Anne Scheck

LONG BEACH, CALIF. — Antioxidants have been taking a back seat to fatty acids in research on the dietary factors that may influence systemic lupus erythematosus, but an overview of the literature suggests that vitamins may affect disease progression more than lipids.

That is the tentative conclusion of Glinda Cooper, Ph.D., who presented the results of a review of the potential dietary influences on systemic lupus erythematosus (SLE) at the annual meeting of the American College of Nutrition.

“What is it that affects the expression of these self-antigens” associated with disease? Dr. Cooper asked. Because fatty acids have been shown to influence inflammation, they have been studied much more extensively than any other dietary component, she noted.

Over the past decade, one hypothesis has been that omega-3 fatty acids protect against inflammatory responses in lupus. Fatty acids are precursors to prostaglandins, which either inhibit or promote inflammation, she explained. However, a review of the literature shows “we're just not seeing much” in terms of a demonstrated effect from their intake, said Dr. Cooper, principal investigator of the Carolina Lupus Study at the National Institute of Environmental Health Sciences, Research Triangle Park, N.C.

Neither the Nurses' Health Study nor an observational study of 200 patients with SLE showed an association with fatty acid ingestion. In the latter, however, there was a link between decreased disease activity and increases in vitamins C, E, and A, she said. Some investigations are showing that vitamin C, along with other antioxidants, may help curb expression of symptoms.

A study done by researchers at Johns Hopkins University, Baltimore, found lower blood levels of β-carotene, α-tocopherol, and retinol in blood donors who developed SLE 2–15 years later, compared with donors matched for race, age, and sex. This was a small study, but the results bear more investigation, she said.

Studies in mice have associated the course of disease and the level of fatty acids in the diet, Dr. Cooper said. But in human studies, “there is a disconnect.” It may be that other factors enhance the influence of fatty acids, or that the dietary source from which they originate has some kind of effect on how well they are used by the body.

LONG BEACH, CALIF. — Antioxidants have been taking a back seat to fatty acids in research on the dietary factors that may influence systemic lupus erythematosus, but an overview of the literature suggests that vitamins may affect disease progression more than lipids.

That is the tentative conclusion of Glinda Cooper, Ph.D., who presented the results of a review of the potential dietary influences on systemic lupus erythematosus (SLE) at the annual meeting of the American College of Nutrition.

“What is it that affects the expression of these self-antigens” associated with disease? Dr. Cooper asked. Because fatty acids have been shown to influence inflammation, they have been studied much more extensively than any other dietary component, she noted.

Over the past decade, one hypothesis has been that omega-3 fatty acids protect against inflammatory responses in lupus. Fatty acids are precursors to prostaglandins, which either inhibit or promote inflammation, she explained. However, a review of the literature shows “we're just not seeing much” in terms of a demonstrated effect from their intake, said Dr. Cooper, principal investigator of the Carolina Lupus Study at the National Institute of Environmental Health Sciences, Research Triangle Park, N.C.

Neither the Nurses' Health Study nor an observational study of 200 patients with SLE showed an association with fatty acid ingestion. In the latter, however, there was a link between decreased disease activity and increases in vitamins C, E, and A, she said. Some investigations are showing that vitamin C, along with other antioxidants, may help curb expression of symptoms.

A study done by researchers at Johns Hopkins University, Baltimore, found lower blood levels of β-carotene, α-tocopherol, and retinol in blood donors who developed SLE 2–15 years later, compared with donors matched for race, age, and sex. This was a small study, but the results bear more investigation, she said.

Studies in mice have associated the course of disease and the level of fatty acids in the diet, Dr. Cooper said. But in human studies, “there is a disconnect.” It may be that other factors enhance the influence of fatty acids, or that the dietary source from which they originate has some kind of effect on how well they are used by the body.

LONG BEACH, CALIF. — Antioxidants have been taking a back seat to fatty acids in research on the dietary factors that may influence systemic lupus erythematosus, but an overview of the literature suggests that vitamins may affect disease progression more than lipids.

That is the tentative conclusion of Glinda Cooper, Ph.D., who presented the results of a review of the potential dietary influences on systemic lupus erythematosus (SLE) at the annual meeting of the American College of Nutrition.

“What is it that affects the expression of these self-antigens” associated with disease? Dr. Cooper asked. Because fatty acids have been shown to influence inflammation, they have been studied much more extensively than any other dietary component, she noted.

Over the past decade, one hypothesis has been that omega-3 fatty acids protect against inflammatory responses in lupus. Fatty acids are precursors to prostaglandins, which either inhibit or promote inflammation, she explained. However, a review of the literature shows “we're just not seeing much” in terms of a demonstrated effect from their intake, said Dr. Cooper, principal investigator of the Carolina Lupus Study at the National Institute of Environmental Health Sciences, Research Triangle Park, N.C.

Neither the Nurses' Health Study nor an observational study of 200 patients with SLE showed an association with fatty acid ingestion. In the latter, however, there was a link between decreased disease activity and increases in vitamins C, E, and A, she said. Some investigations are showing that vitamin C, along with other antioxidants, may help curb expression of symptoms.

A study done by researchers at Johns Hopkins University, Baltimore, found lower blood levels of β-carotene, α-tocopherol, and retinol in blood donors who developed SLE 2–15 years later, compared with donors matched for race, age, and sex. This was a small study, but the results bear more investigation, she said.

Studies in mice have associated the course of disease and the level of fatty acids in the diet, Dr. Cooper said. But in human studies, “there is a disconnect.” It may be that other factors enhance the influence of fatty acids, or that the dietary source from which they originate has some kind of effect on how well they are used by the body.

LONG BEACH, CALIF. – Dietary supplements will soon bear labels worded a whole lot more like the ones on over-the-counter medications and a whole lot less like the text of infomercials.

In a move designed to protect consumers by requiring that health claims are supported by scientific evidence, the Food and Drug Administration is ratcheting up the standards for health claims in the labeling of foods and supplements.

The changes come under the provisions of the agency's Consumer Health Information for Better Nutrition Initiative.

Under this initiative, the agency will use evidence-based rankings to evaluate everything from plant-derived tablets purporting to lower cholesterol to “natural” appetite suppressants that promise easy weight loss, J.C. Rowlands, Ph.D., said in a presentation at the annual meeting of the American College of Nutrition.

The FDA embarked on this revision as a result of two simultaneous trends in the last few years: the apparent rise of misleading claims about dietary supplements, and the actual increase of solid research on their potential benefits, said Dr. Rowlands, a scientist for the Center for Food Safety and Applied Nutrition at the FDA.

As a result of the initiative, manufacturers will have to make a stronger case for claims of prevention and symptom relief. Their evidence will be reviewed for scientific soundness by looking not just at how studies were conducted, but how many participants they included and how many different trials occurred. Randomized, placebo-controlled trials top the list. “The [current] evidence-based ranking system defines credible evidence,” he said, adding that “we are looking for consistency.”

It has been 10 years since Congress enacted the first such oversight restrictions in its unprecedented Dietary Supplement Health and Education Act, but the battle against its concept began even before the act was signed into law. “Lawsuits began being filed before the ink was even dry,” Dr. Rowlands said. Using arguments centered on first-amendment rights, some supplement makers waged successful court battles in favor of language that allowed certain promises on the packaging, such as better heart health or bone growth.

Under the new initiative, several steps are taken to identify the relevant studies underpinning such claims, and the system includes rating those studies based on quality. The research is assessed for “strength” by looking at the number of studies that are available, as well as the similarity–or lack thereof–within the findings.

There are essentially four ranks for health claims, with the highest level called “significant scientific agreement.” The three lower levels are substantiated by less scientific evidence than an SSA claim. As such, they require qualifying language on their labels, Dr. Rowlands said.

Any supplement that claims to reduce the risk for a certain disease in the general population or a targeted subgroup is to be reviewed under the new system. The system is likely to evolve even more, as the research on and manufacture of health-promoting foods and supplements continues to grow. “We wish we had an exact formula” for evaluation, Dr. Rowlands said. But a precise, black-and-white, all-inclusive method of assessment has proved elusive in this rapidly changing field, he said.

LONG BEACH, CALIF. – Dietary supplements will soon bear labels worded a whole lot more like the ones on over-the-counter medications and a whole lot less like the text of infomercials.

In a move designed to protect consumers by requiring that health claims are supported by scientific evidence, the Food and Drug Administration is ratcheting up the standards for health claims in the labeling of foods and supplements.

The changes come under the provisions of the agency's Consumer Health Information for Better Nutrition Initiative.

Under this initiative, the agency will use evidence-based rankings to evaluate everything from plant-derived tablets purporting to lower cholesterol to “natural” appetite suppressants that promise easy weight loss, J.C. Rowlands, Ph.D., said in a presentation at the annual meeting of the American College of Nutrition.

The FDA embarked on this revision as a result of two simultaneous trends in the last few years: the apparent rise of misleading claims about dietary supplements, and the actual increase of solid research on their potential benefits, said Dr. Rowlands, a scientist for the Center for Food Safety and Applied Nutrition at the FDA.

As a result of the initiative, manufacturers will have to make a stronger case for claims of prevention and symptom relief. Their evidence will be reviewed for scientific soundness by looking not just at how studies were conducted, but how many participants they included and how many different trials occurred. Randomized, placebo-controlled trials top the list. “The [current] evidence-based ranking system defines credible evidence,” he said, adding that “we are looking for consistency.”

It has been 10 years since Congress enacted the first such oversight restrictions in its unprecedented Dietary Supplement Health and Education Act, but the battle against its concept began even before the act was signed into law. “Lawsuits began being filed before the ink was even dry,” Dr. Rowlands said. Using arguments centered on first-amendment rights, some supplement makers waged successful court battles in favor of language that allowed certain promises on the packaging, such as better heart health or bone growth.

