Saturday, March 31, 2007

Why The World Hates Us

Who is killing the cheese?


Fans of the Internet site cheddarvision.tv, have been watching a 44-pound round of cheddar cheese mature 24 hours a day since January 1. It is anticipated that it will take a year for it to fully mature. The site has counted more than 500,000 hits. The camera was set up in a farmhouse by the West Country Farmhouse Cheesemakers, Somerset farmers who produce handmade cheddar.

On the other hand, if you live in Seattle (and nowadays most cities, probably) you could visit your local supermarket and watch the cheese suffocate. The handlers who run the "Deli Cheese Counters" seem to have forgotten that cheese is a living organism. Wrapped in cling film it slowly suffocates. English Stilton is a typical example. Instead of being a pale creamy crumbly blue veined delight, it dries and turns that dirty brown shade under its plastic seal. Those prearranged wedges might save time but they kill the cheese.

Link to cheddarvision.tv

Organs for Sale

In a macabre description of the growing medical tourism industry, the current edition of Wired offers a world map together with prices for body parts - ranging from the cheapest --- a $15,ooo kidney in Pakistan --- to the most expensive ---- $290,000 for lungs, livers, or hearts in various locations!

Link to Wired article

Friday, March 30, 2007

The Slavery Apology

To Die Well

Sidney Wanzer is a Massachusetts doctor who for years has spoken out for the rights of dying patients. He has co-authored To Die Well which is published on 30 March.

The battle to have his mother's wishes honored at the end of her life gave him personal insight into the rights of the dying.

When I got the news that my 92-year-old mother had had a pacemaker installed to treat an abnormal heart rhythm, I was aghast. She had not wanted to go on living, but the Alzheimer's disease that had trapped her in an undignified, meaningless existence for several years prevented her from protesting. Her living will, written well before the onset of her senility, stated explicitly that if there was no expectation that she would return to a dignified state, she did not wish invasive medical procedures. But her doctor had not paid attention. My brothers and I had not been told what was going on and therefore could not step in to help her. The doctor, without consent - my mother could not give it in her state of senility - had gone ahead unilaterally, consulting no one.

This was 20 years ago, but still appalling even by the paternalistic standards of that time. His action denied my mother a relatively quick cardiac death, which, with morphine, would not have been unpleasant and would have released her from her indignity. What the doctor had done was medical assault, and my brothers and I were furious. We fired him, but the damage had been done. She lived on for another five years, robbed of her dignity and autonomy.

He reminds us that it is a continuing problem that the doctor may still not really listen to what the patient wants. The old paternalistic approach - that doctor knows best - can rear its head and replace what should be decision-making that is shared among the patient, family and doctor.


To Die Well: Your Right To Comfort, Calm And Choice In The Last Days Of Life
Sidney Wanzer, M.D and.Joseph Glenmullen, M.D.

Da Capo Press, Lifelong Books $24, ISBN 9780738210834)

Link -- To Die Well site

Kenneth Williams recalls Dame Edith Evans

Thursday, March 29, 2007

A New Immune System?

The New Scientist (24 March 2007) in

First step to new immune system

reports an artificial lymph node has been transplanted into mice and produced an immune response. It is a first step towards rebuilding the immune systems of people with AIDS or cancer.

Researchers led by Takeshi Watanabe at the RIKEN Research Center for Allergy and Immunology in Yokohama, Japan, used a "bioscaffold" made of collagen impregnated with cells from the thymus gland of newborn mice. First they transplanted the nodes into normal mice, where they acquired white blood cells. Then they put the nodes into mice with no working immune system, where the white blood cells migrated to the animals' own lymph nodes.


reference

Artificial lymph nodes induce potent secondary immune responses in naive and immunodeficient mice
Noriaki Okamoto et al

J. Clin. Invest. doi:10.1172/JCI30379.

Link to JCI abstract


Link to RIKEN’s site

Worth a visit if only to see the Gallery

Internet privacy


Google is no longer to store as much personal information on us.

To help it personalize searches and target adverts, Google keeps an indefinite log of all searches and the IP addresses of the users who make them. Those logs will now be made anonymous after 18 to 24 months, making it harder to connect records to individuals, the company said last week.

"It's an important concession, but we hope it's just a first step," says Kevin Bankston, a lawyer for the privacy group Electronic Frontier Foundation, based in San Francisco. The move is likely to put pressure on rivals Yahoo and Microsoft to follow suit. Yahoo says it keeps search data for "as long as it is useful". Microsoft says that while it does not link searches to IP addresses, it maintains both indefinitely and can connect the two if instructed to by the courts.

From New Scientist 24 March 2007

Deadly TB

The New Scientist issue of 24 March 2007 focusses on

EXTREME TB - suddenly we're as vulnerable as in the 19th century.

It includes a special feature which, unfortunately, is only available on line with subscription. This reports the current TB situation which the New Scientist describes as the Killer on the loose. It asks in its editorial:

Remember when lots of people died of ordinary bacterial infections? Probably not unless you were around before the 1950s. That's when antibiotics stopped the rot, at least for the world's better off.

The bad news is those days are returning Tuberculosis has broken free of antibiotic control, a fact that could affect us all. The bacterium that causes TB is staggeringly common, infecting one-third of humanity, lying in wait for a chance to erupt into disease. Last year it erupted in 9 million people and killed 1.6 million putting it among the world's biggest causes of death.

