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Surging use of improved medical technology, including new drugs, is driving up life expectancy for Americans and driving down rates of major killers such as heart disease and cancer, a new national health report finds.

At the same time, some things about the nation’s health that experts hoped were changing actually did not, the report found, and the use and misuse of medical technology may also be a factor behind the ever-increasing cost of health care.

The findings are included in a report, entitled “Health, United States, 2009,” issued Wednesday by the U.S. National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

Although Americans are living longer than ever before — 77.9 years on average — “a lot of things that should have been changing aren’t really changing that much,” said Amy B. Bernstein, chief of the Analytic Studies Branch in the Office of Analysis and Epidemiology at the U.S. National Center for Health Statistics.

“Cigarette smoking has pretty much leveled off,” she said. “There is still 20 percent of the population that smokes; that’s bad. People are not exercising more. Obesity is not decreasing.”

Obesity has doubled over the past three decades, from 15 percent of adults in 1976 to 35 percent by 2006, according to the report. As of 2006, 15 to 18 percent of school-age children and adolescents were overweight.

These are things that should be changing and need to be worked on, Bernstein said.

The annual report on the nation’s health also found that:
Heart disease, cancer and stroke, in that order, remain the three leading causes of death in the United States, although deaths attributed to all three have declined.
About 10 percent of Americans rate their health as only “fair or poor,” an increase since the last report.
Americans’ use of medications has tripled, with 47 percent of U.S. residents now taking at least one prescription drug. Half of adults older than 45 take diabetes medications, and 10 times as many people took cholesterol-lowering drugs from 2003 to 2006 as took the drugs from 1988 to 1994.
More Americans are going without health insurance, with almost 8 percent of those aged 18 to 64 uninsured, according to the report, based on data collected in 2007, before the worst of the current economic crunch set in.

Nonetheless, Americans are living longer, which might be due in large part to the ever-increasing use of medical technology.

“Technology is really what’s driving our medical care system,” Bernstein said. The report found, for instance, that the rate of magnetic resonance imaging (MRI) scans and computed and positron emission tomography (CT/PET) scans tripled from 1996 to 2007.

Knee replacements, the report found, increased 70 percent in the past decade. And organ transplants also became more common. The number of kidney transplants per 1 million people increased 31 percent, for example, and the number of liver transplants increased 42 percent.

But, all of this technology comes at a price, Bernstein said. “Once a technology is introduced, it seems to have a life of its own,” she said. “Once you start using it, it is hard to stop using it — even if there are reasons that you should.”

As an example, she cited the use of drug-eluting stents, which were highly touted as better than bare-metal stents, used to keep arteries open. However, Bernstein said, new research indicates that they may not benefit everyone.

“There is no doubt that technology can improve life and save life,” she said. “But the question is: ‘Do you need to do everything to everyone?’”

The increased use of technology also raises ethical questions, Bernstein said. For example, the report found a dramatic increase in the use of mechanical ventilation to keep people alive.

“There is no way we can say it’s a good thing or a bad thing,” she said. “It’s clearly a good thing for the people it saved. The question then is: ‘Is it a good thing for the people who aren’t saved?’”

Bernstein said she believes that the use of technology will continue to increase.

That, however, can have a downside, explained Dr. David L. Katz, director of the Prevention Research Center at Yale School of Public Health.

“Age-adjusted mortality rates in the U.S. have been falling steadily over recent years, and life expectancy has been increasing. Advances in medical technology and pharmacotherapy are important reasons for these favorable trends,” Katz said.

“But the rise in use of high-tech scans, such as MRI and PET, and the rise in related health-care costs far exceed any measurable health benefits that may be related,” he noted.

“In other words, the bucks are clearly adding up a lot faster than the bang,” Katz said.

Compounding this concern, he said, is the fact that though medical technology can help stave off death, it does far less to preserve or establish vitality.

“Trends for death rates are favorable, while disability trends are neutral, and trends for the total population burden of obesity and chronic disease are decidedly adverse,” Katz said. “The more societal resources we allocate to medical technology, the less we may devote to supporting the lifestyle practices that can actually build health at its origins.”

In an age of evidence-based medicine and unsustainable health-care costs, Katz said, advanced medical technology cannot be “toys with which we play just because we have them.”

