What to Know About Nicotine Patch

A Guide to Using the Nicotine Patch

The nicotine patch is a proven way of helping relieve nicotine withdrawal symptoms, if you understand how it works and use it properly.

By Dennis Thompson Jr. 

Medically reviewed by Lindsey Marcellin, MD, MPH

If you've struggled to quit smoking and haven't succeeded yet, you're probably feeling pretty frustrated. Although an estimated 70 percent of smokers want to quit, doing so can be quite a challenge. That’s where a little help can go a long way – and combining more than one method can boost the power of both. According to the American Lung Association, nicotine replacement therapies like the nicotine patch can help you quit, especially when combined with counseling, such as using a telephone quit line.

The nicotine patch is one of five nicotine replacement therapies available to smokers who want to kick the habit. The patch works by releasing a measured dose of nicotine into the skin, helping to wean smokers off their nicotine addiction and lessen the effects of nicotine withdrawal. Research has found that the nicotine patch can help some people stop smoking.

What Is the Nicotine Patch?

The U.S. Food and Drug Administration approved the over-the-counter sale of nicotine patches in 1996. Prior to that, the patches were available only by prescription; these days, only smokers who require a higher-dose patch need a prescription. The nicotine patch is available at a wide variety of stores and has an average cost per day of $4.

There are two types of nicotine patches:

• 16-hour patches are for light-to-average smokers. They are less likely to cause side effects, but don’t help with morning cigarette cravings. Because they aren't worn overnight, blood nicotine levels are very low by the following morning.
• 24-hour patches provide a more constant dose of nicotine to help you resist cigarette smoking throughout the day and night, but the chance of side effects is higher.

The Right Way to Apply the Nicotine Patch

A nicotine patch looks much like an adhesive bandage and comes in a variety of sizes. Larger patches deliver a higher dose of nicotine. You put the patch on in the morning, on a clean, dry, and relatively hairless part of the body between the neck and the waist — the upper arm or the chest, for example. Switch around the location of the patch each day to reduce the chance of skin irritation.

Once you apply a nicotine patch, you wear it throughout the dosage period, never removing it. It takes about three hours for the nicotine in the patch to seep through the skin into the bloodstream. Because it releases nicotine in a slower and steadier fashion than a cigarette, the patch cannot be taken off and put on only when a craving strikes.

Nicotine patches generally are used as part of an eight-week smoking cessation programscheduled in three phases:

• For the first four weeks, you wear a nicotine patch that delivers a strong dose of nicotine, about 21 milligrams (mg) per day.
• For weeks five and six, you switch to a moderate-dosage patch, about 14 mg per day.
• After that, you move to a low-dosage patch that delivers 7 mg of nicotine per day.

Side Effects of Nicotine Patch

Researchers have found that smokers get real relief from the nicotine patch, when compared with smokers receiving placebo treatment. However, there are some side effects to contend with during nicotine patch therapy:

• The skin under the patch can get irritated, particularly with the 24-hour patch. As many as half of all patch users will have some skin irritation. Choosing a new skin site each day usually resolves this problem. Consider switching to another brand of nicotine patch if the problem continues.
• Users of the 24-hour patch have reported vivid dreams, insomnia, and other sleep disturbances. If your sleep is still affected after three or four days of patch treatment, try switching to the 16-hour patch.
• Some users report a racing heartbeat and dizziness, although use of the nicotine patch is not considered a risk factor for heart attack. You might try switching to a lower-dose patch if this occurs. However, if you have a history of heart disease, nicotine patches should be used only under your doctor’s guidance.
• Other side effects may include headache, muscle aches, nausea, and vomiting.

Do not smoke while you're using a patch, as that can overload your system with nicotine and cause nicotine poisoning, which includes many of the side effects noted above.

Used correctly, the nicotine patch can be an important part of a successful plan to quit smoking.

AMERICAN DOCTORS OBSERVES MEMORIAL DAY

Today, we observe and pay tribute to those that have fallen and those still standing in bravery for our country. 

We Thank, Love, and Honor You. 

God Bless All.

-American Doctors

Cold Medicine for 65 Cents a Dose?

Cold Medicine for 65 Cents a Dose?
Savings Experiment: The Best Deals on Over-the-Counter Medications
Barbara Thau

With a cold coming on, you're summoning all your energy just to venture out to the drug store, but the thought of having to buy those pricey, over-the-counter meds is giving you a big, fat headache.