Since the 1980s, TB has been creeping back. It is, for example the biggest killer of people with HIV. But only 12 per ccnt of TB sufferers have HIV, so this is not the main reason for its resurgence.

Within the feature -- The White Plague -- there is a piece

Resistant from the start

which reports some people end up with drug-resistant TB not because they have failed to keep to their treatment but because they contracted a resistant strain in the first place.

Until recently this was not thought to be a big problem. In theory microbes pay a price for carrying genes for drug resistance: in the drug's absence they are weaker and so spread less effectively.

That's the theory.

But Gary Schoolnik, a microbiologist at Stanford University in California, took samples of bacteria from individual patients as their infections changed from drug-sensitive to resistant, then pitted them against each other in the test tube. In research published last year, he showed that if anything, the resistant strains were stronger.

This fits with the few field observations available to date. Half the people at Tugela Ferry in South Africa, where extremely drug-resistant TB (XDR-TS) was first reported, had had no prior TB treatment, showing that resistance was already present in the bacteria rather than developing through poor treatment adherence.

Even people who are receiving treatment may be getting “super- infected”, with circulating resistant strains. That’s what Qian Gao and colleagues at Shanghai Medical College in China reported this month in The Journal of Infectious Diseases. They tracked 35 people whose TB became drug resistant. In only five did their initial bacteria evolve resistance - the other 27 were super-infected with new multi-drug-resistant (MDR) strains during treatment

If MDR and XDR circulate that readily, they could pose a much greater risk to people than ordinary TB. Gao says his work shows the importance of strict quarantine. “We cannot wait to implement measures to block transmission,” he warns.

references

Transmission of Drug-Resistant Tuberculosis among Treated Patients in Shanghai, China
Xia Li et al

The Journal of Infectious Diseases 2007;195:864-869

Link to JID abstract

Link to Gary Schoolnik’s published studies

Wednesday, March 28, 2007

Suck it up - what's a little pain in the war on drugs


In the Science section the New York Times (March 27, 2007) John Tierney in

Trafficker or Healer? And Who’s the Victim?

explores the the case of the United States v. William Eliot Hurwitz, which began in federal court here on Monday, and is about much more than one physician. It’s a battle over who sets the rules for treating patients who are in pain: narcotics agents and prosecutors, or doctors and scientists.

Dr. Hurwitz, depending on which side you listen to, is either the most infamous doctor-turned-drug-trafficker in America or a compassionate physician being persecuted because a few patients duped him.

When Dr. Hurwitz, who is now 62, was sent to prison in 2004 for 25 years on drug trafficking and other charges, the United States attorney for Eastern Virginia, Paul J. McNulty, called the conviction “a major achievement in the government’s efforts to rid the pain management community of the tiny percentage of doctors who fail to follow the law and prescribe to known drug dealers and abusers.”

Some of the country’s foremost researchers in pain treatment and addiction supported his appeal for a retrial, which was ordered because the jury in the first case was improperly instructed to ignore whether Dr. Hurwitz had acted in “good faith.” These scientists say they are upset by how their research has been distorted by prosecutors in this case, and suppressed by the Drug Enforcement Administration in its campaign against the misuse of OxyContin and other opioid painkillers.

In the first trial, the prosecution accused Dr. Hurwitz of crossing the line from doctor to trafficker by prescribing irresponsibly high doses of painkillers to his patients in the Virginia suburbs of Washington. He was accused of ignoring blatant “red flags” or signs that some patients were misusing or selling the drugs. That is an emotionally powerful argument for a jury: warning signs can seem perfectly clear with the benefit of hindsight.

But to researchers who study deceptive patients, there is no such thing as a blatant red flag. Deception is notoriously difficult to spot, as Dr. Beth F. Jung and Dr. Marcus M. Reidenberg of Cornell University document in a new survey of the literature. They note, for starters, an experiment showing that even police officers and judges — ostensibly experts at detecting fraud — do no better than chance at detecting lying.

Doctors are especially gullible because they have a truth bias: they are trained to treat patients by trusting what they say. Doctors are not good at detecting liars even when they have been warned, during experiments, that they will be visited at some point by an actor faking some condition (like back pain, arthritis or vascular headaches). In six studies reviewed by the Cornell researchers, doctors typically detected the bogus patient no more than 10 percent of the time, and the doctors were liable to mistakenly identify the real patients as fakes.

Tierney notes there is no standard dosage of medicine: A prescription for opioids that would incapacitate or kill one patient might be barely enough to alleviate the pain of another.

During the first trial, the prosecution argued that it was beyond the “bounds of medicine” for Dr. Hurwitz to prescribe more than 195 milligrams of morphine per day, but dosages more than 60 times that level are considered acceptable in a medical textbook. The prosecution’s supposedly expert testimony on dosage levels and proper pain treatment for drug addicts was called “factually wrong” and “without foundation in the medical literature” in a joint statement by Dr. Russell K. Portenoy and five other past presidents of the American Pain Society.

