Cancer pill 'offers MS benefits'

The drug would be in tablet form

Taking cladribine a few times a year more than halved the chances of a relapse, with few side-effects, the UK study of 1,300 patients found.

UK expert Professor Gavin Giovannoni said the drug could revolutionise the treatment of MS.

Its manufacturer Merck Serono hopes to seek licensing for its use this year.

The drug is already licensed for treating leukaemia.

Prof Giovannoni gave his assessment of its potential value to MS patients at a meeting of the American Academy of Neurology in Seattle.

The UK's drugs watchdog, the National Institute for Health and Clinical Excellence, is considering including cladribine in its next round of assessments.

Cladribine works by suppressing the immune system, reducing the risk of further damage to a patient's nervous system.

Patients who took the drug were 30% less likely to suffer worsening in their disability due to MS.

Easy to take

The study involved over 1,300 MS patients who were followed up for nearly two years and monitored using MRI scans.

Patients were given either two or four treatment courses of cladribine tablets per year, or a placebo.

Each course consists of a single tablet per day for four or five days, adding up to just eight to 20 days of treatment each year.

If it becomes available to patients, cladribine will be the first licensed treatment for MS which does not involve regular injections.

Professor Giovannoni, of Barts and The London School of Medicine and Dentistry, part of Queen Mary, University of London, said: "These results are really exciting. MS can be a very debilitating illness and at the moment treatment options remain limited.

"Having an effective oral therapy will have a major impact for people with MS.

"Our study shows that cladribine tablets prevent relapses and slow down the progression of the disease, making patients feel better.

"Importantly, it does so without the need for constant injections that are associated with unpleasant side-effects.

"We will continue to follow the patients in the trial to see how they fare in the long-term."

Dr Lee Dunster, head of research at the MS Society, said: "These are remarkable results and being able to take a tablet instead of having injections will be a huge step forward for people with MS.

"The evidence is there, but we now need to see cladribine move smoothly through the regulatory process and the price the manufacturer sets will play a crucial part in that."

It is estimated that 85,000 people in the UK currently have MS, with 2,500 new cases diagnosed each year.

How scratching can stop an itch

Nerve cells play a key role in itching

However, the effect only seems to occur during itchiness itself - scratching at other times makes no difference.

While it is widely-known scratching relieves an itch, the physiological mechanisms for how this works are little understood.

The University of Minnesota study appears in Nature Neuroscience.

Previous research has suggested that a specific part of the spinal cord - the spinothalamic tract - plays a key role.

Nerve cells in this area have been shown to be more active when itchy substances are applied to the skin.

Blocks activity

The latest work, in primates, found that scratching the skin blocks activity of nerve cells in the spinothalamic tract during itchiness - preventing the spinal cord from transmitting signals from the scratched area of skin to the brain.

Researcher Dr Glenn Giesler hopes the work could lead to ways to relieve chronic itch effectively for the first time. However, he said more information was still needed about the chemistry underpinning the effect.

Professor Gil Yosipovitch, an expert on itching from Wake Forest University in North Carolina, said the finding was "potentially significant".

He said: "Although there is a long way to go, methods that can induce a pleasurable scratch sensation without damaging the skin, via mechanical stimuli or drugs that can inhibit these neurons, could be developed to treat chronic itch."

However, Professor Yosipovitch stressed that scratching and itching were complex phenomena involving factors such as emotions as well as physiology.

"The main open question is what happens in patients who suffer from chronic itch where scratching may actually aggravate itch perception."

Professor Patrick Haggard, of University College London, said: "We all know that scratching helps alleviate itch, but this elegant study helps to show how this mechanism works.

"It's an interesting illustration of a very general principle of the brain controlling its own inputs, in this case by making movements that triggers an interaction between scratchy touch and itch."

Dr Paul Bays, based at UCL's Institute of Cognitive Neuroscience, agreed that the study provided an important part of a physiological explanation for how the sensation of itch is reduced.

"However, it is still unclear why scratching should have this effect, or why it is only effective for itches and not for painful sensations - which are transmitted to the brain through the same pathway."

Bone-repairing stem cell jab hope

It may be possible to control stem cells with a magnet

A team at Keele University is testing injectible stem cells that they say they can control with a magnet.

Once injected these immature cells can be guided to precisely where their help is needed and encouraged to grow new cartilage and bone, work on mice shows.

