Could a plant help treat Alzheimer's?

National trial is one of a growing number to look at natural treatments

A plant used widely in China is the focus of a national clinical trial that aims to see if it could help treat Alzheimer's disease and other types of dementia.
The University of North Carolina Hospitals are participating in the national clinical trial on Chinese club moss, which is already being sold in stores with nutritional supplements and is used in China as a treatment for cognitive disorders.
The study, sponsored by the National Institute on Aging, is one of a growing number of federally funded research studies focused on natural and alternative therapies. The centers of the National Institutes of Health expect to spend $300.5 million in complementary and alternative medicine research in the 2007 budget year.

Even with the recent financial commitment, research in that area is limited, making it difficult for doctors to get information that is essential to understanding the risks and benefits of certain treatments.
"That kind of data is completely missing today from most nutraceuticals," said Dr. Daniel Kaufer, a neurologist at the University of North Carolina at Chapel Hill who is one of the trial's investigators.
Patients in the trial receive either a placebo or dose of Huperzine A — an alkaloid extracted from the plant — that is larger than what's currently available in stores. After the placebo-controlled phase, all patients take doses of Huperzine A for eight weeks and have the option to continue taking it if they believe it's helping.
Investigators test patients' cognitive functions throughout the trial, Kaufer said.
Marion Hinsdale, 83, decided with help from her daughter, Marjorie, to participate in the trial to see if the treatment could help with her memory and cognitive problems.

"Both my mother and I are interested in anything that would be considered homeopathic," said Marjorie Hinsdale, who lives with her mother in Chapel Hill. "The fact that this is a Chinese herb was intriguing to both of us."
While some studies involving natural therapies have been unsuccessful, trials that prove certain therapies work have credibility with consumers and doctors.
"It gets their attention and provides evidence that botanical medicine is very powerful," said Christie Yerby, a Chapel Hill specialist in botanical medicine.
The Hinsdales aren't sure if Huperzine A helped Marion, who decided to keep taking the supplement after completing the first part of the trial.
"We just wanted to contribute in what small way we can," Marjorie Hinsdale said.

Vaccine shows promise for treating Alzheimer’s

An experimental vaccine is showing promise against Alzheimer’s disease, reducing brain deposits that are blamed for the disorder.
The deposits have been cut by between 15.5 percent and 38.5 percent in mice, with no major side effects, researchers said Monday in the online edition of Proceedings of the National Academy of Sciences.
Tests of the DNA-based vaccine are under way in monkeys, and if those are successful, testing in people could begin, perhaps within three years, said lead researcher Yoh Matsumoto of the Tokyo Metropolitan Institute for Neuroscience in Japan.

If all goes well, this type of treatment might be available for people in six or seven years, he said.
Scientists estimate that as many as 4.5 million Americans suffer from Alzheimer’s, the most common form of dementia. The illness, named after Dr. Alois Alzheimer, a German doctor who studied it in 1906, involves the parts of the brain that control thought, memory and language.
Its cause remains unknown, and while there is no cure some drugs can slow progress of the illness in people in the early and middle stages.
Other efforts to develop an Alzheimer’s therapy also are under way.

Two years ago, trials of a potential vaccine that seemed to help slow the memory decline caused by the disease were halted after several participants developed brain swelling.
Matsumoto said that problem did not occur in the tests of his vaccine.
The brains of people suffering from Alzheimer’s disease are cluttered with a plaque made up of a small protein called amyloid beta, or Ab.
Up to 50 percent reduction in plaqueIn the mouse tests, the Ab deposits were reduced overall, and in certain parts of the brain the reduction was as much as 50 percent, the researchers said.
Dr. Sid Gilman, a professor of neurology at the University of Michigan who has done research in vaccines for Alzheimer’s, said the new research showed the vaccine was efficient and safe in the mice.

He cautioned, however, that it’s very difficult to compare the level of efficiency from one trial to another, “so how effective this may be compared to other approaches is debatable.”
The reasons for the brain swelling in the earlier tests have been determined, Gilman said, and new forms of that therapy are now being tested.
A variety of clinical trials are under way looking at other potential treatments for Alzheimer’s including a hormone that might prevent brain cell death, several drugs, antioxidants, cholesterol-lowering medications and antibodies.
The Japanese research was funded by the ministry of education of Japan and the Novartis Institute of Biomedical Research.

