Doctors warn: Christmas is happiest but deadliest time of the year

MANILA - More people suffer from heart attack and stroke during the Christmas season, and sufferers are more likely to die during this period than at any other time of year. The phenomenon is called Merry Christmas Coronary, Happy New Year Heart Attack.

This was the warning issued by the Philippine College of Physicians (PCP) Foundation as the holidays brings more traffic, overcrowding, and stress.

“Cold weather is not the only cause of the spiking of cardiovascular cases. Study after study shows the culprits to be holiday stress, pollution, and most of all, food and alcohol binging. Eating and drinking sprees send them to emergency rooms for palpitations and light-headedness - symptoms of ‘holiday heart,’” said Dr. Anthony Leachon, President of PCP Foundation.

“For lucky ones the abnormal heart rhythm, usually atrial fibrillation, fixes itself within 24 hours. But others would require admission for monitoring and in extreme cases, electric shock to normalize heart rates. It’s certainly not a fun way to spend the holidays,” he added.

Deadliest days

A 26-year (1973-2001) charting of 53 million deaths in the US reveals a 5-percent jump in natural-cause demise during the holidays.

Christmas Day was the deadliest, followed by December 26, then January 1, according to the study.

Research by sociologist Dr. David Phillips also noted increases in hospital admissions for cardiac and non-cardiac causes. Published in the Journal of the American Heart Association in December 2004, Phillips study excludes suicides, homicides, and accidents.

Could many of the deaths have been caused by lack of specialist attention, as doctors are on holiday too? No, according to a study of 127,959 patients hospitalized for heart attack in 1994-1996 by cardiologist James Jollis at Duke University.

Treatment was basically the same for all patients during the holidays and off-season. Still, according to Jollis, the 30-day mortality of patients in December is higher, with over-indulgence singled out as the culprit.

Cardiologist Robert Kloner’s 1999 report further discounted mere cold weather and pointed to the “holiday effect.”

Focusing on hospitals in Los Angeles, where winters are milder, he noted that change of diet rather than temperature leads to more heart attacks and strokes.

Merrymakers of all ages tend to eat fatty stuff, with adults drinking more alcohol in parties. Pollutants from wood-burning fireplaces further trigger cardiovascular irregularities.

All three studies by Phillips, Jollis, and Kloner exhibit annual 5-percent rises in heart attacks and strokes -- and deaths – during Christmas.

But the situation in the Philippines seems to be worse.

Leachon, who is a cardiologist in the Manila Doctors Hospital, recalled a 2004-2008 survey of Metro Manila hospitals to show a tripling of emergencies and admissions in Christmastime.

Patients were taken in for heart attack, stroke, and diabetes due to overeating and overdrinking.

Usually about 30-50 cases occur from January to November. But this rose to 153 in December 2004, 163 in 2005, 172 in 2006, 170 in 2007, and 170 in 2008.

Half of the holiday patients died.

So for the coming holidays, Leachon gave these health tips to remind the people on how to prevent life-threatening medical condition:

    Stop smoking.
    Eat low-fat low-salt diet. Stick to healthy habits and help your family too.
    Exercise daily for 30 minutes.
    Observe moderate alcohol drinking.
    Don’t skip regular appointments with the doctor.
    Have enough of your usual medications to allow for holiday business or pharmacy breaks and travel.
    Check out the medical facilities where you will be traveling; ask your physician who you could see if you 
    need a doctor away from home.
    If you have symptoms, don’t ignore them.

source: interaksyon.com

Simple test may reduce hospital admissions for suspected heart attacks - study

PARIS, France -- A simple blood test can reduce unnecessary hospital admissions by pinpointing people seeking medical help for chest pain caused by something other than a heart attack, a study said Thursday.

Researchers said they had identified the optimal level of a protein called troponin in the blood below which a heart attack can be all but ruled out as the cause of chest pain.

In a trial of about 6,300 people who went to the emergency room with chest pain at four hospitals in Scotland and the United States, the test correctly identified about two-thirds of those who were not having a heart attack -- all had a troponin level under five nanograms (billionths of a gram) per deciliter (a tenth of a liter).

This meant everyone under this threshold could probably have been sent home instead of being admitted to hospital, the research team wrote in The Lancet medical journal.

"Implementation of this approach would reduce avoidable hospital admission and have major benefits for both patients and health-care providers," the researchers wrote.