The aim is to treat patients with injuries and arthritis the UK National Stem Cell Network conference heard.

Professor Alicia El Haj, working with Professor John Dobson, also of Keele University, says the technology, patented by Magnecell, could be tested in humans within five years.

It would provide a way to treat disease without invasive surgery or powerful drugs.

The injection would use the patient's own stem cells, harvested from their bone marrow.

These mesenchymal cells would be treated in the lab to give them a coating of minute magnetic particles.

Use in scans

These same magnetic nanoparticles are already approved in the US where they are routinely used as an agent to make MRI scans clearer to read.

Targeted magnetic fields could then move the cells around the body to the desired place and switch them into action without the need for drugs or other biochemical triggers.

Professor Al Haj said: "The ultimate aim is to repair cartilage and bone. We have been able to grow new bone in mice. Now we will look at whether we can repair damaged sites in goats.

"We should be able to move to human trials within five years."

Meanwhile, experts at the University of Southampton, led by Professor Richard Oreffo, have treated four patients with hip joint problems using stem cell therapy.

The technique combines the patients own bone marrow stem cells with donor bone cells to patch-repair damaged bones that would otherwise need treatment with metal plates and pins.

They say it is only a matter of years before their method could be used routinely to treat some of the 60,000 people who fracture a hip in the UK each year.

Eczema cases rise dramatically

Emma Wilkinson Health reporter, BBC News

Eczema causes red itchy patches on the skin

There was a 42% rise in diagnosis of the condition between 2001 and 2005, by which time it was estimated to affect 5.7m adults and children.

One potential explanation for the rise is increased frequency of bathing and use of soap and detergents.

A paper in the Journal of the Royal Society of Medicine says eczema is thought to be a trigger for other allergic conditions.

GP records of over 9m patients were used by researchers to assess how many people have the inflammatory skin disorder.

It showed that by 2005, one in nine of the population had, at some point, been affected by eczema.

The highest rate was in boys aged between five and nine.

Prescriptions increased by 57% over the five-year study period and in 2005, GPs issued 13.7m scripts.

Study leader Professor Aziz Sheikh, chair of the allergy and respiratory research group at the University of Edinburgh, said he expected to see a rise but it was fairly marked given the short time period.

"What's quite striking is the very high proportion of people who are getting eczema, it's an incredibly common disorder.

"Why eczema is important is increasingly we think eczema is a herald condition for individuals to go on to develop other allergic conditions, such as asthma and allergic rhinitis."

The theory is that allergens may be able to cross the skin in people with eczema to cause disease whereas in people without the condition the skin is able to act as a barrier.

Environment

He added that it is likely that a proportion of individuals have a genetic predisposition to develop eczema but that environmental factors also play a large part, and it is these which are likely to be causing the increase.

"The environmental factors are frequency of bathing and use of soaps and detergents."

It is also likely that some of the rise is due to better awareness and diagnosis.

He added that more research was needed on whether diagnosing and managing eczema properly early in life could prevent people going on to develop other conditions.

"The basic science suggests we can but the trials need to be done."

Margaret Cox, chief executive of the National Eczema Society, said the general theory was eczema had been increasing but it was thought the rise had levelled off.

"We do know there has been a huge rise in allergic disease of all sorts and what I would like to think is we're seeing some small signs of people concentrating their minds on eczema."

She agreed that modern living seemed to be having an effect.

"Water use dries up the skin and soaps and detergents degrease the skin.

"We are using quite a lot of these products from an early age."

Cancer drug 'fuels tumour growth'

Tumour blood vessels (in red), surrounded by cancer cells (in blue)

UK scientists were investigating a kind of drug called an anti-angiogenesis, still under development, which hampers the growth of tumour blood vessels.

Avastin and Sutent, which act in a similar way, have been proven to work and were not covered in this research.

But cancer experts say the study in Nature Medicine could help make those drugs more effective.

The researchers focused on a drug called Cilengitide which is designed to prevent blood vessel cells sticking together and moving - an important part of angiogenesis.

Previous tests on people have found that a few patients with brain tumours benefited from high doses of the drug, but that it failed to work for most.

In this research, tests carried out on mice showed that low doses of Cilengitide actually stimulated the growth of cancers.

Further investigation showed it did this by switching on a molecule called VEGFR2, which triggers the angiogenesis process.