Under the new initiative, several steps are taken to identify the relevant studies underpinning such claims, and the system includes rating those studies based on quality. The research is assessed for “strength” by looking at the number of studies that are available, as well as the similarity–or lack thereof–within the findings.

There are essentially four ranks for health claims, with the highest level called “significant scientific agreement.” The three lower levels are substantiated by less scientific evidence than an SSA claim. As such, they require qualifying language on their labels, Dr. Rowlands said.

Any supplement that claims to reduce the risk for a certain disease in the general population or a targeted subgroup is to be reviewed under the new system. The system is likely to evolve even more, as the research on and manufacture of health-promoting foods and supplements continues to grow. “We wish we had an exact formula” for evaluation, Dr. Rowlands said. But a precise, black-and-white, all-inclusive method of assessment has proved elusive in this rapidly changing field, he said.

LONG BEACH, CALIF. – Dietary supplements will soon bear labels worded a whole lot more like the ones on over-the-counter medications and a whole lot less like the text of infomercials.

In a move designed to protect consumers by requiring that health claims are supported by scientific evidence, the Food and Drug Administration is ratcheting up the standards for health claims in the labeling of foods and supplements.

The changes come under the provisions of the agency's Consumer Health Information for Better Nutrition Initiative.

Under this initiative, the agency will use evidence-based rankings to evaluate everything from plant-derived tablets purporting to lower cholesterol to “natural” appetite suppressants that promise easy weight loss, J.C. Rowlands, Ph.D., said in a presentation at the annual meeting of the American College of Nutrition.

The FDA embarked on this revision as a result of two simultaneous trends in the last few years: the apparent rise of misleading claims about dietary supplements, and the actual increase of solid research on their potential benefits, said Dr. Rowlands, a scientist for the Center for Food Safety and Applied Nutrition at the FDA.

As a result of the initiative, manufacturers will have to make a stronger case for claims of prevention and symptom relief. Their evidence will be reviewed for scientific soundness by looking not just at how studies were conducted, but how many participants they included and how many different trials occurred. Randomized, placebo-controlled trials top the list. “The [current] evidence-based ranking system defines credible evidence,” he said, adding that “we are looking for consistency.”

It has been 10 years since Congress enacted the first such oversight restrictions in its unprecedented Dietary Supplement Health and Education Act, but the battle against its concept began even before the act was signed into law. “Lawsuits began being filed before the ink was even dry,” Dr. Rowlands said. Using arguments centered on first-amendment rights, some supplement makers waged successful court battles in favor of language that allowed certain promises on the packaging, such as better heart health or bone growth.

Under the new initiative, several steps are taken to identify the relevant studies underpinning such claims, and the system includes rating those studies based on quality. The research is assessed for “strength” by looking at the number of studies that are available, as well as the similarity–or lack thereof–within the findings.

There are essentially four ranks for health claims, with the highest level called “significant scientific agreement.” The three lower levels are substantiated by less scientific evidence than an SSA claim. As such, they require qualifying language on their labels, Dr. Rowlands said.

Any supplement that claims to reduce the risk for a certain disease in the general population or a targeted subgroup is to be reviewed under the new system. The system is likely to evolve even more, as the research on and manufacture of health-promoting foods and supplements continues to grow. “We wish we had an exact formula” for evaluation, Dr. Rowlands said. But a precise, black-and-white, all-inclusive method of assessment has proved elusive in this rapidly changing field, he said.

SAN FRANCISCO – Boys who say they want to become girls may be trying to win a lost mother's love rather than expressing a true desire to switch gender, Judith Fingert Chused, M.D., said at the annual meeting of the American Psychoanalytic Association.

One of the most challenging psychotherapeutic dilemmas is treating young patients who believe they are “biologically incongruent” to their birth gender. Why? “Because the wish to be a different gender may have to do with something else that is going on,” said Dr. Chused of the department of psychiatry and behavioral sciences at George Washington University, Washington.

Although there is growing recognition that some people correctly identify themselves as being a different gender from a very early age, when it comes to children there is every reason to question such self-assessment, she said. In her practice, she has found that early maternal loss–between 12 and 24 months of age–and parent intolerance of aggressive behavior can underlie a boy's repeated assertion that he wants to be a girl.

Treatment of children needs to take into account the role of unconscious fantasies, which can be tough to discern in children, but this aspect may be particularly influential for those who express the wish to be a different gender, Dr. Chused stressed.

In her experience of treating several boys who said they wanted to be girls, she found that they had a universal longing to become like their mothers. “It was to try to find a way to be close to her, by becoming her themselves,” she suggested.

In the cases she has encountered, maternal deprivation seemed to go hand in hand with the expressed desire, although the loss of the mother occurred in different ways, she pointed out. Of course, she added, not all boys who have lost their mothers wish to change into girls, just as a male having feminine traits is not necessarily a sign of pathology.

Dr. Chused speculated that variations of maternal loss may be an underrecognized etiology for certain cases of gender identity disorder. In the panel discussion of the issue, she reiterated that concern, saying, “My sense from this [experience] and from reading the material on it, is that very few boys actually want to be a girl.”

In one case, she concluded that a boy had nothing more than a craving for maternal affection and that his mother had shown disdain for men. “This is different from wanting to be a girl. This is wanting to be loved,” she said. The reverse also seems to be true, according to the literature. When girls have mothers who don't like themselves as women, or who have a strong bias against their own gender, they may express the desire to be boys, believing that if they were male, they would be more acceptable to their parents, she said.

“The way I address such gender issues is to ask, 'Why is this child not comfortable with himself?' and to look at the whole individual within his environment–who is he or she,” she advised.

SAN FRANCISCO – Boys who say they want to become girls may be trying to win a lost mother's love rather than expressing a true desire to switch gender, Judith Fingert Chused, M.D., said at the annual meeting of the American Psychoanalytic Association.

One of the most challenging psychotherapeutic dilemmas is treating young patients who believe they are “biologically incongruent” to their birth gender. Why? “Because the wish to be a different gender may have to do with something else that is going on,” said Dr. Chused of the department of psychiatry and behavioral sciences at George Washington University, Washington.

Although there is growing recognition that some people correctly identify themselves as being a different gender from a very early age, when it comes to children there is every reason to question such self-assessment, she said. In her practice, she has found that early maternal loss–between 12 and 24 months of age–and parent intolerance of aggressive behavior can underlie a boy's repeated assertion that he wants to be a girl.

Treatment of children needs to take into account the role of unconscious fantasies, which can be tough to discern in children, but this aspect may be particularly influential for those who express the wish to be a different gender, Dr. Chused stressed.

In her experience of treating several boys who said they wanted to be girls, she found that they had a universal longing to become like their mothers. “It was to try to find a way to be close to her, by becoming her themselves,” she suggested.

In the cases she has encountered, maternal deprivation seemed to go hand in hand with the expressed desire, although the loss of the mother occurred in different ways, she pointed out. Of course, she added, not all boys who have lost their mothers wish to change into girls, just as a male having feminine traits is not necessarily a sign of pathology.

Dr. Chused speculated that variations of maternal loss may be an underrecognized etiology for certain cases of gender identity disorder. In the panel discussion of the issue, she reiterated that concern, saying, “My sense from this [experience] and from reading the material on it, is that very few boys actually want to be a girl.”

In one case, she concluded that a boy had nothing more than a craving for maternal affection and that his mother had shown disdain for men. “This is different from wanting to be a girl. This is wanting to be loved,” she said. The reverse also seems to be true, according to the literature. When girls have mothers who don't like themselves as women, or who have a strong bias against their own gender, they may express the desire to be boys, believing that if they were male, they would be more acceptable to their parents, she said.

“The way I address such gender issues is to ask, 'Why is this child not comfortable with himself?' and to look at the whole individual within his environment–who is he or she,” she advised.

SAN FRANCISCO – Boys who say they want to become girls may be trying to win a lost mother's love rather than expressing a true desire to switch gender, Judith Fingert Chused, M.D., said at the annual meeting of the American Psychoanalytic Association.

One of the most challenging psychotherapeutic dilemmas is treating young patients who believe they are “biologically incongruent” to their birth gender. Why? “Because the wish to be a different gender may have to do with something else that is going on,” said Dr. Chused of the department of psychiatry and behavioral sciences at George Washington University, Washington.

Although there is growing recognition that some people correctly identify themselves as being a different gender from a very early age, when it comes to children there is every reason to question such self-assessment, she said. In her practice, she has found that early maternal loss–between 12 and 24 months of age–and parent intolerance of aggressive behavior can underlie a boy's repeated assertion that he wants to be a girl.

Treatment of children needs to take into account the role of unconscious fantasies, which can be tough to discern in children, but this aspect may be particularly influential for those who express the wish to be a different gender, Dr. Chused stressed.

In her experience of treating several boys who said they wanted to be girls, she found that they had a universal longing to become like their mothers. “It was to try to find a way to be close to her, by becoming her themselves,” she suggested.

In the cases she has encountered, maternal deprivation seemed to go hand in hand with the expressed desire, although the loss of the mother occurred in different ways, she pointed out. Of course, she added, not all boys who have lost their mothers wish to change into girls, just as a male having feminine traits is not necessarily a sign of pathology.

Dr. Chused speculated that variations of maternal loss may be an underrecognized etiology for certain cases of gender identity disorder. In the panel discussion of the issue, she reiterated that concern, saying, “My sense from this [experience] and from reading the material on it, is that very few boys actually want to be a girl.”

In one case, she concluded that a boy had nothing more than a craving for maternal affection and that his mother had shown disdain for men. “This is different from wanting to be a girl. This is wanting to be loved,” she said. The reverse also seems to be true, according to the literature. When girls have mothers who don't like themselves as women, or who have a strong bias against their own gender, they may express the desire to be boys, believing that if they were male, they would be more acceptable to their parents, she said.

