Saturday, January 31, 2009

Hot, Cold, and Warm all over

Railway tracks buckle due to extreme heat on the Noarlunga train line line near Cromer Parade, Clarence Park, about 3km from Adelaide during heatwave. The top temp of the day was 45.7C


A robin lands on a tree branch in Clifton, Ohio, after an overnight ice storm
Picture: AP

AC Milan's Andrea Pirlo (L) and Clarance Seedorf (R) congratulate British midfielder David Beckham after he scored against Bologna during a Serie A football match at the Renato Dall'Ara stadium in Bologna
Picture: AFP/GETTY

Link to The Telegraph picture galleries

Marketing a ‘miracle drug’

Ben Wallace-Wells for the current issue of Rolling Stone (February 5, no.1071)

Bitter Pill

Created to treat schizophrenia, Zyprexa wound up being used on misbehaving kids. How the pharmaceutical industry turned a flawed and dangerous drug into a $16 billion bonanza

"He says it's got the potential to be a billion-dollar-a-year drug," Wirshing recalls. "I almost pulled off the road and crashed into the side rail." At the time, the entire market for atypical antipsychotics was only $170 million. "How the hell do you make $1 billion?" Wirshing thought. "I mean, who are we gonna give it to? It's not like we're making any more schizophrenic brains."

There is a well-known feature of medical science called the placebo effect, which suggests that, in a clinical trial, patients who are told they are being medicated but are in fact given only a sugar pill will see their symptoms improve, merely out of the misplaced conviction that they are being healed. During the late 1990s, and then with increasing speed during the current decade, Wirshing and other psychiatrists watched as the market for atypical antipsychotics swelled well beyond its marked territory, far exceeding the country's supply of schizophrenic brains — past $2 billion a year, $5 billion, $10 billion, all the way to $16 billion. What had begun as niche drugs are now the third-largest class of medication in the world, their sales greater than those of the antidepressants. The mechanisms used to leverage this growth were in some ways the most modern and perfect the pharmaceutical industry had developed, but they were also, according to state and federal prosecutors, illegal. Lilly has already agreed to pay $2.6 billion to settle charges that it built the market for Zyprexa first by concealing its side effects, and then by marketing it "off-label," for diseases for which it had not been approved.

The on-line posting also has links to

Behind "Bitter Pill": Q&A With Ben Wallace-Wells
How America Lost the War on Drugs by Ben Wallace-Wells
Ben Wallace-Wells on the Writing and Reporting of "How America Lost the War on Drugs"

Link to the Rolling Stone article

mishandling criminal HIV transmission

Edwin J. Bernard for Aidsmap (January 28, 2009)

Report shows police mishandling of investigations into alleged criminal HIV transmission

A new report by the UK’s Terrence Higgins Trust (THT) launched on Tuesday at the House of Commons has revealed a systematic mishandling of complaints for alleged criminal HIV transmission in England & Wales. The report, Policing Transmission was welcomed by the Association of Chief Police Officers (ACPO), which acknowledged that “too many times we have got it wrong".

There have been “scores, if not hundreds” of arrests since the first conviction for reckless HIV transmission in England and Wales, that of Mohammed Dica in October 2003, noted THT's Sir Nick Partridge.
Sir Nick said that whilst most police investigations had been dropped due to a lack of evidence, during the course of these ‘failed’ investigations - which had lasted up to a year - “lives had been turned upside-down and some came close to being destroyed”.

During the period 2005-6, there was an average of one arrest every two weeks. Concerned at this number of arrests and aware of the cost, in terms of “public resources and private misery”, THT approached ACPO and the Metropolitan Police Service (MPS) in order to examine the role of the police in criminal HIV transmission investigations.

This resulted in detailed, but anonymized, police notes from six cases that occurred between 2004 and 2007 (some prosecuted, some not) being made available to a community advisory panel that included representatives from HIV civil society organizations
The panel found that although there were some examples of good practice, much more was found to be lacking, including:

  • · A poor police understanding of HIV, leading to inappropriate management of cases.

  • · A lack of clarity amongst police officers about the current law, and what is, and what is not, an offense. (THT is aware of many investigations following allegations of unprotected sex without disclosure where there was no transmission, which is not an offense in England & Wales.)

  • · Unnecessarily long and drawn-out investigations, ranging between four and twelve months for cases that did not result in prosecution, and between six and 34 months for those that did.

  • · Difficulties in reconciling the realities of HIV transmission with the requirements of the charge. The report points out that “police are having to manage cases brought under a law never designed for such scientific complexity” and notes that the police “repeatedly misinterpreted the strength of their scientific evidence”.

The report makes a total of 19 recommendations, including:

  • · A dedicated police officer should be trained and made available in each force. This officer would specialize in criminal HIV transmission complaints and investigations.

  • · Easy to understand guides to HIV transmission, disclosure, and the law should be written and made available to every police officer.

  • · A series of standard questions should be developed to establish at an early stage whether a viable case exists.

  • · Wider investigations beyond the original complaint should only take place once it is established that the original complainant is HIV-positive themselves.

At the launch Sir Nick eloquently put a human face on the report by highlighting three cases known to THT which reveal how difficult, complex and sensitive allegations of reckless HIV transmission are for all parties involved, including the police.

‘David’ was accused of recklessly infecting two men and, following his arrest, was held in custody for several months and refused bail because the police erroneously believed he was “a danger to the public”. After phylogenetic analysis had been performed on all three men, it became clear that ‘David’ could not have been the source of either man’s infection, the case was dropped and 'David' was finally released from custody.

‘Cesar’ discovered he was HIV-positive when police arrived on his doorstep to arrest him for reckless HIV transmission. (Since one of the prerequisites of this ‘crime’ is to be aware of one’s HIV diagnosis, there were, of course, no grounds for the complaint or his arrest.)

