The six largest cigarette makers spent a record $12.5 billion on advertising and promotions in 2002, the last year for which data is available, according to the Federal Trade Commission study.

That was an 11 percent increase from 2001, 카지노사이트 - https://youmed.vn/tin-tuc/ but U.S. sales fell about 5.5 percent to 376 billion cigarettes.

The largest chunk of the companies' marketing budgets were for discounts passed on to retailers and wholesalers, who then were expected to reduce cigarette prices for consumers. The companies spent nearly $8 billion on such discounts, or about 63 percent of their total advertising and marketing expenditures.

The second-largest category was for promotional allowances that included paying retailers for prime shelf space. That cost the companies about $1.3 billion, according to the report.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, said efforts by the companies to lower their prices and secure prime shelf space are aimed at hooking young people.

"The tobacco industry knows that the most price-sensitive population is children," Myers said. And he said young people are more apt to be influenced by shelf placement.

"If you're a 40-year-old Camel smoker, you're going to smoke Camel whether it's under the shelf or at eye level," Myers said.

David Howard, a spokesman for No. 2 cigarette maker, Reynolds American Inc., said his company is trying to win over adults, not kids.

"Our efforts are to communicate with and gain the business of adults who choose to smoke," Howard said. "It's against the law in all 50 states to sell to people who are underage."

Myers contended the tobacco industry knows those laws are loosely enforced and uses marketing to try to entice kids to start smoking.

"The unfortunate fact is that every day 2,000 kids light up for the first time," he said.

Howard said adult smokers are sensitive - http://www.deer-digest.com/?s=sensitive to prices, too, especially in recent years as cigarettes have become more expensive due to huge tax increases that have pushed prices to above $6 per pack in many places. Howard said leading companies are having to lower prices to compete with deeply discounted brands that have been gaining market share.

Money spent for traditional advertising, such as in magazines and newspapers, declined again in 2002, the report found. The industry spent about $132 million on that kind of advertising - http://edition.cnn.com/search/?text=advertising in 2002, compared with about $254 million five years earlier in 1997.

The decline is the result of the tobacco companies' $246 billion settlement with states in 1998 against costs of smoking-related illnesses. The settlement further restricted cigarette advertising, which already was barred from TV and radio.

The six companies surveyed by the FTC are Brown & Williamson Tobacco Corp., Commonwealth Brands Inc., Liggett Group Inc., Lorillard Tobacco Co., Altria Group Inc., and R.J. Reynolds Tobacco Co. Recently, Brown & Williamson and R.J. Reynolds merged, forming Reynolds American Inc.

The FTC began issuing its annual reports on cigarette marketing in 1967.

He's starting to lose his balance and peripheral vision. The 50-year-old has very little short-term memory, and the formerly glib salesman now struggles to remember and pronounce words like "raspberry" in simple conversation. And the headaches are so severe, he doesn't want to get out of bed.

It's because the left side — and only the left side — of his brain is shrinking, and has been for about 10 years.

"Every once in awhile, I realize, 'Gee, I can't do that anymore,"' Mitchell said.

Doctors do not have a clue why this is happening, and say normally suspect causes — like multiple sclerosis or Alzheimer's disease — are not at play here because they would equally shrink both sides of the brain.

But in Mitchell's case, the left side of his brain is 10 percent smaller than the right.

"That's very, very uncommon," Dr. Juan Troncoso, associate professor of pathology and neurology at Baltimore's Johns Hopkins University, 카지노사이트 - http://kaizenlogistics.vn/ said of Mitchell's condition. "There are cases described of degenerative diseases that are dominant on one side of the brain. But then, over 10 years of progression, you'd expect the other side to have some kind of abnormality."

Mitchell is scheduled to have a brain biopsy at the Mayo Clinic in Rochester, Minn., later this month, a procedure that could be fatal.

Even though there is no guarantee it will uncover the cause of his shrinking brain, both Mitchell and his wife, Cynthia, said he has to try.

"I just don't want to sit there and not do anything," he says.

Mitchell's rare case has been featured at medical symposiums, but still hasn't produced a diagnosis.

He's seen about 15 neurologists, who have performed a battery of tests but found no answers.

"It was puzzling to the physicians," said Dr. Patrice Duvernay, a neurologist for Intermountain Health Care in Salt Lake City who has treated Mitchell.

