Wednesday, April 30, 2008

"The Heinz Story"

Steve Bell - The Guardian


BBC News on line (April 30, 2008)

Chinese virus infections rising

The number of children infected with a deadly virus -- Enterovirus 71 -- in eastern China has increased by nearly 700 in the past two days.
The virus has killed 20 children since it was discovered in Fuyang, a city in Anhui province.
State media said the number of cases had now increased to nearly 1,900.

The outbreak began in early March, but was only reported this week - leading to accusations by Chinese press of a cover-up by local authorities.
The number of infected children has steadily increased since hospitals in Fuyang began admitting patients with fever, ulcers in the mouth, or a rash on their hands and feet, according to the Anhui Health Bureau's website.

An official investigation into the cause of the outbreak has been launched, and a prevention and control team has been set up to contain infected areas in the province, the bureau said.
EV71 - mainly affects children under the age of 10.

The World Health Organization said it was concerned about the number of deaths in the current outbreak, although EV71 has been reported in China before.
The question of reporting infectious diseases is especially sensitive in China, following widespread criticism of the handling of the SARS epidemic in 2003.
Attempts to cover up the scale of that outbreak led to the sacking of China's health minister and promises of reform.

Link to BBC News report

routine HIV testing?

Gus Cairns for Aidsmap (April 30, 2008) reports on a study presented at the Spring Conference of the British HIV Association in Belfast

One in 40 people presenting to A&E departments with ‘flu’ symptoms has HIV

An anonymous survey in Brighton, UK of male patients aged 18-50 reporting to GPs and to hospital accident and emergency (A&E) departments with symptoms suggestive of HIV infection has found an overall HIV prevalence of one per cent in those previously undiagnosed with HIV. However it found a higher prevalence of 2.5% amongst the patients turning up at A&E, suggesting that, at least in a high-prevalence town like Brighton, there is scope for ‘opt-out’ HIV testing to be introduced in emergency settings.

Dr Kate Nambiar from Brighton and Sussex University Hospital told the conference that a study tested residual blood samples left over from patients who had presented to local GP practices and emergency departments between January 2006 and June 2007 and who had been tested for Full Blood Count or for glandular fever.

This was an anonymous unlinked survey: although details such as the sex and (known) HIV status of the patient were kept, samples were anonymized and ones that tested positive could not be traced back to individuals.

In order for samples to be tested, patients had to have presented with flu-like symptoms, muscle and joint aches, fever, night sweats, rash or mouth ulcers or a combination of other symptoms suggestive of primary HIV infection.

Samples were tested for HIV antibodies and the HIV p24 protein (which appears earlier than HIV antibodies in infected people). Pooled samples were also tested for HIV RNA (i.e. given a viral load test) in order to identify people in primary infection before seroconversion.

Samples positive for HIV were then sent on to the Health Protection Agency’s laboratory for confirmation with a Western Blot HIV test and to be tested with the STARHS assay, which can detect infections less than six months to a year old.

A total of 686 samples were tested and of these 7% tested HIV positive. Eliminating patients known to have HIV, this left 1% of patients (seven samples) who tested positive for HIV and were undiagnosed. One of these samples tested positive for primary HIV infection. It was recorded that 33 of the 686 patients had taken a same-day HIV test, but all were negative.

Seventy-one per cent of samples were collected from GPs and 29% from A&E departments; however only two of the positive samples were from GPs and the other five were from A&E. This meant that the proportion of undiagnosed patients attending GPs was only 0.4% (one in 250) but the proportion attending A&Es was 2.4% (one in 40).

Dr Nambiar commented that the study had found HIV in a considerably lower than expected proportion of patients presenting with symptoms suggestive of primary HIV infection (PHI) than had some previous US surveys; these had found PHI levels in undiagnosed symptomatic patients of up to 0.8%.

Dr. Nambiar commented that the suspected reason was that patients presenting with flu-like symptoms, particularly at GPs, were not undergoing any blood tests at all: “They may just be told ‘it’s only a virus’, and sent home with a prescription for paracetamol,” she said.

The study therefore did not support the use of pooled RNA testing as a means of picking up on primary HIV infection in the community.

However, she added, given that HIV screening is probably cost-effective if done in populations where the background undiagnosed HIV prevalence is 0.05% (one in 2,000) or more, the relatively high prevalence of undiagnosed infection in symptomatic individuals presenting to A&E suggested that, even if their symptoms were not caused by HIV, in Brighton at least, “there is a case for routine HIV testing in accident and emergency”.


Diagnosing the undiagnosed: identifying symptomatic primary HIV infection (PHI) presenting to primary and emergency healthcare physicians.
Kate Nambiar et al
Fourteenth BHIVA Conference, Belfast. Abstract O5. 2

Link to BHIVA site
The site links to Conference abstracts

Link to Aidsmap article

HIV target

BBC News on line (April 30, 2008)

HIV drug resistance target find

Pamela Schwartzberg of Boston University and her research team have discovered that a specific protein in the body may be the key to overcoming the increasing problem of resistance to HIV drugs.