But they underlined the approach should not be applied without consulting a patient's medical history and profile.

Chest pain is one of the most common causes of hospitalization worldwide, with international guidelines recommending that people who complain of chest pain be admitted for extensive testing. The vast majority do not have a heart attack.

"Until now there were no quick ways to rule out heart attack within the emergency department," lead author Anoop Shah from the University of Edinburgh said in a statement.

In a comment also carried by The Lancet, experts Louise Cullen and William Parsonage from the Royal Brisbane and Women’s Hospital in Australia, and Martin Than from Christchurch Hospital in New Zealand, urged further study before a troponin benchmark is determined for early discharge of people with chest pain.

source: interaksyon.com

New York health officials test person's remains for Ebola

New York City health officials said they will test the remains of a person who died of an apparent heart attack on Tuesday for Ebola as the person had recently come to the United States from West Africa.

The person, who was not identified, had been in one of the countries hardest hit by the outbreak just 18 days earlier, the New York City Department of Health and Mental Hygiene said in a statement.

"Before death, this individual showed no symptoms of Ebola. However due to travel history within the 21-day incubation period and an abundance of caution, an Ebola test will be performed on this individual's remains," the department said.

The department said results were expected on Wednesday morning.

The New York Times reported that the individual was a woman and that she was pronounced dead at a Brooklyn hair salon at around 2:30 p.m. local time.

Last Tuesday, Dr. Craig Spencer, who worked with Ebola patients in Guinea, was discharged from a New York City hospital after recovering from Ebola following his Oct. 23 diagnosis.

Medical experts say Ebola can be transmitted only through the bodily fluids of a sick person with symptoms.

The World Health Organization on Friday said the Ebola outbreak, which is the deadliest on record, has resulted in 5,177 deaths out of 14,413 cases, mostly in Liberia, Sierra Leone and Guinea.

source: interaksyon.com

Warnings of 'sudden' cardiac death may come weeks early - study

Signs of approaching "sudden" cardiac arrest, an electrical malfunction that stops the heart, usually appear at least a month ahead of time, according to a study of middle-age men in Portland, Oregon.

"We're looking at how to identify the Tim Russerts and Jim Gandolfinis -- middle aged men in their 50s who drop dead and we don't have enough information why," said Sumeet Chugh, senior author of the study and associate director for genomic cardiology at the Cedars-Sinai Heart Institute in Los Angeles.

Some 360,000 out-of-hospital cardiac arrests occur each year in the United States, largely involving middle-aged men, with only 9.5 percent surviving, according to the American Heart Association.

Patients can survive if they are given cardiopulmonary resuscitation or CPR immediately and their hearts are jolted back into normal rhythm with a defibrillator.

Earlier clinical trials have focused only on symptoms or warnings signs within an hour of such attacks.

But Chugh's study set out to determine whether signs and symptoms occurred as much as a month before sudden cardiac arrests.

Researchers went back and examined medical records of men 35 to 65 years old after they had out-of-hospital attacks. In addition, paramedics reaching the scene of fatal attacks asked family members what signs and symptoms the patient may have had in preceding weeks.

Among 567 men who had "sudden" arrests, researchers determined 53 percent had symptoms beforehand. Among those with symptoms, 56 had chest pain, 13 percent had shortness of breath and 4 percent had dizziness, fainting or palpitations.

About 80 percent of symptoms happened between four weeks and one hour before the cardiac arrest, researchers said. And although most men had coronary artery disease, just half had been tested for it before their attacks.

"The findings were entirely unexpected," Chugh said. "We never thought more than half of these middle-aged men would have had warning signs so long before their cardiac arrests. Previously we thought most people don't have symptoms so we can't do anything about it."

Chugh said most people who have the same kinds of symptoms don't go on to have cardiac arrests.

"Even so, they should seek medical care," he said. "The message here is, if you have these signs or symptoms, please don't ignore them: seek healthcare."

Chugh said he and his colleagues are also attempting to identify people at risk by comparing biologies of those that have had sudden cardiac arrests with sample populations in Portland that have never had cardiac arrests.

The new findings, from the 11-year-old "Oregon Sudden Unexpected Death Study," were presented on Tuesday at the annual scientific sessions of the American Heart Association being held in Dallas.

