Dr. Smith's Swine Flu Q&A

First, let me thank you for all the great questions. I wanted to take the time to answer as many as them as I could. They really are quite insightful.

Anonymous said...

I believe someone asked how long the virus can live OUTSIDE the body. For instance, how long is a door knob toxic after someone with the flu sneezes into his/her hand and then touches the door knob?

Dr. Smith: 2 hours or longer ... if the surface is wet, then the virus might live a bit longer.

Anonymous said...

I did have the flu/cold but more flu like. Start to finish over three weeks, still a bit of cough left. Question is How would one know if it was swine flu? Is one a carrier? Should one be tested? And finally can one get it again? Traveled=Yes. sick = one week after traveling. Down Four days before feeling better. Southern climate, Caribbean, tropics. Signed Wondering

Dr. Smith: The only way to know if you have the swine flu is to get tested ... it's a swab. But there's no reason for you to be tested because you are no longer contagious from whatever you had. Good news for anyone that does get the swine flu is that they're now likely immune to that particular strain of the virus.

Anonymous said...

Would you suggest the wearing of a mask? I heard that the germ was so small that it could penetrate through a mask.

Dr. Smith: See my previous post on if you should wear a mask. But to your point, it's not true that a mask wouldn't help. But it's not likely necessary.

Anonymous said...

once a person recovers from a
flu like illness, is here any way to tell if it was swine flue?
I was in Mexico and many people were complaining of a very bad flu, head ache, muscle pain and a cough that persisted. Could they have had swine flu?

Dr. Smith: Once you've recovered, there really is no reason to know if you had the swine flu. The symptoms you describe are certainly consistently with the swine flu but after 7 days, if you're still not sick, then you have nothing to worry about.

Anonymous said...

I'm worried since my Tamiflu packet is 5 years old and we can't get any here so the local hospitals will depend on the stockpiled antivirals. How old are the U.S. Tamiflu and Relenza stocks (or what is their age range)? Tamiflu prescriptions give a 2-year expiration date; is any of the stockpile Tamiflu older than this? And have Tamiflu or Relenza efficacity beyond their expiration dates (and to what degree)?

Dr. Smith: The expiration on your Tamiflu is going to depend on when it was manufactured. But if it was at least 5 years ago, there is certainly the chance that it might have lost some of its effectiveness. I don't know how old the Tamiflu or Relenza is in the government's stockpile but I can assure you that they're tracking expiration dates so they don't send out old medication.

Anonymous said...

My son is 6 months with a cough, but no other symptoms like the swine flu and no fever. My 2 year old has a runny nose with a cough and no fever. I have a cough, stuffy nose, and lost my voice with no cough. Should we all get looked at for the swine flu?

Dr. Smith: At this point, none of you have symptoms consistent with the swine flu, so sounds like you have nothing to worry about.

Anonymous said...

My 6 month old son has a cough, my 2 year old has a cough and runny nose, I have a cough, stuffy nose, and lost my voice. Our symptoms began on Sunday and no one has had any fever. Should we get looked at for the swine flu?

Dr. Smith: Same as above ... your symptoms are not consistent with the swine flu. Check out WebMD's Swine Flu FAQ to learn all about swine flu symptoms and more.

Anonymous said...

Donna
My sister is leaving tomorrow for a Mexican vacation....Our entire family has tried to talk her out of doing this...with no luck. Dr. Smith, do you think this is as dangerous to her health as we do? Yes she has read the information and says she has as much chance of contracting this flu here in the United States as she would in Mexico. Your response would be much appreciated. Thank you.

Dr. Smith: There's certainly a risk and that's why the gov't has recommended against unessential travel. If she decides to go, keep in mind that the overwhelming majority of people who get the swine flu are recovering just fine. Thankfully, serious illness and deaths are very rare. We're still holding at 1 death in the U.S. At a minimum, your sister should call her doctor to see about getting antiviral medications, particularly if she has any other health conditions.

Anonymous said...

I have a bad cough, and for the last 4 days I have woken up with numbness in my hands. I dont feel anything for at least an hour. Are these symptoms of the swine flu?

Dr. Smith: Numbness is not a symptom of swine flu. I would suggest getting this checked out to see what might be going on.

Lesley said...

Lesley said I am planning a trip to Canada in July. Since we do not know what the situation will be, and because it is not always easy to get to a doctor while travelling, a doctor in Europe suggested it might be a good idea to buy one of the two antiviral drugs to keep at hand. It might be in short supply if things get bad. If I don't get the flu and have to throw the things out when they expire, well put it down to very good luck. What do you think?

Dr. Smith: That's really a question you need to pose to your doctor. For some people it's warranted to take antiviral medications if they're exposed to the swine flu. But you have to figure out what's right for you with your doctor. See my post on Swine Flu; Who's Most at Risk?

Mary said...

I am a 55 y.o. female with RA. I am due to take an immunosuppressant (rituxan) via I.V. on May 8th. Should I do this treatment or look for something else? I am due to travel to New Mexico then 3rd week in May.

