20000227

Gene may help to diagnose, treat colon cancer-study

(Release at 0001 GMT, Friday, Feb 25)

LONDON, Feb 25 (Reuters) - Doctors in the United States said

on Friday they had pinpointed a gene that could be used to help

diagnose and treat colon cancer.

The gene causes tumours of the pituitary gland but

scientists at Cedars-Sinai Medical Center in Los Angeles said it

is also found in cancerous cells in the colon and seems to be

involved in converting normal cells to malignant ones.

"The novel transforming gene known as Pituitary Tumour

Transforming Gene (PTTG1) may prove to be a powerful tool for

identifying colon polyps (growths) most at risk of becoming

malignant and for distinguishing aggressive colorectal cancer,

the third leading cause of death in the U.S." Dr Anthony Heaney

said in a statement.

The gene is found in most human tissue but it is very

abundant in cancerous cells. Scientists think it can also be

used as a marker to determine the seriousness of the disease and

how it responds to treatment.

"These findings indicate that the novel transforming gene,

PTTG1, may be a marker of invasive colorectal carcinoma," Heaney

said.

The researchers discovered the gene's role in colon cancer

by examining samples of malignant and benign tumours.

In a report in The Lancet medical journal, they said high

levels of PTTG1 were found in every cancerous tumour they

examined. In cases where the cancer had spread to the lymph

nodes or liver, the levels were even higher.

Heaney and his team said the discovery should shed new light

on how normal cells change into cancerous tumours.

Vaccine protects against stroke, epilepsy - report

WASHINGTON, Feb 24 (Reuters) - Researchers said on Thursday

a new approach combining gene therapy and vaccination has

prevented epileptic seizures and brain damage in rats and

suggested it could eventually be tried in humans.

A team at the Jefferson Medical College in Philadelphia

said their vaccine, which is given orally, marshaled the immune

system to protect brain cells that are usually killed during

and after a stroke or a seizure.

"It protects them significantly from ... insults such as an

epileptic seizure or a stroke for at least five months after a

single oral dose," Dr. Matthew During, a professor of

neurosurgery who led the study, said in a statement.

The researchers, who reported their findings in the journal

Science, said it might be used to help protect people

considered at high risk of a stroke or a seizure, such as those

who have undergone heart bypass surgery.

And they say the approach might work against a whole range

of diseases involving the central nervous system, from

Parkinson's to Lou Gehrig's disease (motor neuron disease).

"I think it represents a new platform of technology, a sort

of revolutionary approach to the treating of brain diseases,"

During said in a telephone interview.

"What we have shown here is you can harness the amazing

specificity of the immune system so it can go in and act as a

scalpel, so to speak, to target specific brain functions."

During and colleagues, working in collaboration with the

team at the University of Auckland in New Zealand, targeted a

brain protein, part of the NMDA receptor. This bit of the

receptor -- which is a chemical doorway into a brain cell -- is

called NR1.

NMDA receptors are important not only for brain development

and learning, but are involved in a range of diseases including

epilepsy, dementia and the injuries caused by stroke.

The researchers made up a vaccine that caused the rats to

first produce the protein for this receptor, then recognise it

as abnormal and block it. Best of all, the effect was temporary

and seemed to work only in direct response to a brain injury.

They used an adeno-associated virus -- a small kind of

virus that does not make people sick but which is very good at

infecting cells -- to carry DNA from the NMDA receptor into the

bodies of their experimental rats.

They fed this vaccine to the rats, who developed antibodies

specifically targeting this bit of the receptor, and when the

scientists induced an epileptic seizure in the rats a month

later, only 2 of 9 vaccinated rats showed signs of a seizure.

"About 70 percent of the rats should have gone into

seizures, whereas only 20 percent of the rats immunised against

the NMDA receptor did so," During said.

They killed the rats and looked at their brains and found

no sign of the damage usually caused by the chemical used to

induce a seizure. During thinks the effect might be permanent,

but they have to test the rats further to see if they are

protected against repeated injuries or seizures.

The brain is exceptionally fragile because, for reasons not

yet fully understood, when one brain cell dies, as in a blow to

the head or a stroke, it sends out signals that kill other,

uninjured cells surrounding it.

During's team said their study indicates their vaccine

could prevent this kind of damage as well.

To test this, they vaccinated rats and induced a stroke.

The rats did have strokes, but the area damaged was much

smaller in the vaccinated rats, they said.

Normally, a vaccine should not be able to get into the

brain because of a system called the blood-brain barrier that

protects from damage caused by the immune system.

But the researchers noted that sometimes cancer can break

down this barrier, allowing immune system compounds to cause

inflammation of the brain. They think they may have breached

the blood-brain barrier in the same way, but only temporarily,

when they intentionally damaged the rats' brains.

The rats were closely watched to ensure the vaccine did not

damage their brain cells in another way. "They were completely

normal in terms of motor behaviour," During said.

"If anything, the rats were a bit smarter," he added. But

he declined to go any further, saying that part of the study

had not yet been published.

Doctors warn of danger of anti-convulsion drug

(Release at 0001 GMT, Friday, Feb 25)

LONDON, Feb 25 (Reuters) - Doctors said on Friday that a

drug used to control convulsions could be fatal for children

suffering from a severe form of malaria.

Phenobarbital has been used for many years to control

epilepsy and convulsions but researchers who studied its effects

on young Kenyan malaria sufferers said it should not be given at

the maximum recommended dose because it could be fatal.

Jane Crawley and doctors from Oxford University and the

Kenyan Medical Research Institute studied 340 children with

cerebral malaria, a very serious form of the disease.

Half of the children were given a single dose of

phenobarbital based on 20 mg per kilo of body weight and the

remainder received a placebo.

