Darron Cummings / AP

Louisville head coach Rick Pitino and trainers tend to injured guard Kevin Ware during the first half of the Midwest Regional final in the NCAA college basketball tournament against Duke, on March 31, 2013, in Indianapolis. Ware badly injured his lower right leg and had to be taken off the court on a stretcher.

The gruesome break that shattered Louisville Cardinals guard Kevin Ware’s right lower leg during Sunday’s Elite Eight playoff game was a “freak accident” rare outside of car accidents or other high-velocity trauma, a sports medicine expert said.

The 20-year-old sophomore from the Bronx apparently landed awkwardly in the heat of the NCAA Midwest Final game against the Duke Blue Devils, perhaps exacerbating an undetected stress fracture, said Dr. Frederick Azar, a vice president and spokesman for the American Academy of Orthopaedic Surgeons and chief of staff at Campbell Clinic in Germantown, Tenn., who consults for the Memphis Grizzlies NBA basketball team.

“He may have just landed funny and torqued his tibia,” said Azar, who was watching the game. “It was a freak accident.”

Such injuries, don’t often happen at the low velocity of even high-level basketball, which raises the possibility that Ware had a preexisting stress fracture, Azar said.

The bone in Ware’s lower right leg apparently broke in two places and could be seen sticking out through Ware’s skin, observers said.

“To actually see it happen like that is rare,” Azar said. “A bone sticking out of the skin is really, really unusual.”

The injury, which occurred with 6:33 minutes left in the first half of the game, sent 6-foot-2 Ware to floor, stunned his teammates into sickened sobs and silenced the crowd at Lucas Oil Stadium in Indianapolis.

The Cardinals went on to win the game 85-63.

Known as a compound fracture or open fracture, the injury occurs when the bone protrudes through the skin, Azar said. Doctors likely washed out the injury to prevent infection and then quickly performed surgery to place a titanium or stainless steel rod in Ware’s leg.

“They’ll get him up and get him going by tomorrow,” Azar said. “You would hope he gets fixed tonight.”

Cardinals coach Rick Pitino told reporters that Ware would be out of  commission for a year, but Azar said that if surgery went well and there were no nerve complications or infections, the young, healthy player could be back on the court in time for next season, or within six months.

“That’s the good news: We have the technology to fix this,” said Azar.

Related:

• PhotoBlog: Louisville player after horrific injury: 'Don't worry about me. I'll be OK. You guys go win this thing'
• Louisville guard suffers gruesome compound fracture

Hundreds of patients of an Oklahoma oral surgeon accused of unsanitary practices showed up at a health clinic Saturday, looking to find out whether they were exposed to hepatitis or the virus that causes AIDS.

Letters began going out Friday to 7,000 patients who had seen Dr. W. Scott Harrington during the past six years, warning them that poor hygiene at his clinics created a public health hazard. The one-page letter said how and where to seek treatment but couldn't explain why Harrington's allegedly unsafe practices went on for so long.

Background: Dentist's office a 'menace,' HIV tests urged for thousands

Testing for hepatitis B, hepatitis C and the virus that causes AIDS began at 10 a.m. Saturday, but many arrived early and stood through torrential downpours. The Tulsa Health Department said 420 people were tested Saturday at its North Regional Health and Wellness Center. Screenings resume Monday morning.

Kari Childress, 38, showed up at 8:30 a.m., mainly because she was nervous.

"I just hope I don't have anything," said Childress, who had a tooth extracted at one of Harrington's two clinics five months ago. "You trust and believe in doctors to follow the rules, and that's the scariest part."

Inspectors found a number of problems at the doctor's clinics in Tulsa and suburban Owasso, according to the state Dentistry Board, which filed a 17-count complaint against Harrington pending an April 19 license revocation hearing. According to the complaint, needles were reinserted into drug vials after being used on patients, expired drugs were found in a medicine cabinet and dental assistants, not the doctor, administered sedatives to patients.

One patient, Orville Marshall, said he didn't meet Harrington until after he had two wisdom teeth pulled about five years ago at the Owasso clinic. A nurse inserted the IV for his anesthesia; Harrington was there when Marshall came to.

"It's just really scary. It makes you doubt the whole system, especially with how good his place looked," said Marshall, 37.

An instrument set reserved for use on patients with infectious diseases was rusty, preventing its effective sterilization, and the office autoclave — a pressurized cleaner — was used improperly and hadn't been certified as effective in at least six years, according to the complaint.

Dr. Matt Messina, a Cleveland dentist and a consumer adviser for the American Dental Association, said creating a safe and hygienic environment is "one of the fundamental requirements" before any dental procedure can be performed.

"It's not hard. It just takes effort," he said.

Weekly autoclave testing can be performed for less than $400 annually, according to the website of the Autoclave Testing Services of Pearl River, New York.

Autoclaves typically can be purchased for $1,000 to $8,000, depending on their size and features. And an average dental practice can expect to pay more than $40,000 a year in equipment, tools and supplies alone, according to several dental organizations.

Attempts to reach Harrington have been unsuccessful. No one answered the door Thursday at his Oklahoma home, which property records show is worth more than $1 million. His practice a few miles away, in a tony section of Tulsa where plastic surgeons operate and locals congregate at bistros and stores such as Saks Fifth Avenue, has a fair-market value of around $851,000.

Property and tax records show Harrington owns another residence in Carefree, Ariz., in an area of upscale homes tucked into in the boulder-strewn mountains north of Phoenix.

Nobody was at home Saturday at the low-slung, 1950s-style vacation home, across from the Boulders Resort. Neighbors said they had seen a lot of activity at the home in recent weeks.

Harrington's malpractice lawyer, Jim Secrest II, did not respond to phone messages left Thursday or Friday. A message at Harrington's Tulsa office said it was closed and an answering service referred callers to the Tulsa Health Department.

Suzy Horton, an old friend of Harrington's, said she can't believe the allegations about the man who removed two of her teeth in the early '90s. Horton's ex-husband sold Harrington his home in Carefree — a home where she once lived.

"I've been to dentists my whole life, so I know what a professional office looks like," Horton, who now lives in Phoenix, said in a telephone interview. "His was just as professional as anybody."

Horton hasn't seen Harrington in years, but she said he has sent her a Christmas card and wreath every year since her 1999 divorce.

"It was a long time ago, so I suppose anything can change, but the kind of person they're portraying in the news is not the kind of person who sends you a Christmas" card, she said.

___

Associated Press writers Traci Carl in Carefree, Ariz., and Jeannie Nuss in Little Rock, Ark., contributed to this report.

Pouya Dianat/AP

Shawn Lockhart looks at the meningitis-causing fungus Exserohilum rostratum at the mycotic lab at the Centers for Disease Control and Prevention on Oct. 12, 2012 in Atlanta after the fungal meningitis outbreak.

The Food and Drug Administration says it doesn’t have the power it needs to control compounding pharmacies that have expanded out of their traditional one-patient-at-a-time role to making mass drugs.

But consumer advocates say a recent crackdown by the agency shows it most certainly can – and should. A spate of recent FDA inspections have shown that the dirty conditions that led to an outbreak of fungal meningitis that killed 51 people and sickened more than 700 are anything but rare at pharmacies that mix up what are supposed to be “sterile” injectable drugs.

“We are currently deploying resources to work with states to inspect certain state-licensed pharmacies that produce sterile drug products that we believe may present the highest risk,” FDA commissioner Dr. Margaret Hamburg writes in her latest blog entry. “Over the past two months, we have inspected over 30 facilities and will continue to work to protect public health.”

That's a big step up from the previous pace, when FDA might inspect a facility, write a letter, and wait a few years before following up. Hamburg estimates there are more than 7,000 compounding pharmacies in the U.S.

"We had a list of facilities we have been keeping our eye on," says FDA spokeswoman Erica Jefferson.

The FDA sent Medi-Fare Drug & Home Health Center, Inc. of Blacksburg, S.C., a warning letter earlier this month, pointing out both that it wasn’t preparing products to match prescriptions and that it had “serious deficiencies in your practices for producing sterile drug product, which could lead to contamination of the products, potentially putting patients at risk.”

Other FDA reports this year have pointed out patches of rust at one compounding pharmacy in St. Petersburg, Fla. and sloppy sterility practices at one in Swedesboro, N.J.

It's about time, say some. “That’s the type of activity we were calling for,” says Dr. Michael Carome of the consumer group Public Citizen, which is agitating for the FDA to do more to regulate compounding pharmacies. Public Citizen has argued that the FDA has all the authority it ever needed to stop rogue compounding pharmacies, but has failed to act.

Luckily, so far, there’s not been another outbreak of illness like the one traced to the New England Compounding Center (NECC), in which 51 people have died of fungal meningitis and more than 700 infected after receiving contaminated injection steroids.

“We haven’t seen any other large-scale scale compounding outbreaks,” Dr.  Michael Bell, acting director of the division of health care quality promotion at the Centers for Disease Control and Prevention, told NBC News. He says there’s a steady stream of requests from states to check, however.

The FDA is openly telling the pharmacies and drug manufacturers it regulates that things have changed since the outbreak tied to NECC. Hamburg was questioned by both House and Senate committees about how the incident could even have happened.

“They appear to have the authority to take actions against companies that engage in drug manufacturing,” Carome said. “What we are going to have to wait to see is will they stand behind the citations of violations they are making,” he added. “That is what they have failed to do previously. Hopefully it’s not just for show.”

Currently, the FDA regulates drug manufacturers, while state boards regulate pharmacies, including compounding pharmacies. But the line between what is a manufacturer and what is a compounding pharmacy can be blurry.

Compounding pharmacies are supposed to mix prescriptions one at a time, on a per-patient basis. But there’s so much demand for special formulations that hundreds of these compounders have started large-scale production. Now, they closely resemble drug manufacturers – but without the very strict oversight and long list of sterility requirements that manufacturers must follow.

Jefferson says the crackdown hasn't gone entirely smoothly. "We still run into situations where a facility has not cooperated with us," she said. "We might not be able to take samples. They might say, 'No, you can't see this.'" Then FDA has to seek help from state authorities.

Mold in IV solution
State officials are also cracking down. But it’s been astute health care professionals who have blown the whistle on the cases of contamination that have been found since the beginning of the year. It was a nurse in Connecticut who earlier this month spotted mold in magnesium sulfate intravenous solution made by New Jersey-based Med Prep Consulting Inc. That pharmacy has since recalled all its products. The firm had received FDA warnings about its sterility practices in 2001 and 2010, agency records showed.

While none of the FDA actions have resulted in recalls yet, some of the state responses have. In Massachusetts, the state board of pharmacy shut down Pallimed Solutions Inc. after an inspection turned up unsterile conditions. The company recalled 16 of its sterile compound products Monday.

