Prosecution rests in Michael Jackson doctor trial (Reuters)

LOS ANGELES (Reuters) ? Prosecutors rested their case against Michael Jackson's doctor on Monday after nearly four weeks of testimony and evidence against the man accused of involuntary manslaughter in the pop star's death.

The final witness to testify for prosecutors in the trial of Dr. Conrad Murray was Dr. Steven Shafer. He told the jury Murray never should have given Jackson the powerful anesthetic propofol as a sleep aid at home and called Murray's treatment a "pharmacological 'Never-Never Land.'"

Murray has admitted giving Jackson propofol, the key drug that caused the "Thriller" singer's overdose, but defense attorneys have argued that Jackson gave himself an extra, fatal dose of the drug when Murray was absent.

Murray's attorneys called their first witness on Monday. They hope to finish presenting their case on Thursday.

Since the trial began roughly four weeks ago, jurors have heard from several doctors who slammed Murray's treatment of Jackson on June 25, 2009 -- the day the singer died -- and for not keeping records in the weeks he cared for the singer.

Prosecutors have put Murray's defense attorneys in a quandary by presenting the doctor's account to police of what happened in Jackson's final hours, then pointing out glaring inconsistencies between his statements and the evidence.

For instance, Murray never mentioned to police that he was on his phone after giving Jackson a cocktail of propofol and sedatives. But prosecutors have presented records showing Murray using his cell phone for more than 45 minutes before discovering that Jackson had stopped breathing.

Among the trials most dramatic moments, so far, was the playing of an audiotape Murray had recorded of Jackson's slurred and apparently drugged voice that gave the trial an emotional jolt as the singer talked about his desire to help children.

Moreover, defense attorneys have had to withdraw one of their key contentions about Jackson's drug use, telling the judge they would not try to convince jurors he swallowed propofol, as they had argued in hearings earlier this year.

Their reversal was due to the fact that scientific studies showed propofol has little effect when ingested orally. Still, defense attorneys have clung to their argument that Jackson could have taken more of the drug intravenously.

The first defense witness called to testify on Monday was a Beverly Hills police official, who discussed details about the call for an ambulance made from Jackson's mansion on the day he died.

Murray, who has pleaded not guilty to the charge of involuntary manslaughter, faces a maximum of four years in prison if convicted.

(Editing by Bill Trott)

Source: http://us.rd.yahoo.com/dailynews/rss/celebrity/*http%3A//news.yahoo.com/s/nm/20111024/people_nm/us_michaeljackson

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Bombings, beheadings? Stats show a peaceful world (AP)

WASHINGTON ? It seems as if violence is everywhere, but it's really on the run.

Yes, thousands of people have died in bloody unrest from Africa to Pakistan, while terrorists plot bombings and kidnappings. Wars drag on in Iraq and Afghanistan. In peaceful Norway, a man massacred 69 youths in July. In Mexico, headless bodies turn up, victims of drug cartels. This month eight people died in a shooting in a California hair salon.

Yet, historically, we've never had it this peaceful.

That's the thesis of three new books, including one by prominent Harvard psychologist Steven Pinker. Statistics reveal dramatic reductions in war deaths, family violence, racism, rape, murder and all sorts of mayhem.

In his book, Pinker writes: "The decline of violence may be the most significant and least appreciated development in the history of our species."

And it runs counter to what the mass media is reporting and essentially what we feel in our guts.

Pinker and other experts say the reality is not painted in bloody anecdotes, but demonstrated in the black and white of spreadsheets and historical documents. They tell a story of a world moving away from violence.

In his new book, "The Better Angels of Our Nature: Why Violence Has Declined," Pinker makes the case that a smarter, more educated world is becoming more peaceful in several statistically significant ways. His findings are based on peer-reviewed studies published by other academics using examinations of graveyards, surveys and historical records:

? The number of people killed in battle ? calculated per 100,000 population ? has dropped by 1,000-fold over the centuries as civilizations evolved. Before there were organized countries, battles killed on average more than 500 out of every 100,000 people. In 19th century France, it was 70. In the 20th century with two world wars and a few genocides, it was 60. Now battlefield deaths are down to three-tenths of a person per 100,000.

? The rate of genocide deaths per world population was 1,400 times higher in 1942 than in 2008.

? There were fewer than 20 democracies in 1946. Now there are close to 100. Meanwhile, the number of authoritarian countries has dropped from a high of almost 90 in 1976 to about 25 now.

