By Maggie Fox

The Supreme Court upheld President Barack Obama’s health reform law on Thursday, with conservative Chief Justice John Roberts making up the surprise swing vote and writing out a road map for making the law work.

It is of course a big victory for the Obama administration. But it’s not the end of the story, not by a long shot. Even if everything goes smoothly, many important provisions don’t go into effect until 2014 and later. And Republicans, from presidential hopeful Mitt Romney through to members of Congress and governors of close to half the states, renewed their promised on Thursday to fight tooth and nail to either repeal the law or at least chip away at it.

"Today's decision makes one thing clear: Congress must act to repeal this misguided law,” Senate Minority Leader Mitch McConnell, a Kentucky Republican, said Thursday.

More than half the states have been gambling that the law would be struck down and have done little or nothing to put into effect one of the law’s main provisions – the exchanges, where people are supposed to be able to go online and get enough good information to choose a health insurance policy. They’re scheduled to be up and running by 2014. The Health and Human Services Department says 34 states have taken money to set up exchanges.

And HHS hasn’t finished making all the rules clear for how to put the full law into effect, and doesn’t have all the money and staff it needs to do that work. The November elections will be very important for determining whether Congress helps or hinders this effort.

Plenty of provisions look set to move ahead. They include changes meant to make doctors provide more effective care. Starting in 2015, doctors will get paid for keeping patients well, not necessarily for every test or procedure. That means, in theory, that a doctor will get paid the same by Medicare or Medicaid whether she gets a patient’s blood pressure down by prescribing drugs or by persuading him to lose weight and exercise.

Accountable Care Organizations will also continue to be created. These new organizations are meant to encourage cooperation by grouping independent care providers such as doctors with hospitals. And the trend toward consolidation is likely to continue no matter what happens with the health reform law – something that, in theory, will make it easier to connect patients with specialists, for instance.

Rules that stop insurers from what the government considers abusive practices also stay in place. “Insurance companies can no longer impose lifetime limits on the amount of care you receive. They can no longer discriminate against children with preexisting conditions,” Obama said in Thursday in response to the ruling. “They can no longer drop your coverage if you get sick. They can no longer jack up your premiums without reason. They are required to provide free preventive care like check-ups and mammograms -- a provision that's already helped 54 million Americans with private insurance,” Obama added.

“And by this August, nearly 13 million of you will receive a rebate from your insurance company because it spent too much on things like administrative costs and CEO bonuses, and not enough on your health care.” The Health and Human Services Department checks insurance plans to make sure they spend at least 80 percent of premiums on direct health care.

Small businesses will still get tax credits to help pay for health insurance for workers and people who retired at age 55 can get special insurance to hold them until they turn 65 and become eligible for Medicare.

Poll: Do you agree with the Supreme Court ruling on health care?

The controversial requirement that insurers and employers pay for all contraceptive care free of charge to women will also stand.

One group has an uncertain future – poor people without children. The Supreme Court ruling struck down the requirement that states expand Medicaid to about 16 million people who make less than 133 percent of the federal poverty level, or about $30,700 for a family of four. Many states currently offer Medicaid mostly to pregnant women and children, but poor adults are often not eligible. The health care law did require states to broaden that and the federal government was going to pay for almost all of it starting in 2014 and would pay more than 90 percent through 2022.

The ruling says states can’t be forced to do this, and now it’s not clear which states might decide not to.

 More on health care ruling:

Supreme Court upholds health care law

Thrilled and relieved, sick patients cheer court ruling

Health reform is legal, but is it moral? Bioethicist weighs in

The decision by the Supreme Court to uphold the constitutionality of nearly all of President Barack Obama’s health reform plan is ethically very good news. Excluding tens of millions of Americans who had no access to health insurance because they could not afford it or because no one would insure them because they were too sick has long been the single greatest ethical failure of American health care.

The Supreme Court has now affirmed, admittedly on purely legal grounds, that imposing a mandate on each of us to pay for health insurance for all of us can happen. But Obama and the administration cannot become complacent. They still have a huge challenge before them — selling the American people on the morality of insuring access to every American to health care by mandating that we all pay.

Critics of the Affordable Care Act have convinced America that the Obama plan stinks. The government mandate was their best bogeyman in stirring distrust of health reform. They had placed all their chips on a "shock and awe" strategy of having the Supreme Court blow away Obamacare’s mandate in one gigantic negative decision. That did not happen. 

The critics will now shift gears and start to fight a guerilla war to chip away at the plan. They will complain about cost, government meddling in the doctor-patient relationship and reopen talk of death panels. The only way to meet these criticisms is for the administration and its allies to do what they still have not done — convince the American people, not of the legality of health reform as happened today but of its morality.

Poll: Do you agree with the Supreme Court ruling on health care law?

The moral case involves three key arguments. First every American deserves equality of opportunity.  The only way to ensure that is to ensure access to basic health care. Just as is true of food and education, you need access to basic health care to compete and flourish in a free market.

Second, no one should go without health care just because they are sick. Excluding people because of pre-existing medical problems is simply immoral.

And lastly if we are a truly a nation, then we have to act like one and bring everyone into access to basic health care by all being willing to pay something for it. Individual rights dominate our political rhetoric. What we need to hear from the President is more about our duties and obligations as citizens to one another.

The Supreme Court has now deemed health reform legal. It is now up to the president to make sure that Americans buy into the argument that it is moral.

Related news:

Supreme Court upholds health care law

Thrilled and relieved, sick patients cheer ruling

Tom Reel / San Antonio Express-News

Jerry Fielder, 64, of Universal City, Texas, is a cancer patient whose family was turned down by 16 different insurance companies because of pre-existing conditions before accessing coverage under the Affordable Care Act.

Jerry Fielder and Beth Ann Levendoski breathed separate sighs of relief Thursday -- one in Texas, the other in California -- on the news that the U.S. Supreme Court had largely upheld President Obama's signature health care law, preserving the guarantees that the seriously ill women will have health insurance. 

Fielder, a 64-year-old cancer patient from Universal City, Texas, and Levendoski, a 57-year-old San Diego woman with a history of complicated spinal surgeries, were among those with the most to lose from the long-awaited ruling on the Obama Administration’s Affordable Care Act: people with pre-existing health conditions.

"I am thrilled. I can't tell you what this means," said Levendoski, who is still recovering from two 10-hour surgeries in 2011 to correct spinal fractures and a compressed spinal cord, which left her virtually paralyzed. "I hardly slept all night."

On a 5 to 4 vote, the nation’s top court on Thursday upheld the provisions of the Affordable Care Act, including the controversial proposal that requires all Americans to have health insurance, or face financial penalties. The court interpreted the so-called "individual mandate" as a tax, however. 

"I was on pins and needles. I was dreading the results," said Fielder. "Then I was like, Oh my God, they upheld it? I can't believe it."

For Fielder, the ruling means she won’t have to count the months until Medicare kicks in next spring to continue treatment for lymphoma and a fist-sized malignant tumor in her abdomen. 

Fielder spent most of the past decade struggling to acquire and maintain health insurance after giving up employer-sponsored care when the family decided to start a small business. They assumed they'd be able to buy private insurance, but when Fielder and her husband, Charles, now 65, went looking for coverage, they were stunned to be turned down by 16 different providers because of his history of heart problems.

They paid $73,000 out of pocket for Charles' heart surgery in 2003, but then, in 2009, came Jerry’s diagnosis.

“You can pay for a broken leg, you can pay for a broken arm, but you cannot pay for cancer,” she said. 

Without insurance, Fielder received no treatment for months, growing sicker and weaker as the cancer spread. Only after she gained access to a stop-gap program through the ACA did Fielder get care that has slowed her disease and allowed her to return to work. Charles became old enough to qualify for Medicare last year. 

Fielder said she has met many families, including single mothers with young children, struggling to find coverage for existing illnesses.

