Wednesday, February 28, 2007

HIV and the Law

Edwin J. Bernard writing for Aidsmap (February 28, 2007) reports

Scientific evidence alone cannot prove liability in criminal HIV transmission cases

Reviewing the situation in the UK, he notes a briefing paper published today jointly by NAM and the National AIDS Trust (NAT) explains why criminal investigations of alleged sexual HIV transmission cannot be proved conclusively by scientific evidence alone. HIV Forensics: The use of phylogenetic analysis as evidence in criminal investigation of HIV transmission is aimed at virologists and other potential expert witnesses as well as people working in the criminal justice system, but may also be useful for those supporting HIV-positive individuals as either potential complainants or defendants.

Two expert virologists – Anne-Mieke Vandamme of Belgium’s Rega Institute for Medical Research, and Anna Maria Geretti of the Department of Virology, Royal Free Hospital, London – are co-authors of the paper, which focuses on how and why phylogenetic analysis cannot be used as the main, or only, proof that one person infected another in prosecutions for HIV transmission.

Dr Geretti served as an expert witness for the defence in the first – and so far only – criminal HIV transmission trial to end with a ‘not guilty’ verdict. The case collapsed after Dr Geretti explained the limitations of the phylogenetic analysis evidence presented by the prosecution as ‘proof’ that the defendant infected the complainant.

Phylogenetic analysis is a complex scientific process used in molecular epidemiology. An individual strain of HIV can be examined in great detail by analysing its genetic code (RNA). By examining very small differences in different parts of HIV’s RNA (obtained via gene sequencing), it is possible estimate how these HIV strains are genetically related. This involves the use of computational tools to create a hypothetical diagram (known as a phylogenetic tree). However, this method is unable to create a definitive ‘match’ because HIV, unlike human DNA samples or fingerprints, is rapidly evolving.

Even with appropriate comparison samples, phylogenetic analysis cannot ‘prove’ that HIV transmission occurred directly between two individuals. Other possibilities may include:

  • The complainant was infected with a similar viral strain by someone from the same transmission network (i.e. individuals that have had sex partners in common, whether or not they are aware of this).
  • Both the complainant and person under investigation were independently infected with similar viral strains by a person or people from the same transmission network.

Even if phylogenetic analysis suggests that the two viruses are very closely related, this does not provide enough information to know the direction or timing of the alleged transmission (i.e. who might have infected who; or who might have been infected first). Additional detailed samples and complex full genome analysis would be necessary to produce relevant data.

Nevertheless, if phylogenetic analysis is carried out rigorously, it is reliable enough to show that the virus from the person under investigation and the complainant are not closely related to each other. In other words, phylogenetic analysis can exonerate the person being investigated.


The NAM/NAT Briefing Paper –
HIV Forensics: The use of phylogenetic analysis as evidence in criminal investigation of HIV transmission

Link to pdf copy of the report

Link to Aidsmap article

Drug 'stops HIV's entry to cells'

As we said last week, the Conference on Retroviruses and Opportunistic Infections in Los Angeles is the venue for the unveiling of some promising new HIV treatments.

One of these is Pfizer's Maraviroc - which acts as a block to the CCR5 receptor, the "doorway" which HIV uses to get into CD4-T-cells. The 24-week safety study looked at 1,000 patients, all taking their standard medications. Half were also given Maraviroc while the rest were given the placebo version. A quarter of those in the placebo sectionof the study were found to have undetectable viral loads at the end of the study, compared with almost double that number in the group taking Maraviroc. Those taking the drug also had a higher CD4 count.

Michael Carter, from the UK's National Aids Manual (Aidsmap) reminds us that the drug was the first in a new class to reach this stage of research. Another group of drugs, led by Merck's Raltegravir aim to stop HIV integrating into cells.

Keith Alcorn & Michael Carter report for Aidsmap, February 28, 2007

Link to Aidsmap article


Efficacy and safety of maraviroc plus optimized background therapy in viremic ART-experienced patients infected with CCR5-tropic HIV-1: 24 week results from a phase 2b/3 study in the US and Canada.
Lalezari J et al.

