Monday, June 30, 2008

Tim Sanders - The Independent

The Anglican Schism

Want it explained?

Bemused by the sudden attraction of the Thirty-Nine Articles?

Andrew Brown explores in The Guardian (June 30, 2008)

Meet the Focas

They want you to like them.
But are they the kind of people liberal Anglicans will be able to have a nice cup of tea with?

He warn us cynics –

But mocking the Focas is one of the things that got liberals into this mess. Though their beliefs may be variously ridiculous and incoherent, there is a solid spine of hope and hatred to them.

They hate liberalism of all sorts, and they hope God will reward them if they can crush it. Now they have an international base, they will spend decades trying to drive it out of England. First gay people have been the target; the next battle will be over women bishops, because in a conservative reading of the Bible it is always wrong for women to give orders to men. So while they are perfectly happy to tell male bishops to get stuffed, the thought of having to do so to a woman is quite intolerable to them.

What remains to be seen is whether the great bulk of the Church of England, bewildered where it is not outmaneuvered, will recognize the schism for a real threat or go on supposing that surely we can all be friends. That's not the way that most divorces end.

Link to The Guardian article

HIV rising

Roger Pebody for Aidsmap (June 30, 2008)

Rapid rises in diagnoses in US gay men concentrated in black and younger men

Covers the Centers for Disease Control and Prevention (CDC) June 27th edition of the Morbidity and Mortality Weekly Report.

And also notes, during this period the US reporting system was not set up to provide accurate measures of HIV incidence (i.e. the rate of new infections in the population). However this data does strongly suggest that incidence is rising in many groups of American men who have sex with men, and may be higher than previously estimated.

At the Conference on Retroviruses and Opportunistic Infections earlier this year, Ron Stall of the University of Pittsburgh had said that his systematic review of incidence studies concluded that incidence in community samples of American gay men was around 2.4% a year. Moreover, Stall went on to demonstrate the long term implications of such an incidence rate.

Taking this figure as a starting point, Stall ran a mathematic model to see how this incidence in a group of 18 year-olds would translate into HIV prevalence as the group got older. The key assumptions of the model were that each year 2.4% of the group acquired HIV, and that mortality rates were the same as for equivalent age groups in the general population.

By age 20, around 5% of the group would be HIV-positive; by age 25, around 15% would have HIV; by age 30, around 25% would be living with HIV, and when they were 40, 41% of the group would be HIV-positive.

Moreover, Stall re-ran the model for black men, based on a “low” estimate of 4% incidence in this group. The results were even more alarming: by age 40, around 60% of the group would have HIV.

Stall commented that he was “horrified” by these estimates. However he concluded that “at the HIV incidence rates we're already seeing in the published literature, we can expect an ongoing HIV epidemic among gay men that will yield high prevalence rates over time.”

References

Centers for Disease Control and Prevention. Trends in HIV/AIDS diagnoses among men who have sex with men – 33 states, 2001-2006. MMWR 57: 681-686, 2008.
Posted
June 26, 2008


What's driving the US epidemic in men who have sex with men.
R. Stall et al
15th Conference on Retroviruses and Opportunistic Infections, Boston, abstract 53, 2008.

Link to Retro conference 2008

Link to Aidsmap article

HIV-proof T cells?

Science Daily (June 30, 2008)

Zinc Finger Proteins Put Personalized HIV Therapy Within Reach

— Researchers at the University of Pennsylvania School of Medicine and collaborators are using minute, naturally occurring proteins called zinc fingers to engineer T cells to one day treat AIDS in humans.

The Penn researchers and colleagues from Sangamo Biosciences (Nasdaq:SGMO), Richmond, CA, who developed the zinc finger technology, report in an advanced online issue of Nature Biotechnology the first steps towards the goal of using modified T cells from an HIV-infected person for their own treatment. They showed that, using the zinc fingers, they could reduce the viral load of immune-deficient mice transplanted with engineered T cells.

