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Doug McEwen dies; family fears another blood-borne disaster
Hemophiliacs fear blood quarantine lifted prematurely
Obituary for Doug McEwen
Funeral workers fear mad cow disease
Beef hormone label unacceptable, US cattle group says
Mild cognitive impairment?

Family fears another blood-borne disaster

Saturday 27 March 1999  Mark Kennedy  The Ottawa Citizen
Doug McEwen is dying of Creutzfeldt-Jakob disease, but plasma products from his blood have been cleared for distribution. Mark Kennedy reports.

SALT LAKE CITY - Tracie McEwen reaches over to the dying man in the hospital bed that crowds her small living room. His eyes are closed and he has rarely opened them in recent days. As he moans softly, she strokes his arm and kisses his forehead. "It's OK. Doug, it's OK."

Tracie married Doug exactly four years ago on this date in late March. She marked their anniversary by pouring sparkling cider into cups, making a toast, and lovingly dropping some into Doug's mouth. It is celebration enough that he has survived this long, but it is a bittersweet experience. For he is just a shell of the man he was a few short months ago.

Mr. McEwen is dying of Creutzfeldt-Jakob Disease (CJD), a rare and always fatal neurological disorder that has many different forms. The horrifying condition creeps up on its victims, eating away at the brain, giving it the appearance of a sponge.

Experts say only one in a million people gets the most common strain, known as "classical" CJD, which causes death within a year of symptoms first appearing. The World Health Organization is so concerned about the potential growth of CJD that it is holding an international meeting to discuss how to deal with it.

Doug McEwen's case has spawned an international debate over whether a new, more virulent strain -- dubbed "mad deer disease" -- has appeared in North America.

Governments say Mr. McEwen, 30, has the classical strain, but some scientists question that diagnosis. They say it's possible the Utah man, who was an occasional hunter, is the first known victim of a newer strain contracted by eating deer and elk -- much the same way some in Britain contracted "mad cow disease" from eating infected beef in the 1980s.

In the nearby states of Colorado and Wyoming, there are herds of deer and elk suffering from chronic wasting disease (CWD), a neurological disease in animals associated with CJD. Consumer groups say governments are ignoring what could be the beginning of a worldwide epidemic, but other scientists say there is no basis for such a prediction, which they view as irresponsible and alarmist.

Complicating the situation is the fact that Mr. McEwen has been a blood plasma donor for nearly two years, starting in late 1996. His plasma was sent to the pharmaceutical company Bayer, which fractionated it into various blood products at its plant in Clayton, North Carolina. The products were then shipped to 46 countries around the world, including Canada.

When Mr. McEwen was diagnosed with CJD late last year, Health Canada ordered a temporary quarantine on products containing his plasma. Regulators were alarmed by his age -- classical CJD victims usually get the disease in their 50s and 60s. Only one per cent of them fall into Mr. McEwen's age bracket. Could this be like mad cow disease, regulators asked. After consulting outside experts, the U.S. Food and Drug Administration and Centers for Disease Control, it was determined that Mr. McEwen has the classical form. On Christmas Eve, blood products created with his plasma were cleared for redistribution.

At her apartment in the small town of Kaysville, 50 kilometres north of Salt Lake City, Tracie McEwen has been swamped with calls and visits from U.S. regulators and government scientists.

She believes governments in the U.S. and Canada have made a terrible error by underestimating the potential seriousness of her husband's disease and by prematurely lifting the ban on blood products linked to his plasma.

"I'm not a scientist but I think it's a serious threat," says the 28-year-old, who teaches geography to Grade 9 students. "It's a horrible disease and until they know exactly how it's spread, I think that all the governments are fools to ignore it the way they have. They're fools because they still can't tell me how he got it."

She says her husband, a devout Mormon, was "devastated" at the thought that somehow his disease might be spread through his plasma donations. "Of course, he never would have donated, had we had known," says Tracie, tears welling up in her eyes. "It made me sick when I found out they had put it back on the market. They had it. They had it. They didn't have to use it. That would have been how many less people getting it? And they still put it out. And they still don't know. It's wrong."

Last summer, Doug was a big, strapping man who lived life to its fullest. He fished and hiked, and rode his bicycle in the stunning Utah mountains. He devoted himself to Tracie and their daughters, Sharon, 8, and Rilee, 3. Since then, his weight has dropped from 230 pounds to 130 pounds. He has been trapped in a body that has steadily given up on him.

