Health & Fitness (60)
NEW YORK (AP) -- New York City is asking appeals judges to reinstate a ban on supersized sodas and other sugary drinks, which was struck down by a Manhattan judge the day before it was to go into effect.
The city had vowed an appeal and said Thursday that lawyers had filed it late Monday.
In his decision on March 11, State Supreme Court Justice Milton Tingling said the 16-ounce limit on sodas and other sweet drinks arbitrarily applies to only some sugary beverages and some places that sell them.
"The loopholes in this rule effectively defeat the stated purpose of this rule," Tingling wrote in his ruling, which was seen as a victory for the beverage industry, restaurants and other business groups that called the ban unfair.
In addition, the judge said the Mayor Michael Bloomberg-appointed Board of Health intruded on the City Council's authority when it imposed the rule.
In its appeal, the city disputed those points.
"The rule is designed to make consumption of large amounts of sugary drinks a conscious and informed choice by the consumer," it said. "Thus, although a consumer is free to consume more than 16 ounces by ordering a second drink, getting a refill, or going to another store, he or she will be making an informed choice."
The city also said the Board of Health had legislative authority, and "is empowered to issue substantive rules and standards in public health."
Said American Beverage Association spokesman Christopher Gindlesperger, referring to the initial decision overturning the ban, "We feel the justice's decision was strong and we're confident in the ruling."
Also on Thursday, the city announced that other organizations had filed legal briefs in support of the city's appeal. Those organizations include the National Alliance for Hispanic Health and the National Association of Local Boards of Health, as well as 30 others.
Bloomberg has made public health a cornerstone of his administration, from requiring calorie counts to be posted on menus and barring trans fats in restaurant foods.
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
The city had vowed an appeal and said Thursday that lawyers had filed it late Monday.
In his decision on March 11, State Supreme Court Justice Milton Tingling said the 16-ounce limit on sodas and other sweet drinks arbitrarily applies to only some sugary beverages and some places that sell them.
"The loopholes in this rule effectively defeat the stated purpose of this rule," Tingling wrote in his ruling, which was seen as a victory for the beverage industry, restaurants and other business groups that called the ban unfair.
In addition, the judge said the Mayor Michael Bloomberg-appointed Board of Health intruded on the City Council's authority when it imposed the rule.
In its appeal, the city disputed those points.
"The rule is designed to make consumption of large amounts of sugary drinks a conscious and informed choice by the consumer," it said. "Thus, although a consumer is free to consume more than 16 ounces by ordering a second drink, getting a refill, or going to another store, he or she will be making an informed choice."
The city also said the Board of Health had legislative authority, and "is empowered to issue substantive rules and standards in public health."
Said American Beverage Association spokesman Christopher Gindlesperger, referring to the initial decision overturning the ban, "We feel the justice's decision was strong and we're confident in the ruling."
Also on Thursday, the city announced that other organizations had filed legal briefs in support of the city's appeal. Those organizations include the National Alliance for Hispanic Health and the National Association of Local Boards of Health, as well as 30 others.
Bloomberg has made public health a cornerstone of his administration, from requiring calorie counts to be posted on menus and barring trans fats in restaurant foods.
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
NEW YORK (AP) -- Government health officials launched the second round of a graphic ad campaign Thursday that is designed to get smokers off tobacco, saying they believe the last effort convinced tens of thousands to quit.
The ads feature sad, real-life stories: There is Terrie, a North Carolina woman who lost her voicebox. Bill, a diabetic smoker from Michigan who lost his leg. And Aden, a 7-year-old boy from New York, who has asthma attacks from secondhand smoke.
"Most smokers want to quit. These ads encourage them to try," said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention.
The CDC campaign cost $48 million and includes TV, radio and online spots as well as print ads and billboards.
The spending comes as the agency is facing a tough budget squeeze, but officials say the ads should more than pay for themselves by averting future medical costs to society. Smoking is the leading cause of preventable illness and death in the United States. It's responsible for the majority of the nation's lung cancer deaths and is a deadly factor in heart attacks and a variety of other illnesses.
Last year's similar $54 million campaign was the agency's first and largest national advertising effort. The government deemed it a success: That campaign triggered an increase of 200,000 calls to quit lines. The CDC believes that likely prompted tens of thousands of smokers to quit based on calculations that a certain percentage of callers do actually stop.
Like last year, the current 16-week campaign spotlights real people who were hurt and disfigured by smoking. Terrie Hall, a 52-year-old throat cancer survivor makes a repeat performance. She had her voice box removed about a dozen years ago.
In last year's ad there's a photo of her as a youthful high school cheerleader. Then she is seen more recently putting on a wig, inserting false teeth and covering the hole in her neck with a scarf. It was, by far, the campaign's most popular spot, as judged by YouTube viewings and Web clicks.
In a new ad, Hall addresses the camera, speaking with the buzzing sound of her electrolarynx. She advises smokers to make a video of themselves now, reading a children's book or singing a lullaby. "I wish I had. The only voice my grandson's ever heard is this one," her electric voice growls.
One difference from last year: The new campaign tilts more toward the impact smokers have on others. One ad features a Kentucky high school student who suffers asthma attacks from being around cigarette smoke. Another has a Louisiana woman who was 16 when her mother died from smoking-related causes.
