Michael K. Ang-Lee, M.D., and colleagues from the Pritzker School of Medicine, University of Chicago, identified commonly used herbal supplements based on 1999 sales data and surveys. The herbal medications analyzed in this study were ephedra, echinacea, garlic, ginseng, ginkgo, valerian, kava and St. John’s wort. The authors then searched for and reviewed articles published between 1966 and 2000 on the safety, effect, and action of these herbs to determine if they may have a negative impact on patients who undergo surgery, during the period of time surrounding the procedure.

Studies have shown that approximately 12 percent of the U.S. population uses herbal medications, and 22 percent of patients scheduled for surgery reported using such medications. The eight herbal medications studied account for more than fifty percent of all herb preparations sold in the U.S.(the article does not include data on nonherbal supplements such as vitamins, minerals, amino acids and hormones).

According to previous studies, possible complications from use of herbal medications include heart attack, stroke, bleeding, increased or decreased effectiveness of anesthesia, transplant rejection, and interactions with other medications. The effects of some herbal medications can linger two to three weeks after patients stop using them.

In this study, the authors found that the herbal preparations analyzed may pose a concern before, during, or after surgery. Direct effects include bleeding from ginkgo, garlic and ginseng; irregularities in heart rate from ephedra. Valerian and kava may interact with anesthetics, provoking a greater depressive effect of anesthetics on blood pressure and respiration. Possible effects of St. John’s wort include altered metabolism of many drugs used in the period around an operation.

Previous research suggests that patients may withhold information about their herbal medication use from their physicians for various reasons.

There is no mandatory reporting for adverse events in herbal medication use, which is contrary to conventional medication mandates.

“I am living on borrowed time,” Byrd said, but not because of her earlier brush with breast cancer.

Her mother died at age 46 of a stroke and her grandmother at age 39 during childbirth. Living well beyond her 40s is something Byrd never expected. At 63, she has lived longer than the women closest to her in her family. But breast cancer, she insists, would not cut her life short.

“Yes, it’s a shock when you learn about it,” she said. “But I was assured that they found it in its earliest stages. I found out in February [in 1992] and they did the surgery in March. I said then, ‘Lets get this taken care of, so I can get on with my life.’”

“I had a mastectomy,” she said, “and one reason for that was to make certain that all of it [the cancer] was gone.”

Family History?
Even with a stoic attitude toward such devastating news, there was a reason for her take-charge approach: Breast cancer had loomed elsewhere in her family, stalking women, striking at periods in their lives when they least expected to be affected by the disease.

“I learned that I had two cousins who had double mastectomies, so it was something I was always looking out for,” she said of breast cancer. “I had an aunt who also had breast cancer,” Byrd said. One of her cousins was in her early 30s when she was diagnosed with the disease; the other was in her mid-40s. Her aunt was already past 70 when her diagnosis came.

No one in Byrd’s family underwent testing for the presence of any of the known breast cancer genes. In fact, the first of those genes was discovered in 1994 — two years after Byrd was diagnosed. But to say that genes may play a role in a family where four cases of breast cancer have surfaced may be too quick of an answer, doctors say. Sometimes chance and coincidence are equal factors in the occurrences of breast cancer when it is detected among relatives.

Still, Byrd thinks about her mother and grandmother. She has no idea if they would have developed the disease because they died young, and of other causes.

Enjoying Borrowed Time
Despite those sad episodes, Byrd has had a happy and full life. She and her husband Joshua have been married for 44 years. They have no children, but they enjoy each other’s company immensely. They travel frequently together and look forward to June 2001 when Gloria retires after 39 years in her academic affairs position at a university in California.

Byrd, who by nature is very quiet and unassuming, has become in her own way a healthcare advocate, urging friends and co-workers to be mindful of their annual mammograms. “I tell them breast cancer is a very serious thing and to get their mammograms yearly.

“It had been two years,” she said between mammograms at the time she was diagnosed in 1992. “I just wasn’t that diligent. For some reason or another, life sometimes gets in the way.”

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Parkinson’s disease is one of the more common neurological diseases in Americans, affecting perhaps 1 million people, and a large majority is over age 60. However, the disease can strike at a younger age, as it has actor Michael J. Fox and former boxing champion Muhammad Ali. Genetic factors account for a small portion of affected patients, but in general the disease strikes unpredictably.

The new study’s authors, a group from Emory University, administered modest doses of rotenone, a natural or “organic” pesticide derived from plant roots, intravenously to rats, continuously over a period of four to five weeks. About half of the study rodents developed traits similar to humans with Parkinson’s: tremors, slow and unstable gait, and muscle rigidity. On autopsy, the rats’ brains also showed characteristic changes compatible with those seen in the post-mortem exams of Parkinson’s patients.