Dr. Portenoy, the chairman of the pain medicine department at Beth Israel Medical Center, was one of the researchers who worked with the D.E.A. four years ago to draw up guidelines on pain medication for doctors and law enforcement officials. The guidelines assured doctors that they would be safe unless they “knowingly and intentionally” prescribed drugs for illegitimate reasons, and cautioned narcotics agents not to investigate doctors just because they prescribed large quantities.

The D.E.A. published the guidelines, and then abruptly withdrew them on the eve of Dr. Hurwitz’s trial, just after his defense had indicated that it planned to use the document at the trial. The D.E.A., which said the document had not been properly vetted, went on to repudiate some of the guidelines and warned that it intended to keep targeting doctors deemed suspicious because they prescribed large quantities and ignored certain red flags.

Dr. Portenoy, who is to be a witness for Dr. Hurwitz at the retrial, has been one of the pioneers in identifying the risks of prescribing opioids. He says the warning signs that seem so obvious to prosecutors rarely offer clear guidance to doctors. When a patient keeps asking for refills because he runs out of his pills early, does that mean that he is a dealer or that he is not getting enough medication? If a urine test shows the presence of cocaine or other illegal drugs — as it did in some of Dr. Hurwitz’s patients — should a doctor automatically cut him off? That’s what some prosecutors and narcotics agents demand, but doctors realize that there are plenty of illegal drug users who also need pain relief.

“Half of pain patients would have to stop taking their medicine if the rule went out that every so-called red-flag behavior meant you couldn’t prescribe,” Dr. Portenoy says. He and researchers like Dr. Steven D. Passik, a psychologist at the Memorial Sloan-Kettering Cancer Center, have found that about half of pain patients exhibit at least a couple of the warning signs, and that even veteran physicians cannot agree on which signs are the most important to look for.

In a pretrial motion, Dr. Hurwitz’s lawyer, Richard A. Sauber, asked the court to bar the prosecution’s expert witnesses from using the red-flag argument because “it defies reason that any expert could testify” about something without “scientific support.” That motion was denied, however, so the flags may well be waving during the trial.

Even Dr. Hurwitz’s supporters acknowledge that he is not the ideal doctor to be the representative for the cause of pain patients. Although his expertise in pain medicine is well respected, some say he was gullible and reckless to the point of incompetence. But the traditional punishments for such mistakes are malpractice settlements and the loss of a state medical license, not a federal investigation and 25 years in prison.

“Doctors are trained to treat patients, not to be detectives,” says Dr. James N. Campbell, a Johns Hopkins University neurosurgeon specializing in pain, who will be another witness for Dr. Hurwitz. He says that doctors have already reacted to the D.E.A. crackdown by changing the way they deal with the many Americans — at least 50 million, by several estimates — who suffer from chronic pain.

“Opioids were a revolution in pain treatment during the 1990s, but doctors are now more reluctant to use them,” Dr. Campbell says. “If a doctor perceives there’s a 1 in 5,000 chance that a prescription will lead to a D.E.A. inquiry — just an inquiry, not even an arrest — he’s not going to take the chance. So the victims are the patients.”

Link to NY Times article

Community-Based Groups Lose to the Big Boys

David Gonzalez writing in the New York Times (March 27, 2007) in

For Smaller Fighters of H.I.V., Weapons Dwindle

reports community-based groups in New York City are losing public funding to larger groups and hospitals. Community-based organizations, which often target impoverished and minority groups, in the past received a large amount of support through the $120 million New York City gained in Ryan White Program funding. However, three years ago changes in allocations were recommended. The changes were adopted by the New York City Department of Health and mental Hygiene [what a name!], which asked the Medical and Health Research Association of New York City to solicit proposals from service providers, Gonzalez reports.


Proposals received by MHRA were scored on a 100-point scale based on how they met program requirements. The recommendations shifted program priorities to access to medical care and maintaining treatment. Outreach work -- which often focused on access to condoms, clean needles and other approaches -- was downgraded to focus on treatment access. .

Gonzalez gives a graphic example of the consequences. He describes a crazy corner of Brooklyn ---the kind of place where you can catch a few things nobody wants, like a bullet, or a beating.

A small group of women here have taken on another problem ravaging the area: H.I.V. They hit the streets and stores twice a week dispensing condoms and advice about protected sex while urging people to get tested for the virus that causes AIDS. It is hard work, stopping other women in midstride to ask them about how they protect themselves behind closed doors.

Yet as much as these peer educators from Life Force, a Brooklyn-based H.I.V./AIDS education agency for minority women, are used to the streets, they are not prepared to wind up on them. This weekend the agency may have to start laying off some workers after failing to win a renewal of financing for its grass-roots programs. While medical advances are helping people with the disease live longer, some of the very groups that helped them survive are confronting their own demise.

Advocates for people living with H.I.V. and AIDS said community-based groups like Life Force, which have emerged over the past 20 years to confront health crises in poor and minority neighborhoods, could not compete with larger groups and hospitals that offer one-stop shopping for a variety of services. Others said city health officials favor Manhattan-based groups, even though the other boroughs have borne the brunt of the disease.

“A lot of groups in New York are feeling the burn because the opportunities for little groups are drying up as the bigger ones come in,” said Kwame Banks, a project director at the Community Resource Exchange, which advises nonprofit organizations. “They’re out on the streets doing the work and don’t have time to be philosophical about it. They don’t even have the time to do strategic thinking.”