That is significant because although when a patient is initially given a drug, its level in the blood rises quickly ensuring a big dose goes to the tumour, after a while levels start to fall as the body begins to deal with the drug.

This is likely to be why trials of the drug have shown such poor results.

Caveat

Dr Kairbaan Hodivala-Dilke of the Institute of Cancer, who led the study, said it was important that the trials looking at this drug continued.

"We've got evidence now that low doses can enhance tumour growth. So there is no benefit of giving a high dose, which then drops, and then a high dose again.

"But that's not to say it can't work at all. It can, but there is this caveat."

She said it may be more effective to give the drug via an infusion pump, which would allow the dosage to remain topped up at an effective level.

Dr Andy Reynolds, from the Breakthrough Breast Cancer Research Centre at the Institute of Cancer Research, who also worked on the study, said: "Knowledge of this mechanism will help us develop new ways to make these drugs as effective as possible.

"In the future, we may be able to combine these inhibitors with other drugs to maximise their effectiveness for patients."

Dr Lesley Walker, director of cancer information at Cancer Research UK, which helped fund the research, said: "This study is important because it may help to explain the mixed results previously seen in patients and turn around disappointing results so people may still benefit from the drug without the potential harm."

Mechanisms

The research also has implications for the existing drugs Sutent, used to treat kidney cancer, and Avastin, for colorectal cancer.

They work by the same process, but on different targets.

At the moment, they can extend a patient's life by several months. Experts hope that this research could lead to a better understanding of the drugs' mechanisms and so to ways of making them more effective.

Dr Walker said: "Sutent and Avastin have proven effective enough for use in the NHS but there is still need to understand why they can sometime fail.

"It may be that there are similar mechanisms at work."

Last month, the National Institute for Health and Clinical Excellence - the NHS's drugs appraisal body - said Sutent could be considered for people with advanced kidney cancer. However, it decided against recommending Avastin for advanced colorectal cancer.

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Pill changes 'not the answer'

Sarah Jarvis, women's health spokeswoman for the Royal College of GPs, says women forgetting to take the pill is the problem, not availability.

Young women should be encouraged to use long-acting contraception, such as implants or the coil, Dr Jarvis says.

She debates the topic at the British Medical Journal Online.

Writing for the same website, Dr Daniel Grossman, of the University of California, San Francisco, says US data suggests that for some women the prescription requirement represents a barrier to women deciding and continuing to use the pill.

He called the prescription requirement "an out-of-date, paternalistic barrier to contraceptive use that is not evidence based".

He writes: "If governments are committed to addressing the challenge of unintended pregnancy - and the related problem of maternal mortality in the developing world, health systems must create mechanisms to allow freer access to hormonal contraception for all women at low or no cost."

As part of its £26.8m bid to cut unintended pregnancy rates, the UK government recently gave the go-ahead to pilots within London allowing women and girls aged over 16 to get the pill at chemists without a prescription.

If the pilots are successful, the pill could become available over-the-counter like the morning-after pill.

But Dr Jarvis said although the schemes might be safe, they would not work.

Studies suggest that nearly half of all women taking the oral contraceptive pill miss one or more pills in each cycle, and nearly a quarter miss two or more.

These women are three times more likely to get pregnant unintentionally than those who take the pill consistently.

Easy access

Dr Jarvis said: "Increased uptake of reliable, non user-dependent methods has to be the key.

"Rather than making a potentially unreliable method of contraception more easily available, our best avenue for reducing unplanned pregnancies is to encourage general practitioners to help their patients to make the best choices."

A spokesman for the Department of Health said: "We want to improve women's access to contraception and help reduce the number of unintended pregnancies and have invested £26.8 million in 2008/09 to do this.

"This will include a new targeted campaign to highlight the full range of contraceptive choices available to women, including the more effective long-acting reversible contraception."

Simon Blake, chief executive of Brook, said: "Increased access to free contraception for all women is vital to reducing unwanted pregnancy rates.

"Long-acting methods of contraception are very effective and access still needs to be improved.

"People must be helped to make informed choices about the type of contraception that is right for them and suits their lifestyle."

A spokeswoman for the Family Planning Association said: "Contraceptive choice and access are both extremely important and making the pill available in pharmacies means that the millions of women already using it will find it easier to obtain."

Although the teenage pregnancy rate in Britain is falling in many areas, it remains the highest in Western Europe.