“The way I address such gender issues is to ask, 'Why is this child not comfortable with himself?' and to look at the whole individual within his environment–who is he or she,” she advised.

SAN FRANCISCO — If you don't think you have the time or money to produce effective patient education materials guess what? You're right.

But don't let that stop you.

That was the advice of Cindy Barter, M.D., who urged her colleagues at a conference on patient education sponsored by the Society of Teachers of Family Medicine to provide patients with easy-to-read, eye-catching information that they can rely on outside the physician's office.

Dr. Barter, who practices in Bethlehem, Pa., said she was not going to pretend that time and budget constraints are not a big barrier to providing this kind of patient education. “They are,” she said.

However, by mining the Internet and buttonholing her corporate contacts, she has been able to give patients everything from disease-specific literature at a level they can understand to interactive Web-based information at the click of a mouse. It takes some digging around, she conceded, “but you can do it.”

There are ways to trim both cost and time to provide good patient education to this population, Dr. Barter said at the conference, also sponsored by the American Academy of Family Physicians.

“Here are some things to think about doing,” she responded:

▸ Exploit the Internet. Though in the not so distant past many patients did not have online access, that is rapidly changing. A federal survey showed the population of Internet users, even among elderly groups, has climbed from about 25% to nearly 50% over the past several years, according to the Centers for Disease Control and Prevention. As a result, e-mail is being more commonly used to educate and keep in touch with patients.

Lehigh Valley Hospital and Health Network, which is part of the system where she works, offers e-newsletters to help patients take more control over their health, according to its Web site. For physicians who want to provide their own brand of patient education, the AAFP offers advice and tools for building Web sites on the AAFP site. For those who want to look into starting group e-mailings, the American Medical Association's Web site contains guidelines that can help with that effort, too.

▸ Make requests of your drug reps. Tired of posters that plug a drug? In need of handouts that inform patients about the condition without urging them to use a specific product? Let your pharmaceutical representatives know, Dr. Barter urged. Though there were reports at the meeting by physicians who said they were taping over or “whiting out” such references, Dr. Barter stressed that what needs to occur is some revision. “I have no problem with a company name being listed,” she told this newspaper. However, when a pamphlet fairly screams with a message touting the corporation, she finds it less suitable to give out to patients. She feels a need to be selective in her reliance on these materials.

▸ Create your own materials. This sounds harder than it is, Dr. Barter noted. The Web site www.familydoctor.org

▸ Keep in mind that outlandish ideas sometimes fly. Dr. Barter gave the example of one relatively noncompliant patient who needed the kind of help that could not be provided on the Internet or in a pamphlet.

“She had rather poorly controlled diabetes,” Dr. Barter recalled. However, it was the fact that she did not remember to take her medication—and not lack of understanding of her disease—that was the problem. “She said she couldn't remember, and she wanted someone to call and remind her,” Dr. Barter said. “I didn't think it was possible to have someone call her every morning.”

But Dr, Barter was wrong. Under treatment in another part of her institution's program was a woman with multiple sclerosis who was homebound—and felt unproductive. “She agreed to call this patient every morning, and she felt useful doing that,” Dr. Barter said. “So you just never know.”

SAN FRANCISCO — If you don't think you have the time or money to produce effective patient education materials guess what? You're right.

But don't let that stop you.

That was the advice of Cindy Barter, M.D., who urged her colleagues at a conference on patient education sponsored by the Society of Teachers of Family Medicine to provide patients with easy-to-read, eye-catching information that they can rely on outside the physician's office.

Dr. Barter, who practices in Bethlehem, Pa., said she was not going to pretend that time and budget constraints are not a big barrier to providing this kind of patient education. “They are,” she said.

However, by mining the Internet and buttonholing her corporate contacts, she has been able to give patients everything from disease-specific literature at a level they can understand to interactive Web-based information at the click of a mouse. It takes some digging around, she conceded, “but you can do it.”

There are ways to trim both cost and time to provide good patient education to this population, Dr. Barter said at the conference, also sponsored by the American Academy of Family Physicians.

“Here are some things to think about doing,” she responded:

▸ Exploit the Internet. Though in the not so distant past many patients did not have online access, that is rapidly changing. A federal survey showed the population of Internet users, even among elderly groups, has climbed from about 25% to nearly 50% over the past several years, according to the Centers for Disease Control and Prevention. As a result, e-mail is being more commonly used to educate and keep in touch with patients.

Lehigh Valley Hospital and Health Network, which is part of the system where she works, offers e-newsletters to help patients take more control over their health, according to its Web site. For physicians who want to provide their own brand of patient education, the AAFP offers advice and tools for building Web sites on the AAFP site. For those who want to look into starting group e-mailings, the American Medical Association's Web site contains guidelines that can help with that effort, too.

▸ Make requests of your drug reps. Tired of posters that plug a drug? In need of handouts that inform patients about the condition without urging them to use a specific product? Let your pharmaceutical representatives know, Dr. Barter urged. Though there were reports at the meeting by physicians who said they were taping over or “whiting out” such references, Dr. Barter stressed that what needs to occur is some revision. “I have no problem with a company name being listed,” she told this newspaper. However, when a pamphlet fairly screams with a message touting the corporation, she finds it less suitable to give out to patients. She feels a need to be selective in her reliance on these materials.

▸ Create your own materials. This sounds harder than it is, Dr. Barter noted. The Web site www.familydoctor.org

▸ Keep in mind that outlandish ideas sometimes fly. Dr. Barter gave the example of one relatively noncompliant patient who needed the kind of help that could not be provided on the Internet or in a pamphlet.

“She had rather poorly controlled diabetes,” Dr. Barter recalled. However, it was the fact that she did not remember to take her medication—and not lack of understanding of her disease—that was the problem. “She said she couldn't remember, and she wanted someone to call and remind her,” Dr. Barter said. “I didn't think it was possible to have someone call her every morning.”

But Dr, Barter was wrong. Under treatment in another part of her institution's program was a woman with multiple sclerosis who was homebound—and felt unproductive. “She agreed to call this patient every morning, and she felt useful doing that,” Dr. Barter said. “So you just never know.”

SAN FRANCISCO — If you don't think you have the time or money to produce effective patient education materials guess what? You're right.

But don't let that stop you.

That was the advice of Cindy Barter, M.D., who urged her colleagues at a conference on patient education sponsored by the Society of Teachers of Family Medicine to provide patients with easy-to-read, eye-catching information that they can rely on outside the physician's office.

Dr. Barter, who practices in Bethlehem, Pa., said she was not going to pretend that time and budget constraints are not a big barrier to providing this kind of patient education. “They are,” she said.

However, by mining the Internet and buttonholing her corporate contacts, she has been able to give patients everything from disease-specific literature at a level they can understand to interactive Web-based information at the click of a mouse. It takes some digging around, she conceded, “but you can do it.”

There are ways to trim both cost and time to provide good patient education to this population, Dr. Barter said at the conference, also sponsored by the American Academy of Family Physicians.

“Here are some things to think about doing,” she responded:

▸ Exploit the Internet. Though in the not so distant past many patients did not have online access, that is rapidly changing. A federal survey showed the population of Internet users, even among elderly groups, has climbed from about 25% to nearly 50% over the past several years, according to the Centers for Disease Control and Prevention. As a result, e-mail is being more commonly used to educate and keep in touch with patients.

Lehigh Valley Hospital and Health Network, which is part of the system where she works, offers e-newsletters to help patients take more control over their health, according to its Web site. For physicians who want to provide their own brand of patient education, the AAFP offers advice and tools for building Web sites on the AAFP site. For those who want to look into starting group e-mailings, the American Medical Association's Web site contains guidelines that can help with that effort, too.

▸ Make requests of your drug reps. Tired of posters that plug a drug? In need of handouts that inform patients about the condition without urging them to use a specific product? Let your pharmaceutical representatives know, Dr. Barter urged. Though there were reports at the meeting by physicians who said they were taping over or “whiting out” such references, Dr. Barter stressed that what needs to occur is some revision. “I have no problem with a company name being listed,” she told this newspaper. However, when a pamphlet fairly screams with a message touting the corporation, she finds it less suitable to give out to patients. She feels a need to be selective in her reliance on these materials.

▸ Create your own materials. This sounds harder than it is, Dr. Barter noted. The Web site www.familydoctor.org

▸ Keep in mind that outlandish ideas sometimes fly. Dr. Barter gave the example of one relatively noncompliant patient who needed the kind of help that could not be provided on the Internet or in a pamphlet.

“She had rather poorly controlled diabetes,” Dr. Barter recalled. However, it was the fact that she did not remember to take her medication—and not lack of understanding of her disease—that was the problem. “She said she couldn't remember, and she wanted someone to call and remind her,” Dr. Barter said. “I didn't think it was possible to have someone call her every morning.”

But Dr, Barter was wrong. Under treatment in another part of her institution's program was a woman with multiple sclerosis who was homebound—and felt unproductive. “She agreed to call this patient every morning, and she felt useful doing that,” Dr. Barter said. “So you just never know.”

SAN FRANCISCO — Want to provide a low-cost, king-sized dose of patient education? Just invite your entire town to a weeklong, food-filled health fair.

That's what Thomas Weida, M.D., did. And to hear him tell it, the effort not only succeeded in bringing a big portion of the local population past his portals, “it was just a whole lot of fun, too.”

Though some family physicians might consider back-to-back days of health presentations, information booths, and refreshment provisions a tall order, Dr. Weida said it was “a piece of cake.”

The health fair was a simple-to-assemble community service that got him a whole lot more patients and a huge load of professional satisfaction.

“And I am an introvert,” he asserted.

Dr. Weida, professor of family and community medicine at the Pennsylvania State College of Medicine in Hershey, shared his health-fair experience during a conference on patient education sponsored by the Society of Teachers of Family Medicine.

