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HealthWeek No. 203

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

DOCTOR: "Ben, you're going to get a little boo-boo."

SHARYL ATTKISSON: Should it be required for every child?

Dealing with the final days of life.

GWEN COOKE: "We're used to having an illness and getting better. And that's not going to happen with me."

SHARYL ATTKISSON: Find out how Oregon's new doctor-assisted suicide law is affecting end-of-life care.

And it's not your usual high-school science experiment. Meet the teens who are finding genes.


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

It's not easy for women to figure out the best way to stay healthy during and after menopause. Many choose traditional hormone-replacement therapy, which helps to strengthen bones and protect the heart. But there's a catch: over the long-term, it can also increase the risk of breast cancer. In our Behind the Headlines segment, we look at findings out this week that show a new drug, designed to mimic the hormone estrogen, may be a way around that dilemma. HealthWeek's Marcia Brazda reports.

MARCIA BRAZDA: As an OB-GYN, Dr. Karen Perkins sees patients nearly every day who are trying to decide what if any medication they should take to deal with the effects of menopause.

KAREN PERKINS, MD, MERCY MEDICAL CENTER, BALTIMORE: I think it is very confusing. I think there is so much information out there for patients to have to sort through, that they're going to need some help in trying to find the best possible management for them.

MARCIA BRAZDA: One of the newest options is the drug Raloxifene, also known as Evista, which was recently approved by the FDA to prevent osteoporosis.

Now a new study, funded by the drug's manufacturer, finds it may also guard against heart disease. Researchers at Boston's Brigham and Women's Hospital looked at Raloxifene's effects on cholesterol and other risk factors for heart disease. They found the drug lowered levels of LDL, or bad cholesterol, by 12%. That's about the same as the 14% drop produced by traditional hormone replacement therapy.

BRIAN WALSH, MD, BRIGHAM AND WOMEN'S HOSPITAL: We know that LDL cholesterol is a well-known risk factor for heart disease, that for every percent you can lower LDL cholesterol, you can lower heart disease rates by one-and-a-half percent.

MARCIA BRAZDA: But unlike estrogen-replacement therapy, Raloxifene failed to boost levels of HDL, or good cholesterol. Critics say, as a result, they need to see more evidence.

JACQUES ROSSOUW, MD, NATIONAL HEART, LUNG AND BLOOD INSTITUTE: Simply on what we have at the present, we can't say it's a better choice than estrogen.

MARCIA BRAZDA: But more data is on the way. Another study, to be released at a medical meeting next week, looks at Raloxifene's effect on breast cancer. It finds the drug cuts the risk in post-menopausal women by nearly two-thirds. That's likely to be welcome news to women worried about the increased risk of breast cancer associated with estrogen.

BRIAN WALSH, MD: There are very few treatments that could reduce the risk of breast cancer. And I believe that if Raloxifene is able to prevent against breast cancer, it'll have very widespread use.

MARCIA BRAZDA: But for now, women and their doctors still must find their way through a maze of choices that are far from ideal.

SHARYL ATTKISSON: One of the many reasons that we offer it is to show an expression of our confidence in the procedure.

SALLY SQUIRES, THE WASHINGTON POST: Well, that's the disappointing news with this drug. It does not help hot flashes at all. Although of course we know it is good at building bone and it does help with these heart effects. So that's good, but you can't look for it to help your hot flashes.

SHARYL ATTKISSON: When we're talking about the promise that it holds and the risk of breast cancer and preventing that, we don't want it to be confused with a similar sounding drug, Tamoxifen, which has also been in the news in recent weeks, because it can help in the breast cancer area.

SALLY SQUIRES: That's right. And they are confusing because they sound very much alike and they are actually related to each other. But the difference is that Tamoxifen is a breast cancer fighting and prevention drug, while Raloxifene is for building bones, and it looks like it may also have some effects against breast cancer, but it's really a menopause drug.

SHARYL ATTKISSON: All right. What else is in the pipeline down the road? Any other new drugs?

SALLY SQUIRES: Yes, and we're going to see more of what scientists are calling these designer estrogens, which means that they're designed to go to specific parts of the body. Instead of working throughout the body, they'll hit just the areas that a particular woman may need, and they won't have the bad side effects.

