Tuesday, March 31, 2009

Better than RealAge

Today’s New York Times publishes an item by Tara Parker-Pope from her Health Blog Well posted (March 27, 2009)

A Better Health Quiz

After the issues with RealAge, she points out that for her, the problem with its quiz is the lack of scientific validity. She feels the idea that health behaviors can translate into a meaningful “biological age” is just marketing hype, not real science.

More importantly, she suggests a better alternative in the health quiz --- Your Disease Risk --- offered by St Louis’s Washington University School of Medicine Siteman Cancer Center. It was created by Dr. Graham Colditz, a noted expert in disease prevention who first developed the quiz with his former colleagues at the Harvard Medical School.

It is safe! It doesn’t register users, and no information is collected or stored. When a user exits the site, all data are deleted, Dr. Colditz said. He adds that the Your Disease Risk site also doesn’t contain any pharmaceutical ads, links or other commercial sponsorship, and it’s supported entirely by Washington University and the Barnes-Jewish Hospital Foundation in St. Louis.

Link to Your Disease Risk

Link to NY Times Well article

Inscrutable GhostNet


BBC News on line (March 30, 2009)

China denies spying allegations

China has denied involvement in the electronic spy network which researchers say infiltrated computers in government offices around the world. A spokesman of the Chinese embassy in London said that there was no evidence to show Beijing was involved.
He suggested the findings were part of a "propaganda campaign" by the Tibetan government in exile.
The research was commissioned by the Dalai Lama's office alarmed by possible breaches of security.

In an official statement, Liu Weimin writes that the report by Canadian researchers at the Information Warfare Monitor is "just some video footage pieced together from different sources to attack China".
He stresses that in China "it is against the law to hack into the computers of others". Cyber attacks, he says, are "a global challenge" requiring global co-operation.
"China is an active participant in such co-operation in the world."

The Canadian researchers had been approached by the office of the Dalai Lama, who feared the computers of his Tibetan exile network had been infiltrated.

Their report said that the electronic network had infiltrated 1,295 computers in 103 countries, including computers belonging to foreign ministries and embassies. Ministries of foreign affairs of Iran, Bangladesh, Latvia, Indonesia, Philippines, Brunei, Barbados and Bhutan appeared to have been targeted. Hackers were apparently able to take control of computers belonging to several foreign ministries and embassies across the world using malicious software, or malware.
The researchers said that while the network was based mainly in China, there was no conclusive evidence China's government was behind the infiltration.

"We uncovered real-time evidence of malware that had penetrated Tibetan computer systems, extracting sensitive documents from the private office of the Dalai Lama."

They said they believed the system, which they called GhostNet, was focused mainly on governments in Asia.

Link to Information War Monitor/

Link to BBC News report

Polypill

BBC News on line (March 30, 2009)

Polypill 'could become a reality'

A cheap six-in-one pill to guard against heart attacks and stroke will work, research suggests.

The concept of a polypill for everyone over 55 to cut heart disease by up to 80% was mooted over five years ago, but slow progress has been made since. Now a trial in India shows such a pill has the desired effects and is safe and well-tolerated by those who take it.

Although The Lancet study is proof of concept, experts still question the ethics of a pill for lifestyle issues. Critics say the problems of high blood pressure and cholesterol should be tackled with diet and exercise rather than by popping a pill.

The polypill used in the latest study combines aspirin, a statin to lower cholesterol, three blood pressure-lowering drugs and folic acid - drugs that are already widely available separately.

Trials on 2,053 healthy individuals free of cardiovascular disease, but with a risk factor such as high blood pressure or a long-term smoker, showed combining the drugs into one tablet delivered a similar effect to each drug separately.

Reductions were seen in both blood pressure and cholesterol without any major side effects.

The researchers believe that the combined action of all the components in their "Polycap" pill made by Cadila Pharmaceuticals, could potentially halve strokes and heart attacks in average, middle-aged people.

On a global scale, this would save tens of millions of lives.

The study, led by Dr Salim Yusuf, from McMaster University in Ontario, Canada, took in people at 50 centers across India.

A spokeswoman for the British Heart Foundation said: "The results suggest that the polypill has the potential to reduce the incidence of cardiovascular disease.
"We now need further research to examine whether the polypill actually reduces mortality."

A UK team led by Professor Simon Thom of Imperial College London is hoping to do just this.

They have been testing a four-in-one polypill called the Red Heart Pill, which could cost as little as 15 Euros per person per year.

Professor Thom said it would be at least five years before there was enough data to convince drug regulators to approve a polypill.

"Mounting evidence shows the polypill does exactly what it should, but no more, whereas exercise has wide reaching effects on health and wellbeing. So a polypill is an addition rather than a replacement for lifestyle interventions."

reference

Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial
The Indian Polycap Study (TIPS)
The Lancet, Early Online Publication, 30 March 2009 doi:10.1016/S0140-6736(09)60611-5

Link to The Lancet article

Link to BBC news report

Hand washing & MRSA


Science Daily (March. 31, 2009)

Hand washing More Important Than Isolation In Controlling MRSA Superbug Infection, Study Suggests

Regular hand washing by hospital staff and visitors did more to prevent the spread of the MRSA superbug than isolating infected patients.

At the Society for General Microbiology meeting in Harrogate, Dr Peter Wilson from University College Hospital, London, reported on a year-long study in two hospital intensive care units. In the middle six months of the year patients with MRSA were not moved to single rooms or nursed in separate MRSA bays. The rates of cross infection with MRSA were compared to the periods when patients were moved. Patients were tested for MRSA weekly and hand hygiene by staff and visitors audited and encouraged. There was no evidence of increased transmission of infection when patients were not moved.

