The China Advertising Association officially released its newest set of self-discipline rules on Tuesday.
The rules stipulate that advertising must be true and legal and should not cheat or mislead customers, Beijing Youth Daily reports.
Suggestions include stating that milk powder advertisements must contain phrases in support of breast feeding and sanitary towel advertisements should not advocate long period usage without changing.
Breast feeding should not be intentionally discouraged by milk powder advertisements. "Breast-feeding Encouraged" or similar phrases should be marked clearly on milk powder packages, and images of children should be upright standing at least.
As for sanitary towel advertisements, Phrases suggesting that they can treat or prevent disease must be removed. The phrase "no change of the sanitary towels for long time" is strongly prohibited for hygiene reasons.
Tuesday, August 19, 2008
Fringe autism treatment could get federal study
Eight-year-old Charlie Blakey, who was diagnosed with autism at age 3, says a prayer before eating dinner with his family at their home on Oak Park, Ill., on April 23, 2008.[Agencies]
Pressured by desperate parents, government researchers are pushing to test an unproven treatment on autistic children, a move some scientists see as an unethical experiment in voodoo medicine.
The treatment removes heavy metals from the body and is based on the fringe theory that mercury in vaccines triggers autism — a theory never proved and rejected by mainstream science. Mercury hasn't been in childhood vaccines since 2001, except for certain flu shots.
But many parents of autistic children are believers, and the head of the National Institute of Mental Health supports testing it on children provided the tests are safe.
"So many moms have said, `It's saved my kids,'" institute director Dr. Thomas Insel said.
For now, the proposed study, not widely known outside the community of autism research and advocacy groups, has been put on hold because of safety concerns, Insel told The Associated Press.
The process, called chelation, is used to treat lead poisoning. Studies of adults have shown it to be ineffective unless there are high levels of metals in the blood. Any study in children would have to exclude those with high levels of lead or mercury, which would require treatment and preclude using a placebo.
One of the drugs used for chelation, DMSA, can cause side effects including rashes and low white blood cell count. And there is evidence chelation may redistribute metals in the body, perhaps even into the central nervous system.
"I don't really know why we have to do this in helpless children," said Ellen Silbergeld of Johns Hopkins University's Bloomberg School of Public Health, who was invited to comment on the study to a review board of the national institute.
Despite lawsuits and at least one child's death, several thousand autistic children are already believed to be using chelation (pronounced kee-LAY'-shun), their parents not content to wait for a study.
Among those parents is Christina Blakey of suburban Chicago, who uses chelation and a variety of other alternative therapies, including sessions in a hyperbaric chamber, on her 8-year-old son, Charlie.
Before he started chelation at age 5, Charlie suffered tantrums. When she took him to school, she had to peel him off her body and walk away. But three weeks after he began chelation, his behavior changed, she said.
"He lined up with his friends at school. He looked at me and waved and gave me a thumbs-up sign and walked into school," Blakey said. "All the moms who had been watching burst into tears. All of us did."
There is no way to prove whether chelation made a difference or whether Charlie simply adjusted to the school routine.
Autism is a spectrum of disorders that hamper a person's ability to communicate and interact with others. Most doctors believe there is no cure.
Conventional treatments are limited to behavioral therapy and a few medications, such as the schizophrenia drug Risperdal, approved to treat irritability.
Frustrated parents use more than 300 alternative treatments, most with little or no scientific evidence backing them up, according to the Interactive Autism Network at the Kennedy Krieger Institute in Baltimore, Md.
"With a lot of mothers, if they hear about a treatment, they feel like they need to try it," said project director Dr. Paul Law. "Anything that has a chance of benefiting their child, they're willing to give it a shot."
More than 2 percent of the children tracked by the project use chelation. If that figure holds for the general population, it would mean more than 3,000 autistic children are on the treatment at any time in the United States.
Chelation drugs can be taken in pill form, by rectal suppository and intravenously.
Dr. Susan Swedo, who heads the federal institute's in-house autism research and wants to study chelation, gained notoriety by theorizing that strep throat had caused some cases of obsessive compulsive disorder. The theory was never proved.
She proposed recruiting 120 autistic children ages 4 to 10 and giving half DMSA and the other half a dummy pill. The 12-week test would measure before-and-after blood mercury levels and autism symptoms.
The study outline says that failing to find a difference between the two groups would counteract "anecdotal reports and widespread belief" that chelation works.
But the study was put on hold for safety concerns after an animal study, published last year, linked DMSA to lasting brain problems in rats. It remains under review, Insel told the AP.
Insel said he has come to believe after listening to parents that traditional scientific research, building incrementally on animal studies and published papers, wasn't answering questions fast enough.
"This is an urgent set of questions," Insel said. "Let's make innovation the centerpiece of this effort as we study autism, its causes and treatments, and think of what we may be missing."
