Tuesday, May 12, 1998

Bob Levey Todd Cross/TWP

Good afternoon and welcome to "Levey Live." I’m Washington Post columnist Bob Levey, your host.

"Levey Live" appears each Tuesday from noon to 1 p.m. Eastern time. It’s your chance to talk directly to top newsmakers and to key Washington Post reporters and editors.

Our guest today is the editor of The Post’s Health section, Abigail Trafford.

Abbie has been the editor of Health since 1986. She writes a regular column on medical affairs called "Second Opinion."

Post Health editor Abigail Trafford (file photo)

She is also the author of a book called "Crazy Time: Surviving Divorce and Building a New Life."

Among the subjects we will tackle today are the possibility of a cancer cure, the stir over the new impotency drug, Viagra, and progress in the fight against AIDS.

Your questions and comments for Abbie Trafford are welcome throughout the hour.

Bennington, Vt.: Do you think that with the success of Viagra, there will be other impotency drugs coming out by other drug companies?

Abigail Trafford: Yes. This is just the beginning. You can expect many more drugs to treat impotency. Viagra is just the first.

Rockville, Md.: Is carcinoma of the pancreas increasing? There seem to a lot of obituaries wit it as the cause.

Abigail Trafford: Pancreatic cancer is still pretty rare. But it's a devastating cancer that can strike people in midlife. So we are very aware of it. A good friend of mine from elementary just got diagnosed with it. Surgery is the main treatment. But sometimes the cancer is too advanced to operate. It's one of the toughest cancers.

Bob Levey: The big stir over a cancer cure seems to have quieted down a bit. Apparently there's no reason to assume that success with laboratory animals means success in humans. Do you think the journalism about EntreMed Inc. should have stressed this more strongly?

Abigail Trafford: It's an old story. A promising study leads to hope. And hope leads to hype. Leaping from animals to humans is a giant leap for science. The first story on the latest cancer cure said just that -- a cure is around the corner. Within two years. Not true at all. While later stories calmed down and said no, this is just promising, the caution got lost in the media circus. The tragedy here is that these stories give people false hope. One rule to follow in covering this is if it's just in animals, it's a long way from working in people. We follow this rule in the Health section. Falling for preliminary results is a kind of medical Don Juanism. We, the people, are seduced by the fantasy of what might be. We forget about reality because we are swept away. We want a cure for cancer so badly. So we believe the Don Juan study. And then the backlash sets in. In a way we are seduced and abandoned.

Washington, D.C.: I have been hearing the Viagra drug being touted as the new "sexual" wonder drug. My 27-year-old fiance even mentioned something about getting some. Isn't this ridiculous? I thought the drug was for men who were having real problems with impotence, not just some extra sexual turn-on drug. Can you please clarify what the purpose of Viagra is and how it works on the body? Is it a hormone? Any light you could shed on the subject would be great.

Abigail Trafford: Viagra is a drug with a limited purpose. It helps men who have what doctors called "erectile dysfunction." It doesn't make a guy a great lover. It doesn't make a relationship if there isn't one there to begin with. It doesn't heighten sexual feeling. It focuses on the smooth muscles in the penis. It helps men who are really impotent. It helps them have and maintain an erection. That's it.

Seattle, Wash.: I'm a little concerned with Bob Dole taking Viagra, given that he lives in the same complex as Monica Lewinsky. Should we be concerned?

Abigail Trafford: Not to worry. Viagra does nothing to your head. It has a limited purpose. Bob Dole talked about what it did for him. He was part of the human study that tested the drug. The results are being published in a scientific journal this week. But there are no names. You'd have to ask the Doles about the effects of the drug.

Bethesda, Md.: What do you think about salt? Over the years, we have been told that it causes high blood pressure, it does not cause high blood pressure, it is bad for you, it is good for you. What do you think about salt?

Sam Intrater

Abigail Trafford: Salt is an old story. People who are sensitive to salt are the ones who should watch their intake of salt. Estimates vary, but millions of Americans have this sensitivity. They are usually at risk for high blood pressure, too. So eating too much salt just makes the problem worse. But there are also a lot of people who aren't sensitive to salt, and they can stop worrying about the "salt shaker syndrome."

