Dietary Supplements No Better Than Placebo In Slowing Cartilage Loss In Knees Of Osteoarthritis Patients
September 29, 2008 -- In a two-year multicenter study led by University of Utah doctors, the dietary supplements glucosamine and chondroitin sulfate performed no better than placebo in slowing the rate of cartilage loss in the knees of osteoarthritis patients. This was an ancillary study concurrently conducted on a subset of the patients who were enrolled in the prospective, randomized GAIT (Glucosamine/chondroitin Arthritis Intervention Trial). The primary objective of this ancillary study was to investigate whether these dietary supplements could diminish the structural damage of osteoarthritis. The results, published in the October issue of Arthritis & Rheumatism , show none of the agents had a clinically significant effect on slowing the rate of joint space width loss -the distance between the ends of joint bones as shown by X-ray. Comment: One more product highly touted by the vitamin industry shows little effect when studied properly.

Physician's First Watch for October 2, 2008
David G. Fairchild, MD, MPH, Editor-in-Chief

Maraviroc Blocks Host-Cell Receptor in HIV

Maraviroc Blocks Host-Cell Receptor in HIV

Maraviroc, the first of a new class of drugs that blocks a host-cell protein rather than HIV's components, is effective against some HIV subtypes, according to studies in the New England Journal of Medicine. Maraviroc blocks a protein, R5, on host CD4 cells to which certain subtypes of HIV attach themselves.

In two placebo-controlled phase 3 studies designed, conducted, and analyzed by the drug's manufacturer, roughly 1000 patients with R5-tropic viruses were randomized either to maraviroc taken once or twice daily, or to placebo. (Patients could continue to take their usual antiviral therapy.)

After 48 weeks' therapy, those on maraviroc had lower levels of HIV RNA than those on placebo; they also had greater increases in CD4 counts relative to baseline. Treatment-related toxicity did not differ substantially among the groups.

Physician Editors contributing to this issue were: Susan Sadoughi, MD, Lorenzo Di Francesco, MD, FACP, and Danielle Bowen Scheurer, MD, MSc.

Press Association
Tuesday January 30, 2007 6:28 AM

British medical history will be made on Tuesday when cardiologists perform the country's first ever keyhole heart valve replacement operation.
Surgeons will embark on the procedure - which is carried out in just four other hospitals worldwide - at Leicester's Glenfield Hospital.
The technique will spare patients from undergoing open heart surgery by allowing valves to be implanted into the heart using a catheter.
The nature of this less-invasive surgery, performed previously in hospitals in Germany, Belgium, the Netherlands and Canada, will also mean that recovery time for patients is halved.
Dr Jan Kovac, consultant cardiologist at Glenfield Hospital, said: "In the past, patients had to endure open heart surgery and would have been in hospital for at least a week after their operation.
"This new catheter treatment is much quicker and in most cases patients will be back home within a few days of the operation."
Dr Kovac hailed the technique as the biggest invention in cardiology over the last 30 years - since the introduction of the coronary angioplasty.
"As more and more of these operations are performed around the world, there's no question in my mind that many patients in the future will be able to have heart valves replaced percutaneously (through the skin) in a cath lab rather than having to endure open-heart surgery," he said.
Heart valve replacements are the second most common cardiac operation carried out by surgeons at Glenfield Hospital.