In a bittersweet twist for Life Force’s two dozen peer educators, it was that kind of work that inspired “Life Support,” a movie starring Queen Latifah, now showing on HBO.

Link to NY Times article

Day of Silence – Why?


People who have asked why there is any need for a Day of Silence probably did not read all of the 365gay.com report:

A study released by the Gay, Lesbian and Straight Education Network to coincide with last year's National Day of Silence, showed that homophobia is widespread in the nation's schools. Nearly one-in-five students reported they had been physically assaulted because of their sexual orientation and over a tenth because of their gender expression. Three-quarters of students surveyed said that over the past year they heard derogatory remarks such as "faggot" or "dyke" frequently or often at school, and nearly nine out of ten reported hearing "that's so gay" or "you're so gay" - meaning stupid or worthless - frequently or often.

Over a third of students said they experienced physical harassment at school on the basis of sexual orientation and more than a quarter on the basis of their gender expression.

The study also showed that bullying has had a negative impact on learning. LGBT students were five times more likely to report having skipped school in the last month because of safety concerns than the general population of students.

Students who experience more frequent physical harassment were more likely to report they did not plan to go to college, the study found.

Overall, LGBT students were twice as likely as the general population of students to report they were not planning to pursue any post-secondary education.

In addition, the average GPA for LGBT students who were frequently physically harassed was half a grade lower than that of LGBT students experiencing less harassment.

Over 6,000 participants are expected to be silent on April 18, wearing stickers and passing out ‘speaking cards’ that read: "Please understand my reasons for not speaking today. I am participating in the Day of Silence, a national youth movement protesting the silence faced by lesbian, gay, bisexual and transgender people and their allies in schools. My deliberate silence echoes that silence, which is caused by harassment, prejudice, and discrimination. I believe that ending the silence is the first step toward fighting these injustices.

Think about the voices you are not hearing today. What are you going to do to end the silence?"

Link to 365gay.com report

current affairs



Tuesday, March 27, 2007

Silence

The Newscenter Staff at 365Gay.com in their (March 27, 2007) report

Conservative Activist: 'Take Children Out Of School On Day Of Silence'

give us a timely warning of the nasty work being propagated by Conservative activist Linda Harvey who, among other things, is calling on parents to take their children out of school on The National Day of Silence - the day LGBT students and their supporters draw awareness to homophobia in classrooms by keeping silent in school. This year The National Day of Silence will be observed on April 18.

"Teenagers deserve an opportunity to study English, history, math, and science -- without being subjected to pro-homosexual proselytizing sanctioned by school authorities," Harvey said on her web site –Mission America (well isn’t that special) she has opened to call for the boycott. "Students shouldn't be forced to self-censor or adopt beliefs contrary to those of their parents and places of worship," Linda Harvey said on NotOurKids.com."Even the strongest of our junior high and high school children are not equipped to serve as frontline soldiers in this culture war."

NotOurKids.com says it is a coalition of pro-family groups that seeks to protect America's youth from being pressured to approve of homosexual, bisexual, or "transgender" behavior.

Link to 365gay.com report


Link to Mission America


Maybe Linda will organize an alternative Rally --- after all it has been done before!


Monday, March 26, 2007

Safe Haven or Get Back in the Closet?


The Newscenter Staff at 365Gay.com reported (March 23, 2007) in

Homeless, Low Income Elderly Gays Find Home In Hollywood

report on what is described as the first low-cost housing development in the country for homeless and low income older members of the LGBT community which has been opened in Hollywood.

The 104-unit complex, built around a swimming pool and open courtyard, was built by the nonprofit Gay and Lesbian Elder Housing and developer McCormack Baron Salazar at a cost of nearly $21 million.

Affluence in the gay community nationally is often cited - with estimates of buying power in excess of $145 billion annually little is ever reported on the number of low income or homeless gays advocates say.

It is estimated that Los Angeles has an LGBT population of 442,000 making it the second largest gay community in the country after New York. The Gay and Lesbian Elder Housing project said that aging gays face problems not encountered by straights. Same-sex partners cannot share a room in most care facilities. and even though there are many government programs that target the elderly, none are geared towards LGBT older adults.

On top of that there is widespread homophobia among those entrusted with the care of older adults. As a result Many GLBT older adults retreat back into the closet.


Link to365gay.com article

Creation Science 101

Fortune and men’s eyes

Online Journalism Review, published by the Annenberg School of Journalism, University of Southern California has an article by Laura Ruel and Nora Paul (2007-03-13)

Eyetracking points the way to effective news article design

OJR's design experts review usability research and offer suggestions on how you can make your online articles better connect with readers.

This is an interesting (if not typical) example:

When photos do contain people related to the task at hand, or the content users are exploring, they do get fixations. However, gender makes a distinct difference on what parts of the photo are stared at the longest. Take a look at the hotspot below.

Although both men and women look at the image of George Brett when directed to find out information about his sport and position, men tend to focus on private anatomy as well as the face. For the women, the face is the only place they viewed.

This image of George Brett was part of a larger page with his biographical information. All users tested looked the image, but there was a distinct difference in focus between men and women.