The drug was effective in controlling the children's

seizures but there were twice as many deaths in the drug group

compared to the children given the placebo.

"Phenobarbital at this dose in cerebral malaria should not

be used," Crawley said in a telephone interview.

She said further studies are needed to see if a lower dose

of 10 mg per kilo, which would be safer, could also control

seizures.

"Phenobarbital is the only drug that is currently available

and cheap enough to be used throughout tropical Africa which is

why we used it. It's important to finish answering the

phenobarbital question by looking at the lower dose," she said.

She recommended that doctors give half the dose to control

seizures if no other drug is available.

The doctors are not sure if the additional deaths resulted

from the phenobarbital or other drugs to control the disease, or

if the children had more severe cases of malaria.

"Studies are still needed to guide the use of

anticonvulsants in cerebral malaria. Whether smaller doses of

phenobarbital or alternative drugs are evaluated numbers must be

large enough to detect an effect on seizures and on mortality,"

Malcolm Molyneux of the University of Malawi said in a research

commentary reported in The Lancet medical journal.

Malaria kills millions of people each year and 90 percent of

deaths are in Africa. Two-thirds of its victims are children.

Early diagnosis improves anorexia outcome

(Release at 0001 GMT, Friday, Feb 25)

LONDON, Feb 25 (Reuters) - Girls treated early for anorexia

before their weight has dropped to extreme levels have the best

chance of fully recovering from the eating disorder, German

doctors said on Friday.

A follow-up study of 84 anorexia patients 21 years after

they were first treated for the disease showed that patients who

had suffered for a long time before they were treated had the

worst outcomes.

"The finding that a longer duration of illness and a low

body-mass index before the first in-patient treatment were

associated with a poor outcome emphasise the importance of early

identification and intervention," said Dr Stephan Zipfel, of the

University of Heidelberg.

Ninety percent of the patients in the study published in The

Lancet medical journal were still alive more than two decades

after they were diagnosed with the condition and half had fully

recovered.

Ten percent of the women were still anorexic and nearly 16

percent had died from conditions related to the disorder.

Zipfel and his colleagues found that women who restricted

their eating had a better chance of beating the disease than

those who binged and purged themselves.

"The other prognostic findings suggest that clinicians

should target social and psychological symptoms as well as

adequate weight gain during treatment," the researchers added in

a letter to the journal.

An estimated seven million women and one million men

worldwide suffer from either anorexia or bulimia. About six

percent of patient die of the disorder and roughly 50 percent

are cured.

Canada urged to spend billions to heal health system

By David Ljunggren

OTTAWA, Feb 24 (Reuters) - Canada's doctors, nurses and

hospitals say the country's sickly health care system will

remain on the critical list unless Finance Minister Paul Martin

unveils billions in new spending in next Monday's budget.

The presidents of the Canadian Medical Association,

Canadian Nurses Association and the Canadian Healthcare

Association all told Reuters they had pushed Martin and his

officials to add at least C$1.5 billion in health spending.

Last year Martin announced an extra $11.5 billion in health

care spending over five years, reversing deep cuts imposed by

the governing Liberals to eliminate a budget deficit.

"What happened last year was a good first step. It took a

health care patient out of intensive care and put him back on

the floor but didn't get him home," said Canadian Medical

Association president Dr. Hugh Scully.

"It's not good enough when you consider Canada's

increasingly ageing population and (expensive) advances in

technology."

Health Minister Allan Rock acknowledges there is an urgent

need to reform the state-funded medicare system, which is

struggling to cope with previous funding cuts, hospital ward

closures and a shortage of health care professionals.

Scully said the government should link the health budget

to an "escalator" mechanism to ensure spending kept pace with

inevitable increases in medical costs.

"Medical inflation normally runs about 1.5 points above the

cost of living. This includes the cost of pharmaceuticals and

technology," he said, also calling for more money to train

doctors and specialists.

Scully said the CMA -- which represents the bulk of

Canada's 55,000 doctors and health specialists -- also wanted

to see C$1.7 billion ploughed into a national health technology

fund to purchase advanced medical equipment.

He said he remained optimistic the government would pay

attention to opinion polls and feedback that showed Canadians

were most concerned about the need to fund medicare.

"When we started (asking for more budget money) in November

there was a very negative atmosphere from all levels of federal

government. I've found the attitude has been much been more

positive in the last six weeks in particular," Scully said.

Official figures show that spending on the health care

system was expected to reach a record C$86 billion ($59

billion) in 1999, an increase of 5.1 percent from 1998.

But despite this Canada is still ranked alongside Turkey on

the Organisation for Economic Cooperation and Development's

list of how much access patients have to advanced medical

technology such as scanners and radiation devices.

Medicare is also facing a critical loss of nurses. In 1997

the Canadian Nurses Association predicted in a worst-case

scenario that Canada would be 113,000 nurses short by 2011.

CNA president Lynda Kushnir Pekrul said Martin had to show

Ottawa was fully committed to health care and would provide

grants and bursaries to help recruit more student nurses.

"Windfall funding in any one budget is nice but we need

more to provide the certainty and the sustainability we need.

We want some security in how health care is funded and security

for funding in years to come," she said.

Canadian Healthcare Association president Sharon

Sholzberg-Gray said the government would have to plough in more

funds if Rock could realise his plan of setting up a new

national primary and home-care programme to relieve the burden on

emergency wards and hospital beds.

"We are looking in future for more funds to expand medicare

so it follows clients to wherever they require the care," she

said. "You can't deliver a sustainable healthcare system with

single investments. You have to have predictable ongoing

funding."

Organisations belonging to the CHA employ just under one

million workers and have 125,000 hospital beds.

