WellCommons

By Lauren Neergaard, Associated Press

WASHINGTON -- When a stroke hits at 52, like what happened to Sen. Mark Kirk of Illinois, the reaction is an astonished, "But he's so young."

The reality is that strokes don't just happen to grandma. They can happen at any age, even to children — and they're on the rise among the young and middle-aged.

That makes it crucial to know the warning signs no matter how old you are.

"Nobody's invincible," warns Dr. Ralph Sacco, a University of Miami neurologist and past president of the American Heart Association.

Every year, about 795,000 people in the U.S. have a stroke. While some strokes are caused by bleeding in the brain, most are like a clogged pipe. Called ischemic strokes, a clot blocks blood flow, starving brain cells to death unless that circulation is restored fast.

Make no mistake, the vast majority of strokes do occur in older adults. But up to a quarter of them strike people younger than 65, Sacco says.

In the so-called stroke belt in the Southeast, that figure can be markedly worse. At Wake Forest Baptist Medical Center in North Carolina, a stunning 45 percent of stroke patients are young or middle-aged, says stroke center director Dr. Cheryl Bushnell.

More ominous, recent government research found that nationwide, hospitalization rates for ischemic strokes have jumped by about a third among people ages 15 to 44 over the past decade.

Sometimes younger-age strokes are flukes with no warning signs, impossible to predict — like Kirk's appears to be. The Republican senator is a Navy Reserve commander and avid swimmer, but dizziness sent him to the hospital. It turns out he had a tear in the carotid artery in his neck which blocked blood flow to his brain, triggering a stroke. Trauma usually causes such tears, although doctors haven't been able to say what caused Kirk's. His doctor at a Chicago hospital said Monday that Kirk was continuing to improve from the stroke, which affected his left side.

Heart birth defects, such as a little hole in the heart known as a PFO, and blood-clotting disorders also tend to cause strokes more often in younger people than in seniors.

But just like strokes at older ages, a lot of younger strokes are preventable. The increase seems to be part of a troubling trend: As Americans get fatter, high blood pressure, diabetes and other artery-corroding consequences set in at an earlier age — meaning resulting strokes can hit earlier, too.

Indeed, research reported in Annals of Neurology last fall found nearly 1 in 3 of the 15- to 34-year-olds hospitalized for a stroke, and over half of those ages 35 to 44, already had high blood pressure.

More women are having strokes during or right after pregnancy, too, the government reported last summer. That's because more of them start out with unhealthy conditions like high blood pressure even before the hormonal changes kick in.

Whatever the cause or the age, anyone with stroke symptoms needs emergency care: Sudden numbness or weakness in the face, arm or leg, especially on one side; sudden difficulty speaking or understanding speech; trouble seeing or walking; a sudden super-severe headache.

Younger adults are less likely than seniors to know those symptoms, and tend to try to shrug them off, Bushnell says. She points to a recent 50-something patient who twice ignored temporary episodes of weakness on one side. Called TIAs, for transient ischemic attacks, such episodes are a big red flag that a full-fledged stroke may be imminent. A third TIA finally brought him to the emergency room. By then, aggressive treatment wasn't enough to avoid a stroke that left him with impaired speech.

"As people get older, they have more and more direct contact with people who had strokes," and learn what to watch for, Bushnell says. But at younger ages, "there's just a gap in awareness."

Who is at increased risk for a younger-than-usual stroke? African-Americans and Hispanics, more than whites. Someone whose parent had a stroke before age 65 is at extra risk.

But mostly, the same things that are bad for your heart are bad for your brain, making it crucial to control blood pressure, diabetes and cholesterol, to stop smoking and to keep active. At www.powertoendstroke.org the American Heart Association offers a seven-step online test called "My Life Check" that can help assess your risks.

Younger people do tend to survive strokes more than older people, and to recover better.

But Arnold Springs, 48, of Winston-Salem, N.C., knows it was his friends' fast 911 call that made the difference for him earlier this month.

