women’s Hospital
in Boston, whose study appears in the
journal Lancet.
But “once we get LDL into these very
low ranges with very potent statins, HDL
no longer predicts future risk of heart disease,” he said in a telephone interview.
The findings raise questions about
drugs in development to raise HDL to prevent heart attacks, he said.
Several companies are working on
HDL-raising drugs, which would likely be
combined with statins in hopes of developing even more potent weapons against
heart disease.
Tiny Canadian biotech ResVerlogix has
an experimental drug in clinical trials that
increases production ApoA-1 in the blood,
which then raises HDL — a compound
that helps ferry harmful fats out of the
Raising HDL through increased ApoA-1
is a different approach from other HDL
boosters, such as a class known as
CETP inhibitors that included torcetrapib,
Pfizer’s most spectacular clinical failure.
Merck & Co and Roche are still developing CETP inhibitors.
Current drugs that raise natural levels
of HDL, such as niacin, cause unpleasant
side effects such as flushing.
No Difference
In the original study, called JUPITER,
patients with average to low levels of lowdensity lipoprotein or LDL were given
Crestor or rosuvastatin, which cut their
bad cholesterol concentrations to levels
seen in Aboriginal populations but rarely
seen in Western patients.
People in the study who took Crestor had
54 percent fewer heart attacks and 48 percent fewer strokes after two years compared with people who took a placebo.
In the new analysis, Ridker and colleagues looked to see if HDL was still a
predictor of heart attack risk in people
who took Crestor.
They found that HDL was still protective
in people who got the placebo, but in
those whose cholesterol was lowered by
the statin, having high HDL made no difference in predicting which patients would
have heart problems.
The findings suggest higher HDL concentrations may not be a good measure
of heart risk in people who lower their bad
cholesterol levels with statins, Dr Derek
Hausenloy of The Hatter Cardiovascular
Institute at University College London
said in a commentary.
“Whether increasing HDL cholesterol in
patients with very low LDL cholesterol has
any beneficial effects on cardiovascular
risk remains to be shown directly in large
randomized trials,” he said.
Ridker agrees.
“In my heart of hearts, I believe the only
way to address whether or not new
agents that increase HDL will be effective
is through well-done carefully taken out
clinical trials. There is no other way to get
there,” he said.
Harlan Krumholz questioned how doctors
could get patients to give truly informed
consent to participate in a study “where the
best-case scenario is that they are not
harmed by the drug.”
“I just wonder if patients in this trial
really understand that the entire point is to
determine if those randomized to the arm
with Avandia are at higher risk,” said
Krumholz, who is also a professor at Yale.
Public Citizen’s Dr Sidney Wolfe said
the FDA’s move is an “important halfstep,” but said it would not help patients
who are already enrolled in TIDE.
“It doesn’t really speak to the health
risks of the people staying in the trial,” said
Wolfe, who has petitioned the FDA to
withdraw Avandia. “My guess is most, if
not all the people in that study would drop
out if they were given information about
how much more dangerous Avandia is
compared with Actos.”
The FDA first approved Avandia in 1999
and it quickly became the top-selling diabetes pill in the world. However, US sales
have plummeted from $2.2 billion in 2006
to $520 million last year as safety concerns
swirled around the drug.
The drug works by increasing the body’s
sensitivity to insulin, a key protein needed
for digestion that diabetics don’t adequately produce.
The FDA added a black box warning to
the drug in 2007. New studies on the drug’s
safety combined with pressure from safety
advocates has prompted the agency to take
another look at the drug.
The FDA is expected to make a decision
on whether to keep the drug on the market
in coming months.
Woman gets madcow disease: A 42year-old Italian woman was reported as the second ever case of madcow disease in humans in
the country and is currently hospitalised in desperate conditions, the ANSA news agency said
The woman was diagnosed with a variant of
the Creutzfeldt-Jakob disease (CJD) at a Milan
neurological hospital in the past months and
was then transferred to a hospital in Livorno, in
western Tuscany, when she was already in a
coma, ANSA said.
It is still unclear how the woman contracted
the disease.
In 2009, Italy’s health ministry had reported
the woman’s disease as a “likely variant of the
The only previous case of madcow disease
in humans in Italy was reported in 2002 on the
island of Sicily. (AFP)