Dr. Smith: You need to address this with your doctor. If you have severe RA, which I assume you likely do if you're taking Rituxan, then that treatment is vitally important to help prevent flares and possible disability down the road. You should talk to your doctor about whether you should have antiviral medications on hand.

Steve said...

If the W.H.O. has raised the pandemic level to Level 5, why are they not making the vaccines available right now at Dr.'s offices and clinics before we all get the flu and it's too late for a vaccine?

Dr. Smith: Because there is no swine flu vaccine unfortunately. It takes quite a bit of time to create a flu vaccine. As of yesterday, the CDC was saying that it might be available in September. Let's hope it's not needed by then but time will tell. They may decide to include it as one of the strains in this year's flu vaccine, which we typically start getting in November or so.

Anonymous said...

If I am scheduled for surgery (not an emergency) over the summer and a pandemic is declared, should I postpone the surgery (since hospitals won't be the safest place to be during the pandemic?

Dr. Smith: I can't accurately answer this question because I don't know nearly enough about your medical history or the surgery. You need to address this issue with your doctor.

Anonymous said...

How long do these types of things usually last is this the beginning of a year long or a month long or how long of an ordeal is this? And how is it going to stop. I know for the regular flu there is a "flu season" but we are well past that. And we know everyone is not going to follow the standards of staying home if they are sick.

Dr. Smith: Unfortunately, there is no "usual" when it comes to these things. They're all different. Let's hope with the upcoming summer (a time during which the flu is very unusual) and our vigilant efforts to prevent swine flu (you are being vigilant about washing your hands, right), that this outbreak will pass quickly. But at this point, we really just don't know.

Robert Oliveira said...

While the continued spread of Swine Flu (H1N1) is no laughing matter, I strongly believe that someone in an official government capacity needs to reign in the media outlets. At least one FOX affiliate in my part of the U.S. is providing sound bites which will only cause more fear and panic. Right now what we need is well-informed citizens who can take the lead in preventing the spread of the disease and sensational newsreporting isn't going to do it.

Dr. Smith: Robert, you hit the nail on the head about us, American citizens, leading the charge of preventing the spread of swine flu! The government can only do so much and they have admitted that their ability to contain the virus is quite limited. But yours isn't. Take every precaution with frequent handwashing and steer clear of anyone with flu-type symptoms. Keep alcohol-based hand gels or wipes around, particularly if you touch public places, like doorknobs, phones etc.

Anonymous said...

Since this is a new virus I know it will take time to develop and produce a vaccine. About how long will that probably take? When do you think will get the vaccine?

Dr. Smith: The earliest the CDC says is September. It actually takes months to develop even the annual flu vaccine that we hopefully all get. Maybe this outbreak will cause more people to get next year's flu vaccine since it is the most effective strategy for preventing the flu (that, and handwashing).

Anonymous said...

I have to fly to care for my parents this weekend. My mom is on remicade (sp?) which compromises her immune system. Should I wear a mask while travelling to prevent contracting the flu and possible passing it to her? I am flying from Dallas to Orlando. I am concerned about the time on the plane in the confined space - especially in light of VP Biden's comments this morning!

Dr. Smith: I completely understand your concern, but let me just put things in perspective. In total, there are just over 100 cases of confirmed swine flu in the U.S and one death. In an average flu season, 200,000 people are hospitalized and 36,000 people die.

Anonymous said...

Can you provide anymore information on the age demographic that seems to be the most susceptible to this virus?

Dr. Smith: It's honestly a bit early in the outbreak in the U.S. to say for sure. But I suspect this will go the route of most flu viruses in that the very young and the very old are going to be most at risk of severe infections. For other high-risk groups, see my post on Swine Flu: Who's Most at Risk?

Anonymous said...

Who does the Swine Flu affect? Babies and the elderly? Or can anyone get it? If so, how many schools have closed because of this illness?

Dr. Smith: See my post on Swine Flu: Who's Most at Risk. As far as how many schools have closed, that number is changing all the time so I really couldn't tell you.

Anonymous said...

I was in Dallas/Ft. Worth from Monday 4/20 to Thursday 4/23. On Friday evening (24th) I started to get a sore throat. Saturday it got worse and I started having joint and muscle pain along with a "vice" like headache(is persistent to this day). Felt ill all weekend long, went to the Dr. on Monday...gave me a rapid strep test and pain relief for headache and sent me home. Dr. called Tuesday evening to see how I was, and I was actually starting to feel better. Now it is Thursday and my chest has become very heavy and I have a productive, yucky cough (and, still the headache. I have been working from home all week, which I feel so fortunate I can do that. Am a bit concerned it may be swine...now today, 16 yr old daughter has a bad sore throat...kept her home from school. I am feeling confused as to what I should do!

Dr. Smith: If you're confused, I'd suggest calling your doctor. A cold or strep throat is much more common than swine flu. It's important to get strep throat treated too, so that might be a reason to get your daughter into see the doctor if you think that's a possibility.

Paul E said...

