This Week's ProgramSpacer

Spacer Spacer Spacer
Spacer Spacer
HealthWeek No. 204

ANNOUNCER: Funding for HealthWeek is provided by the Howard Heinz Endowment and the Teresa and H. John Heinz III Foundation.

SHARYL ATTKISSON: Today on HealthWeek... Soap operas are filled with secrets. But this soap actor had a real-life secret: a balding head, until doctors stepped in.

JERRY DOUGLAS: "I'd say it is amazing. This looks exactly like may hair looked 15 years ago."

SHARYL ATTKISSON: The latest ways to restore lost hair.

Giving nurses a bigger role. HMO's think it's great. But some doctors don't. Find out what this tug-of-war means for your medical care.

And meet the Mattinglys, a family that's out to unlock a centuries-old medical "mystery" that lies in their genes.

Hello. I'm Sharyl Attkisson. Welcome to HealthWeek.


You may be finding it difficult to keep track of all the recent "breakthroughs" in the fight against cancer. And this week, even more new developments were announced at a meeting of the American Society of Clinical Oncology in Los Angeles. But the cancer researchers tempered all the hopeful news with a caution: don't believe everything you hear about the new treatments. HealthWeek's Robert Davis has more.

ROBERT DAVIS, PhD: Dr. Fred Smith is a cancer specialist, and for the past three weeks, his phone hasn't stopped ringing.

FRED SMITH, MD, SUBURBAN HOSPITAL, BETHESDA, MD: Perhaps ten calls a day; what about these drugs? Where can I get them? Can I go up to Canada, can I go to Europe?

ROBERT DAVIS, PhD: The drugs these patients and millions of other have been clamoring for are natural proteins called Angiostatin and Endostatin. They were discovered by this man, Dr. Judah Folkman of Children's Hospital in Boston. The drugs work by cutting off the blood supply to tumors, causing them to shrink and die.

Recently, the New York Times ran a front-page story on Folkman's research. It was sprinkled with quotes from noted scientists who seemed to suggest he was on the verge of curing cancer. That prompted a flurry of additional media coverage, along with desperate pleas and angry demands for the drugs from cancer patients and their families.

JAMES PLUDA, MD, NATIONAL CANCER INSTITUTE: It's very premature to think of these drugs as anything more than potential.

ROBERT DAVIS, PhD: This week, at the cancer meeting in Los Angeles, experts held a special briefing to set the record straight.

JAMES PLUDA, MD: I think we need to remember that these agents have never ever been given to human beings. These agents have simply been shown to have activity in mice. And there are lots of drugs, the field of cancer is littered with drugs that had activity in mice that didn't translate into activity in people.

ROBERT DAVIS, PhD: Drugs at first hailed as cures, like Interferon, Monoclonal Antibodies and Interleukin-2, which later failed to live up to their billing.

JAMES PLUDA, MD: Mice tolerate often times much higher doses of therapies without side effects than we could ever give to people. So sometimes what you're left with is the dose of a drug in a mouse that may have had great activity and cured the mouse and made the tumor disappear completely is one that's impractical to be able to give to human beings.

ROBERT DAVIS, PhD: The two new drugs haven't been tested in people yet, in part because scientists can't figure out how to make them in large enough quantities. That could take at least a year or two.

In the meantime, drugs similar to these are already being tested in humans.

JAMES PLUDA, MD: So just because Angio and Endostatin are not ready doesn't mean patients can't explore the possibility of receiving drugs that work in a similar mechanism, that work by blocking tumor blood vessels.

ROBERT DAVIS, PhD: Researchers, who've been working on such drugs for decades, think they'll eventually be used in combination with other types of medications, but none will be a magic bullet.

Echoing such sentiments, Dr. Smith tells his patients not to expect too much, but also not to give up hope for better treatments.

FRED SMITH, MD: We need to pursue such things. We need to get patients into these clinical trials. And I think it's always appropriate for our patients to ask for and want to be in clinical trials. What's available now is not enough.

