WASHINGTON – “Why did they cut you?”

The shocking question came from a respected spine surgeon tracked down by Keith Swenson, who was still in severe pain after an earlier back operation.

He didn’t know what to believe. Two other surgeons had urged more operations, different ones.

And Swenson, who’s from Howard Lake, Minn., is far from alone. Even though only a fraction of people with back pain are good candidates for surgery, complicated spine operations are on the rise.

So is the hunt for any relief.

By one recent estimate, Americans are spending a staggering $86 billion a year in care for aching backs — from MRIs to pain pills to nerve blocks to acupuncture. That research found little evidence that the population got better as the bill soared over the past decade.

“The way medicine is so Star-Treky these days, they believe something can be done,” said Dr. Charles Rosen, a spine surgeon at the University of California, Irvine.

The reality is that time often is the best antidote. Most people will experience back pain at some point, but up to 90 percent will heal on their own within weeks. In fact, for run-of-the-mill cases, doctors aren’t even supposed to do an X-ray or MRI unless the pain lingers for a month to six weeks.

Yet a study last year found nearly one in three aching Medicare patients get some kind of back scan within that first month.

Why is that a problem? Those scans can be misleading. By middle age, most people who don’t even have pain nonetheless have degeneration of their disks, those doughnut-looking shock absorbers between vertebrae. So in someone who does have pain, pinpointing that a particular black spot or bulge on a scan is the true cause is tricky.

The bigger problem: When the misery lingers, there’s no one-size-fits-most treatment.

“There are a lot of procedures going on for patients in whom we don’t have good scientific evidence that it’s going to help,” said Dr. Richard Deyo of Oregon Health and Science University in Portland, who long has studied how people fare with different options for this tough ailment.

For example, there’s a wide variety of spinal injections that aim to numb back pain, using different drugs and targeting different spots. Which one works depends on what study you read.

When the Institute of Medicine recently listed the 100 how-to-treat questions that doctors most need answered, back pain neared the top of the list.

Lots of things can cause chronic back pain, from arthritis to bone-thinning osteoporosis, which has its own controversy over whether cementing cracks in the spine really helps.

But those cushiony disks are a big reason. They naturally thin and shrink with age. Sometimes they herniate, or rupture, so the gel-like center leaks and pressures a nerve. Sometimes a vertebra slips out of alignment. Sometimes the spinal canal painfully narrows, a condition called stenosis.

The right operation can help, but specialists say only about 10 percent of people with lasting pain are candidates. More than 333,000 of the simpler decompression operations — laminectomies and diskectomies that cut away part of a bone or disk to relieve nerve pressure — were performed in 2007, the latest data compiled by the American Academy of Orthopaedic Surgeons. There were nearly 381,000 spinal fusions — more complex, riskier surgeries that bind vertebrae together with a bone graft and sometimes metal hardware.

There is some hopeful news — increasing evidence that more people should try pushing past the pain in aggressive exercise programs. Deyo calls them boot camps for back pain.

That’s what ended Swenson’s five-year pain odyssey. After a volleyball injury, scans showed he had degeneration in seven disks but one bulged in a way that doctors thought explained the pain radiating down both legs. They cut away part of that spot; it didn’t help. Neither did multiple pain-blocking options.

“Exercise is medicine, but it has to be the right exercise,” said Dave Carpenter, president of Physicians Neck & Back Clinics in Minneapolis, where Swenson finally turned.

The clinic’s rehabilitation program focuses on strengthening muscles that support the spine, and published a study showing that only three of 38 patients prescribed surgery still needed it in the 13 months after completing tailored rehab.

Swenson, now 51, said he was so debilitated that it took several months to improve, plus two years of “maintenance” conditioning. Today, he’s running a thriving gardening business near Minneapolis that ships peonies nationwide. It’s a job that requires tremendous manual labor.

“Do I have flare-ups? Yes. But now that my back is strengthened, instead of flare-ups lasting one to two months … the flare-ups last one to two days,” he said. “This form of treatment is a lifetime change.”

In New York City, Nicia Cortez wishes someone had told her of other options before her 2003 operation on a herniated disk.

“I was naive, and in severe pain. I didn’t think properly at the time,” said Cortez, who felt worse after surgery. It took her six years to work up the nerve to try again, this time a fusion that mostly relieved the pain: “I have my life back.”

Her new doctor cautions that scar tissue and altered anatomy mean each subsequent back surgery has less chance of success than the one before.

“It’s like trying to pave your driveway, layer upon layer, but at some point you replace the whole driveway. We don’t have that ability with the spine,” said Dr. Alok Sharan, spinal chief at New York’s Montefiore Medical Center.

He makes patients exhaust nonsurgical options first, knowing that about one in five who has one back operation will have another in a decade.

“Sometimes people jump to this and think it will be a cure-all, and then five years later you need another procedure. If you’re only 40, that’s a big deal,” Sharan said.

What’s the best advice? First, some types of back pain are accompanied by red flags that need immediate attention — such as numb or weak legs or urinary problems. But for most people:

_Don’t expect an X-ray, MRI or CT until a month to six weeks has passed, unless the doctor suspects a more serious problem. Following that guideline is becoming a quality-of-care measure in many organizations.

_Get back to normal activity as quickly as possible; the days of prescribed bed rest are over.