"By inducing mutations in the CCR5 gene using zinc finger proteins, we've reduced the expression of CCR5 surface proteins on T cells, which is necessary for the AIDS virus to enter these immune system cells," explains first author Elena Perez, MD, PhD, Assistant Professor of Pediatrics at Penn. "This approach stops the AIDS virus from entering the T cells because it now has an introduced error into the CCR5 gene."

reference

Establishment of HIV-1 resistance in CD4+ T cells by genome editing using zinc-finger nucleases
Elena E Perez et al
Nature Biotechnology
published online: 29 June 2008; | doi:10.1038/nbt1410

Link to Nature Bio abstract

Link to Science Daily report

HPV

Kelly Morris writing for Aidsmap (June 30, 2008)

Asymptomatic anal HPV infection more common than thought in heterosexual men

Anal infection with human papilloma virus (HPV) is more prevalent in heterosexual men than previously thought, according to a US study published in the June 15th edition of the Journal of Infectious Diseases.

As with genital HPV, previous estimates of prevalence of anal HPV have varied widely. Although some studies have reported between 1.2% and 8% prevalence in asymptomatic men who report no sex with other men, prevalence of anal HPV was found to be 46% in a 2003 cross-sectional study of 50 HIV-positive heterosexual male injection drug users with no reported history of anal intercourse.

US investigators studied a cohort of men aged 18-40, recruited from both the community and sexual health clinics, who reported having sex with a woman in the preceding year.
Out of the study population of 463 men, 253 either admitted sex with other men or did not answer the question, and were excluded from this analysis. The remaining 222 men were divided into a case group of men with anal HPV and a comparison group of men with or without genital HPV only. Men with only unclassified HPV at anal sites were also excluded.

Anal HPV was found in 24.8% of men, and 33% of these men had infection with a strain of HPV that has been linked with an increased risk of anal cancer. Although nine men had visible warts or lesions at genital sites none of the participants had these signs at anal sites.

In a multivariate model, lifetime number of female sexual partners and frequency of sex in the preceding month were independently and significantly associated with presence of anal HPV.

However, participants who reported a greater frequency of sex in the past month were found to be not at increased risk of anal HPV, which might suggest that they were in a monogamous relationship. The analysis also found that circumcision was marginally associated with a reduced risk of anal HPV.

These findings parallel research in women and in gay men and other men who have sex with men. However in gay men, anal HPV affects all age groups equally, whereas the current study found that the prevalence of anal HPV is lower in those aged 30-40 compared with younger men.

Although this is the largest study of its kind, the authors acknowledge that the study was not large enough for a clear understanding of the full complement of risk factors. They also acknowledge the possibility of false-positive results; that DNA might have been detected from the skin surface without true infection; and the possibility that some participants may not have reported sexual behaviors with other men.

They suggest that future studies should collect sexual and non-sexual exposure information that may clarify transmission routes – for example, behaviors that involve self- or partner-initiated anal-digital contact.

The authors conclude that the findings should not be used to change clinical practice currently, but further research is necessary, especially to determine factors linked with the persistence of cancer-causing anal HPV in younger and older men.

Reference

Prevalence of and risk factors for anal Human Papillomavirus infection in heterosexual men
Alan Nyitray et al.
Journal of Infectious Diseases 197: 1676-84, 2008.

Link to JID abstract

Link to Aidsmap article

Chris Riddell - The Observer

Sunday, June 29, 2008

Boys in the band




Who

In the Sunday (June 15, 2008) edition of the New York Times, reporting from ‘Cardiff, Wales’, Sarah Lyall puts it:

Who Altered British TV? ‘Who’ Indeed

The pun refers of course to the Doctor Who creator Russell T Davies, described by her as perhaps the most admired writer and producer working in British television drama

Link to NY Times article






Mugabe's inauguration

SHAME!

Saturday, June 28, 2008

Voting --- for your life!

Sartre vs. Camus


No! French existentialists are not all the same.

