Little change in Dutch euthanasia post-legality

The frequency of doctor-assisted euthanasia in the Netherlands has changed little since the longstanding practice was legalized in 2002, according to a new study.

A summary published Wednesday on The Lancet magazine's website said that "in 2010, of all deaths in the Netherlands, 2.8 percent were the result of euthanasia. This is higher than the 1.7 percent in 2005, but comparable with (levels seen) in 2001 and 1995."

Under Dutch law, a person who asks to die may be administered a lethal mixture of sedatives and muscle relaxants if two doctors agree he or she is suffering "unbearable" pain with no prospect for recovery. Most cases involve cancer victims.

The Lancet study used data from the country's death registry and sent confidential questionnaires to doctors, extrapolating results to represent a cross-section of deaths in different social, medical and geographical areas. Researchers used the same methodology as in previous studies in 1990, 1995, 2001 and 2005.

Dutch doctors are also required to report all euthanasia cases on a non-confidential basis to the country's Euthanasia Commission, but that yields numbers that are widely believed to underreport the total number of euthanasia cases in the country.

All cases sent to the Euthanasia Commission are reviewed by a panel of experts, and some cases each year lead to official sanctions for doctors who fail to follow the rules, or even criminal prosecutions in a handful of cases.

According to commission data, there were 3,136 euthanasia cases in 2010, out of 136,000 deaths countrywide recorded by the Central Bureau for Statistics. That suggests a euthanasia rate of about 2.3 percent, less than the 2.8 percent found in the Lancet study. The total Dutch population is around 16.3 million.

"In the Netherlands, the euthanasia law resulted in a relatively transparent practice," wrote the Lancet study's lead author Bregje Onwuteaka-Philipsen. "Although translating these results to other countries is not straightforward, they can inform the debate on legalization of assisted dying in other countries."

One other noteworthy finding of the Lancet study was that the number of cases of "palliative sedation"

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Kids Born Even a Little Early Have Lower School Scores: Study

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FDA panel sees little use for metal-on-metal hips

Government health experts said Thursday there are few reasons to continue using metal-on-metal hip implants, amid growing evidence that the devices can break down early and expose patients to dangerous metallic particles.

The Food and Drug Administration asked its 18-member panel to recommend guidelines for monitoring more than a half-million U.S. patients with metal hip replacements. The devices were originally marketed as a longer-lasting alternative to older ceramic and plastic models. But recent data from the U.K. and other foreign countries suggests they are more likely to deteriorate, exposing patients to higher levels of cobalt, chromium and other metals.

While the FDA has not raised the possibility of removing the devices from the market, most panelists said there were few, if any, cases where they would recommend implanting the devices.

"I do not use metal-on-metal hips, and I can see no reason to do so," said Dr. William Rohr of Mendocino Coast District Hospital, who chaired the meeting.

For decades nearly all orthopedic implants were coated with plastic or ceramic. But in the last 10 years some surgeons began to favor all-metal implants, after laboratory tests suggested the devices would be more resistant to wear and reduce the chances of dislocation.

But recent data gathered from foreign registries shows the devices fail at a higher rate than older implants. That information comes on top of nearly 17,000 reports to the FDA of problems with the implants, which sometimes require invasive surgery to replace them.

The pain and inflammation reported by patients is usually caused by tiny metal particles that seep into the joint, damaging the surrounding tissue and bone. The long-term effects of elevated metal levels in the bloodstream are not clear, though some studies have suggested links to neurological and heart problems.

About 400,000 Americans get a hip replacement each year to relieve pain and restore motion affected by arthritis or injury. Metal hips accounted for about 27 percent of all hip implants in 2010, down from nearly 40 percent in 2008. Doctors have begun turning away from the implants amid several high-profile recalls, including J&J's recall of 93,000 metal hips in 2010.

FDA's experts said Thursday that patients complaining of pain and other symptoms should get regular X-rays and blood testing for metal levels. However, panelists pointed out the problems with the accuracy of blood tests and the difficulties of interpreting the results. There are no standard diagnostic kits for sale that test for chromium and other metals

For patients who are not experiencing pain, panelists said annual X-rays would be sufficient to monitor their implants.

If the FDA ultimately follows the group's advice, U.S. recommendations would be less involved than those already in place overseas.

Earlier this year U.K. regulators recommend that all people who have the implants get yearly blood tests to make sure no dangerous metals are seeping into their bodies.

FDA regulators have suggested they want to take more time to sort out the differences between various implants and patient groups before making recommendations.

"The truth is there are different types of hips and different types of patients," said Dr. William Maisel, FDA's chief scientist for devices, in an interview last week. "Understanding the characteristics of patients who experience adverse events is very important."

Women and overweight people are among the groups that are more likely to have an implant failure.

With little definitive data on U.S. hip implants, the agency has asked manufacturers like Johnson & Johnson, Zimmer Holdings Inc. and Biomet Inc. to conduct long-term, follow-up studies of more than 100 metal-on-metal hips on the U.S. market.

FDA scientists say the studies will help "fill in the blanks" on a number of scientific questions, including the long-term effects of metal particles.

But public health advocates say it could take a decade before that information is available.

"Keeping these metal-on-metal hips on the market for the next five to 10 years while research is conducted is not ethical," said Diana Zuckerman, president of the National Research Center for Women & Families, during a public comment session at the meeting. "If the companies want to sell metal-on-metal hips, they should be required to prove their safety first."

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Little Short-Term Risk of Repeat Bout of Shingles, Study Finds

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Beyond drowsy, too little sleep ups diabetes risk

More people pull the night shift. Teens text past midnight and stumble to class at dawn. Travelers pack red-eye flights.