"We're always hopeful. We think the government understands

the severity of the problem," said Sholzberg-Gray.

Schering-Plough sees 2000 EPS in line with forecasts

MADISON, N.J., Feb 24 (Reuters) - Schering-Plough Corp.,

maker of the blockbuster allergy drug Claritin, on Thursday

said that earnings this year would meet Wall Street forecasts

of $1.64 a share, up from $1.42 in 1999.

Schering-Plough SGP.N, which also makes the cancer

treatment Intron A, said it expected to complete its $1 billion

share repurchase programme in the first quarter and would

consider launching a new buyback programme.

The current programme was started in January 1998 and is

currently 85 percent complete, it said.

Feature-Sex-change victim recalls life as a girl

By Natalie James

TORONTO, Feb 24 (Reuters) - Brenda Reimer was an awkward

child, who did not engage in girlish activities and was

mercilessly teased by schoolmates for her gunslinger stride and

lack of interest in boys.

Doctors told her that her discomfort was due to a passing

phase of "tomboyishness."

What they didn't tell her was that she had in fact been

born "Bruce" and had been subjected to gender reassignment

surgery at 18 months, 10 months after doctors botched a

circumcision and destroyed most of his penis.

Instead of raising their child as a boy, Bruce's young

parents took the advice of a famous American medical

psychologist, John Money of Johns Hopkins Medical Centre in

Baltimore, who said that Bruce could be a happy "Brenda" with

the proper treatment and hormones.

But the experiment did not go as planned, plunging Bruce

into a life of angry depression and isolation before surgery in

his mid-teens transformed him back into a man.

Bruce is now 34 and is known as David. He has decided to

cast aside his veil of anonymity to set the record straight

about the failed experiment in psychosexual engineering. He

tells his tale in a book, "As Nature Made Him," written by

Canadian journalist John Colapinto.

CASE HAILED AS MEDICAL TRIUMPH

Based on this case -- known as the "twins case" because he

was born with an identical twin brother who was raised a boy --

sex reassignments became, and remain, a widely accepted medical

practice for newborns with injured or irregular genitalia.

Although Reimer grew up miserably aware that something was

wrong, the John/Joan case, as it was known in the medical

books, was hailed by Dr. Money in 1972 as a medical triumph.

It was seen as proof of the idea that a person's sexual

identity is ultimately determined by environment, leading

doctors around the world to perform thousands of sex

reassignments on infants with similarly injured or abnormal

genitalia.

"I was surprised at the fact that other people wound up

going through what I had (gone through), because of my

so-called 'success story' -- that wasn't so much a success

story," Reimer told Reuters with thinly veiled sarcasm as he

recounted the horrific calamity of his early life.

Even as Reimer (as Brenda) plunged into suicidal

depression, the fabled version of her life was accepted by

virtually everyone, especially the feminist movement which saw

it as proof of their conviction that gender identity and sexual

orientation are a result of rearing and environment.

SCIENTIFIC PAPER EXPOSES CASE AS FAILURE

In 1997, journalist Colapinto learned through an article in

the New York Times that Dr. Milton Diamond of the University of

Hawaii had exposed, in a scientific paper some 30 years after the

experiment began, that it had indeed been a failure. The case

captured his imagination and inspired the book.

"Scientists had just relied on this case as being a

precedent for the fact that you could assign the sex and gender

to children," Colapinto said in a telephone interview. "Those

who believed that and taught it and based their clinical

practice on it, and who actually performed similar procedures,

were scandalised."

For Reimer, the experiment was a failure from the start.

One of his earliest memories is the day his father

sheepishly informed him that he would have to take female

hormones to grow breasts.

"I was wondering why ... He told me it was so I could wear

a bra. I threw a fit," Reimer said in a telephone interview

from Winnipeg, where he lives.

After the botched circumcision destroyed most of his penis

at eight months old, Reimer's parents, a working class couple

from Winnipeg, agreed to submit their son to a radical

sex-change procedure -- clinical castration, removal of the

remaining shred of penis and hormone therapy.

"I was raised as a girl. I was not comfortable with the

situation. That was not the true me," Reimer said.

The tragedy of David Reimer, however, was considered a

boon for science because David was born with a twin brother,

Brian, who -- with his genitals still intact -- would provide a

perfect matched control for their study.

FINE FEATURES BEAR WITNESS TO HORMONE TAMPERING

Reimer's rumbling baritone voice fits strangely with his

fine facial features, which bear the mark of years of hormonal

tampering.

"You were expected to wear girl's clothing and to behave in

a certain manner and you were expected to play with girls'

toys," he said.

But Reimer knew he wasn't a girl. "I thought I was an it,"

he said.

Reimer's mother recalled that even as a baby Brenda hated it

when she was outfitted in a dainty dress: "She was ripping at it,

trying to tear it off," she said in the book.

Later in life, "Brenda" developed an "angular gunslinging

stride" that was a source of ridicule among her peers. She

wasn't interested in boys and thought sprouting breasts and

developing hips abhorrent.

And although doctors had removed Reimer's testicles, the

then-Brenda began to show the ominous signs of incipient

manhood -- growing muscles on her shoulders, neck and biceps

and sometimes a strange, high-pitched break in her voice.

Regardless of these signs, Dr. Money pressed the family to

continue with the experiment and take it to its final phase:

creating female genitalia.

Only when Brenda's defiance had turned to suicidal

depression when she was 14 did her parents reveal the truth --

that she was a boy. "An amputee," Reimer said.

Although they had all deceived him for more than 13 years,

David said he harboured no resentment toward his parents, who,

barely out of their teens, were persuaded easily by the

opinions of highly educated doctors.