For those who have been trying to distinguish Camus from Satre (and are not willing to do all the reading), some useful insights from Richard Eder in his New York Times book review (June 25, 2008):



Uncomfortable in His Skin, Thriving in His Mind


Albert Camus was one of the two pillars of postwar French literature. The other was Jean-Paul Sartre, his comrade in letters if not quite in arms (during the Resistance, Camus dangerously put out a clandestine newspaper, while Sartre stayed safely studying and writing). Then in the early 1950s, they bitterly split.

Camus’s pillar stood in Paris, but in a sense it belonged elsewhere: perhaps among the Corinthian columns in North Africa’s Hellenistic ruins. He was a French Algerian, of course, but the point isn’t his provenance but his temperament. He was Mediterranean, a creature of sun and water, fierceness and the senses.

In Paris, with its cool symmetries, he was, to adapt a French saying, uncomfortable in his skin — the constricting ideological precision that Sartre and his fellow intellectuals fitted on him. They treated him as a marvel, and then when he rebelled against their leftist rigor, they condemned him.

This odd unsuitability, both of emotions and the mind, comes to life in the third and last volume of Camus’s notebooks, appearing in an English translation (by Ryan Bloom) 19 years after they came out in French.

“Excess in love, indeed the only desirable, belongs to saints. Societies, they exude excess only in hatred. This is why one must preach to them an intransigent moderation.”

Link to NY Times review


NOTEBOOKS
1951-1959
By Albert Camus
Translated by Ryan Bloom. 264 pages. Ivan R. Dee. $27.50.

Link to Ivan R. Dee publisher

Prove it

New Scientist (June 21 - 27, 2008)

Competition puts homeopathy on trial

Want to win £10,000? Then prove that homeopathy works in proper clinical trials in which half the patients receive the treatment, half receive a placebo, and no one knows till the end who got what.

The challenge was issued by Edzard Ernst, professor of complementary medicine at the University of Exeter, UK, and science author Simon Singh, in the wake of what they call a smear campaign against them in response to their book Trick or Treatment, which explores the scientific evidence behind complementary remedies. "We're saying to homeopaths, 'put up or shut up'," says Singh.

The pair are not against complementary remedies. Of those examined in their book, 36 worked for particular conditions - such as St John's wort for mild depression - but homeopathy was not among them.

Homeopaths seem in no hurry to take up the offer. "We have nothing to prove, and certainly not to people with closed minds," says Steve Scrutton of the Alliance of Registered Homeopaths.

Link to Trick or Treatment

Link to ARH

Link to New Scientist report

e-mail privacy

Jonathan D. Glater for the New York Times (June 27, 2008)
A Company Computer and Questions About E-Mail Privacy


reports the case of Scott Sidell, having been fired, finding out that his former employer was reading his personal Yahoo e-mail messages, after he had left the company.

In a lawsuit he claims that executives at the company went so far as to read e-mail messages that he had sent to his lawyers discussing his strategy for winning an arbitration claim over his lost job.

The lawsuit involves an unsettled area of the law, where changes in technology create tension between expectations of personal privacy and companies’ rights to monitor the equipment they provide to employees. The case’s unusual combination of facts, which are in dispute, paves the way for a decision that could help set a precedent for dealing with personal e-mail at work.

The law governing e-mail communications is still evolving. Generally, courts have found that employers can monitor employees’ e-mail communications on company computers. But courts have also recognized greater privacy protection for e-mail messages sent using personal, Web-based e-mail accounts.

Matt Zimmerman, senior staff attorney in the San Francisco office of the Electronic Frontier Foundation, a nonprofit civil liberties organization that seeks to protect privacy rights online. Notes companies often adopt policies explicitly stating that everything an employee does on a computer provided by the employer is subject to monitoring. But even so, and especially in the absence of such a policy, employees may have a reasonable expectation of privacy. Moreover, the expectation of privacy would be even higher if employees used remotely hosted personal e-mail accounts like those provided by Yahoo.

Link to Electronic Frontier Foundation

Link to NY Times article

HIV IS STILL A BIG DEAL

Friday, June 27, 2008

Gay Pride?

As a Gay Pride Celebration, the Onion reposted Bruce Heffernan’s (July 6, 2005 | Issue 41•27) question

Why Do All These Homosexuals Keep Sucking My Cock?