Last year, the National Institutes of Health spent less than 5 percent of its $127 million autism research budget on alternative therapies, Insel said. He said he is hopeful the chelation study will be approved.
Others say it would be unethical, even if it proves chelation doesn't work.
Federal research agencies must "bring reason to science" without "catering to a public misperception," said Dr. Paul Offit, chief of infectious diseases at the Children's Hospital of Philadelphia and author of an upcoming book on autism research. "Science has been trumped by politics in some ways."
Offit is concerned vaccination rates may fall to dangerous levels because some parents believe they cause autism.
Dr. Martin Myers, former director of the federal National Vaccine Program Office, said he believes giving chelation to autistic children is unethical — but says the government can justify the study because so many parents are using chelation without scientific evidence.
"It's incumbent on the scientific community to evaluate it," he said.
Actress Jenny McCarthy, whose bestseller "Louder Than Words" details her search for treatments for her autistic son, Evan, told thousands of parents at a recent autism conference outside Chicago that she plans to try chelation on him this summer.
"A lot of people are scared to chelate ... but it has triggered many recoveries," she said.
But those claims are only anecdotal, and there are serious risks.
Of the several drugs used in chelation, the only one recommended for intravenous use in children is edetate calcium disodium. Mixups with another drug with a similar name, edetate disodium, have led to three deaths, including one autistic child.
A 5-year-old autistic boy went into cardiac arrest and died after he was given IV chelation therapy in 2005. A Pennsylvania doctor is being sued by the boy's parents for allegedly giving the wrong drug and using a risky technique.
No deaths have been associated with DMSA, which can cause rashes, low white blood cell count and vomiting. It is also sold as a dietary supplement, which is how some parents of autistic children get it.
A Food and Drug Administration spokeswoman said the agency is "is looking into how these products are marketed."
Pressured by desperate parents, government researchers are pushing to test an unproven treatment on autistic children, a move some scientists see as an unethical experiment in voodoo medicine.
The treatment removes heavy metals from the body and is based on the fringe theory that mercury in vaccines triggers autism — a theory never proved and rejected by mainstream science. Mercury hasn't been in childhood vaccines since 2001, except for certain flu shots.
But many parents of autistic children are believers, and the head of the National Institute of Mental Health supports testing it on children provided the tests are safe.
"So many moms have said, `It's saved my kids,'" institute director Dr. Thomas Insel said.
For now, the proposed study, not widely known outside the community of autism research and advocacy groups, has been put on hold because of safety concerns, Insel told The Associated Press.
The process, called chelation, is used to treat lead poisoning. Studies of adults have shown it to be ineffective unless there are high levels of metals in the blood. Any study in children would have to exclude those with high levels of lead or mercury, which would require treatment and preclude using a placebo.
One of the drugs used for chelation, DMSA, can cause side effects including rashes and low white blood cell count. And there is evidence chelation may redistribute metals in the body, perhaps even into the central nervous system.
"I don't really know why we have to do this in helpless children," said Ellen Silbergeld of Johns Hopkins University's Bloomberg School of Public Health, who was invited to comment on the study to a review board of the national institute.
Despite lawsuits and at least one child's death, several thousand autistic children are already believed to be using chelation (pronounced kee-LAY'-shun), their parents not content to wait for a study.
Among those parents is Christina Blakey of suburban Chicago, who uses chelation and a variety of other alternative therapies, including sessions in a hyperbaric chamber, on her 8-year-old son, Charlie.
Before he started chelation at age 5, Charlie suffered tantrums. When she took him to school, she had to peel him off her body and walk away. But three weeks after he began chelation, his behavior changed, she said.
"He lined up with his friends at school. He looked at me and waved and gave me a thumbs-up sign and walked into school," Blakey said. "All the moms who had been watching burst into tears. All of us did."
There is no way to prove whether chelation made a difference or whether Charlie simply adjusted to the school routine.
Autism is a spectrum of disorders that hamper a person's ability to communicate and interact with others. Most doctors believe there is no cure.
Conventional treatments are limited to behavioral therapy and a few medications, such as the schizophrenia drug Risperdal, approved to treat irritability.
Frustrated parents use more than 300 alternative treatments, most with little or no scientific evidence backing them up, according to the Interactive Autism Network at the Kennedy Krieger Institute in Baltimore, Md.
"With a lot of mothers, if they hear about a treatment, they feel like they need to try it," said project director Dr. Paul Law. "Anything that has a chance of benefiting their child, they're willing to give it a shot."
More than 2 percent of the children tracked by the project use chelation. If that figure holds for the general population, it would mean more than 3,000 autistic children are on the treatment at any time in the United States.
Chelation drugs can be taken in pill form, by rectal suppository and intravenously.
