Saturday, August 9, 2008
The New York Times reports that the 17th International AIDS Conference ended on Friday in Mexico with a call for the reversal of laws that criminalize and stigmatize groups at risk for H.I.V. Lawrence K. Altman writes,
“Criminalization is a poor tool for regulating H.I.V. infection and transmission,” Edwin Cameron, a justice of the Supreme Court of Appeals in South Africa, said in a plenary session.
“Let one of the conference outcomes be a major international push-back against misguided criminal laws and prosecutions,” said Justice Cameron, who is himself infected.
Citing cases in Texas, Zimbabwe, Sierra Leone, Bermuda and Switzerland to illustrate the “folly of criminalization,” the judge said, “There is no public health rationale for invoking criminal law sanctions against those who unintentionally transmit H.I.V. or expose others to it.”
Justice Cameron said he understood that society feared the deadly virus and that public officials might want to invoke laws to counter those who recklessly passed it to others.
But, he said, “Criminalization is warranted only where someone sets out, knowing he has H.I.V., to infect another and succeeds.”
The Los Angeles Times reports that the safety and effectiveness of the HPV vaccine Gardasil as a preventive cervical cancer treatment for girls are questioned in a report. Linda Marsa writes,
Sandra Levy wants to do everything she can to safeguard the health of her 11-year-old daughter -- and that, of course, includes cancer prevention. She has had her child inoculated with one shot of Gardasil, the human papilloma virus vaccine that may prevent cervical cancer. But now, she says, she has serious reservations about going ahead with the next two injections of the course.
"It's very confusing, and we really don't know if it's 100% safe," says Levy, of Long Beach. "I'm not against vaccines, but I don't want to do anything that would harm my daughter."
Though most medical organizations strongly advocate using the HPV vaccine, some doctors and parents, like Levy, are asking whether the vaccine's benefits really outweigh its costs. They say they aren't convinced that the expensive shots offer any more protection than preventive measures already available -- principally, regular screening via the Pap smear test.
A handful worry that blanket immunizations of the nation's adolescents could backfire by lulling them into a false sense of security that leads them to neglect regular screening. If that happened, vaccination could eventually boost cervical cancer rates instead of lowering them.
In addition, because Gardasil protects only against the HPV strains linked most strongly to cervical cancer, "we don't know if it will make a difference in the ultimate rates of cancer," says Abby Lippman, an epidemiologist at McGill University in Montreal who has researched the HPV vaccine. "The jury is still out on how much benefit we're actually going to get with this vaccine."A report released in June stirred up more doubts. Although cause and effect were not proved, the report listed serious events -- such as seizures, spontaneous abortions and even deaths -- among teens, preteens and young women who had earlier had Gardasil shots.
As a result, the decision -- to vaccinate or not? -- has become controversial. Sorting through the pros and cons can be daunting for many parents.
The Washington Post reports that Whole Foods Market is recalling fresh ground beef sold from June 2 through Aug. 6 because the beef might be contaminated with E. coli bacteria. Annys Shin and Ylan Q. Mui write,
Whole Foods Market pulled fresh ground beef from all of its stores Friday, becoming the latest retailer affected by an E. coli outbreak traced to Nebraska Beef, one of the nation's largest meatpackers. It's the second outbreak linked to the processor in as many months.
The meat Whole Foods recalled came from Coleman Natural Foods, which unbeknownst to Whole Foods had processed it at Nebraska Beef, an Omaha meatpacker with a history of food-safety and other violations. Nebraska Beef last month recalled more than 5 million pounds of beef produced in May and June after its meat was blamed for another E. coli outbreak in seven states. On Friday it recalled an additional 1.2 million pounds of beef produced on June 17, June 24 and July 8, which included products eventually sold to Whole Foods. The recall is not related to the recent spate of E. coli illnesses among Boy Scouts at a gathering in Goshen, Va.
Whole Foods officials are investigating why they were not aware that Coleman was using Nebraska Beef as a processor, spokeswoman Libba Letton said.
