Women With Certain Types Of Migraines Have Higher Risk Of Heart Disease; Many Study Authors Did Not Report Ties To Pharmaceutical Companies

Women who have migraines with visual problems have increased risk for heart disease, according to a study published on Wednesday in the Journal of the American Medical Association, Long Island Newsday reports. For the study, researchers at the Harvard School of Public Health and Brigham and Women's Hospital analyzed the records of 27,800 women older than age 45 who participated in the Women's Health Initiative. None of the women had heart disease when they entered the study between 1992 and 1995. Researchers focused on the records of 5,125 women who had a history of migraines. According to the study, participants who had migraines with migraine aura had more than twice the normal risk for major cardiovascular events. Migraine aura "is a visual sensation -- like lights flashing or lines zigzagging, with some reports of temporary blindness" -- that often lasts for 20 minutes to one hour before migraines begin, Newsday reports. Women who had migraines without migraine aura did not have an increased risk for major cardiovascular events, the study finds. Lead study author Tobias Kurth said that researchers did not determine the cause of the link between migraine aura and heart disease and that the increased risk was small, with about 18 additional cases of heart disease per 10,000 women with migraine aura. Mark Gudesblatt, a neurologist at South Shore Neurologic Associates, said, "It's an important study because it tells you not to take these things lightly" (Talan, Long Island Newsday, 7/19).

Study Authors Did Not Report Financial Ties
The six authors of the study did not disclose to JAMA that they have consulted for, or received research funds from, pharmaceutical companies that manufacture treatments for heart disease or migraines, the AP/Miami Herald reports. JAMA in January implemented a policy that requires financial disclosures from researchers before acceptance of studies for publication, and an editorial published in the journal last week indicated that "JAMA was getting tougher as a result of ... recent breaches" of the policy, the AP/Herald reports. JAMA Editor in Chief Catherine DeAngelis said that journal editors were not aware of the financial ties until the Associated Press informed her about them last week. The authors said they did not report the financial ties because the study does not promote a treatment. JAMA on Tuesday published online a letter from the authors of the study to explain their failure to disclose the financial ties, as well as a response from DeAngelis and a correction. DeAngelis said that the letter, her response and the correction will appear in a future print edition of JAMA. "Let me decide what's pertinent or not," DeAngelis said, adding, "Authors should always err on the side of full disclosure." Kurth in an interview said that the financial ties "do not represent a conflict of interest" (Tanner, AP/Miami Herald, 7/19).

WSJ Examines Issue
In related news, the Wall Street Journal on Wednesday examined how a "spate of recent lapses" from several medical journals has prompted "calls for more journals to ban offending authors from publication." In addition, "medical schools are being urged to regulate relationships between their researchers and industry more closely," the Journal reports. Sheldon Krimsky, a professor at Tufts University who has studied the issue, said, "If journals are going to have ethical standards and if those ethical standards are going to mean anything, there has to be sanctions associated with them." However, many journal editors "are reluctant to ban authors, partly out of concern these researchers will shop their work to a different publication," the Journal reports. DeAngelis has asked medical schools to investigate potential conflicts of interests among their researchers and issue sanctions when appropriate. She said that sanctions have resulted each time she has asked medical schools to investigate their researchers. Jerome Kassirer, a former New England Journal of Medicine editor, said that medical schools require "more stringent policies" because "faculty members are just up to their ears in financial conflicts and academic medical centers are just not doing anything about it" (Armstrong, Wall Street Journal, 7/19).















"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

In Inaugural Address, Obama Vows To 'Restore Science' To 'Rightful Place'

President Obama on Tuesday in his inaugural address pledged that the U.S. "will restore science to its rightful place, and wield technology's wonders to raise health care's quality and lower its cost," the New York Times reports. As one of his first steps, Obama is expected to rescind former President George W. Bush's restrictions on human embryonic stem cell research next week, in contrast to the Bush administration which, according to the Times, "sought to tame, and in some cases suppress the findings of many of the government's scientific agencies" on issues such as stem cells, sex education and contraceptives.

According to Raynard Kington, acting director of NIH, during the Bush administration "there was a fair degree of discussion and one might even say tension between the views of the agency" and those of the administration regarding stem cell research. Kington said NIH is "prepared to respond quickly" to implement stem cell research policy changes, adding that the process could take months. According to Obama transition officials, the new administration also plans to loosen existing regulations regarding oversight on federal scientific agencies. Although reversing the current policies could take time, "[i]f you look at the science world, you see a lot of happy faces," Frank Press, former president of the National Academy of Sciences and former science adviser to former President Carter, said. Press added that scientists are hopeful because of Obama's "recognition of what science can do to bring this country back in an innovative way."