Coyne adds that this difference doesn’t just occur with images of people. Men tend to fixate more on areas of private anatomy on animals as well, as evidenced when users were directed to browse the American Kennel Club site.

Link to OJR article

Sunday, March 25, 2007

Lunch

Clippings

From New Scientist (17 March 2007)

Letter to the editor: Any old sperm

You report that IVF babies are "about 60 per cent more likely to have birth defects than children conceived naturally" and that "scientists are still struggling to explain why" (24 February, p 18).

Surely it is because the sperm used is just any old sperm, not the very best sperm that swims fastest and gets to the egg first. With natural conception, that's what happens. Here is another example of the survival of the fittest - Darwinism in action.

Elizabeth Young London, UK


Armour-piercing ice cream

ONE of the unwritten rules of public relations is that friendly images can make nasty things seem less so. However, this example from Ames Laboratory in Iowa leaves Feedback's head echoing with cognitive dissonance: "Armour-piercing projectiles made of depleted uranium have caused concern among soldiers storing and using them. Now, scientists at the US Department of Energy's Ames Laboratory are close to developing a new composite with an internal structure resembling fudge-ripple ice cream that is actually comprised of environmentally safe materials to do the job even better."

Environmentally safe armour-piercing fudge-ripple ice cream? How nice.


Geeky Graffiti

Comments finger-written on dirty vehicles tend to stick to often-repeated phrases such as "Clean me", "Also available in white" and "I wish my girlfriend was this dirty". Cycling round Cambridge recently, Michael Francis saw one that broke new ground. On the side of a particularly filthy lorry parked near Jesus College was enscribed the phrase "Couldn't afford the TiO2".

Titanium dioxide (TiO2), for those who are not industrial chemists, is a hydrophobic substance used to coat surfaces to make them resist both water and dirt, so they are "self-cleaning". Francis says he is pleased to see the expensive investment in someone's scientific education being put to good use.

Amazing cacti

HOW about this for imaginative science? On a stall selling cacti in a craft fair that Steve Parkes visited was a handwritten sign saying: "One of the hazards of modern life is computer screens, which give off radiation. Cacti grow in deserts in strong sunlight, which has very high levels of ultraviolet. So buy a cactus and stand it in front of your computer screen to absorb all that harmful radiation."

Saturday, March 24, 2007

What do you see?


The New York artist Devorah Sperber, self described as a "visual artist" has always had a fascination with the science of vision. As part of her exploration she recreates famous works of art out of pixilated abstract sculptures.

The sculpture in the picture is After van Eyck (2006) created by Sperber using 5,024 spools of thread.

Her current exhibition The Eye of the Artist: The Work of Devorah Sperber is at the Brooklyn Museum in New York until 6 May.

Link to www.devorahsperber.com


Great Moments in Presidential Speeches

Bill Maher: New Rules For Bush and Cheney

Friday, March 23, 2007

WORLD TB DAY March 24


Just in time for World TB Day, the World Health Organization reported on Thursday. the deadly form of TB spreading through South Africa has now been found in rich nations in Europe as well as Canada and the United States. The virulent strain, known as XDR-TB (extremely drug resistant), has been documented in 35 countries worldwide, 16 of them this year alone.

The STOP TB program at the World Health Organization. produced WHO's TB report, which coincides with the 125th anniversary of the discovery of the microbe that causes TB.


Link to stoptb.org


REAL sex education

The Advocate (March 23, 2007) in

Comprehensive sex education bill reintroduced in Congress

reports members of Congress reintroduced a bill Thursday that would provide grants for comprehensive and age-appropriate sex education. Currently the federal government is slated to spend more than $1 billion in abstinence-only sex education through 2008, which neglects to educate about homosexuality, same-sex marriage, or birth control. Meanwhile, federal funding is denied to institutions that provide comprehensive sex education.

The Responsible Education About Life (REAL) Act is sponsored by Rep. Barbara Lee of California, Rep. Christopher Shays of Connecticut, and Sen. Frank Lautenberg of New Jersey and would grant $206 million per year to states for comprehensive sex education.

Link to Advocate article

Viacom vs google

Thursday, March 22, 2007

Medical Bills


Julie Appleby reporting USA TODAY in

tells of Janet Fredrick who got breast cancer in 1998, but never thought she would face bankruptcy because of medical bills: She had insurance.

But her illness dragged out, then her income plunged when she went on disability. By 2005, her co-payments for treatment, including surgery, medications, doctor visits and hospital care, totaled about $8,000.

Such co-payments and deductibles along with difficult-to-understand policies and complex hospital billing issues, are among the main reasons even people such as Fredrick who have health insurance can face devastating financial costs, ccording to a report published today by The Access Project, an advocacy group that researches medical debt.

The Boston-based Access Project's study, funded by the W.K. Kellogg Foundation and the Missouri Foundation for Health, comes as higher annual deductible policies — those at $1,000 or more for individuals or $2,000 for families — are being touted by some policymakers, insurers and employers as one way to control rising health care spending in the USA.

Even families with lower deductibles are having trouble. In October, a poll by USA TODAY, the Kaiser Family Foundation and ABC News found that one in four Americans had trouble paying for medical care during the year. Among those reporting trouble paying, 69% had insurance.