The tiny woman dubbed the Hobbit who lived 18,000 years ago on a remote Indonesian island deserves to be deemed a new human species and not a deformed modern human, as skeptics assert, researchers said on Monday.
In the latest salvo in a heated scientific shootout, an international team led by Florida State University anthropologist Dean Falk compared the Hobbit's skull to those of nine people with microcephaly, a rare condition in which the head is abnormally small due to improper brain development.
Credit: Florida State University
Dean Falk They concluded that the 3-foot-tall (1-meter) adult woman had a highly evolved brain, unlike that of a microcephalic person, confirming that she belongs to the proposed extinct species Homo floresiensis, closely related to modern Homo sapiens.
"Lo and behold, it doesn't look anything like a microcephalic. In fact, it's antithetical," Falk said in an interview, rebutting scientists such as primatologist Robert Martin of the Field Museum in Chicago who suggest that the skull came from a person with microcephaly.
A previous study by Falk had been criticized because it compared the Hobbit, with a brain a third the size of modern people, to just a single microcephalic skull.
Martin remained unconvinced. "My gut feeling is what they (Falk's team) did is just played around with the measurements until they got something that suited them," Martin said.
Martin said the new study is flawed, questioned whether Falk's team knew enough about microcephaly and insisted that the question of a separate species is unresolved.
The study appears in the Proceedings of the National Academy of Sciences. Michael Morwood, part of the group that discovered the remains, is a co-author.
Scientists in 2003 found the bones in a cave on the island of Flores east of Bali, contending that they were a previously unknown species living at a time the species Homo sapiens was thought to have been the world's only human inhabitant.
These little people--bones from several other individuals also were found--lived in a wondrous place populated by strange animals like pygmy elephants and large rodents. In this isolated locale, evolutionary forces stemming from limited resources may have pushed some inhabitants toward dwarfism and others toward gigantism.
Tools and evidence of fire were found near the bones of the adult female, dubbed the Hobbit after the small people in the writings of J.R.R. Tolkien.
Falk's team compared three-dimensional, computer-generated reconstructions of the brain of the Hobbit to those of nine microcephalics from all over the world and 10 normal people.
Two features in the frontal lobes and a structure called the cerebellum separated the two groups, with the Flores woman fitting in with normal humans, not microcephalics, the study found. But she was unlike modern humans in four other features distinguishing her from Homo sapiens, crying out for recognition as a separate species, the researchers said.
Falk said the origin of this new species is now the key question, adding that she is open to the possibility that it descended from Australopithecenes, ape-like human ancestors, or was a dwarf form of the extinct species Homo erectus.
Martin said it is possible that it is a new species. "But the other strong possibility is that this is actually just a pathological modern human," Martin added.
"At the end of the day, hopefully, the truth will come out," Martin added. "And I'm not mad enough to think I'm right about everything. But there are ways of doing it and ways of not doing it."

The first researchers to use magnetic resonance imaging (MRI) to study the brains of a large group of babies soon after birth found a small amount of bleeding in and around the brains of one in four babies who were delivered vaginally. The study appears in the February issue of Radiology.
"Small bleeds in and around the brain are very common in infants who are born vaginally," said John H. Gilmore, M.D., professor of psychiatry and Vice-Chair for Research and Scientific Affairs at the University of North Carolina School of Medicine in Chapel Hill. "It seems that a normal vaginal birth can cause these small bleeds."

For the study, 88 asymptomatic infants, equally divided between male and female, underwent MRI between the ages of one and five weeks. Sixty-five had been delivered vaginally and 23 had been delivered by cesarean section. MR images showed that 17 (26 percent) of the babies who had been delivered vaginally had intracranial hemorrhages (ICH), or small bleeds in and around the brain. Seven infants had two or more types of ICH. Prior studies have shown a smaller incidence—approximately 10 percent—of intracranial hemorrhage associated with vaginal birth.
While ICH was significantly associated with vaginal birth, it was not dependent on prolonged duration of labor or on traumatic or assisted vaginal birth.
In a newborn, the bones of the skull have not fused together, so the bones of the skull can shift and frequently overlap each other during vaginal delivery, to allow the baby's head to fit through the birth canal. This shifting can compress the brain or cause blood vessels to tear, which causes bleeding.
Most of the bleeds identified were very small subdural hematomas—bleeding between the brain and the thick membrane that covers the brain below the skull—and a majority of them were located in the lower, back part of the brain over the occipital lobe or the cerebellum, which is below the occipital lobe.
Typically, small bleeds resolve over time without causing problems, though larger ones may cause problems later in the child's life, including seizures, subtle learning problems or problems with motor development.
Further studies must be done to measure the long-term effects of ICH in infants, but Dr. Gilmore noted that expectant parents should not rule out vaginal delivery because of these findings.

