Potential new weapon against TB: free cell minutes

CAMBRIDGE, Mass. -- Researchers at MIT believe they've discovered a new weapon in the battle against tuberculosis: Free cell phone minutes.

For years, doctors have struggled to get some TB patients to take all their medication, which generally involves a six-month regimen of multiple drugs.

Now, a student-led group at the Massachusetts Institute of Technology has developed a way to use cell phones to let patients test themselves. And if the tests show patients are following doctor's orders, they get rewarded with free minutes.

The system works like this: Patients test their urine using a strip that reveals a numeric code if it detects TB medicine. They then text message the code to their health care provider and get credit toward incentives such as free minutes.

The in-home tests also eliminate the need for health care workers to make several patient-monitoring visits a week, a routine that is often impractical in remote places, said Jose Gomez-Marquez, one of the project's leaders.

Dr. Mario Raviglione, director of a World Health Organization program to fight TB, called the MIT idea "creative." But he said personal visits must continue because systems that depend heavily on patient self-reporting have often failed.

In 2006, the most recent year statistics are available, 9.2 million people worldwide were diagnosed with tuberculosis and 1.7 million died.

The disease can be cured with a steady regimen of drugs. But many patients start feeling better and stop taking the medicine too soon. Others abandon the drugs because of side effects such as nausea, fever and rashes.

If the drugs are taken only sporadically, the bacteria build up resistance. The WHO estimates that 5 to 10 percent of TB deaths are patients who stop taking medication properly.

The MIT group -- which originally included five students -- took on the TB problem in 2007 as part of the university's annual "IDEAS competition," which challenges participants to solve various world problems.

Cell minutes were chosen as an incentive because patients want them and phone companies are willing to give them out, said Gomez-Marquez, who added that other incentives and reporting methods can be tailored to different regions.

A small study of 20 patients in Nicaragua last year indicated the MIT system could work, and a larger study in Pakistan is planned for this summer.

FDA issues precautionary note on silver fillings

WASHINGTON -- Silver dental fillings contain mercury, and the government for the first time is warning that they may pose a safety concern for pregnant women and young children.

The Food and Drug Administration posted the precaution on its Web site earlier this month to settle a lawsuit -- making the move a victory for anti-mercury activists.

The warning is not aimed at the general population but only at two groups already urged to limit mercury from another source -- seafood -- because too much can harm a developing brain.

The fillings, formally known as dental amalgams, "contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses," reads the FDA Web posting.

That doesn't mean it truly harms, and the FDA advises against removing existing fillings.

The agency is still studying whether the small amount of mercury vapor released by chewing and brushing is enough to cause neurologic disorders or other problems in youngsters. There have been only a handful of rigorous studies comparing children given either amalgam fillings or tooth-colored resin composite fillings that are mercury-free -- and those studies haven't detected any brain problems.

Nor has that research settled the long-simmering scientific controversy. Two years ago, the FDA's own independent scientific advisers said that while amalgam fillings were safe for most people, more research was needed about potential effects on fetuses and children under 6.

And this spring, the FDA put dentists on notice that it is considering additional controls, including whether to require warnings that would advise consumers of the mercury in amalgams before they have a cavity filled or perhaps even restrict use in small children and certain other patients. It is accepting public comments until July 28.

Used since the 1800s, amalgams' popularity is already dropping. They account for about 30 percent of U.S. fillings, still millions of people a year.

They're cheaper than alternatives -- roughly $100 for an amalgam filling versus $150 or more for a composite -- and they're known as particularly durable.

Dental workers make amalgam fillings by mixing liquid mercury with powdered ingredients, requiring special safety steps and filters to limit waste seeping back into the environment.

St. John's wort fails to help kids with ADHD

CHICAGO -- Children and teens with attention deficit hyperactivity disorder fared no better on St. John's wort than they did on dummy pills in a government study, another blow for herbal supplements.

St. John's wort, pine bark extract and blue-green algae are among commonly used herbal treatments for children with ADHD. They appeal to parents who want to avoid stimulants like Ritalin and other drugs used to help children control their behavior.

But unlike prescription drugs, supplements are only loosely regulated by the government, and their makers don't have to prove they are safe or effective.

Wendy Weber of Bastyr University's School of Naturopathic Medicine in suburban Seattle, working with colleagues at Harvard University and University of Washington, focused on St. John's wort because studies in rats found it increases brain chemicals like norepinephrine, which is thought to help focus attention.

Weber reasoned St. John's wort might work the same way as the prescription drug Strattera, approved by the Food and Drug Administration to treat ADHD. Strattera makes norepinephrine more available in the brain.

In the study, appearing in last week's Journal of the American Medical Association, 54 children with ADHD were randomly assigned to take either St. John's wort capsules three times a day or placebos. They ranged in age from 6 to 17 years old.

Symptoms were measured at the start of the study and four other times. After eight weeks, the two groups showed no difference in symptoms or side effects.

The study's results should give pause to parents who have avoided well-researched prescription medicines in favor of herbal remedies, said Dr. Eugenia Chan of Children's Hospital Boston, who was not involved in the new research.

Earlier this year, the American Heart Association recommended that children should be screened for heart problems before getting drugs like Ritalin. That increased parents' anxieties about the drugs, Chan said.

But "natural" doesn't mean risk-free. St. John's wort can increase sensitivity to the sun and reduces the effectiveness of some medications, including birth control pills.

ADHD affects more than 4.4 million children, according to government estimates.

Hispanic teens try drugs, suicide at higher rates

ATLANTA -- Hispanic high school students use drugs and attempt suicide at higher rates than their black and white classmates, according to a new federal survey that shows a continuation of a disturbing trend.

The study is the latest in a series of surveys of U.S. high school students every two years. The new report noted that black and white students are reporting less sexual activity than in years past, but there was no decline among Hispanics.

In addition, Hispanic students were more likely than either blacks or whites to attempt suicide, ride with a driver who had been drinking alcohol or use cocaine, heroin or ecstasy.

Hispanics also most often drank alcohol on school property, were offered or sold illegal drugs and occasionally skipped school because they feared for their safety, according to the 2007 survey by the Centers for Disease Control and Prevention.

Experts were unable to come up with an explanation for why Hispanic behavior trends differed. However, they speculated that school environments many Hispanics face may differ considerably from what adolescents of other races encounter. Earlier research found that Hispanics and blacks more commonly attend highly segregated schools than whites or Asians.

The finding comes from a survey of about 14,000 U.S. high school students that has been conducted every other year since 1991.

Questionnaires go to students in grades nine-12 in public and private high schools in all 50 states and the District of Columbia. Researchers got parental permission for each student who participated.

The survey did not collect information on the parents' income or education levels. Some experts say those factors can also be a strong indicator of a youth's health behavior and academic achievement.

CDC officials say they take many steps to secure accurate responses: Participation is confidential, kids are spaced apart when answering the questions and teachers do not hover.

The survey asks about a wide variety of behaviors, including sunscreen use, seat belt avoidance, drug use and suicide attempts.

Like the 2005 survey, the 2007 data showed higher rates of risk-taking by Hispanics in several areas. One example: About 10 to 11 percent of Hispanic students said they attempted suicide, compared with around 7 percent of whites and 8 percent of blacks.

However, whites reported the highest rates of smoking and heavy drinking, while blacks reported the highest rates of obesity, violence and sexual activity.

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