Cyber Shopping for a Treadmill

LONDON (AP) — A new study of fertility treatment found that women who get three or more embryos have no better odds of having a baby than those who get just two embryos.

They also have a greater chance of risky multiple births.

"Women who have gone through infertility treatment want the best chance of having a baby, but we need to explain that the data shows transferring more embryos doesn't actually do that," said Dr. Scott Nelson, head of reproductive and maternal medicine at the University of Glasgow, who co-authored the study published in Thursday's issue of Lancet.

In Western Europe, where some countries pay for in-vitro fertilization, or IVF, many authorities recommend a single embryo transfer for women under 37 and a maximum of two embryos for women 37 to 40. For women over 40, three is often the limit by law.

In the United States, there are relatively lax guidelines and a lack of regulation. That country has seen a rise in multiple births, including the highly publicized case of Nadya Suleman, labeled the "octomom." She had octuplets in 2009 after her doctor transferred 12 embryos. She already had six children through IVF.

Most fertility treatment in the U.S. is paid for privately and can cost at least $10,000 per cycle, which experts believe encourages the use of more embryos in the belief it will improve odds.

The American Society for Reproductive Medicine recommends single embryo transfers for women under 35, but there is no enforcement of that. For women 35 to 37, they advise two to three embryos, and three to four embryos for women ages 38 to 40.

In their study, Nelson and Debbie Lawlor, of the University of Bristol, analyzed data for all 124,000 IVF cycles in the U.K. between 2003 and 2007, resulting in more than 33,500 live births. The women were 18 to 50 and had varying histories of infertility. During IVF, eggs are fertilized with sperm in a lab dish and then put in the womb.

For women under 40 who had two embryos transferred, the live birth rate was 33 percent overall. With three embryos, that dropped to 25 percent, though researchers weren't sure why. Nelson said it might be due to the higher risk of miscarriage in a multiple pregnancy and that miscarrying one fetus would jeopardize the entire pregnancy.

For women over 40, the live birth rate was 13 percent whether they had two or three embryos transferred.

Nelson said patients going through IVF may pressure doctors to transfer more embryos, believing it may boost their chances of having a baby and avoiding more treatment.

"Doctors may feel if they don't do what their patients want, they'll just go down the street to another clinic," he said. "They need legislation to help control the situation."

The U.K. has tougher policies. Transferring three embryos in women under 40 is banned. And if doctors transfer more than three embryos, they must explain their actions to the fertility regulator. In 2010, about 65 percent of embryo transfers involved two embryos and 4 percent used three. The rest were single embryos.

In the U.S., data from 2009 showed about 52 percent of embryo transfers involved two while 23 percent used three embryos. Nearly 12 percent involved four to seven or more embryos. Only about 14 percent used one.

Multiple births have a higher risk of problems, including an increased chance of miscarriage and pregnancy complications like high blood pressure and diabetes. Twins and triplets are more likely to be premature and have an increased risk of developmental problems such as cerebral palsy.

Dr. James Grifo, director of the New York University Fertility Center, agreed doctors should avoid using more than three embryos. But he said it was warranted for some, such as older women with a history of failed treatment.

Grifo said the fact many Americans pay for their treatment out of pocket makes a big difference. "I spend a lot of time trying to talk patients out of the three-embryo transfer and you can't always do it," he said.

"My last set of triplets was a patient who demanded I put back three embryos," he said.

Grifo said she wasn't swayed by the data. "She delivered the triplets and they're fine, but I wasn't happy about it."

NEW YORK (AP) — It's dramatic news when a marathon runner collapses with no pulse. Now a big study finds such calamities are rare and usually due to a pre-existing heart problem.

The study also found such incidents are increasing as more runners try to go the distance.

"You hear about this more and more," said Dr. Aaron Baggish, senior author of the study

Baggish, who runs a program for athletes with heart issues at Massachusetts General Hospital, and co-authors present their analysis in Thursday's issue of the New England Journal of Medicine.

The study covers 10.9 million runners who participated in marathons or half-marathons in the United States from 2000 to 2010.

By scouring media reports and checking with medical staff of races, the researchers identified 59 cases of cardiac arrest, where a runner became unconscious with no pulse during the race or within an hour of finishing. Cardiac arrest is when the heart stops because of a heart attack, a rhythm problem or other disorder.