The fair was held several years ago, when he had a successful practice in Rothsville, Pa., a town of about 2,000. In his corner of Pennsylvania, Dr. Weida became concerned about lifestyle factor—obesity and smoking, in particular—and decided to tackle the problem in an outreach program that would entice everyone.

“What we need to do is hold a fair for a whole week,” he announced to his office manager, who looked like she was going to faint. “I resuscitated her, and then I explained it,” he joked.

He sought out other local health care professionals—pharmacists, dentists, opticians, and others—and asked them to contribute to the cost of putting on the fair. “We got almost total buy-in,” he said.

Then he wrote a letter to the five major insurers in the area, suggesting that each become an event partner by contributing $1,000. Two sent a check, one wanted to provide ice cream instead of cash, and another suggested the company do on-site cholesterol screening during the fair.

“That was fine with me,” Dr. Weida said. “You have to be flexible in these things.”

Next he told about 20 pharmaceutical representatives they could rent a booth at the fair for $300, and to guarantee foot traffic, he would “let” them occupy a food station, where they could dole out edible treats right along with their product information.

“I sort of felt sorry for the guy at the coffee urn. He didn't get that many people,” Dr. Weida recalled. “But when I told him I felt badly, he said, 'I wanted to be here to support this.'”

Each day, a different event unfolded, thanks to volunteerism from local professionals.

One night, a lawyer offered advice on living wills. Another evening, a physical therapist lectured on injury-preventing exercise. One weekend morning was devoted to cholesterol awareness, with serologic screenings and a low-fat breakfast.

“A local restaurant chef did the breakfast—the best of its kind I ever had: French toast made with egg whites and baked apple mixture on top,” Dr. Weida recalled at the conference, also sponsored by the American Academy of Family Physicians.

The weekend also featured a stand-up comedian (laughter as good medicine); a psychologist who had a device to detect anxiety—it worked on the same principle as the “mood ring,” explained Dr. Weida—and an appearance by the crime-fighting canine McGruff (who held forth on the importance of bike helmets).

The health fair was such a success that Dr. Weida found himself congratulated throughout town, the recipient of honks and hand waves. The phone nearly rang off the hook with patients making new appointments, he said.

Best of all, the health fair cost him little, except in the substantial time he took to help organize it. “It was tremendous bang for our buck,” he said.

SAN FRANCISCO — Want to provide a low-cost, king-sized dose of patient education? Just invite your entire town to a weeklong, food-filled health fair.

That's what Thomas Weida, M.D., did. And to hear him tell it, the effort not only succeeded in bringing a big portion of the local population past his portals, “it was just a whole lot of fun, too.”

Though some family physicians might consider back-to-back days of health presentations, information booths, and refreshment provisions a tall order, Dr. Weida said it was “a piece of cake.”

The health fair was a simple-to-assemble community service that got him a whole lot more patients and a huge load of professional satisfaction.

“And I am an introvert,” he asserted.

Dr. Weida, professor of family and community medicine at the Pennsylvania State College of Medicine in Hershey, shared his health-fair experience during a conference on patient education sponsored by the Society of Teachers of Family Medicine.

The fair was held several years ago, when he had a successful practice in Rothsville, Pa., a town of about 2,000. In his corner of Pennsylvania, Dr. Weida became concerned about lifestyle factor—obesity and smoking, in particular—and decided to tackle the problem in an outreach program that would entice everyone.

“What we need to do is hold a fair for a whole week,” he announced to his office manager, who looked like she was going to faint. “I resuscitated her, and then I explained it,” he joked.

He sought out other local health care professionals—pharmacists, dentists, opticians, and others—and asked them to contribute to the cost of putting on the fair. “We got almost total buy-in,” he said.

Then he wrote a letter to the five major insurers in the area, suggesting that each become an event partner by contributing $1,000. Two sent a check, one wanted to provide ice cream instead of cash, and another suggested the company do on-site cholesterol screening during the fair.

“That was fine with me,” Dr. Weida said. “You have to be flexible in these things.”

Next he told about 20 pharmaceutical representatives they could rent a booth at the fair for $300, and to guarantee foot traffic, he would “let” them occupy a food station, where they could dole out edible treats right along with their product information.

“I sort of felt sorry for the guy at the coffee urn. He didn't get that many people,” Dr. Weida recalled. “But when I told him I felt badly, he said, 'I wanted to be here to support this.'”

Each day, a different event unfolded, thanks to volunteerism from local professionals.

One night, a lawyer offered advice on living wills. Another evening, a physical therapist lectured on injury-preventing exercise. One weekend morning was devoted to cholesterol awareness, with serologic screenings and a low-fat breakfast.

“A local restaurant chef did the breakfast—the best of its kind I ever had: French toast made with egg whites and baked apple mixture on top,” Dr. Weida recalled at the conference, also sponsored by the American Academy of Family Physicians.

The weekend also featured a stand-up comedian (laughter as good medicine); a psychologist who had a device to detect anxiety—it worked on the same principle as the “mood ring,” explained Dr. Weida—and an appearance by the crime-fighting canine McGruff (who held forth on the importance of bike helmets).

The health fair was such a success that Dr. Weida found himself congratulated throughout town, the recipient of honks and hand waves. The phone nearly rang off the hook with patients making new appointments, he said.

Best of all, the health fair cost him little, except in the substantial time he took to help organize it. “It was tremendous bang for our buck,” he said.

SAN FRANCISCO — Want to provide a low-cost, king-sized dose of patient education? Just invite your entire town to a weeklong, food-filled health fair.

That's what Thomas Weida, M.D., did. And to hear him tell it, the effort not only succeeded in bringing a big portion of the local population past his portals, “it was just a whole lot of fun, too.”

Though some family physicians might consider back-to-back days of health presentations, information booths, and refreshment provisions a tall order, Dr. Weida said it was “a piece of cake.”

The health fair was a simple-to-assemble community service that got him a whole lot more patients and a huge load of professional satisfaction.

“And I am an introvert,” he asserted.

Dr. Weida, professor of family and community medicine at the Pennsylvania State College of Medicine in Hershey, shared his health-fair experience during a conference on patient education sponsored by the Society of Teachers of Family Medicine.

The fair was held several years ago, when he had a successful practice in Rothsville, Pa., a town of about 2,000. In his corner of Pennsylvania, Dr. Weida became concerned about lifestyle factor—obesity and smoking, in particular—and decided to tackle the problem in an outreach program that would entice everyone.

“What we need to do is hold a fair for a whole week,” he announced to his office manager, who looked like she was going to faint. “I resuscitated her, and then I explained it,” he joked.

He sought out other local health care professionals—pharmacists, dentists, opticians, and others—and asked them to contribute to the cost of putting on the fair. “We got almost total buy-in,” he said.

Then he wrote a letter to the five major insurers in the area, suggesting that each become an event partner by contributing $1,000. Two sent a check, one wanted to provide ice cream instead of cash, and another suggested the company do on-site cholesterol screening during the fair.

“That was fine with me,” Dr. Weida said. “You have to be flexible in these things.”

Next he told about 20 pharmaceutical representatives they could rent a booth at the fair for $300, and to guarantee foot traffic, he would “let” them occupy a food station, where they could dole out edible treats right along with their product information.

“I sort of felt sorry for the guy at the coffee urn. He didn't get that many people,” Dr. Weida recalled. “But when I told him I felt badly, he said, 'I wanted to be here to support this.'”

Each day, a different event unfolded, thanks to volunteerism from local professionals.

One night, a lawyer offered advice on living wills. Another evening, a physical therapist lectured on injury-preventing exercise. One weekend morning was devoted to cholesterol awareness, with serologic screenings and a low-fat breakfast.

“A local restaurant chef did the breakfast—the best of its kind I ever had: French toast made with egg whites and baked apple mixture on top,” Dr. Weida recalled at the conference, also sponsored by the American Academy of Family Physicians.

The weekend also featured a stand-up comedian (laughter as good medicine); a psychologist who had a device to detect anxiety—it worked on the same principle as the “mood ring,” explained Dr. Weida—and an appearance by the crime-fighting canine McGruff (who held forth on the importance of bike helmets).

The health fair was such a success that Dr. Weida found himself congratulated throughout town, the recipient of honks and hand waves. The phone nearly rang off the hook with patients making new appointments, he said.

Best of all, the health fair cost him little, except in the substantial time he took to help organize it. “It was tremendous bang for our buck,” he said.

SAN FRANCISCO — To improve the level of foot care that family medicine residents provided to diabetic patients, their teachers at the Medical College of Wisconsin put a sock in it.

Literally.

“We came up with this idea that to bring [diabetic] foot care to a level we wanted it to be, we should award a pair of socks to every physician who helped us get there,” said Robin Helm, M.D, associate director of the St. Michael Hospital Family Practice Residency Program in Milwaukee.

The effort was designed to raise compliance with the foot-exam benchmark of the Diabetes Physician Recognition Program, a national quality-of-care project of the American Diabetes Association and the National Committee for Quality Assurance.

For compliance checking, electronic medical records were analyzed for all 18 residents and 6 faculty members who treated or examined diabetes patients. What impact did the socks have? Compliance soared to 85%.

Dr. Helm outlined what was jokingly referred to as “the sock-it-to-–em program” at the annual meeting of the Society of Teachers of Family Medicine. She and Beth Damitz, M.D., the medical director of the program's family care center, gave an informal talk, along with Sandra Olsen, the program administrator. All three were stunned to see the rates of compliance zoom, once the socks were dangled as an incentive.

“I tried to get bright, fun sort of socks. But they were from just a regular store, maybe a little flashier, but nothing special,” Dr. Helm said. In fact, some male residents thought the socks were “too feminine,” so the trio found keychains with charms of tiny feet. “This was given instead of socks to them, but it had the same effect.