_Patients with sciatica, pain radiating down the leg, have the best outcomes from those nerve-easing decompression surgeries, Deyo stressed. California’s Rosen said three criteria determine chances of success: a scan that correlates with the pain site; the patient has some weakness; and specific pain occurs when the doctor raises and straightens the legs.

Herniated disks heal on their own over about two years, but surgery for a faster fix is reasonable in good candidates, he said.

_Fusions are appropriate for far fewer patients, those with fractures, unstable or slipping spines, curvature of the spine and rare other reasons, Rosen said.

_Deyo recently studied surgeries for stenosis, that painful narrowing, and found decompression surgery as effective and less risky than fusions, which are more complicated and costly.

_A formal exercise program is especially effective if coupled with cognitive behavioral therapy that teaches patients to manage and function with pain, Deyo said.

_What if surgery fails? Usually, it was the wrong operation or the wrong candidate, said Rosen, who sees one or two patients a week classified as having “failed back syndrome” because of multiple failed surgeries.

Always get a second opinion. Rosen, who founded the Association for Medical Ethics, also recommends asking about a doctor’s ties to companies that make spine-surgery products. That way you’ll feel assured that a recommendation to cut doesn’t come from a too-cozy relationship.

_Not a good candidate? A primary care physician can be a neutral adviser in helping navigate next steps. Patients with more challenging back problems may fare better at a multidisciplinary spine center with numerous specialists — in rehab and pain management — under one roof.

“You don’t want to leave them hanging,” said Rosen.

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Online:

Government back-pain overview: http://tinyurl.com/2u2th26

Mayo Clinic: http://tinyurl.com/25k5ox

Association for Medical Ethics: http://www.ethicaldoctor.org

WASHINGTON – More medical care won’t necessarily make you healthier — it may make you sicker. It’s an idea that technology-loving Americans find hard to believe.

Anywhere from one-fifth to nearly one-third of the tests and treatments we get are estimated to be unnecessary, and avoidable care is costly in more ways than the bill: It may lead to dangerous side effects.

It can start during birth, as some of the nation’s increasing C-sections are triggered by controversial fetal monitors that signal a baby is in trouble when really everything’s fine.

It extends to often futile intensive care at the end of the life.

In between:

_Americans get the most medical radiation in the world, much of it from repeated CT scans. Too many scans increase the risk of cancer.

_Thousands who get stents for blocked heart arteries should have tried medication first.

_Doctors prescribe antibiotics tens of millions of times for viruses such as colds that the drugs can’t help.

_As major health groups warn of the limitations of prostate cancer screening, even in middle age, one-third of men over 75 get routine PSA tests despite guidelines that say most are too old to benefit. Millions of women at low risk of cervical cancer get more frequent Pap smears than recommended; millions more have been screened even after losing the cervix to a hysterectomy.

_Back pain stands out as the No. 1 overtreated condition, from repeated MRI scans that can’t pinpoint the trouble to spine surgery on people who could have gotten better without it. About one in five who gets that first back operation will wind up having another in the next decade.

Overtreatment means someone could have fared as well or better with a lesser test or therapy, or maybe even none at all. Avoiding it is less about knowing when to say no, than knowing when to say, “Wait, doc, I need more information!”

The Associated Press combed hundreds of pages of studies and quizzed dozens of specialists to examine the nation’s most overused practices. Medical groups are starting to get the message. Efforts are under way to help doctors ratchet back avoidable care and help patients take an unbiased look at the pros and cons of different options before choosing one.

“This is not, I repeat not, rationing,” said Dr. Steven Weinberger of the American College of Physicians, which this summer begins publishing recommendations on overused tests, starting with low back pain.

It’s trying to strike a balance, to provide appropriate care rather than the most care. Rare are patients who recognize they’ve crossed that line.

“Yet let me tell you, with additional tests and procedures comes significant harm,” said Dr. Bernard Rosof, who heads projects by the nonprofit National Quality Forum and an American Medical Association panel to identify and decrease overuse.

“It’s patient education that’s going to be extremely important if we’re going to make this happen, so people begin to understand less is often better,” he said.

Not even doctors’ families are immune.

A hospital appropriately did six CT scans to check Dr. Steven Birnbaum’s 22-year-old daughter for injury after she was hit by a car. But the next day, Molly had an abdominal scan repeated as a precaution despite having no symptoms. When a doctor ordered still another, “I blew a gasket,” said the New Hampshire radiologist, who put a stop to more.

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There are numerous reasons that one of three U.S. births now is by cesarean, but Dr. Alex Friedman blames some on an imprecise monitor strapped to laboring women. Too often, he has sliced open a mother’s abdomen fearing the worst, only to pull out a pink, screaming bundle.

“Everyone knows it’s a bad test,” said Friedman of the Hospital of the University of Pennsylvania. “You haven’t done the patient a big service by doing an unnecessary surgery.”

Electronic fetal monitors record changes in the baby’s heart rate, a possible sign of too little oxygen. They became a tradition — now used in 85 percent of births — years before research could prove how well they work.

Guidelines issued last summer, aiming to help doctors better interpret which tests are worrisome, acknowledge the monitors haven’t reduced deaths or cerebral palsy. But they do increase the chances of a C-section. While they should be used in high-risk women, the guidelines say the low-risk could fare as well if a nurse regularly checked the baby’s heart rate.