Skipping sleep 'hardens arteries'

Calcified arteries were found in nearly a third of people who slept fewer than five hours a night.

This dropped to around one in 10 for those who slept an extra hour, the Journal of the American Medical Association study of 495 adults found.

Experts said getting enough sleep was important for good heart health.

In the study, the volunteers underwent two CT scans, designed to assess the build-up of calcium in the heart's arteries, five years apart.

They also filled out sleep questionnaires, kept a sleep diary and wore a wrist monitor for six nights that measured movement to give an estimate of how long they were actually lying still and asleep.

At the first scan, none of the volunteers had any calcification in their arteries but five years later 61 of them did.

This calcification appeared to be linked with lack of sleep.

The risk was lowest for those who regularly had more than seven hours sleep each night.

Lead researcher Dr Diane Lauderdale, of the University of Chicago, said there were several possible explanations for the link that they found.

Stress-related

Firstly, there may be some factor not yet identified that can both reduce sleep duration and increase calcification.

Or it might be down to blood pressure - high blood pressure increases the likelihood of calcification and blood pressure goes down during sleep.

Alternatively, stress or a stress hormone like cortisol, which has been tied to decreased sleep and increased calcification, may play a role.

She said: "Although there are constant temptations to sleep less, there is a growing body of evidence that short sleep may have subtle health consequences.

"Although this single study does not prove that short sleep leads to coronary artery disease, it is safe to recommend at least six hours of sleep a night."

Ellen Mason, of the British Heart Foundation, said: "It is not yet clear quite how sleep affects our heart disease risk, but this study adds to previous research suggesting that getting enough sleep may help to keep our heart and circulation healthy.

"Sleep is essential for our body's ability to repair itself and with the party season in full flow, it is important to try and get enough rest.

"Drinking alcohol late at night and getting up early can mean we're not getting enough quantity, or quality, of sleep."

Clue' to sexes' pain difference

US researchers found brain differences affecting the potency of opioids such as morphine.

The Journal of Neuroscience study also found drug effectiveness varied during the rats' menstrual cycles.

Another expert said it showed the growing importance of tailoring pain relief to match the individual needs of the patient.

Morphine remains one of the most widely used drugs to alleviate severe persistent pain and doctors have noticed that it frequently does not work as well in women.

However, the study from Georgia State University claims to be the first to pinpoint the reason why.

It looked closely at a tiny area of the brain called the periaqueductal grey area (PAG), which is important in the way that pain signals are interpreted.

Many neurons in this region have, on their surface, "receptors" designed to receive and lock onto the molecules found in opioid drugs.

These "mu-opioid receptors", when locked onto an opioid drug, send a message telling the brain to stop responding to pain signals, reducing the sensation of pain.

The Georgia State team found that, in the rat brain, females had a lower level of mu-opioid receptors in this part of the brain, suggesting that the potential potency of morphine is much reduced.

Additional tests suggested that the response to morphine varied depending on which part of the menstrual cycle the female rat was in.

Better treatment

Professor Anne Murphy, who led the research, said: "It is increasingly clear that morphine is significantly less potent in women compared with men - until now, the mechanism driving the phenomenon was unknown.

"Additional research with the inclusion of female subjects needs to be devoted to determining a more potent treatment for persistent pain in women."

Professor Karen Berkley, from Florida State University, described the research as "important" and called for more attention to be paid to make sure that women received adequate pain relief.

"What this research is trying to do is understand the hormonal influences on pain in women.

"Clinicians are becoming far more aware of this issue, certainly more than they were five or six years ago."

Human trials, already under way, would need to be concluded to confirm the results of this study, she said.

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Jump in US measles cases linked to vaccine fears

ATLANTA (AP) - Measles cases in the U.S. are at the highest level in more than a decade, with nearly half of those involving children whose parents rejected vaccination, health officials reported Thursday.

Worried doctors are troubled by the trend fueled by unfounded fears that vaccines may cause autism. The number of cases is still small, just 131, but that's only for the first seven months of the year. There were only 42 cases for all of last year.

"We're seeing a lot more spread. That is concerning to us," said Dr. Jane Seward, of the Centers for Disease Control and Prevention.

Pediatricians are frustrated, saying they are having to spend more time convincing parents the shot is safe.

"This year, we certainly have had parents asking more questions," said Dr. Ari Brown, an Austin, Texas, physician who is a spokeswoman for the American Academy of Pediatrics.