“At first it seemed kind of goofy,” Ms. Olsen said. However, at the monthly meetings of faculty and residents, a “big deal” was made when the socks were ceremoniously handed out. “After a while, we had residents who said 'I know I should qualify, and I haven't gotten my socks yet!'” observed Dr. Helm.

The physician recognition program's benchmark for diabetic foot exams is 75% compliance, and the “rates started out dismally, at about 5%,” Ms. Olsen said at the meeting sponsored by the American Academy of Family Physicians. Now, with 600 diabetic patients being seen intermittently, the rate is inching to 90%.

Another reason for the now-high compliance may be that letters are sent out to all patients, reminding them to bare their feet during visits. Dr. Helm said she did not know why the initial foot exams were so rarely undertaken. She speculated that some residents may have thought it invasive to have a patient remove shoes and socks after they reported no problems with their feet.

SAN FRANCISCO — To improve the level of foot care that family medicine residents provided to diabetic patients, their teachers at the Medical College of Wisconsin put a sock in it.

Literally.

“We came up with this idea that to bring [diabetic] foot care to a level we wanted it to be, we should award a pair of socks to every physician who helped us get there,” said Robin Helm, M.D, associate director of the St. Michael Hospital Family Practice Residency Program in Milwaukee.

The effort was designed to raise compliance with the foot-exam benchmark of the Diabetes Physician Recognition Program, a national quality-of-care project of the American Diabetes Association and the National Committee for Quality Assurance.

For compliance checking, electronic medical records were analyzed for all 18 residents and 6 faculty members who treated or examined diabetes patients. What impact did the socks have? Compliance soared to 85%.

Dr. Helm outlined what was jokingly referred to as “the sock-it-to-–em program” at the annual meeting of the Society of Teachers of Family Medicine. She and Beth Damitz, M.D., the medical director of the program's family care center, gave an informal talk, along with Sandra Olsen, the program administrator. All three were stunned to see the rates of compliance zoom, once the socks were dangled as an incentive.

“I tried to get bright, fun sort of socks. But they were from just a regular store, maybe a little flashier, but nothing special,” Dr. Helm said. In fact, some male residents thought the socks were “too feminine,” so the trio found keychains with charms of tiny feet. “This was given instead of socks to them, but it had the same effect.

“At first it seemed kind of goofy,” Ms. Olsen said. However, at the monthly meetings of faculty and residents, a “big deal” was made when the socks were ceremoniously handed out. “After a while, we had residents who said 'I know I should qualify, and I haven't gotten my socks yet!'” observed Dr. Helm.

The physician recognition program's benchmark for diabetic foot exams is 75% compliance, and the “rates started out dismally, at about 5%,” Ms. Olsen said at the meeting sponsored by the American Academy of Family Physicians. Now, with 600 diabetic patients being seen intermittently, the rate is inching to 90%.

Another reason for the now-high compliance may be that letters are sent out to all patients, reminding them to bare their feet during visits. Dr. Helm said she did not know why the initial foot exams were so rarely undertaken. She speculated that some residents may have thought it invasive to have a patient remove shoes and socks after they reported no problems with their feet.

SAN FRANCISCO — To improve the level of foot care that family medicine residents provided to diabetic patients, their teachers at the Medical College of Wisconsin put a sock in it.

Literally.

“We came up with this idea that to bring [diabetic] foot care to a level we wanted it to be, we should award a pair of socks to every physician who helped us get there,” said Robin Helm, M.D, associate director of the St. Michael Hospital Family Practice Residency Program in Milwaukee.

The effort was designed to raise compliance with the foot-exam benchmark of the Diabetes Physician Recognition Program, a national quality-of-care project of the American Diabetes Association and the National Committee for Quality Assurance.

For compliance checking, electronic medical records were analyzed for all 18 residents and 6 faculty members who treated or examined diabetes patients. What impact did the socks have? Compliance soared to 85%.

Dr. Helm outlined what was jokingly referred to as “the sock-it-to-–em program” at the annual meeting of the Society of Teachers of Family Medicine. She and Beth Damitz, M.D., the medical director of the program's family care center, gave an informal talk, along with Sandra Olsen, the program administrator. All three were stunned to see the rates of compliance zoom, once the socks were dangled as an incentive.

“I tried to get bright, fun sort of socks. But they were from just a regular store, maybe a little flashier, but nothing special,” Dr. Helm said. In fact, some male residents thought the socks were “too feminine,” so the trio found keychains with charms of tiny feet. “This was given instead of socks to them, but it had the same effect.

“At first it seemed kind of goofy,” Ms. Olsen said. However, at the monthly meetings of faculty and residents, a “big deal” was made when the socks were ceremoniously handed out. “After a while, we had residents who said 'I know I should qualify, and I haven't gotten my socks yet!'” observed Dr. Helm.

The physician recognition program's benchmark for diabetic foot exams is 75% compliance, and the “rates started out dismally, at about 5%,” Ms. Olsen said at the meeting sponsored by the American Academy of Family Physicians. Now, with 600 diabetic patients being seen intermittently, the rate is inching to 90%.

Another reason for the now-high compliance may be that letters are sent out to all patients, reminding them to bare their feet during visits. Dr. Helm said she did not know why the initial foot exams were so rarely undertaken. She speculated that some residents may have thought it invasive to have a patient remove shoes and socks after they reported no problems with their feet.

NEWPORT BEACH, CALIF. — What has a long track record of safety and is tailor-made for dermatologists wary of overcorrection? Radiesse, an injectable filler with a 30-year history of use in bone repair and dental work, Michael Churukian, M.D., said at a meeting sponsored by the Foundation for Facial Plastic Surgery.

"I have never had the courage to use a foreign body" to smooth and contour facial lines, explained Dr. Churukian, who practices in Beverly Hills, Calif. "I am a real sissy about it."

He added that 2 decades ago, after reports of hypersensitivity reactions from certain bulking agents, he decided to turn to a material he had seen used for skull restoration early in his medical career: Radiesse, which is manufactured by BioForm Medical Inc. and, until July 2004, was known as Radiance. It duplicates a naturally occurring mineral, and solid evidence suggests that it is incorporated into the surrounding tissue, then largely replaced by it, over several months' time, he said.

However, the reason for his increasing reliance on Radiesse—aside from his own confidence in it—centers on meeting patient demand, Dr. Churukian said at the meeting, which was also sponsored by Medical Education Resources. Since the advent of collagen and, more recently, Botox, patients have gotten used to the idea of undergoing procedures intermittently. However, they have also become more discerning. They want a product that has a track record of effective, long-term use. Radiesse fits the bill: It has been injected into thousand of patients with no reports of serious adverse effects, and no pretesting of any kind is required, Dr. Churukian said.

"When I started out, there was only one thing—collagen," he said. "Now there are almost too many choices, all these different injectables."

"Everything works; that is not the issue," he said. However, he uses Radiesse to avoid the risk of an allergic reaction, and he injects the microspheres in such tiny increments that the chance of "overdoing it" is almost zero.

Using quantities tantamount to about half of the recommended volume enables him to do less, not more, than he intends. "You never know how exuberant that implant is going to be," he said. "Rather than go for a home run, go for a double."

A subtle result is more likely to guarantee returning patients, he said. "They see you, they trust you, they come back," he said. On the other hand, overcorrection can mean disappointment, and "they will tell their friends [and] family about that."

Most patients who undergo treatment can count on the fact that it will last about 2 years, although there is some variation, he said. There have been some minor complications, such as lumpiness around the injection site, but most of those results have been transient, he said. In addition, Dr. Churukian has largely limited his use of this filler to frown lines and other kinds of furrows, and has avoided attempting to enhance asymmetrical features or augment underlying facial structure.

Responses to 120 patient questionnaires over the past few years showed that most patients believed the treatment adequately improved their appearance, found the cost to be reasonable, and said they would recommend the treatment to their friends.

NEWPORT BEACH, CALIF. — What has a long track record of safety and is tailor-made for dermatologists wary of overcorrection? Radiesse, an injectable filler with a 30-year history of use in bone repair and dental work, Michael Churukian, M.D., said at a meeting sponsored by the Foundation for Facial Plastic Surgery.

"I have never had the courage to use a foreign body" to smooth and contour facial lines, explained Dr. Churukian, who practices in Beverly Hills, Calif. "I am a real sissy about it."

He added that 2 decades ago, after reports of hypersensitivity reactions from certain bulking agents, he decided to turn to a material he had seen used for skull restoration early in his medical career: Radiesse, which is manufactured by BioForm Medical Inc. and, until July 2004, was known as Radiance. It duplicates a naturally occurring mineral, and solid evidence suggests that it is incorporated into the surrounding tissue, then largely replaced by it, over several months' time, he said.

However, the reason for his increasing reliance on Radiesse—aside from his own confidence in it—centers on meeting patient demand, Dr. Churukian said at the meeting, which was also sponsored by Medical Education Resources. Since the advent of collagen and, more recently, Botox, patients have gotten used to the idea of undergoing procedures intermittently. However, they have also become more discerning. They want a product that has a track record of effective, long-term use. Radiesse fits the bill: It has been injected into thousand of patients with no reports of serious adverse effects, and no pretesting of any kind is required, Dr. Churukian said.

"When I started out, there was only one thing—collagen," he said. "Now there are almost too many choices, all these different injectables."

"Everything works; that is not the issue," he said. However, he uses Radiesse to avoid the risk of an allergic reaction, and he injects the microspheres in such tiny increments that the chance of "overdoing it" is almost zero.

Using quantities tantamount to about half of the recommended volume enables him to do less, not more, than he intends. "You never know how exuberant that implant is going to be," he said. "Rather than go for a home run, go for a double."

A subtle result is more likely to guarantee returning patients, he said. "They see you, they trust you, they come back," he said. On the other hand, overcorrection can mean disappointment, and "they will tell their friends [and] family about that."