14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, abstract 104bLB, 27thFebruary, 2007.

Efficacy and safety of maraviroc plus optimized background therapy in viremic ART-experienced patients infected with CCR5-tropic HIV-1 in Europe, Australia and North America: 24 week results.
Nelson M et al.

14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, abstract 104aLB, 27thFebruary, 2007.

HPV Vaccination or Health Care?

Ralph W. Moss (director of online information service writing in New Scientist (February 24, 2007) in

Health checks, not shots

argues that blanket vaccination against a sexually transmitted virus is the wrong way to protect women's health. He raises the fundamental question.

Is this the best way to spend scarce health dollars? Merck charges $360 for a series of three Gardasil injections. Administering the injections will add 18 to 25 per cent to this cost. Nationwide, the cost of vaccinating American girls with Gardasil will amount to some $800 million a year.

Whether or not you agree with is cost benefit analysis, it is certainly troubling that Merck has such a financial interest in driving this program. As Moss writes

Rather than administer high-tech vaccines to pre-pubescent girls [not to mention the increasing demand for boys and gay men], it would make more sense to allocate the money this would cost tax payers to increasing the provision of basic gynecological services to the underprivileged. This may not as attractive to the pharmaceutical companies, buy it is a better way of caring for women in the US and elsewhere.

Link to New Scientist article [subscription required]

Steve Bell - The Guardian

Tuesday, February 27, 2007

Boundaries for Malaria

C. Claiborne Ray wrote a piece for the Health Section in today’s New York Times answering

Why don't Alaskan mosquitoes spread malaria?

Before you say, “Who cares?” [we do know that has been the response from many about the HIV/ Malaria issue] remeber this

While there is no risk of malaria in Alaska, the C.D.C. warns that there is a chance that some comparatively cool places that now have no malaria because of public health measures may face a recurrence. Plasmodium vivax, a malaria variety that is more tolerant of lower temperatures, is found in some cooler regions, along with Anopheles mosquitoes that can transmit malaria.

Link to NYTimes article


Post Oscar Buzz

Rumor has it that Dame Helen Mirren has been invited to lunch with the Queen at Buckingham Palace --- Oh, Yes Ma'am.

Peter Brookes's cartoon from the Times

Sunday, February 25, 2007

The Other Side of Culture

We offer you Sir Les Patterson, Australian Cultural Attaché and nemesis to the refinement of Dame Edna Everage. Before you ask, yes it did appear on television in Britain. If you are wondering how --- ask yourself why on earth the two female guests agreed to appear. Did they, as appears in the case of little Claire Raynor, think they could manage Sir Lez or do they just not get it?

Padded cells

If you want to send someone a bit of brain through the post, use a Staples postal bag. According to the company's online catalogue: "These padded postal bags are the ideal choice for those items that need that added protection, or for that extra piece of mind."

From issue 2591 of New Scientist magazine, 17 February 2007

History's judgement


Saturday, February 24, 2007

Oscar Season

For those who just cannot get enough of the Oscars (or even if you just appreciate real talent), Annie Leibovitz’s 2007 Hollywood portfolio Killers Kill, Dead Men Die; appears in the current edition of Vanity Fair (March 2007). Their website also includes a slide show and behind the scenes videos

Tired of the Oscar buzz? This edition also includes more serious stuff like Washington's $8 Billion Shadow where Donald L. Barlett and James B. Steele look at SAIC, the biggest and most powerful of the "body shops”, which employs 44,000 people and took in $8 billion last year—selling brainpower, including a lot of the "expertise" behind the Iraq war.

Link to Vanity Fair

There is also a report by Steven Daly --- Pirates of the Multiplex---on the U.S.-led attempt to shut down the Pirate Bay, the popular site for illegal trading of video files

Under U.S. pressure, Swedish authorities are going after the popular Pirate Bay Web site for illegal distribution of video files. But, he argues, if Hollywood wants to stop online pirates—who cost the industry some $7 billion in 2005—it needs to join them, not beat them.