Don't want to get ripped off again?

Getting the best deals on everything from cold and allergy medications to headache remedies is simply a matter of knowing how and where to shop. Here's the scoop on finding the best deals on OTC medications.

Shop the Big 'Marts' for Meds

When it comes to finding bargains on over-the-counter medications, it's hard to beat the nation's two biggest discounters for savings. "If you want to save on drugs, Wal-Mart and Target should be your first stop," Jody Rohlena, senior editor at Consumer Reports' ShopSmart magazine, told WalletPop.

ShopSmart conducted an extensive, nationwide price comparison of three major pain relievers -- Advil, Motrin and Aleve -- at drugstores, supermarkets and the national discounters.

Some of the telling findings: 100 tablets of Advil at drugstore chain Rite Aid sold for $9.99. The same size bottle at Target was $8.17 -- a sizable savings of $1.82.

Another example: A 100-tablet bottle of Aleve costs $9.69, on average, at supermarkets nationwide. The same size bottle at Wal-Mart sold for about $8.38, or $1.38 less.

While Wal-Mart and Target blew drug chains out of the water when it came to over-the-counter medications deals, Rohlena says ShopSmart's price scan found that the major drug chains tend to be pretty similar in price to each other. For instance, 100 tablets, of Advil at Rite Aid, CVS and Walgreens drugstores were priced at $9.99, $9.91 and $9.79, respectively, too close to call a winner. At the same time, supermarkets tend to price their over-the-counter drugs on par with drugstores, ShopSmart found.

Wal-Mart and Target also offer the best deals on cold and allergy medications, as well as on heartburn relievers. The allergy drug, Claritin, for instance, can cost as much as 82 cents per pill at Walgreens, compared to just 65 cents at Wal-Mart, ShopSmart reports. And an 8-ounce bottle of Adult Robitussin CF Cough & Cold costs about $6.69 at Wal-Mart, compared to $8.49 at CVS and $9.23 at independent pharmacies.

While it comes as little surprise that independent drugstores are the priciest destination for meds, the difference between their prices and that of the drug store chains Rohlena says, "were not that big a deal."

Store Brands Are a Good Buy

If you're wary of the ingredients in store-brand drugs, consider this: Best Buy Drugs, a division of Consumers Union (Consumer Reports' parent company), examined the safety and effectiveness of over-the-counter medications and found that store brands were just as safe and effective as brand names.

It turns out the generic ingredients used in the store-brand versions of drugs "were the same and equally effective as the name brand," Rohlena says.

And across all retail chains, store brands proved to be a big bargain, saving you as much as 66% of the cost of a number of over-the-counter medications.

Let's say you're buying Claritin, for example. At CVS, a 365-tablet bottle will set you back about $52.99, Dan de Grandpe, chief executive officer and editor in chief ofDealnews.com, told WalletPop. "Even using CVS's occasional 40% off coupon for CVS-brand items, that's [still] $31.79," de Grandpe says.

By contrast, Costco charges about $12.65 for 360 tablets of Kirkland Signature AllerClear Non-Drowsy, its store-brand version of Claritin, whose active ingredient is Loratadine. Even with a 40%-off CVS coupon, you'll pay an eye-popping $19.14 cents more for the CVS brand that contains just five more pills.

Some other telling numbers: A 100-count bottle of Motrin at Wal-Mart costs about $8.24, compared to $2.76 for the retailer's store-brand version of the drug, a whopping 66% savings, ShopSmart found.

When comparing pain reliever prices of the big, national brands to the store brands at drugstore chains, Rohlena says the smallest price difference was 18% less for the store brand. "That's a real savings," she added.

Tap Online Giant for Savings

In addition to brick-and-mortar stores, you might want to consider shoppingAmazon.com for big deals. If you're looking for name-brand, over-the-counter medications, be sure to compare retail prices against Amazon's Subscribe & Savedelivery program, which takes 15% off the current price of a product and offers free shipping, De Grandpre recommends.

What's more, Subscribe & Save can be combined with product coupons. For instance, a 45-tablet box of allergy medication Zyrtec, which comes with a $4 coupon, "drops the price to $8.75 once you clip the coupon and pay via Subscribe & Save," De Grandpre says.

What to Know When Buying in Bulk

Most people think that buying in bulk will save them money, and while that's usually true, when it comes to over-the-counter medications, there are two important factors to consider.