SHARYL ATTKISSON: Here with more on some of the latest developments out of the cancer meeting is HealthWeek's Andrew Holtz, who was there.

We heard about some new drugs being tested in people. Are there any results to speak of yet?

ANDREW HOLTZ: Yes. Two of these drugs that are meant to interrupt the supply of blood to cancer tumors have been tested in people, very early preliminary studies, and they seem that so far these drugs are safe to give to patients. That's the very first question, and there are some hints of effectiveness. In some patients, the cancer seemed to stabilize. In one patient, it actually seemed to shrink. Too early to say anything definitive, but enough for researchers to be enthusiastic.

SHARYL ATTKISSON: Let's turn to breast cancer, because it seems in the last couple of months, there has been a lot of news about new developments in treatment. Were they talking about that at the meeting?

ANDREW HOLTZ: There was quite a bit of news about breast cancer. In particular, one drug called Herceptin got a lot of attention in a trial that it was used in women with advanced breast cancers, and it seemed to increase the effectiveness of chemotherapy. What this drug does is in certain cancers, there is a, it has a property that they tend to grow very aggressively, and this drug can interrupt the signal that tells them to grow and slow it down, perhaps making standard chemotherapy more effective.

SHARYL ATTKISSON: So, of course, not a cure, but a treatment. Any treatments out there for the early stage breast cancer? Because that, you said, was for advanced stages.

ANDREW HOLTZ: That's right. There is a drug available now that researchers said should be used in standard chemotherapy for certain women with early breast cancers. That drug is Taxol. It got a lot of attention a few years ago. This drug originally made from the yew tree was used in ovarian cancer. Now they find that in certain types of breast cancers, if it was given to, say, a hundred women, it could save an additional two lives. So it's something they say is ready for use now.

SHARYL ATTKISSON: In our final moments, we heard in the story that more people should volunteer or take part in these clinical trials. If I asked my doctor, would he know what trials are out there and what kinds of drugs I might help experiment in?

ANDREW HOLTZ: Things are happening so fast, your doctor might not know everything that's going on, so it never hurts for a patient to be a little persistent and aggressive. You can call the National Cancer Institute at 1-800-4CANCER. Look on the Internet at authoritative sites, like the National Cancer Institute has one. Or look at local cancer support groups to find out what's going on out there, because things are happening.

SHARYL ATTKISSON: A lot happening. Thanks for giving us the update, Andrew Holtz.


NANCY SNYDERMAN, MD: Hello, I'm Dr. Nancy Snyderman with this week's healthful hint.

There's nothing like mixing good food and the great outdoors. But even if there's not a cloud in the sky, your picnic can turn into a disaster when food poisoning strikes.

So, here are a few tips to guard against the germs that cause food poisoning.

First, always wash your hands before preparing or handling food. Next, don't leave food out more than two hours. Harmful bacteria thrive in protein-rich foods like chicken and egg salad. Other risky items? Creamy dips and custard pies. And also, remember to cook your food thoroughly. For meat that's until the pink disappears, and for poultry until there's no red at the joints.

If, despite your best precautions, you do get sick, slowly fill up on fluids so you don't get dehydrated. And don't take anti-diarrheal products. Your body needs to get rid of the harmful germs. So let nature take its course.

With Healthful Hints, I'm Dr. Nancy Snyderman.


SHARYL ATTKISSON: For years the line between the duties of doctors and nurses seemed to be pretty clearly drawn. But now that line is blurring. Nurses have started taking on more responsibility. HealthWeek's Bettina Gregory explains why it's a trend HMOs like, but some doctors don't.

BETTINA GREGORY: When people think of nurses, many still imagine them working for doctors -- loyal and unquestioning assistants to the man with the medical degree. That's changing now.

EDWIGE THOMAS, RN, NURSE PRACTITIONER: "Let me look in the back of your throat and see."