By Jessica Berman
Washington
30 January 2007

Archaeologists have unearthed an ancient settlement that they believe is connected to Stonehenge, the legendary monument on England's Salisbury Plain. Archeologists say the village, known as Durrington Walls, once housed a vibrant community of ancient people. VOA's Jessica Berman reports from Washington.
Stonehenge
Durrington Walls is located about three kilometers from Stonehenge not far from the banks of the Avon River.
Archaeologists excavated eight houses from the wooden settlement, but they believe there may be at least 25 more dwellings. Each home was approximately five by five meters.
Using carbon dating, the scientists estimate the houses at Durrington Walls were constructed around 2600 B.C., during the same period as Stonehenge, a circle of massive stones that enclose a series of concentric rings.
But they say the wooden settlement is the larger of the two, each of which has a large path, or avenue, leading to the Avon River.Stonehenge is famous for its solstice orientation. The ancient monument faces the midsummer sunrise and the midwinter sunset. But archaeologists say the wooden circle of Durrington is pointed squarely in the direction of the midsummer sunset and a midwinter sunrise.
Scientists say the evidence suggests that the two were opposite in other ways.
Parker Pearson says he and his colleagues found evidence of 4,600-year-old debris strewn everywhere inside the tiny huts.
"That consists of broken pots, chips, flint, burnt stones used in cooking and vast quantities of animal bones," he said. "And what's really interesting about these is that many of these were thrown away half eaten. This is what we would call conspicuous consumption. It's an enormous feasting assemblage. People were here to have a really good time."
But Stonehenge was a solemn place, according to Parker Pearson, who says anthropologists have so far only turned up cremated remains at the site, suggesting the monument was used to honor important people.
Long after Stonehenge was constructed, according to archaeologist Julian Thomas of Manchester University, Durrington Walls appears to have become some sort of shrine.
"After those timbers had rotted away, people came back and dug holes where the posts had been and placed deposits of animal bones and pottery and stone tools into the craters where the posts had been, so that you are creating a kind of architecture of memory, a commemoration of where the monument that no longer exists, had been," he said.
The archaeologists say the findings confirm that Stonehenge was not built in isolation, but was constructed by a settlement of people who were part of much bigger religious complex of solar worshippers.

NEW YORK: Optimists may enjoy longer lives than people with a dimmer outlook on the future, a long-term study suggests. Researchers found that of nearly 7,000 adults followed since their college days in the 1960s, those who were optimistic in their youth had a lower risk of dying over the next 40 years than their more pessimistic peers.

On average, the most pessimistic study participants were 42% more likely to die of any cause than the most positive participants, according to findings published in the Mayo Clinic Proceedings medical journal.

The results echo those of a number of past studies on personality factors and health, including research that has linked optimism to longer life. One study of elderly adults found that those with a positive view of the future were less likely than pessimists to die over the next decade — regardless of their health at the start of the study.

The current findings could be explained by any number of factors, according to the study authors, led by Dr Beverly Brummett of Duke University Medical Center.

For example, they say, optimists are less likely to suffer from depression than are pessimists, which could, in turn, affect their physical health. They may also maintain a healthier lifestyle, paying more attention to their diet and
exercise habits.

These findings are based on a 40-year follow-up of 6,958 men and women who entered the University of North Carolina, Chapel Hill in the mid-1960s.

At the time, they took a standard personality test that gauges a person's tendency to be optimistic or pessimistic.

In general, optimists believe negative events are only temporary and don't let them affect their overall attitude about themselves and the world.

Pessimists, in contrast, take such events to heart, often blaming themselves and believing that the bad times will last forever.

Steve Irwin killed in freak accident at sea


September 04, 2006 05:19pm

A DOCTOR has told of the desperate efforts to save Australian icon Steve Irwin after the Crocodile Hunter was struck in the chest by a stingray barb today.

Irwin, 44, died this morning after being fatally injured while filming a nature documentary off Queensland.

The news has shocked the nation and prompted a rush of tributes from politicians and the public alike.

Irwin's wife Terri was in Tasmania at the time of the tragedy and had to be contacted by police with the terrible news.

Dr Ed O'Loughlin was aboard the Emergency Management Queensland Helicopter which was called from Cairns at 11.21am (AEST).

Irwin was being given CPR at Low Isles, off Port Douglas, as the helicopter arrived less than one hour after the incident, but Dr O'Loughlin said nothing could be done to save him.

"It became clear fairly soon that he had non-survivable injuries," Dr O'Loughlin said.

"He had a penetrating injury to the left front of his chest.

"He had lost his pulse and wasn't breathing."



Father-of-two Irwin was swimming at Batt Reef, off the Low Isles, when the tragedy occurred.

Tasmania Police this afternoon confirmed his wife Terri was travelling in the state at the time of the tragedy.

A spokeswoman said police had made contact with Mrs Irwin and "passed on a message relating to the death of her husband".

