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Adults also suffer from shaken syndrome-study

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

reported in abused children, adults can also suffer serious

injury from being violently and repeatedly shaken, doctors said

on Thursday.

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

high profile child abuse cases including the trial of British

nanny Louise Woodward who was convicted of killing an

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

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

in the United States alone.

British doctors said adults also suffer from the disorder,

which is also caused by abuse.

In a report in the Journal of Accident and Emergency

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

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

syndrome.

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

Carrigan and his colleagues suspected she had been victim of

domestic violence because she had a trio of symptoms --

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

to shaken syndrome.

Two days after she was released from hospital the woman

admitted she had been abused. Weeks later she was still

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

"The diagnosis of shaken adult syndrome was eventually made,

supported by delayed diagnosis of some of the classical signs

consistent with non-accident injury," Carrigan said.

The researchers said a Palestinian who died under

interrogation by the Israeli security forces had the same trio

of symptoms and had also been diagnosed as shaken adult

syndrome.

Carrigan and his team said the case of the woman illustrates

the difficulty in detecting victims of domestic violence, which

accounts for half of all violent crimes against women and two

deaths per week in Britain.

Scientists identify malaria drug resistance gene

(Release at 1900 GMT, Wednesday, Feb 23)

By Patricia Reaney

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

implications for new antimalaria treatments, Australian

researchers have shown how the parasite that causes the disease

manages to outwit even the most powerful drugs.

Malaria kills millions of people each year despite effective

treatments by building up a resistance to the drugs used to

combat it.

But scientists at the Walter and Eliza Hall Institute of

Medical Research in Melbourne have shown that a mutation in a

gene called pfmdr1 is behind the drug resistance.

"Increased knowledge is power," lead researcher Alan Cowman

said in an e-mail interview on Wednesday.

"A greater understanding of the mechanism used by the

parasite to evade the lethal effect of these antimalarial drugs

means we can consider developing ways of inhibiting this and

increasing the efficacy of the current antimalarials."

The finding provides a potential target for new drugs that

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

leading drugs such as quinine, mefloquine, halofantrine and

chloroquine.

Cowman and his colleagues, whose research is published in

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

involved in drug resistance but it is an important one.

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

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

aiming for a full understanding of these molecular mechanisms so

that we can begin a rationale approach to developing counters to

the mechanisms," Cowman added.

Most of the more than 300 million cases of malaria worldwide

are caused by a parasite called Plasmodium flaciparum that

attacks mature and young blood cells.

Although the mosquito-borne disease, which can also be

transmitted through infected blood, can be cured, research has

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

correct drugs.

The World Health Organisation and other international

agencies have launched a global initiative to fight malaria in

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

where most of the victims are children.

Chemical may predict serious angina in women

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

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

immune system chemical, British researchers said on Thursday.

Their study of more than 100 women with angina showed that

women with unstable angina, when chest pains occur unexpectedly,

tended to have higher levels of the chemical neopterin than

those with a less serious form of the disease.

"Neopterin concentrations may therefore be a risk marker in

women with coronary artery disease," Professor Juan Carlos

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

in the journal Heart.

Angina occurs when the heart is not receiving enough oxygen

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

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

million people in the United States and Europe.

The researchers monitored the heart functions, chest pains

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

over 12 months.

Twice as many women with unstable angina had more serious

attacks and higher levels of the chemical than women with stable

angina.

Neopterin is released when the immune system is activated to

fight illnesses such as cancer and viral infections. The

researchers suspect high levels of the chemical in angina

patients may indicate the disease in getting worse.

Test improves forecast of breast cancer spread

Release at 5 p.m. (2200 GMT)

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

for small traces of cancer cells that have spread to bone

marrow can help doctors predict if breast cancer is likely to

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

The findings may help doctors decide if they should

recommend aggressive treatment with chemotherapy and radiation

after a tumour has been removed.

Currently, doctors try to assess the risk of additional

cancer by seeing if tumour cells have spread to nearby lymph

nodes. But that technique is imperfect. The disease reappears

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

The new study used proteins, known as cytokeratin-specific

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

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

of the hip bone.

The German researchers calculated that four years after

cancer surgery, the survival rate was about 48 percent for

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

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

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

their bone marrow or lymph nodes.