Later this year, the National Institutes of Health will begin a major study to see if adding a newer technology — a type of fetal EKG already used in Europe — to the heart-rate monitor would better identify which babies really are struggling and need rapid delivery.

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Undertreatment was in the headlines over the past year as the Obama administration and Congress wrestled with legislation to get better care to millions who lack it.

The flip side, overtreatment, is a big contributor to runaway health care costs. Yet it’s one that lawmakers, wary of being accused of rationing, largely avoided in the new health care law. Included were modest steps — studies to compare which treatments work best, some Medicare financial incentives — to push higher-quality, lower-cost care.

“Physicians get up every day with the good intentions of wanting to do what’s best for their patients,” said Dr. David Goodman of the Dartmouth Institute for Health Policy. “We also live in environments where there are strong financial incentives to deliver certain types of care. We get well-paid for doing procedures. We get paid relatively poorly for spending time with patients and helping them make choices.”

Where you live plays a role. Two decades of research from the respected Dartmouth Atlas of Health Care shows that in parts of the country, Medicare pays double or triple the price to treat people with the same illnesses. The differences are not fully explained by big cities’ higher cost of living or populations that are poorer, older or sicker. How much care someone gets is a main reason, yet Dartmouth’s data shows people in pricier areas don’t necessarily fare better.

Dartmouth’s check of 2005 Medicare data found that during their last six months of life, older adults in Boise, Idaho, spent 5.3 days in the hospital compared with 17 days in Miami.

Fee-for-service care and local habits aren’t the only drivers.

Fear of malpractice lawsuits “has everything to do with it,” said Dr. Angela Gardner, president of the American College of Emergency Physicians, whose members face intense pressure to overtest in the life-and-death chaos of the ER.

Nor is there always clear evidence for one therapy choice over another. It can be faster to give in to a patient’s demand for medicine than to explain why, for example, a child doesn’t need antibiotics for ear pain.

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Care for the dying is often a powerful illustration of treatment going too far.

Texas author Liza Ely had lined up hospice care for her 93-year-old mother, Verna Burnett, as she lived her last days with Alzheimer’s and heart failure. Yet when Burnett developed an irregular heartbeat, the care provider at her Tyler, Texas, nursing home recommended seeing a cardiologist, to have a tube threaded through blood vessels to her heart to check it out.

“We were speechless,” Ely said. “We asked what could be done if something showed up on the test.”

The response: “Nothing, really.”

Ely said the family refused the “painful, expensive and unnecessary test.”

Congress’ health care overhaul initially included a provision that would have authorized Medicare to pay doctors for counseling patients interested in end-of-life options. The provision died in the hue and cry after Sarah Palin dubbed the effort “death panels,” a charge named 2009 political “Lie of the Year” by the nonpartisan fact-checking organization PolitiFact.

Rep. Earl Blumenauer, D-Ore., said he plans to reintroduce his idea.

“Today there is no guarantee that people will get the care they want when they are incapacitated or in those final stages of life. The default is sometimes the most painful, the most intrusive, the most frightening treatment — whether or not that is what people want,” he told the AP.

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New efforts are beginning to push back against overtreatment:

_In Minnesota, the influential health cooperative HealthPartners saw use of MRIs and radiation-heavy CTs growing between 15 percent and 18 percent a year. So the insurer began a new program: National radiology guidelines pop up on each patient’s electronic medical record whenever a doctor orders a scan. It’s not a requirement, but a gentle reminder of when such tests are recommended.

In two years and counting, HealthPartners estimates it avoided 20,000 unnecessary tests, preventing dangerous radiation exposure and saving $14 million.

Providing the guidelines helps doctors deal with patients who demand a scan, says medical director Dr. Pat Courneya. He recently examined a young man who wanted a brain CT because of dizziness. Courneya’s physical exam turned up no neurologic red flags like weakness or eye problems, but seeing the guidelines helped reassure the man.

_An American Medical Association journal, Archives of Internal Medicine, just began a “Less is More” series to educate doctors about the risks of overused treatments.

First up: Studies saying more than half of the 100 million-plus prescriptions for the strongest stomach acid suppressors — proton pump inhibitors such as Nexium — go to people who don’t need something that powerful. That puts them at unnecessary risk of side effects, including bone fractures and infections.

_This summer, the journal Annals of Internal Medicine begins publishing American College of Physicians‘ guidelines for “high-value, cost-conscious care.”

_To increase patients’ savvy, about a dozen health centers around the country are testing “shared decision-making.” That process uses plain-English guides, often DVDs, to explain the advantages and disadvantages of test and treatment options. Given full information, patients choose a less aggressive approach than doctors initially recommend about 20 percent of the time, says Dr. Michael Barry of the nonprofit Foundation for Informed Medical Decision-Making.

“Where I think no one in the Consumer Reports age would go to the car lot and say, ‘I’m going to let the dealer figure out what car I want or need,’ now we are taking a little of that spirit to the doctor’s office,” he said.

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Associated Press writer Ricardo Alonso-Zaldivar in Washington and Medical Writers Lindsey Tanner in Chicago and Marilynn Marchione in Milwaukee contributed to this report.