Moving seriously-ill patients when they are identified as having MRSA can be hazardous and it involves ward staff in extra hygiene measures.

"If a patient carrying MRSA is critically ill, moving them to a single room is less of a priority than clinical care," said Dr Wilson. "If the criteria are strictly applied, compliance with hand hygiene practices on intensive care units is less than on a general ward because of the very high number of contacts per hour. Another study is needed in a general ward where a high level of compliance with hand hygiene is easier to achieve."

Link to SGM

Link to Science Daily article

‘war pestilence’


Science Daily (March 30, 2009)

Superbug Risk To War Wounded

Soldiers who survive severe injuries on battlefields such as those in Iraq and Afghanistan can be at risk from developing infections of their wounds with multidrug resistant bacteria. The potentially lethal microbes include superbugs such as methicillin resistant Staphylococcus aureus (MRSA), Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella species and Escherichia coli.

Dr Clinton K. Murray, from Brooke Army Medical Center, USA, told the Society for General Microbiology Meeting at Harrogate, UK, that at the beginning of the 20th century improved military hygiene and disease control led to a steady decline in the number of wartime deaths attributable to infections classically known as "war pestilence," which included cholera, dysentery, plague, smallpox, typhoid, and typhus fever.

"The development of more effective personal protective equipment, as well as training medics to provide life-saving procedures on the battlefield, has greatly improved survival rates," said Dr Murray. "Positioning surgical and advanced medical care nearer to the point of injury has also enabled casualties to survive near-catastrophic wounds. But even though combat casualties are surviving these severe injuries, they risk developing wound infections. Microbes on the casualty's skin can be introduced into the wound at the time of injury or during subsequent medical care."

Although most of the infections can be treated with standard antibiotics, some of them may be caused by pathogens resistant to many if not all of these drugs. This requires clinicians to prescribe less commonly used antibiotics such as colistin. Modern microbiology and antimicrobial agents can do a lot but hospital infection control even in a war zone is of essential importance.

Link to SGM Harrogate Meeting

Link to Science Daily article

Monday, March 30, 2009

Obama shielding Bush, Cheney

Forget the fish oil?


Yahoo Health News covers the report by Associated Press Medical Writer Marilynn Marchione (March 30, 2009)

Fish oil pills don't boost benefit of heart drugs

Heart attack patients who are already taking the right medicines to prevent future problems get no added benefit from taking fish oil capsules, a large study in Germany finds.

The study tested a 1-gram daily dose of a prescription version of highly purified omega-3 fatty acid — the "good fat" contained in certain oily fish that is thought to help the heart.

Researchers led by Dr. Jochen Senges of the University of Heidelberg gave fish oil or dummy capsules to more than 3,800 people who had suffered a heart attack in the previous two weeks. About 90 percent were already receiving all the medicines recommended to prevent a second attack, including aspirin, anti-clotting and cholesterol drugs.

After a year, it made no difference whether these patients took fish oil or dummy capsules. In both groups, fewer than 2 percent had suffered sudden cardiac death, 4 percent had another heart attack, and fewer than 2 percent had suffered a stroke.

If recent heart attack patients are already getting good care, "there is almost nothing you can do better on top of this" to further lower risk, Senges said. He presented the results Monday at an American College of Cardiology conference.

The research doesn't mean that fish oil is of no value, and the study didn't address whether it can help prevent heart disease in the first place, doctors said.

Link to Yahoo Health news article

Smoking is bad for you . . . .

Science Daily (March 28, 2009)

Smokers May Have Increased Risk Of Pancreatitis

Smoking appears to be associated with an increased risk of acute and chronic pancreatitis and the risk of developing the disease may be higher in those who smoke more.

The occurrence of pancreatitis (an inflammation of the pancreas usually characterized by abdominal pain) has increased in recent decades, according to background information in the article. Acute and chronic pancreatitis are believed to be commonly caused by gallstone disease and excessive alcohol use, respectively. Studies have suggested that smoking may be associated with damage to the pancreas, but since smoking may be associated with alcohol use and risk of gallstone disease, it is difficult to note whether smoking is an independent risk factor for the disease.

Janne Schurmann Tolstrup, M.Sc., Ph.D., of the National Institute of Public Health, University of Southern Denmark, Copenhagen, and colleagues analyzed results from physical examinations and lifestyle habit self-administered questionnaires of 17,905 participants (9,573 women and 8,332 men) to determine if smoking was associated with an increased risk of acute or chronic pancreatitis independent of alcohol consumption and gallstone disease. Participants were followed up for an average of 20.2 years.

Although alcohol intake was associated with increased risk of pancreatitis, the risk of pancreatitis associated with smoking was independent of alcohol and gallstone disease.

"Apart from the epidemiologic evidence of an association between smoking and development of acute and chronic pancreatitis, a biological effect of smoking seems plausible because both animal studies and human studies have demonstrated changes of the pancreas and in pancreatic functioning after exposure to tobacco smoke," they conclude.

reference:

Smoking and Risk of Acute and Chronic Pancreatitis Among Women and Men: A Population-Based Cohort Study.
Janne Schurmann Tolstrup, MSc, PhD; Louise Kristiansen, BSc; Ulrik Becker, MD, DrMedSci; Morten Grønbæk, MD, PhD, DrMedSci
Archives of Internal Medicine, 2009; 169 (6): 603 – 609 DOI: 10.1001/archinternmed.2008.601

Link to Archives of Internal Medicine abstract

Link to Science Daily article

Action videos improve adult eyes?