"All of a sudden, my right arm went numb. The next thing I knew I was on the floor," Springs recalls.

The ambulance got him to Wake Forest Baptist Medical Center in time for a clot-busting drug to stop his stroke. Springs left the hospital three days later with some loss of vision and trouble walking, problems that his sister says are expected to improve — plus orders to lower his blood pressure to stave off future strokes.

Jim Lash, 83, paints during the Memories in the Making art program, an exclusive program of the Alzheimer's Association at Aspen Village at Lowry in Denver Friday, June 26, 2006. A small study last year of 12 people, ages 65 to 85, found that weekly sessions helped Alzheimer's patients focus their attention for 30 to 45 minutes and that completing artwork brought them "pleasure and satisfaction." Memories in the Making began in 1988 in Orange County, Calif. There are now dozens of chapters in 26 U.S. states and experts say the artwork has provided an extraordinary outlet for Alzheimer's patients.

The federal government is setting forth a plan to help the estimated 5.4 million Americans who have Alzheimer's or similar dementias and their loved ones. I have been looking to feature a Douglas County family who has been affected by this disease because I think it would provide valuable insight for the community. If you would be willing to share your story, please contact me at kbritt@ljworld.com.

Here's today's Associated Press story by Lauran Neergaard about the plan:

The government is setting what it calls an ambitious goal for Alzheimer's disease: Development of effective ways to treat and prevent the mind-destroying illness by 2025.

The Obama administration is developing the first National Alzheimer's Plan to find better treatments for the disease and offer better day-to-day care for those afflicted.

A newly released draft of the overall goals for that plan sets the 2025 deadline, but doesn't provide details of how to fund the necessary research to meet that target date. Today's treatments only temporarily ease some dementia symptoms, and work to find better ones has been frustratingly slow.

A committee of Alzheimer's experts began a two-day meeting today to help advise the government on how the eventual plan, expected by spring, could meet those goals.

"Families have been "reminding us of the enormity of our task, perhaps most important the meaningfulness of it."

— Dr. Ron Petersen, an Alzheimer's specialist at the Mayo Clinic, who chairs the committee

But hanging over the meeting is the reality of a budget crunch. It's not clear how much money the federal government will be able to devote to Alzheimer's, and states have seen their Alzheimer's budgets cut.

"We're not going to fix this without substantial resources," said David Hoffman of the New York State Department of Health, who oversees that state's Alzheimer's programs. "In New York, we're hanging on by our nails."

An estimated 5.4 million Americans have Alzheimer's or similar dementias. It's the sixth-leading killer, and is steadily growing as the population rapidly ages. By 2050, 13 million to 16 million Americans are projected to have Alzheimer's, costing $1 trillion in medical and nursing home expenditures.

The national plan is supposed to tackle both the medical and social aspects of dementia, and advocacy groups had urged that it set a deadline for progress.

Among the draft's other goals:

• Improve timely diagnosis. A recent report found as many as half of today's Alzheimer's sufferers haven't been formally diagnosed, in part because of stigma and the belief that nothing can be done. Symptomatic treatment aside, a diagnosis lets families plan, and catching the disease earlier would be crucial if scientists ever found ways to slow the disease's progress.

To do that, the draft suggests starting with a national public awareness campaign so more people know the early warning signs of dementia — and to include memory assessment tools in the annual Medicare wellness visit.

• Improve support and training for families so they know what resources are available for patients and what to expect as dementia worsens.

A caregiver-training program in New York has shown that families taught how to handle common dementia problems, and given support, are able to keep their loved ones at home for longer. Hoffman said such training programs are far cheaper than nursing homes.

Alzheimer's sufferers gradually lose the ability to do the simplest activities of daily life and can survive that way for a decade or more. In meetings around the country last summer and fall, families urged federal health officials to make sure the national plan addresses how to help patients live their last years at home without ruining their caregivers' own health and finances.

