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Health

Who should get the flu vaccine and why? Our medical analyst explains

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CNN
 — 

Welcome to this year’s flu season.

This year’s flu strain has already begun spreading across the United States, according to new data from the US Centers for Disease Control and Prevention. There have been at least 880,000 cases of influenza, nearly 7,000 hospitalizations and, tragically, 360 deaths from the flu this fall, including one pediatric death. Not since 2009, during the height of the H1N1 swine flu pandemic, have there been this many cases of influenza so early in the season.

Despite these numbers, many people wonder if the flu is really that serious of an illness. What’s the benefit of the vaccine, especially if some people may still get the flu despite being vaccinated? Could you get the flu from the vaccine? If you get the Covid vaccine, do you still need the flu vaccine?

To guide us through these questions and more, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: Is the flu a serious illness? What symptoms do people experience?

Dr. Leana Wen: It certainly can be serious. The CDC estimates that flu resulted between 9 million and 41 million illnesses, 140,000 to 710,000 hospitalizations, and 12,000 to 52,000 deaths annually across the US between 2010 and 2020.

Symptoms of the flu include fever, muscle aches, headaches, fatigue, coughing and a runny nose. A lot of people recover within several days, but some may still be feeling unwell as long as 10 days to two weeks after the onset of their symptoms. Some will develop complications, including sinus and ear infections, pneumonia, and inflammation of the brain. The flu can also exacerbate underlying medical conditions — for example, people with chronic lung and heart diseases can see their conditions worsen due to the flu.

Even generally healthy people can become very ill due to the flu. However, those particularly susceptible to severe outcomes include those 65 and older, young children under 2, pregnant people and people with underlying medical conditions.

CNN: What’s the benefit of the vaccine, especially if some people may get the flu despite being vaccinated?

Wen: The flu vaccine does two things. First and most importantly, it reduces your chance of severe illness — that is, of being hospitalized or dying. Second, it can also reduce your likelihood of getting sick from the flu at all.

In a sense, this is not too different from the Covid-19 vaccine. The most important reason to get vaccinated against both the flu and the coronavirus is to prevent severe illness. New data released in the CDC’s latest morbidity and mortality report shows this year’s flu vaccine reduces the risk of hospitalization by about 50%. A 2018 study found that people vaccinated against the flu were 59% less likely to be admitted to the ICU due to influenza when compared with those who were unvaccinated.

The vaccine’s effectiveness can vary depending on how well matched the vaccine is to circulating influenza strains. The CDC cites vaccine effectiveness against “medically attended illness” anywhere from 23% to 61% depending on the year and vaccine-to-strain match. It’s true, then, that you could get the flu vaccine and still contract the flu. But the vaccine does reduce your chance thereof — and, crucially, it reduces the likelihood that you could end up very ill.

Another thing to consider is that there are a lot of other viruses that can cause flu-like symptoms. The flu vaccine helps protect against viral infections caused by influenza, but there are a lot of other causes of viral syndromes, including adenovirus, rhinovirus, parainfluenza and others. These other viruses spread easily, too, and there aren’t vaccines against them. I often hear patients say they once got the flu the same year they had a flu vaccine, and that’s why they don’t want to get vaccinated again. But when I ask them whether they were actually diagnosed with the flu or just had flu-like symptoms, they would say the latter.

CNN: Should children and pregnant people also get the flu vaccine?

Wen: Absolutely. These are groups particularly vulnerable to severe outcomes, so it’s very important they receive the flu vaccine.

One study found the flu vaccine reduces children’s risk of severe life-threatening influenza by 75%. Another found it reduced flu-related emergency department visits in children by half.

Similar results are found in people who are pregnant. Not only does the flu vaccine protect the pregnant person, if the vaccine is given during pregnancy it also helps protect their baby from the flu for the first few months of its life. That’s important, because the flu vaccine is not available to babies until they are 6 months or older.

CNN: Could you get the flu from the vaccine?

Wen: No. The flu vaccine is an inactivated vaccine, which means it does not contain the live virus and therefore cannot cause the flu. It is also a very well-tolerated vaccine, with the most common side effect being discomfort at the injection site that is gone after a day.

CNN: If you got the Covid-19 vaccine, do you still need the flu vaccine?

Wen: Yes. Different vaccines target different viruses. The Covid vaccine helps to protect against Covid, but does not protect against the flu, and vice versa. You can receive the Covid vaccine (or bivalent booster) at the same time as you receive the flu vaccine, just in a different injection site.

CNN: Some people have been waiting until later in the flu season to get the flu vaccine. Is this a good idea?

Wen: At this point, no, because it’s now clear this flu season is starting earlier than usual. Cases are already high, and it takes about two weeks to reach optimal immune protection after vaccination. I’d encourage people who have not yet received the flu vaccine to get it now.

CNN: What should people know about treatments for the flu?

Wen: Most cases of the flu can be treated symptomatically, meaning patients get rest, hydration and treatment for symptoms that come up — such as fever-reducing medicines like acetaminophen or ibuprofen. There are also antiviral treatments available. These are really important for people at high risk for severe influenza complications and/or who are very ill. The earlier such treatments are started, the better. An oral medication, oseltamivir (Tamiflu), can also be given to non-high-risk patients, too, within 48 hours of the start of their illness.

I’d encourage everyone to have an influenza plan, the same way they should have a Covid plan. Ask your doctor in advance if you should receive Tamiflu or another antiviral treatment. Know how you can get testing and where you can access treatment, including after hours and on weekends.

CNN: How can people prevent catching the flu?

Wen: The flu is primarily spread through droplets — if an infected person coughs or sneezes, these droplets can land on someone else nearby. It’s also possible that the droplets land on a surface, from which someone gets infected after touching it and then touching their nose, mouth or eyes.

We can help to reduce flu transmission by staying away from others while symptomatic. We should all cough or sneeze into our elbow or a tissue, and wash our hands frequently, including after touching high-contact surfaces. Individuals particularly vulnerable to severe outcomes should consider wearing a mask to reduce their chance of contracting viral illnesses like the flu. And, of course, get vaccinated!

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Drinking caffeine while pregnant impacts child’s height: Study

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Editor’s Note: Sign up for CNN’s Eat, But Better: Mediterranean Style. Our eight-part guide shows you a delicious expert-backed eating lifestyle that will boost your health for life.



