To attempt an invasive treatment — a catheter is threaded through blood vessels in the groin up to the kidneys — reflects doctors’ frustration with a disease that too often is underrated because people with it don’t look or feel sick until a lot of damage has been done.

Pharmaceutical therapies have been the cornerstone of medicine for nearly a century, offering convenient, noninvasive treatment for countless diseases. But when it comes to some of the most stubborn chronic conditions, including diabetes, obesity and hypertension, medications too often aren’t enough.

Researchers increasingly are trying medical devices and minimally invasive surgeries to help, such as stomach-shrinking techniques that improve obesity-caused diabetes and the new hypertension experiment.

“I think we have to hit on all cylinders if we’re going to take on these very important diseases,” said Dr. Steven Nissen, chair of the Cleveland Clinic’s department of cardiology. “There are many examples where this convergence is taking place, where you push the drugs as far as you can, but when they can’t go any further, you step in with more invasive approaches.”

Cardiologists’ interest in the nerve-zapping procedure also reflects how severe the burden of hypertension is poised to become, with many middle-aged boomers already affected.

“People are living longer with hypertension, and the disease tends to get worse as you get older,” said Dr. Suzanne Oparil, a hypertension specialist at the University of Alabama, Birmingham. “The complications pile on later.”

If deadening kidney nerves sounds like a strange way to attack hypertension, consider that nerves in the body’s “fight or flight” system play a role in signaling kidney functions, which in turn help regulate blood pressure, such as by relaxing or tightening key arteries.

“If there was a snake in the room, all of our blood pressures would go up, appropriately so,” explained interventional cardiologist Dr. Manesh Patel of Duke University, one of more than 60 medical centers around the country studying Medtronic Inc.’s nerve-zapping procedure.

But sometimes those nerves stay switched on when they shouldn’t be, something today’s medications can’t address. The hope is that destroying a small number of the nerves could calm an overactive system, relaxing arteries and lowering blood pressure.

“Interrupting that signal makes physiologic sense,” Patel said, adding that some patients have driven hundreds of miles to see if they’re candidates. “There’s a large unmet need.”

Some 78 million people in the country, about 1 in 3 adults, have high blood pressure, meaning readings of 140 over 90 or higher. An additional 27 million people will have it by 2030, says a grim forecast from the American Heart Association. That’s because the population is getting fatter and older. In fact, about half of people in their 50s have high blood pressure but by age 75, three-fourths do.

“If people live long enough, the vast majority are going to have hypertension,” says Dr. Michael Mussolino of the National Institutes of Health’s cardiovascular division.

Only about half of patients have their hypertension under control. Most need multiple drugs to treat it. Some 10 percent, more than 7 million people like Ezzell, have the resistant hypertension that is the initial target of the nerve-zapping procedure — people with high blood pressure despite three or more different kinds of medications.

Renal denervation, the procedure being promoted by Minneapolis-based Medtronic and other companies, has its roots in primitive nerve-severing operations performed in the 1950s, which often lowered blood pressure but at the expense of permanently injuring patients. Only in recent years have researchers revisited the technique, after companies developed easy-to-use catheters that can beam radiofrequency waves to burn away specific nerves without damaging the surrounding blood vessel.

It’s aimed at only the hardest-to-treat patients. In small Medtronic studies, those treated saw the key top number of a blood pressure reading drop an average of 33 points, although they still needed their medications. Medtronic reported in March that the improvements were lasting up to three years. The company’s Symplicity catheter is approved to treat hypertension in Europe and Australia, as are some competitors’ versions.

The U.S. Food and Drug Administration required a more rigorous study, now enrolling more than 500 people, that includes an unusual step to prove if it really works. Some patients receive the real procedure and some get a fake — just the catheter, no zapping. Patel describes patients wearing a blindfold and earphones while lying sedated on the treatment table, to ensure they don’t know which they’re getting.

Although pilot studies show few side effects, potential risks include bleeding, an injured blood vessel, immediate blood pressure or heartbeat problems, or complications from medications used in the procedure.

Ezzell’s systolic pressure, that top number, hovers around 190 and sometimes jumps to a super-dangerous 230, despite his six daily drugs.

“The doctors seemed at wit’s end as to what to do about it,” says Ezzell, 74, of Jacksonville, N.C. So he got on the Internet, tracking down the Medtronic study at Duke, about two hours away.

Ezzell was treated this month and is waiting to see if his blood pressure drops, which earlier research shows happens gradually over six months.