The return of the campaign is already being applauded by some anti-smoking advocates, who say tobacco companies spend more on tobacco product promotion in a week than the CDC spends in a year.
After decades of decline, the adult smoking rate has stalled at roughly 20 percent in recent years. Advocates say the campaign provides a necessary jolt to a weary public that has been listening to government warnings about the dangers of smoking for nearly 50 years.
"There is an urgent need to continue this campaign," said Matthew Myers, president of the Campaign for Tobacco-Free Kids, in a statement.
It would seem like a bad time for the CDC to be buying air time - the agency is facing roughly $300 million in budget cuts as part of the government's sequestration cuts in federal spending. However, the ad money comes not from the CDC's regular budget but from a special $1 billion public health fund set up years ago through the Affordable Care Act. The fund has set aside more than $80 million for CDC smoking prevention work.
Frieden argues that the ads are extremely cost-effective - spending about $50 million a year to save potentially tens of thousands of lives.
"We're trying to figure out how to have more impact with less resources," he said.
The ads direct people to call 1-800-QUIT-NOW. PlowShare Group, of Stamford, Conn., is again the advertising company that put the ads together. ---
Online: CDC campaign: HTTP://WWW.CDC.GOV/TIPS © 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
The ads feature sad, real-life stories: There is Terrie, a North Carolina woman who lost her voicebox. Bill, a diabetic smoker from Michigan who lost his leg. And Aden, a 7-year-old boy from New York, who has asthma attacks from secondhand smoke.
"Most smokers want to quit. These ads encourage them to try," said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention.
The CDC campaign cost $48 million and includes TV, radio and online spots as well as print ads and billboards.
The spending comes as the agency is facing a tough budget squeeze, but officials say the ads should more than pay for themselves by averting future medical costs to society. Smoking is the leading cause of preventable illness and death in the United States. It's responsible for the majority of the nation's lung cancer deaths and is a deadly factor in heart attacks and a variety of other illnesses.
Last year's similar $54 million campaign was the agency's first and largest national advertising effort. The government deemed it a success: That campaign triggered an increase of 200,000 calls to quit lines. The CDC believes that likely prompted tens of thousands of smokers to quit based on calculations that a certain percentage of callers do actually stop.
Like last year, the current 16-week campaign spotlights real people who were hurt and disfigured by smoking. Terrie Hall, a 52-year-old throat cancer survivor makes a repeat performance. She had her voice box removed about a dozen years ago.
In last year's ad there's a photo of her as a youthful high school cheerleader. Then she is seen more recently putting on a wig, inserting false teeth and covering the hole in her neck with a scarf. It was, by far, the campaign's most popular spot, as judged by YouTube viewings and Web clicks.
In a new ad, Hall addresses the camera, speaking with the buzzing sound of her electrolarynx. She advises smokers to make a video of themselves now, reading a children's book or singing a lullaby. "I wish I had. The only voice my grandson's ever heard is this one," her electric voice growls.
One difference from last year: The new campaign tilts more toward the impact smokers have on others. One ad features a Kentucky high school student who suffers asthma attacks from being around cigarette smoke. Another has a Louisiana woman who was 16 when her mother died from smoking-related causes.
The return of the campaign is already being applauded by some anti-smoking advocates, who say tobacco companies spend more on tobacco product promotion in a week than the CDC spends in a year.
After decades of decline, the adult smoking rate has stalled at roughly 20 percent in recent years. Advocates say the campaign provides a necessary jolt to a weary public that has been listening to government warnings about the dangers of smoking for nearly 50 years.
"There is an urgent need to continue this campaign," said Matthew Myers, president of the Campaign for Tobacco-Free Kids, in a statement.
It would seem like a bad time for the CDC to be buying air time - the agency is facing roughly $300 million in budget cuts as part of the government's sequestration cuts in federal spending. However, the ad money comes not from the CDC's regular budget but from a special $1 billion public health fund set up years ago through the Affordable Care Act. The fund has set aside more than $80 million for CDC smoking prevention work.
Frieden argues that the ads are extremely cost-effective - spending about $50 million a year to save potentially tens of thousands of lives.
"We're trying to figure out how to have more impact with less resources," he said.
The ads direct people to call 1-800-QUIT-NOW. PlowShare Group, of Stamford, Conn., is again the advertising company that put the ads together. ---
Online: CDC campaign: HTTP://WWW.CDC.GOV/TIPS © 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
A new report says the national health law will push up the cost of medical claims in both Missouri and Illinois.
The study by the Society of Actuaries says the amount paid by insurers who sell policies to individuals in Illinois will rise more than 50 percent by 2017. The jump is even greater in Missouri, where the cost of medical claims could grow by almost 60 percent.
The report says costs will rise largely because of spending on sicker people and other high-cost groups who will gain coverage under the Affordable Care Act. The study did not make similar estimates for Employer-sponsored plans.
The White House disputes the study's claims because they didn't consider other cost-saving aspects of the new law.
The study by the Society of Actuaries says the amount paid by insurers who sell policies to individuals in Illinois will rise more than 50 percent by 2017. The jump is even greater in Missouri, where the cost of medical claims could grow by almost 60 percent.
