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Painless heart attacks may be more deadly and more common than you think, researchers say.
A third of all patients who show up at hospitals with heart attacks have no chest pains and that lack of pain apparently is deceptively fatal, doctors are reporting in Wednesday's issue of the Journal of the American Medical Association. They tend to delay by about 2 1/2 hours their trip to the hospital, and once in the emergency room, doctors tend to miss the diagnosis, identifying heart attacks in just 22 percent of cases.
The result is that no pain may more than double a heart patient's chance of dying, according to the JAMA study of 400,000 heart attack victims.
The stealth heart attack patients were prescribed lifesaving clot-buster drugs in 28 percent of cases while 48 percent of patients with chest pains received the drugs. Only 25 percent with no pain were given angioplasty, against 74 percent of the chest pain group.
The delay in diagnosis was found to slow down treatment for more than two hours, leaving the patient dead or with permanent heart damage. The surprising results come from a study of the records of more than 434,877 people who had attacks between June 1994 and March 1998.
Leader of the study, Dr. John Canto, director of the University of Alabama at BIrmingham's Chest Pain Center, told UPI, "Chest pain is an important symptom, but not the only one."
Canto says absence of chest pain will increase a person's chance of dying by more than 200 percent.
The heart specialist says indigestion, a cold sweat, shortness of breath, even a pain in the foot or low blood pressure can be an indication of an attack.
The doctor says women are especially at risk for the stealth coronaries with 49 percent of the victims being female. Another high-risk group are minorities (blacks, Hispanics, Asians), a third of those in the study fell into that group. The doctor says the reason for the extra risk is not known.
Canto says, "We need to educate both the public and medical providers on the other symptoms of heart attacks." The Birmingham study found six factors that appear to be associated with the absence of chest pains. The most important factor is a prior episode of heart failure, next comes stroke, old age, diabetes, being female or belonging to a minority group.
A person with two or more of the risk factors is 50 percent more likely to die as a result of a heart attack. Canto says that anyone with more than one of the risk factors should "go and have a talk with their doctor," so the physician will be alerted to look for other symptoms that could indicate a heart blockage.
The large number of stealth heart attacks found by the study was "a surprise," said Dr. Joshua Kerstein, assistant director of cardiology at Maimonides Medical Center, in Brooklyn, New York. Kerstein told UPI that cardiologists have been aware of no-chest pain heart attacks for a long time, "But one-third is a very significant number, I didn't know it was in such numbers."
Kerstein said the greatest danger for the patient was that the delay in getting to a hospital for treatment. He says, "Treatment is needed within six hours" to prevent permanent damage.
Kerstein, who teaches at Maimonides says he constantly tells young doctors to look for the other symptoms that go along with a heart attack. He says the most serious is a cold sweat. "If you have nausea, and are sweating, come into the hospital, don't blame it all on the stomach, even if you just ate chili."

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Fatherhood may in fact come naturally. Just as women's hormone levels change as they are about to become mothers, male hormone levels shift significantly throughout the course of their wives' pregnancy, researchers are reporting.
"This validates the experience of men becoming fathers," said lead researcher Katherine E. Wynne-Edwards of Queen's University in Kingston, Ontario. "Things are changing on a biologic level." While Wynne-Edwards didn't link changing hormones to parenting behaviors, animal studies indicate that hormones affect the male's willingness to take care of his offspring. Animal studies have linked nurturing with lower testosterone levels, for example. Sure enough, Wynne-Edwards found that average testosterone levels were significantly lower in 13 expectant fathers compared to 14 guys who had no children. Testosterone levels began to rise in the new dads soon after their wives gave birth, she said, but remained lower than in guys who did not have children.
More soon-to-be dads had detectable amounts of estrogen, the female sex hormone, in their saliva than did men whose partners were not expecting, she reported in Toronto at the annual meeting of The Endocrine Society. Estrogen levels rose after the birth of their child, Wynne-Edwards said.