Yahoo Health News (March 29, 2009) covers the Reuters report

Action video games sharpen eyesight: U.S. study

Adults who play a lot of action video games may be improving their eyesight, according to U.S. researchers. People who used a video-game training program saw significant improvements in their ability to notice subtle differences in shades of gray, a finding that may help people who have trouble with night driving.

"Normally, improving contrast sensitivity means getting glasses or eye surgery -- somehow changing the optics of the eye," said Daphne Bavelier of the University of Rochester in New York, whose study appears in the journal Nature Neuroscience.
"But we've found that action video games train the brain to process the existing visual information more efficiently, and the improvements last for months after game play stopped."

For the study, the team divided 22 students into two groups. One group played the action games "Call of Duty 2" by Activision Blizzard Inc and Epic Games' "Unreal Tournament 2004." A second played Electronic Arts Inc's "The Sims 2," a game they said does not require as much hand-eye coordination.

The two groups played 50 hours of their assigned games over the course of nine weeks. At the end of the training, the action game players showed an average of 43 percent improvement in their ability to discern close shades of gray, while the Sims players showed none.
Bavelier found very practiced action gamers became 58 percent better at perceiving fine differences in contrast.

"When people play action games, they're changing the brain's pathway responsible for visual processing. These games push the human visual system to the limits and the brain adapts to it," Bavelier said in a statement.
The findings show that action video-game training may be a useful complement to eye-correction techniques.

reference

Enhancing the contrast sensitivity function through action video game training
Renjie Li, Uri Polat, Walter Makous, Daphne Bavelier
Nature Neuroscience published on line 29 Mar 2009, doi: 10.1038/nn.2296

Link to Nature Neuro abstract

Link to Yahoo News article

drug resistant HIV


Science Daily (March 29, 2009)

Transmission Of Drug Resistant HIV-1

Drug-resistant forms of HIV can be spread between individuals who have not received anti-retroviral treatment, according to a report Professor Deenan Pillay from University College, London and the UK Health Protection Agency, presented at the Society for General Microbiology Meeting at Harrogate.

Anti-retroviral therapy is a major advance in the treatment of HIV and there are currently over 25 drugs available. It is known that the virus can mutate, reducing its susceptibility to treatment, and that these resistant viruses can be transmitted between individuals.

Professor Pillay found that drug resistant viruses could also circulate between individuals who have not received antiretroviral drugs treatments.

"Our findings show that assuming that drug resistant HIV was only passed on from individuals receiving drug treatment may mean the number and size of the reservoirs of drug resistant virus in the United Kingdom has been underestimated," said Pillay.

"Our results indicate that although the incidence of drug resistance has been declining, this might not continue -- which could have implications for planning and management of treatment programs."

Link to SGM Harrogate Meeting

Link to Science Daily article

Saturday, March 28, 2009

A Letter from "the Other"

Not the Nine O'Clock

Martin Rowson - The Guardian

mixed messages about alcohol

Science Daily (March 27, 2009)

TV Shows Convey Mixed Messages About Alcohol Consumption In Youth

Efforts to dissuade youth consumption through negative alcohol consumption depictions can be thwarted by portrayals of positive consumption in prime-time television programming. A new study reveals that television series often portray mixed messages about alcohol, but the positive and negative messages were shown differently.

The research, led by Dale W. Russell and Cristel A. Russell, research scientists at the Prevention Research Center, is based on a content analysis of US prime-time television series from the 2004-05 season. The primary, more central, alcohol message was often associated with negative elements such as crime, addiction, or lowered job performance while the secondary, more subtle visual message was almost always associated with positive outcomes, such as having fun or partying. Thus, the positive messages might undermine any negative messages.

“Policymakers and parents need to remain vigilant in monitoring alcohol depictions, especially product placements, given the current environment of self-regulation of the alcohol industry’s marketing/advertising efforts,” the authors conclude.

Because of television’s effect on the audience’s attitudes and behaviors, the prevalence of alcohol messages in the content of television programs raises concerns over their likely impact on audiences, especially young ones. The research team is continuing its efforts to study how such messages are processed and the consequences they have on viewers’ beliefs about alcohol and drinking behaviors.

reference:

Alcohol Messages in Prime-Time Television Series.
Cristel Antonia Russell and Dale W. Russell
Journal of Consumer Affairs, 2009; 43 (1): 108 DOI: 10.1111/j.1745-6606.2008.01129.x
Link to JCA abstract

Link to Science Daily article

HIV & liver disease


Michael Carter for Aidsmap (March 27, 2009)

HIV treatment is not the cause of cryptogenic liver disease

HIV treatment does not cause cryptogenic liver disease. Nor is there an association between any individual anti-HIV drug and the development of the disease, UK investigators report in the April edition of the Journal of Acquired Immune Deficiency Syndromes. Their findings contradict the results of earlier research that suggested an association between ddI (didadosine, Videx) treatment and the development of cryptogenic liver disease.

Liver disease is now a major cause of illness and death amongst people with HIV. Causes include co-infected with hepatitis B, hepatitis C (or both), excess alcohol consumption and drug-related toxicities.

Some HIV-positive individuals develop elevations in their liver enzymes that can lead to serious liver damage for no apparent reason. This is often called “cryptogenic” liver disease.