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Online:

American College of Physicians: http://www.acponline.org

National Quality Forum: http://www.qualityforum.org

American Medical Association: http://www.ama-assn.org

National Institutes of Health: http://www.nih.gov

Dartmouth Institute for Health Policy: http://tdi.dartmouth.edu

Dartmouth Atlas of Health Care: http://www.dartmouthatlas.org

American College of Emergency Physicians: http://www.acep.org

HealthPartners: http://www.healthpartners.com/public

Archives of Internal Medicine: http://archinte.ama-assn.org

Foundation for Informed Medical Decision-Making: http://www.informedmedicaldecisions.org

Annals of Internal Medicine: http://www.annals.org

Families from Pakistan to Argentina to Congo are being battered by surging food prices that are dragging more people into poverty, fueling political tensions and forcing some to give up eating meat, fruit and even tomatoes.

Scraping to afford the next meal is still a grim daily reality in the developing world even though the global food crisis that dominated headlines in 2008 quickly faded in the U.S. and other rich countries.

With food costing up to 70 percent of family income in the poorest countries, rising prices are squeezing household budgets and threatening to worsen malnutrition, while inflation stays moderate in the United States and Europe. Compounding the problem in many countries: prices hardly fell from their peaks in 2008, when global food prices jumped in part due to a smaller U.S. wheat harvest and demand for crops to use in biofuels.

Majeedan Begum, a Pakistani mother of five, said a bag of flour for bread, the staple of her family’s diet, costs three times what it did two years ago in her hometown of Multan. She can no longer afford meat or fruit.

“My domestic budget has been ruined,” said Begum, 35.

The U.N. Food and Agriculture Organization’s food price index — which includes grains, meat, dairy and other items in 90 countries — was up 22 percent in March from a year earlier though still below 2008 levels. In some Asian markets, rice and wheat prices are 20 to 70 percent above 2008 levels, it says.

Many governments blame dry weather and high fuel costs but critics in countries such as India, Argentina and Egypt say misguided policies are making shortages worse and collusion by suppliers might be pushing up prices.

No single factor explains the inflation gap between developing and developed countries but poorer economies are more vulnerable to an array of problems that can push up prices, and many are cropping up this year.

Farmers with less land and irrigation are hit harder by drought and floods. Civil war and other conflicts can disrupt supplies. Prices in import-dependent economies spike up when the local currency weakens, as Pakistan’s rupee has this year.

Costs also have been pushed up by a rebound in global commodity prices, especially for soy destined for Asian consumption. That has prompted a shift in Argentina and elsewhere to produce more for export, which has led to local shortages of beef and other food. The global financial crisis hurt food production in some countries by making it harder for farmers to get credit for seed and supplies.

In Mauritania in West Africa, rice prices doubled over the first three months of the year, according to the World Food Program. Over the same period, the price of corn rose 59 percent in Zimbabwe and 57 percent in neighboring Mozambique.

In Kinshasa in the Democratic Republic of Congo, Mami Monga pays $25 for a box of fish that cost $10 a year ago. The price of a 25-kilogram bag of rice has doubled to $30.

“Today I am obliged to buy half the food I used to buy mid-last year,” said Mami, a mother of five.

Kinshasa shopkeeper Abedi Patelli said prices rise when the exchange rate of Congo’s currency falls. “But when our currency improves against the U.S. dollar, prices don’t fall,” he said. “They remain steady.”

WFP spokesman Greg Barrow said poorer countries can suffer a “ratchet effect” that locks in price rises due to high transportation costs and limited competition.

“Prices dropped fairly dramatically toward the end of 2008 on international markets but we found prices remained relatively high in many local markets in developing countries,” said Barrow.

After the cost of food rises, “it tends to take a long time to go down,” he said.

The FAO said the double blow of the global recession and high food prices has pushed 100 million people into poverty.

Opposition parties have organized protests in Pakistan. In Egypt, a 50 percent jump in meat prices in recent weeks has helped to fuel demonstrations outside parliament over wages and other economic issues.

“I am afraid that I will wake up one day and not able to get enough bread for my 12-member family,” said Aboulella Moussa, a doorman at a Cairo apartment building.

People interviewed in a number of countries said they are coping not just by cutting out expensive items but by eating less — a trend that has stirred concern about malnutrition.

In the 2008 inflation spike, WFP found families in some countries skipped meals or switched to eating corn husks or other low-quality produce. “Over the long term, this would lead to the effects of chronic malnutrition,” Barrow said.

“It’s expensive, so we eat less,” said Seema Valmiki, 35, who is raising three children in New Delhi with her husband on his 6,000-rupee ($135) monthly income as a driver.

Valmiki can no longer afford meat, fruit or fish and has put off buying her children new school uniforms, toys and a bicycle.

“If we buy them fruit, we can’t buy them food” like rice, dal and vegetables, she said.

In China, food costs rose 5.9 percent in April over a year ago — a modest rate for a country that suffered 20 percent-plus inflation in 2008. But it was enough to prompt the communist government to try to reassure the public with pledges that prices will ease as the spring harvest comes in. It also threatened to punish price gouging in a new effort to cool inflation.

Even in moderately prosperous nations such as Venezuela, shoppers say they can no longer afford meat and scour markets for bargains.