CNN
 — 

Starting the day with a hot cup of caffeinated coffee or tea may sound divine to some, but it could have negative impacts for the children of people who are pregnant, according to a new study.

Children who were exposed to small amounts of caffeine before birth were found on average to be shorter than the children of people who did not consume caffeine while pregnant, according to the study published Monday in JAMA Network Open.

Children of parents who consumed caffeine while they were in the womb were shown to be shorter in stature at age 4 than those whose parents did not — and the gap widened each year through age 8, according to lead author Dr. Jessica Gleason, a perinatal epidemiologist.

“To be clear, these are not huge differences in height, but there are these small differences in height among the children of people who consumed caffeine during pregnancy,” said Gleason, who is a research fellow at Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The American College of Obstetricians and Gynecologists currently recommends limiting caffeine consumption to less than 200 milligrams per day while pregnant.

For context, a mug of caffeinated tea typically has about 75 milligrams of caffeine, a mug of instant coffee has about 100 milligrams and a mug of filtered coffee has about 140 milligrams, according to the Cleveland Clinic. And even chocolate has about 31 milligrams of caffeine.

But the differences found in the most recent study were found even in the children of parents who drank less than half a cup of coffee per day while pregnant — well below the current guidelines, Gleason said.

It’s not clear whether this study effectively shows causation between maternal caffeine consumption and child height, according to Dr. Gavin Pereira, a professor of epidemiology and biostatistics at Curtin University in Australia. Pereira was not involved in the study.

“The correlation observed in this study can be explained by the existence of a common cause of both caffeine consumption and growth restriction e.g., poverty, stress, and dietary factors,” said Pereira in a statement to the Science Media Centre.

If shorter height in early childhood were to persist into adulthood, there would be a chance those children could face the risk of poor cardiometabolic outcomes, such as heart disease and diabetes, which are associated with smaller stature.

But there is still no way to know if the difference would persist into adulthood, and studies like this that focus on population outcomes are no reason for individual families to panic, Gleason said.

These population-level trends should instead be taken together with other research for organizations to reassess their recommendations, Gleason said.

In the past, there were inconsistent studies regarding whether consuming caffeine during pregnancy impacted the fetus, but the evidence has come together in recent years, Gleason said.

A 2015 meta-analysis that reviewed all of the existing research found there is a dose response association between consumption of caffeine and smaller birth size. And a 2020 study revealed there is no safe level of caffeine for a developing fetus.

Even without the panic that Gleason cautioned against, some people might want to cut back on caffeine — and then find that it’s easier said than done.

Remember, caffeine is found in coffee, tea, soft drinks, energy drinks and shots, as well as cocoa and chocolate. It’s also present in fortified snack foods, some energy bars and even some pain medications. (For a more extensive list of caffeine content from various sources, check the chart from the Center for Science in the Public Interest.)

A 2016 Johns Hopkins University study found that it was helpful when individuals identified situations or moods in which they are most likely to crave caffeine so they could avoid situations that trigger cravings, especially during the first few weeks of modifying caffeine use. Caffeine drinkers could also have a plan for when cravings occur, like taking a five-minute relaxation break involving deep-breathing exercises.

Remember to always discuss any major lifestyle or dietary changes with your health care provider first, as changes may affect your mood or medical conditions.

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Health

Drinking caffeine while pregnant impacts child’s height: Study

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Editor’s Note: Sign up for CNN’s Eat, But Better: Mediterranean Style. Our eight-part guide shows you a delicious expert-backed eating lifestyle that will boost your health for life.



CNN
 — 

Starting the day with a hot cup of caffeinated coffee or tea may sound divine to some, but it could have negative impacts for the children of people who are pregnant, according to a new study.

Children who were exposed to small amounts of caffeine before birth were found on average to be shorter than the children of people who did not consume caffeine while pregnant, according to the study published Monday in JAMA Network Open.

Children of parents who consumed caffeine while they were in the womb were shown to be shorter in stature at age 4 than those whose parents did not — and the gap widened each year through age 8, according to lead author Dr. Jessica Gleason, a perinatal epidemiologist.

“To be clear, these are not huge differences in height, but there are these small differences in height among the children of people who consumed caffeine during pregnancy,” said Gleason, who is a research fellow at Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The American College of Obstetricians and Gynecologists currently recommends limiting caffeine consumption to less than 200 milligrams per day while pregnant.

For context, a mug of caffeinated tea typically has about 75 milligrams of caffeine, a mug of instant coffee has about 100 milligrams and a mug of filtered coffee has about 140 milligrams, according to the Cleveland Clinic. And even chocolate has about 31 milligrams of caffeine.

But the differences found in the most recent study were found even in the children of parents who drank less than half a cup of coffee per day while pregnant — well below the current guidelines, Gleason said.

It’s not clear whether this study effectively shows causation between maternal caffeine consumption and child height, according to Dr. Gavin Pereira, a professor of epidemiology and biostatistics at Curtin University in Australia. Pereira was not involved in the study.

“The correlation observed in this study can be explained by the existence of a common cause of both caffeine consumption and growth restriction e.g., poverty, stress, and dietary factors,” said Pereira in a statement to the Science Media Centre.

If shorter height in early childhood were to persist into adulthood, there would be a chance those children could face the risk of poor cardiometabolic outcomes, such as heart disease and diabetes, which are associated with smaller stature.

But there is still no way to know if the difference would persist into adulthood, and studies like this that focus on population outcomes are no reason for individual families to panic, Gleason said.

These population-level trends should instead be taken together with other research for organizations to reassess their recommendations, Gleason said.

In the past, there were inconsistent studies regarding whether consuming caffeine during pregnancy impacted the fetus, but the evidence has come together in recent years, Gleason said.

A 2015 meta-analysis that reviewed all of the existing research found there is a dose response association between consumption of caffeine and smaller birth size. And a 2020 study revealed there is no safe level of caffeine for a developing fetus.

Even without the panic that Gleason cautioned against, some people might want to cut back on caffeine — and then find that it’s easier said than done.

Remember, caffeine is found in coffee, tea, soft drinks, energy drinks and shots, as well as cocoa and chocolate. It’s also present in fortified snack foods, some energy bars and even some pain medications. (For a more extensive list of caffeine content from various sources, check the chart from the Center for Science in the Public Interest.)