WICHITA, Kan. (AP) — Officials at Wichita State University say a student has tested positive for tuberculosis, an infectious disease that usually attacks the lungs.

University officials released little information about the student Monday, but they say the person has been quarantined. KWCH-TV reports the university could not say if the student lives on or off the campus.

Wichita State has been on winter break since mid-December. Officials believe the exposure of other students to the ailing person has been limited.

Classes at the university resume Tuesday.

ALBANY, NY (AP) -- New York Health Commissioner Nirav Shah says 12 decorative metal tissue boxes contaminated with radioactive material have been removed from four Bed, Bath and Beyond stores in the state.

The retail chain says no other stores in New York had the item, called Double Ridge Boutique.

Shah says the products were not distributed to the public.

The Nuclear Regulatory Commission notified the retailer on Jan. 10 that the shipment of metal boxes was found to contain Cobalt-60. The low-level radioactive material has numerous industrial and medical uses, including cancer radiation therapy.

The New York store locations are in Westbury, Port Chester, Elmsford, and Huntington Station.

The government released a report today about health care spending. According to the report, fewer Americans spent money on office visits, hospital care and prescription drugs. Have you cut back on spending? Has it affected your health?

Here's an Associated Press story about the report:

By RICARDO ALONSO-ZALDIVAR

Health spending stabilized as a share of the nation's economy in 2010 after two back-to-back years of historically low growth, the government reported today.

Experts debated whether it's a fleeting consequence of the sluggish economy, or a real sign that cost controls by private employers and government at all levels are starting to work.

The answers will be vital for Medicare's sustainability, as well as for workplace coverage.

U.S. health care spending grew by 3.9 percent in 2010, reaching $2.6 trillion, according to the report by the Health and Human Services department.

That's an average of $8,402 per person — far more than any other economically advanced country.

Still, the increases for 2010 and 2009 were the lowest measured in 51 years. And health care as a share of the economy leveled off at 17.9 percent, the first time in a decade there's been no growth.

The main reason for the slowdown was that Americans were more frugal in their use of health care, from postponing elective surgery to using generic drugs and thinking twice about that late-night visit to the emergency room.

"Although medical goods and services are generally viewed as necessities, the latest recession has had a dramatic effect on their utilization," said the report published in the journal Health Affairs. "Though the recession officially ended in 2009, its impact on the health care sector appears to have continued into 2010."

DIFFERENT OPINIONS

Independent economists issued conflicting assessments.

"I think it could signal slower growth in the future," said Ken Thorpe, professor of health policy at Emory University in Atlanta. "Any discussion about reducing the deficit is going to focus on how we reduce the growth in health-care costs. And employers are adopting more effective tools to keep putting downward pressure on health-care cost increases."

But his counterpart Len Nichols at George Mason University in Virginia said people are getting less medical care because too many have lost jobs and insurance, and they just can't afford to pay.

"The slowdown is mostly due to postponement of care, due to anticipated inability to pay," said Nichols. If he's right, that could mean costs will spike once the economy is on solid footing.

The report provided relief for a jittery White House facing a 2012 re-election campaign in which President Barack Obama's health care overhaul is a top target for Republicans.

The nonpartisan number crunchers at HHS found that the health care law barely contributed to cost increases in 2010 — just one-tenth of 1 percentage point. Major provisions expanding coverage to more than 30 million uninsured don't take effect until 2014, well after the presidential election.

The federal government's share of the total health care tab — another issue in this year's political debate — grew to 29 percent in 2010, up from 23 percent as recently as 2007. Counting state and local spending, the overall government share stood at 45 percent of the total.

Medicare spending grew by 5 percent in 2010. That was slower growth than in 2009, due mainly to reductions in what the government paid private Medicare Advantage insurance plans. Medicaid spending increased by 7.2 percent, less than the 2009 rate because of fewer people covered by the program.

However, the main finding of the report was a continued slowdown in the use of services across major health-care categories, one its authors termed "dramatic." Higher copayments for those with private insurance are part of the reason.