Dr. Susan Swedo, who heads the federal institute's in-house autism research and wants to study chelation, gained notoriety by theorizing that strep throat had caused some cases of obsessive compulsive disorder. The theory was never proved.
She proposed recruiting 120 autistic children ages 4 to 10 and giving half DMSA and the other half a dummy pill. The 12-week test would measure before-and-after blood mercury levels and autism symptoms.
The study outline says that failing to find a difference between the two groups would counteract "anecdotal reports and widespread belief" that chelation works.
But the study was put on hold for safety concerns after an animal study, published last year, linked DMSA to lasting brain problems in rats. It remains under review, Insel told the AP.
Insel said he has come to believe after listening to parents that traditional scientific research, building incrementally on animal studies and published papers, wasn't answering questions fast enough.
"This is an urgent set of questions," Insel said. "Let's make innovation the centerpiece of this effort as we study autism, its causes and treatments, and think of what we may be missing."
Last year, the National Institutes of Health spent less than 5 percent of its $127 million autism research budget on alternative therapies, Insel said. He said he is hopeful the chelation study will be approved.
Others say it would be unethical, even if it proves chelation doesn't work.
Federal research agencies must "bring reason to science" without "catering to a public misperception," said Dr. Paul Offit, chief of infectious diseases at the Children's Hospital of Philadelphia and author of an upcoming book on autism research. "Science has been trumped by politics in some ways."
Offit is concerned vaccination rates may fall to dangerous levels because some parents believe they cause autism.
Dr. Martin Myers, former director of the federal National Vaccine Program Office, said he believes giving chelation to autistic children is unethical — but says the government can justify the study because so many parents are using chelation without scientific evidence.
"It's incumbent on the scientific community to evaluate it," he said.
Actress Jenny McCarthy, whose bestseller "Louder Than Words" details her search for treatments for her autistic son, Evan, told thousands of parents at a recent autism conference outside Chicago that she plans to try chelation on him this summer.
"A lot of people are scared to chelate ... but it has triggered many recoveries," she said.
But those claims are only anecdotal, and there are serious risks.
Of the several drugs used in chelation, the only one recommended for intravenous use in children is edetate calcium disodium. Mixups with another drug with a similar name, edetate disodium, have led to three deaths, including one autistic child.
A 5-year-old autistic boy went into cardiac arrest and died after he was given IV chelation therapy in 2005. A Pennsylvania doctor is being sued by the boy's parents for allegedly giving the wrong drug and using a risky technique.
No deaths have been associated with DMSA, which can cause rashes, low white blood cell count and vomiting. It is also sold as a dietary supplement, which is how some parents of autistic children get it.
A Food and Drug Administration spokeswoman said the agency is "is looking into how these products are marketed."
Berry delicious recipe recommendations
Chinese Bayberries (yang mei) have high levels of vitamin B and vitamin C.
At my parents' home, the family has perfected the art of stockpiling and freezing berries to get us through the winter months. My parents grow a bountiful crop of raspberries and blackberries. My patient father spends countless hours gathering berries from the hedgerows in the late summer months.
Not everyone is so lucky. Sadly, in China fresh berries now carry a hefty price tag, and buying enough to make a respectable batch of jam would necessitate a small bank loan.
Nevertheless, the country has some intriguing and lesser-known native berries that are worth trying. Many have fantastic health properties.
Nearly all types of berries are rich in polyphenols, a kind of anti-oxidant that can help to reduce risks of heart disease and cancer.
Indeed, a study published in the American Journal of Clinical Nutrition in February recorded significant improvements in HDL (good cholesterol) levels, blood pressure and blood platelet function among people who consumed small portions of berries over a two-month period.
The Chinese Bayberry (yang mei), which is now referred to amusingly as the "Yumberry" in the US, is the fruit of the Myrica Rubra tree, a plant native to southern China. These berries are very distinctive-looking, almost like Christmas tree decorations, with a shiny round shape, and a variety of colors. These berries grow in shades of white, pink, red, and purple; many consider purple berries to be the most delicious. The flavor is sweet yet also tart, and quite refreshing.
Recently, a company in the US called "Frutzzo" began marketing the "Yumberry" as the new "super food", believed to be the next pomegranate of the health food world.
In addition, these fruits have very high levels of vitamin B and vitamin C.
In China, Chinese Bayberries are typically served as fresh fruit, but they can also be dried or preserved. Hardened yang mei consumers like to steep the fruits in bai jiu (alcohol).
While strolling down the leafier avenues of many Chinese cities at this time of year, you may come across the mulberry (sang shen), the fruit of the Fructus Mori tree. This is a particularly delicate fruit, resembling an elongated blackberry. It does not travel well and requires extremely careful handling. Its dark pigmentation indicates an abundance of beneficial phyto-chemicals, and it is especially rich in resveratrol (also present in grapes), which has anti-cancer properties.