It started slowly. First, there was the memory loss and the inability to do simple math, then the light tremors. Eventually, came violent seizures as well as the unexplainable outbursts of emotion -- hysterical laughter, sometimes followed by uncontrollable crying. By late January, he could no longer speak in sentences. Three weeks ago, he stopped walking.

Now, he is near death. Tracie, who has cared for all his needs and slept next to him every night on a floor mattress, can only wait for the inevitable.

"This is the worst thing I have seen," she says. "I wouldn't wish it on my worst enemy."

- - -

John Stauber, of Wisconsin, operates a public-interest advocacy group and is author of "Mad Cow U.S.A: Could the Nightmare Happen Here?" He believes it's quite plausible that McEwen has a new human strain of chronic wasting disease (CWD) contracted from infected deer or elk.

"He could very well be patient zero."

The problem, he says, is that the U.S. agencies charged with protecting animal and human health aren't conducting enough research into CWD -- how many animals have it, where they are, and whether it's crossing the species barrier into humans.

"By the time we see people confirmed as dying of CWD, those deaths are just going to be the tip of the iceberg because of the long latency (incubation can take many years)." He says U.S. government scientists are wrong to rule out CWD in McEwen because they didn't know what to look for under the microscope when they examined tiny particles of brain matter taken from him in a biopsy. A full post-death autopsy is needed, he says.

"I see history repeating itself in the denials," Stauber says in reference to how, in Britain in the 1980s, politicians insisted it was safe to eat British beef. Eventually, they were proven wrong and thousands of cattle had to be slaughtered. So far, 41 people have died from the human strain of mad cow disease, known as new variant CJD, or nvCJD.

An Oregon scientist who studies CJD, also criticizes government actions -- particularly the decision to lift the blood product quarantine. "He may have contaminated the western world's blood supply. The scope of this is breathtaking. You've got a time bomb hypothetically ticking in millions and millions of people. And as they become donors, it spreads further."

For the last few years, Canada and the U.S. had precautionary policies which stipulated that blood products should be withdrawn if they are found to contain plasma from CJD victims -- even those with the classical form. But last fall, both countries relaxed that policy after deciding there was no apparent risk involving classical CJD.

Michael Hansen, a scientist for Consumer's Union, the largest U.S. consumer group, says he believes that -- in the U.S., at least -- the policy reversal was the result of pressure from the blood industry.

In Canada, officials at the federal Health department and Bayer Inc. reject that allegation and say new scientific studies led to the decision. They express sincere sorrow for the McEwens and acknowledge it's understandable that new theories about his illness would emerge. But they say the science surrounding his diagnosis is sound and people should not worry about the safety of blood products linked to his donations.

"If we were not confident that this is classical CJD, we would not have taken the action we did," says Keith Bailey, director of Health Canada's bureau of biologics and radiopharmaceuticals.

Mark Pickett, a senior scientist at Bayer, concurs. He says there's no evidence that CWD in deer have infected humans "To imply that this is a new disease is stretching this inappropriately," says Pickett. "They have no evidence. This is just speculation. He adds that Bayer, along with the governments, is "extremely confident" that McEwen has classical CJD -- not another strain that would have warranted a tighter hold on the blood products.

"A scientist can never say never with absolute certainty. But that doesn't mean you have to paralyze yourself into inaction." Pickett says people must remember there are "consequences" to blood product withdrawals, most notably, the possibility of severe shortages. "If you just start throwing away blood products, then people will die."

Among the factors that led to the diagnosis and relaxed blood policy:

- McEwen's "clinical presentation" (his symptoms) were consistent with classical CJD, not the new variant.

- Pathologists who studied McEwen's brain biopsy (a tiny portion of the infected portion was removed late last year) say it is similar to classical CJD.

- Scientists conducted tests on the renegade protein (called prions) in McEwen's brain which are believed to cause CJD. Again, they say it lines up with classical.

- As for the risk of blood transmission, they say there have been epidemiological studies that found no evidence anyone has ever got CJD from donated blood. One study specifically examined a group of frequent users, hemophiliacs, who would logically be at a high risk. But none were found with the disease (Critics say that study is flawed because its sample was small and, because of the long incubation, many infected hemophiliacs may simply not be showing any symptoms yet.)

Finally, Bayer says its manufacturing process is so sophisticated it can reduce the prions from a CJD-infected donation to negligible levels by the time products are fractionated.

Both Doug and Tracie McEwen began donating plasma in late 1996 at the collection centre in nearby Ogden, Utah because, in part, it provided some pin money -- $20 for the first donation and between $20 and $40 for subsequent visits.