Bob Levey: The Post recently reported that deaths from cancer have declined for the first time since the 1930s. Why? Are lifestyle messages about smoking and diet finally taking hold?

Abigail Trafford: In this country the biggest reason is probably the drop in smoking. The word has been out for a couple of decades. Don't smoke. It stinks. And it raises your risk of lung cancer and other cancers and heart disease. So smoking is down and officials are seeing a leveling off of some cancers. Daily aspirin may be another reason. It has a protective effective against colon cancer.

Arlington, Va.: Am I the only one who believes it is absurd for insurance companies to cover the costs of men's sexual activity (Viagra) while at the same time making women jump through hoops to get coverage of fertility drugs/birth control, etc.? Where is the equity?

Abigail Trafford: I'm with you. Insurance companies are really caught on Viagra. I don't know how they're going to figure out who to cover. Meanwhile, women face many hurdles in getting coverage for reproductive poblems. It gets down to what's a medical problem and what's another kind of problem -- a cosmetic problem or a lifestyle problem. Where does sexual satisfaction fit in? This debate is going to go for a long time. Truth is that it varies case by case. Sometimes it's medical and should be covered. Sometimes, not. Who decides?

Bob Levey: A doctor quoted in a recent Washington Post piece said he could easily foresee college students getting together and saying, "Hey, let's have a Viagra party!" Isn't there a great danger that this drug will be misused? Isn't there a danger that a black market for it will develop?

Abigail Trafford: Parents have a lot to worry about when the kids go off to college. Now it's Viagra. But drug companies are very nervous about abuse and will probably limit wide distribution. It's unlikely that a college-age guy will have a problem that need[s] a prescription with a drug. Colleges will probably be on the lookout for any black market impotence drugs. But in a way, this is an old story. People have always looked for way to get more and get better -- especially when they are young and single and away from home. Grandmother's advice is best: Be careful.

Bob Levey: Half an hour remaining with our guest, Abigail Trafford, editor of The Washington Post's Health section.

Silver Spring, Md.: What is the five-year survival rate on ovarian cancer and why are so many cases caught very late in the disease's progression?

Abigail Trafford: The sad part of this cancer is that it is often detected late in the course of the disease. There is no early screening test for the general population. By the time people have symptoms, the cancer has often spread. But research is continuing on the genetic roots of this cancer and on new tools to detect signs of the disease at an early stage. Women with a family history of certain ovarian and breast cancers are watched very closely by their doctors.

Bob Levey: About "false positives" that often show up after mammograms: Will they reduce the number of women who have mammograms? Will more cancers therefore slip through?

Abigail Trafford: This is really controversial. Studies show that after age 50, mammograms do help reduce the death rate from breast cancer. But many women get a false positive rate on the test and a recent study found that half the women who under[go] regular mammogram screening will get a false positive. This throws them into tremendous anxiety. They have to get more tests, many have a biopsy. But doctors are concerned that the trauma of getting a positive result will discourage women from getting a mammogram. Who needs that trouble and anxiety?

Two things can be done. The technology can be improved to reduce the rate of false positives. Secondly, the health care system can be improved to handle these results in a more informed and timely fashion. A woman should be told, "You may get a positive result. Most of the time it is not a cancer."

Pittsburgh, Pa.: Are there medical treatments currently available that address lack of sexual desire in either men or woman?

Abigail Trafford: This is a tough one. What makes for "desire?" There are many reasons why people don't feel like it. Sometimes there are problems in the relationship that need to be resolved. Sometimes medication can have the unwanted side effect of decreasing libido. Prozac has this side effect. It makes you less depressed but it lowers desire. That's a tradeoff. Sometimes the best aphrodesiac -- or medical treatment -- is an old one: a glass of wine and enough time to get in the mood.

Falls Church, Va.: I have heard that Viagra can cause blindness. Is this true or just a rumor?