The Irwins have two children - a daughter, Bindi Sue Irwin, eight, and a three-year-old son, Robert (Bob) Clarence Irwin.

Steve Irwin - known worldwide as the Crocodile Hunter - was famous for his enthusiasm for wildlife and his catchcry "Crikey!".

In an sad twist, it has been reported that his new documentary was aimed at demystifying the stingray.

Irwin's Crocodile Hunter program was first broadcast in 1992 and has been shown around the world on cable network Discovery.

He has also starred in movies and has developed the Australia Zoo wildlife park, north of Brisbane, which was started by his parents Bob and Lyn Irwin.

Tributes quickly poured in for the larger-than-life character.

Prime Minister John Howard said Irwin was a typical Australian larrikin who brought joy to millions of people around the world.
"I am quite shocked and distressed at Steve Irwin's sudden, untimely and freakish death," he said.

"It's a huge loss to Australia."

A Tourism Queensland spokeswoman said the death was shocking and paid tribute to Irwin's "enormous contribution" to his adopted state.

"I don't think we could even estimate how much he brought us through his personality and his profile and his enthusiasm about Queensland," she said.


My Tributes to the Great Legend, who made snakes and crocodiles exciting for me. RIP

Stefan Lovgren
for National Geographic News

August 31, 2006
Normal immune cells that were genetically altered to recognize and destroy cancer cells have successfully shrunk large tumors, scientists say.
Two of 17 people with advanced melanoma—a deadly form of skin cancer—who underwent experimental treatment with the engineered immune cells saw their tumors shrivel.
A year and a half after therapy began, the two patients were declared free of the disease.
"This is the first example of an effective gene therapy that works in cancer patients," said Steven Rosenberg, chief of surgery at the National Cancer Institute in Bethesda, Maryland, and leader of the research team.
The therapy has so far been applied only to melanoma patients. But the researchers are optimistic that their treatment can be used for many other types of cancer.
The team has already engineered similar immune cells for more common tumors, such as breast, lung, and liver cancers.
The research appears in tomorrow's issue of the journal Science.

Engineered to Kill
Scientists have long been looking for ways to boost the body's immune system against cancer. (Related: "Dogs Smell Cancer in Patients' Breath, Study Shows" [January 2006].)
"There's been a lot of hype about gene therapy for many years, hoping that by genetically manipulating cells we can do good things," Rosenberg said.
His team focused on T (thymus) cells, a type of specialized immune cell that can learn to recognize and attack specific "foreign" objects, such as the cancer cells that make up tumors.
In the new study, researchers created tumor-fighting cells by harvesting normal T cells from melanoma patients and genetically engineering these cells to carry receptor proteins on their surfaces that recognize cancer markers.
The cells were then returned to the patients' bodies to rebuild their immune systems.

The engineered cells showed signs of persisting in most of the patients' bodies two months after they were reintroduced.

Previously, researchers had attempted to treat melanoma by removing naturally occurring tumor-fighting T cells from patients.
They used chemotherapy to clear out a patient's old T cells and then repopulated the patient's immune system with the harvested antitumor cells.
But researchers could only get cancer-fighting immune cells from half of the melanoma patients.
And similar cancer-fighting cells were not found in patients with other cancers, such as breast cancer and colon cancer.
"So the approach was only good for the half of the melanoma patients in whom you could find the cells and not suitable for any other cancer patients," Rosenberg said.
Melanoma makes up only 5 percent of known cancers.
But the newly engineered cells can be tailored to fight tumors other than melanoma, scientists say.
"We now have receptors that will recognize about half of all common cancers in humans, including breast and lung cancer," Rosenberg said.
Refinement Needed

Patrick Hwu, chair of the melanoma department at the University of Texas M.D. Anderson Cancer Center in Houston, calls the research a "landmark study."
"It potentially changes the whole area of using the immune system to attack cancer," he said. "It opens the door to generalizing this kind of treatment for other cancers."
The new findings are the first time that scientists have shown that genetically modified immune cells can be used to affect cancer regression in patients, he says.
But more research is needed before the technique can be widely applied.
Only 2 of the 17 people treated for melanoma showed improvement.
"The other patients did not respond, but we think we know why," Rosenberg said. "We had relatively poor [cancer-detecting] receptors available when we started this trial compared to the ones we have available now."