Most patients who undergo treatment can count on the fact that it will last about 2 years, although there is some variation, he said. There have been some minor complications, such as lumpiness around the injection site, but most of those results have been transient, he said. In addition, Dr. Churukian has largely limited his use of this filler to frown lines and other kinds of furrows, and has avoided attempting to enhance asymmetrical features or augment underlying facial structure.

Responses to 120 patient questionnaires over the past few years showed that most patients believed the treatment adequately improved their appearance, found the cost to be reasonable, and said they would recommend the treatment to their friends.

NEWPORT BEACH, CALIF. — What has a long track record of safety and is tailor-made for dermatologists wary of overcorrection? Radiesse, an injectable filler with a 30-year history of use in bone repair and dental work, Michael Churukian, M.D., said at a meeting sponsored by the Foundation for Facial Plastic Surgery.

"I have never had the courage to use a foreign body" to smooth and contour facial lines, explained Dr. Churukian, who practices in Beverly Hills, Calif. "I am a real sissy about it."

He added that 2 decades ago, after reports of hypersensitivity reactions from certain bulking agents, he decided to turn to a material he had seen used for skull restoration early in his medical career: Radiesse, which is manufactured by BioForm Medical Inc. and, until July 2004, was known as Radiance. It duplicates a naturally occurring mineral, and solid evidence suggests that it is incorporated into the surrounding tissue, then largely replaced by it, over several months' time, he said.

However, the reason for his increasing reliance on Radiesse—aside from his own confidence in it—centers on meeting patient demand, Dr. Churukian said at the meeting, which was also sponsored by Medical Education Resources. Since the advent of collagen and, more recently, Botox, patients have gotten used to the idea of undergoing procedures intermittently. However, they have also become more discerning. They want a product that has a track record of effective, long-term use. Radiesse fits the bill: It has been injected into thousand of patients with no reports of serious adverse effects, and no pretesting of any kind is required, Dr. Churukian said.

"When I started out, there was only one thing—collagen," he said. "Now there are almost too many choices, all these different injectables."

"Everything works; that is not the issue," he said. However, he uses Radiesse to avoid the risk of an allergic reaction, and he injects the microspheres in such tiny increments that the chance of "overdoing it" is almost zero.

Using quantities tantamount to about half of the recommended volume enables him to do less, not more, than he intends. "You never know how exuberant that implant is going to be," he said. "Rather than go for a home run, go for a double."

A subtle result is more likely to guarantee returning patients, he said. "They see you, they trust you, they come back," he said. On the other hand, overcorrection can mean disappointment, and "they will tell their friends [and] family about that."

Most patients who undergo treatment can count on the fact that it will last about 2 years, although there is some variation, he said. There have been some minor complications, such as lumpiness around the injection site, but most of those results have been transient, he said. In addition, Dr. Churukian has largely limited his use of this filler to frown lines and other kinds of furrows, and has avoided attempting to enhance asymmetrical features or augment underlying facial structure.

Responses to 120 patient questionnaires over the past few years showed that most patients believed the treatment adequately improved their appearance, found the cost to be reasonable, and said they would recommend the treatment to their friends.

NEWPORT BEACH, CALIF. — For any dermatologist who wonders whether patients will clamor for the permanent injectable Artecoll when and if it clinches approval from the Food and Drug Administration, David Ellis, M.D., has this answer: yes and no.

At a meeting sponsored by the Foundation for Facial Plastic Surgery, Dr. Ellis predicted a continuing need for a broad array of products to meet patient demand. However, he said that Artecoll may expand the patient population to include those who are squeamish about temporary fillers and want something permanent.

"There is no question that the technology [for permanent filling] is now available, and that it is safer and more effective" than ever before, said Dr. Ellis, professor of otolaryngology and facial and plastic surgery at the University of Toronto.

He has been using Artecoll for about 3 years in women and men in his practice in Canada who don't want to undergo surgery for a facelift but who don't like the idea of periodic injections.

His experience with the injectable has been very favorable, consistent with reports on its use in Europe over the past decade, he said, adding that he has no financial interest in the product. However, Artecoll isn't likely to dampen enthusiasm for existing methods, he predicted at the meeting, which was also sponsored by Medical Education Resources.

Because of heightened consumer awareness, many patients know the options before they ever come in for a consultation, and they often have strong opinions.

"It is very important to match the product with the desires" of the patient, Dr. Ellis stressed.

"I still have one patient who likes collagen, and so I get it for her," he said. It isn't that she is unaware of the benefits of Artecoll; she just prefers collagen.

Artecoll is made up of polymethylmethacrylate microspheres, which are suspended in collagen. The beads, which are a microimplant, spur collagen production to fill in lines over a 2- to 3-month period, Dr. Ellis explained.

Though this technique provides long-term augmentation, it does have its drawbacks. "Even people happy with the correction will feel the implant," according to Dr. Ellis. In clinical practice, Artecoll works best in grooves and creases, and the lip can be a "problem area," he said. In addition, Consumer Reports took a look at cosmetic fillers this past fall and noted that there had been preliminary reports of infection with Artecoll, with resulting red lines.

"These lines are removed through an incision that can scar," Consumer Reports magazine stated.

Dr. Ellis said he has had almost uniformly good results, with implant longevity that matched his use of the product, beginning in 2000.

However, he noted that Artecoll, which is likely to be marketed in the United States as Artefill, will be slightly different if and when it makes its American debut. Because of concerns on the part of the U.S. government and American public over the potential for bovine spongiform encephalitis (BSE), Artefill would be derived from a pristine herd of cattle reared separately in the western United States and subjected to frequent and intensive testing for BSE.

Dr. Ellis also speculated during his presentation that Artecoll users may prefer Dermalive, a permanent filler that may eventually receive federal approval for use in the United States.

Dermalive is made of flexible particles of acrylic hydrogel and hyaluronic acid, and it is not derived from animals. "So, there is no skin test," he noted.

Dr. Ellis has been using Dermalive for at least 1 year, with equally good results. "I find that I get more even flow and avoid lumpiness."

A "few patients will get a lot of swelling and redness," when Dermalive is administered as a permanent filler, so it has some disadvantages, too, he added.

NEWPORT BEACH, CALIF. — For any dermatologist who wonders whether patients will clamor for the permanent injectable Artecoll when and if it clinches approval from the Food and Drug Administration, David Ellis, M.D., has this answer: yes and no.

At a meeting sponsored by the Foundation for Facial Plastic Surgery, Dr. Ellis predicted a continuing need for a broad array of products to meet patient demand. However, he said that Artecoll may expand the patient population to include those who are squeamish about temporary fillers and want something permanent.

"There is no question that the technology [for permanent filling] is now available, and that it is safer and more effective" than ever before, said Dr. Ellis, professor of otolaryngology and facial and plastic surgery at the University of Toronto.

He has been using Artecoll for about 3 years in women and men in his practice in Canada who don't want to undergo surgery for a facelift but who don't like the idea of periodic injections.

His experience with the injectable has been very favorable, consistent with reports on its use in Europe over the past decade, he said, adding that he has no financial interest in the product. However, Artecoll isn't likely to dampen enthusiasm for existing methods, he predicted at the meeting, which was also sponsored by Medical Education Resources.

Because of heightened consumer awareness, many patients know the options before they ever come in for a consultation, and they often have strong opinions.

"It is very important to match the product with the desires" of the patient, Dr. Ellis stressed.

"I still have one patient who likes collagen, and so I get it for her," he said. It isn't that she is unaware of the benefits of Artecoll; she just prefers collagen.

Artecoll is made up of polymethylmethacrylate microspheres, which are suspended in collagen. The beads, which are a microimplant, spur collagen production to fill in lines over a 2- to 3-month period, Dr. Ellis explained.

Though this technique provides long-term augmentation, it does have its drawbacks. "Even people happy with the correction will feel the implant," according to Dr. Ellis. In clinical practice, Artecoll works best in grooves and creases, and the lip can be a "problem area," he said. In addition, Consumer Reports took a look at cosmetic fillers this past fall and noted that there had been preliminary reports of infection with Artecoll, with resulting red lines.

"These lines are removed through an incision that can scar," Consumer Reports magazine stated.

Dr. Ellis said he has had almost uniformly good results, with implant longevity that matched his use of the product, beginning in 2000.

However, he noted that Artecoll, which is likely to be marketed in the United States as Artefill, will be slightly different if and when it makes its American debut. Because of concerns on the part of the U.S. government and American public over the potential for bovine spongiform encephalitis (BSE), Artefill would be derived from a pristine herd of cattle reared separately in the western United States and subjected to frequent and intensive testing for BSE.

Dr. Ellis also speculated during his presentation that Artecoll users may prefer Dermalive, a permanent filler that may eventually receive federal approval for use in the United States.

Dermalive is made of flexible particles of acrylic hydrogel and hyaluronic acid, and it is not derived from animals. "So, there is no skin test," he noted.

Dr. Ellis has been using Dermalive for at least 1 year, with equally good results. "I find that I get more even flow and avoid lumpiness."

A "few patients will get a lot of swelling and redness," when Dermalive is administered as a permanent filler, so it has some disadvantages, too, he added.

NEWPORT BEACH, CALIF. — For any dermatologist who wonders whether patients will clamor for the permanent injectable Artecoll when and if it clinches approval from the Food and Drug Administration, David Ellis, M.D., has this answer: yes and no.

At a meeting sponsored by the Foundation for Facial Plastic Surgery, Dr. Ellis predicted a continuing need for a broad array of products to meet patient demand. However, he said that Artecoll may expand the patient population to include those who are squeamish about temporary fillers and want something permanent.

"There is no question that the technology [for permanent filling] is now available, and that it is safer and more effective" than ever before, said Dr. Ellis, professor of otolaryngology and facial and plastic surgery at the University of Toronto.