Inactivating the ITK protein which is involved in the immune response blocks many steps of HIV replication, studies in the laboratory show.
Most current HIV drugs attack the virus itself which is liable to mutate and become resistant to treatment.
ITK is involved in activating a type of immune cell -- a T cell -- in the presence of infection.
HIV works by infecting T cells, taking them over so they can replicate and create large quantities of the virus, compromising the whole immune system.

The National Institutes of Health team realized that many of the pathways regulated by ITK were also needed for HIV to take hold in the body.
Tests in human cells in the laboratory showed that removing or inactivating ITK could, as predicted, block many different steps in the ability of HIV to enter a cell, spread and replicate.

Dr Pamela Schwartzberg lead author of the study in Proceedings of the National Academy of Sciences said each of the steps only had a small effect but together they were significant.
What remains to be seen is how effective targeting ITK would be compared to existing drugs she said.
But due to other research looking at the role of ITK in immune responses in asthma, there are already potential drugs in development.
"Currently we have multiple options for treating HIV and we use multi-drug regimens but most of these therapies are directed against viral proteins which are subject to rapid changes allowing mutations to develop.
"Our own cellular machinery is less prone to making mistakes."
"ITK had an effect on HIV replication at several stages which if you add them up seems to be a profound effect."


Selective targeting of ITK blocks multiple steps of HIV replication
Julie A. Readinger et al

Proc. Natl. Acad. Sci. USA, 10.1073/pnas.0709659105 Published on line April 28, 2008

Link to PNAS abstract

Link to NIH press release

Link to BBC News report

Tuesday, April 29, 2008

'GET OVER IT' Justice Scalia

Miley Cyrus & the Vanity Fair pictures (not forgetting Disney!)

The Great Pox

Marlene Zuk is a biology professor at the University of California, Riverside, and author of Riddled with Life: Friendly Worms, Ladybug Sex and the Parasites that Make Us Who We Are, contributes an essay to the Health Section of the New York Times (April 29, 2008)

A Great Pox’s Greatest Feat:
Staying Alive

which explores the evolving of syphilis . This includes the research which suggested that syphilis originated as a skin ailment in South America, and then spread to Europe, where it became sexually transmitted and was later reintroduced to the New World.

She suggests the origin of syphilis has always held an implied accusation: if Europeans brought it to the New World, the disease is one more symbol of Western imperialism run amok, one more grudge to hold against colonialism. Sexually transmitted diseases have always taken on moralistic overtones — they seem like the price of pleasure. We tell ourselves that if we can just make everyone behave responsibly, we can halt the attack.

But we may not have as much say as we might like to think. Infectious diseases are caused by living beings that spread from one host to another, and natural selection will favor anything that increases that spread — say, a higher probability of becoming airborne, or a better means of attaching to the gut wall.

The syphilis bacterium, Treponema pallidum, has no nervous system or brain, no consciousness with which to plot an attack. But it has an ability that is even better: it can reproduce at a rate that leaves us in the evolutionary dust. For any STD., making the host more likely to have sex will benefit the pathogen that causes it. And syphilis may be a case in point.

Detailed records of syphilis infection start appearing in Europe from 1495, and a fearsome disease it was. Smallpox was called smallpox to distinguish it from the great pox, syphilis, which evoked this description from Ulrich von Hutten in 1519: “Boils that stood out like Acorns, from whence issued such filthy stinking Matter, that whosoever came within the Scent, believed himself infected. The Colour of these was of a dark Green and the very Aspect as shocking as the pain itself, which yet was as if the Sick had laid upon a fire.”

Two points are noteworthy about this vivid account. First, it contrasts markedly with modern experiences with the disease. Although serious in its overall effects — which can include heart problems, brain damage and infertility — the rash and other overt symptoms of syphilis are now much more muted, and the disease may go undetected for some time, which helps explain why it is so hard to control. Second, it is reasonable to suppose that a sufferer of the symptoms von Hutten describes would be unlikely to get a lot of dates.

These two observations led Rob Knell, a scientist at Queen Mary University in London, to propose (in a 2004 paper in The Proceedings of the Royal Society of London) that they were connected. If a syphilis-ridden individual were less likely to have sex, and hence spread the disease, it would behoove the disease organism to evolve a less acute effect on its hosts. Syphilis became less severe, he argued, because it was transmitted more readily if victims were still attractive to the opposite sex.

And while these changes were too rapid to be attributed to humans’ evolving resistance to the disease, he continued, for the syphilis bacteria, even a few years represents many thousands of generations. So we have syphilis itself to thank for the lessening of its symptoms. The disease is still serious, of course. But the rapid evolutionary change is striking.

Conventional wisdom used to hold that all diseases eventually evolved toward a more benign state, a “don’t bite the hand that feeds you” rationale. The muting of syphilis notwithstanding, we now realize that is not the case.