Pinker says one of the main reasons for the drop in violence is that we are smarter. IQ tests show that the average teenager is smarter with each generation. The tests are constantly adjusted to keep average at 100, and a teenager who now would score a 100 would have scored a 118 in 1950 and a 130 in 1910. So this year's average kid would have been a near-genius a century ago. And that increase in intelligence translates into a kinder, gentler world, Pinker says.

"As we get smarter, we try to think up better ways of getting everyone to turn their swords into plowshares at the same time," Pinker said in an interview. "Human life has become more precious than it used to be."

Pinker argued his case in a commentary this past week in the scientific journal Nature. He has plenty of charts and graphs to back up his claims, including evidence beyond wartime deaths ? evidence that our everyday lives are also less violent:

? Murder in European countries has steadily fallen from near 100 per 100,000 people in the 14th and 15th centuries to about 1 per 100,000 people now.

? Murder within families. The U.S. rate of husbands being killed by their wives has dropped from 1.2 per 100,000 in 1976 to just 0.2. For wives killed by their husbands, the rate has slipped from 1.4 to 0.8 over the same time period.

? Rape in the United States is down 80 percent since 1973. Lynchings, which used to occur at a rate of 150 a year, have disappeared.

? Discrimination against blacks and gays is down, as is capital punishment, the spanking of children, and child abuse.

But if numbers are too inaccessible, Pinker is more than happy to provide the gory stories illustrating our past violence. "It is easy to forget how dangerous life used to be, how deeply brutality was once woven into the fabric of daily existence," Pinker writes in his book.

He examines body counts, rapes, sacrifice and slavery in the Bible, using an estimate of 1.2 million deaths detailed in the Old Testament. He describes forms of torture used in the Middle Ages and even notes the nastiness behind early day fairy tales, such as the evil queen's four gruesome methods for killing Snow White along with a desire to eat her lungs and liver.

Even when you add in terrorism, the world is still far less violent, Pinker says.

"Terrorism doesn't account for many deaths. Sept. 11 was just off the scale. There was never a terrorist attack before or after that had as many deaths. What it does is generate fear," he said.

It's hard for many people to buy the decline in violence. Even those who deal in peace for a living at first couldn't believe it when the first academics started counting up battle deaths and recognized the trends.

In 1998, Andrew Mack, then head of strategic planning for U.N. Secretary General Kofi Annan, said a look at the statistics showed the world was becoming less violent. The reaction from his professional peacekeeping colleagues?

"Pffft, it's not true," they told Mack, arguing that the 1990s had to be the worst decade in U.N. history. It wasn't even close.

Joshua Goldstein, a professor of international relations at American University and author of "Winning the War on War," has also been telling the same story as Pinker, but from a foreign policy point of view. At each speech he gives, people bring up America's lengthy wars in the Middle East. "It's been a hard message to get through," he acknowledged.

"We see the atrocities and they are atrocious," Goldstein said. "The blood is going to be just as red on the television screens."

Mack, who's now with Simon Fraser University in Canada, credits the messy, inefficient and heavily political peacekeeping process at the U.N., the World Bank and thousands of non-governmental organizations for helping curb violence.

The "Human Security Report 2009/2010," a project led by Mack and funded by several governments, is a worldwide examination of war and violence and has been published as a book. It cites jarringly low numbers. While the number of wars has increased by 25 percent, they've been minor ones.

The average annual battle death toll has dropped from nearly 10,000 per conflict in the 1950s to less than 1,000 in the 21st century. And the number of deadliest wars ? those that kill at least 1,000 people a year ? has fallen by 78 percent since 1988.

Mack and Goldstein emphasize how hard society and peacekeepers have worked to reduce wars, focusing on action taken to tamp down violence, while Pinker focuses on cultural and thought changes that make violence less likely. But all three say those elements are interconnected.

Even the academics who disagree with Pinker, Goldstein and Mack, say the declining violence numbers are real.

"The facts are not in dispute here; the question is what is going on," John Mearsheimer, a professor of political science at the University of Chicago and author of "The Tragedy of Great Power Politics."

"It's been 21 years since the Cold War ended and the United States has been at war for 14 out of those 21 years," Mearsheimer said. "If war has been burned out of the system, why do we have NATO and why has NATO been pushed eastward...? Why are we spending more money on defense than all other countries in the world put together?"