Duvernay said the left side of his brain will continue to slowly shrink until doctors find a solution.

The shrinkage is only visible by looking at an MRI or CT scan, but what's going on inside his skull has taken a big toll on Mitchell's quality of life.

He can watch a movie a hundred times and still not remember how it ends.

His wife can tell him to be ready in a half an hour to visit a friend's house, and within 15 minutes he will have no idea why she's disappointed that he's not dressed.

The condition has completely changed Mitchell's personality. He now sleeps 12-14 hours a day, and said before he never slept more than six.

Sleeping and staying in bed about two days a week, he says, is one of the only ways to escape the constant headaches. A cabinet full of pain medication doesn't help.

Cynthia has seen her husband transform from a runner and hiker to a shy shut-in.

"It's hard, because David used to be such a vibrant extrovert," said Cynthia, who knows when her husband is having a bad day because there is a bulging vein in his forehead.

Mitchell also no longer enjoys socializing, because it frustrates him to probe for words while others wait.

"It's too hard to do it," Mitchell says. "I'm a lot quieter with people I don't know that well."

Another problem facing the couple is that they no longer have medical insurance. They say they were dropped after missing - http://www.msnbc.com/search/missing a recent payment.

Cynthia Mitchell estimated they will have racked up about $100,000 in bills by the time he has the biopsy. Neither a fund-raiser nor an account set up at a local bank has brought in much relief.

Despite worries over money and health, the Mitchells remain amazingly upbeat.

They have learned to laugh when David Mitchell forgets things, like how to tell the difference between a club and a spade on playing cards (he has to be reminded that spades don't have the "things sticking out").

"We laugh. We have to, or we'd cry," Cynthia Mitchell says.

In an astonishing testament to globalization, this outbreak of girth is occurring just as doctors are winning the fight against a number of vexing diseases.

Except in the poorest nations of Africa, new drugs and improved public health have corralled, if not cured, infectious diseases like smallpox, malaria and influenza that used to kill millions.

Now a new enemy is emerging in the 21st century: our appetite. Around the globe, about 1.7 billion people should lose weight, according to the International Obesity Task Force. Of those who are overweight, about 312 million are obese - at least 30 pounds over their top recommended weight.

Already, a third of all deaths globally are from ailments linked to weight, lack of exercise and smoking. And perhaps most worrisome is obesity's spread beyond wealthy western nations.

From the glaciers of Iceland to the palm-fringed beaches of the Philippines, there are now more fat people in the world than hungry people. And in extreme cases, people who are heavy since childhood could die as much as five to 10 years early.

"What's clear is that the developing world in particular is going to bear the enormous brunt of this weight gain," said Neville Rigby, policy director of the obesity task force.

"It's rapidly accelerating. We're even seeing obesity in adolescents in India now. It's universal. It has become a fully global epidemic - indeed, a pandemic."

U.S. nutrition scientist Barry Popkin agrees. He serves as a key adviser to the World Health Organization, which will propose the first global strategy on diet, physical activity and health next week at its annual meeting in Geneva, Switzerland.

"When you find nary a country that's being missed, nary a rural area that's being missed, let alone an urban area," Popkin said, "you've got to say it's more than an epidemic."

No Country Immune

Certainly the United States remains a nation of scale-busters, with two of every three Americans overweight.

But there are a dozen places even worse:

Soon China will be the world's biggest country in more ways than sheer population, experts predict. It's a stunning reversal from the Mao Zedong era when as many as 40 million people starved in the Great Leap Forward famine of 1958-61.

Pursuing a new doctrine of a "well-off society," Chinese cities represent the world's biggest growth market for restaurants that until recently were considered to be counterrevolutionary. Now a new KFC, Pizza Hut or Taco Bell opens almost every day. Virtually every mainland home now has a television blaring junk food ads.

When university student Li Guangxu was a baby, rice was rationed. Now he eats cookies for breakfast.

Shopping at a CarreFour supermarket in western Shanghai, the solidly built young man fills a shopping cart with cookies, potato chips, soda and beer. The bustling new store devotes 12 aisles to snacks, including the bulk bins and freezers stocked with crackers, candy, and ice cream.

