ANNOUNCER: Funding for HealthWeek is provided by the Howard Heinz Endowment and the Teresa and H. John Heinz III Foundation.
NANCY OLSON: Today on HealthWeek... Human growth hormone. It's intended to make certain children taller, but some adults say it's making them younger.
LARRY SPEER: "My sex life is better, my durability is better, my strength is better. What's not to love?"
NANCY OLSON: Is it really the
new fountain of youth?
KATHERINE SHINDLE, MISS AMERICA: "It's not just giving kids a condom. It's empowering them to believe in themselves enough to take the lead in their relationships and be strong about this."
NANCY OLSON: Hello. I'm Nancy Olson, in for Sharyl Attkisson. And welcome to HealthWeek.
CIGAR SMOKER: "I'm not concerned about the health risks. I figure that 3 or 4 cigars a week is probably not anything that's going to bother you."
ROBERT DAVIS, PhD: But that may not be the case, according to Donald Shopland of the National Cancer Institute, who helped compile the new cigar report.
DONALD SHOPLAND, NATIONAL CANCER
INSTITUTE: The amount of tobacco in one of these cigars is
equivalent to the tobacco in a pack of cigarettes. That means one cigar
can equal to the health risks of one pack of cigarettes, and we know that
risk to be substantial.
DONALD SHOPLAND: The survival rates for some of these cancers are in the single digits. They're less than 10%. That means that we have no easy way of diagnosing them, we have no easy way of treating them, and your chances of living beyond 5 years for many of these types of cancers is almost zero.
ROBERT DAVIS, PhD: The report dispels some common myths: that people don't get addicted to cigars, and...
CIGAR SMOKER: "Because you're not inhaling on the cigar, I felt that it wasn't as unhealthy as a cigarette is."
DONALD SHOPLAND: Data that we review in this report tells us clearly that inhalation is not necessary to substantially increase the disease risk for many of the head and neck cancers, like the oral cavity, like the esophagus.
ROBERT DAVIS, PhD: Cigar smoking had been on the decline for 20 years, until 1993, when it began to go up again. And since then, cigar sales have jumped nearly 50 percent.
"Many of the people smoking cigars have higher incomes, they have more education, they wouldn't touch a cigarette. So what do you make of the fact they're smoking cigars?"
DONALD SHOPLAND: "We feel it's really a result of how cigars have been pitched to the American public over the last couple of years.
ROBERT DAVIS, PhD: : Pitched by
celebrities, like Arnold, and Jack, Claudia and Cosby. That, along with a
starring role for cigars in many popular movies, has helped attract more
women to cigar smoking. And kids, too. A 1996 survey in Massachusetts
found 20% of eighth graders and over 30% of 12th graders had smoked cigars
in the past year.
JODIE BERNSTEIN, FEDERAL TRADE COMMISSION: Americans really do not understand what the health risks are in the smoking of cigars.
ROBERT DAVIS, PhD: : The FTC may
ask Congress to regulate cigars as it now does cigarettes. That could mean
warning labels on cigars, restrictions on where they're sold and limits on
how they're advertised and promoted.
NANCY OLSON: There's also
important news this week about breast-cancer screening tests. Their
accuracy is being questioned by a study in the current New England Journal
of Medicine. Researchers went through records of more than 2,400 women who
received regular mammograms or breast exams. They found that over a
10-year period, nearly one-third of women received test results that
turned out to be false alarms. Joining us to explain the findings is the
lead author of the study, Doctor Joann Elmore of the University of
Washington School of Medicine.
JOANN ELMORE, MD, UNIV OF WASHINGTON SCHOOL OF MEDICINE: Well, I'm a big advocate of breast cancer screening, so I do want to let people know that it is doing what it should, and breast cancer screening is reducing deaths due to breast cancer. But with each screen, you run the risk of having a false alarm. So I want women to know that this is a common occurrence, and my hope is they won't be as anxious when they have to go through this themselves.
NANCY OLSON: Why do you think we're seeing so many false alarms?
JOANNE ELMORE, MD: Well, it's a fine balance. We don't want to miss cancers, obviously. And I think that we may be concerned that if we lower the false alarm rate, we may be missing cancers. But I think this is such an important issue that we need to look into it to see if it isn't possible to lower this rate.
NANCY OLSON: If a woman has something suspicious show up on a breast exam or a mammogram, what do you advise them? Is there anything that you can do to allay their fears?