Link to Pirates of the Multiplex article

Ooh, it's like a drug

The BBC News on line in the item

Smoking alters brain 'like drugs'

reports on the results of a study by US researchers published in the Journal of Neuroscience, that indicated smoking causes changes to the brain which are evident years after someone has quit. And that cigarettes causes the same changes to the brain as using illicit drugs like cocaine, which explains why why smokers find it hard to stop - and why they often relapse.

The researchers from the National Institute on Drug Abuse (Nida) compared post-mortem brain tissue samples from smokers, former smokers and non-smokers. They looked at samples of human brain tissue from the nucleus accumbens and the ventral midbrain - brain regions that play a part in controlling addictive behaviours.

Eight samples were taken from people who had smoked until their deaths, eight from people who had smoked for up to 25 years before their death and eight non-smokers.

The scientists looked at levels of two enzymes - protein kinase A and adenylate cyclase. Both translate chemical signals, such as dopamine, which exist outside the cells, into a form that can be understood inside.

Smokers were found to have higher levels of these enzymes in the nucleus accumbens, a part of the brain that processes information related to motivation and reward, which virtually all illicit drugs act upon.

But levels of both enzymes were also found to be high in the area of the midbrain that responds to dopamine, which acts as a "reward chemical" in smokers and former smokers.

Link to BBC News.story


Long-Term Upregulation of Protein Kinase A and Adenylate Cyclase Levels in Human SmokersBruce T. Hope et al
The Journal of Neuroscience, February 21, 2007, 27(8):1964-1972,

Link to Journal of Neuroscience abstract

Gay men seek 'female cancer' jab

Michelle Roberts BBC News health reporter writes

Homosexual men are requesting a controversial "sex disease" vaccine designed to prevent a female cancer.

This is in the context of the growing frenzy (and controversy) of the use of the HPV vaccine Gardasil for men. Gardasil protects against the most common of sexually transmitted infections, human papillomavirus (HPV), which can cause cervical cancer. But HPV also causes genital warts and anal and penile cancer, and men are seeking protection against these.

Many private clinics are offering it to men. One in London says it has immunized dozens in the last six weeks. In the UK Gardasil is licensed for boys and girls aged nine to 15 and women aged 16 to 26. But doctors can opt to give it to other people "off licence" if they wish. Dr Sean Cummings at the Freedom Health clinic in Harley Street said he was happy to recommend Gardasil to his adult men, at £450 for a three-dose course. "We've had a strong demand for it. I had a man come in for the vaccine this morning. He was 24. Then I have one this afternoon who is 67 years old.

Opponents say there is no point in immunizing people who are already sexually active. Merck is currently testing the vaccine's efficacy in 4,000 men, including 500 men who have sex with men. US National Institute of Health is also carrying out trials to see what benefits it could have for people with HIV.

Link to BBC News on line story

Friday, February 23, 2007

Condom Applicator: "Passion filler, not passion killer"


On the wire, Reuters Life! announces

S. Africa condom device wins 'most beautiful' award

They report that a South African-designed applicator, which puts a condom on a man with ease in less than three seconds, has been named the "most beautiful object" at the Design Indaba Beautiful Objects Exposition in Cape Town.

Roelf Mulder's plastic condom applicator won top prize beating out 14 other products, including an ultra-modern pre-fabricated house. Wrapped in a serrated package that is split open with the help of two thumb-sized handles inside a foil wrapper, the applicator places a pre-loaded condom that slides over an aroused penis to its base. The applicator then pops off.

The entire procedure takes less than three seconds, according to Mulder, who claims that it would virtually eliminate the possibility of tearing a condom or putting one on the wrong way. Although not yet on the market, the condom applicator will be priced at between 25 and 30 rand ($3.50 to $4.25) for a pack of three, about the same price as other condoms.

There is also a report on IRIN PlusNews with pictures and design links.

Link to PlusNews report

Resistant HIV - New Drugs

Deena Beasley and Ransdell Pierson writing for Reuters AlertNet (23 Feb 2007) report

New AIDS drugs aim to combat resistant HIV strains

Data from several clinical trials will be unveiled at a conference of leading HIV researchers ---the 14th Conference on Retroviruses and Opportunistic Infections to be held at the Los Angeles Convention Center next week.

