Vitamins linked with higher death risk in older women

A healthy diet should provide enough nutrients without the need for supplements, experts advise

When it comes to vitamins, it appears you could have too much of a good thing, say researchers who report a link between their use and higher death rates among older women.

Experts have suspected for some time that supplements may only be beneficial if a person is deficient in a nutrient.

And excess may even harm, as the study in Archives of Internal Medicine finds.

All of the women, in their 50s and 60s, were generally well nourished yet many had decided to take supplements.

Multivitamins, folic acid, vitamin B6, magnesium, zinc, copper and iron in particular appeared to increase mortality risk.

The researchers believe consumers are buying supplements with no evidence that they will provide any benefit.

Harms v gains
They are quick to stress that their study relied on the 38,000 US women who took part in it recalling what vitamins and minerals they had taken over the previous two decades.

And it is difficult to control for all other factors, like general physical health, that might have influenced the findings.

But they say their findings suggest that supplements should only be used if there is a strong medically-based cause for doing so because of the potential to cause harm.

"Based on existing evidence, we see little justification for the general and widespread use of dietary supplements," Dr Jaakko Mursu of the University of Eastern Finland and his research colleagues said.

Less is more
In the study, iron tablets were strongly linked with a small (2.4%) increased death risk, as were many other supplements. The link with iron was dose-dependent, meaning the more of it the individual took, the higher their risk was.
Conversely, calcium supplements appeared to reduce death risk. However, the researchers say this finding needs more investigation and they do not recommend that people take calcium unless advised to by a doctor in order to treat a deficiency.

Drs Christian Gluud and Goran Bjelakovic, who review research for the Cochrane Database of Systematic Reviews to evaluate best evidence, said: "We think the paradigm 'The more the better' is wrong."

They say dietary supplementation has shifted from preventing deficiency to trying to promote wellness and prevent diseases, and caution: "We believe that for all micronutrients, risks are associated with insufficient and too-large intake."

Helen Bond of the British Dietetic Association said some people, like the elderly, might need to take certain supplements. For example, vitamin D is recommended for people over the age of 65.

But she said that generally, people should be able to get all the vitamins and minerals they needed from a healthy, balanced diet.

She said some took supplements as an insurance policy, wrongly assuming that they could do no harm. "But too much can be toxic and it is easy to inadvertently take more than the recommended daily amount."

TB smoking toll 'could reach 40m'

Smoking is a risk factor for TB

Forty million smokers could die from TB by 2050, research suggests.

Smokers are about twice as likely to get the lung infection and die from it, compared with non-smokers.

Many of the new TB cases will be in Africa, the eastern Mediterranean and Southeast Asian regions, according to projections published in the BMJ.

A lung charity said global efforts to fight TB are being undermined by the tobacco industry's "aggressive promotion" of smoking in some places.

Dr John Moore-Gillon is a TB specialist and honorary medical advisor for the British Lung Foundation.

He said: "It is nearly 20 years since the World Health Organization declared tuberculosis to be a 'global health emergency'.

"Since that time rates have risen rather than fallen, and smoking increases the risk of getting - and dying from - TB.

"Concerted international efforts are now under way to try and turn the tide of TB, but this important research shows that all these efforts may be undermined by the tobacco industry's continuing aggressive promotion of smoking in many parts of the world."

Mathematical model
Nearly a fifth of people in the world are smokers; many in countries with high rates of TB where multi-national tobacco companies have expanded their markets.

Smoking is a known risk factor for TB, and may reduce the ability of the lungs to fight off infection.
Dr Sanjay Basu and colleagues from the University of California set out to predict the impact of smoking on future TB rates.

X-ray of the chest of a patient with TB

According to their mathematical model, worldwide smoking could lead to 40 million extra deaths from TB from 2010 to 2050.

If current smoking trends continue, the number of new cases of TB will rise by 18 million.

Smoking alone could undermine the worldwide goal of reducing TB mortality by half between 1990 and 2015, they say.