The chain's managers took action after Massachusetts health officials informed them Aug. 1 that seven people who had gotten sick from E. coli O157:H7 had all bought ground beef from Whole Foods. The same strain has sickened 31 people in 12 states, the District and Canada.
So far, tests have not found contaminated Whole Foods beef, Letton said.
Friday, August 8, 2008
The Washington Post reports that some long-term survivors of HIV infection produce rare and extremely potent antibodies that keep the disease from progressing to AIDS, and might point to a way to protect uninfected people from the virus, as researchers reported yesterday in the closing hours of the 17th International AIDS Conference in Mexico City. David Brown writes,
The antibodies, against a particular part of a much-studied HIV protein called gp120, might prove useful as a microbicide for blocking infection during sexual intercourse. If researchers could find a way to prompt the immune system to make its own supply of the antibodies before encountering the virus, they would have a vaccine.
"I think the road is long before we reach that point," cautioned Stephanie Planque, the researcher who presented two studies.
The search for both an AIDS microbicide and a vaccine has been particularly frustrating. None are in use, and some candidates tested in recent years have turned out to increase the risk of infection.
The antibodies described yesterday attack a small and crucial region of HIV's outer shell where the virus binds to its chief prey, immune-system cells called lymphocytes. Acting as an enzyme, the antibody clips the attachment point, and falls away undamaged and ready to do the job again.
These "catalytic antibodies" have been isolated from people with lupus, a disease in which the immune system malfunctions and produces a large number of unusual antibodies. Catalytic antibodies have also been seen in some long-term survivors of HIV infection, including three people with the blood disease hemophilia, whose cases were described yesterday.
The New York Times reports on a new study that calls into question the use of two common infertility treatments for couples who have unexplained problems having children. The Associated Press writes,
Among the three groups, researchers found little difference in the numbers of couples who had babies. The study was published Friday in the British Medical Journal.
''These treatments are a leap of faith,'' said Dr. Siladitya Bhattacharya, a professor of reproductive medicine at the University of Aberdeen and the study's lead author. ''None of the treatments studied had any significant benefit over no treatment at all.''
The New York Times reports that Johnson & Johnson has been subpoenaed by the Justice Department in connection with its sales of bile duct stents, broadening an investigation that has touched its competitors Abbott Laboratories and Boston Scientific. The New York Times reports,
The United States attorney’s office in Massachusetts requested the information in June, J.& J., which is based in New Brunswick, N.J., said in a filing with the Securities and Exchange Commission. Abbott Laboratories and Boston Scientific, which also produce the stents, have said previously that they have been contacted by investigators.
The devices, also called biliary stents, are plastic or metal tubes intended to treat obstructions to the liver. They had an American market of about $40 million in 2007 for approved uses, according to the Millennium Research Group, a Toronto market research firm.
In February, Boston Scientific said the Justice Department was investigating whether manufacturers had been promoting the devices for unapproved uses, among them the repair of weakened blood vessels.
Johnson & Johnson is “cooperating and responding to the subpoena,” said Carol Goodrich, a spokeswoman for Cordis, the company unit that makes stents. She declined to comment further.
Boston Scientific, based in Natick, Mass., and Abbott, of Abbott Park, Ill., also have said they are cooperating.
Thursday, August 7, 2008
The Los Angeles Times reports on a new proposal that will force many chain restaurants in Los Angeles County to include a caloric breakdown for items listed on their menu. Rene Lynch writes,
You're going on a diet whether you like it or not.
Convinced that you and the rest of California are -- how to put this nicely? -- too fat and getting fatter, government is taking unprecedented steps to watch what you put in your mouth.In recent days, the state ordered restaurants to cook without artery-clogging trans fats. The Los Angeles City Council approved a ban on new fast-food restaurants in some parts of town. And on Thursday, Los Angeles County Supervisor Zev Yaroslavsky announced a proposal that would -- hold on to your deep-fried Snickers -- put calorie counts on some of your menus.
"Most people do not have a clue how many calories they are taking in when they have a milkshake or a double hamburger with cheese and fries," Yaroslavsky said. "This is an incentive for people to make the right dietary choices."