What are the similarities / differences if any between the Swine Flu 2009 type H1N1 and the Spanish Flu of 1918 type H1N1?

Dr. Smith: Well, the viruses are different -- we know that at least. But unfortunately we don't know much more at this point. In 1918, the flu started out as mild and only later became very serious and widespread. Let's hope that today, our containment and flu prevention strategies that I hope everyone is being very vigilant about will help prevent this swine flu outbreak from going that same route.

Thanks for all the great questions and hopefully the information will help keep you calm during these uncertain times.

Swine Flu: Who's Most at Risk?

I've been receiving quite a few questions about whether certain people should be more concerned about catching swine flu. The short answer is "yes."

As with the garden-variety flu, there are some people who are more likely to be severely affected by the swine flu. These people are more likely to get very ill, require hospitalization, and more likely to die.

People at higher risk have one thing in common. Their bodies are more susceptible to serious complications of the flu, such as pneumonia or even bloodstream infection.That said, most of these people recover just fine from the flu with no serious illness. But it's good for them to take steps to be extra careful in preventing the flu.

So, who's most at risk?

1. Children aged 6 months up to their 19th birthday (but the younger the child the higher the risk)
2. Pregnant women
3. People 50 years of age and older
4. People of any age with certain medical conditions, such as heart or lung disease (asthma, COPD, emphysema), diabetes or those with weakened immune systems

So what should these people do to protect themselves?

If there were a swine flu vaccine available, then they'd definitely want to get one. Unfortunately, there isn't one. The CDC says they may have one available by September. Time will tell if it's still necessary by then. Fingers crossed our aggressive efforts will take care of the problem beforehand.

We all need to be very vigilant about warding off the swine flu virus. Wash your hands, wash your hands, wash your hands! Guess you get my drift. It truly is the most effective flu prevention strategy.

Also, until this thing calms down a bit -- and it will -- high-risk people, such as pregnant women, should avoid being around sick people. If someone is coughing, has a fever or sore throat, or other symptoms that could possibly be swine flu, avoid them until they are on the mend.

Wondering about a mask? Check out my blog from earlier this week.

And what about antiviral medications? If anyone from these high-risk groups is exposed to someone with swine flu symptoms, they should call their doctor to see if they should take antiviral drugs, such as Relenza or Tamiflu. These medications can help prevent you from getting the flu, if taken early enough after exposure. Or, if you do get symptoms, they can help lessen the severity of the illness and help you feel better faster. They may also help prevent serious flu complications. The key is to start them early -- within 2 days of symptoms.

Stay tuned with WebMD's Swine Flu Guide for the latest news and tips on combating swine flu.

Do you know anyone that has had the swine flu? Have a question you can't seem to find the answer to? Let me know and we'll do our best to tackle it for you.

Tragic Swine Flu Death Expected

There's no doubt that the swine flu death of a 22-month old baby is devastating. But it's important for the public to understand that this was expected and that this does not mean that the swine flu outbreak is getting exponentially worse.

We knew that there were quite a few people in Mexico that had died from swine flu. And there's no logical reason to expect that the illness would be any less severe than in the U.S. So while it's very tragic and heartbreaking to think of a little baby dying from swine flu, it's unfortunately expected with the flu.

It's important to keep in mind that in an average flu season -- and I'm talking about the normal winter flu season -- about 36,000 people die from the flu. Let me repeat that -- 36,000 people! Yes, that's a huge number and most people are shocked when I tell them that. But it helps drive home a very important point.

All types of flu are very serious and should not be taken lightly. That's why I, and the other doctors and health professionals at WebMD are always trying to drive home the point of flu prevention.

Preventing the spread of swine flu is up to us -- not the government. Sure, the government is going to do everything it can to contain the virus as much as possible -- and take steps to protect people as much as they can, such as by making antiviral medications more available.

But we -- you and me -- have the true power to prevent spread of swine flu. Swine flu prevention is not rocket science -- wash your hands, cover your mouth when you sneeze or cough, stay home if you're sick and make your child stay home if he/she is sick. While it's not foolproof, they are the most effective strategies we have for preventing spread of respiratory viruses, like swine flu.

Keep in mind that no one is suggesting that tens of thousands of people are going to die from swine flu. At this point, thankfully deaths are quite rare -- but will happen.

WebMD is staying on top of this story to keep you informed throughout the day. Our Swine Flu Guide has everything you need to know from prevention and swine flu symptoms to when you need to call your doctor.

We're hearing from our users and quickly responding to their questions with more information.

Is there something you've been wondering about swine flu but can't find anywhere? Let me know and we'll find the answer for you.

Can a Mask Prevent Swine Flu?

While a mask could theoretically help prevent swine flu, it’s a bit much for most people and really not necessary at this point.

Sure, if someone is coughing or sneezing in your face, a mask might help. Also, if you know that you're going to be around someone with swine flu, such as a loved one, a mask might be warranted. But otherwise, that’s not the most effective strategy for preventing swine flu because you don't catch most respiratory viruses from people coughing in your face.