Courtesy Beth Ann Levendoski

Beth Ann Levendoski, 57, of San Diego, is enrolled in a PCIP, a health insurance plan provided under the Affordable Care Act for people with pre-existing conditions.

"Everybody is just a blink away from needing insurance," Fielder said.

Between 36 million and 122 million adults under age 65 in the United States have a pre-existing health condition and as many as 17 million do not have health insurance, according to the Government Accountability Office. The estimates vary widely because of the type and number of ailments used to define pre-existing conditions in each of five estimates. In the lowest estimate, adults reported whether they had ever been told they had one or more of eight specific conditions. The highest estimate included any individual reporting a chronic condition in 2009.

Fielder and Levendoski are among more than 67,000 people nationwide who enrolled in Pre-existing Condition Insurance Plans, or PCIPs, which were created to provide insurance for people too sick to get coverage on the private market. Both women were among the first to join in October 2010.

The PCIPs are temporary programs aimed at bridging the insurance gap until 2014, when the health reform law requires insurers to accept all comers, including those with previously identified health issues.

Their support for Thursday's ruling was largely echoed by a poll conducted by Truth On Call for msnbc.com, which found that nearly 64 percent of family care doctors queried thought that the high court's ruling was correct, while 36 percent disagreed. 

For Levendoski, being able to maintain her insurance coverage is the key to her future.

Poll: Do you agree with the health care ruling?

A former director of a nonprofit agency, she lost her insurance in 2004 after being laid off. She exhausted benefits through the state COBRA health benefits program and then learned that she couldn't get private insurance because of a history of kidney problems and the degenerative effects of childhood scoliosis, which required repeated surgeries. Her condition grew so dire, she suffered spinal fractures and a compressed spinal cord that left her unable to walk. 

She exhausted about $55,000 in savings paying for care out of pocket before the ACA was enacted. She eventually lost her home and had to declare bankruptcy because of the medical bills. Levendoski was able to buy insurance and resume her treatment in 2010 after enrolling in the PCIP.

The two surgeries last year helped relieve the paralysis in her legs, but left her with lasting, debilitating weakness in her arms. Unable to work now, she lives for free with her 80-year-old mother, which allows her to use state disability payments to cover the monthly premium of $467 for the PCIP program. 

Regaining strength in her arms and re-learning to walk mean Levendoski has a long road ahead, including another major surgery planned in just a few weeks. 

She was in an agony of anticipation most of this week. When the high court didn't rule on the law as expected Monday, Levedoski was in tears. On Thursday, as early reports appeared mixed, she was worried, then elated. 

"I am going to be so relieved," she said. 

More health reform coverage:

• Supreme Court upholds health care law
• Dems cheer high court as Romney leads GOP charge to repeal health law    
• Health care reform is legal, but is is moral? Bioethicist weighs in

By Rachael Rettner
MyHealthNewsDaily 

Standing and working for long hours during a mother's pregnancy may slow her baby's growth, a new study from The Netherlands suggests.

In the study, women who stood for long periods at work during pregnancy had babies whose heads were, on average, 1 centimeter (or 3 percent) smaller in circumference than those of the average baby at birth.

In addition, women who worked more than 25 hours a week had babies who weighed five to seven ounces less on average than babies born to women who worked less than 25 hours a week.

An analysis of the babies' growth showed these differences were present from the third trimester on, the researchers said.

However, working long hours and engaging in physically demanding work during pregnancy did not put women at risk for preterm birth or for having babies with a low birth weight (less than 5.5 pounds).

In addition, earlier studies have found women who work have fewer pregnancy complications than women who are unemployed, the researchers said.

The findings mean that, for women who want to work during pregnancy, "by all means keep working," said Dr. Jill Rabin, an obstetrician and gynecologist at the North Shore Long Island Jewish Medical Center in New Hyde Park, N.Y.

However, pregnant women should make sure include a combination of sitting, standing and walking in their work day, Rabin said. Sitting for prolonged periods may increase the risk of blood clots, and standing for prolonged periods may compromise blood flow to the baby, Rabin said. "That’s why you have to mix it up," she said.

Working in pregnancy
Previous studies have suggested long work hours may increase the risk of birth defects, premature birth, and low birth weight, but have not focused on fetal growth.

In the new study, researchers at the Erasmus Medical Center in the Netherlands analyzed the growth rates of babies from more than 4,600 mothers-to-be. During pregnancy, the growth was measured by ultrasound.

Halfway through pregnancy, women were asked about the conditions of their work environments, and the physical demands of their jobs, including whether their jobs required lifting, prolonged periods of standing or walking, night shift work or long working hours.

About 38 percent of women said they spent a long time standing at work, in jobs such as sales, childcare, and teaching. About 45 percent said they spent long periods walking at work, 6 percent said did heavy lifting, and 4 percent worked night shifts.

Long periods of standing was associated with slower rates of fetal growth, and with a smaller head size at birth. Working more than 25 hours per week also was also linked with fetal head circumference and growth, the researchers said.

There was no negative effect of working up to 36 weeks into pregnancy, the researchers found.

Future research
Because the study was conducted in The Netherlands, it's not clear whether the findings apply to other populations, said Dr. Jim Woods, chair of the Department of Obstetrics and Gynecology at the University of Rochester Medical Center.

The study also did not assess how happy women were in their jobs, or whether they experienced stress at work or at home. A healthy mental state can improve the health of the immune system, and may lead to better pregnancy outcomes, Woods said.

More:

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• 11 tips to lower stress
• Exercise during pregnancy is safe for moms and babies
• Baby's cells may transfer to mother during pregnancy
• Unplanned pregnancies common in women in their 20s
• Childbirth takes 2 hours long than 50 years ago

Federal Food and Drug Administration officials approved a new weight-loss pill Wednesday, giving the nod to Belviq used in combination with a reduced-calorie diet and exercise to combat obesity.

The Arena Pharmaceuticals drug, which also goes by the generic name lorcaserin, is one of three new potential weight-loss treatments the agency is considering and the first new weight-loss medication approved in 13 years. More than two-thirds of adult Americans are overweight or obese. 

"Obesity threatens the overall well-being of patients and is a major public health concern," said Dr. Janet Woodcock, the director of the FDA's Center for Drug Evaluation and Research.

Lorcaserin was initially rejected because of concerns about safety issues, particularly concerns about heart valve problems, but a panel this spring agreed that the drug from Arena in conjunction with the Japanese firm Eisai Inc. was now suitable for use. 

The drug works by activating a receptor in the brain that may help a person eat less and feel full after eating smaller amounts of food.

It is approved for use in obese adults with a body mass index or BMI of 30 or greater and in overweight adults with a BMI of 27 or greater if they have at least one weight-related condition such as high blood pressure, type 2 diabetes or high cholesterol. For example, a 5-foot-7 woman who weighed 192 pounds would have a BMI of 30.

The drug was tested in three randomized, placebo-controlled clinical trials involving nearly 8,000 obese and overweight patients, including those with and without type 2 diabetes. They were treated for 52 to 104 weeks. All participants agreed to diet and exercise regimens. Compared with use of a placebo, or sugar pill, patients treated with Belviq for up to one year lost an average of 3 percent to 3.7 percent of their body weight. 

Nearly half of patients without diabetes lost at least 5 percent of their body weight, compared with about a quarter of those who took placebos. In people with diabetes, about 38 percent treated with lorcaserin lost 5 percent of their body weight, compared with about 16 percent treated with placebos. 

The drug is recommended to be discontinued in patients who fail to lose 5 percent of body weight after 12 weeks of treatment because they appear to be unlikely to achieve "clinically meaningful" weight loss. 

Approving lorcaserin will offer big benefits to patients approaching the 30 BMI mark, which increases health risks and decreases the likelihood of future weight loss, said Dr. Jaime Ponce, the new president of the American Society for Metabolic & Bariatric Surgery. 

"I think this is great," he said. "Thirteen years without any other medical option."

