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					BLtltlD, AND HAIR
     IRON,GRAY                        Anemia in old ageis a rising concern
                                                           B Y B E NH A R D E R

        he life of a red blood cell is briefbut fast paced.            molecule that binds to oxygenin the lungs and releases where
                                                                       it's needed. According to WHO, a man is anemicif he has a hemo-
        Eachheartbeatpumps millions ofthe tiny cells                   globin concentrationlower than 13.Ograms per deciliter (dl),
        into the body'svascularsystemat speeds moreof                  whereasa cutoffof t2.o g/dl appliesto women.
        than a meter per second.In about a minute,                         By comparison,averagehemoglobin concentrationsexceed
                                                                       I5.o g/dl and t3.5 g/dl in non-elderlywhite men and white women,
        they can carry oKygen   from the lungs to tissues              respectively.Average concentrations for black men and women
in the rest ofthe body and return to the lungs.And they                are slightly lower than those for whites.
                                                                           In contrastto the pattem seeninyounger adults,"older men tend
die before th ey're4 months old. The body replacesold                  to havelowerhemoglobinthan olderwomenj' salsgeriatricianClau-
red blood cellsby generating    freshones,   typicallypro-             dia Begh6of the JamesA HaleyVA Medical Centerin Tirmp4 Fla.
                                                                           Two years ago, an analysis of the NHANES data found that
ducing about 2 million cellsper second.                                1Opercentof women between75 and 84,yearsold-and 16 per-
   For a variety ofreasons,however,the production ofnew red            cent of men in that agerange-are anemic. In people 85 or older,
cells can fall behind the loss ofold ones.                             eachgenderfaced a 1Opercent greater ris\ Ferrucci and his col-
   The resulting deficiency,calledanemia,turns up among people         leagues  reported  inthe Oct.15,2OO4  Blnod.Thatresearch   excluded
ofall ages,but recent researchshows that it disproportionately         peoplewho were hospitalized or living in nursing homes.
affectsseniors.One study estimatesthat after age 85, 26 percent            In segmentsof the elderly population, anemia is even more
of men and zO percent of women are anemic.And while symp-              prevalent than that. Begh6and two colleaguesreviewed71 stud-
toms in young and old peoplealike include fatigue,headache,      and                                iesin 2OO4,, including the,B/ood study
pale skin, the new findings link anemia in elderly peopleto addi-      Anemia the
                                                                              in                    and some studies that examined only
tional effects,including acceleratedphysical and mental decline              "is
                                                                       elderly                      hospital patients or nursing home res-
and a shorter life span.                                                                            idents.Theyfound that amongpeople
   Far from being an innocuouspart of old age,anemiamay reflect        associated                   in some medical wards as many as 61
a serioushealth problem, recent studies show.
              anemic fand elderly], you won't live aslong as a per-
                                                                       withhigher                   percentare anemic.

