Doc groups issue list of overused tests, therapies

WASHINGTON (AP) — Don't be afraid to question your doctor and ask, "Do I really need that?"

That's the advice from leading medical groups who came up dozens of tests and treatments that physicians too often prescribe when they shouldn't.

No worrisome stroke signs? Then don't screen a healthy person for a clogged neck artery, the family physicians say. It could lead to risky surgery for a blockage too small to matter.

Don't routinely try heartburn medicine for infants with reflux, the pediatric hospitalists say. It hasn't been proven to work in babies, and could cause side effects.

Don't try feeding tubes in people with advanced dementia, say the hospice providers. Helping them eat is a better option.

These are examples of potentially needless care that not only can waste money and time, but sometimes can harm, says the warning being issued Thursday from medical specialty groups that represent more than 350,000 doctors.

Too many people "think that more is better, that more treatment, more testing somehow results in better health care," said Dr. Glen Stream, former president of the American Academy of Family Physicians, which contributed to the list. "That really is not true."

The recommendations are part of a coalition called Choosing Wisely, formed by the American Board of Internal Medicine Foundation. Participating medical societies were asked to identify five tests or treatments that are commonly overused in their specialty. The list is aimed at doctors and includes references to published studies. Consumers Reports and other consumer groups are publicizing the information in more patient-friendly terms.

Last year, the coalition listed 45 overused tests and treatments. It included some of the best known examples, such as too much imaging for back pain and repeating colonoscopies too frequently.

This year's list adds 90 more overused kinds of care. Some are the result of doctors' habits, hard to overcome despite new evidence, Stream said. Others come about because patients demand care they think they need.

Some other examples:

—Don't use opioid painkillers for migraines except as a last resort, say the neurologists. There are better, more migraine-specific drugs available without the addictive risk of narcotics. Plus, frequent use of opioids actually can worsen migraines, a concept known as rebound headache.

—Just because a pregnant woman misses her due date, don't race to induce labor if mom and baby are doing fine, say the obstetricians. Inducing before the cervix is ready often fails, leading to an unneeded C-section. "Just being due by the calendar doesn't mean your body says you're due," Stream notes.

—Don't automatically give a child a CT scan after a minor head injury, say the pediatricians. About half of children who go to the ER with head injuries get this radiation-heavy scan, and clinical observation first could help some who don't really need a CT avoid it.

—And don't leave an implanted heart-zapping defibrillator turned on when a patient is near death, say the hospice providers. This technology clearly saves lives by guarding against an irregular heartbeat. But if someone is dying of something else, or is in the terminal stages of heart disease, it can issue repeated painful shocks, to no avail. Yet fewer than 10 percent of hospices have formal policies on when to switch off the implants.

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Arias Leaves Stand After Describing Killing, Her Lies

Jodi Arias stepped down from the witness stand today after mounting an emotional effort to save herself from death row, insisting to the Arizona jury that an explosive fight with ex-boyfriend Travis Alexander led to his death, and that her lies about killing him masked deep regret and plans to commit suicide.

Arias, 32, will now face what is expected to be a withering cross-examination beginning Thursday from prosecutor Juan Martinez, who has been aggressive to many witnesses throughout the trial and who is expected to go after Arias' claim that she was forced to kill Alexander or be killed herself.

She is charged with murder for her ex-boyfriend's death and could face the death penalty if convicted.

Catching Up on the Trial? Check Out ABC News' Jodi Arias Trial Coverage

The day's dramatic testimony started with Arias describing the beginning of the fight on June 4, 2008 when she and Alexander were taking nude photos in his shower and she claims she accidentally dropped his new camera, causing Alexander to lose his temper. Enraged, he picked her up and body slammed her onto the tile floor, screaming at her, she told the jury.

Arias said she ran to his closet to get away from him, but could hear Alexander's footsteps coming after her down the hall. She grabbed a gun from his shelf and tried to keep running, but Alexander came after her, she said.

"I pointed it at him with both of my hands. I thought that would stop him, but he just kept running. He got like a linebacker. He got low and grabbed my waist, and as he was lunging at me the gun went off. I didn't mean to shoot. I didn't even think I was holding the trigger," she said.

"But he lunged at me and we fell really hard toward the tile wall, so at this point I didn't even know if he had been shot. I didn't see anything different. We were struggling, wrestling, he's a wrestler.

"So he's grabbing at my clothes and I got up, and he's screaming angry, and after I broke away from him. He said 'f***ing kill you bitch,'" she testified.