The CDC's review found that a number of cases involved home-schooled children not required to get the vaccines. Others can avoid vaccination by seeking exemptions, such as for religious reasons.

Measles, best known for a red skin rash, is a potentially deadly, highly infectious virus that spreads through contact with a sneezing, coughing, infected person.

It is no longer endemic to the United States, but every year cases enter the country through foreign visitors or Americans returning from abroad. Measles epidemics have exploded in Israel, Switzerland and some other countries. But high U.S. childhood vaccination rates have prevented major outbreaks here.

In a typical year, only one outbreak occurs in the United States, infecting perhaps 10 to 20 people. So far this year through July 30 the country has seen seven outbreaks, including one in Illinois with 30 cases, said Seward, of the CDC's Division of Viral Diseases.

None of the 131 patients died, but 15 were hospitalized.

Childhood measles vaccination rates have stayed above 92 percent, according to 2006 data. However, the recent outbreaks suggest potential pockets of unvaccinated children are forming. Health officials worry that vaccination rates have begun to fall - something that won't show up in the data for a couple of years.

The vaccine is considered highly effective but not perfect; 11 of this year's cases had at least one dose of the vaccine.

Of this year's total, 122 were unvaccinated or had unknown vaccination status. Some were unvaccinated because the children were under age 1 - too young to get their first measles shot.

In 63 of those cases - almost all of them 19 or under - the patient or their parents refused the shots for philosophical or religious reasons, the CDC reported.

In Washington state, an outbreak was traced to a church conference, including 16 school-aged children who were not vaccinated. Eleven of those kids were home schooled and not subject to vaccination rules in public schools. It's unclear why the parents rejected the vaccine.

The Illinois outbreak - triggered by a teenager who had traveled to Italy - included 25 home-schooled children, according to the CDC report.

The nation once routinely saw hundreds of thousands of measles cases each year, and hundreds of deaths. But immunization campaigns were credited with dramatically reducing the numbers. The last time health officials saw this many cases was 1997, when 138 were reported.

The Academy of Pediatrics has made educating parents about the safety of vaccines one of its top priorities this year. That's partly because busy doctors have grown frustrated by the amount of time they're spending answering parents' questions about things they read on the Internet or heard from TV talk shows.

In June, the CDC interviewed 33 physicians in Austin, suburban Seattle and Hollywood, Fla., about childhood vaccinations. Several complained about patient backlogs caused by parents stirred up by information of dubious scientific merit, according to the CDC report.

Questions commonly center on autism and the fear that it can be caused by the measles shots or by a mercury-based preservative that used to be in most vaccines. Health officials say there is no good scientific proof either is a cause. Also, since 2001, the preservative has been removed from shots recommended for young children, and it was never in the measles-mumps-rubella combination vaccine. It can still be found in some flu shots.

Brown said she wrote a 16-page, single-spaced document for parents that explains childhood vaccinations and why doctors do not believe they cause autism. She began handing it out this spring, and thinks it's been a help to parents and a time-saver for her.

"People want that level of information," she said.

At least one outbreak this year of another preventable disease was blamed on lack of immunizations. At least 17 children were sick with whooping cough at a private school in the San Francisco Bay area, and 13 were not vaccinated against the disease, which can be fatal to children.

---

Associated Press writer Marcus Wohlsen in San Francisco contributed to this story.

Face transplant patient can smile, blink again

LONDON (AP) - Transplanting faces may seem like science fiction, but doctors say the experimental surgeries could one day become routine. Two of the world's three teams that have done partial face transplants reported Friday that their techniques were surprisingly effective, though complications exist and more work is still needed.

"There is no reason to think these face transplants would not be as common as kidney or liver transplants one day," said Dr. Laurent Lantieri, one of the French doctors who operated on a man severely disfigured by a genetic disease.

In Friday's issue of the British medical journal Lancet, Lantieri and colleagues reported on their patient's status one year after the transplant. Chinese doctors also reported on their patient, two years after his surgery.

Last year, the French team operated on a 29-year-old man with tumors that blurred his features in a face that looked almost monstrous. They transplanted a new lower face from a donor, giving the patient new cheeks, a nose and mouth. Six months later, he could smile and blink.

The Chinese patient had part of his face ripped off by a bear. Surgeons in Xian gave him a new nose, upper lip and cheek from a donor. After a few months, he could eat, drink and talk normally, and returned home to Yunnan province in southwest China.