Each of the 17 men in the study -- and their partners -- spit into test tubes at the same time every day. The researchers collected the vials and analyzed the contents for levels of testosterone, estrogen, and cortisol, a stress hormone. Cortisol levels were lower in expectant dads and did not change after the baby was born.
"This is very exciting data," said Lorraine A. Fitzpatrick of the Mayo Clinic in Rochester, Minn. "With mothers we talk about nesting and bonding but there's been nothing to date on what happens with fathers." Behaviors and hormones are pretty tightly linked, she said, so it's hard to tell from this study which comes first. There's probably a feedback loop so that hormones and behavioral changes "are working hand in hand" to promote nurturing behaviors, she said. The men in the study were all first time fathers or had no children. They were in their early 20s to early 30s, and their wives were slightly younger. All of the men in this study were taking prenatal classes with their wives. Men who are less involved in parenting may have different hormonal responses. But men who are less motivated about becoming a parent are probably going to be less motivated to participate in scientific studies, Wynne-Edwards said. So she hopes to look at hormone levels in men from different cultures who may have different expectations about the degree of involvement being a committed dad means.
She also plans to try manipulating hormone levels in hamsters to identify behaviors that in and of themselves influence hormone levels. Ultimately, such research might lead to ideas for how to help moms who have difficulty bonding with their newborn, she said.

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Three newly discovered genes may play a role in protecting the kidneys of people with diabetes from damage, researchers reported at a major endocrinology meeting. The findings may be the first step in developing therapies to hold kidney failure at bay in people with diabetes, they said.
Kidney damage is a common complication of diabetes, occurring in up to three million people with diabetes. Diabetes, characterized by high blood sugar that results from the body's inability to produce insulin or use it effectively, affects about 16 million Americans.
Understanding how these genes work in the kidney could open up new paths to treat diabetic patients already suffering from kidney disease, said Karen Coschigano of the Edison Biotechnology Institute at the University of Ohio in Athens. Potentially, she said in Toronto at the annual meeting of The Endocrine Society, kidney disease that is caught early might be reversed with such treatment.
Almost all patients with kidney failure have diabetes, said Daniel Drucker, an endocrinologist at Toronto General Hospital in Toronto. "This is a huge, huge problem...if we could figure out why diabetics get kidney disease it would have a significant public health impact," he said.
Coschigano and her colleagues first found that mice genetically engineered to produce bovine growth hormone develop kidney problems similar to those found in diabetic mice. In contrast, mice engineered to lack genes for the growth hormone receptor -- the protein on the surface of cells that recognizes growth hormone -- do not develop kidney damage, even if the researchers induce diabetes.
But growth hormone plays an important role in metabolism and regulation of muscle mass, and disrupting its function would probably cause many side effects, Coschigano said. So she and her colleagues then looked at the expression of genes in the damaged kidneys of diabetic mice, the healthy kidneys of normal mice, and the healthy kidneys of diabetic mice missing growth hormone receptors. They found two genes that were active in mice that didn't develop kidney disease but were not active in mice that did. They also found a gene that is active in mice that develop kidney damage but inactive in mice that do not.
It isn't clear yet what those genes do, Coschigano said, but there's good reason to suspect similar genes may be active in protecting people from diabetes-related kidney damage. Some people produce too much growth hormone in adulthood, perhaps because of pituitary tumors, Coschigano said. People with this condition, called acromegaly, suffer from overgrowth of bones including the jaw and the brow, and are also likely to develop heart disease, she said. As treatments get better and these patients live longer, she said, "there's increasing evidence that they are also prone to kidney damage." Many other researchers are looking at genes -- in mice and humans -- that predispose people with diabetes to develop kidney disease, Drucker said.
However, Coschigano points out that she and her colleagues are the only group actively looking for genes that may protect against the disease.

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Two new studies suggest that a single medication may protect against heart attack at the same time that it can reduce by half the risk of fractures associated with osteoporosis, a finding that has taken osteoporosis experts by surprise.
The two new studies -- both case-controlled observational studies -- are published in the June 24 issue of The Lancet.