First, compare the unit price of the bulk-sized bottle to the small- and medium-sized bottles, Rohlena suggests. (The prices can usually be found on the ticker running on the product shelf.) If the unit price is higher for the bulk-sized version, you're not getting a better deal for buying more.

Also, if you're buying in bulk, check the bottle's expiration date, Rohlena says, "because if you're not going to use all that medication before it expires, you're wasting money."

Be especially careful to check expiration dates when shopping at dollar stores, Rohlena adds. When scanning the dollar stores, ShopSmart found some expired--or about to expire--meds on the shelves.

So the simple antidote for inexpensive, over-the-counter drugs? Shop Wal-Mart and Target for deals, always buy the store-brand version of the medication when available, and tap Amazon's Subscribe & Save program to get discounted meds delivered right to your door.

Police: Fake Doc Did 'Acupuncture' With Toothpicks

He gave patient 'Prosperous Farmer' pills that expired in 2002.

By Pam DeFiglio

George Fleming, 61, of Skokie was charged with a Class 4 felony Wednesday after an April 23 incident in which he impersonated a doctor and prescribed medicine without a license.

During that incident, Fleming passed himself off as a doctor to a patient, stuck toothpicks in the patient's chest in what may have been a form of acupuncture and gave the patient pills, labeled "Prosperous Farmer Dietary Supplement," which expired in 2002.

Fleming came into the Niles police station voluntarily Wednesday to speak to investigators and a representative from the Illinois Department of Financial and Professional Regulation. Police said Fleming implicated himself as practicing medicine during the interview, and they contacted an assistant Cook County state's attorney. He was given Miranda warnings before the interview.  

The assistant state's attorney approved charging Fleming with one count of violating the Illinois Medical Practice Act of 1987. If convicted, he could face one to three years of prison time and be fined up to $25,000.

The incident that prompted the charge began when the patient spotted an ad promoting a "doctor's" services in a Bulgarian-language newspaper. The patient made an appointment for 6:30 p.m. on Saturday, April 23 and arrived at an office in the 8900 block of Golf Road in Niles. The office was closed, but after the patient knocked repeatedly, Fleming, wearing a white lab coat, let him in, greeted him, walked him back to an exam room, asked the patient his symptoms and conducted a basic examination. 

The patient later told police Fleming stuck toothpicks in his chest, in what may have been a form of acupuncture. Then, according to police, Fleming gave him a bottle of the "Prosperous Farmer" pills and instructed him to take one a day until they ran out. He charged $150 for the "exam" and would only take cash.

After the patient returned home, his son noticed the pills had expired in February 2002 and the patient recalled that it was odd the "doctor" never had him fill out any paperwork, that the office was empty and that a sign on the door said the clinic closed at 4 p.m. Saturdays.

The patient phoned the clinic during the week, and the employee who answered the phone did not know Fleming. When the patient came to the clinic, Fleming ran out, jumped in his car and drove away, according to the police report. That prompted the patient to call police, who investigated.

Woman Charged With Trying To Sell Daughter's Virginity

Salt Lake City woman busted trying to sell 13-year-old daughter's virginity to man for $10,000

SALT LAKE CITY — A Salt Lake City woman has been charged with offering her 11-year-old daughter's virginity to a man in exchange for $10,000.

The woman was charged Monday in Utah's 3rd District Court with two counts of aggravated sex abuse and two counts of sexual exploitation of a minor. KTVX Channel 4 reports that court documents claim she made the offer after the man asked about oral sex with the girl.

Police say the woman and the daughter would model lingerie for the man. The offer was discovered by the woman's boyfriend, who found multiple text messages discussing the proposal.

The Associated Press is not naming the woman to avoid identifying the daughter. An attorney wasn't listed for the woman, who was in jail Monday night

Doctors Share Their Top 5 Concerns

Doctors Share Their Top 5 Concerns

Experts Issue 'Top 5' List for Better Primary Care

To streamline and save money, reduce unnecessary antibiotics, screenings, report authors urge.

By Amanda Gardner, HealthDay News

Cutting back on unnecessary antibiotics, delaying wasteful imaging for lower back pain and foregoing annual ECG screenings for healthy, low-risk patients are among the actions that could help streamline primary care, experts say.

