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HealthWeek No. 151

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?
Giving your doctor a check-up. A controversial new effort to see if physicians are making the medical grade.
And a Miss America on a mission: preventing the spread of AIDS.

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.


We begin with news about a form of tobacco that some think is a "safe" alternative to cigarettes: cigars. In a ground-breaking report released this week, the National Cancer Institute found cigars are actually far from safe. Smoking as little as one stogie a day poses serious health risks. And even if you don't light up, just hanging around cigar smokers may be hazardous to your health. The 232-page report says concentrations of carbon monoxide at some cigar social events are higher than levels on a
ROBERT DAVIS, PhD: The cigar bar, one of the hottest places to go these days, not to mention the haziest.
Ask these folks about the health hazards of cigars, and most will tell you the same thing.

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.

ROBERT DAVIS, PhD: The report says cigar smoking increases the risk of cancer of the mouth, the throat, the lungs, and possibly the pancreas. The more you smoke, the greater the risk.

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.
In response to the dramatic rise in youth and adult smoking, the Federal Trade Commission has told cigar manufacturers to turn over information about how they're selling and promoting their product. It's the first step of what could eventually be a government crackdown on cigars, which until now have been relatively free of federal regulation.

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.
Regardless of what politicians decide to do, the Cancer Institute hopes its report will have an impact on the public, making the allure of cigars... go up in smoke.

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.
Dr. Elmore, thank you for being with us. What do you think your findings mean to women when you look at these results and one may question whether or not breast cancer screening is really doing what it should?

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.



NANCY SNYDERMAN, MD: Hello, I'm Doctor Nancy Snyderman with this week's Healthful Hint.
When someone tells you to take a hike, it's usually not meant as friendly advice. But when the great outdoors beckons, a nice hike can be a great idea.
Good footwear can make all the difference on whether you enjoy your expedition or find it a real trek. Lightweight shoes that grip well and have good ankle support, like high-tops or running sneakers, are perfect for easy-going day-hikes. More rugged or muddy trails call for waterproof hiking boots. Make sure your boots fit right. Wear thick socks when you try them on at the store and remember, the heavier the boot, the longer it takes to break in.
On the trail, snack as you go along to keep up your energy. Everyone has favorites like apples, peanuts or raisins, but you might try creating your own trail mix. Combine dried fruits or unsweetened coconut with nuts or sunflower seeds to get a healthy blend of carbohydrates and proteins.
One last hint for hiking enjoyment: don't be a slave to your timetable. Pace yourself so you can enjoy the scenery.
With Healthful Hints, I'm Doctor Nancy Snyderman


NANCY OLSON: People try a lot of things to stay young. Many pop vitamins, others take herbs. And now some are even turning to an expensive prescription drug designed for children in hopes of restoring their lost youth. HealthWeek's Pat Anson explains.

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.
It mimics the natural hormone produced by the pituitary, a small gland at the base of the brain. The hormone acts throughout the body stimulating the development of muscle, bone and tissue. Levels are highest in teenagers and young adults, but starting at about the age of thirty, they gradually taper off. By age sixty, growth hormone levels have fallen substantially.
Larry Speer not only uses growth hormone, he now sells it to doctors, and says his business is growing.

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: Physicians like Joe Filbeck. For a man 62 years old, Filbeck was already in pretty good shape, but when he started taking growth hormone, Filbeck says his strength and endurance increased, and he even shed a few wrinkles.

JOE FILBECK, MD: It gave my skin a texture and a smoothness that I hadn't experienced before.

PAT ANSON: Filbeck is so convinced that he's given up his career as an anesthesiologist to become medical director at an anti-aging clinic near Los Angeles. There he prescribes the hormone to people dreading old age. Forty-five-year old Dora Luz Page is a new patient.

DORA LUZ PAGE: I'm not going to wait until I'm 50. And I'm not going to wait until I'm 60 to do something about it. I'm going to do it now.

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 fit.
Research has yet to prove that growth hormone will actually make people live longer. But many scientists are intrigued by its effect on aging bodies.

MARC BLACKMAN, MD, NATIONAL INSTITUTE ON AGING: Carefully conducted studies in people who are deficient in growth hormone have now shown definite significant improvement in well being in a variety of ways.

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 far.

MARC BLACKMAN, MD: With regard to, for example, the heart, deficiencies in growth hormone are bad for the heart and giving back supplemental growth hormone is good for the structure and, more importantly, the function of the heart.

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 wrinkles.
But Blackman stops far short of recommending that people take it.

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 effects.

MAXINE PAPADAKIS, MD, VETERANS AFFAIRS HOSPITAL, SAN FRANCISCO: The fountain of youth has not yet been found.

PAT ANSON: Doctor Maxine Papadakis says she was once enthusiastic about growth hormone. But after conducting a study of it with elderly men, she's now disturbed by its side effects.

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.

MAXINE PAPADAKIS, MD: I have great concerns about its safety. We just don't know. It may be safe. It may be very safe. We don't know that yet.