Diseases can evolve to become more virulent, more benign or neither — it all depends on what’s in it for them. For some diseases — cholera, for instance — killing the host is immaterial if the pathogen can spread via contaminated water sources. But sexually transmitted diseases must get around via sex. From the pathogen’s perspective, simply sitting around in the intestinal tract waiting for a too cursory bout of hand washing is unsatisfactory.

The disease organism from which syphilis arose is spread through simple skin contact. In chilly Europe, that’s too chancy a mode of transmission. Sex, on the other hand, is a fairly reliable means of transport, even for a delicate bacterium.

So you might blame Columbus, not for wreaking havoc on the New World through the spread of a sexually transmitted infection, but for wearing clothes. If he and his fellow Europeans had been more prone to going about au naturel, maybe the great pox wouldn’t have been so great after all.

Link to NY Times article

Syphilis in Renaissance Europe: rapid evolution of an introduced sexually transmitted disease?
Robert J. Knell

Proceedings of the Royal Society B, Volume 271,
Biology Letters Supplement 4 / May 07, 2004 S174-S176

Link to Journals of the Royal Society abstract

Not keeping up!

PlusNews reported from Johannesburg, (24 April 2008)

AFRICA: Epidemic out pacing response says UNAIDS

In less than two months, government officials and AIDS activists from around the world will convene in New York to review the global HIV/AIDS response.

National progress reports, submitted earlier this year, will be compared to targets adopted by the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) in 2001.

Based on a review of the reports from Eastern and Southern Africa, the regions worst affected by the HIV/AIDS crisis, experts from UNAIDS have already concluded that despite significant progress in areas such as treatment, many of the UNGASS goals are still far from being reached.

In the area of prevention, described in the 2001 document as the "mainstay of the response", progress has been particularly disappointing, with some countries even documenting a backward slide since the last round of reporting in 2006.

Children still accounted for one in six of new HIV infections globally in 2007, according to UNAIDS. Although some countries in the region saw a decrease in HIV prevalence among people aged 15 to 24 - the age group that provides the best indication of new adult infections - others saw no change or slight increases.
In 11 countries with high HIV prevalence that recently conducted surveys, only about 15 percent of orphans were living in households that received some form of medical, financial or psychosocial assistance - an increase of just 5 percent from 2005.

Expectations around this year's UNGASS meeting in New York are likely to be influenced by what many described as a disappointing outcome from the last meeting, in June 2006. An attempt to reach consensus between countries with conflicting attitudes and priorities resulted in a declaration that most civil society groups regarded as weak and lacking targets.

Link to UNAids National progress reports,

Link to PlusNews Report

Peace Corps shame

Stephen Barr writing a commentary for The Washington Post (April 28, 2008)

For Volunteer, Early Exit Adds To Disease's Pain

Examines the case of Peace Corps volunteer, Jeremiah S. Johnson who taught English in Ukraine. [covered last week - April 22, 2008 - Peace Corps Fires Man with HIV] His work ended abruptly. A test for HIV came back positive, and the Peace Corps brought him back to Washington, where he was discharged by the agency

Last week, the ACLU wrote to Ronald A. Tschetter, director of the Peace Corps, about Johnson's termination. Rebecca C. Shore, an ACLU staff lawyer, said Johnson's dismissal "appears based upon a Peace Corps policy to terminate volunteers who are HIV-positive without an individualized assessment as to whether they are able to serve with reasonable accommodation." Such a policy violates the 1973 Rehabilitation Act, she wrote.

Amanda H. Beck, the Peace Corps press director, said Tschetter plans to respond to the ACLU, which posted the letter on its Web site and sent out a news release about Johnson's case.

"The Peace Corps does not have a policy of automatically excluding people with HIV," Beck said. "The Peace Corps conducts individualized medical examinations of volunteers and applicants who are HIV-positive."

She said she cannot comment on Johnson's case because of privacy rules, noting that Johnson "has not given us permission to speak about his individual situation."

In its letter, the ACLU pointed out that the State Department in February changed rules that disqualified HIV-positive Americans from becoming diplomats. The department said it revised medical clearance guidelines based on advances in HIV care and treatment and will take a case-by-case approach in deciding on applicants for Foreign Service assignments.

State's policy change came just weeks before a trial was scheduled to start in a lawsuit brought in 2003 by Lorenzo Taylor, who had been rejected for employment when he told the department about his HIV status. He was represented by Lambda Legal, a New York group that is an advocate for people with HIV.

Back in Washington in February, Johnson had another medical exam and was given a "medical separation" from the Peace Corps.

On the notice, the Peace Corps said that it had determined "the resolution of your condition(s) will take longer than the maximum-allowable 45 days" and that "you would be medically unable to perform your volunteer assignment."

The reason for the medical separation written on the form is: "HIV -- lab work positive."

Link to The Washington Post article

The Bailey

April 29, 2008)

Rush to search Old Bailey records of criminal trials

Thousands of Britons, Americans and a fair few Australians began searching an online archive yesterday for news of the nefarious dealings of their distant ancestors in Victorian London.