He has been using Artecoll for about 3 years in women and men in his practice in Canada who don't want to undergo surgery for a facelift but who don't like the idea of periodic injections.

His experience with the injectable has been very favorable, consistent with reports on its use in Europe over the past decade, he said, adding that he has no financial interest in the product. However, Artecoll isn't likely to dampen enthusiasm for existing methods, he predicted at the meeting, which was also sponsored by Medical Education Resources.

Because of heightened consumer awareness, many patients know the options before they ever come in for a consultation, and they often have strong opinions.

"It is very important to match the product with the desires" of the patient, Dr. Ellis stressed.

"I still have one patient who likes collagen, and so I get it for her," he said. It isn't that she is unaware of the benefits of Artecoll; she just prefers collagen.

Artecoll is made up of polymethylmethacrylate microspheres, which are suspended in collagen. The beads, which are a microimplant, spur collagen production to fill in lines over a 2- to 3-month period, Dr. Ellis explained.

Though this technique provides long-term augmentation, it does have its drawbacks. "Even people happy with the correction will feel the implant," according to Dr. Ellis. In clinical practice, Artecoll works best in grooves and creases, and the lip can be a "problem area," he said. In addition, Consumer Reports took a look at cosmetic fillers this past fall and noted that there had been preliminary reports of infection with Artecoll, with resulting red lines.

"These lines are removed through an incision that can scar," Consumer Reports magazine stated.

Dr. Ellis said he has had almost uniformly good results, with implant longevity that matched his use of the product, beginning in 2000.

However, he noted that Artecoll, which is likely to be marketed in the United States as Artefill, will be slightly different if and when it makes its American debut. Because of concerns on the part of the U.S. government and American public over the potential for bovine spongiform encephalitis (BSE), Artefill would be derived from a pristine herd of cattle reared separately in the western United States and subjected to frequent and intensive testing for BSE.

Dr. Ellis also speculated during his presentation that Artecoll users may prefer Dermalive, a permanent filler that may eventually receive federal approval for use in the United States.

Dermalive is made of flexible particles of acrylic hydrogel and hyaluronic acid, and it is not derived from animals. "So, there is no skin test," he noted.

Dr. Ellis has been using Dermalive for at least 1 year, with equally good results. "I find that I get more even flow and avoid lumpiness."

A "few patients will get a lot of swelling and redness," when Dermalive is administered as a permanent filler, so it has some disadvantages, too, he added.

NEWPORT BEACH, CALIF. — Light therapy with a photosensitizing agent is an effective treatment for acne vulgaris and provides an important alternative to other approaches, Dore Gilbert, M.D., said at a meeting sponsored by the Foundation for Facial Plastic Surgery.

Though treatment with retin-A compounds is the front-line option for most dermatologists who have patients with sebaceous acne, this is another way to see visible improvement—and to satisfy patients, said Dr. Gilbert, who practices in Newport Beach, Calif. "It is not a cure, but we do see a long-term deterrence of the condition."

Current drug therapies for acne have side effects, and some adolescents cannot tolerate them, he observed. However, there are no such concerns with light therapy. By adding levulinic acid to the regimen, "you get a much quicker response and better skin texture changes," he said. The effect on the sebaceous gland is fairly well documented: Light activation in the presence of a photosensitizing agent diminishes the sebaceous product inside the pustule and kills the bacteria thriving in it. Shrinkage occurs quickly, Dr. Gilbert said.

The term photodynamic therapy was coined a century ago by German scientists who observed that targeted light benefited certain skin conditions, including acne. Only a few decades ago, it was not unusual to see adolescents with serious involvement who suffered periodic sunburns, thanks to popular home treatments with a UV lamp. Now, with the addition of photosensitizing compounds to activate certain target cells, the administration of light is proving much safer than, and just as effective as, some topical treatments, Dr. Gilbert said at the meeting, which was also sponsored by Medical Education Resources.

He has treated patients with the combination of a photosensitizer and both blue light and intense pulsed-light therapy. Significant clearance with a few treatments, sometimes only one, is achieved about 75% of the time in patients with cystic or superpustular acne, he said. About 50% of his patients have had a quantifiable decrease in pore size.

The photosensitizing compound needs to be activated by wavelengths with good penetration of the skin, he advised. Any wavelength in the range of 415–640 nm seems to work well. Moreover, any type of light source will work in this wavelength zone. Dr. Gilbert said he has relied mostly on blue light and intense pulsed-light lasers. In some cases, a combination of these two is substantially better than either alone, he noted.

Dr. Gilbert recommends using a facial scrub with acetone followed by application of the photosensitizer, which can be left on for at least an hour prior to light treatment. The chemical photosensitizing compound should be one that metabolizes well over a 60-minute waiting period. This should give it significant intracellular photodynamic properties with the introduction of light. The process should result "in rapidly dividing target cells and have a short time between administration of compound and accumulation in the target cells," he said.

"One downside to phototherapy is that for 3–4 days there is redness and scaling," he pointed out. "That can be tough for kids in school." He tries to schedule these patients so that their recovery time does not coincide with school days.

NEWPORT BEACH, CALIF. — Light therapy with a photosensitizing agent is an effective treatment for acne vulgaris and provides an important alternative to other approaches, Dore Gilbert, M.D., said at a meeting sponsored by the Foundation for Facial Plastic Surgery.

Though treatment with retin-A compounds is the front-line option for most dermatologists who have patients with sebaceous acne, this is another way to see visible improvement—and to satisfy patients, said Dr. Gilbert, who practices in Newport Beach, Calif. "It is not a cure, but we do see a long-term deterrence of the condition."

Current drug therapies for acne have side effects, and some adolescents cannot tolerate them, he observed. However, there are no such concerns with light therapy. By adding levulinic acid to the regimen, "you get a much quicker response and better skin texture changes," he said. The effect on the sebaceous gland is fairly well documented: Light activation in the presence of a photosensitizing agent diminishes the sebaceous product inside the pustule and kills the bacteria thriving in it. Shrinkage occurs quickly, Dr. Gilbert said.

The term photodynamic therapy was coined a century ago by German scientists who observed that targeted light benefited certain skin conditions, including acne. Only a few decades ago, it was not unusual to see adolescents with serious involvement who suffered periodic sunburns, thanks to popular home treatments with a UV lamp. Now, with the addition of photosensitizing compounds to activate certain target cells, the administration of light is proving much safer than, and just as effective as, some topical treatments, Dr. Gilbert said at the meeting, which was also sponsored by Medical Education Resources.

He has treated patients with the combination of a photosensitizer and both blue light and intense pulsed-light therapy. Significant clearance with a few treatments, sometimes only one, is achieved about 75% of the time in patients with cystic or superpustular acne, he said. About 50% of his patients have had a quantifiable decrease in pore size.

The photosensitizing compound needs to be activated by wavelengths with good penetration of the skin, he advised. Any wavelength in the range of 415–640 nm seems to work well. Moreover, any type of light source will work in this wavelength zone. Dr. Gilbert said he has relied mostly on blue light and intense pulsed-light lasers. In some cases, a combination of these two is substantially better than either alone, he noted.

Dr. Gilbert recommends using a facial scrub with acetone followed by application of the photosensitizer, which can be left on for at least an hour prior to light treatment. The chemical photosensitizing compound should be one that metabolizes well over a 60-minute waiting period. This should give it significant intracellular photodynamic properties with the introduction of light. The process should result "in rapidly dividing target cells and have a short time between administration of compound and accumulation in the target cells," he said.

"One downside to phototherapy is that for 3–4 days there is redness and scaling," he pointed out. "That can be tough for kids in school." He tries to schedule these patients so that their recovery time does not coincide with school days.

NEWPORT BEACH, CALIF. — Light therapy with a photosensitizing agent is an effective treatment for acne vulgaris and provides an important alternative to other approaches, Dore Gilbert, M.D., said at a meeting sponsored by the Foundation for Facial Plastic Surgery.

Though treatment with retin-A compounds is the front-line option for most dermatologists who have patients with sebaceous acne, this is another way to see visible improvement—and to satisfy patients, said Dr. Gilbert, who practices in Newport Beach, Calif. "It is not a cure, but we do see a long-term deterrence of the condition."

Current drug therapies for acne have side effects, and some adolescents cannot tolerate them, he observed. However, there are no such concerns with light therapy. By adding levulinic acid to the regimen, "you get a much quicker response and better skin texture changes," he said. The effect on the sebaceous gland is fairly well documented: Light activation in the presence of a photosensitizing agent diminishes the sebaceous product inside the pustule and kills the bacteria thriving in it. Shrinkage occurs quickly, Dr. Gilbert said.

The term photodynamic therapy was coined a century ago by German scientists who observed that targeted light benefited certain skin conditions, including acne. Only a few decades ago, it was not unusual to see adolescents with serious involvement who suffered periodic sunburns, thanks to popular home treatments with a UV lamp. Now, with the addition of photosensitizing compounds to activate certain target cells, the administration of light is proving much safer than, and just as effective as, some topical treatments, Dr. Gilbert said at the meeting, which was also sponsored by Medical Education Resources.

He has treated patients with the combination of a photosensitizer and both blue light and intense pulsed-light therapy. Significant clearance with a few treatments, sometimes only one, is achieved about 75% of the time in patients with cystic or superpustular acne, he said. About 50% of his patients have had a quantifiable decrease in pore size.

The photosensitizing compound needs to be activated by wavelengths with good penetration of the skin, he advised. Any wavelength in the range of 415–640 nm seems to work well. Moreover, any type of light source will work in this wavelength zone. Dr. Gilbert said he has relied mostly on blue light and intense pulsed-light lasers. In some cases, a combination of these two is substantially better than either alone, he noted.