"It was good for us towards the end of college. You lay on a bed, you squeeze your hand and you do your homework or you read," Tracie said. "It was something that we did if we wanted money to go to the movies so that we didn't have to take out of our savings for our house. It was extra money. We used to joke about it and call it our blood money." She now shakes her head in dismay at the irony.

Twice a year, they were given physicals at the plasma centre. Among the standard questions: Do you have a family member who has had Creutzfeldt-Jakob disease? They had never heard of it, much less had a relative with it.

Quickly, they forgot about those questions. Over nearly two years, Doug donated 22 times. Then, on the day in late 1998 when he was diagnosed with CJD, the memory of that long-forgotten questionnaire came flooding back to Tracie. She rushed home and before she even called her parents with the dreadful news about Doug, she called the plasma collection centre to warn them.

"I felt we should do this because they may not know. I felt, `O gosh, what if sick people get this?' " The plasma collection centre had already been informed by the hospital and officials told Tracie not to worry.

In Utah and surrounding states people have grown increasingly anxious about CJD. Beth Williams, the leading U.S. researcher on chronic wasting disease, works at the University of Wyoming. She says that in a small area in northeastern Colorado and southern Wyoming, about six per cent of the deer and elk suffer from CWD. They slobber excessively, stagger around and lose weight until they eventually die.

There's no evidence that the disease is spreading to other states or that it has been transmitted to humans, she says.

"But you have to be very careful with that. We can say we don't have any evidence at this point in time, but that certainly doesn't prove that. I think it's reasonable to be careful. There are unknowns."

In Utah, what was once an unknown disease has suddenly become big news. The reason: In this one state alone in 1998, six people died from classical CJD. (McEwen will soon make it seven). Utah barely has two million residents.

People who were told this was a one-in-a million disease immediately began asking questions. Especially Mel Steiger, who lost his wife Ellie to CJD last March at the age of 57. He has become an activist, pushing for more research into CWD and a state law to make it mandatory for doctors to report CJD deaths (He believes it might now be misdiagnosed, perhaps confused with Alzheimer's disease and under- reported.)

Craig Nichols, Utah's epidemiologist, says people are jumping to conclusions about last year's high rate of CJD deaths. It's probably a statistical blip, he says, which happens from time to time.

But Steiger is not convinced. He says a 27-year-old man in nearby Oklahoma was recently diagnosed with CJD. Again, like McEwen, it's extremely rare that people in that age group get classical CJD. So could it be something else? he asks.

Even the funeral directors are becoming concerned. Prions, which tend to collect in the victim's brain and spinal cord, are virtually impossible to kill -- even through incineration or boiling.

Kurt Soffe, president of the Utah Funeral Directors Association, paints a troubling scenario: What if a CJD victim's brain is removed for autopsy and microscopic parts of the brain matter containing prions are dropped on to the scalp and forehead during the procedure? He worries he might put his own employees and family members of the deceased at risk.

"We have no way of disinfecting for this agent," he says. "Many family members will kiss their loved ones goodbye on the forehead. What do I tell them?"

For Tracie McEwen, the last few months have been a blur. She wishes governments would conduct more research on CJD and provide more public education to help people recognize the symptoms.

With Doug, it began last May when he unexpectedly asked Tracie to fill out his expense forms from work. It was an odd request coming from Doug, a territory manager for a large groceries firm who had always been extremely well organized. But it was a clue easy to overlook.

The next sign of trouble was more obvious. Doug spent a lot of time on the road. Every night, without fail, he always called home between 8 and 8:30. One night in June, while he was in Idaho, he didn't call home until 11 p.m.

Tracie leaped for the phone. What's wrong? she asked. He couldn't remember his phone number. Why didn't he just call directory assistance? He couldn't remember how to spell his last name.

It continued throughout July. He'd forget requests to pick up milk on the way home from work. One day, accompanied by his eight year-old in a store, he tried to write a cheque but couldn't remember how. His daughter had to help.

Doug could no longer do his job, so he quit, meaning the family lost its life insurance and health insurance. They had just sold their mobile home and were less than two weeks from moving into a new home.

They could no longer afford the mortgage. The house builder gave them back their downpayment, but they still had to scramble to find a place to live. Soon after, during a visit by two close friends, Doug turned to Tracie with fear in his eyes. He didn't know who they were.

Doctors weren't much help. They could not diagnose the problem. He was asked to visit a psychiatrist and undergo a three-hour interview to determine if he was severely psychotic.