New research based on the experiences of atomic-bomb survivors has found a link between exposure to moderate levels of radiation and higher levels of heart disease and stroke.

It’s not clear, however, if the radiation directly causes the diseases, nor is it clear if there’s a link between lower doses and the health problems.

High doses of radiation to the heart, head or neck have been shown to boost the risk of heart disease or stroke later in life. But the effect of lower doses — 1 gray (Gy) or less — needs clarification, experts say, at least in part because of the increasing use of medical scans that rely on radiation.

Average radiation exposure from medical procedures is considerably lower and usually measured in milligray (mGy). An abdominal X-ray exposes the recipient to 1.4 mGy (0.0014 Gy), and an abdominal CT scan puts out a radiation dose of 8.0 mGy (0.008 Gy), according to background information in a news release from BMJ. The journal published a report on the new research online Jan. 15.

For the study, researchers from the Radiation Effects Research Foundation in Japan examined the medical records of 86,611 Hiroshima and Nagasaki atomic-bomb survivors who were followed from 1950 to 2003. All had been exposed to radiation doses from 0 to 4 Gy, with 86 percent exposed to less than 0.2 Gy.

After taking into account the possible effects of such factors as smoking, education and obesity, the researchers determined that the rates of stroke and heart disease went up among those who were exposed to doses higher than 0.5 Gy, which they labeled moderate. They did not clarify how lower doses affected risk.

In an accompanying commentary, Mark Little, of Imperial College London, agreed with the researchers that future study should explore whether low doses of radiation affect the body’s biological mechanisms in similar ways.

SOURCE: BMJ, news release,

The popular herbal remedy St. John’s wort may help ease menopausal hot flashes, a small study suggests.

St. John’s wort is probably best known as an herbal antidepressant, with some clinical trials suggesting that it can help relieve mild to moderate depression symptoms.

A few studies have also investigated the herb’s effects on menopausal symptoms, but have focused on its impact on mood — and not the so-called vasomotor symptoms of menopause, which include hot flashes and night sweats.

“(The) findings of our study suggest that this herbal medicine can be used to treat hot flashes due to menopause, and it is a new finding about the usage of St. John’s wort,” Marjan Khajehei, of Shiraz University of Medical Sciences in Iran, told Reuters Health in an email.

Khajehei and her colleagues found that among a group of women they randomly assigned to take either St. John’s wort or an inactive placebo for eight weeks, those using the herb saw a greater reduction in daily hot flashes.

Among women taking St. John’s wort, the average number of hot flashes declined from roughly four per day at the start of the study to fewer than two per day at week eight. In contrast, women in the placebo group were having an average of 2.6 hot flashes per day by the eighth week.

The herb also appeared to lessen the duration and severity of the women’s hot flashes, Khajehei and her colleagues report in the journal Menopause.

The study included 100 women who were 50 years old, on average, and had been having moderate to severe hot flashes at least once per day. The women were randomly assigned to take either drops containing St. John’s wort extract or placebo drops three times a day for eight weeks.

While women in both groups saw their hot flashes improve, those taking the herbal extract had a better response, on average.

St. John’s wort contains estrogen-like plant compounds called phytoestrogens, and it’s possible that these compounds explain the benefits seen in this study, according to Khajehei.

However, she said, further research is needed to confirm that the herb eases hot flashes and that phytoestrogens are the reason.

St. John’s wort is generally considered safe when taken as directed, Khajehei noted. Still, she added, since phytoestrogens have mild estrogen-like effects in the body, women who have any contraindications to using estrogen — such as a history of breast or endometrial cancers — should talk with their doctors before starting St. John’s wort.

The herb has also been shown to interact with certain medications, including antidepressants, the heart medication digoxin and the blood thinner warfarin. Experts generally recommend that people on any medication talk with their doctors before starting an herbal remedy.

SOURCE: Menopause, February 2010.

Race and obesity may affect the outcome of men with diabetes who have prostate cancer surgery, a new U.S. study reveals.

“We found that diabetes was significantly associated with more aggressive disease in obese white men and less aggressive disease for all other subsets of men in our study,” Dr. Stephen Freedland, an associate professor of urology and pathology at the Duke Prostate Center at Duke University, said in a Duke news release.