What's happening is that the U.S. is acting as a "pacifier" keeping the peace all over the world, Mearsheimer said. He said like-minded thinkers, who call themselves "realists" believe "that power matters because the best way to survive is to be really powerful." And he worries that a strengthening China is about to upset the world power picture and may make the planet bloodier again.

And Goldstein points out that even though a nuclear attack hasn't occurred in 66 years ? one nuclear bomb could change this trend in an instant.

Pinker said looking at the statistics and how violent our past was and how it is less so now, "makes me appreciate things like democracy, the United Nations, like literacy."

He and Goldstein believe it's possible that an even greater drop in violence could occur in the future.

Goldstein says there's a turn on a cliche that is apt: "We're actually going from the fire to the frying pan. And that's progress. It's not as bad as the fire."

___

Researcher Julie Reed Bell contributed to this report.

___

Online:

Steven Pinker's web site: http://stevenpinker.com/

A lecture by Pinker with his statistics and graphics on a "history of violence:" http://bit.ly/rupVbk

Joshua Goldstein's book website: http://winningthewaronwar.com/

The Human Security Report Project: http://www.hsrgroup.org/

Source: http://us.rd.yahoo.com/dailynews/rss/topstories/*http%3A//news.yahoo.com/s/ap/20111022/ap_on_re_us/us_peaceful_world

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Breast Cancer Risk May Rise With High Hormone Levels (HealthDay)

FRIDAY, Oct. 21 (HealthDay News) -- Elevated levels of hormones increase breast cancer risk in postmenopausal women, and as the number of different elevated hormones rises, so does the risk, a new study has found.

Researchers from Brigham and Women's Hospital and Harvard Medical School in Boston examined levels of eight different sex and growth hormones in blood samples collected from nurses up to nine years before their health information was recorded.

The risk of breast cancer increased 16 percent with each elevated hormone level, according to the study published online Oct. 21 in the journal Breast Cancer Research.

The investigators found that the highest levels of circulating estrogens (estrone and estrogen), prolactin, and androgens (testosterone, androstenedione, DHEA, or DHEA-sulfate) were each associated with between a 50 and 200 percent increased risk of developing breast cancer.

A woman with elevated levels of one hormone had a 10 percent increased risk, while the risk was doubled for those with elevated levels of five or six hormones, and tripled for those with elevated levels of seven or eight hormones, the study authors explained in a journal news release.

And for women with estrogen receptor-positive (ER-positive) breast cancer, all of these risks were slightly higher, the researchers pointed out.

"Elevated estrogens had the biggest effect on risk, especially for ER-positive cancer. However, androgens and prolactin also contribute to increasing risk of breast cancer. These hormones are known to stimulate the growth of breast cancer cells in the lab and, while androgens can be converted to estrogen in the body, these hormones have also been found to stimulate cancer cell growth in the absence of ER," Shelley Tworoger, of Brigham and Women's Hospital, explained in the news release.

"Our results suggest that models used to assess breast cancer risk could be improved by taking into account multiple sex hormone and growth hormone levels," she added.

More information

The American Cancer Society has more about breast cancer.

Source: http://us.rd.yahoo.com/dailynews/rss/cancer/*http%3A//news.yahoo.com/s/hsn/20111022/hl_hsn/breastcancerriskmayrisewithhighhormonelevels

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Arab strongman: With Gadhafi death, an era passes

FILE - In this photo released Tuesday, April 27, 2004 by the European Commission, Libyan leader Moammar Gadhafi walks past a painting at the EU Commission headquarters in Brussels. Libya's information minister said Gadhafi was killed Thursday, Oct. 20, 2011 when revolutionary forces overwhelmed his hometown, Sirte, the last major bastion of resistance two months after the regime fell. (AP Photo/European Commission)

FILE - In this photo released Tuesday, April 27, 2004 by the European Commission, Libyan leader Moammar Gadhafi walks past a painting at the EU Commission headquarters in Brussels. Libya's information minister said Gadhafi was killed Thursday, Oct. 20, 2011 when revolutionary forces overwhelmed his hometown, Sirte, the last major bastion of resistance two months after the regime fell. (AP Photo/European Commission)

FILE - This undated photo shows Libyan leader Moammar Gadhafi. A U.S. official says Libya's new government has told the United States that Gadhafi, 69, is dead. The official said Libya's Transitional National Council informed U.S. officials in Libya of the development Thursday, Oct. 20, 2011. His death on Thursday, confirmed by Prime Minister Mahmoud Jibril, came as Libyan fighters defeated Gadhafi's last holdouts in his hometown of Sirte, the last major site of resistance in the country. (AP Photo/File)