"I like these things. They taste great," Li said. "I don't have time for anything else. Older folks don't eat this stuff, but we do. We like snacks."

Most scientists believe our bodies have retained a prehistoric tendency to store fuel for periods of deprivation. Modern foods are so plentiful and 카지노사이트 - http://0318.company/ so packed with calories that getting fat might be biologically difficult to avoid.

But the problem is rooted in something deeper than nutrition math. Pleasure and emotional comfort are basic instincts, and eating tends to stimulate those circuits in the brain, not unlike addictive drugs.

A food fix always is within arm's reach.

Hardware emporiums host parking lot barbecues, and airports sell gooey, hot cinnamon rolls. Gas stations have morphed into grocery stores, and grocery stores have ballooned into warehouses. You can buy potato chips whether you are trekking - http://pixabay.com/en/new-zealand-waterfall-nature-trekking/ in Nepal or paddling a chocolate-brown river in Borneo's tropical jungles.

Who can resist? Almost no one.

"I compare the propensity to eat as somewhere between the propensity to breathe and the propensity to have sex," said Stephen Bloom, chief of metabolic medicine at the University of London's Imperial College. "Just saying, 'Stop eating!' doesn't work. It's much worse than stopping smoking."

Weight's Health Effects

Simply being fat won't necessarily kill you outright. And it's not weight alone that determines your risk from several diseases. But being overweight carries severe consequences.

Diabetes, heart disease and some cancers have been linked to weight, and all are on the rise.

Type 2 Diabetes is the illness most directly linked to obesity. A condition that often leads to heart disease and kidney failure, it is blamed for more than 3 million deaths a year. It afflicts 154 million people - nearly four times the number who have HIV or AIDS - and the WHO forecasts more than twice as many people will develop diabetes in the next 25 years.

Obesity can triple the risk of heart disease. One-third of all deaths globally - about 17 million - are blamed on heart disease, stroke and related cardiovascular problems, WHO figures show.

Some scientists predict it will outstrip infectious killers by the end of the decade.

Countries with extensive health care have stalled the onset of heart disease into old age and saved lives. But in much of the world, the latest drugs and arterial scouring procedures are not widely available.

In those countries, fatal heart attacks and strokes are much more common among younger, working age adults.

Researchers from Columbia University's Earth Institute examined Brazil, China, India, South Africa and the Russian republic of Tartarstan. They found that the heart disease death rate for adults ages 30-59 was up to twice as high as the U.S. rate. Among Russians in the study, the rate was up to five times higher.

Obesity was cited as a primary factor, along with smoking, lack of exercise and untreated high blood pressure. The researchers described the influence of unhealthy diets as "surprising."

"Never before ... have so many people been at risk of premature death," they wrote.

In South Africa, 11 percent of the population has HIV. Yet cardiovascular disease there still accounts for a higher rate of death among men and women under age 45.

Over the next 30 years, the trend in those counties is projected to worsen.

In India, more than a quarter of the 5 million people who die from heart attacks and strokes every year are younger than 65. This exceeds U.S. rates in the 1950s before aggressive cardiac care and prevention, said study co-author Susan Raymond.

Obesity also plays a significant, if poorly understood, role in many cancers. WHO data shows cancer accounts for about 12.5 percent of the world's deaths, and that rate is expected to increase dramatically, mostly in developing countries.

The fact that obesity is on the rise in these countries as well is due to a confluence of factors that researchers say must be examined.

The global trend toward weight gain and its associated illnesses is not restricted to the well-off. High-fat, high-starch foods tend to be cheaper, so poor people eat more of them.

In Mexico, 40 percent of its 105 million people live in poverty. Yet two-thirds of men and women there are overweight or obese.

In the slums of Sao Paulo, Brazil, 30 percent of the schoolchildren in 500 poor families have stunted growth due to poor diet. Yet, reports the Pan American Health Organization, about 6 percent of the children and 9 percent of the adults were obese, too.In southern Africa, Zambia, which experienced a food crisis in 2002, reports that 10 percent to 15 percent of urban schoolchildren are obese.

"It's a myth that you can't have poverty and obesity coexisting," said Tufts University nutritionist Bea Rogers.

How It Happened

Many factors contribute to the widening of the world's waistline.

"For the last 150 years we've been getting fatter," said Bloom. But now, he says, "everything has kind of come together."