Select patients treated in a program that includes diet, exercise and medication may be able to lose weight without resorting to surgery, he added.

Arena Pharmaceuticals will be required to conduct six post-marketing studies including a long-term trial to evaluate cardiovascular risks including heart attacks and stroke. 

Related stories: 

• Weight-loss surgery linked to higher risk of alcohol abuse
• Could weight-loss surgery help end diabetes?
• Desperate to qualify for weight-loss surgery, some pile on pounds

Mark Ralston/AFP - Getty Images, file

Lionfish may be lovely to look at, but the invasive, voracious fish are regarded as the scourge of the seas.

A federal plan to battle invasive lionfish by dishing them up on America’s dinner plates may have backfired with the news that the flamboyantly-finned creatures can harbor a potentially dangerous neurotoxin.  

Two years ago, officials with NOAA, the National Oceanic and Atmospheric Administration, launched a well-publicized campaign, complete with flashy pull-cards, a lionfish cookbook and a catchy slogan. As one newsletter put it, “If we can’t beat them, let’s eat them."

The effort was aimed at harnessing the power of the U.S. appetite to help battle the voracious fish that has spread far from its native Pacific waters to ravage the reef ecosystems of the U.S. Southeast and the Caribbean.

“Once stripped of its venomous spines, cleaned and filleted like any other fish, the lionfish becomes delectable seafood fare,” NOAA officials enthused.

But another government agency, the Food and Drug Administration, now frowns on the “Eat Lionfish” campaign after tests of nearly 200 lionfish show that more than a quarter exceed federal levels for a toxin that can cause ciguatera, a potentially dangerous fish food poisoning.

“We certainly don’t promote any campaign like that since we have found levels above our guidance,” said Alison Robertson, the FDA’s lead ciguatera researcher for the chemical hazards branch of the Gulf Coast Seafood laboratory. “It certainly wouldn’t be our recommendation at this time.”

Robertson said she and other FDA scientists decided to test the lionfish in the summer of 2010 after hearing about NOAA’s gustatory effort.

Of 194 fish tested, 42 percent showed detectable levels of ciguatoxin and 26 percent were above the FDA’s illness threshold of 0.1 parts per billion. 

That’s enough to potentially sicken a diner with the illness that causes not only typical food poisoning symptoms – diarrhea, vomiting and fatigue – but also neurological problems such as painfully tingling hands and feet, a feeling of having loose teeth, and, oddest of all, a reversed sense of temperature.

“Whatever I touched, if it was hot, it would feel cold. If it was cold, it felt hot,” ciguatera victim Pat Schroeder of Beaumont, Texas, told msnbc.com three years ago. “I couldn’t walk on the tile floor. It felt like it was burning me.”

At least 50,000 cases of ciguatera poisoning are reported worldwide each year, but the real figure may be 100 times higher, experts say. There are dozens of confirmed reports of ciguatera poisoning in the U.S. each year with more than 300 logged by the Centers for Disease Control and Prevention between 2005 and 2009, according to the agency’s database. There were 84 cases in 2007, for instance, including 29 people sickened at a single dinner party.

The link between lionfish and ciguatera is raised in an article in the latest issue of the Annals of Emergency Medicine.

The toxin that causes ciguatera is produced by microscopic sea plants, called dinoflagellates, which are eaten by small fish that are, in turn, eaten by larger fish such as snapper, grouper, sea bass and barracuda. The toxins become increasingly concentrated as they move up the food chain.

Because of that, ciguatera poisoning is usually caused by large reef fish such as amberjack. So far, none of the ciguatera cases confirmed in the U.S. has implicated lionfish, which makes some question the FDA’s caution.

“We have always known that all reef fish can have ciguatera fish poisoning,” said James Morris, a marine ecologist with the National Center for Coastal Ocean Science. “I was not surprised to hear that lionfish contain some toxin.”

The lionfish, dubbed “the Norwegian rats of the sea” by one scientist, are truly destructive, ruining the delicate habitat of every reef they overrun. They have invaded the coastal waters from North Carolina to the Bahamas, now outnumbering native species in some sites.

That’s reason enough to eat them, argues Michael Dimin, founder of Sea to Table, an organization that fosters relationships between fishermen and chefs.

“The best way to solve the lionfish problem is to sauté them,” he said.

No one wants to get ciguatera, but harvesting lionfish for the dinner table might be one way to preserve the ecosystem. As for the ciguatera risk, Dimin likened it to the risk of sticking yourself with your own dinner fork.

“The idea of trying to control the lionfish problem by eating them is a great one, and whatever small risk there is is outweighed by the benefit,” says Dimin, whose group co-sponsored the “Eat Lionfish” campaign.

Chef Barton Seaver, who has been described as an evangelist for sustainable seafood, says legitimate concerns about ciguatera should be balanced by responsible sourcing.

“Nobody wants to serve neurotoxins for dinner,” he said. “I would trust the supply chain.”

The volume of lionfish used in the U.S. totals hundreds, not thousands of pounds, and it’s expensive -- about $16 a pound compared with snapper, which is going for about $8.45.

Seaver says he likes to prepare lionfish in a nice ceviche, as part of a robust romesco sauce or stewed into a tasty curry.

Those dishes may sound delicious, but Robertson, the scientist at the FDA, isn’t convinced.

“Particularly in areas where we know ciguatoxin is present, people should not be eating lionfish," she said. "Just like they shouldn’t be eating grouper or other reef predators.”

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• Do your civic duty: Eat this fish!
• Nearly 400 now sick from tainted tuna in sushi
• Bizarre fish poisoning sparks alarm

Certain bone marrow donors could soon be compensated for their life-saving stem cells after federal officials declined to take the matter to the U.S. Supreme Court, allowing a lower court order to become law.

At least one agency, MoreMarrowDonors.org, hopes to begin a pilot program offering up to $3,000 in scholarships, housing vouchers or charity donations -- but not cash -- in exchange for matching donations of marrow cells derived from blood.

“This decision is a total game-changer,” said Jeff Rowes, a senior attorney with the Institute for Justice, which filed the lawsuit three years ago on behalf of cancer victims and others seeking bone marrow matches. “Any donor, any doctor, any patient across the country can use compensation in order to get bone marrow donors.”

That may be the effect of the decision by U.S. Attorney General Eric Holder to forgo a high court review of a 9^th U.S. Circuit Court of Appeals ruling that certain kinds of bone marrow donations are exempt from federal rules banning compensation.

Under the ruling, donors who provide marrow cells through a process similar to blood donation, called peripheral blood stem cell apheresis, can be compensated because those cells are no longer regarded as organs or organ parts as defined in the National Organ Transplant Act.

The ruling does not apply, however, to bone marrow obtained through traditional techniques that use a needle to aspirate the cells from the hip.

Although it applies only to nine states covered by the 9th Circuit Court, Rowes expects the effects to be felt nationwide. 

The move met with praise from Doreen Flynn, 36, of Lewiston, Maine, the lawsuit’s namesake and the single mother of three daughters with an incurable blood disorder called Fanconi anemia.

She and other plaintiffs had argued that incentives are the best way to broaden the pool of potential donors and to help ensure that those who are matched follow through with the process.

Woman challenges bone marrow donation law in effort to save daughters' lives

Flynn's oldest daughter, Jordan, 13, received a marrow transplant this spring while 7-year-old twins Jorja and Julia may need transplants in the future.

“I’m overwhelmed by the decision and I’m grateful to be part of this case,” said Flynn. “With two kids who still need to go through transplants, this victory means hope for the future. With compensation, that means there is less chance that a potential donor will back out when called upon, which is a very real concern.”

But officials with the National Marrow Donor Program, which maintains a registry of 10 million donors, said they were disappointed that Holder didn’t take the matter to the Supreme Court and worried that the ruling would confuse donors about the issue of compensation.

“Our policy has always been to operate a registry of all volunteers,” said Michael Boo, chief strategy officer with the NMDP and Be the Match. “We will not list donors that have been promised compensation.”