The report says costs will rise largely because of spending on sicker people and other high-cost groups who will gain coverage under the Affordable Care Act. The study did not make similar estimates for Employer-sponsored plans.
The White House disputes the study's claims because they didn't consider other cost-saving aspects of the new law.
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON (AP) - We know a lot about how babies learn to talk, and youngsters learn to read. Now scientists are unraveling the earliest building blocks of math - and what children know about numbers as they begin first grade seems to play a big role in how well they do everyday calculations later on.
The findings have specialists considering steps that parents might take to spur math abilities, just like they do to try to raise a good reader.
This isn't only about trying to improve the nation's math scores and attract kids to become engineers. It's far more basic.
Consider: How rapidly can you calculate a tip? Do the fractions to double a recipe? Know how many quarters and dimes the cashier should hand back as your change?
About 1 in 5 adults in the U.S. lacks the math competence expected of a middle-schooler, meaning they have trouble with those ordinary tasks and aren't qualified for many of today's jobs.
"It's not just, can you do well in school? It's how well can you do in your life," says Dr. Kathy Mann Koepke of the National Institutes of Health, which is funding much of this research into math cognition. "We are in the midst of math all the time."
A new study shows trouble can start early. University of Missouri researchers tested 180 seventh-graders. Those who lagged behind their peers in a test of core math skills needed to function as adults were the same kids who'd had the least number sense or fluency way back when they started first grade.
"The gap they started with, they don't close it," says Dr. David Geary, a cognitive psychologist who leads the study that is tracking children from kindergarten to high school in the Columbia, Mo., school system. "They're not catching up" to the kids who started ahead.
If first grade sounds pretty young to be predicting math ability, well, no one expects tots to be scribbling sums. But this number sense, or what Geary more precisely terms "number system knowledge," turns out to be a fundamental skill that students continually build on, much more than the simple ability to count.
What's involved? Understanding that numbers represent different quantities - that three dots is the same as the numeral "3" or the word "three." Grasping magnitude - that 23 is bigger than 17. Getting the concept that numbers can be broken into parts - that 5 is the same as 2 and 3, or 4 and 1. Showing on a number line that the difference between 10 and 12 is the same as the difference between 20 and 22.
Factors such as IQ and attention span didn't explain why some first-graders did better than others. Now Geary is studying if something that youngsters learn in preschool offers an advantage.
There's other evidence that math matters early in life. Numerous studies with young babies and a variety of animals show that a related ability - to estimate numbers without counting - is intuitive, sort of hard-wired in the brain, says Mann Koepke, of NIH's National Institute of Child Health and Human Development. That's the ability that lets you choose the shortest grocery check-out line at a glance, or that guides a bird to the bush with the most berries.
Number system knowledge is more sophisticated, and the Missouri study shows children who start elementary school without those concepts "seem to struggle enormously," says Mann Koepke, who wasn't part of that research.
While schools tend to focus on math problems around third grade, and math learning disabilities often are diagnosed by fifth grade, the new findings suggest "the need to intervene is much earlier than we ever used to think," she adds. Exactly how to intervene still is being studied, sure to be a topic when NIH brings experts together this spring to assess what's known about math cognition.
But Geary sees a strong parallel with reading. Scientists have long known that preschoolers who know the names of letters and can better distinguish what sounds those letters make go on to read more easily. So parents today are advised to read to their children from birth, and many youngsters' books use rhyming to focus on sounds.
Likewise for math, "kids need to know number words" early on, he says.
NIH's Mann Koepke agrees, and offers some tips:
-Don't teach your toddler to count solely by reciting numbers. Attach numbers to a noun - "Here are five crayons: One crayon, two crayons..." or say "I need to buy two yogurts" as you pick them from the store shelf - so they'll absorb the quantity concept.
-Talk about distance: How many steps to your ball? The swing is farther away; it takes more steps.
-Describe shapes: The ellipse is round like a circle but flatter.
-As they grow, show children how math is part of daily life, as you make change, or measure ingredients, or decide how soon to leave for a destination 10 miles away,
"We should be talking to our children about magnitude, numbers, distance, shapes as soon as they're born," she contends. "More than likely, this is a positive influence on their brain function."
--------------
EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
WASHINGTON (AP) - We know a lot about how babies learn to talk, and youngsters learn to read. Now scientists are unraveling the earliest building blocks of math - and what children know about numbers as they begin first grade seems to play a big role in how well they do everyday calculations later on.
The findings have specialists considering steps that parents might take to spur math abilities, just like they do to try to raise a good reader.
This isn't only about trying to improve the nation's math scores and attract kids to become engineers. It's far more basic.
Consider: How rapidly can you calculate a tip? Do the fractions to double a recipe? Know how many quarters and dimes the cashier should hand back as your change?
About 1 in 5 adults in the U.S. lacks the math competence expected of a middle-schooler, meaning they have trouble with those ordinary tasks and aren't qualified for many of today's jobs.
"It's not just, can you do well in school? It's how well can you do in your life," says Dr. Kathy Mann Koepke of the National Institutes of Health, which is funding much of this research into math cognition. "We are in the midst of math all the time."