He was asked if animals talked to him and if he had ever thought about killing his family. Doug emerged from the room when it was over and pulled Tracie into a corridor. "I'm not crazy. Tell me I'm not crazy. They think I'm crazy." he told her.

More recently, after he was diagnosed with CJD and began dying at home, the pain felt by his family has been truly heartbreaking.

Eight-year-old Sharon was always very close to Doug. But by this winter, when she would climb up on his lap, he would not even look at her. Once, he misunderstood something she said and chased her, his arms flailing.

"It was horrific," says Tracie, adding that Sharon was devastated.

Tracie has tried to explain to the children that this is not their daddy they are seeing. It hasn't been easy. One day, Doug tried to say something to one of his daughters but couldn't form the words. He slumped into the couch and started to cry.

"I walked over and hugged him," Tracie said. "I pulled back and looked at it him and he looked at me and said, `I want my body back.' " On the first night he had a seizure in bed, the episode lasted about three minutes. As it ended, Doug tried to get his breathing back to normal and looked directly at Tracie.

"I love you," he said.

Throughout all the indignity wrought by the disease, Doug has never complained. "This is who we are right now, but this is not who we were six months ago," says Tracie. "Now we are finishing the book of our life together and I want to know why, how and when this disease will get enough attention so that someone, somewhere, is allowed to find answers and solutions to this life stealer."

Obituary for Doug McEwen

Ogden Standard Examiner Sunday, March 28, 1999 

R. Douglas McEwen

KAYSVILLE - R. Douglas McEwen, 30, loving husband and father passed away Friday at his home with his wife at his side after a short, but courageous battle against Creutzfeldt-Jakob Disease (CJD). Though we will never understand why he was taken so soon, we know that Doug has gone to a much better place and suffers no more.

Born Robert Douglas McEwen on October 28, 1968 in Hayward, California, he was the first child of Robert LeGrande McEwen and Kaye (Weaver) McEwen. He moved to his parents' home state of Utah when he was three and has lived in the Kaysville area all his life, except for two years spent in British Columbia, Canada, serving an LDS mission.

Growing up he loved to spend time with family and friends and enjoyed hunting, motor biking, tennis, golf, and basketball. He was active in Scouting; attaining Order of the Arrow. He graduated from Davis High School and Davis HS Seminary in 1986. Doug worked two full-time jobs to pay for the mission that he loved. He served in British Columbia, Canada from April 1989 until May 1991. Doug will always be known for his thoughtfulness and acceptance towards others. He had many good friends with whom he enjoyed spending time with. His acts of kindness will not soon be forgotten, nor will his reputation of being a hard working and honest man.

On March 23, 1995 he married the former Tracie Louise Bernard in the Salt Lake Temple for all time and eternity. They shared two beautiful daughters, Sharon and Rilee. Doug adored his two "little princesses" and loved spending time with both of them more than anything else on this earth. He was a kind and loving husband as well as father, son, brother, grandson, uncle, nephew, cousin and friend. Doug worked for Acosta Sales, Inc. until August 1998, resigning when the disease began taking it's toll on him.

Doug's wife and children want to express their gratitude and appreciation for the people from Vistacare Hospice who helped care for and support Doug. We will be forever thankful to Megan, Pat, Linda, Bob, Shauna, Shelly and Kathy for their compassion, professionalism and caring ways. Also, a thank you to all of our friends who have stood by us during this time.

He is survived by his wife Tracie and two little girls, Sharon Louise and Rilee Sara of Kaysville. Also surviving are his mother Kaye McEwen and grandmother Caryol Weaver, both of Kaysville; brothers, Mark (Janalynn) McEwen of Clearfield; Elder David McEwen, currently serving in the San Pablo Philippines LDS mission; sister, Kachelle (Gary) Bryant of Layton; mother and father in-laws, Sheila and Philip Chretien of Harrington, Maine; grandmother in-law, Shirley Rankin of Westbrook, Maine; brothers in-laws, Curtis (Melanie) Bernard of Newburyport, Mass.; Bill Bernard of Westbrook, Maine; sister in- law, Tricia (David) Radley of Standish, Maine; four nephews, Mark Robert and Mardell McEwen, Ethan Radley and Willie Bernard; four nieces, Ashley, Cara, Kelsey and Sarah Radley; several aunts and uncles, many cousins and many very close friends.

He was preceded in death by his father Robert LeGrande McEwen in December 1989, his paternal grandparents, Eugene and Florence Judd McEwen; his maternal grandfather, Louis Weaver; and two uncles, Val Weaver and Brad Weaver.