A 2016 Johns Hopkins University study found that it was helpful when individuals identified situations or moods in which they are most likely to crave caffeine so they could avoid situations that trigger cravings, especially during the first few weeks of modifying caffeine use. Caffeine drinkers could also have a plan for when cravings occur, like taking a five-minute relaxation break involving deep-breathing exercises.

Remember to always discuss any major lifestyle or dietary changes with your health care provider first, as changes may affect your mood or medical conditions.

Read original article here

Health

New RSV vaccines may soon put an end to rough seasons

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CNN
 — 

It’s shaping up to be a severe season for respiratory syncytial virus infections – one of the worst some doctors say they can remember. But even as babies struggling to breathe fill hospital beds across the United States, there may be a light ahead: After decades of disappointment, four new RSV vaccines may be nearing review by the US Food and Drug Administration, and more than a dozen others are in testing.

There’s also hope around a promising long-acting injection designed to be given right after birth to protect infants from the virus for as long as six months. In a recent clinical trial, the antibody shot was 75% effective at heading off RSV infections that required medical attention.

Experts say the therapies look so promising, they could end bad RSV seasons as we know them.

And the relief could come soon: Dr. Ashish Jha, who leads the White House Covid-19 Response Task Force, told CNN that he’s “hopeful” there will be an RSV vaccine by next fall.

Charlotte Brown jumped at the chance to enroll her own son, a squawky, active 10-month-old named James, in one of the vaccine trials this summer.

“As soon as he qualified, we were like ‘absolutely, we are in,’ ” Brown said.

Babies have to be at least 6 months old to enter the trial, which is testing a vaccine developed at the National Institutes of Health – the result of decades of scientific research.

Brown is a pediatrician who cares for hospitalized children at Vanderbilt University Medical Center in Nashville, and she sees the ravages of RSV firsthand. A recent patient was in the back of her mind when she was signing up James for the study.

“I took care of a baby who was only a few months older than him and had had nine days of fever and was just absolutely pitiful and puny,” she said. Brown said his family felt helpless. “And I was like, ‘this is why we’re doing it. This single patient is why we’re doing this.’ “

Even before this year’s surge, RSV was the leading cause of infant hospitalizations in the US. The virus infects the lower lungs, where it causes a hacking cough and may lead to severe complications like pneumonia and inflammation of the tiny airways in the lungs called bronchiolitis.

Worldwide, RSV causes about 33 million infections in children under the age of 5 and hospitalizes 3.6 million annually. Nearly a quarter-million young children die each year from complications of their infections.

RSV also preys on seniors, leading to an estimated 159,000 hospitalizations and about 10,000 deaths a year in adults 65 and over, a burden roughly on par with influenza.

Despite this heavy toll, doctors haven’t had any new tools to head off RSV for more than two decades. The last therapy approved was in 1998. The monoclonal antibody, Synagis, is given monthly during RSV season to protect preemies and other high-risk babies.

The hunt for an effective way to protect against RSV stalled for decades after two children died in a disastrous vaccine trial in the 1960s.

That study tested a vaccine made with an RSV virus that had been chemically treated to render it inert and mixed with an ingredient called alum, to wake up the immune system and help it respond.

It was tested at clinical trial sites in the US between 1966 and 1968.

At first, everything looked good. The vaccine was tested in animals, who tolerated it well, and then given to children, who also appeared to respond well.

“Unfortunately, that fall, when RSV season started, many of the children that were vaccinated required hospitalization and got more severe RSV disease than what would have normally occurred,” said Steven Varga, a professor of microbiology and immunology at the University of Iowa, who has been studying RSV for more than 20 years and is developing a nanoparticle vaccine against the virus.

A study published on the trial found that 80% of the vaccinated children who caught RSV later required hospitalization, compared with only 5% of the children who got a placebo. Two of the babies who had participated in the trial died.

The outcomes of the trial were a seismic shock to vaccine science. Efforts to develop new vaccines and treatments against RSV halted as researchers tried to untangle what went so wrong.

“The original vaccine studies were so devastatingly bad. They didn’t understand immunology well in those days, so everybody said ‘oh no, this ain’t gonna work.’ And it really was like it stopped things cold for 30, 40 years,” said Dr. Aaron Glatt, an infectious disease specialist at Mount Sinai South Nassau in New York.

Regulators re-evaluated the guardrails around clinical trials, putting new safety measures into place.

“It is in fact, in many ways, why we have some of the things that we have in place today to monitor vaccine safety,” Varga said.

Researchers at the clinical trial sites didn’t communicate with each other, Varga said, and so the US Food and Drug Administration put the publicly accessible Vaccine Adverse Events Reporting System into place. Now, when an adverse event is reported at one clinical trial site, other sites are notified.

Another problem turned out to be how the vaccine was made.

Proteins are three-dimensional structures. They are made of chains of building blocks called amino acids that fold into complex shapes, and their shapes determine how they work.

In the failed RSV vaccine trial, the chemical the researchers used to deactivate the virus denatured its proteins – essentially flattening them.

“Now you have a long sheet of acids but no more beautiful shapes,” said Ulla Buchholz, chief of the RNA Viruses Section at the National Institutes of Allergy and Infectious Diseases.

“Everything that the immune system needs to form neutralizing antibodies that can block and block attachment and entry of this virus to the cell had been destroyed in that vaccine,” said Buchholz, who designed the RSV vaccine for toddlers that’s being tested at Vanderbilt and other US sites.

In the 1960s trial, the kids still made antibodies to the flattened viral proteins, but they were distorted. When the actual virus came along, these antibodies didn’t work as intended. Not only did they fail to recognize or block the virus, they triggered a powerful misdirected immune response that made the children much sicker, a phenomenon called antibody-dependent enhancement of disease.

The investigators hadn’t spotted the enhancement in animal studies, Varga says, because the vaccinated animals weren’t later challenged with the live virus.

“So of course, we require now extensive animal testing of new vaccines before they’re ever put into humans, again, for that very reason of making sure that there aren’t early signs that a vaccine will be problematic,” Varga said.

About 10 years ago, a team of researchers at the NIH – some of the same investigators who developed the first Covid-19 vaccines – reported what would turn out to be a pivotal advance.