BETTINA GREGORY: Meet Edwige Thomas. She's a nurse who diagnoses conditions....

EDWIGE THOMAS: "It's a little bit red in back there."

BETTINA GREGORY: Refers patients to specialists...

EDWIGE THOMAS: I think the best course for us to take is to send you to a specialist, an orthopedist.

BETTINA GREGORY: And writes prescriptions at her office in New York City. She's part of a new primary care practice called CAPNA, composed entirely of nurse practitioners -- nurses with advanced training and a master's degree.

EDWIGE THOMAS, RN: Patients now have a choice to choose a nurse practitioner. They're actually choosing an approach.

BETTINA GREGORY: Among other things, that means spending more time with patients. A study by the American Nurses Association found that nurse practitioners average 25 minutes per visit, while doctors spend only 17.

Some patients say that's why they've come to this clinic.

MARINA CICCERONE, PATIENT: These days it's kind of like assembly line medicine. But I found here they do spend a lot of time and talk to you and see what you're dealing with and how you're taking care of yourself and every aspect of your life.

EDWIGE THOMAS, NURSE PRACTITIONER: As nurses, we are patient centered, is the best way I can put it. Our approach to patients have been all aspects of their health care, all aspects of their lives.

BETTINA GREGORY: In the past, independent nurse practitioners have worked mainly in inner city and rural areas, where there's a shortage of doctors. What's different about CAPNA is that it's in the middle of Manhattan, where there are plenty of doctors.

What's also different is that these nurses are being paid as much as doctors by some HMO's.

MARY MUNDINGER, RN, DrPH, CAPNA: What nurses are doing in primary care is very, very similar to what physicians are doing in primary care, and we think that the compensation should also be very, very similar.

BETTINA GREGORY: But doctors argue the amount of training is not similar and that they are far more qualified to diagnose illnesses.

MELVIN GERALD, MD, AMERICAN ACADEMY OF FAMILY PHYSICIANS: Well, if you look at the training of a physician and the training of a nurse practitioner, the training is significantly different. And if the training is significantly different, therefore what one can do with quality is also significantly different.

BETTINA GREGORY: Thomas says her six years of training are adequate to diagnose and treat basic problems.

EDWIGE THOMAS, RN: I've been functioning as a nurse practitioner for four years. I've never missed a diagnosis.

BETTINA GREGORY: As turf wars continue, nurses are gaining ground. More states are allowing nurse practitioners to work independently from doctors and more insurance companies are paying for their services, in part because nurses tend to order fewer expensive tests than doctors.

BEVERLY MALONE, RN, PhD, AMERICAN NURSES ASSOCIATION: It is a trend. It's not just a one time kind of instance. We are seeing this going on into the future of the way health care is going to be delivered. Advance practice nurses are a key to the future.

BETTINA GREGORY: A key, if enough patients like the idea of nurses growing beyond their traditional roles.

SHARYL ATTKISSON: But if you're wondering what sets advanced practice nurses apart from other nurses, they've had six to seven years of formal training. That compares with two to four years for the average registered nurse and one to two years for a licensed practical nurse.


We all know going bald can be a big blow to a man's ego. Some try to hide the problem with toupees or hair weaves. Others try to grow new hair with pills or potions. Now, with new advances in hair-grafting technology, more men are turning to surgery to restore the hair they thought was lost forever. But HealthWeek's Pat Anson in Los Angeles found out, it's not the answer for every man.

PAT ANSON: The set of a soap opera is one of the last places you'd expect to find an actor talking about hair loss.

JERRY DOUGLAS: "Characters in a soap don't age like people. And they always have to look beautiful."

PAT ANSON: But Jerry Douglas makes no secret of his battle with baldness. For most of his 16 years playing John Abbott on the Young and the Restless, Douglas wore a hairpiece, one that hid a slowly receding hairline.

Last summer, the hairpiece was retired after transplant surgery gave Douglas a new head of hair -- his own.