Dr. Gregory Mundy, the scientist whose work with tissue cultures and rats turned other researchers onto the possibility that drugs called statins may actually increase bone density, says he was taken by surprise by the Lancet studies.
Mundy published a study in Science last December that reported statins could stimulate bone growth in rats and in tissue culture. Since then he has been working on developing a skin patch containing hydrooxymethylglutaryl-coenzyme A reductase, the chemical name for the drugs, so that more of the drug gets to the bone.
"Oral statins are really very poorly distributed to the bone because they are designed to target the liver," Mundy said in a telephone interview. He said he thought that a "bone" statin would be needed to see a real effect in humans." But with these new studies showing a 50% reduction in fracture risk maybe we don't need that," he said.
In one of the two Lancet studies Dr. K. Arnold Chan, assistant professor of medicine, Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, and his co-authors studied medical records from 928 women with osteoporosis-associated fractures and compared them to records of 2,747 healthy women of the same age.Chan says, "we found that using statins for at least 2 years reduced fracture risk by 50 percent." In the second Lancet paper, Dr. Chris Edwards of St. Thomas' Hospital, London reports that 41 women who are taking statins had bone mineral density that was an average of 8 percent higher than 100 women who don't take statins.
Edwards said, "There is really nothing out there that you can take on a regular basis to increase BMD. This is really something new and it needs to be confirmed in prospective studies." He said he is interested in using statins to stimulate bone growth for healing of joints in patients with osteoarthritis.
Mundy, a professor of medicine at the University of Texas Health Sciences Center San Antonio, says that it is very likely that statins could play a role in "all types of situations where new bone is needed: fractures, fixation of prostheses, spinal injury and so on." But Mundy says the biggest role may be for the treatment and prevention of osteoporosis, which currently affects more than 10 million Americans, most of the elderly women. Mundy is on the scientific advisory board of the National Osteoporosis Foundation (NOF) and he says that one real benefit of statins is their tolerability.
Fosamax, the bisphonsponate currently approved for osteoporosis, can cause gastrointestinal problems making it difficult to take. Evista, chemical name raloxifene, a new drug from a class called selective estrogen receptor modulators or SERMs, is better tolerated but not as good at preventing fracture, he says.
That leaves calcium and vitamin D, both considered less than optimum, and estrogen, the hormone that was long held to be the best way to protect against osteoporosis and heart disease in post-menopausal women. New clinical studies have questioned the value of estrogen and many women are fearful of taking it because of a possible link to increased risk of breast cancer.
Those considerations combine to make statins very attractive, says Dr.
Felicia Cosman, clinical director of NOF. She says a drug that could deliver a one-two punch, knocking out both heart disease and osteoporosis would be "major. It's a very exciting prospect." Statins are now used to lower LDL, the so-called bad cholesterol, and some of them also increase HDL, the good cholesterol. It is widely believed - based on clinical trials - that statins can reduce the risk of heart attack and stroke. Cosman cautions, however, that the findings need to be confirmed by prospective studies. She says that too often findings from observational studies are disproved when held up to the more rigorous standards of a prospective, placebo-controlled trial.

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After contentious debate that spilled over two days, doctors at the American Medical Association annual meeting voted Wednesday to have the AMA seek legislation to restrict pharmacists and other non-physicians from performing and/or interpreting medical tests.
Much of the debate over a perceived increase in expansion of the ability of non-physicians to perform such tests as cholesterol and diabetes screening centered on who could prescribe medications, tests and other procedures.
"The idea is to keep pharmacists from performing cholesterol tests and then advising patients whether to change their medication up or down," said Dr. Sandra Olson, a Chicago neurologist.
The resolution decried legislative expansion of the scope of practice of non-physicians and specifically cited pharmacists as lacking "the clinical education and training to assess appropriately the accuracy, reliability or appropriateness of laboratory tests."