son who's not anemici sayshematologist Jerry L. Spivakof Johns          o I ta
                                                                       m rtaiTy ndI ."'#i;11J.ffi?,irTtr:,i.ffiTj,?
Hopkins University in Baltimore.
   "[Anemia]                                                           pOOfgf quality                theunited
                                                                                                             states," Ferrucci'
                is associatedwithhigher mortality, disability,higher
risk offalls in the elderly, poorer quality oflife, increasedhospi-    of life."                          PATTERN OF RISK For the senior
talization rish and increasedhealth care utilizationi saysgeria-       - LUIGI ERRUCCI,                   population,anemiais not abenign con-
trician and epidemiologist Luigi Femrcci oftheNational Institute        N A T I O N A LN S T I T U T E
                                                                                      I                   dition. In oneresearch  effort, for exarn-
on Aging (NIA) in Baltimore.                                           ONAGING                            ple, geriatrician Harvey Jay Cohen of
   Furthermore, in about one-third ofanemia cases      amongelderly                                       Duke University Medical Center and
people,no obvious causecan be found. That makestreating ane-                                             theVAMedica] Centerin Durham.N.C..
mia difficult, if not impossible.                                      and his colleagues        testedblood-hemoglobin    concentrations 1,/<l<[
   Researchers    havebegun to investigatethe causes    ofanemia in    North Carolinaresidentswho were at least 7t yearsold. By the
the elderly population and to explorepossibletreatments. Sofar,        WHO criteria, 24 percentofthe volunteerswere anemicwhen the
they havemore questionsthan answers.But one early result sug-          studybegan.
geststhat injections of the hormone erythropoietin may relieve            At the study'soutset in 1992 and again in 1996,the researchers
anemia'sconsequences relatively healthy elderly people.If fur-
                          in                                           assessed     eachvolunteer'scognitive and physical status,including
ther trials bear out that finding, a vast number ofsenior citizens     his or her memory and handling oflife's daily activities.
could have reasonto seekthe treatment.                                    "People
                                                                                      with anemiahad lower physicalfunction and lower cog-
                                                                       nitive status,"    Cohensays.    Theywerealsomorelikelythanthe oth-
PREVALENT PROBTEM Premenoparualwomen much more     axe                 ersto deteriorate during the 4,-year         interval. "Having anemia pre-
likely to be anemicthan are their male peers.About 12 percent of       dicted further declinesin physical function and cognitive status,"
U.S.womenbetween ages and,[9 haveanemi4whilebarely
                              V                                        Cohensays.
1 percentof similarly agedmen do, accordingto national data.              Furthermore,participants who had anemiain f992 were 7O
   The study that yielded those figures, the National Health and       percent more likely than the othersto havedied by 2OOO,              Cohen's
Nutrition Examination Survey (NHANES), employed a widely               team reports in the Aprilz4mericanJourttal ofMedicine.
used definition of anemia that the World Health Organization              Somefraction of the anemia-associated             deaths can be blamed
(WHO) developeddecadesago.Anemia is typically measuredin               on factors other than the low hemoglobin concentrationthat was
terms of blood concentrationof hemoglobin,the red blood cell           disproportionately common among those with anemia.But even