JERRY DOUGLAS: "I'd say it's amazing. This looks exactly like my hair looked 15 years ago."

PAT ANSON: For years, Douglas wouldn't even consider transplants after seeing what happened to other men.

JERRY DOUGLAS: "It was awful what they used to do. It was terrible. Not only did they scar people and it didn't look well, it looked like a bad hairpiece."

PAT ANSON: Many are taking a second look at transplants because of new techniques in grafting. Gone are the days when patients were left with unsightly plugs of transplanted hair. Micrografting allows doctors to get a more natural look by transplanting hair one or two follicles at a time.

MICHAEL ELLIOT, MD, DERMATOLOGIST: It made everything else obsolete. And now we can transplant almost any area with the small grafts and have it look great.

PAT ANSON: Dermatologist Michael Elliot, who's been doing transplants since the early 70's, says the industry is seeing explosive growth.

MICHAEL ELLIOT, MD: There's been about a 500% increase in the number of people getting hair transplants in the last five years.

"You're going to feel some pressure."

PAT ANSON: A grafting procedure may take four or five hours, with the patient under local anesthesia. A strip of scalp is removed from the back of the head, then cut up into tiny grafts of hair.

DOCTOR: "I want to know if it hurts, okay? Let me know if you have any pain whatsoever."

PAT ANSON: Hundreds of slits are made in bald areas, and the grafts put in the slits.

Getting results takes time; about three months for the transplanted hair to start growing again. More than one procedure is usually necessary, and some patients have temporary swelling in the forehead or numbness in the scalp.

DOCTOR: "We took out a five-eighths of an inch."

PAT ANSON: For many, the biggest drawback is the price. Each procedure will cost several thousand dollars, and they're generally not covered by insurance.

The demand for transplants is growing so rapidly that all sorts of doctors are doing them, not just plastic surgeons. Dermatologists, pediatricians, even urologists are giving up their specialties to embark on new, more lucrative careers transplanting hair.

Much of the work is actually done by technicians, under the supervision of a doctor.

TOBY MAYER, MD, PLASTIC SURGEON: We see people who really aren't very well trained doing this. So someone spends $10,000, they get little clumps of hair in the front of their head.

PAT ANSON: Plastic surgeon Toby Mayer and his colleague, Richard Fleming, offer an alternative to grafting, a transplant technique called the flap.

RICHARD FLEMING, MD, PLASTIC SURGEON: We will take this flap from the side of the head. We will lift it up and rotate it into place like this, remove the corresponding amount of bald skin and stitch the flap at the hairline.

PAT ANSON: The flap is done in four surgical procedures over a period of weeks. Because it's never completely severed from the scalp, the flap doesn't lose its blood supply. As a result, patients heal faster and the hair never stops growing.

David Silverstein is a cantor at a Los Angeles synagogue. While still in his 20's, his hair was receding.

CANTOR DAVID SILVERSTEIN: Some men are very comfortable with more skin than hair, and I was not.

PAT ANSON: Silverstein had a flap done 13 years ago -- the only transplant he's ever needed.

CANTOR DAVID SILVERSTEIN: I actually had this done on a Monday, and I was back in the pulpit on a Friday night.

PAT ANSON: Silverstein's story is unique. Doctors say most patients should wait for a transplant until their 40's -- when hair loss begins to slow.

At too young an age, transplants can lead to a vicious cycle.

TOBY MAYER, MD: We have to educate them to let them know that your baldness will progress.

SET DIRECTOR: "I'm cutting across her, rise and come around center stage here."

PAT ANSON: At age 62, Jerry Douglas doesn't have to worry about his baldness progressing much further. In a business obsessed with looks, his hair has fooled some of Hollywood's keenest eyes.

JERRY DOUGLAS: And she's standing next to me and she said, "I gotta tell you, your piece looks fantastic." And I said to her, "It's not a piece, it's my real hair." And she almost fainted.