The proposal would require chain restaurants in unincorporated parts of the county to include a caloric breakdown for all their offerings. The issue is expected to come before the Board of Supervisors on Tuesday; the supervisors will be asked to call for the drafting of an ordinance. If all goes smoothly, the measure could be in place by the end of the year, Yaroslavsky said.If the measure is successful, Los Angeles County would be following in the footsteps of New York and a handful of other municipalities nationwide that already have implemented calorie counts on the menus at major restaurant chains, or are taking steps to do so.
The New York Times reports that many people with chronic diseases like diabetes or high blood pressure receive inadequate treatment as a result of being uninsured. A new study finds that one of every three working-age adults without insurance in the US is diagnosed with a chronic illness and forgoes doctor's visits and emergency rooms. Reed Abelson writes,
That is the central finding of a new study to be published Tuesday in the medical journal Annals of Internal Medicine.
The study, the first detailed look at the health of the uninsured, estimates that about one of every three working-age adults without insurance in the United States has received a diagnosis of a chronic illness. Many of these people are forgoing doctors’ visits or relying on emergency rooms for their medical care, the study said.
The report, based on an analysis of government health surveys of adults ages 18 to 64 years old, estimated that about 11 million of the 36 million people without insurance in 2004 — the latest year of the study — had received a chronic-condition diagnosis.
“These are people who, with modern therapies, can be kept out of trouble,” said Dr. Andrew P. Wilper, the study’s lead author. Therapies for someone with diabetes and hypertension “are routine and widely available, if you have insurance,” said Dr. Wilper, a medical instructor at the University of Washington in Seattle.
The most recent government estimate of the number of people in this country without health insurance is 47 million, which means that if the proportions found in the study have remained constant, there might be nearly 16 million people in this country with a chronic condition but no insurance to pay for medical care.
The Chicago Tribune reports on a study from the Center for Science that finds 93% of all kids meals offered by thirteen of the top fast food chains contain too many deep-fried calories. Monica Eng writes,
It's 7 p.m. and your tots are cranky and hungry. Where can you go for a fast kids meal that won't make you feel like a bad parent?
Not many restaurant chains, according to a report from the Center for Science in the Public Interest that was released Monday. The CSPI study found a whopping 93 percent of all kids meals offered by 13 top chains contain too many calories. In fact, several meals hover around the 1,000-calorie mark, far above the roughly 430-calorie-a-meal recommendation from the Institute of Medicine for sedentary children 4 to 8 years old.
With so many restaurants called out for heavy use of soft drinks and fried foods on so many of their children's meals, it can be tough to guide your child's dining choices. But at least one dietitian points out that there are smart ways to eat at chain restaurants.
"Don't be too alarmed even when [studies] come out and seem hopeless," said Dawn Jackson Blatner, an American Dietetic Association spokeswoman. "With a few swaps and switches, people really can make healthier choices at these fast-food joints, especially when the decisions are made before going in.
"Many of these restaurants have the nutrition information online that you can print out and go over with your kids even before you go, so that everybody is on the same page before they pull up to the drive-through or [head] to the counter," Blatner said.
Wednesday, August 6, 2008
The Washington Post reports that the CDC has found the average wait time in hospital emergency rooms to be about one hour. This wait is largely due to the increase in emergency visits, the drop in the number of hospital emergency departments, and the limited number of hospital beds. Mike Stobbe writes,
The average time that hospital emergency rooms patients wait to see a doctor has grown from about 38 minutes to almost an hour over the past decade, according to new federal statistics released Wednesday.
The increase is due to supply and demand, said Dr. Stephen Pitts, the lead author of the report by the Centers for Disease Control and Prevention.
"There are more people arriving at the ERs. And there are fewer ERs," said Pitts, an associate professor of emergency medicine at Atlanta's Emory University.
Overall, about 119 million visits were made to U.S. emergency rooms in 2006, up from 90 million in 1996 _ a 32 percent increase.
Meanwhile, the number of hospital emergency departments dropped to fewer than 4,600, from nearly 4,900, according to American Hospital Association statistics.
Another reason for crowding is patients who are admitted to the hospital end up waiting in the ER because of the limited number of hospital beds, Pitts added.