Here's what generally happens. Someone with a virus sneezes or coughs in their hand. Then, they touch something like an elevator button or a doorknob. You come along a few minutes later and touch that same button or knob. Then, without thinking about it, you touch your face – your mouth, nose, or eyes – and the virus takes hold of you.

As mundane as it sounds, the most effective way to prevent getting respiratory viruses like swine flu is washing your hands. But most of us don’t do it often enough and don’t do it the right way.

Obviously, the biggest risk is when you’re in a public place. So, I do whatever I can to not touch anything when I’m out and about – or at least make double sure not to touch my face out in public.

To be more specific, here’s my strategy when I go into a public restroom. It goes without saying that I make sure to not touch my face once entering the restroom. But after I’ve taken care of my business, I wash my hands for a good 20 seconds. I know it feels like a long time, but believe me, it’s worth it. Need to occupy yourself? Sing happy birthday -- twice -- to pass the right amount of time.

Then, when you’re done, don’t touch a thing but a paper towel. Contort yourself or do whatever you need to do to get that paper towel without touching anything else. Turn the water off using the paper towel. Open the door to leave the restroom with the paper towel. And don’t touch anything else with your hands – without the paper towel. I throw the paper towel away when I get back in my office.

Washing your hands is extremely important after you sneeze or cough into your hands. Not around soap and water? Alcohol-based hand gels are also very effective for killing flu viruses.

And if you have any swine flu symptoms, the CDC says call your doctor. It's also a good idea to practice social isolation. Keep to yourself until you’re all better to prevent spreading your germs around. To stay up to date on the latest swine flu news and for more strategies of staying healthy, check out WebMD’s Swine Flu Guide.

So did I convince you to wash your hands or are you still hankering for a mask? Let me know your thoughts.

Swine Flu: Your Guide to WebMD Coverage

The swine flu story is changing by the hour, and in order to keep you up to date on the latest, please check this blog where we'll continue to post information as it becomes available to us.

What We Know Today

• In a press conference this morning with the World Health Organization in Geneva, we found out that the number of confirmed cases of swine flu in the U.S. has doubled since yesterday to 40, in five states. There are also cases in Spain and Canada, but the worst cases are still in Mexico, where of the 1,000 or so people sick with flu-like symptoms, there are 26 confirmed cases of swine flu.

• In a press conference later in the afternoon, WHO officials raised the pandemic threat level from 3 to 4.
  

• The only place where anyone has died is in Mexico, and officials are still trying to determine why that is ... as of yet, they don't know.
  

• The CDC also just wrapped up a press conference, where they confirmed the 40 U.S. cases, with the additional new ones today coming from a single school in New York. That school is closed today and tomorrow. In California there's a media report of a school closing in Fair Oaks due to a sick student.
  

• The CDC is also recommending that people avoid non-essential travel to Mexico.

WebMD's Coverage

Along with our news coverage, we are also planning to bring you much more information to help keep you informed:

• We have a video interview with a CDC official.

• We are creating a slideshow to help further explain the virus.

• A new reference piece is being written to help explain the difference between a pandemic and an outbreak.
  

• We are working on a map to show you the areas of the country affected, and how many people in each area have the flu.
  

• We will combine all this into one page for your ease of use. You will even be able to sign up for an RSS feed or getting the latest news by Twitter.

Those Involved

This is now a global issue, and groups around the world are working together to track this virus and protect the public's health.

The main groups:

• Centers for Disease Control and Prevention

• The World Health Organization

• The U.S. Department of Health and Human Services

• The U.S. Department of Homeland Security

• You can also check with your local board of health

More Background Information

It is easy to hear all this and start to panic, especially since the U.S. declared a public health emergency yesterday, but it's important to remember there's a lot you can do, and the cases so far in the U.S. have been relatively mild.

If you want to know more about the symptoms, or find answers to other questions, check out our FAQ.

We will continue to do more on this topic to bring you the latest information, and the best explanations about what you need to know.

If you have questions, please ask them here and we'll do our best to find answers for you. What are you doing to protect yourself, and what concerns you most?

Sean Swint
Executive Editor, WebMD

U.S. Declares Swine Flu "Emergency"

The U.S. government has declared the swine flu outbreak a public emergency and the Department of Homeland Security is releasing 25% of stockpiled antivirals -- Tamiflu and Relenza -- to U.S. states, prioritizing states where swine flu has already occurred.

If used at first sign of symptoms, those drugs can help -- but health officials are asking people not to hoard their own supply of the drugs.

The CDC says it has gotten lab-confirmed reports of 20 people in the U.S. who have been sickened by swine flu.

Those cases include nine people in New York City, seven people in California, two in Texas, two in Kansas, and one in Ohio.

Eight students at a school in New York have been confirmed to have been infected with swine flu. The school has cancelled classes tomorrow and Tuesday as they monitor the situation,

The World Health Organization (WHO) held a separate news conference this morning in Geneva, Switzerland.

