June 1999

"Dead" Rattlesnakes Can Still Bite Back
June 17, 1999

A reptilian nightmare worthy of Freddy Kreuger: bludgeoned, shot and decapitated rattlesnakes can still inflict one last bite up to an hour after 'death,' researchers report.

"Education to prevent snakebites should include warnings against handling recently killed snakes," suggest Drs. Jeffrey Suchard and Frank LoVecchio of the Good Samaritan Regional Medical Center in Phoenix, Arizona. Their report is published in the June 17th issue of The New England Journal of Medicine.

According to the authors, US physicians often treat patients bitten while handling rattlesnakes though to be dead.

Suchard and LoVecchio recount the case of one such patient, who "shot a rattlesnake, striking the head several times, and observed no movement (in the snake) for 3 minutes." However, upon lifting the apparently 'lifeless' creature, the man felt the snake sink its fangs deep into his right index finger.

A second patient "shot and then decapitated a rattlesnake," which nonetheless still managed to bite his hand as he attempted to pick up the severed head.

Both of these patients -- as well as three others involved in similar cases cited in the report -- recovered from their bites via prompt treatment with venom antidote.

Rattlesnakes appear to be a particularly hard-to-kill -- the Phoenix researchers point to the results of one previous study, which found that "rattlesnake heads are dangerous 20 to 60 minutes after decapitation." Based on their own experience in treating snakebite victims, the authors warn that "imminently fatal injuries do not prevent rattlesnakes from producing serious or even multiple envenomations."

SOURCE: The New England Journal of Medicine 1999;340:1930.

Failure To Follow Medical Advice An "Enormous Problem"
June 17, 1999

According to one heart expert, too many US patients fail to follow prescribed treatment, putting them at increased risk for heart attack or stroke.

And healthcare professionals and the media "are doing a terrible job" in educating patients as to the importance of following doctor's orders, said Dr. Richard Pasternak, director of cardiology at Massachusetts General Hospital, Harvard Medical School, in Boston. He delivered his remarks at an American Heart Association press conference held here Wednesday.

Pasternak cited the example of the use of the highly effective statin family of cholesterol-lowering medications (such as simvastatin and pravastatin). In clinical trials, 94% participants -- coached by researchers -- took their daily dose of statin medications through to the end of the trials.

However, studies conducted in the 'real world' have shown that within 1 year of being prescribed statin medications, just 50% to 55% of patients continue to take them as directed. This number drops to as low as 15% after 2 years of treatment.

Pasternak said that while patient education is pushing these numbers upwards, much more needs to be done to solve the "enormous problem" of patient non-compliance.

Why do patients neglect to take their medications, or fail to adhere to diet and exercise recommendations? The Harvard doctor believes many patients are simply confused by complex dosing requirements, or do not appreciate the full clinical importance of adherence to therapy.

Patient attitudes toward their own health plays an important role as well. "Many patients don't have confidence that (therapy) is going to work," Pasternak explained. Finally, he pointed out that many patients -- especially the uninsured -- simply cannot afford their medications and thus fail to fill or refill prescriptions.

But doctors share some of the blame for patient noncompliance, Pasternak said, with too many patients receiving "incomplete, incorrect or controversial data" regarding particular interventions.

He also believes that the US healthcare system focuses too strongly on 'crisis care' -- attending to patients when they require sudden, in-hospital care, then losing track of them over the longer-term. "The system is terrible once the patient leaves the hospital," he said.

Pasternak believes that doctors must do more to engage patients in the treatment process. He noted that patients who are motivated to improve their health are most likely to stick to a treatment regimen. "If the patient is ready," Pasternak explained, "these types of (healthcare) interventions can have a great impact."

PSA test contributed to decline in prostate cancer deaths
June 16, 1999

Three reports released Tuesday suggest that the introduction of prostate specific antigen (PSA) testing in the late 1980s contributed to the recent decline in deaths from prostate cancer.

But PSA testing cannot explain the entire decline, the research teams agree.

The Food and Drug Administration approved a blood test for PSA in 1986 as a tool to monitor patients with prostate cancer. Since then it has become widely used in healthy men as a tool for detecting disease of the prostate.

All three papers are published in the June 16th issue of the Journal of the National Cancer Institute.