On March 21, the FDA announced that Clinical Specialties, based in Augusta, Ga., was recalling all its products after five people who got eye injections of a cancer drug used to treat a degenerative eye condition got serious eye infections.

The FDA had been trying to work cooperatively with pharmacies, in essence making them promise to keep things clean. But not any more, the agency told PharMEDium Services, LLC  of Lake Forest, Illinois last month, after giving the pharmacy a pass since at least 2005. “These events have caused the Agency to reexamine its exercise of enforcement discretion with regard to the need for valid, patient-specific prescriptions,” FDA wrote.

Hamburg has asked Congress for specific authority to regulate these compounders who make products, from bags of saline solution to morphine injections, on a large scale. “In the absence of such legislation, however, the Agency intends to apply its existing legal authorities,” the FDA added.

Hamburg had complained that companies have pushed back against previous FDA attempts to regulate them, creating tangled legal nightmares. Carome agrees it’s possible that the pharmacies have stopped doing that – at least for now.

“Companies have seen what can happen when they harm patients because of contaminated products,” he said. NECC has declared bankruptcy and faces hundreds of lawsuits, as well as criminal prosecution.

“The fungal meningitis outbreak linked to NECC is a situation that no other company wants to go through,” Carome said.

A new tier of regulation
Hamburg wants to create a new tier of regulation to cover large-scale compounders. Public Citizen opposes this idea, saying if they’re acting like manufacturers, they should be regulated as manufacturers.

The recent crackdown shows the agency can act and should have acted against NECC, which had a history of squabbles with regulators, he says. “We believe yes, their argument falls flat,” he said.

Meanwhile, Bell says the CDC and state officials are still dealing with the fallout from NECC. It has asked doctors to keep a close eye on the 14,000 patients who got injections of steroids from the three contaminated batches shipped out by NECC. “We don’t want anyone to fall through the cracks,” Bell said.

“That was overwhelming in scope,” he added. “It is a frightening illustration of what happens when medications are delivered across multiple states to such a wide range of practices in different parts of the country.”

Some of the infections are taking months to show up.  “One (reason) is the medication that was contaminated was a steroid. They turn off inflammation and hide the symptoms of an infection,” Bell said.

But the contamination that’s been found at other pharmacies since would have caused almost immediate symptoms, Bell says. “Within an hour or two (of injection), you are going to turn red. You are going to get signs of inflammation,” he said.

And, he says, CDC has not seen an outbreak like this linked to a drug manufacturer that is regulated as a drug manufacturer.

Related:

FDA ponders new pharmacy rules

Pharmacy owner refuses to testify about outbreak

Pharmacists admit 'sterile' drugs often anything but

By Alina Selyukh
Reuters

U.S. regulators are looking into how radio frequencies emitted by cellphones and other wireless devices affect people amid lingering concerns about the risks of cellphone radiation. 

The Federal Communications Commission said on Friday it is seeking comment from other agencies and health experts on whether it should update its standards limiting exposure to phones' electromagnetic fields, as they apply to children in particular.

The FCC last reviewed those standards in 1996, before the ubiquitous use of mobile devices. But the agency's officials say they have no reason to believe the current standards are inadequate and called the proceeding, which was announced in documents posted online on Friday, a routine review.

Scientists have been unable to determine whether radio waves emitted by mobile devices pose threats to the brain or other parts of the human body but studies continue as the number of mobile devices Americans own, already in the hundreds of millions, continues to grow.

BUFFALO, N.Y. - Rich Products Corp. has announced a voluntary recall of 192,222 pounds of its Farm Rich Mini Quesadillas and other Farm Rich products because of a possible E. coli contamination.

The recall of also includes the Buffalo, N.Y.-based company's Farm Rich Mini Pizza Slices, Farm Rich Philly Cheese Steaks, Farm Rich Mozzarella Bites and Market Day Mozzarella Bites. They were produced Nov. 12 through Nov. 19.

The Farm Rich products were distributed in retail stores nationwide. The company says it's working with the Food Safety Inspection Service in the U.S. Department of Agriculture to identify the possible contamination source.

The problem came to light after one person became ill and food samples were tested. Twenty four cases have now been reported in 15 states, the USDA said in a statement.

E. coli 0121, the strain implicated in the outbreak, is one of six known as non-0157 Shiga toxin-producing E. coli that were banned in 2011 from the U.S. meat supply.  Testing for the six began last spring, a move that was opposed by the meat industry.

Like E. coli O157:H7, the six new strains are capable of producing bloody diarrheal illness that can lead to kidney failure and death. In 2010, for the first time, the non-O157 strains, were responsible for more infections in the U.S. than E. coli O157:H7, according to federal health officials.

Consumers with questions about the recall can call 1-888-220-5955.

The Associated Press and NBC News contributed to this report.

Related stories:

Six new E. coli strains banned from beef supply

Testing for new E. coli strains in beef finally to begin

Brian Snyder/Reuters

Chihn Ha, 8, gets an influenza vaccine injection from nurse Nho Nguyen, right, during a flu shot clinic at Dorchester House, a health care clinic, in Boston, Mass., in January 2013.

The longer-than-average flu season finally appears to be ending, federal officials said on Friday, but it’s not quite done yet. Only six states, mostly in the Northeast, are now reporting widespread influenza.

The deaths of another five children were reported this past week, bringing the total for the season to 110, the Centers for Disease Control and Prevention reports. That’s just around the unfortunate average for influenza in any given year, the CDC says, although it varies a lot.

The viruses circulating this year were especially hard on people 65 and older and CDC is still trying to work out just how well vaccines may or may not have protected people, especially the elderly, against serious illness and death from flu. So many adults die of flu every year that the CDC can’t keep a precise count, but estimates that it ranges from a low of 3,000 to as many as 49,000.

This year was a “moderately severe” flu year, CDC says in a review of the 2012-2013 influenza season.

“This season, influenza activity started about 4 weeks early and was intense. Influenza-like-illness rose quickly to well above the baseline of expected activity and remained elevated for 15 consecutive weeks, making this season slightly longer than average,” the agency says in a statement.

“Flu-associated hospitalizations began to rise in mid-December with sharp increases seen among people 65 years and older.”

Half of the patients sick enough to be hospitalized with flu were 65 or older, CDC said. “While hospitalization rates have leveled off, this is the highest proportion of persons 65 and older hospitalized for flu that has been measured since this kind of record-keeping began during the 2005-2006 season,” it said.

Sadly, a few were children, and most had not been vaccinated, CDC said. “CDC reported an additional five pediatric deaths this week for a total of 110 to date for the 2012-2013 season. The number of pediatric deaths is likely to climb further as additional deaths are reported,” CDC said. Reports of deaths can take weeks to collate -- some of the five deaths reported this week dated back to December.

Experts have done a batch of studies to see how well the flu vaccine worked this year. That varies from year to year and scientists still are not sure why flu vaccination protects more strongly in some years than in others.

Flu vaccines have to be formulated freshly each year to protect against the most common circulating strains of virus. This year’s vaccine protected against three strains – one called H3N2, one called H1N1 – a descendant of the H1N1 “swine flu” that emerged in 2009 – and one influenza B strain.

Next year’s vaccines are just being formulated now, based on what’s circulating, and some will protect against four strains of flu.

“February results showed the 2012-2013 flu vaccine reduced the risk of flu-associated medical visits from influenza A (H3N2) viruses by one half and from influenza B by two-thirds for most of the population,” the CDC said.

 “This means that vaccinated people reduced their risk of having to go to the doctor for influenza by more than half, thus providing significant benefit to the person getting vaccinated and to public health in general.”

But it only prevented the risk of severe disease by 27 percent among people 65 and older this year. “It’s possible that some people 65 and older did not mount a good immune response to H3N2 from vaccination,” CDC said.

Related:

• Flu kills 105 kids; most not vaccinated
• Why it's so hard to get the flu vaccine supply right
• Flu spreads to all 50 states

A new study adds to years of research showing that childhood vaccines do not cause autism, despite worries among a growing number of parents that their young children receive “too many vaccines.”

Researchers from the Centers for Disease Control and Prevention concluded that even when multiple inoculations are given on the same day, children are at no higher risk of developing autism, according to the report published in the Journal of Pediatrics Friday.

“This study looked into the concern that receiving too many vaccines at one doctor’s visit or too many vaccines during the first two years of life may be linked to the development of autism,” the report’s lead author, Dr. Frank DeStefano told NBC chief medical editor Dr. Nancy Snyderman. “We found they’re not related.” 

The CDC researchers conducted the study by reviewing the vaccination histories collected between 1994 and 1999 of 256 children with autism and 752 children who did not have the disorder. They calculated the number of antigens – the substances in a vaccine that stimulate disease-fighting antibodies – that infants are exposed to either on one doctor’s visit or overall during the first two years.

“We did not find any relationship between the number of antigens and the risk of autism,” said DeStafano, Director of the Immunization Safety Office at the CDC.

The CDC study comes amidst reports that increasing numbers of parents are delaying or skipping childhood inoculations, fearing side effects or the risk of autism and other learning disabilities.

A 2012 study, which examined medical records for 97,711 Portland, Oregon children, found an almost four-fold increase between 2006 and 2009 in the percentage of parents who delayed or skipped vaccinations, researchers reported in the journal Pediatrics. Experts say that by delaying certain vaccinations, parents may be putting their children -- and those of others -- at a far greater risk of contracting deadly diseases, such as pneumonia and whooping cough, also known as pertussis. In 2012, the US experienced the worst epidemic of whooping cough in 50 years

That’s a real concern for Dr. Tanya Altmann, an assistant clinical professor at Mattel Children’s Hospital at UCLA.

“Some parents ask about waiting on vaccines and using an alternative or delayed schedule,” because of worries about autism, Altmann told Snyderman.

Altmann tries to remind parents that while they may worry about the unknown, there are real risks to skipping vaccinations or delaying them: outbreaks of severe, sometimes deadly, illnesses.

“The bottom line for parents is that these outbreaks are real and they will come back,” Altmann said.  “These are serious illnesses, meningitis, whooping cough. This study is just one more piece of evidence to reassure parents that vaccines are safe.”

Although inoculation contents and schedules have changed since the study data was collected, Snyderman sees the findings as applicable to today's children since CDC researchers tallied the total amount of antigens  -- bits of protein in a vaccine that spark an immune response -- that each child was exposed to.

“While the CDC now recommends more vaccinations than it did in the 90s, the level of antigens in today’s vaccines is markedly lower than it was when this data was collected,” Snyderman said.

DeStefano hopes the new research will convince parents that it’s safe to follow CDC vaccination schedules.

“The number of vaccines in the current immunization schedule is what’s needed to protect children,” he said. “It’s not too many for a child’s immune system.”