Keiji Fukuda, MD, the WHO's assistant director-general for health security and environment, told reporters that the WHO is seeking more information about the virus and that the global health community is taking the virus "very seriously" but has not yet decided whether to move the pandemic alert from phase 3 to phase 4 (see yesterday's entry for more on the WHO pandemic alert phases).

Fukuda says one of the things the WHO wants to learn is why cases have varied in their severity, and how deeply it's taking root.

Fukuda also noted that although there have been 1,000 illnesses and 71 deaths in Mexico from respiratory illness, it's not clear yet how many of those cases were due to swine flu.

The virus could continue to change, and Fukuda says it's unpredictable whether those changes will make the virus more or less harsh.

Swine Flu Symptoms, Pandemics, and More

Swine flu news is spreading fast, with media reports buzzing about probable, confirmed, or possible cases in California, Texas, Kansas, and New York.

The story is moving quickly and WebMD is covering this breaking news story as it develops.

Meanwhile, let's get a few things straight on a practical level.

Swine flu symptoms: If you're about to Google "swine flu symptoms," we can save you some trouble. There isn't a special set of symptoms unique to swine flu. It's pretty much flu, and it takes a lab test to tell whether it's swine flu.

Here's what the CDC's web site says about swine flu symptoms: "The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea."

What is a pandemic: Heard the word "pandemic" tossed around during coverage of the swine flu outbreak? That term isn't just the "it" buzzword of the moment -- it has a specific meaning in public health circles.

Here's the official definition from the U.S. Department of Health and Human Services (HHS): "A pandemic is a global disease outbreak. An influenza pandemic occurs when a new influenza [type] A virus emerges for which there is little or no immunity in the human population, begins to cause serious illness, and then spreads easily person-to-person worldwide."

Now, if swine flu sounds to you like a pandemic, it's not quite that simple.

The World Health Organization (WHO) today said there are "gaps in knowledge" about the new swine flu virus -- which actually contains a mix of swine, human, and bird (avian) flu viruses into a brand-new virus. The WHO has asked all countries to be on the lookout for the new virus, but it's not yet ready to bump up the pandemic alert level from phase 3 to phase 4.

Phase what? The WHO has a scale ranging from phase 1 (low risk of a flu pandemic) to phase 6 (a full-blown pandemic is underway). Right now, the WHO is considering whether to shift from phase 3 (which means there is no or very limited human-to-human transmission) to phase 4 (defined as evidence of human-to-human transmission).

Once and for all, how many cases are there in the U.S.? Nobody knows for sure -- and even if there was such a number, it's bound to change, and keep changing.

The official tally of confirmed cases reported to the CDC, as of April 25, are six cases in California and two in Texas. Beyond that, health officials in New York City have sent swabs from at least eight students at a private school in Queens to the CDC for further testing to see if they're swine flu. And earlier today, CNN reported that two confirmed cases are expected to be reported in Kansas. Plus, there are reports of a seventh case in California.

In a press conference today, CDC officials said it wasn't feasible to try to contain the virus, and that more cases are likely to turn up around the country -- and that so far, U.S. cases have been milder than those in Mexico.

How concerned are you about swine flu? To borrow a page from the WHO, how do you rank it on your own radar of health concerns, from 1 to 6, with 1 being "yawn" and 6 being "I'm freaking out"?

AACR Provides Forum to Advance Cancer Knowledge

By Charlene Laino
WebMD Guest Blogger

April 23, 2009 (Denver) -- Of the dozens of medical meetings I attend for WebMD each year, one of my faves is that of the American Association for Cancer Research (AACR), which began Saturday and ended Wednesday.

For starters, the enthusiasm of the researchers themselves is downright refreshing, even addictive. Maybe it’s because they spend the rest of the year toiling away in labs, performing the same experiments over and over to be sure they can replicate the results. Or at their desks, trying to rewrite a grant for the 10th time to obtain ever-scarce government dollars to fund their research. Whatever their motivation, the end result is the same: They can’t wait to share their latest findings with the some 15,000 attendees, from their colleagues to the media.

More importantly, it’s where we first hear of those advances that get us a step closer to the holy grail of personalized medicine -- tailoring treatment to each individual based on his or her genetic makeup. It’s in the lab that researchers first come up with new ways to target cancer’s genetic roots.

My favorite experiment this year came from Boston University, where researchers are using gene therapy to re-educate patients’ own immune systems to attack prostate tumors in the body.

I mean, how cool is that. Although it will be years before those tests move from the bench to the bedside, other researchers are already using a personalized approach to therapy to extend the lives of people with advanced cancer who failed to benefit from standard drug treatments.

Genetic experiments often lead to the unexpected: Still other researchers found that dark-haired people who do not sunburn easily -- a group traditionally thought to be relatively immune to skin cancer -- may be at risk for potentially deadly skin cancer, too. Others found that wine may help protect women against non-Hodgkin’s lymphoma, while still others reported that a couple of handfuls of walnuts a day may help keep breast cancer at bay -- at least if you’re a female mouse.