Large quantities of mulberries are grown in China because they are the major food of the silk worm. But so far, only small amounts of this fruit are marketed for human consumption.
In Beijing, during the summer you often find vendors selling them outside subway stations. When you spot them, I would certainly recommend buying a generous quantity. Initially the berries can be served fresh with breakfast or for dessert. Later, you can freeze them and then stew the berries to make compotes, fruit pies and crumbles.
Mulberry jam is a great way to extend their length of use. Combine equal amounts in weight of sugar and mulberries in a pan with some lemon juice and simmer for 30 minutes, skimming any residue from the surface. Test for setting ability on a saucer and when ready, ladle the mixture into sterilized jars - and enjoy.
At my parents' home, the family has perfected the art of stockpiling and freezing berries to get us through the winter months. My parents grow a bountiful crop of raspberries and blackberries. My patient father spends countless hours gathering berries from the hedgerows in the late summer months.
Not everyone is so lucky. Sadly, in China fresh berries now carry a hefty price tag, and buying enough to make a respectable batch of jam would necessitate a small bank loan.
Nevertheless, the country has some intriguing and lesser-known native berries that are worth trying. Many have fantastic health properties.
Nearly all types of berries are rich in polyphenols, a kind of anti-oxidant that can help to reduce risks of heart disease and cancer.
Indeed, a study published in the American Journal of Clinical Nutrition in February recorded significant improvements in HDL (good cholesterol) levels, blood pressure and blood platelet function among people who consumed small portions of berries over a two-month period.
The Chinese Bayberry (yang mei), which is now referred to amusingly as the "Yumberry" in the US, is the fruit of the Myrica Rubra tree, a plant native to southern China. These berries are very distinctive-looking, almost like Christmas tree decorations, with a shiny round shape, and a variety of colors. These berries grow in shades of white, pink, red, and purple; many consider purple berries to be the most delicious. The flavor is sweet yet also tart, and quite refreshing.
Recently, a company in the US called "Frutzzo" began marketing the "Yumberry" as the new "super food", believed to be the next pomegranate of the health food world.
In addition, these fruits have very high levels of vitamin B and vitamin C.
In China, Chinese Bayberries are typically served as fresh fruit, but they can also be dried or preserved. Hardened yang mei consumers like to steep the fruits in bai jiu (alcohol).
While strolling down the leafier avenues of many Chinese cities at this time of year, you may come across the mulberry (sang shen), the fruit of the Fructus Mori tree. This is a particularly delicate fruit, resembling an elongated blackberry. It does not travel well and requires extremely careful handling. Its dark pigmentation indicates an abundance of beneficial phyto-chemicals, and it is especially rich in resveratrol (also present in grapes), which has anti-cancer properties.
Large quantities of mulberries are grown in China because they are the major food of the silk worm. But so far, only small amounts of this fruit are marketed for human consumption.
In Beijing, during the summer you often find vendors selling them outside subway stations. When you spot them, I would certainly recommend buying a generous quantity. Initially the berries can be served fresh with breakfast or for dessert. Later, you can freeze them and then stew the berries to make compotes, fruit pies and crumbles.
Mulberry jam is a great way to extend their length of use. Combine equal amounts in weight of sugar and mulberries in a pan with some lemon juice and simmer for 30 minutes, skimming any residue from the surface. Test for setting ability on a saucer and when ready, ladle the mixture into sterilized jars - and enjoy.
UK charities urge revamp of sexual education policies
Two leading sexual health charities in the UK are advocating a controversial change to the nation's sexual education curriculum.
Simon Blake, chief executive of the Brook charity organization, says: "All the evidence shows that if you start sex and relationships education early - before children start puberty, before they feel sexual attraction - they start having sex later. They are much more likely to use contraception and practice safe sex."
Blake also says: "If we get high-quality sex and relationships education in every primary and secondary school across the UK, all the evidence shows teenage pregnancy rates will continue to fall and we will improve young people's sexual health."
He wants every primary and secondary school in the UK to provide a preliminary form of sex and relationship education to pupils.
At the moment, Blake says he is worried that "another generation of children and young people do not get the education they need to form healthy relationships and protect their sexual health."
The UK Department for Children, Schools and Families issued new draft guidance on wellbeing education in schools on Friday.
The Sex Education Forum, the national authority on sex and relationships teaching, called for personal, social, health and economic education, which includes sex and relationships.
Julie Bentley, chief executive of the Family Planning Association, another UK charity, says: "This is not about teaching 4-year-olds how to have sex ... it's like maths - in primary school children learn the basics, so that they can understand more and more complex concepts at a later stage."
She adds: "Parents are concerned that if students are told about sex they will go straight out and have it, but the research shows the complete opposite. They have sex later and when they do, they have safer sex."