That policy is also adopted by the Health Resources and Services Administration, or HRSA, which regulates bone marrow transplants in the U.S.

Permitting compensated donors would limit the NMDP’s ability to cooperate with international registries in 35 countries, said David Bowman, a HRSA spokesman. About 40 percent of blood stem cell transplants facilitated by the program involve an international patient or donor, he added.

The NMDP also argues that compensation will limit treatment options, divert money from a wider range of patients and, perhaps, decrease the quality of donations. It could skew volunteers’ motivations, perhaps encouraging them to be less than frank when answering the questions vital to ensuring a match, critics have said. 

About 10,000 people need bone marrow transplants each year, but only about half receive them, according to the NDMP. The Institute for Justice estimates that about 3,000 die waiting for matches, but NDMP officials say there's no way to know that for sure because many factors affect a patient's death, not just the availability of matching marrow.

Not being listed on the NMDP registry could prove to be a blow to donors hoping to reach the widest range of potential patients, of course.

Rowes acknowledged that compensation could not begin immediately and that many details remain to be worked out.

“I’m not saying that we may not have to fight with HRSA and the registry in the future,” Rowes said. “But they are profoundly mistaken if they think they can use their authority as stewards of information that is the property of the American people to interfere with what the courts have said is the lawful use of that information. We’re not backing down.”

Related stories: 

• Cord blood donations surge as hospitals launch public collections
• 'GMA' host Robin Roberts battling blood disorder
• Real 'Benjamin Button?' Stem cells reverse aging in mice

By MyHealthNewsDaily.com staff

Stillbirths are more common among the heaviest and lightest fetuses, according to a new study from Canada.

Researchers found that 19 percent of all stillbirths occurred in fetuses whose weight put them in the lightest 10 percent of all fetuses of their age, with 6 percent of stillbirths occurring in the lightest 1 percent.

Fetuses among the heaviest 1 percent of those their age accounted for another 1 percent of all stillbirths.

“Extreme underweight and overweight states confer the highest risk of stillbirth," the researchers wrote.

Stillbirth  is commonly defined as death of a fetus after 23 weeks pregnancy and after the fetus weighs 500 grams (about 1.1 pounds); in this study, the researchers included fetal deaths that occurred after 20 weeks of pregnancy. The researchers collected data on all births in Ontario between 2002 and 2007 — a total of 767,016 live births and 4,697 stillbirths.

Problems with the placenta can result in a fetus being severely underweight, while fetuses are most at risk for being overweight  if the mother is obese or has diabetes, according to the researchers.

The researchers say their finding may help doctors assess when it might be appropriate to deliver a baby early, in cases where the chance of it surviving outside the womb might be higher than the chance surviving in the womb.

In the developed world, stillbirth s occur in 6 out of 1,000 births — a rate that is higher than the infant death rate from conditions such as sudden infant death syndrome or complications of premature birth, the researchers said.

The research was published yesterday (June 25) in the Journal of Perinatology.

Pass it on: Low or high fetal weight increases the risk of stillbirth.

Follow MyHealthNewsDaily on Twitter @ MyHealth_MHND. Find us onFacebook andGoogle+.

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By MyHealthNewsDaily.com staff

For some men, weight loss plays an important role in raising low testosterone levels, a new study finds.

In the study of overweight, middle-aged men with prediabetes, about half of those with low testosterone levels who attempted to lose weight by changing their lifestyle experienced an increase in their testosterone levels.

The findings suggest "doctors should first encourage overweight men with low testosterone levels to try to lose weight through diet and exercise, before resorting to testosterone therapy to raise their hormone levels," said study researcher Dr. Frances Hayes, a professor at St. Vincent’s University Hospital, Dublin.

Hayes and colleagues analyzed information from nearly 900 men with prediabetes — a condition in which blood sugar levels are abnormally high, but not high enough to be classified as Type 2 diabetes. The men's average age was 54.

The men were randomly assigned to receive one of three treatments: the diabetes drug metformin, an inactive placebo pill or lifestyle modifications, which consisted of exercising for 150 minutes a week and eating less fat and fewer calories. The researchers said they considered men to have low testosterone if their levels were below 300 nanograms per deciliter of blood.

Among the men assigned to change their lifestyle, about 20 percent had low testosterone levels at the study's start. After one year, that number fell to 11 percent.

Among those taking metformin, 24.8 percent had low testosterone at the beginning of the study, and 23.8 percent still had the condition a year later. For the placebo group, the rate fell from 25.6 percent to 24.6 percent during the study.

Men in the lifestyle modification group lost an average of about 17 pounds over the one-year study, and testosterone levels among men in this group increased 15 percent on average, the researchers said. (Men in the metformin group lost about 6 pounds.)

"Losing weight not only reduces the risk of prediabetic men progressing to diabetes but also appears to increase their body's production of testosterone," Hayes said.

The study was presented this week at the Endocrine Society’s annual Meeting in Houston.

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By MyHealthNewsDaily

The number of people who died of swine flu during the 2009 H1N1 pandemic may be about 15 times higher than originally calculated, according to a new study.

Researchers now estimate that 284,500 people worldwide died of infection from the H1N1 virus, commonly called the swine flu, between April 2009 and August 2010. At the time, 18,500 deaths had been laboratory-confirmed as being due to swine flu, according to the study from researchers at the Centers for Disease Control and Prevention (CDC). It was expected that the original number would be revised upward, the researchers said.

In estimating the true number of deaths, the researchers gave a range of 151,700 to 575,400.

Of the global swine flu deaths, the researchers estimated that 59 percent occurred in southeast Asia and in Africa, which together hold 38 percent of the world’s population.

The new numbers could be used “to improve the public health response during future pandemics in parts of the world that suffer more deaths, and to increase the public's awareness of the importance of influenza prevention,” said lead author Fatimah Dawood, a CDC epidemiologist.

Additionally, the researchers confirmed that swine flu  killed an unusually high number of young people compared with seasonal flu viruses — 80 percent of those who died were under 65 years old, they said.

The study is published online today (June 25) in the journal the Lancet.

The researchers used data on H1N1 deaths from 12 countries of differing national income levels in making their global estimates. They included data on lower respiratory tract infection mortality rates from the World Health Organization to assess health differences across countries.

The data included medical information on people who experienced flu symptoms, as well as those who died from the flu. In general, the numbers from higher income countries  were more accurate; the lack of accuracy in the data from low- and medium-income countries accounts for some of the wide variation in the estimate, according to the report.

For example, the estimated number of swine flu deaths in Mexico may be far too low, according to a comment by Dr. Cecile Viboud of the National Institutes of Health and Lone Simonsen of George Washington University, which was published along with the study in the journal.

"These results are likely to be refined as more studies from low-income and middle-income regions become available, particularly from China and India, where about a third of the world's population live but where little information is available about the burden of influenza,” Viboud said.

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Dole Fresh Vegetables has recalled 1,077 cases of bagged salads sold at Kroger and Wal-Mart stores in six states because of concerns about potential listeria contamination. 

No illnesses have been reported in association with the recall. The products carry a best-use date of June 19, 2012, and should have already been removed from retailers' shelves, but consumers should make sure they don't have the products at home. 

The products being recalled are Kroger Fresh Selections Greener Supreme coded N158 211B 1613 KR04 and UPC 11110 91039; Kroger Fresh Selections Leafy Romaine coded N158 111B KR11 and UPC 11110 91046 and Wal-Mart Marketside Leafy Romaine coded N158111B and UPC code 81131 02781.

The product code and use-by date are in the upper right-hand corner of the package; the UPC code is on the back of the package, below the bar code. The salads were distributed in Georgia, Kentucky, North Carolina, South Carolina, Tennessee and Virginia. 

The precautionary recall was initiated after a product in North Carolina tested positive for listeria, Dole officials said in a press release.