BREAK DOWN ON SPENDING

Hospital care, which accounts for just over 30 percent of what Americans spend, grew more slowly because of a decline in a key measure of inpatient admissions, and slower growth in emergency room visits, outpatient appointments, and outpatient surgery.

Spending on doctor visits and related care — about 20 percent of the total — grew at a historically low rate of 2.5 percent, due to an overall drop in visits and a milder 2010 flu season. But spending on dental care increased faster than in 2009.

Prescription drugs, about 10 percent of overall spending, also saw a slower increase — just 1.2 percent in 2010. That was not only due to the continuing shift to generic drugs, but also slower growth in the overall volume of medications that Americans took.

Will less health care hurt consumers?

That remains to be seen, but current evidence suggests it won't. Americans are no healthier than their counterparts in other developed countries, which spend far less. And research suggests that as much as 30 percent of tests and treatments for U.S. patients may be of little or no benefit.

The HHS experts refused to speculate about the implications of the slowdown, although their report stressed the connection to a weak economy. More may be known by the summer, when another team in the same HHS unit will update projections for future health care spending.

Lawmakers in Washington are considering updating sex education standards to incorporate a modern take so students understand "sexual orientation is 'the romantic attraction of an individual to someone of the same gender or a different gender,'" according to the Associated Press. The recommendations for a coalition of health and education groups are aimed at states and school districts, but are non-binding.

Would you like to see these changes implemented in Lawrence?

By Kimberly Hefling, Associated Press

WASHINGTON --** Young elementary school students should use the proper names for body parts and, by the end of fifth grade, know that sexual orientation is "the romantic attraction of an individual to someone of the same gender or a different gender," according to new sexual education guidelines released Monday by a coalition of health and education groups.

The non-binding recommendations to states and school districts seek to encourage age-appropriate discussions about sex, bullying and healthy relationships — starting with a foundation even before second grade.

By presenting minimum standards that schools can use to formulate school curriculums for each age level, the groups hope that schools can build a sequential foundation that in the long term will better help teens as they grow into adults.

Experts say schools across America are inconsistent in how they address such sensitive topics.

Despite awareness of bullying, for example, Debra Hauser, president of Advocates for Youth, one of the groups involved with creating the standards, said some schools don't address it — or at least not in relation to sexual orientation or gender identity, which is where she said a lot of the bullying occurs.

"They should tackle it head on," Hauser said.

Other organizations involved with the release include the American Association of Health Education, the American School Health Association, the National Education Association - Health Information Network, the Society of State Leaders of Health and Physical Education, and the Future of Sex Education Initiative. The latest suggestions were already drawing less enthusiastic reactions from some.

By the end of second grade, the guidelines say students should use the correct body part names for the male and female anatomy, and also understand that all living things reproduce and that all people have the right to not be touched if they don't want to be. They also say young elementary school kids should be able to identity different kinds of family structures and explain why bullying and teasing are wrong.

Beyond lessons about puberty by the end of fifth grade, the guidelines say students should be able to define sexual harassment and abuse.

When they leave middle school, they should be able to differentiate between gender identity, gender expression and sexual orientation, according to the guidelines. And the say they should be able to explain why a rape victim is not at fault, know about bullying and dating violence and describe the signs and impacts of sexually transmitted diseases.

It calls for those leaving eighth grade to also be able to evaluate the effectiveness of abstinence, condoms and other "safer sex methods" and know how emergency contraception works. Many of these issues the groups encouraged to be further addressed in high school as well.

It's unclear how much influence the recommendations will have among educators.

Cora Collette Breuner, a pediatrics professor at the University of Washington and Seattle Children's Hospital and a member of the American Academy of Pediatrics committee on adolescence who was not involved in the creation of the standards, praised the approach of encouraging discussions at an early age.

"The data points that trying to cover this stuff when kids have already formulated their own opinions and biases by the time they're in middle and high school, it's too late," Breuner said.