The researchers are conducting similar studies among women. The ongoing study is being funded by the US Centers for Disease Control and Prevention, AHA and the Doris Duke Charitable Foundation.

source: interaksyon.com

Gym not for you? Easy home tasks also help heart - study

PARIS - Mowing the lawn or washing the car are among simple activities that can reduce the risk of heart attack or stroke by almost 30 percent in people over 60, researchers said Tuesday.

A study in Sweden found that older people who were physically active around the house stayed healthier longer than couch potatoes -- regardless of whether they also did any kind of "formal" exercise like jogging or going to the gym.

"A generally active daily life was, regardless of exercising regularly or not, associated with cardiovascular health and longevity in older adults," said the study in the British Journal of Sports Medicine.

While the health risks of prolonged sitting and the benefits of regular exercise have both been well documented, the contribution to good health of "non-exercise physical activity (NEPA)" is not fully understood.

For the study, researchers screened nearly 4,000 Swedish 60-year-olds in 1997-99 and tracked their health for an average 12.5 years.

The participants recorded how frequently they performed certain activities, including doing home repairs, cutting the lawn or hedge, car maintenance, going hunting or fishing, cycling, and gathering mushrooms or berries.

The researchers found that people with high levels of physical activity, excluding formal exercise, had a 27 percent lower risk of contracting cardiovascular disease compared with inactive people, and a 30 percent lower risk of death from all causes during the study period.

The results were "not significantly different" from those for people who did do regular formal exercise but had low NEPA levels, the study said.

Those who did both had the lowest risk.

"Promoting everyday NEPA might be as important as recommending regular exercise for older adults" -- boosting individual and population health as the demographic shifts towards an ever-older population in many parts of the world, the study said.

The researchers factored in other lifestyle factors that could influence the results, including alcohol intake, education level, smoking habits, and diet.

And they warned that care should be taken applying the findings in cultures that may have different physical activity habits and levels.

source: interaksyon.com

Australian doctors bring woman back from the dead

SYDNEY - An Australian woman has lived to tell the tale after being brought back to life from being clinically dead for 42 minutes, doctors said on Monday.

Mother-of-two Vanessa Tanasio, 41, was rushed to Monash Medical Centre in Melbourne last week after a major heart attack, with one of her main arteries fully blocked.

She went into cardiac arrest and was declared clinically dead soon after arrival.
            


Doctors refused to give up and used a compression device called a Lucas 2 -- the only one of its kind in Australia -- to keep blood flowing to her brain while cardiologist Wally Ahmar opened an artery to unblock it.

Once unblocked, Tanasio's heart was shocked back into a normal rhythm.

"(I used) multiple shocks, multiple medications just to resuscitate her," Ahmar said.

"Indeed this is a miracle. I did not expect her to be so well."

Tanasio said she had no history of heart conditions and was grateful to be alive.

"I remember being on my couch, then the floor, then arriving at hospital, and then two days go missing," Tanasio said.

"I was dead for nearly an hour and only a week later I feel great. It's surreal."

The Lucas device physically compresses the chest, like during cardiopulmonary resuscitation (CPR), allowing doctors to work non-stop to put a stent into a blocked artery.

It is the first a time a patient has successfully used the device, which was donated to the medical center for such a length of time in Australia, the hospital said.

Clinical death is a medical term for when someone stops breathing and their blood stops circulating.

source: interaksyon.com

Married people less prone to heart attacks than singletons - study

PARIS  - Married people are less prone to heart attacks than singletons and more likely to recover if stricken, according to a Finnish study published Thursday.

Researchers collected data on 15,330 people in Finland between the ages of 35 and 99 who suffered "acute coronary events" between 1993 and 2002.

Just over half of the patients died within 28 days of the attacks.

The team found that unmarried men in all age groups were 58-66 percent more likely to suffer a heart attack than married ones.

For women the nuptial benefit was even greater -- single women were 60 to 65 percent more likely to suffer acute coronary events, the Finnish researchers wrote in the European Journal of Preventive Cardiology.

For both genders, wedlock also considerably lowered heart attack mortality.

Unmarried men were 60-168 percent and unmarried women 71-175 percent more likely to die of a heart attack within 28 days, compared to their unhitched counterparts.

"Single living and/or being unmarried increases the risk of having a heart attack and worsens its prognosis both in men and women regardless of age," the team wrote.