Writing in the BMJ, the team concludes: "Tobacco smoking could substantially increase tuberculosis cases and deaths worldwide in coming years, undermining progress towards tuberculosis mortality targets.

"Aggressive tobacco control could avert millions of deaths from tuberculosis."

Contagious
Tuberculosis is a contagious infection that mainly affects the lungs, but can spread to other parts of the body.

If not treated, it can damage the lungs to such an extent that a person cannot breathe properly.

Sometimes, people do not experience any symptoms for many months or even years after being infected.

TB can treated with antibiotics but is sometimes fatal.

Leek and potato soil linked to E. coli outbreak

People who were ill were 40 times more likely to have handled loose leeks than healthy people

Soil stuck on leeks and potatoes may have been the source of an E. coli outbreak in the UK earlier this year, according to the Health Protection Agency (HPA).

There were 250 cases scattered across England, Wales and Scotland between December 2010 and July 2011.

The Food Standards Agency said it was a "myth" that dirt did no harm.

The HPA stressed that the vegetables were safe to eat, but reminded people to ensure their food was washed.

Most of the cases were mild, but 74 people needed to go to hospital and one patient, who had underlying health problems, died.

The disease was caused by a rare strain of E. coli called O157 PT8 which is different to the strain that caused the widespread outbreak in Germany.

'Timely reminder'
Infected people were 40 times more likely to have been in a household where loose leeks were handled and 12 times more likely to have been in a household which bought sacked potatoes than people who stayed infection-free.

Dr Bob Adak, head of the HPA's outbreak control team, said: "The vegetables could have carried traces of contaminated soil.

"It is possible people caught the infection from cross-contamination in storage, inadequate washing of loose vegetables, insufficient hand washing after handling the vegetables or by failing to thoroughly clean kitchen equipment, utensils or surfaces after preparing the vegetables."

Dr Andrew Wadge, chief scientist at the Food Standards Agency, said: "It's sadly a myth that a little bit of dirt doesn't do you any harm.

"Soil can sometimes carry harmful bacteria and, although food producers have good systems in place to clean vegetables, the risk can never be entirely eliminated.

"This outbreak is a timely reminder that it is essential to wash all fruits and vegetables, including salad, before you eat them."

'Baby Joseph,' focus of treatment dispute, dies in his sleep

"Baby Joseph" Maraachli died peacefully in his sleep on Tuesday, in Windsor, Ontario, his family said

Joseph Maraachli, the infant who became the center of an international end-of-life debate, died peacefully in his sleep at his Windsor, Ontario, home, a spokesperson for the family said Wednesday.
Widely known in the media as "Baby Joseph," the 20-month-old boy spent the last several months with his family and died Tuesday afternoon.
"Obviously, it's been a very difficult day for the family today," said spokeswoman Emma Fedor. "In some ways, it was a bit of a relief for the family."
Joseph's family had refused to accept a recommendation by a Canadian hospital to remove the boy's breathing tube and allow him to die. In March, the infant received a tracheotomy at a children's hospital in St. Louis, Missouri.
He was able to go home April 21.
"By providing him with this common palliative procedure, we've given Joseph the chance to go home and be with his family after spending so much of his young life in the hospital," said Dr. Robert Wilmott, chief of pediatrics for SSM Cardinal Glennon Children's Medical Center in St. Louis.
A London, Ontario, hospital where Joseph was receiving care for a progressive neurological disease refused to perform a tracheotomy, a surgical procedure in which an opening is made into the airway through an incision in the neck to allow for suction of fluid out of the lungs.
In court papers, doctors in Canada said there was no hope for recovery. They would not perform a tracheotomy because they considered it to be invasive and not recommended for patients who require a long-term breathing machine.
Parents Moe and Sana Maraachli refused to accept the recommendation. The Maraachlis' daughter, Zeina, had died at home in 2002 after a tracheotomy after suffering similar complications, and the family wanted to offer the same care to their son.
"To go through it once is enough for a lifetime, to go through it twice, it's just ... unbelievable," Fedor said.
Joseph was "very peaceful, in no pain whatsoever, no distress," when he died, Fedor said. He was buried Wednesday next to his sister.
The family was thankful for those who helped and prayed for Joseph, she added.
"The heart of the issue would come down to the mix between respecting the parents' rights ... to be in comfort of (their) own home, to die on God's time," said Fedor.
The family countered assertions that Joseph was nonresponsive, blind and deaf, she said. Instead, the boy could hear the parents' voices and look for them, Fedor told CNN. The family believed that, after a tracheotomy, Joseph could be freed from machinery.
The parents said that they, rather than physicians, should make a judgment on quality of life, Fedor said.
The Maraachli case caught the attention of the group Priests for Life, which funded Joseph's transfer and treatment at the SSM Cardinal Glennon Children's Medical Center. That hospital deemed the procedure medically appropriate and Baby Joseph underwent a tracheotomy there on March 21.
In April, Frank Pavone, national director of Priests for Life, said he considered this a "victory over the culture of death." He says "(Joseph) has gained benefit from his tracheotomy, is breathing on his own, and is going home to live with his parents."
Priests for Life is a Catholic pro-life organization that functions as a network to prevent abortion and euthanasia. The group often is noted for the graphic images depicting abortion its members and supporters use to make their case.
The London Health Sciences Centre -- the hospital where Joseph was initially treated -- in March said that "there are clearly differences in the approach of these centres to the management of end-of-life care in this tragic situation" and that "the medical judgments made by LHSC physicians remain unchallenged by any credible medical source."
Nurses helped the family provide 24-hour care for Joseph in his final months. "There was always somebody by his side," Fedor said.
The child was on almost no medication and apparently was in no pain, Fedor said.
"When he was in the arms of his parents, you could tell," she said. "He was settled when he was in their arms."