345    J U N E3 , 2 0 0 6 V O L . 1 6 9                                                                                                 N
                                                                                                                                  SCIENCE EWS
 after taking into account obesity and other backgrounddiffer-           timeshints at its cause. Roughlyone-third of anemiacases eld-in
 ences,  Cohen's  team found that anemiawas associated     with a 4,O    erlypeoplearecaused deficiencies iron or ofvitamin B' and
                                                                                                by               of
 percentincrease death rate.
                    in                                                   folic acid,which the body needsin order to makered bloodcells.
    Over a 4,-yearperiod, Brenda Penninx of Wake Forest Uni-             These deficienciescan often be corrected by dietary changesor
 versity in Winston-Salem, N.C., and her colleagues,       including     inexpensivetreatments, Fermcci says.
 Ferrucci, found that people over 7O who initially had anemia               Another one-third ofelderly cases, says, relatedto under-
                                                                                                                 he       are
 were 20 percentmore likely to be hospitalizedand about /5 per-          lying chronic diseases  that lead to inadequate utilization, rather
 cent more likely to die than were initially nonanemic partici-          than deficientintake,ofiron.
 pants (SN; 1/1o/Oa,p. 3O).                                                 Specificcauses  ofpoor iron utilization includevariouscancers
    Penninxandher colleagues alsofound that elderlypeople
                                have                            with     and chronickidney disease,   which resultsfrom advanced   diabetes.
 anemialosemore musclestrengthovera <l       -yearperiodthan do peo-     Many scientistsare focusing on the role of inflammation, such as
 ple who dont haveanemia.                                                that seenin rheumatoid arthritis and during chronic infections,
    In another recent study,hematologistMary Cushmanof the               in causing anemiaassociated
                                                                                    the                     with chronic disease.
 Universityof Vermont College                                                                                   Someoftheseconditionsare
 ofMedicine in Burlington and                                                                                 an aftermath of the aging
 her colleagues measured                                                                                     processand defu correction,
 hemoglobin in men and                                                                                       saysSpivak.
 women age 65 or older who                                                                                      Diabetes,chronic kidney dis-
 werewell enoughtobe living at                                                                               ease,and chemotherapy all
 home. Of nearly 5,8O0volun-                                                                                        to
                                                                                                             seem impair the kidneys'pro-
 teers,8.5 percentwereanemic G                                                                               duction of erythropoietin, a
 by WHO criteria when the o                                                                                  hormone that's essentialfor
 study began.                                                                                                red-cell production. Synthetic
    The volunteers remained in                                                                               erythropoietin can boost the
 the studyfor 11.2  yearson aver- I                                                                          body'smanufactureof red blood
 age.By 2OO1,2,350         ofthem     o
                                                                                                             cellsand ameliorate  symptoms
had died. Deathswereleastfre-         o
                                                                                                             of anemiain peoplewho have
 quent in people with moder-                                                                                 severekidney diseaseor who
 atelyhigh hemoglobinconcen-                                                                                 are undergoing chemotherapy.
trations-about 14, g/dl in                                                                                   Tiials have demonstrated that
women and slightly more than                                                                                 injectingepoetinalf4 aform of
 15g/dl in men.                                                                                              erythropoietin, improvesbrain
    Comparedwith thosepeople,                                                                                function and quality of life in
volunteers who were anemic                                                                                   thesepeople.
but otherwiseof similarhealth                                                                                   Even with thorough diag-
 at the outset were 38 percent                                                                               nostic testing, the underlying
more likely to die during the                                                                                problem is unclear in about a
study,the researchers     reported                                                                           third of elderlypeoplewith ane-
in the Oct. 24,,2OO5   Archioesof                                                                            mia, Femrccisays.  Somerecent
Intetnal Medi.cine.                                                     data suggest  that, as a group, elderlypeoplewhoseanemiacan't
    Deathrateswere     alsoelevated amongpeople    whowerenot ane-      be explainedtend to havemild kidney dysfunction and impaired
mic by WHO criteria but who had low-normal hemoglobincon-               productionof erythropoietin.That raises possibilitythit ery-
centrations,Cushman's      team found. Pennirx and other researchers    thropoietin therapy could be usefulin that large group of co".entb
have made similar observations,which cast doubt on the clinical         untreatable  people.
relevance the \AIHOcriterias cutofffor defining anemia.
   Physicians    shouldseekto diagnose   anemiaand,when possible, TEST TREATM ENT No publishedtrial hastestedwhethersyn-
reverse in their elderlypatients,Cushmansays.
         it                                        However,shecau-thetic erythropoietin works against unexplained anemia or ane-
tions that the data don't prove that anemia contributes to mortal-mia caused a variety of chronic ailments,saysgeriatrician parag
ity risk. Someunderlying factor might both causethe anemiaand     funihotri of Michael ReeseHospital in Chicago.Two years ago,
shortenlifespan.                                                  he and his colleaguesset out to determine whether epoetin alfa
   Anemia weighs particularly heavily on blacks, severalstudies   couldimprovequality oflife in patientswho wereatleast 65 years
show.That'strue amongelderlypeople aswell asother agegroups.      old and had chronic anemia.
            in the old is threefold more common in blacksthan in     For 16 weeks,they gaveProcrit, a brand ofepoetin alf4 in rt
whites," Cohensays.In his study,elderly peoplewith anemia had     weeklyinjection 58 volunteers
                                                                                    to             who had lessthan 11.5   g/dl blood
similar ratesofdeath, regardless     oftheir race.                hemoglobin.  Eitherbeforeor afterthat treatment,theygave same
                                                                  peoplea placebofor t6 weeks.Neither the volunteersnor the doc-
SEEKING CAUSE Anemia occurswhen the body produces tors who administeredthe medicationknewduringthe trial which
insufficient amounts of hemoglobin.Sometimes, causeis a patients were getting the drug and which the placebo. procrit's
shortage iron, the metal in hemoglobinthat permitsthe mole- maker,Ortho Biotech of Bridgewater,N.J., sponsoredthe study.
cule to bind and release  oxygen.                                    Blood-hemoglobinconcentrationsimproved dramatically dur-
   In children, common causesof anemia are inadequateiron ing erythropoietintreatment but not during placebotreatment,
intake and geneticdiseases. women of childbearingage,lossof Agnihotri says.
                              In                                                  About two-thirds of the patientsattaineda hemo-
menstrual blood can remove iron more quickly than it can be globin concentrationabove13g/dl, he andhis colleagues           reported
replaced.  Bleedingrobsthe body ofiron that otherwisewould get last Decemberat a meeting in Atlanta of the American Society
recycledinto the next generation ofred cells.                     of Hematology.The anemiawasn't reducedduring the placebi
                ofthe underlyingdisorderis the most efectivemeans treatments.
of alleviating the anemia,"saysSpivak.                               "Based
                                                                            on this study,we can saythat ... epoetinalfa doesincrease
  Atestcalleda completeblood     countidentifiesanemiaand   some- hemoglobinamongchronic-anemic       elderlypatientsj'Agnihotri says.