Look, I'm not a hateful person or anything—I believe we should all live and let live. But lately, I've been having a real problem with these homosexuals. You see, just about wherever I go these days, one of them approaches me and starts sucking my cock.

Take last Sunday, for instance, when I casually struck up a conversation with this guy in the health-club locker room. Nothing fruity, just a couple of fellas talking about their workout routines while enjoying a nice hot shower. The guy looked like a real man's man, too—big biceps, meaty thighs, thick neck. He didn't seem the least bit gay. At least not until he started sucking my cock, that is.

Where does this queer get the nerve to suck my cock? Did I look gay to him? Was I wearing a pink feather boa without realizing it? I don't recall the phrase, "Suck my cock" entering the conversation, and I don't have a sign around my neck that reads, "Please, You Homosexuals, Suck My Cock."

I've got nothing against homosexuals. Let them be free to do their gay thing in peace, I say. But when they start sucking my cock, I've got a real problem.

Then there was the time I was hiking through the woods and came across a rugged-looking, blond-haired man in his early 30s. He seemed straight enough to me while we were bathing in that mountain stream, but, before you know it, he's sucking my cock!

What is it with these homos? Can't they control their sexual urges? Aren't there enough gay cocks out there for them to suck on without them having to target normal people like me?

Believe me, I have no interest in getting my cock sucked by some queer. But try telling that to the guy at the beach club. Or the one at the video store. Or the one who catered my wedding. Or any of the countless other homos who've come on to me recently. All of them sucked my cock, and there was nothing I could do to stop them.

I tell you, when a homosexual is sucking your cock, a lot of strange thoughts go through your head: How the hell did this happen? Where did this fairy ever get the idea that I was gay? And where did he get those fantastic boots?

It screws with your head at other times, too. Every time a man passes me on the street, I'm afraid he's going to grab me and drag me off to some bathroom to suck my cock. I've even started to visualize these repulsive cock-sucking episodes during the healthy, heterosexual marital relations I enjoy with my wife—even some that haven't actually happened, like the sweaty, post-game locker-room tryst with Vancouver Canucks forward Mark Messier that I can't seem to stop thinking about.

Things could be worse, I suppose. It could be women trying to suck my cock, which would be adultery and would make me feel tremendously guilty. As it is, I'm just angry and sickened. But, believe me, that's enough. I don't know what makes these homosexuals mistake me for a guy who wants his cock sucked, and, frankly, I don't want to know. I just wish there were some way to get them to stop.

I've tried all sorts of things, but it's all been to no avail. A few months back, I started wearing an intimidating-looking black leather thong with menacing metal studs in the hopes that it would frighten those faggots off, but it didn't work. In fact, it only seemed to encourage them. Then, I really started getting rough, slapping them around whenever they were sucking my cock, but that failed, too. Even pulling out of their mouths just before ejaculation and shooting sperm all over their face, chest, and hair seemed to have no effect. What do I have to do to get the message across to these swishes?

I swear, if these homosexuals don't take a hint and quit sucking my cock all the time, I'm going to have to resort to drastic measures—like maybe pinning them down to the cement floor of the loading dock with my powerful forearms and working my cock all the way up their butt so they understand loud and clear just how much I disapprove of their unwelcome advances. I mean, you can't get much more direct than that.

Link to the ONION article

Trust me I’m safe


Reuters Health (Jun 25, 2008)


Many may "trust" their partner is a low STD risk


Too many people may consider themselves at low risk of sexually transmitted diseases simply because they trust their partner, a new study in the journal Sexually Transmitted Diseases.

The study of patients at an STD clinic found that many people relied on subjective measures in judging their partner's "safety" -- such as how long they had known the partner or how intelligent or well-educated he or she was.

The findings suggest that when people feel they "just know" their partner, they may consider their STD risk to be low even in the absence of any STD/HIV testing.

For the study, Cindy Masaro and colleagues at the University of British Columbia gave questionnaires to 317 men and women attending an STD clinic. All were visiting the clinic for the first time for an assessment and not yet been diagnosed with any STD.