"There is a confluence of new drugs in the pipeline that people are pretty excited about," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

These include next-generation versions of longstanding HIV fighters as well as drugs that combat the virus through innovative mechanisms, including blocking it from entering immune system cells.

About half of U.S. patients treated for infections with HIV have stopped responding to at least one drug, according to Dr. John Mellors, chief of infectious diseases at the University of Pittsburgh.

Resistance is becoming a problem because the virus can mutate, particularly if patients fail to rigorously follow complicated drug regimens.

Link to AlertNet report

HIV and Circumcision

Writing for the New York Times (February 23, 2007) Donald G. McNeil Jr. reports

Circumcision’s Anti-AIDS Effect Found Greater Than First Thought

The final data from the studies in Kenya and Uganda indicate routine male circumcision could reduce a man's risk of HIV infection through heterosexual sex by 65%. The results are published in the current issue of the Lancet (February 23, 2007)

Link to New York Times article

The full text of the Lancet Report is available on line [Subscription is required] but the audio summary is open.

Link to the Lancet

Thursday, February 22, 2007

Craig Ferguson explains

Resistant TB

Debora Mackenzie reports in New Scientist (17 February 2007) on

Race to beat killer drug-resistant TB

There could be much more XDR-TB out there. Very few TB cases in poor countries are being tested for resistance and many XDR infections may be "latent" without symptoms.

It has also been estimated that half of XDR patients did not breed resistance by skipping medications but caught resistant bacteria to start with.

The TB Alliance has announced funding for the Institute of Materia Medica in Beijing to seek new drugs (in the class riminophenazines). The Alliance also has two more new drugs heading for trials --- moxafloxacin and PA824

Link to New Scientist article [subscription required]

Vaccines for the poor

This report comes from New Scientist (Febuary 17, 2007)

Persuading Big Pharma to make vaccines for the poor

How can pharmaceutical companies be persuaded to develop vaccines for diseases of the poor, when poor people can't afford to buy them? The not-for-profit Global Alliance for Vaccines and Immunisation (GAVI) and the World Bank have come up with a solution: rich countries should give money to poor countries to pay for the vaccines in advance.

This "Advance Market Commitment", launched in Rome on 9 February, has so far received $1.5 billion in donations from Canada, Italy, Norway, the UK, Russia and the Bill and Melinda Gates Foundation, to spur the development of new vaccines for pneumonia and meningitis caused by the pneumococcus bacterium.

Wednesday, February 21, 2007

To break a butterfly

Craig Ferguson the host of CBS Late Late Show did an unusual monologue the other night. As a "sinner" himself, he confronted the now commonplace trend of going after the vulnerable. You can watch it on CBS's site or on Youtube but we cannot show it because "Embedding disabled by(CBS) request".

At best we passively sit back and watch the weak get trashed and at worst take pleasure in their misfortune. Meanwhile, the powerful seem to be able to shrug off criticism in the same way as they have learned to do with responsibility. If only from a pragmatic viewpoint, this is screwed up. It benefits the powerful (and unaccountable) to have the spotlight focused on Anna Nicole or Brittany.

It was the poet and satirist Alexander Pope who answered complaints from his physician (Dr Arbuthnot) that he was attacking influential people with a poem that includes the line

Who breaks a butterfly upon a wheel?

Of course, we wonder how guilty we are. Our rants and raves have offered plenty of critical observations. We think our intent has been to focus on the figureheads and suggest that they take responsibility. How successful we have been, others can judge for themselves. We hope no butterflies were damaged in the process.

There is another historic occasion when the quote was used by The Times in its lead editorial. In those far off days of 1967 it was still a powerful voice for the British establishment. So it was a surprise to have the editor of the Times criticizing as excessive the sentencing of the Rolling Stones to Jail time for possessing pot. It seemed dramatic back then but it was actual only 3 months in prison and even that was overturned.