The walnut story, though, brings me to an important point. Not everything that works in the lab and in animals -- the very stuff that’s the core of AACR presentations -- will end up working in humans. So when the researcher concluded that people should heed recommendations to eat more walnuts, I wasn’t surprised that another doctor called her suggestion “outrageous.”

“You can’t make recommendations to humans based on a study in mice,” says Peter G. Shields, MD, deputy director of the Lombardi Comprehensive Cancer Center in Washington, D.C. Case in point: beta carotene. Animal and some preliminary human studies suggested beta carotene supplements reduce lung cancer. But when they were put to the pivotal test, pitted against placebo in some 29,000 Finnish men, smokers given beta carotene actually got more lung cancer.

“A lot of things we hear at AACR will turn out to be just plain wrong. They’ll never see the light of day,” Shields says.

But that doesn’t make them unimportant. Discovery of what causes cancer and how to treat it is a process, and each year new technologies allow researchers to be that much smarter. “Ten years ago, we could only look at [genes] in 100 people. Now we can look at 100 million. And, now we can look not just at genes, but how they’re regulated,” Shields says.

But even then, “we can get the wrong answer,” he adds.

So back to the lab? Of course, but not right away. What one researcher halfway around the world is working on may provide crucial clues to help out another. And, that’s why the AACR meeting is so important. It provides a forum so researchers can step out of their isolated labs and share their ideas and advance their knowledge. Take the radical report from AACR 2007 suggesting that most current cancer treatments are aimed at eradicating the wrong cancer cells, for example.

This year, other researchers followed up on it, reporting that combination drug treatment slashed the number of pancreatic cancer stem cells in mice, curbing tumor growth.

The latest cure for cancer in mice might not -- it fact, probably will not – translate directly into a cure for human cancer. But it will get us that much closer to conquering the disease.

Plan B Pill for 17-Year-Olds

The FDA has signaled that it will approve Plan B, the so-called "morning after" pill, without a prescription for women age 17 and older.

Plan B is already available to women age 18 and older without a prescription. It was first approved in 1999 and became available without a prescription in 2005 for women age 18 and older.

In March, U.S. District Court Judge Edward Korman of New York ordered the FDA to extend Plan B's availability without a prescription to 17-year-old women -- and to do so within 30 days.

In his ruling, Korman noted that Plan B "is the only emergency contraceptive drug currently available in the United States." He also wrote that politics was a factor in the FDA's 2005 decision to limit nonprescription use of Plan B to women age 18 and older.

The FDA today announced that it will not appeal that ruling, and that the FDA has sent a letter to Plan B's maker stating that, upon submission and approval of an appropriate application, the company may market Plan B without a prescription to women 17 years of age and older.

Plan B is made by Duramed Research, a subsidiary of Teva Pharmaceuticals. In an email to WebMD, Teva spokeswoman Denise Bradley states, "We support the FDA's decision to expand OTC [over-the-counter] access for Plan B to consumers 17 and older. The company believes that timely access to Plan B is extremely important, as the sooner Plan B is taken the more effective it is. We will continue to work closely with FDA to ensure that all provisions of this decision are met."

Would You Follow an Exercise Prescription?

Here's a shocker: Exercise is good for you but most people don't do it. But what if your doctor hauled out the prescription pad and wrote you an exercise prescription?

WebMD Medical Editor Louise Chang, MD, has written many exercise prescriptions for her patients after consulting with them about their abilities and schedule.

"We'd come up with a plan, I'd write it in their chart and write it in my prescription pad, along with their other prescriptions for medication," says Chang.

Writing out a prescription makes exercise "an agreement or an assignment," says Chang, and the fact that a doctor took the time to write it down makes for an added nudge.

"I got the feeling people would at least try to make an effort," says Chang. "I had patients tell me they'd hang it up on the bathroom mirror and the fridge. … Some probably threw it away, but a lot of them liked it."

Chang would follow up with her patients at later appointments to see how they were doing with their exercise prescription. "Patients would say, 'I lost this much weight' or 'I can run 10 minutes now,'" Chang says.

Has your doctor ever given you an exercise prescription -- not a vague recommendation to "get some exercise," but an actual plan? And if they did, did you follow it?

Mediterranean Diet for Heart Health

The traditional Mediterranean diet is particularly good for the heart, according to a new research review by Andrew Mente, PhD, and colleagues. But what's so great about the Mediterranean diet, and how practical is it in real life? WebMD Senior Writer Miranda Hitti asked Mente those questions and more.

What is it about the Mediterranean diet that you think is beneficial for heart health? Is there any one element of the Mediterranean diet that stands out?
The Mediterranean diet includes generous amounts of fruits and vegetables, legumes, whole grains, nuts, cheese or yogurt, fish, healthy fats such as olive and canola oil, [and] small portions of red wine in moderation.

The evidence shows that each of these items is beneficial to heart health on its own, albeit more modestly than when combined together into one healthy diet.

As far as which stands out the most, it seems the evidence is strongest for vegetables, nuts, and monounsaturated fats like olive oil.