SHARYL ATTKISSON: Do you think that down the road then that we will find a more perfect designer estrogen, where women won't have to weigh all of these terrible risks and decide what's best for them? They will just have a simple choice?

SALLY SQUIRES: Yes, I don't think perfection is there yet, but I think there are going to be a lot more choices for women who haven't been able to take estrogen. And I also think there's a cautionary note. We need to remember that estrogen therapy has worked for many, many women for many years, and it's still of great use.

SHARYL ATTKISSON: Well, thanks for helping us understand the confusing information, Sally Squires.



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

If you're like most people, you probably haven't kept track of how long you've been using your toothbrush. But it's a good idea to get a new one every three months.

That can be a challenge, especially if you can't stand having to pick a replacement from the dozens on drugstore shelves. So here are a few tips: First, look for a brush with the American Dental Association seal of approval. That means it's been tested and its claims are accurate. Choose a brush with soft bristles that are rounded on the ends. Hard bristles can damage your gums. Some people find that brushes with curved handles are easier to use, though they haven't been proven any more effective.


SHARYL ATTKISSON: Last fall, Oregon became the first state in the nation to legalize doctor-assisted suicide. Despite predictions there would be a rash of suicides, so far, there have been only a few reports of doctors actually helping people kill themselves. But HealthWeek's Andrew Holtz found out, the law is having a big impact in some unexpected ways.

ANDREW HOLTZ: Gwen Cooke sometimes thinks back on her days as an actress.

GWEN COOKE: And it's easily the best time I ever had in theater.

ANDREW HOLTZ: She left the profession, but not long ago, Gwen contacted an agent to plan a return to the stage. Then she got sick.

GWEN COOKE: I sort of got the agent on one day, and got the diagnosis the next.

ANDREW HOLTZ: Gwen was diagnosed with cancer, a cancer that cannot be cured.

GWEN COOKE: We're used to having an illness and getting better, and that's not going to happen with me.

ANDREW HOLTZ: As an Oregonian, Gwen has the right to ask a physician to help end her life. But she's not doing that, in part because of the care she gets from hospice workers who visit her at home.

GWEN COOKE: I never thought that I would be able to do what you suggested, and that is live day by day. I never thought that I would achieve that. I really didn't. I do now.

ANDREW HOLTZ: hile in most places it's common for patients to ultimately die in a hospital, surrounded by medical technology, not so in Oregon. In fact, in Portland, 4 out of 5 Medicare patients die at home, in a hospice, or somewhere else outside of an acute care hospital.

SUSAN TOLLE, MD, OREGON HEALTH SCIENCES UNIVERSITY: We're doing a better job than most other sates, by most measures: more hospice, more respect for refusal of treatment, more people who want to die at home getting to die at home.

ANDREW HOLTZ: The hospice movement has a long history in Oregon. Yet people on the front lines say the assisted-suicide debate has boosted awareness of hospice care and increased demand for it.

MARIE MANN, RN, LEGACY VISITING NURSE ASSOCIATION: Our referrals are up considerably from 10 years ago, so the word is out there.

ANDREW HOLTZ: Marie Mann, a hospice nurse, visits Gwen regularly to tend to her physical needs...

MARIE MANN, RN: "I'm going to order more of that, Gwen."

ANDREW HOLTZ: ...and to her emotional condition.

MARSHALL BEDDER, MD, PROVIDENCE/ST. VINCENT MEDICAL CENTER: Certainly, because of the whole issue of physician-assisted suicide, I believe physicians have been more willing to prescribe higher doses to treat patients more effectively.

ANDREW HOLTZ: Because underlying the voters' approval of physician-assisted suicide was an insistence that the healthcare profession do more, more pain relief, more hospice, more caring for patients in their final days.

At this hospital, a supportive care team offers physical, psychological and spiritual support to patients like Orville Garrison.

ORVILLE GARRISON: I see them quite frequently, in fact depend on their coming in, it's a happy type of thing.

ANDREW HOLTZ: But even the best end-of-life care won't eliminate requests for assisted suicide, according to Dr. Peter Goodwin, who campaigned for Oregon's new law. He says it gives patients a greater sense of control over their final days.