Now we live in different times. So a young man can languish in prison under a ten year sentence for having consensual oral sex with a teenage female ----even after the state legislature has decided that this should no longer be a felony.

History Lesson

Tuesday, February 20, 2007


Published in theNew York Times: Health Section (February 20, 2007) as

Flame First, Think Later: New Clues to E-Mail Misbehavior

Daniel Goleman’s (author of “Social Intelligence: The New Science of Human Relationships.”) essay explores Flaming which, he explains has a technical name, the “online disinhibition effect,” which psychologists apply to the many ways people behave with less restraint in cyberspace. The hallmark is: thoughts expressed while sitting alone at the keyboard would be put more diplomatically — or go unmentioned — face to face.

In his reviewing a range of studies and expert observations, he cites how flaming can be induced in some people with alarming ease. This is demonstrated in an experiment, reported in 2002 in The Journal of Language and Social Psychology, in which pairs of college students — strangers — were put in separate booths to get to know each other better by exchanging messages in a simulated online chat room. While coming and going into the lab, the students were well behaved. But the experimenter was stunned to see the messages many of the students sent. About 20 percent of the e-mail conversations immediately became outrageously lewd or simply rude.

But who doesn’t have apocryphal stories (or even personal experiences) of the impact of the power of solitary expression?

Link to NYTimes essay


Linguistic Style Matching in Social Interaction
Kate G. Niederhoffer & James W. Pennebaker

Journal of Language and Social Psychology, Vol. 21, No. 4, 337-360 (2002)

Link to JLSP abstract


The Times

The Guardian

Sunday, February 18, 2007

Sex Ed

Ooh, Vicar!

News from the Anglican Bishop's meeting in Dar Es Salaam, as APreports ---

Anglican Leaders Snub Episcopal Head At Tanzania Summit

During the week it was bishops who "refuse to sit down" with The Most Reverend Katharine Jefferts Schori, D.D., Ph.D, Presiding Bishop of The Episcopal Church in the USA. and (not incidentally I imagine!) the first woman elected primate in the Anglican Communion. The latest report from Dar Es Salaam is seven conservative Anglican leaders refused Friday to take Holy Communion with the head of the U.S. branch of the church, who supports ordaining gays and blessing same-sex unions. The demonstrators all belong to a group known as the Global South - theologically conservative bishops from Africa and elsewhere who have joined forces to expand their influence within the communion and counter liberal-leaning Anglicans

Conservative Anglicans have formed a rival network in the U.S., under the leadership of Anglican Archbishop Peter Akinola of Nigeria, who has called the acceptance of gay relationships a "satanic attack" on the church. He was among those who refused to have Holy Communion with her.

The Press Statement by the Global South bishops appears on the Church of Nigeria website (a visit there is a time warp experience in itself). I couldn’t help thinking how “political” the whole thing feels. Sadder, is the way in which they have deformed tradition and theology to justify this tarnishing of a source of comfort and enlightenment --- let alone politicizing the sacrament. It seems to have the taint of the “sin against the Holy Ghost” --- the “unforgivable” sin. But of course saying that puts me in danger of following their new tradition of making rifts even deeper.

Link to the Church of Nigeria site

I wanted to add a musical version of

There's a hole in your Church, dear Henry, dear Henry

but I was told nobody would get it! But perhaps this is what they really mean by the Anglican Tradition --- if you don't like the situation, break away, start your own church. This is where we came in dear Henry! Or I suppose we could really go back to origins and declare her a heretic and burn her

For us, it’s an Oprah-ism, “You go girl

No hymns, instead we dedicate this to the Archbishop of Nigeria and his followers in Southern Comfort (--- sorry, Global South).


Saturday, February 17, 2007


This is not a new video but the message is as current as ever. We also thought that it shows --- very graphically --- another side of Sero Sorting.

Prison science ?

Peter Aldhous writing for the NewScientist (10 February 2007)

Criminal justice: are you ready for the science bit?

is responding to British Home Secretary John Reid's claims that "projecting the prison population is never an exact science". Aldhous suggests a visit to Washington state, which has been using scientific principles to try to avoid Reid's prison overcrowding crisis.