In Argentina, soy production has taken over more than 32 million acres (13 million hectares) of grassland once used to raise cattle and replaced less profitable wheat and corn as well, driving up prices in supermarkets.

Argentina’s government has responded with higher taxes, export limits, controls on supermarket prices of meat, wheat and corn, subsidies to food producers and pay hikes of 30 percent for union workers. The moves have temporarily eased the pain but beef producers have thinned their herds in response to government intervention and the price of meat has doubled in the last year.

“Before, we would eat meat three times a week. Now it’s once, with luck,” said Marta Esposito, a 45-year-old mother of two in Buenos Aires. “Tomatoes, don’t even talk about it. We eat whatever is the cheapest.”

Venezuela’s 30.4 percent inflation is among the world’s highest. The oil-rich country is a major food importer and its bolivar has tumbled against the dollar, forcing up prices in local markets. In April, food prices rose 11 percent over the previous month.

The Venezuelan government has imposed price controls and arrested some shopkeepers for violating them. But the controls have led to shortages of beef, sugar, corn meal and butter, forcing the government to allow some prices to rise by 20 percent this year.

Elsewhere, rising prices highlight a more basic problem: making sure farm productivity keeps pace with burgeoning populations.

India’s food prices were up 17 percent in April over a year earlier but the government hopes normal rainfall this growing season will increase supplies. The rise has been driven in part by growing demand from the rural poor, who can afford to spend more on food thanks to government debt-relief and job-creation programs.

Longer term, experts say India, with more than 1 billion people, has to speed up growth in farm production if it is to keep up with demand.

“Our capacity to feed every Indian is systematically declining with time,” said Harsh Mander, who was appointed by India’s Supreme Court to monitor hunger. “World markets can’t bail us out.”

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McDonald reported from Beijing. AP Business Writer Erika Kinetz in Mumbai, researcher Bonnie Cao in Beijing and Associated Press Writers Debora Rey in Buenos Aires, Salah Nasrawi in Cairo, Sebastian Abbot in Islamabad, Fabiola Sanchez in Caracas, Patrice Chitera in Kinshasa and Tran Van Minh in Hanoi contributed to this report.

CHICAGO – Doctors are reporting a key advance in treating men with cancer that has started to spread beyond the prostate: survival is significantly better if radiation is added to standard hormone treatments.

Results of the study were given Sunday at a cancer conference, where other research showed that an experimental drug boosted survival for women with very advanced breast cancer. The drug is being reviewed by the federal Food and Drug Administration.

The prostate study has the potential to change care right away. About 20 percent of the nearly 200,000 men diagnosed with the disease each year in the United States are like those in the study — with cancer that has spread to the area around the prostate.

“It is this group of patients in whom many of the deaths from prostate cancer occur,” because the condition is usually incurable, said study leader Dr. Padraig Warde, a radiation expert from the University of Toronto’s Princess Margaret Hospital.

These men are treated with drugs that block testosterone, a hormone that helps prostate cancer grow. Only about half also get radiation because of concerns about urinary problems it can cause. Even though these treatments have been used for decades, few studies have been done to establish their value alone or in combination.

The new study assigned 1,200 men to get hormones plus radiation or hormones alone. After seven years, 74 percent of men receiving both treatments were alive versus 66 percent of the others. Those on both treatments lived an average of six months longer than those given just hormones.

Serious side effects occurred in less than 2 percent of men in either group. The study was sponsored by the National Cancer Institute of Canada.

The results show that “radiation is an indispensable element in the treatment of patients with high-risk prostate cancer,” said Dr. Jennifer Obel, a cancer specialist at Northshore University Health System in suburban Chicago who had no role in the study.

Dr. Otis Brawley, the American Cancer Society’s chief medical officer, praised the survival advantage but said he wished it were larger.

“It’s a practice-changing study in certain countries,” especially in Europe, where more men are diagnosed with locally advanced tumors than in the United States, he said.

In the U.S., about 192,280 new cases of prostate cancer were diagnosed last year, and it claimed 27,360 lives.

The breast cancer study tested eribulin, a drug derived from a sea sponge. Unlike Herceptin and other gene-targeted drugs that have been the focus of cancer research for the past decade, this one is a chemotherapy — a drug that kills cancer cells, in this case by attacking cell division in a novel way.

The study tested it in 762 women whose cancer had either recurred after initial treatment or had spread beyond the breast. All were getting worse despite having tried an average of four previous drugs.

Two-thirds were given eribulin, and the others received whatever treatment their doctors wanted to try, since there is no standard of care in this situation.

Median survival was just over 13 months for those on eribulin versus less than 11 months for the others, said study leader Dr. Christopher Twelves, of St. James’s Institute of Oncology in Leeds, England.

About half of women on eribulin had typical chemotherapy side effects — fatigue, low white blood cell counts, loss of hair, numbness and tingling in different parts of the body. About one-fourth of women in each group had serious side effects related to their treatments.

The study was sponsored by Japan-based Eisai Inc., which last week received a promise of quick review from the FDA. A company spokesman said no price has yet been set for the drug.

“There aren’t many drugs that show a survival advantage in this setting,” and the amount of benefit seen in this study gives eribulin “a reasonable chance” of being approved, said Dr. Eric Winer, breast cancer chief at the Dana-Farber Cancer Institute in Boston.