Valerie Huber, executive director of the National Education Abstinence Association, said she does not agree with the topics and goals of the standards. Like the anti-smoking campaign of the last few decades that has had success, abstinence should be the focus of such programs, she said.

"This should be a program about health, rather than agendas that have nothing to do with optimal sexual health decision-making," Huber said. "Controversial topics are best reserved for conversations between parent and child, not in the classroom."

Federal funding for abstinence-centered education funded by a Republican Congress in the late 1990s and later under President George W. Bush has largely gone by the wayside under the Obama administration, which has had a shift in focus to teen pregnancy prevention programs.

A freshman Kansas House member from Manhattan has confirmed that she plans to resign to take a job as director of the state's Medicaid program.

Republican Susan Mosier told KMAN-AM she's not sure exactly when she'll give up her House seat. However, the Kansas Department of Health and Environment has said she'll begin as Medicaid services director March 1.

Mosier is an ophthalmologist who also holds a master's degree in business administration. As Medicaid director, she'll replace Barb Langner, who recently joined the faculty of the University of Kansas Medical Center in Kansas City.

The state's $2.8 billion-a-year Medicaid program provides health coverage for about 330,000 needy Kansans. Gov. Sam Brownback plans to overhaul it, saying he wants to control costs and improve services.

By Marilynn Marchione, Associated Press

The government wants to start regulating face and hand transplants just as it does now with kidneys, hearts and other organs, with waiting lists, a nationwide system to match and distribute body parts and donor testing to prevent deadly infections.

It's a big step toward expanding access to these radical operations, especially for wounded troops returning home. A dozen U.S. hospitals already do face or hand transplants and more are preparing to offer the operations. More than 1,000 troops have lost an arm or leg in Afghanistan or Iraq, and the government estimates that 200 troops might be eligible for face transplants.

"These body parts are starting to become more mainstream, if you will, than they were five or 10 years ago when they were first pioneered in this country," said Dr. James Bowman, medical director of the Health Resources Services Administration, the government agency that regulates organ transplants.

The agency has proposed new rules that expand the regulation of transplants to include faces, hands and other body parts. Waiting lists for these body parts are informal and local now. The new rule would make such transplants part of the nationwide matching system run by the United Network for Organ Sharing, or UNOS.

The rules would regulate transplants of feet, ankles, legs, fingers, windpipes, voice boxes, the abdominal wall and possibly even a uterus or a penis — operations tried at least once in other countries.

"When you think about the human body, there is really nothing that could not be replaced by transplantation. Almost nothing," said Dr. Bohdan Pomahac, who has done four face transplants at Brigham and Women's Hospital in Boston.

At least 18 face transplants have been done around the world, starting in 2005 with a French woman mauled by her dog. The Cleveland Clinic did the first face transplant in the U.S. in 2008.

The U.S. Department of Defense is providing money for more of these surgeries in Cleveland and Boston in hopes of helping soldiers disfigured in battle. The University of Pittsburgh, the University of California, Los Angeles, and other medical centers plan to offer face or hand transplants soon.

The first successful hand transplant in the United States was performed in 1999, and more than three dozen have been done worldwide.

The proposal to treat these like organ transplants "is terrific" and is supported by leading transplant surgery groups, Pomahac said.

"It's a huge step forward in the right direction. It will make it easier for programs to get started," Pomahac said.

The federal agency will accept public comments on the rules until Feb. 14 before making a final decision. The rules are expected to take effect later this year or early next year.

The change would not affect regulation of heart valves, bone and other tissue implants or transplants, which are overseen by the Food and Drug Administration. Instead, it would cover transplants of complex tissues such as a combination of bone and muscle involving blood vessels — like a hand or face.

Many doctors and bioethicists long objected to face and hand transplants because patients must take drugs for the rest of their lives to prevent rejection, which can raise their risk of cancer and other problems. The risk wasn't considered worth the benefit for operations that are not life-saving as heart or liver transplants are.

But the objections have softened as face transplants have been so successful and greatly improved quality of life.