Hypnosis 'can ease bowel illness'

Hypnotherapy could help people with severe irritable bowel syndrome (IBS), researchers say.
Doctors should consider using this and other "psychological" treatments such as antidepressants to help sufferers, King's College London experts say in the British Medical Journal.
However, a shortage of therapists could hinder this, they add.
Experts said there was growing evidence that IBS cases have psychological as well as biological elements.

Other therapies
IBS is a common and painful medical condition that has a wide range of symptoms, including regular abdominal pain, diarrhoea and constipation.
Conventional medicines prescribed for IBS often ease symptoms partially, or not at all.

Many scientists now believe that the cause in many cases is a combination of mental and physical factors, and that the drugs commonly used to tackle it may be aiming at the wrong target.
Patients with IBS are more likely to be diagnosed with depression.
Dr Ian Forgacs, a consultant gastroenterologist from Kings College, says that doctors are often reluctant to prescribe anti-depressants, especially in patients who, apart from their IBS, show no outward signs of being depressed.
He urged them to consider other forms of psychological therapy, including hypnotherapy, as an alternative in some cases.
"Patients with irritable bowel syndrome should be made aware of the existence of these treatments so that they can make informed choices," he said.
"Specifically, they should be made aware that using a psychological treatment does not mean that the disease is 'all in the mind'."
He found that one of the most effective treatments for IBS in research studies were so-called "talking therapies", such as cognitive behavioural therapy, particularly for people whose symptoms were causing them the most distress.
And severe cases of IBS could be improved by using hypnotherapy to target the links between the brain and the gut.
Hypnosis sessions concentrated on encouraging relaxation, then visualising the gut as a fast flowing river which is then imagined to be flowing more slowly and smoothly.

Skill shortage
Dr Forgacs said that one obstacle to providing psychological therapies was a lack of the right specialists in some areas.
"Irritable bowel syndrome is undeniably very common, and many patients are probably denied help by lack of access to therapists with the appropriate psychological skills," he said.
Dr Nick Read, a psychologist and adviser to the IBS Network, said he felt that the majority of IBS patients had a psychologists element to their condition.
He said: "There's now a lot of evidence that psychological therapies can be effective, but a lot of doctors remain sceptical, and carry on treating with drugs which have side-effects, and which basically don't work.
"I work with patients with IBS trying to understand what, for each patient, lies behind the illness."

Cannabis hospital admissions rise

Mental health hospital admissions in England due to cannabis have risen by 85% under Labour, figures show.
In 1996-7, there were 510 admissions, rising to 946 in 2005-6, data obtained by shadow health secretary Andrew Lansley revealed.
Over the last five years alone there was a 65% rise, with experts saying the figures were "the tip of the iceberg".
The government said it had been clear on cannabis - it was illegal and should not be used.
Cannabis is the most widely used illegal drug in the country with over 2m regular users.

The figures obtained from Health Minister Rosie Winterton in a written House of Commons answer are for patients admitted to hospital in England because of a mental or behavioural disorder due to the use of cannabis.
Admissions are not the same as patients, so one patient may have been admitted more than once.
The figures include people with a chronic addiction to cannabis, people with an acute cannabis psychosis as well as those with cannabis-related schizophrenia.
But experts say many more cases may be missed or diagnosed simply as a mental health disorder instead.

Hidden problem

Professor Robin Murray, professor of psychiatry at London's Institute of Psychiatry and member of the Royal College of Psychiatrists, said: "There is no doubt that cannabis-related psychiatric problems have increased substantially.
"This might be down to better recognition, but I would say these figures are just the tip of the iceberg. Its only more recently that psychiatrists have understood the importance of cannabis use."
He said cannabis use was a contributing factor in up to 10% of schizophrenia cases, yet this was under-recognised.