 Related:

Despite evidence, parents' fears of HPV vaccine grows

This year's flu kills at least 110 children; most weren't vaccinated

It’s too early to know how much individual health insurance policies will cost once the online marketplaces created under the Affordable Care Act launch Jan. 1. But that hasn’t stopped experts and interest groups from making predictions.

The latest analysis comes from the Society of Actuaries. It’s attracting attention because of the group’s expertise and nonpartisanship. What actuaries do for a living — predicting future expense based on multiple squishy factors — is at the core of figuring out what will happen under Obamacare.

Thanks to subsidies and the requirement that everybody get insurance or pay penalties, the society forecasts that the number of people covered by individual polices will double to 25.6 million by 2017.

Getting the headlines was the forecast that insurer costs — medical claims per policyholder — will soar, on average, 32 percent for the individual market in 2017, with wide variations among states. That’s not the same thing as saying prices consumers pay for policies will rise 32 percent. But if claims are higher, insurers generally charge more.

Opponents of the health overhaul seized on the figure to suggest the law could really be called the Unaffordable Care Act. The Obama administration says the study leaves out factors that will restrain what plan members actually pay, including more competition among insurance companies.

Kaiser Health News reporter Jay Hancock talked to experts to learn what it means for the consumers the health law was meant to help.

Q: What’s predicted to drive up costs?

A: Many of those seeking coverage in online marketplaces -- known as exchanges -- are expected to be older and sicker. They’ll have more incentive to buy policies, and they’ll tend to increase claims paid by insurers.

On the other hand, “young and healthy people are less likely to be interested in insurance, because they’re less likely to find value,” said Kristi Bohn, a consultant for the Society of Actuaries who worked on the report.

The penalty for not having insurance is likely to be far less than the cost of coverage. The fewer young or healthy people who sign up, the higher the costs per plan member.

The authors also made assumptions about how many employers will cancel their plans. Companies with sicker workforces are predicted to be more likely to end employer-based coverage and steer people toward exchanges.

Q: I get insurance at work, were they talking about my insurance claim costs?

A: No. This report was just about people who buy on the individual insurance market, currently under 10 percent of the country, though that's expected to go up as the law kicks in. The vast majority of Americans get insurance through work or through government programs (Medicare, Medicaid, the military).

Q: Does the study predict health insurance premiums will go up 32 percent by 2017?

No. First, it’s only forecasting the individual insurance market. That’s where millions of Americans newly covered under the ACA are expected to find policies. The report says nothing about costs for employer-based health insurance.

Equally important, the 32 percent forecast is for medical expenses paid by insurers, not what insurers will charge in premiums, and not what consumers will pay.

Q: But if medical claims go up, shouldn't insurance prices also go up? How much difference could there be?

A: In the individual market designed under the health law, quite a bit, say supporters. The ACA limits insurer profits and also gives government regulators oversight of rate increases, both of which could hold premiums down.

Even if sticker prices rise, an important feature of the health law is subsidies for people to buy insurance, through tax credits for those with lower incomes. So what many newly-insured people actually end up paying themselves won’t be the same as what the insurance company bills.

Thanks partly to subsidies, "many people buying individual coverage today will see decreases in costs," said Larry Levitt, senior vice president at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Insurers who end up signing lots of sicker members will also be partly reimbursed for several years by a reinsurance pool designed to lower their risk. That will lower their expenses, and it wasn’t accounted for by the SOA study.

Q: Does it matter where I live?

A: Yes. The report found huge variability, based on geography. While the estimated increase would be 62 percent for California by 2017, in New York state, the report estimates claim costs to drop by almost 14 percent.

Q: Will health plans offer the same coverage in 2017 that they do now?

A: That’s another reason the 32-percent headline could be misleading. Thanks to ACA minimum coverage requirements, benefits will be more generous starting next year. So what insurers pay in claims can expected to be higher, too.

“The number of people who are underinsured has grown dramatically over the last decade,” said Sara Collins, a vice president at the Commonwealth Fund. "One reason claims might be a lot lower now is the benefit package is so crummy.”

The health law was intended to shift spending into the commercial insurance system that is now outside it: high out-of-pocket costs for those in low-benefit plans; uncompensated emergency-room care; patients paying in cash, and so forth. Moving those costs under the insurance umbrella increases insurance-based spending.

Q: The idea of the insurance exchanges is to create competition, isn't that supposed to lower costs?

A: Yes. The idea behind state health exchanges is that insurers will compete for business by pressing providers for discounts and passing part of the savings to members. The actuary study didn’t account for that kind of competition.

"Every insurer I’ve talked to says they’re building lower-cost networks that they plan to use for their exchange plans," said Levitt.

Q: Does this mean costs in the health exchanges aren't a concern?

A: No. Many consumers will pay more in premiums to get more in benefits. The high cost of medicine could mean that, even for those getting big subsidies, affordability will be an issue.

Many consumers "will be moving into a really fully insured product for the first time, so there may be a higher cost associated with getting into that market," Health and Human Services Secretary Kathleen Sebelius said this week.

Related stories:

Health reform turns 3, with the hardest part yet to come

Florida governor expands Medicaid

Few may pay for skipping health insurance

Feds set to run most health insurance exchanges

States get more time for health exchange plans

By Debra Sherman
Reuters

Some of the most popular prescription drugs that recently became available in generic form are sold at the lowest prices at Costco and at the highest prices at CVS Caremark, according to an analysis by Consumer Reports. 

Failing to comparison shop for drugs - such as generic Lipitor to lower cholesterol or generic Plavix to thin the blood - could result in overpaying by $100 a month or even more, depending on the drug, the report said.

The article will be available in the May issue of Consumer Reports.

Consumers may find good deals at local independent pharmacies, Consumer Reports said.

One of the big takeaway messages from the analysis is that the customer must ask the pharmacist for the best price, the publication said.

"Especially for the independent pharmacies, if they want to retain your business and loyalty, they will help you get the best price," Lisa Gill, an editor at Consumer Reports, said.

One reason for the wild cost fluctuations may be that different types of stores have different business incentives, she said.

"It really comes down to a store's business model. For example, big box stores tend to use their pharmacies as a way to get consumers through the door with the expectation that they'll buy other things," Gill added.

Victor Curtis, senior vice president of pharmacy for Costco, said the retailer does not sell below costs and that its pharmacy is a contributor to Costco's overall profitability.

Consumer Reports conducted its analysis by using "secret shoppers" who called more than 200 pharmacies throughout the United States to get retail prices, without using insurance, on a month's supply of five blockbuster drugs that have recently become available as generics.

The drugs were diabetes drug Actos (pioglitazone); antidepressant Lexapro (escitalopram); cholesterol fighter Lipitor (atorvastatin); blood thinner Plavix (clopidogrel); and asthma drug Singulair (montelukast).

There was a difference of $749 between the highest and lowest priced stores. 

For example, one month's supply of generic Lipitor costs $17 at Costco, Consumer Reports' secret shoppers found. The same drug cost $150 at CVS. Rite Aid and Target had similarly high prices.

Consumer reports recommends getting refills for 90 days instead of 30 days, as most pharmacies offer discounts on a 3 months' supply.

The crisp, stucco exterior of an Oklahoma dental clinic concealed what health inspectors say they found inside: rusty instruments used on patients with infectious diseases and a pattern of unsanitary practices that put thousands of people at risk.

State and local health officials planned to mail notices Friday urging 7,000 patients of Dr. W. Scott Harrington to seek medical screenings for hepatitis B, hepatitis C and HIV. Inspectors allege workers at his two clinics used dirty equipment and risked cross-contamination to the point that the state Dentistry Board branded Harrington a "menace to the public health."

"The office looked clean," said Joyce Baylor, who had a tooth pulled at Harrington's Tulsa office 1½ years ago. In an interview, Baylor, 69, said she'll be tested next week to determine whether she contracted any infection.

"I'm sure he's not suffering financially that he can't afford instruments," Baylor said of Harrington.

Health officials opened their investigation after a patient with no known risk factors originally tested positive for both hepatitis C and HIV, the virus that causes AIDS. Further testing determined that the "index patient" was not actually positive for HIV, although was positive for Hep C, the Oklahoma Dept. of Health said Friday. Because Hep B, C and HIV are all bloodborne viruses, officials are still testing Harrington's patients for HIV, as well as Hep B and C.

The investigation began when it was learned the "index patient" had a dental procedure about the likely time of exposure. Investigators visited Harrington's office and found a number of unsafe practices, state epidemiologist Kristy Bailey said.

"I want to stress that this is not an outbreak. The investigation is still very much in its early stages," Bailey said.

Harrington voluntarily gave up his license, closed his offices in Tulsa and suburban Owasso, and is cooperating with investigators, said Kaitlin Snider, a spokeswoman for the Tulsa Health Department. He faces a hearing April 19, when his license could be permanently revoked.

"It's uncertain how long those practices have been in place," Snider said. "He's been practicing for 36 years."

The Centers for Disease Control and Prevention is consulting on the case, and agency spokeswoman Abbigail Tumpey said such situations involving dental clinics are rare. Last year a Colorado oral surgeon was accused of reusing needles and syringes, prompting letters to 8,000 patients, Tumpey said. It wasn't clear whether anyone was actually infected.

"We've only had a handful of dental facilities where we've had notifications in the last decade," Tumpey said.

The Oklahoma Dentistry Board lodged a 17-count complaint against Harrington, saying he was a "menace to the public health by reasons of practicing dentistry in an unsafe or unsanitary manner." Among the claims was one detailing the use of rusty instruments in patients known to have infectious diseases.

"The CDC has determined that rusted instruments are porous and cannot be properly sterilized," the board said.

Health officials are sending letters to 7,000 known patients but cautioned that they don't know who visited his clinics before 2007. The letters urge the patients to be tested for hepatitis B, hepatitis C and HIV — viruses typically spread through intravenous drug use or unprotected sex, not occupational settings.

Harrington could not be reached for comment Thursday. A message at his Tulsa office said it was closed, and the doctor's answering service referred callers to the Tulsa Health Department. Phone numbers listed for Harrington were disconnected. A message left with Harrington's malpractice attorney in Tulsa, Jim Secrest II, was not immediately returned.

Harrington's Tulsa practice is in a thriving part of town, on a row of some of medical practices. The white-and-green stucco, two-story dental clinic has the doctor's name in letters on the facade.

NBCLatino: You may have Hep C and not know it

According to the complaint, the clinic had varying cleaning procedures for its equipment, needles were re-inserted in drug vials after their initial use and the office had no written infection-protection procedure.

Harrington told officials he left questions about sterilization and drug procedures to his employees.

"They take care of that, I don't," the dentistry board quoted him as saying.

The doctor also is accused of letting his assistants perform tasks only a licensed dentist should have done, including administering IV sedation. Also, the complaint says the doctor's staff could not produce permits for the assistants when asked.