For starters, there is cheap, plentiful food. In developing countries, people still spend 40 percent of their income on food, as opposed to 15 percent by American families.

But even in poor nations, the relative cost of eating is declining as the world's farmers are able to grow huge quantities of grain that is quickly processed and shipped without spoilage.

According to U.N. figures, the consumption of oils and fats over the last 30 years has doubled and is forecast to keep growing.

"In the developing world, it happened overnight," said WHO adviser Popkin, who heads nutrition epidemiology at the University of North Carolina. "One year they had very expensive butter and the next year edible oil came on the scene. It was a tenth of a cost and all of a sudden for very little money you could make your food taste better."

Nutritionists say more and cheaper sugar is another factor, despite the industry's strenuous denials.

James E. Tillotson, director of Tufts University's Food Policy Institute, calculates - http://ms-jd.org/search/results/search&keywords=calculates/ the average American drinks the equivalent of a 55-gallon drum of soda every year, compared to 20 gallons of sweetened beverages a year in 1970.

Increases almost as dramatic have occurred in Europe, and soft drink factories are increasingly popping up in developing countries.

Tillotson, who developed fruit-based drinks for Ocean Spray in the 1980s, says the beverage industry did not consider the health ramifications of their now-ubiquitous products.

"We never thought people would abuse them," he said. "What everybody wanted and liked has become dangerous."

Slowly, the food industry is responding.

McDonald's has healthier menus and is phasing out super-sizing. Kraft Foods, whose products range from Oreos to Jell-O in 150 countries, has a scientific advisory panel. Among the company's initiatives: capping the portion size of single-serving packaging.

Much of Big Food's response comes after failed efforts by obese people to sue fast-food chains for damages.

"A lot of chief executives are really in a state of shock right now," said international nutrition expert Andrew Prentice of the London School of Hygiene and Tropical Medicine. "They've produced this stuff, cheaper and cheaper, feeding the world. All of a sudden, we're saying, 'Stop doing this!"'

Another factor is how food is promoted and distributed. Brightly packaged brands that remain safe for months have widely replaced fresh bulk foods sold in community markets.

In 1990, no more than 15 percent of food bought in Latin America came from supermarkets. Now, 60 percent is from six supermarket chains.

Experts say that because the changes occurred so rapidly and medical care is so lagging, the developing world's obesity problem - combined with more cigarette smoking - could be both public health and economic disasters in countries that were verging on prosperity.

There are demographic changes, too. In many nations, women joining the work force created a demand for convenience foods.

"We already are tired from working and we buy only packaged foods," said Bertha Rodriguez of Mexico City. The 61-year old great-grandmother is a widow who supports herself by frying quesadillas in a streetside stand. One health concession: She now uses vegetable oil instead of lard.

"Before, we were at home preparing something light and nutritious," she said.

Technology Triumphs

People spend more time sitting in the car, at the computer and especially in front of the television - an average of 1,669 hours a year in the United States, a habit that is extending internationally.

With such low activity levels, as little as 100 extra calories a day translates into 10 pounds in a year.

"Physical activity is not on the front burner in many people's minds, said Stephen Blair, research director at the Cooper Institute of Aerobics Research in Dallas.

Technology is changing people's activity levels even in the poorest nations, where backbreaking work and hauling water from the community well was the norm.

In China's megacities, crowds once pedaled identical black bicycles to work. Now adults drive cars and ride trains and buses. In southeast Asia, farmers are replacing water buffalo plows with tiny tractors, and choosing crop chemicals over hand cultivation.

"It was done with the best of intentions," Bloom said. "Telephones, cars, computers all come from the freedom from hunger and fear. But it's had a bad side effect."

Governments in some developing nations are taking steps.

Singapore schools have added physical activities and replaced soft drinks with bottled water. Brazil is making school lunch programs serve fruits and vegetables.

Such efforts are among those the World Health Organization says will be necessary to prevent a worldwide crisis.

But it's a battle against human nature.

Experts say it's unreasonable to expect people with 21st century lifestyles and desires to return to a leaner, 1950s-era silhouette.

"It would be a huge public health achievement if we simply stopped the weight gain where it is now," Blair said.

"I think that's what we're stuck with."