More than 1 million women worldwide are diagnosed with breast cancer each year. In the United States last year, there were an estimated 194,280 new cases and 40,610 deaths from the disease.

The studies were reported at the annual meeting of the American Society of Clinical Oncology.

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Online:

Cancer meeting: http://www.asco.org

National Cancer Institute: http://www.cancer.gov

CHICAGO – Researchers have scored the first big win against melanoma, the deadliest form of skin cancer. An experimental drug significantly improved survival in a major study of people with very advanced disease.

The results, reported Saturday at a cancer conference, left doctors elated.

“We have not had any therapy that has prolonged survival” until now, said Dr. Lynn Schuchter of the Abramson Cancer Center at the University of Pennsylvania, a skin cancer specialist with no role in the study or ties to the drug’s maker.

The drug, ipilimumab, (ip-ee-LIM-uh-mab), works by helping the immune system fight tumors. The federal Food and Drug Administration has pledged a quick review, and doctors think the drug could be available by the end of this year.

“People are going to have a lot of hope and want this drug, and it’s not on their doctors’ shelves,” although some may be able to get it through special programs directly from its maker, Bristol-Myers Squibb Co., Schuchter said.

Melanoma is the most serious form of skin cancer. Last year in the United States, there were about 68,720 new cases and 8,650 deaths from the disease. Worldwide, more than 50,000 people die of melanoma each year.

“The incidence is rising faster than any other cancer,” said one of the study’s leaders, Dr. Stephen Hodi of Dana-Farber Cancer Institute in Boston. “When it spreads to vital organs, it’s almost always fatal.”

Doctors also reported Saturday at the conference that an experimental drug for lung cancer patients with a certain gene showed extraordinary promise in early testing. The drug, Pfizer Inc.’s crizotinib, (crih-ZAH-tin-ib) targets a gene that promotes tumor growth and is found in about 4 percent of lung cancers, especially among younger, non-smokers.

Nearly 220,000 new cases of lung cancer are diagnosed each year in the United States alone, and it is the world’s top cancer killer. Two other gene-targeted treatments, Tarceva and Iressa, help about 20,000 lung cancer patients annually in the U.S.

The skin cancer study involved 676 people around the world with advanced, inoperable melanoma who had already tried other treatments — a very grim situation. They were given one of three treatments: ipilimumab by itself, with another immune-stimulating treatment, or the immune-stimulating treatment alone.

After two years, 24 percent of those given the drug alone or in combination were alive, versus 14 percent of those given just the immune-stimulating treatment.

Average survival was 10 months with ipilimumab versus just more than six months for the others, which worked out to a 67 percent improvement in survival for those on the drug, said one of the study’s leaders, Dr. Steven O’Day of the Angeles Clinic and Research Institute in Los Angeles.

Doctors hope the drug can provide more benefit if given earlier in the course of the disease and to less sick patients.

Ten percent to 15 percent of patients on ipilimumab had serious side effects related to the drug’s actions on the immune system. Most were treatable with high doses of steroids, but 14 deaths were thought to be related to the treatment. That’s still far fewer than deaths due to the cancer.

The study was funded by Bristol-Myers and Medarex Inc., a company that co-developed the drug and was bought by Bristol-Myers last year. A spokeswoman said Bristol-Myers has not yet set a price for the drug, but similar treatments for other cancers cost several thousand dollars a month or more.

Results were reported at the American Society of Clinical Oncology’s annual conference in Chicago and published online by the New England Journal of Medicine.

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Online:

Cancer meeting: http://www.asco.org

National Cancer Institute: http://www.cancer.gov

New England Journal of Medicine: http://www.nejm.org

CHICAGO – It’s way too soon to declare success, but an experimental drug for lung cancer patients with a certain gene showed extraordinary promise in early testing, doctors reported at a cancer conference on Saturday.

More than 90 percent of the 82 patients in a study saw their tumors shrink after two months on the drug, Pfizer Inc.’s crizotinib, (crih-ZAH-tin-ib), researchers reported.

Doctors had expected only about 10 percent of these very sick patients to respond to the drug, according to one of the study’s leaders, Dr. Yung-Jue Bang of the Seoul National University College of Medicine in South Korea.

These were people with advanced disease, including some whose cancers had spread to the brain. They had already tried an average of three other drugs. Responses to crizotinib have lasted up to 15 months so far, and the drug has been rushed into late-stage testing, Bang said.

Many leading cancer specialists, who normally don’t get excited until a drug proves effective in large studies against existing treatments, said the research so far on crizotinib was promising.

“It’s early, but I’m impressed by it. It looks extremely effective,” said Dr. Roy Herbst, lung cancer chief at the University of Texas M.D. Anderson Cancer Center in Houston. He has consulted for makers of other lung cancer drugs but not this one.

Dr. Alice Shaw, the Massachusetts General Hospital doctor who is leading a larger study of crizotinib, agreed.

“I don’t think there is false hope. The data are so strong,” she said.

The drug targets a gene that promotes tumor growth and is found in about 4 percent of lung cancers, especially among younger, non-smokers. This small percentage is still a lot of people: nearly 220,000 new cases of lung cancer are diagnosed each year in the United States alone, and it is the world’s top cancer killer.