Simon Blake, chief executive of the Brook charity organization, says: "All the evidence shows that if you start sex and relationships education early - before children start puberty, before they feel sexual attraction - they start having sex later. They are much more likely to use contraception and practice safe sex."
Blake also says: "If we get high-quality sex and relationships education in every primary and secondary school across the UK, all the evidence shows teenage pregnancy rates will continue to fall and we will improve young people's sexual health."
He wants every primary and secondary school in the UK to provide a preliminary form of sex and relationship education to pupils.
At the moment, Blake says he is worried that "another generation of children and young people do not get the education they need to form healthy relationships and protect their sexual health."
The UK Department for Children, Schools and Families issued new draft guidance on wellbeing education in schools on Friday.
The Sex Education Forum, the national authority on sex and relationships teaching, called for personal, social, health and economic education, which includes sex and relationships.
Julie Bentley, chief executive of the Family Planning Association, another UK charity, says: "This is not about teaching 4-year-olds how to have sex ... it's like maths - in primary school children learn the basics, so that they can understand more and more complex concepts at a later stage."
She adds: "Parents are concerned that if students are told about sex they will go straight out and have it, but the research shows the complete opposite. They have sex later and when they do, they have safer sex."
Mother of all exercise routines
Just a few years ago expectant mothers were told to lay off the treadmill. But health experts now believe that exercise during pregnancy is beneficial to the health of both mother and child.
A moderate amount of exercise improves the mother's overall condition, strengthens the cardiovascular system and stimulates blood circulation. "If their gynecologist gives the green light, pregnant women should go ahead and participate in sports," says Christian Albring, president of the Munich-based Association of Gynaecologists (BVF).
The appropriate amount of exercise depends upon the stage in the pregnancy, as well as the mother's prior level of physical activity.
Endurance exercises, as opposed to high-impact competitive sports, are particularly beneficial during pregnancy.
"Jogging, hiking, Nordic walking, cycling, dancing, and swimming in water with a temperature over 20 C are all well-suited to people who don't care for sports," Albring says.
Working out in a pool is an especially attractive option. "Water is felt to be particularly pleasant because it buoys the body and takes weight off the joints," notes Marion Sulprizio, a sports psychologist at the German Sport University Cologne's Department of Health Research.
Also, studies show that strenuous activities are possible in water without raising the heart rate. "So in water you can really let loose," she says.
Another option is the fitness studio. "On the treadmill, cross trainer and ergometer, the training intensity is regulated individually and the amount of strain is monitored," Sulprizio says. This allows pregnant women to continually adjust the intensity of their exercise regimen according to their condition.
Sports involving sudden jumps or movements are less advisable. Pregnant women should be cautious about sports, such as tennis and squash, which require quick bursts of exertion.
Strength training is also permissible - not for the abdomen, but for arms and legs. The weights and resistances should be greatly reduced, however.
"Deep-sea diving is the only thing that's really taboo," says Edith Wolber of the Karlsruhe-based German Midwives Association. She points out that women who dive during pregnancy have a significantly higher rate of children with deformities.
Whatever kind of exercise is chosen, the basic guidelines for pregnant women remain the same: Avoid heavy strain, lower intensity, take regular breaks, drink a lot of fluids, and adapt according to one's comfort level.
"Expectant mothers are not competing. That means, among other things, that they can allow themselves to engage in sports less than they did previously, or reduce their performance level," Wolber says.
It is suitable for expectant mothers who were active before their pregnancy to exercise at least half an hour three times a week. The regularity of workouts is more important than the duration.
Exercise becomes more restricted as the pregnancy advances. "During the last trimester, a supine position should be avoided because it disrupts blood circulation in the uterus," Wolber warns.
In every phase of pregnancy, how the woman feels is the main factor in determining the amount of exercise.
"A workout should stop immediately in cases of blurred vision, shortness of breath, headache, dizziness, nausea or pain," Albring says. These symptoms should be promptly discussed with the treating physician or midwife, he adds.
A moderate amount of exercise improves the mother's overall condition, strengthens the cardiovascular system and stimulates blood circulation. "If their gynecologist gives the green light, pregnant women should go ahead and participate in sports," says Christian Albring, president of the Munich-based Association of Gynaecologists (BVF).
The appropriate amount of exercise depends upon the stage in the pregnancy, as well as the mother's prior level of physical activity.
Endurance exercises, as opposed to high-impact competitive sports, are particularly beneficial during pregnancy.
"Jogging, hiking, Nordic walking, cycling, dancing, and swimming in water with a temperature over 20 C are all well-suited to people who don't care for sports," Albring says.
Working out in a pool is an especially attractive option. "Water is felt to be particularly pleasant because it buoys the body and takes weight off the joints," notes Marion Sulprizio, a sports psychologist at the German Sport University Cologne's Department of Health Research.