The researchers found that people often took such subjective qualities as a sign that their partner would put them at low STD risk. For example, more than 70 percent of patients said they would probably consider a partner "safe" if he or she were generally trustworthy.

However, people's perceptions of their partners do not necessarily match reality.

Past studies, Masaro and her colleagues point out, have found that while many people are "confident in their assessments of their partner's character," their knowledge of the partner's STD risk factors is often off the mark.

"Developing interventions that target assumptions of safety and dispel incorrect beliefs about the selection of safe partners is needed to promote safer sexual behavior," the researchers conclude.

Perceptions of Sexual Partner Safety.
C L. Masaro, RN, MSN et al

Sexually Transmitted Diseases. 35(6):566-571, June 2008.

Link to STD abstract

Link to Reuters article


365Gay.com Newscenter Staff (June 27, 2008)

CDC: Quarter Of Those With HIV Do Not Know

presents a reminder in National HIV Testing Day that the Centers for Disease Control has issued an ominous warning - about one-fourth of the more than one-million people living with HIV in the United States don’t know they are infected.

Link to 365gay.com News report

HIV & syphilis

Kelly Safreed-Harmon for Aidsmap (June 26, 2008)

Antiretroviral use may improve syphilis treatment outcomes in coinfected people

People with HIV who are taking antiretroviral therapy are less likely to experience the failure of syphilis treatment and less likely to develop neurosyphilis, according to two recently published studies.

An observational cohort study in the July 15th edition of Clinical Infectious Diseases found that HIV-positive people taking antiretroviral therapy had a lower syphilis serologic failure rate than those not taking antiretroviral therapy. The June 19th edition of AIDS reported on another study examining neurosyphilis in a subset of the same cohort; the results suggested that HIV-positive people who are taking antiretroviral therapy at the time of infection with syphilis may have lower odds of developing neurosyphilis than those who are not.

An important implication of both studies is that effective management of HIV infection in people who are coinfected with syphilis may increase the likelihood of successful syphilis treatment outcomes. Syphilis treatment was up to six times more likely to fail in HIV-positive people in the Johns Hopkins HIV Clinical Cohort, according to a previously reported study.

Syphilis is a bacterial infection that is transmitted through genital sores or through rashes or lesions elsewhere on the body. Transmission also occurs through contact with infected blood and during pregnancy. Left untreated, syphilis can severely damage the brain, eyes, heart and other organs, and can be passed on to an unborn child and to sexual partners..

In HIV-positive people, untreated syphilis has a detrimental effect on CD4 cell counts and viral loads. Also, the sores caused by syphilis facilitate the transmission of HIV (Zetola, 2007).

References

Antiretroviral therapy is associated with reduced serologic failure rates for syphilis among HIV-infected patients.
Ghanem, Khalil G et al
Clinical Infectious Diseases 2008 47: 258 – 265.
Link to Clin Infect Dis abstract

Neurosyphilis in a clinical cohort of HIV-1-infected patients.
Ghanem, Khalil G et al
AIDS 22:issue 10: 1145 – 1151, June 19 2008.

Link to AIDS abstract


Syphilis and HIV infection: an update.
Zetola, Nicola M et al.
Clinical Infectious Diseases 2007 44: 1222 – 1228.
Link to Clin Infect Dis abstract

Link to Aidsmap article



Steve Bell - The Guardian

‘global disaster’

Imogen Foulkes reports from Geneva for BBC News (June 26, 2008)

Aids epidemic a 'global disaster'

The Aids epidemic in some countries is so severe that it should be classified as a disaster, the Red Cross and Red Crescent (IFRC) has warned. The crisis fits the UN definition of a disaster as an event beyond the scope of any single society to cope with.
The report says much of the money spent on Aids is not reaching those in need.

The IFRC's annual report on world disasters usually focuses on specific natural disasters such as earthquakes. This year IFRC is departing from tradition with its world disasters report, to focus on what it says is one of the most long term and complex problems facing the world: the HIV/Aids epidemic.