That means that up to 10,000 people in the U.S. annually could benefit, said Dr. Mark Kris, a lung cancer specialist at Memorial Sloan-Kettering Cancer Center in New York, who has consulted for Pfizer.

Two other gene-targeted treatments, Tarceva and Iressa, help about 20,000 lung cancer patients annually in the U.S.

“We’re chipping away at large numbers of patients,” and future gene discoveries should add to the number helped, Herbst said.

The gene targeted by crizotinib was discovered in 2007, Kris noted.

“Once we understand a cancer cell, we can come up with a treatment very quickly,” he said.

No show-stopping side effects were seen in the first study — half of patients on crizotinib had diarrhea, nausea or vomiting — but much larger tests are needed to establish safety.

Even more testing is needed to see if the drug is more effective than existing treatments, how long any benefits last, and whether it improves survival — not just shrinks tumors.

Pfizer sponsored the study and has already launched bigger studies to compare crizotinib to current standard treatments. The company hopes to seek federal Food and Drug Administration approval for the drug next year.

The study was presented Saturday at a meeting in Chicago of the American Society of Clinical Oncology.

___

Online:

Cancer meeting: http://www.asco.org

National Cancer Institute: http://www.cancer.gov

Pfizer: http://www.pfizer.com

NEW YORK (Reuters Health) –
The young children of moms abused by their partners are at increased risk of being obese, a new study from Massachusetts finds.

The more often the abuse occurs, the higher the risk that pre-school children, especially girls, will be obese and, as a result, at increased risk of developing diabetes, heart disease, cancer and other illnesses later in life, the study team notes.

“It’s always sobering to see the vast impact that adversities in early life can have on long term health outcomes,” lead investigator Dr. Renee Boynton-Jarrett of Boston University School of Medicine told Reuters Health.

Ties between exposure to adversities in childhood and long-lasting emotional and health problems in adulthood have been established in numerous studies. This is the first study, the investigators say, suggesting a possible connection between violence directed against mothers and obesity in young children.

Boynton-Jarrett and colleagues studied 1,595 children born between 1998 and 2000. The children’s mothers were interviewed when the children were born and up until they reached age 5. The children’s height and weight was measured at age 3 and age 5. Most of the children were born to unmarried parents.

By the time the children were 5 years old, nearly half (788 or 49.4 percent) had been exposed to family violence and 263 children (16.5 percent) were obese, meaning their body mass index (BMI) was higher than 95% of other children their age and sex in the general population.

By comparison, in the general population in 2005-2006, 11 percent of children age 2 to 5 were defined as overweight, a lower standard than obese.

Boynton-Jarrett’s team found that children whose mothers reported being chronically abused by a partner were 80 percent more likely to be obese at age 5, compared to children whose mothers reported no abuse.

The association between exposure to domestic violence and obesity was stronger in girls than boys, and also among kids whose mothers said they lived in “less safe” neighborhoods, the study team notes in the Archives of Pediatrics and Adolescent Medicine.

Studies have shown that childhood weight may be influenced by a number of factors including diet, time spent watching television, weight at birth, mother’s depression, and smoking during pregnancy. The study team took all these factors into account and found the association between obesity and exposure to domestic violence persisted.

“These findings are absolutely applicable across socioeconomic populations,” Boynton-Jarrett told Reuters Health, pointing out that her team controlled for education and other socioeconomic factors.

According to the Centers for Disease Control and Prevention, domestic violence is a “serious problem” in the US; nearly five million women are victims of domestic violence every year. It’s estimated that 3 to 10 million children witness these attacks annually.

Interventions to prevent obesity “must consider the impact of family violence” on the risk of obesity risk, the investigators say. Domestic violence and childhood obesity prevention programs should be designed to work in tandem, they conclude.

“If we can marry the two efforts in some respects, we might be doing a better job of preventing early onset of childhood obesity,” Boynton-Jarrett said. Improving community safety may also help reduce childhood obesity.

SOURCE: http://archpedi.ama-assn.org/cgi/content/short/164/6/540

Archives of Pediatrics and Adolescent Medicine, June 2010.

MONDAY, June 7 (HealthDay News) — For patients battling a type
of cancer that affects the back of the mouth, the chances of survival
increase if the tumor contains the sexually transmitted virus that causes
cervical cancer, new research shows.

In fact, the presence of human papillomavirus (HPV) is the most
important predictor of survival in oropharyngeal cancer, researchers from
the Ohio State University Comprehensive Cancer Center-Arthur G. James
Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James)
found.

“Previous studies indicated a relationship existed between the presence
or absence of HPV in oropharyngeal tumors and patient survival, but they
couldn’t determine if other favorable factors present in these patients
were responsible for their better outcome,” lead author Dr. Maura
Gillison, an OSUCCC-James medical oncologist and head and neck cancer
specialist, said in a news release.

“These findings close the door on these questions,” Gillison added,
“and will allow the field to move forward with clinical trials designed to
determine how we should use molecular and behavioral factors to
personalize therapy for patients.”

The report was published online June 7 in the New England Journal of
Medicine, to coincide with presentation of the findings Monday at the
American Society of Clinical Oncology annual meeting, in Chicago.

The authors noted that a patient’s lifetime smoking history was the
second leading predictor of survival for this particular form of
cancer.