They had isolated the structure of the virus’s F-protein, the site that lets it dock onto human cells. Normally, the F-protein flips back and forth, changing shapes after it attaches to a cell. The NIH researchers figured out to how freeze the F-protein into the shape it takes before it fuses with a cell.

This protein, when locked into place, allows the immune system to recognize the virus in the form it’s in when it first enters the body – and develop strong antibodies against it.

“The companies coming forward now, for the most part, are taking advantage of that discovery,” said Dr. Phil Dormitzer, a senior vice president of vaccine development at GlaxoSmithKline. “And now we have this new generation of vaccine candidates that perform far better than the old generation.”

The first vaccines up for FDA review will be given to adults: seniors and pregnant woman. Vaccination in pregnancy is meant to ultimately protect newborns – a group particularly vulnerable to the virus – via antibodies that cross the placenta.

Vaccines for children are a bit farther behind in development but moving through the pipeline, too.

Four companies have RSV vaccines for adults in the final phases of human trials: Pfizer and GSK are testing vaccines for pregnant women as well as seniors. Janssen and Bavarian Nordic are developing shots for seniors.

Pfizer and GSK use protein subunit vaccines, a more traditional kind of vaccine technology. Two other companies build on innovations made during the pandemic: Janssen – the vaccine division of Johnson & Johnson – relies on an adenoviral vector, the same kind of system that’s used in its Covid-19 vaccine, and Moderna has a vaccine for RSV in Phase 2 trials that uses mRNA technology.

So far, early results shared by some companies are promising. Janssen, Pfizer and GSK each appear effective at preventing infections in adults for the first RSV season after the vaccine.

In an August news release, Annaliesa Anderson, Pfizer’s chief scientific officer of Vaccine Research and Development, said she was “delighted” with the results. The company plans to submit its data to the FDA for approval this fall.

GSK has also wrapped up its Phase 3 trial for seniors. It recently presented the results at a medical conference, but full data hasn’t been peer reviewed or published in a medical journal. Early results show that this vaccine is 83% effective at preventing disease in the lower lungs of adults 60 and older. It appears to be even more protective – 94% – for severe RSV disease in those over 70 and those with underlying medical conditions.

“We are very pleased with these results,” Dormitzer told CNN. He said the company was moving “with all due haste” to get its results to the FDA for review.

“We’re confident enough that we’ve started manufacturing the actual commercial launch materials. So we have the bulk vaccine actually in the refrigerator, ready to supply when we are licensed,” he said.

Even as the company applies for licensure, GSK’s trial will continue for two more RSV seasons. Half the group getting the vaccine will be followed with no additional shots, while the other group will get annual boosters. The aim is to see which approach is most protective to guide future vaccination strategies.

Janssen’s vaccine for older adults appears to be about 70% to 80% effective in clinical trials so far, the company announced in December.

In a study on Pfizer’s vaccine for pregnant women published in the New England Journal of Medicine this year, the company reported that the mothers enrolled in the study made antibodies to the vaccine and that these antibodies crossed the placenta and were detected in umbilical cord blood just after birth.

The vaccines for pregnant women are meant to get newborns through their first RSV season. But not all newborns will benefit from those. Most maternal antibodies are passed to baby in the third trimester, so preemies may not be protected, even if mom gets the vaccine.

For vulnerable infants and those whose mothers decline to be vaccinated, Dr. Helen Chu, an infectious disease specialist at the University of Washington, says the long-acting antibody shot for newborns, called nirsevimab, should cover them for the first six months of life. She expects it to be a “game-changer.”

That shot, which has been developed by AstraZeneca, was recently recommended for approval in the European Union. It has not yet been approved in the United States.

The field is so close to a new approval that public health officials say they’ve been asked to study up on the data.

Chu, who is also a member of an RSV study group of the Advisory Committee on Immunization Practices, a panel that advises the US Centers for Disease Control and Prevention on its vaccine recommendations, says her group has started to evaluate the new vaccines – a sign that an FDA review is just around the corner.

No companies have yet announced that process is underway. FDA reviews can take several months, and then there are typically discussions and votes by FDA and CDC advisory groups before vaccines are made available.

“We’ve been working on this for several months now to start reviewing the data,” Chu said. “So I think this is imminent.”

Watching this year’s RSV season unfold, Brown, the pediatrician who enrolled her son in the vaccine trial for toddlers, says progress can’t come fast enough.

“The hospital is surging. We’re not drowning the way some states are. I mean, Connecticut, South Carolina, North Carolina, they’re really drowning. But our numbers are huge, and our services are so busy,” she says.

Brown says her son is mostly healthy. He doesn’t have any of the risks for severe RSV she sees with some of her patients, so she was happy to have a way to help others.

And while it’s far too early to say whether the vaccine James is helping to test will prove to be effective, the trial was unblinded last week, and Brown learned that her son was in the group that got the active vaccine, not the placebo

He has done well through this heavy season of illness, she says. The NIH-sponsored study they participated in is scheduled to be completed next year.

The vaccine, which is made with a live but very weak version of virus, is given through a couple of squirts up the nose, so there are no needles. The hardest part for squirmy James, she said, was being held still.

“If we can do anything to move science forward and help another child, like, sorry, James. You had to have your blood drawn, but it absolutely was worth it.”

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US woman files lawsuit against L’Oréal, claiming chemical hair straightening products are linked to her cancer

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CNN
 — 

Cosmetics company L’Oréal, along with multiple other parties, is being sued over claims that its chemical hair straightening products put women at an increased risk of uterine cancer.

Civil rights attorney Ben Crump, counsel Diandra “Fu” Debrosse Zimmermann and others filed a lawsuit Friday in Illinois on behalf of 32-year-old Missouri resident Jenny Mitchell, claiming that Mitchell’s uterine cancer “was directly and proximately caused by her regular and prolonged exposure to phthalates and other endocrine disrupting chemicals found in Defendants’ hair care products.”

CNN has contacted L’Oréal, Namaste Laboratories LLC, Dabur International Ltd. and Godrej Consumer Products, parent company of the Just For Me brand, for comment.

Debrosse Zimmermann told CNN on Monday that the lawsuit marks a “watershed moment” for women of color who have used chemical hair-straightening products, such as relaxers.