Records of trials at the Old Bailey throughout the 1800s and early 1900s have been placed online, from infamous murders to bungled bicycle frauds, all catalogued into a searchable archive.

Yesterday the site was creaking under the strain as people logged on, punched in their family name and waited for news of how and when it had been blackened by an unscrupulous ancestor.

Accounts of The Proceedings of the Old Bailey were originally collated and circulated from 1674 in what became a popular London publication.

By the early 20th century the readership had declined and the authorities were no longer willing to bear the expense. The last edition rolled off the presses in April 1913; thereafter the complete record was contained in a handful of rare leather-bound collections.

Efforts to make this rich seam of London’s social history available to even the most casual family researchers were co-ordinated by historians from the universities of Sheffield and Hertfordshire and the Open University.

Workers in India digitalized the words, a team of developers catalogued the data and yesterday a final chunk of court history was placed online.

The new records include the indictment for “acts of gross indecency” of Oscar Wilde and Alfred Taylor in May 1895. There is the case of Dr Hawley Crippen, who murdered his wife, a Camden music-hall singer, and was arrested while fleeing to America with his mistress.

— The latest records are from trials conducted between 1834 and 1913

— About 100,000 trials have been transcribed and digitalized in a searchable online database

— The website contains more than 100 million words

— The first mention of the bicycle appears in the fraud case of 1875

— The motor car makes its debut in 1899 in another case of fraud

Link to the Old Bailey on line

Link to The Times article

Monday, April 28, 2008

Peter Brookes - The Times

personality mail

New Scientist (April 26 – May 2, 2008

How an email address can reveal your character

Think twice about the email address you pick: it may speak volumes about your personality.

Mitja Back and colleagues at the University of Leipzig in Germany asked a panel of 100 students to guess the personalities of 600 teenagers simply by looking at their email addresses.

The panels' guesses agreed most with a personality survey the teenagers had completed when it came to qualities like openness, conscientiousness and narcissism, and diverged most on the trait of extroversion. Addresses that gave away personality often contained periods, numbers or a name that was obviously not genuine

How extraverted is Inferring personality from e-mail addresses
Mitja D. Back et al

Journal of Research in Personality doi:10.1016/j.jrp.2008.02.001

Link to JRP abstract

Link to New Scientist report

Carbon balance

BBC News on line (April 28, 2008)

Nature's carbon balance confirmed

Scientists report, in the journal Nature Geoscience, new evidence that the Earth's natural feedback mechanism regulated carbon dioxide levels for hundreds of thousands of years. But they say humans are now emitting CO2 so fast that the planet's natural balancing mechanism cannot keep up.

They say their findings confirm a long-held theory. Carbon spewed out by volcanoes is removed from the air by rock weathering and transported to the ocean floor.
Using evidence from an Antarctic ice core, the team calculated that over a period of 610,000 years the long-term change in atmospheric CO2 concentration was just 22 parts per million (ppm), although there were larger fluctuations associated with the transitions between glacial and interglacial conditions. By comparison, two centuries of human industry have raised levels by about 100 ppm - a speed of rise about 14,000 times faster.

"These long term cycles are way too slow to protect us from the effect of (anthropogenic) greenhouse gases," said Richard Zeebe from the University of Hawaii in Honolulu.
"They will not help us with our current CO2 problem. Right now, we have put the system entirely out of equilibrium."

Scientists have long believed that the Earth’s climate was stabilized by a natural carbon thermostat. In their model, carbon released into the atmosphere, primarily by volcanoes, is slowly removed through the weathering of mountains, washed downhill into oceans, and finally buried in deep sea sediments.

"A lot of people had tried to refute this hypothesis, but our study provides the first direct evidence (that it is correct)," said Dr Zeebe.
He studied levels of CO2 recorded in air bubbles trapped in a 3km ice core drilled from an Antarctic region called Dome Concordia (Dome C).
Data from the ice core, drilled by the European Project for Ice Coring in Antarctica (Epica), was first published in 2005. But rather than focusing on the peaks and troughs of CO2 - as other researchers have done - this group looked at the long term trend, and compared the ice core data with records of carbonate saturation in the deep sea for the last six glacial cycles.

"It is remarkable how exact the balance is between the carbon input from volcanoes and the output from rock weathering," said Dr Zeebe.
"This suggests a natural thermostat which helps maintain climate stability."
The delicately balanced carbon thermostat has been a key factor in allowing liquid water, and life, to remain on Earth, he said.
"If it weren’t for these feedbacks, the Earth would look very different today."

Close mass balance of long-term carbon fluxes from ice-core CO2 and ocean chemistry records
Richard E. Zeebe & Ken Caldeira

Nature Geoscience published online: 27 April 2008; | doi:10.1038/ngeo185

Link to Nature Geoscience abstract

Link to Epica

Link to BBC News report

Humphrey Lyttelton 1921-2008

Jazz musician & radio broadcaster Humphrey Lyttelton, died on April 25

I'm Sorry I Haven't a Clue

Sunday, April 27, 2008

Cool Wales?