By any standard, the epidemic is a global disaster: 25 million deaths, 33 million people living with HIV/Aids, 7,000 new infections every day.

The IFRC finds the world's response wanting.

There may be billions of dollars to spend on the fight against Aids, but the report warns that much of the money has not been targeted properly and is not reaching those most in need.
"When the history of HIV and Aids is written I think the people will say that we just went for the easier options," says Dr Mukesh Kapila, the IFRC's special representative on HIV/Aids.

Link to IFRC report

Link to BBC News report

National Testing Day

Thursday, June 26, 2008

Orson Welles - Winston Churchill

Kenny Everett - Up Your Way

PRIDE? hiv cases climb

MSNBC on line (June. 26, 2008) covers the Reuters Health release reporting

HIV resurges in men who have sex with men

Cases climb 12 percent among group of U.S. boys and men ages 13 to 24

Based on a new analysis of HIV diagnoses among men who have sex with men pointing to a troubling increase in new cases among young men, reported by the Centers for Disease Control and Prevention in their Morbidity and Mortality Weekly Report

Public health experts use the term "men who have sex with men," or MSM, because many of these men are not strictly homosexual or even bisexual.

Between 2001 and 2006, male-to-male sex was the largest HIV transmission category in the U.S., and the only one associated with an increasing number of HIV/AIDS diagnoses.
The jump was highest — an increase of 12.4 percent — among boys and men between the ages of 13 and 24 years who had sex with other males, particularly among ethnic minorities.

Of 214,379 diagnoses during the study period, 46 percent were among MSM. The rate of new diagnoses declined in all other transmission categories — injection drug use, high-risk heterosexual contact, and other routes of transmission.

Among all MSM, the estimated annual percentage change was 1.5 percent, the great majority of which involved the 13 to 24 year age group.

June 27 is National HIV Testing Day. To address the disproportionately high rate of HIV infection among blacks, the CDC has increased the number of testing sites in 23 geographic areas with the largest number of HIV cases.

Link to CDC Morbidity and Mortality Weekly Report

Link to www.hivtest.org

Link to MSNBC report




cheating?

New Scientist (June 21 - 27, 2008)

'Zero tolerance' proposed for lab cheats

Hands up those who have falsified data. It appears there is vastly more cheating going on in the lab than gets reported.

Sandra Titus of the Office of Research Integrity (ORI) in Rockville, Maryland, surveyed 2212 scientists at 605 institutions funded by the US Department of Health & Human Services. Nine per cent said they had witnessed misconduct, mainly fabrication of results or plagiarism The team calculates that this amounts to 2300 cases of misconduct per year among all DHHS-funded researchers, yet the ORI receives 24 misconduct alerts a year. "I think our findings are the tip of the iceberg," she says.

Titus's team says the key to preventing misconduct is to create a "zero tolerance" culture both for those who commit misconduct and those who turn a blind eye to it.

Repairing research integrity
Sandra L. Titus et al
Nature 453, 980-982 (19 June 2008) | doi:10.1038/453980a;

Link to Nature article

Link to New Scientist report

Homophobic hate crimes

John Carvel, social affairs editor The Guardian (June 26, 2008)

One in five gay people suffer hate attacks

Reports one in five lesbian and gay people in the UK have been victims of homophobic aggression over the past three years, a survey of hate crime will reveal today. Their experiences range from beatings and sexual assault to persistent harassment and insults, often from neighbors and workmates.

The charity Stonewall commissioned YouGov to carry out the first comprehensive national survey of homophobic crime, which analyses the experiences of more than 1,700 lesbian, gay and bisexual people. The poll found that 12.5% had been the victims of a homophobic crime or incident over the past year, and 20% over the past three years.

One in six of the victims had been physically assaulted and one in eight had been subjected to unwanted sexual contact. Almost nine in 10 had experienced homophobic insults and harassment.

Three-quarters of the victims had not reported the incident to the police, often because they did not think the complaint would be investigated. Two-thirds of victims who reported incidents to the police were not offered advice or referred to support services.