At a news conference Monday, Mitchell said that she recalls getting hair relaxers around third grade, when she was about 8 years old.

Mitchell was diagnosed with uterine cancer on August 10, 2018, according to the lawsuit, and underwent a full hysterectomy at Boone Hospital Center in Missouri on September 24, 2018.

“At that time, at the age of 28, my dreams of becoming a mother were gone,” she said. In the lawsuit, she claims to have no family history of cancer or uterine cancer.

“As most young African-American girls, chemical relaxers, chemical straighteners were introduced to us at a young age,” Mitchell said. “Society has made it a norm to look a certain way, in order to feel a certain way. And I am the first voice of many voices to come that will stand, stand up to these companies, and say, ‘No more.’”

Mitchell continued using chemical hair-straightening products from around 2000 until March 2022, and she is seeking compensation in excess of $75,000, according to the lawsuit.

Two other individual cases have been filed – in California and New York – against cosmetic companies, including L’Oreal, claiming a connection between chemical hair-straightening products and cancer diagnoses, Debrosse Zimmermann said.

“We imagine that we will continue representing additional women in filing cases, as will other firms, and more and more women will come forward,” she said.

Mitchell’s lawsuit was filed just days after the publication of a study in the Journal of the National Cancer Institute, which estimates that among women who frequently use hair-straightening chemical products, the risk of developing uterine cancer by age 70 is around 4%. In women who did not use hair-straightening chemical products in the previous 12 months, the study estimates the risk of developing uterine cancer by age 70 to be 1.6%.

Black women tend to use these chemical hair-straightening products more frequently than White women, the researchers noted.

The study data showed that the association between hair straightening products and uterine cancer cases was most pronounced for Black women, who made up only 7.4% of the study participants, but 59.9% of those who reported ever using straighteners.

Several factors probably play a role in the frequent use of hair straightening products: Eurocentric standards of beauty and social pressures placed on Black and Latina women in workplace settings related to microaggressions and the threat of discrimination, along with desired versatility in changing hairstyles and self-expression.

“Black women have long been the victims of dangerous products specifically marketed to them,” Crump said in a news release. “Black hair has been and always will be beautiful, but Black women have been told they have to use these products to meet society’s standards. We will likely discover that Ms. Mitchell’s tragic case is one of countless cases in which companies aggressively misled black women to increase their profits.”

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Hair-straightening chemical products linked to increased uterine cancer risk in new study

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CNN
 — 

Scientists are uncovering new details in the connection between using certain hair straightening products, such as chemical relaxers and pressing products, and an increased risk of cancer in women.

Ongoing research previously suggested that hair straightening chemicals are associated with an increased risk of certain hormone-related cancers, including breast and ovarian cancers, and now, a new study links use of hair straightening products with an increased risk of uterine cancer. Black women may be more affected due to higher use of the products, the researchers noted.

The study, published Monday in the Journal of the National Cancer Institute, estimates that among women who did not use hair-straightening chemical products in the past 12 months, 1.6% developed uterine cancer by age 70, but about 4% of the women who frequently use such hair-straightening products developed uterine cancer by age 70.

That finding “also communicates that uterine cancer is indeed rare. However, the doubling of risk does lead to some concern,” said Chandra Jackson, an author of the study and researcher at the National Institute of Environmental Health Sciences.

“In this study, women with frequent use in the past year had an over two-fold higher risk of uterine cancer,” she said. Frequent use was defined as more than four times in the previous year.

The new study includes data on nearly 34,000 women in the United States, ages 35 to 74, who completed questionnaires about their use of certain hair products, including perms, dyes, relaxers and straighteners. The researchers, from the National Institutes of Health, also tracked the incidence of cancer diagnoses within the study group.

The researchers found a strong association between hair straightening products and uterine cancer cases but the use of other hair products – such as dyes and perms or body waves – was not associated with uterine cancer.

The study data also showed that the association between hair straightening products and uterine cancer cases was most pronounced for Black women, who made up only 7.4% of the study participants, but 59.9% of those who reported ever using straighteners.

Several factors likely play a role in the frequent use of hair straightening products: Eurocentric standards of beauty, social pressures placed on Black and Latina women in workplace settings related to microaggressions and the threat of discrimination, along with desired versatility in changing hairstyles and self-expression.

“The bottom line is that the exposure burden appears higher among Black women,” Jackson said.

“Based off of the body of the literature in this area, we know that hair products marketed directly to Black children and women have been shown to contain multiple chemicals associated with disrupting hormones, and these products marketed to Black women have also been shown to have harsher chemical formulations,” she said. “On top of that, we know that Black women tend to use multiple products simultaneously, which could contribute to Black women on average having higher concentrations of these hormone-disrupting chemicals in their system.”

The researchers did not collect information on brands or ingredients in the hair products the women used, but they wrote in the paper that several chemicals identified in straighteners could contribute to the increased incidence of uterine cancer observed in their study.

“To our knowledge this is the first epidemiologic study that examined the relationship between straightener use and uterine cancer,” Alexandra White, head of the National Institute of Environmental Health Sciences Environment and Cancer Epidemiology group and lead author on the study, said in a news release Monday.

“More research is needed to confirm these findings in different populations, to determine if hair products contribute to health disparities in uterine cancer, and to identify the specific chemicals that may be increasing the risk of cancers in women.”

Some substances found in hair-straightening products, especially those most used by and marketed to Black and Latina women, are hormone-disrupting chemicals, said Tamarra James-Todd, an epidemiologist at Harvard T.H. Chan School of Public Health, who was not involved in the new study but separately has led some of the earliest research finding links between hair products and cancer.

“They modify our body’s normal hormonal processes. So, it makes sense to look at cancers that are hormonally mediated,” she said, adding that hormone-disrupting chemicals could impact other parts of the body too.

“​The challenge is that the impact of these chemicals might not be limited to hormonal processes, but they could also impact other systems, including our immune and vascular systems. Understanding how these chemicals work beyond the hormonal system is still a new and growing area of research,” James-Todd told CNN.

“So, it could be that the way these chemicals are operating is through altering ​not only hormonal responses, but also by altering immune or even vascular responses,” she said. “All of these processes are linked to cancer.”