OK, now that the English national day is gone, back to real national fervor. With the end of BBC America’s season of Torchwood last Saturday (Will Capt Jack be back?) we had to seek solace on line. As a consolation we found The Times (April 22, 2008) acknowledging Doctor Who and Torchwood's residence in Cardiff and explaining that suddenly, all things Welsh are hip. How did that happen? With successes in TV, theatre, music and sport, they're singing in the valleys again, says tell you why in

Why Wales is suddenly cool

But the detractors have also come out-

Wales has always been cool. It has something to do with all that rain and bad weather that comes in off the Irish sea.

The article ends with a somewhat of beat, if not bizarre, list of special Welsh attractions -

The Brecon Beacons - National Park - “and the countryside in general”

Laverbread - Bara Lawr – “delicious with bacon”

The Big Pit “Best interactive museum in the UK”

Portmeirion “Has to be seen to be believed”

The Language “Alive and kicking”

Link to the Times article

Saturday, April 26, 2008

Morcombe & Wise

AIDS vaccine

The London Newspaper The Independent, in an article (24 April 2008) for the Science section by Steve Connor and Chris Green, asks

Is it time to give up the search for an Aids vaccine?

After 25 years and billions of pounds, leading scientists are now forced to ask this question, they say.

Most scientists involved in Aids research believe that a vaccine against HIV is further away than ever and some have admitted that effective immunization against the virus may never be possible, according to an unprecedented poll conducted by The Independent.

A mood of deep pessimism has spread among the international community of Aids scientists after the failure of a trial of a promising vaccine at the end of last year. It just was the latest in a series of setbacks in the 25-year struggle to develop an HIV vaccine.

Apart from a more thorough appraisal of The Independent's survey, they also include some personal views from HIV positive people,

The article also links to The Independent's Survey and to a Comment

Link to The Independent article

The Wall Street Journal (April 25, 2008) publishes an opinion piece by Dr. Seth Berkley President and CEO of the International AIDS Vaccine Initiative

We Are Making Progress on AIDS

Link to Wall Street Journal Opinion

Link to the International AIDS Vaccine Initiative

CD4 cell counts

Michael Carter writing for Aidsmap (April 25, 2008)

Higher CD4 cell counts associated with lower rate of non-HIV-related diseases in patients taking antiretrovirals

Higher CD4 cell counts in patients taking antiretroviral therapy are associated not only with a lower rate of HIV-related illnesses, but a lower rate of serious illnesses such as heart, kidney, and liver disease as well as some cancers, according to a US study published in the April 23rd edition of AIDS.

HIV treatment guidelines have recently been changed in the UK, Europe and US recommending that anti-HIV therapy should be started when a patient’s CD4 cell count is in the region of 350 cells/mm3, mainly because the SMART treatment interruption study showed that a higher CD4 cell count was associated with a lower risk of not only AIDS-defining illnesses, but also some serious diseases not traditionally associated with HIV.

The findings of the current study potentially add to our understanding of the importance of CD4 cell count in reducing the risk of serious illnesses not normally associated with HIV.

On the basis of their findings, the investigators comment, “if the potential reduction in non-AIDS risk as well as AIDS risk could be realized through earlier initiation of antiretroviral therapy (at CD4 cell counts greater than 350 cells/mm3), thereby maximizing CD4 cell recovery and minimizing time spent at lower CD4 levels, the public health benefit would be substantial.”

Potent antiretroviral therapy lowers HIV viral load, allowing the CD4 cell count to increase, thereby reducing the risk of HIV-related opportunistic infections and cancers. Thanks to the success of antiretroviral therapy, the main causes of illness and death in people with HIV are no longer HIV-related.

The investigators comment that their findings show that “rates of non-AIDS diseases decrease with increasing CD4 counts”. They call for a randomized controlled trial “to determine the risk-benefit balance of starting antiretroviral therapy at higher CD4 counts.”


CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection.
Jason V Baker et al
AIDS. 22(7):841-848, April 23, 2008.

Link to AIDS abstract

Link to Aidsmap article

Friday, April 25, 2008

World Malaria Day – April 25, 2008

BBC News on line (April 25, 2008)

UN effort to end malaria deaths

United Nations Secretary General Ban Ki-moon has called for the elimination of malaria deaths by the end of 2010 as he marked the first World Malaria Day.

Mr Ban wants all of Africa to have access to basic measures to control the disease such as bed nets and sprays.
He called for bed nets for an extra 500 million people, more malaria clinics, more training for community health workers, and encouragement of research into the disease.
"We have the resources and the know-how but we have less than 1,000 days before the end of 2010," he said of the goal.

Each year more than half a billion people are infected with malaria ---, which is and treatable and preventable
He described the 2010 deadline as a "bold but achievable vision", saying that several African countries had "made dramatic strides in malaria control".
But he added: "The most affected nations remain off track to reach the goal of halting and reversing the incidence of the disease."