GARDASIL prevents cervical cancer, pre-cancerous and low-grade lesions and genital warts caused by HPV types 6, 11, 16 and 18

WHITEHOUSE STATION, N.J., June 8, 2006 - Merck & Co., Inc. announced today that the U.S. Food and Drug Administration (FDA) approved GARDASIL® [Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) Recombinant Vaccine], the first and only vaccine to prevent cervical cancer and vulvar and vaginal pre-cancers caused by HPV types 16 and 18 and to prevent low-grade and pre-cancerous lesions and genital warts caused by HPV types 6, 11, 16 and 18. In the United States, approximately 10,000 women are diagnosed with cervical cancer every year, and an average of 10 women die each day from the disease.

The FDA approved GARDASIL for the prevention of cervical cancer; cervical pre-cancers [cervical intraepithelial neoplasia (CIN) 2/3 and adenocarcinoma in situ (AIS)]; vulvar pre-cancers [vulvar intraepithelial neoplasia (VIN) 2/3]; and vaginal pre-cancers [vaginal intraepithelial neoplasia (VaIN) 2/3] caused by HPV types 16 and 18. GARDASIL is also approved for the prevention of genital warts and low-grade cervical lesions (CIN 1) caused by HPV types 6, 11, 16 and 18. GARDASIL is approved for 9- to 26-year-old girls and women.

"Merck is proud to be the leader in cervical cancer vaccine research and development," said Richard T. Clark, chief executive officer and president, Merck & Co., Inc. "Bringing forward this life-saving scientific advance is yet another testament to Merck's long-standing mission to research and develop novel vaccines and medicines that can greatly improve public health."

GARDASIL is designed to prevent the majority of HPV-related clinical diseases, those caused by HPV 6, 11, 16 and 18. HPV types 16 and 18 account for approximately 70 percent of cases of cervical cancer, AIS (non-invasive cervical cancer), CIN 3, VIN 2/3 and VaIN 2/3, and account for 50 percent of CIN 2 lesions. HPV 6 and 11 cause approximately 90 percent of genital wart cases. These four types of HPV also cause approximately 35 to 50 percent of all low-grade cervical, vaginal and vulvar lesions (CIN I, VIN I and VaIN I). There are an estimated 4.7 million abnormal Pap results that require follow-up each year in the United States. At least 3 million of these results are caused by some type of HPV. All four types cause abnormal Pap test results; the lesions caused by types 6 and 11 are clinically indistinguishable from pre-cancerous lesions caused by types 16 and 18.

"GARDASIL is a major health breakthrough - the first vaccine specifically designed to prevent cancer - and is approved to prevent not only cervical cancer but also genital warts," said Kevin Ault, MD, associate professor, Department of Gynecology and Obstetrics, Emory University School of Medicine, and clinical study investigator for GARDASIL. "Use of GARDASIL can help significantly reduce the human and economic burden of cervical cancer, pre-cancerous or low-grade lesions and genital warts caused by HPV 6, 11, 16 and 18 in the United States, and the rest of the world, in this generation and future generations."

In clinical studies, GARDASIL prevented 100 percent of HPV 16- and 18 -related cervical cancer in women not previously exposed to the relevant HPV types
The efficacy of GARDASIL, which includes results from an HPV-16 prototype of GARDASIL, was evaluated in four placebo-controlled, double-blind, randomized Phase II and Phase III clinical studies. Together, the Phase II and III studies evaluated 20,541 women aged 16 to 26 years. Study participants were followed for up to five years after enrollment.

The studies' primary analyses were conducted in women who received all three vaccinations within one year of enrollment, did not have major deviations from the study protocol and were naïve to the relevant HPV type(s) prior to dose one and through one month post-dose three (Month 7). Efficacy was studied in the individual studies and in combined analyses and measured starting after the Month 7 visit. In the combined analyses:

Cervical Cancer: GARDASIL prevented 100 percent of HPV 16- and 18- related cervical pre-cancers and non-invasive cervical cancers (CIN 2/3, and AIS, or adenocarcinoma in situ ). There were no cases in the 8,487 women who received GARDASIL compared to 53 cases in the 8,460 women who received placebo.

Cervical Intraepithelial Neoplasia (CIN): GARDASIL prevented 95 percent of low-grade cervical dysplasia (low grade lesions) and pre-cancers (CIN 2/3 or AIS) caused by HPV 6, 11, 16 or 18. There were 4 cases in the 7,858 women who received GARDASIL compared to 83 cases in the 7,861 women who received placebo.