‘Elizabeth’ accused her married lover of recklessly giving her HIV and complained to the police. However, charges were dropped after months of investigations, which included detailed sexual histories and the release of sensitive medical records, since the evidence suggested that ‘Elizabeth’ had, in fact, infected her lover.

Sir Nick said that the report suggests that all complaints and investigations were done in good faith, but that in almost every case, the lead officer had neither enough knowledge of HIV issues, nor anywhere to turn for guidance.

He added that although the police appear to have an understanding of HIV that is “at least ten years out of date", this is not unique to the criminal justice system and is more a reflection of the general public’s lack of knowledge and attitudes about HIV.

Policing Transmission: A review of police handling of criminal investigations relating to transmission of HIV in England & Wales, 2005-2008.
Terrence Higgins Trust
Link to Policing Transmission [pdf]

Link to Aidsmap article


Science Daily (January 30, 2009)

Did I See What I Think I Saw?

Eyewitness testimony is a crucial part of many criminal trials even though research increasingly suggests that it may not be as accurate as we would like it to be. For example, if you witness a man in a blue sweater stealing something, then overhear people talking about a gray shirt, how likely are you to remember the real color of the thief's sweater?

Studies have shown that when people are told false information about an event, they become less likely to remember what actually happened - it is easy to mix up the real facts with fake ones. However, there is evidence that when people are forced to recall what they witnessed (shortly after the event), they are more likely to remember details of what really happened.

Psychologists Jason Chan of Iowa State University, Ayanna Thomas from Tufts University and John Bulevich from Rhode Island College wanted to see how providing false information following a recall test would affect volunteers' memories of an event that they witnessed. A group of volunteers watched the first episode of "24" and then either took an immediate recall test about the show or played a game. Next, all of the subjects were told false information about the episode they had seen and then took a final memory test about the show.

The results were surprising. Volunteers who took the test immediately after watching the show were almost twice as likely to recall false information compared to the volunteers who played the game following the episode.

The results of a follow-up experiment suggest that the first recall test may have improved subjects' ability to learn the false information - that is, the first test enhanced learning of new and erroneous information. These findings show that recently recalled information is prone to distortion. The authors conclude that "this study shows that even psychologists may have underestimated the malleability of eyewitness testimony."


Recalling a Witnessed Event Increases Eyewitness Suggestibility: The Reversed Testing Effect.
Jason C.K. Chan, Ayanna K. Thomas, and John B. Bulevich
Psychological Science, 2009; 20 (1): 66 - 73 DOI: 10.1111/j.1467-9280.2008.02245.x

Link to Psych Sci abstract

Link to Science Daily article

Friday, January 30, 2009

What’s in a name

Science Daily (January 29, 2009)

Adolescents With Unpopular Names More Prone To Committing Crime

A new study in the journal Social Science Quarterly examined the relationship between first name popularity in adolescents and tendency to commit crime. Results show that, regardless of race, juveniles with unpopular names are more likely to engage in criminal activity.

David E. Kalist and Daniel Y. Lee of Shippensburg University analyzed state data by comparing the first names of male juvenile delinquents to the first names of male juveniles in the population.

Researchers constructed a popularity-name index (PNI) for each name. For example, the PNI for Michael is 100, the most frequently given name during the period. The PNI for David is 50, a name given half as frequently as Michael. The PNI is approximately 1 for names such as Alec, Ernest, Ivan, Kareem, and Malcolm.

The least popular names were associated with juvenile delinquency among both blacks and whites. While the names are likely not the cause of crime, they are connected to factors that increase the tendency to commit crime, such as a disadvantaged home environment, residence in a county with low socioeconomic status, and households run by one parent.

Also, adolescents with unpopular names may be more prone to crime because they are treated differently by their peers, making it more difficult for them to form relationships. Juveniles with unpopular names may also act out because they consciously or unconsciously dislike their names.

“First name characteristics may be an important factor to help identify individuals at high risk of committing or recommitting crime, leading to more effective and targeted intervention programs,” the authors conclude.


First Names and Crime: Does Unpopularity Spell Trouble?
David E. Kalist &, Daniel Y. Lee
Social Science Quarterly, 2009; 90 (1): 39-49 DOI: 10.1111/j.1540-6237.2009.00601.x

Link to Soc Sci Q abstract

Link to Science Daily article

Victorian Riddle

Five hundred begins it
Five hundred ends it
Five in the middle is seen
the first of all letters the first of all figures
take up their places between.
Put them together
and then you will bring
before you the name of an eminent King?


500 begins it — D
500 ends it — D
5 in the middle is seen — V
the first of all letters — A
the first of all figures — I
take up their places between.
Put them together
and then you will bring
before you the name of an eminent King — DAVID

And still only an — L PIN?

Stem cells

BBC News on line (January 30, 2009)

MS stem-cell treatment 'success'

Stem-cell transplants may control and even reverse multiple sclerosis symptoms if done early enough, a small study indicates. Not one of 21 adults with relapsing-remitting MS who had stem cells transplanted from their own bone marrow deteriorated over three years. And 81% improved by at least one point on a scale of neurological disability, The Lancet Neurology reported.

MS is an autoimmune disease resulting from a defect in the body's immune system, which turns in on itself, causing damage to the nerves which can lead to symptoms including blurred vision, loss of balance and paralysis.

At first, the condition mostly causes intermittent symptoms that are partly reversible.
Over a 10-15 year period after onset, most patients develop secondary-progressive MS, with gradual but irreversible neurological impairment.

It is not the first time this treatment — known as autologous non-myeloablative haemopoietic stem-cell transplantation — has been tried in people with MS, but there has not been a great deal of success.