PETER GOODWIN, MD, COMPASSION IN DYING: And for only a few will it be the ultimate "out," the ultimate way of ending their lives, but for so many more it will be such a source of reassurance.

ANDREW HOLTZ: Gwen says her reassurance comes from knowing Marie and others are helping tend to all her final needs. Yet, there is still sadness, too.

GWEN COOKE: And I cry sometimes, you know? I mean, I think it's too soon.

SHARYL ATTKISSON: As we've heard, good hospice care goes far beyond easing a patient's physical pain. Here with some advice on finding the best care is David Schneider of the National Hospice Organization.

DAVID SCHNEIDER, NATIONAL HOSPICE ORGANIZATION: The good thing to remember is that 90% of hospice patients receive care in their own home by a team of hospice professionals. Only 10% receive care in an in-patient facility.

To get more information about hospice care, a good first step is for you and your loved one to have a conversation with your physician. Clergy can also be a good source of information on end-of-life decisions. You can also contact the National Hospice Organization in Arlington, Virginia for a list of hospice services and programs that provide care in your area.

Some hospices have specialized programs of care for patients with AIDS, for patients with Alzheimer's. You can check with your hospice program to see if they have such a specialized program of care.

Another good question to ask a hospice program is what is their patient-to-staff ratio. The best hospice programs will assign no more than 12 patients per hospice team.

For patients over the age of 65, Medicare covers the cost of hospice services. Other government funds are available for low income individuals, and hospice care is covered by most insurance programs.

Remember that if you're not happy with the services, speak up. A good hospice program will want to hear your concerns.

SHARYL ATTKISSON: For more information on choosing a hospice or any other HealthWeek story, you can call our toll-free number shown at the end of the program.


MAN: "I'm interested in learning what I can do that is not stressful on ankles and knees."

BRUCE DAN, MD: You may not be able to play football or run marathons. But there are many other things you can do to stay in shape if you have painful knees or ankles.

One of the best is swimming. Thanks to water's buoyancy, you can strengthen muscles and burn calories without putting a lot of strain on your joints. Other "non-weight bearing" activities include rowing and bicycling. If you take up biking, adjust your seat so your knee is only slightly bent when the pedal is farthest away from the seat. And stick with the lower gears because they put less pressure on your knees.

As for jogging, it's definitely more stressful on your knees than things like walking. But if your knees don't hurt when you jog, you can probably continue if you take a few precautions. Make sure your shoes have plenty of cushioning. And switch to jogging on dirt or grass. They're much better shock absorbers than hard old concrete.

But the most important thing to remember is to keep on moving. Knee or ankle problems are no excuse to turn into a couch potato!

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


SHARYL ATTKISSON: Chickenpox is now the leading cause of vaccine-preventable deaths among children. That's in a report released this week by the Centers for Disease Control. While a chicken pox shot has been available since 1995, the CDC says many kids still aren't getting it. And that's prompted some health experts to call for tougher measures, like mandatory chickenpox vaccinations. But not all parents and doctors think that's a good idea. HealthWeek's Lauren Scott in Boston explains why.

LAUREN SCOTT: Chickenpox, for children, it's always been a right of passage. A week to ten days of itchy sores, fevers and sleepless nights. In most cases it's uncomfortable but not serious.

CODY MEISSNER, MD: "Can you sit up for me, Kia?"

LAUREN SCOTT: There can be complications, though. When 4-year-old Kia Rusconi developed the first signs of chickenpox, her mother wasn't too concerned. But within 48 hours, it was obvious Kia needed to see a doctor.

TAMMY RUSCONI: "She couldn't walk, everything that she drank or ate, she threw up, tired, actually she just laid on the couch all day. So I brought her to the hospital."

LAUREN SCOTT: Kia was admitted to the hospital and diagnosed with an infection from so-called "flesh eating bacteria."

CODY MEISSNER, MD, NEW ENGLAND MEDICAL CENTER: "This is a recognized association with chickenpox infections that can result in death in a relatively short period of time. The infection sometimes does not respond to antibiotics such as penicillin, which is the drug of choice for most streptococcal infections, and the infection often requires surgery.