A new study shows trouble can start early. University of Missouri researchers tested 180 seventh-graders. Those who lagged behind their peers in a test of core math skills needed to function as adults were the same kids who'd had the least number sense or fluency way back when they started first grade.
"The gap they started with, they don't close it," says Dr. David Geary, a cognitive psychologist who leads the study that is tracking children from kindergarten to high school in the Columbia, Mo., school system. "They're not catching up" to the kids who started ahead.
If first grade sounds pretty young to be predicting math ability, well, no one expects tots to be scribbling sums. But this number sense, or what Geary more precisely terms "number system knowledge," turns out to be a fundamental skill that students continually build on, much more than the simple ability to count.
What's involved? Understanding that numbers represent different quantities - that three dots is the same as the numeral "3" or the word "three." Grasping magnitude - that 23 is bigger than 17. Getting the concept that numbers can be broken into parts - that 5 is the same as 2 and 3, or 4 and 1. Showing on a number line that the difference between 10 and 12 is the same as the difference between 20 and 22.
Factors such as IQ and attention span didn't explain why some first-graders did better than others. Now Geary is studying if something that youngsters learn in preschool offers an advantage.
There's other evidence that math matters early in life. Numerous studies with young babies and a variety of animals show that a related ability - to estimate numbers without counting - is intuitive, sort of hard-wired in the brain, says Mann Koepke, of NIH's National Institute of Child Health and Human Development. That's the ability that lets you choose the shortest grocery check-out line at a glance, or that guides a bird to the bush with the most berries.
Number system knowledge is more sophisticated, and the Missouri study shows children who start elementary school without those concepts "seem to struggle enormously," says Mann Koepke, who wasn't part of that research.
While schools tend to focus on math problems around third grade, and math learning disabilities often are diagnosed by fifth grade, the new findings suggest "the need to intervene is much earlier than we ever used to think," she adds. Exactly how to intervene still is being studied, sure to be a topic when NIH brings experts together this spring to assess what's known about math cognition.
But Geary sees a strong parallel with reading. Scientists have long known that preschoolers who know the names of letters and can better distinguish what sounds those letters make go on to read more easily. So parents today are advised to read to their children from birth, and many youngsters' books use rhyming to focus on sounds.
Likewise for math, "kids need to know number words" early on, he says.
NIH's Mann Koepke agrees, and offers some tips:
-Don't teach your toddler to count solely by reciting numbers. Attach numbers to a noun - "Here are five crayons: One crayon, two crayons..." or say "I need to buy two yogurts" as you pick them from the store shelf - so they'll absorb the quantity concept.
-Talk about distance: How many steps to your ball? The swing is farther away; it takes more steps.
-Describe shapes: The ellipse is round like a circle but flatter.
-As they grow, show children how math is part of daily life, as you make change, or measure ingredients, or decide how soon to leave for a destination 10 miles away,
"We should be talking to our children about magnitude, numbers, distance, shapes as soon as they're born," she contends. "More than likely, this is a positive influence on their brain function."
--------------
EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
SAN FRANCISCO (AP) -- Have a heart problem? If it's fixable, there's a good chance it can be done without surgery, using tiny tools and devices that are pushed through tubes into blood vessels.
Heart care is in the midst of a transformation. Many problems that once required sawing through the breastbone and opening up the chest for open heart surgery now can be treated with a nip, twist or patch through a tube.
These minimal procedures used to be done just to unclog arteries and correct less common heart rhythm problems. Now some patients are getting such repairs for valves, irregular heartbeats, holes in the heart and other defects - without major surgery. Doctors even are testing ways to treat high blood pressure with some of these new approaches.
All rely on catheters - hollow tubes that let doctors burn away and reshape heart tissue or correct defects through small holes in blood vessels.
"This is the replacement for the surgeon's knife. Instead of opening the chest, we're able to put catheters in through the leg, sometimes through the arm," said Dr. Spencer King of St. Joseph's Heart and Vascular Institute in Atlanta. He is former president of the American College of Cardiology. Its conference earlier this month featured research on these novel devices.
"Many patients after having this kind of procedure in a day or two can go home" rather than staying in the hospital while a big wound heals, he said. It may lead to cheaper treatment, although the initial cost of the novel devices often offsets the savings from shorter hospital stays.
Not everyone can have catheter treatment, and some promising devices have hit snags in testing. Others on the market now are so new that it will take several years to see if their results last as long as the benefits from surgery do.
But already, these procedures have allowed many people too old or frail for an operation to get help for problems that otherwise would likely kill them.
"You can do these on 90-year-old patients," King said.
These methods also offer an option for people who cannot tolerate long-term use of blood thinners or other drugs to manage their conditions, or who don't get enough help from these medicines and are getting worse.
"It's opened up a whole new field," said Dr. Hadley Wilson, cardiology chief at Carolinas HealthCare System in Charlotte. "We can hopefully treat more patients more definitively, with better results."
For patients, this is crucial: Make sure you are evaluated by a "heart team" that includes a surgeon as well as other specialists who do less invasive treatments. Many patients now get whatever treatment is offered by whatever specialist they are sent to, and those specialists sometimes are rivals.