Asked by her lawyer whether she was convinced Alexander intended to kill her, Arias answered, "For sure. He'd almost killed me once before and now he's saying he was going to." Arias had earlier testified that Alexander had once choked her.

Timeline of the Jodi Arias Trial

Jodi Arias Describes Violent Sex Before Shooting Watch Video

Jodi Arias Testifies Ex Assaulted Her, Broke Her Fingers Watch Video

Jodi Arias Gives Explicit Details About Doomed Relationship Watch Video

But Arias' story of the death struggle ended there as she told the court that she has no memory of stabbing or slashing Alexander whose body was later found with 27 stab wounds, a slit throat and two bullets in his head. She said she only remembered standing in the bathroom, dropping the knife on the tile floor, realizing the "horror" of what had happened, and screaming.

"I have no memory of stabbing him," she said. "There's a huge gap. I don't know if I blacked out or what, but there's a huge gap. The most clear memory I have after that point is driving in the desert."

Arias said that she decided in the desert not to admit to killing Alexander, a decision that would last for two years as Arias lied to friends, family, investigators and reporters about what really happened in Alexander's bathroom.

During that time she initially claimed she got lost that night while driving to a friend's house and never went to Alexander's home in Mesa,Ariz. She later changed her story and said two masked people, a man and a woman, burst into the home and killed Alexander and threatened to kill her family if she told anyone what happened.

She eventually confessed to killing her ex-boyfriend, but insisted it was self defense.

"The main reason (for lying) is because I was very ashamed of what happened. It's not something I ever imagined doing. It's not the kind of person I was. It was just shameful," she said. "I was also very scared of what might happen. I didn't want my family to know that I had done that, and I just couldn't bring myself to say that I did that."

"From day one there was a part of me that always wanted to (tell the truth) but didn't dare do that. I would rather have gone to my grave than admit I had done something like that," she said.

Arias said that she continued to lie because she figured she would never get caught; she was planning to kill herself before trial.

"I was concerned with how it would affect my family. I wanted to die. I was going to definitely kill myself," she said. "That was my plan. You can purchase different things in jail and I bought a bunch of Advil... and took it all in the next few days so it was in my system. They have razors for shaving, so I got one and took it apart one night with intentions to slit my wrists."

Arias said she balked at slitting her wrists after accidentally cutting herself, but that she still planned to commit suicide sometime in the future. When she told news reporters that "no jury would convict her," she claims she said it believing that she would be dead before they'd have a chance to put her on trial, Arias testified.

Arias said support from the public and her family eventually led her to change her mind.

"My family remained very supportive, and told me 'it doesn't matter what happens, we love you anyway.' I realized even if I told the truth they would still be there and wouldn't walk away," she testified.

"By the time spring, 2010, rolled around, I confessed. I basically told everyone what I could remember of the day and that the intruder story was all BS pretty much."

She said that her testimony today, a third version of events, was the truth.

Arias was arrested a month after Alexander's death, and prosecutors have argued that her behavior during those weeks showed a lack of remorse for the killing and an attempt to get away with murder.

Arias said today that after she killed Alexander and drove away from his Mesa, Ariz., home in a panic, it dawned on her that police would soon be looking for Alexander's killer, and she decided that she would pretend the bloody confrontation had never happened.

"I knew that it was really bad, that my life was probably done now. I wished it was just a nightmare I could wake up from, but I knew I had messed up pretty badly and the inevitable was going to be something I could not really run from," she testified.

"I didn't want anyone to know that that had happened or that I did it, so I started taking steps in the aftermath to cover it up. I did a whole bunch of things to try to make it seem like I was never there," she said.

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Syria "Scud-type" missile said to kill 20 in Aleppo

AMMAN (Reuters) - A Syrian missile killed at least 20 people in a rebel-held district of Aleppo on Tuesday, opposition activists said, as the army turns to longer-range weapons after losing bases in the country's second-largest city.

The use of what opposition activists said was a large missile of the same type as Russian-made Scuds against an Aleppo residential district came after rebels overran army bases over the past two months from which troops had fired artillery.

As the uprising against President Bashar al-Assad, now a civil war, nears its two-year mark, rebels also landed three mortar bombs in the rarely-used presidential palace compound in the capital Damascus, opposition activists said on Tuesday.