JOANNE ELMORE, MD: : Well, I hope there is. First of all, I think we need to reassure them that the great majority of women with abnormalities actually don't have cancer. I think we need to ask them to talk with us and to ask more questions and to involve their family and their primary care clinicians.
NANCY OLSON: What is all of this doing to our medical bills?
JOANNE ELMORE, MD: : It's adding up the bills. For every $100 that was spent on screening in this study, we found that an extra $33 was spent on all of those extra tests that were ordered because of the false alarms.
NANCY OLSON: So, I guess looking at your study, the bottom line is mammogram is still a very important test.
JOANNE ELMORE, MD: : Both mammograms and physical examinations, yes. They're very important screening tests.
NANCY OLSON: Dr. Joann Elmore, thank you for being with us.
JOANNE ELMORE, MD: Thank you.
HUMAN GROWTH HORMONE
PAT ANSON: At age 62, Larry Speer says he's been rejuvenated. He can ride horseback, bench press 275 pounds, even play full court basketball three times a week.
LARRY SPEER: I have a lot more stamina. I feel better. I jump better. I had these big wings here and to my surprise they're almost totally gone, without doing sit-ups.
PAT ANSON: His secret? Daily
injections of human growth hormone, a synthetic drug developed, not for
adults, but for children with stunted growth.
LARRY SPEER: What made me start
taking this is when I found out that almost every physician that's got a
patient on it is taking it themselves.
PAT ANSON: Growth hormone has
not been approved by the FDA as an anti-aging remedy, but because it has
been approved for other uses, doctors are free to prescribe it as they see
PAT ANSON: At the National Institute on Aging, Doctor Marc Blackman is conducting one of the largest studies to date.
MARC BLACKMAN, MD: I really believe that you have the blood vessels of a person much younger.
PAT ANSON: The results won't be
in for another year, but Blackman is excited by what he's learned so
PAT ANSON: Besides reversing
heart disease, earlier studies show that growth hormone can reduce body
fat, increase muscle tissue, strengthen the immune system, and reduce
MARC BLACKMAN, MD: The non-sanctioned use in elderly people in particular is really, I believe, and many of us believe, inappropriate and potentially hazardous.
PAT ANSON: Scientific research
into hormone replacement is really just beginning. While some of the early
results are promising, hardly anything is known about its long term
MAXINE PAPADAKIS, MD: Swelling of the legs. By far and away that was the most common side effect, followed by feeling like they had aches and pains in their bodies, or arthralgia, the kind of symptoms that you might get when a cold is coming on.
PAT ANSON: Most alarming to
Papadakis and other researchers is the possibility that the hormone may
cause cancer cells to grow.
LARRY SPEER: And there's always
a group of doubting Thomas's, but there's thousands of people who will
tell you this works.
LARRY SPEER: Not bad for an old guy, huh? My vitality is better. My sex life is better. My durability is better. My strength is better. What's not to love? What's not to love?
NANCY OLSON: Well, one thing
"not to love" may be the price tag. A year's supply of human growth
hormone can run anywhere from $6,000 to $12,000.
ANDREW HOLTZ: Physicians are
usually the ones giving examinations, but today Dr. Kathleen Weaver is on
the receiving end, as she and her office get a check-up.
KATHLEEN WEAVER, MD: Each one was coming in and pulling charts, reviewing them, going over our procedures, and if you belong to multiple different ones, this was getting to be quite intrusive.
ANDREW HOLTZ: Yet Dr. Weaver doesn't mind this inspection by the Oregon Medical Association, because this one OMA visit will certify her for all the health plans she's part of.
KATHLEEN WEAVER, MD: I feel better about the OMA doing this than to have the insurance company, where I have no idea what the people's credentials are or if they're professional.
ANDREW HOLTZ: During field visits, evaluators scrutinize office facilities...
"Does each room have a sharps container?"
ANDREW HOLTZ: They quiz staff on policies and procedures...
"How would you handle that?"
"I would take the message, pull their chart..."
ANDREW HOLTZ: And they check a
sample of patient medical charts.
JOANNE HAZEL, RN, OREGON MEDICAL ASSOCIATION: If the doctor fails to raise his score, then he risks being de-certified by the health plan, and that obviously has quite a financial impact on his practice.