"Most of the excess mortality appears already before the hospital admission and seems not to relate to differences in treatment."

Speculating on the reasons, the team said married people may have a higher, combined income, healthier habits and a bigger support network.

"It may be assumed that resuscitation or calling for help was initiated faster and more often among those married or cohabiting," said the authors.

They could also not discount the psychological effects of marital bliss.

"Unmarried people have been found to be more likely depressed and according to previous studies depression seems to have an adverse effect on cardiovascular mortality rates," lead author Aino Lammintausta from the Turku University Hospital told AFP.

Previous studies on the health benefits of matrimony often had sketchy data on women and older people, the researchers said.

The new study showed that marriage protected women even more than men from out-of-hospital heart attack death.

The study included people from different race groups and social backgrounds and the findings "can roughly be thought to be applicable in other western countries," said Lammintausta.

Relying on data from population records, the team could not directly measure the effects for unmarried, cohabiting couples.

source: interaksyon.com

UK study: Obesity not always tied to higher heart risk

NEW YORK — An obese person isn't inevitably at increased risk of cardiovascular disease and death, a new U.K. study finds.

"The people really at risk are the ones who have obesity in combination with other metabolic health risk factors," said Mark Hamer, a principal research associate at University College London who worked on the study.

The results are in line with most previous research that defined metabolic health as having normal levels of markers like blood pressure, blood sugar, HDL, or "good" cholesterol, and C-reactive protein, which is a measure of inflammation in the body.

"People with good metabolic health are not at risk of future heart disease -- even if they are obese," Hamer told Reuters Health.

On the flip side, the non-obese in poor metabolic shape face as much risk as the unhealthy obese, the researchers concluded.

The findings, published in the Journal of Clinical Endocrinology & Metabolism, are based on more than 22,000 middle-aged participants in national health studies conducted in England and Scotland.

According to the researchers, the results suggest that metabolic factors may be more important in predicting a person's risk of cardiovascular disease than excess body weight in itself.

From a clinical perspective, stratifying individuals based upon their metabolic profile may help to identify those -- both obese and non-obese -- who should be treated with drugs or changes in diet and exercise, the study authors noted.

"We encourage obese people to lose weight for their health, but (some) provision should be made in how we screen people for metabolic risk," Hamer told Reuters Health.

An adult who has a body mass index -- a height-to-weight ratio -- of 30 or higher is considered obese. A normal BMI is between 18.5 and 24.9, and a BMI between 25 and 29.9 is considered overweight.

During the past 20 years, obesity has increased significantly in the United States. More than a third of American adults are obese, according to the Centers for Disease Control and Prevention.

Poor metabolic health?

For the new report, Hamer and a colleague collected data on participants' BMI and metabolic profiles and followed individuals, on average, for seven years. Then they looked at how many participants had died during the study period, and from what causes.

None of the participants had heart disease at the start of the study.

Almost a quarter were obese, and just under a quarter of those were considered "metabolically healthy obese" -- meaning they had no abnormal blood pressure, cholesterol, blood sugar or inflammation readings.

During the study period, more than 600 participants died from heart-related causes and 1,800 from other causes.

The obese individuals in good metabolic health were not at greater risk of dying from cardiovascular disease than the metabolically healthy non-obese, the researchers found.

But both non-obese and obese participants in poor metabolic health had a 59 percent and 64 percent increased risk of dying from heart disease, respectively, compared to the healthy non-obese.

Among the metabolically unhealthy participants, the non-obese had high levels of hypertension and inflammation -- comparable to those in the unhealthy obese group.

The metabolically unhealthy obese also had a 72 percent higher risk of dying from non-heart-related causes than those in good health.

That was after taking into account study participants' age, sex, smoking, physical activity and socioeconomic status.

Researchers found the results to be largely unchanged when they used waist circumference to define obesity instead of BMI.

‘Think more broadly'

Hamer and his colleague note in their report that a strength of their study was having a large study population. But because the researchers only measured participants' metabolic risk factors at the beginning of the study, it's possible that some of the metabolically healthy obese went on to develop unhealthy readings.

The study shows the need "to think more broadly about obesity" rather than to focus on body weight alone, said Dr. Cora Lewis, a professor of preventive medicine and an epidemiologist at the University of Alabama, Birmingham, who was not involved in the research.