Along with deductibles and co-payments, The Access Project found other factors associated with medical debt were annual or lifetime "caps" on benefits; extra charges for "out of network" care, even when admitted to in-network hospitals; and complex billing systems by insurers and hospitals that left patients confused about what they owed.


Link to USA Today article

Link to Access Project report

Smoking ages

The BBC on line (03/21/2007) in

Smoking ages skin across the body

reports on a study published in the journal Archives of Dermatology that looked at the upper part of the inner arm in smokers and non-smokers. Previous studies have focused on the face, where skin can also be damaged by exposure to the sun. But the University of Michigan, Ann Arbour, team say this study shows smoking alone makes the skin age.

The researchers note

"We found that the number of packs of cigarettes smoked per day, total years of smoking and pack-years of smoking [an average of packs per day over the number of years of smoking] were correlated with the degree of skin aging."

"After controlling for age and other variables, we found that only packs of cigarettes smoked per day was a major predictor of the degree of photo-protected skin ageing."

Amanda Sandford, of Action on Smoking and Health (ASH) said

'This study provides further evidence of the detrimental effects that smoking can have on the skin.

"No amount of anti-ageing cream will remove the wrinkles caused by cigarettes so the best way for smokers to avoid the wrinkled prune look is to stop smoking."


Link to BBC on line article

reference

Effect of Smoking on Aging of Photoprotected Skin
Yolanda R. Helfrich, et al
Archives of Dermatology 2007;143:397-402.

Link to Archives of Dermatology abstract

TB in the open

Keith Alcorn, writing for Aidsmap (March 22, 2007) in

Opening a window the best way of reducing TB spread in hospitals

reports on the work of researchers from Imperial College, London, published in the February edition of PLoS Medicine.

They suggest ventilating TB wards by opening windows is more likely to reduce the risk of infection than mechanical ventilation and should be practiced wherever the climate permits.

Exposure to TB in health care settings is a particular risk for HIV-positive people because of the high existing rates of HIV/TB coinfection in resource-limited settings. Transmission within health care facilities has come into particular focus in the past year after the finding that the majority of extremely drug-resistant (XDR) TB cases in the first South African outbreak were acquired from health care workers.

Experts have since emphasised the need for better infection control procedures in health care facilities, with some advocating greater investment in mechanical “negative pressure” ventilation, which keeps the air pressure in a TB ward lower so that air does not leak into other parts of the health care facility, but is instead expelled by a fan.

However, a study carried out at six hospitals at Lima, Peru, shows that the old-fashioned method of ventilation and design of TB wards – high ceilings and large windows that can be opened – is considerably superior to mechanical ventilation and to modern hospital layouts when it comes to preventing airborne infection.

However the investigators caution that the risk of infection increases, even with good ventilation, with the infectiousness of patients. This has particular relevance, they say, for clinical areas that are not designated as high risk, such as waiting areas and non-TB wards, since these are the places that undiagnosed TB patients, who are likely to be most infectious, will predominantly be found. (The infectiousness of a TB patient falls markedly within weeks of starting treatment as the bacterial burden in the lungs falls in response to antibiotic treatment).

“Probably the main reason that modern building trends increase patient risk is financial: smaller rooms (which more easily become stuffy and overcrowded) are cheaper to build and heat,” the authors remark.

They found that a 1 metre increase in the ceiling height offered substantially greater protection against airborne infection because it increased absolute ventilation of the room by a quarter, even when using mechanical ventilation.

Addressing concerns that open doors and windows might lead to leakage of airborne TB into other areas of health care facilities, the authors note that it should be possible to locate a TB ward on the top floor of a building and downwind of other rooms.

The authors say that their findings are not suited to cold regions, but Alcorn notes, historically natural ventilation was a standard feature of TB sanatoria in Europe and North America, and public health prevention measures in Europe in the 1920s and 1930s commonly urged people always to sleep with the window open.

Reference


Natural ventilation for the prevention of airborne contagion
Escombe AR et al

PLoS Medicine 4 (2): e68, 2007. doi:10.1371/journal.pmed.0040068

Link to PLoS abstract

Link to Aidsmap report

Tuesday, March 20, 2007

Sophisticated Smoking


The New York Times Health Section (March 20, 2007) publishes an essay by Howard Markel, M.D.

Tracing the Cigarette’s Path From Sexy to Deadly

Reminding us that in contrast to the symbol of death and disease it is today, from the early 1900s to the 1960s the cigarette was a cultural icon of sophistication, glamour and sexual allure — a highly prized commodity for one out of two Americans.

Many advertising campaigns from the 1930s through the 1950s extolled the healthy virtues of cigarettes. Full-color magazine ads depicted kindly doctors clad in white coats proudly lighting up or puffing away, with slogans like “More doctors smoke Camels than any other cigarette.”

He draws on the work of Allan M. Brandt, a medical historian at Harvard, who insists that recognizing the dangers of cigarettes resulted from an intellectual process that took the better part of the 20th century. He describes this fascinating story in his new book, “The Cigarette Century: The Rise, Fall and Deadly Persistence of the Product that Defined America” (Basic Books).

Markel concludes by noting Dr. Brandt acknowledges that there are pitfalls in combining scholarship with battle against the deadly pandemic of cigarette smoking, but he says he sees little alternative.