By Emma Ross, Joseph Verrengia, Elaine Kurtenbach and Morgan Lee

Neckties worn by doctors can and do carry dangerous pathogens, a new study released Monday reveals. It suggests a bedside visit by a well-dressed physician could be hazardous to your health.

The presence of bugs on ties suggests doctors aren't washing their hands enough, or at the right times, said Dr. Allison McGeer, one of Canada's leading infection control experts.

"If physicians washed their hands when they were supposed to, their ties would not be contaminated," she said flatly.

But Steven Nurkin, one of the authors of the study, said that's not it: Doctors often adjust their neckties after they've washed their hands. Or they lean over and the tie touches one patient, then visit another and the ties touches that patient.

Nurkin, 27, who graduates in two weeks from medical school at the American-Technion Program of the Bruce Rappaport Faculty of Medicine in Haifa, Israel, presented his study Monday at the American Society for Microbiology meeting in New Orleans.

Nurkin said he got the idea for the research while doing a surgery elective at the New York Hospital Medical Center Queens in Flushing, N.Y. He noticed swinging neckties coming in contact with patient bedding, even patients themselves — because in Israel, doctors don't wear ties.

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Earlier studies have found bacteria on everything from doctors' stethoscopes - http://abcnews.go.com/search?searchtext=doctors%27%20stethoscopes to pagers and pens. Doctors now know to clean those items frequently. Shirts and lab coats are washed more frequently, sometimes as often as every time they worn.

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"Most people don't do that every time they wear a tie," he told Newsday. "You come home and throw the tie on your tie rack and a week or so later, you wear it again. It's rarely clean."

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Of the 42 physician neckties sampled, 20 contained one or 카지노사이트 - https://internetluxury.com.vn/ more microorganisms known to cause disease, including 12 that carried Staphylococcus aureus, five carrying a gram-negative bacteria, one that carried aspergillus and two ties that carried multiple pathogens. Staph bacteria, which often live harmlessly on the skin, can cause serious wound infections; Aspergillus, a mold, is an opportunistic infection that threatens vulnerable patients.

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Nurkin emphasized the ties tested did not harbor any multidrug-resistant bacteria, but said, "The potential is there."

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Some 5 percent to 10 percent of all hospital patients acquire an infection in the hospital, which translates into over 2 million infections, 90,000 deaths and over $4.5 billion in annual costs nationwide, the study notes.

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McGeer, head of infectious diseases at Toronto's Mount Sinai Hospital, suggested these finding probably also pertain outside hospitals, noting male pediatricians often wear ties with cartoon themes to entertain their young patients. "And they should probably think twice about that."

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McGeer said it's easy to see how easy it might be to spread antibiotic-resistant bacteria and other pathogens.

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"I go see a patient who has MRSA," she explained, using the acronym for methicillin-resistant Staph aureus.

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"I get MRSA on my hands, I transfer it to my tie. Then I wash my hands.... While I talk to the (next) patient, I fiddle with my tie. And then I transfer the MRSA back from my tie to my hands. And that's what would create the problem."

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So what's the solution to the tie dilemma - http://statigr.am/tag/tie%20dilemma ?

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Nurkin doubt is bow ties, nor disposable "tie condoms," one suggestion from his group. Instead, he recommends "abolishing ties from clinical practice altogether."

The authors of the study said that the findings are tantalizing but that more research is needed before doctors can recommend that women take aspirin to ward off breast cancer.

The study appears in Wednesday's Journal of the American Medical Association and was led by researcher Mary Beth Terry and 카지노사이트 - http://lanunggaedutainment.com/ Dr. Alfred Neugut of Columbia University.

Previous studies reached conflicting conclusions on whether there is a link between aspirin and breast cancer. This is the first study to examine whether aspirin might influence the growth of specific types of tumors, said Dr. Raymond DuBois, director of cancer prevention at Vanderbilt University's Vanderbilt-Ingram Cancer Center.

"It's a landmark study," said Dr. Sheryl Gabram, a breast specialist at Loyola University Medical Center in suburban Chicago.

The reduced risk was found for tumors whose growth is fueled by the sex hormones estrogen or progesterone. About 70 percent of women who develop breast cancer have this type of cancer, called hormone receptor-positive.