REIMER PUTS BLAME ON DOCTORS

The responsibility, he believes, rests squarely on the

shoulders of those doctors, especially Dr. Money, who had

developed an international reputation for the "twins case."

Despite the apparent harm it was doing to the Reimer

family, Money appeared bent on seeing it through to the end.

"I thought it was very ignorant for them to think I was no

longer a male because my penis was burned off," Reimer said. "A

woman who loses her breasts to cancer doesn't (become) any less

of a woman."

After his return to being male and his adoption of a new

name, no one suspected the truth about his upbringing, despite

his slim build, relative lack of facial hair and youthful

appearance. He looks 10 years younger then his twin brother,

Brian.

"He's just so masculine that the minute he just starts being

David -- rolling his cigarettes and working his machines and

stuff -- I think people just accepted that that's him," said

John Colapinto, the author who coaxed him out of anonymity.

"There's no sense that this is a performance whatsoever."

Admittedly, it would have been easier for Reimer and his

family -- a wife and three adopted children -- to remain hidden

but he said he is driven by the conviction that he has

something important to say.

His lifelong ordeal has left Reimer deeply distrustful of

the medical establishment and although he is leery of doctors,

he admits they were, at least, able to restore some of what had

been taken away 34 years ago.

"I'm like the six-million-dollar man," he said. "They could

rebuild me and they did."

FEATURE-Sick, or healthy, what's the alternative?

By Patricia Reaney

LONDON, Feb 24 (Reuters) - Forty years ago they were

regarded as quacks, their patients considered gullible and their

remedies dismissed as useless concoctions or wacky therapies.

How times have changed.

Complementary and alternative therapies and the people who

administer them are becoming increasingly popular and accepted,

even by a once sceptical medical establishment.

Be it aromatherapy or reflexology, acupuncture and shiatsu

or homeopathy and cranial osteopathy, alternative remedies

popularised by royalty and film stars have mushroomed into a

billion dollar industry.

Even the esteemed British Medical Journal, one of the

leading medical journals, has featured a series on alternative

therapies because of demand from doctors for more information.

"Our readers wanted it," said editor Richard Smith.

"They wanted it because they want to know more about it

because their patients are interested in it and because they are

wondering whether to refer people. They want to know what works

and what doesn't."

Such is the popularity of complementary medicine that

doctors on both sides of the Atlantic have urged their

governments to provide more funding for research into

alternative therapies ranging from plant remedies for depression

such as St John's Wort (hypericum perforatum) to acupuncture and

reflexology.

PRINCESS DIANA'S FAVOURITE

The Hale Clinic, favoured by the late Princess Diana and

other celebrities, offers more than 40 therapies, a dispensary

and book shop at its elegant Regents Park address in north

London.

Prince Charles, the heir to the throne and a supporter of

alternative medicine, officially opened the private clinic in

1988. Founder Theresa Hale has not looked back since.

The former yoga teacher identified a growing demand for

natural therapies and a need to provide a variety of treatments

for patients. Her foresight led to the establishment of

Britain's leading complementary medicine clinic.

"When I started out about 20 years ago there were these two

camps, alternative and orthodox medicine, staring at each other.

I thought that didn't benefit the patient and felt that if we

brought them together under one roof and got a dialogue going it

would help bring it forward," said Hale.

The clinic now treats 5,000 people a month and is planning

to expand abroad in the United States and Germany.

Hale credits a desire for a more natural approach, soaring

health costs and a proactive population with the boom in

complementary medicine.

"The bottom line is that people are not accepting the

medical diagnosis they are often given and are looking for

alternatives. That's the key thing," said Hale.

Homeopathy, colonic irrigation, osteopathy and breathing

therapies are the most popular treatments at the Hale Clinic.

In addition to being treated for a specific ailment many

people are turning to complementary medicine to help them stay

healthier and live longer.

BOOSTING IMMUNE SYSTEM

"The whole process is designed to reactivate the body's

immune response. When we are fit and healthy it means our bodies

are working properly and keeping the germs and bugs at bay. It

is only because the immune system falls down that we get ill,"

said Michael Endecott, research director of the Institute for

Complementary Medicine in London.

The charitable foundation which was established in 1982 has

set up a registry of complementary practitioners which has 2,000

members so far. It covers about 100 different therapies.

Endecott is convinced the upsurge in the industry is a

result of what he called it's "success ratio" and an increasing

desire of people to treat health problems in a natural way.

"In our view the popularity comes from the fact that when

they (therapies) are in skilled hands and used correctly they

work. They can be very helpful in conditions which, as far as

the medical profession is concerned, are chronic.

Arthritis, rheumatism and allergies are just a few of the

illnesses that Endecott said can be treated so successfully that

all symptoms disappear.

The most high profile therapies, in his estimation, are

osteopathy and acupuncture but massage, aromatherapy and

hypnotherapy are also high on the list.

"People find them as good for treating illness as preventing

them and making them feel good," Endecott added.

LACK OF CLINICAL DATA

Research studies have proved the benefits of yoga, massage

and acupuncture for alleviating the symptoms of asthma, high

blood pressure, arthritis and pain.

St John's Wort has been called Nature's alternative to

Prozac because of its ability to ease mild depression, but there

is little scientific data to prove the worth of many treatments.

Endecott and others are trying to conduct scientific

research on complementary therapies but funding is hard to come

by. Another problem is that in Britain and other countries

virtually anyone can hang up a sign and start practising many of

the therapies.

Endecott believes a national register with strict

requirements such as training, supervised practise and case

studies is the best way to ensure that therapists are well

qualified.

Smith thinks even more stringent criteria are needed.

"I don't see why they shouldn't be regulated in a similar

way to doctors."

Medical schools in Britain are now teaching courses in

complementary medicine and physicians working for the state-run

National Health Service (NHS) are recommending alternative

therapies.