Nodding off behind the wheel isn't the only threat from a lack of shut-eye. There's growing evidence that people who regularly sleep too little and at the wrong time suffer long-lasting consequences that a nap won't cure: An increased risk of diabetes, heart disease and other health problems.

"We have a societal conspiracy for sleep deprivation," says Russell Sanna of Harvard Medical School's sleep medicine division, who attended a TEDMED conference last week where scientists called sleep loss one of health care's big challenges.

Just how unhealthy is it? Consider how sleep may play a role in the nation's diabetes epidemic.

Studies have long shown that people who sleep fewer than five hours a night have an increased risk of developing Type 2 diabetes, the kind that tends to strike later in life.

Rotating shift work

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U.S. Spends Too Little on Public Health Initiatives: Report

HealthDay – 4 mins 40 secs ago TUESDAY, April 10 (HealthDay News) -- The United States needs to spend more on its chronically underfunded public health system and use that money more efficiently, according to an Institute of Medicine report released Tuesday.

The United States spends more on health than any other nation -- nearly $2.5 trillion in 2009 -- but has lower scores on life expectancy, infant survival and other indicators of population health than other wealthy nations, according to the report.

Public health department initiatives, services and expertise can help prevent or decrease rates of chronic diseases that account for the bulk of rising U.S. health spending, the authors report.

However, only 3.1 percent of U.S. health spending went to government-administered public health in 2009, according to the U.S. Centers for Medicare and Medicaid's National Health Expenditure Accounts. That works out to $251 per person in public health spending, compared with $8,086 per person in medical care spending.

The report calls for the U.S. Department of Health and Human Services to establish new goals for life expectancy and per-person health spending. The hope is that setting targets will motivate public health and medical care professionals to work together to maximize the value of health spending, and that public health skills and knowledge are used to address some of the biggest issues facing the larger health care system, such as the unnecessary use of medical procedures.

To achieve efficient use of public health dollars, the report recommended that the U.S. National Prevention, Health Promotion, and Public Health Council -- created by the Affordable Care Act -- should establish the minimum level of public health services every community should receive from its state and local health departments.

In addition, the council should create an expert panel to determine how much money is needed for every public health department to provide at least these minimum services, and to determine the proportion of federal health spending that needs to be spent in public health and medical care in order to get better value, the report said.

"Developing and implementing strategic population-based efforts to improve our health as a nation will increase the quality of life and productivity of Americans at the same time that it will contribute to moderating the expense of the clinical care system," report committee chair Dr. Marthe Gold, a professor and chair of the department of community health and social medicine at City College of New York, said in a National Academies news release.

"The country's failure to maximize the conditions in which people can be healthy continues to take a growing toll on the economy and on society. As the backbone of the health system, public health departments could help communities and other partners engage in efforts and policies that lead to better population health," Gold said.

More information

The U.S. Department of Health and Human Services has more about public health service agencies.

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Too much, too little sleep linked to heart woes, study tells

"Two visitors are seen napping on a couch at a furniture store in Beijing, in February. People who sleep less than six hours per night or more than eight are more likely to suffer heart problems than people who sleep between six and eight hours, according to a US study. (AFP Photo/Ed Jones)" title

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Both Too Little and Too Much Sleep Bad for the Heart: Study

HealthDay – 1 hr 17 mins ago SUNDAY, March 25 (HealthDay News) -- When it comes to what's best for their hearts, people walk a fine line between getting too much and too little sleep, a new study suggests.

Adults who get fewer than six hours or more than eight hours of sleep a night are at greater risk for a variety of heart conditions, according to research led by Dr. Rohit Arora, chairman of cardiology at the Chicago Medical School.

Sleeping too little puts people at significantly higher risk of stroke, heart attack and congestive heart failure, the researchers found. On the other hand, people who sleep too much have a higher prevalence of chest pain (angina) and coronary artery disease, a narrowing of the blood vessels that supply the heart with blood and oxygen.

The findings are scheduled for presentation Sunday at the American College of Cardiology annual meeting in Chicago.

The researchers analyzed data from more than 3,000 patients over age 45 who participated in the U.S. National Health and Nutrition Examination Survey, making theirs the first nationally representative sample to show the association between sleep duration and heart health.

The study showed that people who got too little sleep were twice as likely to have a stroke or heart attack and 1.6 times more likely to have congestive heart failure. People who slept more than eight hours a night were twice as likely to have angina and 1.1 times more likely to have coronary artery disease.

The findings remained significant even after the researchers accounted for heart risk factors such as age, blood cholesterol levels, smoking and obesity, as well as for sleep apnea and other sleep problems.

Previous studies have shown that insufficient sleep is linked to a hyperactive nervous system, glucose intolerance, diabetes, inflammation and a rise in stress hormones, blood pressure and resting heart rate, the researchers noted.

The reasons too much sleep can lead to heart problems are unclear, however, and further research will be needed.

For now, Arora said, health-care providers need to talk about sleep with their patients.

"Clinicians need to start asking patients about sleep, especially those who are already at greater risk of heart disease," he said. "It's really a simple thing to assess as part of a physical exam; it doesn't cost anything and it may help patients to adopt better sleep habits."

Although the new study uncovered an association between sleep issues and heart trouble, it did not prove a cause-and-effect relationship.

Research presented at medical meetings should be viewed as preliminary until it is published in a peer-reviewed medical journal.

More information

The National Sleep Foundation has more on getting a good night's sleep.

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