FILE - In this 1970 photo, Moammar Gadhafi at the Cairo Airport in 1970. A U.S. official says Libya's new government has told the United States that Gadhafi, 69, is dead. The official said Libya's Transitional National Council informed U.S. officials in Libya of the development Thursday, Oct. 20, 2011. His death on Thursday, confirmed by Prime Minister Mahmoud Jibril, came as Libyan fighters defeated Gadhafi's last holdouts in his hometown of Sirte, the last major site of resistance in the country. (AP Photo)

FILE - In this Dec. 20, 1984 photo, Libyan leader Moammar Gadhafi shares a laugh with newsmen during his news conference at Palma de Mallorca in Spain. A U.S. official says Libya's new government has told the United States that Gadhafi, 69, is dead. The official said Libya's Transitional National Council informed U.S. officials in Libya of the development Thursday, Oct. 20, 2011. His death on Thursday, confirmed by Prime Minister Mahmoud Jibril, came as Libyan fighters defeated Gadhafi's last holdouts in his hometown of Sirte, the last major site of resistance in the country.(AP Photo/Mollard)

FILE - In this Aug. 20, 1990 photo, Libyan leader Moammar Gadhafi gestures during a news conference in Tipoli. A U.S. official says Libya's new government has told the United States that Moammar Gadhafi is dead. The official said Libya's Transitional National Council informed U.S. officials in Libya of the development Thursday, Oct. 20, 2011. (AP Photo/Axel Schulz-Eppers)

(AP) ? He often looked like a comical buffoon, standing before audiences, bedecked in colorful robes, spouting words that most of the world considered nonsense.

Yet the death of Moammar Gadhafi was a milestone in modern Arab history, in some ways more significant than the overthrow of lesser autocrats in Tunisia and Egypt.

Gadhafi was the last of the old-style Arab strongmen ? the charismatic, nationalist revolutionaries who rose to power in the 1950s and 1960s, promising to liberate the masses from the shackles of European colonialism and the stultifying rule of the Arab elite that the foreigners left behind after World War II.

He was swept aside by a new brand of revolutionary ? the leaderless crowds organized by social media, fed up with the oppressive past, keenly aware that the rest of the world has left them behind and convinced that they can build a better society even if at the moment, they aren't sure how.

Gadhafi was the last of a generation of Arab leaders such as Gamal Abdel-Nasser of Egypt, Hafez Assad of Syria and Saddam Hussein of Iraq who emerged from poverty, rising to the pinnacle of power either through the ranks of the military or the disciplined, conspiratorial world of underground political organizations.

None of the latter crop of Arab autocrats, including Assad's son Bashar, Yemen's Ali Abdullah Saleh and even Egypt's colorless, ousted president Hosni Mubarak, could rival them in their heyday in terms of charisma, flair, stature and power.

Their model was Nasser, the towering champion of Arab unity who ousted Western-backed King Farouk in 1952 and inspired Arab peoples with fiery speeches broadcast by Egyptian radio from Iraq to Mauritania.

But Nasser's dreams of Arab unity and social revival crumbled in defeat in the 1967 Arab-Israeli War, when Israel seized East Jerusalem, the West Bank, the Golan Heights from Syria and the Gaza Strip and Sinai Peninsula from Egypt. Nasser died three years later, and the fellow strongmen left behind led their countries instead into a political swamp of corruption, cronyism and dictatorship now challenged by the Arab Spring.

The hallmark of the Arab strongman was unquestioned power, the use of state media to promote a larger than life image and a ruthless security network that stifled even a whiff of dissent. That worked in an age before the Internet and global satellite television which opened the eyes of the strongman's followers to a world without secret police and economic systems run by the leader's family and cronies.

The Arab political transformation is far from complete. Autocratic rulers are facing challenges from their own people in Yemen and Syria. Bahrain's Shiite majority is pressing the Sunni monarchy for reform. Rulers in Jordan, Saudi Arabia and the Gulf states are maneuvering to contain the Arab Spring.

Iraq is struggling to build a democracy eight years after American-led arms brought down Saddam's rule.

With Gadhafi's passing, however, a milestone has been passed. The future belongs to a different style of ruler, whoever it may be.