Washington may need three new prisons by 2030 if its jail population follows current trends. But with each prison costing $250 million to build and $45 million per year to run, are more jails the best option? To find out, politicians have turned to the Washington State Institute for Public Policy (WSIPP), which has embraced "evidence-based" criminal justice.

WSIPP's approach mirrors the "systematic reviews" that are helping to turn clinical medicine into a rigorous science. WSIPP has compiled studies on interventions to reduce crime, and then conducted statistical meta-analyses to see which have the biggest effects. It has also calculated the cost of each intervention, and their financial benefits in terms of reduced crime.

The conclusions are striking. Some interventions with young offenders are particularly effective: "multidimensional treatment foster care" (MTFC), in which juvenile offenders are placed with foster families and treated with behavioral therapy, reduces crime by an average of 22 per cent, giving a net benefit of almost $78,000 over 13 years, per offender treated. By contrast, there is no evidence that electronic tagging of adult offenders to offset jail time helps prevent crime.

Incarcerating more criminals does have a positive effect: WSIPP calculates that boosting the prison population by 10 per cent can cut crime by up to 4 per cent. However, it is expensive, and the returns diminish as more offenders are put inside. So WSIPP has put forward a portfolio of alternative policies designed to stabilize the state's prison population at current levels, including treatment for drug addicted prisoners and multidimensional treatment foster care (MTFC). This would leave Washington about $1.4 billion better off by 2030 compared with the business-as-usual approach of building new prisons.

WSIPP: Current Institute Projects
Link to WSIPP site

Link to New Scientist article

Thursday, February 15, 2007

Artificial Intelligence

History's Lessons?

Why is there so much room in the life boats, Dad?

I suppose nobody told the people on deck and anyway they still probably believed the Titanic was unsinkable.

Why didn't somebody tell them the truth Dad?

Well, I suppose they didn't want everyone to panic. Their self-esteem must have been wonderful when they calmly stood on deck as the ship's orchestra played Abide With Me.

But, Dad, they were drowning?

Dad? . . . . What's a Pandemic . . . .?

antibody-based HIV vaccine?

The BBC on line, in the report

Scientists expose HIV weak spot Scientists have shown what happens when an infection-fighting antibody attacks a gap in HIV's formidable defences.

explains the National Institute of Allergy and Infectious Diseases (NIAID) research team's view that the work could advance HIV vaccine development.

The researchers say they may have found the site on HIV’s outer coating that would be most vulnerable to antibodies that could neutralize the virus and prevent it from infecting human cells. Their work, using crystallizations and atomic-level photography, showing the antibody, b12, attacking part of a protein on surface of the virus. is published this week in the journal Nature.

HIV avoids attack by constantly mutating, but this protein segment is a weak spot because it remains stable. The virus is able to mutate rapidly to avoid detection by the immune system, and is also swathed by a near-impenetrable cloak of sugary molecules which block access by antibodies. But certain parts of the virus must remain relatively unchanged so that it can continue to bind to and enter human cells. A protein, gp120, that juts out from the surface of the virus and binds to receptors on host cells, is one such region, making it a target for vaccine development.

Previous analysis of the blood of people who have been able to hold HIV at bay for long periods has shown a rare group of antibodies - including b12 - that seem to fight HIV with a degree of success. This study has revealed the detailed structure of the complex, which is formed when b12 docks with gp120. The NIAID team was able to stiffen up the key protein enough to capture a picture of the complex. They hope that revealing the structure of this bond in such precise detail will provide clues about how best to attack HIV.

Link to BBC on line report

Keith Alcorn, for Aidsmap (February 14, 2007) also reviews the research in his report

HIV surface protein's weak point detected; new lead for antibody-based vaccine?

Link to Aidsmap report


Structural definition of a conserved neutralization epitope on HIV-1 gp120
Zhou T et al.

Nature 445, 732-737 (15 February 2007) | doi:10.1038/nature05580

Link to Nature abstract

Link to Nature’s news item

Dirty Harry

Daniel Radcliffe is all over the internet --- or at least his nude publicity shots for Equus. Add to that the report that he wants Harry Potter to die and you are almost at critical mass in the career of a young actor.