The United Nations estimates 70,000 people have been killed in the conflict between largely Sunni Muslim rebels and Assad's supporters among his minority Alawite sect. An international diplomatic deadlock has prevented intervention, as the war worsens sectarian tensions throughout the Middle East.

A Russian official said on Tuesday that Moscow, which is a long-time ally of Damascus, would not immediately back U.N. investigators' calls for some Syrian leaders to face the International Criminal Court for war crimes.

Moscow has blocked three U.N. Security Council resolutions that would have increased pressure on Assad.

Casualties are not only being caused directly by fighting, but also by disruption to infrastructure and Syria's economy.

An estimated 2,500 people in a rebel-held area of northeastern Deir al-Zor province have been infected with typhoid, which causes diarrhea and can be fatal, due to drinking contaminated water from the Euphrates River, the World Health Organization (WHO) said on Tuesday.

"There is not enough fuel or electricity to run the pumps so people drink water from the Euphrates which is contaminated, probably with sewage," the WHO representative in Syria, Elisabeth Hoff, told Reuters by telephone.

The WHO had no confirmed reports of deaths so far.

BURIED UNDER RUBBLE

In northern Aleppo, opposition activists said 25 people were missing under rubble of three buildings hit by a several-meter-long missile. They said remains of the weapon showed it to be a Scud-type missile of the type government forces increasingly use in Aleppo and in Deir a-Zor.

NATO said in December Assad's forces fired Scud-type missiles. It did not specify where they landed but said their deployment was an act of desperation.

Bodies were being gradually dug up, Mohammad Nour, an activist, said by phone from Aleppo.

"Some, including children, have died in hospitals," he said.

Video footage showed dozens of people scouring for victims and inspecting damage. A body was pulled from under collapsed concrete. At a nearby hospital, a baby said to have been dug out from wreckage was shown dying in the hands of doctors.

Reuters could not independently verify the reports.

Opposition activists also reported fighting near the town of Nabak on the Damascus-Homs highway, another route vital for supplying forces in the capital loyal to Assad, whose family has ruled Syria since the 1960s.

Rebels moved anti-aircraft guns into the eastern Damascus district of Jobar, adjacent to the city centre, as they seek to secure recent gains, an activist said.

"The rebels moved truck-mounted anti-aircraft guns to Jobar and are now firing at warplanes rocketing the district," said Damascus activist Moaz al-Shami.

Russian Deputy Foreign Minister Gennady Gatilov told a news conference a U.N. war crimes report, which accuses military leaders and rebels of terrorizing civilians, was "not the path we should follow ... at this stage it would be untimely and unconstructive."

Syria is not party to the Rome Statute that established the ICC and the only way the court can investigate the situation is if it receives a referral from the Security Council, where Moscow is a permanent member.

(Writing by Oliver Holmes; Editing by Jason Webb)

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Swimming: Trickett urges healing after "toxic" Games

SYDNEY: Australian swimmer Libby Trickett called for healing within the sport after reports exposed a "toxic" atmosphere at the London Olympics including drunkenness, deceit and bullying.

Swimming Australia has vowed to restore its standing with the public after the country's much vaunted swimmers disappointed at the 2012 Olympics and inquiries into its culture revealed discipline was loose and the squad lacked leadership.

Trickett, who has won four gold medals at three Olympics, welcomed the news that officials would further investigate allegations against the team, including that some athletes misused prescription drugs as a prank in London.

"That issue has been left unresolved and it needs to be dealt with in order for us to move on," she told the Australian newspaper.

"It probably has gone too long without being dealt with. It certainly does need to be addressed because... if we let this one go, it's a precedent for the future."

She said all swimmers had been "under a cloud" because no individuals had so far been named.

"But if names are named, we will need to support them through the difficult times that lie ahead for them -- and they will be difficult," she said, The Australian reported.

"We need to come together again as a team and what better way to do that than by embracing these swimmers?"

Australia endured its worst swimming haul in decades in London, winning just one gold medal, six silver and three bronze for its lowest tally in the pool since Barcelona in 1992.

The lacklustre performance, in which no individual swimming gold medal was won for the first time since the 1976 Montreal Games, resulted in the commissioning of two independent reports released on Tuesday.

They revealed that morale within the swimming team was so low one athlete referred to London as the "lonely Olympics" as individuals looked after themselves ahead of the team.

- AFP/al

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Britain's Cameron visits Jallianwala Bagh massacre site, Golden Temple

AMRITSAR: British Prime Minister David Cameron laid a wreath on Wednesday at a memorial for the notorious Jallianwala Bagh massacre where he is reportedly set to express regret for the loss of life.