LARRY SPEER: And there's always a group of doubting Thomas's, but there's thousands of people who will tell you this works.

PAT ANSON: People, like Larry Speer, for whom the promise of never growing old outweighs any concern about side effects.

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.
For more information on human growth hormone or any other HealthWeek story, you can call our toll-free number shown at the end of the program.

Until 1985, human growth hormone was extracted from the pituitary glands of corpses.
Now, genetically engineered bacteria are used to produce the hormone.

NANCY OLSON: When you go to your doctor's office, you probably see a lot of diplomas and certificates hanging on the wall. But do you have any idea what they really mean? Or, more importantly, any idea if your doctor's really got what it takes to give you the best medical care? From Portland, Oregon HealthWeek's Andrew Holtz reports on controversial efforts to give doctors a uniform stamp of approval.

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.
Dr. Weaver is used to evaluations, to earn her medical license, to be board certified, and she's faced numerous inspections from health care plans she's affiliated with.

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.
When it's all over, doctors get a grade and suggestions for improvement. Those who don't meet basic standards are re-evaluated six months later.

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 idea nationwide.
A certificate will be awarded to doctors by the AMA based on several criteria, including whether the doctor has valid credentials, behaves ethically, keeps good records, and provides appropriate care.

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
NANCY OLSON: You know, medicine is such a fast changing field, I mean, new technologies, new treatments all the time. Are doctors ever re-tested? How do you know if your doctor's really up to speed?

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.


BRUCE DAN, MD: I'm Dr. Bruce Dan. Sitting in front of the TV seems fairly safe. But it wasn't for one television viewer, who laughed himself into the hospital.
According to a report in the journal Catheterization and Cardiovascular Diagnosis, a 62-year-old man reported repeated episodes of fainting while watching the popular comedy, "Seinfeld."
He told his doctors that the antics of George Costanza, played by Jason Alexander, made him laugh so hard he passed out. On one occasion, the man fell face-first into his dinner and had to be rescued by his wife.
Doctors found that he had blockages in the arteries in his neck, impairing blood flow to his brain. When he laughed, the increased pressure on his heart further reduced the blood flow and made him faint.
Corrective surgery opened up the man's arteries. And at last report, he was able to laugh his way through an entire episode without passing out.
With "Doctor's Corner," I'm Doctor Bruce Dan.


NANCY OLSON: It's not unusual for modern-day Miss Americas to promote awareness of public health issues like drug abuse or domestic violence. But Miss America 1998 is going a step further, taking a stand on one of the most controversial health issues today.
Kate Shindle's got talent.

"There she is, Miss America."

And of course she's got beauty. But it's her dedication to HIV and AIDS that people are talking about.

SANDRA THURMAN, OffICE OF NATIONAL AIDS POLICY: Kate doesn't look like what people assume an AIDS activist would look like.

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 credit.

NANCY OLSON: A national AIDS organization recently applauded Shindle's efforts educating young people about the disease. And she used the opportunity to ask President Clinton to support needle exchange programs.

KATHERINE SHINDLE: "No more stalling, no more looking into the issue."

NANCY OLSON: Such a controversial stance is unusual for any Miss America...

KATHERINE SHINDLE: "Needle exchange saves lives, all right."

NANCY OLSON: ...much less one like Shindle who describes herself as an anti-abortion, Catholic school Republican.

KATHERINE SHINDLE: There's no way that I would have supported needle exchange had I not really known the issue, but once I did, it was a pretty clear cut issue.

NANCY OLSON: Shindle's support of AIDS causes, like this food program for patients, began when a close family friend was diagnosed.

KATHERINE SHINDLE: He's been living with it for about three years now, but it was an eye opener, and that motivated me to get involved with AIDS related volunteering.

NANCY OLSON: Now, much of Shindle's 20,000 miles a month travel schedule is devoted to visiting schools, and she doesn't shy away from straight talk.

KATHERINE SHINDLE: "Do you have a condom distribution program here at school?"

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 answer it.

NANCY OLSON: In addition to condoms, she also preaches abstinence.

KATHERINE SHINDLE: One girl wrote to me and said, "You know, I was going to have sex with my boyfriend, but since I heard you speak, I decided to wait," and to know that I had that impact on one girl is incredible.

DAVID HARVEY, AIDS POLICY CENTER: She's done the public health and the AIDS community a lot of service by reaching out and helping to educate a new generation of American youth.

NANCY OLSON: A generation still fascinated with the tradition of the crown and the modern-day frankness of the woman who wears it.

KATHERINE SHINDLE: For every day that we try to hedge and decide how can we do this without offending anybody and how can we talk about HIV without talking about sex or without saying the word condom, every day that we delay, 16,000 people contract HIV. We don't have the luxury of time.

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.
Well, that's all for this week. Sharyl Attkisson will be back next week. I'm Nancy Olson. Thanks for being with us.

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