Speakers noted that in certain situations dentists, midwives, podiatrists and other medical professionals might be able to prescribe such tests. The debate included numerous time-consuming amendments and attempts to refer the matter to a committee for further study. The debate took up so much time on Tuesday that leaders agreed to table the issue until Wednesday to allow rewriting the resolution, agreeing with internist Dr. Melvyn Sterling of Orange, Calif., that "if we don't take the time and end up doing the wrong thing we will regret it."
The physicians regrouped on Wednesday and finally agreed that the AMA "through appropriate legislative and regulatory efforts, seek to ensure that diagnostic laboratory testing should only be performed by those individuals who possess appropriate clinical education and training, under the
supervision of licensed physicians and licensed dentists."
In other matter at the AMA annual meeting delegates Wednesday:
--Requested that the Consumer Products Safety Board issue warning labels over the potential eye damage that can occur with the use of "bungee cords" used to secure loads.
It might sound like a trivial problem, but Dr. Bruce Scott, a member of the AMA Board of Trustees and an otolarnygologist from Louisville, Ky., said "when people are being blinded by these objects there is a need to inform and warn the public about their use." He said the cords are used in numerous products, including in children's toys.
--Supported increased efforts to reduce use of products containing mercury in order to lower risks of environmental and health contamination. The delegates rejected an outright ban on mercury in light of testimony that mercury-free instruments for calibrating some conditions -- especially high blood pressure -- might still require further technological advances. "The delegates urged the development of suitable alternatives for mercury and its suitable disposal," noted Dr. Myron Genel, professor of pediatrics at Yale University School of Medicine and chairman of the AMA's Council on scientific Affairs.
--Rejected a proposal that would have urged regulators to demand padding on dishwasher doors to prevent leg injuries. Dr. Diana Dell of Toronto, a psychiatrist and chairman of the public health committee that heard testimony on the issue, said there was no data presented to indicate how often serious injuries due to walking or running into open doors occurs.
--Elected Dr. Nancy Nielsen, an infectious disease specialist from Buffalo, N.Y., as vice speaker. Nielsen is the first women in the 153-year history of the AMA to hold that position. The speaker is the leading officer of the House of Delegates, the AMA's policy-making body.
--Asked its Council on Scientific Affairs to monitor the use of anti-microbials in consumer products, specifically scrutinizing if those products are adversely affecting resistant to antibacterial and antifungal
medications.

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The much publicized telomerase enzyme, shown to extend cells' lifespan, may have a link to cancer, researchers report.
Use of telomerase-based techniques for therapeutic purposes should be approached with caution, they said in an article to be published in the British journal Nature on Thursday.
Other scientists said the study was small, did not show any direct connection to tumors and should have no significant impact on current research in the field.
Biotechnology firms such as Geron Corp. in Menlo Park, Calif., which specializes in aging research, have been conducting a variety of laboratory experiments that take advantage of the special properties of the enzyme, discovered a decade ago in a single-celled protozoan, first connected to aging in 1986 and since then shown to repair key DNA strands at the ends of chromosomes -- called telomeres -- in immortal cancer cells, sperm and ovum and to significantly prolong life in other cells.
Telomerase has captured wide scientific attention because the ability to prolong the life of human cells holds promise in a wide array of biopharmaceutical research, including drug development, screening and
toxicology testing, investigators said.
"The development of better cellular models of human disease and production of human products are among the immediate applications of this new advance," Jerry Shay, professor of cell biology at the University of Texas Southwestern Medical Center in Dallas, told United Press International.
"For example, in the past scientists have used primary cultures derived from patients with chromosomal instability syndromes. Since many of these cell types do not grow well, it has been difficult to compare results between laboratories.... With the ability to...essentially immortalize human cells, there is clear utility in developing better cell culture models of human chromosomal disorders."
In addition, the technology to introduce telomerase into cells has the potential to produce unlimited quantities of normal human cells of virtually any tissue type and may have most immediate practical biomedical applications in transplantation medicine, scientists told UPI.
"In the future, it may be possible to take a person's own cells, manipulate and rejuvenate them without using up their lifespan and then give them back to the patient," Shay said. "In addition, genetic engineering of telomerase-immortalized cells could lead to the development of cell-based therapies for certain genetic disorders."