                          O                                                                                 J U N E3 , 2 0 0 6 v o L . 1 6 9   347
   Among the elderly patients whosehemoglobin concentrations
went up, their self-assessments quality of life and enerry levels
"improved dramaticallyi
    Most of the patients in the trial wereAfrican American women,
but Agnihotri suspectsthat the results are relevant to all anemic
people over age 65, regardlessofsex or race.
    "This is the first intervention trial look
                                         to     at correctionof chronic
anemiain elderlypatientsi he says.      "Before
                                               this study,it wasunclea.r
whether we should correct anemia in elderly peopleJ
   Agnihotri notesthatfuture studieswill be neededto determine
whether the drug produceslifesavinghealth benefitsand whether
it's cost-effective.Currently, eachinjection costshundreds ofdol-
lars. The benefits of treatment wore off quickly when patients
switchedto the placebo,so continuoustreatment would be neces-
sary to permanently relievepatients'symptoms,Agnihotri says.
    Fermcci saysthat it will take large trials to justify widespread
use of erythropoietin to treat elderly people with anemia Even
then, he says,"it is not abroad solutionl
    Many elderly people make more than normal amounts of ery-
thropoietin, but their bone marrow doesnt respondby making as
manyred cellsasit should. Fernrcci suggeststhatchronicinflam-
mation reducesthe marrov/s responsiveness the hormone.
    T\vobranchesofthe National Institutes of Health in Bethesda,
Md., lastAugust ofered an incentiveforfurther research. NIA    The
and the National Heart, Lung, and Blood Institute plan to fund
up to $lo million of researchover a 4-year period.
    "The goalofthe program is to advance
                                              ourknowledge aboutthis
unexplainedanemi4 to tryto determinewhyithappens to some
older peopleandnot to others,fand to] develop        betterwaysofueat-
ing itj' saysSusanG. Nayfield, chief ofthe NIAIsgeriatricsbranch.
    The institutes have receivedmore than 2 dozenresearchpro-
posals,Nayfield says.     With the scopeof anemiain the elderlygrow-
ing wident, researchers the field are readyto focus on what to
doaboutit. r

                                                 Onejar yielded da.rkresiduethat also dis- symbolic meaning for ancient Egyptians
                                                 played traces ofsyringic acid, a substance concerned about the afterlife and rebirth
                                                 derivedfrom the main pigment of red wine. of their rulers. -8.a.
                                                 The otherjars servedup yellow or pale-
                                                 brown residuesthat lacked syringic acid. PHYSICS
                                                 Those vesselsmust have held white wine.

-                                                   The newfindings showthat ajar bearing       Imagine a hurricane with an eye in the
                                                 inscriptions that translate as "sweetwine"     shape of a propeller amid the sqrirling
Scientistsstudyingjarsrecovered  from King       origrnally held white wine, the scientists     clouds.Physicists haveobserved   something
Thtankhamen's tomb have extracted the            say.Writing on another white wine con-         almost as strange in whirlpools thpt they
first chemical evidence of white wine in         tainer describes itas agiftto Tirtankhamen     made by swirling liquids in a novel way.
ancient Eglpt.                                   from aprominent Egptian ofrcial.               Within the whirlpools, they've seenthree-
   Ateam ledby Maria RosaGuasch-Ja^n6               The oldest written accounts of white        blade-propeller shapesas well as regular
of the University of Barcelonaanalyzedthe        wines in Egypt date to the third century       polygons,including squaresand hexagons.
chemical makeup of dried liquid residues         A.D., the scientistsnote. Tirt ruled from         The behavior of liquids in rotating con-
on the inside surfacesof six jars from the 13228.C., dying under mys-          tainers has long fascinatedphysicists.For
boy-kingistomb. Thejars arenow displayed         terious circumstances around age18.
                                                                          at                    instance, afamouslate.l6OOs
                                                                                                          in                    study,Isaac
atthe Egrptian Museum in Cairo.                     Intriguingly, a red wine vessel was at      Newton ponderedwhy the surfaceofwater
   Residue in each jar contained tartaric        the west wall of Tut's burial chamber and      in a rotating bucket becomesconcave.
acid, a chemical marker of grapes, the           a white wine container was at the oppo-           In the new experiments, TomasBohr and
investigators report in the upcoming             site wall. The researchers    plan to inves-   his colleagues the TechnicalUniversity of
AugasL  Journal ofArchanological Sci.ence.       tigate whether that arrangement held           Denmark in Lyngby observedliquids in a