Complementary medicine may have its drawbacks. It requires

more research, funding and regulation but as Smith said, "It

feels to me like it's here to stay."

Gene therapy used to treat hemophilia in dogs

WASHINGTON, Feb 23 (Reuters) - Researchers said on

Wednesday they had used gene therapy to treat haemophilia in

dogs, and said a single treatment had continued to work for 10

months in one of the animals.

They said the next step would be to try the treatment,

which stimulates activity of one of the genes controlling blood

clotting, in humans.

Lili Wang and Inder Verma of the Salk Institute in La

Jolla, California, tested their approach on four dogs that had

naturally developed haemophilia B, a blood clotting disorder, in

just the way humans do.

Haemophilia B, which affects about one in 50,000 males, is

caused by a defect in the gene for Factor IX, a blood clotting

protein. Because a single gene is involved in haemophilia, it is

a key target of scientists testing gene therapies.

With gene therapy, doctors usually try to introduce a new,

healthy gene into the patient's body. Wang, now at the

University of Pennsylvania's Institute for Gene Therapy, tried

a different approach.

Writing in the journal Molecular Therapy, published by the

American Society for Gene Therapy, she said she instead

introduced two genes into the dogs -- one a promoter gene

telling factor IX to turn on, and one a post-transcriptional

factor that would control production of the protein.

Wang's team used an adeno-associated virus to carry the

gene into cells, infusing it directly into the dogs' livers.

After a single infusion, the dogs are all expressing factor

IX, meaning their bodies are producing it. But only the dog

that got the highest dose has enough to prevent the spontaneous

bleeding that marks haemophilia and makes it so dangerous.

"No spontaneous bleeding has been observed in this dog,"

Wang said in a telephone interview. It is now 10 months since

the dogs were treated.

She said the dog expresses about 5 percent of the normal

levels of Factor IX, but said this would be enough in a human

patient to consider that patient well-treated.

Currently, human haemophilia patients must receive regular

injections of Factor IX, or Factor VIII if they have the more

common haemophilia A.

"This study helps establish both the safety and the

efficacy of recombinant adeno-associated virus for liver

transfer of genes related to haemophilia, and suggests strongly

that this approach could work in humans afflicted with the

disease," the journal, edited by Verma, said in a statement.

Gene therapy has been under scrutiny since the death last

year of an 18-year-old patient at the University of

Pennsylvania. Several centres have suspended or slowed down

their gene therapy programmes while they review their procedures

and government regulators examine the issue.

But earlier this week Beth Israel Deaconess Medical Centre

in Boston said its researchers had resumed a trial involving 12

patients with haemophilia.

Alameda, California-based Avigen, Inc. AVGN.O is testing

another gene therapy approach for haemophilia B in humans. Its

Factor IX gene is injected into the muscles of patients and

even in very small doses, in a trial meant to show only that

the treatment is safe, it has seen evidence the new genes are

working.

Adults also suffer from shaken syndrome-study

LONDON, Feb 24 (Reuters) - Although it is most often

reported in abused children, adults can also suffer serious

injury from being violently and repeatedly shaken, doctors said

on Thursday.

Shaken baby syndrome was the cause of death in a number of

high profile child abuse cases including the trial of British

nanny Louise Woodward who was convicted of killing an

eight-month-old American baby in her care in 1997.

An estimated 1,250 children die of the condition each year

in the United States alone.

British doctors said adults also suffer from the disorder,

which is also caused by abuse.

In a report in the Journal of Accident and Emergency

Medicine, Dr Thomas Carrigan, of St James's University in Leeds,

reported the case of a 34-year-old woman with shaken adult

syndrome.

The woman claimed she had fallen down a flight of stairs but

Carrigan and his colleagues suspected she had been victim of

domestic violence because she had a trio of symptoms --

haemorrhaging of the retina, head bruises and swelling -- linked

to shaken syndrome.

Two days after she was released from hospital the woman

admitted she had been abused. Weeks later she was still

suffering from a concussion and had vision problems in one eye.

"The diagnosis of shaken adult syndrome was eventually made,

supported by delayed diagnosis of some of the classical signs

consistent with non-accident injury," Carrigan said.

The researchers said a Palestinian who died under

interrogation by the Israeli security forces had the same trio

of symptoms and had also been diagnosed as shaken adult

syndrome.

Carrigan and his team said the case of the woman illustrates

the difficulty in detecting victims of domestic violence, which

accounts for half of all violent crimes against women and two

deaths per week in Britain.

Scientists identify malaria drug resistance gene

(Release at 1900 GMT, Wednesday, Feb 23)

By Patricia Reaney

LONDON, Feb 23 (Reuters) - In what could have important

implications for new antimalaria treatments, Australian

researchers have shown how the parasite that causes the disease

manages to outwit even the most powerful drugs.

Malaria kills millions of people each year despite effective

treatments by building up a resistance to the drugs used to

combat it.

But scientists at the Walter and Eliza Hall Institute of

Medical Research in Melbourne have shown that a mutation in a

gene called pfmdr1 is behind the drug resistance.

"Increased knowledge is power," lead researcher Alan Cowman

said in an e-mail interview on Wednesday.

"A greater understanding of the mechanism used by the

parasite to evade the lethal effect of these antimalarial drugs

means we can consider developing ways of inhibiting this and

increasing the efficacy of the current antimalarials."

The finding provides a potential target for new drugs that

will have an effect on the parasite and also the efficacy of

leading drugs such as quinine, mefloquine, halofantrine and

chloroquine.

Cowman and his colleagues, whose research is published in

the science journal Nature, said pfmdr1 is not the only gene

involved in drug resistance but it is an important one.