Some scientists and environmentalists used this report to attack pesticides, and environmental chemicals in general, as a cause of Parkinson’s. The facts do not so indicate, by any means. The substance involved, rotenone, was given intravenously and continuously — an exposure not related to human exposure in any meaningful way. And while the doses given were “modest” by rodent-testing standards, they were still far beyond any conceivable human exposure level. A different rat species proved not to be susceptible to the disease-producing effects of the rotenone, despite a much higher exposure dose. The authors themselves acknowledge there have never been any test animals that have developed Parkinson’s disease on oral exposure to pesticides at any dose.

So, what is the lesson to be learned? For one thing, while the production of this animal model for Parkinson’s may well prove to be a tremendous accomplishment, as it may allow testing for possible therapies to treat or even prevent the condition, to extrapolate an association between all human Parkinson’s disease and pesticide exposure from this data is completely unwarranted.

There is currently no proof, or even a basis for speculation, that a cause-effect relationship exists between pesticides and human Parkinson’s. Even if further study were to implicate rotenone in the causation of some Parkinson’s cases, there would be no reason to generalize from that to a widespread effect of all pesticides. The plants themselves produce the large majority of pesticides, while those under attack by “environmental” groups tend to be synthetic. But as this study reiterates that natural does not equal safe, just as synthetic does not equal toxic.

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West recognized that some people are intimidated by the typical gym layout with its hard surfaces and rows of imposing machines. These negative perceptions can even keep them from joining a health club. Gold’s Gym…Health, Fitness & Beyond designed its facility with a sophisticated comic-book decor to help make working out stimulating and fun. A Disney animator designed life-size cutouts of super heroes that celebrate human potential and beckon visitors to discover the hero inside each of them. It offers an inspirational atmosphere that people feel as soon as they enter the facility. The unusual juxtaposition of freeform and geometric shapes also invigorates the senses and motivates customers to perform at their best.

Gold’s Gym…Health, Fitness & Beyond sets a new standard for health clubs. The $5 million project is a virtual high-tech theme park for the fitness-oriented individual. The 22,000-square-foot multi-leveled facility bridges the gap between a health facility and a nightclub. It contains a large exercise area with the usual machines, including 130 pieces of cardiovascular equipment. Its long list of amenities includes a DJ booth, a 600-gallon shark tank, an art gallery, four 10-foot television screens, a stage for live entertainment, nightclub-quality sound and lighting systems, and palm trees. In front of the facility, there is even a large water fountain that uses cutting-edge computer programming.

The hero theme also extends to the nicknames of the staff, which together are known as the G-Force. Among the staff heroes are the manager (G-Man), the flexibility trainer (Elastica) and the nutrition expert (Nutrina). Membership categories include Hero and Superhero, while the lobby and lounge area is called the Heroes Lounge. It’s all part of a total concept to help bring out the true fitness potential in members.

This attention to detail has paid off on the bottom line. The gym signed up more than 2,000 members during its first six months of operation, half of whom had never joined a health club before. Customers have found that the imaginative interior boosts their energy level and motivates them to exercise more intensely. It also adds an element of unpredictable fun that eliminates the intimidation and monotony they may have felt at other clubs. Gold’s Gym…Health, Fitness & Beyond has expanded the boundaries of what a fitness facility can be. Considering the positive response it has received in the Madison marketplace, it just may become a model for health club construction in the future

A new sales representative at a gym I worked for encouraged prospective members to give aerobics a try, and placed them in whatever class was taking place at the moment. Uninformed, he believed that aerobics classes were all alike, and anybody could join in regardless of experience or fitness level. Unfortunately, most of his clients were unconditioned and overweight, and the classes he placed them in were geared for the more fit, experienced students. Needless to say, he didn’t make many sales.

Your first goal should be to make new exercisers comfortable. They should be placed in a class suited to their ability and taught to do the movements and exercises properly. Instructors shouldn’t be concerned if their new students don’t get their heart rates into the “target zone” during the first class.

They also shouldn’t encourage them to work their muscles to fatigue. As their bodies progressively adapt to exercise, the intensity they work at will increase on its own.

Low-intensity classes are great for allowing new students to build confidence and progress gradually without feeling the stress of trying to keep up with those around them. Keeping your students comfortable with exercise is critical to helping them overcome any fears they may have.

Kathleen Meister, M.S., has written a new booklet for the American Council on Health and Science called “Chemoprevention of Breast Cancer.” The report is based on a paper prepared for the ACSH by Scott Lippman, M.D., with Powel Brown, M.D., Ph.D. The paper will soon be published in an academic medical journal.