"There are probably 1,500 new cases of cannabis-related schizophrenia a year," he said.
Paul Jenkins, chief executive of the Rethink mental health charity, said: "These figures show that there is an urgent need for a properly funded campaign to help young people realise cannabis use is risky."
Marjorie Wallace, chief executive of the mental health charity SANE, said: "Psychiatrists have been telling us that 80% of patients admitted with their first episode of psychosis have been taking the drug.
"We strongly urge the government to heed the growing evidence and take urgent action to warn young people that some of them are risking lifelong mental illness - that they are playing Russian roulette with their minds."
Scientists have found that some of the active ingredients in cannabis can have an impact on the symptoms of many diseases, including asthma, glaucoma and muscle spasms, as well as loss of appetite and nausea due to AIDS and chemotherapy treatment.

Policy
Indeed, cannabis-based pain-relief drugs have been licensed for MS patients.
Mr Lansley added: "Awareness of the link between mental illness and cannabis has increased over recent years, as has the strength of the drug.
"Both these factors have contributed to the sharp increase of hospital admissions on mental health grounds.
"That's why the Conservatives have opposed the downgrading of cannabis and pledged to have it reclassified."
At present, cannabis is a class C drug but there have been calls to move it back to class B.
A Department of Health spokeswoman said: "Our message is clear - cannabis is harmful, is an illegal drug and should not be taken.
"Our policy on cannabis is in line with the drugs strategy, with emphasis on enforcement, prevention, education, and treatment; evidence shows that cannabis use is falling across all age ranges."

Yoga tested as back pain therapy

The potential for yoga to be used to treat low back pain is being investigated by researchers.
Millions of UK people suffer from chronic low back pain, and existing treatments have only a limited effect.
A team of academics, yoga teachers and practitioners have joined forces to find out if a 12-week course of yoga can make a difference.
The Arthritis Research Campaign-backed project will assess moves from the two most popular types of yoga.

These are lyengar yoga and hatha yoga, favoured by the British Wheel of Yoga.
More than 260 people between the ages of 18 and 65 who have had back pain in the past 18 months will be recruited for the trial.
Recent, small studies in the US have shown that yoga can be helpful for back pain sufferers.
But David Torgerson, director of the University of York Clinical trials Unit, and Jennifer Klaber Moffett, deputy director of the Institute of Rehabilitation at the University of Hull, believe a bigger study is needed to unequivocally establish the benefits.

'Considerable impact'
Professor Torgerson said: "Yoga offers a combination of physical exercise with mental focus that may make it a suitable therapy for the treatment of low back pain.
"If the trial shows yoga to be effective then this low-cost treatment will have a considerable impact in the quality of life of patients with back pain."
Yoga develops flexibility and muscular endurance by allowing the muscles to be stretched and strengthened.
Patients will be recruited from GP surgeries from September and the 12-week classes, to be held in north and central London, York, Manchester and Cornwall, will begin in November.
The classes will be run by 10 experienced yoga teachers who have all received specialist training.

No difficult poses
Half the participants will take part in yoga classes, and the other half will receive the usual care. They will be assessed at the end of the classes, then six months and a year later to see if there are any longer-term benefits.
The yoga classes will be carefully structured for people who are complete novices and will not involve any difficult poses.
They will be graduated over the 12-week period, starting off gently and becoming more demanding, with a combination of stretches, bends, lying sitting, standing and relaxing poses.
Patients will also be encouraged to practise daily at home.
Anna Semlyen, a yoga teacher who is helping to run the classes, said: "Regular yoga increases the benefits, and we would hope that at the end of the 12 weeks people would carry on."

Rosehip treatment tackles arthritis

ROSEHIPS may provide an effective alternative treatment for sufferers of crippling rheumatoid arthritis, research suggests.
Severely affected patients already being treated with conventional drugs experienced significant improvement after taking capsules of rosehip powder for six months.

Experts want to conduct more extensive trials which could form the basis of clinical guidelines.
Scientists said the rosehip remedy, LitoZin, may help to reduce NHS spending on expensive new drugs.
Rheumatoid arthritis (RA) is a painful and debilitating auto-immune disease which affects about 400,000 people in the UK, 4,000 of them seriously. It occurs when the immune system attacks the joints, causing swelling and damage to cartilage and bone.