In the first paper, Dr. Ruth Etzioni at the Fred Hutchinson Cancer Research Center in Seattle, Washington, and colleagues used computer modeling in an attempt to quantify the link between PSA testing and recent declines in prostate cancer death.

They conclude, based on the data they generated, that it is "unlikely that the entire decline in prostate cancer mortality can be explained by PSA testing."

"The average man... should not read too much in to the declining mortality numbers," said Etzioni in a statement released by the Center. "What we're seeing is probably not all due to PSA testing. There are, most likely, other things going on."

In the second paper, Dr. Benjamin F. Hankey and colleagues report results that also "provide evidence of a role of PSA testing in recent prostate cancer incidence and mortality trends."

"There have been a lot of studies using essentially the same data that we have analyzed showing the dramatic decrease in distant stage disease prostate cancer and the decrease in mortality that has occurred," Hankey told Reuters Health.

"We have looked for what I would call tracks in the data that are left by a screening test. (For example)... the tendency of screening to preferentially detect tumors with a relatively good prognosis and look at the data to try to determine the extent to which that occurred. And we do find suggestive evidence that screening is contributing to the mortality decrease," he said.

Specifically, the data show that the incidence of prostate cancer among whites increased sharply beginning in 1989, peaked in 1992 and declined thereafter. These trends, coupled with the decline in the incidence of and death from advanced disease first noted in 1991, followed by a decrease in early disease beginning in 1992 are "consistent with a screening effect," the investigators say.

Hankey's team concludes that these trends "hold out the promise that PSA testing may lead to a sustained decline in prostate cancer mortality."

"We'll know in the next 5 to 10 years," he said. "What we'd like to think will happen is that since we've seen this dramatic decrease in distant stage disease, the decrease in mortality will continue, and as it continues, it certainly will provide further evidence of a screening effect," he said.

Hankey's group notes, however, that "extreme caution" should be exercised in attributing even small changes in death rates to a single cause.

Dr. Eric J. Feuer and colleagues elaborate on this point in the third paper. These investigators say it is possible that the recent downward trends "may have been affected by cause-of-death misclassification."

SOURCE: Journal of the National Cancer Institute 1999;91:1017-1039.

Active Men At Less Risk For Stroke
June 15, 1999

Staying physically active after the age of 40 protects men against stroke, suggests a study published in the June 15th issue of the Annals of Internal Medicine.

The report also links poor lung function to an increased risk of stroke.

A 10-year study conducted by Dr. Uggi Agnarsson and colleagues at the Icelandic Heart Association and the National University Hospital, Reykjavik, Iceland, found that the risk of stroke was 31% lower in men who remained physically active after the age of 40 compared with their sedentary peers.

Conversely, the risk of ischemic stroke was 90% higher in men who had the poorest lung function on lung function tests compared with men who had the highest levels of lung function. Ischemic stroke, the most common type of stroke, occurs when arterial disease affects blood flow to the brain.

The study involved 4,484 men between the ages of 45 and 80 who were involved in the Reykjavik Study which started in 1967. On entry into the study, participants were asked how often they engaged in leisure-time physical activity as well as the type of sports they participated in. Study participants also underwent lung function testing.

The type of physical activity the men reported did not play a role in reducing stroke risk, although there was a suggestion that low-intensity activities such as walking and swimming might offer the greatest benefit.

"The important factor associated with the protective effect seems to be regular physical activity maintained into ages at which the risk for stroke increases," Agnarsson and colleagues state.

In contrast, the investigators found that men with the poorest lung function are more likely to have an ischemic stroke than those with good lung function, even if they do not smoke. The researchers attribute the link between poor lung function and stroke risk to genetic and environmental factors that contribute to fitness.

SOURCE: Annals of Internal Medicine 1999;130:987-990.

Survey says one in three men would not go to doctor if experiencing chest pains
June 14, 1999

One in three men would not go to a doctor even if they had severe chest pains or shortness of breath, according to a survey released Monday.

Only one in five women would ignore such symptoms, said the report by Men's Health magazine and CNN.

Even among those who did say they would see a doctor if experiencing chest pains, 20 percent said they would wait a day or two first, according to the survey released in conjunction with National Men's Health Week.

"This probably explains why so many men end up in the cardiac care unit of hospitals clutching a package of antacid tablets," said Michael Lafavore, editor-in-chief of Emmaus-based Men's Health. "Guys need to learn there's a big difference between getting indigestion from eating too many nachos, and a potentially clogged artery."