And when both the lymph nodes and bone marrow showed no

evidence of cancer, the estimated survival rate was 99

percent.

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

Maximilians University in Munich, Germany said the results

suggest that women with evidence of cancer cells in their bone

marrow should be treated with chemotherapy, just as women are

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

in their lymph nodes.

But the researchers also urged caution, saying that they

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

be monitored for 10 to 15 years, they said.

Japan says gout drug led to six deaths

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

had died from the effects of Japanese drugs aimed at treating

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

hospitals calling for caution.

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

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

treatment drugs that used benzbromarone as a main agent to

promote excretion of uric acid, the Health and Welfare Ministry

said.

The drug makers include Torii Pharmaceutical Co Ltd which

manufactures 90 percent of the drug used in Japan, Teikoku

Chemical Industries Co and Toyo Pharmar Co.

The company will issue an urgent warning to hospitals to make

sure doctors examine a patient's liver before administering the

drug, a Torii Pharmaceutical spokesman said.

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

issue the same urgent warnings there," he said.

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

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

said.

The company issued a warning that the drug could cause liver

disease in 1996 when similar deaths were reported overseas by

French compound supplier Sanofi-Synthelabo, he said.

The news triggered massive selling in Torii Pharmaceutical

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

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

Clinton medical errors plan worries health groups

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

WASHINGTON, Feb 22 (Reuters) - President Bill Clinton

called on Tuesday for hospitals to report errors that kill up

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

fear this could make doctors more vulnerable to lawsuits.

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

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

reporting of mistakes that cause deaths or serious injuries and

voluntary reporting of other mistakes and "close calls."

The initiative includes requiring all U.S. military

hospitals to report medical mistakes, new rules to make drug

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

million proposal to study errors and how to prevent them.

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

in the Medicare health care programme for the elderly will be

required to set up error reduction programmes and to target

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

"These actions represent the most significant effort our

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

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

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

The White House said that if all states had not created

error-reporting systems within three years it would consider

seeking legislation requiring them to do so.

Leading groups representing U.S. doctors, hospitals and

health insurers said they supported many parts of Clinton's

plan but raised questions about the error-reporting proposal.

"We are concerned that the proposal for mandatory reporting

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

perverse result of driving errors underground," the American

Medical Association said in a statement.

"We need strong protections so doctors and nurses will come

forward without fear of retribution," added the American

Hospital Association. "Without these protections, we could

drive error reporting underground and miss important

opportunities to protect patients."

Senate Majority Leader Trent Lott, a Mississippi Republican

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

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

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

MANDATORY REPORTING SYSTEMS

The thorniest element of such a plan is designing it to

give doctors, nurses and hospitals some incentive to report

errors without increasing their vulnerability to medical

malpractice suits for the mistakes. So far 18 states already

have mandatory reporting systems for their hospitals.

Under the White House proposal, data collected by the

states would be analysed and made public without naming the

patients or health care professionals.

The White House said when hospitals use secret "peer

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

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

meaning they could not be used to buttress malpractice suits.

Carlton Carl, a spokesman for the Association of Trial

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

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

"Generally speaking, we think that all such information

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

the White House and Congress would not support any limitation

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

mistakes."

The specific steps that Clinton will unveil include:

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

mandatory error reporting system in its 500 hospitals and

clinics, which serve an estimated 8 million patients;

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

standards within a year to help prevent errors caused by health

care providers confusing medications because of drug names that

sound similar or packaging that looks similar;

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

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

that handle blood to report serious errors.

Merck sets additional $10 billion stock buyback plan

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

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

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

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

treasury has no specific time limit and can be suspended or

stopped at any time.

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

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

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

that authorisation.

Merck currently has about 2.3 billion shares outstanding.

Eli Lilly strong enough to go it alone--chairman

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

Chairman Sidney Taurel said on Tuesday the Indiana drug maker,

increasingly the focus of merger speculation in a consolidating

industry, has enough strong products to remain independent.

Lilly, maker of top-selling antidepressant drug Prozac,

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

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

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

billion.

Meeting Wall Street's growth expectations has driven

consolidation in the drug industry recently with such pending

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

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

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

While speculation on a partner for Lilly has focused on

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

executives have maintained their pro-independence stance.