The idea is to use the enzyme's special features to induce normal human cells to proliferate for therapeutic purposes. The new study, conducted on human breast epithelial cells, indicates the process might present some level of cancer risk if the cells were put to clinical use, the authors
said.
The team found an unexpected side effect of treating cells with TERT, a component of telomerase, which keeps aging at bay by keeping chromosome ends in good shape. In the absence of telomerase, telomeres shrink with each cell division until they become so short, cells stop dividing.
Experiments in other laboratories had indicated producing telomerase to extend the lifespan of cultured cells did not appear to transform the cells into a cancerous state, but the new study pointed to at least one hallmark of cancer cells -- activation of the cancer-causing c-myc gene.
When TERT was used to prolong cell lifespan, the oncogene was activated, stimulating cells to produce two to three times the normal amount of the c-Myc protein, said lead study author David Beach of the Wolfson Institute for Biomedical Research at University College London.
While the immortalized cells were not fully transformed into a cancerous state, elevated c-myc production is a major step in the multi-phase process leading to malignancy, the scientists said.
Since the activation of the c-myc oncogene occurs in breast and other tumors and is observed in some 70,000 fatal cancers each year in the United States alone, "these findings indicate that the use of TERT for the expansion of normal human cells for therapeutic purposes must be approached with caution," Beach and his colleagues concluded.
"I would characterize our findings as a cautionary warning telling us we have to be careful," study co-author Gregory Hannon, associate professor in the Watson School of Biological Sciences at Cold Spring Harbor Laboratory in New York, said in an interview. "Cells that are produced in this way need to
be characterized in a very thorough manner before being used for therapeutic purposes."
The scientists were quite surprised at the outcome, expecting the opposite result, based on data from previous studies, Hannon said. "This paper is meant to raise concern and no more," he told UPI. "The idea that this is a neutral event has to be approached with caution."It was a small study related to one set of human mammary epithelial cells without biological data," Calvin Harley, chief scientific officer for Geron, said in an interview, adding that there was no evidence the increase observed in the production of the myc oncogene had any consequence or that it was the cell immortalization that caused the activation.
"The implications for our work are really zero," he said. "We're looking at regulated expression of telomerase in terms of in-vivo therapy. We're not proposing permanently immortalized cells in humans."
"I believe the observations reported are accurate, but this is a very brief report with many unanswered questions," Shay said.
"Many cells express both myc and TERT and are not tumor cells. Human reproductive cells have high levels of telomerase, and there is not an increased incidence of cancer in reproductive cells over other tissue types.
Telomerase by itself is not going to cause cancer, only provide the cells with unlimited divisions. The cells would have to accumulate many additional alterations to become a cancer cell. Thus, while it is appropriate to be cautious, I believe that putting TERT into cells that can be well characterized would not increase the risk of cancer very much and may be worth the risk in certain cases."
TERT has been confined mostly to basic laboratory research but is steadily encroaching into animal studies, researchers said.
In one recent investigation, a team led by Peter Hornsby of Baylor College of Medicine in Houston used TERT to prolong the lifespan of bovine adrenal cells, which were then placed in the kidney of a mouse with a suppressed immune system and with a missing adrenal gland. Such mice normally die within 25 days since they are unable to produce life-sustaining steroids called glucocorticoids. The treated mice produced the steroid and survived, said Hornsby, author of the study published in the journal Nature
Biotechnology.
Similarly, delivering the telomerase gene into mice with failing livers spared their lives in a study at the Dana-Farber Cancer Institute in Boston, reported in the journal Science.
In terms of human patients, researchers foresee initial therapy consisting of the removal of a few cells by fine needle or surgical biopsy and the resetting of the telomere clock in the laboratory, thus providing the cells with unlimited divisions. The cells could then be reintroduced into the patient, sparing him the possibility of immune rejection since they are his own, researchers said.