Genital Warts: GARDASIL prevented 99 percent of cases of genital warts caused by HPV 6 or 11. There was one case in the 7,897 women who received GARDASIL compared to 91 cases in the 7,899 women who received placebo.
GARDASIL also prevented 100 percent of HPV 16- and 18-related vulvar and vaginal pre-cancers (VIN 2/3 or VaIN 2/3) in women not previously exposed to the relevant HPV types. There were no cases in the 8,641 women who received GARDASIL compared to 24 cases in 8,667 women who received placebo. VIN 2/3 and VaIN 2/3 are the immediate precursors to vulvar and vaginal cancers.

These studies also showed that administration of GARDASIL to women who are already infected with one or more vaccine related HPV types prior to vaccination protects them from clinical disease caused by the remaining vaccine types but may not alter the course of an infection that is already present.

GARDASIL was generally well tolerated
In all studies, GARDASIL was generally well tolerated and few subjects (0.1 percent) discontinued due to adverse events. Vaccine-related adverse experiences that were observed in clinical trials at a frequency of at least 1.0 percent among recipients of GARDASIL and also greater than those observed among recipients of placebo, respectively, were pain (83.9 percent vs. 75.4 percent), swelling (25.4 percent vs. 15.8 percent), erythema (24.6 percent vs. 18.4 percent), fever (10.3 percent vs. 8.6 percent), and pruritis (3.1 percent vs. 2.8 percent). Most injection-site reactions were reported to be mild to moderate in intensity.

Bridging the efficacy of GARDASIL from young adults to young adolescents
Prior vaccination strategies have shown that the ideal time to administer any vaccine is before exposure to the infection. Adolescents are an important group to vaccinate against HPV - one in four people ages 15 to 24 are infected with HPV. In addition, in a survey of 525 mothers with children as young as 11 years, up to 80 percent of mothers said they would allow their daughters to receive a vaccine that helps protect against cervical cancer.

Merck studied the anti-HPV 6, -11, -16 and -18 immune responses for GARDASIL in 10-to 15-year-old girls compared to those in 16- to 23-year-old adolescent and young adult women. Among the study participants who received GARDASIL, the immune responses (geometric mean titers, GMTs) in 10- to 15-year-old girls were similar to those in 16- to 23-year-old women. Similar outcomes were observed in a comparison of immune responses among 9- to 15-year-old girls to immune responses in 16- to 26-year-old adolescents and females. Based on these analyses, the FDA approved GARDASIL for use in adolescent girls ages 9 to 15.

Studies examine impact of GARDASIL in the general population
A secondary analysis to assess the potential impact of GARDASIL on rates of cervical cancer and other HPV-related diseases on the general population was also conducted. This analysis included all women regardless of whether they were infected with HPV prior to vaccination, developed an infection after the start of vaccination and those who may not have completed the 3-dose vaccination. In this analysis, GARDASIL reduced the risk for development of cervical pre-cancerous lesions and cervical cancer caused by HPV types 16 and 18 by approximately 40 percent in just two to four years. Genital warts (related to type 6, 11, 16 and 18), which develop more quickly than cervical cancer and pre-cancerous lesions, were reduced by almost 70 percent. Virtually all of the cases of CIN and genital warts seen in subjects who received GARDASIL resulted from infections that were present when the women received their vaccination.

Dosage and administration for GARDASIL
GARDASIL should be administered in three separate intramuscular injections in the upper arm over a six-month period. The following dosage schedule is recommended: first dose at elected date, second dose two months after the first dose and the third dose six months after the first dose.

Selected important information about GARDASIL
GARDASIL is contraindicated in individuals who are hypersensitive to the active substances or to any of the excipients of the vaccine.

As with any vaccine, vaccination with GARDASIL may not result in protection in all vaccine recipients. GARDASIL is not intended to be used for treatment of active genital warts; cervical cancer; CIN, VIN, or VaIN. GARDASIL has not been shown to protect against disease due to non-vaccine HPV types. The health-care provider should inform the patient, parent, or guardian that vaccination does not substitute for routine cervical cancer screening. Women who receive GARDASIL should continue to undergo cervical cancer screening per standard of care.