Services will be held at Lindquist's Kaysville Mortuary, 400 North Main, Tuesday, March 30, 1999 at 11 a.m. Family and friends are welcome during viewing hours of 6 to 8 p.m. Monday, March 29th and one hour prior to services on Tuesday.

Interment will follow at Kaysville City Cemetery.

Funeral workers fear mad cow disease

March 26, 1999 CBC news
OTTAWA -- The World Health Organization is meeting in Geneva, Switzerland this week to talk about Creutzfeldt-Jakob disease. The rare illness attacks the brain, and is linked to so-called "mad cow disease" in Britain.

Scientists from all over the world are in Geneva. They're hoping to set up guidelines for health care and funeral workers who deal with C.J.D. victims. Creutzfeldt Jakob disease has become a worry for the people who treat victims. In fact, some funeral workers in Canada and the U.S. are now refusing to embalm the bodies of people who've died of the disease. Medical studies show that the infectious agent doesn't die under standard sterilization, such as heat or chemicals.

The biggest danger for the embalmer is contact with the highly infectious brain and spinal fluids. "The scary part about C.J.D. is we don't have the proper equipment," says Patrick McGarry, an Ottawa funeral director. "It's very expensive, beyond our means for just an embalming. We do have specialized solutions. But they haven't found anything that will kill this disease."

McGarry's policy is not to embalm. But not all funeral workers refuse the service; in fact, some have never even heard of the disease. The World Health Organization is hoping to get the word out. Ottawa bioethicist, Burleigh Trevor Deutsh is at this week's meeting.

"The World Health Organization has the responsibility to keep an eye out for this kind of thing and to set up rules of practice, safe practice, that are applicable world wide, because of the uniqueness of C.J.D. This is an ideal for the WHO to address."

The meeting is expected to result in new infection control guidelines for hospital, home care and funeral home settings. They may include rules about destroying surgical instruments used on C.J.D. patients. Funeral homes may also be encouraged to buy specialized, hi-tech sterilization equipment. Health Canada expects to put out its own infection control guidelines next fall.

US Funeral Homes

Correspndence Wed, 24 Mar 1999 Kurt Soffe of the Utah Funeral Directors
"I recently returned from Washington, D.C. I was given the opportunity to make a brief presentation to the policy board of the National Funeral Directors Assn. The policy board consists a one representative from each of the fifty states. Alaska being the only state absent. The presentation was in keeping with our discussions and circumstances here in Utah about CJD.

The National Funeral Directors Assn. publishes a monthly magazine the "Director", this is sent to some 15,000+ funeral homes, they have asked that I submit an article for publication regarding CJD. This will be a tremendous opportunity to inform the funeral directors regarding CJD.

An interesting point for those who insist on a cranial autopsy and still want an open casket funeral. With the autopsy, there is considerable risk of comtaminating the hair and the forehead with cranial liquids or material, such as bone dust, blood, etc. How do they sterilize the forehead and how do they prevent the visitor from kissing the deceased on the forehead? Use a thin veil????? Tis a source of potential exposure."

Beef hormone label unacceptable, US cattle group says

Tue, Mar 23, 1999 By Doug Palmer  Reuters Financial Report
WASHINGTON - U.S. cattle producers would accept a "Made in the USA" label on their beef shipments to the European Union, but not one that says "made with artificial growth hormones," a U.S. cattle industry aide said on Tuesday.

Labeling has emerged as a potential way out of the bitter trade dispute between the two agricultural powerhouses. The United States is now threatening to impose at least several hundred million dollars of punitive duties on the EU. But "the issue of labeling production practices I think is a very slippery slope," Chuck Lambert, chief economist of the National Cattlemen's Beef Association, told reporters, after a House hearing on international trade issues.

The whole point of the two World Trade Organization rulings against the EU is that "there is no scientific difference" between beef from cattle injected with artificial growth hormones and beef from other cattle, Lambert said. To accept a label that sets U.S. beef apart because of how it is produced would be inconsistent with that ruling and set a bad precedent for other controversial but safe production practices, such as genetically-modified crops, he said.

On Monday, the United States targeted more than $900 million of EU goods for possible retaliation if the EU does not open its market to U.S. hormone-treated beef by a May 13 WTO deadline. The EU has acknowledged that it won't be able to meet that deadline, but has said it is willing to discuss both labeling and compensation for U.S. cattle producers.