Susan Rogers, executive director of the state Dentistry Board, said that as an oral surgeon Harrington regularly did invasive procedures involving "pulling teeth, open wounds, open blood vessels." The board's complaint also noted Harrington and his staff told investigators a "high population of known infectious disease carrier patients" received dental care from him.

Despite the high-risk clientele, a device used to sterilize instruments wasn't being properly used and hadn't been tested in six years, the board complaint said. Tests are required monthly.

Also, a drug vial found at a clinic this year had an expiration date of 1993 and one assistant's drug log said morphine had been used in the clinic last year despite its not receiving any morphine shipments since 2009.

Officials said patients will be offered free medical testing at the Tulsa Health Department's North Regional Health and Wellness Center.

Related:

Dental chain accused of hurting kids, bilking taxpayers

This story was originally published on Thu Mar 28, 2013 4:06 PM EDT

AP

A scene from a Hoveround commercial. Ads for motorized scooters are coming under increased scrutiny for creating the false impression that they're a convenient way to get around, not a medical necessity.

TV ads show smiling seniors enjoying an "active" lifestyle on a motorized scooter, taking in the sights at the Grand Canyon, fishing on a pier and high-fiving their grandchildren at a baseball game.

The commercials, which promise freedom and independence to people with limited mobility, have driven the nearly $1 billion U.S. market for power wheelchairs and scooters. But the spots by the industry's two leading companies, The Scooter Store and Hoveround, also have drawn scrutiny from doctors and lawmakers, who say they create the false impression that scooters are a convenient means of transportation rather than a medical necessity.

Members of Congress say the ads lead to hundreds of millions of dollars in unnecessary spending by Medicare, which is only supposed to pay for scooters when seniors are unable to use a cane, walker or regular wheelchair. Government inspectors say up to 80 percent of the scooters and power wheelchairs Medicare buys go to people who don't meet the requirements. And doctors say more than money is at stake: Seniors who use scooters unnecessarily can become sedentary, which can exacerbate obesity and other disorders.

"Patients have been brainwashed by The Scooter Store," says Dr. Barbara Messinger-Rapport, director of geriatric medicine at the Cleveland Clinic. "What they're implying is that you can use these scooters to leave the house, to socialize, to get to bingo."

The scooter controversy, which has escalated with a government raid on The Scooter's Store's New Braunfels, Texas, headquarters last month, underscores the influence TV ads can have on medical decisions. Like their peers in the drug industry, scooter companies say direct-to-consumer advertising educates patients about their medical options. But critics argue that the scooter spots are little more than sales pitches that cause patients to pressure doctors to prescribe unnecessary equipment.

The Scooter Store and Hoveround, both privately held companies that together make up about 70 percent of the U.S. market for scooters, spent more than $180 million on TV, radio and print advertising in 2011, up 20 percent since 2008, according to advertising tracker Kantar Media. Their ads often include language that the scooters can be paid for by Medicare or other insurance: "Nine out of ten people got them for little or no cost," states one Hoveround ad.

Hoveround did not respond to a half-dozen requests for comment. The Scooter Store, the nation's biggest seller of scooters, said that most people who contact the company after seeing the ads do not ultimately receive a scooter.

"The fact that 87 percent of the persons who seek power mobility products from The Scooter Store under their Medicare benefits are disqualified by the company's screening process is powerful evidence of the company's commitment to ensuring that only legitimate claims are submitted to Medicare," the company said in a statement. The Scooter Store has been operating with a streamlined staff in recent days, following massive layoffs in the wake of the raid by federal agents.

Insurance executives say doctors who don't understand when Medicare is supposed to pay for scooters are partly to blame for unnecessary purchases.

Scooters — which are larger than power wheelchairs and often include a handlebar for steering — are covered by Medicare if they are prescribed by a doctor who has completed an evaluation showing that their patient is unable to function at home without a device.

The doctor fills out a lengthy prescription form and sends it to a scooter supplier that delivers the device to the patient and then submits the paperwork to Medicare for payment. Medicare pays about 80 percent of that cost, which can range from $1,500 to $3,500. The remainder is often picked up by supplemental insurance or the government-funded Medicaid program for low-income and disabled Americans.

The process can help immobile seniors get equipment that improves their lives. Ernest Tornabell of Boynton Beach, Fla., received a scooter from Pride, a smaller manufacturer, through Medicare about six years ago. The 73-year-old suffers from obesity, diabetes and lung disease and says he used to never leave his house. Now, using the scooter he can walk his dog, go to the grocery store and run other errands.

"I couldn't really get out and do anything before. Now I have a lot more mobility," said Tornabell, whose doctor recommended that he get the device.

But Dr. Stephen Peake, medical director for the insurer Blue Cross Blue Shield in Tennessee, says doctors can often be as uninformed about the appropriate role of scooters as patients.

"I talk to a lot of physicians about this subject ... and after our discussions, they don't understand that you can't get a power mobility device so mom can go to the park with the family," Peake said in testimony before the Senate Committee on Aging last year.

One reason for the confusion? Doctors say scooter companies are just as aggressive with health professionals as they are in marketing to their patients.

Dr. Jerome Epplin of Litchfield, Ill., who also testified before the Senate, estimates that only about one out of every 10 patients who ask him for a scooter actually needs one. But he said that sales representatives from some scooter companies put pressure on him by accompanying patients to his office. The effect is coercive, he says.

"It can be intimidating," Epplin says. "I see it as an inappropriate attempt to influence my clinical judgment when I'm evaluating a patient."

Allegations of Medicare fraud within the industry go back nearly a decade.

In 2005 the U.S. Justice Department sued The Scooter Store, alleging that its advertising enticed seniors to obtain power scooters paid for by Medicare, and then sold patients more expensive scooters that they did not want or need. The Scooter Store settled that case in 2007 for $4 million.

As part of the settlement, The Scooter Store was operating under an agreement that made the company subject to periodic government reviews between 2007 and last year. In 2011, the latest review available, government auditors estimated that The Scooter Store received between $47 million and $88 million in improper payments for scooters.

The Scooter Store took no action to repay the money until February 2012, when the Health and Human Services' inspector general threatened to bar the company from doing business with Medicare, which accounts for about 75 percent of its income, according to its congressional testimony.

The company said the government's estimate was flawed and that it was willing to repay $19.5 million in overpayments. The company has paid about $5.7 million, with the rest scheduled for repayment over a 5-year period to be completed in 2017.

Medicare said in a January letter that it accepted the fee based on The Scooter Store's own assessment of what it owed, but that the agreement "does not absolve The Scooter Store from any further liability."

In recent months Sen. Richard Blumenthal, D-Conn. and other members of the Senate Aging Committee have pushed Medicare to recover the millions of dollars spent on unnecessary scooters each year. Those purchases totaled about $500 million in 2011, the latest year available, according to a report by the Department of Health and Human Services' inspector general.

Medicare, which says that it does not have control over how companies market chairs, launched a pilot program designed to reduce wasteful spending on scooters.

Under the program, government contractors in seven states review patients' medical documentation to make sure they need a wheelchair or scooter before approving payments for a device. The program is being tested in a small number of states — including Florida, California and New York — because the government must pay contractors extra to review additional paperwork.

The program has been criticized by The Scooter Store's executives, who say that contractors are too strict in their reviews, rejecting payments for power chairs that are genuinely needed.

The reduced payments are taking a toll on the company, which was founded in 1991. The Scooter Store has spent nearly $1 million lobbying Congress over the last two years, almost exclusively focused on the Medicare review program. And the company laid off about 370 employees in the past year, blaming the reduced payments it's been getting from Medicare.

Then, last week, The Scooter Store notified most of its remaining 1,800 employees that their jobs were being eliminated. The company said in a statement to the Associated Press that it is operating with a workforce of 300 employees — down from the 2,500 workforce it had at its peak — while trying to restructure its operations.

The mass layoffs followed a raid in February by about 150 agents from the FBI, the Department of Justice and the Texas attorney general's Medicaid fraud unit at the company's headquarters.

Federal authorities have declined to speak about the raid, but scooter industry critics in Congress praised the action.

"This raid is a welcome step toward cracking down on waste and fraud in Medicare," said Blumenthal, the Connecticut senator. "I have urged action to stop abusive overpayments for such devices — costing taxpayers hundreds of millions of dollars and preying on seniors with deceptive sales pitches."

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A nasty fungal infection that can spread to the lungs or brain and cause lifetime symptoms is on the rise in the Southwestern U.S., federal health officials reported on Thursday.

Cases of Valley Fever, known medically as coccidioidomycosis, have increased nearly 10-fold between 1998 and 2011, the Centers for Disease Control and Prevention reports.

“Cases in Arizona, California, Nevada, New Mexico and Utah rose from 2,265 in 1998 to more than 22,000 in 2011,” CDC said in a statement.

"Health-care providers should be aware of this increasingly common infection when treating persons with influenza-like illness or pneumonia who live in or have traveled to endemic areas," the agency says in its weekly report on death and disease.

Valley Fever causes at the most mild-flu-like symptoms in most health people, but the fungus can spread and take hold in unlucky victims, requiring a lifetime of antifungal drugs and sometimes even surgery to removed growths of fungus.

“More than 40 percent of patients who get ill from Valley Fever may require hospitalization at some point, with an average cost of nearly $50,000 per hospital visit,” CDC says.

The infection is caused by a fungus called Coccidioides. It lives naturally in the soil, and becomes airborne when dirt or sand is disturbed. Winds can carry the spores far aloft, and people breathe them in unknowingly.

“Because fungus particles spread through the air, it’s nearly impossible to completely avoid exposure to this fungus in these hardest-hit states,” CDC Director Dr. Tom Frieden said in a statement.

“It’s important that people be aware of Valley Fever if they live in or have travelled to the southwest United States.” Antibiotics or antiviral drugs will do nothing to help treat a fungal infection.

CDC and state health officials checked disease surveillance data to see if cases were on the rise. They found that cases of Valley Fever went up 16 percent a year between 1998 and 2011 in Arizona and rose 13 percent a year in California.  More than 90 percent of cases are reported these two states.

“It’s difficult to say what’s causing the increase,” said Dr. Benjamin Park, chief epidemiologist  at CDC’s Mycotic Diseases Branch. “This is a serious and costly disease and more research is needed on how to reduce its effects.” It might be that people are just noticing and reporting it more, or perhaps weather changes are helping to stir up the spores, CDC said.

CDC says 30 percent to 60 percent of people who live in a region where the fungus is entrenched will breathe it in at some point. An estimated 150,000 people are infected every year but many don’t know they have anything other than a cold, and they get better on their own. The elderly and other people with weakened immune systems, such as HIV patients, are especially vulnerable.

According to the University of Arizona, 60 percent of those infected don’t suffer any symptoms, and another 30 percent have just mild to moderate infections. But 5 percent to 10 percent suffer complications, and 1 percent of victims die.