Traditional treatments have only limited effectiveness.

Newer medicines, including TNF Alpha inhibitors and the latest "smart" drugs that target various parts of the immune system, can cost as much as £10,000 a year.
Scientists who conducted the trial in Copenhagen and Berlin said they were surprised by the results, since RA is a far more serious and challenging disease than osteo-arthritis.
A total of 89 mostly female patients with an average age of 57 were recruited, all seriously affected by RA, which they had suffered for more than 18 years.
The patients were asked to fill in questionnaires to assess pain and the ability to carry out everyday tasks.
After six months, activity levels improved by 20-25 per cent for those taking LitoZin. The number of joints causing pain and discomfort fell by 40 per cent, but did not change for patients treated conventionally without the rosehip supplement.

Are Too Many Vitamins Bad for Your Health?

We tend to think of vitamins as healthy. But can you have too much of a good thing?
New research suggests this may be the case when it comes to supplements.

In a meta-analysis study published in the Journal of the American Medical Association, researchers reviewed 68 studies involving more than 200,000 patients to determine whether taking high-dose vitamin supplements -- in particular, beta carotene, vitamin A, vitamin C, vitamin E and selenium -- affected your risk of dying.
What they found was that some of these supplements actually increased risk of death by a small, but significant, amount.
Taking large doses of vitamin A increased the risk of death by 16 percent. Smaller increases were seen for vitamin E (4 percent) and beta carotene (7 percent).
Vitamin C and selenium did not appear to affect the risk of dying.

But exactly how the high doses of supplements affect the risk of death is not clear. The study authors speculate that perhaps the vitamins interfere with the body's defense mechanisms.
The researchers arrived at their conclusions by pooling the results from many different, previously published studies.
Because each of the studies involved in this meta-analysis was very different, though, it is hard to generalize the findings to one particular person, such as you or a family member.
Dr. Meir Stampfer, professor of nutrition and epidemiology at the Harvard School of Public Health, states, "The effects might well differ according to particular characteristics of the population, such as enhanced risk among smokers for beta carotene, but no increased risk among nonsmokers."

Some Still Need Supplements
Select people should still take supplements. For instance, people who have had gastric bypass surgery need large amounts of vitamin A, says internist Dr. Tina Dobsevage, assistant clinical professor of medicine at Mount Sinai School of Medicine.
She says she also prescribes vitamins D and B12 to patients who have low blood levels of these nutrients.

However, others have conditions that increase the health risk associated with certain supplements. Vitamin E, for example, has blood-thinning properties and may increase the risk of bleeding in people taking prescription blood thinners.
Information that large doses of some vitamins can be harmful is not new. When taken in excess, the fat-soluble vitamins -- vitamins A, D, E and K -- are stored in body fat tissues. This can lead to toxic buildup in the liver, brain and heart.
Excess amounts of water-soluble vitamins, on the other hand, are less hazardous because they are eliminated from the body in the urine.
It is also known that vitamins taken as supplements, rather than in whole foods, tend to be less beneficial. Thus, the study authors say, people should not shy away from fruits and vegetables for fear that they are overloading on vitamins.

Vitamins a Big Business
An estimated 10 percent to 20 percent of U.S. adults -- 80 million to 160 million people -- look to vitamin supplements for a nutritional boost.
Supposed health benefits include longer life, a healthier heart and stronger bones.
Antioxidant supplements, which include the vitamins in the current study, are thought to fight off substances called "free radicals" and improve immune function.
Dr. Kathy Helzlsouer, a women's health specialist and director of the Prevention and Research Center at Mercy Medical Center in Baltimore, thinks the study has "extremely significant findings."
"This is a big industry," she said. "Even small risks, with widespread use, result in large numbers of women [and men] affected."
This echoes the thoughts of the study authors, who write, "The public health consequences may be substantial."

Should You Toss Your Supplements?
Doctors tend to agree that moderation is key when it comes to vitamins.
After reviewing the study, internist Dr. Ted Palen of Colorado Permanente Medical Group said, "I will counsel patients that moderate multivitamin intake may be beneficial, but megadoses may actually be harmful."