Abigail Trafford: Side effects include "transient visual disturbances," which means a temporary change in how you perceive color or brightness. But no blindness has been reported. You may also get nausea, backache, headache. But so far the side effects seem relatively mild. But once millions of people start taking Viagra, other problems may emerge.

Bob Levey: With all the complaining about managed care, Capitol Hill can't be far behind, with a crowd-pleasing law or two. How much regulation of the industry can we expect?

Abigail Trafford: Speculating about health care legislation is like speculating on the stock market -- or the weather. Everyone talks about crowd-pleasing bills, but so far, there's not much action. Much depends on the economy and how much the middle class feels squeezed. When that happens -- when premiums go up and people can't afford coverage -- you'll see pressure for action. But without a crisis, the system bumbles along. That's because only 15 percent of the population gets sick and needs care. The other 85 percent say they are happy with their care and don't want to rock the boat. That's the problem with getting popular support for legislation.

Silver Spring, Md.: Speaking of the false positive results, the same thing goes for the PSA test for prostate cancer screening. Some physicians do not recommend the PSA test on a routine basis, except when symptoms show up.

Abigail Trafford: You're right. The prostate test is even more dicey. That's because some prostate cancers are so long-growing, some doctors recommend a watch-and-wait strategy. That's not the case with a breast cancer, which doctors want to treat immediately. But for men, the decision whether or not to undergo the PSA test is a difficult personal question.

Bob Levey: Pet theory: As baby boomers age, Washington will be under huge pressure to make health insurance more affordable for retirees. Do you agree? And can you see it happening when Medicare is already deep into red ink?

Abigail Trafford: Aging is the big story of the century -- the millenium. Medicare is still a very strong program. It works. But not as well as it could. Not just because it's always seeming to run low on money. It doesn't cover a lot of thing[s] older people need. And the baby boomers, the stress will be enormous. The proposal to extend Medicare downward to people in their 50s has gotten a lot of criticism. But some employers say it would be a good idea because it would encourage companies to hire and retain older people longer. Right now, there's a disincentive to hire older workers because their health costs are generally higher than younger workers.

Brookline, Mass.: The New Yorker recently ran an alarmist piece on hepatitus C, which the author asserted was reaching [an] epidemic in the U.S.

Should we all be afraid of hepatitus C? Is it as serious a health threat as AIDS?

Abigail Trafford: You should not be afraid, but you should be concerned. The federal government is sending out a letter to people who received a blood transfusion before a test was available in the 1980s to get themselves checked to see if they have an infection. Often there are no symptoms until the disease takes hold. In worst cases, patients require a liver transplant. The blood is screened for hepatitis C today.

Wheaton, Md.: In your opinion, do you believe that more men prefer having their primary care physician being a male or female, and why do you think this?

Abigail Trafford: Most people don't care. A new poll conducted for the Massachusetts Medical Society found that what people care about most is that their physician be up to date on medical research and treatments. They also cared what other physicians thought -- the doctor's reputation. And they didn't want their physician to have too many malpractice suits. But when asked about age, race or gender, people didn't care.

Bob Levey: Crystal ball time: As Americans do better at managing heart disease risk, they will surely live longer. But will they therefore "age into" cancers they wouldn't have gotten otherwise? Won't Alzheimer's become far more common, for the same reason?

Abigail Trafford: There's no such thing as a free lunch. It's true as people beat the killer diseases of youth and midlife, they open the door to other diseases -- cancers, which are linked to age, and Alzheimer's and other dementias. But it's important to know that these are still rare. The U.S. has the highest life expectancy in the world AFTER the age of 85. Disability among the elderly is also in decline. So life is getting better for older people. Living beyond 100 and being strong in the mind as well as body is the norm for the next century.

Bob Levey: That's it for today. Thanks to Abbie Trafford, editor of The Washington Post's Health section.

Be sure to join us Friday at 3 p.m. Eastern time for a special edition of "Levey Live" -- about the comics! Our guest will be Shirley Carswell, the assistant managing editor of The Post whose domain includes the comics pages. Our guest next Tuesday, May 19, will be Geneva Overholser, who is about to wind up her term as The Washington Post's ombudsman, or reader representative.