Earlier research had suggested that long-term treatment with ddI was a cause of cryptogenic liver disease. Investigators from this hospital undertook further research to determine if long-term treatment with antiretroviral drugs generally or any specific drug were a cause of this condition.

Mitochondrial damage due to ddI treatment had been suggested as a cause of cryptogenic liver disease. The investigators discount this theory, pointing out that no association has been found between other drugs associated with mitochondrial toxicity and the development of this condition.

Nor do they think that HIV itself is the cause as all but one patient had an undetectable viral load, and the remaining patient had a viral load below 400 copies/ml.

The investigators conclude, “our study does not confirm an association between the development of cryptogenic liver disease and the prolonged use of antiretroviral drugs.”

Reference

The relationship between prolonged antiretroviral therapy and cryptogenic liver disease.
Justin Stebbing, MD, MA, PhD, FRCPath, MRCP et al.
Journal of Acquired Immune Deficiency Syndromes 50: 554-55, 2009.

Link to JAIDS contents
[no abstract]

Link to Aidsmap article

Stimulus?

Yahoo Health News covered the report by Ben Evans for Associated Press (March 25, 2009)

Outsourced condom production could shut US factory

The last U.S.-based supplier of condoms for global HIV/AIDS prevention programs could be forced to shut its doors because the federal government sent the work to cheaper suppliers in Asia.

The change came earlier this month as Congress dropped a requirement that the government buy American-made condoms when possible, with exceptions for price and availability.

Congress traditionally has directed the U.S. Agency for International Development to use American suppliers for the hundreds of millions of condoms it sends into developing countries. The main supplier to benefit from that directive is Alatech Healthcare Products, a southeastern Alabama company with about 300 employees.

Over the years, Alatech became the program's sole U.S. provider.

USAID says Alatech has had problems filling orders, and there were complaints from the field about the quality of its condoms.

Link to Yahoo news report

Friday, March 27, 2009

Morecambe & Wise - Peter Cushing




‘very real problem’

Science Daily (Mar. 25, 2009)

Black Girls Are 50 Percent More Likely To Be Bulimic Than White Girls

An important new study challenges the widespread perception that bulimia primarily affects privileged, white teenagers such as "Gossip Girl" character Blair Waldorf, who battled bulimia on the show earlier this season.

Rather, girls who are African American are 50 percent more likely than girls who are white to be bulimic, the researchers found, and girls from families in the lowest income bracket studied are 153 percent more likely to be bulimic than girls from the highest income bracket.

"As it turns out, we learned something surprising from our data about who bulimia actually affects, not just who is diagnosed," says USC economist Michelle Goeree.

Using data from a 10-year survey of more than 2,300 girls in schools in California, Ohio and Washington, D.C., Goeree and fellow economists John Ham (University of Maryland) and Daniela Iorio (Universitat de Autonoma Barcelona, Spain) sought to uncover a more accurate picture of bulimia among young girls. Beginning at age nine or 10, participants were surveyed annually about eating habits and affiliated psychological issues such as body image and depression.

"The difference between public perception and our results is striking," Goeree says.

An analysis of the survey results reveals:

  • Black girls were 50 percent more likely than white girls to exhibit bulimic behavior, including both binging and purging. About 2.6 percent of black girls were clinically bulimic, compared to 1.7 percent of white girls. Overall, approximately 2.2 percent of the girls surveyed were clinically bulimic, close to the national average.
  • Black girls scored an average of 17 percentage points higher than their white counterparts on the widely used medical index gauging of the severity of the bulimia, the researchers found.
  • Girls from families in the lowest income bracket were significantly more likely to experience bulimia than their wealthier peers.
  • Bulimia affected 1.5 percent of girls in households where at least one parent had a college degree.
  • For girls whose parents had a high school education or less, the rate of bulimia was more than double — 3.3 percent were bulimic.

The study has important policy implications: Based on their findings about the persistence of bulimic behavior and who is afflicted, the researchers argue that bulimia, which is currently classified as a disorder, would perhaps be more accurately described — and treated — as an addiction. As with drug and alcohol addictions, this would mean more federal, state and local treatment programs and fewer out-of-pocket insurance costs.

"The results illustrate the importance of having objective information on behavior rather than relying solely on data on diagnoses," Ham says.

According to Goeree, past research has over-relied on hospital admission data, creating a "sample selection bias" that overlooks those who exhibit bulimic behavior but do not receive — or have the means to receive — professional help.

"One explanation is straightforward: Girls with an eating disorder who are African American or come from low-income families are much less likely to be diagnosed. Who goes to the hospital? Those who have insurance. Who tends to have insurance? Wealthier, better-educated people," Goeree says, noting that another part of the difference may be due to parents' sensitivity to bulimic behaviors.

"Remarkably little is known about . . . the factors determining the incidence of bulimia," Iorio says. "Results based on data from diagnosed individuals can present a very misleading picture of the incidence of eating disorders. We present evidence that suggests this is a very real problem, not just a potential one."

The working paper was published by the Institute of Economic Policy at USC.

Link to Science Daily article

‘computerized’ hand-washing


Science Daily (March 25, 2009)

Pilot Study Shows Effectiveness Of New, Low-cost Method For Monitoring Hand Hygiene Compliance

Epidemiologists and computer scientists at the University of Iowa have collaborated to create a new low-cost, green technology for automatically tracking the use of hand hygiene dispensers before health care workers enter and after they exit patient rooms. This novel method of monitoring hand hygiene compliance, which is essential for infection control in hospitals, was released at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA).