A shortage of surgical specialists also contributes. So, too, does the difficulty many patients have in getting appointment to doctor's offices _ which causes some to turn to emergency departments, experts said.
The Washington Post reports on a study that finds Americans are drinking less alcohol, with middle-aged people consuming about one-third less than 50 years ago. Steven Reinberg writes,
Overall, Americans are drinking less beer, but more wine, while consumption of hard liquor has remained fairly constant. Also, more people say they don't drink, and those born later in the 20th century are more moderate drinkers than their parents.
"It looks like moderate drinking has been increasing, heavy drinking is down a little bit, and total alcohol consumption is down a little bit," said lead researcher Dr. R. Curtis Ellison, a professor of medicine and public health at Boston University School of Medicine.
"It is encouraging news that more people are drinking moderately, and the average intake is coming down rather than shooting up," he said.
For the study, Ellison's team collected data on 8,000 people who took part in the Framingham Heart Study. People in the initial arm of the study were born before 1900 up until 1959. Those from the initial enrollment group as well as their children were interviewed every four years from 1948 to 2003 about their alcohol consumption.
The New York Times reports that patients with diabetes who took Byetta, an injectable drug that lowers blood sugar, had a much lower chance of dying that those who took any other drug. Alex Berenson writes,
Can Byetta, an injectable drug that lowers blood sugar, really help people with diabetes to live longer?
Possibly, according to the results of a major clinical trial presented at the American Diabetes Association annual conference. In the trial, called Accord, patients with Type 2 diabetes were prescribed Byetta or any of several other diabetes medicines. Patients who took Byetta had a much lower chance of dying, about 75 percent lower, than those who took any other drug.
The finding, presented in June, has generated a stir among diabetes researchers, although so far it has attracted little public notice. Neither Eli Lilly or Amylin, the companies that jointly market Byetta, is publicizing the findings, in part because no one is sure whether the reduction in the death rate is real or a chance finding. Only about 825 patients in the 10,000-patient Accord trial took Byetta, and those who did were likelier to be healthier than other patients.
“We don’t know whether it’s the drug or the healthy participant,” said Dr. Michael Miller, professor of biostatistics at Wake Forest University and the lead statistician on the Accord trial.
The trial’s finding came as a surprise even to Lilly and Amylin, said Dr. James Malone, the global medical director of Byetta for Lilly.
“We were not aware of the results before they were presented at A.D.A., and I was sitting in the audience and my jaw just dropped,” Dr. Malone said. The trials that Lilly and Amylin have conducted on Byetta, have not shown a reduction in mortality in patients taking the medicine, but they were not intended to do so.
Tuesday, August 5, 2008
The New York Times reports that a federal panel says side effects of cancer treatments and stress from false positives outweigh any potential benefit of cancer screening in men 75 and older. However, there's a backlash to this recommendation among some experts. Tara Parker-Pope writes,
In a move that could lead to significant changes in medical care for older men, a national task force on Monday recommended that doctors stop screening men ages 75 and older for prostate cancer because the search for the disease in this group was causing more harm than good.
The guidelines, issued by the U.S. Preventive Services Task Force, represent an abrupt policy change by an influential panel that had withheld any advice regarding screening for prostate cancer, citing a lack of reliable evidence. Though the task force still has not taken a stand on the value of screening in younger men, the shift is certain to reignite the debate about the appropriateness of prostate cancer screening at any age.
Screening is typically performed with a blood test measuring prostate-specific antigen, or PSA, levels. Widespread PSA testing has led to high rates of detection. Last year, more than 218,000 men learned they had the disease.
Yet various studies suggest the disease is “overdiagnosed” — that is, detected at a point when the disease most likely would not affect life expectancy — in 29 percent to 44 percent of cases. Prostate cancer often progresses very slowly, and a large number of these cancers discovered through screening will probably never cause symptoms during the patient’s lifetime, particularly for men in their 70s and 80s. At the same time, aggressive treatment of prostate cancer can greatly reduce a patient’s quality of life, resulting in complications like impotency and incontinence.