Pricing and CPT information
The catalog price for GARDASIL is $120 per dose. Health economic models that Merck has presented show that vaccination with GARDASIL to reduce the incidence of cervical cancer, cervical intraepithelial neoplasia (CIN) and genital warts caused by HPV types 6, 11, 16 and 18 is likely to be cost-saving in the approved age ranges. Used in conjunction with screening, GARDASIL can help significantly reduce the human and economic burden of cervical cancer and other HPV-related diseases in the United States.

GARDASIL is available for ordering. The American Medical Association has established a Current Procedural Terminology (CPT)® code of "90649". CPT codes allow for the identification and potential reimbursement of existing common procedures, services and products' new and emerging technologies, as well as the collection of data to facilitate performance measures.

Merck has created a new patient assistance program for vaccines. Through this new program, Merck will provide free vaccines to adults who are uninsured and who are unable to afford vaccines. Merck vaccines, including GARDASIL, will become available through this program in the third quarter of 2006.

Worldwide Availability of GARDASIL
On June 1, GARDASIL was approved in Mexico. Applications for GARDASIL are currently under review with regulatory agencies on five continents, including but not limited to agencies in Argentina, Australia, Brazil, the European Union, New Zealand, Singapore and Taiwan. Additionally, Merck is actively working to accelerate the availability of GARDASIL in the developing world: in December, Merck announced a partnership with India's Council of Medical Research to study GARDASIL. Merck is also working with PATH and the Gates Foundation to develop HPV vaccination programs that will facilitate introduction of GARDASIL to the most impoverished nations.

Other Information
In 1995, Merck entered into a license agreement and collaboration with CSL Limited relating to technology used in GARDASIL. GARDASIL also is the subject of other third-party licensing agreements.

GARDASIL is the third new Merck vaccine to be approved by the FDA in 2006: ROTATEQ® received FDA approval in February to prevent rotavirus gastroenteritis, a leading cause of severe infant diarrhea, and ZOSTAVAX® was approved by the FDA and in the European Union in May to prevent shingles in adults 60 and older. Other regulatory agencies around the world are reviewing applications for GARDASIL, ROTATEQ and ZOSTAVAX.

About HPV Disease
In the United States, approximately 20 million people are infected with HPV, and approximately 80 percent of females will have acquired HPV by age 50. For most people, HPV goes away on its own; however in some, certain high-risk types of HPV, if unrecognized and untreated, can lead to cervical cancer. In the United States, approximately 10,000 women are diagnosed with cervical cancer every year, and an average of 10 women die each day from the disease. Cervical cancer is the second most common cause of cancer death in women worldwide, resulting in nearly a half-million diagnoses and 240,000 deaths each year. In addition, certain low-risk types of HPV cause genital warts and can lead to abnormal Pap results. Approximately 1 million cases of genital warts occur each year in the United States and an estimated 32 million cases occur worldwide. Additionally, there are an estimated 4.7 million abnormal Pap results that require follow-up each year in the United States. At least 3 million of these results are caused by some type of HPV. HPV related disease, including screening, follow-up and treatment, costs about $5 billion per year in the U.S. Used in conjunction with screening, GARDASIL can help significantly reduce the human and economic burden of cervical cancer and other HPV-related diseases in the United States.

About Merck
Merck & Co., Inc. is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck currently discovers, develops, manufactures and markets vaccines and medicines to address unmet medical needs. The Company devotes extensive efforts to increase access to medicines through far-reaching programs that not only donate Merck medicines but help deliver them to the people who need them. Merck also publishes unbiased health information as a not-for-profit service. For more information, visit www.merck.com.

Forward-Looking Statement
This press release contains "forward-looking statements" as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements are based on management's current expectations and involve risks and uncertainties, which may cause results to differ materially from those set forth in the statements. The forward-looking statements may include statements regarding product development, product potential or financial performance. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. Merck undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise. Forward-looking statements in this press release should be evaluated together with the many uncertainties that affect Merck's business, particularly those mentioned in the cautionary statements in Item 1 of Merck's Form 10-K for the year ended Dec. 31, 2005, and in its periodic reports on Form 10-Q and Form 8-K, which the Company incorporates by reference.


Full prescribing information and patient product information for GARDASIL® will be available at www.GARDASIL.com.

GARDASIL® is a registered trademark of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A.