Also, studies show that strenuous activities are possible in water without raising the heart rate. "So in water you can really let loose," she says.
Another option is the fitness studio. "On the treadmill, cross trainer and ergometer, the training intensity is regulated individually and the amount of strain is monitored," Sulprizio says. This allows pregnant women to continually adjust the intensity of their exercise regimen according to their condition.
Sports involving sudden jumps or movements are less advisable. Pregnant women should be cautious about sports, such as tennis and squash, which require quick bursts of exertion.
Strength training is also permissible - not for the abdomen, but for arms and legs. The weights and resistances should be greatly reduced, however.
"Deep-sea diving is the only thing that's really taboo," says Edith Wolber of the Karlsruhe-based German Midwives Association. She points out that women who dive during pregnancy have a significantly higher rate of children with deformities.
Whatever kind of exercise is chosen, the basic guidelines for pregnant women remain the same: Avoid heavy strain, lower intensity, take regular breaks, drink a lot of fluids, and adapt according to one's comfort level.
"Expectant mothers are not competing. That means, among other things, that they can allow themselves to engage in sports less than they did previously, or reduce their performance level," Wolber says.
It is suitable for expectant mothers who were active before their pregnancy to exercise at least half an hour three times a week. The regularity of workouts is more important than the duration.
Exercise becomes more restricted as the pregnancy advances. "During the last trimester, a supine position should be avoided because it disrupts blood circulation in the uterus," Wolber warns.
In every phase of pregnancy, how the woman feels is the main factor in determining the amount of exercise.
"A workout should stop immediately in cases of blurred vision, shortness of breath, headache, dizziness, nausea or pain," Albring says. These symptoms should be promptly discussed with the treating physician or midwife, he adds.
'Drugs for kids' fury
Some experts stress diet and exercise should play an important role in reducing the risk of heart disease in overweight children.
Children as young as 8 with high cholesterol levels should be put on drugs to reduce their risk of heart disease, doctors in the United States have recommended.
The move by the American Academy of Paediatrics has triggered a furor, because there is little long-term data on the risks and benefits of the recommended drugs, statins, in children, and no evidence that the drugs can prevent heart attacks when they are adults.
But the number of obese and overweight children is soaring on both sides of the Atlantic and experts in the UK, who are already treating small numbers of very high-risk children with statins, say it is time wider use of the drugs was discussed.
Most doctors agree that the use of statins for some children whose genetic inheritance puts them seriously at risk of a fatal heart attack in their 20s or 30s is justified.
The UK's National Institute for Healthcare and Clinical Excellence (NICE) wants statins to be given after the age of 10 to the one in 500 children who have the FH ("familial hypercholesterolaemia") gene with a high risk of heart disease.
The American academy, however, is taking it further. It wants cholesterol screening for all children with a family history of high cholesterol or heart disease; for children whose family history is unknown; and for those with obesity, high blood pressure or diabetes between the ages of 2 and 10. Statins should be considered, it says, if any of those over the age of 8 have particularly high cholesterol levels.
The academy also says reduced-fat milk should be given to babies in whom obesity or overweight condition is considered a problem by the age of 12 months.
"We are in an epidemic," says Jatinder Bhatia, a member of the academy's nutrition committee, which made the recommendation, and professor and chief of neonatology at the Medical College of Georgia in Augusta. "The risk of giving statins at a lower age is less than the benefit you're going to get out of it."
But a number of doctors in the US have expressed strong reservations about giving drugs to children whose most urgent need is to get more exercise and eat a more healthy diet.
"Where are the data that show this is helpful in preventing heart attacks?" says Darshak Sanghavi, a paediatric cardiologist and assistant professor at the University of Massachusetts Medical School.
"How many heart attacks do we hope to prevent this way? There's no data regarding that."
Others express concern at the public health message the prescription of pills to overweight children might give, but experts in the UK say that statins are already being given to children as young as 6 who have the FH gene and that discussion of their use is welcome.
Chris Hendriksz, consultant in inherited metabolic disorders at Birmingham Children's Hospital, accepts the US guidelines are controversial but agrees with them.
"I lost an 8-year-old with hypercholesterolaemia about 15 years ago," he says. "I could never believe it could happen that early. Things like that change your view."
Hendriksz says the FH gene might not be the only genetic reason that some fathers die of a heart attack at 25 or 30. In his clinic, about a third of the children are, indeed, on statins but two-thirds on diet and lifestyle modifications only.
George Rylance, of the UK's Royal College of Paediatrics and Child Health, says he would expect the public to be worried if the college produced a statement like that of the US academy, but he welcomes their recommendation - "not only the text, but the debate it engenders", he says.
He also feels the FH gene is not the only reason why children should be prescribed statins to keep their cholesterol down. "We see families all the time where people are dying of coronary artery disease and they may not have a gene we recognize," he says.