U.S. cattle producers "conservatively" estimate their annual lost sales because of the EU's import ban at about $500 million, Lambert said. At the time the ban was imposed in 1989, U.S. sales of hormone-treated beef to the EU totaled about $100 million annually and sales to other markets have grown sharply since then, he said.

In a banana dispute that is still pending, the United States initially targeted about $1.5 billion worth of EU goods for punitive duties in retaliation. Later, it trimmed the list to $520 million, or roughly by two-thirds. The Clinton administration will hold a hearing late next month on its beef sanctions list.

Lambert said he expected the final beef list to be trimmed, but maybe by less than in the banana case. It could just be cut by half, instead of two-thirds, he said. A large portion of the EU goods on the list are agricultural products, particularly beef, poultry and pork.

Nick Giordano, international counsel for the National Pork Producers Council, told the House panel his group would make a strong push to make sure that pork stays on the final list. "The EU pork market has basically been closed to the U.S. pork industry for over ten years" because of protectionist rules disguised as food safety measures, he said.

U.S. food experts say trade issue behind beef ban

Reuters Business Report Tue, Mar 23, 1999 By Bob Burgdorfer
CHICAGO - U.S. food and livestock scientists watching the escalating battle between the United States and the European Union over hormone-treated U.S. beef imports say the EU's ban is wrong and U.S. beef is safe. For nearly 10 years the European Union has prevented imports of U.S. beef because of concerns that growth hormones used by U.S. cattle producers might cause health problems in humans.

"There has been no demonstrative health risk that has been shown," said Dennis Bier, director of the Children's Nutrition Center at the Baylor College of Medicine in Houston. "The science has been reviewed over and over again in this country, and every single scientist has said there is no evidence this stuff is harmful to you."

After years of talks, the Clinton Administration said Monday it would impose import tariffs on $900 million worth of European Union farm goods unless the EU lifts the ban by May 13, a deadline set by the World Trade Organization. The global trade body also opposes the ban. U.S. livestock and food safety experts, who argue that there is no evidence to support the EU's claim, say the ban is a trade barrier designed to protect Europe's livestock industry.

"It is a trade barrier that they've been getting by with for years," said Jack Riley, head of Kansas State University's animal science department. At issue is the use by cattle producers of six growth hormones, including estrogen, to speed weight gains in cattle. The hormones are no longer in the cattle's system at the time of slaughter, cattlemen say. "Estrogen is a natural substance. It's harmless," said Kendal Frazier, a spokesman for the National Cattlemen's Beef Association, a cattle industry trade group.

The U.S. cattle industry estimates the EU ban costs U.S. cattle producers about $250 million a year in lost sales. "We basically have lost that market," Frazier said. Some U.S. food experts said the European ban might be based on fear as well as economics.

In 1996, European beef consumption slumped after British scientists announced a probable link between eating beef from cattle with bovine spongiform encephalopathy ("mad cow" disease) and development of the brain-deteriorating disease in humans called Creutzfeldt-Jakob Disease. "I think their experience with BSE has probably made them overly cautious," said Baylor College's Bier.

There has never been a case of mad cow disease in the United States, said Fergus Clydesdale, head of the Food Science Department at University of Massachusetts-Amherst, who added that he thought the ban was probably linked to trade considerations. "There isn't a great of scientific basis for it," said Clydesdale said.

Sue Snider, a food and nutrition specialist at the University of Delaware, also sees Europe's ban on U.S. beef as a trade issue that existed long before the mad cow scare. "U.S. beef does use hormones, but by the time they (cattle) go to slaughter there is no more hormone present. It comes down not to a safety issue but an economic issue," she said.

EU approves U.S. meat plants, averts import block

 Reuters World Report Thu, Mar 25, 1999
BRUSSELS - The European Commission on Thursday published a list of U.S. abattoirs eligible to export to the European Union, removing the possibility it would block imports from the United States over flawed veterinary controls.

EU veterinary experts in January gave temporary approval for the list, which contains around 100 slaughterhouses, saying they would review the situation in three months. But the Commission has now decided to approve a new list after inspections "revealed that the level of hygiene in certain establishments may be considered to be satisfactory."

The EU's influential Standing Veterinary Committee had raised doubts over testing procedures at some U.S. plants after inspections last year revealed shortcomings in the detection of potentially harmful residues of antibiotics in meat. The issue threatened to prompt the panel to reject the entire list, blocking all U.S. meat imports.

The EU imports $20 million of hormone-free beef a year plus some pork and horse meat from the United States.

Mild cognitive impairment?