The patients were not identified although photos were included in the reports.

As is the case with all transplants, doctors use immune-suppressing drugs to prevent the recipient's body from attacking the donated tissue. In both face transplants, the patients started rejecting the transplanted tissue more than once. Their doctors solved the problem by juggling their medications.

The French patient now takes three pills a day to prevent rejection.

"That's less than most people with diabetes," said Lantieri, a plastic surgeon at the Henri Mondor-Albert Chenevier Hospital in suburban Paris.

Other doctors were reassured by the results.

"To be able to wean down the dosage of the medication in small amounts and relatively quickly, that is encouraging," said Dr. Bohdan Pomahac, a plastic surgeon at the Brigham and Women's Hospital in Boston.

Pomahac has permission to do a face transplant in the U.S., as do doctors at the Cleveland Clinic.

Experts have worried that if patients take lifelong anti-rejection drugs after a transplant, their cancer risk will jump. Some also predicted that rejection would destroy the face within a few years. Those fears seem to have been allayed, Pomahac said.

With three successful partial face transplants so far - including the world's first on a woman whose face was bitten off by a dog in France - doctors say that some of the surgery's initial uncertainties, like how functional the new face would be, are being answered.

For example, Lantieri's patient's face was paralyzed by tumors for more than a decade. The French team wasn't sure if nerves could grow after the transplant. But they discovered later their patient could blink, proving the brain was able to restore long-forgotten facial nerve connections.

Not everyone is convinced that face transplants are so revolutionary.

Dr. Patrick Warnke, a plastic surgeon at the University of Kiel in Germany, calls them a "dead-end road," because he doesn't think the rejection problem can be solved. Instead, he hopes to re-grow tissue from patients' own stem cells.

Still, the biggest obstacle to more face transplants may not be scientific, but social.

"When kidney transplants first began, people were reluctant to donate because there were a lot of cultural, social and religious issues," Pomahac said. "This is exactly the same scenario now."

Doctors plan to do more face transplants, but are having a hard time finding donors.

"Everyone says they would accept a face transplant if they were disfigured," Lantieri said. "The real question is, would you be a donor, or would you allow your family member to donate their face? That is the answer we need to change."

---

Trace arsenic in water may be tied to diabetes

CHICAGO - A new analysis of government data is the first to link low-level arsenic exposure, possibly from drinking water, with Type 2 diabetes, researchers say.

The study's limitations make more research necessary. And public water systems were on their way to meeting tougher U.S. arsenic standards as the data were collected.

Still, the analysis of 788 adults' medical tests found a nearly fourfold increase in the risk of diabetes in people with low arsenic concentrations in their urine compared to people with even lower levels.Previous research outside the United States has linked high levels of arsenic in drinking water with diabetes. It's the link at low levels that's new. The findings appear in Wednesday's Journal of the American Medical Association.

"The good news is, this is preventable," said lead author Dr. Ana Navas-Acien of Johns Hopkins Bloomberg School of Public Health in Baltimore.

New safe drinking water standards may be needed if the findings are duplicated in future studies, Navas-Acien said. She said they've begun a new study of 4,000 people.

Arsenic can get into drinking water naturally when minerals dissolve. It is also an industrial pollutant from coal burning and copper smelting. Utilities use filtration systems to get it out of drinking water.

Seafood also contains nontoxic organic arsenic. The researchers adjusted their analysis for signs of seafood intake and found that people with Type 2 diabetes had 26 percent higher inorganic arsenic levels than people without Type 2 diabetes.

How arsenic could contribute to diabetes is unknown, but prior studies have found impaired insulin secretion in pancreas cells treated with an arsenic compound.

The policy implications of the new findings are unclear, said Molly Kile, an environmental health research scientist at the Harvard School of Public Health. Kile wrote an accompanying editorial in the journal.

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"Urinary arsenic reflects exposures from all routes — air, water and food — which makes it difficult to track the actual source of arsenic exposure let alone use the results from this study to establish drinking water standards," Kile said.

Also, the findings raise a chicken-and-egg problem, she said, since it's unknown whether diabetes changes the way people metabolize arsenic. It's possible that people with diabetes excrete more arsenic.

The United States lowered arsenic standards for public water systems to 10 parts per billion in 2001 because of known cancer risks. Compliance was required by 2006, years after the study data were collected in 2003 and 2004.

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