Listeria monocytogenes is a pathogen that can cause foodborne illness, particularly in pregnant women and adults with weakened immune systems. Symptoms of infection may include fever, muscle aches and stomach problems including nausea and diarrhea. 

Dole officials are cooperating with the federal Food and Drug Administration. This is the second time in three months that Dole has recalled bagged salad because of contamination concerns. On April 14, the company recalled 756 cases of Seven Lettuces Salad because of potential salmonella contamination.

Related stories on Vitals: 

• Bagged salad recalled for salmonella contamination

When Adrienne Reed was diagnosed with breast cancer in 2010, she didn't have much choice but to go ahead with the traditional double mastectomy and chemotherapy. When it came to reconstructing her breasts, though, the 39-year-old Seattle piano instructor went a different route.

"What I gleaned from my research was that all implants require changing — like tires — and general anesthesia and probably three surgeries would be required," she says. "I was looking for something more natural and less traumatic."

Reed found it with a technique known as Brava/AFT (autologous fat transfer), a unique method for both breast augmentation and reconstruction featured in the May issue of Plastic and Reconstructive Surgery, the official journal of the American Society for Plastic Surgeons (ASPS).

The six-year study, which focused on breast augmentation only, presented results of Brava/AFT on 81 patients. According to its conclusion, the method "led to significantly larger breast augmentations, with more fat graft placement, higher graft survival rates and minimal graft necrosis or complications."

This is big news in the world of breasts for a couple of different reasons. First, breast enlargement via fat transfer or fat grafting was essentially banned by the ASPS 25 years ago.

"It was beyond controversial," says Dr. Roger Khouri, a Miami plastic surgeon and lead author of the study. "In 1987, they issued a very strong statement that said fat grafting was not recommended for anybody" due to minimal results, unpredictable results and the inability of radiologists to distinguish fat nodules from cancer.    

Since then, however, the new research suggests Khouri and others have ironed out the bugs, creating a new way to augment breasts.

More than that, they've created a third option for women who've undergone mastectomy, particularly women like Reed, who want breasts, but prefer not to go through another major surgery and/or deal with implants.

In a nutshell, cancer survivors are now able to "grow" new girls.

Reconstruction zone
A far cry from your average "boob job," the most common type of breast reconstruction involves tissue expanders which are surgically placed behind the patient's chest wall, then slowly filled with saline over a period of weeks. Once  the skin and muscle are adequately stretched, the devices are surgically swapped for either saline or silicone implants.

Not all women are candidates for this method, though, which is where "flaps" come in. In these procedures, skin, muscle, fat and sometimes blood vessels are nipped from one part of the body and tucked into the breast area, creating a fleshy pocket. That pocket is then filled with the patient's own tissue or fitted with an implant. Tram flaps and DIEP flaps harvest from the stomach; lat flaps from the back and "free flaps" from areas like the inner thigh or buttocks.

In Brava/AFT, however, the patient's fat is harvested with liposuction as opposed to a scalpel, then injected into the breast area. But not before the area's been prepped with an external tissue expander known as the Brava, a suction-pump bra that looks like something you might find in Madonna's costume closet.

"It's definitely a cumbersome device and patients have to be willing to commit to it," says Dr. Frank Isik, a Seattle plastic surgeon who's currently doing a clinical trial on Brava/AFT. "Some patients look at it and say, 'This is not for me.'"

Others, like Reed, eagerly embrace a reconstruction method that requires far less surgery and involves far less recovery time, despite the burden of wearing a "Brunhilda bra" 12 hours a day for six or more weeks.

"The first time I put it on, I was too embarrassed to go out," says Reed of the device that she wore -- usually to bed -- before and after each of her three AFT procedures. "I'm 5'2" and it's like a size EEE bra. But that's not what it's about. I kept my eye on the prize."

Bumps and benefits
Khouri, lead author of the study and creator of the Brava, readily admits his device -- originally developed and FDA-approved for breast augmentation alone -- looks and sounds a bit laughable.

"Suction bras have been in shady catalogs for more than 100 years," he says.

But the science behind the invention is solid, he adds.

"We are able to regenerate breasts," says the plastic surgeon, who's reconstructed breasts on more than 200 women using Brava/AFT and hundreds more using traditional surgeries. "The holy grail of tissue engineering is a vascular scaffold -- a capillary network. The Brava creates the scaffold by pulling on the tissue from the outside. Then liposuctioned fat fills that scaffold with cells. We're regenerating an organ without any incision, without any foreign object, without any chemicals."

Not only that, the procedure comes with a sweet side effect.

"Many patients don't want implants or the major surgery associated with a tram or DIEP flap," says Isik, who's performed Brava/AFT on five women so far. "And some patients don't have the fat in the right spot. The beauty of this method is that it allows body sculpting to be done. It doesn't matter where you have excess fat -- the belly, the back, or the thighs."

Liposuction isn't painless, though.

"The best way to describe it is you feel like you've been hit by a truck," says Jeanne Reid, a 58-year-old retired teacher and breast cancer survivor from Naples, Fla., who in a series of five procedures had fat removed from her stomach, thighs, and lower back to create new breasts. "But my down time was very little. I was walking immediately and back to playing tennis within two to three weeks."

As with all surgical procedures, there can also be complications -- primarily nodules and cysts -- but Khouri says he's found these to be "minimal," a far cry from fat transfer procedures of the late 1980s which were banned by the ASPS due to the frequent lumps and bumps that required biopsies. 

"With today's technology, that's not an issue," says Khouri. "Radiologists now have ultrasound and better mammography and MRI. These tools help them recognize what is cancer and what is not cancer and they've brought down the rate of biopsies."

Fat graft survival rates are better these days, as well, thanks to the "vascular scaffold" -- or blood supply --  created by the external tissue expander.

Michigan-based plastic surgeon Dr. Tony Youn says he considers this method a great addition to the breast reconstruction arsenal, but does raise the question of Khouri's financial interest in the device. (According to the study's disclosure statement, Khouri has an "equity interest" in the Brava device.)

"That definitely poses a conflict of interest," says Youn. "Although Dr. Khouri has always been upfront about his relationship to the company."

For patients like Reed, though, that's a non-issue, especially since the Brava/AFT technique seems to come with an added bonus -- the return of sensation, something  lost after mastectomy.

"The morning after I wore the Brava, the sensation on my chest started to return," says Reed, who's "ecstatic" about her new breasts. "I stood in front of the mirror and just cried because I could feel my chest and that meant everything to me."

Related:

• Breast cancer survivor can now swim topless in Seattle's public pools
• Laughing in the face of cancer, he poses in a pink tutu

Diane Mapes is a frequent contributor at msnbc.com and TODAY.com. She's also the author of "How to Date in a Post-Dating World" and writes the breast cancer blog, doublewhammied.com.

By Maggie Fox

Remember bird flu? New studies show you should still worry.

Bird flu is still out there and mutating into dangerous forms, but there’s good news too – the changes that could make it spread more easily could make it less deadly, researchers reported on Thursday.

Flu experts funded by the U.S. government published a long-awaited a study on H5N1 bird flu on Thursday, and some of their findings are sobering. It only takes a handful of mutations for the virus to become airborne and easily transmitted from one animal to another. And a second study shows those mutations not only can easily occur in nature – they have already started to do so.

“We now know that we're living on a fault line,” Derek Smith of Cambridge University in Britain, who worked on one of the studies published in the journal Science, told reporters in a teleconference. “It's an active fault line. It really could – it really could do something.”

Now here’s the reassuring part – the mutations that make the virus pass easily from one animal to another also make it a little less dangerous. Instead of taking root deep in the lungs, causing a hard-to-treat pneumonia, the mutated version of H5N1 likes to live in the upper respiratory tract.

“And so it's less likely to cause pneumonia,” said Ron Fouchier of Erasmus Medical Center in Rotterdam, the Netherlands. And, Fouchier and colleagues reported in Science, drugs used to treat flu worked against the mutant version.