Keith Ayoob, associate professor in the department of pediatrics at Albert Einstein College of Medicine in New York, agrees.
"The best research says to take a complete multivitamin with 100 percent of the [recommended dietary allowance or RDA] and not more," he said.
Some doctors recommend concentrating on improving your diet rather than stressing about which supplements to take.

People "should spend their money on multiple varieties and colors of vegetables and fruits, whole grains, and lean protein," said Dr. John Messmer, associate professor of family and community medicine at Pennsylvania State University's College of Medicine in Hershey, "and stop wasting it on supplements."
Dobsevage agrees. However, she said, "the American diet is so degraded, and so many of us no longer cook whole foods in our own homes for most of our meals, that I often recommend a modest level of vitamin and mineral supplementation -- less than RDAs."

Celebrities' special health care? Not so much

Caring for a sick celebrity in the hospital offers unique challenges. Fame and fortune bring VIPs great benefits but also some significant problems.
First and foremost, there are issues of patient confidentiality. For this reason, I won't discuss specific examples; suffice it to say that being a well-known VIP at a hospital is no guarantee of receiving excellent care. In fact, it can lead to worse health care.
To many hospitals, having a VIP patient is a sign of prestige and honor. Often, the hospital's name is mentioned in the press: "Mr. X has been diagnosed with cancer of the colon and is now receiving treatment at the John Doe Memorial Hospital." Most readers assume that, given Mr. X's fame and wealth, he could choose any hospital he believed would offer the best care. Since he's at John Doe Memorial Hospital, it must be a darned good hospital. It follows that they might feel that, when they get sick, they also want to go there.
Hospitals love this type of public relations, but there are downsides to VIPs.
Once Mr. X is admitted to the hospital, it becomes a large burden for hospital administrators to respect and assure his privacy and confidentiality. The media are everywhere, and they are sneaky. They are assigned a story, and they need details.
Among the medical staff, word spreads that Mr. X is a patient on 8 North. Each time the doctor orders a test or procedure down in X-ray or surgery, many staff members try to find an excuse to walk by and gaze at the famous Mr. X as he rests on the hospital gurney awaiting his scan. Of course, other patients recognize Mr. X, and they want to talk with him or wish him well.
VIPs often are admitted to special rooms or sections reserved for the elite after their procedures. These wards are often beautifully decorated with large private rooms, provide special foods and offer boutique services. They are staffed by nurses specially trained to respect privacy and deal with the complexities of VIPs and their families.
While these special staff are lovely people and have outstanding bedside manners, they are not always as skilled at managing medical crises as are the floor nurses who deal daily with complex medical situations.
As such, I've seen VIPs go for hours with undiagnosed bleeding ulcers, untreated pain or unusual cardiac arrhythmias – all conditions that would be quickly detected on the wards where the masses reside, where patients often share a room and the nurses are overworked but pop into each room on a very regular basis.
Doctors seem to regularly over-order tests on VIPs, which places these sick people at risk for unnecessary complications and an increased chance of a test result being wrong. Senior doctors often request that interns and residents stay away from their VIPs in an attempt to protect the VIP from bother, aggravation and breaches of privacy. However, without junior doctors regularly looking in on a patient several times each day, VIPs need to rely on their senior doctor, who may stop by only once or twice each day.
When something does go wrong – and for sick people in hospitals, things happen on a regular basis – and the senior doctor isn't immediately available, the nurses are forced to call a medical resident. The resident is now forced to provide care for the VIP without any knowledge of Mr. X or his medical condition, allergies, prior treatments and the like.
Regardless, we love our celebrities and we want to give them special care – it's just that special care isn't always the best care that you and I receive. Maybe we ought to just treat everyone with the same excellent care and not work to provide special services for VIPs.