A 32-page "Men's Maintenance Manual" the magazine publishes says the kind of pain that can signal heart trouble is "sudden, severe pain that lasts more than a few minutes; pain that starts or gets worse with exertion or is accompanied by squeezing or uncomfortable pressure in the chest and dizziness, fainting, sweating, nausea or shortness of breath; or pain that radiates to the jaw, neck or arms."

In addition to tending to ignore danger signs, the survey found that many people do not get screened for cancer, diabetes and heart disease.

Only two in five adults, 40 percent, said they had their cholesterol checked in the past year and only 28 percent had been checked for diabetes.

The survey showed that 55 percent of the women polled had undergone cancer screenings in the past year, with 38 percent being tested for breast cancer and 38 percent for cervical cancer.

Only one in three men had been checked for cancer, and only one in four had been checked for prostate cancer.

Only 15 percent of the men and 14 percent of the women had been screened for colon cancer, one of the most treatable forms of cancer if found early. Colon cancer kills an estimated 48,000 adults, including 25,000 women and 23,000 men, a year.

The most popular medical tests were eye examinations, with 52 percent of those surveyed saying they had had their eyes checked in the past year.

Forty percent of those polled said it was too much trouble getting checkups if nothing was bothering them, and 26 percent said it was too difficult to fit a checkup into their schedules,

One in four said their insurance did not cover regular health checkups, 22 percent said they did not have a regular doctor and 21 percent said dealing with doctors or insurance companies was too much trouble.

The symptom most likely to get people to the doctor was blurred vision, with 82 percent of those polled saying they would seek medical attention for that problem. Three out of four said they would see a doctor for serious cuts or burns.

Next in importance among men respondents, ahead of chest pain, was erectile disfunction, with 73 percent saying they would seek a doctor's help. However, two in five said they would wait a few days before seeking treatment if they thought they might need Viagra, one on four said they would wait a month or more and 11 percent said they would never seek treatment.

The survey was conducted for Men's Health and CNN by Opinion Research Corp. International, based on a nationwide telephone poll from April 15 through April 18 of 1,003 adults 18 or older, with a margin of error of plus or minus 3 percentage points.

More information is available on the Internet at www.nationalmenshealthweek.com, by telephone at (610) 967-8620 or by mail at National Men's Health Week, 14 East Minor Street, Emmaus, PA 18098.

Ways To Protect Women's Knees
June 18, 1999

It took just one wrong jump, and women's basketball star Rebecca Lobo was on the floor in agony, yet another victim of a torn knee ligament called the ACL.

The very day Lobo was writhing in pain last week, doctors were meeting to figure out how to battle a growing problem: Women are far more susceptible to this debilitating knee injury than men.

It's not just a risk for professional female athletes, but for high school and college teams, and even women who like a little weekend skiing, soccer or hoops.

Anterior cruciate ligament injuries are notorious because they're so painful and can require months of treatment and rehabilitation. But they also can predispose people to serious knee arthritis later in life, said Dr. Joan McGowan of the National Institutes of Health.

The good news: There are some ways women can protect their knees, lowering the risk of injury by strengthening their hamstrings and learning to crouch properly while jumping, concluded a consensus conference sponsored by the American Academy of Orthopedic Surgeons.

Now doctors' quest is to alert women.

"These injuries affect young people, and can affect the rest of their lives," said Dr. Letha Griffin, team physician at Georgia State University, who organized the meeting. "We really need to ... help the public know that there are injury prevention techniques."

Her message: "If I'm doing jumping, pivoting, cutting sports, I really need to look into some of these prevention techniques."

Inside the knee, two ligaments pass each other in the shape of a cross, connecting the upper and lower leg bones. The anterior cruciate ligament is the one in front, and it's important in pivoting.

Many sports fans connect ACL injuries to football's crunching hits. But experts say most ACL tears actually are noncontact injuries - and studies show women suffer from them about five times more than men.

ACL injuries are particularly common with lots of jumping, quick deceleration and pivoting, like in basketball, soccer and skiing. But recreational athletes who run, take boxing classes, even do step aerobics can suffer, too, said McGowan.