While the new study is “well done” and shows an association between hair-straightening chemical products and increased uterine cancer risk, it is unable to determine that the products directly cause the cancer, Dr. Otis Brawley, professor at the Johns Hopkins University Bloomberg School of Public Health and former chief medical officer of the American Cancer Society, said in an email to CNN.

“It is unable to show cause, it could be pure association,” said Brawley, who was not involved in the new study.

Yet “the question how do we settle this is difficult. The scientific ideal is a randomized trial of 40,000 or so; 20,000 with regular hair straightener use and 20,000 never using it and never having used it and follow them for 20 years,” he said, adding that at this point, “it’s impossible for science to answer better than” the recent study.

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US

Parkland shooting: School shooter avoids the death penalty after jury recommends life in prison

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Fort Lauderdale, Florida
CNN
 — 

The Parkland school shooter has avoided the death penalty after a jury recommended he be sentenced to life in prison without the possibility of parole for the February 2018 massacre at Florida’s Marjory Stoneman Douglas High School – a move that left some of the victims’ loved ones disappointed and angry.

The jury’s recommendation Thursday, coming after a monthslong trial to decide Nikolas Cruz’s punishment, is not an official sentence; Broward Circuit Judge Elizabeth Scherer still is expected to issue the gunman’s formal sentence on November 1. Under Florida law, however, she cannot depart from the jury’s recommendation of life.

Families of the gunman’s victims bowed or shook their heads as the verdict forms for each of the 17 people he killed were read in court Thursday morning. The jury found the aggravating factors presented by state prosecutors did not outweigh the mitigating circumstances – aspects of Cruz’s life and upbringing his defense attorneys said warranted only a life sentence.

None of the jurors looked in the direction of the victims’ families as their verdicts were read, but instead looked down or straight ahead. Cruz – flanked by his attorneys, wearing a blue and gray sweater over a collared shirt and eyeglasses – sat expressionless, looking down at the table in front of him.

Live updates: Jury reaches decision in Nikolas Cruz sentencing trial

Tony Montalto, the father of 14-year-old victim Gina Montalto, called the jury’s recommendation a “gut punch” for the victims’ families, lamenting that “the monster that killed them gets to live to see another day.”

“This shooter did not deserve compassion,” he said outside the courtroom, after the jury’s findings were read. “Did he show the compassion to Gina when he put the weapon against her chest and chose to pull that trigger, or any of the other three times that he shot her? Was that compassionate?”

Cruz, now 24, pleaded guilty last October to 17 counts of murder and 17 counts of attempted murder for the shooting in Parkland, Florida, in which 14 students and three school staff members were killed, and 17 others were injured. Because Cruz pleaded guilty to all counts, the trial phase was skipped and the court went directly to the sentencing phase.

Prosecutors had asked the jury to sentence the gunman to death, arguing Cruz’s decision to carry out the shooting was not only especially heinous or cruel, but premeditated and calculated and not, as the defense contended, related to any neurological or intellectual deficits.

To illustrate their point, prosecutors detailed Cruz’s thorough planning for the shooting, as well as comments he made online expressing his desire to commit a mass killing.

In their case, the shooter’s defense attorneys said Cruz had neurodevelopmental disorders stemming from prenatal alcohol exposure, and presented evidence and witnesses claiming his birth mother had used drugs and drank alcohol while pregnant with him. Cruz’s adoptive mother was not open about this with health professionals or educators, preventing him from receiving the appropriate interventions, the defense claimed.

Of the 12 jurors, three voted against the death penalty, jury foreman Benjamin Thomas told CNN affiliate WFOR, saying, “I don’t like how it turned out but it’s that’s how the jury system works.”

“There was one with a hard ‘no,’ she couldn’t do it, and there was another two that ended up voting the same way,” said Thomas.

The woman who was a hard no “didn’t believe because he was mentally ill he should get the death penalty,” Thomas said.

The parents of Alyssa Alhadeff, another 14-year-old victim, said they were disgusted by the verdict.

“I’m disgusted with those jurors,” Alyssa’s father, Ilan Alhadeff, said. “I’m disgusted with the system, that you can allow 17 dead and 17 others shot and wounded, and not get the death penalty. What do we have the death penalty for?”

Linda Beigel Schulman, the mother of geography teacher Scott Beigel, echoed that question, telling reporters, “If this was not the most perfect death penalty case, then why do we have the death penalty at all?”

She, like many of the families who addressed reporters, commended prosecutors for their work, saying they perfectly executed the state’s arguments against the gunman.

“Justice was not served today,” her husband, Michael Schulman, said.

The jury’s recommendation robbed the victims’ families of justice, the father of 14-year-old Jaime Guttenberg told reporters, saying it could make another mass shooting “more likely.”

“We are all in this position now of doing the work that we do around this country to keep this from happening to another family,” Fred Guttenberg said after court. “This decision today only makes it more likely that the next mass shooting will be attempted.”

“This jury failed our families today,” Guttenberg said.

The widow of 49-year-old Christopher Hixon, who was the school’s athletic director, said the jury’s decision indicated the gunman’s “life meant more than the 17 that were murdered” and the rest of the community who remain “terrorized and traumatized.”

Debra Hixon also rejected the defense’s arguments about the gunman’s mental or intellectual struggles, pointing to another one of her sons, who has special needs.

“I have a son that checked … a lot of those boxes that the shooter did as well,” she said. “And you know what? My son’s not a murderer. My son’s the sweetest person that you could ever meet.

Florida Gov. Ron DeSantis also was disappointed by the jury’s decision, he said Thursday, as well as how long it took for the judicial process to play out.

“I was very disappointed to see that,” he said of the jury’s verdict. “I’m also disappointed that we’re four and a half years after these killings, and we’re just now getting this.”

Broward County Public Defender Gordon Weekes commended the attorneys in his office who represented the gunman, telling reporters, “With the greatest bit of sympathy, we attempted to prepare this case and present this case in the most professional and legal manner as we could.”

Weekes urged the community to respect the verdict, saying Thursday “is not a day of celebration, but a day of solemn acknowledgment, and a solemn opportunity to reflect on the healing that is necessary for this community.”

Weekes declined to comment when asked whether Cruz had a reaction to the jury’s recommendation.

To decide on a recommended sentence, jurors were asked to weigh the aggravating factors and mitigating circumstances presented by the prosecution and defense during trial.