If it does spread, it’s usually to the skin, where it can cause purplish bumps that turn brown.

In people who develop pneumonia, the fungus can form nodules that cause no symptoms but which can look like lung cancer on an x-ray. A very few patients can also develop what are called cavities in the lung, which can cause chest pain and difficulty breathing. They require surgery to fix.

If it spreads to the brain or spinal cord it can cause meningitis, a potentially deadly condition that requires immediate treatment.

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AP

Terrie Hall, a 52-year-old throat cancer survivor, lost her voice box.

Government health officials launched the second round of a graphic ad campaign Thursday that is designed to get smokers off tobacco, saying they believe the last effort convinced tens of thousands to quit.

The ads feature sad, real-life stories: There is Terrie, a North Carolina woman who lost her voice box. Bill, a diabetic smoker from Michigan who lost his leg. And Aden, a 7-year-old boy from New York, who has asthma attacks from secondhand smoke.

"Most smokers want to quit. These ads encourage them to try," said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention.

The CDC campaign cost $48 million and includes TV, radio and online spots as well as print ads and billboards.

The spending comes as the agency is facing a tough budget squeeze, but officials say the ads should more than pay for themselves by averting future medical costs to society. Smoking is the leading cause of preventable illness and death in the United States. It's responsible for the majority of the nation's lung cancer deaths and is a deadly factor in heart attacks and a variety of other illnesses.

Last year's similar $54 million campaign was the agency's first and largest national advertising effort. The government deemed it a success: That campaign triggered an increase of 200,000 calls to quit lines. The CDC believes that likely prompted tens of thousands of smokers to quit based on calculations that a certain percentage of callers do actually stop.

Like last year, the current 16-week campaign spotlights real people who were hurt and disfigured by smoking. Terrie Hall, a 52-year-old throat cancer survivor makes a repeat performance. She had her voice box removed about a dozen years ago.

AP

The new campaign focuses more toward the impact smokers have on others.

In last year's ad there's a photo of her as a youthful high school cheerleader. Then she is seen more recently putting on a wig, inserting false teeth and covering the hole in her neck with a scarf. It was, by far, the campaign's most popular spot, as judged by YouTube viewings and Web clicks.

In a new ad, Hall addresses the camera, speaking with the buzzing sound of her electrolarynx. She advises smokers to make a video of themselves now, reading a children's book or singing a lullaby. "I wish I had. The only voice my grandson's ever heard is this one," her electric voice growls.

One difference from last year: The new campaign tilts more toward the impact smokers have on others. One ad features a Kentucky high school student who suffers asthma attacks from being around cigarette smoke. Another has a Louisiana woman who was 16 when her mother died from smoking-related causes.

The return of the campaign is already being applauded by some anti-smoking advocates, who say tobacco companies spend more on tobacco product promotion in a week than the CDC spends in a year.

After decades of decline, the adult smoking rate has stalled at roughly 20 percent in recent years. Advocates say the campaign provides a necessary jolt to a weary public that has been listening to government warnings about the dangers of smoking for nearly 50 years.

"There is an urgent need to continue this campaign," said Matthew Myers, president of the Campaign for Tobacco-Free Kids, in a statement.

It would seem like a bad time for the CDC to be buying air time — the agency is facing roughly $300 million in budget cuts as part of the government's sequestration cuts in federal spending. However, the ad money comes not from the CDC's regular budget but from a special $1 billion public health fund set up years ago through the Affordable Care Act. The fund has set aside more than $80 million for CDC smoking prevention work.

Frieden argues that the ads are extremely cost-effective — spending about $50 million a year to save potentially tens of thousands of lives.

"We're trying to figure out how to have more impact with less resources," he said.

The ads direct people to call 1-800-QUIT-NOW. PlowShare Group, of Stamford, Conn., is again the advertising company that put the ads together.

Related:

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Why young smokers should quit before turning 44

The menus offered to children by most U.S. restaurant chains have too many calories, too much salt or fat, and often not a hint of vegetables or fruit, according to a study by the Center for Science in the Public Interest.

The group, which has agitated for everything from healthier popcorn at the movies to calorie labeling in supermarkets, found that among almost 3,500 combinations surveyed, kids' meals failed to meet nutritional standards 97 percent of the time.

That was a marginal improvement over 2008 when such meals failed to meet standards 99 percent of the time.

Every children's meal offered at popular chains such as Chipotle Mexican Grill, Dairy Queen, Hardee's, McDonald's, Panda Express, Perkins Family Restaurants and Popeyes fell short of standards adopted by the center from the U.S. Department of Agriculture's nutritional recommendations.

The meals also fell short of standards set by the National Restaurant Association's Kids LiveWell Program, said the CSPI, which titled its study, "Kids' Meals: Obesity on the Menu."

"Most chains seem stuck in a time warp, serving up the same old meals based on chicken nuggets, burgers, macaroni and cheese, fries, and soda," said Margo Wootan, CSPI nutrition policy director. "It's like the restaurant industry didn't get the memo that there's a childhood obesity crisis."

Among the meals singled out was Applebees' grilled cheese sandwich on sourdough bread, fries and two percent chocolate milk, which has 1,210 calories, 62 grams of fat and 2,340 milligrams of sodium.

The combo meal had nearly three times as many calories as the CSPI's criteria for four- to- eight-year-olds suggest.

At Ruby Tuesday, the macaroni and cheese, white cheddar mashed potatoes and fruit punch combo has 870 calories, 46 grams of fat and 1700 milligrams of sodium, said Wootan.

The U.S. Centers for Disease Control and Prevention has recommended that children eat no more than 2,300 milligrams of salt each day to avoid high blood pressure, which can lead to coronary disease, stroke and other ailments.

Being overweight as a child makes a person vulnerable to heart disease, diabetes and a shortened life span. About one-third of American children are now considered overweight and 17 percent are considered obese, according to USDA's Dietary Guidelines for Americans.

The CSPI cited Subway restaurants' Fresh Fit For Kids meal combinations as exceptions to the salty, fatty norm.

Subway serves apple slices with its kid-sized sub sandwiches and offers low-fat milk or bottled water instead of soda. All eight of its children's meals met CSPI's nutrition criteria.

A few other establishments have begun to offer side dishes beyond French fries. In fact, every child's meal at Longhorn Steakhouse now comes with fruit or a vegetable.

"More chains are adding fruit, like apple slices, to their menus, but practically every chain could be adding more vegetable and whole grain options," said Ameena Batada, an assistant professor in the Department of Health and Wellness at the University of North Carolina Asheville.

Labeling can be a potent tool. The report cited two studies that indicated customers who are provided with calorie counts on the menu sometimes gravitate toward healthier choices.

To produce its study, the CSPI looked at 50 top U.S. chain restaurants, finding 34 of them had meals designed for children and were willing to provide nutritional data. It analyzed those meals and meal combinations.

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Quality prekindergarten programs can boost children’s school skills whether the kids come from poor or well-off homes, a new study shows.

While most previous studies had focused only on kids from underprivileged backgrounds, in the new study Harvard researchers found that regardless of family income children who got a year of quality prekindergarten did better in reading and math than kids who spent the year in daycare, with relatives, or in some other kind of preschool, according to the report which was published in Child Development. 

As a further benefit, the kids who spent a year in preschool developed better “executive functioning.”

That means is that they had developed the skills needed to take advantage of what is being taught in school, said the report’s lead author Christina Weiland, a researcher at Harvard when the study was done and currently an incoming assistant professor at the University of Michigan.

“For example, they’ve learned that they need to raise their hands before yelling out an answer,” she explained. “They’ve gotten better at keeping numbers in their heads when doing a math problem and remembering the teacher’s instructions. They’ve gotten better at shifting their attention from a distracting peer to what the teacher is saying.”

Those kinds of self-regulatory behaviors are highly predictive of how well you do later in life, Weiland said. 

There were some kids who benefited more than others from prekindergarten: Latino children, and to a lesser extent, Asian and African American children.

Weiland was able to study the impact of preschool in a sort of “natural” experiment. In Boston, kids qualify for a free, full-day preschool program during the school year if they turn 4  by Sept. 1.

Children born after that date must wait a year before they are eligible.

For the study, Weiland tested 969 kids who'd finished a full school year of preschool in 2008-2009 and compared them 1,049 kids who weren't quite old enough to have made the previous year's cutoff and so were just starting preschool. (Many of them had spent that year in daycare and being cared for by relatives or in other preschool programs.)

Experts unaffiliated with the new research welcomed the new report.

“I think this is a very important study since the effects weren’t just in children at a lower economic level,” said Patrick Tolan, a professor in the Curry School of Education and director of the Youth-Nex Center at the University of Virginia. “Just as important, though, is the implication that the boost in skills may very much depend on having high quality staff and using programs that have been empirically tested.”

Matia Finn-Stevenson, a research scientist and associate director of the Zigler Center in Child Development and Social Policy and director of the School of the 21st Century at Yale University, agreed that the quality of the program is all important.

“In this study the children were in a high-quality educational environment with teachers with masters degrees, teachers receiving coaching, etc.,” she said. “I know parents who are not satisfied with their PreK and they have told me they simply have to look the other way and not make waves because they have no alternatives.”

How can parents figure out whether their PreK program is good?

Finn-Stevenson suggests that “parents should look for a place that allows parents to come in at any time to see the PreK in action. Look for staff continuity – how long have they been at the school/program? How often and in what ways do they interact with the children? What is the overall atmosphere? How are the children interacting?”

One thing that’s unclear at this point is whether the gains in PreK will carry over into later years. That’s a topic that still needs to be researched, Tolan said.

More and more people are surviving cancer, thanks to earlier detection and better treatment, and a new report out Wednesday projects the ranks of cancer survivors will grow by nearly a third over the next 10 years.

That’s the good news. The bad news: these 18 million cancer survivors are going to cost the health system a lot of money.

“The increase in the number of survivors will be due primarily to an aging of the population. By 2020, we expect that two-thirds of cancer survivors are going to be age 65 or older,” says Julia Rowland of the National Cancer Institute, which conducted the study.

The NCI says 13.7 million people had survived cancer and were still alive in the U.S. as of Jan. 1, 2012. Nearly two-thirds of them were considered "cured,” having survived five years or more. Forty percent had survived 10 years and 15 percent had lived 20 years past their diagnosis.

“Over the next decade, the number of people who have lived five years or more after their cancer diagnosis is projected to increase approximately 37 percent to 11.9 million,” Rowland’s team writes in the journal Cancer Epidemiology, Biomarkers & Prevention.

Patients with some cancers have an especially rosy outlook. “For patients with prostate cancer, we have a nearly 100 percent five-year survival rate, and breast cancer has made tremendous strides as well, with five-year survival rising from 75 percent in 1975 to almost 89 percent in 2012,” said Rowland.