ANDREW HOLTZ: The three-year-old
evaluation program seems to be getting good reviews here, and the concept
is spreading beyond Oregon's borders, with evaluators going to check out
doctors in Idaho, too. Now the American Medical Association is taking the
RANDOLPH SMOAK, MD, AMERICAN MEDICAL ASSOCIATION: We will be able to give an accreditation to a physician that will be very significant to the public, knowing that they have an outstanding physician.
COMMERCIAL: We never knew how important the right health plan could be, now we know better.
ANDREW HOLTZ: In the fierce competition for patients, health plans like the one run by New York Life, try to tout their quality of care. So an AMA seal of approval for their doctors can be a marketing plus. New York Life was the first plan to sign up with the AMA.
DANIEL DRAGALIN, MD, NEW YORK LIFE: Well, I think for the first time this offers a national consistency in credentialling and in the accreditation of individual physicians that wasn't present before the AMA jumped into this arena.
ANDREW HOLTZ: To be certified, AMA members will have to pay $50, non-members, $125.
SIDNEY WOLFE, MD, PUBLIC CITIZEN HEALTH RESEARCH GROUP: No one can even remotely argue that the AMA is an accountable organization.
ANDREW HOLTZ: Consumer advocate, Dr. Sidney Wolfe, who criticizes physicians for not adequately policing themselves, says this program won't work.
SIDNEY WOLFE, MD: If you look upon it as just a way of the AMA making money, it's a good way to make money. The information that will be generated is going to be largely worthless.
ANDREW HOLTZ: Whether or not the AMA program ultimately succeeds will depend on patients, and how well it helps them find what many are looking for... a doctor they can trust.
NANCY OLSON: Here with more on how to make sure you've got a doctor that you can trust is Ellyn Spragins, a Newsweek reporter who covers the health-care industry. She's also author of the book, " Choosing and Using an HMO."
Well, Ellyn, it is so true, as we saw in the story, you walk into your physician's office, and so often you see all of these plaques all over the wall. What do all those certificates mean?
ELLYN SPRAGINS, NEWSWEEK: It's not as confusing as it seems. A diploma of course means that a doctor has completed a course of study at an academic institution, and a certificate from a board means that the doctor has finished residency in a specialty that the board approved and then gone on and passed an exam in that specialty.
NANCY OLSON: It can be confusing.
ELLYN SPRAGINS: It can be, but, you know, I always recommend that a doctor explain it. Simply ask the doctor, " What does this mean?"
NANCY OLSON: What about when an HMO says that a physician is "board eligible"?
ELLYN SPRAGINS: That's a little
tricky, because HMO's sometimes will tout the number of doctors who are
board eligible along with the number that are board certified, but there's
a big difference. Board eligible means the doctor has completed the
training in the specialty, so they're ready to sit down and take that
exam, but they haven't gotten the certificate. And that could mean that
they've actually flunked the exam, once or twice or many times, or it
could mean they just never have gotten around
ELLYN SPRAGINS: Well, some specialties do require re-testing; every seven years, for example, for the pediatric specialties. Others don't require re-testing. So that if you find a certified doctor, it may mean that certification and the testing of the skills and knowledge took place ten, twenty, thirty years ago. So, it's worth looking at what the requirements are of the test.
NANCY OLSON: How do you wade through all of this? I mean how do you really find a qualified doctor? Are there any organizations to help you do that?
ELLYN SPRAGINS: A great place to go is a teaching university, because they can tell you which doctors are on the clinical teaching staff, so they're really up to date. But you have to be careful, because universities also keep, and hospitals also keep, client-doctor referral services, and that's really not what you want. That's a very big list of all kinds of doctors who may use the hospital sometimes.
NANCY OLSON: Well, Ellyn Spragins, thanks so much for being with us and helping to make a difficult process a little clearer.
ELLYN SPRAGINS: My pleasure.
MIGUELINA MALDONADO, NATIONAL MINORITY AIDS
COUNCIL: She's a beautiful woman, but she is also a woman that
incorporates social responsibility, and I think that is to her
STUDENT: "Not exactly in the school, but there's a teen clinic."
KATHERINE SHINDLE: If a question
comes up during question and answer, you better believe that I'm going to
NANCY OLSON: When Kate Shindle's
reign as Miss America ends in September she plans to return to college to
finish her degree in musical theater. But she says she'll continue her
AIDS prevention efforts on a volunteer basis.
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