3rlt    JUNE3, 2006 VOL. 169                                                                                                       N
                                                                                                                            SCIENCE EWS
   IAST Tuesday,      when PresidentBushintroducedHen-            ed to this disconnect. a lesser-known
                                                                                          But                 factor is alsoat
   I     ry M. PaulsonJr. as his choiceto replaceJohnW.           work: the misleadingaggregates.
   I     Snowas Treasury secretary,Mr. Bushrattled off                 Aggregates- big-picturefigures like the unem-
  a string of impressiveeconomicstatistics.                       ploymentrate, productivity andgrowth in the grossdo-
        "In the first quarter of 2006, U.S.economygrew
                                      the                         mestic product- are highly usefulto economists. to     But
  at an annual rate of 5.3percent, the fastest growth in          most people,   they're abstractions.  You can't use a low
  two and a half years," he said,as Mr. Paulson, chief
                                                    the           unemploymentrate to pay a mortgage.
  executiveof GoldmanSachs,        lookedon."We added5.2               As a result, large aggregates   "are somethingthat           {t{
  million new jobs since August of 2003.    The national un-      peoplemay hear aboutin the news,but don't have a di-
  employmentrate is downto 4.7percent.Productivity is             rect impact on how peoplefeql," said Lynn Franco,di-
  high,and tlat's leadingto higher wagesand a higher              rector of the ConsumerResearchSurveyat the Confer-
  standard of living for the American people."                                                                                     R'
        Yet in the latest New York Times/CBSNewspoll,
  only 28percent of the respondentssaid they approved of

                                                                       Aside from being abstract, many of tlle most popu-
                                                                      aggregates simply misleading.DeanBaker, a di-
  PresidentBush'shandlingof the economy,         while 66per-     rector of the Centerfor Economicand Policy Research              r{
  centdisapproved- tlte worst suchratings of his presi-
  dency.Only 6 percent rated the economyas very good,
  while 46percent said it was fairly bad or very bad. And
                                                                  in Washington,puts ConsumerPrice Index - the
                                                                  main gaugeof inflation - at tlle top of tlle list.
                                                                        "It has no direct relationshipto
                                                                                                         what peopleper-
  to tlte ConferenceBoard.
                           plummetedlast montl, according

        This strange and unlikely combination - strong
                                                                  ceiveas inflation," he said.Mr. Baker notesthat the in-
                                                                  dex doesn'ttake accountof rapidly rising co-payments
                                                                  andhigher insurancedeductibles      whenit calculates
  and healthy aegregate macroeconomicindicators and d
  grumpy populace- has beena source of befuddlement
  to the administration and its allies. It's not unreason-
                                                                  health and medicalcosts.And to gaugeinflation in hous-
                                                                  ing, the index approximatesa measureof rent instead              o
   able to assumetiat Mr. Snowis being replaced as                of lookingat homepurchaseprices.
                                                                        "We've had a huge run-up in the price
   Treasury secretaryin part because couldn't make
  Americans appreciatejust how well the economyis per-
  forming. And it's possibleto detect amongBushparti-
                                                                                                                of horlsing,
                                                                  andthat doesn'tshowup in the C.P.I.,"he said.Sowhile
                                                                  the index showsthat inflation is elevated but still under
  sans an element of frustration at the public for what
  they seeas its failure to do so.In Iowa last month,Ru-
  dolph W. Giuliani bluntly diqmissedconcernsabout the
                                                                  control - up 3.5percentfrom April 2005 April 2006
                                                                  many Americansfind themselves
                                                                                                       paying sharply high-
                                                                  er prices for essentialgoodsand services.
   economy andhigher gasprices by saying, "I don't know
   what we're all soupset about."
        Gas pricesand the Iraq war havesurely contribut-
                                                                        In addition,aggregates   generally are averages,
                                                                  which are of decliningutility in an economycharacter-
                                                                  izedby greater inequalityof incomeand assets. an in- I
                                                                                                                                   +                          F'