SHARYL ATTKISSON: Here with more information about how to treat and prevent baldness is Dr. Christopher Nanni, a dermatologist who's an expert on hair loss from George Washington University Medical Center in Washington, DC.

If somebody is looking for the right surgeon who is not going to leave him with that funny plug of hair in the front, how is he going to find him?

CHRISTOPHER NANNI, MD, GEORGE WASHINGTON UNIV MEDICAL CENTER: Well, certainly the best bet is to ask family or friends who they've had their hair transplantation with, but many times they're embarrassed and don't want to give you that information. So, another great resource would be the American Academy of Dermatology who can refer you to a board certified dermatologist in your neighborhood who can do this type of procedure. Plastic surgery referrals are also available through the American Academy of

SHARYL ATTKISSON: We have heard a lot about a pill that can prevent baldness. Tell us about that.

CHRISTOPHER NANNI, MD: Well, that's a pill that's just been recently FDA approved called Propecia. It's a pill for people who want to take something daily, orally, to help reverse hair loss. And it's basically a pill that works by blocking a hormone that causes male pattern baldness, testosterone.

SHARYL ATTKISSON: Is there a downside to that? It sounds simple.

CHRISTOPHER NANNI, MD: Well, there certainly is a downside. Approximately two percent or less of people that take this pill can have, report some sort of sexual dysfunction, either a decreased libido or impotence. But again, that's reversible once they stop taking the medicine, and it's a rare side effect.

SHARYL ATTKISSON: Well, so a lot of people would rather turn to a solution that we've heard a lot about, which is Rogaine. You rub it on the scalp. What's new with Rogaine?

CHRISTOPHER NANNI, MD: Well, Rogaine has come out with a maximum strength formula, which is very exciting because since the original research with Rogaine many, many years ago, it's been shown over and over again that the higher concentration is better at maintaining hair that you have already and also is better at producing the sort of mature, pigmented hairs that are cosmetically noticeable.

SHARYL ATTKISSON: And, in a word, not the same types or extent of the side effects as the pill.

CHRISTOPHER NANNI, MD: Right. The side effects are limited to topical problems.

SHARYL ATTKISSON: What about all of these products that you can buy just over-the-counter, some of them are rather expensive, or at the grocery store? It thickens your hair, extra body. Do these things, if you use them properly, really help prevent hair loss, make your hair healthier?

CHRISTOPHER NANNI, MD: Well, unlike Propecia or Monoxidil or Rogaine, these products don't reverse hair loss nor do they really help you to maintain hair that you have. What they do are basically cosmetic enhancement of your hair. They help your hair to look fuller and thicker, and they do that basically by stripping your hair of oils that can weigh it down.

SHARYL ATTKISSON: Short of turning to medicine, what's some brief advice you can give for people who want to just maintain a healthy head of hair while they have it, do the best thing to not go bald?

CHRISTOPHER NANNI, MD: Well, the old adage of exercise and eating right certainly holds true in this case. If you don't have time to eat a good diet, a multivitamin is certainly helpful. Decreasing stress in your life is a great way to prevent hair loss, because stress produces a lot of hormones that can cause you to go bald. Smoking, stopping smoking is wonderful because smoking decreases the blood supply to your scalp, and that can really be damaging. And lastly, people should remember that the

SHARYL ATTKISSON: Great advice. Thanks, Dr. Christopher Nanni.


SHARYL ATTKISSON: If you'd like more information on hair loss or any other HealthWeek story, you can call our toll-free number shown at the end of the program.


WOMAN: "I've heard that there's no difference between sunscreens that are 15 versus 45. Is there any difference between them? Or do you reach a certain level where it just doesn't really matter?"

DR. BRUCE DAN: Actually, there's not a whole lot of difference between SPF 15 and 45 sunscreens.

SPF stands for Sun Protection Factor, a rough guide to the strength of your sunscreen. For example, an SPF 2 sunscreen blocks half the sun's rays, while the SPF 15 blocks 93 percent. An SPF 45 product blocks 98 percent of the sun's rays, but that's not much more than SPF 15.