The most recent recipient is Charla Nash, a Connecticut woman mauled by a chimpanzee. She had a face transplant last May.

Now, "she's feeling a lot of the face. She can start to move on one side. She's able to talk better. Her spirits are great," said Pomahac, her surgeon.

Other face transplant recipients go out in public, enjoy eating normal food for the first time in years, and some have even become advocates for the procedure.

So far, only two face transplant-related deaths have been reported. One was a Chinese man who reportedly was not given or did not take medicines to prevent his body from rejecting his new face. The other was in Paris, a man who received a face and a double hand transplant. He suffered a heart attack during surgery for a complication.

By Maria Cheng, Associated Press

hawking.jpg

CAMBRIDGE, England — British scientist Stephen Hawking has decoded some of the most puzzling mysteries of the universe but he has left one mystery unsolved: How he has managed to survive so long with such a crippling disease.

The physicist and cosmologist was diagnosed with Lou Gehrig's disease when he was a 21-year-old student at Cambridge University. Most people die within a few years of the diagnosis, called motor neurone disease in the U.K. On Sunday, Hawking will turn 70.

"I don't know of anyone who's survived this long," said Ammar Al-Chalabi, director of the Motor Neurone Disease Care and Research Centre at King's College London. He does not treat Hawking and described his longevity as "extraordinary."

"It is unusual for (motor neurone disease) patients to survive for decades, but not unheard of," said Dr. Rup Tandan, a neurology professor at the University of Vermont College of Medicine. Still, Tandan said many longtime survivors had ventilators to breathe for them — which Hawking does not.

Hawking first gained attention with his 1988 book "A Brief History of Time," a simplified overview of the universe. It sold more than 10 million copies worldwide. His subsequent theories have revolutionized modern understanding of concepts like black holes and the Big Bang theory of how the universe began.

To mark his birthday Sunday, Cambridge University is holding a public symposium on "The State of the Universe," featuring talks from 27 leading scientists, including Hawking himself. For 30 years, he held a mathematics post at the university previously held by Sir Isaac Newton. Hawking retired from that position in 2009 and is now director of research at the university's Centre for Theoretical Cosmology.

Hawking achieved all that despite being nearly entirely paralyzed and in a wheelchair since 1970. He now communicates only by twitching his right cheek. Since catching pneumonia in 1985, Hawking has needed around-the-clock care and relies on a computer and voice synthesizer to speak.

A tiny infrared sensor sits on his glasses, hooked up to a computer. The sensor detects Hawking's cheek pulses, which select words displayed on a computer screen. The chosen words are then spoken by the voice synthesizer. It can take up to 10 minutes for Hawking to formulate a single sentence.

"The only trouble is (the voice synthesizer) gives me an American accent," the Briton wrote on his website.

It took Hawking four years to write his last book, "The Grand Design," missing his publisher's original deadline.

Hawking declined requests from The Associated Press for an interview, but his personal assistant, Judith Croasdell, spoke to the AP. She described her boss as remarkably patient.

"The way he communicates can seem frustratingly slow to most people but he doesn't let that impede his thinking," she said.

After a brief hospital stay, Hawking told her that he spent the time thinking about black holes.

Hawking typically comes into the office after a big breakfast and reading the news, Croasdell said. "He's not an early morning person, but he does stay quite late," until about 7 or 8 in the evening, she said.

Hawking's rooftop university office is crammed full of memorabilia: family photos, a miniature NASA shuttle, and a signed picture of himself with President Barack Obama and his wife, Michelle. On top of physics books sits a disability access guide for the university.

Hawking's fame has led to guest appearances on some of his favorite television shows including "The Simpsons" and "Star Trek." His animated likeness from "The Simpsons" has even been turned into an action figure — one of which sits proudly on his office desk. There's also a Homer Simpson clock that Hawking is known to glare at when visitors are late for an appointment.

"He's a big ham, he loves the spotlight," said Kitty Ferguson, who's written two biographies of the physicist.