"If you are obese and you struggle with weight, but your (metabolic) risk factors are fine, that may not be such a bad place to be," Lewis told Reuters Health -- adding that only "a minority of people" fit the description of "metabolically-healthy obese."

Equally important, the study shows that people may be at increased metabolic risk no matter what they weigh, she noted.

Excess body fat may be carried not only under the skin, but also inside the abdomen, heart, liver and muscles -- making it hard to tell -- she added.

"BMI doesn't always tell you everything. If you are non-obese, but you have high cholesterol or hypertension, you have some work to do," Lewis said. — Reuters

source: gmanetwork.com

Studies find an aspirin a day can keep cancer at bay

LONDON (Reuters) - Three new studies published on Wednesday added to growing scientific evidence suggesting that taking a daily dose of aspirin can help prevent, and possibly treat, cancer.

Previous studies have found that daily aspirin reduces the long-term risk of death due to cancer, but until now the shorter-term effects have been less certain - as has the medicine's potential in patients already diagnosed with cancer.

The new studies, led by Peter Rothwell of Britain's Oxford University, found that aspirin also has a short-term benefit in preventing cancer, and that it reduces the likelihood that cancers will spread to other organs by about 40 to 50 percent.

"These findings add to the case for use of aspirin to prevent cancer, particularly if people are at increased risk," Rothwell said.

"Perhaps more importantly, they also raise the distinct possibility that aspirin will be effective as an additional treatment for cancer - to prevent distant spread of the disease."

This was particularly important because it is the process of spread of cancer, or "metastasis", which most often kills people with the disease, he added.

Aspirin, originally developed by Bayer, is a cheap over-the-counter drug generally used to combat pain or reduce fever.

The drug reduces the risk of clots forming in blood vessels and can therefore protect against heart attacks and strokes, so it is often prescribed for people who already suffer with heart disease and have already had one or several attacks.

Aspirin also increases the risk of bleeding in the stomach to around one patient in every thousand per year, a factor which has fuelled an intense debate about whether doctors should advise patients to take it as regularly as every day.

Last year, a study by British researchers questioned the wisdom of daily aspirin for reducing the risk of early death from a heart attack or stroke because they said the increased risk of internal bleeding outweighed the potential benefit.

Other studies, including some by Rothwell in 2007, 2010 and 2011, found that an aspirin a day, even at a low dose of around 75 milligrams, reduces the long-term risk of developing some cancers, particularly bowel and oesophageal cancer, but the effects don't show until eight to 10 years after the start of treatment.

Rothwell, whose new studies were published in The Lancet and The Lancet Oncology journals on Wednesday, said this delay was because aspirin was preventing the very early development of cancers and there was a long time lag between this stage and a patient having clinical signs or symptoms of cancer.

Rothwell and others said deeper research was now needed into aspirin as a potential treatment for cancer in patients whose disease has not yet spread.

"No drug has been shown before to prevent distant metastasis and so these findings should focus future research on this crucial aspect of treatment," he said.

Peter Johnson, chief clinician at the charity Cancer Research UK, said his group was already investigating the anti-cancer properties of aspirin. "These findings show we're on the right track," he said.

In a written commentary on the research in The Lancet, Andrew Chan and Nancy Cook of Harvard Medical School in the United States said it was "impressive" and moved health experts "another step closer to broadening recommendations for aspirin use".

source: mb.com.ph

Soccer star Muamba in critical condition after heart attack during FA Cup match

(CNN)-- An English soccer match between top-flight teams Bolton and Tottenham was abandoned on Saturday after a player suffered a possible heart attack on the pitch before halftime.

Bolton midfielder Fabrice Muamba was taken to hospital, the Premier League club confirmed, after medics came onto the field to try to revive him.

It later released a statement saying Muamba was in "critical condition" in intensive care.

"Bolton Wanderers can confirm that Fabrice Muamba has been admitted to the heart attack center at London Chest Hospital where he is currently in a critically ill condition in intensive care," the club's website reported.

"No further information will be issued at this stage. The club has requested the media to respect his family's privacy at this time."

The 23-year-old from the Democratic Republic of Congo, who has represented England at under-21 level, fell to the floor in the 41st minute with no other players near him.

Referee Howard Webb consulted both teams before calling off the match in London, which was a quarterfinal tie in England's prestigious knockout competition, the FA Cup.

Bolton said in a statement that the club would release more information when more was known about Muamba's condition.