"We want to get away from that" and do whatever is best for the patient, said Dr. Timothy Gardner, a surgeon at Christiana Care Health System in Newark, Del., and an American Heart Association spokesman. "There shouldn't be a rivalry in the field."
Here are some common problems and newer treatments for them:
HEART VALVES
Millions of people have leaky heart valves. Each year, more than 100,000 people in the United States alone have surgery for them. A common one is the aortic valve, the heart's main gate. It can stiffen and narrow, making the heart strain to push blood through it. Without a valve replacement operation, half of these patients die within two years, yet many are too weak to have one.
"Essentially, this was a death sentence," said Dr. John Harold, a Los Angeles heart specialist who is president of the College of Cardiology.
That changed just over a year ago, when Edwards Lifesciences Corp. won approval to sell an artificial aortic valve flexible and small enough to fit into a catheter and wedged inside the bad one. At first it was just for inoperable patients. Last fall, use was expanded to include people able to have surgery but at high risk of complications.
Gary Verwer, 76, of Napa, Calif., had a bypass operation in 1988 that made surgery too risky when he later developed trouble with his aortic valve.
"It was getting worse every day. I couldn't walk from my bed to my bathroom without having to sit down and rest," he said. After getting a new valve through a catheter last April at Stanford University, "everything changed; it was almost immediate," he said. "Now I can walk almost three miles a day and enjoy it. I'm not tired at all."
"The chest cracking part is not the most fun," he said of his earlier bypass surgery. "It was a great relief not to have to go through that recovery again."
Catheter-based treatments for other valves also are in testing. One for the mitral valve - Abbott Laboratories' MitraClip - had a mixed review by federal Food and Drug Administration advisers this week; whether it will win FDA approval is unclear. It is already sold in Europe.
HEART RHYTHM PROBLEMS
Catheters can contain tools to vaporize or "ablate" bits of heart tissue that cause abnormal signals that control the heartbeat. This used to be done only for some serious or relatively rare problems, or surgically if a patient was having an operation for another heart issue.
Now catheter ablation is being used for the most common rhythm problem - atrial fibrillation, which plagues about 3 million Americans and 15 million people worldwide. The upper chambers of the heart quiver or beat too fast or too slow. That lets blood pool in a small pouch off one of these chambers. Clots can form in the pouch and travel to the brain, causing a stroke.
Ablation addresses the underlying rhythm problem. To address the stroke risk from pooled blood, several novel devices aim to plug or seal off the pouch. Only one has approval in the U.S. now - SentreHeart Inc.'s Lariat, a tiny lasso to cinch the pouch shut. It uses two catheters that act like chopsticks. One goes through a blood vessel and into the pouch to help guide placement of the device, which is contained in a second catheter poked under the ribs to the outside of the heart. A loop is released to circle the top of the pouch where it meets the heart, sealing off the pouch.
A different kind of device - Boston Scientific Corp.'s Watchman - is sold in Europe and parts of Asia, but is pending before the FDA in the U.S. It's like a tiny umbrella pushed through a vein and then opened inside the heart to plug the troublesome pouch. Early results from a pivotal study released by the company suggested it would miss a key goal, making its future in the U.S. uncertain.
HEART DEFECTS
Some people have a hole in a heart wall called an atrial septal defect that causes abnormal blood flow. St. Jude Medical Inc.'s Amplatzer is a fabric-mesh patch threaded through catheters to plug the hole.
The patch is also being tested for a more common defect - PFO, a hole that results when the heart wall doesn't seal the way it should after birth. This can raise the risk of stroke. In two new studies, the device did not meet the main goal of lowering the risk of repeat strokes in people who had already suffered one, but some doctors were encouraged by other results.
CLOGGED ARTERIES
The original catheter-based treatment - balloon angioplasty - is still used hundreds of thousands of times each year in the U.S. alone. A Japanese company, Terumo Corp., is one of the leaders of a new way to do it that is easier on patients - through a catheter in the arm rather than the groin.
Newer stents that prop arteries open and then dissolve over time, aimed at reducing the risk of blood clots, also are in late-stage testing.
HIGH BLOOD PRESSURE
About 75 million Americans and 1 billion people worldwide have high blood pressure, a major risk factor for heart attacks. Researchers are testing a possible long-term fix for dangerously high pressure that can't be controlled with multiple medications.
It uses a catheter and radio waves to zap nerves, located near the kidneys, which fuel high blood pressure. At least one device is approved in Europe and several companies are testing devices in the United States.
"We're very excited about this," said Harold, the cardiology college's president. It offers hope to "essentially cure high blood pressure."
---
Marilynn Marchione can be followed at HTTP://TWITTER.COM/MMARCHIONEAP © 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Heart care is in the midst of a transformation. Many problems that once required sawing through the breastbone and opening up the chest for open heart surgery now can be treated with a nip, twist or patch through a tube.
These minimal procedures used to be done just to unclog arteries and correct less common heart rhythm problems. Now some patients are getting such repairs for valves, irregular heartbeats, holes in the heart and other defects - without major surgery. Doctors even are testing ways to treat high blood pressure with some of these new approaches.
All rely on catheters - hollow tubes that let doctors burn away and reshape heart tissue or correct defects through small holes in blood vessels.