The researchers at Northwestern University School of Medicine in Chicago said most other studies had tried the transplants in people with secondary-progressive MS where the damage had already been done.

In the latest trial patients with earlier stage disease who, despite treatment had had two relapses in the past year, were offered the transplant.
Stem cells were harvested from the patients and frozen while drugs were given to remove the immune cells or lymphocytes causing the damage.
The stem cells were then transplanted back to replenish the immune system - effectively resetting it.

Five patients in the study relapsed, but went into remission after receiving other therapy.

The researchers are now doing a randomized controlled trial in a larger number of patients to compare the treatment with standard therapy.

Study leader Professor Richard Burt said this was the first MS study of any treatment to show reversal of damage.
However, he cautioned that it was important to wait for the results of the larger trial
And that he would not call it a cure but "changing the natural history of the disease".


Autologous non-myeloablative haemopoietic stem cell transplantation in relapsing-remitting multiple sclerosis: a phase I/II study
Richard K Burt MD et al
The Lancet Neurology
, Early Online Publication, 30 January 2009

Link to The Lancet Neurology abstract

Link to BBC News report

Bloomberg News also covers the study
Link to Bloomberg News article


Science Daily (January. 28, 2009)

'Happiness Gap' In The US Narrows

Happiness inequality in the U.S. has decreased since the 1970s, according to a study, by University of Pennsylvania economists Betsey Stevenson and Justin Wolfers, who found that the American population as a whole is no happier than it was three decades ago. But happiness inequality—the gap between the happy and the not-so-happy—has narrowed significantly.

"Americans are becoming more similar to each other in terms of reported happiness," says Stevenson. "It's an interesting finding because other research shows increasing gaps in income, consumption and leisure time."

The happiness gap between whites and non-whites has narrowed by two-thirds, the study found. Non-whites report being significantly happier than they were in the early 1970s, while whites are slightly less happy. The happiness gap between men and women closed as well. Women have become less happy, while men are a little more cheerful.

One demographic area where the happiness gap increased was in educational attainment. People with a college diploma have gotten happier, while those with a high school education or less report lower happiness levels.


Happiness Inequality in the United States.
Betsey Stevenson and Justin Wolfers
The Journal of Legal Studies, 2008; 37 (s2): S33 DOI: 10.1086/592004

Link to JLS abstract

Link to Science Daily article

Thursday, January 29, 2009

Kenneth Williams - Specialists

Rove's Claim of Executive Privilege

Still Bushed! - New Name For Torture: The Bush System

Worst Person

Steve Bell - The Guardian

Visuals – better: critical thinking - worse

Science Daily (January 29, 2009)

Is Technology Producing A Decline In Critical Thinking And Analysis?

As technology has played a bigger role in our lives, our skills in critical thinking and analysis have declined, while our visual skills have improved, according to research by Patricia Greenfield, UCLA distinguished professor of psychology and director of the Children's Digital Media Center, Los Angeles.

Learners have changed as a result of their exposure to technology, says Greenfield, who analyzed more than 50 studies on learning and technology, including research on multi-tasking and the use of computers, the Internet and video games.

Reading for pleasure, which has declined among young people in recent decades, enhances thinking and engages the imagination in a way that visual media such as video games and television do not, Greenfield said.

"No one medium is good for everything," Greenfield said. "If we want to develop a variety of skills, we need a balanced media diet. Each medium has costs and benefits in terms of what skills each develops."

Schools should make more effort to test students using visual media, she said, by asking them to prepare PowerPoint presentations, for example.

"Studies show that reading develops imagination, induction, reflection and critical thinking, as well as vocabulary," Greenfield said. "Reading for pleasure is the key to developing these skills. Students today have more visual literacy and less print literacy. Many students do not read for pleasure and have not for decades."

Among the studies Greenfield analyzed was a classroom study showing that students who were given access to the Internet during class and were encouraged to use it during lectures did not process what the speaker said as well as students who did not have Internet access. When students were tested after class lectures, those who did not have Internet access performed better than those who did.

Another study analyzed found that college students who watched "CNN Headline News" with just the news anchor on screen and without the "news crawl" across the bottom of the screen remembered significantly more facts from the televised broadcast than those who watched it with the distraction of the crawling text and with additional stock market and weather information on the screen.

Yet, for certain tasks, divided attention is important.
"If you're a pilot, you need to be able to monitor multiple instruments at the same time. If you're a cab driver, you need to pay attention to multiple events at the same time. If you're in the military, you need to multi-task too," she said. "On the other hand, if you're trying to solve a complex problem, you need sustained concentration. If you are doing a task that requires deep and sustained thought, multi-tasking is detrimental."

Visual intelligence has been rising globally for 50 years, Greenfield said. In 1942, people's visual performance, as measured by a visual intelligence test known as Raven's Progressive Matrices, went steadily down with age and declined substantially from age 25 to 65. By 1992, there was a much less significant age-related disparity in visual intelligence, Greenfield said.

"In a 1992 study, visual IQ stayed almost flat from age 25 to 65," she said.

Greenfield believes much of this change is related to our increased use of technology, as well as other factors, including increased levels of formal education, improved nutrition, smaller families and increased societal complexity.


Technology and Informal Education: What Is Taught, What Is Learned
Patricia M. Greenfield
Science 2 January 2009 Vol. 323. no. 5910, pp. 69 - 71
DOI: 10.1126/science.1167190

Link to Science abstract

Link to Science Daily article

Adherence better in Africa

Science Daily (January. 26, 2009)

New Study Sheds Light On Higher Adherence To HIV Drugs In Africa Than In North America

Levels of near-perfect adherence to life saving antiretroviral drugs among African HIV patients should be understood as a means of preserving key social relationships, says a new study.