Freedland and colleagues examined the medical records of 1,262 prostate cancer patients who had undergone radical prostatectomy — surgery to remove the prostate gland and some tissue surrounding it.

The researchers found an association between diabetes and an increased risk of cancer recurrence and a trend toward more aggressive recurrence in obese white men. In all other groups of men, diabetes was associated with lower recurrence risk.

“We really don’t know what mechanisms might be in place that could account for this relationship,” Freedland said. “But consider this: diabetes is associated with low levels of insulin and testosterone, an inhospitable environment for tumor growth. This is compounded in obese white men who also have lower insulin-like growth factor levels. The thinking is that if a tumor is powerful enough to grow in such a hostile environment, then it’s probably a pretty aggressive one.”

The study was published in the January issue of Cancer Epidemiology, Biomarkers & Prevention.

In a surprise finding, Canadian researchers report that the immediate effect of the fish oil fatty acids that are good for the heart is a short-term increase in blood fats and the molecules that help them form clots.

“We were surprised to find that the acute response has some potentially negative effects in comparison to what you might expect from chronic, long-term intake,” said Lindsay E. Robinson, an associate professor of nutrition at the University of Guelph, and leader of the group reporting the finding in the January issue of the Journal of Nutrition.

However, the study results shouldn’t affect the current recommendation for eating more oily fish to get the omega-3 polyunsaturated acids that reduce the risk of blood clots that can cause heart attacks and stroke, Robinson said.

“The recommendation to increase intake is very well-studied, and this doesn’t change it,” she said.

And the effects were seen in a selected group of middle-aged men with metabolic syndrome, a combination of high blood pressure, obesity and elevated blood fat levels, Robinson noted.

“We don’t have any reference to a healthy control group, which the study didn’t have,” she said. “It’s possible that in these individuals, there may be a different response to omega-3 fatty acids.”

Still, it does indicate that further study is warranted of the effects of omega-3 fatty acids in the postprandial period, the hours immediately following a meal, Robinson said.

“We spend up to 18 hours a day in the postprandial period,” she said.

In the study, eight men had controlled intake of three regimens: high doses of omega-3 fatty acids, low doses of them and just plain water. Robinson and her colleagues measured several blood components involved in clotting, including fats and clotting factors such as plasminogen-activator inhibitor-1 (PAI-1) for the following eight hours.

PAI-1 inhibits the destruction of blood clots, so high levels of it in the blood increase the risk of artery-blocking clots.

The researchers found that both omega-3 fatty acid regimens increased blood fat and clotting factor activity. But the increase in clotting factor was greater for the higher doses of omega-3 fatty acids than for the lower intakes.

Robinson said her group hopes to do further studies of the immediate effects of omega-3 fatty acid intake. “We need to look at the mechanisms, why blood lipid levels go up,” she said. It’s possible that there are important differences between the short-term and long-term responses to many dietary fats, she said.

“My quick read on it is that they are looking at a one-time treatment of these patients,” said Donald B. Jump, a professor of nutrition at Oregon State University.

“This may be a reflection on the experiment design,” Jump said. “From a clinical perspective, most patients take these compounds over periods of weeks or months. There is probably some adaption that occurs. That metabolic adaption probably requires some time. If they treated the patients for a couple of weeks and did the experiment again, they might get a different response.”

Knowing that a reduction in the amount of PRPP synthetase 1 is what causes deafness in DFN2, Liu and his colleagues are now exploring potential enzyme replacement therapies to either restore hearing or prevent further hearing loss in boys with DFN2. Since the PRPS1 mutations can be used as a genetic marker for DFN2, in the future at-risk boys could be tested at birth and immediately put on enzyme replacement therapy to reduce or prevent the hearing loss that would ordinarily come later in life.

In addition, the knowledge that scientists gather about the mechanisms of PRPS1 potentially could be used to develop treatments to combat acquired hearing loss, such as the hearing loss caused by drugs that are used in some chemotherapy regimens and treatments for HIV/AIDS. These are powerful and helpful medications, but they have the unfortunate side effect of damaging, even killing, hair cells in the inner ear. The results from this study open the possibility for improving these life-saving treatments by eliminating or reducing the disabling side effect of hearing loss.