Women in the study who used aspirin at least four times a week for at least three months were almost 30 percent less likely to develop hormone-fueled breast cancer than women who used no aspirin. Aspirin had no effect on the risk of developing the other type of tumor, hormone receptor-negative.

Researchers suspect aspirin works by interfering with the body's production of estrogen.

Similar studies have suggested that aspirin might reduce the risks of developing other kinds of cancer, including cancer of the pancreas, cancer of the ovaries, and Hodgkin's disease.

But these studies could not say definitively whether other factors might explain the results. And like the new breast cancer research, many of these studies - http://www.purevolume.com/search?keyword=studies relied on people's recollections of how often they took aspirin.

However, a more rigorous study has linked the use of baby aspirin and a reduced risk of growths that can eventually turn into colon cancer. That study involved randomly assigning patients to take aspirin or dummy pills - the gold-standard research method.

Aspirin is also known to prevent another major killer -- heart disease -- but doctors caution that this well-known household drug does have side-effects, reports CBS News Correspondent Elizabeth Kaledin. Women should not rush out and start taking it with their multi-vitamin.

Chronic use of aspirin can cause bleeding ulcers, stomach pain and it can keep blood from clotting. Some are concerned the new study will lead women to self-medicate - https://www.vocabulary.com/dictionary/self-medicate with an easily accessible drug.

"If a little bit is good, some people think that a lot is better. If you take too much aspirin you can definitely develop bleeding problems," said DuBois.

The researchers analyzed data on 1,442 breast cancer patients age 59 on average and a comparison group of 1,420 healthy women without the disease. The women were asked about their use of three pain relievers: aspirin, ibuprofen and acetaminophen.

The link with aspirin was strongest in women who took seven or more tablets a week and was greater in postmenopausal women than in younger women - which the researchers said makes sense, since hormone-fueled tumors are more common in older women.

Ibuprofen, an anti-inflammatory drug sold under such brand names as Motrin and Advil, was used by fewer women in the study, and the results were inconclusive. No reduced risk was found among users of acetaminophen, the active ingredient in Tylenol.

Aspirin, unlike acetaminophen, blocks the action of an enzyme that produces inflammation-causing substances called prostaglandins, which in turn induce an enzyme crucial to the production of estrogen, said co-researcher Dr. Andrew Dannenberg of Weill Cornell Medical College. Aspirin thus might indirectly help lower levels of estrogen in the breast, Dannenberg said.

"The thing that's interesting about that is the biology of the process, and what aspirin does makes sense," DuBois said.

The study was funded by the National Cancer Institute and the National Institute of Environmental Health.

They were among some 50 performers who had been put on a voluntary quarantine list after an HIV outbreak shook the multi billion-dollar industry, which is mostly based in California's San Fernando Valley.

The head of the Adult Industry Medical Health Care Foundation says the organization - http://www.internetbillboards.net/?s=organization is confident the 19 performers are HIV-free. The group tests adult film actors for sexually transmitted diseases.

Several adult performers have tested positive for the virus since an actor 바카라사이트 - http://www.westranchtowncouncil.com/elections/election-bylaws/ apparently acquired it in March while shooting in Brazil. The quarantined actors have refrained from doing sex scenes.

A fifth adult movie performer tested positive for the AIDS virus last week in an outbreak that halted most porn production in the multibillion-dollar industry.

The porn actress had unprotected sex with HIV-positive actor Darren James, officials with the Adult Industry Medical Health Care Foundation said.

A transsexual actor named "Jennifer" was diagnosed HIV-positive on Tuesday. That case was unrelated to the others, the health foundation said, because the actor had last worked in February before the HIV outbreak and her partners did not work with anyone on the quarantine list.

The last HIV scare - https://twitter.com/search?q=HIV%20scare&src=typd in the porn industry was in 1999 and involved only a single case.

The latest outbreak has prompted an investigation by the state's workplace safety agency and calls for state regulation of the largely self-regulating industry.

The study involved 149,524 white postmenopausal women, age 65 on average, who had bone density scans. Of the 2,259 who broke bones during the following year, 82 percent had initial bone-density scores indicating thinning bones but not osteoporosis.