Scientists are studying everything from hormones to anatomy to explain the gender discrepancy. But neuromuscular factors seem to play the biggest role, and that's where women can lower the risk, Griffin said.

Hamstrings, muscles behind the thigh, relieve stress on the ACL when the knee bends. If your hamstrings are too weak, they may not protect the ACL.

Men's hamstrings typically are 60 to 70 percent as strong as their quadriceps, muscles in front of the thigh. Women athletes may have strong quads, but they typically have significantly weaker hamstrings, said Dr. Thomas Lindenfeld of the Cincinnati Sportsmedicine Research and Education Foundation. So as they jump and pivot, the hamstrings don't do their job and the ACL tears.

In addition, women jump and land differently than men - more straight-legged and flat-footed. Men bend their knees more as they jump and land, a built-in shock absorption.

The Cincinnati foundation created a program called Sportsmetrics to strengthen hamstrings and train female athletes to jump with their knees properly bent and body correctly aligned so they don't land off-balance.

In a study of 1,200 high school athletes, the six-week program lowered girls' injury risk to equal boys' risk, Lindenfeld said.

The foundation now sells a video that demonstrates the program, and dozens of high school and college teams already are adopting the techniques.

Also, many ski shops carry pamphlets describing Vermont research on avoiding ACL injuries. Scientists videotaped ski accidents to show positions where skiers got so off-balance that the stress tore an ACL. Teaching skiers about those risky positions and how to regain balance on the slopes can reduce injuries, Griffin said.

This focus on injuries shouldn't scare off women - exercise is key to good health and American women don't exercise enough, stressed McGowan, who led a related NIH meeting last week on women and sports.

But learning to prevent injuries in professional athletes could translate to a more fit general population, she said. It's important to know "this is the kind of thing amenable to training."

Study: Patch Could Restore Sex Drive in Women
June 16, 1999

Middle-aged women who said their sex drives were stuck in park after they underwent hysterectomies found that a testosterone-laced skin patch increased their libidos, according to a new study.

Women naturally produce the male sex hormone, which controls sexual desire, but that stops when the ovaries are removed.

"About 43 percent of the 14 million women who have had hysterectomies reported sexual dysfunction after their surgeries - a decrease in sex drive, a decrease in sexual pleasure, an inability to have an orgasm and sometimes depression," said the study's primary author, Dr. Glenn Braunstein of Cedars-Sinai Medical Center in Los Angeles.

He presented the data Tuesday at The Endocrine Society's annual meeting.

Procter & Gamble Co., which makes a testosterone patch for men experiencing sexual dysfunction, funded Braunstein's study to see whether similar patches would help women.

He studied 57 women for nine months. All had been on hormone replacement therapy for at least a year. The average age was 47.

The women were given either two placebos; a placebo and a patch containing a normal level of testosterone usually found in a woman's body; or two patches containing high levels of testosterone.

They changed the patches every three to four days.

More than half reported an increase in sexual desire with patches that contained normal (150 micrograms) and high levels (300 micrograms) of testosterone.

Braunstein found that estrogen levels in the women remained the same, hot flashes did not increase and there was no acne or increased hair growth in unwanted areas.

The next step is a broader study involving more women over a longer period of time, he said.

"There is nothing really out there for women to treat this type of problem," Braunstein said, noting there are oral medications, creams and injections to deliver testosterone to the body, but they can cause side-effects like acne, liver abnormalities or moodiness.

Dr. Margaret Wierman, chairwoman of the meeting, warned that older women shouldn't interpret the findings as a way to increase their libido and cure depression through male hormones.

"I definitely do not think we should think of this as a Viagra for women," she said.

Raloxifene (Evista ®) Lowers Breast Cancer Risk

June 16, 1999

Medical researchers have found a dramatic drop in the risk of breast cancer for women who take an estrogen substitute prescribed to prevent brittle bones.

The three-year study of 7,705 women found a 76 percent lower risk of breast cancer among post-menopausal women taking raloxifene compared with those given a placebo. The report was published in today's Journal of the American Medical Association.

"It's a very exciting beginning," said lead researcher Dr. Steven Cummings, a professor of medicine at the University of California at San Francisco. "But we've only had 3 1/2 to 4 1/2 years of experience with this. I think women should be cautious about any medications used for prevention."

Deborah Collyar - a patient advocate from California and a breast cancer survivor who was not involved in the study - agreed caution is needed.