"We are doing work to further understand the role of pfmdr1

as well as researching other genes we know are involved. We are

aiming for a full understanding of these molecular mechanisms so

that we can begin a rationale approach to developing counters to

the mechanisms," Cowman added.

Most of the more than 300 million cases of malaria worldwide

are caused by a parasite called Plasmodium flaciparum that

attacks mature and young blood cells.

Although the mosquito-borne disease, which can also be

transmitted through infected blood, can be cured, research has

shown only about 10-20 percent of sufferers are given the

correct drugs.

The World Health Organisation and other international

agencies have launched a global initiative to fight malaria in

Africa where 90 percent of the world's cases are reported and

where most of the victims are children.

Chemical may predict serious angina in women

LONDON, Feb 24 (Reuters) - Doctors may be able to predict

the severity of heart disease in women by measuring levels of an

immune system chemical, British researchers said on Thursday.

Their study of more than 100 women with angina showed that

women with unstable angina, when chest pains occur unexpectedly,

tended to have higher levels of the chemical neopterin than

those with a less serious form of the disease.

"Neopterin concentrations may therefore be a risk marker in

women with coronary artery disease," Professor Juan Carlos

Kaski, of St George's Medical School in London, said in a report

in the journal Heart.

Angina occurs when the heart is not receiving enough oxygen

to function properly. It can lead to a heart attack. Unstable

angina, the more serious form of the disease, affects about two

million people in the United States and Europe.

The researchers monitored the heart functions, chest pains

and any heart attacks of the women and their levels of neopterin

over 12 months.

Twice as many women with unstable angina had more serious

attacks and higher levels of the chemical than women with stable

angina.

Neopterin is released when the immune system is activated to

fight illnesses such as cancer and viral infections. The

researchers suspect high levels of the chemical in angina

patients may indicate the disease in getting worse.

Test improves forecast of breast cancer spread

Release at 5 p.m. (2200 GMT)

BOSTON, Feb 23 (Reuters) - An experimental test that looks

for small traces of cancer cells that have spread to bone

marrow can help doctors predict if breast cancer is likely to

reoccur, Thursday's New England Journal of Medicine reported.

The findings may help doctors decide if they should

recommend aggressive treatment with chemotherapy and radiation

after a tumour has been removed.

Currently, doctors try to assess the risk of additional

cancer by seeing if tumour cells have spread to nearby lymph

nodes. But that technique is imperfect. The disease reappears

in up to 30 percent of the women with clean nodes.

The new study used proteins, known as cytokeratin-specific

antibodies, which honed in on cancer cells that had spread to

the bone marrow. The marrow was removed from the highest point

of the hip bone.

The German researchers calculated that four years after

cancer surgery, the survival rate was about 48 percent for

women who had signs of cancer in both their bone marrow and

lymph nodes. The rate was virtually identical -- about 84

percent -- when tumour cells were spotted in one place, either

their bone marrow or lymph nodes.

And when both the lymph nodes and bone marrow showed no

evidence of cancer, the estimated survival rate was 99

percent.

The research team, led by Dr. Stephan Braun of Ludwig

Maximilians University in Munich, Germany said the results

suggest that women with evidence of cancer cells in their bone

marrow should be treated with chemotherapy, just as women are

given anti-cancer drugs if there is evidence of cancerous cells

in their lymph nodes.

But the researchers also urged caution, saying that they

only have four years of data. Breast cancer patients needed to

be monitored for 10 to 15 years, they said.

Japan says gout drug led to six deaths

TOKYO, Feb 23 (Reuters) - Japan on Wednesday said six people

had died from the effects of Japanese drugs aimed at treating

gout, and ordered 10 drug makers to issue an urgent warning to

hospitals calling for caution.

Over the past three years, six people have died of fulminant

hepatitis -- a severe form of hepatitis -- caused by gout

treatment drugs that used benzbromarone as a main agent to

promote excretion of uric acid, the Health and Welfare Ministry

said.

The drug makers include Torii Pharmaceutical Co Ltd which

manufactures 90 percent of the drug used in Japan, Teikoku

Chemical Industries Co and Toyo Pharmar Co.

The company will issue an urgent warning to hospitals to make

sure doctors examine a patient's liver before administering the

drug, a Torii Pharmaceutical spokesman said.

"We export a very small amount of the drug to Taiwan. We will

issue the same urgent warnings there," he said.

Torii has sold the drug since 1979, with annual sales of 6

billion yen ($54.32 million) and an estimated 300,000 users, he

said.

The company issued a warning that the drug could cause liver

disease in 1996 when similar deaths were reported overseas by

French compound supplier Sanofi-Synthelabo, he said.

The news triggered massive selling in Torii Pharmaceutical

shares in mid-afternoon Tokyo trade, sending the stock down by

its daily limit of 400 yen or 16.23 percent to end at 2,065 yen.

Clinton medical errors plan worries health groups

(Adds Lott comments, details, grafs 7-10)

WASHINGTON, Feb 22 (Reuters) - President Bill Clinton

called on Tuesday for hospitals to report errors that kill up

to 98,000 Americans each year, troubling medical groups who

fear this could make doctors more vulnerable to lawsuits.

Clinton's plan, which aims to cut the number of such errors

in half over five years, calls for states to require mandatory

reporting of mistakes that cause deaths or serious injuries and

voluntary reporting of other mistakes and "close calls."

The initiative includes requiring all U.S. military

hospitals to report medical mistakes, new rules to make drug

packages easier to read and and harder to mix up, and a $20

million proposal to study errors and how to prevent them.

In addition, the more than 6,000 hospitals that take part

in the Medicare health care programme for the elderly will be

required to set up error reduction programmes and to target

mistakes over medications, which kill some 7,000 each year.