The Los Angeles Times reports that fewer patients are undergoing in-depth treatment as antidepressants and other drugs are more widely used. The shift is attributed partly to insurance reimbursement policies. Denise Gellen writes,
Wider use of antidepressants and other prescription medications has reduced the role of psychotherapy, once the defining characteristic of psychiatric care, according to an analysis published today.
The percentage of patients who received psychotherapy fell to 28.9% in 2004-05 from 44.4% in 1996-97, the report in Archives of General Psychiatry said. Researchers attributed the shift to insurance reimbursement policies that favor short medication visits compared with longer psychotherapy sessions, and to the introduction of a new generation of psychotropic medications with fewer side effects.
Although not a surprise to many psychiatrists, the findings were expected to intensify a debate over the increased medicalization of psychiatric care, which in part reflects an emphasis on the biology of mental illness, as opposed to the processes of the mind.
The Wall Street Journal reports that at the International AIDS Conference in Mexico City, Bill Clinton stressed "we must do more." Marilyn Chase writes,
"AIDS is a big dragon," Mr. Clinton said Monday, but unlike the mythical dragon slain by St. George, "this dragon must be slain by millions and millions of foot soldiers."
Basking in applause, Mr. Clinton recited some of his foundation's accomplishments, such as reducing the price of certain AIDS treatments for poor children to $60 a year from the $600 they cost three years ago.
But he also said much work still remains to counteract the high rates of babies born with HIV, the virus that causes AIDS, in many parts of the developing world. In the most desperate locales, the rates of mother-to-child transmission are as high as 15 times the rate in countries where pregnant women with HIV receive proper treatment.
The International AIDS Conference, sponsored by the International AIDS Society, drew more than 22,000 researchers, doctors, activists and members of the press to Mexico City for a week of science and strategy sessions on the global pandemic that has killed 25 million people since it began to emerge in 1981.
Monday, August 4, 2008
The Wall Street Journal reports that the House Energy and Commerce Committee wants the FDA to turn over the results of an analysis that possibly links the cholesterol drug Vytorin to incidents of cancer. Alicia Mundy writes,
The House Energy and Commerce Committee wants the Food and Drug Administration to turn over the results of an analysis looking into the potential links between cancer and the cholesterol drug Vytorin.
A report called the Seas study stunned investors and the medical community in late July, because researchers looking at Vytorin's efficacy in reducing cholesterol had unexpectedly found an increased risk of cancer and deaths from cancer in patients taking Vytorin, compared with those given a placebo.
At the time, the companies said they had funded an analysis of the Seas study by Richard Peto, an epidemiologist at Oxford University. The Oxford researchers, using data on 20,000 patients from two other continuing Vytorin studies, said the study's suggestions of a link to cancer is largely due to chance and "implausible."
The House Energy and Commerce Committee wants the Food and Drug Administration to turn over the results of an analysis looking into the potential links between cancer and the cholesterol drug Vytorin.
The Washington Post reports that the CDC has released an update on the AIDS epidemic saying that although the previous estimates of new cases of infections were wrong, new cases of infections have stabilized since 1998, demonstrating the effectiveness of prevention efforts. David Brown writes,
Updated federal estimates of the annual number of new HIV infections in the United States, released yesterday, reveal that although the AIDS epidemic here is worse than previously thought, prevention efforts appear to be having some effect.
Even though the number of Americans living with HIV has risen by more than a quarter-million people since 1998 -- largely because of life-extending antiretroviral drugs -- the number of new cases each year has declined slightly over that period. That suggests that a person's likelihood of transmitting the virus to someone else is substantially lower now than it was a decade ago.
The new, if indirect, evidence that prevention programs are paying off was one of the few encouraging findings in an update on the American AIDS epidemic released yesterday by the Centers for Disease Control and Prevention on the eve of the 17th International AIDS Conference, in Mexico City.
"Over 95 percent of people living with HIV are not transmitting to someone else in a given year," said David R. Holtgrave, an expert on AIDS prevention at the Bloomberg School of Public Health at Johns Hopkins University. "What that says is the transmission rate has been kept very low by prevention efforts."