H5N1 bird flu has been circulating on and off since 1998, and it has killed nearly 60 percent of nearly 600 people reported infected, according to the World Health Organization. It mostly kills chickens and rarely infects people, but when it does, little can be done for the victims. Many experts believe H5N1 could be the source of the next big deadly pandemic, like those that struck in 1918, 1957 and 1968.

The last pandemic of a new flu was the H1N1 swine flu in 2009. It wasn’t nearly as deadly as other new flu viruses that cause pandemics, probably because it was a mutated form that included bits and pieces of flu viruses that had been infecting people for decades. That could lead people to believe that flu pandemics aren’t that big a deal. But H5N1 is a completely new virus to the human body – one reason it kills such a high percentage of its human victims.

Luckily, the infection doesn’t spread well from birds to people or from one person to another. But like all versions of the flu virus, it evolves and mutates in several different ways. Scientists have been working for years to figure out just which mutations would give H5N1 the ability to spread easily from one person to another, while also staying deadly. The latest work uses ferrets, which get infected with flu in a way very similar to how people get infected.

The work concerned some experts, and last December a committee called the National Science Advisory Board for Biosecurity asked two teams of researchers to hold off on publishing their findings. The U.S. government also asked all flu researchers to agree to a moratorium on genetically changing flu viruses until ground rules could be agreed on. The worry was that the virus could escape and accidentally cause a pandemic or, worse, that terrorists could somehow get hold of the work and use it to make a biological weapon. But the restrictions caused a furor among researchers, who are used to freely sharing their research.

The biosecurity board agreed earlier this year to let the researchers publish their findings.

“It's our hope that (Thursday’s) publication will help to make the world safer, particularly by stimulating many more scientists and policymakers to focus on preparing defenses,” Bruce Alberts editor-in-chief of Science, told the teleconference.

Some of the conclusions from the batch of studies: governments need to loosen rules for drug companies to make it easier and faster to make vaccines against flu; researchers – most funded by governments – need to keep a closer eye on bird flu around the world to watch for the mutations; and the benefits of flu research far outweigh the risks.

“The reason that we accelerated research on influenza is because there's a real threat,” said Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, which paid for the controversial flu studies.

Related stories:

Controversial bird flu study published after terrorism debate

Should scientists create deadly viruses? Yes, says bioethicist

By Malcolm Ritter
Associated Press

The second of two bird flu studies once considered too risky to publish was released Thursday, ending a saga that pitted concerns about terrorism against fears of a deadly global epidemic.

Both papers describe how researchers created virus strains that could potentially be transmitted through the air from person to person. Scientists said the results could help them spot dangerous virus strains in nature.

But last December, acting on advice of a U.S. biosecurity panel, federal officials asked the researchers not to publish details of the work, which identified the genetic mutations used to make the strains. They warned the papers could show terrorists how to make a biological weapon.

That led to a wide-ranging debate among scientists and others, many of whom argued that sharing the results with other researchers was essential to deal with the flu risk.

Bird flu has spread among poultry in Asia for several years and can be deadly in people, but it only rarely jumps to humans. People who get it usually had direct contact with infected chickens and ducks. Scientists have long worried that if the virus picked up mutations that let it spread easily from person to person, it could take off in the human population, with disastrous results.

The two teams that conducted the controversial research eventually submitted revised versions of their papers to the federal biosecurity panel. They said the changes focused on things like the significance of the findings to public health, rather than the experimental details themselves.

The panel announced in March it supported publishing the revised manuscripts, saying it had heard new evidence that sharing information about the mutations would help in guarding against a pandemic. It also concluded that the data didn't appear to pose any immediate terrorism threat. The government agreed in April.

The benefit of scientists sharing data from the new paper "far outweighs the risk," Dr. Anthony Fauci, director of the National institute of Allergy and Infectious Diseases, said Wednesday.

For bioethicist Art Caplan, the controversy's most important lesson was the regulatory committee's "slow realization that blocking published papers about dangerous information in medicine and science is pointless." By the time a paper is ready to be published in a major journal, its contents have been distributed through emails and the web, "which can be hacked by those who really want to know," notes Caplan, a contributor to msnbc.com.

 "If censorship is to be a weapon against the misuse of dangerous knowledge, it will have to be invoked much earlier in the research process -- and much sooner," says Caplan.

One paper, from Yoshihiro Kawaoka of the University of Wisconsin-Madison and colleagues, was published last month by the journal Nature. On Thursday, the journal Science published the second paper, from a team led by Ron Fouchier of the Netherland's Erasmus Medical Center in Rotterdam.

Both papers tested the ability of the altered bird flu viruses to spread through the air between ferrets, none of which died from those infections. The Fouchier paper reports that the virus could spread this way by acquiring as few as five specific mutations.

Two of those mutations are already found frequently in strains of the virus. And the other three could arise during infection of people or other mammals, a new mathematical analysis in Science concluded. But the likelihood is unclear. An author of the analysis compared the situation to earthquake prediction.

"We now know we're living on a fault line," Derek Smith of Cambridge University and the Erasmus center told reporters. "It's an active fault line. It really could do something."

Fouchier said the ferret results don't give a clear answer about how deadly an altered virus would be in people.

Eddy Holmes of Penn State University, who studies the evolution of flu viruses but did not participate in the Fouchier or Kawaoka studies, said those works present the first good experimental evidence about how the bird flu virus could mutate to become more easily spread between people.

The studies are "a useful frame of reference" for studying that question, but not the final answer, he said.

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Mom of first IVF baby has died

Bioethicist: Where is outrage over Pakistan polio vaccine ban?

- / AFP - Getty Images

The world's first test-tube baby Louise Brown, right, poses with her son Cameron, her mother, Lesley Brown, and in vitro fertilization pioneer Robert Edwards on July 12, 2008, during a celebration of Louise's 30th birthday. Lesley Brown died earlier this month after a short illness.

Lesley Brown, the woman who gave birth to the first test tube baby has died at age 64 after a brief illness, the British newspaper The Telegraph reports.

Brown sought out the experimental new treatment, in vitro fertilization, after nine years of trying to get pregnant on her own with her husband John.

She gave birth to a daughter, Louise, in 1978 with the help of two British specialists Dr. Patrick Steptoe and Robert Edwards.

Louise told the BBC, “Mum was a quiet and private person who ended up in the world spotlight because she wanted a family so much. We are all missing her terribly.” Lesley Brown died June 6 at Royal Bristol Infirmary, The Telegraph reported.

Louise’s birth was the beginning of a “revolution,” says Dr. Anthony Wakim, director of assisted reproductive technologies at the Magee-Women’s Hospital at the University of Pittsburgh Medical Center.

“I still remember exactly what I was doing,” Wakim remembers. “I had just started my internship at the University of Maryland and I was pumping gas into my car when I heard it on the radio. It was just mind-boggling. To my mind it was almost science fiction. It was very far fetched.”

It wasn’t long after when groups in the U.S. developed the expertise to produce babies through in vitro fertilization, Wakim says. 

And that changed everything for parents who had been suffering with infertility.

“It was a very big deal,” Wakim says. “Before that we had to rely on micro-surgery to break up the adhesions that were scarring the tubes. Those surgeries could drag on for three or four hours and the results were not so good. The scarring could recur and many times there were ectopic pregnancies.

“I look back and I’m flabbergasted.”

The news of Lesley Brown’s death caught Janice Evans by surprise.

“I felt sad when I heard,” says Evans, an associate professor at the Johns Hopkins Bloomberg School of Public Health.  “Think about the courage and persistence she must have had. She was a real trail blazer. As were Steptoe and Edwards.” Edwards was awarded the 2010 Nobel Prize for developing IVF. Steptoe died in 1988.

Lesley Brown’s story underscores how persistent people can change the world. “If the three of them hadn’t been so determined there would have been a big gap for the many couples who struggle with infertility,” Evans adds.