"We know that a range of pathogens are spread from healthcare workers to patients by direct touch and that the current rates of hand hygiene compliance are suboptimal," said Philip Polgreen, MD, University of Iowa Health Care. This new technology marks a major shift from the current method of monitoring hand hygiene compliance that involves direct human observation.. Older automated monitoring technology, called radio-frequency identification (RFID) infrastructure, is available, but can be prohibitively costly and consumes far more power than Polgreen's method.

The pilot study uses "Zigbee" technology which is part of a new generation of wireless devices that require less power. Workers wear small, pager-sized badges to monitor their use of hand hygiene dispenser stations prior to entering patient rooms. The technology behind the study was developed in collaboration with computer scientists at Iowa. Ted Herman, the lead computer scientist on the project, designed badge construction and placement of small beacons inside patient rooms and other designated locations. "A novel part of our method is how data are recorded," Herman said, "data are recorded and processed in the badges rather than relying on a network." Each use of the dispenser station is automatically reported by the user's badge, which logs the time and length of use, date and dispenser ID number. The data from the badges can be automatically off-loaded multiple times, which means results are recorded and aggregated without any manual data entry.

Link to Science Daily article

Infallibility – NOT!


BBC News on line (March 27, 2009)

Pope 'distorting condom science'

One of the world's most prestigious medical journals, the Lancet, has accused Pope Benedict XVI of distorting science in his remarks on condom use.
It said the Pope's recent comments that condoms exacerbated the problem of HIV/Aids were wildly inaccurate and could have devastating consequences.
Correspondents say the attack from the Lancet was unprecedentedly virulent.

Speaking during his first visit to Africa, the Pope said HIV/Aids was "a tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which can even increase the problem".

The London-based Lancet said the Pope had "publicly distorted scientific evidence to promote Catholic doctrine on this issue".
It said the male latex condom was the single most efficient way to reduce the sexual transmission of HIV/Aids.

"Whether the Pope's error was due to ignorance or a deliberate attempt to manipulate science to support Catholic ideology is unclear," said the journal.
But is said the comment still stood and urged the Vatican to issue a retraction.

"When any influential person, be it a religious or political figure, makes a false scientific statement that could be devastating to the health of millions of people, they should retract or correct the public record," it said.

"Anything less from Pope Benedict would be an immense disservice to the public and health advocates, including many thousands of Catholics, who work tirelessly to try and prevent the spread of HIV/Aids worldwide."

Editorial: Redemption for the Pope?
The Lancet (March 28, 2009) Volume 373 issue 9669 Page 1054 doi:10.1016/S0140-6736(09)60627-9

Link to The Lancet article

Link to BBC News report

Through My Eyes - Trailer



Thursday, March 26, 2009

computerized patient records

Steve Lohr for the New York Times (March 26, 2009)

Doctors Raise Doubts on Digital Health Data

Now that the federal government plans to spend $19 billion to spur the use of computerized patient records, the challenge of adopting the technology widely and wisely is becoming increasingly apparent.

Articles, to be published in the New England Journal of Medicine, point to the formidable obstacles to achieving the policy goal of not only installing electronic health records, but also using them to improve care and curb costs.

One article reports that only 9 percent of the nation’s hospitals have electronic health records, based on a survey of nearly 3,000 hospitals. The studymeasured only the adoption of digital patient records. The survey did not ask whether the electronic records were used to advance the health policy goals of the federal plan, like tracking the quality of care and communicating effectively with outside specialists and clinics to coordinate a patient’s care.

In another article two experts in health information technology at Children’s Hospital Boston assert that spending billions of dollars of federal funds to stimulate the adoption of existing forms of health record software would be a costly policy mistake.

Instead of stimulating use of such software, they say, the government should be a rule-setting referee to encourage the development of an open software platform on which innovators could write electronic health record applications. As analogies, they point to other such software platforms — whether the Web or Apple’s iPhone software, which the company has opened to outside developers.

The incentive payments, industry experts say, are enough to greatly accelerate the adoption of electronic health records. In the new survey of hospitals, the cost of digital record systems was cited as the single largest obstacle to adoption.

References:

Use of Electronic Health Records in U.S. Hospitals
Ashish K. Jha, M.D., M.P.H. et al,
New England Journal of Medicine
March 25, 2009 (10.1056/NEJMsa0900592)
Link to NEJM article


Stimulating the Adoption of Health Information Technology
David Blumenthal, M.D., M.P.P.
New England Journal of Medicine March 25, 2009 (10.1056/NEJMp0901592)

Link to NEJM perspective


Your Doctor's Office or the Internet? Two Paths to Personal Health Records
Paul C. Tang, M.D., and Thomas H. Lee, M.D.
New England Journal of Medicine Volume 360:1276-1278 March 26, 2009 Number 13

Link to NEJM perspective


Link to NYTimes article

More circumcision?


BBC News on line (March 26, 2009)

Call for higher circumcision rate

Circumcision should be routinely considered as a way to reduce the risk of sexually transmitted infections, argue US experts. They spoke out after research found circumcision significantly cut the risk of infection with herpes and the cancer-causing human papillomavirus (HPV). Circumcision is known to sharply reduce the risk of HIV infection.

The research, carried out in Uganda, involved nearly 3,500 men and monitored their sexual activity over a period of up to two years. Researchers, from Johns Hopkins,and colleagues found circumcision reduced the risk of herpes by 25%, and HPV by a third.

Circumcision rates have been declining in the US and are lowest among black and Hispanic patients - the groups with the highest rates of HIV, herpes and cervical cancer.