Cancer cost 'crisis' warning from oncologists

The cost-effectiveness of minimally invasive robotic surgery is questioned

The cost of treating cancer in the developed world is spiralling and is "heading towards a crisis", an international team of researchers says.

Their Lancet Oncology report says there is a "culture of excess" with insufficient evidence about the "value" of new treatments and technologies.

It says the number of cancer patients and the cost of treating each one is increasing.

It argues for reducing the use and analysing the cost of cancer services.

About 12 million people worldwide are diagnosed with cancer each year. That figure is expected to reach 27 million by 2030.

The cost of new cancer cases is already estimated to be about £185bn ($286bn) a year.

Rising costs
A group of 37 leading experts from around the world say the burden of cancer is growing and becoming a major financial issue.
Their report says most developed countries dedicate between 4% and 7% of their healthcare budgets to dealing with cancer.

"The issue that concerns economists and policymakers is not just the amount of money spent on healthcare, but also the rate of increase in healthcare spending or what has become known as the cost curve."

It says the UK's total spend on breast cancer has increased by about 10% in each of the past four years.

"In general, increases in the cost of healthcare are driven by innovation. We spend more because we can do more to help patients."

For example, the number of cancer drugs available in the UK has risen from 35 in the 1970s to nearly 100, but the report warns they can be "exceedingly expensive".

It adds: "Few treatments or tests are clear clinical winners, with many falling into the category of substantial cost for limited benefit."

The cost of drugs is not the only target for criticism.

Lead author Prof Richard Sullivan told the BBC: "It's not just pharmaceuticals. Biomarkers, imaging and surgery are all getting through with very low levels of evidence - the hurdles are set too low."

The report calls for a proper evaluation of the relative merits of conventional surgery and less invasive robotic surgery.

Too much
Another criticism is "overusing" treatments and technologies.
"It is often easier to order a scan than to reassure the patient or physician on the basis of a careful history and a physical examination," the report claims.

There is also criticism of "futile care" - providing expensive chemotherapy which gives no medical benefit in the last few weeks of a patient's life.

Prof Sullivan said: "We're on an unaffordable trajectory. We either need to manage and reduce the costs or the cost will increase and then inequality rises between rich and poor."

He said failure to manage costs could result in a "train crash".

The report says solutions fall into two categories: reducing the cost of services or reducing the number of people using them.