Perhaps taking a page from David Letterman's Top 10 list, the authors of a new report came up with a "Top 5" list of action items for each of the primary care disciplines — family medicine, internal medicine and pediatrics — to help save money and conserve health resources.

Many physicians are already behind the suggestions, according to the report, which appears online May 23 in the Archives of Internal Medicine.

"I have seen many instances where I thought clinicians were not making the right and wisest decisions in ways that were not good for patients' health and not good for prudent use of finite resources," said Dr. Stephen Smith, one of the report's authors and professor emeritus of family medicine at the Warren Alpert School of Medicine at Brown University in Providence, RI.

Smith is also a member of the National Physicians' Alliance (NPA), a group of 22,000 doctors promoting affordable and quality healthcare, which put together the lists.

None of the suggestions are particularly new, having been validated by scores of studies, yet few clinicians seem to be implementing them, Smith said.

Here are the Top Five recommendations for each discipline:

For family medicine:

• Avoid imaging for lower back pain for six weeks unless red flags are present.
• Cut back on prescribing antibiotics for sinus infections, since most are viral.
• Avoid cardiac screening in patients who are low risk and have no symptoms.
• Do not do Pap tests for cervical cancer in women under 21 or those who have had a hysterectomy for benign disease.
• Confine bone density scans known as dual-energy X-ray absorptiometry (DEXA) for osteoporosis to women aged 65 and over and for men 70 and older who also have risk factors, such as those who have already had fractures.

For internal medicine:

• Defer imaging for lower back pain.
• Do not order blood chemistry panels (a set of 8 blood tests to assess kidney function, blood sugar and other health indicators) or urinalysis in healthy adults with no symptoms, since blood lipids (fats) tests alone yield most positive results.
• Forego cardiac screening in healthy patients.
• Prescribe generic statins (cholesterol-lowering drugs) before brand-name ones
• Limit bone-density screening to older, at-risk patients.

In pediatrics:

• Avoid giving antibiotics for sore throats unless a test definitely turns up the bacteria Streptococcus(strep throat).
• Avoid imaging for minor head injuries without risk factors such as loss of consciousness.
• Take a wait-and-see attitude towards middle-ear infections before referring the patient to a specialist.
• Recommend that parents not give their children over-the-counter cough-and-cold medicines.
• Make sure patients with asthma are using corticosteroid medicines properly, as this will cut down on episodes.

The report was funded by a grant from the American Board of Internal Medicine Foundation.

Several of the items — those involving cardiac screening, overuse of antibiotics, bone-density scans and lower-back imaging — appeared in more than one category.

But one item — not doing blood chemistry panels and urinalysis among healthy adults without symptoms — enjoyed only weak support from the practicing physicians who field-tested the suggestions.

The Top 5 lists will now be distributed to all NPA members. The researchers are also hoping to get funding to set up demonstration sites, creating training videos to help physicians hone their communication skills and finding ways to get patients on board, Smith said.

"These are certainly important issues," said Dr. Lawrence C. Kleinman, a primary care physician and associate professor of pediatrics at Mount Sinai School of Medicine in New York City.

But he also pointed out that "the lists were done with some nuance, which [is] valuable and important to incorporate in the understanding of this."

As the report authors point out, Kleinman noted, it's not that all antibiotic use is bad, just that, in the case of sore throats, there should be a verification that the infection is really strep throat before prescribing them. Similarly, imaging for head injuries would need to be done for children with loss of consciousness or other risk factors.

Exercise and Erectile Dysfunction

To avoid ED problems before they start, regular exercise is essential. Find out what you need to add to your routine.

By Madeline Vann, MPH

Medically reviewed by Lindsey Marcellin, MD, MPH

Exercise may be the ticket to a more active sex life, but we’re talking about regular cardio and strength workouts, not targeted “penis exercises.” Research shows that even a little bit of physical activity — the equivalent of walking 30 minutes a day a few times a week — may lower the risk of erectile dysfunction.

Why is exercise such an effective remedy for preventing erectile dysfunction?

“For men who have failing erections, the penis is a barometer of what’s happening in the rest of the body,” explains urologist Wayne Hellstrom, MD, professor of urology at the Tulane University School of Medicine in New Orleans.

The key to all of this is the endothelium, the inner lining of blood vessels that helps blood flow smoothly. Regular exercise has been shown to improve the way the endothelium works. The endothelium lines the blood vessels in the heart and the penis, explains Dr. Hellstrom, but the blood vessels in the penis are about one-third the size of those in the heart. So if you fail to have erections due to vascular problems, that indicates that you’re at risk for heart problems as well.