Related: New gene discoveries help ID cancer risk

“However, we clearly need to have better diagnostic tools and better treatments for lung cancer.” Only 15 percent of lung cancer patients live five years, mostly because the symptoms are so vague that people are not usually diagnosed until it has spread.

The big growth in survivorship is only partly driven by better treatments. A bigger factor is the aging of the population, the report says.

Many studies have shown that cancer patients rarely return to full, 100 percent health. The surgery, radiation and chemotherapy that can save their lives takes a toll on their bodies, raising the risk both for second cancers and for other diseases such as heart disease.

“The growing population of cancer survivors will put pressure on a healthcare system in which cancer drug shortages are increasingly common and the demand for oncology services is poised to outpace the supply of oncologists,” the researchers write.

“The growing number of older survivors also presents a unique challenge to the healthcare system because older cancer survivors are more likely to have multiple chronic diseases and tend to experience poorer physical functioning than younger survivors.”

That means a lot of expense. “By 2020, it is estimated that population growth alone will escalate annual costs of cancer care by 27 percent,” the researchers wrote,  citing a 2011 study in the Journal of the National Cancer Institute.

“Among survivors who are more than one year post-diagnosis, annual healthcare expenditures are double that of the general population, suggesting that the economic burden of cancer in terms of medical expenditures is both considerable and persistent.”

Cancer is the No. 2 cause of death in the United States, after heart disease,  killing more than 500,000 people a year.

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The logic behind weight-loss surgery seems simple: rearrange the digestive tract so the stomach can hold less food and the food bypasses part of the small intestine, allowing fewer of a meal's calories to be absorbed. Bye-bye, obesity.

A study of lab mice, published on Wednesday, begs to differ. It concludes that one of the most common and effective forms of bariatric surgery, called Roux-en-Y gastric bypass, melts away pounds not - or not only - by re-routing the digestive tract, as long thought, but by changing the bacteria in the gut.

Or, in non-scientific terms, the surgery somehow replaces fattening microbes with slimming ones.

If that occurs in people, too, then the same bacteria-changing trick achieved by gastric bypass might be accomplished without putting obese patients under the knife in an expensive and risky operation.

"These elegant experiments show that you can mimic the action of surgery with something less invasive," said Dr. Francesco Rubino of Catholic University in Rome and a pioneer in gastric-bypass surgery. "For instance, you might transfer bacteria or even manipulate the diet" to encourage slimming bacteria and squelch fattening kinds, said Rubino, who was not involved in the study.

For many obese patients, particularly those with type 2 diabetes, gastric bypass has succeeded where nothing else has. Severely obese patients routinely lose 65 to 75 percent of their excess weight and fat after the operation, studies show, and leave their diabetes behind.

Oddly, however, the diabetes remission often occurs before significant weight loss. That has made bypass surgeons and weight-loss experts suspect that Roux-en-Y changes not only anatomy but also metabolism or the endocrine system. In other words, the surgery does something besides re-plumb the gut.

That "something," according to previous studies, includes altering the mix of trillions of microbes in the digestive tract. Not only are the "gut microbiota" different in lean people and obese people, but the mix of microbes changes after an obese patient undergoes gastric bypass and becomes more like the microbiota in lean people.

Researchers did not know, however, whether the microbial change was the cause or the effect of post-bypass weight loss.

That is what the new study, by researchers at Massachusetts General Hospital and Harvard University, set out to answer.

They first performed Roux-en-Y on obese mice. As expected, the animals quickly slimmed down, losing 29 percent of their weight and keeping it off, the researchers report in the journal Science Translational Medicine.

To make sure there was not something about the general experience of surgery, rather than gastric bypass specifically, that affected the animals, the scientists performed sham Roux-en-Y on other obese mice. In this procedure, the researchers made incisions as if they were going to do a gastric bypass, but instead connected everything up as nature had it.

The researchers then transferred gut microbiota from the Roux-en-Y mice to microbe-free obese mice. Result: the recipient mice lost weight and fat - no surgery required. Crucially, obese mice that received gut bugs from mice that had received sham Roux-en-Y, not the real thing, did not slim down.

It is the first experimental evidence that changes in the gut microbiota cause the weight loss after gastric bypass, and that the new, post-bypass mix of microbes can cause weight loss in animals that did not have surgery.

In particular, just a week after surgery the Roux-en-Y mice harbored relatively more of the same types of bacteria that become more abundant in people after gastric bypass and that lean people have naturally.

"The effects of gastric bypass are not just anatomical, as we thought," said Dr. Lee Kaplan, senior author of the study and associate professor of medicine at Harvard Medical School. "They're also physiological. Now we need to learn more about how the microbiota exert their effects."

Slimming bacteria work their magic in either of two ways, studies of gut microbiota show. They seem to raise metabolism, allowing people to burn off a 630-calorie chocolate chip muffin more easily.

They also extract fewer calories from the muffin in the first place. In contrast, fattening bacteria wrest every last calorie from food.

Transferring slimming bacteria into obese people might be one way to give them the benefits of weight-loss surgery without an operation. It might also be possible to devise a menu that encourages the proliferation of slimming bacteria and reduces the population of fattening bacteria.

Another new study published this week found people might be able to find out if they have slimming gut germs or fattening one using a breath test.

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A batch of new gene discoveries nearly doubles the number of genes known to cause three of the most common cancers – breast cancer, prostate cancer and ovarian cancer. While each gene alone affects only a small number of people, taken together they help explain one-third of cases of these cancers, researchers reported on Wednesday.

It took a giant study to find all the genes – nearly 200,000 people took part at 160 institutions. The findings can not only help doctors decide who needs more frequent screening for cancer, but may eventually help target treatments that will work better for particular patients, the researchers said.

People with several of the genetic changes linked with cancer will have a much higher-than-average risk of the cancers, the researchers said. They published their findings in a series of 13 papers in several medical journals, including Nature Genetics and Nature Communications.

“By looking for people who carry most of these variations we will be able to identify those who are at the greatest risk of getting these cancers and then targeting screening tests to these individuals,” said Douglas Easton of Britain’s University of Cambridge, who led some of the studies.

“We now have 76 common genetic variants which are associated with breast cancer risk,” Easton told a news conference. Combined with other research, including the well-known breast cancer genes BRCA1 and BRCA2, genetic susceptibility explains 40 percent of breast cancer cases, he said.

“Any one of those (variants) is so tiny they don’t affect much,” Dr. Fergus Couch of the Mayo Clinic in Rochester, Minn., who worked on the project, told NBC News. “But when we put them together into a complex model … It’s the power of everything together that can make a difference.”

The researchers found 23 new genes linked with prostate cancer and three more for ovarian cancer. Now researchers know about 78 different genes associated with higher prostate cancer risk, and 16 of them are associated with aggressive disease.

The three cancers affect 2.5 million people globally, killing about a third of them. They all are driven by hormones.

“The most immediate practical application is probably going to be for women already at high risk of (breast cancer),” Easton said. A woman with a BRCA1 or BRCA2 mutation already has a very high chance of breast cancer. If she also has one or more of these other alterations, she’s at even higher risk.

Women who have a BRCA1 mutation along with most of the other, newly discovered mutations have an 80 percent chance of developing breast cancer by age 80, the researchers found.

“The 1 percent of people who have lots of these alterations could see their risk of developing prostate cancer increase by nearly 50 percent and breast cancer by 30 percent,” Easton said.

People may soon be able to take a genetic test to see what their risk is. They could then opt for early screening to watch for the disease. “This will be ready for prime time in a little more than a year,” Couch predicted.

Right now, guidelines vary on when women should get mammograms, for instance. Some guidelines call for annual screening starting at age 50; others say women only need them every two years.

A woman with a high genetic risk might opt to start having mammograms at age 30 or younger. There’s also confusion around testing for prostate cancer. U.S. experts say men shouldn’t be routinely screened using a blood test called a PSA test, because it causes too many “false positives” – when men are initially told they may have cancer but it turns out they don’t.

But men with a high genetic risk might opt to have frequent PSA tests.

“These results are the single biggest leap forward in finding the genetic causes of prostate cancer yet made,” said Rosalind Eeles  of Britain’s Institute of Cancer Research.

“They allow us, for the first time, to identify men who have a very high risk of developing prostate cancer during their lifetime,” she added.

The genes play a variety of roles in cancer. Some are supposed to stop the out-of-control growth that marks a tumor; some help cancer cells spread.

Related:

• New gene clues found for 4 types of breast cancer
• Cancer prevention through gene testing
• "Pap" test possible for ovarian cancer

A government watchdog has issued a warning about the risk for fraud when doctors buy an ownership interest in a medical device distributor and then share in its profits from sales to hospitals.

In a report on Tuesday, the Office of Inspector General said its longstanding guidance "makes clear that the opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the anti-kickback statute."

The regulator was addressing physician owned distributors, or PODs, which are most commonly used in orthopedics.

"The anti-kickback statute is violated if even one purpose of the remuneration is to induce such referrals" by healthcare professionals in PODs, the report said.

The language in the report "can't get any more damning," said Cowen & Co analyst Dr. Josh Jennings."

He said PODs mostly involved small, private companies that manufacture orthopedic and spinal devices.

The government report will discourage hospitals to use PODs, even if they save money, and probably keep physicians from joining PODs even if they can make more money by doing so, he added.

There had been some attempts to expand PODs into the joint reconstruction area and even cardiac devices, but this report will probably stall those efforts, Jennings said.

In a research note, Wells Fargo said it believed the OIG was taking a critical view of the POD business model and that any curtailment of PODs would be a positive development for Medtronic Inc, Johnson & Johnson, Nuvasive Inc and other large manufacturers of spinal devices.

These big companies do not participate in PODs.

Related:

Fewer dying in hospitals, more at home

Health reform turns 3, with the hardest part yet to come

Flying Colours Ltd / Getty Images

Fewer patients may be dying in hospitals, but that doesn't necessarily mean they are getting better. More may be dying in hospices or nursing homes or even at home, experts say.

The number of people who died in the hospital has fallen just 8 percent over 10 years, despite a big emphasis on letting people die in hospice or even at home, new federal statistics show.

And a lot of the decrease appears to be from an overall drop in many types of death, the new report from the National Center for Health Statistics shows.

“People don’t want to die in the hospital – yet a lot of them are,” says NCHS’s Margaret Jean Hall, who led the study with colleagues Shaleah Levant and Carol DeFrances.

The study found another trend – deaths in the hospital from sepsis, an overwhelming immune response to infection or injury, rose 17 percent over those 10 years. Other data shows sepsis cases overall more than doubled over that time.

Hall and her colleagues pulled their data from an annual survey done by the Centers for Disease Control and Prevention on nonfederal, noninstitutional, short-stay hospitals and general hospitals.