"This is the replacement for the surgeon's knife. Instead of opening the chest, we're able to put catheters in through the leg, sometimes through the arm," said Dr. Spencer King of St. Joseph's Heart and Vascular Institute in Atlanta. He is former president of the American College of Cardiology. Its conference earlier this month featured research on these novel devices.
"Many patients after having this kind of procedure in a day or two can go home" rather than staying in the hospital while a big wound heals, he said. It may lead to cheaper treatment, although the initial cost of the novel devices often offsets the savings from shorter hospital stays.
Not everyone can have catheter treatment, and some promising devices have hit snags in testing. Others on the market now are so new that it will take several years to see if their results last as long as the benefits from surgery do.
But already, these procedures have allowed many people too old or frail for an operation to get help for problems that otherwise would likely kill them.
"You can do these on 90-year-old patients," King said.
These methods also offer an option for people who cannot tolerate long-term use of blood thinners or other drugs to manage their conditions, or who don't get enough help from these medicines and are getting worse.
"It's opened up a whole new field," said Dr. Hadley Wilson, cardiology chief at Carolinas HealthCare System in Charlotte. "We can hopefully treat more patients more definitively, with better results."
For patients, this is crucial: Make sure you are evaluated by a "heart team" that includes a surgeon as well as other specialists who do less invasive treatments. Many patients now get whatever treatment is offered by whatever specialist they are sent to, and those specialists sometimes are rivals.
"We want to get away from that" and do whatever is best for the patient, said Dr. Timothy Gardner, a surgeon at Christiana Care Health System in Newark, Del., and an American Heart Association spokesman. "There shouldn't be a rivalry in the field."
Here are some common problems and newer treatments for them:
HEART VALVES
Millions of people have leaky heart valves. Each year, more than 100,000 people in the United States alone have surgery for them. A common one is the aortic valve, the heart's main gate. It can stiffen and narrow, making the heart strain to push blood through it. Without a valve replacement operation, half of these patients die within two years, yet many are too weak to have one.
"Essentially, this was a death sentence," said Dr. John Harold, a Los Angeles heart specialist who is president of the College of Cardiology.
That changed just over a year ago, when Edwards Lifesciences Corp. won approval to sell an artificial aortic valve flexible and small enough to fit into a catheter and wedged inside the bad one. At first it was just for inoperable patients. Last fall, use was expanded to include people able to have surgery but at high risk of complications.
Gary Verwer, 76, of Napa, Calif., had a bypass operation in 1988 that made surgery too risky when he later developed trouble with his aortic valve.
"It was getting worse every day. I couldn't walk from my bed to my bathroom without having to sit down and rest," he said. After getting a new valve through a catheter last April at Stanford University, "everything changed; it was almost immediate," he said. "Now I can walk almost three miles a day and enjoy it. I'm not tired at all."
"The chest cracking part is not the most fun," he said of his earlier bypass surgery. "It was a great relief not to have to go through that recovery again."
Catheter-based treatments for other valves also are in testing. One for the mitral valve - Abbott Laboratories' MitraClip - had a mixed review by federal Food and Drug Administration advisers this week; whether it will win FDA approval is unclear. It is already sold in Europe.
HEART RHYTHM PROBLEMS
Catheters can contain tools to vaporize or "ablate" bits of heart tissue that cause abnormal signals that control the heartbeat. This used to be done only for some serious or relatively rare problems, or surgically if a patient was having an operation for another heart issue.
Now catheter ablation is being used for the most common rhythm problem - atrial fibrillation, which plagues about 3 million Americans and 15 million people worldwide. The upper chambers of the heart quiver or beat too fast or too slow. That lets blood pool in a small pouch off one of these chambers. Clots can form in the pouch and travel to the brain, causing a stroke.
Ablation addresses the underlying rhythm problem. To address the stroke risk from pooled blood, several novel devices aim to plug or seal off the pouch. Only one has approval in the U.S. now - SentreHeart Inc.'s Lariat, a tiny lasso to cinch the pouch shut. It uses two catheters that act like chopsticks. One goes through a blood vessel and into the pouch to help guide placement of the device, which is contained in a second catheter poked under the ribs to the outside of the heart. A loop is released to circle the top of the pouch where it meets the heart, sealing off the pouch.
A different kind of device - Boston Scientific Corp.'s Watchman - is sold in Europe and parts of Asia, but is pending before the FDA in the U.S. It's like a tiny umbrella pushed through a vein and then opened inside the heart to plug the troublesome pouch. Early results from a pivotal study released by the company suggested it would miss a key goal, making its future in the U.S. uncertain.
HEART DEFECTS
Some people have a hole in a heart wall called an atrial septal defect that causes abnormal blood flow. St. Jude Medical Inc.'s Amplatzer is a fabric-mesh patch threaded through catheters to plug the hole.
The patch is also being tested for a more common defect - PFO, a hole that results when the heart wall doesn't seal the way it should after birth. This can raise the risk of stroke. In two new studies, the device did not meet the main goal of lowering the risk of repeat strokes in people who had already suffered one, but some doctors were encouraged by other results.