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

showroom shareholder value," he said in an interview before

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

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

analysts' expectations.

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

monster to feed. You have to make the two research

organisations produce more together than the sum of the two

separately and nobody has proven that."

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

per-share earnings estimates compiled by First Call/Thomson

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

billion in sales last year.

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

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

additional size means success.

He added that Lilly has the necessary critical mass --

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

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

marketing. He said the firm has also boosted its research

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

Lilly has numerous collaborations and partnerships,

numbering 140 deals and is looking at more small acquisitions.

"We are certainly very actively involved in looking at

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

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

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

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

technology stocks, as well as the Medicare debate that carries

with it the threat of potential price controls.

Meanwhile, analysts worry about slowing Prozac sales. The

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

growth in newer products should blunt concerns.

He said new products on the way include a treatment for

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

products treating such things as sepsis, attention deficit

disorder, depression and complications from diabetes.

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

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

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

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

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

antipsychotic drug Zyprexa that could help treat the one-third

of patients resistant to antidepressants.

French surgeon to pay patient he infected with HIV

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

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

patient he infected with the HIV virus while performing a hip

operation, judicial sources said.

The doctor, who denied he could have infected the patient

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

convicted after expert testimony by Professor Luc Montagnier,

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

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

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

Florida dentist infected six of his patients.

The French surgeon had apparently been infected after

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

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

transfusions during surgery, later died.

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

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

subsequent patients for the virus.

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

replacement in 1992, tested positive. Investigators concluded

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

highly infectious at the time.

The hospital in a Paris suburb where the operations took

place has already paid the victim 500,000 francs in

compensation.

Men ready and willing to take male pill-survey

(Release at 0001 GMT, Wednesday, Feb 23)

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

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

would trust their partners to control fertility, according to an

international poll released on Wednesday.

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

Hong Kong and Cape Town commissioned by the journal Human

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

"The majority of men felt that responsibility for

contraception falls too much on women and we found that the

strongest incentive for men to use the pill would be their

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

Research Council (MRC) Reproductive Biology Unit in Edinburgh.

Condoms and vasectomy are currently the only contraceptives

available for men but scientists predict a male contraceptive

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

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

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

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

Despite the overwhelming approval of the pill, some men

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

masculinity and whether it would affect their sexual desire or

satisfaction.

Only two percent of women said they would not trust their

partners to take the pill.

"The idea of hormonal contraception for men appears to be

extremely popular among women and this survey should dispel once

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

to use a male pill," Anderson said.

Human Reproduction is a monthly journal of the European

Society for Human Reproduction and Embryology.

Briton cures fatigue by drilling hole in own head

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

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

surgery and drilling a hole in her own head.

Heather Perry, 29, performed the ancient technique of

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

into the skull -- in her bid to overcome myalgic

encephalomyelitis, or ME, which leaves sufferers feeling

permanently exhausted.

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

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

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

when she drilled too far and penetrated a membrane protecting

her brain tissue.

British doctors had refused to help Perry with the ancient

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

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

operation had improved her quality of life.

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

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

Perry, who performed the operation under local anaesthetic in

front of a mirror and a camera crew.

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

particularly dramatic but they are there. I generally feel

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

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

western England.

Trepanning was widely used in the Middle Ages to treat

severe headaches and madness in the belief it would release evil

spirits from the possessed.

German official protests patent on human cloning

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

Tuesday that she wants the government to protest formally

against a European Patent Office decision granting a patent to a

process that could include the cloning of humans.

The Munich-based office granted Edinburgh University a

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

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

potential use on humans.

Health Minister Andrea Fischer said she would propose at a

cabinet meeting on Wednesday that the German government formally

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

the strategy for a challenge.

A spokesman for the patent office said officials did not

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

could not reverse the patent by itself.

Only a formal protest from outside can reverse the decision,

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

spokesman Rainer Osterwadter said.

European guidelines bar patents on human genetic

alterations.

The environmental lobby Greenpeace, which said it would also

challenge the patent, held a small rally outside the patent

office in Munich on Tuesday.

Germany, especially sensative to the issue because of

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

procedure and has tight rules on scientific research.