Currently, the only cancer chemopreventive agents available are tamoxifen and raloxifene. These drugs without a prescription are selective estrogen receptor modifiers and are believed to lower the risk of breast cancer by blocking estrogen’s effect on breast tissue. Tamoxifen has been used for more than 20 years to lower the likelihood of developing new lesions after the removal of a primary breast cancer. In 1998 the Food and Drug Administration approved tamoxifen for chemoprevention. It was the first time any drug had been approved for cancer prevention. Several studies in high-risk women have shown that tamoxifen use may reduce a woman’s risk of breast cancer by 40 percent to 50 percent.

The FDA has not yet approved raloxifene for breast cancer chemoprevention. Raloxifene was introduced for the prevention of osteoporosis in 1998 and for the treatment of osteoporosis in 1999. Preliminary studies have suggested that it may be as effective in chemoprevention as tamoxifen, and might be safer. Tamoxifen can cause the overgrowth of uterine cells and therefore increases the risk of uterine cancer. Raloxifene does not have this side effect, but both drugs have adverse effects that have to be taken into account before they are prescribed.

“Tamoxifen is not for every woman,” study author Lippman notes. “This agent reduces breast cancer risk by about half in high-risk women, but there are potential adverse effects. Nevertheless, women with reason to believe they have an elevated risk of breast cancer may stand to benefit. Any woman with questions about her breast cancer risk should consult her doctor for advice. Also, there are computerized tools available to help both patients and physicians to assess the severity of risk.”

According to Lippman, “The large majority of women, such as those with average or lower-than-average risk, should not take tamoxifen for breast cancer prevention at this time. Current studies will give us a clearer picture of who will be the most likely to benefit.”

Lippman explains, “Raloxifene is an agent related to tamoxifen. Although not approved for breast cancer prevention at this time, it is currently being studied in a large national trial called the Study of Tamoxifen and Raloxifene, or STAR.”

Ongoing studies should shed more light on who should and should not take these drugs. Some of results may become known within the next two years. Until ongoing research on raloxifene indicates otherwise, tamoxifen will remain the only drug with FDA approval for reducing the risk of breast cancer.

Before deciding to take a chemopreventive agent, women should consider all the scientific evidence available and consult with their physician, according to scientists with the ACSH.

ACSH Medical Director Gilbert Ross, M.D., added, “Physicians should discuss breast cancer chemoprevention with all high-risk women unless there is a medical contraindication to its use. The decision to start chemoprevention should rest on two major factors: a woman’s actual risks and what those risks mean to her.”

Ross cautioned that “Women who are considering chemoprevention need to be aware of all of the potential benefits and risks, and should weigh these factors carefully before making a final decision.”

Previous research compared estrogen alone with cholesterol-lowering drugs. In this trial, researchers compared the effects of combination estrogen/progestin therapy — now used by most women taking hormones — with the cholesterol-lowering drug simvastatin (Zocor) in 58 women. The women, who had an average cholesterol level of 305 milligrams per deciliter (mg/dl), took either HRT or simvastatin for eight weeks, and then after a so-called “washout period” switched to the other treatment for eight weeks.

Overall, both drugs and hormones improved lipid levels, and simvastatin was more effective than HRT at lowering established bad guys, including total cholesterol, LDL cholesterol, and triglycerides, a type of blood fat. However, simvastatin had no effect on Lp(a) (pronounced “lipoprotein little a”), which HRT lowered substantially (see chart).

High levels of Lp(a) cholesterol increase the risk of heart attack, but it has yet to be shown whether lowering Lp(a) reduces this risk.

Most cardiologists recommend HRT for women with high blood lipids anyway, because research shows that hormone therapy prolongs life for women with even one risk factor for coronary heart disease. Some women may find that they can reduce their blood lipids to healthy levels with HRT alone, but those with very high lipid levels will probably need to take cholesterol-lowering drugs as well. Women who do not want to take hormones can be assured that the statin drugs alone, including simvastatin, can reduce heart attacks and deaths from coronary heart disease.

At peak maturity, women have less bone mass than men do.

Women experience accelerated bone loss after menopause.

Annually, 80 % of the roughly 210 thousand hip fractures occur in women.

As estrogen levels drop in postmenopausal women, their skin becomes thinner.

This new idea of gender-specific medicine is groundbreaking — a great departure from the way things used to be. Until very recently, scientific medical research was primarily conducted on men and the findings were applied — without modification — to women. Premenopausal women were routinely excluded from scientific study for one significant reason — they could have babies. They were considered “vulnerable” and in need of protection.

But in reality, that well-meaning protection actually left us vulnerable to illness and disease. Because we have been excluded from studies, trials and research, there are huge gaps in what is known about our biology. And that means, over the years, we have been misdiagnosed, mistreated and mistakenly told our symptoms were “all in our heads” or simply hormonal.