In addition to NIDCD support, the following institutions collaborated in this study: Chinese PLA General Hospital, Beijing; University of Science and Technology of China, Hefei; Chinese Academy of Sciences, Hefei; Guizhou Provincial People’s Hospital, GuiYang, China; UCL Institute of Child Health, London; Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, and Shanghai Second Medical University, Shanghai; Department of Genetics, Harvard Medical School, Boston; Massachusetts Eye and Ear Infirmary, Boston; and Howard Hughes Medical Institute, Boston.

NIDCD supports and conducts research and research training on the normal and disordered processes of hearing, balance, smell, taste, voice, speech and language and provides health information, based upon scientific discovery, to the public. For more information about NIDCD programs, see the Web site at www.nidcd.nih.gov.
The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

A gene associated with a rare form of progressive deafness in males has been identified by an international team of researchers funded by the National Institute on Deafness and Other Communication Disorders. The gene, PRPS1, appears to be crucial in inner ear development and maintenance. The findings are published in the December 17 early online issue of the American Journal of Human Genetics.

“This discovery offers exciting therapeutic implications,” said James F. Battey, Jr., M.D., Ph.D., director of the NIDCD. “Not only does it give scientists a way to develop a targeted treatment for hearing loss in boys with this disorder, it may also open doors to the treatment of other types of deafness, including some forms of acquired hearing loss.”

The gene is associated with DFN2, a progressive form of deafness that primarily affects males. Boys with DFN2 begin to lose their hearing in both ears roughly between the ages of 5 and 15, and over the course of several decades will experience hearing loss that can range from severe to profound. Their mothers, who carry the defective PRPS1 gene, may experience hearing loss as well, but much later in life and in a milder form. Families with DFN2 have been identified in the United States, Great Britain, and China.

The NIDCD-funded researchers led by Xue Zhong Liu, M.D., Ph.D., of the University of Miami Miller School of Medicine, discovered that the PRPS1 gene encodes the enzyme phosphoribosylpyrophosphate (PRPP) synthetase 1, which produces and regulates PRPP (phospho-ribosylpyrophosphate), and appears to play a key role in inner ear development and maintenance. The four mutations identified in the PRPS1 gene cause a decrease in the production of the PRPP synthetase 1 protein that results in defects in sensory cells (called hair cells) in the inner ear, and eventually leads to progressive deafness.

“PRPS1 is an interesting example of a human disease gene in which gain of function or loss of function mutations cause several different and distinct hereditary disorders,” says Dr. Liu. “Our findings emphasize the body’s need for tight regulation of PRPP synthetase 1 since a drop in activity can lead to deafness.” Other mutations in the PRPS1 gene have been linked to neurodegenerative disorders such as Arts syndrome and a form of Charcot-Marie Tooth disease, both of which feature deafness in the constellation of symptoms.

Chronic renal failure is a serious condition that, over time, causes the kidneys to stop working properly.

The University of Virginia Health System offers this list of conditions that could lead to chronic renal failure:
Damage to the kidneys in people with diabetes.
Persistent high blood pressure.
The autoimmune disease lupus.
A lingering blockage in the urinary tract.
Hereditary conditions such as cystinosis or Alport syndrome.
Nephrotic syndrome.
Polycystic kidney disease.
Inflammation of structures inside the kidneys.

Replacing or adding wiring increases the risk of major complications for patients having surgery to replace a pacemaker or other heart rhythm-stabilizing device, a new study finds.

U.S. researchers analyzed complication rates among patients enrolled in the REPLACE prospective multicenter registry who underwent replacement of a pacemaker, implantable cardioverter defibrillator (ICD), or cardiac resynchronization (CRT) generator. One group of patients required no new wiring while the other group did.

Major complications occurred in 15.3 percent of the 713 patients who needed wiring. The highest rate of major complications occurred in patients whose replacement procedure required a lead to connect a CRT generator to the left ventricle. Minor complications occurred in 7.6 percent of the wiring patients, said the University of Washington, Seattle researchers.

The average age of the patients needing wiring was 69.5 years at the time of enrollment. Of that group, 75.9 percent were male, 40.1 percent had previously suffered a heart attack, 30.4 percent had diabetes, and 55.7 percent had serious congestive heart failure.

The study was to be presented Sunday at the American Heart Association’s meeting in Orlando, Fla.