Previous efforts to control malaria have proved less than successful.
In 1998 the Roll Back Malaria initiative aimed to halve malaria deaths by 2010 - but halfway through the program deaths had actually risen.
Reversing the trend of increase in malaria and other diseases is one of the UN's Millennium Development Goals, aimed at reducing poverty and improving the quality of life by 2015.

Link to WHO

Link to BBC News report

Day of Silence - End the Silence!

Thursday, April 24, 2008

Day of Silence - April 25

The Big One?

New Scientist (April 19 - 25, 2008)

Californian quake before 2037 almost inevitable

Bad news for Californians. The US Geological Survey has released its first ever earthquake forecast for the whole state, and the odds don't look good.

The three-year study, commissioned by insurance conglomerate the California Earthquake Authority, combined empirical evidence on prior earthquakes with the physical data from various fault lines in the region and precise satellite information about movements of the Earth's surface.

According to the study, there is a 99.7 per cent chance of a quake of magnitude 6.7 or greater hitting California by 2037. Those in Los Angeles have a 67 per cent chance of such a quake in that time and the people of San Francisco have a 63 per cent chance.

Disturbingly for southern Californians, it seems they are more vulnerable to a catastrophic quake than those living in the north - with a 37 per cent chance of a quake greater than magnitude 7.5 before 2037, which is more than twice the probability for the north.

Link to USGS Survey

Link to New Scientist article

Doctors’ struggle

David Noonan writing for Newsweek (April 19, 2008 issue)

Doctors Who Kill Themselves

reports every year, between 300 and 400 doctors take their own lives—roughly one a day. No other profession has a higher suicide rate. And, in sharp contrast to the general population, where male suicides outnumber female suicides four to one, the suicide rate among male and female doctors is the same.

He focuses on a new documentary, Struggling in Silence (airing next month on public-television stations), which explores the dark side of the profession—the little-known and rarely discussed problem of depression and suicide among physicians

"Undiagnosed and untreated depression is the culprit here," says Dr. Charles Reynolds, professor of psychiatry at the University of Pittsburgh School of Medicine, who appears in the film and was co-author of a 2003 paper (one of the few) on physician suicide, published in The Journal of the American Medical Association. While the rate of depression over a lifetime is basically the same for male physicians and the general population of men—about 12 percent—the doctors' suicide rate is 1.4 times higher. Female docs have double the rate of depression and 2.3 times the rate of suicide compared with the general population of women. (Some studies report equal rates of depression for women doctors; others report even higher suicide rates for physicians.)

So why aren't depressed docs seeking treatment for a common illness that millions of Americans have learned to manage with therapy and readily available medications? Because they worry—not without reason—that if they admit to a mental-health problem they could lose respect, referrals, income and even their licenses. Because, despite the steady increase in the number of women in the field, medicine is still very much a macho profession; physicians are supposed to be the strong ones who care for the sick, not the sick ones who need to be cared for. "I did not want it to go on my medical record that I had been treated for depression," says Dr. Robert Lehmberg, 60, whose moving account of his struggle with the condition—and the stigma it carries—is featured in the film. "Once I got treated, I realized how foolish all that was."

The goal of Struggling in Silence, and of the new Web site (both the work of the American Foundation for Suicide Prevention), is to raise awareness, prevent suffering and even save some lives. There could be a bonus as well. "If we teach doctors to recognize depression in themselves," says Dr. Paula Clayton, the foundation's medical director, "they will recognize it in their patients." And then everybody will feel better.

Link to Newsweek article

Link to

Link to American Foundation for Suicide Prevention

Confronting Depression and Suicide in Physicians
A Consensus Statement

Claudia Center, JD et al
Journal of the American Medical Association 2003; 289:3161-3166. June 18, 2003

Link to JAMA abstract

Wednesday, April 23, 2008

April 23 - St. George's Day

Worst person . . .

crime and punishment

Adam Liptak writing for the New York Times (April 23, 2008) in

Inmate Count in U.S. Dwarfs Other Nations’

gives an in depth appraisal of the US penal system. The United States has less than 5 percent of the world’s population. But it has almost a quarter of the world’s prisoners.

The United States leads the world in producing prisoners, a reflection, he says, of a relatively recent and now entirely distinctive American approach to crime and punishment. Americans are locked up for crimes — from writing bad checks to using drugs — that would rarely produce prison sentences in other countries. And in particular they are kept incarcerated far longer than prisoners in other nations.

Criminologists and legal scholars in other industrialized nations say they are mystified and appalled by the number and length of American prison sentences.

The United States has, for instance, 2.3 million criminals behind bars, more than any other nation, according to data maintained by the International Center for Prison Studies at King’s College London.