The "offending" remark was from his interview with Craig McLean in the Magazine section of the London Observer. Read it for yourself if you want the observation in context.

This is the tease (but it hardly does justice to the piece)

From speccy wizard to deranged stable boy, Daniel Radcliffe's trajectory from child actor to rising star of the stage couldn't be more different - or daring, says Craig McLean. But underneath the mature exterior of the nascent leading man is an ordinary teenager about to savour his first legal pint - not to mention his first nude scene.

Link to Observer Magazine Story

Wednesday, February 14, 2007

New York City's Official Condom

As part of
New York City's HIV prevention program the Health Department has a$1.57 million contract to deliver more than 20 million
Ansell Healthcare's Lifestyle condoms and packets of lubricants.

The campaign launch will take place at a Kenneth Cole store in Manhattan.
Kenneth Cole as also produces a T-shirt and boxer shorts as part of the campaign.

Link to NYC site

Just a thought! How
does this compare with other cities ---
say like
SEATTLE? Let's hope they
don't have Mayors
whose primary focus
is preventing
lap dances or
Public Health departments whose only message is
Wash Your Hands

medical marijuana study

Sabin Russell, Medical Writer for the San Francisco Chronicle (February 13, 2007) reports

Medical pot cuts pain, study finds First rigorous research looked at HIV patients

Dr. Donald Abrams, and colleagues at San Francisco General Hospital, in a study published in the journal Neurology reported that HIV-infected patients suffering from a painful nerve condition in their hands or feet obtained substantial relief by smoking small amounts of marijuana in a study funded by the state of California.

Medical marijuana advocates see it as the most solid proof to date that smoking the herb can be beneficial to patients who might otherwise require opiates or other powerful painkillers to cope with the condition known as peripheral neuropathy.

The study found that most volunteers who were given three marijuana cigarettes a day experienced a significant drop in their pain of peripheral neuropathy, which patients liken to a stabbing or burning sensation, usually on the bottoms of their feet. HIV patients are not the only group to experience peripheral neuropathy it can also afflict diabetics, cancer patients and people with injuries or infections that affect nerve tissue.

Because of the unusual nature of the experiment, Abrams first had to receive clearance from eight different government agencies, including the University of California, the federal Drug Enforcement Administration and the National Institute on Drug Abuse.

The cigarettes were made from marijuana grown on a federal marijuana farm in Mississippi, and stored in a locked freezer at San Francisco General.

Publication of the paper is a milestone for Abrams, who has been exploring the medicinal effects of marijuana among AIDS patients since 1984 and fought a long battle to win permission from federal agencies to conduct the study.

In the end, it took the taxpayers of California to pay for the research. Under legislation signed by then-Gov. Gray Davis in 1999, the state created the Center for Medicinal Cannabis Research, headquartered at UC San Diego and operating in partnership with UCSF.

Dr. Igor Grant, executive director of the research center, said a total of $8.7 million has been allocated to the program by the state Legislature since it was launched in 2000. Abrams' study, the first of a dozen similar clinical trials now under way, cost $849,000.


Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial
Abrams, MD et al
NEUROLOGY 2007; 68 :515-521

Link to Neurology abstract

Link to San Francisco Chronicle article

Tuesday, February 13, 2007

Happy Valentines

Beware the Holy Healers!

An Editorial in this morning’s New York Times (Published: February 13, 2007)

Doctors Who Fail Their Patients

draws attention to and comments on the research by Farr A. Curlin, M.D (and colleagues) of the University of Chicago which is published in the current edition of The New England Journal of Medicine. The researchers asked, by mailed questionnaires, some 2,000 doctors whether they had religious or moral objections to three controversial practices

The editorial says:

It was bad enough when pharmacists who call themselves pro-life refused to fill prescriptions for morning-after pills and an emergency medical technician refused to help drive a woman to an abortion clinic. Now a new survey has revealed that a disturbing number of doctors, at the presumed pinnacle of the health professions, feel no responsibility to inform patients of treatments that they deem immoral or to refer them to other doctors for care. Although the close-mouthed doctors claim a right to follow their consciences, they are grievously failing their patients and seem to have forgotten the age-old admonition to “do no harm.”