According to some analysts, the biggest challenges for the new administration might involve funding priorities, particularly during the current economic downturn. However, Obama's proposed stimulus package already contains funding provisions for several scientific agencies, Ken Koizumi, senior budget analyst at the American Association for the Advancement of Science, said. According to Koizumi, this proposal is "an early indication that the administration will go for more science funding in priority areas, even at a time of big deficits" (Harris/Broad, New York Times, 1/21).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.

Women With MS Need Individual Support

The women who I asked would like to have time and opportunity to express grief and vulnerability in contact with health services. They also expect a response based on their individual situation and needs, "said Malin Olsson, Ph.D. at Lule?? University of Technology.


The purpose of Malin Olsson's research is to describe women's experience of living with MS: She has interviewed 25 women with MS, focusing on their daily lives, experiences of extreme tiredness, treatment and their experiences of feeling well. The illness MS means a big change for the women affected, according to Malin Olsson,


-- It's about to go from being healthy and independent to being dependent on others to meet the basic needs of daily life, "she says.


The study shows that woman's experiences of changing relationships between one's own body, self and the outside world is the knowledge needed to identify the individual experiences of women living with MS. This in turn is a precondition for the health care system to be able to communicate on the conditions of women and understand their situation.


Malin Olsson also shows in her research that women living with MS in today's individualistic society are more likely than before at greater risk to be discriminated in their everyday lives.


-- To not feel equal and involved in a community with others is in itself exclusion, "she says.


Source: Lulea University of Technology

Young Women Prefer Individually Tailored Weight Loss Advice

The word is out - young women want
personally tailored nutrition advice and information when it comes to weight loss.
Over 80% of young women are trying to lose weight but are confused about the best way
to achieve this a study published by Wiley-Blackwell in the June 2007 issue of Nutrition
& Dietetics - the official Journal of the Dietitians Association of Australia, including
the Journal of the New Zealand Dietetic Association - has found.



The study is the first in Australia to examine women's views on different approaches to
weight loss, their preferences on how the program are delivered (e.g. individual versus
group sessions), and likelihood of participation.



Lead author Dr. David Crawford, Associate Head at the School of Exercise and Nutrition
Services at Deakin University, said, "Our study suggests young women are moving away
from weight loss groups and classes, with 58% preferring to receive individual face-toface
advice on weight loss from a health professional. They want information on a range
of topics including meal planning, cooking, low-fat recipes and how to better manage
stress."



Co-author Dr. Kylie Ball, Senior Research Fellow at the Centre for Physical Activity and
Nutrition Research, Deakin University added, "This request for information also suggests
they don't currently have access to good quality information about healthy eating and
being physically active, or that the abundance of information that is currently available
simple serves to confuse them. They would also be more likely to participate in a weight
loss program if it was tailored to their needs".



Accredited Practising Dietitian (APD) and Spokesperson for the Dietitians Association of
Australia, Tara Diversi, sees many women in her practice who want to lose weight and
says the study findings confirm what many dietitians already know. "Many of the women lots of different weight loss programs that haven't worked. The key to success is giving
people the information they want and the confidence to eat in a way that is right for them.
APDs work out an eating plan that meets each person's specific needs and fits with their
lifestyle so they can stick with it for life" Ms Diversi said.



This paper is published in the June 2007 issue of

Right To 'Preserve One's Health' At Stake In Supreme Court Case Concerning Federal Abortion Ban, Opinion Piece Says