In Sub-Saharan Africa, adherence to these anti-HIV drugs improves patients' health, which is also a strong predictor of adherence success in developed countries. But for individuals living in extreme poverty, adhering to antiretroviral medicine regimens also helps them protect the relationships they rely upon to survive.

Norma Ware, from Harvard University, Boston and colleagues interviewed 252 patients and caregivers in Nigeria, Tanzania and Uganda, and identified several strategies used by patients to overcome economic obstacles to ART adherence. Strategies aimed at prioritizing adherence included borrowing and begging for funds to pay for travel to clinics, making difficult choices that reallocated available resources in favor of treatment, and "doing without."

Dr. Ware and colleagues report that individuals' prioritizing of ART adherence reflected the importance of relationships as a resource for managing economic hardship: caregivers and supporters expected patients to adhere to ART, and they made their expectations known. This created a responsibility among patients to adhere. Patients, in turn, adhered to their treatment to promote good will from their caregivers, thereby ensuring help will be available when future needs arise, say the authors.

That HIV patients in Africa achieve close to 90% adherence rates—far exceeding those achieved in North America—is remarkable given the "formidable obstacles in the poorest regions of the world," say the authors. This "dispels early scale-up concerns that adherence would be inadequate in settings of extreme poverty." The authors conclude that adherence success is best explained as a means of fulfilling social responsibilities and thus preserving social capital in economic and cultural settings where good relationships are necessary for survival.

In an expert commentary on the study, Agnes Binagwaho and Niloo Ratnayake, who were not involved in the study, discuss the importance of social capital in African societies compared to more developed countries, stating that "people in the US tend to be more individualistic and therefore less focused upon and connected to the group as a whole." The challenge for Africans will be to "maintain social capital while improving economic development, which can bring a more individualistic way of life."


Explaining Adherence Success in Sub-Saharan Africa: An Ethnographic Study.
Norma C. Ware et al.
PLoS Medicine, 2009; 6 (1): e11 DOI: 10.1371/journal.pmed.1000011

Link to PLoS Medicine abstract

Link to Science Daily article

Teen smoking & depression

Science Daily (January 29, 2009)

Teen Smoking Could Lead To Adult Depression, Study Says

Teenagers who smoke could be setting themselves up for depression later in life, according to a groundbreaking new Florida State University study.

Psychology Professor Carlos Bolanos and a team of researchers found that nicotine given to adolescent rats induced a depression-like state characterized by a lack of pleasure and heightened sensitivity to stress in their adult lives. The findings suggest that the same may be true for humans.

"This study is unique because it is the first one to show that nicotine exposure early in life can have long-term neurobiological consequences evidenced in mood disorders," Bolanos said. "In addition, the study indicates that even brief exposure to nicotine increases risk for mood disorders later in life."

The Florida State researchers injected adolescent rats twice daily with either nicotine or saline for 15 days. After the treatment period ended, they subjected the rats to several experiments designed to find out how they would react to stressful situations as well as how they would respond to the offering of rewards.

They found that behavioral changes symptomatic of depression can emerge after one week of nicotine cessation and -- most surprising -- that even a single day of nicotine exposure during adolescence can have long-lasting effects.

"Some of the animals in our study were exposed to nicotine once and never saw the drug again," Bolanos said. "It was surprising to us to discover that a single day of nicotine exposure could potentially have such long-term negative consequences."

The rats that were exposed to nicotine engaged in behaviors symptomatic of depression and anxiety, including repetitive grooming, decreased consumption of rewards offered in the form of sugary drinks and becoming immobile in stressful situations instead of engaging in typical escape-like behaviors. The researchers were able to alleviate the rats' symptoms with antidepressant drugs or, ironically, more nicotine.

Interestingly, adult rodents that were exposed to the same nicotine regimen as the adolescents did not display depression-like traits. It is not known exactly how nicotine works on the brain and nervous system to induce these effects, but exposure has toxic effects in several brain regions and neurotransmitter systems at distinct periods of development, Bolanos said.

Because various neurotransmitter systems in the brain continue to develop throughout adolescence, the researchers theorize that nicotine may negatively influence these systems resulting in altered functionality later in life. The study's findings underscore the need for further research into how this process occurs.

Scientists have long known there is a connection between smoking and mood disorders, but they have not been able to say for sure that one causes the other because there are so many factors influencing human behavior. This study provides support for the idea that smoking can induce symptoms of depression, and paradoxically, can also be a way of managing those same symptoms and enhancing the risk for addiction.

"The message to young people of course is don't smoke and don't even try it," Bolanos said. "If they do smoke, they need to be aware of the potentially long-term effects that recreational or even occasional cigarette smoking can have on their systems."


Nicotine Exposure During Adolescence Induces a Depression-Like State in Adulthood.
Sergio D IƱiguez et al
Neuropsychopharmacology, 2008; DOI: 10.1038/npp.2008.220

Link to Neurosych abstract

Link to Science Daily article

Still Bushed!

Wednesday, January 28, 2009

‘open, non-judgmental, trusting’

Michael Carter for Aidsmap (January 26, 2009)

Gay men who have group sex get better STI care if they feel confident about being open about this with their doctor

Approximately a third of Australian gay men report having unprotected anal sex with a partner assumed to be of a different HIV status during group sex sessions, according to a study published in Sexually Transmitted Infections. Engaging in unprotected sex during group sex was associated with increased levels of testing for HIV and other sexually transmitted infections. Moreover, gay men who told their doctors about their group sex behavior had more tests for sexually transmitted infections than men who did not disclose such behavior. The investigators suggest that encouraging an honest and trusting relationship between gay men and their healthcare providers would ensure that men receive appropriate testing and care.

Overall, 90% of gay men in Australia have had an HIV test and it is estimated that approximately two-thirds have annual tests.