CLOGGED ARTERIES
The original catheter-based treatment - balloon angioplasty - is still used hundreds of thousands of times each year in the U.S. alone. A Japanese company, Terumo Corp., is one of the leaders of a new way to do it that is easier on patients - through a catheter in the arm rather than the groin.
Newer stents that prop arteries open and then dissolve over time, aimed at reducing the risk of blood clots, also are in late-stage testing.
HIGH BLOOD PRESSURE
About 75 million Americans and 1 billion people worldwide have high blood pressure, a major risk factor for heart attacks. Researchers are testing a possible long-term fix for dangerously high pressure that can't be controlled with multiple medications.
It uses a catheter and radio waves to zap nerves, located near the kidneys, which fuel high blood pressure. At least one device is approved in Europe and several companies are testing devices in the United States.
"We're very excited about this," said Harold, the cardiology college's president. It offers hope to "essentially cure high blood pressure."
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Marilynn Marchione can be followed at HTTP://TWITTER.COM/MMARCHIONEAP © 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
WASHINGTON (AP) -- Three years, two elections, and one Supreme Court decision after President Barack Obama signed the Affordable Care Act, its promise of health care for the uninsured may be delayed or undercut in much of the country because of entrenched opposition from many Republican state leaders.
In half the states, mainly led by Democrats, officials are racing deadlines to connect uninsured residents to coverage now only months away. In others it's as if "Obamacare" - signed Mar. 23, 2010 - had never passed.
Make no mistake, the federal government will step in and create new insurance markets in the 26 mostly red states declining to run their own. Just like the state-run markets in mostly Democratic-led states, the feds will start signing up customers Oct. 1 for coverage effective Jan. 1. But they need a broad cross-section of people, or else the pool will be stuck with what the government calls the "sick and worried" - the costliest patients.
Insurance markets, or exchanges, are one prong of Obama's law, providing subsidized private coverage for middle-class households who currently can't get their own. The other major piece is a Medicaid expansion to serve more low-income people. And at least 13 states have already indicated they will not agree to that.
"It could look like two or three different countries," said Robert Blendon, a Harvard School of Public Health professor who studies public opinion on health care. "The political culture of a state is going to play an important role in getting millions of people to voluntarily sign up."
Civic leadership - from governors, legislators, mayors and business and religious groups - is shaping up as a huge factor in the launch of Obama's plan, particularly since the penalty for ignoring the law's requirement to get coverage is as low as $95 the first year.
People-to-people contacts will be key, and the potential for patchwork results is real.
"Obviously it's a possibility in terms of there being some real difficulties," said Sen. Bob Casey, D-Pa., whose efforts helped pass the law. Casey also said he believes the Obama administration will be ready to lead in states holding back.
Disparities already are cropping up.
Town Meeting Day - the first Tuesday in March - is a storied tradition in Vermont, and this year it provided a platform to educate residents about their options under the health care law. As many as 250,000 may eventually get coverage through Vermont Health Connect, as the state's marketplace is known.
"Even before we were a state, these town meetings existed," said Sean Sheehan, director of education and outreach. "It's a way people come together as a community, and we are counting on those community connections to get the word out." The health care plan was on the agenda at about 100 town meetings, and other local gatherings are taking place.
Texas residents are entitled to the same benefits as Vermonters, but in the state with the highest proportion of its population uninsured, Gov. Rick Perry will not be promoting the federal insurance exchange, a spokeswoman said. Nor does Perry plan to expand Medicaid.
The result is a communications void that civic and political groups, mayors, insurers and hospitals will try to fill.
"You have people who aren't really charged up about it because they don't even know that they would qualify," said Durrel Douglas, spokesman for the Texas Organizing Project, an activist group. A national poll this week by the nonpartisan Kaiser Family Foundation found that two of every three uninsured people don't know enough about the law to understand how it will affect them.
Supporters of Obama's law in Texas say the federal government hasn't shown up yet to launch the state's insurance exchange and no one is sure when that will happen.
"It is a much bigger lift here," said Anne Dunkelberg, associate director of the Austin-based Center for Public Policy Priorities, which advocates for low-income people. "The sooner the federal exchange can get engaged and working with all the folks here who want to promote enrollment, the better."
The Congressional Budget Office predicts a slow start overall, with only 7 million gaining coverage through the exchanges next year, rising to 24 million in 2016.
At a recent insurance industry meeting, federal officials directing the rollout rattled off a dizzying list of deadlines. Public outreach will begin in earnest this summer and early fall, said Gary Cohen, head of the Center for Consumer Information and Insurance Oversight.
The government sees three main groups of potential customers for the new insurance markets, he said.
There's the "active sick and worried," people who are uninsured or have pre-existing medical conditions. Under the law, insurers will no longer be able to turn the sick away.
There's the healthy and young. "They feel invincible, they don't feel a need for health insurance," said Cohen.
Finally, there's the passive and unengaged. "For these people, a significant education effort needs to happen," he said.
To keep premiums affordable, the government will need to sign up lots of people from the last two groups to balance those in poor health, who will have a strong motivation to join.
The official heading consumer outreach for the rollout, Julie Bataille, acknowledges the challenge but says she's confident.
"This is a really an enormous opportunity for us to change the conversation around health care and help individuals understand the benefits they can get," she said.