Link to the International Center for Prison Studies

Link to NY Times article

Maybe there is a hint as to the under pinnings of US crime and punishment in another piece in the same edition

Gilbert King, the author of The Execution of Willie Francis: Race, Murder and the Search for Justice in the American South writes an opinion article for the New York Times (April 23, 2008)

Cruel and Unusual History

which looks at the current Supreme Court decision that Kentucky’s three-drug method of execution by lethal injection does not violate the Eighth Amendment’s prohibition on cruel and unusual punishment. In his majority opinion, Chief Justice John Roberts cited a Supreme Court principle from a ruling in 1890 that defines cruelty as limited to punishments that “involve torture or a lingering death.”

King explains - with gruesome details - why the court was wrong in the 19th century and how that

error that has infected its jurisprudence for more than 100 years.

The justices cited and applied Wilkerson’s and Kemmler’s cases as if their executions went off without a hitch.

And 60 years after two drunken executioners disregarded the tortured screams of a teenage boy named Willie Francis, the Supreme Court continues to do so.

Link to NY Times op-ed article

hate speech or just joking? Newscenter Staff (April 23, 2008)

UK Lords Nix Expanded Gay Hate Law

A bill to toughen Britain's hate speech law banning attacks on gays has been defeated in the House of Lords.
The bill would have provided for jail sentences up to seven years for anyone convicted of using threatening language on the basis of sexual orientation.

The legislation had already passed the House of Commons.
The Lords voted 81 to 57 to strip prison sentences from the bill, leaving it toothless.
The vote leaves the Labor government with two choices: either let the bill die, or use a procedural vote in the Lower House to override the Lords.

Even some gay rights advocates, including Peter Tatchell, opposed the bill, saying it would hamper free speech.
Church leaders also fought the legislation claiming it could be used to silence any criticism of homosexuality from the pulpit.
Comedic actor Rowan Atkinson said that if the bill were enacted it would bar humorists and comedians from characterizing gays.

The bill was put together with the help of LGBT rights group Stonewall.
director Ben Summerskill dismissed the criticism of the legislation saying people could still criticize homosexuality as long as they were "temperate and polite".

Attempts to charge people with homophobic speech under existing law has been met with failure.
Similar hate speech laws in Europe and Canada have been met with mixed results as judges attempt to balance hate crime laws with free speech and religious freedom protections.

Link to News report

Peace Corp shame Newscenter Staff (April 22, 2008)

Peace Corps Fires Man with HIV

The American Civil Liberties Union has sent a letter to the Peace Corps demanding that it change its policy of barring people with HIV from serving as volunteers.

The letter was sent on behalf of a Denver, Colorado volunteer who was sent home from his post in the Ukraine and terminated after he tested positive.

"I joined the Peace Corps because I wanted to learn more about the world and help people," said Jeremiah Johnson.
"It was hard enough to learn that I had contracted HIV, but to then be shipped home and told I was unworthy of finishing my service was incredibly humiliating."

Johnson, now 25, began his tour as a Peace Corps volunteer in December 2006. He tested negative for HIV prior to beginning his service.
For nearly thirteen months, he was the sole volunteer in Rozdilna, Ukraine, where he taught English to middle and high school students.
In January 2008, Johnson, who was in Kiev to attend a Russian language program with other volunteers, received a midservice medical examination and opted to take an HIV test.

After the results confirmed that he was positive for the disease, he was immediately told that he could no longer work in the country because of a Ukrainian law barring people with HIV from working in the country. He was also told he would not be able to finish his service elsewhere.
Although he had no health problems, he was only allowed to return to Rozdilna for two days to pack his bags and say goodbye to the people he had met during his tour, the ACLU said in a statement.
He was forced to abandon projects that he had been developing to help the community. Johnson was then sent to Washington, D.C., for an end-of-service medical exam.

The ACLU said that while in DC, he again asked Peace Corps officials to explain why he was being terminated and asked if he could continue his service elsewhere, but these requests were denied. Instead, he was given an automatic medical termination, stating HIV as the reason for his termination.

The ACLU’s demand letter charges that it is illegal under the Rehabilitation Act for the Peace Corps to discriminate against Johnson because he has HIV.

The letter cites a recent federal appeals court decision finding that it is illegal for the Foreign Service to bar people with HIV from serving. In that case, the Foreign Service, which also sends workers around the globe, had argued that it was justified in barring people with HIV from service in order to protect the health of people with HIV who would be stationed in areas with limited access to medical treatment. The court rejected that rationale.

"There is not a single justifiable reason for the Peace Corp to bar people with HIV from serving as volunteers," said Rebecca Shore, an attorney with the ACLU’s AIDS Project.
"Jeremiah was, and continues to be, in good health, fully capable of performing his responsibilities. It is especially disappointing that an agent of our government would have an illegal and discriminatory policy barring people with HIV from trying to make the world better."

The ACLU’s letter demands that the Peace Corps change its policy or confirm that it does not have a policy of automatically excluding all people with HIV. According to the ACLU, the Peace Corps must consider on an individualized basis whether an applicant with HIV can volunteer, including making every effort to place those who are able to serve in a country that doesn’t bar people with HIV from working in the country.

Link to News report

Veteran suicide - 'Shh!'