"There are no magic bullets," said Collyar, president of Patient Advocates in Research. "When you look at the risk reduction, 76 percent sounds like a tremendous amount, and it is. But you have to look at what the absolute risk of those women was in the first place."

Raloxifene is part of a new generation of drugs scientists hope will mimic the good effects of estrogen - stronger bones and a lower risk of heart disease - while inhibiting the possible harmful effects, which may include promoting breast and uterine cancer.

Raloxifene, the first so-called "designer estrogen," was approved in 1997 by the Food and Drug Administration for preventing osteoporosis. It has not been shown to affect heart disease.

It is marketed under the name Evista by Eli Lilly and Co., which paid for the study.

Many women are afraid to use estrogen because of conflicting evidence on whether it promotes breast cancer. However, a study released last week on 37,000 women suggested that hormones do not increase the risk of breast cancer, except for some uncommon and highly curable forms of the disease.

Raloxifene isn't risk-free. It increases the chances of serious blood clots.

In Cummings' study, 5,129 post-menopausal women younger than 81 received raloxifene daily, while 2,576 got a dummy pill. Thirteen cases of breast cancer were diagnosed among the women taking raloxifene; 27 cases were found among those taking the placebo.

Women taking raloxifene had a 90 percent lower risk of a type of cancer called estrogen-receptor positive breast cancer.

However, raloxifene had almost no effect on estrogen-receptor negative breast cancer, one of the hardest forms of the disease to treat. It is most commonly developed by younger women and those with a genetic predisposition to the disease.

Dr. Janet Wolter of Rush-Presbyterian-St. Luke's Medical Center in Chicago said she is encouraged by the findings and hopes more research will determine whether the breast cancer drug tamoxifen or raloxifene is more effective and produces fewer side effects.

An accompanying editorial cautioned that raloxifene cannot yet be considered suitable for most women.

"Its contributions to knowledge intensify the anticipation of finding something even better on this new frontier," wrote Drs. Adele Franks of the Prudential Center for Health Care Research in Atlanta and Karen Steinberg of the U.S. Centers for Disease Control and Prevention.

Leisure Exercise Cuts Disease Risk
June 16, 1999

Exercising is not only good for your heart, but it may also help prevent diabetes and other chronic illnesses by reducing common risk factors, researchers from the University at Buffalo, New York, report.

Their study provides another good reason for people to be physically active.

At the recent annual meeting of the Society for Epidemiologic Research in Baltimore, researcher Jian Liu described how physical activity carried out during leisure time -- but not at work -- was linked to a lower rate of insulin-resistance syndrome in adults.

Insulin resistance occurs when cells become less sensitive to the effects of the hormone insulin. It is associated with obesity, and also with a cluster of metabolic irregularities, including high blood glucose levels, high levels of triglycerides, and low levels of HDL -- the ``good'' cholesterol that protects the heart.

These are all risk factors for heart disease and diabetes. Being active is well known as a way of preventing heart disease, and the study suggests that exercise helps by reducing insulin resistance.

``Insulin resistance can also increase the risk for other chronic diseases such as breast cancer and colon cancer,'' Liu told Reuters Health.

The Risk Factors and Life Expectancy Study conducted in Italy between 1978-1987 included 7,485 men and 5,856 women. They were asked to rate their physical activity as sedentary, moderate, heavy, or very heavy. Blood pressure and blood tests were taken to measure assess insulin resistance.

Researchers found that both men and women who were active in their leisure hours were less likely to have insulin resistance than their sedentary counterparts.

The study results showed that 1.8% of men in the heavy leisure activity group had insulin resistance, compared with 3.5% of sedentary men.

Similarly, the rate of insulin resistance was lower in women who exercised during leisure hours (1.9%) than in sedentary women (3.8%).

There was no conclusive evidence to explain why physical activity at work did not have a similar effect. ``In terms of activity at work, they should have the same physical metabolism,'' said Liu.

However, noting that the environment at work differs from the leisure environment, he suggested that people exert themselves more at play.

Americans Grow Fatter Despite Steady Diet of Advice
June 16, 1999

Cynthia Last doesn't believe in diets, especially the ones that inundate the best-seller list during the summer when many Americans are struggling to lose weight.