Forty-two of the runners died.

The overall figures translate to 1 cardiac arrest per 184,000 participants and 1 death per 259,000 participants, the researchers said. Those numbers are low compared to other athletic activities, as shown by prior studies of deaths in college athletes, triathlon participants and previously healthy middle-aged joggers, researchers said.

Most of the cardiac arrests involved marathons rather than half-marathons, and 51 of the 59 cases happened in men.

More cases showed up during 2005-2010 than in the preceding five-year span, but that's just because more people are participating in the races, Baggish said. More worrisome was the finding that among male marathoners, the rate of cardiac arrest per 100,000 runners was higher during the latter half of the decade than in the first half.

Baggish thinks that's because of a shift in attitudes about who can run long distances. Even a decade ago, 26.2-mile marathons were considered appropriate only for very athletic people, he said. But more recently people have come to think of it as "something anyone can do," and even as a healthy activity for lowering the risk of heart disease, he said. So it has attracted people with a family history of early heart disease or early deaths, and "these are just the people who are likely to get into trouble."

In the 31 cardiac arrests for which researchers could find a cause, most were due to clogged, hardened arteries or hypertrophic cardiomyopathy, a sometimes inherited condition in which an unusually thick heart muscle can interfere with the pumping rhythm. Most of the victims were unaware of their pre-existing conditions, Baggish said.

Baggish said he would encourage aspiring and experienced runners to talk to their doctors about their heart risks for distance running.

Dr. Gordon Tomaselli, president of the American Heart Association, called the study "reassuring" for finding so few cardiac arrests. For most people, "running a marathon, if you are so inclined, is a reasonably safe proposition," he said.

Tomaselli, a heart specialist at Johns Hopkins University, also said runners should pay attention if they feel chest pain, dizziness, lightheadedness or unusually short breath or rapid heartbeat while running. "You should listen to your body," he said.

In the same issue of the journal, other doctors wrote a brief report about treating three runners who suffered heart attacks after finishing last year's Boston Marathon. None had cardiac arrest and all survived.

"We don't want to alarm people about marathon running. The benefits of exercise are well established" said one of that report's authors, Dr. Navin Kapur of Tufts Medical Center in Boston. The report shows even seasoned marathon runners can have heart attacks, something paramedics should keep in mind if a runner shows suggestive signs, he said.

WASHINGTON (AP) — Defending President Barack Obama's signature health care overhaul, the administration is urging the Supreme Court to uphold the contentious heart of the law, the requirement that individuals buy insurance or pay a penalty.

The administration filed a written submission with the court Friday describing the 2010 law as an appropriate response to a "crisis in the national health care market."

The justices will hear arguments in the high court's biggest case this term over three days in late March. The outcome, expected in late June, has the potential to affect President Barack Obama's bid for re-election.

One federal appeals court struck down the so-called individual mandate as exceeding Congress' power under the Constitution. But two other federal appeals courts upheld the law and agreed with the administration's argument that Congress was well within its power to adopt that requirement.

Florida and 25 other states, as well as the National Federation of Independent Business, told the court in separate briefs that if the justices strike down the individual requirement, they should invalidate the rest of the law as well. Thirty-six Republican senators echoed the states' argument in their own filing.

The law is aimed at extending health insurance coverage to more than 30 million previously uninsured people and would, by 2019, leave just 5 percent of the population uninsured, compared with about 17 percent today, according to the Congressional Budget Office. About half of the increase would come from the individual requirement; the rest would come from an expansion of Medicaid and other provisions.

The health care law has attracted intense opposition from Republicans, including the party's presidential candidates, all of whom have vowed to repeal it if elected. The individual insurance requirement has been a particular lightning rod because it forces people to buy a product from a private insurer whether they want to or not, or pay a penalty for failing to do so.

This provision was struck down by a divided panel of the Atlanta-based 11th U.S. Circuit Court of Appeals, the only appeals court that has ruled against the law among the four appeals courts that have considered it. One appeals court held that it was too soon to rule on the law.

But the administration said the requirement falls within Congress' power under the Constitution's Commerce Clause because health care is an issue of supreme national importance that consumes nearly 18 percent of the U.S. economy.