TAMMY RUSCONI: I was terrified, I was terrified. I prayed. And it was a mother's nightmare, honest to God, it was a mother's nightmare.

LAUREN SCOTT: Kia underwent three operations before the infection was brought under control. Looking back, Tammy Rusconi regrets a decision made before Kia got so sick. She had heard about a new vaccine that protects against chickenpox. Tammy's two-year-old daughter got the vaccine and missed the chickenpox, but Kia fell through a crack in the family's insurance and did not receive the shot.

TAMMY RUSCONI: " If I had ever known what I know today, I would have paid it out of my own pocket.

LAUREN SCOTT: Approved by the FDA several years ago, the chickenpox vaccine is recommended for all healthy children age 12-18 months, and for adolescents and adults who've never had the chickenpox.

And now, a number of states are pushing for the chickenpox vaccine to be added to the list of shots all kids must have to enter school.

CODY MEISSNER, MD: "It's important that universal vaccination be mandated to reduce the complications, to reduce the number of hospitalizations, to reduce the number of life threatening illnesses that can occur as a complication of chickenpox."

LAUREN SCOTT: But even though the vaccine has proven safe and effective, it has not caught on as quickly as health professionals had hoped. Many parents are wary, and there's growing opposition to plans that would make the chickenpox vaccine mandatory.

DEBORAH BERMUDES, CITIZENS FOR VACCINATION CHOICE: "We're going to be meeting with some other legislators in the coming weeks."

LAUREN SCOTT: Deborah Bermudes is a parent and an activist. She would like her 3-year-old daughter to catch chickenpox the old-fashioned way and believes parents should have a choice about vaccinating their children against a usually mild disease.

DEBORAH BERMUDES: We're not mandating that people eat healthy foods, we're not mandating that people don't drink alcohol and drive, we're not mandating, you know, whatever it is. We can't mandate everything in someone's life. And given the absence of any kind of true public health emergency around chickenpox, we need to be able to keep that choice.

LAUREN SCOTT: Dr. Roger Spingarn is a pediatrician who supports mandatory vaccination, but not for chickenpox. He worries that immunity conferred by the vaccine could eventually wear off.

ROGER SPINGARN, MD, PEDIATRICIAN:"Those children are susceptible when they're adults. They may in fact get much worse disease than they would have gotten as children."

LAUREN SCOTT:Most pediatricians disagree with Dr. Spingarn.

CODY MEISSNER, MD: "There have been studies in Japan that have followed vaccinated children for more than 20 years now, and there's been no clinically significant loss of immunity in those individuals who have been followed over two decades."

LAUREN SCOTT: Still, no one knows whether immunized children may eventually require a booster shot to protect them beyond twenty years. Given the uncertainty, many parents wonder what to do. Tammy Rusconi does not.

TAMMY RUSCONI: "If parents only knew about things like this that can happen, you know, then I think every parent would get their child vaccinated."

SHARYL ATTKISSON: Here now with more on the chickenpox shot and other childhood immunizations is Doctor Regina Rabinovich, a vaccine expert with the National Institutes of Health.

We heard in the story that most pediatricians think that children should get this shot, so why aren't more parents getting this for their kids?

REGINA RABINOVICH, MD, NATIONAL INSTITUTES OF HEALTH: I don't think it really depends on the parents. We've learned through studies to try to understand why children aren't receiving the vaccine that many pediatricians and other physicians are being somewhat cautious about a new vaccine that they may not fully understand. Often they don't know the rate of complications of chickenpox, which looks like a minor childhood disease. Those that really studied the data know that it's an important disease to pr

SHARYL ATTKISSON: There's another controversy emerging when it comes to vaccinations for children. Some researchers think that vaccines might have something to do with a rise in childhood diabetes. What about that?

REGINA RABINOVICH, MD: Yes, that has received some press recently and caused a lot of concern in parents of diabetics as well as parents with newborn children. This data has been looked at. It is a relatively limited literature, and unfortunately it has certain flaws and draws conclusions that overreach the data. So I think right now physicians can be very comfortable in recommending vaccines, not thinking that it's going to cause diabetes.

SHARYL ATTKISSON: Also on the subject of infectious diseases, there's a new study out in The New England Journal of Medicine on a flu vaccine delivered through a nasal spray. Does that seem like that's promising?