A moderate-fat diet may work better than a low-fat regimen for people suffering from metabolic syndrome, a collection of conditions putting them at higher risk for cardiovascular disease, new research finds.

“This is a good study that essentially confirms that the current recommendations are appropriate,” said Alice Lichtenstein, a spokeswoman for the American Heart Association (AHA). “Since 2000, the AHA has been recommending not a low-fat diet, but one that is low in saturated fats and trans fatty acids.”

People with metabolic syndrome are glucose-intolerant, meaning they can’t process blood sugar well. Low-fat, high-carbohydrate diets exacerbate this condition, Lichtenstein explained.

To be diagnosed with metabolic syndrome, you must have three or more of the following risk factors for heart disease: belly fat, high triglycerides, low good cholesterol, high blood sugar and high blood pressure.

The study was among several to be presented Monday at the AHA’s annual meeting in Orlando, Fla. Researchers from the University of Washington in Seattle randomized 71 men and women with metabolic syndrome into one of two diet arms, the first made up of 40 percent fat, 45 percent carbohydrate and 15 percent protein (the moderate-fat diet) and the other, the low-fat diet, containing 20 percent fat, 65 percent carbs and 15 percent protein. Saturated fat content was about 8 percent in each, and each had about the same amount of fiber.

Levels of LDL (or “bad”) cholesterol fell 3.4 milligrams per deciliter (mg/dL) on the low-fat diet compared with 11.6 mg/dL on the moderate-fat plan. HDL (or “good”) cholesterol also fell, by 4.9 mg/dL on the low-fat plan and by 1.9 mg/dL on the other.

C-reactive protein (CRP), a marker of inflammation linked to heart disease, fell more in the low-fat group than in the moderate-fat group (0.82 mg/L versus 0.63 mg/L), but the authors considered it a good drop in both cases.

While triglycerides, another measure of heart health, increased 11.1 mg/dL on the low-fat diet, they dropped 28.6 mg/dL on the other plan.

Experts familiar with the study aren’t surprised by the findings. “This sort of falls within the boundaries of what we used to call the Atkins diet, which was a high-lipid and low-carb diet. Normally this kind of diet suppresses appetite, improves diabetes,” said Dr. Alfred Bove, president of the American College of Cardiology. “This diet looks like it does a good job of altering the negative metabolic effects of early diabetes or high carbohydrate stimulation,” he said.

“Much of this we’ve known before, but the idea is that a moderate-fat diet is something most people can tolerate,” Bove said. “It probably affects the way insulin is released because if you have a lot of carbohydrates in the diet, you tend to generate a lot of insulin, and insulin is the hormone that lowers blood sugar,” Bove explained. “In addition to lowering blood sugar, it also increases appetite so a lot of people on high-carb diets are restimulated to eat more.”

Another study found yet more evidence to recommend the famed DASH (Dietary Approaches to Stop Hypertension) diet, an eating plan that has been found to lower blood pressure. DASH calls for a diet high in fruits and veggies and low in total fat, saturated fat and cholesterol. Red meat and sweets are limited as well.

This study showed that the diet lowered coronary heart disease risk for a decade by 18 percent compared with people eating as usual and 11 percent compared with people in a fruit- and vegetable-rich program.

“We took our data and plugged it into the Framingham risk equation used to estimate heart disease risk and found a 20 percent reduction in risk of heart disease,” said study senior author Dr. Lawrence Appel, professor of medicine at Johns Hopkins Medical Institutions in Baltimore. “We don’t have a 40,000-person randomized trial but, next to that, this is probably one of the best analyses to show that the DASH diet should reduce heart disease as well as blood pressure.”

Although the DASH diet is recommended to reduce blood pressure, there had been some “quirks” in previous data leading people to question the program’s net effect, Appel said.

A third study confirmed that even small helpings of fruits and veggies can boost your health.

In a Columbia University Medical Center study of 501 patients, just one extra serving of fruits or vegetables was linked with lower levels of both CRP and cholesterol. And adding another gram per day of omega-3 fatty acids, found in fish as well as plant-based oils, also was associated with a drop in CRP levels.

Lowering intake of saturated and trans fats meant reductions in both total and LDL cholesterol, the researchers, led by Dr. Lori Mosca, found.

And more calories from alcohol seemed to move HDL cholesterol levels down, although other measures did not change.