                                                                                                                                   H.                         o
                                                                  tprviewwith The Wall StreetJournal in March, Mr.             I                 I
   Daniel Grosswrites the "Moneybox,,
                                    columnfor                     Snowtook pains to point out that there had beensub-
                                                                                                                                                 =            z                                                     stantial gains in per-capitaincome (8.2percent,after in-                       |n           o
                                                                  flation) andnet worth (24percent,beforeinflation)                                           =
                                                                                                                                                 !            o
Family Valucs                                                   while the other 299,999,999 workers don't get a raise. In
                                                                the aggregate,the average per-capita salary has risen
                                                                                                                                   -      <
                                                                                                                                                 o            s
TheAmerican familyls worth,
average, about6 percent
                             on                   $500,000
                                                                by $1,but only onepersonhas more moneyin his pocket.
                                                                                                                                   R                          €
2001to 2004. themedian
                           from                                      To seehow typical workers are doing,it's better to
                                                                look at median wages and incomes- the midpoint that                ea
networth-the midpoint
thatseparates top
             the       ffi
                                                                separates top 50percentfrom the lower b0percent.
                                                                And medianincome,which was stagnantduring presi-                   S.                   {
                                                                dent Bush'sfirst term, is struggling to keeppacewith                                    fr,

one{ourth largeas
        as ffi
                                                                inflation. "Median householdincome has gonenowhere
                                                                sincetlte turn of the decade,"
                                                                economistat Moody'
                                                                                               said Mark Zandi,chief
                                                                                                                                   €                  i

theaverase                                                           Mr. Zandiputsthe problemwith averagesanother
                                                                way. "If you put onefoot in a tub of hot water and the             +t
                                                                                                                                                 ] F
                                                                other in a tub of cold water and take the average, every-
                             ffi                                thing is fine."
                                                                                                                                   E                 \t
Net worth of an
American  family                                                IIHIS      dichotomyaccurarelydescribesrheeconomy.                 a             B
                                                                       From 2001 2004, overcgenet worth of an
                                                                                   to      the
                                                                       American family rose6.3percent,accordingto                  Cn           r;
                                                                tlte Federal Reserye'sSurveyof ConsumerFinances.
                                                                But not everybodygrew richer. For the bottom 40per-
                                                                centof families by income,the mediannet wortl fell. ..It
                                                                                                                                   o rx
                                                                                                                                   F              }(

      MEDIAN                      AVERAGE
                                                                just doesn'tresonate    with people whenthe Treasury
                                                                secretarysayseverythingis fine," Mr. Zandi said.,ilt's
                                                                                                                                              l q
                                                                                                                                              t :
                                                                fine for half,thepopulation,  and it's clearly not for the

Source: Federal ReseNe                     The New York Tim6    otler half."                                                                   , A
                                                                                                                                              1 -
                                                                      There's a final reasont}tat the aggregates    may not                   l t u
from tlle beginningof 2001 the end of 2005.
     The data he cited were averages, means,and
                                                                accuratelycapturettte public mood.Aggregatesshed
                                                                light on the performanceof t}e economyin tlte last                 o'         j o
                                                                                                                                              r o
that canbe misleading."The averagewage is a useful
indicator if you want to know what's happeningto the
                                                                month,or in the last quarter. By contrast,measuresof
tax base, it might not tell you what's goingon for the
individual worker," said Alan B. Krueger, an economics
professorat Princeton and a former chief economistat
                                                                sentiments and polls gaugefeelings about the pfesent
                                                                and expectationsfor the future.
                                                                     "Consumers    tendto view current conditionsas
                                                                quite favorable, but their expectationsfor six months
the Labor Department.Considera hypotheticalcountry              downthe road are rather pessimistic,"said Ms. Franco
with 300mi[ion workers. Saythe chief executiveof an             of the Conference   Board."It couldbe that we're nearing
                                                                                                                                              \ :
investmentbank gets a 9300    million raise this year,          apeak,andthisis as goodas itgets."                         !

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