“If one of us occasionally crosses the boundary between analysis and advocacy, so be it,” he said. “The stakes are high, and there is much work to be done.”


Link to NY Times article



A good time for a Visit?

Link to Washington’s Quit Line

XDR-TB

Writing in the New York Times Health Section (March 20, 2007), Lawrence K. Altman, M.D. in

Rise of a Deadly TB Reveals a Global System in Crisis

Reviews the current spread of a the resistant forms of TB in South Africa which “illustrates a breakdown in the global program that is supposed to keep the disease, one of the world’s deadliest, under control”.

Link to NY Times article


Fighting Malaria

The BBC on line in

GM mosquito 'could fight malaria'

reports a genetically modified (GM) strain of malaria-resistant mosquito has been created that is better able to survive than disease-carrying insects. It gives new impetus to one strategy for controlling the disease: introduce the GM insects into wild populations in the hope that they will take over.

Details of the work by a US team appear in Proceedings of the National Academy of Sciences journal.

Their approach exploits the fact that the health of infected mosquitoes is itself compromised by the parasite they spread. Insects that cannot be invaded by the parasite are therefore likely to be fitter and out-compete their disease-carrying counterparts.

Malaria, spread by the single-celled parasite Plasmodium , is endemic in parts of Asia, Africa, and central and south America. The organism is passed to humans through the bite of the Anopheles mosquito. Each year it makes 300 million people ill and causes a million deaths worldwide. Some 90% of cases are in sub-Saharan Africa, where a child dies of malaria every 30 seconds.

Why does the mosquito from the experiment have fluorescent green eyes?

Read the report or watch the video

reference


Transgenic malaria-resistant mosquitoes have a fitness advantage when feeding on Plasmodium-infected blood
Mauro T. Marrelli et al

Proc. Natl. Acad. Sci. USA, 10.1073/pnas.0609809104

Link to PNAS abstract

Link to BBC report

Link to video

Monday, March 19, 2007

HIV & Syphilis

Carolyn Partrick writing for Aidsmap (Sunday, March 18, 2007) in

Early syphilis infection lowers CD4 count and raises viral load in HIV-positive patients

reports a third study has found that syphilis infection in HIV-positive patients is associated with increases in viral load and decreases in CD4 cell count. The Spanish study, published in the March 1st issue of the Journal of Acquired Immune Deficiency Syndromes, is the largest of the three and, its authors believe, the first to have analyzed the factors associated with changes in viral load and CD4 cell count during syphilis infection.

The study’s authors also found more than two thirds of the syphilis cases were diagnosed in patients who had previously been diagnosed HIV-positive. This, they say, “highlights the risky behavior of our patients” and their “weak preventive strategies”. They call for public health efforts to prevent new syphilis infections and to identify and treat infected patients as soon as possible, in order to reduce the spread of both syphilis and HIV.

The authors note that though it has previously been thought that increases in viral load occur mainly among patients with secondary syphilis infection, “our study [found] no difference in the virologic change depending on the stage of the syphilis”. They also note that, in line with several other studies of coinfection in HIV-positive patients, they found no reduction in viral load after the syphilis was treated. These findings are thought to be the result of persisting immune activation.

Reference

Impact of syphilis infection on HIV viral load and CD4 cell counts in HIV-infected patients.
Palacios R et al

J Acq Immun Defic Synd 44: 3, 2007

Link to Aidsmap article

Link to JAIDS abstract

Heroes

John Inman died at aged 71 on March8th, 2007.
We weren’t going to post anything until we heard the comment ---“just another old queen?”

If that is what you think take the time to read this piece from The Times (March 10, 2007)

I’m free – and it’s all because of men like John Inman

in which Matthew Parris pays a personal and historic tribute to John Inman and his contemporaries --- heroes of their time.

I raise a salute to that lifesaving human compromise, the open secret. I raise a salute to a band of comrades who, each in their different ways, were the keepers through a dark age of an open secret. My salute is to a dying breed: a breed whose ranks thinned again in the small hours of Thursday morning when John Inman passed away.

Hail to them all: the ludicrous old queens; the drag artists; the pantomime homosexuals; the florid epicureans; the indulgent priests; the sensitive young men in tight trousers; and the wan aesthetes. And hail, too, to their quieter cousins: the discreetly confirmed bachelors and “he never married” brigade, the don’t-ask-don’t-tell soldiers, and the dignified loners who just preferred to stay single and wouldn’t say why. Theirs — all of theirs — to protect and guard was a precious thing: the open secret.

For gay men in the 20th century the open secret was sometimes literally a lifesaver. It was the narrowest of territories: the half-acre that lies somewhere between absolute denial and outright confession, between dishonesty and disgrace. This was a hard place to be in 1970, a narrow line to walk. If our oh-so-modern, who-gives-a-damn, 21st-century gays, of whom I am one, suppose that these men were not brave, that they were not trail-blazers, not part of the struggle, then we don’t know the half of it.

And some of us, it seems, don’t. Already I hear the cry — “living a lie”, “set back the cause”, “self-oppression”, “an insulting stereotype” — from a gay lobby that has taken about five minutes to forget what a dark age England was for us, what light an Inman, a Kenneth Williams, a Danny La Rue or, from America, a Liberace brought into it, and how outrageous, how valiant, those people were.