The iconic photo of Edwards with Lesley and Louise sums it all up, Evans says.

“Edwards has his arm around Lesley, and Louise is standing next to them holding her son. You get the feeling looking at that photo that they were all in the fight together not just to make a change in the Brown family but to push frontiers.”

Today, the results of that groundbreaking birth are all around us. In 2010, 58,727 babies were born through IVF in the U.S., says Sean Tipton, director of public affairs for the American Society for Reproductive Medicine

“It’s remarkable to think that if you look around a preschool classroom, a big chunk of those kids may have come from IVF,” Evans says. 

Susan E. Matthews
MyHealthNewsDaily

How the body responds to opiates — the powerful, pain-relieving drugs that carry a high potential for addiction — may be partly determined by genetics, according to a new study.

Researchers studied 121 pairs of twins to look at the role of genetics in people's reactions to the pain medications. They found that genetic predisposition accounted for 59 percent of the variation between people's levels of nausea, 36 percent of the differences in how much people disliked the drug and 38 percent of the variation in itchiness in reaction to the drug.

The findings are important because the degree to which people experience unpleasant side effects, and like or dislike the drugs, can be a sign of how effectively the drugs treat their pain, and their potential to develop addiction, the researchers said. Liking a drug increases the susceptibility to addiction, while experiencing negative side effects decreases it.

“Genetics matter … people are different, and if we understand why they are different, we can take better care of them,” said study author Dr. Martin Angst, professor of anesthesia at the Stanford University Medical Center.

It's well-known that the pain relievers cause extremely different reactions in people, but the new study gives researchers a better understanding of how genetics could play a role in those reactions.

"Patients vary dramatically in how much pain relief they get, what extent they suffer from opiates and how much pleasure they get from opiates,” Angst said.

Opiates: reactions and addictions
Nearly 2 million people in the U.S. are addicted to prescription painkillers, a 2009 government survey found, and the problem is growing. Painkiller addiction often begins with a patient taking legitimate prescriptions.

Researchers believe the addiction problem could be curbed if people's reactions to the drugs were better understood, or could be predicted. Some patients may require 10 times the typical dose for adequate pain relief; others prefer lower doses that cause less extreme side effects, even though it means experiencing more pain.

In the study, participants were randomly assigned to receive either a small amount of a short-acting opiate or a placebo, followed by a heat probe or ice-cold water. Researchers spent 6 hours with each participant, but didn't know which treatment they'd received. General tolerance to pain was also assessed by applying the heat probe or cold water without any medication.

The study demonstrated that one of the most uncomfortable side effects, nausea, is strongly inherited, as genes account for almost two-thirds of variability between people.

The more severe side effects that come with opiates include slow breathing, which can result in death. Genetics accounted for 30 percent of the variation between people in respiratory depression, and 32 percent of dizziness, the study found.

Opiates represent a "double-edged sword — they’re really important drugs to relieve pain, but they come along with side effects," Angst said.

More personalized treatment
This line of research could result in a more personalized approach to administering the medications, the researchers said. Someday, people could be screened prior to use so doctors could understand their predispositions, and respond appropriately.

For example, screening could prevent a patient with a low tolerance for opiates from getting a high dose that could bring such euphoric feelings that they predispose the person to seek out the drug in the future, which could be the start of an addiction, said Dr. Doo-Sup Choi, who studies addiction at the Mayo Clinic.

Angst said further research must be done to determine which genes affect tolerance.

The study of 242 participants was large considering the amount of time spent with participants, and it was well-designed and well-performed, Choi said.

The study was published Wednesday in the journal Anesthesiology.

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By Michael B. Sauter, Alexander E.M. Hess and Lisa A. Nelson
24/7 Wall St.

According to the National Institutes of Health, nearly 50,000 to 100,000 patients die in U.S. hospitals each year as the result of lapses in safety. Recently, the Leapfrog Group, a nonprofit promoting transparency and safety in hospitals, released its first-ever Hospital Safety Score. The study analyzed data from 2,652 hospitals from across the country based on 26 different safety-related measures. Each hospital received a score of A, B or C. Grades for hospitals receiving D and F have not yet been finalized.

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Some states have much safer hospital systems than others. In several states, 40 percent or more of reporting hospitals received the best possible score. In others, not one hospital scored better than a B. Based on Leapfrog’s report, 24/7 Wall St. identified the states with the largest percentage of hospitals receiving an A.

In an interview with 24/7 Wall St., Melissa Danforth, Interim Senior Director of Leapfrog’s Hospital Ratings, explained the importance of the report compared to other national hospital rankings. “The Hospital Safety Score is unique,” according to Danforth, because Leapfrog only considers what puts a patient’s safety at risk, instead of “looking at the reputation of the hospital.” Danforth said, “We’re really looking to, and wanting to draw attention to, things that could happen to you in a hospital that could kill you.”

Danforth explained that hospitals that received an A grade tended to have close to perfect scores for particular safety measures. Incidence of patient falls, trauma, including broken bones or injuries that occur during a patient’s stay, and the likelihood of receiving a central-line associated bloodstream infection (CABSI) -- a dangerous infection that can occur during certain procedures -- are particularly low among the safest hospitals.

Similarly, the states with the highest percentage of hospitals receiving an A performed better on these important measures compared to the national average. For most of the states on this list, incidents of falls, trauma and CABSIs are below the national average. In Massachusetts, one of the states with the safest hospitals, incidence of particularly bad bedsores -- another critical safety measure -- is one-third the national rate.

24/7 Wall St.: America's Most (and Least) Peaceful States

States with the healthiest hospitals do not necessarily have healthy populations. In addition to the safety scores provided by Leapfrog, 24/7 Wall St. also considered a variety of health-related metrics from statehealthfacts.org, part of The Henry J. Kaiser Family Foundation. Life expectancy, incidence of cancer and diabetes, and heart disease mortality rates were no better in the states with the safest hospitals than the national average.

These are the states with the safest hospitals.

1. Massachusetts 

•  Hospitals with A grade: 76 percent
•  Number of hospitals with A grade: 47
•  Life expectancy at birth: 80.1 years
•  Cancer death rate per 100,000: 186.6

Massachusetts has one of the healthiest populations in the country. Average life expectancy from birth in the state is 80.1 years, the sixth-highest in the country. The state also has one of the best -- and most expensive -- medical systems in the country. The state’s university system produces some of the most prestigious hospitals in the country. More than three-quarters of the state’s hospitals in Leapfrog’s survey received A grades. Just 20 of the of the state’s 62 reporting hospitals failed to record spotless records for pressure ulcers, and two-thirds had a better-than-average percentage of patients receiving the correct type of antibiotics.

2. Maine

•  Hospitals with A grade: 74 percent
•  Number of hospitals with A grade: 14
•  Life expectancy at birth: 78.68 years
•  Cancer death rate per 100,000: 199.7

Citizens of Maine have lower levels of death as a result of heart disease -- 12 percentage points lower than the national average -- but a higher rate of deaths from cancer than the U.S. average. After surgery, patients in Maine hospitals are less likely to experience breathing difficulties or respiratory failure than they would in the average hospital in the United States. All of the 19 Maine hospitals reporting averaged exceptional scores in hand hygiene and care for patients on ventilators. Only three of the state’s 19 graded hospitals received a C.

3. Vermont

•  Hospitals with A grade: 50 percent
•  Number of hospitals with A grade: 3
•  Life expectancy at birth: 79.7 years
•  Cancer death rate per 100,000: 179.7

Though only six Vermont hospitals reported information to Leapfrog, three of these earned A grades. Brattleboro Memorial Hospital received above-average ratings for all Surgical Care Improvement Project (SCIP) measures. The hospital also recorded perfect scores in preventing complications related to air embolisms and pressure ulcers. Southwestern Vermont Medical Center and Central Vermont Medical Center similarly recorded a strong performance, with each receiving above-average SCIP ratings. The quality of medical care in the state may well have major benefits for its residents as heart diseases resulted in just 138 deaths per 100,000 people, far less than the nationwide average of 186.5 deaths.