Wed, 24 Mar 1999 By LAURAN NEERGAARD  The Associated Press 
New Alzheimer's Studies To Begin

WASHINGTON -- Alzheimer's disease is one of the scariest threats of old age, particularly frightening because so far there's no way doctors can protect people at risk. That may be about to change.

Scientists have just discovered that a memory problem called ``mild cognitive impairment'' can be an early warning sign of Alzheimer's -- and they're beginning three huge studies to see if certain drugs could prevent those patients from ever getting Alzheimer's.

``It's very exciting,'' said Neil Buckholtz, chief of the dementia branch at the National Institute of Aging. But ``I don't think people are really aware of this concept'' of mild cognitive impairment. So the NIA is trying to get the word to people over age 55 that if they're getting abnormally forgetful, they should see a doctor.

We all have occasional lapses where we forget where we parked the car or can't recall someone's name. That's normal, particularly as people age or experience stress. Depression also can cause memory lapses, and forgetfulness is a side effect of some drugs. Doctors can offer immediate help for those problems. But mild cognitive impairment is a more persistent memory problem. A golf lover makes a tee time on Tuesday but by Thursday, he leaves his golfing buddies waiting in vain on the links.

A pattern of such forgetfulness can mean mild cognitive impairment -- as long as doctors rule out other dementia symptoms. The mildly cognitive impaired don't have such symptoms as difficulty completing normal daily activities, problems with reasoning or inability to communicate, Dr. Ronald Petersen of the Mayo Clinic reports this month in Archives of Neurology.

A final test is simple: Read a paragraph's worth of information and wait 30 minutes. Someone with healthy short-term memory usually can spout back the information, but the mildly cognitive impaired have trouble, Buckholtz explained.

Mild cognitive impairment doesn't mean you're definitely destined for Alzheimer's. But studies show that every year, 12 percent to 15 percent of those patients will progress to Alzheimer's -- in other words, up to 45 percent will have Alzheimer's within three years. In contrast, only 1 percent of healthy people over age 65 get Alzheimer's each year.

The cause of Alzheimer's is not known. But 4 million Americans have it, a number expected to jump as the baby boomers age. So neurologists want a way to at least delay Alzheimer's onset. Three new studies are hunting such a therapy in patients diagnosed with mild cognitive impairment:

A National Institute on Aging-sponsored study will give 720 patients ages 55-90 either high-dose vitamin E, the current Alzheimer's medication Aricept or a dummy pill. Results are expected by 2003. For information, call 1-888-455-0655 or check the Internet at Study sites are in 28 states and Canada.

Why those choices?

NIA-funded scientists discovered in 1997 that high-dose vitamin E can slow by about six months the progression of moderately severe Alzheimer's. Vitamin E is an antioxidant thought to limit damage from ``free radicals,'' molecular damage that has been found in Alzheimer's patients' brains.

Aricept inhibits the breakdown of acetylcholine, a brain chemical vital for nerve cells to communicate with each other. Also, test-tube studies suggest acetylcholine could decrease the buildup of Alzheimer's-related brain plaques.

Novartis Pharmaceuticals is enrolling 900 patients ages 55-85 in a three-year study comparing its experimental drug Exelon to a placebo. Exelon, which also inhibits the breakdown of acetylcholine, is awaiting government permission to sell in the United States as an Alzheimer's treatment. The new prevention study will be conducted at 50 sites worldwide. For information, call 1-877-554-HOPE.

Merck & Co. is enrolling more than 1,000 Americans over age 64 in a study comparing its experimental drug Vioxx to placebo. Vioxx is a novel painkiller awaiting government sales approval. But it works by inhibiting inflammation, considered another possible cause of Alzheimer's disease, so Merck now is studying its brain effects. For information, call 1-800-65-STUDY.

Hemophiliacs fear blood quarantine lifted prematurely

Sun, 28 Mar 1999 Mark Kennedy The Ottawa Citizen
Doug McEwen, the Utah plasma donor with Creutzfeldt-Jakob disease (CJD) whose case sparked an international debate, has died.

Mr. McEwen's fatal illness was so unique that Canada's hemophiliacs, who suffered the hardest in the tainted-blood scandal of the 1980s, requested that a quarantine be reimposed on blood products containing Mr. McEwen's plasma. They fear the quarantine -- imposed for a week last December -- was lifted prematurely because there isn't enough conclusive evidence to determine that Mr. McEwen has the most common version of CJD and not some new, more virulent, strain.

An autopsy will now be performed on Mr. McEwen by researchers at the University of Utah, though it's not known how long it will take for the findings to be made public.