“We were protected to our own detriment,” says Legato. Ironically, despite the vast number of unknowns in providing effective medical care and treatment for women, we continue to outlive men.

By all rights, women should be heavy hitters when it comes to healthcare. We comprise the majority of the world’s population. We use more healthcare resources than men do and we make most of the healthcare decisions for our families. During the past decade, it dawned on us that we have not received the kind of medical care we are entitled to — care that is as aggressive as men’s. We began demanding better and more aggressive healthcare, and politicians and the medical community began listening. In 1993, Congress passed the National Institutes of Health Revitalization Act. It stipulates that all medical research receiving federal funds must include women in its trials. It was a foot in the door — a foot researchers like Legato have used to kick that door wide open.

Recently, the Partnership for Women’s Health at Columbia surveyed 304 adult women across the country who have visited their doctor within the past two years. The majority agreed it is important for their doctors to know the difference between women’s and men’s bodies and their medical needs. They also think it is important for women to know the difference, as well. In addition, most women believe women and men should be treated differently for some health and medical issues — not just reproductive issues.

“Women want and need health information specific to their gender,” says Legato. “Applying the male models of biology to females is simply not enough. Now that women are taking charge of their healthcare, we need to give them the right gender-specific information. Then, women will no longer be dangerously misinformed about their own health risks.

“When we take action and responsibility for our own healthcare,” Legato adds, “we improve the standards of healthcare for our gender and generations to come.”

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Medical scientists viewed men and women as biological equals in every other way. They thought of us as “small men” who had babies. Well, they thought wrong.

“Equal is equal — but different is different. And women and men are, indeed, biologically different,” says Marianne J. Legato, an academic physician and the author of several books on women’s health. “As I did my own medical research, I grew fascinated by the different experiences men and women had with the same illnesses and diseases. It really started me thinking — and then I got this idea.”

Her idea evolved into the Partnership for Women’s Health at Columbia, one of the country’s first women’s health initiatives. Just beginning its third year, the partnership is a collaboration of great academic minds and generous corporate means. Its leading partners are Columbia University College of Physicians and Surgeons at Columbia-Presbyterian Medical Center in New York City and the Cincinnati-based global marketer Proctor & Gamble, which contributed an unrestricted $4 million grant.

This partnership has swung open the door to a new frontier in medical science — gender-specific medicine, the science of how human biology differs between women and men.

“Through sound research and study we now know that women have unique health concerns and gender-specific differences in many of our organ systems — our hearts, brains, bones, skin, metabolism and immune systems,” says Legato, who is director of the Partnership for Women’s Health at Columbia.

If knowledge is power, this partnership sees gender-specific medical knowledge as a woman’s power tool in making informed decisions about her own healthcare. Currently, they are developing educational programs designed to teach women how to ask their physicians the right questions about such important medical concerns as heart disease, depression and osteoporosis.

Here are some of their recent gender-specific findings:
Women can fight off viruses better than men can because their immunoglobulin levels are higher.

Most autoimmune diseases, such as multiple sclerosis, lupus and rheumatoid arthritis, are more prevalent in women than in men.

Women experience depression two to three times more often than men do.

In the United States, migraines occur in fifteen percent to seventeen percent of women, but only three percent to six percent of men.

Women and men metabolize some drugs — like alcohol, aspirin and benzodiazepines — differently.

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All GST revenue flows to State Governments. The Budget estimates that in 2006-07 all States will receive an amount that is significantly above the Guaranteed Minimum Amount (GMA). The GMA is an estimate of the funding each State would have received had the Australian Government not implemented tax reform six years ago. It takes into account several factors, including lost revenue from the abolition of State taxes.

In 2006-07 the States collectively will receive about $1.9 billion more than the GMA. The estimated gain from the GST in excess of the GMA ranges from $60.6 M in the ACT to $664.9 M in Queensland. NSW (which will be compensated by the Commonwealth in 2009-10 for receiving less from the GST than required by the GMA) will receive an estimated $160.1 M above the GMA in 2010-11. Victoria will receive $298.2 M; WA $270.2 M; SA $193.4 M; Tasmania $102.4 M; and NT $122.8 M. State Governments are free to spend the revenue from GST according to their own priorities.

CSTDA

The Budget’s forward estimates for CSTDA expenditure don’t go beyond 2010-11, when the current Agreement expires. This is normal at this early stage of discussions about a further agreement.

The Commonwealth’s 2010-11 indexation figure was unavailable on Budget night.

International Development

Following the release of the White Paper on overseas aid last month, the Budget Papers include a special supplement on Australia’s overseas aid program for the year ahead.