How would you describe your own diet? Do you follow the Mediterranean diet?
I try to follow the Mediterranean diet as much as possible, and one of its benefits is that it is highly palatable. This is not a “fad diet,” but rather a diet that could be permanently part of a health lifestyle.

Having said that, I’ll occasionally treat myself to some of the “evil” foods, especially desserts. It’s part of being human and the occasional treat is probably harmless, but try not to make poor food choices a regular routine.

Some people become weary of on-again, off-again news about diet and health (such as the ongoing debate about wine’s risks vs. benefits). In your opinion, has the Mediterranean diet stood the test of time?
Absolutely. It was first publicized after World War II but didn’t really get widespread recognition until the 1990s.

During that time, several diet researchers noticed that people living in Mediterranean countries consumed relatively large amounts of fat but had lower rates of heart disease compared to other developed countries like the United States. An important reason for this disparity was that the Mediterranean diet includes healthier fats like olive oil instead of animal fats.

Since the 1990s, study after study has consistently demonstrated that the Mediterranean diet is highly protective against cardiovascular disease and total mortality.

Is there any downside to the Mediterranean diet? And is there anything you would want to note about the importance of portion size?
As with any diet, portion size is important. It is best to consume amounts that are ideal for your body weight.

Certainly this diet is just one aspect of the Mediterranean lifestyle. It is also important to be physically active and take a half-hour walk every day.

You live in Montreal – far from the Mediterranean. How adaptable is the Mediterranean diet if you don’t live in, say, Italy?
Cost can be an issue. Calorie for calorie, junk foods cost less than fresh produce and are less likely to rise with inflation.

Healthier items like vegetables and fruits are rapidly becoming luxury foods, whereas foods with empty calories are cheaper. This probably explains why cardiovascular disease rates are higher among low-income earners. The problem may be even worse in rural areas where healthier food is either too expensive or too far away.

Read WebMD's news story on Mente's latest diet review.

New Advanced Prostate Cancer Drug in the Works

WebMD spoke with Charles Sawyers, MD, who is one of the researchers studying MDV3100, an experimental drug for advanced prostate cancer. Sawyers is an investigator with the Howard Hughes Medical Institute and also chairs the Human Oncology and Pathogenesis Program at Memorial Sloan-Kettering Cancer Center in New York. Here are extended excerpts from his interview with WebMD.

What are the challenges in finding new treatments for this type of advanced prostate cancer?
Advanced prostate cancer is treated with hormone therapy, which is effective in most men at controlling the disease for a period of a couple of years, but resistance is the rule. The challenge was [that] in order to develop a better drug for resistant disease, one needs to understand the cause of resistance.

Several years ago, my group showed that the tumors from men with resistance have higher levels of a protein called the androgen receptor that is the target of hormone therapy. And paradoxically, when the tumors have the higher levels of the androgen receptor, one of the drugs that's used today, called bicalutimide, actually starts to fuel the growth of the tumor rather than block it. There's this paradoxical shift from it being an antagonist, or blocker, to an agonist, or driver, of the tumor.

Armed with that information, in this new paper, what we did is we created a prostate cancer cell line that we can grow in the laboratory that we engineered to make the higher level of the androgen receptor protein so that it was emulating what happens in patients when they develop resistance. And then we searched for new compounds that would still block the androgen receptor in these cells, and what emerged from that, through collaboration with the chemistry group at UCLA ... were these two compounds [RD162 and MDV3100] that are reported in the paper.

The most exciting part is now that [MDV3100] has made [its] way into patients ... the predictions that we had made about resistance several years ago seem to be true, that with this new compound, which can control the androgen receptor even when the levels are high, we're seeing quite impressive clinical results.

You're already looking at MDV3100 in a larger group of 110 other men. Do you have any preliminary results on that yet, or when would you expect to be reporting on those results?
Some of that data has been presented in oral format at a meeting, and another will be presented at the ASCO [American Society of Clinical Oncology] meeting. The complete data will be published in a paper probably within the next year, I would think. It's just a little further behind because higher doses are being examined, and a larger number of patients, and we want to make sure that we have a reasonable period of follow-up to know how long the responses last.

Do you envision this as something that men would only transfer to once resistance has developed, or might it be something that they take all along?
I think over time it could move to the earlier stage and become one of the mainstays of treatment.

For various reasons, primarily ethical, when you have a brand-new drug, you need to test it men initially who have exhausted all of their treatment options, so they're not denied another proven therapy. That's the group that we've been testing it in, and the initial question of whether it will become an approved drug will be addressed in the same patient population with a randomized, phase III trial that's supposed to begin sometime this year.

If that's successful or even before it is successful, it could be possible to move it up earlier and test it in men who haven't had hormone therapy.

The paper talks about RD162 and MDV3100. What was it about MDV3100 that you decided to focus on first, and does that mean you're setting the other one aside? Are you going to come back to it later?
The two compounds are very chemically similar. They both look great in the laboratory models. The company, Medivation, licensed them both and then they made their own internal decision that they wanted to focus on one over the other. There wasn't really a compelling scientific reason to pick one over the other, and because they're so similar, it doesn't make a lot of sense to move both along at the same time. So I think the answer to the question is, it's been set aside for now and all the emphasis is on the MDV3100.