Group sex among gay men has been associated with a risk of HIV and other sexually transmitted infections. Investigators therefore wished to establish a better understanding of recent HIV and sexual health testing amongst gay men engaging in group sex.

One man (who reported being HIV-negative) expressed the belief that as he tested for infections every three months, and had not been diagnosed with any infections, he felt reassured that he had not put himself at risk. However, he also indicated that he had engaged in unprotected anal sex with men during group sex and that he did not know the HIV status of these men. He told the investigators: “I just don’t think it is that risky to have unprotected sex, for the insertive partner…And I get tested regularly, and I haven’t caught anything yet.”

It was also clear that some men felt uncomfortable discussing group sex behavior with a healthcare provider. One man told the investigators that his doctor did not understand his need to be tested for sexually transmitted infections every three months. He told the investigators: “My doctor tries to get me to test every six months, and so I alternate his visit with a visit to the Sexual Health Clinic, and that makes me seem like a bit less of a slut”.

“Our findings confirm that gay men who engage in group sex are at a high risk of transmission and infection with HIV and other STIs and that consideration of potential risks figure highly in their decisions about testing”, write the investigators. They add, “one possible factor for improving the quality of this testing is the relationship between such men and their doctors. Promoting an open, non-judgmental and trusting relationship with doctors with whom they can feel safe discussing all aspects of their sexual behavior may lead to improved testing decisions.”


Testing for HIV and sexually transmissible infections within a mainly online sample of gay men who engage in group sex.
G. P. Prestage et al
Sexually Transmitted Infections 2009;85:70-74; doi:10.1136/sti.2008.031120.
Link to STI abstract

Link to Aidsmap article

‘A Good Clinician and a Caring Person’

Science Daily (January 26, 2009)

The Total Package: A Skillful, Compassionate Doctor

Patients and their families want physicians who are gifted in diagnosis and treatment and who are caring individuals with the interpersonal skills needed to communicate complex information in stressful circumstances.

A new study in the January 2009 issue of Academic Medicine shows training physicians to be humanistic is feasible and produces measurably better communicators.

"Humanism in medicine isn't about sitting and singing Kumbaya, it is about taking the individual patient's concerns and values into account in his or her treatment," said study co-author Richard Frankel, Ph.D. "Those values are clearly linked to higher quality of care and reduction of medical errors yielding safety improvement." Dr. Frankel is a professor of medicine at the Indiana University School of Medicine and a Regenstrief Institute research scientist.

The study was conducted at five very different medical schools – Emory University School of Medicine, Indiana University School of Medicine, the University of Rochester School of Medicine, Baylor College of Medicine and the University of Minnesota Medical School – rather than only one institution. The authors believe their findings are generalizeable throughout American medical education.


A Good Clinician and a Caring Person: Longitudinal Faculty Development and the Enhancement of the Human Dimensions of Care
William T. Branch Jr et al
Academic Medicine January 2009 - Volume 84 - Issue 1 - pp 117-125
doi: 10.1097/ACM.0b013e3181900f8a

Link to Academic Medicine abstract

Link to Science Daily article


Where do you draw your digital line?

Your cell phone, IM, and social networks are all a digital extension of who you are. When someone you're with pressures you or disrespects you in those places, that's not cool. is attempting to raise awareness about digital dating abuse and stop it before it gets worse. Sponsored and co-created by the Family Violence Prevention Fund, the Office on Violence Against Women and the Ad Council, the site is designed to address new and complicated problems between teens who are dating or hooking up—problems like constant and controlling texting, pressuring for nude pictures, and breaking into someone's e-mail or social networking page.

Link to That’s Not Cool

fake internet drugs

Science Daily (January 28, 2009)

Fake Internet Drugs Risk Lives And Fund Terrorism, Warns Journal Editor

People who buy fake internet drugs could be risking their lives and supporting terrorism, according to an editorial in the February issue of IJCP, the International Journal of Clinical Practice.

Editor-in-Chief Dr Graham Jackson, a UK-based Consultant Cardiologist, has called for greater public awareness of the dangers and consequences of the counterfeit drugs market, which is expected to be worth £55 billion by 2010.

"Harmful ingredients found in counterfeit medicines include arsenic, boric acid, leaded road paint, floor and shoe polish, talcum powder, chalk and brick dust and nickel" he points out.

"In one scheme, Americans buying fake Viagra on the internet were actually helping to fund Middle East terrorism, unknowingly jeopardizing the lives of men and women serving in their own armed forces."

The UK's Medicines and Healthcare products Regulatory Agency estimates that nearly 62 per cent of the prescription only medicines offered on the internet, without the need for a prescription, are fakes.

"Alarmingly these include fake drugs that could have devastating consequences, like counterfeit medication for potentially fatal conditions like cancer and high blood pressure. Others can include no active ingredients or harmful ingredients like amphetamines."

"Counterfeit drugs may originate from many different countries, where governments have little or no controls in place, and be then imported into other countries without being inspected" says Dr Jackson.

"In 2004 Pfizer investigated one Canadian online pharmacy and discovered that the domain name was hosted in Korea and registered in St Kitts. Orders placed on the web were dispatched in a plain envelope from Oklahoma City with a non-existent return address."

The challenge of combating these criminal and potentially life-threatening activities is a major concern, he says. However efforts are being hampered by a lack of resources, manpower, adequate legislation and coordination between countries.

Dr Jackson stresses that raising public awareness is essential, as lives are clearly at risk.

"Patient groups need to be motivated to educate men and women about the dangers of buying medication outside the healthcare system" he says. "Prescription only medicines are just that, so being able to buy them without a script is a sure sign of illegal practice.

"The best way to avoid counterfeit drugs is to use a reputable and regulated pharmacy that dispenses with a legal prescription."