"In the case of a genetic disorder, the telomere clock could be reset, then the corrected gene inserted, and finally the cells reintroduced into the patient," Shay said. "In the future we may not need to permanently introduce the telomerase gene; hTERT (the gene) could be introduced to grow the telomeres and then be removed, or perhaps a small molecule will be discovered that can reset the telomere clock. This would avoid potential problems with having too much growth potential, and thus increased risk for cancer."
Genetic engineering of telomerase-immortalized human cells could lead to the development of cell-based therapies for certain genetic disorders, such as muscular dystrophy. Other areas of cell engineering within the realm of possibility include having an unlimited supply of skin cells for grafts for burn patients, for treating chronic (pressure or diabetic) ulcers or for generating cosmetic products for aging skin, scientists said.
Other potential future applications include treatments for patients with age-related conditions, blood diseases, AIDS or bone-marrow disorders.
"Producing an unlimited supply of pancreatic islet cells that are glucose responsive for the treatment of diabetes, telomere modifications of the endothelial lining of blood vessels to prevent arteriosclerosis, bone marrow stem cells for blood transplants, osteoprogenitor cells for rebuilding bone, hepatocytes to alleviate cirrhotic pathology (due to viral hepatitis) and in retinal cells for the treatment of macular degeneration (a leading cause of age-related blindness) are other areas being considered," Shay said.
"The results so far are important as they document that the introduction or activation of telomerase in normal cells is likely to have many applications and a major impact for the future of medicine."

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Residents of key industrial nations are expected to live longer than anticipated by their governments whose, underestimates of longevity may have social and economic repercussions, researchers report. The overly conservative official mortality forecasts may carry implications of overextensions in health services and shortfalls in pension provisions, said the scientists from Mountain View Research in Los Altos, Calif., who analyzed 50 years of data on death rate decline in the so-called Group of 7 nations. 
The team of Shripad Tuljapurkar, Nan Li and Carl Boe found a persistent decline in mortality during the period 1950 to 1994 in Canada, France, Germany, Italy, Japan, the United Kingdom and the United States. Based on their study, the researchers came up with a new death rate forecast that suggests by the year 2050, populations in those countries may be living from 1.3 years -- in the UK -- to eight years -- in Japan -- longer than officials are projecting. The average lifespan has jumped from about 20 years for early humans to 80 or so for inhabitants of modern-day industrialized countries, with most of the increase occurring in the past 150 years, said Shiro Horiuchi of the Laboratory of Populations at Rockefeller University in New York, who wrote an accompanying News and Views article to the study published in the British journal Nature. 
"These days, the existence of a biological limit to human longevity is considered questionable," he said. "Overall, the evidence supports the expectation that scientific, technological and economic developments will lead to more effective control of degenerative diseases and aging processes, making it possible to sustain the rapid pace of mortality decline." Noting the remarkably regular pattern, the authors of the study funded by the National Institute on Aging (NIA) predicted that the 2050 dependency ratio -- those over 65 years of age to those 20 to 64 years of age who are in the workforce -- will exceed official forecasts by anywhere from 6 percent in the United Kingdom to 40 percent in Japan.
The study authors expect this rate to double in the United States in the next 50 years, from .22 to .40 residents over 65 for every working man and woman between 20 and 64. "Studies such as these are important in helping to forecast demographic shifts," said Richard Suzman, NIA associate director for Behavioral and Social Research. "Being able to predict how these populations will age has enormous implications for the planning and provision of services and support. Small increases in life expectancy translate into large increases in the population.
" The aging population is no news to demographers, and the coming of age of the U.S. "baby boomers" has been officially anticipated for some time, with the first boomer to turn 65 in 2011. But the new report talks of lower death rates over longer periods. The mortality data for the seven countries show a significant, steadfast death rate decline at all ages in every nation for the past half century -- a surprising pattern that is expected to continue alongside growing efforts to improve public health, scientists said. The current government estimates of life expectancy in 2050 and new median forecasts reported in the study are: Canada: 81.67 and 85.26, respectively France: 83.50 and 87.81 Germany: 81.50 and 83.12 Japan: 82.95 and 90.91 United Kingdom: 82.50 and 83.79 United States: 80.45 and 82.91. 