What is the timeline for clinical use for a drug like this -- how many years, if things go well, until it's submitted to the FDA?
I think it's probably three to four years. The reasons are that the next test -- the proof that the FDA would like to see and I think that the clinical community and patients would like to see as well -- is that it prolongs survival compared to standard care. That's the phase III study. That's roughly a 1,200-patient trial, and in order to answer the question, it takes several years to follow men out long enough to get the results on survival.

Can you explain why resistance to prostate cancer hormone therapy happens?
Well, it's not clear exactly how it happens, but in some men, the tumor cells amplify the number of copies of the androgen receptor gene. And so that's how they make more androgen receptor protein.

Do you have any feel yet for side effects? I know the paper that's out now says it was well tolerated.
It still is well tolerated. In the larger study at much higher doses, there were some side effects, primarily fatigue. But at doses higher than that are in the paper -- higher than 60 milligrams -- the drug looks to be even more effective without causing fatigue. In that 140 patient study total -- 30 here [in the Science study] and 110 more -- there's pretty strong evidence that you can take a dose that's very effective that will be well-tolerated.

Is there anything else you would like to add?
The mechanism or the way this drug blocks the androgen receptor is different from the current drug [bicalutamide]. And I think that's one of the reasons it's in a high-profile journal like Science is that it clearly is working differently.

To explain it ... androgen receptor protein normally is in the cytoplasm of the cell and it's off. When androgen or testosterone is around, it will bind to the androgen receptor protein. The protein will then change its shape and then get taken up into the nucleus of the cell, and it will bind to specific parts of the DNA in order to turn on genes that make the cell grow. So it's sort of an on-off switch, but it has these steps where it has to go to the nucleus and bind to DNA in order to work.

The drug bicalutimide that's used in the clinic today, when it binds the receptor, it still undergoes this shape change, it goes to the nucleus, it still binds to DNA at the same sites, but it just doesn't turn on the target genes very well. In a way, it's stopping the receptor from working, but the receptor is getting most of its job done, but then it stops it right at the end, which is a way I think that tumors can get around it, just by making more protein.

The new drugs, when they bind to the receptor, the receptor doesn't get taken up into the nucleus very well at all, and what little protein that does get there can't bind to the DNA sites any more.

So it foils it a little bit earlier in the process.
Exactly. I think in that way, there [are] fewer back doors. It has to overcome lots of things in order to get all the way to the nucleus and bind to DNA. ... We didn't screen the drugs for that property initially, but serendipitously, that's what came out.

This is one of the few examples I'm aware of that the actual drug that patients are taking was discovered in the academic community through collaborations between biologists and chemists, rather than in the pharmaceutical community. It speaks to the value of federal dollars for cancer research going toward this kind of work.

Sawyers notes that he is one of the researchers who is a co-inventor on a patent application for MDV3100, RD162, and related compounds; he is also a consultant to Medivation Inc., which has licensed those compounds.

Read the WebMD news story about the experimental drug MDV3100 for advanced prostate cancer.

Male Contraceptive: Gene Clue?

Michael Hildebrand, PhD, of the University of Iowa's department of otolaryngology, spoke with WebMD about the CATSPER1 gene mutations linked to male infertility - and the possibility of a male contraceptive based on the CATSPER1 gene. Here are excerpts from his comments to WebMD.

If we were to develop any therapy for people with infertility or if we were to consider male contraceptives, in either of those cases, we would still need to do studies in animal models to make sure the approach is both safe and effective -- and only then could we test it in humans.

It would probably take at least a couple of years to complete the animal studies, and then it would be additional years beyond that for clinical trials.

Our laboratory focuses on genetic disease -- typically hearing loss, but we also study families with other problems as well.

In this particular case, we identified two families in which multiple male individuals had infertility problems, and so we took those two families and we identified the gene that was underlying their infertility.

This was a sperm-specific gene; it's a calcium channel that's really essential for the normal movement of the sperm. We also had the advantage of previous studies that have been published which had shown that mice deficient for this particular protein had infertility.

One key [next] step is to investigate additional families to see if they have similar mutations affecting the same gene. We potentially could screen the other three genes [related to CATSPER1] in additional families, as well.

Also, there's been some preliminary work done looking at using antibodies as a potential contraceptive device in males, and there's been one study with specifically this CATSPER1 protein and have shown, in the laboratory, that both human and mice sperm treated with this particular antibody... [are] associated with reduced fertility -- those sperm are not as able to fertilize an egg, at least not in a laboratory.

One problem with infertility is it's often difficult to determine the cause -- whether it's related to the male or the female member of the couple, and what the underlying cause is. So there [are] potentially other genes which haven't been identified.

There are other situations where the deletion of multiple genes is associated with infertility as well as other clinical presentations, but there [are] only a few which are just associated with infertility and are presumably due to proteins which are specifically expressed in the sperm.

Read the WebMD news story about the CATSPER1 gene study.