Those include targeting public health messages to high-risk groups, promoting widespread AIDS testing, and getting quick medical care for newly diagnosed cases, which in most cases lowers the person's infectiousness.
Sunday, August 3, 2008
The Washington Post reports that as a result of its link to kidney and liver cancer and to reproductive disorders in fetuses, Congress recently approved a ban on a family of chemicals known as phthalates that are used in soft plastic toys and other baby products. The United States is one of the last industrialized nations to outlaw phthalates in children's products. Lyndsey Layton writes,
Samantha Rosenberg eyed the toy plastic cellphone that her 9-month-old daughter has chewed so much, the color is fading. She wondered if the shiny plaything, and others that fill her home, are endangering Addison's health.
Congress this week approved a ban on a family of chemicals widely used in soft plastic toys and other baby products. Health advocates say the compounds, known as phthalates, have been linked to kidney and liver cancer and to reproductive disorders in fetuses and infants, especially boys.
Toymakers and the chemical industry ran an expensive lobbying campaign trying to block the legislation, arguing that phthalates have been used commercially since the 1950s, that they are safe and that the ban is an overreaction.
Rosenberg and other consumers are not sure what to think.
"Am I being neurotic, or is it really not safe?" Rosenberg, a 30-year-old District resident, said about the toy cellphone. "It just gets compounded, because everything is plastic and made in China. You end up worrying about lead paint, plastics, all these things our parents never worried about."
Her questions are echoed by millions of parents who feel overwhelmed by conflicting information and are struggling to strike the right balance. For those discussing toy safety at neighborhood playgrounds, in Internet chat rooms and in the toy aisles of big-box stores, every plastic geegaw has grown suspect.
The New York Times reports that because Medicaid does not cover long-term care for illegal immigrants or for newly arrived legal immigrants, many American hospitals are taking it upon themselves to repatriate seriously injured or ill immigrants because they cannot find nursing homes willing to accept them without insurance. Deborah Sontag writes,
High in the hills of Guatemala, shut inside the one-room house where he spends day and night on a twin bed beneath a seriously outdated calendar, Luis Alberto Jiménez has no idea of the legal battle that swirls around him in the lowlands of Florida.
Shooing away flies and beaming at the tiny, toothless elderly mother who is his sole caregiver, Mr. Jiménez, a knit cap pulled tightly on his head, remains cheerily oblivious that he has come to represent the collision of two deeply flawed American systems, immigration and health care.
Eight years ago, Mr. Jiménez, 35, an illegal immigrant working as a gardener in Stuart, Fla., suffered devastating injuries in a car crash with a drunken Floridian. A community hospital saved his life, twice, and, after failing to find a rehabilitation center willing to accept an uninsured patient, kept him as a ward for years at a cost of $1.5 million.
What happened next set the stage for a continuing legal battle with nationwide repercussions: Mr. Jiménez was deported — not by the federal government but by the hospital, Martin Memorial. After winning a state court order that would later be declared invalid, Martin Memorial leased an air ambulance for $30,000 and “forcibly returned him to his home country,” as one hospital administrator described it.
Since being hoisted in his wheelchair up a steep slope to his remote home, Mr. Jiménez, who sustained a severe traumatic brain injury, has received no medical care or medication — just Alka-Seltzer and prayer, his 72-year-old mother said. Over the last year, his condition has deteriorated with routine violent seizures, each characterized by a fall, protracted convulsions, a loud gurgling, the vomiting of blood and, finally, a collapse into unconsciousness.
“Every time, he loses a little more of himself,” his mother, Petrona Gervacio Gaspar, said in Kanjobal, the Indian dialect that she speaks with an otherworldly squeak.
Mr. Jiménez’s benchmark case exposes a little-known but apparently widespread practice. Many American hospitals are taking it upon themselves to repatriate seriously injured or ill immigrants because they cannot find nursing homes willing to accept them without insurance. Medicaid does not cover long-term care for illegal immigrants, or for newly arrived legal immigrants, creating a quandary for hospitals, which are obligated by federal regulation to arrange post-hospital care for patients who need it.