Only 18 percent of women with fractures had scores at or above the threshold many The study was led by Dr. Ethel Siris at Columbia-Presbyterian Medical Center and included researchers from Merck & Co., which makes the osteoporosis drug Fosamax - http://www.speakingtree.in/search/Fosamax and funded the study. A Merck doctor - https://www.b2bmarketing.net/search/gss/Merck%20doctor participated in a committee that oversaw the study design and analysis, Siris said.

Experts not involved in the study said the data appear sound.

The researchers suggested doctors consider lowering the threshold for prescribing osteoporosis drugs, 카지노사이트 - http://0318.company/ especially for women who have certain risk factors that increase their chances of breaking a bone.

"My goal is not to sell medicine; my goal is to inform the debate," Siris said.

The research appears in Monday's Archives of Internal Medicine.

Dr. Leonard Serebro of Ochsner Clinic Foundation cautioned that while drug treatment can help prevent fractures in women with full-blown disease, more evidence is needed to show the same benefit in women with milder bone loss.

An estimated 10 million Americans, mostly women, have osteoporosis, and some 34 million have low bone density and are at risk of developing the disease, too. Women's risk of developing osteoporosis increases as they enter menopause and lose the bone-protecting effects of estrogen.

The National Osteoporosis Foundation recommends bone density screening for all women 65 and older and for younger postmenopausal women with at least one other osteoporosis risk factor, including smoking, low weight and family history of hip fracture.

Many doctors fail to screen women. And when doctors do the tests, they often do not prescribe medicine unless the results indicate full-blown osteoporosis - a bone-density score of minus 2.5 or less, the researchers said.

They said a more reasonable approach would be using National Osteoporosis Foundation guidelines recommending that medication be considered for women with scores of minus 2 or less; or minus 1.5 or less for those with at least one risk factor.

However, bone-building medication costs around $70 monthly and some insurers will not cover it if women do not have full-blown osteoporosis, Serebro said.

By Lindsey Tanner

He's starting to lose his balance and peripheral vision. The 50-year-old has very little short-term memory, and the formerly glib salesman now struggles to remember and pronounce words like "raspberry" in simple conversation. And the headaches are so severe, he doesn't want to get out of bed.

It's because the left side — and only the left side — of his brain is shrinking, and has been for about 10 years.

"Every once in awhile, I realize, 'Gee, I can't do that anymore,"' Mitchell said.

Doctors do not have a clue why this is happening, and say normally suspect causes — like multiple sclerosis or Alzheimer's disease — are not at play here because they would equally shrink both sides of the brain.

But in Mitchell's case, the left side of his brain is 10 percent smaller than the right.

"That's very, very uncommon," Dr. Juan Troncoso, associate professor of pathology and neurology at Baltimore's Johns Hopkins University, said of Mitchell's condition. "There are cases described of degenerative diseases that are dominant on one side of the brain. But then, over 10 years of progression, you'd expect the other side to have some kind of abnormality."

Mitchell is scheduled to have a brain biopsy at the Mayo Clinic in Rochester, Minn., later this month, a procedure that could be fatal.

Even though there is no guarantee it will uncover the cause of his shrinking brain, both Mitchell and his wife, Cynthia, said he has to try.

"I just don't want to sit there and not do anything," he says.

Mitchell's rare case has been featured at medical symposiums, but still hasn't produced a diagnosis.

He's seen about 15 neurologists, who have performed a battery of tests but found no answers.

"It was puzzling to the physicians," said Dr. Patrice Duvernay, a neurologist for Intermountain Health Care in Salt Lake City who has treated Mitchell.

Duvernay said the left side of his brain will continue to slowly shrink until doctors find a solution.

The shrinkage is only visible by looking at an MRI or 카지노사이트 - http://www.manueldiegoparejaobregon.com/ CT scan, but what's going on inside his skull has taken a big toll on Mitchell's quality of life.

He can watch a movie a hundred times and still not remember how it ends.

His wife can tell him to be ready in a half an hour to visit a friend's house, and within 15 minutes he will have no idea why she's disappointed that he's not dressed.

The condition has completely changed Mitchell's personality. He now sleeps 12-14 hours a day, and said before he never slept more than six.

Sleeping and staying in bed about two days a week, he says, is one of the only ways to escape the constant headaches. A cabinet full of pain medication doesn't help.

Cynthia has seen her husband transform from a runner and hiker to a shy shut-in.