The bottom line is that taking steps to keep your endothelium healthy will help you prevent or reduce your erectile dysfunction risk. Being more physically active is important to the health of your endothelium and, therefore, to the health of your heart and your penis.

Building Your Exercise Program

The benefits of exercise for your blood vessels last only as long as you keep exercising on a regular basis. Experts recommend that men who want to prevent impotence make a long-term commitment to exercise. Here are some tips to remember:

• Choose activities you enjoy. Your exercise program doesn’t have to be elaborate. In fact, studies have shown that just walking briskly every day for at least three months significantly improves the health of your blood vessels. Aim to be active most days of the week. If you prefer basketball, that’s fine — just keep up the full-court press.
• Spice it up with weight training. Aerobic exercise such as walking, swimming, and jogging, is good for your blood vessels, but resistance training has been shown to improve endothelial function as well. A mix of both can help improve your overall health and keep you interested in your workout routine.
• Don’t let your age stop you. Erectile dysfunction is more common as men get older, but at the same time, habitual exercise has been shown to fight the effects of age on blood vessels.
• Check in with your doctor if you haven’t been physically active in a while. It’s a good idea to get your doctor’s approval — and maybe some additional exercise tips — if you’re starting an exercise program from scratch.

The Dubious Claims of So-Called Penis Exercise

As you seek solutions to impotence, you will undoubtedly run into male enhancement recommendations, possibly suggesting penis exercise to improve your erections.

Penis exercise “may sound good,” says Hellstrom, “but I don’t think there are data to support it.”

The phrase “penis exercise” actually refers to exercises known as pelvic floor or Kegel exercises, in which a man focuses on strengthening the muscles that control the flow of urine and ejaculation. These exercises are often recommended to men who are recovering from prostate cancer treatment, have problems with ejaculation, or have a hard time holding their urine, but they do not appear to help erectile dysfunction.

Patrick Kennedy's New Frontier: Healing the brain

Patrick Kennedy says his final time with his father was "the most important year of my life.

Patrick Kennedy's new frontier: Healing the brain
By Caleb Hellerman

Former Congressman Patrick Kennedy talks about his battle with addiction, the pain of losing his father to brain cancer, and his ambitious new project to ramp up research on the brain and brain disease. "Dr. Sanjay Gupta Reports: Patrick Kennedy: Coming Clean," Sunday on CNN, 7 p.m. ET.

(CNN) -- Patrick Kennedy is sprawled in a too-small chair in a tiny courtyard in Atlanta, talking to a reporter and trying to catch the early spring sunlight.

The 43-year-old Kennedy left Congress in January, after spending more than half his life in public office. Now he's outside the Carter Center, taking a break after talking up his latest plan to a group of mental health advocates, including former first lady Rosalynn Carter.

One thing Kennedy enjoys is talking, and these days, he can say whatever he wants. He shouts when he gets excited. He laughs a lot. He curses when he brings up frustrations.

What he's talking about now is "Moonshot." If Kennedy has his way, 50 years from now the world will remember next week as the first step on one of the great triumphant journeys -- like the call by Patrick's uncle, President John F. Kennedy, that sent men to the moon.

Patrick Kennedy: Brain research is the new 'moon shot'

That call, as Kennedy likes to point out, came May 25, 1961 -- a half-century ago. Today, says Kennedy, the race is to inner space, the goal to create a detailed map of the brain in 10 years, with advances toward curing "every kind of brain disease."

The role Kennedy plays now would have been hard to imagine back in May of 2006, when he made his woozy emergence from a green Mustang convertible with an old Kerry-Gephardt bumper sticker on the back, which he'd just crashed into a concrete barrier near the U.S. Capitol shortly after 2:30 in the morning. A day later, head bowed, Kennedy blamed sleeping pills for the crash and announced he was checking into rehab at the Mayo Clinic in Minnesota.

We didn't know the whole story then, that the congressman had already been to rehab a half-dozen times. As is often the case, there had been hints. Shoving a security guard at the Los Angeles International Airport. A fight on a yacht, that brought a visit from the Coast Guard. Another boat, and another fight, this time with the rental company.