Faking it: the dangers of counterfeit medicine on the internet
G. Jackson.
International Journal of Clinical Practice, Volume 63.issue2, pp 181-184 (February 2009)
DOI: 10.1111/j.1742-1241.2008.01989.x.

Link to IJCP editorial [pdf]

Worst Person

Economic theory

Tuesday, January 27, 2009

Ten sex - the myth?

Tara Parker-Pope’s Well Column (January 27, 2009) for the New York Times

The Myth of Rampant Teenage Promiscuity

The National Center for Health Statistics reported this month that births to 15- to 19-year-olds had risen for the first time in more than a decade.

The news is troubling, but it’s also misleading. While some young people are clearly engaging in risky sexual behavior, a vast majority are not. The reality is that in many ways, today’s teenagers are more conservative about sex than previous generations.

Today, fewer than half of all high school students have had sex: 47.8 percent as of 2007, according to the National Youth Risk Behavior Survey, down from 54.1 percent in 1991.

“There’s no doubt that the public perception is that things are getting worse, and that kids are having sex younger and are much wilder than they ever were,” said Kathleen A. Bogle, an assistant professor of sociology and criminal justice at La Salle University. “But when you look at the data, that’s not the case.”

One reason people misconstrue teenage sexual behavior is that the system of dating and relationships has changed significantly. In the first half of the 20th century, dating was planned and structured — and a date might or might not lead to a physical relationship. In recent decades, that pattern has largely been replaced by casual gatherings of teenagers.

In that setting, teenagers often say they “fool around,” and in a reversal of the old pattern, such an encounter may or may not lead to regular dating. The shift began around the late 1960s, said Dr. Bogle, who explored the trend in her book “Hooking Up: Sex, Dating and Relationships on Campus” (N.Y.U. Press, 2008).

The latest rise in teenage pregnancy rates is cause for concern. But it very likely reflects changing patterns in contraceptive use rather than a major change in sexual behavior. The reality is that the rate of teenage childbearing has fallen steeply since the late 1950s. The declines aren’t explained by the increasing availability of abortions: teenage abortion rates have also dropped.

As for that supposed epidemic of oral sex, especially among younger teenagers: national statistics on the behavior have only recently been collected, and they are not as alarming as some reports would have you believe. About 16 percent of teenagers say they have had oral sex but haven’t yet had intercourse. Researchers say children’s more relaxed attitude about oral sex probably reflects a similar change among adults since the 1950s. In addition, some teenagers may view oral sex as “safer,” since unplanned pregnancy is not an issue.

Link to NYTimes article


Science Daily (Jan. 26, 2009)

Here's Venom In Your Eye: Spitting Cobras Hit Their Mark

Spitting cobras have an exceptional ability to spray venom into eyes of potential attackers. A new study reveals how these snakes maximize their chances of hitting the target. Using high-speed photography and electromyography, scientists uncover the mechanics of a cobra "spit."

The name "spitting cobra" is a bit of a misnomer. Cobras don't actually "spit" venom, says the study's lead author Bruce Young, director of the Anatomical Laboratory in the Department of Physical Therapy at the University of Massachusetts, Lowell. Muscle contractions squeeze the cobra's venom gland, forcing venom to stream out of the snake's fangs. The muscles can produce enough pressure to spray venom up to six feet.

There are no points for distance, however. To be effective, venom must make contact with an attacker's eyes, where it causes severe pain and possibly blindness. Previous studies have found that cobras hit their targets with alarming frequency—nearly 100 percent accuracy from 60 centimeters.

Dr. Young and his colleagues, , have found the secret to the cobra's success.
Cobra venom does not hit a victim in one spot. Instead, the venom lands in complex geometric patterns. This is no accident, according to the study. The patterns are actively produced by the cobra.

Dr. Young and his team used high-speed photography and electromyography (EMG) to detect contractions of head and neck muscles. They found that cobras engage their head and neck muscles a split second before spitting. The muscle activity rotates the head, and jerks it from side to side and back again, producing complex venom patterns.

"The venom-delivery system functions to propel the venom forward while the [head and neck] muscles produce rapid oscillations of the head that … disperse the venom, presumably maximizing the chance that a portion of the spat venom will contact the eye," the authors write.


Functional Bases of the Spatial Dispersal of Venom during Cobra “Spitting”.
Bruce A. Young, Melissa Boetig, Guido Westhoff
Physiological and Biochemical Zoology, 2009; 82 (1): 80 - 89 DOI: 10.1086/595589

Link to PBZ abstract

Link to Science Daily

HIV 'window period'

Michael Carter for Aidsmap (January 26, 2009)

Current beliefs about HIV 'window period' are 'counterproductive to goal of reducing HIV transmission'

“We could do more to diagnose HIV in individuals identified as high risk who already access care”, write the authors of an editorial in the February edition of Sexually Transmitted Infections. They suggest modifications "to the recommendations to defer testing until 3 months after a possible exposure", noting that newer HIV testing technology can provide accurate results within a month of infection with HIV and that the current recommendations could deter testing during primary infection "when individuals are highly infectious."

The editorial accompanies a study showing that substantial numbers of gay men attending sexual health clinics in the UK were not tested for HIV..

Large numbers of HIV-positive individuals in both the UK and US are unaware of their HIV infection. There is also good evidence that a substantial proportion of onward HIV transmissions originate from individuals who are unaware of their HIV infection. To reduce the number of undiagnosed infections, the US Centers for Disease Control and Prevention (CDC) issued guidance in 2006 recommending routine, opt-out HIV testing for adults using both primary and hospital based care. This is a shift away from the previous testing policy that targeted groups and individuals with a high risk of HIV. In late 2007, experts from across Europe met to discuss how to reduce undiagnosed infections.

