Health Scan: The risks of ambulance births [p.6]

By JUDY SIEGEL-ITZKOVICH
Giving birth on the way to hospital - even in a Magen David Adom ambulance - is up to eight times riskier than having the baby in a delivery room, according to obstetricians at Ben-Gurion University's Health Sciences faculty and its affiliated Soroka University Medical Center in Beersheba. Although newspapers like to report cases of babies being delivered by their fathers in the back seat of the family car or in an elevator, Dr. Eyal Sheiner, Dr. Iris Ahel and Dr. Amnon Hadar said such unplanned deliveries pose a risk of up to 800% due to hemorrhaging and other complications. Based on more than 2,300 deliveries in which women did not get to the Soroka delivery room on time - about 2% of all births - compared to those who did, en route deliveries were found to be quite dangerous. The placenta remained inside longer, perineal tissues ruptured and new mothers were hospitalized for considerably longer. The BGU-Soroka study appeared as chapter 46 in the first comprehensive international textbook on hemorrhaging after birth, edited by Prof. Christopher B-Lynch of the UK's Milton Keynes Hospital. Britain's Princess Anne wrote the prologue to the book and attended the recent ceremony marking publication by the Sapiens Publishing Company. Titled A Textbook of Postpartum Hemorrhage, the volume is aimed specifically at the Third World, and can be downloaded at no cost from www.sapienspublishing.com/medical-publications.php#1. MORE USES FOR HERCEPTIN The recent inclusion of the Roche pharmaceutical company drug Herceptin (trastuzumab) in Israel's basket of health services for women with early-stage breast cancer has opened new possibilities for treatment. Local oncologists who wanted to hear more about new uses for the drug - which previously was given only to patients with metastatic breast cancer and more recently to prevent recurrence in women with already treated breast cancer - flocked to hear a US expert brought to Israel recently by Roche to lecture at several hospitals, including Rambam and Hadassah. Prof. Charles Vogel, a specialist in the treatment of breast cancer, was the University of Miami's clinical director, but 20 years ago gave up his full professorship there to head clinical research programs from within the private sector. He is also director of a non-profit clinical cancer research organization offering cutting-edge clinical research protocols to qualified oncologists in Florida. Herceptin's principal use is as an anti-breast cancer therapy in patients whose tumors overexpress (produce more than the usual amount of) the HER-2/neu gene. Herceptin, a biological treatment in the form of a monoclonal antibody, binds to the extracellular segment of the receptor. Only last week, the US Food and Drug Administration approved the use of Herceptin for early-stage breast cancer, which has not spread beyond the lymph nodes in the arm. About 20% of breast cancer cases, he told The Jerusalem Post, are tumors that overexpress HER-2. "Because there are too many copies of the gene, the course of the disease is accelerated. But now with Herceptin, that worsened prognosis is improved, even better perhaps than those without HER-2." Vogel said additional drug companies are looking for other means of suppressing negative implications of the HER-2 gene; GlaxoSmithKline, for example has developed the experimental drug lapatanib, which "looks quite promising" for late-stage breast cancer, but is not yet approved anywhere. Vogel also lectured on Neulastim - an innovative and useful drug developed by Amgen and marketed by Roche. It's a long-acting form of the drug Nupagin, aimed at strengthening the immune system of cancer patients undergoing chemotherapy. It requires only one dose during a chemo treatment (instead of Nupagin's daily dose) to raise a patient's white cell count, he said. FOLIC ACID NOT JUST FOR YOUNG WOMEN Folic acid, the B vitamin recommended to all women of childbearing age and during early pregnancy to reduce the risk of congenital neurological defects, has been found to also benefit older men and women. The British Medical Journal (BMJ) has just reported that the scientific evidence is strong enough to justify using folic acid as a cheap and simple way of reducing heart disease and strokes. Doctors have argued as to whether raised homocysteine levels in the blood (an amino acid implicated in the development of arterial disease) causes heart disease and stroke, and whether folic acid, which lowers homocysteine, will help reduce the risk of these disorders. So cardiologist Dr. David Wald and colleagues at Southampton General Hospital in the UK set out to clarify the issue, examining evidence from different studies to see whether raised homocysteine is a cause of cardiovascular disease. Some looked at homocysteine and the occurrence of heart attacks and strokes in large numbers of people (cohort studies), others focused on people with a common genetic variant that increases homocysteine levels a bit (genetic studies), while the rest tested the effects of lowering homocysteine levels (randomized controlled trials). The cohort studies and genetic studies yielded similar results, indicating a protective effect from lower homocysteine levels; the randomized trials were too small to be conclusive, although their results were consistent with the expected protective effects of folic acid. The conclusion that homocysteine is a cause of cardiovascular disease explains the observations from the different types of study, Wald said. Since folic acid reduces homocysteine concentrations, it follows that increasing folic acid consumption will reduce the risk of heart attack and stroke.