Cardiologists are excited by the early findings, said Dr. Gordon Tomaselli, the heart association’s president.

But “what we don’t know is the long-term effect” of nerve zapping, Tomaselli cautioned. “It’s going to take a little bit of time to make sure there are not adverse effects two years, three years, 10 years down the line.”

In the last three years, the FDA has approved similar catheters that beam radio waves to treat asthma and a type of irregular heartbeat, conditions traditionally treated with medications.

More than five dozen companies are pursuing devices for hypertension, from catheters similar to Medtronic’s to permanent implants left in arteries to regulate blood pressure.

In Europe, Medtronic’s hypertension procedure costs about $14,000, sticker shock compared with the generic prices of standard hypertension medications and another reason for careful study to prove its effects.

Gwen Dirks, 71, of Virginia, Ill., was grateful to get the procedure in an early study. Her blood pressure was 200 over 120 despite two drugs.

“I’ve been on medications since I was 40,” Dirks said. “Over the years I have tried many different things and got to the point where they no longer worked.”

Two years after her experimental treatment, Dirks says her blood pressure is stable at about 130 over 80, although she continues to take her medications.

___

Online:

American Heart Association: http://tinyurl.com/2ew4kv4

The guideline isn’t a mandate. The task force stresses that men who want a PSA test still can get one, but only after the doctor explains the uncertainties. That’s in part because the panel found PSA testing hasn’t been studied adequately in black men and those with prostate cancer in the family, who are at highest risk of the disease.

The Obama administration said Monday that Medicare will continue to pay for PSA screenings, a simple blood test. Other insurers tend to follow Medicare’s lead.

“This is important information for the public and men to have, and they should talk with their doctors about the risks and benefits of prostate cancer screening and make the decision that’s best for them,” said Mark Weber, a spokesman for the Department of Health and Human Services.

The task force advice goes a step further than major health groups including the American Cancer Society, which has long urged that men decide the issue for themselves after being told of PSA’s pros and cons. But it’s not likely to end an annual ritual for many men 50 and older. After all, the same task force has long urged men over 75 to skip PSA screening, and research suggests almost half of them still get tested.

The controversy will end only with development of better tests — to finally tell which men’s tumors really will threaten their lives, and who will die with prostate cancer rather than from it, said Dr. Virginia Moyer of the Baylor College of Medicine, who heads the task force.

“We have been told for decades to be terrified of cancer and that the only hope is early detection and treatment,” she said. The reality: “You don’t need to detect all cancers.”

“We don’t want this to be the answer,” Moyer added. “We want to screen for the ones that are going to be aggressive, manage those early — and leave everyone else alone.”

In an editorial published with the guideline in Annals of Internal Medicine, some urologists argue the panel underestimated PSA’s value and overestimated its harms.

“What PSA screening offers the men is a substantial opportunity to avoid dying a particularly unpleasant death from prostate cancer,” said editorial co-author Dr. William Catalona of Northwestern University, who pioneered the testing.

He spoke Monday from a meeting of the American Urological Association, where doctors debated the guideline’s impact. The urology association advises that men be informed of the potential risks and benefits before screening.

But Dr. Otis Brawley, the American Cancer Society’s chief medical officer, welcomed the task force’s recommendation. He hoped it would help deter mass screenings, where men are given free PSAs at shopping malls and sports arenas without being told of the controversy, screenings that Brawley calls big business when health centers profit from the follow-up care.

“The question is, are we actually curing anybody who needs to be cured right now?” Brawley asked.

Too much PSA, or prostate-specific antigen, in the blood only sometimes signals prostate cancer is brewing. It also can mean a benign enlarged prostate or an infection. Only a biopsy can tell. Most men will get prostate cancer if they live long enough. Some 240,000 U.S. men a year are diagnosed with it, most with slow-growing tumors that carry a very low risk of morphing into the kind that can kill.

To evaluate whether routine screening saves lives, the task force analyzed previous research, focusing in particular on two huge studies in the U.S. and Europe. The panel’s conclusion:

—Without screening, about 5 in every 1,000 men die of prostate cancer over 10 years. The European study found PSA testing might prevent one of those deaths, while the U.S. study found no difference.

—Of every 1,000 men screened, two will have a heart attack or stroke from resulting cancer treatment, and 30 to 40 will experience treatment-caused impotence or incontinence.

—Of every 3,000 men screened, one will die from complications of surgery.