Writing in the journal, Dr Matthew Golden and Dr Judith Wasserheit, from the University of Washington, said: "These new data should prompt a major reassessment of the role of male circumcision not only in HIV prevention but also in the prevention of other sexually transmitted infections."

Dr Wasserheit went on to say: "All providers who care for pregnant women and infants have a responsibility to assure that mothers and fathers know that circumcision could help protect their sons from the three most common and most serious viral sexually transmitted infections, all of which cannot currently be cured."

The reason why a foreskin might increase the risk of infection with various viruses is unclear. Research has suggested that a man with a damp penis has a greater risk of being infected by HIV. Various reasons for this have been put forward, including wetness allowing viruses to stick more easily to the penis, or creating tiny ulcers on the surface of the penis through which a virus might enter.

But the study failed to convince some UK experts.

Dr Colm O'Mahony, a sexual health expert from the Countess of Chester Foundation Trust Hospital in Chester, said the US had an "obsession" with circumcision being the answer to controlling sexually transmitted infections.
He said: "Sure, a dry skinned penis is a bit less likely to contract HIV, herpes and possibly genital warts but it will get infected eventually."

Dr O'Mahony also said pushing circumcision as a solution sent the wrong message.
"It suggests that it is women who infect innocent men - let's protect the innocent men.
"And it allows men who don't want to change their irresponsible behavior to continue to sleep around and not even use a condom."

reference

Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis
Aaron A.R. Tobian, M.D., Ph.D et al,
New England Journal of Medicine
Volume 360:1298-1309 March 26, 2009 Number 13 DOI: 10.1056/NEJMoa0802556
Link to NEJM abstract

Link to Science Daily coverage of the study

Link to BBC news report

Psychiatrists’ financial ties

Yahoo News covers the Reuters Health report by Julie Steenhuysen(March 25, 2009)

U.S. psychiatrists to end drug company seminars

The American Psychiatric Association said on Wednesday it will end medical education seminars and meals sponsored by drug companies at its annual meetings to reduce chances for financial conflicts of interest.

The group, which represents 38,000 doctors, is among the first to say no to the drug-company sponsored seminars at its meetings, which many critics say blur the line between education and advertising.

Psychiatrists have been at the front of a controversy over conflicts of interest following accusations last year by Republican U.S. Senator Charles Grassley that prominent Harvard University psychiatrist Dr. Joseph Biederman and others failed to fully disclose payments from drug companies.

Psychiatric drugs represent billions of dollars in global sales. Last July, Grassley asked the APA to provide information about its financial ties with the drug industry.

Earlier this year, many drug makers said they would stop giving out small gifts such as pens and flash drives as part of new voluntary guidelines from the Pharmaceutical Research and Manufacturers of America, an industry group in Washington.

The group's 2002 code already bans more costly gifts like trips to resorts, and calls for companies that pay for medical education at conferences to leave the content to outside experts.

Link to APA News Release

Link to Yahoo Health news report

RealAge – hidden agenda

Stephanie Clifford for the New York Times (March 26, 2009)

Online Age Quiz Is a Window for Drug Makers

RealAge, which promises to help shave years off your age, has become one of the most popular tests on the Internet.

According to RealAge, more than 27 million people have taken the test, which asks 150 or so questions about lifestyle and family history to assign a “biological age,” how young or old your habits make you. Then, RealAge makes recommendations on how to get “younger,” like taking multivitamins, eating breakfast and flossing your teeth. Nine million of those people have signed up to become RealAge members.

But while RealAge promotes better living through nonmedical solutions, the site makes its money by selling better living through drugs.

Pharmaceutical companies pay RealAge to compile test results of RealAge members and send them marketing messages by e-mail. The drug companies can even use RealAge answers to find people who show symptoms of a disease — and begin sending them messages about it even before the people have received a diagnosis from their doctors.

While few people would fill out a detailed questionnaire about their health and hand it over to a drug company looking for suggestions for new medications, that is essentially what RealAge is doing.

Link to NY Times article

Still offering ‘cure’ for ‘the gay’

Welcome Trust, a UK independent health research charity reports (March 25, 2009)

Therapists Still Offering Treatments For Homosexuality Despite Lack Of Evidence

A significant minority of psychiatrists and therapists are still attempting to help lesbian, gay and bisexual clients become heterosexual despite lack of evidence that such treatment is beneficial or even safe, according to research funded by the Wellcome Trust.

The research, published in the open access journal BMC Psychiatry, coincides with the launch of a website that gathers together oral histories from lesbian, gay and bisexual people who have undergone treatment as well as from professionals who developed and conducted such treatments.

Researchers from UCL (University College London) and St George's, University of London, question over 1,400 mental health professionals on whether they would attempt to change a client's sexual orientation if requested. Although only one in twenty-five (4%) said that they would do so, one in six (17%) reported having assisted at least one client to reduce their gay or lesbian feelings, usually through therapy. Therapists were also asked in what year they had conducted such therapy and there was no sign of a decrease in recent times.

"There is very little evidence to show that attempting to treat a person's homosexual feelings is effective and in fact it can actually be harmful," says Professor Michael King from UCL. "So it is surprising that a significant minority of practitioners still offer this help to their clients."

Professor King and colleagues found that a number of reasons were given by the psychiatrists and therapists for offering assistance, ranging from the counselor’s own moral and religious views about homosexuality through to a desire to help patients who were stressed by discrimination. There was also a degree of ignorance about the lack of evidence surrounding such the efficacy of such therapies – in particular, that no randomized control trials have ever been conducted that show that the therapies are effective.