Kennedy has acknowledged a trip to rehab for cocaine abuse way back in 1985, as a 17-year-old high school senior in Andover, Massachusetts. Along the way he also got a diagnosis of bipolar illness, although he now says recent testing suggests he is not bipolar but has a different, unspecified disorder.

At the time of the infamous Capitol Hill crash, Jim Ramstad was a Republican congressman from Minnesota. He was also a recovering alcoholic, who had his last drink in 1981, shortly before an unpleasant encounter with some Sioux Falls, South Dakota, police officers. "I called Patrick that morning, and told him I knew exactly what he was going through. And if he wanted me to come to him and talk, I would."

Ramstad had worked with Kennedy on mental health legislation but was not a close confidant. That changed over the next few weeks, as he paid repeated visits to the Mayo Clinic. "We really formed a bond of friendship, and got to be close friends," says Ramstad.

The former congressman, who became Kennedy's sponsor at Alcoholics Anonymous, says he's proud his friend was so open about the public crackup. "Patrick got up there and told the truth. He let it all hang out, so to speak. And that's why he has been able to recover."

After getting home from the Mayo Clinic, most politicians -- heck, pretty much any politician you can think of -- would have run from the attention. Kennedy seemed to embrace it.

By 2008, he was leading the drive for "parity," the requirement that mental ailments -- addiction included -- must be covered by insurance companies, along with other kinds of illness. President Bush signed the bill into law that year. Says Ramstad, one of the bill's original sponsors a decade earlier: "Without Patrick and his father (Sen. Ted Kennedy) as catalysts, we never would have passed the legislation."

In a Boston hotel suite in early April, Kennedy explained his vision of parity. "If you have diabetes and have a chemical imbalance so you need more insulin, you don't get any questions about it. But if you need a neurotransmitter -- more serotonin, or dopamine -- then (people) look at that as something askew, as if the brain isn't part of the body," says Kennedy, his voice rising. "I mean, we're in modern times and people are still treating this illness, mental illness, as if it's back in the Dark Ages."

If 2008 was a year of professional triumph, it also brought devastating personal news: that Patrick's father was fighting a brain tumor. "He gave me an implicit message when he asked me to be around him at the end of his life," says Kennedy, who calls the final time with his father "the most important year of my life."

As Kennedy recalls it now, "The only thing that mattered to (my dad) when he was alone at the end of his life was not being alone and being surrounded by the people he loved the most, who he knew loved him the most."

The strain took a toll on Patrick. Two months before his father's death, he checked into rehab again. When Ted Kennedy died in August 2009, Patrick took it hard. Six months later, he announced he would not run for re-election.

He seems to have walked away on his own terms. "He would have won re-election easily," according to Darrell West, a political scientist who has followed Kennedy's career closely since the early 1990s. Incidentally, Kennedy's departure in January marked the first time in 58 years that there is no Kennedy in the national government -- no congressman, senator or president.

Kennedy says he was tired of struggling with the stress of public office. "I have put certain days together, and managed effectively to live and fight for another day legislatively," says Kennedy. But, "I'm looking to live more than just surviving. I'm looking to live a life that's fuller in sobriety. I could function (while still in office), but that's not all I want to do. I want to live."

He's seized the opportunity. Come July, Kennedy will be married, to Amy Petitgout, a sixth-grade history teacher he met after, yes, another talk. It was about special education, the cause championed by his aunts Eunice Kennedy Shriver, who founded the special Olympics, and Jean Kennedy Smith, who received the Presidential Medal of Freedom for promoting the artistic talents of people with disabilities. Petitgout's father, a special education teacher, had a ticket to the event but couldn't go. As Kennedy says, "The rest is history."

Ramstad, his AA sponsor, says his old friend is happier than ever. "He was so close to his dad. They used to talk five or six times a day. Losing him left a huge void in his life. And now here comes Amy."

Kennedy glows when he talks about his fiancée, or about reading bedtime stories to her 3-year-old daughter. But he's all impatient enthusiasm when talk comes back around to Moonshot, or as next week's conference is officially called, "One Mind for Brain Research."

The surroundings will be modest, an academic-style conference in Boston. Then again, President Kennedy's original 1961 call for a space race was prosaic too, the last of several budget requests in a businesslike address to Congress four months after taking office.

What we remember better is the stirring speech he gave at Rice University the following year. "We choose to go to the moon in this decade and to do the other things, not because they are easy, but because they are hard," the president famously declared.