The Department of Justice's appeal to uphold a federal law banning so-called "partial-birth" abortion and the Supreme Court precedent that is "[s]tanding in the government's way" are "not really about the contentious liberty to choose abortion" but "concern the fundamental right to preserve one's health," Randy Barnett, a professor of legal theory at Georgetown University Law School and author of "Restoring the Lost Constitution: The Presumption of Liberty," writes in a Wall Street Journal opinion piece (Barnett, Wall Street Journal, 12/9). President Bush signed the Partial-Birth Abortion Ban Act (S 3) into law in November 2003. The Planned Parenthood Federation of America, the American Civil Liberties Union on behalf of the National Abortion Federation and the Center for Reproductive Rights on behalf of four abortion providers filed lawsuits alleging that the law is unconstitutional because of the absence of an exception for procedures preformed to protect the health of the pregnant woman. In place of a health exception, the law includes a long "findings" section with medical evidence presented during congressional hearings that, according to supporters of the law, indicates the procedures banned by the law are never medically necessary. Federal judges in California, Nebraska and New York each issued temporary restraining orders to prevent enforcement of the ban, all of which were upheld by appellate courts. The Supreme Court last month heard oral arguments in two of the appeals, and the court is expected to rule on the case by July 2007 (Kaiser Daily Women's Health Policy Report, 11/9). The Supreme Court in deciding on DOJ's appeal and other similar cases will decide if Congress is "entitled to blind deference when a person's life and health is at stake" or if "the people themselves deserve deference when their choices are supported by state-licensed and regulated physicians and ... substantial medical authority," Barnett writes. Former President James Madison said the Ninth Amendment was added to the Constitution to affirm "'the just importance of other rights retained by the people,'" Barnett writes concluding, "We will soon learn whether the courts agree" (Wall Street Journal, 12/9).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved

Kansas Abortion Opponents Petition For Grand Jury Investigation Of Abortion Provider Tiller

The antiabortion group Kansans for Life on Wednesday delivered a petition asking for a Sedgwick County, Kan., grand jury to investigate abortion provider George Tiller, who has been charged with 19 misdemeanors for allegedly violating a state law that requires an independent, consulting physician to approve some late-term abortions, the AP/Wichita Eagle reports. In the petition, which contains 7,857 signatures, the group asks the Sedgwick County District Court to convene a grand jury and appoint an independent prosecutor to investigate Tiller (Hegeman, AP/Wichita Eagle, 9/6).

State Attorney General Paul Morrison (D) in June filed charges alleging that Tiller, who owns Women's Health Care Services in Wichita, Kan., had financial ties to physician Ann Kristin Neuhaus, from whom he received a second opinion before performing 19 late-term abortions in 2003.

A 1998 Kansas law says that before an abortion of a fetus of 21 weeks' gestation or more, two physicians must determine if continuation of a pregnancy will lead to death or "substantial and irreversible" harm to a "major bodily function." Consulting physicians cannot have legal or financial ties to abortion providers. Tiller's attorneys have entered a not guilty plea to the alleged misdemeanors and filed a motion to dismiss the charges. If convicted, Tiller could face up to one year in jail and a $2,500 fine for each of the 19 misdemeanor charges (Kaiser Daily Women's Health Policy Report, 8/7).
Grand Jury Petition
According to the AP/Eagle, petitioners want the grand jury to examine late-term abortions that Tiller performed during the past five years and the reasons cited for the abortions. The group said it does not want the Sedgwick County Office of the District Attorney or Morrison's office associated with the investigation because neither could conduct an unbiased investigation. According to the group, Morrison was not thorough enough in his examination of Tiller's case.

"We waited nine years for those in law enforcement to do their jobs," David Gittrich, state development director for Kansans for Life, said. Tiller's attorneys did not have immediate comment on the petition, according to a receptionist at the law office of Tiller attorney Lee Thompson. "I can assure you the attorney general will enforce the law regardless of his personal view," Ashley Anstaett, spokesperson for Morrison, said, adding, "He does not and will not let politics influence this or any other case." Georgia Cole, spokesperson for Sedgwick County District Attorney Nola Foulston (D), said, "We are confident they will do as the law allows."














According to the AP/Eagle, the number of signatures submitted by Kansans for Life is nearly three times the number needed to convene a grand jury (Hegeman, AP/Wichita Eagle, 9/6).
Morrison Allowed To Intervene in Planned Parenthood, Kline Case
In related news, the Kansas Supreme Court on Wednesday ruled that Morrison could intervene in the legal dispute between Planned Parenthood of Kansas and Mid-Missouri's Overland Park clinic Comprehensive Health and former state Attorney General Phill Kline (R), the Kansas City Star reports (Klepper, Kansas City Star, 9/5).

Kline in 2004 subpoenaed the records of 90 women and girls who in 2003 underwent late-term abortions at Comprehensive Health or Women's Health Care Services in Wichita, which is owned by Tiller, saying there is probable cause that each record contains evidence of a felony. The state Supreme Court in February 2006 ruled that Kline could seek access to the records but that he must return to Shawnee County, Kan., District Court Judge Richard Anderson and present his reasons for seeking the subpoenas. Anderson turned over the records to Kline's office in November 2006 after removing information that would identify individuals.

