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One-fourth of all children with cancer have acute lymphoblastic leukemia, but the chemotherapy used to treat patients can damage the liver. A new study, conducted by the Integrative Therapies Program for Children with Cancer, will determine if milk thistle can prevent the liver damage. The phase II trial—led by Dr. Kara Kelly, assistant professor of pediatrics and medical director of the program—is the first test of the herb in people with cancer.

Because of the potential for liver damage, chemotherapy is stopped or decreased temporarily in the one- quarter of patients who have levels of enzymes indicative of liver injury. Some studies suggest that the hiatus in chemotherapy may lead to a relapse of the cancer, but no medications are available to counteract chemotherapy's liver toxicity.

The new trial will determine if the herbal plant, milk thistle, can prevent liver toxicity while having no adverse effect on chemotherapy's effectiveness. The herb is used in Europe for cirrhosis and hepatitis in conjunction with conventional medicine and reduces the level of transaminases and bilirubin in the blood, key indicators of liver damage. It's unknown how the herb limits damage, though laboratory studies show it alters cell membrane permeability, stimulates DNA synthesis, promotes cell growth, stimulates detoxification enzymes and has anti-oxidant properties.

In the double-blind Columbia study, 50 children undergoing chemotherapy for acute lymphoblastic leukemia will be randomly assigned to receive a placebo or silymarin, the active component in milk thistle. The children will take the drug or placebo for four weeks and have their liver enzymes measured after one month and two months. The Children's Hospital of Philadelphia and several other centers are also participating. "We anticipate we'll be done by the end of next year," Dr. Kelly says, "and we're hoping that milk thistle can reduce the liver toxicity without adversely affecting the treatment of leukemia."

—Susan Conova

scaleIn the first long-term randomized trial of the effectiveness of Weight Watchers, a commercial weight loss program, Columbia researchers have found that dieters in the structured weight loss program lose and keep off more weight than dieters who try to go it alone. After two years, the program participants retained an average loss of six pounds, while the others had regained the weight they had lost earlier. The program's most diligent dieters—those who attended 78 percent or more of the meetings—maintained an average loss of 11 pounds.

"There's something in this program that seems to be working," says the study's leader, Dr. Stanley Heshka, associate research scientist in the Institute of Human Nutrition and the New York Obesity Research Center at St Luke's-Roosevelt Hospital. "But we can't say which element—the weekly weigh-ins, the support group, or the points plan that assigns values to different foods—is the most effective component." The research was published in the April 9 JAMA theme issue on obesity.

During the study, the researchers followed more than 300 overweight men and women who wanted to lose weight. Each subject was randomly assigned to the Weight Watchers program or a self-help protocol. The Weight Watchers participants were given vouchers to attend the program's meetings, while the self-help group received 20-minute consultations with a dietician at week 0 and week 12 and were given publicly available printed material on weight loss. All participants were weighed periodically at one of six U.S. medical centers participating in the study.

Although the average number of pounds lost in the Weight Watchers group was modest, Dr. Heshka says 52 percent of the group maintained a loss of at least one body mass index (BMI) unit for two years, a significant long-term loss that may have health benefits, according to an Institute of Medicine report. In comparison, 29 percent of the self-help dieters maintained a loss of one or more BMI units.

Weight Watchers International, which had no input in the data management or conclusions drawn by the investigators, funded the study.

—Susan Conova

Alcohol is known by experts in the field to be teen-agers' drug of choice. But researchers have questioned the accuracy of the numbers of teens who drink; data on how much minors spend on alcohol are also lacking.

Now, a new study by Columbia University researchers indicates that half of all young people between the ages of 12 and 20 drink alcohol. The researchers also found that underage drinkers account for about 20 percent of both alcohol consumption and expenditures in the United States each year.

In the study, Joseph A. Califano Jr., adjunct professor of health policy and management at the Mailman School of Public Health and chairman and president of The National Center on Addiction and Substance Abuse (CASA) at Columbia, and colleagues analyzed three national surveys of more than 200,000 people, which included teens and adults. Minors were responsible for $22.5 billion, or 19.4 percent, of the $116.2 billion spent on alcohol in the United States in 1999.

With such large sums of money at stake, the researchers say the alcohol industry may not be motivated to try to reduce underage drinking. "Our findings signal the need for parents to try to prevent underage drinking and for government involvement to educate the public about the dangers of alcohol misuse and abuse," says Susan Foster, vice president and director of policy research and analysis at CASA and the study's lead author. "Higher taxes on alcohol and stiffer penalties for people who help minors get alcohol might help."

Mr. Califano, the study's senior author, noted that young people are starting to drink at younger ages. The proportion of children who begin drinking in eighth grade or earlier increased by 33 percent from 1975 to 2001. The findings were published in the Feb. 26 Journal of the American Medical Association.

—Matthew Dougherty