About five minutes to forget, too, that the people who wanted these men taken off the stage, screen and wireless, were not the gay-rights campaigners but the bigots and guardians of conservative morality. “Sexual perversion”, they said, wasn’t entertainment: it was wicked and dangerous — and bad taste. The BBC, contemplating making a series of Are You Being Served?, tried at first to insist that Mr Humphries was removed.

How fast we forget context. Always a bit of a giggle to their own era, the Inmans, La Rues and Williamses of the last century are now disowned by their newly brave inheritors: the lately and boldly Out.

John Inman’s breath had barely left his body before right-on spokesmen for that imaginary thing, the “gay community”, were berating the “self-oppression” and “stereotyping” of homosexuals that Inman’s Mr Humphries helped to reinforce. His smutty innuendo, his jokes about fairies and handbags, his limp wrist, camp wit and simpering delivery are, they claim, everything we need to shed.

Yes, they are. Of course they are. They are now. But they weren’t then. Then they were a light in the dark. Between the words, these men insinuated a wordless language of their own; they made a nonverbal statement, a shyly comical way of saying: “This is who and what I am; this is my tribe — and, look, I’m famous and life is fun.” To anxious boys like me, who didn’t even know a tribe existed, the lives and careers of these men showed we were not alone. You may say it was a pity it had to be done by double entrendre. Yes it was a pity; but whether by single, double or triple entendre, it was entendu. You could imply it, at last, and at least you could imply it and nobody would lock you up. This was a huge step forward.

Remember before you sniff at the narrow caricature of a gay man conveyed by that old, camp guard, that these were the gays who didn’t retreat into abusive relationships, dirty little broom-cupboard secrets, guilt, suicide, hatred and shame — or surprisingly often the persecution of other gay men. They were the ones who didn’t ruin women’s lives with wretched sham marriages. Whatever the half-truths and timidities of their estate, they were in some deep way being true to themselves. In the manner in which they talked, dressed and even walked, they were refusing to hide something. There is an inner honesty in this which is perhaps stronger than the honesty of signing up to a sexuality on a dotted line.

Their great achievement was to find a way, however comedic, to be themselves without becoming outcasts; and to show the world. It was desperately important to be able to do that 30 years ago.

Have modern activists no sense of history — even very recent history? Instead of thinking simply of where the gay rights movement is going, they should think too about where it has come from. Read Peter Wildeblood’s Against the Law, a personal memoir of police harassment, public humiliation, distorted evidence, a ghoulishly sanctimonious press, dismissal and an 18-month prison sentence, published (at some risk: many bookshops refused to display it) by Weidenfeld & Nicolson in 1955 to great public excitement, and republished a few years ago to almost complete indifference. The book seems to describe another England, remote from ours.

You need to understand that backdrop to understand how quietly brave were men like Noël Coward (who would now be called “closeted”) to go as far as they did. Believe it or not, Wildeblood has some claim to be the first writer in the English language to say he was a homosexual (as opposed to admitting to homosexual acts).

In 1955! Inman arrived only 17 years later. When Are You Being Served? entered mainstream popular culture (and before it, on the BBC Light Programme’s Round the Horne, Kenneth Williams’s and Hugh Paddick’s Julian and Sandy), the idea that homosexuality might be an amusing, unthreatening and not uncommon oddity rather than scary — a moral poison and a mortal sin — was gaining ground. Such portrayals unsoured what it was to be gay. The point about this version of the Gay Everyman, surely, was that he was likeable. You’d be pleased if he moved in next door. As the 1970s went on, a few gay activists did begin to worry about the stereotyping, but this, I believe, was a sign of how fast the times were moving.

Music hall was probably where it started. At the showy end of the spectrum, men like Inman, La Rue and Liberace helped to tease this idea further into the spotlights. Not all of these men were necessarily gay, or exclusively so. Max Miller (“What if I am?”) was not gay but flirted with the stereotype because it was becoming rather popular: it sold seats in theatres. My Nana loved Miller, loved Inman, loved La Rue, laughed like a drain at all of them.

Nana would have loved Graham Norton, too. Julian Clary and Graham Norton are probably among the last exemplars of a breed that may soon seem awfully old-fashioned. The next age may not even see the joke, but if the day should come when a new generation watches those DVDs and wonders what campery had to do with being gay, it will be partly because of, not despite, camp comic turns. Clary and Norton are the last act in a show that has helped to turn what once was seen as shame into light entertainment. Thus did the shame and the ghetto depart, taking with them (but slowly) the tagging and the typecasting.

We gays can shed these stereotypes because we have outgrown them, because we have won the space and public respect to dispense with prison clothes and walk out of the virtual ghettos in which gay people used to bunch for mutual affirmation. We don’t need to belong to a gang any more, to drink in the same pubs, congregate in the same occupations or dress or talk in ways designed to help us recognize each other, and help the outside world to guess without the unpleasantness of having to ask. We are no longer under siege. Everything can be talked about today.

But yesterday, when things weren’t said, things had to be said without words. Men like Inman found the showbiz shorthand to do it. God rest their souls.

Link to The Times Matthew Parris column

Link to Times John Inman obituary