“The number of inpatient hospital deaths decreased 8 percent from 776,000 in 2000 to 715,000 in 2010,” they wrote in their report. “At the same time, total hospitalizations increased 11 percent, from 31.7 million in 2000 to 35.1 million in 2010.”

People with several conditions were far less likely to die in a hospital , the team found. “Hospital death rates decreased for patients hospitalized for respiratory failure by 35 percent, for pneumonitis due to solids and liquids by 22 percent, for kidney disease by 65 percent, for cancer by 46 percent, for stroke by 27 percent, for pneumonia by 33 percent, and for heart disease by 16 percent,” they wrote.

“We know that overall death rates are down for some of these conditions … for example, the cancer death rate, the stroke death rate,” Hall said in a telephone interview.

“But it doesn’t necessarily mean we are better at getting people well in the hospital. They could just have gone to a post-acute setting like a nursing home…or even home and they could have died soon after,” she added.

It’s well established that hospitals are not necessarily the best place for people who are dying. They are very expensive places to get care, and staff may be less focused on making patients comfortable than on keeping them alive – even if they are ultimately almost certainly going to die soon.

“Sometimes they get care that is more intensive than what they would have requested,” Hall said.

Hospice care aims to keep patients comfortable when it’s clear that their conditions are incurable. Other alternatives to the hospital for patients who may not necessarily be dying include nursing homes, long-term care facilities and home care.

Theresa Forster, vice president for hospice policy at the National Association for Home Care & Hospice, says while an 8 percent reduction in hospital inpatient deaths over 10 years may not be a huge number, it’s at least moving in the right direction.

“This could be the beginning of significant change,” Forster said in a telephone interview. 

“We are getting a whole lot better but we still have a long way to go,” she added. “I think the American public very much desires there to be more discourse around this whole area, and they want to be talking more with their doctors.”

Forster noted that Congress and the federal government have only recently created financial incentives for hospitals to move dying patients to other facilities, as part of efforts to reduce what are called readmission rates – when patients are discharged, and then wind up right back in the hospital a few days or weeks later.

Last month, CDC reported more people are dying at home. The study looked at Medicare patients – a different population of people than Wednesday’s report covers. It found that 33.5 percent of Medicare patients died at home in 2009, compared to 23 percent in 2000.

As for the findings on sepsis, also known as septicemia, Hall says it’s not clear how much of the rise is due to more cases occurring.

"More people are recognizing sepsis," says Dr. Clifford Deutschman of the University of Pennsylvania, a past president of the Society of Critical Care Medicine. Deutschman says hospitals are doing a better job of classifying deaths from sepsis, a still mysterious condition in which the body's immune system gets out of whack, often killing patients in just hours or days.

Hall and colleagues reported in 2011 that both the number and rate of people hospitalized with sepsis more than doubled from 2000 through 2008, from 326,000 in 2000 to 727,000 in 2008. But if deaths only went up 17 percent over a period two years longer, that could indicate that hospitals are doing a good job of saving sepsis patients. Quick recognition and treatment is key, says the Surviving Sepsis Campaign.

Related:

• Fewer Americans die in acute care hospitals
• What you should know about end-of-life care
• New guidelines stress fast treatment for sepsis
• Device speeds ID of sepsis bacteria

AP

This illustration is part of a University of Missouri study that examined first-graders' "number system knowledge.

We know a lot about how babies learn to talk, and youngsters learn to read. Now scientists are unraveling the earliest building blocks of math — and what children know about numbers as they begin first grade seems to play a big role in how well they do everyday calculations later on.

The findings have specialists considering steps that parents might take to spur math abilities, just like they do to try to raise a good reader.

This isn't only about trying to improve the nation's math scores and attract kids to become engineers. It's far more basic.

Consider: How rapidly can you calculate a tip? Do the fractions to double a recipe? Know how many quarters and dimes the cashier should hand back as your change?

About 1 in 5 adults in the U.S. lacks the math competence expected of a middle-schooler, meaning they have trouble with those ordinary tasks and aren't qualified for many of today's jobs.

"It's not just, can you do well in school? It's how well can you do in your life," says Dr. Kathy Mann Koepke of the National Institutes of Health, which is funding much of this research into math cognition. "We are in the midst of math all the time."

A new study shows trouble can start early.

University of Missouri researchers tested 180 seventh-graders. Those who lagged behind their peers in a test of core math skills needed to function as adults were the same kids who'd had the least number sense or fluency way back when they started first grade.

"The gap they started with, they don't close it," says Dr. David Geary, a cognitive psychologist who leads the study that is tracking children from kindergarten to high school in the Columbia, Mo., school system. "They're not catching up" to the kids who started ahead.

If first grade sounds pretty young to be predicting math ability, well, no one expects tots to be scribbling sums. But this number sense, or what Geary more precisely terms "number system knowledge," turns out to be a fundamental skill that students continually build on, much more than the simple ability to count.

What's involved? Understanding that numbers represent different quantities — that three dots is the same as the numeral "3" or the word "three." Grasping magnitude — that 23 is bigger than 17. Getting the concept that numbers can be broken into parts — that 5 is the same as 2 and 3, or 4 and 1. Showing on a number line that the difference between 10 and 12 is the same as the difference between 20 and 22.

Factors such as IQ and attention span didn't explain why some first-graders did better than others. Now Geary is studying if something that youngsters learn in preschool offers an advantage.

There's other evidence that math matters early in life. Numerous studies with young babies and a variety of animals show that a related ability — to estimate numbers without counting — is intuitive, sort of hard-wired in the brain, says Mann Koepke, of NIH's National Institute of Child Health and Human Development. That's the ability that lets you choose the shortest grocery check-out line at a glance, or that guides a bird to the bush with the most berries.

Number system knowledge is more sophisticated, and the Missouri study shows children who start elementary school without those concepts "seem to struggle enormously," says Mann Koepke, who wasn't part of that research.

While schools tend to focus on math problems around third grade, and math learning disabilities often are diagnosed by fifth grade, the new findings suggest "the need to intervene is much earlier than we ever used to think," she adds.

Exactly how to intervene still is being studied, sure to be a topic when NIH brings experts together this spring to assess what's known about math cognition.

But Geary sees a strong parallel with reading. Scientists have long known that preschoolers who know the names of letters and can better distinguish what sounds those letters make go on to read more easily. So parents today are advised to read to their children from birth, and many youngsters' books use rhyming to focus on sounds.

Likewise for math, "kids need to know number words" early on, he says.

NIH's Mann Koepke agrees, and offers some tips:

 -- Don't teach your toddler to count solely by reciting numbers. Attach numbers to a noun — "Here are five crayons: One crayon, two crayons..." or say "I need to buy two yogurts" as you pick them from the store shelf — so they'll absorb the quantity concept.

-- Talk about distance: How many steps to your ball? The swing is farther away; it takes more steps.

-- Describe shapes: The ellipse is round like a circle but flatter.

-- As they grow, show children how math is part of daily life, as you make change, or measure ingredients, or decide how soon to leave for a destination 10 miles away,

"We should be talking to our children about magnitude, numbers, distance, shapes as soon as they're born," she contends. "More than likely, this is a positive influence on their brain function."

Related:

Most babies fed solid foods too soon, study finds

A vital drug used to help feed the tiniest babies is in such short supply that at least seven extremely premature infants in the U.S. developed horrifying skin lesions and life-threatening reactions after their hospitals ran out.

At least 120,000 more fragile babies may be at risk each year from an ongoing shortage of injectable zinc, a trace element added to intravenous nutrition solutions, government and medical officials say.

“It’s very frustrating,” said Dr. Lamia Soghier, medical director of the neonatology unit at Children’s National Medical Center in Washington, D.C. “What can we do? We’re just short. We don’t have it. We can’t borrow it."

The crisis is the latest in the nation’s ongoing struggle with drug shortages. After federal intervention in 2012, the number of new shortages has fallen markedly, down to just 26 this year from a record high of 267 in 2011. But the number of active shortages of essential medications -- including injectable trace elements, vitamins and electrolytes -- is now 323, higher than it’s ever been, according to the University of Utah Drug Information Service, which tracks the problem.

Last December, three very premature infants at Soghier’s hospital, all born at 23 or 24 weeks of pregnancy -- suddenly developed severe diaper rash, skin erosions around their mouths and blistering lesions on their hands and feet, according to a recent CDC report.

At first, doctors were stumped. The babies were all in different rooms, cared for by different nurses. They were tested for infections, drug reactions, even problems caused by medical tape. Then specialists hit on the real source: severe zinc deficiency linked to an IV food solution called total parenteral nutrition, or TPN.

“These kids were not receiving food through any other method. They were exclusively on the TPN,” said Dr. Scott Norton, a dermatologist at Children's National who investigated the cases. 

Injectable zinc is typically added to the TPN mixture in prescribed doses for preemies. The hospital had run out of the drug on Nov. 21 following off-and-on shortages since 2010. Within weeks, the infants -- born without the boost of zinc that typically comes from the mother in the last weeks of pregnancy -- started to fail. Because they also had liver problems caused by receiving only TPN, they became even sicker, with levels of zinc 20 percent to less than 50 percent of the normal range.

That’s a problem because zinc is essential for about 300 enzyme-dependent processes, Soghier said. Premature babies require large doses of zinc for cell metabolism and growth. Without it, they can face issues ranging from severe skin erosion and growth restriction to immune system problems. 

CDC

This premature baby girl was one of three infants who developed severe skin lesions and other problems at a Washington, D.C., hospital as a result of severe zinc deficiency stemming from a nationwide shortage of injectable zinc.
Emergency supplies were rushed to those babies, who are now doing well, but the shortage continues, doctors say.

“Everything in your body probably requires zinc,” she said. “All your cells.”

The zinc crisis dates to 2011, when one U.S. maker of the drug -- American Regent -- suspended manufacture of most injectable products after problems with particulate matter in some drugs. The other maker of injectable zinc, Hospira, couldn’t keep up with the new demand.

Hospitals across the country juggled supplies for months, but, eventually, some ran out, including Children’s National Medical Center.

Doctors knew that the lack of zinc could cause problems in preemies, but they didn’t realize it would escalate so quickly, Soghier said. Such severe symptoms of zinc deficiency hadn't been seen in the U.S. for decades, Norton added. When the effect on the Children’s National patients became apparent, Hospira rushed supplies to the hospital quickly.

“We managed to get an emergency shipment,” Soghier said. Slowly, the children recovered.

But a query of the nation’s neonatologists by officials with the Centers for Disease Control and Prevention found more cases. In Texas, four other tiny preemies had developed the severe symptoms of zinc deficiency, said Dr. Wanda Barfield, director of the CDC’s Division of Reproductive Health. An adult dependent on TPN also showed signs of the problem, she added. 