She said he has a wry sense of humor and has programmed his computer to respond to random encounters with people who ask if he's Stephen Hawking. "No, but I'm often mistaken for that man," his voice synthesizer deadpans.

Lou Gehrig's disease, also called amyotrophic lateral sclerosis, or ALS, attacks motor neurons, cells that control the muscles. Patients typically suffer muscle weakness and wasting, become paralyzed and have problems talking, swallowing and breathing. Only about 10 percent of patients live longer than a decade.

People who are stricken at a young age, as Hawking was, generally have a better chance of surviving longer. Most people are diagnosed between 50 and 70. Life expectancy generally ranges from two to five years after symptoms like slurred speech, difficulty swallowing and muscle weakness set in. Hawking's personal physicians don't discuss his condition with the press, Croasdell said.

For some reason, the disease has progressed more slowly in Hawking than in most. Al-Chalabi and colleagues are analyzing a DNA sample from Hawking, along with those of other patients, to see if there is something rare about his disease or any genetic mutations that could explain his long survival and if that information could be used to help others.

Some experts said the type of care Hawking has, including about a dozen health workers 24 hours a day, may have extended his life expectancy.

"The disease can sometimes stabilize and then the kind of care delivered may be a factor in survival," said Virginia Lee, a brain disease expert at the University of Pennsylvania School of Medicine. "Remaining mentally alert is also extremely important and he has clearly done that."

Hawking says he tries not to think about his limitations.

"I have had (Lou Gehrig's disease) for practically all my adult life," he says on his website. "Yet it has not prevented me from having a very attractive family and being successful in my work," he writes. "I try to lead as normal a life as possible and not think about my condition or regret the things it prevents me from doing, which are not that many."

From the office pictures documenting his achievements, that certainly seems to be the case. Framed photos show the physicist with several popes and on memorable trips to China and Easter Island.

He has even flown in a space simulator. In 2007, Hawking took a zero-gravity flight in Florida, the first time in 40 years he abandoned his wheelchair.

"That was the happiest I've ever seen Stephen," said Sam Blackburn, Hawking's graduate assistant, who accompanied him on the ride along with about a half-dozen others, including two doctors. "He just had the biggest grin on his face."

Hawking has also been married twice and has three children and three grandchildren. With his daughter Lucy, he has written several children's books on physics.

Al-Chalabi said most patients with Lou Gehrig's disease succumb after their breathing muscles stop working. He had no predictions for what the biggest health risks to Hawking's future might be.

"He is truly remarkable," Al-Chalabi said. "This is someone who's managed to find ways around every single problem the disease has thrown at him."

By Marilynn Marchione, Associated Press

Unhappy with today's health care? Think of what it was like to be sick 200 years ago.

No stethoscopes, antibiotics, X-rays or vaccines. Bloodletting was a common treatment. If you had a heart attack or a stroke, doctors put you in bed and hoped for the best. If you needed surgery, you got a few shots of whiskey and a bullet to bite.

Into this medical dark age, two Boston doctors brought a beacon of light. They started what is now the New England Journal of Medicine with the idea that science should guide care — not whoever argued loudest or had the most persuasive theory.

The first 100 copies in January 1812 were delivered by horseback. Today, 2 million people read the journal online every month. It is the oldest continuously publishing medical journal in the world, and it has touched lives in more ways than you may know. Some examples:

—Stroke victims now get clot-busting medicine, not dark rooms to ride out their brain trauma, because a 1995 study in the journal proved its benefit.

—Heart attack patients have arteries unclogged without surgery, then go home on medicines that studies in the journal showed could prevent future attacks.

—Women with early stage breast cancer can have just the lump removed followed by radiation instead of losing the whole breast, thanks to a 1985 study that found the lesser surgery just as good.

—Bone marrow and organ transplants — radical ideas when first tried half a century ago — are now routine. Even face transplants are becoming more common: three were described in last week's issue.