Cameron, dressed in a dark suit and bowing his head, laid the flowers at the Jallianwala Bagh memorial in Amritsar, where hundreds of unarmed protesters were gunned down by British troops in 1919.

Earlier, he paid obeisance at the holiest shrine of Sikh religion Golden Temple where he was presented a robe of honour.

Amid tight security arrangements, Cameron paid obeisance inside the sanctum sanctorum at 10:25am.

Clad in a dark suit and a tie with head covered with a blue-coloured cloth, Cameron was presented a robe of honour inside the sanctum sanctorum of Harmandir Sahib, popularly known as the Golden Temple.

The British prime minister also mingled with a couple of devotees and chatted with them for a brief period as Gurbani played in the backdrop. This is the first visit by a high-profile British dignitary to Amritsar after 1997, when Queen Elizabeth II and her husband Prince Philip, the Duke of Edinburgh, had visited the holy City.

Inside the temple, he was accompanied by Punjab chief minister Parkash Singh Badal, who earlier received the British dignitary at the Sri Guru Ram Dasji International Airport, Shiromani Gurdwara Prabandhak Committee (SGPC) President Avtar Singh Makkar, among others.

The British prime minister reached the Golden Temple at about 9:50am and spend nearly an hour inside.

Before paying obeisance by bowing his head inside the sanctum sanctorum, the British leader was taken around the temple by officials of the SGPC, apex religious body of the Sikhs, and was also shown Shri Guru Ram Dass Langar Hall.

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Drug overdose deaths up for 11th consecutive year

CHICAGO (AP) — Drug overdose deaths rose for the 11th straight year, federal data show, and most of them were accidents involving addictive painkillers despite growing attention to risks from these medicines.

"The big picture is that this is a big problem that has gotten much worse quickly," said Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, which gathered and analyzed the data.

In 2010, the CDC reported, there were 38,329 drug overdose deaths nationwide. Medicines, mostly prescription drugs, were involved in nearly 60 percent of overdose deaths that year, overshadowing deaths from illicit narcotics.

The report appears in Tuesday's Journal of the American Medical Association.

It details which drugs were at play in most of the fatalities. As in previous recent years, opioid drugs — which include OxyContin and Vicodin — were the biggest problem, contributing to 3 out of 4 medication overdose deaths.

Frieden said many doctors and patients don't realize how addictive these drugs can be, and that they're too often prescribed for pain that can be managed with less risky drugs.

They're useful for cancer, "but if you've got terrible back pain or terrible migraines," using these addictive drugs can be dangerous, he said.

Medication-related deaths accounted for 22,134 of the drug overdose deaths in 2010.

Anti-anxiety drugs including Valium were among common causes of medication-related deaths, involved in almost 30 percent of them. Among the medication-related deaths, 17 percent were suicides.

The report's data came from death certificates, which aren't always clear on whether a death was a suicide or a tragic attempt at getting high. But it does seem like most serious painkiller overdoses were accidental, said Dr. Rich Zane, chair of emergency medicine at the University of Colorado School of Medicine.

The study's findings are no surprise, he added. "The results are consistent with what we experience" in ERs, he said, adding that the statistics no doubt have gotten worse since 2010.

Some experts believe these deaths will level off. "Right now, there's a general belief that because these are pharmaceutical drugs, they're safer than street drugs like heroin," said Don Des Jarlais, director of the chemical dependency institute at New York City's Beth Israel Medical Center.

"But at some point, people using these drugs are going to become more aware of the dangers," he said.

Frieden said the data show a need for more prescription drug monitoring programs at the state level, and more laws shutting down "pill mills" — doctor offices and pharmacies that over-prescribe addictive medicines.

Last month, a federal panel of drug safety specialists recommended that Vicodin and dozens of other medicines be subjected to the same restrictions as other narcotic drugs like oxycodone and morphine. Meanwhile, more and more hospitals have been establishing tougher restrictions on painkiller prescriptions and refills.

One example: The University of Colorado Hospital in Aurora is considering a rule that would ban emergency doctors from prescribing more medicine for patients who say they lost their pain meds, Zane said.

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Stobbe reported from Atlanta.

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Online:

JAMA: http://www.jama.ama-assn.org

CDC: http://www.cdc.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com

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Chavez back in Venezuela, on Twitter with four million followers

CARACAS (Reuters) - After Hugo Chavez spent two months out of the public eye for cancer surgery in Cuba, the Venezuelan government hailed his homecoming on Monday and said the president had achieved another milestone - four million followers on Twitter.