"The dependency ratio is often examined by demographers and planners because it is viewed as an important concept for planning retirement systems and health care programs," Tuljapurkar and team noted. If their models are correct, "in 2050, these ratios would be higher by between 6 percent (UK) and 40 percent (Japan), suggesting that programs for old-age support, which may be based on official life expectancy estimates, may need to be re-examined.
" Census Bureau officials said some of the U.S. government projections used in the study have since been updated and that other governments are also realizing the need to take a second look at their forecasts. "It is not surprising that government forecasts of life expectancy and the size of the elderly population in G7 countries are much more conservative than those of Tuljapurkar et al," said Horiuchi. "In the past, national governments, as well as international organizations and academic researchers, have almost invariably underpredicted life expectancy in industrialized market-economy countries." For example, in 1984 the United Nations prepared international population projections based on a human life expectancy of 75 years for males and 82.5 years for females, yet in 1998, the projected lifespans for men and women in Japan were 77.2 years and 82.5 years, respectively.
 "The reason for the underestimates is partly because forecasters regard conservative prospects as less controversial and so 'safe,'" Horiuchi concluded. "It looks as if the same error is still being made."

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Doctors from the around the country meeting in Chicago Monday debated whether they should back a proposal to force Catholic hospitals to provide reproductive services such as sterilization and contraception.
The delegates to an American Medical Association conference considered a resolution, submitted by delegates from California, that asked the AMA to support legislation that would require all hospitals accepting federal Medicare or Medicaid funds to offer a full range of reproductive services.
Proponents of the resolution, which pitted cries of religious freedom against claims of monopolistic policies, charge women were denied those services in some small communities where the only hospitals were run by a Catholic hospital.
The debate was joined by an invited appearance by Cardinal Francis George, archbishop of Chicago. "Clearly this includes requirements for contraception, sterilization and abortion with which Catholic hospitals simply cannot reply," the archbishop said. "Effectively, the AMA is being asked to help abolish Catholic health care in this country. I urge the AMA not to join this campaign against religious freedom."
Dr. Michael Cohen of Walnut Creek, Calif., said his state delegation brought the attention to the AMA following a scenario in Gilroy, Calif., in which a Catholic hospital group purchased the only other hospital in the 40,000-population community and began denying services such as tubal ligation following birth of a child.
Dr. David Priver of San Diego said that in denying such services at the time of delivery -- the optimum time for the sterilization procedure -- the patient was forced to seek another hospital, often considerable distance from home, under go another procedure and another round of anesthesia.
"That's lousy medical care, and the AMA should not side itself with lousy medical care," he said. Dr. Joseph English of New York said the issues was divisive to the AMA and probably impractical to achieve through federal legislation. He noted the difficulty in achieving passage of a Patients Bill of Rights in Congress when it was overwhelmingly favored by the American public, and doubted that the California proposal would achieve that kind of support. "We should not do anything that further separates us," he said.
In a statement submitted to the AMA committee on legislation that heard testimony on the matter, the Catholic Health Association of the United States said: "The resolution is a direct and blatant affront to religious freedom. In fact, it is a thinly veiled attack on the right of Catholic healthcare organizations to provide healthcare services in a manner that is consistent with their religious and ethical beliefs."
However, Dr. Deanna Dell of Durham, N.C., representing the American Medical Women's Association, said the issue wasn't about religion but about economic issues. "This is an issue about monopoly services. Once that hospital elects to become the only provider in an area and then takes what becomes a hidden agenda with regard to providing services for women in that community, then that institution is no longer entitled to the same things in places where it is not a monopoly."
The legislation reference committee which presided over the 90-minute debate will review the arguments, including a substitute proposal from the American College of Obstetricians and Gynecologists to soften the language of the resolution. The committee could recommend to the full House of Delegates of the AMA to either reject the resolution, accept the substitute resolution or refer the matter to committee for further study. The full delegate body which makes policy decisions for the AMA will get to vote on the issue later this week.