Jacqui Smith, the home secretary [Ms ‘safe if discrete’], said the findings of the poll would be considered by the ministerial action group on violence, which is investigating further action against hate crime.

Ben Summerskill, chief executive of Stonewall, said: "We hope the whole criminal justice system will now rise to the challenges that this research poses."

Link to Stonewall

Link to Homophobic Hate Crime: Final Report [pdf]

Link to the Guardian report

HIV & crack

Gus Cairns for Aidsmap (June 25, 2008)

Women with HIV who regularly use crack are three times more likely to die

A US survey of 1686 women with HIV on antiretroviral treatment has found that the 29% who regularly or intermittently used crack cocaine were nearly 60% more likely to develop an AIDS-defining illness, and the 3.2% who used it persistently were three times more likely to die.

It also found that persistent users had baseline HIV viral loads that were on average three times higher than intermittent or non-users, and that this persisted throughout the study despite antiretroviral treatment. This was partly due to lower levels of adherence to HAART, but HIV disease progression in crack users and mortality in persistent users remained higher even when figures were adjusted for reported adherence and baseline viral load and CD4 count.

This was the first longitudinal study of a large group of women to confirm what most, but not all cross-sectional studies have found – that usage of crack and cocaine seems to exacerbate the effects of HIV, independently of treatment status and adherence.



Reference

Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women.
Judith A Cook et al
AIDS
22:1355-1363. 2008.

Link to AIDS abstract

Link to Aidsmap article


Steve Bell - The Guardian

Health care costs

Sarah Rubenstein for the Wall Street Journal (June 26, 2008)

More Americans Delay Health Care:
Cost Concerns Drive Even the Insured To Forgo Treatment

More than 20 percent of the US population in 2007—one in five people—reported not getting or delaying needed medical care in the previous 12 months, up significantly from 14 percent—one in seven people—in 2003, according to a national study released by the Center for Studying Health System Change (HSC).

The jump came after relative stability in patients' access to care from 1997 to 2003, according to the center, a nonpartisan policy-research group in Washington that receives funding from the Robert Wood Johnson Foundation, the Kaiser Family Foundation and the federal government, among others.

"As health-care costs increase, more of those costs are shifting to people and families," often in the form of large deductibles or other requirements that patients pay for a significant share of their care out of their own pockets, said Peter Cunningham, lead author of the report.

Mr. Cunningham said the weakening economy may have been a contributing factor to patients' behavior last year but that they also may simply have "reached a tipping point" in terms of being able to afford care amid a steady rise in medical costs.

Karen Ignagni, chief executive of insurance-industry trade group America's Health Insurance Plans, said that policy makers must address a variety of issues to make the health system more affordable, including variations in quality of care and high costs associated with such things as surgery, medical imaging and numerous specialty drugs.

Link to Center for Studying Health Care System Change

Link to Wall Street Journal article

Wednesday, June 25, 2008

The Attenborough Boys at University of Leicester

The Attenborough Boys at University of Leicester

Empathy

New Scientist (June 21 - 27, 2008)

Empathy is not just a human trait

Chimpanzees reach out to cuddle stressed friends, suggesting it's not just humans who feel empathy.

Following a fight between two individuals, the chimp on the receiving end of aggression tends to spend more time scratching and grooming itself - both indicators of stress. This behavior subsides if the fighters subsequently reconcile. Yet chimps don't always make up, and sometimes a third chimp will step in to comfort the distressed party.

Orlaith Fraser at the Liverpool John Moores University, UK, and her colleagues wondered whether this intervention could provide the same kind of stress relief as reconciliation does. The team studied 22 chimps at a zoo and found scratching and grooming was reduced by half when another chimp - most often a close friend already - offered a hand, an embrace, or other friendly contact after a fight

"The evidence is compelling and makes it likely that consolation behavior is indeed an expression of empathy," says Frans de Waal at Emory University in Atlanta, Georgia.

Stress reduction through consolation in chimpanzees
Orlaith N. Fraser
Proceedings of the National Academy of Sciences,(June 16, 2008) USA, 10.1073/pnas.0804141105.