Of the 1,144 who responded, only 17 percent objected to “terminal sedation” to render dying patients unconscious, but 42 percent objected to prescribing birth control for adolescents without parental approval, and 52 percent opposed abortion for failed contraception.

The encouraging news is that substantial majorities thought that doctors who objected to a practice nevertheless had an obligation to present all options and refer patients to someone who did not object. But that left 8 percent who felt no obligation to present all options and an alarming 18 percent who felt no obligation to refer patients to other doctors. Tens of millions of Americans probably have such doctors and are unaware of their attitudes.

The researchers put the burden on patients to question their doctors upfront to learn where they stand before a crisis develops. But that lets doctors off the hook. Physicians have a right to shun practices they judge immoral, but they have no right to withhold important information from their patients. Any doctors who cannot talk to patients about legally permitted care because it conflicts with their values should give up the practice of medicine.

Link to New York Times editorial


Religion, Conscience, and Controversial Clinical Practices Farr A. Curlin, M.D. et al New England Journal of Medicine Volume 356:593-600 Number 6

Link to NEJM abstract

Bird Flu

a Pugh cartoon (from the London Times)

Monday, February 12, 2007

Mean what you say?

Raves from Lulu's

We were talking last night about old movies. Someone remembered Who's Afraid of Virginia Woolf? and Honey, the young woman guest at the nightmare dinner party, who says she would like to powder her nose. George, the host, turns to his wife and says, "Martha, won't you show her where we keep the euphemism?"

The Englishman told us about his favorite euphemism. As a youngster he watched televised Rugby League (some kind of British football, I believe). As a player was being sent off after a dire foul, the commentator Eddie Warring, would announce, in a broad north country accent, "Well, that's an early baath."

This led us to recollections of childhood brush offs. Who didn't hate "Gone to see a man about a dog" or the infuriating response to an enquiry about where someone was going - "Timbuktu."

Of course, euphemisms have also been life savers. Some of us remember when recommending good "tea rooms" was more a question of safety rather than affectation. Now we can be more blunt. But often, the Drag Queen's - Oh, Pleeeze! (drenched in meaning) conveyed much more than the current "Fuck you, Bitch".Indeed, they can be deadly (Don't ask, don't tell maybe?) and have been so.

Quentin Crisp, a great believer in euphemisms, offered them as "unpleasant truths wearing diplomatic cologne". The problem comes if we think the appearance is the truth.

Unfortunately, there is no more relevant example than the current Prevention philosophy of calling risky behaviors "risk reducing strategies" and relabeling stark realities like Bare Backing with psycho-medico' descriptions like "serosorting". But the current PR attempts to deal with the issue of Resistant HIV are even worse. Doesn't it strike anyone as remarkable when the Prevention Players attempt to marginalize individuals and groups with the notion that they are only throwaway partyers? Wouldn't this be a real "de-gaying" of AIDS? In the early activist days many died in the struggle to demolish the myth of the "innocent victims" of HIV (as opposed to the "guilty" ones --- you can figure out who those were) But even if you adopt this judgmental stance, they (WE!) all still need to be told and told and told! Do you recall the judgment that came out of Tina's Office last year when they made such fools of Seattle in the dispatches from the Toronto AIDS Conference? The claim was that their clients didn't want to know about this kind of information. Hasn't that come back to bite them? Unfortunately, it is the clients (and the rest of the population) that are getting bitten --- not the Prevention Players.

Now, once again, Tina is bleating that ther isn't enough money to do the job. Which she wasn't saying, of course, having raked in all the donations after the best ever AIDS Walk. I would dearly like to know what they actually do but I won't hold my breath for an answer to that. What I do want is for her to keep her promise (which is, incidentally, restated constantly in their website claim as the premiere North West Prevention Agency. Spend the money people gave you, Tina.