His nephew, Patrick, grins at the challenge ahead. "This is a thousand moon shots in order of complexity, and that makes it all the more challenging. For our generation, this is our chance to make the difference."

Spinal Stimulation Helps Paralyzed Man Regain Movement

If replicated, the procedure may eventually help others with spine injuries.

By Steven Reinberg, HealthDay

A patient completely paralyzed below the chest after an road accident has been able to stand up by himself, move his legs and feet and take some assisted steps on a treadmill, thanks to electrical stimulation of his lower spinal cord.

The technique — called epidural spinal cord stimulation — mimics signals the brain normally sends to start movement. In addition to returning voluntary movement to his hips, knees, ankles and toes, the treatment also was able to give the patient back some sexual and bladder function.

"This does not represent a cure for spinal cord injury, but it represents some very new ideas — something to build on," lead researcher Reggie Edgerton, from the Department of Integrative Biology and Comparative Physiology at the University of California, Los Angeles, said during a press conference Thursday.

Edgerton said that the research demonstrated that patients could regain voluntary control over their movements, although so far only with the aid of stimulation.

"We have no idea what the mechanisms are," Edgerton said. "But it is pretty certain that the stimulation and the training have resulted in changes in the brain and changes in the spinal cord. We are really anxious to find out what the mechanism is — we need to know how this occurred."

"This is a first-generation approach, but there will be many generations to come, which will improve on what has been done," he added.

While experts expressed excitement about the findings, they stressed that no one yet knows whether this procedure will work for patients with the most serious spinal injuries and that the results need to be replicated in other studies.

For the patient, Rob Summers, however, this is already a major breakthrough. "This procedure has completely changed my life," he said in a statement to the press.

"For someone who for four years was unable to even move a toe, to have the freedom and ability to stand on my own is the most amazing feeling. To be able to pick up my foot and step down again was unbelievable, but beyond all of that my sense of well-being has changed. My physique and muscle tone has improved greatly, so much that most people don't even believe I am paralyzed," he said.

In Summers' case, the researchers explained that when his spinal cord was stimulated in this way, nerves in the cord — plus feeling in the legs — directed the muscle and joint movement that is needed to allow him to stand and walk on a treadmill.

This was done with assistance, the researchers added. In addition, Summers has been able to stand and take steps, also with help.

In addition to epidural spinal cord stimulation to help retrain nerves there to send signals to produce certain movements, Summers underwent repeated motion training to retrain his muscles, the researchers said.

It took more than two years to complete the retraining project. After that, the device that causes electrostimulation was implanted in Summers' back. Before that, Summers had no voluntary control over his movement, the investigators said.

The report was published in the May 20 online edition of The Lancet.

Whether epidural spinal cord stimulation will work with most spine injured patients is unknown. Summers was classified "B" on the American Spinal Injury Association system, meaning he had some sensation below the point of the injury.

However, if epidural spinal cord stimulation will have any benefit to patients classified as "A" — where there is no sensation below the injury — is unclear, the researchers said.

Other concerns focus on whether it will be possible to develop better hardware — currently, the researchers are using a stimulation device originally designed to relieve pain. In addition, experiments in animals have shown that some drugs might improve the response, but right now they are not approved for human use, the researchers noted.

Gregoire Courtine, from the Experimental Neurorehabilitation Laboratory in the Department of Neurology at the University of Zurich in Switzerland and co-author of an accompanying journal editorial, said that "this is good evidence that the human spinal cord responds to stimulation, [a technique that] was observed in rats."

Courtine thinks it's too early to know what this bodes for the treatment of spinal cord injury. "This is only one patient," he said. "But this is the first time someone with a chronic complete paralysis has shown recovery of some movement."

Whether it will work with patients with the most serious injuries is uncertain, Courtine said. "But there are patients with less serious injury in whom you may expect even better recovery," he said.

"We are entering a new era, but it's only the beginning," Courtine said. While this is not a cure, it could lead the way to help patients regain movement, he said, adding that improved technology and clinical trials will be needed.

Another expert, Dr. Steven Vanni, an assistant professor of clinical neurosurgery, Spine Service, at the University of Miami Miller School of Medicine, said that "if they can replicate this, [it] would be something we could offer our patients currently, with patients with these type of spinal cord injuries."

As for Summers, he is optimistic that the procedure will transform his life still further. "I believe that epidural stimulation will get me out of this chair," he said.