The finding stems from a three-year post-treatment analysis of tumors
and survival rates among 323 patients diagnosed with stage 3 or stage 4
oropharyngeal cancer, among whom 206 had HPV-positive tumors while 117 had
HPV-negative tumors.

More than 80 percent of those with HPV-positive tumors remained alive
three years after treatment, the authors found, while the same was true
for just 57 percent of those with HPV-negative tumors.

Other potential factors — such as being younger, being white, having
more energy, lacking anemia, and/or having a smaller tumor size —
accounted for just 10 percent of the survival rate differences, the team
concluded.

On the other hand, smoking did register as a serious risk factor for
poor survival chances, for both HPV-positive and HPV-negative patients,
the study found. In fact, the risk for dying from the disease or
experiencing a relapse rose 1 percent for every year that patients had
smoked one pack per day.

The study authors said more research is needed before being able to
discern exactly how doctors might best make use of such survival factor
information when designing a patient’s treatment plan. However, knowing a
patient’s HPV status and smoking history should be considered
central –alongside knowing what stage the patient’s cancer is at — to
any decision-making process regarding which treatment strategy to utilize
and how aggressively it should be administered, the authors noted.

More information

For more on oropharyngeal cancer, visit the U.S. National Cancer Institute.

TUESDAY, June 8 (HealthDay News) — There may be a link between
childhood hardships and pregnancy problems in adulthood.

A new study by U.S. researchers involved 4,865 women who’d experienced
at least one hardship during childhood and had given birth at least once
by age 41. Hardships included family problems with alcohol, fathers who
didn’t take an interest in the child’s schooling, family financial
difficulties and neglect.

Most of the women in the study had their first child in their 20s, and
most had one, two or three children. In their first pregnancy, 7.9 percent
of the women gave birth to a baby whose weight was below normal, 7.5
percent gave birth more than three weeks early. About 39 percent of the
women smoked at some point during their first pregnancy. Overall, 5.8
percent of all pregnancies resulted in babies with low birth weights and
6.5 percent of the women had pre-term births.

“When results were examined by timing of exposure, family structure
hardships and violence/mental health hardships most strongly influenced
the birth outcomes if they happened in adolescence,” wrote Emily W.
Harville, of Tulane University in New Orleans, and her colleagues.
“Overall, the highest risk for both low birth weight and pre-term birth
was in those who had multiple hardships in adolescence only, but this was
also a very small group.”

“Our findings suggest that mothers who have experienced childhood
hardship are more likely to smoke during pregnancy,” Harville said. “They
also more often give birth to low birth weight babies who are born
prematurely, but this association may be primarily due to health behaviors
and associated social class.”

The researchers said their findings also suggest that “there are
critical periods for elevated risk, as well as a cumulative effect of
hardships over time, adding that additional study would be needed “to
specify pathways between childhood adversities and reproductive health
outcomes and to evaluate protective factors that could help to alleviate
long-term influences of early adversity.”

The study is published in the June issue of the Archives of
Pediatrics & Adolescent Medicine.

More information

The March of Dimes has more about low birth weight.

Even one of the richest companies in the world, Microsoft Corp., can use some of the financial flexibility that comes from borrowing money at today’s relatively low rates.

Despite sitting on nearly $40 billion in cash and investments, the software company said Tuesday it will raise $1.15 billion by selling debt that is convertible to stock. The new funds will be used to repay earlier debt and could give the company more leeway to boost dividends or buy back shares.

Analysts said the software company is under pressure from investors to use its hefty cash reserves for business expansion and to boost shareholder return.

“They can take on more debt and reinvest in buying back stock, which could have more value” to shareholders, said Sid Parakh, an analyst at McAdams Wright Ragen in Seattle.

When a company buys shares and takes them out of circulation, each remaining share is more valuable because it is a larger stake in the company. Microsoft stock could use a boost; it’s worth about the same now as last October.

As of March 31, Microsoft had $40 billion in cash and short-term investments and $6 billion in short- and long-term debt. The debt is relatively small considering that the company generated $7.4 billion in cash from operations in its most recent quarter alone.

Microsoft sold debt for the first time in May 2009, offering $3.75 billion in senior unsecured notes due in five, 10 and 15 years at interest rates ranging from 2.95 percent to 5.2 percent.

As of March 31, Microsoft had $2.3 billion of debt known as commercial paper on its books that comes due in one to seven months.

Now Microsoft is offering senior notes due in 2013 that can be converted into cash, stock or a combination of both. The company also would offer an additional $100 million in senior notes if there’s excess demand.

The interest rate Microsoft will pay to debt holders, as well as the notes’ conversion rate and other terms, will be set by the company and investors in negotiations. However, Microsoft likely would not do the transaction unless it were confident it could get favorable rates now, said Richard Lane, who analyzes Microsoft’s debt for Moody’s Investor Service. Moody’s and Standard and Poor’s have given Microsoft their highest credit ratings, which generally translate into lower interest rates.

To prevent the dilution of shares once the debt is converted into stock, the company plans to use “capped call” transactions, which means Microsoft would automatically buy shares if the stock goes above a certain price.

Shares of Microsoft, which is based in Redmond, Wash., fell 45 cents, or 1.8 percent, to $24.84 in afternoon trading.