REGINA RABINOVICH, MD: I think that's very promising. The results were just published this week. It is a trial that showed very high efficacy. It worked very well in children from 12 months of age to 5 years of age. And it's very easily accepted by the children because it is a spray rather than an injection.

SHARYL ATTKISSON: Any idea when that might be available?

REGINA RABINOVICH, MD: Well, those studies are still ongoing. The company that's produced it, Aviron, has not presented it to FDA for licensure. So it will be at least one more year before it is available.

SHARYL ATTKISSON: Speaking of vaccines that are more acceptable to children, we've been hearing some about edible vaccines. Is that in our future?

REGINA RABINOVICH, MD: Well, the first human study was published recently, and the subjects, a limited number of subjects, ate raw potato that was cubed up, and the results were very interesting, actually. It showed that the subjects did respond to the vaccine. It was a E-coli vaccine. So it's very promising, but it's very early. There's a lot that's going to need to be known about giving vaccines through foods.

SHARYL ATTKISSON: Dr. Regina Rabinovich, thanks so much.


DENISE AUSTIN: Hi. I'm Denise Austin, and it's time for a fitness break.

Want to know one of my favorite pieces of exercise equipment? A chair that's right a chair, and everybody has one. Here are two great exercises that you can do with the use of your chair.

The first one is to firm the bottom half our hips, thighs and buttocks. All you have to do is tap the chair and come back up. This is a great way to firm the back of your thighs and get a great rear view. Just do this about a minute each day and you should see results in about six weeks.

Okay, now let's firm up those arms no more underarm sag. Let me show you a great triceps exercise. This will firm the back of your arms, the triceps, one of the best exercises to do to firm those arms. So all these exercises, and all you need is a chair.

Remember, get fit, because you are worth it. I'm Denise Austin.


SHARYL ATTKISSON: This week, a Maryland company stirred up excitement when it announced plans to compete with the government in the race to find all the genes in the human body. The firm estimates it can get the job done by 2001, four years sooner than the government, and at one-tenth the price. But don't count out the government-funded researchers just yet. As HealthWeek's Jim Slade discovered, their Human Genome Project may have a secret weapon.

"All right, are we ready to go? Does anybody have any questions?"

JIM SLADE: Early morning in a biology lab at Sacred Heart Academy, Hamden, Connecticut.

"Do you need DNA?"

JIM SLADE: It's a holiday, but the place is buzzing with excitement.

Invited by a Yale University geneticist and a nun who believed teenagers could make a contribution, students and teachers have come to learn about the Human Genome Project.

These talented high school students have joined a vast army of scientists working around the world to understand the genetic code that makes us who we are. Because the code is so large and their army is so small, there are years of work ahead.

Here's what they are up against: Each cell in our body has a nucleus which contains chromosomes. Coiled tightly within each chromosome is the genetic material DNA. DNA is a pair of spiral threads composed of millions of molecules, called nucleotides. The order in which these molecules run on the thread is our genetic code.

"Okay, so what's happening now, the DNA is coming unwound."

JIM SLADE: These students are actually learning to sequence, or sort out, that code. It's a complex process in which each drop of DNA is iced, mixed with a priming solution, and injected into a box which separates the molecules so that the gene's code sequence can be read. Finally, the sequence is sent to an Internet site for identification.

WESLEY BOND, PhD, YALE UNIVERSITY: It's quite conceivable that kids are going to stumble across genes that no one else has found.

JIM SLADE: The students have proven to be willing and very enthusiastic.

SISTER MARY JANE PAOLELLA, SACRED HEART ACADEMY: In all of my years of teaching, kids get very excited about experiments, but not enough to come on a Saturday or stay after school or be in school until late at night.

STUDENT: It really gave me a better understanding about DNA

STUDENT: I mean, finding something that no one else has ever found before, that would be very exciting.

JIM SLADE: And with 95% of the human genome yet to be identified, there's plenty of work ahead.

WESLEY BOND, PhD: It's real discovery here. So for kids who are really interested in science and want to discover something, have at it, just start digging.

SHARYL ATTKISSON: And that's all for this week. Until next time, I'm Sharyl Attkisson. Be well!

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