Both the U.S. and European studies have flaws, and task force critics argue over which are most believable. And while U.S. death rates from prostate cancer have dropped over 20 years, the cancer society’s Brawley says the drop began before PSA testing became widespread. Moreover, the risk of death is the same in Europe and the U.S. even though many more American men are screened, diagnosed and treated, he said.

“We need to do a better job of using PSA wisely,” said Dr. Scott Eggener, a University of Chicago prostate cancer specialist who was disappointed the task force went so far. “Most people would agree that a well-informed, young, healthy patient should have the opportunity to talk about it with their physician.”

But he’s studying a way beyond the screen-or-not controversy: Having men with small, low-risk tumors postpone treatment in favor of “active surveillance,” keeping close watch on their tumors and treating only if they grow. More than 100,000 men a year are candidates, concluded a recent meeting at the National Institutes of Health.

That approach could “maximize the benefits of screening,” Eggener said.

___

Online:

Task force information: http://www.uspreventiveservicestaskforce.org/recommendations.htm

Journal’s patient summary: http://bit.ly/LbhSxH

The guideline isn’t a mandate. The task force stresses that men who want a PSA test still can get one, but only after the doctor explains the uncertainties. That’s in part because the panel found PSA testing hasn’t been studied adequately in black men and those with prostate cancer in the family, who are at highest risk of the disease.

The Obama administration said Monday that Medicare will continue to pay for PSA screenings, a simple blood test. Other insurers tend to follow Medicare’s lead.

“This is important information for the public and men to have, and they should talk with their doctors about the risks and benefits of prostate cancer screening and make the decision that’s best for them,” said Mark Weber, a spokesman for the Department of Health and Human Services.

The task force advice goes a step further than major health groups including the American Cancer Society, which has long urged that men decide the issue for themselves after being told of PSA’s pros and cons. But it’s not likely to end an annual ritual for many men 50 and older. After all, the same task force has long urged men over 75 to skip PSA screening, and research suggests almost half of them still get tested.

The controversy will end only with development of better tests — to finally tell which men’s tumors really will threaten their lives, and who will die with prostate cancer rather than from it, said Dr. Virginia Moyer of the Baylor College of Medicine, who heads the task force.

“We have been told for decades to be terrified of cancer and that the only hope is early detection and treatment,” she said. The reality: “You don’t need to detect all cancers.”

“We don’t want this to be the answer,” Moyer added. “We want to screen for the ones that are going to be aggressive, manage those early — and leave everyone else alone.”

In an editorial published with the guideline in Annals of Internal Medicine, some urologists argue the panel underestimated PSA’s value and overestimated its harms.

“What PSA screening offers the men is a substantial opportunity to avoid dying a particularly unpleasant death from prostate cancer,” said editorial co-author Dr. William Catalona of Northwestern University, who pioneered the testing.

He spoke Monday from a meeting of the American Urological Association, where doctors debated the guideline’s impact. The urology association advises that men be informed of the potential risks and benefits before screening.

But Dr. Otis Brawley, the American Cancer Society’s chief medical officer, welcomed the task force’s recommendation. He hoped it would help deter mass screenings, where men are given free PSAs at shopping malls and sports arenas without being told of the controversy, screenings that Brawley calls big business when health centers profit from the follow-up care.

“The question is, are we actually curing anybody who needs to be cured right now?” Brawley asked.

Too much PSA, or prostate-specific antigen, in the blood only sometimes signals prostate cancer is brewing. It also can mean a benign enlarged prostate or an infection. Only a biopsy can tell. Most men will get prostate cancer if they live long enough. Some 240,000 U.S. men a year are diagnosed with it, most with slow-growing tumors that carry a very low risk of morphing into the kind that can kill.

To evaluate whether routine screening saves lives, the task force analyzed previous research, focusing in particular on two huge studies in the U.S. and Europe. The panel’s conclusion:

—Without screening, about 5 in every 1,000 men die of prostate cancer over 10 years. The European study found PSA testing might prevent one of those deaths, while the U.S. study found no difference.

—Of every 1,000 men screened, two will have a heart attack or stroke from resulting cancer treatment, and 30 to 40 will experience treatment-caused impotence or incontinence.

—Of every 3,000 men screened, one will die from complications of surgery.

Both the U.S. and European studies have flaws, and task force critics argue over which are most believable. And while U.S. death rates from prostate cancer have dropped over 20 years, the cancer society’s Brawley says the drop began before PSA testing became widespread. Moreover, the risk of death is the same in Europe and the U.S. even though many more American men are screened, diagnosed and treated, he said.