Cathy Ross, a cardiac nurse with the British Heart Foundation, says that it is important to be sure there is a genetic component to the high cholesterol reading. "We should always eliminate other possible reasons, like a child's diet and lack of activity and weight in proportion to their height," she says.
Ross stresses parents should first be counseled on diet and exercise, adding: "You don't give an adult statins without implementing lifestyle interventions."
Children as young as 8 with high cholesterol levels should be put on drugs to reduce their risk of heart disease, doctors in the United States have recommended.
The move by the American Academy of Paediatrics has triggered a furor, because there is little long-term data on the risks and benefits of the recommended drugs, statins, in children, and no evidence that the drugs can prevent heart attacks when they are adults.
But the number of obese and overweight children is soaring on both sides of the Atlantic and experts in the UK, who are already treating small numbers of very high-risk children with statins, say it is time wider use of the drugs was discussed.
Most doctors agree that the use of statins for some children whose genetic inheritance puts them seriously at risk of a fatal heart attack in their 20s or 30s is justified.
The UK's National Institute for Healthcare and Clinical Excellence (NICE) wants statins to be given after the age of 10 to the one in 500 children who have the FH ("familial hypercholesterolaemia") gene with a high risk of heart disease.
The American academy, however, is taking it further. It wants cholesterol screening for all children with a family history of high cholesterol or heart disease; for children whose family history is unknown; and for those with obesity, high blood pressure or diabetes between the ages of 2 and 10. Statins should be considered, it says, if any of those over the age of 8 have particularly high cholesterol levels.
The academy also says reduced-fat milk should be given to babies in whom obesity or overweight condition is considered a problem by the age of 12 months.
"We are in an epidemic," says Jatinder Bhatia, a member of the academy's nutrition committee, which made the recommendation, and professor and chief of neonatology at the Medical College of Georgia in Augusta. "The risk of giving statins at a lower age is less than the benefit you're going to get out of it."
But a number of doctors in the US have expressed strong reservations about giving drugs to children whose most urgent need is to get more exercise and eat a more healthy diet.
"Where are the data that show this is helpful in preventing heart attacks?" says Darshak Sanghavi, a paediatric cardiologist and assistant professor at the University of Massachusetts Medical School.
"How many heart attacks do we hope to prevent this way? There's no data regarding that."
Others express concern at the public health message the prescription of pills to overweight children might give, but experts in the UK say that statins are already being given to children as young as 6 who have the FH gene and that discussion of their use is welcome.
Chris Hendriksz, consultant in inherited metabolic disorders at Birmingham Children's Hospital, accepts the US guidelines are controversial but agrees with them.
"I lost an 8-year-old with hypercholesterolaemia about 15 years ago," he says. "I could never believe it could happen that early. Things like that change your view."
Hendriksz says the FH gene might not be the only genetic reason that some fathers die of a heart attack at 25 or 30. In his clinic, about a third of the children are, indeed, on statins but two-thirds on diet and lifestyle modifications only.
George Rylance, of the UK's Royal College of Paediatrics and Child Health, says he would expect the public to be worried if the college produced a statement like that of the US academy, but he welcomes their recommendation - "not only the text, but the debate it engenders", he says.
He also feels the FH gene is not the only reason why children should be prescribed statins to keep their cholesterol down. "We see families all the time where people are dying of coronary artery disease and they may not have a gene we recognize," he says.
Cathy Ross, a cardiac nurse with the British Heart Foundation, says that it is important to be sure there is a genetic component to the high cholesterol reading. "We should always eliminate other possible reasons, like a child's diet and lack of activity and weight in proportion to their height," she says.
Ross stresses parents should first be counseled on diet and exercise, adding: "You don't give an adult statins without implementing lifestyle interventions."
Turn to drink this summer
The intense summer heat brings thirst, dry throats and loss of energy. Water resolves all these problems and, for the health-conscious, does not have any calories. Luckily, there are many more kinds of water to choose from nowadays than just tap and carbonated bottled water.
Alternatives include natural artesian water from Fiji, spring water from Norway, water that is flavored or has added minerals, ready-to-drink fruit spritzers, energy drinks and old-fashioned green tea.
Take your pick; it really doesn't matter. There is only one golden rule this summer: Drink plenty of it! After all, water is not only a trendy lifestyle product. It is also, and most importantly, the main ingredient of life.
Every day we ingest a liter or more liquid via food, for example, by eating watery fruits and vegetables like melons and tomatoes. The German Nutrition Society (DGE), based in Bonn, recommends intaking at least an extra 1.5 liters in the form of liquids. "When temperatures exceed 35 C, you'd also do well to drink double that amount," says DGE spokeswoman Antje Gahl.