24/7 Wall St.: The Most Dangerous Cities in America

4. Illinois

•  Hospitals with A grade: 48 percent
•  Number of hospitals with A grade: 51
•  Life expectancy at birth: 78.76 years
•  Cancer death rate per 100,000: 191.3

Leapfrog surveyed 106 Illinois hospitals. While nearly half received an A grade, the reviewed state hospitals actually performed worse than the national average on many of the key safety metrics, including the frequency of central-line associated bloodstream infections. However, in many other measures Illinois hospitals performed well, including having a low average of the number of deaths from treatable medical complications after surgery. However, many of the state’s 51 hospitals that received an A scored much better than the national average in preventable deaths and ulcers. 

5. Tennessee

•  Hospitals with A grade: 48 percent
•  Number of hospitals with A grade: 31
•  Life expectancy at birth: 76.2 years
•  Cancer death rate per 100,000: 206

With higher rates of cancer death and infant mortality than any other state on this list, as well a lower life expectancy, Tennessee needs hospitals that are both good and safe. Fortunately, 48 percent of the state’s hospitals receive A grades from Leapfrog, while only about 33 percent of hospitals receive C grades. For all of Leapfrog’s safe practice measures, Tennessee’s hospitals receive above-average score. One hospital performing especially well is Vanderbilt University Hospital, which received high scores for its surgery-related antibiotic regimens, as well as for its handling of urinary catheters and prevention of blood clots following surgery.

Click here to read the rest of 24/7 Wall St.'s The States with the Safest Hospitals

The world's reaction to a powerful Taliban commander in northern Pakistan banning the vaccination of 161,000 children against polio, in retaliation against frequent drone attacks by the United States, has been more or less "no comment." That is unacceptable.

Hafiz Gul Bahadur says unless the U.S. stops its frequent drone attacks against the Taliban, he won’t let doctors and public health officials give out free oral polio vaccine to children any longer in North Waziristan, a tribal area on the Afghanistan border. This threat comes at a time of huge progress in eradicating polio worldwide.  

By deciding to hide behind babies as a way to fight drones, Bahadur has chosen a strategy that is cruel, immoral and highly unlikely to have any effect on the use of drones. His action ought to bring loud moral condemnation upon him from all quarters of the globe. So, where are world’s major religious and political voices united in loud condemnation of the crass act of targeting the helpless children of Pakistan and Afghanistan with polio?

In reaching his decision to sacrifice the children of his region, Bahadur noted that the CIA had run a phony vaccination campaign in Pakistan to try to obtain DNA from some of Osama bin Laden’s children. The doctor who was allegedly involved, Dr. Shakil Afridi, was recently sentenced by a tribal court in Peshawar to 33 years in prison. Embarrassment over putting a humanitarian vaccine program to use in the effort to find and kill bin Laden may partly account for the relative silence that has greeted Bahadur’s ban on vaccination. 

But the notion that letting polio run amok in Pakistan and Afghanistan will teach the world about the horror of drone attacks is manifest lunacy. There are plenty of legal, diplomatic and political forums to debate the morality of drone warfare. The ban on the polio vaccine is not needed to appeal to them.

The success to date in getting rid of this horrific plague stands as a mountain of evidence against those who argue that vaccines don’t work, are not safe, or are nothing but a way for pharmaceutical companies to make a buck. In 1988, the World Health Organization passed a unanimous resolution to eradicate polio from the earth by vaccinating every child. The United Nations, Rotary International, and, later, the Gates Foundation joined the effort. Untold numbers of health care workers from around the globe have dedicated their lives to eradicating the virus.

In 2012, according the Centers for Disease Control and Prevention, there have been 73 cases of polio reported from four countries. Almost all of the cases were in three countries where the disease is endemic -- Pakistan, Afghanistan and Nigeria. Globally, polio cases are at an all-time low, after the virus was eradicated in India last year.

That positive momentum shouldn’t be hindered by a ban on polio vaccination, whatever the motivation or excuse. The silence over this ban sends a very loud message that killing and disabling kids is an acceptable strategy in war. It isn’t. 

The world must make it very clear to Bahadur, and any other leaders tempted to follow his lead, that it will not accept turning back the campaign to eradicate polio, with the certain result of killing and disabling children. 

Arthur Caplan is the Sidney D. Caplan Professor of Bioethics at the University of Pennsylvania. After July 1, he will head the Division of Medical Ethics at NYU Langone Medical Center.

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Karen Rowan,
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Exposure to ultraviolet radiation may lower the risk of developing pancreatic cancer, according to a new study from Australia.

Researchers looked at 1,400 people and found that those born in areas with the highest levels of ultraviolet (UV) radiation were 24 percent less likely to have pancreatic cancer, compared with those born in areas with the lowest UV levels. The link held after researchers accounted for factors that could affect participants' pancreatic cancer risk, such as age, smoking and diabetes.

But exposure to UV radiation has long been linked with an increased risk of skin cancer, including the deadliest type, melanoma.

"We need to avoid the sun during the daytime periods when UV levels are the highest, and protect parts of the body that regularly get the highest exposure," said study leader Rachel Neale, a researcher at the Queensland Institute of Medical Research in Queensland. "We don't have the science yet," to recommend a level of ultraviolet exposure that might optimize the balance between the increased risk of skin cancer with the lowered risk of pancreatic cancer, she said.

Researchers aren't sure exactly how the link may work, but Neale noted that there also is evidence that UV exposure may lower the risk of colorectal and other internal cancers.

Neale is presenting the findings June 19 at a pancreatic cancer research meeting in Lake Tahoe, Nev.

Risks and benefits
Pancreatic cancer is a deadly disease — an estimated 44,000 people in the U.S. will be diagnosed with the condition in 2012, and 37,000 are expected to die of the disease this year.

Neale and her colleagues interviewed 704 people with pancreatic cancer and 713 people without the disease. The researchers asked where the participants were born, where they lived since their birth, their skin type and whether they easily developed sunburns, their intake of vitamin D over the course of their lives, and whether they'd been diagnosed or treated for skin cancer or skin lesions.

In this study, participants' birthplaces were matched to NASA data of UV radiation levels, which is one way that researchers assess people's UV exposure. However, Neale said, future analyses of the data — including a look at people's places of residence over the course of their lives — will give a more complete picture of the link between UV exposure and pancreatic cancer risk.

"We found that in all of our measures, sun exposure was predictive of pancreatic cancer," Neale said.

The data showed that people who said they burn readily after sun exposure were half as likely to have pancreatic cancer as those who don't burn at all.

Additionally, people who'd been treated for skin cancer or other sun-related skin lesions had a 40 percent lower risk of pancreatic cancer than those who had not had skin lesions treated.

The strongest association with a reduced pancreatic cancer risk was seen in people who reported that their skin lesions were treated by being burnt off the skin, Neale said. The lesions that are typically treated this way are those that most strongly linked with sun exposure, such as solid keratoses and actinic keratoses.

Why the link?
Researchers aren't sure why there may be a link between UV exposure and a lowered risk of pancreatic cancer, Neale said.

Some studies have linked lower rates of cancer in general with higher vitamin D levels, and vitamin D is produced by sun-exposed skin. 

However, studies of pancreatic cancer looking at vitamin D levels and cancer risk are mixed, Neale said, and one study published this year in the International Journal of Cancer found that people with either very low or very high levels of vitamin D had a higher risk of pancreatic cancer.

Clinical trials are needed to better understand the link, she said.

There are also other possible mechanisms that could explain the link, Neale said. While UV radiation generally has a suppressive effect on the immune system, "the immune system is complicated, and it's possible the link has something to do with immune function," she said. Genetics partly governs people's reactions to sunlight, and may also play a role, she said.

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