The 58-year-old flew back from Havana before dawn and was taken to a military hospital. No new details were given on his health, and there were no images of his arrival. Officials say his condition remains delicate.

The normally loquacious socialist leader, who is struggling to speak as he breathes through a tracheal tube, took to Twitter with a passion back in April 2010, tweeting regularly and encouraging other leftist Latin American leaders to do likewise.

His @chavezcandanga account quickly drew a big mixed following of fans, critics and others just curious to see how his famously long speeches and fiery anti-U.S. invective would work within the social media network's 140-character limit.

But as he fought the cancer and underwent weeks of grueling chemotherapy and radiation therapy, he began to tweet less and less frequently, before stopping altogether on November 1.

Early on Monday morning, he made his reappearance.

"It was 4:30, 5 a.m. He got to his room and surprised everyone: rat-tat-tat, he sent three or four messages, and at that moment fireworks began to go off around the country," Vice President Nicolas Maduro said in a televised cabinet meeting.

During the day, Maduro added, the president's number of followers had shot up to well over four million.

"It's incredible, in just a few hours ... he's the second most-followed president in the world (after Barack Obama), and the first if we make the comparison by per capita," he said.

Obama has more than 27 million Twitter followers and is No. 5 most followed globally. Chavez is Twitter's No. 190 globally.

4TH MILLION FOLLOWER

Maduro said Chavez's four millionth follower was a 20-year-old single Venezuelan woman named Alemar Jimenez from the gritty San Juan neighborhood in downtown Caracas, near the military hospital where the president arrived earlier in the day.

"She's one of the golden generation of youth who support the fatherland and have been waiting with growing love for commander Hugo Chavez," Maduro said, before presenting a dazzled-looking Jimenez to the cameras and giving her a bunch of flowers.

"We were really emotional" she said, recounting how she was with her mother when they heard Chavez had returned. "I sent him a message on Twitter saying he must get better."

There are still big questions over the president's health. He could have come back to govern from behind the scenes, or he may be hoping to ease political tensions and pave the way for a transition to Maduro, his preferred successor.

Chavez has often ordered followers to fight back against opposition critics of his self-styled revolution by using social media, leading from the front himself on Twitter and referring to the Internet as a "battle trench."

As his ranks of followers grew, Chavez said he hired 200 assistants to help him respond to messages - which he said were a great way to receive first-hand the requests, demands, complaints and denunciations of citizens in the thousands.

During his re-election campaign last year, the government launched an SMS text message service that forwards his tweets to cellphones that lack Internet service, broadening their reach to the poorest corners of the South American country.

"He's a communication revolution!" Maduro said, later unbuttoning his shirt on TV to show he was wearing a T-shirt bearing Chavez's eyes emblazoned across his chest.

For the tens of thousands who signed up on Monday to follow Chavez on Twitter, it is unclear how much will be posted there in the weeks and months ahead. Venezuela's 29 million people are mostly wondering something similar.

(Additional reporting by Diego Ore; Editing by Todd Eastham)

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S'pore, Malaysia agree on high-speed rail link

SINGAPORE: Singapore and Malaysia have agreed to build a high-speed rail link between Kuala Lumpur and Singapore, with a target to complete it by 2020.

This was announced by Prime Minister Lee Hsien Loong and Malaysian Prime Minister Najib Razak on Tuesday during their annual Leaders' Retreat.

With the new link, it will take about 90 minutes to get from Singapore to KL and vice versa.

The two leaders described the high-speed rail system as a strategic development in the bilateral relations, saying it will dramatically improve the connectivity between Malaysia and Singapore.

Mr Lee said: "It is a strategic project for the two countries. It will change the way we see each other. It is the way people in London and Paris are able to think of it -- as twin cities, where you can commute, go up there, do business, meet friends, have a meal and come back, all within two thirds of the day.

"And I think it is going to be a game changer. It will transform the way people interact, the intensity of our cooperation and the degree to which we become interdependent on each other and therefore have stakes on each other's success."

The leaders added that it will usher in a new era of strong growth, prosperity and opportunities for both countries.

The link will also facilitate seamless travel between KL and Singapore, enhance business links, and bring peoples of Singapore and Malaysia closer together.

The leaders added that ultimately the project will give both countries greater stakes in each other's prosperity and success.