However, the authors of the editorial believe that the results of the study conducted in UK sexual health clinics “suggest the failure of targeted testing may be partly due to missed opportunities for HIV testing in readily identified high risk populations”.

Targeted testing programs should have two future objectives, recommend the authors:

  • · To increase the proportion of patients tested for HIV when they present for care.
  • · To increase the frequency of HIV testing for individuals such as gay men who are in a group with a high HIV risk.

They suggest that rapid HIV testing and opt-out testing could both help to achieve these aims, and the investigators note recent research showing that gay men in the UK were more likely to be tested for HIV if it was offered on an opt-out basis.

Concern is also expressed by the authors that “some individuals with a recent negative HIV test or risky exposure may be offered but defer testing because of concerns about the anti-body-negative ‘window-period’. They note that newer HIV antibody tests can provide accurate results within one month and that this period can be shortened even further by nucleic acid amplification testing.

Individuals with recent HIV infection have very high viral loads and are especially infectious, with some research suggesting that up to 50% of all new infections originate in individuals who themselves have been recently infected.

The authors of the editorial therefore write: “the avoidance of testing during primary HIV infection…is likely to be counterproductive to the goals of reducing HIV transmission”.

At-risk populations, the authors recommend, should be encouraged to test more often and be educated about the symptoms of primary HIV infection. Some such campaigns have already been targeted at gay men in the US and are being considered in the UK. The US campaign presented gay men with information about the symptoms of primary infection, which can be mistaken for those of flu, and therefore recommended that gay men should avoid sex if they have flu-like symptoms.

Current HIV testing policy is passive, suggest the authors, with clinics waiting for at-risk individuals to present for care. They believe that modern information technology, such as email and text messaging “provide the potential for public health to play a more active role in increasing the frequency with which high-risk individuals seek testing”.

“HIV testing remains one of the sharpest tools in the HIV prevention toolbox”, write the authors. They conclude that this tool could be wielded most effectively by:

  • · Removal of barriers to testing, such as the need for written consent and counseling.

  • · More opt-out testing.

  • · Routine use of the most sensitive tests, including use of pooled nucleic acid amplification, for gay men and other high-risk groups.

  • · Increase frequency of testing for gay men and other high-risk groups.


Learning from missed opportunities for HIV testing.
Joanne D Stekler and Matthew R Golden
Sexually Transmitted Infections 2009; 85:2-3; doi:10.1136/sti.2008.035329
Link to STI editorial extract

Link to Aidsmap article with additional links

Malaria - “canary in the coal mine”

Thomas Fuller reports from Tasanh, Cambodia for the New York Times (January 27, 2009)

Spread of Malaria Feared as Drug Loses Potency

The parasite that causes the deadliest form of malaria is showing the first signs of resistance to the best new drug against it.

Combination treatments using artemisinin, an antimalaria drug extracted from a plant used in traditional Chinese medicine, have been hailed in recent years as the biggest hope for eradicating malaria from Africa, where more than 2,000 children die from the disease each day.

Now a series of studies, including one recently published in The New England Journal of Medicine and one due out soon, have cemented a consensus among researchers that artemisinin is losing its potency here and that increased efforts are needed to prevent the drug-resistant malaria from leaving here and spreading across the globe.

Malaria experts note that several times in the past, this same area around the Thai-Cambodian border appears to have been a starting point for drug-resistant strains of malaria, starting in the 1950s with the drug chloroquine.

Introduced immediately after World War II, chloroquine was considered a miracle cure against falciparum malaria, the deadliest type. But the parasite evolved, the resistant strains spread, and chloroquine is now considered virtually useless against falciparum malaria in many parts of the world, including sub-Saharan Africa.

It took decades for this resistance to spread across the world, so by the same token artemisinin-based drugs are almost sure to be useful for many years to come.

Scientists have documented how malarial parasites that were resistant to chloroquine in the 1950s spread across Thailand, Burma, India and over to Africa, where a vast majority of the nearly one million annual malaria-related deaths occur.

To prevent a recurrence with artemisinin therapies, the United States has put aside political considerations and approved a malaria monitoring center in military-run Myanmar, formerly Burma. The Bill and Melinda Gates Foundation, one of the largest donors to malaria research, is giving $14 million to the Thai and Cambodian governments to help pay for a containment program.

In Tasanh, a village 20 miles east of the Thai border, Dr. Fukuda and a team of researchers work in what is euphemistically called a more challenging environment. Tasanh is served by a dirt road and has no running water and no public supply of electricity.

Dr. Fukuda calls this region of Cambodia the “canary in the coal mine” for drug resistance.

“This is not the death knell of artemisinin,” said Dr. Nicholas White, a malaria expert who is chairman of a joint research program between Oxford University and Mahidol University in Thailand. “The drug still works in Cambodia, maybe not as well as before.”

But given the history of drug failures here, there appears to be a consensus on the solution.

“Get rid of all malaria from Cambodia,” Dr. White said. “Eradicate it. Eliminate it.”

Evidence of Artemisinin-Resistant Malaria in Western Cambodia
Harald Noedl, M.D., Ph.D. et al (for Artemisinin Resistance in Cambodia 1 (ARC1) Study Consortium)
The New England Journal of Medicine December 11, 2008 Number 24 Volume 359:2619-2620

Link to the NEJM abstract

Link to NY Times article

Fear Factor

Stimulus Show Down - Didn't He Win?

Link to Project Inform

John Updike 1932 - 2009

Monday, January 26, 2009

supporting criminalization of HIV?

Michael Carter for Aidsmap (January 26, 2009)

Ignorance and stigma provide foundation for gay men's support of criminalization of HIV transmission

The majority of gay men in the UK support the use of the criminal law to punish people who infect a sexual partner with HIV, a new report published by Sigma Research shows.