People may lack insurance, but they still get health care, and the costs get passed on to the insured, the administration said.

"Congress found that the cost of tens of billions of dollars in uncompensated care provided to the uninsured is passed on to insured consumers, raising average annual family premiums by more than $1,000," the administration said.

The individual mandate also goes hand in hand with another part of the law that prohibits insurers from denying coverage to people with existing medical conditions or increase their premiums, the administration said.

Separately, the insurance industry reinforced this point to the court, arguing that it needs the larger pool of people so that it can afford to cover people regardless of their medical history.

America's Health Insurance Plans and the BlueCross BlueShield Association – major trade groups – said in their court papers that if the individual requirement is struck down, the ban on denial of coverage based on pre-existing medical conditions must also go. Otherwise, premiums will rise and healthy people will drop coverage. The groups did not take a position on the constitutionality of the law.

So far this year, more than 2.2 million people with Medicare have saved more than $1.2 billion on their prescriptions, for an average of $550 per person, the Centers for Medicare & Medicaid Services announced today.   And more than 22.6 million seniors and people with disabilities have taken advantage of at least one free Medicare preventive benefit, including the new Annual Wellness Visit made possible by the Affordable Care Act.  

“Thanks to the Affordable Care Act, seniors are getting cheaper prescription drugs and free preventive care,” said CMS Administrator Donald M. Berwick, MD.  

Under the Affordable Care Act, people with Medicare can receive many preventive services at no charge, including diabetes screening, some cancer screenings and help to quit smoking. 

People with Medicare across the country are also receiving cheaper prescription drugs. Thanks to the Affordable Care Act, seniors and people with disabilities receive a 50 percent discount on covered brand name drugs in the Medicare Part D coverage gap, also known as the “donut hole.”  The coverage gap discount is set at 50 percent on covered brand name drugs again in 2012. Coverage in the donut hole will progressively increase each year until the coverage gap closes in 2020.

In addition to donut hole discounts, average premiums for Medicare Part D prescription drug plans will remain virtually unchanged in 2012.  Medicare also recently announced that average Medicare Advantage premiums will drop 4 percent next year.  Part B premiums, which cover outpatient services including doctor visits, will only rise $3.50 per month for most beneficiaries in 2012, and some will see a decrease.  These changes will be more than offset by the average Social Security cost of living increase ($43 per month for retired workers)

CHICAGO — Thin people may be able to summon more mental defenses to resist tempting, high-calorie foods than obese people, researchers said on Monday.

Brain scans of thin people who looked at pictures of high-calorie foods showed increased activity in a region of the brain used for impulse control, but obese people showed little activity in this region, the researchers found.

"I think there essentially may be biological reasons why people can't necessarily control their desire for food," said Robert Sherwin of Yale University School of Medicine in Connecticut, who worked on the study published in the Journal of Clinical Investigation.

The study is part of a push to understand the underlying biological processes that contribute to obesity, which affects more than one third of adults and nearly 17 percent of children in the United States.

Researchers at Yale and the University of Southern California used functional magnetic resonance imaging, or fMRI, to examine areas of the brain that become active when a person views images of high-calorie foods, healthy foods like fruits and vegetables and non-food items.

The study involved 14 healthy people — nine thin and five obese volunteers — who underwent brain scans two hours after eating. The researchers manipulated blood sugar levels, testing the subjects when they had normal and low blood sugar levels.

They found that when blood sugar levels were low, brain regions called the insula and striatum associated with rewards are activated, signaling a desire to eat.
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The prefrontal cortex, which normally dampens signals to eat, was less able to put the brakes on signals generated from the striatum to eat.

That was especially true in the obese study subjects who were shown pictures of high-calorie foods.

But when blood sugar levels were normal, the thin study subjects showed greater activity in the prefrontal cortex, and this reduced activity in brain regions involved in rewards.

"There is a controller — a higher function that controls your reward centers. That controller is deficient in people with obesity. They don't activate that system," Sherwin said in a telephone interview.

He said larger studies are needed to confirm the findings, but the study does suggest that obese people may be less able to shut off parts of the brain that drive food cravings.

"That probably contributes to their obesity," he said.