"Some of those diets are demon diets where one food is the bad guy," said Last, a Florida psychologist who focuses on food issues. "For virtually all of them, there is no scientific proof."

That doesn't stop many people from buying into fad diets, which typically promote quick weight loss with strategies that most nutritionists say are less than sound.

Remember the Cabbage Soup Diet? More popular today are books like "Eat Right For Your Type," "Sugar Busters!" and "The Zone." While different in the details, all of these books restrict certain foods.

"Sugar Busters!" goes a step further by restricting certain combinations of foods, like forbidding a dieter from eating a piece of naturally sweet fruit after dinner. The premise is that sugar, not fat, is the cause of weight gain, so the sugar in the fruit will encourage the body to store fat.

Never mind that these approaches eschew the best-known medical advice. To lose weight, the best strategy remains to eat less and exercise more. And a calorie is a calorie, no matter where it comes from.

"People are always looking for a new gimmick," said Kathy Kane, a registered dietitian and nutritionist for the Kaiser Permanente health plan. "Weight loss is hard for people to do."

At best, some of these popular books offer traditional weight-loss advice with an emphasis on cutting calories and increasing activity. At worst, they can fuel frustration with the yo-yo effect that often follows any quick weight loss scheme.

Any diet, for example, that promises to help you lose more than one to two pounds a week is unrealistic and, in some cases, unhealthy for most people.

"The problem is when the diet is over, they don't keep the weight off," said Nan Windmueller, a certified nutritionist with a private practice in Albany. "Ninety-five percent of people gain the weight back."

Such statistics help explain how the diet industry continues to get richer as the country gets fatter. More than half of the adults in the United States, or 97 million people, are too heavy. That represents a 50 percent increase since the 1970s, when the low-fat diet craze first took off.

"It's a very lucrative business," Windmueller said. "It's in the diet industry's best interest to have people fail."

Dr. Robert C. Atkins in his best-selling and controversial book "Dr. Atkins' New Revolutionary Diet," addresses that kind of skepticism with a disclaimer about his own approach and a criticism of the low-fat diet obsession.

"I'm not about to fall into the error of the low-fat dieting devotees who claim that their diet works for everyone," he writes. "I would feel rather foolish if I did. No diet works for everyone."

Yet the popular high-protein, low-carbohydrate diets espoused by people like Atkins offer their own particular pitfalls. Besides "Dr. Atkins' New Revolutionary Diet," consider "Protein Power," another popular book that severely restricts carbohydrates and starches but allow meats, egg yolks and other proteins, along with saturated fats.

The premise is that you can eat as many calories from fat and protein as you want as long as you eat very few carbohydrates, such as pasta, breads and potatoes. The idea is that your body will turn to its stored fat to make up for the loss.

Reality, however, is much more complex, health experts say. While you will lose weight fast on such a diet, most of that weight is apt to be water and lean tissue.

Initially, by severely restricting carbohydrates, the insulin levels in your body drop. As Sharon Alger, a registered dietitian at Albany Medical Center explains, one of the many things that insulin does in the body is hold on to salt and water.

"When you stop eating carbohydrates and those insulin levels fall, you start losing water," she said.

Diets that restrict all carbohydrates cause the body to produce compounds known as ketones that accumulate in the blood and must be removed. To achieve that, the kidneys must work overtime. Not only will you go to the bathroom a lot, but you'll also risk constipation, nausea, headache, fatigue and bad breath.

To add insult to injury, eating high-fat foods on a regular basis is a good way to increase your risk for heart disease.

Remember, both the American Dietetic Association and the American Heart Association recommend diets that are high in complex carbohydrates, such as whole grains, vegetables and fruit, and low in fat derived from animal products.

"I think the thing that appeals to people is they can eat as much as they want," Kane said about diets like Dr. Atkins'. "But it can get pretty boring eating meat and fat all the time."

In her practice, Windmueller puts an emphasis on helping people make better food choices and on portion control, the same technique used by many commercial weight-loss programs such as Weight Watchers.

Such programs generally get higher marks from nutritionists than the "fad" diet books because they tend to emphasize lifestyle changes rather than restrictions on specific foods.

"The biggest problem in the American diet is serving size. Period," Windmueller said. "People are members of the clean plate club."

Perhaps no one is more frustrated with American's fascination with the fad diet than Last, whose own book, "The Five Reasons Why We Overeat: How to Develop a Long-Term Weight Control Plan that's Right for You," has yet to make it on the best-seller list.