Mr. McEwen began exhibiting symptoms of the rare neurological disorder last summer, was diagnosed in November and his medical condition rapidly deteriorated throughout this winter. Last Tuesday, while his wife Tracie spoke to a Citizen reporter next to the hospital bed in the couple's living room, Mr. McEwen lay near death. He grew weaker by the end of the week and died Friday. His family did not announce the death until yesterday.

Regulators at Health Canada and scientists at the U.S. Centres for Disease Control say they believe Mr. McEwen died at age 30 of "classical" CJD which they contend cannot be transmitted through blood.

Officials at Bayer Inc., which fractionated Mr. McEwen's plasma into blood- clotting products for hemophiliacs, are also convinced it's classical CJD. And they say there's no risk because their manufacturing process reduced the destructive cellular proteins -- known as prions -- in Mr. McEwen's plasma to negligible levels.

But some U.S. consumer groups and scientists aren't so sure. They say it's possible that Mr. McEwen had a new strain of CJD called chronic wasting disease which he may have contracted from eating infected deer and elk in nearby states.

The Canadian Hemophilia Society, which represents about 2,500 Canadians with the blood disorder, doesn't want the government to take any unnecessary risks. This winter, it asked the government to reimpose the quarantine until there is "definitive proof" that Mr. McEwen had classical CJD -- an assurance they say can't be given until an autopsy is performed.

As well, the hemophiliacs say that whatever diagnosis is ultimately made, they want the right to refuse in future any of the blood products containing his plasma and to have alternate products made available.

"There's certainly some compelling evidence here that says that this is classical CJD," said hemophilia society president Erma Chapman. "But it's not absolutely conclusive. I don't want to cause panic when there's no need for panic. But there is need for caution."

Ms. Chapman said that despite government assurances, "we have not been able to get a scientist to say for certain that this is absolutely classical CJD. They're saying, 'It looks like, compatible with, consistent with,' that kind of terminology. It's not completely reassuring."

She said some hemophiliacs and their family members are living in fear. Many saw their loved ones succumb to AIDS and hepatitis C from tainted blood products in the 1980s.

Ms. Chapman said although they realize there is more scientific evidence this time to suggest they have nothing to worry about with CJD, they can't help but sense that they've seen and heard this all before.

"The rhetoric (about safety) sounds the same, even though this time it might be true. The problem is the last two times it wasn't. When you look around the room (at meetings of hemophiliacs and their families), you can't help but see what those promises have done to people. It's been very devastating and people are being asked to make choices now without necessarily having a guarantee."

At the same time, she said, the worst thing that could happen would be for a hemophiliac to refuse special clotting products to treat a life-threatening bleed -- based solely on the fear of a theoretical risk of getting CJD years from now.

It's a dilemma that has caused great anguish and divided members of the tightly-knit hemophilia community.

In mid-December, Health Canada ordered the Canadian Blood Services (CBS) and Hema-Quebec to put thousands of vials of blood products containing Mr. McEwen's plasma temporarily on hold. The problem was that most victims of classical CJD, a rare disease that strikes one in a million people -- exhibit symptoms in their 50s and 60s. Mr. McEwen was 29 when he became ill and had been donating plasma for nearly two years.

Because of his younger age, regulators initially worried that he might have the "new variant CJD" -- so- called Mad Cow Disease -- that is linked in Britain and France with the ingestion of beef from animals with a similar disorder called bovine spongiform encephalopathy, or BSE. So far, 41 people have died.

But after a week during which Health Canada reviewed medical data -- including a biopsy of Mr. McEwen's brain tissue -- with U.S. officials, it was decided that he had classical CJD, not a new variant, and the quarantine was lifted on Christmas Eve.

Since then, about half of Canada's severe hemophiliacs have refused to take the implicated lots, in part because they were advised by their doctors to take the precaution. CBS bought alternate products to ensure there wasn't a shortage and hemophiliacs have been able to use them. But at current usages, the alternates will likely run out in September. At that point, the blood products linked to Mr. McEwen will still be in distribution and won't be replaced until Bayer begins shipping a new, non-implicated line in early 2000.

Canadian Blood Services spokesman Ian Mumford said the blood agency doesn't think there's a need for the quarantine to be reimposed, but it does understand why hemophiliacs are anxious. For that reason, the CBS agrees that they have the right to refuse products linked to Mr. McEwen. The blood agency will therefore continue to search for more alternates from other companies for hemophiliacs to use this fall.

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