“It could potentially be a life-threatening condition,” Barfield said. “Physicians should recognize that it can occur.”

Three months later, Soghier’s hospital has adequate supplies of injectable zinc, but the risk elsewhere remains high. Supplies of that drug -- and other components of TPN -- remain extremely scarce or unavailable, said Jay Mirtallo, immediate past president of the American Society for Parenteral and Enteral Nutrition, or ASPEN.

“One of the biggest concerns we have is that there has been nothing that has helped and it doesn’t seem like there’s any relief in sight,” said Mirtallo.

The TPN shortage affects not only premature babies, but also some 370,000 patients who receive TPN in the hospital each year, and tens of thousands more who use it at home, he said.

Food and Drug Administration officials, who have struggled to address drug shortages, are aware of the problem, said Sarah Clark-Lynn, an agency spokeswoman. The agency got a boost in 2012 from a new law that requires drugmakers to report imminent shortages in advance and gives the FDA authority to speed applications from firms to make drugs in short supply.

The agency has asked American Regent and Hospira to prioritize production of the injectable zinc, and they’re seeking foreign manufacturers who might be willing and able to ramp up supply, Clark-Lynn said.

American Regent has resumed operations, but no injectable zinc is available yet. Hospira officials hoped to have more drug on the market by now, but the plan has been delayed.

“Hospira is aware of the urgency of this product for patients, and we have prioritized its return to market,” said Dan Rosenberg, a company spokesman. “We have resumed manufacturing and are currently targeting second quarter for return to market.”

FDA officials, however, said there’s no firm timeline for either company to get injectable zinc back on hospital pharmacy shelves.

In the meantime, hospitals are monitoring their tiniest patients closely and working to meet demand under difficult circumstances, said Mark Wietecha, president and chief executive of the Children’s Hospital Association, which includes 220 hospitals in the U.S. and Canada.

There’s more emphasis than ever on conserving scarce drugs and prioritizing need, he said. Hospitals have been willing to share drugs in short supply because they know the next babies in need could be their own.

“Everybody’s kind of soldiering on,” he said. “The alarming thing is if the trend continues over the next five to seven years, we’re going to have more problems than we do now.”

Related:

Drug shortages down overall, but some linger longer

Amid shortages, rules force hospitals to trash scarce drugs

Fallout from fungal meningitis mess: more drug shortages

Researchers have found that the virus that causes cold sores, along with other viral or bacterial infections, might be associated with memory loss, and if further studies establish such a link, it could eventually prove helpful in preventing strokes or Alzheimer’s disease.

A long-term study of a group of people in one neighborhood of New York City found that those with higher levels of infection in their blood -- meaning they had been exposed to various pathogens such as the herpes simplex type 1 virus that causes cold sores -- were more likely to have cognitive problems than people with lower levels of infection in the blood. The results, released Monday, are published in the March 26 issue of Neurology, the medical journal of the American Academy of Neurology.

"While this association needs to be further studied, the results could lead to ways to identify people at risk of cognitive impairment and eventually lower that risk," said Dr. Mira Katan, author of the study. "For example, exercise and childhood vaccinations against viruses could decrease the risk for memory problems later in life.”

Katan, who conducted the Northern Manhattan Study at Columbia University Medical Center in New York, is a member of the American Academy of Neurology . The study was performed in collaboration with the Miller School of Medicine at the University of Miami. She said she found the link between infections and memory loss was greater among women, people with lower levels of education and most prominently, in people who do not exercise.

 The study, performed in collaboration with the Miller School of Medicine at the University of Miami, tested thinking and memory in 1,625 people from northern Manhattan who had an average age of 69. Participants gave blood samples that were tested for five common low grade infections: three viruses (herpes simplex type 1, which is oral; herpes simplex type 2, which is genital; and cytomegalovirus), chlamydia pneumoniae (a common respiratory infection) and Helicobacter pylori (a bacteria found in the stomach).

The results showed that the people who had higher levels of infection had a 25 percent increase in the risk of a low score on a common test of cognition called the Mini-Mental State Examination.

The memory and thinking skills were tested every year for an average of eight years, but infection was not associated with changes in memory and thinking abilities over time.

"While this association needs to be further studied, the results could lead to ways to identify people at risk of cognitive impairment and eventually lower that risk," said Katan. "For example, exercise and childhood vaccinations against viruses could decrease the risk for memory problems later in life."

Katan, who is currently working at the University of Zurich, in Switzerland, said the study grew out of a previous clinical study of stroke victims that found an association between inflammation in the brain and chronic infections.

“We cannot make any conclusions that infections will lead to cognitive problems, but we think there is a connection,” she said. The issue will require further interactive studies. “If a causal effect is established, it could help in the treatment of dementia and strokes,” she said in a telephone interview with NBC News.com from Switzerland.

William Schaffner, chairman of the department of preventive medicine at Vanderbilt University’s School of Medicine in Nashville, Tennessee, said although the study did not definitively establish a causal association between infections and memory loss, it was “nevertheless provocative and would be worth pursuing fully.

“This will stimulate further research by the neurological and infectious disease communities,” said Schaffner, who was not affiliated with the study.

He noted that already researchers suspected a connection between chlamydia and heart attacks and between the pylori bacteria and stomach cancer. Solid evidence of a connection between infectious diseases and non-communicable illness would be very significant, he said.

“The whole area of connecting infectious diseases to diseases we have not considered infectious is on the cutting edge of research.

“I am intrigued and stimulated by it and it could have very positive implications in preventing diseases,” said Schaffner.

Dr. Alireza Atri, a cognitive neurologist at Massachusetts General Hospital and Harvard Medical School, cautioned the results of the study should be considered preliminary. “There is some plausibility but I would also say that these things (cold sore and herpes viruses) are very common. So it would be rare if older people did not develop antibodies to them.”

He also pointed out the study group was about 80 percent non-white and he would like to see it extended to a larger cross-section of the population. “Can the results be attributed to the general population? Maybe, maybe not,” said Atri.

In an editorial accompanying the study in Neurology, Dr.  Timo Strandberg and Dr. Allison Aiello noted there was still much work to be done.

“Undoubtedly, demonstrating that old-age cognitive diseases, including AD, are slowly progressing diseases of viral etiology would revolutionize the dementia research field and be Nobel Prize-worthy,” they wrote. “However, great challenges remain. Such a study is nevertheless worth doing and the editorialists hope that the study… will stimulate this endeavor.”

The study was supported by the National Institutes of Neurological Disorders and Stroke (NINDS), the Swiss National Science Foundation and the Leducq Foundation.

LanaLanglois / Featurepics.com

Tofu is one soyfood that may help at least some women survive lung cancer better, a study finds

Soy foods, long shown to help lower the risk of cancer, may also help people survive at least some forms of cancer better, researchers reported on Monday.

They found that Chinese women who ate the most soy were also less likely to die of lung cancer, the No. 1 cancer killer across the world.

The findings, published in the Journal of Clinical Oncology, lends support to the idea that adding soy foods to the diet can help people in multiple ways, says Dr. Jyoti Patel, a lung cancer specialist at Northwestern University in Chicago, who was not involved in the study.

 “It may be that we do need to change our diets a little bit and eat more of these soy-based diets. The benefits may go beyond cardiac health,” Patel said in a telephone interview.

For the study, Gong Yang and colleagues at Vanderbilt University Medical Center, Shanghai Cancer Institute, and the National Cancer Institute looked at data from a large study of Chinese women called the Shanghai Women’s Health Study. They pulled out the records of 444 of the women, who had lung cancer.

The women had all filled out questionnaires that included details of what they normally ate. They did this twice – when they enrolled in the study, and two years later.

Of the 444 patients with lung cancer, 318 died during the three years of follow-up, the researchers wrote. “Initial analyses including all patients showed that higher intake of soy food was associated with better overall survival after adjusting for demographic and lifestyle characteristics and other nonclinical factor,” they wrote.

Women who reported eating the least soy were 1.8 times as likely to die, on average. Those who ate the most were about 11 percent less likely to die.

“This finding, along with our previous observation of an approximately 40 percent reduction in risk of incident lung cancer associated with high intake of soy food,  provides further support for the role of soy food intake in lung cancer development and prognosis,” the researchers wrote.

Most of the women in the study had never been smokers, and there’s a lot of evidence to suggest that lung cancer is a different disease in smokers versus non-smokers. “In Asian countries, 80 percent of women with lung cancer are never- smokers,” Patel said.

“We don’t know if there is an inherited susceptibility to it,” she added. There might be an infectious disease that causes some cases of lung cancer —like the virus that causes cervical cancer, or the bacteria that causes stomach cancer.

“Although the risks are probably different for American women for developing lung cancer, I do think it is a call to action for more research about how we develop lung cancer,” Patel said.  “There are probably 30,000 people in the U.S. who never smoked and who have lung cancer.”

Lung cancer kills 160,000 Americans a year. It’s diagnosed in 110,000 women and 118,000 men a year in the United States alone.  It accounts for 27 percent of all cancer deaths, according to the American Cancer Society.

Studies suggest that people who eat the most soy have a lower risk of heart disease and osteoporosis. Women may have fewer menopausal symptoms, and perhaps a lower risk of some cancers.

The Food and Drug Administration says soy products may carry a heart-healthy label saying that soy may reduce cholesterol when eaten as part of a diet that is low in saturated fat and cholesterol.

It wouldn’t be difficult to eat enough soy to be protected, Patel noted. “The high soy level patients were eating what the FDA has said is heart-healthy, or 25 grams of soy a day,’ she said.

Studies have shown that supplements containing soy protein don’t have much health benefit. But foods such as soy milk, tofu and edamame do. “We think that consuming food in their whole forms is more important  than the supplements,” Patel said.

Some researchers have wondered whether Western people who eat more soy food are benefiting from the soy itself, or because they perhaps use it as a substitute for meat and dairy foods. Patel says this study in China, where soy is a normal part of the diet and where dairy foods are less commonly eaten, suggests it’s the soy itself that adds the benefit.

Soy and many other plant foods contain hormone-like substances called phytoestrogens. These may be affecting a cell compound called estrogen receptor beta, she said.  That compound interacts with another one called epidermal growth factor receptor or EGRF, which is known to play a role in many cases on lung cancer.

“Lung cancer is the most common cause of cancer death. There are many never-smokers with lung cancer,” she said. “People should consider eating a diet that is healthy. By all accounts one that includes soy decreases cardiac risks and could also affect lung cancer,” Patel concluded.

How can people add soy to their diets? A cup of vanilla soymilk poured over cereal provides 6 grams of soy protein, while an eight-ounce glass provides 8 grams. A soy burger delivers 10 grams of soy protein, while 3 ounces of tofu has 8.5 grams.

Related:

Soy supplements don't help menopause

Soy may keep breast cancer from coming back

Lung cancer on NBCNews