Employers favor health insurance mandates

Most Colorado employers think everyone should be required to have health insurance, according to a recent survey from the Business Health Forum.
The survey, conducted among members of the business community in six cities, was designed to tap employers' perspectives in the debate over health care reform.
According to the survey, 62 percent of the respondents agree that health insurance should be mandatory.
Four out of five of the proposals being studied by the state's Blue Ribbon Commission for Health Care Reform call for individual mandates as one way to provide coverage to Colorado's roughly 800,000 uninsured residents.
Health care experts say the uninsured create higher health care costs because providers like hospitals pass uncompensated costs to health insurers -- resulting in double-digit premium increases for employers.
The commission is preparing a report to state legislators that will outline policies that could retify the problem.
The survey showed that 67 percent of respondents said employees should be protected from having to spend more than a certain percentage of their family income on insurance.
But the survey also showed that only 42 percent of the participants believe employers should be required to provide insurance or pay into a purchasing pool that will help uninsured employees obtain some kind of coverage. Eighty-five percent of the respondents said government subsidies should allow people to buy into the private market.
Ninety-one percent said portability or continuity of health coverage ought to be assured for indiviuals and families.

Health care needs breaking, rebuilding

The health-care crisis seems to be on everyone’s mind today. Politicians have unique solutions to sell you with the objective being your vote. Getting your vote is, unfortunately, not what good health care is really about.
The medical-care crisis is real, and it is multi-faceted. Today, we focus on cost and the uninsured. In reality, we should be more concerned about availability. The number of doctors over age 55 is significant. When those doctors retire, the question will not be the cost of medical care but the rationing of medical care. The shortage of practicing nurses is already well known, but the shortage of doctors is only now becoming a focus.
In order to revitalize our health-care system and provide the solid foundation necessary for access to health care for all, we must drastically overhaul how health care is thought of today.
The individual is the starting point for good health care. We cannot continue to rely on drugs or surgery to reverse years of poor health habits and poor diets. The true solution to our health-care crisis is personal responsibility. This will take years to be effective, but it is the only true long-term solution.

In the shorter run, our health-care system must emphasize wellness and not illness. At present, the emergency room is the physician of choice for many Americans, at great cost to all. It is important to allow nurse practitioners, physician assistants and nurses greater autonomy in providing medical care. Not all medical issues require a doctor. Additionally, the American Medical Association and research facilities should be encouraged to develop standard medical examinations and treatments for each risk group or age, especially the aged. This improves early diagnosis and allows for treatment at a much lower cost than remediation later.

Medical systems must be streamlined by providing funds that will be used to renovate health facilities and find creative means of providing health care. Let the private-enterprise system encourage solutions. Government-imposed pricing with Medicare and Medicaid, regulatory-approval processes and litigation risks all work together to deny us the very thing that our political leaders tell us they are working for. Additionally, insurance companies frequently base their reimbursements on Medicare and Medicaid while at the same time requiring additional paperwork to justify payments. More realistic rate structures and simplified billing administration are needed to encourage the free market system to work as they are intended to work.

Tort reform is needed as well. We must limit noneconomic damages for awards and give the state licensing board greater latitude to punish negligence. Concurrently, physicians and health-care providers have to be willing to police their own ranks.
To alleviate the shortage of health-care professionals, we need to encourage careers in health care through a nationwide tuition-assistance program, loans and tax incentives. It is absurd that our tax code fails to reward education. If you want to fight medical-care shortages, encourage the career (and all careers for that matter) by providing for the deductibility of tuition payments from income. To provide for care to the poor, nonprofit health-care facilities will partially fill the gap, but I would also recommend that the tax code be modified to allow health-care practitioners to deduct the market value of their charity care to the poor on their tax returns.
Prescription-drug-approval processes and research are needed to significantly reduce the costs of developing new drugs. Making villains out of drug companies to get votes is counterproductive.
Finally, revision of HIPAA and the Stark Act to reduce unnecessary and cumbersome regulations that increase costs but do not improve health care should be undertaken immediately. Once again, the Congress passed well-intentioned bills with no understanding of the impact on the industry.
Great health care emphasizes wellness, personal responsibility, and a society that is willing to lead the effort of encouraging health-care careers. Bandages will not fix our health-care problems today but redefining how health care is provided will. We need to break health care in order to fix it.