"These actions represent the most significant effort our

nation has ever made to reduce medical errors," Clinton said.

"It's a balanced, common-sense approach based on prevention,

not punishment, on problem-solving, not blame placing."

The White House said that if all states had not created

error-reporting systems within three years it would consider

seeking legislation requiring them to do so.

Leading groups representing U.S. doctors, hospitals and

health insurers said they supported many parts of Clinton's

plan but raised questions about the error-reporting proposal.

"We are concerned that the proposal for mandatory reporting

will not improve patient safety and may, in fact, have the

perverse result of driving errors underground," the American

Medical Association said in a statement.

"We need strong protections so doctors and nurses will come

forward without fear of retribution," added the American

Hospital Association. "Without these protections, we could

drive error reporting underground and miss important

opportunities to protect patients."

Senate Majority Leader Trent Lott, a Mississippi Republican

often at odds with Clinton, said he had read newspaper reports

of Clinton's plan and added: "I'd like to take a look at it. I

don't reject it out of hand by any means."

MANDATORY REPORTING SYSTEMS

The thorniest element of such a plan is designing it to

give doctors, nurses and hospitals some incentive to report

errors without increasing their vulnerability to medical

malpractice suits for the mistakes. So far 18 states already

have mandatory reporting systems for their hospitals.

Under the White House proposal, data collected by the

states would be analysed and made public without naming the

patients or health care professionals.

The White House said when hospitals use secret "peer

reviews" to analyse how mistakes occurred and to take steps to

prevent them, those findings should not be "discoverable" --

meaning they could not be used to buttress malpractice suits.

Carlton Carl, a spokesman for the Association of Trial

Lawyers of America, said he had not seen the details of the

plan but said his group favoured more, not less, disclosure.

"Generally speaking, we think that all such information

ought to be discoverable," Carl said. "We certainly hope that

the White House and Congress would not support any limitation

of the rights of people who are injured as a result of medical

mistakes."

The specific steps that Clinton will unveil include:

-- the Defence Department this spring will carry out a new

mandatory error reporting system in its 500 hospitals and

clinics, which serve an estimated 8 million patients;

-- the Food and Drug Administration (FDA) will develop

standards within a year to help prevent errors caused by health

care providers confusing medications because of drug names that

sound similar or packaging that looks similar;

-- by the end of this year the FDA will release rules

requiring the 3,000 U.S. blood banks and other institutions

that handle blood to report serious errors.

Merck sets additional $10 billion stock buyback plan

WHITEHOUSE STATION, N.J., Feb 22 (Reuters) - Merck & Co.

MRK.N said on Tuesday its board has approved a plan to buy

back up to an additional $10 billion of its own shares.

Merck said the purchases of up to $10 billion for its own

treasury has no specific time limit and can be suspended or

stopped at any time.

The buyback programme is in addition to a $5 billion plan

that was approved in July 1998. Through Dec. 31, 1999, the

company has spent $3.9 billion to buy 54.9 million shares under

that authorisation.

Merck currently has about 2.3 billion shares outstanding.

Eli Lilly strong enough to go it alone--chairman

DETROIT, Feb 22 (Reuters) - Eli Lilly and Co. LLY.N

Chairman Sidney Taurel said on Tuesday the Indiana drug maker,

increasingly the focus of merger speculation in a consolidating

industry, has enough strong products to remain independent.

Lilly, maker of top-selling antidepressant drug Prozac,

expects per-share earnings growth to be in the mid-teens over

the next three years, Taurel, who is also president and CEO,

told Reuters. Last year, Lilly earned $2.46 a share, or $2.5

billion.

Meeting Wall Street's growth expectations has driven

consolidation in the drug industry recently with such pending

mergers as Pfizer Inc.PFE.N-Warner-Lambert Co. WLA.N ,

Glaxo Wellcome PlcGLXO.L-SmithKline Beacham Plc SB.L and

Pharmacia & UpjohnPHU.ST-Monsanto Co. MTC.N.

While speculation on a partner for Lilly has focused on

Bristol-Myers Squibb Co. BMY.N, Taurel and other Lilly

executives have maintained their pro-independence stance.

"The evidence so far is that size per se has not created

showroom shareholder value," he said in an interview before

speaking to the Economic Club of Detroit. "All mergers really

have been driven by weakness, by the fear of not meeting

analysts' expectations.

"When you put two companies together, you have a bigger

monster to feed. You have to make the two research

organisations produce more together than the sum of the two

separately and nobody has proven that."

He said he was comfortable with first-quarter and full-year

per-share earnings estimates compiled by First Call/Thomson

Financial of 61 cents and $2.63, respectively. Lilly posted $10

billion in sales last year.

With a 3 percent world market share, Lilly is seen as a

prime merger candidate. However, Taurel said there is no proof

additional size means success.

He added that Lilly has the necessary critical mass --

leading the U.S. industry in research dollars spent compared to

sales -- except in certain overseas areas such as sales and

marketing. He said the firm has also boosted its research

staff, hiring about 200 chemists in the last 18 months or so.

Lilly has numerous collaborations and partnerships,

numbering 140 deals and is looking at more small acquisitions.

"We are certainly very actively involved in looking at

opportunities, mostly outside the U.S," he said.

Taurel said Lilly's weak stock price, trading near its

52-week low of just above $58 a share, reflects the state of

the industry. He blamed Wall Street's love of Internet and

technology stocks, as well as the Medicare debate that carries

with it the threat of potential price controls.

Meanwhile, analysts worry about slowing Prozac sales. The

drug will come off patent in late 2003. Taurel, however, said

growth in newer products should blunt concerns.