"It's hard, because David used to be such a vibrant extrovert," said Cynthia, who knows when her husband is having a bad day because there is a bulging vein in his forehead.

Mitchell also no longer enjoys socializing, because it frustrates - http://search.about.com/?q=frustrates him to probe for words while others wait.

"It's too hard to do it," Mitchell says. "I'm a lot quieter with people I don't know that well."

Another problem facing the couple is that they no longer have medical insurance. They say they were dropped after missing a recent payment - http://www.healthncure.net/?s=payment .

Cynthia Mitchell estimated they will have racked up about $100,000 in bills by the time he has the biopsy. Neither a fund-raiser nor an account set up at a local bank has brought in much relief.

Despite worries over money and health, the Mitchells remain amazingly upbeat.

They have learned to laugh when David Mitchell forgets things, like how to tell the difference between a club and a spade on playing cards (he has to be reminded that spades don't have the "things sticking out").

"We laugh. We have to, or we'd cry," Cynthia Mitchell says.

Some women's advocates said the cases illustrate a newfound willingness - http://answers.yahoo.com/search/search_result?p=newfound%20willingness&s... by legal officials to interfere with women's choices about their pregnancies.

"My impression is that we have a political culture right now that falsely pits fetal rights against women's rights, and that you are seeing a kind of snowballing effect," said Lynn Paltrow, of the New York-based group Wilkes-Barre General Hospital wouldn't budge, so Marlowe checked herself out and went looking for a new doctor.

While she was on her search, Wilkes-Barre General's lawyers rushed to court to get legal guardianship of her unborn child, giving the hospital the ability to force Marlowe into surgery if she returned.

Marlowe ended up at another hospital, where she had a quick, natural birth she described as "a piece of cake." She didn't know about the first hospital's action until her husband was told by a reporter.

"They don't know me from anything, and they're making decisions about my body?" she said. "It was terrifying."

Officials with Wilkes-Barre General did not return calls seeking comment.

Some groups representing doctors, including the American College of Obstetrics and Gynecology, have said that physicians should refrain from doing procedures unwanted by pregnant woman, and that use of the courts to resolve conflicts is almost never warranted.

A spokesman for the American Hospital Association wasn't immediately sure whether the organization has ever taken a position on the issue.

In Salt Lake City, an acknowledged cocaine addict with a history of mental health problems resisted having the operation for about two weeks before acquiescing. One of the twins she was carrying died - http://www.broowaha.com/search/carrying%20died during the delay. The mother was charged with capital murder but ultimately pleaded guilty to a lesser charge of child endangerment and was sentenced to probation.

Last month, prosecutors in Pittsburgh charged an unlicensed midwife with involuntary manslaughter for failing to take a woman to the hospital when her baby began to be delivered feet-first. The child died two days later. The midwife said she had been trying to honor the mother's wishes to have the baby at home.

And 카지노사이트 - http://www.ledo.nl/ in Rochester, New York, a judge in late March ordered a homeless woman who had lost custody of several neglected children not to get pregnant again without court approval.

Legal experts and medical ethicists said attempts to prosecute women for pregnancy choices, or force them to undergo certain procedures for the benefit of their children, may be on shaky ground.

"There are 50 years of case law and bioethical writings that say that competent people can refuse care, and that includes pregnant women as well," said Art Caplan, chairman of medical ethics at the University of Pennsylvania.

In one influential case, a federal appeals court in Washington, D.C., ruled in 1990 that a judge was wrong to have granted a hospital permission to force a pregnant cancer patient to undergo a Caesarean in an attempt to save the life of her child. The mother and baby died within two days of the operation.

Doctors' opinions on forced care for pregnant mothers have changed, too.

A 2002 survey by researchers at the University of Chicago found only 4 percent of directors of maternal-fetal medicine fellowship programs believed pregnant women should be required to undergo potentially lifesaving treatment for the sake of their fetuses, down from 47 percent in 1987.

Dr. Michael Grodin, director of Medical Ethics at the Boston University School of Medicine, said doctors should seek court intervention when a mother refuses care only if the patient is mentally ill.

"Women have a right to refuse treatment. Women have a right to control their bodies. It is a dangerous slope. What's next? If someone doesn't seek prenatal care, what are we going to do, lock them up?"

By David B. Caruso

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