—Rehydration is now recognized as the main treatment for many diarrheal diseases. A journal article warned against bloodletting in 1832 as cholera ravaged New York City.

—People no longer suffer surgery without anesthesia, a field that grew from Henry Jacob Bigelow's 1846 report on the first successful use of inhaled ether.

—Medicine is more ethical, and study participants have more protections, because of a 1966 report in the journal about researchers failing to get informed consent. Another top journal had rejected the article as too controversial.

The New England Journal started decades before the American Medical Association was founded in 1847 and is widely credited with promoting evidence-based care.

"It has been very good for society," said Pat Thibodeau, head librarian and associate dean for the Medical Center Library at Duke University. "When I go in, I'm hoping my doctor has read the New England Journal of Medicine or something similar and is following that information."

"It's the cream of the crop," said Dr. Barron Lerner, a Columbia University physician and medical historian.

"They get the best research submitted to them, and they do an extremely good job of peer reviewing" to make sure it is solid, he said.

That's what Boston surgeon John Collins Warren and James Jackson, who helped found Massachusetts General Hospital, hoped for the journal, which is now published weekly. It got its current name in 1928, seven years after it was bought by the Massachusetts Medical Society.

Warren's father, John Warren, surgeon to George Washington's troops, wrote the first article, on chest pain. Doctors had been debating whether it was caused by plaque — "the cement that builds up in arteries" — or blood clots, said Dr. Jeffrey Drazen, the journal's editor-in-chief since 2000. Both proved correct — the "cement" fractures and allows a clot to form that blocks an artery, he said.

Heart care has been a journal specialty, and two prominent doctors — Elizabeth Nabel and Eugene Braunwald of Brigham and Women's Hospital — trace its evolution in this week's issue. Nabel is former director of the National Heart, Lung and Blood Institute and now is president of the Boston hospital.

They describe the first human cardiac catheterization — now a common diagnostic procedure — that Werner Forssman performed on himself in 1929. Under local anesthesia, he put a catheter into his arm and maneuvered it into his own heart.

For a heart attack, "it used to be that all we did was put people to bed for five weeks," but studies in the journal showed "that that was the worst thing you could do," said Dr. Jerome Kassirer, its top editor from 1991 to 1999.

The journal also helped prove "germ theory" and the nature of infectious diseases.

"People didn't realize you could infect people when you were using your dirty gloves or not using gloves. People didn't realize tuberculosis was communicable. They thought it emanated from clouds they called miasma, clouds of dirty smoke in cities," said Lerner, the Columbia historian.

Not all was grand in the journal's history, though, as Allan Brandt, a Harvard University medical historian writes in this week's issue.

When Harvard Medical School debated admitting female students in 1878, the journal expressed concern about men and women mingling during surgeries normally witnessed only by one sex. The school didn't admit women until 1945, when World War II caused a shortage of men.

The journal also agreed with mandatory sterilization of "mental defectives" in the early 20th century. "Most alarming," Brandt writes, was its declaration in 1934 that "Germany is perhaps the most progressive nation in restricting fecundity among its unfit." The journal later condemned Nazi medicine.

In recent years, it has tracked health policy, from the Clinton health care plan and the advent of managed care to current debates about Medicare.

There were oddball reports along the way, like the 2007 account of a cat named Oscar that had a knack for predicting when patients at a Providence, R.I., nursing home were close to death by curling up to them in their final hours.

The journal has printed few studies on alternative medicine because so little good research has been done on it, Drazen said. Unlike some other journals that like controversial research, the New England Journal tries to avoid it.

"People think the cutting edge is sharp. The cutting edge is very dull. It's very foggy and you don't know what the right answer is," so editors try to pick studies that are definitive enough to affect care, Drazen said.

That's why it publishes very few observational studies, the kind that in the 1990s led to pronouncements like "margarine is better than butter" only to be reversed by the next such study.

"Some of those are papers that we've seen and turned back," Drazen said. "I'm looking for a higher evidence standard."