She stresses that even athletes should increase their water intake in summer: A glass of water or apple spritzer a half or quarter-hour before the athletic activity is generally sufficient.
But during activities that last longer than an hour, such as running, she recommends drinking a half-glass or glass "in small swallows" every 15 minutes, even when temperatures are normal.
Another useful tip is not to wait until you're thirsty before having a drink, and this is especially true for older people. With advancing age, the sensation of thirst diminishes, says Wolfgang Wesiack, president of the Wiesbaden-based Association of German Internists (BDI).
The risk of dehydration is especially high in summer because perspiration causes the body to lose more liquid. If the lost liquid is not replenished, the blood can thicken. This reduces the body's ability to function and can lead to confusion and even loss of consciousness or kidney failure.
"The best time to drink water is between meals," advises Barbara Hendel of Munich, a holistic medical doctor and author of the book Water and Salt, Wellspring of Life. The ideal time would be about 15 minutes before a meal or an hour or two afterwards.
"You can also drink water during meals, of course, but too much dilutes the digestive juices and delays or hampers digestion," she says.
The kind of liquid you drink is also important. Although coffee and alcohol consist largely of water, Hendel says, "They also contain other substances, so the water has fewer free docking places to bind toxic substances and excrete them." High-proof spirits even take water from the body.
Wesiack recommends natural mineral water because it contains salts that the body loses through perspiration, but the most popular mineral water is still the carbonated kind, with medium-fizzy varieties not far behind.
Non-carbonated and slightly flavored waters are also enjoying increasing popularity, but Wesiack sees no physical benefits in the latter. He says that lifestyle products with, say, strawberry flavors are "not medically indicated", in other words, unnecessary.
Soft drinks are unsuitable thirst quenchers because of their high sugar content, which makes you thirstier, the DGE notes. It says that herbal or fruit teas, fruit spritzers and low-calorie refreshing drinks are better.
The DGE's Gahl suggests a simpler and cheaper alternative: tap water! Foreigners should note, however, that the DGE was targeting German consumers, and they would do well to stick to the bottled version while in China.
Alternatives include natural artesian water from Fiji, spring water from Norway, water that is flavored or has added minerals, ready-to-drink fruit spritzers, energy drinks and old-fashioned green tea.
Take your pick; it really doesn't matter. There is only one golden rule this summer: Drink plenty of it! After all, water is not only a trendy lifestyle product. It is also, and most importantly, the main ingredient of life.
Every day we ingest a liter or more liquid via food, for example, by eating watery fruits and vegetables like melons and tomatoes. The German Nutrition Society (DGE), based in Bonn, recommends intaking at least an extra 1.5 liters in the form of liquids. "When temperatures exceed 35 C, you'd also do well to drink double that amount," says DGE spokeswoman Antje Gahl.
She stresses that even athletes should increase their water intake in summer: A glass of water or apple spritzer a half or quarter-hour before the athletic activity is generally sufficient.
But during activities that last longer than an hour, such as running, she recommends drinking a half-glass or glass "in small swallows" every 15 minutes, even when temperatures are normal.
Another useful tip is not to wait until you're thirsty before having a drink, and this is especially true for older people. With advancing age, the sensation of thirst diminishes, says Wolfgang Wesiack, president of the Wiesbaden-based Association of German Internists (BDI).
The risk of dehydration is especially high in summer because perspiration causes the body to lose more liquid. If the lost liquid is not replenished, the blood can thicken. This reduces the body's ability to function and can lead to confusion and even loss of consciousness or kidney failure.
"The best time to drink water is between meals," advises Barbara Hendel of Munich, a holistic medical doctor and author of the book Water and Salt, Wellspring of Life. The ideal time would be about 15 minutes before a meal or an hour or two afterwards.
"You can also drink water during meals, of course, but too much dilutes the digestive juices and delays or hampers digestion," she says.
The kind of liquid you drink is also important. Although coffee and alcohol consist largely of water, Hendel says, "They also contain other substances, so the water has fewer free docking places to bind toxic substances and excrete them." High-proof spirits even take water from the body.
Wesiack recommends natural mineral water because it contains salts that the body loses through perspiration, but the most popular mineral water is still the carbonated kind, with medium-fizzy varieties not far behind.
Non-carbonated and slightly flavored waters are also enjoying increasing popularity, but Wesiack sees no physical benefits in the latter. He says that lifestyle products with, say, strawberry flavors are "not medically indicated", in other words, unnecessary.
Soft drinks are unsuitable thirst quenchers because of their high sugar content, which makes you thirstier, the DGE notes. It says that herbal or fruit teas, fruit spritzers and low-calorie refreshing drinks are better.
The DGE's Gahl suggests a simpler and cheaper alternative: tap water! Foreigners should note, however, that the DGE was targeting German consumers, and they would do well to stick to the bottled version while in China.
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