It may be difficult to imagine that the Gadhafi of his final years ? with his flamboyant robes, dark and curly wigs and sagging, surgically altered face ? was a trim, handsome, vigorous 27-year-old when he came to power as a strong and vigorous leader. Over the years he had become a caricature figure associated with grandiose dreams such as a "United States of Africa" or seizing all of Israel and sending Jews "back to Europe."

Even when he was younger, eccentricity was the mark of Gadhafi's public persona.

A generation ago, President Ronald Reagan described him as the "mad dog of the Middle East," and his fellow Arab leaders such as Egyptian President Anwar Sadat considered him a dangerous megalomaniac.

Journalists covered his speeches and international visits primarily for amusement.

Images of Gadhafi's final moments ? toupee gone, terrified, confused, powerless in the grip of men who may be about to kill him ? make the ousted tyrant appear more pitiable than powerful.

All that was far from his image when he and his comrades toppled a Western-backed monarchy in 1969 in a bloodless coup, promising to transform his poor, backwater country into a modern state.

Promising a new era for his people, Gadhafi closed a U.S. air base, forced international oil companies to hand over most of their profits from Libyan oil to the Libyan state and shook the world with his unabashed support for terrorist or insurgent movements in Northern Ireland, Palestine, Latin America, Africa and Asia.

Oil gave him a reach beyond his sparsely populated desert land and enabled him to pursue his revolutionary dreams.

In the 1980s, the lobbies of Tripoli's few hotels were populated by representatives of what the West considered the most dangerous groups on Earth ? stiff North Koreans wearing lapel buttons of their leader Kim Il-Sung, Palestinian extremists huddled over cups of sweet tea, European anarchists and revolutionaries ? all come to town to seek the oil-fueled largesse of the "Brother Leader."

While insisting that Libya was the freest nation on Earth, Gadhafi ruthlessly suppressed dissent, dispatched agents to assassinate his opponents abroad and drove thousands of Libyans into exile.

It all came crashing down in the final battle in his hometown of Sirte. A man who came to power as an Arab revolutionary and self-styled leader of the oppressed and downtrodden died a brutal and inglorious death at the hands of the people he purported to lead.

___

Eds: Robert H. Reid is Middle East regional editor for The Associated Press and has reported from the Middle East since 1978.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/cae69a7523db45408eeb2b3a98c0c9c5/Article_2011-10-22-ML-Mideast-An-Era-Ends/id-0897b7f1871348118348dadb72307bee

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Stock futures signal slight gains for equities (Reuters)

(Reuters) ? Stock index futures pointed to a slightly higher open for equities on Wall Street on Friday, with futures for the S&P 500, for the Dow Jones and for the Nasdaq 100 up 0.2-0.3 percent.

General Electric Co (GE.N) is expected to post an 11 percent rise in earnings per share, reflecting improved results at its large energy operation and strong demand from fast-growing economies including China.

Other companies announcing results include Honeywell International (HON.N) and Verizon Communications (VZ.N).

Economic Cycle Research Institute releases its weekly index of economic activity for October 14 at 1430 GMT. In the prior week the index read 120.2.

Senate Republicans and Democrats rejected each other's economic stimulus bills on Thursday, underscoring their inability to craft a bipartisan solution on job creation before next year's elections.

China is set to show the world that its currency policy begins and ends at home, slowing down the yuan's appreciation to shield exporters from a global economic downturn and show U.S. lawmakers they cannot push the pace of reform.

U.S. coal giant Peabody Energy (BTU.N) cleared the biggest hurdle to its long-running ambitions to buy Australia's Macarthur Coal (MCC.AX) after the target's major shareholder, China's Citic Resources, backed its $4.9 billion ($5 billion) bid.

Duke Realty Corp (DRE.N) said it will sell its suburban office portfolio to private equity firm Blackstone Group (BX.N) for $1.08 billion.

Exxon Mobil Corp's (XOM.N) refining complex in Singapore has suffered a power outage, industry sources said on Friday. It was unclear when the outage started and which units have been affected.

European shares (.FTEU3) rose 0.8 percent on Friday, after losses in the previous session, on hopes decisions to resolve the region's debt crisis would emerge from meetings held by European leaders by Wednesday.

France and Germany said in a joint statement on Thursday that European leaders would discuss a global solution to the crisis on Sunday but no decisions would be adopted before a second meeting to be held by Wednesday at the latest.