Mr Najib said: "Our two cities will complement each other. Our two countries will look at each other differently and the opportunities are boundless between our two countries.

"So I am excited about the project. We will certainly do our level best to meet the 2020 deadline. It may go slightly beyond that, but those are details in implementation."

The prime ministers have tasked a joint ministerial committee to look into the details and modalities of the high-speed rail link.

"The modalities will be offered to Singapore. Basically, we want Singapore to participate in this based on the different kinds of options that we will offer to the Singapore government," added Mr Najib.

- CNA/al

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Nagaland home minister resigns after Rs 1cr cash, arms found in his car

KOHIMA, NAGALAND: Home minister Imkong L Imchen has resigned from the ruling Naga People's Front (NPF) government, a party official said Tuesday.

Imchen put in his papers after the Election Commission authorities seized cash amounting to more than Rs one crore and weapons from his vehicle on Monday by troopers of Assam Rifles.

"I felt imperative to tender my resignation from the Council of Ministers with immediate effect, owning moral responsibility while holding public office, even though I have committed no wrong over the incident under the law," Imchen said in his resignation letter, which he submitted to chief minister Neiphiu Rio.

On the other hand, the opposition Congress has sought disqualification of Imchen from contesting the assembly election for violating the model code of conduct.

The offence committed by Imchen is a very serious crime under Arms Act and the case should be investigated by the National Investigation Agency.

On Monday, troopers of the Assam Rifles seized Rs 1.10 crore in cash, five pistols, two 7.65 mm calibre rifles and 140 round of 303 rifle ammunition from Imchen's vehicle at Sathupang area in Wokha district while he was on his way to his Koridanga constituency in Mokokchung district.

This is the second big cash seizure in poll-bound Nagaland.

On Saturday, election officials seized Rs.one crore in cash from NPF candidate H. Nyemli Phom after his helicopter landed at the Assam Rifles helipad in Longleng district.

Phom, who is seeking re-election from Tamlu constituency, later claimed that the money was given to him by the party and was part of NPF funds.

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Hip implants a bit more likely to fail in women

CHICAGO (AP) — Hip replacements are slightly more likely to fail in women than in men, according to one of the largest studies of its kind in U.S. patients. The risk of the implants failing is low, but women were 29 percent more likely than men to need a repeat surgery within the first three years.

The message for women considering hip replacement surgery remains unclear. It's not known which models of hip implants perform best in women, even though women make up the majority of the more than 400,000 Americans who have full or partial hip replacements each year to ease the pain and loss of mobility caused by arthritis or injuries.

"This is the first step in what has to be a much longer-term research strategy to figure out why women have worse experiences," said Diana Zuckerman, president of the nonprofit National Research Center for Women & Families. "Research in this area could save billions of dollars" and prevent patients from experiencing the pain and inconvenience of surgeries to fix hip implants that go wrong.

Researchers looked at more than 35,000 surgeries at 46 hospitals in the Kaiser Permanente health system. The research, published Monday in JAMA Internal Medicine, was funded by the U.S. Food and Drug Administration.

After an average of three years, 2.3 percent of the women and 1.9 percent of the men had undergone revision surgery to fix a problem with the original hip replacement. Problems included instability, infection, broken bones and loosening.

"There is an increased risk of failure in women compared to men," said lead author Maria Inacio, an epidemiologist at Southern California Permanente Medical Group in San Diego. "This is still a very small number of failures."

Women tend to have smaller joints and bones than men, and so they tend to need smaller artificial hips. Devices with smaller femoral heads — the ball-shaped part of the ball-and-socket joint in an artificial hip — are more likely to dislocate and require a surgical repair.

That explained some, but not all, of the difference between women and men in the study. It's not clear what else may have contributed to the gap. Co-author Dr. Monti Khatod, an orthopedic surgeon in Los Angeles, speculated that one factor may be a greater loss of bone density in women.

The failure of metal-on-metal hips was almost twice as high for women than in men. The once-popular models were promoted by manufacturers as being more durable than standard plastic or ceramic joints, but several high-profile recalls have led to a decrease in their use in recent years.

"Don't be fooled by hype about a new hip product," said Zuckerman, who wrote an accompanying commentary in the medical journal. "I would not choose the latest, greatest hip implant if I were a woman patient. ... At least if it's been for sale for a few years, there's more evidence for how well it's working."

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Online:

Journal: http://www.jamainternalmed.com

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