Comments from the counselors who offered assistance included:

"Where someone had a strong faith, then working to help the person accept their feelings but manage them appropriately may be the best approach if [the] person felt they would lose God and therefore their life was not worth living."

"The individuals I have worked with have all been very unhappy about their sexuality and wish they were heterosexual. This has been because of responses from friends, family and the local community – which outside London is still very homophobic."

"Children and young adults are more likely to be confused about their sexuality and to jump to conclusions (correct or otherwise) if unable to talk through their concerns."

"Although homosexual feelings are usual in people, their physical expression, and being a person's only way of having sexual relations is problematic. The physical act for male homosexuals is physically damaging and is the main reason in this country for AIDS/HIV. It is also perverse."

Professor King believes that it is important to raise awareness amongst both therapists and the wider public about homosexuality and its so-called treatments.

"The best approach is to help people adjust to their situation, to value them as people and show them that there is nothing whatever pathological about their sexual orientation," he says. "Both mental health practitioners and society at large must help them to confront prejudice in themselves and in others."

The researchers’ new website, www.treatmentshomosexuality.org.uk, aims to help raise awareness and collect oral histories from both mental health practitioners and the people they have treated.

Commenting on the research, Derek Munn, Director of Public Affairs at the gay and lesbian equality organization Stonewall, says: "So-called gay cure therapies are wholly discredited. The conclusions of this research are a welcome reminder that what lesbian and gay people need is equal treatment by society, not misguided treatment by a minority of health professionals."

The response of mental health professionals to clients seeking help to change or redirect same-sex sexual orientation
Annie Bartlett, Glenn Smith, Michael King
BMC Psychiatry 2009, 9:11 (26 March 2009)
doi:10.1186/1471-244X-9-11
Link to BMC Psychiatry article

Link to treatmentshomosexuality.org

Link to Wellcome Trust news release including audio by Prof. Michael King

Wednesday, March 25, 2009

Bona Ballet - Round the Horne

J Peasmold Gruntfuttock

Somebody Saw It Coming

Tobacco – something good?

Science Daily (March 25, 2009)

Tobacco Makes Medicine

Tobacco isn't famous for its health benefits. But now scientists have succeeded in using genetically modified tobacco plants to produce medicines for several autoimmune and inflammatory diseases, including diabetes.

A large team of scientists from several European research organizations have participated in the study as part of the Pharma-Planta project. Led by Professor Mario Pezzotti at the University of Verona, they set out to create transgenic tobacco plants that would produce biologically-active interleukin-10 (IL-10), a potent anti-inflammatory cytokine. They tried two different versions of IL-10 (one from a virus, one from the mouse) and generated plants in which this protein was targeted to three different compartments within the cell, to see which would work most effectively.

The researchers found that tobacco plants were able to process both forms of IL-10 correctly, producing the active cytokine at high enough levels that it might be possible to use tobacco leaves without lengthy extraction and purification processes. The next step will be to feed the plants to mice with autoimmune diseases to find out how effective they are.

reference:

Viral and murine interleukin-10 are correctly processed and retain their biological activity when produced in tobacco.
Luisa Bortesi et al
BMC Biotechnology, 2009, 9:22 (19 March 2009) doi:10.1186/1472-6750-9-22

Link to BMN Biotech abstract

Link to Science Daily article

‘Good For You, Good for the Planet’

Universitat Politècnica de Catalunya. – Barcelona Tech - reports

A UPC team develops a device for reducing the power consumption of household appliances

The device, which disconnects electronic appliances in stand-by mode and reduces their power consumption to zero, will provide household energy savings of 12%

A team of researchers from the UPC Center for Technological Innovation in Static Converters and Actuators (CITCEA-UPC) has designed the device "100% Off," which disconnects electronic appliances in stand-by mode and reduces their power consumption to zero. The device is compatible with all existing appliances, and the technology is adaptable to other equipment manufactured in the future.

Over the course of a year, the relative cost of running an appliance is higher in stand-by than when it is switched on, as it spends more time in stand-by mode. According to a study carried out by the European Commission in 2005, household appliances in stand-by mode consume 50 TWh (terawatt-hours) per year in the EU alone. This figure, which is equivalent to the annual consumption of a country like Greece or Portugal, represents a total energy cost of 7000 million euros per year and the emission of 20 million tons of CO2.

100% Off will provide household energy savings of 12% by automatically overriding stand-by mode and switching appliances off. The system, patented and marketed by the Madrid-based company Good For You, Good for the Planet, also protects against power surges and extends the useful life of appliances.

Link to Good For You, Good For The Planet

Link to UPC news release

‘Texas Shouldn't Mislead Science Students’

The American Association for the Advancement of Science announces (March 24, 2009)

AAAS Joins Leading Texas Scientists and Educators in Urging State Board to Reject Anti-Evolution Amendments

Leading members of the Texas scientific community, in collaboration with the American Association for the Advancement of Science (AAAS), have urged the Texas State Board of Education to reject amendments to the state's draft science standards that would undermine sound science teaching.

The scientists said certain amendments, introduced and approved during the January 2009 board meeting, "would mislead students should they make it into the final standards."

Among the concerns, the scientists say, is an amendment to the biology standards that attacks one of evolution's key principles: that all living organisms on Earth are descended from a common ancestor.

The pending amendment says students should "analyze and evaluate the sufficiency and insufficiency of common ancestry." But scientists say there is no real argument about common ancestry, one of the foundational concepts of evolution.