The Dow Jones industrial average (.DJI) ended up 37.16 points, or 0.32 percent, at 11,541.78 on Thursday. The Standard & Poor's 500 Index (.SPX) was up 5.51 points, or 0.46 percent, at 1,215.39. The Nasdaq Composite Index (.IXIC) was down 5.42 points, or 0.21 percent, at 2,598.62.

(Reporting by Atul Prakash; Editing by Hans-Juergen Peters)

Source: http://us.rd.yahoo.com/dailynews/rss/business/*http%3A//news.yahoo.com/s/nm/20111021/bs_nm/us_markets_stocks

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Raw Video: Lohan taken into custody (omg!)

Rocker Duff McKagan is a writer too

6 hours ago

AP 2:04 | 306 views

In the years since Duff McKagan left Guns N' Roses and Velvet Revolver behind, he has emerged as a renaissance man. He writes several columns, started a wealth management company, and now, has an autobiography, 'It's So Easy (and Other Lies).' (Oct. 19)

Source: http://us.rd.yahoo.com/dailynews/rss/entertainment/*http%3A//us.rd.yahoo.com/dailynews/external/omg_rss/rss_omg_en/http___omg_yahoo_com_videos15516/43320784/*http%3A//omg.yahoo.com/videos/raw-video-lohan-taken-into-custody/15516

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Are acid-suppressing drugs prescribed too often in infants?

[ Back to EurekAlert! ] Public release date: 20-Oct-2011
[ | E-mail | Share Share ]

Contact: Brigid Huey
ournal.pediatrics@cchmc.org
513-636-7140
Elsevier Health Sciences

Cincinnati, OH, October 20, 2011 Frequent spitting up, irritability, and unexplained crying in infants can be very distressing to parents. Pediatricians often prescribe acid-suppressing drugs for these symptoms in an effort to treat infants for gastroesophageal reflux disease (GERD); however, GERD is an uncommon cause of these symptoms in otherwise thriving infants. In a soon to be published Commentary in The Journal of Pediatrics, Eric Hassall, MBChB, FRCPC, FACG, cautions against the over-diagnosis of GERD and over-prescription of acid-suppressing drugs in infants.

Dr. Hassall is affiliated with the Department of Pediatrics at the University of British Columbia, Vancouver, Canada, is currently Staff Gastroenterologist at Sutter Pacific Medical Foundation in San Francisco, California, and is an advisor to the U.S. Food and Drug Administration (FDA). Although the FDA has only approved the use of acid-suppressing drugs, such as proton pump inhibitors (PPIs), in children over the age of one year, the use of PPIs in infants less than 12 months old has greatly increased in the last decade.

Dr. Hassall notes that most "reflux" in infants is not acidic because stomach contents have been buffered by frequent feedings. "However, in the absence of better information and physician guidance and fed by advertising and misinformation on the Internet, distressed parents take their concerns to doctors, who very frequently comply and prescribe acid-suppressing medications for symptoms and signs that, in most cases, are not GERD," he states.

Studies have shown that PPIs are no better than placebo for most infants with symptoms of spitting up, irritability, or unexplained crying, which may be because the medications are frequently prescribed for symptoms that are not GERD. Dr. Hassall emphasizes that spitting up in otherwise healthy infants is normal and resolves with time. Irritability or unexplained crying, with or without spitting up, is often a normal developmental phenomenon, especially in infants 2-5 months old. Although some infants are unable to self-calm, this also improves with maturation and age.

"We are medicalizing normality," Dr. Hassall asserts, "In most infants, these symptoms are 'life,' not a disease, and do not warrant treatment with drugs, which can have significant adverse effects." He explains that gastric acid is an early line of defense against infection and is important for nutrition; by prescribing acid-suppressing medications to infants without GERD, pediatricians are putting their patients at a higher risk for infections like pneumonia and gastroenteritis. The use of PPIs in infants can also lead to abnormalities in the levels of essential minerals and vitamins, such as magnesium, calcium, and vitamin B12.

Dr. Hassall encourages his fellow pediatricians to initially explore nonpharmacological approaches, such as changes in maternal diet of breastfeeding mothers or hypoallergenic formulas for bottle-fed infants. However, if these approaches fail or if an infant has severe symptoms and is suspected of having actual GERD, Dr. Hassall suggests beginning treatment with an acid-suppressing medication for a time-limited period of 2 weeks. However, as Dr. Hassall notes, "In most cases, it is not the spitting up that should be treated. The real issue is the unexplained crying, which causes real and considerable distress and concern for parents." He goes on to say, "It is important for pediatricians to acknowledge their concerns, explain the spectrum of normal infant behavior, discuss the range of measures available, start implementation, and be available for follow-up."