The Washington Post (April 22, 2008) covers Matthew Daly’s Associated Press report

Democrats Seek Resignation of Top VA Mental Health Official

Sens. Daniel Akaka of Hawaii and Patty Murray of Washington state called for Dr. Ira Katz, the VA's mental health director, to resign because he withheld crucial information on the true suicide risk among veterans.

A number of Democratic senators said they were appalled at e-mails showing Katz and other VA officials apparently trying to conceal the number of suicides by veterans. An e-mail message from Katz disclosed this week as part of a lawsuit that went to trial in San Francisco starts with "Shh!" and claims 12,000 veterans a year attempt suicide while under department treatment.
"Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?" the e-mail asks.

A VA spokesman declined to comment Tuesday.

Another e-mail said an average of 18 war veterans kill themselves each day _ and five of them are under VA care when they commit suicide.

Harkin, Murray and Sen. Russ Feingold, D-Wis., introduced legislation Tuesday calling on the VA to track how many veterans commit suicide each year. Currently, VA facilities record the number of suicides and attempted suicides in VA facilities but do not record how many veterans overall take their own lives. The agency is reluctant to disclose specific numbers, veterans advocates complain.

The new bill would require the VA to report to Congress within 180 days the number of veterans who have died by suicide since Jan. 1, 1997, and continue reports annually. Harkin's office said statistics provided earlier this year by the VA showed that 790 veterans under VA care attempted suicide in 2007. That figure is contradicted by the e-mail revealed this week.

Two veterans groups last year filed the class-action lawsuit against a sprawling VA system that handled a record 838,000 claims last year. A government lawyer on Monday urged a judge to dismiss the lawsuit, saying the agency runs a "world class" medical care system.

Link to the Washington Post report

Peter Brookes - The Times

Tuesday, April 22, 2008

cancer: scalp & neck

BBC News on line (April 21, 2008)

'Outlook worse' for scalp cancer

A team at the University of North Carolina School of Medicine suggest that skin cancers on the scalp or neck are more deadly than those elsewhere on the body.

An analysis of 50,000 cases of melanoma found people with these cancers were nearly twice as likely to die as those with the disease on arms or legs.

Scalp and neck cancers were often found later but there seemed to be something inherently virulent about them, the Archives of Dermatology study found.

Survival rates from skin cancer are nonetheless relatively high.

The five-year survival rate for patients with scalp or neck cancer was 83%, compared with 92% for those with melanomas on the face and ears and on the extremities - the arms, legs, hands and feet.

Cancers on the scalp and neck appeared to be thicker and were more likely to be ulcerated than cancers at other sites. The lymph nodes were also more often affected in patients with scalp and neck cancers than in the other skin cancer groups.

The researchers acknowledged that people with cancers in areas likely to be hidden by hair were more likely to spot skin abnormalities later. But even after this was factored into the analysis, there was a poorer survival rate overall - leading the researchers to conclude that there were biological differences between the cancers

"Only 6% of melanomas present with the disease on the scalp or neck, but those patients account for 10% of melanoma deaths," said Nancy Thomas, a professor of dermatology who led the research.


Survival Differences Between Patients With Scalp or Neck Melanoma and Those With Melanoma of Other Sites in the Surveillance, Epidemiology, and End Results (SEER) Program
Anne M. Lachiewicz et al
Archives of Dermatology Apr 2008; 144 (4): 515 - 521.

Link to Arch Derm abstract

Link to BBC News report

Breast cancer

BBC News on line (April 21, 2008)

Therapy 'may slow tumor growth'

According to a study, published in the Proceedings of the National Academy of Sciences, scientists from the US National Cancer Institute believe they have identified a gene that may be able to limit the growth of breast cancer tumors. In tests on mice tumors containing the Brd4 gene ended up 10 times smaller than ones that did not. And an analysis of studies involving human breast cancer patients revealed the presence of the gene may be useful as a predictor of survival chances.

Researchers chose to study the effect of the Brd4 gene as it is known to influence the growth of cells. They believe the findings may not be limited solely to breast cancer, although they have yet to test that fully.

The researchers inserted copies of the gene into some of the mice breast cancer tumors. They found after 28 days the size of the tumors had been limited to a tenth of the size of those without the gene, while the spread of the disease to the lungs was much more limited.

The team then carried out research into 1,240 patients, split between five separate groups. They found those with the Brd4 gene had much better survival rates - in some of the groups it was nearly double the rate than those without the gene.

Researchers said as well as being able to predict the consequences of the disease, a treatment could even be developed to stimulate or introduce the gene.

Report author Kent Hunter said: "Potentially, this treatment could help manage and control a cancer.
"That is still a long way off, but in the more immediate future we could at least predict the course of the disease."


Bromodomain 4 activation predicts breast cancer survival
Nigel P. S. Crawford et al

Proc. Natl. Acad. Sci. USA, published April 21, 2008, 10.1073/pnas.0710331105 (Medical Sciences)

Link to PNAS abstract

Link to BBC News story