"The scientific consensus is that evolution is the backbone of modern biology and many other fields of science, underlying advances in areas such as agriculture and medicine," the scientists write. They note that the board "did the students of Texas a great service" when it earlier rejected insertion of language in the science standards that spoke of the "weaknesses" of evolution.

Critics fear that the amendment, using the terms "sufficiency and insufficiency," is little different from the earlier effort to raise questions about evolution. Downplaying evolution's place in science "only serves to confuse students," the scientists say in their letter to the board.

The letter also notes that pending revisions to the Earth and Space Science standards "introduce unwarranted uncertainty to long-settled scientific issues" such as the processes of planet formation.

Link to AAAS news release

Link to Science Daily article

Breathing Earth

Link to Breathing Earth

AIDS & Diversity


The American Public Health Association publishes (April 2009) a supplement to the American Journal of Public Health on diversity and HIV/AIDS


Link to AJPH supplement contents

Tuesday, March 24, 2009

World TB Day 2009

Gay Muslims

Herpes

Science Daily (March 24, 2009)

No More Cold Sores? Scientists Find Cellular Process That Fights Herpes Virus

Scientists have discovered a new way for our immune system to combat the elusive virus responsible for cold sores: Type 1 herpes simplex (HSV-1). This group of virus hunters from the Université de Montréal, in collaboration with American colleagues, has identified a cellular process that seeks out and fights herpes.

The five-year study, partially supported by the Canadian Institutes of Health Research, was a joint project with Washington University and Pennsylvania State University.

"Once human cells are infected with Type 1 herpes simplex, the virus comes back because it hides and blocks protection from our immune system," says Luc English, the study's lead author and a doctoral student at the Université de Montréal's Department of Pathology and Cell Biology. "For the first time, our research team has indentified a combative cellular mechanism in this game of hide-and-seek."
"We've found that the nuclear membrane of an infected cell can unmask Type 1 herpes simplex and stimulate the immune system to disintegrate the virus."

The team made its discovery while conducting various tests in HSV-1 infected mice cells. They replicated environments when Type 1 herpes simplex thrives, namely periods of low-grade fever between 38.5 to 39 degrees, and found that herpes-fighting mechanisms were unleashed.

The research team now plans to study how activation of the herpes-combating cellular process could be applied to other illnesses. The outcome could hasten the development of therapies to prevent other immune-evading bacteria, parasites and viruses. "Our goal is to further study the molecules implicated in this mechanism to eventually develop therapies against diseases such as HIV or even cancer," says English.

reference:

Autophagy enhances the presentation of endogenous viral antigens on MHC class I molecules during HSV-1 infection.
Luc English et al
Nature Immunology, 2009; Published online: 22 March 2009 DOI: 10.1038/ni.1720

Link to Nature Immunology abstract

Link to Science Daily article

Red meat – Death?

Science Daily (March 24, 2009)

Eating Red And Processed Meat Associated With Increased Risk Of Death

Individuals who eat more red meat and processed meat appear to have a modestly increased risk of death from all causes and also from cancer or heart disease over a 10-year period, according to a new article. In contrast, a higher intake of white meat appeared to be associated with a slightly decreased risk for overall death and cancer death.

Rashmi Sinha, Ph.D., and colleagues at the National Cancer Institute, Rockville, Md., assessed the association between meat intake and risk of death among more than 500,000 individuals who were part of the National Institutes of Health-AARP Diet and Health Study.

There are several mechanisms by which meat may be associated with death, the authors note. Cancer-causing compounds are formed during high-temperature cooking of meat. Meat also is a major source of saturated fat, which has been associated with breast and colorectal cancer. In addition, lower meat intake has been linked to a reduction in risk factors for heart disease, including lower blood pressure and cholesterol levels.

"These results complement the recommendations by the American Institute for Cancer Research and the World Cancer Research Fund to reduce red and processed meat intake to decrease cancer incidence," the authors conclude. "Future research should investigate the relation between subtypes of meat and specific causes of mortality."

An editorial points out Reducing Meat Consumption Has Benefits Beyond Better Health

"The publication by Sinha et al is timely," writes Barry M. Popkin, Ph.D., of the University of North Carolina, Chapel Hill, in the accompanying editorial. "There is a global tsunami brewing, namely, we are seeing the confluence of growing constraints on water, energy and food supplies combined with the rapid shift toward greater consumption of all animal source foods."

"Not only are components of the animal-source foods linked to cancer, as shown by Sinha et al, but many other researchers have linked saturated fat and these same foods to higher rates of cardiovascular disease," Dr. Popkin writes. "What do we do?"

Because there are health benefits to eating some red and white (although not processed) meats, the consensus is not for a complete shift to vegan or vegetarian diets, Dr. Popkin concludes. "Rather, the need is for a major reduction in total meat intake, an even larger reduction in processed meat and other highly processed and salted animal source food products and a reduction in total saturated fat."

references:

1. Meat Intake and Mortality: A Prospective Study of Over Half a Million People.
Rashmi Sinha, PhD et al
Archives of Internal Medicine, 2009; 169 (6): 562 DOI: 10.1001/archinternmed.2009.6

Link to Arch Int Med article abstract

2. Reducing Meat Consumption Has Multiple Benefits for the World's Health.
Barry M. Popkin, PhD
Archives of Internal Medicine, 2009; 169 (6): 543 DOI: 10.1001/archinternmed.2009.2

Link ro Arch Int Med editorial abstract

Link to Science Daily article