###

The study, reported in "Over-Prescription of Acid-Suppressing Medications in Infants: How It Came About, Why It's Wrong, and What to Do About It" by Eric Hassall MBChB, FRCPC, FACG, appears in The Journal of Pediatrics (www.jpeds.com), DOI 10.1016/j.jpeds.2011.08.067, published by Elsevier.


[ Back to EurekAlert! ] [ | E-mail | Share Share ]

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.


[ Back to EurekAlert! ] Public release date: 20-Oct-2011
[ | E-mail | Share Share ]

Contact: Brigid Huey
ournal.pediatrics@cchmc.org
513-636-7140
Elsevier Health Sciences

Cincinnati, OH, October 20, 2011 Frequent spitting up, irritability, and unexplained crying in infants can be very distressing to parents. Pediatricians often prescribe acid-suppressing drugs for these symptoms in an effort to treat infants for gastroesophageal reflux disease (GERD); however, GERD is an uncommon cause of these symptoms in otherwise thriving infants. In a soon to be published Commentary in The Journal of Pediatrics, Eric Hassall, MBChB, FRCPC, FACG, cautions against the over-diagnosis of GERD and over-prescription of acid-suppressing drugs in infants.

Dr. Hassall is affiliated with the Department of Pediatrics at the University of British Columbia, Vancouver, Canada, is currently Staff Gastroenterologist at Sutter Pacific Medical Foundation in San Francisco, California, and is an advisor to the U.S. Food and Drug Administration (FDA). Although the FDA has only approved the use of acid-suppressing drugs, such as proton pump inhibitors (PPIs), in children over the age of one year, the use of PPIs in infants less than 12 months old has greatly increased in the last decade.

Dr. Hassall notes that most "reflux" in infants is not acidic because stomach contents have been buffered by frequent feedings. "However, in the absence of better information and physician guidance and fed by advertising and misinformation on the Internet, distressed parents take their concerns to doctors, who very frequently comply and prescribe acid-suppressing medications for symptoms and signs that, in most cases, are not GERD," he states.

Studies have shown that PPIs are no better than placebo for most infants with symptoms of spitting up, irritability, or unexplained crying, which may be because the medications are frequently prescribed for symptoms that are not GERD. Dr. Hassall emphasizes that spitting up in otherwise healthy infants is normal and resolves with time. Irritability or unexplained crying, with or without spitting up, is often a normal developmental phenomenon, especially in infants 2-5 months old. Although some infants are unable to self-calm, this also improves with maturation and age.

"We are medicalizing normality," Dr. Hassall asserts, "In most infants, these symptoms are 'life,' not a disease, and do not warrant treatment with drugs, which can have significant adverse effects." He explains that gastric acid is an early line of defense against infection and is important for nutrition; by prescribing acid-suppressing medications to infants without GERD, pediatricians are putting their patients at a higher risk for infections like pneumonia and gastroenteritis. The use of PPIs in infants can also lead to abnormalities in the levels of essential minerals and vitamins, such as magnesium, calcium, and vitamin B12.

Dr. Hassall encourages his fellow pediatricians to initially explore nonpharmacological approaches, such as changes in maternal diet of breastfeeding mothers or hypoallergenic formulas for bottle-fed infants. However, if these approaches fail or if an infant has severe symptoms and is suspected of having actual GERD, Dr. Hassall suggests beginning treatment with an acid-suppressing medication for a time-limited period of 2 weeks. However, as Dr. Hassall notes, "In most cases, it is not the spitting up that should be treated. The real issue is the unexplained crying, which causes real and considerable distress and concern for parents." He goes on to say, "It is important for pediatricians to acknowledge their concerns, explain the spectrum of normal infant behavior, discuss the range of measures available, start implementation, and be available for follow-up."

###

The study, reported in "Over-Prescription of Acid-Suppressing Medications in Infants: How It Came About, Why It's Wrong, and What to Do About It" by Eric Hassall MBChB, FRCPC, FACG, appears in The Journal of Pediatrics (www.jpeds.com), DOI 10.1016/j.jpeds.2011.08.067, published by Elsevier.


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Source: http://www.eurekalert.org/pub_releases/2011-10/ehs-aad101711.php

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