Prosecutors pointed to seven aggravating factors, including that the killings were especially heinous, atrocious or cruel, as well as cold, calculated and premeditated. Other aggravating factors, prosecutors said, were that the defendant knowingly created a great risk of death to many people, and that he disrupted a lawful government function – in this case, the running of a school.

The defense, meantime, offered 41 possible mitigating circumstances, including that Cruz was exposed to alcohol, drugs and nicotine in utero; that he has a “neurodevelopmental disorder associated with prenatal alcohol exposure;” and that his adoptive mother did not follow the recommendations of medical, mental health and educational providers, among many others.

For each victim, jurors unanimously agreed the state had proven the aggravating factors beyond a reasonable doubt and that they were sufficient to warrant a possible death sentence.

However, to recommend death, all jurors still would have needed to find that the aggravating factors outweighed the mitigating circumstances. They did not unanimously agree on this, the jurors indicated Thursday on their verdict forms – meaning Cruz must be sentenced to life in prison and not death.

In closing arguments Tuesday, prosecutors argued Cruz’s decision to commit the shooting was deliberate and carefully planned, while Cruz’s defense attorneys offered evidence of a lifetime of struggles at home and in school.

“What he wanted to do, what his plan was and what he did, was to murder children at school and their caretakers,” lead prosecutor Michael Satz said Tuesday. “The appropriate sentence for Nikolas Cruz is the death penalty,” he concluded.

However, defense attorney Melisa McNeill said Cruz “is a brain damaged, broken, mentally ill person, through no fault of his own.” She pointed to the defense’s claim that Cruz’s mother used drugs and drank alcohol while his mother was pregnant with him, saying he was “poisoned” in her womb.

“And in a civilized humane society, do we kill brain damaged, mentally ill, broken people?” McNeill asked Tuesday. “Do we? I hope not.”

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Health

Antidepressant use during pregnancy doesn’t harm child development, study says

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CNN
 — 

Expectant mothers taking many common antidepressants need no longer worry the medication may harm their child’s future behavioral or cognitive neurodevelopment, a new study found.

Antidepressant use during pregnancy was not associated with autism, attention-deficit hyperactivity disorder (ADHD), behavioral disorders, developmental speech, language, learning and coordination disorders or intellectual disabilities, according to a study of over 145,000 women and their children across the United States followed for up to 14 years. The study was published Monday in the journal JAMA Internal Medicine.

“This is truly an important paper. Women and health professionals are often concerned about antidepressants in pregnancy, and sometimes decide to suddenly stop these medications as soon as pregnancy becomes known,” said Carmine Pariante, professor of biological psychiatry at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, in a statement.

Instead, women with depression and other mental conditions for which antidepressants are prescribed should be told the risk in pregnancy “is not as high as previously thought,” said Pariante, who was not involved in the study.

“I am grateful for this study,” Dr. Tiffany Moore Simas, a member of the Committee on Clinical Practice Guidelines on Obstetrics for the American College of Obstetricians and Gynecologists, told CNN via email.

“One in 5 perinatal individuals will experience a mental health condition,” said Moore Simas, who was not involved in the study. “We must stop shaming them for doing what is needed to care for themselves. Healthy babies need healthy mothers.”

Numerous studies over the decades have found associations between antidepressant use during pregnancy and developmental concerns in children, predominately autism and ADHD. But newer research has called the quality of that prior research into question. Many older studies were observational in nature and often failed to control for contributing factors such as obesity and other health conditions, environmental toxins, inflammation and even maternal stress.

Older research also failed to consider the impact on a developing fetus carried by a mother with uncontrolled depression, anxiety or another psychiatric disorder. Not treating a mother’s mental disorder has also been linked to “stillbirth, preterm birth, growth restriction and birthweight weight issues, impaired bonding, adverse neurodevelopmental outcomes, and increased risk of offspring mental health,” Moore Simas said.

Depressed women can also miss prenatal visits, skip meals, overuse alcohol or cigarettes, and in general fail to care for their growing fetus as they fail to care for themselves, experts say.

A very small number of antidepressants have been linked to an increased risk of birth defects, according to the US Centers for Disease Control and Prevention, so pregnant women should discuss their medication with their doctors.

Despite the advance of knowledge showing little to any impact from most common antidepressants, many physicians and mothers-to-be are still wary of their use, Moore Simas said.

Consultations between pregnant people and their doctors regarding antidepressant use are often “framed in the context of the risk of the medications – despite the data overall being reassuring,” she said. “Conversations about medication use for mental health in pregnancy or otherwise needs to account for the risk of untreated disease.”

The American College of Obstetricians and Gynecologists meets regularly to update guidance on medications that are safe to use during pregnancy, a spokesperson told CNN, and will be reviewing recent research such as this new study.

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Health

Frozen embryos tied to higher risk of high blood pressure-related pregnancy complications, study suggests

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CNN
 — 

Pregnancies from in vitro fertilization using frozen embryos appear to be linked to an increased risk of complications related to high blood pressure, or hypertensive disorders, compared with when fresh embryos are used or when a pregnancy is conceived naturally.

That’s according to a study published Monday in the American Heart Association journal Hypertension, which included data on more than 4.5 million pregnancies, spanning almost three decades, across three European nations: Denmark, Norway and Sweden.

The risk of pregnancy complications related to high blood pressure was higher after the transfer of frozen embryos compared with naturally conceived pregnancies, and the risk following fresh embryo transfers was similar to that of naturally conceived pregnancies, the data shows.

More research is needed to determine whether similar findings would emerge in the United States.

The researchers – from the Norwegian University of Science and Technology and other institutions in Europe – analyzed medical birth registries from Denmark that were dated between 1994 and 2014, from Norway dated 1984 to 2015, and from Sweden dated 1985 to 2015. The registries included about 4.4 million pregnancies naturally conceived, 78,300 pregnancies that used fresh embryo transfer and 18,037 pregnancies from frozen embryo transfer.

The researchers compared odds of hypertensive disorders during pregnancy across the groups and found that the unadjusted risk of such disorders was 7.4% after frozen embryo transfer, 5.9% after fresh embryo transfer and 4.3% after natural conception. The data also showed that pregnancies from frozen and fresh embryo transfer were more frequently preterm – 6.6% of the frozen and 8.1% of the fresh, respectively – compared with naturally conceived pregnancies, at 5%.