Overall, 57% of gay men supported the prosecution and imprisonment of people with HIV who had recklessly infected a sexual partner with the virus.

The report, titled Sexually Charged, showed that men who had never been tested for HIV were the group most likely to support the use of the criminal law in this way. Earlier research has shown that men who have never tested for HIV are the group of gay men least likely to know somebody with HIV, and often feel that HIV is not present in either their social circles or everyday life.

Men who supported prosecutions generally regarded the responsibility to prevent HIV infections during sexual encounters as being vested solely with the HIV-positive partner. They also held strongly stigmatizing views about HIV and appeared to have little appreciation of the effectiveness of HIV treatment.

The report’s authors note that few gay men thought that prosecutions would help reduce the transmission of HIV and express concern that such cases have created unrealistic expectations that people who know they are HIV-positive will disclose this to their sexual partners.

Since 2001, the criminal law in England and Wales and in Scotland has been used to prosecute and imprison individuals for the reckless transmission of HIV. The cases have involved individuals who did not inform their partner (or partners) that they were HIV-positive before having unprotected sex that resulted in HIV transmission.

In 2006, men completing the annual Gay Men’s Sex Survey were asked a series of questions to assess their attitudes towards these prosecutions. There was considerable mainstream media reporting of such prosecutions at this time.

A total of 8152 men answered questions indicating whether they agreed, disagreed, or were not sure about prosecutions. A clear majority of men (57%) indicated that they thought that it was “a good idea to imprison people who know they have HIV [and] pass it on to sexual partners who do not know they have it”.

Just over a quarter of men (26%) said they opposed this and 18% said they were unsure.

There were significant differences in the characteristics of men who supported, opposed or were not sure about the use of the criminal law to punish transmission of HIV.

Men who had never tested for HIV were the group most likely (64%) to express their support and HIV-positive men were the group most likely to oppose (49%) imprisonment. A majority (57%) of men who said they were HIV-negative supported imprisonment.

Support of prosecutions was also related to demographic, social and behavioral characteristics. Most notably, men with over 30 sexual partners a year, were the only group where a clear majority opposed imprisonment (54%), even though researchers excluded men who were HIV-positive.

The majority of men supporting imprisonment provided information explaining why they held this position. The harm caused by HIV transmission emerged as the major factor why individuals supported prosecution.

Many respondents emphasized the risk of death that they perceived as resulting from infection with HIV. Some individuals equated the transmission of HIV with murder.

“These responses reveal the perception that there is little capacity for living well or longevity among people with diagnosed HIV”, write the researchers, “getting HIV is regarded as utterly disastrous.” There was little appreciation of the effectiveness of HIV treatment.

Moral harm also emerged as a theme amongst respondents supporting imprisonment. For example, a 22 year old from Wales who had never been tested for HIV wrote, “to have sex with someone when you know you are HIV+ without telling them is one of the worst things that could ever be done. These people should be given life sentences.”

It was also clear that those who supported imprisonment viewed the responsibility of preventing HIV transmission as being vested solely with the HIV-positive partner. As one HIV-negative man from southern England wrote, “once you contract HIV it is your responsibility to ensure that you do not transmit it.”

By contrast, men who opposed imprisonment often believed that the responsibility to prevent HIV transmission should be shared between partners, one HIV-negative man from London summing up his position thus: “it takes two to tango”.

The view was also expressed that prison was an inappropriate punishment for this offence, with one HIV-negative respondent from Scotland writing “it’s not a good idea, it’s reactionary.”

Approximately an eighth of those who opposed imprisonment indicated that they did so because of the impact prosecutions could have on the HIV epidemic. A significant proportion of these men expressed the opinion that such action only served to increase the stigma and discrimination surrounding HIV. “Living with the virus is bad enough without locking people up who have it”, wrote a 33-year-old man with HIV from the English Midlands. He noted the exceptional way that HIV was treated by the criminal law, “we do not lock up people who pass on colds, flu or even more serious viruses. The approach of the courts/CPS is another example of prejudice towards HIV sufferers.”

Some men expressed the belief that criminalization would discourage HIV testing.

About a quarter of men were unsure about criminalization. The answers of these men indicated that forming an opinion would depend on the circumstances of the case, including issues such as shared understanding and intent. When the researchers looked at the responses of these men in detail, it became apparent that as many as a third of men who said that they were unsure actually gave responses that suggested that they had very grave doubts about the imprisonment of people for transmission of HIV.

The researchers believe that the findings of the report have important implications for HIV health promotion. They note “most the men who supported prosecutions considered HIV to be invariably fatal”. They express concern that “the perception that HIV equals certain death helps to maintain the stigma related to HIV, which in turn, negatively impacts on the environment in which prevention interventions occur.”

And concern is also expressed by the researchers that individuals supporting prosecutions seem to expect their HIV-positive sexual partners to disclose their status. The researchers note that this is unrealistic given that a third of gay men with HIV are unaware that they have the infection and that large numbers of diagnosed men find disclosure problematic. Furthermore, they write that an expectation of disclosure, “presumes that men without HIV have no part to play in protecting themselves from infection.”

Addressing the evident stigma with which many men regard HIV was also another theme emerging from the report that the researchers believe needs to be addressed. They write: “the degree to which the reality of living with HIV is misunderstood, and the fear and loathing with which men characterize those ‘other’ gay men and bisexual men with HIV is clearly evident”. The researchers conclude, “the othering of HIV continues to be the largest underlying challenge to our HIV response.”


Sexually charged: the views of gay and bisexual men on criminal prosecutions for sexual HIV transmission.
Catherine Dodds et al.
Sigma Research, 2009.

Link to Sigma report

Link to Sigma Research Projects

Link to Aidsmap article