He said new products on the way include a treatment for

colorectal cancer, followed in 2003 and 2004 by six or seven

products treating such things as sepsis, attention deficit

disorder, depression and complications from diabetes.

Lilly will not ignore Prozac either, he added. The company

plans this year to submit for approval from the U.S. Food and

Drug Administration a once-a-week formulation of the drug that

should be launched next year. Lilly is also testing an isomer

with advantages over Prozac, as well as a mixture of Prozac and

antipsychotic drug Zyprexa that could help treat the one-third

of patients resistant to antidepressants.

French surgeon to pay patient he infected with HIV

PARIS, Feb 22 (Reuters) - A Paris court ordered a surgeon on

Tuesday to pay 700,000 francs ($107,000) in compensation to a

patient he infected with the HIV virus while performing a hip

operation, judicial sources said.

The doctor, who denied he could have infected the patient

with the virus that leads to AIDS during the 1992 operation, was

convicted after expert testimony by Professor Luc Montagnier,

the scientist credited with co-discovering the deadly HIV virus.

The case was only the second in the world in which a doctor

was found to have transmitted the virus to a patient. In 1990, a

Florida dentist infected six of his patients.

The French surgeon had apparently been infected after

operating in 1983 on a patient whose HIV-positive status was not

known at the time. That patient, who had multiple blood

transfusions during surgery, later died.

The surgeon learned he was HIV-positive in 1994 and, at his

own request, had health authorities test about 3,000 of his

subsequent patients for the virus.

One patient, a 70-year-old woman who had a total hip

replacement in 1992, tested positive. Investigators concluded

she must have been infected by the surgeon, who would have been

highly infectious at the time.

The hospital in a Paris suburb where the operations took

place has already paid the victim 500,000 francs in

compensation.

Men ready and willing to take male pill-survey

(Release at 0001 GMT, Wednesday, Feb 23)

LONDON, Feb 23 (Reuters) - If a male contraceptive pill was

available most men would be willing to take it and most women

would trust their partners to control fertility, according to an

international poll released on Wednesday.

The survey of 4,000 men and women in Edinburgh, Shanghai,

Hong Kong and Cape Town commissioned by the journal Human

Reproduction showed two-thirds of men would use a male pill.

"The majority of men felt that responsibility for

contraception falls too much on women and we found that the

strongest incentive for men to use the pill would be their

partners' wishes," said Dr Richard Anderson, of the Medical

Research Council (MRC) Reproductive Biology Unit in Edinburgh.

Condoms and vasectomy are currently the only contraceptives

available for men but scientists predict a male contraceptive

pill could be on the market within the next five to 10 years.

The poll showed that when it is, men will be ready for it.

Even in Hong Kong, which is more conservative than the other

centres, nearly half of the men said they would use a male pill.

Despite the overwhelming approval of the pill, some men

admitted they were concerned about the pill's impact on their

masculinity and whether it would affect their sexual desire or

satisfaction.

Only two percent of women said they would not trust their

partners to take the pill.

"The idea of hormonal contraception for men appears to be

extremely popular among women and this survey should dispel once

and for all the myth that women would not trust their partners

to use a male pill," Anderson said.

Human Reproduction is a monthly journal of the European

Society for Human Reproduction and Embryology.

Briton cures fatigue by drilling hole in own head

LONDON, Feb 22 (Reuters) - A British woman says she has

cured her chronic fatigue by resorting to do-it-yourself brain

surgery and drilling a hole in her own head.

Heather Perry, 29, performed the ancient technique of

trepanning -- cutting away a section of the scalp and drilling

into the skull -- in her bid to overcome myalgic

encephalomyelitis, or ME, which leaves sufferers feeling

permanently exhausted.

Perry's bid to rid herself of the inflammation of her brain

and spinal chord, by drilling a two-centimetre hole to allow

blood to flow more easily around the brain, almost went wrong

when she drilled too far and penetrated a membrane protecting

her brain tissue.

British doctors had refused to help Perry with the ancient

procedure, so she flew to the United States where she was given

medical advice and then did it herself. She said the 20-minute

operation had improved her quality of life.

"I have no regrets. I was prone to occasional bouts of

depression and felt something radical needed to be done," said

Perry, who performed the operation under local anaesthetic in

front of a mirror and a camera crew.

"I felt the effects immediately, I can't say they have been

particularly dramatic but they are there. I generally feel

better and there's definitely more mental clarity. I feel

wonderful," she told reporters at her home in Gloucester,

western England.

Trepanning was widely used in the Middle Ages to treat

severe headaches and madness in the belief it would release evil

spirits from the possessed.

German official protests patent on human cloning

BERLIN, Feb 22 (Reuters) - Germany's health minister said on

Tuesday that she wants the government to protest formally

against a European Patent Office decision granting a patent to a

process that could include the cloning of humans.

The Munich-based office granted Edinburgh University a

patent in December on altering cells and human embryos, but said

on Monday that it had made a mistake and overlooked the patent's

potential use on humans.

Health Minister Andrea Fischer said she would propose at a

cabinet meeting on Wednesday that the German government formally

oppose the patent. She said the government had yet to determine

the strategy for a challenge.

A spokesman for the patent office said officials did not

notice the reference to humans in the 235-page application, but

could not reverse the patent by itself.

Only a formal protest from outside can reverse the decision,

and appeals can drag out the process for years, patent office

spokesman Rainer Osterwadter said.

European guidelines bar patents on human genetic

alterations.

The environmental lobby Greenpeace, which said it would also

challenge the patent, held a small rally outside the patent

office in Munich on Tuesday.

Germany, especially sensative to the issue because of

Nazi-era efforts to create a master race, bans any human cloning

procedure and has tight rules on scientific research.