“We need to do a better job of using PSA wisely,” said Dr. Scott Eggener, a University of Chicago prostate cancer specialist who was disappointed the task force went so far. “Most people would agree that a well-informed, young, healthy patient should have the opportunity to talk about it with their physician.”

But he’s studying a way beyond the screen-or-not controversy: Having men with small, low-risk tumors postpone treatment in favor of “active surveillance,” keeping close watch on their tumors and treating only if they grow. More than 100,000 men a year are candidates, concluded a recent meeting at the National Institutes of Health.

That approach could “maximize the benefits of screening,” Eggener said.

___

Online:

Task force information: http://www.uspreventiveservicestaskforce.org/recommendations.htm

Journal’s patient summary: http://bit.ly/LbhSxH

Sebelius made clear that the question is far broader than anthrax.

“There are serious ethical issues around the development of medical countermeasures for children” in general, she said.

Developing protections for youngsters is critically important, but in a way that puts “our children’s safety as our highest priority,” Sebelius said.

A decade after the anthrax attacks in the United States, the government has a multibillion-dollar stockpile of tools to fight back against some of the threats that worry defense experts. Notably missing is information on how to treat children in various emergencies — whether the same drugs their parents will get will work or be safe for them, and even what dose youngsters should receive.

Thus the debate on whether to conduct studies now, before millions of children might need to try an untested product in an emergency. Even if those studies were offered, there’s no way to know how many parents would agree to enroll their children.

Testing medications in children always requires extra safeguards. It’s fairly straightforward to test a potential treatment for cancer or some other childhood disease. But if a child won’t receive a direct medical benefit, federal regulations say studies are allowed only if testing adults can’t provide the answers and if the risks to participating children are minimal.

Anyone exposed during an anthrax attack would require 60 days of powerful antibiotics, or antibiotics until a vaccine could kick in. Last fall, the National Biodefense Safety Board, which advises the government, recommended child testing of the anthrax vaccine, but only if outside ethical experts agreed such studies could be done appropriately.

The shots have been widely used in adults, including U.S. troops, and are considered safe for them, said the board chairman, Dr. John Parker, a retired Army major general who has been vaccinated.

Side effects include shot-site soreness and redness, muscle aches, fatigue and headache. Rare but serious allergic reactions have been reported.

The bioethics commission wrestled with how to define “minimal risk” when there is no imminent emergency, and the chairwoman, Dr. Amy Gutmann, wondered whether people urging such testing would enroll their own children.

Parker responded that he’s discussed that with first-responders and some in the military. “There are groups out there that would want their families protected as much as they are protected as they do their job, in fear of bringing something home,” he said.

Other doctors told the panel that 60 days of antibiotics can cause bad side effects for children, including diarrhea, other infections and dangerous allergic reactions. Plus there’s concern that many people wouldn’t take the full course, Parker said.

___

Online:

Presidential Commission for the Study of Bioethical Issues: http://www.bioethics.gov

National Biodefense Safety Board: http://tinyurl.com/7c79bbd

For patients, the convenience is obvious — shorter drugstore waits. Pharmacists like not having to squint at the doctors’ messy handwriting. And computerized ordering systems allow doctors to easily check that a new drug won’t interact badly with one the patient’s already taking.

New research by Surescripts and some pharmacies and pharmacy benefit managers uncovered another benefit: More patients pick up a new prescription when it’s filed electronically.

Doctors know that too often, patients never fill some of their prescriptions. Maybe they lose the slip of paper, or forget to drop it off, or decide they can’t afford it.

The new research examined 40 million prescriptions, a mix of paper, phoned, faxed or electronic ones — and found a 10 percent increase in patients who fill a prescription when it’s e-prescribed.

The main reasons: Drugstores receive every paperless prescription, and they can call patients to come in and pick up their waiting medicine, said Surescripts’ researcher Seth Joseph. Also, e-prescribing programs automatically show the doctor which brands are covered by the patient’s insurance with the lowest out-of-pocket cost.

For several years, the government has run incentive programs to encourage doctors to adopt e-prescribing and other computerized health records, offering payments to help defray the costs of adopting the systems. Now Medicare is beginning to cut some reimbursements to certain doctors who don’t e-prescribe at least a little bit.

Surescripts’ report counted 390,000 doctors who were e-prescribing at least some of the time in 2011, and its records show an additional 10,000 had begun by the end of February. That translates into just over half of office-based physicians, a big jump since 2008, when only about 12 percent of doctors were e-prescribing.