His peers have been quick to show their support on micro-blogging website Twitter.

"For all those asking, I know as much as you do," wrote clubmate Stuart Holden, a U.S. international. "Waiting anxiously for updates from teammates. Fab is a fighter! prayforMuamba."

Tottenham's Rafael van der Vaart wrote: "Terrible what happened with Muamba during the game. We're all praying for him."

The last player to die after collapsing in a match in Britain was Motherwell's Phil O'Donnell, who suffered heart failure during a game against Scottish rivals Dundee United and passed away on the way to hospital.

The most high-profile such tragedy was when Cameroon international Marc-Vivian Foe collapsed during a Confederations Cup semifinal against Colombia in 2003 and died in hospital.

There have been two similar incidents more recently in Spain, involving Sevilla's Antonio Puerta in 2007 and Espanyol's Daniel Jarque in 2009.

Muamba grew up in Kinshasa, the capital of what was then known as Zaire. After moving to the UK in 1999 he began his football career with Premier League club Arsenal in 2005 but did not make a first-team appearance in the top division and was loaned out to Birmingham.

He signed a permanent deal with the Midlands club in 2007 before moving to Bolton a year later for a fee of £5 million ($8 million).

source: CNN

Diet soda tied to heart attack, stroke risks: study

NEW YORK (Reuters Health) - Diet soda may benefit the waistline, but a new study suggests that people who drink it every day have a heightened risk of heart attack and stroke.

The study, which followed almost 2,600 older adults for a decade, found that those who drank diet soda every day were 44 percent more likely than non-drinkers to suffer a heart attack or stroke.

The findings, reported in the Journal of General Internal Medicine, don't prove that the sugar-free drinks are actually to blame.

There may be other things about diet-soda lovers that explain the connection, researchers say.

"What we saw was an association," said lead researcher Hannah Gardener, of the University of Miami Miller School of Medicine. "These people may tend to have more unhealthy habits."

She and her colleagues tried to account for that, Gardener told Reuters Health.

Daily diet-soda drinkers did tend to be heavier and more often have heart risk factors like high blood pressure, diabetes and unhealthy cholesterol levels.

That all suggests that people who were trying to shed pounds or manage existing health problems often opted for a diet soda over the sugar-laden variety.

But even after the researchers factored in those differences -- along with people's reported diet and exercise habits -- they found that daily diet soda was linked to a 44-percent higher chance of heart attack or stroke.

Nevertheless, Gardener said, it's impossible for a study to capture all the variables that could be at work.

The findings do build on a few recent studies that also found diet-soda drinkers are more likely to have certain cardiovascular risk factors, like high blood pressure or high blood sugar.

This is the first study, Gardener said, to look at actual "vascular events" -- that is, heart attacks, strokes and deaths from cardiovascular causes.

The findings are based on 2,564 New York City adults who were 69 years old, on average, at the outset. Over the next decade, 591 men and women had a heart attack, stroke or died of cardiovascular causes.

That included 31 percent of the 163 people who were daily diet-soda drinkers at the study's start. In contrast, 22 percent of people who rarely or never drank diet soda went on to have a heart attack or stroke.

There was no increased risk linked to less-than-daily consumption. Nor was regular soda tied to heart attacks and strokes.

If diet soda, itself, somehow contributes to health risks, it's not clear how, Gardener said.

There's research in rats suggesting that artificial sweeteners can end up boosting food intake and weight. But whether results in rodents translate to humans is unknown.

"I don't think people should change their behavior based on this study," Gardener said. "And I wouldn't advocate drinking regular soda instead."

Regular soda is high in calories, and for people who need to shed pounds, experts often suggest swapping regular soda for the diet version.

A study out this month found that the advice may be sound. Obese people who were randomly assigned to drink water or diet drinks in place of sugary ones lost about five pounds over six months.

Gardener said that further studies such as hers are still needed to confirm a connection between diet soda and cardiovascular trouble.

Ultimately, she noted, clinical trials are considered the "gold standard" for proving cause-and-effect. That would mean randomly assigning people to drink diet soda or not, and then following them over time to see if there were differences in their rates of heart problems or stroke.

A study like that, Gardener said, would be "difficult and costly" -- since it would have to follow large groups of people over many years, and rely on people to stick with their assigned beverages.

article source: mb.com.ph