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
In half the states, mainly led by Democrats, officials are racing deadlines to connect uninsured residents to coverage now only months away. In others it's as if "Obamacare" - signed Mar. 23, 2010 - had never passed.
Make no mistake, the federal government will step in and create new insurance markets in the 26 mostly red states declining to run their own. Just like the state-run markets in mostly Democratic-led states, the feds will start signing up customers Oct. 1 for coverage effective Jan. 1. But they need a broad cross-section of people, or else the pool will be stuck with what the government calls the "sick and worried" - the costliest patients.
Insurance markets, or exchanges, are one prong of Obama's law, providing subsidized private coverage for middle-class households who currently can't get their own. The other major piece is a Medicaid expansion to serve more low-income people. And at least 13 states have already indicated they will not agree to that.
"It could look like two or three different countries," said Robert Blendon, a Harvard School of Public Health professor who studies public opinion on health care. "The political culture of a state is going to play an important role in getting millions of people to voluntarily sign up."
Civic leadership - from governors, legislators, mayors and business and religious groups - is shaping up as a huge factor in the launch of Obama's plan, particularly since the penalty for ignoring the law's requirement to get coverage is as low as $95 the first year.
People-to-people contacts will be key, and the potential for patchwork results is real.
"Obviously it's a possibility in terms of there being some real difficulties," said Sen. Bob Casey, D-Pa., whose efforts helped pass the law. Casey also said he believes the Obama administration will be ready to lead in states holding back.
Disparities already are cropping up.
Town Meeting Day - the first Tuesday in March - is a storied tradition in Vermont, and this year it provided a platform to educate residents about their options under the health care law. As many as 250,000 may eventually get coverage through Vermont Health Connect, as the state's marketplace is known.
"Even before we were a state, these town meetings existed," said Sean Sheehan, director of education and outreach. "It's a way people come together as a community, and we are counting on those community connections to get the word out." The health care plan was on the agenda at about 100 town meetings, and other local gatherings are taking place.
Texas residents are entitled to the same benefits as Vermonters, but in the state with the highest proportion of its population uninsured, Gov. Rick Perry will not be promoting the federal insurance exchange, a spokeswoman said. Nor does Perry plan to expand Medicaid.
The result is a communications void that civic and political groups, mayors, insurers and hospitals will try to fill.
"You have people who aren't really charged up about it because they don't even know that they would qualify," said Durrel Douglas, spokesman for the Texas Organizing Project, an activist group. A national poll this week by the nonpartisan Kaiser Family Foundation found that two of every three uninsured people don't know enough about the law to understand how it will affect them.
Supporters of Obama's law in Texas say the federal government hasn't shown up yet to launch the state's insurance exchange and no one is sure when that will happen.
"It is a much bigger lift here," said Anne Dunkelberg, associate director of the Austin-based Center for Public Policy Priorities, which advocates for low-income people. "The sooner the federal exchange can get engaged and working with all the folks here who want to promote enrollment, the better."
The Congressional Budget Office predicts a slow start overall, with only 7 million gaining coverage through the exchanges next year, rising to 24 million in 2016.
At a recent insurance industry meeting, federal officials directing the rollout rattled off a dizzying list of deadlines. Public outreach will begin in earnest this summer and early fall, said Gary Cohen, head of the Center for Consumer Information and Insurance Oversight.
The government sees three main groups of potential customers for the new insurance markets, he said.
There's the "active sick and worried," people who are uninsured or have pre-existing medical conditions. Under the law, insurers will no longer be able to turn the sick away.
There's the healthy and young. "They feel invincible, they don't feel a need for health insurance," said Cohen.
Finally, there's the passive and unengaged. "For these people, a significant education effort needs to happen," he said.
To keep premiums affordable, the government will need to sign up lots of people from the last two groups to balance those in poor health, who will have a strong motivation to join.
The official heading consumer outreach for the rollout, Julie Bataille, acknowledges the challenge but says she's confident.
"This is a really an enormous opportunity for us to change the conversation around health care and help individuals understand the benefits they can get," she said.
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
CHICAGO (AP) — The nation's most influential pediatrician's group says research shows that parents' sexual orientation has no effect on a child's development and that kids fare just as well in financially and emotionally stable straight or same-sex families.
The American Academy of Pediatrics endorsement of same-sex marriage has been published online, citing the belief that a two-parent marriage is best equipped to provide the right environment. Their policy says that if a child has two same-sex parents who choose to marry, it's in everyone's best interests for "legal and social institutions (to) allow and support them."
The policy cites reports indicating that almost 2 million U.S. children are being raised by same-sex parents.
Officials with the group said they wanted to make the academy's views known before two same-sex marriage cases are considered by the U.S. Supreme Court next week.
The American Academy of Pediatrics endorsement of same-sex marriage has been published online, citing the belief that a two-parent marriage is best equipped to provide the right environment. Their policy says that if a child has two same-sex parents who choose to marry, it's in everyone's best interests for "legal and social institutions (to) allow and support them."
The policy cites reports indicating that almost 2 million U.S. children are being raised by same-sex parents.
Officials with the group said they wanted to make the academy's views known before two same-sex marriage cases are considered by the U.S. Supreme Court next week.
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