Morrison -- who defeated Kline in the November 2006 election -- in May in a letter to PPKM attorney Pedro Irigonegaray wrote that he has ended the investigation of Comprehensive Health. Morrison added that the attorney general's office "found no evidence of any criminal wrongdoing" by the clinic. Morrison in the letter also said that Kline forwarded copies of the medical records from PPKM patients to the Johnson County, Kan., district attorney's office on Jan. 5 -- three days before he left the state attorney general's office. Kline, who replaced Morrison as Johnson County district attorney, retains copies of the records, according to Morrison's letter (Kaiser Daily Women's Health Policy Report, 7/23). PPKM is seeking the return of the records used by Kline in the investigation.

According to the Star, Morrison also is suing Anderson in a separate lawsuit. Records in that case also are sealed. Kline said that if Morrison is attempting to force Anderson to return the records, it would be "unprecedented, bizarre and contrary to the responsibilities of a prosecutor." Anstaett declined to comment on the details of either lawsuit. She said that because of the court seal, Morrison's office could not review the Planned Parenthood lawsuit without getting permission to intervene (Kansas City Star, 9/5).

Six-Week Course Of Antiretroviral Nevirapine Did Not Clearly Reduce Risk Of HIV Among Breastfed Infants, Study Finds

A six-week extended course of the antiretroviral drug nevirapine did not clearly show a reduced risk of mother-to-child HIV transmission among breastfed infants, according to a study published Saturday in the journal Lancet, the New York Times reports. According to the Times, breastfeeding "presents a life-and-death dilemma" for HIV-positive mothers in developing countries. Although using formula can reduce the risk of MTCT, when formula is mixed with dirty water, it can increase the risk of death among infants from causes such as diarrhea and malnutrition. In most developing nations, women will continue to breastfeed because it is traditional, formula is expensive and because using formula "announces" that a woman is HIV-positive, according to the Times. At least 150,000 infants contract HIV through breastfeeding annually, experts estimate.

In an effort to prevent MTCT, researchers have "stumbled into their own terrible dilemma," the Times reports. A single dose of nevirapine can prevent MTCT, but a single dose is not always effective. In addition, nevirapine can have side effects, and some infants develop liver failure, rashes or low white blood cell counts. Resistance to nevirapine also develops quickly, meaning that an infant who receives nevirapine and still contracts HIV will be unable to combination therapies that contain it or any related drug (McNeil, New York Times, 7/29).

For the study, researchers administered nevirapine to infants in Ethiopia, India and Uganda whose mothers were HIV-positive (Britt, Bloomberg, 7/25). The infants were randomly assigned to receive a single dose of the drug, while the other half received a six-week course (Bollinger et al., Lancet, 7/26). The study found that infants who took daily doses of nevirapine for six weeks reduced their risk of MTCT by 15% (Bloomberg, 7/25). "Although a six-week regimen of daily nevirapine might be associated with a reduction in the risk of HIV transmission at six weeks of age, the lack of a significant reduction in the primary endpoint -- risk of HIV transmission at six months -- suggests that a longer course of daily infant nevirapine to prevent HIV transmission via breastmilk might be more effective where access to affordable and safe replacement feeding is not yet available and where the risks of replacement feeding are high," the researchers wrote (Lancet, 7/26).














However, three members of the research team led by Mrudula Phadke of the Maharshtra University of Health Sciences in Nashik, India, in a letter to the journal wrote that it is "wrong that a drug that has not shown significant benefit and which has serious toxic side effects in 38.4% of babies should be tried for longer." The study's design of six months was based on the 10 to 14 days that it takes nevirapine to build up in infants' blood, the three researchers wrote in the letter, adding that the finding that incidence was lower after six weeks "does not reflect the effect of six weeks of treatment at all." Instead of using nevirapine, HIV/AIDS experts should focus on methods to make infant formula more available and acceptable to HIV-positive mothers in developing countries, the researchers added.

The disagreement among the study's authors is unusual, Lancet editors Pia Pini and Sabine Kleinert wrote in an accompanying commentary. They added that NIH, which funded the study, said there was no "breach of research integrity." They added, "In our opinion, publication of these important data, with complete disclosure, is the best course of action." Jeffrey Stringer and Benjamin Chi from the University of Alabama-Birmingham wrote in an accompanying commentary that "[e]xtended infant prophylaxis with nevirapine is simple enough to be implemented almost anywhere. It represents a long-awaited, if partial, solution to a mother's impossible choice. We should not delay" (Bloomberg, 7/25).


The study is available online. The letter also is available online.


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.