So unless you're at high risk for skin cancer or burn easily, SPF 15 is fine. Apply every two hours, starting before you go outside.

If you're going swimming, or playing sports that make you sweat, you may want to pack a waterproof sunblock and reapply it more frequently.

Finally, beware of mixing bug spray with your sunscreen. A recent study found that some insect repellents containing the chemical DEET cut the effectiveness of sunscreens by one third.

With "Ask the Doctor," I'm Dr. Bruce Dan.

SHARYL ATTKISSON: Most families have something special passed down through the generations, like a hand-made quilt or maybe a treasured book. But there's a family in Maryland that's living with a much more difficult legacy: a gene for a disabling disease that's unique to them. HealthWeek's Jim Slade reports on their search for a cure.

JIM SLADE: Andrew Mattingly Jackson is an enigma. He and his family harbor a mysterious genetic disease that his grandmother called "creeping paralysis."

Doctors don't know what the disease is for certain, they have seen it only in the Mattingly family, but it has been chasing Andy most of his adult life.

ANDREW MATTINGLY JACKSON: "It just really came about, oh, when I was about 20 years of age I noticed some difficulty there in walking."

JIM SLADE: An amateur genealogist, Andy has traced the Mattingly disease back to the 1820's. The physical symptoms have shown up in half the family members. The illness is more severe in men than in women.

Andy's sons Butch and Drew work together in their lock and key shop in suburban Baltimore. Drew doesn't have the disease, Butch does.

The mystery landed on the doorstep of the Johns Hopkins School of Medicine in 1992 when two family members unbeknownst to each other came to consult two separate doctors.

The doctors were intrigued by the mysterious ailment and determined to get to the root of it. They organized a Mattingly family reunion. More than 140 members of the clan came for the event during which the doctors took histories and drew blood.

Now the search has gone to the cellular level. Doctors know what the problem looks like. Here it is: a microscopic examination of spinal cord tissue shows that wide fields of nerve cells are missing.

BRUCE RABIN, MD, JOHNS HOPKINS MEDICAL INSTITUTIONS: "Those motor nerve cells are responsible for motor strength and for muscle tone. So as Andy and his family exhibit, they've lost muscle bulk and they're very weak."

JIM SLADE: Researchers have traced the genetic cause of the disease to a specific location on family members' chromosomes, narrowing the search to about 100 of a possible 100,000 genes.

DAVID CORNBLATH, MD, JOHNS HOPKINS MEDICAL INSTITUTIONS: "Once we know the gene that's abnormal, we have two very important choices. We can begin to think about gene therapies for individual members of the family, and we can begin to think of strategies where we might actually bypass the gene."

JIM SLADE: It's probable that the study of this mysterious disease will lead to new medical techniques that will benefit others with similar afflictions. As it turns out, Andy's lonely search for help may eventually reach millions.

SHARYL ATTKISSON: And that's all for now. Next time on HealthWeek, thinking of going vegetarian? We'll look at whether meat-free eating is really better for your health. We'll also show you why more and more younger people are turning to hip replacements and see why one medical school thinks fine art may make for fine doctors.

Until then, I'm Sharyl Attkisson. Be well!

ANNOUNCER: For general information about stories in this edition of HealthWeek, please call 1-888-562-8300. Or write to the address on your screen:> HealthWeek, Maryland Public Television, 11767 Owings Mills Blvd, Owings Mills, MD 21117.

Funding for HealthWeek is provided by the Howard Heinz Endowment and the Teresa and H. John Heinz III Foundation.

To order a video or a printed transcript of this program, call 1-800-338-8440. Please ask for the program number on your screen. Program #204.

Back to HEALTHWEEK Main Page

Doctor's Corner | Trends in the News | Healthful Hints |
Show Schedule | Order a Video | Subject Archive

HEALTHWEEK Online is a joint production of:
The Washington Post Company
Maryland Public Television

Back to the top