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New research underscores the value of prevention and treatment of diabetes in children, especially obese kids.
A study presented in San Antonio, Texas, at a diabetes conference shows that about 20 percent of obese children have signs of insulin resistance -- a hallmark for approaching diabetes. Further, in a separate study, scientists reported that children with type II diabetes benefit from tight blood sugar regulation, just as adults do.
Among 85 children from an obesity clinic in Connecticut, about 25 percent of 24 children who had not yet hit puberty were resistant to insulin -- a hormone that allows cells to absorb sugar from the blood. About 21 percent of 61 children who had already hit puberty showed signs of insulin resistance, said researcher Sonia Caprio of the Yale University School of Medicine in New Haven, Conn. "This is raising the question: We know there is borderline type II diabetes in these kids. Do we try to treat them to prevent it?" Caprio said at the 60th annual meeting of the American Diabetes Association.
Trials are currently underway in adults to see if getting insulin-resistant people to lose weight and exercise more, or using diabetes medications before they clinically develop the disease, can stave off the onset of diabetes, she said.
People with diabetes either do not produce enough or are resistant to the effects of insulin, and insulin resistance is considered a step along the road to diabetes. About 16 million Americans have diabetes.
Blindness, kidney failure, heart disease and amputations are common complications of the disease.
Strict control of blood sugar levels through an intensive intervention program targeted at lifestyle changes such as diet and weight and aggressive drug therapy if needed can stave off complications related to diabetes. These effects persist up to four years after the patients are returned to "normal" care with a primary care physician, said Neil White of the Washington University School of Medicine in St. Louis.
Among 164 diabetics who were under 18 when the intervention program began, those who received intensive therapy were 67 percent less likely to develop retinopathy, an eye disease that frequently leads to blindness, than were those teens who did not, White said.
"Intensive therapy is beneficial and should be started at an earlier stage in disease and at an earlier age," he said.

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People experiencing stress because of their marriage were about twice as likely to develop diabetes as people not under the same pressures about their partnership, researchers reported at the 60th annual scientific meeting of the American Diabetes Association.
The researchers followed 1,733 people -- all of whom lived in or near San Antonio -- for seven to eight years. Of those people who initially reported feeling tense, annoyed, bored or angry when they thought of their spouse, about 18 percent developed diabetes over the course of the study, said Sharon P. Gaskill of the University of Texas Health Science Center at San Antonio. By comparison, 9 percent of those who reported being content or satisfied when they thought of their partner developed diabetes, she said.
The increased risk actually rose after the researchers took into account age, family history of diabetes, high blood pressure and abnormal blood lipid levels, all factors that increase the chance of a person developing diabetes, Gaskill said. "If our findings are confirmed by other studies...the risk of diabetes due to marital stress is close to that (posed by) hypertension," she said.
"There's no question that in a person at risk who is close to developing diabetes, significant stress could bring it out a little earlier," said Gerald Bernstein of Beth Israel Medical Center in New York and immediate past president of the American Diabetes Association. "But stress does not cause diabetes in and of itself."
Adult-onset, or type 2, diabetes affects nearly 16 million Americans. It is a condition in which the body does not make enough or is resistant to the effects of insulin, a hormone that helps sugar get into cells to provide energy. Hormones released when the body is under stress may counteract the effects of insulin, Bernstein said.
The extra burden might tip the scales towards diabetes-an inability to control blood sugar-in people who are already resistant to the effects of insulin. Regardless of the mechanism, stress is not something people or their doctors should ignore, Gaskill said. Other studies have shown that diabetics under stress have more trouble keeping their blood sugar under control. "Stress does not only affect whether a person will develop diabetes but how well it will be controlled," she said. "It's not enough in preventing or treating diabetes...to look just at blood sugar, hypertension and weight."
None of the study participants had diabetes initially; 194 people developed diabetes over the course of the study. About 150 of them were married, Gaskill said.

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Updated 29 August 2005
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