“Frozen embryo transfers are now increasingly common all over the world, and in the last few years, some doctors have begun skipping fresh embryo transfer to routinely freeze all embryos in their clinical practice, the so-called ‘freeze-all’ approach,” lead study author Dr. Sindre H. Petersen, a Ph.D. fellow at the Norwegian University of Science and Technology in Trondheim, Norway, said in a news release Monday.

“In summary, although most IVF pregnancies are healthy and uncomplicated,” he said, “this analysis found that the risk of high blood pressure in pregnancy was substantially higher after frozen embryo transfer compared to pregnancies from fresh embryo transfer or natural conception.”

Petersen added, “Our results highlight that careful consideration of all benefits and potential risks is needed before freezing all embryos as a routine in clinical practice.”

The findings are “in agreement with earlier population-level studies” showing a higher risk of hypertensive disorders during pregnancy after frozen embryo transfer, the researchers wrote in their study.

Last year, a large study out of France presented at the online annual meeting of the European Society of Human Reproduction and Embryology also found a higher risk of pre-eclampsia and hypertension in pregnancies derived from frozen-thawed embryos – and the risk was found to be greater when the uterus was prepared for implantation with hormone replacement therapies.

“The association between frozen embryo cycles and hypertensive disease in pregnancy has been known for a while, and there is still currently an active debate around the pros and cons of ‘Freeze all for all?’ amongst fertility doctors,” Dr. Ying Cheong, professor of reproductive medicine at the University of Southampton, said in a statement distributed by the UK-based Science Media Centre in July. She was not involved in either study.

“There are two important points to take home here, firstly, whilst frozen embryo transfer technology has transformed reproductive medicine, FET must only be performed where clinically appropriate and secondly, clinicians and scientists need to start joining the dots between what happens at early development and later at birth and beyond, a research area, in my opinion, that is still poorly supported and studied,” Cheong said.

The new study did not evaluate what could be driving this association between frozen embryo transfers and high blood pressure risks, but some IVF doctors question whether it is really fresh vs. frozen.

“There is one thing that is not clear: is it from the actual procedure of freezing the embryo or is it from the protocol used? Most IVF doctors believe from recent studies and evidence that it’s actually the medication protocol, not the IVF procedure,” Dr. Aimee Eyvazzadeh, a San Francisco-based reproductive endocrinologist, who was not involved in the new study, wrote in an email to CNN on Monday.

“There are different ways to prepare a uterus for transfer,” she said. One protocol involves a corpus luteum cyst, a fluid-filled mass that forms in the ovaries and plays an important role during pregnancy, as the corpus luteum produces the hormone progesterone that is needed during pregnancy. Another protocol relies on medications to mimic ovulation.

“Studies show that it’s the lack of corpus luteum that increases the risk and this is potentially why a frozen transfer may have a higher risk of pre-eclampsia,” Eyvazzadeh wrote.

Overall, the new study is “very important” for “anyone taking care of pregnant people after IVF,” she wrote. “Everyone taking care of pregnant people after IVF should pay extremely close attention to this study. More and more studies are showing what IVF doctors already know and that is that IVF after frozen embryo transfer can increase risk of pre-eclampsia.”

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US

Jim Justice: West Virginia governor signs bill into law banning abortion with few exceptions

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Washington
CNN
 — 

West Virginia Gov. Jim Justice announced Friday that he had signed a bill into law that prohibits nearly all abortions except in certain medical situations or in cases of rape or incest.

The GOP-led legislature passed House Bill 302 on Tuesday in a special session, making West Virginia the second state to pass a restrictive abortion bill after the US Supreme Court overturned Roe v. Wade.

The ban goes into effect immediately, with the bill’s criminal penalties to take effect in 90 days.

HB 302 allows exceptions for cases of rape or incest up to eight weeks of pregnancy for adults and the first 14 weeks of pregnancy for minors. The incident will need to be reported to law enforcement at least 48 hours before the abortion.

It also allows exceptions if the embryo or fetus is nonviable, a medical emergency exists or an ectopic pregnancy, a rare event in which the fertilized egg implants outside the uterus and cannot survive.

“I’ve done exactly what I said I would do – I’ve signed it,” Justice, a Republican, said at a news conference Friday morning.

Justice said he’s “proud that I signed it and I believe wholeheartedly that it does one thing that is absolutely so important – it does protect life.”

HB 302 had stalled in July when lawmakers failed to come to a consensus about key details of the bill. This week, when the legislature returned, abortion rights advocates slammed lawmakers for voting to ban abortion “after weeks of discussions behind closed doors.”

Since July, abortion had been legal in West Virginia up to 20 weeks of pregnancy, after a state court judge indicated that she had decided to block a state abortion ban dating to the 1800s.

Justice that month called lawmakers back for a special session and, at the last minute, added abortion to the legislative agenda.

“I said over and over and over that I stand strongly for life,” Justice said Friday. “But I also said we have to have reasonable, reasonable and logical exceptions.”

“And I really, truly believe that there’s reasonable and logical exceptions that they brought us. Now with all that, this is such a volatile, volatile bill. There’s people that are going – on either side – that are probably not going to get everything and anything that they wanted,” he said.

A person other than a licensed medical professional who performs an abortion in violation of the law would be subject to a felony and up to 10 years in prison.

Under the law, miscarriages, stillbirths, in vitro fertilization and medical treatment that results in accidental or unintentional death of a fetus are not considered abortions. The law does not prevent the sale and use of contraceptives. Abortion providers need to report abortions and are required to notify a minor’s parent before an abortion is performed.

It defines medical emergencies as a “condition or circumstance that so complicates the medical condition of a patient as to necessitate an abortion to avert serious risk of the patient’s death or serious risk of substantial life-threatening physical impairment of a major bodily function, not including psychological or emotional conditions.”

Alisa Clements, Planned Parenthood South Atlantic’s director of public affairs, argued that the law “will be deadly for the people of our state.”

“The limited exceptions in this bill are so narrow and so tightly restricted that it will make it extremely difficult for people in vulnerable situations — including minors and survivors of sexual assault — to get the care they need,” Clements said in a statement.

This story has been updated with additional reaction and background information.

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