Link to PNAS abstract

Link to New Scientist article

Anesthesia makes more pain?

BBC News on line (June 24, 2008)

Anesthetics 'could worsen pain'

Some general anesthetics - so-called "noxious" anesthesia drugs , used commonly worldwide - stimulate nerves to cause irritation long after the operation is over and could actually worsen the pain following surgery according to US research, published in Proceedings of the National Academy of Sciences journal, and could prompt the choice of different drugs.

Anesthetists have known for some time that certain drugs, such as the gas isoflurane, while very effective at rendering and keeping patients unconscious, are actually irritant chemicals.
Some already use a painkilling drug to lessen this effect before delivering the anesthetic itself.

The latest finding, by research staff at Georgetown University Medical Center however, suggests that effects of the irritant is not just short-lived, but lingers on long after both the painkiller and the anesthetic have worn off.
The drugs act on the same receptors on nerve cells which are activated by contact with other irritants, such as garlic, mustard or chili.
Mice bred without these receptors were unaffected by the "noxious" anesthetic gases.
If strongly activated, these can lead not just to an immediate sensation of pain, but also a longer over sensitization of pain pathways in the nervous system.
In patients, this might mean that the pain they feel after an operation is significantly increased.

Dr Gerard Ahern, who led the study, said: "It was not really recognized that use of these drugs results in the release of lots of chemicals that recruit immune cells to the nerves, which causes more pain of inflammation.
"The choice of anesthetic appears to be an important determinant of post-operative pain."
He said that while this effect could be reduced by using other types of anesthetic, these might not perform as well in other ways.

reference

General anesthetics activate a nociceptive ion channel to enhance pain and inflammation
José A. Matta et al
PNAS 2008
105: 8784-8789; published online on June 23, 2008, 10.1073/pnas.0711038105

Link to PNAS abstract


Link to BBC News report

Surgery Safety

BBC News on line (June 25, 2008)

Safety checklist for ops launched

A safety checklist designed to cut the risk of surgical complications is to be circulated to doctors world-wide. The list has been drawn up by the World Health Organization (WHO), which says half of complications resulting from major surgery may be preventable.

The WHO estimates that up to 16% of surgical procedures in industrial nations result in major complications.

In developing countries the death rate during major surgery is estimated to be as high as 10%.

In parts of sub-Saharan Africa the death rate from general anesthesia alone is estimated to be as high as one in 150.

The WHO checklist has been drawn up by a team at Harvard School of Public Health, following a consultation with more than 200 medical organizations from around the world. Its primary aim is to target the three biggest cause of mortality in surgery

  • preventable infections·
  • preventable complication from bleeding
  • safety in anesthesia.

It includes six basic steps in care, including verifying that it is the correct patient, ensuring equipment is not left inside the patient, and administering an antibiotic before making an incision - which cuts the risk of infection by half.

Preliminary results from patients at eight pilot sites - including London, Seattle and Toronto - indicate that the checklist has nearly doubled the likelihood that patients will receive proven standards of surgical care, leading to a significant cut in complications and deaths.

The study, published in the Lancet, found that before the checklist was used there was a 64% chance that at least one of the procedures was forgotten - with no difference between rich and developing countries.

Professor Atul Gawande, of Harvard, said: "The quality and safety of surgical care has been dismayingly variable in every part of the world.
"What we identified was that the
idea of a checklist to make sure the basic steps are taken, could make a big difference not only in the poorest part of the world but even in the rich ones."



In the developed world, nearly half of all harmful events (such as miscommunication, wrong medication, and technical errors) affecting patients in hospitals are related to surgical care and services. The evidence suggests that at least half of these events are preventable if standards of care are adhered to and safety tools, such as checklists, are used.
(WHO Safe Surgery Facts)

Link to WHO



Dr. E. Patchen Dellinger
, vice chairman of surgery at the University of Washington, which took part in the W.H.O. research, said that when the checklist was discussed with nonmedical people, “the most common reaction is the question: ‘You mean you haven’t been doing this all along?’ ”
(NY Times)

Link to New York Times article


Link to BBC News report