"People don't eat out of hunger," said Last, who received her doctorate in psychology from the State University of New York at Albany in 1981. "They're overeating because of behaviors, attitudes and emotions. Most of us grow up thinking food is fun."

That's why many health experts say the fad diet is doomed to fail. Because many of the books don't talk about lifestyle changes, people return to the behaviors that made them fat as soon as the official diet is over.

"You can't make a change for one, two or three weeks and then stop," Alger said. "It's got to be something that's long-term."

Studies have shown that lifestyle changes are the biggest predictor of how successful someone will be over the long term in keeping weight off.

And of all lifestyle changes, "exercise is really the key that makes a difference," Alger said.

Half Of Deaths Among Young People Linked To Six Infectious Diseases
June 18, 1999

A World Health Organization report released Thursday shows that half of all deaths worldwide among children and young adults younger than 44 years of age are caused by infection with one of six infectious diseases.

The report shows that half of deaths in this age group are caused by AIDS, malaria, tuberculosis, measles, diarrheal diseases and acute respiratory infections.

"The World Health Organization is today issuing a wake-up call to the world's governments, decision-makers and the private sector to take action against infectious diseases before it is too late, and before the window of opportunity we have to protect ourselves is lost," WHO director general Dr. Gro Harlem Brundtland said in a WHO release.

The WHO report notes that the cost of disease prevention ranges from a maximum of $20 per person down to below $0.35."Yet these diseases still caused over 11 million deaths in 1998," the WHO release says.

Increasing drug resistance and other factors will cause a sharp increase in the cost of disease prevention and a decrease in efficacy of prevention efforts, WHO officials warned.

WHO executive director Dr. David Heyman commented that "[w]e are moving towards a future full of new opportunities for diseases to quickly spread from one continent to another.Simultaneously, drug resistance is sending us back in history to a time when we lacked medicines to cure some diseases."

The WHO report states that malaria, tuberculosis and AIDS "...have claimed six times as many lives in the past 50 years as military and civilian casualties from all wars over the same period.Yet strategies to defend the world against these three diseases receive less than 2% of the funding devoted to global military expenditures."

"Unlike our ancestor of hundreds of years ago, who were at the mercy of bubonic plague, syphilis, cholera and other diseases," Dr. Brundtland stressed, "...we know both the causes and the solutions for most of the epidemics that affect us."

High Systolic Blood Pressure Predicts Long-Term Excess Mortality In The Elderly
June 18, 1999

In elderly patients, systolic blood pressure (SBP) is more influential than diastolic blood pressure (DBP) in predicting total and cardiovascular mortality, according to investigators with the Italian National Health Service.

"SBP, but not DBP, is a strong, positive, continuous, independent indicator of mortality risk in the elderly," Dr. Claudio Alli, of Ospedale Niguarda, Milan, and multicenter colleagues report in the June 14th issue of Archives of Internal Medicine.

In 1983, the team assessed blood pressure and other factors associated with cardiovascular disease and hypertension in 3,858 elderly outpatients.The investigators then followed the group to determine if SBP or DBP correlated with mortality risk.

During the study, more than 1,500 patients died, almost half from cardiovascular causes.Both overall mortality and cardiovascular mortality were strongly associated with baseline SBP, regardless of gender, age, preexisting cardiovascular disease or the use of antihypertensive medications.

The study "...suggests that DBP has been, and perhaps still is, overstressed in the diagnosis and treatment of hypertension in older age groups," Dr. Alli and others write.They conclude that the new data "...highlight the importance of treating all elderly subjects with high SBP more aggressively than has been done recently, as the efficacy of antihypertensive therapy in systolic hypertension, isolated or not, is not well documented by the results of several trials."

Although the Italian findings are subject to several sources of bias, "...the renewed focus on the importance of systolic BP (especially in the elderly) is welcome," Dr. William J. Elliott, of Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois, comments elsewhere in an editorial.

"Perhaps this article will remind physicians and the public alike that, despite the declaration of war on hypertension by the National High Blood Pressure Education Program more than 26 years ago,," Dr. Elliott says, that "...there are still battles to be fought in identifying and controlling hypertension."

Arch Intern Med 1999;159:1165-1166,1205-1212.