Dr. Gilbert recommends using a facial scrub with acetone followed by application of the photosensitizer, which can be left on for at least an hour prior to light treatment. The chemical photosensitizing compound should be one that metabolizes well over a 60-minute waiting period. This should give it significant intracellular photodynamic properties with the introduction of light. The process should result "in rapidly dividing target cells and have a short time between administration of compound and accumulation in the target cells," he said.

"One downside to phototherapy is that for 3–4 days there is redness and scaling," he pointed out. "That can be tough for kids in school." He tries to schedule these patients so that their recovery time does not coincide with school days.

LONG BEACH, CALIF. — Regular physical activity seems to confer a protective effect against the onset of Parkinson's disease in men but not in women—and that's not the only gender-related difference to emerge in recent studies of the disease.

For men who participate in physical activity over their life span, the risk of Parkinson's seems to be significantly lower, compared with men who are more sedentary, Honglei Chen, M.D., said at the annual meeting of the American College of Nutrition. For men, “the higher the [participation in] physical activity, the lower the risk of Parkinson's disease,” he said. But the same does not seem to be true for women.

Differences in dietary influences are being documented, too. Men who consume fewer dairy products and who eat larger amounts of other food groups appear to run a lower risk of symptomatic disease. Conversely, men who are “big milk drinkers” seem to have a higher risk of Parkinson's. But the influence of dairy ingestion on Parkinson's is not turning up in women. The finding first surfaced in the Nurses' Health Study, and other studies seem to be bearing it out, said Dr. Chen of Harvard University, Boston.

Taken together, the data appear to suggest—just as some women's health groups have contended for years—that the inclusion of equal numbers of men and women can be important to interpretation of outcome in studies of disease states. Moreover, the findings on Parkinson's disease could be taken to mean that men and women need to be separately studied once such a difference emerges. “In men, these associations are consistent,” Dr. Chen pointed out. Why isn't the same thing seen in women? That is not known, he said.

In a survey of literature and from data at his own center, he has concluded that exercise offers at least some preventive effect against Parkinson's for men, although it may serve only to delay onset or preserve function longer. Longer-term follow-up studies would be needed to discern whether the cohort in his study, of men in their 60s, simply had not yet become symptomatic. “This is an insidious disease,” he pointed out.

As for diet: The theory that it plays a causative role in Parkinson's disease has been postulated for several decades. However, there are very few studies that have investigated this proposed link in a prospective way, he said.

He and his colleagues conducted a study in which 210 men and 184 women with Parkinson's disease were followed and their food intake recorded (Ann. Neurol. 2002;52:793-801). A positive association was found between dairy intake and disease risk in men but not in women. No other food group seemed to affect risk.

Among men, a significant positive association with risk was seen both for intakes of dairy foods and dairy calcium but not dairy fat. “Fat is out of the picture,” he said. However, supplemental calcium and vitamin D were not related to risk. Further analysis showed that the risk seemed to come from nutrients in dairy products but not from other nutrients in other foods. “We found no association with nutrients from nondairy sources,” he said.

In a separate study performed in Hawaii, the same association was seen.

The investigation, known informally as the Parkinson's Disease Honolulu Study, was helpful in demonstrating a possible link between dairy products and Parkinson's, Dr. Chen said. However, differences between the sexes regarding this risk cannot be drawn from its conclusions. “It only included men,” he stressed.

Could something in the dairy product be a precursor to a factor that influences male risk? “We have some speculations,” Dr. Chen said. “But we don't know.”

Eating too much of anything over time seems to be a risk for both men and women. Obesity is a risk factor for Parkinson's nonsmokers of both sexes; the same is likely to be true among smokers, but it has been next to impossible to control for tobacco and nicotine exposure in studies of the latter population.

LONG BEACH, CALIF. — Regular physical activity seems to confer a protective effect against the onset of Parkinson's disease in men but not in women—and that's not the only gender-related difference to emerge in recent studies of the disease.

For men who participate in physical activity over their life span, the risk of Parkinson's seems to be significantly lower, compared with men who are more sedentary, Honglei Chen, M.D., said at the annual meeting of the American College of Nutrition. For men, “the higher the [participation in] physical activity, the lower the risk of Parkinson's disease,” he said. But the same does not seem to be true for women.

Differences in dietary influences are being documented, too. Men who consume fewer dairy products and who eat larger amounts of other food groups appear to run a lower risk of symptomatic disease. Conversely, men who are “big milk drinkers” seem to have a higher risk of Parkinson's. But the influence of dairy ingestion on Parkinson's is not turning up in women. The finding first surfaced in the Nurses' Health Study, and other studies seem to be bearing it out, said Dr. Chen of Harvard University, Boston.

Taken together, the data appear to suggest—just as some women's health groups have contended for years—that the inclusion of equal numbers of men and women can be important to interpretation of outcome in studies of disease states. Moreover, the findings on Parkinson's disease could be taken to mean that men and women need to be separately studied once such a difference emerges. “In men, these associations are consistent,” Dr. Chen pointed out. Why isn't the same thing seen in women? That is not known, he said.

In a survey of literature and from data at his own center, he has concluded that exercise offers at least some preventive effect against Parkinson's for men, although it may serve only to delay onset or preserve function longer. Longer-term follow-up studies would be needed to discern whether the cohort in his study, of men in their 60s, simply had not yet become symptomatic. “This is an insidious disease,” he pointed out.

As for diet: The theory that it plays a causative role in Parkinson's disease has been postulated for several decades. However, there are very few studies that have investigated this proposed link in a prospective way, he said.

He and his colleagues conducted a study in which 210 men and 184 women with Parkinson's disease were followed and their food intake recorded (Ann. Neurol. 2002;52:793-801). A positive association was found between dairy intake and disease risk in men but not in women. No other food group seemed to affect risk.

Among men, a significant positive association with risk was seen both for intakes of dairy foods and dairy calcium but not dairy fat. “Fat is out of the picture,” he said. However, supplemental calcium and vitamin D were not related to risk. Further analysis showed that the risk seemed to come from nutrients in dairy products but not from other nutrients in other foods. “We found no association with nutrients from nondairy sources,” he said.

In a separate study performed in Hawaii, the same association was seen.

The investigation, known informally as the Parkinson's Disease Honolulu Study, was helpful in demonstrating a possible link between dairy products and Parkinson's, Dr. Chen said. However, differences between the sexes regarding this risk cannot be drawn from its conclusions. “It only included men,” he stressed.

Could something in the dairy product be a precursor to a factor that influences male risk? “We have some speculations,” Dr. Chen said. “But we don't know.”

Eating too much of anything over time seems to be a risk for both men and women. Obesity is a risk factor for Parkinson's nonsmokers of both sexes; the same is likely to be true among smokers, but it has been next to impossible to control for tobacco and nicotine exposure in studies of the latter population.

LONG BEACH, CALIF. — Regular physical activity seems to confer a protective effect against the onset of Parkinson's disease in men but not in women—and that's not the only gender-related difference to emerge in recent studies of the disease.

For men who participate in physical activity over their life span, the risk of Parkinson's seems to be significantly lower, compared with men who are more sedentary, Honglei Chen, M.D., said at the annual meeting of the American College of Nutrition. For men, “the higher the [participation in] physical activity, the lower the risk of Parkinson's disease,” he said. But the same does not seem to be true for women.

Differences in dietary influences are being documented, too. Men who consume fewer dairy products and who eat larger amounts of other food groups appear to run a lower risk of symptomatic disease. Conversely, men who are “big milk drinkers” seem to have a higher risk of Parkinson's. But the influence of dairy ingestion on Parkinson's is not turning up in women. The finding first surfaced in the Nurses' Health Study, and other studies seem to be bearing it out, said Dr. Chen of Harvard University, Boston.

Taken together, the data appear to suggest—just as some women's health groups have contended for years—that the inclusion of equal numbers of men and women can be important to interpretation of outcome in studies of disease states. Moreover, the findings on Parkinson's disease could be taken to mean that men and women need to be separately studied once such a difference emerges. “In men, these associations are consistent,” Dr. Chen pointed out. Why isn't the same thing seen in women? That is not known, he said.

In a survey of literature and from data at his own center, he has concluded that exercise offers at least some preventive effect against Parkinson's for men, although it may serve only to delay onset or preserve function longer. Longer-term follow-up studies would be needed to discern whether the cohort in his study, of men in their 60s, simply had not yet become symptomatic. “This is an insidious disease,” he pointed out.

As for diet: The theory that it plays a causative role in Parkinson's disease has been postulated for several decades. However, there are very few studies that have investigated this proposed link in a prospective way, he said.

He and his colleagues conducted a study in which 210 men and 184 women with Parkinson's disease were followed and their food intake recorded (Ann. Neurol. 2002;52:793-801). A positive association was found between dairy intake and disease risk in men but not in women. No other food group seemed to affect risk.

Among men, a significant positive association with risk was seen both for intakes of dairy foods and dairy calcium but not dairy fat. “Fat is out of the picture,” he said. However, supplemental calcium and vitamin D were not related to risk. Further analysis showed that the risk seemed to come from nutrients in dairy products but not from other nutrients in other foods. “We found no association with nutrients from nondairy sources,” he said.

In a separate study performed in Hawaii, the same association was seen.

The investigation, known informally as the Parkinson's Disease Honolulu Study, was helpful in demonstrating a possible link between dairy products and Parkinson's, Dr. Chen said. However, differences between the sexes regarding this risk cannot be drawn from its conclusions. “It only included men,” he stressed.

Could something in the dairy product be a precursor to a factor that influences male risk? “We have some speculations,” Dr. Chen said. “But we don't know.”

Eating too much of anything over time seems to be a risk for both men and women. Obesity is a risk factor for Parkinson's nonsmokers of both sexes; the same is likely to be true among smokers, but it has been next to impossible to control for tobacco and nicotine exposure in studies of the latter population.